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The injection advantage: Reaching more women with an effective and convenient family planning method

During the month of May, IMPACT will be highlighting USAID’s work in Global Health. This week we are focusing on family planning. 

The women are about 25 to 30 years old. They’re married with two, or as many as nine, children. They’re tired. They may have miscarried, more than once. They want a break.

This is how community health workers in Senegal describe the women who visit village health huts for family planning. “Some are educated and some are not,” one health worker said, “but they are smart. They worry about the health consequences of multiple pregnancies.”

Small, light, and easy to use, Sayana Press is well-suited for community health workers. Credit: PATH/Patrick McKern

These women know what they want: the chance to choose an effective family planning method that meets the reality of their lives.

When convenience and privacy are important

For many women, injectable contraceptives have tremendous advantages: one shot of the popular Depo-Provera® protects for three months. It is safe and effective, with almost no risk of unintended pregnancy.

Injectables have other advantages—with no pills to take daily, they are discreet. “This is a small village,” explained another Senegalese health worker. “Everyone knows what everyone else is doing.”

Partnering to reach more women

Depo-Provera is very popular in sub-Saharan Africa and has great potential to reach millions more women. In Senegal, injectables not only account for one-third of contraceptives used—one-third of women who intend to use family planning say they’d prefer injectables, too.

Typically, trained health workers give the injections in clinics, so women in remote villages have to travel long distances to get them. To quote one more health worker: “Sometimes, having to go all the way to the health clinic is enough to discourage women from doing family planning.”

A new initiative announced at the London Summit on Family Planning in 2012 aims to address this gap in access. USAID, the Bill & Melinda Gates Foundation, DFID, UNFPA, and PATH will bring up to 12 million doses of a new form of Depo-Provera, called Sayana® Press, to women in sub-Saharan Africa and South Asia.

A new form of Depo-Provera goes remote

Sayana Press is packaged in the Uniject™ autodisable injection system—each prefilled dose is administered in the abdomen, upper thigh, or upper arm. Small, light, and easy to use, the system is well-suited for community health workers.

USAID, PATH, and our partners are engaging countries interested in piloting the method and learning if and how it could enhance their family planning programs. We’ll be collaborating with ministries of health to introduce Sayana Press, aiming to achieve their goals for increasing access to family planning and meeting women’s needs. We will rigorously evaluate the product’s impact on contraceptive use and costs so that donors and governments have the information they need to make future decisions about use of Sayana Press.

Health worker quotes are from a Sayana Press acceptability study conducted by FHI 360 with support from the USAID PROGRESS project and PATH.

Sayana Press and Depo-Provera are registered trademarks of Pfizer, Inc. Uniject is a trademark of BD.

Follow USAID for Global Health (@USAIDGH) on Twitter and use #GHMatters to join in the conversation.

Contraceptives Save and Improve Lives

Each year an estimated 74.4 million unintended pregnancies occur in the developing world; primarily among women who had an unmet need for effective contraception. Family planning programs, which provide counseling, services and contraceptive supplies, empower couples to make important decisions about the timing and spacing of their children. By choosing the healthiest times for childbirth, mothers give themselves and their children a better chance to live long, healthy lives. This week at the Women Deliver conference, I join public health professionals from around the world who are discussing family planning as one of the core strategies to save women’s lives.

A woman and her children after a family planning consultation at Kalingalinga Clinic in Lusaka, Zambia, 2009. Photo Credit: Arturo Sanabria

When we think about who plays a role in improving access to family planning, we often think of the nurses, doctors and other healthcare workers who administer contraceptives. Warehouse managers and truck drivers, on the other hand, might not immediately spring to mind. However, these individuals play a vital role in ensuring contraceptive security, which exists when every person is able to choose, obtain, and use quality contraceptives and condoms whenever he or she needs them.

On the USAID | DELIVER PROJECT we work alongside USAID and other partners every day to strengthen health programs by improving the supply chains in-country. In our work we often say “No Product. No Program.” What we mean by that is ensuring an adequate supply of contraceptives is critical to the success of family planning programs. These programs are most effective when healthcare providers have commodities on hand for women who want and need them.

In fiscal year 2012, on behalf of USAID, the project supplied a range of contraceptive methods to 45 countries, including over—

  • 751 million male condoms
  • 64.6 million oral contraceptives, and
  • 36.3 million injectables
  • 1.6 million IUD’s
  • 1 million implants

Coupled with comprehensive counseling and services, these commodities prevented an estimated 15,000 maternal deaths and 230,000 infant deaths.

Despite major gains, we know that 222 million women still have an unmet need for family planning, meaning they want to delay or avoid pregnancy but aren’t using a modern method of family planning. Meeting this need for modern contraceptives will save 79,000 mothers and 1.1 million infants. Ensuring and sustaining contraceptive availability at this scale is a substantial task that requires more effective and efficient supply chains, coordination among the public, private and NGO sectors, engagement of civil society organizations, a willingness to go beyond ‘business as usual,’ and leadership and commitment on the part of national and international partners.

Staff load family planning and other health commodities into a truck as part of the Delivery Team Topping Up system in Zimbabwe. 2009. Photo Credit: USAID | DELIVER PROJECT.

While meeting the family planning needs of women around the world happens one woman at a time, making contraceptives available to each of those women requires the concerted and coordinated efforts of individuals and organizations around the world.

View a new infographic by the USAID | DELIVER PROJECT on the important role contraceptives play in saving and improving women’s lives.

Allowing Women to Nurture Themselves and Their Children Before Giving Birth Again

During the month of May, IMPACT will be highlighting USAID’s work in Global Health. This week we are focused on family planning. 

In too many places around the world, women lack the access to contraception or the decision-making ability to seek services.

Mother in Ethiopia. Photo Credit: Jhpiego

Eighty million unintended pregnancies were estimated to have occurred in developing countries last year. Of these, 63 million occurred among the 222 million women with an unmet need for modern contraception.[1]And in sub-Saharan Africa, one in four women in is unable to decide when and how many children she will have.

The importance of healthy timing and spacing of pregnancies cannot be underestimated. According to the World Health Organization, short birth-to-pregnancy intervals—the time between the date of a live birth and the start of the next pregnancy—greatly affect maternal, newborn, and child health and mortality outcomes. In low-resource settings, preventing another pregnancy by using family planning and waiting to get pregnant again for 36 months can reduce under-five child mortality by 25%.  For neonates in the developing world, this number is even greater—findings indicate that mortality is reduced by approximately 40% for preceding birth intervals of 3 years or more, compared with intervals of less than 2 years.[2]

The likelihood of miscarriages and stillbirths are also much higher for extremely short birth-to-pregnancy intervals. Women who become pregnant 15 to 75 months after a preceding pregnancy are less likely to miscarry or have a stillbirth baby than those with shorter or longer inter-pregnancy intervals.1

Family planning can help women ensure that pregnancy occurs at the healthiest times of their lives. Research shows that positive health outcomes for both mothers and newborns occur when pregnancy happens:

  • 24 months after a live birth (an almost three-year birth-to-birth interval);
  • 6 months after an induced abortion or miscarriage;
  • To women who have had fewer than four live births; and
  • To women between the ages of 18 and 34.

Family planning, including healthy timing and spacing of births, has been recognized as one of the most cost-effective global health interventions. For every $1 spent on family planning, $6 are saved on other interventions. And with a better-spaced family, there are more opportunities for members to grow, remain healthy, and be better educated.

Here at USAID’s flagship Maternal and Child Health Integrated Program (MCHIP), we are working around the world to save and improve lives through increased use and understanding of family planning. In India, for instance, the Program has worked with the Ministry of Health to help prevent nearly 100,000 unintended pregnancies during the extended postpartum period through our work with the postpartum IUCD.  This is just one example of our work in more than 50 countries, but is illustrative of our efforts to scale up results to reach as many women as possible.

And in Africa, where the PPIUD has been slower to gain acceptance, we’re seeing signs of hope. At a regional PPIUD meeting co-hosted by MCHIP last month in Zambia, 60 enthusiastic champions from professional societies, service delivery, INGOs, donors and governments representing 10 countries[3]convened to share their successes and challenges implementing PPIUD programs. But while these international and regional experts will surely help to advance integration of PPIUCDs into maternal health services in their respective contexts, we must multiply this number by a factor of 10—or even 100—to reach all the women who need PPFP to space their pregnancies at the safest intervals. Given the lack of understanding of return to fertility after a birth or miscarriage in much of Africa, as well as elsewhere, coupled with early return to sexual activity after delivery and short periods of amenorrhea, the role of PPFP/PPIUCD is critical to healthy timing and spacing of pregnancies. Raising awareness to dispel myths and misconceptions among clients and service providers is also key to improving PPIUCD uptake.

In our own lives, many of us have had the luxury to determine when and if we will have children. We cannot forget the millions of women in developing countries who do not have this same freedom—and who desire more time before becoming pregnant again, facing the risk of death with every pregnancy. Healthy pregnancy spacing is a cost-effective intervention that can reduce both maternal and childhood mortality and excessive population growth. Investing in women’s reproductive health and autonomy improves not only the health of the individual, but also the welfare of the whole family and, ultimately, the larger society. This investment is modest in relation to the dramatic returns it yields.


[1] UNFPA World Population Report, 2012

[2] Setty-Venugopal V, Upadhyay UD. Birth spacing: three to five saves lives. Baltimore: Johns Hopkins University, Population Information Program, 2002.

[3]Ethiopia, Kenya, Liberia, Malawi, Mozambique, Rwanda, Tanzania, Uganda, Zambia and Zimbabwe

 

Women Deliver Conference Focuses Attention to Women’s Health and Rights

During the month of May, IMPACT will be highlighting USAID’s work in Global HealthThis week we will be focusing on Family Planning. 

This week leaders and advocates from nearly 150 countries are gathering in Kuala Lumpur, Malaysia for Women Deliver 2013, one of the largest conferences of the decade focused on the health and wellbeing of girls and women. USAID is proud to participate in Women Deliver 2013 and highlight the Agency’s strong support and dedication to improving the health and status of women and girls across the globe. A number of our technical experts are presenting at the conference on topics covering family planning, maternal, newborn and child health, and other programming that address the needs of women and girls.

With support from USAID, Masreshah delivers reproductive health information and services to households in the Amhara region of Ethiopia. Photo Credit: Pathfinder International

The discussions in Kuala Lumpur are sparking a larger global conversation on how and why we all must work together to improve access to reproductive and maternal health.  Last night, USAID participated in the launch of WomenDeliver+Social Good, a movement that brings together social entrepreneurs and new media connectors around the world with the leaders who are shaping policies and programmes around women’s health and economic empowerment.  Watch USAID’s Health Development Officer, Judy Manning, present at the launch event where she spoke about the development of new contraceptive technologies as a solution to saving women’s and children’s lives.

Coinciding with the Women Deliver conference, USAID is highlighting our work in family planning this week on IMPACT as part of our Global Health blog series this month.  Family planning plays a critical role in meeting our goals of ending preventable child and maternal deaths and creating an AIDS Free Generation, and is crucial to improving people’s lives across the globe.  We know that family planning enables women and couples to choose the timing and spacing of their pregnancies, resulting in incredible health and economic benefits for families.  A USAID analysis found that, by preventing closely spaced births, family planning could save the lives of more than 1.6 million children under five annually.  Satisfying the global unmet need for family planning could reduce maternal deaths by 30 percent. And enabling young women and girls to avoid early pregnancy allows them to stay in school longer, increasing their economic opportunities.

Check back here all week as we highlight the importance of Millennium Development Goal (MDG) 5b, Universal Access to Reproductive Health.  Keep up with USAID’s participation at Women Deliver by following USAID for Global Health on Twitter for live updates and visit our webpage dedicated to the conference.

Follow USAID for Global Health (@USAIDGH) on Twitter and use #GHMatters to join in the conversation.

 

PEPFAR: Ten Years of Saving Millions of Lives

Originially appeared on Huffington Post

Ten years ago today, the United States Congress, in a remarkable display of compassion and bipartisanship, passed overwhelmingly legislation that established an historic and transforming global health program now known as PEPFAR– the President’s Emergency Plan for AIDS Relief.

The U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) is in its 10th year of helping HIV and AIDS-infected and -affected populations get access to prevention, care and treatment services. PEPFAR, the largest effort by any nation to combat a single disease, is working to achieve former Secretary of State Clinton’s vision of creating an AIDS-free generation. Photo Credit: EGPAF/James Pursey

At the time that PEPFAR was conceived of and then established during the George W. Bush administration, the world was witnessing first-hand the destruction of an entire generation of individuals in the prime years of their lives and the reversal of remarkable health and development gains, particularly in sub-Saharan Africa and to a lesser extent in other developing nations. Rates of new HIV infections were rising rapidly, and hospitals, communities, and families were often too under-resourced and overwhelmed to cope with the enormity of this burden. At that time in 2003, despite the availability of life-saving antiretroviral therapy (ART) in most countries in the developed world, in southern Africa and other regions of the developing world, an HIV diagnosis meant a virtual death sentence, since few had access to such drugs.

Today, as we mark the 10th anniversary of PEPFAR, the situation has changed dramatically. Plummeting life expectancy rates in much of Africa have been reversed; HIV-infected, but healthy, fathers and mothers who are receiving therapy are able to return to work, care for their families, and spur economic development. Doctors, nurses, and community health workers, who once had little to offer their patients beyond a more dignified death, are delivering life-saving ART to millions of people. AIDS-related mortality has declined by more than 26 percent since its peak in 2005. Where despair once cut a devastating swath through so many communities and countries, hope has been renewed.

With regard to the prevention of HIV infection, globally, in the decade since PEPFAR began, new HIV infections have declined by nearly 19 percent. Between 2009 and 2011, new HIV infections among children, still an important component of the epidemic in many southern African countries and other regions in the developing world, declined by 24 percent globally, compared to a 23 percent decline in the previous six years. Not only is progress happening, but its pace is accelerating.

According to a recent report evaluating PEPFAR by the Institute of Medicine, “PEPFAR has played a transformative role with its contribution to the global response to HIV.” As of the end of September 2012, PEPFAR was directly supporting 5.1 million people on ART — a more than three-fold increase in just the past four years. Last year alone, PEPFAR reached more than 750,000 pregnant women living with HIV with antiretroviral drugs to prevent mother-to-child transmission (PMTCT), allowing an estimated 230,000 babies who would have otherwise been infected to be born without HIV.

One key driver of this progress is the development and implementation of a combination prevention program. Just as it became clear that multiple HIV medicines, when used in concert, more effectively control replication of the virus in the body, it was shown that multiple prevention interventions, when implemented together, can more effectively reduce new HIV infections at the population level. This evolution in our thinking and approach to preventing HIV infection has reflected scientific innovation together with practical implementation. Landmark scientific advances, coupled with lessons learned from a decade of implementing programs under PEPFAR, have given us the tools, knowledge, and experience needed to achieve an AIDS-free generation.

Recent statistics show that the promise of an AIDS-free generation is truly within our reach, as President Obama powerfully articulated in his State of the Union address earlier this year. More countries than ever before have reached, or surpassed, the programmatic tipping points in their HIV epidemics — the point at which the annual increase in adult patients receiving treatment exceeds the number of annual new adult HIV infections. Reaching this tipping point is a key indication that a country is on the path to achieving an AIDS-free generation — and the more countries that achieve this goal, the closer we will be to ending the HIV/AIDS pandemic.

While PEPFAR is certainly the largest and most successful foreign health assistance program in history, it is clear that the United States cannot be alone in this endeavor… Other partners, including the Global Fund to Fight AIDS, Tuberculosis and Malaria, to which the U.S. is the largest contributor, multilateral organizations, the private sector, civil society, and host countries must all share in the responsibility. And, as PEPFAR enters its second decade, countries with a high burden of HIV disease must assume greater ownership for addressing the health needs of their own people by building strong and sustainable health systems.

PEPFAR represents the very best of America — the extraordinary generosity and compassion of the American people. Through PEPFAR, we are helping to deliver a better future to millions around the globe. Although much remains to be done in the future, the 10th anniversary of PEPFAR is something to celebrate now.

Ambassador Eric Goosby is the U.S. Global AIDS Coordinator and head of the State Department’s Office of Global Health Diplomacy. Dr. Anthony Fauci is the Director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health.

Follow Ambassador Eric Goosby, MD on Twitter:www.twitter.com/@PEPFAR

 

Remembering and Learning from Those We Have Lost to AIDS

Last week, I joined non-governmental organization (NGO), community, and health care leaders at a ceremony held to honor those whom we have lost to AIDS in Tajikistan and throughout the world.  This year in Dushanbe, the International AIDS Memorial Day ceremony was conducted for the second time at a public City Health Center, rather than at an NGO or AIDS Center, marking a growing acceptance by front-line health care workers of the key populations at higher risk who come to their facility for services. The ceremony was a time to mark the many steps Tajikistan has made in the fight against AIDS, but it was also a time to remember the suffering and loss experienced by many and to call on the community for greater acceptance and support of those in need.

Health care workers and community members honor the lives lost to AIDS in Tajikistan. Photo Credit: USAID

Since 1991, over 800 people in Tajikistan have died due to AIDS-related illnesses. As pointed out by Sevar Rahimovna Kamilova, a brave woman who leads an HIV-focused NGO here in Tajikistan, “Those lost to AIDS come from all genders, ages, religions, social strata, and professions.” Ms. Kamilova also shared that in Tajikistan now, almost 5,000 people are officially registered as HIV-positive. Of these, less than a third receive anti-retroviral therapy. Pulod Jamolov, director of a local NGO that supports people who inject drugs, movingly described why so few HIV-positive individuals are tested and receive treatment. “Discrimination and stigma directed at HIV-positive people result in a reluctance to do anything that would make their status known – including discussing risks with health care workers when they have medical needs, seeking out an AIDS Center to get tested, or receiving the free treatment offered by the government through support from the Global Fund to Fight AIDS, Tuberculosis, and Malaria.” This fear, combined with ignorance of available options, means that many people will die who don’t have to.

Yesterday’s ceremony brought home to me yet again the importance of the work that USAID, PEPFAR, and its partners are doing to reduce stigma and discrimination in Central Asia and to support key populations to access testing and treatment. As the event came to a close, the crowd kneeled as they were led in prayer by a local imam. I looked out at the many white-clad medical workers in the crowd – each braving the noonday heat to honor a group of people that, perhaps just years ago, they would have disdained. International AIDS Memorial Day is indeed a sad day, but it is also a day of hope, courage, and possibility.

Task Shifting to End Preventable Maternal/Child Death in Kenya and Zambia

During the month of May, IMPACT will be highlighting USAID’s work in Global Health.

A mother and her baby. Photo Credit: USAID

 Follow USAID for Global Health (@USAIDGH) on Twitter and use #GHMatters to join in the conversation.

Bondo, Kenya — Babies Gabriel and Mary show the progress that Kenya is making in moving towards an AIDS-free generation. Although their mothers are HIV-positive, the two babies were born free from the virus that causes AIDS thanks to a team of determined community health workers who recruited their young mothers into a project funded by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) through the U.S. Agency for International Development (USAID). The project, carried out by USAID’s flagship Maternal and Child Health Integrated Program (MCHIP), which is led by Jhpiego, connects women to—and keeps them enrolled in—high-quality health care to prevent the transmission of HIV from mother-to-child.
Mothers Beatrice and Grace are grateful they met community health worker Jane Akoth. After recruiting them into the project, Akoth saw both women regularly, through home visits or appointments at the clinic, to ensure that they remained healthy during and after their pregnancies. “After I delivered my baby, Jane advised me on how to take care of my child by exclusive breastfeeding for six months and to continue taking my medication,” adds Grace, the mother of baby Mary. “I want Jane to continue doing what she is doing so that she can help other mothers.”

 

In Africa, HIV and AIDS affects women and mothers at a greater rate than men, creating a heavy disease burden among families. When parents die of the disease, children are left orphaned or given to the care of relatives who may not have the means to raise them. Pregnant and breastfeeding women who are infected with HIV also run the risk of transmitting the disease to their children but antiretroviral drugs can dramatically reduce the risk of vertical transmission. [AE1]

 

The experience of Beatrice and Grace shows that the transmission of this life-threatening virus is indeed preventable. The success of the MCHIP project was due in part to an innovative strategy that was originally developed to improve immunization of children, which links pregnant women to care and keeps them enrolled.

 

More than 300 community health workers like Jane are working in Bondo District to keep the next generation alive and healthy. Since 2010, coverage through this project has expanded so that women in the most hard to reach areas are being connected to health services. As a result, the percentage of expectant mothers going to all four antenatal care visits increased from 25 percent to 41 percent in two years, and the percentage of HIV-exposed infants who were tested for HIV increased from 27 percent to 78 percent.

We know that follow-up by community health workers is key to saving lives—getting mothers into care, keeping them there, and providing them with the lifesaving medications that they and their children need.

 

Community-based Approach Prevents HIV in Children and Keeps HIV+ Mothers Healthy in Bondo, Kenya

During the month of May, IMPACT will be highlighting USAID’s work in Global HealthFrom May 18-27 we will be focusing on an AIDS-Free Generation. 

Bondo, Kenya — Babies Gabriel and Mary show the progress that Kenya is making in moving towards an AIDS-free generation.

Beatrice, holding Gabriel, and Grace, with baby Mary, listen as CHW Jane Akoth (right) counsels them on their health choices. Photo Credit: USAID

Although their mothers are HIV-positive, the two babies were born free from the virus that causes AIDS thanks to a team of determined community health workers who recruited their young mothers into a project funded by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) through the U.S. Agency for International Development (USAID). The project, carried out by USAID’s flagship Maternal and Child Health Integrated Program (MCHIP), which is led by Jhpiego, connects women to—and keeps them enrolled in—high-quality health care to prevent the transmission of HIV from mother-to-child.

Mothers Beatrice and Grace are grateful they met community health worker Jane Akoth. After recruiting them into the project, Akoth saw both women regularly, through home visits or appointments at the clinic, to ensure that they remained healthy during and after their pregnancies. “After I delivered my baby, Jane advised me on how to take care of my child by exclusive breastfeeding for six months and to continue taking my medication,” adds Grace, the mother of baby Mary. “I want Jane to continue doing what she is doing so that she can help other mothers.”


In Africa, HIV and AIDS affects women and mothers at a greater rate than men, creating a heavy disease burden among families. When parents die of the disease, children are left orphaned or given to the care of relatives who may not have the means to raise them. Pregnant and breastfeeding women who are infected with HIV also run the risk of transmitting the disease to their children but antiretroviral drugs can dramatically reduce the risk of vertical transmission.


The experience of Beatrice and Grace shows that the transmission of this life-threatening virus is indeed preventable. The success of the MCHIP project was due in part to an innovative strategy that was originally developed to improve immunization of children, which links pregnant women to care and keeps them enrolled.

More than 300 community health workers like Jane are working in Bondo District to keep the next generation alive and healthy. Since 2010, coverage through this project has expanded so that women in the most hard to reach areas are being connected to health services. As a result, the percentage of expectant mothers going to all four antenatal care visits increased from 25 percent to 41 percent in two years, and the percentage of HIV-exposed infants who were tested for HIV increased from 27 percent to 78 percent.

We know that follow-up by community health workers is key to saving lives—getting mothers into care, keeping them there, and providing them with the lifesaving medications that they and their children need.

Follow USAID for Global Health (@USAIDGH) on Twitter and use #GHMatters to join in the conversation.

Women’s Involvement in Voluntary Medical Male Circumcision for HIV Prevention

During the month of May, IMPACT will be highlighting USAID’s work in Global HealthFrom May 18-27 we will be focusing on an AIDS-Free Generation. 

Kawango Agot works to scale up voluntary medical male circumcision in Kenya. Photo Credit: USAID

I work as part of a team dedicated to scaling up voluntary medical male circumcision (VMMC) in Kenya. In 2007-2008, clinical trial results confirmed that VMMC has the potential to dramatically reduce men’s risk of acquiring HIV from their female partners. While Kenya and 13 other African countries have made great strides in rolling out VMMC (Kenya has circumcised about 500,000 men since VMMC was endorsed by the World Health Organization as an effective intervention against HIV), there has been a glaring gap that many of us have not paid attention to: how to get women fully on board as stakeholders, guardians, and partners. For all practical purposes, we as VMMC program implementers run our business as if this is solely a man’s affair. We forget that involving female partners is critical to turn this procedure into a successful intervention for HIV prevention.

In 2010, a small, unique group of young women in the lakeside city of Kisumu, Kenya, blew my mind away. One challenge we experience in VMMC programs is finding a way to support men through the six weeks of sexual abstinence recommended after surgery. In my attempt to encourage women to look beyond the usual topics surrounding VMMC (for example, that it reduces their risk of cervical cancer if their male partners are circumcised), and broach more difficult topics, my attention was drawn to some young women who accompanied their husbands/boyfriends for circumcision at one of our VMMC service sites. I called some of the couples for a casual chat, and was amazed at how perceptive they were in making decisions about their health.

The young women described how they discussed VMMC with their partners ahead of going for services – benefits, risks, fears, and interestingly, sexual abstinence. Each one of them narrated how, ahead of time, they agreed on sleeping arrangements that would enable them to observe the 42 days of abstinence. Some separated beds, others separated rooms, some slept on the same bed, but fully clothed, some simply dressed unattractively or avoided bodily contact or seductive talk while others took time off to visit with their families. Many reported to have successfully abstained for the recommended period, and attributed this to the fact that their partners involved them in their decision to be circumcised. As a bonus, most also tested for HIV together.

This experience shows us how crucial women’s participation is in the VMMC process, and how female partners might improve adherence to the post-operative abstinence period. These women deserve praise – ordinary women who have the courage to step out into the extraordinary and claim their space in VMMC, who recognize that their partner’s health is their health too.  To such, I bow in respect… and call on many more to come forward and claim their space in VMMC – it is your right!

Follow USAID for Global Health (@USAIDGH) on Twitter and use #GHMatters to join in the conversation.

 

More than 30,000 Fistula Repair Surgeries Supported by USAID

During the month of May, IMPACT will be highlighting USAID’s work in Global Health.

On Thursday, May 23, the world will be marking the first-ever International Day to End Obstetric Fistula, as recently designated by the United Nations General Assembly. USAID commemorates this day by celebrating a milestone in global maternal health: Over 30,000 fistula repair surgeries have been performed with U.S. support since 2005. Fistula, a devastating childbirth injury believed to affect millions of women in developing countries, can be surgically repaired up to 90% of the time. Unfortunately, most women who suffer from fistula lack access to a skilled surgeon or fully equipped health center, making treatment and prevention too often out of reach.

Fistula clients in Uganda after receiving treatment. Photo credit: Fistula Care/EngenderHealth

Ten years ago, USAID launched a global effort to both treat and prevent fistula and is today one of the largest funder of such activities worldwide. To date, through initiatives such as the EngenderHealth-led Fistula Care project, and in collaboration with local governments, regional health care organizations, faith-based organizations, and other partners, USAID has supported training and equipment for medical teams in 15 countries at 56 health facilities across Africa and Asia for fistula repair surgery. Efforts to support fistula prevention have been supported by Fistula Care at an additional 43 sites.

Obstetric fistula is an injury caused by prolonged or obstructed labor, when the head of the baby cannot pass safely through the woman’s birth canal. The baby often dies as a result, and the woman is left with an abnormal opening in the birth canal and chronic incontinence.

The hopeful part of the story is that in addition to most cases being reparable, fistula is almost entirely preventable. This is why USAID-supported projects work to improve access to routine and emergency obstetric care and cesarean deliveries for women who experience complications during labor and delivery. Together with skilled attendance at all births and access to voluntary family planning, these efforts can make fistula as rare in the developing world as it is in the United States. USAID works to engage all levels of society to raise awareness about fistula and its underlying causes, including early pregnancy, poverty, and a lack of education and empowerment for women and girls.

As the largest USAID-supported effort to both treat and prevent fistula, EngenderHealth’s Fistula Care project is committed to transform the lives of thousands more women and girls around the world.

Follow USAID for Global Health (@USAIDGH) on Twitter and use #GHMatters to join in the conversation.

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