Hold On A Minute - Episode 7 - Invest in Her [Transcript]

00:00:03:03

HOST

Hello! You are listening to “Hold on a Minute!”, a podcast by UNFPA Asia and the Pacific.  This podcast series presents inspiring and powerful stories on the sexual and reproductive health and rights of women across the Asia-Pacific region.  I am Poupée, Chaowarat Yongjiranon, your host. 

00:00:23:00

HOST

On this episode of Hold on a Minute! by UNFPA Asia-Pacific entitled, Invest in Her, we discuss the economic benefits of investing in the sexual and reproductive health and rights of women.

00:00:35:03

HOST

The United Nations Population Fund or UNFPA is the United Nations sexual and reproductive health agency.  Its goal is to prevent unintended pregnancies, reduce maternal deaths, and prevent and respond to gender-based violence and harmful practices. The achievement of these three transformative goals relies on the realization of sexual and reproductive health rights, which is a basic human right. 

00:01:04:03

HOST

This requires investments at every stage of a woman’s life, from infancy and childhood, to adolescence, adulthood, and post-reproductive age. Investing in women’s sexual and reproductive health means investing in her physical, emotional, mental, and social well-being in relation to all aspects of her bodily autonomy.

00:01:27:00

HOST

However, UNFPA cannot do it alone.  This is why the organization is calling for governments and the private sector to increase investments in this area.  This is imperative to increasing and improving the availability, acceptability, and affordability of quality services.

00:01:55:18

HOST

An example of how investments can make a difference in women’s lives, let us listen to the story of Dara.  

Feature Story - Story of Dara

(voice talent ver. 2 selected)

00:02:03:19

DARA

My name is Dara. I am 35-years old and I am a doctor. I've been incredibly fortunate to live a life filled with opportunities, thanks to my parents' determination and sacrifices. They grew up in a humble village, but when I was born, they made the bold decision to move to the city so that I could grow up with access to quality education, healthcare, and a chance to reach my fullest potential.

00:02:34:03

DARA

I was still a baby when we moved to the city, but I have heard stories of how my parents worked tirelessly to provide for our family. They instilled in me the belief that with their support, hard work, and the resources at our disposal in the city, I could achieve anything.

 

00:02:55:00

DARA

My education was a priority, and I was lucky to be able to attend one of the best schools in the city as a young girl. My passion for learning blossomed, and I knew that my dream was to become a doctor. I often visited my cousins in my parents’ village and I really wanted to become a doctor so that I could help those who did not have access to quality healthcare. 

 

00:03:21:16

DARA

As I matured, I faced a significant decision about my reproductive choices. My parents, who had always explained the importance of making informed decisions, made sure I had access to comprehensive sexuality education at school. At home, they had open discussions with me as I was going through my teenage years as they wanted me to understand my options fully and choose what was right for me. I was grateful for their openness and support, knowing that my choices were mine alone.

 

00:03:58:11

DARA

In college, I pursued my dream of becoming a doctor. I graduated with honors and became a medical professional, living the dream I had nurtured for so long. While my career thrived, my partner and I decided to delay starting a family until we were financially stable. Access to contraception methods gave us the freedom to plan when parenthood was right for us.

00:04:25:11

DARA

Meanwhile, my cousin, who had remained in the village, faced a very different reality. Limited access to quality education and healthcare constrained her opportunities. She married early and started a family, following a path that was shaped by circumstances beyond her control.

 

00:04:46:17

DARA

Looking back, I realized the stark difference between my life and that of my cousin. Our paths took two very different routes because of the opportunities, education, and access to healthcare that I was lucky to receive. I am forever grateful for my parent’s sacrifices and support, and to the city education and health system that transformed my life. 

 

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THIRD VOICE

‘Hold on a minute, a podcast by UNFPA Asia and the Pacific.’

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Host Introducing speaker

00:05:16:21

HOST

It is clear from Dara’s story that investing in the sexual and reproductive rights of women does make a difference.

00:05:24:12

HOST

To learn more about the impact of investment, I am joined by two individuals working to increase the rights of women, UNFPA Asia-Pacific Regional Office Health Economics Advisor Davide DeBeni and Genesis Analytics Managing Partner Tomas Livens.

00:05:42:07

HOST

Davide joined the UNFPA Asia Pacific Regional Office based in Bangkok in September 2019 as a Health Economics Advisor.  He provides technical support to the region on health economics and financing matters concerning the UNFPA’s mandate areas.  Over the span of 20 years, Davide has worked in developing and supporting economic and financial analyses across Europe, Sub-Saharan Africa, Asia-Pacific, and the Caribbean.  He has worked with the World Bank and other UN agencies.

00:06:17:06

HOST

Tomas Livens is the managing partner of the Human Development practice of Genesis Analytics.  He is experienced in social policy, in the areas of health, education, and social protection and poverty.  Prior to joining Genesis, Tomas has worked with Oxford Policy Management, the International Labor Organization in Africa, and the Belgian ministry for international development.

 

HOST - INTERVIEW – EXPERT TALK

00:06:41:12

HOST

Well, it's a pleasure to meet both of you here on our podcast. Hello, Davide. Hello, Tomas.

00:06:47:21

HOST

I think I want to ask Tomas you the first question, because when we take a look at Dara's story, it's a great example of how a woman can fulfill her dreams through quality access to education and health care throughout her life. She mentions that her parents grew up in the village and that they moved to the city so that Dara could fulfill her dreams.

 

00:07:08:12

HOST

How and why are the quality of services different in cities? You know, we've seen in her story that there is a stark difference. 

 

00:07:17:07

TOMAS

That is something you observe around the world. And you can try to think about it in the following way; the access or sexual and reproductive health rights are a unique part of the Universal Declaration of Human Rights.

 

00:07:32:17

TOMAS

So we collectively believe this is really important. That hasn't been translated very often in constitutions at national level where governments and states say, yes, we recognize that and we will do whatever it takes to actually ensure that our populations, those living in rural and urban areas, have access to or realize that right. Now what is really important to realize is the way this happens is through access, through services, right?

 

00:08:02:04

TOMAS

That is how you realize these rights, and these services in broad terms are information, people need to have the information that is provided through education systems and others, actual health services, but also access to products for family planning. 

00:08:17:03

TOMAS

Now, coming to your question, if you look at the distribution of these services in countries, right, they are offered by private providers and public providers and private providers are more dense in urban areas, and they're more dense in urban areas because that is where populations can actually afford them.

00:08:37:08

TOMAS

So what you then get is a natural tendency for people living in urban areas to have more choice when it comes to providers. But if I may, that is not the only thing. The supply is not the only thing. There are also the demands of populations themselves. And in order to access these services, you actually need to be fully informed about the needs for these services.

00:09:00:03

TOMAS

And also your cultural norms should be supportive of doing so. And what we also see is that both the availability of information and the predominant norms in rural areas is actually biased against accessing these services because of double and double reason, less services available in rural areas and the populations living there actually are less informed and less inclined to use them.

 

00:09:29:12

HOST

Hmm. Very interesting that you point out that there are two factors. You would think that are obviously more services in urban areas, but with that mindset of, you know, the rural areas, may not know what they need, that's a very interesting point. Now, in addition to the rural versus urban divide, what are the other factors affecting the ability of women and girls to access quality, sexual and reproductive health services in the Asia and the Pacific region?

 

00:10:02:19

TOMAS

Yes, this is actually a very interesting question because the rural urban disparity in access to services is part of a bigger picture. And the bigger picture is actually how sexual and reproductive services and information related to them are financed. And as we said before, they are offered through public and private providers and typically the private providers are paid for.

 

00:10:33:22

TOMAS

So you immediately see a picture where the financing of all these services are done both by the people themselves and also by the state. And to put a number to that of the total health expenditure in much of Asia and Pacific, 49% is paid for by people out of their pockets. Right. And so what you see, again, as I sort of hinted at before, is a reach of the population.

 

00:10:59:22

TOMAS

So urban centers contain, on average, more richer populations than rural areas. And that explains why private providers will go where people live that can pay for these services. I mean, voting for the budget. And conversely, they do not go where people cannot afford their payments. So that's real. So the bigger picture that emerges is that it’s not only rural urban, but it is also rich and poor.

 

00:11:29:01

TOMAS

Where you see the disparity between access to these services. And that is really an important notion. The way the states, as I said before, in its constitution, has often guaranteed access for all the population to these services to realize their rights needs to use public expenditure to correct rights on these sort of organic or natural tendencies to create disparities in access to services across the population and therefore rights realization across the population.

 

00:12:02:02

HOST

I think it definitely is a pivotal point in terms of seeking or seeing where the money or the funding is coming from, because it does make a difference, right, Tomas, as to how it is implemented. 

 

00:12:17:22

TOMAS

Yes, absolutely.

 

00:12:21:17

HOST

Davide, when we take a look at the challenges that we have, addressing these challenges means that, you know, countries should invest more resources in these areas.

 

00:12:33:06

HOST

What is the UNFPA doing right now to help countries prioritize financing sexual and reproductive health?

 

00:12:41:16

DAVIDE

Thank you for the question. So UNFPA, as you know, is the UN Sexual and Reproductive Health Agency, and we aim to prevent unintended pregnancy, reduce maternal deaths, and prevent and  respond to gender based violence and other harmful practices. So indeed, to achieve all these ambitious goals, countries should invest more in this area. And we do know that traditional mechanisms for financing these goals are not sufficient to meet these needs.

 

00:13:12:21

DAVIDE

And that was the case even before COVID. I think partners have estimated that around 1 trillion USD was required to achieve the 2030 agenda. But after COVID, and with the consequences of the poly-crises that we call them, right, the consequences of the conflicts and the inflation rate push, this number has been revised upwards.

 

00:13:47:10

DAVIDE

Now, we estimate that more than 3 trillion USD are required to achieve the Sustainable Development Goals. So more than three times. And for UNFPA, we also try to estimate what is required, and that's significant for achieving the three transformative results, as we call them, the one I described earlier. We think that we need around 26 billion USD annually, but out of the 26, we only have 4 from international donors across the globe.

 

00:14:22:20

DAVIDE

So where is the other 22 billion coming from and it is a significant amount? Well, this is what Tomas said. I mean, increasingly, we expect this gap is filled by partners, by governments from their national budgets. So public investments. And this is why UNFPA is increasingly making efforts to convince those partners that health and sexual reproductive health is not a cost, but is an investment.

 

00:14:53:23

DAVIDE

And therefore it is critical to invest more resources in this area. And this is because we do know and we have evidence of that, that by providing women and girls access to, for example, to voluntary contraceptive services, we reduce unintended teenage pregnancies. This will help the girls to continue their education, to develop their professional skills, and therefore to increase their economic and societal participation.

 

00:15:24:02

DAVIDE

So, for example, if maternal health in addition to this pathway, obviously addressing maternal health will save lives, we will have healthy babies. We have healthy mothers that would be able to continue to fulfill their dreams and participate in this society. And this if you look at it, it is exactly the story that Dara told us.

 

00:15:46:21

DAVIDE

And what UNFPA is doing in addition to this is actually we are able to quantify exactly what it is this economic impacts, longer term economic positive economic impacts. And we do so by developing investment cases, where we quantify exactly what is the return of investing in the three transformative results.

 

00:16:14:00

DAVIDE

So, for example, in 120 million lower and middle income countries globally, and it turns out that investing in preventing maternal death and unmet need for family planning by 2030, investing 1 dollar, we will get 8 dollars in return. For addressing female genital mutilation, their returns is even greater. So 10 dollars for 1 dollar investment invested and 33 to end in a child marriage.

 

00:16:45:17

DAVIDE

So the question is really here, you know, why not invest in the social sector, in health, in and sexual reproductive health? Because this is clearly the best way to recover from the pandemic and the other social economic crisis that we are witnessing across the globe and in this region. 

 

00:17:05:23

HOST

Well, thank you, Davide, for clarifying it and seeing how it is very clear how the proper investment or the proper funding really brings about the results that is needed.

 

00:17:19:17

HOST

And both, you know, you and Tomas have been very clear as to the role, the important role of the public sector in playing a bigger role in improving the quality access and availability of health and education services for women and girls. But then on the other hand, in our society, we also have, you know, the private sector, right? So the question is, is it only the responsibility of the public sector or what can the private sector do to ensure that women can exercise their sexual and reproductive health rights as well, Davide?

 

00:17:58:08

DAVIDE

Sure. As I said, the financial need, the requirements are massive, right? So the public sector alone is not sufficient to fill those gaps, those financial gaps. We also know that the private sector can play different roles and this is a strong  ally to UNFPA in delivering our mandates and achieving our goals. So the private sector, for example, could be the actor delivering health services, sometimes, think of pharmacies, private pharmacies, private hospitals and so on.

 

00:18:34:01

DAVIDE

But it can also be a partner through their social corporate responsibility programs. They could also be partners in facilitating the delivering of our programs, in their premises, in their workplaces. And this is particularly important in a region like the Asia and Pacific, where the garment and manufacturing sector employees millions, literally millions of women across the region in countries like Bangladesh, Cambodia, Vietnam, Indonesia, etc., Many of these workers lack adequate access to services, basic health services, including sexual and reproductive health services.

 

00:19:15:01

DAVIDE

Many are women, often young women, that migrated from the rural areas to the cities, and they don't have the possibility to pay for the services, the knowledge to know where these services are. Therefore, this is a space for partnership, working together with the private sector, with the businesses to deliver programs like awareness of service provision in their factories, aiming to increase, at the end of the day, access and reach for these services.

 

00:19:50:22

DAVIDE

And this is what the UNFPA is doing in this region, and we are doing it in a different way. And one way, for example, is estimating, what the economic and financial returns are for the business in terms of increase in productivity for their private sector, increase, decrease in absenteeism, for example.

 

00:20:19:14

DAVIDE

But foremost is to demonstrate that we will have healthcare workers more empower workers and therefore more productive and benefit for the business as well. 

 

00:20:37:14

HOST

Massive task indeed. And the challenges are quite large in itself and thank you so much for clarifying that. When we take a look at, you know, there are a variety of different challenges when it comes to addressing this issue.

 

00:20:53:19

HOST

What more needs to be done to address the challenges in the Asia-Pacific region to ensure that women and girls, you know, enjoy equal opportunities in society, Tomas?

 

00:21:04:23

TOMAS

Yeah, it's indeed a big challenge. And I would sort of like to pick it up where I left it before and where you were heading me with your question then, which is to say that it is actually the role of the states to ensure that everyone can realize these rights.

 

00:21:21:09

TOMAS

And then I pointed out that practically that happens through access services. And then the important condition for making sure these services exist is money. Right. That is making sure there is enough money to finance the services of people that can access. And I would like to answer, if I may, your question by also promoting a little bit of a learning program that UNFPA has set up.

 

00:21:44:03

TOMAS

It's called the Learning Program for the Financing of Sexual and Reproductive Health Rights in Asia Pacific, because I think it answers your question, if I may. So the learning program, importantly, is targeted at the decision makers. So it is decision makers that ultimately make the decision to ensure enough money is made available for these services. Who are these decision makers that are of two kinds essentially.

 

00:22:10:21

TOMAS

They are the legislators, the parliamentarians, ultimately the most important representatives of the people. And then secondly, and in tandem with them, the executives, the governments, ministries of finance, but also the implementing ministries and the ministries of health. So these are the two big targets, areas of the course surrounded by the stakeholders, including the private sector, because they all need to work together.

 

00:22:36:17

TOMAS

And that's one point I make. I want to make the private sector in the countries, but also the donors. So we will come back together quickly. And the course is actually designed to identify the entry points that governments and executives have to ensure financing for the services is available. So the course looks at the various entry points, and I don't want to be technical, but it's about what is the fiscal space for these services, what is the value for money, the cost effectiveness, the cost efficiency also of the equity, what is the role of universal health coverage, etc..

 

00:23:12:10

TOMAS

So it goes through all the entry points that these decision makers have an overview of what they can possibly do to improve financing for sexual and public health rights. If you put that more simply, it is often about spending enough right and spending better. And these two components are important in tandem. And if you look at spending, that's an important element of spending better is to ensure to give the Ministry of Finance options around what it needs to do with what is inevitably limited its public expenditure available.

 

00:23:49:23

TOMAS

And one of the particularities and this is really crucial about spending in sexual and reproductive health rights, which is a right is that in addition to being a right, the economic returns on the investing in it are typically much higher than alternative investment opportunities that Ministries of finance have. The story often starts with that. So really make sure that these decision makers know that this is underfunded, given them the economic return, let alone the rights returns of spending on.

 

00:24:25:21

TOMAS

So that is often the entry point to spending better. And if you look at spending more, this is often to do with ensuring that the allocation from within the budget and even from within the health budget to sexual reproductive health rights goes up. 

 

00:24:42:10

TOMAS

And then I would like to conclude here quickly also around the spending better. So once you've ensured that the resource envelope available for these services goes up to complement perhaps the investments households do through the private sector already and access to these services, so that you've got the complement between the public and the private sector.

 

00:25:04:06

TOMAS

It is also important to ensure that you look at other dimensions of spending better. And this goes back to the study of data. First of all, you need to ensure that the spending available is accurate, equitably distributed. And sort of in layman's terms, it means that governments need to target their spending at those populations that are lagging behind.

 

00:25:27:20

TOMAS

And rural populations will often be a part of those. But it's not a given, as every country needs to figure out who is lagging behind and target progress on that. Now that is one element of spending better. The second one is do not waste money, right? It is important that we use the resources as best as we can.

 

00:25:48:03

TOMAS

So anything to do with cost efficiency, especially in family planning, to do with the procurement of goods or family planning products, is really important. And so this learning program, I think, encompasses all the entry points governments have to ensure they spend more and they spend better, which then ultimately allows to ensure that these rights are better realized.

 

00:26:15:24

TOMAS

And the last point, the very last point I don't know why I'm going on a bit here is that's another dimension of the financing of the services are the international donors they do offer for, especially for low and middle income countries, quite a significant complement to available funding in government budgets and in households. Now, what is particular about these donors is they will phase out as these countries become richer.

 

00:26:43:03

TOMAS

And that is another dynamic element of the financing of these services that needs to be managed quite well. Right. It's not only where does the money comes from, but it is also changing over time where the money comes from. And if you want to have continuous access to these services, you need to ensure smooth, what we call transitioning of funding sources, over time.

 

00:27:06:00

TOMAS

And this course also deals with that. It gives these decision makers the tools and the knowledge to actually manage that transition. And it's, I think, of course, open to all. And if you're interested, I would certainly encourage you to contact UNFPA. My colleague Davide DeBeni here on the line can certainly help you with that. 

 

00:27:25:19

HOST

I appreciate that you're taking your time to explain it to us because often when you talk about these things, they just, you know, the majority, the mass majority of the people, you know, on the street, they think that it's just about funding and getting more funding, but it's just more than that.

 

00:27:42:08

HOST

And in terms of spending smartly, making sure that you're using your resources to the fullest in an efficient way, where at the end the people do or the country do benefit from that. But it is true, as what you said, you know, it's different from region to region, country to country. And you really do have to kind of discover that path, you know, for each country, you know, to do it by themselves.

 

00:28:11:04

HOST

I'm going to come back to you later, just towards the end here. But I want to ask Davide, one of the key main points for, you know, not just only this podcast program or episode, but also in reflection of our previous podcasts. In our series, we've discussed the population dynamics in the Asia-Pacific region. 

 

00:28:33:19

HOST

Davide, what are the implications of aging on countries in terms of investing in sexual and reproductive health? Because that is also a very significant factor. 

 

00:28:46:17

DAVIDE

Sure. So last year the world reached a population of 8 billion for the first time, and most of this population lives in this region, in the Asia Pacific region. Half of it is comprising of women and girls. And although these figures concern many, this is a positive outcome because people live longer, healthier and neonatal child mortality is decreasing, but also fertility is decreasing in some countries.

 

00:29:19:11

DAVIDE

And this is, so women are having less children. And this is also a positive factor, in my opinion, because often the decreasing fertility is positively associated with increased education for women and girls.

00:29:35:05

DAVIDE

But this phenomenon is concerning with many, many societies and governments in the region because they're worried that they need to adjust their policy to address new challenges. And what are these challenges? For example, they need to diversify by the type of health services to account for an increase in the older population. 

00:29:58:17

DAVIDE

Older population means increasing costs. Take care of this portion of their society. And also there is a financial sustainability of the social protection system. Think about the pensions. So we are seeing shrinking of working age population. Therefore there is less room for paying for services like pension of those population that are getting older and that increasingly many.

00:30:28:03

DAVIDE

And finally many countries are also concerned about the decrease in productivity of their society for exactly the same reason because of the working age population that is shrinking.

 

00:30:43:05

DAVIDE

So what is UNFPA thinking about and what are we advising first? Our first advice is to continue investing in health services through the life course. So continue investing from the beginning, start to hear from the mothers with children through the life course in preventive healthcare. Promoting positive behavior of the population. So they will arrive much healthier when they are older.

 

00:31:17:07

DAVIDE

Another way of addressing the issue of a shrinking working age population and decreasing productivity is encouraging women to participate more in the economy or to work more. 

00:31:31:05

DAVIDE

And of course, for that to take place family and women are supported with adequate family support policies that allow the woman to continue working even when she decides to have a child.

00:31:46:17

DAVIDE

So I'm talking about parental leaves policy at childcare. I'm taking into consideration the value of unpaid care, but also and most importantly, continue ensuring the right to reproductive choices. So to provide the choice for women to decide if, when and how many children they want to have. 

00:32:10:01

DAVIDE

So in this way, we think that we will be able to fulfill the desire, fertility level of the family and the women as well of ensuring they they continue to work, to be to continue to be productive and to contribute to this society in a positive way.

00:32:29:10

DAVIDE

Finally, there's also the we call it innovative financing mechanism that I’m looking at to address the challenging of a pensioner, for example. So there are mechanisms like reverse mortgages that allow pensioners to disinvest some of their assets. Think about the houses they accumulated during the younger age and disinvest and be able to spend this money when they're older and they're not able to work anymore.

 

00:32:58:16

DAVIDE

But in general, I think what we try to address is the ability of everyone through the life course to have the right to access to quality health, particularly sexual reproductive health education and be aware that health and education is not a privilege, but is a human right through the life course of individuals. 

00:33:23:08

HOST

Well said, Davide, in terms of how ensuring equal rights not only benefits the individual but also the country as well. And to end of our conversation, I just want to give an opportunity to, you know, both you, Davide and Tomas, to give takeaways from our conversations. For our listeners as to what they should really think about and if they want to know more information, what can they do as well? Tomas.

00:33:56:03

TOMAS

Yeah, thanks for the question and giving me the opportunity. What I'm quite passionate about is this is a real area where governments can do a better job, right. It is by spending more on the services. Sexual and reproductive health services and associated products. 

00:34:16:24

TOMAS

They will ultimately do two things. They will make good on the commitment they've made to their populations to ensure their sexual and reproductive health rights are realized. But at the same time, the economic benefits of doing so are so big that the secondary benefits in terms of the assets, healthy population, the costs saved in the health system, productive populations that grow the economy right, are much, much better achieved.

 

00:34:47:23

TOMAS

So the this is an area where governments can make progress. It is a fantastic opportunity that is still out there in the majority of the countries, even if it's the exact pathway as you've pointed out, that needs to be changed at that country level and there is a partner UNFPA, available to work collaboratively with these governments to to achieve what I think is an exceptional opportunity.

00:35:15:03

HOST

Davide, what can listeners do or find? How can they find more information about the UNFPA? What should they know about what the UNFPA is doing right now? 

00:35:28:05

DAVIDE

Sure. But first let me say that I totally agree with Tomas, and I often like to summarize in a way what Tomas said. What I said in my previous intervention that actually health is not a cost, but an investment that not only saves lives, which is a very important outcome, of course, but delivers strong results for the society and economy. And most importantly is that human rights for all is not a privilege.

00:35:56:07

HOST

Thank you so much to both. You know, you, Davide and Tomas for being with us here today. I know that the topic is quite challenging to clarify to our listeners. I'm sure that a lot of us have been enlightened with what you've said so far. We look forward to hearing from you and your work.

00:36:16:03

HOST

This has been the latest episode of “Hold on a Minute!” by UNFPA Asia-Pacific.  We hope you have gained an insight into how crucial investing in the sexual and reproductive health and rights of women is. 

00:36:28:16

HOST

For more insightful episodes of “Hold on a Minute!” by UNFPA Asia-Pacific, follow our podcast pages on Spotify, Facebook, YouTube, and Apple Podcast.  Just search for  UNFPA “Hold on a minute”. 

See you in our next episode!