As world leaders gather this week in New York to assess progress on the Millennium Development Goals (MDGs), they will face stark challenges to social and economic development, given ongoing wars and the global economic recession.
Yet the MDGs also provide an opportunity – to focus on ensuring basic rights and access to health services for women and girls as the path to achieve the MDG goals. The administration of U.S. President Barack Obama, which has made women and girls a cornerstone of its Global Health Initiative, should seize the opportunity to turn these enlightened MDG goals into effective policies and programs, by making global health, development and gender interlinked components of foreign policy.
Last year, the United States government launched its Global Health Initiative and initiated the second phase of the President's Emergency Plan for AIDS Relief (Pepfar). These programs are being rolled out against the backdrop of the Obama administration's high-level commitment to advance a women- and girls-centered approach.
The challenge now is to maximize the opportunities and tackle the challenges in pursuing policies and programs to link HIV/Aids initiatives with other health and development areas that particularly affect women and girls, including education for girls, economic empowerment for women and reproductive health. It is clear that considerable innovation is taking place in these areas in some of the countries hardest hit by the AIDS epidemic, and that addressing these linkages is critical to meeting the needs of women and girls, and can generate concrete results.
The importance of pursuing this strategy is evidenced by innovative programs that are addressing the multiple needs of women and girls, such as the IMAGE program in South Africa.
IMAGE - Intervention with Microfinance for AIDS and Gender Equity - is a community-based intervention that started in 2001 in rural Limpopo Province that combines microfinance with a gender and HIV curriculum. IMAGE has shown that it is possible to address health and development together and to demonstrate measurable impacts in both areas, underscoring the need for future investments to support programming beyond the health sector to address women's social and economic empowerment and their vulnerability to HIV infection.
Lina, a soft-spoken and committed outreach worker for IMAGE, explained why the approach of combining gender and health training with microfinance has been so successful in enabling women to protect themselves:
"I've seen a lot of changes with the women – now people are starting to talk about HIV and to talk to their children about sex and sexuality, to encourage family members to go for testing. Before I got [the IMAGE] training, I thought it was taboo to discuss these things with children.
"Microfinance is key because if you don't bring income in the household, it's hard to contribute to decision-making. Now we help start conversations in families – husbands and wives discuss issues…. Economic empowerment helps contribute to decision-making… Violence is going down…with training, we know how to approach the situation so we don't escalate violence."
After two years, the IMAGE study found that the risk of violence against women among participants was reduced by 55 percent. Among young women participating in the program, other factors related to HIV risk were also positively affected, including increased communication about HIV, a 64 percent increase in voluntary counseling and testing, and a 24 percent reduction in unprotected sex.
The study also documented positive changes in household economic wellbeing, including increased food security, expenditures and household assets, and the women maintained high loan repayment rates. The evaluation also documented improvements across a range of indicators of women's empowerment, including increased self-confidence, autonomy, social capital, collective action and an ability to challenge gender norms.
While global attention to the importance of integrated approaches to address women's and girls' health is growing, many challenges remain.
In particular, the new U.S. principle of ensuring a women- and girls-centered approach will have to address the challenges inherent in programming in different health and development areas, including how to demonstrate cross-sectoral impact; how to develop a cross-sectoral approach to gender indicators and outcomes; how to replicate and scale up promising programs; how to demonstrate that linkages are key to building cost-effective and sustainable approaches; and how to create space to learn from failure, given that innovation carries certain risks.
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To be successful, the U.S. government should:
• systematically hold implementing government agencies accountable to promote multisectoral linkages;
• put in place better measurement tools to track progress in addressing women's health outcomes and achieving structural change;
• identify intermediate steps to capture impact; and
• set out long-range plans to build sustainability, encourage innovation, and ensure U.S. global leadership.
In August, President Obama said: "In Africa, in particular, one thing we do know is that empowering women is going to be critical to reducing the [HIV] transmission rate." The MDG Summit is an unprecedented opportunity to propel the United States to develop strategies and implement programs that make a difference in the lives of women and girls. For the millions of women like Lina, we have no time to wait.
Janet Fleischman is a senior associate at the Global Health Policy Center at the Washington-based Center for Strategic and International Studies.
