Q&A With Onikepe Owolabi

What brought you to the field of public health?

When I was in medical school in Nigeria, a lot of the textbooks we used had no Nigerian data. And many of these books had pictures of people who did not look African. I found myself asking a lot of questions about why we didn’t have local data and eventually I found out that population-level epidemiological data collection, including complete census data, was not always available in many African countries, or it wasn’t used.

During my clinical rotations, we had to improvise sometimes because equipment and medicines were not readily available, and some patients were too poor to access them. And even when clinicians were driven and passionate, the health system made it difficult to provide the kind of care that could actually save lives and promote health.

I was also deeply inspired by my mother, who was a physician and ran her own private hospital. I learned from her at a young age that many diseases are preventable— through vaccines, handwashing, or access to safe water and sanitation, things you could easily deal with if you had strong public health interventions. These all led me to epidemiology.

Can you tell me more about the work you do at Vital Strategies?

I work with ministries of health and a mix of academic partners in Rwanda, Uganda and Bangladesh to strengthen the health management surveillance systems and bolster their capacity to collect better data on sexual and reproductive health in each country. We then assess the quality of data and strengthen capacity to conduct analysis and drive evidence-based interventions and policies within the health system.

In sexual and reproductive health, there is a strong focus on health justice and human rights and living healthy, meaningful and autonomous lives. Although donors have invested in some areas of sexual and reproductive health, such as family planning and pregnancy care, many other important topics are stigmatized or relatively underfunded. These include access to comprehensive abortion care, prevention and treatment of gender-based violence, infertility and reproductive cancers.

We are helping governments understand some of these issues in their countries, and we prioritize the use of local data within the health information system. We work with them so they can better understand what data is available, and advise them on how to improve the data and indicators used to track progress so they can understand how women are faring. Then, we strengthen their capacity to use data to advocate for national policies and interventions that improve access to comprehensive sexual and reproductive health care services.

What excites you the most about the Data-Driven Policy Initiative to Improve Women’s Health?

Two things. One, the potential to make sure that women’s lives change by collaborating directly with ministries of health who exert a lot of influence on the services available in their countries. Two, advocating for and enhancing the use of local evidence to drive local decision-making. Instead of relying solely on global surveys, and donor-funded evaluations and priorities, we are working with governments to generate and use evidence from their own health systems, to realize the value of their data, improve how it is collected, incorporate it into their internal process and combine it with all the other sources of data to enable them to make better decisions. Through this program we have an exciting opportunity to enhance the data-to-policy process for neglected sexual and reproductive health topics.

Who or what inspires you?

One person who was really meaningful to me in my career was Professor Olikoye Ransom Kuti. He was a pediatrician who was in charge of the Ministry of Health, and he is the father of primary health care in Nigeria. He took his clinical and academic knowledge, applied it to the health system, transformed community medicine in Nigeria and reduced child mortality. He advocated strongly for an integrated approach to delivering services within the health system versus vertical donor-funded programs, and he facilitated the implementation of better national level health policies with a strong focus on preventive medicine. His leadership was transformative for the nation.

My mother inspires me deeply. She was a physician. She was Christian with a very deep faith and yet very progressive and forward thinking on sexual and reproductive health and gender empowerment in her clinical practice. I saw her treat and provide advice to her female clients so they were better able to make full decisions and live full lives.

When I was a child, many lower-income, less-educated young women found themselves in long-term partnerships; they ended up having a traditional wedding not recognized by the courts. Today, and in some contexts, such relationships are recognized and legally protected, but at that time and in my country, it was disempowering for these women. Their partner could marry someone else legally, leaving them with multiple children and no financial support, throw them out of their home for any reason, or die suddenly, leaving them at the mercy of cultural inheritance traditions. Whenever she had patients like this, she would provide heavily subsidized and often free clinical treatment, help them manage their pregnancies and always spend time with them to find out about their personal situations. She encouraged them to go to court to get married, and in many instances would speak with the partner and offer to pay for the process.

She provided women with education on contraception after pregnancies, encouraged them to find credible thrift savings plans, offered money to grow small businesses and encouraged them to make family planning decisions even if it was concealed from a partner. She did all she could to help them avoid unintended pregnancies and have time to work and earn money. She was the first feminist I knew, and she always wanted to make sure a woman had a stake in her household and could take care of herself.

Beyond my mother and Professor Olikoye Ransom Kuti, I have been inspired by every single suffragette—particularly Black women who fought for women to do the things they do today. I know that the opportunities that I have had to be educated at the highest level, to do the work I do today, is thanks to these women. One extraordinary example from my country is Funmilayo Ransome, the mother of Professor Olikoye Ransom Kuti.

What advice would you give to those interested in entering the public health field, particularly women’s health?

I would say there’s not one path to doing this successfully. Diverse perspectives are needed and valued within the field. If the person is a woman, there is always strength in digging deep into your lived experience and those closest to you to figure out the problems you want to solve and what you are passionate about, what resonates deeply with you.

Regardless of what undergraduate college degree you hold, there is opportunity to work and pursue an additional degree that leverages your skills and background to get into public health. Post-graduate degrees in pharmacy, clinical medicine, nursing, sociology, anthropology, health economics or public health are popular and will give you some grounding. That said, engineering, communication, business, and technology degrees are critically important to women’s health. As in all other areas of public health, there is infrastructure and equipment to build, applications to develop, and advocacy and activism to lead.

I have found it helpful to study the career paths and choices of people with backgrounds and skills similar to mine and to ask myself what resonates with my interests, location and career priorities at any given time. Intern and try different things to figure out what you don’t want to do—this is sometimes as important as knowing what you want to do. Overall, there are many ways to work on women’s health and public health. Once you make that decision, a good mix of reading about people, talking to them and volunteering or getting that first job helps direct your path.

What does the future of women’s health look like? How can we create a safer and healthier world for women?

To do this, first, the world needs to recognize that women are equal to men. For someone’s life to be fully lived and their health optimal, they need complete autonomy, respect and control over their lives and decisions. The world needs to give that back to women because we live in historically patriarchal societies.

Secondly, women are diverse and different and there is a lot of intersectionality in the identities they hold. There is not one right way to be a woman nor is there one magic bullet intervention on any topic for all women. When it comes to designing research, interventions and policies for women, scientists, advocates and decision-makers need to ask more questions of the communities of women they are targeting. All decisions must be made collaboratively with the communities whose lives and health are at stake. Decisions on any societal issue, including the health of women, should not be made by only men or mostly men, as we see in many countries and fora today. Nor should a few women speak for all women—that is paternalistic and not respectful of the diversity of lived experiences.

Finally, health is not purely physical. It is mental, psychological and for some people, spiritual. Women’s health is not solely woman’s reproductive health. Everyone should consider all the different domains of health a woman needs to thrive.