“I think of it often and imagine the scene clearly. Even if they come to kill me, I will tell them what they are trying to do is wrong, that education is our basic right.” – Malala Yousafzai
Globally it is estimated that 250 million girls live in poverty and that 65 million girls are missing from primary and secondary school. Three-quarters of all new HIV infections occur among young women; in parts of South Africa, as many as 4 in 10 young women are infected with HIV. Numbers like this are hard to comprehend, but on International Women’s Day we are asked to take time to reflect on the lives of girls.
Let’s start with what we know. We know that girls who stay in school will delay the age of first sexual intercourse. They will have fewer children, and the children they do have will be healthier. Girls who stay in school are also less likely to become infected with HIV and have greater economic opportunities that benefit them and their families over the long term. An extra year of secondary school boosts a girl’s future wages by 15-25 percent, and girls who complete high school are 40 percent less likely to be HIV infected.
And yet many girls are not in school, and the numbers grow as they get older. Secondary school completion rates are less than 5 percent in much of in sub-Saharan Africa. Barriers to schooling for girls include the direct costs of school fees, uniforms, books, and supplies, but there are also indirect costs. Girls are more likely than boys to be kept at home to help with household chores such as collecting water and firewood, and care for smaller siblings or sick family members. The AIDS epidemic has made this all the more apparent.
There are a number of global efforts to keep girls in school and improve their futures, among them The Girl Effect, Girl Rising, and the United Nations Girls’ Education Initiative. The case of Malala Yousafzai, the 15 year-old Afghan who was shot by the Taliban for her campaign to keep girls in school, brought worldwide attention to the issue and highlights the dedication and bravery of individuals in the fight to educate and lift up girls around the world.
My own work is concerned with the relationship between education and HIV risk. There is strong evidence that cash transfers to poor families can help keep girls in school, and there is emerging evidence that cash transfers can reduce HIV risk in young women. In rural Agincourt, Mpumalanga Province, South Africa, I have been collaborating with colleagues at the MRC/Wits Rural Pubic Health and Health Transitions Unit to conduct a randomized controlled trial to determine if providing monthly payments conditioned on girls attending school will keep them in school and reduce their risk of HIV. This research is funded through the NIH HIV Prevention Trials Network (HPTN).
We hypothesize that providing cash to both families and the girls themselves will eliminate the financial barriers to schooling and also provide an economic incentive for girls to stay in school. The study started in 2011 and has enrolled over 2500 high school girls and their families, whom we visit annually to ask questions about things such as schooling, sexual behavior and expenditures. We also test girls for HIV and HSV-2. Results of the study will be available in 2015.
I have a seven-year old daughter who is in second grade. There is no doubt in her mind that she will finish high school and go to college and that her future will be just as bright—she might even say brighter—as her younger brother’s. I know that seven year-old girls in rural South Africa also dream of a bright future. That future should not be in doubt.
As public health practitioners and researchers, we must produce the evidence base for effective programs that reduce structural barriers, such as poverty and lack of education, to enable girls to achieve healthy, bright futures.
Audrey Pettifor, PhD, is associate professor of epidemiology at the UNC Gillings School of Global Public Health. Pettifor has conducted HIV prevention research in South Africa for more than 10 years; her research focuses on HIV prevention among young people, particularly young women, in South Africa and the Democratic Republic of the Congo. Pettifor is also a faculty affiliate of the UNC Institute for Global Health & Infectious Diseases.