Maternal Health - Q3 2020 by Mediaplanet UK&IE

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Q3/ 2020

Maternal & Newborn Health

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“A pathway forward for maternal health amidst unprecedented social and economic upheaval.”

“Parents are facing very restricted or even prohibited access to neonatal intensive care units”

Helga Fogstad Partnership for Maternal, Newborn & Child Health

Franka Cadée and Pandora Hardtman International Confederation of Midwives

Silke Mader & Sarah Fügenschuh European Foundation for the Care of Newborn Infants

“This pandemic could be a golden opportunity to achieve universal health coverage for all”

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IN THIS ISSUE

Could COVID-19 be a turning point for women and girls’ sexual health? Nothing is inevitable about the way the world will rebuild its systems and societies after COVID-19, but the choices we make now about what, how and who we support will shape the future of our planet for decades.

“True health equality requires concerted effort from governments, civil society, academia, media, and the private sector” Fraka Cadée and Pandora Hardtman International Confederation of Midwives

06 “Some parents may see their baby for only 15 minutes a day” Silke Mader & Sarah Fügenschuh EFCNI

08 “Leaders must find a way to include women in response and recovery decision-making .” Anita Bhatia UN Women Project Manager: Alice Golding alice.golding@ mediaplanet.com Business Development Manager: Kirsty Elliott Content and Production Manager: Kate Jarvis Managing Director: Alex Williams Head of Business Development: Ellie McGregor Digital Manager: Jenny Hyndman Designer: Thomas Kent Content and Social Editor: Harvey O’Donnell Paid Media Strategist: Ella Wiseman Mediaplanet contact information: P: +44 (0) 203 642 0737 E: uk.info@ mediaplanet.com All images supplied by Gettyimages, unless otherwise specified

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Please recycle

WRITTEN BY

Helga Fogstad Executive Director of PMNCH

WRITTEN BY

Meredith Jones Russell

lthough women of reproductive age are not among the most at-risk groups for contracting COVID-19, the pandemic has magnified the many inequalities they face in society, especially in developing countries. “The pandemic has had multiple negative effects beyond COVID-19 itself,” said Helga Fogstad, Executive Director of the Partnership for Maternal, Newborn and Child Health (PMNCH). Estimates suggest that over a sixmonth period of the pandemic, as many as 47 million women have lost access to contraception, leading to 7 million unintended pregnancies. Sexual health services deemed ‘non-essential’ Fogstad explains: “This is really because, especially in developing countries, sexual and reproductive health services have wrongly been deemed non-essential, and access to vital contraceptive supplies and health services have been disrupted, leading to a significant rise in unintended pregnancies and sexually transmitted infections.” “Good sexual and reproductive health is critical for women and girls’ general health and wellbeing, and central to their ability to make choices and decisions about their lives, including when and whether to consider having children. This is being taken away from them.” Furthermore, domestic and sexual violence against women and children has also risen, child illness rates are up due to lack of access to primary care services, and women are most likely to face unemployment as an economic consequence of the pandemic.

Equal rights for women and girls in developing countries As a result, PMNCH is calling on the global community to improve access to sexual and reproductive health services and equal rights (SRHR) for women and girls in developing countries, during the recovery from COVID-19 and beyond. PMNCH has created a seven-point call to action, urging governments to protect and promote the health and rights of women, children and adolescents through strengthened political commitment, policies and financing. PMNCH, together with White Ribbon Alliance and Every Women Every Child, will also host an Accountability Breakfast alongside the UN General Assembly in September 2020, calling on civil society, the private sector, grassroots organisations and community advocates to secure high-quality, accessible sexual and reproductive health services, and to strengthen accountability for women’s, children’s and adolescents’ health and rights during the COVID-19 crisis and beyond. Could this be a golden opportunity? Fogstad says the pandemic could represent a watershed moment for ensuring better support in the future. “The provision of a comprehensive package of services that addresses SRHR will benefit women, children, and society as a whole. “This could be a golden opportunity to achieve universal health coverage for all and massively scale up the investment in public health and primary health services which is so important to women, children and adolescents.”

Women are most likely to face unemployment as an economic consequence of the pandemic.

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Financing catalyses innovation for newborns Each year, 20,000 newborns die in Cameroon, primarily because they are born too early or are very small at birth. In response, a consortium of partners led by the Government of Cameroon sought to scale a simple, proven life-saving method nation-wide.

WRITTEN BY Dr Karlee Silver and Ms Jocelyn Mackie Co-Chief Executive Officers, Grand Challenges Canada

angaroo Mother Care (KMC) has proven to reduce newborn mortality in multiple countries through the promotion of skin-to-skin contact, exclusive breast feeding and close follow up with mother and baby. While KMC is an approved practice endorsed by WHO, delivering it on a national scale requires considerable initial costs and new systems. A development impact bond (DIB) can catalyse these needed changes. Grand Challenges Canada (GCC), alongside partners including the Government of Cameroon and Kangaroo Foundation Colombia, launched the first DIB globally focused on the health of newborns to address this need. Investing where funding hasn’t, historically, been forthcoming DIBs catalyse funding for needed social programs by creating the challenge into an investible opportunity with a strong focus on results. The investor, GCC with funding from the Government of Canada, has funded USD 800,000 dollars in upfront funding, which they stand to receive interest on providing agreed outcomes are achieved. “The service provider gets funding, the outcomes funders [Government of Cameroon with funding from the

Global Financing Facility and Nutrition International] only pays if the results they care about are achieved; and the investor is rewarded for enabling the success of the services provider,” explains Dr Karlee Silver, Co-Chief Executive Officer of GCC. Outcomes are key measures of success The word ‘outcomes’ is the significant one here. DIBs work because funding isn’t just tied to outputs, such as the number of hospital visits, but rather measurable results; in this case, the number of newborns receiving quality KMC and healthy weight gain in low birth weight and premature babies. Giving the service provider, Fondation Kangourou Cameroun, flexibility in how they deliver the programme is key. In recent months, the number of women giving birth in hospital and the number attending scheduled check-ups has declined due to COVID-19. Fondation Kangourou Cameroun, which is currently working with nine hospitals (out of the total 10 hospitals planned), responded by building closer links with community partners and harnessing technology to interact with mothers. “This has provided a window of opportunity for innovators to redefine care and reach people where they are,” says Silver.

Promising early results So far, 1,100 low-birth weight and premature babies have received quality KMC and 2,200 newborns will receive quality KMC by 2021. Promising preliminary results show that after being discharged from the hospital, the majority of the babies receiving KMC who return for their 40-week follow up visit are thriving and have gained sufficient weight. In addition, there are plans to develop multiple centres of excellence where a “train-the-trainer” approach will extend Kangaroo Mother Care through hospitals across the nation. The initiative is relatively small in development terms, but GCC hope it will inspire others. As funding becomes even more competitive, DIBs could help to ensure innovations in health care continue to reach the most vulnerable. “There is insufficient funding going toward big challenges in maternal, newborn and child health,” says Co-Chief Executive, Jocelyn Mackie. “GCC has experimented with innovative funding tools to help crowdin new funding and new partnerships that didn’t exist and that can be applied to other challenges.”

Grand Challenges Canada has supported over 1,300 innovations in 106 countries in global health, humanitarian and Indigenous innovation. Funded by the Government of Canada and other partners, the innovations supported have the potential to save up to 1.78 million lives and improve up to 64 million lives by 2030.

Paid for by Grand Challenges Canada

Too often mothers give birth without the assistance of professionals and suffer birth injuries that impair them greatly and can leave them ostracized by their families and community. With surgical repair, they can go on to live healthy and dignified lives. Pictured here is a mother with her baby coming to the outpatient clinic at the hospital in Arba MInch, Ethiopia.”

©Nena Terrell, USAID Ethiopia

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COVID-19 has disproportionately affected black mothers in America

uring the Black Lives Matter movement, inside the confines of the global COVID-19 pandemic, we’ve been painfully reminded of the distressing maternal health outcomes for black American women highlighted in media reports, political speeches, and within the communities impacted by their real-life consequences. As midwives, one black, and one white, and both with extensive experience working within high, middle and low-resource countries, we’ve come together to highlight the realities facing birthing and pregnant women navigating maternal and newborn care in the United States. It’s through this lens we provide our thoughts on a pathway forward amidst unprecedented social and economic upheaval.

“As black midwives, we’re worried that if we get sick, no one will be left to care for our black patients.” What is the role of white women within this issue? As women, we understand the emotional, social, and economic impacts of sexism, and can transfer this knowledge to our understanding of racism. True allyship is grounded in action: calling out friends’ behaviours and searching for authentic opportunities to connect with women of colour. Perhaps most importantly, as white women, we need to sit with our discomfort and acknowledge that comfort is complicity – this is especially true in our hyper-connected digital era where entire movements are accessible on our devices. A comment made to us by one black midwife on the frontlines of this pandemic, does a good job underscoring this topic: “Women of colour are tired of doing the emotional labour that comes with calling out offensive behaviours on the part of white people – start calling each other out!”

©DIGITALSKILLET

Today, black American women are three to four times more likely to experience a pregnancyrelated death than white women, regardless of education, income, or other socioeconomic factors.1 This dismal truth is a brutal indicator of the pervasive inequalities in our systems.

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Prior to ‘Rona’, black Americans were experiencing substantially higher rates of maternal and neonatal mortality, preterm birth, low birth weight and a culture of disrespect compared to their white counterparts.4

How has this global pandemic aggravated the issue? As midwife leaders, we’re frequently contacted by members of our global midwife community with alarming anecdotes regarding this pandemic’s impact on the health outcomes of pregnant and birthing women. Emerging research indicates low and middle-income countries could see an additional 28,000 maternal deaths and 168,000 newborn deaths resulting from the impacts of COVID-19.2 The United States, despite its high-income country status, is already documenting compromised sexual and reproductive health services, disproportionately impacting low-income and minority communities.3 Now, pair this new reality with the knowledge that, prior to “Rona”, black Americans were experiencing substantially higher rates of maternal and neonatal mortality, preterm birth, low birth weight and a culture of disrespect compared to their white counterparts.4 Comments like the one shared below by a practicing midwife indicate COVID-19 could worsen this disparity:

WRITTEN BY

Franka Cadée President, International Confederation of Midwives

WRITTEN BY

Pandora Hardtman Board Member, North America and the Caribbean, International Confederation of Midwives

So, where do we go from here? Maternal morbidity and mortality among black American women are complex issues made more complex by the reality that every system, and every individual plays a role in combatting racism. For this reason, confronting the institutions preventing true health equality requires concerted effort from governments, civil society, academia, media, and the private sector.5 At a policy level, we know women of colour must have proportional representation in decision-making roles, and appointments such as Chief Midwife Officer and Minister of Gender Equality go a long way toward improving health outcomes for marginalised communities.6 Investing in midwives and the sexual and reproductive health services we provide will lead to improved health outcomes for black American women.7 Within this knowledge is the need to grow and diversify the United States’ largely white maternity care workforce. It’s midwives, practicing within a supportive team providing the continuity of midwifery care based on skill and trust, who are uniquely equipped to respond to the culturally specific needs of minority women. This is not new – we know what works, now let’s make it happen! References 1. https://www.nationalpartnership.org/our-work/health/ reports/black-womens-maternal-health.html 2. https://www.guttmacher.org/journals/ipsrh/2020/04/ estimates-potential-impact-covid-19-pandemic-sexualand-reproductive-health 3. https://www.guttmacher.org/article/2020/03/covid19-outbreak-potential-fallout-sexual-and-reproductivehealth-and-rights 4. https://newsmomsneed.marchofdimes.org/hot-topics/ midwifery-care-and-birth-outcomes-in-the-united-states/ 5. https://womendeliver.org/wp-content/ uploads/2019/11/2019-4-D4G_Brief_UHC.pdf 6. https://womendeliver.org/publicationdatabase/?search=&category_name%5B%5D=65&issue_ category%5B%5D=19&issue_category%5B%5D=9&issue_ category%5B%5D=23 7. https://journals.plos.org/plosone/article?id=10.1371/ journal.pone.0192523 Read more at globalcause.co.uk

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INTERVIEW WITH

Myriam El Gaaloul MiMBA co-lead, R&D Projects oversight

INTERVIEW WITH

Maud Majeres Lugand MiMBA co-lead, Access APM Projects oversight

alaria in pregnancy is a significant public health issue, with 23 million women and girls becoming pregnant in developing regions every year. Malaria causes around 10,000 maternal deaths and 200,000 newborn deaths a year, while in 2018 alone an estimated 11 million pregnant women were infected.1 Medicines for Malaria Venture (MMV) is working together with partners to combat the threat of malaria in women that are pregnant, breastfeeding or of child bearing potential. Alongside heightened global awareness and a changing regulatory environment to provide more medicines for a patient population that traditionally has not been part of clinical research before registration of a new drug, MMV has updated its strategy and is planning to intensify efforts to address Malaria in Mothers and Babies (MiMBa) through drug development and deployment strategies. Dr Myriam El Gaaloul, MiMBa initiative co-leader, says: “There are huge concerns about the few treatment options available for pregnant and breastfeeding women, especially in the first trimester and for women who might become pregnant. “They are generally systematically excluded from research and clinical trials for fear of causing harm, as a result, when a new drug is registered, we do not know whether it can be given safely or that it is efficacious for them. As additional data is required, most drugs become available to pregnant women 5–10 years later. We want to change that.” Aiming to bridge the data gap MMV’s MiMBa strategy aims to generate more evidence on existing antimalarials already on the market to speed up access for pregnant and breastfeeding women. For new drugs in development, it prioritises those that are deemed low risk to the mother and the developing foetus; and thus aims to facilitate the inclusion of pregnant and breastfeeding women in clinical trials earlier than currently practiced. In parallel, MMV and Liverpool School of Tropical Medicine have established a pregnancy registry to capture data on the real-life use of ACTs during all stages of pregnancy, including the first trimester. It is hoped that the data generated will inform evidence reviews that could lead to policy change. Low uptake of existing preventive treatment The intervention currently recommended by the WHO to prevent pregnant women from getting malaria is intermittent preventive treatment in pregnancy (IPTp). This takes the

Addressing unmet needs in malaria

Defeating Malaria Together

form of several courses of sulfadoxine-pyrimethamine (SP) administered during routine antenatal care visits starting as early as possible in the second trimester of pregnancy. “It is cost-effective, but uptake remains very low,” says Maud Majeres Lugand, MiMBa initiative co-leader. “Almost 30 years ago, SP was a recommended treatment for uncomplicated malaria, but drug resistance undermined its curative efficacy in the 1990s. Hence there are healthcare providers who do not necessarily trust it as a medicine for preventive treatment during pregnancy, despite its established benefits.” “There is also the issue that prevention is not necessarily a well-accepted concept, and many pregnant women wonder why they should take medicine if they are not sick, so there is a lot of work to do on awareness raising.” “There is a problem of access, too. If you are eight or nine months pregnant, you will not want to walk a few hours to get preventive medicine.” Furthermore, since the onset of the COVID-19 pandemic, the issue has become more acute. “The situation is really worrying. We are anticipating the number of women infected will increase as, given the context, there is an issue with noncommunication, where people are not seeking the essential care they need,” said Maud Majeres Lugand. Addressing the access issue To help address these access issues, MiMBa is supporting projects to explore the impact on uptake of IPTp-SP of including community health workers as part of the delivery mechanism to reach out to pregnant women where they live. A call to action to prioritise IPTp for pregnant women was launched in 2015, but, as uptake remains low, the Malaria in Pregnancy working group from Roll Back Malaria, of which MiMBa is part, is taking the fifth anniversary this year as an opportunity to renew the call. “We want all organisations and stakeholders to continue to sustain their efforts to prioritise the critical intervention,” said Maud Majeres Lugand. “Though we have some way to go, the only way we’ll get there is by working together across organisations, sectors and with the women at risk.” Written by: Meredith Jones-Russell References 1. WHO World Malaria report 2019

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©Toby Madden/Transaid

“MiMBa” means pregnancy in Swahili. It also stands for Malaria in Mothers and Babies, an MMV initiative designed to accelerate discovery, development and delivery of appropriate antimalarial options for women who are of reproductive potential, pregnant or breastfeeding.

©TOBY MADDEN TRANSAID

MiMBa: Combatting malaria in pregnant and breastfeeding women

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“Zero separation” keeping babies and parents together The Global Alliance for Newborn Care (GLANCE) launched the “Zero separation. Together for better care!” campaign to enable infant and family centred developmental care in line with COVID-19 precautions.

T WRITTEN BY

Silke Mader Founder of GLANCE, Chairwoman, EFCNI

WRITTEN BY

Sarah Fügenschuh Founding Member, GLANCE, Head of Communications, EFCNI

he campaign came about after neonatal units worldwide adopted a separation policy, limiting or prohibiting access of parents to neonatal care units.1 Yet, separation in this crucial stage of life can result in long-term health and developmental issues in newborns and impact the mental health of parents.2 Challenging times GLANCE, a global initiative founded and coordinated by the European Foundation for the Care of Newborn Infants (EFCNI), wants to raise awareness of the benefits of zero separation of hospitalised babies and their parents. “Since the global spread of the coronavirus, and the introduction of COVID-19 precautions, many parents are facing very restricted or even prohibited access to the neonatal intensive care units. Some parents may see their baby for 15 minutes a day; some cannot be with their child for weeks or even months. “Our community reached out to us, asking for help, wondering if it was necessary to keep parents and babies apart,” explains Silke Mader,

Chairwoman of EFCNI and founder of GLANCE. Zero separation for better outcomes In exchange with international healthcare professionals and consulting the World Health Organization (WHO) recommendations, it appeared this separation had been decided on no current evidence. The WHO supports rooming-in and skin-to-skin contact, especially immediately after birth and during establishment of breastfeeding, regardless of whether mothers or their babies have a suspected or confirmed COVID-19 infection.3 Zero separation promotes healthy weight gain, neurologic development and increased breastfeeding rates to name but a few. The virus confronts hospital staff with enormous challenges and measures protecting the well-being and safety of patients and staff, must always come first. Yet, bearing the long-term impact of this separation policy in mind, neonatal wards should be encouraged to enable infant and family centred developmental care when and wherever possible, even in times of a pandemic.

Zero separation promotes healthy weight gain, neurologic development and increased breastfeeding rates. Support from experts Numerous medical societies and healthcare professionals support this initiative and provided data underlining the positive effect on health outcomes of zero separation in neonatal intensive care units. The campaign follows the recommendations of the WHO and is continuously being updated. Campaign material is available in more than 20 languages. References 1. World Health Organization, Maintaining essential health services: operational guidance for the COVID-19 context, 1 June 2020, https://www.who.int/publications/i/item/10665332240 (24.06.2020). 2. Bergmann, N.J. (2014), The neuroscience of birth - and the case for Zero Separation, Curationis 37(2), Art. #1440, 4. Page https://www.researchgate.net/ publication/274587588_The_neuroscience_of_birth_-_ and_the_case_for_Zero_Separation (07.09.2020). 3. World Health Organization, Clinical management of COVID-19: interim guidance, 27 March 2020, p.43 https:// www.who.int/publications/i/item/clinical-management-ofcovid-19 (25.06.2020).

More information: www.glance-network.org More about EFCNI: www.efcni.org

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Mothers with babies and staff at health center in small village near Mosango.

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WRITTEN BY

Angela Gorman CEO and Co-Founder, Life for African Mothers

No woman should die giving birth 303,000 women die every year from complications in childbirth, which occur mainly in Sub-Saharan Africa. 99% of all these deaths are avoidable with the right medical care and resources.

The leading way for all of us to rebuild more equal, inclusive, and resilient societies, is to accelerate the implementation of women’s rights. ~Antonio Guterres, UN Secretary-General

The ultimate aim is to make birth safer for women in Sub-Saharan Africa.

A health care worker attends to an expectant mother.

aternal mortality rates have declined since 2000 when the UN launched their global strategy to reduce poverty by raising the standard of living for the poorest on the planet to a basic level. However, mothers are still dying at alarming rates and, in most cases, mortalities can be avoided. Maternal deaths in Sub-Saharan Africa account for two-thirds of maternal deaths globally, reflecting issues prevalent in this region such as poor access to healthcare, insufficient medicine supplies and outdated training for medical professionals. Maternal death is something midwives in Sub-Saharan Africa are frequently faced with in the absence of up to date equipment, drugs and training. As a result, life is extremely challenging for these midwives. They do the same job as UK midwives without access to the basic equipment and medicine a UK midwife takes for granted. They work long shifts in brutal heat for low, sometimes nonexistent wages and frequently have to look after several labouring women on their own. Without proper tools and training, they simply do not have the resources to save the lives of mothers when complications occur in pregnancy or childbirth.

Skills Sharing Workshops, coordinated and run by volunteer UK midwives, provide an opportunity for local midwives to refresh and update their knowledge and practice their skills in a supportive and safe environment. The ultimate aim is to make birth safer for women in Sub-Saharan Africa. 2020 is WHO’s “International Year of the Nurse and the Midwife” and comes at a particularly poignant time to celebrate the work of nurses and midwives who, faced with a global pandemic, have continued to provide patients and mothers with quality care. It also comes as a reminder that there is more work to be done to ensure nurses and midwives have access to the training and equipment they need to continue saving lives.

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Women and COVID-19: Five things governments can do now Governments the world over are struggling to contain the COVID-19 pandemic. While some voices have flagged the impacts on women, gender concerns are not yet shaping the decisions that mainly male leaders are making. At the same time, many of the impacts of COVID-19 are hitting women hardest. Here’s why:

F WRITTEN BY

Anita Bhatia UN Women Deputy Executive Director for Resource Management, Sustainability and Partnerships

irst, while the economic and social impacts on all are severe, they are more so for women. Many of the industries in the formal economy directly affected by quarantines and lockdowns – travel, tourism, restaurants, food production – have very high female labour force participation. Women also constitute a large percentage of the informal economy in informal markets and agriculture around the world. In both developed and developing economies, many informal sector jobs – domestic workers, caregivers – are mostly done by women who typically lack health insurance and have no social safety net to fall back on. At the same time, women typically shoulder a greater burden of care. On average women did three times as much unpaid care work as men at home even before COVID-19. Now, formal sector female employees with children are balancing one or more of the following: work (if they still have it), childcare, home-schooling, elder care, and housework. Female-headed households are particularly vulnerable. Second, the crisis is having an impact on women’s health and safety. Apart from the direct impacts of the disease, women may find it hard to access much needed maternal health services given that all services are being directed to essential medical needs. Availability of contraception and services for other needs may become disrupted. Women’s personal safety is also at risk. The very conditions that are needed to battle the disease – isolation, social distancing, restrictions on freedom of movement – are, perversely, the very conditions that feed into the hands of abusers who now find state-sanctioned circumstances tailor-made for unleashing abuse. Third, because the majority of frontline health workers – especially nurses – are women, their risk of infection is higher. (By some estimates 67% global health force is women). So, while attention must be paid to ensuring safe conditions for ALL caregivers, special attention is needed for female nurses and carers – not only in access to personal protective equipment like masks but also for other needs such as menstrual hygiene products – that may be easily and inadvertently overlooked, but are

essential to ensuring they are able to function well. Finally, it is striking how many of the key decision-makers in the process of designing and executing the pandemic response are men. When any one of us switches on the television anywhere in the world we see a sea of men. This is not surprising given that women still do not enjoy the same degree of participation in major decision-making bodies – governments, parliaments, cabinets or corporations – as men do. Only 25% of parliamentarians worldwide are women, and less than 10% of Heads of State or Government are women. While we have a few shining examples of women Heads of State or Government, women are conspicuous by their absence in decision-making fora in this pandemic. Here are five actions governments can take now to address these issues: First, ensure that the needs of female nurses and doctors are integrated into every aspect of the response effort. At a minimum, this means ensuring that menstrual hygiene products such as sanitary pads and tampons are available for female caregivers and frontline responders as part of personal protective equipment. This will ensure that they do not face unnecessary discomforts in already challenging situations. But most importantly, talk to the caregivers and listen to their needs and respond. They deserve all the support we can provide right now, particularly support in terms of muchneeded critical medical equipment. Second, ensure that hotlines and services for all victims of domestic abuse are considered “essential services“ and are kept open and law enforcement is sensitized to the need to be responsive to calls from victims. Follow the example of Quebec and Ontario, which have included shelters for women survivors in the list of essential services. This will ensure that the pandemic does not inadvertently lead to more trauma, injury and deaths during the quarantine period, given the high proportion of violent deaths of women perpetrated by intimate partners. Third, bailout and stimulus packages must include social protection measures that reflect an understanding

Women typically shoulder a greater burden of care. On average women did three times as much unpaid care work as men at home even before COVID-19. of women’s special circumstances and recognition of the care economy. This means ensuring health insurance benefits for those most in need and paid and/or sick leave for those unable to come to work because they are taking care of children or elders at home. For informal sector employees, who constitute the vast majority of the female labour force in developing economies, special efforts should be made to deliver compensatory payments. Identifying those informal sector workers will be a challenge and will need to take account of a country’s particular circumstances, but it is worth the effort to ensure more equity in outcomes. Fourth, leaders must find a way to include women in response and recovery decision-making. Whether at the local, municipal or national level, bringing the voices of women into decision-making will lead to better outcomes; we know from many settings that diversity of views will enrich a final decision. Alongside this, policymakers should leverage the capacities of women’s organisations. Reaching out to enlist women’s groups will help ensure a more robust community response as their considerable networks can be leveraged to disseminate and amplify social distancing messaging. The Ebola response benefited from the involvement of women’s groups, why not this? Finally, policymakers must pay attention to what is happening in peoples’ homes and support an equal sharing of the burden of care between women and men. There is a great opportunity to “unstereotype” the gender roles that play out in households in many parts of the world. One concrete action for governments, particularly for male leaders, is to join our campaign, HeForShe and stay tuned for more information about “HeforShe@home”, whereby we enlist men and boys to ensure that they are doing their fair share at home and alleviating some of the care burdens that fall disproportionately on women. These actions and more are urgent. Building in the needs of women offers an opportunity for us to “build back better”. What better tribute to our shared humanity than to implement policy actions that build a more equal world?