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).