We Are All One

I am the Regional Director and CEO of the International Planned Parenthood Federation/Western Hemisphere Region (IPPF/WHR), a feminist network of local partners that provide sexual and reproductive health services and fight for reproductive justice.    

I am from Argentina and my outlook has been shaped by the struggles for justice there and across Latin America. I am a committed feminist with 20 years of experience in program development and advocacy for sexual and reproductive rights, health and justice. I also serve as a board member in several leading international organizations.  

I joined IPPF/WHR in 2003 as I knew it was a community-based organization focused on solutions for women, by women. While our vision—sexual and reproductive health and rights for all— remains the same as it did nearly 70 years ago, IPPF/WHR’s new model is focused on meeting the needs of the most vulnerable girls and women, especially during times of crisis.  

The problem I am committed to solve is the over-centralization of sexual and reproductive health care, a symptom of the lack of trust in women's leadership and community networks. This problem has been thrown in stark relief by Covid-related lockdowns and mobility restrictions which has caused a 17% decline in the number of women accessing our clinics. Working with our feminist ecosystem of 46 autonomous partner organizations with nearly seven decades of experience in developing trusting local relationships, IPPF/WHR is building digital solutions that enhance engagement and connectivity around sexual and reproductive health outside the clinic setting. This project elevates humanity by advancing every person’s right to quality health care and bodily autonomy. 

Covid-19 lockdown measures have severely impacted the provision of sexual and reproductive health (SRH) services because of clinic closures, staff redeployment, and supply disruption. This is deeply problematic because sexual and reproductive health is a pivotal factor in disaster resilience and recovery. When people in disaster contexts can access SRH care, humanitarian responses have been proven to reduce morbidity and mortality related to HIV, unplanned pregnancy and pregnancy complications, and gender-based violence.

In the context of Covid-19, even a modest decline in SRH care could have devastating implications. A 10 percent decrease in SRH services in low- and middle-income countries could lead to another 49 million women with unmet need for contraception—resulting in 15 million unintended pregnancies and an additional 28,000 maternal deaths (Guttmacher Institute April 2020). 

 The Covid-19 pandemic starkly illustrates how centralized models of healthcare delivery prevent people from accessing care when they need it most.  Only 12 of IPPF/WHR's 46 local partners were fully operational in the month of April, and we have seen a 16% decline in care from March 15 through May 31 compared to 2019. We urgently need to scale up new modalities of care to reach women when and where they need it.

My goal is for IPPF/WHR to play a catalytic role in building more expansive, flexible, and networked models of SRH care delivery. We will do this by developing digital health and community-based models that draw from IPPF/WHR’s deep traditions of woman-to-woman support. These new modalities by and for women will be designed to challenge power dynamics, cultural beliefs, economic inequality, and other historic barriers.

Our project builds on recent experiences providing SRH care in the context of pandemics and natural disasters, including Zika in Brazil and Puerto Rico; the 2017 hurricane season in the Caribbean; and Covid-19 globally. In the wake of clinic closures, IPPF/WHR’s partners quickly mobilized to shift clinic-based services—like counseling for women experiencing domestic violence—to WhatsApp, Facebook, and other platforms.  We have also seen women form digital support networks to help each other connect to care in extremely deprived environments, such as among mothers of Zika-affected children in rural Brazil. 

These experiences show that we can no longer prioritize an outdated model of care centered on clinics; to expand access and prevent gaps in care, we must transfer care relationships based on trust and respect into the digital realm.

The people IPPF/WHR serves are those who have been most harmed by Covid-19 in Latin America and the Caribbean: Black and Indigenous people, informal workers, inhabitants of the favelas and remote rural areas, and others who live on the margin of privilege. Above all, IPPF/WHR serves women and girls, and here too the effects of Covid-19 have been stark: women comprise the majority of frontline healthcare workers and familial caregivers; are exposed to domestic violence during lockdowns (leading to a 142% increase in emergency calls in places like Colombia); and face increased threats to our bodily autonomy due to healthcare restrictions. 

Women and members of marginalized communities are connected to our local partners in various roles: as patients, community volunteers, educators, staff members, executive directors, and members of the boards of directors. The close connections between our local partners and their communities have generated bonds of trust with women and girls who will be the protagonists of digital health interventions, and who we will engage to design and implement solutions to increase access to sexual and reproductive health care. 

This project will benefit historically-discriminated women and girls who are unable to access sexual and reproductive health services during pandemic and natural disaster contexts.   

Our work is connected to Sustainable Development Goal 3.  Sexual and reproductive health services are essential for tackling health problems like cervical cancer and maternal mortality, and prevent unintended pregnancies and clandestine abortion. 

It also ties back to Sustainable Development Goal 10, which calls for gender equality.  We are dedicated to eradicating gender inequality through our advocacy and services, particularly for women who face multiple forms of inequality.  

In 2015, the Zika epidemic hit Brazil.  Zika, unique in the fact that it is the only mosquito-borne illness that is sexually transmitted, has grave consequences for Zika-positive pregnant women whose children are born with a range of serious developmental issues. 

In Brazil, the epidemic affected poor, young, Black, Indigenous and rural women the most, women who lived in areas with poor sanitation and lacked access to healthcare services and information. Women now found themselves raising children with special needs with little to no support or specialized care.   

WhatsApp began to serve as a lifeline for women with children affected by Zika.  The women built a network, exchanging information, resources, and stories to support each other during very challenging times.  As the epidemic spread throughout Latin America, other networks emerged.  

This experience served as the impetus for the idea for leveraging digital health technologies to bring resources to women during the Covid-19 pandemic. When Covid-19 struck, and our clinics began to close, I knew that we could support women experiencing gender-based violence, women needing contraception, and other sexual and reproductive health services by utilizing technologies, like WhatsApp, that women of all socio economic strata in the region are using.  

I am an activist from a very rural region in the Global South who grew up without clean running water—I am the first person in my family to speak English.  My commitment to this cause began at a very early age as I grew up during Argentina’s “Dirty War.” It was a time when families were torn apart, a time when people lost their voices and abilities to make sense of their own history while living under an oppressive political regime. Thus began my quest to help those who are oppressed, specifically women and girls who were silenced.  

Growing up, many of my peers faced unintended pregnancies and violence which often derailed their educations and life plans. This continues today in the world’s most unequal region, but our region is also home to the most vibrant and mobilized feminist movement in the world. My career is rooted in this activism, and I have long dedicated my efforts to bringing the needs and voices from the most disenfranchised communities in Latin America and the Caribbean to cutting-edge programs and solutions to create a more equitable world.  

As the CEO of IPPF/WHR, my role is to ensure the viability and visibility of our local partners and facilitate capacity-sharing to scale-up new programs and initiatives.  With seventeen years' experience at the organization, including as Director of Programs, I have the institutional and programmatic knowledge needed to advance cutting-edge technologies and innovations.  

I am from the region and know first-hand the gender inequality and lack of health care that women endure, particularly Black, Indigenous, young, and poor women.  I have seen this inequality played out in every aspect of women's’ daily lives, from care giving to gender-based violence.  I have also seen the fragility of local health systems and their inability to provide uninterrupted and rights-based care.    

Throughout our history, IPPF/WHR has pioneered new models of health care and scaled up successful approaches to difficult challenges.  For example, cervical cancer is one of the most common types of cancer in our region. We introduced a model- visual inspection with acetic acid- that allows health providers to use a common household item, vinegar, to detect and treat cancerous lesions on the spot.  This is a cost-efficient and reliable method that has been scaled up throughout the region.   

We work in a region with the most restrictive abortion laws in the world (Guttmacher March 2018). In 2018, a legislative opportunity to change harmful policies around abortion arrived in my home country of Argentina.  

We issued rapid-response grants to grassroots organizations outside of our network leading the charge for approval of legislation that would decriminalize abortion. These women were part of a huge campaign, and we saw it as vital to support other activists and organizations to amplify the movement. 

During the hearings, I was called to testify in Congress.  I never thought I would see the day that I would testify on an issue of great importance to me in my home country.  The law passed in the lower house of congress but was rejected in the upper house.   

This served as an opportunity for me to reimagine the future of IPPF/WHR.  The hearings in Argentina taught us that we needed legal expertise and evidence-based advocacy to strengthen our movement.  We are opening advocacy centers which will strengthen our fight for the health and rights of women and girls.

In recent decades, the rise in the number of middle-income countries in Latin America and the Caribbean led to a withdrawal of donor funding, even though the region is the world’s most unequal. Service records show that six of every ten clients are socially vulnerable and therefore unable to pay the full cost of health services out of pocket.  Compounding these factors are the weak health supply chains and medical monopolies that lead to stock-outs and mark-ups on basic sexual and reproductive health supplies like condoms.

In 2015, I helped lead the creation of IPPF/WHR’s social enterprise program and subsequently,  INNOVA, a social enterprise that provides contraceptive commodities throughout the region. These two strategies have increased the revenue generation of our local partners and access to SRH care in the most marginalized communities.  More recently, I led the structuring of an impact debt fund to provide repayable finance to local partners working to scale projects from our social enterprise incubator.  

During Covid-19 lockdowns health providers have increasingly turned to digital health tools, and we have found that trust between patients and medical institutions is a key missing factor in the success of these methods.  IPPF/WHR has earned women and girls' trust. Our local clinics and mobile health units are often the only providers of affordable and accessible sexual and reproductive health services, and women and girls have been using our partners' digital health technologies when available.

Our local partners are eager for more tools, resources, and partnerships to accelerate the shift to digital health, especially since cellphone usage is high in Latin America and Caribbean.  It is a common but false assumption that only men and higher-income women use smartphones and other digital technologies; in Latin America and the Caribbean, 69% of women have access to mobile internet, and the gender gap in mobile phone use is just 1%, as opposed to 51% in South Asia (GSMA Mobile Gender Gap Report 2020). Many women are already on digital platforms, and our project involves meeting them where they are.

Some of our partners are already experimenting with digital modalities, but we need to better connect these approaches and bring them to scale. We can achieve this by bringing in experts in digital technologies, as well as medical staff, and of course, the women who use our services. The innovation of this project lies in building digital health expertise among local organizations that have earned women’s trust.

The ultimate outcome we seek is that all women have uninterrupted access to quality sexual and reproductive health care wherever and whenever they need it. In striving for this outcome, we seek to fulfill the fundamental human right to bodily autonomy, including in contexts of pandemic or humanitarian emergency.

A long-standing assumption holds that quality health care requires a clinic-based interaction with a doctor. However, IPPF/WHR has decades of successful experience with health care workers and laypeople providing counseling, contraceptives, and medications in communities. More recently, the proliferation of smart phones, social media, and telemedicine platforms has created the conditions for connectivity outside the clinic setting.

Digital health interventions hold tremendous promise for expanding access to SRH care by enabling people in emergency contexts to receive essential care via innovative digital modalities. Therefore, a medium-term outcome of our theory of change is that accessible, rights-based digital health and community-based interventions bridge gaps in access to care for women and girls.

To fulfill this potential, digital health interventions must be effectively scaled and sustained. Therefore, over the coming year we will build the IPPF/WHR Digital Health Center, leveraging our role as an orchestrator of change and a connecting fabric among our local partners, social justice movements, and international platforms. The Center's core activities are: 1) advocating for an enabling legal and regulatory environment for digital health; 2) facilitating digital health capacity building and sharing among our partners; 3) implementing digital service delivery models informed by best practices; and 4) communicating these activities to key stakeholders.

Key outputs to be generated by these activities include:

• Strengthened partnerships with activists and organizations working at the intersection of feminism, universal health care, and digital access
• Landscape analysis of national legal and regulatory policies for digital health
• Advocacy initiatives to build political will and favorable policies for digital health
• A learning agenda for digital health, including webinars and a library  of regionally relevant tools 
• Digital health case studies for learning and fundraising 
• 3-4 digital health pilot projects generated via IPPF/WHR’s social enterprise incubator in Year 1

IPPF/WHR’s network serves 6,257,090 people with sexual and reproductive health services annually, based on verified health and program records. Of these, in 2019 only 6,525 (1%) were served via digital health modalities such as online counseling or telemedicine. As we invest in digital health capacity across our network, we expect to see an increase in both the proportion of people reached through digital health channels, and an increase in the overall service numbers as digital health allows for more efficient service provision. Of the total number of clients who receive sexual and reproductive health services, the estimated percentage to be reached by digital health methodologies is projected to reach 10% by the end of 2020 (625,709 people); 15% in 2021 (938,564 people); and 37% in 2025 (2,315,123 people). These projections align with the diffusion of innovations curve (Rogers, 1962) where uptake grows faster once there is a critical mass of adopters. We anticipate uptake to be even more rapid in 2020 than would be expected under normal conditions due to the mobility restrictions caused by Covid-19.

Although some of our partners are already using digital platforms for care, barriers exist. 

One is financial.  In recent years, donors have withdrawn from the region, and the current economic situation is precarious at best. Finding new funding to scale up this model is a challenge, particularly during the pandemic, when women are in acute need of sexual and reproductive health services.  Logistics and medical monopolies are also a challenge.  While our regional procurement initiative INNOVA has helped us gain control, the international supply chain is complex and costly, even more so during a pandemic.  Furthermore, medical monopolies in countries have made supplies out of reach, particularly for our partners who provide subsidized or free services.

The second is political.  Most countries do not consider sexual and reproductive health services as “essential” during crises and most of our clinics had to shutter due to lockdowns, leading to interrupted access to health care for women.  This is an advocacy and legal challenge that we are prepared to take on, but again, funding remains unpredictable. 

Finally, it may be challenging for some of our partners to implement digital health solutions as this is a rapidly changing and complex field.  

Financial barriers: IPPF/WHR aims to be a go-to source for feminist-driven information about the pandemic in Latin America and the Caribbean, for donors, media, academia, and other strategic allies.  To support the launch of the Center for Digital Health, we will map new donors, investors and funding opportunities and develop a general concept note on the subject, as well as scale up communications channels to raise awareness about our issues.

Political barriers: IPPF/WHR will orchestrate national and regional advocacy initiatives, bringing together diverse voices and best practices from throughout the region to strengthen political commitments and policies for digital health and universal health coverage. To shape effective advocacy, IPPF/WHR is ready to provide evidence-based data on how Covid-19 has affected the lives of women, adolescents and girls with regards to their sexual and reproductive health and rights, including disruptions in access to SRH services, and how they have been exposed to violence during times of confinement. 

Capacity barriers: IPPF/WHR will coordinate a regional Learning Agenda to enable mutual learning, ignite conversations, and support organizational adaptation and change. To help orient our partners and ourselves to the existing universe of possibilities, we will conduct a landscape analysis of digital health best practices and existing initiatives within our network, as well as an assessment of the local technical environment (e.g. broadband access, smartphone usage). We will support and fund organizations to pilot digital health initiatives with the potential for scale.

IPPF/WHR works in a feminist ecosystem comprised of our partner organizations; activists working on issues like racial justice, indigenous rights, and climate change; governments; donors; and other actors working on reproductive justice.  We see our role in this ecosystem as an orchestrator of change and a connecting fabric among partners, other key actors and social justice movements, and international platforms. IPPF/WHR also serves as a multiplier of innovation through the creation of new strategies and capacity sharing.

We recognize that intersectional organizing is urgently needed to effectively tackle health inequities. While continuing to support its longstanding partners in the region, IPPF/WHR is expanding our work with new allies, such as organizations of domestic workers and progressive faith-based groups. IPPF/WHR increasingly facilitates peer learning and capacity sharing among organizations in the Global South to strengthen intersectional collaboration.

This project provides value to beneficiaries and customers (women and girls of reproductive age in Latin America and the Caribbean, with a focus on those in communities in crisis and/or humanitarian contexts) through a blended business model that uses digital and community-based modalities of women-to-women support to bridge health provision gaps, delivering bundles of high-quality low-cost SRH services and products that meet women and girls where they are. It aims to be sustainable and generate income from individual client fees; subsidization from governments and insurance companies; and initial start-up funding from donors and investors. 

These modalities of delivery bring value to the lives of women and girls, by creating a desirable solution for which those women with economic capacity are willing and able to pay. In many cases, closing gaps in care and meeting women where they are can be considered less of a cost burden on the client and beneficiary than traditional modalities of care, even if offered free of charge. For example, a woman who seeks access to SRH care free of charge but needs to travel to an urban center to receive it, will still incur transportation and opportunity costs of lost income or time in the process.

This business model recognizes that there will be women and girls who will still need to continue to access subsidized services through these modalities, which is why it relies on support from government, insurance companies, donors and investors to close this revenue gap. 

The business model for this project is rooted in the principles of social enterprise and spearheaded by our Innovation and Social Enterprise Lab, meaning that these new e-health and community-based models by and for women are designed to generate income and become self-sustainable over time, requiring initial investments from donors, investors or governments to pilot and launch while gaining traction in the market and becoming more effective and efficient in order to scale and grow. 

Cost drivers for this model are heavily focused on initial start-up and development costs to pilot and launch new digital and community-based models. Ongoing costs are primarily human resources. This project will be initially funded by donations to spur the creation of these modalities and establish the necessary infrastructure so that the project can be brought to market and revenue can begin to be generated through sales of services and products.  Although we estimate that revenue generation will begin on a small scale as traction is gained, sales will gradually grow to incrementally contribute to covering ongoing costs.  The project will continue to rely in part on subsidization from government and insurance companies, and also from cross-subsidization of other profitable business models, which our partners are operating, dedicating a portion of surplus to contribute towards operating costs.

In order to support our local partners shifting to digital solutions as part of their response to Covid-19, and to prepare for the launch the IPPF/WHR Digital Health Center, we have reprogrammed $1.3M USD in existing project grants from a few key foundations that have indicated their flexibility during the pandemic.  In addition, IPPF/WHR has earmarked $400,000 in internal capacity-building funds for prototyping, piloting, and/or scaling new or existing digital health models. 

The estimated total cost of the digital health initiative in the first two years is $2M USD. We are seeking to raise this amount through a combination of grants and repayable finance through our social enterprise program.  

The reason I decided to apply for the Elevate Prize is that I see it as a unique and creative way to bring more attention to the issues about which I and my colleagues care so deeply: championing the rights and wellbeing of women and girls, fostering the uniquely powerful feminist movement in Latin America and the Caribbean, and advancing the enormous potential of digital health to overcome persistent gaps in access to sexual and reproductive health care. This Prize will help raise my profile as an innovative leader which will in turn attract more minds and resources to my cause. I also see the connection to MIT as particularly valuable, as IPPF/WHR’s network could greatly benefit from the institution’s vast amount of talent and expertise around digital technology and social entrepreneurship.   

Funding and revenue model: We seek connections with donors and impact investors with interest in our work, as well as experts in repayable financing who could review and provide feedback on our new impact investing strategy.    

Board members or advisors: We seek people whose experiences or research positions them to accompany us as thought partners in the development of the IPPF/WHR digital health center.

Marketing, media and exposure: We are engaged in a number of communications strategies, including an Instagram series called Women in Times of Pandemic to tell the stories of women affected by Covid-19 and gender-based violence. Support on expanding the reach of these strategies would be very welcome. 

We seek to forge strategic partnerships with external organizations to support the learning and expansion of digital health solutions across our network.  We are specifically interested in learning from organizations that have not only developed and implemented telemedicine, online counseling, or other digital modalities, but also engaged in successful advocacy initiatives to create a more enabling policy environment for such interventions.