Parents and caregivers line up with their children at an immunization centre in Janakpur, southern Nepal. Credit: UNICEF

By Rajat Khosla
GENEVA, Apr 25 2025 (IPS)

As the G20 Health Working Group convened in KwaZulu-Natal under South Africa’s presidency earlier this year, a central question echoed across plenaries: How can we accelerate universal health coverage (UHC) in an increasingly unequal world?

With more than half of the global population- over 4.5 billion people, lacking access to essential health services, the answer must begin with those who are most systematically left behind: women, children, and adolescents.

The State of UHC: Lagging and uneven progress

Despite some progress, we are off track to meet SDG target 3.8 on UHC. The UHC service coverage index improved only marginally from 65 to 68 between 2015 and 2021, and has stagnated thereafter. Worse still, the number of people pushed into extreme poverty due to out-of-pocket (OOP) health costs stands at a staggering 1.3 billion globally.

These financial shocks do not fall evenly. Women, children, and adolescents are particularly vulnerable to catastrophic health expenditures due to their higher health needs and frequent exclusion from social protection mechanisms.

For example, an analysis by Save the Children in 2024 found that 1 in 5 children would be born without skilled attendance, a study by WHO notes that a high proportion of SRHR-related services (including family planning, maternal care, and adolescent health) inadequately prioritized in UHC plans and are paid for out-of-pocket.

Rajat Khosla

Essential WCAH services—those that save lives and reduce inequity—are too often omitted or underfunded in national UHC benefit packages. For instance, a review of essential packages of health services found that in 17 countries (of 51 surveyed) that have defined lists of essential interventions only 1 fully includes all nine essential SRHR service bundles recommended by UNFPA in their UHC schemes.

Even when included nominally, coverage is often partial. For example, contraceptive services may be listed in UHC packages but not covered by public financing—leaving costs to women and families. Adolescents, in particular, face acute gaps in services. An estimated 1.2 million adolescents die each year, largely from preventable causes. WHO has committed to integrating adolescent-responsive health services into primary care.

These gaps are not the result of technical limitations—they are political choices. And in an era where the cost of inaction is measured in lost lives and missed opportunities, these are choices we cannot afford to maintain.

Equity: The Litmus Test of Progress

Equity must become the defining lens of the G20’s health agenda. Even where national progress has been made, coverage remains deeply unequal. For instance, a study of 25 countries in sub-Saharan Africa, found children from the wealthiest households more likely to receive essential immunizations than those from the poorest in 23 countries.

In urban slums and rural areas alike, adolescent girls face structural barriers to accessing SRHR services due to stigma, cost, and lack of youth-friendly care.

Across conflict and humanitarian settings, women and children face some of the worst health outcomes but receive the least investment. Aggregate data masks these realities. The promise of UHC cannot be fulfilled without disaggregated monitoring and targeted interventions that prioritize those furthest behind.

A Call to Recenter WCAH in UHC

G20 countries wield immense influence in global health financing and governance. As such, they must:

–Embed Comprehensive WCAH Services in UHC Schemes: Ensure all essential SRHR services are included, fully financed, and protected from OOP costs.

–Expand Equity-Focused Monitoring: Disaggregate UHC indicators by age, gender, income, and geography to make inequities visible and actionable.

–Invest in Primary Health Care (PHC): PHC systems must be equipped to deliver integrated, people-centered WCAH services, with strong community health components.

–Drive Global Leadership and Domestic Commitment: Align financing, governance, and accountability structures to support WCAH as a non-negotiable pillar of resilient health systems.

South Africa, which leads the G20 this year also heads the Global Leaders Network (GLN) for Women’s, Children’s and Adolescents’ Health providing much required southern led global leadership on this issue.

A Defining Moment

This is more than a policy debate. It is a defining moment for global solidarity and justice at a time when these values are under attack. Women, children, and adolescents represent not only a demographic majority—but also the majority of those excluded, underserved, and overburdened by weak health systems.

To build health systems that are truly equitable, inclusive, and sustainable, G20 leaders must put WCAH at the center of the UHC agenda. Not as an afterthought—but as a foundational priority.

We urge the G20 to seize this opportunity—to invest where it matters most, and to ensure that no woman, no child, and no adolescent is left behind.

Rajat Khosla is the Executive Director of the Partnership for Maternal, Newborn & Child Health (PMNCH).

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Credit: World Health Organization (WHO)

By Richarlls Martins and Rajat Khosla
GENEVA / RIO DE JANEIRO, Apr 4 2025 (IPS)

As global leaders prepare to convene for the Commission on Population and Development (CPD) in New York, April 7-11, the world finds itself at a critical crossroads. We can either recommit to human dignity, equality, and justice—or risk unraveling decades of progress in global health.

Central to this choice is the urgent need to prioritize sexual and reproductive health and rights (SRHR) as the bedrock of sustainable development. This is not just a health agenda—it is a human rights imperative.

Globally, over 164 million women still have an unmet need for modern contraception.¹ Every day, more than 800 women die from preventable causes related to pregnancy and childbirth² , and over 73 million induced abortions occur annually, of which 45% are unsafe,³ the vast majority in low- and middle-income countries.

The UN sexual and reproductive health agency, UNFPA, has appealed for $1.4 billion to safeguard the rights and well-being of women, girls and youth in 57 crisis-affected countries in the coming year. Credit: UNFPA/Ralph Tedy Erol

In many countries, young people—especially girls—continue to face systemic barriers to accessing comprehensive sexuality education and adolescent-friendly health services, undermining their autonomy and well-being.

In Brazil, we have made significant strides over the past decades. The country’s Unified Health System (SUS) has played a critical role in expanding access to maternal and reproductive health services, including free family planning, prenatal care, and safe delivery services.

Brazil’s National Policy for Comprehensive Women’s Health Care and the Stork Network (Rede Cegonha), launched in 2011, have aimed to ensure a continuum of care for women before, during, and after pregnancy.⁴ These initiatives represent the kind of people-centered, rights-based approaches we need more of globally.

Yet the work is far from over.

Despite improvements in access to care, Brazil continues to face deep inequalities. Maternal mortality remains disproportionately high among Black, Indigenous, and low-income women. Unsafe abortions persist as a major public health issue, particularly in regions where access to legal services is limited or stigmatized.

Adolescents—especially in rural areas and marginalized communities—often encounter barriers to sexual and reproductive health information, including fear, judgment, and lack of confidentiality.

In 2024, the Brazilian government launched the Alyne Network, a restructuring strategy for the former Rede Cegonha, whose goal is to reduce maternal mortality by 25% in the country. In addition to expanding actions focused on maternal and child health, with an investment of R$400 million in 2024 and R$1 billion in 2025, the new program seeks to reduce maternal mortality among black women by 50% by 2027.

The initiative pays tribute to the young black woman Alyne Pimentel, who died at the age of 28, while pregnant and the victim of medical negligence. The young woman’s case led Brazil to become the first country condemned for maternal death by the Global Human Rights System worldwide.

The CPD offers a pivotal opportunity to galvanize political will and place SRHR at the center of health and development agendas—not just in Brazil, but globally. As governments assess progress on the Programme of Action of the International Conference on Population and Development (ICPD), it is essential that they reaffirm the full spectrum of SRHR as non-negotiable and indivisible from broader development goals.

Investing in SRHR yields powerful dividends. For every dollar spent on modern contraceptive methods, governments can save up to $3 in maternal and newborn health care costs.⁵ Women and girls who can make decisions about their bodies and reproductive lives are more likely to finish school, participate in the workforce, and contribute to economic growth.

In fact, evidence shows that fulfilling the unmet need for contraception alone could prevent 70,000 maternal deaths annually and reduce unintended pregnancies by over 70%.⁶

Moreover, SRHR is a gateway to gender equality, resilience, and social inclusion. It is also a matter of justice. For populations pushed to the margins—people of color, Indigenous peoples, LGBTQIA+ communities, people with disabilities—SRHR is too often the frontline of discrimination.

In Brazil, we have seen how the lack of culturally sensitive care and structural racism in health services deepen health disparities. Addressing these inequities demands intersectional policies and intentional investments in inclusive systems of care.

Brazil has the tools—and the responsibility—to lead. Through its National Commission on Population and Development, Brazil is working to align national priorities of population issues with the Sustainable Development Goals, including SDG 3 on health and well-being and SDG 5 on gender equality. But this leadership must be mirrored and matched globally.

At this year’s CPD, we call on all countries to:

● Reaffirm SRHR as a core component of universal health coverage and the right to health;
● Expand funding for integrated, rights-based sexual and reproductive health services;
● Ensure youth-led participation and accountability in policy-making processes;
● Protect human rights defenders and health providers from discrimination and violence.

The Partnership for Maternal, Newborn & Child Health (PMNCH) and National Commission on Population and Development of Brazil stand united in this call. SRHR is not a siloed issue—it is central to health, equity, and the full realization of human potential.

In a world shaped by crisis—whether conflict, climate change, or pandemics—we must not lose sight of the simple truth: When people, especially women and girls, have control over their own bodies, they build stronger communities, healthier economies, and a more just world.

Let CPD 2025 be remembered as the moment we put people first—by putting SRHR at the heart of our global commitments.

¹ World Family Planning 2022 Meeting the changing needs for family planning: Contraceptive use by age and method. UNDESA. 2022. https://www.un.org/development/desa/pd/sites/www.un.org.development.desa.pd/files/files/documents/2023/Feb/undesa_pd_2022_world-family-planning.pdf

⁶ ibid

Dr. Richarlls Martins is President of National Commission on Population and Development of Brazil (CNPD). Rajat Khosla is the Executive Director of the Partnership for Maternal, Newborn & Child Health (PMNCH).

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Pioneering effort to protect women and children in quarantine centres in Viet Nam Credit: UN Women

By Rajat Khosla
GENEVA, Nov 21 2024 (IPS)

Each year, millions of women and children around the world die from preventable causes. Maternal, newborn, and child health (MNCH) is a shared global priority, yet we often overlook one of its most pressing—and preventable—barriers: violence against women.

As we mark the 16 Days of Activism Against Gender-Based Violence, we are reminded that gender-based violence (GBV) is not just a social issue but a critical health crisis that endangers the lives of mothers and children everywhere.

When we consider that a woman experiencing violence is 1.5 times more likely to have a low-birth-weight baby and that this condition greatly increases infant mortality, the need for urgent, integrated action becomes starkly clear. ¹ Addressing violence is not peripheral to MNCH efforts—it is foundational.

Violence and Health: A Devastating Cycle

Evidence tells us that intimate partner violence (IPV) directly affects maternal and infant outcomes. Pregnant women subjected to IPV face a heightened risk of complications like preterm labor and hemorrhage, often resulting in increased maternal and newborn mortality.^{2 3} The problem doesn’t end with pregnancy: children born to mothers experiencing violence have a higher likelihood of malnutrition, stunting, and developmental delays, perpetuating a cycle of vulnerability. ⁴

The psychological toll is just as concerning. Women subjected to violence are more prone to depression and anxiety, both of which affect maternal health-seeking behavior.⁵ Depressed mothers are less likely to access antenatal care and postnatal services, further endangering the lives of their infants. In turn, these mental health impacts lead to cascading health and social risks for women and their families, affecting entire communities.

Rajat Khosla

Nowhere are these challenges more pressing than in humanitarian settings. Conflict, natural disasters, and displacement magnify the vulnerability of women and children, often leading to spikes in sexual violence and the breakdown of healthcare systems. In conflict zones, over 60% of women report having experienced sexual violence, according to humanitarian reports. ⁶ These women are not only at risk of severe trauma and infection but also of maternal mortality, with rates nearly double those found in stable environments. ⁷

It’s estimated that more than 500 women and girls die every day from preventable complications related to pregnancy and childbirth in humanitarian settings,⁸ underscoring an urgent need for an integrated approach to MNCH and GBV response. These statistics are more than numbers—they represent the lives of mothers, daughters, and children who deserve health, safety, and dignity.

The Overlooked Victims: Women Health Care Workers

It’s not only patients who suffer. Female health workers, the backbone of MNCH services worldwide, are often at grave risk. In fragile and conflict-affected settings, women health workers face high rates of violence, including harassment and physical assault.

Research suggests that up to 80% of healthcare workers in these settings report experiencing violence, a statistic that directly impacts their ability to provide care.⁹ High rates of violence lead to burnout, turnover, and a critical shortage of trauma-informed healthcare providers when they are needed most.¹⁰

For many, this threat is exacerbated by their roles as frontline responders to gender-based violence. The safety and mental health of our healthcare workforce are inextricably linked to the health outcomes we aim to achieve for mothers and children.

A Call to Action for Integrated Policies

As we look to the future, it’s time to broaden our understanding of what it means to support maternal and child health. Policies that address violence against women and protect female health workers must become a central pillar of MNCH efforts. This calls for a multi-pronged approach:
1. Prioritize Funding for Integrated MNCH and GBV Services: Donors and governments should increase funding for programs that integrate maternal health services with GBV prevention and response, particularly in crisis-prone areas.
2. Strengthen Health Systems in Humanitarian Settings: We must scale up support for safe, trauma-informed healthcare in conflict zones, ensuring that women and children have access to life-saving care without the threat of further violence.
3. Protect and Support Women Health Workers: Policies that safeguard the well-being of women health workers are essential. Measures like workplace protections, mental health support, and security protocols can help mitigate the impacts of violence and ensure that healthcare workers can provide essential services safely.

The costs of inaction are too high. Each preventable death of a mother or child as a result of violence marks a failure to uphold the rights to health and safety for all. By placing violence against women at the forefront of our MNCH efforts, we can break the cycle of suffering and create the conditions needed for healthy mothers and thriving children.

This 16 Days of Activism, let’s commit to integrated action against violence—because women’s health, newborn survival, and child development depend on it. Together, we can build a world where women and children live free from violence, and where health and dignity go hand in hand.

¹ World Health Organization. (2013). Global and regional estimates of violence against women: prevalence and health effects of intimate partner violence and non-partner sexual violence. Geneva: World Health Organization.
² Shah, I. H., & Hatcher, A. (2013). The impact of intimate partner violence on women’s reproductive health: A review. Trauma, Violence, & Abuse, 14(2), 128-137. doi:10.1177/1524838012451845
³ Elizabeth P. Lockington et al. Intimate partner violence is a significant risk factor for adverse pregnancy outcomes. AJOG Global Reports. Volume 3, Issue 4, November 2023, 100283
⁴ Ellsberg, M., & Heise, L. (2005). Researching violence against women: A practical guide for researchers and activists. Geneva: World Health Organization.
⁵ World Health Organization. (2013). Global and regional estimates of violence against women: prevalence and health effects of intimate partner violence and non-partner sexual violence. Consequences. https://iris.who.int/bitstream/handle/10665/77431/WHO_RHR_12.43_eng.pdf
⁶ UNODC. (2021). Sexual violence in conflict: Current trends and implications. Vienna: United Nations. Retrieved from UNODC
⁷ UNFPA. (2019). Maternal mortality in humanitarian settings. New York: UNFPA. Retrieved from UNFPA
⁸ UNFPA. (2020). Maternal mortality in emergencies: The hidden crisis. Retrieved from UNFPA
⁹ Médecins Sans Frontières. (2018). Health workers in conflict zones: Risks and realities. Retrieved from MSF
¹⁰ World Health Organization. (2021). Violence against health workers. Geneva: WHO.

Rajat Khosla is Executive Director of the Partnership for Maternal, Newborn & Child Health (PMNCH), the global alliance for women’s, children’s and adolescents’ health and well-being, hosted by the World Health Organization, based in Geneva.

Email: khoslar@who.int

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