The Integration Hypothesis

​Empowering women and girls has taken me from East Africa to South and East Asia. The scope of my work has cut across sectors including health, trafficking prevention, gender based violence, water and sanitation and women’s empowerment. Several years ago, while working in rural Uganda, I learned you can not approach issues for women and girls without recognizing the interconnectivity that exists. Speaking with communities in rural Uganda about gender-based violence brought to light the lack of adequate access to healthcare services for women and girls. In rural India, an immense need existed to involve a variety of stakeholders including community leaders, health workers, men, faith communities, governments, organizations, the private sector and donors in a locally-led process to empower women and girls through water and sanitation (WASH) programs. While working among women and girls who had been trafficked throughout South and East Asia, I realized the power and importance of working with local women. Their ideas and solutions for their own development continually inspired me. Change for women and girls requires a variety of entities working together towards an integrated approach to development.

FHI360 is an organization that strives to improve the lives of women, girls and communities by advancing integrated, locally driven solutions for human development. They challenge the development community to think proactively and provocatively about holistic development for women and girls. Yesterday, FHI360, in partnership with Johnson and Johnson and Women Thrive Worldwide, hosted an event in New York City to discuss what’s being called the ‘Integration Hypothesis’ – which poses the question:

Can breaking development silos make a difference for women and girls?


Abbigal Muleya, Monitoring and Evaluation Officer for Zubo Trust in Zimbabwe is a young woman who is breaking all barriers to improve the lives of women and girls. During the event, she delivered a powerful ‘lightning talk’ about community driven solutions which empower girls and women through fish farming programs. Zubo Trust provides networking, capacity development and rights awareness workshops to expand economic opportunities for women. In conjunction with Zubo Trust, Abbigal has worked tirelessly on locally led solutions to ensure women and girls have the same rights as men to become fish farmers and own their businesses. She has cut across sector, social and cultural lines to make this dream a reality. Abbigal set the stage for an engaging conversation around integrated development. She challenged participants to critically think about ways to approach community-led integrated development initiatives.

Leith Greenslade, Panel Moderator and Vice Chair of the MDG Health Alliance, shared with us her thoughts on integrated development priorities for women and girls on Instagram.

Using #IntegratedDev on Twitter, audience members helped spread awareness of the positive examples of integrated development as well as the challenges related to working in silos:

An integrated approach for women and girls requires the development community to address issues from a variety of angles and perspectives. We cannot work in isolation but rather, we must work together to find creative solutions. Central to this is listening to the voices of women and girls. I sat down with Ann Starrs, CEO of the Guttmacher Institute and a champion for women’s and girls’ health. Ann believes truly listening to women and girls is an essential ingredient for successful integrated development programs. I whole-heartedly agree with her and other panelists who passionately spoke about their work and creative solutions.

After the panel ended, we asked event participants their thoughts and ideas on improving the lives of women and girls through integrated development approaches. Find out what Judith Moore, Principal Associate/Strategic Lead for MNCH at Abt Associates, and Mary Kate Costello, Policy Analyst at The Hunger Project had to say on our Instagram.

Want to join the continued conversation on integrated development? Stayed tuned for more engaging interviews and blog posts!

Follow #IntegratedDev, @GirlsGlobe & @FHI360

Event panelists included (left to right as shown above):

Blogging Empowers Young Women in Nepal!

“Being a blogger enables us to give momentum to a revolution that can change the perceptions of the society we live in.” -Akriti, Women LEAD Nepal

women lead girls
Women LEAD Nepal young leaders discuss effective blogging ideas.

These are powerful words spoken by a young woman leader in Kathmandu, Nepal. Akriti, alongside other young women, has the opportunity to participate in Women LEAD Nepal’s year long leadership training program. As part of this program, they will be equipped with essential life and leadership skills to create change among peers, family, community and the world. Last week, I had the wonderful privilege of meeting with Women LEAD Nepal’s amazing young women leaders in Kathmandu. Women LEAD Nepal became Girls’ Globe’s first featured organization in 2011.

As I sat on the floor with thirteen amazing young women, I learned each of their hopes and dreams for the future. I, also, learned about their passion for writing and blogging. Over the course of several hours, I shared my own journey through starting my own blog and joining Girls’ Globe as a blogger. I, also, gave them six effective tips for starting their own blog or joining an existing blogging network. During the course of the workshop, they talked about the issues they are passionate about and how to effectively blog about those issues. Over the next few months, you will hear their stories through Girls’ Globe.

Blogging truly empowers young women to share their voices and stories.

Visiting Women LEAD Nepal was a powerful picture of what can happen in the lives of young women through leadership empowerment. I was able to ask them what they see as priorities for women and girls in the future and also why they believe blogging and social media are important avenues for empowering women and girls. I, also, sat down with Co-Founder of Women LEAD, Claire Naylor. She shared more about Women LEAD Nepal’s work as well as how our partnership has strengthened their voices as they empower young women in Nepal.

Listen to these amazing young women!

1. What can global leaders not ignore for women and girls?

2. Why is blogging and social media important in the movement to empower women and girls?

3. Girls’ Globe speaks with Claire Naylor, Co-Founder of Women LEAD

The Menstrual Hygiene Taboo: A Vicious Cycle of Silence

Written by Dr. Emily Wilson-Smith, Chair at Irise International

Although half the global population has menstruated since the beginning of time, it has been a taboo topic in cultures across the world for almost as long. The word ‘taboo’ itself may even originate from a Polynesian term for menstruation, ‘tupua.’ Recent grass roots activism in the development community, including the first ever international Menstrual Hygiene Day has highlighted the impact of menstruation in low-income settings on women’s rights to health and education. However, it has remained largely neglected by International Agents ostensibly working towards the realisation of universal human rights.

Irise researcher, Robyn Boosey (@_RobynB) searched over 800 human rights documents, including 17 core international human rights treaties and reports produced by the Committee for the Elimination of All Forms of Discrimination Against Women, the Committee for the Rights of the Child, and the Special Procedures Mandates on the Right to Education, the Right to Health and the Right to Water and Sanitation for references to menstruation. What she found was an overwhelming silence:

Image c/o Irise International
Image c/o Irise International

Where menstruation was referenced or alluded to it was often ambiguous and lacking in detail or specific recommendations.

By remaining silent on menstruation, Human Rights Bodies reinforce the taboo and the perception that menstruation is shameful and private. This has devastating implications for the fulfilment of the human rights of women and girls, particularly in low-income countries. Poor menstrual hygiene affects girls’ right to health as the taboo means that adequate health education is not delivered. Girls engage in unhygienic menstrual practices including using dirty and damp rags which may cause irritation or infection. This impacts on girls’ right to education with many girls reporting missing school during menstruation due to inadequate facilities or struggling to concentrate during lessons due to fears their skirt will become stained by menstrual blood. It affects women’s rights to work in a similar way with a study of factory workers in Bangladesh finding that 60% were using freshly dyed rags from the factory floor as menstrual cloths and that 73% were missing 6 days of work a month.

These menstrual-related human rights violations not only hold women and girls back as individuals but also prevent them from becoming active members in their communities, causing far reaching consequences for economic growth and development. As long as we are afraid to say the word “menstruation” in the political sphere these human rights violations will continue to go undiscussed and unaddressed.

However, the International Human Rights System also has great potential for breaking this vicious cycle of silence and for offering a refreshing perspective on the rights of women and girls. The current focus on female health in the context of pregnancy or sexually transmitted infections sends a message that women’s bodies only become valuable when their health has wider implications. Even in the context on menstrual hygiene and girls’ education, a focus is placed on the economic benefits of keeping girls in school. Menstrual hygiene gives us the opportunity to provide education to women and girls outside of the context of sex and its consequences. This knowledge empowers them to make decisions about their own bodies rather than just dealing with the consequences of their biology. Breaking the menstruation taboo and calling for better menstrual hygiene and education is a chance for the international community to say to women and girls around the world that they matter because they are people with as much right to reach their full potential as any other person on the planet.

Learn more:

IMG_20140526_133535~2Emily has a BSc in International Health from the University of Bristol and a medical degree from the University of Sheffield. She worked as a doctor for a year and now works for Irise full-time in Uganda.  She has nearly ten years of experience of women’s health and development. Previous research includes an evaluation in Kenya for the Kenyan Orphan Project and research into women’s health in Madagascar with Access Madagascar Initiative. Emily led the Irise pilot work in Kenya, Zimbabwe and Uganda in 2011 to  2014. She is now working to develop our Freedom Franchise Model, conduct our large scale study into the impact of menstrual hygiene on school girls’ absenteeism and is soon to take up a post as Research and Teaching Associate at Kampala International University. Follow her on Twitter @emswsmith.

India’s Newborn Action Plan

Globally, 2.9 million newborns die within the first month of life. India, with a population totalling 17.5 percent of the global population, accounts for a startling 27 percent of the global newborn mortality rate with over 780,000 newborn deaths every year, the highest newborn mortality rate in the world. On September 17th, India launched its national Newborn Action Plan (INAP) to stop and reverse this disturbing trend.

Image c/o Gates Foundation

Based on the findings and strategies promoted in The Lancet’s Every Newborn series, INAP aims to reduce India’s newborn mortality rate from its current 29 deaths per 1,000 births to under 10 deaths per 1,000 births by 2030. In order to accomplish this goal, INAP focuses on improving the following six evidence-based, effective strategies:

  1. Preconception and antenatal care
  2. Care during labor and childbirth
  3. Immediate newborn care
  4. Care of healthy newborns
  5. Care of small and sick newborns
  6. Care beyond newborn survival

Additionally, the issue of gendercide does not go ignored. Because a girl’s family traditionally must pay a dowry in order to marry, families – especially in poorer regions – favor having boys over girls. As a result, each month approximately 50,000 female fetuses are aborted or killed at birth, thrown into rivers, or simply left to die. An estimated one million girls in India “disappear” every year. With INAP, the Health Ministry takes this long-standing tradition of gender-bias into account and aims to eliminate gender-based differences in newborn health care.

“These are preventable deaths and now we have an action plan for preventing them.” – Harsh Vardhan, India Health Minister

Although India as a whole is on track to achieve Millennium Development Goals (MDGs) 4 and 5 (reducing child mortality and maternal mortality by two-thirds and three-quarters respectively), MDG success is not consistent across the country. For example, the state of Kerala already has a neonatal mortality rate of seven deaths per 1,000 births, yet the poorer states of Bihar, UP, Madhya Pradesh and Rajasthan are far behind, with a combined neonatal mortality rate amounting to 56 percent of such deaths nationwide.

“Healthy mothers and healthy children are crucial for India to realize the demographic dividend.” – Melinda Gates

It is important to emphasize that India’s efforts to reduce the newborn mortality rate are not limited to merely survival. With the launch of INAP, the Health Ministry will focus increased attention on improving the health and lives of both healthy and sick newborns. In a country where shunning those with disabilities, neuro-developmental delays, and birth defects is not uncommon, recognizing the value of all newborns, both sick and healthy, is a major step in the right direction.

With support from the Bill & Melinda Gates Foundation, the World Health Organization and UNICEF, India’s Health Ministry is confident in its ability to reduce newborn deaths nationwide – and if India’s INAP efforts echo the success of its anti-polio campaign, the future for India’s newborns looks promising.


The Experience Of An Inexperienced Man: Looking Back on The Menstrual Hygiene Day Campaign, 2014

Written by Ephraim Kisangala

World Menstrual Hygiene Day 2014 was the first of its kind and celebrated by more than one hundred organisations world over. Being a member of Friends of IRISE-KIU Western Campus (FOI), I was privileged to have learnt about this subject prior to the day. We discussed in depth the issue of menstruation, activities we wanted for the day and also got training on making reusable sanitary pads.

I do not remember when I first knew that women menstruate, but I am pretty sure it was during one of the biology lessons in high school. The lessons were plain, explaining just the science and cycle and nothing more. Comments on painful periods, cultural practices, menstrual hygiene or management were almost unheard of in class.

The campaign started on a high note as the entire team was eager to engage in activities aimed at empowering and educating the community on breaking the silence around menstruation. The FOI team consisted of several other student bodies including Federation of African Medical Students’ Associations (FAMSA) and Kampala International University Students’ Academic Forum (KIUMSAF). The fear and the silence that usually surrounds the topic seemed to have been replaced by the concern for the poor girl who misses school, knows nothing about menstruation, and uses dirty rags, leaves, cotton or anything else they could find.

Image c/o Irise International
Image c/o Irise International

Despite this prior engagement with the issue of menstruation and all that I had learnt from being involved in Friends of IRISE, I was not prepared for all the lessons from Menstrual Hygiene Day. The FOI group started the preparation for the May 28th celebrations by engaging students on social media, creating school education programmes, making reusable pads, and hosting a community day complete with a school marching band.

As we embarked on the social media campaign on Facebook and WhatsApp, I did not expect to learn as much as I did. The responses to my posts, articles I read and activities in which I participated opened up a completely different dimension on the topic.

The first comment to strike me was asked by a female doctor in response to one of my Facebook posts:

“Ephraim, won’t you relent?”

This response triggered a memory of my mother’s experience of menstruation. Back when she was younger she suffered from menorrhagia and periods that were often irregular, heavy, very painful and scary. Not even medical workers understood her situation, thereby offering little support. She does not remember attending school during those awful days and always wished periods never existed.

Periods were literally a curse even when I was an adult working. Thank God, I am past that.” – My Mother

A friend also surprised me saying, “The only regret I have for being a woman is my period.” She had sought medical attention for the excessive bleeding during menstruation that was affecting her job and lifestyle.

In another article on, a disgusted lady wrote a letter to the manager of Always saying, “Are you kidding me? Does your brain really think happiness – actual smiling is possible during a menstrual period? Unless you are a freak.” She promised never to buy the Always pads because of the words, “Have a Happy Period” on its packaging.

photo 3
Image c/o Irise International

Back at the medical school, the WhatsApp chat page had only a few active females throughout the campaign. Meanwhile, the male students dominated the events and activities in preparation for Menstrual Hygiene Day. The organizing committee was also mainly male except for a handful of female students, including our fantastic chair Buddu Atwiine. The pupils in one of the primary schools were quite disappointed with the gender imbalance and even inquired why the males would go to teach menstrual hygiene without females.

After the fantastic day was over and I had some time to reflect, I began to feel that you can never truly comprehend the magnitude of challenges an African girl faces when it comes to menstruation, be it talk or the process, if you are not female.

At the end of the day, we in East Africa must come up with solutions for the following challenges:

  • The deeply rooted culture and taboos in Africa making talk about the menstruation difficult for everyone.
  • The stigma surrounding menstruation still keeps many females from disclosing their challenges that would otherwise be solved.

I believe menstruation is normal and every woman has the right experience her periods with dignity. I am hopeful we can achieve this in Africa and around the world.



ephraimEphraim is a final year medical student at Kampala International University (KIU) and is currently the President of the Federation of African Medical Students’ Associations (FAMSA). He is also involved in several other organisations in different capacities including Friends of IRISE KIU; Uganda Christian Medical Fellowship- Students’ Chapter; Bushenyi Integrated Rural Development (BIRD). He is also a member of the KIU-GRADUATE TRACKING TECHNICAL WORK GROUP supported by MEPI (Medical Education Partnership Initiative). He is very passionate about identifying ways in which medical students can act as key players in community transformation.

We can’t have a post-2015 agenda without SRHR!

In 2000, the creators of the Millennium Development Goals (MDGs) completely overlooked sexual and reproductive health and rights (SRHR), a mistake that, if repeated, would cripple the dreams of millions of young girls and women for years and generations to come.

Access to SRHR enables individuals to choose whether, when, and with whom to engage in sexual activity; to choose whether and when to have children; and to access the information and means to do so. To some, these rights may be considered an everyday reality. However, that is not the case for millions of young people in the world – particularly girls and women.

On Tuesday night, I had the fantastic opportunity to listen to some of the foremost global leaders speak on behalf of ensuring access to sexual and reproductive health and rights in the post-2015 agenda. The benefits of ensuring SRHR are society wide and inevitably translate into improved education, economic growth, health, gender equality, and even environment.



“At my high school, you would be expelled if found with a condom.” – Samuel Kissi, former President, Curious Minds Ghana

When girls are healthy and their rights are fulfilled, they have the opportunity to attend school, learn life skills, and grow into empowered young women. Wherever girls’ SRHR are ignored, major educational barriers follow. Child marriage and early pregnancy are major contributors to school dropout rates. In South Asia and Sub-Saharan Africa, girls are married before age 18 at an alarming 50 percent and 40 percent respectively. And in Sub-Saharan Africa, where 90 percent of adolescent pregnancies occur in marriage, it is safe to assume that not all those sexual acts were consensual and not all those pregnancies were planned.

Economic Benefits

“Initially I used to oppose family planning, but now I fully support. I support it because my wife has more time to work and earn money.” – The Honorable Dr. Tedros Adhanom Ghebreyesus, Minster of Foreign Affairs for the Federal Democratic Republic of Ethiopia, sharing the story of an Ethiopian man’s changed opinion regarding the importance of SRHR

Protecting SRHR not only saves lives and empowers people, but it also leads to significant economic gains for individuals and for the community as a whole. As previously stated, ensuring SRHR helps to decrease school dropout rates and, as a result, leads to a more productive and healthy workforce as each additional year of schooling for girls increases their employment opportunities and future earnings by nearly 10 percent.

Broader Health Agenda

“We cannot eliminate new HIV infections without providing SRHR services to women so they can make informed decisions to protect themselves and their children in the future. Yes, we will end the AIDS epidemic, but first we need to respect the dignity and the equality of women and young girls.” – Mahesh Mahalingam, Director in the Programme Branch of UNAIDS

Access to SRHR guarantees quality family planning services, counseling and health information. These services are critical, particularly because women are often victims of gender-based violence and sexual assault and thereby face greater risks for sexually transmitted diseases like HIV/AIDS. Failing to secure and uphold SRHR dooms women and girls with an increased risk of unsafe, non-consensual sex and maternal mortality.

Gender Equality

“How can you control your life if you cannot control your fertility?” – Helen Clark, UNDP Administrator

When a woman can easily plan her family, she is more equipped to participate in the economy alongside her male colleagues. When the sexual rights of a woman or girl are fulfilled, she will experience decreased rates of sexual violence and enjoy a healthy relationship with a respectful partner. When a woman or girl does not fall victim to child marriage and early pregnancy, she can stay in school and achieve anything she puts her mind to.


“The woman continues to bring life, to bring up the next generation, to stand before you and say, ‘I am ready to embrace my rights and to deliver a better planet to humanity.’” – Joy Phumaphi, former Minister of Health, Botswana; Chair, Global Leaders Council for Reproductive Health


A 2012 study found that community water and sanitation projects designed and run by women are more sustainable and effective than those that are not. Similarly, women produce 60 to 80 percent of food in developing countries and, with the economic and educational gains that coincide with secured SRHR, a woman is better equipped to effectively manage her land.

The post-2015 Sustainable Development Goals will not happen without SRHR being addressed. So far, the world has failed to recognize that SRHR are equally as fundamental to global development as finance and trade. We can no longer afford to view SRHR as a taboo or promiscuous topic. When 90% of first births in low-income countries are to girls under 18; when the leading cause of death among adolescent girls aged 15 to 19 is pregnancy and childbirth; when two-thirds of new HIV infections in sub-Saharan Africa are among adolescent girls; and when 200 million women want to use family planning methods but lack access, the young girls and women of the world do not have a promiscuity problem – they have a human rights problem.