‘Girls are now central to the agenda’

October 11 will mark the 10th anniversary of International Day of the Girl Child, which was created to address the challenges girls face, promote girls’ empowerment, and help girls attain their full human rights.

One outspoken advocate for girls' rights has been Dr. Venkatraman Chandra-Mouli, who works on adolescent sexual and reproductive health with the World Health Organization’s Department of Sexual and Reproductive Health and Research.

We spoke with Dr. Chandra-Mouli about International Day of the Girl Child and how girls have become part of the global agenda, and about what needs to be done to ensure girls make even more progress in the next decade.

International Day of the Girl Child was launched exactly 10 years ago – how would you describe the situation for girls then and now?

Dr. Chandra-Mouli: In 2010, we were still in the Millennium Development Goal (MDG) era. During the first decade of the era – 2000 to 2009 – most countries were focused on childhood mortality reduction, maternal mortality reduction, and HIV and malaria mortality reduction. Adolescents were on the agenda for preventing adolescent pregnancy and childbearing, and HIV, but most countries didn't really pay attention to these areas. They had other burning fires to address.

By the early 2010s, it became clear that adolescents were not getting the attention they needed. That's when UN Secretary- General Ban Ki-moon launched the Global Strategy for Women’s, Children’s and Adolescents’ Health. Adolescents were still not on the main agenda, but there was a recognition that we needed to start putting them there. That is when the International Day of the Girl was launched. Today, 10 years later, through the advocacy of activists from local to global around the world, girls are central to the Sustainable Development Goals agenda.

Girls are now central to the SDG agenda because of the concerted advocacy of many players, including girls themselves. Advocates have pressed for investment and action on some issues such as girls’ education and preventing HIV in girls and young women for many years. And then menstrual health is different. It was not on the agenda of the International Conference on Population and Development, not in the MDGs, it's still not in the SDGs. It's on the agenda today because of girls and women and activists primarily from the Global South, such as activists from Kenya and activists from India, as well as some activists from the Global North. The girls' movement has really put this issue on the agenda.

I think today, it is clear to all that there are very good reasons to pay special attention to meeting the needs and fulfilling the rights of girls. "What about boys?" is a question that people sometimes ask, and our response is that nobody is saying we shouldn't address boys, all we're saying is that, while we address all adolescents, girls need particular attention for a hundred good reasons.

In 1990s and early 2000s, there were small, short-lived community-based projects to end child marriage. Today, the situation is different. You have the Global Programme to End Child Marriage, co-sponsored by UNFPA and UNICEF, as well as a number of other players such as Plan International. You have substantial resources being invested. At the UN General Assembly, there is strong support for this work from across the board. It's on the African Union agenda. It's on the Southern African Development Community agenda. And most importantly, it's on the agenda of countries in the Global South, who are investing their own resources in ending child marriage. I think as we celebrate the 10 years, we can say that the world community has cemented the place of girls in the global health, education, and human rights agenda.

Progress in girls' rights and health has been described as slow and uneven. What have been some of the high and low points?

Dr. Chandra-Mouli: In 2019, we published a paper taking stock of 25 years of progress since the International Conference on Population and Development. We found that girls and boys are much more likely to initiate sex later. They're much less likely to be married than before. They're much more likely to use contraception and access maternal health care. They're much less likely to experience or support female genital mutilation. They're much less likely to have HIV. They're much more likely to be vaccinated with the HPV vaccine. There's been progress on many fronts where there has been investment. For example, in Bangladesh, in two generations, there are more girls in university than boys in university.

One area where there's been no progress is violence against women and girls. Another is sexually transmitted infections other than HIV, such as chlamydia, and gonorrhea. Even though a growing number of countries in the Global South are liberalizing safe abortion care, unsafe abortion is still an issue. There is also a huge number of other areas of adolescence and health that have come on the agenda, such as mental health, but progress globally in reducing mental health problems such as anxiety or depression will take more time and effort.

What we have seen was that in the past, the whole tone of the discussion around adolescent health was difficult, and it was next to impossible to achieve results. It is not worth the expense and effort. That is nonsense. What we've shown is, if you invest time and effort, as the world has in issues such as adolescent pregnancy and HIV prevention, you can achieve tangible results, in different contexts, including contexts of poverty.

Yes, it is true that there are other issues on the agenda, such as mental health and drug use. As we set out in a paper, we have to remember that in many places the human and financial capacity to meet these needs is wanting; that is true even in high-income countries. What we need to do is to expand the agenda slowly, strategically, and progressively. For example, in many countries there is longstanding experience in contraceptive counseling, and HIV counseling. That expertise can be built upon to address mental health problems such as depression. When the scope of programs is expanded rapidly from some areas of sexual and reproductive health and HIV to all adolescent issues across the board, like in Ethiopia and India, they are broad on paper, but implementation ends up being patchy.

What are your hopes for the next decade for girls around the world? What concrete steps can governments take to ensure a better world for them?

Dr. Chandra-Mouli: One of the most important things that governments should do is to engage and support girls to become equal partners in identifying and delivering solutions for them and their peers. Young leaders, like the ones who contributed to a paper that charted out five things we need to do, are central to my hopes for the future.

The first point is we need to mobilize and make full use of political and social support for girls. Where there is political and social support, we need to use it. For example, for child marriage prevention, there is widespread support. For the provision of contraception to unmarried adolescents or even comprehensive sexuality education in schools, there's a lot of resistance. There's a huge fight going on about what you can do in schools about sexuality education, egged on - in recent years - by local opponents supported from the outside. Where there is support, we need to use it. Where we need to build support, we need to start working on that. Both change agents from within and international organizations could play useful roles here.

The second thing we need to do is expand domestic funding [for girls]. Donors come with their agendas, they come with their pet projects, they come with their organizations. Countries will only be able to define their own agendas and build their indigenous capacities if they put their own money on the table. Jeremy Shiffman from Johns Hopkins says there's real political commitment only when you put money on the table and not just say, this is important. Governments need to expand domestic funding. They're doing that for issues they see as important, such as reducing childhood mortality and expanding health coverage, and for child marriage, and they need to do it for girls.

The third thing we need is laws and policies. There are still laws in some places that prohibit the provision of contraception if you're unmarried or below a particular age. There are policies in some places that restrict the provision of comprehensive sexuality education. Often, there are contradictions between laws. One law says something, and another says something quite opposite. And there are laws which are meant to protect but in fact, do not. In India and Kenya, for instance, laws are in place that criminalize sexual activity in minors, even if it is consensual. I grew up in India. As a 17-year-old medical student, I started to have sex with the girl who became my wife. I would get condoms from a pharmacy far away from home so that my mother wouldn't discover it. In today’s legal framework, they could report someone in my situation to the authorities. We must identify the laws and policies that pose the greatest barriers to adolescents’ health, and work to change them.

Fourthly, sound data and evidence are key. We must make available data easily accessible to promote their use. Alongside that, we must identify and fill key data gaps to strengthen advocacy policies and programs. Similarly, we must work to ensure research findings are made easily accessible to decision makers and are applied as they design policies and programs. And where there are gaps in evidence, we need to support research and evaluation to help shape and reshape programs.

Finally, governments have a central role to play in managing the implementation of [of girls' programs] at scale with quality and equity. They must equip health, education, and social welfare systems with the capacity to deliver with quality. And they must put in place systems that foster intersectoral coordination. As they do this, governments have the mandate and the responsibility to build support and overcome resistance when it occurs. They have to realize that there is discomfort in many places about girls having a voice, standing up for themselves, going and getting educated, and taking charge of their bodies and their sexuality. It's very easy to be a political champion of preventing children dying of pneumonia. No problem. Being a champion for emergency contraception and safe abortion care, or for normalizing discussions about sexual orientation is very different. But this must be done.

The path to scale-up for girls’ programs will be messy and nonlinear, with steps forward sometimes, sideways at others, and backwards at still others. To meet the needs and fulfill the rights of girls today and tomorrow we must plough on, learning from our missteps and mistakes and for our successes as we go.