There are currently 222 million women worldwide who want access to modern contraception but don't have any way to get it. We know that the healthy timing and spacing of pregnancy can improve the health of both mother and child, but did you realize there was a significant economic benefit to making contraception accessible to women living in extreme poverty? This short video by Population Action International summarizes the economic benefits beautifully.

My first week back in Guyana began with the third annual Crash Course in Emergency Medicine. A couple of years ago, Vanderbilt began an Emergency Medicine Residency Training program at Georgetown Public Hospital Corporation (GPHC). With every new class of residents, we put on a “Crash Course,” an intensive four-day lecture series, so that all the new residents can get some intensive training on common emergencies, and all the older residents get an intensive review.

This time, we welcomed our third class of residents. First things first, though—tests for the senior residents! The very first day, we got up early to put all of our upper level residents through an entire day of in-service exams. They had a written test all morning, oral exams, and then an individual simulation case. For the simulation scenario, I was the “nurse” assisting the examinee. It’s a fun position to be in because I get to provide helpful hints if they’re going down the wrong path, or make the case more challenging for the more advanced residents who were knocking it out of the park.

FGHL Ashley Brown Chalkboard

The next day we got up bright and early to begin the crash course. For this four-day session, the new class of residents joined us as well. I participated in the crash course last year, and it was great to see how much the upper level residents had grown, both in knowledge and confidence. I got to lecture on some favorite topics of mine and listen to some great lectures by Vanderbilt faculty as well. One of the most encouraging parts of crash course was the return of faculty from the University of the West Indies in Trinidad. Dr. Joanne Paul, a Pediatric Emergency Physician, returned again to crash course to lecture, along with Dr. Georgia Baird, an Emergency Physician. They both also lectured for a CME course over the weekend that was open to the community. During their visit, they were also able to network with our residents to discuss the role of Emergency Medicine throughout the Caribbean. Our residents are in uncharted territory in Guyana; in fact, Emergency Medicine is a relatively new field throughout the Caribbean. Dr. Paul and Dr. Baird helped to give the residents some insights about how to make the field more recognized and accepted, and how they might begin and organize specialty groups.

FGHL Ashley Brown students

After four days of around 8 hours of lectures daily, we went as a group to tour a local sugar factory (although I think most of the residents were so tired at that point they probably would rather have taken a nap!). It was great to have that time to get to know the new residents I would be working with in the coming weeks, and to see them immediately welcomed as part of the group. Now that we had given them a foundation, it was time to get back to work in the A&E!

Anyone you talk to will tell you that they care about mothers and babies. But many people here in the United States don't realize that a mother dies somewhere in the world every two minutes. Every two minutes. The data is staggering.

Our hope is to make sure Christians don't let that overwhelming statistic leave them feeling overhwelmed to the point that they fail to act. Because the connection between maternal health and faith is so important.

We recently discovered this Q&A article with Courtney Fowler, a conference lay leader in the United Methodist Church, who connects the dots between maternal health, faith, and reproductive justice. It's a great resource for those who are starting to dip their toes in this issue of women's health and who passionately care about the lives of women all over the world, because you believe God cares about them too.

1,000 Days March 4 Nutrition

Last week, 1,000 Days was honored to join with Hope Through Healing Hands and Senator Bill Frist to engage community leaders in Nashville in the effort to improve maternal and child nutrition. With leaders from the faith, business, and academic communities around the table, we examined the issue of poor nutrition around the world and in Tennessee, where one in four children are food-insecure. The gathering of diverse voices—united by their passion to help mothers and children throughout the world—was a unique opportunity to bring greater attention to the issue of poor nutrition early in life and discuss ways that churches, businesses, and individuals can make an impact. 

What became clear is that the importance of good nutrition, right from the start, is universal. Whether a baby is born in Nashville, Tennessee, or Nairobi, Kenya, every child needs basic nutritional building blocks to achieve healthy growth and brain development.   

Poor nutrition—whether measured as hunger, undernourishment, or obesity—is pervasive throughout the world.  Unfortunately, it is also all too pervasive in the US as well. 

As a result, poor nutrition is arguably this generation’s largest public health issue. Globally, nearly half of all childhood deaths worldwide are caused by malnutrition and 165 million children are permanently stunted as a result of chronic undernourishment, leaving them unable to reach their full potential to grow, learn and thrive. In the US, food insecurity and the epidemic of obesity are together fueling a burgeoning health crisis. In the US, about a quarter of preschool children ages 2-5 year are overweight or obese.

Ensuring that children get the right nutrition early in life is one of the most basic yet powerful things we can do to ensure healthier and more prosperous societies. 

There is strong scientific evidence that points to one moment when the quality of a person’s nutrition can shape the foundation of lifelong health and well-being.  It all starts in the first 1,000 days. The 1,000 days between a woman’s pregnancy and her child’s second year of life is a critical window of opportunity when nutrition serves as the foundational building block for a person’s intellectual development, growth and long-term health.  Research shows that a child that is well-nourished early in life is more likely to do better in school, earn more money as an adult and have a lower risk of illnesses such as diabetes and heart disease.  The effects of good nutrition early in life have been estimated to boost economic prosperity as much as 8 percent in terms of GDP gains. 

In this way, improving nutrition for mothers and children during the critical 1,000 day window is one of the most powerful tools we have to unlock greater human and economic potential and help break the cycle of poverty.  It is the reason why the 1,000 Days Partnership was formed and includes over 80 partners working to promote greater action and investment in maternal and young child nutrition.  While the 1,000 Days partnership has helped galvanize much-needed momentum to improve maternal and child nutrition globally, much remains to be done. 

There’s a simple way to get engaged in this conversation. Throughout the month of March, 1,000 Days is hosting an online “March for Nutrition” to raise awareness about the critical role of good nutrition for women and children everywhere. I invite you to join us by sharing your stories and insights on Facebook and Twitter and by following #March4Nutrition.

 

 

Our mission at the Faith-Based Coalition for Healthy Mothers and Children Worldwide is to create advocates for maternal health, infant and children’s health, and for the healthy timing and spacing of pregnancies for women in developing world. This includes mothers in Africa, India, Mongolia, Guatemala, and everywhere where moms and children are living in extreme poverty. Where 222 million women (mostly married) want access to contraception, but it’s simply not available where they live.

It’s hard for us in the United States to get outside of our own experience when we look at these issues. The debate about domestic healthcare rages on, and it’s difficult for us to separate this from international maternal health. But once we’re able to imagine a daily experience outside our own, the need for advocacy becomes crystal clear.

Unicef photo childPhoto (c) Unicef

In the country of Niger, for example, 75 percent of girls become child brides. Of course, this is the country that has the highest prevalence of child marriage, but the truth is that young girls—often around eleven years old—are regularly given in marriage across Africa and southeast Asia. When these girls marry, they’re often forced to leave school, stunting their intellectual development and their social growth. They've also frequently not been educated about reproduction, and their young bodies simply are not ready to become mothers, evidenced by the fact that a girl is 10-14 times more likely to die in childbirth if she has her children before the age of 18.

Or consider Beatrice Namulondo. She was 13 when first became a mother, and she had dreams of raising a small family of children. But at age 36 she’s now mother to 17, because she had no access to any kind of contraception. This is compounded by the fact that the women in her village told her timing and spacing her pregnancies to suit the life she dreamed of and to match what she was economically and emotionally prepared to care for would make her weak and unable to work her garden, when the exact opposite is the truth.

But good work is being done to turn the tide, and in countries like Ethiopia the maternal mortality rate is dropping, the country’s GDP is rising, and political leaders believe these things are intimately connected. With Ethiopia’s Health Extension Worker (HEW) program, women and children receive visits from the 38,000 HEWs like Miheret, who travel to hard-to-reach places (like Ethiopia’s border with South Sudan) to administer vaccines, test for diseases like diarrhea or pneumonia, and monitor the hygiene in the home. Women are given access to contraception and maternal care when they do choose to have children. The results are staggering—child mortality has been slashed in half, poverty rates are down, and twice as many children are in school.

If you want to learn what you can do to help more women get access to this kind of life-saving assistance, visit our Faith-Based Coalition for Health Mothers and Children Worldwide page and see what advocacy activities we’re involved in at the moment. Follow us on Twitter @HTHHglobal and on Facebook. We need you!

The Ethiopian Orthodox Church (EOC) comprises 43.5% of the population, or almost half.  After that, Muslim communities make up 33.9% of the population. In the minority, Protestant denominations comprise 18.6%. And finally, there are a few other traditional religions at 2.6%, and Catholics at less than 1%. The EOC has a long, rich cultural history in Ethiopia. It was a part of the Coptic Orthodox Church until 1959 when it was granted its own patriarch. It is a hierarchical religion with archbishops and bishops worldwide.

rock church_ethiopia

In the Tigray region, there exist a host of monolithic churches, or churches hewn out of one single rock. There is a community of churches in Lalibela that are famous rock churches, but there are a few in Mekele as well. We visited one on the outskirts of town while there.

Perhaps most famously, in the town of Axum, The Chapel of the Tablet at the Church of Our Lady Mary of Zion claims to house the original Ark of the Covenant with the Ten Commandments as held by Moses.

In Mekele, we were able to visit with both an Eastern Orthodox Priest, Keshi Gebre Tsadkan, as well as staff from the St. Frumentius Abba Selama Kessate, Berhan Theological College Mekelle including Mr. Tesfaye Hadera, Dean; Mr. Mekonnen Tesfay, Vice Dean; and Mr. Assefa Reda’e, Bible for Development Coordinator.

priest_ethiopia

Knowing that there are over 500,000 Ethiopian Orthodox Priests throughout the nation of Ethiopia, there is an embedded potential arm of the culture to support and educate citizens about access to health care. Before he died in 2012, the former Patriarch Abune Paulos urged Ethiopians to seek not only “holy water” to heal HIV/AIDS, but he also encouraged his followers to adhere to their regimen of anti-retroviral medications. This was a crucial message for people living with HIV/AIDS to seek proper care and treatment.

In the same way, priests serving as “godfathers” to families throughout the country have the opportunity to educate families about the importance of women’s health, antenatal care, and family planning. This being said, the situation is made complex by the current stigma that still surround issues of sexuality.  The statistics show little participation in pre-marital sex in Ethiopia, probably due to the average age of 16 for marriage for girls. Yet, girls typically marry older men who want children immediately. The gatekeepers of the community including ethnic leaders, mothers-in-law, and religious leaders tend to support the husband in the wish for families. Thus, the highest unmet need for contraception in the country is for young married girls between the ages of 15-19 at 30% as of 2011.

However, some priests are aiding in the destigmatization of family planning in their communities, such as Gebretsadkan. He shared that he goes with his wife to the Health Post to demonstrate his support for her choice of contraception. As a “godfather,” he advises many husbands and families on how to better time and space pregnancies, encouraging contraception, as a life saving mechanism in some cases.

When I asked about his theological position supporting family planning, he asked, is it not a sin to not be able to provide food, clean water, and clothing for your own children? To allow your children to suffer from hunger, malnutrition, and potential disease because you cannot support them? Isn’t it better to take advantage of the knowledge that family planning allows for healthier deliveries, births, newborns and children properly timed and spaced as well as a more stable family economically?

Similarly, in speaking with the Dean and Professors of the Seminary, they too argued that in fact Ethiopia had accomplished the request to “Be fruitful and multiply the earth,” as noted in Genesis. Now, it was time to rethink the health of mothers, children, and families with access to family planning.

The St. Frumentius Abba Selama Kessate, Berhan Theological College Mekelle partnered with UNFPA and Population Council to create a “Developmental Bible.” This book, printed in Amharic, held 365 different devotions with Scripture related to development and health issues. The Scripture correlated with issues such as HIV/AIDS, maternal and child health, infectious disease, hunger, malnutrition, and family planning.

These books are the basis of a “Developmental Bible” course at the Seminary for formal training of priests as well as an informal training for current priests through workshops. At the end of the training, they receive the books to use in their communities in devotion and worship. These Developmental Bibles have been disseminated throughout the nation.

Some argue that the religious leaders pose a barrier to family planning. Others contend that the support of religious leaders has been helpful from HIV/AIDS awareness and education to family planning. We conclude that due to the pastoral, rural nature of the country, that likely there is much work to be done to educate and encourage priests to urge their followers to seek information and services to improve maternal and child health, including family planning.

In every village, there is a priest or an imam or a pastor. If these religious leaders were incentivized to promote awareness and education of health care opportunities, like family planning, the religious communities could also be a powerful arm mobilizing the nation to achieve MDG5, improving maternal health.

Haiti Nursing Graduate Faculty

Two years ago, the Clinton-Bush Haiti Fund granted $462,800 to Regis College to advance Haiti's future nursing leaders through a master's degree of nursing program in the country. The goal was to unite Haiti's government and higher education institutions to support nursing programs in their country. 

The grant enabled the country to elevate their nursing program to a higher level, which has resulted in sustaining nursing jobs, promoting healthcare standards, and transforming the health sector.

On February 18, 2014, the first twelve faculty graduates of the master's degree in nursing program from the University of Haiti. Twenty-four more faculty members will complete the program, who will in turn pass their education on to more than 4,000 students each year.

Read more at Regis College's website.

by Jenny Dyer, PhD

Over the last ten years, Ethiopia has implemented their Health Extension Worker (HEW) program building Health Posts with HEWs throughout the country. To date, there are some 38,000 HEWs; two at every post. This has amazing reach to communities whose individuals might otherwise have to walk for miles and miles just to have basic services for a sick child, contraception, or antenatal care. This being said, the Health Post does have limitations. The HEW cannot provide a high level of skilled care. For instance, women in Tigray are highly encouraged to take a “mobile ambulance” (i.e. stretcher) to the Health Center where they can have access to skilled health workers that are better prepared to manage complications during birth.

Agulae health center_ethiopia

We visited Agulae Health Center in Tigray which won the award for the best Health Center in the country a couple of years ago. The sign outside reads “Healthy Mom, Happy Child.” The Center focuses on maternal and child health , ART treatment, TB treatment, family planning, and youth friendly services, providing a holistic approach for development of identity for teens in the area. Ethiopia is serious about improving maternal health, or conversely, reducing maternal mortality. And, one step to do this is by encouraging moms to have their babies in the health center, not at home.

Healthy Mom happy child_ethiopia

Inside, patients waited for services including anti-retroviral treatment, immunizations, contraception, antenatal care, and pediatric care. The Health Center Director, Tirete Zeleke, shared with us the progress particularly in delivery services over the last five years. See the chart below. Note that Ethiopia’s calendar is eight years behind ours, so it is 2006 currently. In 2001 (Ethiopian calendar – so 2009), they record that only eight percent of mothers were coming to Agulae to have their newborns. But by 2005 (2013), they note 95 percent were choosing to come to the Center to take advantage of the services and resources for a safer delivery. This is an unbelievable change.

D/S_ethiopia

There has been much resistance from Ethiopian women to give birth outside her home. First, the “stretcher” that some communities in Tigray have developed to  carry the pregnant women from their community to the Center, or at least to a paved road to get transportation, has been stigmatized. It was said if you left on the stretcher, you never would return. To destigmatize the stretcher, they now call it a “traditional ambulance.” Secondly, there are rituals to be performed immediately after birth to drive away the evil spirits that might take your life or the life of your newborn. This involves a coffee ceremony and the partaking of porridge. Family and friends in the community join in these rituals, partaking together. The Center has recognized this void for the community, and it has created a space for performing the coffee ritual.

coffee ritual_ethiopia

Also, it has required all farmers in the region to donate 1 kilo of teff (an ancient grain) from their harvest to the Center to make the porridge. This attention to community beliefs and ritual has helped break down the cultural barriers that were impeding the women to leave her home during labor.

Lastly, as a final incentive, they have started to create beautiful, laminated birth certificates after one year of postnatal care and infant care. These special documents serve as birth registries and include a photo of the child and all the necessary health care information. Birth registration is so important for establishing name, nationality, and providing the dignity of identity for citizens.

brith certificates

Finally, they have pursued religious leaders to join them in encouraging couples to seek out both family planning options as well as to encourage women to deliver in the Health Centers. The synergy of religious, social, cultural, and governmental forces working together in Tigray has made Agulae Health Center a model for progress in Ethiopia, particularly for maternal health.

by Jenny Dyer, PhD

Upon the conclusion of the seventeen-year Ethiopian civil war, the region of Tigray, the northernmost province in Ethiopia, is the home to the Ethiopian People’s Revolutionary Democratic Front. Their late Prime Minister Meles Zenawi who led the revolution and won is celebrated still across the country. Today marked the annual Tigray People’s Liberation Front Celebration and the town of Mekele took a holiday to celebrate in a public event.

Tigray

Our delegation, however, was there for another reason. We wanted to learn more about the Health Extension Worker program, and how it worked. To do so, we first visited a Health Post. This post serves a population of about 5,000, and they are placed throughout Ethiopia. A HEW who has achieved an education to the tenth grade and then one year of HEW training is placed with one other HEW colleague at a Health Post and lives in the village she works. Almost all of the HEWs are women.

The drive from Mekele to Gemed Kebele took us over a landscape not unlike that of New Mexico. We wound around paved roads that showcased a vast expanse of an arid landscape with a background of rocky mountains. We traveled up a dirt road the last part of the trip into a small, quiet village where some children were seen carrying yellow water jugs and others were racing through the valley. We finally arrived at the health post to meet Miheret Gebrehiwot.

This health post is a simple concrete structure lacking running water and electricity. But it has a patient bed, sparse pharmaceuticals, and a space to keep data on the health of the community.

Health Post_ethiopia

Miheret is a trained HEW who is one of two who manages the health post. She presented herself in a white coat and welcomed us inside her office and patient’s room. There, she described the kinds of services she provides, largely for mothers and children. She has detailed charts covering the walls, meticulously keeping data on diagnoses and disease in the area. She must then report this data monthly to the Health Centre, which we will visit tomorrow.

Minheret

Miheret herself was a child-bride. She was married at the age of 11 while she was just in the third grade. Upon marriage, she left school to take care of her new home. She bravely retold her journey to becoming a HEW and her passion for educating women about healthy timing and spacing of pregnancies. Miheret had her first child at the age of 16. She knew then that she had to return to school for a better life for herself and her children. With help from her mother with her child, Miheret pursued graduation from the 10th grade. She then sought training to become a HEW. Miheret has been able to space her pregnancies, have a second child, and pursue a happier, healthier life for herself and her family. She wants to become a nurse someday.

The Health Posts, just like the one in Gemed Kebele , provide critical family planning services to women in rural communities who might otherwise lack access to contraception. Moreover, they have HEWs who keep track of their choice of contraception and when they are due for their next appointment. At the Health Post, they offer Depo Provera, an injectable, which is the favored contraception of choice in the area, and it lasts three months. Other options include Implanon (an implant which can be performed by the HEW), birth control pills, and condoms.

Eth_birth control  health post_bed

If these women can access consistent contraception, they can better plan their families according to the best timing for their own health and the health of their children. Again this leads to better opportunities for the mother to return to school or return to work and provide a more substantial income for her family.

HEWs also provide Antenatal care. They carefully track pregnancies in the communities. For every pregnant woman, they recommend four medical visits including one to the Health Centre. They also advocate for the mother to travel to the Health Centre to deliver her baby. There they can have access to skilled attendants, running water, and electricity.  Alongside the rising contraception prevalence rate of expansion of family planning, these combination may be the key to combatting maternal mortality.

Welcome to Addis!

Meeting First Lady Roman Tesfaye

Feb 19 2014

The Center for Strategic and International Studies (CSIS) has pulled together a congressional delegation trip to Ethopia, and they invited me to join them. In leading HTHH’s Faith-Based Coalition for Healthy Mothers and Children Worldwide, I was invited to meet the faith leaders here to learn their stories and the position on the progress of healthy timing and spacing of pregnancies here in Ethiopia.

Ethiopia has achieved the reduction of 2/3 of child mortality for 2015. However, they lag behind, as do many other countries, in addressing maternal mortality. Here, they have rolled out in the last ten years a robust Health Extension Worker (HEW) program of over 35,000 HEWs across the nation. The government manages the HEW program, placing 2 HEWs at a health post to which ideally every person can reach for primary health care services. If there is a health issue that requires a higher level of expertise, the patient is referred to a Health Center, a more substantial facility that has more resources and higher level of trained health workers. This HEW program is taking the lead in educating women about contraception so that they can better time and space their pregnancies. If these young women can delay their first pregnancy and space out their births at least 3 years apart, they have a better chance for their own and their children's survival.

First Lady Roman Tesfaye

Upon arriving, we quickly got ready and drove across town to the Prime Minister’s residence for a private meeting with the First Lady Roman Tesfaye. Ms. Tesfaye knew we were here to learn more about maternal, newborn, and child health and family planning here in Ethiopia, and she clearly had much enthusiasm discussing her country’s progress in these areas. She spoke at length about her passion for women’s health, particularly around family planning. She explained how family planning was the key to gender equality. With contraception prevalence doubling over the last five years from 15% to 29%, young women are emerging as leaders in their communities. Girls are able to stay in school through high school and then even attend one of their new 32 universities, and women are contributing to the rise of the economy.

Ms. Tesfaye noted, “Family planning is liberating our women. Not only can women now contribute to their own lives, but they are contributing to our country as a whole.” 

The goal for 2015 is to provide 66% women access to contraception or education about healthy timing and spacing of pregnancies. Right now, they expect the 2013 statistics to show that 40% of women have access some form of contraception. Their goal is ambitious, but they believe it is within reach.

Ethiopia has a good story to tell, and Ms. Tesfaye tells that story with elegance and quiet excitement. They have success in decreasing AIDS, decreasing poverty, decreasing infant mortality, and they are increasing their economy. They have also set a focus on decreasing maternal mortality; they are optimistic that the indicators will soon reveal success there due to spacing of pregnancies. It is an exciting moment to be here in the midst of this progress.

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