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ROADS II Video: Transforming Corridors of Risk into Pathways of Prevention and Hope

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

Since 2005, the Regional Outreach Addressing AIDS through Development Strategies (ROADS) Project – Phases I and II - funded by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) through the U.S. Agency for International Development (USAID) East Africa and bilateral missions, has linked communities along transport corridors of east, central and southern Africa with critical HIV and other health services. ROADS is also helping vulnerable men, women and children reduce their vulnerability to HIV by expanding economic opportunities, improving food security, supporting community-based substance abuse counseling and working to protect women and girls from sexual exploitation and abuse. In this video, ROADS II project director Dorothy Muroki describes how the project takes an integrated approach to human development and how it is transforming corridors of risk into pathways of prevention and hope.”

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

The Future of Mobile Money in Afghanistan

Steve Rynecki serves as Mobile Money Adviser at USAID. Below is a follow-up to his June 2012 blog.

Afghanistan is a fascinating place to introduce new technology. The country is leap frogging in the mobile technology space and capturing the world’s imagination with its success with mobile money. Where there were no mobile phones in Afghanistan in 2000, there are now 18 million and growing. Competition in the voice market is fierce in Afghanistan, as it is in much of the world today. In fact, anyone arriving at Kabul International Airport is immediately struck by the numerous advertisements for mobile services. It’s truly an amazing development in the market and has people taking notice.

Afghans are finding new ways of using this technology for public benefit. They’re sharing health advice and commodity price information. They’re creating security and traffic alerts and innovating in ways unimaginable even 5 years ago. When I was here in 2008, Roshan just began the use and promotion of the M-PAISA mobile money service. Over these past five years, I’ve seen remarkable progress in the mobile money space here and globally. Back then, Roshan was the only mobile provider in Afghanistan and optimism for the benefits of mobile money was high. Fast forward to 2013 and we see the picture has changed significantly. Roshan is now competing with three, and soon to be four, other mobile operators, each offering their own mobile money product (Etisalat, MTN, AWCC and AfTel).

Afghanistan is leap frogging with mobile technology. Photo credit: USAID

These products include mobile wallet technology, where customers can store their money digitally as opposed to using cash. They can exchange the digital value for in-store purchases and in transferring funds anywhere a corresponding agent is located. Mobile money can be used to pay utility bills, top up mobile phone minutes and pay school fees. It’s also a great way to distribute salaries and social service benefits like pensions and public assistance. Under the right conditions, it could even be used for cross border Customs duty payments. The possibilities are limited only by our imagination.

To truly understand the mechanics of this technology, I tried it myself. In about 10 minutes I had an M-PAISA account set-up with a local agent in Kabul. I loaded my mobile wallet with the Afghan equivalent of $700.00. Since I can’t live in Afghanistan without buying carpets, I used M-PAISA to pay a carpet dealer in Herat and a friend in Mazar-i-Sharif who lent me cash to purchase another carpet. I was able to pay them both with mobile money in less than 5 minutes. There I was, standing in Kabul, sending money to two different people in two different cities. Each person received a text message from M-PAISA telling them how much I sent. The carpet dealer and my friend simply went to their local Roshan shop and cashed-out. It worked for me. The transfer fee for $700.00 came out to $3.00. But if you add the $6.00 I paid to withdraw $700.00 from the Afghanistan International Bank ATM, we’re looking at closer to $10.00 to transfer the funds. Still, it was worth for me.

So why isn’t everyone using mobile money in Afghanistan? What’s keeping this great service from taking off? As mobile money continues to evolve here, USAID and our partners have identified the following opportunities to help scale the uptake and use of mobile money by:

  • Pricing that allows for rural inclusion
  • Providing interoperability between banks, mobile operators and merchants
  • Exploring new branchless banking laws to help mobile money flourish
  • Better understand consumer preferences for informal money transfers (Hawala)
  • Strategies to ensure rural market liquidity (enough cash in the till for payouts)
  • Business models for mobile operators and agents to ensure their sustainability, as well as challenges on agent recruitment and management
  • Increasing caps on mobile money transactions for Customs duty payments and government salaries

The challenging conditions facing the mobile money industry here are not insurmountable, but they do hinder the uptake of mobile money and need to be carefully taken into consideration. With some 70% of Afghan adults using mobile phones, many local technology and business experts believe there’s a case for operators to offer mobile money. And, I would surmise, the lack of convenient bank branches would be reason enough for Afghans to seek out mobile transfers for their funds.

Consumer behavior is challenging in a country where cash is often salted away in tin cans hidden in walls, etc. And, where assets are often converted into precious metals like gold, savings accounts are rare. Rural Afghans often barter goods and cash is seen as an inconvenience, or even irrelevant when basic needs are met by subsistence farming. Given this environment, USAID and our Afghan partners are working in the following areas to help scale the use of mobile money. Here are a few of the activities we’ve completed or are currently underway for 2013-14:

  • Assisted Afghanistan in becoming a member of the Better Than Cash Alliance
  • Helped establish the Afghan Association of Mobile Money Operators (AMMOA)
  • Working with regional leaders of bank-led branchless banking practices to share knowledge with Afghan counterparts
  • Funding monitoring and evaluation on the utility and teacher salary payment pilots
  • Exploring interim and long-term interoperability solutions to link banks, mobile operators and merchants with international payment systems
  • Working closely with the Afghan government in scaling mobile money pilots for salary and utility payments
  • Designing public-private consumer awareness campaigns
  • Exploring possible regulatory reforms that encourage formal financial transactions

I’ve seen firsthand, for several years now, that mobile technology continues to scale. We’re getting a better understanding of market forces and figuring out how to bring interoperability into this burgeoning market. Who would have believed that in this once shattered country millions of ordinary people would be communicating almost daily on mobile phones. The future is indeed bright and the opportunities are limited only by our imagination.

 

Advancing Food Security by Opening Markets

This originally appeared on the UnitedStates Trade Representative Blog.

Ambassador Isi Siddiqui attended The Chicago Council’s Global Agricultural Development Initiative’s fourth annual Global Security Symposium yesterday in Washington, D.C. The symposium was on “Capitalizing on the Power of Science, Trade, and Business to End Hunger and Poverty: A New Agenda for Food Security.” As chief agricultural negotiator in the Office of the U.S. Trade Representative, Ambassador Siddiqui is responsible for bilateral and multilateral negotiations and policy coordination regarding food and agricultural trade.

We face dual challenges in food security: We need to get food to the people who need it today and grow more for the people who will need it tomorrow. Open, well-functioning markets can help.

Global markets are an essential element of food security. Open markets for agricultural commodities, agricultural inputs, and food products help to efficiently move these goods from those who develop and produce them to those who need them, benefiting both producers and consumers.

Markets that allow businesses and countries to share technologies help producers increase yields and output, reduce post-harvest losses, and adapt to climate change, while preserving the incentives for future innovation and transfer that are critically important to improving food security.

Rural chicken farmers like Sagnol Salimata, pictured here, have received technical training and barn-construction support through agricultural development projects. Photo credit: Jake Lyell.

The U.S. Government’s global hunger and food security initiative, Feed the Future, is driving a new model for development that, among other activities, integrates trade. Trade policies that promote open markets enable job creation, and can sustain and accelerate economic growth around the world.

The Office of the U.S. Trade Representative (USTR) lends our expertise and broader global work—increasing the transparency, predictability, and openness of agricultural trade through bilateral and multilateral exchanges—to the initiative’s goals of reducing global hunger, poverty, and undernutrition.

At the World Trade Organization (WTO), for example, we’ve put forth proposals in the area of trade facilitation that would go a long way toward removing barriers to agricultural trade by cutting and reducing border delays. Reducing delays for import clearances is particularly important for perishable food and agricultural products to help ensure that quality products reach consumers.

We’re also working closely with our partners at the Asia-Pacific Economic Cooperation (APEC) on the APEC action plan on food security to continue progress toward our shared goal of free and open trade by 2020. Trade agreements, such as the Dominican Republic-Central America-United States Free Trade Agreement (CAFTA-DR), and ongoing negotiations like the Trans-Pacific Partnership (TPP) are also important tools to facilitate trade, provide reliable market access, and establish dependable distribution systems and supply chains.

Recognizing that agricultural production needs to substantially increase to meet growing global demand for food, USTR promotes science-based, transparent, and predictable regulatory approaches that foster innovation, including in agricultural biotechnologies. These types of approaches contribute significantly to a safe and reliable global food supply as the world’s population grows, and they help producers adapt to climate change.

Through Trade and Investment Framework Agreements (TIFAs), we engage countries in discussions on trade and investment policy reform. We have TIFAs with Feed the Future focus countries like Ghana, Rwanda, Liberia, and key regional economic organizations like the Common Market for Eastern and Southern Africa (COMESA), to name just a few.

In East Africa in particular, there is great opportunity for spurring growth by ensuring Feed the Future and the U.S.-East African Community (EAC) Trade and Investment Partnership (TIP) synergies. The EAC and the United States have taken important steps to advance the TIP, which supports regional integration of the EAC and recognizes the importance that trade and investment play in economic and social development, including in agriculture. Through this partnership, we’re focusing on trade facilitation, a regional investment agreement, stronger private sector linkages, and capacity building.

USTR, the U.S. Department of Agriculture, the U.S. Department of State, and the U.S. Agency for International Development work collaboratively to help countries move from aid to trade.

Together, our efforts to create transparent, efficient global markets help advance global food security.

Follow USTR on Twitter @USTradeRep and read more on the USTR blog. Join USTR and other U.S. Government trade agencies on Twitter every Thursday this May for #TradeChat

Building Capacity: Racking Warehouses in Ethiopia

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

Ethiopia has the second largest population in Africa, and the thirteenth largest in the world. The current population of 84 million is expected to reach 120 million by 2030, and 145 million by 2050. Ethiopia will play a large role in meeting the global goal of putting 15 million people on HIV treatment by 2015 and in helping create an AIDS-free generation. To do so, the population of Ethiopia needs reliable and consistent access to medicine. At present, however, the ability to acquire medicine is limited due to challenges of access, supply, distribution and cost.

The Ethiopian government is undertaking a bold initiative to ensure that medicinal supply and access are available throughout the country. A major challenge is reaching a population whose majority lives in rural areas. Through a series of centralized and regional hubs, this initiative aims to serve thousands of health centers all over the country and overcome the hurdle to reaching patients. Achieving this aim is a complex undertaking, which is becoming increasingly more so as the diversity and volume of medicines regularly expands.

The Supply Chain Management System (SCMS), a project of the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) administered by USAID, has stepped in to support this nation-wide initiative. At ten warehouse sites across Ethiopia, the physical warehousing capacity has greatly increased due to the introduction of a warehouse racking system. Warehouse racking allows for vertical storage without damaging stacked products due to weight.

An Ethiopian warehouse, before. Photo credit: SCMS

The racking system enables improved material organization, as products are stored and sorted by rack location. This ensures that short shelf-life products can be located and distributed in a timely manner. It also helps prevent stockouts as regional hubs can respond faster to need requests. Thus, warehouses become more efficient in terms of space utilization, organization and loss-prevention.

Improved warehouse distribution also enhances the ability of warehouses to reduce and prevent product expiry and handle emergency situations, such as product recalls. Furthermore, a better ability to respond to the supply and demand of the population, as well as reduce loss, facilitates for a reduction in product cost.

In Adama, for example, the warehouse capacity was increased by 35 percent, to 880 pallets (the platforms that boxes of commodities sit on for shipping and storage) with the introduction of racking. Organizational improvement is evident, which facilitates for improved cost-efficiency as the products can be stored, located and distributed in a more systematic manner. That, however, is just the beginning.

An Ethiopian warehouse after support from SCMS, USAID and PEPFAR. Photo credit: Jiro Ose, SCMS

The government, with support from PEPFAR and the Global Fund, is constructing ten new – and larger – warehouse facilities to greatly increase warehouse capacity.

SCMS will outfit these new warehouses and expand upon existing facilities. When Adama’s new warehouse is complete, and racked, the pallet capacity will increase from 880 to 5,160. Across the ten sites, the existing pallet capacity of 6,039 will increase to 27,007.

The outfitting of racking in warehouses is only one contribution of many mechanisms that SCMS has provided to enhance and support the Ethiopian government in their aims of providing reliable and consistent access of medicine throughout the country. SCMS is not only meeting the needs of today, but planning for the needs of tomorrow.

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

Video of the Week: Clean Kumasi: Digital Tools to Transform Urban Waste Management

In the fall of 2012, IDEO.org partnered with Water and Sanitation for the Urban Poor to tackle the issue of open defecation. IDEO.org and WSUP were the recipients of a Development Innovation Ventures  Stage One grant to test a hypothesis that the application of digital tools could effectively change behavior related to the management of human waste.

Building off the lessons learned from rural community-led total sanitation efforts, the team worked to adapt that methodology to an urban context.

The team designed a system that allowed community members to report instances of open defecation by calling them in, in response to signs posted around the neighborhood. This information fed into a database of contacts managed by a community organizer who then called the participants to gather for meetings and clean-ups.

This video shows the IDEO.org and WSUP teams in action – from organizing hackathons in San Francisco to conducting field work in Kumasi, Ghana, live prototyping of the mobile platform and technology, and ultimately to the community gatherings and clean-ups.

IDEO.org’s project is supported by the DIV and Gates Foundation WASH for Life Partnership. Read more about the partnership’s new grantees.

Folow @DIVatUSAID  on Twitter and join the conversation with #DIVWash.

#AskAg Twitter Chat: Intersection of HIV and AIDS & Food Security

Do you wonder how we can improve food security for HIV-affected households? Do you ask yourself how activities in the agriculture sector and for improving economic growth can play a role in helping these vulnerable populations? Well, then please join us on Thursday, May 23 from 12-1:30 pm EDT for an #AskAg Twitter Chat on the “Intersection of HIV and AIDS & Food Security.” The chat is sponsored through the Feed the Future initiative and hosted by Agrilinks, USAID Office of HIV/AIDS, and the Livelihoods and Food Security Technical Assistance (LIFT) project as part of Global Health Month at USAID.

The chat will feature tweets from:

  • Meaghan Murphy (@MurphyMeaghan) — Food Security and Livelihoods Specialist, FHI 360
  • Kirsten Weeks (@klweeks) — Global Lead, Health, Nutrition & Livelihoods, DAI
  • Jason Wolfe (@jasonmwolfe) — Senior Household Economic Strengthening Advisor, USAID’s Office of HIV/AIDS

So why is this topic worth tweeting about?  Here are some key issues to keep in mind:

  • The relationship between HIV and AIDS and livelihood/food insecurity is bi-directional: HIV and AIDS can increase the vulnerability of households and communities to livelihood and food insecurity, while livelihood and food insecurity can also increase the risk of a person becoming infected with HIV.
  • HIV and AIDS can impact all aspects of a household’s livelihood, including directly affecting its income generation and productivity due to compromised health of people living with HIV (PLHIV), increased care costs associated with the chronic illness, stigma, and even death of affected household members. These reduced livelihoods opportunities can have direct impacts on household food access and ultimately the diet quality and quantity of individuals in the household.
  • The increased nutritional needs of PLHIV and the toll that HIV takes on the body complicate and further make food utilization and proper nutrition critical elements of the HIV and AIDS and food security discussion.
  • Vulnerable households with insecure livelihoods and food access, often resort to unsustainable coping behaviors that may include those that can put them at great risk for contracting HIV.

How to participate:

Agrilinks is an activity of the U.S. Government’s Feed the Future initiative, led by USAID’s Bureau for Food Security.

Photo of the Week: USAID Launches Water Strategy

Globally, over 780 million people lack access to safe drinking water and 2.5 billion people lack access to sanitation. Projections are that by 2025, two-thirds of the world’s population could be living in severe water stress conditions. To address these global water-related development needs,  Administrator Rajiv Shah will join Senator Richard Durbin (D-IL), Congressman Earl Blumenauer (D-OR) and Congressman Ted Poe (R-TX) to release the U.S. Government’s first Water and Development strategy in Washington today. Its purpose is to provide a clear understanding of USAID’s approach to water programming, emphasizing how sustainable use of water is critical to saving lives. The new water strategy has health and food security as priorities, highlighting the critical role of water in saving lives.

Read the entire USAID Water and Development Strategy.

Follow @USAID on Twitter and join the conversation with #WaterStrategy.

Optimized Lending Procedures Improve Access to Agricultural Loans

Banks in Azerbaijan in general have cumbersome lending process. Lengthy application forms often require information that is not crucial or needed for granting small or medium-sized loans. Collateral requirements are also onerous requiring additional forms and information. Banks grant loans based on collateral, applicant’s and co-signer’s income rather than taking lending risk. For agricultural lending this means that the time may not be worth the hassle to even apply for a loan. USAID worked with DemirBank to change their lending practices and improve farmers’ access to loans.

DemirBank is one of the leading banks in Azerbaijan with 23 years of operation. The bank has been one of the most active beneficiaries of the USAID assistance. Through its Azerbaijan Competitiveness and Trade (ACT) project, USAID has trained 212 loan officers and managers throughout the bank’s network on a variety of topics including risk-based agricultural lending, sales techniques, early fraud alert systems, etc. The trainings also built the skills and knowledge of the bank’s in-house trainers so that they can provide training from time to time.

An international expert trains the bank officers on new loan approval templates. Photo credit: Vasif Badalov, USAID ACT project

In addition to the intensive training, USAID experts also worked with the bank’s management to improve the bank’s agricultural lending approach by revising and simplifying the credit application forms, lending policies and procedures. The revised consolidated loan application forms have several advantages. They a) link a client’s credit history with the loan value, for which the customer is eligible to borrow; b) include credit scores, a memorandum and committee decision; c) save time by offering “check the right answer” options; d) provide color coding that flag risks; and e) facilitate decisions based on scores. This shortens the time it takes to approve a loan and provides a better evaluation of the borrower in terms of risk.

DemirBank’s management deemed the pilot testing of the consolidated application form in Guba and Gusar branches to be very successful. These branches issued 141 micro-loans between May and November of 2012 using the new forms.

“We are very satisfied with the new approach and its contribution to simplifying the loan application process and improving client outreach,” said Mr. Seymour Imanov, Manager of the Gusar Branch.

Following the success of the pilot test, DemirBank introduced new procedures at all their branches and consolidated all lending operations below 3,000 AZN (3,825 USD) under one system, that will use simplified loan procedures developed with USAID support. To ensure that all branches adopt the new forms in their lending operations, USAID is assisting the bank to train all credit managers in implementing the new procedures.

As part of this effort to streamline the credit application process, DemirBank intends to buy new software, so that it can track all loan approval procedures and processes as well as expand its outreach, facilitate collection of information in the field, accelerate disbursements, and increase productivity.

Living Positively: The Importance of Pediatric HIV Disclosure

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

As a public health practitioner and as a physician, I have seen the challenges that pediatric HIV brings to communities and to families. But I have also seen first-hand the positive, transformative effect that disclosing an HIV status can have. One case from my medical practice stands out as an example:

A grandmother brought in her seven-year-old grandchild, who had been orphaned by AIDS, for emergent care. At the clinic, we discovered that the child was HIV-positive, and we provided the grandmother with medication and dosing instructions. Not long after, the grandmother and her grandchild returned to the clinic. Because she did not know she was HIV-positive, the child was beginning to rebel against taking her medication and was getting very sick again. After careful consideration, it became clear to me, as her physician, and to her grandmother, that it was time to disclose her HIV status to her to help this child become adherent to her medications. Through a collaborative process, the child’s grandmother and I were able to help her understand that she had an illness and that it was very important to take medication so that she would continue to feel good. It was through this process of disclosure that the child was able to begin living positively.                         

Statistics from the World Health Organization show that across the world there are approximately 1.3 million children under the age of 15 living with HIV. These children will need anti-retroviral therapy and medical care for their entire lives to stay healthy. There’s a conflicting factor, though—many of these kids don’t even know they have HIV.

Children and adolescents knowing their HIV status is important for the global goal of “getting to zero.” Some studies show that pediatric HIV disclosure at a younger age decreases mortality due to HIV by half among adolescents. Other studies show that disclosure can increase medication adherence by 20 percent. These positive results highlight the importance of pediatric disclosure for living longer, healthier lives.

Disclosure can also play an important role in the psycho-social development of children living with HIV. Early disclosure may decrease anxiety and depression in kids, and make them feel more normal. Overall, disclosure holds great benefits for a child’s ability to engage and maintain medical treatment.

Although the process of pediatric disclosure is important for a child’s health, it is also complex. Many children who are HIV-positive live with other family members who are also positive. This makes disclosure very sensitive and personal. Disclosure also makes a child’s role in his or her own treatment important, and not all children are ready for this kind of responsibility. For these reasons, disclosure must be tailored to children’s own understanding of their illness and its impact on their life.

The AIDSTAR-One Pediatric and Youth Disclosure Materials (examples below) are designed to help tailor the disclosure process to a child’s specific needs. They are intended to be interactive and to encourage discussion among the child, his or her caregivers, and health professionals. The color booklets and accompanying cue cards are easy-to-read, and suited for children of varying ages. They will be printed in French, Portuguese, and Xhosa.

HIV programs can also use these materials as guidelines for establishing HIV disclosure interventions for their own populations. The materials can be used by health care workers, parents, caregivers and children together, throughout the disclosure process to ensure disclosure is completed appropriately and supportively. Just like the seven-year-old grandchild and her grandmother, all children and their caregivers deserve an appropriate disclosure experience; these materials will help other children with disclosure and encourage them to live longer, healthier lives.

Illustration explaining the importance of medication for children ages 2-6 from AIDSTAR-One’s “Booklet 1: How to Keep Healthy." Photo credit: AIDSTAR-One

Explaining HIV transmission to children 6-12 years of age in AIDSTAR-One’s “Booklet 2: Knowing about Myself.” Photo credit: AIDSTAR-One

“Booklet 3: Living a Life of Health” is AIDSTAR-One’s disclosure materials geared towards children over the age of 9. Photo credit: AIDSTAR-One

AIDSTAR-One is funded by PEPFAR through USAID’s Office of HIV/AIDS. The project provides technical assistance to USAID and U.S. Government country teams to build effective, well-managed, and sustainable HIV and AIDS programs.

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

Saving Lives of Mothers and Babies through Family Planning

During the month of May, IMPACT will be highlighting USAID’s work in Global Health. From May 11-17, we will be featuring the important role of mothers and partnerships in Global Health.

With memories of Mother’s Day in the U.S. this past weekend still fresh in the mind—family gatherings, celebrations, festive meals, presents, flowers, and more—attention turns to the estimated 287,000 maternal deaths that occur each year, mostly in developing countries.

During this week, USAID is focusing on mothers and on how maternal health is critical to achieving its global health goals. Partnerships between the private sector and NGOs, foundations, associations, and others have allowed USAID to maximize its health impact around the world.

The death of a mother profoundly affects the health and well-being of her children. When a mother dies, her children are less likely to survive. If a mother dies in childbirth, her child is 10 times more likely to die before reaching age one.

A mother and her child in India. Photo credit: USAID

While maternal mortality remains unacceptably high throughout the developing world, a number of USAID-assisted countries have achieved significant reductions in maternal deaths from pregnancy-related causes. For example, several countries have already achieved Millennium Development Goal (MDG) 5 (PDF)—reducing maternal mortality by three-quarters between 1990 and 2015—including the following countries in which USAID works:

  • Romania (achieved an 84% reduction, from 170 to 27 maternal deaths per 100,000 live birth)
  • Equitorial Guinea (81% reduction, from 1,200 to 240 maternal deaths per 100,000 live births)
  • Nepal (78% reduction, from 770 to 170 maternal deaths per 100,000 live births)
  • Vietnam (76% reduction, from 240 to 59 maternal deaths per 100,000 live births)

Several countries are also on track to achieving MDG 5, including Bangladesh (with a 5.9% average annual decline in maternal mortality) and Egypt (6% annual decline).

Nevertheless, even with the global decline of maternal mortality by 47% since 1990, the level is far short of the 2015 target and developing regions still have maternal mortality rates 15 times higher than developed regions.

During the 24 hours of Mother’s Day, some 720 women—one every two minutes—died in pregnancy or childbirth—and about 8,000 newborn babies died. The 24-hour period of labor and delivery and the first day of life for babies, in particular, is the most dangerous time period for mothers and babies. Most maternal and newborn deaths during this time period could be prevented, however, with critical, lifesaving interventions, including:

  • Strengthening the capabilities and number of skilled birth attendants
  • Promoting access to and use of low-cost products, such as applying chlorhexidine (a common antiseptic) to the umbilical cord stumps of newborns—which has the potential to prevent 500,000 global neonatal deaths each year
  • Meeting unmet need for family planning could prevent more than 100,000 maternal deaths annually by giving couples the ability to decide when and how many children to have. Expanding access to family planning will help women bear children at the healthiest times so that mother and child are more likely to survive and stay healthy.

USAID programs work to ensure women have access to a wide range of voluntary family planning methods ranging from CycleBeads® (a natural family planning method) to oral contraceptives and other short term as well as long-acting methods, from which a woman can choose. Expanding access to long-acting reversible contraceptives and permanent methods (LARCs and PMs) is particularly important. An article published in the Global Health: Science and Practice Journal (co-published by USAID and the K4Health Project at the Johns Hopkins Bloomberg School of Public Health Center for Communication Programs) explains that if 1 of 5 women in sub-Saharan Africa who were currently using pills or injectables switched to contraceptive implants, more than 1.8 million unintended pregnancies would be averted in 5 years, resulting in 10,000 fewer maternal deaths. Although use of implants worldwide remains low, they are increasingly popular and in high demand when they are actually available in family planning programs.

Not surprisingly, many programs are focusing on increasing access to family planning in countries with low contraceptive prevalence, such as in Africa where modern method use is at 23%. But family planning programs in countries with relatively high contraceptive prevalence also could have the potential for improvement. For example, women in Indonesia have, on average, 2.6 children, and modern method use is at 58%. However, contraceptive prevalence has been stagnant since the 1990s and the method mix is skewed toward short-acting methods, even though Indonesian couples are more likely to want to limit births. Nearly 8 in 10 modern method users rely on injectables and pills. Meanwhile, use of IUDs has dropped dramatically over the years, from 13% in the early 1990s to only 4% today, and use of implants and sterilization is at about 3% each.

The K4Health Project is implementing the Improving Contraceptive Method Mix (ICMM) Project to better understand the situation on the ground. Why has use of certain long-acting methods, such as IUDs, dropped over time? Do women know about LAPMs? Are they interested in using these methods?

This information will help inform the design of an integrated advocacy and knowledge management intervention—informed by Advance Family Planning-Indonesia’s advocacy methodology—in 6 districts in East Java and West Nusatenggara. ICMM will support the availability of a broader range of contraceptive methods for women and couples, with the ultimate goal of improving maternal health in Indonesia. The innovative project, funded jointly by USAID and AusAID and implemented by K4Health in collaboration with the Cipta Cara Padu Foundation, the Center for Health Research at the University of Indonesia (CHR-UI), the Indonesia Ministry of Health, and the National Population and Family Planning Board (BKKBN), is a unique partnership that leverages valuable resources and complementary skills and capabilities of various stakeholders.

With knowledge partnerships such as these and others designed to save mothers and babies through family planning, combined with improved services for pregnant women, perhaps Mother’s Day celebrated in the U.S. will one day become an international celebration event for women all around the world, if not in name, then at least in practice.

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

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