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nt-weight: 400;”>A graduate of Pierre and Marie Curie University in Paris, she is president of FFER (Fédération Française d’Etude de la Reproduction: the French Federation for the Study of Reproduction), and until recently served as president of France’s Society for Reproductive Medicine. Nathalie is also known for advancing scientific and public debates over infertility prevention and testing. 

Dr. Massin’s clinical base is the Créteil Intercommunal Hospital Center, in the suburbs of Paris.  As head of the Reproductive Medicine Department at Créteil, she has pioneered programs to make fertility counseling and services more widely available. In addition she is an associate professor at UPEC, the University Paris-East Créteil. Here are edited highlights from her interview with World Woman Hour. 

Q: What brought you to this field, and why are you passionate about it? 

Nathalie: I knew I wanted to be a doctor when I was nine. It was a shock when I felt my mother was going to die bad pneumonia. The second shock I had was in my second year of medical school, when I saw my first embryo through a microscope, and then the transfer in the uterine cavity of a woman who was trying to have a baby for years. I knew at that time that I wanted to be a reproductive specialist acting for women’s health. Reproduction is one of the main parts in the life plan of a woman. It impacts the well being of women as well as their children. 

Q: You have advocated for education about reproduction and fertility, both in schools and for adults. Could you speak to why this is important? And perhaps point out some things that are not widely known? 

Nathalie: Women need empowerment. It can be provided by good information about all the things they want to have in their lives, and one of the most important things for a woman is having a baby. Fertility education for both boys and girls, as well as information for young people, is empowerment for creating the life they want—including a child, if and when they want. 

For example, oöcyte cryopreservation could deliver women from the pressure of the inevitable decline in fertility with aging. I want women to be aware of what is possible in terms of reproduction, so that they can make more informed decisions to help them to plan their lives.

The new generations want more and more to plan their lives, and while society puts a lot of pressure on women to conceive a child, the chances of success are unfortunately getting lower. There has been a global decline in birth rates, mainly due to the postponing of the desire for pregnancy to a later age. Today, women are studying more and improving their socio-economic situation. They also still feel young at a higher age, but they are exposed to a decline in fertility as time goes by. This can be aggravated from prolonged exposure to substances that are endocrine disruptors, which cause damage to both women’s and men’s fertility.

Q: What does the future of health care look like to you? Will women play more of a leadership role in the system; will there be advances in reproductive care?

Nathalie: The future is already here. In the last two decades, the health care community has changed a lot in France. Women are taking more and more positions, but still usually lower positions. However, women patients can now choose a female health care professional, and this can make a difference for them. Overall, with more women in the health care system, there is more empathy and more patient-centered care, and this is welcome for both men and women. 

Also, France has made a big step with the evolution of our policies. Since September 2021, female couples and single women are now allowed to have access to fertility treatment, as equally as heterosexual couples. So no woman is left out in the journey of being a mother, when we now face a global decline in birth rates.  

Q: What changes still need to be made? 

Nathalie: We put a lot of pressure on women, actually, but we need men to take responsibility. First, because they are a big part of the postponement of having children. It’s not only their partners who delay this. And second, because men are directly involved in the cause of infertility in 50% of cases. So we will need to change our way of thinking. Reproduction is not only a woman’s program. Men are important to support reproduction in our modern families.

And it has been proven that young people and adults’ lack of knowledge of fertility is an issue, for both men and women. Also, I have been overwhelmed to see that in access to health care around the world, women and girls are disproportionately impacted by lack of resources.

Q: Looking back at your career journey, could you share some personal lessons you have learned?

Nathalie: During my journey I learned it’s difficult to be a woman in a man’s world, and to be at the same time a good mother and a professional. This means that you have to put your best foot forward in your agenda every day, so you really need to be passionate about your work to get the opportunities you deserve.

Persistence is important, too. After I raised my children and developed my reputation in a public hospital, when I finally asked to become a university professor, I was told I was too old to run for it. It was really disappointing, and although the answer was not what I was looking for, in fact I felt empowered to take action and go further. I developed a school for advanced training in ultrasound for female fertility evaluation, in addition to a university diploma. I took national action with health care associations, and eventually I became the president of the Society of Reproductive Medicine and now President of the French Federation for the Study of Reproduction. 

The lesson is not to give up. When you’re passionate about something and listen to your intuition, you will find a way to do what you want.

Q: Dealing with setbacks or failures is certainly important. Are there particular challenges you have faced in the area of providing good health care for your patients? How did you deal with these? 

Nathalie: After 15 years of reproductive medicine, I was still upset about our failures, especially when I met couples who came too late or others who waited three or four years before having access to fertility treatment. Moreover there are simple and non-invasive tests that can be done with some techniques. When we created a fertility checkup for women with my colleagues at Centre Hospitalier Intercommunal de Créteil, we worked rapidly and understood it made a difference. Every acknowledgement we receive from women who need advice on their own reproductive potential, in view of their personal plan of life, convinces us that this is the right way to empower a woman.

Q: Speaking broadly, could you name some ways in which women can lead change for a better world?

Nathalie: Women can lead change for a better world by giving the same education to boys and girls.. Women have a key role in general for children’s and adults’ health, starting at conception, and we need to inform them  

Q: Your advice to young women in any field, at any stage of life? 

Nathalie: Go ahead and ask for what you deserve. Don’t forget, you can ask for help. Throw away the unfair judgments you are facing. And above all, don’t forget about yourself.

Q: What could they do right now to make a difference?

Nathalie: If you are a young woman or a young man, you probably will ask yourself if you want a baby in your life. One of the important things is to get information early in your life about what it is to have a child and the problems you can have. Conceiving a child is mainly something that happens naturally, but sometimes not, and there are many things in life that can postpone a pregnancy. So it’s important that you have all the knowledge about fertility you can, to make your life like you want—with or without a child.

Q: If you had a billboard that millions of people would see, what message would you write on it? 

Nathalie: I would write, “Knowledge and a healthy lifestyle go hand in hand when it comes to fertility.”  

> has led efforts across the United Kingdom to improve women’s health care in deprived urban areas. Starting with her own work as a physician in Bradford, England, she expanded the campaign by building out a U.K.-wide network called the Primary Care Women’s Health Forum. For this she received a prestigious award last year, the MBE (Member of the Order of the British Empire), given at the annual Queen’s Birthday Honours. World Woman Hour in collaboration with Organon now honors Anne as one of 60 women leading change in the world. 

Q: Anne, how did you come to do the work you’re doing. Can you trace your story for us? 

Dr. Anne Connolly: When I was very young, I was in a car accident and had to spend a couple of months in hospital, so I got a fascination for health care. Later I was lucky enough to be able to go to medical school, where I started to be interested in women’s health care. Once I had qualified as a general practitioner, my husband and I went to work in a mission hospital in rural Zimbabwe. I looked after the women’s health and maternity sections of the hospital. It was there that I really started to understand the awful experiences that many women had to tolerate, when they didn’t have access to good health care and when they also had to bear the main burden of care for their children and families. 

Then, back here in the U.K., we’ve worked for the last 35 years in inner-city Bradford. Bradford has a very rich culture and it’s very diverse, but there are many people who are very deprived. I wanted to continue to develop my women’s health skills so I took on extra training for that. And, in the out-of-hospital setting, I was fortunate to be supported by local clinicians and local teams so that we could really start to deliver care that was right for the women in the community

It then became obvious that what I was doing for my own patients also needed to be done across the whole system [in Bradford]. And then it became apparent that many other clinicians around the country had this passion for women’s health. Knowing how under-resourced and undervalued women’s health care has been, we saw that we should start a network. The network would give support, deliver education, and help us to improve the care that women were getting in their own local settings. So two of us developed the Primary Care Women’s Health Forum, which now has something like 12,000 members of various multidisciplinary teams.

We have nurses, doctors, pharmacists, physiotherapists—whoever wants to improve the care of the women in a local environment. We’re now invited to strategic decision making on a national footprint. And we’re starting to make a difference in the quality of care that women get, where they want it, closer to their homes. 

Q: Can you say more about the passion that drives you, and where it comes from?

Anne: I think it comes from recognizing the inequality that exists for women, when you look at the health issues that we can have compared to the care that’s often provided. We have the responsibility for reproductive health. We have periods that come every month, and for many women, that’s a big problem if they’ve got painful periods or lots of bleeding, which can impact their chances with education, or with jobs and opportunities. Then we get to menopause, and we have to go through the symptoms of that. So there’s a real inequality for many women, if they can’t understand that maybe it’s not normal to have certain symptoms, or that they can get help that will allow them to function better in the workplace and in their families. 

And it’s more than that. Within deprived communities, there’s the inequality of being a woman, and there is also an inequality within the inequality. Looking at myself, I can navigate hurdles because I’ve got a car; I can speak English as a first language; I’ve got access to the internet. If hurdles are put in my way, I can get around them. But there are many women who can’t. 

So my passion is to make sure that all women get the same opportunities in health care. I want them to understand that if something isn’t right, to get early help, and then to understand the choices of what they can do with that help. That’s why the passion is to develop local services, and to upskill local clinicians—and it’s not just about the doctors. Many times it’s about the nurse, or the health care assistant, or the administration team or the social support network. It’s about all of us working as a team to deliver the right care for the right person, at the right place and the right time. 

Q: What are some difficulties or setbacks you’ve faced along the way? How did you deal with them? 

Anne: I realized that it was important to become part of the decision making process about where public finances would be spent and how to improve local services. And you can’t do that unless you are part of the committees that are making those decisions. It’s not my favorite role. I much prefer to be doing the clinical work. But I joined the local decision making board and spent many hours discussing concerns that actually are not my passion. Then I constantly had to try and raise issues about women’s health, which is under-prioritized but so important—because if we get it right for women, we get it right for the families and for the system. 

And many times, I would hit a barrier. I would bring a proposal and the answer might be “Well, we don’t have extra funding for that. It isn’t our priority at the moment.” But I had learned from those women in Zimbabwe that it’s important to be resilient. So I’d go back to work with the team, or we would talk to other members of the committees, and then I’d come up with another proposal or another way of looking at it. And again I might get knocked back. But the fight was so right that we kept going.

Nationally, we now sit on committees on behalf of the Primary Care Women’s Health Forum, and we constantly raise the importance of making services right locally. Not just in the specialist units, but locally where women really want to go at their first port of call. Because that is where we can understand the complexities of the populations we work with—recognizing that we might get our services right for one group of the population, but it needs to be slightly different for another group. 

Q: Could you share a key lesson or lessons you’ve learned? 

Anne: One is that passion doesn’t get you everywhere. My passion often got the better of me, particularly in the earlier days of my career, before I learned how to be more strategic. Sometimes the “bull at the gates attitude” is off-putting for others, and you just get knocked down and then you take it personally, which is never great. If I was starting out again, I think I’d be more reflective on the advances we’ve made, and how better to navigate some of the negotiations that are so important to make the improvements that you want. 

Q: Looking ahead, what are the main improvements needed, and how can we get there?

Anne: Women’s health care needs to improve in a number of ways. It’s been under-resourced. The needs of women have been under-recognized, and health problems specific to women have been under-researched. There has to be comparative esteem for women, so that the care they get and the recognition of their needs is the same as for other health care concerns. 

Not only are women half the population, they carry the burden of reproductive health, and they are generally the main supporters of family life and bringing up the next generation. So we know that getting a woman’s health right is not just right for that woman. It’s right for everyone around her; it’s right for the social system, and it improves her opportunities within the system. The effects are holisitic, and we need to be better about recognizing the holistic care that women need. There’s the physical well-being, the social well-being, and the psychological impact of having women’s health concerns. 

And here again, it’s not just about the doctors and specialists. Women are much more likely to discuss their issues with a nurse or health care assistant, or another member of the team. They might want to test out the problem they’re having before they decide that it’s big enough to go and bother the doctor. So, at the Primary Care Women’s Health Forum, we acknowledge the need for multidisciplinary teams. We know that each of us can bring something to the table. And we always recognize that we are much stronger as a team than going out as individuals to try to change the world. 

iology.com/authors/angela-maas”>Dr. Angela H.E.M. Maas, a cardiologist and PhD-holding scientist, is prominent among those who’ve been working to change the situation. Over her career she has introduced new medical practices, contributed research, fought resistance, and networked globally to promote female-specific cardiology. Angela is co-author of the Manual of Gynecardiology, a textbook for health professionals, and also the author of a new and highly readable book for everyone, A Woman’s Heart: Why female heart health really matters.

Currently Dr. Maas is professor of cardiology and Managing Director at Radboud University Medical Centre in The Netherlands, her home country. In an interview with World Woman Hour, she told the stories behind a quest that continues to this day. 

Q: How did you become involved in this work? 

Dr. Angela H.E.M. Maas: My father was a general practitioner and from my early ​​years on, I always wanted to be a doctor. I was trained in cardiology in the Netherlands in the 1980s—and it was a bit strange during my training. The standard patient was the male patient. And when I began as a cardiologist in 1988, I realized that I couldn’t answer the questions of my female patients properly. They would ask me often, “What is the reason for my symptoms? Why do I have chest pain?” And I didn’t have the appropriate answers.

Then in ‘91, the first scientific publications appeared saying that there may be differences between men and women with heart disease. So it all fell together about 30 years ago—the questions of my patients, the publications in the medical journals—and I started to read everything that was published, and I have been following this path since then. 

There are so many differences between men and women: in the cardiac vessels, in the heart muscle itself with aging, and much more. And yet still, after all these years, female patients are often treated like male patients. We have made a lot of progress in our knowledge but clinical practice lags behind. We need more education for the next generation of cardiologists, so they can learn how to practice with an awareness of gender differences. 

Also, the cardiology community hasn’t been very friendly for women. Not for female patients and not for women cardiologists, either. So we also have to change the culture of cardiology to make it a more women-friendly discipline. 

Q: Does this mean that your work ties in with larger issues of equality for women? 

Angela: Yes. I remember that when I began as a student in the 1970s, I was quite involved with the second feminist movement. I thought it was important for women to be economically independent; to have equal rights. And when I look back now, I think what I’ve done as a cardiologist is that I’ve incorporated women’s rights for equal health care in my work. Female patients have equal rights to be treated according to the current standards and current insights of cardiology. 

Q: You said that women’s heart care needs to be different from men’s because their hearts and blood vessels are physically different—but you also implied there are many other reasons. Can you explain some of those? 

Angela: We have to take into account that the life course of men and women is quite different. Women have pregnancies, of course, or they are treated for infertility. These kinds of events may impose a higher risk for cardiovascular disease. Women also may have menopause at a young age or at a later age. And, with aging, comorbidities [the presence of two or more medical conditions at the same time] are quite different among men and women. Perhaps these are not exactly risk factors, but they are risk variables that also count for estimating their cardiovascular risk. 

So we have to look more at the whole context of our female patients, which is different than it is for men. This includes socioeconomic factors. We know that men still earn more than women, and that women often have a single-mom household with children. And when we talk about stress, the genders react differently to it. Stress imposes a different kind of risk in men and women. 

Over the past decade or so, we are seeing more myocardial infarctions [i.e., heart attacks] in women in the younger age group, between 40 and 60 years old, and these are different kinds of myocardial infarctions. They are not caused by atherosclerosis [“hardening of the arteries,” a common cause]. Instead they are caused, for instance, by facial spasms, or by dissection of one of the coronary arteries [the spontaneous ripping of such a blood vessel]. These kinds of myocardial infarctions don’t happen very often in men, so our society also imposes new problems for our female patients. 

Q: Other women leaders have pointed out that it’s challenging work to be a change-maker. Can you talk about difficulties or setbacks you have faced and how you dealt with them?

Angela: I have encountered a lot of resistance among my cardiologist colleagues over the past 30 years. It wasn’t easy to bring a new way of gender-sensitive cardiology into the outpatient clinic. I’ve had hate mail and phone calls. Some colleagues have even threatened me with lawsuits, saying that I didn’t treat my patients according to the male standards that we all had learned. 

But with ongoing progress in the scientific field, with more knowledge about sex and gender differences in cardiology, I’ve always felt the strength just to continue. Several times over the past years I also had a coach, a kind of therapist, to help me not to become frustrated. To keep on going with my goals and to help me to get my life’s work done. 

I’ve also learned a lot from my colleagues abroad. We now have a very big network of female cardiologists in North and South America, in Asia, and in other places who are joined together in the Women As One organization. Women As One is a virtual network started some years ago by a few cardiologists from the U.S. and France. It’s very motivating to be in contact with each other, to support each other, and even to write papers together to bring important messages to the public and into the cardiology community. We also raise money for the younger generation, to fund fellowships to support their research projects. So by joining together, as female cardiologists, we are bringing health care for women to a higher level.

Q: In addition to having healthy habits, is there anything that we women can do to help improve our cardiac care in the future? 

Angela: An important change we have seen in women patients themselves is that by using the internet, they have learned to ask more questions, and they ask very good questions. We need them to be more involved with the choices that we make in diagnostics, in treatment, et cetera. So patient involvement in the future will be helpful, and also home monitoring, for instance of blood pressure. High blood pressure is the most important risk factor and it is a deadly risk factor. So women can help themselves to diagnose hypertension—especially women after hypertensive pregnancy disorders. These women are at elevated risk to develop hypertension at a young age. 

The point is that women can help their doctors to establish the most appropriate diagnosis.  We now need to collaborate better together, doctors and patients, and to discuss what is good or what’s not good to do. 

Q: Finally, what advice would you give to younger women entering the health and medical professions today? 

Angela: To younger cardiologists or doctors, or to any women, I would say: Try to learn. Throughout your whole life. By learning from others—as well as from papers and books, and from education—we can influence our current society, which is still quite male-oriented, in positive ways. 

Also, read books about women and what they have accomplished. You can learn from the lives of other women. We ourselves can inspire other women, too, even women who live around the world in places far away. 

And for women who are already in the health fields: There was a report from the World Health Organization in 2019 showing that about 70% of the workers in health care are women, but less than 25% of the leading positions are held by women. So I would say to every woman in health care, that if you can get a higher position or a more leading position—just go for it. You will manage. We need more women in the higher positions, to change the culture and also to drive changes in clinical practice. In order to change things, you need power.

babies to approximately 18,000 women … and that is far from all. 

In Kenya, where she has spent key parts of her career, Marleen did pioneering research on HIV/AIDS with a focus on how the virus impacts women and childbearing. In Belgium, her native country, she founded the Ghent University International Centre for Reproductive Health (which now has branches worldwide), and served as a Senator in the national Parliament. Marleen also held a high post at the World Health Organization, directing WHO’s global programs in Reproductive Health and Research. She has been back in Kenya since 2016, at the Aga Khan University in Nairobi, where she heads the Centre of Excellence in Women and Child Health. 

That’s quite a track record for someone who, in her university days, had a professor tell her that a woman shouldn’t study to be a gynecologist. As Marleen recollects, “He said, ‘You will have a family, who will take care of the children?  Why don’t you do something you can do from 9 to 12 so that you can dedicate your time to your family?” As it turned out, Marleen was able to be a wife and a mother while also forging a remarkable career. She believes that women’s health and women’s equity must go hand-in-hand — a view she advocates with good humor but with firm conviction. Here are excerpts from her interview with World Woman Hour. 

Q: Could you tell us a little about your life’s journey and how you came to be where you are now?

Dr. Marleen Temmerman: As a young girl I was always interested in sharing things and asking questions. Why is there so much inequity? Why do some people have more than others? I was passionate about solidarity and fighting inequity and it actually became the Leitmotiv throughout my journey. 

I wanted to go to the university, which was not often done by girls from the middle class back then in the seventies so I had to fight to convince my parents to allow me to go. Then later, after I finished my training in gynecology, I was intrigued not only by how best to care for the patient but also by health systems in operation so I undertook graduate studies in public health. 

I was invited by a good friend, Professor Peter Piot [a renowned microbiologist], to work with him around a strange disease that had come up in the 1980s. He was looking for somebody to join a research team in Kenya. My dream had been to go to developing countries and there was a need to study this new disease, HIV/AIDS. The research question at that time was, can women be infected with the virus, and if so, can it have an impact on pregnancy and on the baby? I went to Kenya, together with my husband, and although we have lived in other places since then, we kept going back to Africa, to Kenya and Mozambique over the years. And now here we are again in Kenya, where I’m leading the research center in Women and Child Health.  

Q: Why are you so passionate about solving problems for women, especially in health care? 

Marleen: It’s really working with women in all aspects of life, throughout their life course—young children, adolescent girls, pregnancy, family planning, older women. And whether you look at it from a health perspective or a rights and equity perspective, there is still a lot to be done. 

Think of the area of reproductive rights. Can you imagine that it was only in 1994, less than 30 years ago, when the world for the first time even agreed on the terminology of “reproductive rights”? On what it mean for a girl or a woman to have the right to decide how many children she wants, when, and with whom? It’s so basic. And yet 30 years ago we had to fight for it.

Even now, in many parts of the world—like here, where we live—for a lot of girls it’s only a dream. 

So progress has been made, but a lot needs to be done. And that’s why every day I love to continue this work, along with many wonderful partners, allies, colleagues, and friends. 

Q: It’s often said that women are disproportionately affected by health problems. Why is that so, and what are the solutions? 

Marleen: When you look at sexually transmitted diseases, for example, it’s the women and girls who suffer more. STDs can lead to ascending infections and a lot of complications, including infertility or cervical cancer and other diseases that are treatable or preventable, but which are making a lot of victims in this part of the world. So it’s always the girls and women who are kind of badly treated—by nature, by society, by the rights and the agency they are able to have. Their health care is often provided by governments or religious groups limiting their access to health, education, and the ability to reach their full potential.

In many countries, education is still a problem. In Kenya, the new Constitution of 2010 includes that all children go to school. That has really had an impact, because now more girls are going to primary school and secondary school. They continue their education, they participate in the workforce, and that is the beginning of change. So, education and health are really key to achieving equity, and to the development of girls and women.

Q: Many times in your life you’ve had to fight to move forward with your career and your work. What have you learned about overcoming failures and setbacks?

Marleen: Falling down is not failure. It’s just a thing that happens. Failure is not standing up again. You just have to say OK, what can I learn from what happened, and how can I do better?

And not only “I,” but how can we do better? In order to change society, you cannot do it as an individual. You have to find your friends, your partners, your family, and think, how can we do it? An African proverb states “ it takes two to make a child and a village to raise a child” we are all part of that global village and together we can be the change!

To me, this is the most important point. It’s about us. How can we develop not only that one single woman or girl or boy, but do it together as a group, as a community? As a society, how can we do better?

Q: Can you share a story about “doing better” in this way? 

Marleen: It’s not a fun story but I would like to tell it. When I first came to Kenya for my research, in the 1980s, I worked in public health maternity here in Nairobi Pumwani Maternity Hospital. I lost my heart in that place. We had about 80 to 100 deliveries a day, in very difficult conditions. At the time, I was pregnant myself, so you look at things a bit differently when that is the case. And I was confronted with a young girl, 14 years old, who died on arrival. She had been in labor in a slum area, without anyone taking care of her until finally, somebody brought her to the maternity ward. She had a ruptured uterus. The baby had passed on already and we couldn’t save the girl, either. 

In my life I have done so many deliveries that I don’t remember them all. But unfortunately, I had 72 girls or women who died in my hands, so to speak: many from the complications of unsafe abortion, and many very young girls who should have enjoyed their childhood instead of getting pregnant. Those I will never forget. Of course, you can be sad about this. On the other hand, it has given me the motivation to say, “This cannot happen any longer.”

 So, for many years, I have been trying to change the systems—and again, not alone. In that same maternity ward where the girl died, health care providers, nurses, doctors, and everyone has invested a lot. And after all these years, in this particular facility, care has improved a lot. We still see some women dying but thankfully less frequently. In the past, we had at least two or three babies every day who didn’t survive, and now that is the exception. As I said, we are making progress but there is still a long way to g

Marleen: We need more women leaders not only in health care but everywhere….

One of the biggest problems is that so many women are still dying in pregnancy, in childbirth, abortion, or postpartum. Maternal mortality, as we call it, is really an injustice for girls and women. They need good quality care, but it’s not only about the care. They also need the right to use the care. Like here in Kenya, we see so many teenage pregnancies, with very young adolescents. We need to work for the right to avoid being pregnant when you are 13. The right to access family planning, sexual education—the right to knowledge. So, it’s more than simply health care. It’s the whole picture of equity and rights that has to be interwoven with health care.

Q: What can all of us do to help?

Marleen: I think that all of us can be part of the change. If you believe that women and men are equal, that we have the same rights, then fighting for the same rights for all individuals is something that all of us should contribute to. Whenever you see injustice, or a negative situation, don’t turn away from it. Keep on fighting for a better world. For girls and women, men and boys.

Q: One last question. If you could be said to have a superpower, what is it?

Marleen: My superpower is multitasking. Being somebody who works in a group, in a community. And somebody who doesn’t give up. Who doesn’t take no for an answer!