Why our UHC plans must respond to women and girls health – Women Deliver

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Why our UHC plans must respond to women and girls health

By John Muchangi | The Star Kenya | 24 April 2023

Dr Maliha Khan is the President and CEO of Women Deliver, the leading global advocate for gender equality and women’s health and rights, headquartered in New York.  Before her appointment in April last year, Dr Khan served as chief programmes officer of Malala Fund.

Women Deliver convenes the world’s biggest conference on gender equality once every three years. This meeting is coming to Africa for the first time and will take place in Kigali, Rwanda, in July this year. It will bring together thousands of decision-makers from around the world, including civil society, government, the private sector, and international agencies.

The Star’s JOHN MUCHANGI had a discussion with Dr Khan about this meeting and other issues affecting women and girls in Africa.

Many countries in Africa are currently rolling out their Universal Health Coverage plans. In 2019, Women Deliver with partners co-founded the Alliance for Universal Health Coverage and Gender Equality to push for gender-responsive UHC around the world. How can we ensure sexual and reproductive rights are enshrined in our countries’ UHC plans?

You've asked a question about one of my favourite initiatives. So one of the things that happen globally that people often don't pay attention to is that these multi-literal organizations – the WHO and other UN agencies – set international norms around what countries should be doing on certain issues. They set policies and standards. And then national governments crop their own national policies and standards according to these global norms. Right? One big global norm right now is universal health coverage: what governments should be doing to ensure that every citizen in their country has access to healthcare.

But it's being assumed that if you provide health coverage to all citizens, you will automatically be able to meet the specific needs of girls and women. However, given the statistics, for instance, about maternal mortality, we know that that's not the case. Girls' and women's specific needs are not met under general health coverage.

So we need to have a conversation about what are the policies and standards needed for universal health coverage so that every government takes into account the specific needs of girls and women, particularly sexual, reproductive health rights. So that they're able to achieve bodily autonomy. That they can decide when and if they will have children, they're able to delay the birth of their first child, and they're able to space out children.

These are very essential things to do in order to reduce maternal mortality, in order to increase their own body autonomy and increase gender equality. And so this coalition consists of over 160 organizations from around the world, which are working very closely together to make sure that as we have these high-level meetings we are able to put the concerns of girls and women and their sexual reproductive health squarely at the centre of the debate.

We don't want to look back 10 years from now and say, oh, we missed that opportunity.

In Africa, women own less than one per cent of the land. But most of the agricultural work in Africa and a lot of household chores, such as taking care of children, is done by women. This work is not paid for. What's your view on this?

You've hit upon two really, really essential issues in economic justice. One is that women contribute the most to agricultural work yet, in most contexts in sub-Saharan Africa and Latin America, they have the least amount of control over agricultural assets. They tend not to own land. They tend not to be able to make major decisions on the land, or if they do in, in sub-Saharan Africa, they have their own land. But those tend to be the small plots of land which are more towards subsistence agriculture. Sometimes, you know, land might be in their name, but they're not making decisions on it. That's, that's the first part.

The second of it is that women and girls are required to contribute to the informal economy, which is often unpaid. This includes household labour. They don't get paid for it and they often don't have control over how that money is utilized or spent. So that's also part of the injustice.

Third is also the completely unequal burden within the household. Women and girls contribute the most in terms of hours to childcare. You know, also collecting firewood, collecting water, looking after children, looking after the elderly or anyone that might be ill. That burden falls on women. When disasters hit, when families become ill as we saw during the [Covid-10] pandemic, it was the girls and women who had to take care of them. So all of these are deep injustices that we have to start addressing if we want to achieve gender equality.

Is there, is there a global conversation that is ongoing to maybe to shed light on these things and also to correct the situation?

Absolutely. There's an ongoing conversation within the Sustainable Development Goals, and that's been in place for over a decade. And we're nearing the end of the SDG time period.  Not only do you have SDG five, which is around gender equality, but you also have specific development goals around maternal mortality, and then within other goals around education and economic empowerment, you have specific, disaggregated targets for women and men.

And so all those contribute to a global dialogue that's occurring, that we have to pay attention to. Unfortunately, we are not in line to achieve our SDG targets at all. We're very far behind, particularly in the targets for girls and women.

In addition to that, one way Women Deliver contributes to this global dialogue is that every three years we hold our large conference that focuses on gender equality. It's the largest convening in the world that brings together people from over 100 countries.

The last one was in Vancouver in Canada, and we had over 8,000 people attend the conference and talk about all sorts of issues ranging from health systems to economic justice, climate to education. Our next one is going held in Africa for the first, in Kigali, Rwanda, from 17-20 July this year. And we welcome everybody to come there and continue to have this discussion about what is needed in order to get back on target for gender equality.

What can we expect from the conference in Rwanda in July?

I hope we can rethink the world after three years of being so focused on all crises that are happening around the world, having lost focus on gender policy that we can restore the world's attention to these issues. As you know, we had the International Day of Maternal Health and Rights (on April 11). Countries like New Zealand or Canada have a maternal mortality rate of four out of 100,000. That tells us maternal mortality rate can be reduced.

But in Africa, you have a mortality rate of over 500 out of 100,000. Think about that, four versus 500. The science is there in order to make sure that pregnancy and childbirth are safe for women, and yet because of economic inequalities, because of poverty, and because of lack of access to health services, women in Sub-Saharan Africa are dying at a completely unacceptable rate. And this is not because we don't know the science, we don't know the ways to do it; we do know the ways to do it but we need to make sure that something as essential to human life as pregnancy and childbirth is not a death sentence. And so this dialogue is really important to have.

We are hoping many heads of state and heads of government particularly from Africa can come there, and heads of multilateral organizations like UN Women, UNFPA and the WHO to also talk about what is needed to be done across the world to ensure the rights of girls and women. Most importantly, we will have thousands of civil society actors from over 100 countries.

In Africa we have seen a lot of attacks on the LGBTQ community through policy and also actual physical attacks. Do you think this also may affect women's and girls' rights negatively?

I firmly believe that the attack on any person no matter their gender, sexual or other orientation is an attack on everyone. You cannot ensure the rights of the broad population if you do not protect minorities, no matter what the minority may be. This may be an ethnic minority, a linguistic minority or, in this case, someone who does not adhere to or belong to the mainstream of gender or sexual norms.

And so I do sincerely think we need to protect the rights of all LGBTQI individuals, no matter what their gender or sexual preferences might be, in order to ensure the rights of all human beings. This is enshrined in all our human rights charters, but I also think these are just the basic things we need to do to ensure we are able to achieve our full potential as humanity. So to me, these recent attacks are very disturbing. I strongly condemn all of these attacks and all these policies that are criminalising people’s identities.