Bonus Episode: COVID-19

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Respectful care and a life free from abuse is due to every woman in every health system around the world – no matter what. Even during the current COVID-19 crisis.  In this very special episode of the Brave Voices, Bold Actions podcast, we’re talking about the impact the COVID-19 pandemic has had on pregnancy and childbirth. More than ever, women and newborns need quality maternity care services—and healthworkers must be supported to provide that care. There are no exceptions in times of crisis, even the current COVID-19 pandemic, which is putting more pressure on already over-strained health systems around the world.

We hear from new mother Saima from Pakistan and doula Annie Arenas, who share their experiences with birth during the time of COVID. We are joined by Helen Clark, Former Prime Minister of New Zealand and current board chair of PMNCH about what leadership in times of crisis looks like, and how listening to women’s voices is the key to saving lives. Together, we have the power to destroy the structures that harm women during pregnancy and childbirth!

Topics

  • How has COVID-19 impacted women’s experiences of pregnancy and childbirth?
  • How can healthworkers be better supported to provide the care that mothers need during this pandemic?
  • What can governments and individuals do to ensure all women and newborns receive the respectful, dignified care they need during childbirth—even during a crisis?

Resources

Diana Copeland (00:03): Too often treating women with respect is seen as a luxury. It is not. Respectful care and a life free from abuse is due to every woman in every health system around the world, including during the current COVID-19 crisis.

Diana Copeland (00:19): My name is Diana Copeland and I work with White Ribbon Alliance, a locally-led, globally-connected grassroots movement, advocating for the health and rights of women and newborns. In this very special episode of the Brave Voices, Bold Actions podcast, we're talking about the impact the COVID-19 pandemic has had on pregnancy and childbirth. COVID has changed all of our lives and yet life as always marches on. Women are still getting pregnant and they are still giving birth during this crisis. And that means that more than ever women and newborns need quality maternity care services and health workers must be supported to provide that care.

Diana Copeland (00:59): There are no exceptions in times of crisis, even the current COVID-19 pandemic, which is putting more pressure on already overstrained health systems. And from forced medical procedures to mandatory separations of mothers and babies, to the lack of personal protective equipment for health workers, violations of women's, newborn's, and health worker's rights has been widespread during this crisis across geographies and also income levels. It's clear that now, more than ever, it is important to deliver on the top requests coming from 1.2 million women who voiced their needs through the What Women Want campaign: respectful, dignified care.

Diana Copeland (01:38): Saima from Chitral, Pakistan has two children, a five year old daughter and a baby son. She was seven months pregnant with her son when she learned about the first COVID-19 cases in her region.

Saima (01:51): [Urdu spoken 00:01:50].

Saima (01:53): [Translator] My experience in delivering both my babies was very different. I was not that much scared during my pregnancy in delivering the first baby. In the second baby, I was very scared because of Corona. When I reached the hospital, my fear increased as the health facility is not separated for COVID and non-COVID patients. The COVID patients, the pregnant woman, and all other patients come to the same facility, which increases the chances of getting infected.

Diana Copeland (02:22): After giving birth, Saima says her worries continued.

Saima (02:29): [Urdu spoken 00:02:26].

Saima (02:30): [Translator] I saw my baby boy after 10 hours. The delay in showing me my baby further increased my fear as I was scared of my child getting infected in the facility. Based on my experience, to all the mothers out there, I would say that the relationship of a mother and a child is very precious and a mother should stay strong, stay positive, and never lose hope, whatever challenge she has in her hand.

Diana Copeland (02:57): But what is COVID-19 like for health workers? Annie Arenas is a doula in South Eastern Veracruz in Mexico.

Annie Arenas (03:04): [Spanish spoken 00:03:04]

Annie Arenas (03:07): [Translator] Over the past three months during quarantine, the process to adapt to the needs of the pregnant women I accompany, and to safeguard my and my family's safety, has been a surprising one. We are working in a completely new system. As doulas, we don't have the same formal acknowledgement or resources as health personnel, but we do comply with protocols such as hand washing, using hand sanitizer, changing our clothes frequently, and constantly wearing masks, even during birth and delivery. We have adapted to providing virtual consultations and care through online and phone platforms. This is so that we can still provide consistent care without risking overexposure to mothers, their families, and to ourselves.

Diana Copeland (03:56): Despite these challenges and the uncertain course of the pandemic, doulas like Annie are not backing away from their promise to communities and the pregnant women they support.

Annie Arenas (04:04): [Spanish spoken 00:04:05].

Annie Arenas (04:10): [Translator] I just hope that I can keep working with women as I have been, adapting to new situations as they arise. And I hope that slowly by slowly, women regain confidence in themselves, in their health, and in their births. I just want to continue supporting these families.

Diana Copeland (04:30): Joining us in our discussion on how we can ensure women's rights are upheld during childbirth, even during a pandemic, is Helen Clark, the former prime minister of New Zealand and the board chair of The Partnership for Maternal Newborn and Child Health. Helen served three terms as prime minister, from 1999 to 2008. In April 2009, she became Administrator of the United Nations Development Program, while also chairing the United Nations Development Group, a committee consisting of all UN funds, programs, agencies, and departments working on development. As administrator she even led UNDP to be ranked the most transparent global development organization.

Diana Copeland (05:07): Welcome, Helen.

Rt Hon Helen Clark (05:09): Thank you.

Diana Copeland (05:10): Can you share a bit about your current work as Board Chair for The Partnership for Maternal Newborn and Child Health?

Rt Hon Helen Clark (05:17): I've had a long standing interest in health. I have been a health minister. I've worked on health issues all my life. And, of course, as a woman leader, starting at the bottom rung of the ladder as a young university lecturer in politics, going into parliament, climbing that very long and greasy pole up to being prime minister I've had an opportunity to advocate a lot for women. So, being Board Chair of PMNCH brought a lot of things together for me, and what an amazing partnership it is. And in the end, health is all about people. And we need to hear people's voices, people's perspectives, have people's engagement in the defining the services that they need.

Diana Copeland (06:03): How are some of the small and also big ways that your work has evolved with the onset of the COVID-19 crisis?

Rt Hon Helen Clark (06:10): What I see in a crisis like this horrible pandemic is that business as usual get suspended while everybody focuses on COVID. And of course, in a lot of cases, that's completely appropriate. But here we are advocating for sexual and reproductive health services for women. They can't go on hold. They must be business as usual in times unusual. And when we see the forecast that as a result of the response to the pandemic, up to 47 million girls and women could lose access to contraception, resulting in 7 million unintended pregnancies. You know that something is deeply wrong here.

Rt Hon Helen Clark (06:57): So, at PMNCH's work has had to shift focus, too, to saying, hang on, we've been advocating for improvements in these services not abandonment of them. We have to have these services absolutely recognized as core basic services that go on no matter what else is going on in the world. We want women and girls to come out of the pandemic stronger, not weaker.

Diana Copeland (07:24): Speaking on that, could you describe the recently released PMNCH Call to Action on COVID?

Rt Hon Helen Clark (07:31): In essence, the call to action is exactly about saying that it's not an option just to sideline sexual and reproductive health services and services for children and adolescents in a pandemic. The people who staff the services are our midwives, our nurses, our community health workers. In that very dominantly female workforce, they've got to be properly paid and supported.

Rt Hon Helen Clark (07:58): We've seen so many stories, for example, of the community-based midwife not getting the personal protective equipment that they need. Why should they be forgotten? They don't want to endanger themselves or the women and the babies that they're working with.

Rt Hon Helen Clark (08:12): So, our Call to Action says, please prioritize these services and bring those who are users of the services and those who provide the services into the forums where the decisions are being made. Let's face it, women, children, and adolescents are depending on the country, anywhere from two thirds to three quarters of the population. They've got to be heard. They've got to be engaged and their needs have to be met.

Diana Copeland (08:40): It's so important. In recent weeks we have seen U.S. and also global movements against racial inequality regaining attention. In your view, how is this movement relevant to ending maternal mortality in the U.S. and abroad and ensuring respectful maternity care?

Rt Hon Helen Clark (08:59): Firstly, I think the movement in the U.S., which has followed the killing of George Floyd, has reminded us that an injustice to someone somewhere is an injustice to all. And I think that's why the movement has taken off beyond United States itself into countries around the world where people are saying, "This ain't fair."

Rt Hon Helen Clark (09:27): Now, with respect to ethnic minorities in communities, for the most part, they are not enjoying the same access to services, the same socioeconomic status, the same access to justice as more privileged communities do. And that will play out, of course, in the area of maternal health, of access to basic health services, and so on.

Rt Hon Helen Clark (10:00): So, I think the movement shines a big spotlight on injustice and inequity. There are so many inequities, including in health, economic, social, access to justice. And in the end, it has to be positive when these issues come to the fore. They confront decision makers and policy makers and legislators and governments, and they need a response. And the societies that come out of this stronger, will be the ones who listened and said, "We didn't get it all right. And we want to start a process of not just listening to, but engaging in a meaningful way with people so that everyone can enjoy dignity, respect, equality, no inequity in our societies."

Diana Copeland (10:51): It's a long, long time coming. In your recent opinion editorial about how we respond to COVID, you talk about how COVID is not the leveler, but the amplifier of inequalities. You say inclusive, fair, and equitable national policies and budgets as critical in building back better than before. Can you describe what truly inclusive policy making looks like post-COVID?

Rt Hon Helen Clark (11:13): So many people don't want to go back to pre-COVID, because the COVID pandemic period has exposed a lot of things that were wrong. So, we should aim to build back better. My view is we're going to have to fight for that, because it's just so easy for things to drift back the way they were. And they actually for many of the lower middle income countries, who are desperately short of government revenue now with economies stalling, that the prospect is that it might not even go back to the way it was. It might be worse as austerity budgets come in and services are cut.

Rt Hon Helen Clark (11:53): And by the way, that won't only be low and middle income developing countries, it'll be upper income countries, too. Now, when we endeavor to build back better, we can build on the points that are in the call to action from PMNCH for the summit, with core, one to July. And that is absolutely about engaging those who use and those who provide these critical services in the sexual reproductive health area, in the decision. I can process, hear their voices, take onboard their concerns, take onboard the advice that they give about how things could be better.

Rt Hon Helen Clark (12:35): So, if you want to start building a better world post-COVID, it's clear what to do, but we will have to fight for it. This is not going to be automatic.

Diana Copeland (12:44): Well, looking at the news across the world, we know that leadership has been so important during the pandemic. And as a leader yourself, what are the hallmarks of strong leadership during a crisis, and moving forward, how can leaders across the world and leadership be leveraged to advance the health and rights of women, including around respectful maternity care?

Rt Hon Helen Clark (13:05): So, in the COVID pandemic, we've seen leadership responses ranging from the really good to the absolutely woeful. The really good have been those who have transparently and honestly communicated with their publics about the nature of the very serious challenge. They have been leaders who have empathized with the public. They've understood, not only impeded access to the basics of life, the basic services you need, but also being removed from family. Not being able to visit aged parents and relatives, the loneliness that arises. So, the leaders who've done it well have empathized with that. They have also exercised judgment in following the range of advice coming from experts. And, of course, the experts never really agree, so you have to also have a nose for what really makes sense here.

Rt Hon Helen Clark (14:07): So, all of that has been important, but I think fundamentally that approach has to be based on values. And the values that the best leaders have exhibited have been values around human security, that the top priority of any leader is to guarantee the citizens of their country human security.

Rt Hon Helen Clark (14:32): If you don't value that, if you say, "Oh, the economy's more important than X number of people dying," you are never going to get it right. And tragically, those who've completely bungled the public health response by trying to put the economy first will find that the damage to their economies is far deeper and longer lasting.

Rt Hon Helen Clark (14:56): So, hats off to all the leaders who've done well, and many have observed that the women leaders tend to be rather prominent among them, but actually every leader, male and female, can learn from those who've done well.

Diana Copeland (15:12): I know you must be so busy during this truly unprecedented time, but I'm curious if you've had time to read any books or listen to any great podcasts that you would recommend to the people who are listening today.

Rt Hon Helen Clark (15:23): One thing which really I found it incredibly insightful was the range of interviews with Peter Piot, who used to be the leader of UN AIDS, was a young, med graduate intern out in the Democratic Republic of Congo when Ebola was first identified, and now heads the London School of Hygiene and Tropical Medicine.

Rt Hon Helen Clark (15:50): He was nearly taken down by COVID. And he has spoken so eloquently of what he went through. Anyone who listened to what he is saying, reads what he's saying, heeds his interviews, could not just dismiss this disease as, "Oh, you know, it's a passing thing, it doesn't matter much." Here is a man in the prime of life, who was just about killed by it and is very conscious of the legacy effects for lungs, heart, other organs of having had a bad brush. So, that has been the writing that's most impacted on me in the recent months.

Diana Copeland (16:38): Thank you so much for coming on and sharing so much and thank you for your time.

Rt Hon Helen Clark (16:41): Thanks, bye now.

Diana Copeland (16:50): Please join me now in welcoming Kristy Kade, White Ribbon Alliance's Deputy Executive Director, and one of the chairs of the What Women Want campaign, a global survey that heard from 1.2 million women worldwide about their healthcare demands. Welcome, Kristy.

Kristy Kade (17:05): Thanks Diana. Happy to be here.

Diana Copeland (17:07): Wonderful to have you. What exactly did What Women Want show us?

Kristy Kade (17:11): What didn't it show us? One thing that I think is really unique and special about the What Women Want campaign is that it did ask an open-ended question. What do you want for your maternal reproductive health care services? And we did that so we didn't go in with pre-informed ideas about what we wanted to hear or what we expected. In that regard, the results were extremely surprising.

Kristy Kade (17:38): I, myself, was very, very surprised by the results and I was taken aback by the top results. And the number one was respectful and dignified care. Women want to be heard. They want to be listened to. They don't want to be judged. And that was really cross cutting across countries, across economic classes.

Kristy Kade (18:05): And the number two, which was water, sanitation, and hygiene. That was also extremely surprising. And when I shared this result with many people in the field that I work in, maternal reproductive health, I got a little bit like, "What does wash have to do with reproductive and maternal health care?" I'm like, "Well, according to women, everything." Who wants to go to a clinic to give birth if there's not actually water there where you can even wash the blood off yourself. I think what women are really telling us is they want basic infrastructure, basic decency, and that these are not luxuries.

Diana Copeland (18:46): So, this is probably obvious, but why does the What Women Want Action Agenda matter now during COVID?

Kristy Kade (18:53): Well, you know what? I don't think it is as obvious to people. When COVID started, I think a lot of these things got kind of pushed aside as there is a sort of narrow lens on how we just sort of bring COVID under control. But to me, this is going to sound sort of strange, but COVID is the symptom. It is not the disease. COVID has really been able to manifest and spread, partly because we haven't been tackling or addressing underlying vulnerabilities. Or, you know, even addressing things like gender and racial inequity. It's because we haven't really paid attention to women's healthcare needs and vulnerable and marginalized people's healthcare needs. We haven't said that's important and we haven't made those investments. And that's why COVID has been able to take hold in the way it has.

Kristy Kade (19:56): If we're only really focusing on mask and social distancing, and all of that's critical, all of that's important, we need to do all of it, but that alone is not really going to change anything unless we're again, tackling and addressing sort of those underlying issues.

Kristy Kade (20:14): More than ever, the What Women Want agenda truly has resonance and we need to take it seriously, both to lead us out of this pandemic, but to also make sure that we never get here again.

Diana Copeland (20:30): That's why I'm really interested too, about what can listeners at home do to make sure that what women want is what they actually get, COVID and beyond.

Kristy Kade (20:39): I love that question. Thinking about at the home, thinking about what's happening in your backyards, everything is local. Change is so local and needs to be made on a local level in terms of mobilizing local resources to make investments in your backyard. And again, this doesn't matter where you live in the United States. You know, whether you live in Malawi, you can call on your local policy makers, your local decision makers to make those types of investments to really meet the needs of your individual community.

Kristy Kade (21:12): Also, we need to be thinking so much about what we do as individual women and girls, too, in terms of being self advocates. So much of the respectful and dignified care, it really relates to having an individual person or patient or partner or a patient advocate really hold people to account into the moment. You know, so often when we are feeling like we have been disrespected or not been treated accordingly within a healthcare setting, we're often in a place where we feel like we can't or shouldn't say anything or do anything.

Kristy Kade (21:54): And it's so important, I think, to educate people, including yourselves in your immediate community about what you're actually entitled to in terms of your rights. And again, how you can address it and stand up and speak for yourself in a moment. And then also how you can share about your individual experience and highlight that and promote that, so it doesn't happen to others.

Kristy Kade (22:19): Call on people to stand up against disrespectful behavior, and again, demand a better treatment and really create a local conversation and dialogue about that. Do it at your dinner table. Do it when you're in your doctor's office. Do it at a community meeting.

Kristy Kade (22:37): This can be addressed through policy and programming investment, but a lot of it needs to be challenging individual behavior.

Diana Copeland (22:44): That's great. It's on us.

Kristy Kade (22:46): Absolutely. Absolutely. I'm hoping in a year or two, we will not be talking about what women want, we'll be talking about what women got by continuing to demand and not just asking people to listen, but making sure people act on what we're telling them. And that includes ourselves.

Diana Copeland (23:05): I'm looking forward to that. Thanks so much Kristy for joining us.

Kristy Kade (23:08): Thanks Diana. Glad to be here.

Diana Copeland (23:13): Special thank you to Prime Minister Helen Clark, and to Kristy Kate for joining us as well as to Annie Arenas and Saima for sharing their stories of birth during the time of COVID.

Diana Copeland (23:23): This episode of Brave Voices, Bold Actions was produced by Diana Copeland, Elena Ateva, Stephanie Bowen, Nisha Singh, Navroza Sher Ali, Alma Ochoa, David Melendez Navarro, Nina Garcia Wright, Kendra Hanna, with support from the Research & Development Forum for Safe Motherhood in Pakistan, Comite Promotor por una Maternidad Segura En Mexico, and the entire White Ribbon Alliance team.

Diana Copeland (23:51): Our theme song is called Mama by Eric Wainaina and can be found on White Ribbon Alliance�s Advocacy in Audio. Learn more about the Respectful Maternity Care Charter, the What Women Want Action Agenda, and find links to more resources at WhiteRibbonAlliance.org/bravevoicespodcast.

Episode Team: This episode was produced by Diana Copeland, Elena Ateva, Stephanie Bowen, Nisha Singh, Navroza Sher Ali, Alma Ochoa, David Melendez Navarro, Nina Garcia Wright, Kendra Hanna, with support from the Research & Development Forum for Safe Motherhood in Pakistan, Comite Promotor por una Maternidad Segura En Mexico, and the entire White Ribbon Alliance team.

HOST

Diana Copeland

Senior Communications Officer

Diana Copeland joined White Ribbon Alliance in 2016 as the Communication Coordinator, working to strengthen and disseminate the organization’s message on its website and social media platforms, and was promoted in 2018 to Senior Communications Officer in order to oversee and grow White Ribbon Alliance’s digital and offline presence.

GUEST

Rt. Hon Helen Clark

Rt Hon. Helen Clark

Rt Hon. Helen Clark, former Prime Minister of New Zealand, is the Chair of the PMNCH Board. Helen Clark served three terms as Prime Minister from 1999–2008. In April 2009 she became Administrator of the United Nations Development Programme, while also chairing the United Nations Development Group, a committee consisting of all UN funds, programs, agencies, and departments working on development. As Administrator, she led UNDP to be ranked the most transparent global development organization. Follow Helen on Twitter at @HelenClarkNZ.

CONTRIBUTOR

Kristy Kade

Advocacy Manager

Kristy Kade joined White Ribbon Alliance in September 2017 with 15 years of policy, advocacy, and communications experience. She most recently served as the Director of Policy and Advocacy at PATH, where she was responsible for developing and implementing PATH’s strategy for advocacy in low-income countries, including the development of multi-year strategic partnerships and subgranting relationships with large international NGOs and local civil society organizations. She oversaw the development and implementation of advocacy strategies and capacity-building initiatives, was the primary donor liaison for country advocacy implementation and reporting, and has managed advocacy staff and projects in a portfolio of projects totaling over $20 million in more than ten countries across Africa, Asia, and Eastern Europe and spanning maternal, newborn, and child health, HIV, TB, malaria, family planning, nutrition, immunization, and global health research and development. She was the recipient of two PATH Vision Awards for organizational excellence and partnership.

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