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Linking Governance and Positive Maternal Health Outcomes in Africa
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Sub-Saharan Africa is perhaps the riskiest place for a woman to give birth. According to the United Nations Population Fund (UNFPA), African women comprise approximately 56 percent of the maternal deaths and 91 percent of HIV-related maternal deaths worldwide every year. In order to bring life into this world, women in Africa literally must put their own lives on the line.
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Aqueduct Water Risk Atlas Shows Detailed View of Global Water Vulnerability
›As world population pushes towards nine billion by mid-century and millions are elevated to the global middle class every year, demand for water continues to grow as well. More people need more water for drinking and household use, but also for agriculture, mining, energy, and industry. With water often cited as a limit to growth and potential crisis point, the World Resources Institute has released the Aqueduct Water Risk Atlas, which details various types of water stress around the world in impressively detailed fashion.
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Counting the World: UNFPA Highlights the Challenges of Census-Taking
›The United Nations biannual population projections are some of the most (if not the most) widely used numbers in demography. Researchers and policymakers alike rely on the figures to plan for present and future challenges. But few consider the story behind the statistics. Where does the data come from? The United Nations Population Fund (UNFPA) recently released a short documentary on conducting censuses in challenging environments, with a spotlight on Indonesia, Chad, the Palestinian Territories, Belarus, and Bolivia.
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Regulating the Resource Curse: U.S. Adopts International Transparency Rules for Oil Industry
›It’s not often that a change in accounting rules could reduce the probability of war. But that’s exactly what happened at the U.S. Securities and Exchange Commission (SEC) last month.
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Jill Hagey, Behind the Numbers
Sahel Drought: Putting Malnutrition in the News
›The original version of this article, by Jill Hagey, appeared on the Population Reference Bureau’s Behind the Numbers blog.
Over the past few months, the Sahel drought has sparked attention of news media and concerned citizens around the world. Throughout this media blitz, I have been struck by the sharp contrast between this coverage and how the devastating effects of malnutrition are usually portrayed. Malnutrition is often overlooked in favor of more “newsworthy” diseases, and it takes a crisis to focus our attention on this public health issue. Yet an emergency such as this drought – affecting more than 18 million people, including nearly 2 million children – is difficult to ignore.
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Quality and Quanitity: The State of the World’s Midwifery in 2011
›Each year, 350,000 women die while pregnant or giving birth, as many as two million newborns die within the first 24 hours of life, and there are 2.6 million stillbirths. Sadly, the majority of these deaths could be prevented if poor and marginalized women in developing countries had access to adequate health facilities and qualified health professionals. In fact, according to the new UNFPA report, State of the World’s Midwifery 2011: Delivering Health, Saving Lives, just doubling the current number of midwives in the 58 countries highlighted in the report could avert 21 percent of maternal, fetal, and newborn deaths.Launched last week, the report is the first of its kind, using new data from 58 low-income countries with high burdens of maternal and neonatal mortality to highlight the challenges and opportunities for developing an effective midwifery workforce.
“Developing quality midwifery services should be an essential component of all strategies aimed at improving maternal and newborn health,” write the authors of the report. Qualified midwives ensure a continuum of essential care throughout pregnancy and birth, and midwives can help facilitate referrals of mothers and newborns to hospitals or specialists when needed:Unless an additional 112,000 midwives are trained, deployed, and retained in supportive environments, 38 of 58 countries surveyed might not met their target to achieve 95 per cent coverage of births by skilled attendants by 2015, as required by Millennium Development Goal 5.
There is a total shortage of 350,000 skilled midwives globally, with some countries, like Chad and Haiti, needing a tenfold increase to match demand, according to the report. But quantity isn’t the only issue; there has also been an insufficient focus on quality of care. Additionally, most countries do not have the capacity to accurately measure the number of practicing midwives, and national policies focusing on maternal and newborn health services often do not view midwifery services as a priority.
To help overcome these challenges, the report outlines a number of “bold steps” to be taken by governments, regulatory bodies, schools, professional associations, NGOs, and donor agencies in order to maximize the impact of investments, improve mutual accountability, and strengthen the midwifery workforce and services. Of course, the needs of each country are unique, and the report ends with individual country profiles that highlight country-specific maternal and neonatal health indicators.
While this report does much to highlight the critical importance of midwives in promoting the health and survival of mothers and newborns, real impact will only come when governments, communities, civil society, and development partners work together to implement these recommendations.
Sources: UNFPA.
Video Credit: UNFPA. -
World Bank Pipeline Project in Chad Reveals Development Challenges
›This scholar spotlight was originally featured in the Wilson Center’s Centerpoint, February 2011.
In 2000, the governments of Chad and Cameroon teamed up with a three-company oil consortium, with the help of a World Bank loan, to begin building an oil pipeline. By 2003, oil revenues were flowing. This multi-billion dollar pipeline project, which transports oil from Chad through a 640-mile underground pipeline in neighboring Cameroon, is one of Africa’s largest public-private development projects.“Unfortunately, the project fell short on its social and development-oriented objectives,” said Wilson Center Fellow Lori Leonard.
One of the World Bank’s conditions on granting the loan was compensation for the involuntary resettlement this project would cause. However, Leonard said, the World Bank failed to understand, or take into account, social norms around land use and property relations.
“The compensation plan introduced the idea of private property but there was no institutional or legal framework for it,” she said. “This led to a flood of disputes over land and created breaks in the social safety net and societal fabric in Chad.” Uprooting people led to unprecedented problems, from the loss of land and livelihoods to disputes over compensation payments.
The reality was that in Chad, one of the world’s poorest countries, about a quarter-million people were affected. “People in the oilfield region, like people everywhere, are deeply attached to the place where they live – tied to their land,” Leonard said. Suddenly, their property became monetized. “They were asked to think differently about crops, trees, kitchen gardens, everyday objects,” as everything was given a monetary value.
But all the land was populated so there was nowhere to move to and no other trade or skill to easily adopt. “The pipeline project did not create a local economy, that could absorb people who became land poor,” she said.
The World Bank, which withdrew from the project in 2008 when Chad paid off the loan, accused Chad of misspending oil revenues, but that is just part of the story, said Leonard. The problem is not purely economic. “The economy is not outside of society,” Leonard said. “[This project] put a market value on everyday objects and that reshapes societal relations. And it raises the ethical question: ‘How do I live now?’”
In Chad, a largely agrarian economy, large parcels of land became oil fields, wells, and pumping and collection stations.
“Fields were taken or divided up into small fragments and the people wonder what to do next,” said Leonard. “Fertility rates are high and each successive generation will have to divide up [smaller and smaller amounts of] land. And there is already incredible pressure on the land now. The soil is poor but there is not enough [viable land] to leave land fallow.”
Leonard, who teaches at the Bloomberg School of Public Health at Johns Hopkins University, first came to Chad as a Peace Corps volunteer during the post-civil war reconstruction period in the late 1980s.
“From the time of independence, oil was the promise of the future,” she said. “The lessons the World Bank learned do not inspire confidence that it would be different the next time around. We need a fundamental shift in this development model.”
Dana Steinberg is the editor of the Wilson Center’s Centerpoint.
Photo Credit: “Chad-Cameroon Petroleum Pipeline Development Project,” courtesy of the World Bank.
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