Thursday, July 29, 2010

Women Health Care

Women waiting to get medical attention at a rural health centres in Uganda. FILE PHOTO of the Monitor
While there is increasing concern about women health care, the women need to be educated much more about family Planning. Today, all parents are workers. It is wrong for those women who are there to compete in producing children or producing like they were Guinnea Pigs. Women have the challange to ensure that they can manage to look after the children they deliver as there are many shock waves in families which lead to vulnerability of children, hence the the women should produce the number of children within their means to manage in case they end up single parents, hence the need to earn income.
William Kituuka

Why Must Women Suffer for Giving Life? - Source:
Agnes Odhiambo
19 July 2010
Nairobi — Africa places a high premium on childbirth and motherhood.
And so it is fitting that the theme of the AU summit in Uganda this week is "Maternal, Infant and Child Health and Development in Africa."
Yet, a decade after governments - including African governments - made a commitment to reduce maternal mortality by 75 per cent and to provide universal access to reproductive health care by 2015, hundreds of thousands of African women and girls die each year while giving birth.
Sub-Saharan Africa is one of two regions, the other being South Asia, where the vast majority of all maternal and child deaths occur.
Africa lags behind other regions in making pregnancy and childbirth safe.
More than half of global maternal deaths occur in Africa.
A study recently published in the medical journal The Lancet found that about 343,000 women and girls around the world are estimated to have died in 2008 from pregnancy and childbirth-related causes, the majority of which are preventable.
More than half of all deaths of pregnant women or new mothers were in six countries, four of them in Africa.
African women also suffer disproportionately from childbirth injuries.
One of the most devastating is obstetric fistula, which results from prolonged obstructed labour and causes constant leakage of urine and faeces. It requires a surgical repair.
Obstetric fistula causes infections, pain, and odour.
Women who suffer this injury often are stigmatised and cut off from family, work and community life.
The full global extent of this problem is not known, but the World Health Organisation estimates that two million women and girls currently live with fistula, and roughly 50,000 to 100,000 are affected every year, mainly in sub-Saharan Africa and Asia.
In East Africa, about 6,000 to 15,000 fistulas occur annually, with wide in-country variations.
In Ethiopia 9,000 and in Kenya 3,000 women - most of them very young and from rural regions - get fistula every year. Fistula hardly exists in the developed world.
There is no shortage of declarations and commitment on paper to promoting maternal health.
There is the Protocol to the African Charter on Human and People's Rights on the Rights of Women in Africa (Maputo Protocol), the African Roadmap for Accelerating the Attainment of the MDGs related to maternal and newborn health (MNH Roadmap) adopted by over 40 countries, and the Maputo Plan of Action on sexual and reproductive health and rights.
Last year, the African Union began a campaign for accelerated reduction of maternal mortality in Africa (CARMMA), with the slogan "Africa Cares: No Woman Should Die While Giving Life."
It also declared this decade African women's decade.
During this summit, African governments need to ask themselves again why, despite these commitments, women and girls in Africa continue to die preventable deaths or suffer devastating injuries while giving life.
African leaders need to account to the continent, and especially to its women, on what they are doing to guarantee the right to a healthy pregnancy and a safe delivery.
Agnes Odhiambo is a women's rights researcher for Human Rights Watch based in Nairobi.

"Africa cares: no woman should die while giving life"
The 15th Ordinary Session of the Summit of the African Union (AU) will be held in Kampala, Uganda from 19 to 27 July, under the theme "Maternal, Infant and Child Health and Development in Africa". In an interview with New African, the AU Commissioner for Social Affairs, Bience Gawanas, explains why this theme was chosen and its significance, bearing in mind there are just five years to go before the Millennium Development Goals (MDGs) deadline.
New African: Health in general is an important aspect of Africa's development. So why will the Heads of State be discussing "Maternal, infant and Child Health and Development in Africa" at next month's summit?
Commissioner Gawanas: The AU's health programme has been very, very broad and we really focus on issues such as HIV and Aids, malaria, TB and other communicable and non-communicable diseases, we have also focused a lot on strengthening health systems and we have produced quite a lot of policy instruments over the years. For example, the Africa Health Strategy, the Africa Regional Nutritional Strategy and so on. But we have realised that something was amiss in our health strategies--and that is the state of maternal, infant and child health, which are issues absolutely connected to the MDGs. We have seen many reports which say Africa is falling behind in terms of realising the MDGs, especially numbers 4 and 5 which pertain to women and children, and Africa and the AU especially is now bringing this matter to the fore in a broader way than we have done before.

Q: How are you going to do things differently this time?
A: We have built up a lot from a campaign we launched in Addis Ababa in May last year, called the Campaign on Accelerated Reduction of Maternal Mortality in Africa (CARMMA), which is an African-led, and African-owned programme. CARMMA is multi-faceted: it is about advocacy; about social mobilisation; about strengthening and harnessing political will; about coordination and harmonisation. This was decided because many a time, our efforts do not have an impact because they are so diverse and not really coordinated. Our slogan with CARMMA is "Africa Cares: No Woman Should Die While Giving Life".
Through CARMMA, policy instruments and decisions on maternal and child health have been brought on to the continental and global agenda. But the AU has also recognised that there is a very long road between policy and its implementation. CARMMA therefore, allows the AU the opportunity to interact with member states to follow up on the decisions they have taken in regards to maternal, infant and child health. The idea is to mobilise political will, and mobilise financial resources so that we can get effective delivery systems.
Q: with maternal mortality on the rise in Africa, why has maternal and child health been on the bottom rung of the ladder to date, in comparative terms?
A: I believe this is an issue that brings you into full view of what our women are in society. I want to believe that it is also very closely related to the whole issue of gender inequality in our societies. It is only women that give birth and it is only women that die while giving life. This is why as the AU, we are saying we need to challenge our health systems. As you know many of our health systems are very disease-specific. For example, there has been a lot of emphasis on HIV and Aids, TB and malaria. But we are saying that pregnant women can also suffer from malaria, they could be HIV-positive, they could be malnourished, could be poor or could have a lot of other children. This is why we need to have a very comprehensive and integrated approach to health. We are also saying, women and children must come first, even in our health systems.
Q: How is this message being put across to the wider audience and how has it been received so far?
A: I am personally very enthusiastic about how far we have come, in the sense that, at least a lot of people are starting to talk about maternal mortality, sexual and reproductive health as well as rights, which are usually viewed as taboo subjects in some of our traditional societies. But it is good to see that we are increasingly challenging cultural traditions that are harmful to our children. This is not easy, but it is good when you see that since the launch of CARMMA, even our traditional and religious leaders are saying we need to support this initiative because our societies need healthy women, children and babies.
Q: And how does the African Union fit in as a continental body dealing with multi-faceted issues?
A: I believe that by lending its voice to this issue, the African Union and our Heads of State are sending out a message that our organisation is not just a political one. but an organisation that concerns itself with the overall wellbeing of the continent's women and children. Many of the AU member-states already have roadmaps on maternal, newborn and child morbidity and mortality, and it is important that when support is given to a country, it is built around those roadmaps.
We really need to work in such a way that at the end of the day there are five or six actions, because it is five years to 2015 when we are supposed to be reaching the MDGs. So rather than looking at 20 actions that should be taken, we are saying let us look at those that can have the highest impact and can save the lives of women and children.
Q: How optimistic are you about the outcome of the MDGs in Africa, in relation to women and children?
A: In many of the meetings that I have attended, when people are describing maternal mortality, they always say, it's really a shame on Africa. But what I can re-state and emphasise is that it's only once we have recognised the problem, that we can then provide a solution to it. Therefore the mere fact that we are debating the issue, the mere fact that the issue is in everybody's consciousness, will help drive strategies that can lead to interventions that can bring action before the MDGs deadline ends in 2015.
Q: Financing and budgetary allocation is always an issue when it comes to the effective implementation of programmes of such a broad scale. How committed is the AU in funding maternal and child health?
A: Firstly, let us look at the entire social sector. In women's debates, we have always recognised that the ministries of gender, or the ministries of children, or the ministries dealing with disability, are always underfunded. And so you are looking at the extent to which we really pay attention to social challenges within our countries. Health is one of the social sectors, but at least we know that health and education in many countries take up a huge chunk of the budget, what the AU is saying is that health financing is never enough, because sometimes, financing is very disease-specific, for example with HIV and Aids or malaria funding. But there is always a challenge with specific budget allocation. In 2001 our Heads of State at the AU Abuja special summit on HIV and Aids, malaria and TB, decided to allocate 15% of their budgets to that. Many years after that we are looking at how many of the 53 member-states have reached that target. Obviously not many have reached the target, but l am glad that there are some who are allocating more than the 15%.
The concern at the moment is not to repeat this disease-specific allocation of funding by doing the same with maternal and infant and child health. This is the challenge that we have and we are saying, let us move away from disease-specific intervention and look at the health system as a whole. Money will never be enough. What we are pushing for when we are looking at the health system now, is that the focus should be more on women and children. We must recognise the centrality of women's and children's health. And to do this effectively, we are saying, how does the health system as a whole respond to maternal and child health? And linked to this question are not just the issues about budgets for health, but issues such as how the budgets cover areas such as safe drinking water, sanitation, food security and so forth. In other words, all the social determinants of health, contribute to better health. So where there are no roads, no safe drinking water, no sanitation--all these will negatively impact on the health of mothers and children too.
Q: So how can this be effectively addressed? It is a diverse task?
A: What I am advocating for is a holistic and comprehensive approach to the issue of maternal and child health, other than just saying fine, we have the money, we will just focus this money on women and children. The health system should be made to be responsive to all the health needs of women and children.
Q: Could you elaborate on that last sentence?
A: What I am trying to emphasise is that it is not just about resource mobilisation: it is also about the effective use of available resources. For example, you could have your hundred thousand or hundred million dollars, but it is how effectively you use those available funds, and how you prioritise and what you prioritise spending on. When it comes to the health system, we are also talking about the challenges of health workers, the challenges of people having access to medicines.
Q: So come 27 July, the subject will have been dissected and hopefully pricked everyone's conscience, but what should really be anticipated?
A: It is important for the AU, our leaders and the continent that the July summit should not just be an end in itself, but a means to an end, in other words, this summit will not aim for just another declaration. We are looking forward to an outcome that will make real difference--not just another commitment.

By Evelyn Lirri
Posted Saturday, July 31 2010 at 00:00
After a decade of disappointing progress to cut maternal and child deaths, African leaders this week resolved to try again. Concluding the African Union Summit in Kampala on Tuesday, heads of state adopted new resolutions and declared that maternal and child health will remain a standing agenda item for the Union over the next five years-to 2015, which is the deadline to achieve the Millennium Development goals.
More than 500,000 women still die every year in childbirth across the globe, with majority of the deaths occurring in developing countries in Africa-where health systems are weak or non functional and health workers are scarce.
Another 12,000 children-about eight children every minute, including two newborns die on the African continent everyday mainly from treatable conditions like malaria, pneumonia, diarrhea and respiratory tract infections.

Gloomy picture
The grim statistics have persisted despite endless declarations and promises made by governments in the past to tackle the problem-one of the declarations made 16 years ago in Cairo, Egypt agreed to reduce maternal, child and infant mortality in Africa and also increase access to sexual and reproductive health services including family planning.
The picture is not any better in Uganda where maternal mortality stands at 435 for every 100,000 births while under five mortality rate is 76 per 1,000 births.
But to date, efforts to reduce both maternal and child deaths have been slow or off-target-a situation Malawian president and chair of the AU, Mr Bingu Wa Mutharika described as a shameful crisis.
In Africa, one in every 16 women dies in child delivery compared with about one in 8,000 women in the developed world. “Let this not be another song that we are going to sing and forget when we leave this hall. The crisis of maternal mortality is real and we must all take action,” Mr Wa Mutharika said.
He said it was a shame to see African mothers still dying of easily preventable causes
“Africa’s progress in reducing maternal and child deaths is still slow and today we see more children and women dying needlessly of preventable causes than of conflicts,”said Mr Jean Ping, the chairperson of the AU Commission.
For every woman who dies because of pregnancy related complications, at least 20 others suffer injuries and disabilities, like obstetric fistula. In Africa, complications during pregnancy and childbirth are the leading cause of death for women of childbearing age.
Family Planning
According to Dr Hassan Mohtashami, the deputy representative of the UN Population Fund (UNFPA) in Uganda, women continue to die of simple causes that have been resolved easily elsewhere using cost effective interventions. “Ensuring access to family planning services is one way we can reduce maternal deaths. It’s a simple calculation; the less number of pregnancies, the less chances for death,” he says.
According to him, family planning alone can reduce by a third, the number of women who die every year because of pregnancy related complications.
Cheap intervention
Another cheap intervention, he says, is having a midwife present during delivery. “If you have a skilled health worker with a mother during delivery, it will help her to detect if there is any complication and immediately do something to save the life of the baby and mother.”
This, intervention, he said, has the potential of saving another one-third of the deaths, meaning that the two interventions have the potential of saving up to two-thirds of women who would otherwise have died
“The remaining can be saved by Emergency Obstetric Care. If a mother needs specialised and sophisticated care by a doctor like caesarean and blood transfusion, then there should be a centre equipped with these facilities where mothers can be referred,” said Dr Mohtashami.
This strategy, he says, was used by Sri Lanka which has the same economic status with many sub Saharan African countries but has now managed to reduce its maternal mortality to 27 per 100,000 live births.
Prohibitive factor
But challenges still abound in most African countries including Uganda. One of the biggest obstacles to reducing maternal deaths here is the shortage of health workers and poor health infrastructure.
To meet the MDG target, Uganda needs to reduce its maternal mortality rate to 132 per every 100,000 live births by 2015- a target that already looks far from being achieved. One of the resolutions made by the heads of state is to strengthen health systems and make childbirth health care services free for women and children under the age of five. Women advocacy groups had argued that cost was a prohibitive factor for many women and had resulted into a number of them giving birth at home without a skilled attendant.
Ms Bience Gawanas, the commissioner for social affairs at the AU said that she hoped that with the heads of state taking a lead on reducing maternal mortality, much more progress will be made in the run up to the 2015 deadline.

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