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