By CASEY QUACKENBUSH
It has now been a little more than a year since President Donald Trump, on his first full day in office, reinstated the Mexico City Policy, also known as the “Global Gag Rule,” and a picture of its impact is beginning to emerge. The law prohibits allocation of U.S. funding to foreign non-governmental organizations that offer abortion services or information about the procedure. While the measure has been on and off the books for decades, typically enacted by Republican administrations and repealed by Democrats, its scope has expanded under Trump, which healthcare workers say has had a big impact on communities and care providers around the world.
In just one year, health care workers say the policy has had disastrous effect; as expected, clinics are shutting down, unsafe abortions are predicted to rise sharply and families are losing critical services across the globe. While no death count has been directly linked to the policy, providers do have estimates of how many life-saving procedures could have been offered by the funding they are now denied, and the numbers are in some cases staggering.
What is the ‘Global Gag Rule’?
The Mexico City Policy, first enacted in 1984, prohibits U.S. federal funding to NGOs that provide abortion counseling, services or referrals, and any that advocate for decriminalization, even if those activities are wholly detached from U.S. funds. It requires foreign NGOs to pledge that they will not perform or inform patients about abortions. (Some exceptions may be made in cases of rape or incest.) The policy applies to some $8.8 billion in federal funding given toward global health assistance. It formerly applied only to family planning assistance provided through the State Department and the U.S. Administration for International Development (USAID), but Trump’s new provisions expand its application to all global health assistance. The U.S. is the world’s largest provider of such aid.
What kind of impact has it had over the past year?Not good, especially for women in the developing world. As has happened each time the policy was put back into effect, the diversion of aid has shuttered clinics servicing some of the world’s most vulnerable communities. Closures have been particularly devastating in parts of Africa where clinics run by non-governmental organizations are the primary source of women’s health care. Many of these centers offer HIV/AIDS prevention and treatment, maternal health, and counseling on sexual violence like rape and female genital mutilation. “Women are basically stranded,” Amos Simpano, the director of clinical services for Family Health Options Kenya, told the Associated Press.
The International Planned Parenthood Federation, which operates in more than 150 countries, faces setbacks not only in family planning but also in HIV/AIDS and Tuberculosis services for both men and women. IPPF says that for $100 million in lost funding, the organization could have prevented 20,000 maternal deaths in 29 countries affected by the ban. Marie Stopes International, a London-based abortion and contraception provider that operates in 37 countries, estimates that more than 2 million women it serves will lose their access to contraception. This could lead to a further 6,900 maternal deaths. Just those two organizations’ loss in funding could lead to a combined total of about 7.5 million unwanted pregnancies and 2.5 million unsafe abortions.
What do health advocates say?
Those estimates could be the tip of the iceberg. Health providers in Kenya, which is particularly dependent on foreign aid to combat HIV/AIDS and provide reproductive services, have called the measure a “death sentence.” Others claim the policy holds life-saving aid hostage to ideology. Development actors have warned that endangering women’s health and reducing family planning services risks broader instability and economic hardship that will only exacerbate the need for long-term assistance in some of the world’s poorest places.
“Evidence shows that by blocking funding to the world’s largest NGO providers of modern contraception, unintended pregnancies and abortions go up,” Marjorie Newman-Williams, vice-president of Marie Stopes International, said in a statement. “As a result, women and girls are less likely to complete their education, have a career, or pursue their dreams for the future.”
Published on TIME on February 4, 2018
A group of leading health experts have highlighted a number of key issues in reducing maternal, neonatal and infant mortality as a means to achieving SDGs in Africa. Particularly notable was the need for improving the quality of health care provision.
The speakers were participating in a recent webinar, organised by the Aid and International Development Forum, ahead of a major event on Aid and International Development in Africa.
Approximately 500 people from 67 countries registered for the webinar and were keen to learn about the latest innovations and policy developments in maternal, neonatal and infant mortality.
Dr. Lutomia Mangala, Health Specialist - Maternal, New-born and Child Health, UNICEF noted that despite a global improvement in maternal, neonatal and infant health Sub Saharan Africa lags behind.
He explained that the Millennium Development Goals focused on access to healthcare but the primary reason that Sub Saharan Africa has not met expectations is due to the lack of quality in healthcare provision.
Dr. Lutomia highlighted a need to recognise the role of communities, health facilities and district level policies in improving access to quality healthcare. Through the combination of these strategies maternal, neonatal and infant mortality will be more effectively reduced.
John Nyamu, National Coordinator at Reproductive and Maternal Health Consortium-Kenya, agreed and highlighted the need to improve basic health provisions.
Utilising emerging technologies such as mobile technology, drones and the internet is another key aspect of improving maternal, neonatal and infant health, John Nyamu explained.
The introduction of technology such as mHealth and drones is becoming increasingly common in developing countries. John Nyamu noted the sustainability of this method as in Africa access to mobile phones is high, for example in Tanzania it is reported that 97% of people have access to a mobile phone.
The use of technology can be coupled with social support programmes to provide women with spaces for education and knowledge sharing.
Dr. Lutomia noted that the community level can often be reluctant to change and there is a critical shortage of trained healthcare workers. The incorporation of emerging technologies such as mHealth and drones into community healthcare could make significant improvements.
However, the speakers agreed that ‘context specific programme interventions’ were needed as most research into maternal, neonatal and infant health takes place in developed countries. Dr Lutomia further explained that contextualising health care policies for developing countries is likely to bring interventions that are more popular and effective.
The webinar recording will shortly be posted on the Aid & International Development Forum website and YouTube channel.
Hear from other health experts at the Aid & Development Africa Summit on February 27-28 in Nairobi.
Published on Reliefweb on February 7, 2018
By Michelle Thompson (CEO of Marie Stopes Australia)
In July last year the New York-based Commonwealth Fund ranked Australia's healthcare system number 2 in the world. The study found that our public/ private universal approach to the delivery of healthcare services has led to a healthier society than those we ranked against. When it came to equity, however, the same study ranked Australia well below average. In fact we came in at number 8 on the list of 10.
An acute example of inequity in our universal healthcare system is the delivery of sexual and reproductive health services, namely women's sexual and reproductive health and specifically abortion access. Abortion is one of the most common medical procedures for women, yet we have a problem providing for it in Australia. Varied state and territory laws, health policies and health funding means that infrastructure and clinicians to deliver services are either non-existent or reliant on private providers to establish and run these services.
As a national provider of sexual and reproductive health services, including medical and surgical abortions, we see stark contrasts in service delivery between states and territories and within these states and territories.
In Queensland, women in the far north and west of the state must travel days to access surgical abortion services. They have no service within a day's drive. In Tasmania women can no longer access surgical abortions without crossing to the mainland. And for the past year, the future of surgical and medical abortion access in the ACT hung in the balance with the ACT government silent on whether Marie Stopes would be able to continue to operate from a government health facility. We have heard this week that the future of the clinic is secure and that services can continue for ACT women.
The problem is that we are not, as a nation, getting it right when it comes to the delivery of sexual and reproductive health services. State and territory governments are often unwilling or unable to talk to us about abortion provision. It is either deemed too hard, too controversial or not the right time. That needs to end now. In 2018, we need to stop treating women's sexual and reproductive health services as being too hard, too controversial, or a case of bad timing.
Our universal health system in Australia relies on strong relationships between the public and private health sector. The private health sector has a long history of being commissioned to deliver services to Australians on behalf of government. We have seen this through the commissioning of private providers to run public hospitals and through the commissioning of primary health care including General Practice services. With sexual and reproductive health services, we have an opportunity to deliver them to public health patients using existing private providers under a commissioning model.
This approach will streamline healthcare service delivery and enable greater access to services. At the same time it will ensure that our public hospitals can remain focused on delivering tertiary referral services such as chronic disease management while also not placing further pressure on hospital emergency departments, operating theatres and ambulatory care centres.
At the end of the day sexual and reproductive health, including abortion, is primary health care and should be delivered as such. It's time to stop sweeping this important form of women's healthcare under the carpet. If the state and territory governments cannot deliver for women, then it is time for the federal government to step in.
Published on The Sydney Morning Herald on February 4, 2018
Adolescent girls are being put at risk of harmful consequences, including dying in childbirth, in Zimbabwe because inconsistent laws make it harder for them to access sexual and reproductive health information and services, Amnesty International warned in a new report today.
The report, Lost without knowledge: Barriers to sexual and reproductive health information in Zimbabwe, documents how widespread confusion around the legal age of consent for sex, marriage and accessing health services is leaving adolescent girls more vulnerable to unwanted pregnancies and at higher risk of HIV infection. As a result, girls face stigma and discrimination, the risk of child marriage, economic hardship and challenges in completing their education.
“The reality is that many adolescents are sexually active before they are 18 and the government must act to ensure that they can access the services and advice they need to help safeguard their health and their futures,” said Deprose Muchena, Amnesty International’s Regional Director for Southern Africa.
“While age of consent provisions may be intended to protect against sexual abuse and child marriage, it is unacceptable that they be used to deny adolescents their rights to sexual and reproductive health information and services.”
The report found that entrenched taboos around adolescent sexuality, and a lack of affordable healthcare, are also making it harder for adolescents to access the information and services they need. According to demographic health data for Zimbabwe, nearly 40% of girls and 24% of boys are sexually active before they reach the age of 18.
A series of inconsistencies in the country’s legislative and policy framework related to sexual and reproductive health has contributed to significant confusion over whether people below the age of 18 need parental consent to access sexual health services.
Under Zimbabwean law, the age of consent for sexual intercourse is 16. However, the government’s delay in raising the legal age of marriage to 18, in line with the constitution, has fueled confusion in a context of entrenched taboos surrounding pre-marital sex.
The report highlights the widespread misperception that only girls who are already pregnant or married can access contraception and HIV services.
Amnesty International found limited guidance within related health polices to assist health care providers in determining whether or not an adolescent below the age of 16 is eligible for a particular sexual or reproductive health service.
Amnesty International also found deeply concerning knowledge gaps among adolescent girls the organization interviewed on how to protect themselves from unintended pregnancies and sexually transmitted infections, including HIV.
Adolescent girls said they had been barred from clinics and shamed when trying to access services because of their age.
One of them told Amnesty International that: “[you] can’t go to the clinic if you are under 16; they will chase you away and insult you.”
Others thought they had to be 18 to access health services.
Another girl similarly explained to the organization that because of her age she had never visited a health clinic before she became pregnant at age 17. She said: “I knew that I was too young.”
Community stakeholders – including teachers, parents, NGOs and community health workers – corroborated the girls’ testimonies.
Amnesty International calls on the Zimbabwean authorities to raise awareness of the right of adolescents to access sexual and reproductive health information and services. The organization also recommends that laws and policies should be clarified to ensure adolescents have the right to access sexual and reproductive health information, education and services, irrespective of their age and without parental consent.
Taboos over adolescent sexuality
Amnesty International also urges the Zimbabwean government to do more to challenge taboos around adolescent sexuality, including sex before marriage, which form another barrier for adolescents trying to access the information and services they need to protect their health and lives.
These taboos – coupled with the government’s failure to provide comprehensive sexuality education in schools – also serve to perpetuate gender discrimination.
“Zimbabwean authorities must create a conducive environment for adolescent girls to realise and claim their sexual and reproductive rights. Adolescents have a right to comprehensive sexuality education, which should go beyond abstinence-only approaches and challenge gender stereotypes,” said Deprose Muchena.
“Our research shows that harmful gender stereotypes mean girls face especially severe consequences if they become pregnant, including forced marriages and the end of their educational aspirations.”
The report also highlights the high costs associated with sexual and reproductive health services. Despite the government’s commitment to providing access to contraception and free maternal healthcare, fees are often charged to compensate for funding shortfalls.
Amnesty International found that in many cases such fees disproportionally disadvantaged pregnant adolescents, resulting in delayed access to maternal health services or young people not receiving care at all.
The report is based on group discussions and interviews with 120 participants, including 50 adolescent girls, from the provinces of Harare, Manicaland, Mashonaland East and Masvingo between February and May 2017.
Studies show that rates of adolescent pregnancy and HIV are increasing, coinciding with declining levels of knowledge related to sexual and reproductive health.
Adolescent pregnancy is a major factor behind Zimbabwe’s high rates of child marriage and maternal mortality. In 2016, 21% of maternal deaths occurred among girls between the ages of 15 and 19.
Published on Amnesty International on January 24, 2018
A new reproductive health clinic has been opened in the embattled northern Syrian city of Al-Tabqa, which has been the site of intense fighting over the past five years.
The second largest city in Raqqa Governorate, Al-Tabqa was retaken from the Islamic State of Iraq and the Levant (ISIL, also known as ISIS or Da’esh) seven months ago, and is now rapidly filling with displaced families.
Since May 2017, the population has grown by some 200 per cent, according to a joint UN assessment mission conducted there in December. There are now some 90,000 residents and 80,000 displaced people, many from Ar-Raqqa City and the countryside.
The health situation in Al-Tabqa remains precarious, but the new UNFPA-supported reproductive health clinic, opened on 7 January, is already meeting urgent needs among the population.
In the first two weeks of the clinic’s operation, “we have provided medical and reproductive health services in the clinic to 460 women,” said Dr. Adnan Al-Aqoub, who observed services at the clinic this weekend.
Reproductive needs seriously underserved
Basic, critical care is lacking, the December UN assessment found. Routine vaccination is unavailable, medicine prices are increasing, and there are shortages in drugs for diabetes, asthma and other conditions.
Lack of health facilities and qualified health workers has been a serious concern. The national hospital in the area is functional, but lacks essential equipment. Two private hospitals are also functional, but not sufficient to meet the needs of the city’s growing population.
Residents’ sexual and reproductive health needs have been seriously underserved for years. Contraceptives and reproductive pharmaceutical items have long been out of reach or under the control of ISIL, and therefore unavailable to governorate- and NGO-supported health facilities.
It is estimated that there are around 6,800 pregnant women in need of reproductive health services. Yet poverty and insecurity have worsened health-care access for many pregnant women, especially those from surrounding rural areas.
The new reproductive health clinic, opened by UNFPA and local partner Al Mawadda, with funding from the European Civil Protection and Humanitarian Aid, is already bringing relief to women.
On 16 January, 30-year-old Maysaa safely delivered twins – a boy and a girl – in the clinic.
“I am so blissful to have my new twins. They were in a very good health and they were provided with the essential medicines and medical services,” Maysaa said.
She received post-partum care, and neonatal care was provided to the infants, whom she named Zakaria and Hanan.
After she was discharged, a UNFPA-supported medical team provided follow-up care.
“I went back to my home and the medical team are still coming to my home and checking my health and the twins as well,” said Maysaa.
More to be done
Access to Al-Tabqa remains difficult, with some routes into the city still at risk from landmines, although demining agencies are working to improve safety in the area. Other routes into the city have been disrupted by infrastructure destruction.
Communications have also recently been hampered by snowstorms.
Despite these challenges, the new clinic has been fully equipped and staffed.
“We are so thrilled to see all the needed services provided to very poor families from the area,” said Dr. Al-Aqoub.
But there is more work to be done.
The local health council has requested another mobile health team to provide additional services in the surrounding rural areas.
UNFPA is now working with partners to distribute hygiene kits, containing essential sanitation supplies, as well as winterization kits, containing warm clothes, in South Raqqa in the coming weeks.
UNFPA’s presence and response has been enabled by the Emergency Fund, which provided the initial investment for establishing a field office.
Published on UNFPA on January 24, 2018
By Shirin Jaafari
Yassi Ashki left Iran seven years ago, and she came to the US to study. When she first got to the Indiana University campus, she noticed two things.
First, "They were all wearing Uggs and pajamas," and at the health clinic, "there was a huge box of free condoms [...] and so many pamphlets about STDs."
Ashki took a couple of the pamphlets about sexually transmitted diseases home. Over the next couple of days, and after she'd gotten her own pair of Uggs and pajamas, she pored over the pamphlets. "I thought I knew everything," she recalls, "but I knew very little."
A couple of years later, and at a different school, a friend of hers came to the same realization. Narges Dorratoltaj was sitting in an infectious diseases class at Virginia Tech when the instructor began talking about STDs. "They started with the HIV/AIDS. I thought, 'OK, I know, I mean I have some information,'" she remembers, "and they started to talk about HPV, chlamydia, gonorrhea, and I was like ... 'What the hell is she talking about?' I had no clue what the professor was talking about."
Dorratoltaj was a 27-year-old PhD student. She came from a middle-class, educated family in Iran. How could she know so little about sexually transmitted diseases?
The two friends mulled over that question, and they came to a simple answer: Their knowledge about STDs was minimal because they were never taught anything about it. Sex is a taboo topic in Iran, and sex education there is almost nonexistent. "Whatever people learn, if they're lucky, they learn it from their parents; mostly they learn it from their peers and online from websites or social media," explains Dorratoltaj.
And so Dorratoltaj and Ashki came up with an idea: What if they started a website focused on sexual health? Specifically for Farsi speakers?
What started as a simple website with a couple of educational videos has now turned into a much bigger operation. First, it's no longer just the two of them. They have a team. They also run a nongovernmental organization — registered in the US as RAH Foundation and in Iran under Ctrl+S. They have an Instagram account with over 12,000 followers.
Ashki and Dorratoltaj say when they first brought up the idea to their parents, they were skeptical. "Go work on something else," they said, "like cancer, or Alzheimer's. STDs are not a big issue in Iran."
That's not true.
According to the United Nations, there were 66,000 people living with HIV in Iran's Islamic Republic in 2016 — and those numbers are probably low. There's no reliable data on sexually transmitted disease in Iran but Dorratoltaj points to an estimate from the World Health Organization — that around 26 million people in the Middle East and North Africa are infected with curable STDs. "That does not include herpes or HPV, the two most prevalent STDs worldwide," she explains in a TED Talk.
"It is there," Dorratoltaj says, "But we don't hear about it because of the taboo."
When she and Ashki first launched their website in 2014, they didn't know how it'd be received. But then, something unexpected happened. "We started to get many questions, one after another," says Dorratoltaj.
People began to write in. They trusted them with their most intimate problems, things they couldn't talk about with anyone else. To deal with the flood of messages, Dorratoltaj and Ashki teamed up with a group of health experts. The pair forwarded them the questions, and they got answers back.
And, the questions they got reinforced what they already suspected: That there are a lot of misconceptions.
Dorratoltaj reads one of them aloud, keeping it anonymous. "I'm afraid that I have HIV," it reads, "and now I'm dead. So, it doesn't matter if I know I have HIV or not. I'm going to be dead."
Dorratoltaj says her team explained why that is not true. "There are treatments," they wrote, "you can have a healthy life if you get tested."
Iran has a comprehensive health care system. One of its biggest successes has been a very effective birth control program that's been in place for more than two decades. But when it comes to sexual education, it's lacking. And that's what Dorratoltaj and Ashki want to change.
After their website got more recognition, Dorratoltaj and Ashki took their idea one step further. They wanted to run workshops on sexual health inside Iran. It took some negotiations with Iran's Ministry of Health and Medical Education but they finally got the go-ahead.
Today, they run these workshops in mosques and schools. Ashki, who's in Iran, trains volunteers so that they spread the message in the rural areas of the country.
They have also broadened their work to include education about sexual abuse prevention in children. The pair decided to do that after attendees in the sexual health awareness workshops came up to them, asking for advice on how to deal with child harassment cases.
In one recent session, at a school in Tehran, teachers sit around in a circle. Ashki stands in front of some graphics projected on a white screen. "If you find out that a child has been assaulted," she explains, "the first instinct is to be silent, to protect the kid's honor and dignity. But no, you should not be silent. You get help."
Dorratoltaj and Ashki say this is only the beginning of their work in Iran. They have a long list of what they want to change. High up on that list: sexual health awareness in school curricula. Then, more access to HPV vaccines and STD clinics.
"What I think would be [the] ideal scenario," Dorratoltaj says, "is having something like Planned Parenthood in Iran, where people can go and get tested and get whatever service they want."
Talking about sexual health in a conservative society is tricky, Dorratoltaj admits. "There are nights you cannot sleep. There are anxieties, stress because of the unknown that you have in the work."
But those feelings change, she says, when she reads the messages that come in. "Seeing the message of, 'I changed my behavior, I care about myself more than before, I got vaccinated,' I think these are the things that keep us motivated," she says.
And the most satisfying transformation so far?
"It was interesting how our parents changed," Dorratoltaj says. "At first, they were skeptical but now they know how important it is."
Published on PRI on January 10, 2018
By Joan Biskupic
In announcing plans to take up a challenge to California law that requires anti-abortion pregnancy centers to post information about low-cost abortion services, the Supreme Court will return to familiar yet rocky ground pitting speech rights against abortion rights. Such cases turning on the First Amendment sometimes become proxies for the larger, enduring fight over a woman's right to end a pregnancy.
The case centers on a 2015 California state law requiring pregnancy-related clinics, including those with religious convictions against abortion, to provide clients with information about publicly financed contraception, abortion and other family-planning services.
State officials said the notice law ensures that all California women, regardless of income, are aware they can obtain reproductive services. The challengers argue that it unconstitutionally forces centers that oppose abortions to post notices that encourage women to seek information on free or low-cost abortions.
The dispute recalls other speech-related clashes, over rules regarding physician counseling on abortion to regulation of health-clinic protesters. Such cases have at times come down to a single vote and mirrored justices' abortion views. For example, in 1991, the court, by a 5-4 vote with conservatives in the majority, ruled that Congress could prohibit government-funded clinics from counseling women on abortion. Separately, in 1993, it restricted federal judges' ability to prevent clinic blockades by anti-abortion demonstrators.
More recently, in 2014, when the court unanimously rejected a Massachusetts law that kept protesters away from clinics, justices nevertheless split 5-4 in their reasoning. The more conservative justices said that the majority's approach failed to sufficiently protect the protesters' First Amendment rights.
The Supreme Court first declared a woman's right to end a pregnancy in the 1973 Roe v. Wade case. It reaffirmed that right in 1992 by a narrow 5-4 vote. Most recently In 2016, a five-justice majority struck down a restrictive Texas abortion law.
The new case also comes as the Trump administration has continued to satisfy its political base on broader dilemmas of reproductive rights and religion. Last month, after failing to stop a 17-year-old migrant from obtaining an abortion, Trump administration lawyers asked the Supreme Court to void the lower court decision that allowed it and to discipline the teenager's American Civil Liberties Union spell out lawyers, who, the administration said, acted to "thwart" Supreme Court review of the case.
In the California case, the National Institute of Family and Life Advocates and other religiously affiliated groups that provide ultrasounds and other medical services argue that the First Amendment protects the choice of "what to say" and "what not to say." They say the California law, which fines clinics that fail to provide the requisite notices, forces them "to communicate the government's message about state-funded abortions to everyone who walks in the door."
Lower court judges declined to block the law. The 9th US Circuit Court of Appeals sided with California officials about their interest in citizens' health, including access to abortion. The court said the legislature determined that thousands of pregnant women in the state were unaware of state-funded health assistance.
The 9th Circuit also made clear that the legislature had in mind the kinds of "crisis pregnancy centers" the challengers operate when it adopted the legislation, stating, "CPCs pose as full-service women's health clinics, but aim to discourage and prevent women from seeking abortions." Still, the appeals court rejected the challengers' arguments that the law impermissibly targeted them based on their views against abortion.
The appeals court said that California law does not reveal a preference for any type of family-planning service; it only ensures that women know such services exist. The court differentiated the California law from one requiring physicians to perform an ultrasound, display it and describe the fetus to a woman. The 9th Circuit noted that the Richmond-based 4th Circuit appeals court had ruled such a law violated the First Amendment because its goal was to convince women seeking abortion to change their minds.
Lower courts are divided over the legal standard for assessing the constitutionality of state regulation of the medical profession and abortion. The case offers the justices a chance to clarify the standard for regulation of communications between professionals and clients.
Yet the abortion backdrop will likely make it one of the most closely watched disputes of an already major Supreme Court term. Resolution could hang on the vote of centrist conservative Justice Anthony Kennedy, who has been the decisive vote on abortion rights dilemmas for decades.
"Perhaps to belabor the obvious," the National Association of Evangelicals wrote in a "friend of the court" brief as it urged the justices to hear the appeal, "abortion remains one of the most contentious issues of our public life, implicating not just religious and ethical issues, but scientific and political ones."
Published on CNN on November 14, 2017
Today a new national five-year strategy and a policy for Reproductive, Maternal, Newborn, Child and Adolescent Health (RMNCAH) was launched in Sierra Leone, which aims to help reduce maternal and child deaths in the country.
Sierra Leone currently has among the highest rates of maternal and child mortality globally, as well as high incidence of teenage pregnancy. Current estimates suggest that up to 6 percent of women in Sierra Leone will die from maternal causes during their reproductive life. Based on the latest UN figures released, the country has an estimated under-5 mortality rate of 114/1000 live births which means that 1 in 9 children lose their life before their fifth birthday.
“Each year too many of our women and children are dying from causes which are largely preventable and treatable, and the Government has committed to doing everything in its power to overturn this tragic situation,” said Dr Abu Bakarr Fofanah, Minister of Health and Sanitation, speaking at the launch event in Freetown. “Our new RMNCH strategy outlines practical interventions to save lives, improve the quality of care offered at our health facilities, address underlying causes of ill health and help ensure women, children and youth not only survive but also thrive and transform their communities.”
ambitious agenda will not be realized without the active support and engagement of our community champions, health workers at all levels, District Health Management Teams, the media, other Ministries, NGOs, the private sector, and our development partners and communities themselves,” he added.
Sierra Leone has registered good progress in some key areas of reproductive, maternal and child health. Lifesaving vaccines are reaching children and pregnant women across Sierra Leone, to prevent and tackle some of the leading infectious diseases. Attendance of at least four checkups during pregnancy increased from 56 to 76 percent over the previous strategy period; malaria treatment increased from 30 to 48 percent, and recent surveys show that levels of stunting among children under 5 years reduced from 37 to 29 percent.
The new Strategy outlines a number of critical areas for further action including: strengthening the quality of care offered at all levels of the health system, and improving access to services such as family planning; emergency obstetric and neonatal care; management of newborn and childhood illnesses at hospital and primary care levels; nutrition; prevention of teenage pregnancy; and water, hygiene and sanitation (WASH).
“WHO is proud to have supported the country in developing this strategy together with our partners, but we are also aware that this is just the beginning,” said Alexander Chimbaru, Officer-in-Charge of WHO Sierra Leone. “Everyone from communities to health workers, policy makers and the international community, has a role to play now in implementing the strategy, and ensuring women, children and youths are accessing quality health services that save lives.”
The Strategy, which has been developed with technical and financial support of the H6 Global Health Partnership including WHO, UNICEF, UNFPA and the World Bank Group; UKAid, and other health partners, aims to reduce the rate of maternal and child deaths by 45 and 55 percent respectively by 2021. These ambitious targets are needed to bring the country in line towards meeting the targets of the UN Sustainable Development Goals (SDGs).
Published on Reliefweb on November 6, 2017
By Helen Morgan, Naomi Mihara
Indonesia has some of the highest rates of maternal mortality in Southeast Asia, and one of the biggest factors affecting the rate of maternal deaths is a lack of access. Local midwives in remote corners of the country are on the frontlines of primary care, but many women in poor and rural settings don’t have access to such care — and even when services are accessible, the quality varies.
Maternal mortality remains a global issue. Despite a significant reduction in recent years — falling by half between 1990 and 2015 — some 216 women per 100,000 live births still die each year. Now, Sustainable Development Goal 3 on healthy lives and well-being is aiming to reduce the number of women dying due to complications in childbirth to less than 70 per 100,000 live births. This is a huge challenge, and one that many countries are struggling to meet, particularly in a country such as Indonesia, where the numbers fell by just 5 percent in the same time period.
Papua, at the easternmost edge of Indonesia, is among the least developed provinces in the country, and its lack of health care infrastructure is concerning. A report from Human Rights Watch notes that Papua has Indonesia’s highest infant, child, and maternal mortality rates. But in Jayapura, the province’s capital, steps are being taken to counter this problem in primary health centers at the heart of the communities. These government-mandated centers — puskesmas, in Indonesian — are dotted around the sprawling city and its surrounding peri-urban areas. One of these centers, Puskesmas Waena, is tucked down a narrow street on the outskirts of the city, and visited by around 365 pregnant women per year — each of whom are entitled to four free check-ups over the course of their pregnancy.
Devex spoke with health care workers at the center to hear more about how access to care for pregnant women could be improved. This video explores the impact of a new digital data collection system, developed through a partnership between Philips, telecommunications company Telkom, and the local government, to help ensure effective sharing of patient data and to enable local health workers to seek advice from specialists across the country.
The Inter-American Commission on Human Rights (IACHR)—the principal human rights body for the Americas—released a statement that underscores how laws criminalizing abortion in all circumstances lead to human rights violations.
The IACHR statement touches on how restrictive abortion laws have a negative impact on women’s dignity, their rights to health, life, personal integrity, and their right to live free from violence and discrimination.
The Commission expressed that States have a fundamental obligation to ensure timely and adequate access to health services that only women, female adolescents, and girls need because of their sex/gender and reproductive function, free from all forms of discrimination and violence, in accordance with existing international commitments on gender equality.
Said Catalina Martínez Coral, regional director for Latin America and the Caribbean at the Center:
“The criminalization of abortion oppresses and stigmatizes women and girls.
“We commend the IACHR Rapporteurs for recognizing that all women and girls deserve to exercise their fundamental reproductive rights.
“We hope the IACHR continues to urge states to create meaningful policies that protect sexual and reproductive rights.
Sexual violence is widespread throughout Latin America and the Caribbean. The region has some of the most restrictive policies against abortion in the world and as a result, it has the highest rates of unsafe abortions with the exception of East Africa. 12% of maternal deaths are linked to unsafe abortions. El Salvador, Honduras, Dominican Republic, Surinam, Haiti and Nicaragua continue to criminalize abortion-even when the life and health of the women are in danger- putting women and girls at unnecessary risk.
The Center for Reproductive Rights has worked to expose the consequences that blanket abortion bans have on the lives of women. In 2015, together with the Agrupación Ciudadana, the Center filed a case on behalf of nine women who had serious pregnancy complications and are now in prison due to the severe enforcement of El Salvador’s absolute abortion ban. The Commission also admitted the case of Manuela, another Salvadoran woman wrongfully imprisoned after having an obstetric emergency who later died from untreated Hodgkin’s lymphoma in prison.
In May 2017 the Commission hosted a hearing on the status of Chile’s abortion law reform, where the Center for Reproductive Rights, Miles Chile and Isabel Allende Foundation, testified before the Commission to call on Chile to prioritize passage of the abortion bill. In August this year, Chile’s Constitutional Tribunal voted 6 to 4 to pass an abortion bill that will allow women to access safe and legal abortion services in cases of life-endangerment, rape, and fatal fetal impairments.
The Center has also worked on cases in Peru, Brazil, Ecuador, and Costa Rica to guarantee women’s rights in the region. Today, the Center, alongside other international and regional organizations, held a hearing on sexual violence against girls and lack of access to reproductive care.
Published on the Center for Reproductive Rights on October 24, 2017.
"Women’s sexual and reproductive health is related to multiple human rights, including the right to life, the right to be free from torture, the right to health, the right to privacy, the right to education, and the prohibition of discrimination. The Committee on Economic, Social and Cultural Rights and the Committee on the Elimination of Discrimination against Women (CEDAW) have both clearly indicated that women’s right to health includes their sexual and reproductive health. This means that States have obligations to respect, protect and fulfill rights related to women’s sexual and reproductive health. The Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health maintains that women are entitled to reproductive health care services, goods and facilities that are: (a) available in adequate numbers; (b) accessible physically and economically; (c) accessible without discrimination; and (d) of good quality [see report A/61/338]."