First Lady of Tanzania Visits EngenderHealth-Supported Clinic

In November 2009, the First Lady of Tanzania, Mama Salma Kikwete, visited Madaba Health Centre, a facility in the Ruvuma Region in southwestern Tanzania that is supported by EngenderHealth and that serves 50,000 people. The First Lady was there as part of a national campaign to reduce maternal and neonatal mortality, and she spoke about the importance of avoiding early pregnancy, improving maternal health care, and openly discussing HIV and preventing its spread.

EngenderHealth, through a U.S. Agency for International Development–supported ACQUIRE Project Associate Award, is helping to equip facilities in the Ruvuma Region with obstetric wards and is improving the quality and use of family planning services by training health care staff, strengthening supervisors’ skills, and raising awareness in communities. Over the past year, more than 400 clients received long-acting or permanent methods of contraception at Madaba, and nearly 9,000 clients received these methods in the region overall. EngenderHealth, through funding from the President’s Emergency Plan for AIDS Relief (PEPFAR), also trains health care professionals to provide counseling and testing for HIV and AIDS, other reproductive health services, and life-skills coaching to youth.

Last year, EngenderHealth assisted 38 facilities throughout Tanzania in improving the quality of their maternal health and family planning services.

Learn more about EngenderHealth’s work in Tanzania.

Spotlight on Ghana: President Obama Visits EngenderHealth Training Site

Richard Killian, Chief of Party for Quality Health Partners (managed by EngenderHealth) sits with colleagues at an information booth during President and Mrs. Obama’s visit to La General Hospital.

President Obama greets Richard Killian and other EngenderHealth staff at the information booth.

During his visit to Ghana, President Obama traveled to La General Hospital in Accra, where EngenderHealth trains health providers from across the country to provide high-quality family planning services. While at the hospital, the President and the First Lady stopped by an information booth, met a few of our staff who spoke about the importance of family planning, and learned more about our programs across the country.

EngenderHealth has worked in Ghana for more than 20 years to expand contraceptive use, improve health outcomes, and make lasting positive changes in the Ghanaian public health system. Currently, EngenderHealth collaborates with the local government to reduce maternal deaths, by ensuring that clients can prevent unwanted pregnancies and can choose from a wide range of family planning services, including long-acting and permanent methods. Other initiatives include expanding prevention and treatment services for HIV and reducing related stigma. Indeed, we work with all levels of the health system—from doctors to midwives to policymakers—to improve the quality of health care.

During his visit, President Obama spoke passionately about the need to address poor maternal health. “Part of the reason this is so important is throughout Africa the rates of both infant mortality, but also maternal mortality, [are] still far too high—I mean by a factor of a multiple of 10s compared to many other parts of the world,” the President said. The kinds of programs that provide strong prenatal and maternal care, he said, “are very important.” President Obama’s comments, along with proposed funding increases in next year’s budget, signal his commitment to global maternal and child health, as well as to reproductive health and family planning.

Meeting several mothers and their babies at the clinic, President Obama noted, “This is the highlight of the trip.”

Read more information about EngenderHealth’s activities in Ghana.

Fragile, Threatened, and Still Urgently Needed: Family Planning Programs in Sub-Saharan Africa

EngenderHealth staff Dr. Roy Jacobstein, Lynn Bakamjian, John M. Pile, and Jane Wickstrom published a commentary on the fragility of family planning programs in Africa in the current issue of Studies in Family Planning.

Congress Moves to Boost Funding for Global Health Priorities

Recent actions in Congress show growing momentum and support for maternal and child health and family planning, with historic funding increases proposed by both the House of Representatives and the Senate. Equally significant, the Senate Appropriations Committee passed an amendment offered by Senator Frank R. Lautenberg (D-NJ) to legislatively eliminate the Global Gag Rule.

Both the House and Senate called for increased funding for global health in the foreign aid budget for fiscal year (FY) 2010. The House already passed a bill allocating $528 million for maternal and child programs and $648.5 million for family planning, an increase of $100 million for family planning over enacted levels in FY2009.

On the Senate side, a spending bill approved by the Senate Appropriations Committee now awaits a vote by the full Senate. It calls for $628.5 million for family planning and reproductive health programs—$83.5 million above the FY2009 level and $35 million above President Obama’s request. In addition, a total of $555 million for child survival and maternal health was allocated—$31.5 million above President Obama’s request and $60 million above the FY2009 level.

Senator Lautenberg’s amendment to the spending bill would stop the 25-year-long back-and-forth over the Global Gag Rule, with successive presidents instituting and then repealing the policy. Lautenberg proposed an amendment that would prevent a future president from reinstating the policy by executive order.

“It is time to end the dangerous and harmful Global Gag Rule permanently. Health care providers across the globe should be able to care for the health of women and families, without ideological obstacles blocking the way. This amendment will strengthen America’s position as an international leader for women’s rights,” said Lautenberg.

Both houses of Congress are on August recess, but when returning in September, the Senate will be taking up appropriations for foreign aid. Write your senators today and ask them to vote yes and show their support for these global health priorities.

Following the Senate vote, both the bills will go to conference, and the allocations will be finalized. EngenderHealth will keep you informed of new developments.

What is 3FOR1? Watch our new video, and join us.

Today, EngenderHealth is launching the 3FOR1 campaign urging President Obama and
Congress to commit $1 billion to international family planning programs
in 2010. We're asking you to join us.

Family planning is a basic right. Yet, there are an estimated 201
million women worldwide who want to use it, but can't--they do not have
access. Changing this reality through increased U.S. investment can
bring significant short- and long-term returns: When women and couples
are able to plan their families, they have the chance to have healthier
and better-educated children and more productive lives, which can lead
to more stable and economically strong communities and countries.

President Obama has stated that he wants to change the way the United
States is viewed around the world. One way to demonstrate this is to
commit to improving women's health and welfare through a stepped-up
investment in family planning.

Right now, the U.S. budget for international family planning is not much
higher than it was in 1974, when adjusted for inflation. To keep up with
the large and growing need for family planning, we call on the
President to increase the U.S. contribution to this global effort to
$1 billion. This represents less than one twentieth of 1% of the
proposed 2010 federal budget--less than a penny per day for every American.

Help us ensure international family planning and reproductive health are
top priorities for the U.S. government. Watch EngenderHealth's new video
and write a letter to President Obama calling for $1 billion to be
dedicated to international family planning.

Reproductive Health: Front and Center in Azerbaijan

A recent national conference organized by EngenderHealth demonstrates that reproductive health has become a top priority for the Azerbaijani government. On February 17–18, more than 100 policymakers, health care professionals, and other leaders attended the reproductive health quality improvement conference in Baku. Over the last four years, EngenderHealth has been partnering with the Azerbaijani government (through the ACQUIRE Project) to strengthen its reproductive health systems. The need for better health services is great: Like many former Soviet republics, abortion had been the main method of family planning in Azerbaijan, and contraceptive choice was severely limited.

	“This conference brings reproductive health and family planning issues to a new level among parliamentarians—89% of whom are men and think that reproductive health problems are women’s concerns.” –Malahat Hasanova, member of Parliament

Participants in the meeting included four members of the Azerbaijani Parliament, officials from the government’s Ministry of Health (at the national and regional levels), doctors, health care staff, medical school administrators, and representatives of partner organizations. The discussion centered on barriers to care, and the attendees developed an action plan to address these issues.

A centerpiece of the meeting was the government officials’ presentation of a draft of the country’s first reproductive health law, which ensures the right of all Azerbaijanis to high-quality reproductive health care and family planning.

Throughout the process of developing the law and leading up to this meeting, EngenderHealth has emphasized the importance of improving the quality of reproductive health care and family planning, upholding clients’ rights to safe and effective services, and ensuring informed choice and confidentiality. EngenderHealth staff also successfully advocated for the inclusion of contraceptives on the Essential Drug List and helped the government draft the section detailing the country’s contraceptive supply needs. Additionally, EngenderHealth shared its publications on Islam and family planning, its experience working in other Muslim countries, and its expertise in applying evidence-based quality improvement approaches like COPE®.

The Time to Lift the Global Gag Rule Is Now

By Isaiah Ndong, Vice President for Programs at EngenderHealth

Over the last eight years, the impact of the Global Gag Rule has been harshest in parts of the world most in need of better health services. The policy forbids any foreign organization receiving U.S. family planning aid from providing, referring to, or advocating for abortion services in their country—even with their own funds, and even if abortion is legal. Organizations that do not comply lose all U.S. support, including essential supplies of contraceptives.

I am a physician and was working with EngenderHealth in Ghana at the time that President Bush reinstated the policy during his first days in office. We felt the effects almost immediately, as the Global Gag Rule began to limit our reach as an organization. We could no longer work with local partners who put women’s health and the integrity of their medical staff above U.S. policy, even though they counted on us for support that made it possible for them to offer care in rural communities where no other health services were available.

In Ghana, not only were supplies of contraceptives cut in half, but clinics were forced to shut down or drastically reduce their family planning, maternal and child health, and HIV services. And there is no evidence that that this policy has reduced abortion. Indeed, unsafe abortion remains among the leading causes of maternal deaths.

So, while the Global Gag Rule was designed to reduce abortion, the policy’s domino effect has had negative effects on people’s lives in ways that have nothing to do with abortion. Because health clinics often offered integrated care, the loss in funding due to the Global Gag Rule has had dramatic consequences for services like immunizations for children, voluntary counseling and testing for HIV, and treatment for malaria. Throughout Africa, and in parts of Asia and Latin America, entire communities have seen their health care compromised by this policy.

But we are at a turning point. President-elect Obama has the opportunity to repeal the Global Gag Rule, and we must put pressure on him to do so. No doubt there are a number of priorities that he must address immediately (the economy, two ongoing wars), but getting rid of the gag will cost nothing. Rather, it will be a symbolic move saying that the United States cares about women’s health and rights and about the rural poor.

I was in Tanzania at the time of the U.S. election, and I felt a great sense of excitement and expectation. Visiting a clinic where EngenderHealth had worked before the Global Gag Rule was reinstated—a clinic that has faced years of dwindling support and difficult times—I found the few remaining staff exuding optimism.

“We believe that things will change now, that your president will understand how American policies directly affect us,” the chief doctor told me. She, like many others, hope—some even pray—that the Global Gag Rule will be lifted, that their funding and main source for contraceptive supplies will be renewed, and that they will no longer have to turn away people who walk miles to their clinic for care.

Indeed, as the United States reexamines its role in the world and the ways in which it can restore its image abroad, the value of eliminating the Global Gag Rule becomes very clear. In addition to affirming that the United States is committed to women’s health and rights, to global health and development, and to the principles of informed choice, the impact on “the street” would be significant. In rural communities across Africa, where the only clinic in an entire district may be one supported by the United States, people notice and are thankful.

To be sure, there is much more to be done to ensure that every woman has access to high-quality reproductive and maternal health care, and funding increases are needed. The simple fact is that U.S. support for overseas family planning is lower today than it was in the mid-1990s, even though demand is higher and rising every day. But first things first: I hope you will join me in calling on President-elect Obama to lift the Global Gag Rule during his first 100 days in office. Visit engenderhealth.org/globalgag to sign a petition asking for just that.

(This post also appeared on the Reproductive Health Reality Check blog.)

Raise Your Voice : End the Global Gag Rule

The Global Gag Rule has had terrible consequences for the health and lives of poor women and their families, in ways that have nothing to do with abortion. The Global Gag Rule has forced clinics to cut back on all sorts of health services, such as family planning, obstetric care, HIV testing, and malaria treatment.

Urge President-elect Obama to overturn the Global Gag Rule during his first 100 days. Watch the video, sign the petition, then spread the word.

Learn more about the Global Gag Rule.