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The Year Ahead in Political Demography: Top Issues to Watch
June 8, 2012 // By Elizabeth Leahy MadsenMORE2011 and the first half of 2012 have been a remarkable period for political demography, with theories about the relationships between age structure and governance validated in real time by the events of the Arab Spring. Although such game-changers are rarely predictable, the year ahead promises to be eventful as well, with new demographic research and major policy initiatives on the horizon. Below are brief assessments of some of the top issues to watch between now and next summer.
1. The Evolving Story of the Arab Spring
The Arab Spring was anticipated by few observers, but for a handful of political demographers it was a watershed of sorts. As readers of this blog know, political demography research shows that countries with very young age structures are prone both to higher incidence of civil conflict and – most relevant to the outcomes of the Arab Spring – to undemocratic governance. This nuance escaped many observers of the region’s drama. Violence and conflict erupted not from raging citizens in the streets but from military and militia forces unleashed by autocrats unwilling to cede their grip on power. Young people, and their fellow protestors of all ages, were acting as a force for positive change in their demonstrations against corrupt and unrepresentative leadership. The difference in outcomes across the region, according to Richard Cincotta, can be attributed to the fact that as age structures mature, elites become less willing to trade their political freedoms to autocratic leaders in exchange for the promise of security and stability.
When considered with this important distinction in mind, the initial events following the uprising in Tunisia that quickly spread across the region played out in a neatly linear fashion. Among the five countries where revolt took root, those with the earliest success in ousting autocratic leaders also had the most mature age structures and the least youthful populations.
In Tunisia, with a median population age of 29, one month passed between a fruit seller’s self-immolation and Zine El Abedine Ben Ali’s flight to exile. In Egypt and Libya, where median age is close to 25 years (identified by Cincotta as a threshold when countries are at least 50 percent likely to be democratic), Hosni Mubarak and Moammar Gaddafi took three weeks and eight months, respectively, to lose their titles. Ali Abdullah Saleh in Yemen (median age 17), took one year to be convinced to formally resign, while in Syria (median age 21), the 15-month uprising continues to be brutally repressed by Bashar Assad’s forces.
Of course, overthrowing a dictator, while inspiring and liberating to those whose rights have been repressed, is only the first step in achieving democracy. In the coming year, the countries that have already taken steps toward solidifying regime change will face continued tests as internal tensions surface. Even in Tunisia, recent clashes signal that political divisions and economic uncertainty have not been resolved. With potentially divisive elections ahead in Egypt and Libya, a holdover from the Saleh regime leading Yemen, and Syria’s fate unknown, the coming year should offer political demographers further evidence of the soundness of the age structure and democracy thesis.
2. New Commitments to Family Planning
Reproductive health and demography go hand-in-hand, and two milestones for family planning advocates are fast approaching: the 20th anniversary of the 1994 International Conference on Population and Development in Cairo, and the 2015 endpoint of the Millennium Development Goals.
These historic commitments by governments will be joined by a major initiative to generate new funding and political will this summer at an international family planning summit in London on July 11. The summit will be co-hosted by the Bill and Melinda Gates Foundation (Melinda made an impassioned TEDxChange speech in support of the issue in April), and the UK’s Department for International Development, for whom family planning is a priority in efforts to reduce maternal and child mortality.
Details of the summit have yet to be finalized and publicly released, but financial commitments from donors and developing countries are anticipated toward meeting a new and ambitious goal of generating $4 billion to fund contraceptives for 120 million women in developing countries by 2020. Assuming these are new users, rather than those who would be expected by projecting recent growth in contraceptive use forward, this would represent more than half of the estimated 215 million women with an unmet need for family planning.
Why does new family planning funding matter for political demography? Rates of contraceptive use are lowest and fertility highest in countries with youthful age structures. Such population dynamics exacerbate the challenges governments face in providing education, health, and basic infrastructure services, as well as supporting an economic climate conducive to industry diversification and job creation. In turn, the likelihood of civil conflict and undemocratic governance is higher in such countries.
While policies that recognize the benefits of family planning may be solid, funding and implementation often fall woefully short. In the least developed countries, less than one-third of reproductive-age women are using any contraception, and the rate has grown by just 0.4 percentage points annually over the past decade. Meanwhile, funding from all sources is less than half the amount required to meet unmet need. If the July summit motivates a new groundswell of financial support, 2012 could incite major strides toward improvements in individual health and well-being as well as demographic momentum in the remaining high-fertility countries.
3. Demographic Diversity in Sub-Saharan Africa
The current era of global demographic diversity has been distinguished by both record-low fertility rates in parts of Europe and eastern Asia and persistently high fertility across most of western, central, and eastern Africa. More than one-quarter of women in sub-Saharan Africa would like to postpone or avoid pregnancy, but are not using contraception, demonstrating a large unmet need for family planning.
The U.S. government-funded Demographic and Health Survey (DHS) program is the largest single source for detailed data on health status and behavior in high-fertility developing countries, and in turn informs estimates and projections of demographic trends. Recently, DHS reports have been released showing that contraceptive use over the past five years is growing much faster than the regional average in Ethiopia, Malawi, and Rwanda. In turn, fertility rates have dropped, ranging from a relatively modest 0.3 children per woman in Malawi and an unprecedented 1.5 children per woman in Rwanda.
These findings suggest that the pattern of demographic stagnation in sub-Saharan Africa may be shifting, perhaps due to governments’ and donors’ investments in family planning. However, newer survey results for Mozambique, Uganda, and Zimbabwe present a more mixed picture, with modest gains in contraceptive use in Uganda, offset by declines in the other two countries.Click here for the interactive version (non-Internet Explorer users only).
Additional recent survey results show that use of modern contraceptive methods has barely increased in Senegal (from 10 percent in 2005 to 12 percent in 2010-11). And while modern contraceptive use increased in the Republic of Congo from 13 percent in 2005 to 20 percent currently, fertility also rose slightly, from 4.8 to 5.1 children per woman.
Approximately 10 countries in sub-Saharan Africa are slated for DHS fieldwork this year, including one of the continent’s giants, the Democratic Republic of the Congo, and several of the highest-fertility countries in the region. (Outside of sub-Saharan Africa, the demographic heavyweights in this year’s group of DHS reports are Bangladesh, Indonesia, and Pakistan.)
The upcoming surveys will provide greater clarity about whether the promising signs of family planning adoption and the potential for progress through the demographic transition in Ethiopia, Malawi, and Rwanda are initiating widespread change across the continent, or whether the need for commitments such as those generated by the London summit is even stronger.
4. New Population Projections
DHS reports are critical inputs for the world’s most comprehensive and readily accessible set of demographic data, the UN Population Division’s World Population Prospects. This database is fully updated and revised biannually, in large part due to the steady stream of newly available estimates from the DHS and related sources, such as national censuses. The next revision of World Population Prospects, based on estimates for mid-year 2012, is expected to be published in spring 2013.
The previous revision of World Population Prospects was notable for its methodological overhaul. In addition to extending the projections until 2100, the Population Division shifted to a probabilistic technique (as opposed to assuming convergence at a single fertility rate of 1.85 children per woman) that generates 100,000 possible fertility trajectories for each country and selects the median as the medium fertility variant, commonly cited as the most likely projection. Still, the basic parameters remain the same: With fertility rates the strongest driver of population projections, low, medium, and high fertility variants are constructed around the assumption that countries will converge towards replacement level fertility, around 2.1 children per woman.
In some cases, this results in projections that are vastly at odds with recent trends. For example, in Japan, fertility has fallen by 38 percent, from replacement level in the early 1970s to 1.3 children per woman in 2010, but the UN projects it to immediately reverse course and begin rising to 1.8 by mid-century. If the projection holds, Japan’s population will decline relatively modestly, from 127 million to 109 million. But if fertility stays constant at current levels, the population will fall below 100 million. For low-fertility countries like Japan, all UN scenarios assume constant or rebounding fertility rates, even though continued decline may be a plausible outcome in some cases.
When next year’s projections are released, a cluster of media articles will report the projected world population for 2050. In last year’s revision, the medium fertility variant resulted in a projection of 9.3 billion, an increase from the 9.1 billion projected two years earlier based on higher projected fertility in the future. Such reports often overlook the range of population totals possible depending on fertility paths: If the global fertility rate varies by 0.5 children per woman in either direction, the total population could be more than one billion higher or lower in 2050, with an even wider range possible by 2100.
Most of the projected growth in world population, and its potential range, will be driven by the high-fertility countries concentrated in sub-Saharan Africa. Population projections for these countries vary tremendously based on fertility scenarios informed by the recent DHS results described above.
In Nigeria, Africa’s most populous country, fertility has fallen over the past 40 years, but by a gradual 15 percent. The UN projects it to drop more than twice as fast, by more than two children per woman (39 percent), in the next four decades. In any scenario, Nigeria is on track for rapid population growth, but the potential range based on fertility outcomes is wide. If fertility declines as projected in the medium variant, the country would grow from 158 million to 390 million. And although unlikely, the constant fertility projection of 504 million Nigerians in 2050 should be kept in mind given the slow pace of fertility decline to date.
Population projections are highly wonky, but their careful production and regular revision are essential for accurate planning of economic and social needs in countries around the world. While governments with dedicated census agencies, such as those in the U.S., Japan, or India, rely on internally-generated estimates, the UN projections serve as the primary indication of population trends in countries with spottier data coverage and have tremendous utility in gauging future needs for infrastructure, housing, health care across the life cycle, education, jobs, and other investments.
By no means is this an exhaustive list of factors that will affect political demography research and policy over the coming year. Other events to watch for include the Rio+20 conference on sustainable development in June, where the priority issues of jobs, energy, infrastructure, and resources will be shaped by demographic trends, and continued attention to prospects for the demographic dividend in Africa. Political demography is inherently cross-disciplinary, and the field’s researchers and practitioners will be engaged on multiple fronts in the year ahead.
Elizabeth Leahy Madsen is a consultant on political demography for the Wilson Center’s Environmental Change and Security Program and senior technical advisor at Futures Group.
Sources: Al Jazeera, Bongaarts (2008), Cincotta (2008), Cincotta (2012), Cincotta and Leahy (2006), Grist, Guttmacher Institute, MEASURE DHS, The New York Times, NPR, Population Reference Bureau, UN Population Division, The Washington Post.
Image Credit: “The Face of a Tyrant,” courtesy of flickr user freestylee (Michael Thompson); video courtesy of TED; chart created by Schuyler Null, data from UN Population Division.Topics: Africa, democracy and governance, demography, development, Egypt, family planning, foreign policy, global health, Japan, Libya, Middle East, population, security, Syria, Tunisia, UN, video, Yemen, youth -
Dot-Mom
Adenike Esiet: Building Support for Improving Adolescent Sexual and Reproductive Health in Nigeria
MORE“In Nigeria, young people under the age of 25 are driving the HIV epidemic…and that’s been the opening place for people to begin to say, ‘let’s address the issues of young people’s sexual and reproductive health,’” said Adenike Esiet, executive director of Action Health Incorporated in Lagos, during an interview with ECSP.
On any number of health indicators, girls suffer disproportionately. “For every one boy in the age bracket of 10 to 24 who is HIV positive, there are three girls who are HIV positive,” Esiet said. “Over 60 percent of cases of complications from unsafe abortion reported in Nigerian hospitals are amongst adolescent girls. In fact in literature, 10-15 years ago, this was described as ‘a schoolgirl’s problem’…and it’s still an ongoing problem.” She added: “And for girls too, the issue of sexual violence is huge. It goes largely unreported but it’s occurring at epidemic levels.”
Esiet spoke on an adolescent health panel during the April 25 “Nigeria Beyond the Headlines” event at the Wilson Center. Progress is slow on these issues, in large part because “there’s a whole lot of silence about acknowledging young people’s sexuality,” she said.
Adults “want to believe [adolescents] shouldn’t be sexually active.” But turning a blind eye to adolescent sexuality can mean that efforts “to provide access to education or services is hugely resisted by practitioners who should be doing this.”
Action Health works to fill the gap that emerges. “Our work covers advocacy, community outreach, and service provision for young people,” said Esiet.
“Our primary entry road in to work with young people is creating access to sexuality education and youth friendly services. And in the course of trying to do that, we have to do a whole lot of advocacy with government and also with ministries or education and ministries of health and youth development.”
The group has worked with government officials and agencies to establish a nationwide HIV education curriculum and paired with local healthcare providers to increase access to “youth-friendly” sexual and reproductive health services. Funding shortages and insufficient resources have hampered the curriculum’s success, though, and the pervasive attitude against youth sexuality has limited the reach of services, she said. Ultimately, “there are a whole range of issues that truly need to be addressed” for outreach efforts to be successful.
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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 -
From the Wilson Center
Climate Change, Uncertainty, and Conflict in the Niger River Basin
MORENew research on the Niger River Basin finds that the effects of climate change in the region are pervasive and that “latent conflict” between groups – disagreements and disputes over damage to farmland and restricted access to water, but not physical violence – is common.
“You’ve got vulnerable people, vulnerable households, vulnerable communities living within…fragile systems – governance systems [and] environmental systems,” said Phil Vernon, International Alert’s director of programs for Africa and peacebuilding issues, at “Climate Change, Water, and Conflict in the Niger River Basin,” an event hosted by the Wilson Center on November 17. [Video Below]
Together with his colleagues Lulsegged Abebe and Marisa Goulden of the University of Anglia, Vernon examined how communities in Mali, Nigeria, and Niger have been impacted by climate change, how they have adapted to those impacts, and whether these changes spurred conflict.
Competition Over Dwindling Resources
Climate change destabilizes communities by adding uncertainty and stress, Vernon said, and when a community is already vulnerable, the impacts of those uncertainties and stresses are amplified and the potential for conflict is greater. In every community examined in the study, climate-induced vulnerability led to some kind of conflict. More often than not, however, that conflict took the form of disagreements, or “latent conflict,” rather than violent conflict – a reason for optimism in the face of dire predictions that an era of climate wars is upon us.
Throughout the basin, river flows and rainfall have been decreasing since the 1970s, said Goulden, creating tension between two of the major communities living in the basin – farmers and pastoralists. Pastoralists are forced to travel farther to bring their herds to water, while farmers are expanding their cropland to feed growing populations, reducing the pathways available to herders and their livestock.
Unfortunately, poor policy decisions have made tensions worse in some places. In Lokoja, Nigeria, for example, the government began dredging the Niger River in 2009 to improve commercial shipping. Officials said the dredging would reduce flooding, but in 2010, farmers suffered immensely from floods. The government’s false promises increased the farmers’ vulnerability, said Goulden, because, expecting to be protected from flooding, they were not adequately prepared, making the damage worse.
As a result, farmers are now building homes and developing cropland further away from the river, reducing land available to pastoralists and increasing the potential for conflict between the two communities.
Increased Resilience Is a “No-Brainer”
Climate in the Niger River Basin is marked by a high degree of variability – rainfall, river flows, and temperature already fluctuate a great deal and could become even more variable in the future, said Goulden.
That uncertainty has important implications for how people think about responding to climate change, said Abebe. “Development and adaptation policies must be flexible enough to cope with extreme variability both in the wetter and the dry conditions in the Niger River Basin,” he said.
Boosting resilience will be key to ensuring that vulnerable communities have the flexibility they need to respond to future crises, Vernon said.
“If the interaction of stress and vulnerability is the problem…it’s somewhat of a no-brainer that increased resilience is part of the answer,” said Vernon. And decisions on how to increase resilience “should be made at the lowest appropriate level…from high policy down to household and individual decisions.”
Different People, Different Levels of Resilience
Vernon’s emphasis on making decisions at the “lowest appropriate level” reflects the reality that various communities – and individual community members – experience climate change in different ways. Fostering adaptation strategies that take these variations into consideration will be an essential strategy for avoiding climate-driven conflict in the future.
In Mali, the Niger River flooded downstream of the Selingué Dam in 2001 and 2010, and in each case, researchers found divergent responses to the crises.
In the lead-up to the 2001 flood, dam operators had been intentionally keeping reservoir levels high in anticipation of increased demand for hydroelectric power during an upcoming soccer championship match. When heavy rains hit the area, though, the operators were forced to release huge amounts of water over a short period of time, causing massive flooding downstream.
In the flood’s aftermath, downstream farmers were able to successfully sue the power company for their losses, but downstream pastoralists had no comparable option. The pastoralists were therefore more vulnerable to the flood’s long-term impacts.
Responses differed within communities as well, often breaking down along gender lines. In 2010, when floods hit Mali again, men “were trying to help people move away from the flood water, and then afterward with rebuilding of homes,” said Goulden, “whilst women are concerned with finding shelter, cooking, and caring for the sick, elderly, and children.”
No “Massive Risk of Violence” in the Near Future
Policymakers are left with an urgent crisis – climate change – and a solution that is inherently time-intensive: building resilience in vulnerable communities down to the individual level, said Vernon.
“There is a risk of undermining the elements of resilience which exist already in responding too rapidly and too urgently based on the anxieties we have to the problem of climate change and insecurity,” he cautioned.
Fortunately, although the threat of climate change is urgent, Vernon said that the risk of that threat spilling over into violent conflict is still a long way off. “I think policymakers have got to be thinking about where might this lead,” he said, “but at the moment, in terms of this research, there was no evidence that there’s a massive risk of violence happening any time soon.”
Event Resources
Sources: AlertNet, BBC, International Alert.
Photo Credit: “Cattle manure millet field in Niger,” courtesy of flickr user ILRI (International Livestock Research Institute).Topics: Africa, climate change, conflict, environment, From the Wilson Center, gender, Nigeria, video, water -
Guest Contributor
Book Review: ‘Plundered Nations? Successes and Failures in Natural Resource Extraction’
MOREThe principal argument of Plundered Nations? Successes and Failures in Natural Resource Extraction is highlighted by the question mark in the title. In many resource rich countries, natural assets have not led to development. The book advances the hypothesis that “for the depletion of natural assets to be converted into sustained development, a series of decisions has got to be got sufficiently right” (p. 1). That series of decisions is examined in detail through case studies on Cameroon, Chile, Iran, Kazakhstan, Malaysia, Nigeria, Russia, and Zambia, produced by a diverse group of academic and practicing economists under the auspices of the Center for the Study of African Economies and the Oxford Center for the Economics of Resource Rich Countries (OxCarre).
Topics: Africa, Brazil, conflict, development, economics, environment, Guest Contributor, minerals, natural resources, Nigeria, poverty, Russia, Tanzania, Uganda, video -
Reading Radar
The Implications of Urbanization on Food Security and Child Mortality of the Urban Poor
MOREIn the chapter, “Urban Agriculture and Climate Change Adaptation: Ensuring Food Security Through Adaptation,” of the edited volume, Resilient Cities: Cities and Adaptation to Climate Change – Proceedings of the Global Forum 2010, authors Marielle Debbeling and Henk de Zeeuw assess the viability of urban and peri-urban agriculture (UPA) as a method of climate change adaptation for the urban poor. Debbeling and de Zeeuw assert that UPA increases the resilience of cities by diversifying both food supply and income streams for the urban poor; decreasing the negative effects of “heat island effect,” air pollution, and urban flooding; conserving water and utilizing organic waste; and reducing energy use and greenhouse gas emissions. Given the scale and impact of modern urbanization, the authors write that “the integration of UPA into urban development and master plans, urban land use and zoning plans, as well as active maintenance of the protected agricultural zones…is crucial.”In “Urban Area Disadvantage and Under-5 Mortality in Nigeria: The Effect of Rapid Urbanization,” published by Environmental Health Perspectives, authors Diddy Antai and Tahereh Moradi found a significant link between the mortality rate of children under five years of age and a poor and disadvantaged urban environment; such an environment is characterized by poor sanitation, overcrowding, a lack of access to safe water, and high levels of disease-inducing air pollution and hazardous wastes. Although urban living may increase proximity to health care and other social amenities, low- and middle-income countries, such as Nigeria, have overstretched their adaptive capacities and the result is poor health indicators. Antai and Moradi predict that the rapid urbanization of Nigerian cities will bring increased infant mortality, unless individual- and community-based policy interventions are implemented to counter the adverse environmental conditions of deprived areas. -
Dot-Mom // From the Wilson Center
Is Universal Access to Family Planning a Realistic Goal for Sub-Saharan Africa?
MORE“What do we require to ensure universal access to family planning services that are appropriate, affordable, accessible, and of good quality?” asked Michael Mbizvo, director of the Department of Reproductive Health and Research at the World Health Organization at the Wilson Center last month. [Video Below]
To talk about this difficult question and present research and programmatic evidence for sub-Saharan Africa, Mbizvo was joined by panelists Fred Makumbi, senior lecturer and head of the Department of Epidemiology and Biostatistics at Makerere University, Uganda; Oladosu Ojengbede, director of the Center for Population and Reproductive Health, University of Ibadan, Nigeria; and Frank Taulo, director of the Center for Reproductive Health and senior lecturer of obstetrics and gynecology at the University of Malawi.
Integrating Family Planning and HIV Services
Makumbi shared a number of findings on fertility preferences, behaviors, and contraceptive uptake in the context of HIV infection and care in Uganda. “Integrating family planning services into HIV services could help address the family planning needs of both HIV infected and uninfected,” he said.
According to new research conducted as part of the Rakai Community Cohort Study, despite significant gains in family planning use over time, there is still a high unmet need for contraception, irrespective of HIV status, in the Rakai district of central Uganda, said Makumbi. Male partner’s fertility desires were found to play an important role in pregnancy rates, and compared with previous studies conducted in the Rakai district, researchers saw an increase in pregnancy incidence and prevalence among HIV positive women, especially those on anti-retroviral therapy. HIV care that included voluntary counseling and testing was associated with significant increases in the use of family planning, and in particular, the use of condoms.
To effectively promote universal family planning in sub-Saharan Africa, “there is a need to strengthen family planning services in HIV care programs, with promotion of modern contraceptive methods, and with particular attention to women on anti-retroviral therapy,” said Makumbi. “Strategies to address desire for high fertility need to be developed, especially with regard to male involvement,” he added.
Multi-Pronged Approach to Universal Family Planning
“Family planning success in sub-Saharan Africa is a must for the region’s sustainable development,” said Ojengbede. “Poor commitment to women’s health in sub-Saharan Africa” has not only resulted in high fertility rates and poor maternal health indices but has also negatively impacted economic and human development in the region, said Ojenbede.
To increase access to and use of family planning, Ojengbede stressed the need to generate and sustain government commitment, promote legislation to support women’s autonomy, and implement policies to improve access to quality reproductive health services.
At the community level, Ojengbede said, the public health community must work to integrate family planning services into all reproductive health programs, including prevention of mother to child transmission; accelerate female empowerment programs; actively engage males in family planning access and uptake; and address social and cultural barriers that prevent widespread adoption of family planning.
“Traditional rulers can occupy a critical position to enact positive change in their communities and at the national level,” said Ojengbede. In Nigeria, for example, providing education about the health and economic benefits of family planning has helped traditional leaders embrace family planning and develop their own strategies to promote birth spacing in their communities.
“Universal family planning access must be achieved through a multi-pronged approach that should be colored with socio-cultural sensitivity, solid evidence, and sustainability,” concluded Ojengbede.
Eliminating Unmet Need: “Yes, We Can”
“It is time to prioritize issues that are affecting women and family planning is a very critical area,” said Taulo.
There are still many challenges to overcome before Malawi can achieve universal family planning access, including poverty, misconceptions and myths about family planning, lack of availability of reproductive health supplies, poor infrastructure, shortage of trained professionals, and religious and cultural barriers.
“Commodities are also very much dependent on the donor,” said Taulo, pointing to the challenges of insufficient funding and political will. “Failure to connect family planning to economic development and political stability is one of the main areas that we are struggling with,” he added.
“We have lots of challenges, but also many achievements,” said Taulo. Malawi has made important strides in expanding access to family planning by implementing community-based strategies and youth-friendly programs, developing public-private partnerships, engaging policymakers and traditional leaders, and encouraging media coverage of family planning issues.
“Education is another family planning product,” said Taulo. Moving forward, a “deliberate focus on girl child education” and promotion of women’s welfare can have a major impact on fertility reduction, he said.
“We can eliminate unmet need for family planning in Malawi, if we put our heads together, our thoughts together, and our energy together,” concluded Taulo.
Source: World Health Organization.
Image Credit: “Women’s Health Clinic” courtesy of flickr user advencap.Topics: Africa, demography, Dot-Mom, family planning, From the Wilson Center, global health, HIV/AIDS, population, video -
Friday Podcasts
Robert Walker on Family Planning Promotion and Global Population Growth
MORE“Expanding voluntary family planning access and ensuring that all women have access to reproductive health services is, to me at least, a no brainer,” said the Population Institute’s Robert Walker in this interview with ECSP. “I think it’s a win for women, for their health, for their welfare, the welfare of their families, for their communities, for the environment, and for the planet at large.”
While China and India dominate much of the global headlines about population growth, other parts of South Asia – namely Afghanistan and Pakistan – and sub-Saharan Africa receive comparatively little attention. For Walker, a renewed global effort to boost the quality and quantity of reproductive healthcare tools and services in these areas of the developing world is essential.
“This is very, very doable. We face a lot of really incredible challenges in the world today, particularly with respect to food, energy, water, and poverty. But if we can increase what we spend on international family planning assistance by three or four billion dollars a year, we can literally change the world,” Walker said. “And I think we desperately need to.”
The “Pop Audio” series is also available as podcasts on iTunes.
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