Bridging the Gap in Maternal Health for Girls and Women of African Descent in the Americas

By Dilly Severin in conversation with Jessie Schutt-Aine, Chief, Equity, Gender, Human Rights and Cultural Diversity Unit at the Pan American Health Organization

Much of this year has focused on reflecting on the landmark anniversaries of the International Conference on Population and Development and of the reproductive justice movement: recognizing what we have accomplished and what remains ahead of us in the movement for sexual and reproductive health, rights and justice for all. 

But with the Summit of the Future just around the corner, I’m also appreciating this moment in time as an opportunity to coalesce around a blueprint for the future, one that puts every person in the driver’s seat of their own bodies, lives and futures. This is a galvanizing moment for the international community to come together, enhance its collective response to pressing challenges, and work toward a revitalized multilateral system that can effectively address the needs of a rapidly changing world. 

But we cannot accomplish this when entire communities are left behind in our global health efforts. In stark contrast to the progress we’ve made reaching those most “reachable,” are the disparities in health equity for those who have been marginalized.    

This is most evident when we look at sexual and reproductive health disparities, in particular maternal mortality, for women and girls of African descent in the Americas and globally.  

To take a deeper dive into how this is showing up in the Americas, and how the multilateral system is addressing it, I spoke to Jessie Schutt-Aine, Chief, Equity, Gender, Human Rights and Cultural Diversity Unit at the Pan American Health Organization, which is dedicated to improving the health and quality of dedicated to improving the health and quality of, and lengthen, the lives of the peoples of  the Americas: 

PAHO published a recent report assessing the maternal mortality rate in the Americas in the post-COVID era and calling for urgent action to reach zero preventable maternal deaths. What kind of barriers to sexual and reproductive health were exacerbated under the pandemic? How are these barriers disproportionately impacting women and girls of African descent?  

Jessie Schutt-Aine: The pandemic’s impact on women´s lives, especially on women of African descent, has been profound. The COVID-19 pandemic not only exposed the vulnerabilities of health infrastructures but also exacerbated inequalities in access to health services leading to an excess in maternal mortality. For instance, according to a report PAHO recently published, there was one maternal death every hour in 2020, and the pandemic set back maternal health indicators by more than 20 years. Other PAHO publications, including the Regional Report on Afro descendent Health in the Americas, highlight disparities in access to essential sexual and reproductive health services for women of African descent. And, although there is lack of disaggregated data by ethnicity in the health information systems, the results from a multi-country collaborative study from a database of 447 maternal deaths associated with COVID-19 showed that almost 93% of them were women of African descent or from other ethnic groups. 

The challenges are deeply rooted in historical processes, including the legacies of colonialism and slavery, which have led to generations of social, economic, cultural and political exclusion. Unfortunately, these inequities are also reflected within the health system, where women and girls of African descent often encounter discrimination and racism.  

“Unfortunately, these inequities are also reflected within the health system, where women and girls of African descent often encounter discrimination and racism.“

The multiple dimensions of inequality intersect and aggravate one another along the axes of the matrix of social inequality (namely gender, ethnicity, race, age, and socioeconomic status, among others) and tend to persist over time leading to worse health outcomes. The COVID-19 pandemic further exposed and intensified these inequities, particularly within communities that have long experienced rights violations, exclusion and discrimination. This has exacerbated economic inequities, poverty and limited access to education and healthcare services.  

The ongoing lack of culturally appropriate maternal health services continues to negatively affect the health of women and girls of African descent. In response, Dr Jarbas Barbosa, the PAHO Director, has issued a call to action to achieve zero maternal mortality, with a focus on populations experiencing high maternal mortality rates, including women of African descent, among others. It is crucial to invest in health services that adopt an intersectoral approach, incorporating the perspectives and active participation of these communities.   

What role does PAHO play in bridging this gap in the Americas?  

“The Latin America and the Caribbean is the world’s most unequal region.”

Jessie: The Latin America and the Caribbean is the world’s most unequal region. PAHO is committed to ensuring that everyone has access to adequate health care. Through its work, PAHO promotes and supports the right of everyone to good health. PAHO´s mission is to lead strategic collaborative efforts among Member States and other partners to promote equity in health, to combat disease, and to improve the quality of, and lengthen, the lives of the peoples of the Americas. 

Regarding ethnicity and health, PAHO actively promotes the health of diverse ethnic groups, in line with global and regional commitments. It recognizes the importance of adopting differentiated approaches to ensure the respect and enjoyment of the human rights of members of different ethnic groups. PAHO promotes the need to refocus health services by adopting an intercultural approach to advance with equity the achievement of the highest attainable standard of health.  

Therefore, in 2017, PAHO launched the first Policy on Ethnicity and Health, which was unanimously approved by its Member States, and in 2019, the Strategy and Plan of Action on Ethnicity and Health (2019-2025). The policy urges the Member States to consider the connection between ethnicity and health and to promote an intercultural approach that will contribute, among other aspects, to the elimination of barriers to health services and to improve the health outcomes of people of different ethnic groups.  

“The policy urges the Member States to consider the connection between ethnicity and health and to promote an intercultural approach that will contribute, among other aspects, to the elimination of barriers to health services and to improve the health outcomes of people of different ethnic groups.”

These documents were developed following extensive consultations with leaders of the diverse ethnic groups in the region; and the strategic lines of action were the priorities discussed during those consultations.  

Why is a policy on ethnicity and health important, and what recognition has there been of this policy to date? 

Jessie: The Policy on Ethnicity and Health makes the Region of the Americas the first World Health Organization Region to formally acknowledge the importance of adopting an intercultural approach to address inequities in health and together with its Strategy and Plan of Action, is central to advancing universal health by reducing health inequalities among ethnic groups.  

“To overcome these challenges, it is important to build consensus on commitments and develop policies and guidelines with the active participation of the communities, ensuring their values and needs are fully acknowledged.“

Although there is a recognition for the need of an intercultural approach to health services, progress has been slowed by discrimination, racism, and a lack of appreciation for the cultures of these populations. To overcome these challenges, it is important to build consensus on commitments and develop policies and guidelines with the active participation of the communities, ensuring their values and needs are fully acknowledged.  

In this sense, the Policy constitutes a road map through its 5 strategic lines: generation of evidence, policy action, participation and strategic alliances, recognition of ancestral knowledge and traditional and complementary medicine and capacity development at all levels.  

Along with the normative framework, PAHO has tools to promote an intercultural approach to health, such as the knowledge dialogues methodology. This methodology has served to develop other initiatives such as the tool for promoting culturally safe childbirth, which evaluates maternity services and ensures the integration of the intercultural approach, with the participation of women from the different ethnic groups.  

Therefore, we strongly believe that, together with its Strategy and Plan of Action, and the aforementioned tools, the Policy is an important framework to strengthen technical cooperation on ethnicity and health, to improve the health and well-being of people of African descent. 

Broadly speaking, what are some successes you’ve seen within this work?  

Jessie: We have observed a tremendous impact in terms of social participation. Women of African descent are able to contribute to initiatives related to their maternal health that are in line with their views and values. Moreover, we have observed a growing demand from ministries of health to receive training on the tools that address interculturality promoted by PAHO.  

The approval of a Policy and Strategy and Plan of Action on ethnicity and health also reflects the commitment from the ministries of health in our region to adopt intercultural approaches to health when addressing the needs of these groups. The Strategy and Plan of Action has three impact indicators and 19 progress indicators, which help us measure the advancement of the ethnicity agenda in the countries.  

Another important achievement has been the alliances that have been built within these frameworks with representatives of different groups, including women and girls of African descent.  

What challenges remain, and what do you see as a critical next step?  

Some political and social challenges remain. It is important to continue advocating for investment in the ethnicity health agenda in the region. There is still a lack of understanding that differentiated approaches are needed to address the health needs of women and girls of African descent. 

“It is crucial to continue working towards the elimination of racial discrimination to improve the health and well-being of women and girls of African descent in our region and worldwide.”

As evidence shows, reducing inequalities and eliminating racial discrimination in health has a positive effect on health outcomes. It is crucial to continue working towards the elimination of racial discrimination to improve the health and well-being of women and girls of African descent in our region and worldwide. It is also important to continue promoting alliances with strategic partners, including civil society organizations and leaders.   

Learn more about PAHO’s work on ethnicity and health here.