The Year of the Girl

The United Nations declared October 11th the International Day of the Girl Child.  Everywhere I looked for this post’s inspiration, I saw story after story of the daily violence perpetrated against girls worldwide. I had to ask myself, why just a day?  Aren’t girls – roughly half of the world’s population – deserving of much more consideration? I say that we declare 2017 the YEAR of the Girl and devote our efforts to address the following issues.

Female Genital Mutilation

Female genital mutilation, or FGM, is a global concern. Some 200 million girls and women in 30 countries have undergone FGM, usually between infancy and 15 years of age. In many countries, FGM is a deeply entrenched cultural practice that has seen little decrease in the decades since foreign aid workers have been campaigning for is abolition. The risks might be high – infection, infertility, and complications of childbirth – but the perceived social benefits outweigh the physical costs. Bettina Shell-Duncan, an anthropology professor working as part of a five-year research project by the Population Council, has witnessed this conflict firsthand among the Rendille people of Northern Kenya:

One of the things that is important to understand about it is that people see the costs and benefits. It is certainly a cost, but the benefits are immediate. For a Rendille woman, are you going to be able to give legitimate birth? Or elsewhere, are you going to be a proper Muslim? Are you going to have your sexual desire attenuated and be a virgin until marriage? These are huge considerations, and so when you tip the balance and think about that, the benefits outweigh the costs.

Despite cultural ties, FGM is decreasing in some African countries as evidenced by rates from the prior generation.  However, with prevalence as high as 81% (Egypt), 79% (Sierra Leone), and 62% (Ethiopia), there is still much work to be done.


For example, with prevalence at 60-70%, FGM in Iraqi Kurdistan is a “hidden” epidemic.  Prevalence of this practice elsewhere in Iraq is 8%.  Outlawed in 2011 by the Kurdistan Regional Government under the Family Violence Law, FGM has continued largely unabated due to poor implementation and push-back from religious leaders.  You can read the Human Rights Watch harrowing report about FGM in Iraqi Kurdistan here.

Rape and Child Marriage

Last Friday, the BBC reported on a bill under consideration by the Turkish Parliament that would clear a man of statutory rape if he married his victim.  This bill is evidence of increasing violence against Turkish women.  Between 2003 and 2010, the murder rate of women increased by 1,400%.  Of course, the bill isn’t couched in terms of legalizing rape, but as a loophole for those offenders who know not the errors of their ways:

The aim, says the government, is not to excuse rape but to rehabilitate those who may not have realised their sexual relations were unlawful – or to prevent girls who have sex under the age of 18 from feeling ostracised by their community.

If passed, the bill would release 3,000 men from prison as well as legitimize child rape and marriage. Per Girls Not Brides, Turkey has one of the highest child marriage rates in Europe with 15% of girls married before the age of 18. Globally 34% of women are married before the age of 18 and every day 39,000 girls join their ranks. According to a study recently published in the International Journal of Epidemiology, child marriage comes with health and social consequences. Along with unintended pregnancies, infant and maternal mortality, and HIV, girls who are married suffer from social isolation, power imbalance, and experience higher lifetime rates of physical and sexual intimate partner violence.

Coming-of-age “Cleansing” Rituals

Practiced in parts of Africa, girls as young as 12 are forced to have sex as part of a sexual cleansing ritual.  The men, known as “hyenas,” are paid by parents to usher girls through the transition between girlhood and womanhood.  Girls are coerced into this practice through familial and societal pressure.  It is believed that great tragedy will befall the family and community should she not comply.  The use of a condom is prohibited.

A BBC radio broadcast found that communities believe the spread of HIV to be a minimal risk since they can pick men they know are not infected. One Malawian hyena, Eric Aniva, has been charged with exposing hundreds of girls and women to HIV. Aniva knew of his HIV status but did not disclose to his customers.

Forty percent of the global burden of HIV infections are in Southern Africa. Thirty percent of new infections in this area are in girls and women aged 15-24. Young women contract HIV at rates four times greater than male peers and 5-7 years earlier, linked to sexual debut or sexual cleansing rituals.

Let’s face it: Girls around the globe are being short-changed. Though progress has been made, there is still much work to be done. The Sustainable Development Goals have promised to “end all forms of discrimination against all women and girls everywhere” by 2030. Others attest that it will take at least another century for women to reach wage equity in the United States.  However it happens, rest assured it will take more than a day.

Conference Calls and Radio Shows of Interest

Our very own Mini Murthy and Elvira Beracochea are co-hosting a radio show on the MDGs! The inaugural episode aired last week, but you can listen to it in the archives and tune in for future episodes. They will be on every Thursday at 12 p.m. EST. More information can be found below.

Millennium Development Goals: Progress and Challenges

PROGRAM: Millennium Development Goals
TOPIC OF DISCUSSION: Millennium Development Goals: Progress and Challenges


In 2000, 189 nations made a promise to free people from extreme poverty and multiple deprivations. This pledge became the eight Millennium Development Goals to be achieved by 2015. The MDGs provide a framework for the entire UN system to work coherently together toward a common end. UNDP, global development network on the ground in 177 countries and territories, is in a unique position to advocate for change, connect countries to knowledge and resources, and coordinate broader efforts at the country level. In September 2010, the world recommitted itself to accelerate progress towards these goals.

The declaration established eight Millennium Development Goals (MDGs) and time-bound targets by which progress can be measured. With the 2015 deadline looming, how much progress has been made? And is the pace of progress sufficient to achieve the goals? The MDGs break down into 21 quantifiable targets that are measured by 60 indicators.

In our inaugural episode we hope to give a brief over view of the progress and challenges made from the year 2000- 2005 and focus on Sub Saharan Africa to review the progress made with reference to MDGs 1 and 4.

Join us as we explore this very important topic on MDGs.

Padmini (Mini) Murthy is a physician and an activist who did her residency in Obstetrics and Gynecology. She has practiced medicine in various countries. She has a Master’s in Public Health and a Masters in Management from New York University (NYU). Murthy has been on the Dean’s list at NYU stein hart School of Education and named Public service scholar at the Robert F Wagner Graduate School at New York University. She is also a Certified Health Education Specialist.

Elvira Beracochea, MD, MPH, has more than 25 years of experience that encompass her work as physician, public health and international development expert, human rights advocate, epidemiologist, health policy advisor, researcher, health systems and hospital manager, consultant, professor and coach. She has worked in over 30 countries in Latin America, Africa, Asia, Eastern Europe and the South Pacific. Dr Elvira is committed to helping realize the right to health and the right to development and to improving the effectiveness of development assistance. For this reason, in 2005, she founded MIDEGO, an organization with an urgent rights-based mission: accelerate the achievement of the Millennium Development Goals (MDGs) approved by the United Nations in the year 2000.

The Millennium Development Goal is a weekly discussion on AV Radio based on the Millennium Declaration, adopted by all 189 United Nations Member States in 2000, promised a better world with less poverty, hunger and disease; a world in which mothers and children have a greater chance of surviving and of receiving an education, and where women and girls have the same opportunities as men and boys. It promised a healthier environment and greater cooperation-a world in which developed and developing countries work in partnership for the betterment of all.


Next month, APHA’s Trade and Health Forum will be holding an open Educational Session on Tobacco and International Trade Agreements. It will take place on April 12 at 2:30 PM Pacific/5:30PM Eastern.

The first 30 minutes of the call will be an educational session about recent activity pertaining to alcohol and tobacco in trade agreements and the question of “carve outs”. Donald Zeigler, PhD, Director of Prevention and Healthy Lifestyles at the American Medical Association (AMA) will lead the session. Dr. Zeigler has been active in the Trade and Health Forum, representing the Alcohol, Tobacco and Other Drug Section of the American Public Health Association and has been interested in trade and health issues for almost a decade. He was instrumental in getting the AMA to adopt policy on trade and has worked with other medical specialty societies to adopt policy, as well. The AMA recently called on the US Trade Representative to carve out tobacco and alcohol from the proposed Trans-Pacific Partnership agreement.
The second 30 minutes of the call will be dedicated to Trade and Health Forum business. You are welcome to join for the full call, and we welcome your input.

To dial in, please call (605) 475-4850 and use the following access code: 810329#. If you have questions, please direct them to Natalie Sampson (nsampson@umich).

Very best,

American Public Health Association’s
Trade & Health Forum Leaders

Giving Mom(s) a Piece of the Pie: Adding MNCH to the Global Fund

Last week, APHA, along with 58 other organizations, put its John Hancock on an open letter to the board of the Global Fund (pdf), calling on the Fund to “to fully fund the current mandate of the Global Fund; to strengthen the Global Fund’s engagement in maternal, newborn, child, and reproductive health (MNCH); and to mobilize additional resources to support such engagement.” Family Care International, which authored and coordinated the letter, reported an encouraging response from the Global Fund: the board committed to providing guidance to countries on how to integrate MNCH into their requests and to exploring the possibility of “broadening its engagement” as it develops its strategic plan for the next five years.

The prospect of adding MCNH to the Global Fund, while popular, is not without controversy. MCH advocates have been calling on donors to scale up these programs for many years, and proponents argue that organizations like the Global Fund have the drive and resources to implement and coordinate the programs that are so desperately needed to prevent the millions of needless maternal and newborn deaths each year. Others maintain that the Fund’s vertical approach is not appropriate for this issue: Alanna Shaikh argues that a narrow approach focusing on a few factors that affect maternal mortality would not be very effective, and that the funds would be better used by improving health systems in general. The Fund’s shortage of funds is an additional complication – it made headlines this past October when pledges from donors reached a meager $11.7 billion, short of the $13 billion it had set as the bare minimum to maintain its current programs and miles away from the $20 billion it had hoped to raise to expand operations.

IH members raised some very good points in the discussion leading up to the sign-on. MNCH is obviously a top priority and well deserving of attention, and the Global Fund’s current scope is limited in what it can currently do to address these issues. However, the call to expand the Fund’s activities must come with a commitment to help raise the funds needed to do so and to ensure that the energy put toward maternal health works with, and not against, the other programs. It will interesting to see the direction the Fund takes with this as it moves forward.

Mama Drama: The Value of Traditional Birth Attendants

I often seem to have babies on the brain these days, most likely because many of my college friends who got married a year or two ago are beginning to have children. For my generation, this of course means that pictures of a now-pregnant friends or new babies wrapped tightly in blankets are constantly popping up on my Facebook feed. One particular friend’s experience caught my eye, however, because she impressed (or shocked) most of us by delivering her first child, a baby girl named Evelyn, at home. While thinking about it, it struck me that while home births are so unusual (and often frowned upon) in the U.S., they are much more supported in Europe – and they are often the only option for mothers in developing countries.

According to the WHO, skilled attendance at births is considered to be the single most important intervention for ensuring safe motherhood – this means both the presence of a accredited health professional (doctor, nurse, or midwife) and an environment that allows for access to emergency obstetric care. Increasing the number of births with skilled attendance is crucial to reducing the 536,000 maternal deaths and 3.7 million newborn deaths that occur globally each year. Unfortunately, only about 62% of births in the developing world are attended by a skilled practitioner; in some countries, this figure is less than 20%. Additionally, there are regional disparities: while improvement in the proportion of assisted births has increased worldwide, sub-Saharan Africa and southern Asia lag behind other areas, and rural and impoverished women are less likely to receive skilled care.

Many of communities in rural or resource-poor areas already have traditional birth attendants who, though they have no formal medical training, are respected by the residents. While some countries, such as Kenya, have banned these women from practicing to try to encourage women to go to the hospital, others argue that this will only marginalize women who cannot afford medical care (or the transportation to get there). A more constructive approach, utilized by the MOM Project (mobile obstetric medics) on the Thai-Burma border, mobilized the traditional birth attendants in the area to improve health outcomes and could serve as a model for other resource-poor areas. Burma (Myanmar), which spends about 50 cents per capita (about 3% of its budget) on healthcare, has some of the worst health indicators in the world, and the ethnic groups along the borders are even worse off than the rest of the country. This intervention, designed by researchers at Johns Hopkins, incorporated traditional birth attendants into a three-tiered provider network designed to improve access to skilled care. Traditional birth attendants improved antenatal care services, health workers provided supplies and worked to prevent post-birth complications, and maternal health workers provided oversight, training, and emergency care. The intervention increased prenatal care and postnatal visits within seven days, malaria testing and ITN use, de-worming, and vitamin use. Other studies have shown similar improvements in mortality and referral rates after training traditional birth attendants. This underscores the importance of mobilizing traditional birth attendants to improve maternal and newborn health, particularly in areas where medical facilities and trained personnel may not become available any time soon.

MDG 5, which focuses on maternal health, aims to reduce maternal mortality rates by 75%. As countries strive toward this goal, traditional birth attendants could serve as a valuable resource to bridge the gap to skilled maternal care until the capacity of health systems can be built up to provide skilled attendance for every birth.

Annual Meeting, Day Two: MDGs and Refugees

I am always amazed at how exhausted these conferences always leave me. It is an energizing kind of exhaustion – the wonderful thing about the annual meeting’s size and diversity is that there is always so much going on, and we always want to soak up as much of it as we can. But as sponge-y as I try to make myself, absorbing meetings, scientific sessions, the expo hall, and a lovely awards ceremony is enough to leave anyone a little drained. It does, however, make me admire all of our overseas colleagues so much more, because they manage to participate right along with us, despite what must be a serious case of jet lag.

After the business meeting this morning, I wandered through the expo hall. Then I attended a session on the MDGs and the right to development, which was quite a learning experience for me – I had never heard of development framed in a human rights context, so I was definitely exposed to a new way of thinking about the MDGs and global health and development in general. Dr. Elvira Beracochea recommended some great pieces to read on health and development in general, including the Universal Declaration of Human Rights (always a classic), the Paris Declaration, and the Millenium Declaration, among others.

After lunch at an Irish pub on the 16th street mall, I went to a very interesting session on forced displacement and refugee health, chaired by Mr. Jirair Ratevosian. One project in particular captured my interest – Ms. Katherine Robsky, who worked as a fellow with the Global Health Access Program – shared her work with a project on the Thailand-Burma border with a TB treatment project that worked with IDPs targeted by the military junta. Apparently the program takes on a handful of fellows each year for various health-related projects, so that is one to add to my list (all you students looking for opportunities – heads up!) I spoke with her and one of her colleagues afterward, since I have a special interest in refugee and IDP issues (I recently had an article accepted by Forced Migration Review, and I wrote about the Rohingya refugee camp earlier this year). Her colleague invited me to attend her presentation (during the Child Survival and Child Health 2 session) on a project working in the same area tomorrow morning, so I will have to add that to my list.

In the evening, I went to the IH section’s awards reception. I heard so many inspiring stories of people’s devotion to amazing work and got an awesome free dinner to boot. I will post pictures with this entry once I get them from the Dr. Padmini Murthy (probably after we have all recovered back home).