By Alexander Kozul-Wright
GENEVA, Mar 22 2023 – Given the complex interplay between geopolitics and financial markets, Russia’s invasion of Ukraine in February 2022 sent shockwaves across the global economy. Admittedly, the implications both within and between countries have varied. However, there were some common denominators, including higher commodity prices.

Price disruptions were particularly severe for ‘soft’ agricultural commodities. During peacetime, Russia and Ukraine produced a large amount of the world’s grain, supplying 28 percent of globally traded wheat and 75 percent of sunflower products. Before the war, they were also among the world’s top providers of barley and corn.

After the start of hostilities, exports of grain were severely disrupted. For four months, Russian military vessels blocked Ukrainian ports. Supply constraints triggered market volatility and price rises. Wheat, for instance, reached a record high in March 2022. This left millions of people, particularly in developing countries, at the frontline of a food crisis.

Then, in July 2022, two agreements were signed: one was a memorandum of understanding between the UN and Moscow to facilitate global access for Russia’s food and fertilizer exports; the second was the Black Sea Grain Initiative (BSGI), signed by Russia and Ukraine, facilitating the safe export of grain and other foodstuffs from Ukrainian ports via the Black Sea.

Brokered by the UN and Turkey, the BSGI opened a protected maritime corridor through Ukraine. The agreement assuaged concerns about global grain supplies and led to price declines. Over 900 ships of grain and other foodstuffs have left Ukraine’s major ports since last summer.

Prior to the conflict, between 5-6 million tons of grain were exported from Ukraine’s seaports every month, according to the International Grains Council. By the end-2022, Ukraine had once again reached its historical exporting capacity (at just under 5 million tons). Production responses elsewhere also helped to increase global supplies.

Still, Ukrainian exports to developing countries remain below pre-war levels. And while unblocking the trade corridor did help to address food insecurity in 2022, export backlogs were significant. Today, grain prices (while they have come down in recent months) remain elevated.

Against this backdrop, negotiations between UN officials and Russian Federation representatives – headed by Deputy Foreign Minister Sergei Vershinin – kicked off in Geneva last Monday on a possible extension of the BSGI. Subsequent to a four-month renewal last year, the deal was set to expire on March 18^th.

Earlier this month, UN Secretary-General Antonio Guterres highlighted the deal’s importance. He stressed that “it contributed to lowering global food costs and offered critical relief to people…, particularly in low-income countries.” Ukraine’s president, Volodymyr Zelensky, also called for the initiative to be extended.

For their part, Russian officials argued that ‘hidden’ sanctions – targeting fertilizer firms and the country’s main agricultural bank – have undermined commodity exports. By way of background, exemptions were carved out for some Russian food and fertilizer products after Western sanctions first targeted the Kremlin in February 2022.

In Geneva, delegates stressed that over-compliance and market avoidance by private companies had resulted in Russian commodity exports being under-traded. They noted that sanctions on its payments, logistics, and insurance systems created a barrier for Moscow to sell its grains and fertilisers in international markets.

In response, they requested that national jurisdictions enhance exemption clarifications for food and fertilizers products. “I think it’s a fair request,” says Jayati Ghosh, professor of economics at the University of Massachusetts, Amherst. “Hidden sanctions are impeding Russian financial transactions and undermining allegedly exempted exports.”

When the BSGI was last renewed in November, Russia threatened to renege on the deal unless hidden sanctions were addressed. While they eventually agreed to an extension, Moscow has since insisted that its own agricultural exports (notably ammonia) be included in the BSGI as a condition for its renewal.

Under the deal’s latest iteration, Russia’s pre-condition went notably unaddressed. Moscow, in turn, agreed to extend the deal for just two months. Ukraine, meanwhile, issued conflicting statements on the matter. Over the weekend, Deputy Prime Minister Oleksandr Kubrakov tweeted that the agreement had been extended for four months.

So far, the UN has not specified the length of the renewal, but “this could be the last time an extension is agreed,” according to Ghosh. “Russia is probably going to use this latest agreement as a threat. Rejecting a third extension in the spring may force the international community to listen to their concerns”.

IPS UN Bureau Report

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By Nyuma Mbewe and Swati Krishna
LUSAKA / PUNE, Mar 22 2023 – Despite being both curable and preventable, the TB pandemic is a global health crisis and a leading cause of death worldwide. COVID-19 brought into sharp focus how women bear the brunt of pandemics. In 2021, over three million women and girls fell ill with TB, resulting in 450,000 needless deaths.

As women leaders in global health, on this 2023 World TB Day, we believe that systematic and sustained investment to tackle gender-related barriers is essential to get the world back on course and end TB by 2030.

We must confront the root causes of gender inequality and reshape the power dynamics across health systems, promoting the voice of women in their own care, to reach our global goals, for a safer, healthier world for all.

To better understand how gender norms and inequalities increase the burden, stigma and discrimination on women resulting in the failure to prevent, detect and treat TB infection, adopting an intersectional lens is a necessary step.

Differentiating the impact of TB based on the intersection of different determinants such as sex, gender, ethnicity, age, location and socioeconomic status can improve health planning, along with confronting legal, cultural and social barriers that are preventing improved health outcomes.

Using evidence-based knowledge, we can tailor interventions and care strategies for populations with increased vulnerabilities and curb the spread of the disease.

The Global Fund data has shown that women often face additional barriers to accessing TB diagnosis and treatment in countries with high rates of TB. Women generally wait longer than men for diagnosis and treatment, and may be discouraged from seeking care by a lack of privacy or child-care facilities in health services.

In some contexts, women have been less likely to undergo sputum smear examinations due to cultural norms and perceptions about femininity as well as gender dynamics of service provision. Young women in high HIV burden settings face increased TB risk.

The stigma, discrimination and exclusion associated with HIV amplifies and is amplified by TB-related stigma, especially for key populations. This impacts TB detection, access to reliable health services and treatment adherence.

It is past time to prioritize measures that emphasize women’s fundamental role in building resilient health systems and workforce. Globally, women are 90% of frontline health workers, and 70% of the overall health workforce.

Despite challenging working conditions, and lack of formal representation, women continue to show outstanding leadership across the health sector. Evidence shows that community-based and ambulatory care results in better TB outcomes compared to hospital-based or inpatient care. Yet their contribution is often undervalued, underpaid, and they occupy less than one quarter of management roles.

Women are the vast majority of nurses and community health workers (CHW) that play a vital role in the delivery of TB care and people-centered approaches to treatment, yet their voices are more often than not absent from decision-making fora. Valuing women, working at all levels of health, including CHWs is essential for the prevention, detection and treatment success of TB.

Making health systems fit for purpose means promoting gender parity in management, leadership, and governance. Mechanisms that harness the talent and expertise of women in the health workforce will result in better health systems, and support improved health governance.

Women in Global Health is committed to work with global health institutions to ensure that structural gender barriers are addressed and promote accountability for resilient health systems that improve health at every level.

Recent history has taught us that pandemic responses have often overlooked the specific needs of diverse women. Health leaders must promote and create opportunities for gender transformative leadership to strengthen health systems and ensure quality services. It is urgent to both recognize and include women and people of all gender identities for more impactful health interventions.

As we commemorate World TB Day, we appeal for increased efforts and stronger commitments to promote gender parity in decision-making across the health sector. This must be matched with sustained investments in gender transformative policies and programs to build resilient health systems and a workforce that adequately represents the diverse communities it serves.

Dr Nyuma Mbewe, a member of the Women in Global Health, Zambia Chapter, is an Infectious Diseases Physician with Zambia’s National Public Health Institute and is based in Lusaka, Zambia.

Dr Swati Krishna, a member of the Women in Global Health, India Chapter, is Young Investigator at KEM Hospital Research Centre and consultant to the iDEFEAT TB project of the International Union Against Tuberculosis and Lung Disease. She is based in Pune, India.

IPS UN Bureau

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