It’s been twenty-six years since the International Conference on Population and Development affirmed women’s reproductive health as an essential human right. In this episode of A Deeper Look, I sit down with Ann Starrs, Director of Family Planning at the Bill & Melinda Gates Foundation, to hear how new products, policies and practices are disrupting the family planning landscape and offering greater access and better outcomes for users.
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More than ever, American Indians and Alaska Natives face some of the greatest challenges in the United States. Resources — including food, housing, medical care and family support services — have been inaccessible or nonexistent for years. During the COVID-19 pandemic, those resources have become even scarcer. According to researchers at the Harvard Project on American Indian Economic Development, the COVID-19 crisis is “devastating tribes’ abilities to fund their governmental services and forcing tribes to make painful decisions to lay off employees, drop workers’ insurance coverage, deplete assets and/or take on more debt.” At the same time, some Native communities have experienced disproportionately high numbers of COVID-19 infections and deaths.
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While much progress has been made to end the HIV epidemic, not enough has been done to put the power of prevention directly in women’s hands. The dapivirine ring, a flexible silicone ring inserted monthly into the vagina, can change this. If approved by regulators, the ring would be the first discreet, long-acting HIV prevention tool available specifically for women. The ring would complement daily oral HIV pre-exposure prophylaxis (PrEP) as another biomedical tool in the fight against HIV.
Recent evidence suggests significant acceptability of and demand for vaginal rings as a drug-delivery platform among women who used the dapivirine ring during clinical trials — and also among policymakers and other stakeholders in countries with a high HIV burden. To better understand these perspectives, the OPTIONS Consortium interviewed policymakers, implementers and civil society leaders in seven sub-Saharan African countries about possibilities for introduction and scale-up of the dapivirine ring. An analysis of the interviews shows widespread enthusiasm for the ring as part of comprehensive HIV prevention programming.
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The increased pressure on public health systems to respond to the COVID-19 pandemic affects all routine health care, including the provision of essential HIV services. People living with HIV require regular access to treatment, but crowded public health facilities carry increased risk of exposure to COVID-19. Routine treatment sites also may be harder to reach because of stay-at-home orders, curfews and public transportation shutdowns. To maintain gains in HIV epidemic control, we must ensure that people needing antiretroviral therapy (ART) continue to receive medication uninterrupted.
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Although we cannot truly compare COVID-19 with HIV, there are similarities worth exploring. As the COVID-19 epidemiological data pours in, we have learned that communities of color are at heightened risk for hospitalization and death. With the reality that the economic fallout affects minority communities more than anyone else, it is clear the odds are against us yet again. We have seen this story play out throughout the course of the HIV epidemic, with LGBTQ, black and Latinx communities enduring the brunt of the disease’s burden. These health disparities are the result of structural inequities that our nation has not yet found the resolve to address. So, just as we did in the early days of HIV, we must arm ourselves with knowledge and a community-driven purpose to protect ourselves and those around us from COVID-19.
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While the COVID-19 pandemic has been difficult for everyone, imagine you are a young person just out of jail, on parole or dropped out of high school. You are determined to get a new start on your life, and you are focused on getting the education and workforce skills you need to move from surviving to thriving. You already have a steep hill to climb. And then, the pandemic hits and everything becomes more complicated.
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An enduring remnant of colonialism is the notion that global development challenges are confined to the poorer countries in the Global South. The profound human development challenges in countries with higher levels of material wealth are on full display as the United States struggles with its painful history and current reality of racial injustice against people of color. The disproportionate impact that COVID-19 is having on poor communities and people of color exposes the reality that global development challenges are indeed universal.
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COVID-19 shines a spotlight on inequality
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I started to shake with chills, my face became flushed, my temperature soared. The persistent dry coughing I had been experiencing, which I had ascribed to allergies, became intense and, at times, painful. It was Friday the 13th and my luck had turned. It all happened so quickly, as if a switch had been turned from off to on. It was less than two weeks from the first reported case of COVID-19 in New York City.
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Despite the COVID-19 pandemic, basic health needs are largely unchanged, including the need to manage menstruation hygienically, safely and with dignity. As advocates around the world point out, periods don’t stop for pandemics.
On Menstrual Hygiene Day, and every day, FHI 360 works around the world to ensure equitable access to quality menstrual products and appropriate sanitation facilities. We also engage government officials, teachers and community members to improve school-based education, raise community awareness and help fight period stigma. And, we must not forget an important group of people who menstruate: those who are using – or want to use – contraception.
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In just four months, the COVID-19 pandemic has taken a dramatic toll on economies and institutions around the world, and the number of new cases, economic dislocation and deaths continues to mount. Decades of progress raising living standards and reducing extreme poverty could be replaced by increasing food insecurity, conflict and forced migration.
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I recorded this episode of A Deeper Look podcast with Sam Worthington, Chief Executive Officer of InterAction, before the World Health Organization had declared COVID-19 a global pandemic. But, the crisis amplifies the relevance and urgency of the themes we discussed in this episode.
Sam highlights trends that will shape this decade, including the emergence of fragile states as the epicenter of extreme poverty in the world, the impact of climate change and its effects on the most vulnerable and the concerning rise of nationalism and isolationism. We discuss the role of women in bringing about positive change, the evolution and impact of civil society and the concept of localization.