On the eve of the Clinton Global Initiative, which will have as one of its themes efforts to improve the lives of girls and women in poor countries, CGD vice president Ruth Levine answers questions regarding her soon-to-be-released report, Start with a Girl: A New Agenda for Global Health. Co-authored with Miriam Temin, this follow-up to the influential Girls Count report provides a clear plan for taking action to improve adolescent girls’ health worldwide.
Q: Why did you decide to write this report as a follow-up to Girls Count?
A: The response to Girls Count was far greater than my co-authors and I expected. Along with work being done by members of the Coalition for Adolescent Girls and others, it helped to provoke a set of policy-level conversations about what the practical implications are, across different sectors, of putting girls at the center of development policy. I am sure that part of the response was driven by the connection between the report and an engaging video that the Nike Foundation created, but there was also clearly a ‘policy moment’ to amplify the attention the international community gives to these issues. This just happened to intersect with a recent surge of interest in maternal health, girls’ unequal vulnerability to HIV infection, and women’s role in development. Because I work on global health, it was natural for people to ask me, “So, in global health, what should we do?” This report, which was co-authored with Miriam Temin, is an attempt to reframe that question a little bit—to ask, “If we care about the wellbeing of adolescent girls, the women they will become, and the families and nations they are a part of, what should we do to improve their chances for better health?” and to answer that question in a comprehensive way.
Q: Why do we need a specific focus on adolescent girls, not just women in general?
A: Adolescent girls really do represent quite a different population segment than do young children and women who are well established in adult roles—both groups with which donor-funded programs and health systems have long traditions of working. Adolescence is a transition period, when individuals’ adult identities, particularly those that are shaped by gender roles, are being established, and key choices are being made about sexual and other social and health behaviors that have very long-term consequences. It also can be a time of vulnerability. Young people are likely to engage in risky practices, and as girls develop physically they are at greater risk of sexual exploitation and abuse. At this life stage, girls need health services that are “adolescent-friendly”—available in ways that are convenient to people who may not have independent transportation or financial resources, and respectful of the need to sensitively provide confidential information and services. But they also need other specialized approaches to help them navigate the transition to adulthood, which we describe in the report.
Q: How did you decide on the eight interventions that the report calls for?
A: The eight recommendations we highlight are certainly not all that needs to be done. But we came to these from a close look at the available evidence, combined with what’s realistic and, frankly, attractive from a policy perspective. The Advisors to the project were very helpful in serving as a sounding board to refine the ideas. When we launch the report on October 7, we will offer very specific “next steps” for each of the eight recommendations: if you want to accomplish this, here’s what you can do tomorrow, and here’s who’s willing to help.
Q: If you had to start with one, which would it be?
A: They really are all crucially important, so it’s hard to choose one. From the perspective of my work at CGD, I think we can best contribute to thinking through which indicators and monitoring and evaluation frameworks can be most useful in driving attention toward good outcomes for adolescent girls, which is Number 5 in our list of ways to “Take Action for Adolescent Girls.” More broadly, I think the first item on the list is a key place to begin: it’s absolutely vital for a few countries to come forth and take the lead—really define the girls’ health agenda for themselves and work with donors to implement it. Yes, donors and others in the international community can send the signal that girls’ health is a priority area and back that up with resources. But the leadership at the country level, which will come from some combination of political figures, technical leaders and voices from civil society and girls themselves, is what will inspire others and lead to sustained real-world change. In the end, it’s not reports with statistics that change people’s minds about what’s do-able; it’s seeing and hearing about successful, large-scale efforts.
Q: What stands in the way of this agenda being implemented?
A: I think the main barrier to action is a sense that this is just one more issue or set of problems, competing for attention with lots of others, whether in health or development more broadly. But I am very optimistic, because I see that that those who study, make and implement development policy, whether at the national level or internationally, are increasingly recognizing the cost of marginalizing women’s economic and many other contributions—and the benefits of fostering gender equality and improvement in the condition of girls and women. The recent book by Nick Kristoff and Sheryl WuDunn, Half the Sky, articulates this very beautifully.
Q: If implemented, what impact could these interventions have on the broader development agenda?
A: I see the potential for two kinds of impact, both of which are transformative. First, attention to girls and women—both the health services that are geared toward them and the actions outside of the health sector to address social determinants of health—can greatly accelerate achievement of a broad set of global health goals, from prevention of HIV infection to sustained gains in neonatal and child health. Second, we tried to make the case in Girls Count that improvements in girls’ wellbeing, including health, education and economic opportunities, are fundamental to shared economic prosperity, family health, and progress toward a fairer, safer, and cleaner world.