Women’s Health

More than an Outbreak

This blog post was written by Global Health Council (GHC) President & Executive Director Loyce Pace

I had the privilege this month of traveling with members of U.S. Congress and other global health stakeholders to Sierra Leone as part of a CARE Learning Tour. Such trips are designed to expose policymakers, donors, the media, or other leaders to foreign assistance in action. Our visit was especially timely, considering Sierra Leone’s recent Ebola crisis and warnings about new infections in Democratic Republic of Congo. I arrived wondering what I would learn about Ebola’s aftermath and anxious to understand not only how a community or country responds to an outbreak but also how people recover.

Learning tour participants watch as local staff provide care and instruction to new and expecting mothers. Photo courtesy of CARE International

The direct effect of Ebola in Sierra Leone and its neighbor, Liberia, has been well-reported in terms of lives lost. But what came into focus for learning tour delegates during our time on the ground is the impact Ebola had on those left behind. Now that the 2014 crisis has come and gone, clinics have had to replenish resources and bolster systems that were strained under the weight of emergency response. It was inspiring to witness firsthand the resilience of health workers – many of whom lost coworkers to the disease – and see how village clinics have been able to rebound, with the support of local and international actors. This means a young pregnant woman seeking maternal care can once again access important services that would save her life. Or that a child could be treated for malaria, diarrhea, and other conditions that contribute to premature death. We forget these basic needs are at risk in a crisis.

A village savings and loan program in action. Photo courtesy of CARE International.

Beyond health, there are other important considerations following such a significant tragedy in Sierra Leone, a country with high poverty rates and a number of unfavorable human development indices. Learning tour delegates met Ebola survivors as well as widows or widowers and orphans to hear their profound accounts of fear, loss, and stigma and how they reestablished their lives after diagnosis. CARE’s flagship village savings and loan program has proven invaluable to these individuals, giving them the ability to restore capital and regain independence. Participants in local associations spoke of using funds to start businesses, pay school fees, and address family health care needs, bringing it all full circle.

So, as we think about global health security, it is critical that we view our investments and response as part of a continuum of global health and development, one that encompasses a range of priorities. After all, people are more than a disease. They have lives that require multiple resources and avenues of support. Only by acknowledging how their various needs are interconnected can we make lasting progress on the ecosystem of issues they face. I am grateful to CARE for helping me see beyond the Ebola outbreak to what the future holds for affected communities throughout Sierra Leone and beyond.

Loyce from the U.S. meets Loyce from Sierra Leone. Photo courtesy of CARE International

The End of Cervical Cancer

This guest post was written by Vivien Tsuan Associate Director in the Reproductive Health Program at PATH. It was originally posted on PATH’s website on May 21. For 40 years, PATH has been a pioneer in translating bold ideas into breakthrough health solutions, with a focus on child survival, maternal and reproductive health, and infectious diseases. PATH is a 2018 Global Health Council member.

Aisha Nanyombi was among the very first girls in Africa to receive an HPV vaccine. There is now increased urgency to expand screening and prevention programs to eliminate cervical cancer worldwide. Photo: PATH/Will Boase.

When we started working on cervical cancer prevention at PATH 25 years ago, most people were sceptical that much could be done. It was clear that Pap smears (a test to check for cellular abnormalities) were not feasible in low-resource settings where most cases of cervical cancer occur. Even 10 years ago—when new screening and pre-cancer treatment options were becoming available—no one was using the “e” word with cervical cancer. We simply weren’t convinced elimination was possible. But that’s all changing now.

Eliminating a disease means that the number of cases has fallen so low that the malady is no longer considered a public health problem. Elimination is different from eradication; in the latter case, the human papillomavirus or HPV—the bug that causes cervical cancer—would no longer exist in the population. We still don’t believe that HPV can be eradicated, but with the tools now at our disposal—HPV vaccination and screening and treatment of cervical precancer—PATH and our partners feel confident that we can dramatically reduce levels of disease to achieve new elimination targets.

A global tragedy

Cervical cancer kills an estimated 285,000 women each year, mainly in low-resource countries. It is an awful disease—very painful and drawn-out—with an offensive odour that drives women to remove themselves from their compounds and villages to avoid causing discomfort to their friends and families. If they do seek treatment, it is usually too late to benefit much and the expenses may drive the family further into poverty. They suffer, and eventually pass away, often secluded and stigmatized. Every two minutes a woman dies from the disease.

It doesn’t have to be that way. Over 270 million doses of HPV vaccine have been administered, mostly to young adolescent girls, and it works so well—even better, in fact, than we had anticipated—that they can expect to be nearly free of the threat of disease as adults. HPV vaccines have been proven to be safe and effective for use in adolescents. Unfortunately, only a small percentage of girls who need the vaccine, and boys who would also benefit from vaccination because of the other cancers caused by HPV, have been immunized so far.

The vaccine is less effective when given to women once they become sexually active, and are likely to have already been infected with HPV. For those women, screening, and pre-cancer treatment when necessary is crucial. The good news is that we have reliable tools for that as well, including exciting new options for women to collect their own sample for testing for HPV infection.

A new era with a new goal

This week, Dr. Tedros—the Director General of WHO—threw down the gauntlet asking all nations to join in bringing an end to cervical cancer during the World Health Assembly in Geneva. This is the latest in a series of moves the UN has made to mobilize against the scourge—the first being in 2016 when then Secretary-General Ban Ki-moon called for elimination. Last year, leaders of major health organizations and professional societies added their voices to the call for an end to cervical cancer. In 2018, the World Health Organization (WHO) began the process of officially defining what would constitute “elimination,” and PATH was invited along with other technical experts to contribute to the process. For example, in order to certify a country free of cervical cancer, it is necessary to set a threshold like “fewer than X cases per 100,000 population per year.” This already has been done for malaria, newborn tetanus, and other diseases.

Because we have the tools we need to end cervical cancer, it is clear that the barriers to elimination are primarily economic and political—a deficit of will to allocate the funds needed to achieve this important goal. So advocacy aimed at urging Health Ministers, Parliaments and other decision-makers to focus on the issue at the national level is the next big hurdle. Countries also need technical assistance in designing appropriate and affordable national programs to ensure that all girls, and boys if possible, are vaccinated and that all women have access to screening programs.

Allowing the current situation to continue—with hundreds of thousands of preventable deaths occurring each year—violates universal ethical and social values. Furthermore, it does not make economic sense because losing women in the productive prime of their lives cripples families, communities and nations (see an analysis of the investment case). With this new focus on elimination, countries can join with PATH, the WHO and other global partners to advance the fight against cervical cancer, a victory that we think is achievable with concerted action in the next decade or two.

The Answer for Indigenous Mothers? Native Midwives

This guest post was originally posted on the Frontline Health Workers Coalition (FHWC) website and is written by Joy Marini of Johnson & Johnson Global Community Impact and Global Health Council Board Member. Johnson & Johnson invests in people on the front lines of care as they change the trajectory of health for the world’s most vulnerable people, their families, and their communities.The Frontline Health Workers Coalition is an alliance of United States-based organizations working together to urge greater and more strategic U.S. investment in frontline health workers in low- and middle-income countries as a cost-effective way to save lives and foster a healthier, safer, and more prosperous world. FHWC and Johnson & Johnson is a 2018 Global Health Council member.

Midwife Vàng Tả Mẩy shown here with Chảo Tả Mẩy, mother in Nậm Giang 2 community in Vietnam’s Lao Cai province. Photo courtesy of UNICEF Vietnam

I could hear the jingling bells on the midwife’s hand-made, traditional dress as I approached the top of the mountain in Nậm Giang 2 community in the mountains of Lao Cai, Vietnam. Gasping for breath from the hike, I was greeted by the smiling midwife, Vàng Tả Mẩy, who was visiting the home of a young mother in this community. Mẩy and this young mother are one of 1.7 million Tày people, agriculturalists and the second largest ethnic minority in Vietnam. Tày homes are far apart with most not accessible by car, or even motorcycle. Tày indigenous midwives, many educated in a partnership between Johnson & Johnson and UNICEF, travel by foot up the mountains to visit soon-to-be moms, many of them girls between the ages of 15-20.

Kangaroo care from a Hmong mother in Vietnam. Photo courtesy of UNICEF Vietnam.

Mẩy shares information to ensure that pregnancies are healthy and that births take place in a health facility as much as possible. At the same time, the nearest hospital, which is still a long walk, plus a 2-hour drive on winding mountain roads, aims to provide high quality and culturally sensitive care with an emphasis on midwifery education and low-tech interventions. Dr. Nguyen Huy Du, a maternal-child health specialist at UNICEF, said, “The support from Johnson & Johnson has contributed to initial introduction and national wide scale-up of effective maternal and child health interventions in Vietnam, for instance early essential newborn care and Kangaroo Mother Care.”

Vietnam, like many low- or middle-income countries, showed improvement in maternal and newborn mortality during the era of the Millennium Development Goals, but a gap remains between disadvantaged groups and more privileged groups. Poverty, education, language and geography are among the many barriers to health care. Ethnicity may have a direct effect on health inequity, above income and education – indigenous people comprise 5% of the world population, but they make up 15% of the extreme poor.

In the Sustainable Development Goals, indigenous people are referenced only 6 times, and not at all in SDG 3 — “to ensure healthy lives and promote well-being for all at all ages.”

Globally, inequity in health services is often most discernable for indigenous people during pregnancy and birth. Higher rates of home births lead to high maternal and neonatal mortality rates. Current solutions range from forcing Native women to travel to birth centers, to medicalization of birth, but these approaches do not address cultural issues, such as a view in some groups that birth is a ceremony with important rituals or celebration, rather than a medical process.

To achieve the SDGs for mothers and newborns, we must:

1) Ensure that communities have a skilled, indigenous midwife, who understands local culture
2) Deliver health services in native languages
3) Include indigenous people in decision-making and planning for health services
4) Learn from indigenous groups, who experience birth as part of their connection to community, history, and the land
5) Disaggregate data to make indigenous women visible, and understand their unique experiences during pregnancy and childbirth
6) Support solutions developed by indigenous communities from government, civil society and private sector

Programs such as the Bolivian government’s midwifery training program for indigenous midwives are already showing promise in saving the lives of mothers and babies. And there is a growing recognition that mainstream hospital practices are not always respectful of Native women, resulting in a resurgence of indigenous midwifery in Canada and the United States.

With a promise to “leave no one behind”, the SDGs present an opportunity for us to recognize and learn from indigenous populations, who bring cultural traditions and a hope for a rich, diverse future. A welcoming community of women who receive local, respectful care could be one answer to the healthcare gap for indigenous people.

As the bells on her dress whispered in the Lao Cai mountain breeze, Tày midwife Ms. Mẩy proudly said, “This community knows me and trusts me. I have lived here all of my life.”

May 5 marks International Day of the Midwife. Follow @JNJGlobalHealth on Twitter and Instagram for more on the role midwives and midwifery leaders play in a healthy, safe and equitable world.

What Women Want: The World Wants to Know

This blog post was written by Stephanie Bowen, Director, Strategic Communication, White Ribbon Alliance, as part of Global Health Council’s Member Spotlight series. White Ribbon Alliance is activating a people-led movement for reproductive, maternal health and rights so that all girls and women realize their right to quality health and well-being. Launching on April 11thInternational Day of Maternal Health and Rights – the What Women Want campaign has a bold goal of reaching 1 million girls and women worldwide. White Ribbon Alliance is a 2018 Global Health Council member.

In just five days, global and national partners will officially launch the What Women Want campaign. Coinciding with International Day of Maternal Health and Rights, we are coming together under one unified, neutrally-branded campaign to put women’s and girls’ voices front and center in identifying their priorities for quality reproductive, maternal health and rights.

Based on a similar campaign by White Ribbon Alliance India, What Women Want will bring together individuals and organizations worldwide to ask this basic yet often ignored question: What is your one request for quality reproductive and maternal healthcare services? The answers heard in India were simple: My own bed. Enough supplies for mine and my baby’s medical needs. A clean facility. To be treated with respect. Simple, yet profound in that every woman should be able to expect these fundamental services, no matter where she lives, what religion she practices or her income level.

Despite significant progress, the current state of reproductive, maternal and sexual health for women and girls is far from optimal: Approximately 300,000 women die during pregnancy and childbirth every year. Millions still lack access to quality reproductive and sexual healthcare. And for girls age 15 to 19 years old, complications during pregnancy and childbirth are the leading cause of death.

Transforming this picture begins with women and girls.

The findings will be aggregated for a global picture of what women and girls want and disaggregated by country to help governments focus their human and financial resources in a way that will enhance health services, improve health outcomes and strengthen health systems.

More than 150,000 women across India were surveyed by WRA India about their top priority for quality reproductive, maternal healthcare. The results were profound. Photo courtesy: WRA India

A two-year campaign that will collect and analyze responses throughout 2018 and distill and disseminate findings throughout 2019, What Women Want is meant to be owned by the women and girls who respond and all the organizations who participate. Coordinated by the White Ribbon Alliance (WRA) Global Secretariat based in Washington, D.C., What Women Want is guided by a steering committee comprised of White Ribbon Alliance India, White Ribbon Alliance Global Secretariat, the Partnership for Maternal, Newborn and Child Health (PMNCH), Every Mother Counts (EMC), International Confederation of Midwives (ICM) and E4A-MamaYe—with many more participating partners. The steering committee is also consulting with representatives of Every Woman, Every Child (EWEC), the World Health Organization’s Quality of Care Network (WHO QoC Network), and the global Quality, Equity and Dignity Advocacy Working Group (QED AWG) to align efforts and ensure the voices of women and girls are incorporated into current quality-related initiatives.

We’ve built a website, translated surveys into French, Hindi, Spanish and Swahili, and put together shareable graphics to help get the word out. But if it’s going to be successful, we need to hear from as many women and girls as possible, particularly those in low and middle-income countries whose voice often goes unheard.

That’s where you come in!

Help launch the campaign by joining the What Women Want Twitter chat on Wednesday, April 11, 2018, from 10 AM ET to 11 AM ET and share why you are joining this movement for quality healthcare. Then take – and share –  the survey!

Together, we can ensure that all women and girls receive quality healthcare as they understand it.

 

Pressing for Progress: An Interview With Dr. Roopa Dhatt on Women in Global Health

This post originally appeared on Global Health Corps blog AMPLIFY and was written by Lanice Williams, a 2016–2017 Global Health Corps fellow at Global Health Council. Follow Lanice on Twitter and join the International Women’s Day conversation using the hashtags #IWD2018 and #PressForProgress.

Women marching for gender equality. (Source: UN Women National Committee Aotearoa New Zealand)

On Thursday, March 8, the world celebrates International Women’s Day (IWD). Today, women and girls around the globe will join together to reflect on women’s accomplishments and celebrate the acts of courage shown by women who are playing a role in shaping their communities and advocating for efforts around gender equality. This year’s theme of “Press for Progress” is focused on the need to keep momentum going to ensure that we achieve gender parity. This theme is also right in line with the recent news and media attention surrounding women who have been speaking out about sexual harassment and assault. Many women are standing in solidarity and saying “no more,” as demonstrated by the #MeToo campaign that was originally started by an activist named Tarana Burke. Burke created this campaign to reach sexual assault survivors in underserved communities and encourage women globally to speak up about their experiences.

Roopa Dhatt, MD,
Co-Founder & Executive Director of Women in Global Health
(Source: Women in Global Health)

To mark the occasion of IWD and continue the #MeToo discussion, I sat down with Dr. Roopa Dhatt, the Co-Founder and Executive Director of Women in Global Health. We discussed her reflections on International Women’s Day, efforts to integrate violence against women initiatives into global health, and why closing the gender gap in global health leadership matters so much.

Lanice: You are the Co-founder and Executive Director of Women in Global Health, which was established in 2015. What was your motivation for starting the organization?

Roopa: Through my personal and student leadership journey, I discovered gender bias — unconscious and conscious — and realized how women leaders are judged by different standards. I felt passionate that the next generation of global health leadership must be different — more diverse, inclusive and representative of the world. I was also inspired and encouraged by other women leaders in global health, both peer leaders and pioneers in the field, to work together to ensure that women’s contributions no longer go unrecognized and that women are perceived as thought leaders and decision makers in improving the health and well-being of their communities and the world.

As an Indian-American from Punjab state, I have seen how women in my culture have weak power and influence, limited access to higher education and work, and are not allowed to choose their own partners. Due to the lack of visibility and recognition of women leadership in global health, a group of like-minded young women and I co-founded Women in Global Health, a movement striving to bring greater gender equity to global health. Our movement was conceived by a group of four young women in Spring 2015, each of whom found her own unique pathway to global health, but was asking the same question: what more can we do to elevate female leadership and bring it center stage in global health for greater gender equity?

Lanice: This year the theme for International Women’s Day is #PressforProgress. What does that mean to you, and what progress have you seen so far in achieving gender equity in global health leadership?

Roopa: “Press for Progress” is about uniting and advancing the global movement for gender equality, women’s rights, and empowerment in our own spheres of influence. We cannot stand by waiting for change; we each have a responsibility to advance the dialogue, shift mind-sets, change institutional policies and transform societies for greater gender equality. In global health, we have seen significant leadership on gender equality. At the top of the list is WHO Director General, Dr. Tedros, who not only made gender equality a top priority in his leadership, but also acted on those commitments, both by achieving gender parity in his senior leadership cabinet (two-thirds majority posts held by highly qualified, geographically diverse and talented women) and integrating this into the WHO’s 13th Global Program of Work over the next five years. Yet, even at the WHO, the work is only starting. Transforming organizational culture at the global, regional and national levels requires much more commitment and action from all of the WHO and member states that govern it.

We also have seen the academic community coming together to raise the visibility of women’s leadership in global health. 2017 marked the inaugural Women Leaders in Global Health Conference, hosted by Stanford Global Health, where Women in Global Health served as an implementing partner. That brought together 500 women and men from nearly 70 countries, and 250 organizations on this theme. Moreover, we are also seeing greater leadership from the private sector on women’s leadership; an example is GE Healthcare and Women in Global Health’s Heroines of Health, an honorary recognition of women who are at the frontline, taking on the toughest global health challenges in their communities. We also must recognize the thought leadership that Ilona Kickbusch provided to global health by launching the #WGH100 lists, which recognize women leaders and experts in global health.

Lanice: Over the course of last year and so far in 2018, we have seen many women speak up about experiencing sexual violence and sexual harassment. How important is it that the global health community addresses this violence against women, which affects about 35% of women globally?

Roopa: The challenges facing the global health community are centered on gender dimensions. Since 71% of the health and social care workforce globally are women, and unpaid care represents half of women’s contribution to global wealth, resilient health systems and Universal Health Coverage cannot be achieved without consideration of the gendered aspects of the health workforce. When we look closely at the health sector from a gendered lens, women are often under-resourced, underpaid or unpaid, under-trained, and not formally recognized. Moreover, they face greater harassment — sexual and physical- than men, including gender-based violence (GBV).

At the 4th Global Human Resources for Health Forum in Dublin, we hosted a storytelling evening, Lives in their hands, where we heard about the personal safety concerns of female health workers– whether it was Miatta Gbanya from Liberia, who delivered a baby by the roadside at night, or Rushaana Gallow, who faces sexual assault and death every day as she enters the “red zone” in the Cape Flats in South Africa as a first responder. These gender dimensions and personal safety concerns are the reason the WHO and Women in Global Health launched the Gender Equity Hub in the Global Health Workforce Network. We seek policy-oriented solutions to address gender inequities in the health and social care workforce — with a key priority to promote employment free from harassment, discrimination and violence.

Finally, equal numbers of women and men in leadership in global health and other sectors will reduce sexual harassment at work; this is because sexual harassment and violence is almost always committed by men and is a misuse of male power. A critical mass of women in the workplace makes it possible to change organizational culture and outlaw such abusive behavior. A critical mass of women in the workplace also makes it more likely that women will report abuses and be believed. The UN has recognized, for example, that more female peacekeepers and female police will reduce sexual violence against vulnerable populations in emergencies and conflicts. Sexual abuse and violence exist in the shadows as we have seen from #MeToo reports from many sectors. It is an issue for men just as much as women. To solve it, men must also take responsibility for stamping out abuse and making male colleagues accountable, not least because sexual harassment and violence in global health has serious costs for everyone.

Lanice: The 8th UN Secretary General, Ban Kai-Moon, stated, “There is one universal truth, applicable to all countries, cultures and communities: violence against women is never acceptable, never excusable, and never tolerable.” What are your reflections on that, and on what does that means for prioritizing action?

Roopa: I 100% agree! Action is needed; prioritizing action is not a choice, but a must. For us to reach our maximum potential as a society, women and girls must be able to live full lives without fear and violence. Without that, everything we are doing is failing at least half the population and negatively impacting all genders.

Lanice: Your mission statement notes that you work on “building a global movement that brings together all genders and backgrounds to achieve gender equality in global health leadership.” Can you tell me more about the WGH mission and the role you see women leaders playing to ensure that more violence prevention initiatives are incorporated into global health programs?

Roopa: Our vision is to achieve gender equality in global health leadership, as we know that gender equality leads to smarter global health. Our mission is based on the role of leadership–women, men and all genders practicing gender transformative leadership. Our approach is based on our foundation of being a movement and engaging all people, stakeholders, and sectors, at global, regional, and local levels, to achieve our vision. Everyone has a sphere of influence that can shape individual, interpersonal, institutional, societal, community and policy environments. We recognize this and tap into this potential using a holistic approach for greater gender equality in global health leadership.

Women as leaders have the opportunity to be gender transformative and create programs and policies that are enabling for all genders. We know that gender-based violence (GBV) impacts every aspect of society from an early age to ageing populations. Regardless of which silo of global health one’s work is in, gender is crosscutting and so is GBV. Therefore, there is an opportunity to address GBV. In one’s individual leadership role there are a few simple practices that can be integrated:

  • Build Momentum: Raise the profile of GBV in your sphere of influence — bring attention to the issue through stories, data and other evidence.
  • Create Enabling Environments: Look into your organization’s gender impact assessment tools and see whether there is a GBV component.
  • Sustain Change: Integrate it into your policy and program priorities and link your efforts to larger global initiatives.

Lanice — In what ways can the global health community work together to ensure that more violence against women prevention programs are integrated into global health programs?

Roopa — In Women in Global Health, we propose applying a gender lens and using a gender transformative approach in one’s leadership. The global health community, closely linked to the development community, is recognizing more and more how interlinked health and wellbeing are to broader determinants of health, especially gender. Women and men are impacted differently, particularly in changing socio-political environments, as a result of gender social norms, roles, and other axes of identity and inequality (i.e. age, poverty, literacy, geography, disability, and sexuality). Gender inequalities contribute to violence against women, with key factors of violence being linked to institutional and behavioral factors. Moreover, in the context of violence against women, the dialogue needs to be broader and discussed as gender-based violence (GBV).

All genders have a role to play in deconstructing the power structures that promote inequities based on gender. Men, similarly to women, have a responsibility to learn about the socially constructed gender norms and roles, and the inequalities these norms create in limiting health and well being for all people. By being aware, people can begin to address their own biases and the barriers around them, and design context-specific solutions at multiple levels to shift the drivers that are promoting GBV.