Building forward fairer for vulnerable women, children, and adolescents

This year’s World Health Day, celebrated today (7 April 2021), focuses on the critical need to enhance equity for the most vulnerable communities worldwide. Covid-19 has further highlighted this need, as it is unravelling the hard fought gains made over recent decades in reducing maternal, newborn, and child mortality. During 2020, coverage of lifesaving health interventions for women, children, and adolescents in 36 developing countries was estimated to have dropped by up to 25%. Recent UNFPA estimates indicate that across 115 low- and middle- income countries, the pandemic disrupted contraceptive use for about 12 million women, causing nearly 1.4 million unintended pregnancies in 2020. Similarly, according to a UNICEF, WHO, and Gavi pulse survey, three quarters of 82 surveyed countries reported covid-19 related disruptions to immunisation programmes.

These disruptions to essential services are now also translating into worsening inequities in sexual, reproductive, maternal, newborn, child and adolescent health outcomes, demonstrating the importance of maintaining essential services and combatting misinformation. Evidence from Nepal indicates that because there have been far fewer institutional childbirths during the covid-19 lockdown, the country has seen increased numbers of stillbirths as well as newborn mortality. Similarly, while recent evidence suggests that the benefits of breastfeeding and Kangaroo Mother Care (KMC) for newborns far outweigh the risks of a covid-19 infection, results from a global survey in 62 countries found that two-thirds of healthcare professionals do not support KMC and exclusive breastfeeding for mothers with unknown or positive covid-19 status. This trend is particularly alarming in low- and middle-income countries.

But covid-19 is much more than a global health crisis, it is a human crisis that also has immediate and long-term economic and social impacts. It is laying bare and exacerbating existing inequities and leaving the most vulnerable behind, including women, children and adolescents. UNDP estimates that global human development—an index that combines indicators for education, health, and living standards—is set to decline for the first time since 1990, while the World Bank has projected an increase in global poverty for the first time in more than 20 years.

People most at risk are those who were already vulnerable: refugees and displaced populations, urban poor, and groups lacking access to basic social and political protections. UNICEF estimates that two out of every three children worldwide had no access to any form of social protection in 2020, and Gavi reveals that before covid-19, 10.6 million children were not receiving even a first dose of basic vaccines. These children, and the women and girls in their household, are unlikely to be receiving any other essential health and nutrition intervention, such as skilled birth attendance, and sexual and reproductive health services, making them the hardest to reach.

Last July, the Partnership for Maternal, Newborn and Child Health (PMNCH) hosted by the World Health Organization (WHO) rallied its members to issue a seven-ask Call to Action, urging leaders to protect and prioritise the health, wellbeing and rights of women, children and adolescents during the pandemic response.

We now urgently need to prioritise equity enhancing policies and financing actions to cushion the pandemic’s impact and protect the world’s most vulnerable. Unless we do so, we will continue to lose years, if not decades, of global health progress and investments in human capital—turning the global goal of leaving no one behind into an impossible dream. That’s why, in line with the covid-19 Call to Action, PMNCH and its members are making such efforts to mobilize policy and financial commitments from countries across the world.

However, protecting our progress, alone, will not help us achieve the Sustainable Development Goals (SDGs). The covid-19 pandemic, despite its myriad challenges, has given us the opportunity to correct the inequities inherent in our societal and global norms and structures. Instead of thinking about “building back better,” we must encourage our leaders to “build forward fairer.” Governments need integrated health, economic, and social protection systems that are gender-responsive and resilient enough to withstand the shock of future crises. We will need to adapt, extend, and scale up innovative and equity enhancing financing strategies that consider the impacts of global health emergencies on vulnerable groups and populations, including women, children, and adolescents everywhere, but especially in humanitarian and fragile settings.

It is nearly a decade since PMNCH and its partners put forward the case for investing in reproductive, maternal, newborn and child health. Since then, economic evidence, intervention science, global development, and the wider context have evolved in important ways.  PMNCH, the Global Financing Facility (GFF) and the World Bank are therefore developing a Global Investment Framework for Women, Children and Adolescent Health and Wellbeing, and Preparedness and Response Measures. This will offer evidence of the costs and return on investment of high-impact interventions, as well as effective strategies to apply an equity lens in recovery measures, moving forward.

We are faced with enormous challenges. But we also have a tremendous opportunity to break current norms and practices that perpetuate inequities, and to build a healthier and more resilient world. The task of turning this dream into a reality falls on us all. But we can succeed if we work together for better financing, policies and actions that serve the world’s most disadvantaged communities in order, truly, to leave no one behind.

Helga Fogstad, Executive Director Partnership for Maternal, Newborn and Child Health (PMNCH).

Etienne Langlois, Team Lead, Knowledge, Partnership for Maternal, Newborn and Child Health (PMNCH).

Competing interests: none declared.