USAID Impact Photo Credit: USAID and Partners

Archives for Women

Deputy Administrator Announces Initiative to Include Women in Peace Processes and Meets Returnees in Southern Sudan

In a speech at Ahfad University for Women in Omdurman, Sudan, on April 9, USAID Deputy Administrator Donald Steinberg announced a new USAID global grant initiative to increase women’s participation in peace processes.  Grants of up to $2 million each, totaling up to $14 million, may be made available for projects that support UN Security Council Resolution 1325, which calls for women’s involvement in all aspects of peace and security, recognizing their leadership in peacemaking, and ending sexual violence in conflict.

“We all know that when social order breaks down, it is women who suffer most,” said Steinberg, who visited the university during a three-day visit to northern and southern Sudan.  “But we have to reject the vision of women as victims.  Women are not victims.  Women are the key to building just and lasting peace, stable and prosperous economies, and vibrant civil societies.”

The new program provides funding for female negotiators and mediators to fully participate in peace processes, taking into account their potential need for assistance with child care, transportation, accommodations, and security.

Steinberg said USAID will continue to assist people throughout Sudan, as the largest country in Africa prepares to divide into two nations July 9, following the overwhelming vote of southern Sudanese in January to secede and form an independent country.

In Juba, Steinberg visited Juba Port, where thousands of Sudanese have returned from the North to their areas of origin in the South.  Since October 30, more than 307,000 Sudanese have returned from northern to southern Sudan and the “Three Areas” along the north-south border (Abyei, Southern Kordofan, and Blue Nile).  Steinberg learned about the challenges returnees face, including scarcity of livelihood opportunities and access to basic services such as water, education, and health care.

One widow with eight children told Steinberg she has no family members living in the south and didn’t know where she and her children would go or who would help them.  Staff with the UN High Commissioner for Refugees (UNHCR) indicated that returnees in such situations qualify for UNHCR’s vulnerable assistance program that provides help with immediate needs such as transport and emergency shelter.  USAID staff in Juba planned to follow up with UNHCR on her case as an example of how returnees are assisted.

Vivian’s Story—Breaking the Cycle of Poverty by Educating and Empowering Girls

Vivian O. was born in the outskirts of Kisumu, Kenya, and is said to have entered the world smiling.  Life for Vivian and others in her rural fishing village was challenging, requiring families to rely on ingenuity and perseverance in the face of little resources.  With the support of her family and her local community, the opportunities created by U.S. assistance programs, and the force of her determination, Vivian would achieve more than she’d ever imagined.

By the time Vivian finished fourth grade, her mother had a stable job selling used clothes in the open-air market in Kisumu.  Girls in rural communities like Vivian’s typically receive a low level of schooling.  However, having completed high school herself, Vivian’s mother prized education and overcame obstacles to enroll Vivian in a proper primary school.  Vivian was one of the top students in her province and eventually secured a place at Starehe Girls’ Centre, a highly competitive secondary school for gifted girls.

While in high school, Vivian became a member of the Global Give Back Circle, a circle of empowerment designed to transition a girl from poverty to prosperity.  The program mentors and supports girls so they can successfully transition from high school to college to a career and to global citizenship.  As the girls graduate, they commit to mentoring the next generation of girls in the circle.

In 2011, USAID announced a $3.5 million award for the education and empowerment of girls through the Global Give Back Circle.  The award is matched by an additional $3.5 million in private sector funds through a Clinton Global Initiative Commitment, so that the program can help over 500 Kenyan girls progress to higher levels of education and employment.  The process is implemented by the Kenya Community Development Foundation—a program by Kenyans for Kenyans.

Vivian has had many opportunities through the Global Give Back Circle.  She completed a nine-month Microsoft IT course, which allowed her to access educational resources online, research colleges, and obtain a full scholarship to a U.S. college.  She is studying pre-med and IT, aspiring to give back by helping millions through the connection of technology and medicine.  Vivian met the U.S. Ambassador to Kenya, Michael Ranneberger, and pledged to actively participate in improving investments in people in Kenya.  As a result, she made presentations to private sector CEOs in Kenya and invited them to invest in girls.  Vivian says, “I feel privileged and honored to be able to be a voice for the empowerment of girls in my country.”

On March 8, 2011, Vivian joined two other young women of excellence—Maryam from Afghanistan and Terhas from Ethiopia—as special guests to the State Department’s International Women of Courage Awards, followed by a private meeting with Secretary Clinton.  Vivian then visited the White House as a guest of First Lady Michelle Obama for a celebration of International Women’s Day.  Two sixth-grade girls, who have benefited from a girls education program in Burkina Faso administered by the Millennium Challenge Corporation in partnership with USAID, also attended.

At the event, Mrs. Obama said, “We as a nation benefit from every girl whose potential is fulfilled, from every woman whose talent is tapped,” adding that countries worldwide are more prosperous and peaceful “when women are equal and have the rights and opportunities they deserve.”

Read Maryam’s Story

Inspired and Humbled by Nepal’s Female Health Workers in the Rural Villages of Salyan

After a one-hour prop plane ride from Kathmandu, followed by an 11-hour rocky drive through the stunning hills and valleys of Mid-Western Nepal’s upper hilly region, our team reached Salyan District’s remote and rural villages. We were there to video the successes of the USAID-supported, 50,000-strong Female Community Health Volunteer project.  Working in every district of Nepal, these volunteers are often the only health care providers in such remote and isolated villages.

Female Community Health Volunteers of Marke District, Nepal, work to enhance health awareness, improve health standards, and save lives throughout their communities by utilizing the training they’ve received through the USAID-supported Nepal Family Health Program. Photo Credit: Gregg Rappaport/USAID

I’ve spent the last several days traveling with our group comprised of health specialists, program managers, and communicators (Gregg Rapaport, Senior Communications Manager, and Stuti Basnyet, USAID/Nepal) videoing, interviewing, listening and learning.  The stories are nothing short of amazing, and the volunteers’ passion to fulfill what they consider a calling to serve their communities has been inspiring.

It’s been humbling to hear the stories of these dedicated volunteers giving care under arduous circumstances and to meet the many villagers seeking care – a health volunteer who recently saved a newborn baby’s life minutes after delivery; another who has committed more than 22 years to serving her community through this project; a group of women who, in the last six months, have counseled more than 85 couples on family planning; a man seeking care for severe knee problems who arrived in the village on a stretcher after traveling nearly two hours, carried high above the heads of his four nephews. These volunteers are changing the behavior of their villages, increasing awareness to improve health standards, and most importantly, saving lives.  Of the 500 local children checked for pneumonia in the last six months, 73 were treated with antibiotics, 13 were referred to higher level health care at the district level, and all have made a full recovery.

One woman I spoke with, Laxmi Sharma, a volunteer in Salyan’s Ward 4, said that it’s not a matter of money, but rather a matter of helping her community. “We do this as volunteers,” she explained, “because we can improve the health of our communities.”  The women play a crucial role in providing vitamin A supplementation, immunizations, family planning education, safe motherhood interventions, and community-based integrated management of childhood illnesses, particularly in the detection and treatment of pneumonia and diarrhea – Nepal’s top two childhood killers.

With support from USAID and other donors, Nepal is also one of only a handful of countries poised to meet more than one of the Millennium Development Goals (MDGs) in health by reducing the number of maternal and child deaths by nearly half in only 10 years! A remarkable achievement alone, that it was realized at the end of the nation’s prolonged 10-year internal conflict makes it even more profound.

Our return trip back through the town of Dang this afternoon was marked by a rather serendipitous event – hundreds of women, men, and children marched in solidarity to celebrate the global 100th anniversary of International Women’s Day.  One woman I spoke with explained, “Through this (march) forum  … we can work to ensure women have equity, empowerment, and are at the center of mainstream politics. If all the women come together, this is something that is achievable, we just need to work at it.”

Check out this video on USAID/Nepal and their work on family health.

Around the world today, millions of people will flood the streets in their hometowns to voice their enduring support for the advancement of women and girls as key leaders in the creation of a better world.  As new ideas and innovative ways are introduced, USAID/Nepal continues to incorporate these pioneering initiatives in its program design, placing women and girls at the forefront of building the country’s peace and prosperity.

But USAID/Nepal is not only working in the health sector – it is also leading the way in partnership with the Nepalese people to finding solutions to the toughest challenges to driving economic progress, promoting educational opportunities, promoting political stability, sustaining the environment, and feeding the population.

The Education for Income Generation Activity has trained more than 65,000 disadvantaged youth from the Midwestern region—the most conflict affected and one of the poorest regions of Nepal—in basic and business literacy, vocational training and agriculture productivity and enterprise development in the last three years. Of these, 7,900 youth received vocational training with 80% gainfully employed as a result of the training.

Through the Women’s Leadership Academy program, USAID has provided training on the fundamentals of democratic politics and constitution drafting to over 200 elected women parliamentarians and civil servants, providing them with the tools needed to draft the constitution and participate fully in party and parliamentary proceedings.

We know that supporting investment in women and girls can be compelling force multiplier for development and innovation. At the heart of Nepal’s advancement, women will continue to advocate on behalf of their communities, and promote advancements in education, economic growth, politics, climate change, and initiatives to improve access to food.  USAID/Nepal will continue to move this agenda forward, and advance this priority by standing in solidarity with by the women and girls of Nepal.

Educating 1+ Billion Girls Will Make the Difference for Women’s Equality

This week we celebrate International Women’s Day and it’s as good a time as any to remind ourselves of the remarkable accomplishments toward achieving gender equality—and of the challenges that remain to ensuring that the 3.4 billion girls and women on our planet have the same chances as boys and men to lead healthy and satisfying lives.

This year’s International Women’s Day theme, “equal access to education, training, and science and technology,” is a powerful affirmation of the many benefits of educating girls, which come from improving women’s well-being, such as through better maternal health and greater economic empowerment. A recent Lancet article concluded that half of the decline in child mortality in low-income countries over the past 40 years can be attributed to better education of girls. Another recent study concluded that countries that have more educated women have coped with extreme weather conditions better than other countries—and  these are just two studies that have found empirical evidence for why investing in girls’ education is smart policy.

Girls’ enrollment in primary education has risen from 79% to 87% in the past decade, and gender equality, as measured by the ratio of girls’ to boys’ enrollment rates, seems almost within sight. Even in rural areas in poor countries, more girls are entering school. But these gains have not been the same across countries or even within countries. Being poor, living in a rural area, being from an indigenous community and being a girl means having much less schooling. According to the 2010 UNESCO Global Monitoring Report, for example, poor Hausa girls in rural Nigeria complete only one-third of a year of schooling as compared with more than 10 years for rich, urban boys and girls. Indeed, in many countries across the world, multiple sources of disadvantage leave girls’ schooling lagging behind that of boys. The uphill battle for these girls in areas torn by conflict is even worse.

Special challenges exist for girls. These challenges may be a heavy workload that takes time away from schooling and learning. In Mozambique, for example, young teenage girls work 50% more hours each week than boys, not only cooking and taking care of younger siblings but also collecting water or firewood for their families. Because they are often not expected to use academic skills later in life, girls and their parents may not place sufficient value on schooling—and probably just as typically, their teachers may believe that it is more important to teach to the boys than to the girls in their classrooms. 

When I first joined the World Bank 20 years ago, girls’ education was the first issue I worked on. With three other women who were passionate about the issue (two at USAID and one at an NGO), I organized the panel session on girls’ education at the Education for All conference in Jomtien, Thailand. We have come a long way since. We now know more about the effectiveness of programs such as targeted scholarships or vouchers, conditional cash transfers, and removal of tuition fees that influence the family’s demand for girls’ education. We also know that making more people aware of the benefits of girls’ education, measuring gender inequalities, and rallying more voices to speak about those inequalities are powerful ways to remind people of this critical development issue.

Educating girls is a priority for the World Bank and is a fundamental tenet of our forthcoming Education Strategy 2020, which is dedicated to ensuring that all children, everywhere, are afforded the right to learn and reach their full potential.

Elizabeth King is Director of Education for the World Bank. Elizabeth blogs on Education for Global Development, at blogs.worldbank.org/education.

How Will We Shape the Next One-Hundred International Women’s Days?

As the 100th celebration of international women’s day approaches, I’ve been musing over the origins of the day and what it symbolizes. The first international women’s day was formally celebrated on March 19, 1911 throughout Europe, where both women and men advocated for women’s right to work under fair conditions.

In 2011, as USAID reiterates its support for advancing women’s rights, it is appropriate to reflect on how international development programs can continue to support this objective of international women’s day. The time is ripe to ask ourselves how we, as development practitioners, can continue to advance women’s role as income earners around the world.

From my twenty-six years of working in international development around the world, I believe that the key to a women’s ability to earn income is how the law defines her as an independent economic actor. Can she own and register a business? Qualify for credit without the signature of her husband, father or brother on a loan? Can she purchase property in her own name? Can she file taxes herself? Inherit property from her mother or father? What happens if she is widowed? To address these questions, USAID has sponsored several initiatives over the years that advance women’s legal rights, including rights related to income generation. These projects have initiated the dialogue over legislation which defines women status as individuals, statutes concerning marriage and divorce, inheritance and children, among other things.

USAID projects work to protect women’s rights by engaging government, civil society organizations, communities, and local leaders to change legislation that advances women’s rights. In some instances legislation change is directly related to enabling women’s economic engagement. However projects must also consider how to establish environments that are conducive to women’s economic participation. USAID has supported several projects which advance other aspects of women’s empowerment and ultimately contribute to her ability to earn an income. Projects such as the Women’s Legal Right Initiative worked in nine countries around the world on activities such as establishing policy to prohibit sexual harassment in the workplace and schools, and criminalize violence against women. In Benin, for example, this was put to practice by working with local NGOs to draft sexual harassment legislation that became law.

The first international women’s day was celebrated by both women and men. Recent studies on advancing women’s rights confirm that family dynamics for women get better when social policies and programs support greater involvement by men in these issues. A new publication by the UN documents this process showing how women’s status increases when she has earning opportunities that are reinforced with social policies that support both women and men.

As we begin to think about how we will shape the next one hundred international women’s days, it is good to remember the lessons we have learned to advance the conditions for working women; in terms of women’s role within the family and women’s role as income earners. USAID’s fresh focus on monitoring and evaluation of development programs will help document how specific activities help bring women into the development process as equal partners and the impact this has on family welfare and economic development.

Dr. Tisch is a social scientist with 22 years project management and technical expertise including 17 years of project experience in Asia. Serves as home office director of the USAID Indonesia Changes for Justice project and the USAID Anti-Trafficking in Persons project. Dr. Tisch is a three-time USAID chief of party (Women’s Legal Rights Initiative; dot-GOV program; Farmer-to-Farmer Program Russia and Ukraine). She served as project manager for the e-government Knowledge Map for the World Bank InfoDev program, project leader for the USAID/ANE Bureau ASEAN ICT Enhancement project, and program leader for the Global Women’s Leadership Initiative (Atlantic Philanthropic Services).

Unleashing the Power of Women and Girls

Women and girls are an extremely powerful force for development. A woman’s economic wellbeing is fundamental to her family, her community, her children, and her children’s children. Women are vital to economic growth, income generation, and security and stability. More than 70 percent of the farmers in Africa are women, often toiling on small plots to grow fruits, vegetables and grains for their families.

They are central to the household economy — they not only grow most of the food, they prepare it and serve it, and keep the house clean and take care of the children. Young girls are responsible for much of the labor families need to survive: tending livestock, carrying water, harvesting crops, watching younger children, and doing chores.

Increasing family incomes, fighting poverty, improving nutrition, and building the skill base needed to sustain development – teachers, doctors, nurses, accountants, engineers – all depend on investing in and providing opportunities for women and girls. When women do earn income, they are more likely than men to spend it on food, education, and health care for their families. They are a huge and growing part of the population in many developing countries: in Nigeria, girls and young woman under 30 years of age account for 35% of the population; in the United States they account for just 20%. And gender equality matters for development: evidence shows that the incidence of poverty tends to be lower and the rate of economic growth higher in countries with greater gender equality.

A woman voting in the 2005  Liberian elections. Photo Credit:©2010 Benjamin Spatz

And yet women and girls face huge systematic disadvantages and hurdles that undermine their own progress, and the progress of their families, communities, and countries. According to the path-breaking report Girls Count, girls and women are less educated, less healthy, and less free than their male counterparts. Many are forced to marry at a young age and are extraordinarily vulnerable to HIV, sexual violence, and physical exploitation. They typically cannot own land, get credit, or even apply for many jobs. Between one-quarter and one-half of girls become mothers before age 18, and 70% of the people in the world living in poverty are women and girls.

I’ve seen first-hand the power of creating opportunities for girls and women. As a Peace Corps teacher in an all-girls school in the tiny village of Leulumoega in Samoa, I saw how girls with a basic high school education could get good jobs, help provide for their families, and become leaders in their communities.

I’ve met young women working in garment factories in Indonesia and data-entry centers in Ghana that speak about the empowerment that comes from earning their own incomes, and how they are able to wait longer to be married, have fewer children, and take better care of their families. And I’ve seen close up how, when given the opportunity, a woman president – Ellen Johnson Sirleaf of Liberia – can lead her country from the brink of ruin at the end of a terrible civil war and regain peace, stability, credibility, and the beginnings of economic growth and vibrant democracy.

We can and must do better to support women and girls. That’s why through President Obama’s Feed the Future Initiative we are focusing on investments that provide new opportunities for women farmers and help improve nutrition for their families. That’s why our microfinance and SME programs emphasize creating new opportunities for women to earn incomes to support their families. That’s why the Quadrennial Diplomacy and Development Review and USAID Forward puts a huge emphasis on investing in women and girls, and incorporates gender equality into our core aid effectiveness principles. We know that to accelerate development and build strong, stable and well-governed societies, we must unleash the power of girls and women.

Improving Rural Livelihoods by Empowering African Women Researchers in Agricultural Science

With sharp minds, inquisitive souls, and iron wills, they are an 11-strong group of top-level women scientists in agricultural research with their eyes set on influencing national and regional policy to improve livelihoods in Mozambique and across Africa. Through their work, they are helping to change the face of a continent where women are seldom heard, but are always called on to give and to nurture. They are Mozambique’s scientists in the AWARD program for African Women in Agricultural Research and Development, funded by USAID and the Bill and Melinda Gates Foundation.

Dr. Anabela Manhica proudly exhibits a laptop received from the AWARD program. Photo Credit: USAID/Mozambique

Esperanca Chamba, who specializes in natural resources management, is one of 11 women scientists in Mozambique who were selected from among hundreds of applicants from 10 sub-Saharan countries as fellows of the African Women in Agricultural Research and Development (AWARD) project. AWARD was established in 2008 by the Gender & Diversity Program of the Consultative Group on International Agricultural Research, following a three-year pilot program in East Africa. It is a professional development program that strengthens the research and leadership skills of African women in agricultural science, empowering them to contribute more effectively to poverty alleviation and food security in sub-Saharan Africa. The US$15 million, five-year project is funded by the Bill & Melinda Gates Foundation and USAID, with plans to extend to a second phase starting in 2013.

Chamba’s example of a foiled attempt in experimental nutrition finely captures the context of women and agricultural research and development in Africa. “Most of the work in the fields is in women’s hands,” says rural extension officer Claudia Nhatembe, during a break from the sweet potato fields on the rich soils of IIAM’s Umbeluzi Agricultural Station, some 30 km outside the capital, Maputo. “It’s hard work–plowing, sowing and harvesting. For men, it’s mostly handling the plantation’s irrigation systems.”

In Africa, women like Nhatembe carry most of the burden of running the household, raising children, tending to their husbands, fetching water, collecting firewood, cooking and cleaning, and plowing and sowing. They are the pillars of society, yet are commonly ignored. “We give rural women a voice, because through our work, they will also have a voice,” says Carla Menezes, a researcher and Head of Nutrition at IIAM, who is studying alternative feeding options for small ruminants to lower production costs of animal breeding in rural households.

“Scientists are on the cutting edge of solving Africa’s food crisis. But we need to urgently address the gender gap in our scientific community,” says Akinwumi Adesina, Vice President of Policy and Partnerships of the Alliance for a Green Revolution in Africa. “We need more women pursuing careers in agricultural science because women are the face of African farming.”

Research shows that the number of women enrolling in agricultural sciences is steadily increasing, but women researchers tend to drop out as they move up the career ladder. Termed the “leaky pipeline”, this phenomenon is generally attributed to traditional, male-dominated organizational dynamics, in additional to cultural barriers to women’s education and advancement. AWARD seeks to reverse that trend.

“We need good collaboration to make sure that women are equal partners with men farmers all the way through the process,” U.S. Secretary of State, Hillary Clinton, said recently in Nairobi. “The AWARD program is a great example. It supports women scientists working to improve farming here in Africa and to fight hunger and poverty. And we need women represented in our laboratories, as well as in our fields.”

Recent studies indicate that the majority of those who produce, process, and market Africa’s food are women, but only one in four agricultural researchers is female. A study by AWARD and the Agricultural Science and Technology Indicators on “Women’s Participation in Agricultural Research and Higher Education”, which looked at key trends in sub-Saharan Africa, found that the overall proportion of female professional agricultural and higher education staff increased from 18 percent in 2000/01 to 24 percent in 2007/08. On a national basis, female staffing levels were particularly low in Ethiopia, Togo, Niger and Burkina Faso, whereas in Botswana, Mozambique and South Africa levels were high. However, the benchmarking survey—which was conducted in 125 agricultural research and higher education agencies in 15 sub-Saharan countries—showed that only 14 percent of the management positions were held by women.

“Only with the full involvement and leadership of women in agriculture will Africa succeed in its quest for food security and prosperity,” says Vicki Wilde, Director of AWARD and the CGIAR Gender & Diversity Program. “There is no time to lose.”

Mozambique, a former Portuguese colony in southeastern Africa, is a member of the Commonwealth and the only non-English speaking country represented in AWARD. With a population of 20 million, it was ranked 22nd out of 134 countries in the Gender Gap Index for 2010. Although the country scores poorly in terms of educational attainment (123rd), it boasts a good female-to-male ratio in terms of economic participation and opportunity. Analysts say there is an increasing trend in women’s contribution to economic growth, although there is a lowering contribution in sectors like agriculture, where there are more women but incomes are lowest.

“We know the people who matter most aren’t the financiers or the agriculture ministers or the assistance workers and partners. They are the women farmers who are the untapped solution to this problem,” says USAID Administrator Rajiv Shah. “We’re working to ensure that women get equal access to services and support, such as financial services that preferentially target women and extension services delivered by female workers. To make this happen, we are investing in women producer networks and expanding fellowship programs, such as the AWARD program.”

The 11 Mozambican fellows cover a broad range of agricultural sciences, from forestry management to agro-economics and veterinary medicine, including animal production, reproduction, and nutrition. “I am inquisitive by nature. I feel enraptured by the process of looking at a problem, imagining solutions, and seeking the adequate answer,” says Paula Pimentel, a senior researcher at IIAM, who is currently studying gender relations in goat-breeding families in the remote district of Chicualacuala, about 500 km from Maputo.

What drives all these women is a focus on pro-poor, community-oriented research objectives, and an awareness of the need to combine traditional knowledge with modern methods as a fundamental contribution to scientific advancements. “Learning from local techniques should always be the starting point,” says Anabela Manhiça, Senior Researcher and Head of the Technology Transfer Department at IIAM. “Rural producers have abundant knowledge. It’s always best to learn what they are doing, how they are doing it, and then add the new technology. It doesn’t work when you try to introduce something completely new.”

“These outstanding Mozambicans debunk the myth in some science circles that qualified African women researchers ‘aren’t out there’—that they don’t exist in significant numbers,” says Wilde. “Qualified women scientists are out there. These women prove it.”

Maternal Death Preventable and Treatable with Low-Cost Interventions

In September, the World Health Organization (WHO) reported that fewer women die each year from complications during pregnancy and childbirth than previously estimated, but efforts to sharply cut maternal mortality by 2015 are still off track. A new report found that 358,000 women died during pregnancy or childbirth in 2008, mostly in poor countries of sub-Saharan Africa and South Asia. While the number of deaths is disturbing enough, it is estimated that an additional 15-20 million women suffer debilitating consequences of pregnancy.

Despite the challenges faced in reducing maternal mortality, USAID has helped to demonstrate that real progress can be made.  Our work proved that many of the major causes of maternal death are substantially preventable and treatable with low-cost interventions.  USAID has sharpened its focus on a set of effective interventions targeting high-mortality complications of pregnancy and birth – hemorrhage, hypertension, infections, anemia, and prolonged labor.  Together, these complications account for two-thirds of maternal mortality.  Hemorrhage alone accounts for almost one-third, and USAID has been in the forefront of promoting “active management of the third stage of labor (AMTSL),” a highly-effective technique for preventing postpartum hemorrhage.

The active management of the third stage of labor is a combination of actions to speed the delivery of the placenta and prevent up to 60% of postpartum hemorrhage cases. Through these simple actions, trained providers can prevent postpartum hemorrhage and play a vital role in saving women’s lives.

Spreading best practices like AMSTL are critical to saving lives of women and improving health around the world.  The U.S. Global Health Initiative has set ambitious targets like a 30% decrease in maternal mortality in assisted countries, with a priority on supporting innovation and sharing best practices, as well as building up the health systems that deliver these interventions.

A nationally representative facility-based delivery survey funded by USAID and conducted in 10 countries found limited use of AMTSL in only 0.5 to 32 percent of observed deliveries, and revealed multiple deficiencies in practice. These surveys helped to identify barriers and served as important catalysts to action. With the evidence and this data, USAID has worked with professional societies, researchers, UN agencies, NGOs and the private sector to safely and effectively introduce and expand AMTSL use in at least 40 high-mortality countries.

USAID supported efforts have led to policy changes in 16 countries in Asia, sub-Saharan Africa and South America. The Agency and its partners also contributed to the development and dissemination of the 2007 WHO recommendations for the Prevention of Postpartum Hemorrhage providing a clear global policy on the correct application of AMSTL and the 2009 WHO guidelines for the management of PPH and retained placenta. The strength of multiple implementation strategies—policy change, systems strengthening, social mobilization, technology development, and research— has yielded many valuable lessons about opportunities, challenges, and strategies for scaling up AMTSL.  A key lesson we have learned is that, when there is political commitment, AMTSL is rapidly scalable.

But USAID asks hard questions and supports the renewed attention to the programmatic implementation of this approach.  With that in mind, USAID is supporting a WHO-led study on the impact of eliminating the most complicated element- of AMSTL, controlled cord traction. If this study has positive results, a simplified AMTSL regimen would significantly reduce the complexity of training and AMTSL practice in health facilities and in the community.

Community-based strategies for preventing PPH are also important since between 40-50% of births occur at home.  USAID has piloted community-based distribution of misoprostol and  use of the Uniject® device prefilled with oxytocin, to address these needs.   Misoprostol is an effective uterotonic to prevent postpartum bleeding; unlike oxytocin, it can be administered orally and does not require refrigeration. USAID-supported studies in Nepal, Afghanistan, and Senegal have shown the feasibility of community-based distribution of misoprostol, indicating that the drug should be considered when oxytocin is not available at the community level. In Nepal, where 82 percent of women do not give birth in health facilities, a USAID-supported study showed that it is feasible to achieve high-population coverage of misoprostol through trained community health volunteers under the Government primary health care system and still have increased use of facility births due to the education provided to women/ families through the program.  USAID’s partnerships in Nepal contributed to a change in national policy and the pilot study has now become the Nepal government’s national program.  With support from multiple partners, the program is now being scaled up throughout the country.  Pilot projects or studies on oxytocin in Uniject in Mali proved that a 6-month trained birth attendant (matron) could provide oxytocin as safely as the midwives or physicians.  Mali has also changed its policy to allow matrons to use oxytocin and practice AMTSL.

Maternal mortality is still unacceptably high.  Together, we need to seize the momentum and enhance family planning and maternal health programs to quickly reduce the still unacceptably high toll of preventable maternal deaths. Secretary Clinton challenged USAID to build on existing global health programs and create lasting change. We have made great strides with previous investments, but as she noted, in many places a woman might be treated for HIV but die in childbirth.  This is not acceptable.

Pic of the Week: U.S. Congratulates Winner of Charming Plus Pageant

winner hivU.S. Ambassador to Vietnam Michael W. Michalak congratulates Ms. Tran Thi Hue, winner of Charming Plus 2010 — the first pageant for HIV positive women in Vietnam. Tran Thi Hue, a 27-year-old HIV outreach worker from Ha Nam province, was crowned on November 14.  Photo is from Richard Nyberg/USAID.

The Ability to Plan Your Family Is a Game Changer

Having seven children would be a challenge for any woman. In a developing nation like Mali, where the average number of children per woman is 6.6, calling it a challenge may be an understatement. Because they fall pregnant at an early age, young mothers don’t have the opportunity to finish their education, they aren’t able to work outside the home, and they face an increased risk of pregnancy-related health complications that could be fatal. Without contraceptives to plan how many children to have and when to have them, this scenario becomes reality for billions of women in the developing world and feeds the cycle of poverty.

There are an estimated 215 million women who wish they had the ability to plan their family but don’t have access to contraceptives.  In some developing nations where health care systems are grossly inadequate, or in rural areas where they may be non-existent, the availability of something as simple as contraceptives can be a matter of life and death.  Women understand the grave risk that comes with pregnancy when there are no trained health professionals or doctors to consult and provide care.  The ability to mitigate that risk is a right that should be afforded to every woman.

A World Health Organization report in 2005 stated that 1 in 75 women in developing countries risk facing maternal death in their lifetime versus 1 in 7,300 in developed countries. At the extreme, in Niger a women’s lifetime risk of dying from pregnancy-related complications is 1 in 7 versus 1 in 48,000 in Ireland. Behind each of these statistics is a story of a mother who died giving life. Behind each statistic there are heart wrenching stories of broken families that lost a loved one. The stories are all the more tragic when the woman had hoped to avoid the pregnancy, but didn’t have access to contraceptives.

The 16 Days Campaign to End Violence Against Women: From 25 November to 10 December, USAID will post a blog each day that aims to prove a single point: The human race cannot progress when half of the world population lives without the same rights and respect afforded to its male counterpart. If you are moved by what you read and want to share, we’ve made it easy for you. Click here to find out how.

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