The dilemma of family planning in Pakistan

The last time the Government of Pakistan took family planning seriously was during the period of the Third Plan in the 1960s. The dawn of democracy in the country also heralded in an era where pacifying a range of stakeholders, including those at the far right of the spectrum, became de rigueur. The government began to take a more cautious approach, culminating in the period in the 1980s when family planning was re-named ‘population welfare’ and disappeared from the priority list of the government’s service provision. 35 years after that trend began, the population growth rate is optimistically estimated at a little over two percent, but we will only know for sure when the census is tabulated by the end of this year. In any case, it is clear that Pakistan’s ever growing population would face ever increasing resource constraints.

Clergies’ views on population planning are not uniform. In addition, limited but significant empirical work on the subject suggests that religious leaders have less influence on this account than is commonly believed. The definitive source of data on demographic indicators in the country is the Pakistan Demographic and Health Survey (PDHS), carried out by the National Institute of Population Studies (NIPS). With a sample size of 14,000 households, and outreach across Pakistan, this is a formidable data collection effort which has taken place only thrice in the last two decades.

The survey is most often referred to when fertility rates or contraceptive prevalence rates are to be quoted. But the more interesting findings relate to attitudes and perceptions. The 2013 PDHS findings show that over half of the currently married women do not want to have more children, while 19 percent would like to delay their next birth. The same pattern holds for men, with 42 percent of married men who were interviewed saying that they do not want more children. Having said this, the same survey shows that only a quarter of currently married women used a modern form of contraception. There is clearly an unmet demand here with the demand that is met, only about 40 percent is met by public health services.

The fact that married couples across different parts and income groups of the country want to restrict family size is unsurprising due to an increase in the costs of living over time. While inflation is on a downward trend for the past couple of years, as per official estimates, it has been in double digits for many years in the last decade. Rapid urbanisation means that families that previously relied on subsistence grain harvests and kitchen gardening to meet their basic food needs are increasingly having to buy food from the markets. The decline in public schooling standards and in health facilities is ensuring that even households in middle to lower income quintiles are looking to access private schooling and clinic options. Even in the remotest parts of the country, there is some sort of access to print, electronic and even social media, which are feeding aspirations like never before.

And here lies the tragedy. If Pakistan’s population growth was primarily the result of people’s desire for large families, it could be explained away in the short-term, as a function of free will. What is very likely happening, though, is that a sizable proportion of people are looking for reproductive health services, and are drawing a blank, at least when it comes to the public sector. If the government feels that it is not up to the task of convincing people to restrict family size, so be it. However, it should at least ensure that those in search of basic public health services are able to access them.

UNFPA, Laos to increase investment in adolescent girls’ education

Lao Ministry of Education and Sports and the United Nations Population Fund (UNFPA) have agreed to strengthen their partnership by continuing to build on their campaign titled: “Noi.’’

The “Noi’’ campaign was launched in 2016 on International Day of the Girl Child October 11 and acknowledged the grim reality of adolescent girls informed by the country’s 2015 Population and Housing Census.

The census, which showed that 42,000 adolescent girls, have never attended school and 91,662 girls aged between six and 16 have dropped out of school.

Girls out of school tend to marry younger and have children at a younger age with Laos having the earliest age of marriage in the region; one in 10 girls marry by the age of 15 while early marriage is often related to early pregnancy.

Laos has the highest adolescent birth rate in the region, with an estimated 76 births per 1,000 girls aged 15-19.

Lao education and sports ministry signed off on the Implementing Partner (IP) Agreement and 2017 Annual Work Plan with the UNFPA on Tuesday, inked by the Minister of Education and Sports, Sengdeuane Lachanthaboun and UNFPA representative, Frederika Meijer.

The newly signed agreement would particularly be focused on issues that keep girls in school and strengthen girls’ social, health and economic assets.

Local media Vientiane Times on Tuesday quoted Sengdeuane as saying that, in particular, girls in rural areas face more challenging situations to access information and education.

“They need special attention to be able to stay in school, to be empowered so that all girls can develop and strive towards reaching their full potential,’’ she said.

This reaffirmed the Lao governments commitment to investing in “Noi,’’ as well as the alignment of the UNFPA supported activities with the ministry’s sector plans and priorities, said the report.

UNFPA’s sixth Country Program (CP6) 2017 to 2021 has partnerships with a number of different ministries and focused on youth and adolescent issues through supporting data analyses as well as strengthening and increasing access to reproductive health information and services.

Meijer said, “currently, adolescents and young people are often left out of the dialogue about them and their voices are often not heard.’’

To change this there is a need for an enabling policy environment where adolescents and young people are given specific attention and where national development takes their particular needs into account, she added.

She pointed out that investing in girls’ education is crucial for the advancement of women and gender equality and provides for the best returns on investments.

Canada and PAHO sign an important agreement for Haiti: Essential Health Care for Mothers and Children (SESAME) project

A new partnership between the Pan American Health Organization/World Health Organization and the Government of Canada aims to reduce the number of maternal and infant deaths addressing reproductive needs of women as well as health care priorities of newborns and infants in Haiti.

The SESAME project aims to improve the health, the lives and rights of women and children in Haiti and to advance the unfinished agenda on women’s health from a development perspective. Its strategy is to provide greater access to quality sexual and reproductive health services for women, and postnatal care for mothers and their children in the context of extreme poverty. It is also an essential contribution to strengthening the organization of health services at both the national and regional level.

“This agenda places great importance on improving women’s and children’s health in Haiti, one of PAHO’s top priority areas”, said Dr Luis Codina, PAHO/WHO Representative in Haiti.

The SESAME (Essential care for Mothers and Children) project, , will support 45 referral hospitals, 10 at the departmental level and 35 community hospitals in all departments in the countryThe core interventions will provide increase the number of women who give birth in a health institution with quality health care and without financial barriers.

“The project will improve the well-being of Haitian women and children through an innovative approach that strengthens core health services functions, with renewed efforts to implement solutions and stay resilient after recent downturns in Haiti,” added Dr. Codina.

Key components of the project include: establishing performance based contracting ; developing a strengthening plans for each hospital; trainingto improve personnel competencies of  on sexual and reproductive health and child health. Furthermore, improving hospital management and improve information system to have quality health data.

The priority action areas highlighted in the SESAME project approach are fully in line with the strategy and policies on women’s and children’s health approved by the member countries of PAHO/WHO as well as the strategy for Universal Access to Health and Universal Health Coverage

The CA $39.8 million project will be executed by PAHO/WHO in collaboration with Global Affairs Canada over the course of four years.

Q&A: UNFPA West Africa director on the security benefits of family planning

Family planning in West Africa has increased in popularity in recent years, as local religious leaders, community groups and health outreach programs have gotten behind the message. This multi-pronged approach is responsible for rising contraceptive use, according to the United Nations Population Fund West Africa Regional Director Mabingue Ngom. Places such as Ethiopia, Kenya, Madagascar and Senegal have see an average 2 percent growth in contraceptive prevalence each year, he said.

“Countries are beginning to take family planning very seriously, even within fiscal efforts from their own budget to support family planning related initiatives,” Ngom said.

However, a 2015 United Nations research on trends in contraceptive use still points to Africa as the region with the lowest contraception use, at just 33 percent of reproductive-aged women.

High population growth rates in persist in sub-Saharan Africa, where women average six children in places such as Chad and Mali. Other figures suggest that the population of African youth will increase 42 percent by 2030.

Ngom warns that these growth rates could be the basis for increased radicalism and youth involvement in extremist groups. Though messaging is crucial to progress, Ngom told Devex that family planning needs to remain a priority to avoid future security issues in the region. Here is our conversation with Ngom, edited for length and clarity.

Has UNFPA’s messaging on family planning changed in West Africa over the years?

We have developed a smarter way to articulate some of the issues. Our engagement strategy is important, so we tried working with religious leaders. Innovative approaches in how we engage with the community have been instrumental in terms of helping us make progress. We also make an ongoing effort to bring parliamentarians on board, to push the political dialogue. I’m also proud of how we have actively increased our engagement with youth organizations. We work with community leaders, local NGOs, partners, women’s groups and families to achieve our purpose. It’s really a multi-pronged approach. If you work with one group and ignore the others, you might make progress, but it will continue to be slow.

We had to change the message that the impact is not just private: Family planning impacts individuals, families, communities and governments. We also [discuss] the impact this issue could have on jobs in the next 10 to 20 years. When you take this road, it is very easy for the leaders of Africa, for the young people themselves and for their partners to see why it’s important to do something about women’s access to family planning.

Sub-Saharan Africa has one of the highest regional population growth rates in the world. How do you explain the importance of this issue to local communities and political partners?

We try to find ways to talk about population growth with youth in a manner that makes sense to them. I tell them that lack of access to family planning could equate to 18 million additional people in the job market every year. I explain about the 88 million young children that go to bed every night without dinner. Beyond the additional classrooms and health centers, we also have to focus on education and talk to governments so they understand the additional fiscal efforts they have to invest in to face the demands of high population growth.

We must also articulate the message around population growth, and the issues of migration, radicalization and violent terrorism. In cases like Boko Haram in Nigeria, for instance, you have 50 million young Africans in the streets, because they don’t have access to classrooms.  

This is certainly a health issue, and one that affects women’s rights, but it’s also a big issue in our fight against poverty. All of our efforts, and those of the government in terms of keeping people out of poverty, are absorbed by high population growth. This affects education and health. Young people who don’t have access to jobs tend to migrate and when they fail, they come back and can radicalize. Then you have an open door for terrorism.

How can a lack of family planning pose security threats to local populations?

High population growth makes fragile countries even more fragile. High population growth is the number one support to radicalization, violent terrorism and migration. If you want to be involved in stopping some of these radical groups, there is no other way than to deal with high population growth.

We need to be strategic with our investments. We need to focus more on prevention, by helping ensure access to family planning and by creating work for the young people in Africa to contain radicalization. The cost of responding to a humanitarian crisis is too much. We have seen recently the cost of meeting the needs of recent crises. Although we have seen financial support, we have also seen the financial gap that still exists in some of these crises. We have to be proactive and smart.

I have seen extraordinary momentum rising behind the agenda, but we need to keep our focus.

Uganda’s Overburdened Midwives

The caseload for a midwife in the Kotido district of Karamoja, tucked in a remote part of north-eastern Uganda, strains belief: with just 18 midwives serving 9,600 mothers, according to district health officials, each midwife cares for at least 533 mothers a year.

That’s more than triple the number recommended by the WHO (1 midwife/175 mothers a year).

As a result, midwives are overloaded, says Phillip Oringa, MD, the Kotido District Health Officer (DHO), “which affects the quality of services provided.”

But the heavy caseload is not the only issue confronting midwives. They face a complex array of problems, I learned during a visit earlier this month to examine the state of health and midwifery in Kotido and the Karamoja sub-region.

Food security is one challenge. Karamoja is at the mercy of extreme weather conditions, such as prolonged drought—and when the rains finally come, they cause flooding. Agriculture, despite the fertile soil and the best efforts of the government and several NGOS, is failing. In response, the World Food Programme gives food rations to expectant and breastfeeding mothers—but this has an unintended consequence: Mothers avoid family planning services, in order to stay eligible for food rations. “(A mother) wants to ensure that by the time she weans one child, she is pregnant again, because being pregnant is the only way to get the food rations,” explained Angella Emmanuelle, 23, a midwife at Moroto Health Centre IV. “So when you tell her about child spacing, she will think you are denying her food.” Although the use of modern family planning services has increased from 0% in 2006, it is still very low, at 6.5% in 2016, according to the Uganda Demographic and Health Survey.

It is also concerning that amid the serious shortage of midwives, myths and misconception about family planning are rife. For example, Sarah Adiaka, a midwife at Rupa Health Centre II in Moroto district says mothers subscribe to the myth that a mother on family planning should not come near a fireplace. Thus, in an area where mothers cook and burn charcoal for a living, many are shunning family planning services.

More educated midwives could help counter some of the myths surrounding family planning, as well as the shortage of skilled health workers. In response, UNFPA introduced a bonded scholarship scheme for midwives, to sponsor young women in the region to study midwifery. In exchange, the young women commit to work in the area for at least 3 years after graduation. The program has trained 126 midwives since 2010, deployed throughout the sub-region’s 7 districts. “We encourage mothers to deliver at the health centres under the care of skilled attendants, and we are seeing results,” says Caroline Akello, 23, a bonded midwife at Loktelabu Health Centre III, “We used to have over 12 BBA (Born Before Arrival) cases a year, today we are seeing less than 5.”

Across the whole sub-region, the UN agency also pays salaries for 30 midwives. In a bid to ensure its sustainability, last April the agency asked the government to take over salaries for that group of midwives after 1 year. It remains to be seen whether or not the government will raise to the challenge—but the need for the government to support these recruits, and indeed train and incentivize more midwives to work in this hard-to-reach part of the country is clear.

ACCES DES JEUNES A LA PLANIFICATION FAMILIALE : Les hauts et les bas d’une politique

Le Burkina Faso, à l’instar d’autres pays du monde, a entrepris d’impliquer les jeunes dans les campagnes nationales en faveur de la planification familiale. Plusieurs actions ont été entreprises dans ce cadre mais au constat, « beaucoup reste à faire » puisque, même les jeunes se disent mis à l’écart. Que faire ? Comment parvenir à une sexualité responsable sans une implication des principaux concernés ? S’il existe des structures de sensibilisation, il reste que les programmes eux-mêmes sont défaillants. Jeunes, éducateurs, sociologues et acteurs de la chaîne de la santé sexuelle et reproductive des jeunes semblent parler le même langage mais le chemin est encore long.

La planification familiale ou l’espacement des naissances au moyen de méthodes contraceptives est l’une des voies de recours du Burkina Faso en vue d’assurer un développement contrôlé de sa population. Avec une structure démographique où les moins de 20 ans sont fortement dominants, l’implication des jeunes dans cette politique nataliste est plus qu’une nécessité. Et pour cause, a expliqué le chef de service Planification familiale à la Direction de la santé de la famille (DSF), Mathieu Bougma, l’activité sexuelle des jeunes et des adolescents est « de plus en plus précoce » et dans la majorité des cas, sans protection, ni contraception. Ce, par le truchement surtout, a-t-il dit, des  nouvelles technologies de l’information et de la communication, grâce auxquelles, les jeunes acquièrent de mauvais comportements. 

Pour Adissa Konaté, responsable du Centre d’écoute pour jeunes de l’Association burkinabè pour le bien-être familial (ABBEF), les grossesses non désirées, tributaires d’une sexualité précoce, « exposent les jeunes à des risques élevés de cancers et d’handicap ou de décès lors de l’accouchement ». A l’échelle nationale, la forte natalité qui en est aussi une résultante, pose à l’Etat un souci de planification appropriée des ressources pour un développement harmonieux du pays.

C’est fort donc de cela, que dans les plans d’accélération de la planification familiale dont la mise en œuvre implique le ministère en charge de la santé, certaines organisations de la société civile et les partenaires techniques et financiers, l’accès des jeunes aux services d’une sexualité responsable tient une place de choix, soutient Mathieu Bougma. Malheureusement, en dépit des actions menées,  « beaucoup reste à faire », confesse madame Konaté.

La forte proportion des jeunes, selon elle, nécessite le renforcement des actions à leur profit sur le terrain. En outre, a-t-elle poursuivi, les actions de sensibilisation qui avaient permis une baisse notable de la séroprévalence ont connu un relâchement au cours de ces dernières années. Ce  qui justifie l’augmentation des grossesses non désirées surtout en milieu scolaire.

Dans le même registre, Aïcha Ouédraogo, chargée de suivi et de programme du Réseau africain des jeunes contre le SIDA au Burkina Faso (RAJS/BF), a relevé que l’ancien plan de relance de la planification familiale (2013-2015) a présenté des insuffisances notables. « La prise en compte des jeunes n’était pas remarquable dans l’ensemble des offres de service », a-t-elle dit avant d’ajouter qu’il y a eu « un déficit au niveau de la promotion de certaines méthodes de planification en milieu jeune, notamment les pilules de lendemain ».

Renforcer les actions

Selon la responsable du Centre d’écoute pour jeunes de l’ABBEF, madame Konaté, plusieurs actions sont nécessaires pour une réelle implication des jeunes aux méthodes de planification familiale. Au premier plan, cite-t-elle, les ministères concernés par la question des jeunes doivent s’impliquer davantage et travailler en synergie, « en développant des actions multiformes ». Les médias de masse également doivent être mis à contribution pour une plus large diffusion des informations « justes » à l’endroit des jeunes.

Les parents, pour leur part, ont le devoir de « lever en famille le tabou sur la sexualité et discuter de la question avec leurs enfants ». Faute de quoi, « c’est à travers les amis et les films », qu’ils vont se forger un mauvais caractère, déplore madame Konaté. Un autre aspect non moins important, est la responsabilité même des jeunes. La responsable du centre d’écoute de l’ABBEF, lance un appel dans ce sens où, il faut que les jeunes prennent conscience de l’intérêt pour eux-mêmes de retarder leur premier rapport sexuel et surtout de s’ouvrir davantage aux structures d’écoute.

Du reste, selon Adissa Konaté, pour avoir « une jeunesse épanouie et responsable », la bataille pour l’information, l’éducation, la sensibilisation et l’accompagnement doit se faire à tout moment, aussi bien par les dirigeants que par les acteurs de la société, conclue-t-elle. 

La sensibilisation et l’éducation, des préalables

Embouchant la même trompette, Rose Kambou, étudiante en gestion des ressources humaines, préconise une sensibilisation de la frange jeune, parce qu’il y a certains qui ne savent même pas ce que signifie la PF (planification familiale). Aussi, a-t-elle poursuivi, il conviendrait de renforcer la disponibilité des produits de planification familiale en milieu jeune et péri-urbain, des endroits où les jeunes ont parfois un accès limité aux services et aux informations concernant la planification familiale. Au-delà de la sensibilisation, Abdoul Kader Stéphane Somé, étudiant en Master I en communication, souhaite que le futur plan d’accélération de l’accès à la PF, intègre plus d’actions en faveur et en direction des jeunes.

Il a surtout insisté sur la formation et des actions de plaidoyer. Touwindé Kindo est sociologue et pour lui, le succès du futur plan d’accélération 2016-2020 réside dans  la prise en compte d’un certain nombre de facteurs. Le «contexte dans lequel nous nous trouvons et les valeurs sur lesquelles nous voulons bâtir notre société» doivent être une boussole.  A l’écouter, il est primordial de trouver le juste  milieu entre ces deux bords afin d’avoir un référent qui convient pour une éducation de qualité. Il a soutenu que beaucoup d’éléments manquent à la chaîne éducative telle que conçue actuellement. Il souhaite que l’accent soit mis sur la famille, la communauté de même que les encadreurs qui, selon lui, ont un rôle capital à jouer. 

Du reste, la difficulté fondamentale à laquelle est confrontée l’éducation sexuelle actuelle est l’appropriation des messages véhiculés. Car, « il ne sert à rien de mener des actions pour sensibiliser les jeunes si à la fin, les messages véhiculés ne sont pas pris en compte ». Pour ce faire, le sociologue  Kindo a reconnu que les médias peuvent être d’une utilité capitale dans ce domaine. En effet, a-t-il justifié, les nouvelles technologies de l’information et de la communication font désormais partie intégrante du vécu quotidien des jeunes. Il a donc préconisé que les éducateurs saisissent ces canaux de communication pour faire passer leurs messages à condition de déterminer exactement « quoi transmettre ».

Mamaye campaign on maternal and newborn health phases out

Having advocated on issues of maternal and newborn health in the country for five years, Mamaye, a campaign managed by Parent and Child Health Initiative (PACHI) has phased out. 

This was disclosed at a dissemination meeting held on Friday in Lilongwe where Mamaye took stock of their activities and showcased their activities to stakeholders.

The project which was implemented in the Northern and Central regions targeted Ntcheu, Mzimba, Nkhatabay and Rumphi.

In an interview, Mamaye Country Director, Mathias Chatuluka said it was a day of celebration having fulfilled their goals and reducing maternal and newborn deaths.

“Through this event, we are here to demonstrate our passion in saving lives of pregnant Mother’s and new born babies.  We are proud to say we have done it and fulfilled our goals where in some cases some mothers survived the most critical conditions when giving birth.”

“That is what we wanted and as we say goodbye to the people in the communities we were working in,”  Chatuluka said.

He pointed out that the issue of maternal health is quiet complex but at the same time if interventions or approaches that are very effective are all engaging, it can actually change the landscape and have figures that are going down every time and eventually reducing maternal deaths.

According to him, there was transparency and accountability scorecard which supported the districts systems to manage their budget property making sure it is consultative helping to have supported structures.

He added that this allowed citizens to be entitled to knowing how the funding the districts got were used and therefore encouraged proper budget implementation.

“We have used quality of institution care in selected sites in health facilities and used the results that showed facility readiness to manage a maternal case and linked the results to the budget process so that it responds to the issues on the ground.”

“We build the capacity and empowered the activists in all the areas by giving them skills and using the results from the quality of institution tool. This has made them to understand the concept and we are very hopeful that they will sustain the initiative,” Chatuluka added.

Commenting on the issue, an activist from Chikangawa Health Centre, Elizabeth Kaliyande said that the centre has benefitted and transformed said it was sad that the campaign has phased out as they would have loved to continue working with them longer than they have.

“It is sad that they are leaving. But we are grateful for the job well done. Chikangawa was one of the centers that had poor services therefore leading in maternal deaths. Now it’s a new song for us, everything has completely changed at our health center and we are so grateful,” Kaliyande said.

She added that Mamaye also strengthened their relationship with councilors, chiefs and their Member of Parliament (MP) because they worked so closely and that there was transparency and accountability on issues to with money allocated to the council.

Speaking in a separate interview, Director of Reproductive Health in the Ministry of Health, Fannie Kachale said the initiative has helped in making strides in terms of women that are able to access contraceptive methods.

“In 2010, only 42 percent of women in the country had access to contraceptive and now 58 percent of them are able to access the services. The initiative has also played a big role in reducing deaths in new born from 31 percent in 2010 and now at 27 per 1000 births,” she said.

Kachale added that in terms of the indicators, the country has improved and is moving in the right direction and promised to push from the central level, interact more with councilors, communities and health workers.

“As government we are so grateful and encouraged to hear from the activists themselves that they are not going to rest.  As a ministry we will make sure that we don’t lose these gains,” she said.

The one day meeting attracted different partners in maternal health such as Action Aid, Mai Khanda and Population Services International (PSI) just to mention a few.  It also attracted the presence of District Commissioners from the four councils and activists from different health centres.

Promoting the rights of girls and women

The situation for girls and women in Bangladesh is changing for the better, especially in terms of economic participation. The past decades have brought in significant improvements, including in terms of labour force participation or access to better sexual and reproductive health care, as evidenced by a drop in maternal mortality ratios. However for women from poor, marginalized communities, and those living in remote locations, reproductive health related morbidity and mortality remains a serious challenge.

Entrenched patriarchal norms and low prioritization of rights of girls and women have detrimental effects on social and health outcomes. Such outcomes include child marriage and early child-bearing, other forms of gender based violence, limited access to competent skilled birth attendance and emergency obstetric care, gaps in evidence based respectful maternity care, limitations in access to screening and treatment of illnesses including reproductive cancers, denial of right to family planning as well as gaps in educational attainment.

The global Sustainable Development Goals (SDGs) directly address and call for universal health care, including sexual and reproductive health, and gender equality:  SDG 3: ensure healthy lives and promote well-being at all ages, which includes universal access to sexual and reproductive health reducing maternal and neonatal mortality, and SDG5: achieve gender equality and empower all women and girls, as well as working towards reduced inequalities (SDG 10).

One pivotal approach to achieving the SDGs is the development of a cadre of professional midwives and integrating them into the national health system. Professional midwives are globally recognized as experts on sexual and reproductive and as champions of rights of women and girls. Professional midwives combine ancient traditions of advocating for, and nurturing women, with modern science and technology.

Bangladesh has recently introduced the cadre of professional midwives. The advent of this cadre can be attributed to the commitment made by the Honorable Prime Minister in 2010 towards the UN Secretary General’s Every woman, Every child initiative,and is already making a difference in the lives of women and girls in rural Bangladesh. Approximately 1200 midwives are currently deployed in government health facilities in rural areas.  More midwives have also taken up deployment through NGOs to serve in some of the remotest areas that are also most affected by disasters.

Midwives are starting to provide respectful midwifery led continuum of reproductive health care in Bangladesh. Inclusive in this care are family planning, ante-partum, post-partum and newborn care, nutrition counselling, normal delivery services, menstrual regulation, cervical cancer screening, and clinical management of sexual violence services. Midwives strive to respect the wishes of girls and women, promote health, and minimize complications and interventions.

Through the continuum of care provided by professional midwives, rights of women and girls to quality reproductive health services have been strengthened in Bangladesh. Women and girls receiving midwifery services are empowered through the provision of information and access to compassionate care. The knowledge and awareness midwives can provide to girls and women will contribute towards greater control over their fertility, better health seeking behavior, satisfying child birth experience and overall improved reproductive health.

Midwives can also contribute towards ensuring:

* Girls and women are respected as a people of value and worth

Girls and women have a right to the security of their bodies

Girls and women are free from discrimination and receive updated health information

Girls and women have a right to participate actively in decisions regarding their own health care and can provide informed consent

Girls and women have a right to privacy and can choose where to give birth.

Pregnancy is a time of particular concern for women and girls. Globally, complications of pregnancy or childbirth lead to the loss of a woman’s life every two minutes. In Bangladesh maternal causes contribute to 15 women dying every single day. These tragedies, are for the most part completely preventable, and the world has remedies at hand to avert such deaths. Having a professional midwife present during delivery for instance can ensure that early warning signs of possible complications are detected at an early stage and managed in consultation with doctors and hence decreasing the risk of mortality. From a health economics perspective, midwives are considered as the best buy to provide quality reproductive health services. More data substantiates the value added by midwives to national health systems:

Estimates show that about two-thirds of all maternal and newborn deaths can be avoided where there are professional midwives at hand to provide support to mother and baby.

Evidence shows that midwives who are educated and regulated to international standards can provide 87 per cent of the essential care needed by women and their newborns.

Investing in midwifery education and deployment to community based services can potentially yield a 16 fold return on investment in terms of lives saved and costs of caesarian sections averted.

Midwifery care covers more than just assistance during delivery, but is in fact an integral part of universal health coverage.

The establishment of the midwifery cadre has opened up a new career path for girls in Bangladesh. Currently professional opportunities for midwives exist in government, NGO, private service and even as an entrepreneur. A respected midwifery profession will attract talented and ambitious young people who are committed to empowering women by improving the quality of sexual and reproductive health care. 

Together with the Bangladesh Midwifery Society, UNFPA has started reaching out to girls in secondary schools to raise awareness for the profession and its potentials. With international partners including Sweden, the UK and Canada new opportunities are being established allowing midwives to pursue master degrees in sexual and reproductive health and enabling them in future to ascend to higher level academic and clinical posts in the public and private sectors.

Midwives can provide optimum services only when they are given a conducive working environment. Unfortunately, global experience reveals that too often midwives, as women caring for women, face effects of the same entrenched patriarchal values that affect all women.   Midwives risk facing low and irregular pay, harassment and disrespect, and a limited enabling environment. By empowering midwives and enabling them to be part of decision- and policy-making processes in the field of sexual and reproductive health, important insights can be gained and women’s needs can be better taken into account.

The International Confederation of Midwives (ICM) has called on governments to globally recognize and support accessible and effective midwifery care as a basic human right for all women, babies and midwives. ICM believes that women have a right to a midwife as the most appropriate care provider in most situations and midwives in turn have a right to obtain adequate education, regulations to foster their practice and associations to forward their mission. Bangladesh has already taken the first steps in realizing this goal but more can be done to accelerate progress. An opportunity exists for Bangladesh to demonstrate its fullest commitment to the rights of girls and women by ensuring the success of the midwifery profession.

From Here To Uganda: Why U.S. Leadership On Reproductive Rights Matters

Margaret Nakanjakke was born in a small village in Uganda. As a young adult, she worked hard selling banana leaves, eggplant and plantains by the roadside to support her family and pay her school fees. A star student – and close to graduation – Margaret became pregnant at age 18.

Margaret dropped out of school and was kicked out of her home. She gave birth to a son, but he was taken from her against her wishes – she wouldn’t see him again for 10 years. Forced to live on her own, Margaret found work as a janitor for Reproductive Health Uganda (RHU), where she began learning about her reproductive rights and health, family planning, and contraception – information and services she never had access to as a child and adolescent.

“If I had known about at least condoms, or the pill, I wouldn’t have gotten pregnant,” said Margaret. “Because I didn’t want that. It did not occur to me that I was going to get pregnant.”

Margaret was one of more than 225 million women around the world who want to control the timing, number and spacing of their children but are not using modern contraceptives. As the largest funder of international reproductive health and family planning programs – including RHU, where Margaret works – U.S. foreign aid helps women just like Margaret access the information and resources they need to plan their families and their futures. In 2016 alone, U.S. funding for such programs provided 27 million women and couples around the world with the contraceptive services and supplies they wanted.

But this access is in serious jeopardy.

Unprecedented efforts are under way to roll back gains in sexual and reproductive health and rights around the world. The U.S. Administration’s January reinstatement and dramatic expansion of the Global Gag Rule will make it more difficult for millions of girls and women to access the contraception and health care they need. Just last week, the president’s proposed budget outlined slashed funding for the United Nations, which would drastically impact UN agencies providing humanitarian assistance – including reproductive health and family planning – across the globe.

These policy and funding changes mean that health care clinics worldwide will be forced to close; that the world’s poorest families will lose access not only to family planning but also to crucial services like maternal and child health care, HIV testing and counseling, and comprehensive sex education; and that the delivery of irreplaceable humanitarian services like domestic violence counseling, pregnancy checkups, and even safe childbirth will be on the line.

This impact is not limited to women and girls. Access to reproductive health care and family planning generates a ripple effect, creating healthier and more prosperous families, communities, societies and economies. Now is the time to build on progress, not to reverse it. We can support the dreams of millions of girls and women like Margaret – and that of their families and communities – but only if the U.S. protects critical investments in women’s health globally.

Margaret eventually got married to man she loves and had two more children, whom she planned, using contraception.

“The people down here, they are capable of being anyone,” she said. “But they need help … I tell you, our girls can go far.”

Entrepreneurs trained to reduce high maternal deaths

Scaling up low-cost technological innovations and incorporating business model into healthcare could help cut maternal and child deaths in Sub-Saharan Africa, experts say.
 
According to World Health Organisation, Sub-Saharan Africa alone accounted for 66 per cent of global maternal deaths in 2015.
 
At a meeting of the General Electric (GE) healthymagination Mother and Child Program meeting held in Kenya last month (23 February), experts called for a paradigm shift to address the program.

“Technological innovation alone is insufficient. We also need business model to get technology to the people.”

Thane Kreiner, Miller Center for Social Entrepreneurship

 The GE healthymagination program graduated 14 social entrepreneurs who completed training and mentorship aimed at improving and accelerating maternal and childhealth outcomes in Africa. The 14 entrepreneurs have innovations in countries such as Ethiopia, Ghana, Kenya, Nigeria, Rwanda and Uganda.
 
Robert Wells, executive director for strategy, healthymagination, says that although the health sector is in poor conditions, there are affordable, accessible and quality healthcare interventions for all.
 
He notes that the graduates completed a three-day, in-person workshop followed by a six-month online accelerator programme that included weekly, in-depth mentoring from Silicon Valley-based executives in the United States and local GE business leaders.
 
Wells explains that healthymagination Mother and Child program is designed to help social entrepreneurs acquire business fundamentals, improve their strategic thought processes and articulate a business plan that demonstrates impact, growth and long-term financial sustainability.
 
Thane Kreiner, executive director of Miller Center for Social Entrepreneurship at Santa Clara University in the United States, tells SciDev.Net that too many mothers and children are dying especially in rural communities and urban slums from preventable diseases.
 
“Technological innovation alone is insufficient,” says Kreiner. “We also need business model to get technology to the people.”
 
He adds that creating innovative business model to train local people as community health workers could boost job creation and provide livelihood for the people. According to Kreiner, having more community health workers, especially in rural communities where physicians are not available, could help prevent maternal and child deaths.

Segun Ebitanmi, one of the social entrepreneurs and chief operating officer at Outreach Medical Services in Nigeria, challenges African governments to invest more in healthcare not by building hospitals alone.
 
However, he suggests that although health insurance could help poor people access good health facilities, African governments should also provide a conducive environment through infrastructure such as electricity and water.
 
Ebitanmi urges the implementation of quality standards that will regulate, monitor, evaluate and audit the health sector in Africa for sustainability.

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