Persistent gender disparities lead to gaps in funding and research for health conditions that primarily affect women. In low- and middle-income countries, the situation is further compounded by barriers related to the high costs of health products, often poorly suited to the setting, and additional societal inequalities that limit women’s access to critical health solutions.
On International Women’s Day, 8 March, Unitaid remains committed to addressing barriers to improve the lives and health of women in resource-constrained settings.
“Some years back, I had a baby,” explains Rhoda, a Nigerian woman who had given birth at home when suddenly everything went wrong. “I delivered my baby and the blood now started rushing. They rushed me to the hospital. I was unconscious.”
Rhoda was hemorrhaging – a traumatic and life-threatening condition and a leading cause of death during childbirth. Women living in low- and middle-income countries account for 99% of all deaths from post-partum hemorrhage, largely due to a lack of appropriate prevention and treatment options for these settings.
Oxytocin, the most common drug for preventing and treating post-partum hemorrhage, requires cold-chain storage to remain effective. Because this is challenging to maintain in resource-limited settings, the quality of the medicine can be affected. Another treatment can only be delivered intravenously which restricts its use in lower-level health settings. Additionally, like Rhoda, many women in these countries deliver their babies at home without trained medical assistance, and thus cannot access the medicines that prevent or stop severe bleeding when it occurs at all.
Rhoda was extremely lucky to survive but the experience was terrifying. She had already lost her younger sister from complications during childbirth.
Tools and treatments that prevent serious conditions like this one are typically developed with high-income countries in mind. Too often, this leaves people in lower-income settings without the possibility of benefiting from a product that simply cannot be implemented widely due to infrastructure constraints, high costs, or other challenges.
Several potential high-quality alternatives for preventing and treating post-partum hemorrhage exist, but additional clinical and operational research is needed to enable implementation. Unitaid is supporting work to address barriers to access for three promising medicines. These heat-stable products for severe bleeding would enable women to access life-saving care in lower-level health settings. This work is also advancing use of a preventive medicine that can be self-administered, which would help protect the lives of the millions of women like Rhoda who give birth at home.
“I was scared – I thought that I had cancer,” says Aminata, upon learning that she had screened positive for the human papillomavirus (HPV). “But [the health worker] explained that I only had the virus that causes cervical cancer.”
Recent progress in cervical cancer screening and prevention has made it a highly preventable cancer when women have access to services. However, 90% of the 300,000 women who die from this cancer each year live in low- and middle-income countries, where preventive services are largely unavailable.
Cervical cancer occurs when abnormal cells on the cervix grow and replicate, almost always as a result of an HPV infection left untreated. Regular screening with high-performing tests is essential to catching pre-cancerous cells early, and treatment to remove the cells is critical in averting the progression to cancer.
Innovative solutions hold promise – new HPV tests help accurately screen for the infection, and simple to operate, battery-based portable devices for treating pre-cancerous cells better respond to the unique needs of resource limited settings. Unitaid programs in 14 countries are demonstrating how to integrate these tools into existing health services and promoting a more affordable and highly effective cervical cancer prevention model that is ready for broad scale up.
“I had the treatment and the following year I tested negative” says Aminata, one of more than one million women who has already been reached with preventive services through the Unitaid program. “I now encourage other local women to get tested. I tell them that they shouldn’t fear the test – it’s the disease that they should fear!”
“You know, they come when they are down, when they are broken,” says Jackie, a Ugandan woman living with HIV who provides peer support to other women taking HIV treatment. “I talk to them. I make them strong. I tell them that life continues. I tell them, you see, I am also positive, I take the drugs. And gradually, they become strong when they see me doing this.”
Many women discover their HIV status while pregnant. And in resource-poor settings where the majority of women with HIV live, it is not uncommon to only seek health services for a pregnancy in the second or third trimester.
Antiretroviral treatments can prevent mother to child transmission of the virus. However, when an HIV diagnosis is made late in pregnancy, the drugs need to work quickly to reduce a woman’s viral load before giving birth.
When a new treatment for HIV became available that more quickly and effectively delivered reductions in viral load, it had the potential to greatly reduce the risk of HIV infection from mother to child. The drug, called dolutegravir, had never been tested in pregnancy and concerns that it could cause complications in childbirth had led many countries to advise pregnant women and many other women ‘of childbearing potential’ against using the new treatment.
Clinical research among pregnant women is a complex process that pharmaceutical companies often deprioritize, opting instead to focus on getting approvals for use of medicines in larger swaths of the population.
But funding this research is crucial for ensuring all people can safely benefit from the best treatments available. Unitaid’s efforts through the DolPHIN2 clinical trial have helped welcome significant advances in treatment for women affected by HIV. Today, dolutegravir is the recommended first-line treatment for all people and is helping to prevent countless HIV infections in newborns.
“I enjoy my work,” says Jackie. “Eventually, the women become strong. I feel good when these ladies are given back negative babies. I feel good when they respond to their treatment.”
“I would need more than ten fingers to count the number of times I suffered from malaria,” says Manuela Brito, a nurse and fieldworker for a malaria project in Mozambique.
For several years, Brito worked as a nurse in a maternal health unit. Pregnancy reduces a woman’s immunity to the malaria parasite, putting women and their babies at high risk of infection.
“It was hard to witness the fear in the eyes of pregnant women suffering from malaria. No amount of verbal reassurance could alleviate their concerns. After all, the threat of malaria loomed over two lives, not just one. And yet, those who make it to the hospital are still the lucky ones,” she says.
Preventing infection among those at greatest risk is a critical concern. Unitaid is supporting a range of interventions to protect pregnant women, including optimized delivery of antimalarial medicines, supporting the introduction of more effective bed nets, and novel vector control strategies, among others.
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