“Glimmers of Hope” for Improving the Health of Women, Newborns

Improving the health of women and newborns around the world is a goal that is within our reach,” said Leslie Mancuso, PhD, RN, FAAN, President and Chief Executive Officer of Jhpiego, an international nonprofit organization focused on women’s health and is affiliated with Johns Hopkins University.

Dr Mancuso, who has led Jhpiego from an annual budget of $5 million to $85 million, delivered the keynote address at the 2010 meeting of the Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN).

Her inspiring remarks centered on Mahatma Gandhi’s challenge, “Be the change that you want to see in the world.” She called on the thousands of nurses who attended the meeting to identify, commit to, and believe in making their own change, and asked them to join nurses around the world who are working to improve maternal and newborn health. “Know that you are part of this global nursing community,” she said.

Having traveled around the world to identify global health needs of women, Dr Mancuso applauded nurses, saying, “I am amazed and awed by the role that nurses and nurse midwives play in healthcare systems everywhere.”

Throughout the developing world, mothers and newborns are dying from preventable diseases, she emphasized. “We know how to save their lives, but only a fraction of those in need have been reached,” she said. “My own personal change is to prevent these needless deaths.”

Sobering Statistics
Every minute, 1 woman dies from pregnancy-related causes worldwide. More than 500,000 die during pregnancy or within 6 weeks of delivery, and 90% of them live in the developing world. This leaves 100 million children motherless and at a 10-fold risk of dying within 2 years compared with their peers, according to Dr Mancuso.

Cervical cancer, HIV/AIDS, and malaria remain other areas of concern. Cervical cancer is the leading cause of death for women living in developing countries, with nearly 500,000 new cases annually, resulting in 274,000 deaths.

Cervical cancer is particularly sinister in the setting of coinfection with HIV/AIDS. In sub-Saharan Africa, 60% of those with HIV are women; therefore, it is necessary to move to a “women-centered approach” in ad dressing this disease, she said.

Malaria claims the lives of 10,000 pregnant women and 200,000 infants each year, and is a risk factor for anemia and low birth weight. Tuberculosis is rampant in many countries as well.

Jhpiego Saves Lives
Jhpiego prevents these needless deaths, Dr Mancuso said. Founded in 1973, the organization employs more than 700 persons in 54 countries. Jhpiego saves lives by:

• Building local human resource capacity
• Working in partnership with the government, nongovernmental organizations, universities, professional associations, and communities
• Strengthening healthcare systems
• Developing evidence-based innovations
• Sharing best practices.

The organization targets virtually all areas that affect the health of women— family planning, maternal and child health, malaria in pregnancy, cervical cancer prevention, HIV/AIDS, and tuberculosis. The aim is to provide a “household-to-hospital continuum of care” in the developing world, and many innovative approaches are helping to accomplish this.

For example, in a village in Kenya, nurses organized a “women’s reproductive health camp” that drew 450 women in a single day to be screened for and counseled about HIV and cervical cancer. The camp used the “single- visit approach” that is emerging as an effective means of cervical cancer screening in the developing world.

Nurses use acetic acid to visually inspect the cervix and treat lesions immediately with cryotherapy. In Thailand, 450 health professionals have been trained in the single-visit approach; 500,000 women have been screened, and more than 2600 have been treated.

Other innovative approaches have included community-based distribution of misoprostol (3-pill pack) to prevent postpartum hemorrhage and calcium “sprinkles” to prevent preeclampsia.

“I have traveled around the world meeting with nurses and midwives who are working to improve healthcare, and I can tell you, there have been enormous accomplishments,” she concluded. “Despite the challenges, we see glimmers of hope.”