Posts Tagged ‘women’s health’

Teen Pregnancy Prevention Program Defunded in Baltimore…and Beyond

August 20, 2017

The teen pregnancy rate in Baltimore is 2-3 times the national average, with rates reaching upwards of 64 pregnant teens for every 1,000 female adolescents in 2009. According to the Center for Disease Control, teen pregnancy costs taxpayers $10 billion annually in health care and foster care costs. On the personal level, unplanned pregnancies significantly reduce life opportunities for teen moms, with the CDC finding that only 50% of teen moms graduating from high school by age 22. This lack of education causes a ripple effect, and teen moms have more chronic health problems and higher rates of incarceration.

Courtesy of the Baltimore Sun

Courtesy of Baltimore Sun

Teen pregnancy in Baltimore has seen a steady decline over the last decade, joining a national downward trend. This comes in no small part to programs such as the Health and Human Services’s Teen Pregnancy Prevention Program (TPPP). With funding from the TPPP, 80 city health departments have been empowered to create science-based prevention programs for teens to understand contraception and sexuality.

Unfortunately, the TPPP was abruptly defunded last week. The Trump administration offered little explanation, leaving pro-abstinence groups such as The Abstinence and Marriage Education Partnership to justify such cuts with claims that abstinence is correlated to lower rates of teen drug abuse.

Here in Maryland, the Baltimore City Health Department expressed frustration at losing $3.5 million out of the $214 milling being cut. Health Commissioner Leana Wen called the cuts “shocking.” The Health Department has joined the Big Cities Health Coalition, comprised of the 80 beneficiary cities of TPPP funds, in decrying the budget cuts. Even the American Academy of Pediatrics has joined the plea, adding a link to its website for pediatricians to contact their congressmen in protest.

There’s good news. The National Campaign to Prevent Teen and Unplanned Pregnancy found that 83% of adults support teen pregnancy prevention programs. Now is the time to tell Congress that the constituency wants the TPPP funded. Call your congressman today!


The Global Gag Rule, a harmful human rights violation

March 12, 2017

The Global Gag Rule (GGR) is harmful to women and families and violates human rights. Originally known as the “Mexico City Policy” because it was enacted by Ronald Reagan in 1984 at a conference in Mexico City, the policy is more commonly known as the Global Gag Rule because of how it silences NGOs and health care workers. Specifically, the original policy dictated that no USAID family planning funds could be awarded to organizations that performed or promoted abortion and therefore prohibited them from even speaking about abortion.

The GGR is highly partisan- every Democrat president since Reagan has rescinded the policy and every Republican has reinstated it. The current administration, however, has not only reinstated the GGR but has dramatically expanded the funds that are affected.

Reagan’s version applied to USAID family planning funds; G.W. Bush’s version limited the GGR by exempting USAID HIV/AIDs related work. The latest iteration, however, greatly expands the affected funds to cover all foreign aid arising from any agency or department. The current version restricts up to $9.5 billion in aid, or 16x the amount of funds that would have been affected by previous versions.

Worse yet, beyond being a clear example of religious overreach in US politics and a violation of human rights, evidence suggests that the policy reduces sex education and contraception use while increasing both abortions and the proportion of abortions that result in health complications- maternal, family, and child health all suffer. There is a large coalition of organizations that oppose the GGR. You can take action today by learning more information about the GGR and volunteering or donating to organizations like IPPF, PAI, and the Bill and Melinda Gates Foundation who, together with UN member countries, are attempting to counteract the extreme funding deficit.

Renewing the debate for an HPV school-entry vaccination mandate in Maryland

August 14, 2015

HPV vaccine being administered (JOE RAEDLE / GETTY IMAGES)

In 2007, a human papillomavirus (HPV) school-entry vaccination mandate was introduced and then withdrawn in the Maryland legislature.  The major concerns at the time was that the vaccine was too new, it was too costly, and that it was intended to prevent a sexually transmitted disease.

Since then, no substantial action has been taken and there has been no formal deliberation about re-introducing an HPV vaccine mandate in Maryland.  In the years since the mandate was introduced, cervical cancer has continued to rise in Maryland with nearly 200 new cases per year according to the most recent data from the Maryland Department of Health.

It is unanimous among the scientific community that nearly all cervical cancer cases are caused by HPV.  It is understandable that the public was apprehensive of the HPV vaccine in the past, but now we know that:

  • The vaccine has been administered for nearly 10 years and is proven to be safe
  • The vaccine is very effective and can prevent thousands of deaths from cervical cancer
  • There is no evidence that the HPV vaccine increases the chances of risky sexual behavior
  • Insurance plans are required to cover the cost of the vaccine under the ACA and it is also available at no cost through Medicaid’s Vaccines for Children Program

Virginia, the District of Columbia, and recently Rhode Island have enacted school-entry mandates for HPV vaccination.  DC passed the law in 2007 and as a result, they are now a national leader in HPV vaccination coverage.

It has been eight years since the HPV vaccine mandate was first debated in Maryland and it is time to renew that debate.  If Maryland is serious about preventing a deadly form of cancer, they should follow their neighbors’ lead and enact a school-entry HPV vaccination mandate.

Breaking the Intergenerational Cycle of Under-nutrition: Community Based Interventional Approach in Bangladesh

March 7, 2015


Malnutrition has always been one of the major Public Health issues in Bangladesh. Malnutrition includes both under-nutrition and over-nutrition. However, Bangladesh is a highly under-nutrition (wasting, stunting and underweight) prevalent country which include macro and micro-nutrient deficiency. In Bangladesh, commonly children aged under 5 years and women suffer most from under-nutrition . Among the children under 5 years, the prevalence of chronic under-nutrition (stunting) is around 44% (7.8 million) and acute under-nutrition (wasting) is 14% (2 million) which is nearly the WHO “critical threshold” of 15%. More than one in five newborns (22%) have a low birth weight in Bangladesh due to maternal under-nutrition and early pregnancy. Early pregnancy contributes to the inter-generational cycle of under-nutrition. Although the prevalence of under-nutrition has reduced over the past few years, but progress has been slow due to poverty, lack of health education, natural disaster, food insecurity and caring practices.

Source: WFP Bangladesh Nutrition Strategy

Intergenerational cycle of under-nutrtion; Source- WFP Bangladesh Nutrition Strategy

Improvement of maternal and child nutritional status has been a priority of the government of Bangladesh for several decades. In 2012, to reduce maternal and child under-nutrition, along with World Food Programme (WFP) Bangladesh govt. introduced National Nutrition Service (NNS) strategy 2012-2016 which is multi-sectoral collaborative approach aiming on strengthening national and local capacities to adequately deliver nutrition services, and improving access to nutrition services through integrated community based interventionsThe policy specifically focused on the first 1000 days of a child from conception to two years when nutrition needs are the highest and nutrition intervention have the most long-term effect and contribute to breaking the inter-generational cycle of under-nutrition.

We believe, this short-term comprehensive approach will be very effective to reduce nutritional problem in Bangladesh. However, active coordination of all sectors, adequate training of health worker, uninterrupted supply of nutritional services and active involvement of community need to be ensured.

Reproductive Health in Jordan: A Multi-Faceted Investment in the Future

March 6, 2015

Jordan’s population is rising at exponential rates which, if maintained, will double the population in approximately 27 years.  The cause for this dramatic growth is a high fertility rate coupled with the population demographic – 60% of Jordan’s population is under the age of 25Jordan is already heavily dependent on imported goods and resources at current time, and if the population growth is sustained at its current rate, the country will no longer be able to sustain itself adequately. The Government of Jordan has identified this as a national issue and established a goal to lower the fertility rate by 2020; however, this threat to socioeconomic growth and resources is not without challenges. The Kingdom of Jordan is an Islamic country, and national funding allocations are heavily influenced by government entities that do not fully support education regarding contraception and family planning options.

Muslim religious leaders heavily influence the attitudes and beliefs of the population, and more conservative Islamic leaders have openly campaigned against the use of condoms or other birth control methods, thus making population planning largely ineffective.  While reproductive health is a topic that once had the attention of internally led non-profit organizations, over time these have lost funding and advocacy due to lack of prioritization about the issue – despite recognized impact. In fact, external organizations are now the strongest promoters of the cause.  USAID is currently the largest donor to Jordan’s efforts to educate the population on family planning and reproductive health through the Health Policy Project (HPP), but more adequate participation from Jordan’s governing bodies is needed.

There must be further measures taken to increase funding and awareness of family planning methods in order to ensure resource availability and sustainability in the future.  A partnership between internal health organizations and religious leaders is necessary to fully ensure national support is available.  Working together as much as possible to maximize efficient use of donor resources and provide more value for money is vital based on the current resource situation.

Task Shifting is the solution to shortages of health care workers in Pakistan.

March 6, 2015

Health workers shortage has a major impact on accessibility of medical care in Pakistan. Evidence shows that currently there are only 8 physicians, 4 nurses, 1 dentist, 1 pharmacist and 4 community health workers (CHW) per 10,000 populations in Pakistan (World health statistics, WHO 2010). The anticipated shortage of future medical professional workforce for Pakistan range between 57,900 and 451,102 physicians by 2020, which is dependent on assumptions of future needs. Given the human resource gap in health field, many countries developed national programs for community health workers (CHWs) to expand and strengthen health system. For example, Malawi once with a shortage of health worker (2 doctor per 100,000 population) has been successful to reduce workload on physician by increasing number of CHWs and shifting workload to them, that now in some part of Malawi, CHWs are the only health worker serving the area.

Shaban Rafiq (in blue), A Lady Health Worker, consulting a women in Chikar in Pakistan

Shaban Rafiq (in blue), A Lady Health Worker, consulting a women in Chikar in Pakistan

The current health care system is marked by an imbalance in the health workforce, with insufficient health managers, nurses, CHWs and skilled birth attendants in the rural and peripheral areas (Country cooperation strategies, WHO 2013). The health ministry has more focus on urban health care development leaving the rural areas majorly deprived of health care. Although CHWs and other mid-level health workers are working in Pakistan health system, more CHWs can be hired and trained. Task can be shifting or dividing between physician, nurses, mid-level health worker and CHWs

based on complexity of disease is an effective approach to increase accessibility of medical care within limited human resources. By this approach, patient with relatively severe cases and complicated procedure can be attended by physician, whereas, simple cases and minor procedure can be handled by the nurses, mid-level health workers and the CHWs.

Advocacy to legalize sex work to reduce risk of HIV.

March 4, 2015
Senator Thuli Mswane, Photo credits:

Senator Thuli Mswane, Photo credits:

Swaziland has one of the highest Human Immunodeficiency Virus (HIV) prevalence in the world at 17.3% compared to 2.7% in the region and 0.05% globally, with a higher incidence in females compared to males. Further, female sex workers (FSW) have 14 times the odds of acquiring HIV compared to other women in sub-saharan Africa.

While the Swazi government has directed substantial efforts toward reducing HIV infection rates there are certain structural factors that play into exacerbating the spread of HIV.  Owing to the fact that sex work in Swaziland is illegal and soliciting sex is a criminalized, FSWs are at greater risk of social isolation and discrimination, and accessing public amenities e.g. health care. Further, FSW are plagued with the vicious cycle of, sexual violence, police brutality, primarily due to the inequitable law and policies. Decriminalizing sex is an established strategy to reduce the stigma and to protect women against the risks of acquiring HIV.

A public debate around the legalizing sex work, has seen strong support from Senator Thuli Mswane, Director of a local home-based care organization. Senator Mswane has announced her intention to champion the cause of legalized sex work by requesting that the justice ministry introduce a bill legalizing the sex trade as a means of controlling the spread of HIV. We believe that legalizing sex work will result in better access to public services and thus reduce FSW’s risk of acquiring and transmitting HIV. We support the bill and trust that you will too.

Devolution of Women’s Rights: Access to abortion services in PEI

August 15, 2014

The Supreme Court of Canada recognized abortions as a medically necessary service in 1988. It is therefore harrowing that the last legal surgical abortion performed on Prince Edward Island was in 1982.

Recently, the National Abortion Federation (NAF) proposed a program that would allow for safe, timely, and cost-neutral pregnancy terminations in the only remaining Canadian province that does not offer this service. This proposal was stonewalled by the provincial government last May.

At the current time, the PEI government covers the medical costs of the procedure for women to have the procedure in Halifax hospitals. The out-of-province trip and accommodation, however, is not covered, rendering it difficult for lower socioeconomic class women to access this health service. Additionally, two doctor referral letters are also required. For women without family physicians, or for those with physicians that refuse to  refer, there are few options. As Dr. Sethna, an associate professor at the University of Ottawa stated, “abortion doesn’t have to be illegal in order to be inaccessible”.

Desperation is dangerous. It is well-known that when women are deprived of their reproductive rights, they can turn to illegal, unsafe means. And in fact, abortions do continue to take plan on the island. Unsafe abortions are currently one of the biggest contributors to maternal mortality world-wide.

The PEI government’s decision is at odds with the Canadian Charter of Rights and Freedoms, specifically the right to life, liberty, and security of the person. Up until now, the government has attributed the problem to the lack of qualified physicians willing to travel to the island. The rejected NAF proposition, however, identified 3 gynaecologists that had volunteered to provide this service in-province.

Access to safe and timely abortion services is a fundamental component to women’s rights and reproductive health. Help restore women’s freedom of choice by writing to your local media outlet or contacting your elected official (Rona Ambrose – Minister of Health, Kellie Leitch – Minister for the Status of Women, Robert Ghiz– PEI Premier). Join the PEI Reproductive Rights Facebook page and follow them on Twitter. Attend Canada’s Day of Action and show your commitment to Women’s Rights.

Postpartum Depression in Saudi Women: Culture and Biology Collide

March 10, 2014

Postpartum depression (PPD) is one of most common complications of childbirth. Currently, the prevalence rate of PPD is between 10–15% of mothers who recently delivered. Many women experience some emotional disturbances in the month after giving birth, often typified by crying, anxiety, and irritability. The “baby blues,” a normal, temporary period after childbirth, usually resolving a few weeks after delivery; however emotional disturbance may predict the development of chronic mood disorders that can have a lasting negative impact on the mother and her family.

Its high profile in the United States often overshadows its presence in nations outside the western hemisphere. In fact, compared to its prevalence of 10-20% in developed industrial countries, it is estimated that developing nations hold a prevalence of 20-40%.


Figure: From Postpartum Depression and Miriam Carey


Figure: From Postpartum Depression: Information for Rehabilitation Counselors

Saudi Arabia is one of the largest countries in the Middle East in size and population. Its recent economic growth and development has led to improvements in medical care and technology. However, psychological services are still in short supply for most of the population, most of all, pregnant women.

As an OB/GYN resident in Saudi Arabia, I found that most of my patients do not know about PPD and the vast majority of the time, do not seek help, even when having experienced similar problems in previous pregnancies. In addition, those mothers can be very young in age, with low educational levels, simply accepting the status quo. Conversely, a recent study showed that women who work and have children in Saudi Arabia have marginally increased prevalence of PPD. Researchers interpreted these results as stemming from the pressures of financial need: while Saudi Arabia’s economic development is growing fast, social systems to support low income families are non-existent.

The Saudi health system must improve their health policy and increase awareness of the risk and complications of PPD. Given the wide reach that primary health care services have in Saudi Arabia, general physicians must be involved in identifying the risk factors and early signs of PPD to prevent its complications. In addition, OB/GYN physicians must be familiar with PPD and at the very least, know the required methods available to detect PPD during standard postpartum visits. More specifically, physicians have to be familiar with Edinburgh Postnatal Depression Scale, the standard, validated scale used to measure a woman’s postnatal mood that has also been translated into Arabic.

Women whose PPD is identified are often shuffled around different specialists in the prospect of acquiring treatment. Unfortunately most Saudi primary care physicians did not have adequate training in identifying this condition, let alone the basics of its treatment. Moreover, OB/GYN staff usually refer any patients they believe to have any sort of psychiatric disorder to psychiatrists. Large hospitals usually have psychiatrists as well as a psychiatric ward, but hospitals like this are few throughout Saudi Arabia. However, knowledge of the postpartum needs of women is improving as recently, the new Health minister, D.Alrabeaah recommended that the government establish two large and well equipped hospitals to serve the community, especially poor and medically underserved communities.

PPD is also affected by a woman’s home life. Postpartum support from husbands is low in Saudi Arabia and it represents one of the major obstacles to improving a woman’s postnatal state. Husbands must be educated about the needs of their wives and provide support. Moreover, the child’s gender can often contribute to a mother’s PPD. When a mother delivers a baby girl, they tend to receive less care and support from mothers, sisters, and family. Saudi culture prefers boys for their potential to add to family wealth and productivity. These cultural expectations and beliefs must be fundamentally changed if mothers are to feel supported and worthy of their family’s care. To do this, people should be educated, starting with young children and women, who often serve to perpetuate these beliefs of unequal gender worth.


Figure: From Ica’s Tales of Mommyhood

From my experience as a Saudi citizen and physician, the only real support new mothers can receive after delivery is from immediate family, especially their own mothers, who usually take their daughter and the new baby to stay with them for 1-2 months. While families can increase a woman’s risk of experiencing PPD, this much needed support serves to help a woman acclimate to her role as a mother to a new child.

Kuwait, a neighboring country, shares the same beliefs and cultural values and generally experiences similar issues with PPD. In recent years, the government of Kuwait took many steps forward in improving the mental health of its citizens, particularly those afflicted with PPD, and I hope the Saudi government uses these changes as an example to make strides in its own mental health system for women.

In conclusion, it is imperative that we improve access to PPD screening by increasing training for primary care physicians and OB/GYNs and on a more long term level, change cultural attitudes that decrease a husband’s involvement in the postpartum period and places greater value on one sex over the other.

Combating Vesico-vaginal fistula and Recto Vaginal fistula(VVF/RVF) through girl child education in Northern Nigeria

March 8, 2014
VVF Pre operation preparations

VVF Pre operation preparations


For each maternal death 10 to 20 women suffer permanent injuries or disability during the process of child birth. The most prominent among these injuries is obstetric fistula called Vesicovaginal fistula (VVF). Vesicovaginal fistula constitutes a major gynecological problem in developing countries. It is prevalent in communities where malnutrition and untreated infections stunt the growth of future mothers during their childhood and adolescence leading to contracted pelvis. In Situation where maternity services are scarce or far or even mistrusted contract pelvis go undiagnosed and survivors of obstructed labor may be left with bladder or rectal injuries resulting in constant uncontrollable loss of urine or stool into the vagina.  The women if not treated are likely to suffer consequences ranging from physical disability, psychological, social, and economic consequences. They may also be ostracized from their own community; some become homeless, divorced or abundant by their husbands. The trauma is often compounded by the psychological trauma of delivering a stillborn baby. VVF is a major public health issue in Northern Nigeria where the prevalence is on the raise because of increasing poverty, girls are married off at early (under 19 years), high school dropout and low girl school enrolment are school.

Although the campaign to end VVF in Nigeria is ongoing over the last 20 years, little attention has been paid to prevention of new cases. The government and national foundation of VVF campaign (NF-VVF) and other non-governmental organization have their focused on the repair and treatment of the over 200000 thousand backlog cases. Currently there are 8 VVF centers in Nigeria mostly in the northern states caring for VVF cases. According to Dr Kees Waaldijk over 25000 repairs were performed since the inception of the foundation.  488 health professional trained in the pre and post-operative care for VVF. USAID developed a strategy they called pooled effort for fistula repair, the society of obstetrics and gynecology encourage trained gynecologist to repair and manage VVF cases, the ministry of women affairs in Jigawa state are working in collaboration with USAID to clear the backlog of fistula case. All these efforts are curative and none are preventative efforts.

Neglecting preventive strategies will only make matters worse as new cases add to the backlog every day.  The NF-VVF acknowledges that there are no national VVF policies or policies that support prevention of VVF. Less than 7% of girls are enrolled in school in Jigawa state, followed by large drop after the first year. This is when the girls get married. The girl child has no say over her choice whether to be in school or to be married, that decision is left with the father.

Let us therefore end this mayhem by educating girl child.  Putting girls in school will delay early marriage and delaying marriage will lead to reduction of teen pregnancies hence reduction in pregnancy related complications such as VVF and maternal mortality. Other benefits of girl child education include development of essential life skills, such as self-confidence, the ability to participate effectively in society, and protect themselves from HIV/AIDS, sexual exploitation.  Additionally they will contribute to national wealth, their children are more likely to go to school and, consequently, this will have exponential positive effects on education and poverty reduction, reduction of VVF for generations to come.