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Posts Tagged ‘UNFPA’

This post is the first in a series on maternal health in the Seraikela block of Jharkhand, India. 

In 2009, Sarah Blake and I worked together at the Maternal Health Task Force, a Gates Foundation funded maternal health initiative based at EngenderHealth in New York City. Since then, Sarah went on to work as a consultant with several non-profit organizations, including UNFPA and Women Deliver.  I took off for India as a Clinton Fellow with the American India Foundation where I have been working for the past nine months on a maternal and newborn health project in Jharkhand, a state with high levels of maternal and newborn deaths.

A new mom holds her newborn in a small community called Sini, in the Seraikela block, as community members look on.

Sarah and I recently teamed up again (this time, in India) to explore our common interest in maternal health. Over the past two weeks, we have visited hospitals, health centers, government offices, rural villages, and homes in the Seraikela block, a rural area with rugged terrain and limited infrastructure outside the industrial city of Jamshedpur, in the state of Jharkhand.  We conducted a series of interviews with women, families, health workers, and government health officials. We asked questions about pregnancy, childbirth and the postpartum period. We learned about the women’s experiences with home and institutional deliveries–and the factors that influence their decision to deliver at home or in an institution. We explored the implementation of and attitudes toward Janani Suraksha Yojana, a conditional cash transfer program that aims to increase institutional deliveries across India.

A collapsed road on the way from Jamshedpur to the Seraikela Block of Jharkhand.

Conditional cash transfers are trendy. Various governments, non-governmental organizations, and private enterprises across the globe are supporting cash transfer initiatives in efforts to improve school attendance, reduce child under-nutrition, improve maternal and newborn health, and to address other development goals.

What is a conditional cash transfer program? According to the World Bank, “conditional cash transfer programs provide cash payments to poor households that meet certain behavioral requirements, generally related to children’s health care and education”.

Janani Suraksha Yojana (JSY) is a widely discussed (mostly within the global health community but to some extent in mainstream media) and frequently praised cash transfer program. JSY was launched by the Indian government as part of the National Rural Health Mission in 2005, in an effort to reduce maternal and newborn deaths by increasing institutional deliveries.

JSY provides cash incentives to women who deliver in government health institutions as well as accredited private health centers. The program also provides a cash incentive to the health worker who supports the woman throughout her pregnancy and accompanies her to the facility. (For details and FAQs on JSY, click here.)

A community health worker accompanies a pregnant woman to Mahatma Gandhi Memorial Hospital in Jamshedpur, the main referral hospital for the surrounding rural communities.

Maternal and newborn death rates have gradually been declining across India (and the world), but the problem has yet to be resolved. Both maternal and newborn deaths in India continue to make up an extremely large percentage of the overall global burden. According to a study published in the Lancet last year, 20% of global maternal deaths and 31% of global newborn deaths in 2005 occurred in India.

JSY is a big program (the biggest of its kind in the world) that aims to deal with a big problem. The lessons that are drawn from it have the potential to influence global health policy in a big way. The 2010 evaluation of JSY published in the Lancet suggested that the program is having a significant impact on perinatal and neonatal health, but the paper asserted that the verdict was still out in terms of any impact on maternal mortality.

The lesson that has emerged from JSY for newborn health is that giving women money increases institutional deliveries and reduces perinatal and neonatal mortality.  It is likely that the same message will emerge in terms of reducing maternal mortality—and there is a good chance that this approach will be picked up in national health programs in numerous other countries that also have high levels of maternal and newborn mortality.

Our concern is that JSY is far more complex than providing women with money—and reducing maternal mortality is far more complex than increasing institutional delivery.

Given the scope, cost, and potential of JSY; it is incredibly important that we ask questions about the nuances of JSY—the role of money as an incentive for women, families and health workers; the readiness of institutions;  the challenges with transportation; the human rights implications of the program; and a variety of other related factors.

Over the next week (or couple of weeks), Sarah and I will share our experiences and insights from our time with the women, families, health workers, and government health officials of the Seraikela block of Jharkhand, a focus state for JSY. We will highlight stories from the people most impacted by and involved in Janani Suraksha Yojana.

We believe that we have scratched the surface of some interesting issues related to JSY, but our time in Seraikela certainly left us with more questions than answers, and we will be sharing those questions in upcoming posts.

We will also be asking our colleagues working in maternal and newborn health to share their thoughts through guest blog posts. If you are interested in submitting a guest post, contact us at katemitch@gmail.com and sarahcblake@gmail.com.

Tata Steel Rural Development Society, my host organization for my fellowship, provided us with transportation and interpreter services. Many thanks to Shabnam Khaled for her help with translation. 

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In April, the Lancet published new maternal mortality estimates (out of the Institute for Health Metrics and Evaluation) that showed a significant reduction in global maternal deaths, shaking up the global health community’s understanding of the global burden of the issue–and providing new hope. The report also illustrated the important links between HIV/AIDS and maternal mortality.

In the wake of the Lancet report, maternal health professionals from various organizations engaged in robust dialogue (like this one) about measurement methodologies–and raised questions about when the World Health Organization would release their estimates and how they might differ from the IHME estimates.

On September 15th, WHO, UNICEF, UNFPA, and the World Bank released their new maternal mortality estimates in a report, Trends in maternal mortality. Their report also showed a significant drop in maternal deaths—a 34% decrease between 1990 and 2008.

Excerpt from the WHO press release:

“The new estimates show that it is possible to prevent many more women from dying. Countries need to invest in their health systems and in the quality of care.

‘Every birth should be safe and every pregnancy wanted,’ says Thoraya Ahmed Obaid, the Executive Director of UNFPA. ‘The lack of maternal health care violates women’s rights to life, health, equality, and non-discrimination. MDG5 can be achieved,’ she adds, ‘but we urgently need to address the shortage of health workers and step up funding for reproductive health services’…”

More highlights from the report:

  • Ten out of 87 countries with maternal mortality ratios equal to or over 100 in 1990, are on track with an annual decline of 5.5% between 1990 and 2008. At the other extreme, 30 made insufficient or no progress since 1990.
  • The study shows progress in sub-Saharan Africa where maternal mortality decreased by 26%.
  • In Asia, the number of maternal deaths is estimated to have dropped from 315 000 to 139 000 between 1990 and 2008, a 52% decrease.
  • 99% of all maternal deaths in 2008 occurred in developing regions, with sub-Saharan Africa and South Asia accounting for 57% and 30% of all deaths respectively.

Click here to read the press release and here to read the full report.

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The Woodrow Wilson Center’s Global Health Initiative, the Maternal Health Task Force, and the United Nations Population Fund (UNFPA) invite you to attend (or watch online) the sixth event of the series, Advancing Policy Dialogue on Maternal Health: The Impact of Maternal Mortality and Morbidity on Economic Development. The event will take place on July 29th from 3-5pm in Washington, D.C.

Woodrow Wilson International Center for Scholars

Event Details:

Investing in women and girls health is smart economics. According to the United Nations Population Fund (UNFPA) women contribute to a majority of small businesses in the developing world and their unpaid work on the farm and at home account for one-third of the world’s GDP. The U.S. Agency for International Development (USAID) estimates that maternal and newborn deaths cost the world $15 billion in lost productivity.

Mayra Buvinic, sector director of the gender and development group of the World Bank, will address the economic impact of maternal deaths and the role of education and gender equality on economic development. Dr. Nomonde Xundu, health attaché at the Embassy of South Africa in Washington DC will discuss the policy implications of maternal health and share lessons learned in empowering women and girl’s economic status in South Africa. Mary Ellen Stanton, senior maternal health advisor of USAID, will present the foreign policy and economic case for increased donor investment in maternal health.”

For more info and to RSVP, click here.

For info on future events and links to videos of previous events in the maternal health policy dialogue series, click here.

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Today, July 12th, marks six months since the devastating earthquake that shook Haiti earlier this year, killing more than 200,000 people.  An article, published today on Relief Web, outlines several of the components of the national health plan of the Haitian Ministry of Public Health and Population (with support from UNFPA) that was developed after the earthquake. The plan includes reviving the National School of Nurses and Midwives to reestablish midwifery training programs, working with UNICEF to set up clinics to provide skilled reproductive health services and basic emergency newborn care, supporting the Haitian Association of Obstetricians and Gynecologists to improve referral systems for maternal and neonatal services, and a variety of other activities to reduce morbidity and mortality among Haiti’s most vulnerable populations.

Relief Web

Excerpt from the article:

“…Life in the temporary camps poses a number of health challenges, especially for women and girls. Living in tight, often insecure quarters with minimal access to sanitation can expose women and girls to sexual violence and other dangers.

Over the past months, UNFPA, the United Nations Population Fund, has provided maternal health supplies, including birthing kits to serve a population of 2 million people, as well as 22,000 hygiene kits aimed at the female population living in temporary camps, along with nearly 1,000 tents, 2000 mattresses and 17,000 solar lamps…”

Click here for the full story.

For information on UNFPA’s work in Haiti, click here.

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The Woodrow Wilson Center’s Global Health Initiative, the Maternal Health Task Force, and the United Nations Population Fund (UNFPA) invite you to attend (or watch online) the fifth event of the series on Advancing Policy Dialogue on Maternal Health: Improving Transportation and Referral for Maternal Health. The event will be held on May 20th from 3-5pm in Washington, D.C.

The MHTF Blog

“…Access to skilled birth attendants and emergency obstetric care are key solutions to improving maternal morality, yet functioning referral systems and poor road infrastructure delay efficient care. Increased research, funding, knowledge sharing, and coordination between private and public sectors are necessary to make transportation and referral a global health priority.

Today’s discussion will highlight the lessons and knowledge gaps identified at a Wilson Center workshop in Washington DC with 25 experts from the transportation and maternal health communities, as well as representatives from the private sector and donor community.

Víctor Conde Altamirano, obstetric nets manager, CARE-Bolivia will discuss how transportation and referral data is being incorporated into Bolivia’s health system to improve maternal health. John Koku Awoonor-Williams, east regional director, Ghana Health Service, will address the utilization and maintenance of ambulances in rural Ghana. Subodh Satyawadi, chief operating officer, GVK Emergency Management Institute will discuss the lessons learned and challenges faced through India’s “Emergency 108” call system. Strategies and recommendations identified at the Wilson Center workshop in Washington DC will be provided by Patricia Bailey, public health specialist, Family Health International…”

Click here for event details, information on how to RSVP or watch the live/archived webcast, and additional info on the series!

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A new report by Save the Children, “State of the World’s Mothers 2010,” identifies Norway as the best place in the world to be a mother–and Afghanistan as the worst.

Save the Children

The focus of the report is on the shortage of front line health workers in developing countries–and the critical need to train more female health workers in order to save the lives of women, children and newborns living in the most marginalized communities.

“Mothers in Norway and Australia are living in the best places in the world, according to Save the Children’s 11th annual “Mothers’ Index”, which ranks the best and worst places to be a mother.  Afghanistan ranked at the bottom of the list of 160 countries, which included 43 developed nations and 117 in the developing world.

The “Mothers’ Index” is highlighted in Save the Children’s State of the World’s Mothers 2010 report, which examines the many ways women working on the front lines of health care are helping to save the lives of mothers, newborns and young children, and makes an urgent call to increase the number of front-line health workers in the world’s poorest nations….”

Read the full post on the Save the Children site for an overview of the report with a list of the top ten (and bottom ten) places to be a mother–and several very interesting country comparisons across maternal and child health indicators.

UNFPA and the International Confederation of Midwives are also speaking out about the urgent need to train more front line health workers in difficult to reach communities. I posted an excerpt of their statement a couple hours ago.

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Today, May 5th, is International Day of the Midwife—and UNFPA and the International Confederation of Midwives have released a joint statement calling on world leaders to address the shortage of 350,000 midwives around the world. Their statement explains that increased investments in training midwives are critical to reaching the most marginalized communities–who typically lack access to health services.

UNFPA

“…The UNFPA and ICM point out that midwives can prevent up to 90 per cent of maternal deaths where they are authorized to practice their competencies and play a full role during pregnancy, childbirth and after birth. They have a critical role in providing family planning, counselling, and preventing HIV transmission from mother to child.

As the world gears up for the 10-year review of the Millennium Development Goals, both organizations will be campaigning to increase funding for goals 4, 5 and 6 to reduce child mortality, improve maternal health and combat HIV and AIDS.

We look forward to the high-level Midwifery Symposium from 5 to 6 June in Washington, D.C., immediately preceding the Women Deliver Conference. The symposium aims to raise awareness around the core role of midwifery services in achieving MDGs 4, 5 and 6; address challenges in global standards on education and regulation of midwives; and strengthen midwifery services…”

Read the full statement.

Also, take a look at this video statement of the President of the International Confederation of Midwives, Bridget Lynch.

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