FCI Bolivia is a key partner in the promotion of indigenous women’s rights
(November 2009) FCI Bolivia was one of the organizers of the planning and coordination meeting of the regional initiative to promote maternal and intercultural health of indigenous women. In partnership with UNFPA and the indigenous women’s association Enlace Continental-Southern Region, FCI took an active role at the meeting held in Santa Cruz de la Sierra, Bolivia, from October 27-29, 2009. Indigenous women leaders, together with representatives from UNFPA, the Spanish Agency for International Development (AECID) and FCI, met to evaluate the progress made this year and prioritize key strategies for 2010. The project is funded by UNFPA and AECID.
As part of the same initiative, Alexia Escóbar Vásquez, FCI Bolivia’s National Coordinator, was invited to be facilitate at the International Workshop to Increase Participation of Indigenous Women in Public Policies. Sixty indigenous women leaders participated at the workshop, held in Buenos Aires November 4-6, 2009.
The Bolivian government has also moved to use materials developed by FCI throughout the country. ¡Cuídate! Una Guía de Salud y Bienestar, an educational flipchart on gender and reproductive health and rights that FCI developed with the Confederation of Indigenous Peoples of Bolivia (CIDOB), will be adapted by the UN Population Fund (UNFPA) for use by the Bolivian Ministry of Health in indigenous and rural communities across the country’s Highlands. The National Maternal and Newborn Health Committee (Mesa de Maternidad y Nacimiento Seguros), headed by the health minister, has also expressed interest in updating and reprinting a national policy brief on maternal health that FCI produced two years ago. Click here to learn more about FCI’s work in Latin America and the Caribbean.
Global Consensus on Maternal, Newborn and Child Health to save 10 million lives
(September 2009) FCI, as lead advocacy partner in the Partnership for Maternal, Newborn & Child Health, helped to organize the event Investing in Our Common Future: Healthy Women, Healthy Children at the UN. Hosted by the UK prime minister and the president of The World Bank, the focus was on funding for health systems: the presidents of several developing nations promised to provide free health care for women and children, and donor countries committed their support with over $5 billion in new health aid over six years. The event also launched a new global Consensus for Maternal, Newborn and Child Health, setting out five key action steps to save the lives of more than 10 million women and children by 2015. Read more.
View a clip of the event.
Global NGO forum calls for delivering on promise of ICPD
(September 2009) Nearly 200 civil society organizations came together in Berlin for the Global Partners in Action: NGO Forum on Sexual and Reproductive Rights and Development, an event to mark the 15th anniversary of the historic International Conference on Population and Development (ICPD) in Cairo in 1994. Participants reviewed progress on the commitments in the ICPD Programme of Action and the Millennium Development Goals (MDGs), and made plans for joint advocacy to fulfill their great promise. Interviewed by the British medical journal The Lancet (hear the interview here), Ann Starrs said that the forum helps to “ensure that sexual and reproductive health and rights is part of the broader development agenda and can be a key part of the dialogue in 2010 when we are talking about what needs to de done to achieve the MDGs.” The resulting Call to Action demands “concrete, practical and fully funded actions” by governments to fulfill 15 years of promises to invest in equality, human rights, and social and economic development for women and girls.
FCI research shows primary health facilities are key to increasing skilled care use
In an article published in the September 2009 issue of Social Science & Medicine, FCI presented findings from our work to improve access to skilled maternity care in Burkina Faso, research conducted as part of FCI’s groundbreaking Skilled Care Initiative with funding from the Bill and Melinda Gates Foundation. The Skilled Care Initiative resulted in a significant increase in women’s use of facility-based maternity care in the intervention district, particularly at lower-level health facilities. Most importantly, large wealth inequities in the use of professional care during childbirth were almost eliminated — among all women, and among women who experienced complications during delivery. FCI’s results, described in “Improving poor women’s access to maternity care: Findings from a primary care intervention in Burkina Faso,” suggest that efforts to upgrade maternity services at primary care facilities may be key for improving poor women’s access to and use of skilled care during childbirth.
Community leaders are crucial to increasing use of maternity services
(August 2009) In rural African villages, community leaders — chiefs, religious leaders, women's group leaders, and others — can have a major influence on how local people manage health issues, including pregnancy and childbirth. They also provide an important link between communities and health facilities, and can help mobilize communities to demand better health services. Many such leaders, however, have little if any information about maternal health. Last year, FCI trained over 200 community leaders in three districts in Tanzania to encourage greater use of maternal health services. "If women in our community experience safer pregnancy and childbirth, they will have a healthier family," said one participant. During the training, community leaders developed messages tailored to their unique social and cultural environment to encourage women to seek skilled maternity care, as well as action plans for sharing these messages with members of the community.
In a recent post on the Global Health Council’s blog, Ann Starrs argues that ending maternal death requires not only more funding but change at the community level. “Yes,” she writes, “it is urgently important to build health systems that can provide skilled care, emergency treatment, postpartum care, reproductive health services, and family planning for every woman everywhere. But clean, accessible, professionally-staffed health centers can only save the lives of women who use them… Communities — and the respected, influential local leaders who can be such powerful agents of change at the grassroots level — need the education and empowerment to take ownership of their local health services, to demand and create accountability, and to help change the social and cultural norms that stand between women and the skilled care that they need.” Click here to read more.
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.