USAID Impact Photo Credit: USAID and Partners

Archives for Women

Filling the Bellies of Hungry Kids

Julia Gibson is a member of Mom Bloggers for Social Good. Photo credit: Julia Gibson

Growing up as the kid of a car mechanic who worked on flat-rate, we did not have much money. On weeks my dad didn’t turn many hours, we survived on generic macaroni and powdered cheese (4 for $1!) and if we were lucky there was a can of tuna fish to mix in. While that might not have been the most nutritious dinner, I never went to bed hungry. I never went to bed with the gnawing of hunger pains from deep within.

But, millions of children are going to bed hungry around the world.

There are children who have that gnawing hunger pains every single day of their lives.

Hungry children can’t concentrate at school. They don’t care about math and science… they just want food in their bellies.

165 million children under five are under nourished. Poor nutrition can affect a child’s health and learning ability. Poor nutrition in the first 1000 days of a child’s life – from pregnancy to their second birthday – can cause irreversible growth and mental issues. From hunger.

Through USAID and the Feed the Future program, investments are being made in agriculture, health and social protection. Programs like encouraging the growth of orange maize in Zambia, assisting in food security in Guatemala for women and children and other programs are helping teach women how to provide healthier food for themselves and their families.

These aren’t handouts, folks. These are programs to encourage the women of these countries to help themselves. They are given the information and training to grow better crops and to get the food from the plants to the table without any issues.  They are being given the potential to succeed. They are being given the knowledge to fill their children’s empty bellies.

Feed the Future is helping women and their families rise above poverty and under nutrition and provide for themselves and their families. These children are being given the chance to succeed at school and in life– because of better nutrition.  Last year, they were able to reach 12 million children. Twelve million children went to bed with full tummies because of USAID and Feed the Future.

Whether you love or hate the United States government… you have to be amazed at Feed the Future. The initiative, led by USAID, is comprised of eight other governmental agencies all working together to help others.  They are Feeding the Future.

Recently, I saw a sign that said “Childhood shouldn’t hurt.”  Childhood shouldn’t hurt– this includes hunger pains. A child should be given every opportunity to succeed. Thankfully, programs like Feed the Future are giving them that opportunity.

I encourage you to check out Feed the Future’s website to learn more.

Julia Gibson is the mom of boy/girl twins, wife, accountant, scrapbooker, card maker, and nap sneaker. Relatively new to the blogging scene, she recently became involved with social good and is proud to be a member of the Global Team of 200, part of Mom Bloggers for Social Good, a global coalition of 1000+ mom bloggers, in seventeen countries, who spread good news about the amazing work non-profit organizations and NGOs are doing around the world. You can read more of Julia’s blog posts at Mom on the Run x2.

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

Video of the Week: Turning the Tide on Global Hunger

In this Feed the Future video, narrator Matt Damon discusses efforts to turn the tide against global hunger and increase agricultural production around the world. The video was shown at the “Feed the Future: Partnering With Civil Society” event on September 27, 2012.

This morning, during a global nutrition-focused event co-hosted by Bread for the World Institute and Concern Worldwide, USAID announced its ongoing commitment to work with the U.S. Government’s leadership to reduce undernutrition around the world. The event followed the Nutrition for Growth event in London. During his trip and on behalf of the U.S. Government, Administrator Shah signed the Global Nutrition for Growth Compact which commits donors and private partners to scale up nutrition programs specifically targeted to reduce undernutrition in women and children.

Also last week, Administrator Rajiv Shah and Tjada McKenna, deputy coordinator for Feed the Future, participated in a Google+ Hangout on the role of nutrition in child survival and food security nutrition with representatives from the ONE Campaign, GAIN and 1,000 Days, as well as Candice Kumai, who is a chef, food writer, Iron Chef Judge and nutrition champion for Future Fortified.

Learn more about USAID’s work on improving nutrition

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

Promoting Empowerment and Education in the Americas

This originally appeared on the White House Blog.

Last week I had the pleasure of accompanying my husband Joe on a trip to Colombia, Trinidad and Tobago, and Brazil. In each country, I witnessed the good work of the United States to promote economic growth and development through education and empowerment of women entrepreneurs.

Dr. Biden and Colombian First Lady María Clemencia de Santos met with carpentry students at Escuela Taller in Bogota. Credit: Jenny Murcia, U.S. Embassy Bogota Public Affairs Press Assistant

Colombia: Vocational Training for At-Risk Young Adults

As an educator for more than 30 years, I enjoy meeting students wherever I go. I love to hear about their experiences and see exciting and innovative programs that are working. One of those programs is the Escuela Taller in Bogota, which I had the pleasure of touring with Colombian First Lady María Clemencia de Santos. Escuela Taller is a vocational school that serves low income and high-risk youth and provides training for jobs such as carpentry, culinary arts, construction and wood working.

Since 2006, USAID has provided funding to the Bogota, Cartagena, and Buenaventura locations of Escuela Taller, funding that, in part, supported the construction of the school’s in-house restaurant and kitchen. Through the U.S. partnership, the school is mitigating gang recruitment risk factors such as lack of education, unemployment and low-self-esteem for young adults. Alumni like Jonothan Medina who attended the culinary school are now dreaming big – he wants to study in France at the Cordon Bleu! In fact, over 90 percent of the graduates from the culinary program are employed in local restaurants.

Trinidad: Women Entrepreneurs Invigorate a Local Trade

As I travel around the US and across the globe, I always notice the important role women entrepreneurs play in local economic development. Trinidad and Tobago is known for its high-quality cocoa beans, but they only make up about 5 percent of the world’s market. Women like Isabel Brash, owner of Cocobel Chocolates, and Darril Astrida Saunders, owner of Exotic Caribbean Mountain Pride, use only local products from start to finish and are trying to revive the local cocoa trade, while simultaneously promoting women’s entrepreneurship.

I toured Isabel’s kitchen and saw her turn cocoa beans into delicious bars of dark chocolate. I also heard from Darril how the U.S. State Department’s Women’s Entrepreneurship in the Americas (WEAmericas) and the International Visitor Leadership (IVLP) programs provided her with business training and networking opportunities. WEAmericas connects women entrepreneurs from throughout the Americas and leverages public-private partnerships to increase women’s economic participation.

Read the rest of this post.

 

Contraception: Not to be left to serendipity

A couple of years ago, I was in Abuja, Nigeria, working to integrate family planning within a health systems strengthening project. It was a Sunday; the day Goodluck Jonathan was being sworn in as president and the entire city was shut down because of the inauguration.

My colleague, a physician ob/gyn wanted me to see firsthand, the different service points in the health system. We drove about an hour or so out of Abuja and arrived at the maternity ward of a referral hospital. The delivery room was bustling, but supplies were minimal and facilities were bare boned.

The two midwives on duty had their hands full. They had already delivered four to five babies and were struggling to help a young woman through a difficult delivery. The woman showed up at the hospital that morning and as far as the midwives knew, she had not received any prenatal care. My colleague quickly jumped in to assist.

Kenyan women learning about IUDs. Photo credit: MSI

I remember sitting on a wooden bench with one of the midwives. We were separated from the delivery room by only a flimsy, green colored curtain. On the floor in front of us sat a young girl with orange ribbons in her hair, drawing continuous circles on the ward’s floor.

About 20 minutes passed and my colleague emerged asking for a sterile plastic clip to tie off the umbilical cord. He chastised the midwives for not using them and relying on string instead. They shrugged and told him the clips didn’t work; a conclusion he reached after trying five times. The midwife smiled and leaned against me to whisper – “That’s why we use the string- at least we can be sure the umbilical cord is tied off, even if it is not sterile.”

A few moments later, he appeared again, this time he was holding up a healthy, bawling, baby boy.

This experience crystallized in one powerful moment the challenges of getting health services to work for the people who depend on them. Mostly, I was struck by the sense of serendipity. If it hadn’t been for the presidential inauguration and for a random visit by a caring physician, this woman and her child may have died, or at minimum, had a long and painful labor.

Instead, we were able to celebrate the birth of her son, and her safe recovery from labor.

I sat back down and looked at the little girl on the floor and wondered…what choices would make the difference for this child? What health care and services could she count on in her lifetime? What opportunities would change her future prospects?  And I was convinced once again of the simple truth that access to contraception is pivotal in determining the equation of future opportunities – hers, mine, all of ours. If this young girl had the information and means to make choices about her sexual health and childbearing, she would have a better chance to determine her own future.

Contraception matters. It not only changes lives, it saves lives. If an additional 120 million women who want contraception could get it by 2020, we could have 100 million fewer unintended pregnancies, 3 million fewer children dying in their first year of life, and 200,000 fewer women and girls dying in pregnancy and childbirth.

And now, we have an opportunity before us to truly level the playing field for all women and girls. A global community is recommitted and reenergized and we as individuals have the power to ensure that women’s autonomy over health-related decisions is a fundamental right, not a privilege.

The effort to make contraception available is part of our commitment to reduce poverty, enhance human rights, feed the hungry, give water to the thirsty and share the wealth we have with those who need it. Each of these pieces needs the other, and is integrally connected to each other in order to thrive. And without family planning – without support for women and girls’ lives and dignity – our vision for real, lasting change in this world is simply not whole.

If we act now and keep our promises, we can circle back to the little girl with the orange ribbons and assure her that she will not have to rely on the vagaries of chance appearances, if and when she is ready to give birth.

We can’t leave women’s lives up to chance. When we get the choices right for women, we get it right for development. And in the next seven years, with the lives, dreams and opportunities of millions of the world’s women at stake… we simply have no choice but to get it right.

Learn more about Family Planning 2020.

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

 

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