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Posts Tagged ‘Women Deliver’

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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On July 1st, the Women Deliver team announced the top five highlights from the 2010 conference (June 7-9). See below for a summary of the conference highlights–with links to publications, videos, photos, and additional information that came out of the conference.

This post was originally posted on the Women Deliver website and is reposted on MMD with permission from Women Deliver.
conference-participants.jpg

Women Deliver 2010 Conference participants

Thank you to everyone who contributed to the success of the second Women Deliver global conference. To put world leaders on notice that the time for action on maternal health is now, 3,400 advocates, policymakers, development leaders, health care professionals, youth, and media from 146 countries converged on Washington, DC on June 7-9 at Women Deliver 2010. More than 800 speeches and presentations were given at the six plenaries and 120 breakout sessions.  The heads of five UN agencies, plus the Secretary-General of the United Nations, attended. Thirty countries, UN agencies, the World Bank, corporations, and foundations helped support Women Deliver. Please see below for highlights and recaps of the conference.

1. Key Statements. Read the outcome statements from the:

2. Webcasts. Watch the videos from our plenary sessions and our press conferences, and watch Hillary Clinton’s address to the Women Deliver 2010 attendees.

3. Photos. Take a look at photos from the plenary sessions, breakout sessions and other conference events, and download them at no cost.

4. Programme. Review the plenary and breakout sessions that were held at Women Deliver 2010.

5. Publications and Advocacy Tools. Visit our Knowledge Center to download publications and advocacy tools, including:

Stay tuned for our summary report on breakout sessions by theme.

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Tuesday (6/8) marked day two of Women Deliver 2010. Day two was all about innovation and (high and low) technology to improve the health of women and infants worldwide–in fact, the conference organizers marketed Tuesday’s sessions as a stand-alone symposium called Technology as a Catalyst for Social Transformation.

Take a look at two examples of technologies that were discussed at the conference on Tuesday…

Microbicide Vaginal Rings (High Tech)

“The nonprofit International Partnership for Microbicides (IPM) today announced the initiation of the first trial among women in Africa testing a vaginal ring containing an antiretroviral drug (ARV) that could one day be used to prevent HIV transmission during sex. The clinical trial, known as IPM 015, tests the safety and acceptability of an innovative approach that adapts a successful technology from the reproductive health field to give women around the world a tool to protect themselves from HIV infection…”

Read the full press release here.

Clean Delivery Kits (Low Tech)

Clean Birth Kits–Potential to Deliver?, a publication supported by Save the Children/Saving Newborn Lives, Norwegian Ministry of Foreign Affairs, Immpact (University of Aberdeen), and the Maternal Health Task Force at EngenderHealth, was released at a session at Women Deliver yesterday. The session was chaired by Claudia Morrissey of Save the Children; moderated by Richard Horton, Editor of the Lancet; and presenters included Wendy Graham of University of Aberdeen, and Haris Ahmed of PAIMAN. The goal of the session was to summarise the evidence base for clean delivery kits, discuss practical implementation experiences from the field, and to have a lively debate on the “risks” associated with promoting birth kits. The report will be available online soon.

Subscribe to the MHTF Blog for updates on this project/report–as well as updates on other MHTF projects and commentary on a variety of maternal health issues.

Check out a recent blog post, A Good Idea or an Expensive Diversion: Workshop on the Evidence Base for Clean Birth Kits, by Ann Blanc, Director of the Maternal Health Task Force, on a workshop leading up to the new report on delivery kits.

Click here for the webcast of a session at Women Deliver 2010 that explores “What’s on the Horizon” for new technologies in contraception.

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In this video, Richard Horton, Editor of the Lancet, talks about the key themes of the upcoming Women Deliver conference (June 7-9)–specifically the focus on Millennium Development Goal 5, improving maternal and reproductive health.

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The official launch of the Countdown to 2015 Decade Report (2000-2010) will be at the Women Deliver and Countdown to 2015 for Maternal, Newborn and Child Survival conferences next week (the Countdown meeting is being held in conjunction with Women Deliver) –but the report is now available to download on the Countdown to 2015 website.

Countdown to 2015-Maternal, Newborn, and Child Survival

From the report:

“The Countdown report for 2010 contains good news–many countries are making progress, reducing mortality and increasing coverage of effective health interventions at an accelerating pace. But the news is not all good. Many Countdown countries are still off track for achieving Millennium Development Goals 4 (reduce child mortality) and 5 (improve maternal health) and are not increasing coverage of key health interventions quickly enough…”

Click here to download the report and/or the brochure with highlights from the report.

Click here for a press release on the new report.

Click here for a special message from Countdown for conference participants about the special track at Women Deliver for Countdown to 2015 sessions.

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Dr. Fred Sai is co-host of Women Deliver 2010, former reproductive health and HIV/AIDS advisor to the Ghanaian government, and has spent 40 years working to improve the health of women and children in Ghana and throughout Africa.  In his June 2nd blog post, A New Role For Africans in Maternal Health, on the ONE Blog, Dr. Sai comments on the new maternal mortality estimates published in the Lancet that show a dramatic reduction in global maternal deaths–and asks questions about why Africa (as a whole) has not seen these same reductions. He also expresses confidence that a shift in approach (described in his post) will lead to major improvements in the health of women and children throughout Africa.

The ONE Blog

“…It is an unfortunate truth that progress for the world at large does not necessarily mean progress for Africa. In 1980, almost a quarter of maternal deaths occurred in African countries. Today that figure has doubled to more than half. All but one of the 30 countries with the worst maternal mortality statistics are in Africa. And while countries like Ghana and Rwanda have seen a steady decline in maternal deaths over the past 15 years, others such as Malawi, Lesotho, Zimbabwe, Nigeria and Cote d’Ivoire actually have higher maternal mortality rates than they did in 1990.

Addressing maternal mortality in Africa is complex and challenging. Our countries face increasing rates of HIV, entrenched and debilitating poverty, food shortages, weak education and health care systems, problematic governance, corruption, and civil conflict. These are huge issues in their own right, but they also have significant impact on maternal, newborn and child health. The challenges, however, are not the whole story…”

Read the full post, A New Role For Africans in Maternal Health.

For additional reactions to the Lancet publication from other leaders in the maternal health field, click here.

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The Maternal Health Task Force currently has three interactive (and fast growing!) maternal health maps; maternal health knowledge hubs, MPH programs that offer a concentration/focus on maternal health, and maternal health organizations. As part of my role at the MHTF, I am working to spread the word about these maps and further populate them so that they can serve as useful resources for maternal health professionals and students around the world. See below for a recent blog post on the MHTF Blog with info on how to put your organization or school of public health or medicine on the maps!

The MHTF Blog

“Using geographic maps provides a global view of where maternal health activity is occurring and helps the community to understand where gaps exist. So far, we have three interactive maps on our site containing information that we hope will be useful in your work or studies; maternal health knowledge hubsMPH programs that offer a concentration/focus on maternal health, and maternal health organizations.

At the upcoming Women Deliver conference in Washington D.C. (June 7-9), we will be engaging conference participants in our mapping activities and encouraging them to put their organization or school on the map! If you are attending Women Deliver, please visit our table in the Registration Hall to map your organization or school and to see a demo of how our mapping system works.

Putting your organization on our maternal health map will help to build a growing interconnected community of maternal health organizations. It will link the important work of your organization or school with the work of maternal health organizations and schools around the globe.

If you are not attending Women Deliver, you can still get mapped! Click here to download the mapping form. Fill it out and return it to Kate Mitchell at kmitchell@engenderhealth.org.”

Also, be sure to check out Maternova’s maternal health mapping activities! Maternova is working to map clinics and hospitals with maternal health services around the globe.

Maternova

“We aim to host a global map of maternal health clinics using crowdsourcing to create an unprecedented resource and exchange mechanism for millions of frontline professionals.”

Click here to visit the Maternova maternal health map–and learn more about the initiative.

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