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First Person: Women in Madagascar too ashamed to seek help giving birth

The predominantly rural region of Androy has been beset by a series of humanitarian crises which have affected the most vulnerable people there, including mothers-to-be, however the delivery of simple, inexpensive maternity kits is encouraging more women to access a range of services that will help keep them and their babies healthy.

Ahead of the International Day of the Midwife, celebrated annually on 5 May, Jeanne Bernadine Rasoanirina, a midwife in Behara, in Androy, spoke to UN News’s Daniel Dickinson about the challenges of reaching the poorest women.

“This is a very poor rural area, and many women are too ashamed to come to the health centre to have their babies delivered because they don’t even have the money for transport or to buy clean cloth in which to wrap their newborn. They don’t want other people to know they are poor.

A baby is weighed at the primary health care centre in Behara.
UN News/Daniel Dickinson

The mothers-to-be who come here get all the support they need to give birth, and it’s free of charge, thanks to the government as well as UN agencies, including [the UN reproductive health agency] UNFPA.[The UN Children’s Fund] UNICEF and the World Food Programme (WFP) provide important nutrition advice and support, which complements our work and is essential to keeping mothers and their children healthy.

Even though I have done this job for 19 years, it still really saddens me when women arrive who don’t have the means to look after themselves. They may be wearing dirty clothes, which is a sign of poverty, but also a lack of knowledge or respect for cleanliness.

In the last week, I have delivered three babies and over the past month, I attended over 330 antenatal and postnatal consultations, so there is definitely a demand for services.

Jeanne Bernadine Rasoanirina sits at her desk with the recently delivered maternity kits.
UN News/Daniel Dickinson

Jeanne Bernadine Rasoanirina sits at her desk with the recently delivered maternity kits.

Maternity kits

I think more women will be encouraged to come to the health centre, as yesterday we had a delivery of 240 maternity kits [supported by UNFPA] for the first time in over a year, which will last about three months.

The kits include everything a mother needs to give birth – gloves, gauze, umbilical cord clip and a syringe for the delivery and then cloth wraps and clothes in which to dress the baby. They will remove the shame that mothers feel.

It is frustrating that we have not had a consistent supply as this small item can make a big difference. It means more women will come to our health centre, which is a safer place to give birth. In 2023, we had only successful births; there were no deaths. We don’t know how many women gave birth at home nor how many children and mothers died as a result. There is definitely a risk of death if a woman doesn’t come here to deliver her baby.

Polygamy

There are still many cultural barriers to safe childbirth in the south of Madagascar. Children are considered a sign of wealth, even if families don’t have the means to look after them properly, so it is common to have many children, sometimes as many as 10.

Polygamy is also practiced, and some men have up to five wives and want to have children with all of them. We provide information here and offer training about these issues, but we must always be sensitive about the local culture.”

Europe: Report highlights direct link between pandemic and childhood obesity

Results from 17 countries showed that boys and girls aged seven to nine spent more time looking at screens and less time playing outside, mirroring an increase in overweight children in this same age range.

More than 50,000 children were surveyed from 2021-23, following the start of the worldwide shutdowns in March 2020.  

A nuanced picture 

“The picture that this report paints is nuanced – in some countries there were positive changes, such as more families eating together, but there were also some concerning findings, including an increase in unhealthy dietary habits and sedentary time,” said Dr. Kremlin Wickramasinghe, WHO/Europe’s Regional Adviser for Nutrition, Physical Activity and Obesity.

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The report revealed that 36 per cent of children increased their time spent watching TV, playing online games, or using social media during the weekdays, and 34 per cent increased their recreational screen time on weekends. 

Other key highlights include 28 per cent of children experienced a decrease in time spent in outdoor activities during weekdays, 42 per cent reported a decline in happiness and well-being, and one in five reported feeling sad more frequently. 

On a more positive note, families reported an increase in consuming home-cooked meals, eating together, and cooking meals together with children. 

Create supportive environments 

Dr. Wickramasinghe hoped the report will push countries in the region to take urgent action to improve nutrition and physical activity by creating environments that support healthy behaviours.

 “We cannot afford to ignore these trends – in our Region, one in three children is living with overweight and obesity, and already fruit and vegetable consumption is low,” he said.

Dr. Ana Rito, Head of the WHO Collaborating Centre for Nutrition and Childhood Obesity, and co-author of the report, underscored its significance. 

“Equipping the Region and Member States with concrete evidence of problematic outcomes of global pandemic-based behavioural changes will enable us to approach future health crises with greater strategy and sympathy,” she said. 

A brighter future 

The pandemic highlighted the urgency of tackling childhood obesity, WHO said, and countries need to build back better by prioritizing healthy eating and physical activity for all children.  

WHO recommended measures such as marketing restrictions and taxes on unhealthy products, clear nutrition labels on foods, and school-based programmes to improve diets and promote physical activity.  

The agency said the new data “can be used to inform and improve current policies across the Region and shape much-needed plans for future emergencies and pandemics that may lead to interruption of educational processes or school closures.” 

‘Just in case’ antibiotics widely overused during COVID-19, says UN health agency

In an alert, WHO noted that although just eight per cent of hospitalized coronavirus patients also had bacterial infections which can be treated with antibiotics, a staggering three in four were given them on a “just in case” basis.

At no point during the global pandemic did the UN health agency recommend using antibiotics to treat the coronavirus COVID-19, insisted WHO spokesperson Dr Margaret Harris.

Viral, not bacterial

“The advice was very clear from the start, that this was a virus. So it wasn’t that there was any guidance or any recommendation that that clinicians go in this direction, but perhaps because people were dealing with something completely new, they were looking for whatever they thought might be appropriate.”

According to the UN health agency, antibiotic use ranged from 33 per cent for patients in the Western Pacific Region to 83 per cent in the Eastern Mediterranean and the African Regions. Between 2020 and 2022, prescriptions decreased over time in Europe and the Americas, but they increased in Africa.

Last hope

Data compiled by WHO also indicated that most antibiotics were given to critically ill COVID-19 patients at a global average of 81 per cent. Antibiotic use in mild or moderate infections showed considerable variation across regions, with highest use in Africa, at 79 per cent.

Worryingly, the UN agency found that the most frequently prescribed bacteria-busting antibiotics globally were those with higher potential for antimicrobial resistance (AMR) to antibiotics.

“When a patient requires antibiotics, the benefits often outweigh the risks associated with side effects or antibiotic resistance. However, when they are unnecessary, they offer no benefit while posing risks, and their use contributes to the emergence and spread of antimicrobial resistance,” said Dr Silvia Bertagnolio, WHO Unit Head for Surveillance, Evidence and Laboratory Strengthening, Division for AMR.

No positive impact

The UN health agency report maintained that antibiotic use “did not improve clinical outcomes for patients with COVID-19”

Instead, their systematic prescription “might create harm for people without bacterial infection, compared to those not receiving antibiotics,” WHO said in a statement. 

“These data call for improvements in the rational use of antibiotics to minimize unnecessary negative consequences for patients and populations.”

The findings were based on data from the WHO Global Clinical Platform for COVID-19, a database of anonymous clinical data from patients hospitalized with COVID-19. Data came from 450,000 patients in 65 countries from January 2020 to March 2023.

Superbugs

Antimicrobial resistance threatens the prevention and treatment of an ever-increasing range of infections caused by bacteria, parasites, viruses and fungi.

It occurs when bacteria, viruses, fungi and parasites change over time and no longer respond to medicines making infections harder to treat and increasing the risk of disease spread, severe illness and death. As a result, the medicines become ineffective and infections persist in the body, increasing the risk of spread to others.

Antimicrobials – including antibiotics, antivirals, antifungals and antiparasitics – are medicines used to prevent and treat infections in humans, animals and plants. Microorganisms that develop antimicrobial resistance are sometimes referred to as “superbugs”.

Gender therapy review reveals devastating impacts on teens

The development is in line with several western European countries that have reportedly reduced access to similar gender identity treatments whose benefits were found to be “remarkably weak”, according to a National Health Service (NHS) England-commissioned review, published on 10 April by consultant paediatrician Dr. Hilary Cass.

UN Special Rapporteur Reem Alsalem also welcomed the commitment by the UK Secretary of State for Health and Social Care to implement the implications of the Cass Review.

It “has…very clearly shown the devastating consequences that policies on gender treatments have had on human rights of children, including girls…its implications go beyond the UK,” said the UN Special Rapporteur on violence against women and girls, Ms. Alsalem.

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Referrals spike

The independent rights expert cited the Review’s findings that between 2009 and 2016, the number of adolescent girls referred to NHS-England’s service for gender distress – or dysphoria – increased from just 15 to 1,071.

These referrals “breached fundamental principles, such as the need to uphold the best interest of the child in all decisions that affect their lives”, the Special Rapporteur insisted, while transgender rights groups have maintained that there are long waiting lists for treatment.

Mental anguish

Noting the “extraordinarily high number of teenage girls” impacted by anxiety and depression in recent years, Ms. Alsalem said it was crucially important that health authorities stopped “rapidly initiating permanent gender transition pathways that usually begin with puberty blockers, which could cause temporary or permanent disruption to brain maturation”.

Instead, girls potentially seeking “gender affirming interventions” should be offered more holistic psychological support, protected by legislation that should ensure “transition does not become the only option that is acceptable to discuss with them”.

‘Detransition’ support

The same opportunity for wider therapeutic support should also be available to “detransitioners” – individuals who have discontinued gender transitioning – “most of whom are girls”, Ms. Alsalem maintained, in support of the Review’s findings.

Far too long, the suffering of this group of children and adults has been ignored or discounted. The report’s findings and recommendation signals that they have been heard, seen, and that their specific needs have been recognised.”

Toxic debate

According to Dr Cass’s report, “many more” young girls are being referred for gender transition treatment today, marking a distinct change from the past, when most requests for medical help came from adolescent boys.

Reiterating an earlier call for tolerance regarding discussions surrounding gender treatments amid a “toxicity of the debate” identified by the Cass Review, Special Rapporteur Alsalem stressed that researchers and academics who expressed their views should not be “silenced, threatened or intimidated”.

Special Rapporteurs are not UN staff and are independent from any government or organization. They serve in their individual capacity and receive no salary for their work.

Teen alcohol and nicotine use in Europe is up, WHO urges preventive measures

Data covering all three areas revealed that more than one in two 15-year-olds experimented with alcohol, while one in five teenagers recently used e-cigarettes, the UN health agency said, in a call for urgent preventive measures. 

“The widespread use of harmful substances among children in many countries across the European Region – and beyond – is a serious public health threat,” said Dr Hans Kluge, WHO Regional Director for Europe. 

“Considering that the brain continues to develop well into a person’s mid-20s, adolescents need to be protected from the effects of toxic and dangerous products.” 

Alcohol prevails, e-cigarettes follow 

Alcohol use remains prevalent among teenagers; 57 per cent of 15-year-olds claim to have tried it and 37 per cent drinking it within the last month. Roughly one in 10 young people across all age groups HAS experienced significant drunkenness, including being drunk at least twice in their lifetime. This rate climbs from five per cent at age 13 to 20 per cent by age 15, demonstrating an escalating trend in alcohol abuse among youngsters. 

E-cigarettes have also surged in popularity, surpassing traditional cigarettes, with 32 per cent of 15-year-olds trying them and 20 per cent using them in the last 30 days. This compares with 25 per cent of 15-year-olds who have smoked a conventional cigarette in their lifetime and 15 per cent who tried one in the past month. 

Perhaps surprisingly, cannabis use slightly declined: 12 per cent of 15-year-olds surveyed tried it in 2022, compared with 14 per cent in 2018. Early cannabis use can lead to dependence and problematic use patterns later in life, the report warns.  

The report also highlighted that although boys have traditionally drunk and smoked more than girls, this trend appears to be changing, with girls either matching or even exceeding boys in smoking, alcohol, and e-cigarette use by age 15.

Harmful product placement  

WHO experts expressed alarm at product placement for all substances in video games, entertainment programmes and other content aimed at young people via multimedia platforms, in a call for the implementation of comprehensive preventive measures.  

“Today, children are constantly exposed to targeted online marketing of harmful products, while popular culture, like video games, normalizes them,” Dr Kluge said. To preserve the health of youngsters, WHO is already working with countries to protect them from toxic and addictive products that could affect their quality of life in the years. 

To curb alcohol, nicotine, and tobacco use among youngsters, WHO wants countries to raise taxes, restrict product availability and sales locations, enforce the minimum legal purchasing age.

The UN health agency has also called for all flavourings to be prohibited, including menthol, in nicotine and tobacco products, while also imposing a comprehensive ban on advertising across mainstream and social media platforms. 

New global campaign boosts lifesaving vaccines

The Humanly Possible joint global communication campaign aims to boost vaccination programmes around the world, with support from the UN World Health Organization (WHO) and the UN Children’s Fund (UNICEF).

“Thanks to vaccinations, more children now survive and thrive past their fifth birthday than at any other point in history,” said UNICEF Executive Director Catherine Russell.

Indeed, global immunisation programmes have shown what is humanly possible when many stakeholders, including world leaders, regional and global health agencies, scientists, charities, aid agencies, businesses and communities work together.

WHO Director-General, Tedros Adhanom Ghebreyesus said “vaccines are among the most powerful inventions in history”, making once-feared diseases preventable.

“Thanks to vaccines, smallpox has been eradicated, polio is on the brink and with the more recent development of vaccines against diseases like malaria and cervical cancer, we are pushing back the frontiers of disease,” he said. “With continued research, investment and collaboration, we can save millions more lives today and in the next 50 years.”

A child receives a dose of polio vaccine in Madagascar.
© UNICEF/Tsiory Andriantsoarana

A child receives a dose of polio vaccine in Madagascar.

154 million lives already saved

A landmark study to be published by British medical journal The Lancet reveals that global immunisation efforts have already saved an estimated 154 million lives over that past five decades, 101 million of them infants.

That’s the equivalent of six lives saved every minute of every year over the past 50 years.

Led by WHO, the study showed that immunisation is the single greatest contribution of any health intervention to ensuring babies not only see their first birthdays but continue leading healthy lives into adulthood.

Measles vaccines had the most significant impact on reducing infant mortality, according to the study, which also showed that vaccination against this and 13 other diseases – among them diphtheria, polio, rubella, tetanus, tuberculosis and yellow fever – directly contributed to reducing infant deaths by 40 per cent globally and by more than 50 per cent in the African region over the past half century.

For each life saved through immunisation, an average of 66 years of full health were gained, with a total of 10.2 billion full health years gained over the five decades, wrote the authors of the study, which is expected to be released ahead of the 50th anniversary of the expanded programme on immunisation (EPI) next month.

Girls await their turns to get immunised at Rusung Raya Elementary School in Indonesia.
© UNICEF/Clark

Girls await their turns to get immunised at Rusung Raya Elementary School in Indonesia.

Protecting a generation of children

In 2000, WHO, UNICEF and the Bill and Melinda Gates Foundation were core founding members of Gavi, the vaccine alliance, which was created to expand the impact of EPI and help the world’s poorest countries increase coverage; benefit from new, lifesaving vaccines, and expand the breadth of protection against an increasing number of vaccine-preventable diseases.

Today, Gavi has helped to protect a whole generation of children and now provides vaccines against 20 infectious diseases, said the alliance’s chief executive officer Dr. Sania Nishtar.

“In a little over two decades, we have seen incredible progress, protecting more than a billion children, helping halve childhood mortality in these countries and providing billions in economic benefits,” she said.

Delivering vaccines along the last mile

UNICEF, one of the largest buyers of vaccines in the world, procures more than two billion doses every year on behalf of countries and partners for reaching almost half of the world’s children.

To increase immunisation coverage, UNICEF also works to distribute vaccines to the last mile, sometimes using camels, to ensure that even remote and underserved communities have access to immunisation services.

The agency’s chief said it’s all about working together.

“We must build on the momentum and ensure that every child, everywhere, has access to lifesaving immunisations,” Ms. Russell said.

That’s the ultimate goal of World Immunisation Week: for more people and their communities to be protected from vaccine-preventable diseases. Learn more about what’s going on this week here.

 

SDG 3
United Nations

SDG 3

SDG 3: HEALTHIER GLOBAL POPULATION

  • Promote mental health and wellbeing and strengthen the prevention and treatment of substance abuse
  • Reduce the number of deaths and illnesses from pollution, contamination and tobacco
  • Achieve universal health coverage, and provide access to affordable, essential vaccines and medicines
  • Reduce global maternal mortality rate to less than 70 per 100,000 live births and under-five mortality to at least 25 per 1,000 live births
  • End epidemics of AIDS, tuberculosis and malaria and combat hepatitis and other communicable diseases

 

Sustainable development hinges on ensuring healthy lives and promoting wellbeing at all ages.

Latest hunger data spotlights extent of famine risk in Gaza, Sudan and beyond

According to the latest Global Report on Food Crises, more than one in five people in 59 countries faced acute food insecurity in 2023, compared with around just one in 10 in 48 countries in 2016.

“When we talk about acute food insecurity, we are talking about hunger so severe that it poses an immediate threat to people’s livelihoods and lives. This is hunger that threatens to slide into famine and cause widespread death,” said Dominique Burgeon, Director of the UN Food and Agriculture Organization (FAO) Liaison Office in Geneva.

COVID-19 threshold

The report – a joint initiative involving FAO, the UN World Food Programme (WFP) and the UN Children’s Fund (UNICEF) – found that although the overall percentage of people defined as dangerously food insecure last year was 1.2 per cent lower than in 2022, the problem has worsened significantly since the COVID-19 crisis.

When the coronavirus hit in late 2019, around one in six people in 55 countries faced worrying food insecurity levels, compared with one in five just a year later, the Global Report on Food Crises indicates.

GRFC 2024: Number of people in GRFC countries/territories facing high levels of acute food insecurity
FSIN

GRFC 2024: Number of people in GRFC countries/territories facing high levels of acute food insecurity

‘People clearly dying of hunger in Gaza’ 

Food crises escalated alarmingly in 2023, the report’s authors noted, citing particular concerns over Gaza and Sudan today “where people are clearly dying of hunger”, said Gian Carlo Cirri, WFP Director, Geneva office. 

After nearly seven months of Israeli bombardment, “people cannot meet even the most basic, food needs. They have exhausted all coping strategies, like eating animal fodder, begging, selling off their belongings to buy food. They are most of the time destitute and clearly some of them are dying of hunger,Mr. Cirri said.

The only way to halt the famine is to ensure daily deliveries of food supplies “in a very short time”, the WFP official told journalists in Geneva.

“We’ve mentioned the necessity to rebuild livelihoods, to address root causes and so on. But, in the immediate time, like tomorrow, we really need to significantly increase our food supplies. This means rolling out massive and consistent food assistance in conditions that allow humanitarian staff and supplies to move freely and (for) affected people to access safely the assistance.”

‘Closer by the day to famine’

The new warning on Gaza is in line with repeated dire assessments from respected food insecurity experts who issued an alert that famine is likely “anytime” between now and May 2024 in northern governorates.

We are getting closer by the day to a famine situation. Malnutrition among children is spreading. We estimate 30 per cent of children below the age of two is now acutely malnourished or wasted and 70 per cent of the population in the north is facing catastrophic hunger,” WFP’s Mr. Cirri said. “There is reasonable evidence that all three famine thresholds – food insecurity, malnutrition, mortality – will be passed in the next six weeks.”

Sudan danger

On Sudan, the UN report noted that 20.3 million people – or 42 per cent of the population – struggled to find enough to eat last year, after conflict erupted in April. 

This represents the highest number of people in the world facing “emergency” levels of acute food insecurity, or phase four, in line with the Integrated Food Security Phase Classification warning scale, where phase five (IPC5) indicates the highest level of danger.

With only a few weeks left before the beginning of the planting season, humanitarian assistance must be allowed immediately inside and across Sudan to avoid any further deterioration of the situation, the report’s authors insisted. 

WFP and its partner World Relief provide emergency food supplies in West Darfur.
© WFP/World Relief

WFP and its partner World Relief provide emergency food supplies in West Darfur.

“What is very concerning for us is that the bulk of those people depend on agriculture for their livelihoods. And that, for example, if you take the Al-Jazeera state, this is a critical state for food production; it’s about 50 per cent of the wheat production of Sudan that is coming out of the state,” said FAO’s Mr. Burgeon.

“It is absolutely critical that wherever it will be possible to access the people [that] we provide them with agricultural inputs on time so that they can plant their fields. If those people fail to plant their fields, it means we have to be prepared for massive food assistance requirements until the next harvest next year.”

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The report also warned that people in South Sudan, Burkina Faso, Somalia and Mali likely endured the worst levels of food insecurity – IPC 5 – in 2023. 

Data were not available for some countries where there have been enduring fears over food crises, including Ethiopia, the report’s authors noted, while also pointing out that in Haiti, 19,200 people identified as IPC5 from September 2022 to February 2023 “no longer faced these conditions for the rest of 2023”.

Around 36 million people in 39 countries faced emergency – IPC4 – levels of acute food insecurity last year, which was four per cent more than in 2022. More than a third of them were in Sudan and Afghanistan. 

“Households in this severe situation face large food gaps, which are either reflected in high acute malnutrition rates and excess mortality or mitigated by use of emergency coping strategies,” the Global Report on Food Crises said.

In addition, some 165.5 million people in 41 countries faced crisis – IPC 3 – levels of acute food insecurity and around 292 million people in 40 countries were in IPC2.

Learn more about famine and how it is monitored in our explainer here.

Heatwave deaths increased across almost all Europe in 2023, says UN weather agency

New data published jointly by the World Meteorological Organization (WMO) and the Copernicus Climate Change Service confirmed fears that 2023 was the joint warmest or second warmest year on record in Europe.

In practical terms, this led to a record number of days with “extreme heat stress” across Europe, “an increasing trend” in the number of “strong heat stress” days on the Continent and an “extended summer” from June to September, marked by heatwaves, wildfires, droughts and flooding.

“2023 was the joint warmest or second warmest year on record depending on the dataset,” WMO said. “Heat-related mortality has increased by around 30 per cent in the past 20 years and heat-related deaths are estimated to have increased in 94 per cent of the European regions monitored.”

Unenviable record

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A precise estimate of heat-related deaths is not yet available for 2023, but WMO noted that between 55,000 and 72,000 people died in heatwaves in 2003, 2010 and 2022.

The findings in the WMO’s 2023 European State of the Climate report reflect increasing wider climate change shocks globally, but they are particularly significant because the continent is the fastest-warming, WMO said.

“The climate crisis is the biggest challenge of our generation,” said Celeste Saulo, WMO Secretary-General. “The cost of climate action may seem high but the cost of inaction is much higher. As this report shows, we need to leverage science to provide solutions for the good of society.”

Researchers who tracked back a decade found that members of the public and some health providers also had “a low-risk perception” of the dangers of heat exhaustion. To counter this, early warning systems including the WMO’s Regional Climate Centre’s Climate Watch are designed to raise awareness of impending extreme weather events and encourage preparedness.

According to the UN agency, land temperatures in Europe were above average for 11 months of the year in 2023, including the warmest September on record. 

Rainfall was also seven per cent higher than average, WMO’s weather report found, with European rivers flowing at record levels in December and “exceptionally high” flow in almost a quarter of the river network. 

This meant that during 2023, “high” flood thresholds were crossed in one third of the European river network, while close to one in seven exceeded “severe” flood thresholds.

‘Beyond extreme’ sea heat spike

Record sea surface temperatures around Europe also reflected the deeply worrying warming trend on land, with an alarming “marine heatwave” present in June, in the Atlantic Ocean west of Ireland and around the United Kingdom. The event was classified as “extreme” and in some areas “beyond extreme”, WMO said, with sea surface temperatures as much as 5 degrees Celsius above average.

“For the year as a whole, the average sea-surface temperature for the ocean across Europe was the warmest on record,” WMO said. “Parts of the Mediterranean Sea and the northeastern Atlantic Ocean saw their highest annual average sea-surface temperature on record.”

In a focus on sustainability and resilience to climate change shocks, the UN agency report underscored a record increase in electricity generation using renewable technology in Europe.

This was linked to higher-than-normal storm activity from October to December, which resulted in above-average wind power production. Also significant was above-average hydroelectric power generation across much of Europe over 2023, linked to above-average rainfall and river flow.

On the other hand, solar panel power generation was below average in northwestern and central Europe, but above average in southwestern Europe, southern Europe and Scandinavia.

Fewer snow days

WMO’s State of the Climate update also confirmed suspicions that much of Europe experienced fewer days with snow than average, particularly across central Europe and the Alps over the winter and spring.

This resulted in “exceptional” glacier ice loss in the Alps, made worse by strong summer melt caused by heatwaves, with glaciers losing around 10 per cent of their remaining volume over 2022 and 2023.

Arctic shock

Data for 2023 did little to allay concerns about the earth’s poles, with Arctic temperatures the sixth warmest on record. Breaking this down further, temperatures on Arctic land masses were the fifth warmest on record, closely behind 2022. “The five warmest years on record for Arctic land have all occurred since 2016,” WMO noted.

The fluctuating extent of Arctic Sea remained below average through most of 2023, the UN agency also reported. “At its annual maximum in March, the monthly extent was four per cent below average, ranking fifth lowest on record. At its annual minimum in September, the monthly extent ranked sixth lowest, at 18 per cent below average.”

Persistent wildfire threat

Total wildfire carbon emissions from the sub-Arctic and Arctic regions were the second highest on record in 2023, WMO said, linked to high-latitude wildfires, the majority occurring in Canada between May and September.

 

Pandemic experts express concern over avian influenza spread to humans

Dr Jeremy Farrar, Chief Scientist at the World Health Organization (WHO), said that the avian influenza virus – which is also known as H5N1 – has had an “extremely high” mortality rate among the several hundred people known to have been infected with it to date.

To date, no human-to-human H5N1 transmission has been recorded.

“H5M1 is (an) influenza infection, predominantly started in poultry and ducks and has spread effectively over the course of the last one or two years to become a global zoonotic – animal – pandemic,” he said. 

“The great concern, of course, is that in doing so and infecting ducks and chickens – but now increasingly mammals – that that virus now evolves and develops the ability to infect humans. And then critically, the ability to go from human-to-human transmission.”

Cattle mystery

Commenting on an ongoing outbreak of H5N1 virus among dairy cows in the United States, the WHO senior official urged further close monitoring and investigation by public health authorities, “because it may evolve into transmitting in different ways”.

Cows graze near a drilling rig in Texas, USA.
Unsplash/Donald Giannatti

Cows graze near a drilling rig in Texas, USA.

He added: “Do the milking structures of cows create aerosols? Is it the environment which they’re living in? Is it the transport system that is spreading this around the country? This is a huge concern and I think we have to … make sure that if H5N1 did come across to humans with human-to-human transmission, that we were in a position to immediately respond with access equitably to vaccines, therapeutics and diagnostics.”

Equal to next pandemic

The development comes as the WHO announced updated language to describe airborne pathogens, in a bid to increase international cooperation in the event of a new – and expected – global pandemic.

The initiative was originally sparked by the COVID-19 emergency and the recognition that there was a lack of commonly agreed terms among medics and scientists to describe how the coronavirus was transmitted, which increased the challenge of overcoming it, Dr Farrar explained.

Global appeal

To counter this, the WHO led consultations with four major public health agencies from Africa, China, Europe and the United States, before announcing agreement on a number of agreed new terms. These include “infectious respiratory particles” or “IRPs”, which should be used instead of “aerosols” and “droplets”, to avoid any confusion about the size of the particles involved.

Over and above the new terminology, the initiative cements the commitment of the international community to tackle ever “more complex and more frequent epidemics and pandemics”, Dr Farrar told journalists in Geneva.

“It’s a hugely important first step. But next, we need to keep the disciplines, the experts together. 

“We’re using the same terminology, the same language, and now we need to do the science that provides the evidence on tuberculosis, on COVID and other respiratory pathogens, so that we know how to control those infections better than we have done in the past.” 

On the potential HN51 public health risk, the WHO Chief Scientist cautioned that vaccine development was not “where we need to be”. Neither was it the case that regional offices and country offices and public health authorities around the world have the capability to diagnose H5N1, he noted.

Violations of women’s reproductive health rights trigger rise in preventable deaths

Interwoven Lives, Threads of Hope: Ending inequalities in sexual and reproductive health and rights, reveals that more than half of all preventable maternal deaths occur in countries which are in a state of crisis or distress.

It highlights the role that racism, sexism and other forms of discrimination play in blocking progress on sexual and reproductive health issues. 

Women and girls trapped in poverty are more likely to die prematurely due to lack of sufficient healthcare if they belong to minority groups or are trapped in a conflict setting, according to the findings. 

Overall, there have been significant advances in sexual and reproductive health it became a global sustainable development priority three decades ago.

In the space of a generation, we have reduced the unintended pregnancy rate by nearly one fifth, lowered the maternal death rate by one third, and secured laws against domestic violence in more than 160 countries,” UNFPA Executive Director Natalia Kanem said, launching the report.

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Stalled progress

But progress is slowing down or stalled in several key areas. In a world where a quarter of women cannot say no to sex with their partner and nearly one in 10 have no say over contraception, 800 women die every day giving birth – a disturbing figure that has remained unchanged since 2016.

Nearly 500 of those preventable deaths per day are happening in countries living through humanitarian crises and conflicts. 

The world made zero progress in saving women from preventable deaths in pregnancy and childbirth,” said Ms. Kanem, adding that for the first time, data was collected on whether women’s bodily autonomy is strengthening over time.

In 40 per cent of countries where information is available, autonomy is weakening due to an inability to reach “those furthest behind”, she added.

There is a clear disparity between the global North and South, West and East, when it comes to contraceptives, safe birth services, respectful maternity care, and other essential services, the report documents.

Pockets of inequality

Yet, even within those regions there are “pockets of inequality”, the report underscores. Women of African descent in the Americas face higher maternal mortality rates compared to white women, which is especially evident in the United States where it’s three times the national average. 

Indigenous and ethnic minorities also face elevated risks related to pregnancy and childbirth. 

Within Europe, in Albania, for example, over 90 per cent of Roma women from the most marginalized socioeconomic groups had serious problems in accessing healthcare compared with only five per cent of ethnic Albanian women from the most privileged strata. 

Additionally, women with disabilities are up to ten times more likely to experience gender-based violence, and individuals of diverse sexual orientation and gender expression encounter significant violence and barriers to care.

 

No ‘one-size-fits-all’ solutions 

The report highlights the importance of tailoring programmes to the needs of communities and empowering women and girls to craft and implement innovative solutions. 

It also calculates that if additional $79 billion are invested in low and middle-income countries by 2030, 400 million unplanned pregnancies could be averted, a million lives saved and $660 billion in economic benefits could be generated

The ability to secure reproductive health rights, the UNFPA Executive Director believes, is another major challenge.   

“It is indeed the responsibility of men to be champions of women’s reproductive rights, of everyone’s reproductive rights,” Ms. Kanem said.

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