Turning Data Into Action to Prevent Violence Against Children

Education

I studied anthropology, mainly medical anthropology, as an undergraduate at Virginia Commonwealth University and in graduate school at the University of Alabama.

Jobs Prior to CDC

I felt the need to work in in the field so, in 2006, instead of moving on to the PhD after my master’s work, I accepted a position with the North Carolina Division of Public Health. As part of their School Health Centers program staff, I entered and managed data and wrote the 1st state-level report on the Centers’ activities.

I love global work, so I moved on to a project called the Zambia Emory HIV Research Project. It was partially funded by CDC and based at Emory University. I was assigned to Lusaka, Zambia. My work there entailed program management within the Couples HIV Testing part of the project). While there, I helped open 10 new couples HIV testing clinics within government health clinics in Lusaka. After a year, I returned to the Emory campus in Atlanta to provide technical support to other team members with various overseas assignments.

First CDC Job

In June of 2009, I was selected for a 2-year, fixed-term position with CDC’s violence prevention unit.

Final CDC Job

The unit hired me permanently as a health scientist in 2011 and I stayed there for 15 years. My role was research coordinator for the Violence Against Children and Youth Surveys (VACS). Among my duties were developing IRB protocols, communicating with partners, monitoring activities in the field, training interviewers, data analysis, and authorship of reports and publications.

These were national surveys in low-and-middle income countries. When I joined the team, the survey project was in its pilot phase, with data collection in Tanzania and Kenya. Eventually, we conducted surveys in 24 countries spread across Africa, Asia, Latin America and Eastern Europe. At peak capacity, there were surveys in 4 countries per year.

Large, random, representative, household samples were selected by statistical experts, and interviews were conducted face-to-face. In each household, a male or female between the ages of 13 and 24 was interviewed, and there was a second interview for the household. The surveys pertained to children’s experiences with emotional, physical,s and sexual violence. Proposed survey procedures and content were reviewed for ethical concerns by both CDC and in-country ethical boards. Because the results were intended to drive violence prevention efforts, and because the topic is extremely sensitive, we worked closely with surveillance partners from each country. The mix of partners reflected a given government’s structure and the country’s resources, but several governmental ministries were typically included. Countries chose their own priority indicators of progress.

Proudest Achievement

At CDC, you have generalists who move around and get experience in several disease areas and then you have specialists; the specialists are fewer in number. I’m most proud of staying to build a project from something pilot to something rigorous that could allow comparisons across countries and time points, and that collected data from children using the highest ethical standards.

Impact of My Work

The toxic stress of violence has negative, lasting, well-documented multi-generational effects on the brain development, health, and life-expectancy of children. It also exacerbates social problems and reduces economic prosperity.

In 4 countries, we were able to conduct a second national survey several years after the original one to detect changes in violence trends. In all 4 countries, there were steep and statistically significant drops in the estimated prevalence of violence experienced by boys and girls. For example, in Eswatini (formerly Swaziland), one of two real monarchies remaining in the world and the country with the highest HIV prevalence in the world, the estimated lifetime prevalence of girls under 18 who had experienced sexual violence was 35.2% in 2007, but that estimate was down to down to 5.5% in 2022. We did qualitative work to help ensure that this was no accident. When the baseline data came out from the first surveys in each country, the data shocked the governments, and laws were changed and evidence-based prevention and response programs were initiated.

In 2009 in Tanzania, the first country I worked on, there was very little local capacity for a project like this. However, when we came back in 2024, a local NGO barely needed our help. Their rigor, attention to detail, and ownership of the project were striking -- that’s the kind of capacity-building and strengthening that the survey helped bring about.

Finally, in 2024, there was an international ministerial conference specifically on the topic of child violence. It was the first of its kind and everyone would agree that our survey data catalyzed it. Country representatives shared their experiences and response strategies and future plans with each other. Ministries made commitments to take relevant action.

Leaving CDC

On April 1st at 5am, I received an email from OPM HR that my job and access to CDC were being terminated immediately. There were 20+ people in my unit and, except for 1 Commissioned Corps member, we were all terminated in a so-called “reduction in force.” Our leadership worked with OPM HR to allow us to get back into the building for 1 day to get our things out.

The cleaned datasets were already housed in an umbrella organization called “Together for Girls.”  One lone Commissioned Corps member is trying to figure out what to do with this year’s data and the codebooks and protocols and so forth. Meanwhile, that person has to find a new position too.

Future Plans

I’m lucky that I have a husband who is gainfully employed, but we have 3 kids at home and our income has been cut in half. I feel—and I don’t use this word lightly because of my field—traumatized. It was like a death. You go into this work as a calling, and grief is exacerbated under those conditions. I loved my work family. I’m looking for jobs but the whole academic and global health ecosystem has been hit so hard. Every job has hundreds, even thousands, of applicants.

I’m so passionate about this violence prevention work—I’ve seen it work in low-and-middle-income countries. But I would come back to CDC only if the job were improving world health, and they would let me do it, and any change for the better would stick.

Other Comments

I see CDC’s mission shifting before my eyes. As of today, there’s still PEPFAR, and Gates Foundation, and some other major NGOs and foundations. However, I’m most fearful that the important gains that have been made will recede. The violence prevention pledges that country health ministries made at our 2024 conference may not be honored now—the funding cuts in the U.S. are affecting the whole world.