Category Archives: Maternal and Child Health

Notes on IH Section Conference Call: Current Developments in MCNH (June 27, 2011)

The IH Section held its third topic-focused conference call on Current Developments in MCNH on Monday, June 27, 2011 from 1:00 to 2:00 EST. We had several members of the IH section offer their commentary and expertise on current issues concerning maternal and child health.

Speakers
Laura Altobelli (Future Generations)
Elvira Beracochea (Midego)
Carol Dabbs (U.S. Department of State)
Miriam Labbock (Carolina Global Breastfeeding Insititute)
Mary Anne Mercer (University of Washington)

Laura Altobelli: Brief presentation of the APHA policy resolution proposal submitted by the IH section entitled, “Call to Action to Reduce Global Maternal, Neonatal, and Child Morbidity and Mortality.”
Laura discussed the new APHA policy proposal on MCH. There was nothing previously on the APHA policy regarding global action on this issue per se – one previously existing resolution focuses on reducing maternal and child mortality in the US, and one focuses on breastfeeding and has both domestic and global aspects. This, then, is the first policy proposal on global MNCH. Justification for the policy proposal is lack of progress on the MDGs and lack of policy commitment to protect vulnerable populations. APHA will be joining important other organizations that are putting out strategies, including the Partnership for MNCH (WHO), and the UN, and attended global meetings in 2010 in observation of the Year of Maternal Health (some of these mentioned below). There is also an effort to increase attention to this in the Global Fund and GHI. Six other sections/forums are co-sponsoring the resolution.

Elvira Beracochea: Update on the Millennium Development Goals 4 and 5.
A factsheet has been sent out (available upon request – please contact jmkeralis [at] gmail [dot] com). These MDGs and their targets have served us well to measure our progress so far. There have been improvements, though progress has been uneven. MDGs 4 and 5 focus on reducing mortality but not necessarily on improving health, development and well-being, and we need to address this as well. We know where women and children die and how. We also have the knowledge to prevent these deaths. We need to coordinate work at global scale and have a concerted strategy to ensure the rights of all women and children are met. We need to take global health goals to a new level of effectiveness using efficient strategies and a human-rights-based approach. A rights-based approach does not focus on only survival, but also on development. We need new targets and indicators that measure not only deaths but also number of children whose right are fulfilled; the children that are breastfed, fully immunized, drink clean water, are protected from malaria, and that that attend school. We need targets and indicators that measure not only the number of women that died or delivered with assistance of a skilled attendant, but that also measure the number of pregnancy complications effectively treated. We need new MDGs and targets.

Miriam Labbok: An update on reproductive health continuum (birth, breastfeeding and birth spacing promotion, protection, support) as an essential MNCH intervention approach.
It is vital that we pay attention to the reproductive health continuum within the life-cycle approach: birth, breastfeeding and birth spacing. Programming must include not only promotion, but also skill- and capacity-building so that support can be provided. In addition, policy change is needed to: support treating women with dignity, provide NFP knowledge (at least for the times that family planning supplies run out), and create the capacity to support health-supportive birth, breastfeeding and spacing practices. All such programming and policy creation should be carried out with recognition of the rights of both women and children to the best possible health support and with attention to appropriate technologies, as one size does not necessarily fit all. In addition, programs that address cultural change and intimate family and social decisions demand the building of trust that comes with reliability and long-term relationships. Programming should be designed for the long term, with a strong base and phased in activities, and with excellence and sustainability as the focus.

Mary Anne Mercer: Partnership for Maternal, Neonatal and Child Health – what it does and how one can get involved.
The Partnership for Maternal, Neonatal and Child Health is a WHO-based coalition of organizations that support increased funding commitments to MDGs 4 and 5. Any organization that supports MCH can be a member simply by filling out an application from the PMNCH web site at http://www.who.int/pmnch/. Be sure your organization is a member (it’s free!) by checking the member list. Also check out the ‘Knowledge Portal’ that aims to maintain updated programmatic information on current approaches to improving MCH. I am on the Board of Directors of the Partnership as an NGO representative, and we will be electing a new member of the Board this year that will represent an Africa-based NGO or the Africa office of an international NGO — please let me know if you have any suggestions for good candidates for that position.

Carol Dabbs: Trends in US government funding levels for global MNCH.
Funding has increased and is overseen by the State Department. Global Health targets are to be achieved with funding from FY 09-14, generally for implementation in FY 10-15. The Global Health Initiative includes principles supporting country-led plans and to coordination with other partnerships and donors, as well as between USG agencies and health programs. Eight countries have been selected as “plus” countries (places to conduct learning laboratories): Ethiopia, Kenya, Mali, Malawi, Rwanda, Bangladesh, Nepal, and Guatemala. Almost all of the Global Health Initiative funding is from USAID and State (there is also some DHHS funding, but that was not included in this discussion). There are two stages in the fiscal year: requesting funds from Congress and appropriation of funds by Congress. Unfortunately, delays have been a reality this year. However, we should look at trends and context of the rest of foreign assistance and of overall health fundig. The budget now includes nutrition as a separate item, and it’s included in the MNCH numbers here. There has been a trend of increased funding; funding for MNCH has increased about by 22% over two years (FY 2008 to FY 2010), but the full year continuing resolution for FY 2011 allocation to MNCH is still pending. We do not know what the appropriations for FY 2012 and FY 2013 will be.

Discussion: Is this in addition to Dept of State HIV funds? Yes, there are additional funds in USAID for HIV/AIDS, as well as funds for MCH and the rest of the health programs.

A Golden Moment: Global Partners Unite to Expand Access to Skilled Birth Attendants

Guest Contributor: Conrad Person, Director of Corporate Contributions, Johnson & Johnson
As a record-setting 3,000 delegates from more than 111 countries gathered last week in Durban, South Africa for the 2011 International Confederation of Midwives Congress, I believe that we are witnessing a “golden moment” for the global campaign to realize the right of every woman to have access to the best possible health care during pregnancy and childbirth.

Two things give me hope. First, a new analysis from the United Nations Population Fund verifies what we’ve known for decades – only by expanding access to quality midwifery services, especially in the world’s most needy countries, can we curb maternal and newborn mortality. Second, the groundbreaking Millennium Cities Initiative (MCI) is demonstrating what is possible when we focus on improving health in the world’s poorest cities.

This “golden moment” was on full display on a recent blazing hot afternoon in the Jamestown section of Accra, Ghana. With the Jamestown Lighthouse looming in the background, I was reminded that this Ga fishing community was once the heart of historic Accra. But now, it is a poor neighborhood in a city where the mean household income is less than $4 U.S. a day. In a brick courtyard, about 300 women wearing the distinctive colors and patterns of West Africa sat beneath a canvas tent. While Ga drummers, famous the world over, quickly attracted an overflow crowd and the First Lady of Ghana and Accra’s Mayor also inspired the audience, the stars of the show were the babies these women held in their arms.

Five of the midwives took their places in the center of the courtyard. One pretended to be in labor and from beneath a blanket another extracted a mannequin baby. “The baby is not breathing,” she announced. The team quickly went into action to resuscitate the baby.

At this point a regional director for MCI, Abenaa Akuamoa-Boateng, whispered into my ear, “This is the golden minute. Success depends on acting swiftly.” In a minute or so, the mannequin seemed to give a cry like a lamb’s bleat. Even with babies in their arms, the audience clapped.

Each year, an estimated one million babies die from birth asphyxia, or the inability to breathe right after delivery. But skilled birth attendants can change that. More golden moments would be successful if more midwives and skilled attendants had the authority and support of their government to attend these births. MCI is working to tackle one aspect of this global campaign – bringing critical health care services to the most vulnerable mothers and newborns in the world’s poorest urban centers.

Much is made, rightly, of the plight of rural women and children, but MCI makes the case that the urban poor represent a great challenge as well. MDGs 4 and 5 simply can’t be achieved if major African population centers have persistently poor health outcomes for mothers and babies.

MCI addresses this problem through a Neonatal Survival Program, piloted during the past year in Accra and Kumasi, Ghana. This program has incorporated training for 120 frontline caregivers in neonatal resuscitation and infant care with follow-up outreach to and health education of more than 1,500 new mothers, demonstrably saving newborn lives. This program has had the support of Johnson & Johnson, AmeriCares, the American Academy of Pediatrics and local and national health agencies. Statistically, it’s all but certain that without this program, some of those 1,500 children would not have survived.

I left Jamestown with the strong conviction that if we are to meet the MDGs, we must treat every minute that we have left as a “golden minute.” I hope we take full advantage of this unique – and critical – moment to act.

IH Section Conference Call: Current Developments in MCNH

Please join us for our next bi-monthly conference call!  The IH Section is hosting its topic-focused conference call for the month of June.  The call will be held on Monday, June 27 from 1:00 to 2:00 p.m. EST.  This call will be hosted by section members Miriam Labbock and Laura Altobelli, who will be discussing current developments in maternal, neonatal, and child health (MCNH).  The call will include:

  • Brief presentation of the APHA policy resolution proposal submitted by the IHS entitled, “Call to Action to Reduce Global Maternal, Neonatal, and Child Morbidity and Mortality”
  • Update on the Millenium Development Goals 4 and 5
  • An update on breastfeeding and child spacing as essential MNCH interventions
  • Update on the Global Alliance to Prevent Prematurity and Stillbirth
  • Partnership for Maternal, Neonatal and Child Health – what it does and how one can get involved
  • Trends in US government funding levels for global MNCH

Background information to review before the call includes:

  • APHA policy resolution proposal submitted by the IHS entitled, “Call to Action to Reduce Global Maternal, Neonatal, and Child Morbidity and Mortality*
  • Factsheet on the Millenium Development Goals 4 and 5*
  • Innovations June 2011 (newsletter on maternal health)*
  • Partnership for Maternal, Neonatal and Child Health
  • Global Alliance to Prevent Prematurity and Stillbirth:
    1. The Lancet special series on Stillbirth came out in late April and all articles and comments are available for free from the series webpage. People may need to register on The Lancet website, but that is also free.*
    2. The Global Alliance to Prevent Prematurity and Stillbirth plans to launch additional advocacy around preterm and stillbirth and the GAPPS conference in July 2012 will highlight research and discovery needs around both PT and SB.*

*If you would like copies of these documents or have questions about these two issues, please contact Andrew E. Barrer, Ph.D., at aebarrer@gmail.com or (202) 674-9294.

 TOPIC: Current Developments in Maternal, Neonatal, and Child Health (MCNH)
DATE AND TIME: Monday, June 27, from 1:00 p.m. to 2:00 p.m. EST
PHONE NUMBER: (712) 432-1001 (please note that this is not a toll-free number)
PASSCODE: 477461343#

You are welcome to submit comments and questions for the speakers; however, we ask that you submit them in advance so that the panel can present them to the speaker. This will allow us to keep things organized. Please e-mail questions for the speakers to jmkeralis [at] gmail [dot] com  by Friday, June 24 at 8 p.m. EST (June 3, 2011).

IH Section Conference Call: Current Developments in Maternal, Neonatal, and Child Health (MCNH)

UPDATED: Please note that the date has changed from June 13 to June 27.

Please join us for our next bi-monthly conference call!  The IH Section is hosting its topic-focused conference call for the month of June.  The call will be held on Monday, June 27 from 1:00 to 2:00 p.m. EST.  This call will be hosted by section members Miriam Labbock and Laura Altobelli, who will be discussing current developments in maternal, neonatal, and child health (MCNH).  The call will include:

  • Brief presentation of the APHA policy resolution proposal submitted by the IHS entitled, “Call to Action to Reduce Global Maternal, Neonatal, and Child Morbidity and Mortality”
  • Update on the Millenium Development Goals 4 and 5
  • An update on breastfeeding and child spacing as essential MNCH interventions
  • Update on the Global Alliance to Prevent Prematurity and Stillbirth
  • Partnership for Maternal, Neonatal and Child Health – what it does and how one can get involved
  • Trends in US government funding levels for global MNCH

You are welcome to submit comments and questions for the speakers; however, we ask that you submit them in advance so that the panel can present them to the speaker. This will allow us to keep things organized. Please e-mail questions for the speakers to jmkeralis [at] gmail [dot] com  by Friday, June 24 at 8 p.m. EST.

 TOPIC: Current Developments in Maternal, Neonatal, and Child Health (MCNH)
DATE AND TIME: Monday, June 27, from 1:00 p.m. to 2:00 p.m. EST
PHONE NUMBER: (712) 432-1001 (please note that this is not a toll-free number)
PASSCODE: 477461343#

“We won’t be applying for your prize money, Nestle”: Aid agencies in Laos Call Nestle Out for Pushing Baby Formula

A number of NGOs and aid organizations working in Laos have spoken out against Nestlé by refusing to apply for a half-million dollar prize – and writing them a vehement letter explaining why. These organizations are speaking out against the company for violating the International Code of Marketing of Breast Milk Substitutes.

I remember seeing ads on television for baby formula, but I never noticed that they stopped running until many years later. As global health blogger Alanna Shaikh helpfully explains, advertising baby formula, or providing it as a component of relief supplies for victims of natural disasters, is a bad idea for several reasons. First of all, many women mistakenly believe that formula is safer and more nutritious for their babies, when in reality it is not. It also places babies at risk for malnutrition: women who switch to formula will eventually stop producing breast milk naturally, and if the supply of formula dries up or they can no longer afford it, then the availability of adequate nutrition is compromised. Additionally, women in resource-poor settings may not have access to clean water to mix formula powder or properly clean bottles.

The full text of the letter is below.


Aid agencies working in Lao PDR:

 Save the Children Australia in Lao PDR
Health Frontiers
Francophone Institute for Tropical Medicine, Lao PDR
Adventist Development and Relief Agency, Lao PDR
Oxfam in Laos
Plan International Laos
Health Unlimited
Village Focus International
CRWRC
Handicap International
HELVETAS LAOS
ERIKSHJALPEN Laos
CARE International in Lao PDR
Japan International Volunteer Center
Welthungerhilfe
ChildFund Laos
World Vision Lao P.D.R
World Concern Lao P.D.R
Médecins du Monde Laos

24 May 2011

Peter Brabeck-Letmathe, Chairman of the Board
Paul Bulcke, Chief Executive Officer

Nestlé Suisse S.A.
Case postale 352
Vevey
CH-1800
Switzerland

We won’t be applying for your prize money, Nestle.

Your marketing of formula milk still jeopardizes the health of infants and children in Laos.

We write to inform you that our organizations will not be applying for the “Creating Shared Value” Prize, recently announced by Nestle. This prize is worth approximately USD 480 000.

We represent a number of aid agencies in Lao PDR (Laos), working to improve infant, child and maternal health, and to reduce poverty.

We won’t be applying for the prize, because Nestle continues to make millions of dollars of profit, at the expense of infants and children in Asia, through violations of the International Code of Marketing of Breast-milk Substitutes.

Unethical marketing by food companies, including Nestle, contributes to the situation of high infant and child mortality in Laos.

Babies and children are dying in Laos because food companies such as Nestle are weakening national regulatory frameworks and aggressively flooding the market with information that dilutes public health campaigns that promote breastfeeding.

In Laos, Nestle has violated the Code in the following ways:

  • Public advertising and promotion of breast-milk substitutes.
  • Promotion in hospitals and health care facilities of breast-milk substitutes
  • Labelling of infant formula shows that they are to be used by infants from birth, thus misleading mothers from exclusive breastfeeding their infants for the first six months of life.
  • Labels are not translated into the local language: labels in English and Thai are found throughout the country.
  • Even if the labels are translated into Lao language, the marketing approach of Nestle does not give enough public health consideration to the local fact that the poorest and most vulnerable mothers and families are ethnic, and do not speak or read Lao language.
  • Nestle representatives actively visit hospitals, especially paediatric wards and nurseries.
  • Nestle representatives give different types of incentives to doctors and nurses, such as organizing and funding trips and gifts
  • Conducting seminars for health workers in which misinformation is given.
  • Conducting promotions of formula milk at pre-schools in which misinformation is given.
  • Advertising is promoting unscientific and unsubstantiated claims that formula increases intelligence and enhances immunity. This creates a situation where family income is being spent unnecessarily on formula for infants and young children, keeping households poor.

Nestle is actively working to dilute and weaken the national regulatory framework

The first effort by Laos to enact the International Code of Marketing of Breast-milk Substitutes was in 2004, through a decree issued by the Ministry of Health entitled “Regulations on Infant and Child Food Product Control“.

In 2007, the decree was revised by the Ministry of Health (Department of Hygiene & Prevention, MOH). The changes were influenced by outsiders, mainly baby food companies. The main changes include:

  • The title was changed from “Regulations on Infant and Child Food Product Control” to “Agreement on Infant and Young Child Food Products Controls”. This change clearly weakened the status of the decree from regulations to a mere voluntary agreement. This enables Nestle to claim they are in compliance with local regulations, even if these do not meet the standards in the Code.
  • The MOH changed the contents of the Regulation and several new paragraphs were added. The meaning of some was changed thus making them difficult for readers to understand.
  • One important change includes the removal of the following sentence (section III, Article 7/c, page 6 of the first version): “Manufacturers or distributors are forbidden from giving free donations or gifts to health staff or health services such as small scholarships, research funds or meeting sponsorships for seminars, continuous studies or for conference events“.

After the 2007 revisions were made, Nestlé printed 1,000 copies and distributed them to hospitals across the country. This is a clear example of Nestlé working to weaken the national regulatory framework in Lao PDR.

We call on Nestle to:

  • Comply fully with the International Code of Marketing of Breast-milk Substitutes.
  • Fund an independent and external review of the use, marketing and impact of Bear Brand in the Asian region, as it impacts on infant and child mortality (death) and morbidity (illness). The marketing approach should give consideration to illiterate and rural people who neither speak nor read Lao language.
  • Cease the practice of giving gifts, trips and other incentives to Lao doctors and nurses.
  • Cease promoting and distributing breast-milk substitutes in hospitals and clinics.
  • Cease aggressive marketing of formula to children of any age and their parents using unscientific and unsubstantiated claims regarding growth and intelligence.
  • Cease the practice of promoting and marketing formula at pre-schools.
  • Cease the practice of gifts and incentives to pre-school and primary-school teachers.
  • Cease efforts to weaken the national regulatory framework.

Signed by

  1. Matthew Pickard, Country Director, Save the Children Australia in Lao PDR
  2. Carol Perks, Health Chief Technical Advisor (Midwife and Lactation Consultant), Save the Children Australia in Lao PDR
  3. Elizabeth S. Clarke, MD, Field Representative, Health Frontiers Laos
  4. Leila Srour, MD MPH, Health Frontiers Laos
  5. Hubert Barennes, MD PhD, Research Coordinator, Francophone Institute for Tropical Medicine, Lao PDR
  6. Grant Hillier, Country Director, Adventist Development and Relief Agency (ADRA), Lao PDR
  7. Dominique Van der Borght, Country Director Designated, Oxfam in Laos
  8. Terence McCaughan, Country Director, Plan International Laos
  9. Bangyuan Wang, Country Director, Health Unlimited, Lao PDR
  10. Richard L. Reece, Regional Representative, Village Focus International, Lao PDR
  11. Mike Fennema, Country Director, CRWRC, Laos
  12. Luc Delneuville, Country Director, Handicap International, Lao PDR
  13. Anne-Sophie Gindroz, Country Programme Director HELVETAS LAOS – Swiss Association for International Cooperation
  14. Jason Vogt, Country Manager for ERIKSHJALPEN, Laos
  15. Henry Braun, Country Director, CARE International in Lao PDR
  16. Masahito Hirano, Country Representative, Japan International Volunteer Center, Lao PDR
  17. Angela Kahl, Finance Manager, Welthungerhilfe Regional Office, Lao PDR
  18. Chris Mastaglio, Country Manager, ChildFund Laos, Representative Office of ChildFund Australia
  19. Stephen Rozario, National Director, World Vision Lao PDR
  20. Rob Kelly, Acting Country Director, World Concern Lao PDR
  21. Isabelle Decout, General Coordinator, Médecins du Monde Laos

For media enquiries:

  • Louise Sampson, Save the Children Australia in Lao PDR louise.sampson@savethechildrenlaos.org, Tel +856.71.260.647 / +856.20.2259.7971
  • Leila Srour, MD MPH, Health Frontiers, Tel +856.20.5579.7111 / +856.86.400.030

Safe motherhood, now on a mobile device

Sharon D’Agostino, Vice President, Worldwide Corporate Contributions and Community Relations, Johnson & Johnson
It’s a well-known phenomenon: on Mother’s Day, long distance and international call volume spikes higher than on any other day of the year. Collectively, we reach across countries or oceans to send our love and thanks to the wonderful women who brought us into the world. Technology allows us to let our mothers know that we are thinking about them even if we can’t be with them on Mother’s Day. For women who live in some of the most challenging places on earth to give birth, the same technology – the phone – can help women have safer pregnancies and healthier babies.

Today, one billion women in low and middle-income countries own mobile phones, but 48 million give birth every year without the help of a skilled birth attendant. In some countries in Africa and Asia, the lifetime risk of dying in childbirth is greater than 1 in 20. Without access to basic health care or critical information during pregnancy, a woman might not recognize signs of trouble or know when to visit a health clinic. She faces the threat of infection and preventable complications that can lead to death before she even has the chance to meet the baby whose due date she anxiously awaits.

This Mother’s Day, I was excited to be part of the team that unveiled a program to bring crucial health information to pregnant women and new mothers in low-resource countries. USAID and Johnson & Johnson have partnered with the United Nations Foundation, mHealth Alliance and the White House Office of Science and Technology Policy to launch the Mobile Alliance for Maternal Action (MAMA). This initiative, announced by Secretary of State Clinton last week, will reach women in South Africa, India and Bangladesh with customized text messages timed to the stage of their pregnancy or age of their new baby. We are also committed to collaborating with similar initiatives in order to encourage a global exchange of information and best practices, accelerating efforts to reach the women who most need vital health information.

True public-private partnerships are rare, and this one is special because it applies each partner’s expertise and resources to leverage
an infrastructure that is already in place. Mobile Alliance for Maternal Action’s goal is to raise US$10 million to support country-led sustainable programs to scale up mobile health services in some of the hardest-to-reach places in the world.

If you are one of the millions who picked up a mobile phone to call your mother on Mother’s Day to show your appreciation, it is my hope that you will also take a moment to appreciate the technology that made your call possible – and that holds the promise of be the gateway to a healthier pregnancies for millions of women.

Global Health TV Video: Stillbirths – The Invisible Public Health Problem