Sept. 2, 2015 | Huffington Post

September is Infant Mortality Awareness Month in the U.S with the goal of bringing attention to our relatively high Infant Mortality Rate (IMR), representing the estimated number of infant deaths for every 1,000 live births.

According to the Center for Disease Control, "the IMR is often used as an indicator to measure the health and well-being of a nation, because factors affecting the health of entire populations can also affect infant mortality rates." The most recent data here in the U.S. shows that for every 1,000 babies born, six die during their first year.

While that seems like a relatively low number, the U.S. ranks 50th in the world in infant mortality. Compared to other developed nations, we fall behind many including most European countries, Japan, Canada, and Australia.

But the good news is that we now have a greater understanding of the main factors affecting fetal health, and we can address key risk factors such as obesity and pre-natal smoking. This number has been reduced over the last 60 years due to medical advances in pre- and post-natal care, and through education, we will continue to drive those numbers down.

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As we promote awareness here in the United States, we also want to hold up the issues of infant mortality in developing nations, where the IRM can be as high as 60 for every 1,000 live births. In many low-income countries, the average age of marriage for young women is 16, as in Ethiopia or Guatemala. And if these young women can delay their first pregnancy until 20-24, they are 10-14 times more likely to survive the complications of pregnancy and childbirth, than if they were pregnant in their late teens. And the child is twice is likely to survive the newborn stage if the mother can space her pregnancies just 3 years apart.

These young mothers need a spectrum of interventions including access to folic acid, prenatal care, nutrition, and skilled attendees during childbirth for themselves and the health of their newborn. We need to provide both education and the resources, including access to contraceptives, to help these women time and space their pregnancies, so that their families, too, can thrive.

In an increasingly globalized world, mothers in the United States have much more in common with moms around the world than we might realize. We all love our children and want them to flourish, and we all deeply mourn the loss of a child in any of our villages and communities. As we promote awareness here in the United States to combat infant mortality rates, let's also consider how we might advocate for women in developing nations to reduce infant mortality rates there as well.

Together, we can build a healthier, happier world for moms and children.

This piece originally appeared on the Huffington Post.

But who is a statistic? A statistic is a person, a mother, daughter, sister, an aunty. She is the nameless woman that gets added to the reports about the problems, the needs, and the gaps to be filled.

Aug. 19, 2015 | CNN

Kano State, Nigeria (CNN) Ahmadu Kanduwa's home is just two kilometers away from the local clinic in Nigeria's northern Sumaila district -- two kilometers from the vaccine that could have prevented his son, Isa, from contradicting polio more than a year ago. It's something Kanduwa thinks about often.

"I have this thought, if he had received say five or six doses, he would have been immune from this ailment," Kanduwa said.

He says Isa received two of the oral polio vaccinations. Painfully close to the four doses recommended for complete immunity.

In a district that now has an immunization rate of around 85%, officials hope Isa's will be Nigeria's last new case of polio. More than a year of being polio-free highlights how close the country is to a major milestone. But Isa's case also shows just how difficult polio can be to fully eradicate.

Standing outside of the clinic, Kulchumi Hammanyero from the World Health Organization smiles when she sees the line of mothers with babies in their laps and immunization cards in their hands, waiting patiently for the vaccine. But her smile is matched by a heavy dose of caution.

"When we see there is no more wild polio virus (WPV) and all indicators are showing us that we have covered the necessary ground, then we can say, ok, we have reached a certain point. But we are not out of the woods, not out of the woods at all," Hammanyero said.

Read the full article on CNN.

My colleagues and I have settled into a routine and I have been able to foster relationships that are built on honesty and trust. Trust to do things the way I know and honesty to discuss why certain practices are in place and how to best improve them.

Aug. 15, 2015 | Forbes

In the United States, our health system is far from perfect, but we like to pride ourselves on delivering the highest quality and newest innovations in care.  But one area where we lag behind even some African nations is in preventing cervical cancer – the most common gynecologic cancer worldwide.

In Rwanda for example, as breast and cervical cancer rates began to rise in 2010, Rwanda’s Minister of Health, Dr. Agnes Binagwaho, quickly responded by launching a national campaign to vaccinate schoolgirls against HPV—the human papilloma virus that causes nearly all cases of cervical cancer. Among eligible girls, vaccination rates of 93.2 percent and 96.6 percent were achieved in 2011 and 2012 according to the Rwanda Ministry of Health.

The move seems obvious: a proven-safe vaccine can snuff out a virus that we know causes deadly cancer. Yet what was accomplished in Rwanda is still desperately needed across parts of the world—and here at home.

An HPV viral infection causes cancer in over 400,000 women globally each year. In developing countries, a woman dies every two minutes from cervical cancer, with 230,000 lives lost annually.  In sub-Saharan Africa, it is the number one cancer-killer of women.

Screening programs, such as the Pap test, have been effective in industrialized countries at catching precancerous lesions before they develop into cancers—thus saving us from the alarming death rates. But a Pap test does nothing to clear the underlying viral infection and prevent cancerous cells from growing in the first place. And as a screening tool, it is hard to enforce in the developing world due to high costs and lack of patient follow-up.

Groups such as the public-private partnership Pink Ribbon Red Ribbon have been seeking to reduce cervical and breast cancer deaths in underdeveloped regions. Soon after Dr. Binagwaho launched the vaccination program in Rwanda, Pink Ribbon Red Ribbon began working to vaccinate over 42,000 girls Zambia and Botswana and perform cervical cancer screening for over 180,000 women for cervical cancer in Zambia, Botswana and Tanzania.

Yet only thirty-five percent of American girls and young women receive the vaccination.

The current vaccine routinely used in the United States, Gardasil, can prevent up to seventy percent of new cases of cervical cancer, and is approved for children and young adults ages 9 to 26.  A newly developed European vaccine, effective against nine variants of HPV (the so-called “nine-valent” vaccination) hopes to improve on this further, with an estimated prevention rate of ninety percent. Gardasil has been available in the U.S. for nearly a decade and has been shown to be both safe as well as exceedingly effective. In Australia, for example, uptake rates are as high as 80%.

Why, then, is the U.S. so hesitant to accept a vaccine that could save hundreds of thousands of cancer diagnoses each year? The reasons include safety concerns propagated by the anti-vaccine movement and worries that a cervical cancer vaccination will increase promiscuity.

Neither argument is compelling. The vaccine has been shown to be exceedingly safe with minimal side effects, and is supported by the pediatrics community and the American College of Obstetricians and Gynecologists. It works so well at clearing viral infections that it has also been approved for boys as well, and can prevent penile and anal cancer caused by the same viral infection. The advent of the new 9-valent vaccine from Europe has the potential to truly cure this cancer and eradicate it—a first in human history. Fears of increased promiscuity are a strawman argument at best. The vaccine only addresses one sexually transmitted virus, and protecting women from HPV would in no way suggest other protections.

The U.S. shouldn’t take its access to this cure for granted; we must change our attitude and health practices here at home.

Various programs have been instituted to help in the uptake of the cervical cancer vaccine. The Vaccines for Children (VCF) program, for example, is a federally funded program that offers free vaccines for low-income families, including the Gardasil vaccine.  But we need to reach beyond the demographic targeted by VCF.

An educational approach including both schools and healthcare professionals should elucidate what the health benefits of the vaccination are, their indications for administration, and the proven safety data. The lack of education about the advantages of receiving the vaccine among healthcare providers remains one of the greatest barriers to increasing compliance rates.  Health care workers must be educated and trained to inform the young women in their care of the availability of a vaccination against HPV.

We also need increased coordination between our nation’s regulatory bodies, such as the Centers for Disease Control (CDC), the National Institutes of Health (NIH) as well as state and local health care agencies. The lack of harmonization in health-care policy among the states, further engenders misinformation and decreased vaccination rates. A coordinated national policy would alleviate these issues.  New York is in the process of passing legislation to offer the vaccine through the public school system, while Hawaii and Texas are attempting to  legislate an increase in HPV education vaccine awareness as a matter of policy. While these remain important and promising steps in the right direction, more work remains to be done.

In truth, the eradication of cervical cancer from the United States is low hanging fruit. We now have a cost effective, easy method of cancer prevention, and the time for excuses has come to an end. We must ensure that our young women have the chance to enter this century free from preventable diseases such as cervical cancer, so they can realize their maximum potential.

Read the original article on Forbes.

Aug. 12, 2015 | CNN Español

Guatemalan Mothers

This is a difficult statistic to understand and even more difficult to ignore in the second decade of the century.

According to the World Health Organization, nearly 800 women die each day from complications related to pregnancy and childbirth worldwide.

All but 1% of these deaths occur in developing countries and perhaps most tragic of all is that 80% of them are preventable.

When speaking of maternal deaths, much of the focus is on Africa, which represents about 50% of global statistics.

But the problem goes far beyond the borders of sub-Saharan Africa; Guatemala, in Central America, has the highest maternal and child mortality rates in the region.

Maternal mortality in Guatemala

While in Guatemala maternal deaths have decreased since the United Nations included improving maternal health in their Millennium Development Goals in 2000, the rate is still unacceptably high.

According to WHO, 140 deaths occur for every 100,000 births. Most of these deaths occur among indigenous peoples, most of them Mayans where poor women are the least likely to receive adequate medical care and where fertility rates are highest.

Poor maternal health is one of the key issues at the center of the malnutrition crisis in Guatemala ... and very young children are the undeniable face of hunger. The first 1,000 days of a child's life - from conception to his or her second birthday - are the most important.

But in Guatemala, almost 50% of children under five are chronically malnourished to such a degree that they remain stunted for life, both physically and in their development, as indicated by UNICEF

According to the World Food Programme, Guatemala has the fourth highest rate of stunting in the world.

This can lead to severe developmental delays, poor performance in school and reduced productivity throughout their adulthood. But despite the many problems that can result from an unwanted pregnancy, many women have no say as to whether or not they get pregnant or how often.

Family planning, the big challenge

This can be particularly difficult in part because it is a patriarchal society where women's health is not considered a priority. But also because many families have much value and contraceptives are at odds with the culture and tradition.

Dr. Jenny Eaton Dyer is the executive director of Hope Through Healing Hands (HTHH) based in Nashville, Tennessee. Its aim is to educate Americans about family planning and maternal and child health around the world, and increase funding for these causes.

Earlier this year, Dyer traveled to Guatemala with the humanitarian organization CARE with a diverse delegation. The delegation traveled to Quetzaltenango, in the western highlands, to visit Mayan women and learn about nutrition, how to care for themselves and their newborns, and to discuss some of the main challenges they faced.

One of the main problems they found was that women had limited access to health services, especially in rural areas. Part of this is due to lack of transport, but also women have no influence on the decision-making process.

Because of this, many women don't space their pregnancies, as recommended by the UN to wait at least two years after delivery.

This creates another set of problems. Pregnancies too close together can lead to health problems for both mothers and newborns, and that's one of the underlying causes of child mortality.

Dyer said that educating families on this issue is a primary goal of HTHH. "If we can help empower women to improve both the timing and how long they wait between pregnancies, they have the opportunity to continue to study, get a job or a profession and become economically independent."

The benefit, according to Dyer, extends beyond the immediate family. "This then is a virtuous circle that women have healthier and stronger children, stronger families and ultimately, stronger nations."

Although programs designed to help indigenous women learn about the value of nutrition, family planning and healthy spacing of pregnancies, much remains to be done, not only in Guatemala but throughout the world.

The Faith-Based Coalition for Healthy Mothers and Children campaign says that maternal, newborn and child health, along with the healthy timing and spacing of pregnancies (HTSP) is "an axis of global health," and one of the most cost-effective and powerful strategies to empower women.

"If we are able to improve maternal health and child survival, mothers can return to work, which increases the GDP per capita for the family and fights extreme poverty and hunger," says Dr. Dyer.

"If family planning is linked, children can stay in school because if there are fewer children, parents can afford to pay for their education, women can stay in school and finish high school and even go to college if they can prevent pregnancy ... and if women can get an education and compete for jobs because they make healthy choices for themselves and their families, this supports maternal health promoting gender equality," she adds.

Read the original article on CNN Español

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