June 27, 2018 | By Madeleine Nicholson

Guest Commentary - Hidden Infections Deplete Girls' Education Momentum and Undercut Economic Growth for All

By Madeleine Nicholson

It’s been well documented that investing in female empowerment is essential for long-term economic growth and produces a hefty return on investment. In fact, the McKinsey Global Institute estimates that if women are empowered to participate in the economy equal to men, it would add 26 percent to annual global gross domestic product by 2025. That’s $28 trillion annually. But in order for women to participate in the economy as men are currently able to, they need identical resources—including access to quality education.

Millions of rural girls around the world are not in school. According to UNESCO’s Institute for Statistics, 15 million primary-school-aged girls will never go to school, compared to about 10 million boys. This is reflected in the gender gaps at various levels of education as well. The UN Girls’ Education Initiative reports that only 66 percent of countries have achieved gender parity in primary education. This number drops to 45 percent in lower secondary education and 25 percent in upper secondary education.

Gender parity in schools cannot be attained until the barriers to school attendance for girls are first addressed. Menstruation, child marriage, safety, and the need for domestic work all prevent rural girls from completing their studies, but one public health issue is often so overlooked in this discussion that its name reflects its nature. Neglected tropical diseases (NTDs), more specifically parasitic infections, contribute considerably to the global disease burden. Children infected with parasitic worms often exhibit fatigue, lack of concentration, anemia, and immunosuppression. Chronic infection can also lead to undernutrition, which stalls cognitive and physical development. These health effects keep kids out of school, and those who attend have trouble staying engaged.

In order to generate the projected trillions of dollars in economic growth gender equality can bring, we must first ensure that girls stay in school—and to ensure productive school days—a dynamic strategy needs to be employed to prevent parasitic infections.

Parasitic Infections and Undernutrition Stunt the Body and the Mind

More than 1.5 billion people globally are infected by soil-transmitted helminths, or parasitic worms like roundworm, hookworm, and whipworm. Among these billions of people, over 267 million preschool-age and 568 million school-age children are at risk. Endemic to tropical and subtropical regions and particularly prevalent in areas that have inadequate access to health care and poor sanitation, these parasites use their host as a source of energy and nutrients, both leading to and exacerbating undernutrition.

As separate conditions, parasitic infections and undernutrition can have devastating consequences for girls’ health outcomes and educational pursuits. But when present in tandem, the conditions create a feedback loop of vulnerability with undernutrition making the body susceptible to infection and parasitic infections draining the body of nutrients.

The physical and cognitive toll of the two conditions severely hinders long-term educational achievement. In one case study of children in America, persistent hookworm infections were found to shorten educational attainment by more than two years and stunt future wage earnings by 40 percent. At the same time, malnourished children have been found to score 7 percent lower in mathematics and are 19 percent less likely to be able to read by age eight than their well-fed peers. Slowed cognitive and educational growth permanently impacts children’s future workforce productivity levels, limiting economic returns. In fact, childhood malnutrition has been shown to decrease a worker’s future earnings by 20 percent and costs the global economy $125 billion in healthcare costs.

Rural Girls at Risk

Rural girls are hit particularly hard by parasitic infections, undernutrition, and their social consequences. In general, women and girls are more likely to be undernourished than men and boys as females make up 60 percent of all undernourished people globally. They also take in less calories at the household level compared to their brothers. One study of children in rural Eastern Kenya showed that household gender inequality and disproportionate food allocation resulted in a stark 51.7 percent stunting rate among girls compared to 35.9 percent among boys.

Poor households that lack proper sanitation and health resources are more at risk for infection and disease, and rural girls and women experience poverty at higher rates. There are 105 girls living in extreme poverty for every 100 boys. This inequality increases with age with 122 women aged 25 to 34 living in poverty for every 100 men.

While some studies have observed no difference in parasite prevalence across gender and region, depending on the cultural context, environmental setting, and type of infection, rural women and girls are often more exposed to opportunities for infection. In many rural communities, female family members contribute heavily to cooking, cleaning, and collecting water. Because parasitic worms are commonly transmitted in contaminated soil and water, women and girls experience heightened risk. Even when women and girls avoid infection, they are more often responsible for caring for sick family members. In some cases, girls are pulled out of school to help with these domestic tasks, impacting their educational goals.

Investments in Public Health are Investments in Educational and Economic Growth

The World Health Organization has a global target to eliminate morbidity from soil-transmitted helminths by 2020, and with partners like Evidence Action and their Deworm the World Initiative, more than 260 million children received treatment in India alone in 2017.

The results have been transformative for both public health and school attendance. School-based deworming programs produced a weight gain per dollar 35 times greater than traditional school feeding programs. In rural Kenya, they resulted in a reduction in school absenteeism by at least 25 percent, and among females, deworming increased the rate of passing the national primary school exam by 9.5 percentage points. The case for school feeding programs to combat associated undernutrition is also strong. One study in rural Senegal found that math scores for girls saw greater improvements than scores for boys.

While great strides have been made to include rural girls in education, ensuring that girls have access to education is not enough. In order for rural girls to succeed and contribute to global economic growth, global leaders, economists, and public health professionals must collaborate to ensure that rural girls are able to stay healthy and engaged in school. Nutrition-focused programming and investments in deworming are essential steps in empowering girls and tapping into the $28 trillion economic growth they can help produce.



The Global Food and Agriculture Program aims to inform the development of US policy on global agricultural development and food security by raising awareness and providing resources, information, and policy analysis to the US Administration, Congress, and interested experts and organizations.

The Global Food and Agriculture Program is housed within the Chicago Council on Global Affairs, an independent, nonpartisan organization that provides insight – and influences the public discourse – on critical global issues. The Council on Global Affairs convenes leading global voices and conducts independent research to bring clarity and offer solutions to challenges and opportunities across the globe. The Council is committed to engaging the public and raising global awareness of issues that transcend borders and transform how people, business, and governments engage the world.

Support for the Global Food and Agriculture Program is generously provided by the Bill & Melinda Gates Foundation.


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