MCH Leads Health Equity Edition – In order to advance health equity for MCH populations, beginning January 2023, MCH Leads will feature trainees’ health equity-focused work. We look forward to highlighting trainees’ experiences supporting the health and well-being of vulnerable and underserved populations and communities. Also, their work assessing and addressing the underlying causes of health disparities–and their efforts to promote diversity, equity, and inclusion–ultimately improving MCH outcomes. In addition, we encourage trainees to reflect on how the MCH Leadership Competencies are applicable to their health equity-focused stories.
Mahnoor Fatima (She/Her) is a first-year Master of Public Health candidate focusing on Behavioral, Social, and Health Education Sciences at the Rollins School of Public Health at Emory University. She is also completing a certificate in Maternal and Child Health from Emory University’s Center of Excellence in Maternal and Child Health. Before moving to Atlanta, Mahnoor graduated from Shaheed Zulfikar Ali Bhutto Institute of Science and Technology (SZABIST University) in Karachi, Pakistan with a bachelor’s degree focused in Sociology. Prior to graduate school, Mahnoor worked as a Sexual and Reproductive Health and Rights (SRHR) Fellow with the SRHR Global Program Services Team at Pathfinder International where she led a specialized internal task force consisting of country directors, technical advisors, and business unit directors to advance Pathfinder’s work on Child, Early, and Forced Marriages. She currently works at her school as a graduate research assistant with the Hubert Department of Global Health on a review of psychometric measures to assess intimate partner violence against women and girls and as an engagement coordinator with the Emory Center for AIDS Research. Her professional interests include gender, psychometric methods, and the application of behavior change theory for reproductive health, maternal and child health, and global health that integrates a person-centered approach, particularly in crisis and humanitarian settings. If you are interested in connecting with Mahnoor and learning more about her work and passions, you can find her on LinkedIn!
In 2021, I had the opportunity to become a Fellow with the Sexual and Reproductive Health and Rights (SRHR) Global Program Services Team at Pathfinder International. The team consisted of technical directors for various domains within SRHR including Adolescents and Youth, Family Planning, Maternal and Neonatal Health, Gender, Gender-based Violence, Safe Abortion, Self-Care, and Social and Behavior Change. My initial role was to support the advisors in the development and dissemination of global goods and technical products for the program countries. However, I then became tasked with supporting the Executive Director to advance work on strategic priority areas such as Child, Early, and Forced Marriages (CEFM). The underlying purpose was to support expansion and recommendations to intervene in this area.
To advance the work in this specific area, a specialized internal task force was created across the various teams and units at Pathfinder.
To lead the taskforce, I undertook literature reviews, evidence, and data-gathering to understand the prevalence, need, and burden of CEFM globally as well as in the countries already in our portfolios. This included understanding the global and country-specific definitions of CEFM, the legal and policy landscapes of CEFM, the theoretical frameworks and approaches used by other organizations for CEFM, the organizational work that has already been done, and the most active key players within this area. To organize the information, I created an expansive document with the latest global statistics and interventions and then more specifically, CEFM-specific information for the 17 countries in the organization’s portfolio. For each country, I mapped the CEFM findings to a Political, Economic, Social, Technological, Legal, and Environmental (PESTLE) Framework. In order to categorize and provide a range of interventions, I divided them into three main groups: Prevention, which emphasizes actions to prevent Child, Early, and Forced Marriage (CEFM); Support, which centers on responding to girls and women already in such unions; and Integration, which combines efforts related to both prevention and support.
Competency 10: Interdisciplinary & Interprofessional Team Building
When my data and documentation work was completed, I then began hosting a series of dissemination meetings with the taskforce with the intention to seek their input and recommendations. Based on interest and a mapping of technical expertise, the taskforce consisted of country supervisors, country field teams, representatives from advocacy and business development, and technical advisors for Adolescents and Youth, Gender, Gender-based Violence, and Social and Behavior Change who were experts in their own specific fields and had their own portfolios to attend to. We also had French-speakers in our taskforce.
I knew that bringing together such a diverse group of experts would require careful planning and coordination to ensure that everyone could work together effectively. To ensure everyone is abreast with the developments of the taskforce, I created a repository of the CEFM resources that I found and utilized in my own documentation, as well as the documents that I had prepared to guide our taskforce discussions. I also put together a brief that contained a summary of all the resources I found. Moreover, ahead of our scheduled sessions, I would share the slide-decks in English and French with all the members and would also include live French captions during the meeting. This was in addition to the communications channel to ensure updates and collaboration on tasks was easily visible.
Through each session, I learned how each individual, despite being grounded in their own perspective, contributed extensively to the taskforce to advance our work. For example, I was able to gather field and community insights and receive constructive feedback regarding the scope and role that we can take from a business development perspective and the value of integrating CEFM within the Pathfinder Social and Behavior Change framework. Despite the specific technical expertise of each individual, the holistic and integrated work as a taskforce showed me the need for diversity in making decisions. I also believe that such a diverse taskforce was needed to address the multidimensionality of the complex issue of CEFM. For example, representatives from advocacy discussed the aspects of awareness and mobilization of resources, while country directors and teams helped ensure that our way forward was contextually appropriate and accessible to those most in need, while technical advisors for Gender and Gender-based violence helped unpack the gender considerations for CEFM programming.
Moreover, all members of the taskforce were also able to provide tools and methods from their specific subject matter to support us in our work. This highlighted how each team member had their own expertise and perspective but all were essential and synergistic and supported the development of our decisions to address CEFM upon a spectrum of prevention and response.
Advancing Health Equity
I believe that this work contributes significantly to health equity. Despite maternal and child health being a core focus for many individuals, we often forget to include the children who become mothers. Child, Early, and Forced Marriages are significant violations of human rights, and they are linked to a wide range of negative health outcomes, including mental health issues, reproductive health problems, and exposure to gender-based violence.
Moreover, responding to CEFM through both prevention and support ensures that we are facilitating and empowering the inherent agency and autonomy of girls and young women. Supportive measures, such as essential healthcare packages, can help girls and young women at-risk for or already in CEFM by providing SRHR information and services based on harm reduction and gender transformative approaches. These measures respond to the unique healthcare and psychosocial needs of this population, ensuring that they are able to thrive.
UNICEF. 2021. Understanding the Relationship Between Child Marriage and Female Genital Mutilation.
UNICEF. 2018. Child Marriage: Latest Trends and Development.