Waiting Houses in Mozambique Aim to Decrease Maternal Mortality

Waiting houses, or Casas de Espera, as they are referred to in Mozambique, allow at-risk pregnant women to reside in a home near the local hospital in order to provide immediate care when labor begins. As many of Mozambique's citizens live in rural areas, far from a reliable hospital, these waiting houses are crucial to prevent pregnancy related complications and maternal death from occurring. The Mozambique government has recently decided to revamp its waiting house programme in order to combat maternal mortality and progress toward achieving MDG5.

At the African First Ladies Health Summit last week Maria de Luz Guebuza, the First Lady of Mozambique, explained how 75% of Mozambique's 128 districts now have waiting houses for mothers-to-be. By providing such accommodations, pregnant women are able to travel before their labor begins and remain in the vicinity of well trained professional health care workers, should a complication arise. Women in the community at risk for complicated deliveries, such as pre-eclampsia, history of cesarean section or severe bleeding, malpresentation, or cases of multiple births, are often advised to travel to a casas de espera anywhere from 2 to 4 weeks before their pregnancy. Once there, the women are often able to learn from midwifes on pregnancy-related topics such as development of the fetus, labour and delivery, breast-feeding, immunization and family planning. In some cases the women use their spare time to make crafts and dresses, in order to sell their products to the local community and generate funds for maintenance. Since most of these houses are free of charge, any extra revenue is especially helpful in maintaining the facilities.

Mozambique is not alone in providing such waiting houses. Many other countries throughout Africa and Asia have instituted similar programmes and are moving toward achieving MDG5. In 1987, a study was conducted in Zimbabwe that found that women who stayed in these antenatal accommodations experienced better pregnancy outcomes than those women who entered the hospital directly from the community. Since then, improvements have been made and the effectiveness of such a program is remarkable. In addition to maternal mortality decreasing, infant survival rates are also being positively affected.

It is crucial that governments provide funding for such initiatives and that South-South cooperation continues to be emphasized at international conferences, such as the African First Ladies Health Summit. By sharing the effectiveness of such a program with other regional leaders and policy makers, it is PPD's hope that maternal mortality can be significantly reduced in the next few years.

You can read about other country case studies at http://who.int/reproductive-health/publications/MSM_96_21/MSM_96_21.chap4.en.html

African First Ladies Health Summit Meets in Los Angeles

"You as First Ladies are powerful champions for the causes you support. Powerful role models, motivators and catalysts for action. Your work is formidable. If we can also harness the efforts of civil society and clinicians to support you, you will be unstoppable."

- Sarah Brown

On April 20th and 21st, 14 First Ladies from across Africa met in Los Angeles, California to discuss and publicize prominent health issues in Africa. Organized by U.S. Doctors for Africa (USDFA) and African Synergy, the two day summit focused on maternal health, malaria, gender inequalities in education, and HIV/AIDS related issues.

Although the meeting tackled a wide range of topics, the focus was unquestionably on women's health and the likelihood of achieving Millennium Development Goal #5, reducing maternal mortality by 75% by 2015. Sarah Brown, wife of British Prime Minister Gordon Brown, spoke at the event and emphasized the importance of maternal health care, stating that "a health system that works for mothers, works also for early infant care, for vaccinations, for infection control, for blood transfusions, for emergency surgery for every member of the community. Build for mothers and you build for everyone." The 14 First Ladies that met in L.A. emphasized the importance of South-South cooperation and finding answers to complicated African problems through dialogue. By sharing both their own countries policy and programmes, as well as holding one another accountable for achieving Millennium Development Goals, the First Ladies summit looks promising as a catalyst for action.

Los Angeles may seem an unlikely venue for a summit promoting African health, but the high celebrity turnout and the First Ladies fashion choices drew a horde of media attention and helped to spread the importance of addressing African health issues worldwide. Agreeing to strengthen their leadership roles in their respective nations and work with U.S. based health experts, the First Ladies departed with a commitment to launch new efforts in health care. USDFA Chairman, Ted Alemayhu explained how "empowering Africa's First Ladies is an innovative approach to bettering the lives of Millions of Africans." South-South cooperation and the pairing of African First Ladies with U.S. experts and organizations creates ongoing partnerships and the potential to achieve change.

You can read Sarah Brown's entire keynote address online, at http://www.huffingtonpost.com/sarah-brown/build-for-mothers-and-you_b_189527.html

Pictures from the First Ladies Health Summit can be viewed at http://www.huffingtonpost.com/sarah-brown/build-for-mothers-and-you_b_189527.html

http://www.unicef.org/specialsession/about/sgreport-pdf/09_MaternalMortality_D7341Insert_English.pdf provides more information on maternal mortality and progress toward achieving MDG5

Bongaarts and Sinding on International Family Planning Programs: Myths v. Facts

Bongaarts and Sinding (a "founding father" of PPD) published "A response to critics of family planning programs" in the recent issue of International Perspectives on Sexual and Reproductive Health.

In this article, the authors argue that funding for international family planning programs in developing countries has declined by 30% since the mid-1990s. Decisions by policymakers and donors to reduce investments in contraceptive services and supplies were based on plausible-sounding—but misguided—arguments. “Donor fatigue” and persistent opposition from conservative governments and institutions, in particular the Bush administration and the Vatican, contributed to this decline. Family planning programs were placed on the back burner as other pressing problems, such as the AIDS epidemic, rose in prominence.

Myth: Family planning programs have little or no effect on fertility.

Fact: Decades of research show that comprehensive family planning and reproductive health services lead to sharp rises in contraceptive use that help women avoid unwanted pregnancies. Over a thirty-year period (1960–1990), fertility declined in the developing world from more than six to fewer than four births per woman, and almost half of that decline—43%—is attributable to family planning programs.

Myth: Fertility declines are under way everywhere, so the population problem has largely been solved and family planning programs are no longer needed.

Fact: Population will keep growing even if fertility could immediately be reduced to the replacement level of 2.1 births per woman, because:

• Current birthrates still leave fertility above the level needed to bring about population stabilization.
• People live longer as higher standards of living, better nutrition, expanded health services, and greater investments in public health measures have reduced death rates, and further improvements are likely.
• The large number of young people entering their childbearing years will result in population growth for decades to come. For example, in sub-Saharan Africa, 43% of the total female population was younger than 15 years in 2005.

Myth: The death toll of the AIDS epidemic makes family planning undesirable and unnecessary.

Fact: Despite the substantial mortality from AIDS, UN projections for all developing regions predict further large population increases. Despite a severe epidemic in sub-Saharan Africa, the region’s population is expected to grow by at least one billion between 2005 and 2050. This is because the annual number of AIDS deaths (two million) is equivalent to just 10 days’ growth in the population of the developing world.

Myth: Family planning programs are not cost-effective.

Fact: The World Bank estimates the cost of family planning at $100 per life-year saved. This is of the same order of magnitude as other health interventions, such as basic sanitation for diarrheal disease, a short course of chemotherapy for tuberculosis, and condom distribution for HIV prevention. All these interventions, including those for family planning, are much more cost-effective than antiretroviral treatment of AIDS, which currently receives a large proportion of health-related development aid.

Myth: Family planning programs at best have made women the instruments of population control policies and, at worst, have been coercive.

Fact: Today, nearly all programs around the world respect the right of couples to make informed reproductive choices, free from undue persuasion or coercion. An important exception is China, however, where the one-child policy continues to violate reproductive rights standards.

Population growth and what to do about it has been the subject of controversy since the 1700s. Perhaps because at its most fundamental level the subject deals with sex, it has been a peculiarly incendiary topic of public policy debate. Yet much of today’s discussion about family planning programs, a principal instrument through which population policies have been implemented over the past 50 years, is based on faulty perceptions and misinformation. Large-scale national family planning programs have, for the most part, been remarkably successful.

Why does this matter? Because women and children continue to suffer and die as a consequence of unwanted and unintended childbearing. Beyond that are renewed concerns about a variety of environmental issues and about the security of nations and the stability of governments, as well as deepening worries about food security and pervasive poverty.

“In the face of declining political and financial commitment to family planning programs, we must address head-on the faulty criticisms that have held back efforts to satisfy the unmet demand for family planning services,” say Bongaarts and Sinding. “High fertility and rapid population growth remain real problems that merit our attention and action.”

Read the entire article online at: http://www.popcouncil.org/pdfs/JournalArticles/IPSRH_35_1.pdf

The journal International Perspectives on Sexual and Reproductive Health can be read online for free at: http://www.guttmacher.org/journals/toc/ipsrh3501toc.html

Film on Abortion in Ethiopia: Not Yet Rain

In 2004, Ethiopia enacted one of the most progressive abortion laws in Africa. A woman may now seek an abortion if her life or health is threatened. Abortion is also permitted in cases of rape, incest, fetal impairment, or if the woman is a minor or physically or mentally injured or disabled. Before 2004, abortion abortion was permitted only to save a woman’s life and protect her health and in cases of rape.

However, many women still continue to perform self-induced abortions for multiple reasons: the stigma of sex outside of marriage, the cost of abortion, an inability to travel to safe clinics, and late term abortion restrictions. The new film Not Yet Rain examines the topic of abortion in Ethiopia through the voices of women who have faced the challenge of accessing safe abortion care within their communities.

Each year, 68,000 women around the world die from unsafe abortions. After hearing some of the techniques described in the twenty-three minute documentary Not Yet Rain, this comes as no surprise. One woman describes how a catheter and an umbrella were used to terminate her daughter's pregnancy, ultimately resulting in her death. Others resort to using sticks, plastic objects, and roots to attempt self-induced abortions. Whatever the reason behind being unable to access safe abortion services, the decision to turn to self-remedies is an extremely unsafe option, and it is vital that education is improved in the most remote communities, in order to ensure that women know their options and rights.

As a result of Ethiopia's revised law and 2006 guidelines for safe abortion services, abortion services are some of the safest in all of Africa. At a clinic in the documentary, the midwife/nurse explains that abortion services are now free, allowing women of all economic levels to receive proper care. Furthermore, the use of a manual vacuum aspirator (MVA) to perform the procedure is extremely safe and does not require the use of anesthesia, thus allowing clinics in the poorest and more remote areas of the community to provide such services. Regardless, the system is still full of problems. Due to a lack of education about reproductive health in Ethiopia, late term abortions are still one of the biggest factors leading to self inducement or use of traditional medicines.

Unintended pregnancy is a root cause of induced abortion and maternal mortality. An estimated 108 million married women in developing countries have an unmet need for contraception. Thus, meeting the need for contraception is a critical step toward reducing the incidence of unintended pregnancy.

In light of the mandates of intergovernmental agreements (ICPD, MDGs, Maputo) the prevention of unsafe abortion and death in all countries is an imperative goal for women’s health and rights.

To view the entire film Not Yet Rain online, visit http://www.notyetrain.org/

For useful resources on maternal mortality and MDG 5, check out the Women Deliver Resources at: http://www.womendeliver.org/resources/womendeliver.htm

For more information on the legal status of abortion, read the Center for Reproductive Rights 2007 briefing, “Abortion Worldwide: Twelve Years of Reform” http://reproductiverights.org/sites/default/files/documents/pub_bp_abortionlaws10.pdf

Related articles from The Lancet on global abortion rates and trends are available online at:

• David A Grimes, Janie Benson, Susheela Singh, Mariana Romero, Bela Ganatra, Friday E Okonofua, Iqbal H Shah. Unsafe abortion: the preventable pandemic. The Lancet Sexual and Reproductive Health Series, October 2006: http://wwwlive.who.ch/reproductive-health/publications/articles/article4.pdf
• Gilda Sedgh, Stanley Henshaw, Susheela Singh, Elisabeth Åhman, Iqbal H Shah. Induced abortion: estimated rates and trends worldwide. The Lancet 2007; 370: 1338–45: http://media.mcclatchydc.com/smedia/2007/10/17/13/Chang-Guttmacher_Institute_abortion_report.source.prod_affiliate.91.pdf
  

Parliamentarians Call for Action on Adolescent Girls' Rights

From April 5th-10th, 2009 more than 600 parliamentarians from over 100 different countries met in Addis Ababa, Ethiopia to attend the 120th Assembly of the Inter-Parliamentary Union (IPU). Their primary goal was to discuss parliament's role in promoting global peace and security, democracy, and development, with special attention given to the importance of investing in adolescent girls in developing nations.

Last week, parliamentarians addressed the issue of the current global financial crisis, and looked to the importance of investing in young girls as a critical strategy to repairing economies. Adolescent girls in developing countries are often overlooked as fundamental components of a society's progression. However, as both economic actors and future mothers, the importance of investing in young girls' safety, health, and education is crucial to creating a stable society with high levels of growth. At the present moment, less than half a cent of every single international development dollar is spent on adolescent girls, greatly inhibiting their development into empowered young women, able to escape poverty and ignite progress.

In order to counterbalance gender-based inequality, Dr. Theo-Ben Gurirab, President of the IPU, discussed the importance of “addressing discrimination and promoting the well-being and empowerment of adolescent girls" as both a human right and a core component of achieving the Millennium Development Goals.” Parliamentarians at the 120th Assembly focused on three key points in ensuring the improvement of adolescent girl's well being: investing in girls' education, promoting an end to violence against girls in all settings, and working with both governments and the private sector to build life skills for young women, ensuring that they make a smooth transition from school to work. By focusing on such initiatives, adolescent girls as well as society as a whole will progress and grow.

During the meeting in Addis Ababa, members of paliament (MPs) had the opportunity to see for themselves the importance of investing in such proposals. By visiting UNICEF supported initiatives, MP's were quickly able to see the importance of such programs.

It is the PPD ARO's hope that this realization will prompt MPs to implement similar programs in their countries to promote adolescent girls' empowerment. More than 600 million young girls' live in the developing world today, and it is crucial that the international community continues to address issues of gender inequality and appropriates actions to be taken.

To access the 120th Assembly's agenda, please visit: http://www.ipu.org/conf-e/120agnd.htm

To learn more about UNICEF's role in working with the IPU, visit: http://www.unicef.org/infobycountry/ethiopia_49258.html

Achieving the Millennium Development Goals: The Contribution of Family Planning

The Millennium Development Goals are quickly approaching their target date of 2015, and in order to ensure that progression is being made in a positive direction, the USAID Health Policy Initiative has specifically focused on the considerable and noteworthy contributions that family planning has thus far made to achieving the goals. Updated analysis for more than 30 countries demonstrates how family planning can help accomplish MDG's by reducing costs for meeting the goals and improving health outcomes.

MDG Briefs for Bangladesh, Bolivia, Burkina Faso, Cameroon, Chad, Democratic Republic of Congo, Dominican Republic, El Salvador, Ethiopia, Ghana, Guatemala, Guinea, Honduras, India, Indonesia, Kenya, Madagascar, Malawi, Mali, Nepal, Nicaragua, Niger, Nigeria, Pakistan, Peru, Rwanda, Senegal, Tanzania, Uganda, Yemen and Zambia can be accessed in English (and often French or Spanish) at: http://www.healthpolicyinitiative.com/index.cfm?id=publications&get=Type&documentTypeID=15

Converting PDFs to editable documents

One of the most common ICT-related questions asked by PPD's partners is how to convert Adobe PDF documents to Microsoft (MS) Word or another editable format. Until recently, it has not been easy without the purchase of expensive (around $300US!) software.

A new website called PDFtoWord will convert PDF documents to MS Word (or just text) for free and email them to you: http://www.pdftoword.com/

We've tried out this site for a while and it works wonderfully! The MS Word results are impressively faithful to the PDF originals, including all graphics, lines, boxes, and bullets that can be easily edited to your liking. In addition, the conversion can also pull readable text from scanned images.

To use this converter site, all you have to do is:
1) Go to the website http://www.pdftoword.com/
2) Upload a PDF
3) Choose Word or Rich Text Format (RTF) (choose MS Word if you want full formating and graphics or RTF if you only want the text), and
4) Enter your email address.
5) Check your email inbox-- it may take a few minutes to receive the file.


Converting Microsoft (MS) Word documents to PDF has always been much easier. Newer versions of MS Office can save documents as PDF, and there are plenty of free online and downloadable programs that can do this.

1) One of the easiest free websites to use is PrimoOnline. It converts documents, images and websites to PDF for free: https://online.primopdf.com

2) You can always convert through your email inbox:
These email addresses do free file conversion for Word docs, PDFs, and even MP3s easily-- all you have to do is send an email with an attached file and you will shortly receive a reply with the converted file attached.

• pdf@koolwire.com—Converts MS Word, Excel or PowerPoint files to PDFs.
  
• doc@koolwire.com—Convert PDFs to MS Word or Rich Text Format files.

3) If you convert a number of documents, files, and websites to PDFs, you can download free software such as PDFCreator: http://www.pdfforge.org/products/pdfcreator

World Health Day 2009: Save Lives. Make Hospitals Safe in Emergencies

Since 1950, World Health Day has been celebrated around the globe on April 7th. Each year, the World Health Organization (WHO) chooses a theme, which highlights a key public issue that affects the international community.

This year, the focus is on the resilience and safety of health facilities and the health workers who treat those affected by emergencies. It is the WHO's hope that this annual celebration will promote a greater understanding of the issues at hand, as well as a long term advocacy program that will continue well beyond April 7th, 2009.

Worldwide, the number of disasters and emergencies are constantly increasing. In 2008 alone, 321 natural disasters killed more than 235,816 individuals. With an increasing desire toward urbanization, as well as a continuous population growth, the reliance on hospitals is becoming exponentially greater. In her Statement for World Health Day 2009, Dr. Margaret Chan, the Director-General of the WHO explains that, "when an emergency or disaster occurs, most lives are lost or saved in the immediate aftermath of the event. People count on hospitals and health facilities to respond, swiftly and efficiently, as the lifeline for survival and the backbone of support." However, in some cases the hospitals themselves are prone to simultaneous destruction, and as a result, health care workers are often killed or injured at the time when they are most critically needed. In other instances, health care systems that are already fragile are often unable to continue functioning in the event of such a disaster, further amplifying the tragedy of such an occurrence. Moreover, infectious diseases are one of the most prevalent causes of death and illness during a disaster, and if hospitals are unable to provide necessary care and infection prevention during an emergency, the propensity to amplify such an outbreak will increase, further inhibiting the hospital's capacity to provide other emergency services.

This year, the WHO is emphasizing the importance of investing in health infrastructure that will be able to withstand such disasters, and subsequently provide necessary care to those in need. Resilient construction, safe site decisions, and good planning are all crucial components to maintaining a functioning hospital. By anticipating such emergencies or disasters in advance, hospitals will have a greater ability to prepare themselves in the event that such a tragedy should occur, and will be able to provide the maximum potential for care to those affected.

A concern about funding is completely justified, as the WHO have calculated that the construction of a new hospital that can withstand such destruction costs surprisingly little in relation to the lives that can be saved. In many new health facilities, incorporating earthquake and severe weather protection into preliminary designs will add only 4% to the overall costs. Furthermore, reconstruction of existing facilities has minimal costs, and the incorporation of emergency preparedness and risk management into a hospital's operational plans costs almost nothing. World Health Day 2009 encourages both energy efficient and cost effective designs for the safety of new hospitals, and it is the hope of PPD ARO that such measures will quickly be implemented, helping to save countless lives worldwide.

We can all help to support better health care in emergencies, and involvement from within the community is essential in creating safer hospitals and better outcomes for those affected by such emergencies.

Recommendations for governments include:

• Champion the need to make health facilities safe and functional in emergencies for health, social and economic reasons
• Integrate “Safe Hospitals” programmes and health-risk reduction into national platforms for disaster-risk reduction
• Develop national multisectoral programmes and policies to make health facilities safe in emergencies. Countries that have established a “Safe Hospitals” programme will have taken an important step towards protecting their health facilities and providing health care when most needed
• Invest only in health facility projects that ensure safe location, design, construction, provision of care and emergency preparedness
• Integrate health facility safety and emergency preparedness into procedures for the licensing and accreditation of health facilities.

More information: English: http://www.who.int/world-health-day/2009/en/
French: http://www.who.int/world-health-day/2009/fr/index.html

To learn more about what you can do year-round, check out: http://www.who.int/world-health-day/2009/everyone_role/en/index.html

Read more about the planning framework for a national policy and programme for making health facilities safe in emergencies: http://www.afro.who.int/whd2009/planning_framework.pdf

Commission on Population and Development to Focus on Contribution of ICPD to MDGs

This week (30 March- 3 April) the forty-second session of the Commission on Population and Development will meet at the United Nation's headquarters in New York. The theme this year is "The contribution of the Programme of Action of the International Conference on Population and Development to the internationally agreed development goals, including the Millennium Development Goals."

Founded by the Economic and Social Council in 1946, the Commission is most recently involved in monitoring and assessing the implementation of the International Conference on Population and Development (ICPD 1994). This year's session will focus on lowering population growth, and effective family planning in the least developed nations of the world, in order to reduce overall poverty and remove the barrier to achieving Millennium Development Goals (MDGs).

Since the 1960's, the least developed nations, many in sub-Saharan Africa, have been unable to reduce their overall fertility rates, leading to rampant population growth. On average, these countries have fertility rates of 4.6 children per woman, which is significantly higher than the estimated goal of 2.17 births per woman to achieve "near-replacement-level fertility." Hindered by their inability to reduce population growth, the Commission will emphasize the necessity for these least developed nations to ensure a quicker decline in fertility, in order to "reduce maternal mortality, improve child survival, promote women's empowerment and contribute to poverty reduction." The Commission on Population and Development's second focus this year is on effective family planning, helping to contribute to poverty reduction. By reducing the number of births within a family, the ability to save money becomes more easily attainable and a greater investment in the health and education of each individual child born into the family can be achieved. Furthermore, improved access to efficient family planning contributes to enhanced maternal health and a greater survival rate of young children.

Although efforts are underway to improve the implementation of both population reduction and family planning, the forty-second session this week will express the need for a stronger political commitment and increased funding, in order to achieve significant progress on the ICPD PoA. In addition, the Commission recommends continued implementation of successful programs, an emphasis on national leadership and ownership, the development of effective health systems, and an investment in pro-poor policies.

The Commission explicitly points to South-South cooperation as vital in order to identify what programs are working, and what policies are most efficient, stating that "South-South cooperation is valuable, especially for the identification of best practices and the exchange of lessons learned." A continuous exchange of information between countries will help to improve the overall trend in reaching the MGDs.

Population growth and family planning are crucial topics that must quickly be addressed, and it is the PPD ARO's hope that the this year's session of the Commission on Population and Development will be able to bring to light this year's crucial issues and further encourage South-South cooperation in population and development. Keynote speakers this year include David Canning (Harvard School of Public Health), Jean-Pierre Guengant (Representative from Institut de Recherche pour le Développement, Burkina Faso), and Zeba Sather (Country Director of the Population Council in Pakistan).

To learn more about the Commission on Population and Development, you can access a summary of the session at http://www.un.org/News/Press/docs//2009/pop970.doc.htm

You can also read the keynote address, official statements, and agenda items in English and French for the Forty-second session at: http://www.un.org/esa/population/cpd/cpd2009/comm2009.htm