Women & Gender

 {Photo credit: Kate Ramsey/MSH}A midwife in Uganda leads a group antenatal care session, an approach that can transform how quality care is delivered and experienced.Photo credit: Kate Ramsey/MSH

For many people living in poor and underserved regions – whether rural communities or growing cities – midwives are the health system.

Midwives play a vital role for women during pregnancy and childbirth, but their care expands much more than that. Midwives provide solutions that ensure girls and women have access to a comprehensive range of services promoting their right to physical and mental health. They provide family planning and reproductive health services and care for newborns and young children not only at health facilities but also in communities. They deliver the respectful and excellent quality of care that can prevent more than 80 percent of all maternal deaths, stillbirths, and newborn deaths worldwide.

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MSH Delegation: Matthew Martin, Crystal Lander, Catharine Taylor, Marian Wentworth, Stuart Knight, Barbara Ayotte, and Alison Corbacio

As the Trump Administration released its truncated global health budget last week, ministers of health, members of civil society and the private sector, and government delegations met in Geneva for the annual World Health Assembly to discuss programs that exemplify the value of foreign assistance and its tangible effect on families in some of the poorest countries. In advance of the meeting, MSH released position statements on WHA agenda items. Dozens of governments led by Germany and South Africa, signed the Global Compact for Universal Health Coverage 2030 committing to make affordable and quality healthcare accessible for all. This year’s WHA was particularly historic with the nomination of the WHO’s first African Director-General, Dr.

{Photo credit: Amelie Sow-Dia}Charlene Chisema, a community mobilization officer, conducts an Education Through Listening session on antenatal care.Photo credit: Amelie Sow-Dia

It is early afternoon in the village of Kanjuwale at the foot of Nguluyanawambe Mountain in central Malawi. Charlene Chisema, a community mobilization officer, asks a group of local women about best antenatal care (ANC) practices.

“It should start early – in the first months,” said one woman.

“You need four visits,” said another.

“Great!” said Chisema, who works with the USAID Organized Network of Services for Everyone’s (ONSE) Health Activity. “How many ANC visits did you all have during your last pregnancy?”

Silence.

Suddenly, a frail woman with a baby on her lap stood up, wiped a tear from her face, and said, “I will not return to ANC.” 

The women looked shocked – they were not used to such candid talk.

“Thank you for being honest,” said Chisema, leaning forward with an encouraging smile.  “Please tell us why.” 

Grace sat back down, wiped her face with her cloth wrap, and explained how the nurse at the local health post has been teasing her for “being pregnant again, while my baby, barely six months old, is still exclusively breastfeeding!”[1]

{Photo credit: Simon Chambers/PWRDF}Indigenous midwives' centre, Chiapas, MexicoPhoto credit: Simon Chambers/PWRDF

Over the past year, Tijuana, Mexico, has seen an influx of U.S.-bound Haitian migrants fleeing communities left in disrepair from the 2010 earthquake and further devastated by Hurricane Matthew in October 2016. These migrants often begin their journey in Latin America and trek through multiple countries and hostile terrain only to find they cannot enter the U.S. once at the border. Among the stalled Haitian migrants living in makeshift shelters as they contemplate their next steps, pregnant women face another uncertainty: whether they or their baby will languish during pregnancy and childbirth without access to skilled maternal and newborn health care.  Recognizing this health crisis, a group of midwives, Parteras Fronterizas (Borderland Midwives in English), arrived on the scene to provide antenatal and safe childbirth care, with help from women who translated from Spanish or English to Haitian Creole. 

{Photo Credit: Warren Zelman}Photo Credit: Warren Zelman

Malaria in pregnant women contributes to several negative outcomes including miscarriage, premature birth, labor complications, low birth-weight babies, anemia, and maternal and newborn death. In Sierra Leone, malaria in pregnancy and child mortality rates are especially high: the disease contributes to nearly 40 percent of deaths of children under the age of five. While there is a clear understanding of the interventions needed throughout the country, at training institutions and health facilities, there is a gap in the skillset and knowledge of how to implement effective malaria diagnosis and treatment.

{Photo Credit: Mark Tuschman}Photo Credit: Mark Tuschman

Pregnancy and childbirth are times of unparalleled change and hope for the future. But for many women, the arrival of a new baby is also a challenging time — one that can be overshadowed by depression.

The World Health Organization (WHO) estimates that more than 1 in 10 women suffer from postnatal depression, a devastating statistic that too often receives no attention. In African countries and contexts where women are exposed to poverty, persistent poor health, migration, conflict, gender-based violence, extreme stress, and unwanted pregnancy, the estimates are even higher, with up to 25 percent of women experiencing clinical depression after childbirth.  

The effects of depression on social and economic wellbeing and on families are enormous, as the risks and consequences go well beyond an individual woman. Depression in pregnancy is linked to preterm birth and low birth weight, which increases the risk of complications such as undernutrition and heart disease. Women who suffer from postpartum depression are often stigmatized and less likely to benefit from postnatal and preventive health care for themselves and their children. Partners and families may have difficulty understanding why a new mother who should be happy at the birth of a healthy baby is depressed.

A community health volunteer explains the use of pregnancy tests to a client.

This World Health Worker Week (April 2-8), we honor the health workers around the world who work every day to improve health in their communities. This photo essay illustrates the important role that community health volunteers play in strengthening Madagascar's health system.

Community health volunteers (CHVs) play a critical role in providing primary health care services in Madagascar, especially for rural populations who live far from health facilities. In many areas of the country, CHVs often collectively offer services to more people than health centers do. CHVs are important extensions of the Malagasy health system, particularly for women and children.

As of 2016, the USAID Mikolo Project, led by MSH and funded by USAID, supported nearly 7,000 CHVs across 506 communes. They fill a critical gap in human resources for health in support of the Ministry of Public Health’s efforts to improve health care in the country.

[A CHV provides reproductive health education.]A CHV provides reproductive health education.

 {Photo credit: Todd Shapera}Community Health Workers during a morning of training on the lawn at Rukumo Health Center, Rwanda.Photo credit: Todd Shapera

(This post originally appeared on the WomenDeliver blog.)

Throughout global societies, women’s roles place them at the epicenter of risk from disease outbreaks and epidemics. This is true everywhere, but especially so in poor countries with health systems unprepared to meet the ever-surging demands of a public health emergency.

The interaction between gender roles, disease transmission, and socio-economic stability reach a perilous tipping point in epidemics; failing to address that interaction will result in deficient strategies for outbreak prevention and control, and in massive setbacks for women’s health, and development gains. Unless global health security measures help us understand the impact of emerging diseases on women, nations and the world will remain vulnerable to pandemics.

{Women in Malawi are increasingly engaging in sustainable ways to grow household income and end poverty, such as village savings and loans groups. (Photo Credit: Feed the Children / Amos Gumulira)}Women in Malawi are increasingly engaging in sustainable ways to grow household income and end poverty, such as village savings and loans groups. (Photo Credit: Feed the Children / Amos Gumulira)

Follow the conversation at the Commission on the Status of Women:

As we prepare to join the Commission on the Status of Women (CSW) next week, where the focus will be on women’s economic empowerment in the changing world of work, I am reminded of my visit to Malawi last month.

{Fatimata Kané, Project Director of the FCI Program of MSH in Mali.} Photo Credit: Catherine LalondeFatimata Kané, Project Director of the FCI Program of MSH in Mali.

(Français)

Putting a child on the earth is a whole different type of work. Not everyone can guide a woman and her baby safely through pregnancy and childbirth.

I know what it means to keep women and babies alive and healthy because I am a midwife.

As a young girl in Mali, I passed the village dispensary on my way to school every day. I felt sorry for the people lined up outside waiting for treatment for their illnesses. I always told myself that one day I would wear the white coat of health workers and help those who are sick. During my health education training, I studied midwifery because I wanted to educate, advise and assist women before, during, and after pregnancy. 

Although I stopped practicing midwifery in maternity wards, I apply my professional passion to my work with MSH. No matter where I am or what project I’m working on, I speak with midwives, visit community health centers, and counsel pregnant women about their health and about that of their children whenever I can. When I visit communities, I encourage women to go to their local clinics for prenatal exams and to breastfeed and vaccinate their babies.

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