The UN Secretary General’s renewed Global Strategy for Women’s, Children’s, and Adolescents’ Health, to be launched in September 2015, will be a roadmap for improving the health and well-being of women, children, and adolescents. The first Global Strategy, launched in 2010, galvanized the Every Woman Every Child movement and achieved significant progress in reducing preventable deaths.
The Zero Draft of the updated Global Strategy was released earlier this month. Adolescent health is a focus area of the Global Strategy for the first time and we are calling on young people around the world to provide their input on adolescent health priorities. Yesterday, together with The Partnership for Maternal, Newborn and Child Health (PMNCH) we hosted the Calling on Youth Voices to Improve Adolescent Health Google+ Hangout to engage youth on their reflections of the UN’s Zero Draft.
This post is the second in a series of interviews from women and girls at the Georgetown Public Hospital Corporation (GPHC) in Georgetown, Guyana.
I’m here in Georgetown, Guyana to conduct interviews with inspiring women and girls and to listen to their stories. I recently met Nozema Pul, 41, in the GPHC maternity ward. Nozema was days, or possibly hours, away from giving birth. But being the shero that she is, she agreed to share with me her thoughts on motherhood, her dreams for her children, and advice for young girls.
What does being a mother mean to you?
A: Happiness. It means happiness.
How has your mother influenced your life?
A: My mother was a loving, caring and thoughtful mom. She taught me all about the good things in life. She raised me the right way, as a mother should. She gave me everything that she could afford in order to make me happy.
What do you wish for your children?
A: I wish for lots of happiness. I wish that they follow Christ and to have faith. I want them to be a good person and treat others as they want to be treated, not to be rude. I hope they are thoughtful and dedicated. But most of all, I want them to make the most out of life.
How did you first learn about reproductive and sexual health?
A: I was about 10 years old and I read about it in school.
Did you have easy access to family planning? What were the challenges?
A: No, access to family planning was not easy. I learned it from friends, family members, teachers, and others. I learned about contraception, condoms, and protecting oneself from sexually transmitted diseases, and not to have many children – especially one right after another. I learned that I needed to wait 6 to 7 weeks before planning the next pregnancy. It was challenging because I had to learn much about family planning by myself. I had to learn how to find doctors by myself and what family planning and pregnancy entailed. I was scared.
What are the challenges you have faced as mother?
“I love making my children happy. I want to give them everything they deserve as my mother did for me.”
A: I had my first child at 17. It was very hard. I didn’t know how to raise a child, but I was living with my mother and she taught me how to be a good mom. I learned from her and how she brought me up.
How can we make sure all babies and mothers survive and thrive?
A: Mothers and pregnant women should go out and talk to the right people to get the correct advice for their children so they know how to love and care for their child when the time comes.
What is your favorite part of being a mother?
A: I love making my children happy. I want to give them everything they deserve as my mother did for me. I want to teach them kindness, how to treat people, and not to be rude.
What advice can you give to young girls about pregnancy?
A: Do not get pregnant early. Get educated, stay in school, and get a good job. Get your own home and everything you want. Get a degree so you can stand up for yourself. Don’t be a single parent because it is very hard.
No photos were permitted inside the maternity ward.
There is a movement stirring in the global community to build a new strategy to address maternal, newborn, child and adolescent health around the world. One of these mechanisms is the proposed Global Financing Facility (The GFF). The GFF in support of Every Woman Every Child aims to contribute to global efforts to improve the lives of women, children. With more resources effectively allocated towards innovative solutions and programs it is estimated that 4 million maternal deaths, 107 million child deaths and 22 million stillbirths can be prevented between 2015-2030 in over seventy countries.
While significant progress has been made to improve the the health of women, children and adolescents, there is still more that needs to be done. Youth voices are vital to this global conversation. Young people around the world are already doing amazing work to empower communities and save lives. Often with little resources, youth are making an enormous impact in their communities. Samuel Kissi is one of these young leaders. As a core team member of the organization Curious Minds, Kissi works to ensure that all children and youth have a seat at the table to create change. Similarly, Felogene Anumo, Girls’ Globe blogger, reproductive health activist and Program Associate for the Africa Women’s Development and Communication Network (FEMNET) passionately works to raise awareness and mobilize communities for women’s health and rights.
Yesterday, we “sat down” with Samuel and Felogene in an engaging Google+ Hangout. They openly shared their opinions and perspectives related to a new post-2015 global strategy for women, children and adolescent health. Addressing issues of literacy, child marriage, female genital mutilation were outer lying issues that were highlighted. Both remarked about the enormous potential the Global Financing Facility can have on improving maternal, children and adolescent health. These passionate advocates boldly expressed that in order for true change to occur there must be a shift in the conversation. A handful of youth can not be the only ones sitting at the decision making table. There is a need for scores of youth voices to be taken into consideration. If given the opportunity, young people can directly influence change for women, children and adolescents not only at a grassroots level but an international level.
For those of us passionate about improving access to quality maternal healthcare, thinking about progress towards the MDGs can be disheartening. But this holiday season, as we celebrate Thanksgiving in the United States, we are reminding ourselves to be grateful for the little victories.
A long way to go
It’s a sobering fact that, despite encouraging steps in the right direction, we are very far from reaching our goals (1).
The global maternal mortality ratio has dropped by 45% between 1990 and 2013: far short of the 75% target.
The maternal mortality ratio in developing regions is 14 times higher than in developed regions.
300,000 women worldwide died in 2013 due to pregnancy or childbirth related causes.
Tanzania: The national context
Kupona Foundation is a non-profit committed to improving access to quality maternal healthcare in Tanzania. If I focus on the Tanzanian context, the picture is still bleak.
Every year, 8,000 women die as a result of childbirth or pregnancy related causes (2).
For every woman that dies, 20 more will develop an infection, injury or life changing disability (3).
There are still significant gaps in the technical skills and critical infrastructure required to enable teams on the ground to save lives.
We have just over 12 months to reduce Tanzania’s maternal mortality rate by 57%. It’s easy to be discouraged about if this is possible.
That’s not to say that the country isn’t pushing for change. Earlier this year, the President of Tanzania, Dr. Jakaya Mrisho Kikwete, launched the ‘Sharpened One Plan’. Inspired by the country’s laudable achievements in the reduction of child mortality, the plan is designed to accelerate progress towards improving maternal healthcare. In Kikwete’s words
We are still grappling with reducing maternal mortality…we still have a long way to go (4).
~President Dr. Jakaya Mrisho Kikwete
“The one person you save means something.”
It is easy to get lost in the statistics, but one of Comprehensive Community Based Rehabilitation in Tanzania’s (CCBRT) OB/GYNs recently reminded me of the need for perspective. Dr. Fatma Sulieman is one of several district mentors conducting on-the-job training and mentoring at maternity facilities across the region of Dar es Salaam, which has a population of over 4.3 million (5). Dr. Fatma is based at Temeke District Hospital, a facility managing approximately 2,000 deliveries each month with one of the highest maternal mortality rates in the region. (You can learn more about our comprehensive maternal and newborn healthcare program here).
At first, I used to get disappointed when I didn’t get the results I wanted immediately, but then I realized that the one person you save means something.
~Dr. Fatma Sulieman
Dr. Fatma is right. As we come together this week and give thanks for what we appreciate most, I urge you all to recognize that change is happening.
By taking things one step at a time, Dr. Fatma has seen incredible results at Temeke. The facility reported zero maternal deaths for the month of September. This is remarkable. Thanks to the continued efforts of CCBRT and the Regional Health Management Team to train staff, improve infrastructure and distribute life-saving equipment to maternity facilities in the region of Dar es Salaam, every mother that gave birth at Temeke in the month of September survived. This is huge step forward, and a victory for the families of Dar es Salaam.
We need to step back and celebrate every individual life saved. Step back, and give thanks for the little victories.
Of course, not every month is going to be as successful as September. Thousands of women and their babies are still dying in Tanzania every year. We need to build upon this year’s successes and continue to enable the teams on the ground to improve skills of healthcare providers, ensure that they have access to the facilities and the equipment they need to do their job, and decongest health facilities so that they have the time and space to attend to every patient. We need to step back and celebrate every individual life saved, and give thanks for the little victories.
Written by Abbey Kocan
Executive Director, Kupona Foundation
Share this post on social media and remind your followers to give thanks for #littlevictories.
The Millennium Development Goals Report 2014’, United Nations’
Tanzania Demographic and Health Survey (TDHS) 2010, National Bureau of Statistics, Tanzania, April 2011, Dar es Salaam
Nanda, Geeta, Kimberly Switlich and Elizabeth Lule, Accelerating progress towards Achieving the MDG to Improve Maternal Health: A Collection of promising Approaches, World Bank, Washington D.C., April 2005, p4.
Putting Mothers of Tanzania First, UNFPA Tanzania, UNFPA.org. August 8, 2014.
Tanzania National Bureau of Statistics Online Census Database, November 2014
Globally, 2.9 million newborns die within the first month of life. India, with a population totalling 17.5 percent of the global population, accounts for a startling 27 percent of the global newborn mortality rate with over 780,000 newborn deaths every year, the highest newborn mortality rate in the world. On September 17th, India launched its national Newborn Action Plan (INAP) to stop and reverse this disturbing trend.
Based on the findings and strategies promoted in The Lancet’s Every Newborn series, INAP aims to reduce India’s newborn mortality rate from its current 29 deaths per 1,000 births to under 10 deaths per 1,000 births by 2030. In order to accomplish this goal, INAP focuses on improving the following six evidence-based, effective strategies:
Preconception and antenatal care
Care during labor and childbirth
Immediate newborn care
Care of healthy newborns
Care of small and sick newborns
Care beyond newborn survival
Additionally, the issue of gendercide does not go ignored. Because a girl’s family traditionally must pay a dowry in order to marry, families – especially in poorer regions – favor having boys over girls. As a result, each month approximately 50,000 female fetuses are aborted or killed at birth, thrown into rivers, or simply left to die. An estimated one million girls in India “disappear” every year. With INAP, the Health Ministry takes this long-standing tradition of gender-bias into account and aims to eliminate gender-based differences in newborn health care.
“These are preventable deaths and now we have an action plan for preventing them.” – Harsh Vardhan, India Health Minister
Although India as a whole is on track to achieve Millennium Development Goals (MDGs) 4 and 5 (reducing child mortality and maternal mortality by two-thirds and three-quarters respectively), MDG success is not consistent across the country. For example, the state of Kerala already has a neonatal mortality rate of seven deaths per 1,000 births, yet the poorer states of Bihar, UP, Madhya Pradesh and Rajasthan are far behind, with a combined neonatal mortality rate amounting to 56 percent of such deaths nationwide.
“Healthy mothers and healthy children are crucial for India to realize the demographic dividend.” – Melinda Gates
It is important to emphasize that India’s efforts to reduce the newborn mortality rate are not limited to merely survival. With the launch of INAP, the Health Ministry will focus increased attention on improving the health and lives of both healthy and sick newborns. In a country where shunning those with disabilities, neuro-developmental delays, and birth defects is not uncommon, recognizing the value of all newborns, both sick and healthy, is a major step in the right direction.
With support from the Bill & Melinda Gates Foundation, the World Health Organization and UNICEF, India’s Health Ministry is confident in its ability to reduce newborn deaths nationwide – and if India’s INAP efforts echo the success of its anti-polio campaign, the future for India’s newborns looks promising.
No country sends its soldiers to war to protect their country without seeing to it that they will return safely, and yet mankind for centuries has been sending women to battle to renew the human resource without protecting them. -Fred Sai, former President of the International Planned Parenthood Federation
Pregnancy is the one of the leading causes of death for girls aged 15-19 in developing countries. Maternal and child mortality remains a big problem for many countries in Africa with young women even more vulnerable. However, almost all maternal deaths can be prevented, as evidenced by the huge disparities found between the richest and poorest countries. The lifetime risk of maternal death in industrialized countries is 1 in 4,000 in comparison to 1 in 51 in countries classified as ‘least developed.’
Why We Cannot Wait
Mothers are the cornerstones of healthy societies. Not only do they give physical birth to new life, they give moral and intellectual guidance to children who will become productive members of society. A society where mothers are not valued and protected is is one that will slowly diminish. Through prioritizing the welfare of mothers a ripple effect occurs for the health of newborns and children.
Time for Action is – NOW!
Maternal health is a matter of life and survival. This issue needs to be addressed from a rights based approach falling under the broader scope of sexual and reproductive health and rights. Citizens need to hold governments accountable for the availability, accessibility, affordability and quality of health services available for women and youth by ensuring:
Universal access to comprehensive sexual reproductive health and rights including modern contraceptive services for all young people regardless of sexual orientation, sex, race, ethnicity and geographic location
Access to safe and affordable, quality, nondiscriminatory, stigma free, comprehensive safe abortion care and post abortion care
Universal access to evidence based, age-appropriate context specific comprehensive sexuality education that enables adolescent and young people to understand and make informed decisions about their sexuality and plan their lives.
As Heads of State continue the discussion around a transformative post-2015 development agenda, it is critical that African governments galvanize political will, mobilize resources and prioritize maternal health in the next development framework. Then and only then, will we have future that we are proud to present to future generations.