Take collaborative strategic action to lower maternal deaths

By Azka Asif, Rotary Service and Engagement staff

In honor of Maternal and Child Health Month, Past District Governor Dr. Himansu Basu, a Rotary Foundation Cadre of Technical Advisors for Maternal and Child Health, shares about his team’s work to save the lives of mothers and babies in partnership with Rotarians, other professional volunteers, and governments.

Azka: Dr. Basu, last year you shared an update on the success of the Calmed (Collaborative Action in Lowering of Maternity Encountered Deaths) programme. Have you had any recent developments?

Dr. Basu:
Calmed, started in 2013, is funded through Rotary Foundation grants, supported by hands-on efforts of volunteer doctors and Rotarians from the United Kingdom and India. Two global grants have supported six vocational training team (VTT) visits to Sikkim, with a target population of 0.7 million, and Gujarat with a target population of 2.5 million.

Our team of 12 Obstetricians has trained 39 master trainers who continue to train professionals (currently just over 250) in emergency care of pregnant women and babies. The team has also trained approximately 100 Accredited Social Health Activists (ASHA) who raise awareness about pregnancy, child care and related issues through community women’s groups.

The programme was recognized with two international awards for excellence in 2016 — Times Sternberg award and Rotary GBI Champion of Change.

AA: Have you achieved your objectives for the programme?

HB: Maternal mortality reduction programmes take time to achieve their goal – zero preventable maternal death. We are on track for improvements in access to effective care. After three years, we see a steady fall in the number of avoidable maternal deaths in all of Sikkim, our first pilot site. We are moving towards our target of zero preventable maternal deaths.

AA: What can Rotarians do to reduce maternal and child mortality?

HB: Maternal mortality is an index of development in any community – an effective project in any of Rotary’s six areas of focus will also decrease maternal and child mortality, albeit slowly. For a more direct measurable response, a comprehensive strategy based on the Calmed template aimed at reducing the shortage of trained professionals while promoting community awareness regarding childbirth and child care issues should be implemented.

AA: What advice can you offer Rotarians planning a global grant project to reduce maternal and child mortality?

HB: Create a strategic programme with vocational training teams being a key component. It’s important to have experienced project committees supported by health professionals, and public health experts. Close collaboration with motivated Rotarians and government in the project host country is essential for impact and sustainability. The Rotary Foundation Cadre of Technical Advisors can be a valuable resource in planning, implementation and the follow-up stages. Expertise is also available from Rotarian Action Groups such as the Population and Development, Health Education and Wellness, and Preconception Care groups.

A planning visit to the project area by the international partner is very important and should focus on identifying local assets and needs, partnership opportunities with local government and professionals.

AA: What advice can you offer for organising a vocational training team aimed at reducing maternal and child mortality?

Himansu: A vocational training team for improving maternal and child health should be structured to meet the needs of the community. Here are examples of scaling a project:

Scenario 1 targets several smaller hospitals or one large hospital. Two to four experienced doctors train a group of 10 to 20 doctors and nurses on emergency care of pregnant women and new-borns.

Scenario 2 targets several larger hospitals or many smaller hospitals. 5-7 experienced doctors train 20 to 25 motivated trainers who then qualify as master trainers. These master trainers go on to train others (30-40 at a time). Two return team visits should be conducted for evaluation and further training.

Scenario 3 targets a community of one million or more. This is a most effective method, but requires close collaboration with local government. A team of 7 to 10 experienced doctors undertake:

  • training cascade as in Scenario 2 (above)
  • training 15 to 20 ASHA trainers to raise community health awareness. The ASHAs then train women’s groups in towns and villages throughout the target area
  • analysing all maternal deaths in the target area to identify preventable causes and facilitate corrective measures in partnership with local government

AA: Which scenario is most effective in your opinion?

HB: Clearly Scenario 3, but it is also the one requiring more time and resources.

AA: Thank you for sharing your knowledge and expertise! What is your vision for the future?

HB: We cannot rest on our laurels. We need to facilitate and provide support for Rotarians in many low resource countries to introduce more strategic programmes for the entire community based on the Calmed VTT template. Please contact me for further information and suggestions. Also, visit the Calmed programme website for more information.

We are in discussion to establish maternal and child health academies in partnership with governments and NGOs to provide academic support, carry out the work of vocational training teams and advocate to develop future programmes and future leaders achieve our goal of zero preventable maternal death.

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Empowering women and girls in Afghanistan

By Bibi Bahrami, member of the Rotary Club of Muncie and founder of AWAKEN

Growing up as a young girl in the peaceful village of Qala-e-Malakh in Afghanistan, I was part of a loving family with ten brothers and sisters. We were happy, but little did we know that our lives would soon face devastation as the Soviets invaded Afghanistan in 1979. I was frightened and scared for my life and for the lives of my loved ones. Every time I heard shots or explosions, I trembled at the thought of losing a family member.

In the face of war, we were forced to flee our home, leaving everything behind to head towards refugee camps in Pakistan. A long journey awaited us as we traveled through mountains without much food or water, with small children and my mother who was eight months pregnant at the time. We arrived to the camps safely where I spent the next six years of my life. My life had been turned upside down. Growing up, I always had aspirations and dreams to be educated, and hoped for the opportunity to pursue them. My six years in the camp did not give me that opportunity, but I tried to learn what I could from my brothers’ books.

In 1986, I boarded a plane to meet my fiancé, who was a medical student in the United States who I had met in the refugee camp in Pakistan. My trip brought me to Muncie, Indiana, and I was blessed with the opportunity that I had always wanted. I was finally able to pursue my education, completing a GED and continuing on to receive an art degree from Ball State University. As my life has moved on from my home in Qala-e-Malakh and the refugee camps, I never forgot about the girls I left behind who have the same dreams as I did.

My husband and I continued to travel back to the refugee camps in Pakistan every year, with medicine and other humanitarian supplies. In 2002, with the support of family and friends, we established AWAKEN (Afghan Women and Kids Education & Necessities) to provide educational opportunities, vocational training, and healthcare services to the people of Afghanistan, especially the women and children.

As part of AWAKEN, we offered a vocational training program where we traveled from village to village and rented a room conveniently located near women’s homes. We conducted a six-month course teaching women basic hygiene, reading, writing, and sewing. At the end of the course, all women received a sewing machine and kit so they could become self-sufficient.

There were also no opportunities for education in my hometown of Qala-e-Malakh. In 2004, AWAKEN established a school for children grades K-12. The school now has more than 1200 students enrolled.

Most villages in Afghanistan do not have access to any sort of healthcare. In 2008, we built the Behsood Health Clinic which provides over 500 families access to basic treatments such as vaccines, birth control, etc. The clinic sees more than 180 patients daily.

Recently, AWAKEN partnered with the Rotary Club of Muncie Sunrise (United States) and the Rotary Club of Jalalabad (Afghanistan) to establish a Saheli Center. The center will open near the current AWAKEN clinic and school providing literacy, nutrition, and reproductive health classes. The center will also provide vocational education, including but not limited to computers and tailoring expanding upon AWAKEN’s efforts.

One of my biggest dreams was to open a birthing center in the village. AWAKEN created a birthing center to provide prenatal and postnatal care. With the support of partnering Rotary clubs, we will expand our efforts by conducted Family Planning Workshops taught by medical professionals from the Rotary Club of Jalalabad and the AWAKEN clinic staff. Birth attendants will also conduct small workshops on pre-natal nutrition, birthing practices and infant nutrition, including breast feeding for those receiving pre-natal care. Small packages of infant care supplies provided by the Rotary clubs will be given to women who complete all the classes.

I was once a little girl in Afghanistan with limited opportunities, and am blessed to have the life I enjoy today. Unfortunately, people living in impoverished countries do not have access to the opportunities and resources that I do now. Together we can make a difference in the lives of many women and children in Afghanistan, so that they can awaken to a brighter future with opportunities for continuing their education and becoming self-sufficient!

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Rotary members are dedicated to maternal and child health

By Azka Asif, Rotary Service and Engagement Staff 

According to the World Health Organization, nearly 830 women die every day from preventable causes related to pregnancy and childbirth. 99% of maternal deaths occur in developing countries where nearly half of all mothers and newborns do not receive care during and after birth. The leading causes of death for children under 5 are birth complications, pneumonia, birth asphyxia, diarrhea and malaria. These deaths can be prevented and treated with access to healthcare services.*

Healthcare before, during and after childbirth can save the lives of women and newborn babies. The United Nation’s Sustainable Development Goal 3: Ensure healthy lives and promote well-being for all at all ages, addresses all major health priorities, including reproductive, maternal and child health; access for all to safe, effective, quality and affordable medicines and vaccines.*

Rotary members are working diligently towards this goal through projects that provide education, immunizations, birth kits, mobile health clinics, and much more. Women are taught how to prevent mother-to-infant HIV transmission, how to breast-feed, and how to protect themselves and their children from disease. Here are just a few examples of Rotary projects that are saving mothers and children:

  • Rotary clubs in the Philippines are implementing the Cradle of Hope project which provides cradle boxes for newborn babies. Each box contains postpartum care materials and newborn supplies such as grooming and healthcare kits, and clothing for babies up to 9 months of age.
  • The Rotary Club of Accra East in Ghana conducted a community-wide medical outreach program. More than 300 members of the community, including many women and children, benefited from health screenings and received necessary medical supplies.
  • The Rotary Club of Dhaka North in Bangladesh assists pregnant women who cannot afford the cost of delivery by providing no cost surgeries and other necessary medicine during emergencies.
  • After learning about high mortality rates in India, Past Rotary International Director Ken Collins organized a vocational training team consisting of two gynecologists and two midwives. The team traveled with him from Australia to Raipur, India, to train local health workers on best obstetrical practices aimed at reducing the high mortality rate of mothers and babies due to childbirth.
  • In Nigeria, the Rotary Club of Calabar South-CB partnered with the Rotaract Club of Canaan City CB to educate mothers on how to combat infant mortality, and promote the health of both mother and child during and after birth. Rotary members donated materials to help nursing mothers and babies including diapers, detergents, toilet papers, and baby soaps.

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Throughout the month of April, Rotary Maternal and Child Health Month, take action to support mothers and children. Read more stories about maternal and child health to gain inspiration for club and district service projects. Post your club’s project on Rotary Showcase, find a project to support on Rotary Ideas, or join the conversation in My Rotary’s discussion groups!

*http://www.who.int
https://sustainabledevelopment.un.org

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Rotarians are committed to ending malaria

By Azka Asif, Rotary Programs Staff

Today, World Malaria Day, is dedicated to highlighting the progress made in malaria prevention and treatment. It is also a day to commit to continued action and investment in fighting the dangerous disease.

Malaria is a life-threatening disease caused by parasites that are transmitted through female mosquitoes. According to the World Health Organization, about 3.2 billion people – almost half of the world’s population – are at risk. In 2015, there were an estimated 214 million new cases of malaria and 438,000 deaths, mainly in sub-Saharan Africa.*

Pregnant women and children under five years old are more vulnerable to malaria. Malaria infection during pregnancy is a major health risk to the mother and her unborn baby. Rotarians are committed to fighting malaria and keeping mothers and babies healthy. Here are just a few examples of how the Rotary family is preventing and treating malaria:

  • The Rotary Club of Asaba in Nigeria led an awareness campaign focused on educating expectant mothers on the dangers of malaria. Rotarians explained ways to prevent the disease through the use of mosquito nets and keeping your environment clean.
  • The Rotaract Club of Niger Delta University in Nigeria led a Roll Back Malaria campaign to raise awareness and teach causes and prevention methods.
  • The Rotary Club of Borivli, India, in partnership with the Rotary Community Corps (RCC) of Devlapada, organized a public seminar on malaria. Local doctors provided insight on causes, ways of prevention, and treatment of the diseases. More than 50 families were educated at the seminar.
  • The Rotary Club of Nashoba Valley aims to use Indoor Residual Spraying (IRS) for mosquitoes in six villages benefiting more than 20,000 villagers in Malawi. Each village was identified based on their malaria rate and will also receive training and education on malaria transmission and how to remove areas of standing water for a cleaner environment.

Millions of people still lack access the services they need to prevent and treat malaria. Partner and collaborate with Rotarian experts on malaria related projects and initiatives: 

  • Rotarians Eliminating Malaria: A Rotarian Action Group unites Rotarians to reduce malaria morbidity and mortality through provision of goods, education and other interventions that lower infection rates.
  • Rotarian Malaria Partners encourages the Rotary family to work together to eliminate malaria through advocacy, partnerships, hands on projects, and raising funds to support malaria related efforts.

Use the blog’s commenting feature below and share how your club is working to End Malaria For Good. Join the conversation on Twitter and Facebook by using the hashtag #WorldMalariaDay. How much do you know about malaria? Take the quiz on malaria.

*[World Health Organization’s World Malaria Report 2015]

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Stopping mothers from dying: a Rotarian’s quest for vocational service

By Past District Governor Dr. Himansu Basu, Rotary Foundation Cadre Technical Coordinator in Maternal and Child Health

Three mothers and twenty babies die every five minutes; the majority of these deaths occur in Africa and the Indian subcontinent. I was always aware of the huge global burden of maternal and new born deaths, many of which are preventable.

When my Rotary district was chosen to be a part of the Future Vision Pilot in 2010, we saw an opportunity to support a project focused on maternal and child health. I realized that to make a meaningful and sustainable impact, the programme would have to be strategic with measurable impact and evidence-based components. It became clear that such an innovative programme would need to be tested as a pilot with close monitoring and evaluation.

Collaboration

Many of my friends and supporters in global professional organisations, governments, NGOs and of course Rotary at all levels helped develop the initial programme. Through these collaborations, the Calmed (Collaborative Action in Lowering of Maternity Encountered Deaths) programme was conceived.

It became obvious that although maternal and child health was a designated area of focus for Rotary International, the problems were not very visible to many Rotarians and non- Rotarians. Many didn’t know about the high life time risk  of woman dying at childbirth: 1 in 40  in Nigeria, 1 in 250 in India and 1 in 5900 in the United Kingdom.* Even though these deaths were largely avoidable, they continued to occur in areas with limited resources.

Leveraging the Rotary Network

As part of the pilot, we also identified a need to mobilize and strengthen resources available within Rotary, including professionals (doctors, nurses, midwives, hospital workers and volunteers) who would support effective maternal and child mortality reduction programmes.

As chairman of International Fellowship of Rotarian Doctors, it was natural for me to promote the Calmed programme to a global audience through Rotary International conventions, regional and district conferences, international institutes and other meetings. I accepted the Medical Directorship role with the Rotarian Action Group for Population and Development, a RI group of technical experts who advise on Rotarian-led maternal and child health programmes.

As a Rotary Foundation Cadre Technical Coordinator in Maternal and Child Health, I remain engaged and connected with Rotarians seeking assistance with programmes and projects related to reproductive, sexual health and family planning.

What is the Calmed programme?

 The Calmed programme utilizes the train the trainer model to build medical expertise in emergency obstetric and new born care. The programme also raises awareness of pregnancy and child birth related issues in rural villages with limited access to larger health care facilities.

The third component of the programme analyses all maternal deaths to identify avoidable causes and makes recommendations for corrective action (Maternal Death Surveillance Response- MDSR). As the state of the art programme evolves, we continue to add new elements and technologies such as Kangaroo Mother Care (KMC), anti-shock garments (NASG), Golden Hour concept, etc. to address identified needs.

Calmed Vocational Training Teams:

There are three Rotary Global Grant funded Calmed programmes that are currently taking place in:

  • Sikkim, India l Target population 0.7 million – introduced in 2013, with repeat visits in 2014 and 2016.
  • Bhuj, Gujarat, India l Target population 2.5 million  – introduced in 2014 with a second visit in 2016.
  • Madhya Pradesh, India l Target population 3.5 millionpreparatory work is in place and the visit is planned for October, 2016.

So far, these teams have trained 39 approved Master Trainers (goal is 100). These Master Trainers have trained 264 doctors and nurses (goal is 500) in emergency obstetric and new born care, as well as 95 ASHA trainers.

Impact of Calmed Vocational Training Teams:

The primary aim of the programme is to enhance trained workforce in the emergency care of pregnant women and babies and to improve participation of village women groups in raising awareness for health care issues during pregnancy and childbirth. Doctors and nurses in target areas have reported increased confidence in tackling emergencies since the inception of Calmed. A three year follow up from Sikkim shows progressive reduction of maternal deaths to a quarter of yearly deaths in the population since Calmed was introduced 3 years ago.

What can you do?

  • Invest in women and children’s health as it is vital for sustainable economic and social development.*
  • Unleash the power of vocational expertise of Rotarians and professionals, the Calmed VTT programme is a template for action.
  • Share Calmed’s success stories and consider introducing the programme in areas with high rates of maternal and child mortality.

Please act now! Visit the programme website and contact me with any questions or comments. Together, let’s stop mothers from needlessly dying!

The Rotary Calmed programme is an award winning programme having received two coveted national awards – The Times Sternberg Award in 2015 and Rotary GBI Champions of Change Award of 2015-16.

*[World Bank 2014], *[PMNCH, 2013]

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Rotarians taking action to improve maternal and child health

By the Rotarian Action Group for Population and Development (RFPD)

We believe that maternal and child health is not only an important area of focus, but the most important of the six areas of focus. Women in the twentieth century have achieved significant progress in the economically progressive areas of the world. Meanwhile, women and girls in non-developed countries have a much more difficult life, especially in comparison to their male counterparts. Many of these women and girls accept their inferior social status and tend to fall into traditional roles.

Economic depression often times forces extended families to live together under one roof, leaving young women who desire to make even the smallest change in their lives to fall under the subordinate customs and values of their parents and their grandparents. In addition, many non-developed countries still commonly marry off underage girls, many of who are under the age of thirteen but the vast majority being under the age of 18. This not only impacts their opportunity for an education, but has a profound effect on the number of pregnancy-related complications that occur for girls who are not physiologically ready to bare children. To combat this, we must address family planning to reduce 30% of maternal deaths which will ultimately empower women and achieve a demographic dividend for developing countries.

The Rotarian Action Group for Population and Development (RFPD) is a resource in the Maternal and Child Health area of focus and supports clubs and districts in initiating, planning and implementing professional projects. Our group is headed by three dedicated leaders from around the world:  Mr. Buck Lindsay of the U.S., Prof. Robert Zinser of Germany, and Dr. Emmanuel Adelodolapo Lufadeju of Nigeria. Each has served in various leadership roles in Rotary International and has a vast network of Rotary contacts.

As an organization of 20,000 Rotary members, we address the population crisis around the world. RFPD agrees that more aid is needed in this area. We are dedicated to motivating the 1.2 million Rotarians around the world in developing and implementing projects that directly address population issues.

The Rotary Foundation grants more than $70 million USD each year to Rotarian-led projects around the world.  Within this framework, RFPD plays an important role in developing, promoting, obtaining financial support and coordinating projects that specifically address population and development issues. We serve as liaison between the local Rotary clubs applying for funds and the Rotary Foundation to ensure proper paperwork is completed in a timely manner.

In its work, the Rotarian Action Group for Population and Development shifts values among community and political leaders in countries, by speaking out on population and development issues and commiting resources and efforts towards solving the problem.  In most communities, Rotarians are seen as the leaders in all professions and vocations, and as multipliers in society.  When sufficiently convinced of the merits of population advocacy, Rotarians can be most effective in further spreading the word and work.

Visit RFPD’s website for the latest updates.

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Rotary’s commitment to saving mothers and babies

By Azka Asif, Rotary Programs Staff

Everyone everywhere has the right to the highest attainable standard of physical and mental health. However, gender-based discrimination often undercuts this right. It causes women to be more susceptible to sickness and less likely to obtain care, for reasons ranging from affordability to social conventions keeping them at home. *

Through projects focused in maternal and child health, Rotary members are committed to reaching United Nation’s Sustainable Development Goal 3: Ensure healthy lives and promote well-being for all at all ages.

A mother and her daughter hang out outside the classrooms at Rancho Alegre schools in California, USA.Each year, at least seven million children under the age of five die from diseases, malnutrition, poor health care, and inadequate sanitation. To help reduce this rate, Rotary members provide immunizations and antibiotics to babies, improve access to essential medical services, and support trained health care providers for mothers and their children. Nearly 80% of maternal deaths can be prevented with access to reproductive health services and trained health care workers. Rotary projects aim to provide education, immunizations, birthing kits, and mobile health clinics to support these causes.

During April, Rotary Maternal and Child Health Month, we’re celebrating our commitment to improving the lives of mothers and babies around the world. Here are just a few examples of service projects that are aiming to create healthier lives:

  • The Rotary Club of Metro East Taytay in the Philippines partnered with a group of medical practitioners to provide free health services to more than 100 women who come from low-income families and were unable to afford healthcare.
  • In Nigeria, the Rotary Club of Port Harcourt GRA provided free healthcare treatment to mothers and children from more than 120 families. Women and children were tested and treated for various diseases and ailments and those whose conditions were severe, were referred to hospitals for further checkups and treatment.
  • The Rotaract Club of Kampala annually leads a Save a Mother, Save a Child in their community. This year the project aimed to educate expecting mothers, provide cervical cancer screening, family planning services, and HIV/AIDS testing and counseling.
  • Haiti has the highest rate of maternal and infant mortality in the western hemisphere. 91% of women deliver at home. Rotary members provided a fully equipped medical jeep carrying up to 12 volunteers to any region in Haiti. The jeep allows mobile clinics to be run in hard to reach places to provide health services to expecting mothers. Watch the video below about this project.

Throughout the month of April, encourage fellow Rotary members to check back here for tips, resources, and inspirational success stories to help plan club and district maternal and child health projects. Add your voice to the conversation using the blog’s commenting feature and share how your club supports water and sanitation initiatives on Rotary Showcase. 

*[www.unwomen.org]

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Celebrating women and promoting gender equality

By Azka Asif, Rotary Programs Staff

Today, International Women’s Day, the world is celebrating the progress we’ve made towards gender equality and empowering women. Although much has been accomplished, there is still much more to be done.

TFotorCreatedo learn how we can assist the Rotary family in supporting the United Nations Sustainable Development Goals 5: Achieve gender equality and empower all women and girls, and 4: Ensure inclusive and quality education for all and promote lifelong learning, a group of staff from Rotary International attended a Women’s Day Global Health Symposium in Chicago. We were inspired by the strong speakers who shared about how they are working to elevate the status of girls and women around the world.

We hope our reflections below will encourage you to continue promoting gender equality across all of our communities through your clubs and districts:

Women, girls and peace

“I was particularly interested in the panel discussion on Women and Girls in Crisis Zones because of Rotary’s investment in peace. Learning that human traffickers, many of who target girls and women, have the mobility and means to arrive on the scene of a disaster zone within 24 hours, prior to many relief agencies, was an alarming fact.  E. Anne Peterson, Senior Vice President of Global Programs at AmeriCares, emphasized the need for NGOs and government agencies to be prepared to provide protection to vulnerable populations during this critical 24-hour period, even before the delivery of food and medical aid.”  Sarah Cunningham, Rotary Peace Centers

Maternal and child health

“I was moved by the work of Dr. Pat Mosena, President and Founder of Options for Youth, an organization that works in vulnerable neighborhoods in Chicago. I was particularly taken with the Subsequent Pregnancy Program (SPP,) a community based approach to assist first-time adolescent mothers in becoming self-sufficient before choosing to have another child. SPP focuses on developing long term relationships with home mentors. The work Options for Youth is doing is outstanding– it is vital that the needs of young mothers, many from low income and vulnerable situations, are attended to.”  Cate Sauer, RI Programs  

“I was inspired by the UNICEF Kid Power initiative. By getting active, kids can go on missions, earn points and unlock therapeutic food packets for malnourished children around the world. It’s a fun way to get our kids moving and can be easily integrated into schools. The statistics shared with us about youth inactivity are troubling. I appreciate the added connection they’ve made to also teach kids about new cultures and allow them an opportunity to make a difference. I went home and bought one for both my daughter and me.”  – Rebeca Mendoza, Rotary Grants

Creating leaders through sports

Personally, I was inspired by Katayoun Khosrowyar, the coach of Iran’s first under 14 girl’s national soccer team. Katayoun is empowering young girls who’ve been told their whole lives only boys are allowed to play soccer and pursue their dreams. Through sports, girls learn leadership skills as well as team work. Girls and women who play sports are more confident, have a more positive body image and higher states of psychological well-being than girls and women who do not play sports. I think it’s very important to encourage girls to follow their dreams and create young leaders that will grow up to do great things.


Join Rotary today at 1 p.m. CST Chicago time for an International Women’s Day live streamed panel with the World Bank on the power of women to change the world and improve lives through innovative and impactful projects. Follow the #RotaryWomen hashtag on Twitter and Facebook to read inspiring stories of Rotary Women in Action.

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Why do mothers die? A Rotarian’s mission to reduce maternal mortality

By PDG Dr. Himansu Basu, MD, PhD, RI Technical Coordinator on Maternal and Child Health 2013-16

My world stopped when I was 15 – my mother died after her seventh childbirth (I was the eldest). The pain and misery in the years that followed were unimaginable. Since then, I have been asking myself the question –“Why do mothers die?”

I entered medical school, specialised in Obstetrics and Gynaecology and did full time research on pregnancy haemorrhages. My interest in childbirth-related mortalities did not wane, but I did not get real answers to my question.

Then I became a Rotarian. I wanted to utilise my hands-on vocational efforts for service, but the opportunities at that time were limited.

In the 1990s, global organisations like the U.N. challenged the world to address this question in the form of Millennium Development Goals. Global organisations and governments put a lot of funding towards improving hospital facilities and started promoting institutional childbirth deliveries but progress remained slow.

Two events in 2010 helped me find an answer to my question. First, my district, 1120 (England), became part of the Future Vision pilot. This opened the door for service through hands-on vocational efforts and advocacy through a global grant-sponsored Vocational Training Team. Second, I had the good fortune to chair an international collaborators meeting on maternal mortality in Delhi focused on why mothers die in low resource settings. The combined results were fantastic.

Second CALMED1The concept of Calmed (Collaborative action in lowering maternity encountered deaths) developed during the next three years with the help of important collaborators including FIGO (The International Federation of Gynecology and Obstetrics), GLOWM (Global Library of Women’s Medicine) and MAF (Medical Aid Films), Laerdal, Department of Health and Family Welfare, National Health Mission and of course our own Rotarian Doctors Fellowship and Rotarian Action Group on Population Development.

India remained our challenge. In spite of massive efforts by the Indian government, maternal mortality reduction in India was slow. Still today, the lifetime risk of a woman dying at child birth is 40 times higher in India than in the UK. India has the highest annual number of maternal deaths (about 55,000). Ironically, most are preventable.

TRF-sponsored Vocational Training Teams played leading roles in implementing the Calmed model. Using hands-on approaches, modern technology and a “train the trainer” model in two states in India, the team led skills trainings in managing emergencies at childbirth and raising awareness of childbirth related issues in the villages and urban communities. Monitoring and evaluation is an important component of the Calmed programme.

1st Calmed programme

First CALMEDIn Sikkim, India, where the programme was first introduced in 2013, our vocational training team of six doctors from the UK trained 13 local Ob Gyn staff members who became master trainers after stringent pre- and post-test assessments. The local master trainers have since trained over 200 doctors, midwives and health activists in the practical management of emergencies at child birth. Following the introduction of Calmed, the maternal mortality ratio was halved in just over 12 months.

2nd Calmed programme

Second CALMEDInvitations from the government and local Rotary clubs led to a second vocational training team to visit Gujarat in 2014 and train 26 master trainers. More than 40 doctors and midwives were then trained and the training cascade continues with outstanding results.

As we move forward, we are planning to take a team this year to Madhya Pradesh, India, for the third Calmed programme.
We are also working with India’s government to establish skills trainings and development centres where selected local master trainers (rather than vocational training team members from England) will be responsible for training future master trainers. This will offer a sustainable, realistic local solution to eliminate preventable maternal and new born deaths.

CALMED teamWe would not have been able to move forward without the constant support, encouragement and stewardship of Rotarians at all levels, from the clubs t to districts , RIBI and RI, including past Rotary International Presidents, Directors, Trustees, and many officers (past and present). Our collaborators remain fully supportive.

It has taken more than 50 years of searching, but I am glad I have found the answer to why mothers die and more importantly, how we can save mothers and babies from dying or experiencing complications from childbirth. We have found a solution that works.

Read more about the Calmed programme and contact me if you would like to support this vocational service effort.

Pledge your support now and join the Calmed revolution!

20-year maternal health partnership started with a conversation over coffee

By Jesse Allerton, Rotary Programs staff

Nigeria has one of the highest rates of maternal mortality in the world: women there have a 1 in 23 lifetime risk of dying in childbirth. In 2010, a five-year Rotary pilot project concluded in the rural northern states of Kaduna and Kano Nigeria. Led by the Rotarian Action Group for Population Growth & Sustainable Development (RFPD) and supported by Rotary members and public and private partners in Germany, Austria, and Nigeria, this US$3 million initiative reached nearly one million at-risk women of childbearing age. Through an array of awareness and advocacy campaigns and hospital-based interventions, the rate of maternal mortality in ten participating hospitals was reduced by 60% and newborn mortality by 15%. To ensure sustainability, the state governments of Kano and Kaduna were given control of the program, which continues to this day.

This amazing program all resulted from a meeting of two Rotarians 20 years ago. Emmanuel Adedolapo (Dolapo) Lufadeju from Nigeria and Robert Zinser from Germany met at the 1994 International Assembly as incoming district governors. The two men had a conversation at the first coffee break and they’ve been close friends and collaborators ever since. We asked Dolapo and Robert to reflect back on their first meeting and how it led to one of Rotary’s most impactful maternal and child health projects.

PDGs Lufadeju and Zinser
PDG Emmanuel Adedolapo (Dolapo) Lufadeju (left) and PDG Robert Zinser (right)

What did you talk about in your first conversation, and what made you each decide you wanted to work with the other?

Dolapo: As incoming governors we talked about population concerns and thought about possible ways of tackling this issue through Rotary projects. I could not only hear Robert’s interest in the conversation but also saw his commitment to help in his eyes and learned from him about his experience as a manager in a third world setting.

Robert: Hearing from Dolapo that he is an agriculturalist I was very interested in his analysis of the reasons and obstacles for the plight of the poor and asked him for a needs assessment. Feeling that the population concern he raised is a global concern I asked him for a project proposal which I could discuss with the incoming club presidents in my district.

You come from very different cultural backgrounds. Were there any special challenges you had to overcome as you began working together?

Dolapo: I had to learn to cope with Robert’s fast pace and respond quickly to communications. While I was very busy as a governor in my large district, Robert invited me to attend his district conference in Germany and later insisted that I should come to meet him at the first Population Conference of Rotary International in Dakar, Senegal, which was a long and adventurous trip by bus and ship for me.

Robert: Having taken to heart the RI theme “BE A FRIEND” at the 1994 International Assembly we did not experience problems in working together. Of course, I had to get used to African habits, but we quickly sorted out the difference between Nigerian time (“fixed time plus x”) and German time (“punctual”) [laughing].

What advice would you give to a Rotarian who wants to take the first step in establishing a partnership like yours?

Dolapo: To meet the person and explore common interests, develop and cultivate friendship and trust. Be dedicated to the common issue. Be open-minded, devote time and be willing to work hard.

Robert: The most important thing is sharing a passion for the same goals. Ideally these goals should be linked to one (or more) of Rotary’s areas of focus, since these are global aims that can be best contributed to through Rotary’s network. Project work—from planning to implementation—is the best way of truly getting to know another person and building up trust and a strong friendship. Our absolutely reliable contact is the basis of our 20 year long friendship and partnership in ongoing successful project work.

Learn more about Robert and Dolapo’s work by visiting RFPD’s maternal health program website, www.maternal-health.org.