In this week’s episode of Lessons from Leaders, Lynne Gilliland invites Dr. Rehana Ahmed—Senior Reproductive Health Consultant for the World Health Organization (WHO)—to share her personal story. Dr. Ahmed explains how she approaches challenges in her field and discusses the importance of courage in decision-making. This is an abridged version of Lynne’s interview with Dr Ahmed – watch the full video embedded below.
So welcome, everyone, to another episode of Lessons from Leaders. I am very honored to have Dr. Rehana Ahmed with us today. She has such a wide background; she is a medical doctor; she’s been very instrumental in working on reproductive health in Pakistan and elsewhere. She is currently, amongst the many things that she’s doing, an advisee for WHO. She’s on the board for PS Kenya. She founded some organizations in Pakistan. So welcome to you, and if you would start out by telling us a little bit about your background.
Dr. Rehana Ahmed:
I am a medical doctor, and most of my experiences are from that background. When I was an intern, what happened was that the very first emergency case that I admitted was a botched-up abortion, and the young girl despite all our efforts (she was only 16 years old) she died. And that left a huge impact on me. Subsequently, a number of women came in with different complications all related to delay in seeking care, and also not getting care in the community. These were women who came with uncontrolled bleeding, with severe infections, and even convulsions. It was very clear to me that there were missing pieces in our care, in our community health system.
And why were these women suffering? It was something that needed to be prevented. Prevention was something that was not being talked about, along with having poor services or lack of services. Then as I moved from the internship into actual clinical practice, I came across the same problem where women came in with unplanned pregnancies. We counseled them and we tried to ensure that they got contraception so that the next pregnancy would be delayed or there wouldn’t will be the same issue of unplanned pregnancy.
The clinical practice grew and the clinic itself became quite popular, and the World Health Organization included it in the feasibility studies it conducts in different countries on new contraceptives. Medical students and nursing students would come to our clinic for clinical training and family planning, because we had the critical mass of clients coming to us. And then at the same time, NGOs and donors would stop by on their visits. And they founded this center of excellence for training of medical professionals in this particular area, which was really not being focused on in the larger hospitals and in larger settings. So, this clinic became very popular as a result of that.
Then in 1991 something interesting happened. Population Services International came to Pakistan and founded an NGO and a joint venture for social marketing of condoms. Now that joint venture also took off very well, and it was for family planning. It was at that point, a few years later, that I was recruited by this joint venture to add female methods of family planning. Now, interestingly for female methods, you can’t sell them just over the counter, you do need a provider and it has to be a trained provider. At that point when I joined, I had a team, a dedicated team, and we now pursue training of these providers and formed a very large network of reproductive health providers. Now these are existing clinics. So, what we did was add the preventive service and supported them in being able to give a quality service to low-income women. So that’s how my background has shaped out, with all these events that took place along the way.
Don’t you have a personal philosophy that—so Dr Rehana and I spoke before, full disclosure, and she was telling me that she sees challenges as either a mystery or an obstacle.
Dr. Rehana Ahmed:
I think the biggest mystery challenge is why women don’t use contraception and opt for abortion. To me, that’s a mystery that needs to be solved, because it just shows that we have not understood the pain she goes through, the fears that she has. We have not really understood that and until we solve that mystery, we won’t be able to get women to use contraception, which really is the need because we have a large youth population—young people, women under 30—and nearly 50 percent of these women are not using contraception. We know for a fact that if a [heterosexual] couple doesn’t use contraception for a year,85 percent end up with a pregnancy. If it’s an unplanned pregnancy, then we know that either they’re going for an unsafe abortion or they’re having many children, and both are really not optimal outcomes. That reflects life plans, right? The challenges are there, and we do need to categorize them, and we do need to then take actions accordingly.
I’m imagining the challenges that there have been for you to be working in this sector in Pakistan, or in East Africa, and so what’s coming up for me is your own courage, to be a leader as you have been in a sector that’s not probably always welcoming. Where do you think you’ve shown courage and what does courage have to do with it?
Dr. Rehana Ahmed:
So really, largely, it is to do with taking timely action—taking decisions. One of the things I’ve found, very often, is that people take too long to decide—and now there’s no right or wrong decision. You have to take a decision and move on. And that’s where courage is required. You can think about it, but you also have to bring it to a close. And closure is not easy, it requires a lot of courage. Often you have to give bad news and you have to put on your professional face and go and do it. Even though you’re quaking inside, you know that it has to be done and cannot be put off. So, you can’t really be like an ostrich, you have to face it and get on with it. That’s the commitment, the development.
So, looking back, what do you wish you knew when you started, that you know now?
Dr. Rehana Ahmed:
I think the best thing I did, and I continue to tell anybody who wants my advice, is invest in yourself. Because you see if you do that and you keep yourself updated—you become a leader in your field of work.
So, what I say to myself is, ‘stay steady.’ You build a foundation then don’t move away. Build the walls. Build the roof, put in the furniture, and put it all together. Because currently what I find is people do keep moving and they’ve built a little foundation and they go away and do something else. So, they’re continually making foundations, but then the rest of the structure is missing. I think that is the main lesson that I had, and that is take a decision and then go all the way and with commitment. Because really if that commitment is missing, you will always be looking for something new to do. You can add other things, but don’t lose your main focus. I think I’ve managed to do that, stay very focused.
They say begin with your passion. I think passion comes further down. It doesn’t always begin with the passion, but once you are all working away at it, chipping away at it, the passion does develop. That’s what I have learned.