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educating_girls
Menstruation in low-income countries isn’t an issue often talked about, but one group is doing what it can to help teach girls about their changing bodies.

Grow and Know is an organization working toward educating girls who don’t have access to learning materials about menstruation. The company launched after successfully distributing a book on girl’s puberty in Tanzania.

The book, which was approved for use in primary schools by the Tanzania Ministry of Education, garnered positive responses from girls, mothers, fathers and teachers. There have been over 470,000 copies distributed throughout the country to date.

According to Grow and Know’s website, the organization “aims to develop books that are grounded into the local social, cultural, and economic context, and that capture the real perspectives of young people growing up today.”

It’s important to talk about menstruation in low-income countries, as many girls living in Africa, Asia and Latin America don’t have access to sufficient information, guidance and support about their changing bodies.

As a result, many don’t ask for assistance when first experiencing menstrual periods, as they feel too afraid, embarrassed or ashamed.

Without proper hygiene management, such as adequate information, safe and private places to change a menstrual cloth or pad, and water at school, girls may end up missing class, or stop going to school completely.

Educating girls, however, is shown to improve the overall health of not only their peers, but their communities as well.

When girls are more educated, they can live a healthier lifestyle, participate more in the labor market, make more money, have fewer children, and give their children access to better health care and education. Doing so improves the wellbeing of individuals in households and can spread throughout generations and communities.

After seeing success in Tanzania, Grow and Know worked to adapt the girl’s puberty book to Ghana, Ethiopia and Cambodia. All three countries’ Ministries of Education approved the book, and almost 300,000 copies have been distributed to date.

Matt Wotus

Sources: Grow and Know, Medical Xpress, The World Bank
Photo: Grow and Know

How Warren Buffett Generosity Can Save Generations
According to Forbes Magazine, Warren Buffett is one of the wealthiest men in the world, with a net worth of over $72 billion. Buffett amassed a great portion of his wealth through investment and involvement in his family’s business, Berkshire Hathaway. Since coming into his fortune, Buffett has created a non-profit called The Susan Thompson Buffett Foundation, which is a large family foundation third only to The Bill and Melinda Gates Foundation and The Ford Foundation.

After Buffett’s first wife, Susan Thompson, passed away at the age of 72, he decided to focus the foundation’s efforts on charitable causes. One of the most funded causes was creating an IUD, an intrauterine contraceptive device. All of the foundation’s donations to research, funding and supplying were made in confidence, but it is evident that without funding for research the world would be in a much different place.

When IUDs were first created, they had more negative side effects than positive outcomes. Since few women saw their use, research on this form of contraceptive slowed to a halt, but after ten years of minimal research, the Buffett Foundation decided to invest in better contraceptives for women who did not have access to medical facilities. According to Buffett, not allowing women to decide when they want to get pregnant is essentially failing to utilize half of the brainpower in the world, as these people are constantly worried or concerned about pregnancy and their children.

Since Buffett’s investment, three major IUDs have emerged: ParaGard, which is a copper IUD that can last 3 years; Mirena, which is a plastic IUD that secretes hormones and can last up to five years; and most recently, Liletta, which is very similar to Mirena and was developed by a non-profit funded by Buffett in order to offer a cheaper option to women who could not afford a standard IUD.

The longevity of IUDs, some lasting up to 10 years, has made them an ideal form of contraception for busy women who do not have a steady schedule and cannot take pills at the same time every day. IUDs are 99 percent effective and have proven to be safe and beneficial for women in underdeveloped countries. In some developing countries, women are still dying in childbirth due to far too many pregnancies and a lack of control over their fertility. However, as female reproductive rights become a more pressing issue, IUDs and their cheap — or maybe even free — existence could make a huge difference.

Many women who live in poverty feel as though they do not have control over their bodies, an issue that has been brought up with several women’s rights’ activist groups. In order to grant women more control, we must grant them access first to contraceptives and next to education. When women are given the option to decide whether or not to have a child, they are able to make better decisions for their families and for their futures. Childhood mortality rates will decrease, female life expectancy will increase and overall national GDP will also increase. This is one simple change funded by one outstanding man that could provide women in developing nations a chance to take control of their lives and make a difference.

Sumita Tellakat

Sources: Bloomberg, Forbes
Photo: Forbes

Interview With Mardge Cohen, Co-Founder of WE-ACTxWomen’s Equity in Access to Care & Treatment, or WE-ACTx, aims to provide the women and children of Rwanda with proper access to healthcare and treatment. Nearly 10 years after the Rwandan Genocide, this HIV/AIDS initiative brought much needed aid to communities of women and children in Kigali. Now, more than 12 years later, the organization continues its work, offering not only clinical care and mental health services for people infected with HIV/AIDS, but also youth programs and support with income generation—aimed at addressing both poverty and malnutrition.

I caught up with Mardge Cohen, co-founder of WE-ACTx, and spoke a bit about the organization’s origins, progress and successes, which have allowed this quite exceptional organization to thrive among the people of Kigali, Rwanda.

Tell me, how did WE-ACTx begin?

“The organization was started in 2004. We went to Rwanda because one of the other people who formed the organization, named Anne-Christine d’Adesky, a journalist, had been writing a book about HIV and women. She had been to Rwanda and these heads of associations talked to her about how the women of Rwanda, who had been raped during the genocide and were then infected with HIV, were not getting access to medicines for HIV. But the men who raped them, who were in jail, were getting medicines for their HIV. These women thought that was very unfair, and they asked Anne-Christine to bring a bunch of physicians and advocates to help fast-track medicine for these women because they were getting very sick and dying.

The genocide was in 1994 and this was in 2004, and it takes about a decade, 10 years, after you’re infected with HIV to become very sick. The women were just getting sick and the leaders of these associations wanted to do something about it.”

Do you feel that these at risk populations of Rwanda are ignored by the government, or were ignored?

“In 2004, nobody was getting medications for HIV. It was before PEPFAR (The U.S. President’s Emergency Plan for AIDS Relief). It was before the global fund. It was at a time… you know I’d been working on HIV since 1987, and people were saying things about Africa: ‘Well, we’ll just give them medication for pneumonia, for prophylaxis. We can’t afford… and the people in Africa wouldn’t know how to manage, there isn’t a good enough infrastructure to manage the antiretroviral therapy, so we’ll just ride them off.’ And they were going to ride them off. You know, right now there are 36 million people living with HIV worldwide and 26 million of them are in Africa, and most of them are in Sub-Saharan Africa.

That’s an enormous number of people that people were thinking of just riding off, so the governments of those countries in Africa really had no wherewithal to actually help people. The drugs weren’t there. They weren’t letting the drugs get there, so my feeling is my experience in Rwanda was in fact the government seriously wanted to help people. Once medication became available, they figured out ways to actually control the dispersal of the medicine so that it got out to people, and they tested everybody. I was aware of some countries where tests got outdated, expired, in garages and never got to people—that’s not what happened in Rwanda. In Rwanda, they really tried.”

You didn’t face much resistance from the government?

“Well, our approach was a little bit different from the government’s because our approach was very women-centered and youth-centered, and their approach was more decentralized… sort of a public health model where people would just go to the nearest clinic to where they lived. Everybody would sort of be engaged in the healthcare system that way, but because HIV comes with a lot of stigma people didn’t really want to go to clinics near where they lived. Women sort of liked the idea of going to a place that cared about women and worried about their emotional reaction to HIV, gender-based violence and helping them try to become productive members of society—not just worrying about HIV as it affected the baby or the husband, but rather cared about them as real people. So, people wanted to come to our program even though it may not have been a neighborhood clinic.

That was a little bit problematic for the Rwandan government. They didn’t like that so much, but they then saw that we did very well with connecting women to care and having people with very good retention rates and adherence to medication. Then, after a while, we had a lot of good youth programming because we had so many women who they had kids—a lot of attention to youth friendly programs. Then we got on better with the Rwandan government public health system and now we’re in very good shape. We do a research program with their principal investigators, and we’re principal investigators; It’s much more collegial.”

What did you have to do to overcome cultural differences? I know that specifically in Rwanda, people don’t very much like to talk about things involving sex.

“So, there was a pretty big public health campaign to get people tested. And, you know, in Africa it’s said that one of the major risk factors for a woman having HIV was being in a monogamous relationship with her husband. It’s just that he probably is not in a monogamous relationship with her. Women who had done everything they were supposed to do, get married, have children, they were at risk for HIV. As a result, we didn’t really have to have that many difficult conversations with them, but they were reticent to talk about things… but after a while, we used a model of peer advocacy.

We found some Rwandan women who were HIV-infected who were sort of a bit more leader-ish and wanted to sort of help other women. We utilized them to help us understand what the cultural differences were and for them to sort of share with the other women what efficacy the drug we had and the approach we were taking. That really, really helps—a peer model really got through some of those cultural differences. I think one of the things that I learned was that you have to be very patient; I’m a very impatient person and things are very slow, and change happens over a long period of time. It’s not quick. There was a lot of stigma related to HIV and there still is because we went there 11 years ago and now its 2015 but there’s still a lot of stigma.”

Did you do some advocacy in the community to try to change that perception?

“We did, especially if there were kids in schools or if there were neighborhoods that were giving people a hard time or landlords who kicked people out of their homes. We did legal training of advocates to sort of have the people… you see, there aren’t that many lawyers in Rwanda and the case loads that they have are so great that there’s sort of a paralegal system and we try to train our patients—a significant number of them—to participate that way in dealing with those issues. That sort of helped. We also tried to provide a very joyous atmosphere for the children because their lives are pretty rough, and every year we have this thing called ‘Day of the African Child’—a big party for all the families, like 1,200-1,400 people come and have a big party and its just to celebrate that they’re alive. Those kind of thing help the parents and the patients realize that we were not trying to get away with anything or do anything bad, but really just trying to provide a better quality of life for people who are HIV-infected.”

Was it a bit difficult to break into the community in Kigali?

“Well, luckily, these groups—these women’s groups, these leaders who had spoken to my friend Anne-Christine d’Adesky—they were still there. Initially, it started with 5 groups, and they called us in and told us where to go and they told us what to do, so I never felt like I was . . . bringing our stuff and putting it on people in Rwanda. I felt that the Rwandans had called us in. I thought that we were very lucky to have that approach, and they told us what they wanted from us. That made it, I think, a good way to be in another culture, in another country, and we’ve maintained that. We have partner association meetings four times a year where we review what’s going. We didn’t have to put up a shingle and hope people would come. Basically, those associations keep bringing their members to us, so I think it a pretty good model for being connected to community groups. You know, AIDS groups, women groups, local groups, service groups…

Then there’s the issue of the genocide and I think those are some of the lessons we learned, too. In some of the groups, people didn’t always want to work together, and we had a sort of… We didn’t understand that, or we didn’t think of that as behind some of the problems that we encountered, but it sometimes was. But now, the staff is sort of mixed grouping and everybody have bought into the mission to provide good HIV care for children, women, their partners and their families. And I think everybody does the best they can to make that happen.”

Do you feel that a substantial amount of progress has been made?

“Oh yeah! I mean, HIV is a deadly disease. We now have about 2,600 people—I’d say 90 percent—of those over 25 adhere wonderfully to their medicines and are doing great. A small percentage need a lot more help to take their medicine and keep doing well. The younger people, who have had the disease longer because most of them were born with it, have sometimes become resistant to some of the medicine. So, we have to put them on more complicated regimens.

Some of the good medicines we have in this country are not readily available there. When I first started that was true. Then for a while, the medicines we had in Rwanda and the medicines we had in the U.S. were the same. Now the U.S. is way, way passed Rwanda and a lot of countries in Africa and Latin America. They don’t have the medicines we have, which are really excellent medications. So, that’s a problem, but there is generally progress. I watched, at this ‘Day of the African Child,’ I watched kids who I knew when they were 10 who are now 21 years of age, and they’re confident, they’re strong, they’re going to university—it’s amazing! It’s an enormous amount of progress!”

Was the genocide the main reason why you chose to work in Rwanda?

“It was more HIV, but in the context of the genocide. I had an interest in intimate partner violence because I had seen a lot of that in the care I gave women in Chicago who were HIV infected. We’ve done studies, and there’s just high prevalence of gender-based violence, like 62 percent lifetime—here [in the U.S.]—experience with either sexual, physical, or emotional abuse. Then, we looked at it in Rwanda, in our clinic, post-genocide, and it was 62 percent also. It was the same in both countries—you know poor population, difficult situation of sexually transmitted disease where people go off to try to make a living somewhere else… In the U.S. there was lot of drug use and a lot of difficult relationships with partners. There had been issues [in Rwanda]—people had lost partners during the genocide, people had been raped during the genocide. I was interested in Rwanda because my friend had been here and we had been asked to go, but I thought that because of everything that I had learned related to women with HIV and their experiences, it would be useful in this ultimate experience of gender-based violence, which was the genocide, where about a quarter of a million women were raped. So it was sort of both things.”

What do you think the main difference is between the government in Rwanda and in a country like Zimbabwe, which has seen a lot of resistance to NGOs that are trying to come into the country trying to help people with HIV?

“I think Rwanda sort of benefited post-genocide and by the 2001-2003 people coming in. A lot of Western and European countries that felt so guilty of not helping during the genocide were now giving lots of money. At the same time, there was lots of money going into HIV in a lot of countries, but the difference was that . . . there was money straight to the government and there was NGOs’ money, but what Rwanda did—very importantly—was it controlled the NGOs a lot, or tried to. There was a very strong government presence… very strong. One can’t write anything related to Rwanda without mentioning how wonderful the Rwandan government is. One can’t really be there without somehow being acknowledged by or understand the relationship with the Rwandan government, but its not just that; It’s that there was a lot of government will in Rwanda to do well in terms of the HIV epidemic, and in some sense, I think they wanted to be a poster-child for being able to distribute medicines well and lower the prevalence as opposed to be known for the genocide. It was a way to sort of make history—current history—much more positive as a country. And they were one of the best at utilizing the many millions of dollars that were given to them to help with the HIV epidemic. I think it was disproportionately more than what other countries got, but they utilized it extremely well. The other countries who maybe should have gotten more never used it well, often. There wasn’t the same governmental will, which I think you need.

It’s not just an issue of, are the NGOs disorganized? are they sort of stepping all over each other? and are they not doing what’s right? There are those issues, which I did see a bit in Rwanda and I had seen in a lot of other countries, but what I didn’t see in Rwanda was a government that wasn’t taking the epidemic seriously. They really put energy and resources… they used the resources they got to have a very strong public health system which helped HIV and other things along the way. It really addressed maternal mortality, infant mortality… When I started in Rwanda there were 30 doctors for 10 million people, and now there are so many more physicians and nurses who are trained related to HIV. And I think it’s an issue not just of the government’s relationship to NGOs, but of the government itself, having a strong presence related to the problems that the society is facing. I think that’s different from Zimbabwe and other countries.”

What do you think is lacking in terms of support for NGOs that do the same work that you do?

“Well, we have to do a lot of fundraising and I mean that is hard . . . that is one of our issues and it is a lot of work to raise money. I think what we do is really deliver the product we say we’re going to deliver, and I think that’s why we’ve been successful so far in our fundraising. We’ve been sustained for 11 years, so that speaks to our success in itself.

What I think we did that was good is that right now in Rwanda there is a local NGO called WE-ACT for Hope. It’s all Rwandan-run and they now manage the entire clinic, so our job is to fundraise a certain amount that we commit to, along with a few other groups that they get money from, and we do a lot of guidance related to program and other things, research… but they’re responsible—they are running the show. I think if you have local folks running the show, not just in a body, but rather the responsibility of a true locally credentialed NGO, which is also what Rwanda encourages, that’s a good way to go!”

Jaime Longoria

Sources: Mother Jones, WE ACTx
Photo: WE ACT

Contraception

For all the immense scientific progress made over the past decade, methods of contraception, particularly for women in the developing world, has stagnated. It is estimated that in 2013, only $65 million was used for contraception research and development for middle and low income women in developing countries, compared to $580 million used for tuberculosis and $549 million for malaria. Clearly, R&D in these areas is of primary importance, but improvements in birth control technology will make it more affordable and accessible for women in developing countries.

This technology is in huge demand—the Bill & Melinda Gates Foundation estimated that there are 200 million women in developing countries who want family planning services but have none available to them. Access to birth control would prevent an estimated 72 million unintended pregnancies and 70,000 maternal deaths annually. It would also put the power in the hands of women to decide when to start families and how big they will be. Preventing unintended pregnancy will help women who cannot financially support more children, or those who have insecure food resources.

One reason that contraceptive technology has gone largely underdeveloped in the past is that there is very little communication amongst those in the field: private corporations, university labs and investors. Beyond financial restraints that may prevent a company from advancing a new solution down the pharmaceutical pipeline, some corporations may lack certain innovations that allow them to develop a drug all the way to completion. Even further, a lack of communication within the medical community limits knowledge on the market for this kind of medicine, discouraging investors from funding technological endeavors.

Unification among private corporations, academia, donors and nongovernmental organizations is essential to leveraging funds, technology and information that will help progress access to birth control for women in developing nations. Family Health International 360 has recently partnered with private companies, university laboratories, and international medical research centers to expand development on two types of technology: the long-term injection and biodegradable implant. In doing so, FHI 360 has also linked up with research centers that had not previously applied their work to contraceptive development and also connected nonprofit funding organizations with private companies.

Another advancement spurred by the Bill & Melinda Gates Foundation is the Contraceptive Technology Innovation Exchange, a website that houses information on over 170 in-development or recently developed contraceptive technologies. Founders hope this kind of information will lead to increased funding for medical innovation and partnerships between groups. This will improve the accessibility of contraceptive technologies and expand the market for them internationally. Such a database will spur the growth of the industry for contraceptives.

Progress at home, whether through medical research, food technology and investment, spurs growth all over the world. When corporations, organizations and academic groups work together for a common cause, they can improve innovations that will benefit people all over the world.

Jenny Wheeler

Sources: Impatient Optimists, Contraceptive Technology Innovation Exchange
Photo: Pacific Standard Magazine

Hillary-Clinton-Women's-Health

In April of this year, Hillary Clinton announced her candidacy for president. As a strong democratic nominee with a lot of political capital, she has the power to raise big money and advocate for issues on her platform.

According to her website and her voting record, she is an advocate for small business and defining America’s core values. Many see her as a strong candidate for the election next year.

However, unlike her last campaign, Clinton seems to be focusing more on women’s issues.

In 1995, Clinton gave a speech in Beijing entitled, “Women’s Rights Are Human Rights” to the U.N.’s Fourth World Conference on Women. At the time, Clinton was First Lady of the United States. In the speech, Clinton spoke of the continual rape of women during armed conflicts and the act of silencing women and girls around the world. She declared that women’s rights must now be seen as human rights and solved.

Since the 90’s, Clinton has seemed to not focus on women’s issues or place them at the focal point of her 2008 election.

However, this round, she seems to be doing the opposite. Before announcing her candidacy in a speech at Georgetown, Clinton told the audience that women’s rights are not only a responsibility for women, but also men.

At her first major campaign event in June of this year, Clinton seemed to emphasize her support for women’s issues. She supports a women’s right to choose and have easier access to contraceptives.

Clinton has proved herself to be an advocate for women domestically, but what about abroad?

Clinton does not seem to shy away from economic aid to developing countries. In 2012, Clinton visited Africa, promising U.S. assistance to revitalize African economies. Although many attacked her for attaching so many contingencies onto the package, she does want to help.

Combining her commitment to providing assistance to impoverished nations and her advocacy for women’s rights, she would be a tremendous help to women’s health abroad.

Under her watch, we could see a real attempt to repeal the Helms amendment and provide access to family planning tools. Because of her commitment to women domestically, she would support women’s access to education abroad.

Although the campaign trail is long, her commitment to women and impoverished nations would mean great things for women being affected by the lack of access to a proper education, birth control and water.

– Erin Logan

Sources: Hillary Clinton, American Rhetoric, The Guardian, Slate, LA Times, New York Magazine
Photo: Illinois Review

Doctors Without Borders Discuss Obstetric Fistula
Obstetric Fistula, a medical condition virtually unheard of in the developed world, was the sole topic of a 90-minute discussion with Doctors Without Borders/Médecins Sans Frontières (MSF) on June 25, 2015. In this 2nd webcast, “A Shameful Condition,” part of MSF’s project Because Tomorrow Needs Her, three panelists discussed why women still suffer from this preventable condition, the horrific impact it has on women, their families and their communities, as well as the options for treatment and prevention. Managing obstetric fistula contributes to the fifth Millennium Development Goal, improved maternal health.

The panelists, all experts in obstetric fistula, completed many MSF projects in Africa in different capacities to alleviate this condition endured by an estimated 2 million women in sub-Saharan Africa and Asia. Africa Stewart, an obstetrician/gynecologist from the U.S., worked in Nigeria, Sudan and South Sudan. Wilma van den Boogaard, a nurse and a Master of Public Health from Holland, organized a fistula repair project in Burundi. Gillian Slinger, a trained midwife, coordinated the United Nations Population Funds’ Campaign to End Fistula and is the current project manager of the Fistula Surgery Training Initiative for the International Federation of Gynecology and Obstetrics in London. Nina Strochlic, a reporter at the Daily Beast covering women’s rights and international development, was the moderator.

As Stewart explained, obstetric fistula is an opening between the womb and the bladder that causes urine to leak out or between the womb and the rectum, causing feces to leak through the vagina. Many women in developing countries suffer from both types of fistula. They occur during prolonged labor when the baby’s head does not descend into the woman’s birth canal, which puts pressure on the tissue between the womb and the bladder. When the labor is prolonged, this pressure causes the tissue to die, creating the hole, or fistula. This condition, if left untreated, also leads to skin infections, kidney disorders and death.

This is the physical description of how obstetric fistula occurs, but it is not that simple. In prosperous countries today, fistulas rarely occur. The last fistula hospital in the U. S. closed in 1865. In impoverished countries, especially in Africa, cultural factors play a huge role in its persistence, which the panelists detailed throughout the discussion.

In Africa, the story has many common elements: young mothers-to-be, often teenagers, have prolonged, agonizing labors as long as 3 days. These young girls can be as young as 14. Their birth canals are not mature enough for delivery causing long labors. Furthermore, the babies are usually stillborn.

Due to the uncontrollable leakage and odor as well as the loss of their babies, these young women are stigmatized. They become outcasts not only in their community, but from their friends, families, husbands and other children they may have. Much confusion exists in the community about why these women have such a condition.

Few doctors are automatically trained in treating obstetric fistulas, especially in developing countries. The women with fistulas who are not afraid to seek help from medical personnel are told that it is not a medical problem, and even that it may be due to adultery, according to Van den Boorgaard. There is a strong belief in the communities that these women are cursed or bewitched. Many want to commit suicide and others become prostitutes to make some kind of living.

Slinger knew of an 80-year-old woman who suffered for about 60 years with obstetric fistula, not knowing why she had the condition. Fortunately, the MSF project was able to provide surgery to repair her condition.

Besides the lack of knowledge regarding obstetric fistula, people in developing rural communities have little or no access to emergency medical care. Transportation, such as by taxi, is expensive, or must be done by motorcycle—a method difficult enough when pregnant, let alone in labor. According to Stewart, even in Nigeria where the roads are better than most, the roads can change erratically due to armed conflict or storms. Van den Boogaard also pointed out that in areas where genocide is taking place, women just do not go anywhere. Even if a pregnant woman can get to a hospital or emergency care setting, it may be too late. For these reasons, women and their families chose to stay at home to have their babies.

However, the problem is bigger than getting to the hospital on time. Trained surgeons are needed to perform the difficult surgery. Few surgeons in Africa are inclined to perform this surgery. The panelists pointed out that this surgery does not provide a big income. In Africa, it is expected of a doctor to be rich. If a doctor does not have a large income, there must be something wrong. This problem is being addressed in one area by offering surgeons scholarships in urology or gynecology after being trained and serving 3 years in a fistula camp. Slinger urged that this same offer be provided in other needed areas.

MSF first started “fistula camps” in 2007 to provide for the neediest communities. Boogaard described the three current types of interventions in place today. The first type is non-surgical, and works best immediately or shortly after a fistula occurs. A catheter is used to eliminate urine from the bladder by-passing leakage into the womb, allowing the womb to heal on its own. The second type, called a campaign, takes 6 weeks, in which care is provided before, during, and after surgery. The third type, long-term, complete care is provided for many months and also involves before, during and after surgery care. The after surgery care includes more physical therapy and psycho-social care.

The panelists pointed on that in all settings, providing a safe environment in the camps for the women, as well as any children they already have, is a key factor in their success. Even more important is that the whole family understands the condition and the necessary after care. The two biggest after-care difficulties are abstaining from sex for 4-6 months and having a C-section for all subsequent babies. Many women in these cultures are afraid to say no to their husbands in regard to sex. When it comes to checking back into a fistula camp for a C-section, they are equally afraid to stand up to their mothers-in-law, in whose homes they live in. Mothers-in-law may tell them that they are strong enough to have their babies at home like any good African women. In these cultures, a woman’s self-worth and very life depend on being married and having children.

In spite of the cultural issues that hinder progress, MSF has been able to perform approximately 5,000 surgeries a year. Approximately 85 percent are successful. Success means repairing the fistula, as well as remaining continent after surgery.

Boogaard and Stewart both told many happy stories of women who arrived in misery but are soon heard giggling with other women in the same condition, forming friendships, and starting to heal the emotional wounds. When they are ready to leave, they are feeling both emotionally and physically healed, ready to rejoin the very people who had shunned them.

Stewart related that the most rewarding experiences for her are the women who arrive back at the fistula facility for a C-section and leave nursing their babies. One particular success story was a woman who arrived under a lot of commotion in a taxi. The taxi driver sent the woman with a note stating that because he would be paid by MSF, he was convinced to take her to the fistula facility even though she had no money. She stepped out of the taxi with her chart announcing that she was 38-weeks pregnant and ready for her C-section. And, yes, the taxi driver was paid. The program provides transportation as well as a safe environment, a nutritious diet, surgery, and post-operative care.

Perhaps the most inspiring story was of an older woman who, as a teenager, delivered a stillborn after a lengthy labor and developed a fistula. Many pregnancies after that had the same result. She was an outcast, isolated, and desperate. After having her fistula successfully repaired, she became a resilient, confident woman, boosting other women in the facility. Now, she is an ambassador for the MSF fistula program, raising awareness about fistula prevention and repair. Women like her successfully spread the word and life can dramatically change for the 50,000 to 100,000 women who develop obstetric fistula every year.

More success stories can be found at http://womenshealth.msf.org/. This webcast is available at http://www.doctorswithoutborders.org/fistula-webcast. More webcasts and photo exhibits will be made available in the future as part of MSF’s project Because Tomorrow Needs Her.

– Janet Quinn

Sources: Doctors Without Borders, Doctors Without Borders, WHO, International Women’s Health Program

baobab_fruit
In The Little Prince by Antoine de Saint-Exupéry, the baobab tree questions the prince’s discipline and represents the unpleasantness of nature. In Ghana, however, the baobab tree brings health and hope to women. Its fruit has the potential to change millions of lives.

Baobab trees grow in dry, remote areas in over 30 African countries. In many of the rural households, the crop already grows nearby yet the fruit goes to waste because of the lack of demand for and knowledge of the fruit. This is where Aduna comes in. Aduna is an African inspired health and beauty brand that uses baobab as a key ingredient.

Aduna’s goal is to create a demand for this under-utilized natural resource and empower women in business. Aduna already sources for their products from 1,000 women baobab producers in Ghana’s poverty-stricken Upper East Region, increasing their annual income from £12 ($18.88) to £120 ($188.81) as a result.

The baobab fruit is a win-win situation: it helps the people and helps the market. Baobab fruit is rich in vitamin C, calcium, potassium and iron. Many pregnant women consume baobab fruit as a source of calcium. It can be used to make jams and juices or stirred into stews and sauces. Aside from the fruit itself, the leaves and roots are known to lower fevers and help treat diseases.

They are not only versatile and healthy to consume but are also the ideal trade product for villagers: the fruit is light to transport, easily dried and readily accessible. The baobab market gives women the opportunity to harvest and sell their own product, and to actually have ownership in their own business.

Traditionally, women are in charge of the baobab trees. Because of this, Aduna focuses on womanpower to spark global interest in baobab fruit. Aduna is marketing to the superfood consumers, to the well off and to first-world health nuts in order to generate interest in baobab fruit.

Their campaign is to #makebaobabfamous. It is a combination of supporting women all over the world, supporting small businesses and promoting healthy eating. They hope to create a market that will help over 10 million households across Africa. Baobab fruits have the capability to connect the Third World with the First through the new superfood trend.

– Hannah Resnick

Sources: Aduna, Marie Claire Mother Nature Network, Powbab Seed
Photo: jacabswellappeal

Improving Women's Health Leads to Sustainable DevelopmentThe Lancet Commission on Women and Health, a report discussing ways of improving women’s health. The report on women’s vital contributions to healthcare, economic welfare, environmental protection and societal stability, was recently published after three years of research. The Commission, headed by Dr. Ana T. Langer from the Harvard T. H. Chan School of Public Health and Afaf Meleis from the School of Nursing at the University of Pennsylvania and composed of public health experts, social scientists, policymakers and advocates, not only highlights the importance of women’s work in the success of nations, but also promotes recognizing and protecting these roles to increase sustainable development in nations around the world.

The Commission aimed to make policy recommendations in terms of economic, social and cultural factors that would make governments accountable for recognizing the need for improving women’s health and the welfare of them and their communities. Published at a critical point in which Millennium Development Goals are ending and the world is beginning to adopt new Sustainable Development Goals, the Commission aims to heighten women’s roles in national and international leadership and set developments in their health and social status as a measured requisite for completing each Development Goal.

The Commission’s work was primarily concerned with developing ideas about women’s health from a productive standpoint – how they contribute to societies economically, culturally and environmentally – rather than reproductive standpoint. Viewing women’s health solely in terms of reproduction allows gender inequity to prosper because it defines women solely based on their ability to have children. The report demonstrates that improvements in women’s healthcare from a comprehensive standpoint will expand their contributions in education, the economy and the environment.

Globalization, the Commission reports, has contributed to the improvement of women’s status globally but has worsened it in individual countries, threatening social stability. Thus, though globalization has led to more widespread recognition of gender inequality, it has not done anything to change it. The increasingly rapid transmission of communicable diseases, another outcome of globalization, has increased the importance of women in caring for family members and preserving the welfare of their communities.

As humanitarian crises and ecological degradation continue to grow and conditions for populations around the world worsen, the protection of women’s health and social status are increasingly vital to the well-being of societies. Thus, it is essential that nations adopt plans to improve women’s healthcare and equality.

According to the Commission, financing healthcare should take into account persistent health challenges that affect women, such as communicable diseases and violence against women and girls. They should also take on measures to promote women’s rights and recognize their invaluable roles in society. Doing so will improve not only gender equality and societal harmony but also economic stability, healthcare, education and environmental quality. Thus, in investing in the needs and welfare of women, policymakers will help achieve sustainable growth and development for their nations.

– Jenna Wheeler

Sources: The Lancet, Impatient Optimists, The Lancet
Sources: Flickr

Facts About MalnutritionWhen focusing on the fight against poverty, hunger and malnutrition are two things that are frequently brought up. People tend to have an awareness of the concepts along with their prevalence, yet many facts tend to be ignored in discussions relating to malnutrition. Discussed below are the leading facts about malnutrition and their implications.

Top 10 Facts About Malnutrition

1. Two Billion People Worldwide Suffer from Malnutrition
Although malnutrition is often discussed as a problem, it is generally discussed as a problem of the unlucky few. Yet, the reality shows just how widespread the problem truly is. Two billion people, or nearly a third of the global population, suffer from malnutrition.

2. Two-Thirds of Those Suffering from Malnutrition Live in Asia
Although Asia is not the continent with the highest rate of malnutrition, it is the continent with the largest number of malnourished citizens. There is some good news on the issue, however, as the percentage of the population suffering from malnutrition in South Asia has fallen in recent years.

3. Almost 14 Percent of the Population in Developing Countries is Malnourished
The fact that malnutrition primarily affects developing countries tends not to surprise people. However, it is still shocking how widespread the problem is in these countries. More than one in nine people in developing countries suffer from malnutrition.

4. Scaling Up Programs to Target Malnutrition Worldwide Would Cost Only 11.8 Billion Dollars Per Year, According to the World Bank.
For context, the United States spent 618.7 billion dollars on military expenditures in 2013. The need for action is great, and action on behalf of the United States has never been more possible in the fight against hunger.

5. One in Four of the World’s Children is Stunted.
Being “stunted” is defined as having one’s physical and mental growth and development stalled due to a lack of food. This problem mainly impacts developing countries where the number has the potential to rise to one in three.

6. One in Four People in Sub-Saharan Africa are Malnourished
Sub-Saharan Africa is the region with the greatest rate of malnutrition among its population. The global need to address malnutrition is a challenge, but with the unfair impact it has on regions such as sub-Saharan Africa, it is a challenge we must be willing to face.

7. Half of All Pregnant Women in Developing Countries are Anemic
Anemia, a possible result of malnutrition, causes 110,000 deaths each year during childbirth. Women as a whole also tend to suffer more from malnutrition due to often-sexist norms relating to the issue.

8. Underweight Children are 20 Times More Likely to Die Before the Age of Five
Malnutrition’s biggest victim, of course, is children. Along with the one in four children who are stunted by malnutrition, underweight children are victims of malnutrition. Underweight children, particularly those born to malnourished mothers, are 20 times more likely to die before the age of five.

9. One Third of Child Deaths Prior to the Age of Five are Caused by Malnutrition
As mentioned, malnutrition particularly harms children. Perhaps that harm to children is the most inexcusable aspect of malnutrition. One-third of child deaths prior to the age of five are caused by malnutrition, something that could be addressed through a deeper global focus on improving access to food worldwide.

10. It’s Getting Better, but There is Progress to be Made
So, here’s a little bit of good news: since 2009, the number of children receiving treatment for the acute malnutrition they suffer from has tripled. There is still progress to be made, however. Although the number of children receiving treatment has tripled, the number of children receiving treatment still remains as low as 15 percent.

Through understanding the facts that surround malnutrition, a shift can be made toward addressing the issue. The challenge is great and the global community’s ability and need to face that challenge is even more so. Only through a willingness to take action, can meaningful action be made.

– Andrew Michaels

Sources: USA Today, World Food Programme World Food Programme Action Against Hunger World Food Programme
Photo: Adfinitas

merck for mothers
Merck for Mothers is a 10-year, $500 million initiative that envisions, and works toward, a world where no woman dies giving life. Currently, an estimated 800 women die per day, primarily in developing nations. Merck’s global mission is to bring better healthcare and innovative health solutions to millions of people across the developing world; a commitment that has been in standing for more than 150 years. Working closely with its program leadership, advisory board, healthcare workers, maternal health experts and policy makers, the Merck for Mothers initiative has already served in more than 30 countries across the world.

As stated on its website, “Women are the cornerstone of a healthy and prosperous world. When a mother survives pregnancy and childbirth, her family, community, and nation thrive.”

Merck for Mothers aims to see nations thrive by saving as many lives as possible, and it does this by tackling the two leading causes of maternal mortality: excessive bleeding after labor and high blood pressure disorders during pregnancy and childbirth.

For example, in Uganda, where a woman faces a one in 49 chance of dying during pregnancy and childbirth, many of the private healthcare providers, such as independent midwives and local pharmacies, offer services that are not always regulated and can vary in quality. As a result, Merck for Mothers explores the ability of these local private providers and health businesses to deliver affordable and high-quality maternal healthcare. This is a program that has estimated to reach more than 150 thousand pregnant women over the span of three years.

Each of the 30 country programs is different and tailored to that country, yet they all strive for the same goal: giving mothers a better chance at surviving pregnancy and childbirth. In addition, Merck for Mothers focuses on family planning, which is known to play a key role in reducing maternal mortality. Merck for Mothers explains this through the Ripple Effect. When a mother dies, the ripple effect begins with her child who is more likely to die before the age of two. If she has other children, they are also up to 10 times more likely to leave school and suffer from poor health. But a mother’s death affects more than just her family.

Merck for Mothers believes that a woman’s death also impairs her community. Representing as much as one-third of the world’s gross national product, a woman’s unpaid work contributes to a community’s economic prosperity. In the end, this becomes a global economic issue. For these reasons, Merck for Mothers focuses on three key areas: innovation, access and advocacy.

At Merck, corporate responsibility is the cornerstone of its daily commitment to tackle global health challenges, such as river blindness, HIV/AIDS and cervical cancer. It has been a 150-year commitment, but that has not stopped Merck from making new additions.

With Merck for Mothers, it can now expand its scope and save the lives of millions of mothers across the globe, so that every day 800 more lives of women are spared.

– Chelsee Yee

Sources: Merck for Mothers, Poughkeepsie Journal, Mobi Health News
Photo: Modern Mom