Showing posts from category development.
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Evidence, Links, and Solutions
Maternal Undernutrition
›“Maternal undernutrition is often overlooked as a strategy for reducing poverty and as a key intervention to reduce maternal mortality and morbidity,” said Mary Ellen Stanton, senior maternal health advisor at the U.S. Agency for International Development. Stanton was joined by Dr. Doyin Oluwole, director of the Africa’s Health in 2010 program, and Amy Webb Girard, assistant professor at the Emory University School of Public Health, in the final meeting of the Advancing Policy Dialogue on Maternal Health series on December 15 where they addressed the linkages between poverty, undernutrition, and poor maternal health outcomes.
The Cycle of Malnutrition and Poverty
Many factors contribute to a woman’s nutritional status, including lack of capital, access to land, and poverty; thus, said Oluwole, “we must adopt a multi-pronged and multi-sectoral response.”“General malnutrition is usually associated with iron-deficiency anemia, which leads to poor cognitive function and educational achievement, poor health, and fatigue.” Oluwole said. “These three factors lead to low worker productivity, and low worker productivity leads to income poverty.”
“All of these aggravate malnutrition and so the vicious cycle of malnutrition and poverty continues,” said Oluwole. To break this cycle, she pointed out that countries like Malawi and Mexico have implemented various multi-sectoral interventions that have “stimulated economic growth; implemented targeted social, health, and nutrition programs; and put in place safety nets.”
“In the window of opportunity during pregnancy and the first two years of life, we can make a big difference,” Oluwole said. She advocated for an “integrated anemia package” that provides anti-malarials, de-worming medicine, iron folic acid tablets, and extra food during pregnancy. She also noted the importance of family planning and targeted high-coverage interventions, such as salt iodization, vitamin A supplementation, and breastfeeding promotion.
In conclusion, Oluwole provided several recommendations for the development community to improve maternal mortality rates and undernutrition of women:
Maternal Undernutrition: Our Global Disgrace- Promote universal primary and secondary education, especially for girls
- Stimulate economic growth with a focus on gender and equity
- Invest in infrastructure to reduce transportation time to hospitals
- Postpone age of marriage and of first pregnancy
- Provide targeted and effective nutrition and health interventions
- Encourage private sector participation and government leadership
- Integrate the maternal health and nutrition communities and services
“We don’t tend to look at maternal nutrition and its impacts on the woman herself,” said Girard. The lack of data on the relationship between nutrition and maternal health outcomes “hampers our ability to move maternal nutrition onto the health and development agenda,” she added.“Anemia is widespread; worldwide, it is a significant public health burden, both in women of reproductive age as well as in pregnant women,” said Girard. Studies have shown that moderate anemia increases risk of hemorrhage and may also increase the risk of sepsis, while severe anemia has been shown to directly contribute to maternal mortality. Targeted interventions can help reduce these risks greatly. “For every one gram per deciliter increase in hemoglobin level, you can reduce maternal mortality by approximately 25 percent, but the mechanisms by which this occurs are not well elucidated,” noted Girard.
“We need to include women not as just targets of nutritional interventions, but as beneficiaries in their own health,” said Girard. Key nutritional interventions such as micronutrient supplementation, fortification, and behavior change communication can help to improve not only fetal, infant, and child health, but can also reduce maternal morbidity and mortality. In addition, Girard recommended the following strategies to achieve greater impact:
Together, these strategies can help improve access to nutrition and health services, as well as adequate food for women throughout their lives. “We need to integrate health and nutrition – they are actually the same pillar, complementing each other,” Girard concluded.- Improve nutrition throughout the life cycle, not just during pregnancy
- Look for alternate strategies for micronutrient delivery
- Integrate maternal nutrition into food security and agricultural strategies
- Collect indicators specific to women’s health impacts
- Recognize and address gender bias
Photo Credit: “Bangladesh mothers, kids,” courtesy of flickr user Bread for the World. -
Too Few or Too Many? Joel E. Cohen on How Education Can Address Both
›December 17, 2010 // By Wilson Center Staff“So which is it: Is it too many people or is it too few people?” asks Joel E. Cohen of the Rockefeller University in this interview with ECSP. “The truth is, both are real problems, and the fortunate thing is that we have enough information to do much better in addressing both of those problems than we are doing – we may not have silver bullets, but we’re not using the knowledge we have.”
Cohen has studied the population-resources equation, trying to determine how best to support global demographics in a sustainable, equitable way. He points to the cross-cutting power of education to both curb rapid population growth in the developing world and ease the cost of aging populations in the developed.
“On continuing rapid population growth, we know that more education is associated with reductions in fertility,” said Cohen. And when combined with voluntary family planning, it’s also cheap “compared to the costs of having children that are not well cared for – the opportunity costs,” he said.
On aging, “we know that people who are educated well in their youth – both at primary, secondary, and especially tertiary levels – have better health in old age,” said Cohen. “So the costs of an aging population are diminished when people are educated. They take better care of themselves and they have options – they can use their minds as their bodies mature.”
Education is a long-term solution, but shorter-term policy options, like France’s bump of the retirement age to 62 that prompted rioting this fall, will also be necessary. “Sixty-two is only a way station,” Cohen said. “The retirement age has to move up, because people are living longer, they’re more productive, they’re in better health, and they’re going to have to keep working to take care of themselves.” -
Rebuilding Stronger, Safer, Environmentally Sustainable Communities After Disasters
The GRRT Toolkit for Humanitarian Aid
›Natural disasters present an immediate humanitarian crisis but are also an opportunity to rebuild societies to be more resilient and environmentally sustainable than they were before. The “Green Recovery and Reconstruction Training Toolkit” (GRRT), created by World Wildlife Fund (WWF) and the American Red Cross and launched at the Wilson Center on November 19, will help future humanitarian efforts integrate principles of environmental conservation into their disaster recovery strategies. This strategic partnership has been “an incredible effort and marriage between organizations that have different operating styles, different approaches to situations,” said WWF Chief Operating Officer Marcia Marsh. While implementing the GRRT may not be easy, “we need integrated solutions for integrated problems,” said Erika Clesceri, bureau environmental officer at USAID.
A Critical Partnership
In the midst of a crisis, humanitarian workers on the ground often do not have the time, skills, or funding to incorporate environmental concerns into relief efforts, said Robert Laprade, senior director for emergencies and humanitarian assistance at CARE. Humanitarian workers are “going a hundred miles an hour, they’re going on adrenaline and they’re there to save people’s lives – and the environment is just of secondary importance,” he said.
But “environmental sustainability is critical to the achievement of long-lasting recovery results,” said Roger Lowe, senior vice president of communications at American Red Cross. The Red Cross Principles of Conduct state that “relief aid must strive to reduce future vulnerabilities to disaster as well as meeting basic needs” and “avoid long-term beneficiary dependence upon external aid,” he said.
From Damnation, Purgatory, and Armageddon to Redemption
For many crisis-stricken regions, lack of an emphasis on environmental sustainability during disaster recovery efforts can mean “damnation in the present, purgatory in the near future, and Armageddon in the long term,” said Peter Walker, director of the Feinstein International Center at Tufts University. Stress on the environment caused by climate change or unsustainable resource consumption can often contribute to conflict, he explained.
In Darfur, “the environmental change was part and parcel of what led to that conflict,” Walker said. At one time an “environmental Eden” of diverse ecological zones, Darfur gradually became an environment that could not support a society of livestock herding. As the environment changed, some former herders became salaried, armed gunmen, known as the Janjaweed who felt they faced “a choice of no choice,” Walker said, to either “die as pastoralists or become pariahs as mercenaries.”
The challenge for humanitarian aid organizations is to not only help communities recover from disasters, but help them adapt to future environmental stress caused by globalization, climate change, or other factors. “If you cannot adapt,” Walker said, “that’s going to lead to violence.” To avoid aid dependency or resurgence in conflict it is critical to integrate environmental sustainability into disaster relief efforts from the beginning, he said:We used to believe that our world in the aid business was divided between relief on the left and long-term development on the right, and one would gradually go into the other in this relief-development continuum. But the reality is that you have a significant population – a population of millions of people – who are effectively trapped in a form of aid purgatory. They’re basically on a drip feed. Humanitarian assistance does not get you forward, it keeps you alive.
The GRRT offers organizations guidelines for implementing integrated disaster relief to provide a sustainable solution. While every crisis is different, the GRRT’s guidelines should be as applicable to “flooding in Boston as they are to flooding in Aceh,” said Walker.
Implementing Integrated Solutions
Securing funding for this integrated approach will be a challenge, as a significant portion will go towards staffing and training people on the ground, said Clesceri. A stand-alone, dedicated budget for environmental issues within humanitarian assistance programs must “be fought and re-fought for on a continual basis,” she said.
Local partnerships are essential. “Replicate” should be “stricken from the lexicon,” said Marsh. “You can’t replicate, and this toolkit isn’t meant to be a one-size-fits-all.” Instead, she said, the goal of the GRRT is to “create very practical approaches with communities.”
The key to helping communities recover from disasters is to form the kinds of strategic partnerships demonstrated by WWF and the American Red Cross in the creation of the GRRT. “Interdisciplinary groups are always, in my mind, going to get you a better solution in the end, but the risk is that they take more time…but it’s absolutely worth it,” she said.
Photo Credit: “Dark Clouds from Haiti’s Hurricane Tomas Loom over Camps,” courtesy of flickr user United Nations Photo. -
Watch: Joel E. Cohen on Solving the Resource-Population Equation in the Developing World
›December 14, 2010 // By Wilson Center Staff“It’s very hard to put a number on a quantity that depends on future events, processes we don’t understand, and values that may change over time,” said Joel E. Cohenof the Rockefeller University in this interview with ECSP. “That doesn’t mean we have no problems and it doesn’t mean there’s nothing we can do.”
There are three schools of thought or proposed “panaceas,” when it comes to balancing natural resources and population, said Cohen: a bigger pie (new technology to increase productivity), fewer forks (reduced consumption), and better manners (reduced irrational market inequities and better governance).
In the 15 years since his book How Many People Can the Earth Support? was published, Cohen’s approach has changed. While the 1996 book lacked a definitive policy recommendation, he is now analyzing options. “The evolution of my thought has moved from ‘how many people can the Earth support?’ to ‘what do we need to solve problems?’” he said.
You need adequate child and maternal nutrition to produce potential problem solvers and you need education to give them the tools to do it with, said Cohen, who studied the impact of universal primary and secondary education with colleagues at the American Academy of Arts and Sciences.
“If you look at a map of stunting in the world, there are parts of South Asia and sub-Saharan Africa where more than half the children are stunted – that means two standard deviations [of] height below normal for their age,” said Cohen. “Those populations are handicapped at the starting gate because they don’t have the problem solvers.” -
Whither the Demographic Arc of Instability?
›December 14, 2010 // By Richard CincottaAfter the Berlin Wall came down in 1989, the demand for geostrategic mapping went up. Pentagon geographers revised maps almost monthly in order to keep pace with the rapid sequence of events – the toppling of Eastern Europe’s communist regimes, the rise of pro-Western liberal democracies in their place, and the reunification of Germany. Then came more borders, and even more maps: the breakup of the Soviet Union and the withdrawal of forces from former Warsaw-Pact states, the splintering of Yugoslavia and Czechoslovakia, and requests for accession to NATO. When, in the late 1990s, it became apparent that the end of the Cold War would have little effect on the emergence of civil and ethnic conflicts in Africa, Asia, and Latin America, and that a network of militant Islamist organizations had coalesced across Muslim Asia and Africa, strategic mapmaking shifted focus to identifying conditions in the Global South.
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An Integrated Climate Dialogue
COP-16 Cancun Coverage Wrap-up
›December 13, 2010 // By Schuyler NullAfter focused last-minute negotiations, the UNFCCC COP-16 parties meeting in Mexico finally reached an agreement on a package being called “The Cancun Agreements” on Saturday. One of the most important impacts of the agreement (also referred to as the “balanced package”) is the establishment of a green climate fund which will help developing countries adapt to and mitigate the effects of climate change.
For more on the green fund as well as the integration of gender, population, development, and even a little bit of security in the broader climate dialogue, see The New Security Beat’s coverage of Cancun below.- Interview with Karen Hardee: Climate-Proofing Development
- Pop Audio: From Cancun: Roger-Mark De Souza on Women and Integrated Climate Adaptation Strategies
- Guest Contributor Alex Stark: From Cancun: Getting a Climate Green Fund
- The Number Left Out: Bringing Population Into the Climate Conversation
Kicking off our coverage was an email interview with Karen Hardee, visiting fellow with the Population Reference Bureau, on “climate-proofing” development. Hardee gives a brief overview of the UN National Adaptation Programmes of Action system and the current state climate adaptation integration in international development. She points out that one of the enduring positives from COP-15 was a renewed focus on financing tools that has permeated to the top levels of the UN.
Hardee also touched on the nascent but largely unfulfilled connection between population growth and resilience, noting that “of the first 41 programs submitted to the UNFCCC…37 noted that population growth exacerbated the effects of climate change, but only six explicitly stated that meeting an unmet demand for RH/FP should be a key priority for their adaptation strategy and only two proposed projects that included RH/FP.”
Next, Population Action International’s Roger-Mark De Souza was kind of enough to speak with us briefly over the phone from the conference itself, providing a run-down on a PAI-sponsored side event focusing on empowering women in climate debates.
“When you look at the negative impacts of climate change, the impacts on the poor and the vulnerable – particularly women – increase, so investing in programs that put women at the center is critical,” De Souza said.
Leaving gender issues, like child and maternal health and education, out of deliberations like those COP-16 are missed opportunities to get more “power for your peso,” he said.
Alex Stark, formerly of CNAS and now with the Adopt a Negotiator program in Cancun, provided an update and a strong argument for one of the most critical elements of the “balanced package” that many are hoping will come out of Cancun – the establishment of an international fund to help pay for adaptation and mitigation programs in developing countries.
Stark provides an insight into some of the chatter on the floor at COP-16 and also outlines the moral, development, and security advantages to supporting a green fund, pointing out that “by managing displacement, migration, and violent conflict driven by the effects of climate change, such as water scarcity, climate change adaptation can help bolster international security and stability.”
“Within the UN process itself,” she writes, “a robust, well-run, equitable green fund would help rebuild the trust lost between developed and developing countries at Copenhagen last year.”
Lastly, Bob Engelman, of the Worldwatch Institute, provides a broad argument for more inclusion of a key variable in climate debates – population (and not in the Ted Turner mold). He enumerates the common pitfalls of population debates, from sensitivities about personal choices to squeamishness about sexuality and reproductive health, and just plain gender bias.
But despite these barriers, says Engelman, population – and not just growth but demographics too – matters in the climate debate and therefore needs to be part of the conversation (an argument he makes more comprehensively in a new report, Population, Climate Change, and Women’s Lives). Echoing De Souza, he concludes by pointing out that although the discussion may be difficult, the solution is relatively simple: “On population, the most effective way to slow growth is to support women’s aspirations.”
“As societies, we have the ability to end the ongoing growth of human numbers – soon, and based on human rights and women’s intentions,” Engelman said. “This makes it easy to speak of women, population, and climate change in a single breath.”
Sources: Population Action International, Slate, UN Framework Convention on Climate Change, The Washington Post, Worldwatch Institute.
Photo Credit: Adapted from “Trees Dead on Shore of Timor-Leste Lake,” courtesy of flickr user United Nations Photo; Roger-Mark De Souza, courtesy of David Hawxhurst/Wilson Center; “Will you back a climate fund?,” courtesy of flickr user Oxfam International; and “Met Office Climate Data – Month by Month (September),” courtesy of flickr user blprnt_van. -
Bringing Cambodia Back from the Brink: An Audio Interview with Suwanna Gauntlett
›December 10, 2010 // By Hannah MarquseeThree decades after the Khmer Rouge regime wiped out an estimated 1.7 million people – one fifth of Cambodia’s total population – the environment and Cambodian people are still feeling the effects.
The Pol Pot regime’s policy of agrarian collectivization dramatically reorganized land ownership and relocated millions from urban to rural areas. The ensuing decades of Vietnamese occupation and civil war further changed Cambodia’s workforce, dislocating millions.The “Khmer Rouge regime increased the destruction of natural resources exponentially,” Suwanna Gauntlett, founder and CEO of Wildlife Alliance, told ECSP in this interview. Today, 78 percent of Cambodia’s 14.5 million people live in rural areas, according to the World Bank, nearly all of whom work as subsistence farmers. These rural households account for almost 90 percent of Cambodia’s poor and 36 percent of the total population in 1997.
“These Forests Were Silent”
When Wildlife Alliance arrived in Cambodia in 2000, “these forests were silent,” Gauntlett said. “You couldn’t hear any birds, you couldn’t hear any wildlife and you could hardly see any signs of wildlife because of the destruction.”
In one village, Chi Phat, Gauntlett noted how years of slash-and-burn agriculture had left a “circle of death” around the village as farmers gradually encroached further into the forest.
Cambodians have compensated by turning from traditional subsistence farming to illegal logging, wildlife trafficking, slash-and-burn agriculture, mining, and other unsustainable development (with significant Chinese investment). This has contributed to food and water insecurity, rapid deforestation, habitat loss, and species extinctions. In 1990, 73 percent of Cambodia’s land was covered by forest. By 2007, that number had dropped to 57 percent. Cambodia’s 146 threatened plant and animal species have also felt the effects of this loss. The Indochinese tiger, native to Cambodia, is now thought to have less than 30 individuals remaining in the entire country.
Integrated Solutions
Focusing on the Cardamom mountain range – Cambodia’s largest remaining intact forest – Wildife Alliance established several community-based agriculture and ecotourism programs to help villagers escape the “vicious circle” of poverty and environmental destruction. Ten years later, “there’s been tremendous progress in the geographic areas of our projects,” said Gauntlett.
In another village, Sovanna Baitong, Wildlife Alliance’s community agriculture program has raised the incomes of some residents to over $200 a month when the national poverty level is $200 a year, Gauntlett said. Today this village has a school, a clinic that provides health care and family planning, and a micro-credit fund. This is all managed by the community leaders, 30 percent of whom are women.
Ten years ago, “it was a mess,” Gauntlett said. “It’s amazing to see the difference.”
However, in parts of the country where Wildlife Alliance does not operate, deforestation continues at an alarming pace, often fueled by Chinese and other foreign investment. In some parts of the country, “deforestation has led to very severe water shortages,” including villages where people have to walk up to 20 kilometers for water because “there is no more underground water,” said Gauntlett. This has troubling implications for Cambodian security, particularly with aggressive hydrological development of the Upper Mekong continuing in China and Laos.
“I’m afraid that’s what’s going to happen throughout Cambodia – that this water shortage will lead to food shortage [which] will lead to civil unrest,” Gauntlett said.
Sources: BBC, Cambodian Genocide Program, The Washington Post, Wildlife Alliance, World Bank, WWF, UNEP.
Photo Credit: “Farmer at Sovanna Baitong” and “Suwanna Gauntlett” Courtesy of Wildlife Alliance. -
Expanding Access to Maternal Health Commodities
›“This is not just about getting quantities of drugs out, this is about saving women’s lives with really simple products that work,” said Julia Bunting, team leader of AIDS and reproductive health at the UK Department for International Development and coalition chair of the Reproductive Health Supplies Coalition, at the ninth meeting of the Global Health Initiative’s 2009-2010 Advancing Policy Dialogue on Maternal Health series. Joined by panelists Melodie Holden, president of Venture Strategies Innovations (VSI), and Elizabeth Leahy Madsen, senior research associate at Population Action International (PAI), the panel discussed the challenges and strategies for expanding access to maternal health commodities.
Integrating Maternal Health and Family Planning Supply Chains“It is often said that the family planning and the maternal health communities have very different views of supplies… but actually [both communities] recognize that we need to explore the continuum,” said Bunting, addressing the need to integrate maternal health commodities into existing reproductive health supply chains. “I really think the stars are aligned right now for advancing this agenda,” added Bunting.
“Many of the commodities that we talk about in terms of reproductive and maternal health cost tiny amounts to deliver, but actually save lives and are some of the most cost-effective interventions we have both in public health and in broader development,” said Bunting.
No Product, No Program
“Supplies are a key element in programs to improve maternal health and they are also a tangible and visible hook to increase awareness and commitment,” said Madsen. “Policymakers whose eyes glaze over when they hear the term ‘health systems strengthening’ can grasp… much better when they learn that supply shelves in clinics are bare and that women are making great efforts to reach facilities, only to leave empty- handed,” said Madsen.
Presenting research conducted by PAI, Madsen discussed the availability of four key maternal health medicines and products in Bangladesh and Uganda including:
By focusing on supplies that target the three leading causes of maternal mortality, Madsen and her colleagues identified factors that inhibit access to these commodities and developed recommendations for strengthening maternal health supply chains.- Oxytocin: used to prevent post-partum hemorrhage
- Misoprostol: used to prevent post-partum hemorrhage
- Magnesium Sulfate: used to treat pre-eclampsia
- Vacuum Aspirators: used for treatment of early and incomplete abortion
Madsen identified several strategies to strengthen supply chains for maternal health commodities including forecasting and preparing for growing demand, advocating for government and donor support, encouraging scaling-up of community-based approaches, promoting family planning, and focusing on human resource training.
“In maternal health, if a supply to prevent or treat a life-threatening complication is in stock, there must also be a way for a woman to reach it in time… and in most cases a provider who knows how to administer it,” said Madsen.
“This research is intended to lay the groundwork for future advocacy and policy initiatives by providing an evidence base that is informed by local expertise,” said Madsen. “We hope that this information will inform program implementation, funding decisions, and awareness raising.”
Getting the Product to People: The Case of Misoprostol
“The story of Misoprostol is still being written. The goal is to invest in creating access to interventions that are low-cost and relatively simple to use,” said Holden. By sharing lessons learned, Holden described VSI’s experience registering and procuring Misoprostol and demonstrated how community mobilization is imperative to overcoming major challenges for large-scale implementation.“Making products available is not without challenges,” said Holden. To increase access to Misoprostol in rural communities, maternal health experts must work to “engage communities, educate and mobilize women, train providers at all levels of the health care system, and provide support to distributors to jump start sales,” said Holden. “By looking holistically across entire health systems, bringing in great interventions, addressing the components of supply and demand, and working with local partners, we can have lasting impact.”
While the price of Misoprostol has decreased significantly, Holden stressed the need to identify creative ways along the supply chain that reduce costs to the end user. Additionally, “establishing policies around this new intervention not only establishes its reach, but also makes its use institutionalized, which means it will be part of the system even if governments or individuals change,” said Holden.
“If there is a gap between what could be achieved with Misoprostol and what is being achieved, we need to go back to the model and figure out what pieces aren’t working,” concluded Holden. “The work is complex and takes time, but it’s worth it.”
Photo Credit: “Rapid HIV testing,” courtesy of flickr user DFID – UK Department for International Development.
