Article analyzes out-of-pocket costs for maternity care in Africa
In an article, “Out-of-pocket costs for facility-based maternity care in three African countries,” published in the journal Health Policy and Planning, FCI presents population-based household survey data on costs of maternity care in Kenya, Burkina Faso, and Tanzania. This research, conducted as part of FCI’s groundbreaking Skilled Care Initiative (SCI), showed that that the vast majority of women incur out-of-pocket expenses for maternity care, even where it is nominally free of charge. These costs generally represent a considerable portion of monthly household income. There was no difference in the out-of-pocket costs reported by the poorest women compared with women in the wealthiest quintiles, indicating that both user fee and nominally free services appeared to be equally regressive.

FCI selected to be strategic partner of Burkina Faso Ministry of Health
FCI Burkina Faso has been selected as a strategic partner of the Ministry of Health, and asked to provide technical assistance in the implementation of national health policies in the country’s Sahel region over the next three years. As one of only 10 such strategic partners selected from among more than 80 applicants, FCI will provide technical assistance to the ministry in the areas of sexual and reproductive health and maternal health, focusing its work on strengthening the capacity of grassroots and community organizations.

FCI’s expertise in community mobilization grew in large part out of the Skilled Care Initiative, described above. This month, an article co-authored by FCI Burkina Faso’s national coordinator, Brahima Bassané, and reporting on key SCI findings, was published in the journal Global Health Action. In “Towards reduction of maternal and perinatal mortality in rural Burkina Faso: communities are not empty vessels,” the authors report that the SCI community mobilization program resulted in an increase in institutional births and a reduction in maternal and perinatal deaths. “Although there is no magic bullet, nor a one-size fits-all ideal community mobilization approach,” they write, “closely working with communities by consulting them at all stages of design, planning and implementation of delivery care is critical for achieving reduction in maternal and perinatal mortality.”

Bilingual flipchart aims to improve maternal health in indigenous communities in Ecuador
Cuidémonos para vivir bien / Alli Kawsay Kamayuk (Take care to live well) is a bilingual (Spanish – Kichwa) adaptation of FCI’s ¡Cuídate! (Take Care!) flipchart, especially developed for use in Kichwa-speaking indigenous communities in the Andean region. In Ecuador , where internal disparities in access to and utilization of health services remain very high, maternal and infant mortality rates are high among indigenous communities in rural areas. This tool is designed to be used to educate and empower indigenous groups about their sexual and reproductive health and rights — knowledge that is key to ensuring safe pregnancy and childbirth. This flipchart was produced by FCI, Ecuador’s Ministry of Health, and partners FECABRUNARI, UNFPA, CARE, and CEMOPLAF.

WHO names misoprostol “essential medicine” for incomplete abortion and miscarriage
Responding to an application from Gynuity Health Projects, the World Health Organization announced in April the addition of misoprostol to its Model List of Essential Medicines, based on its proven safety and efficacy for the treatment of incomplete abortion and miscarriage. Misoprostol stimulates uterine contractions and can be used to effectively prevent or end bleeding after delivery, miscarriage, or incomplete abortion — post-partum hemorrhage and incomplete abortion are leading causes of maternal death. Over the last 3 years, Gynuity and FCI have been partners on a large-scale project, funded by the Bill & Melinda Gates Foundation, to clinically evaluate misoprostol for the prevention and management of postpartum hemorrhage and help raise awareness about its potential, especially in low-resource settings where it could have the greatest impact. Click here to read more about the use of misoprostol for safe motherhood.

FCI's president Ann Starrs speaks out on maternal health
On February 23, FCI president Ann Starrs presented at a "Special Event on Philanthropy and the Global Health Agenda" organized by ECOSOC, the United Nations Economic and Social Council. The event focused on two key issues: maternal health and infectious diseases. Secretary-General Ban Ki-Moon, in his opening speech, noted that “maternal health is a critical component of the well-being of any society.” During a panel discussion on the role of philanthropy in improving maternal health, Ann observed: "Pregnancy is not a disease. Pregnancy is something that women WANT and that is essential to the survival of the human race."

On March 4, Ann presented at a seminar on “Global Health Spending: Why Maternal Health Is Not a Political Priority,” at the Woodrow Wilson International Center for Scholars in Washington, D.C. Appearing with Jeremy Shiffman, Ph.D., a professor at Syracuse University who has published research on why certain global health issues are not prioritized by political leaders, Ann analyzed why maternal health is higher on the political agenda now than it has ever been in the past, and what needs to be done to turn that political support into financial investment. Video of the event and Ann Starrs' presentation are available on the Wilson Center website.

Urging that new U.S. administration take action on reproductive and maternal health
During the months since Barack Obama’s election last November, FCI has been working with colleagues in the reproductive and maternal health communities to offer policy recommendations to the new administration. Key actions range from the immediate — like repealing the Global Gag Rule and restoring funding to the UN Population Fund — to a number of bigger-picture goals. Specifically, FCI and its partners are calling for the U.S. government to allocate $1.3 billion for maternal and newborn health in 2010, and for an additional $1 billion allocation to support family planning programs. The community is also urging the Administration to develop a comprehensive, evidence-based Maternal and Newborn Health Emergency Action Plan, and to take the lead in global efforts to provide universal access to life-saving health care for mothers and newborns in the developing world. “This is the first real maternal health coalition we’ve built in the U.S., and it’s also the first time we’ve pulled together as a community to ask the U.S. government for increased funding, “ said Ann Starrs. “FCI doesn’t accept USAID funding, but U.S. policy is still crucial to any solution for maternal mortality. It’s important that we make our unique voice heard, at this time when America seems ready for real change.” 

Providing comprehensive sexuality education in Niger

In Niger, whose maternal and infant mortality rates are among the highest in the world, education on basic aspects of sexuality and reproductive health is not widely available to young people. To help meet this challenge, FCI Niger developed Responsible Choices, Healthy Youth (Choix responsables, jeunesse en bonne santé,) a comprehensive curriculum which includes comprehensive information on issues of sexuality and reproductive health. After extensive pre-testing with more than 500 young people and their teachers over the course of three years, it has been reviewed and validated by the Nigerien Ministries of Youth, Education, Health and Population, and Social Reform, along with other key partners. Both officials and NGOs have expressed intense satisfaction with the curriculum, which contains a preface by the Education Minister. Choix responsables, jeunesse en bonne santé and its teacher’s guide, which contains extensive background information and tips on how to teach the program in ways that appeal to adolescents, are available for download in French.



Promoting culturally sensitive maternity care in Bolivia
Bolivia has made progress in stemming maternal and infant death rates by providing free medical care during pregnancy and childbirth, according to an article ("Bolivia Pushes Birthing Practices Closer to Home”) published last November by Women’s E-news. But many indigenous women still prefer to labor at home rather than take advantage of free hospital care, which often unfortunately comes packaged with insensitive treatment at the hands of medical professionals — like the doctor who chided a patient for her “dirty rituals,” or hospitals that turn away women with serious labor complications because they first tried to give birth at home. The continued preference for home birth helps explain why the maternal mortality ratio has remained high in many of Bolivia’s rural areas. FCI Bolivia is working with indigenous organizations and district health teams on an innovative project in the Lowlands region to help break this pattern. This project, implemented with the support of the Spanish Agency of International Cooperation for Development, will identify cultural barriers preventing indigenous women from seeking free maternal health services, develop strategies to address them, and train doctors and nurses in building cultural sensitivity into their treatment of patients. Read more about FCI’s work in Bolivia.