Janet Fleischman
Palladium
March 2022

This is a pivotal moment for the Biden administration and the U.S. Agency for International Development (USAID) as they formulate a new vision for sustainable global health and development. The chief proponent is USAID Administrator Samantha Power, who is championing locally led and inclusive development, known as localisation.

The aspiration is to make U.S. foreign assistance more accessible, equitable, and responsive by shifting leadership, decision-making, and funding to local actors – government, civil society, and private sector.

While previous U.S. administrations promoted country ownership, the current discussion has taken on far greater urgency; it is happening amidst a pandemic and a global reckoning around structural racism and social determinants of health, decolonisation of global aid, and the power imbalances inherent in donor-driven development. Despite many challenges ahead, this vision holds the promise of advancing partner countries’ needs and priorities and transforming the global health landscape through a more equitable, collaborative, and sustainable approach.

As USAID moves forward with localisation, lessons learned from the Health Policy Plus Project (HP+) experience in partnering with local actors in 49 countries to design and apply policy, advocacy, financing and governance solutions to health challenges can help inform the way forward.

Click here to link to the full commentary.

Topics: Health Policy Plus (HP+), localization, USAID, U.S. policy

Janet Fleischman

Center for Strategic and International Studies
March 31, 2022

The urgency and the challenges of advancing gender equity and equality are glaringly evident around the world. While the impacts of Covid-19 are reversing decades of health and development gains for women and girls, conflicts from Afghanistan to Ethiopia and, increasingly, Ukraine expose how failure to address gender dynamics significantly worsens those crises and further undermines global peace, prosperity, and security. This is an inflection point for U.S. policymakers—a year into a Biden administration that has made bold pronouncements on gender, with a world celebrating Women’s History Month—to assess the road ahead for the global dimensions of the new National Strategy on Gender Equity and Equality. Amid so many competing priorities, the question is, what will it take to propel this significant gender initiative to the next stage and establish the credibility and attention to deliver concrete results, not simply aspirational words?

On March 8, 2022, International Women’s Day, President Biden reaffirmed his commitment to advance gender equity and equality domestically and globally. Framed by the launch of the first-ever national gender strategy and supported by a $2.6 billion budget request for gender programs in foreign assistance, the administration is seeking to reinvigorate U.S. leadership with an ambitious vision for a whole-of-government approach. The administration has put in place exceptional leadership and capacity to deliver at high political levels, including at the White House, the State Department and the U.S. Mission to the United Nations, the U.S. Agency for International Development (USAID), and the Department of Health and Human Services (HHS). Yet the time window for action and impact is narrowing, and next steps for implementation involve protracted, inside government processes. At the same time, the path ahead is increasingly complicated, with multiple world crises, a global pandemic, toxic partisanship, and institutional resistance all threatening to derail the agenda. After the sustained attacks on gender-related issues under the Trump administration, especially around sexual and reproductive health and LGBTQI+ rights, the Biden administration is faced with the strategic imperative of advancing gender equity and equality as essential to achieving U.S. goals on global health and development, economic prosperity, and national security, and proving that this can be accomplished.

To demonstrate the necessity of prioritizing global gender issues, the strategy will have to be executed effectively and deliver results. This will require the administration to expedite the timeline, identify a limited number of top-line priorities, widen the circle of committed champions, and garner operational and political support from key external, global partners.

Click here to link to the full commentary.

Topics: gender equality, global health security, U.S. policy

Authors: Fannie Kachale, Imelda Mahaka, Fatima Mhuriro, Mary Mugambi, Joseph Murungu, Barbra Ncube, Getrude Ncube, Albert Ndwiga, Rose Nyirenda, Violet Otindo, Anna Carter, Megan Dunbar, Janet Fleischman, Jessica Rodrigues

Global Health Action
March 24, 2022

The HIV pandemic has long revealed the inequities and fault lines in societies, one of the most tenacious being the pandemic’s disproportionate impact on adolescent girls and young women. In east and southern Africa, renewed global action is needed to invigorate an effective yet undervalued approach to expanding HIV prevention and improving women’s health: integration of quality HIV and sexual and reproductive health (SRH) services. The urgency of advancing effective integration of these services has never been clearer or more pressing. In this piece, national health officials from Kenya, Malawi, and Zimbabwe and global health professionals have joined together in a call to catalyze actions by development partners in support of national strategies to integrate HIV and SRH information and services. This agenda is especially vital now because these adolescent girls and young women are falling through the cracks due to the cascading effects of COVID-19 and disruptions in both SRH and HIV services. In addition, the scale-up of pre-exposure prophylaxis (PrEP) has been anemic for this population.

Examining the opportunities and challenges of HIV/SRH integration implemented recently in three countries – Kenya, Malawi, and Zimbabwe – provides lessons to spur integration and investments there and in other nations in the region, aimed at improving health outcomes for adolescent girls and young women and curbing the global HIV epidemic. While gaps remain between strong national integration policies and program implementation, the experiences of these countries show opportunities for expanded, quality integration. This commentary draws on a longer comparative analysis of findings from rapid landscaping analyses in Kenya, Malawi, and Zimbabwe, which highlighted cross-country trends and context-specific realities around HIV/SRH integration.

Click here to link to the article.

Topics: Adolescent girls and young women, family planning, family planning-HIV integration, HIV/AIDS, Kenya, Malawi, maternal-child health, reproductive health, Zimbabwe

Janet Fleischman, senior associate
CSIS Global Health Policy Center
January 26, 2021

The Covid-19 pandemic has glaringly illuminated and exacerbated gender inequalities in health and development around the world. These mutually reinforcing crises, further compounded in countries with high HIV burdens, demonstrate that strengthening global health security requires a concerted focus on the health, development, and leadership of women and girls. Given the Biden-Harris administration’s new commitments to global health and gender, this is a propitious moment for the United States to catalyze programs, policies, and resources focused on women and girls to advance global health security strategy. “No country can recover from this pandemic,” President Biden said on March 8, International Women’s Day, “if it leaves half of its population behind.”

Requiring a gender lens for global health security is consistent with U.S. national interests in advancing women’s and girls’ access to healthcare, promoting social and economic development, providing humanitarian assistance, and increasing the odds of success for preparedness, response, and recovery activities. Such an approach calls for concerted action on four key fronts, and the administration will be judged on the progress it makes in these areas:

• • prioritizing women and girls in the global response to Covid-19, including by addressing the secondary impacts such as gender-based violence (GBV), economic hardship, and loss of educational opportunities;
  • strengthening access to sexual and reproductive health and maternal health as cornerstones of U.S. support for primary health care (PHC) globally and for building stronger health systems;
  • elevating women’s and girls’ health and protection in humanitarian crises, especially addressing GBV and supporting the provision of reproductive and maternal health services; and
  • engaging and elevating women at the family, community, national, and global levels as decisionmakers on health security, which includes female healthcare workers, who make up 70 percent of the global health workforce.

Click here to read the full commentary.

Topics: Adolescent girls and young women, COVID-19, economic development, education, family planning, gender equality, global health security, HIV/AIDS, maternal-child health, reproductive health, U.S. policy, women’s empowerment

Lead authors: Janet Fleischman, senior associate, CSIS Global Health Policy Center; J. Stephen Morrison, senior vice president and director, CSIS Global Health Policy Center

January 11, 2021

Thirty experts in global health, foreign policy, economic development, and national security signed "A Call to Action: Women’s Health and Gender Equality." The group represents a range of political views, but agrees that advancing women’s health and gender equality as fundamental rights is not only critical for global health and development, but also serves U.S. national security interests.

The results of the 2020 elections have brought the United States to a pivotal juncture. The Biden-Harris administration should capitalize on the window of opportunity of its first months in office to establish key pillars that will guide its tenure; a priority should be to reimagine U.S. global leadership on women’s health and gender equality. This will require Americans from diverse political persuasions to come together to promote a new vision and proactive strategy for the reinvention of the U.S. international agenda on these issues. With unprecedented domestic and global mobilization around women’s health and gender, this moment calls for decisive and inclusive action.

We represent a range of political views, but our engagement on women’s health and gender equality draws from a series of high-level activities organized by the CSIS Global Health Policy Center: the CSIS Commission on Strengthening America’s Global Health Security (2018–2022), the CSIS Women’s Health Policy Forum (2017–2020), and the CSIS Task Force on Women’s and Family Health (2015–2017). All these endeavors have shown that advancing women’s health and gender equality as fundamental rights is not only critical for global health and development, but also serves U.S. national security interests; in particular, this includes reaching long-standing U.S. goals on global health, poverty reduction, economic development, conflict prevention, and humanitarian response. Our purpose is to cut through the divisive partisanship and congressional deadlock to promote the renewal of a common sense, bipartisan approach to women’s and girls’ health, empowerment, and gender equality, building on points of continuity from prior Republican and Democratic administrations. Now is the time to bring people together, to look forward, and to rebuild consensus.

To meet this challenge, the new administration should adopt a signature focus on women’s health and gender equality as a fundamental pillar of U.S. foreign and development policies and programs. The time has come to restore U.S. leadership and capacity, repair frayed alliances around the world, and renew U.S. commitments to support a robust strategy to promote women’s health, development, and gender equality. This means adopting a new style of U.S. leadership, characterized by greater multilateralism and humility, learning from others and joining them as a supportive partner, and using U.S. power and influence to lift up and amplify voices from the Global South and women’s movements. To accomplish this, the new administration should adopt a bold approach to elevate this agenda and galvanize bipartisan support, while simultaneously reaching beyond Congress to forge a coalition that heightens the visibility of the private sector, health care providers, and the faith community to join with nongovernmental organizations and advocates for women’s and girls’ health and rights and gender equality. Such an approach would advance U.S. interests in saving lives while promoting prosperity and stability, and could help overcome the reluctance among more moderate voices in Congress.

Click here to read the full document and to see the signatories.

Topics: Adolescent girls and young women, COVID-19, economic development, education, family planning, gender equality, global health security, HIV/AIDS, maternal-child health, PEPFAR, reproductive health, U.S. policy, women’s empowerment

Janet Fleischman
Center for Strategic and International Studies
November 30, 2020

On World AIDS day in 2014, the U.S. Global AIDS coordinator, Ambassador Deborah Birx, sounded the alarm on HIV infections in adolescent girls and young women (AGYW) and launched an ambitious initiative called DREAMS—Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe—to significantly reduce new HIV cases in the highest-burden countries. After five years and over $900 million invested, DREAMS is now at an inflection point, with Covid-19 threatening to reverse its impact, along with decades of health and development gains for women and girls.

Faced with the intersecting crises of HIV, Covid-19, and gender inequality, the Biden-Harris administration should advance a strategic vision around securing a healthy future for this growing population of young women as key to the Covid-19 response and to the prosperity and stability of their countries—all central to U.S. national interests. While Covid-19 and vaccine distribution will dominate U.S. global health policy in the near term, these issues do not exist in a vacuum: in countries battling HIV epidemics, efforts to tackle the health and economic impacts of Covid-19 will not succeed without also addressing the fundamental challenges of HIV and gender inequality, which increase risk and vulnerability, especially for AGYW. To launch such a timely and targeted response, the incoming administration should build on the existing platform of DREAMS, adapting and amplifying its focus on AGYW as a priority health and development initiative.

You can read the full Commentary here.

Topics: Adolescent girls and young women, Covid-19, DREAMS (Determined, Resilient, Empowered, AIDS-Free, Mentored, and Safe), gender-based violence, gender equality, global health security, HIV/AIDS, Kenya, reproductive health, PEPFAR, South Africa, U.S. policy, violence against women and children, Zambia

Janet Fleischman, consultant on a project for the Ouagadougou Partnership
Marie Ba, Director of Ouagadougou Partnership Coordination Unit (OPCU)

Council on Foreign Relations, Think Global Health

March 18, 2020

Sometimes innovation to spur social change arises in unexpected places. At a time of increased extremism and insecurity in West Africa, the remarkable story of a partnership to advance women’s health and empowerment through family planning is worthy of global attention. By tackling such challenges, the partnership provides hope for women, girls, and their communities in a troubled region, with lessons for other parts of the world.

The story began in 2011, in Ouagadougou, the capital of landlocked Burkina Faso, when representatives from nine Francophone West African countries joined with international donors to launch a simple but radical plan. The idea was to expand access to contraception in a region that was dramatically lagging behind the rest of the continent in maternal and child health. What became known as the Ouagadougou Partnership achieved a level of success that was unimaginable at its outset almost a decade ago, when even discussing family planning in such conservative societies was still perceived to be taboo. Even more important for future prospects, the partnership has evolved into a dynamic and influential regional platform involving governments, donors, civil society, and implementing partners, with a special emphasis on engaging young people.

Click here to read the full article.

Topics: Adolescent girls and young women, economic development, education, family planning, Francophone West Africa, funders, maternal-child health, reproductive health, U.S. policy, women’s empowerment

Janet Fleischman and Sara M. Allinder
CSIS Global Health Policy Center
April 2, 2019

In some communities of KwaZulu-Natal Province, South Africa, 60 percent of women have HIV. Nearly 4,500 South Africans are newly infected every week; one-third are adolescent girls/young women (AGYW) ages 15-24. These are staggering figures, by any stretch of the imagination. Yet, the HIV epidemic is not being treated like a crisis. In February, we traveled to South Africa, to understand what is happening in these areas with “hyper-endemic” HIV epidemics, where prevalence rates exceed 15 percent among adults. We were alarmed by the complacency toward the rate of new infections at all levels and the absence of an emergency response, especially for young people.

This is no time for business as usual from South Africa or its partners, including the U.S. government through the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR). The epidemic is exacerbated by its concentration in 15-49-year-olds, those of reproductive and working age who are the backbone of South Africa. Without aggressive action to reduce the rate of new infections in young people, HIV will continue to take a tremendous toll on the country for years and generations to come. Collective action is needed to push beyond the complacency and internal barriers to implement policies and interventions that directly target HIV prevention and treatment for young people. PEPFAR should ensure its programs support those efforts.

Click here to read the full commentary.

Topics: Family planning, HIV/AIDS, PEPFAR, maternal-child health, South Africa, U.S. policy

Janet Fleischman and Katey Peck
CSIS Global Health Policy Center
November 2016

With each passing week, the political unrest and repression in Ethiopia is attracting new levels of global attention: from Feyisa Lilesa’s protest sign at the Rio Olympics in August, to recent clashes in Oromia where hundreds of protesters were killed by security forces and hundreds more jailed, and now the government’s declaration of a sweeping state of emergency for the next six months.

There is little doubt that the inherent contradictions of Ethiopian rule—tight restrictions on human rights and governance while pursuing pro-poor policies—now threaten to derail its notable but fragile progress in women’s and children’s health. The current crisis also exposes the shortcomings of U.S. policy in Ethiopia; while providing substantial funding for health and development and maintaining close security ties, U.S. reluctance to hold its longtime ally accountable for its repressive tactics could put these investments at risk.

Click here to read the full article. 

Topics: Ethiopia, family planning, maternal-child health, U.S. policy

Janet Fleischman
CSIS Task Force on Women's & Family Health
October 27, 2016

“Ending preventable maternal and child death is an admirable goal that we can all be proud of…. But we need to get to a place as a country where we view this goal with the same commitment and determination as when we went to the moon.”

That powerful message was delivered by Ryan Kaldahl, a foreign policy advisor to Senator Susan Collins (R-ME) at a CSIS event on October 20. The event marked the launch of a new Lancet series on maternal health, with a panel discussion about the implications for U.S. policy. The featured speakers were Dr. Margaret Kruk, associate professor of global health at the Harvard T.H. Chan School of Public Health; Dr. Elizabeth Fox, director of the office of infectious diseases and deputy coordinator for maternal and child survival at USAID; Dr. Mariam Claeson, director of the Global Financing Facility at the World Bank; and Mr. Kaldahl.

The panel discussion emphasized the importance of this moment in prioritizing maternal health, an area directly related to the work of the CSIS Task Force on Women’s and Family Health, of which Senator Collins is a member. In addition to examining the global progress made in reducing maternal mortality and the critical role that USAID has played in that effort, the panelists highlighted new elements that could contribute to consolidating these gains and identified some of the challenges ahead. These include the need to address quality of care, to mobilize sustainable financing, and especially to reach the 53 million women and girls not receiving childbirth care at all—adolescents and unmarried women, refugees and migrants, and those living in fragile or conflict states.

Click here to read the full blog post. 

Topics: Maternal-child health, U.S. policy

Janet Fleischman
Population Council
December 1, 2015

The data are stark and incontrovertible: In eastern and southern Africa, 7,000 girls and young women aged 15–24 are infected with HIV every week. A global convergence is finally emerging around the urgency of going beyond biomedical interventions to address the social and economic factors driving HIV risk for this population. Unprecedented high-level attention is highlighting this crisis – in July 2015 in Addis Ababa, President Obama emphasized the need “to keep teenage girls safe and AIDS free,” and in September the U.S. announced significant additional resources for this effort. Yet addressing HIV risk in adolescent girls and young women remains a fundamental challenge for controlling the AIDS epidemic.

On World AIDS Day 2014, a new initiative was launched by the President’s Emergency Plan for AIDS Relief (PEPFAR), in partnership with the Bill & Melinda Gates Foundation and the Nike Foundation (now spun off to Girl Effect). With an accumulated $500 million in resources and highly ambitious goals, the DREAMS (Determined, Resilient, Empowered, AIDS-Free, Mentored, and Safe) Partnership aims to address HIV risks for adolescent girls and young women in high-burden “hot spots” in 10 countries in southern and eastern Africa.

Click here to read the full blog post.

Topics: Adolescent girls and young women, DREAMS, HIV/AIDS

Janet Fleischman
Center for Strategic and International Studies, Global Health Policy Center
July 24, 2015

The contribution of faith-based organizations (FBOs) to health services and in reaching poor communities around the world has long been the subject of debate among public health experts and policymakers. To explore the nexus between faith and health, the CSIS Global Health Policy Center convened two recent events. The first focused on faith-based organizations and family planning in Kenya, and the second, timed for the release of the new Lancet series on faith-based health care, examined the contributions of faith organizations to global health efforts, and implications for U.S. policy. Both events identified unique strengths and challenges associated with faith-based health programs, as well as opportunities for greater dialogue and collaboration among governments, donors, and faith-based health providers to reach health goals. 

You can read the full blog post here.

Topics: Faith-based organizations, family planning, Kenya, reproductive health, U.S. policy

Janet Fleischman
Center for Strategic and International Studies, Global Health Policy Center
June 18, 2015

Debate about President Obama’s legacy will shift to Africa in late July, when he travels to Kenya on his fourth and likely final presidential trip to the continent. The trip is expected to focus on supporting economic entrepreneurship and combatting terrorism, which, along with increasing Africa’s energy capacity and food security, have been central to his Africa policy. In my latest blog, I write that this agenda misses a necessary component for progress on the continent; the President could cement a lasting legacy by explicitly linking U.S. Africa policy to the health and empowerment of women and girls, arguably the continent’s most dynamic and underdeveloped resource and an indispensable component of any successful economic and security program.

This piece is based on Janet's recent trip to Malawi and Kenya as part of a CARE learning tour that focused on the importance of U.S. investments in women and girls. The delegation included five members of Congress and senior administration officials.

You can read the full blog post here.

Topics: Education, family planning, gender-based violence, Kenya, Malawi, maternal-child health, reproductive health, U.S. policy, women's empowerment

Janet Fleischman
Center for Strategic and International Studies, Global Health Policy Center
April 30, 2015

Anta Ba is a 26-year-old woman living in Guédiawaye, a poor urban area of Senegal’s capital, Dakar.  In a new CSIS video, Anta explains why she decided to access family planning, despite her husband’s opposition, and why these services matter for her own life and for women’s health and empowerment in Senegal. Through her story, and through the voices of other champions of family planning in Senegal—government and NGO health workers, an imam, and the Minister of Health—the video illustrates new approaches to expanding access to family planning as well as the challenges ahead.

The video was released at a vibrant CSIS event on April 27 called “Partnerships to Advance Family Planning in Senegal: Lessons for U.S. Policy,” which featured the minister of health, Dr. Awa Marie Coll Seck. In her keynote address, Dr. Coll Seck passionately articulated her commitment to family planning for the health and development of her country and the Francophone West African subregion: “You can understand my enthusiasm in defending such a cause considering my activism in women’s rights. And my role as a mother, because I am also a mother, and grandmother; and as a medical doctor. But also after listening to people, men and women, in my own country but also in many corners in Africa…. This is not a story of Senegal alone, it’s a story of all Africa but at least let us do something clear for the West African countries.”

Two panels focused on implementation and funding for family planning in Senegal and the subregion. The first panel – with Dr. Bocar Mamadou Daff from Senegal’s Ministry of Health, Pape Gaye from IntraHealth, and Maaike Van Min from Marie Stopes International – delved into the new approaches to advance access to family planning and the importance of the leadership and coordination by the Ministry of Health. Valuable lessons are emerging from Senegal’s experience, including the Informed Push Model to eliminate stock-outs of contraceptives, integration of family planning with immunizations, mobile clinics to reach vulnerable women, and engagement with religious communities and civil society. Yet all the panelists agreed that clear challenges remain for continued progress, such as addressing the reproductive health needs of young people, expanding the engagement of religious leaders, building a multisectoral response, and attracting private sector support for greater sustainability.

The donor perspectives on funding were the subject of the second panel, which included Katie Taylor from USAID, Nomi Fuchs-Montgomery from the Bill & Melinda Gates Foundation, and Fatimata Sy from the Ouagadougou Partnership. They all emphasized the importance of building on public-private partnerships and attracting new donors for family planning in Senegal and for the subregion, as well as the critical role of country-led, costed plans and political will to ensure progress. Taylor noted that since USAID’s primary health goal is to end preventable maternal and child deaths, family planning has to be a critical intervention, and that Senegal’s progress demonstrates why these investments are so effective. Fuchs-Montgomery underscored the foundation’s approach to ensuring that their investments in Senegal and Niger are leveraged by other donors, with the aim of improving women’s health and accelerating a regional demographic transition. To accomplish this, she emphasized, will require leadership, partnerships, and perseverance. Speaking from a regional perspective, Sy noted the importance of donors aligning with countries’ national plans, and expressed her concern that despite costed plans, significant funding gaps remain.  Fragile progress will require continued outside funding, Sy added.

You can read the full blog post here. watch Partnerships for Family Planning: Lessons for U.S. Policy in two parts, here and here.

Topics: Family planning, Francophone West Africa, maternal-child health, reproductive health, Senegal, U.S. policy, women's empowerment

Janet Fleischman
Center for Strategic and International Studies, Global Health Policy Center
April 21, 2015

“The very progress we’ve made in HIV/AIDS over the last 20 years is at risk right now because of our lack of engagement with young women.” That was the stark message delivered by Ambassador Deborah Birx, the U.S. Global AIDS Coordinator, at a dynamic, high-level panel at CSIS on April 17, which also featured Ambassador Mark Dybul, executive director of the Global Fund to Fight AIDS, Tuberculosis and Malaria; Geeta Rao Gupta, deputy executive director of UNICEF; and Judith Bruce, senior associate and policy analyst at the Population Council. Ambassador Dybul echoed the urgency of new initiatives working to address this population: “This opportunity is one we just can’t miss.”

At the event, CSIS released a new report, Addressing HIV Risk in Adolescent Girls and Young Women. The report examines how adolescent girls and young women have become a priority focus in the fight against global HIV/AIDS, the approaches that have proven effective, and the gaps and challenges that remain. In particular, the report highlights the new DREAMS Partnership, launched by PEPFAR in partnership with the Bill & Melinda Gates Foundation and the Nike Foundation, to significantly reduce new HIV infections in adolescent girls and young women. With $210 million and highly ambitious goals, the DREAMS (Determined, Resilient, Empowered, AIDS-Free, Mentored, and Safe) Partnership aims to address HIV risks for adolescent girls and young women in high-burden “hot spots” in 10 countries throughout eastern and southern Africa. The partnership’s goal is to reduce HIV incidence in this population by 25 percent in two years, and by 40 percent in three years. Whether these targets are attainable or simply aspirational remains to be seen, but they represent a determined effort to do things differently.

The panel discussed new ways to increase the empowerment, security, and agency of adolescent girls and young women, including looking at the impact of gender-based violence, cash transfers/incentives, education for girls, safe spaces for girls, and reproductive health/family planning. Although little research has evaluated the combined impact of putting all these interventions together, the panelists agreed that this is the moment to move forward in pursuit of a multisectoral approach. The panelists also expressed the hope that new funding would continue to emerge from multilateral institutions, government partners, and the private sector.  These different funders can leverage each other’s investments.

Topics: Adolescent girls and young women, DREAMS (Determined, Resilient, Empowered, AIDS-Free, Mentored, and Safe), funders, HIV/AIDS, PEPFAR, U.S. policy, women’s empowerment

Janet Fleischman and Cathryn Streifel
Global Health Policy Center, Center for Strategic and International Affairs
December 16, 2014

In a recent interview with the CSIS Global Health Policy Center in Dakar, the Senegalese Minister of Health, Dr. Awa Marie Coll-Seck, used a familiar term to express her commitment to expanding access to family planning—“yes we can.” That is a bold proposition in such a conservative country, in a region with some of the world’s highest maternal mortality and unmet need for family planning. Her leadership reflects an important moment in Senegal. Participants at this week’s annual meeting of the Ouagadougou Partnership should examine lessons from Senegal as they work to advance women’s health and family planning in the subregion.

Click here to read the full blog post.

Click here to read the Global Health Policy Center's report on this topic.

Topics: Faith-based organizationsfamily planning, Francophone West Africa, reproductive health, Senegal, U.S. policy

Janet Fleischman
Global Health Policy Center, Center for Strategic and International Studies
November 4, 2014

Many of us remember the HIV/AIDS prevention mantra “ABC” – Abstinence, Be faithful, use Condoms – but I recently heard a new “ABC” message emanating from the Ebola crisis: Avoid Body Contact, a chilling message for the epidemic ravaging West Africa.

While prevention messages are critical, a lesson from the struggle against HIV/AIDS is that women’s and girls’ risk of infection is compounded by gender disparities and inequalities, and many U.S. programs lost precious time before realizing that A, B, and C were often not within a woman’s or girl’s power to control. Similar concerns might apply to the Ebola crisis. As the United States mounts its emergency assistance to combat Ebola, these lessons should be applied from the start; targeted strategies to address the realities and vulnerabilities that women and girls face are key to an effective and sustainable response.

To read the full blog post, click here.

Topics: Ebola, U.S. policy, women's empowerment

Janet Fleischman
Global Public Square, CNN
May 14, 2014

The international outrage over Boko Haram’s abduction of Nigerian schoolgirls has escalated since the story first hit the news; mothers in Nigeria took action and celebrities from Angelina Jolie all the way to First Lady Michelle Obama have made their voices heard. With mainstream attention finally focused on why the education, health, and empowerment of women and girls matters to Americans, it is time for the Obama administration to re-enforce its commitment to these issues and elevate them as central to U.S. foreign policy.

Click here to read the article. 

Topics: Economic development, education, gender-based violence, reproductive health, U.S. policy, women's empowerment

Janet Fleischman and Alisha Kramer
Global Health Policy Center, Center for Strategic and International Affairs
April 23, 2014

“Investing in family planning is investing in the future.” These words from Ethiopian health official, Dr. Tewodros Bekele, summarize key findings of a new CSIS video and report about family planning in Ethiopia. 

The CSIS video is designed to bring the voices of Ethiopian women and girls as well as champions of family planning into the U.S. policy discussion. Through the voices of rural women, health extension workers, and an Orthodox priest, along with an official of the Ministry of Health and the First Lady, the video vividly highlights the importance of family planning as a core component of Ethiopia’s development.

Click here to read the full blog post.

Topics: Economic development, Ethiopia, family planning, reproductive health, U.S. policy

Janet Fleischman
Global Health Policy Center, Center for Strategic and International Affairs
March 6, 2014

To mark International Women’s Day, First Lady Michelle Obama participated in the 2014 International Women of Courage awards ceremony at the State Department on March 4. The honorees, representing ten countries, were recognized for their extraordinary work on behalf of women and girls -- from combatting gender-based violence and acid attacks, to advancing reproductive health and human rights. The First Lady spoke passionately about the need to confront the challenges that women and girls face at home and around the world, and about how the women being honored “are creating ripples that stretch across the globe.”

Click here to read the full blog post.

Topics: Gender-based violence, U.S. policy, women’s empowerment

Janet Fleischman and Alisha Kramer
Global Health Policy Center, Center for Strategic and International Affairs
November 13, 2013

Billboards in Ethiopia’s capital announce the 2013 International Conference on Family Planning from November 12-15, under the theme “Full Access, Full Choice.” The conference participants from around the world should draw lessons from Ethiopia’s own experience that family planning is central to broader women’s health and development, contributing to the empowerment of women and girls and more stable and prosperous families. Secretary of State John Kerry’s video message to the conference offers a unique opportunity for the United States to strategically reposition family planning as key to sustainable development, and to re-double U.S. commitment to national family planning programs.

Click here to read the full blog post.

Topics: Economic development, Ethiopia, family planning, FP-HIV integration, reproductive health, U.S. policy

Janet Fleischman
Global Public Square, CNN
June 18, 2013

President Barack Obama’s trip to Africa this month is focused on the pressing issues of economic growth and investment, democratization, and the next generation of African leaders. Yet a central element for achieving those goals is missing from the list—advancing the health and empowerment of women and girls. The Obamas have an opportunity to make this trip historic by explicitly committing the United States to focus on women and girls as a key pathway to progress for Africa. But will they seize it?

Click here to read the article.

Topics: U.S. policy

Janet Fleischman and Alisha Kramer
Global Health Policy Center, Center for Strategic and International Affairs
May 21, 2013

U.S. policymakers and private-sector partners increasingly appreciate the importance of targeted U.S. investments in women’s health to achieve global health outcomes, especially in sub-Saharan Africa. With budgetary constraints worsening, progress in women’s health will require maximizing investments by engaging new partners, identifying program synergies, and aligning with countries’ national priorities to meet women’s needs. Such strategic coordination—involving maternal newborn and child health, voluntary family planning, and HIV and AIDS services—presents new opportunities to expand the impact of U.S. investments. 

In March 2013, the CSIS Global Health Policy Center led a delegation to Zambia to examine the opportunities and challenges of strengthening U.S. policy approaches to women’s global health issues. 

Click here to read the full blog post.

Topics: Family planning, FP-HIV integration, HIV/AIDS, reproductive health, U.S. policy, Zambia

Janet Fleischman and Julia Nagel
Global Health Policy Center, Center for Strategic and International Affairs
February 10, 2013

Cervical cancer kills an estimated 275,000 women every year, 85 percent of whom are in developing countries. The link between HIV and cervical cancer is direct and deadly; HIV-infected women who are also infected with specific types of human papilloma virus (HPV) are 4-5 times more susceptible to cervical cancer than HIV-negative women. This has important implications for HIV programs, especially in countries with significant HIV epidemics. 

Click here to read the full blog post.

Topics: Cervical cancer, HIV/AIDS, Zambia

Janet Fleischman and Julia Nagel
Global Health Policy Center, Center for Strategic and International Affairs
January 8, 2013

When Joyce Banda unexpectedly ascended to the presidency of Malawi last April, after the death of President Mutharika, many in her country and around the world wondered what her impact would be as Malawi’s first female president. Among the many challenges, her government faces high rates of maternal mortality, high total fertility rates, and high HIV prevalence among women and girls, combined with low levels of women’s economic empowerment and widespread violence against women.

A short video interview with President Banda explores how women leaders in Africa are bringing new attention to women’s health and empowerment in their own countries, and how they're bringing those voices into the discussion about U.S. policy priorities for women’s global health.

Click here to read the full blog post. You can watch the video here.

Topics: HIV/AIDS, Malawi, maternal-child health, women’s empowerment

Janet Fleischman
Global Health Policy Center, Center for Strategic and International Affairs
July 25, 2012

Senators John Kerry and Lindsey Graham delivered strong messages of bipartisan political support for U.S. engagement on global AIDS in Monday’s plenary session of AIDS 2012.  The participation of this senior Senate Democrat and Republican testified to the crucial bipartisan support that has characterized the President’s Emergency Plan for AIDS Relief, PEPFAR, since its inception.

Click here to link to the full blog post.

Topics: HIV/AIDS, PEPFAR, U.S. policy

Janet Fleischman
Global Health Policy Center, Center for Strategic and International Affairs
July 23, 2012

This is an exciting and promising moment in the global effort to eliminate new HIV infections among children; we can finally see the possibility of eliminating mother-to-child transmission of HIV. To address the current status of these efforts and the way forward, the heads of WHO, UNICEF, and PEPFAR joined with ministers of health from Africa, representatives from the Global Fund, UNAIDS, UNITAID, the private sector, and women living with HIV at CSIS on July 22. You can find full video of the event here.

Click here to link to the full blog post.

Topics: HIV/AIDS, PEPFAR

Janet Fleischman
Global Health Policy Center, Center for Strategic and International Affairs
July 20, 2012

The world's HIV/AIDS leaders are gathering in Washington, D.C., this week under the theme "turning the tide together." Yet the hope and optimism around creating an "AIDS-free generation" needs to be channeled into critical strategies that could make an immediate difference for women and girls. 

The President’s Emergency Plan for AIDS Relief (PEPFAR) is well positioned to serve as a foundation for other global health programs, building on its health infrastructure, training, and systems. To fulfill that potential in the vital area of women’s health will require integrating HIV/AIDS services with family planning and reproductive health services. I was recently in Tanzania, where the results of U.S. health investments indicate that this is a feasible and cost effective strategy to combat the AIDS epidemic and promote the health of women and girls, and through them their families and communities. 

Click here to link to the full blog post.

Topics: HIV/AIDS, PEPFAR, Tanzania, U.S. policy

Janet Fleischman
Global Health Policy Center, Center for Strategic and International Affairs
July 11, 2012

The dual global epidemics of HIV/AIDS and gender-based violence (GBV) exert a destructive and disproportionate impact on women and girls, especially in high HIV prevalence countries in Africa. Despite bipartisan political consensus on the intersection of HIV and GBV, efforts to address this area have not attracted the necessary attention and resources to drive the program innovation that could demonstrate progress. That may now be beginning to change, with new momentum being brought to this agenda by the President’s Emergency Plan for AIDS Reliefs (PEPFAR) GBV initiative.

Click here to link to the full blog post.

Topics: Gender-based violence, HIV/AIDS, PEPFAR, Tanzania, U.S. policy

Janet Fleischman
Global Health Policy Center, Center for Strategic and International Affairs
June 20, 2012

On June 1 in Oslo, U.S. Secretary of State Hillary Clinton announced the “Saving Mothers, Giving Life” project—an ambitious, dynamic effort by the U.S. government with a new public private partnership to drive efficiencies, spur innovation, and ensure impact in this fundamental area of global health.  Maternal mortality is the ultimate health indicator, reflecting both a health system’s strength and how accessible it is to women and girls of reproductive age.  If successful, “Saving Mothers” will be an important dimension of Clinton’s legacy as Secretary, lifting the lives of women, families, and communities around the world.

Click here to link to the full blog post.

Topics: Maternal-child health, Saving Mothers-Giving Life, U.S. policy

Janet Fleischman
Global Post
June 1, 2012

Secretary of State Hillary Clinton announced the “Saving Mothers, Giving Life” project today—an ambitious, dynamic effort by the U.S. government to increase efficiency, spur innovation, and ensure impact in a fundamental area of global health.

Click here to read the full blog post.

Topics: Maternal-child health, Saving Mothers-Giving Life, U.S. policy

Janet Fleischman
Global Health Policy Center, Center for Strategic and International Affairs
December 2, 2011

The Obama administration designated Malawi as a GHI Plus country in June 2010, one of the first eight countries selected to implement the Global Health Initiative’s (GHI) more comprehensive approach to global health and serve as learning labs for other GHI country programs.

The GHI team in Malawi has identified the health of women and girls, including HIV and family planning (FP)/reproductive health (RH) services, as critical, promising areas for GHI success. Though still in early stages of implementation, new approaches are emerging in Malawi that leverage resources from the President’s Emergency Plan for AIDS Relief (PEPFAR) to develop greater program synergies for women and girls. Yet Malawi’s weak health system, combined with ever more serious concerns about governance and human rights issues that are undermining donor support, present challenges that may threaten GHI’s ability to achieve sustainable results.

Click here to read the full blog post.

Topics: Family planning, FP-HIV integration, Global Health Initiative, HIV/AIDS, Malawi, PEPFAR, reproductive health, U.S. policy

Janet Fleischman
Global Post
July 29, 2011

The growing political and economic crisis in Malawi, highlighted by the government’s use of force against peaceful demonstrators last week, could also imperil the groundbreaking expansion of Malawi’s national HIV/AIDS program.

Click here to read the full blog post. 

Topics: HIV/AIDS, Malawi

Janet Fleischman
Global Health Policy Center, Center for Strategic and International Affairs
May 3, 2011

On April 28, the U.S. Global Health Initiative (GHI) issued guidance on the women, girls, and gender equality principle – the first guidance to be issued about the GHI principles. The purpose of the guidance is to provide clarification on the goals and programming options for GHI country teams and partner countries. By explicitly recognizing that gender-related inequalities “disproportionately compromise the health of women and girls and, in turn, affect families and communities,” the GHI is moving forward in putting women and girls at the center of its response. Importantly, the guidance seeks to go beyond looking at women and girls just as beneficiaries of health services and extends into empowering women as key actors and decision makers.

Click here to link to the full blog post.

Topics: Global Health Initiative, U.S. policy

Janet Fleischman
Global Health Policy Center, Center for Strategic and International Affairs
February 2, 2011

Could distributing kits of re-usable sanitary pads to schoolgirls in Kenya help adolescent and teenage girls’ ability to stay in school? Could it educate them about HIV prevention? Could it ultimately help empower girls? The Huru project – which means “freedom” in Swahili – is working to show that it can. 

Click here to link to the full blog post.

Topics: Kenya, HIV/AIDS

Janet Fleischman
Global Health Policy Center, Center for Strategic and International Affairs
November 11, 2010

The opportunities to integrate health services to better address the client’s needs – especially women – is a key piece of the Obama administration’s Global Health Initiative (GHI). I went to Kenya in November to look for lessons for GHI from another US program -- the PEPFAR-USAID program called the AIDS, Population, Health and Integrated Assistance Project (known as APHIA II; the next phase, APHIA Plus, will begin in 2011). APHIA II has shown that integration of HIV/AIDS and family planning can be an important component of HIV services for women, and that PEPFAR funds can be used effectively in an integrated setting to promote access to HIV services as well as broader health outcomes for women and children.

Click here to link to the full blog post.

Topics: Global Health Initiative, HIV/AIDS, Kenya, PEPFAR

Janet Fleischman
AllAfrica.com
September 21, 2010

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.

Link to the column.

Topics: Millennium Development Goals

Janet Fleischman
Global Health Policy Center, Center for Strategic and International Affairs
April 21, 2010

With all the troubling political news coming out of Kenya these days, it’s important to highlight some promising initiatives that are under way in the arena of women’s health, often driven by civil society groups or international NGOs in collaboration with the government. One area where such initiatives are getting some traction involves the bi-directional integration of family planning/reproductive health with HIV/AIDS services. Indeed, the new approaches toward broader integration hold the promise of helping to address both the country’s HIV/AIDS crisis and women’s reproductive health needs, including addressing the huge unmet need for family planning.

Click here to link to the full blog post.

Topics: Family planning, HIV/AIDS, Kenya, FP-HIV integration, reproductive health

Janet Fleischman
Global Health Policy Center, Center for Strategic and International Affairs
November 10, 2009

Pregnant women are known to be especially vulnerable to infection with influenza, including with the H1N1 virus, and to have an elevated risk of serious health complications, including disproportionately high fatality rates and spontaneous miscarriages. This increase in risk is due to the fact that a woman’s immune system is compromised during pregnancy, and because she faces a greater risk of respiratory complications in the later stages of pregnancy as the enlarging uterus compresses her diaphragm and chest. While the number of H1N1-associated deaths in pregnant women has not been huge, the Centers for Disease Control and Prevention (CDC) has reported that 13% of all H1N1-related deaths between April and June were among otherwise healthy pregnant women. In addition, pregnant women infected with H1N1 face a 4x greater risk of hospitalization than non-pregnant H1N1 patients.

Click here to link to the full blog post.

Topics: H1N1 (Swine Flu)

Janet Fleischman
Global Health Policy Center, Center for Strategic and International Affairs
October 6, 2009

Girls’ education has long been recognized as a critical tool in the fight against HIV/AIDS, in the empowerment of women and girls, and in enhancing the health and welfare of families and communities. In a severely AIDS-affected country like Zambia, education and HIV/AIDS are inseparable: the epidemic is causing many girls in poor communities to lose access to education, often compelling them to withdraw from school to look after sick parents or to care for their siblings, or the absenteeism resulting from their care-giving duties leaves them unable to keep up at school. Even those who stay in school face risks related to sexual abuse by teachers themselves or by older men who offer them money in exchange for sex, sometimes as a way to pay for school fees.

Click here to link to the full blog post. 

Topics: Education, HIV/AIDS, Zambia

Janet Fleischman
Global Health Policy Center, Center for Strategic and International Affairs
September 22, 2009

The province of KwaZulu Natal in South Africa is the hardest hit with HIV, with HIV prevalence rates at antenatal clinics estimated to be over 40 percent - about twice as high as the national prevalence. When combined with high rates of teenage pregnancy – about one-third of 18 and 19 year olds have already given birth - it is critical to address the social and economic factors that are contributing to this alarming situation. Data collected by the New York-based Population Council have shown that factors such as poverty, orphanhood, and social isolation can influence sexual behaviors, and therefore HIV risk.

Click here to link to the full blog post.

Topics: Education, HIV/AIDS, South Africa

Janet Fleischman
Global Health Policy Center, Center for Strategic and International Affairs
September 18, 2009

I’m heading to South Africa and Zambia to look at innovative programs that link gender, AIDS, and development. While PEPFAR is not designed to fund development programs, there is a growing recognition that U.S. HIV/AIDS funding must link with the broader development agenda. Given the high HIV infection rates among women and girls in southern Africa, I am going to investigate how HIV/AIDS funding can be linked to aspects of the development agenda to address the structural, societal factors that shape women and girls’ risk of HIV infection and complicate their situations once infected. Key linkages with the development arena include family planning and reproductive health as an essential component of HIV/AIDS services, and education for girls and economic empowerment for women as HIV prevention strategies.

Click here to link to the full blog post.

Topics: Economic development, HIV/AIDS, South Africa

Janet Fleischman
AllAfrica.com
May 29, 2009

When Michelle Obama, the first lady of the United States, visits Ghana with President Barack Obama in July, the powerful voice she has used to empower disadvantaged girls at home can be extended to Africa. By spotlighting the disproportionate impact of Aids on women and girls, she can help strengthen the Aids response - at home and abroad.

Link to the column.

Topics: HIV/AIDS, U.S. policy

Janet Fleischman
The Boston Globe
March 7, 2007

Asunta Wagura'shealthy baby boy has sparked considerable controversy in Kenya. As an HIV-infected woman and AIDS activist, Asunta's decision to conceive a child exposes an emerging feature of the global HIV/AIDS pandemic: increased access to life-prolonging treatment is affecting women's reproductive choices, and challenging ideas about the kind of services and policies required.

If we are to keep pace with the evolving pandemic, concerns about women's reproductive health must become an integral part of HIV/AIDS services and policies.

Click here to read the full article. 

Topics: Family planning, FP-HIV integration, HIV-AIDS, Kenya, reproductive health, women's empowerment

Janet Fleischman
The Washington Post
June 29, 2004

"Access for All," the theme of next month's International AIDS Conference in Bangkok, sets an appropriately high standard for the world's response to the pandemic. Unfortunately, all too many prevention and treatment programs fail to address the needs of most of those living with the virus, especially in Africa: women and girls. It's time to design programs targeted to the risks that women and girls face in a world of AIDS.

Most prevention messages, and certainly those favored by the Bush administration, focus on the "ABC" approach to fighting HIV-AIDS: abstinence, be faithful, and use condoms. While important messages, these things are often not within women's power to control. It is urgent that we develop a "DEF" approach that responds to needs repeatedly expressed by women living with HIV-AIDS and by AIDS activists in Africa.

Click here to read the article. 

Topics: Education, HIV-AIDS, reproductive health, U.S. policy

Janet Fleischman and Kathleen Cravero
The Boston Globe
March 8, 2004

International Women's Day, focusing this year on the plight of women and HIV/AIDS, carries special significance. In the worst-affected regions of sub-Saharan Africa, women and girls account for 58 percent of those living with HIV/AIDS, and girls age 15-19 are infected at rates four to seven times higher than boys, a disparity linked to sexual abuse, coercion, discrimination, and impoverishment.

The Bush administration's new five-year global HIV/AIDS strategy recognizes the urgent situation of women and girls, but much more is needed to translate this into action on the ground.

Click here to read the full article. 

Topics: HIV-AIDS, U.S. policy, women's empowerment

Janet Fleischman and Binaifer Nowrowjee
International Herald-Tribune
July 25, 1996

In the genocide two years ago, many of Rwanda's women were brutally raped — in front of their relatives, sometimes with gun barrels or pieces of wood — and were then forced to watch as their assailants murdered their loved ones.

Thousands of women were raped, gang-raped, mutilated, held in sexual slavery or forcibly taken as "wives" by their persecutors. Not one of those indicted so far by the International Criminal Tribunal on Rwanda, however, has been charged with rape. This aspect of the genocide must not be neglected, and right now the tribunal has a perfect opportunity to include rape in its prosecution.

You can find the article here. 

Topics: Gender-based violence, rape and genocide, Rwanda, U.S. policy