Start with a Girl: A New Agenda for Global Health - Center for Global

116 Pages·2009·5.16 MB·English

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The Girls Count Series S
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The Girls Count series uses adolescent girl–specifi c data and analysis to drive R
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meaningful action. Each work explores an uncharted dimension of adolescent girls’ WITH A GIRL
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lives and sets out concrete tasks for the global community. Together, these actions I
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can put 600 million adolescent girls in the developing world on a path of health, H

education, and economic power—for their own wellbeing and the prosperity of their A A NEW AGENDA

families, communities, and nations. G
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The Girls Count series is an initiative of the Coalition for Adolescent Girls. : FOR GLOBAL

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www.coalitionforadolescentgirls.org

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Start With A Girl: G
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A New Agenda for Global Health N
D A GIRLS COUNT REPORT ON
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In Start with a Girl: A New Agenda for Global Health, Miriam Temin and Ruth Levine ADOLESCENT GIRLS
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describe the positive multiplier effect of including adolescent girls in global health O
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programs and policies—and the risks if they continue to be left out.

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“Protecting the health of adolescent girls is a human- “Everyone has a role to play in fulfi lling the promise A
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rights priority. Whether by combating child marriage, of girls’ futures. Much of what needs to be done
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facilitating access to quality health care, or eliminating challenges us: we need to work across sectors, in E
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harmful traditional practices, gains in adolescent girls’ a sustained way over many years, tackling some of
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health permit the full realization of human potential.” the most controversial topics. But to do less is to fail T
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girls—and ourselves.”
Mary Robinson
President of Realizing Rights: The Ethical Helene Gayle
Globalization Initiative and former President and CEO of CARE USA
President of Ireland
“Prioritizing the health and prosperity of adolescent
“There are 600 million adolescent girls in developing girls is fundamental to ensuring the health of future
countries and their health and wellbeing should be generations and to accelerating economic progress.
a top priority. If educated, healthy and empowered, To get there, we need to transform the health-care
they can build a better life for themselves, their sector to reach girls specifi cally with services and
families and nations. UNFPA is proud to be an active to engage them as the next-generation health-care
member of the UN Interagency Task Force on Adoles- workforce.”
cent Girls. I hope this report contributes to action to
Muhammad Yunus
improve their health and unleash their full potential.”
Founder and Managing Director of
Thoraya Ahmed Obaid Grameen Bank
Executive Director of the United Nations
Population Fund
MIRIAM TEMIN
RUTH LEVINE
CENTER FOR GLOBAL DEVELOPMENT
Cert no. SW-COC-000850
START
WITH A GIRL
A NeW AGeNDA
foR GLoBAL
HeALTH
TAKe ACTIoN foR
GIRLS’ HeALTH
1 3
Implement a Place adolescent girls at
comprehensive health the center of international
agenda for adolescent girls and national action and
in at least three countries. investment on maternal
Working with countries that demonstrate national health.
leadership on adolescent girls, bilateral donors, the
New advocacy and programmatic investments give
World Bank, the WHO, UNFPA, and UNICEF can
renewed hope for maternal health. Within advocacy
comprehensively support girl-focused interventions
and program efforts, specific attention to girls will
(including girl-friendly reproductive health services),
pay off. Donors should support research on the
broad health sector changes, transformations in
risk factors for pregnant adolescents and evalua-
social norms, community resources for girls, and
tions of programming for girls facing high hurdles
girls’ schooling. Accompanied by operational and
to health care. They should translate evidence into
evaluation research and funded by domestic and
programming to reduce adolescent maternal mortal-
international resources, the aim is to achieve full pro-
ity beyond labor and delivery to also include family
gram coverage among the poorest segments of the
planning, nutrition, and abortion-related care. Fund-
population by 2016.
ing should be earmarked for adolescents within any
new resource package for maternal health.
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Eliminate marriage for
Focus HIV prevention
girls younger than 18.
on adolescent girls.
Child marriage is a manifestation of girls’ powerless-
ness and a driver of health risks. International To turn off the tap of new infections and break the
agencies should identify the practice, affecting back of the epidemic, HIV prevention efforts must
at least half of all girls in about a dozen countries, focus more on girls and young women. As the
as a human rights violation. Girls need national laws Global Fund to Fight AIDS, TB and Malaria, the
to prevent child marriage, along with donor sup- U.S. President’s Emergency Plan for AIDS Relief,
port for national responses—for example, marriage and other major international HIV/AIDS initiatives
registration systems and incentive schemes to keep step up HIV prevention efforts, adolescent girls must
daughters in school—and programs to mobilize com- be at the forefront. This means supporting efforts
munities and create viable alternatives to marriage. to transform harmful social norms, ensuring that
essential services and commodities are in place
for girls, educating girls about avoiding HIV/AIDS
as part of comprehensive sexuality education,
and working with boys and men to change their
behavior—for themselves and their partners.
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5 7
Make health–system Create an innovation
strengthening and fund for girls’ health.
monitoring work for girls. The evidence base on girls’ health, and effective
strategies to improve it, is weak. Girls urgently need
If the health system is failing girls, it’s failing. Strate-
investments in data collection (e.g. through the
gies to strengthen health systems are unfolding,
Demographic and Health Surveys and longitudinal
funded by vertical and health sector sources and new
studies) and multi-country evaluations of promising
resources. Those designing health system reforms
programs, including the 12-year-old check-in and
should pay particular attention to community-based
programs to change boys’ and men’s attitudes and
service delivery for girls, girl-friendly reproductive
behaviors. Philanthropic funders could create an
health services, health worker training to increase
innovation fund to stimulate knowledge generation
competency on adolescent girls’ and boys’ health,
and dissemination, leveraging resources from govern-
and financing and payment strategies that prioritize
ments and official donors’ agencies along the way.
girls’ health.
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Increase donor support
Make secondary school
for adolescent girls’
completion a priority for
health.
adolescent girls.
Obtaining better health for girls requires signifi-
Getting girls through secondary school is one of cant—yet feasible—investment by governments,
the most important actions governments can take donors, and the private sector. There is no valid
to improve girls’ chances for good health. Gov- estimate of current spending on girls’ health. In the
ernments should extend the definition of basic absence of a baseline, but knowing that girls’ health
education, to which all are entitled, to lower sec- programs constitute a small share of current effort,
ondary or to age 16. Governments and the private OECD donors should increase official development
sector, with donor support, must increase formal assistance in areas that benefit girls by at least $1
and non-formal school places by extending primary billion per year. This constitutes approximately 6% of
school facilities, offering targeted scholarships or current spending on global health. In addition, non-
household cash transfer schemes to disadvantaged traditional donors, including emerging donors in the
girls, and offering open-learning programs so girls Middle East, should identify girls’ health as a focus
can study at their own pace. area and commit $1 billion per year.
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START
WITH A GIRL
A NeW AGeNDA
foR GLoBAL
HeALTH
A GIRLS CoUNT RePoRT oN
ADoLeSCeNT GIRLS
MIRIAM TeMIN
RUTH LeVINe
Center for Global Development, Washington 20036 Support for this project was generously provided by the Nike Foundation
© 2009 Center for Global Development and the Bill and Melinda Gates Foundation. The views expressed are those
ISBN: 978-1-933286-42-6 of the authors and should not be attributed to the directors or funders of
Miriam Temin and Ruth Levine. 2009. the Center for Global Development.
Start with a Girl: A New Agenda for Global Health.
Washington, D.C.: Center for Global Development. Cover Photo Credit: Brent Stirton / Getty Images
10 9 8 7 6 5 4 3 2
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START WITH A GIRL
CoNTeNTS
ii Take Action for Girls’ Health 57 Creating family and community resources
to protect girls’ health
xi foreword
60 Increasing the health benefits of schooling
xii Acknowledgements and investments in other sectors
xiii Preface 65 Livelihoods and microcredit approaches
to improving girls’ health
1 executive Summary
66 Reaching girls and young women in the
6 Chapter 1: Why Adolescence, and workplace
Why Now
67 The research agenda
8 The numbers are large
68 Chapter 5: The Way to Adolescent Girls’
11 Why girls’ health matters Health: An Action Agenda
16 Chapter 2: Today, Adolescence Is Bad 70 Succeeding for girls in the health sector
for Her Health
73 Accelerating success through other
18 Social determinants of adolescent sectors
girls’ health
75 The bottom line: costs and benefits
22 Causes of death and burden of disease
79 Who can take the next step?
23 Girls’ health and reproduction
80 Start here: priority actions for change, now
31 Girls’ health and unequal sexual
relationships 82 References
33 The legacy of unhealthy childhoods 93 Advisors
36 New risks in a changing world 97 About the Authors
39 The barriers to good health care
42 Chapter 3: Keeping Girls Healthy:
Working through the Health System
44 Making the health sector work for girls
49 Making health-system strengthening and
demand-side financing responsive to girls
52 Chapter 4: for Higher Pay-off: Working
outside the Health System
54 Changing social norms to promote
healthy behavior
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START WITH A GIRL
BoxeS, fIGUReS
& MAPS
— Boxes 61 4.7 A combined approach has an impact,
but a limited one: school, community, and
11 1.1 Governments have already committed health services in Tanzania
to girls: international treaties that protect
girls’ health 62 4.8 Aahung: surmounting cultural and
political barriers to improve sexual and
23 2.1 Dangerous preparation for woman- reproductive health in Pakistan
hood: female genital cutting
64 4.9 The IMAGE project in South Africa
27 2.2 One of early childbearing’s most
devastating consequences 66 4.10 Keeping young domestic workers
healthy and safe in the Philippines
31 2.3 Especially vulnerable adolescents
74 5.1 Tracking global spending on adolescent
36 2.4 Poor access to water takes a toll girls’ health
on girls’ health
45 3.1 Using hospitals to support young rape
victims in Zimbabwe — figures
45 3.2 WHO framework for youth-friendly 12 1.1 Mother’s age is a risk factor for children’s
health services health problems
46 3.3 A modest proposal: the 12-year-old 22 2.1 The effect of mother’s household
check-in wealth on child mortality by age of mother
48 3.4 Pharmacist training to improve 24 2.2 Adolescent girls’ burden of disease
adolescents’ access to essential goods by cause, 2002
and information
28 2.3 Unmet need for contraception among
56 4.1 Using partnerships and technology married women by age and region
to broaden access to comprehensive
sexuality education in Nigeria and Brazil 34 2.4 Physical and/or sexual intimate-
partner violence and non-partner sexual
57 4.2 Stepping Stones: addressing gender- violence among adolescents 15-19
based violence in South Africa
38 2.5 Percentage of students 13-15 years
58 4.3 Changing young men’s gender norms who are overweight
through the Promundo Program improves
girls’ and women’s health in Brazil 41 2.6 Illustrative factors impeding adoles-
cent girls’ use of health services
59 4.4 Involving young adolescents, their
mothers, and the media in Nicaragua 76 5.1 Estimated average annual financial
requirements (millions US$2009) of
60 4.5 A safe space for out-of-school girls a comprehensive priority intervention
in Egypt package for adolescent girls (2010-2015)
60 4.6 Safe spaces for adolescent mothers: the 77 5.2 Estimated annual costs of priority
Women’s Centre of Jamaica Foundation interventions by region
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