1. Why is out-of-school comprehensive sexuality education so important? What gaps does it address and who might it reach that traditional CSE does not? EWEC advocates for the well-being of women, children, and adolescents, so we would be especially interested in hearing about the impact of CSE on these groups. 

Let me first explain how we came to the current understanding of CSE. The term Comprehensive Sexuality Education is relatively new, and its rights-based and gender-focused definition became widely used, largely due to UNFPA, after it was adopted in its Operational Guidance for CSE in 2014. The next milestone was reached four years later when the UN International Guidance on CSE (ITGSE) provided the first  joint UN definition on CSE as a “curriculum-based process of teaching and learning about the cognitive, emotional, physical and social aspects of sexuality. It aims to equip children and young people with the knowledge, skills, attitudes and values that will empower them to realize their health, well-being and dignity; develop respectful social and sexual relationships; consider the well-being of others that are affected by their choices; and understand and ensure the protection of their rights throughout their lives.” The new guidance for 2020 defines out-of-school CSE as not being delivered at school to students as a part of the school curriculum, whether within or outside the regular school timetable.

We are talking about out-of-school CSE for many reasons. First of all, moving CSE outside of the more rigid school setting provides a number of opportunities to adapt content, methodologies, timing and dosage. Compared with CSE delivered in school, out-of-school CSE affords the opportunity to create a more informal and flexible setting than may be possible in school, with the potential for smaller learning groups, longer class times, more varied and creative delivery of the curriculum, and more interaction among learners. Out-of-school CSE can also include challenging topics and promote a rights-based approach rooted in gender equality and empowerment in a way that may not always be feasible or acceptable in school settings. Learners could feel more safe and free to share questions and perspectives that they may be reluctant to voice to a teacher at their own school.

Another reason to promote CSE out of school is the number of children and adolescents who don’t have access school. Experts estimate this number of 263 million.  

We know, that CSE is even more effective when it links to sexual and reproductive health services, as well as to condoms and contraceptives. Out-of-school programmes may be better able to provide sexual and reproductive health commodities and link children and young people to services, mentors and other forms of support.

Adolescents and young people are not a homogeneous group. Different populations of youth have different needs which should be addressed differently. And out-of-school programmes can provide an opportunity to tailor CSE to the needs of specific groups of children and young people. For example, the new out-of-school CSE Guidance covers delivering CSE to young people with disabilities; young people in humanitarian settings; young indigenous people; young lesbian, gay and bisexual people, and  other young men who have sex with men; young transgender people;  young intersex people; young people living with HIV;  young people who use drugs; young people who sell sex;  and young people in detention

2. Has the pandemic—especially with so many kids worldwide learning online—created new challenges for developing an out-of-school CSE program? How has it been necessary to adjust to the reality of kids in this “new normal”?

The COVID-19 pandemic is having a tremendous effect on young people’s lives, health and well-being, and its medium- and long-term impacts could be devastating if adequate measures are not taken to guarantee basic rights for young people. Unknown and unfolding periods of physical distancing measures and school closures leave adolescents and young people across the world without access to essential sexual and reproductive health information, services, and rights, including comprehensive sexuality education (CSE). In fact in many, settings all CSE became delivered out of school.

At the same time, the pandemic gave us a once-in-a-lifetime opportunity to do things differently. First of all, the pandemic intensified the development and implementation of digital CSE. Digital sexuality education can be more accessible and effective by reaching many young people at the same time across large geographical areas, and engages marginalized, left-behind populations of young people who may otherwise be excluded from mainstream programmes. Digital sexuality education may also potentially deliver CSE with increased fidelity, since content is fixed and not dependent on a facilitator’s willingness to present it, and be interactive for the learner while letting the learner more actively engage with their own learning at their own pace. While not a silver bullet on its own, digital CSE complements face-to-face CSE and, during this COVID-19 pandemic period, is an especially important supplement in the absence of, or with significantly reduced, access to face-to-face CSE in and outside school settings. Also it’s important to address the drivers of existing inequities, such as inequities in accessing digital platforms and technology (the digital divide), particularly for girls and young women and vulnerable populations. 

Let me remind you that sexuality education includes variety of topics, e.g. violence, including gender-based violence; safe use of the internet; consent, bodily integrity and privacy. In the time of lockdowns and schools closing, we see alarming data about the rise of domestic violence, unplanned or forced sexual activities, and sexual violence that makes us consider the delivery of CSE to be a crucial action.

The pandemic required us to reach out to health care providers and to encourage them to join CSE forces and to use contact with adolescent patients to communicate key CSE messages, provide educational materials, and inform them about educational programmes in mass media or digital media.

I would like to refer you to UNFPA technical brief “LEARNING BEYOND THE CLASSROOM ADAPTING COMPREHENSIVE SEXUALITY EDUCATION PROGRAMMING DURING THE COVID-19 PANDEMIC” to get practical detailed advice for programme adaptation of CSE during COVID-19.

3. When doing research to put together the new guidelines, did you come across anything particularly surprising or interesting, either about the experiences of youth with CSE or about how they respond? Anything that particularly stuck out? 

This is the brand-new Guidance. It is based on the evidence together with the input of a wide range of experts, including the perspective of young people, and an understanding of current good practices and successful programmes. There were a lot of interesting and surprising facts that we found out while working on it. Let me give you just some examples.

We usually use a mantra that kids, especially adolescents, do not trust their parents as reliable sources about relationship, love and sex. Which is not correct. Parent-focused interventions and interventions that include parents were found to be more effective than family-based programmes and programmes delivered only to youth. In particular, even one session bringing youth and parents together improved effectiveness, and parents may be able to increase condom use if they talk to their children about using condoms.

As I always say, CSE without gender focus is not CSE. Gender-transformative approaches are more effective than gender-neutral or gender-sensitive approaches in changing gender norms and attitudes in boys, and presumably in all genders.

We recommend starting CSE from the age of 5. Programmes that reached younger age groups before they became sexually active were more effective in improving young people’s sexual health, compared with those that reached young people who were already sexually active. Of course, all content of CSE programmes should be age and developmentally appropriate. 

One of the key CSE topics is tolerance, inclusion and respect. We have evidence that successful interventions to reduce stigma and discrimination should be led by or actively engaged communities experiencing stigma – e.g. LGBTQ+ youth, or young indigenous people, or adolescents living with HIV, etc.

4. What are some of the key recommendations for those trying to successfully implement out-of-school CSE?

One of the critical recommendation, which is often left behind by smart adult experts, is the meaningful engagement of adolescents and youth in CSE  programs development, implementation, evaluation and advocacy. Youth participation is crucial now more than ever: engagement with youth stakeholders is needed to identify the needs of young people, including the ones from left-behind populations, and gaps in accessing CSE during the pandemic. 

That work is more important than ever due to the effects of COVID-19—especially as food insecurity disproportionately affects women. To learn more about the task of fighting hunger, Every Woman Every Child interviewed World Food Program USA President and CEO Barron Segar.  This interview has been lightly edited for clarity.

As noted in the Nobel Prize announcement, the coronavirus pandemic has contributed to the number of victims of hunger around the world. Can you tell me in more detail about how the pandemic has affected the efforts of WFP, and what WFP USA has been doing in response?

Due to the socio-economic fallout of COVID-19, we are facing a global hunger catastrophe on a scale not seen since WWII. The economic impacts from Covid-19—from the closure of the informal economy to the loss of remittances— threaten to double the number of people facing crisis levels of hunger around the world. We’re estimating that because of COVID-19 the number of severely hungry could rise to more than a quarter of a billion people by the end of 2020.

Already, four countries face the prospect of looming famine (Burkina Faso, northeast Nigeria, South Sudan and Yemen), with more than a dozen others close behind. This global health emergency has become an unprecedented global food security crisis. With it, we are already seeing a rise in destabilizing trends like food-related instability and mass migration. Food assistance, we know, can help prevent these dangerous forces from metastasizing into greater instability. We have launched the largest humanitarian food assistance operation in our history, with plans to feed up to 138 million people by the end of the year. In the first nine months of 2020, the U. N. World Food Programme has scaled-up to reach 97 million people, nearly as many people as we reached in all of 2019. Every day, we are adapting and innovating to meet the unique demands of the pandemic. We estimate that a record 235 million people will need humanitarian assistance and protection in 2021, nearly a 40 percent increase from 2020, almost entirely brought on by the pandemic.

The pandemic has also changed the face of hunger. Urban populations, that were previously immune to food insecurity, are now being dragged into hunger. Over half of the U.N. World Food Programme’s operations are now expanding into urban areas, helping those who had previously managed to escape severe levels of hunger. For example, the U.N. World Food Programme has launched new food and cash programs to support the hungry in urban areas. We’re supporting over 50 governments to scale up their safety nets and social protection programs for the most vulnerable.

The U.N. World Food Programme has been the logistics backbone of the humanitarian community’s pandemic response. Through its sophisticated network of hubs, passenger and cargo airlinks and medevac services, it has transported humanitarian staff as well as cargo including PPE, medical supplies, and food to the frontlines on behalf of 67 humanitarian organizations. As of December 2020, the U.N. World Food Programme has dispatched more than 100,000 cubic meters of critical health and humanitarian cargo to 171 countries to support governments and health partners in their response to COVID-19.

World Food Program USA is doing all it can to help the U.N. World Food Programme’s global response to COVID-19. We secure funds from corporations, foundations and individuals; ensure U.S. policies and policymakers support global hunger initiatives; and, conduct engaging and thought-provoking campaigns that tell our story to an American audience to build awareness and gain support. Our messages about the increasing impact of COVID-19 on vulnerable populations resonated with the American public and when our 2020 fiscal year ended in September of this year, we had exceeded our revenue projections by more than 30 percent.

Every Woman Every Child advocates for the well-being of women, children, and adolescents. How does hunger affect these groups specifically, and what is most at stake now?

Food insecurity disproportionately impacts women. Because of deep-rooted gender norms, war and conflict, and a lack of equal rights and representation, women often eat last and least. In fact, women represent about 60 percent of the world’s food insecure population, and globally, women are more likely than men to live in extreme poverty. The U.N. World Food Programme is tackling this disparity head on, delivering lifesaving support, food assistance and skills training to empower women to not only survive, but thrive. This disparity has become more pronounced during the pandemic.

Good nutrition is essential to maintaining a strong immune system that can fight infection.  This involves consuming adequate micronutrients like zinc and vitamin A which play an important role in the functioning of the immune system. A person with an infection requires more micronutrients to fight off the infection and replenish body reserves. As the pandemic drives up demand for specialized nutrition foods, the U.N. World Food Programme is pre-positioning these items and is working to ensure that manufacturing lines of these foods are not disrupted by trade restrictions. 22 million children and pregnant or breastfeeding women rely on the U.N. World Food Programme for specialized foods that prevent and treat malnutrition.

The pandemic’s impact on school children across the world has been tremendous and the U.N. World Food Programme is working with partners to make sure vulnerable students get back to learning in a safe and healthy way. The coronavirus has disrupted education systems across the world, forcing school closures that have affected 90 percent of the world’s school children. This has huge implications for students’ learning, health and nutrition. Nearly 370 million schoolchildren missed out on school meals on which they depend, exacerbating hunger – including 13 million children who receive school meals from the U.N. World Food Programme. Missing school meals means missing a lifeline to health and nutrition for many children in poor countries. The meal these children get in school is often the only meal they get each day. The U.N. World Food Programme has assisted 7 million schoolchildren in 45 countries affected by school closures with take-home rations or cash-based transfers.

As of December 2020, school systems in over 80 countries still have not yet fully resumed after interruptions to education due to COVID-19. Almost 250 million schoolchildren remain without the school meal they used to rely on. As a result, we estimate between 16 and 24 million students, including 7.6 million girls, are at risk of dropping out of school this year. Our priority now is to enhance support to governments to safely reopen schools and restore access to meals, and to scale up school feeding programs in areas of most need. Our goal is to reach an additional 73 million vulnerable children who did not have access to school meals before the pandemic.

What are some solutions to addressing hunger during the pandemic and beyond? What should policymakers and leaders be doing?

Our ultimate goal is to create a Zero Hunger world. It’s an ambitious goal, but it is possible, if we all unite to do it. The world has enough food to feed everyone. The problem is not a food shortage – it’s access and availability, due to conflict, climate change and extreme weather events, gender inequality, and food loss. As we address global hunger during the pandemic and beyond, funding is critical to our mission, so that we can continue our operations. We have an urgent need for significant funding now, to avert greater death and instability on a global level.

We call on U.S. policymakers and leaders to continue supporting our efforts through the pandemic. The United States is the single largest funder of the U.N. World Food Programme. Last year, the U.S. Government provided over $3.4 billion in support to the organization. This is a bipartisan and bicameral legacy that dates back to the earliest days of the U.N. World Food Programme and it is consistent with the United States’ legacy as a leader in the global fight against hunger. As global hunger threatens an entire generation, our fervent hope is that robust funding for international aid, especially humanitarian food assistance, remains a priority for U.S. policymakers.

For World AIDS Day, Dr. Luo spoke with Every Woman Every Child about the state of HIV advocacy work, the important role of technology, the effects of COVID-19, and what remains to be done. This interview has been lightly edited for clarity. 

What is the current state of HIV/AIDS advocacy? 

It’s important to recognize that the global community has agreed to end AIDS by 2030. When we talk about “ending AIDS,” we mean bringing down to the minimum both the number of children that are born with HIV and the number of adolescents getting infected. We have global goals for two interventions, which are prevention and treatment, and we think that if we bring the two together, no child should be dying of HIV. That’s the thrust of UNICEF’s work. 

We have made enormous strides in making sure that women who are pregnant and living with HIV and AIDS globally can access the treatment they need to prevent infection from being transmitted. Today, globally, 85 percent of the 1.4 million women living with HIV have access to lifesaving antiretroviral treatment for their own health and to prevent infection from being passed on. Without treatment, about 30 to 40 percent of mothers who have HIV and are breastfeeding will transmit to their child. When they do get treatment—especially if they get it both during pregnancy and continue to take it while breastfeeding—that number is less than 2 percent. Overall, we’ve actually reduced infection in babies by as much as 52 percent from 2010. So that’s progress. 

But the same is not true when we talk about treating children. Of the children that are getting infected, only about 54 percent of them have access to antiretroviral treatment, so UNICEF is concerned about the gap that we have between mothers and children. And when it comes to adolescents, we don’t even have good numbers of how many adolescents are accessing treatment or transitioning from being children into adolescent care. Mortality in adolescents is high. We need to look at transition points and make sure that adolescents are comfortable with the way services are being delivered to them.

What are the factors that lead to such a gap between access for mothers and access for young children?

Well, we know that if 85 percent of women with HIV have access, we’re missing 15 percent, which means they’re not coming to prenatal care, or they weren’t tested even if they came. These women are not coming to prenatal care, maybe because user fees are prohibitive, maybe because there is stigma and discrimination. For children, the situation is different. The WHO recommendation is to test all children around 6 to 8 weeks of age because the disease in children is very aggressive without treatment. Without treatment, 30 percent of children with HIV will have died by year one, 50 percent by year two, and 80 percent by year five. So early recognition of infection and treatment is what we’re aiming for. 

But the tools for making a diagnosis in a small child are very different from the tools for making a diagnosis in an older child. For the young child, we’re looking for the virus itself—we’re looking for viral particles in the diagnosis—and that technology is very complicated. It requires a sophisticated laboratory and trained personnel. For adults, there’s a rapid test that can be done by everybody, so access to testing is much easier for older children and adults than for younger children. 

UNICEF has been working with industry to come up with a simplified diagnostic platform that can be applied in facilities where we don’t have specialized technical people to do the test. I’m happy to tell you that the point-of-care diagnostic platforms are now available for use and it’s now up to the programs to upscale their use. We’re excited about that. That’s likely to be a game changer. 

What have been other barriers?

Tech has been a big barrier. And then another barrier is access to optimal drugs or medicines for children. It’s been a challenge to calibrate what the youngest children need and what the older children need. The pills for adults don’t work for children. The liquid formulations that are available in developed countries are not available to the same level in developing countries. Even if they are, very few mothers will have refrigerators for storage. So we’ve been working to make sure that we transform the liquid into pellets and sprinkles that you can put in the baby’s mouth while breastfeeding and the child will still get the drug. 

How has the COVID-19 pandemic affected the lives of women and children with HIV and AIDS?

COVID has caused disruptions in service for all kinds of reasons: fear, lockdowns, health professionals being deployed to deal with the COVID response. We just finalized some analysis with UNAIDS and WHO and now have some figures that are quite disturbing: up to 50 percent disruption in testing of children in some settings and that’s impacting new initiations of treatment in children that are getting infected through mother-to-child transmission. So that’s very concerning and we are looking at this and trying to work with the communities. 

We want to make sure that, first of all, we deal with the misinformation that is out there about coming to clinic. But we also want to look at the best way to deal with the issue of lockdown and people not being able to move freely. One thing we’re looking at is making sure that the prescribing of medication is bundled by three-month timepoints. So instead of asking somebody to come every month for medication for their child, we bundle into three months to limit the contact. We have relied a lot on SMS platforms and telemedicine to make sure that are we linking up with mothers and we are aware of what’s going on, and also building on home visits and community networks to make sure we have local solutions and continuity of care. 

What more still needs to be done? 

I’ve told you about the new tools that we have. We work with industry and push them hard to develop the tools we want for children. It’s been a good journey with them, but one of the frustrations is that even when we do have tools that have been proven to be effective and help advance the cause of children, sometimes licensing and registration adoption at the country level takes a long time. So we work closely with countries to make sure that guidelines and systems are in place to absorb new technologies and new medications for children. 

The second thing is that we really want HIV response for children to be a family-centered approach. Imagine that mothers are going into clinic and they are also living with HIV and able to get their medication, but their chart doesn’t even talk about how many children they have at home that have probably not been tested and linked into care. We want to make sure that as pregnant mothers with HIV access care, we’re reaching out to their household to make sure every child is tested and linked into care too. A family-centered approach to testing is important to pick up on all the children that are sitting at home and not receiving treatment. All these things require policy change, guideline change, and that’s the work that UNCIEF does on the ground.

For a deeper dive into the new report, we interviewed Walk Free’s Global Research Lead Jacqueline Joudo Larsen on stories from the new report, why child marriage cannot be addressed in isolation, and what governments can do.

What is the methodology of the new report? How did you come to the conclusion that 1 in 130 girls are victims of modern slavery and how does that number compare to previous estimates?

One of the key findings of the Global Estimates of Modern Slavery that Walk Free produced with the ILO and IOM was that 71% of all people living in modern slavery were female.

Our methods in the Global Estimates:

As no single source provides suitable and reliable data for all forms of modern slavery, we adopted a combined methodology to produce estimates at the regional and global level.

The central element was 54 specially designed, national probabilistic surveys involving interviews with more than 71,000 respondents across 48 countries for estimates of forced labour and forced marriage.

We also drew on case data from IOM’s victims of trafficking database which contained information on 30,000 victims of trafficking around the world who had received assistance from the agency.

Importantly, this 1 in 130 number should be taken as a baseline estimate. Our estimates in the Arab States are impeded by inability to adequately survey forms of modern slavery that predominantly affect women and girls, for example, forced marriage. Data from other sources suggests our estimate is an underrepresentation.  The real current scale of modern slavery for women and girls is likely far higher, particularly in the wake of COVID-19. 

While putting together the report, did the team come across any particular stories that stood out or were especially affecting?

In drafting this report, the team read over 80 survivor stories from countries around the world. Each story was horrific and heart-rending in its own way – but what was truly overwhelming was the pattern that emerged from these stories: the real examples of iterations of gender inequality exposing women and girls to modern slavery. 

In terms of individual stories, we try not to compare trauma with trauma. This kind of pain is unquantifiable, and incomparable. If a survivor feels comfortable in sharing the details of their lived experience, this should not determine whether their story is more or less deserving of empathy or attention than another, who may not want to re-live those details.

Something that will stay with the team long after this report is survivors’ resiliency in the face of truly awful circumstances. We have seen case studies from all over the world, where despite continued oppression and abuse, survivors have hope for the future, and continue to seek justice for themselves, and for others. We have had the privilege to witness the unending strength in these women and girls, who simply never give up fighting for a better tomorrow.

By way of one example, Purity (not her real name) is a 38-year-old woman in Kenya. As a young girl, she was subjected to FGM, and soon after taken out of school as her father considered that being able to sign her name was sufficient for her education. Shortly thereafter, Purity was forced by her father to marry to a far older man when she was only 14 years old. Her new husband subjected to her domestic servitude, forced sexual exploitation, domestic violence, death threats, forcibly married off one of her daughters despite her protests, and repeatedly tried to starve her and her children. And despite all of this, Purity still has hope, and the determination, to try and change the story for her children. Against her husband’s wishes, and in the face of his violence and threats, Purity accepted assistance from a local NGO to better the lives of her children. In her words:

“It is very hard to live. But I have hope of seeing a bright dawn. My children are being sponsored  by [NGO]. I know when they get good education which will one day change their lives and mine. I wish I was not married young; my life would be so different now.”

How has COVID-19 affected the experience of modern slavery and the problems that must be fixed?

Like most crisis situations, COVID-19 has exacerbated the risks facing already vulnerable populations, like women and girls. Traditional gender roles which cast women and girls as caretakers in the home increase their risk of contracting the disease: and similarly, women often at the frontline- in care work and nursing- experience increased risk of disease. 

Economic impact of COVID-19 also increases risk to modern slavery.

• There are reports of an increase in child marriages in some areas as families are faced with financial pressure due to COVID. Increase in child marriages, eg in Nepal, Kenya, and other countries. COVID-19 has increased unemployment, especially for those working in informal sectors.
• Garment industry particularly affected (for example, garment workers forced to continue working in factories in Leicester).
• Sex workers disproportionately affected. Anecdotally seen increase in live streaming and sexual exploitation of women and girls during the pandemic.

Domestic work- increase in violence, increase in wages being withheld, and closing borders led to workers being stranded with few options before them beyond starvation and homelessness and slavery.

When COVID hit the Gulf States, closing borders led to workers being stranded, increasing vulnerability and increase in homelessness. Workers already vulnerable because of kafala system left at further risk as no protections in country. In Lebanon, we have seen the compacted impact of disasters including the financial collapse, COVID-19, and the Beirut blast on domestic workers: as noted by This is Lebanon in our Stacked Odds report, these multiple disasters in addition to the exploitative kafala system, allows employers to operate in a climate of impunity.

Measures designed to reduce the spread of COVID-19 also disrupt existing responses for victims. For example, for those who have already experienced modern slavery and are vulnerable to re-exploitation, the closure of shelters, disruption to criminal justice, unsafe migration increases risk of re-traumatisation. For example, we have seen this in the UK, where insecure immigration status, isolation, poverty, poor housing conditions, underlying health conditions, lack of access prevent victims from seeking assistance, leaving them vulnerable to re-exploitation. In the wake of COVID-19, Governments should urgently provide vulnerable migrants with access to temporary visas, facilitate safe repatriation, and provide access to victim services.

The report points out that modern slavery cannot be tackled alone. Rather, its root causes—including gender equality—must be addressed. Can you talk a little more about those root causes and why it’s necessary to have a multi-pronged approach?

At the heart of it all is the view that girls hold less value than boys. Girls’ value is tied to their future role as a wife and mother: while boys’ value is linked with economic earning. In many parts of the world, girls are seen as a drain on family resources as it is expected they will one day marry and join another family, and in doing so won’t bring an economic benefit to their family.

Boys on the other hand, often inherit family assets, are seen as having more future earning potential, and as the ones to rely on to care for elderly parents. Through sex selection during pregnancy, combined with infanticide, this preference for sons is in part to blame for reduced birth and survival rates of infant girls which in turn, contributes to the nearly 130 million missing women in the world. And this imbalance in the sex ratio itself also contributes to the risk of modern slavery: in countries like China and India, which together account for 84 per cent of the world’s missing women, women and girls are trafficked domestically and internationally trafficked from neighbouring countries for marriage.

Existing attitudes about the role of girls can prevent them entering or completing school. Many societies consider the education of girls to be an unnecessary investment, making girls more vulnerable to child marriage, forced labour and other forms of modern slavery. From an early age, girls are disproportionately at risk of gender-based violence. This limits their social and economic mobility – and in doing so, increases the risk of child marriage, trafficking, and exploitation.

In situations of widespread disaster, like war zones, women and girls are not only disproportionately affected, but their vulnerability to slavery and trafficking continues to rise. Embedding interventions that take into account the specific needs of women and girls in humanitarian action plans is urgently necessary, particularly in order to combat the increased risk to modern slavery that women and girls face in crisis situations. And in many countries, laws and systems can exacerbate, rather than protect from modern slavery.  This is typically the case where laws entrench gender inequality and reflect the opinion set out above: that girls are of less value than boys. Gender discriminatory laws can prevent women from inheriting land and assets, conferring citizenship on their children and traveling freely.

Laws must change to signal the minimum that we are wiling to accept as the standard for girls, however, there needs to be a corresponding shift in attitudes through awareness raising campaigns and behavioural change interventions. For modern slavery to be truly abolished, attitudes that devalue women and girls must be uprooted wherever they are found. 

Can you talk in more detail about the recommendations in the report? What are some of the most important policy/legislative changes that governments must make?

This report is a blueprint for change and a wakeup call for governments and citizens everywhere. No country is doing enough to disrupt gender inequality and meet the SDGs. No country is doing enough to end modern slavery. Particularly given the impact of COVID-19, there is no time to slow down the fight against modern slavery, and its key drivers like gender inequality.

It is incredibly important that governments remove gender discrimination from within their legal frameworks. Specifically, we are calling on governments to legislate against forced and child marriage, to eradicate systems which normalise the exploitation of migrant workers, such as kafala, and to prioritise supply chain transparency to ensure workers are protected.

Other areas to act on include overturning laws and practices that strip women of their rights and agency, such as inheritance and citizenship laws. Law and culture must change together to reduce the risk of modern slavery for women and girls: It is also important for governments to challenge cultural norms which allow harmful and exploitative practices to continue. 

Every Woman Every Child interviewed Plan International CEO AB Albrectsen about the status quo of girls’ virtual lives and the part we can play in making the situation better.

Why did Plan International decide to focus on online harassment for this year’s International Day of the Girl?

Because online abuse is disempowering girls. Girls have a right to speak up and take part in public life – and yet more than half are hounded by harassment and abuse when they express themselves online. By shutting them out of a space which plays a huge part in young people’s lives, online violence is limiting their potential to thrive and become leaders. This has to stop. With social media and other digital platforms becoming increasingly central to girls’ lives, it’s clear that more needs to be done to make online spaces safe so girls can take part in the debates and decisions that affect them. 

With the COVID-19 pandemic forcing key societal functions online, the issue has become yet more pressing. As of July, 134 million girls were affected by school closures worldwide, making the internet essential for them to study and communicate. Now more than ever, girls must have the access they need to be able to continue their education, seek support, socialise and speak out for gender equality in online spaces. This makes it all the more important that girls can express themselves online without fear of being harassed.

How gendered is online abuse and harassment? How much of a growing problem is online harassment for girls and what are the consequences? 

Very. Girls told us they are harassed simply because they are girls. If they are disabled, black, belong to marginalised ethnic or religious groups or identify as LGBTIQ+, the harassment gets worse. Misogyny, racism and other forms of discrimination that exist in the offline world are recreated and multiplied online.

The consequences are that girls’ voices are silenced and freedom of expression curtailed. The report found that nearly one in five of those who have been harassed stopped or significantly reduced their use of the platform on which it happened. Harassment rates also rise when girls state their opinions and speak out politically online, creating a barrier to meaningful participation in our increasingly digital world.

Online abuse also has clear consequences for girls’ lives offline, with one in five girls exposed to harassment left fearing for their physical safety. For many girls experiencing harassment or abuse, it takes a huge toll on their confidence and wellbeing. 39% said it lowers their self-esteem or self-confidence, 38% said it creates mental and emotional stress and 18% said it caused problems at school.

What are some key takeaways from the new report? Are there any stories or experiences that particularly stood out? 

Part of the research involved a deeper dive into girls’ stories. One thing that really struck me was that girls felt that being online makes them even more vulnerable to abuse than they are offline. 50% saying online harassment is more common than street harassment. And the stories of harassment themselves were powerful and distressing.

Describing her experience of using social media as a young girl, one woman from Sudan, now 20, told us: “I used to get a lot of messages from boys asking me to send nudes or blackmailing me about a picture that I posted that they’re going share it or edit it in a bad way and share it with everyone if I don’t do this or that.

“Or just generally talking, like saying bad words to me. At that young age it was, honestly, horrible. So, it was the worst time in my life, using social media. Between the age of 9 and 14.”

This kind of harassment and abuse should have no place in any of our lives. But in high and low-income countries alike, we found that girls had similar stories of explicit messages, pornographic photos, cyberstalking and other distressing forms of harassment and abuse.

The open letter calls on social media platforms to pay more attention to this problem. What should they be doing to better protect girls? 

Of all the power holders who must act, girls told us that social media companies are the priority. No major social media platform is currently doing enough to protect girls from online harassment, and none have fully recognised girls’ specific experiences and needs. One in three girls already report or block their harassers, but abuse persists because they can simply make new accounts, or because action isn’t taken until large numbers of people have reported harmful content.

Girls and young women are calling on social media companies to listen to them and work with them to create stronger, more effective and accessible reporting mechanisms. These must be specific to online gender-based violence, hold perpetrators to account and be responsive to girls’ needs and lived experiences. We are also asking social media companies to publish disaggregated data on online gender-based violence, to provide insight into the scale, reach, measurement and nature of harassment and violence against girls and young women in all of their diversity.

Social media companies have the power to make change. They must do more to tackle harmful behaviour and ensure that their platforms are safe environments that allow girls, young women, LGBTQ+ young people and other groups that are vulnerable to harassment to fully express themselves and play their rightful role in shaping the modern world.

What can other leaders be doing to protect girls from this online abuse?

Online harassment is a complex problem that all power holders have a role in tackling. All members of society – including communities, family, and civil society organisations – need to be allies for girls and young women experiencing online abuse. This includes being active allies and supporting girls to report online harassment.

Crucially, governments must consult girls and young women in order to better understand what their specific requirements are. They must develop and implement initiatives that support a safe online environment, including educational and awareness programmes on digital citizenship and a broad range of support services such as helplines for victims, training for government officials and collecting and publishing disaggregated data on online gender-based violence.

Finally, the international community needs to follow and implement international human rights laws to ensure corporations and businesses prevent, monitor and respond to all forms of online violence and harassment towards girls, women and other marginalised groups.

Can you tell readers a little more about how the new initiative came to be? I know that UNICEF is already the main procurement partner of GAVI—did working together on COVID-19 vaccine procurement seem like a natural extension of this work?

The COVAX Facility is a key pillar of the global ACT-Accelerator—the global collaboration to accelerate the development, production, and equitable access to tools to fight COVID-19, including diagnostics, therapeutics and vaccines. 

As the world mobilizes for the introduction of COVID-19 vaccines, UNICEF has been appointed to lead efforts to procure and supply doses of COVID-19 vaccines on behalf of the COVAX Facility for 92 low- and lower middle-income countries, and will also serve as procurement coordinator to support procurement by 80 higher-income economies.

What does UNICEF bring to this role? We are the largest single vaccine buyer in the world, procuring nearly 2.5 billion doses of vaccines annually on behalf of nearly 100 countries, reaching nearly 45 per cent of the world’s children under 5 years of age for routine immunization and outbreak response. We are the main procurement partner of Gavi, the Vaccine Alliance, which over the last 20 years has reached more than 760 million children with life-saving vaccines, preventing more than 13 million deaths. 

UNICEF also has a long history of working with governments, manufacturers, global and local partners to align supply and demand of vaccines to achieve vaccine security, ensuring that there is sufficient supply of vaccines, and ensuring equitable access to meet immunization coverage goals in low- and middle-income countries alike. 

Beyond market shaping and procurement, we also work closely with these stakeholders to strengthen supply chains for vaccines, including cold chain infrastructure, freight, logistics, and storage to keep vaccines safe through their journey from manufacturer to the child.   

In this new central procurement role on behalf of the COVAX Facility, UNICEF will leverage its unique strengths and expertise in vaccine procurement and market shaping, to support these global efforts to ensure equitable access for all countries to COVID-19 vaccines.

How will the new initiative benefit women and children? Both are at lower risk for infection than other groups, but have suffered greatly because of the knock-off effects of the lockdowns, so I’d love to hear about the effect vaccine procurement will have on their lives.

Indeed, the pandemic and its secondary effects are taking an unprecedented toll on the health and well-being of children around the world, threatening to roll back years of progress. Disrupted immunization programmes are leaving children vulnerable to vaccine-preventable diseases. Disrupted food supply chains are leaving children vulnerable to malnutrition. School closures are leaving children without access to learning. More children are confronting poverty than before. And the list goes on…

Ending the pandemic and addressing these consequences will require strong collaboration, and a combination of products and interventions. 

While it will not be an immediate silver bullet, vaccines are a critical element to these global efforts to end the pandemic. A coordinated approach to their rollout is also critical. When the vaccines first become available, there will be limited numbers of doses until global supply can be scaled. The COVAX Facility is planning to allocate these initial tranches according to the greatest public health impact, with the goal of to delivering 2 billion doses globally by the end of 2021. The primary objective of the COVAX allocation strategy is to reduce mortality and protect health systems. Therefore, the first doses of vaccines will target health and social care workers. By protecting the health of these frontline workers, we are ensuring that these essential services can continue to serve children and their communities. These are critical services without which millions of children’s lives are at stake, given the widespread disruptions to services during the lockdowns. We cannot let one disease lead to an outbreak of another.

The span from development to production could be one of the fastest timelines in history, with manufacturers potentially able to produce the vaccine in 1 to 2 years. What are some other possible timelines? What are some other factors that will affect the timeline?

According to the timelines indicated by vaccine manufacturers, the span from development to production is likely to be one of the fastest scientific and manufacturing leaps in history: from a decade or more, down to 18-24 months. And in turn, once the vaccines are available, this will be the largest and fastest procurement and supply operation ever. 

The situation is evolving rapidly – just between April and August the number of vaccine candidates in the pipeline doubled. And we are seeing more and more are entering clinical trials, and some are in late stages. Of course, the timelines will also depend on these clinical trial outcomes, however we are proceeding with the assumption that a vaccine will be available by early 2021. 

Given the urgency and the unprecedented scale of this operation, the COVAX Facility stakeholders are mobilizing plans now to prepare for procurement. It is imperative that once the COVID-19 vaccines are approved and available for distribution, that we are fully prepared to get them to countries as quickly as possible. This means addressing a spectrum of considerations along the supply chain, from freight – to logistics – to storage, and supporting countries to prepare for introduction and rollout.

As the largest vaccine buyer in the world, UNICEF already has much of the infrastructure in place for supply and procurement . What are some new challenges (or opportunities) when it comes to procurement for the COVID-19 vaccine?

At this point in time, the central challenge from a procurement perspective is managing the unknowns. Of the approximately 200-300 COVID-19 vaccines currently under development, we do not yet have certainty how many will demonstrate sufficient safety and efficacy to achieve approval by a stringent regulatory authority, be recommended for use, and eventually reach the countries that UNICEF serves. And we do not know with certainty the details product features of vaccines that might be licensed, such as the number of doses per course, the specific cold chain requirements, and shelf life. Manufacturers are also facing unknowns with regards to their production yields and hence their likely levels of output and cost of goods – both of which inform their pricing decisions. These uncertainties all add considerably to the complexity of the procurement process.

Despite the unknowns, it is imperative that we lay the groundwork now to ensure swift procurement once vaccines become available. For example, we are already preparing to tender and enter into supply agreements with a wide range of manufacturers, with the procurement of doses conditional on products achieving regulatory approvals.

Challenges aside, the COVAX Facility also presents opportunities to accelerate our efforts to reach children with immunization programmes more generally. There will be opportunities to further improve the cold chain capacity in countries, and to sensitize populations to the benefits of vaccines. It will also bring opportunities to strengthen routine immunization services in countries, and to intensify efforts to restore previous immunization coverage levels and reach ‘missed children’. Building back better with efficient, integrated and sustainable approaches will be key. 

From procurement, to supply, to delivery – UNICEF works together with partners and leverages every ounce of its strength and expertise to meet this enormous challenge before us: to procure and deliver safe and effective COVID-19 vaccines, on an accelerated timeframe, and at an unprecedented scale – to protect the most at-risk, wherever they may be in the world.

The Accountability Breakfast, which is being jointly hosted by the Partnership for Maternal, Newborn & Child Health (PMNCH), White Ribbon Alliance (WRA) and Every Woman Every Child (EWEC), is happening at a pivotal time. Poor and marginalized women, children and adolescents are among those worst affected by COVID-19’s indirect consequences, which can compound and exacerbate the many social and health inequalities they face in their daily lives. Yet, they are still excluded from making decisions that inform the design of programs meant to help and support them.

Staging the Accountability Breakfast as a virtual event will increase opportunities for people from a diverse range of backgrounds across the world to participate, who might otherwise have been unable to attend had the event been held in a physical space in New York, as originally proposed.

By bringing high ranking government ministers together with representatives from grassroots organisations, the event provides a platform for those with the power to make changes to hear directly from those calling for fundamental changes to be made.

“This important event will provide a safe and inclusive platform for women and young people, campaigners and health workers involved in improving WCAH outcomes, as well as other citizens with important lived experiences and perspectives, to share their views, speak truth to power, and help forge a new agenda for change,” said Helen Clark, former prime minister of New Zealand and Board  Chair of PMNCH.

The programming of the Accountability Breakfast includes the presentation of data and evidence for greater equity during Covid-19; a citizen’s parliament featuring a panel of women and youth citizen leaders from India, Kenya, Mexico and Nigeria discussing strategies to strengthen accountability and ensure future preparedness; and powerful grassroots testimony with leadership commentary and response. PMNCH, which is marking its 15^th anniversary this month, will also be launching its 2021-2025 Strategy.

The event takes place as the global Every Woman Every Child movement’s new report published last week, warns that a decade of remarkable progress, including under five deaths reaching an all-time low, maternal deaths falling by 35 per cent, 25 million child marriages avoided and one billion children vaccinated is now threatened by conflict, the climate crisis, and increasingly by the health, social and economic consequences of the COVID-19 pandemic.    

“Every Woman Every Child has been fighting for the health and well-being of women, children and adolescents worldwide for a decade. The Protect the Progress report provides evidence that committed leadership, global cooperation, wise investments, and innovative financing mechanisms can and have changed the trajectory of millions of lives,” said Vivian Lopez, Executive Coordinator of Every Woman Every Child.

“As the triple threat of COVID-19, conflict and the climate crisis threaten this important progress, now more than ever, leaders need to recommit to the EWEC agenda and protect the health and rights of all women, children and adolescents.”

The Accountability Breakfast will also highlight the multi-sectoral dimensions of COVID-19 on the health, wellbeing and broader lives of the world’s women and children, through the participation of the world’s largest partnerships on education, nutrition, Water, Sanitation and Hygiene (WASH), as well as leading regional and media partnerships.

The Accountability Breakfast aims to convert talk into action with the launch of PMNCH’s Call-to-Action in response to the devastating effects of the pandemic on the health and rights of women, children and adolescents.  Partners will join forces to advocate for firm political commitments, as part of a 24-month program of action to reinvigorate WCAH during the COVID-19 pandemic and beyond.

“We are pleased that today’s Call to Action reflects many of the top demands from more than one million women and girls who responded the global What Women Want survey about their needs for quality reproductive and maternal health. White Ribbon Alliance strongly believes that when citizens and decision-makers come together, it creates stronger policies that are based on actual needs. Public platforms like the 2020 Accountability Breakfast help to put a spotlight on challenges, hold leaders to account, and in turn, accelerate progress,” says Kristy Kade, Deputy Executive Director, White Ribbon Alliance and Co-Chair of the Global What Women Want Campaign.

COVID-19 not only threatens hard-won gains for women, children and adolescents around the world, it could also push new progress yet further away. Going forward, the moral, political and fiscal choices we take about what, how and who we support, will shape the future direction of our planet for decades.  

This Accountability Breakfast will set the agenda and articulate the expectations of the world’s women, children and adolescents for a world that respects their contributions, meets their needs and guarantees their inviolable rights. 

Register and take part in the Accountability Breakfast here.

For further information contact:

Cathy Bartley  

Email: [email protected]  

Tel:  +44 7958561671 

Organizing Partners:

The Partnership for Maternal, Newborn & Child Health (PMNCH, the Partnership) is the world’s largest alliance for women’s, children’s and adolescents’ health (WCAH), bringing together over 1,000 partner organizations across 192 countries. Since its inception, PMNCH has worked to forge and strengthen partnerships and drive momentum towards the attainment of global targets for women’s, children’s and adolescents’ health.

Through its global network of advocates, White Ribbon Alliance is activating a movement for the health and rights of all women and girls. We partner with individuals, communities and all sectors of government. Our approaches put citizens at the center so that health policies and practices are responsive to actual needs.

Launched in 2010 and led by the UN Secretary-General, Every Woman Every Child aims to intensify national and international commitment and action by governments, the UN, multilaterals, private sector and civil society to keep women’s, children’s and adolescents’ health and wellbeing at the heart of development.

Protect the Progress: Rise, Refocus, Recover, 2020 highlights that since the Every Woman Every Child movement was launched 10 years ago, spearheaded by the United Nations Secretary-General, there has been remarkable progress in improving the health of the world’s women, children and adolescents. For example, under-five deaths reached an all-time recorded low in 2019, and more than 1 billion children were vaccinated over the past decade. Coverage of immunization, skilled birth attendant and access to safe drinking water reached over 80 per cent. Maternal deaths declined by 35 per cent since 2000, with the most significant declines occurring from 2010. An estimated 25 million child marriages were also prevented over the past decade.

However, conflict, climate instability and the COVID-19 pandemic are putting the health and well-being of all children and adolescents at risk. The COVID-19 crisis, in particular, is exacerbating existing inequities, with reported disruptions in essential health interventions disproportionately impacting the most vulnerable women and children. At the height of pandemic lockdowns, schools were closed in 192 countries, affecting 1.6 billion students. Domestic violence and abuse of girls and women increased. Poverty and hunger are also on the rise. 

“Even before the COVID-19 pandemic, a child under the age of five died every six seconds somewhere around the world,” said Henrietta Fore, UNICEF Executive Director. “Millions of children living in conflict zones and fragile settings face even greater hardship with the onset of the pandemic. We need to work collectively to meet immediate needs caused by the pandemic while also strengthening health systems. Only then can we protect and save lives.”

In 2019, 5.2 million children under the age of 5 and 1 million adolescents died of preventable causes. Every 13 seconds a newborn baby died. Every hour 33 women did not survive childbirth; and 33,000 girls a day were forced into marriages, usually to much older men. 

The report examines the deep-rooted inequities which continue to deprive women, children and adolescents of their rights – noting birthplace as a significant determinant of survival. In 2019, 82 percent of under-5 deaths and 86 percent of maternal deaths were concentrated in sub-Saharan Africa and South Asia. Nine in 10 paediatric HIV infections occurred in sub-Saharan Africa. Maternal, newborn, child and adolescent mortality rates were substantially higher in countries chronically affected by conflict. 

“For too long, the health and rights of women, children, and adolescents have received insufficient attention and services have been inadequately resourced,” said former Prime Minister of New Zealand and Board Chair of the Partnership for Maternal, Newborn and Child Health, Helen Clark. “We call on all partners to work together to support governments to strengthen health systems and tackle the inequities that constrain progress.” 

The report calls upon the global community to fight COVID-19 while honoring and respecting commitments that can improve the lives of women and children, and not widen the gap between promise and reality. 

“The COVID-19 pandemic threatens to turn back the clock on years of progress in reproductive, maternal, child and adolescent health. This is unacceptable,” said Muhammad Ali Pate, Global Director for Health, Nutrition and Population at the World Bank Group and Director, Global Financing Facility. “The GFF partnership will double down on its efforts to engage with partners and countries and honor the global commitment to ensure that all women, adolescents and children can access the quality, affordable health care they need to survive and thrive.”

The past decade of progress to advance the health of women, children and adolescents must be protected from the impact of the pandemic and the responses to it, the report says. 

“Rapid reversal of hard-fought progress in women’s, children’s and adolescents’ health is a real threat,” said Ties Boerma, Director of the Countdown to 2030 for Reproductive, Maternal, Newborn, Child and Adolescent Health. “As the intensive tracking of the COVID-19 pandemic tells us, timely local data are necessary to be able to target actions and prevent rising inequalities. Global and country investments in local health information systems are much needed to guide the response and protect progress.” 

Without intensified efforts to combat preventable child deaths, 48 million children under age 5 could die between 2020 and 2030. Almost half of these deaths will be newborns.

The report advocates for countries to continue investing in the health of all women, children and adolescents, in all crises.

“As we respond to COVID-19 and reimagine a better future, with sustained peace, including at home, we must repeat unequivocally that the rights of women and girls are not negotiable. Even in times of crisis – especially in times of crisis – their sexual and reproductive health and rights must be safeguarded at all costs,” said Natalia Kanem, UNFPA Executive Director.

The report argues that the Every Woman Every Child movement is more critical than ever as we step into the SDG Decade of Action in the midst of the worst global health crisis of a generation. The momentum of the movement must continue to champion multilaterialism, to mobilize action across all sectors to safeguard the tremendous investments and gains realized by commitments since its launch 10 years ago, and to protect the health and well-being of every woman, child and adolescent, everywhere.

“There is no doubt that the pandemic has set back global efforts to improve the health and well-being of women and children, but that should only serve to strengthen our resolve,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General.  “Our joint action under the Every Woman Every Child movement is more important than ever.  We now must renew our commitment to a healthier, safer, fairer and more sustainable world for women, children and future generations.”

Findings and discussion of the report will be presented at an 11:30 am to 12:00 pm EDT United Nations Briefing on 25 September. A live stream and recording of the briefing can be viewed here.

Speakers include:

• H.E. Ms. Kersti Kaljulaid, President of the Republic of Estonia and Co-Chair of the High-Level Steering Group for Every Woman Every Child (@KerstiKaljulaid)
• H.E. Ms. Erna Solberg, Prime Minister of Norway and Co-Chair of the UN Secretary-General’s Sustainable Development Goals Advocacy Group (@erna_solberg)
• Ms. Henrietta Fore, Executive Director of UNICEF (@unicefchief)
• Ms. Inger Ashing, CEO of Save the Children International and member of the High-Level Steering Group for Every Woman Every Child (@ingerashing)
• Mr. Ayanda Makayi, Actor from MTV Shuga: Down South, South Africa (@AyandaMcKayi)
• H.E. Ms. Amina J. Mohammed, Deputy Secretary-General of the United Nations (via video) (@AminaJMohammed)

The launch will be followed by a deeper dive into data, analysis and solutions at the PMNCH, White Ribbon Alliance and Every Woman Every Child Accountability Breakfast on 29 September, 8am – 12pm EDT. Register here.

Media Contacts:

For media enquiries or interview requests for the participants of the event, journalists are invited to contact: [email protected]

1.What is the state of global newborn health right now? What progress has been made in the past few decades?

Over the last few decades, the world has made great progress in reducing newborn deaths. In 2000, there were 31 neonatal deaths for every 1000 live births. By 2018, that number had almost been cut in half, falling to 17 deaths for every 1000 live births.  

While this is certainly good news, we need to accelerate this progress – and quickly – if we want to achieve the Sustainable Development Goal targets on newborn mortality. To do this, we need to understand why some babies are still dying in their first month of life and design and implement interventions to address these root causes. 

We’re especially focused on the most vulnerable newborns: those born too soon and too small. 

More than a third of neonatal deaths worldwide are due to severe bacterial infections, and yet more than 70% of infants who could have these infections don’t receive proper treatment because they may live too far from the nearest hospital or because their parents simply cannot afford the cost of care. Today, these conditions are being better managed because health workers are able to diagnose these cases locally and offer treatments even within first-line or community-based facilities. 

We’ve also learned that simple interventions like Kangaroo Mother Care (KMC) – which provides skin-to-skin contact between a mother and her baby – can be very effective at improving newborn outcomes. Although typically initiated at health facilities, more than a fifth of births occur at home, so when KMC is expanded within communities, the impact has been shown to be even greater. 

Beyond expanding access to life-saving, essential interventions and medicines, we need to redesign health systems to improve the quality of care newborns receive since evidence suggests that poor-quality care accounts for the majority of neonatal and maternal deaths particularly in low and middle income countries. Every mother should be supported throughout her pregnancy and have a healthy and respectful birth experience with skilled midwives; should complications arise, she should receive high-quality, life-saving care from skilled and compassionate health care workers who have tools and resources needed to do their jobs well. 

2.How has COVID-19 affected maternal and newborn health? Which services have been the most disrupted?  

In times of crisis, women, children and newborn are especially vulnerable as essential health services become increasingly disrupted – particularly labor and delivery services and newborn care. Modeling shows that if these disruptions are severe, we could see as much as a 45% increase over existing child mortality levels, including for newborns.  

These disruptions are not hypothetical, they’re happening today. Pregnant women and frontline health workers are unable to reach health facilities due to lockdowns and travel restrictions, or they may not seek care out of fear of contracting the virus. Many health workers are being redirected to the COVID-19 response, while others may not have the personal protective equipment they need to provide care safely, so some have understandably abandoned their posts. Supply chain disruptions have led to stock-outs of key medicines and supplies critical to maternal and newborn care. And we’re already seeing the impact this is having on women: a recent study from Nepal saw dramatic reductions in health facility deliveries and disturbing increases in neonatal deaths and stillbirths during the pandemic. 

Many women were also fearful of contracting COVID-19 and passing it onto their babies, including while breastfeeding. Given the importance of breastfeeding for a baby’s development and growth, experts have recommended that all mothers – even those sick with COVID-19 – should be encouraged to breastfeed their newborns while taking all possible precautions to avoid spreading the virus. Recent research continues to support this advice, and early studies of lactating women with COVID-19 found no traces of the virus in their breast milk. 

Beyond the impacts to health, the pandemic has been devastating to the livelihoods of women around the world, especially those already living in or on the brink of poverty. Lost income and overburdened social safety nets are pushing vulnerable women further into poverty, thereby increasing financial barriers to health care. 

3.What are some of the challenges to ending preventable stillbirths and what are some of the opportunities? 

More than two million stillbirths occur every year – nearly all of them (98%) in low and middle-income countries. These numbers are alarmingly high, particularly since we know that almost all stillbirths are preventable. 

About half of stillbirths occur in the intrapartum period – after labor has started, but before delivery. Most health systems – particularly those in remote communities– do not enable high-quality childbirth care that could detect fetal distress early enough to offer women the immediate care and labor management needed to prevent stillbirths. 

Part of the problem is that the current global standard of care – that a baby must be delivered within 30 minutes of fetal distress – is not attainable in many remote health facilities. Women are laboring and giving birth without access to the lifesaving interventions and support they need to respond to complications. This would be unacceptable in high-income countries, and yet we know this is happening in many communities around the world. That’s why we need to support leaders at every level to re-design their health systems to meet their communities’ needs, and ultimately eliminate all preventable maternal and newborn deaths and stillbirths. We must develop truly equitable health systems that deliver on their promise to women and children globally – this should be our ‘north star.’

Even the seemingly simplest ways to contain the virus – staying home and washing hands – are luxuries for an alarmingly high number of people throughout the world. Many people do not have the option or ability to isolate safely at home. Frequent handwashing is not an option for the 40% of the global population who do not have access to basic hand washing facilities. For a large portion of people living in low-income countries and countries affected by conflict and instability, a daily wage is a matter of survival. The impact of the virus, combined with decreased family income due to layoffs and lockdowns as well as rising food prices, affects those with fewer choices for longer and with greater severity. It could lead to a global hunger and a malnutrition crisis on a scale not seen for decades. Early World Food Programme projections show that 265 million people could be facing food insecurity in 2020, twice 2019 levels.  

As leaders in the areas of water, education, sanitation and hygiene, nutrition, health and gender, we recognize that just as human beings do not live their lives in siloes, the aid they need and deserve must also operate collaboratively across sectors, especially in response to crises like COVID-19.  Massive inequities in access to education, nutrition, water, sanitation and hygiene, as well as health services, must be eliminated. These key services, if combined and implemented at scale, can make a big difference for the most disadvantaged, increasing their resilience and that of their communities.

Those are fundamental human rights that cannot be compromised. That’s why we’re urging countries and donors to ensure overseas development assistance programmes and national economic stimulus and recovery plans are well-resourced and tailored to protect those who are least protected from the threat of COVID-19 and from the indirect consequences of the pandemic. 

As countries worldwide ponder how to reopen schools, we are most concerned with the inextricable link between education, health and hygiene. Sustaining water, sanitation and hygiene programmes in schools helps prevent diseases and can empower children to participate as agents of change for their siblings and their parents, contributing to the health of their communities at large. Furthermore, if schools fail to reopen, the nutrition outcomes for a staggering 310 million schoolchildren – nearly half of the world’s total – who rely on school for a daily nutritious meal will be at risk. These essential interventions are not only lifesaving, they help children learn better and unlock their precious potential. 

Protecting the right and access to education in the recovery phase is particularly critical for young and adolescent girls who are twice as likely to be out of school in crisis situations and face greater vulnerabilities, such as domestic or gender-based violence, when not in school. Equal access to quality education for girls and women is also critical to reduce malnutrition. If all women in low and middle-income countries received a secondary education, 26% fewer children’s growth would be stunted.

With only ten more years to deliver on the Sustainable Development Goals, we must take stock of the lessons learned during the COVID-19 crisis. During the lockdown, we have seen many examples of communities coming together to support each other in hope and solidarity. To some extent, this crisis is also an opportunity to acknowledge that we are interdependent and that the health and well-being of the most vulnerable matters to all. This is both our fragility and our strength. 

As international leaders devoted to realising the 2030 Agenda, we are committed to scaling up and channelling the strategic efforts of our organisations across education, health, nutrition and sanitation as well as empowering women and girls. The goal is to extend to everyone equal access to these most essential human services. Only then can we break the intergenerational cycle of malnutrition and poverty while reinforcing the resilience of the most fragile in the world. 

Gerda Verburg, United Nations Assistant Secretary-General and Scaling Up Nutrition Movement Coordinator (@GerdaVerburg)

Catarina de Albuquerque, Chief Executive Officer, Sanitation and Water for All (@CatarinadeAlbuq)

Vivian Lopez, Coordinator of Every Woman Every Child (@VivianEWEC)

Alice Albright, Chief Executive Officer, The Global Partnership for Education (@AliceAlbright)

Why did the WHO decide on 5 as the age when children must start wearing masks?

[The decision] was linked to the principle of “do no harm.” It was linked to dexterity: how well they’d be able to tie the mask and how long they’d be able to keep it on, and would they touch it too much and make it more of a source of infection? The other thing around design is obviously the fit. Children tend to have the nasal ridges a bit lower, so the masks don’t always fit so well. Looking at all those different areas was very informative. 

Children tend to have different milestones at different ages, and by the age of five they can tie their own shoelaces. That is a proxy for them being able to tie the mask. And also [by five] they have a good understanding about not touching it too much. It’s one thing to put on the mask, another thing to keep it on. Some of the data that was looked at showed that some children were actually okay with putting it on, but for them to keep it on was very difficult. That was also taken into consideration. 

The WHO guidance differs from other guidance. For instance, the US CDC states that children over 2 should wear a mask. What is your advice for parents who may be confused by the discrepancy?

WHO is an organization giving advice to policymakers and decision-makers at a high level. It’s up to every country to then adopt and adapt those guidances. In local contexts, there can be very different types of transmission, not just within one country but within one state. So there could potentially be some differences. And that’s also why we say it’s a risk-based approach because what’s right in one country is very different from another and there will be those discrepancies. As an individual, the first place people should go is to their local government to see what the policies are. 

Can you provide some insight into the process of issuing this guidance? 

It was actually quite a long process. It starts with this specific area in which we’re working, which is infection prevention control (IPC). We have a group of over 30 experts that meet on a regular basis and discuss any themes there are and look at the evidence and really come to consensus. 

This is probably the tenth guidance that has come out from this group over the last eight to nine months. There was an evidence review, done by the WHO Scientific Committee, which looked at the evidence on the transmission in children and also looked at the use of masks and children. That was presented to the IPC GDG (guideline development group), and there were also discussions and meetings with UNICEF, who is a co-lead, and with the International Pediatric Association. It was a consensus-building process which started in June and went on through July and August. Eventually, once the guidance was drafted, it was also shared with some external experts. 

What kinds of research did these experts look at? 

There was two main areas that we looked at. One is around transmission in children. What is the percentage of children that are getting infected with COVID? What is their vulnerability and susceptibility? Where’s that transmission happening? That means looking at the different settings, and obviously critical to that is the school settings. The trend seems to be that transmission is linked to social interactions, which tends to happen [more] as the children grow older and have more and different types of interaction groups. That was a trend that tends to increase as they grow into teenagers and young adults.

The other area was looking at the effect of the use of masks. We looked at influenza as a proxy and for indirect evidence, and there seemed to be some evidence [for masks being helpful]. However, there were issues around compliance and around fit. One thing that has come out of this is the real need for some implementation research. This guidance are now being adopted in countries and school settings and I hope that some of this [implementation] research will be done to better inform future guidances.

Is there anything else that’s important to know in this discussion around children and masks?

It’s important to reiterate that masks are a tool and part of a comprehensive package. There’s quite a lot of focus  on masks, and that is a positive thing, but on its own, masks can’t solve all the issues. That’s why it’s critical to maintain physical distance and do the hand-washing too. 

1.Can you tell me more about how the pandemic has affected the Arab states specifically, and what challenges and opportunities are unique to the region?

The COVID-19 pandemic has affected every aspect of peoples’ lives while amplifying inequalities, destabilizing communities and reversing development gains made in the past decade—including in the Middle East and North Africa (MENA) region. 

 While the impact of the pandemic varies across continents, many countries in the MENA region are experiencing complex emergencies, which are compounded by occupation, fragile health systems, weak disease surveillance, overwhelmed response capacities and low levels of public health preparedness. These factors leave the region extremely vulnerable to the rapid spreading of COVID-19 and further complicate all response efforts.

Millions of migrants, refugees, people who have been forcibly displaced, women and children bear the brunt of the health and socio-economic impacts of the COVID-19 pandemic because of their pre-existing vulnerabilities. There are currently 11.5 million refugees, and 14.5 million internally displaced persons (IDPs) in the region who reside in camps, informal dwellings or underserved communities, and lack regular access to health care and, crucially, water and sanitation services. Reaching IDPs, refugees, migrants, and returnees during this pandemic is a huge challenge.

Border closures and travel restrictions, lockdown and stay at home measures have contributed rising rates of violence against women and children and have a massive impact on people’s livelihoods and their capacity to cope with the outbreak.  Millions of jobs have already been lost and people are left with no means to provide for their families. 

 On top of this enormous public health and economic crisis, food prices are soaring. In Yemen, for example, where malnutrition rates amongst women and children are among the highest in the world, food and other essential goods are becoming inaccessible for millions. There is a very real concern that the pandemic could lead to an even larger food crisis for some countries in the MENA region facing complex emergencies. 

Through our work with communities and government authorities across the world, IFRC and its network of 192 Red Cross and Red Crescent societies have significant insight and experience in responding to the COVID pandemic at global, regional and local levels.

There is a real opportunity for government authorities and international partners to work in solidarity and in a coordinated manner with humanitarian actors on the ground to help the most vulnerable and hardest-to-reach people in this pandemic. This includes providing necessary access for Red Cross and Red Crescent staff and volunteers to carry out and expand their vital work and allowing critical movement of medical equipment and supplies to those who need it most.

National Societies across the MENA region have unique access to remote or hard-to-reach communities, groups and individuals who are amongst the most affected by the pandemic. Red Cross and Red Crescent volunteers are working around the clock providing mental health and medical care, distributing food parcels, hygiene kids and protective equipment to these vulnerable people.  As the COVID-19 pandemic evolves, National Societies are adapting their response activities to growing crises and humanitarian needs and are well-placed to provide support to people affected by disruptions in education and increases in violence, discrimination and exclusion linked to COVID-19.  

2.The recent policy brief published by the Secretary-General has set four priorities to guide the response to build back better from COVID-19 and achieve the SDGs. The first priority focuses on slowing the spread of COVID-19 and ending conflict. In what ways is IFRC working towards this goal? 

The International Federation of Red Cross and Red Crescent Societies (IFRC), comprised of 192 member National Societies works in a coordinated manner within the Red Cross and Red Crescent Movement and with UN agencies at global, regional and country level to prevent the spread of COVID-19.  Our network of Red Cross and Red Crescent Societies and their 14 million volunteers are delivering life-saving services, equipment, water and sanitation, while mitigating against the socio-economic impacts of this pandemic for the most vulnerable people. Protecting and supporting these communities requires a sustained and coordinated scale-up of Red Cross and Red Crescent local action alongside ongoing global response efforts.

Since the beginning of the pandemic, IFRC has supported National Societies to increase their health care services, community engagement and pandemic preparedness activities for vulnerable populations. Red Cross and Red Crescent Societies across the world have scaled up their response to address the different health and socio-economic needs in their countries. Frontline volunteers are also helping to trace contacts, isolate and treat people with COVID-19.

In the MENA region, IFRC has been actively working with governments, and has provided a set of clear recommendations to States and other authorities on how best to adapt their emergency response and work with humanitarian actors  like the Red Cross and Red Crescent National Societies.

This includes granting access to Red Cross and Red Crescent staff and volunteers in a number of MENA countries to carry out essential humanitarian work in hard to reach communities, health facilities and prisons.  Critical medical equipment—masks, goggles, face shields and supplies — must be allowed to reach health staff and first responders including those in conflict zones.  It is important that government authorities continue to provide this crucial flexibility and grant exemptions so that humanitarian organizations can carry out their vital work during this crisis and similar crises in the future.

As levels of unrest and violence increase due to the impact of COVID-19 exacerbating pre-existing tensions and conflicts in some countries in the region, reaching people in need continues to be a challenge in many countries. Red Cross and Red Crescent volunteers are some of the best-placed people to provide localized responses as they are already trusted members of the communities.

Sadly, disasters do not stop in the middle of a pandemic. The devastating explosion in Beirut in early August that affected over 300,000 people is a reminder that disasters can happen at a moment’s notice and further hinder COVID-19 response efforts.  Now is the time to ensure we plan for the long-term. Our coordinated emergency appeal for 1.9 billion Swiss francs allows the IFRC to provide layered funding specifically for COVID-19 prevention measures to continue, on top of other humanitarian needs. Collectively, we are learning to live with this virus, while we work to slow its spread and scale up our planning and response efforts to meet the growing needs on the ground.

3.The brief also states that the COVID-19 recovery is an opportunity to invest in women and ensure that they can be equal contributors in society through bridging the gender divide. Can you tell me more about the specific challenges facing women and children in Arab states, and elaborate on the guidelines for how organizations and stakeholders can do better? 

Some countries in the MENA region are facing double or triple crises as COVID-19 merges with existing humanitarian emergencies, conflict and violence.  This has exacerbated deep, pre-existing gender inequalities and threatened the well-being and safety of millions of women and children. Pre-existing, restrictive social norms and gender biases means that women and children are at a disproportionate risk of malnutrition, illness, increased violence in the home, more rates of child labour, and growing barriers to accessing education, support services and health care.

The increased risk of domestic violence during the pandemic is of particular concern. While stay at home measures means safety for many in a time of disease and uncertainty, for thousands of women and children, home becomes a place of violence and fear. Marginalized women and children who are disabled, or are from minority, refugee, migrant communities face even greater barriers to accessing health and mental care, basic services and legal support.

IFRC through its Protection Gender and Inclusion approach is ensuring the dignity, access, participation and safety of the people and prioritizing women and children in Red Cross and Red Crescent operations.  Red Cross Red Crescent volunteers in MENA countries are raising awareness about sexual and gender-based violence and ensuring that psychosocial support services are available to affected people. They are also focused on supporting the most affected and marginalised learners to access education and learning opportunities in safe and supportive learning environments.

In their auxiliary role to governments, national societies, with the support of the IFRC, play an important role in advocating against violence, discrimination, xenophobia and providing livelihoods opportunity for women.  Through their unique access to local communities, Red Cross Red Crescent volunteers build trust and by listening and adapting the needs of communities to the COVID-19 response programmes.

 As the COVID-19 pandemic continues to magnify inequalities and marginalize entire communities across the MENA region, there is a clear need to ensure a strong protection, gender, diversity and inclusion approach in national COVID-19 pandemic response and humanitarian programming: health, livelihoods, shelter,  cash, migration response and risk-communication.  Targeted interventions to address these issues must be based on engagement, accountability, participation and a focus on individual and group agency within every community.