* Any views expressed in this opinion piece are those of the author and not of Thomson Reuters Foundation.
Women have been telling us what they want from their health services – now the world must start listening
Helen Clark is board chair of the Partnership for Maternal, Newborn and Child Health (PMNCH) and the former Prime Minister of New Zealand; Margaret Kobia is Cabinet Secretary of the Ministry of Public Service and Gender in Kenya; Preeti Sudan is Secretary of the Ministry of Health and Family Welfare in India; and Nadine Flora Gasman Zylbermann, is President of the Mexican government's National Women's Institute.
In just six months the COVID-19 pandemic has travelled the world, profoundly testing the resilience of even the most advanced health systems, and causing massive shocks to national economies. It has also deepened systematic and structural racial, ethnic and gender inequities everywhere.
As the pandemic hit and countries grappled with how best to address the mortality and morbidity directly caused by the virus, many other primary health care services were severely disrupted, among them crucial sexual, reproductive, maternal, newborn, child and adolescent health, as well as mental health care.
While women of reproductive age, children, and adolescents are less likely to die from COVID-19, the virus and the measures taken to control it can compound and exacerbate many inequities they face in their daily lives.
Scarce financial resources and interrupted supply chains, combined with social restrictions limiting movement and closing clinics, are impeding access to services and putting hard-won gains in women's, children's and adolescents' health at risk. Estimates suggest that some countries could see as much as a thirty per cent increase in maternal mortality, while globally over a six- month period, as many as 47 million women and adolescent girls could lose access to contraception, leading to seven million unintended pregnancies.
As the world moves into the next phase of the pandemic--and reflects on the hard lessons learned-- the priority must be to ensure that the health and rights of women, children, and adolescents are not neglected, as they so often have been in the wake of other major disease outbreaks.
One of the most important lessons to be learned as health systems build back better is to take account of the voices of women and girls which have often gone unheard. Women and girls must be at the centre of the response and the recovery decision-making processes.
It is a simple, yet profound idea to ask those who use health services what they most need, and then ensure that their responses help shape policy development, investment, and accountability.
We acknowledge the outcomes of the campaign What Women Want: Demands for Quality Healthcare from Women and Girls which has been asking women and girls what their priorities for maternal and reproductive health services are. In 2018-2019, more than 350 partners sought the views of women and girls in 114 countries about their priorities in those areas. More than 1.2 million gave their opinions, making this the largest ever survey of its kind.
Their answers were often unexpected, challenging assumptions and shining new light on the realities of their daily lives. Their top demands: respectful and dignified care; water, sanitation, and hygiene; medicines and supplies, such as blood; more and better supported midwives; and health facilities within reach.
In these times of COVID-19, women and girls are experiencing disruptions in accessing basic services and supplies, as already limited resources for sexual, reproductive, maternal, child, newborn, and adolescent health are diverted towards the pandemic response.
Midwives who primarily take care of women and girls within communities are being left with little choice but to stay home or risk their health and safety. They are among the least prioritized for receiving personal protection equipment, and often work in places without access to running water for hygiene or other preventative measures.
With curfews and restrictions on movement in place, some pregnant women and girls can face obstruction and harassment, sometimes even from social gatekeepers and enforcement agencies, when trying to make their way to distant health centres to deliver safely. If they arrive, they then often risk experiencing the rollback of fundamental rights to respectful maternity care, including through coerced c-sections, denial of birth companions and unjustified separation from their new born babies.
All of these concerns - and others – are reflected in the policy demands of a COVID-19 Call to Action produced by the Partnership for Maternal, Newborn and Child Health (PMNCH), an alliance of over 1,100 organisations from 192 countries worldwide.
This week, the Partnership, together with CORE Group, will convene Lives in the Balance: a COVID-19 Summit on Women’s, Children’s and Adolescents’ Health and Wellbeing. This will bring global leaders together in a two-day interactive online forum on ways to protect and advance women’s, children’s and adolescents’ health during the COVID-19 response and recovery phases, and to keep their needs to the forefront as health systems and the social fabric of societies are rebuilt after the pandemic.
As women leaders, we commend the women and girls who have bravely voiced their needs. We acknowledge the importance of instituting transparent, functional mechanisms where women’s and girls’ self-articulated needs are heard and where they are involved equally in policy designing processes, including in the response to COVID-19 and well beyond.
By listening to women and letting their voices lead the way, we will strengthen health systems and get back on track with reaching critical global health targets. These include reducing maternal mortality and ending preventable deaths of newborns and children under five. We also need to ensure we meet our commitments under the International Conference on Population and Development’s programme of action, accelerating our progress towards universal health coverage.
Women and young people have been telling us for years what they need. Now we must listen.