Saving Lives: One New Mother at a Time

2012/N o. 1

Uma-Shree Pal (right) with client, Rashida Begum, who survived after giving birth, because of misoprostol.

In This Saving Lives: One New Mother at a Time ISSUE As a young girl, Uma-Shree Pal dreamed of An estimated 85% of women in Bangladesh The Shang Ring being able to improve health for people in give birth in their homes without the her community. Helping to save mothers’ presence of a formally trained health Interview with lives during childbirth fits perfectly into her professional. Postpartum hemorrhage kills Pam Barnes childhood vision. so many new mothers in settings like this because without medical knowledge, it is New Board At age 35, Uma-Shree is now a government- difficult to tell the difference between normal Members trained field worker in the Tangail District of and excessive bleeding before it is too late— Bangladesh, working to distribute misoprostol, women often accept all postdelivery bleeding Empowering a drug that can prevent postpartum as normal, mistakenly thinking that it is Youth for a hemorrhage (PPH)—the leading cause of simply menstrual blood that built up for Healthy Life maternal death in the country and globally. nine months.

“I wanted to serve my community,” said But a single dose of misoprostol, which Uma-Shree, mother of a 5-year-old boy. costs just 50 cents, can help prevent “That is what motivated me to help mothers women from dying needlessly. As part of an access the medicine and assistance they need EngenderHealth-led program, Uma-Shree to stay healthy.” works in four villages, home to 3,000 people

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and some 62 home births per year, to distribute a dose and nongovernmental organizations to distribute of misoprostol to pregnant women during their third misoprostol and ensure their appropriate use. To date, trimester. Uma-Shree and her colleagues received training all mothers have survived. on how to educate women to use misoprostol through EngenderHealth’s Mayer Hashi project, in collaboration These days, because of misoprostol, Uma-Shree finds that with government partners. excessive vaginal bleeding postpartum is controlled. She believes that educating women and families about the In addition to training, Uma-Shree also received flipcharts, dangers of PPH is saving mothers’ lives in her community. leaflets, and stickers, which strengthened her ability to counsel women in her catchment area. The support base “Seeing the smile of a woman who has just given birth for her work is also strong, with monthly meetings with gives me such great happiness,” Uma-Shree said. “I other nearby fieldworkers and EngenderHealth experts. consider that smile a priceless reward for my hard work.”

“EngenderHealth’s training was very effective and Following the success of the program in Tangail District, comprehensive,” Uma-Shree said. “It gave me the EngenderHealth has continued training community information I needed to communicate effectively and health workers in misoprostol distribution in Cox’s Bazar demonstrate how a simple pill, when taken properly, can District, where nearly 31,000 pregnant women—97% save their lives or the lives of their daughters and wives.” of home deliveries recorded under the program there— opted to use the lifesaving tablets after giving birth to During the project’s first phase, Uma-Shree and other prevent PPH. The project is now being scaled up in three field workers distributed misoprostol to nearly 13,000 additional districts in Bangladesh: Comilla, Moulvibazar, pregnant women, at or after 32 weeks of pregnancy. and Barisal. More than 90% of these women used the tablets as directed, demonstrating the effectiveness of using For more information about how we are improving community-level fieldworkers from the government maternal health, visit www.engenderhealth.org. The Shang Ring: A Promising Device to Prevent HIV among Men

A novel medical device called the Shang Ring has the potential to revolutionize how male circumcision services are offered in Africa, where the procedure is in high demand among men seeking protection against HIV. A recent study, conducted by EngenderHealth and the Weill Cornell Medical College, confirmed that the Shang Ring is highly acceptable to men in Africa and safe for further study.

Strong scientific evidence has shown that male circumcision cuts the risk of female-to-male HIV transmission by as much as 64%. As a result, the United Nations has recommended that these services be included in HIV prevention programs across Africa. The Kenyan government is among those that have endorsed voluntary adult male circumcision services in their health programs, taking a bold step to encourage the practice in places where it has not traditionally been performed.

Compared with conventional surgery, the Shang Ring offers a faster, more cost-effective way to perform male circumcisions. The disposable device consists of two concentric plastic rings that lock together over the foreskin. Whereas surgical circumcisions can take 20–40 minutes, the Shang Ring takes just 3–5 minutes, Indeed, adult male circumcision rates in requires no sutures, and causes minimal bleeding and Africa remain low; since 2007, only about few complications. All health professionals—not just 600,000 men have been circumcised, in spite surgeons—can be trained to use the Shang Ring, an of high demand for the procedure. The dearth important benefit in countries where trained surgeons of trained surgeons and critical medical supplies may be scarce. can make surgical circumcisions more challenging to perform on a large scale. “Given the Shang Ring’s success in China, we decided to investigate whether it could be adapted for use in Africa, EngenderHealth has decades of expertise in simplifying where the HIV epidemic is most serious,” said Jared medical procedures for low-resource settings, while Nyanchoka, EngenderHealth Technical Advisor, based also ensuring safety, quality care, and informed choice. in Kenya. “Our hope is that the Shang Ring can help EngenderHealth is conducting additional studies on meet the growing demand here for safe, voluntary adult the Shang Ring, in partnership with the Kenyan and circumcision.” Zambian governments, FHI 360, and Weill Cornell Medical College.

The increase in the number of individuals in Sub-Saharan Africa 20% receiving antiretroviral treatment between 2009 and 2010. 100,000 Miles and Just Getting Started: A Chat with EngenderHealth President Pamela Barnes

As EngenderHealth’s President, in your first year you EngenderHealth has been working in Tanzania for traveled more than 100,000 miles, to India, Ethiopia, 30 years. What more needs to be done to improve Bangladesh, Tanzania, and beyond. What is your favorite health care there? travel memory? One area we must continue to address is the need I have so many incredible memories, and one is from for more skilled health care professionals. I remember my recent trip to Tanzania. For example, I saw men and visiting a maternity ward in Tanzania where two women visiting health clinics together and deciding as laboring women were assigned per bed. With only partners whether and when to have children. We know two doctors and four nurse midwives on staff, the that men are becoming increasingly supportive of the facility was delivering two to four babies every hour health of their partners, but to see it in real time is always of the day. While it was incredible to see so many a great reminder that our work is making a difference. At women choosing to deliver at a health facility, the the government and community levels, EngenderHealth facilities need more staff and equipment to meet that is recognized as a “Tanzanian” program, one that has growing demand and provide the necessary care. This truly leveraged local skills and talent to improve health is why we train health professionals to expand their throughout the country. skill sets, particularly the lower-level health workers who can help fill this critical gap.

“Innovation isn’t about finding a shiny new penny. It’s about doing what we know works well and finding ways to do it better at a lower cost to make even greater impact.”

As the leader of a global nonprofit organization, one of your many roles is inspiring people to care about important issues and to take action. Who inspires you? From community health workers to ministers of health, I meet people whose passion for their work really lights a fire in me. They are all so genuinely committed to improving the welfare of women, families, and communities and to seeing their nations thrive. Another source of inspiration is the EngenderHealth staff. From fistula repair to HIV prevention breakthroughs to contraceptive technologies—I’m awed by their deep technical knowledge, and I learn something new every day. New Board Members

From where you sit, what do you think EngenderHealth welcomes Mark Chiaviello and are the emerging issues for the field of Sara Seims to its Board of Directors, who bring reproductive health? deep financial and technical expertise to the I think that innovation will be a key driver of Board, with a strong track records of leadership in success in reproductive health. But innovation international development and health. isn’t about finding a shiny new penny. It’s about doing what we know works well and finding ways to do it better at a lower cost to make even greater impact. We already have a deep basket of expertise and we need to find a way to advance that know-how.

Also, in the field of public health, ideas come into favor, fall out of favor, and then come back again. Right now, there is a focus on stronger, integrated health care that is comprehensive and centered on the client. Quite frankly, that has always been Mark Chiaviello, M.B.A. EngenderHealth’s philosophy and approach. I’m proud of that and what it means in the current Mark Chiaviello has extensive experience in environment of having to work better and smarter. both finance and development, serving today as Director of Corporate and Investment Banking at Standard Bank, the largest financial institution in Africa. Chiaviello previously ran Deutsche Bank’s South African equity business and worked with the United Nations Development Programme in Africa.

Sara Seims, Ph.D.

Dr. Sara Seims is a demographer and reproductive health expert, having served as Director of the Population Program at the William and Flora Hewlett Foundation and as President of the Guttmacher Institute. Seims has served in high- From top to bottom: Pam Barnes with participants in an level positions at The Rockefeller Foundation, the EngenderHealth training on lifesaving comprehensive postabortion care protocols, Kenya; Pam speaking with U.S. Agency for International Development, and Dr. Haji Mponda, Minister of Health and Social Welfare, Tanzania the National AIDS Fund. Empowering Youth for a Healthy Life

In a classroom in Austin, Texas, teenage boys health. EngenderHealth is a pioneer in gender and girls spend a week of their summer vacation programming, applying deep international performing skits about safe sex and talking about experience from its Gender and Men As Partners® what it means to be a man or woman. Springing (MAP) initiative, which engages men in Africa and from the creative imaginations of 14- to 16-year- Asia and encourages them to challenge harmful olds, memorable catch phrases like “Don’t be silly, notions of masculinity that impact their health and wrap your willy” and “If you don’t wrap it, you that of their partners. can’t tap it” help remind them of the importance of using condoms to prevent pregnancy and The five-year program is based in Travis County, sexually transmitted infections. where the teenage pregnancy rate for girls aged 13–17 exceeds that of Texas, which ranks third The unique exercises are part of Gender Matters in the nation for the highest birthrates among (“Gen.M”), a new teenage pregnancy prevention girls aged 15–19. In 2008, the cost of teenage program led by EngenderHealth that focuses on pregnancy to U.S. taxpayers was $10.9 billion; in how gender influences adolescent behavior and Texas alone, the burden was nearly $1.2 billion.

9.1 million New cases of sexually transmitted infections each year In Brief Empowering Youth for a Healthy Life

Through Gender Matters, young Supporting Guinean Women Permanently Disabled by Fistula adults will be better able to protect Obstetric fistula is a devastating childbirth injury that can create themselves against the risks of severe physical, mental, economic, and social obstacles for women. pregnancy, disease, and violence in To date, EngenderHealth has worked in 15 countries to increase their relationships and to make their access to repair surgeries for women living with fistula. But a own decisions about if and when to number of fistula injuries are so complex they cannot be repaired, have sex. leaving some women permanently disabled by the condition and leaking urine and/or feces. With funding from USAID, In its pilot stage, the program consists EngenderHealth is working in Guinea with the Ministries of Health of a curriculum totaling 20 hours over and Social Affairs to support such women, building their technical five days. Using an innovative mix of and entrepreneurial skills to help lift them from lives of isolation workshops, social media strategies, and and poverty. community-based events, the program fosters co-ed discussions about gender stereotypes and how they affect youth’s health. A Link between Increased Abortions and the Mexico City Policy? A recent Stanford University study suggests that the Mexico In one exercise, participants were City Policy, or Global Gag Rule, may be linked to a dramatic rise asked to choose a gender stereotype in induced abortions in Africa. The Mexico City Policy denied they reject. “A stereotype I reject U.S. funding to organizations that offer any abortion-related about men is that all men cheat,” one information or services, even if abortion is legal in their country. boy said. “Because I don’t.” A teenage Ghana, Guinea, and Mozambique, which experienced the girl rejected the stereotype that all greatest cuts in U.S. support for health organizations under the women depend on men. “Some do,” policy, saw the number of induced abortions double between she said, “but not all.” These activities 2001 and 2008, while contraceptive use declined. Reduced help young people examine, question, access to contraceptives resulting from funding cuts may have and redefine harmful notions of what it led women to substitute abortion for contraception, according means to be male or female and enable to the study, which is the first quantitative effort to examine the them to create new positive gender policy’s impacts. norms together.

“We believe that youth have the power to make their own healthy The Partograph: An Essential Tool for Improving the Quality decisions about sex and relationships,” of Care in Childbirth said Andrew Levack, M.P.H., Project The partograph (pictured on the back page) is a practical tool Director. “We help them apply critical used to monitor labor and prevent obstructed labor in places thinking skills to situations that are real where other technologies such as the ultrasound are not in their lives.” available. Developed more than 40 years ago, it is now universally recommended by the World Health Organization. The partograph is a preprinted one-page form on which labor observations are recorded. It acts as an early warning system, alerting health providers to any deviations from the normal progress of labor, so that appropriate and timely emergency action can be taken to preserve the health and life of mother and child.

Stay informed by subscribing to our monthly e-newsletter, New cases of sexually transmitted infections each year among Americans ages 15–24. , at www.engenderhealth.org/connect.

President Pamela W. Barnes

Board of Directors Brenda J. Drake, J.D., Chair Janice Hansen Zakin, M.D., Vice Chair Cecily C. Williams, J.D., Executive Committee Chair and Secretary Mary K. Stevens, Assistant Secretary Donald J. Abrams, Treasurer Robert D. Petty, Assistant Treasurer

Mark Chiaviello, M.B.A. Elizabeth Ngozi Ebi Rosemary Ellis Julio Frenk, M.D., M.P.H., Ph.D. Supanya Lamsam, Ph.D. Mehret Mandefro, M.D., M.Sc. Margaret Neuse, M.P.H., M.A. Jeffrey O’Malley, M.A. Sara Seims, Ph.D. Michael Stevens Belle Taylor-McGhee Marie Washington, M.B.A. Wendy L. Wysong, J.D.

Directors Emeriti Lyman B. Brainerd, Jr., M.B.A., Ed.D. Anne H. Howat

EngenderHealth is a leading international reproductive health organization working to improve the quality of health care in the world’s poorest communities. EngenderHealth empowers people to make informed choices about contraception, trains health professionals to make motherhood safer, promotes gender equity, enhances the quality of HIV and AIDS services, and advocates for positive policy change. The nonprofit organization works in partnership with governments, institutions, communities, and health care professionals in more than 20 countries around the world.

Update may be reproduced without permission, provided the material is distributed free of charge and the publisher is acknowledged. How can this piece of paper

© 2012 EngenderHealth. “Men As Partners” is a registered trademark of save a woman’s life? EngenderHealth. 440 Ninth Avenue Visit EngenderHealth.org to learn about the New York, NY 10001 1-800-564-2872 partograph and other low-cost solutions that [email protected] www.engenderhealth.org are saving women’s lives. Photo credits: Staff/EngenderHealth, M. Tuschman/ EngenderHealth, W. Murray/EngenderHealth, W. Gallagher/EngenderHealth. World Health Organization. 1994. World Health Organization partograph in management of labour. World DEV0013.NL Health Organization Maternal Health and Safe Motherhood Programme. Lancet. 343(8910):1399–1404.