Showing posts from category poverty.
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Accessing Maternal Health Care Services in Urban Slums: What Do We Know?
›“Addressing the needs of urban areas is critical for achievement of maternal health goals,” said John Townsend, vice president of the Reproductive Health Program at the Population Council. “Just because there is a greater density of health services does not mean that there is greater access.”
Townsend moderated a discussion on the challenges to improving access to quality maternal health care in urban slums as part of the 2011 Maternal Health Dialogue Series with speakers Anthony Kolb, urban health advisor at USAID; Catherine Kyobutungi, director of health systems and challenges at the African Population Health Research Center; and Luc de Bernis, senior advisor on maternal health at the United Nations Population Fund (UNFPA). [Video Below]
Mapping Urban Poverty
“Poverty is becoming more of an urban phenomenon every day,” said Kolb. With over 75 percent of the poor in Central Asia and almost half of the poor in Africa and Asia residing in cities and towns by 2020, “urban populations are very important to improving maternal health,” he added.
Collecting accurate data in informal settings such as slums can be very challenging, and there is often a “systematic undercounting of the urban poor,” said Kolb. Data often fails to capture wealth inequality in urban settings, and there is often a lack of attention to the significant variability of conditions between slums.
Kolb also warned about the risk of generalization: “Slums and poverty are not the same.” In practice, there is not a standardized definition of what constitutes a slum across countries, he said. “It is important to look at different countries and cities individually and understand how inequality is different between them.” Slum mapping can help to scope out challenges, allocate resources appropriately, and identify vulnerability patterns that can inform intervention design and approach, he said.
Maternal Health in Nairobi Slums
Addressing the maternal health needs of the nearly 60 percent of urban residents who live in slums or slum-like conditions will be a critical step to improving maternal health indicators of a rapidly urbanizing Kenya, said Kyobtungi.
Only 7.5 percent of women in Kenyan slums had their first antenatal care visit during their first trimester of pregnancy and only 54 percent had more than three antenatal care visits in all – rates significantly lower than those among urban women in non-slum settings.
“In some respects, [the urban poor] are doing better than rural communities, but in other ways they are behind,” said Kyobtungi. But, she said, there are many unique opportunities to improve maternal health in slums: “With these very high densities, you do have advantages; with very small investments, you can reach many more people”
Output-based voucher schemes – in which women pay a small fee for a voucher that entitles them to free, high-quality antenatal care, delivery services, and family planning – have been implemented to help poor, urban women access otherwise expensive services. But poor attitudes towards health care workers, transportation barriers, and high rates of crime still prevent some women from taking advantage of these vouchers, said Kyobtungi.
The majority of maternal health services in slums are provided by the private facilities, though size and quality vary widely. “There is a very high use of skilled attendants at delivery, but the definition of skilled is questionable,” said Kyobtungi
“Without supporting the private sector,” Kyobutungi said, “we cannot address the maternal health challenges within these informal settlements.” Combined with an improved supervision and regulation system, providing private maternal health facilities with training, equipment, and infrastructure could help to improve the quality of services in urban slums, she concluded.
Reducing Health Inequalities
“While we have evidence that health services, on average, may be better in urban areas than in rural areas, this often masks wide disparity within the population,” said de Bernis. “Reducing health inequities between and within countries is a matter of social justice.”
When it comes to family planning, total fertility rates are lower in cities, but “the unmet need…is still extremely important in urban areas,” explained de Bernis. Many poor women in cities, especially those who live in marginalized slum populations, do not have access to quality reproductive health services – a critical element to reducing maternal morbidity and mortality rates.
Economic growth alone, while important to help improve the health status of the poor in urban settings, will not solve these problems, said de Bernis. To reduce health disparities within countries, de Bernis advocated for “appropriate social policies to ensure reasonable fairness in the way benefits are distributed,” including incorporating health in urban planning and development, strengthening the role of primary health care in cities, and putting health equity higher on the agenda of local and national governments.
Event Resources:Source: African Population Research Center, United Nations Population Fund.
Photo Credit: “Work Bound,” courtesy of flickr user Meanest Indian (Meena Kadri). -
Population Growth and its Relation to Poverty, the Environment, and Human Rights
›“Population, Poverty, Environment, and Climate Dynamics in the Developing World,” in the Interdisciplinary Environmental Review, by Jason Bremner, David Lopez-Carr, Laurel Suter, and Jason Davis, attempts to illuminate and clarify the complex relationships between environmental degradation, population dynamics, and poverty. Population growth is a key driver for the degradation of ecosystem services which has a direct impact on livelihoods and human well-being, write the authors, especially for the poor. They argue that “population growth itself, however, remains an insufficient explanation of the relationship between population, ecosystems, and poverty.” While the field has a come a long way since its “original Malthusian roots,” they write, the relationships between these dynamics differ greatly depending on the area in question, and much work remains to be done on the less well-studied ecosystems.In “An End to Population Growth: Why Family Planning Is Key to a Sustainable Future” from the Solutions Journal, Robert Engelman reminds us that population projections are not set in stone and that the widespread belief that population has to reach nine billion before leveling off is wrong. Nor is coercive “population control” necessary, he writes: “Population growth rates and average family size worldwide have fallen by roughly half over the past four decades, as modern contraception has become more accessible and popular.” Unfortunately, there remains a large number of people around the world without access to family planning, the majority of whom live in developing countries. Engelman points out that while the number of people of reproductive age has steadily increased in these countries over the last decade, donor support has declined. He argues that research, courage, and creativity are needed to reverse this situation, but in a world where most of all pregnancies were intended, population growth would slow long before reaching nine billion. -
Overcoming Pakistan’s Demographic Challenges
›Download Reaping the Divided: Overcoming Pakistan’s Demographic Challenges from the Wilson Center. Excerpted below is the introductory essay, “Pakistan’s Demographics: Possibilities, Perils, and Prescriptions,” by Michael Kugelman.
On July 11, 2010, Pakistani Prime Minister Yousaf Raza Gilani delivered a speech in Islamabad to commemorate World Population Day. He announced that in order to highlight the crucial connection between demographics and economic growth, 2011 would be designated “Population Year” in Pakistan. “All hopes of development and economic prosperity would flounder if we as a nation lose the focus and do not keep [the] population issue in the spotlight,” he declared.
Hopefully that spotlight comes with a long shelf life. Pakistan faces acute population challenges. If they are to be overcome, they will need to be illuminated for far more than a year.
Yet, there are exciting opportunities here as well. A long-term approach to managing the challenges presented by Pakistan’s burgeoning population, if accompanied by effective policies and sustained implementation, could spark a monumental transformation: one that enables the country to harness the great promise of a large population that has usually been viewed as a hindrance to prosperity. Indeed, demographers contend that Pakistan’s young, growing, and rapidly urbanizing population can potentially bring great benefits to the country. If birth rates fall substantially, and if young Pakistanis are properly educated and successfully absorbed into the labor force, then the nation could reap a “demographic dividend” that sparks economic growth, boosts social well-being, and promotes the rejuvenation of Pakistan.
The Young and the Rising
Because Pakistan has not conducted a census since 1998, estimating the country’s total population size is a highly inexact science. The Pakistani government lists the current figure at about 175 million people, while the United Nations believes the number is closer to 185 million. However, while the precise figure may be in doubt, the population’s rapid rise is not. Though no longer increasing at the 3 percent-plus rate seen in the 1980s, Pakistan’s population is still growing at a 2 percent pace. According to the UN Population Division’s latest mid-range demographic projections, released in 2009, the population will rise to 335 million by 2050. More than 60 million people are expected to be added in just the next 15 years.
This explosive increase, however, merely represents the best-case scenario, and will prevail only if the country’s fertility rates drop from the current average of about four children per woman to two. Should fertility rates remain constant, the UN estimates the population could exceed 450 million by 2050, with a total population of nearly 300 million as early as 2030.
Pakistan’s population is not only large and growing, but also very young, with a median age of 21. Currently, two-thirds of Pakistanis are less than 30 years old. As a percentage of total population, only Yemen has more people under the age of 24. Additionally, given that more than a third of Pakistanis are now 14 years old or younger, the country’s population promises to remain youthful over the next few decades. In the 2020s, the 15-to-24 age bracket is expected to swell by 20 percent. Pakistan’s under-24 population will still be in the majority come 2030. And as late as 2050, the median age is expected to be only 33.
Pakistan’s demographic profile contrasts with what is happening in much of the rest of the world. Sub-replacement level fertility rates (about two births per woman) prevail not only throughout the developed world, but also across much of Southeast Asia, the Middle East, and Latin America. As one commentator has noted, “the twenty-first century’s hallmark [demographic] trend appears to be a fertility implosion.” South Asia, along with sub-Saharan Africa, is one of the last regional bastions of youthful, rapidly proliferating populations. Yet even within South Asia, Pakistan stands out. Excluding Afghanistan, of all the member states of the South Asian Association for Regional Cooperation – Bangladesh, Bhutan, India, Maldives, Nepal, and Sri Lanka – Pakistan has the highest population growth, birth, and fertility rates; the youngest median age (tied with Nepal); and the largest percentage of people 14 years old or younger.
Continue reading “Pakistan’s Demographics: Possibilities, Perils, and Prescriptions,” or download the full report from the Wilson Center.
Michael Kugelman is a program associate with the Asia Program. -
Integrating Development: A Livelihood Approach to Population, Health, and Environment Programs
›Rural communities in developing countries understand that high population growth rates, poor health, and environmental degradation are connected, said Population Action International’s Roger-Mark De Souza at a recent Wilson Center event. An integrated approach to development – one that combines population, health, and environment (PHE) programs – is a “cost-effective intervention that we can do very easily, that responds to community needs, that will have a huge impact that’s felt within a short period of time,” said De Souza. “This is how we live our lives, this makes sense to us – it’s completely logical,” community participants in PHE projects told him.
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The Continuing Challenges of Integrated Development
›March 20, 2011 // By Schuyler Null“How are we going to feed all these mouths?” asked Bekele Hambissa, director of the Environmental Protection and Development Organization in Addis, on day two of the PHE Ethiopia Consortium general assembly (read about day one here). Environmental resources are directly tied to Ethiopia’s population growth, said Hambissa, during a discussion of balancing efforts to address population growth, environment, and livelihoods. While poverty alleviation is an important goal of population, health, and environment integration (PHE), it must be environmentally sustainable, he said.
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“Better Bang for the Buck”: Blogging From Ethiopia’s Population, Health, and Environment General Assembly
›March 18, 2011 // By Schuyler NullHello from Addis Ababa, where I am blogging from the 5th annual general assembly of the Population, Health, and Environment (PHE) Consortium of Ethiopia (see further coverage here). Along with the Philippines, Ethiopia is the largest PHE programmer in the world, both in terms of number of programs and people affected, and for good reason: The country combines dire need, willing donors, and a great deal of local capacity and will.
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Mapping the Hot Spots of the 2010/11 Food Crisis
›If you’ve taken a trip to the supermarket lately or scanned the headlines you may have noticed something: Food prices are on the rise. Worldwide, food prices are on track to reach their highest point since their peak in 2008. Using data from the Food and Agriculture Organization (FAO), the International Food Policy Research Institute (IFPRI), and the World Bank, the Environmental Working Group (EWG) and ActionAid have collaborated to create an interactive world map called, “Hot Spots in the Emerging Global Food Crisis.”
The focus of the map is to highlight the 52 most at-risk countries where increases in staple food prices could tip the scales of stability. There are three variants of the map to choose from: countries at risk which depend on imported cereals, countries where prices are already increasing (featured above), and countries with vulnerable economies and high rates of hunger.Food prices have become a hot topic of conversation lately for their alleged role in the instability that is rocking the Middle East/North Africa region. But the Middle East is not the only area affected: Besides in Algeria, Tunisia, Morocco, Jordan, and Egypt, food-related riots and protests have also broken out in Mozambique, Bolivia, and India. As the map’s accompanying text puts it, these food riots “feed deeper discontent about economic inequalities and hunger and help give rise to revolutions that can topple governments, as in Tunisia and Egypt.”
Scrolling over a country reveals more information, like, for example, the specific percentage increases in the price of wheat or rice over the past year (wheat prices have risen 15.9 percent in China vs. 54 percent in Kyrgyzstan) or the amounts of corn, soybean, and wheat annually imported and exported (Afghanistan exported 908 million metric tons of wheat in 2010 while Egypt imported 4,978).
Users can also click on vulnerable countries to see how many people are malnourished and their per capita income per day. In the Democratic Republic of the Congo, for example, an estimated 42 million people were undernourished between 2005 and 2007, and the average person lives on $0.28 per day. According to EWG and ActionAid, the total number of people living in extreme poverty rose by 25 million in 2008 during the last global food crisis. Since June 2010, the start of the current upward trend in prices, the World Bank estimates that 44 million people have fallen into extreme poverty.
One recommendation from EWG and ActionAid for developed countries and the United States in particular: Stop looking to biofuels as an energy option. In their view, “spending scarce taxpayer dollars to shift crops from food to biofuels at the expense of hungry people and already stressed resources like soil, water, and air is unsustainable.”
Image Credit: Map courtesy of the Environmental Working Group and ActionAid, and Food Price Index and Food Commodity Indices, extracted from Global Food Price Monitor, January 2011, courtesy of the Food and Agriculture Organization.
Sources: ActionAid International, BBC News, CNN, the Environmental Working Group, The European Union Times, Time, Voice of America, World Bank. -
Rural Poverty: The Bottom One Billion
›March 10, 2011 // By Hannah MarquseeThere are currently 1.4 billion people in the world living in extreme poverty, and 70 percent of them – about one billion people – live in rural areas, according to the Rural Poverty Report 2011, published recently by the International Fund for Agricultural Development (IFAD). The two regions most affected by rural poverty are South Asia, home to half of the world’s rural poor, and sub-Saharan Africa, where, team leader Ted Heinemann points in the accompanying trailer, “the number of rural people living in extreme poverty is actually increasing and the proportion is a very high 62 percent.”
The State of Rural Poverty
While the number of rural poor in the world has actually declined sharply since the late 1980s, the decline is due almost entirely to gains made in East and Southeast Asia, particularly China. Despite these gains, rural poverty remains a stubborn challenge in South Asia, Southeast Asia, and sub-Saharan Africa: three-quarters of the poor in these areas are rural, and “the proportion is barely declining, despite urbanization,” says the report. In the Middle East, North Africa, Latin America, and the Caribbean, the majority of the extremely poor live in urban areas.
The number of undernourished people in the world has also declined slightly from its historic high of 2009, after a doubling of international food prices between 2006 and 2008 left a staggering one billion hungry. (However, food prices recently passed 2008’s historic high point, and some have argued they may have been a factor in the recent uprisings in the Middle East and North Africa.) From a high of one billion, the world’s hungry have since decreased to 925 million, a figure that the UN Food and Agriculture Organization nonetheless calls “unacceptably high.” The current rate of decline is far from meeting the MDG target of halving the number of people who suffer from hunger by 2015, says the IFAD report, and with continuing population growth and resource and energy scarcities, they predict little change in the number of hungry worldwide.
Meeting Rising Demand, Sustainably
“Feeding a global population of just over 9 billion in 2050 will require a 70 percent increase in global food production,” says the report. To do this, the report calls for more sustainable agricultural intensification driven by small-holder farmers. “Small-holder agriculture…can offer rural people a route out of poverty just as they can offer the world a solution to meeting its future food needs,” says IFAD President Kanayo Nwanze, in the trailer.
Increasing global agricultural production must be done “in the context of a weakened natural resource base, energy scarcities, and climate change,” says the report. This will require more efficient use of water, less waste, and a shift towards more resilient crops. It will also require linking scientific knowledge with local farmer knowledge in order to create a sustainable, context-specific approach. The report recommends a sustainable small-holder agriculture system that gives rural people incentives to protect their environment, while helping them adapt to climate change.
Providing Economic Opportunities
Since 80 percent of rural households “farm to some extent,” agricultural intensification will be “a primary engine of rural growth and poverty reduction,” says IFAD, especially in the poorest countries. In a statement to announce the launch of the report, Nwanze said, “rather than romanticizing the concept of lifting poor rural women, men, and children above the poverty line, like a plague that can be eradicated by charity and humanitarian gestures, we are advocating the proactive creation of vibrant rural economies.”
But lifting the one billion rural people out of poverty is not just about stimulating rural farm economies, says the report; it also means creating opportunities in the rural non-farm economy to minimize the risk of economic shocks that drive people into poverty in the first place. While agriculture remains central to rural economies, urbanization, globalization, improved information systems, and growing investments in renewable energy all offer opportunities for growth in rural, non-farm economies. Helping rural people take advantage of these opportunities will require multiple investments, says the report: in education to improve the capabilities of rural youth; in infrastructure and social services to make rural areas better places to live; and in governance mechanisms and collective organizing so that rural people can better represent their own interests.
“Robust action is required now to address the many factors that perpetuate the marginalization of rural economies,” says IFAD. “Above all, this action needs to turn rural areas from backwaters into places where the youth of today will want to live and will be able to fulfill their aspirations.”
Sources: AFP, FAO, IFAD, United Nations, The Washington Post.
Video Credit: “Rural Poverty Report 2011,” courtesy of YouTube user IFADTV.
