UN Transcripts — https://transcripts.un.org/es/asset/k1e/k1ep520cfe Beyond band-aids: Innovation to improve women's healthcare (CSW70 Side Event) — 18 March 2026 Language: en Automatically generated transcript — may contain errors. Not an official United Nations record. --- Holy See · Expert · Nadia Wolfe [11:16]: Thanks very much to everyone who's come for our site event today we are starting promptly at 1:15 and concluding promptly at 2:30. So we're very glad to have you with us and we'll start in just a couple of minutes and thanks for your attendance and your patience. It. Speaker 2 [11:55]: It's. Holy See · Expert · Nadia Wolfe [13:26]: All right. Good afternoon, your Excellencies, distinguished speakers, delegates, ladies and gentlemen. Thank you for joining us today. My name is Nadia Wolfe and I'm an expert here at the Holy See mission, where my portfolio includes issues related to women, children and health. This event, Beyond Band AIDS Innovation to Improve Women's Health Care, is offered in a spirit of dialogue and reflecting the Holy See's commitment to ensuring that everyone can realize her rights to the highest attainable standard of health. Women and girls health needs have not been given the attention and resources that they deserve. For that reason, we're pleased to partner with Fertility Education and Medical Management, or fem, which is working to address those needs in ways which are scientifically sound, culturally appropriate and accessible. Before we begin a bit of housekeeping for those in the room, we should have index cards and writing utensils available. Those are for questions. So if, as you're listening, you think of something you'd like to ask, please write it down and we'll collect those later for use during the interactive segment. Also, there is another side event that is scheduled for this room at promptly at 3 o'. Clock. So we ask everyone to clear the room once our event is finished on time at 2:30, so that that next event can set up and continue any discussions outside of the room. There. Okay, without further ado, we will first hear some remarks from Archbishop Gabriela Caccia, Apostolic Nuncio and Permanent observer of the Holy See to the United Nations. A native of Milan, Archbishop Katja has served in the diplomatic service of the Holy See since 1991, with postings in Tanzania, Lebanon and the Philippines. Before taking up his appointment at the United nations in January of 2020, he has just been appointed as Apostolic Nuncio to the United States, where we'll soon take up his post. Your Excellency, you have the floor. Holy See · Permanent Observer · Gabriele Caccia [15:14]: Thank you. Your Excellencies, distinguished speakers, delegates to the Commission on the Status of Women. Dear ladies and gentlemen, dear friends, I would like to welcome you to this afternoon's event on the theme of Beyond Band AIDS Innovation to Improve Women's Health Care, which the Permanent Observer Mission of the OLEC is co sponsoring together with Fertility Education and Medical Management foundation, normally referred to by its acronym femme Health is both an outcome of and an enabler for integral human development. It facilitates education, work and participation in family and community life. For that reason, the Holy See strongly supports efforts to realize the right to the highest attainable standard of health for everyone. We must recognize, however, that far too often women and girls lack access to medical care and have needs which are not met. This is due to a variety of factors, including discriminatory attitudes and social norms, lack of financial resources or weak health systems. Yet even when women do seek medical assistance, many doctors are unable to treat them. For decades the field of medicine has made great leaps in preventing and treating diseases, but oftentimes women were left behind. This has occurred both in determinations of what is studied with female health problems not given due consideration and who is studied with men and male models, the norm for research and pharmaceutical testing, among other things. Thankfully, there have been significant efforts to correct this, but gaps persist. One often overlooked factor is the over reliance on hormonal contraceptives as a treatment. As we will hear from our panelists, contraception at best provides symptom management for endocrine disorders, a band aid solution to much deeper problems. For some it also has harmful side effects, some of which impact long term health, but for many doctors it is all they have to offer. Sadly, contraception also has negative social effects. By turning women's unique capacity for childbearing into a problem to be managed, it reinforces the same attitudes that led to underinvestments in women's health. This places the burden of women not to inconvenience others, particularly employers, with their fertility, when in reality we all have a shared responsibility to respect women and men equally in their distinctiveness. Women deserve better Respecting the dignity of woman means accepting and valuing her at the level of her full humanity, including her fertility and capacity for motherhood. These are not problems to be solved, maladies to be remedied, or worse, evils to be rejected, but rather ought to be embraced as part of of the reverence owed to woman in accordance with her dignity. By accepting women in her fullness, medicine can also better serve women through accurately diagnosing and treating problems which are both too common and sadly, too often dismissed and left untreated. Our partner for today's event, fem, assisted by his affiliated research organization, Research Reproductive Research Institute, has taken up the task of meeting women's needs through holistic health care. Its Fertility education programming provides women with the knowledge to understand their bodies, including the health hormonal connection, and identify signs both of health and of conditions that need to be addressed, empowering them to seek care when needed and make informed choices about their health and fertility. Its medical Management side trains a medical practitioner to diagnose and treat health conditions, including underlying issues involved in infertility, menopause, thyroid dysfunction, migraines, depression, weight gain, fatigue, pain, polycystic ovarian syndrome and other complaints which may be common but are not healthy or normal. And all of this is undergirded by cutting edge medical research into hormonal health. I look forward to hearing from them more about this and I thank you for all your interest in this important topic. Thank you very much. Holy See · Expert · Nadia Wolfe [20:52]: Thank you very much, your Excellency. With that, we will now begin our panel. Our first panelist is Ms. Anna Halpine. Anna is the CEO of FEM. She has traveled and worked internationally, first with World Youth alliance, which she founded, and now with global partnerships for fem. She has her Bachelor's in Music from Mount Allison University in Canada and a Master of Arts in Philosophy from Yale Divinity School. She lives and works in New York City. Anna, you have the floor. FEM · CEO · Anna Halpine [21:22]: Thank you. Thank you, your Excellency. Thank you, distinguished guests, friends. It's really a pleasure to be here and we're grateful for the opportunity to share our work with you today. For decades, the Commission on the Status of Women has met to discuss a total spectrum of issues facing women, with a particular focus on the need for improvements in women's health information, knowledge, care and access. Despite this long standing focus on women's health, women around the world still experience significant gaps in women's health care knowledge, access to medical care and services. This is not just self perception. Research and data back up this reality. There is a gap from research advances to clinical application. On average, clinical care lags 17 years behind known research. Advances in knowledge to improve diagnosis, treatment and healthcare outcomes take almost one generation to reach women. Clinically, there is a gap in accessing effective care. On average, it takes a woman eight years to get a diagnosis. This gap is further compounded and exacerbated when women face lack of access to care in rural or underserved communities and there is a gap in knowledge. Informed choice is the foundation of exercising patient agency in healthcare. The WHO recognizes the principle of informed consent as the foundation to achieving human rights. To advance women's health, women must be informed about their own bodies. They must know what is healthy and normal. According to published research only 3% of women worldwide can identify when they ovulate. Yet ovulation is a critical sign of health for women and and can easily be taught and known. Fem, in collaboration with the Reproductive Health Research Institute, is working to solve these gaps in order to advance and improve the standard of care for women and women's health around the world. FEM is leveraging innovations in technology use in order to reach women. Fem's free app is available on the iPhone and Android stores and and is currently available in over 16 languages. The app has been downloaded and used in most territories and countries and is built to the highest privacy standards. FEM never sells our user information for marketing or advertising and the FEM app uniquely teaches users about their own body and health and provides individual feedback to each user. Not algorithm based content, but information about their own body, their own cycle and what is healthy or not for them. A Nigerian app user shared her story with us. The app kept flagging my luteal phase as short. I knew that was a red flag. Sure enough, when I got pregnant about 13 months later, I lost the baby. At seven weeks after that loss, my whole system went haywire. There were no more obvious signs of ovulation. I had all sorts of uncomfortable symptoms. One year later, this user sought out a FEM doctor in Nigeria, completed the full panel of FEM medical testing, got treatment and her health returned. Following this treatment, she gave birth to a beautiful, healthy baby boy. We hear this story from women and app users all the time, all around the world. A femme teacher in Paraguay taught femme to a women's soccer team. These athletes were able to better understand their bodies which optimized performance. Some of the players also identified a need for femme medical care which further improved their health and led to better athletic performance and capacity. The FEM app can lead women into the full FEM ecosystem, linking them to a complete network of education and healthcare services around the world. FEM recognizes that informed consent is the basis of excellence in women's health and that informed women make better choices for their own health as well as for those in their families and networks. In 2025 alone, fertilizer 260 new Femme Health teachers were trained in 53 different countries. These teachers work directly to teach and inform women and families in their communities and local settings, allowing us to link every woman who reaches out to us through our app, through our website or any other linked platform to a femme teacher who can help them learn about their body, their health and their fertility. We've realized this information is also needed in schools and school based curriculum for students now also exists. Teen FEM and Teen Men content is now available for grades 5 to 9 or ages 10 to 15, which brings information to children and adolescents as they enter and walk through puberty so they can understand their own body and and the meaning of the changes they are experiencing as they grow and mature. Hormones direct physical changes as well as emotional change. A 13 year old girl told the teen FEM researcher she was happy and relieved to learn the TeenFEM content. Before that she said she thought that one day she would start bleeding like having a cut and continue to bleed until she died. Now, she said she's relaxed, knowing how her body works, not having the fear of something healthy and normal that will happen as she grows. A 12 year old boy informed his researcher that hormones are like text messages which the brain sends to every system and part of his body telling it what to do. These young people have understood this complex science well and they've translated it into their own words and concepts. But more importantly, it has impacted their attitudes and behaviors, driving change for them to make healthy decisions about their own life and body at a young age. UN agencies tell us that women's health and maternal health deserts exist where 1 million or more women do not have access to the critical health care they need for health support. Waiting eight years to receive a diagnosis is a health care desert. Women and teens who do not know how their bodies work and that ovulation is a sign of health is a health care information desert. Lack of access to medical providers who can diagnose and treat underlying conditions is a global health care desert. And FEMS clinical care providers and networks are actively working to solve this need in the United States but also around the world. At Bugando Hospital in Mwanza, Tanzania, one of the top medical research schools and residencies in the country, trains every new OBGYN in the clinical guidelines of fem. These medical residents showcase their knowledge and skill at the most recent annual FEM medical training in Africa. Guiding department heads and medical school faculty from across the continent, they showed them the patient care protocols and the clinical successes that they experience every day. These young medical residents, in collaboration with the outstanding leadership of their faculty and residency program, are changing the standard of care in Tanzania. Their own published clinical data tells the story. Story Mental health improved Uncontrolled bleeding solved Fertility outcomes improved Improved maternal and infant health The Dean described this success succinctly, quote FEM speaks for itself. Prior to FEM, we could diagnose and treat 40% of our patients. Now we are up to 90%. Once we finalize the integration of all these protocols with our labs, we will hit 1, 100%. Hospital and teaching faculty across Africa are looking at Bugando and working to replicate this extraordinary change. Hospitals in Nigeria will host the first FEM medical training in Nigeria this April. And I have to say, FEM is grateful to collaborate directly with these outstanding African healthcare leaders. We are now working in 11 different countries, hosting two annual Femme Medical trainings on the continent. Here in the United States, FEM telehealth is making this clinical care model available to women and families across the United States. We are now in 43 states. We accept health insurance, and we are grateful for the opportunity to work directly with women and families to make better health care available, affordable and accessible. FEM is on the front lines of improving healthcare for women around the world. Linking technology, advances, education and research, and access to clinical care allows us to solve longstanding gaps in care. These advances need to drive new policy goals as well as concrete changes for women's health education and delivery around the world. Thank you very much for the opportunity to present this work to you. Holy See · Expert · Nadia Wolfe [31:48]: Thank you very much, Anna. Our Next speaker is Dr. Virginia Della Lastra. A graduate of the University of Chile, she specialized in clinical microbiology. She serves as the head of prevention of Healthcare associated Infections at Hospital di Preca in Santiago, Chile. A former assistant professor of medicine at Universidad de los Andes, Santiago, she has over 15 years of medical training and education. Her current work at the Reproductive Health Research Institute focuses on women's health care. You have the floor. RHRI · Physician · Virginia Della Lastra [32:24]: Thank you. Good afternoon. I would like you to meet Isabella. She is 15. It is summer, the most terrible time of the year. On Tuesday, she goes to the mall with her friends. They take turns getting waxed. When Isabela's turn comes, the woman stops. She stares at her through those thin linen curtains and says, why do you have so much hair? I'm going to have to charge you extra. Her friends look at her. Isabella says nothing. Three weeks ago, her mother took her to the dermatologist because of her acne. He gave her creams. She asked about the hair. He said, oh, for that you are a laser hair removal candidate. When she gets home, the hunger hits hard. Sudden crashes. She cannot explain. She is on a diet and her mother is watching. So Isabella eats in secret. Not a cookie, the whole package. In the dark, standing up, listening for footsteps. Then the guilt comes. Because if she is hiding, she must be doing something wrong. Surely she is the problem. The nutritionist told her, you Just need to eat less, go swimming. Her mother now takes her to an endocrinologist. Surely this one will find what is wrong. He orders lab work. They come back normal. He prescribes oral contraceptives. The bleeding becomes regular. The acne begins to clear. The chart looks normal. Everyone moves on. But Isabella does not move on. The weight increases. The hunger crushes, worsen. A sadness settles in permanently. She survives because she tells herself, this is what life must be like for everyone. Seven years pass. Isabella is 22. She walks into a different doctor's office. And this doctor does what no one had done in seven years. She does not prescribe. She does not refer. She investigates. She orders tests no previous doctor has ordered before. She tests how Isabella's body processes sugar. She measures a hormone. No previous doctor has thought to check. The results explain everything. Insulin resistance. An atypical form. The standard test had missed. Hormonal imbalance. Pcos. Seven years of symptoms. One diagnosis. The treatment. Metformin spironolactone. Simple, affordable, available in every pharmacy in the world. In one year, Isabella loses 34 pounds. No extreme diet. No surgery. Her skin clears. The hair normalizes. The hunger crashes, disappear. Her chart shows ovulation besides her regular bleeding pattern. She looks in the mirror and sees someone she has never met. In medicine, we are taught that symptoms are clues. A fever may tell you about infection. We do not treat fever by turning off the thermometer. And yet, in women's reproductive health, this is often done. A woman comes in with irregular cycles, with pain, with mood changes. The question her doctor asks is, how do we restore irregular bleeding pattern? The answer, overwhelmingly, is hormonal intervention. Some symptoms disappear. The chart looks normal. Everyone moves on. But Isabella's body was not malfunctioning. It was functioning perfectly, communicating exactly what was wrong. Her irregular cycles, the hair, the weight, these were not the problem. They were the message, and we silenced the messenger. Each time Isabella left an office, she was symptomatically better and clinically worse. There's a certain kind of thinking that ask the wrong question. Not is the tool suited for the problem, but is the problem suited for the tool? Not does the head fit the hat? But how do we make the hat fit the head? We turned the means into an N. A regular bleeding pattern became the goal when it should have been the diagnostic tool. The question was never how do we make her cycle look normal? But what is her cycle telling us about her health? When a health care system systematically fails to diagnose half the population because it treats their symptoms as inconveniences to be suppressed. This is not just a medical failure. This is a structural injustice. So how many Isabellas are there? How many of you have experienced irregular cycles, unexplained pain, fatigue, mood changes and were told it was normal? How many of you were put on appeal and told the problem was solved? You may be Isabella. One in five women has PCOS. Not one in 100. One in five. And its prevalence is rising. The sadness Isabella felt, let me see, at 15, was not a personality trait. It was not weakness. Research shows that at least 57% of women with PCOS have at least one psychiatric depression, anxiety, OCD. Her sadness had a name, had a cause, and it was treatable. But no one connected it to what her body was trying to say. Last week in Washington, D.C. our institute presented findings from 251 women and girls with menstrual irregularities. We ran a real investigation, not the standard panel, but the kind of comprehensive endocrine evaluation no one ran on Isabella for seven years. 26% had a suboptimal thyroid function. No rare infection. Sorry. Roughly half had hyperandrogenemia. More than half of the adolescents had insulin resistance. These were not rare exceptions. These are the majority. And here's what makes this devastating. The the distribution was nearly identical between the adolescent and adult women. What was not diagnosed at 15 was not diagnosed at 25. The system failed them twice at the same rate, a decade apart. This is hundreds of millions of women whose symptoms were silenced instead of read. And the failure doesn't stop at diagnosis, even when someone does listen, even when a woman finds someone who takes her seriously. There is a well documented gap of 17 years between what research discovers and when it reaches the average health care provider. 17 years. So even the women who are hurt are being treated with tools that are almost 20 years behind the science. We know that oral contraceptives prescribed to an estimated 98% of adolescent girls with PCOS produce a normal ovulation rate in only 12% of patients. After treatment, the chart looked normal. But this girl was not well. She was being channeled quietly toward the fertility crisis she would face a decade later. Isabella, 15 was not just failed. She was set up to fail again at 28. And the failure does not stop with hair. The offspring of women with untreated PCOS carry more than double the risk of neuropsychiatric disorders. More than double. The consequence of not treating Isabella at 15 do not end with Isabella. They move forward, impacting her children and the next generation. This is where our research becomes The Bridge we established that PCOS is not one condition. It has four distinct phenotypes, each requiring a different treatment approach. A one size fits all protocol is not just ineffective, it is scientifically wrong. We demonstrated that when you investigate instead of suppress, when you run the right tests and treat the underlying cause. More than half of women who were told they had fertility problems conceived naturally. No surgery, no ivf, no technology. Diagnosis and correction of what was already there waiting to be read. We shortened that 17 year gap. We don't just want Isabela to be seen. We want her treated with the best, latest evidence based tools that exist. When we reversed the question, when we stopped suppressing and started listening, everything changed. Femme's approach teaches women to read the signs their bodies are already producing. Cycle charting patterns, biomarkers visible to any woman who knows what to look for. These are not problems to be managed, they are information to be understood. And when a woman understands that information, she becomes an active participant in her own health care, not a passive recipient of a prescription. But knowledge alone is not enough. That knowledge must be connected to current evidence based medical support. This is what FEM Medical management programs does. It trains doctors to diagnose and treat the underlying conditions, not just suppress the symptoms. It brings the latest research into the clinic. And here's what makes this approach powerful. It works everywhere. The same knowledge, the same diagnostic tools, the same protocols. They work just as effectively in Manhattan as they do in a clinic in Nigeria or Tanzania. Because once a woman has this knowledge, she carries it with her. It does not run out, it does not depend on a supply chain, and it requires only basic laboratory settings that already exist in most health care systems around the world. This is not a problem. This is not a program for privileged women. This is health care that meet women where they are in high resource and low resource settings alike. Accessible, affordable, grounded in the best science we have. Isabella is thriving today after 15 years of being told she was a problem. After learning finally to read herself, she is now teaching other women to do the same. The real injustice, it's not just misdiagnosis. It is that millions of women were never taught to read their own bodies. Left illiterate about themselves and therefore powerless. The system did not just fail to diagnose them, it failed to give them the language to even ask the right questions. The knowledge exists, the protocols exist, the breach exists, and we are crossing it every day, one woman at a time. Thank you. Holy See · Expert · Nadia Wolfe [46:52]: Thank you very much. I heard a lot of murmurs that I think we have a number of Isabellas or people who know and care for Isabellas in the room. Really on that many things sounded familiar, I'm sure. So thank you very much. Okay. Our Next speaker is Dr. Danielle Kessner, who is a family medicine DO with expert in reproductive healthcare, women's health and fertility. A fellow of RHRI, she's trained in the FEM and RHRI protocols for the management of women's health. Dr. Kessner offers telehealth services in a variety of US states. You have the floor. Danielle, thank you for this opportunity. RHRI · Physician · Danielle Kessner [47:27]: You know, I was a physician and I was speaking here about the science of fertility based awareness methods. And. And it's when I met Anna Halpin, the founder and CEO of Femme and the World Youth Alliance. And it was her who invited me to this FEM training for doctors. And I remember sitting in the back of the room with my arms crossed thinking, what do they know about evidence based medicine in women's health? This is what I do. I'm family medicine ob. I take care of women all day. And I sat there and Dr. Pilarvey Hill, who's mentored many of us but physicians, was speaking so much truth and giving so much science and evidence, and I couldn't deny that this was the evidence that I needed to really help my patients. I went into medicine to make a difference in women's health, to help women be healthy and prevent disease. And I found that I fell short so often of the mark as an Isabella. I had many Isabellas that I couldn't help fully. And what I say to physicians now, after doing this for about 10 years, is if you choose not to learn the science and you choose not to implement it, your patients are going to know more than you very soon. And many of them. I spoke to a physician this morning from New York and she said, listen, I am often getting patients in my office saying, I read this online and I wanted you to test me for this. And she's so grateful that she's come to our training and she knows what they're talking about. So I think more and more women are becoming informed. So I want to share with you one of my very first cases of implementing this as a physician and how it felt so rewarding to be able to talk to this woman and be able to really help her. And I think what I want you to hear in this story is a lot of women's story. So this case is Allison. And Allison came to me as a 31 year old and she had had one child already. They actually got pregnant on Their honeymoon, and. And they were very happy. And four years later, no more babies came along. And she said, what's happening? I have a regular cycle. I am healthy. What's wrong with me? I've never had any health issues. I take a thyroid medication, and I'm pretty healthy. And on exam, she was pretty healthy. She was normal weight, she was normal height. She had normal blood pressure. Everything looked normal. And she had regular cycles from the beginning. And no bleeding, no significant pain, no abnormal bleeding, no significant pain. Her mom had some thyroid disease, no infertility. And it seemed like I was gonna find nothing. But I came to the course, and I was gonna check all this panel that I was taught to check. So I did. And of course, she had an app. All women have apps right now, right? But they're only tracking their periods on the app. They're not understanding that ovulation is the sign of health. And so she saw. I saw her app, and if you look here, she has regular bleeding pattern, and the app says she's ovulating. So I told her, listen, this is what I've been taught to do. I literally pulled out the book in the room and said, I need to order this blood work. I need to get you charting on an app that uses ovulation tracking. Femme's free. Go ahead and download it, and I'm going to do an ultrasound. So I did those three things. Here's her fem app. Now, maybe none of you are trained in this, but if you look at this, it shows she's bleeding regularly, but she's not ovulating. So the app was able to identify that she's anovulatory or not having an ovulation. So of course she can get pregnant, but otherwise it looks okay. So the other app failed her on her laboratory test. This is a lot of medical stuff and designed for medical people. But just to point out that her FSH hormone from her brain was elevated, her vitamin D levels were low. Everyone has access to vitamin D. We can do that. The TSH is abnormal for a woman that's having infertility. So that's a high number when someone's having infertility. And based on the research, NIH has all these papers, and then the insulin and glucose test was very eye opening. She had three glucose levels above 200, which is a diagnosis of type 2 diabetes in a skinny, healthy woman with regular cycles. Healthy woman. So of course, we treated her hypothyroidism. We actually had to increase her treatment slightly. She had type 2 diabetes, vitamin D Deficiency and infertility, but only because she's not ovulating. So we increased her thyroid medication. We gave her diet and exercise. She admitted she was eating Oreos. She was that closet Oreo eater. And we gave her the metformin. We titrated it again, very cheap, safe medication. I was one of the doctors originally in Tanzania. They had full access to all of these treatments. Vitamin D, prenatal vitamin. And we told her, wait three months to conceive because we want to make sure you have a healthy egg. So she did. Here's her chart. If you look at the dates she conceived, she knew she was pregnant on cycle day 37, when she took a pregnancy test. And here's her cute little baby, right? Which is great. We love babies, right? But when what's most important is that this woman had type 2 diabetes. And she would have become, if we didn't catch this young, she would have become a patient if she did conceive with poor pregnancy outcomes. These are our women that get gestational diabetes, preeclampsia. These are our preterm delivery. These are our preeclampsia. So she would become obese eventually. If we left her, she would have cardiovascular disease, she would maybe get cancer. These are our women that have these. So when we have healthy moms, we have healthy babies, and we have healthy families, and that's why what we do is so important. So thank you so much for being here, and please check us out and become a patient if you have these problems. Holy See · Expert · Nadia Wolfe [53:27]: Thank you very much, Danielle. I'm hearing more murmurs of interest and agreement in the room. We will shortly begin the full interactive portion of our event. So this is a good time to write down questions on your index cards, after which I'll invite members of our team to collect them. So if you hold it up, they'll be collected. But before we do that, I would like to recognize and invite the distinguished representative of Burundi to take the floor to share a national perspective on these issues. We're very grateful to have our colleague in the room. You have the floor. Burundi [54:03]: Thank you, Excellencies. Distinguished participants, the Republic of Burundi, in its constitution places emphasize on Almighty God. It fully associates itself with the importance of today's discussion and expresses its deep appreciation to the permanent mission of the Holy See, as well as to the fertility education and medical management firm for organizing these timely and relevant side events. Ensuring the highest attainable standard of health for women and girls is not only a fundamental human right, but also a prerequisite for inclusive and sustainable development in Burundi we recognize that women's health, particularly in the area of reproductive health, is addressed through state structures, notably the National Program for Reproductive Health. With regard to access to health care, including sexual and reproductive health, the geographical coverage of health facilities have been improved. In particular, free health care has been maintained for pregnant women, women in childbirth and children under 5 years of age. It is worth noting that more than 80% of the population has access to a health facility within a radius of less than 5 km. In addition, innovative initiatives have been introduced to address fertility challenges, notably the establishment of an in vitro fertilization IVF Central Adopo Clinic initiated under the leadership of Her Excellency Angelina Shime, the First lady of the Republic of Burundi, marking a significant step forward in expanding specialized reproductive healthcare services in Burundi. However, challenges remain, particularly in the insufficient availability of equipment and highly qualified personnel. The surveillance of maternal and neonatal death have been institutionalized along with response mechanisms at all levels of health systems. Furthermore, the institutionalization of screening, early diagnosis and treatment of precancerous lesion of cervical cancer should be highlighted. Specific health services for women and girls have been developed including sexual and reproductive health services, mental health services, maternal health services and HIV related services like the continuation of free health care for pregnant women and children under five, the establishment of a center for the screening and management of obstetrical fistulas, the creation and operationalization for the Humura center in Rumonge for the prevention and holistic care of victims of gender based and sexual violence and the delegation of tax to community health workers to bring health care services closer to communities. Burundi therefore welcomes approaches that go beyond temporary or symptomatic solutions and aim to address the root causes of health issues. We emphasize the importance of accessible evidence based innovation adapted to national contexts. This include strengthening diagnostic capacities in improving medical training and promoting approaches that respect the dignity, needs and biological realities of women and girls. At the level of public policy, Burundi remains committed to promoting women's health through strengthening national health strategies, developing partnership with international organization and continuing investments in capacity building. We believe that international cooperation is essential to address existing gaps in research, financing and access to care. To conclude, Burundi remain ready to collaborate constructively with all partners in advancing this common objective. I thank you, Holy See · Expert · Nadia Wolfe [58:39]: Thank you very much for sharing that valuable national perspective and describing all of the efforts to present really increase access to healthcare, which we know is so fragile in so many places and so it's so vital to do that. If anyone has questions that they've written down on their index cards, please hold them up and a member of our team will come and collect them. In the meantime, I will exercise moderator privilege to ask. Actually, I'll ask the full panel. What do you consider kind of the main challenges in bringing this to more. More women and girls so that they can get this level of care? Thank you. FEM · CEO · Anna Halpine [59:19]: Thank you. Thank you, Nadia. Thank you to everyone. I think we can identify gaps on our side or needs that are required. But the most fundamental need, which I think each of us have identified in our remarks, is that once we have an educated and informed woman, she needs access to a medical care provider who can offer this care to her. So PHAM is really working as fast as we can to meet the demand that already exists for medical training around the world. We're expanding our network quickly in the United States, we're expanding as quickly as we can across Africa, but we're training in countries around the world and medical providers are excited and interested to receive this information. Holy See · Expert · Nadia Wolfe [1:00:17]: All right, thank you very much. We have some initial questions to start. Oh, this is one. So we've talked a lot about kind of the reproductive years. I think we have a lot of people with pretty direct experience in the room. So some of these are quite specific and I'll maybe generalize a bit. But for women who are over their reproductive years, how does FEM help them in some of the hormonal loss or the symptoms that they're experiencing, where ovulation, I guess, is not going to be part of this picture anymore, but you still have other symptoms and experiences and things that need to be addressed. So I guess maybe for Dr. Kessner or Dr. De Las, RHRI · Physician · Danielle Kessner [1:00:57]: people of reproductive age that are past their reproductive age. So what's really important in these women is first and foremost diagnosing and treating anything that was missed in their early reproductive years. So we get a very good history about their birth history. Looking back at how big were their babies, did they have any poor birth outcomes, understanding their family history really well in regards to underlying disease like cancer, cancer, metabolic disease. So we have to treat really importantly those underlying things that were missed, but then also help them with the evidence based treatments of hormonal therapy that women are using. And so that's something we do in our women that are in perimenopause or menopause. Holy See · Expert · Nadia Wolfe [1:01:44]: Thank you very much. We also have a very interesting question on the over medicalization of women's reproductive health, in particular in the treatment of infertility. So I guess that would be maybe treating fertility as a disease or not managing it appropriately. I think Is the intent of that question, if one of you would like to speak to that maybe. Speaker 18 [1:02:07]: Okay. Okay. RHRI · Physician · Danielle Kessner [1:02:11]: At the Department of Health and Human Services, one of our research papers was about the. This exact issue of what's happening in infertility. And what we found in a study that we did of women, again, was very much what Dr. Vergino talked about in that we found these underlying disease issues. Pcos, insulin resistance, thyroid disease, and hyperprolactinemia. When we treated those underlying issues, these women very often conceived. Now, there's still a group of women that has ovarian failure, which is less common, but it's there. And so there's still a need in our kind of. There's still underlying issues that IVF leads to ivf. And. But what happens in our women is that we treat the underlying disease, and many of these women conceive. So, yes, there's this over medicalization, but when we do treat the underlying disease, we have less women that have a need for those services. And then as well, like Anna was talking about just the availability and accessibility in every country. So these are access to labs and ultrasound and medications that many women can have access to. So that really helps. Holy See · Expert · Nadia Wolfe [1:03:30]: All right, I think this is just a practical question. Are all femme teachers medical professionals or doctors? So that's probably one for Anna. And is it necessary to use the app in areas where there's limited access to online resources? So if you don't have a smartphone and you don't have the Internet, can you still use this sort of method? Anna? FEM · CEO · Anna Halpine [1:03:56]: Yes. So femme teachers, anyone can become a femme teacher. So this is very important. This is educational certification and knowledge that's available to individuals that are interested to learn this. So they become local health educators. They could be the women in the community that everyone trusts. They could be a mother in the church or the school. They could be a church or teacher at the local school. We even have teenagers who learn fem. And then they want to be femme teachers. They want to be direct peer advocates to their peers. So FEM teacher education is available to anyone. FEM medical training can be used only by certified medical providers. But we invite everyone, let's say who's interested to audit the FEM training as well. So our FEM teachers will listen and learn nurses and midwives. It's so critical to engage and include them in this process. They're frontline line individuals, Counseling, providing education, and being that bridge and link between a woman and her family and her questions and her doctor. So all of this information and all These courses are available. We run these courses in person, but all of our courses are also available online so that we can increase access and make this knowledge and this certification in this knowledge available to everyone. The FEM app is available wherever phones and apps are used. As we all know, that is an increasing footprint. But if you remember the first picture that we showed in this presentation, it's a very beautiful picture because it's one of the women that our FEM teachers in Nigeria have trained directly in Nigeria, and they went into a very remote area of the country, and they work directly with women who don't have access to cell phones. They're not working in that type of area. And so these were local Nigerians who understood the local language. They went to their own communities and they worked with these women directly to transfer this information to them. And what the women is showing, that's the local translator working with this tribe, that they worked together and identified that this plant grew in this area and that this was a way for the women to track and notate the information that they were receiving from the femme teacher. So this is another way that femme teachers are so important. We need women who can access the course and information, who can receive that content, and they're the ones who will then translate that into the communities in the way that's appropriate so that every woman can receive this in their own context, in their own manner, in their own language, from someone trained and able to manage that process with them. Holy See · Expert · Nadia Wolfe [1:07:03]: Thank you very much. We've got a couple of questions. I think everyone has now a greater familiarity than we used to with things like polycystic ovarian syndrome, but it's still not very well understood. So we have some questions for more information, basically about how ovarian cysts are diagnosed, the treatment protocols for treating pcos, and if there's more about the different causes there. So I think it's probably something that everyone at this point probably knows someone. As you said, one in five was. It has. Yeah. So you have the floor? RHRI · Physician · Virginia Della Lastra [1:07:39]: Well, yes, thank you. That's a great question. And actually, yes, now we have described more subpopulation of pcos, and information is coming because we are studying and we are not covering up the symptoms. We are studying the underlying causes of menstrual irregularities. And the more we do that, the more we know. But for that, we actually need to see them and to understand what is going on. And we also need the women to learn how to read themselves, and that is empowering them. And we are doing that every day now. And if you want to be part of it, it would be wonderful because then every woman would be literate and they would know how to when to ask for help. RHRI · Physician · Danielle Kessner [1:08:41]: The only thing I would say that's exactly right is that we would do ultrasound in these cases of diagnosing ovarian cysts. But it sounds like this person who asked this question needs to come and audit our medical training. So become a FEM teacher and come and audit the course so you can hear more about what we're doing. Exactly. Holy See · Expert · Nadia Wolfe [1:09:03]: So I think we also have a couple of questions about really getting access to these sorts of things. So we have a question from someone citing a personal experience who has unfortunately experienced a miscarriage. So I'm so sorry for that, for that person. So how can women find help? What's the way to find a FEM doctor or someone connected with the FEM program and get evaluated? And how? I think, in the broader sense, when we have limited resources, health care deserts all these sorts of things, how are we working to improve that access? And what's fem's vision in that regard? Thank you. FEM · CEO · Anna Halpine [1:09:45]: The FEM tagline is FEM is for everyone. And we believe that. We know the science supports that. And so now the job is to make this a reality so that every woman who wants this information and care can access this. In the United States, like I said, we're now available in 43 states. So we take insurance. You can book your appointment online, and you can have your appointment online. So this is available simply by going to the website Femme Health f e m mhealth.org and you can follow the steps to book your own appointment or to get help or ask questions. We see international patients who don't have a FEM doctor near them, so that is another option as well. In Africa, we're now working with hospitals and hospital networks, medical schools and doctors in 11 countries. So if you are interested and have contacts in Africa and want this information, we would love to link you to the medical trainings that are happening in Africa twice a year. In Asia, we have medical teams and medical schools that we are working with in East Timor, in Indonesia, and starting to have these conversations across the Philippines. But again, every doctor, every person in this room, anyone who's interested, can take the course online, and they can then link us with any of these institutions that want to provide this content through existing institutional platforms or bring their own doctors and providers to us. We have generous donors who are working to make sure that where partners want to participate, funding is not an obstacle. So we really invite you if this sounds like something interesting for you, for your community, for your country, speak to us after this event or go to the website, contact us, provide information, and we can link you to the resources we have or work with you to continue to expand this network over time. Holy See · Expert · Nadia Wolfe [1:11:55]: Okay, I've got a pair of questions kind of on opposite sides of the issue. We've talked a lot about fertility outcomes and achieving pregnancy. So someone has asked about getting the word out about these natural family planning methods or fertility awareness based methods and of course the them protocols and treatments so that women don't feel like they have to rely on these assisted reproductive technologies like ivf, which of course raises serious ethical concerns from a Catholic perspective and more generally. So when they don't have the knowledge, how can we kind of get the word out to them and explain they might have other options here and things that there is a possibility of restoring health? And on the flip side of that, so someone has raised that there's a high failure rate of avoiding pregnancy with natural family planning methods. So I don't have the source of the statistic, but it's been listed as, I think 33 pregnancies per 100 women per year from natural family planning methods when women are not trying to become pregnant. So how do we explain the kind of gap on that and how do we help women to identify achieve their fertility goals through this program accurately and successfully? RHRI · Physician · Danielle Kessner [1:13:11]: Sure, because I am super passionate about it, because I went into medicine really with the idea of like, how do you avoid pregnancy? And so my idea was I did what I was taught. So I prescribed all the birth control that I could think of and switched the method as often as women wanted to switch, which we know on average women will not continue their method for over a year. They will typically discontinue before the end of the year. So when in my office I had the CDC guidelines on a poster and it showed that fertility based awareness methods had a failure rate of 24%. But when I picked apart that research and when we've picked apart that research, we find that they've mixed together all of the calendar methods and the fertility based awareness methods that actually are based on research. So when you're using a method that is backed by research and does have included biomarkers that are evidence based, that track mucus temperature, LH testing or other hormone monitors that check the four different hormones, we are able to have good accuracy in avoiding pregnancy as well when that's indicated. So the numbers vary based on the study. But upper 90% are able to avoid pregnancy when they need to, for, for whatever reason they need to. So that is available. And then for the first question, just send the link to your friends. If you have a friend that needs treatment for a history of miscarriage, just send the ww.femhealth.org and tell them to click on schedule an appointment. And that's the best way to do that for now. But then again, send other your doctor friends, send them to our training and bring us to your country to teach your doctors there or reach out so we can bring your doctors to us. Thanks. FEM · CEO · Anna Halpine [1:15:04]: Add one more item that we've realized in the research, which is that when health is restored in a woman, when a woman has a healthy and normal cycle, then it is straightforward, let's say not always easy, but it is straightforward for her to manage her fertility as well. So it's very important to remember health is for everyone and fertility is a sign of health. So if a woman is struggling to understand her signs, then she will struggle to use that information to avoid or achieve fertility. So when we can restore a woman's cycle to health, then she has very effective achieving and avoiding success and, and rates in that. And so that's another very important factor is that women that, that knowledge that we want every woman to have also empowers her. If she can work in collaboration with a trained medical provider to restore her health, that's really the first step. And then managing her fertility, whether it's to delay or avoid pregnancy or to achieve pregnancy, that is, that sets her up for success. Holy See · Expert · Nadia Wolfe [1:16:20]: Thank you for that. Okay, we've got a couple of questions, I think really about the weight issue. So we have a question about the perspective on the use of the new GLP1 drugs for PCOS. Is that a band aid or is that getting toward the, to the root cause? And also about sugar in the food supply. So I cover health issues. I'm always hearing about health promotion and food security and also nutrition and not just the undernutrition, but malnutrition in excess foods or foods with a lot of salt or sugar, things like that, and kind of striking that healthy balance. So what do you respond to that on the kind of diet, exercise, how do we do that in a food system where we don't have a lot of control over what's in our food and then medication help. RHRI · Physician · Virginia Della Lastra [1:17:13]: Thank you. That's a really good question. And actually it comes down to the thought of do we have a protocol fits all or we go person to person and actually with that regard, it's the same argument. It's we see the patient and we assess them and based on what we find, we make the treatment. There's not a protocol fits all. There's not a head that fits all. We don't hammer their heads to fit into the head. If we measured, we assess and then we give treatment. So about we have to assess how the body is processing sugar, how her other issues are, her comorbidities, their family history, their symptoms, what is she feeling, what is she actually consulting about. And based on that, we see what the best treatment for her is. This is a personalized approach. RHRI · Physician · Danielle Kessner [1:18:28]: The GLP1s, they are a tool and they're a really great tool. But what I see a lot of doctors using is them alone and not diagnosing and treating underlying disease. So many patients come and say, I'm already taking a GLP1 and I've had some weight loss, but I still have hair and I still have acne and other things. And so alone, no one. We treated the obesity symptoms, but we didn't treat the underlying issue. And so the food is very important. So it is a big part of our treatment. It's definitely a lot of women have a lot of guilt or shame around what they've done. And so our focus isn't you have to go exercise and eat healthy and you have to change everything today. It's first of all assessing where you're at in your food. We have a lot of patients with eating disorders as well, so we have to be careful and just they've developed these, these maybe because of their hormone imbalance, many times trying to fix what's happening inside their body, they'll restrict and different things. So we have to be careful about that just sending them. But we do use a dietitian resource, we use exercise coaches, things like that. And then we do use medications. So in combination, we just did an obesity course for physicians that was really great. We got a lot of great feedback and used some of the best research from Dr. DeFronzo, who's the researcher on insulin resistance and really looking deep dive at his papers and often using a combination of different treatments for patients that do include GLP1s but not alone, and then trying to remove them if we can once they've met their goals. So that's a more deeper dive. But thank you, Holy See · Expert · Nadia Wolfe [1:20:10]: thank you. And just thinking from the perspectives of possible Isabellas, just the weight loss is not going to solve a lot of other symptoms. Right. You're going to, I mean, there's so many other things that women could be experiencing. And frankly, between the two, sometimes that's more of an impact on your daily life. So. Yeah, so thank you very much for those answers. I think it's so interesting with the development of medications and how do we use them? Well, right. So they're a tool. They're not the only tool. They're not the substitute for everything. So that holistic approach is really important. Okay. On a more technical note, which I think is going to go to Anna, we have a couple questions about digital governance strategies and the kind of how, you know, how does FEM compare to other apps on maintaining privacy, data sharing, things like that, and how is that used? FEM · CEO · Anna Halpine [1:21:02]: The FEM app really is built and structured to the highest privacy settings in the industry. Our developer at the time said at one point, when we were investigating this with someone else, I would take a bullet for our privacy. So what does that mean? A lot of apps leak privacy data because you have the ability to sign onto your app through Facebook, through Gmail. These are access pathways that are convenient, but those. Each of those convenient access pathways leaks data. That's where this happens. Other apps can take all your data and sell it for marketing and advertising. So you have to read an app's privacy policy to see what they do with the information they take from you. Apps will use the information you give to them to directly market information. So if you get on an app and now you're getting ads through through the app or through your email, you know that that is a marketing aspect, and the app is making money off of those areas. So FAM really uses the highest coding privacy guidelines. We adjust that privacy perspective as we go. Fem, for instance, does not have the ability to link a user's name and their data. That is how we have set it up. So the data is owned by the user. The data is anonymized immediately as soon as it gets off the user's phone. And these are ways that we follow those data privacy policies to make sure that women can use this information, they can receive this help to interpret and understand their own bodies. They can go from the app to try to reach out to a FEM teacher, a FEM medical doctor, or get more help interpreting their own cycle on the app. But those are decisions that each user has the option to make. FEM doesn't sell or market any of the information. We don't give it to third parties. We don't use it to even market other aspects through fem. So it really is one of the most secure privacy apps in the industry. Second to that, I would say it's really one of the most, if not among the top science and evidence based apps that exists in the field of women's health. So those are, of course, statements that you as users have to evaluate, but I really invite you to do that. Women's health apps are becoming an enormous business. They have marketing and capacity to hundreds of millions, if not billions of users. And so it's really important for you to have an understanding on your own about what kinds of privacy information you're looking for, but also what kind of health or scientific information you expect or want to see in an app. We believe FEM fulfills all of those guidelines in the strongest possible way, and we're always happy to receive more input and questions. Holy See · Expert · Nadia Wolfe [1:24:05]: All right, thank you. And as we're approaching the end of our time, I've got a couple of questions that I will reframe a little bit. So something about in the reproductive health sphere, I think we often see focuses on when all you have is a hammer, every problem is a nail with contraception or kind of expanding on rights based only without kind of the broader context or understanding or vision of health. So how does FEM approach making sure that we defend the right to health in a holistic way and also address those who might look at this critically and say, this is, you know, you're saying it's beyond band aids, but sometimes we need the band aid or we have to, we have to have those quick solutions and we can distribute this very easily across, you know, developing countries or things like that. So how would you answer those, those questions? RHRI · Physician · Danielle Kessner [1:25:00]: Short answer is the research continues and we're committed to following it wherever it goes. And so we will continue to do that over the years and we will continue to look at the newest developments as they arise. I am so proud to be on the team. Anna has really led this and her commitment to privacy. As she said, many people have offered to buy this app, but it's not about the money. It's about changing the standard of care and women's health. And so that includes following the research wherever it leads, over time. Thank you. FEM · CEO · Anna Halpine [1:25:44]: I think just to follow on that and maybe to further expand on the question. FEM is committed to the highest standard of health care for each woman. That is our mission, that's our goal. We believe that it's possible to provide the highest standard of health, the highest standard of health education, and the highest standard of health care to every woman. And also to find ways to make this accessible and affordable through network partnerships, through hospital and education partnerships. So FEM is committed to that. We think that women deserve that and this is our commitment here at the UN and to our patients every day. Holy See · Expert · Nadia Wolfe [1:26:33]: Please join me in thanking our speakers. Thank you so much for this very interesting, the very interesting presentations on the policy, the research and providing care to women and girls. I think it's a very exciting time and hopefully we can see more and more of this level and quality of care there, get to more and more women and girls who need it really through over the course of their lives. So we're very grateful to learn about this and hope that this can maybe lead to further knowledge awareness, awareness raising, knowledge sharing and policy implications. So thank you very much for joining us. Thank you to everyone who attended here as well as those watching online. We'd ask for those who are in person to please exit the room promptly so that we can clear for the next event. And thank you so much for your time and attention.