Women & Gender

Family planning client Meva and her son at their home in Mananjary, Madagascar

In 2018, Madagascar enacted a new family planning law allowing youth to seek family planning services without parental consent. However, young couples still face major obstacles accessing these vital services due to a lack of availability, persistent cultural and religious beliefs, and minimal information about available options.

Training and empowering midwives to provide contraceptive services, particularly to Malagasy youth, is a key to overcoming these challenges. Here’s how the many midwives, supported by the USAID-funded ACCESS program, are playing this critical role.

{Asther Zabibu, an MDR-TB survivor sits outside the TB treatment centre at Mulago National Referral Hospital in Uganda. where she now provides psycho-social support to other patients and counsels them on adherence. Photo Credit: Sarah Lagot}Asther Zabibu, an MDR-TB survivor sits outside the TB treatment centre at Mulago National Referral Hospital in Uganda. where she now provides psycho-social support to other patients and counsels them on adherence. Photo Credit: Sarah Lagot

For some groups of particularly vulnerable people - the elderly, disabled, those suffering from physical and mental ill-health or those at risk of violence and abuse - the restrictive measures have a significant and negative effect. These people’s health and wellbeing, in all senses, are being corroded. In some cases, people are in extremely threatening and deadly situations.

So who is making these decisions on isolation and lockdowns? How do their judgments take into consideration the wider impact on the population and the secondary effects of these restrictions, especially on vulnerable people? We, a group of colleagues working on universal health coverage, decided to do a rapid analysis of 24 national COVID-19 Taskforces to identify their composition and investigate their decision-making processes. What we found out was shocking.

{Participants during one of the trainings on the integrated support model for GBV survivors. Photo credit: Raphael Gnonlonfoun/IHSA}Participants during one of the trainings on the integrated support model for GBV survivors. Photo credit: Raphael Gnonlonfoun/IHSA

Meet Dr. Omer Adjibode, Gender-Based Violence (GBV) Advisor for the USAID-funded Integrated Health Services Activity (IHSA) in Benin. The purpose of IHSA is to strengthen local capacity for the delivery of high-impact malaria, family planning, maternal and child health (MCH), and GBV services with strong citizen engagement to reduce maternal, newborn, child, and adolescent girls’ mortality and morbidity.

In his role, Omer is responsible for defining strategies to improve care for GBV survivors. In this issue of Leading Voices, he talks about the virtual One Stop GBV center, an innovative resource for GBV survivors in Benin. According to national legislation in Benin, “GBV includes physical, moral, sexual or psychological violence, female genital mutilation, forced or arranged marriages, "honour" crimes and other practices harmful to women.”

Can you tell us more about how GBV is addressed in Benin? What are the key components of successful strategies or, on the contrary, some areas for improvement?

{Girls carry water to their homes in Mopti region, Mali. Photo credit: Debbo Alafia consortium/MSH}Girls carry water to their homes in Mopti region, Mali. Photo credit: Debbo Alafia consortium/MSH

In recent years, and following the coup in 2012, Mali has experienced increased political unrest and violence, especially in the country’s north and central regions. Coupled with droughts and flooding, the situation has resulted in a significant increase in forced internal migration. In the Mopti region, many health centers have closed, and health providers have fled to safer urban areas as a result.  

Such instability has had dire consequences for the health of rural communities there. Women and girls are particularly vulnerable due to power imbalances within the family, limited access to resources, and increased vulnerability to sexual and gender-based violence (SGBV). Sexual violence remains underreported due to insecurity and the stigmatization of survivors, making it more difficult to ensure care and services effectively reach those who experience such violence.

{A woman receives depo-provera contraceptive method at Area 18 health center in Lilongwe District, Malawi. Photo credit: Rejoice Phiri/MSH}A woman receives depo-provera contraceptive method at Area 18 health center in Lilongwe District, Malawi. Photo credit: Rejoice Phiri/MSH

Program seeds providers in high-density health center

In July, 23-year old Esther walked a fair distance to Area 18, a health center in Malawi’s Lilongwe District, since no family planning services were available in her area. She has one child and wants to wait before having a second. At the health center, Esther joined a group counseling session where all family planning methods were presented. Afterwards, during individual counseling, she shared her desire to wait at least five years before becoming pregnant. Once informed of her options, including long-term reversible contraceptives, she chose to receive an intrauterine contraceptive device (IUCD), and had it inserted right away.

“I will tell my friends about the IUCD,” says Esther. “I know the truth about how it works. We need to be careful not to pay attention to the stories people tell.”

{A mother and child wait outside a clinic on the outskirts of Mbuji Mayi, Democratic Republic of the Congo. Photo credit: Warren Zelman}A mother and child wait outside a clinic on the outskirts of Mbuji Mayi, Democratic Republic of the Congo. Photo credit: Warren Zelman

In the face of conflict, natural disasters, or other crippling events, women disproportionately suffer from preventable illnesses and death. In such circumstances, women are more likely to experience gender-based violence, and they have more difficulty accessing basic health services, such as obstetric care and family planning. This was evident in the wake of the Ebola outbreak in West Africa, when maternal mortality rose sharply between 2013 and 2015; with the HIV epidemic, when rates of HIV among young women soared in sub-Saharan Africa; and with spikes in sexual and gender-based violence that occur during a humanitarian crisis.

{Photo credit: Rudi Thetard/MSH}Photo credit: Rudi Thetard/MSH

"There is a great joy when the family comes back to hospital wanting to show that their less than 1500g baby has now grown into a healthy newborn with no trace that they were premature. Sometimes we meet parents in the market place who keep appreciating our efforts in saving their premature babies... I appreciate it so much when babies are born in hospital so care can be initiated as soon as possible." - Chelmsford Gondwe, Registered Nurse Midwife

The USAID-funded Organized Network for Everyone’s Health (ONSE) Activity and lead implementer Management Sciences for Health joined the world to commemorate World Prematurity Day on November 17, 2019. This global movement seeks to raise awareness about prematurity, calling for the participation of everyone in the prevention and care of small and sick newborns to avert deaths. This year’s celebrations were under the theme “Born Too Soon: Providing the right care, at the right time, in the right place.” 

Mother and baby await health services at a health center in Mulanje, Malawi. Photo credit: Samy Rakotoniaina/MSH

This story was originally published by Deliver for Good

Many women are the bedrock of families yet tend to lack access to and control over resources to ensure a diverse and nutritious diet before, during, and after pregnancy. Luckily, gender sensitive nutrition programming that is integrated with MNCH and reproductive health activities can deliver healthier lives for women, their children, and their families.

Violet, a young mother living in Karonga district in central Malawi, delivered her first baby at a community hospital in September. Throughout her pregnancy, she attended six antenatal care (ANC) visits. Her delivery was smooth and without complication, due to her good health and nutrition. Her husband attended her delivery as her guardian.

 {Photo Credit: Pablo Romo/MSH}Iginia Badillo delivered her child at Huasca Health Center under the care of midwifery interns supported by the FCI program of MSH.Photo Credit: Pablo Romo/MSH

This story was originally published by Global Health NOW

After decades of effort by the global health community and governments, more women are giving birth in health facilities than ever, and maternal and newborn mortality have declined since 1990.

But global and country-level averages hide a tragic, more complex story: Even in countries where 80% of births take place in health facilities or are attended by skilled health workers, maternal mortality often remains high.

Many of these deaths could be prevented. In the 81 countries with the highest maternal and neonatal mortality rates, well-functioning health systems would prevent 520,000 stillbirths, and save the lives of 670,000 babies and 86,000 women by 2020—even at current rates of access to maternal and newborn health services, according to the November 2018 report from The Lancet Global Health Commission for High-Quality Health Systems.

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