As the COVID-19 pandemic gripped the world in late 2019 and early 2020, the world’s great hope was in the rapid development and deployment of vaccines. Global public health organizations hoped to seize upon the crisis to advance international cooperative efforts to fight COVID-19, and the promise of advanced economies embracing “vaccine diplomacy” to get shots into arms around the planet was a key element in this strategy.

“Globally women and girls continue to face barriers to access healthcare services—whether it be transport costs, financial costs, or even language barriers,” said Shakira Choonara, Technical Specialist with the World Health Organization (WHO) at a recent launch event of the Sexual and Reproductive Health (SRH) and Universal Health Coverage (UHC) Learning by Sharing Portal (LSP).

In its June 2022 decision, Dobbs v. Jackson Women’s Health Organization, the U.S. Supreme Court abandoned decades of precedent to strike down the constitutional right to abortion. This ruling—and a shift in regulatory power over abortion to individual states—is having a profound impact in American society. Already, a record number of abortion measures are on ballots to protect or abolish abortion rights. In many states, the fight over abortion access continues to take place in courtrooms. Far from settling the matter, the Supreme Court’s ruling showcases the deep divide over abortion in American society.

Of COVID-19’s many lessons, one is most critical to our collective next steps:

Business as usual in global health is no longer possible.

The pandemic exposed weaknesses in health systems across the world, and particularly in the delivery of equitable, high-quality reproductive, maternal, newborn, adolescent, and child health (RMNCAH) services. It also reinforced that effectively addressing these challenges requires rapid, responsive approaches driven and owned by countries and local institutions.

While the world’s population now approaches 8 billion people, global fertility rates have been declining for decades. The overall drivers of this decline include increased access to contraception and reproductive health care, an increase in women seeking higher education, women’s empowerment in the workforce, lower rates of child mortality globally, increased cost of raising children, and overall greater gender equality.

“Half. This is the proportion of all pregnancies that are unintended. That is 121 million pregnancies every year,” said Sarah Craven, Director of the Washington D.C. Office at UNFPA during a recent U.S. launch event for the 2022 UNFPA State of World Population (SWOP) report. “For these women, the most life altering reproductive choice, whether to become pregnant or not, is no choice at all. This is an unseen crisis unfolding right before our eyes.”

More than 60 percent of preventable maternal deaths and 45 percent of newborn deaths take place in countries affected by recent conflict, natural disaster, or both. Yet as Sarah B. Barnes, Project Director of the Maternal Health Initiative, observed at a recent event hosted by the Wilson Center and UNFPA, in collaboration with the Inter-agency Working Group on Reproductive Health in Crisis (IAWG) and White Ribbon Alliance, “the leading causes of both maternal and newborn death occurring in humanitarian settings are considered to be preventable if managed by skilled providers and adequate resources.”