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USAID Activities Respond to Gender-Based Violence

From November 25th (International End Violence Against Women Day) through December 10th (International Human Rights Day), USAID joins the international community for 16 Days of Activism Against Gender Violence. During this time IMPACT will highlight USAID’s work to combat gender-based violence.

In Rwanda, in 2012 alone, 3,472 women and girls were raped, defiled, beaten or killed, according to a statement by the Commissioner of Police John Bosco Kabera to The New Times, July 9, 2012.  More than half of newly married women reported suffering physical or sexual violence by an intimate partner. Nearly 80 percent of those women claim the violence occurred during the last 12 months (Rwanda Demographic and Health Survey, 2010).

Before the establishment of One Stop Centers, victims had to first go to the police station to give testimonies of their ordeal, and then travel back to the hospital to receive treatment, and only then received the official report to take back to the police station. No legal counsel was available onsite. The process could take days to complete, with victims shuffled from one service to another, re-living their traumatic experience and sharing the same details with different groups. Many would give up and go home. With the new One Stop Centers, all services are located on the same site. The whole process takes approximately four hours, during which time the victim remains at the Center while a dedicated staff of doctors, nurses, police officers, and social workers handle her case.

A group of community health workers being trained to identify and help respond to GBV cases in their community surrounding the Nyamata Health Center; discussion around the importance of gender equality and establishment of one stop centres in Nyamata/Bugesera district. Photo credit: USAID/Rwanda

A group of community health workers being trained to identify and help respond to GBV cases in their community surrounding the Nyamata Health Center; discussion around the importance of gender equality and establishment of one stop centres in Nyamata/Bugesera district. Photo credit: USAID/Rwanda

USAID’s Rwanda Family Health Project is supporting the Ministry of Health in fighting gender-based violence through the establishment of two One Stop Centers in Nyamata and Nemba Hospitals. One Stop Centers offer critical integrated services to victims, including immediate counseling, treatment, lab tests for HIV and other sexually transmitted diseases, and a physical examination by a doctor. Once exams are completed and evidence recorded, an onsite police officer submits the medical report to the court for legal proceedings.

Olive Mukase, a psychiatric nurse that is trained in dealing with victims of gender-based violence reflects, “It is a cultural and economic matter. In Rwanda, women believe that they need to remain silent so as not to bring attention or trouble to the household. The husband is the chief and a woman must respect what he says and does. Sometimes, she is scared that if she reports him to the police he could be sent to prison and she will not be able to provide for her family.” Ms. Mukase counsels victims and encourages them to help other women in their community find the courage to speak up and get help. Unfortunately, few women that are victims of gender-based violence will seek help, believing that the perpetrator will eventually stop. Only when the violence becomes unbearable do some women seek help.

Marthe Nyirarutimana, a Community Health Worker in a rural village outside of Nyamata, has recently been trained by the Program to raise awareness of gender-based violence in her community and how to refer victims to support services.  She shared that before receiving training, she did not think about how, as a community health worker, she would be involved in this issue. She now plays an active role in identifying cases, referring, and accompanying victims to health centers for care and treatment.

Marthe continues to work closely with local authorities to raise awareness of gender-based violence in her community. She describes how at first the community was resistant.  After her outreach, members began to discuss gender-based violence-what it is, why it occurs and how it should be handled. Most importantly, the community now knows that the victims should and can be taken to the One Stop Center for help.

One message that was echoed by these brave front-line workers is the need to break the silence around gender-based violence. Olive and Marthe are just two of the people committed to changing gender perceptions and providing services to the victims of gender-based violence in Rwanda. During these 16 Days of Activism Against Gender-Based Violence, support Olive and Marthe and others by becoming a part of the movement that gives voice to victims around the world.

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Previous 16 Days Blog Post: A Courageous Journey

A Courageous Journey

From November 25th (International End Violence Against Women Day) through December 10th (International Human Rights Day), USAID joins the international community for 16 Days of Activism Against Gender Violence. During this time IMPACT will highlight USAID’s work to combat gender-based violence.

I am always impressed by the spirit and courage of acid survivors. One of the women I recently met during a public event is 32-year-old  Nadia Bano from the suburbs of Punjab in Pakistan.

Nadia had been a happily married woman with three children, two sons and a daughter. Her brother had refused an attempted forced marriage to Nadia’s sister-in-law which provoked the deplorable attack that became the turning point in Nadia’s life. Furious at the rejection, and seeking revenge, her in-laws threw acid on her face one night while she was asleep. Her face was severely burnt, and she lost one of her ears.

"Like Nadia, women at a USAID-supported vocational center in Punjab, Pakistan are trained in different skills so they can earn a living for themselves and their families." Photo credit: Raja Zulfiqar

“Women at a USAID-supported vocational center in Punjab, Pakistan are trained in different skills so they can earn a living for themselves and their families.” Photo credit: Raja Zulfiqar

In Pakistan, acid attacks are predominantly against women, although there are a few attacks on men. The motivation behind such brutal acts is usually hate, revenge, jealousy, or disputes about money or land. Survivors of domestic violence are often left with long-term psychological and physical trauma; after 4 years and 17 surgeries, Nadia recovered physically, but not psychologically. It is a fundamental human right that women must be free to live without fear of domestic violence, and that’s what Nadia was  looking for.

“I didn’t want people to pity me, all I desired was for someone to help me find a job so I could actually be able to feed my children,” said Nadia. During one of her treatment sessions in Islamabad, a doctor told her about USAID’s Gender Equity Program. The program provides small grants to Pakistani organizations to fund projects that expand access to justice for women, increase knowledge of women’s rights and combat gender-based violence.

Under the USAID project, Nadia took part in a “Visual Arts Expression” workshop and learned the art of taking photographs. As a part of the training, she also was given a camera. She had always wanted to capture and praise the beauty of others through her camera, and she is now using her new skills to do so, and earn an income.

“I was keen to use my skill to spread smiles across my community which I am able to do now,” Nadia said. She is hopeful that in the near future she will be able to start her own professional photography and events management business, so she can continue to capture happy moments for her family and friends. Female photographers are in demand in communities like Nadia’s, where many people are not comfortable hiring a male photographer to take photos of women.

Today, in the wake of the Oscar-winning film, “Saving Face,” the issue of gender-based violence, specifically acid attacks in Pakistan, has received global attention. But much more work is still needed to be done to eradicate this brutal act from society. Talking about the 16 Days of Activism Against Gender-Based Violence to me means that we should support courageous women like Nadia in reviving their hopes and let them realize that their existence for this world is even more important than any other person as they are the genuine  symbols of courage and bravery.

Combating gender-based violence is a long-standing goal of the United States Government. The equal participation of women in the political, economic and social spheres is a key ingredient for democratic development. As in other countries, USAID provides critical support to Pakistani institutions and communities working on gender-based violence issues. Central to this effort is USAID’s Gender Equity Program, implemented by the Aurat Foundation, which seeks to build the capacity of governmental and non-governmental organizations throughout Pakistan so that women like Nadia can live a better life.

Using Photography to Evaluate Project Impact

From November 25th (International End Violence Against Women Day) through December 10th (International Human Rights Day), USAID joins the international community for 16 Days of Activism Against Gender Violence. During this time IMPACT will highlight USAID’s work to combat gender-based violence.

As researchers, it is sometimes easy to become engrossed in the mechanics of the research process – fretting over sample size, quality control, response bias and other technicalities. Admittedly, there are moments when we fail to really “see” the actual people our research strives to help.

My colleague Jeffrey Edmeades and I were reminded of this while in Ethiopia’s Amhara region for a project working to improve the lives and future opportunities for child brides in the region. Called TESFA, which means “hope” in Amharic, the project was implemented by CARE Ethiopia, evaluated by the International Center for Research on Women (ICRW) and funded by the Nike Foundation. TESFA gave young, married, extremely marginalized girls unprecedented opportunities to learn about their health, to interact with their peers, and to participate in the social, economic and political life of their families and communities.

A young married girl is learning how to use a camera during the first day of a week long Participatory Research Activity using the  Photovoice method. She, along with nine other program participants were asked to use photography to document their lives and the impact the TESFA program had on them. Photo credit: Robin Hayes

A young married girl is learning how to use a camera during the first day of a week long Participatory Research Activity using the Photovoice method. She, along with nine other program participants were asked to use photography to document their lives and the impact the TESFA program had on them. Photo credit: Robin Hayes

Most of the more than 5,000 girls we worked with over the three-year project had similar stories: Married off by their parents at nine, 14, 16, to much older men – strangers, really. Forced to drop out of school. Frightening, unwanted first sexual encounters.

Because of the remarkable similarity in their experiences, it was at times easy to fall into viewing these girls – our “research subjects”– as a large, homogenous group. Our experience in Ethiopia reminded us how critical it is not to have such a lens, but rather, to see participants as the individuals they are. We found that giving greater prominence to the individual experiences of program beneficiaries – in their own voices – illuminated our research and evaluation processes.

Specifically, during the final year of TESFA, we implemented the Photovoice strategy, which gives marginalized communities an opportunity to represent themselves through photography, as an element of program evaluation. It can also serve as a tool for advocacy and policy change. If adapted into a program, it can also become part of the intervention itself, where participants can gain confidence and communication skills to speak up about their lives.

We trained ten girls in the mechanics and ethics of photography, and for five days in April 2013, they used donated digital cameras to document their days and the impact the program had on their lives. Their images are beautiful and revealing. Accompanied by the girls’ descriptions, the photos helped us see the aspects of the program that they most valued.

Our research findings support much of what Photovoice revealed. Among them: Young wives reported much more communication with their husbands. Girls’ management of household finances improved and couples experienced greater financial security. Girls’ knowledge about their sexual and reproductive health increased significantly. And they were using contraceptives at a higher rate than before they became involved in TESFA.

Using participatory research methods like Photovoice to complement traditional approaches can lead to a richer understanding of programs’ outcomes. For beneficiaries like the child brides we worked with in Ethiopia – and other often overlooked groups – it can provide an unprecedented opportunity to build confidence and skills. And, to really be seen.

Robin Hayes is an Independent research consultant and Social Justice photographer who was part of the TESFA research team at ICRW. Jeffrey Edmeades also contributed to this blog. Edmeades is a senior social demographer who directed ICRW’s evaluation of the TESFA project.

Next 16 Days Blog Post: A Courageous Journey
Previous 16 Days Blog Post: New Evidence on Child Marriage Prevention in Ethiopia

New Evidence on Child Marriage Prevention in Ethiopia

From November 25th (International End Violence Against Women Day) through December 10th (International Human Rights Day), USAID joins the international community for 16 Days of Activism Against Gender Violence. During this time IMPACT will highlight USAID’s work to combat gender-based violence.

Defined as a formal marriage or informal union before the age of 18 years, child marriage is a practice that increases a girl’s risk of school dropout, maternal mortality, short birth intervals, vulnerability to gender-based violence, and poor mental health, among other adverse outcomes. Estimates suggest that 1 in 3 girls in the developing world are married before the age of 18. In areas such as the Amhara Region of Ethiopia, the prevalence of child marriage (CM) is among the highest in the world, with 2009 estimates showing that 50% of girls were married before the age of 18.

To help address the needs of 50 million adolescents who are already married, USAID invested in programs through PEPFAR to reach more than 220,000 married adolescent girls in Amhara, Ethiopia with access to family planning, STI services, HIV services, financial literacy, and menstruation management.

To help combat child marriage before it happens, USAID invests in research to prevent CM in “hot spot” areas with high CM prevalence. In Amhara, Ethiopia, as well as hot spot regions of Tanzania and Burkina Faso, USAID is supporting an innovative five-arm study on the effectiveness and cost of community education, economic incentives, and educational support on delaying marriage among adolescent girls, compared to control communities not receiving interventions.

Join the conversation with @USAID on Twitter using #16days.

Join the conversation with @USAID on Twitter using #16days.

USAID promotes dissemination and use of new evidence on effective strategies for child marriage prevention. A 2013 study (PDF) published by Anastasia Gage, supported under the USAID-funded MEASURE Evaluation project, sheds new light on how exposure to behavior change communication (BCC) affects knowledge and attitudes on CM among parents and guardians in Amhara Region. Although parents and guardians often decide when and who a girl marries, little data exists on effective strategies to change CM attitudes and knowledge among these gatekeepers.

Results from Gage’s study show that almost all parents were exposed to CM prevention messages from 1-2 communication channels.  Social influence was important to parents. Parents who believed their communities disapproved of CM were more likely to believe that marriage before age 18 was too early and that their daughters had the right to choose their own partner. By addressing parental attitudes and perceptions, programs can change social norms around child marriage. Future BCC campaigns on CM prevention should address the role of social influence on parental behaviors and attitudes and reinforce the health, economic, and educational benefits of delayed marriage. Evaluations of BCC programs should include a comparison group, monitor interventions for coverage, and measure changes in behaviors and practices.

USAID continues to support data collection on CM. Since 1984, the Agency has funded more than 260 Demographic and Health (DHS) surveys, which allow for identification of areas with the highest prevalence of CM. USAID supports rigorous evaluations of conditional cash transfer programs to delay CM among girls in India and Bangladesh, countries that account for the largest number of child brides in the world.

Learn more about USAID’s policies to address CM in Ending Child Marriage and Meeting the Needs of Married Children: The USAID Vision for Action. This vision is part of a suite of interlinked gender policies including the U.S. Strategy to Prevent and Respond to GBV Globally, the Gender Equality and Female Empowerment Policy, National Action Plan on Children in Adversity, Youth in Development Policy and National Action Plan on Women, Peace & Security.

R.E.S.P.E.C.T Find Out What It Means To Us

From November 25th (International End Violence Against Women Day) throughDecember 10th (International Human Rights Day), USAID joins the international community for 16 Days of Activism Against Gender Violence. During this time IMPACT will highlight USAID’s work to combat gender-based violence.

It is no accident that Aretha Franklin’s rendering of “Respect” rapidly became an anthem for marginalized and disenfranchised individuals and groups. The denial of human rights, particularly the most basic rights, such as respect, touches on a universal chord.

In recent years, global attention has been growing surrounding the horrifying issue of disrespect and abuse of women during childbirth.

Indonesia Maternal Health

USAID’s presence in Indonesia has been vital to the success of various health initiatives. The Blue Circle campaign of the 1980s and the Bidan Delima program in 2005 are just two examples of these initiatives that made it possible for women, like those pictured waiting in line, to receive maternal and child health and family planning services at community health centers. Photo credit: USAID/Indonesia

Think about the treatment you, or your wife, sister or daughter, expect from your maternity care provider. He or she is responsible for helping you (or your partner) give birth safely. Can you imagine a doctor scolding you for not using family planning to control your fertility? Or being separated from your newborn because you don’t have enough money to pay the discharge bill? Or giving birth unclothed while visitors walk by?

In both developing and developed countries around the world, pregnant women experience disrespect that ranges from subtle denial of their autonomy to blatant abuse. Numerous studies (PDF) document physical abuse in childbirth, including slapping, restraining, suturing without pain medication, or forcibly pushing on a woman’s abdomen. For women carrying or at high risk for HIV, the fear of stigma and discrimination from providers is often compounded by stigma from partners and families, especially regarding HIV testing or positive status disclosure.

This lack of respectful care also deters many women from seeking hospital care; instead they choose to give birth at home without the care of a skilled health attendant. This increases the change of complications from childbirth, possibly causing death.

While some may blame healthcare providers, many of these providers are working under suboptimal conditions, with many being overworked, underpaid, and burdened with unmanageable caseloads. The lack of empowerment, dignity, and security for midwives and nurses is driven by deep-rooted attitudes derived from gender, class, caste, race and cultural norms towards women. These problems undermine the resilience of midwives and nurses and negatively impact their capacity to provide quality care.

What does respect for women giving birth mean? The Universal Rights of Childbearing Women Charter (PDF) clearly outlines what respect means; certainly it includes the physical safety of pregnant women, but it also includes the respect for women’s basic human rights, including respect for women’s choices, preferences, feelings, and autonomy. It also means addressing the conditions of healthcare providers.

To eliminate the humiliation and abuse of women in childbirth, USAID supports the White Ribbon Alliance to lead global and country level advocacy and the University Research Corporation TRAction Project (PDF) to carry out implementation research to assess the prevalence of disrespect and abuse and test approaches to decrease these behaviors. With USAID funding, the Jhpiego/MCHIP Project has developed a comprehensive Respectful Maternity Toolkit available throughout the world. Furthermore, USAID is partnering with the World Health Organization to review the evidence on the status and working conditions of midwives and address the disrespect and abuse of women in childbirth.

We see the need for increased awareness and support for civil society engagement and advocacy, and the need to work with all involved in the direction, management and provision of care to women giving birth. Global initiatives, such as the Third Global Forum on Human Resources for Health, are key opportunities to realize these basic human rights.

Until recently, this was a problem hidden behind a veil of silence. Now we hear the silence being broken across the globe, but it is just a start.  Women’s voices need to be heard. And all of us need to respond to promote social justice and improve quality of care. Women’s lives depend on it.

Meeting the Needs of Children and Adolescents Who Have Experienced Sexual Violence

From November 25th (International End Violence Against Women Day) through December 10th (International Human Rights Day), USAID joins the international community for 16 Days of Activism Against Gender Violence. The blog below highlights USAID’s work to combat gender-based violence and celebrates ten years of our HIV and AIDS work under PEPFAR in advance of World AIDS Day (December 1).

Ruth was doing “okay,” with the help of her HIV medication and the friends she had made in a local support group for people living with HIV. With a shy smile, Ruth told me that she was getting by, but she missed her two young daughters. Her nine-year-old, Sarah, had been raped a year before and was now at a recovery center with her sister, who stayed with her for company. “She still hasn’t spoken, but she is getting better,” Ruth said with a sad smile.

In Swaziland, just before sunset, a young girl tests out a new seesaw on a playground built by the Elizabeth Glaser Pediatric AIDS Foundation at the Mkhulamini Clinic. Photo credit: Jon Hrusa, Elizabeth Glaser Pediatric AIDS Foundation

In Swaziland, just before sunset, a young girl tests out a new seesaw on a playground built by the Elizabeth Glaser Pediatric AIDS Foundation at the Mkhulamini Clinic. Photo credit: Jon Hrusa, Elizabeth Glaser Pediatric AIDS Foundation

Like many single mothers, Ruth worked during the day doing laundry and chores for other families. A male neighbor took advantage of her daughter when she was home alone. The attack had been so brutal that her daughter had been in the hospital for over a month. With the help of friends, Ruth made sure the man was arrested and prosecuted. It had been hard. The time spent on the case had left little time to earn income. Ruth’s family was struggling, but people were helping. She had hope that things would get better, and that her daughter would recover.

Ruth’s story and her courage epitomize the struggle to achieve an AIDS-free generation. Treatment is a miracle, but the true test of our resolve to end AIDS lies in our commitment to end the inequities of gender, of rich and poor, of powerful and vulnerable.

Girls, often marginalized by age and social status, are at a particularly high risk. Globally, young women aged 15-24 are the most vulnerable to HIV and account for 22 percent (PDF) of all new HIV infections (twice as high as young men). Furthermore, an estimated 150 million girls have experienced some form of gender-based violence before age 18. But this is not just limited to girls. According to the World Report on Violence Against Children (PDF), an estimated 73 million boys globally have also experienced sexual violence before age 18. Such violence has severe consequences for their immediate and long-term health and well-being, including increased risk for sexually transmitted infections such as HIV, reproductive and sexual health complications, alcohol and drug abuse, and psychosocial health issues. In addition, results from the PEPFAR Sexual Gender Based Violence Initiative showed that when sexual assault services were introduced to primary health centers, a large percentage of patients presenting for care were under 18, but services were not tailored to meet their unique needs.

USAID, as a key implementing agency of PEPFAR, has a strong commitment to addressing the unique needs and vulnerabilities of children and adolescents experiencing sexual violence, including addressing the gender-related factors that underlie such violence. The recently launched guide, Clinical Management of Children and Adolescents Who Have Experienced Sexual Violence: Technical Considerations for PEPFAR Programs, offers step-by-step technical advice for clinicians, social workers, pediatricians, child protection workers, HIV specialists and others on appropriate clinical care and management. These technical considerations are meant to serve as a starting point for national level adaptation and development of comprehensive, integrated services for children.

As we travel down the road to an AIDS-free generation, we hope that stories like that of Ruth’s daughter dwindle into extinction. In the meantime, for those children that are afflicted by such unspeakable sexual violence, we pledge to continue serving their unique needs and vulnerabilities.

Achieving Equity Through Women in Leadership

I’ve just returned from the International Conference on Family Planning in Addis Ababa, Ethiopia, where thousands of leaders and experts came together to discuss how to improve access and choice in family planning services across the globe. One of the highlights of the conference for me was speaking on a panel about the role women leaders can play in this arena.

I don’t think you have to be a woman to be committed to achieving equity in access to family planning services.  There are countless men in leadership roles that are deeply committed to expanding equity across the board, including in access to family planning.  That said, I think having women in leadership positions is incredibly important.

Mother and child at a health clinic in Ethiopia. Photo credit: USAID

Mother and child at a health clinic in Ethiopia. Photo credit: USAID

We often talk about women leaders as role models for girls.  Certainly having women in leadership roles lets girls see someone who looks like them doing things they might dream of doing and helps validate those dreams.  But women in leadership positions are role models for boys too—that women belong in leadership positions, that having women in these roles is normative. Having women in leadership roles in government is an especially public acknowledgement of legitimacy.

Governments have a responsibility to treat their citizens equitably, which means they have a special role to play in addressing disparities, whether that is as a direct provider of health services or by making it attractive for the private sector to serve the underserved or both. When governments prioritize making it possible for poor women, rural families, adolescents, and racial or ethnic minorities to exercise their right to choose the number, timing, and spacing of their children by expanding access to high quality, voluntary family planning information, services, and methods, they send a message about their commitment to equity and rights.

Having women employed in visible roles in government programs, whether they are in formalized leadership positions or not, also sends that message.   And there are great examples all around us:

  • Managing the largest portfolio that USAID has in Asia, female Foreign Service Nationals at USAID’s Bangladesh mission have strengthened the family planning portfolio. Dr. Umme Meena in the mission there—and other men and women like her employed as Foreign Service Nationals by the U.S. government worldwide—demonstrate America’s commitment to equity in family planning every day.
  • In Amhara, Ethiopia, USAID supports activities to prevent child marriage by identifying young female community mentors who can advocate against marriage before the age of 18. These youth leaders are powerful agents of change and gender equity in their communities.
  • Community health workers are some of the most passionate and committed champions for equity in access to family planning and health services. Esther Nyokabi in Kenya is an illiterate woman who overcame significant personal obstacles to become a champion for post-abortion care. She mobilized her community to demand better health infrastructure from the government. She is now a passionate community health worker and part of a government –sponsored training team for post-abortion care. Her efforts have brought life-saving antenatal care, skilled attendance at delivery, and family planning services to a community that did not have health services previously.

It is the commitment, passion, and actions of leaders like these that will achieve full choice in family planning.

Watch a video clip of Ellen Starbird at the International Conference on Family Planning and read news and announcements made by USAID at the conference. 

A Lesson in Holistic Care: What I Learned from Working with Transgender Women and Health Providers in the LAC Region

November 20 is Transgender Day of Remembrance.

I have collaborated closely with transgender women and health providers in Latin America and the Caribbean to learn more about the needs of transgender populations and to train health workers to provide quality services. Working alongside transgender women on needs assessments, trainings for health providers, and in the development of a blueprint (PDF) for comprehensive transgender services, opened my eyes to their experiences, gaps in existing programs that limit access to critical services, and the opportunities we need to pursue. To help you understand my recommendations, I would like to share a story I heard repeatedly from transgender women:

I was 13 years old when my family threw me out of the house because of who I am. I tried to continue my studies, but I dropped out of school because my classmates insulted me every day and sometimes hit me, and I was afraid to use the boys’ bathroom (the only one I was allowed to use) because I was afraid of being assaulted by male students. The teachers looked the other way or called me names. I have developed a thick skin because when I step out of my home, people stare, make comments and give menacing gestures. Going to a clinic is also unpleasant. I get sick like everybody else, but the nurses always assume that I am a sex worker and that I have HIV. Frequently, they give me condoms and an HIV test and send me home. One time I was jumped by four guys in the street, and I ended up in the emergency room. When one of the nurses opened my robe and saw that I am a transgender woman, she gave me a look of disgust and called me a homosexual. She must have told others about me because several nurses came, opened my robe and walked away laughing. I waited for a long time before a doctor saw me. He told me that real men do not dress like women, and that I should cut my hair and stop wearing make-up so I could get a job. I had a cut in my head that needed stitches and the doctor did not even clean the blood in my hair.

REDTRANS and Miluska staff conducting a workshop on HIV and human rights. Photo credit: Manuel Contreras

REDTRANS and Miluska staff conducting a workshop on HIV and human rights. Photo credit: Manuel Contreras

This story, and the others that I heard through this work, underscored the need for a new approach to transgender health:

  1. Prevention efforts must engage families and schools to foster supportive environments.  Transgender teens frequently experience rejection from their families and bullying in school. Homelessness, low literacy, and lack of family protection not only increase the likelihood that these teens will experience exploitation, but also severely limit their opportunities to find jobs.
  2. Many people, including health providers, do not clearly understand the spectrum of sexualities, genders, and identities. Their confusion often leads to stigmatizing attitudes and discriminating practices in health care settings, which in turn discourages transgender women from seeking care.
  3. Increasing access to counseling and testing and other HIV services should not be an end in itself. Securing the human rights of transgender communities and creating a safer environment where they can access appropriate services without fear of violence or discrimination should be the focus.
  4. Increasing access to condoms and HIV information are cornerstones of HIV prevention, but national prevention programs need to go beyond these two strategies. Policies and programs should also support employment and education opportunities for transgender persons. The pressure to put food on the table and a roof over their families’ heads can lead to poor decision making, resulting in risk-taking behaviors.
  5. Engaging transgender persons in program activities as facilitators or data collectors strengthens their technical capacities and allows them to engage with health providers and communities as professionals and peers. This can effectively dispel myths and negative beliefs about transgender women, their capacity, and their behavior.

By sharing my observations and the stories I heard, I hope to raise awareness of the issues that come into play and to encourage all of us to reconsider how our programs can better contribute to the well-being of transgender persons and their communities. We can make that commitment today on Transgender Day of Remembrance, an internationally recognized day to memorialize those who suffered or died as a result of anti-transgender hatred or prejudice.

Aysa Saleh-Ramirez, MPH is AIDSTAR-One Senior Technical Advisor at John Snow, Inc. AIDSTAR-One is funded by PEPFAR through USAID.

Empowering Women to Address Climate Change

Today marks the second annual Gender Day at the Conference of the Parties to the United Nations Framework Convention on Climate Change (UNFCC) Conference, which opened (PDF) last week in Warsaw, Poland. Leaders from around the world are focusing on how to achieve their commitments to promote gender balance and improve women’s participation in international and local level decision-making related to climate change.

This year, USAID is proud to announce that we are initiating a new partnership with the International Union for the Conservation of Nature (IUCN) to work together to expand and enhance USAID’s efforts to address gender issues through programming and support to our partner governments.

Members of the Huruma Women’s Group in Kenya. Photo credit: Photo Credit: Fintrac Inc.

A group of women in Kenya who supply maize for sale in local markets. Photo credit: Photo Credit: Fintrac Inc.

This support is critical as climate change will have a serious impact on the livelihoods of poor women in developing countries; the increasing frequency of droughts and stronger storms will affect agriculture and water resources, sectors in which women have an essential management role.

Speaking on a panel this morning, Nancy Sutley, Chair of the White House Council on Environmental Quality emphasized that “globally, women are central to unlocking solutions to the climate change challenges we face.”

IUCN has found that women often lead the way in adapting to climate change impacts, and play a key role in mitigating climate change by optimizing energy efficiency, using low-footprint energy sources and techniques, and influencing a household’s and community’s consumption patterns. Women’s participation in decision making at higher levels has specifically benefited environmental policy, such that countries with a higher number of women in their parliaments are more likely to set aside protected land areas and ratify international environmental treaties. In fact, recent data (PDF) reveals that there is a causal relationship between environment and gender; when gender inequality is high, forest depletion, air pollution and other measures of environmental degradation are also high.

While women can be agents of change, their contributions are seldom fully harnessed. The result is a lost opportunity. This new partnership will be aimed at advancing women’s empowerment and gender quality to achieve greater strides in reducing emissions to mitigate climate change, building resilience to climate change impacts, and promoting better development in general.

While plans are necessary to illuminate the pathway to a goal, they are not sufficient for attaining those goals.  This new agreement with IUCN to implement the Gender Equality for Climate Change Opportunities (GECCO) project will provide USAID and our partner governments with support for our mutual goal of advancing women’s empowerment and gender equality through and for the benefit of climate change and development programs.

We have seen great progress in recent years, with growing attention to gender issues within the UNFCCC and within projects addressing these issues at the country level.  However, there is much work still to be done, so we are excited about the opportunities this new partnership with IUCN brings.

 

Access to Water Empowers Women in Morocco’s Middle Atlas

I recently returned from Outerbate, a village high in the Atlas Mountains in central Morocco, where USAID broke ground on a new water supply system. In this Amazigh, or Berber village, the water supply system is more than 80 years old and serves only a handful of the village’s 300 homes.

I met Fatima Mazrou, a woman in her late 70s, who shared, “When we look for water, we sometimes get frozen and sick because the weather can go to below 10 degrees. It takes me at least one hour lining up to get water. Water and bread are critical to our survival.”

Increased access to water changes women and girls' lives in Morocco. Photo credit: USAID

Increased access to water changes women and girls’ lives in Morocco. Photo credit: USAID

I was surprised to see that women do most of the hard work of filling buckets to provide their families with water. The challenge is that the village’s 1,200 inhabitants must fill buckets and water containers at a common tap, and the task disproportionately falls to the village’s women and girls.

During the summer months, the tap frequently runs dry. Water-related health problems are common. In the winter, this arduous trek up the mountain in freezing weather and back to the village carrying heavy pails of water leads to health problems for women, including miscarriages.

The time and work involved collecting water also means reduced primary school attendance by the village’s girls. Kuba Hamou, a sheep herder, told me that “having better access to water would eventually free women to pursue income-generating activities and help keep our daughters enrolled in school.”

Financed by USAID’s Development Grants Program, the Outerbate water system is being installed to address some of these challenges. Implemented by a local NGO, Al Kheir, the program will provide clean drinking water to every home in the village, ending the current practice of women and girls filling water containers at a common tap. With the introduction of the new system, girls’ attendance in schools should also increase and hundreds of families will have access to water and improved sanitation conditions in their homes, schools and public areas.

In addition, we have been able to work with Al Kheir in other life-improving ways. We helped the village set up a thriving artisan business selling locally produced honey and apple juice. And within Al Kheir, two young women are now on the association’s board of directors – the first time a woman or a youth has served in this capacity. Since this project began, Al Kheir has begun working with European and Japanese donors on other projects.

“None of this would have been possible without the engagement of USAID. We appreciate their support and its effects on our village,” said Haddou Maadid, Al Kheir’s president.

At the heart of USAID Forward is a belief that our results are always better when we partner directly with local institutions since they are empowered to take control of their future. In Outerbate, we are helping a village access safe water. By working directly with local partners, our assistance is amplified far beyond the water tap.

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