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Andrea Mestrov

Maternal Age Matters: for a lifetime, and longer

Maternal age matters—for the mother's own health and survival, for her child's well-being throughout his or her lifetime, and even longer if the well-described intergenerational cycle of growth failure continues into the next generation, according to a recent article published in The Lancet Global Health[1]

Causes and effects of young (≤19 years) maternal age

Despite an almost universal decline in the adolescent birth rate since 1990, adolescent fertility still accounts for 11% of all births worldwide, with 95% of these births occurring in low income countries and low middle income countries. In 2014, the average global birth rate among 15–19-year-olds was 49 per 1000 girls (1 in 20), with startling differences in rates between countries (from 1 to 299 per 1000), the highest rates occurring in sub-Saharan Africa. Early marriage remains a strong factor underlying adolescent fertility, with most adolescent childbearing (90%) occurring within marriage, although premarital conception for first births that occur within marriage is common[2].

A new study is adding to a growing body of evidence that young (≤19 years) and advanced maternal age (≥35 years) are associated with adverse birth and child outcomes. As described in The Lancet Global Health[3], the COHORTS Collaboration mustered the enhanced statistical power of pooling data from 19 403 participants located in five birth cohorts in Brazil, Guatemala, India, the Philippines, and South Africa, to identify an increased risk of low birthweight, preterm birth, stunting at 2 years, failure to complete secondary schooling, and lower adult height in children of young mothers (≤19 years) compared with mothers aged 20–24 years. Mothers were recruited for the study before or during pregnancy, and the children followed up to adulthood.

The article also points out different underlying factors responsible for preterm birth (in younger and older mothers) including socio-economic, biological and behavioural factors. Such factors have implications for designing cost-effective public health interventions. For instance, if effects are mostly explained by socioeconomic factors that happen to correlate with age, then interventions that simply delay age at marriage may have little effect.

Concomitant policy changes in other areas may have unintended consequences on adolescent childbearing. One example is the decision in Chile to lengthen the school day, resulting in a 5% reduction in adolescent pregnancy prevalence[4]. Introducing legislation on mandatory schooling, statutory rape, or a minimum marriage age may be similarly effective in decreasing adolescent pregnancies.

Ultimately, the challenge is to identify a combination of measures that is feasible within the financial and societal contexts of low income and lower middle income countries (LMICs). The study concludes that children of young mothers in LMICs are disadvantaged at birth and in childhood nutrition and schooling and recommends efforts to prevent early childbearing should be strengthened[5]. It also makes a strong case for continued and uninterrupted allocation of resources (even in situations of scarcity) through the life cycle, well beyond the current international mobilization around the “first 1000 days of life”[6] .

Interventions to address young (≤19 years) maternal age

Another recent systematic review,[7] specifically examining LMICs, identified various interventions aimed at reducing adolescent fertility. These included improved communication, peer education, school-based interventions, health counselling, and cash transfer programmes, many offered in combination. Programmes promoting or facilitating school attendance among adolescent girls reduced marriage and childbearing significantly. Conditional cash transfers performed best, [delaying] the age of marriage, and reducing the rate of, marriage, total fertility rates, and the prevalence of adolescent pregnancy. Evidence from a recent study on one of the pioneer conditional cash transfer programs in the world, The Female Secondary Stipend Program (FSSP) in Bangladesh introduced in 1994, estimates age at first marriage to be delayed by at least 0.4 years and finds age at first marriage to be lower on average for Muslim girls compared to non-Muslim girls[8][a].

The number of programs to address child marriage has grown significantly in the last five to ten years. However, this growth is still not keeping pace with the needs of the millions of girls who are at risk of child marriage every year, and the tens of millions of girls who are already married[9] . Some argue that interventions in this area are still largely research-driven i.e. theories are still being tested, with no roll-out of national initiatives in any LMIC.

Universal child support grants should be given closer attention as a cost-effective intervention to address child marriage and thus adolescent childbearing. Namibia and South Africa are at the forefront of such systems in LMICs. These are not specifically set up to address child marriage but rather to protect the most vulnerable children. Evidence from the Impact Assessment of the Child Support Grant in South Africa on adolescent risky behaviours reports[10]

reduced sexual activity and a fewer sexual partners, particularly when the adolescent also received the grant in early childhood

reduced pregnancy, again particularly when the adolescents also received the grant in early childhood

The assessment also concludes that the Child Support Grant promotes nutritional, educational and health outcomes. Early receipt significantly strengthens a number of these impacts. This is an investment in people that reduces multiple dimension indicators of poverty, promotes better gender outcomes and reduces inequality. The Assessment also finds that adolescents receiving the Child Support Grant are more likely to have some positive educational outcomes, are somewhat less likely to experience child labour, and are significantly less likely to engage in behaviours that put their health and well-being at serious risk.

Child support grants are relatively easy to administer and scale up. Namibia is about to expand its comprehensive social protection system to provide a universal child grant system, replacing the current grants targeted at just a few groups of particularly vulnerable children.

In 2004, the Ministry of Gender equality and Child Welfare (MGECW) inherited responsibility for the administration of child welfare grants from the Ministry of Health and Social Services (MOHSS). Between 2002 and 2014, child welfare grants expanded from 9,000 to approximately 164,000. Despite this expansion (both in terms of numbers of grantees and resources allocated to administration) and a considerable parallel drop in child poverty from 43.5% in 2003/2004 to 34% in 2009/2010[11], one in three children in Namibia were still growing up in a poor household according to the Child Poverty in Namibia report published in 2012[12].

This report also provides evidence on the effectiveness of social grants in reducing child poverty, and simulates some options for expanding child welfare grants and the impact this would have on household poverty. The analysis of simulated options projects a drop in child poverty rates from 34% to 13% upon introduction of universal child welfare grants for all children under 18.

Global evidence on inclusive child-sensitive social protection, meanwhile, has demonstrated that the impact of social grants on child poverty, vulnerability, and social inclusion can be maximized when coupled with investments in public social services in health care, nutrition, education and protection[b][13]. This combination of cash and services has the potential to be truly transformative for children’s lives with significant impact on adolescent risky behaviours - reducing sexual activity and pregnancy in adolescent girls, particularly when the adolescent receives the grant early in childhood.

Meanwhile, in Botswana, a randomized control trial on Young 1ove´s “sugar daddy” HIV education intervention is underway[14]. Modeled after a similar intervention delivered and studied in Kenya, it attempts to educate young adults about the relative likelihood of HIV infection among men of different age groups and to correct the misconception that young men are more likely to carry the virus. In fact, “sugar daddies” (older partners) are nine times riskier.

In Kenya, this intervention was shown to reduce pregnancy - a proxy for unprotected sex and HIV - by 28%. Young 1ove has adapted the intervention to Bostwana and already reached 32,010 youth. If the evaluation of the intervention shows a large, positive result in Botswana and there is a clear path to scaling-up, Evidence Action[15] plans to support Young 1ove´s scaling-up across other southern African countries with high HIV rates. The “sugar daddy” intervention has the potential to be low cost and sustainable because it can be integrated into existing government curricula.

Moving Forward – Giving What We Can´s approach to address young maternal age

In closing, exploring emerging thinking on “systems change” and “collective impact” which may be better suited to the endeavour of child marriage prevention[16], and understanding the cost effectiveness of cash transfers and universal child support grants in addressing adolescent childbearing are themes to be investigated further by Giving What We Can. One place to start is the Pixel Project[17], which lists 16 organisations involved in ending the practice of child marriage. Progress on measuring the impact tailored “sugar daddy” education programs have on protecting adolescent girls from HIV and pregnancy should also be followed up and incorporated into Giving What We Can´s research on cost-effective interventions that address young maternal age and HIV in adolescent girls.

In the meantime, 39,000 adolescent girls become child brides every single day, often married to much older men[18]. UNICEF Namibia is quoted in the media this year[19] saying that “according to the 2011 National Census, about 26% of Namibian girls gave birth to their first child before their 18th birthday. Across Eastern and Southern Africa, 12% of the girls are already married before they turn 15, while 38% are married before their 18th birthday. Children in rural areas and those from the poorest families are most at risk of child marriage and teenage pregnancy.” UNICEF is therefore pledging its commitment to the Namibian government’s strategies to empower families economically through child welfare grants.

The Lancet: Maternal Age Matters, for a Lifetime and Longer

The Lancet: Association between maternal age at childbirth and child and adult outcomes in the offspring: a prospective study in five low-income and middle-income countries (COHORTS collaboration). Lancet Glob Health. 2015;(published online May 19.)

Journal of Public Economics: Risky behavior among youth: incapacitation effects of school on adolescent motherhood and crime in Chile.

The Lancet: Association between maternal age at childbirth and child and adult outcomes in the offspring: a prospective study in five low-income and middle-income countries (COHORTS collaboration).

The efficacy of reduced adolescent childbearing in low- and middle-income countries: a systematic review.

Effect of Girl’s Secondary Stipend on Schooling and Age at Marriage:Evidence from Bangladesh

ICRW-Power to her: How empowering girls can end child marriage

The South African Child Support Grant Impact Assessment

The Namibia household Income and Expenditure Survey (NHIES) 2009/2010

Child Poverty in Namibia – a child-centered analysis of the NHIES 2009/2010, National Statistics Agency, 2012

Evaluation report - Unicef." 2015. 2 Nov. 2015

Young 1ove is an organisation with the sole aim of protecting girls from HIV by highlighting the risks of "sugar daddies" who trade gifts for sexual relationships.

Evidence Action scales proven development solutions to benefit millions of people around the world. We fill the gap between knowing “what works” and having impact at scale. "

Giving What We Can: Child marriage report

The Pixel Project: 16 Organisations Working to Stop Child Marriage

Namibia sun: over 5400 child marriages in Namibia

Erwan Atcheson

How To Overcome the Disappointment of Not Receiving This Year's Nobel Prize for Medicine

Thirty-two times in a row now I've failed to win the Nobel Prize. Each year I have to swallow the same bitter medicine. These Nobel Prizes celebrate the extraordinary achievements of extraordinary people and they show me how worm-like I am in comparison. But there is a way to overcome this. If you, like I, have the post-Nobel blues, then this article might help.

 is well-deserved, as usual. Youyou Tu, William C. Campbell and Satoshi Omura have been awarded the prize for two separate anti-parasitic drug discoveries.

Youyou Tu has been awarded the prize for developing the anti-malarial drug artemisinin. 

, in the middle of the Vietnam war, Mao Tse-Tung realised he needed a new antimalarial; more soldiers were falling to malaria than to enemy bullets. There was an existing drug, chloroquine, but malaria parasites had largely 

. Hundreds of Chinese scientists were engaged, and Youyou trawled through ancient Chinese literature for an alternative cure for malaria and discovered artemisinin.

Malaria is a single-celled parasite transmitted by mosquitoes, killing 

 people every year, most of whom are children under five in sub-Saharan Africa. The major symptoms are fevers, anaemia as the parasite destroys the red blood cells, coma, and death. Artemisinin, in the past 15 years, has averted about 

The other two winners, Omura and Campbell, discovered a compound called avermectin and proved it has potent deworming effects. A few chemical modifications later, avermectin became ivermectin and is now used to treat people for onchocercial worms (which cause river blindness) and filarial worms (which cause elephantiasis).

 are irreversibly blind as a result of onchocerciasis, caused by larvae dying in the eye. 

 are affected by lymphatic filariasis. Filarial worms block the lymphatic system, often in the leg or genitals, causing swelling and hardening due to bacterial infections. The disease is stigmatising, resulting in sufferers sometimes becoming outcast from their own society.

For decades before ivermectin was developed, the only treatment for onchocerciasis was 

. A major side-effect of this drug was to make the patient blind. An alternative, Suramin, was worse, producing fatal side-effects. In contrast to DEC, ivermectin kills the worms slowly, preventing a dangerous immune response to the killed worms. Since the 1980s ivermectin has reduced the burden of onchocerciasis alone by 

9 million disability adjusted life-years (DALYs)

 of both onchocerciasis and lymphatic filariasis.

Youyou, Campbell and Omura, in short, are good at making me feel bad about myself. Other Nobel prizewinners have also directly saved millions of lives. Those for 

 are good examples. How am I ever to compete with this magnitude of do-goodery? Do I have to be a Nobel prize-winning researcher to do this much good?

The answer is, yes, it certainly helps. The careers advice group 80,000 Hours have recently assessed 

 as a career option and conclude it has potential for very high impact, if you are a good fit. Biomedical research can dramatically improve people's lives even if it doesn't earn a Nobel Prize for its investigator. However, it isn't the only way a person can do good, and even a Nobel Prizewinner will have little positive impact unless somebody does something with their work. As John Donne famously said: 

Campbell, Omura and Youyou don't pay for the production and distribution of artemisinin and ivermectin. They couldn't even if they wanted to; it costs too much. The money comes instead from institutions and individuals. The funding for those institutions, like the WHO, USAID, DfID and so on, come from taxpayers or from donors.

This is the crucial point: it is a community of people who have impact, not any one individual. Without Campbell, Omura and Youyou, there would be no artemisinin or ivermectin to distribute. But it is also true that without funders, including you and I, these drugs would not reach the people who need them.

When it comes to doing good, the impact of any one individual is almost negligible compared to the impact of the community. There are a few individuals who have a huge positive impact by themselves. Bill and Melinda Gates and Warren Buffet are obvious examples. I want to argue, however, that the people with the most power to do good are you and I. This is demonstrated by Giving What We Can.

Giving What We Can was founded in 2009 and has recruited 1300 members. This community has pledged a small fortune to high-impact causes, including antimalarial bednet distribution and deworming. $486 million has been pledged and almost $10 million donated. 1300 members is about the size of a small village. How many more Giving What We Can-ers would be required to match Bill and Melinda Gates' generous pledge of 

? A quick calculation tells me we'd need less than 200,000 new members. In other words, a couple of large towns, or a decent-sized concert audience, has as much power to end global poverty as Bill Gates. If everyone earning the US median wage gave 10% of their income, it would dwarf the contribution of any individual billionaire.

Making the world a better place isn't a solitary endeavour. If you have the right skills, you could develop the next life-saving drug; or you could earn as much as Bill Gates and donate it all to charity. Without a collective effort, however, involving us all, we won't achieve what we need to achieve and eradicate the scourge of extreme poverty. 

. It's the perfect antidote to not winning the Nobel prize.

Ahimza Thirunavukarasu

Confessions of a Giving What We Can member - how the pledge saves lives

Unlike most hobbies and pastimes picked up in my university years, Giving What We Can has become a bigger part of my life over time. I first learnt of the organization when, as a frustrated medical student, I was browsing the web looking for a forum or community which would empathise with how I felt about the world. Even though I was studying to be a doctor, I felt that there was so much more I could be doing with my time and money that could actually save lives.

Giving What We Can appealed to me as a pragmatic and genuine way to do this. The standards they set for both charities and individuals who are serious about making a difference in the world, could have a huge impact on how the future of aid and development looks. The ethical arguments behind these standards are compelling, and so by joining Giving What We Can and attempting to live by the moral principle of 'doing the most good', I feel more comfortable in my decision making.

In this post, I will address some questions that you might have about the reasons for taking the pledge, and the impact of doing so on your life.

Since taking the pledge over a year ago, I have not told many people about it. This is mostly because I don’t really like talking about myself, fear coming across as self-righteous, and bringing up charity during social conversation can be a pretty difficult thing to do.

However, putting my own issues aside, and in the spirit of getting more people thinking about these issues, I finally wrote a post about Giving What We Can on my personal blog a few months ago. This received a mixed response. I know a lot of my friends read it, but did not comment or broach the subject with me afterwards. Some asked me more about my giving habits but left it at that. The positive comments I did receive were from people who either already knew about Giving What We Can, or those who liked me enough to say nice things.

Spurred on by the confidence I’d earned from writing about it, I later managed to bring up the topic with a hospital Consultant I work with. Her reaction was of utter horror – that I was giving away money instead of saving it for my family and future. Even though I hadn’t prescribed my values to her, she became defensive, gave me her views on the nature of charity, and then listed off all of the voluntary work she does in her spare time.

This simply confirmed what I already knew about the inherent beliefs that make people back away from such a pledge. When presented with the vision and mission statement of Giving What We Can, it is difficult to disagree with the basic premises behind them. [Extreme poverty should be eliminated. Supporting charities that do this in the most effective way ensures a much greater impact. We should be seeking out effective charities, and encouraging others to follow suit.]

Where people shut down is when a 10% pledge is mentioned. How can this organisation be suggesting that we all part with 10% of our income – on top of the outgoing expenses already seeping away in rent, bills and tax? How is anyone supposed to save up for a mortgage, or have any kind of social life? And actually, on second thought (because this is the point at which people start having second thoughts), doesn’t using ‘evidence’ and trying to be ‘effective’ seem like a rather cold and calculated way of being charitable?

When personal finances come under threat, people often forget their beliefs about justice and equality. These knee-jerk responses may arise because we live in a society in which, knowingly or unknowingly, we measure our happiness, freedom and success based upon our financial freedom. We value having the choice of what to spend our money on, and how much we’ll spend; even if we know that we don’t necessarily make the wisest decisions in that process. Often, the decisions we make with respect to charitable giving are actually very poorly thought out, yet we never bear the consequences of those decisions and so still congratulate ourselves on the good we’ve done.

The money we spend can indicate something about what we value. If I buy a cappuccino for £2, I am stating that I place the value of the caffeine hit and foamy milk, and the absence of time cost of making my own coffee, as greater than £2. However, that is also the same cost of giving someone at risk of malaria a long-lasting insecticidal net, which could reduce that risk and contribute to an overall improvement of their life. Knowing this doesn't mean I always stop myself from buying non-essential items, but it does help put into context how little it can cost to make real impact. In the developed world, we don’t have to be heroes to save lives; we can in fact save lives in the developing world at a fairly low expense to ourselves.

The ugly truth that surfaces when we start thinking in these terms is that we place a greater value on our lifestyle than on other people’s lives. We can only do this because we happen to be on the right side of the poverty line, and hence seemingly exist in an entirely different world from those on the other side.

We sidestep this problem using some common excuses. For example, some people argue that foreign aid isn’t efficacious – which is a reasonable concern, but one that should lead one to investigate how to maximise effectiveness, rather than closing that door completely. As illustrated by Giving What We Can, there are plenty of options available.

Others argue that charity should begin at home; either by being generous with those in your circle, or by giving to local charities. Whilst it is understandable that emotional bonds might lead you to make certain value judgements, this does not mean you have no moral responsibility to the wider world. People often assume that they only have finite resources to spend on others; but in our personal lives, we can usually find extra time and money to spend on new family members, friends, or local charity initiatives. The fact that 

the potential impact of giving to charities in the developing world is far greater than when giving locally

 means that we should be expanding our circles to include those who need this generosity the most.

Thinking about effectiveness doesn’t need to be cold-hearted – in fact it takes a great deal more empathy to be caring about people on the other side of the world, who lead such different lives.

Many young people decide that it’s more sensible to save up as much money as possible in the early part of their careers when their income is probably at its lowest. They argue that it makes more sense to first invest in their own future and then give to charity later, when they will have a larger bank balance and the financial security to be able to do so.

Although this sounds reasonable, I believe that, for people who are genuinely interested in giving money to charity, it is not the best strategy. I’ve set out a few reasons below, but if you’re interested, 

 highlights more points from both sides of the argument pretty well.

you never know how your priorities will change

. You might decide to have children, or acquire responsibilities that require money to be set aside. As possibilities increase, giving to charity may no longer feature high up on your radar. Getting into the practice of giving to charity early on makes it easier to smoothly incorporate it into your routine, such that having a baby or a mortgage later on doesn't become another excuse not to give. It's perfectly possible to combine charity with these other commitments if it's made into enough of a priority.

an increase in earnings over time is usually accompanied by a more extravagant lifestyle and set of needs

. Society expects people to adapt to their salary so that there is always a need to continue striving for a higher pay. Although this is a pretty good way of motivating people to work harder, it means that the deadline to start giving to charity gets pushed further and further away. Setting proportionate charitable giving as a part of lifestyle early on, means that, alongside the motivation to earn more for oneself, there is an added motivation of earning to also give more.

being part of the movement whilst young can provide many opportunities for personal growth and improvement of skills

, I have met a variety of motivated, intelligent and hard-working people with a passion to make the world a better place. I agree wholeheartedly with entrepreneur Jim Rohn when he said, “You are the average of the five people you spend the most time with.”

I have made a resolution to try and attend more events organised by effective altruists, and take part in the debates and conversations that allow us all to grow and improve individually and collectively. I had the chance to attend the 

 conference on 28th-30th August 2015, where I met people from various disciplines who had become interested in ‘doing good’, and hence were using their backgrounds to contribute to a better future. Not only did I learn about the range of problems that the world faced (being a medic can be rather isolating), but I also learnt a bit more about how my own skills and ideas could fit into this.

The 10% suggestion is simply a target value for those who are serious about giving. If that seems too high, a more easily digestible 1% starting point is recommended. The idea is that once you start allocating a portion of your money to charity, you stop seeing it as a ‘big deal’, and slowly realise that it doesn’t eat away at your lifestyle nearly as much as you’d have expected it to.

If every month you were making a conscious decision to give away £300, this could seem like a pretty big sacrifice. Once you’ve made the pledge, on the other hand, you can set up your charitable donation to leave your account automatically, and continue to budget for a lifestyle that never included that portion of money. 

There’s less of a sense of giving your money away, and more of a sense of setting some aside for a cause larger than your own wants and desires.

Why 10%? It’s an amount that’s enough to require a certain degree of commitment, without being too difficult to achieve. Many Giving What We Can members pledge a higher percentage than this; or choose to always give anything they earn above a certain value.

Once you start giving, it becomes a good kind of addictive habit, and you are more likely to continue to give larger and larger amounts over your lifetime

 - another reason to start early. This is not only because through giving effectively, you learn how far the money can go, but also because the return on your own personal satisfaction usually leads to more motivation to keep on giving. Don’t underestimate the impact of charitable giving on one’s baseline amount of happiness – it’s been 

 to be a lot more powerful than spending on oneself.

By joining Giving What We Can and identifying yourself as part of a larger group, it is easier to maintain motivation to act in the way you believe you should.

 Whilst living in the expensive city of London, where it can sometimes feel like most people are striving towards a lifestyle they don’t yet have, I’ve found it a lot easier to stay committed to this idea by having the knowledge that over 1000 people throughout the world buy into it. Many are actively involved in ways others than donating; some are actively involved in 

the growth of the charity and its research

; many go into high-paying careers in order to contribute huge portions of their income, and others are spreading the word through 

This year, I set aside £6000 of my earnings to charity; about 20% of what I have received from my junior doctor salary. I can’t say that in this first year as a doctor, my presence has been enough to ‘save’ any lives, but I believe that my charity donations may well have.

By stating this fact, I am not attempting to show off – I feel that I can be doing a lot better – but rather showing that it can be done. 

I am not struggling financially as a result, and have added to my quality of life rather than detracted from it. It has also given me more sense of perspective on what matters.

 Rather than feeling guilty when I spend on myself or my family, I feel happier knowing that I have contributed to the lives of others as well.

Currently, Giving What We Can recommends global health charities, which they believe to be the most effective at improving lives. Many other types of charities are difficult to evaluate due to difficult follow-up, uncertain outcomes and very long term aims. This can seem problematic for people who feel very strongly about particular causes, such as climate change or female empowerment.

 (the top recommended charities by GWWC) as two of my main recipient charities, I also distribute my money to causes I have reason to believe are effective, but more difficult to evaluate due to the nature of their work.

For example, the neglect of psychiatric conditions as a global health priority despite 

 it causes means that this area needs a lot more attention – but cannot be treated simply with a pill or a bednet. Giving money to causes that aren’t as ‘direct’ at saving lives needn’t make my giving less effective – as long as I feel that I have sufficiently researched them and am confident about the possible gains that they might produce.

For people fortunate enough to be working in a well-paid job in the developed world, the principles of this movement are worth considering. Indeed, 

I believe that the biggest benefit of being part of Giving What We Can is the exposure to a refreshing way of thinking about the world

. To think about what your impact is every time you put £10 towards charity, rather than a pizza. To ask yourself what kind of world you want to live in, and how you’re going to contribute towards that. 

By a small shift in our perspectives regarding the value of our money, we can make a huge impact. Through this shift, we can galvanise other people, charities and global organizations to become leaner and more effective – making the value of one’s contribution much greater than the purely financial effect.

Larissa Hesketh-Rowe

Would you save two strangers or your partner? A review of 'Strangers Drowning'

It all started well. The writing style is very vivid, very intimate. It draws you in. You peer through the window into these people’s lives, they invite you in and you become friends. Together you share in their triumphs and their pain.

Strangers Drowning: Voyages to the Brink of Moral Extremity

 profiles a few extraordinary individuals living lives of extreme ethical commitment. We meet a family that founded a leper colony out in the wilderness in India, despite the risk to their children. We share in the hardships of a couple who adopt twenty children alongside two biological children because they keep finding young people in need. We follow a nurse on an incredible journey of hunger strikes and self-sacrifice to bring about change for her people and protect some of the most vulnerable women during conflicts in Central America. And we get to know people who donate large percentages of their money to the most worthwhile causes.

Blog

Maternal Age Matters: for a lifetime, and longer

How To Overcome the Disappointment of Not Receiving This Year's Nobel Prize for Medicine

Confessions of a Giving What We Can member - how the pledge saves lives

Would you save two strangers or your partner? A review of 'Strangers Drowning'

Reaching for Greater Impact Through US Legislation

Explain like I'm five: Essential surgeries

A Statement from Giving What We Can

The scourge of women's health you've never heard of

Why I choose to give now

Action on the refugee crisis and action on global poverty: thoughts, facts and ways to do good better.