Bringing Women and Reproductive Health Back to the Global Agenda: Interview with Halida Akhter, MSH Family Planning/Reproductive Health Expert

Halida Akhter after being awarded a 2006 United Nations Population Award. {Photo credit: MSH.}Photo credit: MSH.

On January 11, 2010, Secretary of State Hillary Clinton, gave a speech marking the 15th anniversary of the United Nation’s International Conference on Population and Development held in Cairo, Egypt (Cairo ICPD). During the course of the conference, 179 countries came to an agreement that population and development issues are inextricably linked and that for countries to evolve, promoting reproductive health, as well as supporting education and health, is essential. Human rights and empowering women, including gender equality, supporting a woman’s ability to participate in her reproductive health, and eliminating violence and discrimination against women, were acknowledged at Cairo ICPD as vital to development and population policies.

MSH interviewed Halida Akhter, our Global Technical Lead in Family Planning/Reproductive Health soon after Secretary of State Clinton’s speech.

What does Secretary of State Clinton’s speech and recognition of Cairo ICPD now mean for family planning?
Clinton’s speech reflects a renewed commitment for women’s health and is bringing women’s health back to the development agenda. She emphasized that reproductive health care is critical to a nation’s development and that it can be achieved through shared responsibility and partnership.

What happened to the goals set by Cairo ICPD for women and reproductive health over the last fifteen years?
In the years immediately after Cairo ICPD, developing countries began to incorporate reproductive health into larger health programs and policy and were able to make progress. India, China, Nepal, Bhutan, and Bangladesh, in particular, made notable strides to put reproductive health at the forefront of their national health programs and policies. However, by the late 90s, priorities in the donor community shifted—especially as the need to respond to the HIV & AIDS crisis became more and more imperative—and funding for family/reproductive health and adolescent reproductive health fell.

What was it like hearing Secretary Clinton affirm all that Cairo stood for so many years later?
It is very encouraging that there is now a renewed interest in women’s health and empowerment and family planning/reproductive health (FP/RH), not just in the United States as reflected in Secretary Clinton’s speech but globally. And, that there is an understanding that addressing women’s issues and increasing access to family planning/reproductive health services are vital for other health and social sector interventions—including those directed at HIV & AIDS—to have an overall impact on a country’s well-being.

In her speech, Secretary Clinton said, the administration will integrate “women’s issues as key elements of our foreign policy agenda”? Why is this significant?
Secretary Clinton is recognizing that the health and status of women are vital to the stability and economic well-being of a country. No country can develop if they leave behind 50 percent of their population who often in these cases have little access to health care and education, no cash income, no means to control the size of their families, and are not participating politically.

Developing countries need resources to support women’s participation in the labor force so women can better care for their families, gain economic independence, and increase their value to society. They need support to improve women’s health, including access to health services that include FP/RH, and prenatal/antenatal care. And, they need encouragement to empower women to openly address the social conditions that endanger their health and lives, including taking steps in policymaking to end gender discrimination and violence.

Secretary Clinton also said, “we have pledged new funding, new programs, and a renewed commitment to achieve Millennium Development Goal Five, namely a [three-fourths] reduction in global maternal mortality, and universal access to reproductive healthcare.” What interventions do we know will help us reach this goal?
Universal access to reproductive healthcare, including family planning is vital. Regrettably, the goal of universal access to reproductive health, agreed to at Cairo ICPD, was not explicitly included in the Millennium Development Goals (MDGs), and investments in this area are now considered essential to their achievement. Care in pregnancy during and after childbirth and emergency obstetric care are necessary to reduce unwanted pregnancy, unsafe abortion, and maternal death, saving lives of women and the lives of their children.

Secretary Clinton noted that the President’s Global Health Initiative, announced in May, will “address interrelated health challenges together, for example by integrating family planning, maternal health services, and HIV & AIDS screening and treatment…”  What does this mean for health programming in international development?
Integration means offering multiple health care services at the same facility or through a community-based program to benefit clients, providers, and programs. Integrated services increase program efficiency, clients’ convenience, and save money that might have been spent maintaining separate facilities.

When services are not integrated, there can be missed opportunities to reach populations with critical information and services. For example, there are many countries where FP/RH services are not being funded or have been overlooked in favor of programs with funds directed to a particular health area, such as HIV & AIDS. Preventing unintended pregnancies in women with HIV is a key strategy for preventing new infections through mother-to-child transmission. By integrating FP/RH services with HIV care and prevention services, people with HIV have greater access to family planning. At the same time, offering HIV testing and counseling to clients already receiving family planning services increases access to those services with possibly less stigma.

Integrated services are helpful in many cases, but they can be challenging. They demand a strong political commitment and additional resources to get off the ground—funds, trained personnel, and more importantly, operational models, and adequate data.

What is MSH’s approach to FP/RH health work?
MSH has been helping public and private organizations build effective FP/RH programs for more than 30 years. In recent years, MSH has been playing a leadership role in repositioning family planning as an essential health and development intervention. We’ve also been promoting evidence-based best practices, including the return of healthy timing and spacing of pregnancy, to the forefront of global reproductive health policy. Since 2000, we have offered FP/RH support to state and national governments, public-private partnerships, and community-based organizations in more than 50 countries.

Interventions include the support of antenatal care, safe delivery, postpartum care, adolescent FP/RH, voluntary family planning services, and postabortion care. They also address newborn and child survival issues. In all cases, MSH realizes the critical importance of integrating various reproductive health components in both health and non-health systems. Among other things, the model ensures greater access to, and use of, FP/RH services—including commodities—through well-targeted health systems strengthening actions. It also increases demand for services and products by integrating behavior change communication into all activities dedicated to the target populations.

Now that the Obama Administration has given a clear mandate that there is a need for a renewed focus on women’s health, what should the international health community be doing?
There is still a need for a focused emphasis on family planning across the health sector—particularly related to healthy timing and birth spacing—with a stronger systems approach. To achieve the Cairo ICPD goals and MDGs, the international health community can help governments set up robust family planning programs with a focus on policy advocacy, program management, and creating demand at the community level. We can help develop quality services, assist with having in place practical clinical services guidelines, as well as trained, supervised, and motivated service providers and promoters at both the facility and community level.  And, we can assist countries with increasing the visibility of governments’ reproductive health policies, build capacity in governments to ensure that integrated reproductive health remains a priority for governments, and identify gaps and opportunities for the scale up of family planning services, particularly at the district and community levels.

Halida Akhter is a reproductive health epidemiologist with over 25 years of national and international work experience in reproductive health issues. She was closely involved with the preparatory meetings for Cairo ICPD both nationally and at the United Nations level and represented the Bangladesh government as a reproductive health expert delegate at Cairo ICPD and at ICPD +5, which met five years later in New York City. Prior to joining MSH, Dr. Akhter was the founder and director of the leading reproductive health research institute of Bangladesh named Bangladesh Institute of Research for Promotion of Essential and Reproductive Health and Technologies, served as Director General of the largest reproductive health nongovernmental organization of Bangladesh Family Planning Association of Bangladesh. She has trained numerous medical and paramedical professionals in family planning/reproductive health and has created many reproductive health professionals and researchers. Dr. Akhter is the founder of a grassroots organization that trains women to become community maternity practitioners in rural Bangladesh.