Repro Health in Review: 11 Highlights of 2011

We saw a number of significant moments in global reproductive health during 2011 -- from historic court rulings to scientific breakthroughs to the launch of a new UN agency dedicated to women's equality and empowerment. Check out our digital timeline of 2011 highlights! Or scroll down for a complete list.

Repro Health in Review: 11 Highlights of 2011 on Dipity.

October 31: The world’s 7 billionth baby joins the global community.

October 4: A study published in Lancet Infectious Diseases (October issue) suggests a possible link between hormonal contraceptives and HIV.

August 10: The UN CEDAW issues an historic ruling that governments have a human rights obligation to guarantee access to maternal health services.

August 1:  The Obama Administration issues new standards requiring health insurance plans to cover women's contraceptives without co-payments.

July 6: In a 2-1 decision, a New York appeals court ruled that the “anti-prostitution pledge” violates the First Amendment by forcing funding recipients to take on the government’s viewpoint as if it were their own.

May 17: The World Health Organization expands its list of essential medicines to include misoprostol, a lifesaving drug that prevents postpartum hemorrhage, a leading cause of maternal death.

May 12: A study by National Institute of Allergy and Infectious Diseases reveals that early treatment for HIV patients can significantly reduce chances of transmission.

April 15: The U.S. Congress passes the FY2011 Continuing Resolution, ending a budgetary impasse that sparked a nationwide debate about women’s reproductive health and rights.

March 3: Two Ugandan families take maternal health rights into their own hands by bringing a lawsuit against their government for the needless deaths of two mothers in a North Uganda clinic.

February 1: A 2010 Demographic Health Survey in Bangladesh reveals a significant 40% decline in maternal mortality in less than a decade. Learn about EngenderHealth’s role in improving maternal health in Bangladesh.

February 24: Secretary General launches UN Women, signifying a historic step to marshal resources and mandates for greater impact in gender equality and women’s empowerment.

January 6: 600 UK women reported unwanted pregnancies while using the Implanon contraceptive implant, creating a pregnancy scare among clients. Read our commentary on the role of training for implants.

Snapshots: Eliza of Tanzania

In Arusha, Tanzania, Eliza talks with a patient at the Ngarenaro Health Clinic. Learn more about EngenderHealth’s work to improve clinical quality.

Photo credit: Mark Tuschman

What It Will Take to Achieve an AIDS-Free Generation

In a November 8 address, Secretary of State Hillary Rodham Clinton set forth a bold vision that the end of HIV and AIDS is finally in sight, marking the first time in history that the U.S. government has made it a policy priority to end HIV and AIDS.

Major scientific advances in the last few years offer an historic opportunity for achieving an AIDS-free generation, Secretary Clinton said. This goal is attainable through a combination of three proven interventions—prevention of mother-to-child transmission (PMTCT), voluntary medical male circumcision, and antiretroviral (ARV) treatment to prevention transmission—in addition to condoms and other prevention tools. The Obama Administration is characterizing this approach as “combination prevention.”

Here, EngenderHealth experts on HIV and AIDS offer their perspectives on the U.S. government’s new policy as well as the new 2011 Worlds AIDS Day report released by the Joint United Nations Programme on HIV and AIDS (UNAIDS).

Pamela W. Barnes, President and CEO

Bringing family planning back into the conversation…

I fully applaud the ambitious goal set forth by the Obama Administration, yet its response doesn’t measure up to the realities facing the majority of individuals living with HIV—women and girls—in Africa. Achieving an AIDS-free generation will require a broad, integrated approach that extends beyond PMTCT to include reproductive choice, which is a fundamental human right for women and girls and an indispensable component of a comprehensive solution to ending HIV and AIDS. (Photo: Pamela Barnes on the right)

Family planning is part of a four-pronged approach to achieving strong sexual and reproductive health for women living with HIV. We can all cheer when a mother gives birth to an HIV-free baby—no doubt, PMTCT is a critical tool for HIV-positive women who wish to expand their families. But the reality is that we cannot have comprehensive PMTCT without family planning.

To be effective, PMTCT services must encompass comprehensive care for pregnant women, mothers, and newborns, including family planning, primary prevention, and care and treatment for HIV-positive women and infants. Moreover, women with HIV who have just delivered a healthy baby through PMTCT must also have the means to avoid or delay future pregnancies, if that is what they wish to do.

The bigger picture of reproductive health...

In the broader context of sexual and reproductive health, we must also ask ourselves: How do we keep that same mother healthy throughout her life? She may access HIV treatment, but in these very same places, getting pregnant is one of the riskiest things she can do. For example, in places like Niger, a woman has a one in 16 chance of dying due to pregnancy in her lifetime, so meeting a woman’s broader reproductive health needs, including family planning, is imperative if we are to make measurable progress.

Paul Perchal, Director, HIV and STI
Universal access to HIV programs is the lynchpin to achieving an AIDS-free generation…

We are in a truly new era of the AIDS response, with unprecedented opportunities for realizing an AIDS-free generation, but we have a long way to go. Universal access to HIV programs is the lynchpin to achieving an AIDS-free generation. By the end of 2010, only about 47% of eligible people living with HIV were on ARV treatment, and about 48% of pregnant women living with HIV received PMTCT treatment. Moreover, after male circumcision was shown to offer protection against HIV, the United Nations set a goal for 20 million African men to be circumcised by 2015, yet to date only about 600,000 have undergone the procedure. For these numbers to change, strong referral networks are key – they help with client follow-up, and will be critical in scaling up comprehensive prevention, care, and treatment programs.

On “combination prevention” (PMTCT, MC, and care and treatment)…

Combining proven approaches must also include behavioral interventions (such as encouraging people to use condoms to reduce risks of transmission) and structural interventions (such as using microfinance loans to reduce women’s dependence on transactional sex for income). Even if HIV services are available, people may not access them or adhere to care and treatment unless they develop positive health-seeking behaviors and can do so without facing stigma and discrimination.

A shared responsibility…

An effective global response to HIV and AIDS involves a shared responsibility and ongoing moral and financial commitment from both developed and developing countries, communities, and donors. We also need to help support and strengthen local governments and civil society organizations by building their institutional capacity to increase transparency and accountability and ensuring that donor resources actually reach the people they are meant to support in a timely and cost-efficient way.

On the new global framework described in the 2011 UNAIDS World AIDS Day Report…

The comprehensive global framework for HIV and AIDS should deliver significant results if countries, donors, and multiple development sectors can commit to it. The framework underscores the need to promote “social enablers,” such as human rights and the capacity of community-based organizations, as well as “program enablers,” such as community-centered program design and delivery, integration, management and incentives, and research and innovation.

Achieving universal access to HIV prevention, treatment, care, and support by 2015 through the framework will require scaling up funding, including moving closer to spending 15% of government revenue on health (as per the Abuja Declaration for Africa), as well as using existing resources more cost-efficiently. It will also require leveraging synergies with other sectors such as gender, education, social protection and welfare, and economic development.

Finally, maximizing critical enablers requires program efforts and new innovations that function together and include a combination of biomedical, behavioral, and structural components.

U.S. Troops Deploy to Central Africa to Fight Sexual Violence

Restoring stability could increase access to critical health care in the region
The U.S. government is deploying 100 troops to Central Africa to help fight the Lord’s Resistance Army (LRA), a decades-old organization notorious for rape, sex slavery, and other forms of violence against women. The troops will be armed for self-defense but will primarily advise regional military forces in hunting down the leader of the LRA, Joseph Kony, who became the International Criminal Court’s first indictee for war crimes about 10 years ago.

Since 1987, the LRA has terrorized civilian populations throughout the central African region, including parts of Democratic Republic of the Congo, northern Uganda, South Sudan, and the Central African Republic. Over the years, tens of thousands of children have been abducted to serve as child soldiers, women and girls were enslaved for sex, while tens of thousands more were disfigured or killed. Those who have been displaced by the violence continue to live in refugee and displacement camps with little opportunity for education, work, or proper health care.

While it will inevitably take time, restoring stability in the region is a prerequisite for improving physical security and developing roads and other critical infrastructure that are key to expanding people’s access to medical care. This includes access to quality reproductive health care, a goal that EngenderHealth works to achieve in both Uganda, the DRC, and throughout Africa. EngenderHealth’s Fistula Care project supports health centers in both Uganda, where the LRA originated, and the DRC, where the group continues to operate today. The project focuses on providing treatment for women living with fistula resulting from both obstetric and traumatic injury. Read a story about EngenderHealth-trained fistula surgeons in the DRC.

Some consider President Barack Obama’s deployment decision to be a positive sign that the United States will not tolerate sexual violence in Africa. The decision to deploy is consistent with legislation in Congress, the “International Violence Against Women Act” (IVAWA), which aims to establish gender-based violence as a top priority for U.S. foreign policy. IVAWA passed in the Senate Foreign Relations Committee in December 2010 but failed to pass in the U.S. House of Representatives.

Capturing the Count: A Round Up of Global Voices on 7 Billion

In the weeks leading up to the 7 billion milestone, we’ve seen the global population issue captured in so many ways across the multimedia landscape—through videos, web sites, photo essays, social media, and of course, the good old op-ed. Below is a collection of some of the most interesting “7 billion” projects that reflect the diversity, not only of these views, but of our growing world.

7 billion … in pictures:

• Photo essays from The Atlantic, Boston Globe, National Geographic, and the Washington Post.

• In a colorful two-and-half-minute video, NPR tells the story of how we got “so big, so fast.”

7 billion … in soundbytes:

• A podcast featuring Dr. Babatunde Osotimehin, Executive Director of UNFPA, on family planning and the 7 billion milestone (published by the UK’s Department for International Development).

• An NPR segment about the most densely populated place in India.

7 billion … on the web:

• The National Geographic magazine is culminating a special year-long series on population, including an article, photo gallery, video, and game.

• What’s your number? Population Action International and the BBC have launched online campaigns showing you where you fit among the world’s 7 billion, using just your birthday.

• USAID Global Health’s “World at 7 Billion” project demonstrates how a single person in a world of 7 billion can make a difference in his or her community. (Features a story on our very own Esther Nyokabi of Kenya!)

• UNFPA’s 7 Billion Actions campaign shares stories and films on how individuals and organizations around the world are bringing about positive change.

7 billion … in social media:

• Check out the conversation on #7billion in Twittersphere as well as EngenderHealth’s #CountTo7B project on key population factoids and statistics.

7 billion … in writing:

• In an Oct. 21 essay on CNN.com, Jeffrey Sachs says technology and stabilization of the population are the answers to this question: How can we enjoy “sustainable development” on a very crowded planet?

• Helen Epstein discusses the role of religion in contraceptive use for Ghanaian communities in her Oct. 22 New York Times article, Talking Their Way Out of a Population Crisis.

• On Oct. 24, the Guardian UK underscores the role of education in increasing opportunities for women and girls and, ultimately, slowing population growth in places like Tanzania.
  
• Bloomberg offered its own round up of the voices on 7 billion in an Oct. 31 article.

Top Tweets on #UNday!

On Oct. 24, we celebrated the 66th birthday of the United Nations, an important EngenderHealth partner and crucial supporter of lifesaving reproductive health programs worldwide. There was no cake (at least for EngenderHealth :)) but the conversation rocked! Check out our favorite tweets from #UNDay:

@StateDept
President Obama: The men and women who created @UN understood that peace is not simply the absence of war. http://go.usa.gov/XrT #UNDay

@WeCanEndPoverty
On Monday, UN Day, find out what you can do to help meet the Millennium Development Goals here: http://bit.ly/drl2ep #UN4U #7billion #MDGs

@UNfoundation
"The UN brings the world together to consider issues that affect all of the planet's human beings" - Sen. Wirth #UN4U

@AmbassadorRice
66 years after the #UN's founding Charter entered into force, it pays more than ever to share the burden of our common challenges. #UNDay

@USEmbassyAthens
On #UNDay, we join our 192 fellow member states in celebrating the founding ideals of the #UN Charter: http://go.usa.gov/XrT

@ICTYnews (International Criminal Tribunal for the former Yugoslavia)
The ICTY marks 2011 UN Day with no remaining fugitives and nearing successful completion of its mandate: http://ow.ly/786ON

@UNICLagos (United Nations Information Centre, Lagos)
On UN Day, Ban underlines need for unity to confront global challenges http://shar.es/bYAk4

@UNICEFLive
Happy #UN Day! Thanks for helping to build a better world where no one is left behind. http://bit.ly/psLyec #UN4U

@UNfoundation
Tomorrow is #UN Day! Check out this great interactive map with @unausa events happening around the country: http://ow.ly/76bp9

@EngenderHealth
Happy #UNday! Thnx to the entire #UN family for working to advance the welfare of #women and girls, esp in the field of #reprohealth. #MDG5

On the Hill: House Foreign Affairs Committee Votes to End Support for UNFPA

In a strict party-line vote, the Republican-led House of Representatives Foreign Affairs Committee voted 23-17 yesterday to prohibit United States financial support for the United Nations Population Fund (UNFPA). President Barack Obama had requested $50 million for the group. In denying this request, Republicans cited UNFPA's work in China, where they believe funds could be used to coercively enforce that country's one-child policy. Democrats on the committee offered various amendments to allow U.S. money to UNFPA to be directed to specific programs, such as ending child marriage and female genital mutilation, preventing and repairing obstetric fistula, and providing safe birth kits to pregnant women following a natural disaster. Republicans uniformly voted against each one. We will continue to keep you updated on this and other policy developments.

On the Hill: Senators Challenge House Cuts to Family Planning, Reproductive Health

In a challenge to the dramatic cuts proposed by the House of Representatives in July, the Senate Appropriations Committee has voted to provide $700 million for international family planning and reproductive health in fiscal year 2012—a $239 million increase over the amount proposed in the House version of the State Department and Foreign Operations bill. The committee also adopted an amendment introduced by Sen. Frank Lautenberg (D-NJ) that would block the Global Gag Rule proposed by the House and to permanently prohibit the use of the policy under future leadership.

The Senate actions set the stage for what will be a contentious debate over reproductive health and rights in the upcoming budget process. In its version of the bill, the House cut family planning funding by 25% from current levels and barred the United States from making any contributions to the United Nations Population Fund (UNFPA). The House also seeks to impose the Global Gag Rule (GGR), which prohibits foreign organizations from receiving U.S. aid if they provide any services related to abortion—even if they use their own non-U.S. funding and even if the activities are legal in their own countries. Also known as the Mexico City Policy, the GGR has proven in the past to needlessly hamper access to critical health services and endanger the lives of millions.

The FY2012 State Department and Foreign Operations Appropriations bill covers U.S. programs in diplomacy, development, health, and humanitarian assistance. While the new fiscal year officially began October 1, no agreement on the spending bill has been reached between the two houses of Congress. In the meantime, the House and Senate are negotiating a continuing resolution that would temporarily fund the government until an official FY2012 appropriations bill is signed into law.

Historic UN Ruling: States Must Ensure Access to Maternal Health Care

Governments have a human rights obligation to guarantee women’s access to timely and nondiscriminatory maternal health services, according to a recent ruling by a major United Nations human rights body.

The UN Committee on the Elimination of Discrimination Against Women (CEDAW) issued the Aug. 10 ruling, concluding the first maternal death case ever to be decided by an international human rights body.

The case began in 2002 with the tragic death of Alyne da Silva Pimentel, a 28-year-old Brazilian of African descent. Alyne was denied timely care at a public health facility and later died after giving birth to a stillborn baby. Five years later, her mother brought the case to CEDAW, stating the government of Brazil violated her daughter’s right to life and health by failing to meet its obligation to ensure the health and rights of her daughter.

In her complaint, Maria de Lourdes da Silva Pimentel invoked Articles 2 and 12 of the Convention on the Elimination of All Forms of Discrimination Against Women, which call on the government to pursue all appropriate means to eliminate discrimination against women in the field of health care.

Brazil is an emerging economic power in South America. While the country has dramatically reduced maternal deaths in the last 10 years, the progress at the national level belies the extreme disparities in maternal health care that still exist based on race, socioeconomic status and geography.

The ruling sends a powerful message in the international arena and demands that the government compensate Alyne's family and take steps to ensure women's rights to safe motherhood and health care. More broadly, it establishes that maternal health is a human rights responsibility of governments that must be taken seriously and that applies to all women, including indigenous, impoverished women who are most affected by maternal mortality.

Created in 1982, the Committee is made up of 23 experts on women’s issues worldwide. The Committee mandate is to monitor progress for women in countries that are parties to the Convention. Members review national reports to assess the steps being taken to improve situations for women—a process that itself enables continuous dialogue and focus on anti-discrimination policies.

Photo by C. Ngongo/EngenderHealth

Insights from 2011 Int’l AIDS Society Conference

Back from Rome where they participated in this year’s International AIDS Society (IAS) Conference, Mark Barone and Jared Nyanchoka, Technical Advisors at EngenderHealth, took time to share highlights from the annual meeting:

Q: What were some research highlights from the conference?

A: Two major research advancements drew much attention at the conference: 1) treatment as prevention and 2) pre-exposure prophylaxis, known as PrEP. In the first case, a large, randomized study showed that when people living with HIV begin antiretroviral (ARV) treatment before they normally would, their chances of transmitting the virus are reduced by an astounding 96%. The second breakthrough involved two randomized studies among heterosexual couples in Botswana, Kenya, and Uganda, which showed that a daily dose of ARV drugs for HIV-negative men and women reduced the risk of contracting HIV by 60-70%.

Another interesting study addressed male circumcision for HIV prevention, one of EngenderHealth’s HIV focus areas. A study from South Africa showed for the first time that male circumcision reduced the number of new HIV infections within a population. Among 15- to 34-year-old men, there was a 76% reduction in new HIV infections between 2007 and 2010 in the Orange Farm area outside of Johannesburg.

Q: What are the key issues emerging in light of the recent findings involving HIV treatment for prevention?

A: Treatment as prevention took center stage at this year’s IAS conference in Rome. While everyone seems very excited about these amazing results, many debates have surfaced about the practical issues that must be addressed before this approach can become a reality.

Currently, in Africa, as in other parts of the world, many people need treatment now, yet are unable to get it because of lack of availability and resources. How can we begin giving anti-HIV drugs to people who do not need them yet clinically, even though we know that doing so will decrease the chances of passing HIV to others? Treatment-as-prevention approaches are extremely expensive, and stigma is an obstacle to getting tested and accessing treatment. There are also concerns about human rights issues surrounding drug distribution in limited resource settings. These are only a few of the many issues that complicate this discovery.

It is also important for people to keep in mind that treatment as prevention and PrEP have a major behavioral component. People actually need to take the drugs. With past prevention measures (condom use, reduction in sexual partners, safe drug injection practices), we have seen that behavior change is not easy. We must not be lulled into thinking that these prevention approaches using ARV drugs will be any more likely to succeed without significant efforts.

The ethics of using placebos in future HIV research were also debated at the conference, particularly with regard to developing an HIV vaccine. How ethical will it be to give placebo medication in place of other near effective biomedical approaches such as treatment as prevention and PrEP when researching effectiveness?

Q: What new HIV-related research did EngenderHealth present at the conference?

A: EngenderHealth gave two poster presentations on our male circumcision work in Kenya, both of which were very well-received. One demonstrated that male circumcision provided by non-physicians (nurses and clinical officers) is safe, effective, and acceptable, when the providers are well trained and facilities have the required equipment and supplies. The second confirmed the safety and acceptability of the Shang Ring, a novel device for adult male circumcision that EngenderHealth is researching in Africa. Participants were eager to use the findings as a lobbying tool to push their governments to support male circumcision.

Q: What role do you think this and similar conferences play in knowledge sharing and advancement?

A: Scientific conferences are crucial for knowledge sharing. They provide a forum for presenting the latest developments and advances in the field, for exchanging ideas about projects, and for immersing oneself in the latest work in many different subfields of HIV research. Conferences allow researchers to present their data and solicit input from others, as well as provide input on others’ work. They allow for critical discourse, discussion and debate that help to move the field forward and provide an opportunity to network with colleagues and to develop new collaborations with people from around the world.

Obama Administration Requires Zero Copay for Birth Control

In a historic decision announced today, the Obama administration has required health insurance plans to cover the cost of birth control without copayments from patients. The rule will likely go into effect in January 2013.

Department of Health and Human Services Secretary Kathleen Sebelius announced the new rule, after the Institute of Medicine, a leading medical advisory panel, recommended that contraceptives be included as part of women’s preventive health care.

In addition to birth control, insurance providers will be required to pay for breast pumps, HIV testing, annual physicals, screening for domestic violence, counseling for breastfeeding, and other procedures that qualify as “preventive healthcare” services. Insurance premiums are expected to rise to cover the increased costs to insurance companies.

The requirement will only apply to insurance plans designed on or after Aug. 1, 2012. A provision in the new rule also allows some employers to opt out of the requirement on grounds of religion.

Sebelius called the guidelines “historic” and “based on science.” Previously there has never been an established set of guidelines for women’s health and preventive care, and according to the Institute, almost half of all pregnancies in the United States are unintended; 40% of them end in abortion.

Expanding access to contraceptives is critical for women’s health and rights, not just in the United States, but in developing countries across the world. Currently, EngenderHealth works to improve and expand access to quality family planning services, with a focus on long-acting and permanent methods in Africa and Southeast Asia.

House Bill Proposes Dramatic Cuts for Reproductive Health

The U.S. House Appropriations Subcommittee on State and Foreign Operations has approved a foreign assistance bill that proposes dramatic cuts to family planning and reproductive health (FP/RH) programs. The legislation will govern funding for fiscal year 2012 (FY2012), which begins on October 1, 2011.

The full draft of the bill, published (PDF, 364KB) on the Appropriations Committee web site, reveals a number of measures that would harm the health and lives of millions of women and children around the world. Below are a few notable provisions from the bill, compared with those in the final FY2011 Continuing Resolution passed in April. The draft bill:

• Allots a maximum of $461 million for FP/RH activities in FY2012, compared with a total of $615 million in FY2011.

• Reinstates the Global Gag Rule, prohibiting U.S. assistance to any foreign entity that “promotes or performs abortions.” The final FY2011 Continuing Resolution did not include this controversial policy.

• Prohibits any U.S. contributions to UNFPA or any organization that “supports or participates in the management of a program of coercive abortion or involuntary sterilization.” The FY2011 budget appropriated $40 million in U.S. contributions to UNFPA, an international development agency dedicated to promoting reproductive health and rights.
  

In response to the bill, Sec. of State Hillary Rodham Clinton said she would urge a veto of any bill that would impose new restrictions on aid to critical partners and countries. Rep. Nita Lowey (D-NY), Ranking Democrat on the subcommittee, also issued a July 26 statement on the issue: “I am disappointed that the 2012 State and Foreign Operations Appropriations Act ... includes divisive and partisan policy riders that are counterproductive to effective diplomacy and development."

Lowey also recently introduced a bill to prevent the reinstatement of the Global Gag Rule, which would prevent women and children from accessing critical health services such as family planning, obstetric care, HIV testing, and malaria treatment that have nothing to do with abortion.

Rep. Lowey Introduces Bill to Prevent Global Gag Rule

Rep. Nita Lowey (D-NY) has introduced a bill to prevent the reinstatement of the Global Gag Rule (GGR). The House Foreign Affairs Committee voted to reinstate the controversial policy during a markup last week of the fiscal year 2012 State authorization bill.

The Global Democracy Promotion Act (H.R.2639), which has already garnered more than 100 sponsors in the U.S. House, would prohibit the U.S. government from imposing any funding restrictions on foreign organizations that would otherwise be unconstitutional for U.S. organizations. The bill would prevent overseas NGOs from being barred from U.S. aid, based on the services they provide.

To learn more about the devastating impacts of the GGR, watch our 90-second video.

House Committee Votes to Reinstate Global Gag Rule

The House Foreign Affairs Committee on July 21 voted (25-17) to reinstate the Global Gag Rule (GGR) in the fiscal year 2012 foreign aid bill.

The controversial policy prohibits international family planning organizations receiving U.S. aid from providing information, counseling, or referrals related to abortion—even if using their own non-U.S. funding and even if the practices are legal in their own countries. During the July 20-21 markup, the committee defeated an amendment by Ranking Member Rep. Howard Berman (D-CA) to remove the Global Gag Rule from the bill.

If reinstated as a matter of law, the GGR would have terrible consequences for women and their families. While it was in effect between 2001 and 2009, the policy forced clinics to cut back on a range of critical health services that have nothing to do with abortion, such as family planning, obstetric care, HIV testing, and malaria treatment. Watch our 90-second video to learn how the GGR negatively impacts the health and lives of women and children.

The GGR was first adopted in 1984 by President Ronald Reagan but has since been removed and reinstated several times. President Obama rescinded the policy when he took office in January 2009.

EngenderHealth at 2011 IAS Conference (July 17–20)

EngenderHealth will participate in the 2011 International AIDS Society conference, the largest open scientific meeting on HIV and AIDS. Held in Rome from July 17 to 20, the conference will focus on HIV pathogenesis, treatment, and prevention and aims to convert theory into practice while building a body of evidence for successful HIV programming.

Jared Nyanchoka, EngenderHealth Technical Advisor, will present “Improving Male Circumcision Coverage Through Task Shifting to Non-Physician Clinicians.” Mark Barone, Senior Medical Associate, will present “Spontaneous Detachment of the Shang Ring following Adult Male Circumcision.”

Other conference papers by EngenderHealth address the prevention of mother-to-child transmission (PMTCT) of HIV and the role of men in reproductive and child health, based on our experience in Tanzania:

• The role of male involvement in improving reproductive and child health: Lessons from Iringa, Tanzania
• Intensified counseling and support on treatment adherence and infant feeding options improves clients' health practices in PMTCT Services: Experience from Iringa, Tanzania
• The efficacy of triple antiretroviral treatment during pregnancy and breastfeeding for prevention of mother-to-child transmission of HIV-1: Hospital setting experience from Tanzania

Read more about EngenderHealth's work to support male circumcision service delivery, expand PMTCT services, and expand men's roles in improving reproductive health.

Expanding Choice for Young Couples in Bangladesh

By October this year, the world's population is projected to reach 7 billion, making access to family planning more urgent than ever. In Bangladesh, for example, 1.2 million young couples get married every year, creating a pressing demand for contraceptive services. EngenderHealth's work there has helped new couples access the full range of reproductive health services they need to plan their families and their lives.

Read how our efforts have affected the lives of one young couple, Sathi and Saydur, providing them the opportunity to save money and enjoy their marriage while focusing on completing their education.

Revitalizing the Partograph to Prevent Fistula in Uganda

Jenny Nalukwago of Uganda became pregnant when she was 16. But after spending more than 48 hours in labor, Jenny lost her baby because the health clinic couldn't provide the care she needed. After the harrowing ordeal, Jenny also discovered she was leaking urine. She had developed fistula, a heartwrenching condition that often forces women into lives of isolation and malnourishment.

With quality and timely maternal health care, fistula is preventable. Today, we have a simple tool—the partograph—that can easily help prevent needless maternal deaths and injuries. But as EngenderHealth's Fistula Care team learned last year, the partograph was not being used in Ugandan health facilities.

Read more to find out what the partograph can do to help prevent fistula for millions of other women like Jenny.

Rising Maternal Mortality in Argentina

Maternal deaths are on the rise in Argentina, with mortality ratios tripling that of neighboring countries Chile and Uruguay. Many of the deaths are the result of complications from unsafe abortion.

According to the Argentina National Ministry of Health, the maternal mortality ratio reached 55 deaths per 100,000 live births in 2009—up from 44 per 100,000 live births the year before. For Argentina, achieving Millennium Development Goal No. 5 (Improving Maternal Health) would mean reducing the mortality ratio to 13 deaths per 100,000 live births by 2015.

Every year, hundreds of thousands of women die during pregnancy or in childbirth. Thirteen percent of these deaths result from complications of an unsafe abortion. In April, the World Health Organization reported a notable global decline in deaths from unsafe abortion, suggesting that interventions to improve postabortion care are bearing fruit. But in Argentina, where abortion is illegal except in cases of rape, unsafe abortion remains deadly for Argentine women.

With access to quality care, almost all maternal deaths are preventable. EngenderHealth’s work has produced lifesaving results in places like Tanzania, where complications from abortion are also a leading cause of maternal death. We have partnered with the Tanzanian government to improve the availability of comprehensive postabortion care (cPAC) in rural areas. Prior to 2004, when the ACQUIRE Tanzania Project (ATP) began, these services were only available at regional hospitals, which were too far away for many women to receive timely emergency care. Learn more about EngenderHealths' work in maternal health.

You can help support our work by giving or by following us on Facebook and Twitter to help spread the word about maternal health.

EngenderHealth at Global Health Council Summit (June 13-17)

EngenderHealth next week will host two events at the Global Health Council's annual international global health conference in Washington, DC:

A June 13 workshop (1pm, Executive Room) highlighting the Supply-Enabling Environment-Demand (SEED) Programming Model, our comprehensive approach to achieving sexual and reproductive health. The session will introduce the new SEED Assessment Guide for Family Planning Programming, outlining 25 essential elements for robust and comprehensive family planning programs.

A June 14 evening reception (6:30pm, Governor's Ballroom), "EngenderHealth: Celebrating the SEEDs of Success," to celebrate our SEED programming model, along with another great year for EngenderHealth.

RSVP to these events by writing to rsvp@engenderhealth.org.

For more on EngenderHealth events this summer, see the "Upcoming Conferences" section in our June issue of Connect.

Act Now to Support Bill on Fistula Prevention & Treatment

Urge your Representatives in Congress to cosponsor critical legislation on obstetric fistula that will bring hope and dignity to mothers across the globe.

Introduced in March by Rep. Carolyn Maloney (D-NY), H.R. 949 supports increased assistance for fistula prevention and treatment initiatives abroad. These efforts include improving maternal health care, strengthening national health systems, increasing the number of skilled birth attendants, as well as addressing underlying the social and economic causes of fistula.

Send a sample letter to your Representative by entering your zip code here.

A Congressional Briefing: Ending Fistula Forever

On May 24, EngenderHealth joined with legislators, advocates, and health experts on Capitol Hill to discuss progress in preventing and treating obstetric fistula around the world. Together with our partners in the Campaign to End Fistula, we highlighted not just the heartbreaking stories of women living with fistula, but a vision of strong, healthy mothers—one that is only possible when women have access to quality maternal health care. The goal of the event, hosted by Rep. Carolyn Maloney (D-NY), was to garner support for H.R. 949, a bill supporting increased assistance for fistula prevention and treatment.

Alliance Launches HIV-related Stigma and Discrimination Website

A new website for the Stigma Action Network (SAN) is now live, offering a clearinghouse of information for experts working in HIV-related stigma and discrimination.

This network aims to support a global alliance of practitioners, researchers, advocates, people living with HIV, and donors by providing a one-stop shop for sharing and exchanging information about HIV stigma and discrimination.

The SAN steering committee includes EngenderHealth, Colectivo Sol, Futures Group, The Communication Hub and the International HIV/AIDS Alliance Africa Regional Programme. The International Center for Research on Women (ICRW) serves as the network’s technical secretariat and will manage SAN’s daily functions for the next three years.

Read more.

Shang Ring™ Device Shows Promise for Helping to Prevent HIV among Men

Results of a study conducted by EngenderHealth and Weill Cornell Medical College and published in the May issue of JAIDS show that the Shang Ring has the potential to revolutionize the provision of male circumcision services in Africa and help prevent the spread of HIV among men. First developed in China, the Shang Ring is a novel device for adult male circumcision, which has been shown to reduce HIV transmission by up to 64%. Compared with conventional surgery, the Shang Ring significantly reduces risk and procedure time for patients. Health professionals of all skill levels can also be trained to use the device, which is key in low-resource settings. Read more.

Alliance Launches HIV-related Stigma and Discrimination Website

A new website for the Stigma Action Network (SAN) is now live, offering a clearinghouse of information for experts working in HIV-related stigma and discrimination.

This network aims to support a global alliance of practitioners, researchers, advocates, people living with HIV, and donors by providing a one-stop shop for sharing and exchanging information about HIV stigma and discrimination.

The SAN steering committee includes EngenderHealth, Colectivo Sol, Futures Group, The Communication Hub and the International HIV/AIDS Alliance Africa Regional Programme.

Read more.

The Smile of a Healthy Mother

Rashida Begum, 32, experienced severe bleeding after each of her five deliveries, which left her weak and in need of costly medical attention. But after learning from an EngenderHealth-trained health worker about misoprostol, an inexpensive drug that is used to stop postpartum hemorrhage, Rashida safely delivered twin babies and was healthy and strong enough to care for her newborns. Read Rashida’s story.

Approved Budget Cuts Repro Health Funding, Excludes Global Gag Rule

April 19, 2011 – Following months of intense debate, Congress passed a budget (H.R.1473) on April 14 to fund the government for the rest of fiscal year 2011. While it excludes some of the more extreme policy riders proposed by the House, it still includes cuts to sexual and reproductive health programs. Below are select health highlights from the bill:

- $615 million for international family planning and reproductive health programs, which represents a 5% reduction from FY 2010 levels of $648.5 million. The $615 million includes $575 million for bilateral family planning programs provided through the U.S. Agency for International Development.

- $40 million contribution to the UN Population Fund (UNFPA), which is $15 million lower than FY 2010 and reverts back to FY 2008 spending levels.

- Maintains funding for Title X family planning programs in the United States and for domestic teenage pregnancy prevention programs that House lawmakers sought to cut.

- Excludes policy riders such as the Global Gag Rule and a ban on U.S. contributions to the UNFPA that House lawmakers also proposed to include.

Overall, the measure reduces spending by $38.5 billion from FY 2010 levels and represents the largest non-defense reduction in history. The bill passed in the House (260-167) and in the Senate (91-19).

Thank you for your support in writing Congress and spreading the word over the last few months, which helped avert some of the most devastating cuts to women’s health sought by House lawmakers.

World Health Organization: Significant Decline in Deaths from Unsafe Abortion

Significantly fewer women are dying from unsafe abortion today, a sign that interventions to improve postabortion care are effective and save lives, according to a new report from the World Health Organization.

Between 2003 and 2008, deaths related to unsafe abortion fell about 16% globally-from 56,000 to 47,000-despite an overall increase in the number of unsafe abortions. Today, complications from unsafe abortion account for 13% of all maternal deaths. The vast majority of women dying from unsafe abortions are in the least developed countries, including parts of Sub-Saharan Africa. More than one-third of these deaths happen in countries with stringent abortion laws or where women have limited or no access to contraception.

One of those countries is Tanzania, where complications from abortion are a leading cause of maternal death. Through the ACQUIRE Tanzania Project (ATP), EngenderHealth has partnered with the Tanzanian government since 2004 to improve availability of services for comprehensive postabortion care (cPAC) in rural areas. Previously, these services were only available at regional hospitals, which were too far away for many women to receive timely emergency care.

Together with the Tanzanian Ministry of Health and Social Welfare, EngenderHealth's ATP is decentralizing cPAC services so that medical personnel at local health facilities are trained to treat complications from unsafe abortion. ATP also works with community leaders to reduce the stigma around abortion, which is illegal in Tanzania, so that community leaders can spread information about the availability of both cPAC and family planning services.

In addition to cPAC, ATP is expanding access to family planning nationwide, which is key to reducing unplanned pregnancies and pregnancy-related deaths. Indeed, between 2004 and 2009, maternal deaths in Tanzania dropped to 454 deaths per 100,000 live births (from 578 deaths per 100,000 in 2004), according to the 2010 Tanzania Demographic and Health Survey.

Lawmakers Take New Steps to Prevent and Treat Obstetric Fistula

Congressional leaders are taking a new step toward ending obstetric fistula by introducing “The Fistula Prevention, Treatment, Hope and Dignity Restoration Act” (H.R. 949). Leading global advocates applaud this legislation, introduced on International Women’s Day (March 8), which will support the variety of interventions needed to effectively treat and prevent this condition.

The bill was introduced by Rep. Carolyn Maloney (D-NY), together with Tammy Baldwin (D-WI), Mazie Hirono (D-HI), Gwen Moore (D-WI), and Pete Stark (D-CA).

Read a March 10 joint statement from EngenderHealth, the International Women’s Health Coalition, and the United Methodist Church.

"The Best Investment in Global Women's Health"

On March 8, 2011, as part of our larger effort to mark the 100th anniversary of International Women's Day, EngenderHealth President Pamela W. Barnes and Global Health Council President Jeffrey Sturchio addressed “The Best Investment in Global Women’s Health" at The Huffington Post.

Significant Drop in Maternal Mortality in Bangladesh

A new health survey reveals a stunning 40% drop in maternal mortality in Bangladesh in less than a decade—from 322 deaths per 100,000 live births in 2001 to 194 deaths per 100,000 in 2010. This progress is due to a number of factors, including improved access to obstetric care and complications, more women giving birth in a hospital, and greater use of family planning. These encouraging numbers put Bangladesh on track to achieve Millennium Development Goal No. 5 by 2015.

EngenderHealth has been part of this positive change. In 2001, more than half of all maternal deaths resulted from complications such as postpartum hemorrhage and eclampsia. Since 2008, EngenderHealth’s Mayer Hashi project has piloted a successful program to distribute misoprostol to pregnant women to prevent postpartum hemorrhage when they give birth at home. The program has also promoted active management of the third stage of labor at health care facilities. The survey shows a 35% drop in deaths from bleeding and a 50% drop for deaths from eclampsia.

Congress Debates FY 2011 Spending Bill; Fate of Critical Reproductive Health Programs

The U.S. Senate is considering a spending bill that would fund the federal government for the remainder of FY 2011. At stake is funding for international family planning programs and Title X, the only federal program dedicated to domestic family planning and reproductive health. The House version of the bill, which was passed on February 19, proposed an unprecedented $60 billion in spending cuts, including potentially detrimental impacts for reproductive health. The bill seeks to:

• Cut by 39% President Obama’s FY 2011 request for bilateral international family planning and reproductive health funding, from $716 million to $440 million. This represents a $208.5 million reduction from current levels.
• Reinstate the Global Gag Rule, which prohibits any overseas organization receiving U.S. aid from having anything to do with abortion. When it was instituted in the past, the Global Gag Rule had detrimental consequences for the health and lives of women and their families, by creating more barriers to critical health services such as family planning, obstetric care, HIV testing, and malaria treatment.
• Prohibit U.S. contributions to the United Nations Population Fund, an international development agency dedicated to promoting reproductive health and rights.
• Completely eliminate funding for Title X, a $317 million program signed into law in 1970 to cover family planning and reproductive health for low-income women in the United States. It is the only federal program dedicated to this end. Sign our action alert today and ask your senators to protect Title X funding.
• Bar Planned Parenthood from receiving any federal funding for any purpose.

The proposal by Rep. Rob Latta to eliminate international family planning funding was not considered as part of the House bill, which is good news. The potential cuts, however, to the U.S. Department of Health and Human Services Teen Pregnancy Prevention programs were included in the final, approved version.

Despite these challenges to sexual and reproductive health in the current spending bill, President Obama’s proposed budget for FY 2012 increases funding for development and global health. Unveiled last month, the budget proposal reflects the global development strategy announced last year. In the proposal, the Global Health Initiative received $8.7 billion, an 11% increase from the previous year. Development assistance also rose from $2.5 billion to $2.9 billion.

We will continue to keep you informed with policy updates as we receive them. We appreciate your support and action.

Fistula Blog Series Features EngenderHealth Articles

EngenderHealth co-launched a special blog series that seeks to bolster efforts to increase U.S. international support for obstetric fistula. At RH Reality Check, the series features articles by EngenderHealth experts Karen Beattie, Joseph Ruminjo, and Moustapha Diallo.