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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 GhanaEvery 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 a 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 the 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

Health Care in Afghanistan
Since 2002, the improvement of health care in Afghanistan has been great. According to USAID, “9 percent of Afghans lived within a one-hour walk of a health facility.” Today, over 50 percent of the population has access to a health care facility, the infant and child mortality rates have decreased and maternal mortality rates have declined as well.

The country’s turbulent history, filled with war and internal strife, has contributed a deteriorated health care system. The old Taliban regime stifled access to adequate medical facilities and professionals. With the help of groups like UNICEF, WHO and USAID the Afghan people are seeing tremendous progress within their country.

On May 16, 2016, a campaign to vaccinate every child under five years of age for polio was launched. Afghanistan and Pakistan are the only two countries still struggling against the illness. According to WHO, the campaign could put an end to the disease in the next few months.

This is just one example of the efforts being made to improve health care in Afghanistan. U.S. support in the country has also led to success in fighting tuberculosis. Data from 2012 reports daily TB treatments to have a 91 percent success rate.

Women’s health has improved immensely over the last decade. With the help of the U.S. government, more trained midwives were available in Afghanistan. As a result, by 2010, 60 percent of women had care prior to birth. This is an enormous step forward from 2002 when only 16 percent had this same access.

Despite its progress, the country still has a long journey ahead in improving the health care system. According to the Thomas Reuters Foundation, nearly 1.2 million Afghans have been internally displaced.

These individuals have little to no access to healthcare, which is a major problem as they also struggle for food and clean water. Violence against medical facilities has not helped the issue either. In 2015, 42 people were killed in a Doctors Without Borders hospital in Kunduz.

Increased foreign aid and peace efforts are necessary to solve the health care crisis in Afghanistan. This will involve supporting organizations already involved in the country as well as increased pressure on foreign governments for humanitarian action.

Saroja Koneru

Photo: Flickr

birthing kit

A birthing kit for low-income women promises to help diminish the adverse health effects of childbirth in poor areas.

According to the World Health Organization, about 830 women die from complications during pregnancy or childbirth around the world every day. “By the end of 2015, roughly 303,000 women will have died during and following pregnancy and childbirth,” the organization reports. “Almost all of these deaths occurred in low-resource settings, and most could have been prevented.”

While up to 99 percent of these deaths occur in developing countries, the United States itself has struggled with surprisingly high rates of maternal mortality. A report from Save the Children showed that the United States had the worst maternal death rate among developed countries. In fact, mortality rates in the U.S have been on the rise since 1987.

In developing countries, women often lack the tools and sanitation equipment necessary for a healthy childbirth. The WHO reports that many deaths during childbirth occur due to severe bleeding and infections. “Only 51 percent of women in low-income countries benefit from skilled care during childbirth. This means that millions of births are not assisted by a midwife, a doctor or a trained nurse,” states the WHO.

Zubaida Bai is a woman trying to change all of this. In an interview with TED, Bai describes her background and explains why she became interested in women’s health. “Growing up in India, I witnessed my mother and many women struggle with financial hardship and poor health. At a young age, I often dreamed of solutions to end this silent suffering of women.”

With a Master of science degree in mechanical engineering and an MBA from Colorado State University, Bai took her skills and founded AYZH, described on its website as “a for-profit social venture providing health and livelihood solutions to impoverished women worldwide.”

AYZH has created a simple birthing kit about the size of a purse called a Janma, containing all the materials necessary for a healthy and clean birth, for just two to five dollars. The website states that “the kit contains simple tools recommended by the World Health Organization to provide sanitation and sterility at the time of childbirth, which not only saves the lives of mother and baby but also helps ensure a healthy and happy start to life.”

Michael A. Clark

Photo: Flickr

Pregnant Woman's Journey Made EasierIn some developing countries, giving birth does not mean simply rushing to the hospital in pursuit of a doctor. In fact, most women with low-risk pregnancies deliver their baby at home with a trained midwife or trained birth attendant. But for women experiencing high-risk pregnancies, rushing to the hospital could mean traveling 15 miles or more in stressful and unpredictable conditions, which is quite a distance for a woman in labor to travel.

The journey toward emergency care includes many obstacles such as rough, unpaved terrain and unreliable transportation. The harsh conditions of the road serve as a catalyst for the 2.8 million deaths of newborns every year. Similarly, on average, one woman per minute dies due to pregnancy and childbirth.

Fortunately, pregnant women’s journeys are being made easier through the use of maternity waiting homes. The World Health Organization (WHO) defines maternity waiting homes as residential facilities located near a qualified medical facility, where women defined as “high risk” can await their child’s birth and be transferred to a nearby facility shortly before delivery or earlier should complications arise.

These waiting homes serve as a crucial component in closing the geographical gap between rural areas with poor access to equipped facilities and urban areas with available obstetric care. Their main function is to link communities with the health system in a continuum of care.

However, recent studies show that an increasing number of women do not want to stay in maternal waiting homes because of poor, unsafe and unclean conditions. In response, Merck for Mothers, the Bill and Melinda Gates Foundation, Africare in partnership with Michigan and Boston University intervened and encouraged local communities to build and upgrade their waiting home facilities.

In an attempt to improve the waiting home conditions, many facilities have started selling produce and handmade goods to generate income, turning the facility into a community managed enterprise. Once the waiting homes acquire the proper funds, they can begin adequately supporting pregnant women.

Without the acceptance and participation of the entire community, waiting homes are unlikely to succeed. The satisfaction of women staying in the home is an essential part of the facility’s success or failure. The credibility of a waiting home determines whether or not it is worth the trip.

Health services generally benefit from favorable reports and the best way to spread these is by word of mouth, according to WHO. Also, the more a community talks about the provided services, the easier it becomes to identify the services that need to be improved and additional ones that need to be created. If implemented and promoted correctly, these maternity waiting homes have the potential to save lives.

Megan Hadley

Sources: Impatient Optimists, WHO, Africare
Photo: Flickr

Agriculture_Effective_Poverty_Reduction
According to the Word Food Programme, around 795 million people globally do not have enough food to lead active lives. Lack of nutrition leads to a number of other health problems among the world’s poor such as disease, stunted growth and even death. Here are three methods that can help prevent hunger:

1. Invest in Agriculture

Agricultural investment prevents hunger in the long and short term because it allows the poor to become more independent. Most of the world’s poor live in rural areas where agriculture is the source of income and food.

More investment is needed for programs that provide farmers with land incentives, train them on how to maximize their produce and teach them when and what to plant throughout the year.

Through such programs, farmers will not only be able to feed their family but also sell their harvests for profits.

In turn, parents can invest in their children’s education and end the generational cycle of poverty. This financial stability could also mean less pressure on parents to force their daughters into early marriage.

2. Financial Planning

With unpredictable climate and political changes in developing countries, financial planning acts as a safety net in case of drought, famine or war.

Financial security gives families a head start when they are displaced due to conflict and also helps prevent hunger during times of drought.

Training farmers on how to save and invest their money also allows them to invest in machinery and livestock to maximize their productivity and prevent malnutrition.

3. Focus on Women

Empowering women by educating them on agriculture and giving them the resources to provide for their families will make households mores sustainable. The tradition of gender inequality is what makes hunger inheritable in developing countries.

Each year, around 19 million children are born underweight because their mothers were not adequately nourished during pregnancy. More often than not, malnutrition continues through infancy because their mother’s breast milk does not provide enough nutrients.

In addition, weak immune systems due to malnutrition allow the transmission of HIV/AIDS from mother to child. HIV/AIDS treatments and prenatal health care ensure the birth of healthy babies.

A program combining these three methods to prevent hunger would ensure impoverished communities are able to sustain healthy lives and break the cycle of poverty and hunger.

Marie Helene Ngom

Sources: WFP, AIDSInfo
Picture: Google Images

biharThe benefits-transfer payment system in Bihar, India provides cash incentives to women so that they may have access to health care. The recent digitization of the system maximizes accessibility of women’s health services and reduces the waiting time and corruption.

With the help of The Public Financial Manage System (PFMS), Health Module India is pursuing its goal of having healthy mothers deliver healthy babies as a part of the overall development plan. The initiative is especially focused on pregnant women from rural areas.

Prior to the introduction of digital transfers, the paper-based government cash-transfer was a slow process and in many cases money went missing due to widespread corruption. However, the World Bank reports that digitizing the program will help prevent these “leakages” of money and save the project 36 million dollars per year.

The program trains female attendants, called ASHAs to care for pregnant women in their own rural neighborhoods. They then offer cash incentives in order to encourage women to deliver in healthcare centers and bring their children back for immunization.

The project aims to train 88,000 ASHAs by 2016 in order to expand the program to all four districts of Bihar.

With less paperwork, women’s health workers are more focused on providing health care: “We can utilize that time in monitoring, hospital and field work,” explained a local health care worker in a World Bank report.

With the paper-based benefits-transfer payment system, ASHAs had to wait 191 days to receive payment. Some beneficiaries even reported having to pay a “facilitation fee” in order to receive funds. Now with the digitized system beneficiaries receive cash within two days and ASHAs only wait 30 days for payment.

In addition, the rate of bribes has fallen. “Through the system, the payment comes directly to my account. No one can take the money,” ASHA Madhu told the World Bank.

The International Finance Corporation (IFC) supports the program by calculating and authenticating the records of payments. IFC also automates the depositing of funds directly into recipients’ bank account.

Since the installation of the new system in April 2014, 11 million rupees have been processed to beneficiaries and ASHAs. In order to receive transfers, women are required to get an ID and open a bank account; direct transfers have played a big role in empowering women in Bihar.

Marie Helene Ngom

Sources: World Bank, CGAP, IFC

health_education_for_women
Non-governmental organizations (NGOs) across southern Asia have developed programs in line with the new United Nations Sustainable Development Goals (SDGs) on health education for women.

SDG #3 aims to ensure healthy lives and promote well-being for all ages, and SDG #5 aims to achieve gender equality and empower all women and girls.

In Bangalore, India, mDhil, an online medical resource center, has developed social media campaigns that provide important health education for women. The organization has created a variety of videos that inform women about topics such as menstruation, pregnancy and hormones. mDhil content reaches over 2.5 million people each month.

These videos are available in many local languages, are easily accessible and can be viewed in private. In a survey, mDhil found that 60 percent of women prefer watching videos about intimate health issues rather than visiting a doctor.

Because most doctors offering healthcare for women were male, most women did not feel comfortable discussing family planning or reproductive health with them.

mDhil is empowering girls and women by giving them the information to better understand their bodies and make choices to better their health.

In Bangladesh, the HERHealth project aims to educate female factory workers on their health. Women employed in large factories tend to come from low-income backgrounds and work in unsafe, unhealthy conditions.

Using peer educators, HERHealth raises awareness on common diseases such as anemia and reproductive tract infections. Their health education for women even includes family members and communities of the female factory workers. Reportedly, this has resulted in decreasing cases of cholera.

The quality of work from factories involved with HERHealth has improved because the female workers are less likely to miss work due to injury or sickness. The impact of HERHealth is also met with factory managers asking for the same program for male workers.

In Ho Chi Minh City, Vietnam, the first Human Milk Human Babies Bank opened, allowing mothers to share their extra milk. The milk bank provides mothers the opportunity to give milk to other mothers who do not have enough milk to feed their own babies.

The founder of the bank, Trinh Tuan, also started a Youtube channel called the Journey of Breastmilk to allow women to share maternal and childcare knowledge.

NGOs in the global south are working towards the SDGs, particularly health education for women, and are making a difference using peer training, technology and sharing strategies and knowledge.

Marie Helene Ngom

Sources: URB, Huffington Post, UN
Photo: Google Images