Global Health Reproductive Rights

Day One of Women Deliver: Melinda Gates, Ban-Ki Moon, Hillary Clinton

The three-day international conference Women Deliver 2010 opened in Washington, D.C., Monday morning, and the Ms. Blog was there on the scene. The conference intends to hammer home the point that maternal and reproductive health is a global priority.

Want to do something to help? You can click here to urge President Obama to keep the U.S.’s promise to ensure women everywhere universal access to reproductive-health services, family planning, and basic education by 2015.

No Woman No Cry

8:10 p.m. I am listening to Martha Wainwright’s cover of Bob Marley’s No Woman No Cry as the credits roll for Christy Turlington Burns‘ documentary of the same name. The hour-long film follows several women around the world as they dealt with a striking and unfortunately common array of barriers facing women during pregnancy. Turlington Burns was inspired to make the film after her own post-partum hemorrhage.

The movie is visually compelling, and lets viewers see intimate moment,s from doctors brusquely dismissing poor pregnant women in Bangladesh to post-abortion care in Guatemala (where nobody says the word abortion). As the narrative jumps from Turlington Burn’s New York apartment to Tanzanian hospitals, we see that women from all backgrounds are affected by maternal healthcare.

Turlington Burns had been working for CARE International as a maternal advocate and said she wanted to create more interaction with these issues on a global level.  She chose to include footage from the U.S. to show how close to home these issues are.

Nan Strauss, researcher for Amnesty International, USA, who worked on the film and the Amnesty report Deadly Delivery released earlier this year, mentioned that it’s not the statistics that inspire people, as much as the stories and the proof that “they are not isolated incidents, and they are not inevitable incidents.”

Suellen Miller reiterated the importance of the connecting statistics to individual experiences, and the importance of images, names and narratives in media. She said the movie was a great tool for introducing the issue of maternal healthcare to those who were completely unfamiliar with it. Turlington Burns added she financed this film personally.

When a film hits at the right moment in time, and had the ability to engage people and be an advocacy tool [she added she didn’t want to make an advocacy video, but a film that could be a tool]…and to tell an abortion story and a transportation story, and all the others, I needed ownership for that.

Danielle Roderick

A Closer Look at the New Statistics on Maternal Mortality

3:25 p.m. Gathering data about maternal mortality appears to be really hard. According to Christopher Murray, Director of the Institute for Health Metrics and Evaluation at the University of Washington, 42 percent of possible maternal deaths don’t get classified as maternal deaths due to a lack of data.  There are 21 countries for which there is no data available at all. These countries account for about 2.2 percent of births in the world.

Dr. Ties Boerma of the World Health Organization showed several slides of the number of maternal of deaths per day in 1990 and 2005.  Large orange bars mark the number of deaths by location. The south of the world is covered; the U.S. and Europe are bare.

Boerma also emphasizes the lack of data. The top 30 countries for maternal mortality account for 90 percent of deaths, and all of these are in Sub-Saharan Africa and Asia.  However, only South Africa has a full registration system to register maternal deaths; all other data is gathered from household surveys, which are a much cruder tool. About 40 million people are born and unregistered every year, and 40 million die from unregistered causes. The issue of inadequate civil registrations is a major issue in addressing maternal mortality and morbidity.  “Without this data,” noted Boerma, “we may be shooting in the dark.”

When asked if it was possible to meet Millenium Development Goal 5, both Murray and Boerma said no, emphasizing the ambitious number of reducing maternal mortality by three quarters (compared to 1990) by 2015. Moderator Sharon Camp, President of the Guttmacher Institute ended by saying “That is the last word,” and then added, “I hope that both of you are wrong.”

Danielle Roderick

Condoms and Climate Change: Can Family Planning Save the World?

3:23 p.m. Laurie Mazur, Director of Population Justice and moderator of this panel, frames the discussion within the context of the past marriages between the women’s movement and population programs: Population policies tended to trump feminist progress. Now that there’s a growing concern with global warming and population growth, environmentalists, reproductive rights advocates and population-justice workers seek to redefine and restructure demographic goals within a human rights framework.

According to Scott Moreland, principal investigator for the MEASURE Evaluation Project of the Futures Group, the cost savings of investing in the unmet family planning needs can be huge: In countries like India, an investment of $1.41 billion in family planning could lead to a savings of over $15 billion dollars. Moreland concludes that moving the dialogue of family planning and reproductive health into non-health related forms of intervention would offer additional benefits, such as reduced resource depletion, reduced costs of providing public services (education, clean water, housing and health) and reduced carbon emissions.

“Feminists scared them off!” says Frances Kissling, visiting scholar for the Center for Bioethics at the University of Pennsylvania. She was speaking frankly of the historical partnership among reproductive health advocates, environmentalists and population-justice workers. She added,

“Our social movements are in transition … We went from new social movements to defunct movements… But with climate change there’s an opportunity for environmentalists, population and family-planning advocates to redefine [themselves] in order to meet the unmet family-planning needs.

Katie Chau, consultant on advocacy and young people for International Planned Parenthood Federation spoke, on the sexual and reproductive health and rights-based (SRHR) approach to climate change:

“We have to look at consumption, technology, rural/urban areas in mitigating climate change and we can’t assume that fewer people will reduce climate change. We also have to look at the ethical nuance where countries that have fewer fertility rates produce greatest amounts of carbon emissions and countries with higher fertility rates have limited ability to impact the reduction of climate change.”

Chau also went on to stress the significant role young women play in uniting advocacy efforts around climate change and SRHR. “We will inherit this problem and young people make up the largest percentages in many countries around the world. We have to be at the forefront of climate change.”

Patrice L. Guillory

CARE collaborates with UNFPA

3:10 p.m. CARE International, one of the world’s largest humanitarian aid agencies and UNFPA have signed a joint agreement to strengthen collaboration. Executive director of the UNFPA, Thoraya Obaid, and Helene D. Gayle, president and CEO of CARE International announced the partnership, highlighting CARE’s expertise working with local communities and UNFPA’s experience working with national governments. Lots of pictures, and happy people greeted the announcement. By the way, this took place at the conference’s Speaker’s Corner, which has an oversized soapbox as the speaking platform.

Danielle Roderick

Combination HIV Prevention for Girls and Women

3 p.m. “Combination prevention [scientifically proven risk-reduction strategies such as one-on-one counseling, small-group programs and community education to encourage people to adopt safer sexual behaviors and avoid risky drug use] is more of a fantasy than a reality, and we need to do more work on making HIV prevention more holistic,” said Gertrude Khumalo-Sakutukwa from the Center for AIDS Prevention Studies at UC San Francisco. She addressed the need for more heightened awareness about male circumcision and its impact on reducing women’s vulnerability to HIV.

Patrice L. Guillory

Women & Power Session

1:45 p.m. I am sitting front row at the Chairman’s Women and Power Session! Arianna Huffington opens by explaining her accent, audience erupts in laughter. With her on stage are Ashley Judd, Valerie Jarrett and Michele Bachalet. Huffington says:

Our job as women is to deal with power not like men, but to do it with wisdom! There have been a lot of men with high IQs, but not with wisdom. If Lehman Brothers was called Lehman Brothers & Sisters, they would still be standing!

Her humor warms up the audience and creates a very relaxed atmosphere, despite the fact that the women on the stage are so accomplished.
She recalls a story of passing out from exhaustion and breaking her chin, almost losing her right eye. The drive for success, Huffington says, is driving us to the ground and giving us heart attacks. She says she wants us to talk about sleep–her new obsession–and now makes appointments with it and never breaks them! Huffington says women, especially young women, are terrified of failure, but failure is a key part of success. She recalls how her first book was rejected by 36 publishers and she was convinced she was not a writer. Wow. There could have been a world without the Huffington Post?

Huffington introduces the first panelist, actor Ashley Judd, and asks her to talk about the difference between formal and informal power. Judd says she is an example of informal power: “For some reason, people pay attention to me even though I have never headed an organization or state.” Judd talks about the significance of listening to your emotions: “Listen to your rage, and with some tools you can do a lot with it!”

Helen Clark, head of the UNDP and former prime minister of New Zealand, is asked by Huffington what one can do with formal power? Clark recalls getting legislation passed in New Zealand which allowed midwives to practice without being supervised by a doctor. The crowd erupts in applause. Huffington recalls story how she lost her first child, had her second child with a midwife at age 40. She says she is a big proponent of midwifery and that women should not be in bed to give birth–”It’s the wrong place to be!” The audience is very warm and laughs a lot.

Panelist Michele Bachelet, the former president of Chile, is asked to tell us about her delivery experiences. She had her first child in Germany with no anesthesia, as she did with her other children. Said Bachelet:

I believe women can make a difference in politics. Power for what? I wanted to use power to make people’s lives better, happier. How can we not burn out and not have anxiety about failure? It is not easy. You can not do it wrong because you will make it harder for other women. People will say, ‘Look at this woman, she is not doing very good.

Bachelet spoke at length about how women serve as important role models for other women and for the credibility of all women. To play many roles, you need to take care of yourself, she said, and Bachelet added that she has not slept in so long she does not remember the word! Bachelet says we are great women, but not superwomen. She tells us to prioritize, because the world is not ready to give us all the support that we need.

White House senior advisor Valerie Jarrett is introduced next as someone who is in the midst of power and “exemplifies power.”  Jarrett tells audience that you can do it all–just not at the same time. She says women are great at listening and nurturing others, but not themselves. She recalled her first job after law school at a large, fancy firm in Chicago, looking out over her lake view and thinking how miserable she was. Jarrett now makes a point to make room for herself, even if it’s just a quick lunch with friends. She advises the audience “to find your inner circle, find your balance…You have to demand what you need. No one is going to give it to you.”

Judd talks about how men have always built alliances and women are just starting: “Female to female alliances are essential,” Judd says.

Jarrett tells us how she was afraid of asking for a promotion even though she had been working so hard for so long. She believed her boss would give it to her when he was ready to. A colleague told her that that would not happen, and pushed her to ask for the promotion. As nervous as she was to do so, she did and got the promotion right away. Jarrett said if she hadn’t asked for that promotion, she still would be in her cubicle: “If you do not demand respect, no one will give it to you. Be resilient!”

Judd gets off from her chair and does a dance to positive energy slogans (“I can do anything!” I love my thighs!”) to inspire women to let criticism roll off their backs. Jarrett interjects, “Just like men do.”

Huffington recalls a devastating review of of the Huffington Post from the LA Weekly that she memorized. Later, the reviwer wrote her saying he was wrong and asking if he could write for her. “Don’t hold grudges,” she advises. She tells us to be more childlike–children go from crying to not even remembering what made them upset.

Huffington asks Jarrett about the White House Council on Women and Girls. Jarrett says it’s about thinking every day how to improve lives of women and girls in the U.S. and around the world. Every U.S. agency now has to give a report on what programs they have that do this. How can we make the Treasury department or the corporate world more appealing to women? Women need to be more financially literate, how can we do that? It’s all about figuring out what we can do.

Anushay Hossain

Melinda Gates speaks

1:15 p.m. Melinda Gates just spoke to a room of hungry conference attendees. As we ate box lunches, she focused on what are developing as conference themes: the connection between family planning and empowerment, how to “scale up” successful models to improve maternal mortality, the importance of large-scale coordination and how to navigate the social and cultural intricacies of global development.  Gates emphasized that the statistics often referenced refer to human beings, asking the audience to “design our work around women and children, not around our areas of expertise.”

She went on to note that access to family planning could reduce maternal deaths by 30 percent. With the modern contraception available, she said, “Quite simply, it’s reckless to prevent women from using them.”

Gates also noted that the medical health community is not often comfortable with treating childbirth as a rite of passage or a cultural ritual instead of a medical procedure. She advocated the science of behavioral change, noting success stories where maternal mortality rates were reduced by 51 percent not because of any technology developed in a lab, but from the success of promoting skin-to-skin care (when a mother puts the baby on her chest right after delivery), exclusive breastfeeding and education about drying the umbilical cord (using knowledge based in the culture of the community). Looking at these regional successes, Gates asked how these successful models can be used globally.

She ended her speech with the announcement that the Bill and Melinda Gates Foundation is committing $1.5 billion dollars over the next 5 years to the cause of women and children’s health. She also said she would take the issue as her personal priority, promising to continue the conversation and bring attention to maternal health. This announcement was met with loud applause, and the commendation from Dr. Fred Sai that Gates was an example of those who “give their all.”

Danielle Roderick

Breakout Session: Maintaining the Momentum: Five Countries Share Experiences Reducing Unmet Need for Family Planning

12:18 a.m. Bocar Duff, Director of Reproductive Health at the Ministry of Health in Senegal highlights one of its greatest successes in combating maternal mortality: a Presidential initiative to (a) involve more Senegalese women leaders in addressing these issues and (b) promote investments in maternal health via private-public partnerships. A theme in three presentations has been the need for more funding.

11:55 a.m. In contrast to Indonesia, Ethiopia faces a very grim reality, with extreme high rates of pregnancy-related injuries such as fistula and a stagnantly high rate of maternal mortality, says Kesete Admassu, Director General for Health Promotion and Disease Prevention in Ethiopia. However, the national government has worked to institute programs like the Health Extension Program (HEP), which trains over 33,000 community health workers (98 percent women) to serve as health liaisons who provide primary care services to families in various parts of the country. HEP workers are trained to bring injectible contraception and implants to women and adolescents. (So far there’s been no mention of health, safety and hygiene concerns with regards to injectibles.)

11:39 a.m. Sugiri Syarif, Chairman of Indonesia’s national family planning board, shares a remarkable success story: Indonesia has increased contraceptive and family planning access to 81 percent. Abandoning pro-natalist policies, Indonesia mandated municipal and district governments to carry out family planning programs. This has helped to normalize small family sizes. Where would the U.S. be in terms of maternal health if we took bold steps like Indonesia to mandate, for example, comprehensive sexual education for American youth?

11:13 a.m. It was just announced that presenter Stella Simela-Chiriva, executive director of Zimbabwe’s National Family Planning Council has suddenly passed away in route to this conference. The women of Zimbabwe have lost a warrior in the fight for empowerment of women and families. Our thoughts are with her family and the communities she has served.  A moment of silence was observed.

10:00 a.m. Senior government officials from five countries–Indonesia, Ethiopia, Malawi, Senegal, and Zimbabwe–share insights into their efforts to reduce unmet contraceptive need in their settings.

Surprisingly, all the presenters on this panel are men. Though I am proud to see men engaged and working on family planning and maternal health issues, it is ironic that in these countries where maternal mortality rates are so high, no women are here to describe what the greatest challenges and successes are–particularly when it is known these countries experience huge barriers to women’s empowerment.

Patrice L. Guillory

Opening Plenary – Christiane Amanpour

9:30 a.m. The first plenary panel begins, with Christiane Amanpour taking the stage. She says all she can think about are are the women in Afghanistan and Africa who have to travel for days on horseback or in carts just to deliver their babies. Amanpour says that the finances exist to change the situation but that there are political challenges and “gross double-standards.”

The first question to panelists is about the state of maternal mortality today, citing the recent study in the Lancet that maternal mortality rates are declining. The panel agrees that it is positive and encouraging sign but that we still need to create and maintain urgency around the issue.

Anushay Hossain

Welcome Address: Celebrate Progress and Sustain Momentum – Ban Ki-Moon, Hillary Clinton

9:20 a.m. “Mother of Women Deliver” Jill Sheffield of Family Care International acknowledges how the election of Barack Obama heralded a new era for women and women’s health by reinstating funding for UNFPA, creating the first-ever White House Council for Women and Girls, naming an ambassador-at-large for Global Women’s Affairs and making Hillary Clinton Secretary of State.

9:25 a.m. And here’s Hillary Clinton, via satellite! She congratulates the U.N. Secretary-General for promoting women and children’s health reiterates the theme that “women deliver for the world; now the world needs to deliver for women.”

9:10 a.m. Ki-Moon says that “an isolated approach does not work. When we work together we succeed.” Governments, businesses and NGOs should all be part of the picture of maternal health. He announces a new commitment from the U.N. and renews a pledge by the U.N. Joint Action Plan to accelerate programs for women and children. He also addresses the issue of violence against women:

Gender inequality is a danger to women’s health. Women cannot fulfill their potential when they live in fear, fear of rape, domestic violence and being trafficked. … Empowering women starts at home.

Ki-Moon is on a roll: He also acknowledges that women are still outnumbered by men at the U.N. at every level–and this must change! He ends his speech by recalling his own home-birth in Korea. He later asked his mother why women looked so scared before going into a room to give birth. She told him it was because they did not know if they would come out of the room alive. Concludes Ki-Moon:

No woman should have to pay for giving life with her own life. Let us change this world by helping women deliver.

9 a.m. U.N. Secretary-General Ban Ki-Moon takes the stage amidst thousands of flashing lightbulbs. Goosebumps! The significance of his presence is tangible; you can feel the power he is bringing to Women Deliver. He tells Michelle Bachelet that even though she is no longer president of her country, the world still needs her leadership. Then he introduces all five U.N. agency heads who are also present here today, sitting in the front row, and he acknowledges that women’s rights are central to all U.N. policies and declares that “delivering for women and children is men’s work, too.” Massive applause from the standing-room-only audience.

8:55 a.m. The “Godfather of the Women’s Health Movement” and co-chair of the conference,  Ghana’s Fred Sai, takes the stage and declares he would rather be called a “master midwife” than a godfather so that we can get “women really delivering.” He says that despite research showing that maternal mortality rates are declining globally, he has not been seeing enough progress in the field of maternal health. What’s missing? Action, education and leadership.

8:50 a.m. Michelle Bachelet, former president of Chile–did you know she is also a physician?–says …

A health system that delivers for women delvers for everyone else also. My government delivered for women and women delivered for my country.

8:30 a.m. There’s an electric atmosphere in the massive ballroom of Washington’s Convention Center as 3,000 world leaders, doctors and activists gather here for the opening plenary. We watch an inspirational photo essay by Lindsay Orario and hear these words:

When women are healthy, they deliver for their families, communities and for their nations. It’s a virtuous cycle. We know what to do to save their lives. It’s time to deliver for women. Invest in women. It pays.

Anushay Hossain (Originally posted on Ms. magazine Blog)

Above image courtesy of Women Deliver.

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