The Plight of Adolescent Mothers in Tanzania

The month of March boasts International Women’s Day and Women’s History Month – two observances which highlight great achievements of women, both and past and present, that have radically changed mankind. But although women and girls have made great strides worldwide in many areas and disciplines, there are many challenges and hurdles that they continue to face.

In June 2017, President John Magufuli of Tanzania called for the ban of adolescent mothers returning to school after giving birth. His reasoning? Adolescent mothers would encourage the other school girls to have sex.

And it gets worse.

In December 2017, authorities called for the arrest of pregnant girls in hopes of getting them to testify against the men who got them pregnant. Subsequently, five girls were arrested along with their parents. Although the girls and their families were released, these acts have outraged non-governmental organizations around the world. They have also brought to light the challenges that many girls in Tanzania face, such as limited access to education, lack of sexual and reproductive health education, child marriage, pregnancy checks, and predatory male teachers.

Each year in Tanzania, 8,000 girls drop out of school due to pregnancy. Tanzania has no official re-entry policy that allows adolescent mothers to attend school and complete their education and continues the practice of immediate expulsion of girls who become pregnant.

International Women’s Day has passed and Women’s History Month will soon come to a close, but advocacy efforts for adolescent mothers must continue. We cannot sit by idly as the rights of adolescent mothers are violated. Instead, we must continue to raise awareness and support them in their efforts to lead successful lives.

There are several campaigns and petitions geared towards supporting adolescent mothers in Tanzania but more needs to be done. Adolescent girls need a government that understands the importance of completing education and recognises the need for safety in and out of classrooms. They need environments that are free of shame and stigma.

As Michelle Obama so eloquently stated: “There are still many causes worth sacrificing for. There is still so much history yet to be made.”

Equal access to education for adolescent mothers and formal re-entry policies that support them in completing their education are causes not only worth sacrificing for, but also worth fighting for.

Shero Sara Conquers Kilimanjaro

At Kupona Foundation, we encounter incredible women every day. Today, we want to introduce you to our latest Shero. Meet Sara Safari.

Sara (left) carried a banner for Kupona Foundation to Kilimanjaro’s summit.

Sara is an author, engineer, professor, mountaineer, TedEx speaker, recipient of the 2015 Global Citizen Award from the United Nations, advocate for the empowerment of women and girls, and newest member of the Kupona community.

In 2015, Sara was climbing Mt. Everest to raise funds to empower Nepali girls who were trafficked or forced into marriage. On day 25 of Sara’s climb, Nepal was struck by a 7.8 magnitude earthquake. Sara survived the quake and the devastating avalanche that followed while clinging to the edge of the treacherous Khumbu Icefall by her harness and anchor.

Today, Sara continues working to empower women and girls. She aims to climb the highest mountain on every continent (The Seven Summits) to raise funds for seven organizations working for women’s empowerment. When she completes her challenge in July 2018, she will be the first Iranian in history to conquer The Seven Summits.

Last week, Sara summited Mount Kilimanjaro to raise funds and awareness, through Kupona Foundation, to empower women living with and recovering from obstetric fistula in Tanzania.

Her goal is to raise $19,000, $1 for each foot of Kilimanjaro’s elevation. Funds raised will support comprehensive treatment for women and girls at our partner hospital, CCBRT, as well as vocational training and socioeconomic empowerment for women recovering from fistula at the Mabinti Centre. You can show your support for Sara’s challenge here.

“Women living with obstetric fistula are often denied the opportunity to live to their fullest potential. Many are cast aside by family members and neighbors, and confined to their homes to avoid the stigma and shame associated with this debilitating childbirth injury. They cannot work, attend community functions, and are often susceptible to infections and disease.  I climb on behalf of all women who don’t have the opportunity to live fully self-expressed lives around the world.” – Sara Safari

Sara visiting the ladies recovering from obstetric fistula surgery at CCBRT.

Kupona Foundation is honored to be Sara’s charity of choice on the African continent. We were also thrilled to welcome her to CCBRT and The Mabinti Centre after her climb last week, where she visited the ladies she had been climbing for.

“I feel so honored that I met these women. They are so strong and resilient. They deserve a better life and I wish I could give them everything. As they were sharing their stories, I was so moved.” – Sara Safari

She was also able to meet the young woman whose picture she had carried to the top of Kilimanjaro.

“There is a huge difference between the women [on the ward] at CCBRT and [training at] Mabinti. At CCBRT, they are vulnerable but at Mabinti, they are empowered, strong, hopeful about the future. I can see how learning a new skill and making money can give them their confidence back.” – Sara Safari

Together, we can conquer fistula

Thanks to Sara’s incredible commitment, and the contributions of her supporters, we will be able to reach more women living with fistula, supporting their comprehensive treatment and rehabilitation, and their reintegration to their community as they rebuild their lives. The road to recovery is not an easy one, but like Sara’s climb to the summit of Kilimanjaro, their destination is within reach.

We’re excited to conquer fistula together, returning hope, health and empowerment to women and girls in Tanzania.

Are you inspired by Sara’s incredible efforts?

You can support Sara’s CrowdRise project today. You can also follow her journey on Facebook and Instagram.


Meet the Midwife for Life Award Winners

The Save the Children and ICM Midwife for Life Award is an international recognition of exceptional midwives. Presented this morning at the ICM Congress by Patricia Erb, CEO of Save the Children Canada, the award seeks to recognise those who show great vision and leadership in midwifery. Two new winners were announced and I had the opportunity to speak with them about their achievements.

Amina Sultani, from Afghanistan, is a midwifery specialist for the Afghanistan Ministry of Public Health and Vice President of the Afghanistan Midwives Association.

Loveluck Mwasha, from Tanzania, who has been a steadfast advocate for, and a mentor to, midwives in Tanzania for many years. She’s the Vice President of the Tanzania Midwives Association and a midwifery teacher.

Girls’ Globe is at the 31st ICM Triennial Congress in Toronto, Canada. See all of the Girls’ Globe LIVE coverage here

Tragedy to Triumph: How sewing lessons are changing the lives of women with fistula

Written by Samantha Bossalini, Development and Communications Associate 

The city of Dar es Salaam, Tanzania is anything but quiet. An increasingly modern metropolis overlooking the Indian Ocean, Dar is home to 4.4 million people, and is one of the fastest growing cities on the African continent. It’s a cacophony of noises, sounds, colors, and smells; ironic for a city whose name means “Place of Peace.”

On one of Dar’s residential streets, however, there is a peaceful haven. Behind a stone wall sits the Mabinti Centre. The simple house hums with the sound of sewing machines.  The women working at the machines range in age from 16 to 30-years-old. They greet visitors with smiles and a warm welcome: “Karibu!” Bright kanga fabric and canvas slips beneath their whirring needles as an instructor crouches down to talk them through a difficult stitch, or to share encouragement. In the garden, ladies gather under a thatched gazebo to practice screen-printing on bolts of fabric. Some are learning to tie-dye, some to stitch tiny dolls made of beads and yarn. All are beginning to heal.

One thing unites these women. Each of them women developed obstetric fistula during childbirth.

Whenever I explain obstetric fistula to someone, I start with the physical symptoms: a hole caused by prolonged, obstructed labor without access to timely medical care. The pressure of the baby’s head on the laboring woman’s pelvic floor kills the soft tissue and creates a hole between the vagina and bladder (or rectum, or both). Women with fistula are left chronically incontinent, leaking urine, feces, or both. They are at severe risk of infection, often in pain, and sometimes suffering nerve damage that limits their mobility.

It feels like a cold, clinical definition for something so devastating.

In 90% of cases, the baby dies during the traumatic delivery. The mother is left to process the physical trauma with the grief of losing a child; she is often left to endure this pain alone. Misconceptions associate obstetric fistula with witchcraft or a punishment for adultery. The constant leaking and smell means many women live in isolation and shame. Often abandoned by their husbands, family and communities and unable to work, women with obstetric fistula are some of the poorest and most marginalized people in the world.

Standing in the Mabinti Centre, surrounded by women who are healing, smiling, and building friendships, it’s hard to imagine they were once outcasts living in unimaginable pain.

The Mabinti Centre was established by Kupona Foundation’s sister organization, CCBRT (Comprehensive Community Based Rehabilitation in Tanzania). Recognizing that surgery is just the first step to recovery, CCBRT’s holistic approach addresses the psychosocial as well as physical impact of fistula. Each patient receives counseling, family planning resources and health education. CCBRT offers numeracy and literacy lessons to women who do not know how to read and write. Members of the Mabinti Centre team offer crochet lessons, providing women with an opportunity to learn a skill. Every year, over 600 women participate in these sessions.

Photo credit: Sala Lewis

Since 2006, 100 women have completed a training course in sewing, screen-printing, beading, design, English or business skills at Mabinti. These women graduate equipped to start their own business or seek meaningful employment, helping them to build brighter, healthier futures for themselves and their families.

Obstetric fistula is preventable and treatable.

When an expectant mother has access to high quality care, her risk of developing fistula decreases significantly. Since 2010, CCBRT has been improving the quality of maternal and newborn healthcare in 23 medical facilities throughout Dar es Salaam. Thanks to the generous support of our donors and partners, including Fistula Foundation and Johnson & Johnson, CCBRT is one of the largest providers of obstetric fistula treatment in the world, providing over 5,800 fistula surgeries in Tanzania since 2003.

We still have a long way to go. An estimated 3,000 women develop fistula in Tanzania every year. The backlog of women awaiting treatment is in the thousands, so while we work to stop new cases of fistula from developing, we must continue to provide fistula surgery and holistic care to help women recover and thrive after they are treated.

For the women at the Mabinti Centre, they are approaching a new chapter in their story of recovery. Equipped with the skills to move forward, they are building their futures, one stitch at a time.

Interested in learning more? Meet Lidya, who completed her training at Mabinti in 2012 after developing fistula twice. In honor of International Women’s Day on 8 March, consider sharing Lidya’s story and this article on social media or with your contacts.

Cover photo credit: Sala Lewis, Kupona Foundation 

Four ways we’re making progress toward the Global Goals

This week marks the first anniversary of the launch of the Global Goals. As the global development community convenes in New York City for the United Nations’ General Assembly week, what better time to reflect on progress?

In a country where, on average, one woman will die every hour from mostly preventable complications in pregnancy or childbirth1, Tanzania is one of the most dangerous places in the world to give birth. The good news: thanks to your support and the dedicated team on the ground, lives are being saved. We are making progress toward the Global Goals.

1. Empowering Medical Teams to Save Lives.

Dar es Salaam is one of the largest, and fastest growing cities in Africa, with a population projected to exceed 7 million by 20252. Today, a healthcare system designed to support 750,000 people is supporting 4.4 million. Hospitals and clinics throughout the region are severely overcrowded, understaffed, and under resourced, with patients suffering as a result.

Our sister organization, CCBRT, recognized that healthcare teams in the Dar es Salaam region were desperate to save their patients’ lives. With the support of the Government of Tanzania, CCBRT launched their Capacity Building program in 2010, offering on-the-job training and mentoring, distributing critical equipment and supplies, and refurbishing labor wards and operating rooms in 23 public healthcare facilities in Dar es Salaam. CCBRT also introduced a Standards Based Management and Recognition tool (SBMR)3 to measure quality of care, raising the bar for quality across the region.

Since CCBRT’s Capacity Building program began:

  • The maternal mortality rate in the region has fallen by 30%.
  • The average quality of care score increased from a baseline of 9% to 79%.
  • As of mid-August, one of the largest referral hospitals in the region completed a 20-week run with zero maternal deaths, a significant improvement on previous years.

2. Training to Create a Brighter Future

Like most of the developing world, Tanzania has a deficit of trained healthcare workers. Many doctors and nurses work extended shifts to make sure their floor is covered, which can lead to exhaustion and burnout. Night and weekend shifts are not sufficiently staffed, so emergency cases are sometimes not attended by a qualified team.

 In 2015, CCBRT provided on-site training and mentoring to 473 healthcare professionals.

Dr. Gloria Manyangu. Photo courtesy of CCBRT.
Dr. Gloria Manyangu. Photo courtesy of CCBRT.

Dr. Gloria Manyangu joined CCBRT’s team this year. She now trains teams in best practices and life saving techniques in 12 public healthcare facilities throughout Dar es Salaam.

“It’s very possible to reduce maternal death. Despite the many challenges […] if we are motivated, we can get it done. The harder we work, the better the outcomes.” ~Dr. Gloria Manyangu

A consultation at Tim's Corner. Photo courtesy of Sala Lewis.
A consultation at Tim’s Corner. Photo courtesy of Sala Lewis.

3.  Improving Access to Family Planning

An estimated 225 million women in the developing world want contraceptives and information on how to safely space their pregnancies, but cannot access those resources due to societal pressures, and a lack of information and products.4

Estimates suggest that meeting the need for family planning worldwide could prevent5:

  • 79,000 maternal deaths
  • 11 million infant deaths

CCBRT’s family planning program provides patients and staff with access to contraceptives, screening for cervical cancer, and one-on-one family planning counseling from a qualified nurse. CCBRT also provides counseling sessions for every obstetric fistula patient, to help women make informed decisions about their sexual and reproductive health, and future.

4. Strengthening Emergency Referrals

With support from partners, and the Regional Health Management Team, CCBRT launched a Closed User Group (CUG) to facilitate free communication between ambulance teams, doctors and nurses across Dar es Salaam. These teams have been given cell phones that can only call numbers in the group, and use these phones to coordinate patient referral. Neighboring hospitals can now alert each other to incoming patients, seek information or medical counsel, share patient history, and make critical decisions collectively and quickly. For women experiencing complications during labor and delivery, a life saving referral is a call away.

Moving Forward

At their core, the Global Goals are interdependent. While we specialize in addressing specific healthcare challenges in Tanzania, our approach is comprehensive and integrated. Training and education is a critical component of our efforts to strengthen and empower medical teams, and give the women and girls we serve agency to make informed decisions about their reproductive health. With an empowered medical workforce, and informed community, they will become healthier, unlocking access to educational and employment opportunities. The impact will continue to ripple, as healthier people build healthier communities, and break the cycle of poverty.

  1. Tanzania Demographic and Health Survey (TDHS) 2010, National Bureau of Statistics, Tanzania, April 2011, Dar es Salaam
  2. Boyle, Joe, “Dar es Salaam: Africa’s next megacity?”BBC News Magazine, 31 July, 2012, Accessed 29 August, 2016.
  3. Measured by Standards-Based Management and Recognition (SBMR) assessments, developed by Jhpiego, an affiliate of Johns Hopkins University.
  4. United Nations Population Fund. Accessed 19 September, 2016.
  5. Guttmacher/UNFPA. Adding It Up: Costs and Benefits of Contraceptive Services, Estimates for 2012. June 2012.

Featured image courtesy of Sala Lewis.

#11 – Maternal Health in Tanzania: Inside Maternity Africa

Welcome back to The Mom Pod! After a brief summer break, we are excited to continue with our podcast series and continue to bring you interesting, sincere and thought provoking podcasts on all things related to pregnancy, motherhood, parenthood and babies around the world!

Starting from today, our new episodes will now air every other week on Mondays – to mark the important #MaternalMonday advocacy campaign by the Wellbeing Foundation Africa. The #MaternalMonday social media campaign brings awareness to the importance of ensuring a safe and healthy pregnancy and delivery for mothers and babies everywhere in the world. To participate, head over to Twitter, follow @Maternal_Monday and join the conversation with the hashtag #MaternalMonday, or visit their website to learn more.

In this episode of The Mom Pod, we take a closer look at the state of maternal health and midwifery in one particular African country: Tanzania. I had the pleasure to visit a great organization, Maternity Africa, based in the Selian hospital in Arusha, Tanzania, where I interviewed a few of their midwives and nurses about maternal and newborn health and their experiences as midwives. Katie, Sarah and Neema told me about the many challenges they face in their day to day work, ranging from lack of basic supplies like medicine and oxygen to challenging attitudes in the medical profession – but these challenges pale in comparison to the unimaginable difficulties pregnant women face just to obtain the very basic and minimum level of care during their pregnancy and in labor, such as having to walk tens of miles to the nearest clinic if they wish to give birth with a trained birth attendant in a medical facility. I’ve given birth – and while in labor, I could barely walk from the bed to the bathroom. Imagine walking miles and miles and miles, under the sun and the heat, often on very bad roads – while in labor. Would you go and look for medical care – or would you take your chances birthing at home without any trained assistance?

Many women continue to die during pregnancy or childbirth needlessly in Tanzania, often because they lack access to proper prenatal and postnatal care – but midwives like Katie, Sarah and Neema are working tirelessly day in and day out to ensure that the women in their care come out of pregnancy and birth alive and well, with a healthy baby to take home. This isn’t always the case – but at least the women who come to Selian hospital and to Maternity Africa are getting treatment from trained, skilled health personnel who treat them with respect and dignity. Something every single mother, everywhere around the world, should have access to. Midwives all around the world are doing their very best to keep mothers safe and well during pregnancy and birth, and ensure babies stay healthy in the womb and outside of it – and some really amazing work is happening right here, in Selian hospital, in Arusha, Tanzania.

Maternity Africa’s work is divided into two main areas – fistula prevention, which includes the maternal health work that Katie and her fellow midwives do – and fistula repair, which you will learn more about in another episode airing in October. If you are interested to learn more about Maternity Africa, visit their website and Facebook page – and if you are a midwife or nurse, perhaps look into lending your skills to very good use and volunteer with them or with another similar organization. I can’t imagine a more impactful way to make a difference in this world. After all, mothers and babies deserve the very best. If we are failing them, we’re failing at the most important task imaginable.


Cover image: UNFPA Flickr / Abbie Trayler-Smith