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Dot-Mom // From the Wilson Center
Delivering Solutions: Advancing Dialogue to Improve Maternal Health
“Throughout the 2009-2011 Advancing Dialogue on Maternal Health lecture series, we always heard the same good news: we know how to save the lives of women and girls. But more political will is needed,” said Calyn Ostrowksi, program associate for the Wilson Center’s Global Health Initiative on December 15 for the launch of the series’ culminating report, Delivering Solutions: Advancing Dialogue To Improve Maternal Health.MORE
Joining Ostrowski were co-author Margaret Greene, director of GreeneWorks; Luc de Bernis, senior advisor on maternal health at the UN Population Fund; Tim Thomas, interim director for the Maternal Health Task Force; and Chaacha Mwita, director of communications at the African Population and Health Research Center.
One of the few forums dedicated to maternal health, the series brought together senior-level policymakers, academic researchers, members of the media, and NGO workers from the United States and abroad. The series consisted of 21 separate events, with hundreds of experts sharing their experiences and thousands of participants and stakeholders providing their expertise. The final report captures, analyzes, and synthesizes the strategies and recommendations that emerged from the series.
Promoting Social Change
Unlike other health issues, said Green during her presentation on the findings of Delivering Solutions, the field of maternal health requires a holistic and multi-faceted approach; that is, an approach that looks not only at health systems, but also at underlying social factors. The report divides maternal health into three broad categories: social, economic, and cultural factors; health systems factors; and research/data demands.
Looking first at the social, cultural, and economic issues, Greene highlighted the need to improve nutrition and educational opportunities for young women in developing countries. Policymakers must be convinced that investing in women is not just good for women but good for families and children, she said. The participation of male partners and other male family members is also needed to increase access to maternal health services, such as family planning, and promote gender equality. The report pointed to a number of recommendations to promote male engagement:- Target interventions that educate men about danger signs and pregnancy complications.
- Address pressures that many young married men feel to prove their fertility.
- Inform men about sexual rights and how they relate to the health and wellbeing of their partners.
Health systems and medical resources play an equally pivotal role in reducing maternal mortality as social factors. The report highlights several key areas for strengthening the health system including the expansion of healthcare workers, health finance schemes, technology, and commodity distribution.
One key recommendation is to integrate reproductive health and maternal health supply chains. Four key medicines, oxytocin misoprostol, magnesium sulfate, and manual vacuum aspirators, target the three leading causes of maternal mortality (post-partum hemorrhage, obstructed labor, and unsafe abortion). Efforts to improve the distribution of these commodities should be more widely dispersed in developing countries and supported by community-based interventions. Women in urban slums, for example, face unique challenges that are not being adequately addressed.
Additionally, new technologies should be more creatively and effectively used, in particular the use of mobile phones in rural communities.
Many of the policy recommendations offered by the report, as Greene pointed out, are low-cost and highly effective. Yet three significant challenges remain for the field in general:- Six countries – Afghanistan, Democratic Republic of Congo, Ethiopia, India, Nigeria, and Pakistan – account for over half of the maternal deaths worldwide. The unique problems of each of these countries must be addressed and solved.
- Integration of maternal health with existing health services along with an over-reliance on community health workers can overburden weak infrastructure.
- Unnecessary cesarean births are on the rise as more women deliver in private sector facilities. These births cost 2 to 18 times as much as vaginal births and create unnecessary risks for mothers.
Chaacha Mwita of the African Population and Health Research Center (APHRC), located in Nairobi has seen firsthand the result of an overburdened and inadequate maternal health system in both his personal and professional life. Mwita endorsed the findings of the series report, emphasizing in particular the focus on transportation systems, male involvement, stakeholder dialogue, and education.
Mwita said that collaboration at all levels is the key to improving maternal health. Policymakers must communicate with researchers, who, in turn, must communicate with doctors, nurses, and hospital administrators in the field. The collaborative in-country dialogue series between the Wilson Center and APHRC, he believes, was a highly useful and easily replicable way of encouraging dialogue among relevant stakeholders in the field.
The Big Picture
”Our hope is that we’ve been able to seed discussions,” said Tim Thomas of the Maternal Health Task Force, one of the co-sponsors of the maternal health series. “We hope those seeds will take root and flourish.” Luc de Bernis, senior maternal health advisor of UNFPA, echoed Thomas’ sentiments, emphasizing the need for continued dialogue.
While maternal health has drawn increased international attention, creating political agreement among policymakers is a complex and often difficult process. There has been marked, though uneven, progress in improving maternal health across the globe, but more must be done. The Delivering Solutions report provides a state of the field assessment as well recommendations for existing, easy-to-implement solutions.
Event Resources:Topics: Africa, Dot-Mom, From the Wilson Center, funding, gender, global health, Kenya, maternal health, video -
Ten Billion: UN Updates Population Projections, Assumptions on Peak Growth Shattered
May 12, 2011 // By Schuyler NullMORE
The numbers are up: The latest projections from the UN Population Division estimate that world population will reach 9.3 billion by 2050 – a slight bump up from the previous estimate of 9.1 billion. The most interesting change however is that the UN has extended its projection timeline to 2100, and the picture at the end of the century is of a very different world. As opposed to previous estimates, the world’s population is not expected to stabilize in the 2050s, instead rising past 10.1 billion by the end of the century, using the UN’s medium variant model.
Topics: Afghanistan, Africa, China, demography, development, family planning, India, Iraq, Japan, Korea, Nigeria, population, security, UN, Yemen -
Report: Family Planning and U.S. Foreign Policy
May 10, 2011 // By Wilson Center StaffMOREThe original version of this brief, by Isobel Coleman of the Council on Foreign Relations, is based on the report, Family Planning and U.S. Foreign Policy: Ensuring U.S. Leadership for Healthy Families and Communities and Prosperous, Stable Societies, by Isobel Coleman and Gayle Lemmon.Click here for the interactive version (non-Internet Explorer users only).
U.S. support for international family planning has long been a controversial issue in domestic politics. Conservatives tend to view family planning as code for abortion, even though U.S. law, dating to the 1973 Helms Amendment, prohibits U.S. foreign assistance funds from being used to pay for abortion. Indeed, increased access to international family planning is one of the most effective ways to reduce abortion in developing countries. Investments in international family planning can also significantly improve maternal, infant, and child health. Support for international voluntary family planning advances a wide range of vital U.S. foreign policy interests – including the desire to promote healthier, more prosperous, and secure societies – in a cost-effective manner.
Saving Lives of Mothers and Children
More than half of all women of reproductive age in the developing world, some 600 million women, use a form of modern contraception today, up from only 10 percent of women in 1960. This has contributed to a global decline in the average number of children born to each woman from more than six to just over three. Despite these gains, an estimated 215 million women globally – particularly in sub-Saharan Africa and southern Asia – are sexually active but are not using any contraception, even though they want to avoid pregnancy or delay the birth of their next child. With the world’s population poised to cross the seven billion mark later in 2011, and expected to grow by nearly 80 million people annually for several more decades, global unmet need for family planning is likely to increase.
Studies have shown that contraception could reduce maternal deaths by a third, from approximately 360,000 to 240,000; reduce abortions in developing countries by 70 percent, from 35 million to 11 million; and reduce infant mortality by 16 percent, from 4 million to around 3.4 million.
For a woman in the developing world, the lifetime risk of dying from pregnancy is still one of the greatest threats she will face. In developed countries, 1 out of 4,300 women will lose her life as a consequence of pregnancy, compared to sub-Saharan Africa, where that figure soars to 1 in 31, and Afghanistan, where the lifetime risk of dying from pregnancy is 1 out of 7.
Unsafe abortions are one factor contributing to high maternal death rates. As of 2008, 47,000 abortion-related maternal deaths occur annually, accounting for 13 percent of all maternal deaths. Filling the unmet need for modern family planning would lead to a reduction in mistimed pregnancies and a significant decline in abortions and abortion-related health complications. In 2000 alone, if women who wished to postpone or avoid childbearing had access to contraception, approximately 90 percent of global abortion-related and 20 percent of obstetric-related maternal deaths could have been averted.
Maternal mortality has a devastating and irreversible effect on children and families. Indeed, countries with the highest maternal mortality rates also experience the highest rates of neonatal and childhood mortality. When a mother dies, her surviving newborn’s risk of death increases to 70 percent.
Family planning presents an opportunity to curb maternal and under-five deaths not simply by giving women of all ages the ability to determine their family size, but by enabling women to delay pregnancy until at least age 18 and to space and plan their births. In this way, modern contraceptive methods help women avoid high-risk pregnancies. Studies suggest that short pregnancy intervals (when the pregnancy occurs less than twenty-four months after a live birth) are associated with an increased risk of maternal and under-five mortality. In fact, if all mothers were to wait at least 36 months to conceive again, it is estimated that 1.8 million deaths of children under five could be prevented annually.
Enhancing International Security
While much of the developed world is experiencing population stability or even decline, many countries in the developing world continue to see rapid population growth. Population imbalances have emerged as a serious issue affecting economic opportunity, global security, and environmental stability. Ongoing civil conflicts, radicalism, weak governance, and corruption are endemic problems for many fragile states. While high fertility rates are not the cause of their problems, they do complicate the challenges these countries face in trying to reduce poverty, achieve per capita income growth, provide education and productive opportunities for youth, and address increasing shortages of natural resources.With the world’s population poised to cross the 7 billion mark later in 2011, and expected to grow by nearly 80 million people annually for several more decades, global unmet need for family planning is likely to increase.
Yemen, for example, has the highest rate of unmet need for family planning of any country. Its population has doubled in less than 20 years, and it has the world’s second-youngest population. High fertility – around six children per woman – taxes Yemen’s infrastructure, education and health systems, and environment. In addition, its labor force is growing at a pace much faster than the growth of available jobs, resulting in high youth unemployment. Increasing access to family planning would help improve Yemen’s long-term prospects for achieving per capita growth and stability. Conversely, continued high fertility rates will only deepen Yemen’s current crises.
Many countries experiencing fast population growth – like Yemen – do not have the capacity to harness the potential of their young populations. In these cases, high fertility rates can lead to a vicious cycle of poverty at the community, regional, and national levels. Rapidly growing populations are also more prone to outbreaks of civil conflict and undemocratic governance. Eighty percent of all outbreaks of civil conflict between 1970 and 2007 occurred in countries with very young populations. Demographers have shown that the statistical likelihood of civil conflict consistently decreases as countries’ birth rates decline.
Countries with the highest population growth rates face real resource constraints, particularly arable land and clean water. As of 2010, 40 percent of populations in more than 35 countries have insufficient access to food, with the largest concentration in central and eastern sub-Saharan Africa. Given that many of these food-insecure countries will continue to experience significant population growth in decades ahead, malnutrition will remain a challenge.
Continue reading at the Council on Foreign Relations or download the full report, Family Planning and U.S. Foreign Policy: Ensuring U.S. Leadership for Healthy Families and Communities and Prosperous, Stable Societies.
Isobel Coleman is a senior fellow for U.S. foreign policy; director of the Civil Society, Markets, and Democracy Initiative; and director of the Women and Foreign Policy Program at the Council on Foreign Relations.
Sources: Council on Foreign Relations, Population Action International, Population Reference Bureau, UNFPA, World Health Organization.
Chart Credit: Arranged by Schuyler Null, data from UN Population Division, World Population Prospects, 2010 Revision. -
From the Wilson Center
A New Security Narrative: What’s America’s Story for the 21st Century?
MOREWe rarely had to question our place in the world during World War II or the Cold War when good guys and bad guys were easier to identify. A clear narrative, whether in the form of opposing Hitler or containing the spread of “The Evil Empire,” fueled our sense of global mission. Sure there were disagreements, but the big picture (and the big enemy) loomed large.
Our sense of realities, large and small, begins with the stories that frame our understanding of the events around us. The fall of the USSR took the wind out of the sails of our mythic sense of purpose. We were still “us,” but we now lacked a “them.”
A security narrative often emerges from our collective sense of threat assessment. It’s not only about what we stand for, but also what we stand against. On that fateful day of September 11, 2001, many believed that we had found the enemy that would provide the story lacking from our national security narrative since the fall of the Soviet empire. But an ill-defined foe lacking a nation-state home has only contributed to our post-Cold War drift. When we ask ourselves why we are committing military might in Libya (or Afghanistan, or Iraq), we’re really asking bigger questions. What is our purpose in the world? What is the story that defines our friends and our foes? And what does that story tell us about when to sit back or step up? When to watch or when to act?
The lack of a storyline also gives those who hate us the opportunity to define us as evil. So it becomes ever more urgent to start the conversation and to provide a non-partisan forum for what is bound to be a difficult deliberation. When Jane Harman left Congress to accept the leadership post at the Wilson Center, she brought her sense that toxic partisanship prevents Congress from addressing the biggest questions facing the nation in a productive and nonpartisan manner. Under her leadership, the Wilson Center has begun the “National Conversation” series to tackle the toughest issues.
The recently held inaugural event showed great promise. Two active military officers, Captain Wayne Porter (USN) and Colonel Mark Mykleby (USMC), writing under the pseudonym, “Mr. Y,” provided the framework for the discussion. Their vision for a new U.S. security story was presented in a white paper titled, “A National Strategic Narrative.” Their stated purpose is to provide a framework through which to view policy decisions well into the 21st century.
The encounter was lively and challenging, sometimes provocative, but always civil. I can summarize the immediate outcome by reporting a consensus that a narrative is missing and needed. It was a good start, but the discussion needs to continue until we reach a national consensus and not just one among five panelists and a moderator. I will not go into great detail in recapping the arguments and ideas presented, but will instead offer a contribution from each participant to whet your appetite.
Anne-Marie Slaughter, Princeton professor and former Director of Policy Planning for the U.S. Department of State began the session with a summary of the white paper, describing the changing nature of power and influence:We were never able to control international events but we had a much better possibility during the Cold War when you essentially had a bipolar world with two principal actors than we do in a world of countless state and non-state actors. Nobody controls anything in the 21st century, indeed it’s just not a very good century to be – it’s not a good time to be a control freak. [Laughter] Whether it’s your e-mail or global events it’s sort of the same problems. What you can do is influence outcomes. So we have to start by saying it’s an open system; you can’t control it but you can build up your credible influence.
Brent Scowcroft, National Security Advisor to two U.S. presidents, provided an historical framework for the discussion:I think we’re facing a historical discontinuity. The Treaty of Westphalia recognized the existence of the nation-state system codified it and so on. That was a replacement for the feudal system where our sovereignty was vague, divided between kings and princes and landowners and religious leaders. It created a new system and I think the epitome of the nation-state system was the 20th century. I think that globalization writ large is changing that system and globalization is eroding national borders. The financial crisis of 2008 showed us we’ve got a global economic system, what happened in one country spread immediately around. It also showed we don’t have a global way to deal with a global economic situation. Now, this force of globalization to me the best way to look at it is akin to the force of industrialization 250 years ago. Industrialization really created the modern nation state with a lot more power over its citizens to deal with issues than the earlier Westphalia state system had. And it brought the state together. It made it more powerful. Globalization is reacting the same way but in the opposite direction. It is diluting the power of the nation state to deal with the important things.
Thomas Friedman, Pulitzer-prize winning columnist for The New York Times, described the difference between virtual and real action:Exxon Mobil, they’re not on Facebook, they’re just in your face. [Laughter] Peabody Coal, they don’t have a chatroom. They’re in the cloakroom of the U.S. Congress with bags of money. So if you want to change the world, you gotta get out of Facebook and into somebody’s face whether that’s in the U.S. Congress or Tahrir Square. You’ll say, why I blogged on it. I blogged on it, really? That’s like firing a mortar into the Milky Way Galaxy, okay. [Laughter] There is a faux sense of activism out there that is really dangerous. The world, your world, may be digital but politics is still analog and we’ve kind of gotten away from that. Egypt changed. Yes, Facebook was hugely important in organizing people, but the fundamental change happened because a million people showed up in Tahrir Square.
Steve Clemons, founder of the American Strategy Program at the New America Foundation, added this thought on the essence of globalization:What globalization really is, is the disruption of cartels. What blogging is, individual blogging is saying is, I’m not gonna wait for The New York Times editor to tell me no any more or [laughter] to say yes three weeks from now. You know, it is the disruption of cartels and that is happening in every sector of society.
Robert Kagan, senior fellow with The Brookings Institution and a former State Department Policy Planning Officer, cautioned against rushing to utopian conclusions about the impact of our new levels of interconnectedness:Let me just give you an example of how even something new doesn’t necessarily change things the way we want them to or the way we expect them to. I’m positive by the way that human nature is not new. So you’re kind of dealing with the same beast, and I use the term advisably, as you’ve been dealing with for millennia. Let’s talk about the fact that everyone can communicate with each other on the internet. You know, when people communicate with each other especially across national boundaries sometimes it makes them grow closer. Sometimes it makes them hate each other more. If you read the Internet in China now it’s hyper nationalistic. Now, you can argue that because that’s where the government channel said and because they don’t let anybody else or anything else or you could say the Internet is a great vehicle for the Chinese people to express their hatred of the Japanese people. It certainly is doing that now. So does that mean the Internet is going to bring nations closer and solve problems? Not necessarily.
Representative Keith Ellison (D-MN), talked about the expectations of youth and how demographics will be a key consideration when defining a narrative:The Middle East is on my mind a lot these days, what it means if you have all these societies where 50 percent of the population is under 18 years old? You know this is – this has big implications. I mean, this is a demographic reality that is going to have vast implications for the United States. So one thing is it’s not going away because lots of these people who are 18 years old, their cohort just moves through. You know, they’re going to be there a long time and they have demands, they’re going to have needs, they’re going to have expectations. You mentioned justice. They expect us to act justly. And I, when people talk about anti-Americanism, for me part of what’s going on is unmet expectations not just ‘we don’t like it.’
For this abbreviated summary of the discussion, I give the final cautionary word to Steve Clemons, who had this to say in response to an audience question about how to begin the process of constructing a new narrative:This is a town of risk-averse institutions, a town of inertia, a town of vested interests. It’s not a town that really embraces the notion of how do you pivot very quickly and rapidly in a different direction. So, fundamentally you need to begin putting out narratives like this.
A transcript and video of the event is available from the Wilson Center and additional coverage can also be found right here on The New Security Beat.
John Milewski is the host of Dialogue Radio and Television at the Woodrow Wilson Center and can also be followed on The Huffington Post or Twitter.
Photo Credit: Adapted from “1989 – Berlin, Germany,” courtesy of flickr user MojoBaer.Topics: Afghanistan, demography, foreign policy, From the Wilson Center, Iraq, Libya, Middle East, military, security -
Watch: Jennifer Dabbs Sciubba on Population and National Security
April 28, 2011 // By Schuyler Null“Long-term trends really are what shape the environment in the future,” said Jennifer Dabbs Sciubba in this interview with ECSP. “As we’ve seen recently with…revolution in North Africa, it’s the long-term trends that act together for these things to happen – I like to say demography is not usually the spark for a conflict but it’s the fodder.”MORE
Sciubba is the Mellon Environmental Fellow in the Department of International Studies at Rhodes College. In her new book, The Future Faces of War: Population and National Security, she discusses the importance of demographic trends in relation to security and stability, including age structure, migration, youth bulges, population growth, and urbanization.
One of the most important things to emerge from the book, said Sciubba, is that countries that are growing at very high rates that are overwhelming the capacities of the state (like many in sub-Saharan Africa) really will benefit from family planning efforts that target unmet need.
Afghanistan, for example, “has an extremely young age structure,” Sciubba pointed out. “So if you’re trying to move into a post-conflict reconstruction atmosphere…you absolutely have to take into account population and the fact that it will continue to grow.”
“Even if there are major moves now in terms of reducing fertility, they have decades ahead of this challenge of youth entering the job market,” Sciubba said. “Thousands and thousands more jobs will need to be created every year, so if you have a dollar to spend, that’s a really good place to do it.”
For more on Jennifer Dabbs Sciubba and The Future Faces of War, see her book launch at the Wilson Center with Deputy Under Secretary Kathleen Hicks of the Department of Defense (video) and some of her previous posts on The New Security Beat.Topics: Afghanistan, Africa, demography, family planning, Middle East, military, population, security, video, youth -
Watch: Addressing the National Security Implications of U.S. Oil Dependency
April 27, 2011 // By Schuyler NullBoth the civilian and military sectors have key roles to play in achieving energy security as the United States addresses the national security implications of its oil dependency. Yesterday, the White House hosted a forum with senior officials from both the public and private sector to highlight avenues toward achieving that security. Co-hosts Deputy Energy Secretary Daniel Poneman and Deputy Defense Secretary William Lynn were joined by Woodrow Wilson Center President Jane Harman, John Podesta of the Center for American Progress, and John Deutch of the Massachusetts Institute of Technology.MORE
The panelists discussed ongoing cooperation between the Department of Energy and Department of Defense, and Harman in particular highlighted the power of the military to drive innovation and more efficient production of energy-efficient technologies.
“‘Energy security’…reminds us that important domestic energy developments have international consequences, and important international events have domestic consequences,” said Deutch, pointing out the linked, global nature of energy markets and climate change.
Deputy Secretary Lynn highlighted the tactical tactical benefits of reduced petroleum dependence with the example of a solar panel pilot program being conducted by the Marine Corps in Afghanistan:The regiment selected to try out the solar panels deployed to one of the most violent districts in Helmand province. The operational gains were immediate: Marines ran two patrol bases completely on solar power and cut diesel fuel consumption at a third base by over 90 percent. On one three-week foot patrol, flexible solar panels eliminated battery resupply needs entirely, ending supply drops that previously were required every 48 hours.
Watch the full forum above, and see also the recent National Conversation at the Woodrow Wilson Center that focused on “A New National Security Narrative.” -
Watch: Richard Cincotta on Political Demography and Unrest in the Middle East
March 9, 2011 // By Schuyler Null“Countries that have a high proportion of young people are typically more prone to political violence,” said demographer-in-residence at the Stimson Center, Richard Cincotta, in this interview with ECSP. “That is, not necessarily international war [but] internal conflict, which may take different forms,” including civil and ethnic strife, domestic terrorism, and violent political demonstrations.MORE
The role of unemployed and angry youths in the recent unrest that has swept the Middle East has received a great deal of coverage, but though the region in general is very young, some countries are more so than others.
Tunisia (median age of 29) is actually well into its demographic transition, where fertility declines towards replacement level. “Fertility – the number of children women have in their lifetime – is now lower than it is in the United States,” said Cincotta. As a result, Tunisia’s prospects for achieving a stable, liberal democracy – based on the historical relationship between age structure and political freedoms (see Cincotta’s full post on Tunisia and the two follow-ups for a more complete treatment of that relationship) – are about even.
In contrast, Egypt’s age structure remains young (median age of 24) and Yemen’s (median age of 17) is extremely young. “Those difference are very stark,” said Cincotta, and they play out in the risk of political violence: Tunisia is less likely to experience continuing political violence; Egypt, more so; and Yemen, even more likely.
The relationships between age structure and political violence and the emergence of democratic institutions can be useful in other conflict-prone regions as well. “Afghanistan, Pakistan, Iraq, the Palestinian Authority, most of the central band of sub-Saharan Africa – from Nigeria to the Congo, to Kenya and Ethiopia – we know that these countries are volatile, we’re not always sure why,” said Cincotta. But “age structure gives you a clue, because it tells you something about a lot of barriers that are important to development.”
Sources: UN Population Division.Topics: Afghanistan, Africa, conflict, democracy and governance, demography, development, DRC, Egypt, Ethiopia, Iraq, Kenya, Middle East, Pakistan, Tunisia, video, youth -
QDDR Coverage Wrap-up: Institutional Shifts, Development-as-Security, Women’s Empowerment, and Complex New Threats
February 23, 2011 // By Schuyler NullMORESomewhat lost in the wake of turmoil in the Middle East and the budget battle in Congress has been the State Department’s most aggressive attempt yet to reshape itself for the dynamic foreign policy challenges of the 21st century.
Topics: Afghanistan, development, foreign policy, gender, global health, Iraq, Middle East, military, QDDR, Reading the QDDR, State, youth
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