The Value of Saving Women and Girls’ Lives Around the World

The U.S. government’s approach to foreign assistance, following weeks of wholesale funding freezes, contract cancellations, and mass personnel layoffs is far from clear, but a few indications are surfacing amid the chaos. A much-rumored plan would reorganize some functions of the U.S. Agency for International Development into a new entity under the State Department. According to an unofficial, unsigned memo reported by Politico, this entity, which would require congressional approval, would address humanitarian assistance, disaster response, food security, and global health. Other functions, previously divided between USAID and the State Department, would be consolidated at State, to include democracy promotion, women’s empowerment, conflict prevention and stabilization, religious freedom, and civil society.

The unofficial document indicates a commitment on the part of the Trump administration to continue some activities of previous administrations, including the first Trump administration. Creating a new agency will not only require law, but also thoughtful design that has been the topic of study for decades. Few experts would argue that USAID was a perfectly functioning organization; indeed, the Biden administration tried to make some reforms under its “localization” strategy, and Congress legislated requirements for rigorous assessment, monitoring, and evaluation of its programs (as well as others across the U.S. government) to ensure taxpayer dollars are well spent. Given that the memo mentions humanitarian assistance and women’s empowerment, there may be hope for continuation of vital life-saving work, including programs that have saved millions of lives and empowered millions of women and girls, amid the many efforts that have bolstered American interests and allies around the world.

Status of current USAID programs

In the meantime, many lives are being lost and many more are at risk since USAID was summarily gutted, probably illegally. On March 18, District Court Judge Ben Chuang ordered that USAID employees be reinstated in a ruling stating that the actions taken to halt programs and dismiss USAID employees “likely violated the United States Constitution in multiple ways” since Congress had created the agency and approved the current funding of its programs for this fiscal year. His 68-page opinion stated that these actions “deprived the public's elected representatives in Congress of their constitutional authority to decide whether, when, and how to close down an agency created by Congress.”

This order will not automatically restart programs that were funded by Congress for this fiscal year, and while legal battles continue lives are being lost. Humanitarian waivers have been issued to allow resumption of a very few programs, such as the PEPFAR (U.S. President’s Emergency Relief Plan for AIDS Relief) program initiated under the George W. Bush administration, which is credited with saving 26 million lives since 2003. It is not clear how much of that activity has resumed. Moreover, the limited waiver issued for that program was narrowly drawn to treat only those already infected. It excludes critical preventive programs to keep more people from becoming infected.

One component of PEPFAR that was not included in the waiver is the DREAMS (Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe) initiative which ran throughout the first Trump administration and up through this January. If it is not restarted, 80,000 adolescent girls and young women could become infected by HIV this year, based on the rates reported by the U.S. government. The program has been highly effective, reducing new HIV diagnoses among adolescent girls and young women by 25 percent or more in nearly all regions implementing the initiative. Including adolescent girls and young women is vital because they are up to fourteen times more likely to be infected than their male counterparts. Over the last four years the program has reached millions of women and girls.

The success rate of PEPFAR and its DREAMS component is due to the interlocking facets of the program, which is true of much of the programming in the humanitarian and development space. Without prevention efforts, humanitarian disasters are more severe. PEPFAR also addressed violence against women because it is a primary vector for infection. Surveys conducted under PEPFAR found that one in three young women reported their first sexual experience as forced or coerced. To address that DREAMS including a “Faith and Community Initiative” to engage “key faith, traditional and other community leaders on the issue of sexual violence against children, interventions to change harmful gender norms, support for the development of child safeguarding policies in youth-serving organizations, as well as linking with and strengthening the criminal justice sector.”

The PEPFAR/DREAMs example is one among many casualties of the current wrecking-ball approach to reform. Numerous humanitarian organizations have called for the funding to be restored to allow the life-saving work to continue as Congress intended through its appropriations that authorized, allocated, and obligated funding for the current fiscal year. According to one analysis, the cuts in funding to the UN Population Fund or UNFPA will have numerous repercussions, including 17.1 million unintended pregnancies and 34,000 preventable pregnancy-related deaths. UNAIDS and other organizations are attempting to track and relay the daily cost of the programs’ cancellations around the world.

Sustaining public support for foreign assistance

There is both wide support among the American public for foreign assistance, as well as widespread ignorance of its modest scale in relation to overall government spending. According to a 2019 Pew Research Center poll, 68 percent of Americans said the U.S. should spend the same (33 percent) or more (35 percent) on foreign assistance. Sustaining support requires communicating the value to U.S. interests and the benefits this country reaps from global security, stability, and prosperity. In addition, ensuring the effectiveness of programs is a legitimate demand. Program design and monitoring and evaluation are routine stipulations in government contracts, but common standards for rigorous evaluation should be pursued as the quality of assessments varies widely. An example of demonstrated success is a scientific study that found that USAID programs in sixteen countries prevented one million to 1.3 million deaths among women of reproductive age in 2009-2015. The compact model of the Millennium Challenge Corporation is another mechanism to ensure that the recipient country formally shares the commitment and the objectives of the programs.

Foreign assistance represents about one percent of the federal budget, including some military assistance. While the U.S. government has traditionally been a significant player in global development, the United States plays an equally important role as a force multiplier to generate even greater sums from other partners. It has increasingly turned to public private models that generate millions, even billions, from other governments, the private sector, and multilateral and civil society organizations. The DREAMS program discussed above is a case in point. The latest expenditure of $800 million dollars was primarily funded by non-U.S. government dollars in partnership with the U.S. government. The primary donors have been the Bill & Melinda Gates Foundation, Girl Effect, Johnson & Johnson, Gilead Sciences, and ViiV Healthcare.

In the past administration, $2.6 billion in U.S. foreign assistance for women and girls was mobilized to generate a total of $4 billion in support with partners. Most of the efforts relied on this joint approach to funding and implementation: Among them are promotion of women’s economic and political empowerment and the programs under the bipartisan Women, Peace, and Security Act of 2017:

• Women in the Sustainable Economy Initiative—a $2 billion program for women’s economic empowerment through employment, financing, and training, with $173 million funded by the USAID and the State Department and the rest from non-US government sources, including the private sector and other governments.
• Women LEAD (Women Leading Effective and Accountable Democracy in the Digital Age) made a $150 million commitment to gain other non-US government participation for a total $900 million program to address violence and promote political empowerment and participation in government, criminal justice, peacebuilding, and conflict resolution.
• A combined investment of $303 million by USAID and the State Department has supported implementation of the Women, Peace, and Security Act of 2017, which was passed with bipartisan support. It is overseen by the Women, Peace and Security (WPS) Caucus in the U.S. Congress, co-chaired previously by Representative Mike Waltz (R-FL), who is now the White House National Security Adviser, and Representative Lois Frankel (D-FL). Governments around the world have adopted national action plans to implement WPS programs and commitments.

Congress, as well as the courts, should insist that programs authorized by Congress be allowed to continue while deliberate reform is undertaken. U.S. interests, as well as its leadership around the world, will benefit.