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

In areas fraught with conflict, is it possible to advance conflict resolution through environmental discourse? A recent conference hosted by Tel Aviv University’s Porter School of Environmental Studies explored this question through an examination of existing peace parks, as well as possible future preserves.

The wide-ranging discussion sought to apply theories of conflict resolution and environmental peacemaking to local conflict in the Middle East. Touching on conservation, conflict resolution, local history, geography, ecology, and diplomacy, the participants underscored the importance of restoration efforts, local environmental maintenance, and the pursuit of peace through environmental cooperation.

“Water disputes that can start at the local level—little things—have the potential, in extreme cases, to burgeon into something much bigger,” warned Ken Hackett, president of Catholic Relief Services (CRS), during a discussion at the Woodrow Wilson Center (Webcast) for the launch of CRS’ new publication, Water and Conflict: Incorporating Peacebuilding into Water Development. The report provides guidance to water development practitioners, civil society members, and others striving to incorporate water and peacebuilding into their project frameworks.

In recognition of water’s potential to drive conflict, Hackett—part of a panel featuring Jason Gehrig, Water and Conflict‘s primary author; William Hall, professor of conflict resolution at Georgetown University; and Tjip Walker, team leader of USAID’s conflict management and mitigation office‘s warning and analysis unit—urged those working on water to focus attention on identifying and diffusing areas of emerging disagreement while they are still manageable. “We must, in a proactive way, incorporate peacebuilding methodologies in water and sanitation work,” said Hackett.

Looking Beyond Tubes and Tanks

Prior to witnessing violent protests within the Altiplano region of Bolivia, Jason Gehrig assumed that the primary obstacles to successful water development efforts would be found in the technical phase of designing or building delivery systems. Local political developments, however, demonstrated that “we can’t just be looking at development without also looking at the structural issues at play,” said Gherig.

Emphasis on “social infrastructure” and the inclusion of peacebuilding paradigms allows for conflict transformation and the mitigation of future violence through heightened conflict sensitivity by local practitioners. Such understanding and sensitivity to local conflicts and structures, Gehrig asserted, can only be achieved by “listening, winning hearts and minds (beginning with our own) by getting close to the people so that their struggle for life, for dignity, for peace, becomes our own.”

Defining the Role of Environmental Conflict Resolution

William Hall noted that conflict sensitive practices apply several elements of environmental conflict resolution (ECR), such as in-depth social participation, context analysis, stakeholder involvement, and the use of neutral parties.

For Hall, the goal of ECR is not only conflict resolution, but “also how people will be involved.” Adapting a framework design from the International Association for Public Participation, Hall reminded the audience that decision-makers must clearly communicate both the goals of their intervention as well as the degree of public involvement required and desired. These issues are sensitive; Hall emphasized that, once a commitment has been made, it is extremely important “to be true to [one’s promises.]”

In situations such as those included in the CRS report, successful peacebuilding efforts—which result in high-quality agreements and improved working relationships between the affected parties—must include effective engagement of appropriate stakeholders, proper mediation, and high-quality information. While many of these factors may be seen as additional procedural complications and expenses, Hall countered that recent research has shown that, compared to standard methods, agreements reached within an ECR context grant economic and environmental benefits beyond those afforded by alternative processes.

Peacefully Managing the Commons

Tjip Walker noted that effective governance of water and other common pool resources, often magnets for mismanagement and contention, should be a pivotal concern for peacebuilders in fragile states. Drawing on research on governance and conflict, Walker explained that countries that are more democratic, and allow for greater social participation, are at a lower risk for violent conflict.

With regard to threats posed by common pool resources, Walker reminded the forum that Elinor Ostrom’s work demonstrates it is possible—providing a “enabling environment” for governance—to manage such resources without exposure to dire consequences. In many cases, however, Ostrom’s requirements for sustainable management are unfortunately difficult to achieve and are further complicated by pre-existing challenges stemming from economic dependencies and political arrangements.

Referring to previous trans-boundary river conflict projects, Walker noted that “most of them have been positive…[which] seems to suggest that we are all in this together.” Successes such as these grant hope for the future, yet also demonstrate a need for negotiated agreements across political boundaries. “Under the right circumstances,” Walker concluded, “we do have the ability to manage these resources effectively in ways that are perceived as generally being effective and legitimate.”

For more information about water, conflict and cooperation, as well as other events and publications under ECSP’s Navigating Peace Initiative, please visit www.wilsoncenter.org/water.


Photo: Courtesy David Hawxhurst, Woodrow Wilson Center.

The PHE Toolkit, launched by Building Actors and Leaders for Advancing Community Excellence in Development (BALANCED), is a new source of information and resources on Population, Health, and Environment (PHE).

The interactive online library of documents, videos, and other resources will provide “one-stop shopping” for the target audience of program managers working on health, family planning, development, and conservation programs—as well as policymakers, researchers, academics, and educators. All users can contribute resources and participate in discussions through the toolkit.

The Environmental Change and Security Program, along with several PHE partner organizations, helped build the framework and will contribute its PHE resources to the toolkit. ECSP is also a member of the PHE Gateway, which can be accessed through the toolkit.

The PHE toolkit is one of five public toolkits housed on the Knowledge for Health (K4Health) website, which is supported by USAID’s Bureau of Global Health. Together, the current and forthcoming toolkits will form an updated and vibrant community for information on health, including family planning, HIV/AIDS, and reproductive health.

The PHE toolkit is made possible through the collaboration of Johns Hopkins University Center for Communication Programs (JHU/CCP) and the BALANCED Project. BALANCED is spearheaded by the Coastal Resources Center (CRC) at the University of Rhode Island and its partners, PATH Foundation Philippines Inc. and Conservation International.

Africa’s elephants and black rhinos—already at risk—are increasingly threatened as the price of black market ivory rises, global markets contract, and unemployment rates rise. To fight poaching of these tusked animals, Ian Craig, founder of the Lewa Conservancy in Kenya and the brains behind the Northern Rangelands Trust, takes a unique approach to conservation that involves both local community members and high-level government officials, as well as private and public sector investors.

In the 1970s the black rhino population was at about 20,000. Less than three decades later, it had fallen to 200. Today, the population is about 600, of which 79 live in the Lewa Conservancy. The vast regions of Kenya covered by the Northern Rangelands Trust and the Lewa Conservancy are difficult to govern, so the conservancies partner with local communities to ensure the security necessary to protect the animals from poachers. By investing in community institutions, the conservancies create long-term sustainability and self-sufficiency.

But why should local communities—often beset by poverty, disease, and hunger—care about saving elephants or rhinoceroses rather than killing them for their tusks or meat? Revenue from tourism can total hundreds of thousands of dollars, especially because of the high cost and exclusive nature of tourism facilities in the area. This money is then injected back into community programs to improve adult literacy, school nutrition, health care, micro-credit, water and irrigation systems, community livestock and agriculture, and forestry and aquaculture.

In some politically volatile areas, the conservancy serves not only as a platform for ecological security, but also as a mediator of disputes. Where livestock theft is rampant, multi-ethnic anti-poaching teams have been able to act as intermediaries. Community elders and other traditional leaders serving on the conservancies’ boards have bi-annual meetings to further intra- and inter-regional cooperation. Along with regular managerial and council meetings, the board meetings set standards for good practices, open dialogue for policymaking and cooperation, and act as a unique platform for communication between different ethnic and regional groups.

Community members understand they have a stake in protecting not only the animals, but in ensuring security and building trust within the country. With its unique combination of local-level engagement, the cooperation and support of the Kenyan Wildlife Service and the national government, and with the resources available to the conservancies as a group, the Lewa Wildlife Conservancy hopes to create a model of conservation that can be used across Africa and in other at-risk regions.

The future is shaky: ivory prices continue to rise, the migration of animals has facilitated poaching, and small arms are abundantly available. However, the new community-focused approach has helped to create positive attitudes that aren’t just about saving animals, but about developing the nation.

Justine Lindemann is program assistant with the Africa Program at the Woodrow Wilson International Center for Scholars.

Photo: Elephants in Lewa Conservancy area, courtesty Flickr user Mara 1