By HRH Princess Sarah Zeid, WFP Special Advisor, Maternal & Child Health and Nutrition, UNHCR Patron for Maternal and Newborn Health, and Elaine Scudder, IAWG Senior Advisor, Maternal and Newborn Health.
‘’No woman, child or adolescent should face a greater risk of preventable death because of where they live or who they are’’. This audacious vision underpinned (EWEC), a movement to mobilize collective action to reduce preventable mortality and morbidity. Yet, with less than 10 years remaining for governments to deliver on the promises made in the SDGs, being born in a humanitarian or fragile setting is still, all too often, a death sentence for women, girls, and their newborn babies.
On 28 June 2021, the UN Secretary General Antonio Guterres announced the appointment of a Global Advocate for Every Woman Every Child. During the next two years, H.E. Kersti Kaljulaid, the President of Estonia, is tasked to work across and alongside numerous global platforms to accelerate progress against the Global Strategy for Women, Children’s, and Adolescent’s Health and to advance 3 key goals: reducing maternal mortality, increasing nutritional security, and enhancing innovation and the use of digital solutions.
President Kaljulaid has an ambitious and challenging agenda ahead of her. The COVID-19 pandemic has had a devastating impact on the health and well-being of women, children, and adolescents, with 50% of EWEC countries reporting partial or severe disruptions in routine immunization services, malaria prevention campaigns, family planning, and antenatal care services. While the pandemic has revealed the dire need for more protection of health services for women and children, we cannot let the calls for action to strengthen global health security detract from the continuing – and largely unmet – critical needs of the most vulnerable: women and babies in humanitarian settings.
Every year, increasing numbers of women, children and adolescents are impacted by crises. Despite the pandemic, violence and persecution continued this year, with UNHCR reporting on World Refugee Day that 82.4 million people have been forcibly displaced from home; a 4% increase from the record-breaking numbers in 2019.
President Kaljulaid states up front in the 2020 progress report for EWEC that progress has been unequal and unjust, noting that “[h]umanitarian crises are a major source of injustice. Maternal and child mortality rates are substantially higher in countries chronically affected by conflict, and 40% of under-5 deaths globally occur in fragile contexts.” One million children were born as refugees between 2018 and 2020, many at risk of remaining in exile for years. The numbers are hard to grasp; the scale is overwhelming and disheartening. But the good news, for President Kaljulaid, governments, stakeholders and those whose lives and wellbeing are dependent upon action, is that there is a path forward.
The Roadmap & IAWG Newborn Initiative
In April 2020, a shared vision and global strategy was launched to save and improve lives: the Roadmap to Accelerate Progress for Every Newborn in Humanitarian Settings 2020 – 2024. Convened by HRH Princess Sarah Zeid, WHO, UNICEF, UNHCR, and Save the Children, it was developed in collaboration with more than 100 stakeholders, practitioners, researchers, and representatives from governments, donors, private sector, and professional associations. The Roadmap lays out objectives, guiding principles, and indicators to reduce newborn deaths in humanitarian crises, and works toward global targets to reduce neonatal mortality and stillbirths. It builds upon existing tools to prevent maternal and newborn deaths, such as national Every Newborn Action Plans, the Newborn Health in Humanitarian Settings: Field Guide, and the Inter-Agency Field Manual for Reproductive Health in Crises, to scale up evidence-based interventions and invest in research agendas to improve service delivery.
A thoughtful and strategic process was undertaken to design a strategy that pushes against the silos so commonly seen in the health sector and to achieve the goal of providing holistic and comprehensive services to women and children throughout each stage of the humanitarian cycle of preparedness, response, and resilience. The process and priorities within were recently published in a journal commentary.
While we’re proud of the process, the real progress has come in what we’ve done since. To hold the global community accountable to moving this Roadmap off the shelves and reaching those in need on the ground, a dedicated time-limited secretariat has been established to coordinate around, advocate for, and direct resources to the priorities identified in the Roadmap. Thus, the IAWG Newborn Initiative (INI) was established in October 2020. It collaborates closely with partners and networks across the humanitarian-development nexus to jointly advance an evidence-based agenda aimed at delivering a continuum of care across the life course.
What does this actually mean in practice? When developing the Roadmap, we consistently asked ourselves, “will this save the lives of babies in Yemen?” It served as our North Star, if you will – consistently pushing ourselves past jargon and buzzwords to ensure that the actions outlined in the document will lead to meaningful change for those who need it. Grand Bargain Eminent Person, Jan Egeland, has his own version called the “Kivu test.” He believes that the “endless bureaucracy of the aid system” has often failed to actually impact the lives of people living in the North and South Kivu provinces of the DRC.
Current activities include supporting WHO and UNICEF to make maternal and newborn health guidance more accessible through digital technologies; working with professional associations, Ministries of Health, and implementing partners to elevate the voices of frontline health care workers; supporting the Global Health Cluster to strength maternal and newborn heath content within humanitarian funding appeals; and collaborating with IAWG and WRA to advance agendas for safe and effective practice of self-care for maternal health needs so that women have tools and support to better manage their own health.
In addition, the fifth key action of the Roadmap is focused on strengthening linkages with key humanitarian sectors across the continuum of care, with necessary emphasis placed on cross-sectoral integration with early childhood development, infant and young child feeding, nutrition, immunization, WASH, protection, cash/voucher programs, mental health and psychosocial support, and sexual and reproductive health. This is perhaps the crux of the Roadmap – where the true multi-sectoral work has the potential to change the way humanitarian aid is delivered. Success is dependent upon ensuring every sector, every player, every actor knows they have a role to play in improving the lives of women and babies.
Take the sexual and reproductive health sector. A recent OpEd published in Devex advocates for the need for increased access to contraceptives, noting that “for women and girls affected by crises like conflict… the need for contraceptive access is particularly acute. They face an increased risk of unintended pregnancy, maternal death and disability, and sexual violence.” The maternal health benefits that arise from access to contraceptives are clear, and thus advocating for increased investments can be even more pronounced when delivered on behalf of both agendas. But we shouldn’t stop there – improving access to contraceptives will help to decrease unintended pregnancies, but stronger investments in high-quality maternal and newborn care will also help to improve health during antenatal and postnatal care, and will support women with family planning and birth spacing, ensuring the children they choose to have will survive. A joint agenda here is needed to move the needle.
To ensure those children then thrive, linkages are needed with the nutrition community. A second Devex OpEd draws attention to a critical priority agenda on maternal nutrition, noting that globally, 40% of pregnant women and 42% of children under 5 are anemic, that anemia is linked to about 20% of all maternal deaths, and that children born to anemic mothers are more likely to be born too early or too small, and face an increased risk of death. The article calls for “urgent and renewed emphasis must be placed on cost-effective and proven nutrition interventions and actions during the first 1,000-day window, the critical period between a woman’s pregnancy and the baby’s second birthday.”
In humanitarian settings, where access to sufficient nutrition is nearly impossible, the time to act could not be more critical. In Cabo Delgado, Mozambique, stunting affects more than half of all children under 5 years of age, deemed a “ticking time bomb” by WFP. WFP and UNICEF note that to address this crisis, “multi-sectoral approaches are needed – in nutrition, agriculture, health, and water and sanitation – to ensure that when the insecurity ends, Cabo Delgado’s children have the future they deserve.” Indeed, maternal and newborn health services should be delivered in lockstep with nutrition services, ensuring that when a woman receives antenatal care, or she and her baby receive postnatal care, she is screened for signs of undernutrition and immediately provided appropriate support and services. This proactive approach not only likely saves lives, but may also be more resource efficient and improve care seeking.
These solutions sound simple and common-sense – and rightfully so. The improvements needed for large-scale change are surprisingly small, but they take commitment, collaboration, and a willingness to push long-standing norms. This includes changing the financing structure for humanitarian aid to allow for more flexible, predictable, and multi-year funding. We look forward to President Kaljulaid joining forces with Grand Bargain Eminent Person, Jan Egeland to make this happen.
Time to Act
The EWEC 2020 progress report highlights the troubling investments gaps in humanitarian and fragile settings: in 2019, 34 million were reached with services by nongovernmental actors with EWEC commitments. Conversely, in 2019, global humanitarian needs grew to their highest levels ever with more than 1 in every 45 people in the world – nearly 168 million people – needing urgent humanitarian assistance. (In 2020, that number grew to 1 in every 33 people.) In other words, a mere 20% of those living on the edge of humanity received lifesaving care to ensure their health and wellbeing.
We are failing the world’s most vulnerable at their time of their greatest need. A global declaration released in 2019 by numerous leading partners calls for action, advocating for the dignity, health, and wellbeing of every woman, every child, and every newborn – in humanitarian and fragile settings – to be urgently upheld and prioritized.
The attention that Her Excellency Kersti Kaljulaid can draw to this agenda as the first Global Advisor of the UN SG for Every Woman Every Child is invaluable: we look to her and colleagues to elevate the issues, to demand accountability from donors, to push the humanitarian sector and the UN to rethink how they work to bring more coordinated actions to those in need, and to bring equal attention to acute and protracted crises – to ensure the needs of women in Tigray are as important as those of babies in Cox’s Bazar, children in Cabo Delgado, and adolescents in Venezuela.
But attention alone is not enough. With answers available for why and how to save these mothers and babies, the global actors that have committed to this agenda must address the Roadmap’s objectives and work with diverse partners to realize the vision of EWEC. Is their work passing the Kivu test every day? Is it saving babies in Yemen?
Those in crises have no time to wait. The IAWG Newborn Initiative stands ready to support.