2017 IMPACT REPORT
Ulla MĂźller with Khadija and her daughter at an EngenderHealth-supported site in Tanzania.
PRESIDENT’S MESSAGE We are living in a new reality.
It’s the power of she.
For nearly 75 years, EngenderHealth has been on the front lines fighting for women’s sexual and reproductive health and rights across more than 110 countries. We have tackled tough issues before and have weathered daunting political challenges and constrained funding climates. Yet today is different: Attacks on women’s sexual and reproductive rights are unprecedented in scope and are growing.
Looking ahead, EngenderHealth is more committed than ever to championing at all levels rights-based approaches to sexual and reproductive health, advancing knowledge and solutions to reach more women and girls, and expanding strategic partnerships that will unleash women’s and girls’ potential and ensure sustainable development. As you will read in the stories that follow, we are well on our way toward achieving our goals and forging a new reality for women and girls everywhere.
This reality only fuels our resolve to work smarter and harder—we will not rest until sexual and reproductive rights are respected as human rights, so that women and girls have the freedom to reach their full potential. Because when a woman can access contraception and the full spectrum of sexual and reproductive health services, including safe abortion, she can determine the course of her future. She will be healthier, is more likely to finish her education, and will earn more throughout her life. There is no doubt that when we focus on catalyzing the value of women and girls, they become a driving force that can transform communities and nations.
Thank you for your invaluable partnership and generous support to make this vision a reality.
Ulla E. Müller President & CEO
WOMEN &
EngenderHealth is a pioneer in improving access to contraception and
sexual and reproductive health care, always guided by the belief that sexual and reproductive health is a human right and is crucial for women and girls to determine their futures. Grounded in the core values of quality, rights, and sustainability, EngenderHealth is poised to make an even greater impact with our new organizational strategy, Women & Girls First. 4
GIRLS FIRST Building upon our successes to date, this strategy reboots our mission in a
new era of international development, embraced by the global community under the umbrella of the United Nations Sustainable Development Goals. This new time calls for new approaches that prioritize women and girls as crucial drivers to ending poverty, mitigating climate change, and achieving global progress and development. 5
Winnie Namatovu
IMPACT HIGHLIGHT
Winnie is one of 38,290 individuals trained last year on sexual and reproductive health by EngenderHealth.
REACHING MORE WOMEN & GIRLS Uganda To Winnie Namatovu, 26, a nursing assistant and peer educator from Kyantale Village in Uganda, topics such as generating income, managing money, and using contraception are all connected. She has a deep and personal understanding of the linkage between delaying unwanted pregnancy and the ability to earn a living. Her younger sister became a mother at age 13 and later had another unintended pregnancy. As a mother of two children herself, Winnie also knows how important the spacing and timing of pregnancies are to one’s future.
reach and underserved areas. Because ensuring contraceptive choice and rights is as important as providing reproductive health information and services, EngenderHealth also supported the Ugandan Ministry of Health in developing a national implementation plan on family planning, focusing on long-acting reversible contraceptives and permanent methods, to ensure that women have options throughout the national health care system.
Becoming a peer educator on contraception was a natural fit for Winnie, who learned counseling and community mobilization skills from EngenderHealth. She receives ongoing training, support, and advice from public health workers in her town and is proud to have counseled her sister, who is now using contraception and is back in school. When talking to her peers and to parents of youth, Winnie also uses locally sensitive youth booklets developed by EngenderHealth to aid discussions about sexual and reproductive health.
EngenderHealth’s Expand Family Planning project, supported by The Bill & Melinda Gates Foundation, takes a holistic approach to ensuring women’s and youth’s access to a range of contraceptives, including longacting reversible contraceptives and permanent methods, with ongoing or past activities in Uganda, the Democratic Republic of the Congo, and Tanzania. EngenderHealth and our ExpandFP project are part of Family Planning 2020, a global partnership with the goal of reaching an additional 120 million women and girls with modern contraception by 2020.
In addition to providing ongoing training and engagement of peer educators, EngenderHealth enables local health facilities to offer mobile outreach services and hold special family planning service days to bring providers, counselors, and community outreach workers to hard-to-
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Tigist Tefere
IMPACT HIGHLIGHT
When women use contraception, it reduces the need for abortion, especially unsafe abortion. Last year, our family planning activities around the world prevented an estimated 1.4 million unsafe abortions.
WHEN THE POWER OF CHOICE IS IN HER HANDS Ethiopia Tigist Tefere, a family planning counselor, will never forget the pregnant teenager who came to see her at the Kolfe Health Center in Addis Ababa. She counseled the teen on conception, her body, and her choices. The teenager said that she was not ready to be a mother and that her father might harm her if he found out she was pregnant. Tigist feels good to this day for her role in supporting this teen through a challenging time and decision and in offering counseling that enabled her to see that she had options and that all hope was not lost. She might have tried to end her own life if she had not had access to safe abortion, or she might have died from an unsafe abortion if she had no other options. Tigist’s passion for women’s health does not stop at work. She also advised her older sister, who was married at age 14 and already had two children, on the importance of planning her family and not leaving it up to chance. In partnership with the Ministry of Health, EngenderHealth’s Access to Better Reproductive Health Initiative (ABRI) is working to reduce maternal death and disability in Ethiopia by training health care providers like Tigist, who serve on the front lines of rights and choice, to provide
compassionate and quality care, including contraception and comprehensive abortion care services. EngenderHealth is proud to have led the way in dramatically expanding Ethiopian women’s access to contraception and safe abortion by engaging providers with our competency-based training packages and individualized post-training mentorship approach; advocating for a positive policy environment that supports sustained, integrated services; and fostering a quality improvement approach to services. EngenderHealth also ensures the availability of contraceptive supplies and instruments and supports facility readiness.
EngenderHealth has made it possible for an increasing number of women and girls to access an integrated package of health care services in a single visit to a health facility in Ethiopia. To date, 460 health facilities supported by EngenderHealth offer quality reproductive health services, including safe abortion and contraception.
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FORGING STRATEGIC PARTNERSHIPS Bangladesh Inside a garment factory in Dhaka, Bangladesh, Fatema Begum spends most of her day at a sewing machine—one of hundreds lined in rows humming under the fluorescent lights. In addition to sewing, Fatema works as a peer educator to 1,400 co-workers about a topic that is personally very important in her own life: contraception. Married at age 10, Fatema had her first child at 13 and her second by 19. Now 29, Fatema shares her story with her co-workers and advises them about their right to plan their families by design and not by chance. Garment workers work long hours, which can make accessing reproductive health services a challenge. EngenderHealth is bridging this gap by supporting the provision of family planning information and services within the factory through its public-private partnership with the government and a Bangladesh garment trade association. At the mini–health clinic established on the factory premises, EngenderHealth trains and equips health care providers and
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peer educators to ensure quality of care, informed choice, voluntarism, respect for client rights, safe services, and referrals to other services, as needed. There is regular supervision and feedback to ensure quality of care and support to Fatema and other providers. At first, some of Fatema’s co-workers were hesitant to discuss contraception with her. “Women aren’t accustomed to talking about these things openly,” Fatema explained, “but they want to avoid pregnancy because having children can hamper their earnings.” She says that her co-workers now see family planning as a basic health care need that can help keep doors open to other opportunities. Fatema is proud of her role as a peer educator and family planning champion. She is a testament to how we must devise creative ways and partnerships to bring reproductive health information, counseling, and services to women—when and where they need them—so they in turn can make an even greater impact on their communities.
Fatema Begum
IMPACT HIGHLIGHT
Last year, EngenderHealth reached 17.9 million people with sexual and reproductive health information, which is crucial for women and girls to plan their futures by design, not chance.
IMPACT HIGHLIGHT
Today, 214 million women want to prevent pregnancy but are not using modern contraception. Addressing this unmet need would reduce unintended pregnancies, unplanned births, and induced abortions by approximately 75%. Source: Guttmacher Institute, 2017. Adding it up: Investing in contraception and maternal and newborn health, 2017. New York.
WHERE OUR GLOBAL WE WORK IMPACT Driving Change Through Advocacy In addition to strengthening health care services, within countries EngenderHealth advises district- and regional-level government partners to collect programmatic evidence, including data, to advocate for positive policies and funding to meet local needs. We collaborate with ministries of health to prioritize support for and allocate more resources to sexual and reproductive health programs. Our advocacy efforts are vital to ensuring an enabling environment that will result in better health
outcomes for women and girls, which will contribute to building stronger communities and aid governments in reaching their overall national development goals. For example, last year EngenderHealth engaged the governments of Burkina Faso, Côte d’Ivoire, and Togo to devise national action and advocacy plans that allocated and significantly increased funding to expand contraceptive choice and access to sexual and reproductive health services.
WHERE WE WORK: Bangladesh Burkina Faso Burundi Côte d’Ivoire Democratic Republic of the Congo Ethiopia
Guinea India Kenya Malawi Mauritania Niger Nigeria
The Philippines Senegal Tanzania Togo Uganda United States
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OUR GLOBAL IMPACT Last year, EngenderHealth worked in nearly 20 countries and reached:*
11,350 health care providers trained to strengthen sexual and reproductive health services
10,740 hospitals and health centers to deliver better care
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7.1M women and men with contraceptives at sites supported by EngenderHealth programs
17.9M people with sexual and reproductive health information
By the Numbers EngenderHealth’s leadership in ensuring women’s rights to contraception, quality care, informed choice, and safe services is unparalleled.
These activities prevented an estimated:**
4.9M
child deaths (as a result of improved contraception)
unintended pregnancies
7,173 maternal deaths
In addition,
62,270 1.4M unsafe abortions
$260M
was saved in direct
health care costs (by avoiding adverse events related to pregnancy, death, and disability). *EngenderHealth trains health care providers and supports hospitals and clinics in partnership with governments and local organizations to offer high-quality reproductive health services. The EngenderHealth-supported sites provided health care services that will reduce preventable deaths and disability and result in cost savings. The data cover FY2016–17. **Estimated using Marie Stopes International’s Impact 2 Model.
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ADVANCING RIGHTS TO HEALTH Every day, 830 women die from pregnancyor childbirth-related complications. In addition, many others survive but suffer serious injuries, including obstetric fistula, which is caused by prolonged labor without medical intervention and leaves a woman leaking urine and/or feces uncontrollably and continuously.
during labor and delivery, and increased access to quality emergency obstetric care. Also, we are supporting fistula survivors to reintegrate successfully into their families and communities, reengage with their loved ones, and ultimately become productive members of their communities. Recently, EngenderHealth has:
In many ways, fistula—which affects 2 to 4 million women worldwide—epitomizes the physical and psychological damage caused when women are denied their right to lead dignified lives and attain quality health care through prevention, treatment, and postoperative services. In many cases, women living with fistula face abandonment by their husbands and social isolation from their families and communities, leaving them unable to lead lives to their fullest potential. EngenderHealth’s Fistula Care Plus project is leading efforts to transform the lives of these women by ensuring that they receive prevention and repair services addressing the complex physical, emotional, and social dimensions of fistula and its aftermath. We are propelling the field forward by strengthening skills and capacity at health facilities, creating regional and global alliances, conducting research, and developing tools and resources for surgeons and health care clinicians. As important as ensuring that women can receive fistula repair treatment is focusing on prevention, specifically through contraception, appropriate monitoring 16
• Developed tools to standardize safe surgical care for women with fistula, uterine or vaginal prolapse, and incontinence—ensuring that patients receive high-quality care spanning from their admission to the hospital until long after their discharge. The tools also focus on prevention of pregnancy, especially during the lengthy recovery period. • Convened experts from the public and private sectors, civil society, health care associations, and academic institutions to develop a dynamic, multisectoral strategy with the goal of ending obstetric fistula in South Asia by 2030. This integrated effort is key to ensuring sustainability and quality of care for women, which requires a complex network of committed actors. • Led global efforts to raise awareness about the growing burden of fistula caused by surgical error during cesarean sections and gynecologic surgery, which is preventable through surgical and anesthesia training, supervision, and strengthened systems within facilities.
IMPACT HIGHLIGHT
EngenderHealth is helping women in Bangladesh, the Democratic Republic of the Congo, Niger, Nigeria, and Uganda receive fistula repair, contraception, and maternal health care. To date, we have supported 38,174 fistula surgeries. More needs to be done to reach women awaiting repair and to prevent fistula from occurring altogether.
THE ADOLESCENT GIRL EngenderHealth is leading efforts across Africa, Asia, and the United States to ensure that adolescent girls receive comprehensive sexuality education and youth-friendly health services and that communities where they live are informed about the benefits of delaying early marriage/pregnancy and the consequences of harmful practices that needlessly put girls at risk. This is crucial to realizing our strategic vision: to reach young women and girls where they are and to ensure that all women and girls, regardless of age or geography, have every
West Africa Our Agir pour la Planification Familiale (AgirPF) project leads the way in Burkina Faso, Côte d’Ivoire, Mauritania, Niger, and Togo by taking a comprehensive, impactoriented approach to ensuring that women and girls can fulfill their reproductive intentions. We launched a comic book series with reading groups in primary and secondary schools to engage young people about sexuality, reproductive health, and local services. The comic book follows the lives of girls in villages and in cities and shows how sexual and reproductive health–related choices can impact their lives and futures. It explains girls’ rights and presents information on how they can stay healthy, protect their futures, and achieve their life goals.
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opportunity to spark a positive change in their lives—with the potential to transform their communities and the world.
Among 1.1 billion young people ages 15–24 worldwide, 85% live in developing countries. Young people, especially girls, face significant risks of unplanned pregnancy, HIV and other sexually transmitted infections, genderbased violence, and additional serious health issues.
IMPACT HIGHLIGHT
In West Africa, we trained 300 health care providers in 76 health facilities on youth-friendly sexual and reproductive health services. To date, an estimated 256,000 young people have participated in our educational programs on gender, contraception, and sexual and reproductive health.
The Philippines Tzytel Castro, 19, has an 8-month-old baby boy—and she isn’t alone. In fact, the Philippines has one of the highest teen pregnancy rates throughout all of Asia. More than one-quarter (27%) of young Filipino women between the ages of 15 and 19 is either already a mother or pregnant with her first child.
at the hospital, exclusively breastfeed their newborns for at least six months, and use contraceptives. The program creates space and opportunity for girls like Tzytel to pursue plans to earn a college degree, have a second chance at finishing school, keep their children healthy, and ultimately reach their fullest potential.
Many Filipino girls have little to no access to information about their sexual and reproductive health, pregnancy prevention, or the dangers of early pregnancy. Stigma, laws, discrimination, poverty, and fear are just a few of the many barriers they face.
In addition to leading the PYP, EngenderHealth’s VisayasHealth project is improving maternal and child health and family planning services in eight provinces of the Visayas, by strengthening reproductive health services and educating communities with health information and referrals (including using mobile phones to communicate with young women). VisayasHealth also offers video refresher trainings to health care providers, which are crucial to those living and working in remote and rural areas.
To support teens like Tzytel, EngenderHealth leads a Program for Young Parents (PYP) aimed at addressing the critical needs of young expectant mothers, encouraging them to attend prenatal consultations, deliver their babies under the care of trained professionals
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Tzytel Castro
United States Young women and girls in the United States face many of the same challenges as youth in other countries. Recently, millions of dollars of U.S. federal funding were cut from programs around the country, including EngenderHealth’s own Teen Pregnancy Prevention Program in Austin, Texas. This was unexpected, with the only reason given that it is no longer a priority in the current administration. These programs provide essential services for teens. Through our Re:MIX project in Texas (which has one of the highest teenage pregnancy rates in the country), we are utilizing game-based tools, technology, and storytelling to impart the crucial skills that teens need, while integrating hip-hop and theater techniques to meet young people where they are, culturally and socially. The program emphasizes empowerment and positive youth development for young parents and teens by providing professional development and leadership programming. Check out the courageous digital stories from young parents on YouTube’s EngenderHealth channel, at www.bit.ly/remix-stories.
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Khadija and her daughter
IMPACT HIGHLIGHT
In Tanzania, we helped increase modern contraceptive use nationwide by 60% during the past decade, from 20% to 32%.
MAKING LASTING IMPACT Tanzania After living with HIV for more than a decade, Khadija recently visited Magugu Health Center in Tanzania with her bubbly 3-year-old daughter. In addition to receiving antiretroviral therapy, Khadija was supported throughout her pregnancy by health care providers at Magugu to keep her baby HIV-free. She received counseling on a variety of contraceptive methods and chose the method that worked best for her, so she could decide if and when to have a second child. For now, Khadija is happy to have a healthy daughter and to have been able to make this choice, so she can concentrate on staying healthy, take care of her family, and run her small business as a street food vendor. EngenderHealth supports Magugu Health Center and Tanzania’s national family planning and reproductive health program in 110 districts across all 30 regions. In partnership with the Tanzanian Ministry
of Health, Community Development, Gender, Elderly, and Children, we ensure contraceptive choice, including long-acting reversible contraceptives and permanent methods; strengthen integration of family planning with other reproductive health and HIV prevention and treatment services; equip health centers with supplies and medicines and renovate them as needed; standardize training for health care providers; and support services, including mobile outreach to rural, remote areas. EngenderHealth is also making a lasting impact by providing expertise and training on lifesaving postabortion care and decentralizing these crucial services to lower-level health care facilities, to fill the gaps where there are too few doctors, especially in rural areas. We are also responding to community needs by preventing violence against women and children.
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FINANCIALS Statement of Activities Operating revenue U.S. Agency for International Development $ 41,074,149 Individual and institutional contributions
$ 19,232,581
Total operating revenue
$ 60,306,730
Operating expenses Program services: Reproductive health services
$ 50,462,233
Total program services
$ 50,462,233
Support services: Administration
$ 10,041,325
Fundraising
$ 1,053,396
Total support services
$ 11,094,721
Total operating expenses
$ 61,556,954
Nonoperating revenue Investment return
$
(134,294)
Change in value of split-interest agreements $
46,665
Pension-related changes other than net periodic pension costs
$
(482,004)
Total nonoperating change in assets
$
(569,633)
Increase/(decrease) in net assets Decrease in net assets before nonoperating revenue
$
(1,250,224)
Total nonoperating change in assets
$
(569,633)
Total decrease in net assets
$ (1,819,857)
Net assets, beginning of year
$ 35,879,377
Net assets, end of year
$ 34,059,520
Note: The above data represent the audited financial information for the 12-month period ending June 30, 2016. For detailed financials, please visit www.engenderhealth.org/financials.
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We are grateful to our longstanding individual and institutional supporters for their steadfast commitment to EngenderHealth and our work. It is through our partnerships with national and local governments, nongovernmental organizations, communities, and health professionals that we are able to work toward ensuring sexual and reproductive rights are respected as human rights, so that women and girls have the freedom to reach their full potential. In 2016, EngenderHealth’s total income was $60.3 million, made possible through the generosity of thousands of caring individuals as well as foundations, corporations, the U.S. Agency for International Development, and other bilateral, multilateral, and technical agencies. We deeply appreciate this vital support.
82% Program services 16% Administration 2% Fundraising
THE TEAM Board of Directors
Executive Team
Robert D. Petty Chair
Ulla E. Müller President and Chief Executive Officer
Linda Rosenstock Chair, Executive Committee
Mina Barling Director, Policy and Advocacy
Rosemary Ellis Secretary Margaret Neuse Assistant Secretary Donald J. Abrams Treasurer Constance A. Carrino Mark Chataway Francine Coeytaux Denise Dunning Ryan Hawke Paul Hinks Karen Koh Michael McDermott Mark Simmonds Andrew L. Sommer Director Emeritus Lyman B. Brainerd, Jr.
Gary Camus Chief Financial Officer Mustafa Kudrati Vice President, Innovation, Impact, and Quality Reme Moya Chief Operating Officer Paul Perchal Vice President, Program Management Lauren Wolkoff Global Director, Communications and Marketing
© 2017 EngenderHealth (CM0141) Photo credits: p. 1: M. Tuschman/EngenderHealth; p. 2: S. Lewis/EngenderHealth; pp. 4–5: Robin Wyatt/EngenderHealth; p. 6: A. Ackerman/EngenderHealth; p. 11: T. Murad/EngenderHealth; p. 12: R. Shryock/EngenderHealth; p.14–15: Robin Wyatt/EngenderHealth; p. 17: R. Islam/EngenderHealth; p. 19: R. Shryock/EngenderHealth; p. 21: J. Licardo/EngenderHealth; p. 23: Will Gallagher/Gallagher Studios/EngenderHealth; p. 24: S. Lewis/EngenderHealth
EngenderHealth is a leading global women’s health organization committed to working toward a world where sexual and reproductive rights are respected as human rights and women and girls have the freedom to reach their full potential. In nearly 20 countries around the world, EngenderHealth creates lasting change by training health care professionals and by partnering with governments and communities to make high-quality family planning and sexual and reproductive health services available today and for all generations to come.
www.engenderhealth.org