Developing strategies to end hunger
 

163 posts categorized "Foreign Aid Reform"

The Return of an Important Acronym: A New QDDR

  Global women's movement photo
Two sources of energy for development in Bangladesh. Photo by Todd Post for Bread for the World.

By Michele Learner

When I first heard the term "QDDR," it was 2010 and Hillary Rodham Clinton was Secretary of State. Was it just another acronym on the list of official Washington's contributions to the English language?

QDDR is the Quadrennial Diplomacy and Development Review, produced by the State Department and the U.S. Agency for International Development (USAID). As you can guess from my mention of it now, it wasn't just another acronym.

Even in 2010, advocates had been arguing for some time that diplomacy and development are necessary tools for U.S. national security. As Bread and other organizations explained, development assistance to reduce hunger and poverty was "not just the right thing to do, but the smart thing to do."

Now, it seemed, the State Department and USAID agreed. The first-ever QDDR was a comprehensive assessment of how best to use diplomacy and development as tools to reach objectives such as the Millennium Development Goal of cutting hunger in half. The Department of Defense is required by law to prepare a periodic comprehensive assessment, but, of course, its Quadrennial Defense Review focuses on defense as a tool. The 2010 QDDR was a companion document that helped to elevate diplomacy and development as equal partners with defense in U.S. foreign policy.

This week, the second QDDR was released by Secretary of State John Kerry. As the State Department explains, the review identifies major trends "that constitute threats or opportunities," sets priorities, and recommends reforms "to ensure our civilian institutions are in the strongest position to shape and respond to a rapidly changing world."

The new QDDR is more narrowly focused than the first. Secretary Kerry said that he was given some good advice early in his career: If everything is important, nothing is important. Accordingly, the State Department and USAID will concentrate on four global policy priorities:

  • preventing and mitigating conflict and violent extremism
  • promoting open, resilient, and democratic societies
  • advancing inclusive economic growth
  • mitigating and adapting to climate change

"Each of these priorities is related to the need for better governance across the globe," said Kerry. "They're all linked."

Of course, developing an effective strategy for a nearly limitless topic such as "global affairs" requires a close look at that globe through more than one lens. From a different viewpoint than the policy priorities, for example, the QDDR focuses on four "cross-cutting areas." These flow from analysis of major long-term trends. They are:

  • increasing partnerships and engaging beyond the nation-state (for example, partnering with mayors since almost 60 percent of the global population will be urban by 2030)
  • improving governance (partnering with nations and individuals committed to what the review describes as "the difficult work of building strong, democratic governance")
  • managing and mitigating physical risk (Kerry's remark that "diplomats cannot avoid risks in their work" headlined some media coverage of the QDDR's release)
  • enhancing the use of data, diagnostics, and technology ("better application of data for crisis prevention," "greater accountability for strategic planning")

 Michele Learner

"If she did not fight ... it would have been another story"

In sub-Saharan Africa, a girl with hopes for more than a primary education is unlikely to realize them. For rural girls, the odds are even worse. In a region where a minority of all school children—regardless of gender—even complete lower secondary school (ninth grade), parents must fight to give their daughters an equal chance. This was the experience of Fouzia Dahir, a Kenyan Somali woman whose mother personally shielded her from the social and physical forces that threatened to knock her off the path to a college degree. Fouzia’s story is featured in the 2015 Hunger Report video, just released this week and posted above.

Not only are women and girls the majority of the world’s hungry people, but they are the chief agents the world relies on to help end hunger. Evidence shows that gender discrimination causes hunger, but it also shows that removing gender discrimination leads to benefits that reach every level of society. When women are empowered, families, communities, and even economies are healthier and wealthier. Fouzia’s life and work illuminate this truth. She is the founder of the Northern Organization for Social Empowerment, a non-profit organization in Kenya that advocates for equal opportunities for rural women and girls and equips them to seize those opportunities.

Fouzia’s organization takes direct aim at the largest, most obstinate barriers that stand between rural girls and an education. The most threatening of these is deep poverty, which forces many parents to pull their children out of school to work—simply because the family’s survival depends on it. Scarce economic opportunity and the poverty that results from it exacerbate gender inequality by driving families to make difficult choices about which child gets to go to school. Fouzia’s organization trains rural women to be more productive farmers and connects them to markets so they can earn enough income to send all of their children to school and keep them there.

Social norms pose another pervasive, if invisible, threat to women’s empowerment. Fouzia’s community is no exception. Families who embrace modern education often still hesitate to educate their girls, convinced that their rightful place is in the kitchen. Early marriage is commonplace and virtually always means an end to the child bride’s education. Even girls who manage to evade an early marriage face the next challenge of balancing school and studying with an oppressive burden of domestic work that they alone are expected to shoulder. They must walk miles each way to fetch water, gather firewood, and also do the household cleaning, leaving little or no time for homework. Many eventually drop out of school. This is why Fouzia’s organization works to start conversations among families and between families and schools that encourage a more equitable sharing of household work within the family.

Fouzia is a catalyzing force in her community who is generating very real economic and social returns and making lasting improvements. This would not be possible but for the uncompromising insistence of her mother, herself illiterate, that Fouzia stay in school. Fouzia sees potential similar to her own lost in every young girl denied an education.

You can read Fouzia’s story in her own words and learn more about the importance of education to women’s empowerment by reading the 2015 Hunger Report, When Women Flourish …We Can End Hunger

Derek Schwabe

Sad Statistics for the United States on Maternal Mortality

Infant feet

As a policy analyst, my life revolves around data related to hunger, poverty and nutrition of mothers and their children. Statistics are the tool of my trade. I use them to report, to convey information, and often to advocate on issues. A few stay with me: 805 million hungry people in the world (one person in nine); 165 million stunted children who will never reach their full potential in life.

In my research for the Institute’s series celebrating Women’s History Month, I came across another statistic that will stay with me for a long time. A study by the respected British medical journal The Lancet found that the United States is one of only eight countries where maternal mortality (death from complications of pregnancy or childbirth) is on the rise. The other countries are Afghanistan, Greece, and several countries in Africa and Central America.

In this country, 18.5 mothers died for every 100,000 births in 2013—almost 800 women died here that year alone. This is double the rate of Canada and triple the rate of the United Kingdom! What is going on here? How is it that women in the United States are dying at a faster rate from causes related to pregnancy and childbirth than in almost any other place in the developed world?

There seem to be several contributing factors. Some of the reported rise in mortality is likely due to more rigorous data collection; the United States is one country where data on almost anything is readily available. Another factor is the rise in the number of pregnant women here who have conditions—such as hypertension and diabetes—that contribute to making their pregnancies “high risk.” More girls with heart or neurological diseases are surviving to adulthood—good news, but they remain at higher risk during pregnancy and childbirth.

Perhaps the most shocking statistic is that American women of color – particularly African Americans -- are three times more likely to die as a result of pregnancy or giving birth than their white counterparts. Higher poverty rates, which carry numerous consequences such as more chronic health problems and less access to prenatal care, are a major reason that women of color in our country run much higher risks in becoming mothers. 

There is a parallel between efforts to end maternal mortality and efforts to end global hunger. We know that a lack of available food is not the problem. It is getting access to nutritious food — a particular problem for pregnant women and children – that is a major problem. Affording food and reaching a place where it is available pose the biggest challenges. Researchers have found the same to be true in efforts to end maternal mortality -- particularly during or shortly after childbirth. The major problems are affordability and access to skilled care. This is true in the United States as in many developing countries.

The situation is even worse in “fragile states,” developing countries suffering armed conflict or civil war while also confronting high rates of food insecurity. 

Womwn in healthclinic_UN
Mothers and small children line up at a health clinic. Credit: UN

In its State of the World’s Mothers 2014 (SOWM) report, the international organization Save the Children says: “These countries and territories (more than 50 in number) lack resilience to emergencies and face chronic underlying challenges, including extreme poverty, weak infrastructure, and poor governance. In these settings, children and mothers face an everyday emergency, whether or not a humanitarian crisis is officially recognized by the international system.”

During this Women’s History Month, I encourage you to read Save’s SOWM report and take a look at the statistics on maternal mortality compiled by the World Bank and the United Nations World Health Organization. As a result of a concerted effort by governments, international donors, and civil society, we are making remarkable progress toward the goal of ending hunger.  Much less progress has been made toward the fifth Millennium Development Goal of reducing maternal mortality by three-fourths. An equally concerted and collaborative effort, accompanied by sustained funding for healthcare programs in the United States and overseas, particularly in fragile states, is needed to help women survive as they secure humanity’s future by bearing children.

Blog3

Momentum Builds to Reduce Poverty and Violence in Central America

Photo 1

A couple of years ago, the thousands of Central American children fleeing poverty and violence – and arriving at the U.S. southern border – was a phenomenon ignored by policymakers and scarcely mentioned in the U.S. media.

Fast forward to 2015 and we have a New York Times op-ed penned by Vice President Joe Biden calling for more U.S. investment in the region, backed up by a $1.1 billion Obama administration budget request “promoting prosperity, improving governance, and enhancing security” in Central America.

The President’s proposal would increase funding to the Northern Triangle nations of Guatemala, Honduras, and El Salvador – the home countries of most of the children who migrate – to a level four times that of fiscal year 2014. As reported in Devex, the request would make Guatemala the single largest recipient of funding from USAID’s Development Assistance account.

Meanwhile, the State Department and USAID are developing a new strategy to reduce poverty and improve security in Central America. A new strategy was mandated in the congressional spending bill passed in December 2014. Unlike the president’s fiscal year 2016 budget request, which is an aspirational document, the new State Department/USAID Central America strategy includes $130 million allocated to implement it. It is a “done deal.”

Yet another proposed strategy in the mix is the proposal for the region advanced  by the Inter-American Development Bank, the “Plan of the Alliance for Prosperity in the Northern Triangle.” This plan, as well, was created in response to the child migration issue and seeks to improve the economic and security situation in the region.

Within the past six months or so, Congress, the president, and an important multilateral organizations have all proposed major re-thinking and increases in funding to respond to the Central American child migration crisis.

But what does that mean for Central Americans? According to Vice President Biden’s op-ed, the Northern Triangle nations are already taking ownership of the problem by attacking corruption. But on the ground, we’ve seen little to no change.

The Northern Triangle’s problems of inequality, poverty, and violence are decades – if not centuries – in the making. There is no quick solution. But policy proposals from Washington will certainly need to have an impact in the countries themselves if they are to be taken seriously.

Analysts expect details of the State Department plan to be made public in the coming weeks. So far, there is little information publicly available about how Washington’s analysis of the causes and impacts of poverty and violence in migrant-sending regions will be reflected in the plan’s policies and programs. The administration’s previous strategy was called the Central America Regional Security Initiative (CARSI).

A May 2014 Congressional Research Service report on the $800 million CARSI project states, “It is unclear what has been accomplished with the funding appropriated thus far since U.S. agencies have not released the metrics they are using to assess the initiative’s performance.” Subsequent evaluation has found some positive impact from CARSI but overall, the program has a mixed record in addressing the regions insecurity problems.

Analysts have stated that the State/USAID team drafting the new strategy has realized that CARSI was not working and are integrating those critiques into the new plan.  

Reducing poverty should be front and center in any new strategy seeking to create alternatives to undocumented immigration for Central American children and adults. While the motivations for migration from the region are mixed, poverty and a lack of economic opportunity are primary factors in driving migrants to the United States.

In the coming months Bread for the World Institute will be analyzing and sharing examples of programs and strategies that U.S. development agencies can adopt – and then work to bring to scale – to help ease the deep socioeconomic divisions and inequalities in the three Northern Triangle nations. 

Andrew Wainer

Celebrating the Tenure of USAID Administrator Rajiv Shah

Raj Shah

Dr. Rajiv Shah welcomes guests to the launch of Bread for the World Institute's 2011 Hunger Report in November, 2010. (Laura Elizabeth Pohl/Bread for the World)


Dr. Rajiv Shah will be departing USAID (the U.S. Agency for International Development) this week. His appointment as USAID Administrator came in the wake of Haiti’s devastating earthquake in early 2010, just as famine was hitting South Sudan and at a time of continued powerful aftershocks from the global food price crisis. USAID sets and implements the U.S. government’s development and emergency food aid policies, and its employees staff U.S. Missions in countries around the world where hunger and poverty are endemic. In addition to managing a series of crises, Dr. Shah also set out to revitalize an agency that had long been criticized for being overly bureaucratic and dependent on large U.S. implementing partner organizations to carry out many of its programs.

We will remember Dr. Shah’s time at USAID for his passionate commitment to and impatience in the fight to end hunger and malnutrition. In five years, remarkable progress has been made against food insecurity and malnutrition, and U.S. leadership has played an important role. In 2010, Dr. Shah created the Bureau for Food Security at USAID to implement Feed the Future, the U.S. global food security initiative. Under his leadership, USAID also developed the first-ever Multisectoral Global Nutrition Strategy, which will improve coordination across the agency’s bureaus and programs and, most importantly, the effectiveness of U.S. investments in nutrition. 

In addition, President Obama and Administrator Shah have been relentless advocates at the global level for greater and smarter investments in agriculture, food security, and nutrition. They secured new commitments of resources from other countries, multilateral institutions, and the private sector. Dr. Shah served on the Lead Group of the Scaling Up Nutrition (SUN) movement, helping to provide strategic direction as SUN was getting off the ground. At the country level, USAID has been a key SUN partner. Today, SUN, whose members at last count are 54 countries with high rates of childhood stunting, has begun to change national policies and commit funding to fight malnutrition.

We also remember Dr. Shah’s time at USAID for increasing attention to strengthening local capacity and institutions, including recognizing the key role of local civil society. David Beckmann, president of Bread for the World, is a member of USAID’s Advisory Committee on Voluntary Foreign Aid, designed to give policy guidance directly to the Administrator, and was honored to participate in an ACVFA working group that developed a paper on local capacity development. Beckmann later co-chaired the ACVFA task force on strengthening Feed the Future’s collaborations with civil society. Reflecting on Shah’s tenure, Beckmann said, “I thank God for Raj Shah’s outstanding leadership. USAID’s increased effectiveness is making a difference in the lives of millions of people, and it has set the stage for bipartisan collaboration in the U.S. Congress on international development issues. ”

We were honored by Dr. Shah’s presence at important moments for Bread for the World. At Bread’s 2011 Hunger Report launch, Dr. Shah called the report, Our Common Interest: Ending Hunger and Malnutrition,
“the best statement [he’s] read about the importance of Feed the Future to U.S. efforts to combat global hunger and malnutrition.”  He announced the establishment of the Bureau of Food Security at the launch. Dr. Shah was also the keynote speaker at Bread’s 2012 Gala to End Hunger.

He addressed Bread for the World members, representatives of international civil society, and global nutrition stakeholders at the 2013 Sustaining Political Commitments to Scaling Up Nutrition event in Washington, DC. It was here that he announced USAID’s plan for a Global Nutrition Strategy.

Dr. Shah’s individual accomplishments, and USAID’s accomplishments during his tenure, are too numerous to list. Under his leadership the agency prospered. Bread for the World developed closer working relationships with key management and program staff. He has set the bar very high for his successor and has put in place strategies and programs that assure continued U.S. government leadership in the global fight to end hunger and extreme poverty. We at Bread for the World wish Dr. Shah continued success in all his endeavors and look forward to working with the next USAID Administrator.

Scott Bleggi

The President's Budget a Mixed Bag on Food Security and Nutrition

President Obama released his final budget on Monday, February 2, 2015. As was reported by Bread for the World in a press release, the budget invests in people as a key to sustained economic recovery. It includes increased funding for maternal, newborn and child health, and it prioritizes early childhood care and education.

The budget can be lauded for these important domestic funding initiatives, but it is more of a mixed bag in addressing international food and nutrition security. It requests a $14 million reduction from Fiscal year 2015 enacted funding levels in nutrition spending, which is allocated to USAID’s Global Health Bureau.  This is disappointing given worldwide recognition of nutrition’s role across development sectors, and global momentum to improve nutrition policies and programs, especially those focused in the 1,000 days ‘window of opportunity’ from a women’s pregnancy to her child’s second birthday.  Investments here are among the smartest that can be made, with long-term health, social and economic benefits accruing to both individuals and countries themselves.

The International Affairs (150) account in the budget, which funds overseas operations, counterterrorism efforts, humanitarian relief and development assistance is again less than 1% of the total.  At $54.8 billion it does enjoy a small (2.4%) increase over the previous year’s funding but is still many billions below what was spent as recently as the year 2010.

As was reported by the World Food Program, “…humanitarian aid programs were among those that got hit the hardest by budget cuts. Overall humanitarian accounts went down by 13%. International Disaster Assistance was cut by $154 million. Food Aid was cut by $66 million.”  All this during times of historic demand for global assistance. To say that USAID and its implementing partners are stretched thin is an understatement. In fact, according to the Famine Early Warning System web site, there are eight “areas of concern” – Central African Republic, Central America and the Caribbean, Mauritania, Nigeria, Senegal, Sierra Leone, South Sudan and Yemen – that are being watched closely.  Any of these countries or regions can easily slip into food insecurity, requiring additional funding.  Save the Children reported it was “concerned with the funding levels for humanitarian assistance”.

The President’s budget builds on the Administration’s efforts to increase access to early childhood care and education for U.S. children from birth to age five. But at the same time it proposes cuts in disaster assistance, food aid and nutrition, cuts which paradoxically, could have a devastating effect on children from birth to age five overseas in countries where help is most needed.

The President’s budget has been presented to Congress, which will likely now develop a budget of its own.  If the final budget is approved with additional cuts to the 150 Account and any new global humanitarian conflicts arise, a very tight funding scenario could turn disastrous.

The advocacy community will surely be focused with Congress on restoring funding to this critical account.  And surely Congress can find ways to not have the most vulnerable population overseas – women and children - bear a disproportionate amount of cuts in a budget of $4,000,000,000,000.

Scott Bleggi

Three Charts, Three Reasons Empowered Women and Progress on Malnutrition Go Hand in Hand

Improvements in the status of women drove about half of the dramatic reduction in child malnutrition that the developing world has achieved in recent decades. This and many more pieces of evidence brought together in the 2015 Hunger Report affirm that ending discrimination against women and girls–besides being the right thing to do–is crucial to ending hunger. Here are three compelling charts that show how this plays out across an array of important empowerment measures:

As More Girls Complete Secondary School, Stunting Rates Fall

As More Girls are Married before Age 18, Stunting Rates Rise

As Maternal Deaths Increase, Stunting Rates Rise

 

The three charts above compare rates of child stunting (a key measure of chronic malnutrition) in low- and middle-income countries against three sample empowerment indicators: rates of secondary school completion for females; rates of death from complications of pregnancy or childbirth; and rates of child marriage. Each dot represents one country. 

Measuring gender discrimination is complicated because it is pervasive. It cuts across all aspects of human life. This is why the United Nations named a minimum list of 52 gender indicators that are essential to gauging progress. (Yes – these 52 items are the minimum list). The indicators encompass five areas: health, education, human rights, public life, and economic participation.

We can see that stunting rates are lower in countries where women are more empowered – i.e., where they do better on these indicators. This is an issue that merits a more robust research agenda because it shows us an important way forward on hunger.

A note on stunting: stunting means that a child has suffered chronic malnutrition before her/his second birthday. We can “tell by looking” because stunted children are far too short for their age, but the most significant effects can’t be seen: damage to health and cognitive development. Stunting undermines how well a child does in school and even her lifetime earnings. At the national level, stunting can cost several percentage points in GDP growth. Globally, one in four children is stunted.

Visit an interactive tool on the 2015 Hunger Report website to compare global stunting rates with any of 15 important women’s empowerment indicators, view trends by region, and see where individual countries fall. Read this to learn the story of how the tool was created.   

This post is part of Institute Notes’ ongoing series on data to end hunger.

Derek Schwabe

A Global Nutrition Report: Passing Grades, But More Effort Needed

GNRBlog 120914

These children will reach higher and go farther with proper nutrition. (Photo credit: accesstonutrition.org)

What is the extent of malnutrition and how effective are the measures being taken to fight it around the world? What’s being done by governments through policy mechanisms, development assistance, and donors with their program partners? Is civil society sufficiently prepared to be active partners and eventually take over efforts in their own countries? What measures of program and policy effectiveness have been developed?

The Global Nutrition Report (GNR) seeks answers to all these questions. First launched in London last month, its launch in Washington, DC, takes place today with events at the International Food Policy Research Institute (IFPRI), which co-authored the report, and later at USAID, where Administrator Rajiv Shah will speak to his agency’s and U.S. government efforts to reduce malnutrition through its programs and policies. The GNR is a “call to action” to place malnutrition – both undernutrition and obesity – higher on the development agenda.

IRPRI notes in the GNR that "165 million children under the age of five are estimated to be stunted (i.e. low height for age). Two billion people are estimated to be deficient in one or more micronutrients. Nearly 1.5 billion people are estimated to be overweight and over 500 million to be obese. These conditions all have severe consequences for survival, for morbidity, and for the ability of individuals, the economy and society to thrive.... and yet, resources to specific nutrition programs amount to a small fraction of one per cent of domestic or aid budgets."

The GNR includes a “dashboard” of more than 80 indicators of nutrition outcomes, program coverage, funding, and political commitments for all 193 United Nations member countries, “…which they can use to hold policymakers to their commitments and urge them to make new ones.” The report was first announced at the Nutrition for Growth Summit in 2013, and its release was a main topic of discussion at the Second International Conference on Nutrition (ICN2) held in Rome last month.

The report was delivered by an Independent Expert Group and guided at a strategic level by a Stakeholder Group whose members also reviewed the report. IFPRI oversaw the production and dissemination of the report, with the support of the Institute of Development Studies (IDS) in London. The Lancet medical journal provided an external review of the report, which is funded by the U.K. Department for International Development (DFID), the Bill & Melinda Gates Foundation, the Government of Canada, the Children's Investment Fund Foundation, the European Commission, Irish Aid, 1,000 Days, and the CGIAR Research Program on Agriculture for Nutrition & Health.

Recommendations in the report for governments, donors, NGOs, and nutrition community stakeholders include:

  • Building and sustaining global alliances to generate substantial improvements in nutritional status at the national level;
  • Larger investments in human infrastructure;
  • Scaling up nutrition interventions by scaling up local partner capacities; and
  • Expanding investments in “nutrition-sensitive” actions in agriculture, social protection, water, sanitation and hygiene, education, and women’s empowerment programs.

The GNR emphasizes that key challenges remain -- especially in the area of accountability, which must be strengthened in all areas. The report notes pointedly that relying on coordinated actions across development sectors, none of which have nutrition as the primary goal, allows policymakers to avoid responsibility.

Three suggestions were made for improving accountability and leadership. First, in the new set of Sustainable Development Goals (SDGs) for 2030 that is currently being developed through a global process, the nutrition stakeholder community needs to ensure that more ambitious SDG targets are set, including a target for nutrition, and that additional nutrition indicators are included. Second, national legislation and policies must insist on accountability among nutrition stakeholders, including self-evaluation and monitoring processes for member countries of the Scaling Up Nutrition (SUN) movement.

And finally, there is an urgent need to fill the huge gaps that remain in collecting nutrition data. As an example of this, the report says that only 60 percent of the 193 member states of the UN have sufficient data to assess whether or not they are on course to meet global targets.

Without better data and stronger accountability, we stand to lose much of the global momentum on fighting malnutrition that has been built in just a few years’ time. The next GNR could contain more failures than passing grades. But if we sustain the political will that has been created, build local capacities, and scale up successful nutrition interventions, a goal once thought to be merely aspirational gets ever closer: ending hunger and malnutrition in our lifetimes. Scott Bleggi

World AIDS Day 2014: Thoughts from Mozambique

By Rebecca Vander Meulen

Editor's Note: Rebecca Vander Meulen has lived and worked in the province of Niassa in northern Mozambique since 2003. Bread for the World Institute thanks Rebecca for allowing us to repost her World AIDS Day 2014 reflection and photos from her website, Views from Mozambique.

   2014-10-Lichinga 136-001

   Photo by Rebecca J. Vander Meulen

 AIDS in Africa is no longer the cover story that it was when magazines like Newsweek and Time drew my attention to it back in 2000. We have responded deeply—both those of us in places where HIV touches every family, and those of us in places where HIV hides in pockets, away from the view of many.

Globally, the number of new HIV infections each day has gone down steadily since 2000. More than 13 million people around the world are now taking life-giving HIV medications. How miraculous are these antiretrovirals!

Mona’s daughter, Fernanda, who didn’t believe in antiretrovirals (ARVs) and was convinced they would make her sicker, now vigorously runs her household and serves as an informal neighborhood ARV officer, hounding her positive neighbors when they are late in going to the health post to replenish their ARV stock.

And Esperança, whose story I shared two years ago, continues strong.

In 2004, there were fewer than a dozen sites in the whole diocese (the northern half of Mozambique) where HIV testing was available, and even fewer offering HIV treatment. I didn’t actively encourage people to get HIV tests, because if they found out they were positive, it was hard to know what to do. I remember thinking that the global “3 by 5” goals (getting 3 million people on treatment by 2005) were excessively ambitious—but those goals have been met, and now we’re talking about 20 x 20 (20 million people on treatment by 2020). Science has made great strides, and we are at a point where medical understanding and pharmaceuticals mean that a person living with HIV can live as long and as well as a person not living with HIV. What progress we’ve made in the past decade!

IMG-20141201-WA0007

Photo by Rebecca J. Vander Meulen

But this is not the reality for many people living with HIV in Mozambique. Perhaps we have claimed victory too soon. There is still much more work ahead of us—oh, so much more. At least three friends died of AIDS-related causes this year. One had told me of his HIV positive status and proclaimed how eager he was to live openly with HIV, but when he told his wife, she beat him and refused to acknowledge his status. He then decided that telling people he’d gotten a false positive result—and not pursuing treatment—was easier than bearing the stigma associated with HIV. Another friend developed cerebral TB, but her family took her to traditional healers for several weeks before seeking hospital treatment. She was too unwell to argue. And another had been a keen student of HIV, asking just the right questions and understanding the key role of the church in responding to HIV. I never knew he was living with HIV until he died a few months later. We live in the already-but-not-yet of advent—so much good has already happened, and so much is left to be done.

Global figures hide specific pockets, and Mozambique is one of those pockets in which the fight against HIV and its effects is lagging behind. As a country, we are making much slower progress than our neighboring countries. I am particularly concerned about young girls—kids who I might have carried on my back when I first started working in Mozambique—and who now are at risk of acquiring HIV sexually. 6% of Mozambican women aged 15-24 are living with HIV (more than double the level of men in the same age group), and a quarter of all girls have had their first sexual relations before age 15, many with older boys or men, and often in exchange for a simple gift, like a new skirt. Just yesterday in a conversation about HIV, a church leader decided that the root of the problem was that we see women as objects, not as equal human beings. In Mozambique, the community of people living with HIV grows by one every five minutes, on average, and every seven minutes a family loses someone to AIDS-related causes. The science may be there, but we still have so much work to do in terms of improving access to testing and treatment, in providing safe environments in which talking about HIV is as non-interesting and matter-of-fact as talking about malaria, in helping everyone understand how HIV can be prevented, and in creating contexts in which people who choose to prevent HIV are able to do so. “Até quando?,” we lament! “How much longer?”

Last year, in the week before Christmas, a close friend came to me with the worry that his diarrhea was becoming a little bit too frequent and a little bit too intense, and suspected IMG-20141201-WA0005

Photo by Rebecca J. Vander Meulen

that HIV might be behind it. He was spot-on, and his HIV result was positive. We went to the hospital together for a follow-up CD4 count, and when the nurse gave a result of 29, I asked for clarification—certainly I wasn’t hearing him correctly. I’d never before met someone with a CD4 count so low who was still managing to walk and get on with life. But Paulo’s CD4 count is now in the 300’s, and he’s back at work (doing a lot of manual labor), and just got a promotion. His wife and baby daughter are still negative, and they shamelessly accompany him to his appointments. Paulo is alive thanks to antiretroviral medications.

And as I was writing this, Rafael came into my office to talk about his robust business. If he hadn’t sent me a text message first, I might not have recognized him. Not so long ago, he looked like someone who might be blown away by a strong Lichinga wind—but now, taking antiretrovirals, he is now strong and healthy. HIV is no longer the focus of Rafael’s life. HIV didn’t come up in the conversation until I asked about his CD4 count, which last registered at 1050—a level well within the range of someone not living with HIV. Yes, he’ll need to  2012-11-cobue 227

Esperanza, whose name means "hope." Photo by Rebecca J. Vander Meulen

take medication for the rest of his life, but he’s not alone in that: his eight-year-old daughter affectionately pesters him not to forget his medication, ever.

As I post this, we are wrapping up the first 22 of 52 World AIDS Day celebrations to be held this week in the Diocese of Niassa. The 3,000 activists taking part are together celebrating the progress made and re-kindling the energy that will drive the continued work ahead. May we each let those around us know they have our love—regardless of whether or not there is a specific virus circulating in their veins. We must continue, united. Onward.
==

Footnote: HIV is not just a Mozambican issue. More than 1.2 million people in the United States are living with HIV, and almost 1 in 7 are unaware of their infection. If Washington, DC, were a country in Africa, it would rank 23rd out of 54 countries in percentage of people living with HIV. For those in the United States, AIDSvu can show you local prevalence levels, and perhaps one of the organizations listed on Avert’s website of services available in the United States could help you get an HIV test or put you in touch with someone who would be willing to trust you with his or her story. If you are not someone living with HIV, try to get to know someone living with HIV in your own community—and learn how HIV can so quickly affect more than just physical health. We enrich each other.

Engaging Discussion Launches the New Hunger Report on Gender

  Photo for Hunger Report 2015

There was a lot of energy in the room -- particularly for a Monday morning -- as Bread for the World Institute released our 2015 Hunger Report, When Women Flourish...We Can End Hunger, yesterday at the National Press Club in Washington, DC.

Our understanding of several issues raised in the report, some older and some newer, was enhanced by the experiences and perspectives of our speakers: 

        Fouzia Dahir, executive director of the Northern Organization for Social Empowerment in Kenya, which works to help women from pastoralist backgrounds transition to agriculture and bring an end to gender discrimination;

        Victoria Stanley, senior rural development and land specialist at the World Bank, whose focus is on efforts to make development programs more fair and effective by ensuring that they have been seen through a "gender lens" (here's an example of the Bank's development work in rural Bangladesh);

 

        Gary Barker, international director of Promundo-US, which engages men and boys in several parts of the developing world in the effort to end gender discrimination, particularly violence against women;

        Andrea James, executive director of Families for Justice as Healing, which raises awareness of the toll that rising female incarceration rates in the United States takes on children and communities, and advocates for alternatives based on community wellness.

        Asma Lateef, director of Bread for the World Institute, just returned from ICN2, the second International Conference on Nutrition.

Many of the current barriers to women's empowerment have already been the subject of decades of struggle. For example, although the U.S. Equal Pay Act was enacted in 1963, women in 2014 continue to be paid less than men for the same work. The wage gap is a major cause of poverty: in fact, if it were closed, poverty would be cut in half among single mothers and their families.

Gender-based violence is another "old" problem that remains at epidemic levels. In many countries, a woman cannot  leave the house on errands, earn a living by working on her farm or traveling to a job in a nearby city, or sometimes even sleep at night without fear of violence. A fairly new and promising approach to the problem -- taken by male and female advocates alike -- is to engage with men, helping them to see how greater respect for women can help not only their wives and daughters, but themselves and their families as a whole. Adolescent boys and young men are often open to these messages.

Other barriers have become visible more recently, sometimes as a side effect of progress in other areas and the swift pace of change in women's roles in many societies. As Fouzia Dahir explained, in some Kenyan cultures, girls simply didn't go to school, let alone secondary school. When this changed fairly recently, bullying and lack of proper sanitation facilities emerged as obstacles that still stand between many girls and their hopes of an education. 

A significant amount of the energy at the launch was among the audience -- more than 100 professionals committed to gender equality, access to nutritious food for all,  and respect for human rights. Moderator Sandra Joireman, chair of Bread for the World's board of directors, and Bread President David Beckmann emphasized the opportunities now before us to move toward the goal of ending hunger by 2030. If we are to end hunger -- and secure women's rights as human beings -- global communities must work in collaborative ways to ensure that gender is no longer a barrier to developing and contributing to one's full potential, whether as a worker, a parent, a citizen, or any of a myriad of other roles.

Learn more about this year's Hunger Report and see interactive features at the 2015 Hunger Report website.

 Michele Learner

Stay Connected

Bread for the World