Family Planning Matters!!

Sign on the wall at a health center in Mayuge District

Hello from Uganda!  I am here again in the warm sunshine just narrowly missing the start of the cold rain in Seattle.  Sometimes trip timing has its benefits.  I am in Uganda for the next 7 days on the way to the International Conference of Family Planning happening in Addis Ababa, Ethiopia next week.  Believe it or not, it was more cost effective for me to come to Uganda first than to go straight from Seattle to Addis.  Fine by me, there is plenty of work to do here in Uganda.

As you may know from my previous posts, PATH is responsible for the introduction and evaluation of Sayana Press (http://sites.path.org/rh/recent-reproductive-health-projects/sayanapress/) in the four countries of Senegal, Uganda, Burkina Faso and Niger.  The product is intended to be delivered to woman by lower level community health workers to inject.  Theoretically, this could help women access family planning in their communities rather than having to travel  to a health facility and  see a trained medical professional for their family planning injection.

So, you may be asking yourself at this point, why does that matter?  This photo may help to illustrate.

New mother to triplets at a heath center in Mayuge

We met this woman yesterday at a maternity ward at a health center III in Mayuge District. Two days prior she had given birth to triplets, which were her 7^th, 8^th and 9^th child at the age of 32.  The story was rather remarkable.  She is from rural Uganda and never had a prenatal appointment during this pregnancy.  When she went into labor she went to her TBA (traditional birth attendant) in her community to give birth.  She thought she was only having one child.  After hours in labor, the woman was weak and in trouble, and the baby was breached.  The TBA recommended she go to the health center, but they had no money for her to get there.  So, while she was struggling through this difficult labor the family begged from the kindness of strangers to help her get to the health center.  Luckily, help came through and she was transported to the maternity ward of this health center.  After the first baby was delivered, her stomach was still very large and they realize another one (or two!) were still in there. The midwife at the health facility said, “She is lucky she made it there and there were plenty of us around to help” deliver her babies.  She only brought one dress to change into and has no money for clothes for the children.  She was accompanied by her husband in the maternity ward, where they are trying to keep her and the babies there for another couple of days because they are so small and as the midwife stated, “They only have a dirt floor and it is not safe for the babies with sensitive immune systems.”  It goes without saying we offered money to help with the babies and their basic needs.

The gravity of a mother with nine children at the age of 32 weighs heavily on me.  This is not uncommon in rural Uganda, where access to family planning services is limited.  I hope that Sayana Press can help make a difference in hard to reach areas and gives some women more choice and control over their reproductive health.

You know you are in Uganda and not in Seattle when.....

Truck going to the market

1.  Your driver throws all his trash directly out the window, including 1 Liter plastic water bottles (every time!).

2. The truck carrying people to the market looks like the photo instead of the Seattle city bus.

3.  Large 4WDs are not only popular, but absolutely necessary.

4.  You spent most of your time the last two weeks on unpaved dirt roads that are TERRIBLE.

5.  There are grass huts throughout the neighborhoods as opposed to Craftsman Bungalows.

6.  You have suddenly gone vegetarian the past two weeks because you don't like the taste of boiled meat.


7. The bigger the vehicle the more right-a-way you have on the road.  Bicycles...look out!

Current banana surplus

8.  You are expected to eat at least 4 or 5 mini-bananas a day and if you do or don't, people will keep buying them for you and you will have a banana surplus.

9.  Big IS beautiful for women.  If you are thin, something is wrong with you or you must be sick.

10.  There large beautiful mango trees everywhere.

Mango Tree

Sayana Press

Maternal mortality rates are alarmingly high in sub-Saharan Africa with over 800 women dying a day from preventable causes related to pregnancy and childbirth.  Almost all these women are among the rural poor in developing countries.  A landmark announcement was made at the 2012 London Summit on Family Planning where donors and leaders around the world pledged their commitment to ensure that 120 million women gain access to voluntary family planning services by 2020.  Read more in the press release here: http://www.londonfamilyplanningsummit.co.uk/1530%20FINAL%20press%20release.pdf

At this summit the Ugandan President, H.E Yoweri Kaguta Museveni, said “In developing countries like Uganda, women continue to die so needlessly during pregnancy and childbirth. Yet the causes of these deaths are well known and so are the solutions. The causes are largely preventable. Use of relatively cheap technologies, including family planning can lead to rapid improvements in conditions of women.”

Sayana Press

At this meeting a donor consortium made up of The Bill and Melinda Gates Foundation, DIFD, USAID, UNFPA, and Pfizer, Inc. agreed upon the purchase of 12 million doses of Sayana® Press to help reach some of the 120 million women pledged by the Family Planning 2020 goal.  Sayana Press is a form of the injectable birth control, very similar to the method Depo Provera.  Depo, as many of you know, is a shot that women get to prevent pregnancy protecting them for 3 months.  In its current form, Depo Provera must be administered in a clinic by a trained practitioner intramuscularly with a one inch long needle.  The new product, Sayana Press, is the same medicine (Depo) but in a different injection system.  This system, called Uniject, is a technology that was developed by PATH, and is an all in one injection device, with a small needle that can be injected subcutaneously.  The Uniject system allows for the same drug, Depo Provera, to be delivered to women outside the clinic setting.  Therefore unskilled community health workers can take the injection to women in the most rural of areas and administer it without them having to come to a clinic.  The donor consortium and PATH have a strong hunch that this will greatly increase access to family planning for the women who need it most. 

PATH won a grant to coordinate the introduction and evaluation effort for Sayana Press.  Within our grant we will be introducing the product in four to six countries and conducting a large outcome evaluation in 3 countries between 2013-2016.  I was hired on the Reproductive Health, Sayana Press team, to provide technical support of the evaluation. 

Plans are well underway to introduce in Senegal, Uganda, Burkina Faso, and Niger.  We will be evaluating in Senegal, Uganda, and a third country yet to be determined.  I am currently in Uganda conducting district visits in 22 selected districts that the Ministry of Health would like to introduce. The purpose of my trip is to visit with government district health teams and discuss the project and get some information from them that will help with introduction.  In addition, I am visiting a health care center in each district where women receive family planning services.

Community health worker in Uganda with Sayana Press

More about our project here:  http://www.path.org/projects/uniject-dmpa.php

I feel honored to be a part of this team and excited about the next 3 years.

Update - New Beginnings

In February, I made the difficult decision to switch teams at PATH from the WASH team to the Reproductive Health team.  The decision was precipitated by a number of uncertainties and difficulties within the WASH team, not the least of which was the lack of funding.  With the help of my super supportive supervisor, I was able to identify two promising options for teams at PATH which could potentially benefit from my skill set and expertise.  After carefully considering both options and consulting a number of old colleagues and friends, I decided to pursue the opportunity with the Reproductive Health team.   The Reproductive Health Global Program at PATH is solid and well-established.  The work ranges from the cervical cancer prevention, to breast cancer research, to the development of new, more acceptable methods of family planning, to advocacy for safe abortion.  After working 100% with team for the last 6 months I am happy to report it was a really good switch for me. 

I think my biggest concern/hesitation of making a topical switch was wondering if I would be as passionate about Reproductive Health issues as I am about water and sanitation.  After spending nearly a decade in WASH and pouring a good amount of my heart and soul into that work, would I be as excited within this new position?!  As I debated this, I thought about how lucky I am to have spent nearly the last 20 years of my life avoiding unintended pregnancy by having easy and cost-effective access to a variety of family planning options at more or less the drop of a hat AND in the near absence of oppressive stigma.  And then I thought about women in developing countries that I have worked in and I thought about how their choice, options, and means of obtaining contraception must be severely constrained.  Not to mention access to preventative cancer screening such as the ye ol’ dreaded pap smear that I now feel we TOTALLY take for granted.  Needless, to say the new team has opened up my eyes to a wide-array of public health issues in global reproductive health.  I feel happy and reinvigorated in the new position and am happy to report the team dynamics have also improved dramatically.  Suffice it to say, Liz Blanton is much happier in the RH group and you know when I say it in the 3^rd person I really mean it.    More about the current trip soon...