citation

Janet Fleischman. "How Can We Better Reach Women and Girls in Crises?." CSIS Commission on Strengthening America's Health Security, Center for Strategic and International Studies, October 29, 2019. Accessed November 18, 2019. https://healthsecurity.csis.org/articles/how-can-we-better-reach-women-and-girls-in-crises/

A categorical shift is required for the U.S. to prioritize women’s and girls’ health and protection in crisis settings to advance resiliency and health security. This report proposes an approach to harness USG capacities and catalyze action for women and girls.

Photo Credit: Per-Anders Pettersson / Contributor / Getty Images

LALIYA, UGANDA - MAY 26: Gladys Aromo, age 12, carries a container with drinking water while walking to her house on May 26, 2005 in Laliya, Uganda. Gladys is a night commuter, one of about 20,000 children that sleep in Gulu town, as they are afraid of being abducted by the Lord's Resistance Army (LRA).
LALIYA, UGANDA - MAY 26: Gladys Aromo, age 12, carries a container with drinking water while walking to her house on May 26, 2005 in Laliya, Uganda. Gladys is a night commuter, one of about 20,000 children that sleep in Gulu town, as they are afraid of being abducted by the Lord's Resistance Army (LRA). Per-Anders Pettersson / Contributor / Getty Images

The United States is the world leader in supporting global health and humanitarian response, making it uniquely placed to elevate the critical health and safety needs faced by women and girls in emergencies and fragile settings around the world. While addressing these needs is an important goal on its own, it also forms a pillar of global health security, as the preven­tion of health crises and conflict, and recovery after they occur, are greatly enhanced when these needs are met.

The United States has unrivaled financial and pro­grammatic capacities in maternal health, reproductive health, family planning, and gender-based violence (GBV) prevention and response. However, it seldom marshals these extensive capacities in emergency settings, where the needs and vulnerabilities of women and girls are most severe. In emergencies around the world—from the Ebola outbreak in the Democratic Republic of the Congo (DRC) to the simmering conflict in Venezuela to the protracted crises in Yemen and Syria—the United States has not channeled its exten­sive capacities to address glaring operational gaps in these critical areas. The alarmingly high risks of GBV and severely limited access to maternal health, family planning, and reproductive health services are too often overlooked in these and other crisis settings.

A categorical shift is required for the United States to prioritize women’s and girls’ health and protection in emergency settings to advance resiliency and health security. There is growing recognition among both practitioners and policymakers that failure to address these gaps significantly worsens the impact and trauma of crises and significantly undermines global health security. Conversely, the engagement of wom­en, girls, and communities in decision-making and program design can help build public trust and confidence, which is sorely lacking in many health security crises around the world.

This report was produced under the auspices of the CSIS Commission on Strengthening America’s Health Security, which is calling for a doctrine of continuous prevention, protection, and resilience to protect the American people and the world from a growing number of health security threats.[1] The Commission has recog­nized the importance of strengthening the U.S. govern­ment’s capacities to operate in a “disordered world,” spanning chronic and emerging conflicts, humanitarian crises, fragile states, and stateless and misgoverned places. In such contexts, women and girls are acutely vulnerable. Studies have shown that when women and girls are healthy, safe, and empowered, they form a cornerstone for building resilient communities.[2] Con­versely, the trauma and impact of widespread GBV, combined with poor access to essential maternal health, family planning, and reproductive health services, can fracture families and communities while exacerbating fragility and instability.

This report proposes an approach to ensure that the extensive capacities of the U.S. government in the areas of maternal health, reproductive health, family plan­ning, and GBV prevention and response are no longer left on the sidelines in crisis response and recovery. The overarching goal of this approach is to correct this persistent problem and bring existing resources and programs to bear to ensure the health and safety of women and girls in crises and disordered settings.

The United States has shown increased leadership and commitment to addressing these issues in recent years and is poised to do much more. This report reviews existing capacities and investments, analyzes progress made, identifies ongoing gaps, and proposes practical and affordable solutions for the U.S. government to adapt and focus current programs and investments in those disordered settings where the needs of women and girls are greatest.

This report calls on the U.S. government to:

  1. Bring forward $30 million in flexible fund­ing annually over five years, which will be used to launch a model of service delivery for wom­en’s and girls’ health and safety in two to three crisis settings. This additional flexible funding is essential to spearhead this effort and incentivize U.S. agencies and their partners to rapidly begin execution of the program. The funding will be catalytic: it is intended to attract higher-level financial commitments from existing programs at USAID and the Department of State’s Bureau of Population, Refugees, and Migra­tion (PRM).
  2. Pilot this model in two to three emergency or fragile settings of high unmet need and importance to U.S. health security and foreign policy interests. This model would provide an integrated package of quality maternal health, repro­ductive health, family planning, and GBV prevention and response services as a core element of all emer­gency responses. An emphasis would be placed on building local capacity of health care providers, community outreach workers, and women’s organiza­tions to provide these essential health and protection services. This model should adapt, refocus, and integrate programs at USAID’s global health bureau, the Office of Foreign Disaster Assistance (OFDA), PRM, and the Centers for Disease Control (CDC), where appropriate. The pilot should be used to demon­strate impact and generate data and learnings to inform future expansion of the model.
  3. Establish a secretariat composed of USAID and PRM senior officials and technical experts to oversee delivery and ensure alignment and coordination of planning and investments. The secretariat would lead ongoing evaluation, adjustment, and analysis of results to inform future work and ensure accountability.
  4. Ensure high-level, committed U.S. leader­ship to encourage other donor countries, multilateral organizations, UN agencies, and other implementing partners to contribute to and participate in this strengthened model.

This catalytic, incremental approach will ultimately ensure that existing U.S. government resources and capacities are channeled to those disordered settings where the needs of women and girls are greatest.

Download full report above. This report is a product of the CSIS Commission on Strengthening America’s Health Security, generously supported by the Bill & Melinda Gates Foundation.


[1] CSIS Commission on Strengthening America’s Health Security, https://healthsecurity.csis.org/.

[2] See: CARE, Women and Girls in Emergencies (Copenhagen: 2018), https://insights.careinternation­al.org.uk/media/k2/attachments/CARE_Women-and-girls-in-emergencies_2018.pdf; Sarah Zeid et al., “Women’s, children’s and adolescents’ health in humanitarian and other crises,” British Medical Journal 351 (September 2015), https://www.bmj. com/content/351/bmj.h4346.