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.