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A Complicated Delivery: G8 Commits $5 billion to Maternal and Child Health But Big Questions Remain

7:22 am in Uncategorized by RH Reality Check

Written by Amy Boldosser for RHRealityCheck.org – News, commentary and community for reproductive health and justice.

Amy Boldosser is reporting for RH Reality Check from the G8 meetings, in partnership with Family Care International.  See other coverage of the G8 by Amy here and here, and a piece by Stephen Lewis of AIDS-Free World.

The first day of the G8 Summit answered some of the questions that maternal, newborn and child health advocates had about Canada’s signature G8 initiative, The Muskoka Initiative for maternal and child health. Speculation had been rampant all day following Canadian Prime Minister Harper’s midday announcement that Canada is committing $1.1 billion Canadian dollars in new spending over five years for maternal and child health programs in poor countries, bringing Canada’s total maternal and child health spending to almost $3 billion Canadian.  Harper made the announcement in his brief comments before the beginning of the G8’s afternoon session with invited leaders from Africa and the Americas. As the G8 leaders headed in to closed door meetings, advocates were left to wonder whether Canada could pull off the heavy lift of gaining similar concrete, new financial commitments from the G8 member states for saving the lives of women and children.

So did they deliver for the world’s women and children? Well, sort of. When the doors were opened and Prime Minister Harper addressed advocates and press again, he announced that the, “G-8 leaders made a historic commitment to the Muskoka initiative to maternal, newborn and child health. Together, G-8 members have committed US $5 billion over the next 5 years.” In addition, Harper revealed that, “G-8 leadership has also attracted the donations and contributions from other countries and foundations of more than US $2.3 billion for a total of US $7.3 billion.  In addition to our G-8 partners, we would also like to thank the Netherlands, Norway, New Zealand, South Korea, Spain, Switzerland, the Gates Foundation and the United Nations Foundation.”

Canadian officials refused to release specifics on what each country pledged. Harper indicated that each of the G8 countries did make a contribution, although he admitted some contributed more than others relative to the size of their economies. He chalked up the differences in pledges to differences in priorities among countries and differences in country financial situations and said that since Canada’s economy is in the strongest financial position, it had made the largest country contribution to this flagship initiative.  Press sources provided some rough figures on country commitments:

  • The US committed $1.346 billion over two years (the US didn’t commit to the requested five years of funding) pending “Congressional appropriations”
  • Germany committed more than $500 million over five years
  • Japan committed about $500 million over five years
  • France committed to about $400 million over five years
  • Britain committed $300 million per year over two years (like the US, Britain didn’t commit to five years of funding)
  •  and Italy, to no one’s surprise, apparently pledged the least of all.

Canada’s leadership in putting maternal and child health on the agenda was generally praised by advocacy groups, and Canada’s $1.1 billion pledge, the largest among G8 members although still short of what advocates had been asking for, was regarded as a “respectable” amount. Reaction to the total Muskoka Initiative pledge, however, was one of disappointment that G-8 leaders had failed to heed calls to double their collective aid on maternal and child health to $4 billion a year, for a total of $20 billion over five years. According to Save the Children, that investment could have saved an additional 1 million children a year and more than 200,000mothers a year. 

So now we know what money is on the table but some very important questions remain if we are truly to make progress in reducing the numbers of maternal deaths (more than 350,000 women die every year in pregnancy and childbirth) and newborn and child deaths (more than 8 million children die before their fifth birthday every year). 

How will these funds be distributed and used? There is a global consensus on the package of high quality, low cost interventions that are needed to prevent maternal, newborn and child deaths including comprehensive family planning programs; skilled care before, during and after pregnancy and childbirth, including emergency obstetric care, for mothers and newborns; safe abortion, when and where legal; and improved child nutrition and prevention and treatment of major childhood diseases.  But some governments, including Canada, have given into political pressures to announce that this money won’t be used to fund provision of safe abortions or potentially even family planning.  Advocates will be watching to see how the G8 spends its money and to hold governments accountable for meeting these commitments.  As the G20 Summit starts today, we are also hopeful that G20 governments will take up the G8 commitment to maternal and child health.  South Korea, host of the next G20, and some other G20 governments are pushing for a bigger role on development and we are hopeful that the pledges made to the Muskoka Initiative by non G8 member countries may hint at a broader commitment of non G8 countries to save the lives of women and children.

Congenital Syphilis Taking Toll on Mothers and Babies

7:01 am in Uncategorized by RH Reality Check

Written by William Smith for RHRealityCheck.org – News, commentary and community for reproductive health and justice.

April is National STD Awareness Month and sexual and reproductive health organizations throughout the country urge you to Get Yourself Tested!!  RH Reality Check has partnered with The National Coalition of STD Directors (NCSD) to produce a series of articles on the importance of STD prevention and treatment among populations throughout the United States.  Other articles in this series include one by Sandra Serna-Smith, Dana Cropper Williams and Peter Leone and a feature article by William Smith published earlier this week.

Last week, and as part of STD Awareness month (April), I and several other colleagues wrote about just how significant the STD situation is in our country. It might not be in the headlines everyday, but we’ve got very serious STD epidemics affecting the most vulnerable in our society. This week, I want to pick up on a theme from my own article and that of my colleague Peter Leone in North Carolina: The issue of the resurgent syphilis epidemic in the United States.

Headlines were made recently about the shockingly high rates of syphilis among men who have sex with men. These rates are indicative of behaviors—such as not using condoms–that put people at risk for other sexually transmitted diseases, including HIV. But that is just one aspect of the resurgent syphilis epidemic. Another is the equally disturbing trends of syphilis infection passed along to babies by their mothers, known as congenital syphilis.

On April 16th, the CDC released new data about the rates of congenital syphilis (CS) and the trends are going totally in the wrong direction. From 2003 to 2005, there were roughly 339 cases per year in the United States. In 2008, however, nearly 100 additional cases of CS were reported for a total of 431 that year. That means nearly 500 children being born in 2008 with a totally preventable life-threatening illness.

CS is preventable. Treating maternal infection 30 days prior to delivery is highly successful in reducing or eliminating transmission. The CDC reports, however that in about a quarter of CS cases where maternal infection was detected within this 30-day window for treatment, an identified infection was left untreated. In another quarter of cases, infection was identified less than 30 days out from delivery and in about 30 percent of cases, no prenatal care was provided and infection was identified at the time of delivery.

What is worse: This isn’t just about babies born sick and easily treated with an “all’s well” ending. In 2007 and 2008, 54 babies born with CS were stillborn and another 7 died within thirty days of birth.

Drill down into the data a bit deeper and we find the same persistent and disturbing trends in terms of how this infection and its outcomes disproportionally affect the southern part of the country. Nearly 60 percent of all cases of CS in 2008 are in the South.

And of course behind the numbers of CS cases are also women whose sexual health is already compromised, particularly black women. Nearly 50 percent of all cases of CS were among those born to black mothers. An even more astonishing statistic provided by the CDC analysis that brings these two pieces of data to appalling convergence – 79 percent of those black mothers involved in CS transmission were from the South.

The current National Plan to Eliminate Syphilis sets a goal of reducing the rate of congenital syphilis to fewer than 3.9 per 100,000 births by 2010. It is highly unlikely that we will meet it. In 2008, the rate was 10.1 per 100,000 births. That is a huge gap to close when the evidence is all around that ground is being lost – not gained.

So, we have yet another window into a disturbing increase of syphilis in this country and it is part of a clarion call to renew and refresh our domestic commitment. This renewed effort must focus on greater efficacy of delivering treatment to pregnant mothers and the CDC recommends this going forward. The great success in preventing mother-to-child transmission of HIV is a good model to look to and the impact of health care reform may also hold promise. After all, good access to prenatal care could facilitate a dramatic drop in rates of syphilis and of CS. But we must focus these efforts and resources in the south where the ugly intersection of history and poverty allow syphilis to thrive.

A decade ago, we were on the precipice of a major public health success story in eliminating syphilis. In fact, syphilis rates in 2000 were the lowest since 1941 when it first became a reportable disease. Now, with insufficient resources and too much politics that has set back behavioral interventions and access to sexual and reproductive healthcare services, we have a big mess on our hands.

But it is a mess we can fix. And fix it we must.

Breastfeeding: Putting the Stats into Practice

6:44 am in Uncategorized by RH Reality Check

Written by jaz for RHRealityCheck.org – News, commentary and community for reproductive health and justice.

Breastfeeding has been a hot topic over the past couple of weeks, most recently with the release of a study in Pediatrics that asserted that over 900 children’s lives can be saved each year if 90 percent of new mothers breastfed their babies for six months. It seems like a fairly simple goal; six months is a relatively short amount of time. However, the study explicitly says that mothers would have to exclusively breastfeed their children for six months, meaning exclusively feeding their babies breast milk; no water, formula or infant juice. This makes achieving this goal much more complicated.

Another study by the CDC highlights racial, ethnic and geographic disparities in breastfeeding. In 13 states (mostly southeastern), the difference between breastfeeding initiation rates between white women and black women was over 20 percentage points, and in six states black women’s breastfeeding initiation rates were under 45 percent. This means that the majority of these women didn’t even breastfeed at all.

So what’s the connection? Considering maternal and infant mortality rates in the black community are disproportionately higher than in white and "Hispanic" communities, it seems that increasing breastfeeding could make result in better outcomes for black women and their children. But will these monetary and infrastructural investments be made?

If we look to the workplace, employers are required to give only 12 weeks of (unpaid) maternity leave. It’s no wonder why breastfeeding rates take a sharp decline six months after birth. If a new mother is to exclusively breastfeed for six months but has to return to work, she will have to do a lot of pumping before and/or after work to ensure her baby is fully-fed throughout the day. At many places where people work for an hourly wage, there is no effort made to support new mothers and breastfeeding or pumping can instead be seen as a nuisance, resulting in reduced productivity. Because of economic, educational and geographic barriers to employment opportunities that offer full health benefits, women of color often cannot afford to take a long period of unpaid leave from work.  In this case, a woman is likely to be compelled to go back to work in order to provide for her family, especially if she is the sole breadwinner.

Some lactivists have taken issue with media assertions that workplace barriers are the primary culprit. Although they agree that many women have to struggle to find places and time to pump, health care reform will require employers to provider clean and safe spaces for breastfeeding or pumping. We will have to wait and see how this will be enforced. It seems that this is only one piece of the solution as some lactivists cite a myriad of issues including societal and cultural stigmas against breastfeeding moms, lack of education, lack of promotion of breastfeeding, and the abundance of free formula samples given at hospitals to new mothers and their babies. 

There’s also the issue of nutrition. If the point of breastfeeding is to provide nourishment and pass on immunities to the baby (along with mother-baby bonding and other health benefits), then women should be given quality food in the hospitals. Women of color are less likely to be insured, so you can pretty much guarantee that the hospitals serving these women will be serving processed, mass-produced foods with low nutritional value. I have seen not only nasty-looking meals given to new moms, but also foods that have no nutritional value, like Italian ice, which is full of sugar and artificial colors. These meals are not only unappetizing but unbalanced and do not provide proper nutrients to the mother or child.

Since most hospitals aren’t giving moms nutritional support from the start, it is likely that once women leave the hospital they still have to fight to maintain good eating habits as they manage a newborn. In many communities of color, there is little access to fresh and affordable fruits and vegetables, again making it difficult to eat healthy and thus pass on vitamins and nutrients that assist in development. If we are committed to more widespread breastfeeding, we should also be fighting to ensure that all communities have access to fresh and affordable fruits and vegetables.

Breastfeeding may not be a panacea to maternal and infant mortality disparities but it is a proven way to improve health outcomes. The Pediatric study points out that the U.S. could save $13 billion dollars by getting 90 percent compliance of mothers breastfeeding exclusively during the first six months. If we really want to save lives and of course, the almighty dollar, then the government should invest in creating a infrastructure that holistically supports new mothers and their babies.