Global Health Reproductive Rights

Day Two of Women Deliver: Ellie Smeal, Rachel Leigh Cook, Ali Larter

At Day 2 of the three-day international conference Women Deliver 2010 in Washington, D.C., Ms. Bloggers are 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.

Funding, Funding, Funding!

Over 215 million women want access to contraceptives but can’t get it. The Guttmacher Institute, International Planned Parenthood Federation and Planned Parenthood Federation of America, three reproductive-rights advocacy organizations, talk about what’s getting in the way.

818 million women across the globe want to limit their childbearing, according to the Guttmacher Institute, yet more than a quarter have no means to do so. Contraception is unavailable for millions of women in the developing world, and knowledge about contraception is equally limited. Young women are at greater risk due to lack of information and awareness, as well as sexual exploitation.

What’s needed is more funding to address the problem, along with a broad-based global advocacy strategy built on successful models, says Cecile Richards, president of Planned Parenthood Federation of America. Ironically, she says, the global reproductive health community can learn a lesson or two from opponents of family planning, who are building and strengthening their networks across the globe to deny women access to basic contraception and safe abortion. The just-passed 50th anniversary of the birth control pill should be cause for celebration, but also a somber reminder that millions of women desire the means to plan and space their families, but face barriers to that basic human right.

Belle Taylor-McGhee

Actors for Maternal Health

I started my second day at Women Deliver 2010 by speaking with actors Rachel Leigh Cook and Ali Larter, both guests of the United Nations Foundation (UNF) and both impressively well-versed in maternal health issues.

4:25 p.m. Interview with Ali Larter:

Ms. Magazine Blog/Anushay Hossain: How did you get involved in the issue of maternal health?

Ali Larter: I’ve always cared deeply about women and girls issues, and coming here I’ve actually learned so much–I didn’t know I cared so much! I believe that there should be universal access to every woman for reproductive health care, and they should have a choice for their own family planning. I found out that over 200 million women around the world want to have access to contraceptives but don’t.

AH: How do you think your celebrity helps advocate this cause?

AL: You know it’s almost embarrassing, because I feel so lucky that I get to maybe raise some attention for it, but at the same time I am just a woman who feels a sense of responsibility to help other girls and women. Growing up in America, I have had such extraordinary opportunities, and I feel a sense of responsibility to help other girls that haven’t been as lucky as I have.

AH: What would you say is one of the most shocking statistic on maternal mortality or maternal health that has stayed with you, that haunts you?

AL: When [UN Secretary General] Ban Ki-Moon opened up the conference and said, “Every woman has the right to give life without fearing [for] her own.” I just found that to be so extraordinary. And that a lot of the girls that are dying are between 14 and 18 years old. And if they don’t die during childbirth then they deal with different complications like fistula…this is a preventable problem with a dollar amount, $400, and it could change these women’s lives. One of the things I was so moved about was Melinda Gates talking about how we’re not trying to come up with a cure for a disease here. We have the cure! Let’s do it. Let’s get the money and build these hospitals and get women access to the doctors that they need.

AH: And lastly, do you identify yourself as a feminist?

AL: I do, I do. I definitely believe in women’s issues, but I am also a Mrs. and proud to be!

Here we ran out of time, so I was unable to tell her that you can be a feminist and be married–I am as well, as of two weeks ago–and you don’t need to add the “r” to “Ms”. Perhaps it’s lucky Larter was spared my lecture!

Anushay Hossain

4:00 p.m. Interview with Rachel Leigh Cook:

Ms. magazine Blog/Anushay Hossain: How did you get involved with the issue of maternal health?

Rachel Leigh Cook: Well, I was enlightened of the fact that it was even this serious of an issue when I got invited out here to this conference by the UNF, and they’ve been amazing hosts and teachers. I am just overwhelmed and honored to be here.

Ms.: So the UNF reached out to you?

RLC: Yes. I have no idea why. I think it’s just because I haven’t been arrested recently or something! Did I say recently? I mean ever!

Ms.: Thanks for clarifying! How do you think your celebrity helps advocate for this cause?

RLC: The simple fact that you have given me some of your time I think is a statement about that. I don’t consider myself … I don’t even like the word celebrity, to be completely honest. I know how sort of falsely modest that sounds, but I don’t get stopped on the street left and right. I am lucky enough to be a working actor. But if I can use whatever amount of spotlight given to me occasionally, then I would love to use that to highlight wonderful causes like this.

Ms.: Yesterday at Arianna Huffington’s session on Women & Power, they were talking about formal and informal kinds of power, and Ashley Judd said she is an example of informal power and for some reason when she speaks people listen to her. Would you say that that is where you are coming from–you are a source of informal power?

RLC: I think I am casual Friday’s power! I think that she [Judd] might be informal power, but I don’t even consider myself on that level! [laughs]

Ms.: OK, What is the most shocking fact or statistic about maternal health that has stuck with you?

RLC: What really haunts me is that less than half a cent of every development dollar is spent on care for women and girls, or directed towards women in a positive way. The maternal death rates are staggering,  and in some places one in seven. In the session I was just in, they were saying that women from the ages of 14–and I imagine even younger–to 19 years old are twice as likely to die in childbirth. And I had no idea the statistics on child marriages; it is beyond shocking. I frankly cannot believe how in the dark I was about the fact that this is even a major issue. That’s why I am so happy that this conference is happening. I had never heard the words maternal death even put together. People need to know about this.

Ms.: What would you say the is the most important thing you have learned at this conference?

RLC: Women need access to family planning. And when you say family planning, the “A” word starts lingering in people’s minds–and it is not about that. We want to keep mothers alive, we want to keep children alive. We don’t want anyone to die in childbirth. We need to get these women the resources to save their own lives.

Ms.: Do you consider yourself a feminist?

RLC: I think that the majority of women, especially of our generation, are feminists … It just means equality. It just means to be the ultimate girl’s girl. Look out for each other, because we might not have anything in common but we face a lot of the same issues, whether we realize it or not. Have each other’s back and do this because no one else is going to.

Anushay Hossain

2:25 p.m. Eleanor Smeal and Belle Taylor-McGhee Take the Soapbox!

Ellie Smeal, publisher of Ms. and president and founder of the Feminist Majority Foundation, took the podium at the “Speaker’s Corner.” Raising high the latest issue of Ms., she told the people crowding around her that she wanted to bring their attention to rates of women dying needlessly around the world:

The rates are out of sight. In Niger it is one in seven [women dying in childbirth]. Afghanistan now according to the latest study has moved to the worst position…a tremendous chance of women dying from pregnancy, from things that we know we can solve.

Smeal underscored that we need to invest much more money into midwives and community groups like Women’s Dignity.

Essentially the grassroots groups are still underfunded big time. We need the establishment of a health infrastructure that treats women seriously and eliminates this surge that is costing the lives of some 500 million women a year, and an additional 6-8 million women who are left with serious illnesses [related to pregnancy] that are absolutely and utterly unnecessary.

Smeal then turned the podium over to another long-time reproductive-health advocate, Belle Taylor McGhee, who is working on a three-part series for Ms. magazine on maternal health and maternal death in Africa.

McGhee passionately recounted her recent trip to Uganda and Tanzania, countries she described as beautiful with their lush, green hills. But, she said, they had almost no hospitals or health-care facilities–and the issues and the needs there are so complex they can’t be boiled down to a “one size fits all” solution. She highlighted the importance of grassroots groups such as Women’s Dignity that connect public officials with communities who will hold them accountable. Surprisingly, says McGhee, public officials do listen, but because of a lack of funds they don’t know whether to put money into maternal mortality, child mortality or HIV/AIDS: The officials themselves are torn. The bottom line? “We don’t have money,” says McGhee.

Anushay Hossain

Vaginal rings and HIV

11:45 a.m. The International Partnership for Microbicides announced the first safety trial in Africa of a vaginal ring designed to prevent HIV. Vaginal rings have been successfully used as hormonal birth control methods, especially because they are discreet (a key word in discussions here about contraception, and forgettable (unlike the pill, which needs to be taken around the same time every day, the ring is changed once a month).  This new study brings together reproductive health and HIV prevention, possibly leading to a future vaginal ring that can offer protection from pregnancy and HIV simultaneously.

The most exciting thing about this development is that addresses the intersection between women, their sexual lives and sexually transmitted infections. The most common HIV protections are condoms or abstinence, and neither of these are acceptable choices for all women, especially a woman who desires children, is married or whose livelihood depends on sex work.

Elizabeth Mataka of Zambia National AIDS Network, said:

For a woman in Africa, to use condoms depends on the express communication and cooperation of her partner, [but with this new ring] nobody needs to know…women can have total control over its usage.

The development of the ring is also promising because of its ease of distribution and low cost—less than $5 a month.  Mataka added that the ring is also exciting because it would reduce infection rates, thus lowering treatment costs. After this safety trial, efficacy trials will take place next year, and hopefully the results will be available by 2015.

–Danielle Roderick

New Maternal-Health Research–Hot off the Presses!

12:40 a.m. Moderator Richard Horton, Editor-and-Chief of The Lancet leaves advocates with a resounding message:

We need to think about science not in its conventional meaning, but political, social and economic, ethical science. … And we need a formal mechanism to push these studies further.

11:55 a.m. Saving mothers’ lives

Anuraj Shankur of the Harvard School of Public Health shares new research:

  • Higher doses of oxytocin could help prevent postpartum hemmorrhage.
  • Vitamins C and E, commonly used to prevent pre-eclampsia/eclampsia,  don’t work. But calcium supplements during preconception and first trimester show promise, and magnesium sulfate aids treatment.
  • Mifepristone or methotrexate and misoprostol are the best methods to avoid botched abortions–but there’s a lack of access, especially in countries where abortion is illegal.

11:39 a.m. What’s new for newborns?

“Kangaroo Mother Care”–24-hour-a-day mother-newborn skin-to-skin contact with incubating thermal care and increased breastfeeding–is one of the most effective ways of nursing preterm newborns to survival, says Joy Lawn, director of global evidence and policy for Saving Newborn Lives/Save the Children. Two recent trials of Kangaroo Mother resulted in a 51 percent reduction in neonatal mortality.

Another needed yet under-researched intervention is community-based post-natal care, which includes home visits and women’s groups.

11:10 a.m. Child and infant survival

Betty Kirkwood, Professor of Epidemiology and International Health, London School of Hygiene and Tropical Medicine highlights promising new child-health interventions:

  • Oral, at-home Amoxycilin effectively treats severe pneumonia.
  • Early antiretroviral treatment for HIV-positive infants drastically reduces mortality.
  • Antenatal iron–a relatively old intervention–has been newly shown to  increase child survival.
  • Indoor residual spraying (IRS) protects children from the onset of malaria.

And a few interventions that may be on the horizon:

  • Malaria vaccines
  • “Lab-on-a-chip” diagnostic tools, tiny chips that can detect bacteria, viruses and cancers and even conduct DNA analysis.
  • Interventions to address maternal depression and domestic violence, which increase infant/child mortality.
  • Interventions to improve infant nutrition within the first 2 years of life, aiding crucial weight gain that reduces the future risk of chronic diseases

Patrice L. Guillory

Good morning, birth control!

9:30 a.m. Nothing like a cup of coffee and a long talk about contraception to start the morning off right.  At the first plenary today, “Modern Contraception Comes of Age,” 50 years of birth control were examined. Throughout the conversation, I kept thinking of the basic sex ed found in U.S. high schools, the privilege of information and the wildness of technology.

Regine L. Struik-Ware, executive director of research and development for the Population Council mentioned that a three-month vaginal ring was available in Latin America and that a one-year ring will be available soon.   This sounds amazing.  I think, Do you ever wash it?

There was also talk of why common contraceptives aren’t used. About 50 percent of women discontinue taking the pill in the first year because of logistical problems regarding cost, access and privacy.  Ward Cates of Family Health International outlined issues and possible solutions:

  • The female condom is coitally dependent (a professional word for “in the heat of the moment”). Later in the presentation, Gloria Quansah Asare of the Ghana Health Service mentioned that while the female condom is seen as empowering women, it depends on the cooperation of the male partner.
  • The male condom: another coital dependent. Also, while the condom has a great deal of visibility because of HIV protection, this might be part of the problem. Use of the condom often introduces trust issues between partners.  Cates recommended that the condom be marketed as pregnancy prevention instead of STI protection.
  • Diaphragm: The biggest factor here is that it requires fitting. Cates recommended a “one size fits most” model.

The talk ended with a look at the needs of young people, especially when they are having sex even though cultural attitudes insist they are not. Sitruk-Ware emphasized that young people need a method that is on demand, simple and reversible, and highlighted the development of a drug that would act like emergency contraception before “the event” (sex), a pill you could take just once to postpone ovulation. I’m hoping there are more details at the next plenary, “What’s on the Horizon.”

–Danielle Roderick

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.

Above image courtesy of Women Deliver.

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