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Posts Tagged ‘maternal health’

Below is a sampling of reading material here at Science Speaks that you might find interesting. Let us know your thoughts!

  • A study released this week found that the mining industry may be a driving force in the TB epidemic in Sub-Saharan Africa.  From lead author Dr. David Stuckler of Oxford University: “It’s well known that miners have the highest risk of tuberculosis of any occupational group in the world, especially in sub-Saharan Africa.  But the striking finding of our study was that not just miners are at risk…these risks are spread to their families, communities and entire countries.”
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This post is by the Global Center’s Rabita Aziz.

The White Ribbon Alliance for Safe Motherhood joined with several other health and development organizations to host a panel discussion on maternal health in Africa on Capitol Hill today.  The forum was moderated by African Medical and Research Foundation (AMREF) board member and journalist Carol Jenkins.  It also featured Eric Friedman with Physicians for Human Rights, Katie Porter with CARE, and Dr. Miriam Were, another board member of AMREF and the former chairperson of the National AIDS Control Council of Kenya. 

The panelists discussed ways to reach the 4th and 5th UN Millennium Development Goals, which focus on reducing child and maternal mortality rates and achieving universal access to reproductive health care by 2015.  Africa is home to 24 percent of the world’s disease burden and more than over half of the world’s maternal mortality cases, but only 3 percent of the world’s health care force.

The panelists outlined actions that must be taken to reduce the disturbingly high maternal mortality rate, while also generally improving health systems in Africa.  Eric Friedman cited this recent Lancet study, which showed that maternal mortality rates have decreased to less than 350,000 deaths in 2008 from over half a million in 1980. But study also found that HIV remains a major barrier to saving more mother’s lives.  For example, Friedman pointed the study’s findings that 20 percent of deaths during pregnancy, childbirth , or post-partum are linked to HIV/AIDS.  (Read more about that study here and here.) He went on to say that ensuring universal access to HIV/AIDS treatment is critical for reducing the number of maternal mortalities.  In addition, it is vital that additional care and support are provided to HIV-infected mothers and that prevention programs are scaled up.  One audience member pointed out that many of the women who died due HIV/AIDS complications had no access to treatment whatsoever.  Friedman said the number of AIDS-related maternal deaths could potentially increase in the future because of the flat funding for US global AIDS programs, which has resulted in some patients—including pregnant and breastfeeding women— being turned away for treatment.

When asked about how international support can be galvanized to increase financial support for maternal health programs, Porter answered that the best way to mobilize world leaders is for the U.S. government to take stronger actions and make larger contributions to global health programs.  She said if the U.S. shows a larger commitment to reaching the MDGs, then that will help leverage greater support from other donor nations 

Dr. Were said because the U.S. has an elevated position in the world, it is uniquely poised to dedicate more resources to greatly improve the dismal state of maternal health in Africa.    Friedman said that just an additional $35-$40 contribution per American, per year, would save 23 million lives by 2015.  The panelists urged lawmakers and members of civil society alike to take such numbers into consideration and ask what our priorities are.

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This posting is by Rabita Aziz, Program Associate at the IDSA/HIVMA Global Center

The new report by the Center for Strategic and International Studies (CSIS) Commission on Smart Global Health Policy  calls for the U.S. to double contributions to better maternal and child health, to $2 billion a year.  Such investments should be focused on a few core countries in Africa and South Asia where there is a clear need, where partner governments are willingly engaged, and where concrete health gains can be made along with increasing a country’s capacities.

The report demonstrates that maternal mortality is a profound problem by offering this data: a woman’s risk of dying in pregnancy or childbirth is 1 in 7,300 in the industrialized world, 1 in 120 in Asia, and 1 in 22 in sub-Saharan Africa.  Although there are clear preventative solutions in many of these cases, accessing such measures is problematic.

The report states that improving maternal mortality requires an interlinked set of interventions that are supported and sustained over time, including heightened efforts to improve local transport.  In addition to addressing maternal mortality, it is imperative that efforts to end child and infant mortality are undertaken.  The report states that it is estimated that a package of 16 simple and cost-effective measures could prevent nearly 3 million of the estimated 4 million deaths in the first month of life.  Additionally, expanding access to immunizations can save the lives of 2 million children under the age of five.

Although the report clearly states that maintaining America’s commitment to fighting against HIV/AIDS is one element in a global health strategy, it fails to integrate this commitment within the framework of strengthening maternal and child health.

Globally, HIV/AIDS is the leading cause of death among women of reproductive age.  When half of the 31.3 million people living with HIV worldwide are women, and 98 percent of them reside in developing countries, the importance of envisioning HIV/AIDS as a maternal and child health issue is clear.  Integrating HIV/AIDS efforts within efforts to improve maternal and child health, and scaling them up, is key to a rights-based approach to health.

Among pregnant women in Johannesburg, South Africa’s most populous city, HIV is the main cause of death, according to a five-year study of maternal mortality at one of the city’s largest public hospitals

It is also important to recognize that HIV-negative children born to HIV-positive mothers still face high mortality risks as long as their mothers are not receiving treatment.   A Ugandan study found that not only is there a 95% reduction in mortality among HIV infected adults after 16 weeks of antiretroviral treatment, but there is an 81% reduction in mortality in their uninfected children younger than 10, and an estimated 93% reduction in orphan hood.[1]

Unfortunately, there is no mention in the report of undertaking initiatives to reduce the prevalence of HIV/AIDS among women and ensure access to treatment as a key maternal health strategy, even though it is clear that taking such measures will greatly strengthen families and communities.  Prevention of mother to child transmission of HIV is imperative, as well as ensuring access to ongoing treatment for the mother.


[1] Mermin et al (2008) Mortality in HIV-infected Ugandan adults receiving antiretroviral treatment and survival of their HIV-uninfected children: a prospective cohort study Lancet 371: 752-759.

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The Center for Strategic and International Studies yesterday unveiled  a new “must-read” report for global health advocates, “Smart Global Health Policy.” While a panel at the Congressionally-chartered Institute of Medicine, made up primarily of scientists, issued recommendations on US global health policy last year, the CSIS panel is the first to involve high-level business leaders and sitting members of Congress.

The report drew on observations made during a study trip to Kenya, but it is unclear if consultation in developing countries went beyond that, for instance to include global representatives of affected communities and of developing country civil society, such as those on the boards of UNITAID and the Global Fund.

The report and the webcast of the launch event are available online.  Here are a few highlights:

The report makes a strong case that it is in the interest of the United States to continue and increase  our investment in global health and that the issue should matter to all Americans. It calls for keeping funding for AIDS, TB and malaria on a “consistent trajectory,” doubling spending on maternal and child health to $2 billion a year, forging a collaborative response to emerging heath threats, establishing strong coordination of global health policy across US agencies, and increasing support for multilateral efforts.

In 2009 there was a massive drop off in the expansion of treatment by US programs, and the report notes that AIDS advocates are “particularly anxious” at the slowing growth rate, a stalling that could also impact health systems.  The report suggests that funding is a concern for treatment advocates, yet, in fact, HIV prevention advocates have also been quite alarmed at the essentially flatline funding picture.

Despite World TB Day (March 24) being just a few days away, no mention is made in the report of immediate tuberculosis funding concerns, lowered TB targets in the 6-year Global Health Initiative or USAID’s role in responding to TB.  Instead, the report includes TB within a much longer timeframe, stating that “we can accomplish great things in the next 15 years:  We can cut the rate of new HIV infections by two thirds, end the threat of drug-resistant tuberculosis, and eliminate malaria deaths.”

In terms of overall funding, the report calls for less spending in the near term than either the IOM panel or the Global Health Initiative coalition did; instead, the CSIS document endorses the President’s proposed funding of $63 billion by 2014.  While the IOM called for specific increased funding levels on AIDS, TB and malaria consistent with Lantos-Hyde, the CSIS report does not delve into specific funding levels, with the exception of maternal and child health.  Instead, taking the long view, it calls for $25 billion in annual spending by 2025.

One exciting aspect of the CSIS report is that it endorses innovative financing as a means of raising funds for global health.  The report does not touch on the concept of innovative taxation for health, recently championed by maternal health advocates at Family Care International and many other groups. However, it identifies some specific mechanisms, such as borrowing the money needed through an international finance facility, and it urges the US National Security Council to review the most promising ideas on innovative financing and develop a US position.

Admiral William J. Fallon kicked off the launch event, stating that global health is a “bipartisan enterprise… which can unite US citizens in collective action.”  He stated the importance of maintaining forward momentum, noting that “we do not want to coast or slide backward.”  Helene Gayle said that global health efforts are showcasing the American spirit of generosity and said “we need forward momentum even in a period of constrained resources.”

Jack Lew, the top State Department official developing the US Global Health Initiative, spoke about the Administration’s goals in developing the new strategy. He said that the Administration’s aim was to “challenge a way of doing business by moving beyond a primary focus on disease treatment.”  He said the goal was “not to do harm to existing programs.”

Advocates for effective HIV prevention have felt stymied in recent weeks by the lack of specific HIV/AIDS guidances from the Administration to the field and have noted that Kenya’s Partnership Framework with the US even appears to rule out family planning integration.  Family planning came up at the event when Dr. Michael Merson, of Duke University, criticized the Canadian government’s rejection of the inclusion of family planning as a part of its maternal health initiative.

But Lew’s presentation did not delve into details — and there was no opportunity at the event for questions from the floor.  He stated that program integration was crucial to meet the needs of women, and he commented on the importance of having family planning and HIV/AIDS services in one location.

The report is particularly noteworthy for the very strong focus on measurement for accountability in delivering services. Business leaders at the event decried the reporting burden on health programs and, along with Dr. Merson, called for a common set of impact indicators.

Rajeev Venkayya, Director of Global Health Delivery at the Bill and Gates Melinda Foundation, said that measurement matters because it allows us to maximize efficiency and stretch dollars while identifying what works and what doesn’t.  In addition, measurement allows us to hold accountable institutions, organizations, and even individuals, which in turn allows for greater project improvement.  Exxon Mobil Chairman and CEO Rex Tillerson agreed, and cited a Lancet article which said that evaluation must be a top priority for global health.

Robert Rubin, former US Treasury Secretary and former head of Citigroup and Goldman Sachs, told the audience that global health leaders “face wrenching choices” as a result of US fiscal problems.  He asked two members of Congress, Rep. Keith Ellison and Senator Jeanne Shaheen, whether global health is an issue that can “break through the mire” on Capitol Hill.

Senator Shaheen said that the issue can succeed, but it is crucial to explain to Americans that international affairs spending is only a tiny fraction of the US budget, much less than people realize.   She said it was cheaper to spend on global health than on war, noting Bill Clinton’s recent statement about the appreciation of PEPFAR expressed by Muslim residents of Tanzania.  She also said the current committee structure in Congress is an impediment and endorsed the recommendation included in the report for a consultative body that would work across committees.

Congressman Ellison also voiced strong support for greater US action on global health, stating that “infectious diseases know no borders.”  He said that while in Kenya, he made good progress in persuading Kenyan leaders of the necessity of stepping up their own contributions.  He suggested that by reducing US spending on outmoded weapons systems the US could improve its budget outlook and make global health spending easier.

Gayle Smith, the NSC official leading the development of the US Global health Initiative, was the concluding speaker at the event. She said global health was a bipartisan issue and that in fact President Obama specifically directed that the achievements of the previous Republican Administration be recognized.  She praised the CSIS report, and said that its ideas were remarkably congruent with those of the Administration.

She said the Administration’s commitment to fighting global HIV/AIDS was “absolute” and, she added, “this will grow over the life of the initiative.” She said the Administration’s plans for the Global Health Initiative “include an ambitions set of targets in terms of outcomes.”

She did not respond to concerns submitted to the Administration by the Global Center, TAG, the Global Health Council, and the GHI Working Group that the Administration’s targets regarding tuberculosis contradict a directive from Congress approved in 2008 as a part of Lantos-Hyde.  In fact, it was surprising that the event unfolded without  reference  to the consultative process which numerous NGOs have engaged in regarding the US Global Health Initiative or to the detailed analyses these groups have submitted to the Administration.

There were a range of reactions from health NGOs to the event.  Eric Friedman at Physicians for Human Rights noted the “surprisingly little attention in the report to human resources for health and health systems, and no mention of including civil society in the development of country compacts.” He praised the report for “proposing that the Administration develop a long-term, 15-year framework for making progress in and committing the United States to improving global health, a good idea so long as it does not set the stage for underambition, and is flexible to respond to changes in the years ahead. ” He also would have liked to see “a recommendation that the United States should deliberately integrate a right to health approach throughout U.S. global health programs, including the consistent focus on equality, accountability, and participation that this entails.”

Matt Kavanagh at Health GAP praised what he heard from the report, which included an emphasis on keeping up the fight against HIV/AIDS, especially important for the health of African women. But he noted with concern that “some of the Administration comments that seemed to favor prioritizing ‘cheap’ interventions that do not work in the long term, such as single dose nevirapine instead of treatment for HIV positive mothers, an approach abandoned long ago as ineffective in wealthy nations.”

The American Medical Students Association’s Farheen A. Qurashi said that the report “takes a bold, but necessary, approach to U.S. global health planning by insisting upon a 15-year comprehensive plan.”  She said, “Unfortunately, the Commission’s report does not appear to specify the need for scaling-up of PEPFAR investments versus the dangers of flat-funding, and instead uses language that suggests that a continuation of current levels of funding without annual growth is sufficient.”

On health systems, she said that “though integration and health systems strengthening is mentioned in general terms, and the need for training and retention of health care workers is noted, there is no detailed analysis of the measures, funding, and support necessary to establish and retain adequate numbers of health professionals and other health care workers.”

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