Global Health Institute

By Rachel Williamson

On Tuesday, January 21, 2020, the Conversations in Global Health lecture series had the pleasure of talking with Keifer Buckingham, Senior Policy Advisor for International Public Health at Open Society Foundations. Buckingham shared her post-grad trajectory and provided valuable insights and experiences into the fields of global health, reproductive rights and advocacy. Over the course of the evening, Keifer spoke of the roads that lead her to where she is, domestic public health and advocacy work, and the importance of collaboration and trust while working on Capitol Hill for Congresswoman Lee.

Towards the end of the evening, the conversation came to Universal Health Coverage (UHC), a landmark goal of global health and development. As a Global Health Senior here at Georgetown, we have touched upon and discussed this goal of the United Nations in many of our classes. While the question originally concerned how reproductive health can be a comprehensive component of UHC, especially in the Trump-era, Buckingham stepped the question back. The global health professional was up-front about the lofty-nature of this goal, as even the United States is far away from having UHC. Instead, Buckingham focused on what needs to happen in order to put the systems in place that will allow UHC to become a reality in the long term; how the conversations of global health aid and assistance in the US need to shift toward helping countries get to a place where they will eventually be ready for UHC.

Starting with a bit of history, she touched upon the siloed nature of much global health assistance. Key programs that have achieved enormous success, such as PEPFAR and the Global Fund to Fight AIDS, TB and Malaria, focus on select diseases. As a result, systems are weak and services unintegrated. Buckingham explained, “right now, a mother can go into a clinic and get effective HIV medication, but she cannot get basic family planning services.” She was clear that the current appropriations system is not set up to think in the way of breaking down the silos in which global health aid and development has operated for decades. Appropriators are much more inclined to do the quantitative work of providing x number of bed nets or vaccines, as opposed to the less tangible work of health system strengthening - the exact activity that is necessary if the world is going to get close to achieving UHC for all. The path forward now seems a bit more clear, the pressing work is to convince the decision makers to think differently about aid and how strengthening systems for health is most effective path forward if the world is to get closer to actualizing UHC for all. 

Rachel Williamson (NHS ’20) is an undergraduate student studying global health. She is also an intern at the Global Digital Health Network.

By Shuait Nair 

The sphere of global health has witnessed an impressive growth in progress over the past few decades. The notion of the right to health has gained familiarity across many societies, though the term itself is still shrouded in ambiguity. Today, many global health activists are working to clearly define the right to health, primarily by identifying the types of health services which fall under this broader umbrella, while ensuring that all populations have access to any essential services. Keifer Buckingham, Senior Policy Advisor for International Public Health at Open Society Foundations, is one such global health advocate who has worked on elucidating the right to health. In particular, she has devoted her career to the advocacy of a form of health which many countries either ignore or are quick to dismiss: reproductive health. Buckingham’s career began with examining the right to HIV care among populations throughout the world. In her freshmen year of college, Buckingham had the opportunity to travel to Rwanda on an exchange program. While there, she visited a PEPFAR-funded clinic– her first-hand experience with seeing international communities and the extent to which health impacted their livelihoods inspired her to create her own major in international development at a time when the now popular field was virtually non-existent. In graduate school, her health focus transitioned from global HIV care to domestic reproductive rights. 

Buckingham claimed that this shift in interest was catalyzed by her discovery of an unsettling irony rooted in the U.S. global health agenda, namely that while the US fought hard to provide HIV treatment for women abroad, the country was all too quick to limit reproductive rights at home. Buckingham began pursuing research on domestic policies that regulated reproductive health, such as the Global Gag Rule (Mexico City policy), which blocked funding to NGOs that directly supported or advocated for access to abortions. With time, Buckingham unearthed the reproductive health paradox in the U.S., noting in her article published in The Hill, how post-Roe v. Wade, U.S. policies like the Global Gag Rule and Helms Amendment restricted a woman’s fundamental right to reproductive health. 

A central part of Buckingham’s career has been to consolidate this concept of reproductive health rights. In our conversation, Buckingham mentioned how reproductive health rights had largely varying associations between countries. For example, Buckingham noted that while reproductive health rights in the U.S. mostly focused on the right to terminate an unwanted pregnancy (abortion), the term often referred to the right to access prenatal care and postnatal in refugee camps across the Middle East and Asia. However, Buckingham argued that the concept of reproductive health was its own umbrella consisting of a spectrum of rights, from the right to survive a pregnancy and have a healthy baby to more nuanced rights, such as the rights to have a child (via fertility treatment), receive sexual education, and exercise gender identity. Buckingham reminded us that even though the U.S. often debated the more complex concepts of reproductive health, it still struggled with the more fundamental rights, noting the disparity in maternal mortality rates between white women and women of color in the country. 

For the past year, Buckingham has worked as a senior policy advisor on international health at the Open Society Foundations, an organization which develops and provides grants to smaller independent groups hoping to tackle global health initiatives. Her work in the Open Society Foundations has given activists the opportunity to open up conversations on the more divisive issues within the realm of global health. It is essential that we these platforms to spread awareness of reproductive health rights despite the efforts of countries to avoid such matters. Whether they are ready or not to recognize this issue should no longer be a ground for delay; it’s about time we address the elephant in the room. 

Shuait Nair is a sophomore in the School of Foreign Service studying Science, Technology, and International Affairs. He is also a researcher on refugee and migrant health rights.