What an enormous privilege it has been...

Dear colleagues, collaborating partners and friends,

I am very pleased to share the good news that the Rotary International’s Reproductive Maternal and Child Health Action Group has bestowed on me the Nafis Sadik Award for Outstanding Humanitarian Service for my contribution to the adolescent sexual and reproductive health field. The Award was first given in the late 1990s. Its awardees include many leaders in the field, including Dr Nafis Sadik herself. I am deeply honoured and humbled.

In 2022, I received a lifetime achievement award from the USA’s Society for Adolescent Medicine and Health: for which I felt deeply honoured. This Award is special because of its focus on adolescent sexual and reproductive health, its association with Dr Sadik and the International Conference on Population and Development, which has guided and framed my work for over 25 years, and notably because it is granted by Rotary International, an organization which has made such a huge contribution to the health of the world.

The Award could not have come at a better time for me. I am due to retire from WHO on 31 August 2023, after 30 years of service with the organization. This huge personal milestone coincides with a year of other meaningful milestones, notably the 50th anniversary of the co-sponsored Human Reproduction Programme that I am part of and the celebration of WHO’s 75th anniversary.

I would like to share some reflections with you on WHO as an organization, on working as a WHO staff member for three decades, and on the evolution of the field of adolescent health over the last thirty years.

In a nutshell, it has been an enormous privilege to have been part of this great organization, to have worked in and grown with the field of adolescent sexual and reproductive health, and to have been commended for my work in such a wonderful manner.

I invite you to share your own reflections and to leave a message in the box provided below.

My heartfelt thanks,

Chandra (Venkatraman Chandra-Mouli)

I joined WHO in April 1993 and worked on HIV prevention research in WHO’s Global Programme on AIDS. When the Programme closed in December 1995, I moved to the Joint United Nations Programme on HIV/AIDS where I did a short stint supporting country programmes in Asia. I re-joined WHO in June-July 1996 and from then on worked on adolescent health in different departmental configurations – with the Adolescent Health and Development Programme (1996-1999), the Department of Child and Adolescent Health and the Department of Maternal Newborn Child and Adolescent Health (1999 – 2011), and the Department of Reproductive Health and Research which includes the UNDP, UNFPA, UNICEF, WHO, World Bank cosponsored Human Reproduction Programme (2012-23).

Before joining the organization, I worked for 12 years in Zambia (first in providing clinical services, then in preventing childhood malnutrition, and finally in preventing HIV and providing care and support to people living with HIV, in India (providing technical and financial support for HIV-related work at the early stage of the country’s response), and in Zimbabwe (setting up a regional training and mentoring initiative, the School-without-walls).

It has been a privilege to work for WHO for three reasons.

Firstly, because of WHO’s track record over 75 years, individuals and institutions trust the organization, its work, and its staff. They want to know our views on issues that concern them, they want to use our guidance, and they want to work with us.

Secondly, WHO stands by science, and by facts and figures. It is not scared to say what it needs to. And it is not intimidated into silence by pressure or money.

Thirdly, WHO is willing to admit its shortcoming and its mistakes. It also is ready and willing to learn – from within and outside – on how to do better as an organization.

I am so very proud to be part of WHO.

Working with WHO for three decades has been enormously rewarding at multiple levels. I would like to share five reflections with you.

Firstly, I have worked in a number of WHO programmes/departments over the years. Each of these programmes has shaped the global agenda in its area of work. In each of them, I worked with and befriended knowledgeable, committed, and hardworking colleagues from/with different levels of the organization, different disciplines, different countries and cultures, different sex and gender orientations and expressions, and different life experiences. It has been a joy to be part of this enormously diverse team working towards the shared goal of Health for All.

Secondly, over these past decades, I have travelled to and worked in around 70 countries in all the five continents of the world. In these countries, I worked with, learned from, and befriended wonderful people. In addition to opening my eyes with their insights and experiences, many opened their homes and shared meals with me.

Thirdly, over the years, I have learned that in WHO, one is judged by one’s competence and ability to work with others, to deliver products and services. One is not judged by one’s race, sex, which professional discipline one is from, which university one went to, and how wealthy one’s country is.

Fourthly, working for WHO has challenged me to grow and develop. Firstly, I joined WHO in the early 1990s, in the pre-email, pre-mobile phone, pre-Internet age. All aspects of work were done in multiple paper-based systems. Like other colleagues, I grappled with and learned to make full use of the constantly evolving digital technologies. Secondly, I learned French and then Spanish; this enables me to understand, relate to and work with colleagues and collaborators in the French and Spanish speaking worlds. Finally, I came to WHO with training and experience as a medical doctor and as a programme coordinator, with some experience in research. Through learning by/while doing, I now carry out the entire spectrum of public health functions – generating evidence through research, evaluation, documentation, and reviews; strengthening metrics; advocating for investment and action, building capacities of individuals and institutions, and supporting countries to strengthen their policies and programmes through the application of good science and good management.

Fifthly, I have experienced WHO as a caring organization. Eighteen months after I joined the organization, my wife was diagnosed with cancer. I got enormous empathy and support from the organization and from my colleagues, during her 20-month long fight with cancer which sadly ended with her death in 1996. I have got the same level consideration and help in addressing my daughter’s medicine-resistant epilepsy. I feel deeply grateful and rewarded at many levels.

I would like to share three reflections.

Firstly, when I started working on adolescent health in the mid-1990s, the question being asked from the global to the national levels around the world was: Why do we need to address adolescents ? We responded by setting out the public health, economic and human rights arguments for this. By the start of the 2010s, there was growing recognition of the importance of addressing adolescents. The question being asked then was: What do we need to do to address adolescents ? We responded with syntheses of the available evidence of the effectiveness of interventions and intervention delivery mechanisms, as well as tools to translate this evidence into policies and programmes. Today, the question that is increasing being asked is: How do we do what needs to be done to address adolescents, in our social, cultural, and economic context ? While continuing to make the case for action and to point to what works and what does not, our focus now is on supporting countries to deliver proven interventions at scale, with quality and equity, while involving adolescents meaningfully. And we are learning by doing with them.

Secondly, when I joined WHO’s Adolescent Health Programme in 1996, only three other departments in WHO were working on adolescent health. Today, 27 years later, over 17 WHO departments are doing so. This increase in interest in adolescent health within WHO reflects what is happening within and outside the United Nations system, and more importantly in countries and communities around the world.

Thirdly, because of the coordinated and concerted efforts of individuals and organizations from the local to the global levels, there is tangible progress in adolescent sexual and reproductive health.

Globally, adolescent girls and boys are more likely to initiate sexual activity later than their peers did 10 years ago. Adolescent girls are less likely to be married and to have children before 18. They are more likely to use contraception and to obtain maternal health care. They are less likely to support and to experience female genital mutilation.

Adolescent boys and girls are less likely to have sex with a partner who they were not married to or living with; and when the do so, they are also more likely to use condoms. They are less likely to be infected with HIV and to die of AIDS. While it is true that the progress being made is slow and uneven and much more needs to be done, there is no doubt that it is happening. While this is cause for celebration, it challenges us all to do more to speed up equitable progress in these areas, and to extend the progress to areas within and outside sexual and reproductive health in which there has been limited progress (e.g., levels of sexually transmitted infections, intimate partner violence and sexual violence, obesity, and mental health).

It has been such a privilege to be part of this journey.

I am proud of many things that we have done on adolescent health in WHO. But rather than set out a long list, I would like to describe how we have taken one health issue and developed a solid body of work ‘brick by brick’, over 25 years.

  • Adolescent pregnancy and childbearing were placed on the global agenda by the International Conference on Population and Development (ICPD) in 1994. In the aftermath of the ICPD, we worked to make a case for attention to it.
  • In 2000, the Millennium Development Goals (MDG) were announced. Goal 6 on reducing maternal mortality provided a new impetus for our work. In the 2000s, we pressed for attention to adolescent pregnancy (and to HIV in adolescents and young people as part of Goal 4). We developed tools to strengthen the abilities of health workers and health facilities to respond to adolescents effectively and with sensitively. We worked with United Nations partners to develop guidance on providing sexuality education in schools and elsewhere in communities. Despite concerted efforts, we struggled to find engagement because in the first decade of the MDG era, adolescent health was not really a priority.
  • In the early 2010s, there was growing realization worldwide that adolescents were being left behind, and that this had implications not only for their health and wellbeing but for efforts to reduce maternal and childhood mortality. To respond to the call for guidance, in 2011 we published guidelines on preventing early pregnancy and poor reproductive outcomes in adolescents, and we used the forum of the World Health Assembly to organize a session on Early marriages, and adolescent and young pregnancies in 2012.
  • In the last five years of the MDG era (i.e., 2011-2014), we worked with GirlsNotBrides and the newly established Joint UNICEF-UNFPA Programme to Accelerate an End to Child Marriage, to establish/strengthen national efforts to end child marriage, and with Family Planning 2020 to support countries in including adolescent contraception in their national commitments.
  • The Sustainable Development Goals and the updated Global Strategy for Women’s, Children’s and Adolescents’ Health which were launched in 2015 placed adolescents at the center of the agenda. This has provided a solid basis for us to step up our efforts in the second half of the 2010s and the first half of the 2020s. We have published country profiles synthesizing available data, distilled evidence of what works and what does not, documented analytic case studies of ‘positive deviant’ countries that have demonstrated success in reducing levels of child marriage and of adolescent childbearing, stimulated and supported implementation research, built the capacity of researchers, policy makers and programmers from the global South, and set up an innovative mechanism to provide technical assistance to countries that is responsive to their needs, and is timely, effective, efficient, and contributes to strengthening national capacity.
    • As we approach the 30th anniversary of the ICPD, we can say with satisfaction that our efforts – in conjunction with those of partners within and outside the United Nations system – have contributed to a global reduction in the levels of child marriage and adolescent childbearing, and to increases in the levels of adolescent contraceptive use and maternal health service use. Although this progress is slow and uneven, it is heartening that it has been achieved even in countries even in countries with weak health and education systems, restrictive social norms, and financial constraints. Further, whereas in the 1990s, indigenous and international NGOs which were at the forefront of efforts, in the 2020s, governments are increasing taking the lead and beginning to invest their own resources. This augurs well for the future.

      As I look back, I am proud to have contributed to changing the discourse on ASRH from: ‘This is difficult to do. It is nearly impossible to show results in this area.,’ to ‘Yes, we can. Yes, we have!’

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