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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


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

Livestock Production: Empowering Women in Ethiopia

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

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

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

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

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

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

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

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

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

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

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

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

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


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

Five Promising Innovations in Contraception

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

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

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

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

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

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

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

SILCs Diaphragm. / Credit: PATH/Mike Wang

SILCs Diaphragm. / Credit: PATH/Mike Wang

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

Sayana Press. / Credit: PATH/Patrick McKern

Sayana Press. / Credit: PATH/Patrick McKern

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

Woman's Condom. / PATH

Woman’s Condom. / PATH

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

NES/EE vaginal ring. / Julie Sitney

NES/EE vaginal ring. / Julie Sitney

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

CycleTel. / Institute for Reproductive Health, Georgetown University

CycleTel. / Institute for Reproductive Health, Georgetown University

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


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

5 Things You Didn’t Know About Female Condoms

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

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

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

FC2 Female Condom Packaging

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

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

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

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

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

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

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

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


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

How Gender Analyses Shaped the Future of Microbicides

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


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

If You ‘Let Girls Learn,’ You Save Lives Too


Oppression and prejudice toil in a cage of ignorance and cruelty.  Before the U.S. Civil Rights movement altered the course of history, Jim Crow laws and terror imposed segregation and licensed discrimination, casting a pall of shame over America.

Today, the inhumane degradation and culturally sanctioned abuse of girls in many parts of the world is a shockingly similar shame. Denied the most basic universal human rights, girls have limited access to health care, nutrition, education and job skills training, as well as productive resources, such as water, land and credit.

The kidnapping of 300 Nigerian girls by the extremist group Boko Haram focused global attention, issuing a clarion call that girls’ education and health are civil rights worth fighting for, leading to benefits, not only for girls, but for entire communities and nations. In low income countries, mothers who have completed primary school are more likely to seek appropriate health care for their children. A child born to a literate mother is 50 percent more likely to survive past the age of 5.

  • In low income countries, mothers who have completed primary school are more likely to seek appropriate health care for their children.
  • A child born to a literate mother is 50 percent more likely to survive past the age of 5.
  • Women with some formal education are more likely to seek medical care and ensure their children are immunized.
  • Women with some formal education are more likely to be better informed about their children’s nutritional requirements, and practice better sanitation.
  • An educated girl is three times less likely to contract HIV.

Segenet Wendawork was 5 years old when her mother died. After her father moved away, she bounced around, living with her grandmother for a while, then an aunt who kept her home from school to help with chores.  Thanks to a USAID scholarship program, Segenet was able to return to school in Ethiopia and complete her education. “Before the scholarship, I was unable to dream about the future,” she said.

Sixty-two million girls are not in school, and are also unable to dream about their future. And millions more are fighting to stay in school. The U.S. Government invests $1 billion each year through USAID in low-income countries to ensure equitable treatment of boys and girls, to create safe school environments, and to engage communities in support for girls’ education.

According to the Working Group on Girls (WGG), a coalition of over 80 national and international non-governmental organizations, schoolgirls of all ages report sexual harassment and assault, ranging from gender discrimination to rape, exploitation and physical and psychological intimidation in school.

Last week, a new effort was launched by the U.S. Government, and led by USAID, to provide the public with meaningful ways to help all girls get a quality education. Let Girls Learn aims to elevate a conversation about the need to support all girls in their pursuit of a quality education. In support of the effort, USAID also announced over $230 million for new programs to support education around the world.

Thomas Staal, a senior leader with USAID, said education is essential to fight poverty and all its corollaries: hunger, disease, resource degradation, exploitation and despair. “Women are the caretakers and economic catalysts in our communities. No country can afford to ignore their potential.”

Since education level has the greatest effect on the age at which a woman has her first birth, and adolescent mothers are more likely to die in childbirth, education both empowers young people directly and affects family planning choices and labor force participation.

 “Education is essential to fight poverty and all its corollaries.” In this photo, school children in Haiti. / Devon McLorg, USAID

“Education is essential to fight poverty and all its corollaries.” In this photo, school children in Haiti. / Devon McLorg, USAID

Conversely, a healthy start in life and good nutrition are essential for children to thrive, develop and spend more time in school. Last month, USAID launched a new global nutrition strategy  aimed at reducing the number of chronically malnourished or stunted children by at least 2 million over the next five years. Every year, under-nutrition contributes to 3.1 million child deaths—45 percent of the worldwide total.

In the strategy, USAID is prioritizing the prevention of malnutrition given the irreversible consequences of chronic under-nutrition early in life. Under-nutrition inhibits the body’s immune system from fighting disease and impedes cognitive, social-emotional and motor development.

In addition to focusing on good nutrition in the first 1,000 days for mother and child, USAID is also saving newborns from severe infections, protecting young children from the risks of diarrhea, pneumonia and malaria, and helping women space the births of their children to protect their health and that of their children.

This week, USAID, the governments of Ethiopia and India, in collaboration with UNICEF, the Bill & Melinda Gates Foundation, and others will hold a high level forum to take stock of recent efforts aimed at reducing child and maternal deaths and plot a new course that will ensure progress continues.

USAID will refocus the majority of our maternal and child health resources toward specific, life-saving tools in 24 countries where the need is greatest and empower our partner countries to lead with robust action plans and evidence-based report cards to save an unprecedented number of lives by 2020.

USAID Assistant Administrator Ariel Pablos-Mendez said by coupling family planning investments with policies supporting child survival, girls’ education and job creation – especially those targeting women – countries can be positioned to realize substantial economic growth that lifts everyone out of poverty.

Doing so will allow girls and boys to follow their wildest hopes and dreams and live productive lives.


Chris Thomas is a communications advisor in the Bureau for Global Health. Read more from the author in the latest FrontLines, which features articles about the Agency’s work in maternal and child health: In Health Research Fueled by USAID Is Fielding Innovative Solutions, he writes about innovative, cost-effective and life-saving health care solutions whose research and development were aided by USAID; and in Your Voice: Frontline Health Workers are the Unsung Heroes of Global Health Progress, he describes just how essential community health workers are to rural and other underserved communities in developing nations.

Why Fighting Gender Violence is Also Fighting Hunger in the DRC

Ms. Namuhindo demonstration her new writing skills./Rachel Grant, USAID

Ms. Namuhindo demonstration her new writing skills. / Rachel Grant, USAID

Ms. Rurayi Namuhindo, pictured above writing her name, is proud of her reading and writing skills. They are giving her a new lease on life, as she can now help her children with homework and use her newfound skills when selling her bread and soap. Ms. Namuhindo and others are just a few of the empowered women I met recently while in the Democratic Republic of the Congo (DRC).

The people of the DRC have faced so many challenges, which are unfathomable to someone growing up in the developed world – years of conflict, occasional natural disasters, and poverty.

The lives of women are especially hard.

Today, armed conflict, sexual violence, and abuse continue to be widespread. Some 2.6 million people have been displaced, and 6.4 million lack enough food to be able to eat every day.  Eastern DRC is said to be the “rape capital of the world,” according to a 2011 American Journal of Public Health study.

So how does this relate to that country’s food crisis?

Women play a critical role as agricultural producers, yet most of their work goes unrecognized.

They lack access to land and other resources, limiting their ability to fully participate in the agricultural sector. Though women suffer among the highest rates of gender violence in the world, their attackers often go unpunished. In fact, attacked women can even be rejected by their families, and left to fend for themselves.

If the DRC can alter its behavior towards women, these women can stay in their communities. Just being able to stay put means they can increase production on their land, earn incomes, and put food on their families’ tables.

Tackling gender inequities is key to resolving any food insecurity in the communities where we work.

In my role as East, Central and Southern African Division Chief for the Office of Food for Peace, I have visited my fair share of countries in crisis. With a history of working in 150 countries over the last 60 years, Food for Peace has helped many countries recover from crises and thrive. And for the last several decades we have worked to tackle the root causes of chronic food insecurity in places like the DRC – through interventions to increase agricultural yields, develop new ways to earn an income, or empower women, for example.

I came away from the DRC feeling an immense sense of accomplishment and hope in our work, particularly around elevating the role of women. Women Empowerment Groups are a critical aspect of some of our programs. These groups provide women with literacy, numeracy, and business skills training while helping them to start projects to generate income such as soap making, bread making, or breeding of small livestock.

Intermittent evaluations of these programs tell us that we are having an impact, supporting the abundance of evidence that indicates that if the status of women is improved, then agricultural productivity will also increase, poverty will be reduced, and nutrition will improve.

These skills elevated Ms. Namuhindo’s status at home and increased her role in decision making; she is now seen by her husband as a breadwinner and partner. The pride I sensed in her as she explained the life-changing effect on her left an indelible impression on me.

Similarly the role-play dramas led by Gender Discussion Groups left me convinced that gender-sensitive activities are crucial to promoting change. Groups of men and women come together to discuss issues affecting their households and community, including alcoholism, domestic violence, treatment of boys as compared to girls, and division of household labor.

Gender Based Violence Role-Play by community members./Jessica Hartl, USAID

Gender Based Violence Role-Play by community members. / Jessica Hartl, USAID

The discussions are dynamic and animated, and would certainly be day-time Emmy contenders. “Who picked this topic?” I asked as I watched the first drama  that portrayed a father marrying off his 14-year old daughter to make money for his alcohol addiction. “We did,” answered the community. Alcoholism affects the homes in many ways – financially, women carry an unfair work-burden, girls drop out of school and many marry at a young age. These messages, delivered through live dramas or other media, have attracted a large following. Surveys in Katanga and South Kivu found that nine out of 10 of those surveyed listened to the discussion. And six out of 10 of the people surveyed believe the drama contributed to a changed attitude and behavior.

I was compelled by the dramas we watched and genuineness with which men and women answered about resultant changes;  men and women making decisions together about money, working hand-in-hand on chores, and men changing their decisions as they better understood the effect of their choice on their household.  Ms. Nkumbula*, another participant, said, “Since my husband is attending Gender Discussion Group meetings, we are now in peace at home. He began to tell me all the truth about finances and the money he earns fixing bicycles, and to consult me on other problems.”  Mr. Kalambo* shared how after a local trader had come to his home and offered to buy his stock of beans he had replied, “I have to talk to my wife first.  We have to make a joint decision; either we will sell this stock of beans or not.”

Needs remain vast across eastern DRC. But I came away from the trip with evidence that our approach is working, and that it will have long-lasting impacts on individuals, homes and communities.

*No first names given.



Rachel Grant is Division Chief in East, Central and Southern Africa Office for USAID’s Office of Food for Peace


The Syrian Conflict Through the Lens of Women and Girls

Syrian refugees walk along the outer perimeter of a refugee camp on the Syrian border. / Odd Andersen, AFP

Syrian refugees walk along the outer perimeter of a refugee camp on the Syrian border. / Odd Andersen, AFP

The numbers are stark. The Syrian Observatory for Human Rights currently estimates that some 150,000 Syrians have perished in that country’s ongoing conflict. Over 6 million Syrians have been displaced inside the country, often multiple times; and approximately 2.7 million people have fled Syria, mostly into neighboring nations.

The majority of those are women and children, who have been exposed to serious risks during their flight, in camps, and in unfamiliar countries’ cities and towns.

The crisis in Syria presents humanitarian, developmental and demographic challenges that are seldom seen at this magnitude. We recently returned from Jordan and Turkey where we came away with very profound impressions regarding the gendered lens of the conflict; the challenge of gender-based violence (GBV); and, the roles that women are playing as agents of change.

It is hard to tell with any certainty exactly how many women are suffering various forms of sexual violence in Syria. Assessments, done by local and international organizations, do identify women and children as among the most vulnerable.

Anecdotally, many displaced Syrian women and girls report having experienced violence or knowing people that have suffered attacks, in particular rape.

A women carries food commodities in the Aleppo neighborhood of Tariq al-Bab. / Odd Andersen, AFP

A women carries food commodities in the Aleppo neighborhood of Tariq al-Bab. / Odd Andersen, AFP

But in spite of this horrifying situation, we also heard several heartening stories that humble us and provide the motivation to push forward and continue to elevate the voices of women enmeshed in this conflict:

  • Stories of women negotiating local cease fires in Zabadani and of removing armed actors from schools in Aleppo;
  • Stories of women delivering life-saving medical supplies despite the grave risks to themselves and their families;
  • Stories of women in eastern Syria who worked with merchants to stabilize commodity prices so that citizens could remain in their homes;
  • And stories of women in Latakia who convinced armed groups to permit establishment of a local civil society presence focused on peace-building.

Making sure these women are heard will be key to ending the violence.

These stories show some of the ways Syrian women are leading their communities. And USAID is working to create space for other fearless women across the country as we support the establishment of democratic processes and institutions in Syria that advance freedom, dignity, and development for all of its people.

Syrian women cook their food their makeshift houses at the refugee camp of Qah along the Turkish border. /  Bulent Kilic, AFP

Syrian women cook outside their makeshift houses at the refugee camp of Qah along the Turkish border. / Bulent Kilic, AFP

Consistent with our commitments under the U.S. National Action Plan on Women, Peace and Security (NAP) [pdf] we are seeking to increase the participation and representation of women, youth, and minorities in governing bodies, with a view to building confidence in peaceful and representative transitional political processes.

Our mission in Jordan is helping to create inclusive, effective and accountable institutions that serve all of its population. For example, one community and medical center that we visited in one of the largest and poorest urban areas in Jordan now serves a dynamic population of Jordanians, Palestinians, Iraqis and Syrians — women, men, girls and boys — in the areas of computer literacy, job training, psycho-social care and basic education for young children. As a result of the far-reaching nature of the conflict and changing demographics of the neighborhood, the community has expanded its efforts to make services available to the entirety of the population.

USAID has stepped up commitments to meet the needs of women and girls, not only through our Implementation Plan for the NAP, but also in realizing the U.S. Government Strategy to Prevent and Respond to Gender Based Violence Globally [pdf]; the joint State-USAID Safe from the Start initiative; and through our shared leadership in 2014 of the Call to Action to Protect Women and Girls in Emergencies. We strive daily to live up to those commitments and eagerly look to the broader international community for collaboration.

USAID’s response in Syria and elsewhere around the world must serve, protect and empower all of those affected by crisis and conflict, and ensure their voices and priorities shape the humanitarian response and the approach to recovery and reconstruction.

Maintaining Women’s Potential in Yemen

“The women of Yemen should never again be relegated as second class citizens.”
-Attendee of the New Voices of Yemen Dinner, March 3, 2014

This was the heart of the messaging from the New Voices of Yemen: Women Leaders Dinner I attended on my second evening in the country’s capital, Sana’a. These women, a far larger network than the 20 who attended the dinner, gathered together once again to promote women’s political participation in the continuing transformation of the country.

Deputy Assistant Administrator Elisabeth Kvitashvili in Yemen

Deputy Assistant Administrator Elisabeth Kvitashvili in Yemen

With the recent successful conclusion of Yemen’s National Dialogue Conference, the women lobbied me to ensure USAID would continue to maintain its support in amplifying their voices, calling for a commitment to the quota of 30 percent women’s representation in constitution drafting, elections, and cabinet positions. They also recognize the need to promote opportunities for women in leading private sector roles in support of much needed economic reforms for Yemen.

Women play such a critical role in all of Yemeni society as demonstrated by the small representation at the dinner of a much, much larger community. Women leaders from the government, civil society, and private sector connect through various networks such as Women’s Integrated Network and Women’s National Committee that they themselves established. These women transcend the country’s north and south divisions as much as political differences. They represent the women of Yemen, young and old.

The two women who facilitated the lively and energetic discussion, Entiem and Rabab both represent the dynamic and articulate nature of these new voices of Yemen. They are part of the youth segment representing the future of Yemen.

These new voices play a critical role in assuring Yemen continues on a path toward peace and prosperity, and USAID plans to continue to support their empowerment and equality.

Bringing Hope to Women in Sri Lanka’s Former Conflict Zones

Like most places that have experienced conflict throughout the world, women were deeply affected by Sri Lanka’s 26-year conflict.  For most women who lived in the Indian Ocean island’s conflict zones, displacement, destruction, violence, harassment and loss were part of their everyday life.  The conflict ended in 2009, leaving many women traumatized and in need of psychosocial care, without belongings or livelihoods, and after the loss of their spouses, as heads of households.  Several USAID initiatives continue to support these women by integrating them into society and bringing normalcy back into their lives.

Thaminy Vedaasingham* is one of the BIZ+ program’s beneficiariesOne such initiative is USAID’s BIZ+ program which helps to increase and enhance equitable economic growth in the former northern and eastern conflict zones.  BIZ+ is partnering with small and medium-sized local businesses to create 5,000 new livelihoods and increase household incomes. The program primarily targets women; including war widows, disabled women and female-headed households.

Thaminy Vedaasingham* is one of the program’s beneficiaries. She is 25 years old and lives in one of the worst conflict-affected northern districts of Sri Lanka.  Having lost a limb during the conflict, Thaminy faced many hardships.  This is when Thaminy heard about the vocational training and production center in her district that provides livelihood assistance to war widows, women abandoned or women separated from their spouses or families. USAID is supporting the center to expand production and marketing of rice flour and spices and provide vulnerable women like Thaminy with new skills and sustainable livelihoods.

“The profit of the business belongs to the vulnerable women who work so diligently in the center. USAID’s assistance and support – in the way of building new hostel and storage facilities, and providing new equipment and transportation – have helped us to overcome any challenges and be successful businesswomen.” says Thaminy.

Thaminy is now economically independent and has the confidence to socialize with others.  “Thaminy is now enjoying life without worrying about the leg she lost. She is happy to work and earn for her family and for herself. As a mother, I am very proud of it”, quips Thaminy’s mother.

The Managing Director of the Vocational Training and Production Centre is happy to see the socio-economic business enterprise model with a vision of improving livelihood of vulnerable women come this far.  But above all, he is happy to see how the project has increased hope in the minds of women who seek empowerment through employment opportunities.

* Name has been changed to protect identity 

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