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Subsistence to Surplus: How Gifty Went from Barely Making Ends Meet to Meeting President Obama


Gifty Jemal Hussein met President Obama this week during his visit to Ethiopia. Read on to find out how she transformed her life from a subsistence existence to extraordinary success that’s benefiting her entire community—with a little help from the United States.

Gifty Jemal Hussein was a typical smallholder farmer in Ethiopia. She grew Ethiopian banana, corn and a few coffee plants in her backyard to feed her family and earn a meager income to make ends meet.

Harvests were low and unpredictable. Land was limited. This was life.

But 2013 was different.

In 2013, Gifty planted her small patch of land with new corn seeds, using techniques she’d learned from a development program in her community. She used just the right amount of fertilizer and checked on the corn stalks as they grew. When it came time to harvest them, she exclaimed to herself: Thank God! Her crops had yielded three times as much corn in a single season as before.

It seemed almost too good to be true. She touched every ear of corn she’d harvested. The results were real.

Gifty was so surprised, happy and proud of her harvest that she laid the ears of corn out in front of her house for all to see. She went door-to-door telling others and inviting them to see it with their own eyes. She took a quarter of the harvest to her four adult children in the capital city.

Her neighbors, impressed and happy for her, wanted to know how she’d managed to turn a sparse backyard garden into an abundant farm.

Gifty Jemal Hussein, a smallholder farmer in Ethiopia, spoke with President Obama today. Through a USAID-DuPont partnership, she began using high-yield corn that allowed her to increase her household income. / Daniella Maor, USAID

Gifty Jemal Hussein, a smallholder farmer in Ethiopia, spoke with President Obama today. Through a USAID-DuPont partnership, she began using high-yield corn that allowed her to increase her household income. / Daniella Maor, USAID

Unlocking Agriculture’s Potential

Gifty had been a leader in her community before 2012, but it took on new meaning now. People were paying more attention. She had newfound confidence that life could change—and she would be the one to make it happen.

Gifty went to the local government and asked to lease one hectare of land – for free – for her women’s group to farm. She rented a tractor with her own money to plow the land. She gathered other women in her community to help her sow the corn seeds that had given her a bumper harvest last season and then apply fertilizer, which she bought on her own.

As the corn grew, she brought the 20 women in her group to show them how tall the plants were getting. Then she asked each to invest in this farming venture – to become stakeholders in their shared success. Each woman paid a portion to compensate her for the cost of the tractor and fertilizer. The following season, they also helped buy the seeds.

“It isn’t reasonable to invest in something that doesn’t give you a return,” Gifty said. “So I don’t invest in the [old seed], instead I invest in the new hybrid seed.”

Gifty and her group opened a savings account for the income they were earning from better corn harvests. With it, they’re making investment plans for the future and have a safety net for tough times.

Women representatives visited from other districts to see the group’s bountiful corn crop. They were so impressed that they gifted Gifty a set of farm tools to honor her for her initiative and entrepreneurship.

Taller plants and larger ears of corn translated into more income for Gifty. She’s invested the returns into her farming enterprise, buying a cow, which she’s leveraged into an additional revenue stream by selling the milk and calves. With this money, she’s purchased extra seeds to grow more nutritious and lucrative crops like teff, cabbage, carrots and potatoes. She’s expanded the number of coffee plants she grows too.

Gifty is also using her income to improve her family’s standard of living. She built a new home—her proudest undertaking. She’s paid for her husband’s medical treatment for a disability he has and for her son’s final years of high school. She even had enough to contribute to one of her daughters’ weddings.

From Individual Success to Global Impact  

Fortunately, Gifty’s story is less and less unique these days. Rural communities across countries like Ethiopia are establishing a new normal: One with less poverty and hunger and with more prosperity and opportunity.

Smallholder farmers, with help from the United States, are moving from barely surviving off their farms to running profitable farming businesses—ones that give them enough income to pay for things like school, health care and new homes.

In Ethiopia last year, the U.S. Government’s Feed the Future initiative helped more than 218,000 producers like Gifty use new technologies and management practices to increase their yields. And through nutrition programs, the U.S. Government reached more than 1.3 million young children in Ethiopia with help—including training more than 20,000 adults in child health and nutrition.

Results like these add up to impact, in the lives of individual farmers like Gifty and – increasingly – nationwide. Between 2011 and 2014, stunting – a measure of malnutrition often associated with undernourishment – among young children dropped in Ethiopia by 9 percent. This impact reflects the leadership and efforts of the Government of Ethiopia as well as U.S. Government.

The United States has led the world in taking hold of the tremendous opportunity to unlock the transformative potential of agriculture to connect more people to the global economy and pave a path out of poverty through initiatives like Feed the Future and partnerships like the New Alliance for Food Security and Nutrition.

In fact, as President Obama was meeting with Gifty today, we announced that the program that helped Gifty jumpstart her success with new seeds – a public-private partnership between Ethiopia, the United States and DuPont Pioneer – is expanding to reach 100,000 more farmers and help them flourish, much like Gifty has.

The work is far from finished, but the results and impact are promising. The future looks bright for rural families like Gifty’s.

ABOUT THE AUTHOR

Tjada McKenna is the Assistant to the Administrator for USAID’s Bureau for Food Security. She also serves as the Deputy Coordinator for Development for the U.S. Government’s Feed the Future initiative.

Leadership at USAID Q&A: Susan Markham Shares Why Gender Equality Matters

Susan Markham, pictured in her office. / Ellie Van Houtte, USAID

Susan Markham, pictured in her office. / Ellie Van Houtte, USAID

Susan Markham, USAID’s senior coordinator for gender equality and women’s empowerment, recently celebrated her one-year anniversary with the Agency. I sat down to talk with her about her work and how it relates to the Agency’s mission of ending extreme poverty. Follow her @msmarkham.

An Ohio native, Susan went to The Ohio State University, majoring in political science and international relations, and later studied public policy and women’s studies at George Washington University in D.C.

After graduation she became involved in domestic politics. She worked at EMILY’s List recruiting and training state and local women candidates to run in 35 U.S. states. Later, through the National Democratic Institute, she traveled overseas to work with women voters, advocates, candidates and officeholders.

Could you briefly describe what your work involves here?

Little known fact, my position was actually created through a Presidential Memorandum. It recognized that gender equality is both a goal in itself and critical to achieving our country’s global goals. My job is to provide strategic guidance to the USAID Administrator and the agency to ensure that gender equality and women’s empowerment is integrated throughout our programming–that it’s woven into the very DNA of the agency.  

How is gender equality and women’s empowerment related to USAID’s mission of ending extreme poverty?

We cannot end extreme poverty without addressing gender. Period. Women are key drivers of economic growth. In order to eradicate extreme poverty and build vibrant economies, women and girls must gain access to and control of capital, land, markets, education, and leadership opportunities.

This isn’t just lip service. Women account for one-half of the potential human capital in any economy. More than half a billion women have joined the world’s work force over the past 30 years, and they make up 40% of the agriculture labor force. These are big numbers showing that women are a powerful force for change that shouldn’t be ignored.

As USAID’s senior coordinator for gender equality and women’s empowerment, Susan advocates for the inclusion of issues affecting women and families into development work. A women and her children prepare food for dinner in the Aldoosh Village in Yemen with food provided through a USAID program. / Mercy Corps

As USAID’s senior coordinator for gender equality and women’s empowerment, Susan advocates for the inclusion of issues affecting women and families into development work. A women and her children prepare food for dinner in the Aldoosh Village in Yemen with food provided through a USAID program. / Mercy Corps

How is gender equality and women’s empowerment connected to other sectors such as education, economic development, health, etc.?  Do you have much interaction with them?

Of course! Development cannot be delivered in a vacuum. From education to health, there is no program or intervention that wouldn’t be more effective if it included gender at its foundation. Women are not only impacted by these issues, they have invaluable insight in how we can best address them.

When women are empowered, they often lead the way in managing the impacts of climate change and disasters. When they play an active role in civil society and politics, governments tend to be more responsive, transparent and democratic. When women are engaged at the negotiating table, peace agreements are more durable. And countries that invest in girls’ education have lower maternal and infant deaths, lower rates of HIV and AIDS, and better child nutrition.

That’s why I work closely with colleagues tackling water, energy, climate change, infrastructure and agriculture. Gender equality is not only in our job descriptions and policy goals, it’s in our best interest as development professionals.

The White House’s Let Girls Learn initiative has been getting a lot of buzz lately–could you touch on USAID’s involvement with that?

Let Girls Learn is really exciting and timely. It’s a United States Government effort to help adolescent girls stay in school. We know it’s not enough to build schools and equip classrooms. Girls in developing countries face complex and sometimes dangerous barriers while trying to get an education. Because USAID works on a range of issues from reproductive health to child marriage, we’re in a unique position to approach the challenge holistically by addressing the whole girl. All girls should have the opportunity to gain the skills, knowledge and self-confidence to chart their own course.

Susan takes a photo with  participants of a youth council roundtable in West Bank, Gaza. /  Global Communities

Susan takes a photo with participants of a youth council roundtable in West Bank, Gaza. / Global Communities

What are you working on right now that you’re most excited about?

Ha, everything. This is a great gig. That said, I’ve noticed real momentum in two interesting areas. First, countering violent extremism. For too long, women have been seen only as victims. Yet recently a movement began  that recognizes women as potential recruiters and perpetrators, as well as influencers and leaders who can help prevent the growth of terrorist groups and provide critical information on how to counter them. Thanks to this perception shift, USAID is re-examining counterterrorism issues and possible solutions.

Second, USAID’s Global Development Lab. It both confounds and fascinates me, but I know that if we can harness technology, we can close gender gaps more quickly. Women in developing countries are 25 percent less likely to be online than men. 200 million fewer women have access to mobile phones. And a woman is 20 percent less likely than a man to own a bank account. Technology has the power to create connections, foster learning, increase economic growth, and provide life-saving information. It can also help change social norms and stereotypes, and reduce inequality. At USAID, we’re doubling down to make sure women and girls can take full advantage.

ABOUT THE AUTHORS

Clara Wagner was an intern for USAID’s Bureau of Legislative and Public Affairs working on content and public engagement.

Slam Dunk: Empowering African Women Through Sports

 Astou Ndiaye shows off her ball-handling skills at last year’s launch of Live, Learn, and Play, a partnership between USAID and the National Basketball Association. / Zack Taylor, USAID

Astou Ndiaye shows off her ball-handling skills at last year’s launch of Live, Learn, and Play, a partnership between USAID and the National Basketball Association. / Zack Taylor, USAID

In Senegal, where I grew up, I guess you could say girls look up to me. After all, I’m 6-foot-3. I also won a professional basketball championship, worked my way through graduate school, and now manage a successful career while raising three kids.

Sure, I was a natural fit for basketball. But there was more to it than just the rebounds and my jump shot. The skills I learned playing the sport have led to my success off the court as much as on it.

I was back in Senegal last year to share this idea with hundreds of my compatriots at the launch of a new partnership that brings together the development expertise of USAID and the global cachet of the National Basketball Association.

The project — called Live, Learn and Play — provides opportunities few of us had when I was growing up. As an alumna of the WNBA, the women’s counterpart to the NBA, I was happy to support this new project, which uses basketball to train youth ages 13-18 in leadership, gender awareness and equality, and community participation.

Basketball changed my life. During the course of my career it opened doors, exposed me to new experiences, and taught me a lot about the world and myself.

But in any capacity–professional or not–getting involved in a sport means mastering skills, having the discipline to stay in school, keeping out of trouble, and leading a healthy lifestyle. These little things give young people the inspiration and ability to become leaders in any field. What you learn on the court can apply to any aspect of life.

Growing up in Dakar, I was fortunate to not lack the basics. However, with 20 siblings you can bet I learned to fight for my share. My mother always emphasized the importance of a good education–when I had to find a creative way to pay for schooling, those lessons in “fighting” paid off.

From the age of 13, I focused all of my strength and toughness on basketball. I practiced all the time: in the rain, and even through Ramadan, when I couldn’t get a drink of water until sunset. Luckily, some great coaches showed me that basketball was something positive that could lead to better things down the road. Mentoring is critical.

A few years later, I made Senegal’s national team. When I figured out that my game could open academic as well as professional doors, I took advantage of an athletic scholarship to go to university, where I graduated cum laude. After being drafted into the WNBA in 2003, I not only had the joy of having triplets, but also of being a part of the Detroit Shock championship team.

Girls learn basic basketball skills under the Live, Learn, and Play partnership with the NBA.“What you learn on the court can apply to any aspect of life,” former WNBA star Astou Ndiaye says. / Zack Taylor, USAID

Girls learn basic basketball skills under the Live, Learn, and Play partnership with the NBA.“What you learn on the court can apply to any aspect of life,” former WNBA star Astou Ndiaye says. / Zack Taylor, USAID

Basketball careers can’t last forever, so in 2008 I retired, became a coach and pursued a graduate degree in human resources. I’ve settled down now, and work with the state Health Care Authority in Oklahoma.

I know that my natural athletic gifts and supportive upbringing gave me better chances than many girls in Senegal. Still, I am convinced the principles I learned on the court led me to where I am today. If you understand early that hard work will pay off, everything else “comes around at the boards,” as they say in basketball. That means stay healthy, pay your dues, and know nothing will be handed to you.

Back in Dakar for the Live, Learn and Play launch, I had a chance to speak to the kids in the program. I told them that the odds of making it to the big leagues are tough, but that’s okay.  Dedication to basketball–at any level–teaches the toughness and resilience you need to find a pathway to a bright and successful future.

What’s great about Live, Learn and Play is the development of a network of skilled coaches, mentors and role models who will help thousands of kids become solid, productive citizens and active community members, whether they continue with sports or not.

This program can help empower girls in Africa, an issue close to my heart. Senegal is among the more forward-thinking countries in West Africa, but women there still face significant hurdles because of their gender.

Wherever I go, I encourage women and girls to push themselves to the forefront in whatever they do. Get out there and own it. Because when women get that, they are the real champions.

ABOUT THE AUTHOR

Astou Ndiaye, a former star in the WNBA, is a human resources specialist at the Oklahoma Health Care Authority and motivational speaker.

From Kenya to Kabul: Women as Decision-Makers, Entrepreneurs, and Leaders

My name is Joanne Lewa, and I am from Kenya. Six months ago, I came to Afghanistan on a temporary work assignment with USAID to assist in the Agency’s outreach to the Afghan public. Before arriving, much of what I had seen in the news about the country was negative.

But the Afghanistan from the news was not the one I experienced during my six-month tour; I found Afghanistan to be a country of breathtaking landscapes and kind people who are embracing positive change and helping their country grow.

My time in Kabul has helped me understand the expansive scope of USAID’s work in Afghanistan—from education, health, democracy and governance, to economic growth, agriculture and women’s empowerment.

But when I step on my Kenya-bound flight this week, the memories of the Afghan women and girls I met will endure—against tremendous odds, they are becoming influential, decisive actors in their country’s development. I think of my two daughters and hope that they will follow in the footsteps of my brave Afghan sisters. Their achievements and the support they receive from their brothers, sons, fathers and husbands have left the greatest impression on me.

USAID assistance to community-based education enabled nearly 105,000 students (more than 65 percent of them girls) in remote villages to attend school. / USAID/Afghanistan

USAID assistance to community-based education enabled nearly 105,000 students (more than 65 percent of them girls) in remote villages to attend school. / USAID/Afghanistan

Girls’ Education

I was particularly interested in how USAID is working to solve a fundamental barrier to girls’ access to education: a lack of school buildings near many villages. To prevent girls from having to travel precariously long distances to reach the nearest schoolhouse, USAID’s community-based education programs provide a way for Afghan students to attend classes near their homes.  USAID has supported the Ministry of Education’s efforts to build thousands of new schools and has also distributed millions of textbooks, trained thousands of teachers—many of them female—and carved out new opportunities for higher education.

USAID’s 14-year partnership with Afghanistan’s Ministry of Public Health has ensured that more children have healthy, thriving mothers and more women survive their pregnancies. / USAID/Afghanistan

USAID’s 14-year partnership with Afghanistan’s Ministry of Public Health has ensured that more children have healthy, thriving mothers and more women survive their pregnancies. / USAID/Afghanistan

The Health of Women and Children

Of course, children—girls and boys—will never make it to their first day of school if they and their mothers do not have access to basic health care. Since 2002, USAID has worked side by side with the Afghan Government and other international donors to rebuild Afghanistan’s health care system. USAID alone has trained thousands of community health workers and midwives across the country. More babies than ever are now delivered by skilled birth attendants, and thousands more are living to see their fifth birthday

Friba Hashimi is living proof of this drastic transition. I met Friba  when I recorded the names of  the women who attended a USAID-sponsored midwifery training. Once confined by the conservative views of her village, she is now a pillar of her community, helping to deliver a new generation of Afghans into the world.

Female participation in the 2014 Afghan elections was unprecedented in scale, with women voters accounting for 38 percent of total turnout according to government counts. / USAID/Afghanistan

Female participation in the 2014 Afghan elections was unprecedented in scale, with women voters accounting for 38 percent of total turnout according to government counts. / USAID/Afghanistan

Women in Politics

I landed in Kabul in the midst of one of the most exciting and important events in Afghanistan’s recent history: the 2014 elections. As I was settling in, women were playing a game-changing role in the election process. Voter participation reached a record high for both men and women. Women also served as election observers, ran for public office and were victorious on the campaign trail. Over the course of my assignment, I saw more and more women getting involved in the leadership of their nation.  Women made up 21 percent of winners from the 2014 Provincial Council Elections, 11 percent of judiciary seats, and 20 percent of judges in training.

USAID is working to increase job placements and wages for Afghan women through increased access to quality technical and business education and training, job placement support services, and facilitated access to credit and business development opportunities. / USAID/Afghanistan

USAID is working to increase job placements and wages for Afghan women through increased access to quality technical and business education and training, job placement support services, and facilitated access to credit and business development opportunities. / USAID/Afghanistan

Women in the Economy

While in Kabul, I also had the chance to speak with many Afghan women who have become business owners, workers and entrepreneurs. In response to the growing demand for the skills needed to participate in the increasingly advanced job market, USAID has provided job training for thousands of women and helped thousands more to find rewarding jobs. In Kenya, women’s contributions in the workplace have greatly improved the economy, and I have faith that USAID’s programs will continue to help women to do the same in Afghanistan.

Afghan women have more opportunities to receive job training and apply for loans to start or expand businesses. Much work remains to be done, and USAID is committed to building upon these critical gains. / Joanne Lewa, USAID/Afghanistan

Afghan women have more opportunities to receive job training and apply for loans to start or expand businesses. Much work remains to be done, and USAID is committed to building upon these critical gains. / Joanne Lewa, USAID/Afghanistan

Women’s Leadership

In November 2014, I was in Kabul when first lady Rula Ghani spoke at the launch of Promote, the largest women’s empowerment program in USAID’s history. Promote will serve as the missing stepping stone between education and careers for thousands of Afghan women driven to serve as political, civil society and private sector leaders.  These women will be pioneers for the rights of Afghan women and girls in every sector of society.

First lady Ghani emphasized the weight of this new opportunity, telling the women in the audience, “This is your world. Shape it or someone else will.”

At the launch, I met inspiring Afghan women who are already making an impact on their communities. They all shared the same refrain: “Afghanistan cannot fly with just one wing.” For the country to prosper, women must be empowered to play decisive roles in Afghanistan’s government, civil society and economy.

Manizha Wafeq, an Afghan business woman, says: “In Afghanistan, men were like birds flying with one wing. With economically empowered women, we shall be able to be the ‘other wing’ and together, we can fly stronger, building our country’s economy and have peace in Afghanistan.” / USAID/Afghanistan

Manizha Wafeq, an Afghan business woman, says: “In Afghanistan, men were like birds flying with one wing. With economically empowered women, we shall be able to be the ‘other wing’ and together, we can fly stronger, building our country’s economy and have peace in Afghanistan.” / USAID/Afghanistan

From Kabul to Kenya

Lately, I’ve been taking stock of the moments that will stay with me from my tour in Afghanistan. The first snow in Kabul and the taste of Afghan bread and rice will long endure in my memory. However, the warm welcome I received from the dedicated team of Americans and Afghans will be unforgettable.

These men and women are committed to one mission: improving the lives of all Afghans day by day, textbook by textbook, job by job, life by life. For those who come to Afghanistan after me, I promise you a once-in-a-lifetime experience. This is a great nation filled with amazing people who are working tirelessly to rebuild their country.

ABOUT THE AUTHOR


Joanne Lewa is a Public Outreach Officer for USAID’s mission in Kenya. She just returned from a six-month temporary assignment in Kabul, Afghanistan.

Breaking Invisible Barriers in the West Bank and Gaza

USAID supports girls’ education in the West Bank. The Agency built the new Nahalin Secondary Girls' School in the Bethlehem Governorate  / Credit Alaa Badarneh

USAID supports girls’ education in the West Bank. The Agency built the new Nahalin Secondary Girls’ School in the Bethlehem Governorate / Alaa Badarneh

It’s nearly impossible to watch the news or read a newspaper without hearing about the West Bank and Gaza. It seems every week there’s a breaking story of violence and destruction. And yet when I visited USAID’s West Bank and Gaza Mission in November, the message I consistently heard was one of hope.

I went to see first-hand how USAID’s diverse programs are helping to ensure women and girls have the tools and capacity to realize their rights. From the justice system to small business, it was inspiring to witness the positive impact of USAID’s work.

The trip was also a powerful reminder that gender relations in the West Bank and Gaza are unique and complex but also obscured by the ongoing conflict. The main challenge Palestinians face is occupation, being both physically and socially restricted in everyday life that we take for granted.

Susan Markham meets with USAID staff, beneficiaries, and partners to promote the importance of gender equitable structures, institutions, and infrastructure in Palestinian society. USAID/West Bank/Gaza

Susan Markham meets with USAID staff, beneficiaries, and partners to promote the importance of gender equitable structures, institutions, and infrastructure in Palestinian society. / USAID/West Bank/Gaza

While the physical roadblocks inhibit movement, there are also invisible barriers that Palestinian women face. Despite a commitment to girl’s education, and a long tradition of women’s engagement in political life, separate social structures and a male dominated culture endure. However, instead of being demoralized, what really shone through was the enthusiasm and determination of both women and men to fully engage on equal terms.

I was energized to meet Maysa, a 26-year-old entrepreneur breaking ground within the tourism industry. By organizing photography tours throughout the West Bank, running her own YouTube channel, and designing original souvenirs, she is staying at the forefront of tourism and opening doors to women who wish to work in the industry.

I spoke with inspiring women entrepreneurs who are breaking barriers within their communities and launching successful businesses in information and communication technology (ICT), marketing, tourism and international training and certification. Thanks to assistance from USAID, many of these women are already planning to start a second business.

Through USAID’s Local Government and Infrastructure Program, I was able to hear from young women participating in and leading Youth Local Councils across the West Bank where women and men work together to advance community driven ideas around education, health, infrastructure and governance.

Perhaps nowhere was progress in gender equality so evident than at the Youth Development and Resource Center in Hebron. There I met Omar whose parents forbid him to go to the center as a boy because there would be girls there. Today, he runs the center, providing skills training, work experience, and a dynamic example of what’s possible when men and women work together.

From the teachers fighting for improved training for their students to the women working in cutting edge technology fields, there was optimism for a brighter future and a fierce resolve to get there.Vera Baboun, the mayor of Bethlehem, summed up the experience best when she quoted poet Mohja Kahf to me:

All women speak two languages:
the language of men
and the language of silent suffering.
Some women speak a third,
the language of queens.
They are marvelous
and they are my friends.

 

ABOUT THE AUTHOR

Susan Markham is the USAID Senior Coordinator for Gender Equality & Women’s Empowerment. Follow her @msmarkham

The Intersection of HIV/AIDS and Gender-Based Violence: A Critical Connection

A mother plays with her child while waiting for services at Jose Maria Cabral y Baez Hospital in Santiago, Dominican Republic. Health workers and supervisors from this hospital participated in a workshop and supportive site supervision system designed and delivered by the Directorate of STI/HIV/AIDS (DIGECITSS), the health services network (REDES), and CapacityPlus to improve the quality of services to eliminate mother-to-child transmission of HIV and congenital syphilis. / Wendy Tactuk, courtesy of CapacityPlus and IntraHealth International

A mother plays with her child while waiting for services at Jose Maria Cabral y Baez Hospital in Santiago, Dominican Republic. Health workers and supervisors from this hospital participated in a workshop to improve the quality of services to eliminate mother-to-child transmission of HIV. / Wendy Tactuk, courtesy of CapacityPlus and IntraHealth International

This week we mark World AIDS Day. Appropriately, it occurs during the Sixteen Days of Activism Against Gender-Based Violence. Why so appropriate? Because we know that gender-based violence (GBV) prevention and response are critical to effectively treating and reducing the spread of HIV. Though not always self-evident, the connection is clear.

For me, the linkages were driven home during recent conversations I had with health experts in Ghana. While discussing our health programs, I casually asked how important attention to GBV was within efforts to treat and stem the spread of the HIV.  As soon as I asked the question, the room’s atmosphere changed palpably. Everyone sat up and leaned in. People began speaking all at once, tripping over one another to respond. The passion was tangible and the analysis compelling. It was all the more persuasive because it is backed up by research.

In Ghana, the HIV rate is low and declining, though the rate is 15 – 20 times higher for key populations at risk of contracting HIV, which include female sex workers (FSWs) and men who have sex with men.

GBV is particularly common among female sex workers (FSWs), 24 – 37 percent of whom are HIV-positive. How do GBV and HIV rates correlate and relate, and how do we bear that in mind in our work to prevent and treat the infected?

A traditional leader discusses multiple concurrent partnerships, a key driver of HIV in Zambia, during a November 2013 training on HIV/AIDS leadership messaging in Kanyembo Chiefdom in Luapula Province / JSI/SHARe II

A traditional leader discusses multiple concurrent partnerships, a key driver of HIV in Zambia, during a November 2013 training on HIV/AIDS leadership messaging in Kanyembo Chiefdom, Luapula Province. / JSI/SHARe II

Many of my conversations in Accra focused on how to help people change behavior to decrease the risk of transmitting the virus and to increase the likelihood of seeking testing and treatment. The experts discussed how much more difficult it is for a woman or a man to negotiate condom use with an abusive partner.

The victim is less likely to try to persuade the abuser to use protection. The perpetrator is less likely to listen. The practitioners also talked about how victims of gender-based violence have less self-esteem and a lowered sense of self-worth. As a result, victims of abuse don’t believe they have the “right” to receive health services. It is much harder to coax people who face GBV or who fear violence or abandonment to seek services, test for HIV, or to successfully access or adhere to treatment.

A 2010 study of FSWs in Karnataka state, south India, confirmed what the Ghanaians explained to me; fear of partner violence prevented women and girls from seeking health services and from asking their partners to use condoms. The study found that condom use was some 20 percent lower those who had been beaten or raped within the last year compared with those who had not faced such violence.

The experts I spoke with also mentioned how gender-based violence cements relationships in which one partner is clearly dominant; they discussed how that feeling of dominance can give the abusive partner a sense of invincibility, reducing his or her willingness to practice prevention.

If you don’t believe you are vulnerable to harm or disease, there is no need to protect yourself. A 2014 study in South Africa supported this contention. The study, which considered women and girls attending four health centers in Soweto, found that abusive relationships with high levels of male control were “associated with HIV seropositivity.” In relationships where men had a great deal of power or where violence was frequent, researchers found that females were less likely to request condom use and had about a 12 percent greater likelihood of being HIV-positive.

Sometimes, the statistics were actually pretty astonishing.  A 2012 study in Moscow, Russia found that FSWs were more than 20 percent more likely to be HIV-positive or to carry a sexually transmitted infection (STI) if they experienced client violence. In addition, over forty percent of FSWs who were coerced into sex with the police were STI/HIV infected. Researchers concluded that reducing the risk of infection would require decreasing client, pimp and police abuse and coercive behavior.

A 2013 WHO systematic global review and analysis of studies across different HIV epidemic settings underscored the association between GBV and HIV, finding that intimate partner violence increases the risk for HIV infection among women and girls by more than 50 percent, and in some instances up to four-fold.

There are two bottom lines to the research and experiential data. First, reducing and responding to gender-based violence should be a key tool in efforts to prevent the spread of HIV. Second, additional research is needed to understand those violence-reducing interventions that best reinforce HIV prevention and treatment.

USAID has seen important dividends from integrating GBV prevention and response into HIV and AIDS programs in collaboration with the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR). In Tanzania, USAID has supported development of National Management Guidelines for Health Response and Prevention to GBV, which provide a framework to guide comprehensive management of GBV survivors.

The Guidelines have led to training of health care providers and roll-out of a GBV register at health facilities across the country. In Zambia, USAID with PEPFAR funding, is collaborating with the British Department for International Development (DFID) and six government ministries to strengthen the response to GBV; this includes doubling the number of one-stop centers in several provinces, reaching 5 million adults and children with preventive messages, assisting 47,000 survivors, and training 200 police and justice sector personnel through 2018.

All told, USAID has contributed significantly to important results under PEPFAR; in FY2013, 2.5 million people in 12 countries were reached by efforts to address GBV and coercion, and an additional 800 health facilities began offering GBV screening, assessment and/or referrals to service providers.

The connection between gender-based violence and HIV infection is unambiguous. The data combined with the experience and perspectives of field experts make it clear. As we renew our commitments this week both to combat the spread of AIDS and to prevent GBV, let’s recognize and ensure that programs address the intersection. It could make the difference between the success and failure of efforts around the world.

ABOUT THE AUTHOR

Carla Koppell is USAID’s Chief Strategy Officer. She was formerly the Agency’s Senior Coordinator for Gender Equality and Women’s Empowerment. You can follow her @CarlaKoppell

Livestock Production: Empowering Women in Ethiopia

For some, Ethiopia conjures images of famine and extreme poverty. I see a completely different picture.

Ethiopia is a country rich in opportunity and resources, composed of hardworking men and women with innovative ideas and entrepreneurial spirits. However, agricultural technology and best business practices are not widely available or utilized. Women are also not fully empowered to make financial decisions for their families and struggle to own land or access credit.  Ethiopia’s dairy sector is dominated by smallholder farmers caring for dairy cows. Processing milk is traditionally viewed as women’s work.

Recently, Ethiopian women have turned this traditional role into an economic opportunity based on the training and financial assistance provided by USAID. Livestock fattening and dairy production are areas that employ women. However, in most parts of Ethiopia, a lack of training and knowledge has prevented women from taking on leadership roles.

Yeshi, a professional milkmaid, milks cows for households throughout Bishoftu twice a day—early in the morning and again at night. / CNFA

Yeshi, a professional milkmaid, milks cows for households throughout Bishoftu twice a day—early in the morning and again at night. / CNFA

As part of the U.S. Government’s Feed the Future initiative, the USAID Agricultural Growth Program-Livestock Market Development project seeks to improve nutrition and boost incomes, through training and investments in commodities like dairy, meat, and live animals. The project targets both men and women, with specific interventions to integrate women entrepreneurs into the broader livestock value chain. For example, the project developed a specific female entrepreneur training package designed to enhance the business capacity of women. Moreover, to better facilitate the participation of women in the offered technical trainings, the project provides innovative daycare services for the children of women participants.

One of the project’s key objectives is to strengthen local Ethiopian organizations and help them build effective, long-term partnerships. In June 2013, USAID signed an agreement with Project Mercy; a local, faith-based not-for-profit relief and development agency established by Marta Gabre-Tsadick, the first woman senator of Ethiopia. Through the agreement, USAID is assisting with an innovative cattle cross-breeding program. The local cattle – when crossed with Jersey breed bulls, create offspring that are up to ten times more productive. The project specifically assisted input suppliers’ import of Jersey Cattle inputs to Ethiopia.

Every morning, farmers drop off milk collected from their dairy cows at one of three collection centers for Ruth and Hirut Dairy in Cha Cha, Amhara, Ethiopia. / CNFA

Every morning, farmers drop off milk collected from their dairy cows at one of three collection centers for Ruth and Hirut Dairy in Cha Cha, Amhara, Ethiopia. / CNFA

A year and a half into its five-year time frame, this project is achieving significant results To empower women, the projecthas launched various training and technical assistance programs, including a leadership program and grants for female entrepreneurs. More than 100 rural women were trained in entrepreneurship and leadership during one 2013 session. These women now serve as business role models in livestock market development in their communities.

Hirut Yohannes embodies the entrepreneurial spirit I see in so many Ethiopian women. In 2008, she launched Rut and Hirut Dairy, a milk processing company located in Cha Cha, Amhara, just outside Addis Ababa. After some initial successes, she wanted to expand her company’s operations but needed guidance. Hirut approached USAID for support and was trained in production and marketing of quality products. She learned to make higher quality gouda and mozzarella cheese, flavored yogurt, cream cheese, and several other types of cheese. USAID also assisted Hirut to introduce packaging for fluid milk products.

Following support from the project, Rut and Hirut Dairy saw an almost immediate 50 percent increase in sales, which enabled Hirut to increase the volume of milk she purchases from farmers and to increase its sale price by 12 percent per liter. Hirut now provides market access for more farmers in her area and has plans to establish new milk collection centers to further expand her business.  With higher quality products, she has increased her income and profitability and is now able to service the bank loan that she had accessed to originally establish her milk processing facility.

Extreme poverty is still a serious problem in many parts of Ethiopia. Projects like this, however, are providing sustainable solutions to some of the most intractable issues that Ethiopians face. Successful women entrepreneurs serve as role models for other women who see little opportunity to improve their family’s income. While the role models are the ones that inspire other women to initiate and expand their livestock businesses, USAID provides essential training and support to help their endeavors succeed.

ABOUT THE AUTHOR

Dr. Yirgalem Gebremeskel is a Livestock Program Specialist Economic Growth and Transformation Office, USAID Ethiopia

Five Promising Innovations in Contraception

You may know that there are countless forms of contraception available to choose from: pills, IUDs, injections, implants, and more.

What you may not know is that USAID has supported the development of essentially every modern contraceptive available today, both in the U.S. and abroad.

World Contraception Day on September 26th draws attention to the important health and economic benefits contraception brings families, communities, and nations. Studies show that pregnancies that occur too early or late in life or too close together can result in devastating consequences for both the mother and child.

Increasing access to modern contraception across the globe could avert an estimated 7 million child deaths and 450,000 maternal deaths by 2020.

We also know that family planning is crucial to ending extreme poverty by opening the opportunity for countries to reap the benefits of the demographic dividend, a phenomenon that can add as much as two percent to annual GDP growth for decades.

For this reason, USAID has worked for nearly half a century to expand access to voluntary family planning information and services across the globe.

As we work to meet the needs of the 222 million women who want to avoid pregnancy but aren’t using modern contraception, it is vital for us to invest in new methods that expand women’s options. Studies show that some women don’t use currently available contraceptives because of concerns over potential side-effects, preference for non-hormonal methods, and a lack of options for women who have infrequent sex. Furthermore, we must expand availability of long-acting reversible contraceptives and permanent methods for women who choose to delay or limit childbearing.  Here are five promising new innovations in contraception:

SILCs Diaphragm. / Credit: PATH/Mike Wang

SILCs Diaphragm. / Credit: PATH/Mike Wang

1)  SILCs Diaphragm: The SILCS diaphragm, marketed as the Caya® contoured diaphragm, is a new type of diaphragm that is easy to use, non-hormonal, does not need to be fitted by a clinician, and is reusable for up to three years. In addition to being a contraceptive, this diaphragm has the potential to be a true multipurpose prevention product, serving as a delivery platform for gels that help protect against HIV and other STIs. After numerous studies clinically proving safety, acceptability, and comfort, Caya® recently received FDA regulatory approval for marketing within the United States. USAID and partners are currently working in Malawi and Zambia to make this new contraceptive available to women.

Sayana Press. / Credit: PATH/Patrick McKern

Sayana Press. / Credit: PATH/Patrick McKern

2) Sayana Press: Sayana Press is an injectable contraceptive packaged in a pre-filled single-use syringe. Its unique delivery system makes it more portable and easier to use, allowing injections to be delivered by health care workers to women at home or in other convenient settings. This new delivery system has the potential to drastically expand the availability of injectable contraceptives in the hardest-to-reach areas. Through a public-private partnership, USAID, DFID, the Bill and Melinda Gates Foundation, Pfizer, and Path are supporting the introduction of Sayana Press in Senegal, Uganda, Burkina Faso, Niger and Bangladesh.

Woman's Condom. / PATH

Woman’s Condom. / PATH

3) Woman’s Condom: The Woman’s Condomis designed to be easy to insert, use and remove, making it unique compared to other female condoms. Condoms offer contraception and protection against HIV in one inexpensive, simple-to-use package. As awareness about the multipurpose protection benefits of the female condom grows, global demand is increasing.

NES/EE vaginal ring. / Julie Sitney

NES/EE vaginal ring. / Julie Sitney

4) One-Year Contraceptive Vaginal Ring and Progesterone Vaginal Ring:  The NES+EE Contraceptive Vaginal Ring is the first medium-term hormonal method completely under the woman’s control that lasts for one year. This discreet method meets the needs of women who may encounter partner opposition and who don’t want a family planning method that requires a daily routine. The three-month Progerone Vaginal Ring for breastfeeding women is an effective, user-controlled method that can be used safely by breastfeeding women to aid in spacing pregnancies. It does not affect a woman’s ability to produce breast milk and does not require insertion by a healthcare provider.

CycleTel. / Institute for Reproductive Health, Georgetown University

CycleTel. / Institute for Reproductive Health, Georgetown University

5) Digital Fertility-Awareness Based Methods of Family Planning iCycleBeads™ Smartphone Apps, CycleTel™ and CycleBeads® Online are mobile and digital services that enable women to use the Standard Days Method (SDM) directly on a phone or internet-enabled device. This effective, natural family planning method helps women track their cycle and know on which days there is a high likelihood of getting pregnant.

ABOUT THE AUTHOR

Ellen Starbird is the Director of USAID’s Office of Population and Reproductive Health.

5 Things You Didn’t Know About Female Condoms

Langton Ziromba promotes female condoms in the casual and friendly space of his barbershop. / UNFPA

Langton Ziromba promotes female condoms in the casual and friendly space of his barbershop. / UNFPA

Since the first female condom hit global markets in 1992, the female condom has become more effective, more comfortable, and more accessible. Today, a variety of female condom products are sold worldwide, including the FC2, the Cupid, and the Women’s Condom. With more options for keeping yourself and your partner protected from HIV and STIs, there’s a lot to celebrate this Global Female Condom Day.

FC2 Female Condom Packaging

New packaging released for FC2. / The Female Health Company.

While the female condom has come a long way in user acceptability, user rates are still below targets needed to achieve an AIDS-free generation and prevent HIV and STI transmission among people of all genders. As awareness about the multipurpose protection benefits of the female condom grows, global demand is increasing.

In honor of Global Female Condom Day, read and share these five facts about female condoms, and help ensure that we continue celebrating successes in advancing sexual and reproductive health for all.

1. Best Multi-purpose Protection: According to research, the FC2 can be 97 percent effective in reducing risk of sexual transmission of HIV. The female condom is also approximately 80 percent effective in preventing  pregnancy. As a multi-pronged protection method, the female condom can transform women’s sexual and reproductive health lives and provide them with a means of taking control over their health, especially in circumstances where their choices are limited.

2. Global Appeal: The United States Government through the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) is one of the largest procurers of female condoms worldwide. In 2003, PEPFAR supplied roughly 1.1 million female condoms worldwide. By 2009, global shipments had increased to almost 15 million per year. In 2012, a record 32 million female condoms were distributed in total by the international donor community. Today, the female condom is available in over 100 countries.

3. Becoming More Popular: In the past, many have been reluctant to use the FC2, or other female condom styles, claiming they feel unnatural. Subsequent designs made of latex can offer a natural feel for male partners.

4. Easy To Use: Female condoms can be inserted up to 8 hours prior to sex, giving people even more control over their bodies. For detailed instructions on proper usage, see here.

5. They Keep Getting Better!: In 2013, the Gates Foundation launched a $1 million award to create the next generation of more user-friendly condoms. Among the 11 proposed designs, is a new female condom infused with air that would be faster and easier to insert. Other innovations include the 100 percent silicone Origami female that is made of a single accordion-like piece that can be washed and reused. Several of these promising designs are set to reach the market in 2015.

ABOUT THE AUTHOR

Clancy Broxton is the Senior Social Marketing & Commodities Advisor for USAID’s Office of HIV/AIDS and Rahel Beigel is a Global Health Fellows Program intern working with Clancy on condoms.

How Gender Analyses Shaped the Future of Microbicides

Engaging women in conversations about microbicides will help facilitate an effective introduction of this HIV prevention tool when it becomes available / Lisa Marie Albert

Engaging women in conversations about microbicides will help facilitate an effective introduction of this HIV prevention tool when it becomes available. / Lisa Marie Albert

Women account for more than half of all people living with HIV worldwide. In sub-Saharan Africa, young women are twice as likely to have HIV as young men. It is clear that women are disproportionately affected by the virus. Women’s vulnerability to HIV stems not only from a higher biological risk than men, but also from violations of women’s human rights, gender inequalities and marginalization.

USAID, through PEPFAR, is committed to expanding the array of woman-controlled HIV prevention methods so that women and girls can better protect themselves from infection../ Lisa Marie Albert

USAID, through PEPFAR, is committed to expanding the array of woman-controlled HIV prevention methods so that women and girls can better protect themselves from infection. / Lisa Marie Albert

USAID, through the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), is committed to expanding the array of woman-controlled HIV prevention methods so that women and girls can better protect themselves from infection. In 2010, the CAPRISA 004 trial, funded in part by PEPFAR through USAID, provided the first proof of concept that a vaginal microbicide made of tenofovir gel could protect women against HIV infection when used appropriately. Microbicides are substances applied vaginally or rectally to protect users against HIV infection. This scientific breakthrough presented the global health community with a potential new, female-initiated tool in the fight against HIV.

With these encouraging findings and continued clinical trials to test microbicides, we now need to look ahead toward their meaningful introduction and use. Through this process, we will recognize potential barriers to successful roll out, and identify ways to mitigate those barriers. Are women interested in using microbicides, and if so, how easy will it be for women to access them? To what extent do women want to communicate with their male partners about microbicides? How accepting are men to women’s choices about HIV prevention? To what degree are policies supportive of women’s microbicide use?

One of our implementing partners, FHI 360, foresaw these concerns and acted. Under the USAID-supported Preventive Technologies Agreement, FHI 360, with support from Sonke Gender Justice in South Africa,  conducted gender analyses in South Africa and Kenya, two countries where microbicide development work makes its future introduction likely. Gender analyses are systematic processes used to identify and understand gender differences. They examine how gender norms and inequalities affect relationships and power dynamics between men and women, as well as women’s access to resources, their rights, their opportunities, and their health practices and outcomes. In South Africa and Kenya, FHI 360 implemented this analysis to understand gender-related barriers to women’s microbicide use, identify solutions, and prepare for a gender transformative introduction

Of FHI 360’s findings, there are three key takeaways we would like to highlight:

1.  Promoting microbicides to all women, not just most at risk populations, will be important to avoid stigmatizing the product. People in both countries cautioned against promoting this HIV prevention method as a niche product for specific populations, fearing that targeted promotion of microbicides might stigmatize the method and lead to microbicide rejection by the populations who could benefit from it the most.

2.  Balancing women’s autonomy and male partner engagement in microbicide introduction is crucial. Women have the right to choose whether they inform their partners of their microbicide use, and health providers need to support women in making the decision that is appropriate for them. At the same time, educating men about microbicides may help increase acceptability and adherence and foster couples’ communication about sex and HIV protection. Microbicide introduction programs must take care to position women as the gatekeepers to their male partner’s involvement.

3.  Sex sells. Many believed that microbicide promotion should focus on sexual benefit and pleasure in order to increase its appeal. By highlighting these positive aspects of the gel, which were identified throughout earlier microbicide trials, people may be more likely to adopt this HIV prevention method.

In Sub-Saharan Africa, women’s access to sexual and reproductive health services is key to protecting their health and preventing HIV infection / Lisa Marie Albert

In Sub-Saharan Africa, women’s access to sexual and reproductive health services is key to protecting their health and preventing HIV infection. / Lisa Marie Albert

FHI 360’s gender analyses filled critical gaps in understanding that will enable public health practitioners to introduce this HIV-prevention method most successfully. As USAID and PEPFAR move closer to creating an AIDS-free generation, we recognize that gender analyses are a vital practice in order to better understand the communities with which we engage, strengthen the impact of our programs, and empower women and girls to protect their health and achieve their fullest potential.

ABOUT THE AUTHOR

Celia Karp is a public affairs intern in the Global Health Fellows Program II working in USAID’s Office of HIV/AIDS. Follow her @celkarp

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