To celebrate World Health Day, Karolinska Institutet hosted an afternoon seminar to discuss the protection of sexual and reproductive health rights (SRHR) of women and girls in a crisis-prone world. With an impressive panel of speakers, the afternoon was kicked off by Dr Babatunde Osotimehin, Executive Director of the United Nations Population Fund (UNFPA). We also heard from Professor Anna Mia Ekström, head of the Global Health, HIV and SRHR research group at Karolinska Institutet; Per Örneus, Ambassador for Humanitarian Affairs; and Hampus Holmer, PhD and medical student at Lund University.
Story by Emily Clark
The scene was set by Osotimehin: conflict and crisis are not new phenomena. In fact, we are seeing increasing numbers of disasters. So long as the underlying volatile issues such as climate change, religious tensions, poverty and widening inequality exist, we can expect to see conflict. Camps that were initially built for temporary respite have sadly become all that many children know as home.
Holmer brought up the question, “What is health?”. So much of health and ill-health can be associated with how and where we live, most of which is outside of what we would consider the health system. We should not consider SRHR in isolation; instead we need a holistic approach. Örneus emphasized the need for a longer-term health systems view, as well as looking at the bigger picture. Osotimehin reflected on these ideas later, asking, “Who owns our health?”. Evidence suggests that more exercise and a better diet will improve our health, yet arguably industry drives many of our choices that will impact on our health.
“Who owns our health?”
The UNFPA has many ways in which it aims to improve SRHR for women and young children. It has established maternity units, which has recently delivered their 5000th baby. So far, their maternal and neonatal mortality rates are zero, highlighting what is possible with good quality care despite ongoing trouble. They have created safe spaces: physical spaces just for women. They have listened to what women want, for example by constructing toilets that are within the safe space, obviating the need for a dangerous journey at night time, outside, alone. They have established centres for women to learn new skills, to obtain assistance – whether it be legal, psychological, or medical, including contraception. “Pregnancy does not know war or conflict.” The UNFPA strengthens existing health systems, working closely with local services providers to improve sustainability.
“Pregnancy does not know war or conflict”
Ekström discussed the topical issue of migration. Migration is a time of great vulnerability for all, with difficulties in access to knowledge – including sex education, geographical or financial access to health care, language barriers, different cultural and sexual norms, stigma, and arduous journeys representing just some of these difficulties. Upon arriving in Sweden ongoing inequities exist as migrants have higher mortality rates, and later diagnoses of HIV. A basic health screen involving tests for syphilis, HIV, hepatitis B and TB is available to all refugees in Sweden, however, uptake of this initiative is about 50%. Why? How can we improve this? Firstly, we must learn. We can learn from the experience of those in other settings. In these tough financial times with increasing demands, it is imperative to implement the best and most cost-effective evidence-based interventions. Countries in conflict or in crisis can little afford – in money, in trust, in opportunity cost – to try what doesn’t work. And, of course, it needs to be contextualized. Underpinning any intervention are the concepts of accountability, quality assurance, strong leadership and policies, as well as education and capacity building. Communication is key – to bridge the gap between research and the people, research and policy-makers. Mobile phone based technology has the potential to reach many people very simply, and this should be embraced. Lastly, the big issues need to be addressed. Prevention of economic collapse, of conflict, prioritising women’s and children’s welfare, building robust health systems and infrastructure. As Osotimehin put it,“Health belongs to the people”.
Medicor exclusive interview with Dr Babatubde Osotimehin
Dr Babatunde was kind enough to speak with us after the seminar so we could pick his brains some more.
Sexuality is fundamental to our existence. Yet, SRHR is often overlooked, overshadowed, ignored. “People don’t want to talk about sexuality” – cultural norms bear the responsibility here of sweeping SRHR under the carpet, out of sight, out of mind. Despite insufficient resources, the UNFPA has been “able to bring visibility” to SRHR. Through connecting with civil society and integrating and engaging with students, the UNFPA has helped shine the spotlight onto SRHR.
As the UNFPA looks ahead, challenges loom. Their aspiration? Aiming to “reach everybody and [leave] nobody behind”. They think that concentrating on young people, who number 1.8 billion, is a good place to start. And certainly the impact of supporting, caring for, and protecting just this demographic group will be a significant one. Girls in particular suffer during war situations: one such example is the use of rape as a weapon of war. It is imperative to be very clear on this: “…we do not condone it and that the ones who are caught, are penalised for it”. It is vital that cases are reported, documented and that offenders are prosecuted.
As we all know, prevention is better than cure. How does the UNFPA employ this adage in their work? Resilience building is a concept which aims to “develop people to learn to cope with crisis”. It is not limited to conflict situations but is employed also for disasters such as flooding, where, in the acute setting, the population needs aid and food and shelter. But building resilience involves prioritising a long-term outlook and the “building [of] systems to prevent flooding”, which will avoid or reduce the need for such acute interventions in the future.
Interventions should be contextualised to improve success, engagement, and acceptability. Does the UNFPA ever struggle with local customs? “We do, but we overcome them”. The key is, as ever, down to interpersonal relationships and communication: “you sit down on the floor, you talk to people, you tell them what value you are bringing”. It’s a process, requiring time and ongoing discussion. Underpinning this dialogue is evidence for the proposed intervention, and inspiring the other party to realise the importance and benefits to be had. Avoiding judgement is imperative. What about deeply engrained beliefs? The UNFPA identify and engage gatekeepers, people who need to be on board in order to reach the rest of the community. Gatekeepers fullfil a vital role of motivating the proposal, “champions of the program”. Without this, there cannot be sustainability.
“Health belongs to the people”
What can we do, as students? “Reach out to other students in the world” – students of any kind. We should realise we are in a very privileged position. We are able to discuss ideas, challenge ideas, generate new ideas, educate and empower people all over the globe. We have access to all sorts of research, evidence and statistics. We can highlight issues so that they become more prominent, we can “raise awareness…raise resources…find solutions”. Networking, and again, communication, is key. And the beauty is all of this can be done from home. There is no requirement to travel anywhere. Contact people affected by the crisis, ask them what they need, what they want us to do to help. Ask them how we can best work together. How can we put this issue in the spotlight? What resources do they need, and how can we obtain them?
Do not underestimate the opportunities we have here, now. These global friendships are “incredible and powerful”.