The State of the World's Midwifery 2011

I don't generally post on stuff like this, but I, personally, think this is an extremely big deal:  the UN Population Fund (UNFPA) released the first ever State of the World's Midwifery Report.  It's the first ever comprehensive analysis of midwifery services and the countries where the need for midwives is the greatest, and a really important step in getting midwifery solidly onto the public health agenda (where it ABSOLUTELY belongs, and has belonged for hundreds of years).

The Senior Maternal Health Advisor at UNFPA, who headed drafting the report, said at the release, "Public health advisers and practitioners are not relying on the key health professional that can improve maternal mortality--the midwife.

This is why:  As the Chairperson of the Board of Trustees at the White Ribbon Alliance for Safe Motherhood – Malawi says, "The good news is that, when women are within reach of a midwifelikelihood of dying from the complications of childbirth drastically reduced, but also the midwife becomes the critical link to well-baby care and health care for the entire family.  We must prioritize investment in midwives to deliver life-saving care in the communities where mothers are needlessly lost.”  And this report puts a number to those lives needlessly lost:  it says that up to 3.6 million deaths could be avoided each year in 58 developing countries if midwifery services are upgraded by 2015.

Among other things, the report says the world lacks some 350,000 skilled midwives, including 112,000 in the neediest 38 countries surveyed alone, to fully meet the needs of women around the world, and details how the world might go about building up this "key workforce."  (Me!  Me!  I'm on it!)  In order to reach the Millennium Development Goal of 95% of births being assisted by a skilled birth attendant*, of these 38 countries that need midwives the most, 22 need to double the workforce by 2015; seven need to triple or quadruple it; and nine (Cameroon, Chad, Ethiopia, Guinea, Haiti, Niger, Sierra Leone, Somalia and Sudan) need to dramatically scale up midwifery by a factor of between 6 and 15.

Let me say that again.  These countries need 6 to 15 times as many midwives as they currently have.

The report recommend things like recognizing midwifery as a distinct profession, increasing investment in the number of schools, trainers and tutors for midwifes, and making adequate budget allocations for midwifery services in national health plans. But given that capacity for training more midwives hovers somewhere between zero and nothing in some countries, and between very little and little in many more, there's some serious work needing to happen in the next few years.

So I think this report is amazing, but the hard part comes now:  getting humanitarian aid donors, humanitarian organizations, and recipient governments all excited and motivated to take these recommendations to heart, take the time and energy to invest wisely and make changes meaningful, and ultimately creating a vibrant, dedicated and skilled new workforce of midwives. 

*Right now about 50% of births worldwide have a skilled birth attendant present at the birth, but there are huge rural/urban developed/developing nation disparities reflected in this.

London and....Utrecht?

After this post I will be up-to-date again and will try to go back to blogging at more regular intervals.

From Boston, I headed straight to London to work in our London office for a week, doing a training on monitoring and evaluation and finally meeting the lovely people who work in that office and who I Skype with all the time but hadn't met in person.  It was a good week of work--some new angles on programs we run, a better understanding of the way European donors work as compared to American donors, some interesting conversations on how well humanitarian aid works and just generally a nice time working in a big open office with lots of light and nice people.

I might have been working during the day, but I used my evenings to go out and see London, which I hadn't been to before except for a whirlwind day there when my grandparents took my sister and I on a week-long bus tour of England, Scotland and Wales my senior year of high school as a graduation present.  So I was excited to see London.  In some ways it felt very familiar--the quick trip there, trips to elsewhere in the UK, time in South Africa (which has distinct Englishness in places at times), and, more than anything, having read so many books and seen so many movies set there.

Except for an evening that I met up with a good friend of Anthony's for dinner by the London School of Economics (where he's a student) and a dinner out with several people from work in the Angel area of Islington, I mostly just wandered around in the evenings, taking advantage of how late it stays light.

Right on Bedford Square, Bloomsbury:  I want that room, those bookshelves, those books.  You know, I'll just take the whole house actually....I have a soft spot for Georgian architecture.

On Friday night, I walked across the Thames to the Tate Modern, which stays open late on Fridays.

In addition to a large performance art piece (not really my cup of tea) they had a number of great photography exhibits:  New Documentary Forms, Diane Arbus, the war in Afghanistan, and the recent elections in the Democratic Republic of Congo (very much my cup of tea).

The photo exhibit of the elections in the DRC, by a South African photojournalist named Guy Tillim who began his career in the 1980s covering popular uprising against white minority rule, included one of the actual ballots.  According to the sign by the ballot, "The Congo Democratic series was made in Kinshasa during the 2006 presidential elections, which followed successive civil wars that devastated the Democratic Republic of Congo. This multi-party election, the first in 46 years, was particularly fraught, with some 3,400 politicians contesting the 500 seats in the house of assembly, and 33 presidential candidates. ‘The ballot was an amazing six-page poster-size document with pen pictures of all the candidates that were hard to recognise,’ Tillim recalls. Tensions ran high in the capital between the two frontrunners, Joseph Kabila and Jean-Pierre Bemba and their supporters. According to Tillim, ‘young men in Kinshasa fought battles with police … as they tore down and burned election paraphernalia."

Can you imagine?  I feel like it really puts some of the debates we have in the US about voting specifics into perspective...

I walked back across the Thames and went to Soho to try to find something to eat.  Too bad everything remotely in my price range had closed 8 minutes before I got there...except the crepe place!  A white chocolate crepe?  Why, yes, thank you.

On Saturday, I headed to the Portobello Road market in Notting Hill.

There were a few cool things (see pictures above), but on the whole I wasn't that impressed at first--lots of people, lots of junk.  And then I found it.  The dress seller.  Selling some of the literally exact same dresses from my favorite clothing website modcloth.com at a fraction of the cost.  I practiced really admirable restraint in only purchasing two.  I really could have walked away with at least 10 or 15.  No joke.

I went to the travel bookshop that Hugh Grant character's bookshop is supposedly modeled after in the movie Notting Hill but was not impressed with its Africa section, or how seriously the store clearly took itself.   That's what being in a movie will do to you, I guess.

I left Notting Hill and walked through Holland Park, heading vaguely in the long-way around direction of the Victoria and Albert Museum.

And on a whim, I went into Daunt Books, right on Holland Park's main strip of stores.  You would not believe their Africa section, which I kindly donated the rest of my afternoon to.  This wasn't the standard guidebooks and "what's wrong with Africa" books, either--this was novels, memoirs, histories.  The good stuff.  Daunt Books, you have my heart forever.

When I finally managed to stumble out, it was clearly to late to make it to the V&A Museum (which closes at 5:30), so I went with plan B:  walk through Kensington Gardens, a quick trip to see Herrods, the tube to Hampstead Heath, a walk around the health, and dinner on Hampstead High Street, followed by a little BBC in my hotel room to put me right to sleep after a long day of walking.

Sunday morning it was freezing and pouring, but when I finally convinced myself to set out walking to the Columbia Road Flower Market, I was glad I had.

Then I actually did manage to make it to the V&A Museum.  I can't think of a better way to spend a cold rainy English day.  Especially since there were TWO South African photography exhibits, one a single photographer who chronicled decades of apartheid and one a variety of contemporary South African photographers on topics ranging from security guards in Johannesburg's wealthy suburbs to gay men in rural areas to portrait photographers in an urban park.  If you have time, definitely look at this page about the photographers in the second exhibit, a fascinating and wildly diverse bunch.  It also has some of their photographs from the exhibit on it.

When I was done and it was close to closing, it was still cold and still rainy so I succumbed to the day and sat in a cozy cafe drinking coffee and reading, ate fish and chips at a gastro-pub for dinner and went pack to the hotel to pack for my trip to the Netherlands the next morning.

I spent 3.5 days in the Netherlands, 3.3 of the them in a conference center.  A beautiful conference center in a beautiful woodland in a beautiful country, but a conference center nonetheless.  It as a major monitoring and evaluation conference and I learned a tremendous amount, much more than I had at the other conference in Boston.  This was partly due to the fact that all of the panels were centered on case-studies, so automatically people were there presenting their successes and failures to common M&E problems, not just rehashing the same problems.  But there will still a fair number of people present who were so far removed from the realities of my day-to-day work in the field as to be almost irrelevant, no matter how great their ideas were.

I slipped out late one afternoon to take the bus to Amersfoort, the little town closest to the conference center.  It was pleasant in that quintessentially Dutch kind of way.

And that's about it--I left for Kenya the next day, which is a whole new blog post...

Spring in DC: A Retrospective

As is pretty evident, I got a little bit behind in blogging.  But I didn't fall off the planet, I kept having fun, albeit in DC.  Here's a few random things from spring in DC.

I saw the cherry blossoms for the first time.

They were pretty, but I was a little disappointed because right before I went somebody told me that these were cherry blossoms.

So that's what I was expecting.  But that's okay.  Cherry blossoms make up for their individual relative lack of drama with sheer mass.

As long as you are looking at the cherry blossoms, you might as well look at the other pretty stuff, too.

I went running very early one morning around the tidal basin, hoping to miss the crowds. Ha!  Not only were the tourists there with their tripods to catch the sunrise, every couple getting married in the greater Baltimore-Washington area in the next 5 years was there getting engagement photos. 

I went to the Lego skyscrapers exhibit at the Building Museum.  The best part was when they let you play with thousands and thousands of Legos at the end, but the skyscrapers were cool too I guess.

Enjoyed the roof deck with friends on many multiple occasions, including Jess's going away party (she's off to Colorado to start a PhD in social psychology).  It's nice that prime farmer's market season coincides with prime roof deck season, and that you know people like my friend Alexis to come over make delicious things from the farmer's market for you in return for a spot on the deck.

Went to the United States Botanical Gardens with Jess in her quest to do everything in DC she'd meant to do in the 5 years she lived here in her last month.

Discovered there's a food truck that roams DC bringing mac and cheese to the people.  Yep, those are crumbled up Cheezits on my mac and cheese.  If you know me, you understand why the CapMac truck has revolutionized my lunching experience.  However, tracking down whether it is going to be in my vicinity at lunch time has really cut into my morning-time productivity at work.  Fortunately Kevin proved himself worthy by also loving it.

My neighbors grew some dinosaurs.  This definitely counts as neighborhood beautification in my neighborhood.

I finally had a cupcake from the (to TLC viewers at least) famous Georgetown Cupcake.  I had heard that, despite the bakery's claim that they were "DC's destination for designer cupcakes", the "designer" cupcakes were not worth the line.  But I was out for dinner in Georgetown with friends one evening (at the excellent Kafe Leopolds, thanks Anthony!) and as we were headed home the line was manageable.  And you know what?  It's all lies.  Those salted caramel cupcakes were out of control delicious (and Kristina was just as excited as me apparently).  It's possible I had two.

The best part about Georgetown Cupcake, however, was definitely when the police showed up to cut the line off and guard the door.  Apparently there's some people out there who take their cupcakes really seriously.  These weren't even rent-a-cops.  These were legit DC police officers with guns.  I mean, it's DC.  You can't tell me there wasn't something better they could have been doing, probably on my block, actually.

Went to Boston for a conference on world humanitarian studies at Tufts and found a new dog walker for Eskimo in Boston's (heavily Italian) North End.

The conference was so-so.  Too many academics without enough field experience and not very many answers for some big problems, problems everybody who does any work in the field already know exist.  Yes, capacity building is a problem (um, see basically any prior blog post when I'm overseas...).  I want your research to tell me what to do about it, not to keep telling me it's a problem.  I KNOW.  But there were some interesting discussions going on if you looked in the right places.  And it gave me a chance to hang out with Caitlin and Pete in Cambridge some more (thanks for letting me stay with you!)

I mean, some other stuff happened too, like Mary coming to visit, but I didn't take any pictures, so we'll leave it at that.