Repairing and Preventing Obstetric Fistula in Sierra Leone

At the Aberdeen Women’s Centre (AWC) in Freetown, Sierra Leone, women from around the country receive life-changing surgery to repair obstetric fistula. This year, AWC opened an emergency obstetric services department so that more women have the chance to avoid developing this devastating and eminently preventable condition.

EngenderHealth’s Fistula Care Project, supported by the U.S. Agency for International Development (USAID), partners with the Aberdeen Women’s Centre, where more than 1,000 fistula repairs have been performed since the partnership began in 2007. Restoring health and dignity to the women of Sierra Leone is a tall order, given that the nation’s rate of maternal mortality is among the highest in the world. Now, in addition to supporting fistula repair services (e.g., surgeries, postoperative care, nutrition, housing, and patient recruitment), Fistula Care is supporting training for nurse midwives, medical supplies, and prenatal screenings in the new maternity wing.

Read more and view a slideshow at EngenderHealth.org.

Spotlight on Tanzania

Kisa and Stanley, a couple in their 30s living in Arusha, Tanzania, are proud parents of five healthy children—and that was enough for them. Before EngenderHealth’s ACQUIRE Tanzania Project (ATP), with support from the American people through the U.S. Agency for International Development (USAID), partnered with their local health clinic to make a range of contraceptive options available, they were resigned to the possibility of Kisa’s becoming pregnant again—a prospect that caused her endless worry. But, according to Stanley, contraception has “helped us plan our life, and take care of our family.”

Read more at EngenderHealth.org.

Closing the Gap Between Contraceptive Technology and Those Who Are in Need

	Learn about the benefits of family planning beyond better health. Check out our 3for1 video!

Birth Control Over Baldness, Nick Kristof’s op-ed column on September 26, calls for increased investments in contraceptive development, and touts promising new technologies, including a vaginal ring that offers up to one year of contraceptive protection. The ring is a product of our valued partner and sister organization, the Population Council, which has made significant and important contributions to contraceptive development during the past 50 years (including program support so that new products may be available to all women).

Below, EngenderHealth experts weigh in on what it will really take to forge the missing link in making contraceptive technologies – old and new alike – available to the 215 million women who don’t have access to a modern method of birth control:

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Innovation is Just Half the Equation

Family planning indeed has a direct link to alleviating poverty. Moreover, its cost effectiveness is irrefutable: In addition to saving lives, each dollar spent on voluntary family planning can save governments $31 in health care, water, education, housing, and more.

Developing new contraceptive options is critical. But no matter how many technologies come to market, a major challenge remains: ensuring that those who need contraceptives the most—poor women and couples often living in remote communities—can get them. Strengthening health care systems, including training local providers, must be part of the solution.

We’ve learned from our own experience on the ground that all the technology in the world won’t work without trained providers to offer counseling, information, and quality care for family planning and reproductive health. Innovation is just half the equation. Access and delivery is the other half. Only when you have both will new contraceptives break through.

— Pam Barnes, President and CEO

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“Software” v. “Hardware”
New technologies are important, but so many of the access issues in poorer countries relate to “software”. These include knowing about available methods and where to go to get them; human resources, such as the scarcity of trained providers; a competing disease burden (such as HIV and AIDS); and traditional gender norms and other sociocultural barriers. The “hardware” issues of not having sufficient technology to meet demand are still secondary in many places.

— Dr. Roy Jacobstein, Medical Director

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Interconnections

To make vaginal rings – or any contraceptive technology - available to those women who currently don’t have access to modern birth control methods is quite simply going to require more than the technology itself. There is a complex set of interconnections among what women and men need, the technologies that can address those needs, the services that can provide those technologies, and the resources available to sustain supply and services.

— Karen Beattie, Director, Fistula Care

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Investment, Policy, and Accountability

New contraceptive technology is only part of the solution. Training health providers at every level – community health workers, nurses, midwives, physician’s assistants, as well as doctors – and positive changes in health systems are needed. But more than that, donors need to invest more in finding innovative solutions. For instance, supplies like condoms, IUDs, and contraceptive pills, don’t always get to where they are needed when they are needed. Without solving what ought to be simple distribution problems (but are actually quite complicated), the vaginal ring will just be one more supply that is stuck in a warehouse and takes weeks if not months to get to rural clinics.

There needs to be local policy commitment, and investment of local resources and accountability. If we look at success stories, like Thailand, Mexico, and Colombia, where use of modern contraception has greatly expanded (and contraceptive prevalence rates are 70.9%, 71.5% and 78.2%, respectively), it’s because there was political support and investment in improving health systems and making contraceptives available.

— Terry Jezowski, Vice President, External Relations

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Technology and Stronger Health Systems – We Need Both

New contraceptive technologies always hold the promise of better options for women and couples. But options don’t de facto equal access. Addressing the health care worker crisis and improving commodity security (e.g. getting needed supplies to clinics and pharmacies so customers can get them when they want them) would go a long way towards helping women access modern family planning methods.

The cost-effectiveness of family planning is paramount. I was curious that Kristof reports Sino-Implant costs only $3, when the cost typically cited is $8. Both prices make it a less expensive option than Jadelle®, yet in the countries where women most need better access to modern methods, health ministries still don’t have (or allocate) enough money to procure commodities.

Nonetheless, there are some interesting additional contraceptive technologies on the horizon that Kristof did not mention:

• Essure is a form of non-surgical female sterilization that is tremendously quick and less invasive than tubal ligation.
• Mirena® is an IUD that also delivers a minuscule dose of progesterone, which reduces menstrual bleeding – a side effect that women in the U.S. and Europe have warmly welcomed!
• Sub-Q Depo has the potential of clients self-injecting at home.

Still, the fact remains that to make any of these viable options for women and men everywhere, we need strong health systems, staffed with well-trained workers and strong distribution networks.

— Erin McGinn, Senior Technical Advisor for Family Planning

The Five Steps to Achieving MDG 5 and Saving Mothers' Lives

Read President Pam Barnes at the Huffington Post on The Five Steps to Achieving MDG 5 and Saving Mothers' Lives.

EngenderHealth's perspective on new UN maternal mortality estimates

by Pam Barnes, President of EngenderHealth

Trends in Maternal Mortality, 1990 to 2008, just released by the World Health Organization, the United Nations Children’s Fund, UNFPA, and The World Bank, reports that the number of women dying globally due to complications during pregnancy and childbirth has decreased by 34%, from 546,000 in 1990 to 358,000 in 2008. This is one more piece of evidence that investments to improve maternal health are indeed paying off. It also corroborates research published in Lancet earlier this year that showed a similar, modest decline in the number of women dying from pregnancy complications.

While we know that fewer women are dying, there is clearly much more work to be done. In this latest United Nations report, only 10 out of 87 countries with maternal mortality ratios equal to or over 100 in 1990 are on track to achieving Millennium Development Goal No. 5 (MDG 5) by 2015. Also, 30 countries made insufficient or no progress since 1990. (See the full report and press release for more information.)

Furthermore, for every life lost due to pregnancy or childbirth complications, about 20 women suffer from maternal morbidity, including obstetric fistula. And if we are going to continue this positive downward trend, we must improve the health of mothers in places with high levels of HIV, specifically Sub-Saharan Africa, and refocus attention to address women's holistic needs, providing high-quality family planning, obstetric, and HIV services under one roof.

As we were reminded at the recent Global Maternal Health Conference 2010, which brought together nearly 700 maternal health experts, solutions exist, and we know what they are. To reduce maternal mortality and morbidity, women must have better access to:

• Family planning, with other related sexual and reproductive health services
• Skilled care during pregnancy
• Emergency obstetric care
• Immediate postpartum care

Next week, the world’s leaders will descend on New York City for high-level events, including the UN Summit on the Millennium Development Goals and the Clinton Global Initiative Annual Meeting. The good news is momentum behind MDG 5 has never been higher. This is welcome news for all of us who care deeply about improving sexual and reproductive health in the world's poorest communities. The key now is to harness this energy to ensure that our governments deliver on their commitments to ensure universal access to reproductive health and to reduce maternal mortality by 75%.

Global Artists and Activists Kick Off New Media Initiative and Online Video Contest to Spotlight Global Maternal Health

MDGFive.com offers free online video “remixer” to raise awareness

SEPTEMBER 16, 2010, NEW YORK—Next week, global leaders will descend on New York City for the United Nations (UN) Millennium Development Goals (MDG) Summit to review progress made on the UN’s eight MDGs, which aim to reduce poverty worldwide by 2015. Launching today, in anticipation of the Summit, is a new media initiative that draws artists and activists together behind one goal: improving maternal health, the fifth MDG, on which progress has lagged most.

Cofounded by Emmy-winning filmmaker Lisa Russell and Grammy-winning singer Maya Azucena, MDGFive.com includes creative content by world-renowned musicians and poets, including Zap Mama, DJ Spooky, Toni Blackman, and Carlos Andrés Gómez, as well as visual material from filmmakers and photographers Christy Turlington Burns, Paul Blackthorne, and Azfar Rizvi. The site features a “remixer” that can be used to create short videos using a library of music tracks, spoken word, film, and photos supplied by renowned mixed media artists from Brazil, Honduras, Pakistan, South Africa, Sri Lanka, Thailand, and other countries.

“The arts are one of the most powerful ways to build bridges among people from all over the world. MDGFive.com has great potential to reach, inform, and mobilize people to make a difference for women’s and children’s health,” said UN Secretary-General Ban Ki-moon. “No woman should have to pay with her life for giving life. No child should have to die from a preventable disease. Investing in women and girls is one of the best investments we can make for this and future generations.”

"By working collaboratively with professional artists from around the world—who have tremendous influence in their respective societies and are eager to lend their voice—we feel MDGFive.com will engage a local-global dialogue in this new media environment," said cofounder Lisa Russell. The innovative project has caught the attention of leading international women’s health organizations such as EngenderHealth, UNFPA (the United Nations Population Fund), Ipas, and Women Deliver, who are supporting MDGFive.com to further the reach of the initiative and spur more action on women’s health.

MDGFive.com co-founders will be involved in various high-profile events during the three-day MDG Summit at the UN. Lisa Russell will attend the TEDxChange event (co-hosted by the Bill & Melinda Gates Foundation and TED.com) as a special media guest, and Maya Azucena will perform at the Secretary General’s “Every Mother, Every Child” event, to kick off the Global Strategy on Women’s and Children’s Health.

A Letter from Pamela W. Barnes, EngenderHealth's New President and CEO

Our new president and CEO, Pamela W. Barnes, wrote to our friends and supporters today. She began:

“I’ve just returned from Delhi, India, where I participated in the Global Maternal Health Conference 2010, an unprecedented gathering of more than 600 of the world’s foremost experts on the issue. The energy in the air was palpable. For those of us who have dedicated our lives to improving global health, now is the time.”

Read the rest of her inspiring letter.

Day One at the Global Maternal Health Conference

By Pam Barnes, President and CEO, EngenderHealth

What a thrill it is to be part of the Global Maternal Health Conference 2010, along with nearly 700 of the world’s foremost experts in maternal health hailing from 55 countries. I’m so proud that EngenderHealth is home to the Maternal Health Task Force, and that together with the Public Health Foundation of India, we are co-hosting this meeting—the first global conference dedicated exclusively to maternal health.

Today kicked-off with a dynamic opening by the Health Minister of India and followed by a panel of experts in research, policy and academia discussing the maternal mortality estimates, their implications, and what lessons we can learn to truly make progress towards improving maternal health. We were challenged by Wendy Graham to learn as much from our successes as our failures and we should all take that to heart. And it isn’t just about the numbers. It’s how we use the numbers to make change. As health economist Gita Sen also aptly reminded us, when discussing estimates, improving maternal morbidity is an equally important goal: For every woman who dies during pregnancy or childbirth, 10 to 30 women suffer long term disability, including a devastating condition such as obstetric fistula.

The lively conversations taking place throughout the sessions make it crystal clear that we are without doubt, at a unique moment in time. I say unique because whether we live in Rwanda, China, Brazil or southern India, all of us (those at the conference and all of you who are joining us via live streaming) have come together to exchange knowledge, experience, and ideas to move the needle towards realizing maternal health. Being here with so many creative minds and passionate professionals is truly energizing. It is palpable. And this energy is vital for the field. It is vital for the world’s women.

Stay up to date with the conference happenings! Follow the Maternal Health Task Force and EngenderHealth on Twitter: @MHTF and @EngenderHealth. The conference hashtag is #GMHC2010.

For more posts about the Global Maternal Health Conference, click here.

The Maternal Health Task Force Announces New Grants

Innovative Maternal Health Projects to Inform National Policies

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NEW YORK, July 22--The Maternal Health Task Force at EngenderHealth announced today that it has awarded eight new grants supporting innovative maternal health research across Asia, Africa, and Latin America. The research, which will be carried out by local organizations in developing countries, will lead to national policy recommendations for improving maternal health.

Each research project will evaluate an ongoing effort to advance maternal health in places where too many women still die from preventable complications of pregnancy and childbirth. Examples of such projects include integrating maternal health care with HIV prevention and treatment, organizing support groups for pregnant mothers, and outfitting health workers in rural communities with cellular phones to facilitate emergency care for pregnant women. Following are summaries of the new grants:

In Bangladesh, scientists and nonscientists will collaborate at the International Centre for Diarrhoeal Disease Research in Bangladesh (ICDDR,B) in translating new and existing knowledge about maternal health into proposals to improve government policies and practices. They will seek consensus on identifying key questions raised by three recent research programs, ensure access to the findings, reach out to national policymakers, and build ICDDR,B capacity and visibility for future work in knowledge translation.

In India, the Centre for Development and Population Activities (CEDPA) will combat India's high maternal mortality and morbidity rates by demonstrating the value of integrating maternal health programs into HIV and AIDS programs. Using forums, workshops, and consultations, CEDPA will evaluate existing programs of the government's National Rural Health Mission, the National AIDS Control Programme, and the National Health Policy Administration in the Rajasthan area, to compile best practices and build consensus on a set of recommendations for policymakers.

In Malawi, the MaiMwana project will be a pilot effort to strengthen the current inadequate Maternal Death Review (MDR) system with a village-level program of maternal death audits. Kamuzu Central Hospital and the Mchinji District Hospital will support the formation of three-member MDR teams in each village to conduct a verbal autopsy (a structured interview) among relatives and neighbors within two days of every maternal death. Improved data will allow better analysis and service improvements and will contribute to recommendations to the Ministry of Health for a national audit procedure.

In Mexico, the Centro de Investigaciones y Estudios Superiores en Antropologia Social (CIESAS) is conducting an assessment of the Ministry of Health's Advanced Life Support for Obstetrics Program (ALSO), which manages delivery emergencies in Oaxaca. CIESAS will determine whether ALSO courses improve the technical skills and professional morale of health care providers enough to justify expanding the program nationwide.

In Peru, Future Generations, in partnership with the Peruvian Ministry of Health, will field test promising methods of reducing maternal and newborn mortality by organizing groups of pregnant women to share their pregnancy histories and experiences. In a controlled trial involving 500 pregnant women, health workers will guide the discussions, document benefits, develop a training manual and materials for possible nationwide use, hold workshops on the materials, and advocate for policy change.

In South Africa and Kenya, the mothers2mothers program, which offers education and emotional support to pregnant women and new mothers living with HIV, will field test "active client follow-up" to increase the number of HIV-positive pregnant women who return to a health care facility for care after an initial visit. In much of Africa, the return rate is low, posing a major obstacle to preventing mother-to-child transmission of HIV. Mothers2mothers will use peer "mentor mothers" to send text messages or cell phone calls to previously contacted pregnant women to urge them to make return visits. Best practices will be collected for integration into the mothers2mothers standard model used continent-wide.

In Sri Lanka, the Department of Community Medicine at Rajarata University will work to improve the collection of data on the impact of maternal death and postpartum illness, a process that is now limited to hospital reports. University researchers will develop a survey questionnaire for field testing among a sample of expectant mothers in the resource-poor Anuradhapura District, where maternal mortality rates are high. Researchers will analyze the frequency and prevalence of health events and their direct and indirect economic impacts on families, to contribute to national service delivery planning.

In Tanzania, the Ifakara Health Institute (IHI) will seek to improve emergency care for pregnant women and newborns by providing free cellular phones and business-related services for mid-level health care providers, to allow better communication with distant emergency obstetric specialists. Cooperating with district councils and a local telecommunications company IHI will evaluate the cost, feasibility, and implementation issues that arise if health workers at the district level have better access to long-distance counseling, faster referrals and resupply services, and emergency clinical support.

[See the original press release.]

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EngenderHealth is a leading international reproductive health organization working to improve the quality of health care in the world's poorest communities. EngenderHealth empowers people to make informed choices about contraception, trains health care providers to make motherhood safer, promotes gender equity, enhances the quality of HIV and AIDS services, and advocates for positive policy change. The nonprofit organization works in partnership with governments, institutions, communities, and health care professionals in more than 20 countries around the world. For more information, visit www.engenderhealth.org.

The Maternal Health Task Force at EngenderHealth brings together existing maternal health initiatives and engages new organizations to facilitate global coordination of maternal health evidence, programs, and policies. Supported by the Bill & Melinda Gates Foundation, the Maternal Health Task Force convenes stakeholders and creates an inclusive setting to engage in dialogue, build consensus, foster innovation, and share information. For more information, visit www.maternalhealthtaskforce.org.

Contact:
Tim Thomas, Maternal Health Task Force/EngenderHealth
646-436-6555, tthomas@engenderhealth.org

EngenderHealth joins the global health community in celebrating proof-of-concept of microbicides

At the International AIDS Conference in Vienna, there was standing ovation in a packed conference hall for the Caprisa 004 microbicide study. As the New York Times reports:

After two decades in which researchers searched fruitlessly for an effective vaginal microbicide to block H.I.V., South African scientists working in two AIDS-devastated communities of South Africa, one rural and one urban, say they have finally found something that shows real promise.

Women who used a vaginal microbicidal gel containing an antiretroviral medication widely used to treat AIDS, tenofovir, were 39 percent less likely over all to contract H.I.V. than those who used a placebo. Those who used the gel most regularly reduced their chances of infection 54 percent, according to a two-and-a-half year study of 889 women by Caprisa, a Durban-based AIDS research center.

Download the official press release (PDF, 168KB).

EngenderHealth at the International AIDS Conference: Highlights

PEPFAR Gender Symposium: Practical Approaches for Integration with HIV and AIDS, featuring Dunstan Bishanga of EngenderHealth’s CHAMPION Project, and new (as of 1 September 2010) EngenderHealth President Pamela W. Barnes

Sunday, July 18
Mini Room 8, 1:30–3:30 pm

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EngenderHealth co-launches the new Global HIV Stigma Reduction Network

Wednesday, July 21
Mini Room 3, 6:30–8:30 pm

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Leadership & Accountability Development Workshop: Scaling Up Key Programmes to Protect Human Rights, led by Paul Perchal, Director, HIV and STI program, EngenderHealth

Monday, July 19
Mini Room 1, 2:30–6:00 pm

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The Language of Love: Tanzanian Women Define Intimacy, Sexuality, and Violence in the 21st Century, M. Leslie-Rule, EngenderHealth CHAMPION Project

Wednesday, July 21
Session Room 9, 2:30–4:00 pm

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EngenderHealth will be featured in more than 25 sessions at the International AIDS Conference. Download our complete schedule of activities (PDF, 376KB).

EngenderHealth at the International AIDS Conference 2010

Beginning on Sunday, July 18, policymakers, scientists, program experts, persons living with HIV, and others committed to ending the AIDS pandemic will gather in Vienna, Austria, for AIDS 2010, the 18th International AIDS Conference. Visit us at Booth #418!

Paul Perchal, director of EngenderHealth’s HIV/STI Program, will be among the conference participants. Paul’s commitment to this field is in part the legacy of losing two of his closest friends to AIDS during the mid-1990s. Gearing up for the conference, the theme of which is “Rights Here, Right Now,” Paul offers his perspective on the upcoming week in this brief Q&A:

As we head into the conference, what do you see as the most vital issues facing the field?
Universal access to prevention, care and treatment for people living with HIV and AIDS, regardless of where they live, remains paramount. The economic crisis means that donors are rethinking their priorities, and that some of the gains we’ve made in recent years could be undermined. There’s also renewed focus on human rights, and increased recognition that in places where HIV stigma persists, people just aren’t getting tested. Likewise, pregnant women are not accessing care and treatment to prevent transmitting the virus to their newborns. We really need more effective strategies to reduce stigma and its effects.

Male circumcision is also receiving wide attention. It has been proven to reduce the risk of HIV transmission in men by up to 60%, and many governments are now introducing large-scale programs to make the procedure widely available. In Kenya, for example, the government is rapidly expanding services so that 1.1 million men can opt for the procedure by 2015. While not a panacea, male circumcision is an essential tool for HIV prevention that is currently not available to millions of men who want it.

How will EngenderHealth be represented at the conference?
EngenderHealth’s expertise in reducing HIV-related stigma, engaging men to prevent HIV in their relationships and communities, and preventing mother-to-child transmission, along with what we’re learning in our large-scale male circumcision program in Kenya, will be showcased through special satellite sessions, oral presentations, and more than 20 posters. I’m especially excited that we’ll be sharing the results of our safety study of the Shang Ring, an innovative male circumcision device.

What are you most looking forward to?
The International AIDS Conference is always an opportunity to be part of the conversation about the direction the field is going in. It’s also inspiring to learn the latest in technical and clinical breakthroughs, and to engage with young and emerging leaders. Of course, it’s also great to catch up with colleagues. The opportunity for an exchange of ideas around our innovative work and for collective problem-solving is really incomparable.

EngenderHealth Names Pamela W. Barnes as New President/CEO

NEW YORK, JULY 6, 2010—EngenderHealth, a leading international reproductive health organization, has selected Pamela W. Barnes as its new President and Chief Executive Officer. Ms. Barnes, former President/CEO of the Elizabeth Glaser Pediatric AIDS Foundation, will assume her new role on September 1.

“Pamela is a visionary leader who brings more than 30 years of experience in both private and nonprofit sectors to EngenderHealth,” said Brenda Drake, Board Chair. “After considering many extraordinary candidates from around the world, the Board Search Committee found the right CEO to lead this dynamic organization as it continues its vital work to improve the quality of health services and bring lasting change to more than 20 countries.”

Ms. Barnes served as President/CEO at the Elizabeth Glaser Pediatric AIDS Foundation since 2006, leading successful programs across 18 countries in Africa and Asia with more than 1,000 employees. During her tenure, Barnes significantly expanded the foundation’s program portfolio and budget, from $45 million in 2004 to $150 million in 2009. Prior to this position, Ms. Barnes was COO at the Foundation, where she managed the organization’s exponential growth and created new strategic partnerships with public and private donors.

“I am thrilled to be joining EngenderHealth and look forward to bringing a strong voice to advocate for the millions of women and families who want but still lack access to quality sexual and reproductive health services,” said Ms. Barnes. “I am wholly committed to advancing the mission of EngenderHealth and to working with our partners to strengthen health systems and improve the health and lives of those living in the world’s poorest communities.”

Ms. Barnes has also served as the Vice President of Finance and Administration at the International Trachoma Initiative and as Vice President of Operations and Finance for Planned Parenthood Hudson Peconic in New York. She is a former Peace Corps volunteer and currently serves as co-leader of a global partnership addressing sexual violence against girls. Ms. Barnes also worked for more than 20 years in investment management and corporate finance, including stints as Assistant Treasurer of Corporate Finance at GTE and Assistant Treasurer at RCA.

Ms. Barnes holds a Bachelor of Science in Economics from Marymount College in Tarrytown, New York, and a Master of Business Administration from Fordham University. She has published in peer-reviewed journals as well as in print and online media. Ms. Barnes is also a frequent lecturer and presenter at numerous professional, academic, and policy forums.

Until Ms. Barnes assumes her role as EngenderHealth President on September 1, Terrence Jezowski, EngenderHealth’s Vice President of External Relations, will serve as Interim President, starting July 19.

About EngenderHealth
EngenderHealth is a leading international reproductive health organization working to improve the quality of health care in the world’s poorest communities. EngenderHealth empowers people to make informed choices about contraception, trains health providers to make motherhood safer, promotes gender equity, enhances the quality of HIV and AIDS services, and advocates for positive policy change. The nonprofit organization works in partnership with governments, institutions, communities, and health care professionals in more than 20 countries around the world. For more information, visit www.engenderhealth.org.

Contact:
Theresa Kim
212-993-9834
tkim@engenderhealth.org

Good news about increased IUD use in the US

Here at EngenderHealth, we are encouraged by the recent news that IUD is an increasingly popular contraceptive method in the United States. We know through our work in the field that when correct information about the device and high quality health services are offered, the IUD is a safe, effective, and acceptable form of family planning.

Last month, the Centers for Disease Control and Prevention released the results of its National Survey of Family Growth. The results of the survey, which was conducted from 2006 to 2008, show that IUD use in the US increased from 2 percent in 2002 to 5.5 percent in 2006-2008. Among women with two or more children, the increase was even greater, from 3 to 11 percent. There are now more than 2 million women using IUDs in this country.

As a long-acting contraceptive method, the IUD is one of the most effective forms of birth control. It can be used for medium and long-term planning, preventing pregnancy for up to 12 years, and is reversible.

From 2006-2008, during the same time period as the family growth survey was being conducted U.S., EngenderHealth’s ACQUIRE Project team worked with Kenya’s Ministry of Health to expand IUD use in the country’s Kisii District. In the East African country, as in the U.S., the number of women using an IUD to prevent pregnancy dropped significantly in the past two decades.

In Kisii, EngenderHealth worked with local partners to ensure this convenient and low-cost contraceptive method was more widely available and accepted by improving family planning counseling so Kenyan women could make informed choices and by providing trainings in IUD insertion and removal. In just one year, IUD use in Kisii District tripled.

Read more about how the IUD is saving lives in Ghana in this recent article by EngenderHealth’s Medical Director, Dr. Roy Jacobstein.

Action Alert: Urge Congress to End Fistula

Today, EngenderHealth joined a broad coalition of organizations in applauding Rep. Carolyn Maloney (D-NY) and Rep. Michael Castle (R-DE) for introducing important legislation that will help transform the lives of millions of women worldwide. The Obstetric Fistula Prevention, Treatment, Hope and Dignity Restoration Act of 2010, H.R. 5441, would authorize funding to prevent obstetric fistula and treat women suffering from this debilitating condition. Read the joint press release here.

“We are thrilled to see that the bill recognizes the importance of partnering with national governments and institutions and strengthening local capacity as the way forward,” said Ana Langer, M.D., President of EngenderHealth. “We know this is the most sustainable approach to preventing and treating obstetric fistula. This captures the spirit and intent of the Obama Administration’s Global Health Initiative.”

H.R. 5441 was introduced just days before the start of Women Deliver, the largest-ever conference on maternal and reproductive health, convened in Washington, DC, from June 7–9, 2010. Download the full legislation here (PDF, 41KB).

Take a moment now to write to your representatives today and ask them to co-sponsor the bill.

Learn more about Fistula Care, which is bringing vital fistula prevention and treatment services to women in 11 countries, with support from the U.S. Agency for International Development.

The 50th Anniversary of the Pill: A Moment to Reflect and Recommit to Expanding Options

By Lynn Bakamjian, Director, RESPOND Project

The flurry of media attention around the 50th anniversary of the oral contraceptive (popularly known as “the pill”) has been a great reminder to those of us who came of age during this time of the advances that women in the United States were able to make once they had the means to safe, available, and (mostly) affordable contraception.

On a personal level, having the pill as an option provided me with the knowledge and comfort that whenever I needed to, I had the means to manage my fertility and pursue my education and career without worrying about a poorly timed or unwanted pregnancy. As I reflect on what the pill has meant to generations of women, including my own, I cannot imagine how different my life might have been without it.

And while there are many blog posts and news articles about the impact that this female-controlled, easy-to-use contraceptive had on women’s lives here in the United States, I am reminded that this is, unfortunately, not yet the case for many women and couples in developing countries.

More than 200 million women around the world have a desire to use contraception but are currently not using any effective method. This unmet need is largely due to lack of available and affordable options, to fear and concerns about safety due to misconceptions about contraceptive methods, and sometimes even to opposition by husbands or family members.

There are many options that can provide women with a choice that meets their particular family planning needs—while the pill is great, it’s not the only method. In many countries in Sub-Saharan Africa, for example, many women exceed their desired family size by one or more children, which points to a greater need for options beyond short-acting methods such as the pill, especially underutilized options like intrauterine devices, implants, and sterilization. In most developing countries, however, contraceptive choice is elusive; rarely do women have the range of methods available to meet their needs.

As we mark this milestone in American history, let us remember the hundreds of millions of women who are living today, like American women were a half century ago, in fear of unintended pregnancy, and let us honor them with renewed commitment and action to bring them not only the pill, but the whole wide range of family planning methods that all women deserve.

Support Women's Health with the Global MOMS Act!

Having a baby should be among a woman's most joyous moments in life. Unfortunately, for many women around the world, childbirth can be dangerous and even deadly -- for both mother and child.

The Global MOMS Act will expand access to maternal health services and greatly reduce maternal mortality.

In 2000, the U.S., along with 191 countries, pledged to meet the Millennium Development Goals, including targeting a 75 percent decrease in maternal mortality, by 2015. The Global MOMS Act will help fulfill the pledge, as well as help countless mothers worldwide get quality health care services. For some moms, this act will be the difference between life and death.

No woman should have to put her life or health at risk during pregnancy or childbirth, and all newborns should have a healthy start in life. Tell your members of Congress to support the Global MOMS Act and fight for women's health around the world. Click here!

ACTION ALERT: Urge Congress to Support Global Health!

We need your help now. There is growing momentum in Washington around three very important new bills concerning global health. Take a moment now to write to Congress and urge your representatives to support these bills:

• The Global Democracy Promotion Act (H.R. 4879/S.311) would create a permanent legal barrier to attempts by any future administration to reinstate the Global Gag Rule. While President Barack Obama overturned the Gag Rule during his first week in office, this measure is needed to ensure that U.S.-funded organizations will be able to continue delivering lifesaving information and services to women and families around the globe.
  
  
• The Global Sexual and Reproductive Health Act of 2010 (H.R. 5121) supports voluntary family planning services, education and outreach, the reduction of unsafe abortions, prevention of HIV and other sexually transmitted infections, the training of health care professionals, and various other initiatives.
  
  
• The Global HEALTH Act (H.R. 4933) would improve the effectiveness of U.S. global health programs by strengthening health systems in developing countries and supporting the training of local health workers.

This is important. Write to Congress now!

South Africa ramps up its response to HIV and AIDS

In a move that United Nations officials say is the biggest and fastest expansion of AIDS services ever attempted, South Africa is opening up a new front in its response to HIV. In the past month, some 500 hospitals and clinics have begun dispensing antiretroviral drugs, and the government has trained hundreds of nurses to prescribe the drugs, work that was formerly the domain of doctors, the New York Times reported yesterday. The plan is to train enough nurses so that all of South Africa’s 4,333 health clinics will be able to dispense antiretroviral medicines.

South Africa is home to an estimated 5.7 million HIV-positive people, the largest number in the world. More than half of South Africans living with HIV are women, and 20 percent of pregnant women accessing public health services in 2008 tested positive for HIV. South Africa also has a high rate of sexual and domestic violence toward women, which increases women’s vulnerability to HIV infection.

Since 1998, EngenderHealth has worked in South Africa to transform men’s attitudes and behaviors to reduce gender-based violence and HIV infection rates. We have also introduced innovative approaches for improving men’s access to HIV counseling and testing and care and treatment services. We applaud South Africa’s increased efforts to respond to HIV and the campaign that was kicked off on Sunday to test 15 million of the country’s 49 million citizens for the virus by next June. We also know from our experiences in places where doctors are scarce that properly trained nurses and midwives can offer high-quality health care.

Read more about EngenderHealth’s work to train nonphysicians to perform male circumcision in Kenya.

At the Huffington Post, More Commentary from Dr. Ana Langer on the Maternal Mortality News

Today at the Huffington Post: Dr. Ana Langer, EngenderHealth's president, explains the importance of the latest maternal mortality research published in the Lancet -- and how it inspires us to keep moving ahead.

For decades, the maternal health community has been stuck on the number 500,000 -- the estimated number of women dying from pregnancy and childbirth each year -- a stubborn figure that keeps us up at night, that horrifies us, that refuses to budge. That changed this week.

Read the full article.

At Salon.com, Dr. Ana Langer's Perspective on the Maternal Mortality Numbers

At Salon.com, EngenderHealth's president Dr. Ana Langer provided some perspective on the maternal mortality numbers in today's headlines, including why the U.S. is lagging.

Dr. Ana Langer, president of EngenderHealth, an international reproductive healthcare organization, said that better record keeping might account for some of the increase in the U.S. The window for classifying maternal mortality has been extended from 42 days after a woman gives birth to one year. Also, in recent years, U.S. death certificates began tracking whether or not a woman of reproductive age is pregnant at the time of death. As for global changes, Langer points to an increase in contraceptive use, women's education and the use of skilled medical providers during birth. However, she was quick to point out that it's somewhat deceptive to say that maternal mortality is declining worldwide. The reality is that it's "declining in some countries with large populations."

Read the full article.

Global Maternal Health Conference 2010

This summer the Maternal Health Task Force at EngenderHealth and the Public Health Foundation of India are hosting the Global Maternal Health Conference 2010 in New Delhi, August 30—September 1. The meeting is expected to bring together approximately 500 maternal health experts and advocates for an unprecedented global technical and programmatic meeting focused exclusively on maternal health.

The Global Maternal Health Conference 2010 aims to build on gathering momentum around United Nations Millennium Development Goal #5, improving maternal health. The meeting is being designed to build consensus around what is needed to make real improvements in the health and lives of pregnant women.

A steering committee has been established and will be confirming the conference themes, and a call for abstracts will be issued soon. The organizers envision a robust youth presence, with the Young Champions of Maternal Health and Indian professionals recruited by the Public Health Foundation of India participating. A scholarship program is also planned to ensure broad participation from around the world.

Stay tuned to this space and the Maternal Health Task Force website for upcoming details.

Men As Partners Video profiles by UNiTE to End Violence

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A digital story from EngenderHealth’s Men As Partners program in South Africa is the featured video of the week on the Say NO—UNiTE to End Violence against Women YouTube channel. In this video, a young woman from South Africa tells of the abuse she suffered by the men in her life, the trauma she endured, and the healing she has been through as a gender activist. Learn about Thoko's story, share comments, and view other empowering videos at http://www.youtube.com/SayNoToViolence.

Transforming Women's Lives in Niger

With one of the highest rates of maternal death in the world, a woman in Niger has a one in seven chance of dying in childbirth or pregnancy during her lifetime.

By age 16, more than half of girls in Niger are married, and many have already borne children. The overwhelming majority of these births are at home—not at health facilities. Nationwide, barely one-third of births are assisted by trained health professionals.

This International Women’s Day, we celebrate individuals in Niger who are helping women fight these odds and transforming lives. This photo essay profiles nurse-midwives who participated in a recent training by EngenderHealth’s Fistula Care Project, which is supported by the U.S. Agency for International Development (USAID), as well as young Nigerien women who are benefiting from fistula repair surgery and better maternal health services. With EngenderHealth’s—and your—help, women and girls here can have a better tomorrow.

Fourth Africa Conference on Sexual Health and Rights

Teshome Woldemedhin is Youth and Gender Advisor for EngenderHealth in Ethiopia. Here, he shares his perspective on the Fourth Africa Conference on Sexual Health and Rights, which has been held in Addis Ababa, Ethiopia, this week.

The room was abuzz after Ethiopia's president, Girma Woldegiorgis, made the opening remarks at the Fourth Africa Conference on Sexual Health and Rights, getting things off to a promising start. The president called for increased access to sexual and reproductive health care for the poorest and most vulnerable, signaling the kind of political will that we need more of from our leaders. All too often, as Dr. Kebede Kassa of the Social Affairs Department of the Africa Union Commission later noted, "Political will is a scarce commodity."

Approximately 1,000 people are attending the conference from across Africa and elsewhere. I'm glad to see ministers of health from several countries in attendance, as well as high-ranking officers from the International Planned Parenthood Federation, World Health Organization, Joint United Nations Programme on HIV and AIDS, and other organizations.

In my opinion, some of the most valued participants are the youth EngenderHealth sponsored to attend--six young women and six young men ages 18-24, from our university project. This initiative works with universities and youth clubs and focuses on improving the sexual and reproductive health of youth by raising awareness, improving services at health clinics, and reducing gender-based violence. These 12 young people, who were also involved in planning the conference, can personally testify to the critical issues that African youth face.

I moderated a panel session on emerging issues in the area of youth's sexual and reproductive health. Some of the key issues raised included the vulnerability of young girls and the need to get young people more involved in advocating for better sexual and reproductive health services.

One of the most interesting sessions I attended was on "South-to-South" exchange: the importance of developing countries' sharing experiences and lessons learned. I think this kind of learning and partnership is one of the key outcomes of these kinds of gatherings. Instead of working on parallel tracks, we can all learn from each other. Identifying those strategies that are the most effective, then transferring and expanding upon them, can lead to smarter HIV prevention that better meets the needs of those most vulnerable.

The open dialogue of this conference is inspiring and served as yet another humbling reminder of why EngenderHealth's work in all areas of reproductive health is so vital--in Ethiopia and beyond.

Fistula in the Congo: A Response to Nick Kristof's Feb. 7 Column

It’s shocking what’s happening every day in the D.R. Congo. The sexual violence is shattering to both women and their communities. But people like Dr. Mukwege prove that we are not powerless and something can be done about it. It’s so important to support health facilities like Panzi Hospital and doctors like Denis Mukwege—who are beacons of light in a tremendously bleak environment.

EngenderHealth supports Panzi Hospital and another hospital in the Congo, HEAL Africa, through the Fistula Care project, funded by USAID. These two facilities are centers of excellence for fistula repair, drawing women from all over the country and region in need of treatment.

With USAID support, doctors and nurses at Panzi and HEAL Africa have been trained to strengthen maternal health and fistula repair services—dedicated, local professionals who will be there for the long haul. In addition, the project ensures that women have transportation to the hospital for treatment and helps them reintegrate back into their communities once they have had surgery.

Obstetric fistula also occurs when women can’t access timely emergency obstetric care—namely, cesarean sections—during long or obstructed labors. With better maternal health care, obstetric fistula cases (which still make up the majority of fistula cases in the Congo) could be averted altogether. To prevent such fistula cases in Congo and elsewhere, we work with doctors, nurses, and midwives to help them better manage complicated pregnancies and births. At the community level, the project helps rural health workers refer pregnant women with complications to hospitals that can provide comprehensive care.

Strengthening health systems by building on existing resources is the best way to both treat women with fistula and prevent new obstetric fistulas cases. And a holistic approach that improves fistula prevention—by improving maternal health care and reducing sexual violence—is crucial. In terms of providing surgical repair, it’s important to keep in mind that the vast majority of fistula surgeons live and work in the developing world. Seeing fistula cases on a daily basis, local health providers should be supported to treat and prevent fistula. It makes sense to enhance the capacity of in-country health care professionals like Dr. Mukwege who can make lasting changes, both in their country’s health system and in the lives of women and their families.


Bethany Cole
Senior Program Associate
EngenderHealth

(This post appeared February 11 as a comment in response to Nick Kristof's column in the New York Times.)

Dr. Ana Langer: One of the "21 Leaders for the 21st Century"

Please join all of us at EngenderHealth in congratulating Dr. Ana Langer, our president, for her recognition as one of the "21 Leaders for the 21st Century" by Women's eNews, an independent online news service. Every year, Women’s eNews selects and honors 21 outstanding people who have improved the lives of women and girls worldwide. This year, Dr. Langer was chosen for her leadership and dedication to improving the health of women and families in some of the world’s poorest communities. Ana’s profile is featured today under “Seven Who Rewrite the Rules,” which you can read here. Other honorees this year include: Kathy Cloninger (CEO of Girl Scouts), Tonya Lewis Lee (author and television producer), and Patricia Gruber (Peter & Patricia Gruber Foundation).