What do "husband schools" have to do with saving women's lives? That is my favorite quote from the Women Deliver 2013 Conference in Kuala Lumpur Malaysia, the largest global health event of the decade.
Coming from a US political climate where women's most basic sexual rights are at risk, the consensus of over 4000 highly educated and sensible people that "Reproductive health is a human right" feels eerily shocking. And yet at Women Deliver, family planning is depoliticized. In the opening session, everybody addressed sexual and reproductive health and rights as absolutely key to the health of global economies and a secure future. "The recognition effect of being heard is absolutely enormous" said Maria Eitel from Nike Foundation. She referred to addressing the needs of adolescent girls, but I take it to mean the fact that global leaders share the vision that the health and freedom of women and girls is key to the future of our planet, our world economies and our families. In the words of Hillary Clinton, "Women are the majority of the world's poor and uneducated. [But] there is a direct connection between a woman's ability to plan her family, space her pregnancies, get an education and provide for her family...We declare reproductive healthcare is essential to the health of women and women's health is essential to the health of everyone." It is magical to be in a space, 4000 people strong, who agree that gender equality and women's reproductive health is an economic driver. The health of women has a broad and positive systemic effect.
For too long, however, focusing only on the health of women as mothers and those holders of half the sky has been too limited. Karl Hoffman, President of Population Services International noted that women's health -including reproductive health- must be taken much more broadly if we're to make the progress that we aim for.
Two key groups have been left out of the development goals equation: Men, and girls between infanthood and adolescence. But men--and girls-- are now being very much encouraged to be part of a global system to helping women have healthy babies, and healthier lives. It feels obvious to write that, and yet for example, girls have not been on the global health agenda. Things are changing, though.
In Sierra Leone, a new program knows reproductive health is about a relationship between men and women. For a woman to be healthy during pregnancy but men need to be fully on board too. Reverend George Buannie is the Executive Director of the Fambul Initiative Network for Equality (FINE). He developed a "husband school," where men teach other men to respect women's rights and sexual health. The villages where FINE works have seen a 60% decrease in rape and gender based violence, and maternal mortality has decreased by more than 60%. Contraceptive use has increased from 30 to 51%.
A true "it takes a village" mentality has been built into several mHealth programs aimed at providing ante and postnatal care to women via mobile phones. After much user testing, developers of these mHealth recognized the importance of reaching gatekeepers to help pregnant women and new moms. Although we in the US are overly familiar with the notion of mom as "Chief Household Officer," and the notion that a woman would not have her own phone might feel scandalous to many US women, only 32% of adult women in the rural state of Bihar, India own their own phone. But 83% of women have access to one. Bihar has among the highest rates of maternal and child mortality in India, but also one of the most rapidly expanding mobile markets: mobile phones outnumber water taps and toilets. In India, BBC Media Action is developing Kilkari, a service to provide subscribers with staged, weekly calls linked to pregnancy, birth and infant health.
Kilkari is actually developed in a male tone of voice to reach the man of the house, who is the gatekeeper and probably owner of the mobile phone in rural Bihar. By motivating the husband or guardian to recognize warning signs, taking action when necessary to get help, and get vaccinations, antenatal visits more women will survive. In Bangladesh, where MAMA just launched one in four moms has at least 4 antenatal care visits; one woman dies every hour from pregnancy related complications. But 80% of these deaths are preventable. Again, in Bangladesh 63% of households have at least one mobile phone and 39% of women have their own handset. The Aponjang program targets men, however, not women. Male "Gatekeepers" are 50% of subscribers to the mobile information service. That would be as if 50% of readers of a popular mom blog were dads- not a terribly likely scenario in the US.
And what about girls? There's a mistaken assumption that girls are included when NGO's and aid agencies invest in women. This is a crucial mistake. In the words of Maria Eitel from Nike Foundation, "Before they're women, they're girls. If we can catch girls at that critical transition of adolescence we have such hope...between 9 and 19 when things either go in the right direction or the wrong direction." A girl before 15, growing up in a poor country is full of hope and dreams. By 15, she knows her future is inextricably linked to her family's economic future and it is her meals, her schooling, her future that will be the first to go.
And as Dr. Nafis Sadik stresses, girls themselves cannot change their own situation- whether girls go to school or not is not their decision. They may want to, but they need adult intervention. And educating girls, preventing child brides, and ensuring girls become healthy women is one of the safest economic bets we can make.
Reeta Roy, head of the Mastercard Foundation, shared the incredible story of CAMFED, an NGO based in Africa that's been working 20 years to create programs focused on highly vulnerable, rural young women. CAMFED ensures them safe passage through their education. They have achieved a 94% retention rate of girls through secondary school. The average age of marriage has been delayed to 22.5 years from 18 or younger. And remarkably, and even without Kickstarter, 17,000 alumnae from CAMFED across the country have funded sending girls to school.
In Uganda, the most youthful country on the continent of Africa, organizations working with adolescent girls simply provide a space for girls to be girls, be with friends and play. In villages where clubs were present there was close to a 25% reduction in pregnancy. 83% of girls reported they were able to put aside unwanted sex: they learned the crucial negotiation skills that would keep them on track to getting an education.
So what's next for the world's girls? It seems unclear now. You can help by literally Putting Girls on the post 2015 Millenium Development agenda. Join the Girl Declaration, to bring the authentic voice of girls to the global development agenda. You can also join GirlUp, bringing the world's girls together for a better world.