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Hope in the shadow of death

December 29, 2010 by Mark R. Dybul

Recently more than 150 heads of state gathered at the United Nations in New York to review progress on the Millennium Development Goals (MDG) – a framework adopted in 2000 to significantly reduce poverty and improve health, education and the status of girls and women by 2015. There was a special emphasis on the health goals with the least progress the past decade. We are still a long way from achieving part of MDG 4-to reduce deaths among children by two thirds before their first birthday, and 5– to reduce childbirth related deaths of moms by 75 percent. The tragedy is that there is no reason for these goals to be lagging. Access to relatively straightforward and inexpensive interventions (drugs that cost pennies) to treat high blood pressure, excessive bleeding and to provide women and families with modern contraception to prevent unintended pregnancies – many of them from violence and abuse - would prevent 80 percent of deaths among new mothers. Eleven countries are home to 65 percent of the deaths. By increasing service coverage in those countries alone, the goal is reachable. And we know that if mom stays alive, her baby is far more likely to thrive. Because it is relatively cheap and easy to protect vulnerable families, we were shocked by a US poll showing that the lowest priority, and the third least likely thought to be achieved (implying a high degree of difficulty) of all the MDG targets was maternal deaths. To gather proof that existing strategies work and are scalable, we traveled far from Manhattan to villages, towns and cities in Ethiopia a few weeks before the UN meeting. We met girls and women, both clients and caregivers, who shared their stories from the frontlines of the struggle to survive. Walking with them in the shadow of death, we heard heartbreaking stories but we also found great hope. The itinerary, designed by our host, the humanitarian organization CARE and funded by the Gates Foundation, was designed to reflect the adage that to understand someone you need to walk a mile in their shoes. But we had to travel many miles in a 4-wheel drive vehicle because walking the terrain and distances during the rainy season was too difficult. Yet many pregnant women must make the trek each day to receive the services they and their families need. Under the leadership of a visionary and energetic minister of health, Dr. Tedros as he is admiringly known, more than 30,000 community health workers are being trained and stationed – two per village – in more than 3,000 health posts that are being built. The vast majority of the workers are women so there is a shared understanding and openness to discuss sensitive topics. The workers receive training in prenatal and delivery care, to watch for danger signs so that they can transfer women in distress to facilities that are equipped to handle emergencies in time to save their lives. The workers are supported by a slew of volunteers, both men and women, to create community ownership. We met village elders, of course all men, who felt a greater sense of accountability for the health of girls, women and children in their community because of the knowledge spread by the workers and volunteers. That local ownership and accountability can change everything. We also had a renewed sense of what instinct and experience has taught most everyone, and what data confirms – healthy mothers are at the heart of happy, healthy families. Poverty reduction, education, equality for girls and women, health – the MDGS – cannot be achieved unless we achieve the pivotal goal of greatly reducing the preventable deaths of mothers and their babies. While we remain inspired by what is happening in Ethiopia, it is too early to know the full impact of the interventions. But the early signs are good. Anecdotal data everywhere suggested that services have improved and deaths are declining. Perhaps the greatest proof was that the people involved were hopeful, a transformative belief that they could succeed. The UN summit was a good start, but now is the time for action. What we learned from the Ethiopian people in the villages, towns and cities is that a with clear focus on the causes of death, the places they are occurring, the relatively simple and inexpensive interventions that can prevent them, and innovative ways to get quality services where people live, a world filled with thriving families is possible and it starts with healthy mothers and children. Making that happen is a moral imperative. Together we can make the death of a woman or infant in childbirth a very rare event – giving the gift of life to women, families, communities and nations. Mark Dybul is a Distinguished Scholar of the O’Neill Institute, Georgetown University and Global Health Fellow of the George W. Bush Institute. Christy Turlington Burns is Director/Producer of No Woman, No Cry Founder of the Every Mother Counts Campaign MPH candidate, Mailman School, Columbia University


Author

Mark R. Dybul
Mark R. Dybul

Ambassador Mark R. Dybul is the inaugural Fellow in Global Health at the George W. Bush Institute. He plays a key leadership role in the Institute’s Pink Ribbon Red Ribbon campaign. From 2006 to 2009, he served as the United States Global AIDS Coordinator, leading the implementation of PEPFAR, the President’s Emergency Plan for AIDS Relief. Launched by President George W. Bush, PEPFAR is the largest-ever international health initiative for a single disease.

Dybul received his medical degree from Georgetown University.

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