The Center for Global Development’s latest report, Start With A Girl: A New Agenda For Global Health, sheds light on the risks of ignoring the health of adolescent girls. Like other reports in the Girls Count series, it links broad social outcomes with adolescent health. “Adolescence is a critical juncture for girls. What happens to a girl’s health during adolescence determines her future–and that of her family, community, and country,” state coauthors Miriam Temin and Ruth Levine.

Between childhood and pregnancy, adolescent girls are largely ignored by the public health sector. At the same time, programs and policies aimed at youth do not necessarily meet the specific needs of girls. Understanding the social forces that shape girls’ lives is imperative to improving their health.

Like recent books by Michelle Goldberg and Nicholas Kristof, the report argues for increased investment in girls’ education to break down the social and economic barriers that prevent adolescent girls from reaching their full potential. Improving adolescent girls’ health will require addressing gender inequality, discrimination, poverty, and gender-based violence.

“For many girls in developing countries, well-being is compromised by poor education, violence, and abuse,” say Temin and Levin. “Girls must overcome a panoply of barriers, from restrictions of their movement to taboos about discussion of sexuality to lack of autonomy.” The report points to innovative government and NGO programs that have successfully changed negative social norms, such as female genital cutting and child marriage. However, the authors urge researchers to examine the cost-effectiveness and scalability of these programs.

In the last five years, the international community has become increasingly aware of the importance of youth to social and economic development. Some new programs are focused on investing in adolescent girls, such as the World Bank’s Adolescent Girls Initiative and the White House Council on Women and Girls, but significant additional investment and support is needed.

“Big changes for girls’ health require big actions by national governments supported by bilateral and multilateral donor partners, international NGOs…civil society and committed leaders in the private sector,” maintain Temin and Levin. They offer eight recommendations:
1. Implement a comprehensive health agenda for adolescent girls in at least three countries by working with countries that demonstrate national leadership on adolescent girls.
2. Eliminate marriage for girls younger than 18.
3. Place adolescent girls at the center of international and national action and investment on maternal health.
4. Focus HIV prevention on adolescent girls.
5. Make health-systems strengthening and monitoring work for girls.
6. Make secondary school completion a priority for adolescent girls.
7. Create an innovation fund for girls’ health.
8. Increase donor support for adolescent girls’ health.

“We estimate that a complete set of interventions, including health services and community and school-based efforts, would cost about $1 per day,” say the authors of Start With a Girl. There is no doubt in my mind that this small investment would indeed have a high return for the entire global community.

“Family planning is one of the biggest success stories of development cooperation,” said Bert Koenders, Dutch Minister for Development Cooperation, via video at a Wilson Center roundtable discussion on the future of family planning funding. Koenders was followed by representatives of three of the field’s largest donors, Musimbi Kanyoro, director of the David and Lucile Packard Foundation’s Population and Reproductive Health Program; José “Oying” Rimon, senior program officer for Global Health Policy and Advocacy at the Bill and Melinda Gates Foundation; and Scott Radloff, director of USAID’s Office of Population and Reproductive Health.

“We have a new administration that places a priority on family planning and reproductive health,” Scott Radloff, director of the Office of Population and Reproductive Health at the U.S. Agency for International Development (USAID), tells ECSP Director Geoff Dabelko after a discussion on the future of family planning at the Woodrow Wilson Center.

“The downward trend, in terms of donor funding for international family planning, since the middle of the 1990s to around 2006 has been reversed,” José Rimon II, senior program officer for global health policy and advocacy at the Bill and Melinda Gates Foundation, told ECSP Director Geoff Dabelko following a discussion on the future of family planning at the Woodrow Wilson Center.

Here in Morocco, where I am attending the IUSSP conference on population, if you never went to elementary school or if you married at a young age, you are likely to have more children.

A Bangladeshi couple is more likely to have a third child if they have 0-1 sons, but a European couple is increasingly likely to prefer daughters because they take better care of their aging parents.

Globally, a forthcoming Harvard study shows that the “Reproductive Health Laws Index”—which includes the legal framework governing abortion, condoms, IUDs, and birth control pills—can predict fertility (more liberal laws = fewer children) and potentially increase female participation in the labor force.

Such causes of population growth are favorite topics for demographers and family planning experts here at the conference, and were quite well attended. However, perhaps due to the large number of European attendees, the panels on this popular topic were empty in comparison to those examining aging, fertility decline, and migration—issues at the forefront of European policymakers’ agendas.

A Message From His Majesty

“One of the characteristic features of our population policy stems from our firm belief that [its] impact … cannot be determined in isolation from economic, social, cultural and political factors,” wrote Morocco’s King Mohammed VI in a welcome letter delivered to the conference, which also discussed aging, climate change, food security,natural resource scarcity, the economic crisis, and growing levels of income inequality.

Morocco is taking steps to tackle this complicated set of problems. The government has launched a National Initiative for Human Development to fight poverty and social inequalities, and help Morocco meet the Millennium Development Goals (MDGs). He also notes that the country’s “political and social reforms aimed at increasing the scope of democratic participation and ensuring the advancement of women.”

Like all leaders, Morocco’s will be measured not by his words—eloquent as these may be—but by his deeds and the country’s progress. Morocco has some work to do to reach the MDGs and other social and economic goals.

“Although a half million women die each year, that doesn’t get attention, because the victims invariably have three strikes against them: They are poor, they are rural, and they are female,” journalist Nicholas Kristof says in a video interview about his new book, Half the Sky: Turning Oppression into Opportunity for Women Worldwide.

“If men had uteruses and were dying at this rate, every country would have a minister of paternal mortality, the security council would be meeting, this would be a real international priority,” he says.

“Poor countries can’t begin to deal with food issues, with economic pressures, with conflict and shortages of water and grassland that may lead to social conflict, unless they begin to deal with population problems,” journalist Nicholas Kristof tells ECSP Director Geoff Dabelko in a video interview.

Demographers often get a bad rap for being boring. There’s a saying that demography is all about sex—but the details aren’t as much fun. To find out, I’m in Marrakech, Morocco, reporting on the biennial gathering of number crunchers, the 26th conference of the International Union for the Scientific Study of Population (IUSSP). After the first day, I have only 4 days, 86 panels, 327 presentations, 5,340 PowerPoint slides, and 426 poster presentations left to go.

To most of you, this may not seem exciting. But it is terrifically important. For example, at a panel on maternal health, the presenters offered easier, more accurate, and less expensive ways to collect maternal mortality data, which led to a discussion of strategies for meeting MDG 5 and for improving maternal and infant health throughout the world. Similar panels addressed the challenges facing scientists and programmers working on issues as disparate as water, migration, and the effect of armed conflict on children.

For its 50th Anniversary, IUSSP also indulged in a bit of navel-gazing. Wolfgang Lutz called for more research on predictions and more policy recommendations—what he dubbed the “Demographers’ Transition” (an inside joke, to be sure). Ndola Prata’s “Opportunity Model” (developed jointly with Malcolm Potts and Martha Campbell), argues that use of contraceptives may increase simply if they are more available. Borrowing from marketing theory and such examples as remote controls and Post-It notes, the model generated quite an uproar. A UNFPA-hosted plenary on “After Cairo” closed the day with a strategic discussion about future population, family planning, reproductive health, and development strategies.

A Visit to the Hospital

At the Ibn Zohr Hospital’s crisis center in Marrakech, victims of sexual, physical, and psychological violence are treated and counseled free of charge. Though only founded in 2006, the clinic has defied expectations by helping hundreds of women and children each year, thanks in large part to an effective referral network comprising NGOs, media (especially radio), the police, hospitals, and health professionals. “Listening centers,” local outposts offering basic education on health and rights, are responsible for 56 percent of all referrals.

Ibn Zohr’s services are funded by the Moroccan government and UNFPA. Data has been collected since service delivery began, and shows that the overwhelming type of abuse suffered by women is physical (86 percent), while children under 15 report a mix of sexual (40 percent) and physical (43 percent) abuse, with more sexual abuse occurring among boys than girls.

Other IUSSP site visits included a rural reproductive health clinic, a center for abandoned children, and a house for female students. Too often, site visits are far away from the conference and before or after the main events, costing attendees extra time and money. Instead, the IUSSP site visits are here in Marrakech, where even the most experienced practitioners can learn more about Morocco’s unique blend of modernization and religious and cultural conservatism. These trips are truly unique and invaluable learning opportunities—organizers of similar conferences take note.

Gib Clarke reported from Marrakech, Morocco.

Photo courtesy flickr user DavidDennisPhotos.

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