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What should we aim to achieve?
Our ultimate aims are to improve women’s control of their reproductive lives and to save mothers’ and newborn lives. Within the context of strengthening health systems to deliver for all and recognising that different countries have different needs, what do you think that we should be aiming to achieve?
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Our thanks for all the comments submitted. All of the ideas and suggestions put forward will feed into our new policy, helping to shape the direction of our work.
Once the final policy document is released you will be able to find it at www.dfid.gov.uk
We love your effort Dfid toward strengthening health of mothers and newborn babies. Keep up your usual coorporation and May Allah bless u abondantly, Ameen.
Yours faithfully,
Ibrahim Umar
Many women in Africa are suffering from reproductive related problems. I have a case in point of an old woman in my home village who has suffered in the last one year. She occationally bleeds from her reproductive system and she has thinned badly. She has visited many hospitals but no help. This is only one of them. Is there any help your organization can help this woman so that many others can come out and be helped? You are doing a wonderful job. Kindly let it be seen in my rural village of Kenya
Yes, our aim should include an informed health society. People need to know that our bodies are self healing if given the right materials. This can happen through reading of the relavant information. i.e. the cell concept. A human being comes through a single cell and what happens thereafter. Once this is recognized…….then we should aim at giving the self healing body the right materials to sustain this self healing mechanism.
What an inspiring article you wrote! I totally like the useful info shared in the article.
We strongly welcome the new focus on reproductive health and maternal care and newborns but also think that the strategy should be based on the “continuum of care” for maternal, newborn and child health, i.e. include children up to five. There are many good reasons to take an integrated approach. Women with young children need contraceptive support. Addressing child mortality should be done through the same services. We will be making a full submission but have also blogged about it here: http://www.savethechildren.org.uk/blogs/2010/07/excluding-children-from-dfid-strategy-is-illogical-and-inefficient/
The aim should be to achieve a situation in which: all women are empowered to take control of their own fertility; all conceptions are intended; all mothers and children are healthy; and all parents understand the economic and environmental implications of having large families. As Kofi Annan said last year: “Population stabilisation should be a priority for sustainable development”.
Please see http://www.34millionfriends.org. We must bring the grassroots to bear on gender equality in all realms. That is the aim of 34 Million Friends, asking people become informed and to take a stand. With climate, poverty, environmental, and population crises upon us, the only hope it seems to me is a revolutionary change in priorities of the entire world with women’s human rights at the top of the world’s agenda. The Packard Foundation has suported the idea of a film to bring gender equaltiy, the MDG’s and women’s health and education to the top of the world’s agenda much like An Inconvenient Truth put climate change on the world’s map. If you would like to talk about this, please contact me.
DFID is way out front on all of this. I was at WOMEN DELIVER in London in 2007 when Gordon Brown announced a very substantial gift to UNFPA. Cheers, Jane
I believe the concept and the importance of exclusive breastfeeding is not well understood in Nigeria as a result of cultural and social factors. The mindsets of these women need to be worked on based on evidence to attest to the positive e…ffect of exclusive breastfeeding. Exclusive breastfeeding is giving of breast milk alone to the babies for the first six months of life. This means not giving water for this period of six months. In moving to complementary feeding, the foods given should be rich in extra protein, extra energy and extra vitamins in addition to the staple foods.See More
Drawing on the extensive knowledge base relating to the links between water, sanitation and hygiene (WASH) and women’s health, WaterAid wishes to emphasise the following aims, which address the indirect and direct impacts of WASH:
• Indirect: Ensuring sustainable access to safe sanitation and drinking water services for women and girls: The availability of sanitation services at school has a tremendous impact on the drop out rate of girls from full time education, linked with the specific sanitation needs of adolescent girls, such as menstrual hygiene. When water is not available close to the home, it is often girls who are tasked with fetching water, a time-consuming and strenuous activity. Access to Water, Sanitation and Hygiene (WASH) thereby affects the duration of girls’ education, with a knock on effect on their age at marriage and the age at which they first give birth. WASH provision therefore contributes significantly to efforts to reduce the number of unintended pregnancies, reducing the adolescent fertility rate, and the number of unsafe abortions.
• Direct: access to WASH directly relates to women’s health and their vulnerability to the risks involved with pregnancy and child birth. DfID should aim to:
- Improve maternal and newborn survival by providing a safe and hygienic environment for childbirth and post-natal care, thereby increasing the chances of survival of mothers and newborns;
- Improve maternal nutrition and health: by reducing diarrhoea and reducing worm infections to reduce maternal anaemia;
- Provide access to safe sanitation and drinking water in order to support efforts to prevent mother-to-child transmission of HIV/AIDS; HIV/AIDS positive mothers are advised to avoid breastfeeding, and need safe drinking water for child feeding. Unsafe water and poor sanitation not only threatens child survival; it can also reduce the effectiveness of anti-retroviral treatments, thereby reducing the chances of the mother’s survival with obvious impacts on her child’s chances of survival.
Individual response
Thanks for highlighting the importance of FP in achieving the MDG 5 and also 4. I often had my doubts that our policy makers and governments understood this.
I feel that Family planning which has been identified as an important factor for the achievement of MDG 5 has not had the attention it deserves from our Governments. Governments in developing countries have not addressed the FP commodity needs of their populations. One can not expect women to have easy access to contraception when clinics continue to experience FP Commodity stock outs. This has often led to unplanned pregnancies and subsequent unsafe abortions.
Developing country governments have often left the purchase of FP commodities to donors and therefore do not have a budget line for these commodities. This is not sustainable. DFID should aim at playing an advocacy role in ensuring that Governments take responsibility for contraceptive commodity purchases while supporting the strengthening of the logistics systems.
The objective of reducing the number of unintended pregnancies is fundamental to reducing maternal mortality and morbidity, and integrally connected to many of the other aims listed above. Although global investment in making a range of modern contraceptive methods accessible and affordable is grossly insufficient, an even more neglected issue is reducing the number of unsafe abortions. The commendable leadership that DFID has shown in this area is still sorely needed.
Even full access to effective contraception will not eliminate unintended pregnancy, and some women will always choose to terminate unwanted pregnancies. Ensuring that they can do so safely is critical and requires investment in a number of strategies. In addition to improving contraceptive availability and use, these include:
- Removing legal and policy restrictions on abortion
- Training and equipping health-care providers in safe abortion
- Supporting sustainable availability and affordability of vacuum aspiration and medical abortion technologies,
- Ensuring that women have access to comprehensive information and care in their communities,
- Better addressing the reproductive health needs of adolescents, and
- Reducing the stigma associated with abortion.
DFID’s active involvement in and support of these and other strategies has the potential to prevent tens of thousands of needless deaths and countless injuries every year.
Christian Medical Fellowship (CMF) holds that we need to be clear about the specific problem we need to address; what our specific aims are; and the specific, evidence based interventions that will achieve these aims.
CMF’s submission comes from the experience and evidence presented by our members who work or have worked in maternal health in resource poor regions including Afghanistan, Bangladesh, Malawi and Nigeria.
Based on the most recent evidence, we emphasise the following:
1. In the last two decades we have seen a marked reduction globally in maternal mortality from 500,000 deaths per annum to 350,000 per annum. The vast majority of these are still in the developing world. (Trends in maternal mortality: 1990 to 2008 – Estimates developed by WHO, UNICEF, UNFPA and The World Bank (2010) ISBN: 978 92 4 150026 5 & Hogan M C, Foreman K J, Naghavi, M et al Maternal Mortality for 181 Countries 1980-2008: a systematic analysis of progress towards Millennium Development Goal 5. Lancet 2010:375:1609-23)
2. The interventions that have reduced this mortality rate have been multi-level: addressing social attitudes towards women, pregnancy and child birth; providing education for girls and the empowerment of women; increasing access to good quality obstetric and midwifery care (in the local community and in accessible secondary care institutions); and providing family planning services to allow better birth spacing, etc. We hold that the evidence suggests that only such multi-level interventions will have significant or lasting success in tackling maternal mortality; and further, that strengthening health systems for maternal health will have collateral benefits for other areas of health need.
3. Positive engagement with religious leaders, communities and faith based organisations (FBOs) is vital, as they are not only significant providers of services, but also hold the key to challenging and changing social attitudes and values that can devalue women and their health needs.
4. Empowering women, and changing socio-cultural and religious values that disenfranchise women and girls and deny them access to healthcare and education, are priorities. This requires engagement with community leaders in general, and religious leaders and communities in particular, in their own terms and context, rather than imposing Western worldviews and values.
5. Single issue interventions are damaging to wider health needs in the long term. We advocate strengthening the broad range of health infrastructure and provision (both primary and secondary) in developing nations. This includes appropriate training (undergraduate and postgraduate), professional support for healthcare staff, and adequate provision of properly maintained equipment with appropriate supply chains.
The phrase used in the title, ’Choice for Women‘, pinpoints one of the fundamental issues for millions of women; namely that they do not have any choices with regard to pregnancy and birth. Furthermore, they don’t know that they could have choices.
Maternal and newborn health needs to be viewed in its entirety rather than its individual component parts. Much ill health stems from the position of women in society, so the biggest single issue here is the value placed by society on the lives of women. In many societies women are deemed of less value than goods or livestock, and it can be perceived that investing in their education, health and wellbeing is a waste of good resources when a new bride can always be found to replace one who has died or whose health has been ruined. Without changing these attitudes, no amount of infrastructure development or resource allocation will significantly reduce maternal and infant mortality rates.
Many of these beliefs have a religious base, so CMF would specifically urge DFID to look at faith based responses to this issue. Faith leaders can have a huge impact on behaviour, as we are learning from the HIV field,(Eg Faith in Action: Examining the Role of Faith-Based Organisations in Addressing HIV/AIDS. Catholic Medical Mission Board & Global Health Council (s005)) but to reach them, change their attitudes and engage them with the issues requires an outreach from within their wider faith community. Such an outreach can refer to sacred writings, and draw upon traditions that support the value of women and good care for mothers to be. (It is worth noting that, certainly among the Abramic monotheisms, there are strong scriptural precedents for valuing women highly – it is usually the selection of particular texts out of context that has exacerbated gender inequalities.)
DFID needs to start by engaging with FBOs and faith communities already addressing these issues. To quote Steve De Gruchy of the African Religious Health Assets Programme (ARHAP): ‘Though often hidden from Western view, religion is so overwhelmingly significant in the African search for wellbeing, so deeply woven in the rhythms of everyday life, and so deeply entwined in African values, attitudes, perspectives and decision-making frameworks that the inability to understand religion leads to an inability to understand people’s lives’.(RHAP and World Health Organisation Research Project: Zambia and Lesotho (2006) http://www.arhap.uct.ac.za/research_who.php) This is not unique to Africa, but is true throughout the non-Western world.
However, there also needs to be an engagement at governmental level to see good maternal health as a matter of national priority. A well mobilised civil society (and especially faith communities) and well motivated governments taking a strong lead, working in partnership with one another and with the international community have had the most significant impact on health. We would cite the examples of Uganda and Senegal in the response to HIV as good examples historically.(Green E (2003). Rethinking AIDS Prevention: Learning from Successes in Developing Countries. Praeger ISBN: 0 865569 316 1)
Improving women’s health needs to be rooted and grounded in the community. Increasing accessibility to contraception and appropriate family planning services, as well as good education about family planning and efforts to contextualise family planning services into local cultural practices and norms will reduce unwanted pregnancies and thus unsafe abortions; and will increase birth spacing, thus improving infant health. Investing in the training and ongoing support and resourcing of skilled birth attendants and midwives from the local population, to increase access to good maternal healthcare outside of healthcare institutions, will improve neonatal and maternal survival, especially if these trained birth attendants and midwives are seen as part of, and trusted by, the local community.
In addition, there is evidence that access to primary level education by girls has a significant long-term uplift in community health and development in general, and in the health, social status and empowerment of women in particular. CMF would emphasise that it is not just in the area of health-specific interventions that DFID can invest to see a long term improvement in maternal mortality rates.
While many women in poor communities do not access maternity services with skilled staff and adequate equipment, recent research has shown that community interventions can improve healthcare seeking behaviour. A systematic review of community-level interventions to reduce maternal mortality by Kidney et al (BMC Pregnancy and Childbirth, 2009, 9, 2) found two high quality cluster randomised trials aimed at improving perinatal care practices. They succeeded in reducing perinatal mortality and also showed a significant reduction in maternal mortality (producing an Odds Ratio of 0.62 with CI of 0.39 – 0.98).
Several additional trials such as those in India, Nepal and Malawi (eg by Lewycka et al in Trials, 2010, 11, 88) are showing similar beneficial results. The challenge for national governments and for DFID is how to support and scale up these pilot schemes. The practical experience of CMF members is that church based women’s groups in many poor communities already provide such cadres of women who are highly motivated and experienced in encouraging women of reproductive age to be highly active in social action. In many situations such women’s groups work in an ad hoc way; in others they use carefully produced training materials such as ‘Guardians of Our Children’s Health’, produced by Tearfund, UK in association with their African church partners. Many of these programmes now involve fathers, as improvement in their understanding of reproductive health is critical to achieving improved access to safe delivery and contraceptive services.(Rev Joe Kapolyo. The Role of the Father. Tearfund International Learning Zone, accessed at http://tinyurl.com/36ypak8 – The Tearfund International Learning Zone (TILZ) website is at http://tilz.tearfund.org/).
Finally, we would stress that the majority of the world is community-orientated rather than individual-orientated, and we should focus on the health (in the wider physical, mental, spiritual, educational and socioeconomic sense) of communities rather than of individuals alone.
In summary, CMF would urge DFID to address:
• wider social attitudes and values
• empowering women
• engaging national governments and investing in strengthening health systems
• working with innovative projects (especially within the faith sector)
• and the wider health, education and empowerment of the local community
as the most effective ways in which maternal mortality can be reduced. (Bhutta Z A et al (2010). Countdown to 2015 decade report (2000-2010): taking stock of maternal, newborn and child survival. Lancet 2010;375:2032-44)
Improving mothers’ and childrens’ life expectancy and life chances are obviously highly desirable. But as our planet’s resources to sustain population growth are limited, reducing unwanted and/or teenage pregnancies is even more important – by education (for men and women), supporting abstinence programmes and reducing violence against, and coercion of, women.
I think the aim would appear to be slightly different to what is stated. It seems in fact that the main aim in this exercise is to stop, as much as is possible, women in the developing world from reproducing. This attitude is hardly a “development” for these countries, it is more condecending than anything else.
We agree with DFID’s emphasis on women and children in addressing development issues and the themes highlighted such as the Unmet need for family planning; Adolescent fertility; Unsafe abortion; Antenatal care; Skilled attendance at delivery; Emergency obstetric and newborn care; Newborn deaths; Prevention of mother to child transmission of HIV; Nutrition; and Malaria in pregnancy. These are all very important issues to reduce maternal and child mortality and they are interlinked to a large extent.
Aim 1:
Minimise acute and chronic maternal and child undernutrition in both development contexts as well as in humanitarian, fragile and conflict-affected states in order to prevent its acute/short-term and chronic/long-term impacts. In the short term, consequences include mortality, morbidity and disability. In the longer-term consequences include reduced adult-size, diminished intellectual ability, restricted economic productivity, reproductive performance as well as metabolic and cardiovascular diseases that blight the lives of those who are lucky enough to survive. This should include addressing chronic energy and micronutrient deficiencies as well as provision of safe water in its capacity as an essential non-calorific micronutrient. Safe water is also essential for personal, household and community sanitation and hygiene, particularly during pregnancy and lactation.
Aim 2
In order to enable women to breastfeed as fully and adequately as recommended, women need to have their workload reduced as much as possible. Reliable sources of safe drinking water, work close to home, national policies that protect a woman’s right t o breast feed fully and other such initiatives will help greatly towards preventing 1.4 million deaths in children under 5 years attributed to suboptimum breastfeeding.
Aim 3
Target women who have the greatest need and create demand and enable access to health care services in rural and urban areas, for the poorest, least educated and/or unemployed.
Rationale:
Prevent stunting in all children, most especially females in the most vulnerable groups. Stunting (short height-for age) in girls increases the risk for adverse pregnancy effects on their pregnancy outcomes such as caesarean section. Minimising stunting will reduce the requirement for skilled birth attendants and the need for advanced medical interventions. This is particularly desirable when it is well documented that the majority of women in developing countries deliver their babies at home and have minimal access to antenatal care or medically supervised birthing suites. It will take years to increase skilled midwives to attend to these women. In the mean time, we should scale up what we know minimizes risks for women, i.e. ensuring the nutritional well being of women before and during pregnancy and whilst breastfeeding. Low maternal weight or body mass index is associated with increased risk for reduced growth of the child whilst in the womb or intrauterine growth retardation (IUGR). Stunting, severe wasting, and intrauterine growth restriction are together responsible for 2•2 million deaths child deaths under 5yeasrs of age. Decreasing neonatal deaths therefore also depends to a significant extent on ensuring mother have access to and consume an optimal diet during pregnancy and lactation.
Even though maternal undernutrition has a minimal effect on the amount or quality of breast milk, unless in the case of extreme malnutrition, the concentration of vitamins such as Vitamin A, iodine, thiamine, riboflavin, pyridoxine, cobalamin and Vitamin D in breast milk are dependent on the mother’s diet and ensuring an adequate intake of these vitamins during pregnancy and lactation may mitigate the requirements for child supplementation programmes.
Abortion does not solve the problem, it creates trauma for women. It gives women mental damage and it can make them truly regret having the abortion.
Abortion is the killing of an innocent baby, the womb is supposed to be the safest place for the baby to grow, develop and prepare for birth, but abortion destroys all this. Abortion is MURDER.
Also breast-feeding must be promoted. It has so many advantages
So how can you promote abortion and contraception to vulnerable women in 3rd world countries?
Women in poor countries need good healthcare, clean water, access to antibiotics, injections to protect them from diseases, NOT abortion!
More should be invested into improving care for babies and pregnant women. Doctors should be saving and keeping babies alive, not killing them!
(From the NHS Choices Website)
breastfeeding
The immune system of a newborn baby takes time to mature and produce antibodies. Breast milk contains the mother’s antibodies to a wide range of infections, providing her baby with valuable protection against infection until their own immune system has fully developed. For some infections, immunity continues after breastfeeding stops.
Breastfeeding benefits
Evidence suggests that breastfeeding for at least the first six months of a baby’s life provides significant benefits for both the mother and baby. These benefits are listed below.
* Breastfeeding provides the baby with milk that is perfectly suited to the baby’s needs. The composition of breast milk changes over time to provide the baby with the nutrients needed as it grows.
* Breastfeeding is free, convenient, the right temperature and easy for the baby to digest.
* With breastfeeding, there is no need to sterilise breast milk or use expensive equipment.
* The baby is less likely to develop allergies, such as asthma and eczema, if they have been fed only breast milk.
* Fewer breastfed babies get diabetes in childhood.
* Fewer breastfed babies get respiratory tract infections, middle-ear infections, and gastroenteritis (infection of the stomach and intestines).
* In the long-term, the mother is less likely to develop certain types of cancer of the ovary and breast.
* Breastfeeding helps the uterus (womb) return to its pre-pregnancy size after the birth. The release of certain hormones as the baby starts to feed encourages the uterus to contract.
* Breastfeeding encourages the mother to relax and spend time sitting with her baby, giving her and the child the opportunity to form a close bond.
* Breastfeeding can help with weight loss and premenstrual syndrome as women who breastfeed burn more calories than women who do not.
* Breastfeeding also offers some protection against osteoporosis (a condition where the bones become thin and weak). It is thought that the body uses calcium more efficiently when producing breast milk.
Due to the many benefits associated with breastfeeding, the NHS promotes breastfeeding as the first choice form of nutrition for infants and provides a wide range of information, advice and support to pregnant and breastfeeding mothers, and women who are planning pregnancy.
The pill is very harmful to women. It has a number of bad side effects and it increases risks in cancer, hart & blood abnormalities.
Read this: http://ccli.org/resources/pub/brochures/ThePill.pdf
If you give artificial birth control to women in 3rd world countries and they develop cancer etc (but the healthcare in their country is not as good as in the developed world) then they have a greater risk of dying.
Natural family planning must be promoted as it is truly safe, effective (can be 99% effective when used properly) and there are no moral issues.
Women natural family planning, women learn how to monitor their fertility and they can effectively plan their family without using artificial birth control and condoms.
Also by using natural family planning properly, a woman is far less likely to have an “unplanned pregnancy.” BUT all babies should be loved and NOT seen as a “nuisance” or a burden, even if the pregnancy is not planned. Unplanned pregnancies are not bad things in themselves, they can be lovely surprises!
Abortion only kills babies and destroys women emotionally. In China women are forced to have abortions if they are pregnant with another child (there is the 1 child policy) and this is very tragic.
DFID should aim to achieve a significant contribution to the reduction of maternal, newborn and child mortality by 2015 in line with MDGs 4 and 5.
Progress is possible, some of the poorest countries in the world have made noteworthy reductions in child mortality since the adoption of the MDGs, and both maternal and child mortality have fallen by approximately one-third compared to 1990 levels. Despite this, more than 350,000 women and over 8 million children under five still die each year, mostly from preventable causes.
In its efforts to improve maternal, newborn and child health, World Vision thinks tha DFID should provide financial and technical support to strengthening comprehensive health systems in line with developing country government plans, with a particular focus on:
• Reaching the poorest, most vulnerable and hardest to reach. Ensuring that they overcome often substantial barriers to accessing healthcare – including user fees and transport costs.
• The continuum of care that spans the time period from pre-pregnancy to age 5 and ensures healthcare is available at all levels, from family/household to community, through to health facility.
• The causes of mortality and illness – priority and resources must follow the burden of disease, too often major causes of child mortality such as pneumonia and diarrhoea are not prioritised and there are similar gaps in relation to maternal health.
• Demand creation – empowering individuals, families and communities to become active participants in improving their own health and in holding governments accountable for the delivery of health care.
DFID should aim at expanding women’s access to equitable maternal health services, especially emergency obstetric care provided by the State. Women’s deprivation in health care contributes to increase maternal and child mortality rates. High child mortality rates lead to high fertility which affects women’s health in one hand and paves the way to population explosion on the other. Furthermore, in developing countries maternal morbidity/maternal death push males towards polygamy to a great extent and this leads to high fertility. All such situations could be prevented by enabling women to avail maternal health services.
I would like to endorse the comments of Emma Wilcox above – I agree with her wholeheartedly. We must respect the integrity of all women and not pressure them into practices that harm them and their families.