~Written by Jasmine L. Hamilton (Contact: lajuaniehamilton@gmail.com; Twitter: @jasminogen) with Michaela Cisney (Twitter: @priyamglobal)

*A mother supports her son during a therapy session in Hope Special School, Chennai, India.*

Disability affects an estimated 1 billion persons worldwide (1). An estimated third are children, the majority of whom (>80%) live in low and middle income countries (LMICs) (1-2). Children affected by disability and their families face significant challenges, including social isolation and stigma, high risk of poverty and violence, minimal resources and programming, and inadequate services, to name a few (1-2). Further, although the convention on the rights of the Child (CRC) and the Convention on the Rights of Persons with Disabilities (CRPD) (3-4) state that children with disabilities are entitled to the rights of all children and should be provided access to health care, education and protection from violence, abuse and neglect, the current challenges faced by children with disabilities demonstrate failures in translating these values at policy, national and international levels (5-6). The millennium development goals (MDGs) for example, excluded disability from its agenda, a major oversight with dire consequences on children worldwide. For example, a recent report by Human Rights Watch revealed that in South Africa, the second largest economy in Africa, over 500,000 disabled children are unable to access primary education, an issue thought to be a prevalent problem in LMICs (1,5-6). The World Health Organization, UNICEF, and others have repeatedly outlined the shortage of research, policy, or action on behalf of children affected by disabilities in developing countries.

Fortunately, recent developments at the policy level indicate movement towards a more equitable approach for addressing disability. Most importantly, the inclusion of targets toward improving access to education and employment for disabled persons in the sustainable development goals (SDGs), stands to profoundly affect the way disability is perceived worldwide, with a significant possibility of increased access to healthcare, education, and other services available to children affected by disability.

These developments are bringing optimism and a surge of hope to organizations and volunteers that have been working tirelessly to bring about positive change in this area. I recently spoke with the director and co-founder of Priyam Global (http://www.priyamglobal.org/#who-we-are) a new NGO working to improve quality of life, opportunity, and global perception of value for the world’s poorest children who have disabilities, in an effort to outline major challenges and steps that can be taken towards creating a more equitable world for children affected by disability. What follows are her comments on some of the challenges and hopes that she has for Pryiam Global and the children with disabilities in Chennai, India who inspire her work.

Q1: What does Priyam stand for, when was it founded and what is your vision for the organization?

Michaela Cisney: Priyam is a word meaning ‘love’ that is shared among the Tamil, Hindi, and Sanskrit languages. The name was selected through a collaborative process with the children’s home we partner with in Chennai and reflects what is essential to the success of our work: a simple, abiding love for all of humanity, but especially for its children. I co-founded Priyam in July 2014, with the vision of bringing childhood disability to the heart of global health by creatively and attractively reframing the ways we look at children, ability, and value.

Q2: How many disabled children are you currently reaching and what assistance do you provide?

Michaela Cisney: Our collaborative work with a special education school and a children’s home currently reaches about 200 children affected by disability in India. We’ve been able to support and increase special nutrition initiatives to combat India’s severe child malnutrition rates, cost-share the expenses of additional therapists, provide start-up funding to selected families for self-employment opportunities, train and place national and foreign volunteers, and—importantly—take a critical role in increasing awareness and understanding of childhood disability as an urgent and relevant global maternal and child health issue.

Q3: What is your biggest challenge working in the area of CD?

Michaela Cisney: As a connector organization and catalyst, the greatest challenge we face is general low awareness in high-income countries of childhood disability realities, contexts, and opportunities for change in developing countries. Disability makes people uncomfortable, reflecting a great need for disability issues to be framed as secondary to universal values that resonate with all of us: a child’s beautiful personality, a toddler’s wellbeing and ability to thrive, a mother’s love bound by her inability to provide for her children in extreme poverty. Disability is somehow seen as “other” to these issues and so it’s a challenge to gently dismantle prejudices many of us are not even aware we hold, to then attractively frame CD in positive contexts of change and growth while also portraying urgent realities in a balanced way.

Q4: What is your greatest hope for Priyam Global and the children in Chennai that you currently work with?

Michaela Cisney: My greatest hope is that every child, in Chennai and beyond, would see the full and beautiful realization of her rights and dreams: a family that loves her without limits, a body and mind that are cared for and well, and the opportunities to explore her interests and thrive using her strengths.

To learn more about the work of Priyam Global visit www.priyamglobal.org For information on the global plan to address the challenges faced by persons with disabilities visit: http://www.un.org/disabilities/default.asp?id=1618

About Michaela Cisney

Michaela earned a Master’s in Public Health in Behavioral, Social and Community Health from Indiana University, focusing on maternal and child health, and nutrition and disease interactions. Before launching Priyam Global, she worked with Timmy Global Health to develop culturally-relevant monitoring and evaluation plans for a WASH program in rural Ecuador. In addition to her role as Executive Director for Priyam Global, Michaela works as a consultant for World Vision International (WVI), where she helps WVI communicate critical impact of community health worker programming globally for marketing and advocacy. She has also worked with WVI to design and launch a global training on individual/household health behavioral counseling (ttC). Follow her on Twitter: @priyamglobal

References:

www.un.org/disabilities/documents/review_of_disability_and_the_mdgs.pdf
http://www.who.int/disabilities/media/news/2012/13_09/en/
Convention on the Rights of the Child. New York: http://www.ohchr.org/en/professionalinterest/pages/crc.aspx
Convention on the Rights of Persons with Disabilities: http://www.un.org/disabilities/convention/conventionfull.shtml
https://www.hrw.org/sites/default/files/report_pdf/southafrica0815_4up_0.pdf
http://www.theguardian.com/global-development/2015/aug/18/disabled-children-poorer-countries-out-of-primary-education-south-africa-human-rights-watch-report

- Written by Kate Millar, Technical Writer, Maternal Health Task Force

This post originally appeared in the American College of Nurse Midwives’ Quickening, Volume 46, Number 2 (Spring 2015). It was also posted on the Maternal Health Task Force blog on May 5th.

Today, May 5, is the International Day of the Midwife. This is an opportunity for the global community to come together to recognize the incredible impact midwives have on maternal and newborn health and decreasing mortality. Want to know more about what global leaders are doing to strengthen midwifery?

On Monday, March 23rd, global leaders in midwifery and maternal, newborn and child health gathered in Washington, DC at the Wilson Center for Call the Midwife: A Conversation About the Rising Global Midwifery Movement. This symposium hosted four panels to discuss current data, country investments, important global initiatives and public private partnerships and innovation in midwifery. Each of the panels was presented in the context of exciting new strides in maternal health with the forthcoming Sustainable Development Goals, an updated strategy for the United Nations’ Every Woman, Every Child initiative and the World Bank’s Global Financing Facility that supports it.

While each speaker’s background and focus varied, the themes of the symposium were consistent:

Improve management and leaderships skills of midwives
Improve pre-service and in-service education
Innovate to keep midwives in rural areas
Fill the need for well-trained midwifery faculty
Integrate maternal and newborn healthcare
Provide respectful maternity care (RMC)
Build capacity

To kick-off the symposium, His Excellency Björn Lyrvall, Swedish Ambassador to the United States told the story of midwifery in Sweden: in 1751, it was reported to parliament that 400 of 651 maternal deaths could be averted with midwifery. Parliament took this seriously and by training midwives with safe delivery techniques decreased Sweden’s maternal mortality ratio (MMR) from 900 deaths per 100,000 live births (among the highest in Europe at the time) to 230. Sweden’s passion and investment in midwifery can act as an example to countries that are now facing a similar burden of maternal mortality.

The data on midwifery

The first panel on data summarized the State of the World’s Midwifery 2014 (SoWMy 2014), the Lancet Series on Midwifery and the International Confederation of Midwives’ (ICM) vision and programs. In his presentation on SoWMy 2014, Luc de Bernis, Technical Adviser at UNFPA, focused on projections of workforce availability and met need, or the ratio of workforce time available to time needed. Projections identify countries with a low-met need, medium-met need and high-met need in 2030. Interestingly, two countries that are doing well now, Ethiopia and Burkina Faso, will not be able to meet their health workforce needs by 2030 if investment does not accelerate now to keep up with an increasing need for services.

In her review of the Lancet Series on Midwifery, Holly Kennedy, Varney Professor of Midwifery at Yale University, announced two papers that will be added to the series: one on disrespect and abuse and RMC and another that summarizes the top 10 research priorities from the series to improve maternal and newborn health using the QMNC framework.

Frances Day-Stirk, President of the International Confederation of Midwives (ICM), then spoke on her organization’s vision and programs, including “A Promising Future,” a campaign to promote midwifery as the norm and not a novelty. The focus of ICM is to have midwives who are appropriate (well-educated and regulated), accessible (especially in poor geographic areas) and cost-effective. Day-Stirk also outlined the critical pillars of midwifery—education, regulation and association—which stand on a foundation of ICM core competencies. The focus and pillars of ICM were echoed throughout the remainder of the symposium.

At the end of this panel, countries were encouraged to look at long-term plans for strengthening and scaling-up professional midwifery, instead of quick fixes with training auxiliary midwives.

Country investments and lessons learned

Representatives from Cameroon, Afghanistan, Liberia and Ethiopia presented data on current initiatives in their countries to support and scale up midwifery. Ethiopia and Cameroon have both seen improvements in midwifery and maternal health indicators through investing in midwifery education and establishing accreditation of schools and training sites. Although they have seen success in their efforts, challenges still remain with a shortage of midwifery faculty and clinical training sites.

In Afghanistan, the Community Midwifery Education (CME) program, supported by USAID, Jhpiego, WHO and UNFPA, provides quality, sustainable midwifery education. The 2-year program supports women with at least a 10th grade education, chosen by their communities to participate. After training is complete, women return to their communities where child care and transportation is provided to enable them to use their skills and also to incentivize them to stay in their community. Other initiatives include leadership training, accreditation and mobile programs.

Marion Subah, a senior nurse midwife and Jhpiego’s country representative in Liberia, reported that since Ebola, antenatal care (ANC) coverage, skilled birth attendance and institutional delivery have all had an absolute decrease of about 10%, reversing recent advances in maternal health in Liberia. She recounted the difficulties of delivering maternal health care in the context of Ebola: six midwives have died from Ebola and women who need post abortion care are especially at risk because of the fears associated with contracting Ebola through bodily fluids. Moving forward, the ministry of health (MOH) has created a 10-year plan that focuses on increasing the number and quality of midwives, faculty development and establishing well-working computer and science labs and clinical sites.

Global midwifery initiatives

All over the world, organizations of all types are banning together to improve maternal and newborn health by investing in midwifery. With initiatives by the World Bank, USAID, GE Foundation and global policy experts, there was a lot to be excited about.

These initiatives are focused on creating a sustainable midwifery workforce, strengthening professional associations, improving workplace conditions for midwives, promoting RMC,building leadership and management skills, implementing global policies for ending maternaland newborn deaths and a new ICM Midwifery Services Framework. Many of the initiatives presented have overlapping goals, all to the end of creating a healthy, well-educated, accessible midwifery workforce.

At the close of this panel, Laura Laski, Chief of the Sexual and Reproductive Health Branch at UNFPA, noted three upcoming critical turning points for midwifery:

The Global Maternal Newborn Health Conference in Mexico City: timed right after the agreement of countries on the SDGs, this conference in October 2015, provides an opportunity to emphasize the need to invest in midwives to accomplish the SDGs
The World Health Assembly: provides a forum in May to discuss the new version of Every Woman, Every Child
The Women Deliver Conference in 2016

Innovation and Public-Private Partnerships for Midwifery

To end the day, we looked forward to the future with a focus on innovation and pioneering public-private partnerships (PPPs). Greeta Lal of UNFPA shared recently developed e-learning modules that were created in partnership with Jhpiego, UNFPA, Intel and WHO. With topics ranging from family planning to essential newborn care, these e-learning modules can be conducted almost anywhere with a battery-operated projector, solar powered charger and a cheap tablet, these modules can be used in almost any part of the world.

In addition, Survive & Thrive and Nurses Investing in Maternal Child Health both seek to strengthen young professionals to become leaders in the field to create sustainable change. Both programs work internationally, but with different strategies. Survive & Thrive, supported by ACNM and other partners, works to strengthen professional associations and host master training of trainer courses for the management of maternal and newborn complications, from Malawi to Afghanistan. Nurses Investing in Maternal Child Health is an 18-month program supported by Johnson & Johnson and Sigma Theta Tau for nurse fellows to work with a mentor in order to gain leadership and technical skills in order to improve maternal and child health through evidence-based practice, health systems improvements and program evaluation.

Lastly, the NGO Direct Relief, with technical support from ICM, creates midwife kits for facility-based deliveries. With essential commodities, these kits have the potential to decrease MMR and the neonatal mortality rate by 63%. Thus far, these kits have been distributed in the Phillipines after Typhoon Haiyan and in Sierra Leone in the wake of Ebola.

The symposium was a full day of reviewing the incredible impact midwifery can have and what we need to do as a global community to realize that impact.

Resources discussed at this symposium:

Sustainable Development Goals

Highlighting Childhood Disability: DiaBlog with Priyam Global

International Day of the Midwife: What are Global Leaders Saying?