ShareEmailPrint To learn more, read: Posted on April 11, 2017May 8, 2017By: Sarah Hodin, Project Coordinator II, Women and Health Initiative, Harvard T.H. Chan School of Public HealthClick to share on Facebook (Opens in new window)Click to share on Twitter (Opens in new window)Click to share on LinkedIn (Opens in new window)Click to share on Reddit (Opens in new window)Click to email this to a friend (Opens in new window)Click to print (Opens in new window)Every woman around the world has a right to receive respectful maternity care. The concept of “respectful maternity care” has evolved and expanded over the past few decades to include diverse perspectives and frameworks. In November 2000, the International Conference on the Humanization of Childbirth was held in Brazil, largely as a response to the trend of medicalized birth, exemplified by the global cesarean section epidemic, as well as growing concerns over obstetric violence. Advocates emphasized the need to humanize birth, taking a woman-centered approach.The concept of “obstetric violence” gained momentum in the global maternal health community during the childbirth activism movement in Latin America in the 1990s. The Network for the Humanization of Labour and Birth (ReHuNa) was founded in Brazil in 1993, followed by the Latin American and Caribbean Network for the Humanization of Childbirth (RELACAHUPAN) during the 2000 conference. In 2007, Venezuela formally defined “obstetric violence” as the appropriation of women’s body and reproductive processes by health personnel, which is expressed by a dehumanizing treatment, an abuse of medicalization and pathologization of natural processes, resulting in a loss of autonomy and ability to decide freely about their bodies and sexuality, negatively impacting their quality of life.Disrespect and abuse (D&A), a concept closely related to obstetric violence, has been documented in many different countries across the globe. In a 2010 landscape analysis, Bowser and Hill described 7 categories of disrespectful and abusive care during childbirth: physical abuse, non-consented clinical care, non-confidential care, non-dignified care, discrimination, abandonment and detention in health facilities. A 2015 systematic review updated this framework to include:Physical abuseSexual abuseVerbal abuseStigma and discriminationFailure to meet professional standards of carePoor rapport between women and providersHealth system conditions and constraintsSome evidence suggests that ethnic minorities are at greater risk of experiencing D&A during facility-based childbirth. Other factors that might influence a woman’s risk include parity, age and marital status. Women who have experienced or expect mistreatment from health workers may be less likely to deliver in a facility and to seek care in the future.Respectful maternity care (RMC) is not only a crucial component of quality of care; it is a human right. In 2014, WHO released a statement calling for the prevention and elimination of disrespect and abuse during childbirth, stating that “every woman has the right to the highest attainable standard of health, including the right to dignified, respectful care during pregnancy and childbirth.” WHO also called for the mobilization of governments, programmers, researchers, advocates and communities to support RMC. In 2016, WHO published new guidelines for improving quality of care for mothers and newborns in health facilities, which included an increased focus on respect and preservation of dignity.While a number of interventions have aimed to address this issue, many women around the world, including those living in high-income countries, continue to experience aspects of disrespectful and abusive care during childbirth. As facility-based birth and the use of skilled birth attendants continue to rise, a focus on quality and RMC remains critical for improving global maternal health.Access resources related to respectful maternity care >>Share this:
Finance is a critical agenda item at the COP21 climate summit as country negotiators hone in on different pieces of the Paris Agreement. Meanwhile, finance is also featuring prominently outside of the formal negotiations process, and a new initiative launched on Monday demonstrates the growing recognition that action by financial institutions – both public and private – is necessary to begin shifting the trillions of dollars needed to address the climate change challenge.Several institutions have already begun major initiatives, and some are already providing significant amounts of climate finance. For instance, the International Development Finance Club (IDFC), an association of national, bilateral and regional development banks from around the world, committed $85 billion of climate finance in 2014, according to their latest Green Finance Mapping Report.While impressive, the current commitments aren’t reaching the scale required to keep global temperature rise below 2 degrees C (3.6 degrees F). The New Climate Economy estimates $90 trillion (about $6 trillion annually) will be invested in infrastructure between now and 2030, and the shift to low-carbon investments necessary to prevent the worst impacts of climate change requires about $4 trillion (about $270 billion per year) in additional investment.Because dealing with climate change will not only require additional resources, but also a new way of making financial decisions, a group of financial institutions have been working since early 2015 to build consensus around a set of voluntary principles to effectively incorporate climate change considerations (both opportunities and risks) into their strategies, programs and operations. This process is often referred to as “mainstreaming climate change.”5 Voluntary Principles for Mainstreaming Climate ActionLaunched here in Paris at the start of this week, these Principles were spearheaded by several IDFC members and the multilateral development banks, but have recently been joined by other public and private financial institutions. The Principles aim to position financial institutions to capture opportunities while mitigating core business risks, and guide them through the process of mainstreaming climate change for better adaptation and promotion of climate-smart development through the following actions:COMMIT to climate strategies: Be strategic when addressing climate change. Financial institutions must make commitments from the top with senior management leadership defining explicit strategic priorities, policy commitments and targets.MANAGE climate risks: Be active in understanding and managing climate risk. Financial institutions should ask which climate risks are present in their portfolio, pipeline and new investments, as well as what are the most appropriate ways to help clients manage their risks. These aren’t easy questions to answer, but public resources can help the process.PROMOTE climate-smart objectives: Promote approaches to generating instruments, tools and knowledge on how best to overcome risks and barriers to investment in low-carbon and resilient investments. This could include developing new financial instruments, vehicles and products to raise additional financing and manage risks for climate-smart activities; engaging clients and other stakeholders (including rating agencies and accounting firms) on climate change risks and resilience; and sharing lessons learned with peers and others.IMPROVE climate performance: Set up operational tools to improve the climate performance of activities. Under this principle, financial institutions would track and monitor indicators tied to climate change priorities (see Principle 1 above), e.g. greenhouse gas emissions reporting, lending and advisory volumes supporting green investment, climate-related asset allocations, and each institution’s own climate footprint.ACCOUNT for your climate action: Be transparent and report, wherever possible, on the climate performance of your institution. Tracking and monitoring are important steps to improving climate performance, but performance transparency and reporting on financing increases in clean energy, energy efficiency, climate resilience or other climate-related activities and investments will help ensure targets are met and empower the full range of stakeholders outside the institution (e.g. investors, clients, civil society) to make informed decisions and hold institutions accountable.What’s Next?Twenty-six private and public sector financial institutions have joined the initiative as of the formal launch of the Principles on the COP21 sidelines. The hope is these principles will appeal to a wide range of financial institutions and guide them through a process that will help shift trillions of dollars towards low-emission and climate-resilient activities.With negotiators at the UN talks currently discussing how best to signal to investors about the need to align their portfolios with a below 2 degrees C (3.6 degrees F) world, the launch of these principles is timely. However, civil society in particular has called for more leadership from financial institutions on the issue of climate change, and warned against a lack of ambition to create a fundamental change in business practice.As a concrete next step, the Initiative will form a Planning Group in 2016 to map out future work, including sharing knowledge about processes and tools to implement the Principles. Discussions around how to take the Principles forward have already started, revealing several key questions, among them: On accountability, how will progress with implementation be measured and by whom? On reach, how can an Initiative seeking to expand and reach financial institutions worldwide attract more developing country financial institutions to join?Answering these questions and putting these voluntary principles into actual practice across financial institutions will take time. However, the Principles have the potential to provide a useful roadmap to help guide institutions toward efficiently and transparently providing the trillions of investment needed to support the world’s low-carbon, sustainable development.
ShareTweetShareEmail0 Shares April 10, 2014; PoliticoKathleen Sebelius tendered her resignation as Secretary of the Department of Health and Human Services (HHS) late Thursday. Her almost five years of service in President Obama’s cabinet was marked by her high profile and combative oversight of the implementation of the Affordable Care Act (ACA), or Obamacare. The widely-reported problems associated with the rollout of the insurance signup site healthcare.gov, including its exorbitant cost and shaky technology, are seen as the key events associated with her tenure as HHS Secretary.Although Politico says that Sebelius is “leaving on her own terms,” the timing and nature of her departure leaves no doubt that even her supporters were ready for a change at HHS. As recently as March 31st, she said that she would remain as HHS Secretary at least through November 2014. “I’m in,” she said at the time. Many reports of the announcement of her resignation were based on HHS statements, not the White House, and there has been a notable weakness in the standard praise and regret quotes from the White House that typically accompany the resignation of a Cabinet officer. (More than twelve hours after her resignation was reported in the press, the White House website had no press release or remarks from the president on her resignation.)Sebelius has been the classic “good soldier,” being the target of blame for the negative effects of Obamacare while allowing the president to be the lead spokesperson for the controversial law’s successes. She was a lightning rod for critics of the Affordable Care Act while also being blamed by supporters for any action her vast department took that appeared to call the ACA into question. Four years after its becoming law, HHS is still grappling with implementation of the ACA. Thousands of waivers from coverage requirements, delays in drafting key regulations (including regulations required to program the healthcare.gov website), and dozens of administrative decisions to change various deadlines associated with the law have frustrated both opponents and supporters of the president’s signature healthcare legislation.Sylvia Mathews Burwell, the current head of the Office of Management and Budget (OMB), is expected to be nominated as the new HHS Secretary. Formerly the head of the Walmart Foundation and president of the Global Development Program for the Bill and Melinda Gates Foundation, Burwell has extensive nonprofit foundation experience. She has been a politically active Democrat since her childhood in West Virginia, including work on the Dukakis and Clinton campaigns and on the Clinton transition team. She served in the Clinton administration as chief of staff to Treasury Secretary Robert Rubin and Deputy Chief of Staff to President Clinton.The Wall Street Journal praises Burwell as one of the most experienced members of the Obama administration, a low-visibility individual who works across party lines to achieve goals. It’s notable that the 2013 U.S. Senate vote on her confirmation as OMB Director was 96–0. Conservative Rep. Paul Ryan (R-WI) praises her ability to “budget responsibly.” Sen. John McCain (R-AZ) says, “Sylvia Burwell is an excellent choice to be the next HHS Secretary.” Bipartisan praise and a history of having done well in the Senate confirmation process are two signs that the Obama administration seeks a drama-free transition at HHS.Any tension or fireworks in Burwell’s Senate confirmation hearings are likely to center on HHS policy and priorities, especially the Affordable Care Act, where her low-key reputation will be tested. Will the continuing controversy over the ACA force Burwell into the harsh public spotlight, or will her leadership style help take HHS and the ACA off the front pages during the drawn-out implementation of healthcare reform?—Michael WylandShareTweetShareEmail0 Shares