Space to Dream | Lynn P. Freedman Discusses the Evolution of Women’s Health and Rights
Lynn P. Freedman, JD, MPH, Director of the Averting Maternal Death and Disability (AMDD) program, initially got involved with the program as the human rights advocate in 1999. It was a pivotal time. The end of the Cold War enabled the potential to think about health and human rights in a new way.
“In essence, I was able to be in on the ground floor of the development of the field of Health and Human Rights,” Freedman explained.
For PopFam’s 50th Anniversary, we sat down with Freedman to discuss the important work AMDD has done to reduce maternal mortality and what she sees for the future of the field.
What drew you to Columbia and to the PopFam department in particular?
I was a practicing lawyer, doing largely intellectual property and First Amendment work, and decided to transition to public health. Columbia was the obvious––maybe the only––place to do that in New York in the late 1980s. The fact that PopFam did global work interested me.
At the time PopFam had a program called Development Law and Policy, where I worked as a research assistant while I finished my MPH in 1990. I’ve been here ever since.
What made you take the leap to public health, and women’s issues specifically?
I have to say, prior to enrolling in the MPH program, I was clueless. After taking a few courses, it became clear to me for the first time that the status of women was intimately connected with their health––especially globally. Women’s issues seemed like a meaningful place to apply my background in law to critical problems in public health.
I came on right as the new field of health and human rights emerged. At the same time, there was a growing women’s human rights movement that was engaging with the UN. I was able to cross over these different movements, working in partnership with practitioners on the ground outside of Columbia. We focused on applying human rights ideas to issues of sexual and reproductive health, and also to maternal mortality.
Tell us about the focus on women’s health and maternal mortality?
In the 1990s, there was a paradigm shift from traditional family planning to reproductive health programs built on women’s reproductive rights and their ability to decide on the number and spacing of children, free from coercion, discrimination and violence. So these ideas about women’s rights were starting to suffuse much of the work in maternal child health, as well as so-called “population” field. They were part of lively discussions and debates we were having here at PopFam, involving leaders in the field like Allan Rosenfield and Deborah Maine.
Through my interaction in the 1990s with the PopFam colleagues involved in the Prevention of Maternal Mortality (PMM) Network, we made the connection between these issues and women dying in pregnancy and childbirth and found that it was almost entirely avoidable. PMM was very much about improving health services on the ground. But we understood the extent to which failing health systems were about the bigger set of problems poor countries faced.
Tell us about your work with Averting Maternal Death and Disability?
Deborah Maine asked me to join the project as the human rights person. In the early years, we worked with Ministries of Health, UN agencies and various NGOs to set up projects focused on emergency obstetric care –– the care you need to save lives when women experience complications, such as hemorrhage or preeclampsia. That was an incredibly influential program and a huge learning experience for me.
When Deborah stepped down in 2006, I became the Director, and we were able to add a range of different projects to the AMDD roster. For example, we were the first to do studies on the disrespect and abuse of women in childbirth, designing a research project with our colleagues in Tanzania, and we linked those studies with the Population Council doing similar work in Kenya.
The field is now called respectful maternity care, using the positive rather than the negative. We also started looking at disrespect and abuse in the U.S. and it rapidly became clear that this wasn’t a rich or poor country issue, it was a women’s rights issue. It was about valuing women.
How have PopFam’s resources, global network and approach to research helped to shape your work?
First, there’s been complete freedom to do whatever we could imagine needed to be done. Which meant that we could develop new conceptual areas, like Health and Human Rights and the whole respectful care field.
Second, PopFam has always emphasized implementation and actual services. It’s now often called “Implementation Science” and includes monitoring and evaluation, but that emphasis gave us the space to work in the field, in an ongoing way, with colleagues who were delivering services or advocating for change. We were not limited to classic public health research studies or clinical trials.
We had space to dream, imagine and go wherever we could find the funds to support us.
What PopFam contributions are you most proud of?
If I had to choose one thing, it would be introducing and integrating a human rights perspective into the way we think about public health challenges in general and women’s health challenges in particular.
What is the most pressing challenge for women’s health and maternal mortality today?
Today? A big chunk of the funding is gone, and the programs have been decimated. And so many of my colleagues in the field have lost their jobs. That’s obviously a huge, immediate challenge.
It’s going to be difficult to climb back out of that hole and repair the damage done to everything–– the infrastructure, the people, the views of this work among the public.
Five or six months ago, my answer would have been different. Even then, we had not sufficiently addressed the challenges of inequity and disparities within and between countries. That inequity has been and will continue to be a critical, pressing challenge, especially in the current political climate, when efforts to understand and address disparities based on race or class or any kind of social disadvantage are condemned by our own government as being “ideologically laden” and wasteful.
How will the field change over the next 50 years?
Maybe the biggest thing is that our colleagues in low- and middle-income countries will lead the way.
What exactly that will mean for these specific programs isn’t clear, but I think it will yield results that are more effective. It will enable programs to zero in on the most critical problems and, hopefully, to face them in a more direct, nuanced and transparent way.
That’s the main development and an exciting one. If it can happen, we’ll all need to rethink how we engage globally. We’re actively in that process now and I hope we can continue to do that.
Do you have any messages you’d like to give to current or prospective students and colleagues?
Keep the faith. This is just one more challenge to push back against. The fundamental values that our work is about — promoting health, wellbeing, access and equality — are still worth fighting for. In the face of today’s political dynamics, we need to keep working with agility and creativity. We need to find new models for organizing our work and arguing for its importance. But we need to stick to the fundamental values we’re committed to.
Interested in learning more about her work?
Freedman was the lead author for the UN Millennium Development Project’s Who's Got the Power? Transforming Health Systems for Women and Children, detailing the strategy to approach these issues as human rights.
With a focus on strengthening health systems, the report proved an important step in moving the field in the right direction.
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