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This post was written by FHI 360’s Tanzania field office staff.

A Swahili tradition—initiation of young women into adulthood—has long served as a vehicle for older women to pass on reproductive health knowledge and skills. Swahili families hire traditional “initiators” (manyakanga) to lead small groups of young women through several days of training on puberty, sex education, and the roles of husbands and wives. The initiation culminates with a celebration attended by hundreds of community members.

Young women in Tanzania, as elsewhere, face a disproportionate threat from HIV and AIDS, and reaching them in creative, effective, and culturally-acceptable ways is increasingly important. To address this need, PEPFAR has funded a groundbreaking pilot activity through FHI 360’s youth-focused UJANA project, which employs a range of innovative HIV prevention methods. Implemented through a local nongovernmental organization, Partnership for Youth Development (PAYODE), 21 manyakanga and a group of musicians who lead the graduation ceremonies were trained on HIV prevention and supported to integrate HIV prevention education in the initiation teachings and ceremonies.

Girls ranging in age from 10 to 18 were initiated by trained manyakanga. Both younger and older women praised the training they received. Asma, 14, says, “We spread all the good information we learned. Our friends wish they had done the same initiations. They missed something important.”

The chairperson of the manyakanga group, Blandina Mbagi, concurs, “I wish my young girls could have known all these things before. There is a big, big difference between girls who go through our initiations and girls who go through other initiations. These ones know the risks; they become careful.”

Community members and local government authorities praise the use of culturally grounded methods for imparting HIV education, rather than attempting to eliminate a valued practice. This integrated approach, as manyakanga Amina Sadiki points out, means that “Now we give them our cultural values together with an HIV component.”

Kate Stence is the communications manager of Knowledge for Health. As a writer and endurance athlete, her writing and running support females worldwide in achieving gender equity.

In late July, Secretary of State Hillary Clinton took the stage to speak at “Saving Lives at Birth: A Grand Challenge for Development.” A joint effort of USAID, the Bill & Melinda Gates Foundation, the Government of Norway, Grand Challenges Canada, and the World Bank, the event called on the brightest researchers around the world to identify and scale up transformative prevention and treatment approaches for pregnant women and newborns in rural, low-resource settings around the time of birth.

Clinton relayed how great the opportunity was to internationalize efforts and bring change through innovation. “We want to do development more effectively. That is our goal. We want to change systems. We want to deliver highest possible impact for every tax payer dollar we spend,” she said.

According to Clinton, few challenges are as persistent or heartbreaking as the poor health of many women and children around the world. She cited WHO’s calculation that 2.6 million children are stillborn each year and that a woman living in Sub-Saharan Africa is 136 times more likely to die during childbirth than women elsewhere in the world.

Like so many development issues, saving lives at birth has strong ties to the health and safety of the mother. For example, is currently featuring child marriage with a focus on how greatly it influences maternal and child health, both directly and indirectly. “Children of child brides are also at risk. Babies born to mothers younger than 18 are more likely to be underweight or stillborn. Girls forced into early marriage are also at an increased risk of contracting sexually transmitted diseases [infections] and HIV/AIDS because they are unlikely to be able to negotiate safe sex with their husbands.”

According to PBS, child brides can be as young as 5 or 6 when they enter marriages, often with much older men. In April 2011, Who Speaks for Me? Ending Child Marriage was released by the Population Reference Bureau, further clarifying how vast this problem is on a global scale.

In the last decade, 58 million young women in developing countries — one in three — have been married before the age of 18, many against their will and in violation of international laws and conventions on women’s rights. Even more disturbing, according to new figures, one in nine girls, or 15 million, has been forced into marriage between the ages of 10 and 14. With limited education and economic opportunities, child brides are often condemned to a life of poverty, social isolation, and powerlessness, infringing on their human rights, health, and well-being.

 In the coming years, the number of child brides will increase drastically. As such, the Elders, a group of global leaders ranging from Nelson Mandela to Mary Robinson, introduced an initiative to bring more awareness. They state, “Every single day, it is estimated that more than 25,000 girls under the age of 18 are married. At this rate, 100 million more girls — around 10 million each year — will become child brides over the next decade.”

In June, National Geographic documented why whole cultures continue to abide by child marriage as cultural tradition. The article opened in India on the night of a wedding for three girls.

They squatted side by side on the dirt, a crowd of village women holding sari cloth around them as a makeshift curtain, and poured soapy water from a metal pan over their heads. Two of the brides, the sisters Radha and Gora, were 15 and 13, old enough to understand what was happening. The third, their niece Rajani, was 5. She wore a pink T-shirt with a butterfly design on the shoulder. A grown-up helped her pull it off to bathe.

In the story’s outcome, journalist Cynthia Gorney spent her own money to educate an 8-year-old child bride from Northern India so she could access education post-high school. Months after Shobha Choudhary began school, Cynthia received a video of the young girl thriving while living in a safe house for girls and continuing her education. “She looked straight into the camera at one point, and in English, an enormous smile on her face, she said, ‘Nothing is impossible, Cynthia Mam. Everything is possible.’”

Shobha’s story is one of hope but hers is also rare. Yet, the report Paying the Price: The Economic Cost of Failing to Educate Girls highlights why education will lead countries toward economic vitality. “Based on World Bank research and economic data and UNESCO education statistics, it estimates the economic cost to 65 low and middle income and transitional countries of failing to educate girls to the same standard as boys as a staggering US$92 billion each year. This is just less than the US$103 billion annual overseas development aid budget of the developed world.”

You can learn more about gender equality through the IGWG Gender and Health Toolkit and on the Interagency Gender Working Group web site.


This blog entry, titled “International Youth Day: Meeting the Reproductive Health Needs of Youth,”  was written by Cate Lane, youth technical advisor for USAID’s Office of Population and Reproductive Health on August 12, 2011. It originally appeared on USAID’s “Impact” blog and can be accessed here.

I first came to D.C. in 1994, the year of the International Conference on Population and Development in Cairo, which marked a milestone in the field of population and reproductive health.  The conference set a turning point as the world agreed that population is not about numbers but about people and their rights.  It also solidified my commitment to youth, health, and development, which began when I served as a Peace Corps Volunteer working with youth in Ghana.  Today, I am the youth advisor for USAID’s Office of Population and Reproductive Health.

More than half of the world’s population is under age 25.  I believe meeting the reproductive health needs for today’s young people is vital in ensuring that future generations are able to lead healthy and dignified lives.  When girls are able to delay first pregnancy, they are more likely to obtain an education and end the cycle of poverty.  The United Nations proclaimed the past year commencing on August 12, 2010 as the International Year of Youth.  As the year comes to an end on International Youth Day, let us continue to stress the need for investment in programs that reach out to youth.


Today on International Youth Day, we would like to take the opportunity to reflect on why we are working in the field of youth sexual and reproductive health, and look back at some of the accomplishments the global health community has achieved thus far. 

There are 1.2 million youth in the world today, representing 18% of the global population.  Nine out of ten youth live in developing countries, where they face profound challenges, such as limited access to resources, healthcare, education, training, employment, and economic opportunities.  Great strides have been made in improving the lives of youth, yet much remains to be done.  Since 2001, the rate of HIV among young people has decreased by 12%, yet every day, approximately 2,500 young people are infected with HIV. An estimated 5 million young people ages 15-24 are living with HIV, and AIDS is the eighth leading cause of death among adolescents ages 15-19 years old. The rate of adolescent pregnancy is declining worldwide.  But high rates of adolescent pregnancy still persist in many developing countries, where approximately a third of young women give birth before age 20. Furthermore, deaths related to child birth are still the number one cause of death among adolescent girls.  Worldwide, 70 million young people are out of school, and one in three girls is married before she is 18.

Despite these sometimes seemingly insurmountable challenges faced by adolescents, there are equally as many opportunities to improve their lives.  Stated eloquently by Anthony Lake, the executive director of UNICEF, “Adolescence is not only a time of vulnerability, it is also an age of opportunity.”  Investment in this age group is imperative to addressing poverty, gender discrimination, and inequality.  Young people hold the key to a world without poverty; “adolescence is the pivotal decade when poverty and inequity often pass to the next generation as poor adolescent girls give birth to impoverished children.” By investing in adolescents now, we are investing in the future.   So, today we urge you to consider the opportunities for further improving the lives of youth and to remember the reason for the work that you do.

Elizabeth Futrell is an associate technical officer at FHI360, where she works on activities related to community-based family planning and youth sexual and reproductive health.

© 2011 Onasis Odelmo, Courtesy of NBC Chicago

On July 26, ten up-and-coming Chicago fashion designers competed in the Heshima Kenya Fashion Challenge, an innovative event to benefit unaccompanied refugee girls who have arrived in Nairobi from conflict- and famine-ravaged regions of Africa. In 2007, Anne Sweeney and Talyn Good founded Heshima Kenya, a U.S. nonprofit organization based inNairobi, after noticing that most humanitarian relief efforts focus on general aid and overlook the unique and pressing needs of unaccompanied refugee minors.

© 2011 Melissa Hayes Photography

Heshima is the Swahili word for respect, honor, and dignity, and Heshima Kenya was founded on the belief that young people deserve to grow and develop with integrity and thrive in communities where their rights and interests are respected. Heshima Kenya works to carry out its mission by providing a continuum of holistic care to address issues of medical care, shelter, education, legal documentation, and family tracing. The program also promotes self-sufficiency by providing skills-building opportunities, resources, and economic support for a healthy transition to adulthood. Its staff works with partner organizations and local schools, clinics, and religious organizations to identify and protect additional unaccompanied refugee minors and spread awareness of their needs. Finally, the program builds the capacity of the refugee community to effectively care for minors and encourage youth participation as caregivers, volunteers, and mentors.

One initiative that has developed from Heshima Kenya, the Maisha Collective, offers refugee girls and young women from the Democratic Republic of Congo, Somalia, Ethiopia, Sudan, and Burundi economic opportunities with which to rebuild their lives. By managing a business collective that designs and produces a line of unique hand-dyed scarves, participants gain business and marketing skills that prepare them for future independence.

© 2011 Onasis Odelmo, Courtesy of NBC Chicago - The winning design.

The Heshima Kenya Fashion Challenge was a Project Runway-inspired competition, emceed and judged by local celebrities and members of the Chicago fashion community. Competing designers each received one Maisha Collective scarf, chosen at random, and had two weeks to design an original women’s look. The judges critiqued each look and chose the winning design. The audience also voted on one designer to receive the People’s Choice Award. Guests had the opportunity to bid on the designer looks and, of course, purchase scarves.

Many of the designers said that their creations were inspired by the young women who made the scarves; in turn, there is no doubt that the members of the Maisha Collective in Nairobi will be inspired to see how the 10 American designers transformed their scarves into unique and beautiful couture.

© 2011 Onasis Odelmo, Courtesy of NBC Chicago

For a full slideshow of photos from the event, click here.

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This blog is brought to you by the Interagency Youth Working Group (IYWG) with financial assistance from the U.S. Agency for International Development and the U.S. President's Emergency Plan for AIDS Relief. The content is managed by FHI, which functions as the secretariat for the IYWG.
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