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FP2020: Plans, Partnerships and Progress – One Year On

This originally appeared on The Huffington Post Blog.

Sometimes it’s hard to tell if your work really makes a difference. Three months after the London Summit on Family Planning, I led a delegation of UNFPA supporters to Ghana. We saw a diverse and inspiring range of maternal health programs — from government hospitals to an entrepreneurial midwife who designed and produced birthing stools with the help of a local carpenter.

In Tamale, we visited a brand new Marie Stopes clinic fully stocked with a range of modern contraceptive methods. It was located in the heart of the city, at a vibrant, open air market that stands at the crossroads of three ancient trade routes. For the women and men who work there, the clinic could not be more convenient — they could easily dash off for an appointment or for supplies.

Ghana woman at USAID health event. Photo credit: USAID

From there we flew north to Bolgatanga, then traveled by bus towards the border with Burkina Faso. As we drove, the tarmac gave way to unpaved roads. Cracks became grooves, and grooves became ditches. As the hours passed, the villages became smaller and the distance between them grew. Wherever we were headed, it felt worlds away from the hustle and bustle of Tamale.

Finally we arrived at our destination: a plain, L-shaped building in a small compound. It was a Planned Parenthood of Ghana clinic that provides an integrated mix of family planning and other health education and services.

Despite its remoteness, we were greeted with as much enthusiasm and excitement as we felt in Tamale. About 200 people — village elders, mothers and fathers, grandmothers and grandfathers, children — had come out to show support for their clinic. They told us about the difference the clinic was making in their lives. In this isolated location, it was their only source of medical care.

But as we toured the facility, I happened to notice one person who wasn’t taking part in the excitement. Her name was Afia, and she sat very quietly, in a corner, on a hard wooden bench. A midwife was by her side.

Afia’s face was etched in pain, but her cries were muted. With quiet dignity, and few of the trappings that attend births in countries like my own, I found out she was in labor to deliver her first child.

As a mother myself, I knew how scared she must have felt. I also knew that in Ghana, for every 100,000 women who go into labor, 350 die giving birth or because of pregnancy-related complications. The statistics can be numbing.

Afia remained on my mind and two days later, I learned she had a lovely baby girl, and both mother and child were happy and most importantly, healthy.

I know that in the coming months and years, the clinic will help Afia keep herself and her baby healthy, and will give her the contraceptives she needs to plan her family and her future.

Our work does make a difference. This is what Family Planning 2020 is all about: reaching women, no matter where they live, with the information, services and supplies they need. Program by program, clinic by clinic, and woman by woman.

One year after the London Summit on Family Planning, I am pleased to report that FP2020 continues to build the foundations of a global movement and is accelerating progress towards achieving our goal of reaching an additional 120 million women with lifesaving contraceptive information, services and supplies by 2020.

Countries are championing the cause — over twenty governments have already made commitments and a few more are gearing up to do so. National, costed family planning plans are being drafted and implemented, new health laws are being passed and service delivery barriers are being addressed. Price-reduction agreements on long-acting, reversible contraceptive implants and the scale-up in delivery of discreet, injectable contraceptives ensures that millions of women will be able to access a range of family planning methods. We’ve improved relations with allies, built and strengthened new partnerships, and established our global governance framework. I am proud of what we’ve accomplished together.

And yet, I remain acutely aware that the work of FP2020 has only just begun. We have so much more to do to ensure that family planning remains front and center on the global development agenda. This will require even stronger international partnerships to uphold and guard the unified aspirations of millions of women and girls to chart their own future.

Women like Afia are depending on us to keep the promises we made one year ago at the London Summit. As we move forward into the second year of FP2020, I am convinced and confident that working together, we shall.

Ensuring Access to Reproductive Health for All

Approximately 16 million girls ages 15 to 19 (most of them already married) give birth each year. On July 11, World Population Day, we join the global community in raising awareness on the issue of adolescent pregnancy in the hopes of protecting and empowering millions of girls around the globe.

Adolescent pregnancy has dire health, social and economic consequences for girls, their communities, and nations. Complications from pregnancy and childbirth are a leading cause of death for girls ages 15 to 19 in low-and middle-income countries. Stillbirths and death are 50 per cent more likely for babies born to mothers younger than 20 than for babies born to mothers in their 20s. We know that girls who become pregnant often face discrimination within their communities, drop out of school, and have more children at shorter intervals throughout their lifetime. A World Bank study (PDF) found that the lifetime opportunity cost related to adolescent pregnancy in developing countries ranges from 10 percent of annual GDP in Brazil to 30 percent of annual GDP in Uganda.

World Population Day 2013 aims to draw awareness to the issue of adolescent pregnancy. Photo credit: Netsanet Assaye, Courtesy of Photoshare

I believe meeting the reproductive health needs for today’s young people is vital to ensure future generations are able to lead healthy and dignified lives.  In developing countries overall, 22 per cent of adolescent girls (aged 15-19) who are married or in union use contraceptives, compared to 61 percent of married girls and women aged 15-49 (PDF). Lack of information, fear of side effects, and other barriers—geographic, social, and economic—prevent young people from obtaining and using family planning methods.

It’s appropriate that this World Population Day also marks a year since the historic London Summit on Family Planning, and the launch of Family Planning 2020. This global partnership supports the right of women and girls to decide, freely, and for themselves, whether, when, and how many children they want to have. I am proud to be on the Reference Group of the Family Planning 2020 initiative (PDF) that aims to enable 120 million more women and girls to access family planning information and services by 2020.

As the largest bilateral donor for family planning, USAID is uniquely poised to accelerate progress and improve education and access to reproductive health services for youth.  We support programs and research on adolescent health and development, and we have approaches that work to improve knowledge and change behaviors. Our programs focus on gender equality, because we know that boys and men who have access to reproductive health information and services are better able to protect their own health, support their partners, and participate in planning of their future and that of their families.

USAID is committed to protecting reproductive rights for all people and especially for the world’s adolescents and youth. Young people are the future, and we want and need their valued contributions to and participation in the social, economic, political, and cultural life of their communities.

Follow @USAIDGH on Twitter and join the conversation about World Population Day using the #WorldPopDay hashtag. Share our new infographic on adolescent pregnancy.

Mujeres Adelante: Leading Change Against Violence

This originally appeared on DipNote

“¡Eres maravillosa!” (You’re wonderful!)

Repeating this mantra in unison as they received their certificates, each of the 14 women civil society leaders – lawyers, social workers and psychologists, academics and student leaders – from Central America and the Dominican Republic, affirmed one other’s work to eliminate gender-based violence (GBV) in the region. For the participants of Mujeres Adelante (Women Moving Forward), the past two weeks had been a whirlwind of meetings with local, state, and federal government officials, coalitions and advocacy organizations, as well as NGO service providers. This final affirmation was a reminder of how important the issue and each participant’s individual contribution to its elimination truly is.

“Mujeres Adelante” participants. Photo credit: State Department

The 2013 class of Mujeres Adelante included participants from El Salvador, Costa Rica, Nicaragua, Honduras, Guatemala, Panama, and the Dominican Republic. For each of them, the two weeks in the United States — first in Seattle, and then in Washington, DC. — were both a respite from the daily and very real threat of working on GBV and an occasion to strengthen the women’s ongoing commitment to the issue. Approximately 30 percent of women in the Americas have experienced physical and/or sexual abuse at the hands of a partner, or sexual abuse by a non-partner. Strikingly, and unique to Central America, two out of three women murdered are killed for a gender-related reason. This program provided the participants an opportunity to highlight the scourge of GBV in their home countries, and access new tools they could use upon their return home.

“Working [on GBV] is incredibly difficult,” one participant said. “Sometimes, we don’t get to the victim in time to help her. Sometimes, there is a lack of will [by authorities] to respond, and always, there is a lack of resources.  That is why alliances like these are so important, so we can work together better.”

Launched in October 2012 by the Secretary’s Office of Global Women’s Issues, in collaboration with the Seattle International Foundation and the Bureau of Educational and Cultural Affairs, Mujeres Adelante is a network of Central American and Dominican women leaders who work to:

  1. Raise awareness of the pervasiveness of GBV as well as awareness of women’s rights and available resources;
  2. Increase governments’ accountability for preventing, responding to and addressing GBV;
  3. Share best practices on service provision and advocacy efforts; and
  4. Facilitate ongoing networking, skills and capacity-building of women in their home countries.

The United States has made preventing and responding to gender-based violence a cornerstone of our commitment to advancing gender equality and women’s empowerment. The United States Strategy to Prevent and Respond to Gender-based Violence Globally and the U.S. National Action Plan on Women, Peace and Security recognize that gender-based violence is a human rights abuse and a manifestation of the low status of women and girls around the world. Working together, we can ensure that women and girls live up to their true potential and live lives free of violence – and are able to contribute fully to their families, communities, and economies.

Learn more about USAID’s Mission of the Month: Guatemala and our work in eliminating gender-based violence

A Bright Future for Agriculture in Africa

As my final tour with USAID winds down in the coming months, I can step aside with pride and confidence in the work we’re doing on the African continent to increase food security and nutrition. Having worked in Africa for much of the past 30 years, I am firmly convinced that the Agency’s new focus on modernizing and improving agricultural technologies through Feed the Future, President Obama’s global hunger and food security initiative, is having a demonstrable impact.

Here in Senegal, recent statistics indicate a near-doubling of yields in rain-fed rice, from about 1 ton per hectare to 1.82 tons. In some of the country’s most vulnerable areas, undernutrition has been reduced by a large margin in the last year.

What makes these and other statistics really exciting is an opportunity some USAID Mission Directors don’t get in their entire career: a chance to exhibit some of our major successes to the President of the United States himself, who made Senegal the first stop on his second trip to Africa last week.

While here, President Obama toured the Feed the Future Agricultural Technology Marketplace, where at each stop he was able to see how agricultural research and innovation are helping West African farmers to increase incomes and nutrition for their families.

At one booth, Anna Gaye, an entrepreneur, demonstrated how switching to a small-scale, efficient rice mill and an improved rice variety has tripled yields in her region and freed up her time for alternative activities.

At a Feed the Future agricultural technology marketplace in Senegal last week, President Obama met with farmers, innovators and entrepreneurs whose new methods and technologies are improving the lives of smallholder farmers throughout West Africa. Photo credit: Kate Gage, USAID

At another booth, Pierre Ndiaye, the owner and operator of a factory producing a popular nutritious yogurt-and-millet porridge, explained how USAID helps smallholder producers create his product. We support women’s producer groups around the country to grow quality millet, providing employment to hundreds of women who produce the porridge for local schoolchildren to get a nutritious meal every day.

We were also excited to demonstrate how nutrient fortification of Senegal’s staple foods can result in a radical decrease in undernutrition. Nutrition plays a critically important role in the Feed the Future approach, and fortified food can have a profound effect on the health of children in Senegal and all over Africa.

Yet another stop showed how the technology of today can help farmers as businessmen and women.  A young woman president of a 3,000-strong maize farmers’ union explained how they use the internet and mobile devices to control product quality and organize the marketing of their crops, which allows them to collectively compete with large industrial farms across the globe.

What makes these innovations yet more exciting is the potential for scaling them up and sharing them with other nations. New technology is only as good as our ability to get it into the hands of the millions of smallholder farmers who are the foundation for agriculture-led economic growth. Through Feed the Future, we are working to make successful technologies more and more accessible to the farmers who need them the most.

Looking back on the visit and on our tremendous successes in agriculture thus far, I can’t think of a more exciting, rewarding way to end a career with USAID.

Resources:

Equipping Women Teachers in South Sudan with the Skills to Succeed

Traditional gender roles in South Sudan have hindered women from improving their professional skills and limited their contributions as teachers and leaders of parent-teacher associations, school management committees and boards of governors. As a result, children lack female role models and South Sudan has a shortage of teachers.

Most of South Sudan’s teachers lack professional training, a legacy of decades of conflict. Women constitute only 12.3 percent of the teaching force in South Sudan’s primary schools and 10.5 percent of teachers in secondary schools.

USAID is helping to improve female teachers’ professional skills and retain female teachers in South Sudan’s workforce through training and providing working mothers with childcare so that they are able to focus on their professional development.

Teacher Samna Basha (middle) with colleagues. The women are benefiting from USAID-supported child care services that enable them to improve their professional development as teachers. Photo credit: Creative Associates International

Samna Basha, a third grade teacher enrolled in USAID-funded training, said that childcare helped her to concentrate and avoid inconveniencing colleagues in the classroom. “I did not expect to complete the training because I am a nursing mother and therefore unable to focus my undivided attention on the training material,” said Basha, who teaches at the Lokoloko Primary School in Wau, Western Bahr el Ghazal state. “I was pleased when a … staff member [told] us that child care services would be provided by a caretaker of our choice at a venue provided by the school and that the service would be paid for by the project. It was a great relief for all the mothers … this is the first time in my experience that working mothers have been supported to fulfill their professional duties while caring for their children.”

Pasqulina Jackino is a mother of six and has been a teacher of mathematics, science, and religion in Primary 1, 2, and 3 at Ezo Community Girls School in Western Equatoria State for nearly seven years. She had received no formal teacher training until she was offered the opportunity to participate in a USAID-funded in-service training course. “I quickly packed a bag for me and my baby and set out to attend the training because I knew this was an opportunity to make me a better teacher,” she said.  “I am now able to plan my lessons and make them more lively and interesting. Through interactions with fellow teachers and tutors from other counties, my English has improved. I am now able to explain the subject matter of the lesson to my pupils in English.”

Pasqulina can now effectively manage her classroom and encourage pupils to learn. As she explains, “to be a mother and teacher at the same time is a challenge but I am ready to take it up. This is the only way I can come out as a better person and contribute to the growth and development of my community and the entire nation.”

USAID’s Investment in Africa

As President Obama embarks on his trip to Africa, USAID is proud to take this opportunity to highlight the important work we are doing to partner with Africans in new and innovative ways to build a peaceful and prosperous future. For the first time in over a generation, sub-Saharan Africa is seeing steady progress toward ending extreme poverty, fueled by robust economic growth and better governance and service delivery in many countries. These gains have been supported by USAID’s investments in improved agriculture, health care, and democratic institutions, and our increased focus on women and a new generation of African thinkers, entrepreneurs, and innovators, each of which are delivering transformational results. In concert with partners throughout Africa, we are working toward ending poverty and providing millions a foothold in the global economy—and helping to realize the promise of the world’s most youthful region.

Women in Senegal. Photo credit: USAID

The President will visit Senegal, South Africa and Tanzania–some of USAID’s most important development partners–but his messages are relevant for the entire continent. USAID with thousands of grassroots organizations, communities and local businesses in 42 African countries to achieve these shared goals. Some examples of these partnerships are featured in this collection of stories about our work in Africa.

Throughout the President’s trip, our teams on the ground will provide regular social media updates. Be sure to follow Administrator Shah on Twitter (@rajshah) as he accompanies the President and join the conversation using #USAIDAfrica! Follow us also on Facebook and our Impact Blog for real-time stories from our missions in Senegal, South Africa, and Tanzania. We look forward to continuing the conversation with you throughout this trip and beyond.

On the Front Lines in Africa

Nowhere is development such an important part of U.S. engagement as it is in Africa. In anticipation of the President’s trip next week, we thought we’d share some of our favorite FrontLines stories about our work in Africa. President Obama’s strategies on global development and Africa have laid the foundation for a new approach that focus on sustainable development and a new operational model for assistance. We look forward to the opportunities that this visit will bring.

Our Favorites include:

Food Security

Child Survival

Innovation

Women and Development

Conflict Mitigation and Prevention

  • Ethiopia: Peace Brokers: USAID-sponsored reconciliation efforts usher in historic truce accord in Ethiopia’s pastoral south.

Democracy, Human Rights, and Government

Humanitarian Assistance

Resilience

  • Niger: Niger’s Tree of Life: In the face of recurring food insecurity and acute malnutrition, USAID is promoting the cultivation of hardy, vitamin-packed moringa as one way to build resilience in communities in the drought-prone Sahel.

Follow @USAID and @rajshah on Twitter for updates on the trip and to learn more about our work in Africa. Join the conversation using #USAIDAfrica.

Introducing SILCS: It’s Not Your Mother’s Diaphragm

In the early 20th century,  distribution of and education about contraceptives were illegal in the United States, leading to the widespread use of ineffective contraceptive methods. This continued until Margaret Sanger visited a Dutch birth control clinic where she learned about diaphragms and thus began a revolution in the United States. The diaphragm was the first safe and effective woman-initiated contraception in much of the world and was widely used in the United States and other countries until the introduction of the birth control pill. While use of the device has decreased over the past 50 years, a comeback may be in the wings.

The SILCS Diaphragm, set to officially launch in Europe this June, is the first new cervical barrier method that will enter the market in more than a decade.

The SILCS Diaphragm is the first new cervical barrier method that will enter the market in more than a decade. Photo credit: Kessel Marketing

PATH, in collaboration with CONRAD and funded by USAID, designed the one-size-fits-most SILCS Diaphragm to increase access to nonhormonal barrier contraception for women in low-resource settings, as well as developed countries. PATH led a user-centered design process involving input from women, their partners, and providers. The design was then verified in clinical studies by couples in the Dominican Republic, South Africa, Thailand, and the United States. The single size should remove the need for a pelvic exam and fit assessment which are obstacles to both providers and women in many settings.   PATH licensed the SILCS design to Kessel Marketing & Vertriebs GmbH of Frankfurt, Germany, who will introduce the device as the Caya™ contoured diaphragm.

While SILCS was developed to expand women’s options for nonhormonal barrier contraception, SILCS has added value due to its potential to be used as a multipurpose prevention technology when paired with tenofovir gel—a product currently in Phase III clinical testing—which is designed to protect women from acquiring HIV.

CONRAD, which owns a license for tenofovir gel, is working on a protocol for a study that will assess the safety, pharmacokinetics, and pharmacodynamics of the SILCS plus tenofovir gel. Another study will evaluate the potential of a modified tenofovir gel as a contraceptive by pairing it with the SILCS to assess their ability to prevent sperm from penetrating cervical mucus.

PATH is working with research partners in India, South Africa, and Uganda to identify opportunities and challenges for future introduction of the single-size diaphragm in developing countries. There are 222 million women worldwide who would like to avoid pregnancy but aren’t using a modern method of contraception. Some women are either unable or unwilling to use hormonal contraceptives, and many also have infrequent sex and prefer to use a product that is on demand and woman initiated.

Imagine a world where every child born is planned and their mothers are free of HIV infection. As Louis Armstrong sang, what a wonderful world this could be.

Visit Medintim to learn more.

Follow @USAIDGH on Twitter and use #GHMatters to join in the conversation about global health issues.

It’s The Silent Killer: Undernutrition

Shivani Cotter is a member of Mom Bloggers for Social Good. Photo credit: Shivani Cotter

This morning, my daughters ate a hearty breakfast. They had eggs, toast and a yogurt each. What do you think women and children in poverty-stricken regions throughout the world ate (or did they)?

I remember reading an article by Anap Shah a few years ago that I have never been able to get out of my head. The heading read, “Today, around 21,000 children died around the world.”

I was shocked! Living in a bubble, I rarely paid attention to how devastating the numbers were (about 1 child dying every 4 seconds)! Although written a few years ago, that article was the catalyst for my quest to learn more about global nutrition and it’s effect on women and children.

Anap Shah caused two conflicting emotions: First, relief that my children didn’t fall into one of those statistics. Second, sick to my stomach that I even felt that way!

Did you know that nearly 165 million children under 5-years-old suffer from undernutrition today? According to the Lancet medical journal, malnutrition contributes to 3.1 million under-five child deaths annually. The numbers are stunning but don’t have to be. The U.S. Government’s Feed the Future initiative, led by the U.S. Agency for International Development (USAID), is dedicated to reducing them. It’s working towards building a better future for mothers and children.

Feed the Future, the U.S. Government’s global hunger and food security initiative, has already improved nutrition and helped people lead healthier lives in Zambia, Guatemala, Tanzania and more. Through Feed the Future in the past year alone, 12 million children have been positively affected — and that is just the beginning. Feed the Future shares their knowledge with the people in poverty-stricken locations and support country-owned programs addressing undernutrition. Their monthly newsletter is filled with information regarding their latest goals and progress.

USAID believes in integrating their approach on dealing with global health and nutrition by forging the right partnerships through initiatives like Feed the Future. USAID, on behalf of the U.S. Government, signed on to the global Nutrition for Growth Compact, and supports the Lancet Series on Maternal and Child Nutrition, which is chock filled with information about the importance of improving nutrition globally. Their goal is to ensure every child is given the best start possible in life.

The first 1,000 days from a woman’s pregnancy to a child’s second birthday are the most critical for a child’s development. By focusing on maternal health and young children, the U.S. Government through USAID and the Feed the Future initiative are striving to cut the death toll for children under 5 years old. Find out more about their goal and ways to help here.

Shivani Cotter is a writer, blogger and social media activist. Through her blog, TrendingMom.com, Shivani is dedicated to teaching others how to live positive and fulfilling lives as well as leaving a lovely legacy for her daughters. Shivani is part of Mom Bloggers for Social Good, a global coalition of 1000+ mom bloggers, in seventeen countries, who spread good news about the amazing work non-profit organizations and NGOs are doing around the world.

Follow @USAID@USAIDGH and @FeedtheFuture on Twitter and use #GHMatters to join in the conversation about global health issues including #nutrition.

SPRING to Better Nutrition Across the Globe

Amanda Pomeroy is a Research & Evaluation Advisor for the SPRING Project. Photo credit: SPRING

Evidence has been mounting to support the hypothesis that maternal undernutrition, as well as in-utero infant and young child undernutrition, are correlated with the risk of developing nutrition related non-communicable diseases (N-RNCDs) later in life. Since 2012, the Strengthening Partnerships, Results, Innovations around Nutrition Globally (SPRING) Project has been mining this evidence base for information that can help program planners and policy makers better conceptualize what this correlation could mean in practical terms for maternal and child nutrition interventions.

SPRING has completed several activities that contribute to this effort. As a first step, we conducted descriptive analyses of secondary data in selected regions and countries to explore where future N-RNCD risks may lie, and to identify how undernutrition programs may need to be tailored to reduce health problems as children and adolescents reach adulthood. Currently SPRING has ten country profiles across Africa and Southeast Asia, and two regional profiles that summarize trends across countries for these two regions.

Based on these descriptive analyses for our selected countries, we found that most nutritionally at-risk countries had several sub-populations with overlapping nutritional burdens (where both under- and over-nutrition were present at the same time within the same household or same individual). While one would expect this to consistently happen in the wealthier, more educated households, this pattern was not uniform across countries, and several countries such as Zambia and Malawi, the less wealthy, rural, and the less educated also saw significant overlap.

While sub-national analyses could not be conducted for pre-NCD and N-RNCD conditions, in the regional profiles we were able to examine trends and prevalence across nations. According to the World Health Organization (WHO) type II diabetes mellitus (diabetes) and cardiovascular disease (CVD), along with cancer and other NCDs, account for around one-quarter to one-third of all deaths in SSE Asia (calculated from WHO 2011) and around one-third of all deaths in Africa (calculated from WHO 2011). The data that have been estimated for prevalence of diabetes, show that while growth of diabetes in SSE Asian countries has not been remarkable, it does in fact have one of the highest average prevalence rates of diabetes among adult women, only recently overtaken by the Americas region in 2007. While Africa overall does not have a particularly high rate of diabetes, there has been a steady increase over the ten most recent years of data. The range of diabetes prevalence is quite wide for this region, with the lowest figure being 5.9% in Burundi, and the highest being 14.7% in Cape Verde (2008 estimates). Southern Africa seems to have the highest sub-region burden, with Swaziland and Lesotho both coming in at around 12%. For comparison, the United States had an average prevalence for adult women of 9.1% that year.

The regional profiles also discuss the national trends in calorie availability and child nutritional status, to highlight where future risk may be building. For copies of the regional and country briefs, and to learn more about SPRING, please go visit their website. SPRING will be adding new country profiles as needed, so check back for additional countries.

The country and regional profiles are a useful first step in operationalizing research into usable information for program planning and policy advocacy. As a second step, SPRING completed the first phase of a cost effectiveness simulation model looking at the short and long term effects of undernutrition interventions that are conducted in the first 1,000 days. The goal is to produce a more inclusive understanding of the relative value of nutrition interventions by extending the time frame for estimating benefits, specifically in terms of quantifying the ‘value added’ by their impact on early life genetic programming and any resulting later life course N-RNCD risk. For more information on our simulation model, please see our activities.

Going forward, SPRING will actively work with USAID to identify innovative applications of these resources to country programs. Via improved planning, advocacy, and targeting, this information can contribute to reducing the impacts of NCDs via better nutrition across the globe. 

Follow @USAID@USAIDGH and @FeedtheFuture on Twitter and use #GHMatters to join in the conversation about global health issues including #nutrition.
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