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We would like to welcome our new intern, Wendy Wai-Yei Leung, an MPH candidate at the University of Waterloo, with primary interests in global maternal and child health and nutrition.

 

You are what you eat

Television, YouTube… catching up on interesting documentaries can be stimulating. As much as I love learning about food, this is a topic there is much to talk about. I separated this blog in three parts so to cover the three main aspects of the topic on a global level. What is happening in well-developed countries, what about underdeveloped countries, and how complex is really the food issue?

You are what you eat: Food Police (Part 1)

Obesity is prevalent in as high as 50% of adults in industrialized nations and has been found more often in lower income countries over the last ten years. Industrialized nations obesity stems from the over-abundance of processed foods full of preservatives, loaded with sodium, unhealthy fat, and sugar. Government agencies attempt to regulate food to ensure that the population accesses healthy food, and makes efforts to teach consumers to make healthier choices.  However, the issues around health education and communication efforts to educate the population on nutrition are conflicting and different in various nations.

In May 2013, I had the opportunity to attend a meeting organised by Canada 2020 on Crisis in Public Health. The topic was related to issues related to obesity: which policies were implemented and lessons learned. There were 4 speakers:

  • Melody C. Barnes, Vice Provost, NYU and former White House Director of Domestic Policy under President Barack Obama
  • Alex Munter, President and CEO, Children’s Hospital of Eastern Ontario
  • Rodney Ghali, Director General of the Centre for Chronic Disease Prevention, Public Health Agency of Canada
  • Alexis Williams, Director of Health and Wellness, Loblaw Companies Limited

Each of them provided an insight of what is done, but my personal highlight of the discussion was about the effort made by Loblaws Supermarket to encourage customers to make healthier choices easier and faster, which include:

  • offering affordable cooking classes for all ages
  • healthier food choices (Blue and Black label) by voluntarily reducing the amount of sodium in food
  • “Guiding Stars” program (3 stars-scoring for nutritional value)
  • Pharmacist, dieticians
  • Gym found within the supermarket

I was interested to learn that a local Ontario supermarket had taken such great initiatives to promote health, aside from all the debatable issues on food, namely food tax.

Food tax and ban

Various government agencies in a variety of cities worldwide have tried implementing bans on food advertising, bans on sugary drinks (New York City), controlling fat tax (in Denmark, dropped in 2012 following criticism), or establishing a sodium reduction plan (Canada). Since many stakeholders are involved, from consumer, chefs (restaurants), sellers, manufacturers, etc.,  the issues and discussions pile up and consensus can not be reached. As much it involves health concerns, and even if New York City has a population where nearly 60% of New York City adults and 40% of city schoolchildren are overweight or obese, as per CNN report, argument stands that it interferes with the freedom of choice.  Even more surprising are restaurants that promote unhealthy eating by providing free meals if the customer weighs over 350 lbs, and offers to their client- at 8000 calories per burger.

While regulation/legislation or enforcement is difficult to implement, health promotion is the way to go. With the goal of changing/altering behaviors, the key is to ensure children are adopting healthy habits and keeping them as they grow. Many initiatives have been taken to reduce fat, sodium and sugar in food, while providing healthier food choices at school. Results? As much as we care about our future generations, these initiatives are much more accepted by parents. What more can we do? The power of marketing, habits, behaviors, and addiction overpowers the idea of a healthy lifestyle. It doesn’t help if processed food is always more accessible and cheaper than healthy food.

 

Reference: http://canada2020.ca/event/the-canada-we-want-in-2020-public-health/

http://www.loblaw-reports.ca/responsibility/2012/make-a-positive-difference-in-our-community/live-life-well/

http://en.wikipedia.org/wiki/Fat_tax#Japan

http://www.bbc.co.uk/news/world-europe-20280863

http://money.cnn.com/2013/03/11/news/companies/soda-ban/index.html

http://www.organicauthority.com/restaurant-buzz/heart-attack-grill-restaurant-review-las-vegas.html

 

 

written by: Wendy Wai-Yei Leung, Go-MCH intern

 

 

 

 

 

SomaliaFamine_11-12

Photo courtesy of CBSNews

Somalia is recognized as having an ongoing food crises over the last several decades. Most recently, between late 2010 and 2011, the nation experienced an extreme drought that led to a global food crisis in an area where women and children were already entrenched in desperate food and economic conditions.  Somalia’s 2011-2012 drought was the worst since the 1992-1993 famine. Acute malnutrition and illness further decimated the women and children whose immune system had already been lowered through from long term low access to food, health care, and unsanitary, unsafe living environments.

 

The United Nations and multi-partner Integrated Food Security Phase Classification system (IPC, an analysis template used for determining relative severity of food insecurity) and regions in Somalia were identified as suffering from severe famine and in the midst of major food shortages. Many people migrated to refugee camps in neighboring countries and as a result, populations in those camps soared and the prevalence of disease also spread throughout the already malnourished and weakened populations. This analysis however did not become realized until 6-9 months after the famine had already spread across southern Somalia and therefore, not only had the damage had been done, but the opportunity to save the lives of women and children had passed. Most families had lost their most vulnerable members or had left the area for refugee camps where they faced more dire circumstances.

Please see the FAO’s Food Security and Analysis Unit’s full report, recently published and commented through the FAO blog. Their report finds that over half of all deaths were children under 5:

To read the full report, please click on the following link: Download the Study Report (PDF, 3.84MB)

 

 

 

 

 

 

MSF-scientificday2013

 

This year’s event, held at the Royal Society of Medicine was highly anticipated by the academic and professional world of international health. Their integration of online media and live online streaming really opened the access to this event for everyone to watch. We wish more conferences provided this type of open access!

This is the full document of their abstracts, articles and presentation schedule:

http://www.msf.org.uk/sites/uk/files/scientific_day_2013_final_lo-res.pdf

Visit their website: http://www.msf.org.uk/

Summary of a key presentation: 

Tuberculosis treatment in a chronic armed conflict setting: treatment outcomes and experiences in Somalia

(Karin Fischer Liddle, Riekje Elema, Sein Sein Thi, Jane Greig. Médecins Sans Frontières (MSF), Amsterdam, Netherlands; MSF, London, UK)

Key findings: the programme successfully treated a high percentage of patients, though results were variable with only one project nearing the WHO target of 90%. However—It seems obvious in they’re conclusion that, “Insecurity often reduces mobility and may limit patients’ ability to seek healthcare”, that “adherence may be supported by a broader network of healthcare providers with a common agreement to continue TB treatment for mobile patients, but this is a substantial challenge.”  They brought up an important topic: collaboration and partnership development. The broader network of healthcare providers with common agreements in TB treatments for mobile patients could be facilitated through partnership development and coordination. In addition, perhaps technology may be helpful, depending on ease of use of technology in this setting. However, the combination of improved communication and coordination through partners via common agreements along with tools to facilitate communication and data tracking, should be explored by larger strategic funding agencies, as it has the potential to provide a higher impact.

We hope to summarize more presentations with future blog articles!

Literacy is a fundamental human right and is linked directly to improved rates in health and nutritional status, economic empowerment and growth, reduction in child marriage, and infant and maternal survival rates.

Literacy is the key to survival, improvement, growth, and achieving well-being.

We are all familiar with the political, economic and cultural barriers low income nations face to helping women and children access literacy. Nepal is no different than other nations. Their government does not provide enough funding for teachers or infrastructure to deliver the education necessary to help their population thrive.

As a result, families generation after generation suffer lack of ability to raise themselves out of poverty.

Go-MCH is helping rural communities in Nepal build the infrastructure and access resources in a way that can provide long term, affordable, and sustainable solutions. Our partner, Smiles Nepal is building schools with green energy (solar panels) and wiring for electricity and internet that enables schools to remain open with lights on after dark, powers computers all day and into the evening, and provides the resources necessary to support the literacy growth of children, women, and the community.

During the day, children are accessing literacy curriculum  learning how to read, learning science and math with the most up-to-date learning materials available in their native language and endorsed by Nepal’s Ministry of Education.

In the evenings, women’s groups visit the computer labs. Teaching aids show them how to use the computer and train them on using a basic literacy curriculum. Once they start learning, they can access online resources to reach family in other nations, learn more about educational and economic opportunities… the sky is the limit.

OLYMPUS DIGITAL CAMERA

Computer_kids_1000x700

SMILES Nepal, Pilot schools in stages of development, being powered with renewable, reliable electricity:

  1.  Binayak Lower Secondary School in the village Kalimati, Jhagajholi Ratamata VDC-5, Sindhuli District
  2. Chilaunekharka Primary School in Chilaunekharka, Jhagajholi Ratamata VDC-6, Sindhuli
  3. Shree Krishna Lower Secondary School Virpani-2, Ramechap
  4. Shree Himalaya Secondary School Sipali-5, Kavrepalanchowk

ClassroomKids_1

Wondering how to help? Visit our donations page here: http://www.go-mch.org/pages/Fundraising.html

The expense is small, it is tax deductible, and you can change a child’s life forever!

If you are interested in volunteering or learning more, visit our program page:

crpd-stamps

U.N. Convention on the Rights of Persons with Disabilities (CRPD).   On December 4, the U.S. voted against ratification of the CRPD.  A two-thirds majority of the Senate (66 votes) was needed to ratify the treaty, which was signed by the US in 2009.  The treaty does not protect persons with disabilities in the womb and would have put American laws under United Nations control. The Senate failed to reach the two-thirds majority needed to ratify the treaty, after a 61-38 vote on December 4th, 2012.

Though there was significant controversy over increased UN oversight of US law, the treaty is modeled on the American Disabilities Act, which Congress passed in 1990. Former Republican Senator Bob Dole (R-KS), who has a war-related disability and was a strong proponent of disability rights during his Senate career, returned to the Senator Floor to urge ratification.  About 300 disabilities organizations in the United States strongly supported the treaty.  Those opposed to the treaty, including former Senator Rick Santorum (R-PA), were concerned that it would limit US sovereignty, parental rights, and the rights of people with disabilities, although mainstream international legal scholars seemed to disagree with this view.  Senate Majority Leader Harry Reid said he would bring the treaty before the Senate next year for reconsideration.  For more information about the treaty and its text, see http://www.un.org/disabilities/.

International Classification of Functioning, Disability and Health (ICF)

The International Classification of Functioning, Disability and Health, known more commonly as ICF, is a classification of health and health-related domains. These domains are classified from body, individual and societal perspectives by means of two lists: a list of body functions and structure, and a list of domains of activity and participation. Since an individual’s functioning and disability occurs in a context, the ICF also includes a list of environmental factors.

The ICF is WHO’s framework for measuring health and disability at both individual and population levels. The ICF was officially endorsed by all 191 WHO Member States in the Fifty-fourth World Health Assembly on 22 May 2001(resolution WHA 54.21). Unlike its predecessor, which was endorsed for field trail purposes only, the ICF was endorsed for use in Member States as the international standard to describe and measure health and disability

Source: http://www.who.int/classifications/icf/en/

Publications:

  • Status of the Convention on the Rights of Persons with Disabilities and the Optional Protocol thereto (DRAFT, A/C.3/67/L.25 PDF version)
  • Realizing the Millennium Development Goals and other internationally agreed development goals for persons with disabilities towards 2015 and beyond (DRAFT, A/C.3/67/L.10/Rev.1 PDF version)
  • Addressing Socio-Economic Needs of Individuals, Families and Societies Affected by Autism Spectrum Disorders (ASD), Developmental Disorders (DD) and associated disabilities (DRAFT forthcoming)

Handbook for parliamentarians on the Convention on the Rights of Persons with disability

disabilities_pubFrom Exclusion to Equality, Realizing the Rights of Persons with Disabilities
The Handbook was jointly prepared by the Department of Economic and Social Affairs (UN-DESA), the Office of the United Nations High Commissioner for Human Rights (OHCHR) and the Inter-Parliamentary Union (IPU).
Release date: October, 2007
English

 

 

 

 

monitorin_COPDMonitoring the Convention on the Rights of Persons with disability: Guidance for HR Monitors

Monitoring the Convention on the Rights of Persons with Disabilities: Guidance for Human Rights Monitors (PDF)
Release date: April 2010
English and Russian.

Prevention of Mother-to-Child Transmission (PMTCT) of HIV is one of the primary focuses of HIV/AIDS prevention programs in low income nations. It is the centralized feature this week in USAID’s 5th Birthday campaign, due to its essential role in keeping children alive to their 5th birthday and beyond.

Key Measures
One of the key measures of effectiveness is how many are able to complete the PMTCT cascade: which should be initiated starting at antenatal care, to counseling and testing, through starting timely treatment, to returning to test the infant and follow-up care for the infant.[i] Antiretroviral therapy (ART) is effective in reducing rates of mother-to child transmission of HIV to low levels in resource-limited contexts but the applicability and efficacy of these programs in the field continue to be scarcely known.

Source: USAID/AIDSTAR One/ PEPFAR

ART and Protective Factors

It is important to note that PMTCT includes prenatal care, pregnant women receiving triple-drug ART coupled with exclusive breastfeeding after the infant is born. The longer and more comprehensive the treatment, the lower were the risks for transmission. Exclusive breastfeeding and triple-drug antiretroviral treatment (ART) are both protective factors, while unplanned pregnancies and mixed feeding are risk factors associated with MTCT. Close to two-thirds of the pregnancies among HIV-infected women were unplanned in South Africa according to a 2011 report: South Africa’s first national PMCTC impact evaluation. Results from this evaluation were presented at the Sixth International AIDS Society conference (IAS 2011) in Rome.

Another critical factor is the realization that providing ART treatments to mothers is the key turning point in their own survival. HIV is the leading cause of death for women of reproductive age worldwide and a major contributor to infant mortality. Once a woman is able to be properly diagnosed, her access to ART treatments will continue to keep her viral loads low, maintaining her own health. According to a recent study published in May of 2012 in The Lancet, CD4 count increased less in participants with pre-treatment drug resistance than in those without. Which means that at least three fully active antiretroviral drugs are needed to ensure an optimum response to first-line regimens and to prevent acquisition of drug resistance.

Improved access to alternative combinations of antiretroviral drugs in sub-Saharan Africa is warranted.[ii] We already know the research in linking the survival of the mother to the survival of her children. Thusly once again, mortality factors of mother and infant are inextricably linked.


Outreach is still needed

In one study many women presented too late for PMTCT, and about 20% of infants did not complete follow up. This suggests the need of targeted interventions that maintain the access of mothers and infants to prevention and care services for HIV.”[iii] In Nigeria, a study showing the Reduction of MTCT of HIV is possible with effective PMTCT interventions, including improved access to ARVs for PMTCT and appropriate infant feeding practices. Loss to follow up of HIV exposed infants is a challenge and requires strategies to enhance retention.[iv]

 

According to the WHO’s Global Health Sector Strategy on HIV/AIDS 2011-2015[v], Option B+ proposes further evolution—not only providing the same triple ARV drugs to all HIV-infected pregnant women beginning in the antenatal clinic setting but also continuing this therapy for all of these women for life. Important advantages of Option B+ include: further simplification of regimen and service delivery and harmonization with ART programmes, protection against mother-to-child transmission in future pregnancies, a continuing prevention benefit against sexual transmission to serodiscordant partners, and avoiding stopping and starting of ARV drugs. While these benefits need to be evaluated in programme settings, and systems and support requirements need careful consideration, this is an appropriate time for countries to start assessing their situation and experience to make optimal programmatic choices.”[vi]

 

South Africa, which has drastically declined its prevalence of PMTCT to under 4%, has these critical guidelines for all HIV Infected pregnant women[vii]:

  • Receive routine antenatal care, including iron and folate supplementation.
  • Be offered information on the availability of PMTCT interventions at all health care consultations, and not only when visiting the antenatal clinic.
  • Be clinically staged and have a CD4 cell count taken on the same day as the HIV test is done, and preferably at the first ANC visit (or at the earliest opportunity).
  • Be screened for TB, in line with the BANC.
  • Be screened and treated swiftly for syphilis and other STIs, in line with BANC.
  • Receive regimens to prevent mother-to-child transmission of HIV (PMTCT regimen) OR lifelong ART if CD4 cell count <350 cells/mm (ART regimen).
  • Be offered appropriate PCP and TB prevention prophylaxis.
  • Be counseled on safer sex, family planning, postnatal contraception and partner testing

For more information about USAID’s and PEPFAR’s efforts in PTCTC, visit: http://www.aidstar-one.com/focus_areas/pmtct

Additional Reading:


[ii] Hamers, Ralph, et al. Effect of Pretreatment HIV-1 drug resistance on immunological, virilogical, and drug resistance outcomes on first line antiretroviral treatment in Sub-Saharan Africa: a multicenter cohort study.   http://www.thelancet.com/journals/laninf/article/PIIS1473-3099(11)70255-9/fulltext

[iii] Lucianna C. et al. Effectiveness of a Prevention of Mother-to-Child Transmission Programme in an Urban Hospital in Angola. PLoS One. 2012;7(4):e36381. Epub 2012 Apr 30. http://www.ncbi.nlm.nih.gov/pubmed/22558455

[iv]  Anjoe et al, Reducing Mother-to-child transmission of HIV: findings from an early infant diagnosis program in south-south region of Nigeria, BMC Public Health. 2012 Mar 12;12:184.  http://www.ncbi.nlm.nih.gov/pubmed/22410161

[v] The WHO’s “Global Health Sector Strategy on HIV/AIDS 2011-2015: Let’s do what’s right for everyone”: http://www.who.int/hiv/topics/mtct/en/index.html

[vi] Use of Antiretroviral drugs for treating pregnant women and preventing HIV infection in infants, WHO, April 2012: http://whqlibdoc.who.int/hq/2012/WHO_HIV_2012.8_eng.pdf

[vii] Clinical Guidelines, National Department of Health, South Africa, 2010: http://www.fidssa.co.za/images/PMTCT_Guidelines.pdf

Its 11:11, make a wish.

It’s a moment that comes twice a day.  What is your wish?

This Mother’s Day, our wish at Go-MCH is for an equitable world where all women have the chance of surviving childbirth through ongoing access to prenatal and maternity care and a delivery with a health care professional.

Every year, 360,000 women who are giving birth, die in the process. No woman should die while giving life.

Source: WHO, Systematic Review of Causes of Maternal Death (preliminary data), 2010

Maternal Mortality is a multi-faceted issue related to social, economic, and cultural issues spanning from the quality of health care available in a nation, to the health and nutritional status of the mother, to whether she can be allowed to leave the house on her own to seek health care. Ultimately, a systems approach is the only way maternal deaths will truly be reduced and ensure that interventions are not only saving a life, but saving the lives of women to enable them thrive to support their families and their communities long term.

When a mother dies:

The probability of survival to age 10 years was 24% in children whose mothers died before their tenth birthday, compared with 89% in those whose mothers remained alive. The greatest effect was noted in children aged 2—5 months whose mothers had died. The effect of the father’s death on cumulative probability of survival of the child up to 10 years of age was not as obvious. Age-specific death rates did not differ in children whose fathers died compared with children whose fathers were alive.  (The Lancet, Volume 375, Issue 9730, Pages 2024 – 2031, 5 June 2010)

Why are women dying?

Access to Health Care Workers during Childbirth

  • There is a mass demand for access to health care workers in low income nations. For example, For every 100,000 women who give birth Tanzania, almost 800 die (compared to 24 in USA ). Almost all of these deaths could be prevented if women had access to skilled health workers.
  • Yet there is a dire shortage of health workers with midwifery skills in rural Africa and Asia. In Tanzania, and half of women still give birth with no one to help them except neighbors or relatives. It is estimated that of the 1000 women and 8500 babies who die every day around the world, a third could be saved if they had access to skilled health care. (Huffington Post, White Ribbon Alliance: http://www.huffingtonpost.com/mobileweb/rose-mlay/international-midwives-day_b_1480842.html)

Access to Clinical care:

  • A woman can die of post partum hemorrhage within 24 minutes. The probability of a woman accessing life saving drugs to stop post-partum hemorage in a low resource region are very small, as clinics and access to medical care are hours and even days away. Women who can plan ahead, or have access to resources are lucky, but that is often not the case in high need areas of Asia, Africa, and Latin America. Skilled health care workers are at a dire low. According to the White Ribbon Alliance, only 63% of women deliver with a skilled health professional. In the poorest, least developed countries the situation is even worse with only a third receiving skilled care.
  • Ongoing research over the last ten years has concluded that both oxytocin and misoprostol are the best treatments, as a prophylactic and during PPH, to ensure a woman does not bleed to death during or right after childbirth.

Poverty

  • Education and economic status vastly improves a woman’s probability of accessing health care, being strong enough in their own health and nutritional status, to survive childbirth, in any country. Globally, women and girls make up 60% of the world’s poorest people and two-thirds of the world’s illiterate people. Yet, with education and empowerment, they can lead healthy lives, lift themselves and their families out of poverty and disease, usually marry later, and have fewer and healthier children.” (Lancet: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2810%2960905-1/fulltext)

Nutrition

  • A woman who is malnourished is likely to be anemic, vitamin A deficient, and too weak to sustain a healthy childbirth, especially in an area without proper medical care, clinical resources, and trained health workers. Additionally, the fetus would have been taking all the necessary calcium and other vital nutrients during gestation and therefore her nutritional status would be drained due to internal and external factors.
  • According to an article in the American Journal for Clinical Nutrition, The risk of death is greatly increased with severe anemia (Hb <70 or 80 g/L). Current programs of universal iron supplementation are unlikely to have much effect on severe anemia. There is an urgent need to reassess how to approach anemia control in pregnant women. Obstructed labor is far more common in short women as well- which is attributed to those women who have been stunted due to severe malnutrition within the first five years of life. (http://www.ajcn.org/content/72/1/212S.full)
  • “Girls more so than boys become severely malnourished and that the cause of maternal death often has its roots in a woman’s life before pregnancy—during infancy or even before her birth—when deficiencies of calcium, vitamin D, or iron begin. Malnutrition may result in chronic iron deficiency anemia and death from hemorrhage, and referred to maternal depletion from pregnancies spaced too closely together. “ Malnutrition and maternal mortality is a cyclical problem that is passed on from mother to child and dependent on social, educational, and economic factors.

Around the World

North-South Korea Maternal Health Project:

  • Paediatric and Maternity hospitals have been renovated and supplied with medicines and laboratory equipment, WHO said in a statement. “It is an extremely cost-effective measure that gets a high rate of return in terms of incidence of disease, in terms of reduction of mortality, and so on”, Eric Laroche, assistant director-general for health action in crises at WHO said. “Along with that there were strategies to reduce the ill health of mothers and to reduce maternal mortality with emergency obstetric care.” WHO statistics support his upbeat appraisal. The number of operations undertaken has increased 8% since 2006, while postoperative infection rates have fallen by more than 42%. Over the same period, North Korea has trained more than 6000 health professionals in emergency obstetric care, newborn care, and the management of childhood illnesses. The project is in place in 80 of North Korea’s 220 counties, and there are plans to take it to other parts of the country over the coming years. (The Lancet, Volume 375, Issue 9730, Page 1953, 5 June 2010)

Bolivia’s Maternal Health Project:

  • Bolivia’s health ministry hopes the initiative, which is a signature policy of the leftist government of Evo Morales and a declared state priority, will reduce maternal mortality rates by roughly half by 2015. With 290 maternal deaths per 100 000 livebirths in 2009, according to government data, Bolivia has one of the highest rates in the Americas. Since 2009, hundreds of thousands of women and children have benefited from the initiative but an array of teething problems, logistical bottlenecks, and a lack of resources continue to mar its progress and prevent its widespread implementation. (The Lancet, Volume 375, Issue 9730, Page 1955, 5 June 2010)
  • The conditional cash transfer programme known as the Juana Azurduy stipend, offers cash payments totalling US$260 to pregnant women paid in instalments on condition they attend regular prenatal and postnatal check ups until their child is 2 years, and have a skilled attendant present during birth. (The Lancet, Volume 375, Issue 9730, Page 1955, 5 June 2010)

Pakistan

  • “In a decade, the number of annual deliveries has increased from 6000 to 16 000. Services are due to expand to include a separate obstetric fistula repair centre, as well as a learning resource centre. The department has already trained hundreds of obstetricians and gynaecologists, now “serving the women of Pakistan”, including those in remote rural areas and deprived districts, says Shereen Bhutta.  Another successful project that Shereen Bhutta oversees is the Pakistan Society of Obstetricians and Gynaecologists’ collaboration with the International Federation for Gynecology and Obstetrics in rural Sindh province. After 4 years, implementation of the first emergency obstetric and newborn care services in the area has been challenging. “But the effort was worth it because it has contributed to reduction of maternal and perinatal mortality”. She adds that the community is now the strongest advocate of the services.” (The Lancet, Volume 375, Issue 9730, Page 1962, 5 June 2010)

This Mother’s Day in the United States… our wish is for all mothers to be remembered. Please view the public service announcement, by our partner Every Mother Counts (www.everymothercounts.org) :

Image Source: USAID Saving Lives at Birth

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