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, medical follow, analysis, coverage, and authorities, and for the previous eight years, work throughout 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 world financial improvement. As a midwife, I used to be profoundly moved by the ladies I cared for, however it was heartbreaking to know that so many deaths and poor outcomes had been preventable with a robust, 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 girls, and fragile well being programs disadvantaged folks of high quality care.
Poverty, uncared for tropical ailments, and systemic inequities created the proper storm for top maternal mortality. Since then, I’ve sought out alternatives to deal with these challenges holistically, recognizing that gender equality, well being, and human rights are deeply intertwined with politics, energy, and financial justice.
Attaining gender equality and ladies’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 numerous 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 essentially the most urgent challenges in guaranteeing wholesome pregnancies and births globally?
A whole lot of hundreds of girls lose their lives as a result of issues of being pregnant or childbirth every year. That’s roughly 1 preventable dying each two minutes. When you 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 direction of lowering maternal, new child, and baby mortality and morbidity, growing entry to inexpensive, high quality healthcare companies, together with secure important high quality medicines and cost-effective evidence-based interventions, and reorient well being programs in 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. Underneath 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 programs, and enhance the long-term well being and well-being of girls 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 essentially the most instant influence?
Insurance policies that prioritize the well being of women and girls, particularly essentially the most marginalized in societies, will forestall maternal and new child deaths. Individuals die when science and proof are forsaken for ideologies. A current WHO evaluation, led by my division, was printed within the Lancet World Well being and exhibits 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 remedies and high quality care throughout being pregnant and childbirth. Pressing motion is required to make sure each lady can entry secure, high-quality maternity companies that save lives and shield well being.
It’s nearly a cliché, however there isn’t a lack of options to make a distinction.
The progress up to now is the results of evidence-based insurance policies which have pushed funding, motion, and innovation. This contains 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 exhibits that skilled midwives have the aptitude to avert hundreds of deaths and antagonistic outcomes for each moms and infants, particularly if they’re able to ship complete SRHR, together with contraceptive companies. As well as, cell clinics are a significant intervention, significantly in battle zones, the place limitations to care are excessive and preventable deaths persist. Guaranteeing entry to complete sexual and reproductive well being companies in emergencies is important.
Sexual and reproductive well being and rights are elementary to common well being protection. Guaranteeing entry to a complete package deal of sexual and reproductive well being companies upholds the dignity, rights, and well-being of individuals in all places.
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 women at school, and extra ladies 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 numerous voices contribute to decision-making. How does this apply to maternal and new child well being, and why is it important for bettering outcomes?
World well being continues to be formed by establishments, donors, and actors based mostly largely within the World North. These entities typically set priorities, allocate funding, and outline success, typically 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 practically 70% of world maternal deaths. Whereas weak well being programs 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 selections to make sure that options align with the realities of affected populations. Neighborhood-driven options cut back limitations to care, significantly for marginalized populations.
Stark inequalities additionally happen inside international locations; between city and rural areas, between revenue teams, and based mostly on age, incapacity, ethnicity, and gender. World well being efforts typically fail to deal with these intra-country energy dynamics.
By acknowledging, addressing, and discussing these challenges, international locations can enhance outcomes for all residents. Except all ladies have entry to common well being protection (together with entry to sexual and reproductive well being commodities and companies) and an adequately staffed well being system, we can not really hope to deal with the previous and present imbalances.
Well being programs should tackle 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 captivated with. The worldwide concentrate on ladies’s well being has disproportionately centered on maternal well being. This slim, reductionist strategy successfully confines ladies’s well being to the comparatively temporary window of being pregnant and the postpartum interval, overlooking the total spectrum of well being dangers, wants, and rights that girls navigate all through their lives.
Ladies’s well being can’t be solely outlined by motherhood. Recognizing ladies as sexual beings with distinct sexual wishes, orientations, identities, and reproductive capacities calls for that well being programs transfer past a maternal-centric mannequin and prioritize complete, life-course approaches to ladies’s well being.
Biology is foundational, however it doesn’t exist in isolation. The identical organic determinants that allow motherhood additionally form ladies’s publicity, vulnerability, and response to a variety of ailments, that are additional influenced by social norms, cultural, financial, and structural well being system elements. A holistic, women-centered strategy should acknowledge these intersections and make sure that healthcare programs proactively tackle the total continuum of girls’s well being wants earlier than, throughout, and past being pregnant.
Whereas direct obstetric issues akin to hemorrhage and preeclampsia stay the main causes of maternal mortality, non-obstetric and pre-existing circumstances contribute to almost 1 / 4 of maternal deaths worldwide. These embody anaemia, noncommunicable ailments (NCDs), psychological well being circumstances, and infectious ailments akin to malaria and HIV, all of which improve well being dangers for tens of millions of girls globally.
Gestational diabetes, the commonest medical dysfunction in being pregnant, together with cardiac circumstances, bronchial asthma, epilepsy, hemoglobinopathies, and substance use problems, considerably influence maternal and fetal well being outcomes. But, these circumstances are sometimes underdiagnosed, undertreated, and overshadowed in maternal well being discussions.
To make sure holistic, women-centered care, well being programs should:
- Transfer past a singular concentrate on being pregnant to deal with ladies’s well being throughout the life course, together with adolescence, reproductive years, and post-menopause.
- Combine sexual and reproductive well being companies 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 circumstances, and infectious ailments that disproportionately have an effect on ladies.
- Put money into gender-responsive well being programs that acknowledge the structural limitations ladies 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 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 constructive postnatal expertise (you may learn extra right here).
We additionally printed a sequence 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 influence of being pregnant on ladies 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 essentially the most strategic areas for funding?
Current extreme and drastic funding cuts have instantly impacted the well being and wellbeing of girls and infants, together with maternal well being companies, instant losses in well being care personnel, HIV remedy and care, entry to medicines, and household planning companies. 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 influence this can have on progress up to now.
Proof exhibits that spending on maternal and new child well being will not be a value, 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 creating international locations will unlock US$660 billion in financial advantages by 2050.
WHO is looking for investments in high-quality antenatal companies to help wholesome pregnancies by lowering 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’ve gotten an intensive 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 Copy (referred to as HRP), I’ve the chance to work with a exceptional workforce that’s devoted to producing helpful insights, offering evidence-based steerage, and partnering with dedicated professionals throughout numerous international locations and organizations to reinforce sexual and reproductive well being and rights.
We have now lengthy realized that by tackling stopping deaths as a result of postpartum hemorrhage (PPH) – outlined as extreme bleeding after childbirth – we will save tens of millions 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 underneath one plan to assist international locations tackle the stark variations in survival outcomes from PPH, which mirror main inequities in entry to important well being companies.
Over 85% of deaths from PPH occur in sub-Saharan Africa and South Asia. Many danger elements for this situation might be managed if there’s high quality antenatal care, together with entry to ultrasound, alongside efficient monitoring within the hours after start. Too typically, nonetheless, well being services lack mandatory healthcare employees or sources, together with lifesaving commodities akin to oxytocin (which will help cease hemorrhage), tranexamic acid, or blood transfusions.
Main progress has occurred with the success of the EMOTIVE trial. The research discovered that objectively measuring blood loss utilizing a easy, low-cost assortment machine known as a ‘drape’ and bundling collectively WHO-recommended remedies, slightly than providing them sequentially, resulted in dramatic enhancements in outcomes for ladies. Extreme bleeding, when a lady loses greater than a liter of blood after start, was lowered by 60%, they usually had been much less prone to lose their life. Extra not too long ago, 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 danger elements and offering instant entry to remedies when wanted, alongside broader efforts to strengthen ladies’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 employees, important tools, and cabinets stocked with acceptable and efficient commodities – that is essential for treating postpartum bleeding and lowering maternal deaths.
Precedence actions embody creating new and broader steerage for PPH masking prevention, detection, and remedy; conducting analysis to ship improvements and improve entry to confirmed interventions; establishing a brand new procurement mechanism to enhance the availability of high-quality medicines and commodities; advocating and awareness-building; and, on the nation stage, coaching, and facility-based enhancements.
Listening to ladies and supporting households is a key message of this marketing campaign. How can well being programs higher combine ladies’s voices and lived experiences into maternal healthcare insurance policies and companies?
Lowering maternal deaths would require strengthening antenatal care to detect and forestall issues, emergency obstetrics, and expert care throughout childbirth, in addition to postnatal companies. Well being programs must evolve to handle the numerous well being points that influence 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 tackle problems with fairness and guarantee entry to healthcare services earlier than, throughout, and after start. Nevertheless, we can not do that with out consulting ladies themselves, their communities, and native well being employees to know the wants of girls higher. Native legal guidelines and insurance policies should take into account the numerous and ranging wants of these they serve.
WHO advocates for well being planning wherein ladies’s values and preferences are on the centre of their care. Significant engagement and empowerment of girls, households, communities, and suppliers are important for high quality enchancment initiatives.
HRP has a protracted 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 desires of girls weren’t on the forefront of anybody’s minds, together with researchers and the general public well being group. I’m glad to say we’ve come a great distance since then, however we nonetheless have a protracted technique to go.
With social media taking part in a major position in public well being consciousness, how can platforms be leveraged to share correct, evidence-based details about being pregnant, childbirth, and postpartum care?
When looking for data on-line, folks ought to really feel assured that respected web sites are truthful and correct. At WHO, technical specialists with deep understandings of the topic areas guarantee the knowledge on our digital platforms is evidence-based and up-to-date.
We’re nicely conscious of the unfold of misinformation and disinformation, particularly concerning ladies 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 knowledge they’re searching for, and supporting wholesome, knowledgeable decision-making.
Even nonetheless, it’s typically 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 accessible to influencers, implementers, and builders of digital platforms who’re more and more on the forefront of how people acquire well being data and combine it into numerous digital person journeys.
Digital applied sciences – together with synthetic intelligence – convey each alternative and hazard. The sector of sexual and reproductive well being and rights typically grapples with underlying problems with entry and fairness, which might be drastically amplified and exacerbated by AI.
AI is already reworking expertise for sexual and reproductive well being. If we’re conscious of the potential risks, cautious about implementation, and acknowledge AI as a software and never an answer, we’ve an important alternative to make sexual and reproductive companies and knowledge 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 increase consciousness in regards to the gaps in maternal and new child survival and the necessity to prioritize ladies’s well-being. Policymakers should be persuaded to spend money on interventions that can produce essentially the most enhancements for ladies’s and infants’ well being—irrespective of the place they reside. In our communities, we should actively help dad and mom and well being professionals who present crucial care.
At WHO, we are going to at all times 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 lowering maternal and new child deaths.
Entry to sexual and reproductive well being companies is a human proper and ought to be accessible to all folks all through their lives as a part of guaranteeing 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 contains difficult the boundaries of world well being, advocating for accountability within the decolonization of world well being and worldwide improvement, and increasing alternatives to diversify the voices of contributors to world debates and determination making – significantly in proof era, coverage and programme implementation throughout the UN system, with governments, NGOs and the tutorial group.
Dr Allotey is a triple-certified nurse, midwife and public well being nurse with a multidisciplinary background in medical well being sciences, implementation analysis, anthropology, and epidemiology. She holds a PhD in Public Well being and a MMedSci in Neighborhood 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 world public well being researcher, Dr Allotey has printed extensively together with on: sexual and reproductive well being; dangerous conventional practices; gender, intercourse and illness; migrants and refugees; well being programs 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 embody: Professor of Public Well being and Deputy Head of Faculty (Analysis) on the Jeffrey Cheah Faculty of Drugs and Well being Sciences, Monash College (Malaysia); founding Affiliate Director of the South East Asia Neighborhood Observatory (SEACO Malaysia); Professor of Race, Range and Skilled Follow, Brunel College (United Kingdom). Dr Allotey is a former Co-Chair of the HRP Gender and Rights Advisory Panel.
