In what ways do you think that investments in females can have an impact?

The following question and answer session was originally posted on the Bill and Melinda Gates Foundation’s Blog Impatient Optimists January 9. 2011 as part of an ongoing and upcoming commitment to family planning and contraception for women in developing countries. Stay tuned for Part 2 of the conversation coming soon!

Melinda Gates and Nick Kristof Answer Your Questions

MELINDA FRENCH GATES

Melinda recently returned from a three-day trip to Bangladesh. She, along with Nick Kristof, agreed to answer readers’ questions about development issues focusing on that part of the world. Here is the first installment of the Q&A session reposted from Kristof’s  New York Times blog “On the Ground.”

Q. How can a “small” person without a lot of financial resources help the women of the world? What can each of us do to reach out to the women in Africa, Haiti, South America and the Far East? I feel so helpless and it really hurts. –JEANIE, New York City

A. MELINDA: That’s a great question, Jeanie. I believe that each of us can do important and meaningful work to make the world a better place. It’s not about the money. It’s about using whatever resources you have at your fingertips to try to improve the world.

A group of Bangladeshi women learning about childhood health and nutrition at a clinic that they visit five days a week for five months, as part of an initiative sponsored by the Bill & Melinda Gates Foundation.

I think that real giving starts with caring about others and wanting to learn more. I encourage everyone to become a student of the causes they care about. And if you are interested in learning about what you can do to help women in developing countries lead healthy and productive lives, you can go to the websites of organizations such as UNICEF, UN Women, CARE, and Save the Children that support programs focused on women. At Nothing But Nets you can purchase a bed net for just $10 to protect a mother and her children from getting malaria.

One thing that touches me the most when I travel is the fact that so many of the women I meet don’t have a voice—not in their government, often not even in their own household. They want to be able to deliver their babies in a clinic or get their children immunized, but there is no place for them to be heard. They go to incredible lengths to take care of their children, like the group of women I met with today who were at the clinic learning about health and nutrition. This is something they will do for five days a week for five months, to make sure their children are properly fed, thanks to a program put together by the Foundation.

By supporting programs like this, we in the developed world can use our voices to demand that those women have the same basic health services we do.

This is the reason why I’ve started using Twitter and Facebook to share stories and communicate with people who are making a difference—as well as those who are eager to make a difference. I’m a big believer in the power of social networks, whether they are local networks of women working together to improve newborn health in rural Bangladesh, or online networks. Use your own network to spread the word about challenges that these women face or successful organizations that you learn about so others can also become engaged.

A. NICK: Two suggestions for Jeanie’s good question. First, you don’t have to be wealthy to make a difference. Even modest donations do make a difference. For less than $1 a day, for example, you can sponsor a child through PLAN USA (I have a PLAN child in Dominican Republic, whom I visited a few years ago). Or you can browse Kiva.org or GlobalGiving.org and probably find a better use for $25 than you could find at the mall.

But even if you don’t have $25 to spare, there are other steps you can take – such as lobbying for good programs, or for change in bad ones. The CARE action network, for example, suggests who to send emails or letters to on humanitarian causes. Many other organizations have similar online campaigns. You can even introduce your child to freerice.com and, through educational game play there, support food donations. So sure it helps to be a billionaire, and Jeanie is unlikely to affect as many people as Melinda. But I’ll bet that Jeanie or anyone else can affect one or two people or more in ways that are transformative. If you see a girl who can go to school, for example, because someone has paid her school fees through Camfed, and who as a result now has an entirely different future – well, that’s the most gratifying feeling in the world.

Q. I’d like to thank the Gates, and I would like to ask how they factor in the unintended consequences which may result from their work. For example, earlier efforts to use vaccinations and other means to reduce child mortality were extremely successful in the Third World, but the consequence was very rapid and substantial population growth. I’m not suggesting that saving lives is bad; it is the most noble act a person can perform. My question is how does the Gates Foundation estimate the results of their programs, and do you plan additional efforts to ensure that the results of your work, such as population growth, are effectively managed as well? Thank you. –MARSHALL GOLDBERG

A. MELINDA: This is a question that we think a lot about. The foundation is data-driven in everything we do, from making grants to estimating and evaluating their impact. For example, here in Bangladesh, we are funding several research studies to better understand which viruses and bacteria cause the most cases of pneumonia. Only by generating solid data will we be able to make well-informed decisions. And, of course, we need to know if our work is having impact. Measurement and evaluation is built into every single grant so we can analyze the results of programs that we fund.

I want to share with you something that surprised Bill and me when we first started learning about global health. Like many people, we thought that if you made advancements in global health, rapid population growth would result. But, in fact, the opposite is true. When the health of a population improves, family size starts to decrease and population goes down. If a mother knows that her children are going to make it through to adulthood, she will have fewer children. She will have an easier time feeding those children and sending them to school. Life for her family starts to get better by every measure.

I encourage everyone to become a student of the causes they care about.Melinda Gates

But in order for this to happen, family planning is critical. More than 215 million women want to use modern contraceptives but don’t have access. That’s a crime. We need to make sure that every woman is able to choose how many children she wants to have and when she wants to have them.

A. NICK: People often push back at me when I talk about saving lives and say, in effect: There’s no point. Those people who are saved will just have more children until everyone is starving again. That’s a canard. In fact, it’s increasingly understood that one reason people have large families is because they expect some children to die. If they can be assured that their children will live, they’ll have fewer kids (after a lag). That’s why birth rates are already dropping in poor countries. Indians, for example, now have just 2.6 babies – down from almost 6 in 1950. Bangladeshis average just 2.3 babies.

The bottom line is this: the way to deal with population pressures is to support family planning, not to let children die of disease.

Q. I attended a talk once with the British economist Benny Dembitzer. He thinks that too much money is spent on the fight against malaria and other diseases, believing that a child may be saved from malaria today but could die from diptheria tomorrow. Instead, he’d rather see that money spend on primary education. As a molecular biologist, I think that the fight against insect transmitted diseases can be won, but I can understand the argument. Do you think that a point might be reached at which we have to say: Enough’s enough. Let’s give everyone bed nets and we can fight malaria through bringing people out of poverty? –ROBERT JONES

A. MELINDA: I hear that question a lot, and I don’t think it is either or. We have to do both. It is incredibly important not only to invest in health, but also to invest in efforts that stimulate economic growth, expand access to opportunity, and help the poor raise themselves out of poverty. Take agriculture, for example. We invest in agriculture because we believe that if smallholder farmers, the majority of whom are women, had access to better information and higher yielding and more resilient crops, they could better feed their families, earn higher incomes, and become self-sufficient.

On the health front, we’ve learned that in addition to causing some children to die, infectious diseases take a massive toll on those who get sick but survive. For instance, some studies have shown that children who suffer from cerebral malaria have more trouble paying attention and remembering information. The same holds for children suffering from diarrhea and for those who are undernourished, especially newborns and infants. Over 80 percent of calories in the first year of a baby’s life goes towards brain development. If that energy is used instead to fight malaria or diarrhea, the brain may not develop properly. And then children can’t live up to their full potential, no matter how good a primary education they receive. Good health is fundamental to breaking the cycle of poverty.

Just this morning, I met a beautiful little girl named Shrabonti in Mirpur, a slum in the Northwest of Dhaka, while visiting a study site exploring the link between intestinal infections, nutrition, and cognitive development. Shrabonti, who shares her name with the rainy season, looked fairly normal, until I realized that she was already 20 months old.

Melinda Gates met a 20 month-old and her mother in Mirpur, a slum in the Northwest of Dhaka, Bangladesh.

She only weighed 19lbs, the size and weight of a healthy nine-month-old. Shrabonti had already been sick 27 times in her short life, including seven bouts of diarrhea. I was left thinking—life shouldn’t be so hard for her. How do we make sure that all children like Shrabonti have the greatest chance of living up to their full potential?

A. NICK: Should American presidents focus on the economy or on national security? Obviously, the answer is both. We have many priorities and we’re fated to juggle them all. In the same way, combating malaria is important not only to save lives but also to promote economic development – but education is also critically important to build skills and transform economies and societies. So I agree with Melinda that we don’t have the luxury of picking and choosing a single target; to make a difference, we have to be jugglers.

That said, I think Robert is right that we have to scrutinize the challenges and figure out where we can be more cost-effective. One of the things that the development community has gotten better at doing is introducing metrics and rigor to see what kinds of interventions get the most bang for the buck. I do think that the evidence is pretty good that work in both education and public health tend to be highly cost-effective, and also are mutually supportive. Deworm kids and give them bed nets, and they’ll miss less school. And as they become better educated, they’ll become more concerned with their own health and will have fewer children whose health they’ll take better care of. We’re already seeing this virtuous cycle in action right now, which is why Africa is economically the fastest growing part of the world today.

For example, JHPIEGO is working to protect women and girls with strategies like HPV vaccination and improved screening.

Researchers at the University of Pennsylvania, lead by Dr. Carrie Kovarik, are using innovative techniques like mobile phone based telemedicine to improve screening for cervical cancer in resource-challenged countries.

The Global Initiative against HPV and Cervical Cancer also has several programs to fight against cervical cancer including education, strengthening HPV vaccination programs and improving screening and treatment programs for cervical cancer.

What other innovative programs are you aware of to fight this deadly disease? What approaches do you think will be most successful at eradicating cervical cancer globally?

• Gender-Based Violence: From Commitment to Action by  Daniela P. Ligiero, PhD
• Sanctions and Sanctuary: Reducing Violence-Related Health Inequities for Women and Children by Jacquelyn C. Campbell, PhD, RN, FAAN

Check out the Johns Hopkins Center for Clinical Global Education for more webcasts and resources. ]]> http://www.globalpulsejournal.com/blog/index.php/2011/12/27/confronting-gender-based-violence/feed/ 0 http://www.globalpulsejournal.com/blog/index.php/2011/11/29/global-developments-in-family-planning-and-contraception/ http://www.globalpulsejournal.com/blog/index.php/2011/11/29/global-developments-in-family-planning-and-contraception/#comments Tue, 29 Nov 2011 15:15:43 +0000 Jennifer Weinberg http://www.globalpulsejournal.com/blog/?p=1585 Today, the second annual International Conference on Family Planning (ICFP)  in Dakar, Senegal began. This conference is co-hosted by The Bill and Melinda Gates Institute for Population and Reproductive Health at the Johns Hopkins Bloomberg School of Public Health and the Ministry of Health and Prevention in Senegal to bring together participants to share research, best practices, and progress on national strategies to deliver family planning services, with the ultimate goal of universal access to family planning.

Currently, over 215 million women worldwide want but do not have access to family planning tools. “We’ve made a lot of progress in putting maternal health on the global agenda; now we must call on leaders to put family planning on their to-do list. Every individual deserves this – women, men, and young people,” said Jill Sheffield, President and Founder of Women Deliver.

These speakers reinforced the importance of the demographic dividend – the concept that health and social development, enabled by full access to contraception, are inextricably linked with strong economic growth. They provide examples of success in Asia, where declining fertility, spurred by rising contraceptive use, have led to increased education, improved health, and market-driven economic policies which have allowed for significant income growth.  With an expanded world population of over seven billion, “Now is the time to prioritize family planning – as a strategy to reduce maternal mortality, to improve the lives of women and their families, and ultimately, to enable broad and enduring economic development,” said Dr. Amy Tsui, Director of the Gates Institute for Population and Reproductive Health, Professor at Johns Hopkins Bloomberg School of Public Health, and a lead conference organizer.

To proceed into the future, investments must be made in the health sector maintaining adequate numbers of midwives, OB/GYNs, facilities, etc. and examining past successes around the globe. As Hon. Stephen O’Brien stated, “having a child should bring joy” not dying in childbirth and women must be able to plan for the future. Family planning is smart and cost-effective. As Dr. Osotimehin stated, we must empower young people to take control of their futures along with the future of their countries and make sure that economic and social justice drives this process. Issues of family planning are issues of human rights.

According to Judy Manning from USAID, their priorities include: 1) Improve existing methods to make them more acceptable, easier to use and more affordable like injectable forms of contraceptives. 2) Develop new contraceptives to fill gaps such as duration of effectiveness between 3 month injectables and 5 year inserted rings. 3) Develop technologies that simultaneously prevent pregnancy, HIV & other STDs like the silk diaphragm which delivers tenofovir.

Clearly there is an immense need for family planning access, affordability, and effectiveness. Fortunately, there are also attainable solutions. Meetings such as ICFP brings together a wealth of scientific knowledge, family planning experience, and critical discussions to help ensure that universal access to family planning becomes a reality.

Rachel Nugent has an interesting take on these new estimates and the methods behind them in her recent op-ed published in the New York Times International Edition. She suggests that we think about how fertility and mortality differentially affect population levels and growth rates instead of thinking about “population.”  Additionally, she suggests that discussions of population growth consider how effective family planning policies can lead to lower fertility and therefore reduce maternal and child mortality. This approach, she suggests, is more effective in bringing about actual change.

We can be inspired by both the work that these world leaders are accomplishing and by the fact that, in today’s modern society, a global list such as this exists to recognize and honor the work being done to improve girls’ and women’s lives throughout the world. Not only is this a reflection of what forward-thinking, hard-working, intelligent minds can accomplish, but it is also an indication of the progress which has been made in the recent decades towards acknowledging the injustice which exists amongst the world’s females and the vast potential which women and girls have to create positive change in the world.

Below are just a few of the 100 inspirational individuals, each with a unique story and an innovative approach to bettering the lives of females:

• Somaly Mam, Cambodia: as an orphan during the Khmer Rouge, Mam survived forced prostitution, later escaping to France before returning home to start a network of sanctuaries to aid other survivors of human trafficking across South East Asia.
• Chief Kwataine, Malawi: after learning of the high maternal death rate in 89 Malawian villages under his traditional authority, Chief Kwataine launched a community-wide, grassroots effort to educate women and assist them with getting to hospitals to give birth. The success of his efforts is reflected in a drastic change in statistics, with no local mothers dying in childbirth in the last three years.
• Christiane Amanpour, UK: as a prominent journalist at CNN, and more recently at ABC News, Amanpour brought attention to many injustices facing women globally in the past two decades.
• Melinda Gates, USA: as co-Chair of the Bill and Melinda Gates Foundation, Gates has prioritized the wellbeing of girls and women around the world while advocating for the importance of investing in females, supporting practical solutions and much-needed funding.
• Michelle Bachelet, Chile: Bachelet a physician, the Executive Director of UN Women and the Former President of Chile, was the first woman in Latin America to be appointed as Minister of Defense and has been an ardent advocate of women’s political and reproductive rights worldwide. She has strove  to increase the UN’s efforts on gender equality and female empowerment worldwide.
• Tatiana Therosme, Haiti: Therosme is one of too few psychologists in Haiti. She has worked to help women recover from the trauma of the 2010 earthquake as well as the epidemic of physical and sexual abuse, depression and anxiety which occurred in the aftermath.
• Jill W. Sheffield, USA: Sheffield is the Founder and President of Women Deliver, and Co-founder of Family Care International and has worked as a champion of maternal health and rights. Her efforts have targeted the 350,000 lives lost each year during pregnancy and childbirth.
• Heads of State: Jens Stoltenberg, Norway – Prime Minister of Norway; José Luis Rodríguez Zapatero, Spain – Prime Minister of Spain; Tarja Halonen, Finland – President of Finland; Ellen Johnson Sirleaf, Liberia – President of Liberia: these world-leaders are working to advance the cause of gender equality while leading their nations.

Check out the webcast from the recent “The Future We Make” meeting on the Bill and Melinda Gates Foundation website for an engaging and insightful discussion of issues related to the Millennium Development Goals such as child mortality rates, birth rates, literacy, HIV/AIDS and more on a global level.

TEDxChange Webcast

Figure 1.

For the first time in the 15 year-long search for an HIV prevention method that women can control, a vaginal microbicide gel called Viread has been shown to decrease the risk of HIV infection by as much as 54%.  Even though the microbicide does not prevent transmission in every woman who uses it, this is the first promising tool that women are able to use without the cooperation of the male partner.  This is an important consideration most of the new HIV infections in women living in Africa were acquired through forced sex with infected men who refuse to wear condoms. Women and girls represent 60 percent of the 22 million people infected with HIV living in Africa.

The gel was developed by Conrad, a nonprofit organization based in Arlington, Virginia, and funded by the U.S. and South African governments under royalty-free license from Foster City, California-based Gilead, the world’s biggest maker of AIDS medicines. The Bill Gates Foundation also helped fund the trial.

In the clinical trial, coordinated by scientists at the Centre for the AIDS Program Research in South Africa (CAPRISA), the use of the microbicide was compared to a placebo in a group totaling 889 women located in either the urban setting of Durban or the  rural setting of Pietermaritzburg in the KwaZulu-Natal province of South Africa.

The main active ingredient of Viread was a 1% vaginal gel formulation of the nucleotide reverse transcriptase inhibitor tenofivir. The pill form of tenofivir is already used in combination with other antiretroviral agents for the treatment of HIV and works  by slowing HIV’s spread through a patient’s body.  The secret to tenofovir’s success as a topical agent may be that it absorbs into the vaginal wall and into the cells targeted by HIV. Other gels have had to be sufficiently spread around and present in the vagina during intercourse in order to work.

Participants of the clinical trial were instructed to apply the gel 12 hours before and up to 12 hours after intercourse. Participants were told that the gel was experimental and were also counseled to use condoms or another means of HIV prevention. According to the trial results, when compared with the placebo group, women in the tenofovir group showed 39 percent fewer HIV infections. Within the tenofovir group, women who used the gel more than 80 percent of the time had 54 percent fewer infections than women who used the placebo gel .  For women who did not use the gel regulalrly ( less than 80 percent of the time) there was a 28 percent reduction.

Some theories as to why the gel did not perform better:

The net impact seen in the study reflects the combined effect of many variables, only one of them the action of tenofovir, which penetrates into the vaginal tissue, protecting the cells that HIV targets for infection. Other variables include the prevalence of HIV infection in the male population; the number of sexual partners a woman had; the amount of AIDS virus (“viral load”) in an infected man’s semen; concurrent use of condoms; and, most important, the consistency with which a woman used the gel.

For that reason, the researchers said, it’s impossible to say how much protection this microbicide might afford any woman.

“We can only approximate it,” said Salim Abdool Karim of the University of KwaZulu-Natal in Durban, South Africa, who helped lead the study. “What you see is a mixture of the efficacy of the product mixed with the ability to use the product. It is fundamentally dependent on human behavior.”

Other scientists speculated that some women who became infected despite using the tenofovir gel might have been exposed to men with very high HIV load (which occurs soon after infection).

“My most likely explanation is that you have to go up on the dose,” said Anthony S. Fauci, who heads the National Institute of Allergy and Infectious Diseases at the National Institutes of Health. “You may have maxed out on 1 percent,” he said, meaning a more concentrated gel might produce greater protection.

Over the past 15 years, six other microbicides were tested in 11 clinical trials, with none showing a protective effect.  Previous gels relied on drugs that weren’t specifically designed to target HIV.

Another important finding in the trial was that the gel prevented the transmission of genital herpes (caused by the herpes simplex virus-HSV) by 51%.  A genital herpes infection increases the susceptibility to HIV infection because the HSV virus can cause open lesions to form.

If further development and testing continues to be successful, more potent formulations combined with marketing that makes the product more appealing to women could lead to increased prevention of HIV transmission.

A product could be ready as early as 2013 if the results are confirmed by a second study known as Voice that is enrolling patients.

Gilead, which donated the active ingredient in the gel, won’t participate in the commercialization of the product in developing nations. They are unsure of whether or not will market the gel in the U.S. and Europe. Conrad gave the rights to manufacture the gel to the government of South Africa to get the product to women in the country most affected by the disease as quickly as possible.

The findings of the study were described at the 18th International AIDS Conference in Vienna, Austria and the research article was published in Science magazine.

For More Info:

1. Sciencenews
2. Businessweek
3. WashingtonPost

This is not the first time that Slim and Gates have partnered up.  They have been working together at Prodigy MSN, which has just celebrated its 10^th anniversary.

A related webcast and fact sheets on maternal and child health and family planning are also available.

Visit http://www.pbs.org/now/sched.html for more information on air times or the documentary will be available online starting Friday night January 29th at http://www.pbs.org/now/.

This New Year as you set down and make resolutions, we at AMSA urge you to make another one. Ghandi once said “Be the change you want to see in the world.” Imagine how much of a difference we could make in our practices, medical schools and in our communities if each of us 30,000 AMSA members made this resolution? Apply for AMSA’s inaugural International Women’s Leadership Institute and BE THE CHANGE.

Read on for details.

2010 does not mark a new beginning for many women and girls in this world that are suffering from gender-based violence and oppression:

1. For Mahabouba in Ethiopia it may be another year that she must live with the obstetric fistula she developed after 3 days of labor. Her 13 year old pelvis was far too narrow to pass the baby’s head and without emergency obstetric care her baby died and she was left with a hole between her rectum, bladder and vagina that constantly leaks feces and urine.
2. For Neth in Cambodia this may be the year that this 10 year old is forced into child prostitution. Her poor family can not afford to send her to school and the recent economic downturn they had no other options but to sell her to become a servant in the city. They thought she was just being sold to a wealthy family that could provide for her but instead she was sold into child prostitution. According to UNICEF, 2 million children are victims of child sex workers and 1.2 million children are victims of child sex trafficking, most of them are girls.
3. Sia arrived at the maternity hospital I interned in with severe hemorrhaging. She was bleeding as a complication of unsafe abortion. According to an article in the Lancet, 97% of all unsafe abortion occur in low-income nations yielding 68,000 deaths and millions more injured.
4. This may be the year that Dina in the Congo continues to waste away from her traumatic fistula. Dina was raped as another casualty for the long conflict in the Congo.
5. Prudence in Cameron died in childbirth last year. According to Word Health Organization data 1/47, 600 women have a lifetime risk of dying in childbirth compared to Niger where women have a 1/7 chance of death.
6. Edna Adan was a victim of FGM. According to the UNFPA, 3 million girls and young women undergo FGM each year.
7. Ethel was a Sioux women in South Dakoata who was murdered by her husband. According to the United States Department of Health and Human Services, rates of sexual and domestic violence are highest in Native American women versus any other group. More over Native women are have a 1 in 3 chance of being sexually assaulted or raped in their lifetime which is more than 2 times higher than that of non-Native women.

All these stories are true. Most of them came from the Nicholas Kristof and Sheryl WuDunn book Half the Sky about international women’s empowerment, the story about Ethel came from Marianne Perl (A Mighty Heart) and the story of Sia came from my own personal experience in Liberia (name changed). Are you willing to step in and say “NO” to this situation and make a difference in the lives of these women and girls?

JOIN US ON JAN 30 – FEB 1ST AS WE HOST AMSA’S FIRST INTERNATIONAL WOMEN’S HEALTH LEADERSHIP INSTITUTE. Training will be provided on clinical skills, advocacy and on the pressing topics of international health. We will also provide you with resources for global health mentoring, electives and how to hold great, interactive service or awareness building programs at your school. Let us use the privilege and power that we have in getting an education and having a response government to advocate on behalf of these women. They could be our patients one day.

The application deadline has been extended to January 9th. Please apply early so that you can write your Dean of Student Affairs to help pay for the $150 program fee. This institute is offered to ALL AMSA members. Please visit our website to enter your application! We will get back with you in 5 business days. We look forward to hearing from you!

Thanks,
Vanessa

Sheena McCormack, who led the trial, was disappointed in the results because a smaller trial held earlier, indicated that that the results for the current larger trial would be different from what they were. The smaller trial included more than 3,099 women and was funded by the National Institute of Allergy and Infectious Diseases (NIAID), part of the NIH. The sites include 6 countries in sub-Saharan Africa and one site in the United States. The results of the smaller trial were presented at the Conference on Retroviruses and Opportunistic Infections in Montreal, Canada in February. These results indicted that the Pro 2000 gel would reduce transmission rated by 30 %. Earliers this year, ENDO Pharmaceuticals purchased the PRO 2000 from Indevus Pharmaceuticals.

Currently, women make up half of all people worldwide living with HIV and in sub-Saharan Africa, women represent nearly 60 percent of adults living with HIV.

In most cases, women become infected with HIV through sexual intercourse with an infected male partner. Manufacturers were hoping that this microbicide would be a potential solution for hose whose partners refuse to use condoms and could have empowered women with a prevention method they could initiate. Even though this microbicide failed to prevent the spread of HIV, scientists have not given up hope, as here are currently dozens of microbicides being tested. A previous post on the Global Pulse Blog discusses the debates that have taken place about the role of microbicides on HIV prevention.

This is an important effort given the impact of mother-to-child transmission of the virus.

• Currently, over 45% of HIV-infected pregnant women receive ARV prophylaxis (up from 10% in 2004)
• Only 15% of children born to mothers infected with HIV in reporting low- and middle-income countries were tested for the virus within the first two months of life
• Only 38% of the over 730,000 children in low- and middle-income countries in need of ARV treatment in 2008 received these medications

For more on these efforts, see press coverage of the Global Fund’s World AIDS Day activities.

From the publisher’s website:

The book grapples with fundamental questions about the relationships among population, fertility decline, reproductive health, human rights, poverty alleviation, and development and assesses the various arguments — demographic, public health, human rights-based, and economic — for an against ICPD today.

A number of the chapters address institutional challenges to ICPD and consider how the challenging political, religious, academic, and disciplinary contexts matter.  Other chapters engage operational and conceptual issues and whether ICPD has been able to move the reproductive health agenda forward on topics such as maternal mortality, abortion, HIV/AIDS, adolescents, reproductive technologies, and demography.  Finally, several chapters examine how ICPD has been sidelined by emerging health and development agendas and what could be done in response.  Unlike any book yet published, Reproductive Health and Human Rights: The Way Forward examines the state of the arguments for reproductive health and rights from a multidisciplinary perspective that provides policymakers, scholars, and activists with a better understanding of how reproductive health and rights have developed, their place in the global policy agenda, and how they might evolve most effectively in the future.

To read an excerpt from the book, click here.

You can see them and hear what they have to say here: http://www.overstream.net/view.php?oid=spr5lzmgn8l6

According to the World Health Organization (WHO) , 99% of deaths during childbirth occur in low-income countries. For example, the chance of maternal death in high income countries is 1 in 7300, where as in low income countries it is 1 in 73. As young people, this is especially important and relevant because most of the young women who are dying could very well be our friends, schoolmates and classmates had they lived in a different country (particularly if they had been fortunate enough to live in a high income country as we do). The leading cause of death in young women aged 15-19 in low-income countries is from childbirth complications.

Leading causes of maternal mortality worldwide:

Within the US, maternal mortality rates are hardly cause for complacency.  The world’s foremost economic power (pending post-recession change in paradigm), we rank 28th in infant mortality, and 41st in maternal mortality:

Based on 2005 estimates, the U.N. analysis suggests that one in 4,800 women in the United States carry a lifetime risk of death from pregnancy. By contrast, among the 10 top-ranked industrialised countries, fewer than one in 16,400 are facing a similar situation.  The reason? According to experts, in many European countries and Japan in the industrialised world, women are guaranteed good-quality health and family planning services that minimise their lifetime risk.  Many independent experts and sympathetic legislators hold the current U.S. public health policy responsible for its dismal record because some 47 million U.S. citizens have no access to health insurance, most of them African Americans and other minorities. [IPS News]

Steep disparities in maternal health are linked to ethnicity and socioeconomic status, with African-American women being 4 times more likely to die in childbirth than white women, a point that is alternately called our “national shame”, and goes ignored.

More reading: How do socioeconomic factors affect disparities in mortality? by Deborah Maine, in the Journal of the American Medical Women’s Association, provides some nice historical context on maternal mortality in the US.