The following guest post by Miriam Temin, Health & Social Policy Professional and Co-Author, Start With a Girl: A New Agenda for Global Health, with contributions by Sandy Stonesifer, Program Coordinator at the Center for Global Development, is part of Disruptive Women’s “The Value of Health: Creating Economic Security in the Developing World” series.

Miriam Temin has 12 years of experience in Africa, the United States, and Europe working on HIV/AIDS, sexual and reproductive health, and social protection with donors, UN agencies, and non-profit organizations. Previously, Temin was a senior AIDS policy advisor at UNICEF headquarters, where she brought greater attention to children affected by HIV/AIDS through research, advocacy, and technical assistance.

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The recent attention given to women’s role in development is great. Even better, it happens to coincide with an increasing focus on health system strengthening. And in the case of the Obama administration’s Global Health Initiative, these two are coming together to promote women-centered health care.

We’re thrilled. But we also need to remember that healthy, empowered women don’t just spring out of the ground ready to contribute to their nation’s development. Adolescent girls are the foundation for progress on a slew of major global health goals—including maternal mortality, HIV, and infant mortality reduction—not to mention accelerated social and economic development. Yet there are around 600 million adolescent girls whose rights aren’t assured. So what can we do to make sure that girls pass through the critical juncture of adolescence with their rights to health, education, and safety intact?

Most girls enter adolescence healthy. It’s what happens to them in the eight or nine years following puberty that shapes their future. Unacceptably, it is factors largely beyond their control—both social and biological—that put them at risk.

Girls’ health status during adolescence has lifelong consequences for them, as well as for the next generation. Unhealthy mothers pass on poor health status to their babies. This relationship spans multiple generations; research in several countries shows that grandmothers’ height is significantly associated with their grandchildren’s birthweight. The inter-generational transfer of ill health is amplified when mothers are young, since babies of young mothers are less healthy than babies born to older women.

Yet despite their vulnerability and their critical role in social and biological reproduction, adolescent girls are often overlooked. While it isn’t difficult to find high level commitments to adolescent girls—their importance is recognized in a few of the Millennium Development Goals, in UN Declarations of Commitments, and in some important donors’ White Papers—these grand statements are not matched by the serious funding, scale up, and research that girls need to make real progress. According to coverage surveys of youth centers and peer based programs, even youth oriented programs often fail to reach them.

One of the starkest illustrations of how inattention to adolescent girls jeopardizes their wellbeing is child marriage. In 10 countries, over half of all girls are married by the age of 18 (a full 77% in Niger) despite the fact that in almost half of those countries, the practice of child marriage is illegal (Sierra Leone, Central Africa Republic, Bangladesh and Nepal). Where are the focused efforts in communities to enforce the laws, promote alternatives to marriage, and help girls stay or re-enroll in school instead of marrying? Some current approaches are having notable success in delaying marriage, but they are too often small scale, fragmented, and unsustainable.

There’s no question child marriage is bad for girls. Those available for marriage have left school prematurely and ended their chance for vocational training. Most young wives face isolated lives of restricted mobility, with little or no control over household finances. And the health risks are significant. Early childbearing, which poses threats to mothers and their babies, and heightened vulnerability to HIV infection are but a few. The nature of sex within marriage, typically frequent, unprotected, with wives unable to insist on condom use, and the typical age gap between young wives and their older husbands, conspire to place young wives at increased risk.

Tackling the social forces that underlie girls’ ill health, such as child marriage and limited education, and most importantly, the gender inequality that lays the foundation for these social determinants of girls’ health is the only way to achieve a real transformation in adolescent girls’ health.

So where is the health sector in all of this?

While addressing the social determinants of health is imperative, adolescent girls also need health systems that work for them. Yet from the age of their last immunization, usually five, until their first pregnancy, developing country health services often fail to reach girls. The consequences? Unplanned early pregnancies; maternal mortality; HIV infections; undetected gender-based violence and mental health problems; and a looming burden of chronic disease due to poor diets, sedentary lifestyles, and tobacco and substance abuse picked up during adolescence.

There is much we can do to make health systems more responsive to adolescent girls. Girl-friendly adaptations are feasible and timely given the current surge of interest in health sector strengthening. Measures include training health workers to be more competent in adolescent health, using adolescent girl-specific indicators to measure health system performance, and ensuring that service delivery approaches and demand side financing mechanisms reach girls. Expanding high quality youth friendly health services is also key. Without a doubt, all users of health systems stand to benefit from changes made in the name of adolescent girls.

A new report by the Center for Global Development, Start with a Girl: A New Agenda for Global Health, sheds light on the realities of girls’ health and wellbeing in developing countries, on the links between their health and prospects for their families, and on the specific actions that will improve health prospects for millions. It lays out an ambitious yet feasible agenda for governments, donors, the private sector, and civil society organizations—complete with indicative costs.

We know what to do: expand proven and promising approaches to protect adolescent girls’ health through the health sector, communities, schools, workplaces, and the media to alter the equation for girls, women, and beyond. Start with a Girl and unleash the transformative power.

Related posts:

1. The Value of Health: Creating Economic Security in the Developing World: Disruptive Women in Health Care is Going Global with a New Series and e-Book on Global Health
2. Global Health Starts at Home
3. Solutions to Poor Health in Developing Countries
4. Employment : A Public Health Intervention
5. Economic Security and Reproductive Health

This entry was posted on Friday, December 11th, 2009 at 9:14 am and is filed under Global Health, Women's Health, Young Adults. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.