Globally, the demographic transition from high to low fertility and mortality has improved quality of life for billions of people over the past several decades. The average number of children born per woman worldwide decreased from nearly 5 in 1950 to 2.47 by 2020. Improvements in infant and child mortality boosted life expectancy at birth from a global average of 47 years in 1950 to over 72 years today. These gains in fertility and mortality were a result of rising incomes and significant investments and improvements in public health, education, and family planning access—18 months into a global pandemic, it’s becoming increasingly apparent that COVID-19 has disrupted these gains, slowing progress along the demographic transition for those countries in the earliest stages. This World Population Day is therefore an important opportunity to recommit to investments in health and education and resume our progress in improving lives for the world’s poorest and most vulnerable.

After enduring sexual violence in the DRC conflict, Steven Kighoma fled to Uganda where he became an activist with the NGO, Men of Hope Refugee Association, supporting male victims of conflict-related sexual violence. The experiences of male victims include rape, being forced to watch family members being raped, being beaten on the genitals, and enduring other kinds of abuse. Compounding their trauma, men who have suffered sexual violence in the region are often seen as not properly masculine and face homophobic violence and criminalization, regardless of their sexual orientation. In addition, they face exclusion from survivor support services which assume that only women face sexual violence.

The biggest challenge is “the ignorance of the government, the medical institutions, the community, not knowing a male victim of sexual violence exists,” says Kighoma. “There is a confusion when you talk about male victims of sexual violence. People confuse it with homosexuality.”

“The impacts of displacement present major challenges at every level of decision-making, but the opportunities for interventions that build resilience to climate change, foster social cohesion, and address gender and other disparities—well they’re also very real as well,” said Ambassador Mark Green, President, Director, and CEO of the Wilson Center, during his opening remarks at a recent event hosted by the Wilson Center and Population Institute to explore innovative approaches to addressing the underlying drivers of forced displacement in the Sahel.

Joyce Makasi, a young woman in Kambiti village, Kitui County, Kenya, went into labor with her second child one afternoon in December 2020. She had just enough money to hire a motorbike to take her to nearby Waita health center. At the facility, the clinical officer and nurse told her she would need a cesarean delivery. It wouldn’t be her first cesarean, but COVID-19 presented new obstacles.

Africa was predicted to be hardest hit by the COVID-19 pandemic, given its poor health systems. However, this outcome has not been the case. Despite the U.S. being the highest spender on health care globally, COVID-19 has shown that its primary care infrastructure is in much need of strengthening. But we should not mistake COVID-19 as the biggest pandemic of our time. If anything, it is only a dry run, with other epidemics brewing on the horizon. Therefore, if the global community is serious about epidemic preparedness, global health security, and protecting the most vulnerable, we need to redesign health systems for resilience. Africa’s lessons from the COVID-19 pandemic, as well as from concurrent outbreaks of cholera, Ebola virus disease, yellow fever, and chikungunya, could provide a roadmap.

When Mwanahamisi Abdallah’s mother announced plans to marry her off to a stranger, the 14-year-old Tanzanian girl burst into tears. She had no desire to marry—especially after learning the man already had three wives. Remembering advice from a teacher, she phoned authorities to intervene. They blocked the wedding and eventually delivered Mwanahamisi from her village in southeastern Lindi region to a girls’ shelter in Dar es Salaam.

“If there’s one message, it’s health systems need to be resilient, agile, and equitable,” said Uzma Alam, a researcher at the Africa Institute for Health Policy Foundation and Senior Program Officer of the Africa Academy of Sciences. “No one person, no one community, no one minority can be left behind. After all, your health system is as agile, as resilient as your weakest link.” She spoke at a recent Wilson Center event co-sponsored with the Population Institute, “Lessons from Africa: Building Resilience through Community-Based Health Systems.” The event focused on how locally led interventions improved the resilience and responsiveness of health systems in sub-Saharan Africa.