The Greatest Silence: Rape in the Congo, a film about sexual and gender-based violence (GBV) in the Democratic Republic of the Congo (DRC), premiered yesterday on HBO. GBV is perhaps nowhere more prevalent than in the war-torn eastern provinces of the DRC, where untold numbers of women and girls—likely in the hundreds of thousands—have been raped, mutilated, and abused. GBV encompasses rape, sexual mutilation, and abduction into sexual slavery, and is often worsened by war and civil strife.

The Wilson Center’s Africa Program and Environmental Change and Security Program, in conjunction with Catholic Relief Services, recently hosted a discussion on GBV in the DRC. Kristin Kim Bart, a gender-based violence program officer at the International Rescue Committee, delivered a powerful presentation that outlined the nature and scope of the problem and offered suggestions for how to address it. She explained, “This rape is not about sexual desire—it is about the domination and decimation of the woman, her family, and entire community. And we have seen that it works as strategy of war again and again, and today in DRC.”

GBV can have severe health consequences, including traumatic fistula, severed limbs, transmission of HIV/AIDS and other diseases, and unwanted pregnancy, but “it is the social and psychological consequences of sexual violence that are sometimes the hardest to overcome,” said Kim Bart. “Survivors are stigmatized, shunned, rejected by their families and communities, and blamed for the violence they suffered.”

Despite this bleak picture, there is hope for women and girls who have suffered from GBV. NGOs like CARE and the International Rescue Committee have become increasingly active in providing health, psychological, and economic assistance to survivors, and governments and other donors have begun to make funding these services a higher priority. In addition, Senator Joe Biden (D-DE) and Senator Richard Lugar (R-IN) recently introduced the International Violence Against Women Act, which would make the prevention of violence against women a key priority in U.S. foreign assistance.

“The silver lining of this is that conflict opens a door to address and discuss what is usually a totally taboo subject,” said Kim Bart in an email to the New Security Beat. “And with the proper resources and technical expertise, we see small changes resulting from our work over time. We have witnessed communities begin to recognize the violence women and girls are facing [and] local health professionals treating survivors with care and compassion.”

Earlier this week, public health practitioners, scientists, economists, and policymakers gathered at the Wilson Center in Washington, D.C., to launch The Lancet‘s new series on maternal and child undernutrition. The series aims to bring attention to the burden of undernutrition and raise support for evidence-based interventions that are implemented to scale. The speakers—including Joy Phumaphi, vice president for Human Development at the World Bank; Kent Hill, assistant administrator for global health at the U.S. Agency for International Development; and Tadataka Yamada, president of the Bill & Melinda Gates Foundation’s Global Health Program—emphasized the linkages between undernutrition and national productivity and prosperity. “Improved health for the world’s poor is not only a moral imperative, but also a pragmatic investment for peace, security, and worldwide economic growth,” said Hill. It is not surprising that the Japanese government recently gave $300,000 to fund a maternal and child health and nutrition program in Pakistan in an effort to alleviate poverty and increase security in the area.

Robert Black of Johns Hopkins Bloomberg School of Public Policy, the lead author of the series, emphasized that many national plans to improve nutrition have yet to be effectively implemented or have failed to achieve high coverage. He stressed the need to incorporate nutrition priorities into non-health programs and policies such as those addressing poverty, trade, and agriculture. Boldly, Black characterized the international nutrition system as fragmented and dysfunctional and called for reforms that included greater funding, capacity strengthening, and accountability.

According to The Lancet, “3.5 million mothers and children under five die unnecessarily each year due to the underlying cause of undernutrition, and millions more are permanently disabled by the physical and mental effects of a poor dietary intake in the earliest months of life.” It is time national governments and the international community acknowledge the negative impact of undernutrition on health, education, productivity, and human security. Nations will not be healthy, prosperous, and peaceful until their people are properly nourished and given the chance to develop to their full capacity. For more information on this event, visit the Global Health Initiative’s website.

The President’s Emergency Plan for AIDS Relief (PEPFAR), a $15 billion commitment, is set to expire at the end of fiscal year 2008. This critical boost in U.S. AIDS funding has helped millions of individuals infected with HIV, and in so doing, has improved developing nations’ health and education systems and decreased violence against women. In an original podcast by the Environmental Change and Security Program and the Global Health Initiative, UNAIDS Executive Director Dr. Peter Piot discusses how reauthorizing PEPFAR at increased levels of funding, expanding AIDS prevention programs, and coordinating global efforts to combat HIV/AIDS under U.S. leadership could amplify the effectiveness and sustainability of the global AIDS response.

Click here for the Wilson Center, “PEPFAR Reauthorization and the Global AIDS Response” event summary.

Former Senate Majority Leader Bill Frist, who was a practicing surgeon before his political career, announced last week that he would return to medicine—in a big way. The New York Times reports that Frist will lead Save the Children’s new “Survive to Five” initiative. This program aims to reduce the number of children—estimated at nearly 10 million annually worldwide—who die before they turn five years old. Save’s website describes five solutions to the five biggest contributing factors to child mortality. By applying these solutions—all of them proven, and most of them very inexpensive—they hope to save as many as 6 million children every year.

The Times mentions that other American politicians, such as Jimmy Carter and Bill Clinton, have dedicated much of their post-political lives to global health, with excellent results. Perhaps even more encouraging is that some current world leaders are addressing these issues as well. Last month, British Prime Minister Gordon Brown and German Chancellor Angela Merkel vowed “urgent action” on health issues in developing countries. Their International Health Partnership, which began on September 5, will address child mortality, as well as maternal mortality and HIV/AIDS prevention and education.

The Times notes that Frist is playing a key role in a similar campaign with the Bill and Melinda Gates Foundation, along with former rival Senator Tom Daschle—although it doesn’t mention that while majority leader, Frist broke with political tradition by campaigning against his counterpart. It is encouraging that they have put political differences behind them and are working together on a new campaign that could save and improve the lives of millions of children around the world. Hopefully, they will be successful in persuading Americans and their elected officials that child mortality is not only unacceptable and preventable, but that reducing it is a worthy use of taxpayer dollars.

This effort may seem daunting, given that less than one-half of one percent of the U.S. budget goes to international assistance. Frist was successful in ushering through the President’s Emergency Plan for AIDS Relief (PEPFAR), which dedicated $15 billion over five years to fighting AIDS, principally in Africa. This was a major victory for global health, but there is room in the budget and the priorities of American leaders for more global health programs—especially if PEPFAR is doubled, as is now being considered, to $30 billion over the next 5 years. Campaigns to reduce childhood mortality do not face the political scrutiny of HIV/AIDS programs such as PEPFAR, but it will still be important that Frist and others involved allow science-based medicine to dictate funding priorities; one of PEPFAR’s main failings is that it has caved to ideology in placing an unadvisedly large emphasis on abstinence education.

Frist and his colleagues certainly have a difficult battle against child mortality ahead of them. But Frist—a surgeon, politician, and businessman—has an impressive range of skills and an equally enviable Rolodex of supporters to call upon.

They say that a good man is hard to find. But in some countries, the opposite is true: a good woman is hard to find—because it’s hard to find women at all. According to a recent article by the BBC, the Chinese city of Lianyungang has eight men for every five women. Ninety-nine cities in China have gender ratios as high as 125 (125 men for every 100 women, or a 5:4 ratio).

But China is not alone. India has a gender ratio of 113, and the ratio in Asia as a whole is 104.4. In the United States, by contrast, the rate is 97, meaning that there are more women than men.

Gender imbalances are caused by cultural and economic preferences for male children, which contribute to sex-selective abortion and female infanticide. Over 60 million girls are “missing” in Asia as a result of these practices.

Furthermore, some government policies may intensify these gender preferences. China’s one-child policy, for example, may cause concern among parents, particularly in rural areas, that having a female child endangers their family’s future. Government policies intended to combat skewed gender ratios, such as bans on prenatal ultrasounds for the purpose of determining the baby’s sex and bans on sex-selective abortion, have proven ineffective.

Unbalanced gender ratios have consequences that reach beyond just the mothers and children involved. According to Valerie Hudson, high gender ratios leave many men without prospects for marriage, which may mean these men have fewer incentives to contribute peacefully to society. The men with the slimmest prospects for marriage are likely to be unemployed, poor, and uneducated, so they are already at increased risk for violent behavior. Hudson cites statistical evidence showing links between high gender ratios and higher rates of violent crime, drug use, trafficking, and prostitution.

Hudson and co-author Andrea den Boer cover these links in greater detail in their book Bare Branches: The Security Implications of Asia’s Surplus Male Population. In the 11th issue of the Environmental Change and Security Report, Richard Cincotta takes issue with some of the statistical methods that Hudson and den Boer use. He argues that what is important is not nationwide gender ratios, but the number of “marriage-age men” (25-29 years old) and “marriage-age women” (20-24).

While there may be some debate over whether the relationship between gender ratios and violent behavior is a causal one, there is little doubt about what causes the gender imbalances in the first place. An end to preferences for female children will be beneficial not only to girls and women, but to societies as a whole.

Photo Credit: A subway in China, courtesy of flickr user 俊玮 戴.

The breadth and depth of statistics available on the WomanStats Project, a new online resource for statistics on women’s security, lends strength to the website’s claim that it is “the most comprehensive compilation of information on the status of women in the world.”