Bringing Washington to Kuala Lumpur

by Crystal Lander and Brigid Boettler

(Photos by MSH/Brigid Boettler, CARE/Ben Weingrod, and MSH/Rachel Hassinger)

For seven days last month, Management Sciences for Health was proud to host six Congressional staffers as they participated in a study tour to Malaysia—to learn about how the country has made major global health investments and how those investments have saved the lives of women and families.

The staffers—Adriane Casalotti, Legislative Director (Rep. Lois Capps, D-CA), John Ariale, Chief of Staff (Rep. Ander Crenshaw, R-FL), Maggie Dougherty, Legislative Aide (Senator Marco Rubio, R-FL), Aaron Allen, Legislative Assistant (Rep. Juan Vargas, D-CA), Kelli Ripp, Legislative Aide (Rep. Aaron Schock, R-IL), and Melinda Cep, Policy Advisor (Rep. Rosa DeLauro, D-CT)—took part in 17 different educational briefings, networking receptions, dinner panels and meetings.

Staffers met with over 50 technical, political, advocacy, and global health experts and heard personal stories from mothers, patients, and global health advocates from around the world. A noted highlight of the tour included a meeting with US actor/singer/humanitarian Mandy Moore, who described firsthand the benefits of malaria bednet distribution projects in Central Africa.

An added benefit of  this informational tour of Malaysia was the staffers’ opportunity to attend the 3rd Women Deliver Conference, this decade’s largest event on maternal health and women’s rights. Along with over 4,500 attendees from around the world, the US staffers were able to attend sessions of their interest.

Thanks to the Ministry of Health of Malaysia and the Negeri Sembilan Family Planning Association (the leading voluntary family planning, sexual and reproductive health organization in Malaysia), the study tour included visits to Putrajaya, the small town of Seremban, and the historic city of Melaka to visit government and NGO reproductive health clinics and youth centers. During a tour of the Negeri Sembilan Family Planning Association, the staffers joined a group of neighborhood youth to identify important “social ills” that children and adolescents face in Malaysia. All of these site visits served as vivid demonstrations of the benefits of Malaysia’s investment in maternal and child health.

As the study tour came to a close, the staffers found themselves informed, inspired, and better able to understand the cross-cutting investment that is maternal health and women’s rights.

“Just think of all the good that could come from advocating for ensuring that women and girls have the right to access maternal and reproductive healthcare … women’s rights and access to maternal and reproductive healthcare must be a highlight of our global development agenda,” John Ariale blogged during the tour. “The issue is too important to ignore, or be mired in obtuse political innuendo. With the right focus and attention we can ensure that sexual and reproductive health is readily available and sustainable for all women.”

Learn more about the Congressional Study Tour

Crystal Lander is the director of policy and advocacy, and Brigid Boettler the outreach and events specialist, at MSH.

Women’s Rights and Access to Maternal and Reproductive Healthcare

Editor’s note: This guest post from John Ariale, one of the participants in the MSH-led congressional study tour, originally appeared on Vantage Points.

As someone who has worked on international development issues from my desk in Washington, I was excited to participate in the 2013 Women Deliver Conference last week in Kuala Lumpur, Malaysia.

The conference afforded me an amazing opportunity to listen and talk to a variety of people from 149 countries about their experiences and views related to the health and well-being of women and girls. A recurring theme that emerged from the week was the issue of women’s sexual and reproductive health. I have never written about reproductive health before, but I’ll credit that up to never spending a week at a conference focused on maternal and reproductive health before this experience.

Since returning home, I have spent a lot of time thinking about the issue of reproductive health and I firmly believe that we need to start thinking about this issue in a different way – through the lens of a woman or a young girl in a developing country, and with an eye on equality.

In the U.S., we all face the reality that a majority of young adults engage in sexual relations outside marriage, and we educate our kids to wait to have sexual relationships – preferably until marriage. But as parents, we also want to ensure that they know how to protect themselves when they decide to engage in such activities.

This was a key part of the international dialogue I participated in; however, on the international front, in many poor or developing countries, access to reproductive health includes a very different reality.

That reality is that girls and women’s rights are systematically violated in too many places around the world today. (I would encourage anyone reading this or interested in this issue to check out the trailer, and the movie called Girl Rising, an innovative new feature film that highlights the struggles of women and girls around the world). In some cultures, it is still considered acceptable for a husband to beat his wife for not having sex. In too many places, girls are forced into marriage at far too young an age. HIV disproportionately impacts women. In many cultures, when reproductive health options are available, a woman’s male partner often vetoes her decision to use those options.

Women and girls in developing nations are more likely to become mothers at a young age. We know that pregnancy during adolescence has serious health impacts for girls and their babies. There are complications from pregnancy and childbirth – which is the leading cause of death among girls, aged 15-19 in developing countries.

Approximately one in three women will experience gender-based violence in her lifetime. In some pacific countries, more than 60% of women and girls experienced violence at the hands of their partners.

I met a woman from the Congo at the conference. We were discussing access to female contraception and she explained to me that access to female condoms in her village have been transformative because women and girls are now using these resources when walking miles to the wells to get water. The incidence of rape is so great, that these women and girls have decided to use female condoms to avoid unwanted pregnancies.

In developing countries, desire for smaller families and the motivation for healthy spacing of births has steadily increased. Yet, 222 million women in developing countries do not have the ability to determine the size of their families, or have a say in the planning of their families.

MDG 5 — Improve Maternal Health — has two sub targets. Target 5A set a target of reducing maternal mortality by three-fourths by 2015, while Target 5B set a target of universal access to reproductive health.

The achievement of the MDGs is strongly underpinned by the progress that the world makes on sexual and reproductive health. It is a pillar for supporting the overall health of communities, in particular, that of women. Ill health from causes related to sexuality and reproduction remains a major cause of preventable death, disability, and suffering among women. Apart from the health consequences, poor sexual and reproductive health contributes significantly to poverty, inhibiting affected individuals’ full participation in their own social and economic development.

I was surprised to learn that the world has not made as much progress on this front as is needed to meet MDG5 by 2015. Many countries in sub-Saharan Africa and South Asia have shown little progress in recent years; some have even lost ground. Globally, the rate of death from pregnancy and childbirth declined between 1990 and 2005 by only 1% per year. In order to be on track to achieve MDG 5, a 5.5% annual rate of decline was needed from 2005 to 2015.

During my week at the conference, our group was fortunate enough to have a conversation with Melinda Gates. We were all enlightened and her comments during our conversation were extremely helpful to me. Mrs. Gates stated that when she talks about health with women from developing countries, they explain to her that their job is to feed the children. They explain that if they cannot space out their births, they cannot work or properly care for and feed the other children. In many places, Melinda explained that while condoms might be readily available, women – due to cultural perceptions – couldn’t even fathom negotiating the use of condoms because it means they are suggesting that their partner might have AIDs or that she is trying to say she has AIDs.

The Gates Foundation does not fund abortions, and has it right when they state that we need to put girls and women at the center of this debate. We need to start trusting one another and realize that “family planning” is not code for anything else in this debate.

As the week progressed, I became certain that the only way for the world to begin to correct this problem is for us to start trusting one another and to look at this issue as an equality rights one, not something else. Advancing equality among boys and girls and men and women is a goal we can all support.

I am confident that if we are successful in achieving equality, many other aspects of this problem begin to fall into place. Perhaps, once achieved, we might even begin to have a significant impact on achieving MDG5.

Just think of all the good that could come from advocating for ensuring that women and girls have the right to access maternal and reproductive health care. Treating women and girls all around the world equally might eradicate early and forced marriage, keep girls in school, give women a say in their family planning, and end gender-based violence.

One of my take-aways from the conference was that women’s rights and access to maternal and reproductive healthcare must be a highlight of our global development agenda. The issue is too important to ignore, or be mired in obtuse political innuendo. With the right focus and attention, we can ensure that sexual and reproductive health is readily available and sustainable for all women.

John Ariale is chief of staff for Congressman Ander Crenshaw.

Against all odds: Meeting maternal, newborn, and child health needs in the DRC

Kristin Cooney. (Photo courtesy K. Cooney)

Kristin Cooney. (Photo courtesy K. Cooney)

by Kristin Cooney

I had the pleasure of presenting stories and results from a successful DRC project on Tuesday, May 28, day one of Women Deliver 2013.

The USAID-funded Integrated Health Project (IHP) in the Democratic Republic of Congo (DRC), implemented by Management Sciences for Health, the International Rescue Committee and Overseas Strategic Consulting, Ltd, is creating better conditions for, and increasing the availability and use of high-impact health services, products, and practices in 80 health zones in four provinces (Kasaï Occidental, Kasaï Oriental, Katanga, and Sud Kivu.

IHP addresses three major bottlenecks hampering the performance of health services: (1) poor availability of medicines and essential inputs related to supply chain management; (2) limited availability of qualified human resources to implement high-impact interventions for the health of the mother and the child; and (3) low quality of care.

Audience members participate in a Q&A with the panelists. (Photo: R. Hassinger/MSH)

Audience members participate in a Q&A with the panelists. (Photo: R. Hassinger/MSH)

Although working in a fragile state where instability persists, IHP applies a development approach that demonstrates that, even against many odds, health programs can achieve results in challenging settings—they just need to be innovative and persistent to achieve their goals.

Using a range of high-impact practices and approaches in maternal, neonatal, and child health and family planning that were selected through careful analysis, including use of the Lives Saved Tool (LiST)—such as integrated services, Leadership Development Programs, fully-functional service delivery points, and a range of behavior change communication approaches (i.e. mHealth and Champion Communities)—IHP has achieved impressive results in fistula care, family planning, rates of assisted delivery, and active management of the third stage of labor, among other health indicators.

DRC-IHP

An important focus of the program is counseling women and families on healthy timing and spacing of pregnancies at health center and community level. Community-based distribution of family planning methods is improving contraceptive security and promoting a range of modern contraceptive methods and includes training and supporting community workers to deliver family planning and to refer and accompany couples to health centers to choose a contraceptive method.

Selected findings include:

  • Couple years of protection as of March 2013 was 122,523, which is 111% of the target of 110,000.
  • New acceptors of family planning as of March 2013 was 136,302, or 113% of the target of 120,728.
  • As of December 2013, the percent of women receiving Active Management of the Third Stage of Labor, at 84%, was 105% of the target of 80%.

IHP is getting the right commodities into the right, competent hands at the right time to produce impressive results, against all odds.

Kristin Cooney is a director, country portfolio, at MSH.

Saving Lives of Women and Newborns by Improving Access to Essential Maternal Health Commodities

By Suzanne Diarra and Maheen Malik

Maheen Malik

Maheen Malik. (Photo credit: Rachel Hassinger/MSH)

Suzanne Diarra

Suzanne Diarra. (Photo credit: R. Hassinger/MSH)

For many women and newborns in developing countries, pregnancy and childbirth can be life-threatening. Ensuring access to essential high quality medicines and supplies across the continuum of care is often a hidden part of the solution.

Safe and effective maternal health medicines and supplies exist but are not often available when and where women, newborn and children need them the most.

These topics and more were discussed at a Maternal Health Commodities pre-conference event on Monday, May 27, sponsored by Family Care International, PATH, and Population Action International.

As maternal, newborn and child health medicines and supplies needs are being elevated on global agendas through global initiatives such as the UN Commission for life saving commodities for women and children, it takes multifaceted skills and efforts at country level to translate these global initiatives into appropriate local interventions that improve access to high quality medicines and supplies for women across the continuum of care.

MSH promotes a systems-strengthening approach to identify challenges with delivering essential pharmaceuticals and services to women, newborns and children by working with managers at all levels of health systems, policy makers, providers, and communities to build capacity and strengthen health systems to address these challenges and improve access of women and children to life saving medicines and supplies.

Suzanne Diarra and Maheen Malik are senior technical advisors for Systems for Improved Access to Pharmaceuticals and Services (SIAPS) at MSH.

WOMEN LEAD: On Gender Equity, UHC, and Family Planning

Photo by Warren Zelman.

Photo by Warren Zelman.

The May issue of the MSH Global Health Impact newsletter (subscribe) features stories on gender equity, UHC, and family planning including:

Read newsletter now >>

(You might notice that our website has a different look and feel. We are in the process of redesigning MSH.org; and YOU are getting a sneak peak of the site before our June 14 launch! More >>)