Giving birth ranks among the scariest moments for any mother. It certainly was for me. I was living in Hong Kong at the time when my second child was born. And he was born in a hurry. He came so fast that I actually thought I’d give birth in our car on the way to the hospital! Fortunately, that didn’t happen and I safely delivered my son Patrick surrounded by a team of well-trained doctors and nurses, not to mention my loving (and relieved!) husband by my side.
I met one of those women in Nepal about five years ago. I was there visiting our programs in the south of the country and stopped in to see a mom who had given birth a month prior. She sat with us and talked quite matter-of-factly about how when she went into labor with her third child, she didn’t panic. She merely laid down in a clean part of her house, caught the baby when she came out, cut the umbilical cord and wrapped her to keep her warm.
When she had finished telling her story, and I had stopped shaking my head in amazement, I couldn’t help but compare her experience to mine. After all, both of our children came into the world faster than we had anticipated. However, while my husband was there to drive me—fast—to a first-class hospital, this woman had no one. Her husband was away in India on business and her two daughters were in the next village. Even if she could manage to get herself to the nearest clinic, which was 2 kilometers away, she would have had to travel on foot. So she did the next best thing; she left it up to chance.
Fortunately for this mom both she and her newborn survived. But for too many women in the same situation, the outcome is much more tragic.
So many things can go wrong when a mother gives birth without a skilled birth attendant (SBA). Things such as prolonged labor, pre-eclampsia and infection—which are perfectly manageable when an SBA is present—can mean a death sentence in the absence of one.
For this reason, Save the Children is calling on world leaders, philanthropists and the private sector to commit to ensuring that by 2025 every birth is attended by trained and equipped health workers who can deliver essential health interventions for both the mother and the newborn.
Photo above: Fountain of Hope center in Lusaka, Zambia.
Jay Bolkin is the founder of Promise or Pay
Mom Bloggers for Social Good is full of fascinating and inspiring stories of people doing all kinds of wonderful things to make those big changes that the world really needs. From to fearless Frontline Health Workers to courageous female genital mutilation activists. It is a distinct and constant reminder that that the actions of one individual can make a difference.
If you read this blog and are interested in the topics covered, you likely have an attitude of sensitivity toward social problems and need little reminder of the injustices and vulnerabilities affecting so many people in the world today. Billions of people are living in poverty, one billion are starving, and millions are sold into modern day slavery. Sometimes it is just all too much – we stop reading, we switch off the TV, we change the conversation – we become paralysed by all the pain and inequity. We can be compassionate and empathetic and still end up thinking, “it sucks but that’s the way things are.”
Too many people think they can do nothing, but they are wrong. It is when we think about singlehandedly solving huge world problems that we get overwhelmed. While it is true that no one can do everything, everyone can do something. Whether it is volunteering your time, donating blood, giving away your unwanted stuff or spending time with the elderly. This is not a new concept and I don’t think the hard part is thinking up the ways we could help. I think the challenge is following through on our good intentions – actually doing what we ‘could’ or ‘should’ do. Unfortunately life gets busy and even when we make promises to ourselves to do the things that would make the world a better place we often get sidetracked by distractions, lack motivation or simply slip back into routine.
The truth is that making promises to ourselves is often not enough and that to really increase the likelihood that we will follow through with our declarations to ‘do good’ we need to put something on the line. Intuitively this makes sense and is backed by years of social and behavioral research. Studies show that the chance of achieving a goal increases 33% if it is shared with others and by 72% if money is put on the line.
Promise or Pay is a newly launched social enterprise that integrates these proven techniques to help you uphold your commitments and change the world for the common good. The formula is simple. You publicly promise to do something or pay a nominated contribution to a charity if you do not follow through.
Promise or Pay harnesses social media to make your goal public and thereby strengthen the intention of keeping it and integrates charitable giving to ensure a win-win outcome is always achieved and you are left feeling good. Either you keep your promise thereby benefiting yourself, or you contribute towards solving a pressing social problem via your donation, thereby benefiting others. In doing so, Promise or Pay helps overcome the disappointing and discouraging feelings that are often the aftermath of failing to accomplish something important.
By combining social motivation with charitable giving, Promise or Pay motivates people to do the things they most want to do with their lives, while creating a more engaging and empowering way to donate to charities that are making a real difference in the world.
We need to remember the power of the individual to improve the world and that minor acts can spark major change. So the next time you get inspired to give back and hear yourself saying “I really should…”, why not tell the world and put your money where your mouth is? Whether you want to set up your own social enterprise, help out at the local food kitchen, or initiate something that has never been tried before – Promise or Pay will increase your chances of being the change you wish to see in the world. And the great thing is that if you slip up you will still feel good knowing that you are helping worthwhile charities fund their good work.
If you like the idea behind Promise or Pay and would like to get involved – whether it is a helping hand, some advice, an endorsement, pro-bono services or straight up funding – I would love to talk. Feel free to drop me an email me at firstname.lastname@example.org
In our country there are two kinds of marriages: one is settled marriage and another one is love marriage. Settled marriage means, where guardians select bride or groom for a person and the marriage happens. As far as I have seen, most of the people like, or respect settled marriage. Well you won’t find it by surveying on blog because most of the Bangladeshi don’t know what a blog is. When any couple makes a love marriage (where couples choose each other), people will congratulate them, but behind them they will say what they actually feel, and off course, they are not good comments though everyone wants to marry a person who they like.
When a husband hurt a wife, everybody will dislike it but won’t react, because they think its natural or a common thing. If a woman tries to hit back, nobody will like that and will make an issue. But nobody wants to be beaten.
Everybody wants their husband to help them in their work. But if she saw any other husband helping their wife, she will say, it’s not good and many more things. And rest of the society will agree with her.
Every woman will like to take enough rest and do all work in her own way. But she will never let other woman (bride of her son) do her work in her own choice. People think that is bad and our society will never agree with the bride.
Why are our thoughts like that? Why can’t we be fair with all humans?
As the world learns more about the promise of women to bring peace, prosperity and economic well-being to nations, Rwanda has become a poster child of this promise. Thriving after one of the most brutal genocides in history, today Rwanda is referred to as the heart of the African Renaissance.
In September’s elections Rwandans once again voted in a female majority parliament, directly electing 26 women in addition to the 24 seats reserved for females in the constitution. Rwanda has come to be the world’s leader in women lawmakers holding an unprecedented 64 percent of seats in Rwanda’s parliament, more than any another country in the world. Women also occupy some of the most important government ministries, holding approximately one third of all cabinet positions.
As a result, life is changing fast for women in Rwanda and these investments in women will have a ripple effect that will improve life for their families, communities and the country as a whole. To begin a list of astounding accomplishments, the small African nation has cut poverty by 12% in six years, from 57% of its population to 45%. This is roughly one million Rwandans emerging from poverty, most of them women and children — one of the most stunning drops in the world.
Paul Collier, director of the Center for the Study of African Economies at Oxford University notes that Rwanda can be compared to an East Asian-style “developmental state,” where the government is very serious about growing the economy. “The economy was well managed, with inflation kept low, and the business environment improved.” As a result, over the course of six years Rwanda has moved from around 140th to 60th in the World Bank’s “Doing Business” annual rating.
Some changes in Rwanda are obvious to the eye, such as houses that have tin roofs instead of thatch. A decent roof is one of the first changes people make when they start the ascent out of poverty. Some of the changes are psychological. There is a sense and a hope that things really can improve, and a sense that individual families can do something to better their circumstances.
Josh Ruxin, director of Rwanda Works has lived with his family in Rwanda since 2005. He notes the amazing infrastructure and economic development improvements he has witnessed. “Five years ago, traveling anywhere in the country was bound to be a bumpy ride, if the way was even passable. Today, east-to-west and north-to-south, the road infrastructure is impressive and continues to expand. Five years ago, the country struggled to get tourists in for $375 permits to visit Rwanda’s mountain gorillas. Today, during high season, there are not enough $500 tickets to meet the demand. Five years ago, there were no supermarkets or ATMs, and the cheapest cell phones cost $50. Today there are multiple supermarkets, over a dozen international ATMs, and cell phones that cost $14 are plentiful.”
Ruxin notes that access to formerly inconsistent electricity and running water even for those who could pay for it, is being constantly improved. Hotels and restaurants are popping up everywhere and a service sector is emerging to meet heightened tourism demand. Wireless broadband is being installed across the country and more universities, technical schools, and preschools are opening. The second national language has shifted from French to English.
A Dedicated Focus on Health Outcomes and Family Planning
To accomplish the stunning drop in poverty major investments were made in the rural poor and extensive improvements were made in health programs and outcomes. Collier notes that “most of the achievement is likely due to domestic policies.”
At a summit to review the UN Millennium Development Goals (MDG), Rwanda was commended for its very likely success in meeting and possibly even surpassing the MDG targets for child and maternal mortality by 2015. According to officials at UNFPA, the United Nations Population Fund, which provides contraceptives and other support to rural communities, Rwanda has literally brought its health care system back to life. The government has initiated bold reforms and innovative approaches to make health care accessible and affordable for everyone, with a strong emphasis on reproductive health, including family planning.
Much of the credit for successes goes to the government’s successful health insurance program. Its removal of user fees for family planning services has contributed to significant increases in use of services. There has been a jump from 9% to 26% of contraceptive prevalence among married women aged 15-49, and the skilled birth attendance rate increased from 39% to 52%.
“This a real achievement,” says Asha Mohamud, a reproductive health advisor for UNFPA. “It often takes decades for countries to see this kind of change.”
The Mayange Health Centre is located in the heart of the Bugesera district, just south of the capital city of Kigali. Built in 1999, the clinic serves 25,000 people. Until early 2006, it saw only 5 to 10 patients a day. Nurses were rarely in attendance and pharmaceuticals were not available. Lights had been installed in the facility but there was no electricity to power them. With the new investments in the government’s health insurance program the center has rapidly transformed into a model for the nation.
Enrollment in the clinics programs has grown quickly, and the number of patients has skyrocketed to more than 150 each day. Those enrolled pay an annual premium equivalent to 2 US dollars and women who keep four appointments during a pregnancy can deliver at no cost. Staff training and infrastructure improvements have significantly enhanced services, and now the lights are turned on permanently.
Other major changes include new equipment and more staff to contribute to safe and hygienic births. The clinic used to only have three trained nurses and most mothers were still giving birth at home. Now it has eighteen nurses available and most of the mothers in the area now give birth at the health center. Life expectancy for the babies has improved as well and mothers are educated to stay for three days after delivery to ensure the health of their newborn.
The initial results of these health investments in Rwanda are impressive. Child mortality has decreased by over 30% since 2005 and maternal mortality declined by 25 % in the years up to 2005. There has been a decline in the fertility rate from 6.1 to 5.5 children per woman, and achievement of immunization rates of 95% were attained by 2008.
The Need for More Progress
These new achievements will have notable effects on the population as a whole as the country grows, but even more progress is needed. The land in Rwanda is already intensively settled, and the hillsides densely cultivated with bananas, coffee and vegetables. With approximately 368 people per square kilometer, Rwanda is one of the most densely populated countries in Africa. And because of its terrain — the country is known as the land of a thousand hills – that means that not all of the land is arable. And with two thirds of its population under the age of 25, dropping fertility rates are good news. The dramatic expansion of family planning that is taking place and the growing desire for smaller families will be a key feature to managing future growth.
There is still much to done, however. For example, women in the rural Muhura area still bear an average of six children or more. Until recently, they had little choice in the matter. According to representatives from UNFPA, the nearest health clinic, like about 60% of the health services in Rwanda, is run by the Catholic Church. The only contraceptive devices offered there are cycle beads, a refinement of the rhythm method. Transportation to these rural health posts is problematic as busses pass through town only a couple of times a week, and there are no private cars. An “ambulance” is traditionally four men carrying someone in a hammock dozens of kilometers or more over hilly rutted roads to the nearest hospital.
But thanks to new investments from the government today women can be referred to new secondary health posts, where family planning counseling and contraceptives are available free of charge. In Muhura for example, the Health Ministry converted an empty building into a secondary health post that offers family planning information and services three days a week. 65 secondary rural health posts have already been established throughout the country, and 21 more centers are planned.
Once the health post opened, women began coming, first in a trickle, then in droves. “Now we see about 50 women a day,” said the nurse who runs the rural post program in Muhura.
Rwandan women have not always been so accepting of family planning. Traditionally, having children has been a source of respect and pride and rumors and misconceptions about contraceptives, and fear of side effects were common. But According to UNFPA officials a massive effort is underway to educate Rwandan communities, both men and women, about the value of smaller families. The government is very conscious of demographic trends, said Cheik Falls, the UNFPA deputy representative in the country. “They know that they have a special country because of the all the hills. If the demographic aspects are not mastered, it will jeopardize development efforts.”
As a result of this growing awareness attitudes are changing and the desire for smaller families is increasing. At a meeting in Muhura hosted by UNFPA, officials noted that when local women were asked, “How many have more than five children?” dozens of women raised their hands.
And when asked “How many are done having children?” almost all of the hands went up. According to DHS data, only 7 % of married women in Rwanda want to have another child soon.
“I want to raise the three children I have properly and pay for their education,” says a 28-year-old mother. “When you have a lot of children you will remain poor.”
Now that contraception has been made more widely available, women who want to stop having babies but whose husbands object are told it is their right to choose. Some even go to these rural health posts in secret for three-monthly injections.
These secondary health posts are attracting clients and interest in modern contraceptive methods, says Daphrose Nyirasafali, a reproductive health and rights officer with UNFPA Rwanda. “The government and its partners are optimistic this strategy will boost the adoption of modern family planning methods, resulting in a more manageable fertility rate and sustainable development.”
Changing Laws are Changing Perceptions
Clearly, what is happening in Rwanda is little short of revolutionary.
“There used to be a lot of rapes, wife beating, male domination of women, boys sent to school and not girls,” said Nyirasafali. “That has all changed, even in the countryside.” Rape is now acknowledged as a very serious offense and there is a free police hotline and heavy jail sentences for perpetrators. The legislature has also passed bills aimed at ending domestic violence and child abuse, although these issues remain a vexing issue for the country.
Rwandan women now have the right to own land and property and when they marry they may choose to combine their assets with their husband or they can keep them separate. Inheritance laws have been passed to split a man’s property equally between his wife and both female and male children. As a result the divorce rate is increasing.
A legislative committee has combed through the countries legal code and has compiled a list of laws to modify or toss out altogether to put an end to gender discrimination, including one that requires a woman to get her husband’s signature to receive a bank loan.
New social norms are also unfolding. Traditionally in Rwanda men and women operated in separate spheres and played different roles, said Juliana Kantengwa, a member of Rwanda’s senate. “There were no-go areas, like drumming,” she said, that were male only preserves. During opening ceremonies, we now have teams of girls drumming with strength, enthusiasm and skill. “We (now) see fathers encouraging their daughters to do engineering and get out of nursing. (And) we have quite a number in the army and police force.” Women are driving the economy — working on construction sites, in factories and as truck and taxi drivers.
Louise Mushikiwabo, Rwanda’s foreign affairs minister, and one of eight female ministers, said no one should view Rwanda’s women parliamentarians as “window dressing”. “We have a lot of influence,” Mushikiwabo said. “The president is present most of the time in our cabinet meetings. He encourages us to think out of the box and initiate policy. It’s a very open forum. That’s where all the major decisions for the country are made.”
Having a female majority voice can certainly change priorities. “The fact that we are so many has made it possible for men to listen to our views,” said lawmaker Espérance Mwiza. “Now that we’re a majority, we can do even more.”
Rwanda’s progress for women is being admired around the globe. The government convened an international forum on the role of leadership in gender equality and woman’s empowerment, attracting women ministers, MPs and dignitaries from all over Africa and the world, including the UN deputy secretary general from Tanzania, Asha-Rose Migiro. “I salute you for bringing gender and equality to the heart of the political process,” she told the forum in the Rwandan parliament.
So what is next for this African Renaissance? The government has now set its sights on getting the country to middle-income levels. Growth so far has come primarily from improving existing systems and services. Collier says that to reach middle income, “Rwanda needs pioneer investors and aid to support them with public infrastructure; I hope that it gets them. If it does, then, yes, poverty can continue to fall fast.”
Rwanda’s astounding achievements are welcome news on a continent where overall progress towards these goals has barely registered. They demonstrate what is possible when political will and innovative policy meet the promise of women in leadership.