If, When and Whom to Marry: Young Women Choosing Their Best Future of Health

28796175381_0b954aa4ae_zIt is perhaps easy to envision what should constitute quality health care for all people. What about choice in what quality health care means per person, according to what one wants for their lives?

When a person reaches the age of adolescence, they become more aware of how their surroundings and choices affect their future. When that adolescent is entrenched in a patriarchal society, the set expectations for their future more so affects their current life and health. Examples include teen pregnancy as a result of early and child marriage, lack of access to age-appropriate sexual and reproductive health education, and young women dropping out of school.

The Hunger Project is working in Africa and South Asia to shift these patriarchal mindsets and empower youth – both young women and men – to make decisions about their health and future through the Her Choice Program.

Through a community-based mentoring approach, including peer mentors, the program mobilizes relevant community actors to build local ownership over ending child-marriage. Activities aim to foster empowerment among girls and young women to take control of decision-making, and sensitize the community to value such.

Girls and communities become increasingly aware of the negative [health] consequences of early, child and forced marriage, which allows girls and young women to better participate in society and apply newly gained knowledge from sexual and reproductive health rights (SRHR) into their life choices. “If, when and whom” to marry is the primary choice in focus.

Early, child and forced marriage pervades the cycle of poverty, especially for young women: dropping out of school, teen pregnancy, limited or no household decision making capacity, poor health of young mothers and newborns, lack of decisions around one’s sexual and reproductive preferences, and stagnated economic empowerment and income generation among women. The program aims to improve access to formal education for girls by supporting girl-friendly schools and access to youth-friendly SRHR services.

035Relevant community actors are key in helping shift the patriarchal social norms to ensure an enabling environment wherein girls can make their own life choices. Women’s “self-help” groups carry out trainings and education about financial services to improve economic security of girls and their families. This helps to decrease incentive for marrying off daughters and increase women’s independent economic empowerment. Relevant community actors also include traditional leaders and supportive groups of men of all ages to help transform social and traditional norms toward inclusion of women and girls in decision-making. Traditional leaders are especially crucial in helping enforce national policies around child marriage, in not approving or overseeing child marriages in their respective communities.

By imbedding youth-friendly SRHR leadership and program activities into communities, Her Choice is influencing sustainable results. They can continue building on local assets and train additional young leaders to continue fostering women’s choice in marriage.

Do you want to marry? If so, when would you want to marry? And to what kind of person would you like to be married? Do you want to finish school before you consider marriage? Do you want to finish school and pursue work more than you want to be married? The choices – at least in some way – affect health and economic security.

There are many ways we can degrade, stabilize or improve our own health. Everyday habits like washing your hands, drinking clean water, eating healthily, to more long-term choices like getting vaccinated. Young women have a right to choose their future of health, and that right includes choosing “if, when and whom” they should marry.



Countdown to 2015 – 2014 Report

cd14tCountdown launched its 2014 Report on June 30, 2014, at the Partners’ Forum of the Partnership for Maternal, Newborn & Child Health (PMNCH), held in Johannesburg, South Africa. Countdown was a co-sponsor of the Forum, together with PMNCH, A Promise Renewed, and the independent Expert Review Group (iERG). THP is a member of PMNCH and A Promise Renewed.

The 2014 Report, Fulfilling the Health Agenda for Women and Children, was released exactly 18 months to the day from the deadline for the Millennium Development Goals at the end of 2015. Like previous Countdown reports, it includes an updated, detailed profile for each of the 75 Countdown countries (including all 12 THP program countries. The 75 Countdown Countries together account for more than 95% of the global burden of maternal, newborn and child death. The report shows that progress has been impressive in some areas, but it also highlights the vast areas of unfinished business that must be prioritized in the post-2015 framework.

Key facts in the report:

  • There were 6.6 million preventable under-5 deaths in 2012 of which 3 million are due to malnutrition – 8,200 per day,
  • A key indicator is the Annual Rate of Reduction, which needed to be 4.4% from 1990 to 2015. It currently stands at only 3.8%, putting MDG 4 out of reach globally, however 41 of the 75 countries have achieved that rate from 2000-2012, pointing to what’s possible.

Key profile indicators for THP Program Countries:

We strongly recommend you download and use the two-page profiles created for your country:


Link to profile Annual Rate of Reduction 1990-2000 Annual Rate of Reduction 2000-2012
Bangladesh 4.9 6.4
Benin 2.0 4.2
Burkina Faso 0.8 5.0
Ethiopia 3.4 6.3
Ghana 2.1 3.0
India 3.2 4.0
Malawi 3.4 7.5
Mexico 6.0 3.7
Mozambique 3.4 5.1
Peru 6.9 6.5
Senegal 0.2 7.1
Uganda 1.9 6.3


CSW58 Women’s Health in Conflict Areas

Isis-WICCE Model on Comprehensive access to Healing and development

2014-03 CSW-1

Editor’s note: THP organized a parallel event on the opening day of the 58th Session of the UN Commission on the Status of Women, co-sponsored by the Center for Health and Gender Equality (CHANGE) and BRAC. What follows is the presentation by Ruth Ochieng, brought here by CHANGE.

As you all know, Peace and security was not one of the MDG Goals, neither did the agenda recognize gender based violence as one of the underlying causes of gender inequality and discrimination, especially among the vulnerable and the minority. As a result, challenges of many survivors of armed conflict especially women, who experience rape and sexual violence have had no direct concrete policies or mechanism to improve their well being. Even the DDRR or the peace and rehabilitation development plans that nations implement, that are specifically meant to address the concerns of those affected by the conflicts (from fighters to civilians), have continued to marginalize sexual violence in particular, as a priority aspect that needs immediate intervention. This has been a reality in many countries where Isis-WICCE has worked namely; Uganda, Liberia, DRC, South Sudan, even in western Kenya after the political crisis, Nepal and Kashmir in India, where war is silently affecting many women’s bodies, mind and spirits.

Whereas in addressing goal 1 to 8 one could argue that it is one way of bringing peace and security to an individual and in communities as a whole, the goals were not explicit to the needs that are unique to survivors of rape and sexual violence in conflict settings. I will give you a short scenario;

While documenting the experiences of women in conflict settings, I met a woman liberator who put her life on the front line to fight injustice, and give good governance a chance in her country. While she successfully commanded her troops, the male counterpart did not relate to her as a comrade in the struggle but as a sex object. She shared with me how her superiors would force her into sex in her own words “they raped me several times”. Out of the rapes she conceived two children…. 10 years later she was on her own …she was told “the war is over, you can now go back to your gender roles…..she left with her 2 children…At the time we met her she had nothing to feed her children, she had no income she was emaciated as her children too were malnourished. The first call she made to us was please get something for my kids….they have not eaten anything since morning…it was 4 pm when we talked to her. At that time the DDR process was going on in her country, a mechanism specifically catered for combatants. Her case would have been intervened by the first 6 goals of the MDGs, but she was not able to access any, neither did the mechanism at national level reach out to her numerous needs;  This is a story of millions of women and girls survivors of wars. Instead she was given a package of $300, a mattress and some seeds. The package did not recognize the two children in its system.

Our 18 years of documenting the voices of women affected by wars, particularly rape and sexual violence survivors reflect huge magnitude of health complications that have not been taken care of. In Uganda for example where we have documented and worked with over 15,000 survivors, more than 35% of these reported to have been raped, 45% reported to have experienced other physical attacks that targeted their physical and sexual organs, which resulted to fistula, prolapsed of the Uterus, chronic illnesses such as STDs and HIV/ADs and for other this resulted in cervical cancer among others health complications.  In the countries where we have documented survivors, 70% of the violation led to different levels of trauma.

The lessons we have learnt over the years point to the fact that the available mechanisms ( such as MDGs, UNSCR 1325, DDRR  processes the national constitutions), continue to marginalize SRHR of women and girls when we all know that it is extremely difficult in circumstances as explained above to engage in any form of productive activity, including being part of any decision making processes. Therefore it is impossible to imagine that communities whose infrastructure is destroyed, and individual special needs such as those explained above are not taken care of, can realize any given target among the Millennium Development Goals.

Isis-WICCE response.

This prompted Isis-WICCE since 1997, to endeavor and bridges some of the gaps through its multiple innovations that have focused on the healing of body, mind and spirit, especially survivors of sexual violence in conflict setting, in order for survivors to become productive and developmental.

Research among the survivors helped us to establishing the extent of the problem, and the kind of needs to solve the bigger problem. Isis-WICCE then undertakes strategic partnerships with health workers, government institutions and women activists’ at village levels to carry out healing camps among the survivors in the affected rural settings. The interventions include a range of services such as collecting data on the individual health complications, (which forms yet another set of knowledge for further analysis); treatment, surgery particularly for those with reproductive complications, and counseling for those identified to have mental illness. The strategy has a component of referral in appropriate institutions (especially mental health), for long term healing. This healing process is the first step to activate their re-entry into the active spaces and become effective actors in development.

Skills building; after the healing process, Isis-WICCE conducts skills building programs for the survivors and the women leaders in their communities. They are introduced to a range of programs and training that is meant to expand their horizon and understanding of their political environment, peace building processes and engaging the governance processes to implement their commitments. Today a number of these survivors have been the force of change and peace building in many communities.

Experience has shown us that with the healing and skills acquired, many survivors are finally able to reclaim their esteem and dignity. They start to engage and become active citizens. Many of the survivors have moved on to run for elective political offices and challenge the status quo. We have seen this happen in all the countries we have worked in. In Uganda for example, survivors have formed community based organisations that are presently addressing all the MDGs at village levels, using the knowledge, available natural resources and the human capital of course with the limited financial support received from different actors. The trained women have moved to the next level, where they have been supported by Isis-WICCE to engage the local leadership. They started what is called a Peace Exposition, an annual platform where the women mobilized survivors of conflict to interface directly with their leaders, to challenge them on the gender gaps in the implementation agendas, as well as learn from one another critical issues affecting their well being, such as the climate change, food security, insecurity in their communities, rights of women, ending sexual violence against women and girls, engaging male youth and men, among others.

Isis-WICCE has continued to use this platform to provide women, men, and the youth in these communities access to quality services such as screening of cervical cancer, HIV/AIDs, STD, and STIs from qualified health worker, whom many of such communities cannot access. From the past 4 peace expositions we have held in Uganda rural districts of Soroti, Kasese, Lira and Karamoja (all affected by conflict), health workers have been able in a month of the peace exposition in each of the districts to screen over 3,000 women and men, girls and boy each year. Every year, between 50 and 100 women and girls have been found to have cancer of the cervices, some at the early stage but others at a very advanced stage. All are provided with appropriate information and referral for their next service in the nearest hospital, where the local health team takes charge of the next process.  Many of the survivors have indicated that without the peace exposition they would not have known their status. However, the ill stocked hospitals (human and drugs), has left many not to access the needed services in time, leaving them with no option but to wait for death!

Some of our alumni who are also  part of the Women Task Force to monitor the government implementation of the peace and recovery programs have continued to demand for good quality health services, including reduction of child mortality, improved maternal heath, combating HIV/AIDs, as well as reminding government about other health complications among survivors of armed conflict, which are not directly part of the MDGs Agenda, which have also not been prioritirized by the peace and recovery and development plan (PRDP). This has left huge gaps in the achievements of the MDGs, especially for quality health services for women and girls survivors of armed conflict.

The Gendered GAPS

Although collectively governments and other stakeholders have provided some successes in bridging the gender gap in taking commitments to fight HIV/AIDs; improving maternal health, address poverty, provide access to education for all, more women taking up decision making positions; There are still numerous gaps in providing comprehensive access to health services to survivors of sexual violence, including care to address the long term consequences of sexual violence in conflict, such as caring for children born out of rape, pregnancies after rape and trauma.

Another gap the survivors have identified is the narrow focus of the agenda on promoting gender equality and empowerment of women, where the component of education is only targeting the mainstream education for girls and boys and leaving out adults (especially women who have for decades been marginalized in this area), who lost the opportunity because of the long conflicts. Communities need a diverse spectrum of education, such understanding the pattern of weather, climate change, nutrition, leadership and governance, and rights in general. This lack of enhancing adults with appropriate knowledge for relevant interventions, has left many survivors of conflict extremely poor, sick an informed, and therefore cannot effectively participate in the development agenda.

Policy Recommendations

The failure for the MDGs to recognize the impact of violence against women and particularly sexual violence is a fundamental gap for any country to achieve the MDGs. About two weeks ago, the European Union released its biggest survey ever among all EU states that still reveal that about a third of women in the EU have experienced some form of sexual violence. If this can happen to EU, where some systems and people centered policies are in place, what do we expect to find in countries hit by crisis?  This is a clear manifestation that the implementation of the MDGs have not resolved one of the most devastating violations in the history of human kind, and that The MDGs continue to fail to connect with the holistic needs of women survivors of sexual violence, especially in conflict settings, making it unable for half of the population to be part of this development agenda, hence leaving many countries unable to achieve their expectations.


As the world prepare to launch the new Agenda (+2015), we have observed that real peace and development can only happen if individuals are at peace with themselves. Therefore, the Post 2015 framework therefore should focus on;

  • Providing comprehensive access for sexual and reproductive health services, especially for raped victims, and do away with bad policies that continue to affect the reproductive health and rights of women and girls.
  • Provide resources in preventing sexual violence and support women organisations in the generation of data and information on SRHR.
  • Ensure that women are no longer invisible decision makers in all levels of governance, and their power is utilized to make rights based approach to policy formulation. Numbers alone without giving them power to make decisions is not right
  • Consult experiences CSOs especially at local level in the designing and formulation of policies.

Thank you for Listening.

2013 Report on Children and AIDS

Children_and_AIDS_Sixth_Stocktaking_Report_ENUnicef reports that “More progress has been made between 2009 and 2012 than during the previous decade, according to 2012 data, which show a 35 per cent decline in new HIV infections among children under the age of 15 years, compared with 2009.2 In 2012, coverage of antiretroviral drugs (ARVs) for pregnant women living with HIV reached 62 per cent in the 22 priority countries…”

You can download the full report here.

Five of the eight THP countries in Africa are among the 22 priority countries for reducing mother-to-child transmission. Ethiopia, Ghana and Malawi are hailed for achieving “rapid decline” (50% or more) with Mozambique and Uganda achieving “moderate decline (30-40%).  India is the one non-African priority country: while infection rates are relatively low, the number of HIV+ mothers and childrens are enormous, and are spread out across the country.

Here are three key statistics: the rate of HIV infection among adults, coverage of HIV positive mothers receiving antiretrovirals (ARVs) to prevent mother-to-child transmission, and coverage of HIV positive children receiving ARVs.

Country Adult HIV+ Mom ARV Kids ARV
BD <0.1%
BF 1%
BN 1.1% 49%
ET 1.3% 41% 24%
GH 1.4% 95% 25%
IN 0.3%
MW 10.8% 60% 36%
MX 0.2%
MZ 11.1% 86% 27%
PE 0.4%
SN 0.5%
UG 7.2% 72%