drArielPablosMendezAttention to gender issues and women's empowerment has been galvanized by President Obama's Global Health Initiative. The Initiative has acted as a catalyst in shifting the accepted paradigm from a disease-centric to a person-centric model of care, especially for poor women and children. We invest in women because they have been neglected and because the health, education and status of women is intimately linked to the health of children and the economic progress of nations. We know children who grow up under the care and influence of a mother, fare better in life. Improving maternal health has a ripple effect on the wellbeing of families and communities.

As Secretary Clinton said at the Fourth High-Level Forum on Aid Effectiveness November 30th in Busan, South Korea, "the United States is putting women at the center of our development efforts."

Women in much of the developing world still suffer disproportionately from inadequate health services, including deficits in maternal health and family planning services, discrimination, the effects of war and, at times, victimization by harmful traditional practices.

Gender-based violence has profound adverse effects on the health and well-being of women and men, girls and boys, and hinders the overall development of societies. The overall cost of violence, whether through additional health expenditures or through lost productivity, adds a tremendous socio-economic burden on developing countries

This year, more than 350,000 women will die in pregnancy or childbirth and more than 7 million children will die of preventable diseases before their fifth birthday. Ninety-nine percent of maternal deaths each year occur in developing nations.

The U.S. Global Health Initiative has set ambitious targets like a 30% decrease in maternal mortality in assisted countries, with a priority on supporting innovation and sharing best practices, as well as building up the health systems that deliver these interventions.

Nearly two-thirds of our maternal and child health funds (and 90% of our bilateral country program funds) are focused in 24 countries where approximately three-quarters of maternal and child deaths occur. These are the priority countries for MCH under the GHI. Women should be involved in designing and implementing the solutions to these problems and not mere recipients of assistance

USAID concentrates on the pre-pregnancy through postpartum period through a continuum-of-care approach with high-impact interventions from the community to obstetric care facilities.

By allowing women to practice healthy spacing and timing of pregnancy, family planning could prevent as many as one in three of the more than 358,000 maternal deaths that occur every year. Our programs bring voluntary family planning services to meet the high unmet need for women to time and space their pregnancies.

Once pregnant, women face complications, some of which are preventable. The biggest maternal killer is postpartum hemorrhage and we are promoting "active management of the third stage of labor" to prevent or treat hemorrhage if it does occur. Likewise, we are tackling other major killers, such as hypertensive disorder of pregnancy – the second biggest maternal killer, by standard setting, training, and ensuring that magnesium sulfate is available in all facilities where women give birth. Beyond mortality reduction, we have a program that supports prevention and repair of obstetric fistula in a dozen countries.

Women will not survive pregnancy-related complications if they are not in contact with skilled birth attendants or if they cannot access emergency care, when needed. We support health workers to engage with families to develop birth plans to ensure that they have the funds, transport, and even blood donors identified, in case they are needed.

Women are usually the people attending births. Therefore, we work with health care providers, often midwives, in programs that involve not only training in normal birth and life-saving procedures, but also smart recruitment, targeted deployment and effective retention of midwives. We are working to enhance the status and working conditions of these women health care workers who are on the frontline to save mothers' and newborns' lives.

To address the prevalent disrespect and abuse of women giving birth in facilities, including lack of consent, confidentiality and privacy, humiliation, discrimination and physical abuse. USAID is actively engaging in advocacy to reduce the "veil of silence" that has obscured the poor treatment of women in health facilities. In addition to promoting positive gender and cultural perspectives in all its programs, USAID is also engaging in implementation research that will lead to increased practical knowledge on how to address these degrading practices.

USAID is forming new partnerships with the private sector, foundations, governments and technical agencies to drive forward new innovations in technologies and approaches to improve lives, deliver results and create opportunity for women in developing countries. For the past year, USAID, the UK Department for International Development, Australian Agency for International Development and the Bill and Melinda Gates Foundation have worked together to contribute to the goal of reducing the unmet need for family planning by 100 million women, expand skilled birth attendance and facility-based deliveries, and increase the numbers of women and newborns receiving quality post-natal care by 2015. The Alliance for Reproductive, Maternal, and Newborn Health has resulted in increased joint planning, coordinated implementation, joint problem solving and learning across ten countries in Africa and Asia.

This summer, USAID launched the Saving Lives at Birth Grand Challenge for development with the Government of Norway, the Bill & Melinda Gates Foundation, Grand Challenges Canada, and The World Bank to bring American and global innovation to the task of saving maternal and child lives in that critical window of birth and the first 72 hours of life.

The partnership took a novel approach to development, by leveraging the resources of partners and crowdsourcing innovative prevention and treatment approaches for childbearing women and newborns in rural, low-resource settings. The response was overwhelming with more than 600 applications pouring in from around the world. From those initial submissions, partners awarded 21 award nominees with seed grants and 3 larger transition-to-scale grants.

The competition received innovative ideas and proposals, including:

A mobile network that could link mothers with community leaders and healthcare providers so they can quickly respond to labor complications.

Pre-paid electronic vouchers and transportation subsidies so that pregnant mothers can quickly seek care.

And a simple, low-cost antiseptic for cord care to prevent infections in newborns.

In May 2011, Secretary Clinton launched Mobile Alliance for Maternal Action MAMA, a partnership between USAID and Johnson and Johnson, supported by the UN Foundation, the mHealth Alliance and BabyCenter. MAMA is growing a global network of organizations to harness the power of mobile technology to deliver critical information to new and expectant mothers during pregnancy, delivery and early childhood.

Lessons learned from these and other initiatives will be shared globally in a coordinated exchange of expertise and information. The partnership will foster collaboration among similar initiatives in other countries to accelerate efforts to reach millions of women with mobile phone access around the world with critical health information.

Other factors such as poverty, ethnicity, socio-economic status, poor infrastructure, distance from health facilities, lack of health insurance, and the low status of women and girls, including gender-based violence, continue to limit equitable access to health care. Lack of capacity and poorly functioning health systems challenge the delivery of quality affordable health care, especially to the poor.

USAID is spearheading strategic planning around best practice approaches for addressing inequities at the community, health system and health sector levels, transforming harmful norms, and promoting gender equality. Central to this work is the recognition that promoting gender equality involves empowering women and girls and engaging boys and men integrally in our programs.

By investing in women we are enhancing our own prosperity and national security. That's why investing in global health isn't just the right thing to do, it's the smart thing to do. GHD