Enabling women to GROW

Rollins initiative supports scholarship, leadership, and change

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Group photo of woman on stairway

Pictured here are some of the GROW professors, doctoral students, and postdocs. Back row, l-r: Monique Hennink, Dabney Evans, Lauren Maxwell, Stephanie Miedema, Kristin Wall. Middle row, l-r: Usha Ramakrishnan, Irina Bergenfeld, Sheela Sinharoy, Emily Dore. Front row, l-r: Cari Jo Clark, Bethany Caruso, and Kathryn Yount.

Pictured here are some of the GROW professors, doctoral students, and postdocs. Back row, l-r: Monique Hennink, Dabney Evans, Lauren Maxwell, Stephanie Miedema, Kristin Wall. Middle row, l-r: Usha Ramakrishnan, Irina Bergenfeld, Sheela Sinharoy, Emily Dore. Front row, l-r: Cari Jo Clark, Bethany Caruso, and Kathryn Yount.

She began studying violence against women and girls, particularly when inflicted by husbands or intimate partners, more than 20 years ago. She has since spearheaded an initiative that connects a global network of like-minded scholars.

Global Research for Women (GROW) unites researchers from across Emory and across the globe with a three-pronged agenda—promote research on women’s and gender issues, support women scholars and practitioners to address the shortage of female leaders in global health, and use both to promote lasting social change. The initiative has grown to a network of individuals and institutions in countries across the globe.

“I started GROW in response to demand from students, faculty, and global partners for a community of scholars who were committed to social change,” says Yount, the Asa Griggs Candler Chair of Global Health and professor of global health and sociology. “The community has just taken off…it has its own momentum and continues to grow.”

GROW’s research spans three inter-connected areas: women’s global health, women’s and girls’ empowerment, and gender-based violence. Topics of recent research include child marriage, female genital mutilation/cutting, access to contraception, and cyber violence.

Global interest in these areas seems to be surging. For example, the UN Sustainable Development Goals, launched in 2015, for the first time included gender-based violence as a focus for goals.

“Demand for research in this area is reaching new heights among private foundations and international agencies,” says Yount. “We are moving as quickly as we can to respond to invitations for funding.”

Though demand for research about women’s and girls’ issues is high, women’s presence in global health leadership positions is lacking. Across 191 countries, only 51 have a female minister of health, according to the World Health Organization. Closer to home, at Emory University, 91 percent of undergraduates and 84 percent of master’s students in global health are women, yet 75 percent of full professors in the area are men.

To fill this gap, GROW affiliates are committed to training the next generation of female leaders. “GROW engages early career professionals in a way that advances their careers, connects them with peers, assists in their scholarship support, and builds mentorship into their training,” says Yount. “A training program for early career women also dovetails with our focus on women’s empowerment. Part of our training includes skill-building in negotiation, project management, and leadership.”

The initiative has a core research team of about 15 from across the university, and many more researchers participate on specific projects. Postdoctoral fellows, doctoral students, masters students, and undergraduates routinely collaborate on GROW projects, including traveling abroad to work with partners.

Yount and her team also have assembled a robust graduate curriculum around women’s issues, including courses in gender and global health, gender-based violence in a global perspective, maternal and child nutrition, Roger Rochat‘s Global Elimination of Maternal Mortality Abortion seminar, and a webinar and journal club. “I don’t know any other school of public health that has a curriculum as comprehensive as ours,” says Yount.

Building an evidence base and moving women into leadership positions count for naught if they don’t produce actual change on the ground. To that end, GROW sustains a social media presence that reaches more than 7,800 connections—researchers, practitioners, policy makers, activists—on a bimonthly basis. It sends out a quarterly newsletter to more than 2,000 people. Its researchers blog regularly and are quoted in national media. Here is a look at a few GROW projects:

Members of the field team for the Room-to-Read evaluation project receive training. Room-to-Read is an international NGO that focuses on early literacy programs in primary schools and a life-skills based girls’ education program in secondary schools. it is funded by Gender and Adolescence Global Evidence Consortium.

Members of the field team for the Room-to-Read evaluation project receive training. Room-to-Read is an international NGO that focuses on early literacy programs in primary schools and a life-skills based girls’ education program in secondary schools. it is funded by Gender and Adolescence Global Evidence Consortium.

Kathryn Yount, front row center, led training to evaluate the Room-to-Read program under the Gender and Adolescence Global Evidence Consortium in two districts in Nepal. Room-to-Read is an international NGO that focuses on early literacy programs in primary schools and a life-skills based girls’ education program in secondary schools.

Kathryn Yount, front right, leads Global Research for Women, which brings together researchers from around Emory and the world to study women’s issues.

Medical staff in Rwanda educate pregnant women and their partners about the effectiveness of IUDs in family planning as part of an intervention by Kristin Wall, who is not pictured here.

Medical staff in Rwanda educate pregnant women and their partners about the effectiveness of IUDs in family planning as part of an intervention by Kristin Wall, who is not pictured here.

Medical staff in Rwanda educate pregnant women and their partners about the effectiveness of IUDs in family planning as part of an intervention by Kristin Wall, who is not pictured here.

A nurse speaks with a patient about contraception.

A nurse speaks with a patient about contraception.

Medical staff at a facility in Kigali educate pregnant women about the benefits of IUDs.

Medical staff at a facility in Kigali educate pregnant women about the benefits of IUDs.

Projet San Francisco in Kigali is the NGO that supportson-the-ground work for Wall’s project.

Projet San Francisco in Kigali is the NGO that supportson-the-ground work for Wall’s project.

Post-partum family planning

For the health of babies, mothers, and families, WHO recommends a gap of at least two years between births. However, many women have little to no control over the size or spacing of their families, lacking access to contraception and family planning services.

Dr. Kristin Wall, assistant professor of epidemiology, is testing a novel intervention in Rwanda to encourage women who have just delivered to get an IUD. To get funding, Wall won a highly competitive Grand Challenges Explorations grant from the Bill & Melinda Gates Foundation. These grants support innovative thinkers worldwide to explore ideas that can break the mold in how persistent global health and development challenges are solved.

Previous interventions concentrated on training providers to offer IUDs, but Wall focused on building demand, which in Rwanda was extremely low. After focus groups revealed common myths and misconceptions about IUDs among Rwandan women—the IUD could travel throughout the body and end up anywhere or the baby would be born holding the IUD—Wall developed a flip chart explaining the basic facts, debunking the myths, and showing a picture of the actual size of the device.

In two hospitals in Kigali, the Rwandan capital, trained staffers presented the flip chart and answered questions in groups of pregnant women and their husbands when they came in for regular checkups. Uptake was impressive. In the first 18 months, approximately 3,000 IUDs were inserted, accounting for about a third of the women who gave birth during that time.

In the second phase, Wall plans to expand the program to other hospitals and health centers in Kigali and expand promotions with community health workers. In Rwanda, government-employed community health workers are assigned households, which they visit regularly for years.

“If these community health workers could fold information about IUDs into the conversations they are already having with their families, they could reach women of reproductive age who are not yet pregnant,” says Wall. “We would like to make this into a sustainable intervention that we could just hand off to the Rwandan Ministry of Health.”

A radio drama is  part of an intervention to curb intimate partner violence  in Nepal. Cari Jo Clark , who is not pictured here, is working with Equal Access International to roll out the next phase.

A radio drama is part of an intervention to curb intimate partner violence in Nepal. Cari Jo Clark , who is not pictured here, is working with Equal Access International to roll out the next phase.

A radio drama is part of an intervention to curb intimate partner violence in Nepal. Cari Jo Clark , who is not pictured here, is working with Equal Access International to roll out the next phase.

Violence at home

About one in three women suffers physical, sexual, or emotional violence at the hands of their intimate partners, according to data from 81 countries published in Science. Cari Jo Clark, associate professor of global health, is hoping to change those statistics with the help of a radio drama and community engagement.

Clark is working with Equal Access International, an international nonprofit, in Nepal. The country is a patriarchal society in which women rank in the household hierarchy below men and older women, and where it is widely acceptable for men to use violence to maintain order in the household.

Equal Access has wrapped up a nine-month intervention in which a group of couples met each week to listen to a radio drama about a husband and wife navigating typical marital issues. The couples broke into discussion groups and then went home with assignments. Every few weeks, extended family members were invited to attend.

“Of course, we don’t expect a radio drama alone to change complex human behaviors,” says Clark. “But it can be an effective way to model different behaviors. We would modify the storyline based on the feedback we got during the discussion sessions to make them very lifelike and reflective of what the couples were dealing with.”

In the last three months of the intervention, the couples were taught and supported in how to be ambassadors of what they had learned. They hosted events and showed films in their communities, and just spread the word day by day.

Although Clark’s team is still evaluating the data, an MPH student looked at results at the halfway mark and found changes among participating couples in the use of alcohol, in communication in general and around sex (many men said they seek consent now, where they had not before), and in the distribution of household chores.

In the next phase of the study, Clark wants to see if the couples who went through the program were able to nudge the norms in their extended families and villages. “Did family members and neighbors pick up on how the couple’s interactions had changed? Did the husband reprimand his brother for smacking his wife? Did the wife feel she was able to voice concerns to her mother-in-law?” says Clark. “For this intervention to be sustainable, it must reach beyond the couples who participated into the wider community.”

A facilitator leads a group of couples in a discussion about intimate partner violence, aided by a radio drama.

A facilitator leads a group of couples in a discussion about intimate partner violence, aided by a radio drama.

Men and women meet together for some sessions to discuss intimate partner violence. In other sessions, the genders meet separately.

Men and women meet together for some sessions to discuss intimate partner violence. In other sessions, the genders meet separately.

Men may find it easier to openly discuss some issues without women present, so some of the session are men only. Women have separate sessions as well.

Men meet seprately in some sessions of the Change Starts at Home intervention.

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Measuring disclosure in campus sexual assault

Kathleen Krause 18PhD was drawn to Emory to pursue her doctorate by the chance to work with Yount. After volunteering for five years at a rape crisis center in Boston and studying gender violence and health, Krause was ready to take her interest in gender-based violence to the next level.

“Dr. Yount has done such extensive and important work in this area, I wanted the chance to study under her,” says Krause. “When you do research about gender-based violence, you can collect data that is accurate and focused on prevention, but you want to do it in a way that emphasizes the safety of participants and is respectful of them. That is what I knew Dr. Yount could teach me.”

Krause devised a dissertation topic focused on those skills. When she came to Rollins, activism around sexual assault on campus was bubbling across the country. It was an issue whose time had come to be addressed. But, before it could be dealt with effectively, it needed to be accurately measured. And that’s where Krause found a bit of a roadblock—how best to measure the scope of the problem.

Specifically, WHO and an Obama White House task force had different recommendations regarding how to survey women about sexual violence. WHO prescribed face-to-face interviews while the White House backed an online questionnaire. Also, WHO favored using supportive language emphasizing that the woman is not to blame and reminding her she can stop the questionnaire at any time or skip any questions. The White House recommendation did not include any such language.

“We want our data to be accurate, but at the same time, we don’t want our questions to cause harm to people who have had traumatic experiences,” says Krause.

She enrolled 200 Georgia college students and divided them into four groups with different combinations of face-to-face vs. online delivery and supportive language vs. neutral language. In the end, Krause found no significant differences between the groups, perhaps because her survey size was small. “I see my study as adding to the evidence base and hopefully inspiring more research into the methods about how we ask these questions,” she says.

Krause is now an Epidemic Intelligence Services officer at the CDC. She credits landing this competitive position to her Rollins experience. “I think Dr. Yount’s mentorship and all the opportunities she exposed me to helped make me a desirable candidate for the EIS program,” she says.

Amy Webb Girard, who is not pictured here, works to empower women through agriculture, including women-run duckweed ponds in Ethiopia and dairy cooperatives in Tanzania and Kenya.

Amy Webb Girard, who is not pictured here, works to empower women through agriculture, including women-run duckweed ponds in Ethiopia and dairy cooperatives in Tanzania and Kenya.

Amy Webb Girard, who is not pictured here, works to empower women through agriculture, including women-run duckweed ponds in Ethiopia and dairy cooperatives in Tanzania and Kenya.

Sowing seeds of empowerment

Some of Dr. Amy Webb Girard’s work revolves around empowering women through agriculture. “That’s because women do the bulk of agricultural work globally,” says Girard, assistant professor of global health and epidemiology. “They are often the food producers, food procurers, and food preparers. So, when you look at ways to empower women, to improve their ability to generate income, and to have more voice in decision making, you are often looking at agricultural interventions.”

Girard is involved in several agriculture-based projects in East Africa and India that aim to improve women’s empowerment and maternal and child nutrition. In Tanzania and Kenya, she works with partners to develop and evaluate dairy cooperatives, which bring dairy producing households together. The organizational structures of the co-ops are designed to give women more voice in running them, and training is included in an effort to make men more open to input from women. In addition, women receive education in matters of livestock management, finance, and resources.

In Ethiopia, Girard is working with other groups to form similar sweet potato farming cooperatives, again with the aim of giving women greater access to nutritious crops, income from those crops, and agency in how to use those crops for the household. “Men typically control how much land is allocated to crops to be sold and how much to crops for the household, as well as what is planted,” she says. “We develop strategies that engage husbands to think about the benefits of allowing women greater participation in agriculture decision-making. For example, women are likely to keep more and higher quality food for the household; they also are more likely to use their income on food and health care, which translates into better health and nutrition for their children.”

In Ethiopia, Girard worked with colleagues at Georgia Institute of Technology and a local NGO, Stand for the Vulnerable, to establish women-run agricultural businesses. The businesses, which use low-technology duckweed algae ponds, allow women to grow a nutrient-rich material that can be converted into animal feed. Ethiopia has a huge shortage of high quality animal fodder, so demand for the product is strong.

Groups of about 20 women band together to establish and run the ponds and micro-businesses. They are also supported to develop small-scale poultry or fish pond businesses to complement this work. The curriculum, developed by Girard and partners, trains women in business plans, budgeting, financial literacy, negotiation, and conflict resolution skills. It also includes training in nutrition and health. As of May 2018, the team had reached about 2,400 households. Over the next five years they expect to scale up to 15,000 households.

“The whole curriculum is built around increasing women’s independence and empowerment,” says Girard. “It dovetails with GROW’s founding principal— women’s and girls’ empowerment is a pillar of sustainable development.”

For more information about GROW, visit growemory.org.

A woman milks a cow in Tanzania. Some dairy cooperatives are designed to give women more voice in management of the operations.

A woman milks a cow in Tanzania. Some dairy cooperatives are designed to give women more voice in management of the operations.

People gather around a duckweed pond in Ethiopia. Women-run duckweed ponds allow women to run their own business.

People gather around a duckweed pond in Ethiopia. Women-run duckweed ponds allow women to run their own business.

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