CSIS Ethiopia blog

In January, we traveled as part of a CSIS delegation to Ethiopia to see the work happening there in their Health Extension Workers program. Because of their leadership focus on advancing maternal health and the healthy timing and specing of pregnancy, contraception use has risen from 15% in 2005 to 29% in 2011. This is a tremendous gain, although there is still a long way to go before every women who wants access to contraception has it.

Watch this video to learn more about the program.

Having just concluded teaching my annual course at Vanderbilt, Global Health Policy and Politics, I am inspired to write a blog series based on a session I teach regarding the “psychology of global health.” In that session, I have students read a chapter from Peter Singer’s The Life You Can Save. In this chapter, he outlines six reasons for “Why We Don’t Give More” in terms of philanthropy.

Technology and Poverty

Contraception in Ethopia

Apr 09 2014

Today, I am speaking at the Information and Communications Technology for Development and Faith (ICT4DF) Network Conference preceding the Infopoverty World Conference hosted at the United Nations this week. This conference focuses on the interface of technology and the alleviation of poverty in the developing world. In particular, my session hosts a number global health experts speaking to this issue from a faith-based perspective. Questions include: (1) How do ICT4DF tools maximize results in empowering global missions outreach and sustainable development; and (2) how can we transform traditional organizational paradigms from charity-based missions to maximum impact for developing communities.
While working in the Accident & Emergency Department in Georgetown, Guyana, I noticed one thing that was very different from what I’m used to back in Nashville: few to no ambulance arrivals. That is because there is essentially no EMS system in Guyana.

There are a few ambulances that are a part of the hospital system. These are used mainly for transport between outlying hospitals and GPHC, where I was working. They are also used to transport patients in our hospital to the CT scanner, located in another building, or to transport laboring mothers from the L&D ward to the main hospital, where the operating rooms are located. When used for transport from an outlying facility, they are staffed with a driver, sometimes a nurse, and an “attendant”, who might be able to assist the nurse. In addition, multiple family members will usually ride with the patient.
It took a while for me to realize how spoiled I am back at my home hospital, as compared to GPHC. Of course I immediately realized that that had different medications, fewer medications, and access to fewer labs and imaging tests, but I had expected and was prepared for most of that. But then one day it hit me: individually wrapped alcohol prep pads. There are at least a hundred of them in every patient room back home. In my haste to grab one, I probably drop about 3 on the floor and never pick them up. They don’t exist at GPHC. Here, there is a large container of cotton (like a giant cotton ball), over which someone pours alcohol and then you pull off a piece of cotton.

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.

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.

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.

TIME.com

by Bill Frist, MD and Jenny Eaton Dyer, PhD

When it comes to the health of children and mothers worldwide, there are immense challenges yet many signs of hope.

Over 6.9 million children die every year in the developing world from preventable, treatable causes. While the loss of these children is a tragedy of epic proportions, the good news is that over the last six years, this number has been lowered by 35%. We know we can combat newborn mortality and enhance child survival. Simple, low-cost measures are being taken to ensure better health for these children around the world. Measures like oral rehydration therapy, bed nets to prevent malaria, and access to immunizations have accelerated the rate of reducing child mortality in developing nations.

With an increased focus on maternal, newborn, and child health over the past few years, the global community has seen real progress against daunting challenges. An underappreciated part of that story is healthy birth spacing and timing, or family planning, which has a profound effect on the survival and quality of life of both mothers and children. As Michael Gerson, former speechwriter for President George W. Bush and Washington Post columnist, puts it, “family planning is a pro-life cause.”

When we talk about voluntary family planning in the international context, what do we mean? The definition I use is enabling women and couples to determine the number of pregnancies and their timing, and equipping women to use voluntary methods for preventing pregnancy, not including abortion, that are harmonious with their values and beliefs.

It shocks Americans to learn that one in every 39 child-bearing women in sub-Saharan Africa die in childbirth. However, when a woman delays her first pregnancy until she is at least 18, her chances of surviving childbirth increase dramatically. If she can space her pregnancies — through fertility-awareness methods (sometimes called natural family planning) or modern contraceptive tools — to at least three years between births, she is more likely to survive and her children are more than twice as likely to survive infancy.

The Center for Strategic and International Studies (CSIS) hosted a delegation in February for congressional staff, foundation, and nonprofit leaders, including Jenny Eaton Dyer, to see the emerging success of family planning in Ethiopia. With the infrastructure of their path-breaking Health Extension Worker (HEW) program, training 38,000 women as health workers in just a few years, women in the most rural communities now have access to antenatal care and family planning. With a Health Post designated for every 5,000 people, women have access to tools for healthy timing and spacing of pregnancies without having to walk for miles to a higher level health facility. In less than a decade, since 2005, Ethiopia’s contraceptive prevalence rate has nearly doubled, from 15% to 29%.

Healthy timing and spacing of pregnancies, alongside an increase in births taking place in Health Centers with skilled care during delivery and post-partum care, offers a strikingly successful model to reduce maternal mortality and improve child survival.

In addition to expanding access to voluntary family planning information and services, Melinda Gates, co-chair of the Bill & Melinda Gates Foundation, has also focused on healthy timing and spacing of pregnancies as a critical factor for global health and development. Hope Through Healing Hands, with support from the Gates Foundation, is promoting awareness and advocacy among Americans to support maternal, newborn, and child health. We are highlighting the crucial role that voluntary family planning is playing in nations such as Ethiopia.

Healthy timing and spacing of pregnancies does more than save lives from health risks: it also allows girls to stay in school. In Ethiopia, where the average age of marriage is just 16 (with many girls married as young as age 11), girls are often forced to drop out of secondary school to begin families. If girls can delay their first pregnancy and stay in school, ideally until the university level, they will be better equipped to partner with their husbands to meet their children’s needs, in a more stable family economic environment.

And as First Lady Roman Tesfaye of Ethiopia stated, “When a mother can contribute to her own life and family, she contributes to the nation as a whole.” Moving beyond the national level, healthy timing and spacing of pregnancies is also a key to other global health goals, like combating hunger and improving the status of women and girls. Family planning is a key, often hidden, engine for additional global health achievements.

Family Planning 2020 is a global partnership of more than 20 governments working with civil society, multilateral organizations, the private sector and others. Created at a 2012 London summit, it represents a commitment to meet the needs of an additional 120 million women who want to delay or prevent pregnancy but lack access to information and tools.

With a focus on healthy timing and spacing of pregnancies, we can make major strides in just a few years. That’s great news for mothers, children, and our entire world.

Bill Frist is a former U.S. Senator from Tennessee. Jenny Eaton Dyer, Ph.D., is the executive director of Hope Through Healing Hands.

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