The May 2016 issue of the Bulletin of the World Health Organization was published today. The Volume 94, Number 5, May 309 – 404 journal has a special theme devoted to the health of women, adolescents and children, focused on the implementation of the Global Strategy (2016 – 2030).
South African social justice writer and Girls Globe blogger, Zanele Mabaso’s article is featured amongst the high-level editorial publications, which ascribes the inclusion of adolescent outcomes in the global strategy to young people’s participation titled “Young people’s contribution to the Global Strategy for women’s, children’s and adolescents’ health (2016 – 2030)” with contributions from co-authors Temitayo Erogbogbo and Kadidiatou Toure.
The issue additionally features young medical doctor from Benin, Dr Joannie Bewa sharing how campaigns for sex education and free contraception are changing reproductive health prospects for young people in Benin.
The Youth Editorial on Young people’s contribution on the Global Strategy for women’s, children’s and adolescents’ health(2016 – 2030) can be found here.
Post Written By: Esther Sharma, Board Member for Women and Children First UK
As an expectant mum, with an excited toddler eagerly awaiting the arrival of his new baby, I am more mindful than ever before of the fortunate position I am in, living in the UK with access to great healthcare and lots of support. However, as many of us are acutely aware, with the MDG’s well and truly behind us now, there is still a huge amount of work to be done to ensure that this is the experience of all women and their babies across the world.
How many women have the choice about when to start having children, how many children to have and how far apart to space them? Or access to antenatal care and a skilled birth attendant to ensure a safe birth? And what about healthcare facilities for those requiring medical assistance? And vital support in the early days of motherhood?
Since 2002, Women and Children First has been working in some of the poorest countries of the world to empower women, using Women’s Groups – a powerful, low cost, participatory community mobilization approach. Rather than being a ‘top down’ approach, Women’s Groups seek to empower women to find long lasting approaches to maternal and newborn health issues. The women identify local strategies to address these problems, take action on the local strategies and evaluate their impact. Throughout the life cycle of the groups, based on their interests, women prioritize and discuss different topics on infant and maternal health. In order to capture the interest of the group and communicate effectively, storytelling, role plays, the use of picture cards and song and dance are often used.
Such is the effectiveness of this approach, (studies of seven communities show that you can cut deaths among newborns by one third using this low cost method), it has been formally recognized by the World Health Organization as being an important component in designing global maternal and child health programmes.
Women and Children First are scaling up this vital approach by providing advice and training to other organisations across the globe (including those in Guatemala, El Salvador, Nicaragua, Malawi, Ethiopia, Uganda, Sierra Leone, Honduras and Myanmar), passing on the deep knowledge and expertise that they have gained about Women’s Groups over the years to ensure that more women than ever before have the opportunity to shape the future of maternal and newborn health in their communities.
Mikey Rosato, Director of Programmes and Technical Assistance, says, “It’s a privilege to be able to pass on Women and Children First’s expertise in delivering Women’s Groups. Our aim is to save as many mothers and babies lives as possible and what better way to do this than by sharing an approach that is proven to work. It is so exciting to see the enthusiasm from our partners in the field who will be on the frontline in saving lives and helping us to reach the goal of an equitable world where all women and children have good health, no matter where they live.”
This training has been very well received. Mikey has recently returned from the World Health Organization where he shared expertise in how to run Women’s Groups, which he says, “This was an important step towards our goal of good health for all women, adolescents and children. With the support of the trainees from WHO, UNAIDS and World Vision we can now work in partnership to bring the women’s group approach to more communities where the greatest inequalities exist in health and mortality.”
Women’s Groups are by very nature designed to replicate themselves across communities to reach more and more women. Now that Women and Children First are providing training to other organizations, Women’s Groups will not only spread across communities, but across the world, bringing about much needed change to maternal and newborn health. To donate to these initiatives please visit www.womenandchildrenfirst.org.uk.
In villages in southern Laos, breastfeeding mothers are as ubiquitous as thatched roofs and playing children. In my time among villagers, I have never seen a breastfeeding mother cover up or go inside to continue feeding. Breastfeeding stigma seems non-existent. On front stoops and in gathering places, babies get their fill, comfortably ensconced in slings or resting on laps.
This freedom to feed however, isn’t reflected in Lao’s exclusive breastfeeding rates: just 39% of babies benefit from early initiation of breastfeeding and only 40% are exclusively breastfed until 6 months.
With child mortality rates in Laos among the highest in the region – nearly 79 deaths per 1,000 children under 5 – the government has taken measures at improving child survival. One such initiative is a joint Lao government-UNICEF program to promote exclusive breastfeeding.
In a 2012 presentation on the progress of this joint program, Dr.Khamseng Philavong from the Lao Ministry of Health tied breastfeeding to improving child survival:
“Evidence indicates breastfeeding as the most important preventive intervention with potentially the single largest impact on reducing child mortality.”
Given that breastfeeding is common practice and the government is promoting it why isn’t exclusive breastfeeding the norm in Laos?
One reason, according to the nurses we work with, is that there is a long tradition of feeding pre-chewed rice to babies as early as the first week of life.
A study by Kaufmann et al found that pre-chewed rice was given to 20-48% of Lao infants in the first week of life. There is a belief that breast milk is not enough – that supplementation is needed. While rice has long been the traditional addition to a baby’s diet, the marketing of breast milk substitutes is proving effective in urban areas.
The consequences of supplementation seem to be significant. According to another study, the practice of supplementing rice is tied to Laos’ high rate of stunting (low height for age as a result of chronic malnutrition) which stands at 44 %. In Salavan Province where I work, stunting affects 54 % of children under 5, one of the highest rates in the country.
So what can be done to promote exclusive breastfeeding?
My organization, CleanBirth.org which works to promote safe birth, trains Lao government nurses to promote the WHO’s breastfeeding strategy among their families. This includes:
Early initiation of breastfeeding within I hour of birth
Exclusive breastfeeding for first six months
Continued breastfeeding for two years or more
Safe, appropriate and adequate complementary foods beginning at six months.
The local nurses understand the efficacy of exclusive breastfeeding. They have told us that they believe that with education, families will eventually move away from supplementation.
This type of education is essential because when parents understand how to properly feed their children, children survive and thrive.
Featured Image: Lao government poster promoting breastfeeding at local clinic. Photo Credit: CleanBirth
I remember the first time I heard about the legendary Efua Dorkenoo. It was 2007 and I was 9 years old, sitting in my back garden in Lagos, Nigeria, clutching my copy of her book “Cutting the Rose: Female Genital Mutilation, The Practice and its Prevention”. I was completely inspired by this brave woman who had chosen to write so poignantly about the practice of Female Genital Mutilation (FGM). At 9, I ran into the house and went into my bedroom, scrambling around for my black notebook. In my rather poor handwriting, I wrote one word ‘Mama’ and added her to the list of women who inspired me. And for years to come, I would continue to admire and be inspired by this woman who was incredibly beautiful – inside and out.
Efua Dorkenoo, OBE, known affectionately to many, as ‘Mama Efua’ was a shining light in the movement to end FGM, dedicating her life to the eradication of the practice. Often referred to as the mother of the end FGM campaign, she fought for decades and battled to ensure that FGM stopped being a minority issue that was ignored to an issue was recognized as a priority by governments and policy makers around the world. She co-founded the organization FORWARD (The Foundation for Women’s Health, Research and Development) in 1983, which became a leading organization in the fight against FGM. She ensured that FGM was put on the agenda for ministries of health while working at the World Health Organization (WHO) from 1995 to 2001 and she went on to become the Advocacy Director and subsequently Senior Advisor on FGM at Equality Now. She was awarded an OBE in recognition of her campaigning work against FGM.
Efua Dorkenoo’s tireless campaigning and work culminated in the launch of The Girl Generation on October 10. The Girl Generation, an African-led movement to end FGM in a generation was the lifelong dream and brain-child of Mama Efua. At the event, we celebrated the progress made towards ending FGM in a generation. And I know that we could never have reached that point without Mama Efua. Mama Efua was a woman who refused to be silent. She saw the devastating effects of FGM, she stood up and raised her voice to stop the suffering of her sisters worldwide and never gave up, no matter what came her way. She was a rare gem, a rare beauty. She did exactly what every human being should do – she stood up for what she believed in. FGM may not have ended in her generation, but Mama Efua has paved a path of gold, she has prepared the way and FGM will end in a generation, thanks to her.
Efua Dorkenoo was a giant. She was a visionary who strived to see the end of FGM. We stood on her shoulders and we will continue to stand on her shoulders to further her legacy. We will stand on her shoulders because when we do this, we will borrow her strength. It is her strength that will allow us to see the end to this practice. We owe it to her to end FGM in our generation.
I will remain eternally grateful to Mama Efua. Generations will remain eternally grateful to Mama Efua. It was her courage, her humility, her fearlessness and her passion that enables me to say that I am The Girl Generation, the generation of fearless girls, the generation of hope and change, the generation where FGM ends.
Mama Efua, you have changed the lives of millions of women and girls worldwide. You have showed us that it is possible to strive for equality and you have taught us the most important lesson: never, ever, give up.
Rest in perfect peace, Mama Efua. You will always be remembered.
It’s stopped raining now.
But the tap-tap sounds on my windowsill continue.
The raindrops continue to fill the puddles even though the rain has stopped.
It reminds of Mama Efua, the woman who never stopped.
And although she is no longer here to be our mother, our leader and our friend,
Maternal mortality is a growing global concern. The United Nations Millennium Development Goal 5, aims to reduce the maternal mortality ratio by three quarters and achieve universal access to reproductive health by 2015. The United Nations reports that while the level of maternal mortality worldwide has declined by 47% over the past two decades, the maternal mortality ratio in developing regions remains 15 times higher than in developed regions.
According to the World Health Organization in 2013, 289,000 women died following pregnancy and childbirth, with most of these preventable deaths occurring in low-resource settings. Many of these women lack access to a skilled midwife and emergency obstetric care. In countries where maternal mortality rates are high, mothers and children often also lack access to proper nutrition, water, sanitation, and education.
Access to trained midwives and proper care for women during childbirth must be leveraged to ensure mothers and their babies are healthy.
The positive outcomes associated with improved maternal health, catalyzed by midwives and skilled birth attendants, are unrivaled. Midwives provide a bedrock of support for women and families during pregnancy, childbirth, and the postpartum period. These amazing women and men play a crucial role in maintaining and improving maternal health, facilitating childbirth, and empowering women to make informed decisions about their healthcare. The benefits of midwifery and maternal health contribute to economies – healthier mothers achieve greater productivity in their jobs, which positively drives economic growth. In addition, when mothers gain knowledge about maternal health, the availability of health services and the importance of proper nutrition and hygiene, their children are healthier and child mortality is reduced.
Unless a country has healthy mothers, it will be unable to break the perpetual cycles of poverty and put an end to the marginalized status of women and girls.
Save the Children’s efforts to fortify community-based health systems in over 20 countries has equipped local women and midwives in Afghanistan with the health training needed to offer life saving services to mothers, children and families. Mujeres Aliadas advances the lives of women in Mexico in a two-fold way – by giving them reproductive health and educational services based on professional midwifery models and developing a network that encourages women to advocate for their health rights.
CleanBirth strives to prevent the deaths of mothers and babies in Laos by providing clean birth kits, training nurses, midwives, and providing funding for training village volunteers who educate their community about safe births. The Edna Adan Hospital Foundation supports and advocates for the Edna Adan Hospital in Somaliland. The Edna Adan Hospital Foundation’s goal is to provide women in Somaliland the opportunity for healthy pregnancies and safe childbirth, through increasing women’s access to skilled public health professionals, revamping healthcare facilities, educating midwives, and ending the practice of female genital mutilation.
The results and impact of the work of our featured organizations is far reaching. When education, midwifery training, healthcare and economic advancement are properly harnessed the future of improving maternal health in developing countries becomes brighter.
As the world turns to the 67th World Health Assembly this week in Geneva, the development community rightly focuses on what the Millennium Development Goals will look like in a post-2015 world. Health issues like HIV/AIDS, Malaria and maternal/child health have been at the forefront of international development, and rightly so. While big gains have been made in issues like child survival, efforts would have to be redoubled to meet the global targets to reduce child mortality. There is a key issue beginning to gain traction in international development, one that could cost the global economy more than $30 trillion in the next 20 years – non-communicable diseases (NCDs).
What are NCDs?
NCDs refer to chronic diseases that are not passed from person to person. There are four main types of NCDs:
Cardiovascular disease (i.e., heart attack and stroke)
Chronic respiratory disease (i.e., chronic obstructed pulmonary disease and asthma)
Diabetes, illnesses that result in more than 36 million deaths annually
While NCDs are typically associated with the elderly, all age groups and all regions are affected by them. According to the World Health Organization (WHO), more than 9 million of all deaths attributed to NCDs occur before the age of 60. In fact, NCDs are the leading cause of death for women worldwide, causing 65% of all female deaths (18 million deaths annually).
Caused by genetics or lifestyle choices (i.e. unhealthy diet, physical inactivity, exposure to tobacco smoke, harmful use of alcohol) NCDs threaten progress towards the Millennium Development Goals as diseases are driven by things like ageing, rapid urbanization, and the globalization of unhealthy lifestyles. Poverty exacerbates these issues, especially in low-income countries where the world’s most vulnerable are exposed to harmful pollution and poor nutrition yet have limited access to health services.
NCDs can have a devastating effect on families due to high medical costs, cost of transportation to and from health facilities, and loss of productivity. Death by NCDs can drive families deeper into poverty, resulting in a greater burden to children and surviving family members. As women in the developing world are often responsible for household work – such as collecting firewood, cooking, gathering water, and tending livestock – that burden then falls onto children.
In order to decrease the impact of NCDs, WHO recommends a comprehensive approach of all sectors (i.e., health, finance, foreign affairs, education, agriculture) to change the behavior of members of at-risk communities. By encouraging a healthy lifestyle (free of tobacco use, less alcohol, and proper nutrition) communities can begin to understand the risks of unhealthy habits and inform their families and communities. With this in mind, the International Federation of Red Cross and Red Crescent Societies (IFRC) and the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) launched a global initiative called ‘4 Healthy Habits‘ during a side event at the 67th World Health Assembly.The partnership will provide Red Cross and Red Crescent volunteers information and tools to promote healthy lifestyles and change behaviors within communities around the world.
’4 Healthy Habits’ core strength is the empowerment of communities. Using simple tools adapted to local contexts, beneficiaries will be able to take charge of their own health.” – Eduardo Pisani, IFPMA Director General
The ‘4 Healthy Habits’ initiative kicks off this month in Asia-Pacific and Europe, where 50 trained facilitators and volunteers from 33 countries will work to raise awareness about the dangers of NCDs, promote healthier habits, and conduct basic screenings.
While behavioral change is challenging in itself, other trials loom in the face of preventing NCDs. Early diagnosis is a critical component of preventing deaths yet remains extremely difficult in less developed countries where communities have little to no access to health centers, vaccines, or proper equipment. Initiatives like ‘4 Healthy Habits’ are hoping to prove that interventions and early detection are positive economic investments as they can reduce the need for more expensive treatment or long-term care.
As the ‘4 Healthy Habits’ initiative launches this week, advocates for increasing visibility of NCDs are hopeful that NCD prevention will soon be included in donor and policymaker agendas. Preventative care is a cost-effective approach to creating a healthier world for all and ensuring the livelihood of men, women, and children all over the world.