On International Women’s Day: Girls and the Power of Education


“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

Nail polish is a very popular way to help retain young women in Pettifor’s research study. Photo: Lisa Albert

Nail polish is a very popular way to help retain young women in Pettifor’s research study. Photo: Lisa Albert

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).

Girls heading home after choir practice at the Hlomani Secondary School. Photo: K. Schatz, University of the Witwatersrand

Girls heading home after choir practice at the Hlomani Secondary School. Photo: K. Schatz, University of the Witwatersrand

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

Audrey Pettifor, PhD, is associate professor of epidemiology at the UNC Gillings School of Global Public HealthPettifor 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.

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UNC assists longtime partner in Malawi with a critical drug donation


Tidziwe Centre, headquarters of UNC Project-Malawi, on the campus of Kamuzu Central Hospital

With a generous donation, UNC Project-Malawi has helped to ease drug shortage problems at Kamuzu Central Hospital in Lilongwe.

UNC-Project Malawi is headquartered on the campus of KCH, and the two institutions have a long, more than 20-year relationship. Ultimately, it was this close relationship that led UNC to decide to make the donation, as Malawi-based UNC OB-GYN Jeff Wilkinson said in an article that appeared Feb. 2 in local newspaper, The Nation.

Mabel Chinkhata, deputy director at KCH, said that although the hospital still faces shortages, the medications from UNC—about $7500 worth—will help some patients get much needed treatment.

The news story appears online here. (Note: at the time of this posting, the linked website is down).

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Photo of the Day: Celebrating Years of Service to UNC Project-Malawi

Saulos Muyaya, a security guard at UNC Project-Malawi who retired in January 2014 after more than 13 years of service.

This is Saulos Muyaya, a security guard at UNC Project in Lilongwe, Malawi. On January 31, Mr. Muyaya, 65, will retire from UNC Project after more than 13 years of service.

Starting more than two decades ago with just two faculty members working on a single project, UNC Project-Malawi now employs nearly 300 people, has a large and diverse portfolio of activities, and is active throughout the central region of Malawi.

“Each of us at UNC Project has a role to play in our success, and in improving the health of Malawi, and we are indebted to Mr. Muyaya for being part of that team effort all these years,” wrote Irving Hoffman, U.S. director of UNC Project-Malawi.

We all wish Mr. Muyaya the best in the coming years.

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Photo of the Day: Our Family of Trainees in Malawi

mina-and-trainees-webOur 2013-2014 Malawi fellows and trainees took a moment to gather for a photo with their mentor and UNC Project-Malawi clinical director Mina Hosseinipour.

Standing in back (L to R): Michael Herce, Esther Giezendanner, Sarah Rutstein, Mina Hosseinipour, Melanie Sion, Nora Rosenberg, Kelly Kohler, Robertino Lim
Middle: Robert Krysiak (with Lukaz), Innocent Mofolo, Laura Hamrick, Eva Stein, Jen Tang
Front: Kashmira Chalwa, Michelle OShea, Sonia Patel,  and Christopher Mbera (aspiring future trainee).

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Giving thanks, building the future of women’s health in Malawi

The day before Americans celebrated Thanksgiving, the UNC ex-pat community in Malawi—in fact the entire country of Malawi—had something wonderful to be thankful for.

That day marked the official (ceremonial) launch of the first residency training program in obstetrics and gynecology in Malawi. The inaugural class of residents started training in October. They are: George Chilinda, Priscilla Mvula, Priscilla Phiri, and David Zolowere.

UNC collaborates with the Malawi College of Medicine on this four-year residency program. The goal is to have a qualified OB/GYN consultant in every district hospital within 10 years. This has the potential to save thousands of lives and dramatically improve the health of women throughout the country. Other partners in this effort include the U.S. CDC, the Norwegian government, the Bill and Melinda Gates Foundation, Baylor College of Medicine, and private donors.

Attending the launch ceremony were the Malawi Minister of Health Catherine Gotani Hara, the deputy chief of mission at the U.S. Embassy in Malawi, Mike Gonzales, the head of the residency program, Dr. Ron Mataya, the Principal of the Malawi College of Medicine, and other dignitaries.

Jeff Wilkinson, the UNC OB-GYN in Malawi who led the effort to establish the residency wrote, “The UNC team here in Malawi and back in the U.S. is absolutely thrilled that this effort has finally taken wings.”

This is indeed something to be thankful for.

The inaugural cohort of the Malawi OB-GYN residency program. From left to right: Priscilla Mvula, David Zolowere, Priscilla Phiri, George Chilinda

The inaugural cohort of the Malawi OB-GYN residency program. From left to right: Priscilla Mvula, David Zolowere, Priscilla Phiri, George Chilinda

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North Carolina Awards Banquet

Last week, IGHID director Myron Cohen and five others were recognized with the state’s highest civilian honor, the North Carolina Award.  The awards were presented by Governor Pat McCrory. Cohen was recognized for his contributions to science.

Watch the video tribute to Dr. Cohen

The other 2013 honorees were John E. Cram of Asheville for Fine Arts; John M. H. Hart Jr. of Keswick, Va., for Literature; Phillip J. Kirk Jr. of Raleigh for Public Service; Dr. John Harding Lucas of Durham for Public Service; and Dr. Walt Wolfram of Cary for Public Service.

Family, friends and colleagues of Dr. Cohen were there to celebrate.


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Photo of the Day: The Four AIDS Avengers

Truth, justice, and a world free of AIDS. From left: David Wohl, Joseph Eron, Charles van der Horst, and David Margolis

Truth, justice, and a world free of AIDS. From left: David Wohl, Joseph Eron, Charles van der Horst, and David Margolis

There is only one thing to say: your move, ladies.


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Photo of the Day: A Picture is Worth a Thousand Gallons

Of all the Tar Heel hopefuls, graduating seniors, new faculty members and other visitors who have had their photograph taken drinking from the Old Well, we think this one is pretty special.


Catarina de Albuquerque was on campus to deliver the 2nd annual UNC Health and Human Rights lecture, “Implementing Human Rights to Eliminate Inequalities in Water and Sanitation.”


Catarina de Albuquerque is the United Nations Special Rapporteur on the right to safe drinking water and sanitation, and here she is, drinking from Carolina’s most recognizable symbol—a well—as the University celebrates a two-year, campus-wide theme, “Water in Our World.”

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Helping mothers, inspiring awe in Malawi

[The author, Dr. John M. Thorp, Jr., is UNC professor of OB-GYN and director of of the women’s primary healthcare division]

Drs. Jeff Wilkinson, John Thorp and David Mayer in Malawi.

Drs. Jeff Wilkinson, John Thorp and David Mayer in Malawi.

I recently returned from a trip to Malawi, where I observed the tremendous progress and growth of our maternal and neonatal health program in that country. I never fail to be moved and inspired by what my colleagues are doing there, and this trip was no exception.

Malawi has the unfortunate distinction of being one of the poorest nations on earth. It also has one of the highest maternal mortality rates: about one in 36 women die during childbirth. Malawi’s first woman president, Joyce Banda, is determined to change that. She launched the President’s Maternal Health and Safe Motherhood Initiative (SMI).  Earlier this year, UNC was awarded $8 million from the Bill and Melinda Gates Foundation to assist with implementation of the SMI.

There is already much progress to report. The accomplishments of Jeff Wilkinson, Sumera Hyat, Jen Tang, and the rest of their team is nothing short of amazing.

Alfred, a staff member at the fistula center, with the chief of Matolokela village and some members of the village.

Alfred, a staff member at the fistula center, with the chief of Matolokela village and some members of the village.

A lack of skilled health workers contributes significantly to Malawi’s high rates of maternal mortality, and a core part of the UNC’s collaboration with Gates on the SMI is to support training of maternal and newborn health care providers across the spectrum, from nurse midwives to physician specialists. This fall, we enrolled more than 150 students in community midwife training programs. This is already about one quarter of the proposed total number of midwife trainees.

We have broken ground on two new maternity waiting homes. Malawi is overwhelmingly rural, and most pregnant women live too far from proper obstetric care. The maternity waiting homes are designed for women who live in remote areas. They will come to the homes toward the end of their pregnancies and have access to well-equipped facilities and skilled health workers.  UNC has been assisting with the construction of the first maternity waiting homes that will serve as models for similar homes across Malawi. Our partners at Gates have expressed interest in improving the maternity homes further, for example, by powering them with renewable energy.

Already more than 100 village chiefs have participated in community mobilization efforts to make motherhood safer. Gaining the support of traditional chiefs is critical to the success of the SMI. In addition, family planning has been incorporated into every phase of the work. Giving women the ability to control their own fertility is one of the most powerful tools that can help lift families out of poverty.

David Mayer (center) with Yohann Chikwatu and Melvis Longwe, two anesthetists at the Fistula Center.

David Mayer with Yohann Chikwatu and Melvis Longwe, two anesthetists at the Fistula Center.

Dr. David Mayer, division chief of obstetric anesthesia at UNC, planned and hosted the first-ever OB-GYN anesthesia educational event in Malawi, and perhaps in all of sub-Saharan Africa. More than 50 anesthetists from across the country attended.

And finally, at the end of the month, the first doctor will train at Bwaila Hospital in UNC’s OB-GYN residency program, also the first of its kind in the country.

In summary, I am elated by the progress that has been made and am so proud of the leadership of the Wilkinson-Hayat team. My goal is to do all I can to make sure they have all the support they  need, and it is a great joy to play a small role in all of this.

- John Thorp

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Vote for CIDRZ for the 2013 Sustainia Award!

13.09.05_SAC-Banner-VoteElectronic Cervical Cancer Control (eC3),  a cell phone-based cancer treatment program developed at UNC’s partner organization, the Centre for Infectious Disease Research in Zambia, has been nominated for the 2013 Sustania Award.  The Sustainia Award is an annual international award given to a solution, technology or project with a significant potential to help build a more sustainable future.

Cervical cancer kills 250,000 women each year, and most are in developing countries. Cervical cancer is the number one cause of cancer killer in sub-Saharan Africa.

CIDRZ has developed a low-cost and effective cervical cancer prevention solution for sub-Saharan Africa.  eC3 uses traditional marriage counselors to raise awareness about cervical cancer in the target community. Nurses then screen, diagnose, and treat pre-cancer and cancer patients, and when necessary, use cell phones and digital photography to get an immediate remote consultation.

Led by UNC professor Groesbeck Parham, who lives full-time in Zambia, the program has opened 25 clinics across Zambia, where it has screened over 100,000 women and treated 20,000 pre-cancers and cancers since 2006. More than 225 health care professionals from 12 African countries have been trained to deploy eC3.

The list of finalists is down to 10, and one winner will be announced at the grand Sustainia Award Ceremony in Copenhagen on November 7. Sustainia invites everyone to have their say. Cast your vote, and the solution with the most votes will receive the Sustainia Community Award.

This is the only nominee from the African continent. Vote for CIDRZ!

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