The power of empowerment

Living in Geneva, one admires the beauty of the surrounding mountains. But on a recent trip to India, my home country, I was rather startled to find myself surrounded by an altogether different kind of mountain range. This was made up of peaks of rubbish and waste piled high at a landfill site in Ahmedabad in the state of Gurajat. And in this wasteland, I met women who were simply extraordinary, rummaging through this waste for 6-8 hours a day in search of pieces of scrap that they are able to sell on. For them, it is a precious livelihood that brings them income, autonomy and respect.

Just being in this setting made this country visit unique. Rather than meeting with Heads of State, Ministers of Finance or Ministers of Health, this trip was focussed on meeting with women who are fighting poverty, prejudice and injustice. They may be exposed to health hazards on landfill sites, they may reside in areas without clean water and sanitation, or suffer from chronic malnutrition, they may be victims of social dogma including child marriage, domestic violence and lack of contraception, and they may be denied education. And yet, undeterred, they are working hard to provide subsistence to their families. I undertook this visit with our Board Chair, Dr Ngozi Okonjo-Iweala, to understand how we can leverage the power of these extraordinary women to ensure sustained demand for immunisation and reach those children who are missing out on vaccines.

The women that we met are part of India’s ‘Self-Employed Women’s Association’ or SEWA, a word which also means “service.” The organisation was set up 50 years ago by an incredible woman called Ela Bhatt, who was moved by the plight of women engaged in informal occupations. At that time, these women had no legal rights or access to finance, skills and markets. They were an invisible community unable to lift themselves out of poverty.

So Ela began to organise these women into trade cooperatives. The movement grew dramatically, and now SEWA has 124 cooperatives, with a collective membership of over 1.5 million. As we interacted with SEWA members, we were moved and inspired by their personal stories of struggle and triumph – their authenticity, eloquence, confidence and aspiration to press-on. UN Women, which was only created in 2010, rightly says that “investing in women’s economic empowerment sets a direct path towards gender equality, poverty eradication and inclusive economic growth.” SEWA is a real testimony to the fact that once women are economically empowered, they lead the march to inclusive, healthy, peaceful and prosperous societies. 

SEWA members are already working on broader determinants of health, such as projects to improve water supply, sanitation and nutrition. They are women who are becoming increasingly aspirational for the next generation, and want better access to services like education and healthcare for their children.

And it is not just their zeal that makes SEWA so impactful – its their reach. They are the largest association of self-employed women in the world, with 1.5 million members throughout the country, including in remote communities. In one discussion during my trip, SEWA members suggested that each member could take on responsibility for ensuring the immunisation of ten underimmunised children in their community. Such a strategy would reach 19 million children, a potentially phenomenal outreach in a country that has an annual birth cohort of 26 million.

As I learned more about SEWA and its impact, my mind was buzzing with how it could help Gavi reach more children with life-saving vaccines. Gavi and SEWA have already partnered on a small scale, to understand community perception of cervical cancer prevention and human papillomavirus (HPV) vaccine. In the future, could we train them to help repair our vaccine fridges, or transport vaccines to remote locations? Could they spearhead community-based surveillance efforts? With such a confident, clever and enthusiastic group of women, the possibilities are endless.

Most conversations around gender and health focus on the difficulties women face and solutions to breaking down these gender barriers. But SEWA women, working on the landfill sites, fields and streets of India, are overturning this narrative. 

It’s also a narrative being challenged at this week’s Women Deliver conference in Vancouver. Gavi representatives have joined world leaders, experts and activists to drive progress to a more gender equal world. Gavi, along with other partners, is co-organising several side-events to share new ideas and accelerate momentum to empower women, girls and adolescents.

It is time for us to reconsider how we think about gender. Leveraging women’s networks like SEWA, we have a unique means of reaching some of the hardest-to-reach children on the planet. We should ensure our programmes are gender-sensitive and gender-focussed, but they can also be gender-leveraged. Economically empowered and driven by a desire to protect their children’s health, these women can be a powerful force for change towards building healthier, more equitable societies.