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U.S. Prohibits Access to Safe Abortions in Other Countries

 
 
In Haiti, a girl runs by a pharmacy that illegally sells drugs to induce abortion. Photo by Patrick Farrell

In Haiti, a girl runs by a pharmacy that illegally sells drugs to induce abortion. Photo by Patrick Farrell

A girl or woman who is raped and impregnated by Boko Haram in Nigeria might have no access to a safe abortion, leaving her with only bad and worse choices, thanks to the United States. The U.S. is the single largest donor country for women’s health programming and the only major donor country that puts draconian restrictions on access to safe abortion, even in cases of rape.

“Unsafe abortions are a leading cause of maternal deaths in Kenya, which has one of the 20 highest maternal mortality rates in the world,” writes Laura Bassett in ‘Instruments of Oppression’, published in the Huffington Post’s Highline. By the end of the [last] decade, some 100,000 women a year were dying or landing in emergency rooms with complications from unsafe abortions—fever, sepsis and organ failure. The crisis became so urgent that Kenya’s new constitution, approved by popular vote in 2010, declared that abortion would be legal when, ‘in the opinion of a trained health professional, there is need for emergency treatment, or the life or health of the mother is in danger, or if permitted by any other written law.’” 

Soon after, the U.S. stepped in and warned Kenyan health providers receiving U.S. aid that performing abortions would be a violation of the 1973 Helms amendment.

Two months later,” Bassett writes, “in February, the ministry wrote a second letter instructing all health providers to halt safe abortion trainings and stop stocking the medication that doctors use to perform non-surgical abortions in the first trimester. ‘Abortion on demand is illegal,’ the letter said, so ‘there is no need of training health workers on safe abortion or importation of drugs for medical abortion.’”

President Obama could remove the restrictions attached to U.S. funding on providing abortions in Kenya and other countries where the unsafe termination of pregnancy kills and injures so many girls and women; Bassett explores why he hasn’t. Read ‘Instruments of Oppression’.

  #tomorrowneedsher #womenshealth Because Tomorrow Needs Her focuses on some of the impediments to women’s health, exposing injustices that disproportionately affect women and girls around the world.

Before the Beginning

 
 
A pregnant woman waits to receive treatment at Gondama Health Center in Bo, Sierra Leone, in 2014. The Ebola outbreak forced MSF to close the GHC, as patients' and staff's safety could not be guarranteed. Recently MSF began supporting another maternal health hospital  in the region. Photo by Lam Yik Fei

A pregnant woman waits to receive treatment at Gondama Health Center in Bo, Sierra Leone, in 2014. The Ebola outbreak forced MSF to close the GHC, as patients’ and staff’s safety could not be guarranteed. Recently MSF began supporting another maternal health hospital in the region. Photo by Lam Yik Fei

“She arrived septic and in a bad condition”.

  I’m sitting in the morning meeting of the hospital that MSF is starting to support, it’s only 8am and already the heat and humidity is building up. 

Dr. Benjamin Black, MSF OBGYN in Sierra Leone

  Before Ebola hit West Africa last year, maternal mortality accounted for roughly 36% of all deaths of women between ages 15 and 49 in Sierra Leone, already an extremely high number.  Since the epidemic shattered what health systems were functional in that country, the percentage is certain to be substantially higher now and rising.

  Benjamin Black is on his third assignment to Sierra Leone with MSF and in his most recent blog post, he writes about one patient whose experience represents the entirely preventable and  largely ignored public health emergency of maternal death – “on an epic scale burning in the hills around us.”

  Read the blog.  
  #tomorrowneedsher #womenshealth #SierraLeone #Ebola

Because Tomorrow Needs Her focuses on some of the impediments to women’s health, exposing injustices that disproportionately affect women and girls around the world.

Meet MSF OBGYN Rachel Seay, Speaking in Annapolis, MD

Photo by Mathieu Fortoul/MSF

Photo by Mathieu Fortoul/MSF

OBGYN Rachel Chan Seay will hold a talk in Annapolis, Maryland, on October 21 in support of the Because Tomorrow Needs Her project. Dr. Seay has worked with Doctors Without Borders/Médecins Sans Frontières (MSF) in Sierra Leone and South Sudan, and she is a clinical instructor at the Johns Hopkins School of Medicine. Her research focuses on the history of medicine, strategies to decrease maternal mortality, and the designing of medical education curricula in global health.

In her talk, Dr. Seay will share her experiences in the field with MSF and discuss some of the challenges that women and girls face in trying to access the medical care that they need.

Where have your missions with MSF been and what has been your role in each?

My first mission with MSF was in Fall 2013. The project was in Bo, southeastern Sierra Leone, in a freestanding MSF maternal and pediatric hospital. I was there for about three months working on emergency obstetrics and maternal and child health with two other OBGYNs.

My next project, in South Sudan, was structured a bit differently. There, MSF runs the pediatric and maternity department within a larger government-run Ministry of Health hospital. At this project there is normally one OBGYN at a time who works with an ex-pat midwife, who is supervising and training a larger team of local midwives. My primary role in this project was to work with the midwives and to treat the patients who had complicated obstetrical or surgical cases.

You were recently honored as a 2015 Fellow in the History of American Obstetrics and Gynecology with the American Congress of OBGYN (ACOG). What has been the primary focus in your research to decrease maternal mortality?

Aside from my work with MSF, I’m very actively involved in global health and global health education. I’m on the faculty of Johns Hopkins University where I help with both the OBGYN resident and medical student electives and global health interest groups.

One of my particular areas of interest, both clinically and academically, revolves around the education, prevention and treatment of postpartum hemorrhage. My fellowship research project with ACOG is focusing on the history of the management of post-partum hemorrhage in the United States from approximately 1900-1940. I’m looking at the application of techniques and maneuvers that were used at that time and that might still be applicable in developing and low-resource settings.

In your work on the ground and in your research, what do you see as some of the biggest barriers facing women in terms of accessing medical care?

The issue of women accessing medical care in many MSF-based settings is a complicated and multi-factorial problem. While there are certainly problems in terms of just logistical access, including quality of roads, availability of transportation, and distance from home to a primary or tertiary center, there are also the issues of access related to the prioritization – or lack of prioritization – of women’s health care issues by governments, health administrations, and even health care workers.

Take for example, the issue of how ministries of health prioritize the importance of contraception and prenatal care and how this affects access to those services for women. Meanwhile, I think an additional barrier has to do with the availability of specialized care providers. There is a lack of medical education for general providers with some OBGYN experience and for those with specialty training in OBGYN and maternal health-related issues.

When have you seen these issues of access for women and girls arise in your missions with MSF?

It happens all the time, but there is one story that sticks out in my mind. While in Bo, we had two young girls, both 17, who started off on really parallel courses that ended dramatically differently. Both girls were pregnant with their first babies and had been laboring at home for several days with obstructed labor. Eventually, they each made their way out of the bush to a primary clinic where they were transferred to our facility. By the time one of the girls had arrived, her baby had died, while the baby of the other was still alive. Both girls delivered by C-section and ended up having really bad pelvic and abdominal infections. After about six to eight weeks in the hospital with us, the mother whose baby died ended up dying as well. The mother whose baby survived recovered and ended up doing well and being discharged.

The complications and suffering of both of these girls were happening at the same time – they even shared the same room! To me, this story paints such a stark picture of two different outcomes from a problem that is completely preventable. Both of these girls exemplify the incredible complication and suffering that can come from a lack of access to timely and appropriate medical care. We just don’t see this in developed countries because we have access to quality, timely care.

We also saw a lot of patients who developed obstetric fistulas after suffering from obstructed labor. While our project wasn’t specifically treating those with obstetric fistulas, we would often identify them and refer them to another NGO that was working in the area. Like many complications that I saw result in morbidity and mortality, obstetric fistula is an entirely preventable problem.

As mentioned, often times these issues aren’t as recognized in developed nations because the issue of access doesn’t exist to the same degree as it does in some other settings. What would you hope that people who come to your talk take away from it?

Partly just an expanded awareness of how fortunate we are to have access to medical care, contraception and preventative health care. I would like for the project to encourage people to take responsibility for their own preventative health care and encourage their families, friends and community to be involved as well. Prevention is always better than treatment.

I believe that the improvement of the global maternal health situation is truly an inter-disciplinary effort. And that’s why I’m not only doing talks at medical schools and schools for public health, but also at general universities, not specific to medical audiences.

I think it’s important to raise awareness that there is a need for a lot of different support and skill sets, whether it’s medical or engineering or education. There are many roles and skills needed to improve access to health-related services. I hope these talks will help illuminate these issues, update people about what is being done, and motivate people to get involved – whatever their skill

And I think that traveling abroad is not for everyone, and not everyone who attends these talks will want to or have the capacity to live abroad for several months at a time. So I would like to spread awareness that there is also plenty of work to be done here; you don’t always have to go far away to look for it.

I recently did an interview for the Association of American Medical Colleges (AAMC) because 2015 was actually the first time that all of the positions for OBGYN residency programs were filled in the U.S. I think it’s really encouraging that more people here are taking an interest in women’s health issues. The world needs more providers dedicated to these issues.
Register below for Rachel’s discussion on some of the challenges that keep women in developing countries from getting the medical care they urgently need.

October 21, 2015 – 7:00pm – 8:30pm – Annapolis, Maryland

Check out MSF’s event listing to see when a local MSF field worker will be speaking near you!
  #tomorrowneedsher #womenshealth #maternalhealth #OBGYN #sierraleone #southsudan

Because Tomorrow Needs Her focuses on some of the impediments to women’s health, exposing injustices that disproportionately affect women and girls around the world.

Meet MSF Nurse Rebecca Singer, Speaking in Madison, Evanston, and Chicago

 
Photo by Giulio Di Sturco/MSF

Photo by Giulio Di Sturco/MSF

Because Tomorrow Needs Her is holding speaking events with local Doctors Without Borders/Médecins Sans Frontières (MSF) field nurses, midwives and doctors in cities throughout the U.S. Speakers will talk about their experiences in the field and the challenges that women and girls face in getting the medical care they need.

In October there will be talks in Madison, Wisconsin; Evanston, Illinois; and Chicago with doctorally-prepared MSF nurse Rebecca Singer. Rebecca is a Chicago local with over a decade of experience in humanitarian and development work. She has provided services to survivors of sexual and family violence in Liberia, Kenya, Chad, Democratic Republic of Congo, Zimbabwe, Papua New Guinea and most recently in Tanzania.

Where have your missions with MSF been and what has your role been in each?

Most of my 10 years of MSF experience has been responding to sexual and gender-based violence. I started with MSF as the sexual violence response nurse in Monrovia, Liberia, where I helped to set up a clinic exclusively for survivors of sexual and gender-based violence, and then I became a sexual violence referent for MSF. My other roles have ranged from being the field coordinator for a family and sexual violence project in Papua New Guinea, to a primary care nurse and medical focal point for a project in Uganda, to a medical team leader for a malaria response in Democratic Republic of Congo earlier this year. Most recently, I returned to Tanzania to do an evaluation and assessment of the sexual violence situation there.

How does MSF provide care to survivors of sexual violence?

MSF is committed to providing the appropriate response to any survivor of sexual violence at any of their projects. Sometimes patients receive full, direct and psycho-social care, as well as a medico-legal certificate that they can use if they want to take legal action. Sometimes they receive just the medical response and sometimes we refer them to existing care.

What was the sexual violence situation you recently encountered in Tanzania?

There were reported cases of rape among the refugee population that occurred in transit from Burundi or Congo to Tanzania. At one point, there were nearly 500 cases reported in a month – cases which had occurred en route to the camp or before relocation.

Burundi has a very big problem with sexual violence. MSF in Burundi had established a sexual violence response center that was gradually handed over and became a local NGO. So the Burundian populations are highly sensitized to the issues of sexual violence – which is positive. In Burundi they know they should go to the doctor in circumstances of sexual violence and they are a little more open to talking about it.

There were also some incidents of forced marriage where girls living in poverty were being sold to families and forced to marry against their will.

Were their other issues of sexual violence or exploitation in the camp?

Yes, there was a large occurrence of sexual exploitation or transactional sex in the camp. Exchanging sex for food, exchanging sex for grades or for jobs. There were many women, especially Burundians, who came to the camps alone – either their partners did not come with them or got lost along the way. And the distribution of food in the camp was just not enough for these women trying to provide for six or seven children. They would be approached by men who would offer money for sex – which is not a choice in that situation. I believe if a woman is faced with the decision of exchanging sex for money or letting her children starve that is not a choice.

How are these issues of sexual exploitation in the camp being addressed?

They are being addressed in terms of sensitization by raising awareness throughout the camp. However, this is a population that is very hard to bring forward for services. Many women do not see that this is exploitative. And there are many women who have been desensitized to the issue after being raped within the context of war – they see this as something that just happens. So there is a sort of resignation that this is not a reason to seek help.

How has your work with sexual violence translated into a calling for women’s health?

My entire nursing career, other than a very brief period of time, has been in humanitarian response and development work. I prefer to work with women because I feel that women are more vulnerable in that they are denied access to health care more often than men, and they can make fewer decisions on how money is spent and whether to access health care. So I want to make those choices available to women – a healthy woman has a healthier family.

What have been the biggest barriers you’ve seen women face in terms of accessing health care?

I think that in places where there is a fee for services, and where women do not have access to money, they are completely denied access to health care. If you have to go through your husband to try to get health care services, you might not do it. Another thing is that women will often spend money on themselves last because they are going to want to save the money for their children. And often times what money a family has will be spent on the husband because the husband is making the choices.

What is one story about a patient that really sticks out in your mind?

One of the most poignant stories for me is of a woman I met in Papua New Guinea. I was the project coordinator for a clinic that provided care to survivors of family and sexual violence and it had an amazing impact by providing much needed services to this population.

One day, a woman arrived and said that she wanted to talk to me because she had gotten care in our clinic. She had been so satisfied with the care that she wanted to share her story so that other women in her community would come forward and avoid suffering in silence.

She was a very sophisticated and clearly quite educated schoolteacher who arrived with both arms in casts. She told me that one day at the end of the school year her husband called while she was proctoring an exam. She couldn’t pick up her cell because her students were testing. When she came home from work that day her husband went into a rage for missing his call – he beat her so badly that he broke both of her arms. She was so severely injured that she had to come straight to the hospital. After receiving medical care, she continued to access all of the services we provided including psychosocial care and legal information. She told me that she wanted to be an example for other women to come forward.

What do you hope people who come to your talks will take away from them?

I think it’s really good for people to be confronted with the reality of what most of the world’s population faces. All too sadly, your life is determined by where you live. For women facing issues ranging from safe delivery to cancer care to just basic health care – that’s so unjust. In the U.S. we challenge and complain about our quality of health care – and we absolutely should advocate for our own best care. But I think it’s a good opportunity to remember the care that is needed globally and what so many people lack that we take for granted.

We also need to remember that all women everywhere face the same issues. It doesn’t matter if you are a mother or a young girl or an elderly woman in the U.S., Tanzania, China or Colombia – the things that you want for your family and yourself – and the health needs that you have are the same. I think it’s a very powerful reminder to acknowledge that half the world’s population has these issues in common.
Register below for Rebecca’s discussion on some of the challenges that keep women in developing countries from getting the medical care they urgently need.

October 13, 2015 – 7:00pm – Madison, Wisconsin

October 21, 2015 – 5:30pm – Northwestern University in Evanston, Illinois

October 27, 2015 – 7:00pm – Chicago, Illinois 

Check out MSF’s event listing to see when a local MSF field worker will be speaking near you!
  #tomorrowneedsher #womenshealth #Tanzania #refugees

Because Tomorrow Needs Her focuses on some of the impediments to women’s health, exposing injustices that disproportionately affect women and girls around the world.

ISIS’ Sex Slave Market: The Brutal Abuse of Women and Girls

Photo by Gabrielle Klein/MSF

Photo by Gabrielle Klein/MSF

A recent New York Times story detailed how the Islamic State formally introduced the use of systematic sexual slavery in the areas it controls– justifying the act as a means of ibadah, or worship. On August 3, 2014, the story reports, Islamic State fighters invaded the southern part of Mount Sinjar, Northern Iraq where the Yazidis communities reside. Yazidis are members of a small religious minority which makes up only 1.5% of Iraq’s population. Within hours, families were systematically torn apart and men and boys were separated from women, girls and young children. The unmarried women and young girls were packed into painted buses, forced to sit on each others’ laps and hidden behind makeshift curtains that blocked out the light. After hours of transport, women and girls were herded into abandoned facilities including elementary schools, municipal buildings and wedding halls in the towns of Mosul, Solah and Tal Afar. In the Galaxy Banquet Hall of Mosul, alone, some 1,300 Yazidis girls were being held at one time.

They were held for days, weeks, or months in confinement in census-boarding facilities, and then young women and girls were transported in smaller batches around Iraq and Syria to be sold as sabayas, or sex slaves. Those who resisted were often “dragged out by their hair,” or coerced with the threat of pistols and daggers on themselves or sisters and relatives in the same facility. One 15 year old Yazidi girl who was able to escape enslavement recalls being told “…that Taus Malik’ — one of seven angels to whom the Yazidis pray — ‘is not God. He…is the devil and that because you worship the devil, you belong to us. We can sell you and use you as we see fit” (NY Times, 2015).

A few months later, the Islamic State stated through their online magazine that enslavement of Yazidi girls and women was explicitly planned and executed based on their highly dubious interpretation of Shariah law, as part of an effort to reward fighters who participated in the Sinjar operations. Experts and scholars on Islamic theology have roundly rejected this interpretation of the Quran and emphasized that Islam does not justify slavery, but to these fighters, the girls were seen as prizes. Those who escaped recalled fighters receiving girls according to rank, with some obtaining multiple girls at a time on “slave market day.” One survivor, at only 12 years old, recounted that her abuser “explained” that raping her would bring him closer to God. Before and after each assault, he would kneel beside the bed that she was gagged and bound to, praying to “bookend the rape with acts of religious devotion” (NY Times, 2015).

The New York Times story significantly increased awareness of the Islamic State’s formalized market for sexual slavery. It also helps illustrate the systematic abuse that women and girls face in times of war and conflict globally, however efforts are made (or not made) to justify it. Recently, the UN Special Representative on Sexual Violence in Conflict reported that 19 countries and 45 armed groups were suspected of using conflict-related sexual violence as a tactic of war. MSF is not working in IS controlled areas, but in the past decade alone, MSF has treated more than 100,000 survivors of sexual violence in a number of these contexts. It’s been one year since the attacks on Mount Sinjar, and nearly 3,144 Yazidis are still being held, many through this formalized infrastructure of a sex slave market. While on the agenda of governments world-wide as a threat to domestic security, ISIS’ treatment toward women and girls on the front-lines of conflict had previously garnered little attention and spurred little action. The voices of survivors caught in the cross-hairs of ISIS’ abuse must be vocalized in an effort to bring their dehumanized war tactics to an end.
#tomorrowneedsher #womenshealth #Syria #Iraq

Because Tomorrow Needs Her focuses on some of the impediments to women’s health, exposing injustices that disproportionately affect women and girls around the world.

MSF Launches Women’s Health Speakers’ Tour: An Interview with Dr. Hiller, OB/GYN

Photo by Ashley Hamer/MSF

Photo by Ashley Hamer/MSF

In an effort to help raise awareness for women’s health, MSF’s Because Tomorrow Needs Her campaign will be hosting a regional speaking tour in cities around the U.S. These talks will be led by locally-based MSF field nurses, midwives and doctors who have experienced first-hand some of the challenges women and girls face in trying to access equitable, high-quality and affordable medical care.

In preparation for the launch of the regional speakers’ tour in Johnson City, TN and Asheville, NC, we spoke with MSF-OB/GYN Dr. Durell Hiller –a Dandridge, Tennessee local who has worked with MSF to improve women’s health in Nigeria and South Sudan. Dr. Hiller is former active duty military with the U.S. Army Medical Corps, providing medical assistance during Operation Desert Storm, and has over three decades of private practice experience.

Dr. Hiller, what have been your assignments with MSF?

My first mission was in Goronyo in northwestern Nigeria and that consisted of training midwives on care, treatment, and what to do when there are complications in pregnancy. It also involved working with the Nigerian Ministry of Health to try to establish better access for pregnant women to receive care. My second mission was in Aweil, South Sudan, and that involved a lot of surgical treatment for complications in pregnancy.

How did your experience with the U.S. Army Medical Corps and in private practice prepare you for your missions in the field?

Well my background and experience both in the military and in practice provided me with the knowledge and skills needed to perform these duties. In the military you have only the equipment that they’re giving to you, not like in private practice where you can ask for a lot of things. With MSF we had just what was available and you get used to using that to help the people you’re taking care of.

As you know, the theme that’s at the crux of this project is that of women facing barriers to high quality and equal access to emergency medical care. What types of barriers did you see women experiencing in some of your missions?

Well there are many major barriers that these women face, just some of them being the inadequate referral system, inadequate transportation to facilities, lack of ambulance services, lack of skilled medical professionals, lack of education and training. Women really need medical care nearer to their villages so that they don’t have to travel great distances.

Is there one particular story or experience from an MSF patient that really sticks out in your mind?

Well there are many. One particular story that really comes to mind is a patient who came to us and required a C-section. She had been in labor for several days and the baby was in an abnormal position. Three of her previous children had died in childbirth. [After a successful delivery] …she came back at her fourth week after surgery for a follow up. She was doing well, the baby was doing well, and she told us that she was so happy to finally have a baby that lived.

Do you find situations like this occur frequently in your missions?

Yes, the people that we take care of in both of the missions I’ve been on are so appreciative of the care we give them. They are so happy to have healthy babies – it happens frequently.

What were some of the challenges that you experienced in your missions, aside from being without all the medical supplies you were used to having? How were you able to adjust?

In addition to the medical challenges, just working in another country, you have different cultures, customs, languages, food, housing. Working with our fellow ex-pats was very rewarding. We all get together and attack these challenges and try to work with them to the best of our advantage.

Plus, working with the national staff, who are very helpful, especially with the languages, is great. They love the training, they love the teaching – the midwives were just outstanding. They were very receptive to our recommendations on how to do things and in the different ways that we wanted them to treat the patients. It was all very positive.

What were some of the other rewards that you experience working in the field?

Working with the patients – they were great. They were so grateful for our assistance and they were so nice. That was just a great reward in itself.

You mentioned before that you had worked with some of that Ministry of Health staff. Why does MSF do this?

All MSF projects in some way work with the Ministry of Health in that country. The projects where I worked are also trying to teach the national staff to take over some of the responsibilities. So working with the Ministry of Health is helpful in trying to do that, to give a life-long or prolonged access to care for these women – even if MSF is no longer there.

What do you hope people who come to your talk or come to any of the regional talks for the Because Tomorrow Needs Her project will take away?

I hope that they will be able to see the risks that women face in developing countries and that MSF has shown that there are simple steps that can help these women. The book, Because Tomorrow Needs Her, shows the experiences of not only the staff, the OB/GYNs, nurses and midwives, but also the patients and how access to care affects their lives and helps them have healthier pregnancies and healthier babies. I hope people will be tuned in to helping through whatever means they can.

My work with MSF has been very personally rewarding, just working with patients, ex-pat staff, national staff, the support staff in New York and around the world. I hope that through these talks, people who are not directly exposed to what women are facing in developing countries will see how it affects their lives.


Register below for Dr. Durell Hiller’s discussion on some of the challenges that keep women in developing countries from getting the medical care they urgently need.

August 27, 2015 – 6:00pm –Johnson City, TN
September 15, 2015 – 6:00pm – Asheville, NC

Check out MSF’s event listing to see when a local MSF field worker will be speaking near you!
  #tomorrowneedsher #womenshealth #Nigeria #SouthSudan

Because Tomorrow Needs Her focuses on some of the impediments to women’s health, exposing injustices that disproportionately affect women and girls around the world.

The Rose of Masisi: MSF Counselor Brings Joy to Expectant Mothers

 
Maman Agathe, also known as The Rose of Masisi - Photo by Sandra Smiley/MSF

Maman Agathe, also known as The Rose of Masisi – Photo by Sandra Smiley/MSF

Access to quality healthcare is often an obstacle to pregnant women and girls in conflict and remote areas of the world. In an effort to provide quality medical attention to mothers with high-risk pregnancies, MSF created a maternal waiting home known as the Village d’Accueil, or Home Village. Located in North Kivu, Democratic Republic of Congo (DRC), the village gives women the opportunity to stay at the facility under medical supervision until they give birth. Nearly 1/3 of all deliveries last year at the MSF-supported Masisi Hospital were to women staying at the Village d’Accueil, (MSF, 2015).

Agathe Farini Sena, known to expectant mothers as Maman Agathe, helps to run the Village d’Accueil as a counselor. Always dressed in a bright pink blouse so she is easy to identify, Maman Agathe welcomes and monitors the physical and emotional well-being of the 70 or so mothers at the facility as they prepare to give birth. Many of these women, of various ethnic backgrounds, come from war-torn and conflict-ridden regions that have led to stressful pregnancies. Maman Agathe, coming from North Kivu, is no stranger to conflict. And she regards the women as her own children, who she likes to “spend time with…dance with…laugh with… and muck about with.”
 

#tomorrowneedsher #womenshealth #DRC

Because Tomorrow Needs Her focuses on some of the impediments to women’s health, exposing injustices that disproportionately affect women and girls around the world.

The Diary of an MSF OB/GYN in Sierra Leone

Photo by Martina Bacigalupo, MSF

Photo by Martina Bacigalupo, MSF

MSF’s Because Tomorrow Needs Her campaign for women’s health investigates why so many women in developing countries are unable to access life-saving medical care. An integral feature of the project is the intimate journal by Dr. Betty Raney who documented her experiences as an OB/GYN in Bo, Sierra Leone for six months in 2012. Dr. Raney’s writings illustrate the raw fear and despair that both staff and patients experienced in trying to get or give this care in such a challenging environment.

“It was a terrible night. I feel like a boat that leaves nothing but death in its wake. I delivered 32-week twins by C-section three days ago. They were both… lying sideways across the mother’s abdomen. The second one died today, the first one yesterday.”(- Dr. Betty Raney, MSF)

Dr. Raney’s patients faced life-threatening unsafe abortions and other obstetric emergencies that disproportionately kill and injure women in developing countries, as well as the global problem of sexual violence. The stories are heartbreaking. Yet, she also highlights the incredible strength and resilience of her patients, emphasizing that they are  “anything but victims.”

“There are small glimmers of hope here at times. The woman in septic shock…is alive and I think she will make it. This is very unusual in her circumstances and our chief health officer calls it ‘a truly miraculous case.’…The healing properties of the body plus the resilience of women here amaze me.” (- Dr. Betty Raney, MSF)

Dr. Raney, and MSF staff in over 70 countries around the world, work to provide women and girls with the care they need to overcome challenging medical conditions that threaten their lives. Read Jezebel’s interview of Dr. Raney’s experiences in Sierra Leone and her work with MSF’s Because Tomorrow Needs Her project here.
Because Tomorrow Needs Her focuses on the impediments to women’s health, exposing injustices that disproportionately affect women and girls around the world.

#tomorrowneedsher #womenshealth #childshealth

The Lottery of Life: How Location Impacts Survival

Photo by Mathieu Fortoul

Photo by Mathieu Fortoul

Today, the world relies on a number of factors to determine the overall health of a city, including child and maternal mortality rates. Often times, these statistics reflect the deaths of mothers and their babies that are preventable with access to life-saving care. In May, Save the Children released their State of the World’s Mothers 2015 report, which highlighted some of the health disparities that exist for mothers and their babies in urban areas of the world.

Currently, 54% of the global population lives in urban cities. This number is predicted to increase to nearly 66% in the next 35 years. Of these, nearly 1/3 or 860 million people, live in urban slums. This is cause for concern because in urban areas, children of the lowest socioeconomic status are twice as likely to die as those in the highest socioeconomic bracket. In the urban slums of countries such as Nairobi and Kenya, the chances of survival for mothers and their children (infants and those under 5 years of age) is 50% lower than that of the country’s national average. And in some countries, this gap is even wider. In the urban areas of Cambodia and Rwanda, children born into the poorest 20% of homes are nearly 5 times more likely to die, before age 5, than those born into the richest 20% of homes, (Save the Children, 2015).

“This is the lottery of birth. Across the world, children’s chances of surviving to see their fifth birthday depend on where they happen to be born, how much their parents can afford to invest in their well-being, the ethnic identity that has been ascribed to them, whether or not they have a disability, and other factors that are all outside their control.” (- Lottery of Birth, 2015).


Nearly 2.8 million babies died before their one month birthdays in 2013. Every day an estimated 800 women die from pregnancy-related causes, (WHO, 2014). Many of these deaths are preventable with access to proper medical care, including supplies, medicines, and trained health staff.

MSF provides maternal and child care as a top priority in one-third of its projects around the world, and teams provide access to emergency obstetric care in every project. 
Because Tomorrow Needs Her and MSF take the position that no woman or child should be entered into a lottery of life, with location being their winning ticket. 
 
 

Because Tomorrow Needs Her focuses on the impediments to women’s health, exposing injustices that disproportionately affect women and girls around the world. #tomorrowneedsher #womenshealth #childshealth #lotteryoflife

Creating an HIV-Free Generation

Photo by Sydelle Willow Smith

Photo by Sydelle Willow Smith

Just this week, UNAIDS announced that targets of MDG #6 (Millennium Development Goal) have been not only achieved, but exceeded. The UN’s MDGs are the world’s time-bound and target-oriented goals for eradicating poverty by improving the health, education and equality of humans around the world. MDG #6 calls attention to reducing the spread of HIV/AIDs, Malaria and other diseases by 2015.

“The world has delivered on halting and reversing the AIDS epidemic…” – Ban Ki-moon, Secretary-General of the United Nations.

Efforts to halt the spread of new infections have resulted in a global decrease of 35% from 2000 to 2014. UNAIDS reports that epidemics have ceased or even reversed in 83 countries where nearly 83% of the world’s HIV population lives. In addition, significant strides in reducing HIV among children of pregnant women have been made. From 2000 to 2014, access to antiretroviral treatment increased 73% among pregnant women living with HIV. As a result, the annual rate of new HIV infections among children fell 58% globally. And just last month, Cuba was named the first country to eliminate mother to child transmission by WHO.



Yet, with significant progress made on achieving MDG #6, it is important not to lose sight of those who fall outside of the UN’s target. While MSF currently treats 341,600 women, men and children living with HIV/AIDS in projects of more than 20 countries, over 50% of the 37 million people living with HIV are still unable to access treatment. And while MSF provided PMTCT (preventing mother-to-child transmission) to approximately 18,489 women in just 2013, there are still an estimated 700 children newly infected every day – many of which, lack access to proper treatment, (MSF, 2013).

“Despite this tremendous progress, more than 220,000 children were newly infected with HIV in 2014… The majority of these children don’t have access to the treatment they need—only 32 percent of the 2.6 million children living with HIV had access to ART in 2014. Without treatment, half of these children will die before age 2, and 80 percent won’t live past age 5.” -EGPAF 

Many pregnant women living with HIV will do anything possible to prevent transmitting HIV to their unborn babies. Because Tomorrow Needs Her examines the barriers many of these women face in getting proper PMTCT treatment and the efforts they make to create an HIV-free life for their children.

#tomorrowneedsher #womenshealth #PMTCT


Because Tomorrow Needs Her focuses on some of the impediments to women’s health, exposing injustices that disproportionately affect women and girls around the world.