Showing posts from category maternal health.
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Cultural Conundrums: ‘State of World Population 2008’
›November 21, 2008 // By Calyn OstrowskiReleased at the National Press Club on November 12, 2008, the UN Population Fund’s State of World Population 2008 encourages policymakers and the development community to embrace culturally aware approaches to achieving human rights such as gender equality and reproductive health. Noting the role local culture plays in these issues, the report makes suggestions for addressing traditional attitudes toward maternal mortality, female genital mutilation, honor killings, and contraceptive use, highlighting the need to develop alliances with local opinion leaders in program design and service delivery.
U.S. Representative Carolyn Maloney (D-NY) urged both policymakers and development professionals to carry out development projects within the context of local cultural norms. According to Maloney, the Obama administration has promised to allocate funds to help implement the report’s recommendations. Azza Karam, senior culture advisor with UNFPA, explained that much development work still does not guarantee women’s rights and argued that State of World Population 2008 includes effective approaches to addressing harmful cultural practices. Karam encouraged the development community to approach culture pragmatically, demonstrating to local community leaders how changes in cultural practices benefit the whole community.
State of World Population 2008 devotes an entire chapter to the need to include women in post-conflict reconstruction, using case studies to demonstrate how gender equality can be incorporated into a variety of different peace interventions. The report pushes policymakers and program managers to endorse gender-sensitive approaches and abandon preconceptions that women lack the expertise to assist in long-term peacebuilding. Increasing women’s participation in post-conflict reconstruction “can help development practitioners mitigate some of the ill effects of conflict, minimize deterioration in gender relations and work with local communities and relevant stakeholders” to ensure women’s rights such as reproductive health and gender equality. -
Watching the World Grow: The Global Implications of Population Growth
›October 16, 2008 // By Will Rogers
In a recent nationwide Roper Poll commissioned to study the U.S. public’s attitudes toward population, barely 50 percent of respondents believed there is a strong link between global population growth and climate change, reported Thomas Prugh of World Watch magazine at the September 30, 2008, launch of World Watch’s population issue co-sponsored by the Worldwatch Institute and the Environmental Change and Security Program. People need to learn about population growth’s impact on climate change and other indicators of environmental health, said Prugh.
To Grow or To Shrink? That Is the Question
Historically, governments viewed population growth as a sign of a nation’s vitality; some promoted it by offering incentives to have more children. Prugh noted that such pronatalist attitudes are far from obsolete: “Last year, Russian President Vladimir Putin declared September 13th a national holiday for conceiving children. And couples who delivered a baby nine months later, which not coincidentally would have been on Russia Day, got refrigerators for that accomplishment,” he said. In contrast, many governments are now promoting voluntary family planning rather than population growth. But a lack of political urgency has limited their success. “Support and funding for family planning is actually flat or in decline,” Prugh emphasized.
Empowering Women and Expanding the Discourse
Population has always been an “incredibly gendered issue,” argued Robert Engelman of the Worldwatch Institute, which is one reason for the lack of public discourse on the subject. He called for a broader discussion of population and urged women who work in the sexual and reproductive health and rights fields to actively participate. If you “don’t talk about population from your perspective and from what you know about these issues, others will,” he warned, “and they may not know as much as you do about it.” For Engelman, providing access to family planning and placing population decisions in the hands of women “is natural—this is understandable—and in general, it’s a very good thing.”
The Good, The Bad: Urbanization
“This is the first year, 2008, in which half of us have become city-dwellers,” said Karen Hardee of Population Action International, a development that will have both positive and negative consequences. Urban populations have better access to family planning and education. However, urban growth can outpace local governments’ ability to enforce environmental regulations, treat hazardous and solid waste, and limit air pollution. At the same time, Hardee argues, technological innovation, access to information, efficient land and energy use, and better living conditions—as well as economies of scale—can limit urbanization’s negative environmental impacts. “Urbanization is inevitable, and it’s also accelerating, with most of the growth in the population in developing countries,” she stated.
Population and the Changing Nature of Security
“To be sure, rapid population growth does not have a simple causal relationship with conflict. And to suggest so would fail to take into account additional aggravating factors, such as poverty, poor governance, competition over natural resources, and environmental degradation,” said Sean Peoples of the Wilson Center’s Environmental Change and Security Program. But population dynamics can fuel instability and increase the risk of a country falling victim to intrastate violence. According to The Shape of Things to Come, a report by Peoples’ co-author, Elizabeth Leahy, countries with youthful age structures—where 35 percent of the population is younger than 15—have a 150 percent greater chance of seeing conflict erupt than countries with more balanced age structures, due to pervasive joblessness, lack of education, and competition over resources.
Since countries with very young and youthful age structures represent a great challenge to international stability, population should be included in national security discussions. Secretary of Defense Robert Gates recently said, “We also know that over the next 20 years certain pressures—population, resource, energy, climate, economic, and environmental—could combine with rapid cultural, social, and technological change to produce new sources of deprivation, rage, and instability.” But there is hope of avoiding insecurity: “Progress toward more balanced age structures occurs when health care improves, leading to lower mortality rates and longer life expectancies, and when fertility rates fall, which happens when women and men have access to the services they need to choose their own family size,” said Peoples.
Photo: Thomas Prugh. Courtesy of Dave Hawxhurst and the Woodrow Wilson Center. -
Senators McCain, Obama Announce Priorities for Alleviating Poverty, Tackling Climate Change at Clinton Global Initiative
›September 25, 2008 // By Rachel WeisshaarSpeaking at a Clinton Global Initiative plenary session (webcast; podcast) this morning, Senator John McCain (R-AZ) and Senator Barack Obama (D-IL) laid out their proposals for addressing the interconnected problems of global poverty, climate change, and disease. Excerpts from each senator’s speech are below.
Senator McCain:
“We can never guarantee our security through military means alone. True security requires a far broader approach using non-military means to reduce threats before they gather strength. This is especially true of our strategic interests in fighting disease and extreme poverty across the globe.”
“Malaria alone kills more than a million people a year, mostly in Africa….To its lasting credit, the federal government in recent years has led the way in this fight. But of course, America is more than its government. Some of the greatest advances have been the work of the Gates Foundation and other groups. And you have my pledge: Should I be elected, I will build on these and other initiatives to ensure that malaria kills no more. I will also make it a priority to improve maternal and child health. Millions around the world today—and especially pregnant women and children—suffer from easily prevented nutritional deficiencies….An international effort is needed to prevent disease and developmental disabilities among children by providing nutrients and food security. And if I am elected president, America will lead that effort, as we have done with the scourge of HIV and AIDS.”
“America helped to spark the Green Revolution in Asia, and…[we] should be at the forefront of an African Green Revolution. We should and must reform our aid programs to make sure they are serving the interests of people in need, and not just serving special interests in Washington. Aid’s not the whole answer, as we know. We need to promote economic growth and opportunities, especially for women, where they do not currently exist. Too often, trade restrictions, combined with costly agricultural subsidies for the special interests, choke off the opportunities for poor farmers and workers abroad to help themselves. That has to change.”
Senator Obama:
“Our security is shared as well. The carbon emissions in Boston or Beijing don’t just pollute the immediate atmosphere, they imperil our planet. Pockets of extreme poverty in Somalia can breed conflict that spills across borders. The child who goes to a radical madrassa outside of Karachi can end up endangering the security of my daughters in Chicago. And the deadly flu that begins in Indonesia can find its way to Indiana within days. Poverty, climate change, extremism, disease—these are issues that offend our common humanity. They also threaten our common security….We must see that none of these problems can be dealt with in isolation; nor can we deny one and effectively tackle another.”
“Our dependence on oil and gas funds terror and tyranny. It’s forced families to pay their wages at the pump, and it puts the future of our planet in peril. This is a security threat, an economic albatross, and a moral challenge of our time.”
“As we develop clean energy, we should share technology and innovations with the nations of the world. This effort to confront climate change will be part of our strategy to alleviate poverty because we know that it is the world’s poor who will feel—and may already be feeling—the effect of a warming planet. If we fail to act, famine could displace hundreds of millions, fueling competition and conflict over basic resources like food and water. We all have a stake in reducing poverty….It leads to pockets of instability that provide fertile breeding-grounds for threats like terror and the smuggling of deadly weapons that cannot be contained by the drawing of a border or the distance of an ocean. And these aren’t simply disconnected corners of an interconnected world. And that is why the second commitment that I’ll make is embracing the Millennium Development Goals, which aim to cut extreme poverty in half by 2015. This will take more resources from the United States, and as president, I will increase our foreign assistance to provide them.”
“Disease stands in the way of progress on so many fronts. It can condemn populations to poverty, prevent a child from getting an education, and yet far too many people still die of preventable illnesses….When I am president, we will set the goal of ending all deaths from malaria by 2015. It’s time to rid the world of a disease that doesn’t have to take lives.” -
“New Demography” Drives World Bank Population Policy in Africa
›August 26, 2008 // By Sonia Schmanski“African elites have long had the perception that rapid population growth was not an issue because of the vastness of Africa, abundance of resources, relatively low population densities and, more recently, the threat of HIV/AIDS,” but as rapid population growth becomes a more urgent problem across the continent, that view is increasingly falling out of favor, said World Bank lead demographer John May in a recent interview with the African Press Organization. As governments work to improve their population programs, the World Bank is adopting “new demography” principles that examine age structures, dependency ratios, human capital investments, and the demographic dividend to craft cross-sectoral approaches to population policy.
Current demographic trends, the result of reduced infant and child mortality and slowly falling fertility rates, will double the population of Africa by 2036 if left unaddressed, said May. The security implications of this population growth are readily apparent. Rapid population growth has been identified as a factor in increasing resource scarcity and can help lead to conflict. In Sudan, for example, the pressures of overgrazing, desertification, ongoing drought, and escalating competition between pastoralist and agriculturalist communities have contributed to violence. Kenya presents a similar scenario: Rapid and uneven population growth led to land scarcity in the late 1980s, exacerbating latent political and ethnic tensions. The violent conflict that erupted between 1991 and 1993 was fueled in part by natural resource scarcity. More recently, insecure land tenure, shaky property rights, and competition over natural resources have triggered violence across East Africa. Population pressures also play a part, and some argue that demographically-induced land scarcity was at the heart of violence in Kenya earlier this year.
May lamented that far less attention has been paid to population than to humanitarian crises, good governance, and climate change—despite compelling evidence that population growth is likely to negatively impact the chances for peace. Sexual and reproductive health, for example, form 20 percent of the global disease burden, and there is compelling evidence that good reproductive health leads to poverty reduction. He reminds us that demographic issues are inextricably tied to larger development issues, and must be addressed together.
Some countries have successfully reduced fertility rates, May noted. In the 1960s, the Tunisian government introduced a program to reduce fertility rates through increased education for girls, government provision of family planning services, and legal reforms to increase the economic status of rural women and girls. Today, the country boasts a replacement-level fertility rate. Efforts to improve gender equity are highly effective in reducing unsustainable population growth: “It could be argued that the population issue in sub-Saharan Africa is in essence a gender issue,” said May, who argued that “[e]conomic and social development is of course the best contraceptive.”
“The task ahead is huge and difficult, however some concrete results have already been obtained,” said May. He offered a simple suggestion to governments wondering how to craft population policies: “let people, especially women, decide for themselves and…provide them with the means to exert their choices.”
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Population Reference Bureau Releases 2008 World Population Data Sheet
›August 20, 2008 // By Sonia SchmanskiThe Population Reference Bureau (PRB) officially launched its 2008 World Population Data Sheet yesterday at the National Press Club. The 2008 Data Sheet features key population, health, environmental, and economic indicators for more than 200 countries. New in this year’s edition, co-authored by Carl Haub and Mary Mederios Kent, are data on percent of population in urban areas, number of vehicles per 100,000 people, and percent of population with access to improved drinking water.
Several findings highlight the significant health inequalities between wealthy and poor countries. For example, while around 1 in 6,000 women in developed countries dies from pregnancy-related causes, in the 50 least-developed countries, the risk is an astonishing 1 in 22. Because maternal mortality is generally seen as a proxy for the general state of a country’s health care system, these statistics point to alarming systemic health care failings in many of the world’s least-developed countries.
The 2008 World Population Data Sheet also highlights disparities between developed and developing countries in population growth rate trends; as wealthier countries’ populations stagnate or even begin to decline, the populations of the world’s poorest countries continue to grow at a rapid clip. PRB president Bill Butz noted that “[n]early all of the world population growth is now concentrated in the world’s poorer countries,” and that “[e]ven the small amount of overall growth in the wealthier nations will largely result from immigration.” As Kent pointed out at yesterday’s press conference, the United States is the major exception to this trend, because most of its population growth over the next several decades will come from natural increase.Unfortunately, the countries with the least access to improved water sources—and therefore some of the highest rates of diarrheal disease and child malnutrition—have among the world’s fastest-growing populations. For instance, in Ethiopia, which has a total fertility rate of 5.3 births per woman, only 42 percent of the population has access to an improved water source, and in Afghanistan, which has a total fertility rate of 6.8, the figure is a mere 22 percent.
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Access to Contraception Could Reduce Maternal Mortality by One Third, World Bank Reports
›August 14, 2008 // By Sonia SchmanskiFertility rates worldwide have been on the decline for many years, the result of a steady decrease in desired family size. But more often than not, fertility rates have not fallen as quickly as desired family size, as access to contraceptives has not kept pace with increasing demand. Consequently, more than 75 million pregnancies each year are unintended, finds “Fertility Regulation Behaviors and Their Costs: Contraception and Unintended Pregnancies in Africa and Eastern Europe & Central Asia,” a World Bank discussion paper surveying decades of research from Africa, Eastern Europe, and Central Asia. One fifth of these pregnancies end in induced abortion, fully half of which are classified as unsafe, meaning they are not attended by a properly trained health care worker or in an environment that conforms to minimum medical standards.
The costs of unsafe abortion are tremendous, financially and in terms of human lives. Approximately 67,000 women die annually from complications resulting from unsafe abortion, leaving more than 200,000 children motherless. Sexual and reproductive health issues constitute 20 percent of the global disease burden, and produce additional “direct and indirect costs to the individual woman, the woman’s household, the country’s health system and society as a whole.”
In Africa, post-abortion care can consume up to half of obstetrics and gynecology department budgets. The cost of this care is often much higher than the patient’s monthly salary. The authors report that “comprehensive family planning services to prevent unwanted pregnancy and reduce unsafe abortion in Nigeria would cost only a quarter of what is being spent in direct costs to treat post-abortion complications.” This point is taken up by author Margaret E. Greene is the latest issue of FOCUS, ECSP’s series of occasional papers featuring Wilson Center speakers. She writes that “[r]obust, compelling evidence linking good reproductive health to poverty reduction,” as is offered in the World Bank report, will “support efforts to include it in country-level poverty reduction strategies and in the allocation of international poverty reduction funding.”
This situation repeats itself across the globe. In Central Asia and Eastern Europe, induced abortion is “the principal method of birth control,” due to the expense of importing Western contraceptives, the medical community’s stigma against oral contraceptives, and the availability of abortion result. In Russia, government concerns about low fertility led the government to dismantle its sex-education curriculum and to carry out widespread layoffs in the government-controlled offices of contraceptive manufacturers.
Without exception, the case studies in this discussion paper find significant financial benefit to increasing modern contraceptive availability. Inadequate access is “an important barrier,” the authors write, discounting the argument that the contraceptives are there and people simply don’t use them. DHS surveys worldwide find that cost has prohibited contraceptive use for fewer than 2 percent of the estimated 137 million women with an unmet need. Women have decided, it seems, that the costs of childbearing far outweigh those of contraceptives.
“It is imperative,” the authors write, “that policies and programs address the need for contraception globally – for all population groups but with special emphasis on those who are most disadvantaged.” Community insurance schemes to reduce out-of-pocket payments can help accomplish this. Other ideas include increased subsidies for basic health services and adjusted user fee policies. The report also urges expanded and improved provision of contraceptive information and services, as well as improved training for health care providers. The problem is not a lack of good ideas and policies, but a lack of political will.
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Population, Health, Environment in Ethiopia: “Now I know my family is too big”
›July 16, 2008 // By Sonia SchmanskiIn “Life in Abundance,” an article from the latest issue of Sierra magazine, Paul Rauber gives us an inside look at family planning in Ethiopia, speaking with women in urban and rural environments to understand what government support of family planning has meant in practice. The government’s official embrace of family planning is a sharp and welcome shift from the previous dictatorship’s ban on mentioning it, but this endorsement, welcome as it is, doesn’t guarantee funding. Consequently, family planning programming, robust in urban areas, has yet to reach much of the vast rural expanse of Ethiopia. It is also heavily dependent on outside donors and NGOs for funding.
Thanks to one of the highest fertility rates in the world—5.4 children per woman—Ethiopia’s population has quintupled in the last 70 years. It now stands at 77 million, and is projected to double by 2050. Other indicators are equally discouraging: Rauber reports that average life expectancy is 48 years, that one in eight children dies before reaching five years of age, and that half of all children are undernourished.
One group trying to improve these statistics is Pathfinder International, whose integrated population-health-environment program in Ethiopia aims to “boost family planning, healthcare access, and environmental-restoration efforts through improving the lot of women and girls.” Rauber notes that Ethiopian women with at least some secondary education have one-third as many children as women with no or little education. Ethiopia, he says, is ripe for such integrated interventions; two-thirds of women want but lack access to family planning, and only one in 10 rural women uses any form of contraception. Pathfinder’s program, strongly backed by communities, has been successful in enrolling women in literacy classes, testing for HIV, planting mango and avocado trees, and curbing female genital mutilation.
For a look at another integrated PHE program in Ethiopia, see ECSP Director Geoff Dabelko’s photographs of the Berga Wetland Project, which includes conservation activities oriented around the White-Winged Flufftail bird; a small health facility offering basic maternal, children’s, and reproductive health services; and a community school.
Ethiopia has hosted several large PHE events in recent months, demonstrating the country’s enthusiasm for the approach. In November 2007, more than 200 members of the PHE community gathered in Addis Ababa for “Population, Health, and Environment: Integrated Development in East Africa,” a conference sponsored by the Population Reference Bureau and LEM Ethiopia. Rauber’s tour of Ethiopia, which also included substantial birdwatching, was jointly organized by the Sierra Club and the Audubon Society, both participants at the November meeting. Also emerging from this conference, which ECSP helped organize, was the East Africa Population-Health-Environment Network, a group working toward “an Eastern African region where men, women, and children are healthy, the environment is conserved, and livelihoods are secure.” In May of this year, Ethiopia launched its national chapter of the network, the Consortium for Integration of Population, Health, and Environment, in Ambo.
Photo: Health workers in Ethiopia’s Berga valley, where families average seven children. Now, thanks to the Ethiopian Wildlife and Natural History Society’s Berga Wetlands Project, hundreds of local women get contraceptives from health worker Gete Dida, allowing them to limit their family size – and giving the area’s wildlife a chance at survival. Reproduced from Sierraclub.org with permission of the Sierra Club. © 2008 Sierra Club. All rights reserved. -
Jeffrey Sachs’ Memo to the Next U.S. President
›April 22, 2008 // By Wilson Center StaffIn his keynote address at the 5th Annual Unite for Sight International Health Conference, held earlier this month, Jeffrey Sachs argued that world leaders must redouble their efforts to alleviate poverty, protect human and environmental health, and balance economic growth and sustainable development. He advocated many of the same solutions that appear in his new book, Common Wealth: Economics for a Crowded Planet, including increasing investment in sustainable technology research and development; hastening the diffusion of sustainable technologies to the poorer regions of the world; and allocating a smaller percentage of the national budget for military spending and instead achieving the international target of 0.7 percent of GNP for foreign aid.
One part of Sachs’ presentation that was not included in his book was a memo to the next U.S. president, consisting of ten objectives to achieve global sustainability. Included in this list were the following recommendations, which illustrate Sachs’ view that human health, the environment, economic growth, and security are all integrally linked:
- “Stop putting food into the gas tank.” Sachs spoke out against the current U.S. subsidies for converting corn into ethanol. He linked the initiative to the recent global increase in food prices and the resulting turmoil in areas such as Haiti and Burkina Faso.
- Create a global forum for the leaders of dry lands. Sachs argued that it is important for leaders of areas such as Senegal, Mali, Chad, Saudi Arabia, Iran, and California to discuss water scarcity, its impact on livelihoods, and strategies to ensure human security.
- Immediately send a U.S. envoy around the world to back climate change negotiations. Sachs emphasized the need for the United States to step up as a leader on curbing climate change and its environmental and social impacts, rather than stalling international cooperation and progress, as he believes the current administration has done.
- Increase U.S. funding for the UN Population Fund (UNFPA). Sachs disapproved of the U.S. government’s decision to decrease its financial support of the UNFPA, which he argued is instrumental in fueling the voluntary decline of fertility rates in less developed countries. He identified access to contraceptives and reproductive services, the empowerment of girls and women, and the promotion of maternal and child health as crucial strategies for slowing population growth and maintaining resource sustainability.
- Make the Millennium Development Goals (MDGs) the heart of international development policy. Sachs noted that he had heard President Bush make reference to the MDGs only once during his two terms in office. He hoped the new administration’s approach to foreign relations and international aid would put a stronger emphasis on achieving the MDGs, which aim to increase health, stability, and prosperity worldwide.
In a recent nationwide 
