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Archives for Women

Family Planning for the World’s Youth Promotes Peace, Health and Prosperity

A mother with her child at the Nhamatanda Health Center in Mozambique. / Arturo Sanabria, Photoshare

With close to 600 million girls growing up in developing countries, achieving global prosperity starts with educating and empowering these young women so they can be healthy, productive members of their communities and become agents of change.

This year’s World Population Day encourages us to “Invest in Teenage Girls.” Voluntary family planning is one tool that can both educate and empower young women worldwide.

Access to voluntary family planning and reproductive health services for everyone, including youth, is vital to the future of our planet. About half of pregnancies among adolescent women in the developing world are unintended, with about 23 million young women wishing to avoid pregnancy, but not using modern contraception. This puts them at high risk of unintended pregnancy.

As we observe World Population Day on July 11, we acknowledge that young people hold the key to determining the future of our planet and to ensuring we meet the Sustainable Development Goals (SDGs)17 goals focused on ending all forms of poverty, achieving social justice for all, and tackling climate change by 2030.

Voluntary family planning is an important intervention that cuts across the five themes of the SDGS: people, planet, prosperity, peace and partnership.

A nurse shows a client an implant rod, and explains how it works during a family planning outreach at a Nairobi informal settlement. / Tobin Jones, Jhpiego

Voluntary family planning affects people. It supports adolescents’ rights to information, and the rights of girls to remain unmarried and childless until they they are ready and desire to bear children.

Family planning saves lives. Today, pregnancy and childbirth are the leading causes of death for adolescent women. By helping young women time and space their pregnancies, family planning helps reduce the number of high-risk pregnancies, and allows women to properly feed, clothe and educate the children they decide to have. Studies show that by 2020, family planning could help avert approximately 7 million under-5 deaths and prevent 450,000 maternal deaths in USAID’s priority countries.

A poster in a Sare Bilaly health hut in the region of Kolda, Senegal. / Amy Fowler, USAID

Family planning impacts the planet. Access to family planning can slow global climate change and improve the health and environment of households and communities worldwide, and research shows that it already has. A 2013 report warns: “poor reproductive health outcomes and population growth exist hand-in-hand with poverty and unsustainable natural resource use.”

Family planning helps reduce poverty and contributes to economic growth and prosperity. Nearly 21 percent of the world’s population—some 1.5 billion people—still live on less than $1.25 per day. By slowing rapid population growth, family planning can help to decrease the sheer number of poor people.

Reducing adolescent fertility can contribute to a “demographic dividend” of rapid economic growth. Having fewer children per family leads to more household savings and increased investments in each child. In Korea and Thailand, governments aligned population policy and family planning services with human capital development policies, particularly girls’ education, to accelerate economic growth.

Voluntary family planning can contribute to peace. Studies show that a large “youth bulge” (defined as a high number of 15- to 29-year-olds) is associated with a high risk of civil conflict. The political impact of fertility decline is measureable: Research shows as a country’s population ages, the probability of attaining and maintaining a liberal democracy is increased.

Worldwide, more than 30 million adolescent women are not in school. Early and unintended pregnancy can be both a cause and a consequence of dropping out of school, so family planning can help women and girls stay in school, become literate, and achieve their educational and employment aspirations. All of these outcomes lead to more peaceful communities and societies.

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Health workers in Mali. / Jane Silcock, USAID

Family planning partnerships at the global and country level will be critical to achieving success as we work toward reaching a grand convergence between the developed and developing world in the next 15 years. As the largest bilateral donor for family planning assistance, USAID has played a crucial role in increasing access to modern contraception. And through our youth policy, USAID strives to integrate youth reproductive and sexual health needs into all of our programs and partnerships.

Young people today will decide our future. We need them to participate in the social, economic, political and cultural life of their communities to eliminate poverty and achieve our collective goals. We also need to recognize the diversity of need and experience of this age group when developing reproductive and sexual health programs and services. As we help youth to succeed, voluntary family planning will be an essential element of our long-term development strategies.

ABOUT THE AUTHOR

Ellen H. Starbird is the director of the Office of Population and Reproductive Health at USAID. Get updates about USAID’s Family Planning work via @USAIDGH.


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Responding to Madagascar’s ‘Silent’ Emergency

With support from Catholic Relief Services, Sisters of Charity provide hot meals to the elderly and children in Tshiombe./Christopher LaFargue, USAID

With support from Catholic Relief Services, Sisters of Charity provide hot meals to the elderly and children in Tshiombe. / Christopher LaFargue, USAID

Because of its slow onset, Southern Africa’s drought may not be headline news. But its impacts are being felt by millions. At least 12.8 million people in Southern Africa will face crisis levels of food insecurity by the end of this year.

Madagascar has been especially hard hit. About 80 percent of the population in the country’s seven southern districts—665,000 people—are in need of emergency food assistance.

I recently traveled to Madagascar with U.S. Ambassador to the United Nations Agencies for Food and Agriculture David Lane. There we met with communities struggling to find enough to eat after three years of consecutive drought made worse by El Niño.

20160519 Tshiombe CRS Community Canteen 1

Soeur Josiane from Sisters of Charity speaks to Dina Esposito about the soup kitchen in Tshiombe. / Christopher LaFargue, USAID

During our trip, we saw visibly malnourished children and adults, including many elderly. In Tshiombe, we spoke with Soeur Immaculata, a nun from Sisters of Charity, who opened up an emergency soup kitchen to provide regular hot meals to children and the elderly. She told us she had not seen so much suffering since the severe droughts of 1992 and 2006.

We also visited Ankilimafaitsy Primary School in Ambovombe, where the U.N. World Food Program is providing children with lunch as part of a school lunch program that feeds almost 300,000 Malagasy children daily. For most of these children, this school lunch is the only food assistance they receive; it has become a vital lifeline in these communities as parents struggle to put food on the table.

Here are three steps we—and other donors—must take to help the people of Madagascar during this “silent,” but devastating emergency:

20160518 Ambovombe WFP School Canteen 3 (1)

Children receive hot meals from the Sisters of Charity soup kitchen supported by Catholic Relief Services in Tshiombe. / Christopher LaFargue, USAID

1. Coordinate support

During my trip, we announced an additional $8 million in food assistance to the Malagasy people, bringing the United States’ total El Niño response in Madagascar to $17 million. But we must work with the government and the donor community to coordinate our assistance. We encourage Madagascar’s national and local officials to assess immediate needs, more proactively mobilize their own response, and more effectively draw global attention to the crisis, mobilize contributions, and facilitate donor planning.

Ready-to-use supplementary food provide children with much needed protein, vitamins and minerals to fight malnutrition./Christopher LaFargue, USAID

Ready-to-use supplementary food provide children with much needed protein, vitamins and minerals to fight malnutrition. / Christopher LaFargue, USAID

2. Plan early for a scaled up emergency and recovery response 

As in the ongoing Ethiopia drought response, early warning is the key to early response. Forecasts indicate that Madagascar’s lean season could begin as early as August rather than October. Children under 5 in this area have unusually high rates of malnutrition. It is urgent that we complement expanded food assistance for families in these southern districts with specialized foods to prevent and treat malnutrition.  

I was particularly impressed by Madagascar’s National Office of Nutrition and its efforts to screen and treat cases of moderate acute malnutrition. We met with well-trained volunteers who were educating young mothers about nutrition. With USAID support, children are being provided with ready-to-use supplementary food. Sustained assistance will be critical in the months ahead to prevent children from sliding into the more serious condition of severe acute malnutrition.

Equally important will be ensuring that families can grow their own food in the next cropping season. A seed distribution plan must get seeds in the hands of farmers by September.

Women farmers in Amboasary tend to a cleared communal vegetable field through a World Food Programme food for assets activity. / Christopher LaFargue, USAID

Women farmers in Amboasary tend to a cleared communal vegetable field through a World Food Programme food for assets activity. / Christopher LaFargue, USAID

3. Continue to invest in resilience

Although the current drought is outpacing the ability of many Malagasy farmers to cope, some farmers have remained self-reliant with our investments. Some of our disaster mitigation efforts include working with farmers to grow more drought-resistant crops like sweet potato and cassava. We are also helping farmers to build assets, access more land near water sources, and improve nearby water points for humans and cattle. Voucher programs help fishermen buy tools and other resources during this drought.

Under a creative arrangement, local farmers are growing corn on large-scale plantations, between rows of sisal (a plant used to make rope and rugs), in exchange for keeping the fields cleared and tended. The farmers keep one-third of what they grow to sell or eat, they reserve a third for seeds for the next season, and another third is sold to the World Food Program for its school lunch program.

The program has especially benefitted women farmers, one of whom told me, “We used to have to take our children out of school when they turned 15. Now they can stay on into high school. Our girls no longer have to ask men for money to buy soap [a local euphemism for prostitution].”

These efforts are making a clear difference as communities cope with drought. We must continue to scale up these investments—and help expand opportunities for populations to make a living during both good and bad times.

The people of Madagascar will inevitably face future climate shocks in addition to the current drought. We can help them to mobilize, plan and build resilience to those shocks to promote security and avert emergencies.

ABOUT THE AUTHOR

Dina Esposito is USAID’s Acting Deputy Assistant Administrator for Democracy, Conflict, and Humanitarian Assistance. @DEsposito_FFP


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Even Amid a Humanitarian Crisis, Education Cannot Wait

Nepalese children attend school in a temporary learning center following the April 2015 earthquake / Derek Brown for USAID/Nepal

Nepalese children attend school in a temporary learning center following the April 2015 earthquake / Derek Brown for USAID/Nepal

Education is a core component of a humanitarian response. However, too often education remains severely underfunded given competing priorities. But without it, children — and girls in particular — are at increased risk of abuse, exploitation, disempowerment or worse.

While working in international education for more than 30 years, I’ve seen how natural disasters, famines and wars can sideline education.

And yet we know from research — and our own life experiences — that going to school and learning is critical; it provides children with a sense of normalcy and helps prepare them for the future. An extra year of secondary school for girls can increase their future earnings by 10 to 20 percent. Research even shows that investing in women and girls can boost an entire country’s GDP.

Children attend a morning assembly at a temporary learning center in Nepal / Kashish Das Shrestha for USAID/Nepal

Children attend a morning assembly at a temporary learning center in Nepal / Kashish Das Shrestha for USAID/Nepal

However, over the past decade, we have seen greater consideration of the long-term need of children affected by crisis and conflict. Education in these contexts is prioritized by the U.S. Government — we know it’s critical to the global effort to end extreme poverty and build peaceful democratic societies.

Providing access to quality education for children and youth in crisis and conflict is one of USAID’s priorities for education. Between 2011 and 2015, we provided millions of out-of-school children and youth in 20 countries with access to education.

That’s good progress, but it’s not enough. As a result of the conflict in Syria, the world is experiencing the worst humanitarian crisis since World War II. Syria is among 35 crisis-affected countries where 476 million children are in desperate need of educational support.

Aminata, 16, teaches her younger siblings while schools in Liberia were closed during the height of the Ebola epidemic / Neil Brandvold for USAID

Aminata, 16, teaches her younger siblings while schools in Liberia were closed during the height of the Ebola epidemic / Neil Brandvold for USAID

A shift in USAID education response

For decades, humanitarian and development assistance were often partitioned, and this sometimes led to not focusing on returning many displaced children and youth to school until after a crisis or conflict had ended. Education has always been a key focus in the international refugee response; but this at times has not been true in the case of natural disasters or even in the case of internally displaced children.

As crises have become longer — families are displaced for 20 years on average — children may spend their entire childhood exiled from their homes. Without education, a new generation grows up without the basic skills needed to contribute to their community and society.

The U.S. Government is now committed to ensuring that whenever a crisis or conflict hits, education is not disrupted. Prioritizing the continuity of education reaps long term rewards, and contributes to a smooth transition from humanitarian assistance to sustainable development.

Victoria Cole, 12, hasn’t let the Ebola crisis interrupt her education. Here she participates in in an outdoor classroom while schools in Liberia were closed during the height of the Ebola epidemic / Neil Brandvold for USAID

Victoria Cole, 12, hasn’t let the Ebola crisis interrupt her education. Here she participates in in an outdoor classroom while schools in Liberia were closed during the height of the Ebola epidemic / Neil Brandvold for USAID

In the past year, the United States has responded to the education needs of children living in a range of crises, including violent conflict in South Sudan, gang violence in El Salvador and Guatemala, the Syrian refugee crisis, earthquakes in Nepal, and the Ebola outbreak in Liberia.

  • Nepal: On April 25, 2015, Nepal was shaken by a magnitude 7.8 earthquake that claimed lives, destroyed homes, and reduced thousands of schools and classrooms to rubble. USAID and partners sprang into action by building more than 1,000 temporary learning centers to ensure children could continue their education while the rest of the communities were rebuilt around them.
  • Liberia: In August 2014, at the height of the worst Ebola outbreak in history, all schools were closed, leaving 1.5 million children at home and unable to learn. Crises like Ebola don’t only affect the health of communities, but also their ability to continue working and learning. In response, USAID worked with the Liberian Government to integrate basic Ebola prevention and treatment information into the curriculum, supply classrooms with prevention supplies, and prepare for future suspected cases. These measures allowed schools to reopen six months later.
  • Syrian refugee crisis: Since the start of the conflict in Syria, the Department of State has worked with international and nongovernmental organizations to open and refurbish schools, provide educational materials, pay school fees, and offer accelerated learning programs for refugees and host communities in neighboring countries where 2.4 million Syrian refugee children now reside. These same partners provide protective family care and reunification, protect distressed children from violence and abuse, provide counseling and psychological support, and meet other critical needs of children both inside Syria and in neighboring countries.
  • Nigeria: Since 2009, a violent insurgency has gripped much of northeastern Nigeria and displaced more than 1 million children and youth, greatly diminishing their education and job prospects. Since 2014, USAID has worked with local partners and officials to ensure their education can continue by establishing about 600 nonformal learning centers in communities where displaced children and youth have relocated – temporary shelters, markets, churches, mosques and under the shade of trees. The international community is far from reaching all of those children in need, however. We must do more.

Bridging the humanitarian and development divide

No one donor can do this alone — we must work together with countries affected by these crises and a range of education experts. That is why the U.S. Government is enthusiastically supporting Education Cannot Wait: A Fund for Education in Emergencies.

The fund is championed by the UN Secretary-General’s Special Envoy for Education Gordon Brown, Chair of the Global Partnership for Education’s Board of Directors Julia Gillard, UNICEF’s Executive Director Anthony Lake, the U.S. Government and other donors.

Education Cannot Wait, managed by UNICEF, will help transform the global education sector and bridge the humanitarian and development divide by collaborating with non-traditional actors for a more agile and rapid response to education in emergencies. Ultimately, the fund will increase safe and quality education so that all children have the opportunity to learn, amid emergency and protracted situations.

With 75 million girls and boys most directly affected by crises globally, we know that solving this problem requires collective action. This is why we call on the private sector, host country governments, civil society, and traditional and non-traditional donors to all come together.

Education Cannot Wait must engage new actors — non-traditional donors, the private sector, foundations and philanthropists — to contribute to financing the platform. They can make education as much a priority as food security, shelter and health. New actors can unlock new funds, and their participation can help the international community create transformative and long-lasting change in the lives of the world’s most vulnerable young people.

It’s a challenge that must be addressed through strong political will and financial support.

As a veteran development worker and education specialist, I’ve seen firsthand what happens when children and youth are given an education–how going to school and continuously learning allows them to heal and grow.

These children and youth, when provided with an education are given a new hope for a better future and a chance to succeed — they become self-sufficient, are better able to earn a decent living, and contribute to their societies in a productive way. We all benefit.

ABOUT THE AUTHOR

Evelyn Rodriguez-Perez is the Director of USAID’s Office of Education in Washington, D.C. Ms. Rodriguez-Perez is a veteran educator of 30 years and a Foreign Service Officer previously stationed in Peru, Egypt and Honduras.

Empowering Women Through a Simple Purse

Imagine giving birth without the help of sterile tools, a doctor, nurse or midwife. This is the experience of nearly half of women giving birth in low-income countries — and many are at high risk of infection. With limited access to antibiotics, these infections often prove fatal.

One woman is trying to change that.  

Zubaida Bai, founder and CEO of ayzh, speaking at USAID's Partnering to End Extreme Poverty and Achieve the Global Goals event. / USAID

Zubaida Bai, founder and CEO of ayzh, speaking at USAID’s Partnering to End Extreme Poverty and Achieve the Global Goals event. / USAID

Zubaida Bai is the co-founder of ayzh, an organization providing women’s health resources to underserved women globally.  The venture’s first product is a clean birthing kit that includes all the items recommended by the World Health Organization to prevent infection at birth.

Infections at birth affect more than 6 million women annually. Even worse, poor hygiene and sanitation during birth is directly linked to the preventable deaths of more than 1 million women and newborns each year.

In celebrating International Women’s Day earlier this month, we recognize women like Zubaida who are revolutionizing their field and making history with their achievements. With the support of USAID and other organizations, Zubaida’s work establishing ayzh has saved the lives of women and newborns on a global scale.

Zubaida posing with the clean birthing kit. / Ayzh

Zubaida posing with the clean birthing kit. / Ayzh

This is her story: After earning her engineering degree, Zubaida Bai decided to go back to India to serve the women she had seen suffer her whole life from health and financial hardship.

She worked in India for four years developing technology appropriate for low-resource settings, before she decided to spin off on her own. Both Zubaida and her husband Habib were passionate about helping women, so they started looking for opportunities to design for this underserved population.

On a field visit to a rural village, Zubaida discovered that some midwives used a sickle — normally used for cutting grass — to cut the umbilical cord. This was an “aha” moment for her.

Reflecting on the infection she contracted when her first child was born in one of the best facilities in India, she thought, “If I had everything and had to suffer an infection, what would women in these villages be facing?” This is the moment that launched Zubaida into a whole new world of maternal health.

“It made me very determined to make my childhood dream come true – to improve the lives of women,” she said in a blog for TED.

In 2007, Zubaida and her husband participated in MIT’s International Development Design Summit, a program that brings together people from across the globe to collaborate and build projects that address issues faced by the world’s poorest communities.  The program exposes participants to practical design for development.

Zubaida and other IDDS participants in morning circle, the way that summits start their days with team building exercises, announcements, and appreciations. / IDIN

Zubaida and other IDDS participants in morning circle, the way that summits start their days with team building exercises, announcements, and appreciations. / IDIN

After studying how to best succeed in markets in developing countries, Zubaida founded ayzh in 2009 and a year later launched the clean birth kit. She called it “janma,” which means “birth” in Sanskrit. The $3 purse comes with six items to ensure a safe and sterile delivery at half the cost of comparable birth kits.

Ayzh hires local Indian women to assemble the packages, allowing them to develop a stable income. Since 2010, about 250,000 kits have been sold in India, Afghanistan, Gambia, Laos, Ghana, Malawi, Nigeria, Zambia, and Haiti — reaching 500,000 mothers and babies.

Ayzh plans to reach 6 million women over the next five years, improving maternal health and breaking the cycle of poverty one woman at a time.

With support from USAID’s Higher Education Solutions Network (HESN) through MIT’s International Development Innovation Network, ayzh is developing a similar kit for newborns. It will provide the tools necessary to make transitions for new mothers and their babies as smooth and healthy as possible.  

Through HESN, USAID is empowering entrepreneurs and researchers at universities so that people like Zubaida can get the funding and mentoring they need to jump start their ventures.

Zubaida Bai and ayzh intern Kelly Brennan iterating on potential impact metrics they can use when communicating with their stakeholders during a workshop in Chennai, India. / Kyle Munn, SEAD

Zubaida Bai and ayzh intern Kelly Brennan iterating on potential impact metrics they can use when communicating with their stakeholders during a workshop in Chennai, India. / Kyle Munn, SEAD

Last year, ayzh was selected to be a part of a cohort of innovators at the Social Entrepreneurship Accelerator at Duke  — another HESN partner — to receive mentorship and capacity building to expand their global reach and impact. The Evidence Lab at Duke is providing support to ayzh to find the best ways to measure and communicate its impact.

With the support of USAID and other organizations, we hope this venture and others like it will continue to improve the health of women around the world.

ABOUT THE AUTHOR

Danielle Somers is a communications analyst for the U.S. Global Development Lab’s Higher Education Solutions Network (HESN). Emily Jablonski is a virtual intern for HESN and student at the University of Michigan.

Innovative HIV-Prevention Product for Women Could Be New Tool in the Fight for an AIDS-Free Gen

Ending the HIV/AIDS epidemic can only be achieved with multiple prevention options that meet women’s needs and fit within the context of their lives./Kate Holt/Africa Practice

Ending the HIV/AIDS epidemic can only be achieved with multiple prevention options that meet women’s needs and fit within the context of their lives./Kate Holt/Africa Practice

HIV/AIDS is the leading cause of death worldwide for women of reproductive age.

Even with marked improvements in HIV treatment, women — especially those ages 15-24 — continue to be at a disproportionately high risk of HIV infection throughout Africa. In fact, in some parts of Africa, young women are more than four times more likely than men to become infected with HIV.

There are structural drivers that directly and indirectly increase women’s HIV risk, including poverty, gender inequality, sexual violence and a lack of education. Many women face unequal access to reproductive health services, including HIV/AIDS education, diagnostic services and treatment programs, putting them at an increased risk of contracting HIV.

Gender norms can also discourage women from asserting control over the timing and circumstances of sex, including negotiating protection against HIV using common prevention methods, such as condoms.

Women need HIV-prevention options that are discreet, do not need their partner’s agreement to use, and that are easy to access and convenient to use.

The Ring Study findings may give new hope to women who need diverse options to protect themselves from HIV and AIDS./ Matthew Willman/Oxfam, Courtesy of Photoshare

The Ring Study findings may give new hope to women who need diverse options to protect themselves from HIV and AIDS./ Matthew Willman/Oxfam, Courtesy of Photoshare

Results released today at the Conference on Retroviruses and Opportunistic Infections in Boston show we are one step closer to having a new prevention tool exclusively for women that fits within the context of their lives.

Through the United States President’s Emergency Plan for AIDS Relief, USAID has invested $25 million in an innovative research trial known as the Ring Study, which was led by the International Partnership for Microbicides.

The Ring Study looked at women’s use of a simple vaginal ring, which is prescribed by a doctor and self-inserted to provide 30 days of continuous, sustained release of the antiretroviral dapivirine. The study found the dapivirine ring helped protect against HIV during vaginal sex among women ages 18 and older.

The monthly dapivirine ring is a longer-acting HIV prevention method specifically designed for women, who bear the greatest burden of the global HIV/AIDS epidemic./ Molly Snell, Courtesy of Photoshare

The monthly dapivirine ring is a longer-acting HIV prevention method specifically designed for women, who bear the greatest burden of the global HIV/AIDS epidemic./ Molly Snell, Courtesy of Photoshare

The Ring Study showed that the monthly dapivirine ring safely reduced HIV infection overall by 31 percent compared to a placebo. Similar results were seen in a sister study, known as ASPIRE. ASPIRE found that the ring safely reduced infection by 27 percent overall. This is the first time that two large clinical trials have yielded statistically significant results in finding that a microbicide can protect against HIV infection.

However, we must recognize that these results are only the starting point for further research. Despite both the Ring and ASPIRE studies showing a statistically significant protective effect against HIV, the dapivirine ring did not reduce infection quite as much as researchers had hoped. While disappointing, we should see this as an opportunity to gain more information in order to create a more effective HIV-prevention product.

To do this, researchers need to look closely at the information collected during the study to figure out why there wasn’t a bigger effect: Was the dapivirine ring itself not as effective in the women in the study? Were women not able to use the product consistently? So far, we know that women who used the ring more had a lower chance of becoming infected with HIV, but we need more information to say for certain.

It is particularly important to understand the influence of consistent use of the dapivirine ring on the study results for younger women. If we look at the Ring Study results broken down by age, women 18-21 years had only a 15 percent reduction in infection, while women older than 21 had a 37 percent reduction.

If younger women, who are at the highest risk of infection, are not able to use the dapivirine ring consistently, we need to understand why and look at whether different marketing, education or additional interventions could improve use and, as a result, decrease their risk of infection.

While the Ring Study’s results have raised many new and important questions, ultimately, the dapivirine ring is the first longer-acting and discreet female-controlled HIV prevention method that has been shown to safely offer protection.

Innovative prevention methods like the dapivirine ring could offer an important additional prevention tool for women unable or unwilling to use other strategies.

If we hope to achieve an AIDS-free generation by 2030, we must continue to invest in products that empower women across the world to protect themselves from HIV.

ABOUT THE AUTHOR

Elizabeth Russell PhD, MSc, is a Senior Advisor for Biomedical Prevention Technologies in the Research Division of the Office of HIV/AIDS. She provides technical assistance for pre-clinical and clinical research projects supported by USAID for new microbicide products.

Healthy Beginnings: New Evidence Cites Breastfeeding’s Health Benefits for Moms, Babies and Economies

A new mother at the Karambo Health Center in Rwanda breastfeeds her newborn baby. Immediate breastfeeding after delivery helps prevent diseases and malnutrition in newborns. / Amy Fowler, USAID

A new mother at the Karambo Health Center in Rwanda breastfeeds her newborn baby. Immediate breastfeeding after delivery helps prevent diseases and malnutrition in newborns. / Amy Fowler, USAID

When it comes to the health of the world’s most vulnerable mothers and children, supporting the practice of a few simple behaviors can be just as beneficial as the most high-tech innovations.

Handwashing with soap helps prevent the spread of communicable diseases. Skin-to-skin contact between mothers and premature babies keeps preemies warm and helps regulate their breathing and heart rate. Having a skilled birth attendant deliver the babies of pregnant women significantly decreases the risk of mortality for both the moms and their babies.

Each of these behaviors has been shown to improve mothers’ and newborns’ health and wellbeing, without requiring new technologies or significant funds.

And new evidence shows one of the most effective of these behaviors is breastfeeding.

In a series published today in The Lancet journal, researchers cite compelling evidence of the benefits afforded by optimal breastfeeding practices, both health-related and economic, for women and children in high- and low-income countries alike.

At USAID, we have already begun to act on the evidence. We concentrate our maternal and child health efforts in 24 priority countries that together account for 70 percent of the world’s maternal and child deaths, and we employ a data-driven approach to maximize our impact through the most effective interventions available.

We’ve identified breastfeeding as one of 10 “Accelerator Behaviors” — the key feature of USAID’s Accelerate project, begun last year to expand the ability of stakeholders in those priority countries to implement high-quality behavioral programming.

And in our Multi-Sectoral Nutrition Strategy, we recommend early initiation of breastfeeding within one hour of birth, exclusive breastfeeding for the first six months, and continued breastfeeding for two years or longer.

This mother in Bakapome, Senegal, a rural village near Thies, knows that breastfeeding doesn’t just benefit infants: it also reduces the risks for breast and ovarian cancers in women. / Jane Silcock, USAID

This mother in Bakapome, Senegal, a rural village near Thies, knows that breastfeeding doesn’t just benefit infants: it also reduces the risks for breast and ovarian cancers in women. / Jane Silcock, USAID

The health benefits are significant. Higher rates of breastfeeding could save more than 820,000 lives — 87 percent of them infants — in low- and middle-income countries each year.

Breastfeeding is also associated with a reduced risk of breast and ovarian cancers for women. At current breastfeeding rates, 20,000 maternal deaths are averted annually. Improved breastfeeding practices could prevent another 20,000 each year.

The new Lancet series also highlights the economic benefits of increasing the number of women who breastfeed. Currently, the cognitive losses associated with not breastfeeding amount to $302 billion globally — including more than $70 billion lost in low- and middle-income countries and $230 billion in high-income countries.

Even a 10 percent increase in breastfeeding rates would translate into hundreds of millions of dollars in healthcare savings through reduced child and maternal mortality and morbidity.

The evidence speaks for itself: Supporting women to practice optimal breastfeeding is a health intervention that we cannot afford to ignore.

USAID is working with national governments, NGOs, the private sector and civil society organizations to generate data and provide insights into the impact that social and behavior change programs can have on saving lives. We work with our partners to then use that data to design and apply effective and innovative behavioral programming.

Throughout the process, we track and measure our programs’ successes and persistent barriers, and provide technical assistance and share lessons across our network of partners — contributing to our goal to reach 38 million women with improved health services by 2020.

When it comes to interventions such as breastfeeding, collecting evidence is a necessary first step. But we must then act on our findings, incorporating the evidence across all levels of our health programs — from the policies of national governments to the daily routines of individual households.

The USAID-funded Suaahara project in Nepal engages young mothers as well as fathers and other men in the family to ensure supportive environments for healthy behaviors, such as breastfeeding, to promote the wellbeing of women and children. / Suaahara Project

The USAID-funded Suaahara project in Nepal engages young mothers as well as fathers and other men in the family to ensure supportive environments for healthy behaviors, such as breastfeeding, to promote the wellbeing of women and children. / Suaahara Project

In Nepal, for instance, USAID began implementing an integrated approach to nutrition in 2012, incorporating community education and personal counseling. Since then, rates of exclusive breastfeeding for the first six months have increased from 46 percent to 69 percent.

The Lancet’s series bolsters our behavior change work and solidifies the evidence base for including breastfeeding as an Accelerator Behavior.

I am encouraged by the successes that USAID has already seen in using these evidence-based approaches to save children’s and mothers’ lives.

Most of all, I am excited about our past, present and future progress towards maternal, newborn, child and adolescent health worldwide, as support for breastfeeding and other lifesaving interventions continues to grow in the global community.

ABOUT THE AUTHOR

Elizabeth Fox is the Director of the Office of Health, Infectious Diseases and Nutrition in USAID’s Bureau for Global Health.

USAID Delivers: Quality Care for Expectant Moms Results in Fewer Stillbirths

Fatima holds her 2-day-old baby, safely and successfully delivered at the USAID-funded Smiling Sun Clinic in Tongi, Bangladesh. / Amy Fowler, USAID

Fatima holds her 2-day-old baby, safely and successfully delivered at the USAID-funded Smiling Sun Clinic in Tongi, Bangladesh. / Amy Fowler, USAID

At the Smiling Sun Clinic in Tongi, Bangladesh, Fatima happily holds her healthy newborn baby, delivered in the facility a short while ago. Fatima chose to deliver in the facility to ensure a healthy outcome, for her first pregnancy had ended in tragedy.

Each year, over 130 million babies are born into the world. For a mother, pregnancy is a time of excitement, and the birth of a baby is a time of joy.

Yet, for millions of others, pregnancy can end in tragedy. Each year, nearly 3 million children die in their first month of life, and an additional 2.6 million women suffer a stillbirth. Fatima was one of them.

Through the support of USAID, she was able to access the care and services she needed to ensure that her next pregnancy had a happier ending: a safe pregnancy, a successful delivery and a healthy baby.

At USAID, we are committed to saving the lives of mothers and children. Our vision is to end preventable child and maternal deaths within one generation. Our efforts to achieve this vision are also helping address the tragedy of preventable stillbirths.

In a new Lancet series of papers on stillbirths published today, more than 200 researchers, investigators and advisors — including myself and my USAID colleague Donna Vivio — have collaborated to report on the problem of stillbirths worldwide.

Skilled birth attendants, like these nurse-midwives at a midwifery education center in Afghanistan’s Bamyan province, are vital for ensuring safe and healthy deliveries for mothers and their babies. USAID has helped train more than half of all midwives currently working in Afghanistan. / USAID Afghanistan

Skilled birth attendants, like these nurse-midwives at a midwifery education center in Afghanistan’s Bamyan province, are vital for ensuring safe and healthy deliveries for mothers and their babies. USAID has helped train more than half of all midwives currently working in Afghanistan. / USAID Afghanistan

Unavoidable stillbirths, which are caused by congenital abnormalities, account for only 7.4 percent of all stillbirths in the world. The rest are largely preventable. In fact, nearly half of all stillbirths — 1.3 million each year — occur during labor and delivery.

The hours and days surrounding childbirth are the times when women and babies are most vulnerable, and high-quality care at these times has the greatest potential to reduce maternal and newborn mortality and stillbirths.

Another way to reduce these unnecessary deaths is through family planning. Empowering and educating women and girls helps families choose the number, timing and spacing of their pregnancies, translating into improved birth outcomes for both mothers and their babies.

In fact, quality care for pregnant women before and during childbirth — coupled with optimally-timed pregnancies — would prevent most stillbirths, as well as most preventable maternal and newborn deaths.

During pregnancy, adequate nutrition and quality prenatal care, including treatment for maternal infections, keep women healthy and increase the likelihood of a healthy newborn. These measures have also been shown to improve child development outcomes, thereby yielding a quadruple return on investment.

A network of 300 Smiling Sun clinics throughout Bangladesh, supported by USAID, provides essential services to individuals and communities across the country. / Amy Fowler, USAID

A network of 300 Smiling Sun clinics throughout Bangladesh, supported by USAID, provides essential services to individuals and communities across the country. / Amy Fowler, USAID

In Bangladesh, USAID works to provide these vital services to the most vulnerable populations of women and children. We support a network of Smiling Sun Clinics that are active throughout the country.

The Smiling Sun Clinic in Tongi serves a population of some 94,000 individuals, providing prenatal and postnatal care, immunizations, and family planning services. Now in its 19th year of operation, the clinic provides services free of charge to the poorest of the poor through funds paid by other clients, ensuring the clinic’s sustainability. And it was this clinic in Tongi that changed Fatima’s life.

After losing her first child, Fatima resolved to seek care from the Smiling Sun Clinic during her next pregnancy. She delivered in the facility, open 24 hours a day for delivery services, in the presence of skilled birth attendants.

Gift Usami Ava, pregnant with her third child, receives prenatal care at the Ugep General Hospital in Nigeria’s Cross River State. Quality prenatal care during pregnancy helps reduce stillbirths and improves maternal and newborn health. / Amy Fowler, USAID

Gift Usami Ava, pregnant with her third child, receives prenatal care at the Ugep General Hospital in Nigeria’s Cross River State. Quality prenatal care during pregnancy helps reduce stillbirths and improves maternal and newborn health. / Amy Fowler, USAID

Fatima’s story had a happy ending, and her baby was delivered safe and healthy. We believe all women should have that chance.

Pregnancy and motherhood ought to be a time for celebration rather than for mourning. We have set ambitious targets to save the lives of babies, children and mothers worldwide, and we are confident that, with the support of strong global and local communities, we will be able to achieve them.

ABOUT THE AUTHOR

Katie Taylor is the deputy child and maternal survival coordinator at USAID and the deputy assistant administrator for the Bureau for Global Health.

All in Good Faith: Partnering with Malawian Ministries for Maternal Health

In USAID’s—and the world’s—goal of ending preventable child and maternal deaths, the faith sector is a powerful partner.

Close to 90 percent of the world’s people adhere to some religious belief, and in rural areas in many of the developing countries in which we work, health care is provided by religious organizations. Faith-based organizations like the Christian Health Association of Malawi (CHAM) reach deep into the community, and bring a unique set of skills, experience and contributions to the development arena.

They play a pivotal role in improving the quality, accessibility and respectfulness of maternal and child health services—and in promoting the demand for these services. Many faith-inspired groups are enthusiastic supporters and invaluable allies in our efforts to save the lives of mothers and children.

Memory Mponda (right), Priscilla Ziyaye and Pacharo Kumwenda, USAID-supported students training to become nurse-midwives, stand outside the Kangaroo Mother Care ward at the Chonde Health Center. / Grace Soko, Christian Health Association of Malawi

Memory Mponda (right), Priscilla Ziyaye and Pacharo Kumwenda, USAID-supported students training to become nurse-midwives, stand outside the Kangaroo Mother Care ward at the Chonde Health Center. / Grace Soko, Christian Health Association of Malawi

Take the Ndirande Health Center in the city of Blantyre, Malawi, where 15 students from St. Joseph’s College of Nursing and Midwifery work alongside clinical staff to check the vital signs and collect the histories of women who have come to give birth. They assist during the deliveries, and administer necessary care when emergency situations arise.

Recent visitors to the hospital have been pleased that their waiting time has been reduced, as the students, organized into teams, quickly and efficiently check people in and get them the care that they need. As the only public health facility in a district of more than 300,000 people, there is never a dull moment at Ndirande.

On the other side of Blantyre, at the Chilomoni Health Center, 19 of their classmates perform similar duties. Both facilities see upwards of 300 deliveries a month; at Ndirande, that number sometimes approaches 450. On average, 10 or more women come to each facility to give birth each and every day.

For the nursing students at St. Joseph’s, the challenges and experiences that they face at the health facilities are an invaluable learning tool. And for the clinical staff, the extra hands on deck provide much-needed assistance throughout the busy days. At Chilomoni, the hospital’s staff is more than doubled by the addition of the students.

St. Joseph’s is one of 12 constituent training colleges funded in part by USAID and operated by CHAM. Established in 1966, CHAM is an ecumenical organization overseen by the Episcopal Conference of Malawi and the Malawi Council of Churches, and provides administrative and technical support to the health care services of member units across the country.

With 175 member health facilities, CHAM reaches more than 4 million Malawians with health services—37 percent of all care provided in Malawi, and second only to the Ministry of Health. Through training programs like those at St. Joseph’s, students are able to become nurse midwife technicians, medical clinicians, laboratory technicians and psychiatric nurses.

This training helps students bring knowledge and experience to Malawian communities—and is an important step towards ending preventable newborn, child and maternal deaths.

Chimwemwe (“Joy” in the local Chichewa language), a community health worker in Malawi, meets with an HIV-positive pregnant woman at her home in Lilongwe through the USAID-funded Tingathe program, which works closely with the Ministry of Health. / Chris Cox, Baylor College of Medicine Children’s Foundation.

Chimwemwe (“Joy” in the local Chichewa language), a community health worker in Malawi, meets with an HIV-positive pregnant woman at her home in Lilongwe through the USAID-funded Tingathe program, which works closely with the Ministry of Health. / Chris Cox, Baylor College of Medicine Children’s Foundation.

In the 2014 Acting on the Call report, USAID laid out a framework for using proven, high-impact interventions and data-driven investments to improve health outcomes in 24 priority countries for maternal and child health, saving the lives of 15 million children and 600,000 thousand mothers through 2020.

In Malawi, a scale-up of key interventions could save more than 25,000 newborns and 5,000 mothers—lives that we know how to save, but that will likely be lost if we do not act.

Already, our efforts are yielding results and translating into lives saved. The 2015 report shows that Malawi is on track or has exceeded the year’s target for improving key interventions, such as the percentage of live births occurring in a health facility or being overseen by a skilled birth attendant, or the percentage of households with at least two insecticide-treated bed nets. But more rapid progress is needed in pregnant women receiving antenatal care and in women and children having access to clean water.

Our collaboration in Malawi with CHAM is one of many ways we are leveraging strategic partnerships, promoting country ownership and building the capacity of local communities. The holiday season reminds us how vital these partnerships are—now, and all throughout the year.

As the students at St. Joseph’s graduate next year, we will be there applauding them for their hard work, wishing them future success, and welcoming in the next class of students to begin their training.

ABOUT THE AUTHOR

Katie Taylor is the deputy Child and Maternal Survival Coordinator and a deputy assistant administrator for the Bureau for Global Health at USAID.

16 Days: Making Schools Safe Everywhere For Students Anywhere

In 2013, this 11-year-old girl from the Democratic Republic of Congo was raped by a family friend. In the aftermath she faced social stigma, isolation and teasing in school. USAID-supported interventions like counseling and medical care helped her regain her voice and her dignity. / Morgana Wingard, USAID.

In 2013, this 11-year-old girl from the Democratic Republic of Congo was raped by a family friend. In the aftermath she faced social stigma, isolation and teasing in school. USAID-supported interventions like counseling and medical care helped her regain her voice and her dignity. / Morgana Wingard, USAID.

“He told me I couldn’t tell anyone.”

Angelina was only 14 years old when she was sexually abused by her teacher. Born into a poor family in rural Mozambique, she sold eggs on the side of the road to help cover the cost of her education and dreamed of becoming a nurse.

Teachers wield incredible power to positively influence young lives. However, they are also able to abuse that power. In this case, Angelina’s teacher promised financial support in exchange for her silence.

Scared and struggling to afford school fees, Angelina continued to suffer abuse for an entire year. It wasn’t until she participated in a school health program run by USAID partner ANDA that Angelina realized what was happening to her was wrong.

Worldwide, 246 million children experience gender-based violence at or on their way to school every year. A report released by the United Nations Human Rights Council noted that attacks on schools occurred in at least 70 countries between 2009 and 2014, and that about 3,600 attacks against schools, teachers and students were recorded in 2012 alone.

A student at the Saffa Girls School in the West Bank raises her hand in class. The school is one of 57 in the area that USAID provided teacher training to. The school now also has 28 rehabilitated classrooms, a computer and science lab, a library, resource center, and a protected playground. / Bobby Neptune for USAID.

A student at the Saffa Girls School in the West Bank raises her hand in class. The school is one of 57 in the area that USAID provided teacher training to. The school now also has 28 rehabilitated classrooms, a computer and science lab, a library, resource center, and a protected playground. / Bobby Neptune for USAID.

And those are the numbers we know. The truth is that gender-based violence in schools is happening in every country around the world right now. It is a global phenomenon depriving children, especially girls, of their right to a safe, quality education.

From kidnappings to shootings, from acid attacks to poisoning, and from discrimination to intimidation, girls are being threatened, harassed, attacked and killed while trying to learn.

With the help of her school health program, Angelina was finally able to recognize her abuse, prosecute her abuser, and pursue an education free from fear and harassment.

In Mozambique and around the world, going from the classroom to the courtroom can be incredibly challenging. It requires survivors, communities, teachers, law enforcement and governments to work together for justice. But Angelina’s counselor hopes other girls will have the courage to say no and speak out.

We at USAID believe that schools free from abuse and violence are possible. It is exhausting and difficult work. Changing mindsets, fighting stigma, and speaking up for those who’ve been silenced can sometimes feel futile.

But behind every statistic and every story is a hero like Angelina and the brave men and women who worked tirelessly to support her. We must continue to fight alongside them until schools everywhere are safe so students anywhere can reach their potential.

The 16 Days of Activism Against Gender Violence campaign begins today. The 2015 global theme is From Peace in the Home to Peace in the World: Make Education Safe for All. This year, USAID will spotlight 16 teachers, students, leaders and activists worldwide who have triumphed over gender-based violence and/or are helping students learn and thrive.

Whether it’s creating safe spaces for students to grow and play, strengthening laws to protect the most vulnerable, or training teachers to give support when it’s needed, these individuals are working to ensure that girls and boys, and women and men, can realize their universal human right to education. Starting today and throughout the campaign, follow their stories on Instagram and Medium.

ABOUT THE AUTHOR

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

Back in the Classroom: Displaced Students in Nigeria Find Education & Hope

Ikilima Shuib Chiroma teaches a class of adolescent girls on Sept. 21 in a non-formal education facility in Yola, capital of the state of Adamawa in Nigeria. Creative is implementing USAID’s Education Crisis Response program here through partner agency International Rescue Committee to assist youth displaced by Boko Haram. / David Snyder for USAID

Ikilima Shuib Chiroma teaches a class of adolescent girls on Sept. 21 in a non-formal education facility in Yola, capital of the state of Adamawa in Nigeria. Creative is implementing USAID’s Education Crisis Response program here through partner agency International Rescue Committee to assist youth displaced by Boko Haram. / David Snyder for USAID

Like most 10-year-old students, Dinah solves her math problems in the old-fashioned way—with her fingers. She counts to six and jots down the number.

For Dinah’s extended family, they are counting something entirely different—the months since the girl lost her mother during a raid by Boko Haram insurgents on her village in northern Nigeria.

After the vicious attack, the young girl eventually made it to a center for internally displaced persons. Dinah’s uncle drove from the city of Bauchi to bring her to his home.

Today, some seven months after the incident, Dinah is adjusting to a new school and a new future.

An insurgency has wreaked havoc on parts of Nigeria, forcing some 2.2 million people from their homes—one of the largest concentrations of internally displaced persons in Africa. Hundreds of thousands of school-aged children have been set adrift inside the country, ripped from their communities and their schools.

With the magnitude of the situation, USAID, state officials and NGOs stepped in with the Education Crisis Response program.

Launched in 2014, the goal of the program is to expand access to quality and protective non-formal education and alternative education opportunities for out-of-school children, ages 6 to 17, in three Nigerian states and reduce the burden on local schools already stretched thin by limited resources. It is implemented by Creative Associates International and the International Rescue Committee, along with local NGOs.

The project has established 294 non-formal learning centers that provide education, in-class meals and psycho-social services to the displaced children, says Ayo Oladini, director of the Education Crisis Response program.

Local facilitators identified and trained by the program use a government-approved curriculum to teach basic literacy, numeracy and life skills. The learning centers are housed in existing structures like schools or meeting houses that are made available by the local community.

The students attend class three days a week for at least two hours each day and are provided basic school materials.

Adolescent girls in a non-formal education class on Sept. 21 at a school in Yola, capital of the state of Adamawa in Nigeria. Creative is implementing USAID’s Education Crisis Response program here through partner agency International Rescue Committee to assist youth displaced by Boko Haram. / David Snyder for USAID

Adolescent girls in a non-formal education class on Sept. 21 at a school in Yola, capital of the state of Adamawa in Nigeria. Creative is implementing USAID’s Education Crisis Response program here through partner agency International Rescue Committee to assist youth displaced by Boko Haram. / David Snyder for USAID

Paving the way for mainstream education

State officials evaluating the non-formal learning centers say they are working.

“The type of education they do receive is a good one,” says Halilu Usman Rishi of Bauchi’s State Education Secretariat. “That is going to [pave the] way for them to mainstream to a formal system of education.”

The opportunity to return to class is life changing, especially for the many who have been displaced and out of school for years.

“For the kids who had forgotten most of what they have learned [and are] now coming back to a classroom — to say it is therapeutic is an understatement,” Oladini said. “It’s a thing of joy.”

Youth displaced by Boko Haram take part in a non-formal learning class in Gombe, Nigeria on Sept. 26 as part of USAID’s Education Crisis Response program. / David Snyder for USAID

Youth displaced by Boko Haram take part in a non-formal learning class in Gombe, Nigeria on Sept. 26 as part of USAID’s Education Crisis Response program. / David Snyder for USAID

Addressing psychosocial needs

And while education is the foundation of the program, children traumatized by conflict and upheaval can only learn when their fears are also addressed.

USAID responded to the psychological needs of the displaced children by incorporating a psychosocial approach to teaching. Facilitators are trained to teach in a student-friendly manner by incorporating group exercises and encouraging positive, interactive student-teacher relations. Working through local partner agencies, the program also encourages the local community to spread messages of peace.

“We make sure that we don’t create any more trauma, either for these children or within the community where they live,” Oladini explained. “We tell them ‘Look, the future is still there for you. You [may] have lost this, you [may] have lost that…but there is still hope for you.’”

Officials in Bauchi are embracing this strategy to help students deal with what has happened to them and their families.

“The program is, in fact, doing as much as possible to ensure that the children are associating with their friends in the learning centers,” says Bauchi’s Rishi. “Some of them used to tell us as we go around to discuss with them, that initially, they found it very difficult to associate with the other children. But as they interact so much with their friends in the learning centers, they forget thinking about such ugly happenings.”

Preparing for sustained success

Scheduled to phase out in 2017, the Education Crisis Response program is supported by Nigeria’s state and federal governments, which, Oladini said, will help ensure the long-term sustainability of the program.

From the outset, government education officials have been involved in every detail of program planning and worked with the program to identify communities, develop a teacher training manual and sit in on classes.

For every learning center, Education Crisis Response has also trained two local government education officials to serve as mentor teachers whose job is to work with the facilitators and provide feedback to teachers.

“From day one, we made sure [the government understood] that this is your program, it’s not our program,” Oladini said. “So from year one before the end of year two, they’ll be able to plan within their budget to see how they can scale up all these programs.”

And while government’s support of the Education Crisis Response program is essential, it is one part of an overall effort that also depends largely on the communities themselves.

“We’re letting them know that with or without parents, there is what we call ‘your own mindset’ – your own ability to move forward and persevere in a state of difficulty,” Oladini said. “This is what we are teaching them.”


Produced for USAID by Creative Associates International, with reporting by Michael J. Zamba and Ernest Akoma in Nigeria.

ABOUT THE AUTHOR

Michael J. Zamba is senior director of communications at Creative Associates International and David Snyder is a photographer and writer. Creative Associates International is implementing USAID’s Education Crisis Response program in northern Nigeria. Follow Creative @1977Creative.
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