April 13, 2023
Doctors of the World warns of the humanitarian needs of thousands of migrants abandoned in the desert in Assamaka (Niger)
Women play a vital role in addressing humanitarian crises. Over 40% of the 500,000 humanitarian workers who are first responders providing emergency care on the front lines, are women (Patel et al., 2020). They have a rapidly growing presence in improving health and wellness for conflict-affected populations through advocacy, research, education & capacity training, as well as service delivery.
Experience has shown that when women are included in humanitarian action, the entire community stands to benefit.
Dr. Therese McGinn has spent over 30 years conducting research to improve the scope and quality of reproductive health services globally. Her research has been used to allow for women and men to make better choices about their sexual and reproductive lives, especially for populations that have been affected by wars and disasters. She has co-founded the Reproductive Health Access, Information and Services in Emergencies (RAISE) Initiative, which you’ll hear more about shortly.
From a young age I knew I wanted to travel and learn new languages. In College I loved sociology, demography, economics, and global affairs.
After my bachelors, I joined the Peace Corps, and I solidified my interest in women’s health and SRH. Women always came to me and asked questions about pregnancy, menstruation, contraception, and safety.
They wanted to know how not to have babies every year. Cameroon, for example, was pronatalist at the time and there were no services available, no family planning. So, I decided that was what I was going to work on.
After I got a master’s degree in Public Health in Population and Family Planning, I returned overseas to work in the field for another 8 years. I need to be on the ground and see how things work to really be able to do a good job. I think that field sense, what’s really feasible, what is missing, how to get things done. That is what I bring to the board.
The other piece is my obsession with data. When it comes to programs, we need to have clear objectives about what we want to obtain, and then we need to measure those. We need to know what is working and what isn’t. That way we can make improvements. It’s a weak component of many organizations. So, I push on the board to do that. Measurement is key.
And then there is dissemination, getting the news out to the field. So, once you know there are programs working, how they’re working, and how it can be made to work better, we need to share with other organizations, with the professional field, and of course the communities. This way we don’t need to reinvent the wheel each time and can learn from other programs. So, sending the word out is also what I’m trying to accomplish on the board.
I’ve loved all my programs, and I really am very proud of the work I’ve done. The early programs, which for me were in the 80s starting with the first ever family planning programs in so many countries in Western and Eastern Africa, was very exciting. It was brand new in public health systems. People were concerned, wondering if the men were going to revolt or if the women were going to storm the streets! We studied, tested, measured to understand not only the health effects, but all the other implications in family life. It worked and countries made the programs larger. That was thrilling!
I also co-founded RAISE with Sarah Casey. We took on not only services and research, but also advocacy, education, medical training, all aspects to make this standard in humanitarian organizations. It’s a great program that affected the field very broadly.
You must listen, listen to women, to colleagues. And you must be respectful. As public health professionals, we bring lots of skills to the table, but the other partners bring their awareness and knowledge too. You don’t have all the answers and you must work together to develop new solutions.
People interested in getting into this field need to keep in mind that it’s hard. It can be hard physically and it’s searing on the soul. Sometimes you see things that nobody should ever see or experience, and it can be dangerous. Also, any job that requires frequent absences can weigh on your personal life. So young people coming into their career need to think about what they want professionally and in their personal life and find the right balance.
If prior emergencies are of any guide, Sexual and Reproductive Health will be sidelined. It’s not food, water, shelter, or sanitation. We need to do everything and that is incredibly difficult. Unfortunately, when it comes to SRH, it’s always secondary and that’s because women are seen as second-class citizens.
The health needs remain there despite the crisis; women are still pregnant, women are still having sex, women still don’t want to get pregnant, women still want to terminate pregnancies safely, women are still going to get STIs, and women are still experiencing gender-based violence. There’s a whole range of reproductive health services that are needed. And it’s very likely they’re not going to be there and that’s a big problem.
In addition, there’s one specific concern with this current crisis. Ukraine has quite a liberal abortion policy, while Poland for example (where a large part of the population is going) has very restrictive abortion policies. Many Ukrainian women who find themselves in Poland will discover that they can’t get the kind of care that they are accustomed to.
Dr. Ribka Amsalu is a physician with extensive experience in emergency health. She trained in clinical research at UCSF, and applied methods of epidemiology to develop, implement, and evaluate new technologies, tools, and interventions to improve obstetric outcomes, maternal health, and neonatal health. Dr. Amsalu, who was once a medical coordinator on the ground with MSF, has become a leader in health responses to disease outbreaks, conflicts and natural disasters in Asia, Middle East, and sub-Saharan Africa. She serves as a senior technical adviser on global task forces focused on maternal health and neonatal health in humanitarian settings and her research has contributed to the Newborn Health in Humanitarian Settings Field Guide and The Roadmap to Accelerate Progress for Every Newborn in Humanitarian Settings 2020-2024
My career progressed from field clinical care in a refugee camp in Ethiopia with Somalian refugees to medical coordinator with MSF before settling into a headquarter position. It was kind of a natural progression, and I have always been driven. It is important to have allies who are rooting for you and who believe in you. I am privileged in that I have always had allies in various stages of my career.
Global health, generally, is hierarchical. A good number of organizations in the global health field have a headquarter, and much of the mission and strategy is driven by HQ. My role was to shift that way of thinking and bring in the preferences, experiences, and priorities of individuals with lived experience, especially voices from developing countries.
In general, I think we need to shift our approaches in the global health field from concentrated power in Western Institutes to a shared platform with academics, citizens, and advocacy groups, policy makers and implementers in low- and middle-income countries and have that diversity whether it’s in terms of gender or where people come from.
I shifted from a senior technical advisor level in a Global Health Organization in Washington D.C. to an academic position. Academia provides a platform where you can work on things that you deeply care about, and you are not caught up in day-to-day implementation work that sometimes doesn’t give you room to be innovative or to think outside the box.
Today I have the opportunity to work with people that challenge the status-quo, and who interrogate the data you have. They push you to find a better solution, one that is more inclusive, efficient, and cost-effective. It also provides me a platform to influence and to drive the agenda for the global health field.
There are a few. To begin, being in academia provides the opportunity to do internships and training, to inform the future leaders of the global health field. We need to increase the pool of candidates, and I have a role in that.
In terms of care, I work on maternal and newborn health, making sure that we work with women and that mothers are supported. For a long time, we have known that babies born too soon, prematurely, are more at risk of developing complications. I am working on implementation science questions on that at the moment and hope that our study will contribute to improving medical care that can be provided to newborns and preterm babies. It builds on the newborn health in humanitarian settings field guide that was published few years back.
I just finished an editorial on maternal health in conflict settings, another area of interest, with colleagues from other universities – which I think is a boost to motivate all of us to strive for quality care and equity, and not settle for what is available.
On a positive note – leaders and influencers are talking about it and are aware of it. However, the progress has been very limited in terms of gender equality and diversity. We need to stay on it, measure it, and talk about it till we achieve a shift. We need to make sure that this equal representation is visible and that leaders follow through the commitment they are saying.
Also, in the Global Health field we have a limited pool of candidates. To move forward, we need to start engaging girls from a young age, giving them the opportunity to get into science and public health.
We are listening to the population of Ukraine, to Ukrainian women because they are able to communicate directly and share on their social media platforms what their concerns are. This is a good thing because we need to listen to them. Sometimes there is an assumption from the global health field that we know what is needed. We need to be good listeners and be guided by what they say they need and science. This way we can support them and tackle the challenges they face in terms of reproductive health but also all the other life aspects.
Women, those who are expecting, will continue to give birth, this is a reality, the war will not change that. So, we need to make sure that there are hospitals functioning, safe, and accessible to women, hospitals where they can get the best obstetric care and care for their newborns.