Showing posts from category MDGs.
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In Uganda, Integrating Population, Health, and Environment to Meet Development Goals
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Fifty years after independence, Uganda has one of the highest population growth rates in the world at 3.3 percent – a rate which puts the country on track to nearly double in population over the next two decades. More than 50 percent of the population is under the age of 18. This large youth cohort will ensure that the country continues to grow for decades to come, even if couples choose – and are able – to have smaller families. And according to the State of Uganda Population Report 2011, “with more than one million people added to the population every year, the quality of [health] service delivery will suffer.”
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Behind the Numbers
Reproductive Health and Population Issues in the MDGs: An Interview With Stan Bernstein
›February 8, 2013 // By Wilson Center StaffStan Bernstein, a retired UNFPA senior policy adviser and former health adviser on the UN Millennium Project, recently attended the Seventh Annual Research Conference on Population, Reproductive Health, and Economic Development in Oslo, Norway. During the conference, Bernstein reflected on the presence of reproductive health and population issues among the Millennium Development Goals (MDGs) and their indicators. He also commented on prospects for including relevant reproductive health and population goals or indicators in the development agenda beyond 2015. Bernstein hailed the role of research from the PopPov network in the past and its potential contributions to future development agendas. He answers some questions for PRB below.
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Setting Development Goals for Population Dynamics and Reproductive Rights
›“I’d like to start by stating emphatically that since addressing global inequality and inequity are our overall principles in revising the MDGs [Millennium Development Goals], we must focus on health inequities to have a meaningful and lasting impact on human development,” said Beth Schlachter of the State Department’s Bureau of Population, Refugees, and Migration, speaking at the Wilson Center on January 9. “And for the most vulnerable – women and girls – that means we must focus on sexual and reproductive health and reproductive rights.” [Video Below]
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Three UN Millennium Development Targets Reached and a Review of the Human Drivers of Climate Change
›“It is plausible that key transitions in human evolutionary history have been driven in large part by climate change,” write Eugene A. Rosa and Thomas Dietz in “Human Drivers of National Greenhouse-Gas Emissions,” a literature review published by Nature Climate Change. “Changes in climate will doubtless be a key force in the future evolution of social systems, including all aspects of social, economic, and political life, while impinging on the health and well-being of the individuals who populate them.” Rosa and Dietz cite numerous studies to argue that nearly every facet of society will be affected by climate change. “The critical point,” they write, “is that population, affluence, technology, and all other drivers act not alone or additively but in a multiplicative fashion.” For example, rapid population growth can lead to an increase in urbanization, which generates “substantial demand for goods and services that can induce emissions in distant places.” They conclude that huge changes must be made in technology and consumption in order to combat the effects of climate change that are being caused by a growing population and an increasingly affluent world.The United Nations’ 2012 Millennium Development Goals Report, released last month in New York City, announces that three of the eight major human development goals have been reached ahead of their 2015 targets. The Millennium Development Goals, set at a conference in 2000, were established to “uphold the principles of human dignity, equality, and equity at a global level.” The 2012 report indicates that the number of people living in extreme poverty has been halved since 1990; the proportion of people in the world without sustainable access to safe drinking water has also been halved; and more than 200 million slum dwellers have “gained access to either improved water sources, improved sanitation facilities, or durable or less crowded housing.” At the report launch, UN Secretary-General Ban Ki-moon noted that “these results represent a tremendous reduction in human suffering and are a clear validation of the approach embodied in the MDGs, but they are not a reason to relax.” Goals that have yet to be achieved include universal primary education; gender equality; reduced child mortality and improved maternal health; reducing rates of diseases such as HIV and malaria; and creating a global partnership for development.
Keenan Dillard is a cadet at the United States Military Academy at West Point and an intern with the Woodrow Wilson Center’s Environmental Change and Security Program. -
Royal Society Launches ‘People and the Planet’ Study
›“This is a time of rapid and multifaceted change in both population and the planet,” said Parfait Eloundou-Enyegue, a member of the U.K. Royal Society’s People and the Planet working group and contributing author to the report of the same name launched at the Wilson Center on June 4. “The question that the report is trying to address is whether we can actually envision a world in which we can sustainably and equitably meet the consumption needs of seven billion people, and the more to come.” [Video Below]The Royal Society is a self-governing fellowship of scientists that fosters research to address pressing social issues and better inform policy on a global scale. Eloundou-Enyegue, also an associate professor of development sociology at Cornell University, was joined by fellow working group member and African Institute for Development Policy Director and Founder Eliya Msiyaphazi Zulu to discuss their assessment of growing population and consumption pressures on global wellbeing.
Current Trends Are Unsustainable
“The current trends of global population growth and material consumption and the concomitant changes in the environment are unsustainable,” said Zulu.
On the population side, “you have changes that are affecting not just the size, the growth of the population, but also changes in family structure, in the population distribution, [and] population movement,” said Eloundou-Enyegue.
On the consumption side, “beyond the increase in consumption itself, there’s also a dramatic rise in aspiration,” he continued. “People are in greater contact and this tends to encourage…an increasing aspiration to mimic or to emulate the consumption standard of the more industrialized countries.”
Limits to Equitable Growth
When measuring consumption, which itself tends to be a misplaced barometer of wellbeing, according to Eloundou-Enyegue, there is a “disproportionate focus on GDP.”
Using GDP growth as a measure of consumption and wellbeing both “misses a lot of the economic production that’s not mediated through the market,” and “counts as positive things that are damaging to the planet,” he said.
The People and the Planet report marks a departure from the traditional consumption framework by asking “about the relevance of growth – is growth what we ought to be after?”
“The report tried to make a distinction between two types of consumption – the consumption of material resources and the consumption of goods and services – that are all relevant to wellbeing but have different implications for the environment,” Eloundou-Enyegue said. “So there is a need to think about how to shift or to favor consumption that is less damaging to the environment.”
Not an “Either-Or” Proposition
There is “a tendency to look at population and consumption when you’re addressing the impact of the environment in an either-or format, as if you had to choose either population as being the main culprit or consumption,” said Eloundou-Enyegue. “The reality is that they all have to be integrated and considered jointly.”
At the same time, there is “a tendency to shy away from population issues when you set development goals because they tend to be controversial,” he said. And yet, said Zulu, “there’s no question about it, the global population growth needs to be slowed down and ultimately stabilized for both people and the planet to flourish.”
The vast majority of future population growth is expected to come from Africa. Based on the United Nation’s medium variant projection, 70 percent of global population growth over the rest of the century will come from the continent.
That projection, however, belies a big assumption: “that the high fertility countries now will follow the same pattern in decline in fertility as the countries that have [already] achieved lower fertility had [in the past],” said Zulu, which “may actually not be the case.”
“You might actually find a situation where fertility might stabilize around three to four children in some of the…least developed countries,” he said, “and if that happens, it means that actually we stand a much, much bigger chance of getting to the high variant [of 15.8 billion by 2100] than we often tend to assume.”
In spite of that dire warning, however, Zulu said that “we should recognize that demography is not destiny, that through…appropriate socioeconomic and health policies and investment, we can actually slow down population growth.”
The report concludes that voluntary and non-coercive “reproductive health and family planning programs are urgently required,” said Zulu. “There is also a need for strong political leadership and financial commitment to make sure that these programs and services reach out to all women around the world who need them.”
Have We Missed the Boat Again?
Part of the urgency from the working group is because, so far, commitments to reproductive health appear to be falling short. It is the international community’s responsibility “to make sure that women have the contraceptives that they need in order to achieve their fertility aspirations,” said Zulu, but some of the most important agenda-setting events in global development over the past 20 years have sidelined population, reproductive health, and family planning.
The Millennium Development Goals, for instance, “tried to stay clear of population,” said Eloundou-Enyegue, even though “all the indicators that I see are either intrinsically demographic or have a strong demographic component.”
“If you think about stratification and the reproduction of inequality and poverty across generations and the role that differential fertility and reproduction plays, there’s no way you can sidestep population,” he continued. “If you’re talking about maternal mortality and child mortality…it doesn’t make sense to set population aside.”
Now, as the international community prepares for the upcoming Rio+20 summit, “there’s been a big struggle to get…consideration of population issues” on the agenda, said Zulu.
“Population is at the peripheral of all those discussions,” said Zulu. When in Nairobi for a preparatory conference earlier this year, Zulu said UNFPA Executive Director Babatunde Osotimehin “told me that he was quite alarmed that there was hardly any mention of population in all those discussions. And he asked me the question, ‘have we missed the boat again?’”
That concern reinforces the main argument of People and the Planet, said Zulu: there is an “urgent need to reduce material consumption of the richest, and increase consumption and healthcare for the poorest 1.3 billion people.”
“We’re talking about having the majority of people in the world being able to flourish, being able to lead decent lives.”
Event Resources:Photo Credit: “Market_Kampala, Uganda,” courtesy of the Hewlett Foundation. -
Africa on the Move: The Role of Political Will and Commitment in Improving Access to Family Planning
›Excerpted below is the adapted abstract, by lead authors Eliya Msiyaphazi Zulu and Violet Murunga. The full report is available for download from the Wilson Center’s Africa Program.
Despite commitments to the program of action for the 1994 International Conference on Population and Development and Millennium Development Goal 5 (focused on maternal and reproductive health), little progress has been made in improving access to family planning and slowing rapid population growth in Africa. Lack of political will has been highlighted among the key factors behind the lackluster performance in addressing these sensitive development issues. However, the situation is changing with some African governments embracing family planning as a key tool for improving child and maternal health, slowing population growth, preserving the environment, and enhancing broader efforts to alleviate poverty.
This study examines factors that have propelled the change in attitudes of some political leaders to champion family planning, assesses how such political will has manifested in different contexts, and explores how political will affects the policy and program environment. Mixed policy analysis methods were employed, including desk review of policy and program documents and stakeholder interviews conducted in Ethiopia, Malawi, and Rwanda – three countries that have made phenomenal progress in increasing contraceptive use in the recent past.
Lessons from this study will help galvanize efforts to improve access to reproductive health services in countries where little progress is being made. The results provide useful insights on the dawn of a new Africa where strategic political leadership is playing an increasingly valuable role in overcoming the continent’s longstanding development shackles. The study shows that political will is mainly changing due to increased availability of evidence showing that high population growth undermines efforts to alleviate poverty and hunger as well as investments in the quality human capital that least development countries desperately need in order to transform their economies.
The high sensitivity about childbearing and suspicions regarding the intentions of western development partners in promoting family planning in order to slow population growth are dissipating as more Africans are opting to have fewer children and demanding family planning. This study points to the need for global development partners to be much more cognizant of the drivers of Africa’s emerging success and focus their development assistance on enhancing, nurturing, and highlighting local leadership traits, capacities, and systems that are producing positive results, as well as support governments that have embraced family planning to ensure that no woman has an unwanted pregnancy due to lack of family planning.
Download the full report from the Wilson Center. -
Family Planning and Results-Based Financing Initiatives
›“Family planning means healthier moms and kids – and it’s good for development too,” said Lindsay Morgan, a senior health analyst at Broad Branch Associates, a healthcare advocacy group. But any number of hurdles can keep women from accessing family planning services. Morgan spoke at a May 21 discussion about results-based financing (RBF) programs, which aim to address hurdles on both the supply and demand sides of the equation in developing countries by incentivizing the provision of a variety of quality services while removing barriers to access for women in need of those services.
Removing Barriers to Providing and Using Family Planning Services
Incentives in RBF programs can come in a variety of forms – like subsidies or fees paid to clinics or vouchers sold to women, said Morgan. In Burundi, for example, under a pilot program rolled out across three provinces in 2006, health facilities receive payments for each patient that uses a modern method of contraception. In 2009, the government and international partners began scaling up the program to a nationwide level. In addition to expanding the program’s geographic reach, the scale-up incorporated new payment criteria to better incentivize quality of care (as opposed to just quantity) and longer-lasting methods of contraception.
Since the RBF pilot began, maternal and child health indicators have improved. The number of children being fully immunized is up, as is contraceptive prevalence, said Morgan. Additionally, those immediate results can lead to a slew of additional benefits down the line. For instance, improving modern contraceptive prevalence is one of the most cost-effective interventions available for reducing maternal death, she said.
In nearby Kenya, the health ministry leads a voucher system across four districts and two Nairobi slums to help some of the country’s poorest women afford maternal healthcare, family planning, and gender-based violence services.
The program is “written into large policy documents [and] strategic pieces,” including Vision 2030, a long-term government-wide strategy document “unveiled in 2008 as a way to reach middle-income country status by 2030,” said Ben Bellows, a reproductive health associate at Population Council Kenya. The government’s emphasis on the voucher program as more than just a health initiative is an acknowledgment of the downstream impact that improved maternal and reproductive health can have on the country’s development, he said.
“An Equity Gap in Family Planning”
However, the fact that the voucher program is needed at all is evidence of “an equity gap in family planning,” Bellows said. Access to family planning services can be significantly skewed depending on a woman’s income level, he said, pointing to a recent article in The Lancet assessing health inequalities in 12 different maternal and child health services across 54 priority Millennium Development Goal countries.
The equity gap reflects “an interesting problem with development,” said Bellows: Though low-income countries are converging with higher income countries, in terms of economic growth rates and income levels “the benefits of growth aren’t being evenly distributed.” The Africa Progress Panel’s annual report, released last month, echoes that point, he said.
“Governments are failing to convert the rising tide of wealth into opportunities for their most marginalized citizens,” the report concludes, and “unequal access to health, education, water and sanitation is reinforcing wider inequalities.”
Kenya’s voucher system is designed to help shrink that gap. Among the poorest of the poor – those benefitting from the system – inequalities are dropping, even if on a broader scale, inequity still exists between poor and wealthy Kenyans. “We’re seeing lower inequalities of service in areas exposed to the voucher,” said Bellows.
“RBF supports progress on a path towards universal health coverage,” said Beverly Johnston, the senior policy advisor at USAID’s Office of Population and Reproductive Health. And within the context of family planning “the whole idea is to level the playing field” so that all contraceptive methods are equally readily available to the women seeking them.
“A Catalyst for Change” in Family Planning
In addition to addressing equal access concerns, RBF programs can serve as “a catalyst for change…to stimulate quality of care and quality of family planning counseling in particular,” said Johnston.
A commonly cited hurdle to better family planning access is social norms that support large family sizes or otherwise limit a woman’s ability to space or limit her pregnancies. Given community health workers’ unique roles within their communities – “often on the front lines…where many of these social taboos and barriers exist,” as Morgan described – simply strengthening their training, and in turn improving the quality of care that women receive, can help counter norms that might otherwise prohibit access to family planning.
As more women receive higher quality care, norms dissipate even further, said Morgan. “There is evidence that [quality of care] is strongly associated with a woman’s decision to choose a method to use, to continue to use it, and to recommend it to others.”
“Rights Are Tantamount”
One trap RBF programs need to be aware of is over-incentivizing expansion of coverage to the detriment of quality or individual women’s concerns about what makes sense for them, said Johnston.
“Rights are tantamount,” she said. In order to ensure that rights are upheld, programs must reflect and be sensitive to local histories and local needs – particularly given the fact that some countries have had “a history of coercive programs and policies.”
Ultimately, “we really look at RBF as just one tool,” said Johnston. “RBF is not for every place and every context,” and neither is family planning’s place in RBF programming.
As one tool of many, RBF programs are gaining prominence as a way to meet MDGs related to maternal and child health. Bellows sees RBF’s importance lasting long past that 2015 deadline, though.
“The high inequity that we witness across many low-income countries, and the ability of targeted mechanisms [like Kenya’s voucher program] to address that, suggest that this may be a kind of generalized solution,” he said. “Obviously it will be context specific in the way in which it is rolled out, but the strategy of incentivizing clients and providers suggests that there’s some sort of globalized solution that could be considered for this widespread challenge.”
Event Resources
Photo Credit: Sean Peoples/Wilson Center. -
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.
