Five million women and children die every year from entirely preventable causes. The Global Financing Facility (GFF) supports the 50 countries with the greatest needs by investing in their health systems but that is not enough, writes Mariam Claeson.
Mariam Claeson is a medical doctor who’s worked across the developing world and is now the director of the Global Financing Facility. She was previously the director for maternal newborn and child health at the Bill & Melinda Gates Foundation.
Simple direct investment is insufficient to end the five million preventable deaths. Holistic approaches such as women’s empowerment could, for example, reduce the rate of adolescent pregnancies, the primary cause of death for adolescent girls.
If you’re looking for a single statistic to sum up how gender inequality undermines health, it’s probably five million. That is the number of women and children who die from entirely preventable causes every year. It’s often hard to conceptualise big numbers, so comparisons can help.
That’s the equivalent of the entire population of Norway or New Zealand dying every year, from causes of death we can prevent at critical periods of life: in pregnancy, at birth, and during the newborn, early childhood and adolescent periods.
There’s no doubt that the global community has narrowed the equity gap between men and women in many areas over the last 20 years. More girls are staying in school longer. Literacy rates among women and girls are increasing.
Fertility rates among girls under 18 are down nearly a quarter. But those five million preventable deaths are a blunt reminder that gender inequalities still result in millions of lives lost.
The scale of the challenge we face was underlined in 2015, when just 15 out of 134 countries achieved their Millennium Development Goal 5 – to reduce maternal mortality. That same year, we launched the Global Financing Facility (GFF) as a way to finance the health and nutrition of women, children and adolescents. We focus on the 50 countries with the greatest needs.
Chronic, systemic underinvestment in areas like maternal and reproductive health and nutrition worldwide remains a huge barrier to progress. Countries in the Sahel, for example, receive disproportionately little support for reproductive, maternal, newborn, child and adolescent health and nutrition, yet have some of the highest needs among growing populations, especially adolescents.
The GFF’s financing model aims to change that, by ensuring that health and nutrition investments prioritise the interventions that can have the biggest positive impact on people’s lives.
For many countries, this means more funding for primary and community health systems, and on interventions like contraceptive access, quality emergency obstetric and newborn services, exclusive breastfeeding promotion, and cervical cancer screening and treatment.
But while this direct investment in frontline services is necessary, it is insufficient to meet the challenge we face. Ending the five million entirely preventable deaths a year requires a genuinely holistic approach – one that extends far beyond traditional ‘women’s health,’ to tackle deep-rooted gender inequity.
That’s why women’s empowerment and gender equality must go hand-in-hand with specific health investments. There’s a wealth of evidence that women’s empowerment can transform health outcomes across the entire lifecycle.
For example, for every additional year a mother has been in formal education – which is, of course, an important development objective in its own right – research suggests that child mortality falls by nearly 10% (Gakidou, (2010).
Empowering women and girls also helps reduce the rate of adolescent pregnancies, which result in poorer child health outcomes compared to pregnancies later in life. Adolescent pregnancies also are a leading cause of death for adolescent girls in many counties – and have a negative impact on life chances.
In Bangladesh, nearly a third of girls under 18 become pregnant. With support from the GFF for women, children and adolescents, Bangladesh is developing more gender-responsive schools to reduce dropout rates among girls. This includes learning about health and reproductive rights, making sure girls have access to menstrual hygiene, better sanitation, counselling and nutrition services.
These interventions can help keep girls in school, delay the age of marriage and postpone the timing of the first birth. They also ensure that girls are better educated and have greater earning power, which in turn drives economic advancement across society.
To think and act holistically, we also need to better capture the data that must underpin health service delivery. Without accurate statistics, countries can’t make effective interventions or efficient investments.
Birth and marriage registration systems help combat child marriage, a critical gender equality issue and one that is directly linked to early pregnancies and childbearing, limited future socio-economic prospects, as well as a host of poor maternal and child health and nutrition outcomes.
Death registration helps to establish property rights and inheritance, as well as access to social benefits associated with orphanhood or widowhood.
Civil registration and vital statistics systems are also essential for understanding causes of death to swiftly tackle emerging problems; determine accurately the extent to which women and adolescents are dying disproportionately of certain diseases; and derive maternal mortality ratio and other reproductive, maternal, newborn, child and adolescent health indicators at sub-national level on a regular basis.
Improving countries’ abilities to capture this important data is part of the GFF’s work.
The GFF was launched to transform health systems and turn the theory of empowerment into a reality. It is the way to finance the health and nutrition of women, children and adolescents – now and in the future. The GFF is working in 26 countries.
But at least 24 other countries with the greatest needs are ready to lead the charge for women, children and adolescents’ health and nutrition. The GFF’s unique systems-based approach that combines direct and indirect means to improve sexual and reproductive health rights (SRHR) outcomes can play a pivotal part.
Replenishing the GFF Trust Fund will enable the GFF to extend comprehensive SRHR services to millions of women and adolescents who need them the most.
It will move the world’s poorest countries further towards gender equity by giving women more control over their bodies and access to the vital care they need – for them and their children, now and in the years to come.
It’s not just a smart investment, it’s also sustainable. When we invest in women, they invest in their children. Everyone gains.