Author Archives: Michele Alexander

Recap: May 31 – Day 7, Friday

The whirlwind, week-long, study tour concluded on Friday with a local NGO site visit to the Negeri Sembilan Family Planning Association and Reproductive Health Association Melaka Clinic and Youth Program outside of Kuala Lumpur. Delegates toured the NGO’s health clinics and youth center to gain an overview of the NGO and its work. There, they met with NGO staff and the patients who are benefiting from the health services. Both this site visit, and Monday’s visit to the Putrajaya Health Clinic, gave delegates the unique opportunity to witness Malaysia’s health successes first hand. Overall, the week was success as the delegates left with a greater understanding of Malaysia’s health system and reproductive, maternal, newborn and child health successes, and the importance of investing in women and girl’s health worldwide.

Recap May 31 Day 7 Youth Clinic 1

Youth at the Negeri Sembilan Family Planning Association and Reproductive Health Association Melaka Clinic and Youth Program.

Full group at the NGO site visit.

Full group at the NGO site visit.

Recap: May 30 – Day 6, Thursday

The last day of the Women Deliver 2013 Global Conference focused on looking to 2015 and beyond. Of all of the Millennium Development Goals (MDGs) set to expire in 2015, MGD 5 is the furthest behind and it is critical to take a stock of why it is not being reached. To do so, delegates attended panels, plenaries, and sessions highlighting why the well-being of girls and women should be a top developmental priority in the new development framework. Delegates attended “To the Point” sessions which were similar in structure to TEDTalks.  There, they heard MSH President and CEO Dr. Jonathan Quick speak about Why Universal Health Care is a Women’s Issue.

During the afternoon, the delegates had the opportunity to meet one-on-one with Melinda Gates and Chris Elias from the Gates Foundation. During the meeting, they were briefed on the Gates Foundation’s work and gained a better understanding of the role foundations play in advancing global health priorities. The day concluded with an interactive dinner discussion hosted by the Global Health Corps, Pathfinder International, and PSI, entitled “Smells Like Teen Spirit – A Look at the Role and Importance of Youth in Global Development Efforts. Delegates and youth facilitators discussed the unique services and interventions that young people need, why rolling out and implementing youth-specific policies are key,the important role young people play in health and development efforts, and where young people fit into the post2015 development agenda.

Melinda Gates speaking at the Women Deliver 2013 Conference after meeting with the group.

Melinda Gates speaking at the Women Deliver 2013 Conference after meeting with the group.

Recap: May 29 – Day 5, Wednesday

The fifth day of the tour started with a briefing at the US embassy, where delegates met with US Ambassador to Malaysia Paul W. Jones and other US officials. After the briefing, delegates headed back to the convention center to attend the Women Deliver Conference. The second day of the conference discussed reducing unmet needs to contraception for the 220 million women who lack access. In particular, the day focused on Millennium Development Goal 5, which calls for universal access to reproductive health to allow women to plan the number and spacing of their pregnancies. The panels and sessions explored how the global community can continue to address and decrease this unmet need and ensure that women around the world have safe and healthy pregnancies. In the evening, delegates attended the 2013 Impact Awards Reception, hosed by PSI and Women Deliver. The Impact Awards honored individuals from an array of sectors integral to women’s global health efforts.

Tour delegates with Chelsea Clinton at the Women Deliver 2013 Conference.

Tour delegates with Chelsea Clinton at the Women Deliver 2013 Conference.

Recap: May 28 – Day 4, Tuesday

The fourth day of the study tour marked the first day of the Women Deliver 2013 conference, which convened more than 4,500 participants from 149 countries to discuss women’s empowerment and the health and well-being of women and girls, with a particular look to the future of the development framework. Delegates attended high level plenaries, concurrent panels, and engaged in a lunch dialogue with Rosmanh Mansor, first lady of Malaysia. The first day’s theme highlighted the investments made in the health, education, empowerment, and rights of girls and women around the world. Delegates learned how healthy girls are more likely to attend school, have safe pregnancies and deliveries, and grow up to have healthy and educated children. They learned that when we invest in women and girls, they survive, and simply put, families, communities, and countries thrive.

The evening concluded with a dinner panel discussing the delivery of maternal, newborn, and child health services in fragile, post conflict states. Panelists presented on the challenges faced, and success achieved, in the delivery of maternal, newborn and child health (MNCH) and reproductive health (RH) services in fragile states, such as Afghanistan, Haiti, and Democratic Republic of the Congo. Delegates left the dinner with a stronger understanding of the political, economic, and health conditions in fragile states, the major barriers to MNCH and RH service delivery, and the roles leadership and governance play in saving the lives of women and children.

Opening of the Women Deliver 2013 Conference.

Opening of the Women Deliver 2013 Conference.

First Lady of Malaysia (center in blue) at the Women Deliver 2013 Conference.

First Lady of Malaysia (center in blue) at the Women Deliver 2013 Conference.

In Kuala Lumpur, U.S. Congressional Staffers Briefed on Maternal Health Challenges in India

By Sandeep Bathala

This post is cross-posted, with permission, from New Security Beat, the Wilson Center’s Environmental Change and Security Program’s blog. The original post can be found here.

It’s funny when you bump into your neighbors on the other side of the world. Today I spoke about the Global Health Initiative’s recent collaboration with the Population Foundation of India at a regional briefing on health in South and Southeast Asia before the 2013 Women Deliver conference in Kuala Lumpur, Malaysia. The special roundtable was part of a week-long study tour for a group of U.S. Congressional staffers that work on foreign affairs.

Management Sciences for Health, CARE, the Center for Health and Gender Equity(CHANGE), the Global Health Council, PATH, Population Services International (PSI), andWomen Deliver all partnered to bring this study tour to Kuala Lumpur during the Women Deliver conference for briefings and site visits that demonstrate the importance of investing in global health. I participated in a briefing that provided the staffers with important insight on the diversity of the health needs of countries in South and Southeast Asia.

Progress and Challenges in India

Drawing on our dialogue in New Delhi last month and a forthcoming report summarizing its recommendations, I discussed the recent progress and remaining challenges in maternal health care in India.

India has made big strides over the past decade to reduce maternal mortality. A decade ago, close to 75,000 women died every year during childbirth or due to pregnancy-related causes. By 2010, this number had fallen to 50,000. The country’s maternal mortality ratio fell from 301 maternal deaths per 100,000 live births in 2003 to 212 in 2009.

But despite this, India is not on pace to reach the maternal mortality Millennium Development Goal of 109 or fewer maternal deaths per 100,000 live births by 2015. Twenty percent of all maternal deaths worldwide still occur in India. To close this final gap, special effort needs to be made to reach disadvantaged communities.

The National Rural Health Mission (NRHM), its rural health care workers, and the Janani Suraksha Yojana (a conditional cash transfer program for institutional births) have contributed positively to improving the Indian women’s access to health care. According to the 2009 Coverage Evaluation Survey, nearly three out of four births took place in institutions – up from less than 40 percent in 2005-06. More than two-thirds (69 percent) of pregnant women received at least three antenatal checkups, and around 90 percent received more than two tetanus toxoid injections.

Wide disparities and inequities in women’s access to healthcare continue to persist, despite the overall progress. Sadly, access to health services still depends on a woman’s education, wealth, the community she belongs to, and where she lives. For instance, although in total 73 percent of Indian women give birth in institutions, the number is much lower (54 percent) among women who have no education, who belong to the lowest wealth quintile (55 percent), are a member of the Scheduled Tribes (57 percent), or live in rural areas (68 percent).

The poorest women–those belonging to Scheduled Castes and Scheduled Tribes–have yet to be brought into the fold of an inclusive healthcare system in many parts of the country. For example, over a period of eight months in 2010, 26 maternal deaths took place in the Barwani district hospital in Madhya Pradesh. Tragically, 21 of these 26 women belonged to Scheduled Tribes. Even more alarming is that an inquiry commissioned by the government found all 26 deaths were avoidable.

Regional differences are also important. States like Assam, Rajasthan, and Uttar Pradesh have maternal mortality rates over 300 maternal deaths per 100,000 live births. Attention also needs to be paid to transient populations, including women who temporarily migrate to their birthplace for delivery.

Expert Recommendations

As summarized by Executive Director of the Population Foundation of India Poonam Muttreja in a column for the Hindustan Times, seven strong conclusions emerged from the deliberations we helped organize in New Dehli:

One, we must recognize maternal morbidity as a serious health issue. For each woman who dies, an estimated 20 more suffer from infection, injury and disability during pregnancy and childbirth. Some women die, while for others, life is a living death experience. These complications range from fistula, uterine prolapse, painful sexual intercourse, reproductive tract damage and infections, anemia and even infertility. Maternal morbidity, like maternal mortality, can be easily prevented.

Two, we must integrate maternal health, reproductive health and family planning – now delivered as vertical programs – into a universal health coverage plan that recognizes woman’s health as a basic right. For example, anemia among girls needs to be addressed at a younger age. Waiting till they are pregnant and then treating them for the condition may be too late. Similarly, a substantial number of maternal deaths can be prevented by merely meeting the unmet need for family planning and providing access to safe abortion services. The government of India has taken a right step by announcing a comprehensive strategy on reproductive, newborn, child and adolescent health (RMNCH+A).

Three, we must focus on the marginalized. Within an overall framework of universal health coverage, India needs to adopt special and differentiated strategies to reach women in remote rural areas, those belonging to tribal communities, and the more disadvantaged groups in society.

Four, we must improve the quality of care by putting in place adequate guidelines, protocols, checklists and introducing a system of accreditation for facilities and services for both the public and private sector.

Five, address the shortage of human resources. Despite the more than 10-fold increase in institutional births over the past five years, there has not been a matching increase in staff strength. Skills of field functionaries such as auxiliary nurse and midwives (ANMs) have been lost as they have been instructed not to conduct deliveries. Many healthcare providers trained in the Indian systems of medicine fail to recognize clinical symptoms of an obstetric emergency.

Six, ensure greater accountability from the highest level instead of holding the frontline health worker or the Accredited Social Health Activist (ASHA) responsible. A greater involvement of the communities in monitoring the health services, which has begun under the NRHM, needs scaling up with adequate budget allocation.

Seven, gaps in knowledge must be addressed. Better monitoring and evaluation systems need to be introduced. A community perspective should be brought into the assessment of service delivery. A robust methodology should be developed for measuring morbidity and collecting real time data. More regular studies on maternal mortality and morbidity should be planned.

I also emphasized an eighth recommendation to the staffers: Social determinants to maternal health need to be addressed. Key among those are social customs, beliefs, and practices that occur across much of the world that contribute to poor health and inequity for women, including child marriage and early pregnancy, violence against women, and the political and economic disempowerment of women.

As Muttreja so eloquently says, “the last mile is always the most exhausting, exasperating and difficult to cover.” Collectively, we can do it. Whether here at global gatherings like Women Deliver or in New Delhi and Washington, DC, we need to continue to spread the message about the importance of investing in maternal health.

Read the Global Health Initiative’s full coverage from Women Deliver, part of our Advancing Dialogue on Maternal Health series with the Maternal Health Task Force and UNFPA.

Sources: Hindustan Times, UN.
Photo Credit: Schuyler Null/Wilson Center.

Sandeep Bathala is senior program associate for the Wilson Center’s Environmental Change and Security Program and Maternal Health Initiative.

Recap: May 27 – Day 3, Monday

On Monday morning, the delegation visited the Ministry of Health, where they were briefed on the current investments in, and the successes of, the Malaysian healthcare system. The briefing identified how the Malaysian health system’s successes can be used as an example to achieve similar results in other countries and helps meet the Millennium Development Goals.

After the Ministry briefing, delegates visited the Putrajaya Health Clinic outside of Kuala Lumpur. There, they toured an integrated family health clinic with Malaysian government officials. Delegates gained an overview on the clinic’s holistic health services; saw the impact of family counseling, education, reproductive health, and family planning services; and gained a better understanding of health research and development, social marketing, and health promotion initiatives. The delegates also met directly with the women and children who are benefiting from the Putrajaya Health Clinic‘s services.

Full group at the Ministry of Health.

Full group at the Ministry of Health.

At the Putrajaya Family Clinic.

At the Putrajaya Health Clinic.

Recap: May 26 – Day 2, Sunday

Sunday started with The Global Health Landscape roundtable, which discussed the landscape of global health development and what is being done today and what is needed for the future. The panel discussed how US investments in global health protect national security, build partnerships, demonstrate moral leadership, and improve public diplomacy. Speakers Mandy Moore and Jonathan Quick, and panelists Barbra Bush, Robert Clay, and Karl Hofmann also discussed the progress and challenges of current global health programs.

In the afternoon, a regional briefing on health in South and Southeast Asia was held. Regional experts briefed study tour delegates on the health status of countries in South and Southeast Asia with a special focus on maternal and child health. The briefing addressed the diversity of the countries and their health needs and what health progress has been made in the region, while also identifying the health challenges that remain.

After the regional briefing, delegated attended a roundtable discussion on US Global Health Engagement: Trends and Opportunities. The discussion highlighted how global health provides the US with opportunities to address some of the most important international challenges and discussed the fundamentals of US government engagement in global health, including what the US has done well and what future priorities should be.

In the evening, delegates attended a reception, co-hosted by MSH and PSI, with special guests US Ambassador to Malaysia Paul W Jones, Barbara Bush, and Mandy Moore. The reception highlighted public-private partnerships and how both public and private organizations can better confront global health challenges together.

Lively discussions arose during the day's roundtables.

Lively discussions arose during the day’s roundtables.

Mandy Moore and a tour delegate during the evening's reception.

Mandy Moore and a tour delegate during the evening’s reception.

The study tour delegates, Mandy Moore, and US Ambassador to Malaysia Paul Jones at the reception.

The study tour delegates, Mandy Moore, and US Ambassador to Malaysia Paul Jones at the reception.


Recap: May 25 – Day 1, Saturday

After disembarking twenty (or more) hour flights, and doing some whirl-wind sight-seeing around Kuala Lumpur, the study tour kicked off in Malaysia on Saturday May 25th with a meeting to discuss the activities and main objectives for the week. Women Deliver President Jill Sheffield spoke to the group about the Women Deliver 2013 Global Conference and the importance of maternal health and women’s issues. The learning objectives for this trip were also addressed, stressing how the Malaysian government’s health investments, particularly in maternal health, have led to sustainable, wide-spread impact throughout the country.

MSH staff and tour delegates bond and sing some karaoke before the start of a very busy week!

MSH staff and tour delegates bond and sing some karaoke before the start of a very busy week!