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Archives for Youth

Eliminating Female Genital Mutilation/Cutting

February 6th marks the International Day of Zero Tolerance to Female Genital Mutilation/Cutting.

While in Senegal, I had the opportunity to meet “village godmothers” who had endured Female Genital Mutilation/Cutting (FGM/C) as young girls. Each described the raw pain of the excisor cutting her as the worst she’s ever experienced. Today, these women are standing in solidarity to prevent their daughters from being cut and advocating for reproductive health for girls in their village. With them are other activists and the government, who are working together to eliminate FGM/C in Senegal. Since the first Senegalese village publicly rejected FGM/C in 1998, more than 5,500 communities in Senegal have stopped cutting women’s genitals.

Every year, more than three million girls in Africa, Asia, the Middle East and among diaspora communities in the West are at risk of Female Genital Mutilation/Cutting. According to the World Health Organization, as many as 100 to 140 million girls and women worldwide currently live with the consequences of this dangerous practice.

The procedure, which involves the partial or total removal of the external genitalia, is largely performed on infants to girls as old as age 15. As the women I talked to in Senegal testified, it is extremely painful and generally carried out without anesthetics and  using implements ranging from kitchen knives and razor blades to cut glass and sharp rocks. The health risks are great: in the short term, death from blood loss is not uncommon, nor is serious infection that can cause long-term problems. FGM/C may result in infertility, incontinence, pregnancy complications and increased risk of obstetrical problems like fistula and infant death.

Genet, Tsiyon and their friends are the first generation in Kembata, Durame Woreda, Ethiopia, who do not have to undergo FGM/C at their young age. Their mothers are not willing to let them be cut because they have realized the consequences of that practice during their own lifetimes.

Genet, Tsiyon and their friends are the first generation in Kembata, Durame Woreda, Ethiopia, who do not have to undergo FGM/C at their young age. Their mothers are not willing to let them be cut because they have realized the consequences of that practice during their own lifetimes.

FGM/C has no basis in any religion, nor is it done for health benefits. Instead, the practice has been perpetuated for centuries through socio-cultural, psychosexual, chastity, religious and aesthetic or hygienic arguments. Almost all of these are linked to girls’ social status and marriageability and the practice is often seen as a necessary step towards womanhood. In many cultures, girls and women who are not cut are stigmatized and their families can be ostracized. The Sengalese, largely because of work done by the USAID funded non-governmental organization Tostan, created a community education program that has changed social norms. The program, the women tell me, has shown them that despite common perception that FGM/C is a good thing, it is in reality very harmful to their daughters.

USAID has supported FGM/C abandonment efforts since the 1990s, after being approached by many African women who asked why we were doing nothing about this issue. The Agency began programming and introduced an official policy that states the practice is not only a public health issue, but a violation of a woman’s right to bodily integrity. USAID assistance on this area has been a multi-faceted approach, focusing on surveillance, research, and program implementation.

The Agency has collected important information about the distribution and practice of FGM/C at the community level in 16 countries. This information is shared with all partner and donor organizations and used for decision making about program priorities and implementation approaches. A recent USAID-sponsored comparative analysis of data on FGM/C shows that although FGM/C prevalence is decreasing in many countries and among numerous communities, many girls are being cut at earlier ages and the service is increasingly performed in medical settings. To validate and improve interventions, USAID has supported important evaluations of existing programs.

When communities as a whole understand the physical and psychological trauma FGM/C causes, social transformation takes place – and this has proven to be the best way to ensure lasting support and an eventual end to the practice.

A Moment For Hope in the DRC?

The Panzi Hospital in Bukavu, eastern Congo (DRC)

The Panzi Hospital in Bukavu, eastern Congo (DRC)

A clean, well-ordered oasis in this bustling provincial capital – Dr. Mukwege, his staff, and his patients reek of the triumph of reliant humanity over the unspeakable brutality of the last 18 years of conflict. The particular mutation here – an almost unimaginably vast campaign of sexual violence – has devastated the lives and bodies of tens of thousands of young women.

But a visit to Panzi, which is supported by USAID and several other donors, inspires more admiration and hope than despair. In the hospital, Dr. Mukwege didn’t catalogue the horrors of the war or the problems his hospital faces in this, perhaps the poorest country in the world. Instead he spoke about a rare moment that has arrived in the Democratic Republic of the Congo (DRC), the prospect of real peace. They are already seeing the signs that Sexual and Gender Based Violence (SGBV) may be declining, albeit gradually. He wants to extend his efforts into the recently stabilized areas to the North, where he believes thousands of young abused women may never have had access to the types of health and psychological services Panzi and USAIDs large USHINDI project support.

And economic activity is picking up, including efforts that provide skills training and employment to young women and men. In Bukavu we also visited the Annunciata Accelerated Learning Center, which offers a three year accelerated elementary education program and skills training to older girls who missed the opportunity to go to school. Getting these girls into school and jobs is a top priority of the government and donors alike. I spoke to the DRC Minister for Gender, Genevieve Kassongo., and she sees educating girls as the key to addressing so many of the challenges facing the DRC – high infant and maternal mortality, extremely low education rates, and the highest rate of extreme poverty in the world.

USAID has persevered with the Congolese through years of strife, our partnership could be even better in peace.

In Morocco, Perseverance and Good Luck Ensure Three Young Boys a Quality Education

By Dr. Helen Boyle, Associate Professor in Educational Leadership and Policy at Florida State University

In early December education leaders, donors and partners met to discuss and plan for the future of early grade education in the Middle East and North Africa at the All Children Learning Workshop in Rabat, Morocco.

Youssef, Moustafa and Redouan were lucky boys.  In the late 1970s, school was not a given for all children in Chefchaouen, Morocco. Their five older siblings never attended school. The advocacy of their mother and older siblings ensured that these younger boys would get a formal education. It was a privilege to go to school in this world, not a right, and they had to do very well indeed to maintain that privilege.

Every evening, when they came back from the kuttab (Quranic school) and later from elementary school, they would all sit down with their older sisters and review everything they did at school. They would review all the letters—the sounds, the letter shape and the letter name—with their sisters. They reviewed and read the verses of the Qur’an that they learned that day and would take their booklets and read aloud anything they wrote down.

Youssef reflected, “I remember we spent countless hours doing that. For example, we would open the book and look at the letters that we wrote that day and say ‘lam, l + a = la, l + o = lo,’ or, we would explain the vowel markings to them—‘the line on top of the letter makes an “a” sound and the one below makes an “e” sound and the one above with the curl makes a “u” sound.’ “  In turn and as the boys grew older, the girls would quiz them, asking them questions after they read a passage aloud.  Redouan said, “The thought was that they were doing this to help us succeed, but we were also teaching them indirectly.” Indeed, the sisters are literate and “read better than some who have been to school,” said Moustafa.

This story is inspiring for many reasons as it demonstrates family love and loyalty and the power of perseverance.  However, one of its most critical messages is less obvious and needs to be brought to light. These were indeed lucky boys as they had a teacher in primary school, Umm Kalthoum, who knew how to teach reading.  It is almost certain, in those days, that she received minimal training, but she understood the importance of teaching reading skills.  Under her guidance, the boys—and their sisters—developed phonological awareness, knew the name of each letter, understood that each letter made a sound; understood what the vowel markings (diacritics) were for and did segmenting and blending activities in class and at home. They developed vocabulary in Modern Standard Arabic and then listening and eventually reading comprehension skills in a language which was in many ways different from the dialect they spoke in their home and in everyday life.

Thanks to Umm Kalthoum, with whom they all studied in the early grades, these boys learned the foundational skills of reading and were able to pass them on to their sisters; these boys all went on to professional careers and great success.

USAID is working with Morocco’s Ministry of Education to leave behind a teacher training program that will support the continuous professional development of teachers.

USAID is working with Morocco’s Ministry of Education to leave behind a teacher training program that will support the continuous professional development of teachers.

Today, despite higher rates of school enrollment than ever, many Moroccan children are not as lucky as these three boys were over 30 years ago. Educational quality has not kept pace with the growing number of children seeking an education in Morocco. Indeed, Morocco’s PIRLS (Progress in International Reading Literacy Study) and EGRA (Early Grade Reading Assessment) scores indicate that there is significant room to improve reading instruction and reading levels in Morocco.

In early December USAID co-funded a workshop in Rabat, Morocco to mobilize education leaders and advocates to improve early grade learning in the Middle East and North Africa. Other donors included the Global Partnership for Education, German Society for International Cooperation (GIZ), the Islamic Development Bank, and the Islamic Educational, Scientific and Cultural Organization (ISESCO). Country teams, including representatives from Ministries of Education, civil society and local donor organizations, gathered to discuss innovative solutions to give all children a chance to learn. At the All Children Reading workshop, delegations created action plans that will provide clear and concise goals for initiating or scaling up existing early grade learning programs at the country level. Opportunities were provided for country teams to network and to build mechanisms for support and accountability to push planning into practice. Global literacy leaders’ and advocates’ discussions during this workshop focused on key thematic areas in early grade learning, including large scale learning assessments, teacher training and supervision, curriculum and lesson plans, assessment tools  and impact evaluations, and reading materials.

On the PIRLS test, a score of 500 corresponds to the mean of the overall reading achievement distribution across the 45 countries. Morocco scored a 310, which was the lowest score of the 45 countries that took the PIRLS in 2011.Indeed, in 2011, all of the Arabic-speaking countries that took the test were below the 500 average with scores ranging from 439 to 310 for 4th graders (Mullis, Martin, Foy, & Drucker 2012). This points to an issue with how reading is taught in a rich and complex language like Arabic, a language with many spoken variations, not just in Morocco but across Arabic-speaking countries.

Good teaching focused on the foundational skills of reading can make an enormous difference, as we see in the example of the three boys and their sisters. Supporting teachers to develop skills and strategies to teach reading will ensure that the success that these children experienced in learning to read can be replicated in every early-grade classroom in Morocco.

Helping Bright Ideas Shine Through Spotlight: Brian Gitta, Makerere University, Uganda, ResilientAfrica Network

USAID’s Higher Education Solutions Network (HESN) – a multidisciplinary research and development effort led by seven universities working to evaluate and strengthen real-world innovations in development – recently spotlighted young academics and their creative approaches to development challenges during TechCon 2013, the first annual HESN meeting in Williamsburg, Virginia. As part of a contest, more than 40 students and researchers presented innovations designed to help communities in developing countries.  

Winner Brian Gitta, from Makarere University in Uganda, invented  a tool that can diagnose malaria without the need for blood samples and a laboratory. This is the story of that innovation.

Brian Gitta wasn’t in the mood to get stuck by another needle – he was already getting injections three times a day to fight off a foodborne illness. But as his fever spiked and the pain in his joints worsened, he suspected he was suffering yet another occurrence of malaria, the disease he’d contracted as a child and currently kills one child every minute in the developing world.

A nurse at a local clinic confirmed his suspicion by drawing blood using a needle and syringe. “I hated the needles and kept thinking of ways people could be diagnosed without pain,” Gitta recalled.

Brian Gitta, from Makerere University in Uganda pitches his winning idea that uses cell phones and light – not needles and blood samples to test for malaria. Photo Credit: Cynthia Kao-Johnson/USAID

Brian Gitta, from Makerere University in Uganda pitches his winning idea that uses cell phones and light – not needles and blood samples to test for malaria. Photo Credit: Cynthia Kao-Johnson/USAID

That puzzle was still on Gitta’s mind weeks later as he began his studies in Computer Science at Makerere University and started thinking about ways technology could be used to improve malaria detection. The standard method of determining whether someone has malaria is drawing blood and viewing it under a microscope, which requires health workers and facilities that are scarce in many low-income communities.  For Brian, the goal wasn’t just to alleviate momentary pain; eliminating needles and the need for a lab would not only limit the risk of infection but allow for diagnosis in communities that had no medical centers.

Gitta shared the idea with his friend Joshua Businge and they began researching new ways to detect malaria.  They learned that for years, light sensors have been used to read the blood’s oxygen content through the skin. This seemed like a promising avenue to explore, so the pair recruited Josiah Kavuma and Simon Lubambo, students skilled in engineering hardware.  Together, the team designed a prototype that plugs into a smartphone and can detect malaria using only light. Results are available in seconds and the smartphone can email them and map them for epidemiological purposes.  They named the device Matibabu, Swahili for medical center.

By coincidence, Makerere University was launching an initiative called the ResilientAfrica Network (RAN) as part of HESN and an upcoming launch event in Uganda would give local innovators an opportunity to demonstrate concepts for solving public problems.  The team demonstrated their prototype to Alex Dehgan, director of USAID’s Office of Science and Technology, RAN director William Bazeyo, and Deborah Elzie from RAN partner Tulane University.  “I was very impressed,” Elzie said. “When we talk about innovation, people are often just improving on something that’s already out there…These guys really found a whole new way of looking at how to determine if someone has malaria.”

RAN searches for creative minds like Gitta’s and helps them overcome obstacles that often keep bright ideas from making it to the marketplace.  RAN gave Gitta’s team a workspace, training on writing business proposals, mentoring, and the resources needed to make a better prototype.

They teams hopes to a commercially viable product and plans to partner with an established organization working against malaria.

Reflecting on his innovation, Gitta noted, “as long as you put your mind and hard work to it, you can accomplish anything at any age.”

Transforming Gender Norms and Ending Child Marriage: The Role of Boys

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.

Child marriage has recently gained heightened attention by donors, researchers, activists, program implementers, and policymakers. The international community has increasingly recognized child marriage as a violation of girls’ rights, health, and well-being, and efforts to prevent and respond to child marriage have prioritized critical “hot spots” where the practice is particularly grave and widespread. Yet, it is also crucial to shed light on a current “blind spot” in these efforts: the role of boys in ending child marriage.

When males are included in strategies and interventions to address child marriage, the focus is mostly on the key role that men play as powerful gatekeepers: fathers and religious and community leaders, whose support must be galvanized to intervene on behalf of girls. The forward-looking USAID Vision for Action on Child Marriage, for example, includes engaging men as an important part of mobilizing communities to shift norms that perpetuate child marriage. But the Vision does not stop there; it further states that, “equally important is reaching out to boys at a young age to encourage equitable gender attitudes and norms so that they can be allies in preventing child marriage and change agents within their communities.” This aspect of male engagement is usually not highlighted in child marriage discussions, yet raises a vital question: What needs to happen to create a generation of boys that resists and rejects child marriage for themselves in the future?

A young girl.  Photo Credit: Kendra Helmer/USAID

The international community has increasingly recognized child marriage as a violation of girls’ rights, health, and well-being, and efforts to prevent and respond to child marriage have prioritized critical “hot spots” where the practice is particularly grave and widespread. Yet, it is also crucial to shed light on a current “blind spot” in these efforts: the role of boys in ending child marriage. Photo Credit: Kendra Helmer/USAID

This “demand-side” orientation requires long-term investments aimed at changing the social and behavioral gender norms that drive child marriage. What if all future men refused to marry a child bride? Though directly addressing this side of the equation is seldom mentioned, there are promising interventions with young girls and boys that seek to transform gender attitudes and behaviors with the goal of promoting gender equality more broadly. One example is the USAID-funded Gender Roles, Equality, and Transformation (GREAT) project.

Although GREAT does not directly address child marriage, it works with adolescents (ages 10-19) and their communities to reduce gender-based violence and improve reproductive health in Uganda. Building on the CHOICES project in Nepal, GREAT recognizes early adolescence as a window of opportunity—a time when the formation of gender norms and identities is taking place. The project utilizes participatory activities to engage young girls and boys in gender equality discussions. For example, project staff ask young girls and boys to pile-sort cards representing various household and community tasks, to show who is responsible for them. Girls and boys (including sisters and brothers) see the pile of tasks assigned to girls steadily grow larger than the boys’ pile. The activity prompts conversations about fairness, as boys remark on the larger burden carried by their sisters.

These types of “a-ha” moments are crucial entryways to deeper critical reflections that can begin a journey towards gender equality. By tapping into young boys’ sense of justice at a very young age, interventions such as these, which seek to transform gender norms early in the process of childhood development, hold the promise of shaping a future generation of men as allies in wiping out child marriage globally.

Testing Readers in the Early Grades in Pakistan

I wish you could have been there. The little girl, a third grader, in a sky blue uniform with a white sash sat across from the evaluator. Her manner was shy, her voice barely audible but her dark eyes were determined. She was going to do her best, no doubt about it, despite a bunch of strangers standing around to watch.

A young girl in Pakistan attempts to read the story of Rani, testing her reading and comprehension skills as part of an Early Grade Reading Assessment being carried out in Pakistan.  / Christie Vilsack

A young girl in Pakistan attempts to read the story of Rani, testing her reading and comprehension skills as part of an Early Grade Reading Assessment being carried out in Pakistan. / Christie Vilsack

The evaluator explained that she could help us understand how children read by participating in some word games. He told her about himself and asked her to do the same. He asked about the language she uses at home with her family.

Each page required a certain task. The first determined whether she knew where to begin reading on the page and in what direction. She used her pointer finger to show that she did.

Next he asked her to say the name of some letters, and then to name some simple words. She could do this also.

Then he asked her to say the sounds produced by letters (b is the sound made by the letter “b”). And then he gave her some made up words to sound out like pum and tep. Most of us remember this as phonics, which we learned in kindergarten and first grade. This task was more difficult for her.

When he asked her to read a short paragraph she stumbled through the words and the timer went off long before she finished. Anyone watching could tell it was the letter sounds that were tripping her up.

She was so busy trying to decipher the words that the meaning behind the story escaped her. She couldn’t tell the evaluator why the character, Rani, was scared of what was behind the door, or why she smiled when she saw it was just a mouse.

By now 33,000 children in Pakistan have been tested, a random sampling in each of Pakistan’s seven administrative units. The test that was used in Pakistan is called EGRA, the Early Grade Reading Assessment, and it was developed with World Bank and USAID support to RTI International here in the United States, starting in 2005.

EGRA is an essential tool in our educational toolbox as USAID invests in teaching 100 million children to read in 39 countries around the world. The EGRA instrument is translated into the local language and tests the foundational skills of reading as well as reading fluency and comprehension. It can help teachers know which skills need more attention and can help policy makers know which aspects of instruction need more attention and funding.

The evaluator in a primary school in Pakistan talks with the young girl about the reading assessment, explaining how it works and what she will be doing. Credit: Christie Vilsack

The evaluator in a primary school in Pakistan talks with the young girl about the reading assessment, explaining how it works and what she will be doing. / Christie Vilsack

If you’ve had a child in a U.S. school then he or she has probably taken DIBELS© or another oral assessment in the early grades to test her or his understanding of the key building blocks of reading.

EGRA was inspired by DIBELS and other early grade assessments and experts at RTI, USAID and the World Bank, other institutions picked the key skills and subtests that predict reading competency and can be tested in the context of developing countries. EGRA is so easy to administer that any of us could do it with our own children and get a sense of their strengths and weaknesses.

We can use the data we gather from the test to help ministries of education determine how best to proceed to meet the reading needs of their students and where to invest their scarce resources.  EGRA is also a diagnostic tool that can provide teachers and principals a roadmap for improving teaching and learning. USAID works to build capacity at the ministry level, train teachers and develop textbooks in a languages that children speak and understand, and produce supplemental reading materials so that government officials, communities, and parents develop sustainable programs that improve students’ reading skills.

In developing countries, the solutions are not difficult to understand. They mirror the solutions here at home. Those who work on these issues say it’s carrying out the solutions under difficult circumstances that is a bigger problem.

How do you administer tests if no one in the country knows how to assess early grade students? If schools are far from cities and towns and transportation is difficult? If schools have been closed by insurgents? How do you administer the test if an earthquake has suspended classes? How do you get to villages high in the mountains to administer the test? And if you get there and there aren’t the necessary number of students in the classroom to make the test statistically correct because they’re farming with their parents in the fields, what do you do?

It’s essential to find ways around such barriers because the most important person in the room is the child who wants to learn, who wants to know about the girl, Rani, in the story and why she smiles at the end.

The little girl before me smiles at the evaluator as the assessment ends, smiles shyly at all of us because she has done her best. We leave with a sense of purpose. It’s hard to teach 100 million children to read, but it’s not impossible. And, when we succeed, this little girl and many like her will be able to raise her own children, including her daughters, in a culture that values education and the economic and global security it ensures.

ABOUT THE AUTHOR

Christie Vilsack is USAID’s Senior Advisor for International Education

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.

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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.

The Power of a Grandmother’s Love

USAID is observing World AIDS Day this year by celebrating ten years of our HIV and AIDS work under PEPFAR.

As we approach World AIDS Day 2013, children affected by and living with HIV/AIDS must remain central to the global response.  As the largest funder of programs that mitigate the impact of HIV/AIDS in the lives of children worldwide, PEPFAR would like to celebrate the courage and compassion of all the caregivers, the grandmothers, the mothers and fathers, the aunts and uncles and older siblings, who have stepped forward to care for children affected by the epidemic.

GoGo means Grandmother in most South African languages. Photo credit: Tash McCarroll/USAID

“GoGo” means Grandmother in most South African languages. Photo credit: Tash McCarroll/USAID

GoGo is an old woman with a young girl’s bright smile. She lives in a small, tin-roofed, two room house in Soweto, with eight of her grandchildren. When her first daughter died of HIV, she took in her three young children, the oldest of whom was named Precious. At the time, Precious was 14. She was a clever girl who always did well in school and loved learning. When her mother became sick, Precious was forced to drop out of school to take care of her younger siblings and mother. And when her mother died, Precious moved in with her GoGo, who had no income and no means to support Precious to continue her education. Just as Precious began to lose hope, Grace walked into their lives. Grace is a Child and Youth Care Worker (CYCW) with the PEPFAR- supported Isibindi project.

CYCWs are para-social workers that support orphaned and vulnerable children whose lives have been turned upside down by HIV/AIDS. Grace helped Precious return to school and supported all of GoGo’s grandchildren to be tested for HIV. When GoGo’s younger daughter died and she took in her three children as well, Grace helped ensure they were also tested as well. And when tests indicated that none of the children were HIV-positive, GoGo and Grace were relieved, but they knew that they would have to continue to protect themselves and support these children in order to maintain healthy lives. Thanks to help from Grace, GoGo was able to complete an application and gain access to a government grant to cover basic expenses.

Grace still supports the family and visits with them twice a week. She makes sure the children are attending school and doing well psychologically, and helps GoGo to meet their other needs. GoGo still has eight children in her care, but she does not seem burdened or discouraged. She looks to the future with hope. When complimented on the care that she provides to her grandchildren, GoGo responds, “Of course I do this work. They are my children. No one can hold them like I can.”

Learn more about USAID’s role as a leading implementer of PEPFAR programs for orphans and vulnerable children.

This story is part of an ongoing series of blogs from the Office of the Global AIDS Coordinator in recognition of the 10th anniversary of PEPFAR. Previous blogs in the series can be found on the PEPFAR blog site. 

Follow @USAIDGH on Twitter through World AIDS Day, observed on December 2, for key facts, resources, and photos from our programs and partners and join the conversation using the hashtag #WAD2013.

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.

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