Testimony of Deputy Administrator Donald Steinberg before the Senate Appropriations Subcommittee on State, Foreign Operations

Tuesday, May 21, 2013


Chairman Leahy and Ranking Member Graham, Members of the Subcommittee, thank you for having me here today.  Let me first take a moment to express my appreciation for your ongoing and steadfast support for foreign assistance and in support of children throughout the world.

In his State of the Union address, President Barack Obama reaffirmed America’s commitment to global development.  In an inspiring challenge, he said:

“We also know that progress in the most impoverished parts of our world enriches us all.  In many places, people live on little more than a dollar a day.  So the United States will join with our allies to eradicate such extreme poverty in the next two decades: by connecting more people to the global economy and empowering women; by giving our young and brightest minds new opportunities to serve and helping communities to feed, power, and educate themselves; by saving the world’s children from preventable deaths; and by realizing the promise of an AIDS-free generation.” 

If we are to achieve this objective, we know that healthy mothers and children are the key. 

USAID makes critical contributions to the U.S. Government’s work to aid children in adversity. Our work to help children to first survive, then thrive, is an important piece of the efforts being coordinated under the recently-released U.S. Government Action Plan for Children in Adversity. The action plan represents the work of more than seven different agencies across the government—and is one of finest examples of interagency collaboration and coordination in recent years.

USAID’s Global Health programs focus on ensuring child survival and basic health. USAID’s foreign disaster assistance program works to protect the health and welfare of children in disaster situations, an especially acute form of adversity. USAID’s Displaced Children and Orphans Fund program prevents family separation, promotes family-based alternatives to institutional care for children, and reduces other protection risks for children through strengthening the capacities of families, communities and governments to care for children.

Together, our global health, humanitarian and disaster assistance programs, along with our broader development efforts, directly contribute to achieving the principal objectives of the Action Plan for Children in Adversity: building strong beginnings, putting families first, and protecting children from violence, exploitation, and neglect.

Strong Beginnings

The effort to strengthen our support for children in adversity begins by ensuring that all children live to celebrate their 5th birthday.

Nearly 30 years ago, USAID and UNICEF, with the support of the U.S. Congress, launched a “child survival revolution” aimed at reducing the number of deaths among young children in developing countries.  Back then, every year, almost 15 million children under age 5 died from common preventable diseases.  Without action, that number today would be about 17 million. Instead, by 2011 it had dropped to 6.9 million – still a shocking figure, but arguably the lowest level in my lifetime. 

Almost a year ago in June, the Governments of the United States, Ethiopia and India, in close cooperation with UNICEF, held a Child Survival Call to Action in Washington D.C.  World leaders embraced the strategic shifts necessary to speed up progress in reducing preventable child deaths, including: increasing efforts in the countries where most deaths occur; focusing on vulnerable populations; investing in high impact solutions to address the main causes of mortality; and supporting a strong enabling environment for women, including education and empowerment.

Since the Call to Action event, 172 countries have signed the A Promise Renewed pledge to accelerate declines in child deaths, with a goal of all countries having fewer than 20 deaths per 1000 live births by 2035. More than 400 civil society and faith-based organizations and more than 2,000 individuals also pledged support. Each signature represents a renewed commitment to give every child the best possible start in life.

Healthy children need healthy mothers. Global health programs are working to combat the majority of these preventable maternal deaths. We help women have children when her body is healthiest for pregnancy. We provide pregnant mothers with quality antenatal care and nutrition and with cost-effective interventions that target the preventable complications of pregnancy and birth.

USAID has contributed to better care for childbearing women by training midwives as primary health care providers and introducing a results-based financing scheme to increase coverage of assisted deliveries throughout countries such as Afghanistan, and we are seeing much success. This is one reason why the average life expectancy for women has increased by 15 years in Afghanistan over the past decade. Ten years ago, Afghanistan's maternal mortality was estimated to be among the highest in the world.  Despite years of conflict and insecurity, today 60 percent of women receive prenatal care (compared to 16 percent in 2003), one third of women deliver with a skilled birth attendant, and the level of maternal mortality is approaching other countries in the region. 

Roughly 40 percent of all child deaths occur in the first month of life. Up to two-thirds of these deaths can be prevented through existing effective interventions delivered during pregnancy, childbirth and in the first hours, days and week after birth.  USAID is developing and testing simple, low-cost approaches to prevent death and treat severe illness in newborns in low-resource settings with limited access to quality facility-based care.

USAID’s newborn health programs provide training and improve policies for delivering high-impact interventions like immediate and exclusive breastfeeding, warmth, clean cord care, resuscitation, and antibiotics.  In Bangladesh, Nepal, Rwanda, and Malawi, USAID supports successful community-based newborn health programs that are linked to strengthened health facilities.  

USAID invests in vaccine research directed at major killers of children and research to develop innovative vaccine delivery models. To help end preventable child deaths from pneumonia and diarrhea, USAID is supporting the introduction of pneumococcal and rotavirus vaccines, to children most in need.

Thanks to support from USAID and partners, more than 100 million children receive a set of basic immunizations each year, and tens of millions more receive supplemental immunizations against polio, measles, and other killer diseases.  

In the early 2000s in Kenya, a partnership between USAID and the Kenyan Ministry of Health addressed the needs of each district and focused on systems issues. Our support helped to increase immunization coverage from 76 percent in 2005 to nearly 88 percent in 2011.

Investments in nutrition are some of the most powerful and cost-effective in global development. Good nutrition during the critical 1,000-day window from pregnancy to a child’s second birthday is crucial to developing a child’s cognitive capacity and physical growth.

In some countries half of all children are chronically undernourished or “stunted.” I recently traveled to Guatemala and to Bangladesh, where such stunting levels for children under five are 48 and 43 percent respectively.

Undernutrition is an underlying killer of more than 2.6 million children and more than 100,000 mothers every year. Sustained poor nutrition weakens immune systems, making children and adults more likely to die of diarrhea or pneumonia. Ensuring a child receives adequate nutrition during this window can yield dividends for a lifetime.  A well-nourished child will perform better in school, more effectively fight off disease and earn more as an adult.

In 2012, USAID reached more than 12 million children under five through nutrition programs such as micronutrient supplementation and food fortification, anemia reduction, and the treatment of acute malnutrition.

The financial and technical contributions of the President’s Malaria Initiative (PMI) are the major catalyst in the remarkable progress that has been achieved over the last seven years. Of the twelve PMI focus countries (Angola, Ethiopia, Ghana, Kenya, Madagascar, Malawi, Mozambique, Rwanda, Senegal, Tanzania, Uganda and Zambia), where baseline and follow up health surveys with data on childhood mortality have been conducted, all-cause mortality rates among children under five have dropped by 16 percent (in Malawi) to 50 percent (in Rwanda).

Early childhood health and development links health and survival with the young child’s cognitive, social/emotional, language, and motor development.  The mix of effective, proven health interventions and stable and supportive caregiving helps break cycles of poverty and inequality. Over the last year, USAID, together with UNICEF, CDC, and NIH has been undertaking an evidence review process on effective social and behavior change interventions to achieve child survival and development.  We are hosting an evidence summit next month to report the findings on how best to promote child survival and development through population-level behavior change.  These findings will inform an evidence-to-action strategy.

Putting Families First

USAID supports programs to identify children who are separated from their families in crisis situations and care for them while their families are traced and until children can be reunited with their caregivers. USAID supports efforts like these in Mali, DRC, and other crises situations.

In the aftermath of the devastating earthquake in Haiti, we implemented emergency family tracing programs to reunite children with their parents. And this past year in the Horn of Africa, when the worst drought in 60 years sent tens of thousands of families fleeing, we helped establish a single database that multiple partners across different refugee camps could use to identify and reunite separated and unaccompanied children.

To preserve families, USAID sets up safe, child-friendly spaces in IDP camps, where children can receive on-site food and water and join classes and activities, and changes community attitudes about the stigma of rape through door-to-door outreach.

The impacts of illness, conflict, poverty, and lack of access to basic services seriously undermine families’ abilities to care for their children. For some children the result is family separation and their living outside of family care, whether on the streets or in institutions or in exploitive labor situations away from the protective care of families. These children face increased risks of violence, abuse, exploitation and insufficient access to the emotional and developmental support they need.

USAID’s Displaced Children and Orphans Fund (DCOF)  provides financial and technical assistance to programs benefiting children in vulnerable households and outside of family care, including children living on the streets and in residential care, in more than forty-five countries.

DCOF programs prevent family separation, promote family-based alternatives to institutional care for children, facilitate de-institutionalization, and reduce other protection risks for children through strengthening the capacities of families, communities and governments to care for children. DCOF supports innovative programs that promote household economic strengthening with caregiving support, including education on child protection risks and prevention strategies. DCOF leverages its resources through a learning agenda aimed at influencing and improving the state of the art in programming for children in adversity who lack adequate family care.

Last year, DCOF support resulted in over 3,000 children directly moved from institutional or orphanage settings into family-based care alternatives.  To strengthen child protection systems DCOF worked to help governments and civil society partners develop and apply relevant national child protection legislation and policies, strengthen coordination among key actors, develop information systems to identify and monitor children at risk, build social service workforce capacities, strengthen community capacities to identify vulnerable children and increase their access to protective interventions.  In FY12 over 550 social workers or government child welfare staff was formally trained and thousands of parents received coaching and mentoring.  In Belarus alone, 1,208 foster/adoptive parents from 45 local communities were trained in parenting skills and 216 children were placed within these families.

For USAID, strengthening families is a top priority—whether that means providing cash transfers in times of hardship or linking families to support networks.

Nyepue Bondo is a widow and a mother of five children in Bong Country, Liberia and a participant in the DCOF-funded “Agriculture for Children’s Empowerment” (ACE) project.  Before joining the project, Nyepue grew vegetables on a small scale.  With inadequate farming skills the results of her work did not yield sufficient vegetables for her to sell and adequately support her family.  The project trained her how to do nursery preparation, planting in line, weeding on time and how to keep farm records.   After one year in the project, Nyepue generated $371 from vegetable sales. Part of her income was used to pay for her children’s school expenses and to start a small dry goods business.


In Burundi, we’ve developed a three-year randomized impact evaluation to explore how village savings and loans associations and family counseling could reduce poverty and nurture families. Results from the mid-term evaluation are in—and it is already clear that these combined interventions led to a 20 percent increase in the amount the household spends—a key indicator of welfare. And cases of harsh discipline—like hitting a child with a stick—fell by 64 percent.

Protecting Children

A 2011 report on global funding for child protection in humanitarian crises found that in 2009 the US Government was the single largest donor for humanitarian child protection programming.

In FY 2012, USAID funded 26 humanitarian assistance programs to address child protection for especially vulnerable children in 10 countries affected by disasters and conflicts. USAID invests in innovative technologies and capacity building initiatives to facilitate rapid, high quality responses for separated children, and other highly vulnerable girls and boys in the wake of conflict and disaster.

USAID works with children remaining within family care in crises to support them, their families, and their communities with holistic assistance.  For example, to rapidly restart education in crisis-affected communities by providing school supplies and repairs to school buildings.  We support safe recreational activities for children - places where they can play with their peers and be watched over by trained, caring adults or older children.

To ensure children's survival when faced with life-threatening crises, USAID also supports maternal and child health care, nutrition supplements for malnourished children, clean water, sanitation, hygiene materials, shelter, food, and blankets.

USAID supports the roll-out of the newly developed Minimum Standards for Child Protection in Humanitarian Action.  These standards provide guidance for all types of humanitarian interventions on how to ensure that children’s unique needs are met, and that they are protected from harm, exploitation, and abuse. 

Across the world today, 5.5 million children are engaged in forced labor. Roughly 300,000 children serve as soldiers for rebel and government forces. And disturbingly large numbers of children—150 million girls and 73 million boys—have experienced rape or other forms of sexual violence.

USAID is harnessing the power of science and technology and the creativity of problem-solvers everywhere to end the enduring outrage of human trafficking and prevent and respond to atrocities—whether it is a new mobile app to help locate children and reunite them with their family in a crisis or a new monitoring tool that helps governments remain accountable to their citizens.


In closing, for USAID, support to children in adversity starts with making sure they are planned and spaced, their mothers well-nourished, and they grow and flourish in the womb. 

It continues with saving their lives at birth, along with that of their mothers.  And it goes on, making sure they are fed, kept warm, and protected from vaccine-preventable diseases through vaccines, rehydrated from diarrhea, kept safe from mosquitos, and given the right care at the right time when they are sick. 

Finally, our support preserves families and protects children in crisis situations and ultimately contributes to the economic growth and development needed to create a future with many positive possibilities. 

This is the vision our programs strive for.

I appreciate the opportunity to testify today and look forward to your questions. 

U.S. Foreign Assistance for Children in Adversity
Committee on Appropriations, Subcommittee on State, Foreign Operations

Last updated: May 23, 2013

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