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Women’s Health in IndiaWomen’s health in India is still vulnerable to several risks such as high maternal mortality rates, lack of preventative care and misinformation about family planning and contraception. Despite this, India has proven itself a pioneer in technological innovation among developing countries and it is putting its new innovations towards improving women’s healthcare. 

Maternal Health and Newborn Development

Although maternal mortality rates in India have declined substantially in the last decade, the number of recorded deaths related to pregnancy complications in the country is still remarkably high. A report by UNICEF estimates that 44,000 women die due to preventable pregnancy-complications in India yearly. These complications often stem from a lack of knowledge and inherently the inability to understand that their baby isn’t developing correctly. This lack of knowledge results in fewer women seeking treatment that could save their lives. To combat this, organizations are developing innovative mobile apps to help women stay proactive and educated about the health of their babies and the status of their pregnancies. 

For example, in 2014, MAMA (Mobile Alliance for Maternal Action), an organization dedicated to women’s maternal health in developing countries, developed a digital service called mMitra. The service sends recordings and SMS messages to new and expectant mothers with crucial information about the early stages of pregnancy and child development within the first year of life. The app, which collected 50,000 subscribers within months of its launch, sends educational content to women in their native languages and at times of their choosing. The app,  mMitra ultimately aims to help women pick up on pregnancy and child development issues early and seek treatment before symptoms escalate or endanger the mother and child. 

Breast Exams and Preventative Care

Mammograms are an essential part of preventative care for women globally. Despite this, it is estimated that over 90 percent of women in the developing world go without this essential screening examination. Particularly, in India, high-costs, unsustainable electricity and lack of properly trained radiologists are major causes for the inaccessibility to mammograms and other procedures like it. More women die of breast cancer in the country than anywhere else in the world (around 70,000 women annually). While these high death rates due to inaccessibility to preventive care are tragic, they’ve inspired innovative medical devices that have revolutionized women’s health in India. 

One such device, known as iBreastExam was invented by computer engineer Mihir Shah. Shah invented the device to ensure that women in even the most rural parts of India could get affordable, accurate breast exams and seek treatments as needed. The battery-operated wireless machine is designed to record variations in breast elasticity and performs full examinations in five minutes, posting and recording results through a mobile app. Not only that, the exams are painless, radiation-free and are extremely affordable at $1 to $4 per exam.

Family Planning and Contraceptive Options

Lack of family planning and knowledge of contraceptive options is another challenge in improving women’s health in India. Many Indian women shy away from modern family planning and contraception due to things like familial expectations, cultural influence and a general fear stemming from misinformation from disreputable resources. Family planning and the use of contraception could reduce India’s high maternal mortality rates. However, without proper education on these matters, it is difficult for young Indian women to make informed decisions about what options are best for them. But, in the midst of India’s technological revolution, an increase in accessibility to mobile devices is steadily transforming the way women are gaining health awareness in India. 

There is a particular mobile app that is playing a huge role in improving women’s health awareness in India. Known as Gyan Jyoti, the mobile app provides credible information through educational films, TV advertisements and expert testimonials from doctors. It also acts as a counseling tool for ASHAS (appointed health counselors). The app allows ASHAS to expand their knowledge of family planning through an e-learning feature, customize their counseling plan according to the needs of clients and monitor and store client activity in order to provide the best information possible. 

Overall, while there are still many challenges in improving women’s health in India, the country has proven itself to be a pioneer in technological innovation. Just as well, it’s proven that transformation is possible by putting its innovations towards women’s health awareness through mobile apps, life-saving hand-held devices, and educational platforms that can be accessed at the click of a button. 

Ashlyn Jensen
Photo: Flickr

 

Top Ten Facts about Period Poverty in the U.K.
Nearly 800 million women and girls menstruate daily. Period poverty encompasses the shame, guilt and cost barriers around access to sanitary products. One in 10 girls in the United Kingdom is unable to afford sanitary wear, resulting in detriment to their self-esteem, education and overall quality of life. Eliminating period poverty has often been the focus of nonprofits and the U.K.’s government. Below are the top 10 facts about period poverty in the U.K. that are important to know.

Top 10 Facts About Period Poverty in the U.K.

  1. An estimated 49 percent of girls have missed a day of school due to their periods. One in five girls surveyed in a 2019 study reported being a victim of bullying and teasing because of their periods. Girls faced increased feelings of shame and embarrassment when on their periods or discussing their period in an academic setting. This resulted in absences from school and led female students to struggle to keep up with their schoolwork.
  2. Women in the U.K. spend as much as 18,450 euros ($20.744 USD) due to their period across their lifetime. The total accounts for the costs of sanitary items, pain relief for cramps, new underwear and other period-related costs such as sweets or magazines. Of those interviewed, 91 percent purchase pain relief to ease the symptoms of periods on a regular basis. All of the 2,134 women surveyed responded that feminine hygiene products should cost less money, and some added that the government should remove its tax on those products.
  3. Free Periods is a campaign supplying low-income girls with menstrual products. Amika George, a 19-year-old student studying at Cambridge University, founded Free Periods. George called on the U.K. government to assure sanitary products are widely available in educational settings. The campaign also held a protest in London to bring attention to the ongoing issue.
  4. Plan International UK found that 10 percent of girls are unable to afford sanitary products. The cost of sanitary products has led 14 percent of girls to borrow sanitary products from friends, 12 percent to improvise sanitary products and 19 percent to change to less suitable products.
  5. Bloody Good Period, created by Gabby Edlin in 2018, supplies 25 asylum seeker centers in the U.K. with a flow of menstrual products. The growing initiative aspires to supply more food banks and centers in its mission to end period poverty.
  6. Girls throughout the U.K. not only miss school but often improvise sanitary products to use during their period. Girls have shared their stories of wrapping a sock around their underwear to control the bleeding. Others have wrapped rolls of tissues or newspapers in order to prevent leakage through their uniforms.
  7. In 2018, the Scottish government rolled out a plan to provide free sanitary products to women unable to afford them. Projections determine that it will reach approximately 18,800 low-income women and girls in an attempt to combat period poverty.
  8. The Gift Wellness Foundation provides non-toxic sanitary pads to women in crisis throughout the U.K. The Foundation relies on donations and the generosity of local community businesses. Donated sanitary products contain all-natural ingredients to ensure they are free of harmful chemicals.
  9. As of 2017, an estimated 68,000 women lived on the streets in temporary housing or shelters. These women have to make decisions that often leave them without sanitary products due to their financial situation. Each year, shelters get an allowance for condoms but not for sanitary products.
  10. Three individuals who met as interns at a London advertising agency founded #TheHomelessPeriod. Inspired to minimize the hidden side of an inequality, #TheHomelessPeriod aims to have tampons and towels available in homeless shelters through donations, crowdfunding and fundraising.

The top 10 facts about period poverty in the U.K. show the frequent inaccessibility of sanitary products to girls and women throughout the nation. While the Scottish government leads the way in the efforts to end period poverty, other governments have yet to replicate its actions. Individuals within the U.K. have taken it upon themselves to create campaigns to combat the hidden inequality and have seen success in their efforts.

– Gwen Schemm
Photo: Unsplash

Microlife CRADLE VSA Saves MothersRoughly 800 women die every day as a result of obstetric hemorrhaging, sepsis and pregnancy-related hypertension. The majority of these deaths occur in low-income areas that do not have the necessary tools to check a mother’s blood pressure and heart rate during or after childbirth.

In response, Professor Andrew Shennan and the CRADLE research team at King’s College London developed the CRADLE Microlife Vital Signs Alert (CRADLE VSA). The device features a “traffic light” early warning system that uses the traditional red, yellow and green colored lights. The user-friendly system indicates when a patient has pre-eclampsia or sepsis, even if the user has not undergone formal training.

CRADLE VSA relies on Shock Index, “the most reliable predictor of serious maternal adverse outcome. Appropriate thresholds for shock index were therefore incorporated into the traffic light algorithm, together with universally understood hypertensive thresholds, to trigger the coloured lights.” Several research studies have investigated the benefits of CRADLE VSA devices.

2013

A CRADLE research team found that over 90 percent of health clinics in a rural district of Tanzania lacked blood pressure devices. Often, the ones they did have were broken. The team provided 19 CRADLE VSA devices, containing tally counters to monitor use, to these clinics.

The CRADLE researchers conducted preintervention and postintervention studies over 12 months in three rural hospitals in Tanzania, Zimbabwe and Zambia. During the three-month preintervention phase, pregnant women who went to the hospital at twenty weeks gestation or more had their blood pressure measured twice with the validated CRADLE prototype device. The three-month intervention phase resulted in twenty rural and semirural peripheral antenatal clinics receiving one to two CRADLE prototype devices. They also received training sessions, instructions and a guide to referring based on blood pressure readings.

The researchers analyzed readings from 1,241 women (694 from the preintervention phase and 547 from postintervention). They discovered a link between the use of the device in these rural clinics and improved antenatal surveillance of blood pressure. They found a decrease in the proportion of women who never had their blood pressure measured in pregnancy from 25.1 percent to 16.9 percent.

April 2016

Researchers held a 20-month trial to determine the device’s efficiency. Over this time, new healthcare sites received the CRADLE VSA device every two months until 10 sites had the device. The goal of the trial was to determine the device’s ability to detect obstetric hemorrhaging, sepsis and hypertension and help providers reduce the number of deaths occurring during childbirth. In June 2016, researchers implemented the device in 10 low-income countries including Uganda, Sierra Leone, Ethiopia and Haiti.

June 2018

Studies showed that clinics in twelve countries across Africa, Asia and the Caribbean were using over 6,700 CRADLE VSA devices. A cluster randomized controlled trial in Mozambique, India and Pakistan used a prototype of the device in the intervention phase of pre-eclampsia. The trial enrolled a total of 75,532 pregnant women.

The CRADLE VSA saves lives by foreseeing the early diagnosis of pre-eclampsia. For many women, these health risks may have otherwise gone unnoticed. This innovation is contributing to the prevention of maternal deaths. This could help the world meet the United Nations Sustainable Development Goal 3, “to reduce the global maternal mortality ratio to less than 70,000 per 100,000 live births by 2030.”

– Sareen Mekhitarian
Photo: Upsplash

treating obstetric fistula
Obstetric fistula is a condition in which there is an abnormal opening in a woman’s birth canal due to prolonged, obstructed labor. When left untreated, obstetric fistula leads to skin infections, kidney disorders, incontinence and death of the child, and is responsible for around 6 percent of all maternal deaths.

This ailment is highly preventable and treatable, yet there are an estimated two million women living with it untreated in Asia and sub-Saharan Africa. An additional 50,000 to 100,000 women are diagnosed each year. These women are predominately underprivileged, poor and young.

Operation Fistula Raises Awareness of the Necessity of Treating Obstetric Fistula

Operation Fistula is one of the few organizations that has collected data on the condition. It has measured the burden on life that not treating obstetric fistula has had and compared that weight to that of other debilitating diseases. The organization found that living with obstetric fistula is ranked just below terminal cancer.

In developed countries, obstetric fistula is practically non-existent because women have access to the education and medical services that assure a healthy pregnancy. Unfortunately, these care services are not readily available to women in poverty-stricken areas.

Even with the establishment of care centers in the most prominently affected areas, the lack of attention that obstetric fistula receives is incredible. Because the condition is nearly unheard of in Europe and the U.S., there is limited global awareness and therefore very little capitalization. In fact, treating obstetric fistula receives less than1 percent of annual global health funding even though it is relatively inexpensive to care for.

Global Efforts Bring Treatments to Women in Need

To counter the mass neglect, Operation Fistula works to provide women with timely and high-quality treatment. It also plans to eliminate fistula altogether by 2045. The organization’s approach is data-centric and focuses on performance-based funding to surgeons who have successfully treated patients. This simple solution yielded four times the target amount of patient treatments between 2012 and 2014.

In addition, USAID’s Health Service Delivery project is working to make the proper medical services available by establishing treatment centers at multiple hospitals in Guinea, where obstetric fistula is extremely prevalent. The treatment centers allow women to undergo the reconstructive surgeries necessary for recovery.

Operation Fistula’s most recent effort in continuing its 2045 eradication plan is working with the government of Madagascar and the United Nations Population Fund to wipe out fistula in every region of the country.

Operation Fistula concentrates on the patient first and foremost. With its performance-based funding, Operation Fistula makes sure that each patient gets the best possible treatment rather than focusing solely on the number of patients treated. Through their endeavors, every woman that Operation Fistula has treated so far has gained back, on average, almost 11 years of healthy life.

While advancements in the global treatment of women with obstetric fistula have been made, there is still a need for prevention. Health professionals in affected areas are being trained continuously and efficiently in order to prevent and manage obstetric fistula, but the most basic method of prevention is through awareness.

– Samantha Harward
Photo: Flickr

tools to prevent cervical cancerCervical cancer continues to be a big problem for developing countries. More than eight out of ten cervical cancer deaths will happen in developing countries, in spite of the fact that the tools to prevent cervical cancer are available now.

How Countries are Addressing the Issue

In May 2018 in Geneva, Gavi the Vaccine Alliance “welcomed the call” issued by the World Health Organization Director-General, Dr. Tedros Adhanom Ghebreyesus, for coordinated action against cervical cancer. The first steps on the path to eliminating cervical cancer are sustainable disease control through significant investments and holistic health systems.

Currently, cervical cancer is projected to overtake childbirth as the leading cause of death among women, especially in low- and middle-income countries. Around the world, 266,000 women and girls die each year as a result of cervical cancer. By 2030, that number could increase to more than 380,000.

Eight Gavi-supported countries have launched the vaccine nationally with 30 countries implementing a demonstration program. Ethiopia and Senegal begin nationwide vaccination in 2018. These countries understand that the tools to prevent cervical cancer are available now.

Battling Cervical Cancer in Developing Countries

Cervical cancer is the third most common cancer worldwide, with 80 percent of cases happening in the developing world. It is the leading cause of death among women in developing countries, where it causes about 190,000 deaths each year. Cervical cancer risk is highest in Central America, sub-Saharan Africa and Melanesia.

A lack of effective screening programs used to detect and lead to treatment of pre-cancerous conditions is the major reason for the much higher cervical cancer occurrence in developing countries. Roughly about five percent of women in developing countries have been screened for cervical dysplasia, compared to 40 to 50 percent of women in developed countries.

Of the total number of cases of cervical cancer worldwide, 99 percent were estimated to contain HPV DNA. HPV virus infects the cells of the cervix and slowly causes pre-cancerous cellular changes (dysplasia) that progress. Women are generally at the highest risk of HPV infection in their teens, 20s or 30s. It can take as long as 20 years after the initial HPV infection for cancer to develop.

Using the Proper Tools to Prevent Cervical Cancer

In many developing countries, treatment options are limited. Cervical lesions are often treated with aggressive approaches like cone biopsies or hysterectomies (removal of the uterus) rather than with appropriate outpatient approaches.

Simple outpatient procedures should be used instead to destroy or remove pre-cancerous tissue. A common outpatient method is cryotherapy; another is a loop electrosurgical excision procedure (LEEP). LEEP does involve more equipment and supplies, but it removes diseased tissue while at the same time providing a specimen for analysis, reducing the possibility of overlooking invasive cancer.

The keys to curing cervical cancer and reducing HPV infections are education, screening and access to vaccines. What is required is the removal of barriers preventing women and girls from accessing the necessary healthcare. From vaccination campaigns to self-administered screenings, many countries are already on the right path to helping stop unnecessary deaths from cervical cancer. The tools to prevent cervical cancer are available now, and women in developing nations have a right to access those tools.

– Gustavo Lomas
Photo: Flickr

The Marshall Islands are located in the northwest of the Pacific Ocean, with a land area of just 181 square kilometers and a population of just over 74,000. While some organizations have promoted women’s empowerment in the Marshall Islands since its independence in 1986, the progress of legal rights for girls and women has not been significant.

For the past 30 years, the Marshall Islands has had few female senators. In the country’s 2015 elections, three women won seats, taking up 9 percent of the total 33 members in parliament. In January 2016, Hilda Heine won the presidential election to become the first female president of the Marshall Islands.

Though the nation did ratify the U.N.’s Convention on the Elimination of All Forms of Discrimination Against Women in 2006, the Marshall Islands has no current legislation on any issues related to domestic violence, human trafficking, sexual harassment or sex tourism. Furthermore, there is no minimum sentence for sexual violence.

Due to the insufficiency of the law, violence against women in this nation is not unusual. A report by Women United Together Marshall Islands has shown that 51 percent of women experience domestic violence, while more than half of the population generally agrees that it is normal to commit violence against women in marital relationships, according to U.N. Women.

On the other hand, as a crucial metric on women’s empowerment in the Marshall Islands, gender parity and equality in education has some good news. Literacy rates among male and female youth are above 98 percent at present. A 2015 national review on education in the Marshall Islands reported that girls perform better than boys on all tests except for science in grade three.

However, the gender pay gap and inequality in employment still call for more attention to women’s empowerment in the Marshall Islands. Statistics have shown that the male and female unemployment rates are, respectively, 28 percent and 37 percent. Annual wages of women are $3000 less than those of men in the same occupations. Potential discrimination in job markets frequently restrict women from earning credits or managing businesses, which affects their economic independence.

Another concern is related to women’s health and environmental issues. Due to a shortage of fruits and vegetables, more than half of women in the Marshall Islands have obesity or risk factors for related diseases. Teenage marriage, adolescent pregnancy and mortality for children under five in this nation still remain high compared to the global average, despite significant decreases in the past few decades.

Founded in 1987, a nonprofit organization named Women Union Together Marshall Islands serves as the leading voice for eradicating violence against women in the nation. Several other U.N. organizations have also dedicated efforts to promoting gender equality in the Marshall Islands.

Significant progress on women’s empowerment in Marshall Island has been achieved. Political leaders play a strong role in promoting gender equality and ending violence against women. However, further efforts to improve the status of women are still challenging and necessary.

– Xin Gao

Photo: Flickr

How Emergency Transportation Has Addressed Disparity Gaps in Women's HealthIn September 2017, the United States Agency for International Development’s (USAID) High Impact Health Services Project constructed emergency transport systems in Tienfala, a small community located in Mali, which has allowed for pregnant women to be transported to health facilities in order to give birth. This project was a part of USAID’s efforts to increase health outcomes around the world and close the consistently widening disparity gaps in women’s health.

According to USAID, the completion of the emergency transport systems were in large thanks to a community effort. People from the small Tienfala community worked together in order to help increase the health outcomes of pregnant women in their community. USAID’s project in Tienfala is very promising for the promotion of women and girls in developing countries.

Many other organizations have placed a focus on increasing the health outcomes of women and girls in developing countries in order to address the widening disparity gaps in women’s health around the world. In fact, the aim of the United Nations International Children’s Emergency Fund (UNICEF), in regards to women and girls, is to “promote the equal rights of women and girls and to support their full participation in the political, social and economic development of their communities.”

Like UNICEF, USAID has placed a value on promoting women’s health in developing countries like Mali. Specifically, according to USAID, the focus of the High Impact Health Services Project is to decrease the incidence of maternal and child deaths, and the construction of the emergency transport systems in Tienfala has greatly helped reduce such mortality rates.

Kadia Coulibably, a woman from Tienfala, lacked any sort of prenatal care during her fourth pregnancy, reports USAID. However, the emergency transport systems allowed Coulibably to experience an organized, healthy childbirth. Without the valuable help of U.S. foreign aid through the governmental agency USAID, Coulibaly may have faced complications during her childbirth due to the lack of proper care.

Of course, a focus on the health of women and girls in developing countries is incredibly vital to the empowerment of women in their respective communities. When pregnant women can receive accessible, adequate health care, they can thrive happily and healthily. Thus, the construction of the emergency transport systems for pregnant women in Mali is a step in the right direction for the advancement of women’s health.

Emily Santora

Photo: Flickr

Sanitation Leads to Education for Girls in Ghana
Every year, millions of girls all around the world experience their first period. To many, it is a moment of pride as they enter womanhood. For many others, the experience is significantly disruptive. This is especially true for school girls in Ghana, where the start of their period is simultaneously the start of missing 30 to 50 school days each calendar year. Inevitably, these young girls are falling behind in their education quickly. Education for girls in Ghana loses much to this.

One of the greatest obstacles for young girls in Ghana is acquiring sanitary supplies. For those who cannot afford the supplies, choices are limited. Many are left to fend for themselves by using scraps of clothing, fabric or even mud. Due to the risk of being exploited by their needs, many girls choose to stay home and simply avoid the embarrassment. According to a study in 2012 by WaterAid, upwards of 95 percent of the girls surveyed choose against attending during their period each month.

Fortunately, some non-profit organizations have begun tackling this issue of lacking proper sanitary supplies for the young girls in Ghana. The Educational Empowerment Initiative (EEI) has since been distributing free disposable sanitary supplies to school-aged girls within the school systems. As a result, schools have reported a drastic reduction in the number of period-related absences. All it took was distributing feminine hygiene supplies to show the fact that sanitation leads to improved education for girls in Ghana.

Moreover, the program has also sought to provide basic healthcare and reproductive educational classes to the girls as well as train teachers to talk to their students when they may have questions about their seemingly new bodies. Education concerning periods is just as crucial as general studies for girls in places like Ghana. A UNICEF study in 2013 revealed that nearly 48 percent of young girls were completely unaware of menstruation until they had their first experience.

UNICEF and Ghana Education Services (GES) are also pushing for research and improvements through Ghana. These two organizations have partnered together in order to conduct project research on the myths that haunt Ghana’s people regarding menstruation. For example, many believe menstrual blood to be a bad omen and that women are impure during their menstrual cycles. UNICEF and GES are seeking to use their finding to improve ongoing Water, Sanitation, and Hygiene (WASH) programs in schools. Specifically, UNICEF is focusing on advocating for better Menstrual Hygiene Management throughout the country, hoping it will improve girls’ attendance and retention.

Another real concern for all students in Ghana—not just the girls—is the overall lack of access to sanitation facilities. For some schools, like the Adusa Municipal Assembly Primary School, a couple of pit latrines and one makeshift, semi-open structure is all the students have to use to relieve themselves. Due to the extremely poor conditions of the facilities, many of the students report that they “hold it,” but admit to being unable to concentrate during class. The Ghana WASH project has specifically mentioned that institutional latrine improvements will address some of the girls’ absences, too. A simple extension of privacy and a brief excuse from class allows young girls to take care of themselves without missing a whole day of school.

The entrepreneurial young woman behind EEI, then-15-year old Winnifred Selby is a part of a global movement recognizing how important it is to aid young girls and women in fulfilling their basic needs. By helping the girls and women remain in and prioritize school, the chances they eventually enter and contribute to the workforce grow. Education is a powerful tool that enables people around the world to develop and participate in their local, national and international workforces and communities. Investing in educating women is an investment in improving society. Therefore, what is happening in Ghana is not isolated to Ghana. Improving sanitation is a greater concern for the world at large. As shown by some of the actions of EEI, UNICEF and the WASH projects, improved sanitation often leads to improved education.

Taylor Elkins

Photo: Flickr

Low-Income Communities Deserve Sanitary Menstrual Products
In 2015, 18 percent of Rwandan females didn’t go to school or work because they couldn’t purchase sanity menstrual products.

Sustainable Health Enterprises (SHE) recycles trunk fiber from banana farmers to be cut, carded, washed, fluffed and solar dried for menstrual pads. The company supplies farmers with the necessary equipment and training services for production. They offer health and hygiene education to the community through schools.

SHE believes it’s personal injustice that menstrual hygiene is seen as a luxury item. In Rwanda each year, the country has roughly a gross domestic product (GDP) loss of $115 million for women needing to take sick leave due to their periods. The company is fighting for a removal of value-added taxes on menstrual pads.

“We’re creating a blueprint to franchise globally. It’s a sustainable system that can be rolled out anywhere. We think it’s straight up common sense,” SHE outlined on the company’s website.

Most U.S. food stamp programs do not define sanitary menstrual products as an essential item. In India, people believe menstruation makes women impure. Most of the time females who are on their period are banished from completing their household obligations such as cooking, or even from inhabiting their homes at all.

In the largest slum, Mukuru, in Nairobi, Kenya, a study found that girls 10 to 19 years old were having sex with older men to gain access to sanitary menstrual products, according to Dignity Period.

In Burkina Faso, 83 percent of girls don’t have a sanitary menstrual changing area, and more than half of schools in the poorest countries lack private toilets, according to UNICEF.

Diana Sierra, a founder of Be Girl Inc., created a pair of underwear with a menstrual, mesh pocket that females can fill with any type of recyclable materials, such as cotton, grass or fabric, depending on the materials readily available in their geographic location.

After Sierra finished a master’s program in sustainability management at Columbia University, she traveled to Uganda for her internship. While conducting research on a coffee farm and cultural arts, she was working on the side to create a prototype for the most effective sanitary pad.

“So I said okay I’m going to hack this material with what I have handy. I took an umbrella for the layer on the bottom, I took like a mosquito net and cut it in pieces and stick it all together and created a kind of a universal pocket, a mix-proof pocket for a certain material,” said Sierra.

Sierra took her product to a school and the children found it successful, but they didn’t like the color black because they found it boring. In Tanzania and Malawi, the stigma associated with menstruation is more than a negative connotation. It is considered a curse.

“When we were asking them, they were talking about how they can’t touch an animal because the animal would just drop dead, and they cannot touch a baby because the baby can die. They cannot go through the crops because the crops will die,” said Sierra.

Sierra realized that she spent years working for global companies, designing for about 10 percent of the population with their extra TVs and face steamers, but she wondered about the other 90 percent of the world who feel that they aren’t deserving of a sanitary product.

Be Girl was launched in the U.S. to fiercely distinguish between and within genders. Sierra is mining a conversation of equality worldwide. It’s a product not exclusive to any socioeconomic status. She wants women to educate themselves about their options and teach others in every country, so that generations that follow will spread the knowledge.

“They have the same value as a human being, but they’re completely overlooked. So that was the very first thing that I said I have to go and see this for myself and experience firsthand what it is that a designer can do for this type of scenarios,” said Sierra.

Rachel Williams

Photo: Flickr

midwifery
During the 14-year civil war in Liberia, the health system became increasingly fragile, and a lack of roads and transportation made it difficult for pregnant women to receive necessary emergency care. This issue has created a strong need for strengthened midwifery in Liberia.

As a result, Liberia had one of the highest maternal mortality rates in the world according to a 2015 USAID article, but the country is now trying to change that through investment in midwifery programs.

Currently, 44 percent of Liberian women give birth without a skilled attendant, and nearly one out of 138 mothers die from preventable causes during childbirth. Such issues could be avoided with basic or strengthened midwifery in Liberia, according to the World Health Organization.

Bentoe Tehounge, a trained midwife in Liberia, told WHO, “We need midwives who can ensure a safe pregnancy even before a woman is pregnant. People who can provide advice on family planning, nutrition, physical activity and preventing mother-to-child transmission of HIV.”

There are six midwifery schools in the Liberia, half of which are in rural areas, and less than 200 midwives for over four million people. Most of these midwives work in urban areas. Strengthening these schools, especially the rural ones, will improve access to quality care for women around the country.

Retaining these midwives is one step towards Liberia’s investment in the profession. According to WHO, many health professionals were driven out of the country due to the civil war and the Ebola crisis, and now midwives lack “safe accommodation and transport, are overworked and paid poorly and have limited opportunities for career advancement.”

A new B.S. program addresses a portion of these concerns by providing further professional development. The program graduates 50 to 75 registered midwives per class, which is expected to staff more than 700 health facilities in the country. To develop better teaching methods, Liberia is working with the Danish Midwives Association to pair Liberian and Danish midwives in order to learn more advanced skills, like preventing and treating hemorrhages. It is hoped that this new alliance will result in strengthened midwifery in Liberia.

In the United States, this final element is comparable to the apprenticeships or clinicals that midwives do to obtain a license. Mary Anne Brown, a midwife serving the Great Falls and Helena areas of Montana, said that degree programs require that their students find and work directly with a midwife to gain clinical experience.

Past midwife training in Liberia tried to work within a culture of home birth in Liberia (USAID reported that 63 percent of Liberian women gave birth outside of a health facility) and with the knowledge of traditional midwives.

The goal was to shift the focus to encouraging birth preparedness, recognizing and referring complications and providing appropriate emergency care through what USAID called “home-based life-saving skills.” By utilizing storytelling, case histories, discussion, role-play and demonstrations, midwives, expectant parents and community leaders were able to educate themselves at community meetings.

One of the greatest achievements of the previous midwife training in Liberia was its ability to connect traditional midwives to both health facilities and certified midwives. Certified midwives perform their own visits to discuss problems the traditional midwives are having, replenish supplies and reinforce the training.

The current programs are a part of WHO’s efforts to provide clear guidelines, tools and an evidence base to lead to strengthened midwifery in Liberia and around the world in order to improve care for pregnant women and reduce both maternal and neonatal mortality rates.

Anastazia Vanisko

Photo: Public Domain Images