Out of time. Out of patience. Women’s and adolescents’ health and rights cannot wait.

Women are suffering and dying because of preventable health issues, exacerbated by climate change and conflict. This must end now.

Oyeyemi Pitan, Founder and Executive Director at Gem Hub Initiative

In Nigeria, Africa’s most populous country, a woman is more than 100 times more likely to die giving birth than in the UK, France or Germany. This massive inequality, along with the challenges facing women accessing basic health rights and services, is not unique to Nigeria.

Right now, 250 million women and girls who want to avoid pregnancy are not using safe, modern methods of contraception. Today, 800 women will die from preventable causes related to pregnancy and childbirth. Tomorrow, more than 40,000 girls under the age of 18 will be married – losing their childhood as well as their education and agency. This is unacceptable. Alongside a devastating human toll, the economic burden is vast.

Despite the massive unmet needs and the dividends investment will reap in terms of health and economic gains, global development assistance for maternal and reproductive health has stagnated.

Despite the massive unmet needs and the dividends investment will reap in terms of health and economic gains, global development assistance for maternal and reproductive health has stagnated at a time when lower-income countries are struggling to finance both health and education.

Until women and girls are prioritized time and again, year after year, by national governments and international donors, adolescent pregnancies will remain high, just as complications during pregnancy and childbirth will continue to be a leading cause of mortality among teenage girls in Africa. Preventable deaths will continue.

Until women and girls are prioritized time and again, year after year, by national governments and international donors, adolescent pregnancies will remain high.

Climate change, conflict, soaring food costs and mounting debt are adding to the already sizeable burden, making it even more difficult for governments that want to prioritize this agenda at home. This is a clarion call to partners to double down in their support. Now is not the time for underinvestment – doing so will carry significant consequences.

While the scale of the problem is daunting, countries across Africa are moving forward decisively, prioritizing the health of women with the support of partners. Countries such as Kenya, Cote d’Ivoire and Mozambique have significantly cut the number of adolescent births. Liberia saw a rise in the number of adolescent girls receiving family planning counselling. And Nigeria is embarking on a landmark ambitious health reform agenda with an aim to crash maternal mortality.

These examples provide important lessons and illustrate why we need to give greater attention to efforts that protect and empower women – and that are sustainable while delivering the biggest possible impact.

First and foremost, it is clear that countries must take the ownership and lead the way in setting health priorities and implementing programs to support women and girls. Health plans must be funded with domestic resources, with external sources playing a complementary and aligned role.

In a resource-constrained environment, it is essential for governments and their global health partners to align behind a single national plan to deploy their funds in the most efficient way. Strong leadership within countries is key to harmonizing the work of partners, ensuring ‘one plan, one budget, one report’ to improve health outcomes.

This is a clarion call to partners to double down in their support. Now is not the time for underinvestment – doing so will carry significant consequences.

Second, country ownership is not only about the government. It must include engagement with community leaders and advocates who understand these challenges deeply, particularly in the hardest to reach communities. Grassroots projects supporting women and girls play a crucial role in helping push the ambition further, holding governments to account, and bringing about long-term change.

In Senegal, a program with community and youth leaders is providing 900 adolescent girls in a rural community with a small bursary and dignity kits to improve menstrual hygiene and provide access to safe spaces and community groups that discuss reproductive health, female genital mutilation and early marriage. They are also learning to read and write and take part in vocational courses. In partnership with village health committees, the project is set to enrol another 50,000 young girls this year.

Another program is targeting hot spots with high rates of adolescent pregnancy and maternal mortality, including the community of Kabusa in Nigeria’s capital city, Abuja. Kabusa is one of about 30 informal settlements in Abuja with a high rate of poverty and prevalence of teenage pregnancies. It is estimated that 20 percent of adolescent girls in this community are pregnant or have at least one child.  The project, led by the Gem Hub Initiative, an organization I founded in 2021, is helping young people to share sexual and reproductive health information, and provide counselling and training to prevent unintended pregnancies and support women and teenagers if they do become pregnant. Our goal is to cut this maternal death toll dramatically and give women in lower-income communities the opportunity to realize their potential.

Third, this agenda goes within and beyond the boundaries of typical health projects. To reach adolescent girls, you must work outside of health clinics and traditional settings. In Mozambique, sexual and reproductive health services have been expanded through a school health platform with a particular focus on adolescent girls. That same platform will also support the roll out of HPV vaccines to reduce cervical cancer rates.

The results I see, and the positive responses from country and local leaders, together with young people, makes me know that we are on the right path.

As we take steps to increase access to services for women and adolescents, widen opportunities and save lives, I believe that new ways of working and collaboration grounded in such principles are key. These are at the heart of the partnership with the Global Financing Facility for Women, Children and Adolescents (GFF), a multi-stakeholder partnership housed at the World Bank, supporting 36 countries including those I’ve mentioned here. The GFF model brings together a wide range of partners, including governments, donors, global health organizations, youth representatives and the private sector, to carry out country-led health plans. The results I see, and the positive responses from country and local leaders, together with young people, makes me know that we are on the right path.

With countries in the driver’s seat implementing their health and development plans, and global partners aligned behind them, I am optimistic that we can achieve better health outcomes for women and girls and bring about lasting and meaningful change.

The cost of inaction will not just impact lives today. It will limit future growth, restrict resilience and risk security. All of these are needed for a more stable future.

We have the solutions; we know what needs to be done. But we are out of time, and I am out of patience. Women’s and adolescents’ health and rights cannot wait.