It has been two decades since President George W. Bush launched the U.S. President’s Emergency Plan for AIDS Relief – or PEPFAR, and a recent Wilson Center event to celebrate the anniversary demonstrated that its impact as one of the most successful global public health programs is indisputable. Since its inception, PEPFAR has invested more than $100 billion in the global fight against HIV and AIDS, resulting in more than 25 million lives saved and millions of new infections prevented.

“Too many children are dying in the first month of life,” said Richard Horton, Editor-in-Chief of The Lancet at a recent launch event for the 2023 Lancet Series on Breastfeeding, hosted by The Royal Society of Medicine, London. Indeed, the global numbers are staggering. Horton observed that 2.3 million children died in the first month of life in 2021—that’s more than 6,000 newborns dying every single day.

Under the narrow shade of our umbrellas, a community health worker from a local NGO and I walked along a dirt path to the edge of some paddy fields in a village in Tamil Nadu, South India in the summer of 2015. There we met a group of Dalit (oppressed-caste) women who were squeezed together under a clump of trees on a small strip of raised land between two fields.

The summer of 2015 was one of the hottest on record in South India at that time, with temperatures consistently above 40ºC (104ºF) every day. Rains which should have begun to arrive had not come by mid-July. These women were hoping to be called for daily agricultural wage labor in the fields, and they had taken refuge under the shade while they waited. They had been waiting all morning with no work available; it had been the same for several days because there was a drought and the crops were failing.

In 2022, the Dot-Mom column published several pieces from expert guest authors from the greater maternal and reproductive health community. In our top read guest contributor piece of the year, Susie Jolly examined the role of colonialism in sexuality education globally. Jolly highlighted examples where sexual health knowledge is built on unethical medical research carried out on racialized people, such as the study of untreated syphilis among Black men in the United States. Sexuality educators, especially those placed in the Global North, have a responsibility to work to decolonize their work. Jolly suggests supporting resources led by marginalized people, critically examining colonialism’s influence in the understanding of sexuality, and shifting the dynamics of who decides on content to lend more weight to non-Western expertise and young people learning from their own experiences.

More than 60 percent of preventable maternal deaths and 45 percent of newborn deaths take place in countries affected by recent conflict, natural disaster, or both. Yet as Sarah B. Barnes, Project Director of the Maternal Health Initiative, observed at a recent event hosted by the Wilson Center and UNFPA, in collaboration with the Inter-agency Working Group on Reproductive Health in Crisis (IAWG) and White Ribbon Alliance, “the leading causes of both maternal and newborn death occurring in humanitarian settings are considered to be preventable if managed by skilled providers and adequate resources.”

Reducing maternal mortality is key to promoting population health. It is also a main priority of the UN General Assembly’s Sustainable Development Goals. And the reasons for concern are clear. Globally, 800 women and 6,500 infants die during pregnancy and birth every day. More than 94 percent of these deaths occur in low-and-middle-income countries (LMICs).

“When women can decide on the timing and spacing of their births, are treated with respect, and offered quality of care across the life course—they are not only able to survive, they, their families, and their communities are able to thrive and flourish. By directly and indirectly contributing to women’s empowerment, midwives are contributing to strengthen economic and productive and equitable societies,” said Dr. Julitta Onabanjo, Director of the Technical Division at the United Nations Population Fund (UNFPA), New York, at a recent event hosted by UNFPA as part of the 66^th Session of the Commission on the Status of Women. Midwives and midwifery experts convened to discuss the important role that midwives play in the improvement of gender equality, women’s economic empowerment, and climate justice.

Greater than one third of all women experience mistreatment during facility-based childbirth. Mistreatment, particularly in humanitarian settings, may include verbal or physical abuse, poor patient-provider rapport, a lack of information about maternal and newborn health (MNH) services for both pregnant women and providers, lack of privacy within facilities, challenges with receiving informed consent from women for medical procedures due to language and cultural barriers, and denied or delayed care. Such mistreatment can stem from historical tensions between populations seeking care and health workers (both foreign and local) as well as systemic mistreatment of providers who are burned out and possibly carry their own biases. Evidence shows that some women delay seeking care, or avoid care entirely because of social fears stemming from negative stigma or negative perceptions of their situation.