Opinion: 'Heroines of health' face risks amid women's rights rollback

Preventing maternal deaths, giving contraceptive information to teenagers, getting clinical support for women in local communities: These are just some of the things motivating women health workers in Africa who will receive the 2023 Heroines of Health Awards in Kigali, Rwanda on July 19. This year’s awardees include community health workers, nurses, and doctors who, despite being from 10 different African countries and having different backgrounds and specialities, have a common backstory. They are women health workers who had to break through barriers throughout their careers to deliver the care they needed to give to their communities. Reading their stories, we were struck by the already difficult situations each of the heroines have faced. But we are more alarmed when we consider their hard-fought wins are at risk in the context of a global pushback on women’s rights. In the outcome of the Group of Seven leading industrial nations summit in Hiroshima, Japan, in May, heads of state made an extraordinary statement about sexual and reproductive health and rights, SRHR, in their accompanying universal health coverage commitments: “Given the well-coordinated and funded rollback on gender and rights movement at country and multilateral levels, the G7 will step up our efforts to work together on promoting SRHR and explore ways to assess the impact on sexual and reproductive health services and rights.” Their reference to a growing rollback — which was unusually undiplomatic — hit hard. This rollback is impacting women in all regions of the world. It includes Africa, where women and adolescent girls already have some of the world’s highest maternal death and morbidity rates, along with low access to modern contraceptive methods and safe abortions. Campaigns to convert or revert to “family values” will lead to more preventable deaths of women and young girls in pregnancy, childbirth, and from unsafe abortions. In many countries, women and girls are still suffering the negative impact of the pandemic on their health and well-being. “Family values” is code for the progressive denial of information, contraceptives, and safe abortion to women and girls — who are forced into bearing children earlier than they would plan to, having more children than they want, or dying sooner than they were meant to. The groups promoting family values are often funded by religious groups, many coming from the United States, where they are buoyed by recent wins from their well-planned campaign to roll back legal protections at the national level and language protecting women’s rights in United Nations agreements. They circle decision-making dialogues at the diplomatic and ministerial levels, applying unrelenting pressure to weaken and remove any recognition or commitments to sexual and reproductive health care and rights. Given our roles in the 2023 Heroines of Health Awards and as women leaders in health, we are appalled by the speed and scale of this global rollback on decades of progress. Women health workers such as the 12 heroines of health are the backbone of our health systems, comprising the majority of health workers and accounting for almost 90% of nurses and midwives globally. They play a crucial role in counseling and supporting women to access a range of modern contraceptives and make informed decisions about high-risk or unwanted pregnancies. Unfortunately, they face increasing challenges when carrying out this essential work. From violence and harassment within facilities to online abuse, from legal threats or defunded services, women health workers are on the front lines. Despite the intimidation, the dangers, and the moral injury, many put themselves at daily risk to provide care and support to women and girls. When SRHR services are defunded or deprioritized, health workers are unable to assist service users in need of vital information or support. This results in a significant gap in the provision of essential health care services, further marginalizing women and girls and impeding their right to health and bodily autonomy. Despite commitments made by United Nations member states almost 30 years ago, many women and girls around the world still lack access to comprehensive sex education, modern contraception, and safe abortion. The resilience of health systems, the protection of fundamental rights of women and girls, and ensuring SRHR all rely on the dedication, expertise, and bravery of women health workers. By recognizing their vital contributions and offering them the necessary support, we can foster progress of women's and girls' rights worldwide, ensuring improved well-being and upholding the principles of human rights. While health workers are facing increasing uncertainty and danger on the frontlines, those in the programmatic, policy, and political spaces must back them up with the strongest possible advocacy against the rights rollback campaign. We owe it to the millions of heroines of health who are doing their bit as agents of change and protection in their communities. Now leaders, with considerable experience and commanding respect in their roles, the 2023 heroines have something else in common — they are calling for action. As Ethiopian Heroine of Health Worknesh Kereta Abshiro said, “There are 33 million adolescents and youth in Ethiopia … We need to help them get age-appropriate SRH information and services, raise their own voices to participate in the policy-making process, engage in community action and become active citizens.”