Showing posts from category global health.
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Family Planning in Fragile States
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“Conflict-affected countries have some of the worst reproductive health indicators,” said Saundra Krause of the Women’s Refugee Commission at a recent Wilson Center event. “Pregnant women may deliver on the roadside or in makeshift shelters, no longer able to access whatever delivery plans they had. People fleeing their homes may have forgotten or left behind condoms and birth control methods.”
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Thinking Outside the (Lunch) Box: Meat and Family Planning
›May 3, 2010 // By Dan AsinJoel Cohen, a renowned population expert and professor at Columbia and Rockefeller universities, recently gave a lecture simply titled “Meat.” As it was co-sponsored by the International Food Policy Research Institute and the Population Reference Bureau, I was hoping for an insightful discussion of meat eating and its implications for feeding a world of nine billion. While I think Cohen avoided the question of whether meat eating is ultimately sustainable, I was pleased that he included two key insights: the potential for family planning services to contribute to food security, and the importance of using multidisciplinary approaches to solve today’s global problems.
Family Planning for Food Security
In working to improve food security, Cohen said policymakers and practitioners need to focus on those who are most vulnerable. To this end, he identified five groups and suggested targeted policies for each:While the healthy eating policies will not surprise food security experts, his recommendations on family planning might. He highlighted what should be–but is not always–apparent: that tackling food security without thought for family planning is like attempting to fill an empty bucket without first plugging the holes.
Feeding the one billion hungry people in the world today is an enormous challenge that cannot be met by any single policy. Instead, it will take an array of partial solutions, and offering family planning services to women and young people is an important part of the package. Such projects can help reduce the number of children being born into hunger by allowing women and couples to assess their economic and food situations and plan according to their needs and wishes. Voluntary family planning services and materials will not solve the food security challenge on their own, but they can make it more manageable, especially in the long run.
Family planning’s potential contribution to food security is just one part of Cohen’s larger take-home message: population, economics, environment, and culture all interact. To meet today’s multidisciplinary challenges, single-sector approaches are not up to task.
The Many Faces of Meat
Cohen offered two competing perspectives on meat eating. On the one hand, average global meat production generates a fraction of the calories and protein, per unit of land, that could be derived from plant sources. It is likely the “largest sectoral source of water pollution,” said Cohen, and is at least partly responsible for the spread of over a dozen zoonotic diseases. It contributes to only 1.4 percent of world GDP while comprising 8 percent of world water consumption.
These hidden “virtual water” costs made headlines in Britain the other week, when a study on global water security published by the Royal Academy of Engineering popularized the Water Footprint Network’s earlier findings that that an average kilogram of beef requires 15,500 liters of water–over eight times the volume needed to produce the equivalent weight in soybeans and greater than 10 times that needed for the equivalent amount of wheat.
On the other hand, Cohen pointed out that meat production provides livelihoods for an estimated 987 million of the world’s rural poor, and has important cultural significance in many societies. And it can provide many essential nutrients, even in small doses.
In one study he cited, children living in Kenya who were provided 1 ounce of meat a day received 50 percent of their daily protein requirements and showed greater increases in physical activity and development, verbal and arithmetic test scores, and initiative and leadership behaviors as opposed to students who received the calorie-equivalent in milk or fat.
The Four Factors: Population, Economics, Environment, and Culture
Clearly, Cohen’s four factors all come in to play when evaluating meat’s role in food security. An analysis of any global health issue that looks at only one factor would miss indispensable parts of the problem.
“Population interacts with economics, environment, and culture,” Cohen concluded. “If you use that checklist when somebody gives you a simple-minded solution to a problem, you can save yourself a lot of simple-minded thinking.”
Photo: Pigs on a farm, courtesy Flickr user visionshare. -
Food Security Comes to Capitol Hill, Part Two: Women’s Edition
›April 30, 2010 // By Schuyler NullThe focus on food security on Capitol Hill continued with Wednesday’s House Hunger Caucus panel, “Feeding a Community, Country and Continent: The Role of Women in Food Security.” According to panel organizers Women Thrive Worldwide, “over half the food in developing countries – and up to 80 percent in sub-Saharan Africa – is grown by women farmers, who also account for seven in ten of the world’s hungry.”
The panel illuminated some of the inequities routinely faced by female farmers that often prevent them from using the same inputs as men (tools, fertilizer, etc.), bar their access to credit, and force them onto less productive land.
“Women around the world face unique economic and social barriers in farming and food production,” said Nora O’Connell of Women Thrive Worldwide. “But they are key to increasing food security and ending hunger, and all international programs must take their needs into account.”
Panelist David Kauck of the International Center for Research on Women (ICRW) cited the State Department’s Consultation Document on the Global Hunger and Food Security Initiative: “Economic output could be increased by 15-40 percent and under-nutrition reduced by 15 million children simply by providing women with assets equal to those of men.”
According to the 2008 ICRW report, A Significant Shift: Women, Food Security, and Agriculture in a Global Marketplace:Women also are more likely than men to spend their income on the well-being of their families, including more nutritious foods, school fees for children and health care. Yet agricultural investments do not reflect these facts. Women in forestry, fishing and agriculture received just 7 percent of total aid for all sectors.
One of the most fundamental problems faced by women in developing countries is a lack of basic education leading to illiteracy and innumeracy, making it difficult for women to understand agricultural policy or the fair market values of their products. Therefore, men are much more likely to control valuable markets.
In addition, women are less likely to learn about and adopt new agricultural technologies and best practices. Lydia Sasu, director of the Development Action Association, said that when she attended agricultural school in Ghana she was one of only three women, compared to more than 40 men, in her class.
Women in developing countries rarely own the land they farm, which can make it difficult to apply for credit and extension services without collateral. According to the ICRW report:In Uganda, women account for approximately three out of four agricultural laborers and nine out of 10 food-producing laborers, yet they own only a fraction of the land. Women in Cameroon provide more than 75 percent of agricultural labor yet own just 10 percent of land. A 1990 study of credit schemes in Kenya, Malawi, Sierra Leone, Zambia and Zimbabwe found that women received less than 10 percent of the credit for smallholders and only 1 percent of total credit to agriculture. Women receive only 5 percent of extension services worldwide, and women in Africa access only 1 percent of available credit in the agricultural sector.
“The fundamental barrier to women in agriculture,” said USAID’s Kristy Cook, “is access to assets.” Cheryl Morden of the International Fund for Agricultural Development (IFAD) said we have reached the “tipping point,” where action on this issue seems inevitable on the international policy level. However, she questions how quickly that momentum can translate to change on the ground.
The State Department has made improving women’s lives an important part of both their Global Hunger and Food Security Initiative and the Global Health Initiative. ”Investing in the health of women, adolescents, and girls is not only the right thing to do; it is also the smart thing to do,” said Secretary of State Hillary Clinton in January.
Reproductive health and family planning services will be key to both initiatives. A policy brief by ICRW’s Margaret Greene argues that poor reproductive health can have negative effects on women’s educational and economic opportunities. As Secretary Clinton said, “When women and girls have the tools to stay healthy and the opportunity to contribute to their families’ well-being, they flourish and so do the people around them.”
Photo Credit: “Transplanting at rainfed lowland rice in Madagascar,” courtesy of flickr user IRRI Images. -
Maternal Health Solutions in Peru
›Media reports on the neglected discussion of maternal and child health often focus on the problems and projects in sub-Saharan Africa or South Asia, which is understandable, as a disproportionate 90 percent of global maternal deaths occur in these two regions. Last month, however, PBS correspondent Ray Suarez reminded us that maternal and child mortality affects countries all over the world, including Peru, where “maternal death rates has historically been unusually high,” he noted in a report for NewsHour.
“Few people in the highlands of central Peru own automobiles and it’s hard to know exactly when the next bus is going to rumble by,” said Suarez. “Villagers are a long way from the nearest health clinic, even further from a fully equipped clinic.” Unfortunately, this scene could describe most developing countries struggling to reach the Millennium Development Goal (MDG) 5 target of reducing maternal deaths by 75 percent by 2015. Maternal health advocates argue that MDG 5 does not require a cure, but rather increased political willpower.
“Health officials, obstetricians, nurses, and community activists looked for ways to make better use of existing resources and connect expecting mothers with them,” said Suarez, reporting from the remote town of Vilcashuaman. At the Casa Materna, or “mother’s house,” nurses plot on a felt, bulls-eye map the names, due dates, geographical proximity, and travel times of pregnant women in nearby villages. Utilizing two-way radio communication, Casa Materna stays in contact with these remote villages and can signal the regional hospital, hours away in Ayacucho, for ambulance assistance for women needing emergency obstetric care.
Delivery teams at the Ayacucho hospital are familiar with indigenous languages and cultures, and welcome traditional practices, such as displaying herbs and giving figurines to new mothers. “The medical professionals in the area know bringing delivering mothers to the hospital can mean the difference between life and death and are prepared to be as accommodating as possible to lure women from home delivery,” reports Suarez. In the Ayacucho district, maternal mortality rates have decreased by 50 percent in five years.
While Suarez said “cultural competence, a welcoming atmosphere, and low-cost, high-result treatment strategies” may seem “pretty smart and straightforward,” it is important to evaluate the regional health system at a larger level, and consider additional factors, such as access to family planning, that may have contributed to Ayacucho’s success in reducing maternal mortality.
Another part of the solution is improving transportation and referral strategies, but increased research is needed to evaluate best practices and scalability of programs such as the one in Ayacucho. On May 19-20, as part of the Maternal Health Dialogue Series, the Wilson Center’s Global Health Initiative will host a two-day conference on “Improving Transportation and Referral for Maternal Health.” Speakers working on transportation and referral strategies in Bolivia, Ghana, and India will share their experiences and best practices.
Calyn Ostrowski is the program associate for the Wilson Center’s Global Health Initiative.
Photo Credits: Mothers in Peru learn to identify risk factors during pregnancy. Courtesy of Flickr user International Women’s Health Coalition -
Cassie Gardener
Integrating Population, Health, and Environment in Ethiopia’s Bale Mountains
›Ethiopia suffers from vast deforestation, rapid population growth, and high rates of maternal mortality. But development programs that address these issues in an integrated fashion may help end that suffering. As part of my two-month internship with the PHE-Ethiopia Consortium, I recently visited the Movement for Ecological and Community Action (MELCA) Project in the rural Bale Zone of southeastern Ethiopia to witness these programs in action.
Ethiopia’s Spectacular Bale Mountains
The little-known Bale Mountains are national and global treasures of biodiversity, teeming with dozens of endemic mammal, bird, and plant species. Ethiopia’s most important region for migrating birds, the rivers and streams in the Bale watershed flow to more than 12 million people in southern Ethiopia and western Somalia. Bale Mountains National Park hosts half of the world’s population of its rarest canid, the Ethiopian wolf, which has dwindled to a mere 250 individuals due to human interaction. When I toured the park, I was lucky enough to spot bushbucks, mountain nyalas, molerats, and several Ethiopian wolves.
As in many parts of the country, rural communities around the park face grave livelihood and health challenges, and their unsustainable use of land to eke out a living is threatening its conservation efforts. Due to diminishing agricultural land and an average total fertility rate of 6.2 children per mother in the region, people are increasingly forced to cut trees for fuel and timber in order to feed and house their families.
If Bale’s resources continue to be exploited in an unsustainable way, more mammal species would become extinct here than in any other area of equivalent size in the world. Even worse, MELCA Project Manager Tesfaye Teshome told me that if deforestation and impending climate change dry up Bale’s precious watershed, drought and famine could lead to the displacement or death of millions of Ethiopian citizens.
Raising PHE Awareness in the Community
Since 2005, MELCA, a member organization of the PHE-Ethiopia Consortium, has been working to protect biodiversity and culture in the Bale region through research, advocacy, and their award-winning youth environmental education program called SEGNI, or “Social Empowerment through Group and Nature Interaction.” In March 2008, with funding from Engender Health and the Packard Foundation, MELCA launched an integrated population, health and environment (PHE) project that provides culturally sensitive training at the community, school, and government levels.I was impressed that after just seven months of raising awareness, I met dozens of community members and key stakeholders who strongly believe in both the conceptual and operational benefits of PHE integration. For example, the Health Extension Workers and beneficiaries explained to me that community members in the Bale region, most of whom are conservative Muslims, held negative perception of family planning, which contributed to the area’s large family sizes and maternal mortality. But by involving Islamic community leaders in the project’s discussions, MELCA helped convince religious leaders that family planning is an important part of improving the health and livelihoods of the community.
“After the PHE training, we have improved awareness of population, family planning, health and environmental issues, and we understand that child spacing is better. Even my wife is now using family planning services, and as a result our lives are improved,” said Shihase, a religious leader in the community.
Join the Club: PHE Goes to School
Inspired by training sessions at schools, the SEGNI nature clubs, women’s clubs, and anti-AIDS clubs joined together to form new “PHE Clubs.” With the support of MELCA, PHE Club students plant indigenous tree seedlings in school nurseries for distribution to the community. They also create dramas, songs, poems, and illustrated storyboards about population, health, and environment issues, and use modest “mini-media” equipment such as a stereos and microphones to share these stories with their peers and other community members.
When I arrived at Finchaa Banoo Elementary School, hundreds of students greeted me with a PHE song, wearing traditional costumes with PHE banners strewn across their chests. They led me to their nursery site where they had planted 60,000 indigenous tree seedlings. A beautifully decorated cultural hut was filled with 10 PHE storyboard panels, painted by a local PHE-trained artist.
Fatiye, a 21-year old PHE club leader in 8th grade, proudly told me, “Before the coming of PHE, I’d been working only on SEGNI and knew only about biodiversity and culture. But now, I clearly understand health and population issues, including HIV/AIDS, taught to me by my peers. By having the integration of clubs, we’ve strengthened our power to accomplish more.”
Working Together to Save Time and Improve Health
MELCA’s PHE trainings also helped government officials and development workers who had previously operated in isolated sectors to integrate their work at the planning and implementation levels. Health Extension Workers and experts from the Agricultural and Rural Development Office said that collaboration is beneficial to them and the community, because it saves time and accomplishes greater results. Shankore, one of the Health Extension Workers, told me that integrating efforts across sectors allows them to help more households adopt both family planning and better sanitation, by more consistently and efficiently delivering services at the same time.
And their efforts are paying off: “Previously, we were giving birth just like chickens, our forest coverage was diminishing, and we were damaging our resources. We had cattle in our homes, and our children had health problems. Now, we understand how to improve these issues,” Khasim Sheka, a male member of the community, told me. “Health Extension Workers are teaching us about cleaning our home gardens and homes, and we separate our house from our cattle, liquid, and solid waste. My wife wasn’t using any family planning before, and now she’s using five-year Norplant.”
Although MELCA’s PHE project is still in its early stages, it appears capable of being scaled up with a little investment in additional training and by building the capacity of its staff and community members. In particular, the reproductive health component of the project needs to be strengthened, since Health Extension Workers are not trained on simple long-term family planning methods like IUDs, and are afraid they will lose clients if they continue to have to refer them to the distant health clinic.
With these improvements, MELCA could more successfully implement the integrated PHE approach, which will not only reduce the impact of population growth and deforestation on Bale Mountain Natural Park, but will improve the health and livelihoods of its neighbors, and ultimately protect its biodiversity for Ethiopia and the global community.
For more information about PHE-Ethiopia, please contact phe-ethiopia@gmail.com or visit their website at http://www.phe-ethiopia.org. For more information about MELCA, please contact melca@ethionet.et or visit their website at http://www.melca-ethiopia.org.
Cassie Gardener was the National Campus Organizer for the Sierra Club’s Global Population and Environment Program from 2006-2010, and is currently traveling around the world and volunteering for integrated health and development programs like PHE-Ethiopia and GoJoven prior to beginning her Masters in Public Health Program at UCLA in the fall.
Photo Credits: Morgennenbel034_31a, courtesy of flickr user Agoetzke Practitioners, courtesy of Cassie Gardener. -
City Living: World Health Day 2010 Focuses on Urban Health
›April 7, 2010 // By Julien KatchinoffCelebrating World Health Day, the World Health Organization, with its partners around the globe, today launched an initiative for healthly lives in urban settings, through the theme “1000 Cities, 1000 Lives.” “We are at a critical turning point in history where we can make a difference,” said Dr Ala Alwan, assistant director-general for noncommunicable diseases and mental health.
Since the first World Health Day 60 years ago, the world has seen a dramatic rural exodus. Today, more people live in urban areas than anywhere else. Providing healthy livelihoods for the urban poor is a challenge, as poverty-stricken urban centers face a number of health obstacles, from high child mortality rates, environmental pollution, and widespread disease, to a lack of access to basic water, sanitation, and health care.
“In general, urban populations are better off than their rural counterparts,” said WHO Director-General Margaret Chan. “They tend to have greater access to social and health services and their life expectancy is longer. But cities can also concentrate threats to health such as inadequate sanitation and refuse collection, pollution, road traffic accidents, outbreaks of infectious diseases and also unhealthy lifestyles.”
The 1000 Cities campaign hopes to encourage all cities to promote healthy activities during the week following World Health Day (4/7-4/11). Through a new website, the WHO is collecting profiles and pictures in an easy-to-navigate map. Notable activities include HIV/AIDS-awareness flashmobs, skateboarding and cycling competitions, car-free days, outdoor sports events, and dance performances, in cities as diverse as Mandalgobi, Mongolia; Bangalore, India; and Luanda, Angola.
The Wilson Center’s Environmental Change and Security Program and its Comparative Urban Studies Program have collaborated on urbanization events and publications that examine the strong and critical connections between healthy urban populations and environmental sustainability.
With proper attention paid to delivering population, health, and environmental services in our urban centers, it may be possible to leverage the benefits of higher urban densities—such as lower aid dispersion costs, communication access, infrastructure services, and fertile environments for ideas and productivity—to ensure urban sustainability for the future. -
Population, Health, and Environment
›The WWF and Equilibrium Research released a report on the interplay between the environment and human health. Vital Sites: The Contribution of Protected Areas to Human Health documents the environmental-human health connection, provides case studies from both the developed and developing worlds, and offers recommendations to enhance the health outcomes that can be gained from environmental good governance. “[P]rotected areas are not a luxury but are key sites to protect not only biodiversity, but also ecosystem services and our wider well-being,” the World Bank’s Kathy MacKinnon writes in the foreword.“Family Planning and the Environment: Connected Through Human and Community Well-Being,” part of PATH‘s Outlook series, details the importance of family planning-environmental projects to communities living in remote and ecologically vulnerable areas. Designed for practitioners, the article aims to promote cross-discipline dialogue and offers case studies from the Philippines and Uganda. The article concludes that “more collaborative family planning and environmental efforts aimed at reducing inequities would better ensure sustainable community development as well as the right of individuals to achieve what they value.” -
To Invest in a Sustainable Future, Fund Voluntary Family Planning
›President Obama’s proposed federal budget for FY2011 includes $715.7 million for international family planning and reproductive health assistance—10 percent ($67 million) more than what was included in the FY2010 budget that Congress approved last December. If approved, the FY2011 allocation would be 54 percent more than the FY2008 budget, which was equivalent to the amount allotted in 1974 when adjusted for inflation. The recent increases mark the end of more than 30 years of stagnation in U.S. funding for voluntary family planning—and herald a new investment in a sustainable future.
Over the last 20 years, the number of women of reproductive age in the developing world has increased by 465 million. Today, the Guttmacher Institute estimates that 201 million women in developing countries want but lack access to modern contraceptives. “Satisfying the unmet need for contraceptive services in developing countries would avert 52 million unintended pregnancies annually, which, in turn, would save more than 1.5 million lives and prevent 505,000 children from losing their mothers,” the Institute reports.
Rapid population growth in some of the world’s most economically disadvantaged countries poses a significant threat to their natural resources and the environment. Currently, more than 1 billion people live in ecological hotspots—areas that are both rich in plant and animal diversity and highly threatened by human activity. Although these areas comprise just 12 percent of the Earth’s land surface, they hold nearly 20 percent of the global population and possess a population growth rate nearly 40 percent greater than the world average. The cumulative impact of a growing global population, which demands more natural resources and exacerbates already unsustainable patterns of consumption, degrades the most basic foundations of life—air, water, croplands, forests, and fisheries—and contributes to climate change.
Improving access to voluntary family planning not only contributes to smaller, healthier families, but also eases the strain on natural resources. By giving couples the information and supplies to plan the number and timing of their children, U.S.-funded population and reproductive health programs have helped countries slow population growth and reduce population pressures on finite natural resources, including local habitats and wildlife. In addition, the success of USAID’s population, health, and environment programs also offers important lessons for climate change adaptation and building resilience in local communities.
In our interconnected environment, the impacts of natural resources use, management, and protection around the world are felt here in the United States. Despite the difficult budgetary and economic environment our country faces, the president’s request for approximately $716 million in international family planning and reproductive health assistance funding is a wise long-term investment. These resources are an important step toward the broader goal of investing $1 billion in these critical programs to create a healthier, more sustainable future for our world.
Rebecca Wadler Lase is the program associate for the Sustainability Education Program at the Izaak Walton League of America.
Map: “Poverty-Biodiversity Mapping Applications.” Courtesy UNEP/Grid Arendal.
