Dr. Allotey, you have dedicated your career to gender, equity, health, and human rights. What inspired you to pursue this path, particularly in the area of sexual and reproductive health?
I am deeply privileged to have had a career spanning direct engagement with communities, clinical practice, research, policy, and government, and for the past eight years, work within the multilateral system.
I come from a culture where, despite increasing opportunities, gender inequality remains pervasive. Sexual and gender-based violence still do not receive urgent attention, and sexual and reproductive health and rights, including maternal morbidity and mortality, lag behind expectations, given the level of global economic development. As a midwife, I was profoundly moved by the women I cared for, but it was heartbreaking to know that so many deaths and poor outcomes were preventable with a strong, resilient health system and a comprehensive approach to sexual and reproductive health and rights across the life course.
With the opportunity for postgraduate training, I undertook a PhD in medical anthropology and epidemiology, focusing on tropical diseases in pregnancy. My research took me to a remote community in Ghana, where female genital mutilation was still the norm, polygamy further entrenched the undervaluing of women, and fragile health systems deprived people of quality care.
Poverty, neglected tropical diseases, and systemic inequities created the perfect storm for high maternal mortality. Since then, I have sought out opportunities to address these challenges holistically, recognizing that gender equality, health, and human rights are deeply intertwined with politics, power, and economic justice.
Achieving gender equality and women’s empowerment, universal health coverage, and shared prosperity requires an integrated, intersectional approach, one that acknowledges inequities, demands justice, and is informed by diverse forms of evidence. This is the work that continues to drive me.
The theme of this year’s World Health Day highlights the importance of maternal and newborn health. What do you see as the most pressing challenges in ensuring healthy pregnancies and births globally?
Hundreds of thousands of women lose their lives due to complications of pregnancy or childbirth each year. That’s roughly 1 preventable death every two minutes. If you add in the number of babies who are stillborn or die in the first month of their life, that is one preventable death every 7 seconds.
Last year at the World Health Assembly, Member States adopted a resolution calling for urgent action to accelerate progress towards reducing maternal, newborn, and child mortality and morbidity, increasing access to affordable, quality healthcare services, including safe essential quality medicines and cost-effective evidence-based interventions, and reorient health systems towards primary health. Importantly, the resolution acknowledges that access to sexual and reproductive health is fundamental to this.
This year's World Health Day campaign is designed to drive much-needed action in this critical area. Under the theme "Healthy Beginnings, Hopeful Futures," the campaign aims to support governments and the global health community to prioritize efforts to end preventable maternal and newborn deaths, strengthen health systems, and improve the long-term health and well-being of women and newborns.
Image Credit: maxim ibragimov/Shutterstock.com
Despite significant progress in maternal and newborn health, we still see alarming numbers of preventable deaths. What key interventions or policy changes do you believe could have the most immediate impact?
Policies that prioritize the health of girls and women, especially the most marginalized in societies, will prevent maternal and newborn deaths. People die when science and evidence are forsaken for ideologies. A recent WHO analysis, led by my department, was published in the Lancet Global Health and shows that severe bleeding (haemorrhage) and hypertensive disorders like preeclampsia are the leading causes of maternal deaths. These deaths are preventable, but tragically, too many women lack access to lifesaving treatments and quality care during pregnancy and childbirth. Urgent action is needed to ensure every woman can access safe, high-quality maternity services that save lives and protect health.
It’s almost a cliché, but there is no lack of solutions to make a difference.
The progress to date is the result of evidence-based policies that have driven investment, action, and innovation. This includes solutions like the recent EMOTIVE studies that showed a 60% reduction in severe bleeding when a drape was used to detect blood loss, then applying a bundled approach to postpartum hemorrhage treatment rather than individual sequential interventions.
WHO research also shows that trained midwives have the capability to avert thousands of deaths and adverse outcomes for both mothers and babies, especially if they are able to deliver comprehensive SRHR, including contraceptive services. In addition, mobile clinics are a vital intervention, particularly in conflict zones, where barriers to care are high and preventable deaths persist. Ensuring access to comprehensive sexual and reproductive health services in emergencies is essential.
Sexual and reproductive health and rights are fundamental to universal health coverage. Ensuring access to a comprehensive package of sexual and reproductive health services upholds the dignity, rights, and well-being of people everywhere.
We know that when girls and women have control over their bodies, there are fewer unintended pregnancies and fewer unsafe abortions, which all lead to fewer maternal deaths, more girls in school, and more women participating in the workforce. And so, policies that enable access to sexual and reproductive health and rights are indicative of a society’s interest in delivering health for all.
Your work has emphasized the need to redress inequity and power imbalances in global health and ensure diverse voices contribute to decision-making. How does this apply to maternal and newborn health, and why is it essential for improving outcomes?
Global health is still shaped by institutions, donors, and actors based largely in the Global North. These entities often set priorities, allocate funding, and define success, sometimes without meaningful input from those most affected. This undermines national ownership and limits the relevance of policies to local realities. For instance, sub-Saharan Africa accounts for nearly 70% of global maternal deaths. While weak health systems are often blamed, this is only part of the story. Gender inequality, systemic racism, poverty, and discriminatory policies all intersect to deepen health disparities. These root causes are often ignored in global health approaches that focus narrowly on service delivery
Local voices need to help shape research priorities and policy decisions to ensure that solutions align with the realities of affected populations. Community-driven solutions reduce barriers to care, particularly for marginalized populations.
Stark inequalities also occur within countries; between urban and rural areas, between income groups, and based on age, disability, ethnicity, and gender. Global health efforts often fail to address these intra-country power dynamics.
By acknowledging, addressing, and discussing these challenges, countries can improve outcomes for all citizens. Unless all women have access to universal health coverage (including access to sexual and reproductive health commodities and services) and an adequately staffed health system, we cannot truly hope to address the past and current imbalances.
Health systems must address not just obstetric complications but also issues like mental health and noncommunicable diseases. How can we ensure more holistic, women-centered care before, during, and after pregnancy?
This is an issue that I am particularly passionate about. The global focus on women’s health has disproportionately centered on maternal health. This narrow, reductionist approach effectively confines women’s health to the relatively brief window of pregnancy and the postpartum period, overlooking the full spectrum of health risks, needs, and rights that women navigate throughout their lives.
Women’s health cannot be solely defined by motherhood. Recognizing women as sexual beings with distinct sexual desires, orientations, identities, and reproductive capacities demands that health systems move beyond a maternal-centric model and prioritize comprehensive, life-course approaches to women’s health.
Biology is foundational, but it does not exist in isolation. The same biological determinants that enable motherhood also shape women’s exposure, vulnerability, and response to a wide range of diseases, which are further influenced by social norms, cultural, economic, and structural health system factors. A holistic, women-centered approach must recognize these intersections and ensure that healthcare systems proactively address the full continuum of women’s health needs before, during, and beyond pregnancy.
While direct obstetric complications such as hemorrhage and preeclampsia remain the leading causes of maternal mortality, non-obstetric and pre-existing conditions contribute to nearly a quarter of maternal deaths worldwide. These include anaemia, noncommunicable diseases (NCDs), mental health conditions, and infectious diseases such as malaria and HIV, all of which increase health risks for millions of women globally.
Gestational diabetes, the most common medical disorder in pregnancy, along with cardiac conditions, asthma, epilepsy, hemoglobinopathies, and substance use disorders, significantly impact maternal and fetal health outcomes. Yet, these conditions are often underdiagnosed, undertreated, and overshadowed in maternal health discussions.
To ensure holistic, women-centered care, health systems must:
- Move beyond a singular focus on pregnancy to address women’s health across the life course, including adolescence, reproductive years, and post-menopause.
- Integrate sexual and reproductive health services within broader health frameworks, recognizing that women’s health needs extend far beyond pregnancy.
- Strengthen prevention, screening, and management of NCDs, mental health conditions, and infectious diseases that disproportionately affect women.
- Invest in gender-responsive health systems that recognize the structural barriers women face in accessing comprehensive healthcare.
We must look beyond a woman’s reproductive capacity and see her holistically. Our recent publication “Extending Sexual and Reproductive Health and Rights to Future Generations Through Science and Evidence” addresses how we hope to do this.
Practically, this year, we plan to release guidelines on the management of non-communicable diseases in pregnancy, including sickle cell anaemia and gestational diabetes. We also have a body of work around respectful care before, during, and after pregnancy and childbirth, as well as recommendations on maternal and newborn care for a positive postnatal experience (you can read more here).
We also published a series in The Lancet Global Health on maternal health in the perinatal period and beyond, which contributed to ways to approach maternal health holistically and articulated the long-term impact of pregnancy on women and the need for follow-up care that extends well beyond the 6-week postpartum period.
This year's World Health Day campaign calls for increased investments in maternal and newborn health. Where do you see the biggest gaps in funding, and what are the most strategic areas for investment?
Recent severe and drastic funding cuts have immediately impacted the health and wellbeing of women and infants, including maternal health services, immediate losses in health care personnel, HIV treatment and care, access to medicines, and family planning services. The long-term effects of these cuts are being monitored, but lessons from the last few decades give a clear indication of the devastating impact this will have on progress to date.
Evidence shows that spending on maternal and newborn health is not a cost, it's an investment in human capital, leading to economic development and happier, healthier societies. UNFPA estimates that by meeting the unmet need for family planning and ending preventable maternal deaths in developing countries will unlock US$660 billion in economic benefits by 2050.
WHO is calling for investments in high-quality antenatal services to support healthy pregnancies by reducing risks and detecting possible complications; access to quality care from skilled providers during and after childbirth; midwifery care models; access to family planning; and more research into what will work in low-income contexts.
Beyond survival, we should invest in compassionate and respectful care, postnatal support, family-friendly policies, and the empowerment of girls and women.
You have an extensive background in implementation research and community engagement. Can you share an example of a research initiative that has successfully improved maternal or newborn health outcomes?
As the Director of WHO’s Department of Sexual and Reproductive Health including the UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research Development and Research Training in Human Reproduction (known as HRP), I have the opportunity to work with a remarkable team that is dedicated to generating valuable insights, providing evidence-based guidance, and partnering with committed professionals across various countries and organizations to enhance sexual and reproductive health and rights.
We have long realized that by tackling preventing deaths due to postpartum hemorrhage (PPH) – defined as excessive bleeding after childbirth – we will be able to save millions of lives.
In October 2023, WHO and HRP released a first-of-its-kind roadmap that sets out a clear path to combat PPH. This Roadmap has brought all major players together under one plan to help countries address the stark differences in survival outcomes from PPH, which reflect major inequities in access to essential health services.
Over 85% of deaths from PPH happen in sub-Saharan Africa and South Asia. Many risk factors for this condition can be managed if there is quality antenatal care, including access to ultrasound, alongside effective monitoring in the hours after birth. Too often, however, health facilities lack necessary healthcare workers or resources, including lifesaving commodities such as oxytocin (which can help stop hemorrhage), tranexamic acid, or blood transfusions.
Major progress has occurred with the success of the EMOTIVE trial. The study found that objectively measuring blood loss using a simple, low-cost collection device called a ‘drape’ and bundling together WHO-recommended treatments, rather than offering them sequentially, resulted in dramatic improvements in outcomes for women. Severe bleeding, when a woman loses more than a liter of blood after birth, was reduced by 60%, and they were less likely to lose their life. More recently, this approach was found to be cost-effective, which is fantastic news for resource-poor settings.
We need a multipronged approach focusing on both prevention and response, preventing risk factors and providing immediate access to treatments when needed, alongside broader efforts to strengthen women’s rights. Every woman, no matter where she lives, should have access to timely, high-quality maternity care, with trained health workers, essential equipment, and shelves stocked with appropriate and effective commodities – this is crucial for treating postpartum bleeding and reducing maternal deaths.
Priority actions include developing new and broader guidance for PPH covering prevention, detection, and treatment; conducting research to deliver innovations and increase access to proven interventions; establishing a new procurement mechanism to improve the supply of high-quality medicines and commodities; advocating and awareness-building; and, at the country level, training, and facility-based improvements.
Listening to women and supporting families is a key message of this campaign. How can health systems better integrate women’s voices and lived experiences into maternal healthcare policies and services?
Reducing maternal deaths will require strengthening antenatal care to detect and prevent complications, emergency obstetrics, and skilled care during childbirth, as well as postnatal services. Health systems need to evolve to manage the many health issues that impact maternal health, and we must centralize sexual and reproductive health and rights as critical to helping reduce maternal deaths.
We must also address issues of equity and ensure access to healthcare facilities before, during, and after birth. However, we cannot do this without consulting women themselves, their communities, and local health workers to understand the needs of women better. Local laws and policies must consider the many and varying needs of those they serve.
WHO advocates for health planning in which women’s values and preferences are at the centre of their care. Meaningful engagement and empowerment of women, families, communities, and providers are essential for quality improvement initiatives.
HRP has a long history of bringing together a gender and rights advisory panel to advise on integrating gender equality and human rights in all aspects of HRP's work. This panel was created in the 1990s, at a time when the wants and needs of women were not at the forefront of anyone’s minds, including researchers and the public health community. I am glad to say we have come a long way since then, but we still have a long way to go.
With social media playing a significant role in public health awareness, how can platforms be leveraged to share accurate, evidence-based information about pregnancy, childbirth, and postpartum care?
When searching for information online, people should feel confident that reputable websites are truthful and accurate. At WHO, technical experts with deep understandings of the subject areas ensure the information on our digital platforms is evidence-based and up-to-date.
We are well aware of the spread of misinformation and disinformation, especially regarding women and their health, including pregnancy, childbirth, and the postpartum period. Distrust, politicization of issues, and opportunities for revenue can create an atmosphere that can be rife with confusion. We want to be sure that we are meeting people where they are, providing the information they are looking for, and supporting healthy, informed decision-making.
Even still, it is often difficult for people to know what is true or false. WHO will launch evidence-based digital content repositories, starting with contraception, to ensure validated health information is more easily available to influencers, implementers, and developers of digital platforms who are increasingly at the forefront of how individuals obtain health information and integrate it into diverse digital user journeys.
Digital technologies – including artificial intelligence – bring both opportunity and danger. The field of sexual and reproductive health and rights often grapples with underlying issues of access and equity, which can be greatly amplified and exacerbated by AI.
AI is already transforming technology for sexual and reproductive health. If we’re aware of the potential dangers, cautious about implementation, and recognize AI as a tool and not a solution, we have a great opportunity to make sexual and reproductive services and information more accessible to all. We produced a technical brief about this in 2024.
Finally, as we launch this year-long campaign, what message would you like to share with policymakers, healthcare professionals, and communities to ensure healthier beginnings and more hopeful futures for mothers and babies worldwide?
This campaign will hopefully raise awareness about the gaps in maternal and newborn survival and the need to prioritize women's well-being. Policymakers must be persuaded to invest in interventions that will produce the most improvements for women's and babies’ health—no matter where they live. In our communities, we must actively support parents and health professionals who provide critical care.
At WHO, we will always strive to provide useful health information relating to pregnancy, childbirth, and the postnatal period. We hope that at the end of this campaign, in 2026, we will be able to report back and show real progress in reducing maternal and newborn deaths.
Access to sexual and reproductive health services is a human right and should be available to all people throughout their lives as part of ensuring universal health coverage. This not only contributes to improved maternal and overall health outcomes but also to gender equality and wider development.
Where can readers find more information?
About Dr. Allotey
Dr Pascale Allotey is a leader in gender, equity, health and human rights. Her recent work includes challenging the boundaries of global health, advocating for accountability in the decolonization of global health and international development, and expanding opportunities to diversify the voices of contributors to global debates and decision making – particularly in evidence generation, policy and programme implementation within the UN system, with governments, NGOs and the academic community.
Dr Allotey is a triple-certified nurse, midwife and public health nurse with a multidisciplinary background in clinical health sciences, implementation research, anthropology, and epidemiology. She holds a PhD in Public Health and a MMedSci in Community Health from the University of Western Australia, and a BA in Nursing and Psychology from the University of Ghana, Legon.
Bringing over three decades of experience as a global public health researcher, Dr Allotey has published extensively including on: sexual and reproductive health; harmful traditional practices; gender, sex and disease; migrants and refugees; health systems research; implementation research, and community engagement.
Prior to joining WHO, Dr Allotey was Director of the United Nations University International Institute for Global Health (UNU-IIGH) in Kuala Lumpur Malaysia.
Originally from Ghana, her other previous posts include: Professor of Public Health and Deputy Head of School (Research) at the Jeffrey Cheah School of Medicine and Health Sciences, Monash University (Malaysia); founding Associate Director of the South East Asia Community Observatory (SEACO Malaysia); Professor of Race, Diversity and Professional Practice, Brunel University (United Kingdom). Dr Allotey is a former Co-Chair of the HRP Gender and Rights Advisory Panel.
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