Prof Hassan Shehata, president of the Royal College of Obstetricians and Gynaecologists, Dr Hannah Nazri, Asia Network to end FGM/C and Anna af Ugglas, chief executive of the International Confederation of Midwives.

CAPE TOWN – More and more health workers are performing female genital mutilation (FGM) in South and South East Asia – although the process is internationally recognised as a serious human rights violation with no medical justification. 

Health professional associations mulled over how to ensure that health workers stop performing this harmful practice at the World Congress of Gynaecology and Obstetrics (FIGO) in Cape Town on Wednesday.

Growing “medicalisation” has been observed in Brunei, India, Indonesia, Malaysia, Pakistan, Singapore, Sri Lanka, and Thailand, according to a new report released at the FIGO congress.

Around 80 million women and girls have experienced FGM or cutting (FGM/C) in the region, which entails procedures that involve partial or total removal of external female genitalia, or other injury to the female genital organs for non-medical reasons. 

Of the eight countries, only Indonesia explicitly bans the performance of FGM, including by healthcare professionals, according to the report, which was compiled by Equality Now, the Asian-Pacific Resource and Research Centre for Women (ARROW), Orchid Project, and the Asia Network to End FGM/C.

Despite this ban, implemented in 2024, almost half of all procedures in Indonesia are now done by trained midwives, often as part of maternity packages.

In Malaysia, doctors are the primary providers, and 85.4% of the doctors interviewed in a 2020 study said that female genital cutting should continue. 

In Singapore, almost half the women interviewed in a 2020 study had been cut by doctors. In Sri Lanka, FGM is increasingly being performed by physicians in private clinics, with services being advertised on social media, according to a 2025 report.

“FGM is being offered in government hospitals in Brunei, which indicates government support,” according to Equality Now’s Julie Thekkudan.

In Thailand, there is a rise in girls undergoing FGM/C in health facilities, with doctors disclosing that they perform 10 to 20 procedures monthly. 

‘Regulation of sexual desires’

The motivation for cutting women’s and girls’ genitalia is rooted in cultural and religious beliefs – primarily that it will prevent promiscuity. 

It is also often performed on babies and young girls before they reach puberty, subjecting them to intense pain as the area is dense with nerve fibres and blood vessels, added Nazri.

In the Gambia, 70% of girls have undergone FGM by the age of nine, while in Malaysia, it is most commonly performed on infants and pre-school girls. 

“If you have to perform a harmful procedure to regulate a person’s sexual desires, there is something very wrong,” said Dr Hannah Nazri from the Asia Network to End FGM/C.

“If people want to prevent their daughters from being promiscuous, then they should educate them,” she said, adding that parents should not be able to give consent on behalf of their daughters for a procedure that would cause permanent harm.

Nazri, who also represents Malaysian Doctors for Women and Children, added that human sexuality is a complex process that is rooted in reactions in the brain as well as the body, so damaging a woman’s genitals will not remove her sexual desire.

Dr Hannah Nazri

Medicalising does not reduce harm

There is no evidence that the use of health workers reduced the harm. Instead, some studies found that healthcare professionals were more likely to conduct more severe forms of the procedure than traditional practitioners, using their anatomical knowledge and anaesthesia, which often resulted in deeper, more extensive cuts.

“Medicalisation of FGM/C does not make the practice safe. On the contrary, it risks embedding it within health systems, undermining medical ethics, and exposing women and girls to long-term physical and psychological harm,” said ARROW’s Safiya Riyaz.

“Medicalising FGM/C may be intended to reduce harm, but it does not make the practice safe,” she added. “With medicalisation rising across Asia, healthcare professionals are in a unique position to protect women and girls. They must be supported by clear laws, accountability, and cultural change to end this harmful practice.”

Role of professional bodies

The World Health Organization (WHO) strongly urges health workers not to perform FGM and has developed a global strategy to support the health sector and health workers to end FGM medicalisation, which is practised in 94 countries.

Dr Christina Pallito, WHO lead on harmful practices, said that the global body’s guidances on the issue are aimed at “shifting values, shifting beliefs and to change the behaviours, to bring more health workers to be against medical FGM and understand why they should not do it”.

Anna af Ugglas, chief executive of the International Confederation of Midwives (ICM) which has over one million members, said that her organisation believes FGM is a “harmful cultural practice that should never be performed”.

She called for closer alignment between health professionals to stop FGM/C.

While she advocated for a “stick and carrot” approach to stop health workers from performing the procedures, “there must be consequences for harm”, she added.

Professor Hassan Shehata, president of the Royal College of Obstetrians and Gynaecologists (RCOG), said that 44,000 women and girls died each year from FGM: “That’s one every 12 minutes.”

The RCOG, which has members across the world, makes it clear that FGM/C is a human rights abuse and has clear guidelines for its members, said Shehata.

“We have embarked on a lot of work about FGM in Africa, and [run] a training course where we address three main issues: One, advocacy; Two, training that FGM has no place, whether it’s medically, religiously or socially. Three for members to understand the complexities and implications of FGM – mental health, sexual health, physiology, obstetrics, and gynaecology.”

Nazri believes educating health workers is more effective than banning FGM: “A lot of health workers are not aware that FGM is a human rights violation. The law is silent about it in Malaysia and often junior doctors don’t want to go against their seniors, so a legal framework would help and also allow doctors to educate their patients.”

Equality Now’s Thekkudan said there was low awareness of the harms of FGM/C and there need to be “national awareness campaigns” that include the medical fraternity.

The procedure is not taught in medical schools, and health workers learnt how to perform it from older health workers and traditional birth attendants, she added.

International development aid is still prioritising fossil fuel-based energy projects while funding for clean air initiatives fell sharply in 2023, according to a new Clean Air Fund Report.

Development funding for fossil fuel-based energy projects jumped 80 per cent in 2023 to $9.5bn, up from $5.3bn in 2022, even as toxic air causes more than 8m premature deaths annually, according to a new report.

Governments continue to channel billions more in international aid into projects that prolong fossil fuel use than into tackling air pollution, the Clean Air Fund found. Direct support for outdoor air quality initiatives fell 20 per cent to $3.7bn, representing just 1 per cent of all international development financing, according to the organisation’s annual State of Global Air Quality Funding report released Wednesday.

However, total international development aid for clean energy projects with air quality co-benefits reached $32.6 billion in 2023, nearly 3.5 times fossil fuel investments — a marginal increase from $31.8 billion in 2022.

“Air pollution is a public health emergency hiding in plain sight,” said Jane Burston, chief executive of Clean Air Fund. “Every year, toxic air kills more people than tobacco — contributing to 8.1 million deaths — yet governments are still funnelling billions into the fuels that cause it.”

Beyond international aid budgets, national fossil fuel subsidies from governments totalled $7 trillion globally in 2022, equivalent to 7.1% of global GDP, according to International Monetary Fund data. That represents 1,400 times more than what flows to clean air projects, even as roughly 85% of global air pollution stems from burning fossil fuels and biomass.

“You can’t build healthy societies on dirty air,” Burston added. “When aid money props up fossil fuels instead of cleaning our air, it’s not just bad for the planet — it’s deadly for people.”

Total air quality funding, including clean energy projects, as a proportion of international development aid, 2019-2023.

The scale of the mismatch has prompted calls for a fundamental reorientation of development finance. World Bank research shows that integrated air quality and climate policies could save more than 2 million lives annually by 2040 while boosting global GDP by up to $2.4 trillion each year.

As funding continues flowing towards fossil fuels, the report calls for development institutions to go in the opposite direction: embed clean air objectives at the core of climate and development finance, redirect fossil fuel funding toward cleaner transitions and target resources toward currently underfunded regions, particularly Africa.

The findings come as governments face pressure to deliver on a pledge made earlier this year at the World Health Organization’s World Health Assembly to halve the health impacts of anthropogenic air pollution by 2040.

Air pollution ranks as the world’s second-largest health risk factor after high blood pressure, claiming over 8 million lives annually. Fine particulate matter known as PM2.5 — particles smaller than 2.5 micrometres — penetrates deep into the lungs and bloodstream, damaging the cardiovascular system, triggering strokes and heart attacks, and contributing to dementia, cancer and respiratory disease.

Total air quality funding compared to fossil fuel funding as a share of international development finance, 2019-2023.

The WHA resolution marks the first time air quality has been included in a WHO roadmap with a clear global health target tied to pollution reduction. Under South Africa’s G20 presidency, air quality was also elevated as a standalone priority for the first time in the G20’s environment and climate workstream.

But with the Trump administration having axed the vast majority of USAID, which contributed 29 per cent of official development assistance in 2023 – by far the largest single provider of aid in the world, supporting everything from infectious disease prevention to food security programmes – development budgets are under strain globally.

Wider cuts by OECD donors could see development aid fall by 9 to 17%, with least developed countries facing declines of 13 to 25%, respectively. Air pollution, already a relatively minor component of global aid budgets, representing just 1 per cent of international development funding, risks falling by the wayside. Experts warn that momentum risks stalling before meaningful progress can be made.

“Governments pledged to halve air pollution harm by 2040, but the money is still flowing the wrong way, Burston said. “With budgets already under pressure and the world’s largest development donor shutting down, we cannot afford to keep bankrolling fossil fuels. Unless we change course, millions more people will die from toxic air. Every dollar spent on fossil fuels pushes that goal further out of reach.” 

Most polluted regions are left behind

The ten most polluted countries for air quality, according to the Air Quality Life Index.

The limited funding available for air quality is highly geographically concentrated. Three countries — the Philippines, Bangladesh and China — received 65 per cent of all outdoor air quality finance between 2019 and 2023, while regions bearing the heaviest pollution burdens received almost nothing.

Nine in ten air pollution deaths occur in low and middle-income countries, where resources to respond are most limited. The World Bank projects deaths from outdoor air pollution will rise from 5.7 million in 2020 to 6.2 million by 2040 without stronger action. 

Sub-Saharan Africa experienced a 91% collapse in outdoor air quality funding in 2023, dropping to just $11.8m — less than 1 per cent of global clean air support and roughly equivalent to the cost of a single superyacht. The staggering drop occurred as the region faces the world’s fastest urbanisation rate, leaving communities increasingly vulnerable to worsening air pollution.

Seven of the ten countries with the highest air pollution levels received less than $1 per person in total air quality financing in 2023. Countries including Cameroon, the Democratic Republic of Congo and Burundi received as little as $0.02 per person.

“Air pollution is the world’s largest environmental health crisis, yet it receives neither the attention nor the resources it demands. Each year, eight million people die prematurely from a crisis that is largely preventable. Today, nine in ten of these deaths occur in lowand middle-income countries,” Dr Dion George, South Africa’s minister of forestry, fisheries and the environment, wrote in the report’s foreword. “Without urgent action, this tragic toll will continue to rise.”

Air quality funding by type and sector, 2019-2023.

Children face particularly severe impacts. Air pollution causes over 700,000 deaths annually in children under five, making it the second leading risk factor for child mortality worldwide after malnutrition. Air pollution is also linked to 34 per cent of preterm births globally, with 570,000 neonatal deaths attributed to pollution exposure in 2021. 

“What we see currently is not so good – the availability of data from public actors is poor, and when available, the level of finance directed to improve air quality is far too low,” said Barbara Buchner, global managing director of Climate Policy Initiative, which co-authored the report. “But our work confirms that the opportunities are tremendous. With public budgets constrained, increasing air quality finance is one the most impactful investments that can achieve multiple goals: to address climate change, strengthen economies, and significantly improve daily life for millions globally.”

The economic burden is also crushing. World Bank analyses place global health damage costs at $8.1tn annually, equivalent to 6.1 per cent of global GDP. Lower-middle-income countries bear losses equivalent to 9 per cent of GDP compared to 2.8 per cent in high-income nations. India alone loses $95bn annually from reduced productivity, work absences and premature deaths, while China spends $44bn annually on healthcare for PM2.5-related illness.

In 2023, development funders committed 2.5 times more to fossil fuel-prolonging activities than to outdoor air quality improvements. The tension between energy access and air quality poses particular challenges for developing countries. While fossil fuel projects may offer faster paths to expanding electricity access, they lock in polluting infrastructure that carries severe long-term health costs.

Outdoor air quality funding as a share of total international development commitments, 2019-2023.

“Financing remains a major barrier to progress,” George wrote. “The evidence in this report is stark. In 2023, outdoor air quality funding fell by a fifth, even as the health burden grew.”

Funding for projects with air quality co-benefits — initiatives that improve air quality without explicit objectives to do so — rose 7% from $27.1 billion in 2022 to $28.8 billion in 2023. Examples include electric vehicle incentive programmes and projects that promote alternatives to crop residue burning.

Between 2019 and 2023, 86% of total air quality funding was directed towards projects that also addressed climate change, the report found. Transport sector investments attracted 61% of outdoor air quality funding during this period.

In the Greater Beijing-Tianjin-Hebei Region, coordinated action supported by the World Bank, Asian Development Bank and KfW reduced annual average PM2.5 concentrations by 44.2% from 2015 baseline levels by 2030, showing policy action is possible and effective.

“We know how to fix this,” Burston said. “Clean air policies deliver results within months — healthier lungs and fewer deaths. The science is clear, the technology exists, and the health benefits are immediate.”

Image Credits: Pete Markham.

Newborns are susceptible to malaria but there has been no treatment specially for them until recently.

Ghana is the first country in the world to roll out a malaria treatment specially formulated for newborn babies.

The new treatment, known as Coartem <5 kg Baby, uses a new ratio and dose of artemether-lumefantrine to account for metabolic differences in babies under 5kg. Small babies handle drugs differently due to the immaturity of their metabolising organs

The treatment received regulatory approval in Ghana in February and was also approved by the Swiss agency for therapeutic products, Swissmedic, in July.

Three-quarters of those who die from malaria are children under the age of five. Until now, babies under 4.5 kg with malaria were given formulations designed for older children, which increased either the risk of overdose and toxicity or underdose and treatment failure.

Coartem Baby was developed by Novartis, with support from the Medicines for Malaria Venture (MMV). It was tested in a trial known as CALINA, which was conducted in eight African countries with support from the PAMAfrica consortium, which is funded by the European and Developing Countries Clinical Trials Partnership (EDCTP2).

“These tiny patients handle drugs differently due to the immaturity of their metabolising organs, which can lead to overdose and toxicity. Coartem <5 kg Baby provides optimised dosing specifically tailored to the needs of these vulnerable patients,” according to Novartis in a media release, following the successful conclusion of the CALINA trial.

“Infants under 5 kg can be affected by placental malaria, leading to poor birth outcomes, or contract malaria from the bite of an infected mosquito. The prevalence of the disease in this age and weight group is poorly understood, and it is therefore often misdiagnosed.

“Infants below 5 kg make up a critical neglected group, and developing antimalarials specifically suited to their needs is essential to malaria control efforts,” added Novartis.

Protecting the most vulnerable

“Malaria remains one of the deadliest diseases for children under five years old, and Ghana’s leadership in approving Coartem Baby is a powerful step toward protecting the most vulnerable,” said MMV CEO Dr Martin Fitchet

“This optimised formulation offers a well-tolerated and effective solution to a long-standing unmet medical need.”

Ghana is one of 11 African countries designated by WHO as High Burden to High Impact for malaria. 

About 30 million babies are born in malaria-risk areas in Africa every year, and a large survey across three West African countries reported infections in babies under six months old ranging from 3.4% to as high as 18.4%.

Novartis has committed to introducing Coartem Baby on a largely not-for-profit basis.

This week, Mali recruited the first pregnant woman infected with malaria into a Phase 3 trial that is evaluating the efficacy and safety of antimalarial drugs during the first trimester of pregnancy.

MMV is also supporting this trial, known as SAFIRE,which will compare the safety and efficacy of pyronaridine-artesunate (PA) and dihydroartemisinin-piperaquine (DP), both approved for the general population but not yet in early pregnancy, to artemether-lumefantrine (AL), which is approved by the WHO for use in the first trimester.

Pregnant women are more susceptible to malaria as they have reduced immunity, and malaria poses serious risks to both mothers and babies.

Malaria in pregnancy is responsible for 20% of all stillbirths and 11% of all newborn deaths in sub‑Saharan Africa, as well as 10,000 maternal deaths globally each year. It can also cause severe maternal anaemia, miscarriage, stillbirth, preterm delivery and low birthweight. 

Image Credits: UNICEF/Zahara Abdul 2019.

Tobacco use is waning worldwide.

There has been a significant global reduction in smoking, but use remains stubbornly high in some countries and groups – while the tobacco industry is aggressively marketing new nicotine products to young people.

This is according to the World Health Organization (WHO) tobacco trends report, which was released on Monday.

“In 2000, one in three adults in the world used tobacco. By 2010, it was one in four. Today, in 2025, it’s fewer than one in five,” Jeremy Farrar, WHO’s Assistant Director General, told a media briefing.

“That means millions of premature deaths have been, and will be, averted,” he added, crediting “stronger policies, better awareness and the extraordinary efforts of individuals, governments, civil society and communities” for the progress.

South East Asia has achieved the most progress, with tobacco use in men almost halving from 70% in 2000 to 37% in 2024. In this region, India and Nepal have made good progress.

Tobacco use trends (2000-2030)

However, despite progress, the world is 3% short of achieving a 30% reduction in tobacco use between 2010 and 2025 (Sustainable Development Goal 3).

Slightly less than a third of the world – 61 countries, including 24 in Africa – are likely to achieve this target.

Three regions – Eastern Mediterranean (19% reduction), Europe (19%) and the Western Pacific (12%) – are also going to miss the target.

However, women already met the 30% target five years early in 2020.

“Most countries that are on track have something in common,” Farrar noted. “They all implement the WHO Framework Convention on Tobacco Control, and they put MPower measures in place, raising taxes, banning advertising, protecting people from smoke and warning of the harms and providing help for those to quit.”

MPower refers to the measures the WHO recommends to countries to reduce tobacco use.

“Nearly 20% of adults still use tobacco and nicotine products. We cannot let up now,” said Farrar. “The world has made gains, but stronger, faster action is the only way to beat the tobacco epidemic.”

Jeremy Farrar, WHO Assistant Director-General.

Progress lagging in Europe and men 

Europe has the highest prevalence in the world, with 24.1% of its adults using tobacco in 2024. Countries in the Balkans and former Soviet republics have the highest rates.

In Bulgaria, almost 36% of people smoke, the highest in Europe.

Some 17.4% of European women smoke, which is more than double the current global average of 6.6% (down from 11% in 2010).

Alison Commar, WHO technical officer and lead author of the report, said that only one Western European country, the Netherlands, has implementing MPower, the full WHO anti-tobacco suite of policies.

“They are really having success bringing down prevalence,” Commar added. In 2010, almost 28% of Dutch people smoked, whereas 20% currently smoke.

“Many of the European countries rely on the EU [Tobacco Products] Directive, which we call the minimal floor,” Commar added.

Alison Commar, WHO technical officer and lead author of the report

“Women in Europe have been using tobacco products a lot longer than women in other areas,” she added, explaining that the industry had “heavily advertised” cigarettes in the women’s movement in the early 1900s.

“So the use has really begun from then, and the normalisation as well. People have grown up with their mothers and their grandmothers smoking.” 

In the Western Pacific Region, some 43.3% of men smoke – the highest prevalence in the world. Indonesia has the highest rate in the region (30.2%), followed by China (22.7%), while a mere 8% of Australians smoke.

Globally, smoking is highest in men aged 45 to 54 and women aged 55 to 64. Men in upper-middle countries smoke the most – some 39%.

Over 40 million adolescents are reported to smoke cigarettes (26 million boys), with the Western Pacific Region having the highest prevalence of teen smokers.

“The tobacco and nicotine industries are deliberately targeting the next generation with new and many times under-regulated products. We cannot allow this to continue and to succeed,” said Farrar.

New nicotine products

Smokeless tobacco use

For the first time, WHO report estimated global e-cigarette use, finding that more than 100 million people worldwide are now vaping – some 7% of the world’s population.

Around 86 million adults, mostly in high-income countries, and 15 million children aged 13–15, already use e-cigarettes. 

Use is by far the highest in the Southeast Asia region, averaging 21.1%. The second-highest region is the  Eastern Mediterranean (4.9%).

Among the 85 countries with data on e-cigarettes, the highest use was reported in Serbia (18.4%), Luxembourg (17%), New Zealand (14%), Croatia (12%), Ireland (11.2%), Czechia (11.1%) and Brunei (11%).

In all but six countries, more teens vaped than adults.

More teens are likely to vape than adults, fuelling nicotine addiction, according to the WHO.

“In countries with data, children are on average nine times more likely than adults to vape,” according to the WHO, which accused the tobacco industry of “introducing an incessant chain of new products and technologies” to market tobacco addiction, including “e-cigarettes, nicotine pouches, and heated tobacco products”.

“E-cigarettes are fuelling a new wave of nicotine addiction,” said Etienne Krug, WHO Director of Health Determinants, Promotion and Prevention. 

“They are marketed as harm reduction but, in reality, are hooking kids on nicotine earlier and risk undermining decades of progress.” 

Comma said that the science is “now showing that [e-cigarettes] are very much a gateway for the young people to move later into tobacco or to maintain a nicotine addiction as they grow older”.

“WHO recommends that all countries regulate e-cigarettes immediately,” she added.

The report, which is produced every two years, derives most of its data from national surveys.

Image Credits: PAHO, WHO, WHO.

While babies and children are being vaccinated againts malaria, few options exist for pregnant women.

The first pregnant woman infected with malaria has been recruited into a Phase 3 trial in Mali that is evaluating the efficacy and safety of antimalarial drugs during the first trimester of pregnancy.

Pregnant women are more susceptible to malaria as they have reduced immunity, and malaria poses serious risks to both mothers and babies.

Malaria in pregnancy is responsible for 20% of all stillbirths and 11% of all newborn deaths in sub‑Saharan Africa, as well as 10,000 maternal deaths globally each year. It can also cause severe maternal anaemia, miscarriage, stillbirth, preterm delivery and low birthweight. 

Some 12.4 million pregnant women in sub-Saharan Africa were exposed to malaria in in 2023, according to the World Health Organization (WHO), yet treatment options for pregnant women, particularly in the first trimester, are extremely limited.

The SAFIRE consortium aims to address this research gap through this trial, which will also be run in Burkina Faso and Kenya.

“To advance the malaria elimination agenda in a meaningful and sustainable manner, properly tolerated and effective options must be made available to everyone at risk of malaria, including pregnant women,” says Myriam El Gaaloul, SAFIRE co-principal investigator. 

‘More equitable’

“Enrolling the first patient into the SAFIRE trial is a decisive step forward that will help pave the way towards a more just and equitable future in the fight against this disease,” added El Gaaloul, who heads the Malaria in Mothers and Babies (MiMBa) strategy at Medicines for Malaria Venture (MMV).

The trial is recruiting women in the first trimester of pregnancy with a malaria who will be treated with one of the three artemisinin-based combination therapies (ACTs).

The trial aims to compare the safety and efficacy of pyronaridine-artesunate (PA) and dihydroartemisinin-piperaquine (DP), both approved for the general population but not yet in early pregnancy, to artemether-lumefantrine (AL), which is approved By the WHO for use in the first trimester.

The women will receive follow-up care throughout their pregnancy until delivery, while their newborns will be followed for up to six months after birth.

Fill ethical gap

“The SAFIRE trial will, on one hand, fill the ethical gap of excluding pregnant women from clinical trials, and on the other hand, provide the necessary information to increase therapeutic options in the guidelines for the management of malaria in all stages of pregnancy, thus contributing to reducing the unacceptable burden of malaria among pregnant women,” says Prof Kassoum Kayentao of The Université des Sciences, des Techniques et des Technologies de Bamako in Mali, SAFIRE’s co-principal investigator.

Before recruiting the women, the consortium conducted formative research to ensure recruitment strategies and participant materials were culturally appropriate and reflected the realities of local communities. 

“The formative research we conducted as part of community engagement was key in understanding socio-cultural beliefs and barriers that could hinder the recruitment and retention of participants,” said Dr Innocent Valea, SAFIRE co-principal investigator from The Institut de Recherche en Sciences de la Santé Burkina Faso.

“It allows us to leverage facilitators and co-design appropriate messages targeted at pregnant women and communities. Moving forward, we remain committed to maintaining this engagement to foster trust and successful collaboration.”

Image Credits: WHO.

A pregnant woman gets examined by a nurse.

Women who lose 300ml of blood after giving birth should be diagnosed with postpartum haemorrhage (PPH) according to new guidelines published by the World Health Organization (WHO), the International Federation of Gynaecology and Obstetrics (FIGO) and the International Confederation of Midwives (ICM).

In the past, PPH has only been diagnosed if a woman loses 500ml of blood, but this has often meant that the diagnosis is too late for adequate interventions.

Doctors and midwives are now advised to monitor women closely after birth using a calibrated drape, a simple device that collects and accurately quantifies lost blood.

As soon as PPH is diagnosed, the guidelines recommend the immediate deployment of the MOTIVE bundle. This stands for: Massage of the uterus; Oxytocic drugs to stimulate contractions; Tranexamic acid (TXA) to reduce bleeding; Intravenous fluids; Vaginal and genital tract examination; and Escalation of care if the bleeding persists.

PPH affects millions of women annually and is one of the leading causes of maternal mortality, causing nearly 45,000 deaths. 

Even when not fatal, it can cause lifelong physical and mental health impacts, from major organ damage to hysterectomies, anxiety and trauma.  

“Postpartum haemorrhage is the most dangerous childbirth complication since it can escalate with such alarming speed. While it is not always predictable, deaths are preventable with the right care,” said Dr Jeremy Farrar, WHO Assistant Director-General. 

“These guidelines are designed to maximise impact where the burden is highest and resources are most limited – helping ensure more women survive childbirth and can return home safely to their families.”

Fast, feasible and effective

Motivation for the change comes from a large study published in The Lancet last week, which analysed 12 datasets involving 312,151 women.

The study found that blood loss of 300ml offered the “preferred sensitivity threshold”, particularly when combined with “any abnormal haemodynamic sign”, such as increased pulse rate or a drop in blood pressure.

In rare cases where bleeding continues, the guidelines also recommend surgery or blood transfusions to safely stabilise the woman.

“Women affected by PPH need care that is fast, feasible, effective and drives progress towards eliminating PPH-related deaths,” said FIGO President Professor Anne-Beatrice Kihara.

The guidelines were launched at the president’s session at FIGO’s world congress in Cape Town, South Africa, on Sunday 5 October, which was also declared as the first World Postpartum Haemorrage Day.

“These guidelines take a proactive approach of readiness, recognition and response. They are designed to ensure real-world impact – empowering health workers to deliver the right care, at the right time, and in a wide range of contexts.”

The guidelines also stress good antenatal and postnatal care to mitigate critical risk factors such as anaemia, which increases the likelihood of PPH and worsens outcomes if it occurs. Recommendations for anaemic mothers include daily oral iron and folate during pregnancy and intravenous iron transfusions when rapid correction is needed, including after PPH, or, if oral therapy fails.

The guidance also discourages routine episiotomies to reduce the likelihood of trauma and severe bleeding after birth.

During the third stage of labour, the guidelines recommend administering medicine to support uterine contraction, particularly oxytocin or carbetocin. 

If intravenous options are not available and the cold chain is unreliable, misoprostol may be used as a last resort.

More evidence and protocols

“Midwives know first-hand how quickly postpartum haemorrhage can escalate and cost lives,” said Professor Jacqueline Dunkley-Bent, ICM’s Chief Midwife. 

“These guidelines are a game-changer. But to end preventable deaths from PPH, we need more than evidence and protocols. We call on governments, health systems, donors, and partners to step up, adopt these recommendations, adopt them quickly, and invest in midwives and maternal care so that postpartum haemorrhage becomes a tragedy of the past.”

According to a commentary in The Lancet, the new guidelines are “an equity intervention” and they align “the prevention–detection–treatment continuum with enablers (eg, supportive infrastructure)” and also state “what not to do when skills or supplies are scarce”.

“The guidelines recognise where women give birth, who is present, and what commodities are reliably available, and they reduce ambiguity that so often paralyses action in the first minutes of a dire emergency.”

Image Credits: Elizabeth Poll/MMV.

From climate shocks to protracted conflicts and shrinking budgets, today’s “metacrisis” is reshaping the future of child health.

In this recent episode of Global Health Matters, host Garry Aslanyan speaks with Landry Dongmo Tsague, director of the Centre for Primary Health Care at Africa CDC, and Debra Jackson, Takeda Chair in Global Child Health at the London School of Hygiene & Tropical Medicine, about what it will take for children not just to survive, but to thrive.

Both guests note the real gains of the last three decades.

Aslanyan points to under-five mortality falling by over 60% since 1990, while Tsague stresses that “we recorded unprecedented gains over the past two decades,” driven by investments in community-based primary care and immunisation reaching underserved populations. But those advances are fragile.

“Since COVID-19 … there’s now serious concern that these gains will be lost,” Jackson says, citing rising temperatures, conflict and the fact that “as of last year, 2024, we reached or exceeded the 1.5-degree target.”

Conflict zones, from the Sahel to Sudan, put children at immediate risk of malnutrition, disease and interrupted services.

“Without peace, there is no health,” Tsague underscores.

He also flags steep funding declines and outlines emerging solutions endorsed by African leaders: boosting domestic budgets, tapping innovative financing such as levies and diaspora remittances, and mobilising blended finance for primary care infrastructure and local manufacturing.

What works on the ground?

Jackson argues for integrated services and better data: “Information systems are going to be critical if we’re going to address this.”

Community engagement is central; in Zimbabwe, mothers co-created a heat early-warning approach and became local advocates.

Looking ahead, Tsague points to youth as a game-changer: “I can’t be optimistic without highlighting the strength that the continent has in its young people,” including plans for 2 million community health workers by 2030.

Watch the full episode: 

Image Credits: Global Health Matters.

In the latest episode of Trailblazers with Garry, host Dr. Garry Aslanyan sits down with Professor Adalsteinn (Steini) Brown, dean of the Dalla Lana School of Public Health at the University of Toronto.

Together, they explore how public health education must evolve to meet the challenges of a rapidly changing world. From integrating data and evidence into policymaking to designing learning health systems that continuously improve, Brown shares insights from his career spanning academia, government, and industry.

He also reflects on the skills and values the next generation of leaders will need to drive meaningful impact in global health.

Listen to the full episode:

 

Image Credits: "Trailblazers with Garry".

An infant surrounded by malaria bednets. Malaria bed nets are still not accessible enough in Africa’s most endemic countries, leading to the needless deaths of hundreds of thousands of people, mainly children and pregnant women, from the parasitic disease.

The President of the Republic of Botswana and Chair of the African Leaders Malaria Alliance (ALMA), writes about the urgency of mobilising funding to defend the gains and further progress in the fight against malaria. 

Despite decades of progress, we are not on track to defeat malaria in Africa. Without more resolve, innovation, financing, and partnerships, we risk sliding back to the days when malaria killed over a million children each year. 

Malaria remains one of Africa’s leading killers of children. This cannot be our legacy. 

The fight against this disease is threatened by a perfect storm: insufficient funding, extreme weather events linked to climate change expanding mosquito habitats, rising drug and insecticide resistance, and humanitarian crises exposing millions to infection. 

Science has done its part. It has given us the tools: new dual-insecticide mosquito nets, effective medicines, and the world’s first malaria vaccines. Unless we act decisively, malaria will continue to claim lives that should have been saved. 

We know what is needed: strong global commitment, effective financing, and shared responsibility. We must achieve a successful Global Fund replenishment to ensure the effective tools reach everyone who needs them.

The Global Fund replenishment is decisive

People with access to an insecticide-treated mosquito nets In sub-Saharan African countries where the Global Fund invests.

The Global Fund to Fight AIDS, Tuberculosis, and Malaria provides over 60% of all international financing for the fight against malaria.  

Since 2002, the Global Fund has helped cut malaria deaths by nearly a third, distributing hundreds of millions of mosquito nets, treatments, and diagnostic tests. That progress cannot be taken for granted – without a fully funded replenishment, millions of children’s lives hang in the balance. The 2025 replenishment will determine whether we advance or retreat. 

Expert economists calculate that every dollar invested in malaria yields four times that in economic growth. It is also an investment in pandemic preparedness, because the systems strengthened to fight malaria are the same ones that detect and respond to new threats. 

These investments strengthen primary healthcare systems by training community health workers, improving diagnostic capabilities, and enhancing supply chain management. They create a foundation for comprehensive healthcare delivery that extends far beyond malaria treatment.

Strengthening domestic resource mobilisation

Twenty African nations rank among the world’s most dependent on U.S. health aid, with several receiving American assistance that exceeds their own government health spending, leaving the continent acutely vulnerable to potential funding cuts.

Africa’s health financing is entering a new era. We must face the reality that official development assistance for health in Africa has fallen by 70% in just four years. Without decisive action, Africa CDC warns that declining aid and rising debt repayments could cost the continent up to four million additional preventable deaths each year by 2030.  

First, we must strengthen domestic resource mobilisation by allocating an increasing proportion of our national budgets to health. We must also tap into public–private partnerships. It makes economic sense for the private sector to operate in a healthy environment. 

We already have proof of concept through innovative platforms such as national End Malaria Councils and Funds, which bring public and private actors together in coordinated action across 11 countries. To date, they have raised more than $166 million in domestic resource commitments to support national malaria strategies. 

These efforts must now be scaled across the continent. We should embrace innovative financing, for example, through solidarity levies on airline tickets, tobacco, or alcohol; diaspora bonds; and community health insurance. We see how possible this is in Rwanda’s Mutuelles de Santé, which covers over 90% of its population.

Next, we need to expand blended finance. This means using public funds to reduce risk and attract private investment, unlocking billions for health infrastructure, supply chains, and local pharmaceutical production. 

The Global Health Investment Fund has used blended finance to bring private investors into funding new vaccines and treatments. With the African health market projected to reach $259 billion by 2030, these investments can build resilience and sovereignty if governed well.

Leveraging World Bank financing 

The International Development Association (IDA) of the World Bank has long supported health system strengthening, be it training community health workers in Senegal or upgrading surveillance systems and strengthening supply chains. 

These investments make a real difference. When health workers can diagnose and treat malaria in the community, through integrated community case management, it also significantly improves maternal and child health.

The IDA’s Booster Program for Malaria from 2005 to 2010 showed that front-loading investment can rapidly cut malaria cases and strengthen the primary health care system. We urgently need to bring back this approach through a second Malaria Booster Program, aligned with national plans, which would help Africa close financing gaps while strengthening systems for the long term.

Where should UN focus?

Global malaria incidence, which accounts for population changes, ticked up last year, translating to 11 million more cases, most of which occurred in the African continent.

In the short term, we must place our emphasis on securing additional financing. 

The Global Fund replenishment, domestic mobilisation, including through the private sector, and World Bank International Development Association financing are not competing choices. They offer a path to close the funding gap, putting Africa back on track to end malaria, and building health systems strong enough to withstand the next pandemic.

But time is not on our side. Donor retrenchment, rising debt, and climate shocks mean that the cost of inaction grows by the day. 

I urge world leaders gathering in New York to see the fight against malaria for what it is: a measure of how committed we are to safeguarding health and human dignity worldwide.

If we fail to finance the fight, history will judge us harshly. If we succeed, millions of children will live, communities will thrive, and Africa will stand stronger against tomorrow’s threats. The choice is ours.

Duma Gideon Boko is the President of the Republic of Botswana and Chair of the African Leaders Malaria Alliance (ALMA). 

Image Credits: Peter Mgongo, Arne Hoel/World Bank.

EHFG President Clemens Marten Auer warned Europe’s health systems face an existential threat from artificial intelligence.

BAD HOFGASTEIN, Austria — Artificial intelligence poses an “existential” threat to Europe’s health and social security systems through its potential to “completely replace” human work and eliminate the income tax funding base on which they depend, a leading health policy figure has warned.

Clemens Marten Auer, president of the European Health Forum Gastein, used the opening of the summit’s 28th edition in Austria’s Tauren mountains to sound the alarm that AI automation could hollow out the tax revenues that underpin Europe’s postwar welfare systems.

“AI will drastically change, even obliterate, the very foundations of the social contract as we know it today,” Auer said, arguing that the tax base funding Europe’s social provisions requires “total reformation” to preempt the coming transformation of the labour force and collapse of tax revenue.

“AI will transform societies, but may also devalue human labour, deepening inequality and creating instability,” Auer said. “The sustainability of solidarity systems is threatened at its core by this development and cannot be rendered future-proof unless the basis for funding of these systems changes.”

Europe’s social contract—the postwar consensus guaranteeing health, housing and education funded through employment-based taxation—is under attack from all sides as stagnating economic growth and ageing populations collide with budgets strained by war, climate change and digitalisation.

Demographics lead the assault. The EU’s active workforce is projected to shrink by 2 million by 2040, pushing the ratio of workers to pensioners from 3:1 to 2:1 as medical advances extend life expectancy and healthcare costs. Fewer workers mean less tax revenue even as spending on an ageing population rises.

“Society is changing in a positive way. We have lots of technological changes, new drugs, we can treat more diseases,” said Slovenia’s health minister Valentina Prevolnik Rupel. “In developed countries, the number of citizens does not really grow—what grows is the life expectancy. All this is positive, but it brings changes in demand, and needs are growing.”

Those same trends are pushing Europe’s medical workforce to the limit with a projected shortage of 4 million staff by 2030, despite increasing the import of foreign nurses by 67% and doctors by 54% over the last decade, according to WHO figures.

“If we keep the social contributions or the funding unchanged, and on the other hand, we see that the needs are increasing, we have some discrepancies that cause issues in trust,” she said.

‘Learn to speak Russian’

NATO Secretary-General Mark Rutte warned in July that nations face a choice between welfare system spending and defence.

Geopolitical tensions on European borders have intensified competition for scarce funds. Russia’s four-year full-scale invasion of Ukraine has forced a fundamental rethink of EU defence budgets, which stalled in a holding pattern around 2% of GDP in recent decades.

Nato allies are now pushing for member states to reach 5% of GDP in defence spending. The EU has already relaxed budget rules to allow member states to boost defence output, driving a 19% increase in defence spending across the bloc last year.

“If you do not do this, if you would not go to the 5%, including the 3.5% core defence spending, you could still have the National Health Service…the pension system, etc.,” Nato secretary-general Mark Rutte said ahead of a summit in The Hague in June. “But you’d better learn to speak Russian.”

“Sounds a little cynical,” Auer quipped, “but he said it.”

The landmark Draghi report on European competitiveness, released last month, estimates that investment in decarbonisation, defence, economic independence and digitalisation will require an additional 5% of GDP to keep pace with global powers in the US and China, a daunting figure given the bloc’s minimal economic growth and correspondingly stagnant government revenues.

“It’s high time to wake up and to start reflecting these political developments for our sector,” Auer continued. “All these developments will have a massive impact on how we finance, how we organise the level of and the access to health services.”

The 5% calculation in the Draghi report does not include health or pensions, which are largely absent from the document that charts the EU’s growth roadmap and investment priorities. Health and welfare budgets will have to compete for what’s left.

“You need additional money for the investment in infrastructure, that’s the fact. Through social contributions, we just fund the [social] programs,” Prevolnik Rupel said, noting that Slovenia has spent more in the last two years on health than in the previous decade combined to meet rising demand.

“That’s investments in the infrastructure—they are needed because the technological events are so fast,” she explained. “We need new equipment, we need new buildings, we need new spaces, because the protocols of how the patient travels through the systems change.”

Steam engine or hot air? 

The financial pressures on European welfare systems from demographic ageing, geopolitical instability and climate change are clear, as is the looming crisis in health worker shortages. The apocalyptic impact of AI that Auer outlined, however, remains far less certain.

In an essay accompanying his opening remarks, Auer compared AI’s potential to automate work processes to “the invention of the steam engine…and the First Industrial Revolution” in transformative power.

He cited Sam Altman, OpenAI’s chief executive, who predicted ChatGPT “will soon be more powerful than any person who has ever lived,” and Eric Schmidt, Google’s former chief executive, who forecast AI will reach 80 to 90% of top expert skills in mathematics, law, science and programming by 2033. Schmidt maintains one of the largest private AI investment portfolios worth billions of dollars.

Yet nearly all predictions of AI’s looming takeover come from inside the industry itself, where executives and investors have substantial financial stakes in the technology’s success. A significant decline in AI’s perceived value would cost companies like OpenAI hundreds of billions in valuation, and industry figures personally many billions of dollars.

The optimistic industry narrative has fuelled historic valuations despite record cash burn. The AI industry’s leading companies—Google, Meta, Microsoft, OpenAI, Amazon and Tesla—have spent a combined $560bn on capital expenditure since 2024 and generated just $35bn in return, netting $525bn in combined losses.

Despite the losses, OpenAI reached a $500bn valuation on Thursday, cementing its place as the world’s most valuable start-up.

The lack of profitability has contributed to growing concerns that the AI market might be a bubble, potentially undercutting its perceived revolutionary potential—and threat to solidarity systems in Europe.

AI’s capacity to “completely replace human work,” as Auer wrote, echoing warnings from other AI industry figures such as Anthropic’s Dario Amodei, has scarcely materialised.

A Yale University study published on Thursday found that US labour market metrics show “the broader labour market has not experienced a discernible disruption since ChatGPT’s release 33 months ago, undercutting fears that AI automation is currently eroding the demand for cognitive labour across the economy.”

Meanwhile, AI advancement has stalled as models hit walls in processing power, energy infrastructure, compute capacity and diminishing returns, all while companies have yet to identify profitable use cases for the technology.

A Massachusetts Institute of Technology report in August found that 95% of companies experimenting with AI are not making money from it, despite widespread promises from corporate leaders about efficiency gains.

Large language model technology is currently built on burning cash and the environment. Data centres consume more energy annually than all but 16 of the world’s 192 nations, with consumption set to double by 2030.

Global AI demand for water to cool servers and microchips is projected to require a supply equal to the total annual water withdrawal of countries like Denmark by 2027.

Continuing AI scaling and power-hungry data centres are eating into gains from green energy sources such as solar and wind, forcing gas, oil and coal plants back online to meet demand as air, noise and environmental pollution from digital waste threaten the health of nearby communities.

AI leaders including Altman have acknowledged that an energy breakthrough, likely from nuclear fusion, will be required if AI is to continue scaling. Google and Microsoft have started investing in nuclear technology, but a scalable breakthrough in the field is still a long way off.

“Naturally, historic predictions are difficult, especially when it comes to developments and employment in the labour market,” Auer acknowledged. “I do not want to oversimplify the issue here.”

AI’s healthcare promise 

If AI does fulfil its transformative potential, healthcare is seen as one of the most promising frontiers. Yet here too, the gap between promise and reality remains wide.

Nearly two-thirds of physicians surveyed in the United States reported using AI in 2024, a jump to 78% from 38% the previous year, according to a study by the American Medical Association. The usage, however, was primarily for administrative tasks such as documentation of billing codes, medical charts, visit notes, discharge instructions and translation services rather than medical or scientific breakthroughs.

Slovenia’s experience illustrates the challenge facing health systems. The government issued an open call for AI healthcare proposals and received 52 potential solutions for a country of just 2 million people.

“It’s like a flood of artificial intelligence applications, and we have to decide which ones to take on—and it’s very difficult because we don’t know,” Prevolnik Rupel said. “We don’t have enough evidence yet on which solutions work and which don’t.”

The government decided to pilot the most promising submission, an artificial intelligence program for scheduling healthcare workers’ shifts. Like the administrative applications in the AMA survey, the use case was organizational rather than medical, as doctors remain wary of trusting AI with decisions that could impact patients.

“Because it was an artificial intelligence, a logical program, it was more fair than when it was a nurse who would say, you do this,” she said. “Everybody was happy, and the level of satisfaction increased, and actually, the absenteeism among the healthcare workers fell in that hospital.”

The proliferation of untested AI applications has raised questions about how to regulate the technology safely. But experts say existing regulatory frameworks can be adapted rather than reinvented.

“When we started regulating medicines, 70 years ago more or less in the European Union, it was one of the first success stories,” said Natasha Azopardi-Muscat, division lead for WHO’s Europe office.

“We said medicines have to meet certain criteria: quality, safety, efficacy. And then we went further. We said that they have to be better than the alternative,” Azopardi-Muscat explained. “We can use the same [standards] for AI… We need to have a very clear system of evaluation.”

Despite the gap between AI predictions and current reality, Auer argued that political leaders are ceding crucial decisions about society’s future to private investors.

“If the automation stimulated by AI leads to a broad reduction of costs, meaning labour costs, meaning a significant loss of jobs,” he said, decisions about “how much capital to invest in development are made by financial investors, and not in parliaments or cabinet tables of governance.”

“The political call of the economic elites to strengthen Europe’s innovative power as forcefully as possible will come to nothing if at the same time we ignore the political concerns that innovations of the tech industry have the potential to dehumanize economic activity and weaken human labour,” he said.

“We must discuss and politically initiate steps to protect the solidarity systems in the long term and ensure the social and economic participation of as many segments of the population as possible.”

Image Credits: CC.