All those caveats noted, the case for investing in girls' education is still very, very strong. Anecdotally, we know of many women who, with education, were able to obtain jobs or start businesses and transform their lives and the lives of those around them. More broadly, it's generally accepted that one of the reasons East Asia has prospered in recent decades is that it educates females and incorporates them into the labor force, in a way that has not been true of India or Africa.
A few studies with unimpeachable methodology examined the consequences when there was a huge expansion in schooling for girls, even those from poor or conservative homes. Between 1973 and 1978, for example, Indonesia vastly increased school attendance. One study, by Lucia Breierova and Professor Duflo of MIT, suggests that this led women to marry later and have fewer children. Educating girls had more of an impact than educating boys in reducing fertility.
Similarly, Una Osili of Indiana University and Bridget Long of Harvard examined a vast expansion of primary education that began in 1976 in Nigeria. They concluded that each additional year of primary education leads a girl to have .26 fewer children--a considerable reduction. It's often said that a high school education is what's most crucial, but this study found that even elementary education has a vast impact on fertility.
The challenges are manifest: Of the 115 million children who have dropped out of elementary school, 57 percent are girls. In South and West Asia, two thirds of the children who are out of school are girls.
Americans often assume that the way to increase education is to build schools, and in some areas that is necessary. We ourselves have recently built a school in Cambodia, like those students in Seattle under Frank Grijalva, but there are drawbacks. School construction is expensive, and there is no way to verify that teachers will do their jobs. One study in India found that 12 percent of all schools were closed at any time because teachers had not gone to work that day.
One of the most cost-effective ways to increase school attendance is to deworm students. Intestinal worms affect children's physical and intellectual growth. Indeed, ordinary worms kill 130,000 people a year, typically through anemia or intestinal obstruction, and the anemia particularly affects menstruating girls. When deworming was introduced in the American South in the early twentieth century, schoolteachers were stunned at the impact: The children were suddenly far more alert and studious. Likewise, a landmark study in Kenya found that deworming could decrease school absenteeism by a quarter.
"The average American spends fifty dollars a year to deworm a dog; in Africa, you can deworm a child for fifty cents," says Peter Hotez of the Global Network for Neglected Tropical Disease Control, a leader in the battle against worms. Increasing school attendance by building schools ends up costing about $100 per year for every additional student enrolled. Boosting attendance by deworming children costs only $4 per year per additional student enrolled.
Another cost-effective way of getting more girls to attend high school may be to help them manage menstruation. African girls typically use (and reuse) old rags during their periods, and they often have only a single torn pair of underwear. For fear of embarrassing leaks and stains, girls sometimes stay home during that time. Aid workers are experimenting with giving African teenage girls sanitary pads, along with access to a toilet where they can change them. Initial findings are that this simple approach is effective in increasing female attendance at high schools.
FemCare, the arm of Procter & Gamble that makes Tampax tampons and Always pads, started its own project to distribute free pads in Africa, but it ran into unexpected challenges. First, the girls needed a place to change their pads and clean up, but many schools lacked toilets. So FemCare began building toilets--with running water--at the schools, and that added hugely to the costs. Then the project encountered cultural taboos about blood, such as resistance to disposing of used pads in the garbage. FemCare had to make special provision for the disposal of pads, in some places even distributing incinerators. The project was an education on both sides, and the outcome was a familiar one: Because corporations want their brand to be associated only with the best, they often support gold-plated projects that are very impressive but not particularly cost-effective.
Another tantalizingly simple way to boost girls' education is to iodize salt. Some 31 percent of households in the developing world do not get sufficient iodine from water or food. The result is occasional goiters and, much more frequently, brain damage when children are still in the womb. Fetuses need iodine in the first trimester to develop proper brains, and both human and animal studies show this is particularly true of female fetuses. A study in Ecuador suggests that iodine deficiency typically shaves ten to fifteen points off a child's IQ. Worldwide, iodine deficiency alone reduces humanity's collective IQ by more than 1 billion points. According to one estimate, just $19 million would pay for salt iodization in poor countries that need it. This would yield economic benefits that another study found were nine times the cost. The result is that while salt iodization is one of the least glamorous forms of assistance possible, development geeks rave about it.
Alternatively, a capsule of iodized oil can be given every two years to all women who may become pregnant--at a cost of only fifty cents per capsule. Research by Erica Field of Harvard focused on Tanzania, where these capsules were given to women in some areas beginning in 1986. Professor Field found that daughters of those women given capsules managed to stay in school markedly longer and performed better.
Still another smart strategy to expand girls' education is bribery. (Nobody uses that word, but that's what it amounts to.) One of the pioneers is Mexico, where in 1995 the deputy finance minister, Santiago Levy, was alarmed that the crash of the peso and resulting recession would be devastating to the poor. The existing antipoverty program, built around food subsidies, was inefficient and served the needs mostly of food companies. So Levy quietly organized an experimental antipoverty program far away from the capital, in Campeche, where it wouldn't arouse interest or opposition. The essence of Levy's idea was to pay poor families to keep their children in school and take them in for regular medical checkups. Records were carefully kept, tabulating the results in villages where the program was introduced and in a control sample of comparable villages. Afterward, Levy showed President Ernesto Zedillo how successful the experiment had been, and Zedillo bravely agreed to phase out food subsidies and launch the new program nationwide. The program is now called Oportunidades.
About one quarter of Mexican families are served in some way by Oportunidades, and it is one of the most admired antipoverty programs in the world. The poor get cash grants in exchange for keeping children in school, getting them immunized, taking them to clinics for checkups, and attending health education lectures. Grants range from $10 per month for a child in the third grade to $66 for a girl in high school (grants are highest for high school girls because their dropout rates are highest). The payments are made directly by the central government, to reduce local corruption, and to mothers rather than fathers. That's because research has shown that mothers are more likely to use cash for the children's benefit, and because the payments elevate the status of the mothers within the household.
Oportunidades provided for rigorous evaluation--something that is lacking in too many aid programs. In this case, outside experts get contracts to perform the evaluations, making comparisons with control villages (villages are assigned randomly either to the experiment or to the control group), so that it is possible to measure how well the program worked. The outside evaluators, the International Food Policy Research Institute, rave about the program: "After only three years, poor Mexican children living in the rural areas where Oportunidades operates have increased their school enrollment, have more balanced diets, are receiving more medical attention, and are learning that the future can be very different from the past." The World Bank says that the program raised high school attendance by 10 percent for boys and 20 percent for girls. Children in the program grow one
centimeter taller per year than those in the control group. In essence, Oportunidades encourages poor families to invest in their children, the way rich families already do, thus breaking the typical transmission path of poverty from generation to generation. Oportunidades is particularly beneficial for girls, and some early studies suggest it will pay for itself by creating more human capital to power Mexico's economy. The program is now widely copied in other developing countries, and even New York City is experimenting with paying bribes to improve school attendance.
Bribery comes into play as well in the UN's school feeding program, run by the World Food Programme (WFP) and UNICEF and long championed by former senator George McGovern. Typically, the WFP distributes food to a rural school, and local parents provide the labor to prepare daily meals with it. All the children at that school get a free meal--usually an early lunch, on the assumption that they've had no breakfast--as well as regular deworming. In addition, girls with good attendance often get a take-home ration as an inducement to parents to keep educating them.
"This helps keep girls in school," said Abdu Muhammad, principal of the elementary school in Sebiraso, in a remote grassy plain of Eritrea in the Horn of Africa. He watched the students lining up as parents ladled stew onto their plates, and added: "Now students can concentrate; they can follow the lesson. And we haven't had any girls drop out since the feeding program started, except for those who got married. Girls used to drop out in fifth grade."
School feeding programs cost just ten cents per child per day, and researchers have found that they considerably improve nutrition, reduce stunting, and increase school attendance, especially for girls. But money is short, so the WFP says there are some 50 million children who could benefit from the program but don't.
Aschool feeding in Rutshuru, Congo, encourages children to stay in school (Nicholas D. Kristof)
The approaches we've discussed have proven effective at increasing school attendance, but there's also the question of how to increase learning once the children are in school. One especially cost-effective way to do that is to offer small scholarships to girls who do well. A study in Kenya by Michael Kremer, a Harvard economist, examined six different approaches to improving educational performance, from providing free textbooks to child sponsorship programs. The approach that raised student test scores the most was to offer the top 15 percent of girls taking sixth-grade tests a $19 scholarship for seventh and eighth grade (and the glory of recognition at an assembly). The scholarships were offered in randomly chosen schools, and girls did significantly better in those schools than in the control schools--and that was true even of less able girls who realistically had little chance of winning a scholarship. Boys also performed better, apparently because they were pushed by the girls or didn't want to endure the embarrassment of being left behind.
Aid to these kinds of programs is of proven benefit, but not all aid programs are created equal. So in the last few years, there has been a backlash against calls for more foreign aid. Skeptics such as William Easterly, a New York University professor who has long experience at the World Bank, argue that aid is often wasted and sometimes does more harm than good. Easterly has unleashed withering sarcasm at the writings of Jeffrey Sachs, the Columbia University economist who has evangelized indefatigably for more aid to fight malaria and AIDS and to help countries fight their way out of poverty. Other economists have noted that it's difficult to find any correlation between amounts of aid going to a country and development in that country. As Raghuram Rajan and Arvind Subramanian put it in a 2008 article in The Review of Economics and Statistics:
We find little robust evidence of a positive (or negative) relationship between aid inflows into a country and its economic growth. We also find no evidence that aid works better in better policy or geographical environments, or that certain forms of aid work better than others. Our findings suggest that for aid to be effective in the future, the aid apparatus will have to be rethought.
We're great admirers of Bono, who has been indefatigable in support of aid for Africa and who knows the subtleties of development; he talks poverty policy as well as he sings. Yet when Bono spoke at an international conference in Tanzania in 2007, he was heckled by some Africans who insisted that aid isn't what Africa needs and that he should back off. Andrew Mwenda, a Ugandan, complained about the calamitous consequences of "the international cocktail of good intentions." James Shikwati of Kenya has pleaded with Western donors: "For God's sake, please just stop."
The skeptics make some valid points. Anybody traveling in Africa can see that aid is much harder to get right than people usually realize. In 2000, a world health conference in Nigeria set a target: By 2005, 60 percent of African children would use bed nets to protect them from malaria. In reality, only 3 percent were using bed nets in 2005. There is also a legitimate concern that aid drives up the local exchange rate of African countries, undermining business competitiveness.
Even simple interventions, such as stopping mother-to-child transmission of HIV in childbirth, are more difficult to get right than anyone sitting in an armchair in America might imagine. A $4 dose of a drug called nevirapine will normally protect a baby from infection during childbirth, so this intervention has been dubbed the low-hanging fruit of public health. But even if a pregnant woman gets an AIDS test, and even if she goes to a hospital to deliver, and even if the hospital has nevirapine and the efficiency to administer it, and even if the woman is taught not to breast-feed the baby for fear of passing the virus in her milk, and even if the hospital gives the mother a free supply of infant formula and teaches her how to sterilize the bottles--even then, the system often fails. Many women simply discard the formula in the bushes outside the hospital as they walk home. Why? Because the women feel that they simply cannot feed a baby from a bottle in an African village. Every other villager would immediately realize that they were HIV-positive and would ostracize them.
While empowering women is critical to overcoming poverty, it represents a field of aid work that is particularly challenging in that it involves tinkering with the culture, religion, and family relations of a society that we often don't fully understand. A friend of ours was involved in a UN project in Nigeria that was meant to empower women, and his experience is a useful cautionary tale. The women in this area of Nigeria raise cassava (a widely eaten root, vaguely like a potato) and use it mostly for household food, while selling the surplus in the markets. When the women sold the extra cassava, they controlled the money, so the aid workers had a bright idea: If we give them better varieties of cassava, they'll harvest more and sell more. Then they'll make more money, and then spend it on their families. Our friend described what came next:
The local women's variety of cassava produced 800 kilos per hectare, and so we introduced a variety that got three tons per hectare. The result was a terrific harvest. But then we ran into a problem. Cassava was women's work, so the men wouldn't help them harvest it. The women didn't have time to harvest such huge yields, and there wasn't a capacity to process that much cassava.
So we introduced processing equipment. Unfortunately, this variety of cassava that we had introduced had great yields, but it also was more bitter and toxic. Cassava always produces a little bit of a cyanide-related compound, but this variety produced larger amounts than normal. So the runoff after processing had more cyanide, and we had to introduce systems to avoid contaminating ground water with cyanide--that would have been a catastrophe.
So we dealt with that, and finally the project looked very successful. The women were making a lot of money on their cassava. We were delighted. But because the women were making so much, the men came in and kicked the women out of the cassava fields. The tradition was that women raise staple crops, and men raise cash crops. And the men reasoned that if cassava was so profitable, it must now be a man's crop. And so the men took over cassava, and they used the profits for beer. The women had even less income than when we started.
So let's freely acknowled
ge that Murphy's Law plays a role in the aid world. Foreign assistance is difficult to get right, and it sometimes is squandered. Yet it is equally clear that some kinds of aid do work; those that have been most effective have involved health and education. In 1960, 20 million children died before the age of five. By 2006, that figure had dropped below 10 million, thanks to campaigns for vaccination, sanitation, and oral rehydration to treat diarrhea. Think about that: An extra 10 million children survive each year now, an extra 100 million per decade. That's quite a success to weigh alongside the many failures of aid. Likewise, through his philanthropic efforts, Jimmy Carter has almost succeeded in wiping out guinea worm, an ancient parasite that has afflicted humans throughout recorded history.
Or consider the $32 million that the United States invested over ten years in the global battle to eradicate smallpox. Some 1.5 million people once died annually from smallpox; since it was eradicated in 1977, about 45 million lives have been saved. That's an astonishing total. And the United States recoups its $32 million investment in smallpox every two months, simply because Americans no longer need to pay to be vaccinated against it. Because of the money saved by eradication, that investment has yielded a 46 percent annual return in the three decades since smallpox was eradicated--a better investment than any stock in that period.
Ann and Angeline
Angeline Mugwendere's parents were impoverished farmers in Zimbabwe, and she was mocked by classmates when she went to school barefoot and in a torn dress with nothing underneath. Teachers would sternly send her home to collect school fees that were overdue, even though everyone knew there was no way her family could pay them. Yet Angeline suffered the humiliations and teasing and pleaded to be allowed to remain in school. Unable to buy school supplies, she cadged what she could.
Half the Sky: Turning Oppression Into Opportunity for Women Worldwide Page 21