Showing posts from category maternal health.
-
Nigeria Beyond the Headlines: Demography and Health [Part One]
›
“Nigeria is a country of marginalized people. Every group you talk to, from the Ijaws to the Hausas, will tell you they are marginalized,” said Peter Lewis, director of the African Studies Program at the Johns Hopkins University School of Advanced International Studies. Lewis spoke at an April 25 conference on Nigeria, co-hosted by ECSP and the Wilson Center’s Africa Program, assessing the country’s opportunities for development given its demographic, governance, natural resource, health, and security challenges. [Video Below]
-
Learning From Success: Ministers of Health Discuss Accelerating Progress in Maternal Survival
›“The gains we have made [in reducing maternal mortality rates] are remarkable; however, gains are fragile and donor resources are declining. Substantial investments must be maintained to safeguard these hard-wins,” said Afghan Minister of Health Suraya Dail at the Wilson Center on April 23. [Video Below]
As part of the Wilson Center’s Global Health Initiative, the Advancing Dialogue to Improve Maternal Health series partnered with the U.S. Agency for International Development to co-host Minister Dail, along with Honorable Dr. Mam Bunheng, Minister of Health, Cambodia; Honorable Dr. Bautista Rojas Gómez, Minister of Health, Dominican Republic; and Dr. Fidele Ngabo, Director of Maternal and Child Health, Ministry of Health, Rwanda.
These ministers spoke about the lessons learned in countries where there has been tremendous progress under challenging circumstances.
In the Dominican Republic, Bautista Rojas Gomez said the first challenge was to address the “Dominican paradox,” where maternal mortality rates were high despite the fact that 97 percent of women received prenatal care and delivered in hospitals. The government created a zero tolerance policy that included a comprehensive surveillance system, mandatory maternal death audits, and community oversight of services, which assured better quality services.
Similar political commitment improved indicators in Cambodia, where maternal mortality rates dropped from 472 to 206 per year from 2005 to 2010. “It takes a village…and the prime minister has inspired the country to act,” said Mam Bunheng. Through increased access to contraception the number of children per woman went from seven to three and commitment to family planning, education, technology, infrastructure, and community have been the key drivers of success.
“In Rwanda, the big challenge we are having is education,” said Fidele Ngabo. “Many of the maternal health indicators depend on education.” When women and girls are educated they are twice as likely to utilize modern contraception. The efforts of Rwanda’s government have been instrumental in facilitating positive change, he said, particularly the efforts of First Lady Jeannette Kagame, who he called a “champion” for women and girl’s health.
As witnessed throughout the Advancing Dialogue to Improve Maternal Health series – and reiterated by the ministers of health – the interventions to improve maternal mortality rates exist, what’s left is to generate the needed political willpower.
Event Resources
Photo Credit: David Hawxhurst/Wilson Center. -
Carl Haub, Behind the Numbers
Bangladesh 2011 Demographic and Health Survey Shows Continued Fertility Decline, Improved Health Indicators
›May 7, 2012 // By Wilson Center StaffThe original version of this article, by Carl Haub, appeared on the Population Reference Bureau’s Behind the Numbers blog.
The Bangladesh 2011 Demographic and Health Survey is the ninth demographic survey taken in the country since 1975. Except for a few very small countries and city-states, Bangladesh is the world’s most densely populated country with about 1,100 people per sq. kilometer. The country’s area is about the same as the U.S. state of Arkansas and a bit more than Greece but is home to over 150 million people.
The preliminary 2011 report has just been released and it shows that fertility has continued its decline to a low level. The total fertility rate (TFR) for the three-year period before the survey was 2.3 – 2.0 in urban areas and 2.5 in rural areas. The survey interviewed 17,842 ever-married women ages 12 to 49 and 3,997 ever-married men ages 15 to 54 from July to December 2011. Rural women accounted for two-thirds of those interviewed. From 1975 to 1994, the TFR in Bangladesh was in continuous decline. But the next three surveys showed a tendency for TFR decline to “stall” at a medium level (see graph). Desired family size has greatly decreased. In the survey, 76.2 percent of women with two living children said that they did not wish to have any more children, an additional 5.3 percent had been sterilized, and 1.3 percent said they were incapable of conceiving.
In the survey, 61.2 percent of currently married women said that they were using some form of family planning, a level comparable to developed countries. The use of modern methods was quite high at 52.1 percent. Unlike neighboring India, where female sterilization predominates, the contraceptive pill is the most widely used modern method at 27.2 percent, followed by injectables (11.2 percent), and the male condom (5.5 percent). Contraceptive use has risen steadily in surveys, up from 7.7 percent in 1975. Family planning use has risen despite the fact that fewer women report a visit from a family planning worker, either government or private. Overall, only 15.5 percent reported contact with a home visitor, which has been an important part of the country’s family planning program. The report notes that this may be due to workers deciding to provide services from community clinics for three days a week.
Continue reading on Behind the Numbers.
Sources: MEASURE DHS.
Imaged Credit: Carl Haub/Behind the Numbers. -
Nabeela Ali on How PAIMAN Is Improving Maternal Health in Pakistan
›“Maternal mortality is a very complex thing – it’s not just patient-doctor relationships, it has so much to do with behaviors, with communities, with the household, with family members,” said Nabeela Ali, chief of party for the Pakistan Initiative for Mothers and Newborns (PAIMAN), which received USAID maternal and child health funding from 2004 to 2010.
Pakistan is the world’s sixth most populous country, yet has long held one of the world’s highest maternal mortality rates. Ali spoke at the Wilson Center last fall about strategies to better engage faith-based organizations on maternal and child health issues. In this interview with ECSP, she stressed that despite Pakistan’s very religious society, these interventions are possible with the right messaging.
PAIMAN aims to reach vulnerable and isolated groups, including poor, rural, or conservative women. “The areas where no one can reach [are] where we targeted,” Ali said.
In these areas, ulama – influential religious leaders and scholars – are highly trusted. “It was not a one-size-fits-all strategy,” Ali emphasized. “Religious leaders are not technical people, but they are experts in their own field. You have to approach them with trust and respect.”
“The first step is establishing rapport with them; then they listen to you,” said Ali. This is best done through another alim, not a technical person. Those ulama that were approachable proved to be valuable allies in the promotion of maternal health. PAIMAN has reached over 35 million people in Pakistan over its now eight-year run.
Projects like PAIMAN are necessary in areas of the world where religious leaders are the most respected community authorities. In Pakistan, Ali believes that now that this strategy has been demonstrated to be viable, the government should help bring it to scale. An NGO-funded project ends, but a government-funded program has much more continuity, which in turn helps build trust with local leaders, she said.
Sources: UN Population Division. -
Women’s Rights and Voices Belong at Rio+20
›This summer, world leaders will gather in Rio de Janeiro for the 20th anniversary of the first UN Earth Summit to hammer out a new set of agreements on what sustainable development means and, more importantly, how both rich and developing nations can get there before it’s too late. However, for the scores of women who will be attending (and just importantly for those who aren’t), there are glaring omissions: reproductive health, gender equality, and girls education are nowhere to be found on the Rio+20 agenda.
Women offer many of the most promising levers for the transformation to sustainable development. My experience with the Global Fund for Women tells me that women are full of creative and strategic solutions to the problems facing their communities around the world. Their voices must be included in critical decisions affecting our world. And the fact is, sustainable development isn’t sustainable if it doesn’t include empowering women to plan their families, educate themselves, and their children, and have a voice in government at all levels. Rio+20 must have human rights – and women’s rights – at its core. Earth summit planners haven’t yet done that, but women can make it happen.
Women are 51 percent of the world’s population, yet own only one percent of its assets, are two-thirds of the world’s workers but earn a mere 10 percent of wages. Rio+20 must not become another forum in which women’s issues are not heard. Instead, the summit must demonstrate that women’s voices are integral to all development. Environmental sustainability simply can’t happen without women’s inclusion.
For example, in West Africa, women make up 70 percent of workers in agriculture. In Burkina Faso, deforestation, water scarcity, and soil erosion show us that climate change is already impacting women farmers. Women tend to “sacrifice themselves” in order to care for their families – feeding themselves last. And women are most likely to suffer and die in environmental disasters – particularly in the Asian countries most at risk from climate change.
So how do we support women while supporting the environment that sustains us all?
Simply meeting women’s needs for family planning is one inexpensive and powerful development strategy with a host of environmental benefits. Over 200 million women around the world want the ability to choose the spacing and number of children but don’t have access to, or accurate information about, basic contraceptives like condoms, pills, and IUDs. One-hundred and seventy-nine nations already agree that meeting this need is a top priority, and the Millennium Development Goals (MDGs) reflect a goal of universal access to family planning as well.
Satisfying this demand would dramatically reduce maternal and child mortality and enhance human rights. What’s more, two recent studies show that a reduction of 8 to 15 percent of essential carbon emissions can be obtained by meeting women’s needs for family planning. This reduction would be equivalent to stopping all deforestation or increasing the world’s use of wind power fortyfold.
The Earth Summit presents a major opportunity to ensure that women’s needs and rights are given top priority in plans for sustainable development. In a time of multiple, interlinked human and environmental crises and a very tight funding environment, investing in women is a clear winner.
A greater understanding of the impact of environmental degradation, pollution, and climate change on women, coupled with solid public policy that respects and protects women’s reproductive rights, is essential to the “Sustainable Development Goals” that many believe will emerge from Rio+20 to replace the MDGs, which expire in 2015.
As the summit approaches, it’s time to reflect on why women’s full participation and inclusion is so important and call for world leaders to harness the power of women as we launch the era of sustainable development.
Musimbi Kanyoro is president and CEO of the Global Fund for Women, which advances women’s human rights by investing in women-led organizations worldwide.
Sources: Food and Agriculture Organization, Guttmacher Institute, Moreland et al. (2010), O’Neill et al. (2010), Princeton Environmental Institute, UN, UNEP, World Bank, World Health Organization.
Photo Credit: “Reokadia Nakaweesa Nalongo,” courtesy of Jason Taylor/Friends of Earth International. -
Uganda’s Demographic and Health Challenges Put Into Perspective With Newfound Oil Discoveries [Part One]
›April 26, 2012 // By Kate DiamondUganda’s population is the second youngest in the world, with half of the country younger than 15.7 years old (just older than Niger’s median age of 15.5 years). In the past 10 years, the country – about half the size of France in land area – has added 10 million people, growing from 24 to 34 million. That growth, paired with other factors like poor governance and long-standing insecurity, has made providing basic services a difficult task for a government that is one of Africa’s most aid-dependent.
-
Karen Newman: Population and Sustainable Development Links Are Complex, Controversial, and Critical
›April 23, 2012 // By Kate Diamond“The one child family norm in China has fixed the global imagination around population to be around doing something which constricts people’s and women’s choices, rather than expands women’s possibilities to take control of their lives,” said Karen Newman, the coordinator for the UK-based Population and Sustainability Network. But contemporary population programs are about educating people on and providing access to voluntary reproductive, sexual, and maternal health services.
Newman spoke to ECSP, during the Planet Under Pressure conference this year, about family planning efforts and the connection between population dynamics and the environment.
“You have what I would describe as a sort of kaleidoscope of complexity” between climate change and population dynamics – not just growth, said Newman, but urbanization and migration.
For example, China recently overtook the United States as the world’s largest emitter of carbon, and although China has 1.3 billion people compared to the United States’ 310 million, population can hardly be credited as the most important driver for the country’s emissions. “How fair is it [to credit population growth] without in the same nanosecond saying, ‘but most of the carbon that was emitted in China was to manufacture the goods that will of course be consumed in the West?” said Newman.
“It makes it more difficult to say in a sound bite that ‘OK, population and sustainable development, it’s the same conversation,’ which I believe it to be.”
The Population and Sustainability Network, working through the Population and Climate Change Alliance, collaborates with international organizations from North America, Europe, Ethiopia, and Madagascar to support on-the-ground groups working on integrated population, health, and environment programming. These programs address environmental issues, like marine conservation and deforestation, while also providing reproductive health services, including different methods of contraception, diagnosis and treatment of sexually-transmitted diseases, antenatal and postnatal care, and emergency obstetric care.
“As a result of people wanting to place a distance between those coercive family planning programs in the ‘60s and the way that we do reproductive health now…because it’s such a large package, there is a sense that…this reproductive health thing is too much, we can’t really get ahold of this,” said Newman.
“What I think we need to do is keep people focused on the fact that these are women’s rights,” she said. “But we at the same time have to say ‘this is relevant if you care about sustainable development and the world’s non-renewable resources.’”
Sources: United Nations Population Division. -
Food Security in a Climate-Altered Future, Part Two: Population Projections Are Not Destiny
›March 20, 2012 // By Kathleen MogelgaardRead part one, on the food-population-climate vulnerability dynamics of Malawi and other “hotspots,” here.
Too often, discussions about future food security make only a passing reference to population growth. It is frequently framed as an inevitable force, a foregone conclusion – and a single future number is reported as gospel: nine billion people in 2050. But adhering to a single path of future population growth misses the opportunity to think more holistically about food security challenges and solutions. Several recent food security reports illustrate this oft-overlooked issue.
Accounting for Population a Challenge
Oxfam International’s Growing a Better Future: Food Justice in a Resource-Constrained World is a thorough and fascinating examination of failures in our current food system and future challenges related to production, equity, and resilience. It reports newly-commissioned research, carried out by modelers at the Institute of Development Studies, to assess future agricultural productivity and food prices given the anticipated impacts of climate change.
But both the modeling work and the report text utilize a single projection for population growth: the UN’s 2008 medium variant projection of 9.1 billion by 2050 (which has since been revised by the UN up to 9.3 billion). Early on, the report does recognize some degree of uncertainty about this number: “Greater investment in solutions that increase women’s empowerment and security – by improving access to education and health care in particular – will slow population growth and achieve stabilization at a lower level.” But such investments do not appear in the report’s overall recommendations or Oxfam’s food security agenda. This is perhaps a missed opportunity, since the range of possibilities for future population growth is wide: the UN’s low variant for 2050 is 8.1 billion, and the high variant is 10.6 billion.
Food Security, Farming, and Climate Change to 2050: Scenarios, Results, and Policy Options is another frequently-cited report published by the International Food Policy Research Institute in 2010. In recognizing that economic growth and demographic change have important implications for future food security, IFPRI researchers modeled multiple scenarios for the future: an “optimistic” scenario which embodies high GDP growth and low population growth, a “pessimistic” scenario with low GDP growth and high population growth, and a “baseline” scenario which incorporates moderate GDP growth and the UN’s medium population projection. Each of these scenarios was then combined with five different climate change scenarios to better understand a range of possible futures.
Using different socioeconomic scenarios enabled researchers to better understand the significance of socioeconomic variables for future food security outcomes. The first key message from the report is that “broad-based economic development is central to improvements in human well-being, including sustainable food security and resilience to climate change.” This focus on economic development is based in part on the “optimistic scenario,” which counts on high GDP and low population growth (translating to high rates of per capita GDP growth).
Unfortunately, the socioeconomic scenario construction for this analysis doesn’t allow for an independent assessment of the significance of slower population growth, since high population growth is paired only with low GDP and lower population growth is paired only with high GDP. Therefore, none of the report’s recommendations includes reference to reproductive health, women’s empowerment, or other interventions that would contribute directly to a slower population growth path.
Expanding the Conversation to Better Inform Policy
Without a more nuanced treatment of population projections in technical analysis and popular reporting on food security, decision-makers in the realm of food security may not be exposed to the idea that population growth, a factor so critical in many areas where food security is already a challenge, is a phenomenon that is responsive to policy and programmatic interventions – interventions that are based on human rights and connected to well-established and accepted development goals.
There are some positive signs that this conversation is evolving. A new climate change, food security, and population model developed by the Futures Group enables policymakers and program managers to quickly and easily assess the impact of slower population growth on a country’s future food requirements and rates of childhood malnutrition. In the case of Ethiopia, for example, the model demonstrates that by 2050, a slower population growth path would make up for the caloric shortfall that is likely to arise from the impact of climate change on agriculture and would cut in half the number of underweight children.
And recently, we’ve begun to see some of this more nuanced treatment of population, family planning, and food security linkages in a riveting, year-long reporting series (though perhaps unfortunately named), Food for 9 Billion, a collaboration between American Public Media’s Marketplace, Homelands Productions, the Center for Investigative Reporting, and PBS NewsHour.
In January, reporter Sam Eaton highlighted the success of integrated population-health-environment programs in the Philippines, such as those initiated by PATH Foundation Philippines, that are seeing great success in delivering community-based programs that promote food security through a combination of fisheries management and family planning service delivery. Reporting from the Philippines in an in-depth piece for PBS NewsHour, Eaton concluded:So maybe solving the world’s food problem isn’t just about solving the world’s food problem. It’s also about giving women the tools they want, so they can make the decisions they want – here in the world’s poorest places.
Making clear connections of this nature between population issues and the most pressing challenges of our day may be the missing link that will help to mobilize the political will and financial resources to finally fully meet women’s needs for family planning around the world – an effort that, if started today, can have ongoing benefits that will become only more significant over time. Integrating reproductive health services into food security programs and strategies is an important start.
Back in Malawi, just before we turned off the highway to the Lilongwe airport, I asked the taxi driver to pull over in front of a big billboard. We both smiled as we looked at the huge government-sponsored image of a woman embracing an infant. The billboard proclaimed: “No woman should die while giving life. Everyone has a role to play.” Exactly. The reproductive health services that save women’s lives are the same services that can slow population growth and bring food security within closer reach.
