Dr. Allotey, you could have devoted your profession to gender, fairness, well being, and human rights. What impressed you to pursue this path, significantly within the space of sexual and reproductive well being?
I’m deeply privileged to have had a profession spanning direct engagement with communities, scientific apply, analysis, coverage, and authorities, and for the previous eight years, work inside the multilateral system.
I come from a tradition the place, regardless of growing alternatives, gender inequality stays pervasive. Sexual and gender-based violence nonetheless don’t obtain pressing consideration, and sexual and reproductive well being and rights, together with maternal morbidity and mortality, lag behind expectations, given the extent of worldwide financial improvement. As a midwife, I used to be profoundly moved by the ladies I cared for, nevertheless it was heartbreaking to know that so many deaths and poor outcomes had been preventable with a powerful, resilient well being system and a complete strategy to sexual and reproductive well being and rights throughout the life course.
With the chance for postgraduate coaching, I undertook a PhD in medical anthropology and epidemiology, specializing in tropical ailments in being pregnant. My analysis took me to a distant group in Ghana, the place feminine genital mutilation was nonetheless the norm, polygamy additional entrenched the undervaluing of ladies, and fragile well being techniques disadvantaged folks of high quality care.
Poverty, uncared for tropical ailments, and systemic inequities created the right storm for top maternal mortality. Since then, I’ve sought out alternatives to handle these challenges holistically, recognizing that gender equality, well being, and human rights are deeply intertwined with politics, energy, and financial justice.
Reaching gender equality and girls’s empowerment, common well being protection, and shared prosperity requires an built-in, intersectional strategy, one which acknowledges inequities, calls for justice, and is knowledgeable by various types of proof. That is the work that continues to drive me.
The theme of this yr’s World Well being Day highlights the significance of maternal and new child well being. What do you see as probably the most urgent challenges in making certain wholesome pregnancies and births globally?
A whole lot of 1000’s of ladies lose their lives as a result of issues of being pregnant or childbirth every year. That’s roughly 1 preventable dying each two minutes. For those who add within the variety of infants who’re stillborn or die within the first month of their life, that’s one preventable dying each 7 seconds.
Final yr on the World Well being Meeting, Member States adopted a decision calling for pressing motion to speed up progress in the direction of decreasing maternal, new child, and little one mortality and morbidity, growing entry to inexpensive, high quality healthcare providers, together with secure important high quality medicines and cost-effective evidence-based interventions, and reorient well being techniques in the direction of main well being. Importantly, the decision acknowledges that entry to sexual and reproductive well being is key to this.
This yr’s World Well being Day marketing campaign is designed to drive much-needed motion on this crucial space. Beneath the theme “Wholesome Beginnings, Hopeful Futures,” the marketing campaign goals to help governments and the worldwide well being group to prioritize efforts to finish preventable maternal and new child deaths, strengthen well being techniques, and enhance the long-term well being and well-being of ladies and newborns.
Picture Credit score: maxim ibragimov/Shutterstock.com
Regardless of vital progress in maternal and new child well being, we nonetheless see alarming numbers of preventable deaths. What key interventions or coverage modifications do you imagine might have probably the most fast impression?
Insurance policies that prioritize the well being of women and girls, particularly probably the most marginalized in societies, will forestall maternal and new child deaths. Folks die when science and proof are forsaken for ideologies. A current WHO evaluation, led by my division, was revealed within the Lancet World Well being and reveals that extreme bleeding (haemorrhage) and hypertensive problems like preeclampsia are the main causes of maternal deaths. These deaths are preventable, however tragically, too many ladies lack entry to lifesaving therapies and high quality care throughout being pregnant and childbirth. Pressing motion is required to make sure each lady can entry secure, high-quality maternity providers that save lives and shield well being.
It’s virtually a cliché, however there isn’t any lack of options to make a distinction.
The progress thus far is the results of evidence-based insurance policies which have pushed funding, motion, and innovation. This consists of options just like the current EMOTIVE research that confirmed a 60% discount in extreme bleeding when a drape was used to detect blood loss, then making use of a bundled strategy to postpartum hemorrhage remedy slightly than induvial sequential interventions.
WHO analysis additionally reveals that skilled midwives have the aptitude to avert 1000’s of deaths and antagonistic outcomes for each moms and infants, particularly if they’re able to ship complete SRHR, together with contraceptive providers. As well as, cellular clinics are a significant intervention, significantly in battle zones, the place obstacles to care are excessive and preventable deaths persist. Making certain entry to complete sexual and reproductive well being providers in emergencies is important.
Sexual and reproductive well being and rights are elementary to common well being protection. Making certain entry to a complete bundle of sexual and reproductive well being providers upholds the dignity, rights, and well-being of individuals all over the place.
We all know that when women and girls have management over their our bodies, there are fewer unintended pregnancies and fewer unsafe abortions, which all result in fewer maternal deaths, extra ladies in class, and extra girls collaborating within the workforce. And so, insurance policies that allow entry to sexual and reproductive well being and rights are indicative of a society’s curiosity in delivering well being for all.
Your work has emphasised the necessity to redress inequity and energy imbalances in world well being and guarantee various voices contribute to decision-making. How does this apply to maternal and new child well being, and why is it important for enhancing outcomes?
World well being continues to be formed by establishments, donors, and actors based mostly largely within the World North. These entities usually set priorities, allocate funding, and outline success, generally with out significant enter from these most affected. This undermines nationwide possession and limits the relevance of insurance policies to native realities. As an example, sub-Saharan Africa accounts for almost 70% of worldwide maternal deaths. Whereas weak well being techniques are sometimes blamed, that is solely a part of the story. Gender inequality, systemic racism, poverty, and discriminatory insurance policies all intersect to deepen well being disparities. These root causes are sometimes ignored in world well being approaches that focus narrowly on service supply
Native voices want to assist form analysis priorities and coverage choices to make sure that options align with the realities of affected populations. Group-driven options cut back obstacles to care, significantly for marginalized populations.
Stark inequalities additionally happen inside nations; between city and rural areas, between earnings teams, and based mostly on age, incapacity, ethnicity, and gender. World well being efforts usually fail to handle these intra-country energy dynamics.
By acknowledging, addressing, and discussing these challenges, nations can enhance outcomes for all residents. Except all girls have entry to common well being protection (together with entry to sexual and reproductive well being commodities and providers) and an adequately staffed well being system, we can’t really hope to handle the previous and present imbalances.
Well being techniques should deal with not simply obstetric issues but in addition points like psychological well being and noncommunicable ailments. How can we guarantee extra holistic, women-centered care earlier than, throughout, and after being pregnant?
This is a matter that I’m significantly obsessed with. The worldwide concentrate on girls’s well being has disproportionately centered on maternal well being. This slim, reductionist strategy successfully confines girls’s well being to the comparatively temporary window of being pregnant and the postpartum interval, overlooking the complete spectrum of well being dangers, wants, and rights that girls navigate all through their lives.
Girls’s well being can’t be solely outlined by motherhood. Recognizing girls as sexual beings with distinct sexual wishes, orientations, identities, and reproductive capacities calls for that well being techniques transfer past a maternal-centric mannequin and prioritize complete, life-course approaches to girls’s well being.
Biology is foundational, nevertheless it doesn’t exist in isolation. The identical organic determinants that allow motherhood additionally form girls’s publicity, vulnerability, and response to a variety of ailments, that are additional influenced by social norms, cultural, financial, and structural well being system components. A holistic, women-centered strategy should acknowledge these intersections and be certain that healthcare techniques proactively deal with the complete continuum of ladies’s well being wants earlier than, throughout, and past being pregnant.
Whereas direct obstetric issues corresponding to hemorrhage and preeclampsia stay the main causes of maternal mortality, non-obstetric and pre-existing situations contribute to almost 1 / 4 of maternal deaths worldwide. These embrace anaemia, noncommunicable ailments (NCDs), psychological well being situations, and infectious ailments corresponding to malaria and HIV, all of which improve well being dangers for hundreds of thousands of ladies globally.
Gestational diabetes, the commonest medical dysfunction in being pregnant, together with cardiac situations, bronchial asthma, epilepsy, hemoglobinopathies, and substance use problems, considerably impression maternal and fetal well being outcomes. But, these situations are sometimes underdiagnosed, undertreated, and overshadowed in maternal well being discussions.
To make sure holistic, women-centered care, well being techniques should:
- Transfer past a singular concentrate on being pregnant to handle girls’s well being throughout the life course, together with adolescence, reproductive years, and post-menopause.
- Combine sexual and reproductive well being providers inside broader well being frameworks, recognizing that girls’s well being wants lengthen far past being pregnant.
- Strengthen prevention, screening, and administration of NCDs, psychological well being situations, and infectious ailments that disproportionately have an effect on girls.
- Spend money on gender-responsive well being techniques that acknowledge the structural obstacles girls face in accessing complete healthcare.
We should look past a lady’s reproductive capability and see her holistically. Our current publication “Extending Sexual and Reproductive Well being and Rights to Future Generations By means of Science and Proof” addresses how we hope to do that.
Virtually, this yr, we plan to launch tips on the administration of non-communicable ailments in being pregnant, together with sickle cell anaemia and gestational diabetes. We even have a physique of labor round respectful care earlier than, throughout, and after being pregnant and childbirth, in addition to suggestions on maternal and new child take care of a optimistic postnatal expertise (you’ll be able to learn extra right here).
We additionally revealed a collection in The Lancet World Well being on maternal well being within the perinatal interval and past, which contributed to methods to strategy maternal well being holistically and articulated the long-term impression of being pregnant on girls and the necessity for follow-up care that extends nicely past the 6-week postpartum interval.
This yr’s World Well being Day marketing campaign requires elevated investments in maternal and new child well being. The place do you see the most important gaps in funding, and what are probably the most strategic areas for funding?
Latest extreme and drastic funding cuts have instantly impacted the well being and wellbeing of ladies and infants, together with maternal well being providers, fast losses in well being care personnel, HIV remedy and care, entry to medicines, and household planning providers. The long-term results of those cuts are being monitored, however classes from the previous couple of many years give a transparent indication of the devastating impression this may have on progress thus far.
Proof reveals that spending on maternal and new child well being isn’t a price, it is an funding in human capital, resulting in financial improvement and happier, more healthy societies. UNFPA estimates that by assembly the unmet want for household planning and ending preventable maternal deaths in growing nations will unlock US$660 billion in financial advantages by 2050.
WHO is asking for investments in high-quality antenatal providers to help wholesome pregnancies by decreasing dangers and detecting potential issues; entry to high quality care from expert suppliers throughout and after childbirth; midwifery care fashions; entry to household planning; and extra analysis into what’s going to work in low-income contexts.
Past survival, we must always spend money on compassionate and respectful care, postnatal help, family-friendly insurance policies, and the empowerment of women and girls.
You may have an in depth background in implementation analysis and group engagement. Are you able to share an instance of a analysis initiative that has efficiently improved maternal or new child well being outcomes?
Because the Director of WHO’s Division of Sexual and Reproductive Well being together with the UNDP-UNFPA-UNICEF-WHO-World Financial institution Particular Programme of Analysis Improvement and Analysis Coaching in Human Replica (referred to as HRP), I’ve the chance to work with a exceptional workforce that’s devoted to producing precious insights, offering evidence-based steering, and partnering with dedicated professionals throughout numerous nations and organizations to boost sexual and reproductive well being and rights.
We’ve got lengthy realized that by tackling stopping deaths as a result of postpartum hemorrhage (PPH) – outlined as extreme bleeding after childbirth – we will save hundreds of thousands of lives.
In October 2023, WHO and HRP launched a first-of-its-kind roadmap that units out a transparent path to fight PPH. This Roadmap has introduced all main gamers collectively beneath one plan to assist nations deal with the stark variations in survival outcomes from PPH, which mirror main inequities in entry to important well being providers.
Over 85% of deaths from PPH occur in sub-Saharan Africa and South Asia. Many threat components for this situation will be managed if there may be high quality antenatal care, together with entry to ultrasound, alongside efficient monitoring within the hours after delivery. Too usually, nevertheless, well being amenities lack obligatory healthcare staff or sources, together with lifesaving commodities corresponding to oxytocin (which may help cease hemorrhage), tranexamic acid, or blood transfusions.
Main progress has occurred with the success of the EMOTIVE trial. The examine discovered that objectively measuring blood loss utilizing a easy, low-cost assortment system known as a ‘drape’ and bundling collectively WHO-recommended therapies, slightly than providing them sequentially, resulted in dramatic enhancements in outcomes for girls. Extreme bleeding, when a lady loses greater than a liter of blood after delivery, was decreased by 60%, and so they had been much less more likely to lose their life. Extra lately, this strategy was discovered to be cost-effective, which is improbable information for resource-poor settings.
We’d like a multipronged strategy specializing in each prevention and response, stopping threat components and offering fast entry to therapies when wanted, alongside broader efforts to strengthen girls’s rights. Each lady, irrespective of the place she lives, ought to have entry to well timed, high-quality maternity care, with skilled well being staff, important gear, and cabinets stocked with applicable and efficient commodities – that is essential for treating postpartum bleeding and decreasing maternal deaths.
Precedence actions embrace growing new and broader steering for PPH overlaying prevention, detection, and remedy; conducting analysis to ship improvements and improve entry to confirmed interventions; establishing a brand new procurement mechanism to enhance the provision of high-quality medicines and commodities; advocating and awareness-building; and, on the nation degree, coaching, and facility-based enhancements.
Listening to girls and supporting households is a key message of this marketing campaign. How can well being techniques higher combine girls’s voices and lived experiences into maternal healthcare insurance policies and providers?
Decreasing maternal deaths would require strengthening antenatal care to detect and forestall issues, emergency obstetrics, and expert care throughout childbirth, in addition to postnatal providers. Well being techniques have to evolve to handle the various well being points that impression maternal well being, and we should centralize sexual and reproductive well being and rights as crucial to serving to cut back maternal deaths.
We should additionally deal with problems with fairness and guarantee entry to healthcare amenities earlier than, throughout, and after delivery. Nonetheless, we can’t do that with out consulting girls themselves, their communities, and native well being staff to know the wants of ladies higher. Native legal guidelines and insurance policies should contemplate the various and ranging wants of these they serve.
WHO advocates for well being planning through which girls’s values and preferences are on the centre of their care. Significant engagement and empowerment of ladies, households, communities, and suppliers are important for high quality enchancment initiatives.
HRP has an extended historical past of bringing collectively a gender and rights advisory panel to advise on integrating gender equality and human rights in all facets of HRP’s work. This panel was created within the Nineties, at a time when the desires and wishes of ladies weren’t on the forefront of anybody’s minds, together with researchers and the general public well being group. I’m glad to say now we have come a good distance since then, however we nonetheless have an extended strategy to go.
With social media enjoying a major function in public well being consciousness, how can platforms be leveraged to share correct, evidence-based details about being pregnant, childbirth, and postpartum care?
When trying to find data on-line, folks ought to really feel assured that respected web sites are truthful and correct. At WHO, technical consultants with deep understandings of the topic areas guarantee the data on our digital platforms is evidence-based and up-to-date.
We’re nicely conscious of the unfold of misinformation and disinformation, particularly relating to girls and their well being, together with being pregnant, childbirth, and the postpartum interval. Mistrust, politicization of points, and alternatives for income can create an environment that may be rife with confusion. We need to make certain that we’re assembly folks the place they’re, offering the data they’re on the lookout for, and supporting wholesome, knowledgeable decision-making.
Even nonetheless, it’s usually tough for folks to know what’s true or false. WHO will launch evidence-based digital content material repositories, beginning with contraception, to make sure validated well being data is extra simply out there to influencers, implementers, and builders of digital platforms who’re more and more on the forefront of how people get hold of well being data and combine it into various digital consumer journeys.
Digital applied sciences – together with synthetic intelligence – convey each alternative and hazard. The sector of sexual and reproductive well being and rights usually grapples with underlying problems with entry and fairness, which will be tremendously amplified and exacerbated by AI.
AI is already reworking know-how for sexual and reproductive well being. If we’re conscious of the potential risks, cautious about implementation, and acknowledge AI as a instrument and never an answer, now we have an awesome alternative to make sexual and reproductive providers and data extra accessible to all. We produced a technical temporary about this in 2024.
Lastly, as we launch this year-long marketing campaign, what message would you prefer to share with policymakers, healthcare professionals, and communities to make sure more healthy beginnings and extra hopeful futures for moms and infants worldwide?
This marketing campaign will hopefully elevate consciousness in regards to the gaps in maternal and new child survival and the necessity to prioritize girls’s well-being. Policymakers have to be persuaded to spend money on interventions that can produce probably the most enhancements for girls’s and infants’ well being—irrespective of the place they dwell. In our communities, we should actively help dad and mom and well being professionals who present crucial care.
At WHO, we are going to all the time attempt to present helpful well being data regarding being pregnant, childbirth, and the postnatal interval. We hope that on the finish of this marketing campaign, in 2026, we will report again and present actual progress in decreasing maternal and new child deaths.
Entry to sexual and reproductive well being providers is a human proper and needs to be out there to all folks all through their lives as a part of making certain common well being protection. This not solely contributes to improved maternal and total well being outcomes but in addition to gender equality and wider improvement.
The place can readers discover extra data?
About Dr. Allotey
Dr Pascale Allotey is a pacesetter in gender, fairness, well being and human rights. Her current work consists of difficult the boundaries of worldwide well being, advocating for accountability within the decolonization of worldwide well being and worldwide improvement, and increasing alternatives to diversify the voices of contributors to world debates and choice making – significantly in proof technology, coverage and programme implementation inside the UN system, with governments, NGOs and the educational group.
Dr Allotey is a triple-certified nurse, midwife and public well being nurse with a multidisciplinary background in scientific well being sciences, implementation analysis, anthropology, and epidemiology. She holds a PhD in Public Well being and a MMedSci in Group Well being from the College of Western Australia, and a BA in Nursing and Psychology from the College of Ghana, Legon.
Bringing over three many years of expertise as a worldwide public well being researcher, Dr Allotey has revealed extensively together with on: sexual and reproductive well being; dangerous conventional practices; gender, intercourse and illness; migrants and refugees; well being techniques analysis; implementation analysis, and group engagement.
Previous to becoming a member of WHO, Dr Allotey was Director of the United Nations College Worldwide Institute for World Well being (UNU-IIGH) in Kuala Lumpur Malaysia.
Initially from Ghana, her different earlier posts embrace: Professor of Public Well being and Deputy Head of Faculty (Analysis) on the Jeffrey Cheah Faculty of Medication and Well being Sciences, Monash College (Malaysia); founding Affiliate Director of the South East Asia Group Observatory (SEACO Malaysia); Professor of Race, Range and Skilled Observe, Brunel College (United Kingdom). Dr Allotey is a former Co-Chair of the HRP Gender and Rights Advisory Panel.