Category Archives: Uncategorized

19th International AIDS Conference

The 19^th International AIDS conference came to a close this summer amid much talk of the beginning of the end of AIDS, turning the tide on HIV and even a potential cure. It is now more certain than ever that we have the tools, the medicine and experience to stop this epidemic.

While we make gains in certain areas of the globe, we remain mired in a global epidemic. For every person placed on HAART, two more people become infected. We now have 34 million people living with HIV/AIDS and are treating only 8 million of the 15 million eligible people in resource poor countries. At least 25% of HIV infected individuals do not know they are infected and, as a result cannot protect themselves or their sexual partners. These statistics are sobering to an organization like ours—since we treat pregnant women who may or may not know they are infected while a new life steadily grows inside them.

While it is really encouraging to read reports from the conference that the technology and science exists to keep infected individuals healthier and the secondary benefits of healthier communities, it is frustrating that more countries aren’t falling all over each other to fund the global roll out of HAART. Fortunately President Obama and Secretary of State Clinton reinforced their support of creating an AIDS free generation—and added another $150million to get more medicine to the patients we treat in resource poor countries. Change is incremental but the vision of an AIDS free generation is one that I hope to witness and certainly one I hope the women and infants who face so many other obstacles to keeping healthy can witness as well.

See an overview of the conference program here.[image position=”left”/]

photo © Tori Stuart Photography 2011

Life Continues…

Hurricane Isaac pummeled Haiti’s southern peninsula last weekend leaving the 400,000 men, women and children still living in flimsy tents sitting out high winds, pelting rain, streaming water and mud in the dark. Much of the power along the southern peninsula was knocked out and roads washed away leaving some communities stranded without access to health care, food and clean water. Amidst so much suffering from the 2010 hurricane, a natural disaster is unfair and cruel. Our staff members, Dr Calvaire, Jean Dube and Natacha Denis, are all safe and we are extremely thankful for their well being. I myself have been haunted by the thought of the young 19 year-old girl named Annette who was 8 months pregnant when I met her in Port-au-Prince in May (see June 8th blog entry). She is single, an orphan and now, a new mother of a beautiful baby boy. The idea of her and that new baby in the middle of a hurricane with flying debris, torrential rain, whipping wind and flooding water and mud in the flimsy tent where she lives in the Delmas neighborhood would be a nightmare for any mother to endure. The fact that she faced it alone with no family to help and no where to go to keep herself or her son safe is almost unfathomable. C2C remains committed to the people of Haiti, to lend them the support and care when their courage fails and they feel forgotten by the global community in which they live. As always, we thank C2C’s supporters for making our work possible and helping us uphold the promise we have made to this devastated nation.

Maternal Health and Economic Health

Did you know that the global impact of maternal ill health on economic productivity is estimated to be over 15 billion USD per year? The consequences of lack of access to prenatal care are destructive at all levels: for a woman and her unborn baby, for her family and the community, and for economic health of nations. Simple interventions save lives and have the potential to build a healthier economic future for millions of people living in poverty around the globe.

image via

A Decade of Change for Newborn Survival

Health Policy and Planning recently published a supplement, A Decade of Change for Newborn Survival, that shares a multi-country analysis of the changes in newborn care and survival from 2000-2010. The supplement also includes 5 detailed country case studies (Bangladesh, Malawi, Nepal, Pakistan, and Uganda) focused on the process of taking solutions to scale. In one of the papers, Gary Darmstadt et al describe the state of neonatal health in the world today versus a decade ago and the persistent disparities between those countries that have improved its newborn mortality rates and those that have not.

[pullQuote position=”center”]Progress in improving newborn survival has been slow and the global averages hide increasing regional, national and subnational disparities. For sub-Saharan Africa, on average, there has been no statistically significant change in neonatal mortality over the past decade. Without a dramatic change in the trajectory for Africa it is estimated that it will take over 150 years for an African newborn to have the same chance of survival as one born in Europe or North America (Oestergaard et al. 2011). In sharp contrast, five African countries have reduced neonatal deaths by over 25%, more than double their neighbours. Important lessons emerge from this supplement, especially around seizing opportunities to promote community-based newborn care, and to integrate newborn care interventions into frontline health worker delivery platforms, and especially into facility-based maternity care, which is already being scaled up (Mbonye et al. 2012; Zimba et al. 2012).[/pullQuote]

To read the full article, click here.

Ugandan Women Protest Maternal Mortality

At C2C, we regularly see news stories, blog posts, and personal narratives that remind us how important basic health care to ensure safe childbirth. Recently, the Boston Globe reported on a story that has been circulating around the world of international development. Ugandan women, fed up with their country’s staggering maternal mortality rate, have petitioned the Supreme Court “to declare that women’s rights are violated when they die in childbirth”. If successful, this tactic would put pressure on the government to address the dire health statistics facing young women. According to the article, 16 Ugandan women die each day in childbirth, creating tremendous fear for pregnant women during a time in their lives which should be full of joy. We’ll be following this story closely, and hope the news coverage creates a push toward greater access to health care for all Ugandans.

No Controversy!

Take Action! This week, an important global summit on family planning is being convened in London, sponsored by the Bill and Melinda Gates Foundation, DFID, and UNFPA. The intention is exciting and ambitious: to mobilize global commitments to support the rights of an additional 120 million women and girls in the world’s poorest countries to use contraceptive information, services and supplies, without coercion or discrimination, by 2020.

Help to build this important movement by signing a “no controversy” pledge. The proposition is simple: Access to contraceptives saves lives and leads to healthier, more prosperous families, communities and nations. There is “no controversy” in raising your voice for millions of women and girls who want access to lifesaving contraceptives

For more information, read about the summit at: http://www.londonfamilyplanningsummit.co.uk/

Family planning has been described by Management Sciences for Health (MSH) as a “triple win” health intervention: it helps reduce maternal mortality, prevent child deaths, and greatly contributes to an AIDS-free generation.

Rio+20- A Missed Opportunity

Rio+20, the United Nations Conference on Sustainable Development, recently brought together more than 100 Heads of State to discuss sustainable development and poverty reduction. However, the conference’s outcome document (The Future We Want) failed to include meaningful discussion about reproductive health.

[pullQuote position=”left”]”You cannot have maternal health without reproductive health.” -Hillary Clinton[/pullQuote]

This exclusion is unacceptable, as reproductive rights are an essential priority in the effort toward sustainable development worldwide. Women Deliver, an advocacy organization, recognized the impact of reproductive health in a recent article:

“More than 220 million women in developing countries have an unmet need for modern contraceptives. The World Health Organization estimates that there are almost 80 million unintended pregnancies every year, which lead to approximately 20 million unsafe abortions, and 68,000 maternal deaths annually.”

Not only was reproductive health excluded, but the section on gender equality was relegated to the end of the document, an issue that should have been a key element of their overall development framework.

At C2C, we believe that focusing on women’s health, rights, and development provides a powerful return on investment. Women are the drivers of social change at a national level, and investing in maternal health will have a ripple effect of positive impact on the community as a whole. While the Rio+20 Conference created positive dialogue around many development issues, it missed a huge opportunity to fully recognize the value and capacity of women across the globe.

Birth Story

The upcoming documentary film Birth Story: Ina May Gaskin and The Farm Midwives, will be a fascinating look at the role of midwives in the US maternal health system. The film is directed by Sara Lamm and Mary Wigmore, who decided to make the movie after their own experiences with childbirth. Ina May Gaskin has delivered more than 1000 babies during her 40 year career, and her birthing practices are now studied at major medical schools. More info about this documentary can be found on their Facebook page, and in a featured article in the July issue of Whole Living Magazine.

*photo by David McClister, via The Guardian

Maternal Mortality in Namibia

During my two week trip to Namibia at the end of May, the national media was humming with renewed interest in the country’s alarming maternal death rate. Three women died of preventable obstetric complications in Namibia’s primary tertiary hospital in the past month alone. Namibia’s maternal death rate has doubled in a decade and the contributing factors are complex: rural populations without accessible clinics, lack of sufficient antenatal care for pregnant women, lack of emergency obstetric capacity in regional hospitals, and a deficit of health care professionals in the public system. In the DRC community, an informal settlement outside the town of Swakopmund, C2C’s maternal and child health clinic will open next month and will provide comprehensive pre- and post-natal care, immunizations for children <1 year of age, and urgently needed family planning services.

See this story at AllAfrica.com for more details about how the Namibian Ministry of Health is viewing and tackling its maternal death crisis:

http://allafrica.com/stories/201206020003.html

Stories from Haiti

On my recent trip to Port-au-Prince, I had the honor of collecting the narratives of 11 brave Haitian pregnant women and girls who were willing to tell me their personal stories. I asked them about their childhoods, their current living situations, what they did for food and water each day, how they became pregnant and their feelings about their pregnancies. These women opened up to me with astonishing courage given the daily struggle they face to keep themselves healthy, sheltered and safe.

Of the 11 women I interviewed, not one of them had planned their pregnancy. For hours, I sat across from girls, age 19 to 23, most of whom were students who had since dropped out of school due to their pregnancies, and watched them choke back tears of disappointment and fear. They won’t be going back to school. And without a trade, these girls will be forever caught in a cycle of poverty that continues to plague much of Haiti and the developing world. Nike calls it “The Girl Effect” and it was devastating to see their future independence and well-being shattered by an unwanted pregnancy and accompanying cost burden.

Two of the girls I spoke with still haunt me. “Marie” is 22 years old, 5 months pregnant, and comes to Port-au-Prince from the border area with the Dominican Republic to receive antenatal care at our clinic at Grace Children’s Hospital. Why does she come to Grace from Terre Roche which is over 3 hours, a motorcycle and tap-tap ride, away? Because Marie is HIV-positive and, due to the enormous social stigma HIV still carries in Haiti, she gets up at 5am on her appointment days to arrive at the clinic by 8am only to wait 2-3 hours to see the doctor and then turn around and return home. It takes her all day. She was in school, but now, due to her pregnancy, she relies completely on her “boyfriend,” a motorcycle taxi driver. Marie was given by her father at the age of nine as a gift to a man in Terre Roche and has worked, unpaid, for him ever since.

“Annette” is a 19-year old orphan whose parents died when she was young, most likely from tuberculosis. She is still living under a makeshift tent with a friend in Port-au-Prince, two and a half years after the 2010 earthquake. She is HIV-positive and refuses to tell anyone of her condition, even her two sisters who live in the Dominican Republic. Annette was raped by her boyfriend who, when she became pregnant, tried to force her to take an abortion pill. Annette refused and her boyfriend abandoned her. She is unable to stay in school due to her pregnancy and has no idea how she is going to support a child. She walks to the clinic for her appointments, an hour each way in the 95-degree Haitian sun at 8 months pregnant. She currently begs on the street for money to buy food and water. She is unable to stay on her anti-retroviral therapy as she does not always have food available to avoid the extreme nausea that comes with taking ARTs on an empty stomach. She is completely terrified and wept openly for the majority of our discussion. Yet she insisted on continuing the interview.

How can one not be humbled in the presence of such suffering and courage? What future do the young girls of Haiti have without information about safe sex, access to contraception and the empowerment to use it? When will there be a national public health education campaign about HIV to reduce the acute social stigma of the disease so that women like Marie and Annette are not forced into silent dungeons of isolation for fear of family and community members ostracizing them? Their circumstances are dire and the pubic systems that are supposed to support them are broken. But we cannot, nor shall we, turn our backs on these girls. Their determination to survive and to support their young children despite their bleak outlook requires our unconditional commitment to change their future and, that of their daughters, for the better.

*Photo courtesy of Nadia Todres

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