The original version of this article, by Emily Puckart, appeared on the Maternal Health Task Force blog. This is the second post about MHTF and the Woodrow Wilson Center’s trip to Nairobi, Kenya to host a cross-Atlantic web-cast meeting on “Maternal Health Challenges in Kenya: What New Research Shows.” The first is available here along with video of the conference.

“Do you want to be a pregnant woman or a prisoner in Kenya?” asked Dr. Margret Meme, one of speakers in Nairobi at the recent policy dialogue “Maternal Health Challenges in Kenya: What New Research Shows.” She explained that the last prisoner killed in Kenya through capital punishment was over 20 years ago, yet pregnant women continue to die of treatable causes not just in Kenya, but globally.

The original version of this article, by Emily Puckart, appeared on the Maternal Health Task Force blog.

I attended the two day Nairobi meeting on “Maternal Health Challenges in Kenya: What New Research Evidence Shows” organized by the Woodrow Wilson International Center and the African Population and Health Research Center (APHRC). [Video Below]

High population growth and population density have placed serious stress on natural resources in the Philippines. No one lives far from the coast in the 7,150-island archipelago, making the population extremely dependent on marine resources and vulnerable to sea-level rise, flooding, and other effects of climate change. The coastal megacity of Manila – one of the most densely populated in the world – is beset by poor urban planning, lack of infrastructure, and a large population living in lowland slums, making it particularly vulnerable to increased flooding and natural disasters. [Video Below]

The Philippines is now home to 93 million people and by 2050 is expected to reach 155 million, according to the UN’s medium fertility variant projections. Development programs in the country have made great strides towards increasing access to family planning and reproductive health services as well as improving management of marine resources, but the underlying trends remain troubling.

The Battle Over Reproductive Health

Since 1970, the government’s Commission on Population has been addressing population growth, reproductive health, and family planning. “The impact of the high rate of population growth is intricately linked to the welfare and sustainable development for a country like the Philippines, where poverty drives millions of people to overexploit their resource base,” wrote the commission. As a result of these efforts and others, total fertility rate has dropped from 6.0 children per woman in 1970, to the present 3.2.

The Philippines has also made great gains towards achieving Millennium Development Goal targets, “particularly in the alleviation of extreme poverty; child mortality; incidences of HIV/AIDS, tuberculosis, and malaria; gender equality in education; household dietary intake; and access to safe drinking water,” according to the United Nations Development Program (UNDP). Yet, “glaring disparities across regions persist,” UNDP states.

One of the poorest regions in the country, the Autonomous Region of Muslim Mindanao, is also home to a violent separatist movement. With limited access to health services, fertility and population growth rates are the highest in the country. Women in Mindanao average 4.2 children per woman; one in four married women has an unmet need for contraception; and 45 percent of households live in poverty (compared to 24 percent nationally).

Nationally, “serious challenges and threats remain with regard to targets on maternal health, access to reproductive health services, nutrition, primary education, and environmental sustainability,” according to UNDP–in particular, indicators on maternal health are “disturbing” and of all the MDGs, are labeled “least likely to be achieved.”

Out of three million pregnancies that occur every year, half were unplanned and one-third of these end in abortions, according to a 2006 report of the Allan Guttmacher Institute conducted in the Philippines. Induced abortion was the fourth leading cause of maternal deaths, and young women accounted for 17 percent of induced abortions. Over half of births occurred at home and one-third of them were assisted by traditional birth attendants. Around 75 percent of the poorest quintile did not have access to skilled birth attendants compared to only 20 percent of the richest quintile.

The politically influential Catholic Church recently blocked passage of a reproductive health bill, despite support by President Benigno Aquino and a majority of Filipinos. The bill seeks to provide universal access to contraception and would make sex education required from fifth grade onwards, a provision that has angered Church officials.

Manila Under Water

The Philippines’ combination of high population growth and limited land area (nearly all of which is near the coast) makes the country extremely vulnerable to the effects of climate change. Sixty-five percent of Filipinos live in coastal areas and 49 percent live in urban areas. Paul Hutchcroft, in Climate Change and Natural Security, writes that “even in the best of times, the frequency of typhoons, floods, earthquakes, and volcanic eruptions makes the Philippines one of the most disaster-prone countries in the world” (p. 45).

Population growth, climate change, and deforestation will only increase the severity of these disasters, he concludes. Hutchcroft points out that by 2080, projected temperature increases of between 1.2 to 3.9 degrees Celsius could raise sea levels by an estimated 0.19 to 1.04 meters – a scary thought for the 15 million living within a one-meter elevation zone (p. 46).

In 2009, metropolitan Manila, currently home to 11 million people (18,650 per square kilometer) and projected to grow to 19 million by 2050, was hit by tropical storms that caused devastating flooding – at their peak, waters reached nearly seven meters, according to a World Bank report. “More than 80 percent of the city was underwater,” write the authors, “causing immense damage to housing and infrastructure and displacing around 280,000-300,000 people.”

“Even if current flood infrastructure plans are implemented, the area flooded in 2050 will increase by 42 percent in the event of a 1-in-100-year flood,” says the World Bank report. Climate change could also increase the cost of flooding as much as $650 million, or 6 percent of GDP. Only by considering climate-related risks in urban planning can the Philippines hope to mitigate the effects of climate change, the report concludes.

Integrated Development: One Piece of the Puzzle?

Population, health, and environment (PHE) programs that integrate family planning and natural resource management are one way to help the majority of Filipinos that live in densely populated and resource-stressed coastal areas.

In ECSP’s FOCUS Issue 15, “Fishing for Families: Reproductive Health and Integrated Coastal Management in the Philippines,” Joan Castro and Leona D’Agnes explain how Path Foundation Philippines, Inc.’s IPOPCORM project – which ran from 2000 to 2006 – helped “improve reproductive health and coastal resource management more than programs that focused exclusively on reproductive health or the environment – and at a lower total cost.” A recent peer-reviewed study, co-authored by Castro and D’Agnes and published in Environmental Conservation, proved the same point with rigorous analysis.

“When we started IPOPCORM, there was really nothing about integrating population, health, and environment,” said Castro in an interview with ECSP. IPOPCORM provided some of the first evidenced-based results showing there is value added to implementing coastal resource management and family planning in tandem rather than separately. In part due to the success of the IPOPCORM, the Philippines have become one of the major PHE development implementers in the world.

Creating sustainably managed marine sanctuaries while improving access to family planning provides a way forward for many coastal communities. However, the Philippines’ urban woes – 44 percent of urban dwellers live in slums, according to the Population Reference Bureau – internal divisions, and natural vulnerability will likely make it difficult to dodge considerable climate-related effects in the near future. Already the archipelago’s vast biodiversity is in crisis, according to studies over two thirds of native plant and animal species are endemic to the islands and nearly half of them are threatened; only seven percent of its original old-growth less than 10 percent of the islands’ original vegetation remains; and 70 percent of nearly 27,000 square kilometers of coral reefs are in poor condition.

Sources: CIA, Conservation International, Field Museum, The Guardian, The Huffington Post, Philippines National Statistics Office, Population Reference Bureau, United Nations, U.S. Census Bureau, World Bank, World Wildlife Fund.

Photo Credit: “Climate Risk and Resilience: Securing the Region’s Future” courtesy of Flickr user Asian Development Bank.

Download FOCUS Issue 23: “To Live With the Sea: Reproductive Health Care and Marine Conservation in Madagascar,” from the Wilson Center.

Christine does not know how old she is. She has 16 children and lives on a remote island off the southwestern coast of Madagascar. She and her children, like other members of the Vezo ethnic group, depend entirely on the ocean for their survival. Her husband, a fisherman, struggles to catch enough to feed his family.

Each year, 350,000 women die while pregnant or giving birth, as many as two million newborns die within the first 24 hours of life, and there are 2.6 million stillbirths. Sadly, the majority of these deaths could be prevented if poor and marginalized women in developing countries had access to adequate health facilities and qualified health professionals. In fact, according to the new UNFPA report, State of the World’s Midwifery 2011: Delivering Health, Saving Lives, just doubling the current number of midwives in the 58 countries highlighted in the report could avert 21 percent of maternal, fetal, and newborn deaths.

“Practice, Harvest and Exchange: Exploring and Mapping the Global, Health, Environment (PHE) Network of Practice,” by the University of Rhode Island’s Coastal Resources Institute and the USAID-supported BALANCED Project, explores the successes and challenges of their global population, health, and environment (PHE) network (with a heavy presence in East Africa). In order to increase support of the nascent PHE approach, the network seeks to shorten the “collaborative distance” between “PHE champions,” so they can develop a stronger body of evidence for the links between population, health, and the environment. In their analysis, the authors write that the network has facilitated the development of independent, information-sharing relationships between “champions.” However, they also observed shortfalls in the network, such as its limited reach into less technologically advanced yet more biodiverse regions, its bias toward BALANCED meet-up event participants, and its exclusion of those experts unlikely to be included in published works.

Download FOCUS Issue 22: “Coffee and Community: Combining Agribusiness and Health in Rwanda,” from the Wilson Center.

Rwanda, “the land of a thousand hills,” is also the land of 10 million people, making it the most densely populated country in Africa. Rwandans depend on ever-smaller plots of land for their food and livelihoods, leading to poverty, soil infertility, and food insecurity. Could Rwanda’s burgeoning specialty coffee industry hold the key to the country’s rebirth, reconciliation, and sustainable development?

In the latest issue of ESCP’s FOCUS series, author Irene Kitzantides describes the SPREAD Project’s integration of agribusiness development with community health care and education, including family planning. She outlines the project’s successes and challenges in its efforts to simultaneously improve both the lives and livelihoods of coffee farmers and their families.

In the chapter, “Urban Agriculture and Climate Change Adaptation: Ensuring Food Security Through Adaptation,” of the edited volume, Resilient Cities: Cities and Adaptation to Climate Change – Proceedings of the Global Forum 2010, authors Marielle Debbeling and Henk de Zeeuw assess the viability of urban and peri-urban agriculture (UPA) as a method of climate change adaptation for the urban poor. Debbeling and de Zeeuw assert that UPA increases the resilience of cities by diversifying both food supply and income streams for the urban poor; decreasing the negative effects of “heat island effect,” air pollution, and urban flooding; conserving water and utilizing organic waste; and reducing energy use and greenhouse gas emissions. Given the scale and impact of modern urbanization, the authors write that “the integration of UPA into urban development and master plans, urban land use and zoning plans, as well as active maintenance of the protected agricultural zones…is crucial.”