The Largest SRHR Wins and Challenges of the Past 30 Years

The United Nations Population Fund (UNFPA) is the United Nations sexual and reproductive health agency. The agency advocates for, provides access to, and educates on sexual and reproductive health and rights services.  Rebecca Zerzan, editor with UNFPA, sits down to talk with us about UNFPA’s 2024 state of world population report, Interwoven Lives, Threads of Hope: Ending Inequalities in Sexual and Reproductive Health and Rights. Rebecca also details the ways in which global misinformation impacts access to care.

UNFPA is the world’s largest procurer of donated contraception, which is distributed mostly in low- and middle-income countries. UNFPA also works closely with local organizations and agencies to facilitate access to medically accurate, culturally sensitive education. UNFPA’s recent report looks back over the last three decades, when the scale of maternal death was unknown, rates of adolescent births were higher, and rates of women’s contraception usage was halved, and discusses global progress. The report also researches misinformation around the world and how that impacts an individual’s access to comprehensive care.

Links from this episode

UNFPA on X
UNFPA on Facebook
Interwoven Lives, Threads of Hope: Ending Inequalities in Sexual and Reproductive Health and Rights
Myths and Facts About Sex Education: Research Contradicts Misinformation and Distortions by Advocates for Youth

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Transcript

Jennie: Welcome to rePROs Fight Back, a podcast on all things related to sexual and reproductive health, rights, and justice. [music intro]

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Jennie: Hi rePROs. How's everybody doing? I'm your host Jennie Wetter, and my pronouns are she/her. So y'all, I'm back from my vacation in Wisconsin. I had a great time. It was so nice to see family and spend time with my mom. Yeah, it was a lot of fun. I was able to meet with some aunts and cousins and planned a trip with an aunt and some cousins. And yeah, it was a lot of fun. It was just nice to, honestly, I just stepped away from everything. I didn't check my email at all. I spent some time outside. I may have gotten attacked by some bugs and, like, my legs had these huge and terribly itchy bug bites on them, but it was still delightful and nice to just get away from everything. I was able to do some reading and just have some quiet time and get to see my mom, which was always nice. And we didn't do anything super exciting, like, ran some errands, went out to dinner with one of my aunts and one of my cousins. Unfortunately, my other cousin that I usually try and see when I'm home was unable to make it, but since I know he listens—John, we missed you! See when I'm home at Christmas. Yeah. But it was, it was nice. It was just really nice to be away from all the things. And then I came back and was, you know, plunged back into all of the things that were waiting for me, being gone for a week, but I'm now all caught up. I think I've got through all my emails and did all the things. There was a big podcast conference in DC but I decided not to go this year 'cause it was like back-to-back with my trip to Wisconsin. And I would've had to stay at the hotel, like, outside of town. And my poor kitties were already so upset with me being gone for a week that they were, like, attached to me. So I thought being gone another four days to go to that conference was probably not the best choice. And, you know, I didn't need to go. But I did make sure to run out one day and see the wonderful Elsie Escobar, who's been a wonderful mentor and coach through my work and podcasting. And so, I had some things I wanted to talk to her about. And so, it was really lovely to go and have a chat with her and get to see her in person for the first time in a while. So yeah, it was very lovely. So, I'm now ready to dive back into the fray and all the things that are, like, have been, like, waiting for me to get caught up on. But yeah, so I'm ready to, like, dig in and get going and feeling a little refreshed, which is exciting. And I'm really excited to share this week's episode. It was a lot of fun. I had a great conversation with Rebecca Zerzan, with United Nations Population Fund, talking all about the progress we have seen over the last 30 years around sexual and reproductive health and rights and where there are gaps still and how the progress is slowing down and talking about the in inequities we are seeing around sexual and reproductive health and rights. It was a wonderful conversation and I hope y'all enjoy it. So, let's go to my interview with Rebecca.

Jennie: Hi Rebecca. Thank you so much for being here.

Rebecca: Hi. It's great to be here.

Jennie: I'm so excited to talk to you today. Would you like to introduce yourself before we get started and include your pronouns?

Rebecca: Excellent. So, my name is Rebecca Zerzan and I'm an editor at UNFPA, the UN Sexual Reproductive Health Agency. And my pronouns are she/her.

Jennie: So, I think that's like a really great place to start. Like, I do a lot of work with UNFPA and, like, the other side of my job, but I think a lot of people, particularly in the US maybe aren't as familiar with UNFPA, so it feels like maybe a good time to take a minute and talk a little bit about the work that UNFPA does.

Rebecca: Awesome. Yeah, so UNFPA, our letters are a little bit, you know, long and confusing. It's because we're technically the UN Population Fund and we were created in the 1960s. It was a super long time ago when everyone was, like, you know, really concerned about population. But we describe ourselves now as the UN Sexual and Reproductive Health Agency because even from the very beginning, the majority of our work has really focused on making sure that people have access to sexual reproductive health services, particularly family planning, and also that we are teaching people about their sexual and reproductive...their bodies and their rights. And so, that's the basis of a lot of the work that we do. We're, I think, the world's largest procure of donated contraceptives, which we distribute mostly in low and middle income countries. And it's not just a matter of, you know, handing out contraception to people and saying, you know, plan. It's also really kind of like the A to Z of everything that people need to be able to exercise their reproductive rights. So, that includes working with organizations and communities and governments to make sure that teachers are equipped with medically accurate, culturally sensitive education materials so that people can learn about their bodies. And a really important part of that is about their rights. So, we are really involved in measuring, for example, the percentage of women in the world who are able to say no to sex. Those numbers unfortunately are really not great. We also work with midwives to ensure that women who are pregnant are able to access antenatal care, that they're able to give birth in a safe environment with the care of a trained professional and receive all of the postpartum care that they need. So, it's all of those elements from health education that involve human reproduction that we really work in.

Jennie: I do, like I said, I do a lot of work with UNFPA, and, like, they do such amazing work. Y'all. I think where my audience may be a little more familiar—in that we've talked about it before in the podcast—is UNFPA really plays an important role around sexual and reproductive health, particularly in humanitarian settings. We've had a couple episodes talking about that work, but yeah, they do amazing work in a lot of other contexts as well.

Rebecca: Excellent. Yes, I really appreciated those episodes, by the way.

Jennie: Yeah. I was so grateful that y'all were able to help with the Gaza one because I know that your people were so busy and trying to do so much that I was really grateful that they were able to take some time to record something for it.

Rebecca: I mean, just as a, as a total aside, you know, the work that we do in humanitarian settings really illustrates how sexual and reproductive health and rights are so much broader than people think. You know, people think, oh, it's a, you know, gotta go to the gynecologist and get my pap smear, gotta get access to condoms or whatever. But when you look at a humanitarian crisis, you really realize that, like, if you don't have access to your contraception, if you don't have your doctor or your prescription, how are you gonna protect yourself and your family from an unintended pregnancy? You know, the issue of sexual violence spikes in a humanitarian context. And then there's this whole area of work that is totally necessary and part of sexual and reproductive health that people don't think about, which is, you know, trauma support for experiencing gender-based violence for experiencing rape. You know, all of these things really fall under the umbrella of sexual and reproductive health and rights.

Jennie: Yeah. It's one of those things that we have really been trying to uplift because it is such an important thing that it is coming higher on the agenda. But so often in a humanitarian crisis, the first thing that people think of is like food, water, and shelter. But like, people don't stop being pregnant. People don't stop wanting to not be pregnant. Sexual assault goes up. Like, it is so important to have those resources in place from the start to ensure that people can access them.

Rebecca: Absolutely.

Jennie: Okay. But we're not here to talk about all that. We're here to talk about the report that you worked on. So I think a really great place to start is the progress that's been made. Can you tell us about some of the progress that I really love that the report starts focusing on, like how far we've come, and I think that's important to do 'cause it's so easy to get caught up in like, what needs to be done that you can forget that, like, so much has been done.

Rebecca: Totally, totally. So, we released a report pretty recently that really tried to look at the last three decades, what has happened in the world over the last three decades. And it's easy to forget that three decades ago the world was just a completely different place. You know, as a person who remembers three decades ago, very clearly, it's almost shocking to see how different the world was and how far we've come and in a really, in the best possible way, you know. So, three decades ago we saw that we were really just grappling with: what is the scale of maternal death? We didn't even have really great statistics. And now not only do we have really firm numbers, but we also see that the rates of maternal death, meaning dying from complications of pregnancy or childbirth or the immediate aftermath of childbirth, have fallen a huge amount—34% in the last three decades. We've also seen that the number of women who are able to use contraception has doubled. Adolescent births have fallen by a third. We see more than a hundred countries—I think it's, like, 160+ countries—have passed legislation against domestic violence. I mean, just really, really great progress that we're seeing in the world. And it's easy to lose sight of when you look at the headlines, but it's really something for us to celebrate.

Jennie: Yeah, I think about that even just like in my own work. Like, I have been doing this for a little over 16 years now, and so, it's easy to think of, like, right now talking about the maternal mortality crisis and how, how bad it is and things need to change. And while that is still true, full stop. Still true. When I first started, I remember we were talking about a woman dying from pregnancy-related causes every minute. And, like, that's not the case anymore. So, huge progress has been made, but there is still so far to go. So, maybe we turn to that, like, progress does seem to be slowing a bit. Like, I'm sure it's very complicated and there are lots of reasons, but do you wanna talk a little bit about why?

Rebecca: Yeah, absolutely. That's one of the big questions that the report is seeking to answer because we are seeing across a lot of different measures that progress is slowing. And by some measures really, you know, really tragically progress is stopping or even reversing. And I'm gonna keep talking about maternal mortality just because that's one of the really clear areas where there's really urgent need and where we have really good global data. But this applies to all areas of sexual reproductive health and rights, you know, and so if we look just at the maternal mortality data where, you know, we have more than 30 years of commitments to dramatically lower maternal death rates. And we have, and yet now when we have all this technology, when we live in this global society, when we've got telemedicine and we've got, you know, incredible training available globally, we're still seeing that maternal death rates, that the year on year improvement has reached zero. We are not improving in terms of reducing maternal death. And our data only really goes to the first year of the pandemic, which we know had a negative impact on...you know, that COVID itself increased maternal mortality. We know that all of the systems, you know, shuttering and everybody having to sort of pivot where their health resourcing was going, that also had a negative impact on maternal survival. So, we have every reason in the world to think that those rates might be going up and we actually see in a lot of really rich countries really tragically that the trajectory from, like, 1990 to now is actually worse. So, there's a lot that we need to be doing.

Jennie: Yeah, I think one of the ways that some of this was really illustrated to me in the last year was seeing the almost—luckily they just, they changed their mind—but Gambia talking about rolling back their FGM protections and, like, that was scary to think that we had gained so much ground on banning that practice that we might start to see this trend of countries rolling back their commitments.

Rebecca: Yeah, that was really horrifying. And I have to say, I'm just so, so, so admiring of the work that people on the ground in Gambia did, particularly community members and activists. And I think that that's a really interesting kind of entry point into the question of: why is progress stalling? And of course there's, you know, a million factors, you know, there's issues like the pandemic, there's the debt crisis. I mean, there's a million reasons, but one really core reason is that we have just globally as a society, not really looked into how our systems really emerge from periods of really terrible inequality and continue to perpetuate a lot of those assumptions. A lot of those resource gaps, you know, the acquisition of knowledge and things, they're really based on biased information and they perpetuate bias in ways that are really unfortunate. And then when we try to correct that, when we try to bring in more inclusive voices, the voices of women and girls on the issue of female genital mutilation as one example, we very often experience a backlash of people, often people who are in power or people who have experienced a lot of the benefits of society, which have again, been tremendous. But a lot of people will say, "oh, well, we shouldn't be privileging those voices," for example, or we, you know, we, our culture or what our perspectives and the process of seeking greater inclusion in these areas can be seen as a threat. And I think that's really unfortunate.

Jennie: Yeah. It's always so much more complicated and the pandemic definitely didn't help. We know that like gender-based violence and child marriage went up. And so again, the thought of there being, like, there's never like the one easy silver bullet answer, right? Like, if we just fix this one thing, everything will be so much better. But I think one of the things the report talked about was misinformation. And I know that's something we talk about a lot, like, in the domestic context of misinformation and disinformation in the US but we also see it a lot globally and it affects people's ability to access care.

Rebecca: Absolutely. And, you know, misinformation is really, you know, it sounds like it's specifically, like, disinformation that is baked into information, but it's also inclusive of just the omission of information. And we see that from bottom to top the way that, you know, and we see it baked into medical education even right, with outcomes that are, that are deeply and extremely unequal. So, for example, a lot of medical textbooks still use a classification of pelvic shapes that considers the pelvic shapes that are more common to white women as being more standard. And other pelvic shapes are considered less standard and researchers say there's potentially extremely dangerous consequences to that of thinking of people of color as being non-standard. We see it in how medical students report perceiving the experience of pain among people of color. And that's not, you know, just in any one part of the world, you know, these biases are global. We see them as well in how people talk about human development, right? And we see it in classrooms. So for example, in a lot of places people still think menstruation is a sign that, you know, you've become a woman, your body can become pregnant, you know, you are in some places marriageable. And that idea, you know, it's such a simple idea. And if we just altered it slightly to say that menstruation is one part of a long process of development, which makes a person able to have a baby. It's such a subtle distinction, but it makes clear, you know, things like girls shouldn't be robbed of her girlhood just because she started to menstruate. And those misperceptions can have huge consequences when they're held by doctors, by community leaders, by policy makers.

Jennie: Yeah. All of this together, like, and also thinking back to what you talked about, what UNFPA does is making sure that people are able to access sexual and reproductive health services, but this all plays together, right? Like, if you aren't given the information to know that these are your options, you are not able to access the service because you don't know it exists. If the provider doesn't understand that young people should have the ability, or unmarried people should have the ability to access birth control or other sexual and reproductive health services, they will, you know, prevent young people from accessing that care. So, this is all part of one story that, like...using the word access, it has so many layers to it, right? Like, if you are in a child marriage, your spouse may be preventing you from doing from accessing services. So, "access" covers so many things that seem so simple when you just say somebody's unable to access birth control.

Rebecca: Absolutely. Absolutely. And I think that there's a really common misconception that the biggest barrier to using contraception is, you know, that a person can't go to the corner store. Maybe there's no corner store or that, you know, the biggest barrier is that your husband has blockaded the doors or something. And in fact, you know, the social and cultural norms are some of the biggest barriers, you know, opposition to the use of contraception, concerns about side effects because you don't have a wide variety of options. All of those are huge, huge, huge barriers that really just go to the issue of having the right information.

Jennie: Yeah. And again, misinformation, right? So, the misinformation isn't just the ability to know that you can access the services. Sometimes it's hearing that, you know, birth control is gonna cause infertility or whatever the misinformation that may be in your community that may be blocking you from accessing that care.

Rebecca: Absolutely. The stigma that using contraception means that you'll be unfaithful. The stigma that if you have access to contraception, suddenly you'll become promiscuous. All of these things serve as enormous barriers and you know, those are falsehoods, right? Those are demonstrable falsehoods that we can and should be talking about.

Jennie: So, are there other parts that you wanna raise up around what else is slowing the ability to get progress?

Rebecca: Sure. Well, if I could first just mention one other, you know, form of misinformation that I think is really-

Jennie: Oh yes, please.

Rebecca: -pernicious and is really widespread. It's the idea of, you know, forgive the term, but you know, "gender essentialism," right? There is, and we see that being, you know, taught in schools, we see it being taught in communities and we see it just kind of, you know, in the broader atmosphere of how people talk about, you know, relationships and sex and gender. And gender essentialism is basically the idea that there's just like these fixed categories of men and women and they're fully distinct in their biology and in their innate capacities. And yeah, we could make sort of general statements, like, you know, "women and girls have XX chromosomes," you know, "men and boys have XY chromosomes." But even that framing, which captures, you know, 98% of people potentially, it ignores a huge number of people who have variable traits, have variable hormone levels, have variable characteristics. And we're not really learning that that is just a part of the normal spectrum of human experience, right?

Jennie: And we just saw that, right? We just saw that at the Olympics.

Rebecca: Absolutely. Totally. A hundred percent. A hundred percent. And we look at, you know, we don't think about teaching things in that way as being exclusive, but it is. It is a form of exclusion. And that form of exclusion, that form of kind of binary thinking enables really abusive behavior as we see. And so I think, you know, and when we see that in medical settings where people who are, you know, fully a man or fully a woman and have, you know, one variable trait or experience can be treated terribly in a medical setting or by their community or even potentially killed, you know? And so, if we could just recognize that, you know, that there's a diversity of expressions of how bodies exist in the world, I think that that would be so much better.

Jennie: Yeah. And this is, like, another one of those where it felt like there was being real progress made on it, and all of a sudden, the anti-rights agenda has really become so much louder and is really spreading. And I'm really worried about not just progressing, I'm really worried about seeing regression, and I think we are already seeing it in some places.

Rebecca: Absolutely. And that's one of those forms of progress being reversed because these things are being politicized and they just truly don't need to be politicized. One of the key kind of recommendations of the report that has me the most excited is really thinking anew about ways that we can be more inclusive in all of our decision making in, you know, whether it's how health systems are structured and designed, or whether it's how we're teaching about human bodies and sexuality in classrooms. I just think that calling for people to make a proactive effort to listen to communities that have traditionally been excluded from the conversation could make everything so much richer and also doesn't contribute to polarization. There's this false notion that including more voices means diminishing my share of the space. And history shows us that inclusion benefits everyone. We've got really amazing examples of that. The simplest example, and I think, you know, but I think that is kind of the most telling is, you know, in the 1970s, all of these disability activists went out at night and crushed the corners of sidewalks in order to install their own curb cuts because the cities weren't doing that. And the result of having curb cuts is people realize, oh, it's not just for people with mobility impairments. It actually helps if you're a human being who's ever pushed a stroller or pulled a wagon or a shopping cart. Everyone benefits. Rides a skateboard, right? And that is true of increasing the inclusivity of our sexual and reproductive health systems. We found, for example, one of the key findings of our report is that inequality, when we look at women and how they answer the question, has your access to healthcare improved? You know, we look at those answers across surveys where we have ethnicity data. So, it's not that many countries that even have this data, but in the countries where we do have that data, we see that inequality, you know, obviously there's been progress, right? Women have better access to health services, they're better able to get, this is self-reported. I can go out and I can seek care, I can, but the pace of improvement is so much greater among women who are affluent and belong to a more privileged ethnic group. And those disparities are growing over time in many, many countries. And what we see is very often inequalities are greater within countries than between countries, which is something that a lot of people don't wanna hear. They don't wanna hear that society's becoming more unequal. And yet what we find from some of the good examples, Ghana, for example, is one of the countries where we found that ethnic disparities in health access among women were sharply declining, sharply declining. And so, we called up our colleagues in Ghana and said, look, we found this incredible story that is so different from what we're seeing in so many parts of the world. What do you think accounts for it? And they said, well, probably because you know, we implemented—not UNFPA, but Ghana—implemented a policy of free maternal healthcare and national health insurance. And that's not something that is directed specifically to, you know, exclusively helping ethnic minorities who are poor. That's something that's for everyone, everyone benefits and we reduce inequality. Same for gender affirming care, for example. Researchers say that the things that they have learned from providing, you know, hormone therapy and gender affirming care could greatly advance how we treat menopause symptoms. You know, so the act of inclusion, it doesn't hurt people. It helps everyone.

Jennie: Yeah. I just, you know, making sure that services are getting to those, the most marginalized, means that if we know that they are having access, then we know everybody does.

Rebecca: Yeah, absolutely. And there's a real fear that I have about how efforts to be more inclusive is really kind of being contorted into, you know, something like a wedge to divide us.

Jennie: Yeah. Like, we're favoring or...

Rebecca: Absolutely. And in the case that you just described with the, you know, the Olympic boxers who are being falsely claimed to be, you know, to have gender diverse characteristics or, or sex traits—it's just not true first of all. But maybe if we stop trying to police women's bodies, all women would benefit. Maybe if we recognize that, you know, it is most often women of color who are perceived as failing to meet certain feminine standards and stop trying to apply those standards, then people of color would benefit. I mean, people on all parts of the spectrum of humanity would benefit.

Jennie: Yeah. I mean, as trans people have been saying, it's not only us who is going to be harmed by these anti-trans policies, particularly around women in sports, but even just around any number of things, it's also gonna be cis women and cis women of color who are gonna feel the impacts of these restrictions.

Rebecca: Absolutely. And we talk in the report about Caster Semenya, who very similarly, an incredible woman runner who's just being attacked and being prevented from participating in her sport. And, you know, if we could just reflect what's- not only just have a more open mind about accepting people, but also if we just reflect the biological reality that there is diversity in the world, I think everything would be a lot better and we could figure out how to reform our systems in a way that better meet everyone's needs.

Jennie: And I think it's also important to note, like, this was a conversation around a couple specific Olympic athletes, but it was then taken over and by people who have very large platforms. And it was seen by young trans people who may be wanting to think about getting into sports. And this may be something that prevents them from even wanting to do that. And that is just crushing.

Rebecca: I mean, it's just really sad when you see all of the various ways that a misunderstanding about the human body and human sexuality and a lot of norms that are based in assumptions can really derail people's lives and make it very hard for them to thrive. A lot of our medical systems are based on historical inequalities and people don't want to see all of the various ways in which those historical inequalities are continuing to yield unequal outcomes because they see it as an attack, right? “Oh, you're bringing up the past.” But it doesn't have to be about blame, you know, it doesn't have to be about—this happened 200 years ago, therefore we're, you know, we're mad at you. It's just saying, look at the outcomes that we are still having and let's use those outcomes as an opportunity to reevaluate which parts of our system are not serving people.

Jennie: This all makes me think of one of my favorite, like, hobby horses of the important role and need for comprehensive sexuality education and making sure that everybody is getting an inclusive sex education. And I always go back and talk about: I did not have that. I went to Catholic school K through eight. I had sex ed from a nun. There are so many things that I could have learned and didn't learn, and there are so many people who are getting similar or worse than I got. And it's just really important we could cover some of that gender inclusion and all of those things and so many things that can be covered in that. And you get rid of that stigma and fear and the unfamiliarness, which I think so many people are grappling with right now.

Rebecca: Totally. Totally. And I think there's just kind of, like, a real disconnect when people even think about sex ed. So for example, we say “comprehensive sexuality education,” and that just is to distinguish this education that is provided to international standards from what somebody might just give based on, you know, whatever's happening in their textbook or whatever. And there's also a misunderstanding that sexuality education provided to international standards means that we are bringing in, you know, these foreign ideas that are being imposed on our communities. And that is just completely false. Again, fake news, it's misinformation. Sex education provided to international standards involves and requires the participation of communities. It is not imposed externally onto communities. This is not saying, "hey, you need to change your pronouns." You know, "hey, young people need to have sex." I mean, no, of course not. It means culturally responsive curricula that are developed with community members, meaning parents and young people themselves to reflect their needs, right? It makes no sense to take a sex ed class that's being given in Poland and impose it on a community in Burkina Faso or the other way around, right? Totally different needs. There's parts of the world where girls have to grapple with the fact that they are, you know, facing predation from sugar daddies who are offering to pay for their school fees in exchange for sex. Girls in those communities need to learn about their rights, need to learn that that's a form of exploitation. Boys in those communities need to learn that that is not acceptable. Parents in those communities need to learn that they should not be victim blaming girls who fall prey to these kinds of schemes. That is a different lesson that needs to be taught in a community where, you know, there's, I don't know, high rates of a very specific kind of STD, right? Like, there's lessons that need to be localized and determined by the community according to the community's values, and they also need to be medically accurate. And those two things don't have to be in conflict. And yet, you know, people think, oh, well, I don't want my kids to be taught by some, you know, foreign cabal of Western educators or whatever. And it's like, that's just not what that is.

Jennie: Oh, I don't wanna cut this conversation short, but man, I think we've already covered a lot of this, but just in case there's anything we missed, what else can we do to fix this?

Rebecca: Well, something in our report that I think, obviously the issues of the inequalities that exist, you know, I think that that's hopefully ringing loud and clear to people that there's so much work that we have to do. You know, our report finds that one in four women in the countries where we have data cannot make decisions about their own healthcare. One in four can't say no to sex with their husband or partner. I mean, those things are, they should be shocking. And yet they're just, they're not because it's the case for so many people. I think that, hopefully, those are messages that are ringing loud and clear. Something that I think has maybe been overlooked is how a history and a legacy of racism and sexism and colonialism has really continued to infiltrate our health systems. It's really unfortunate, but the reality of modern sexual reproductive healthcare, and this is often used to attack those of us who are working in this space, but we are the first to recognize that the history of that healthcare emerges from women midwives being shunted aside by an emerging medical establishment that was male-dominated, and their knowledge of contraception and childbirth was called, you know, “arcane” and “harmful” and “primitive.” And male quote unquote "scientific doctors" really kind of took over that space. And not just in western countries, but everywhere. And we also see, you know, a legacy of women being experimented on—enslaved women, women in colonized societies, Indigenous women. And those are terrible, horrible, horrible histories that we all as a human rights community fully reject. But we've not looked at the subtle ways that history is continuing to influence our health systems. And so, you know, as an example, we see that even today, midwives are not empowered in the workplace and midwives who are by the way, trained to medical standards. They have, you know, extremely high pay gaps. When we correct for occupational segregation, female health workers have some of the biggest pay gaps that we see across industries. And we know that there's a massive shortage of trained skilled midwives. And that if we corrected that shortage, we would be able to avert something like 30, 40% of all maternal deaths, 30, 40% of stillbirths and neonatal deaths. But we're not doing that. And one of the reasons that that shortage persists is because midwives say they face discrimination in the workplace, including sexual harassment. So, there are things that we need to look at and that we need to evaluate, not just because a bad thing happened a long time ago, but because we continue to see the impact of that bad thing today.

Jennie: Okay. I always love to wrap up by focusing on actions the audience can take. So, what can the audience do? I mean, this all seems so big and complicated, but I'm sure there are actions or ways that they can get involved.

Rebecca: I think, you know, going back to our discussion on misinformation and how misinformation can include the absence of correct information, I think it would be really great for people to just get really involved and learn everything that they can about how sex ed is being taught in their communities. Finding out: who's designing those curricula? Are they inclusive? As we had said, not saying to, you know, go in and change things. That's not the point. But making sure that they're both medically accurate and reflective of the needs of the community. That young people have a voice in the development of those lessons, that they're not being shunted aside, that marginalized communities have access to sexuality education. You know, that's just a very concrete way that we can look into what's happening in our own communities. And you don't have to be an expert, but there's a lot of really great information that's out there, and it would be great to make sure that that information is penetrating into our own communities and spaces.

Jennie: Yeah. And along that vein, very similar to, like, you don't need to know all the things, but if people can know that you are a trusted person, they can come to you with questions. And that doesn't mean I need to have all the answers, right? I don't, but I know where I can point somebody and be like, hey, you have a question about this. Advocates for Youth has really great youth stuff that you can put your young person on. And let them go look at their AMAZE program, and they have AMAZE Jr. And this is where you can send your young people to get the right resources. So, I don't need to have the answers, but I maybe know, like, helpful resources I can point people to, to make sure that they are getting the correct information instead of just the crap shoot that is Googling.

Rebecca: And recognizing that, you know, so much of the information that we have right now is based on only a subset of people. There's so many people who've not been reached by data collection systems. You know, we're still not studying the female body, women are not included in clinical trials. There's so many people who have not been included in this. And just taking a beat and saying: well, where did this information come from? And are there people being excluded? And maybe finding ways to reach out to those voices.

Jennie: Well, Rebecca, thank you so much for being here. It was such a lovely conversation about a great report.

Rebecca: Thank you so much. This has been a real pleasure.

Jennie: Okay, y'all, I hope you enjoyed my conversation with Rebecca. It was really wonderful to get to talk to her about, you know, some good news, some of the making sure we celebrate the progress that has been made the last 30 years, but also making sure that we are addressing all those inequities that still exist. And with that, I will see everybody next week. [music outro] If you have any questions, comments, or topics you would like us to cover, always feel free to shoot me an email. You can reach me at jennie@reprosfightback.com or you can find us on social media. We're at @RePROsFightBack on Facebook and Twitter or @reprosfb on Instagram. If you love our podcast and wanna make sure more people find it, take the time to rate and review us on your favorite podcast platform. Or if you wanna make sure to support the podcast, you can also donate on our website at reprofightback.com. Thanks all!