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Maryan’s Milk Mustache

During the first week of June, IMPACT will be highlighting the key role of nutrition in Global Health

Three-year-old Maryan is wearing a pretty blue headscarf and a milk mustache.

She is drinking one of the 30 cups of milk that Save the Children provides monthly to each of the nearly 11,000 women and children enrolled in its milk voucher program.

Successive droughts in the country have taken their toll on Wajir, in the northeast region of Kenya. As water sources dried up and crops failed, the livestock that the people have always depended on for their livelihoods perished. Milk became increasingly rare and children began to show signs of hunger.

Three-year-old Maryan drinks milk. Her mother Habiba (left) enrolled her in Save the Children’s milk voucher program when she showed signs of malnutrition. Photo credit: Susan Warner. February 2013

A survey taken in October 2012, found one in four children to be malnourished. To address this, Save the Children launched a nutrition project funded by USAID, which gives the local dairy industry a boost by issuing milk vouchers to those who need it the most. The vouchers, coupled with nutritional supplements, are distributed to malnourished pregnant women, breastfeeding mothers and children under the age of five. The vouchers can be traded for milk at the market, which traders and pastoralists can redeem for money. The cash infusion is slowly rehabilitating the pastoral economy as investments in livestock, fodder and veterinary services increase.

Today Maryan’s milk mustache is framed by cheeks that are round and full, but this wasn’t always so. When she first enrolled in the program a few months ago she was weaker and thinner than her peers. Her upper arm circumference, one of the measures used to determine nutritional status, had shown her to be moderately undernourished. After three months in the program her weight increased by 10%, an astonishing gain, when one factors in an illness that set her back slightly in February.

“The program has helped my child. She is more playful and happier and even though she is not fat, she is quite strong.” says Habiba Osman, Maryan’s mother.

Though Maryan remains somewhat slender, “she has shown great progress in terms of her weight gain,” says Saadia Ibrahim Musa, the community health worker who first treated Maryan at the local health clinic, where Habiba brought her for a screening in October last year.

Habiba and Maryan see Saadia regularly now, since they walk to the health clinic, where the supplements and vouchers are distributed, twice weekly. There, Habiba also attends nutrition classes with other Wajir mothers. “We discuss the dangers of malnutrition to a child’s development, the importance of feeding a child a balanced diet, and the importance of handling food in a hygienic manner,” says Saadia.

“Saadia has taught me a lot of things,” says Habina, “I now know to take Maryan to the hospital as soon as I notice something is wrong and how important it is not to share Maryan’s [nutritional] supplements with anyone else in the household as this makes her recovery more difficult.

The changes are visible throughout the community. “The children are happier and more playful now. The mothers are happy as their children now get the milk they couldn’t afford before the project. The traders involved in the project have increased their incomes and their lives are better. Everyone is happy,” says Habiba. “And Maryan loves the milk!”

Learn more about USAID’s efforts to improve nutrition.

Follow USAID (@USAID) on Twitter and use #GHMatters to join in the conversation about global health issues including nutrition.

What I Saw and Learned in Southeast Asia and Why I Left Inspired

This originally appeared on the Clinton Foundation Blog

Over last week, I traveled across Southeast Asia, delivering clean water as part of Procter & Gamble’s Clinton Global Initiative (CGI) commitment in Myanmar, attending the Women Deliver conference in Kuala Lumpur and ending my trip in Cambodia, where I saw how the Clinton Health Access Initiative (CHAI) is working with the government to fight HIV/AIDS and improve health care delivery at the national level through better supply chain management and at the local level in different hospital and clinic settings.

Chelsea Clinton visits a Clinton Health Access Initiative project. Photo credit: Thu Van Dinh

In Myanmar, I helped Naw Phaw Si Hser and her family turn dirty, unsafe water into clean, drinkable water. Procter & Gamble (P&G) first came to the village a couple of months ago and the families, particularly the mothers, all said their children no longer get sick from the water – and that the water tastes better now too! The liter of water that Naw Phaw Si Hser and her family received marked the six billionth liter of clean water from P&G’s CGI commitment. Through their CGI commitment, P&G aims to save one life every hour, every day, every week, every year by delivering more than two billion liters of clean drinking water every year by 2020, preventing cholera, diarrhea and other water-borne illnesses that still too often bring disease and death around the world.

While I was in Myanmar, P&G announced a new partnership with USAID to improve maternal and child health in Myanmar and provide 200 million more liters of clean drinking water over the next two years, furthering its CGI commitment. It is these types of innovations and partnerships that will continue to save millions of lives and fundamentally change health care in developing countries.

Mission Director for USAID Burma, Chris Milligan, greets children in Burma. Photo credit: Thu Van Dinh

After Myanmar, and a trip to Kuala Lumpur for the Women Deliver conference, where I joined leaders and experts to discuss the health of women and girls, my last stop was in Cambodia – a remarkable country and a model in the fight against HIV/AIDS. CHAI began working in the country in 2005, at a time when only 6,000 patients – including 400 children – were receiving the treatment and care they needed. Today, there is close to universal access for antiretroviral (ARV) treatments for adults and children with HIV/AIDS and I am proud that CHAI has been part of drastically changing the treatment equation in Cambodia. CHAI works in part by helping countries like Cambodia access ARVs at affordable prices, because CHAI and its partners have worked with the pharmaceutical industry to increase supply, and with governments to guarantee demand, which has led to a more than 90 percent drop in ARV prices in the developing world since 2002 when CHAI began. Cambodia is one of the first countries in the world to achieve universal access to ARV treatment for both adults and children and one of the first to meet its Millennium Development Goal (MDGs) targets for maternal and child health – truly a leader.

Now, Cambodia is uniquely placed to be one of the first countries to eliminate new pediatric HIV infections, and through collaborative partnerships, I have no doubt Cambodia will be able to reach its goal. Last Thursday, I joined the National Center for HIV/AIDS, Dermatology and STDs (NCHADS) where they announced, in partnership with CHAI and the government of Cambodia, the Cambodia Strategy 3.0, which aims to reduce HIV transmission between mothers and children to less than five percent by 2015 and less than two percent by 2020, while simultaneously reducing HIV-related mortality among children. The three ultimate goals of Cambodia Strategy 3.0 are no HIV/AIDS deaths, no new infections, and no stigma. Goals we all can and should get behind.

In Phnom Penh, I met with women and children who have benefited from the country’s Prevention of Mother to Child Transmission (PMTCT) programs, and saw first-hand how their country’s health system has transformed their lives. I saw the technologies, treatment, and direct impact that CHAI is having in this community and communities across the country. Outside Phnom Penh, I met Basil, a little boy my father first met in 2006 when he was a baby and his body was ravaged by AIDS and tuberculosis. Today, he is healthy, in school and as rambunctious as any child should be. I am grateful and proud that CHAI can play a part in the Cambodian government’s efforts to ensure there will be more children with stories like Basil’s in Cambodia’s future.

From reducing the prevalence of HIV/AIDS to providing clean drinking water to rural communities, these programs are examples of how, when corporations, NGOs, governments, and people work together, incredible strides can be made to challenges that were once thought intractable. These achievements give me hope that other countries will be able to replicate these models and provide similar health care access to individuals – and that, in my lifetime, we’ll achieve an AIDS-free generation and eliminate mortality caused by unclean water.

MCHIP’s Respectful Maternity Care Toolkit Promotes Positive Attitudes in the Care of Women and Newborns

Abuse and disrespect during maternity care has been documented and observed globally. In response, USAID’s flagship Maternal and Child Health Integrated Program (MCHIP) is launching the Respectful Maternity Care (RMC) Toolkit. This package of materials is designed to provide clinicians, trainers, managers and other stakeholders involved in the provision of maternity care with the tools necessary to begin implementing RMC in their area of work or influence. This toolkit contains program learning documents, such as: surveys and briefs on country experiences; training materials; tools to assess and improve RMC within programs and services; job aids; and a resource list.

Women who chose to give birth at home without a skilled health care provider, as well as their newborns, are more likely to suffer complications and die. In less developed countries, there may be many reasons women chose not to give birth in a health facility, such as distance, and lack of transport or money to pay for health services. However, all too often a lack of respectful care from frontline health workers—such as doctors and midwives—cause women and their families to distrust the health care system and opt for more risky homebirths, with unskilled traditional birth attendants (TBAs). Women often choose to deliver with TBAs not only because their services cost less, but also because they provide RMC and follow up care, and are trusted and known within their communities.

Mozambican mother holds her newborn. Photo credit: Jhpiego

Multiple factors may contribute to disrespect and abuse within healthcare services. Health systems may be underequipped, and healthcare workers may be overwhelmed due to inadequate pay, lack of infrastructure, or insufficient staff and supplies. An attitude of disrespect for clients and patients may permeate the healthcare system, and healthcare workers may not receive any guidance or supportive supervision related to RMC or their work in general.

The goal of this toolkit is to empower frontline health workers to provide RMC, allowing women and their families to experience better maternity care and to choose to deliver with a skilled provider at home or, preferably, in a health facility. The ultimate impact of more women using skilled birth services during child birth will be reduced newborn and maternal deaths.

RMC in Mozambique                                    
 ”Giving birth is such a special time for a woman, but it is also filled with stress and fear,” said MCHIP Senior Technical Advisor Veronica Reis. She often wondered during her more than 20 years of clinical practice in Brazil why ensuring women’s comfort and preferences during childbirth was almost never discussed at medical school: “Most of the training in medical school was technically focused, about diagnostic treatment and clinical procedures.”

Therefore, Dr. Reis was pleased to hear about a movement known as Humanization of Childbirth, which centers on putting women and their families at the center of care, especially during childbirth. This movement began in Brazil and has increasingly gained prominence in Latin America and elsewhere. Grounded in respect for human rights, this movement has evolved into what is known as Respectful Maternity Care, which promotes the idea of the client as a person with values and expectations that should be respected during the provision of health care.

Therefore, when asked in 2003 to help promote RMC at the Ministry of Health’s National Maternal Health Program in Brazil, Veronica jumped at the chance, convinced this was a worthwhile initiative that was long overdue. There she learned that the presence of a companion at birth, usually a family member or loved one, is an important part of RMC. She was amazed that in all the hospitals where she had worked, policies never permitted family members to accompany the woman in labor; they were always forced to stay outside and/or not be present. Nor did policies allow women to make many other choices in their care, including the right to choose their birth position.

Importantly, Veronica was able to take the skills and knowledge she developed in RMC and successfully help apply them in Mozambique, where she supported USAID’s Jhpiego-led maternal and newborn health program (ACCESS) starting in 2006.  At a large stakeholders meeting in 2007, attendees learned that one important reason women were not giving birth in hospitals—and therefore more often suffering from complications of and dying in childbirth—was fear of not being treated well.  ”Women were afraid of being treated badly and dying alone in the hospital,” Veronica explained.

With continued advocacy by Veronica and her colleagues, the Minister began to prioritize RMC through on-going health programs, most notably through MCHIP’s Model Maternity Initiative (MMI), starting in 2009.  This initiative, carried out in the largest 34 hospitals in the country, supports birthing practices that recognize women’s preferences and needs.  Not only are these hospitals continually evaluated on the quality of care they provide, but also on their ability to provide RMC. Some RMC behaviors include: respect for beliefs, traditions and culture; the right to information and privacy; the choice of a companion during birth; freedom of movement and position; keeping mother and baby together after birth; and the prevention of violence and disrespectful care.

Thanks in large part to strong commitment from the country’s key decision makers and local communities, and with financial backing from USAID through MCHIP, RMC is becoming more widespread in Mozambique. The influence of RMC can be seen increasingly in training institutions, professional associations, and civil society. In fact, the MOH, with the support of USAID and other partners, has now scaled up RMC to more than 80 facilities, and is working to scale up the MMI to more than 122 health facilities by 2014. Significantly, this figure covers about half of all facility births in the country. The MOH and its partners are taking action so that women won’t have to fear that they will be treated poorly during one of the most beautiful—and challenging—times of their lives.

The Toolkit includes:

  • “RMC: Country Experiences” survey offering an RMC overview from 19 countries
  • RMC Program Review Instrument to be used for country-level RMC self-assessment
  • “RMC: General Concepts and Considerations” presentation for guidance on the promotion of RMC
  • Learning Resource Package for RMC with all materials needed to conduct a one-day RMC workshop for clinicians
  • Operational Standards for RMC for antenatal care, childbirth care and postnatal care, which establish objective guidance to gauge health care workers’ clinical performance promoting RMC
  • Resource List for RMC with related references and links
  • Program Briefs detailing examples of RMC being implemented at the field level
  • Monitoring Indicators for RMC to measure the success of RMC interventions
  • Job Aids to serve as on-the-job reminders of the importance of maintaining RMC

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

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.

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

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.

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