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.

A Safe Haven for Fistula Survivors in Ethiopia

For more than 30 years, the Hamlin Hospital in Ethiopia, formerly the Addis Ababa Fistula Hospital, has provided free surgical repair procedures for tens of thousands of women living with obstetric fistula.

On February 10, the hospital’s cofounder, Dr. Catherine Hamlin, and CEO Marc Bennett visited EngenderHealth’s headquarters in New York to present the history and philosophy behind this singular institution. They met with EngenderHealth’s Fistula Care team to discuss collaboration on improving fistula treatment and prevention in Ethiopia. With support from USAID, Fistula Care works there to prevent fistula and provide Ethiopian women with pre-hospitalization care, postoperative care, and referral to three regional centers of the Hamlin Hospital.

In his presentation, “Moving From Treatment to Prevention,” Bennett offered a glimpse into the half century of fistula care in Ethiopia that has developed under the joint vision of Dr. Hamlin and her late husband, Reginald. Although the couple first traveled to Ethiopia in 1959 with the intent of training midwives, they were moved by the plight of fistula survivors and refocused their work on treating and rehabilitating Ethiopian women with fistula and preventing fistula from occurring during childbirth.

A specialized hospital

By 1974, the couple had established the Hamlin Hospital. Today, that hospital and the five regional hospitals they have also established, offer free fistula repair for more than 2,500 women each year. To date, more than 30,000 women have been treated, with a success rate exceeding 90%. The hospital also provides rehabilitation services to help women reintegrate into society.

“Dr. Hamlin’s vision and commitment to Ethiopian women is truly inspiring,” said Karen Beattie, director of the EngenderHealth-led Fistula Care project. “Sharing the successes and challenges of Hamlin Fistula International, together with Fistula Care, is vital for advancing the field of fistula treatment and prevention.”

Elsewhere, the Fistula Care project and others are supporting an integrated approach to fistula treatment and prevention by enhancing existing facilities, training local surgeons and health workers to provide quality care, increasing timely access to medical care, and engaging communities to change social norms and encourage families and expectant mothers to seek skilled care during pregnancy and labor.

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.