Teaming Up for Respectful Maternity Care

Pregnancy and childbirth are momentous events in the lives of women and families everywhere. But too often, a woman's experience with her health care providers results in lasting damage and emotional trauma, rather than comfort and trust.

This is why EngenderHealth is partnering with the White Ribbon Alliance to promote Respectful Maternity Care, a campaign to raise awareness of the disrespectful treatment that many women experience in seeking and receiving maternity care.

To learn more, read our guest blog on the White Ribbon Alliance website.

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.

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!

Save the Date: Accelerating Equality for Women and Girls Around the World

If you live in the New York City area, please join us on Thursday, December 3, for this important event. "Accelerating Equality for Women and Girls around the World: A Conversation with Media, Activists, Entrereneurs, and You" will include:

• Nicholas Kristof and Sheryl WuDunn, authors of Half the Sky
• Taina Bien-Aime, Equality Now
• Bill Drayton, Ashoka
• Ana Langer, EngenderHealth

The event will be moderated by Maria Hinojosa, Senior Correspondent, NOW on PBS.

This event is free and open to all, but space is limited. To attend, you must RSVP to rsvp@engenderhealth.org. For more information, read the online invitation, or call 212-561-8456.

Inspired by Half the Sky? Check out our new Reader's Companion!

Inspired by Half the Sky? EngenderHealth’s online Reader's Companion to Nicholas Kristof and Sheryl WuDunn’s best-selling book will deepen your understanding of women's health and rights and the change that is happening around the world, every minute, every day. Hear the voices of those working on the front lines of global health and development, and of the women and men who are beating impossible odds and improving lives in their communities.

EngenderHealth is named in Half the Sky as an organization doing important work to support women in developing countries. Chapter-by-chapter, the Companion offers diverse perspectives, interviews, facts, and stories that expand on the topics in the book, drawing on EngenderHealth's expertise and program experiences around the world.

Learn more about what you can do to turn oppression into opportunity for women and girls everywhere!

Live from MenEngage Rio: How the Privileges of Patriarchy Can Work Against Men

Posted by Eric Ramírez-Ferrero

On day four of the conference, the workshop that clearly stood out for me was, “Gender and Masculinity in Post-Conflict Settings.” In it, we examined experiences of men in war-torn societies, including post-genocide Rwanda, northern Uganda and eastern Congo, East Timor and Gaza.

One speaker used an interesting phrase, “gender against men,” to describe how strict notions of manhood are a liability to those men who fall outside of the limits it sets, men who don’t live up to the expectations inherent in “being a man.”

In post-conflict settings, such men might include those who have been the victims of sexual violence. The speaker from Uganda showed a moving video documenting the experience of one Congolese man (his identity was protected) who candidly described the horror of being held prisoner by the forces fighting in eastern Congo: Over a period of days, he was repeatedly gang-raped by soldiers. Though the physical trauma was beyond daunting, this man also knew that his perpetrators’ intention was to humiliate him, to diminish him, to demonstrate their power over him by putting him “in his place”—as a “woman.”

This sounded disturbingly familiar. We know that, ultimately, rape is about power, even when both the perpetrator and victim are men. As an anthropologist, I also found it fascinating how gender definitions are used to make sense of those who have power and those who don’t. It’s not merely academic - it plays out daily in the most devastating ways: In these and other post-conflict settings, men who aren’t willing to fight—to take up that traditionally “male” role –are feminized and subject to the same reign of terrors as women.

Unfortunately, the humiliation of male victims of sexual violence is further compounded when they seek counseling and care. The limited systems available (in this case United Nations missions) to support survivors of rape are closed to men. Indeed, support workers’ own definition of rape has excluded men as possible victims, and even those who did “get it” conceded that, “We have programs for women at-risk and for those who traumatized by sexual violence, but we have nothing for men.”

The same speaker explained that this is in part a result of what he called “patriarchal feminism” – a one-sided concept wherein only women are vulnerable. He went on to say that this is quite damaging for women, too, because it limits them to the role of victims rather than as agents of change. He seemed to be saying that many efforts to promote women’s equality actually reinforce traditional visions of womanhood and manhood (thus the “patriarchy”).

I agree with the speaker that, inadvertently, some “empowerment” efforts may reinforce rather than change norms. But the term “patriarchal feminism” sounds like plain old patriarchy to me, because there is no doubt that pervasive and age-old ideals of what women and men should be and do really DO oppress women! Yet this workshop made clear that we all need to be more conscientious of and concerned by how the meanings of “manhood” affect men, too. Clearly, they continue to benefit men in power, but they render other men even more vulnerable and sometimes invisible—and in the worst cases, beyond the safety net of services and support.

If I Had a Billion Dollars...

(This post by Dr. Isaiah Ndong, M.D., M.P.H., is Vice President for Programs at EngenderHealth, recently appeared on Reproductive Health Reality Check.)

If I had a billion dollars, I know exactly how I would spend it: improving women's access to family planning in the world's poorest communities.

Some might think this is an unusual choice. But throughout my 29-year career as a doctor and public health professional working in developing countries, I have seen first-hand how contraception can change women's lives-allowing them and their families to survive, thrive, and plan for better futures.

We need to remember - amidst daily reports about a troubled economy here in the United States - that many of those living on the other side of the world confront daily emergencies of their own: poverty, malnutrition, HIV and AIDS, lack of health care, civil strife, and depleted environmental resources.

There's no doubt that $1 billion is a lot of money. But for what amounts to just .03% of President Obama's proposed federal budget, a $1 billion investment in family planning can help mitigate all of these challenges at once.

Family planning as a global health and development priority does not get the attention it deserves, particularly the direct connection between population and poverty. The chances that you can achieve a better life for your family are diminished when you are struggling just to feed and support your children. But with smaller families, parents can afford more for each child-providing better food, shelter, education, and health care-and can save more. This greatly improves their chances of breaking the cycle of poverty.

With better access to family planning come opportunities to improve social, political, and environmental conditions. When women and couples can decide when to have children, their opportunities outside the home can also expand, and they may contribute more to their communities socially and economically. There is less competition for food, jobs, and housing and more equitable and less harmful use of natural resources. For families in rural areas, this could reduce the need to seek a better life in urban areas, where the daily influx of new migrants strains already limited infrastructure.

Yet right now, millions of women and couples who wish to limit or space their births have no way to access the contraception that would let them do so. Over the last several years, U.S. support for family planning programs has dwindled while the need for it has increased, and few donors have stepped in to fill this gap. So a good portion of a $1 billion investment is needed just to rebuild these programs to the levels they were at several years ago. And across Africa and Asia, high levels of unmet need for contraception are likely to only grow as the largest youth generation in the world's history comes of reproductive age.

These are all compelling reasons to support family planning, but the bottom line for me is that it is a right, and not having access to it is a price paid in women's lives. Maternal mortality continues to devastate families - with more than 500,000 women dying during pregnancy or childbirth every year. Up to one-third of these deaths could be prevented if women had access to contraception. And, family planning reduces deaths from AIDS; it is the most effective way of preventing mother-to-child transmission of HIV.

the coming weeks, President Obama will be making allocations for the fiscal year 2010 federal budget. Please join me in calling on him to raise the United States commitment to international family planning programs to $1 billion in 2010-less than a penny per day per American.

It's sure to be one of our wisest investments.

Visit www.3for1.org or www.engenderhealth.org to send President Obama a letter and join our campaign.

Ten Thousand Women with Fistula Receive Life-Changing Surgery

Dear colleagues and friends,

EngenderHealth and the U.S. Agency for International Development (USAID) today celebrate a milestone in global maternal health: A total of 10,000 women have received fistula repair surgery with U.S. support since 2005. Fistula, a devastating childbirth injury affecting millions of women in developing countries, can be surgically repaired up to 90% of the time, but most of those with the condition lack access to a skilled surgeon or health center, making treatment out of reach.

Four years ago, USAID launched a global effort to both treat and prevent fistula. To date, through initiatives such as the EngenderHealth-led Fistula Care Project, and in collaboration with local governments, regional health care organizations, and faith-based organizations, medical teams in 12 countries and 25 health facilities across Africa and Asia have been trained and equipped to provide surgery for fistula.

It is these trained medical professionals, as well as their supporting institutions, whose dedication has made it possible for 10,000 women to regain dignity and hope through fistula repair surgery. We honor the tireless efforts of the surgical teams as we mark this maternal health milestone.

Obstetric fistula is an injury caused by prolonged obstructed labor, when the head of the baby cannot pass safely through the woman's birth canal. The baby often dies as a result, and the woman is left with an abnormal opening in the birth canal and chronic incontinence. If left untreated, fistula can lead to skin ulcerations and infections, kidney disease, social isolation, and even death.

The hopeful part of the story is that in addition to most cases being reparable, fistula is almost entirely preventable. This is why the Fistula Care Project is working to improve access to emergency obstetric care and cesarean section for women who develop complications during delivery. Together with skilled attendance at all births and the availability of voluntary family planning, this could make fistula as rare in the developing world as it is in the industrialized world. The Fistula Care Project is working to engage all levels of society to raise awareness about fistula and its underlying causes, including early pregnancy, poverty, and a lack of education and empowerment for women and girls.

As the largest USAID-supported effort to both treat and prevent fistula, the Fistula Care Project will keep you apprised of our work to transform the lives of thousands more women and girls around the world--work that is possible thanks to your partnership. To learn more, please visit our web site at www.fistulacare.org.



Gratefully yours,

Karen J. Beattie
Project Director
Fistula Care Project





The Fistula Care Project is a five-year cooperative agreement funded by USAID and managed by EngenderHealth. The project works to address the enormous backlog of women awaiting life-altering fistula repair, ensuring that they receive timely and quality care from trained providers. At the same time, it works to remove barriers to emergency obstetric care that lead to fistula in the first place, so that women in labor get to the right place with the right services at the right time. The project is supporting a network of facilities offering a continuum of services, from emergency obstetric care, referrals, and family planning to complex fistula repairs and advanced surgical training. Visit www.fistulacare.org for more information or contact fistulacare@engenderhealth.org.

The American people, through USAID, have provided economic and humanitarian assistance worldwide for nearly 50 years. For more information about USAID and its programs, visit www.usaid.gov.

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.