2017 IMPACT REPORT PRESIDENT’S MESSAGE

We are living in a new reality. It’s the power of she.

For nearly 75 years, EngenderHealth has Looking ahead, EngenderHealth is more been on the front lines fighting for women’s committed than ever to championing Ulla Müller with Khadija sexual and and rights at all levels rights-based approaches to and her daughter at an across more than 110 countries. We have sexual and reproductive health, advancing tackled tough issues before and have knowledge and solutions to reach more EngenderHealth-supported weathered daunting political challenges women and girls, and expanding strategic site in . and constrained funding climates. Yet today partnerships that will unleash women’s is different: Attacks on women’s sexual and and girls’ potential and ensure sustainable reproductive rights are unprecedented in development. As you will read in the stories scope and are growing. that follow, we are well on our way toward achieving our goals and forging a new This reality only fuels our resolve to work reality for women and girls everywhere. smarter and harder—we will not rest until sexual and reproductive rights are Thank you for your invaluable partnership respected as human rights, so that women and generous support to make this vision and girls have the freedom to reach their a reality. full potential. Because when a woman can access contraception and the full spectrum of sexual and reproductive health services, including safe , she can determine the course of her future. She will be healthier, is more likely to finish her Ulla E. Müller education, and will earn more throughout President & CEO her life. There is no doubt that when we focus on catalyzing the value of women and girls, they become a driving force that can transform communities and nations. WOMEN & GIRLS EngenderHealth is a pioneer in improving access to contraception and Building upon our successes to date, thisFIRST strategy reboots our mission in a sexual and reproductive health care, always guided by the belief that sexual new era of international development, embraced by the global community and reproductive health is a human right and is crucial for women and girls under the umbrella of the United Nations Sustainable Development Goals. to determine their futures. Grounded in the core values of quality, rights, and This new time calls for new approaches that prioritize women and girls as sustainability, EngenderHealth is poised to make an even greater impact crucial drivers to ending poverty, mitigating climate change, and achieving with our new organizational strategy, Women & Girls First. global progress and development.

4 5 Winnie Namatovu REACHING MORE WOMEN & GIRLS

Uganda

To Winnie Namatovu, 26, a nursing reach and underserved areas. Because assistant and peer educator from ensuring contraceptive choice and rights Kyantale Village in Uganda, topics such as is as important as providing reproductive generating income, managing money, and health information and services, using contraception are all connected. She EngenderHealth also supported the has a deep and personal understanding of Ugandan Ministry of Health in developing the linkage between delaying unwanted a national implementation plan on family pregnancy and the ability to earn a living. planning, focusing on long-acting reversible Her younger sister became a mother at contraceptives and permanent methods, age 13 and later had another unintended to ensure that women have options pregnancy. As a mother of two children throughout the national health care system. herself, Winnie also knows how important the spacing and timing of pregnancies are to one’s future.

Becoming a peer educator on EngenderHealth’s Expand Family contraception was a natural fit for Winnie, Planning project, supported by The who learned counseling and community Bill & Melinda Gates Foundation, mobilization skills from EngenderHealth. takes a holistic approach to ensuring She receives ongoing training, support, and advice from public health workers in her women’s and youth’s access to a range town and is proud to have counseled her of contraceptives, including long- sister, who is now using contraception and acting reversible contraceptives and is back in school. When talking to her peers permanent methods, with ongoing and to parents of youth, Winnie also uses or past activities in Uganda, the locally sensitive youth booklets developed Democratic Republic of the Congo, by EngenderHealth to aid discussions and Tanzania. EngenderHealth and our about sexual and reproductive health. ExpandFP project are part of Family In addition to providing ongoing training Planning 2020, a global partnership and engagement of peer educators, with the goal of reaching an additional EngenderHealth enables local health IMPACT HIGHLIGHT 120 million women and girls with facilities to offer mobile outreach services modern contraception by 2020. Winnie is one of 38,290 individuals trained last year on sexual and and hold special service reproductive health by EngenderHealth. days to bring providers, counselors, and community outreach workers to hard-to-

7 Tigist Tefere WHEN THE POWER OF CHOICE IS IN HER HANDS

Ethiopia

Tigist Tefere, a family planning counselor, compassionate and quality care, including will never forget the pregnant teenager who contraception and comprehensive abortion came to see her at the Kolfe Health Center care services. in Addis Ababa. She counseled the teen on conception, her body, and her choices. The EngenderHealth is proud to have led the teenager said that she was not ready to be a way in dramatically expanding Ethiopian mother and that her father might harm her if women’s access to contraception and safe he found out she was pregnant. abortion by engaging providers with our competency-based training packages and Tigist feels good to this day for her role in individualized post-training mentorship supporting this teen through a challenging approach; advocating for a positive policy time and decision and in offering counseling environment that supports sustained, that enabled her to see that she had options integrated services; and fostering a and that all hope was not lost. She might quality improvement approach to services. have tried to end her own life if she had not EngenderHealth also ensures the availability had access to safe abortion, or she might of contraceptive supplies and instruments have died from an if she had and supports facility readiness. no other options.

Tigist’s passion for women’s health does not stop at work. She also advised her EngenderHealth has made it possible older sister, who was married at age 14 and for an increasing number of women and already had two children, on the importance girls to access an integrated package of planning her family and not leaving it up of health care services in a single to chance. visit to a health facility in . To In partnership with the Ministry of Health, date, 460 health facilities supported EngenderHealth’s Access to Better by EngenderHealth offer quality Reproductive Health Initiative (ABRI) is reproductive health services, including working to reduce maternal death and safe abortion and contraception. IMPACT HIGHLIGHT disability in Ethiopia by training health care providers like Tigist, who serve on the When women use contraception, it reduces the need for abortion, front lines of rights and choice, to provide especially unsafe abortion. Last year, our family planning activities around the world prevented an estimated 1.4 million unsafe .

9 Fatema Begum FORGING STRATEGIC PARTNERSHIPS

Bangladesh

Inside a garment factory in Dhaka, peer educators to ensure quality of care, Bangladesh, Fatema Begum spends most informed choice, voluntarism, respect for of her day at a sewing machine—one of client rights, safe services, and referrals to hundreds lined in rows humming under other services, as needed. There is regular the fluorescent lights. In addition to supervision and feedback to ensure quality sewing, Fatema works as a peer educator of care and support to Fatema and other to 1,400 co-workers about a topic that is providers. personally very important in her own life: contraception. Married at age 10, Fatema At first, some of Fatema’s co-workers had her first child at 13 and her second by were hesitant to discuss contraception 19. Now 29, Fatema shares her story with with her. “Women aren’t accustomed her co-workers and advises them about to talking about these things openly,” their right to plan their families by design Fatema explained, “but they want to avoid and not by chance. pregnancy because having children can hamper their earnings.” She says that her Garment workers work long hours, which co-workers now see family planning as a can make accessing reproductive health basic health care need that can help keep services a challenge. EngenderHealth doors open to other opportunities. is bridging this gap by supporting the provision of family planning information Fatema is proud of her role as a peer and services within the factory through educator and family planning champion. its public-private partnership with the She is a testament to how we must government and a Bangladesh garment devise creative ways and partnerships to trade association. bring reproductive health information, counseling, and services to women—when At the mini–health clinic established on and where they need them—so they in the factory premises, EngenderHealth turn can make an even greater impact on trains and equips health care providers and their communities.

IMPACT HIGHLIGHT Last year, EngenderHealth reached 17.9 million people with sexual and reproductive health information, which is crucial for women and girls to plan their futures by design, not chance.

10 WHEREOUR GLOBAL WE WORK IMPACT

Driving Change Through Advocacy

In addition to strengthening health care outcomes for women and girls, which will services, within countries EngenderHealth contribute to building stronger communities advises district- and regional-level and aid governments in reaching their government partners to collect overall national development goals. For programmatic evidence, including data, to example, last year EngenderHealth engaged advocate for positive policies and funding the governments of Burkina Faso, Côte to meet local needs. We collaborate with d’Ivoire, and Togo to devise national action ministries of health to prioritize support for and advocacy plans that allocated and and allocate more resources to sexual and significantly increased funding to expand reproductive health programs. Our advocacy contraceptive choice and access to sexual efforts are vital to ensuring an enabling and reproductive health services. environment that will result in better health

WHERE WE WORK:

Bangladesh Guinea The Philippines IMPACT HIGHLIGHT Burkina Faso India Senegal Today, 214 million women want to prevent pregnancy but are not Burundi Kenya Tanzania using modern contraception. Addressing this unmet need would reduce Côte d’Ivoire Malawi Togo unintended pregnancies, unplanned births, and induced abortions by Democratic Republic Mauritania Uganda approximately 75%. of the Congo Niger Ethiopia Nigeria Source: Guttmacher Institute, 2017. Adding it up: Investing in contraception and maternal and newborn health, 2017. New York. 13 By the Numbers EngenderHealth’s leadership in ensuring women’s OUR GLOBAL IMPACT rights to contraception, quality care, informed choice, and safe services is unparalleled.

Last year, EngenderHealth worked in nearly 20 countries and reached:* These activities prevented an estimated:** 11,350 7.1M 4.9M 62,270 health care providers women and men unintended child deaths (as a result of trained to strengthen with contraceptives pregnancies improved contraception) sexual and reproductive at sites supported by health services EngenderHealth programs 7,173 1.4M maternal deaths unsafe abortions 10,740 17.9M hospitals and health people with sexual In addition, was saved in direct centers to deliver and reproductive $260M better care health information health care costs (by avoiding adverse events related to pregnancy, death, and disability).

*EngenderHealth trains health care providers and supports hospitals and clinics in partnership with governments and local organizations to offer high-quality reproductive health services. The EngenderHealth-supported sites provided health care services that will reduce preventable deaths and disability and result in cost savings. The data cover FY2016–17. **Estimated using Marie Stopes International’s Impact 2 Model.

14 15 ADVANCING RIGHTS TO HEALTH

Every day, 830 women die from pregnancy- during labor and delivery, and increased or childbirth-related complications. In access to quality emergency obstetric care. addition, many others survive but suffer Also, we are supporting fistula survivors serious injuries, including , to reintegrate successfully into their which is caused by prolonged labor without families and communities, reengage with medical intervention and leaves a woman their loved ones, and ultimately become leaking urine and/or feces uncontrollably productive members of their communities. and continuously. Recently, EngenderHealth has: In many ways, fistula—which affects 2 to 4 million women worldwide—epitomizes • Developed tools to standardize safe the physical and psychological damage surgical care for women with fistula, caused when women are denied their right uterine or vaginal prolapse, and to lead dignified lives and attain quality incontinence—ensuring that patients health care through prevention, treatment, receive high-quality care spanning from and postoperative services. In many cases, their admission to the hospital until long women living with fistula face abandonment after their discharge. The tools also focus by their husbands and social isolation from on prevention of pregnancy, especially their families and communities, leaving during the lengthy recovery period. them unable to lead lives to their fullest potential. • Convened experts from the public and private sectors, civil society, health care EngenderHealth’s Fistula Care Plus project associations, and academic institutions is leading efforts to transform the lives of to develop a dynamic, multisectoral these women by ensuring that they receive strategy with the goal of ending prevention and repair services addressing obstetric fistula in South Asia by 2030. the complex physical, emotional, and social This integrated effort is key to ensuring dimensions of fistula and its aftermath. sustainability and quality of care for We are propelling the field forward women, which requires a complex by strengthening skills and capacity at network of committed actors. health facilities, creating regional and IMPACT HIGHLIGHT global alliances, conducting research, • Led global efforts to raise awareness and developing tools and resources for about the growing burden of fistula EngenderHealth is helping women in Bangladesh, the Democratic surgeons and health care clinicians. caused by surgical error during cesarean Republic of the Congo, Niger, Nigeria, and Uganda receive fistula sections and gynecologic surgery, which repair, contraception, and maternal health care. To date, we have As important as ensuring that women is preventable through surgical and can receive fistula repair treatment is anesthesia training, supervision, and supported 38,174 fistula surgeries. More needs to be done to reach focusing on prevention, specifically through strengthened systems within facilities. women awaiting repair and to prevent fistula from occurring altogether. contraception, appropriate monitoring

16 THE ADOLESCENT GIRL

EngenderHealth is leading efforts across opportunity to spark a positive change in , Asia, and the United States to ensure their lives—with the potential to transform that adolescent girls receive comprehensive their communities and the world. sexuality education and youth-friendly health services and that communities where they live are informed about the benefits Among 1.1 billion young people of delaying early marriage/pregnancy and ages 15–24 worldwide, 85% live in the consequences of harmful practices that developing countries. Young people, needlessly put girls at risk. especially girls, face significant risks of This is crucial to realizing our strategic vision: unplanned pregnancy, HIV and other to reach young women and girls where they sexually transmitted infections, gender- are and to ensure that all women and girls, based violence, and additional serious regardless of age or geography, have every health issues.

West Africa

Our Agir pour la Planification Familiale (AgirPF) project leads the way in Burkina Faso, Côte d’Ivoire, Mauritania, Niger, and Togo by taking a comprehensive, impact- oriented approach to ensuring that women and girls can fulfill their reproductive intentions. We launched a comic book series with reading groups in primary and secondary schools to engage young people about sexuality, reproductive health, and local services. The comic book follows the IMPACT HIGHLIGHT lives of girls in villages and in cities and shows In West Africa, we trained 300 health care providers in 76 health how sexual and reproductive health–related facilities on youth-friendly sexual and reproductive health services. choices can impact their lives and futures. It explains girls’ rights and presents information To date, an estimated 256,000 young people have participated in on how they can stay healthy, protect their our educational programs on gender, contraception, and sexual and futures, and achieve their life goals. reproductive health.

18 Tzytel Castro

The Philippines

Tzytel Castro, 19, has an 8-month-old at the hospital, exclusively breastfeed their baby boy—and she isn’t alone. In fact, the newborns for at least six months, and use Philippines has one of the highest teen contraceptives. The program creates space pregnancy rates throughout all of Asia. More and opportunity for girls like Tzytel to pursue than one-quarter (27%) of young Filipino plans to earn a college degree, have a women between the ages of 15 and 19 is second chance at finishing school, keep their either already a mother or pregnant with her children healthy, and ultimately reach their first child. fullest potential.

Many Filipino girls have little to no access In addition to leading the PYP, to information about their sexual and EngenderHealth’s VisayasHealth project reproductive health, pregnancy prevention, is improving maternal and child health or the dangers of early pregnancy. Stigma, and family planning services in eight laws, discrimination, poverty, and fear are just provinces of the Visayas, by strengthening a few of the many barriers they face. reproductive health services and educating communities with health information and To support teens like Tzytel, EngenderHealth referrals (including using mobile phones leads a Program for Young Parents (PYP) to communicate with young women). aimed at addressing the critical needs of VisayasHealth also offers video refresher young expectant mothers, encouraging them trainings to health care providers, which are to attend prenatal consultations, deliver their crucial to those living and working in remote babies under the care of trained professionals and rural areas.

20 United States

Young women and girls in the United States face many of the same challenges as youth in other countries. Recently, millions of dollars of U.S. federal funding were cut from programs around the country, including EngenderHealth’s own Teen Pregnancy Prevention Program in Austin, Texas. This was unexpected, with the only reason given that it is no longer a priority in the current administration.

These programs provide essential services for teens. Through our Re:MIX project in Texas (which has one of the highest rates in the country), we are utilizing game-based tools, technology, and storytelling to impart the crucial skills that teens need, while integrating hip-hop and theater techniques to meet young people where they are, culturally and socially. The program emphasizes empowerment and positive youth development for young parents and teens by providing professional development and leadership programming. Check out the courageous digital stories from young parents on YouTube’s EngenderHealth channel, at www.bit.ly/remix-stories.

22 Khadija and her daughter MAKING LASTING IMPACT

Tanzania

After living with HIV for more than a of Health, Community Development, decade, Khadija recently visited Magugu Gender, Elderly, and Children, we ensure Health Center in Tanzania with her bubbly contraceptive choice, including long-acting 3-year-old daughter. In addition to reversible contraceptives and permanent receiving antiretroviral therapy, Khadija was methods; strengthen integration of family supported throughout her pregnancy by planning with other reproductive health health care providers at Magugu to keep and HIV prevention and treatment services; her baby HIV-free. She received counseling equip health centers with supplies and on a variety of contraceptive methods and medicines and renovate them as needed; chose the method that worked best for her, standardize training for health care so she could decide if and when to have providers; and support services, including a second child. For now, Khadija is happy mobile outreach to rural, remote areas. to have a healthy daughter and to have been able to make this choice, so she can EngenderHealth is also making a lasting concentrate on staying healthy, take care of impact by providing expertise and her family, and run her small business as a training on lifesaving postabortion care street food vendor. and decentralizing these crucial services to lower-level health care facilities, to EngenderHealth supports Magugu Health fill the gaps where there are too few Center and Tanzania’s national family doctors, especially in rural areas. We are planning and reproductive health program also responding to community needs by in 110 districts across all 30 regions. In preventing partnership with the Tanzanian Ministry and children.

IMPACT HIGHLIGHT In Tanzania, we helped increase modern contraceptive use nationwide by 60% during the past decade, from 20% to 32%.

25 FINANCIALS THE TEAM

Statement of Activities Board of Directors Executive Team

Operating revenue We are grateful to our longstanding Robert D. Petty Ulla E. Müller U.S. Agency for International Development $ 41,074,149 individual and institutional Chair President and Chief Executive Officer Individual and institutional contributions $ 19,232,581 supporters for their steadfast commitment to EngenderHealth Linda Rosenstock Mina Barling Total operating revenue $ 60,306,730 and our work. It is through our Chair, Executive Committee Director, Policy and Advocacy partnerships with national and local Operating expenses governments, nongovernmental Gary Camus Rosemary Ellis Program services: organizations, communities, and Chief Financial Officer Secretary Reproductive health services $ 50,462,233 health professionals that we are able Mustafa Kudrati Total program services $ 50,462,233 to work toward ensuring sexual and reproductive rights are respected as Margaret Neuse Vice President, Innovation, Impact, human rights, so that women and Assistant Secretary and Quality Support services: girls have the freedom to reach Administration $ 10,041,325 Reme Moya their full potential. Donald J. Abrams Chief Operating Officer Fundraising $ 1,053,396 Treasurer Total support services $ 11,094,721 In 2016, EngenderHealth’s total Paul Perchal income was $60.3 million, made Total operating expenses $ 61,556,954 Constance A. Carrino Vice President, Program Management possible through the generosity of Mark Chataway Nonoperating revenue thousands of caring individuals as Francine Coeytaux Lauren Wolkoff well as foundations, corporations, Investment return $ (134,294) Denise Dunning Global Director, Communications the U.S. Agency for International Change in value of split-interest agreements $ 46,665 Ryan Hawke and Marketing Development, and other bilateral, Paul Hinks Pension-related changes other than multilateral, and technical agencies. net periodic pension costs $ (482,004) We deeply appreciate this vital Karen Koh Michael McDermott Total nonoperating change in assets $ (569,633) support. Mark Simmonds Increase/(decrease) in net assets Andrew L. Sommer Decrease in net assets before nonoperating revenue $ (1,250,224) Director Emeritus Total nonoperating change in assets $ (569,633) Lyman B. Brainerd, Jr. Total decrease in net assets $ (1,819,857)

Net assets, beginning of year $ 35,879,377 82% Program services Net assets, end of year $ 34,059,520 16% Administration 2% Fundraising © 2017 EngenderHealth (CM0141) Photo credits: p. 1: M. Tuschman/EngenderHealth; p. 2: S. Lewis/EngenderHealth; pp. 4–5: Robin Wyatt/EngenderHealth; Note: The above data represent the audited financial information for the p. 6: A. Ackerman/EngenderHealth; p. 11: T. Murad/EngenderHealth; p. 12: R. Shryock/EngenderHealth; p.14–15: Robin 12-month period ending June 30, 2016. For detailed financials, please visit Wyatt/EngenderHealth; p. 17: R. Islam/EngenderHealth; p. 19: R. Shryock/EngenderHealth; p. 21: J. Licardo/EngenderHealth; www..org/financials. p. 23: Will Gallagher/Gallagher Studios/EngenderHealth; p. 24: S. Lewis/EngenderHealth

26 EngenderHealth is a leading global women’s health organization committed to working toward a world where sexual and reproductive rights are respected as human rights and women and girls have the freedom to reach their full potential. In nearly 20 countries around the world, EngenderHealth creates lasting change by training health care professionals and by partnering with governments and communities to make high-quality family planning and sexual and reproductive health services available today and for all generations to come.

www.engenderhealth.org