For Health Impact, Fix the System

January 2021 marked the exciting start of a new term for PSI’s Board of Directors. We are conducting interviews with the Board members, delving into their backgrounds, personal and professional journeys, as well as their call to PSI and its mission to deliver consumer-powered healthcare. 

Below, we talk with  Beverly Winikoff, MD, MPH, the President of Gynuity Health Projects.

PSI: Tell us about yourself, Beverly. Your background, areas of expertise and your professional journey.

BW: I am a native New Yorker, born and bred. I went to an all-girls high school which was formative for me, because I saw that women could be anything that they wanted to be, given the right environment. My favorite subject in high school was history, I went to Radcliffe College at Harvard University and majored in Social Studies, a combined program in which one could choose from all the social science offerings within a theme. My thematic focus was international relations. After college, I spent an impactful year teaching American History to teenagers in Brazil and learning Portuguese. Working and traveling internationally was thrilling because of the richness of things to discover around the world: the varied historical imprints, the many kinds of ways that people live and organize themselves, the many languages people speak, how people can communicate from one language to another.

And still somehow, I ended up in medical school.

I chose med school, in part, both because my mother had always encouraged that choice and because I developed an interest in the conjunction of health and social issues, particularly how different health issues play out in different places. I will say that medical school was the low point of my academic career in terms of loving what I was learning. But I did love epidemiology, as I also like numbers and figuring things out using data, which keyed in well with my interest in seeing how things work in other places. I found people more fascinating than microbes, however I am fascinated by infectious diseases because human behavior is so centrally involved.

That is how I ended up being a public health professional.  

I arrived at my professional track because of my natural inclination to be a feminist, which came from my all-girls high school where women could do everything. It was a rude awakening when I got to the “real” world and saw how women were often treated. Having had some experience being freed of that burden, I was ready to fight for it.

While at the Harvard School of Public Health, I started working on nutrition with a focus on the social determinants behind why women gave up breastfeeding. I saw it as a feminist issue. I was recruited by the Rockefeller Foundation to work on their nutrition programs. During that time, I was asked to testify to the U.S. Senate Select Committee on Nutrition and Human Needs in 1977 on why the U.S. should spend more money on childhood nutrition. One of my fellow witnesses in the hearing – Dr. Phil Lee, at that time from the University of California – told his colleague Dr. George Brown at the Population Council about me, as they were looking to recruit a woman who could work on natural methods of fertility control, including breastfeeding.

I spent 25 years at Pop Council; it was a really good match. I worked a lot on contraception and breastfeeding. We even won USAID’s first large grant to study why women were abandoning breastfeeding in different countries. As part of my work, I also participated in the research and meetings on contraceptive development. I’ll never forget that in the mid-1980s, there was a meeting to learn about a new molecule being developed that could induce an abortion without requiring surgery. And my reaction was: Whoa! This is important! But there were also suggestions by the community to develop it for its contraceptive potential instead. It became a full-time obsession for me to make sure that this option for abortion didn’t go away. I said, “Why do you want to make it a contraceptive when it can make an abortion? We don’t have anything like this. Don’t divert it: use it for its purpose.”

I remember we had a guest from India who did a lot of work with poor, rural women. She said, “My people are asking me for a pill for abortion, is there such a thing?” And I realized this was not just for American women, this was going to be for all women. It was a full-time occupation for me after that; in many ways it felt like a crusade. People were too afraid to let it move forward, so I worked alongside others to make sure it did.

It has been so fascinating to see the maneuvers and the fights over so many different aspects of the debate. Part of it is legal, part of it is regulatory, commercial, biological, part of it is international, part of it is feminist theory. So many things came together for me in this, including the founding of a new nonprofit, Gynuity Health Projects. We had a few donors who were very committed to this work, and they wanted to support me in setting up.

PSI: Your story is impressive. How did you come to know PSI?

BW: PSI to me was an influential international player. I knew the mission and the organization, including some reproductive health staff, particularly the Global Medical Director at the time, Paul Blumenthal. Through Paul, I learned about PSI’s work and its private sector orientation, which struck me as progressive and impactful.

In particular, I knew that PSI was active in distributing high quality medical abortion products in several countries. That was very important to me. I wanted to engage with a group with a bigger reach than we had at Gynuity. PSI had programs and products and could distribute both to people who needed them in alignment with local laws and policies. PSI was tackling real world issues by connecting people with the solutions they wanted and needed.

PSI: That goes to the heart of PSI’s consumer-powered healthcare approach. Can you speak a bit about that connection?

BW: Since going to medical school, I have been very skeptical of the way that health care is provided by the professional medical field. I believe consumer-powered health care is an antidote. People should be allowed to make their own choices; but it is more than that. We need less top-down medicine and a greater distribution of power from the provider to the patient. Yes, it is worse not to have any medicine, but the advanced practice of it needs to be changed, particularly the way it is proffered in the United States. I believe my commitment to feminist ideals helped me to see the flaws in the medical system. I believe women have the agency and power to make their own decisions, but the system often won’t let them. I experienced this myself when I had my first child in a birthing room in a hospital, where there still was little attempt to meet my needs in the birth experience. While everything in life is a compromise, those compromises should be reasonable when it comes to medical care. I decided to have my second child at home.

PSI: You’re in your last year of service on the PSI Board, what were some highlights of your tenure?

BW: I learned a lot from PSI’s CEO and President Karl Hofmann about leadership, which was instructive to me as I’ve been running my own mini version of PSI. I enjoyed the companionship of the people on the Board and really regret not seeing people over the last year. 2021 would have been the year that the Board visited some of PSI’s country programs. I greatly enjoyed seeing PSI programming in Cambodia and Kenya and learned a lot on those trips that has stuck with me. For example, in Cambodia, we saw the instrumental role PSI played in transforming safe abortion access. Particularly exciting for me was learning of PSI’s work to launch the first safe, high quality medical abortion product in the country in 2010 and to see medical abortion’s wide availability and acceptance in clinics and pharmacies in the present day.

PSI: What is a fun fact about yourself that hasn’t come up in our conversation?  

BW: I have spent a huge chunk of my time during COVID taking ballet lessons, dancing five or six times a week. I have been taking adult ballet lessons for at least six or seven years now, but this year I finally got my first pointe shoes (since age 10), which hurt a lot! Classes were online, but we also created a pod of four – a sociologist, a banker, the ballet teacher and me. It was a nice way of developing and nurturing friendships that we were all too busy to have before.

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