Maternal & Child Health

The Answer for Indigenous Mothers? Native Midwives

This guest post was originally posted on the Frontline Health Workers Coalition (FHWC) website and is written by Joy Marini of Johnson & Johnson Global Community Impact and Global Health Council Board Member. Johnson & Johnson invests in people on the front lines of care as they change the trajectory of health for the world’s most vulnerable people, their families, and their communities.The Frontline Health Workers Coalition is an alliance of United States-based organizations working together to urge greater and more strategic U.S. investment in frontline health workers in low- and middle-income countries as a cost-effective way to save lives and foster a healthier, safer, and more prosperous world. FHWC and Johnson & Johnson is a 2018 Global Health Council member.

Midwife Vàng Tả Mẩy shown here with Chảo Tả Mẩy, mother in Nậm Giang 2 community in Vietnam’s Lao Cai province. Photo courtesy of UNICEF Vietnam

I could hear the jingling bells on the midwife’s hand-made, traditional dress as I approached the top of the mountain in Nậm Giang 2 community in the mountains of Lao Cai, Vietnam. Gasping for breath from the hike, I was greeted by the smiling midwife, Vàng Tả Mẩy, who was visiting the home of a young mother in this community. Mẩy and this young mother are one of 1.7 million Tày people, agriculturalists and the second largest ethnic minority in Vietnam. Tày homes are far apart with most not accessible by car, or even motorcycle. Tày indigenous midwives, many educated in a partnership between Johnson & Johnson and UNICEF, travel by foot up the mountains to visit soon-to-be moms, many of them girls between the ages of 15-20.

Kangaroo care from a Hmong mother in Vietnam. Photo courtesy of UNICEF Vietnam.

Mẩy shares information to ensure that pregnancies are healthy and that births take place in a health facility as much as possible. At the same time, the nearest hospital, which is still a long walk, plus a 2-hour drive on winding mountain roads, aims to provide high quality and culturally sensitive care with an emphasis on midwifery education and low-tech interventions. Dr. Nguyen Huy Du, a maternal-child health specialist at UNICEF, said, “The support from Johnson & Johnson has contributed to initial introduction and national wide scale-up of effective maternal and child health interventions in Vietnam, for instance early essential newborn care and Kangaroo Mother Care.”

Vietnam, like many low- or middle-income countries, showed improvement in maternal and newborn mortality during the era of the Millennium Development Goals, but a gap remains between disadvantaged groups and more privileged groups. Poverty, education, language and geography are among the many barriers to health care. Ethnicity may have a direct effect on health inequity, above income and education – indigenous people comprise 5% of the world population, but they make up 15% of the extreme poor.

In the Sustainable Development Goals, indigenous people are referenced only 6 times, and not at all in SDG 3 — “to ensure healthy lives and promote well-being for all at all ages.”

Globally, inequity in health services is often most discernable for indigenous people during pregnancy and birth. Higher rates of home births lead to high maternal and neonatal mortality rates. Current solutions range from forcing Native women to travel to birth centers, to medicalization of birth, but these approaches do not address cultural issues, such as a view in some groups that birth is a ceremony with important rituals or celebration, rather than a medical process.

To achieve the SDGs for mothers and newborns, we must:

1) Ensure that communities have a skilled, indigenous midwife, who understands local culture
2) Deliver health services in native languages
3) Include indigenous people in decision-making and planning for health services
4) Learn from indigenous groups, who experience birth as part of their connection to community, history, and the land
5) Disaggregate data to make indigenous women visible, and understand their unique experiences during pregnancy and childbirth
6) Support solutions developed by indigenous communities from government, civil society and private sector

Programs such as the Bolivian government’s midwifery training program for indigenous midwives are already showing promise in saving the lives of mothers and babies. And there is a growing recognition that mainstream hospital practices are not always respectful of Native women, resulting in a resurgence of indigenous midwifery in Canada and the United States.

With a promise to “leave no one behind”, the SDGs present an opportunity for us to recognize and learn from indigenous populations, who bring cultural traditions and a hope for a rich, diverse future. A welcoming community of women who receive local, respectful care could be one answer to the healthcare gap for indigenous people.

As the bells on her dress whispered in the Lao Cai mountain breeze, Tày midwife Ms. Mẩy proudly said, “This community knows me and trusts me. I have lived here all of my life.”

May 5 marks International Day of the Midwife. Follow @JNJGlobalHealth on Twitter and Instagram for more on the role midwives and midwifery leaders play in a healthy, safe and equitable world.

More Than Words – The Case for Cultural Sensitivity in Translation

This blog was written by Sandra Alboum, founder and CEO of Alboum Translation Services as part of Global Health Council’s Member Spotlight Series. Alboum Translation Services is a translation agency that serves nonprofits worldwide. Their clients include the World Health Organization, Elizabeth Glaser Pediatric AIDS Foundation, American Cancer Society, Johns Hopkins Bloomberg School of Public Health, Pathfinder International, and Planned Parenthood, as well as other organizations working in public health, education, the environment, human services, and arts and culture. For more information, visit www.alboum.com or contact Sandra at sandra@alboum.com. Alboum Translation Services is a Global Health Council 2018 member.

Tibetan nomadic women attend a maternal and child health education session © 2005 Aleksandr Dye, Courtesy of Photoshare

“Your auntie’s aunt.” Roughly translated from Mandarin to English, that’s how Chinese women refer to getting their period each month. Your auntie’s aunt arrives and then when she longer comes because of menopause, she goes on holiday. More than slang, this is how physicians also refer to women’s monthly cycles in conversations with patients.

Understanding this cultural nuance was critical to the success of one nonprofit’s recent global patient education campaign. The organization had embarked on an effort to educate women worldwide about early signs of ovarian cancer. US-based program managers felt strongly that all materials should use accurate medical terminology rather than colloquialisms, as the program sought to provide women with appropriate language to use when speaking with their doctors. Brochures and fact sheets were translated from English into six languages. When, as part of the quality control process, translations were back-translated into English, the less formal language of “your auntie’s aunt” and “holiday” were found. Program managers insisted these be changed – calling into question the overall quality of the translation. Translators and editors pushed back, however, citing the program’s goals as the reason for the non-medical terminology.

In the end, the translation team’s recommendations prevailed and the educational materials were published utilizing language that was truly understood by the intended audience. While not the terminology we’d use in the United States in English, it was the terminology that made the campaign the most effective and impactful in China.

Had translators used medical terminology in the ovarian cancer prevention campaign described, the materials would have been rendered useless before they were placed in a single patient’s hand. Terms like menstruation, menstrual cycle, and menopause would have not been understood as relevant to them – they would have been glossed over as something they’d never heard of and therefore never experienced. With this story in mind, and as you consider your own organization’s global campaigns, here are a few ways to ensure effective communications and materials.

1) Skip Google Translate (and other automated tools). You get what you pay for with a free tool. Professional translators bring the human element of communication – the understanding of context and cultural nuance that is essential to a quality translation. While fluency in both the original and target language is essential, translators who are familiar with the subject matter of the material being translated bring additional value to delivering an accurate, effective translation.

2) Know Your Audience. Spanish isn’t Spanish worldwide and even in the United States. Start by defining your audience – where will the material be used or where is your audience from? If you’re targeting European Spanish speakers, their dialect will be notably different from those hailing from Mexico or Ecuador. Also consider the reading level of your audience. If you’re talking to a population with lower (or no) education, their ability to understand complex material may be limited.

3) Consider Cultural Nuances. How one culture refers to a health condition is often notably different from another. Be flexible with both words and graphics to most effectively convey your message in another language or geography. In addition, review images to ensure they reflect the audience as well. There’s little value in a photograph of a white woman in shorts and a short-sleeved t-shirt on a tree-lined street in a communication being used in the Middle East where women traditionally cover their bodies and communities look markedly different that those in suburban America.

As with any marketing, advocacy, fundraising, or communications program, global campaigns and domestic programs targeting non-English speaking populations must consider the program goals, audience, materials, and budget for them to have maximum effectiveness.

Why UHC Day is a Call to Action for the World’s Youth

This guest post was written by Arush Lal, Global Health Corps Fellow at Frontline Health Workers Coalition (FHWC) c/o IntraHealth International.  The post was originally published on the FHWC website. The Frontline Health Workers Coalition (FHWC) is an alliance of United States-based organizations working together to urge greater and more strategic U.S. investment in frontline health workers in developing countries as a cost-effective way to save lives and foster a healthier, safer and more prosperous world. FHWC is a 2017 Global Health Council member.

It’s no accident that Universal Health Coverage Day December 12 — falls on the heels of Human Rights Day. Universal health coverage (UHC), the goal of ensuring that all people can access essential health services without exposure to financial hardship, is a dignity and a right not afforded to many around the world.

Today, I remember Gabriel, a Panamanian boy half my age who first taught me how a fractured health system fails people. I met Gabriel in the waning hours of our fourth clinic day, where our team of passionate doctors and volunteers was visibly exhausted after treating hundreds of patients in the remote islands along Panama’s rugged coastline. I vividly recall watching him bear the sweltering heat as he waited to be examined, and felt proud when I saw him leave with a much-needed bottle of Albendazole and a bag of nutritional supplements for his sister back home. As I instructed the team to wrap up for the day, I suddenly noticed Gabriel running the winding path back to the clinic, stopping in front of me wide-eyed and out of breath. He urgently explained that his disabled grandmother needed medications to control her diabetes, but no health workers reached their part of the island. I asked him if he could bring her to the clinic before we left, but he informed me she was too weak to make the hour-long journey to meet us. I desperately wanted to help, but we were short-staffed, facing a surge of patients and a setting sun. As the leader of the group, I was faced with an impossible decision: provide the medication without an examination or send the boy home empty-handed. I was forced to choose the latter.

Gabriel is one of 400 million people who lack access to health workers, and that number grows every day. In fact, it’s estimated that the world will face a shortage of 18 million health workers by 2030, meaning a shameful rise in stories like Gabriel’s.

Where someone lives should never determine if they live, but although illness is universal, healthcare isn’t. As a vocal advocate for UHC, I now focus on health workers, because without them, health doesn’t happen. Frontline health workers are the first and only point of contact for many marginalized populations, often facing unsafe conditions with limited training, equipment, and resources needed to perform their lifesaving duties.

Investing in health workers isn’t just a cost-effective solution (the UN Secretary-General’s Commission on Health Employment and Economic Growth estimates a 9 to 1 return on investment), it’s essential to achieving the Sustainable Development Goals (SDGs) — eliminating poverty, fueling economic growth, reducing gender inequalities, and saving millions from preventable diseases.

In many ways, Gabriel reminded me of myself. Just as I, one of the youngest team leads in VAW, was busy overseeing our clinic operations to ensure rural populations had access to lifesaving care, so was he, a compassionate nine-year-old, spending his day scouting medications for his family rather than, well, being a kid. But where healthcare is scarce, everyone, including our youngest, must step up to the plate.

Arush Lal asks a question during a plenary at the Fourth Global Forum on Human Resources for Health in Dublin, Ireland, Nov. 13–17, 2017. Image Credit: Frontline Health Workers Coalition

With the support of Global Health Corps and IntraHealth International, I recently attended the Fourth Global Forum on Human Resources for Health, convened by the World Health Organization and several partners in Dublin, as a youth delegate and panelist. Along with 1,000 policymakers and advocates, we discussed possible solutions to the health workforce crisis and the pivotal role young people play.

Over half the world’s population is under 30, and young people have woefully untapped potential as crucial advocates and partners in achieving UHC. Youth aren’t just the leaders of tomorrow; they’re leaders today, as young doctors, policymakers, and researchers. Bold, innovative, and visionary, my peers are making noteworthy advances in the way we pursue global public health. Youth must be empowered to push for greater accountability, stronger policies, and sounder investments to improve access to frontline health workers and resilient health systems. Without over three billion of us at the table, world leaders will continue to struggle achieving their global health targets.

Innovative Education

As the next health workforce, young people must be actively involved in planning their future, and we should push for academic programs that cultivate students who are well-versed in the SDGs and UHC. This includes expanding models like the UN Regional Centers of Expertise, one of which I recently helped create in Atlanta, to bring the global goals onto college campuses. Similarly, there is a need to create effective education programs, like an undergraduate degree in global health systems and technology I proposed at Georgia Tech, aligning interdisciplinary curriculum with the goal of achieving UHC.

Taking Action

Young people should work with local governments and NGOs as implementers in the fight for UHC, because youth are effective at reaching vulnerable populations. IntraHealth is a shining example of how to mobilize young people as frontline health workers. Through its CS4FP Plus program, IntraHealth has trained 92 youth ambassadors to lead family planning campaigns, featuring advocates like 16-year-old Nina Kone of Burkina Faso, who pushes for gender equality while de-stigmatizing sexual education, and Abou Diallo, who ensures that young people have access to contraceptives and reproductive health services in Guinea.

A Voice For Change

Few things are more effective than a passionate young person with a platform and a voice to cut through cynicism and question the status quo. Youth can and should advocate globally, ensuring governments commit to the policies they enact.

The Dublin Declaration and an accompanying Youth Call to Action are promising examples of youth engagement in UHC done right. For the first time, “youth” appears as a key stakeholder in the Dublin Declaration — and for good reason too. Youth perspectives are catalytic in achieving the SDGs, and our fluency in social media to push our messages far and wide make us an asset to governments trying to drive change. The first generation faced with climate change and an innately powerful imagination for new technology, we apply innovative solutions to health systems gaps, creating database and information systems, training health workers online, and improving telemedicine.

Young people: Be proactive and vocal advocates for change in achieving UHC, building relationships with diverse stakeholders and holding leaders accountable when they fail to deliver.

Established leaders: Engage youth more meaningfully, as key partners and not as an afterthought or disconnected silos. Mentor us, empower us, give us a platform.

For me, the story of Gabriel regularly reminds me of two truths we simply can’t ignore:

Emboldened youth today are our future — it’s time we start recognizing it.
Our world needs more health workers — it’s time we start showing it.

To Move Forward Is To Move Together: Creating Collective Action Through Roundtables

This post was written by Melissa Chacko, Policy Associate, Global Health Council.

The global health advocacy community is diverse and functions as a conglomerate of roundtables, working groups, and coalitions (hereafter referred to as Roundtables). Roundtables can work independently or collectively, bringing advocates and researchers across various sectors together to discuss global health policy issues and to increase U.S. funding for global health accounts. The Roundtables’ impact on global health policy is a culmination of these groups’ work such as sign on letters, meetings on Capitol Hill, advocacy around legislation, and engagement with the administration. For organizations that advocate for U.S. investment in global health, the Roundtables amplify this work, as they provide strategy, build a collective voice, and push for a comprehensive holistic approach to global health delivery and care.

Provides Strategy

Roundtables give organizations the opportunity to share their knowledge with each other. Sharing this knowledge allows organizations to be current and devise collective action.

Aaron Emmel, Manager of Global Health Advocacy Initiatives at the American Academy of Pediatrics (AAP), explained, “Information sharing is essential for roundtables to move forward with advocacy strategies.” Aaron is a member of the Steering Committees for the Noncommunicable Diseases Roundtable and the Maternal, Newborn, and Child Health (MNCH) Roundtable, and the working group for A Global Agenda for Children (early childhood development). AAP also participates in other advocacy groups such as the International Family Planning Coalition; the civil society group organized by Gavi, The Vaccine Alliance; the Water, Sanitation and Health (WASH) Working Group; and the 1000 Days (nutrition) Working Group.

Aaron elaborated on how sharing knowledge brings different viewpoints to the table. “AAP shares information on pediatric health, from child survival to NCDs and chronic care. Other partners such as maternal health experts including the American College of Gynecologists, share complementary information that helps to tell a fuller story. Together we are able to add to each other’s credibility.”

Lisa Schechtman, Director of Policy and Advocacy, at WaterAid, who sits on the Steering Committee for the MNCH Roundtable and is also the co-chair for WASH Working Group, said, “Sharing information allows roundtables and individual organizations to be strategic and current in advocacy issues that organizations work on.” Lisa continued, “For smaller teams like WaterAid, and [as] one of the few organizations that work in the WASH space, having these spaces allow us to amplify our contribution as few WASH advocates are able to do that.”

Builds a Collective Voice

Roundtables build a collective voice around global health issues, bringing multiple focuses together to create stronger messages to send to Congress and the administration. Aaron emphasized this point, “Diverse voices show consensus around global health issues and allow us to validate programmatic evidence from different perspectives. There is not necessarily a national constituency for global health so it is important that roundtables allow for coordination, for members to come together and present evidence to policy makers and agencies to reinforce global health agendas.”

Lisa reinforced the power of collective voice and that “we are stronger together.” WASH is one example of this. Lisa added, “WASH focuses on the outcomes of providing services and most of these outcomes are linked directly to the goals of the MNCH Roundtable. The MNCH Roundtable helps to provide context to do what we do and MNCH-focused groups can learn from WASH and consider our inputs and strategies. This gives us credibility for the health benefits of WASH and our position in the global health community doing advocacy on WASH.”

Comprehensive Holistic Approach

Roundtables provide a space for points of integration and create holistic approaches to global health agendas. Aaron explained, “For the Reach Every Mother and Child Act (Reach Act), the child survival groups needed buy-in from the maternal health groups to create a strong message to legislators. Bringing diverse voices to policy makers shows that we are united around this issue. For NCDs, we serve as a bridge for maternal and child health; without the NCD voice, global maternal and child health policies and interventions would not necessarily include chronic illness, and without the maternal and child health voice NCD policies have not adequately addressed the unique needs of children and youth.”

On WASH integration, Lisa said, “Integration was the original reason we joined the MNCH Roundtable several years ago. Although members of the Roundtable do WASH service delivery there was almost no health organization working on WASH advocacy. WASH underlies the success of the MNCH and Nutrition community which builds more WASH champions and raises opportunities and issues.” By being a part of the MNCH Roundtable, Lisa said that “WASH is now at the table for the MNCH annual appropriations process.”

Moving Forward

To move global health forward, is to move together. Roundtables allow the global health advocacy community to come together, find areas of integration and collaboration, and build a collective voice. Lisa discussed this benefit and used WASH integration as an example. “Being a member of the Roundtables and of Global Health Council has worked hand in hand.” Lisa emphasized, “Both memberships increase the profile of WASH as a health issue and create new partnerships, in addition to the opportunity to work with Global Health Council staff.”

Looking forward, the global health advocacy community’s collective voice is now more important than ever. Aaron added, “We work in different spaces but we recognize that there is a shared agenda and vision to help and maintain the role of America as a trusted leader and partner for global health issues.”

Global Health Council works with the Roundtables to support information sharing, coordinate advocacy efforts, and be a part of the collective voice of the global health community. If you are interested in attending roundtable meetings or would like to find out more information please email advocacy@globalhealth.org.

U.S. HOUSE OF REPRESNTATIVES INTRODUCES LEGISLATION AIMED TO SAVE LIVES OF WOMEN AND CHILDREN AROUND THE WORLD

Washington, DC (October 13, 2017) – On October 10, Global Health Council (GHC) applauded U.S. Representatives David Reichert (R-WA), Betty McCollum (D-MN),Barbara Lee (D-CA), and Daniel Donovan (R-NY), who reintroduced the Reach Every Mother and Child Act (H.R. 4022) in the U.S. House of Representatives. This bipartisan legislation aims to accelerate the reduction of preventable child, newborn, and maternal deaths, putting us within reach of the global commitment to end these deaths within a generation.

“We are in reach of ending preventable maternal and child deaths—a great accomplishment in part due to U.S. leadership and investments in maternal and child health programs. Although we have drastically reduced the number of maternal, newborn, and child deaths, every day, 800 women die from complications of pregnancy and childbirth and more than 16,000 children still die from preventable causes,” said Loyce Pace, GHC President and Executive Director. “The Reach Every Mother and Child Act is an important step to ensure that we end these preventable deaths within a generation.”

The Reach Act builds upon the success of such global health initiatives as PEPFAR and the President’s Malaria Initiative (PMI), and would enact key reforms that increase the effectiveness and impact of USAID maternal and child survival programs. The U.S. Senate reintroduced the Reach Act in August.

Specifically, the legislation would require a coordinated U.S. government strategy that addresses ending preventable child and maternal deaths, as well as institute reporting requirements to improve efficiency, transparency, accountability, and oversight of maternal and child health programs. In addition, it would establish the position of Child and Maternal Survival Coordinator at USAID and ensure that the return on U.S. investments are maximized through a scale-up of the highest impact, evident-based interventions. The legislation would also allow USAID to explore innovative financing tools.

The Reach Act is supported by more than 50 diverse non-profit and faith-based organizations working to end preventable maternal, newborn, and child mortality at home and abroad.

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