Impact. No. 13 by Impact Magazine

THE MAGAZINE OF PSI

No. 13

7 MELINDA GATES

QUESTIONS WITH

INVEST IN GIRLS AND WOMEN. IT PAYS. WOMEN D E L I V E R CONFEREN C E 2013 PRE V I E W

GC H AA NGING ME-

IDE A S FOR

WOMEN &

G I R LS

I N PA RT N E R S H I P WITH

CUTTING EDGE NEWS AND INSIGHT FOR

THE WORLD’S LEADING SOCIAL INNOVATORS

ON SOCIAL ENTREPRENEURSHIP

EVE ENSLER, FOUNDER OF V-DAY AT THE 2012 SKOLL WORLD FORUM

SKOLLWORLDFORUM.ORG

@SKOLLWORLDFORUM

NO. 13

2. L ETTER FROM THE EDITOR

3. S EVEN QUESTIONS

• Melinda Gates, co-Chair, Bill & Melinda Gates Foundation

6. 5 GAME-CHANGING IDEAS FOR GIRLS AND WOMEN

8. W HAT’S THE BIG

IDEA: INVESTING IN A COMPREHENSIVE APPROACH TO WOMEN’S HEALTH

Amy Lieberman

10. P SI AND PARTNERS

AT WOMEN DELIVER CONFERENCE 2013

12. A WORD FROM THE ELDERS

• 12 Let Us Measure Up as Men Archbishop Emeritus Desmond M. Tutu • 13 It is Time to Stop Discrimination against Girls and Women Dr. Gro Harlem Brundtland

15. O N THE FRONTLINE

• Midwife Frozan Admadi Shares Her Story Leslie Manusco, President & CEO, Jphiego

16. YOUTH ANSWER THE CALL

20. S KOLL WORLD FORUM • Social Innovation for Girls and Women

Marshall Stowell, Editor-inChief, Impact

22. E XPERT INSIGHT

• 22 Grassroots Mobilization Saves Mothers’ Lives Sarah Brown, Global Patron of the White Ribbon Alliance • 23 Making Girls and Women a Priority Every Day Dr. Fred Sai, Adviser to the Government of Ghana on Reproductive Health and HIV and AIDS • 24 We Must Act Now to Save Lives from Cervical Cancer John R. Seffrin, CEO, American Cancer Society, Inc., and Sally Cowal, Senior Vice President & Chief Liaison Officer, PSI • 25 Reaching Women with Tuberculosis Care Dr. Lyn Vianzon, National Tuberculosis Control Program Manager, Philippines

EDITOR-IN-CHIEF

Marshall Stowell

Director, Corporate Marketing, Communications & Advocacy mstowell@psi.org

MANAGING EDITOR & CREATIVE DIRECTOR

Mandy McAnally

amcanally@psi.org

EDITORIAL CONTRIBUTORS WOMEN DELIVER

Janna Oberdorf

Director, Advocacy and Communications

Vanita Gowda Senior Director, Advocacy and Communications

SKOLL FOUNDAITON

Rahim Kanani

Editor, Skoll World Forum on Social Entrepreneurship

PSI

Janie Hayes

26. P OLICY MATTERS

• 26 Europe Policy News By Michael Chommie, Director, PSI/Europe • 26 U.S. Budget Snapshot • 27 U.S. Policy Maker Perspectives Rep. Kay Granger (R-TX) and Sen. Jeanne Shaheen (D-NH)

28. A WORD FROM OUR PARTNER

Jill W. Sheffield, President, Women Deliver

Communications

Diana Denton Graphic Design

Jyoti Kulangara Online Engagement

Laetitia Llemoine Sexual & Reproductive Health & TB

Cate O’kane Corporate Marketing, Communications & Advocacy

Regina Moore Communications & Advocacy

Elizabeth Petoskey Advocacy

Petra Stankard Technical Advisor, Sexual & Reproductive Health & TB

29.FINAL WORD

Karl Hofmann, President & CEO, PSI

PSI is a global nonprofit organization dedicated to improving the health of people in the developing world by focusing on serious challenges like a lack of family planning, HIV and AIDS, barriers to maternal health and the greatest threats to children under five, including malaria, diarrhea, pneumonia and malnutrition. psi.org CONNECT WITH PSI COVER PHOTO: © MARK TUSCHMAN – WOMEN DELIVER

blog.psiimpact.com

Population Services International

follow @PSIimpact

youtube.com/ HealthyBehaviors

LETTER FROM THE EDITOR

n the previous issue of Impact, we examined the new era of philanthropy and giving to global health. In this issue, produced in partnership with Women Deliver and the Skoll Foundation, we focus on one of the most effective ways to lift families, communities and countries: investment in the health and rights of girls and women. Today’s plan for improving the health of girls and women looks different than a decade ago. We asked Impact readers to identify 10 game-changing moments for girls and women throughout the past decade. Here’s what they said: ➊ 1994: Ghana becomes the first African country to ban female genital cutting. ➋ 2000: The Millennium Development Goals are drafted, making gender equality and female empowerment key to the development agenda. ➌ 2006: CDC's Advisory Committee on Immunization Practices votes unanimously to recommend that all girls ages 11 and 12 receive the HPV vaccine. ➍ 2009: President Obama rescinds the Mexico City Policy. ➎ 2009: Hillary Clinton is appointed U.S. Secretary of State, taking a leadership role in advocating for girls and women. ➏ 2010: The Women Deliver Conference brings together thousands of leaders in Washington, D.C., to advance the conversation on girls and women. ➐ 2010: Every Woman Every Child is launched by UN Secretary-General Ban Ki-moon to save the lives of 16 million women and children by 2015. ➑ 2011: GAVI Alliance takes first steps toward introducing the HPV vaccine in developing countries. ➒ 2012: The London Summit on Family Planning galvanizes financial commitments from world leaders to improve access to contraception. ➓ 2013: The UN Commission on the Status of Women breaks new ground on prevention of violence against women. Building on these moments, today corporations are working together with nonprofits, donor and local governments to develop new solutions that meet the needs of girls and women. Melinda Gates has made a compelling case for meeting the contraceptive needs of women and couples. Philanthropists are providing critical funding for pilot projects that might be too risky for governments to fund but that

are poised to be tomorrow’s game-changers. Initiatives like Women Deliver’s ‘crowd-funding’ site Catapult enable donors to fund projects meaningful to them and to track progress. If there’s a common thread, it’s greater engagement in the process. In partnership with local health experts and partners like the Bill & Melinda Gates Foundation, PSI has developed a handful of simple, low-cost ‘bright idea’ pilot projects that have potential to really deliver for girls and women. On pages 6-7, we share a few. Answering “7 Questions,” Melinda Gates talks about the women who inspire her, where change begins, and how donors can best help girls and women. Dr. Gro Harlem Brundtland calls for ending discriminatory practices such as child marriage, and Archbishop Desmond Tutu points out the important role of men and boys in achieving gender equality for girls and women. And Sarah Brown, Global Patron of the White Ribbon Alliance for Safe Motherhood, addresses the need for quality maternal health services for all girls and women. From May 28-30, we join Women Deliver President Jill Sheffield and 6,000 advocates, leaders, corporate supporters and gender experts in Kuala Lumpur at the Women Deliver conference to share and be inspired by the amazing work happening on behalf of girls and women. On page 10, find out where PSI health experts and our partners will be at the conference. If you’ll be with us in Kuala Lumpur, make sure to stop by PSI’s booth in the exhibit hall. If you can’t make it, we’ll be tweeting, blogging and capturing the excitement online so that you won’t miss a thing. Sincerely,

MARSHALL STOWELL Editor-in-Chief, Impact

Learn more about our partners at womendeliver.org and skollworldforum.org.

impact | No. 13

Melinda Gates and participants at a Sure Start Project initiative to promote maternal and newborn health in Kathghara Village, Fatehpur District, U.P., India on March 23, 2010. The women are playing a stacking game to promote family wellness.

7 QUESTIONS WITH MELINDA GATES CO-CHAIR OF THE BILL & MELINDA GATES FOUNDATION

IMPACT: In your travels, you’ve met many women who have shared their personal stories with © BILL & MELINDA GATES FOUNDATION/BARBARA KINNEY

you. Is there one story that stands out?

M E L I N DA GATES: I am inspired by the women I meet everywhere I go. They have to work so hard just to make sure their families survive, but somehow they stay optimistic and do everything in their power to make the future better than the past. I try to talk and write about all of them when I come back from trips, because I believe their stories will inspire others as they’ve inspired me. On my most recent trip to India, I met a young mother named Sharmila who had the courage to stand up to her husband’s family and insist on spacing her pregnancies. I’ve been telling her story a lot lately. In terms of one woman who stands out, I always come back to Marianne, who I met in a slum outside Nairobi, Kenya. I was talking with a group of mothers at a community center about why they use contraceptives, and Marianne said, “I want to bring every good thing to one child before I have another.” That is now a mantra for me. It expresses why I am motivated to do the work of the foundation.

MELINDA GATES

is co-Chair of the Bill & Melinda Gates Foundation. Along with Bill Gates, she shapes and approves the foundation’s strategies, reviews results, and sets the overall direction of the organization. Together they meet with grantees and partners to further the foundation’s goal of improving equity in the U.S. and around the world. They use many public appearances to advocate for the foundation’s issues. In July of 2012, Gates made headlines by spearheading the London Summit on Family Planning, with the goal of delivering contraceptives to an additional 120 million women in developing countries by 2020. While involved in all of the organization’s endeavors, Gates believes that empowering women in developing countries to decide whether and when to have a child is a critical driver of her work at the foundation, since this decision can be the source of transformational improvements in the health and prosperity of whole societies. Bill and Melinda Gates live in Medina, Washington, near Seattle. They have three children.

psi.org | impact

“

The change needed to unlock the boundless potential of women and girls starts with keeping women and girls at the heart of the global agenda.” —Melinda Gates

Melinda Gates meets a mid-wife (far left) in Misi Village in Malawi. Evelyn Zimba of Save the Children at right.

IMPACT:

Global advocacy efforts have successfully underscored the importance of investing in girls and women. Beyond advocacy, what do you see as the next step needed to turn the tide?

M G : I think the word that says it best is empowerment. It’s funny, because empowerment is not something we do for others. Women empower themselves. But I believe there are things we can do to help. Our advocacy can encourage governments to be responsive to their citizens and, in some cases, create the conditions necessary for change. However, change happens in communities, and change for women and girls starts with women and girls. One of the most effective approaches is working on creative ways of helping mothers adopt lifesaving practices like immediate and exclusive breastfeeding and kangaroo care in northern India. In large pilot studies, this initiative cut newborn deaths by more than half in 18 months, using no new technologies. Yes, the initiative required expertise, funding and political commitment from many. But the women of that community did the work. The initiative relied on their social capital to get results, and it worked. 4

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And this kind of empowerment feeds on itself. Once women and girls experience a mind-shift – for example, the knowledge that they have power over when they have children or that they can take action to increase their child’s chance of survival – they start to feel empowered in other areas of life and are better able to lift themselves, their families and their communities out of poverty and create a better future.

IMPACT:

You have stated that philanthropists are needed to develop promising solutions that governments and businesses can’t afford to make. What exactly did you mean and how do you see philanthropists, corporations and governments working together to address global health issues?

MG:

Governments, whose responsibility is to provide for people’s basic needs and ensure the proper functioning of the country, often have to minimize risk. Businesses are great at taking risks, but they can’t justify it if they can’t see the market opportunity. Hence, innovation for the public good sometimes just doesn’t happen. That’s where we hope the Gates Foundation can intervene, and where we think philanthropy has a comparative advantage. African agriculture is a good example. For years, yields in Africa have been stagnant. African governments had neither the resources nor the mandate to experiment with new policies, and businesses didn’t see the profit potential. But if philanthropies can assume some of the

risk of, say, developing new and better seeds, then governments can help make sure they get to farmers at scale. And if philanthropies can experiment with ways to increase efficiency (by developing information systems, for example), then businesses might be willing to step in to the market.

IMPACT:

Last year, Forbes surveyed the philanthropic work of 2012’s most powerful women – from heads of state to businesswomen to supermodels – and found that these women made an incredibly significant impact in the issues they care about. What advice would you give women who are looking for ways to empower girls and women around the world?

MG:

I think we are on the cusp of a big change in the way people can engage with important issues in the world. Until recently, the average person could donate money to a cause, such as famine relief. But increasingly, with the help of technology and social media, the average person can connect much more deeply to issues he or she is passionate about or to organizations that are doing very meaningful work in this space. That increased accessibility enables people to understand how their support is contributing to increased empowerment and sparks more conversation and more action within their networks – both of which are critical to keeping women and girls at the heart of global development. I am continually impressed by the ease with which people can learn about injustices and then use their voice, their network, their money,

We all want to bring every good thing to our children. I have three kids, and I can relate to that. Sharmila risked everything to give her children every good thing. The work we do with our partners is all about helping brave women like Marianne and Sharmila achieve that goal.

WOMEN DELIVER

CONFERENCE SPOTLIGHT PLENARY: Global Progress on Family Planning - Putting Women at the Heart of the Global Health Agenda Melinda Gates and UNFPA Executive Director Babatunde Osotimehin talk with moderator Patricia Amira, media host of Mandala TV, about the global community’s progress in advancing Family Planning 2020.

WEDNESDAY, MAY 29, 2013 9:00-10:30AM

Melinda Gates and Kofi Annan visit farmer Elia J. Meena and his wife Joyce Elia in their farm in Mbuguni, Tanzania on September 26,2012.

or their time to get involved directly. We are just at the very beginning of this trend. In the next decade, we’ll see entirely new platforms that facilitate multiple and varied forms of engagement. I recently launched a page on Catapult.org, which is a crowd-funding platform dedicated to improving the lives of women and girls around the world. I particularly like that it encourages people to explore different organizations globally and share what they’re learning with their friends so that together, they can help fund solutions that result in meaningful and sustainable change.

IMPACT:

The Gates Foundation played a critical role in organizing the London Summit on Family Planning, and you have made expanding access to contraception your personal mission. What do you think are the biggest opportunities and challenges to ensuring that 120 million more women and girls have access to contraceptives by 2020?

MG:

I think we’re in the midst of our greatest opportunity and challenge right now, because we’re in the period during which all the energy from the Summit has to be converted into tangible results through grueling work. The Summit was a breakthrough. It generated unprecedented political commitment and funding. It helped the community come together around some new language that makes consensus possible. The question is: What happens now? Global health is an ongoing project. We host

these events and create moments in time, but the real results come after years of continued collaboration with many partners. So now, in the years after the Summit, we need to make sure the ‘basic’ fundamentals of global health work are taken care of.

IMPACT:

To effectively reach girls and women with needed health interventions, countries need a supportive policy environment. What role do organizations like PSI that implement health programs on the ground have in addressing policies changes?

MG:

One of the challenges we face at the Gates Foundation is that we’re headquartered in Seattle and the people we’re working for live thousands of miles away. That’s why partnership is so critical to our success. Not only do we not have the resources to make big changes on our own, we don’t have the proximity to the ground to take note of the nuances that are the difference between success and failure. The organizations we make grants to – organizations like PSI – help keep us in touch with the beneficiaries of the work and tell us what’s working and, importantly, what’s not. You know us, and you also know them. I believe you play the same role in the policy-making environment. You serve as connective tissue between those making the policy and those the policy is for, ultimately enabling the most effective initiatives to be brought to scale and contribute to meaningful change for families, communities and nations.

IMPACT:

Based on available burden of disease data, where do you think we should focus our efforts in improving the health of girls and women? Are there any statistics that stand out to you as particularly alarming?

MG:

The target we set last year to reach an additional 120 million women with contraceptives in the world’s poorest countries is a critical place where I think we need to focus our efforts. While there is still a lot of work needed to reach that goal, each woman I speak to reminds me that this has the potential to be the source of transformational improvements. Another statistic I’ve been focusing on recently is newborn deaths. About 40 percent of the children under the age of 5 who die are newborns, meaning they die in the first month of life. This proportion has been going up and up, for two reasons. First, the good news, which is that we’ve done a great job of saving the lives of older children. Second, the bad news, which is that we haven’t improved the mortality numbers among newborns in recent years. To me, this statistic describes an opportunity. There are a few interventions that will save newborn lives in large numbers, and I am optimistic that the global health community will increasingly focus its energy on things like corticosteroids, immediate and exclusive breastfeeding, and kangaroo care. n visit MelindaGates follow@MelindaGates visit the Gates Foundation blog at www.impatientoptimists.org

psi.org | impact

SMALL PROJECTS, BIG RESULTS:

5 P

GAME-CHANGING IDEAS FOR GIRLS AND WOMEN

SI’s team of technical experts, in consultation with health practitioners around the globe, have developed five simple ideas to deliver better health for girls and women, quickly and affordably. Lifesaving solutions to some of the most challenging health problems for girls

and women already exist. But often, finding sustainable, cost-effective ways to

deliver them poses a major barrier. Here are five Bright Idea Pilots that are ready today.

Cervical cancer kills more than 270,000 women every year. Yet it’s preventable. The majority of women in the developing world are unaware of the dangers of cervical cancer. Fewer know that it is preventable if detected early. Most health providers do not offer screening, and where it is available, many women do not know about it. Moreover, preventive treatment services are often disconnected from screening, making them hard to access for women who live far from a health facility.

BRIGHT IDEA PILOT #1:

Use health clinic franchises, mobile services and public sector partnerships throughout the developing world to offer simple and inexpensive cervical cancer screening, treatment and referrals. Integrate cervical cancer screening and preventive treatment into the existing menu of services offered by providers. With a small investment, we could save countless lives and better integrate women’s health services.

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Tuberculosis (TB) is a curable disease, yet it is among the top three causes of death among women aged 15-44. Each year, 3 million women become infected with TB and 700,000 women die from the disease. Women are less likely to be diagnosed with TB because they are unaware of the risks associated with TB infection and fear seeking care at TB clinics due to high levels of stigma. TB screening and testing are typically unavailable in facilities where women seek other healthcare such as family planning services, further complicating efforts to reach them with TB care.

BRIGHT IDEA PILOT #2: Develop targeted communications for girls and women about the risks of TB. Make it easier for girls and women aged 15-49 years to access TB care by introducing screening and diagnosis in health clinics already providing reproductive health services. Collaborate with National TB Programs to train these same providers to correctly prescribe and dispense high quality TB drugs. The result? Lives saved, more women educated about the risks of TB, and an integrated approach to women’s health.

Safe delivery should be a available for every mother and child. Today childbirth takes the lives of millions of women and children each year. The international community has made it a priority to encourage childbirth in health facilities, the best and safest place for mothers to give birth.However, in many developing countries, women are unnecessarily dying as a result of childbirth because of limited access to health facilities. Approximately 1 million newborn babies die each year to largely preventable severe infections, accounting for nearly one third of the total burden of newborn deaths.

BRIGHT IDEA PILOT #3: Develop an improved, low-cost Safe Delivery Kit that includes basic supplies like soap, gloves, a razor, a sterile cloth, along with two notable, very important additions: antiseptic (chlorhexidine) to clean the umbilical cord to avoid newborn infections, and misoprostol, a medication taken after childbirth to prevent severe life-threatening bleeding. Reach women where they already seek health solutions by arming community health workers with low-cost Safe Delivery Kits. Train them on how to use the kits, and why. That way, the kits can be used at home or at a nearby health facility.

Every woman and couple should be able to decide whether, and when, to have children. Unintended pregnancies often have unexpected consequences for poor women, including health complications and even death. More than 200 million women and couples in the developing world want to plan for the families they desire but lack access to modern contraceptives. For women in the developing world, unintended pregnancy dramatically increases the likelihood of health complications or death. The London Summit on Family Planning set a goal of reaching 120 million additional women by 2020 with contraception, but currently funding is inadequate to meet the growing need for free and subsidized contraceptives for the lowest-income women and couples.

BRIGHT IDEA PILOT #4:

Treat provision of contraception as a business, through the creation of a social enterprise for a range of contraceptives sold in the private sector to target those who have the ability to pay. This shifts those who can pay away from free and subsidized access, freeing precious resources to reach those with the least ability to pay. Use profits from selling higher-priced products to subsidize other family planning products, providing greater options and access and bringing us one step closer to reaching those 120 million women.

Life for teenage girls doesnâ&#x20AC;&#x2122;t need to be any more complicated than it already is. But millions of girls who need long-acting contraceptives canâ&#x20AC;&#x2122;t access them, putting their lives and futures at risk. Complications from pregnancy and childbirth are a leading cause of death for young women aged 15-19 in developing countries. Yet there are very few efforts to reach young women with a full-method mix of contraception. New evidence shows that long-acting reversible contraceptives such as the intrauterine device and implant are safe and effective for young women.

BRIGHT IDEA PILOT #5:

Through existing networks of health providers, develop cutting-edge communication and education programs that reach young women in urban and rural settings about a wide range of contraceptive options. At the same time, educate policymakers about the health and economic benefits of long-acting contraception and supportive policies for young women. n

Technical briefs available upon request at impact@psi.org.

psi.org | impact

BY AMY LIEBERMAN

MILLENNIUM

DEVELOPMENT

GOAL 5: REDUCE BY THREE QUARTERS THE MATERNAL MORTALITY RATIO BY 2015.

WHAT’S THE BIG IDEA? INVESTING IN A COMPREHENSIVE APPROACH TO WOMEN’S HEALTH

here are still two years left before the United Nations’ eight poverty, health and gender Millennium Development Goals expire and lapse into a new international development agenda. Yet MDG 5 remains one of the most off-track targets, potentially too derailed to meet the benchmarks on time.

- Karl Hofmann

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reverse the abysmal health outcomes facing millions of girls and women?

MOVING TOWARD A HOLISTIC STRATEGY Health and gender equality experts say that there is not just one emerging, solve-all idea. The best answer, they say, is a comprehensive and holistic approach to forging partnerships and implementing health interventions. “It is easy for people to focus on mothers, but the reality is you have to focus on girls and women, and the men, and communities who support them,” says PSI President and CEO Karl Hofmann. “You have to look at women and girls in a holistic way,” agrees Françoise Girard, President of the International Women’s Health Coalition (IWHC). “It should not be a fight between the different sectors.”

“

It is easy for people to focus on mothers, but the reality is you have to focus on women.”

Every year, more than 1 million children are left motherless as a result of complications during pregnancy and childbirth. In sub-Saharan Africa, a woman's maternal mortality risk is 1 in 30, compared to 1 in 5,600 in developed regions. And more than 200 million women lack access to critical family planning services. The situation is dire, but signs of progress are emerging. Increased advocacy in recent years has spurred a wide array of new commitments from donors, government leaders and corporations. Many advocates, health experts and supporters are looking at new models for improving the health of women and girls in the world’s poorest countries. But what strategies will ensure that those regional and global commitments – in policies, partnerships and dollars – will be maintained during this decade and beyond? And what models for health service delivery can successfully

The current MDG approach, she says – which divides goals for women and girls by education, maternal health and participation in society and leadership roles – excludes major populations, including adolescent girls. The partition approach also ignores key gender issues, such as noncommunicable diseases and gender-based violence. In recent months, however, a new vision, which does not necessarily prioritize specific health services, is emanating from post-2015 agenda discussions, says Girard. During the UN high-level dialogue on health in Botswana in early March 2013, civil society agreed to push for a life-cycle approach. “They really brokered a major breakthrough,” Girard says. The IWHC is among the organizations and agencies – including the UN gender entity UN Women – that is advocating for a stand-alone gender goal under the new framework.

FUNDING INTEGRATION While many advocates and experts agree that a comprehensive approach will prove most

successful in improving health outcomes, such an approach poses challenges for donors and policymakers. Kate Tulenko, the Washington, D.C.-based Senior Director for Health Systems Innovation at IntraHealth International, an international nonprofit that works to boost public health capacities in developing countries, notes that development funding remains siloed by health area. “Everything is vertical, due to the way that development money is raised and generated and given,” Tulenko explains. “It's easier to go to Congress or to private donors and make the case about these many women dying of this particular problem, and let’s help that, rather than saying the whole health system is a mess.” Nevertheless, the idea of funding for comprehensive service delivery is catching on. This month, the Women Deliver 2013 conference will bring together civil society organizations, government leaders, corporations and gender experts to discuss how new and current investments in women and girls can make the greatest impact. Women Deliver President Jill Sheffield says that investment – across the spectrum of women’s issues – will be a priority area at the conference. “We want a public conversation about investing in girls and women, and what development plans are needed. Civil society organizations, development banks, ministers of health and ministries of finance – they all know this is a good investment. It’s really a question of how this issue can be a real progress point on the global development agenda.” Other partnerships, like the public-private partnerships and commitments that the Clinton Global Initiative (CGI) helps to facilitate, are also exploring comprehensive approaches to funding. “We are seeing an increase in commitments by people moving beyond issue-based silos and working together, recognizing that education, health or technology projects really don’t happen in three different silos,” says Penny Abeywardena, who oversees commitments for girls and women at CGI. “The most effective commitments are those that bring people together to collaborate across issue areas.” Most CGI members emerge from the private sector. Throughout the past few years, Abeywardena has seen more of those members reconsidering how their overall business approaches prioritize girls and women. “We are definitely seeing an increase in commitments that are really looking at their [companies’] core business strategies and figuring out how best to engage girls and women,” explains

Abeywardena . “There is not a core business strategy or project that will not be maximized by thinking about women and girls strategically.” Hofmann notes that, as the global financing landscape changes, civil society organizations should consider how private investments might leverage public funding, particularly in areas where government dollars are not sufficient to fund the entire life cycle of a solution. “We are looking at new approaches and interventions that need to be proven before they are taken to scale. That is where private money can play a hugely important role,” he says.

A VISION FOR THE FUTURE? The post-2015 development agenda – and how this might increase girls’ and women’s abilities to access health care on the ground in developing countries – remains uncertain, say Hofmann and other experts. The UN Secretary-General’s high-level panel of eminent persons on the post2015 development agenda will release a report in May 2013, following three rounds of consultations around the world. Conferences like Women Deliver will continue to advance the dialogue regarding investments and a holistic approach to women’s issues. But Hofmann sees a conversational shift slowly moving in the right direction. “At the moment, the reality is trailing the rhetoric,” he says. “But all of the rhetoric is flowing toward integration and a more strategic approach to investing in the lives of women and girls.” n Amy Lieberman is a freelance journalist based in New York City.

WOMEN DELIVER

CONFERENCE SPOTLIGHT SOCIAL ENTERPRISE CHALLENGE The competition will allow 10 challengers the opportunity to pitch their social enterprise to a panel of expert judges. As a part of this Social Enterprise Challenge, one contestant will be chosen to receive the “Global Solution Award” for 2013. MAY 30, 2013 11:00AM – 1:00PM; 3:00 – 3:45PM LOCATION: EXHIBIT HALL 5 psi.org | impact

CATCH PSI AND PARTNERS AT THE 2013 WOMEN DELIVER CONFERENCE. AN INSIDERS GUIDE TO MUST ATTEND SPECIAL SESSIONS AND EVENTS. MONDAY, MAY 27

TUESDAY, MAY 28

CERVICAL CANCER FORUM: Integrating Cervical Cancer Prevention and Control with other Health Interventions

Health Systems Strengthening: The Role of the Private Sector

11:15AM - 12:30PM CERVICAL CANCER FORUM: Integrating Cervical Cancer Prevention and Control with other Health Interventions MODERATOR: Doyin Oluwole, Pink Ribbon Red Ribbon SPEAKERS: • Karl Hofmann,PSI • Groesbeck Parham, African Centre for Excellence for Women’s Cancer Control • Phil Castle, Global Coalition Against Cervical Cancer

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11:30AM - 1:00PM MODERATOR: Karl Hofmann, PSI SPEAKERS: • Marguerite Farrell, USAID • Jennifer Pope, PSI •A lysha Beyer, Marie Stopes International • Susan Mitchell, Abt Associates • Klaus Brill, Bayer HealthCare Pharmaceuticals Presidential Session: Women's Health

2:45 - 4:15PM MODERATOR: Karl Hofmann, PSI SPEAKERS: • Barbara Bush, Global Health Corps & PSI Board Member •A na Langer, Harvard School of Public Health • Babatunde Osotimehin, UNFPA • Her Royal Highness Crown Princess MetteMarit of Norway • Harshad Sanghvi, Jhpiego

Youth-Friendly Service Delivery Models

Celebrating Youth at Women Deliver

2:45 - 4:15PM MODERATOR: Jovana Ríos Cisnero, International Planned Parenthood Federation Western Hemisphere Region, Panama

6:30-8:30PM Women Deliver celebrates the young women and men who have traveled to this event from all over the globe. Sponsors: Ipas, Pathfinder International, PSI, HIV Young Leaders Fund, PPFA, and Advocates for Youth, with support from the Global Youth Coalition on HIV/AIDS, International Center for Research on Women, Save the Children, the Youth Health and Rights Coalition, and the World Association of Girl Guides and Girl Scouts.

SPEAKERS: • Mandy Moore, PSI Ambassador • Rena Greifinger, PSI • Callie Simon, Pathfinder International • Claire Tebbets, Planned Parenthood Federation of America • Regina Benevides, Evidence to Action Project Investing in Women and Girls: How and Why Foundations and the Corporate Sector Make Investments in Support of Gender Equality

2:45-4:15PM MODERATOR: Penny Abeywardena, Clinton Global Initiative SPEAKERS: • Jean Sung, J.P. Morgan • Reeta Roy, The MasterCard Foundation • Maria Eitel, Nike Foundation

WEDNESDAY, MAY 29 Life-Saving Commodities for Women

11:00AM-1:00PM MODERATOR: Valerie DeFillipo, Director, Family Planning 2020 SPEAKERS: • Maxine Eber, PSI •A ndrés de Francisco, WHO; Partnership for Maternal, Newborn and Child Health

• Monica Kerrigan, Bill & Melinda Gates Foundation • Jeffrey Smith, Jhpiego, • Saumya RamaRao, Population Council • Richard Lowe, Venture Strategies Innovations • Edward Wilson, John Snow, Inc. • Rosemarie MugandaOnyando, PATH Communicating with the Undecided

11:00AM-1:00PM MODERATOR: Marshall Stowell, PSI SPEAKERS: • Latanya Mapp Frett, Planned Parenthood Federation of America • Maria Consuelo Mejia, Catholics for the Right to Decide, Mexico No Woman Left Behind: Leveraging Sexual, Reproductive, and Maternal Health Services to Address Non communicable Diseases

11:00AM-1:00PM MODERATOR: Anso Thom, Health-e, South Africa SPEAKERS: • Isabella Danel, CDC • Karl Hofmann, PSI

• Helen McGuire, PATH • Seth Berkley, GAVI Alliance • Maria Blair, American Cancer Society Quality of Care in the Sexual and Reproductive Health and Rights Context

2:45-4:15PM MODERATOR: Kate Gilmore, UNFPA SPEAKERS: • Stephanie Schlitt, Amnesty International • Serra Sippel, Center for Health and Gender Equity • Koki Agarwal, Maternal and Child Health Integrated Program • Krishna Jafa, PSI • Julia Bunting, International Planned Parenthood Federation • Faustina Fynn-Nyame, Marie Stopes International • Marguerite Farrell, USAID Universal Health Coverage through Health Financing

2:45PM-4:15PM MODERATOR: France Donnay, Bill & Melinda Gates Foundation SPEAKERS: • Peter Okwero, World Bank •A bdus Salam Khan, WHO SouthEast Asia • Ben Bellows, Population Council •A slam Fareed, Greenstar Social Marketing Pakistan • Jonathan Quick, Management Sciences for Health •A lysha Beyer, Marie Stopes International Ensuring Reproductive Health Commodity Security

2:45PM-4:15PM MODERATOR: Jagdish Upadhyay, UNFPA SPEAKERS: • Edward Wilson, John Snow, Inc. • Karl Hofmann, PSI • Tewodros Melesse, International Planned Parenthood Federation • Kechi Ogbuagu, UNFPA

THURSDAY, MAY 30 Delivering Health and Rights for Women and Girls through Integrated Health Care

11:00AM-1:00PM MODERATOR: Serra Sippel, Center for Health and Gender Equity, USA SPEAKERS: • Mandy Moore, PSI Ambassador •Y etnayet Demissie Asfaw, EngenderHealth • Krishna Jafa, PSI • Helena Nangombe, Namibia Women’s Health Network, International Community of Women • Kay Thi Win, PSI/ Myanmar Breast and Cervical Cancers

11:00AM-1:00PM MODERATOR: Preetha Rajaraman, National Cancer Institute SPEAKERS • Doyin Oluwole, Pink Ribbon RED Ribbon Initiative • Maxine Eber, PSI • Cheng-Har Yip, Sime Darby Medical Centre • Jo Anne Zujewski, National Cancer Institute Men in Conversation: Engaging Men in the Struggle for Equality for Women and Girls

3:00-4:00PM MODERATOR: Elaine Martyn, Global Fund for Women SPEAKERS: • Kumi Naidoo, Greenpeace International • Lester Coutinho, David and Lucille Packard Foundation

THE 2013 IMPACT AWARDS HONORING -PAVING SIXTHEPIONEERS WAY FOR IMPROVED HEALTH AND WELL-BEING FOR GIRLS AND WOMEN AROUND THE GLOBE - SPECIAL GUEST HER ROYAL HIGHNESS CROWN PRINCESS METTE-MARIT OF NORWAY

- HOSTED BY JILL SHEFFIELD, PRESIDENT WOMEN DELIVER KARL HOFMANN, PRESIDENT AND CEO, PSI BARBARA P. BUSH, CEO AND CO-FOUNDER, GLOBAL HEALTH CORPS & PSI BOARD MEMBER MANDY MOORE, SINGER, SONGWRITER, ACTOR AND PSI AMBASSADOR

WEDNESDAY, MAY 29TH KUALA LUMPUR, MALAYSIA Honorees will be profiled on Impact blog May 28-30th. Visit blog.psiimpact.com to share your words of support and congratulations.

psi.org | impact

a word from the Elders

Article courtesy of the Elders and first published by the Skoll World Forum (skollworldforum.org) in November 2012. The Elders is a group of independent global leaders brought together by Nelson Mandela in 2007. www.theElders.org

LET US MEASURE UP AS MEN Against Women. It is deeply saddening, though perhaps not shocking, to learn that around 70 percent of all women experience physical or sexual abuse during their lifetime. Despite the progress we have made, this world remains a cruel and arbitrary one for too many women and girls.

Do not be fooled, however: this is not some so-called “women’s issue”. After all, we know that more often than not, the violence suffered by women is inflicted by the men they share their lives with – their fathers, husbands, intimate partners. If the majority of women in this world have suffered at the hands of their men, how many millions of men must have hurt and abused women? How many millions of men have stood by and let it happen? If men overwhelmingly brutalize women, then men are overwhelmingly brutal. This is something I cannot accept. This is why I call on men and boys everywhere to take a stand against the mistreatment of girls and women. It is by standing up for the rights of girls and women that we truly measure up as men. 12

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AN UNSPOKEN KIND OF VIOLENCE I am an Elder now, and have witnessed many forms of brutality. There is the direct, physical violence often committed in anger or in war. But there are other forms of violence, too – more complex, more insidious, more unspoken – that we must not overlook. In Ethiopia, last year, my fellow Elders and I met a woman called Himanot who was forced to get married when she was 13 years old. She was not physically forced or dragged to her wedding in chains – in fact, she wanted to run away. But her mother told her that she would kill herself if Himanot ran away. So what choice did the child have? Inflicting this kind of emotional pressure is a form of violence against women. Taking away

a girl’s education, a girl’s right to develop in her own time, to fulfill her potential: yes, this is violence. Yet, I do not judge Himanot’s mother too harshly. Most parents who marry off their daughters young have their best interests at heart – not many of them would willingly have their child face the shame and stigma of defying “tradition”. So if this is violence, who is the perpetrator? If not the family, is it the community? Where does the responsibility end? The statistics tell us that 70 percent of women suffer violence at some point in their lives. But I suspect this figure would be higher if we included all the emotional, structural violence that for many girls and women forms the warp and weft of everyday life.

CHILD MARRIAGE IS VIOLENCE AGAINST WOMEN When it comes to violence against women, there are few practices as harmful, or as widespread, as early marriage. It is not just the intense emotional and social pressure that the young bride is put under. Fundamentally, it violates a girl’s right to determine her own future – how can a

n November 25, we mark the International Day for the Elimination of Violence

child give her “consent” to marry when she is just 10 or 12 years old? In such an unequal union, we know that girls are far more vulnerable to physical violence, especially when they are married to older men. It is hard to insist on practicing safe sex, leaving them more likely to contract HIV or become pregnant before they are ready. And early childbearing itself can be devastating to a girl’s body – across the entire developing world, childbirth is the number one cause of death for girls aged 15-19. And despite all this, the practice is defended in the name of “tradition”. This is why my fellow Elder Ela Bhatt says, “Child marriage is violence that is happening with the consent of society.” Of course, not all of society consents. There are a few courageous voices, growing louder and stronger every day, who are challenging the status quo. I have been privileged to meet some of those who are showing their true mettle, defying tradition to protect the rights of girls and women in their communities.

TEENAGE BOYS CHALLENGING TRADITION IN INDIA The state of Bihar has one of the highest rates of child marriage in India – 69 percent of girls are married before the age of 18. It is actually illegal in India to marry before the age of 18, for girls, or 21, for boys. But for most young people there, the weight of family and community tradition overrides this relatively recent law. When I travelled to Bihar with my fellow Elders earlier this year, a boy called Premnath told me how his father is pressuring him to find a wife who can help with the housework after his mother passed away last year. But Prem – just 18 years old – is resisting. He has pledged to delay marriage, and proudly showed us a book of similar pledges from other young people and their families. Together with his peers in the “Jagriti” movement, both girls and boys, he is now mobilizing young people all over Bihar to make the same commitment. They already had more than 21,000 signatures when we visited last year – a staggering achievement. It seems, in fact, that he and his peers are defying their own Elders! This takes some guts, and I have to salute them for it.

MEN AND BOYS: TAKE A STAND I want to mark the International Day for the Elimination of Violence Against Women by recognizing the work of young men like Premnath. It is one thing to stop an individual act of violence, or perhaps a violent individual. But to take on a whole community, a whole tradition, and try to challenge something that has been harming girls for generations –that is courage. Men have a lot to answer for, I cannot deny it. We have built institutions that oppress and harm women, and we justify our practices as “the way things are” or “the way things have always been”. Yet, as I always say, I am a prisoner of hope. I do believe that we men can help put a stop to these traditions. We can refuse to participate in them, and we can refuse to condone them. We can go further, and campaign against them. It is not an easy task. But if an 18-year old boy in a patriarchal, traditional community like Prem’s can do it, I have faith that others can do it, too. n

IT IS TIME TO STOP DISCRIMINATION AGAINST GIRLS AND WOMEN MANDY MCANALLY, MANAGING EDITOR OF IMPACT, INTERVIEWS DR. GRO HARLEM BRUNDTLAND.

M A N D Y MCANALLY:

As Norway's youngest and first female prime minister, and a leader in many other capacities, you are an extraordinary example of how women can lead and change the world. What is your message to global leaders today who wield the power to give girls and women opportunities to reach their goals, particularly as we think about post-2015?

D R . G R O HARLEM BRUNDTLAND: Women and girls are still discriminated against and treated as second-class citizens and individuals in many countries across the world. They often have no free choice in crucial decisions for their

future lives, if, whom or when they marry, or when and with whom to have children. In all too many cases they are ‘owned’ by their father, brother or husband, with no property or inheritance rights, and no opportunity for secondary schooling, or loans for investment in a productive activity for income and employment. Child marriage is still rampant, far into the 21st century. Every year an estimated 14 million girls are married before they are 18. Given the enormous consequences of the large gaps still there between the opportunities of men and women, boys and girls, I believe it is now extremely important that we overcome

the traditions that are keeping societies back. We need to reach many more people across the world, and not only global leaders, with the knowledge and evidence already available to us. Empowerment of women is not just self-evident as a result of principles of human rights and equity, it increases the productivity of societies and countries. It pays to invest in girls and women. Now is the time to agree to unleash the largest untapped potential for sustainable economic development and stop all discrimination against women and girls. Our post-2015 development goals need to take this fully into account. It is a good sign that psi.org | impact

a word from the Elders

GRO HARLEM BRUNDTLAND is a medical doctor, she was Norway’s first woman Prime Minister, serving a total of ten years as head of government. She chaired the World Commission on Environment and Development – known as the Brundtland Commission – which articulated the principle of sustainable development for the first time at a global level. She was DirectorGeneral of the World Health Organization from 1998-2003, and from 2011 to 2012, she was a member of the United Nations Secretary-General’s Global Sustainability Panel.

M M : In your recent speech before the U.K. parliament, you said that while many societies have made great progress on women’s rights, gender-based violence in all its forms still exists around the world. What are examples of how countries like the U.K., U.S. and Norway can take stronger action to end this violence?

G H B : In countries like Norway and the UK, we still see examples of violence, rape and abuse, both within the traditional parts of society, and within families who have immigrated into our countries, bringing with them cultures and traditions which are no longer prevalent within our societies. We need to speak openly about these issues, make clear that no discrimination against women and girls is acceptable, according to our laws. They apply irrespective of different religions. We also need to give concrete support to individuals who are affected by such violations and discrimination.

MM:

Why do The Elders see child marriage as an entry point into ending gender-based violence? What is the pillar of the strategy to stop girls from being the victims of this engrained cultural ritual? Can you identify one country that has made great progress?

GHB:

As long as child marriage is left to remain ‘under the radar screen’ of international 14

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attention, traditions like these will be left in peace, leading to new generations of very young girls having their lives shattered at the very outset. Harmful practices like these must just not be left to fester. This is how things were a quarter century ago with regard to female genital cutting or mutilation. Taking action and working consistently with affected communities have proven to lead to measureable change. As Elders we travelled in 2011 to the Amhara region in northern Ethiopia, where the situation was already changing due to work organized by the United Nations Foundation, in collaboration with local and central government.

MM: Many experts in our last issue of Impact talked about a new era of investment in global health with middle-income governments, foundations and corporations playing larger, dynamic roles as donors. As the head of government in Norway for 10 years, what are your thoughts on this changing donor landscape? Where do traditional bilateral donor governments fit in moving forward?

GHB:

Yes, we have had a dynamic change process in global health, building partnerships to address critical issues, by combining the forces and experiences of many actors. It has led to improved results and measurable outcomes, thanks to the principles built into these new partnerships. Governments are crucial as main partners. Norway is one good example of a country that

has chosen to support and inspire this new trend, and been an active participant in getting better results, not least in the area of maternal and child health (e.g., Every Woman, Every Child).

MM:

You have been an international leader in sustainable development and climate change. What connections do you see between women’s health and these issues? What can global leaders do to better address the linkages?

GHB:

Already back in 1987 when “Our Common Future” was published, we made very clear that women are essential for sustainable development. In Rio this was partly acknowledged, but the rights of women were not sufficiently dealt with in international conferences before Cairo 1994. The rights of women in the area of health and reproductive rights are crucial to empower women as full and equal partners in the process of building prosperous sustainable societies. Also, the choice of smaller families will be a contribution not only with regard to positive social change, but also to reduce the total impact of an exponentially growing population and consumption on our one Planet Earth. In the coming years, the incorporation of sustainable development goals as an integrated part of future development goals will need to be pursued in a way that place girls, adolescents and women right at the center of the analysis. n

the recent UN Commission meeting on violence against women and girls ended in a good text and a consensus document.

on the frontline

ENSURING A HEALTHY AND SAFE DELIVERY

DR. LESLIE MANCUSO, PH.D., R.N., F.A.A.N., PRESIDENT AND CEO, JHPIEGO

rozan Admadi places her ear on one end of a pinard horn. She holds the other end of the stethoscope on the belly of her pregnant client, smiling as she hears the fetus’ steady heartbeat. Frozan is the only midwife in Marabad, a rural community in Afghanistan’s

Helmand Province, which is in the southern part of the country and has a population of 17,000.

“There was no full-time midwife here before me,” she recalls. “Some used to come to the village for one or two weeks at a time.” As one of 3,000 newly trained midwives in Afghanistan, Frozan travels to the homes of pregnant women in her community to check on their health. It’s a routine with a single purpose – to ensure a healthy and safe delivery. Frozan checks their blood pressure for any indications of preeclampsia, a potentially fatal pregnancy-related hypertensive disorder. She educates her clients about the signs of labor, provides iron pills to ward off anemia, and helps craft birth plans to get to a health facility in time. “Many women are unable to get to the hospital if they were having problems. I try and treat them in the health center and encourage them to come there to give birth. If I think they are going to have a complicated delivery, I refer them to the provincial hospital so they get there in time.” Frozan remembers when many women died in their homes due to a lack of midwives and limited access to medical facilities. During the Taliban rule – when women were barred from school – the once female-dominated health workforce was depleted, leaving only 467 practicing midwives and one midwifery school for a country of 22 million people. The country’s health indicators turned abysmal: Maternal mortality was the second highest in the world, and the lifetime risk of a mother dying during childbirth was one in six. After a mother’s death, her children are 10 times more likely to die before the

age of two. Consequently, child mortality was the highest in the world; nearly one in five children died by the age of five. After the fall of the Taliban in 2002, Jhpiego, in partnership with the Afghan government and with funding from the U.S. Agency for International Development, led the development of a community-based national midwifery education system. More than 3,000 new midwives, like Frozan, have graduated from 29 accredited community and hospital midwifery schools located throughout Afghanistan. In addition, 14,389 community health workers have been trained in providing misoprostol, a drug that prevents women from bleeding to death after childbirth, as well as in educating women on the signs of labor and the basics of caring for their newborn. Frozan also provides access to family planning. Before she became a midwife, no woman in Frozan’s village used any form of family planning, nor did they have access to information about reproductive health options. “A lot of families here have nine, ten children. There is even one woman with 16 children. That’s just too many for them to be able cope economically and physically,” she says. “I really like being a midwife and being able to help women in my community. It is also good to earn a salary and support my own family.” Frontline health workers such as Frozan are helping mothers in many parts of Afghanistan to have a much greater chance of surviving. And when a mother survives, her children, family, community and country can thrive. n

Frozan Ahmadi, who trained as a community midwife at the midwifery college supported by Jhpiego, with an expectant mother at her home in the village of outside of Jawjzan, Afghanistan.

FRONTLINE HEALTH WORKERS COALITION According to the World Health Organization, at least 1 million additional health workers are needed in developing countries to deliver essential health services. As a result of this shortage, 48 million women every year are giving birth without a skilled health worker. Thirty U.S-based organizations, including Jphiego and PSI, have formed the Frontline Health Workers Coalition to raise the profile of this shortage and provide recommendations to U.S. policymakers on how they can elevate the government's response. FHWC recommends that the U.S. articulate and implement a country-wide strategy that includes specific targets to train, equip and support new and existing frontline health workers in developing countries. This strategy is critical to the U.S. government’s overall efforts to dramatically improve global health. Visit www.frontlinehealthworkers.org to learn more. – Vince Blaser, Deputy Director, FHWC psi.org | impact

YEMURAI NYONI

is the youth representative in the core committee of the White Ribbon Alliance for Safe Motherhood in Zimbabwe and in the National Adolescent Sexual and Reproductive Health Forum.

“

Our greatest strength as today’s youth generation is our interconnectedness. Through these interactions we define our recommendations in tackling important global development issues like peace, environmental sustainability, poverty eradication, food security and health. Our role in helping to achieve the post-MDG agenda will be to organize ourselves into thematic groups that will share information, deliver youth-focused interventions and hold governments to account in delivering on their commitments. We are a powerful force for change, and we need to position ourselves strategically to influence decisions and actions that will enable us to reach our full potential.

”

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YOUTH ANSWER THE CALL Q U E STION

oung people can drive change. With a focus on achieving Millennium Development Goal 5 – to improve maternal health and achieve universal access to reproductive health – Women Deliver identifies youth advocates, and then trains, inspires, and builds their capacity to advocate for MDG5 at the national, regional, and global levels. This year, 100 youth leaders will meet in Kuala Lumpur to participate in discussions with other leaders and advocates from around the world. Impact asked four of these leaders one question that was on the minds of our readers. Check out what they say.

What is your generation’s role in shaping the post-MDG agenda?

JOVANA MAGDALEIN RIOS CISNERO

is a member of the International Planned Parenthood Federation Governing Council. From Panama, she is a psychologist with a postgraduate degree in Education.

“

Our generation increasingly faces threats to our health and well-being including HIV, human rights violations and unemployment. In December, thousands of young people from around the world gathered in Bali, Indonesia, to develop their platform for post-MDGs. The Bali Declaration is a forward-looking vision for development with the human rights of all – regardless of gender, sexual orientation, income, education or location – at the heart of future development efforts. This declaration will inform ongoing events within the post-2015 process.

AISTE DACKAUSKAITE

is a feminist and human rights activist from Lithuania with particular interest in sexual and reproductive rights.

“

My generation plays an important and active role in shaping global policies and in achieving desired goals. We advocate for change voicing our recommendations on the issues and goals to include into the global development agenda and lobby decision makers not only to adopt them but also to live up to the commitments they have made. We lead by example, implementing initiatives, programs and projects that address the most urgent issues and thus make our contribution to the achievement of the global goals.

”

” AHMED AWADALLA is a member of Y-PEER Network in Egypt, a network that empowers and mobilizes youth. He also works on sexual and gender-based violence issues in Cairo.

“

My generation is challenging patriarchal values and false perceptions about them. Young people are portrayed as if they lack the capacity or skills to positively impact their communities. Yet, the status quo says otherwise, as young people are organizing themselves and creating change worldwide. The Bali Declaration produced at the Global Youth Forum is a good example of the progressive vision for the world beyond 2015.

BIJOYETA DAS

is a journalist and photographer. She has reported from Bangladesh, India, Nepal, Turkey and the U.S.

“

Our generation has to stop looking for institutional support for change and become the change. We have to invest in us, believe in the energy of youthful vision, so that we can trigger holistic changes in our lives. One important step would be to connect the young leaders and changemakers so we can question systemic failure, brainstorm, share best practices and return to our communities. Together, we can look beyond the Millennium Goals and carve out a sustainable future.

”

Go to psiimpact.com to read extended interviews with Women Deliver's youth leaders.

”

A CLOSER LOOK

@BIJOYETA DAS 2012

Impact features photos by Bijoyeta Das from her series, Branded Girls, about the garment industry in Bangladesh, and from an ongoing project documenting children affected by insurgency and ethnic conflict in Northeastern India. Go to www.bijoyetadas.com to see more photos and read the full stories.

A young garment worker in Dhaka, Bangladesh.

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impact | No. 13

@BIJOYETA DAS 2012

A young garment worker in Dhaka, Bangladesh.

@BIJOYETA DAS 2012

One of many children being rehabilitated in shelters across India as a result of ethnic conflict in northeastern India.

Go to psiimpact.com to read an extended interview with Bijoyeta and see more photos.

psi.org | impact

SKOLL WORLD FORUM COMMUNITY TALKS MHEALTH FOR WOMEN AND GIRLS GOPI GOPALAKRISHNAN ABOUT OUR PARTNER: SKOLL WORLD FORUM The Skoll World Forum on Social Entrepreneurship is the premier, international platform for accelerating entrepreneurial approaches and innovative solutions to the world's most pressing social issues. Each year in Oxford, England, nearly 1,000 distinguished delegates from the social, finance, private and public sectors convene in Oxford for three days and nights of critical debates, discussions and work sessions aimed at innovating, accelerating and scaling solutions to social challenges. The Forum is also now a year-round platform where executive audiences can learn about the latest news and innovative approaches in a variety of focus areas (e.g. deforestation, education and economic opportunity, or healthcare access and treatment), and engage with the world's leading thinkers and doers of social change on key questions, challenges and opportunities. Skoll World Forum is proud to partner with PSI to bring you this special edition of Impact. Learn more and join the discussion at SkollWorldForum.org.

President, World Health Partners Visit worldhealthpartners.org to learn more.

“ Among health providers, including the estimated 200,000 informally trained ones serving as first-line providers in rural areas [in Bihar, India], mobile phones are universal. We started incorporating the use of simple voice and text-based functions to extend the reach of our services, and we are adding more functionality day by day. These mobile tools have now become a necessity for our rural health infrastructure.”

FRANK BEADLE DE PALOMO CEO, mothers2mothers Visit m2m.org to learn more.

“ An important lesson we have learned is that the people we serve live complicated lives. Women want care. A personal text message or phone call goes a long way toward encouraging a woman to walk great distances, endure long waits, and seek health care in a world with many competing priorities.”

TIM WOOD

“Mobile phones have become a pervasive technology in developing countries. But can information delivered over a mobile phone change the outcome of a pregnancy? Can a network of mobile phones be deployed that coherently engages communities and healthcare workers to save the lives of newborns? These were the questions that we first asked ourselves four years ago when considering the challenges of maternal and child mortality in Ghana.”

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Director, Mobile Health Innovation, Grameen Foundation Visit grameenfoundation.org to learn more.

To Reach Scale, Build Trust B Y A L I C E L I N FA B I A N O Senior Program Officer and Adviser, Johnson & Johnson

or more than a decade, the proliferation of mobile phones has fueled a new field called ‘mHealth’ – the potential to transform health care through mobile phone technology in developing countries. The reality, however, has not lived up to its promise – a survey conducted by the World Health Organization in 2011 showed mHealth adoption at an all-time low in Africa. Yet there is reason to be optimistic. Bill Gates recently said that mHealth’s time has come. Digitally empowered users are promoting adoption of positive, healthy behaviors. For me, there is no better example of this than reaching new and expectant mothers with vital health information. While there are many traditional health promotion channels, including radio ads, TV shows, posters and advice from community health workers during periodic visits, the ubiquitous nature of mobile phones is uniquely positioned to reach scale. If we hope a new mother will listen and act upon the messages she receives, gaining her trust is the single-most critical factor in succeeding at scale. While infrastructure, regulations and funding are frequently cited as potential barriers to scale, I urge practitioners and policymakers to remember the importance of building trust with the mother. At Johnson & Johnson, we have a legacy of putting the needs of mothers first. Johnson & Johnson is a founding partner of MAMA, a public-private partnership whose mission is to engage an innovative community to deliver vital health information to new and expectant mothers through mobile phones. One of our companies, BabyCenter, worked closely with a team of health experts to develop a set of adaptable text and voice messages written specifically for mothers in low-resource settings. More than 100 organizations in some 40 countries have downloaded these messages. I believe that there are three critical success factors in developing messages that mothers will trust. These include: ➊ Mobile phones allow for stage-based messages – mothers register with their baby’s due date, which allows personalized messages tailored to the exact week of pregnancy or a newborn’s life. By providing “exactly the right message at the right time,” we start to develop a connection between the mobile phone and the mother receiving the message. Trust begins to form. ➋ Messages are written for mothers by writers, not doctors or health practitioners, and in words they can understand. Fast and iterative user testing also helps to identify topics such as cultural superstitions and traditions that could be a barrier for moms acting on the advice they get from their mobile phone. ➌ Mothers are encouraged to share messages with their family and friends. Once a mom trusts the messages, she tells others, and the number of users starts spreading across a community. One of the most powerful examples is the personal testimonial of a mother I met last year in Bangladesh. While visiting Asha Sarkar in Dhaka, I was struck by how she was empowered by these messages. She shared a story about how her newborn was not getting enough breast milk. Her mother-in-law encouraged her to substitute with milk from the market. As in many households, the mother-in-law’s voice is important, and she is often a primary decision-maker for a baby. However, Asha Sarkar got a text message just that morning letting her know that she could produce more breast milk by feeding her baby more often. Having built trust with the mobile messages she received twice a week for 40 weeks over the course of her pregnancy, she listened to the text message instead of her mother-in-law. Soon, her baby was getting enough milk through breastfeeding. Based on her positive experience, she recommended the service to others, and now many in her community are using it. MAMA Bangladesh recently launched this service (known as Aponjon) nationally, and aims to reach 2 million mothers and their families. There are more than 7 billion phones in the world; 5 billion alone are in developing countries. If we use these devices to reach mothers directly and build trust, then programs will scale. n

“

I f we hope a new mother will listen and act upon the messages she receives, gaining her trust is the single-most critical factor in succeeding at scale.

”

SKOLL WORLD FORUM. ORG INFORMATION AND INSIGHT ON THE ISSUES YOU CARE ABOUT FROM SOURCES YOU TRUST n L EARN what innovations are solving global challenges and what drives investment decisions of major funders n D ISCOVER thousands of hand-picked articles and reports on the issues you care about most n S UBSCRIBE to get the most important social sector news, in a simple bite-size email n C ATCH UP on Forum 2013 sessions you missed through articles and videos n C ONTRIBUTE an opinion piece and let us help you access an influential audience through our global media partners

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expert insight Article courtesy of the Skoll World Forum.

SARAH BROWN

is the Founding Chair of the Global Business Coalition for Education and co-Founder of the A World At School initiative to mobilize and support all efforts to achieve education and learning for every child by 2015. She is President of the international children’s charity PiggyBankKids, as well as co-Founder of the Maternal Mortality Campaign and Global Patron of the White Ribbon Alliance for Safe Motherhood. Visit www.whiteribbonalliance.org to learn more.

GRASSROOTS MOBILIZATION SAVES MOTHERS’ LIVES

o need to explain here the recent progress in reducing needless maternal deaths around the world and the challenges ahead. At Women Deliver, most participants have devoted their working lives and a lifelong passion to feminism, equality, access to rights and fair treatment. We are looking at the final run toward the 2015 Millennium Development Goal deadline and must never

WOMEN DELIVER

CONFERENCE SPOTLIGHT SESSION: Delivering Health and Rights for Women and Girls through Integrated Healthcare MODERATOR: • Serra Sippel, President, CHANGE, USA PANEL: • Mandy Moore, PSI Ambassador •Y etnayet Demissie Asfaw, EngenderHealth • Dr. Krishna Jafa, PSI • Helena Nangombe, Namibia Women’s Health Network • Kay Thi Win, Targeted Outreach Programme, PSI/ Myanmar THURSDAY, MAY 30, 2013 11:00AM-1:00PM

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It is not good enough that pregnancy and childbirth remain the biggest killers of girls and women in many countries. It is not acceptable that there are still barriers in terms of access to quality health care, choices regarding reproductive health and age of marriage, and opportunities for education, employment and personal safety. Women Deliver has led the way in convening women (and men) to collaborate and improve the lives of the poorest girls and women. This hubbub of personal exchanges highlights just how much momentum is building across all of our home communities and across the world. As Global Patron of the White Ribbon Alliance for Safe Motherhood, I am continually moved by the power of citizens at the grassroots level who bring their voices together to drive change. For the past decade, White Ribbon Alliance (WRA) members across Africa and Asia have been calling for decent and respectful maternal health services for all girls and women – and politicians and policymakers have been getting the message. As a response to the increased calls for action, governments have pledged new resources and promises. Led by the UN SecretaryGeneral, global leaders have recognized that saving the lives of women is critical to development and stability; they have pledged $70 billion toward improving women’s and children’s health. Now, who is holding those leaders to account, making sure the funds are delivered and spent as promised? It is people at the community level who know, care and attempt to fix the problems. The ‘watchdog’ activities of volunteer White Ribbon Alliance members

– often midwives, teachers, journalists, civil servants and parents – are keeping up the pressure to ensure that political commitments are realized on the ground. Volunteers include Dr. Nabin Pati of WRA Orissa, who works with a checklist in hand to compare the reality of health services with promises made by the government, and then supports local officials to make sure things change. In his area, safe motherhood services and safe births have doubled as a result of this citizen-led campaign. Another volunteer is midwife Rose Mlay, leader of WRA Tanzania, who visits schools in rural areas to encourage young people to sign up for further education in midwifery, and encourages wider learning about health and well-being to support safer pregnancies. Yet other volunteers are the fathers in a town in Yemen, who upon learning that early marriage and childbirth made maternal death five times more likely for girls, signed a community pledge that none of their daughters should be married before the age of 18. As volunteers likes this achieve local improvements, they are mobilizing others to achieve change as well. Mobile technology and social media have enabled us to widen our call as well. If Melinda Gates can sanction some thoughtful disruption, then we all can give ourselves permission to make a lot more noise, and put out the call for something we know that needs to be done better. We all have a part to play in supporting those around the world who strive for change, so that together we can realize our shared goal of no woman dying needlessly as she brings another life into the world. n

Debate and discuss the issues at www.skollworldforum.org

give up working for further progress.

expert insight

MAKING GIRLS AND WOMEN A PRIORITY EVERY DAY

s we convene in Malaysia for Women Deliver’s third global conference, we have much to celebrate. In the past year alone, we have made tremendous strides in women’s health and equality: the United Nations adopted a historic resolution to end female genital mutilation; global leaders convened at the London Summit on Family Planning to make $2.6 billion in new financial pledges and a series of unparalleled policy commitments to family planning; and

together, we celebrated the first-ever International Day of the Girl Child. Individual countries have also made remarkable headway toward improving women’s health and equality. I have witnessed progress in reproductive and maternal health in my home country of Ghana. Thanks to improved care and services, the country's maternal mortality rate decreased by approximately 40 percent between 1990 and 2010. Although these are strong steps forward, they can and should be accelerated. Women Deliver 2013 is a unique opportunity to applaud these achievements, while also remembering the challenges that remain. Global maternal deaths have dropped by nearly 50 percent since 1990, but 287,000 mothers-to-be still die every year – that is 800 women every day. More than 200 million women want but do not have access to the tools they need to plan their families. Countless girls are held home from

DR. FRED SAI

serves as an adviser to the Government of Ghana on Reproductive Health, and HIV and AIDS. He co-founded the Planned Parenthood Association of Ghana in 1967 and was President of the International Planned Parenthood Federation from 1989 to 1995. Dr. Sai also chaired the UN conferences on population and development in 1984 and 1994. He has served in several positions in the Ghana Health Services and as a professor of Preventive and Social medicine at the University of Ghana Medical School.

school; rape of girls and women is a tool of war and oppression in many conflicts; other forms of violence against women are all-too-common; and girls and women continue to face barriers at nearly every rung of the economic, social and political ladders. With the 2015 Millennium Development Goal target date rapidly approaching and discussions taking place at the highest levels about the post-MDG development framework, the time to act is now. Stronger political will and financial commitments are urgently needed at the national, regional and global levels – and we must advocate to ensure that girls’ and women’s health and rights remain priorities. The issues being discussed at this global meeting are not ‘women’s issues’; they are everyone’s issues. We know for a fact that prioritizing girls and women is not only the right thing to do – it is also the smart thing to do. When women do well, families flourish, communities thrive and nations grow. The math is simple – investing in women pays dividends. While we should celebrate the remarkable recent successes, we must also recognize that our work is far from finished. It is up to all of us to ensure that global leaders from all regions and sectors deliver on promises made to girls and women. We cannot stop fighting. We cannot stop working until every girl and woman – no matter where she lives – has access to the education she deserves; the contraceptives she wants; the maternal health care she needs; and, ultimately, the opportunity to achieve her dreams. Our calls to action are being recognized and our voices are being heard. We can – and we will – work together to accelerate progress for girls and women around the world. n

WOMEN DELIVER

CONFERENCE SPOTLIGHT PRESIDENTIAL SESSION: WOMEN’S HEALTH Speakers will explore challenges in creating a comprehensive approach to women’s health, and ways in which girls and women’s health needs can better be meet. MODERATOR: • Karl Hofmann, PSI PANEL: • Barbara Bush, Global Health Corps and PSI Board Member •A na Langer, Harvard School of Public Health • Babatunde Osotimehin, UNFPA • Her Royal Highness Crown Princess Mette-Marit of Norway • Harshad Sanghvi, Jhpiego TUESDAY, MAY 28, 2013 2:45 - 4:15PM

psi.org | impact

expert insight

NO WOMAN SHOULD DIE FROM CERVICAL CANCER

irls and women in the developing world are losing the fight against cervical cancer because we have failed to close deadly gaps in prevention, screening and treatment that could spare their lives and end this disease. More than 85 percent of the estimated 275,000 women who die from cervical cancer globally every year live in low- and middleincome countries. As global leaders convene in Kuala Lumpur for the third Women Deliver conference, the American Cancer Society and PSI are proud to join forces with other critical members of civil society to raise our collective voices and amplify the message that no woman should die from cervical cancer. We know what it takes to save lives from this disease – and we have a moral obligation to ensure that all girls and women, regardless of their location, benefit from this knowledge.

WOMEN DELIVER

CONFERENCE SPOTLIGHT CERVICAL CANCER FORUM: Integrating Cervical Cancer Prevention and Control with other Health Interventions Global Health Strategies and partner organizations bring together global cervical cancer prevention leaders, advocates, academics and policymakers for an informative, consensusbuilding conversation to share best practices and advocacy tools, highlight early adopters, and explore innovative financing options for the rollout of new technologies. MONDAY, MAY 27, 2013 11:15AM-12:30PM 24

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The control of cervical cancer is at a global tipping point with the advent of the human papillomavirus (HPV) vaccine. HPV is the leading cause of cervical cancer. And new screening technologies that enable cervical cancer to be effectively detected and addressed in all resource settings. But we must accelerate adoption of the HPV vaccine, improve access to resource-appropriate cervical cancer screenings, and increase global resources for and attention to cervical cancer prevention and treatment. With proven, costeffective interventions at hand and a recent commitment to wider accessibility of the HPV vaccine by the GAVI Alliance and the Pan American Health Organization Revolving Fund, as well as engagement from the Bill & Melinda Gates Foundation, we have an unprecedented opportunity to save lives from this disease. Partnerships are absolutely critical to advance the fight against cervical cancer worldwide and to ensure that women and girls are given priority on global health and development agendas. One example is the Taskforce on NonCommunicable Diseases (NCDs) and Women’s Health that launched during the first-ever United Nations High-level Meeting on NCDs in September 2011. This initiative, co-chaired by PSI and Jhpiego, with the American Cancer Society providing secretariat support, brings together leading global health organizations from the women’s health and NCD communities and supports a gender-focused approach to women’s health. The taskforce collectively advocates for the prevention and treatment of these diseases to be integrated into current programs, policies and services that address women’s health needs. The global toll of NCDs is staggering, with more than half of all female deaths in low- and middle-income countries caused by these diseases. Left unaddressed, NCDs risk undermining decades of progress in women’s health and development.

The American Cancer Society is working to strengthen advocacy efforts for national adoption of the HPV vaccine and improved screening policies, as well as drive public demand and acceptability of the vaccine and cervical cancer screening. As the American Cancer Society celebrates its 100th birthday this year, it is also urging people to raise their voices against the silence and complacency that have allowed this disease to claim so many lives unnecessarily. As part of global efforts to support the prevention and awareness of cervical cancer, PSI is integrating cervical cancer screening and treatment services into many existing sexual and reproductive health services. PSI is offering women the opportunity to further protect their health by building upon existing resources and programs and forging new partnerships. We have an unprecedented opportunity – and a moral obligation – to change the course of cervical cancer and NCDs. But we must ensure they are a priority at the global policy level, with investments and action reflecting these diseases’ tremendous impact on society, health and the economy. Please join us in our efforts to ensure that where a person lives does not determine whether they live. n

John R. Seffrin, Ph.D., is the CEO of the American Cancer Society, Inc.

Sally Grooms Cowal is the Senior Vice President and Chief Liaison Officer at PSI.

Visit the Global Forum on Cervical Cancer Prevention at www.cervicalcancerforum.org. Visit the American Cancer Society at www.global.cancer.org.

expert insight

REACHING WOMEN WITH TUBERCULOSIS CARE

uberculosis (TB) is the leading killer of women of reproductive age, surpassing all causes of maternal mortality. Impact interviewed Dr. Lyn Vianzon, National Tuberculosis Control Program Manager with the Government of the Philippines, to learn about the country’s innovative approach to reaching women with TB services.

IMPACT: Since 2000, the Philippines has achieved global targets for case detection and treatment. Tell us about the strategies that were implemented to improve TB care for women.

DR. LYN V I A N ZO N :

The Philippines’ health system has a large population of community health volunteers (CHVs) who serve as the first line of care for patients, especially in hard-to-reach areas. Eighty to 90 percent of our volunteers are women. Typically, men are the main source of income for the family and work outside the home. Women take care of the home and the children. Thus, women are available to volunteer and actively participate in community initiatives. Through this system, female CHVs become extended arms of healthcare providers, and the role of women becomes significant in the community to identify potential TB cases, support treatment adherence and increase awareness about TB through local events like World TB Day. CHVs are selected by the local government and their voluntary efforts are recognized through rewards, transportation support, hospitalization privileges and other mechanisms.

IMPACT:

The emergence of multiple drugresistant TB (MDR-TB) is a growing concern globally. What effect does this growing health threat have on women?

LV:

TB and MDR-TB affect the economically productive age group, so if a man gets infected with MDR-TB, this poses an economic loss for the family. It then becomes the role of the woman to support the family as the wife, mother and even as the wage earner because her husband cannot continue to work. This is a significant burden. Additionally, there is an added risk of TB transmission to the mother

and her children, increasing the potential health impact of MDR-TB on the entire family. These unseen impacts of MDR-TB should be thoroughly addressed. Programs that address MDR-TB seem to be focused on the patient, but indirectly you can see the financial burden on the household and, in particular, on the woman and her children.

services receive a financial incentive for the quality of the services rendered. This is a good incentive for providers because they see their time and effort rewarded by the government, while their clients receive proper TB management. Finally, we also established a coalition called the Philippine Coalition Against TB (PhilCAT). The coalition is represented by 64 members, the majority of which are NGOs that are allies of the National TB Program. The coalition is chaired by a private entity, but vice chairmanship is given to the government. The coalition is an avenue for the government to engage with and involve private providers and NGOs in the National TB Program. n

IMPACT:

The Philippines is leading the way in public-private mix (PPM) approaches to TB care and control. How did you successfully leverage the involvement of public and private providers, as well as nongovernmental organizations?

LV:

There are a number of reasons behind this success. First, the government’s high political commitment to TB is felt by our partners, and they know that there is leadership and direction for their work. Second, our PPM efforts recognize that service providers from the public and private sectors have different perspectives in terms of provision of care. The public sector is paid by the government for services rendered, while the private sector is paid by clients. Thus, to entice the private sector to participate in PPM activities and provide TB care free of charge to their patients, a ‘payment’ mechanism, as an incentive, must be implemented. Private providers will then deliver services, contributing to the increase in TB case detection nationally. The ‘payment’ used in the Philippines is our TB-DOTS Out-Patient Benefit (OPB) Package. The OPB builds access to TB care from both the patient and provider perspective. The TB-DOTS OPB package of the Philippines Health Insurance Corporation insures an enrollee for the provision of quality TB services, including free diagnosis and treatment. Participating private sector providers and local NGOs who offer TB

WOMEN DELIVER

CONFERENCE SPOTLIGHT ENGAGE-TB: INTEGRATING COMMUNITY-BASED TB ACTIVITIES INTO MATERNAL CHILD HEALTH PROGRAMS In 2011, nearly 3 million women developed tuberculosis and an estimated 500,000 died of it. Half a million children developed TB in 2011. TB is preventable and curable. Integrating community-based TB services into maternal and child health programs could help reduce mortality and morbidity. The World Health Organization's ENGAGE-TB approach describes how. The session will discuss what is needed and share experience of select NGOs. DATE: WEDNESDAY, MAY 29, 2013 TIME: 2:45-4:15PM LOCATION: IMPIANA KLCC HOTEL, BANQUET HALL 1, LEVEL 2

psi.org | impact

policy matters US BUDGET SNAPSHOT ALL RISE: WOMEN T ON THE EUROPEAN DEVELOPMENT AGENDA T his year has already proven to be an unusual one for the U.S. budget process. In March, Congress passed a full-year Continuing Resolution (CR) for fiscal year 2013. Funding the government through September 30, 2013, the CR reflects an approximately 5 percent cut to the International Affairs account due to the automatic spending cuts known as sequestration. While generally maintaining FY12 funding levels, Congress made some small changes to the budget. These changes, known as “anomalies,” include an increase of $300 million for global health. Though funding remains below the levels enacted in FY12, the increase shows a continued commitment to global health efforts. Soon after passing the CR, both the House of Representatives and the Senate passed Budget Resolutions for FY14. The House and Senate bills stand in stark contrast to each other, with $38.7 billion in base funding allocated for International Affairs in the House and $45.6 billion in the Senate, a difference of nearly $7 billion. President Obama released his budget on April 10, two months late and after congressional budget resolutions had passed. Though it holds no legal bearing, the budget typically outlines the Administration’s priorities and serves as a benchmark for Congressional budget decisions. This year, the president’s budget maintained flat funding for the International Affairs account with increases in maternal and child health and malaria, as well as significant decreases in tuberculosis and bilateral HIV/ AIDS funding. The budget signals a focus on engaging multilateral organizations through strong commitments to the Global Fund to Fight AIDS, Tuberculosis and Malaria and the GAVI Alliance. Additionally, the budget prioritizes a focus on girls and women. Currently both chambers of Congress are working on individual appropriations bills that, once passed, will go to a conference committee to resolve differences in the bills ideally before the start of FY14 on October 1, 2013. Regina Moore, Associate Manager, Advocacy & Communications, PSI 26

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his past February, a Eurobarometer poll conducted by the European Commission showed that a majority of Europeans believe that improvements in gender equality in developing countries could lead to significant gains in human rights, living conditions and security for those nations. More than 90 percent of those polled supported efforts to integrate gender equality into all European aid programs. The European Union’s development policies reflect the consensus of its citizens, prioritizing women’s empowerment as a key tool for achieving growth and decreasing poverty in lowincome countries. The European Consensus on Development, a 2006 guiding policy statement that outlines the EU’s development efforts, stresses the importance of gender equality in strengthening the impact and sustainability of EU development cooperation. EU aid programs aim to incorporate gender issues into all aspects of development policy. EuropeAid, which implements EU development programs, has backed up its policy statements with significant financial investment. Nearly 60 million euros (U.S. $78 million) of funding is being spent on both gender equality action programs and integrating gender issues in existing programs. Major focus areas for EuropeAid include improving literacy among women and addressing inequalities in countries where women’s lives are shaped by customary laws; empowering women in conflict situations; and ensuring greater coordination between donors and national governments on gender equality. Violence against women also remains a major priority. The EU Guidelines on Violence against Women and Girls put in place effective, coordinated strategies, and address the impunity of those who have perpetrated violence against women. The document also sets out a strategy for dealing with individual cases of human rights violations. The Women’s Charter

from 2010 includes explicit mention of the EU working toward gender equality that reaches beyond EU borders. The EU works closely with UN Women, participates in the UN Commission on the Status of Women and is an active supporter of a resolution on renewed efforts to eliminate all forms of violence against women. The EU’s vision for women and their rights extends beyond its current programs to the future. The EU is considering a focus on sexual and reproductive health rights in its post-2015 development framework and several members of the European Parliament are actively supporting that inclusion. The European Parliament Women’s Rights and Gender Equality Committee has recommended that the post-2015 agenda focus on the elimination of gender-based violence and all forms of harmful traditional practices (such as female genital mutilation or early and forced marriages), and include the right to health and education. In addition, gender issues are high on the agenda of High Representative for Foreign Affairs Catherine Ashton, and both children and gender issues are mainstreamed throughout the EU’s diplomatic corps. n

MICHAEL CHOMMIE Michael Chommie serves as director of the Strategic Partnerships Unit and PSI’s Europe office. He meets regularly with counterparts across Europe to ensure they are informed of PSI’s health programs around the globe. He divides his time between Geneva and Amsterdam.

THE HEALTH OF GIRLS AND WOMEN: WHAT WILL OUR LEGACY BE?

e are at a critical moment in our collective effort to advance the health and lives of girls and women in the developing world. For decades, the U.S. has funded evidence-based, cost-effective programs that address the multitude of issues that girls and women face. We can be proud of our progress, but we must recognize the work that remains to be done. Approximately 800 women die every day from preventable causes related to pregnancy and childbirth, and 99 percent of these maternal deaths occur in developing countries. Girls make up more than half of the world’s 143 million out-of-school youth, and one in seven girls in the developing world marries before the age of 15. This is the reality today. But it does not have to be our legacy. The U.S. and our partners across the globe have the knowledge, power and resources to provide girls and women access to essential health services; to increase their opportunity to

attend school; to enable them to enter the workforce and, ultimately, to help achieve gender equality worldwide. As Chairwoman of the Appropriations Subcommittee on State and Foreign Operations, my role is to ensure that U.S. taxpayer dollars are spent wisely. I know that by funding programs to improve the health and lives of girls and women in the developing world, we are making smart investments. Studies show that every year of schooling increases a girl’s future earning power between 10 and 20 percent. Ensuring skilled care in delivery and, in particular, access to emergency obstetric care, would reduce maternal deaths by about 74 percent. Beyond that, even small investments in girls and women change the lives of their families, communities and countries. I expect that the thousands of advocates gathered at the third Women Deliver Conference in May will mobilize U.S. and international leaders to act. We must keep that momentum

EMPOWERING GIRLS AND WOMEN TO SHAPE THE WORLD

ifteen years ago, I was the first woman elected governor of New Hampshire. Times have certainly changed since then and now I am a proud member of America’s first all-female state delegation – New Hampshire boasting a female governor, both senators and all members of the House of Representatives – as well as a part of the historic 20 women senators of the 113th Congress. Like the women with whom I am proud to serve, my political journey began with a conviction that all people – regardless of gender, ethnicity, race or income – deserve the opportunity to live healthy, safe and productive lives. This month, as I cheer on the Women Deliver conference from Washington, D.C., I’m reminded that while the past political and social achievements of women are truly remarkable, we still have a lot left to accomplish. One of the biggest challenges facing women around the world is access to affordable health care, particularly preventative care. In 2013, for example, more than 200 million women in the developing world lack access to modern contraceptives. Many of these same women account

for nearly two thirds of the 1.4 billion people living in extreme poverty around the world. And, according to the United Nations, one in three women worldwide has experienced some form of gender-based violence. These statistics are staggering and unacceptable. That is why I have made it a priority to continue the U.S. government's leadership when it comes to protecting young girls and women from senseless gender-based violence and to accessing critical health services. This year for International Women’s Day, March 8, I introduced a resolution to commemorate the day and reaffirm the U.S. Senate’s commitment to pursuing policies that guarantee the basic human rights of girls and women. The resolution, which passed with bipartisan support, is an important sign that the U.S. government is deeply committed to these issues. During this difficult economic time, it is even more important to commit ourselves to gender equality and women’s empowerment everywhere. When we give women and girls the opportunity to live healthy lives, we can lift entire families, communities and countries

moving forward. We face daunting challenges, but we must hold each other accountable to our bold commitments so that our legacy will be to have advanced the lives of girls and women far beyond what they experience today.

REP. KAY GRANGER (R-TX) Rep. Kay Granger has proudly served Texas’ 12th District since 1997. Throughout her tenure, she has been a champion for women and girls, both domestically and abroad. Rep. Granger is one of the most recognized leaders on national security and foreign policy. She is the Chairwoman of the House of Representatives Appropriations Subcommittee on State and Foreign Operations.

out of poverty. We know that women drive economic development in their communities – operating the majority of small businesses and farms in developing countries and investing more of their income directly back into their children and families. These women have the potential to improve lives and drastically alter the global economy for the better. We need to give them the opportunity to do so.

SEN. JEANNE SHAHEEN (D-NH) The only woman in U.S. history to be elected both a governor and U.S. Senator, Jeanne Shaheen has been committed to serving the citizens of New Hampshire for decades. On a global scale, Sen. Shaheen has been a dedicated champion for women’s rights and health throughout her career. She has served in the U.S. Senate since 2009 and is a member of the Senate Committees on Armed Services, Foreign Relations, Appropriations, and Small Business and Entrepreneurship. psi.org | impact

a word from our partner

INVESTMENTS IN GIRLS AND WOMEN DELIVER PRICELESS RETURNS

JILL SHEFFIELD

is the President and Founder of Women Deliver, a global advocacy organization working to generate political commitment and financial investment for fulfilling MDG 5 – to reduce maternal mortality and achieve universal access to reproductive health. Sheffield serves on the UN Secretary General’s Commission on Information and Accountability for Women’s and Children’s Health. She also is the Founder of Family Care International. In 2008, Sheffield received the American Public Health Association’s Lifetime Achievement Award.

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omen deliver enormous social and economic benefits to their families, communities and nations. Investing to improve maternal health and save women’s lives is not only the right thing to do, it’s also the smart thing to do. This has been the Women Deliver key message since the beginning: Invest in girls and women. It pays. We now know that when girls and women have access to education about sexual and reproductive health and rights, they are more likely to delay marriage and their first pregnancy, and more likely to stay in school and secure productive employment. When women have the ability to plan their fertility – they have the ability to plan their lives. We see time and again that investing in girls and women has a ripple effect that benefits entire societies. In the past decades, we have seen tremendous momentum growing for the health and empowerment of girls and women worldwide. Maternal deaths have declined by nearly 50 percent since 1990, proving that our goals are within reach. The Every Woman Every Child campaign launched by United Nations Secretary-General Ban Ki-moon in 2010 has brought about a new spirit of collaboration, partnership and innovation within the maternal and reproductive health field. Clearly, the tide of change has come for girls and women. Yet our work is not over and, in fact, progress is very uneven around the globe. Research shows that more than 200 million girls and women in developing countries who want to delay, space or avoid pregnancy are not using effective methods of contraception. The human toll of the unmet need for contraception is staggering, and each year, almost 300,000 women die from pregnancy- and childbirth-related complications. Maternal morbidity continues at 30 times the level of maternal deaths. With the deadline for the Millennium Development Goals fast approaching, the time is now for us to

ensure that girls and women are central pillars in the new development agenda. We have taken huge steps toward improving women’s health and rights in recent years, and we cannot stop now. That’s why the Women Deliver 2013 conference is so important. This event will be the biggest and best conference we’ve had to date. At the 2007 Women Deliver conference in London, together we put maternal health on the map. In 2010 in Washington, D.C., we highlighted effective solutions to improve maternal and reproductive health. Now, in Kuala Lumpur, we will galvanize action and accelerate progress to meet our goals. This requires us to join forces and work collaboratively across sectors, genders and generations around the globe. Together, we can and will ensure that one day, women across all geographic, socioeconomic and cultural lines will have access to the care they need, and no woman will die while giving life. On the first day of the conference, we will examine how investments in girls and women result in a domino effect of positive outcomes for girls and women, their families, societies, nations, and the world. The second day will highlight the unmet need for contraception and look back at the commitments made at the London Summit on Family Planning. Panelists will discuss how we can ensure that every woman has stigma-free access to affordable family planning services. On the last day, we will develop an action plan for ensuring that girls and women are prioritized in the new development framework and lay out a clear, measureable roadmap to success. Women Deliver 2013 is a place for you to share, learn, interact and get inspired. And when participants leave Kuala Lumpur to return to their work at home, I hope their commitment to the health and well-being of girls and women around the world is only stronger. n

final word

Karl Hofmann PSI President and CEO

CONTROVERSY AND PROMISE

elinda Gates galvanized the global health community in the run-up to last year's London Family Planning Summit when she said there should be "no controversy" about widespread provision of contraception. Nearly a year later, as reproductive health and rights leaders and activists gather in Kuala Lumpur for Women Deliver 2013, Melinda's words continue to echo...but still as a challenge, rather than a statement of fact. Widespread access to contraception should be without controversy. But the sad truth in many parts of the world remains far short of this sensible ideal. I am thinking of my recent visit to Niger, where the average woman is giving birth to between seven and eight children and contraceptive access remains very low. I am thinking of my recent visit to the Democratic Republic of Congo, where women are victims of sexual violence and unwanted pregnancy at rates that none of us can accept. Clearly, much work remains ahead of us, and achieving MDG 5 remains too distant.

▼ Below, Karl Hofmann talks with Charlotte Kabirigi during a visit to Burundi. Charlotte, 33, has had seven pregnancies, but lost three of her children to malaria.

There are hopeful and positive signs, though. Advocacy and leadership are on the rise. Women leaders across the world are inspiring new generations to follow them. Girls now outnumber boys in secondary schools in nearly 30 percent of developing countries, according to the World Bank’s 2012 World Development Report. Hundreds of millions of women seeking to work outside their homes have joined the global workforce and are helping their countries to close the economic growth gap. New funders and new funding models for women's and girls' health and welfare also offer a chance for optimism. Corporations, foundations and philanthropists are taking an increasingly active role in partnering with governments to protect the progress already made against health threats facing girls and women. Philanthropists are bringing fresh thinking and capital to fund the type of innovation that provides proof of concept for health delivery models that governments can later take to scale and advance. This issue of Impact discusses how PSI's technical teams, with local health experts and partners like the Bill & Melinda Gates Founda-

tion, have identified some key pilot health projects that are primed for innovation and scaling. These include increasing access to safe delivery kits that include chlorhexidine to reduce newborn infection and creating social enterprise business models to sell contraception at subsidized prices. Many of these simple and inexpensive lifesaving tools remain on a shelf waiting to be funded, beyond the reach of girls and women who need and deserve them. We can do better by them. I am reminded of a conversation I had recently with a senior health official in Central Africa, who had just had his eyes opened to the importance of investing in girls. “The longer they stay in school, the fewer babies they have while too young, and the less they get married as children! I am pushing my colleagues in the government to do more for girls’ education!” Good that he had this epiphany. Sad that it seemed like such a revelation for him. Women Deliver 2013 will give us new energy to tackle the persistent “controversy” around family planning; to bring lifesaving innovations faster to market in favor of women and children; and to redouble our efforts to end the patriarchy’s hold on the vitality of girls and women. n

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