For the past few weeks, a group of 70 men and women gathered in a Livingstone conference center to bring an end to maternal mortality, starting with bending tradition. The men of the group knew they would be skirting the taboo when talking sex in public, but few expected to be conducting business in a chitenge, the traditional wrap skirt worn by Zambian women, and playing female roles in health-themed dramas. It’s all meant to get these community leaders out of their comfort zone in preparation for addressing the traditional practices which put mother and baby at risk.
Zambia is a country of approximately 12 million, most living on a dollar per day. The average woman has six pregnancies, with one mother dying in every 200 births. Four of the country’s districts are part of a US government initiative to reduce maternal death by 50 percent in 12 months. It is a joint effort between the Zambian government, multilateral organization, and nongovernmental organizations, with many programs in place to meet this goal. One of these programs is training community leaders to prepare families to seek local clinics or trained health care workers, both when problems arise and for preventative care.
These community leaders come from the local health care facilities. The training focuses less on clinical techniques and more on facilitating community meetings, transferring the knowhow of trained health workers to the community, and addressing dangerous traditional practices with sensitivity. The curriculum includes 12 meeting topics on maternal and child health, but the aim is for leaders to build on the initial framework and choose what issues need to be discussed locally.
As a trainee, each community leader must conduct a full meeting in front of their peers. Each meeting is meant to create a dialogue on common problems for Zambians, such as a child being born too small. The leader asks participants what actions they take in each scenario. Their answers are most likely to run the gambit from safe to unsafe; many of the latter are based on tradition, such as the potentially harmful practice of dunking small newborns in cold water.
The leader then shares what a trained health worker does in the same scenario, showing pictures and acting out demonstrations. Some of these actions will be the same and the community is encouraged to keep up those healthy behaviors. Other ideas will be new and the community is encouraged to adopt these simple practices. Lastly, the leader must address where the community differs with the trained health care worker and tackle the unsafe practices. While these traditional practices have a local foothold, there are likely members of the audience who have seen such cultural remedies lead to death. It’s the meeting leader’s goal to have the community agree to follow their guidelines, seek a trained health worker when needed, and eliminate, modify or save traditional practices as a last resort.
The program has already seen results from previously trained districts; clinics reported an increase in births at health facilities and overall clinic attendance. In addition, raising the issue of maternal health has mobilized communities to build shelters for expectant mothers who must travel long distances to deliver.
Myth #1 Marriage before the age of 18 is natural, even American girls marry young.
Unlike their American counterparts who may choose to marry before 18, sixty million girls around the world are forced into marriage. The decision to marry is often made by her parents or the community under economic, cultural or social pressure. Child marriage is a violation of human rights and holds serious consequences for the health and education of both the girl and her community.
Myth #2 Early marriage can prevent HIV/AIDS and violence.
The opposite is generally true – child marriage increases the risk of contracting HIV and violence. Men who marry young girls are likely to have been sexually active prior to the wedding, and may continue to have partners outside of the marriage, while having unprotected sex with his young bride. In developing countries, most sexually active adolescent girls are married, and have higher rates of HIV infection than sexually active girls who are not married. For example, in Kenya the Population Council found 33 percent of married girls aged 15 to 19 were HIV positive, compared to 22.3 percent of their sexually active, unmarried peers. According to CARE, these girls are also twice as likely to be victims of threats or beatings by their husbands compared to girls who marry later in life.
Myth #3 Marriage provides opportunities for young girls whose family can’t provide for them.
Many well-intentioned parents arrange child marriages for a better life for their daughters; however, the consequences are often diminished opportunities. Child brides often stop going to school, resulting in limited opportunities and income-earning potential later in life. Furthermore, child marriage has grave health consequences for both the young women and their children. Child brides are more likely than those married as adults to report early, frequent, and unplanned pregnancies increasing the risk of maternal and infant morbidity and mortality. Young mothers are more likely to experience pregnancy complications and fistula, a hole between the birth passage and one or more internal organs causing inability to control their urine and bowel movements. A girl suffering from fistula is often abandoned by her husband and community, and left to die. In fact, complications associated with pregnancy and childbirth are a leading cause of death for girls aged 15 to 19. The chance of dying in pregnancy or childbirth for girls married at or before age 14 is five times that of those aged 20 to 24. Child brides are more likely to have children with low birth weight, inadequate nutrition and anemia.
Help Stop Child Marriage
Although laws forbidding early marriage exist in most countries, much effort is still needed to ensure enforcement of such laws. The International Protecting Girls by Preventing Child Marriage Act would help young women access health services and family planning programs as well as create effective youth programs to educate and empower youth on reproductive health and rights.
Contact your representative to help pass the International Protecting Girls by Preventing Child Marriage Act and end this human rights abuse now!
The previous post, entitled “Men can be the Answer”, explored the need for men to become advocates for reproductive health, so it seems appropriate with Mother’s Day approaching to discuss the impact women can make for maternal health.
Save the Children’s recently released State of the World’s Mothers 2010 index measures the survival rate of mother and child in 160 countries, furthermore it shows the many ways women working on the frontlines of health care are saving lives.
Every year the world’s mothers loose 9 million babies and children before reaching the age of five. Nearly 350,000 women die due to pregnancy or childbirth complications.
A woman living in the developing world is more likely to give birth at home without medical attention and must be given permission by a male or elder decision maker to seek care or treatment or to even leave the home. Save the Children found that having health care providers who were women increased the likelihood that a woman might access care. It is estimated having a skilled birth attendant would save 74 percent of women’s lives.
The hope is to have women health workers to come from and live in the community where they work. There are critically too few female health workers, especially in rural areas.
This is a difficult position to fill because of the state of girls’ education. According to the report, 39 million girls have never attended school while millions more complete only a year or two of education. An equally distressing hardship being faced is the perceived widespread violence and sexual harassment of female health workers.
The clear solution is investing in education for girls. Successful programs around the globe are showing how women health workers can make a big impact with only a few years of education, yet across the board schooling for girls will empower future mothers. Studies show, more education leads to smaller, healthier families.
A good example is in India, where not health care providers but respected, knowledgeable women of the community organized monthly women’s meeting to discuss pregnancy and child care issues. Within three years the newborn mortality rate dropped dramatically and healthy practices increased.
See why Norway was ranked first, the United States came in at 28 and Afghanistan was last by reading the report.
In reducing the spread of HIV/AIDS several organizations are coming to the same conclusion: educating only women about safe-sex isn’t the answer when women are often powerless in the making decisions about sex. For the cycle to change, men have to become involved.
The leading national Latino AIDS organization, The Latino Commission on AIDS, recently released a report on the state of New York’s response to the HIV/AIDS crisis in the Latino community. Latinos in New York represent 16 percent of the population, but account for 30 percent of people living with HIV/AIDS. Gender inequalities and oppression have caused an even more disproportionate amount of Latina women to be infected. Latinas make up nearly a third of HIV prevalence in New York City compared to only 8 percent of white women.
In a 2009 study based in the country of Puerto Rico, HIV researchers found that educating women about safe-sex fails to consider the dynamics of gender roles. These roles include sexual norms that are explicit in the Latino culture. Historically, machismo upholds hyper sexuality, power, authority and virility. On the other hand, Latinas live by marianismo, encouraging chastity, submission, inferiority, obedience and purity.
Men in the study had sex with multiple partners to prove their sexuality and were opposed to condom use because sex isn’t “real sex” without penetration and that condoms block spontaneity or sensation. Women in the study were not willing to discuses sex with their partner because of social taboos, fear of a negative or violent response, or being accused of infidelity.
The study found the responsibility of using protection was placed on the women, while the culture facilitates a dependence and deference to men. But, there were some positive gender roles that could play an important part in getting men to advocate for safe-sex.
Most importantly, the study found men more willing to use condoms by appealing to their role as provider and protector and that safe-sex practice increased their assertiveness and confidence in continuing the practice.
A good example of working with men to promote gender equality and safe-sex is the long running program established by EngenderHealth. In South Africa, the Men As Partners program holds workshops on what it means to be a man. Participants are asked to challenge long held beliefs on gender roles and compare the oppression of apartheid – which the men can relate to – to the sexism women face today.
EngenderHealth has developed the Men As Partners program in more than 15 countries in Africa, Asia, Latin America and the United States.
The hope is that programs such as these will get advocates in the field to move on from focusing on women-only safe-sex education to asking how to identify and work beyond traditional gender roles in the whole community.
In rural Central America women are dying. Before becoming wives, mothers or grandmothers, they are dying because poverty, inequality and geography are keeping them from education, care, and treatment. They are dying largely from preventable and treatable diseases such as cervical cancer.
These women are only part of the more than 500,000 maternal deaths every year, and millions more who suffer from preventable disabilities because they cannot access the services they deserve.
Ashoka and the Maternal Health Task Force are trying to change this injustice through a competition of innovative maternal health projects that transform the field of maternal health globally.
One of these projects comes from a group of Rice University undergrads who are working to end the cycle of maternal death and disability with only a pack on their back. What is so innovative about the OB-GYN Lab in a Backpack is they are taking the age-old concept of the house call and updating it with a solar-powered pack of medical supplies bringing rural women access to health care for the first time.
In 2008, the students who designed the pack were recognized by the Clinton Global Initiative and awarded a grant to refine and produce more of the packs. In the words of President Clinton, “The potential of this to save lives is really quite staggering.”
Today the packs come with tests specific to the community’s needs, such as pregnancy, HIV or syphilis. In 2009, the pack provided care for an estimated 500 women in Ecuador, Nicaragua and Guatemala. The organization is competing to continue and expand efforts in Guatemala.
In Guatemala, only 67 percent of women have received a Pap smear and, in rural areas, the amount is only 58 percent. The backpack provides health care providers with the appropriate tools to reach these women, screen for cervical cancer and provide reproductive health services and treatment.
The plan is to have packs for maternal, dental and eye care manufactured in-country within three years—bringing health to vulnerable women and girls no matter where they are.
Read the original post at http://ashleyarnold.net/healthygirlsblog/ob-gyn-in-a-backpack/. Check out other solutions for improving maternal health or to participate in the global call to solutions, please visit Healthy Mothers, Strong World: The Next Generation of Ideas for Maternal Health. www.changemakers.com/maternalhealth.
This Earth Day is an important time to reflect on not only climate change, but its effects—including poverty and disease. According to USAID, it is anticipated that the world’s population will increase by 50 percent by 2050; 99 percent of this growth will take place in developing countries, and more than 90 percent of the growth comprises the poorest individuals of these countries.
Organizations such as Population Services International (PSI) are champions in combating the effects of climate change preventing HIV, unintended pregnancies and death from malaria and diarrhea.
Watch Anna Kournikova, former tennis star and PSI Ambassador, as she visits Haiti as part of a public-awareness campaign.
10 Population Health Facts
- Between 1995 and 2005 alone, the urban population of developing countries grew an average of 1.2 million people per week or around 165,000 people per day.
- Evidence from 47 countries on child health outcomes shows higher socioeconomic inequality in urban areas compared to rural areas.
- One in three urban dwellers or 1 billion people worldwide lives in slums.
- Around 32 percent of urban residents in developing regions lack improved sanitation. Globally, it is estimated that 3 percent of all deaths and most diarrheal disease are attributable to the lack of improved drinking water sources, sanitation, and adequate hygiene.
- About 25 percent of city dwellers in developing countries and 70 percent in least developed countries use solid fuels for heating and cooking, causing indoor pollution. This greatly increases the risks of respiratory disease, especially in children, and exacerbates outdoor air pollution.
- Tuberculosis (TB) incidence is much higher in big cities. In New York City, TB incidence is four times the national average. Incidence of TB in some parts of London is as high or higher than in China. The situation is no different in resource-poor countries: 45 percent of TB cases in Guinea live in Conakry; 83 percent of TB cases in the Democratic Republic of the Congo live in cities.
- Developing country cities are particularly vulnerable to health hazards from climate change. In particular, the coastal location of many major cities makes populations more vulnerable to extreme weather and rising sea levels. Heat waves also place cities at risk of the “heat island’ effect, where temperatures may be as much as 41°-52° F (5-11° C) warmer than surrounding rural areas due to dense urban geography and energy sources.
- Prevalence of HIV in generalized epidemics is generally higher in urban areas; population-based household surveys indicate that prevalence is 1.7 times higher in urban than in rural areas.
- The rapid growth of cities has increased the visibility of unequal access to skilled care at birth and to emergency care for urban women.
Source: Knowledge Network on Urban Settings report, the WHO Commission on Social Determinants of Health