Capello, C; Perkins , J; Sankara , T; Portela, A; Fyon , C; Santarelli , C

1. Advancing women’s right-to-health by increasing access the maternal health services in Tenkodogo, Burkina Faso Capello, C; Perkins, J; Sankara, T; Portela, A; Fyon, C; Santarelli, C APHA 139th Annual Meeting and Exposition November 2, 2011

2. Presenter Disclosures Janet Perkins No relationships to disclose (1) The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months:

3. Presentation summary • Learning objectives • Project background • Results of participatory community assessment • Planned response • Conclusion

4. Learning objectives • Explain the importance of supportive treatment by health care providers in maternal and newborn health (MNH) within the broader arena of women’s rights and social justice • Formulate a strategy to improve the awareness of rights to quality MNH services for disadvantaged women.

5. Inequity in maternal health • 358,000 women die annually due to causes related to pregnancy and childbirth (WHO 2008) • 99% of maternal deaths occur in low- and middle income countries (WHO 2008) • As most of these deaths are avoidable, this data exhibits a grave social injustice

6. Rights related to maternal health • Already in 2001, WHO recognized that “the failure to address preventable maternal disability and death represents one of the greatest social injustices of our time.” • In 2010, the Office of the United Nations High Commissioner on Human Rights (OHCHR) issued an historic statement denouncing preventable maternal mortality and morbidity as violations of women’s rights to health, life, education, dignity and information • In September 2011, UN Human Rights Council adopted resolution on preventable maternal mortality and morbidity

7. MNH in Burkina Faso Burkina Faso • Maternal morality ratio: 560/100 000 (WHO 2008) • Newborn mortality rate: 38/1 000 (UNICEF 2010) • MMR reduced from 770 in 1990 to current rate, but progress is insufficient to reach MDG 5 target of 190 Tenkodogo district (AnnuaireStatistique 2010) • 65.3% of births with skilled attendant • 20.9% antenatal care coverage (four visits) Tenkodogodistrict

8. IFC Framework • The World Health Organization’s framework for working with Individuals, Families and Communites (IFC) to improve MNH is currently being rolled out in Burkina Faso within the context of their MNH Road Map • This framework stresses community participation at all programme phases, beginning with planning • Through participatory community assessments (PCAs), community members identify and prioritize MNH needs and develop solutions

9. PCA Methods • Round table discussions: • Pregnant women/women having given birth within the previous one-year period • Husbands/partners • Influential family members (mothers, mothers-in-law, grandmothers) • Community leaders • Health care providers • Institutional forum: • Representative from each of the named groups • Development partners • Political, cultural, religious, administrative authorities

10. Exercising rights related to MNH • Women and families are not aware of a of women’s right to seek and demand MNH services • Women have low decision-making ability • Women are economically dependent on men “Among certain people, if a women goes to the health centre without the consent of her husband, it is because she does not respect him and it becomes a source of conflict.” -Spouse “When a woman decides to seek a consultation at the [health centre] without asking her husband, it is because the baby is not his.” -Community leader

11. Satisfaction with health services “Health services are not always available in health centres. You can go to the health centre several times and have them tell you to come back another time because the provider is not there.” -Spouse • Community members feel that there are not a sufficient number of health care providers in health centers • Lack of supplies • Lack of privacy • Lack of separate maternity area in some health centres

12. Interactions with providers • Previous negative experiences with health care providers, including: • Poor reception at health services • Reports of verbal and physical mistreatment “Certain health care providers often say, ‘You are dirty. ’” -Woman “Sometimes, when you go to health care provider for a consultation and he judges that [your condition] it is not serious, there are certain ones that insult you and yell at you.” -Woman

13. Planned interventions • Objective 1: Increase awareness of women’s rights related to maternal health • Inclusion of maternal health rights in the ongoing Literacy and Informal Education Programme of Burkina Faso • Education sessions, theatrical performances, film projections and radio spots on MNH rights • Use of community representatives to increase the awareness of the population on MNH rights • Disseminate materials related to reproductive and maternal health rights

14. Planned interventions, cont. • Objective 2: Improve interactions between health care providers and women/families • Advocacy to reinforce the number health care personnel at health facilities • Build the interpersonal and intercultural skills of health care providers • Involve the community in the monitoring of health services

15. Conclusion • Women in Tenkodogo district face multiple challenges in exercising their rights related to maternal health • Lack of awareness of these right and lack of satisfaction with MNH services contribute heavily to preventing women from exercising these rights • The current MNH programme will address these factors using community-developed solutions

16. Thank you! Questions?