Building on 15 Years of Progress

By Alexandra Cairns, External Affairs Manager, Kupona Foundation

For anyone studying, working in, or interested in global development, this week will be monumental. The framework upon which the development community built 15 years of programing, funding strategies and advocacy is shifting. A new set of targets has dominated the discourse for the last 9 months, and will continue to do so until 2030: SDGs (Sustainable Development Goals) will replace the MDGs (Millennium Development Goals), renewing our focus on long term, scalable solutions for the many challenges facing the development and prosperity of global communities.

At Kupona Foundation, we believe that people and communities need to be empowered to realize their full potential, and build productive futures. This starts with improving their access to healthcare. Healthy people can work, go to school, and care for their families. Access to quality healthcare has a ripple effect, amplifying positive impact across communities.

Photo Credit: Kupona Foundation
Photo Credit: Kupona Foundation

We are encouraged by the themes and conversations surrounding the UN General Assembly and associated events this week: safe surgery, mobile innovations in maternal health, and integrated approaches to development, to name a few. These are all signs that the diverse community of organizations committed to sustainable development are not looking to reinvent the wheel with this new agenda. This approach is vital to ensure that the collective progress made by the global development community over the last 15 years does not grind to a halt.

Look at the efforts to improve maternal healthcare since the MDGs were announced in 2000. Progress hasn’t come at the rate the world hoped for, but programs designed to improve women’s access to quality care during pregnancy and delivery are having an impact.

Tangible change for Tanzanian women

Last year, we reported on Girls’ Globe about exciting achievements at Temeke District Hospital in Dar es Salaam, Tanzania. Under the capacity building program coordinated by CCBRT (our sister organization in Tanzania), in partnership with the Government of Tanzania, Temeke reported zero maternal deaths in the month of September. For a full month, every mother that delivered at Temeke survived; a statistic unheard of in Temeke’s recent history. Encouraged by this success, CCBRT continued to:

  • Provide training and on-the-job mentoring to healthcare teams at 22 public facilities
  • Improve infrastructure, including ward renovations and operating theater refurbishments
  • Distribute life saving equipment to fill critical resourcing gaps

In August 2015 – nearly one year since the original report — the team at Temeke confirmed two consecutive months of zero maternal deaths, and consistently lower maternal mortality rates for the first half of 2015. September 2014 wasn’t a stroke of luck. It was the result of hard work, collaborative partnerships, and integrated approaches to improving the quality of care available to mothers and newborns.

Building upon a solid foundation

There is still a long way to go. We’re working to ensure every mother and newborn in Tanzania has access to safe, quality healthcare. This week, we’re delighted to be joined in New York City by Erwin Telemans, CEO of CCBRT. Our joint attendance at events and meetings is a practical demonstration of our commitment to a collaborative model that combines our passion for innovative solutions and sustainable, life changing programs with CCBRT’s local expertise in providing quality healthcare.

Together, we look forward to exchanging ideas, and building and expanding partnerships with like-minded organizations, as we all work towards ambitious goals for the future of people and communities across the globe. We’re most excited to share our experiences, and learn from others, ensuring the ideas and initiatives we implement over the next 15 years are built upon the lessons learned and foundation of progress built since 2000.

We look forward to seeing you there!

Stay tuned to Twitter (@KuponaFdn, @ErwinTelemans, @CCBRTTanzania) for our live updates from UNGA Week, and to Girls’ Globe in October for a round up of our experiences and thoughts following the announcement of the Sustainable Development Goals.

Post-2015 Priorities: Maternal Health

As we start to count down the last year of the Millennium Development Goal (MDG) Challenge, we should celebrate the positive change associated with MDG5: improving maternal health. Since 1990, the world has experienced an incredible 47% decline in the rate of maternal mortality. However, many countries will not reach MDG5.


MDG5 is measured by two factors: achieving universal access to reproductive health for all women by 2015 and cutting the rate of maternal death by three-quarters between 1990 and 2015. Many countries have made remarkable progress, like several sub-Saharan African countries, which have halved their maternal mortality rates since 1990. Yet, the area still accounts for half of all maternal deaths globally.

Every minute, a woman still dies during pregnancy or childbirth. That’s half a million unnecessary deaths every year. According to the WHO, a woman’s ‘lifetime risk of maternal death’, or the probability that a 15 year old will eventually die from maternal complications, is 1 in 160 in developing countries, while it is only 1 in 3700 in developed countries. But this is not just a third world problem. Although maternal mortality has dropped 3.1% on average since 1990 in the developed world, the United States faces a 1.7% increase in the rate of pregnancy-related deaths, jumping from 12.4 deaths per 100,000 in 1990 to 18.5 in 2013, meaning more women are dying of avoidable causes now.

maternal healthThese rates are unacceptable, especially because these deaths are almost entirely preventable. Prioritizing maternal health should be at the forefront of our post-2015 agenda. Nearly two out of three women located in rural areas of developing communities will never interact with their country’s formal health care system, and more than one-third of all births will take place without the assistance of a skilled birth attendant. By investing in new, creative solutions, including improving supply-chain management and expanding the network of frontline community health workers, we can connect isolated women to the care they need, and help all countries achieve MDG5.

Midwives and skilled birth attendants have played an integral role in the success of the countries that have shown positive change. Midwives can reach women to provide prenatal and post-partum care in their own homes and on their own terms, as well as help to mitigate risk during childbirth. Midwives also provide needed family planning programming and education to help women time and space births for when they are physically ready and able to care for their children. They are often the only link many families have to health care, providing HIV tests, contraception, and vaccinations to their patients, as well. Most importantly, midwives are trusted members of the communities they serve and well-versed in the cultural norms of their patients.

c/o World Bank
c/o World Bank

There is no reason for a woman to die during childbirth of controllable factors. The UNFPA estimates that just 350,000 more trained midwives would ensure that all women have safe pregnancies and deliveries. We must provide opportunities for midwifery training and easy access to supplies for their services. Policies to improve coordination, communication, and collaboration between these frontline health workers and the more formal public health hospital system should be the priority of every country experiencing high maternal mortality. And communities should work to support the work of midwives to ensure motivation and retention, especially in more rural areas.

This goal, in particular, serves an integral role in accomplishing the other seven MDG’s, including reducing child mortality (MDG 4), achieving universal primary education (MDG2), promoting gender equality and empowering women (MDG 3), eradicating extreme poverty and hunger (MDG 1), and arguably the rest, as well. Investing in a mother’s health has reverberating impact in the health of her child, not only for the healthy development of the newborn, but to ensure her survival to care for the child. Concentrating resources to support midwives, as a proven strategy to tackle maternal mortality, should be a focal point of the post-2015 agenda. Doing so would save hundreds of thousands of lives, maternal and newborn.

To access the 2014 Midwifery Toolkit to advocate for the improved availability, accessibility, acceptability, and quality of midwifery services in your country, click here.

Learn more:

Celebrating Healthy Mothers on World Water Day

Picture Courtesy: Pippa Ranger/Department for International Development (DFID)
Picture Courtesy: Pippa Ranger/Department for International Development (DFID)

Today, March 22, is World Water Day. This international day to celebrate water has evolved over the years, since it was first recognized by the UN in 1993. It is only fitting that World Water Day shares a place in the same month as International Women’s Day, celebrated every year on March 8, as the two are so intertwined. The presence and quality of water plays a role in women’s lives throughout the world like no other resource. It can mean educational opportunities, job opportunities, healthy families, or none of that.

Water, sanitation, and hygiene (WASH) have important impacts on many of the Millennium Development Goals (MDGs), including poverty and hunger, child deaths, and environmental sustainability. Notably, WASH impacts maternal health in significant ways, as well. MDG target 5A seeks to “reduce by three quarters the maternal mortality ratio,” and investing and supporting WASH programs can help do just that.

While poor hygiene at childbirth is the most obvious factor in maternal deaths related to WASH, there are other ways it influences maternal health. Waterborne illness during pregnancy reduces good nutrition and inhibits the immune system. Neglected tropical diseases (NTDs) like hookworm are associated with anemia during pregnancy. Poor water storage encourages mosquito breeding and transmission of malaria; and the daily back-breaking drudgery of carrying 40 pounds of water on their heads is especially hard on pregnant women. WASH can even influence women’s childbirth choices: if health facilities do not have running water or offer toilet facilities, women sometimes choose to give birth at home, increasing risks of potential complications.

Picture Courtesy: Robert Yates / Department for International Development (DFID)
Picture Courtesy: Robert Yates / Department for International Development (DFID)

More and more countries are recognizing the linkages between WASH and healthy mothers, like Malawi. Last year, President Joyce Banda created the President’s Initiative on Maternal Health and Safe Motherhood as part of her commitment to improving Malawi’s maternal health status. As part of this initiative, Freshwater International is stepping in to provide WASH facilities at the maternal waiting shelters (MWS) for mothers waiting to deliver and training healthcare personnel in hygiene practices.

Traditionally, maternal health programs and WASH programs are performed separately. To have real and lasting impact on the health of mothers, it will take a new way of thinking about these programs and working together to achieve mutual outcomes. Let’s not be stuck inside the same boxes in looking at women’s issues around the world! WASH is essential for healthy pregnancies and childbirth.

On this World Water Day, let’s recognize the important role that WASH has in healthy women, healthy mothers, and healthy children, and let’s make sure that all women and children around the world have access to safe drinking water, sanitation, and hygiene. It really is a matter of life or death.

For more information:

Carol Perks: My Maternal Health Hero

Post by ​Kristyn Zalota, Founder

I want to tell you about Carol Perks, an Australian nurse who has transformed maternal and child healthcare in northern Laos. She has inspired my maternal heath work in Laos and shown me the importance of generously sharing knowledge.

The Encouragement I Needed

When I started, my maternal-infant health project in southern Laos, some said, “Are you qualified to do that? You’re not a midwife” or “Can Clean Birth Kits have a real impact?”

Carol Perks, a true expert in this field, never asked me those questions. Her first words to me via email were:

Good to hear from you and congratulations on trying to help the situation for women and children in Salavan. I’d be happy to help you in any way that I can…

Into the Unknown

When Carol arrived in Sayaboury Province in 1991, on a 2-year Save the Children contract, there were no other foreigners, “virtually no transport, no electricity, no water.” In this video, she explains with a laugh, Sayaboury was “very wild in those days.”


The health situation was dire: the infant and maternal mortality rate were abysmal, with only 18% of women receiving antenatal care and just 7% having a skilled attendant at their births.

Family planning in Sayaboury Province was limited to theeating of elephant placenta.”

Twenty Years of Hard Work

Carol’s planned two years turned into more than twenty. During this time, she worked with district and provincial officials to develop a comprehensive model for providing healthcare in rural communities, with a strong focus on maternal and child health.

The model mandates building clinics, renovating hospitals, training health staff and volunteers, improving water and sanitation and more. Importantly, with technical assistance from Save the Children, the Lao government implements and manages their own health departments.

By 2007, all districts of Sayaboury Province had successfully implemented the model. So, Carol and Save the Children moved on to neighboring Luang Prabang Province.

Within 3 years, in one Distrtict, they had achieved Millennium Development Goals 4 and 5.

Carol’s Legacy

Carol retired in 2013. Yet, her work continues in Laos’ north and will inspire my own in the south. She has shown me what one woman can do to improve maternal and infant health.

IMG_0121She also showed me how to support other women. Even when my organization was in its infancy, she honored the work I was doing. She took time out of her demanding days to answer my questions and share best practices. That meant so much to me and I will try to emulate her example when others seek my help.

Thank you Carol Perks for your work in Laos and for your generosity of spirit!

Your Turn

Who is the woman that most inspires you to work harder and be better? Post a shout out to your hero below and share with a tweet using #WomenInspire.