Women’s 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.

What Women Want: The World Wants to Know

This blog post was written by Stephanie Bowen, Director, Strategic Communication, White Ribbon Alliance, as part of Global Health Council’s Member Spotlight series. White Ribbon Alliance is activating a people-led movement for reproductive, maternal health and rights so that all girls and women realize their right to quality health and well-being. Launching on April 11thInternational Day of Maternal Health and Rights – the What Women Want campaign has a bold goal of reaching 1 million girls and women worldwide. White Ribbon Alliance is a 2018 Global Health Council member.

In just five days, global and national partners will officially launch the What Women Want campaign. Coinciding with International Day of Maternal Health and Rights, we are coming together under one unified, neutrally-branded campaign to put women’s and girls’ voices front and center in identifying their priorities for quality reproductive, maternal health and rights.

Based on a similar campaign by White Ribbon Alliance India, What Women Want will bring together individuals and organizations worldwide to ask this basic yet often ignored question: What is your one request for quality reproductive and maternal healthcare services? The answers heard in India were simple: My own bed. Enough supplies for mine and my baby’s medical needs. A clean facility. To be treated with respect. Simple, yet profound in that every woman should be able to expect these fundamental services, no matter where she lives, what religion she practices or her income level.

Despite significant progress, the current state of reproductive, maternal and sexual health for women and girls is far from optimal: Approximately 300,000 women die during pregnancy and childbirth every year. Millions still lack access to quality reproductive and sexual healthcare. And for girls age 15 to 19 years old, complications during pregnancy and childbirth are the leading cause of death.

Transforming this picture begins with women and girls.

The findings will be aggregated for a global picture of what women and girls want and disaggregated by country to help governments focus their human and financial resources in a way that will enhance health services, improve health outcomes and strengthen health systems.

More than 150,000 women across India were surveyed by WRA India about their top priority for quality reproductive, maternal healthcare. The results were profound. Photo courtesy: WRA India

A two-year campaign that will collect and analyze responses throughout 2018 and distill and disseminate findings throughout 2019, What Women Want is meant to be owned by the women and girls who respond and all the organizations who participate. Coordinated by the White Ribbon Alliance (WRA) Global Secretariat based in Washington, D.C., What Women Want is guided by a steering committee comprised of White Ribbon Alliance India, White Ribbon Alliance Global Secretariat, the Partnership for Maternal, Newborn and Child Health (PMNCH), Every Mother Counts (EMC), International Confederation of Midwives (ICM) and E4A-MamaYe—with many more participating partners. The steering committee is also consulting with representatives of Every Woman, Every Child (EWEC), the World Health Organization’s Quality of Care Network (WHO QoC Network), and the global Quality, Equity and Dignity Advocacy Working Group (QED AWG) to align efforts and ensure the voices of women and girls are incorporated into current quality-related initiatives.

We’ve built a website, translated surveys into French, Hindi, Spanish and Swahili, and put together shareable graphics to help get the word out. But if it’s going to be successful, we need to hear from as many women and girls as possible, particularly those in low and middle-income countries whose voice often goes unheard.

That’s where you come in!

Help launch the campaign by joining the What Women Want Twitter chat on Wednesday, April 11, 2018, from 10 AM ET to 11 AM ET and share why you are joining this movement for quality healthcare. Then take – and share –  the survey!

Together, we can ensure that all women and girls receive quality healthcare as they understand it.

 

Pressing for Progress: An Interview With Dr. Roopa Dhatt on Women in Global Health

This post originally appeared on Global Health Corps blog AMPLIFY and was written by Lanice Williams, a 2016–2017 Global Health Corps fellow at Global Health Council. Follow Lanice on Twitter and join the International Women’s Day conversation using the hashtags #IWD2018 and #PressForProgress.

Women marching for gender equality. (Source: UN Women National Committee Aotearoa New Zealand)

On Thursday, March 8, the world celebrates International Women’s Day (IWD). Today, women and girls around the globe will join together to reflect on women’s accomplishments and celebrate the acts of courage shown by women who are playing a role in shaping their communities and advocating for efforts around gender equality. This year’s theme of “Press for Progress” is focused on the need to keep momentum going to ensure that we achieve gender parity. This theme is also right in line with the recent news and media attention surrounding women who have been speaking out about sexual harassment and assault. Many women are standing in solidarity and saying “no more,” as demonstrated by the #MeToo campaign that was originally started by an activist named Tarana Burke. Burke created this campaign to reach sexual assault survivors in underserved communities and encourage women globally to speak up about their experiences.

Roopa Dhatt, MD,
Co-Founder & Executive Director of Women in Global Health
(Source: Women in Global Health)

To mark the occasion of IWD and continue the #MeToo discussion, I sat down with Dr. Roopa Dhatt, the Co-Founder and Executive Director of Women in Global Health. We discussed her reflections on International Women’s Day, efforts to integrate violence against women initiatives into global health, and why closing the gender gap in global health leadership matters so much.

Lanice: You are the Co-founder and Executive Director of Women in Global Health, which was established in 2015. What was your motivation for starting the organization?

Roopa: Through my personal and student leadership journey, I discovered gender bias — unconscious and conscious — and realized how women leaders are judged by different standards. I felt passionate that the next generation of global health leadership must be different — more diverse, inclusive and representative of the world. I was also inspired and encouraged by other women leaders in global health, both peer leaders and pioneers in the field, to work together to ensure that women’s contributions no longer go unrecognized and that women are perceived as thought leaders and decision makers in improving the health and well-being of their communities and the world.

As an Indian-American from Punjab state, I have seen how women in my culture have weak power and influence, limited access to higher education and work, and are not allowed to choose their own partners. Due to the lack of visibility and recognition of women leadership in global health, a group of like-minded young women and I co-founded Women in Global Health, a movement striving to bring greater gender equity to global health. Our movement was conceived by a group of four young women in Spring 2015, each of whom found her own unique pathway to global health, but was asking the same question: what more can we do to elevate female leadership and bring it center stage in global health for greater gender equity?

Lanice: This year the theme for International Women’s Day is #PressforProgress. What does that mean to you, and what progress have you seen so far in achieving gender equity in global health leadership?

Roopa: “Press for Progress” is about uniting and advancing the global movement for gender equality, women’s rights, and empowerment in our own spheres of influence. We cannot stand by waiting for change; we each have a responsibility to advance the dialogue, shift mind-sets, change institutional policies and transform societies for greater gender equality. In global health, we have seen significant leadership on gender equality. At the top of the list is WHO Director General, Dr. Tedros, who not only made gender equality a top priority in his leadership, but also acted on those commitments, both by achieving gender parity in his senior leadership cabinet (two-thirds majority posts held by highly qualified, geographically diverse and talented women) and integrating this into the WHO’s 13th Global Program of Work over the next five years. Yet, even at the WHO, the work is only starting. Transforming organizational culture at the global, regional and national levels requires much more commitment and action from all of the WHO and member states that govern it.

We also have seen the academic community coming together to raise the visibility of women’s leadership in global health. 2017 marked the inaugural Women Leaders in Global Health Conference, hosted by Stanford Global Health, where Women in Global Health served as an implementing partner. That brought together 500 women and men from nearly 70 countries, and 250 organizations on this theme. Moreover, we are also seeing greater leadership from the private sector on women’s leadership; an example is GE Healthcare and Women in Global Health’s Heroines of Health, an honorary recognition of women who are at the frontline, taking on the toughest global health challenges in their communities. We also must recognize the thought leadership that Ilona Kickbusch provided to global health by launching the #WGH100 lists, which recognize women leaders and experts in global health.

Lanice: Over the course of last year and so far in 2018, we have seen many women speak up about experiencing sexual violence and sexual harassment. How important is it that the global health community addresses this violence against women, which affects about 35% of women globally?

Roopa: The challenges facing the global health community are centered on gender dimensions. Since 71% of the health and social care workforce globally are women, and unpaid care represents half of women’s contribution to global wealth, resilient health systems and Universal Health Coverage cannot be achieved without consideration of the gendered aspects of the health workforce. When we look closely at the health sector from a gendered lens, women are often under-resourced, underpaid or unpaid, under-trained, and not formally recognized. Moreover, they face greater harassment — sexual and physical- than men, including gender-based violence (GBV).

At the 4th Global Human Resources for Health Forum in Dublin, we hosted a storytelling evening, Lives in their hands, where we heard about the personal safety concerns of female health workers– whether it was Miatta Gbanya from Liberia, who delivered a baby by the roadside at night, or Rushaana Gallow, who faces sexual assault and death every day as she enters the “red zone” in the Cape Flats in South Africa as a first responder. These gender dimensions and personal safety concerns are the reason the WHO and Women in Global Health launched the Gender Equity Hub in the Global Health Workforce Network. We seek policy-oriented solutions to address gender inequities in the health and social care workforce — with a key priority to promote employment free from harassment, discrimination and violence.

Finally, equal numbers of women and men in leadership in global health and other sectors will reduce sexual harassment at work; this is because sexual harassment and violence is almost always committed by men and is a misuse of male power. A critical mass of women in the workplace makes it possible to change organizational culture and outlaw such abusive behavior. A critical mass of women in the workplace also makes it more likely that women will report abuses and be believed. The UN has recognized, for example, that more female peacekeepers and female police will reduce sexual violence against vulnerable populations in emergencies and conflicts. Sexual abuse and violence exist in the shadows as we have seen from #MeToo reports from many sectors. It is an issue for men just as much as women. To solve it, men must also take responsibility for stamping out abuse and making male colleagues accountable, not least because sexual harassment and violence in global health has serious costs for everyone.

Lanice: The 8th UN Secretary General, Ban Kai-Moon, stated, “There is one universal truth, applicable to all countries, cultures and communities: violence against women is never acceptable, never excusable, and never tolerable.” What are your reflections on that, and on what does that means for prioritizing action?

Roopa: I 100% agree! Action is needed; prioritizing action is not a choice, but a must. For us to reach our maximum potential as a society, women and girls must be able to live full lives without fear and violence. Without that, everything we are doing is failing at least half the population and negatively impacting all genders.

Lanice: Your mission statement notes that you work on “building a global movement that brings together all genders and backgrounds to achieve gender equality in global health leadership.” Can you tell me more about the WGH mission and the role you see women leaders playing to ensure that more violence prevention initiatives are incorporated into global health programs?

Roopa: Our vision is to achieve gender equality in global health leadership, as we know that gender equality leads to smarter global health. Our mission is based on the role of leadership–women, men and all genders practicing gender transformative leadership. Our approach is based on our foundation of being a movement and engaging all people, stakeholders, and sectors, at global, regional, and local levels, to achieve our vision. Everyone has a sphere of influence that can shape individual, interpersonal, institutional, societal, community and policy environments. We recognize this and tap into this potential using a holistic approach for greater gender equality in global health leadership.

Women as leaders have the opportunity to be gender transformative and create programs and policies that are enabling for all genders. We know that gender-based violence (GBV) impacts every aspect of society from an early age to ageing populations. Regardless of which silo of global health one’s work is in, gender is crosscutting and so is GBV. Therefore, there is an opportunity to address GBV. In one’s individual leadership role there are a few simple practices that can be integrated:

  • Build Momentum: Raise the profile of GBV in your sphere of influence — bring attention to the issue through stories, data and other evidence.
  • Create Enabling Environments: Look into your organization’s gender impact assessment tools and see whether there is a GBV component.
  • Sustain Change: Integrate it into your policy and program priorities and link your efforts to larger global initiatives.

Lanice — In what ways can the global health community work together to ensure that more violence against women prevention programs are integrated into global health programs?

Roopa — In Women in Global Health, we propose applying a gender lens and using a gender transformative approach in one’s leadership. The global health community, closely linked to the development community, is recognizing more and more how interlinked health and wellbeing are to broader determinants of health, especially gender. Women and men are impacted differently, particularly in changing socio-political environments, as a result of gender social norms, roles, and other axes of identity and inequality (i.e. age, poverty, literacy, geography, disability, and sexuality). Gender inequalities contribute to violence against women, with key factors of violence being linked to institutional and behavioral factors. Moreover, in the context of violence against women, the dialogue needs to be broader and discussed as gender-based violence (GBV).

All genders have a role to play in deconstructing the power structures that promote inequities based on gender. Men, similarly to women, have a responsibility to learn about the socially constructed gender norms and roles, and the inequalities these norms create in limiting health and well being for all people. By being aware, people can begin to address their own biases and the barriers around them, and design context-specific solutions at multiple levels to shift the drivers that are promoting GBV.

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.

Where is HER voice in the Global Fund’s next Executive Director?

This post originally appeared on the Women in Global Health website. This guest post was written by Kelly Thompson, Ann Keeling, Roopa Dhatt, and Caity Jackson from Women in Global Health. Established in 2015, Women in Global Health (WGH) was founded with the values of being a movement. WGH works with other global health organizations to encourage stakeholders from governments, civil society, foundations, academia and professional associations and the private sector to achieve gender equality in global health leadership in their space of influence. 

**Update: The original version of this blog featured data points from 2008 and early 2017. The graphic has been updated to reflect the most recent data from the GFATM Secretariat.

Infographic Courtesy: Women in Global Health

Last Tuesday, without much fanfare, The Global Fund to Fight, AIDS, Tuberculosis and Malaria (GFATM) unceremoniously announced the 4 short-listed candidates for its next Executive Director (ED). In contrast to the World Health Organization’s (WHO) recent attempts at developing a more transparent and open process for the selection of their Director General, the GFATM process has been shrouded in secrecy. The first attempt to select its ED, set to replace Dr. Mark Dybul, who stepped down in May, was abruptly aborted. With rumors swirling and one of the candidates, Helen Clark, suddenly removing her candidacy, the GFATM Board noted that due to problems encountered in the recruitment process they were going to draw that round to a conclusion and restart the process (1). In this new round, 3 men and 1 woman have been shortlisted, also harkening back to the WHO election where gender parity was not reached in the final candidates. There is also a startling lack of geographical diversity in the final candidates with two from the United Kingdom, and one each from the USA and Tanzania.  

In one way, we should not be surprised that the shortlist is dominated by men, every previous ED has been a man, with the exception of Dr. Marijke Wijnroks, who is currently serving as the Interim ED. But since women are the majority of the workforce in the sectors of health the GFATM covers it is surprising that the shortlist is not 3 women and 1 man or at least 50/50 women and men. In the lead up to the second round the names of some outstanding women leaders in global health were circulating as being in the race. Talented women are out there and we should be surprised that the final shortlist is not gender balanced. It goes without saying that whoever is selected, regardless of gender, needs to have a strong understanding of the interplay of gender within the three diseases and how to apply a gender transformative approach to their leadership.

The GFATM’s own 2017 report notes the variety of ways in which the three diseases are gendered (2). Some of the key examples include, in some parts of Africa, young women (15-24 years old) are eight times more likely than young men to be living with HIV, and in the hardest hit countries 80% of new HIV infections are among adolescent girls. Those same adolescent girls are also more likely to be impacted by tuberculosis. Whilst malaria greatly affects pregnant women and children under 5, in some areas, like the Mekong, malaria greatly impacts men, who make up the migrant and mobile population. GFATM has adjusted its funding and programming to reflect these gender needs, with 60% of current investments being targeted at women and girls, and the announcement of the HER Voice fund to be launched in November 2017. However, as noted by Hawkes, et al there are still major gaps in transforming this policy into reality and often ‘too few grant agreements are found to specify, fund or monitor gender-sensitive or transformative activities’ (3).

We urge the Board to prioritise these considerations in the ED’s selection:

1) Strong development background and connection with the reality of the context of the GFATM’s work.
2) Strong commitment to gender equality essential to delivering GFATM’s work and Universal Health Coverage (UHC).
3) Commitment to reform of the GFATM including promoting diverse leadership.
4) Commitment to partnerships and building/engaging civil society particularly from the global south.


In closing, we ask all ED candidates, how will you address gender equality in the Global Fund?  


(1) Zarocostas, John. Controversy embroils selection of new Global Fund head The Lancet , Volume 389 , Issue 10072 , e3.

(2) Results Report 2017. The Global Fund. https://www.theglobalfund.org/media/6773/corporate_2017resultsreport_report_en.pdf

(3) Hawkes, Sarah. Gender blind? An analysis of global public-private partnerships for health. Globalization and Health 201713:26