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Archives for Women

Women Deliver: Bold Visions for Women’s and Girls’ Health and Rights

Robert Clay serves as deputy assistant to the administrator for Global Health. Photo credit: Robert Clay

I’ve just returned from an inspiring and thought-provoking week in Kuala Lumpur, Malaysia where leaders and advocates from 149 countries gathered for the Women Deliver 2013 conference. My USAID colleagues and I were proud to participate in one of the decade’s largest conferences on the health and rights of girls and women.

One of the most memorable parts of the week for me was speaking on a panel at the Ministerial Forum with Yemurai Nyoni, a youth representative from Zimbabwe. He was a strong and articulate voice for youth and urged that young people be included in program design and implementation of youth-focused programs. It’s people like Yemurai that give us hope for the future. And with 1.8 billion youth in the world today, it is vital that we listen and include them in our development work.

Women Deliver served as a pivotal opportunity to renew commitment to meeting the needs of girls and women across the globe. USAID places women and girls at the center of our global health programs because we know improving women’s and girl’s health is critically important to almost every area of human development and progress. We’re helping countries acquire the resources they need to improve health outcomes through strengthened health systems and integrated services. This week in Kuala Lumpur I discussed the bold visions we have for our future to end preventable child and maternal deaths and create an AIDS Free Generation. Bold visions inspire action, and action paves the way for progress.

Over the past decade, we’ve seen wonderful success in reductions of maternal and child deaths and improved access to family planning. But despite all the good we have done, millions around the globe still do not receive the reproductive, maternal, newborn, and child health services they need. Every year 6.9 million children die of preventable causes and 287,000 women lose their life in pregnancy or childbirth. Some 222 million women who want to avoid pregnancy are not using a modern method of family planning.  Closing this access gap to family planning information and services would reduce maternal deaths by 30 percent and could save the lives of 1.6 million children annually (PDF).

After a week of renewed commitments, sharing lessons learned, and listening to those pioneering the way forward on women’s health and rights, I feel inspired to do my part in leading USAID to achieve our global health goals and improve women’s and girl’s health and rights across the globe.

Learn more about USAID’s work at Women Deliver and share with us your thoughts below.

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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.

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

 

How the Future of Women & Girls is Tied to Water

Almost 800 million people in the world today lack access to clean water.  Africa and the Middle East are the most water scarce regions in the world. Three hundred million people in Sub-Saharan Africa live in water-scarce environments and every year the number of people under water stress grows larger and larger.

Girl travels by camel in Mongolia Photo Credit: James Orlando

Fresh water scarcity affects everyone, but no one is touched more than women and girls. The consequences of constrained water access for them are dramatic. In much of the world, women and children are primarily responsible for water in their households. Some two-thirds of the households that lack easy access rely on women and girls to get the family’s water. Girls under the age of 15 are twice as likely as boys their age to be the family member responsible for fetching water.

This may not seem so important but about 40 billion hours are spent carrying water each year in Africa alone. Those are hours that could be spent in school or earning an income. They also represent time when women’s and children’s health and safety are threatened. In Asia and Africa, it’s common for women to carry 40 pounds of water on their heads while making a trek than can exceed 20 kilometers each way, especially in times of drought. This increases their risk of violence and sexual assault

In 2010, this reality was brought home to me when I served on USAID drought relief task force for the Horn of Africa. I visited a Kenyan community where under-nourished women and girls were spending the vast majority of their time fetching water; their donkeys had died during the previous drought cycle, leaving them to hand carry water back and forth almost daily for their homes. The need for water to survive subsumed their ability to perform other basic tasks, obliterating any hope for an education and further undermining their nutritional well-being by inhibiting their ability to garden and grow food.

The broader implications of water scarcity can be dramatic too. It has been estimated that, 443 million school days are lost and 700 thousand children die each year due to water related disease and poor sanitation. Poor water and sanitation keep children, especially girls, out of school; inadequate sanitation and the lack of separate toilets in schools particularly reduces girls’ attendance, sometimes pushing them to drop out at puberty. According to the United Nations Development Programme: “every $1 invested in water and sanitation generates on average an $8 return in the form of saved time, increased productivity, and reduce health cost.”

 

While women and children are most burdened by the need to obtain drinking water and basic sanitation, they are often excluded from decision making about water. What’s more, if women were more regularly included in water management it could improve deliberations. They know a lot about the reliability of water supplies, where it can be found, and how availability varies by season. Their personal knowledge can improve water-related management. Community-based organizations that successfully involve women in discussions regarding water access, sanitation, and hygiene, are more likely to result in robust economic growth and improvements in the quality of life. Sustainable economic growth and development goals simply cannot be achieved without a focus on water and gender.

Now that USAID has released its new water strategy, we must remember that while easy access to clean water can have profound implications for the ability of societies to thrive, it can have particular importance for women and girls. Their lives and futures are often inextricably tied to whether or not water is available close by to meet families’ and communities’ basic needs.

 

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.

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.

Join My Village Lift Women and Girls out of Poverty

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.

In the last 23 years, global mortality rates have decreased by 47 percent. With funding from international governments and non-governmental organizations, developing countries across the globe have received unprecedented aid in the form of education and healthcare support to decrease mortality rates.

Join My Village (JMV), a program of CARE in partnership with General Mills and Merck, is working to resolve this issue by building awareness online and providing on-the-ground programming that includes support groups for men and women as well as community engagements to reduce misconceptions about pregnancy and maternal health. JMV helps to lift women and girls out of poverty through education while also providing sustainable improvement in maternal and newborn health through effective service delivery and women’s empowerment initiatives. The programs are having a remarkable impact on communities in India by changing the behavior and attitude of whole communities around the treatment of women.

Preventing maternal deaths not only saves women’s lives, it can positively impact families and whole communities. Photo credit: PATH/Evelyn Hockstein

Along with working to uplift women, JMV is has also made a point to engage men in these communities. Men have a larger say in decisions that ultimately affect women’s economic, educational and reproductive health. To ensure that the women have a conducive and supportive environment at home, their husbands are invited to participate in the interactive meetings.

Recently, we heard from a young husband and wife participating in the JMV program in Uttar Pradesh, India. After going through a difficult first pregnancy where the mother did not receive prenatal care, the young woman almost lost her life and her baby. Of the second pregnancy, her husband said, “Though that incident taught me the risks involved in home deliveries, today’s meeting taught me how to be better prepared even before the child arrives. My wife stopped taking her iron tablets as she said they made her nauseous. I didn’t bother much about it until I came here today and learned how important they are for both the child and my wife. Now I will ensure she takes them at the appropriate time to avoid uneasiness. Planning for the future is another critical thing I learned, and I will start saving for the child right away.” The couple, happy to have attended the meeting, feel that they are now better equipped for the birth of their second child.

Preventing maternal deaths not only saves women’s lives, it can positively impact families and whole communities. When a mother dies, her family oftentimes breaks apart and her children are less likely to go to school, receive immunizations against diseases and eat nutritionally sound diets. By equipping women and their partners with lifesaving information, women will bear children at the healthiest times so that mother and child are more likely to survive and stay healthy.

Through these outreach programs, JMV encourages communities to be supportive of the health, education and empowerment of women and girls. To learn more about Join My Village and its partners please visit www.joinmyvillage.com.

Akanksha Nigam is a Media Officer for Join My Village, a program of CARE.

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

From Haiti to Kenya – Honoring the Wisdom & Contributions of Moms

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.

While visiting Haiti last month, I met with a group of farmers to discuss how they were using micro-loans from a local cooperative association. During the conversation, a woman mango grower spoke about using credit to pay her kids’ school fees prior to harvest and then using profits from the sale of her fruit to pay off the loan. It reminded me of a conversation with Maasai women during a trip to Kenya where they recounted the use of proceeds from their cattle fattening business to pay school fees for kids in their community. Both exchanges brought to life the critical role that mothers—and women generally—play in promoting development around the world.

A woman and her baby. Photo Credit: Adriane Ohanesian

Mother’s Day provides a special opportunity for us to reflect on the role moms play in our lives and in the lives of people around the world. In the home, mothers are often the primary caregivers. They are important in ensuring that children receive the food, health care and education needed to grow into healthy, productive adults. They are educators, teaching children skills that will last a lifetime. The American Sociology Association estimates that moms spend 10 more hours a week multitasking than fathers, mainly doing housework and taking care of kids. At the same time, they are often also generating income for the family. That income is critical to kids’ well-being because girls and women have been found to spend 90 percent of their earned income on their families, while men only spend between 30-40 percent that way. Given their multiple, critical roles, we need to think about how we can support moms and leverage their contributions. Invest in mothers and we can grow economies, alleviate poverty and create the foundation for sustainable growth and development.

In the past twenty years, mothers have been instrumental in helping reduce the mortality rate for children under five years old by almost fifty percent. Unfortunately, today, every two minutes, a mother dies during childbirth. A staggering 80 percent of those deaths could be prevented by providing access to basic health services. Similarly, almost 19,000 children under five still die daily from preventable causes. Sub-Saharan Africa and South Asia bear 75 percent of the global disease burden, and mothers and children continue to suffer disproportionately from these illnesses borne of poverty. USAID is working hard, in partnership with country governments and non-governmental organizations globally, to reduce these preventable deaths.

Through continuous improvements to monitoring and evaluation, we are  directing resources toward increasing services for underserved populations; concentrating on the primary causes of child deaths in the hardest hit countries.  We are being strategic with taxpayer dollars by investing in programs that yield the greatest results. Our development efforts are increasingly focused on educating girls, empowering women, and promoting inclusive economic growth. That’s because we know that educated mothers are less likely to die in childbirth, more likely to send their kids to school, and provide better nutrition and health care at home. In fact, data suggests that each additional year of schooling reduces the likelihood that a mother’s child will die as an infant by 10 percent.

At USAID, we are supporting mothers worldwide. Since June 2012, the agency has been helping lead the U.S. Government’s push to renew the global effort to end preventable child death. We are committed to utilizing resources, technology, and expertise to achieve the A Promise Renewed for Child Survival goal of reducing the under five-mortality rate to below 20 deaths per 1000 live births by the year 2035. Reaching this target is a team effort by governments, civil society, the private sector, innovators, and the global health and faith-based community. Workings together, the international community can help ensure a promising future for all women and their children.

We know the statistics and we know what we need to do. We know that investing in mothers pays dividends for children, families, communities and nations. The data is clear but it’s the stories from the women in Haiti, Kenya, and around the world that bring those numbers to life. This Mother’s Day, let’s honor their wisdom and their contributions.

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

 

Malian Midwife Champions Respectful Care for Pregnant Women and their Families

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.

The man brings his pregnant wife into the health center and is confronted by the irritated midwife who raises her voice: “I’m too busy, what do you want? Go outside, this is no place for a man!” Later, the man returns for news about his wife’s condition and is promptly told to “go back and sit there.”

This role play session about abuse and disrespect in maternity care was part of a training in Burkina Faso sponsored by MCHIP. Through role play, MCHIP trainers demonstrated to doctors and midwives what not to do when attending to their patients, as disrespectful treatment of pregnant women and their families is all too common in health facilities around the world. This is especially true in developing countries, where doctors and midwives often lack basic infrastructure, supplies, manpower, or even awareness about patients’ rights to be treated with dignity during birth.

Pregnant woman with companion at the renovated maternity ward in Bobo Dioulasso, Burkina Faso. Photo credit: USAID

Training participant Haoua Ba had never heard about respectful care until this MCHIP training, even after 22 years as a midwife in Mali. Haoua and about 30 other midwives, pediatricians and obstetricians are known as Africa “Champions” (or advocates) for improving maternal and newborn health by promoting up-to-date knowledge, practices and attitudes in their countries and region. Mali is one of 10 key African countries—along with Benin, Guinea, Kenya, Liberia, Madagascar, Senegal, South Sudan, Uganda and Zambia—where the MCHIP Africa Champions Program is being implemented over two years (2011-2013).

MCHIP maternal and newborn health trainings have always emphasized “women friendly care,” for example by introducing skills checklists with which providers are evaluated on their ability to provide respectful care. However, given the prevalence of disrespect and abuse—in Africa in particular—and the lack of knowledge about this issue, Africa Champion trainers developed an entire training module devoted to this topic. In this 1.5 hour session, a facilitator helps training participants understand during group discussion that there is evidence that key components of respectful care, such as involving a woman in her care, will make the birth experience go more smoothly for both the woman and the health care provider.

Haoua described how this training session taught her to respect pregnant women and their families by greeting them politely and continually informing them in a soothing voice about everything she is doing. And since the training last year, Haoua has seen a big difference after putting into practice these new skills.

“When you show respect, it really facilitates things,” she said. “If you calmly tell the woman what to do and explain things her, it comforts her. And word gets around so women know who is going to treat them well and they request that midwife when they come into the hospital.”

After participating in three Africa Champions maternal and newborn health trainings on innovative, lifesaving practices, Haoua is uniquely positioned to transfer these lessons learned. She plans to do so with both staff and student interns at the busy Referral Health Center in Bamako, Mali, where she also works as a midwife with 22 other midwives and three gynecologists. In fact, one of her primary goals as a Champion is to help strengthen the health center team by promoting evidence-based care. She described how she and one of the doctors will organize trainings about twice a month on a particular theme and have attendees practice on mannequins under their supervision to ensure they are correctly using their newly acquired skills and knowledge.

Importantly, Haoua has taught her colleagues that a woman should be allowed to have a companion by her side during the birth, which is a central tenant of respectful care. Having a loved one present provides women with essential comfort and support during the birth process, especially when the health center staff are busy or overworked. Evidence supports this practice as one that can help to shorten labor and increase normal outcomes.

A pregnant woman who must give birth without the company of a loved one or who must lie on the floor because there are not enough tables, without the privacy of a curtain, is not receiving respectful care. But even in the worst conditions, said Haoua, “if you have the will to do things well, you can help women.”

She is a perfect example of how the USAID-funded Africa Champions program is helping to prevent the untold suffering of women during one of the most vulnerable but extraordinary times in their lives.

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

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