Posted by: blog4globalhealth | 10/28/2009

Investing in girls health: Starting at age 10 is too late

The following posting is by Sara Friedman and Hourig Babikian. The opinions expressed in the posting are solely theirs and not necessarily that of the Global Health Council.  This is the first of four postings from Friedman and Babikian on the subject of girls in development from a gender perspective.

Earlier this month, we attended the launching of a major report by the Center for Global Development, entitled Start with a Girl: A New Agenda for Global Health. A follow-up to its 2008 publication, Girls Count, the report and panel discussion made a strong case for investing in the health of adolescent girls. “Most girls enter adolescence healthy,” the report says, but then face a myriad of gender-driven pitfalls, trapdoors and health risks that can short-circuit their own development and that of generations of women. Investing in the health of adolescent girls can smooth their entry into adulthood as empowered young women with productive healthy futures and as agents of positive change for coming generations of families, communities and society.

The standing-room-only event (filled by half or more with girls and young women) reflected an explosion of recent interest in the importance of girls (as in women and girls) from a number of public and private spheres – the U.S. State Department, the Clinton Global Initiative, the Nike Foundation, publications such as Girls Count and three installments of PLAN International’s excellent yearly reports, called Because I am a Girl. The United Nations Secretary General has just released a new report on the girl child. Next February also is 15th anniversary review of the Beijing Platform for Action, which includes a separate section on girls.

For those of us who have long been advocating for girls’ rights, this event and the revival of attention to the reality of their situation – and promise – is welcome news. But is this the right message? Adolescent girls represent a critical population and life stage whose needs and promises are largely ignored. But pitfalls and trapdoors and health risks don’t appear at age 10; they are there from birth and before. So using the term “girls” to mean adolescent girls runs the risk of ignoring another critical population and life stage.

If girls are defined by age 10 and older, what then are girls under 10? They are “children”a stage of life viewed widely and erroneously as gender neutral. But children are not gender neutral, and many girls do not enter adolescence healthy. Women in developing countries, who argued for a life cycle approach to women’s rights, did not suggest it that life cycle started at 10 years of age any more than it started at 18.

There is no shortage of evidence that children are gendered from birth and before. Deeply entrenched son preference in parts of the world has resulted in millions of “missing girls” through sex selection, female infanticide and deaths of young females whose health is often ignored until it is too late.

Ample research shows that gender norms are in place between ages three and five, that by 10, girls themselves already know what society expects of them and that they are second-class citizens. Girls in countries such as Ethiopia and Djibouti are subjected to female genital mutilation between the ages of three and 10, and many girls are already promised in marriage at six or seven or even at birth. Preadolescent girls are still fetching water miles from their homes, and at six and seven are taking care of even younger siblings and ailing relatives. They are facing dangers on the road that delay their entry into school and/or curtail their ability to pay attention, furthering the likelihood of early dropout of school and increased vulnerability to the exploitation and health risks of adolescence. In some countries, young girls face the risk of HIV infection – defiled by men who think that raping virgins will cure or protect them from the virus. In short, as preadolescent girls face unprecedented gender-based violence, we can’t wait until they are adolescents to pay attention.

It was not so long ago that many leaders of the women’s movement in Europe and the U.S. viewed all females under the age of 18 as “children” whose inclusion in the struggle for women’s rights would only dilute their efforts. The growing support for adolescent girls is significant progress, but advocates should not make the same mistake by dismissing their younger sisters (who will one day be adolescents) as children who are safe, protected and healthy – free from the dangers of discrimination – until age 10.  Young or infant female children are already at the bottom of the heap after boys, men and women. Let’s not take away their identity as girls.

Including the word “adolescent” in advocacy for girls leaves space for others to define girls from birth – or before – onward.


Sara Friedman, former managing editor of Global AIDSLink with the Global Health Council, is currently a freelance writer who continues to write on health and development issues with a special emphasis on gender and human rights.


Hourig Babikian, former U.N. representative for Christian Children’s Fund, served at UNICEF in the Office of Public Partnership for more than ten years. She helped to found the NGO Working Group on Girls in 1994 and was a co-coordinator of the group until 2002. Hourig lives in the Philadelphia area where she is currently a management consultant.

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