“After a period of populist nationalism…multilateralism is back, and climate is the multilateral challenge of the moment,” said David Lammy, a member of Parliament for Tottenham in the United Kingdom and Shadow Secretary of State for Justice, in a recent 21st Century Diplomacy event, co-hosted by the Wilson Center and adelphi. The election of Joe Biden and Kamala Harris is not a “reset,” but rather a catalytic moment for the international community precisely because of the pandemic and consequences for the global economy, he said. When you look at who has been left behind in countries like the United States and United Kingdom, and globally, who is at risk climate impacts, it is “black and brown people suffering all over the planet, and that is a call to arms,” said Lammy.
While climate change poses threats to human security, climate responses can provide opportunities for human progress. “The reality is that as we face the COVID crisis, an economic crisis as a result of that, and a crisis around inequality and inclusion, we see that climate solutions, climate action, are perfectly poised right now to be drivers of job creation, growth, inclusion, sustainability, and resilience,” said Jennifer Austen, Director of Policy and Strategy for COP26. It is a myth that society faces a binary choice between protecting the planet and growing the economy. “There is a real recognition amongst businesses, investors, cities, states, both in the risk of inaction and the opportunities of taking action,” said Austen.
For some U.S. states, equity is increasingly becoming the core of their climate policies, said Julie Cerqueira, Executive Director of the U.S. Climate Alliance. Specifically, we may look to state climate policy for examples of how to not only avoid introducing additional burdens for communities, but to also reverse past damages, said Cerqueira. California, for example, recently moved towards 100 percent zero-emissions vehicles by 2035, including heavy duty vehicles. “Vulnerable communities, communities of color, are the ones that are around ports, they’re the ones that around highways, they’re the ones that around sort of the transit corridors for these heavy duty vehicles,” said Cerqueira, “and by focusing on addressing pollution from heavy duty vehicles, you are alleviating a lot of the pollution that those communities are sustaining.”
Having robust, sustained dialogue with stakeholders is extremely important, said Cerqueira. “Likewise, it’s looking at job growth and making sure that it’s not just creating new jobs, but that there are real pathways to those jobs for vulnerable communities, which means the right training for jobs that exist in those areas.” Economic diversification must be a part of planning as well, Cerqueira said. “If you’re going to be closing a coal plant or going to be converting a plant that is focused on producing gas vehicles, what is the strategy for diversifying the local economy, because it is not easy to just replace what ends up being the core economic driver in those places.”
“We focus a lot on federal policy in the U.S., especially as federal policy relates to climate, but the truth is that most of these decisions are taking place at the hyper-local level,” said Elan Strait, Director of U.S. Climate Campaigns for the World Wildlife Fund. “And how this relates to what we’re talking about in terms of race and equity—the best predictor of where a coal plant is going to be in the United States is the race of the surrounding community, not the income level or the education level of the community,” said Strait. “If black and brown communities had as much political power at the local level in the United States as white communities do, I don’t know that we’d have coal plants in the United States—anywhere.” Giving communities much more authority to determine what goes on in their backyards could help solve a major emissions problem in the United States, said Strait.
Sources: American Chemical Society, Deloitte, National Bureau of Economic Research, State of California, US Department of Energy, World Economic Forum, World Resources Institute
Camille Harris, Registered Māori Midwife, is unapologetic about her decision to study midwifery and practice exclusively with Māori families, in this week’s Friday Podcast. “It was always to serve my people,” she said. Both Harris and her professional partner, Registered Māori Midwife, Waimaire Onekawa, started their midwifery careers later in life with a clear dedication to Māori women in New Zealand. “And we just want to be able to give women—Māori women—and whanau [family], the love and care that we would hope to receive if we were the people being the recipients,” said Onekawa.
Investing in indigenous midwifery is critical, said Onekawa. Indigenous midwives understand indigenous birthing practices, such as the Māori practices of returning to a woman’s papakainga (homeland) for the birth; welcoming the baby into the physical realm with traditional waita and karakia (songs and prayers); tying the umbilical cord with muka (a flax fiber); burying the placenta; and putting newborns to sleep in a wahakura (traditional woven bed), as well as subtler cultural nuances. “They understand us,” Onekawa said of the women they serve. “We have this innate sameness. Even if we’re not exactly the same, we know the experiences they’re having. It’s highly likely that we’ve had them too.” This understanding helps Māori midwives provide culturally respectful care, she said.
Unlike post-colonial birthing that tends to exclude men, Māori midwifery focuses on traditional practices, when men and family were included in the birth process. Onekawa and Harris encourage fathers (as opposed to medical professionals) to be the first to touch their baby, so that “their heritage, who they are and where they’re from, and all that they carry” is passed onto the baby from the start, said Harris. This is a powerful moment of cultural reconnection and can have long-term benefits for fathers, especially considering the past traumas of Māori men, she said. “And you see that change in them from the moment they lay their hands first on their baby,” said Harris. “They’re just beaming for weeks and weeks after, and it’s just so beautiful to see the softer side of these men being reborn through that process,” said Onekawa. Having men there from the start improves outcomes for mothers and babies, as men also become more involved in postnatal care, she said.
Although midwives are essential, Camille and Waimarie both stressed that the real strength lies within the women they serve. Midwives are just “the enabler, the fire starter,” empowering women with the knowledge to realize their own strength and keep themselves and their babies well, said Harris. “We’re public servants at the end of the day,” said Onekawa. “We’re just here to help guide them through their journey. And what a pleasure at the end that we get to be a witness to them bringing their new baby into the world.”
“We need to give more weight to the voices of people who are most affected by climate change,” says Vanessa Nakate, a prominent Ugandan climate activist, in this week’s Friday Podcast. At the local, regional, and global levels, Nakate’s work sheds light on the imperative for policymakers to value the lived experiences of oft-overlooked groups such as women, youths, and citizens of developing nations. “When I talk about climate justice, it is not something that I want for the future—it is something that I want right now, because our present is catastrophic,” she says.
Nakate began her journey as an activist in 2018. With a desire to catalyze the betterment of her community and country, she investigated people’s needs and determined that climate insecurity presents a fundamental challenge. “Everything I was seeing in the news—in regard to the landslides, to the floods, to the droughts in my country—they had a connection with climate change.”
Uganda relies heavily on agriculture to support livelihoods, putting the country on the front lines of climate change. “The changing weather patterns are a danger to us because they are causing shorter and heavier rain seasons, and longer and hotter dry spells,” says Nakate. Beyond the threat of economic and food insecurity, uneven rainfall presents a public safety risk. Nakate says that the water levels can submerge people’s homes, farms, and businesses. “It’s quite dangerous to walk in the middle of the city after a heavy downpour because you could step in a ditch and the next time they see you, you’re already gone,” she says.
Nakate led her first climate strike in early 2019. “We are doing everything we can to hold governments accountable and to demand climate justice,” says Nakate. Part of her message is urging political leaders to divest from fossil fuels and to combat corporate pollution. “Around one hundred corporations are responsible for 71 percent of global emissions,” she says. “We should move from just talking about how badly they are destroying our home, our planet, to actually holding them accountable.” In pursuit of this accountability, Nakate spoke of the need to prosecute ecocide in international courts, describing environmental destruction as a crime against humanity, ecosystems, the present, and the future.
In addition to championing climate justice in the international arena, Nakate is working to build resilience for local communities. In 2019, she started a project installing solar panels and clean cooking stoves in education facilities. “I wanted to drive a transition to renewable energy, especially in rural schools,” says Nakate, adding that energy inaccessibility and food insecurity hinder the learning process. “The students have to eat, no one can study on an empty stomach.”
In a year that has presented enormous challenges, it is even more gratifying to present evidence that strengthens the importance of midwives as providers of essential sexual and reproductive health (SRH) services and the impact they can have on maternal and neonatal mortality and stillbirths, said Anneka Knutsson, Chief of the SRH Branch at the United Nations Population Fund (UNFPA) in this week’s Friday Podcast. Knutsson spoke at a recent Wilson Center event, in partnership with UNFPA and Johnson & Johnson, to launch the Impact of Midwives study conducted by UNFPA, the International Confederation of Midwives (ICM), and the World Health Organization (WHO) and published in The Lancet Global Health.
This research will provide an updated, evidenced-based, and detailed analysis of the present progress and future challenges to deliver effective coverage and quality of midwifery services, said Knutsson. The study will enable stronger policy dialogue within countries and strengthen existing sexual, reproductive, maternal, newborn, and adolescent health services, said Knutsson.
This study also adds confidence to findings from the 2014 Lancet paper on midwifery, said Andrea Nove, Technical Director of Novametrics and lead author. The study examined four scenarios of coverage for midwife-delivered interventions: 1) a modest 10 percent scale up every five years, 2) a substantial 25 percent scale up in the same time period, 3) universal coverage, and 4) a decrease in coverage. The data showed that a substantial 25 percent scale up by 2035 could avert 40 percent of maternal and newborn deaths and one-quarter of stillbirths. That would translate to 2.2 million fewer deaths by 2035, said Nove.
The study specifically focuses on “midwife-delivered interventions,” said Nove. Such interventions must directly affect mortality or nutritional status, be listed in the Global Strategy for Women’s, Children’s, and Adolescent’s Health, and be able to be delivered in entirety by a midwife trained to ICM standards, said Nove. “Nobody is suggesting here that midwives should be left alone to deliver these interventions. But we did want to highlight the fact that they are an occupation group, which can have a massive impact,” said Nove.
Franka Cadée, President of ICM, could barely contain her excitement about the study. “And I’m excited mainly, because this paper supports and confirms growing scientific evidence that should be celebrated by every woman and every midwife worldwide. And of course, if we care about healthy families and the healthy future generation, it should be celebrated by everyone worldwide,” she said. “Midwifery has a long-term impact. And this paper shows that.”
In addition to decreased maternal deaths, neonatal deaths, and stillbirths, greater access to midwifery care worldwide could improve many other aspects of reproductive health. For example, in many high-income countries, midwives provide contraceptive care, abortion services, antenatal care, breastfeeding care, cervical cancer screening, and immunizations, said Cadée, and these types of care should be accessible through midwives globally. “So what it boils down to,” she said, “is that women worldwide should have access to midwives, who’ve been educated to the standards of the International Confederation of Midwives, and who are supported by a team and that magic word, the enabling environment.”
“If we implement this evidence, the world would look brighter,” said Cadée. “Not just for midwives and women, but for humanity.”
Sources: The Lancet Global Health, World Health Organization.
“If solar radiation management were done well—that is, the science is right, the engineering is right, and the policy and governance frameworks around all of the stuff work—then solar radiation management could be a really important, positive contribution to humanity’s responding to climate change,” says Simon Nicholson, associate professor at American University’s School of International Service and co-founder of the Forum for Climate Engineering Assessment in this week’s Friday Podcast. “But, there are all kinds of risks associated with this endeavor.”
Solar radiation management (SRM) denotes a set of ideas about responding to climate change by reflecting solar energy back into space before that energy can be captured by greenhouse gases and cause temperatures to rise. Proposed SRM techniques include stratospheric aerosol injection (introducing reflective particles, like sulphur dioxide, into the stratosphere) and marine cloud brightening.
SRM could enter the scene very quickly, bringing massive and far-reaching implications with them, says Nicholson. “We’re talking about potentially intervening in the climate system in a way that drastically reduces global average temperatures in a very short span of time, which could have massive positive implications, but could also, if mishandled, have massive negative implications.”
Although scientists say it will likely be a couple of decades before SRM technologies are ready to deploy, avoiding the potential downsides of SRM will require anticipatory governance to shape SRM research and manage its deployment. “[I]t's much better to try and shape something like this on the front end than to respond to it when it's suddenly in the world,” says Nicholson.
While a coordinated, well-designed international effort is not impossible, it is more likely that SRM initiatives will be more scattered throughout the world, says Nicholson. The Australian Government is already experimenting marine cloud brightening to cool the area around the Great Barrier Reef, which has been severely impacted by higher temperatures. There have also been efforts in the United States to begin outdoor experimentation on stratospheric aerosol injection. Without anticipatory planning that helps to shape the research on solar radiation management and its eventual deployment, people will respond to these experiments as they emerge, says Nicholson, resulting in a “co-creation of a scientific research agenda that's more expansive, and at the same time, governance apparatus around them."
SRM has remained on the fringes of conversations about climate change, in part due to concerns that even conversations about its potential might distract politicians from taking action to properly mitigate climate change. Indeed, SRM is no silver bullet, says Nicholson. Solar radiation management only dampens the temperature signal. If greenhouse gases continue to be released into the atmosphere, as soon as you stop the solar radiation management, the warming will continue. “Solar radiation management would be just one small piece, alongside all of the other things that need to be done,” he says.
Even so, SRM research is already underway, and excluding it from climate discussions will not change this, says Nicholson. “Whatever one thinks about solar radiation management as a good or bad idea, the governance challenge still remains.”
If there’s anything about responding to an epidemic, it’s that speed matters, and so does investing in people closest to the problem, said Dr. Raj Panjabi, Assistant Professor of medicine at Harvard Medical School and CEO of Last Mile Health, in this week’s Friday Podcast. The latter, he said, is the root of resilience.
In addition to threatening immune systems, COVID-19 is a serious threat to the broader health system and to non-COVID-19 health care. Drawing on lessons from the Ebola outbreak, Panjabi said that the best system is an everyday system capable of surging in a crisis. Creating such a system would involve sufficiently funding community health workers before communities experience a state of emergency.
In the absence of existing and well-funded health systems, communities are left scrambling in a crisis and quality of care declines as a result. During the Ebola epidemic, the availability of skilled facility-based birth attendants across Liberia plummeted three-fold because health workers were becoming infected, Panjabi said. To complicate the issue further, health systems had poor infection control, and people were afraid to go to the hospital. Even in low-transmission areas, expectant mothers who believed they could get an infection from a health worker in a health center were about 50 percent less likely to go to the hospital for the birth, said Panjabi.
However, there were cases of strong community-based responses. South Africa, for instance, had about 27,000 HIV & TB community health workers who were retrained. They went on to screen more than 11 million people—about 20 percent of the population— and help detect COVID-19 at the community level in the first months of their pandemic, Panjabi said. South Africa managed to do this because it had been already investing in everyday health workers. And Liberia has improved its health systems since Ebola as well. One in two rural children with malaria are being tested and treated “by their neighbors, by community health workers,” said Panjabi.
These case studies illustrate why it is crucial that community health workers in Africa—most of whom are women from poor communities—should be viewed as invaluable employees rather than as informal volunteers. After all, investing in community health workers is not simply a health issue, said Panjabi. The COVID-19 pandemic has been a reminder that robust health systems can benefit both the economy and the security of nations, he said. Based on fiscal stimulus projections from the UN Economic Commission for Africa, Panjabi said that allocating just $2 to $4 billion of a $100 billion budget would help fund a potential pandemic health workforce that could not only help us deal with this current pandemic but help us become better prepared for the next one.
For every dollar invested in community health workers, there is ten dollars’ worth of economic return. That stimulus provides protection against the next outbreak and allows patients to lead longer, healthier, and more productive lives, said Panjabi. “But it’s also one of the fastest ways to create jobs for young people on the continent,” he said.
“Vaccine hesitancy is to be expected in a normal circumstance—it’s very different from being what we call ‘anti-vaccine,’” says Dr. Rahul Gupta, Senior Vice President and Chief Medical and Health Officer at March of Dimes, in this week’s Friday Podcast. He spoke at a recent Wilson Center event on ongoing efforts to develop and deliver a COVID-19 vaccine, co-sponsored by the University of Pittsburg, March of Dimes, and the Jonas Salk Legacy Foundation. "It is normal for average citizens and residents to be questioning the vaccine before they take it into their bodies. That's where the transparency of the manufacturing process, the regulatory process, and building trust in that system is so critical and important. It is not wrong, at all, to be hesitant. What is important is to demand that we have a safe and effective vaccine," said Gupta. “Leadership matters,” said Dr. Lisa Waddell, Chief Medical Officer of COVID-19 Emergency Response at the CDC Foundation. “If we have a consistency in messaging around the vaccine and everyone is actually sharing that message, then yes, it is going to build trust.” It is important to communicate early, often, and in different ways to ensure that people receive these messages, said Waddell. We also have to consider the role health inequities and racial injustices play toward vaccine hesitancy, particularly in African American and Latinx populations, and provide information on the COVID-19 vaccine and address concerns through trusted messengers, said Gupta. “It is good to ask questions and it is good and important to have trusted messengers in front of you who can answer the questions, who can relate, who can communicate,” said Dr. Paul Duprex, Director of the Center for Vaccine Research and Professor of Microbiology and Molecular Genetics at the University of Pittsburgh. “We have before us a national and a global teachable moment when it comes to vaccines,” said Dr. Ruth A. Karron, Director of the Center for Immunization Research and the Johns Hopkins Vaccine Initiative at the Johns Hopkins Bloomberg School of Public Health. While vaccines are regularly researched, developed, and deployed, the process is not often on center stage. This gives us an opportunity to really educate the public, said Karron. “And I think that if we do this right, we could not only increase confidence in COVID-19 vaccines, but increase confidence in all of the vaccines that we deploy.” “It's important to remember that we need to champion these products, we need to show what they have done in the past,” said Duprex. Polio, which ravaged the world’s youth for decades, has been “pushed to the edge of eradication by safe, efficacious vaccines,” he said. “I think we have to remember not to forget. Not to forget what these diseases did in the past and to actively collaborate, to work with each other, and to communicate well that vaccines work.”
Globally, Indigenous women experience worse maternal health outcomes than non-Indigenous women. In the United States, the risk of maternal death is twice as high for Native women than for white women, while in Australia the risk is four and a half times higher. This week’s edition of Friday Podcasts highlights remarks from a recent Wilson Center event with the United Nations Population Fund (UNFPA) and the International Confederation of Midwives about Indigenous midwifery.
“The decline of Indigenous midwifery really happened through the outlawing and the denigration of Indigenous midwifery, and was an attack on our Indigenous knowledge systems, our ways of being, our ceremonies and our practices,” said Claire Dion Fletcher, an Indigenous Potawatomi-Lenape Registered Midwife and co-chair of the National Aboriginal Council of Midwives. “The control of Indigenous women through the, at times, violent control of our reproduction was and continues to be a tool of colonization.”
“In the 19th century with the medicalization of birth, there was a decline of midwifery in Canada, almost to the point of non-existence,” said Fletcher. Yet Indigenous women still wanted to have traditional births according to their customs and knowledge. “The Inuit women in Nunavik wanted Inuit midwives,” she said. “They wanted to give birth in their communities with their families surrounded by their knowledge and their teachings.” To this day, the resulting community-driven Inuit midwifery program has some of the “best health outcomes in the world,” said Fletcher.
Similarly, colonization played a key role in the decline of Indigenous midwifery in New Zealand, said Nicole Pihema, Māori Registered Midwife and President of the New Zealand College of Midwives. In New Zealand in 1840, British colonizers and Māori leaders signed a document intended to ensure that the British would not interfere in Māori life, said Pihema. But instead, the colonial government continued to interfere in Māori life by passing harmful legislation including the Tohunga Suppression Act of 1907, which led to the desecration of Māori midwifery practices. However, there is a resurgence within Māori midwifery to try to rediscover traditional practices, said Pihema. This resurgence requires a commitment to normalizing inclusive language, “because you can teach cultural competency all you want, but you're never [going to] get it unless you know the language,” she said.
“In Mexico, midwifery has existed even before we were colonized by the Europeans,” said Ofelia Pérez Ruiz (through a translator), an Indigenous Registered Midwife and spokesperson for the Chiapas Nich Ixim Movement of Traditional Midwives. “And traditional midwifery in Mexico has been here despite criminalization and going through exclusion policies,” she said. In Mexico, Indigenous midwives are not included in conversations about maternal health. “They [doctors and health institutions] don't take us into account as part of the maternal and neonatal care,” said Pérez Ruiz. “We want to have a relationship with health institutions, but based on respect. We wanted to work along and hand in hand with the doctors using those skills and knowledge of all of us as a team … so that indigenous women will receive a timely care and respectful care during their pregnancy, birth, and after birth.”
“Unintended pregnancy and abortion are reproductive health experiences shared by tens of millions of people around the world, irrespective of personal status or circumstance. What differs though are the obstacles,” said Dr. Zara Ahmed, Associate Director of Federal Issues at the Guttmacher Institute in this week’s Friday Podcast. Research from the Guttmacher Institute on sexual and reproductive health (SRH) found that in 2018, there were 121 million unintended pregnancies globally, and of those, 61 percent ended in abortion. About half of these abortions were in unsafe conditions and led to approximately 23,000 preventable pregnancy related deaths, said Ahmed.
“A major finding of our research is about the legal status of abortion,” said Ahmed. “This is important. Abortion rates are the same where abortion is broadly legal and where it's restricted - exactly the same.” Guttmacher research shows that in settings where abortion is restricted, the proportion of unintended pregnancies that end in abortion increased nearly 40 percent over the last 30 years.
“There are persistent inequities in meeting needs for contraceptive services,” said Ahmed. Today, 923 million women want to avoid a pregnancy and among these women, about one in four, or 218 million, have an unmet need for modern contraceptive methods. Unmet need for modern contraception is higher in low-income countries and for adolescents than it is in high- income countries and for older women. In order to meet this global need for family planning, the United States must restore funding for UNFPA and increase funding for global family planning and reproductive health programs, said Ahmed.
The COVID-19 pandemic has threatened access to SRH services worldwide. A decline of 10 percent in access to SRH services, said Ahmed, would lead to “an additional 49 million women with an unmet need for modern contraception, an additional 15 million unintended pregnancies, an additional 28,000 maternal deaths, an additional 168,000 newborn deaths, and an additional 3 million unsafe abortions, as well as an additional 1,000 maternal deaths due to unsafe abortion.”
“In the middle of a global pandemic, the Trump administration is trying to make it harder for people to get the [SRH] care they want and need. A few weeks ago, the administration announced that it's proposing to expand the dangerous and harmful Global Gag Rule even further than it already has,” said Ahmed. The Global Gag Rule (GGR) is a policy that “prevents foreign NGOs that receive U.S. funds through grants and cooperative agreements from using their own non-U.S. funding to provide abortion services, information, counseling, referrals, or advocacy,” she said. Guttmacher research in Uganda shows that the GGR led to a “reduction in the number of community health workers, engaged in family planning work.”
“People are complex and they live multifaceted lives with changing [SRH] needs,” said Ahmed. The global community must invest in the full range of SRH services to meet these needs. “Doing so is a smart investment, but it's also the right thing to do.”
“I believe that we're experiencing a national reckoning and in this unique moment, I definitely see an opportunity for Congress, but also for our local governments to enact policies that begin to address our country's greatest ills,” said Representative Alma Adams (D-NC-12) at a recent Wilson Center event on women, race, and COVID-19 in the United States. “COVID-19 has revealed what the Black community and communities of color have known for a long time—health outcomes are further compounded by systemic and structural racism. COVID-19 has exposed what women have known for a long time—gender inequality exists, it threatens economic empowerment, and it increases vulnerabilities.”
“The pandemic has shown us in the starkest terms how wide the gaps are in health outcomes between Black and White America and between men and women,” said Rep. Adams. Black women, regardless of their educational level or socioeconomic status, are nearly four times more likely to die from preventable pregnancy-related complications than women of other races. “The United States has the highest maternal mortality rate among affluent countries because of the disproportionate death rate of Black mothers,” she said. “Black maternal health in the coronavirus era is truly a crisis within a crisis.”
“The pandemic has completely wiped out the historic job gains women have made over the past decade,” said Rep. Adams. Before COVID-19, women made up the majority of the U.S. workforce. They are highly represented in the sectors most impacted by the pandemic. Women are the majority of essential workers, and non-white women are more likely to be doing essential jobs than anybody else, said Rep. Adams. “The work that they do has often been underpaid, undervalued, and an unseen labor force that keeps the country running.”
While there has been a positive reduction in women’s unemployment since the pandemic’s onset, most of those impacted are mothers. 41 percent of mothers, and close to 80 percent of Black mothers are the breadwinners for their families, yet continue to face wage inequality. “They're doing the providing, yet they're not getting the income,” she said. “We deserve equal pay for equal work. You know working hard is not enough if you don't make enough.”
“We are finding that from the offset of the COVID-19 pandemic there has been an increase in gender-based violence around the world. For every three months of lockdown, there will be an additional 15 million cases of gender-based violence,” said Sarah Barnes, Project Director of the Maternal Health Initiative and Women and Gender Advisor at the Wilson Center.
“As a survivor myself of domestic violence, I know firsthand how important it is that we keep working to pass and strengthen legislation to improve services for survivors like the Violence Against Women Act,” said Rep. Adams. “I see a tremendous opportunity for Congress and our society, as well, to pursue transformational structural change because the system isn't working for so many people, especially women and minorities, and it really is time to try to do something else.”