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As head of the gender equality division and director of the development and surveillance programs for vaccines and enteric and diarrheal diseases at the Bill and Melinda Gates Foundation, Anita Zaidi is one of the world's most prominent voices on issues affecting women. women and girls.
In this interview, he talks about the sexist nature of the covid-19 pandemic and what it will take to ensure continued progress towards the Sustainable Development Goals (SDGs), despite the setbacks of the past year and a half.
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The gender-poverty link
Question:
In November 2020, you became the first president of the newly created gender equality division of the Bill and Melinda Gates Foundation.
In explaining what attracted you to that role, you said: “The root cause of many diseases is related to poverty, and poverty is sexist.
If gender inequality is not addressed, progress in both health and development will stall. "
What are some of the most significant ways that poverty disproportionately affects women, and how would progress on gender equality lift more people out of poverty?
Answer:
Without a doubt, poverty widens and deepens existing inequalities.
Gender inequality persists everywhere, but the experience is shaped by interconnected factors that develop and extend beyond gender.
These include race, socioeconomic class, age, sexual orientation, and disability.
Anita Zaidi, Gates Foundation
Women who are poor have fewer rights, fewer protections, and fewer options.
As a doctor, I have seen first-hand how women do not attend hospital appointments because they cannot miss work, they do not have their husband's permission to leave the house (sometimes even for medical emergencies) or they are needed for tasks unpaid family members.
I have seen teenage girls drop out of school to get married and stop being a financial burden on their families.
And I know that many mothers face an impossible choice between taking care of their children and working outside the home.
Gender equality is essential to lift people out of poverty
Gender equality is essential to lift people out of poverty. We know that interventions such as childcare assistance and universal health care are vital to women's well-being and financial prospects. Government investment in transportation, power grids, sanitation, and water can support women and ease the burden of unpaid work.
This is why the UK's decision to cut development aid is a blow to efforts to reduce poverty, particularly for women and girls. It is much more regrettable because the UK has been an advocate for women and girls in the past. At a time when all the evidence points to a sexist pandemic, when women's poverty levels rise sharply, donors need to redouble their commitment, not step aside.
Q:
Data from the United Nations Program for Women and the United Nations Development Program reveal that "for every 100 men between the ages of 25 and 34 living in extreme poverty" this year, "there will be 118 women". That means a total of 435 million women and girls living on $ 1.90 a day or less, including 47 million who were pushed below the poverty line because of the pandemic. This gap is expected to increase to 121 women for every 100 men by 2030. What interventions can reduce women's vulnerability to future shocks?
A:
Right now, there is a small window of opportunity to address inequalities and protect women in future crises.
This implies introducing social protection programs and policies for the most vulnerable people, especially women in the informal economy.
Governments should also accelerate the digitization of identification systems and payment platforms to ensure that the most economically marginalized women can access financial services.
Investing in high-quality and affordable childcare is essential for women - and for developing an inclusive and resilient economy more broadly.
By offering lines of credit and other forms of financing, governments can support women-owned businesses.
Q:
If you could wave a magic wand and launch some global intervention against poverty, where would you point first?
What are the biggest obstacles to overcome?
A:
Gender equality, of course.
The best way to address poverty is to break down the barriers that prevent women from reaching their potential.
Women face barriers everywhere - from making decisions about their bodies and accessing health care and education to pursuing leadership opportunities.
We have evidence that shows that they can have a substantial impact on the economy.
Today they contribute 37% of global GDP, including through unpaid work, which generates $ 11 trillion each year.
It would be remiss of me not to say that not getting vaccines to people in low-income countries today is a huge obstacle.
Covid-19 has caused large-scale unemployment and reduced incomes in many sectors.
The pandemic has also disrupted vital non-covid-19 vaccination programs around the world, substantially affecting health care and mortality.
A woman carrying her baby in a cassava plantation in Sierra Leone.Annie Spratt (Unsplash)
Rebuild again for women
Q:
In an interview last year, you stated that COVID-19 had exposed how "our world today is basically built on the backs of women and their unpaid labor."
How should care and unpaid work be reformulated or revalued after the pandemic?
What structures need to be "rebuilt better" (or built from scratch) to support economic participation and women's empowerment?
A:
Put them at the center of policy formulation and implementation.
Women's ability to work has direct consequences for poverty reduction, because the amount of time devoted to unpaid care is negatively related to female participation in the labor force.
The amount of time devoted to unpaid care is negatively related to female labor force participation
Proven solutions include investing in public services - such as running water, sanitation, electricity, and transportation - to reduce the effort and time women spend on household chores and provide childcare support and subsidies to help households better manage paid work and unpaid care.
At the same time, evidence shows that workshops, media campaigns, and school programs can help change attitudes towards unpaid care work.
Policies that encourage family-friendly leave and work arrangements can support women both directly and indirectly.
Governments and donor organizations also have to ensure that child care is included in financial stimulus and relief packages.
Q:
You mentioned that childcare should be considered a "vital piece of public infrastructure."
What are some of the most undervalued benefits, financial or otherwise, of investing in childcare?
A:
Investing in childcare is good for everyone.
The sector employs women and offers opportunities for them to own childcare businesses while at the same time freeing up others to engage in paid work or take advantage of educational or training opportunities.
A report by the International Finance Corporation shows that when companies invest in childcare, productivity and motivation improve for both men and women.
That, in turn, makes it easier for companies to hire and retain talented employees.
We know that the more household income women control, the greater the chances of investment in children's education
Investing in childcare is also an investment in human capital.
It provides children, especially girls from underserved communities, benefits such as early education and socialization that improve their learning outcomes, skills development, and income potential.
Q:
How can we change the mindset and attitude towards the economic potential of women, particularly in societies with deeply ingrained patriarchal values?
A:
First, you have to follow the money. There is a ton of evidence showing that women's economic empowerment benefits not only women themselves, but also their children, households, communities, and the broader economy. We know that the more household income women control, the greater the chances of investment in children's education and the lower the rates of child marriages and gender-based violence.
Women make up nearly 50% of the world's 5 billion working-age people, but only about half participate in the workforce, compared to 80% of men. The International Labor Organization has shown that reducing gender gaps in labor force participation can substantially boost global GDP. The larger the gap, the greater the benefit of narrowing it.
Proven solutions include investing in public services - such as running water, sanitation, electricity, and transportation - to reduce the effort and time women spend on household chores and to offer and subsidize childcare to help children. households to better manage paid work and unpaid care e economic justice and rights, to promote gender equality. We hope it will be the start of a multi-year process, establishing a platform and a program that demands accountability from leaders and drives faster progress towards the SDGs.
Q:
In the United States, funding from organizations that focus on women and girls makes up a very small percentage of philanthropic giving, despite the fact that gender equality is essential to so many other development goals. Why is it and how could it be corrected?
A:
Philanthropic giving to women's and girls' organizations in America reached $ 7.1 billion in 2017, which seems like a lot until you realize that that figure represents only 1.6% of giving overall. Between 2012 and 2017, philanthropic support from organizations dedicated to women and girls increased by 36.4%, most likely in response to increased awareness of gender issues, such as the World March of Women and the #MeToo movement. . While this is wonderful, there is still a huge need.
Likewise, we do not have basic data and figures, due to significant gaps in data disaggregated by sex.
We do not know what we cannot count or measure.
And measuring support for women's and girls' organizations is tricky because it comes down to how an organization defines the work itself.
Philanthropic giving to women's and girls' organizations in the United States reached $ 7.1 billion in 2017, representing just 1.6% of overall giving
Viewed in a positive light, female donors make up the majority of donors to women's and girls' causes. This shows that more women are acquiring wealth and using it to back them up. At the same time, we must not forget that gender equality is not just a women's issue. Men still hold most of the wealth; They have an essential role to play in supporting organizations and causes that will help us achieve gender equality.
An unanswered question is how pandemic relief will affect the donation landscape for women and girls.
We know that these increased dramatically in 2020, and that women have been more adversely affected by the social and economic repercussions of the pandemic.
We will see what role this plays for organizations that support women and girls specifically.
The gender-health link
Q:
Health is an important factor in gender equality.
Are there exemplary health systems that work well for women or models of work that can be scaled up or replicated?
A:
It is true that there are significant gender disparities in health and that health systems are not gender neutral.
Women face multiple challenges: not only do they have to take on the responsibilities of caring for their families, but the parts of health systems that primarily care for women are often the most fragile and the worst funded.
Health systems are not gender neutral
For health systems to work for women, it is necessary to understand the challenges at all levels.
This includes collecting data that is disaggregated by sex, so that we are aware of trends in service use and health outcomes.
This is how it is ensured that health facilities and medical workers are equipped to meet the needs of women and girls.
A great example of systems design for women is Bangladesh's effort to train thousands of community health workers (most of them women).
This has increased access to skilled midwives and has led to more integrated reproductive health services, where family planning, prenatal care and neonatal care are all in one place.
Q:
Are there issues that are not being discussed in terms of global public health, but should be discussed?
A:
There is still a huge lack of investment in research and development for groups historically excluded from medical research. An obvious consequence of this is the lack of vaccines for diseases that mainly affect low- and middle-income countries. While we have had recent progress, such as the development of new typhoid vaccines, we still do not have an effective vaccine against tuberculosis, HIV, or reproductive tract infections. In terms of access, the majority of women and girls in sub-Saharan Africa have yet to receive the human papillomavirus vaccine against cervical cancer, one of the deadliest cancers for them.
Likewise, innovation in women's health tools has stopped. On average, pharmaceutical companies spend just 2% of their contraceptive sales revenue on research and development of new products, far less than the industry average for other drugs. However, contraceptive options still do not meet the needs of all women and girls. To address this issue, we need R&D in contraceptive technologies, as well as investment in new platforms that can offer discreet, convenient and affordable family planning services and information.
Q:
Through your work as director of diarrheal and enteric disease and vaccine development and surveillance programs at the Gates Foundation, and your research on immunization-preventable diseases in resource-limited settings, you have excelled in more than one occasion the crucial role of well-trained community health workers. What else can we do to support them, and what needs to be done to overcome the global shortage of these staff, particularly in low-income communities?
A:
Healthcare workers are truly the center of the health care system and are integral to providing immunization services. Supporting them involves investing in health and education at all levels: helping children go to school, creating training programs, and then supporting health workers with the resources, such as personal protective equipment, necessary to provide care for children. high quality safely.
This, in turn, requires focusing on the leaders who make the high-level decisions. Women make up 70% of the global healthcare workforce, but only 25% of senior positions in global healthcare are held by women. This lack of representation not only delays them and wastes their talents; many times it also results in non-gender responsive health policies, which can have devastating consequences. The economic and educational empowerment of girls and women is part of the solution to this problem. But we must also ask the men in the field to support their female colleagues.
Q:
In 2019, you praised recent successes in delivering vaccines to vulnerable countries.
But when it comes to COVID-19 vaccines, we are seeing serious global disparities.
How can the current vaccine distribution infrastructure be adapted to improve that situation?
A:
We now have many safe and effective vaccines against COVID-19.
The biggest challenge for most countries at this point is unequal access to a consistent supply.
We need higher-income countries to redouble their efforts by donating doses or contributing to Covax, the global effort to ensure equitable distribution of covid-19 vaccines.
Rwanda distributed 96% of its covid-19 vaccines in the first two weeks of its campaign by converting its existing infrastructure
When it comes to the infrastructure itself, many low- and middle-income countries actually have more experience than rich countries with effective vaccine delivery and mass immunization. We are already seeing good results in this matter. For example, Rwanda distributed 96% of its covid-19 vaccines in the first two weeks of its campaign by converting its existing infrastructure; including a skilled health workforce and data management system, which was originally created for routine immunization. Global partners, such as the World Health Organization, Unicef and Gavi, the Vaccine Alliance, are also constantly working with countries to strengthen this infrastructure.
Q:
More generally, how can communities everywhere better prepare for the next pandemic?
A:
The world has learned a lot about what it takes to prepare for the next pandemic.
We have seen everyone from scientific researchers and global healthcare organizations to frontline workers innovate to respond to COVID-19 in the most effective way possible.
But after this emergency has passed, countries must continue to work together to create and maintain a permanent infrastructure for epidemic preparedness and response.
At the national level, this requires strengthening health systems so that health care workers can do their day-to-day prevention and treatment work.
Around the world, it will require investment in cutting-edge disease detection and the ability to research, develop and manufacture billions of doses of safe and effective treatments and vaccines against new diseases.
So effective preparation for the next pandemic will require a combination of significant investment and considerable collaboration, a country-by-country strategy will not solve it- It will cost billions of dollars from all sectors, but as we are seeing today, not investing thousands of Millions of dollars will cost the world many trillions of dollars in the long run.
Lessons from the field
Q:
You have spent much of your professional life working both in Pakistan and in the West.
How important was this to you not only personally but also professionally?
A:
My life and work experience in Pakistan has had a considerable influence on my career in maternal and child health, as well as in advocating for women's equality.
I have thought a lot that we are designing systems of care that do not serve them and that global health does not work for them.
For example, I saw how women are invariably the ones who bring their children to the clinic for immunizations, yet the design of the programs was not focused on their needs.
Women have to make one trip to the clinic for immunizations, another for family planning, a third for postnatal care, and so on.
A woman can walk for hours with a baby in her arms or on her back to get there and the health service she is looking for is not available that day
Many times, the availability of services is irregular. A woman can walk hours with a baby in her arms or on her back to get there and the service is not available that day. A community may have the best health services, but if we expect women to stand in line for hours and have to spend half a day away from their market stall or work at home, are we genuinely helping them overcome the barriers? ? As soon as you put a gender lens on something, you can see where the disproportionate impacts are.
Q:
In 2013, you were awarded the Caplow Children Award for your work to bring health services to mothers and children in low-income areas of Karachi. What did you learn from that experience, and what are some of the most innovative solutions you have seen or used to improve health outcomes in resource-poor settings?
A:
Our goal was to reduce maternal and child deaths, increase prenatal care rates, and improve immunization rates.
We integrated services for them, so that access was easier and more agile, while generating support through an active commitment of the community and coordination of care, and we offered them transportation.
For working mothers, we made sure they had midwives as qualified assistants at birth.
Extreme poverty, gender inequality, patriarchal norms, maternal malnutrition, and lack of access to advanced-level obstetric care create structural barriers
We learned that an integrated, patient-centered strategy could rapidly improve health indicators.
But we also saw how extreme poverty, gender inequality, patriarchal norms, maternal malnutrition, and lack of access to advanced-level obstetric care create structural barriers that impede progress beyond a certain level.
These systemic issues must be resolved to meet the SDGs by 2030.
Q:
You helped create the WomenLift Health program, which seeks to promote diversity in global health leadership.
How can this goal be framed in local contexts to improve health equity and health outcomes?
A:
Women make up an
untapped and underutilized talent
pool
.
We all make better decisions when we work with diverse teams that bring a range of lived experiences and perspectives to the table.
The benefits of diversity have been repeatedly demonstrated in corporate governance research, and all indications are that the same results apply in other domains as well.
Leaders should resemble the communities they serve, both locally and globally.
Copyright: Project Syndicate, 2021. This interview was originally published in
English
.
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