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Beat on the Ground
Watch: Dr. Vik Mohan on Integrating Family Planning and Conservation in Madagascar
The integration of population, health, and environment programming “enables us to create synergies that mean we are more effective at achieving both health and conservation goals,” said Dr. Vik Mohan, director of sexual and reproductive health programming for Blue Ventures, in an interview with ECSP at the 2011 International Conference on Family Planning.MORE
After Blue Ventures established their first clinic in 2007 in the village of Andavadoaka, on Madagascar’s southwest coast, “we felt immense pressure to scale up our intervention,” said Mohan. “We started with one clinic in one village, and now we have a multi-site service covering all 40 villages that we partner with for our community-based conservation work,” he said.
According to data compiled by Blue Ventures, the average total fertility rate in the region is 6.7 children per woman. The London-based eco-tourism-turned health and environment NGO offers a variety of family planning services to meet local demand, including mobile outreach clinics and community-based distribution of contraceptives. They also partner with Marie Stopes International to offer long-acting and permanent methods of contraception for those that want it.
“This Model Can Be Taken to Scale”
By integrating conservation and reproductive health messaging and service delivery, “we are getting greater buy-in from the community because they all see the added value of the breadth of things that we offer them,” Mohan said. “Men who came to hear about fisheries management get to hear about family planning technologies, practically for the first time in their lives.”
The fishermen are able to see the links between food security and population growth through their own experience, he added. “We believe very passionately this model can be taken to scale,” Mohan said. “This is something that could be easily replicated in other regions. Definitely in other coastal regions, but almost certainly in other remote areas – perhaps areas of high biodiversity where there are existing projects, perhaps conservation projects – but where there is an unmet need for healthcare and family planning in particular.”
“My advice to other organizations, whether you are doing healthcare or whether you are doing conservation, is just think holistically,” said Mohan. “If you are a conservation organization that recognizes that there is an unmet healthcare need for the communities that you work with, then…don’t be afraid to ask those questions, and don’t be afraid to build capacity to meet the need, if you find one. Or, don’t be afraid to partner with health NGOs to enable that need to be met.”
For more on Blue Ventures’ integrated efforts, see also ECSP FOCUS Issue 23, “To Live With the Sea: Reproductive Health Care and Marine Conservation in Madagascar,” co-authored by Vik Mohan. -
Friday Podcasts
Jotham Musinguzi on Investing in Family Planning for Development in Uganda
MORE
“What we are seeing is not adequate, but we think we are seeing very good positive movement, and we want to build on that,” said Jotham Musinguzi, director of the African regional office for Partners in Population and Development (PPD) in Kampala, Uganda. Musinguzi is a public health physician by training who previously advised the government of Uganda on population and reproductive health issues. “We think that [the government] is now on a firm foundation to continue investing properly in family planning,” he said.
Family Planning for Development
Uganda’s high population growth rate (the country has a total fertility rate of 6.4 children per woman, according to the UN) presents a number of challenges, said Musinguzi, exerting pressure on education and health systems, as well as on basic infrastructure, particularly for housing and transportation. Additionally, high levels of poverty and unemployment can become a source of instability.
Policymakers in Uganda are beginning to recognize the urgency of the issue, however, particularly in regards to young people, said Musinguzi. “They don’t have access to jobs, they don’t have the skills, and therefore the challenges of poverty eradication become even more important.”
Nonetheless, the country’s contraceptive prevalence rate is low, at 24 percent, with 41 percent of married women expressing an unmet need for family planning services, according to the 2006 Demographic and Health Survey (DHS) for Uganda. Low levels of investment and lack of government involvement remain the primary obstacles, according to Musinguzi, in addition to socio-cultural and religious barriers.
Uganda historically depended primarily on donor finance, rather than government funding, to support family planning and reproductive health services, Musinguzi said. However, over the past two years, the Ugandan government has increased investment due to concerted efforts by PPD, as well as USAID, the UN Population Fund, and civil society groups. “Our point was that if the government does not fund family planning, then they are going to find that achievement of the Millennium Development Goals…is going to be very challenging,” he said.
“I think the low investment in family planning in Uganda is a thing of the past, and we are now looking forward to really better investment in this field,” Musinguzi said. “I am sure we are going to witness quite a big change [in the 2011 DHS] in terms of access as a result of the proper social investment that the government is trying to do now.”
South-South Collaboration
“I have a keen and strong interest in South-South collaboration in the field of reproductive health, family planning, population, and development,” Musinguzi said. Countries in the South have experience linking programming on population and development, and may face similar challenges, he said. For instance, Bangladesh and Vietnam had successful family planning programs that helped blunt rapid population growth rates.
“Countries, like Uganda, and others which haven’t gotten there yet, could learn from these other countries,” said Musinguzi, by sharing best practices and lesson learned, and replicating applicable solutions.
PPD also has a regional project reaching out to policymakers to increase commitment and accountability for family planning and reproductive health services. For instance, parliamentarians may not realize that they can play a significant role, but they have a unique function in providing government and budget oversight, Musinguzi said. Furthermore, they can create legal and administrative frameworks that prioritize family planning programs.
“We continue to make the case for more investment in family planning and reproductive health, but also making sure we hold leaders accountable, to show more commitment, and make sure they improve on the welfare of the people that they represent,” Musinguzi concluded.
The “Pop Audio” series is also available as podcasts on iTunes.
Sources: MEASURE DHS, UN Population Division.Topics: Bangladesh, development, family planning, Friday Podcasts, podcast, population, poverty, Uganda, Vietnam, youth -
Family Planning as a Strategic Focus of U.S. Foreign Policy
May 11, 2011 // By Wilson Center Staff“Family Planning as a Strategic Focus of U.S. Foreign Policy,” by Elizabeth Leahy Madsen, was an input paper for the Council on Foreign Relations report, The Role of U.S. Family Planning Assistance in U.S. Foreign Policy. Excerpted from the introduction:MORE
Comprehensive policies that incorporate demography, family planning, and reproductive health can promote higher levels of stability and development, thereby improving the health and livelihood of people around the world while also benefiting overarching U.S. interests. U.S. foreign aid will be more effective if increased investments are made in high population-growth countries for reproductive health and family planning programs. These programs are cost-effective because they help reduce the stress that rapid population growth places on a country’s economic, environmental, and social resources.
Family Planning and Reproductive Health Programs
Family planning and reproductive health programs have successfully reduced the world’s population growth rate, propelled economic development, and improved women’s lives across the world. When people, and especially women, are given the opportunity and technology to limit their family size, they often choose to do so.
Population trends are motivated by three demographic forces: fertility, mortality, and migration. Although they can have dramatic effects on national and local populations, mortality and migration in particular have relatively little influence globally. Across the world, mortality rates have declined to a point where most children born today live to reach their own reproductive years, though much work remains to reduce the effect of communicable diseases and improve nutrition among the young. Meanwhile, three percent of the world’s population currently lives outside of their birth-countries. Therefore, while migration is increasing and an important demographic force, it does not occur at a scale large enough to significantly affect global-level demography.
Fertility rates currently are – and in the short-term will remain – the most important driver of global demographic trends. The total fertility rate, or average number of children born to each woman, has been estimated at 2.7 for the period between 2000 and 2005, a decline from 3.6 children per woman in the early 1980s. Given this decline, population projections generally assume future declines in fertility rates. For example, the widely cited “medium-fertility variant,” which is the United Nations’ projection of a world population growing from 6.9 billion in 2010 to 9.1 billion by 2050, relies upon an assumption that the global fertility rate will decline by 24 percent to two children per woman. However, if fertility rates remain constant at current levels, the world’s population would reach 11 billion by 2050. Fertility rates, whether they decline or remain at current levels, are not distributed evenly among countries and regions.
Continue reading or download the full report, “Family Planning as a Strategic Focus of U.S. Foreign Policy,” from the Council on Foreign Relations. -
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 -
Canada Flip-Flops on Family Planning, Will the G-8 Follow?
April 5, 2010 // By Laura PedroMORE“The Canadian government should refrain from advancing the failed right-wing ideologies previously imposed by the George W. Bush administration in the United States, which made humanitarian assistance conditional upon a ‘global gag rule’ that required all non-governmental organizations receiving federal funding to refrain from promoting medically-sound family planning,” said the Canadian Liberal Party about the country’s Conservative government in a Parliamentary motion last week.
Though Prime Minister Stephen Harper had pledged to include a voluntary family planning initiative in Canada’s foreign aid plan at last year’s G8 meeting in Italy, the Conservative government recently said that the initiative will not be part of its G8 plan at the upcoming meeting in Canada this June.
This move has surprised both Canadians and Americans. U.S. President Obama overturned the Mexico City policy last year, and has fully supported the inclusion of family planning methods as part of foreign aid.
Harper’s government has maintained that maternal and child health services, such as vaccinations and nutrition, will be a priority, but various components of family planning, including birth control and abortion, will not be included in the Canadian initiative.
The Tories, as along with three Liberal MPs, voted down the Liberal motion 138-144, which requested clarification of Harper’s maternal health initiative and pushed for the inclusion of the full range of family planning options. The Tories focused solely on what they called “anti-American rhetoric” in the motion, which drew attention away from the divisive issue of abortion.
The issue has got caught up in domestic Canadian politics, with opposition Liberals trying to equate the Conservatives with the George W. Bush administration and the Conservatives trying to avoid discussion of intra-party debates on the contentious issue of abortion.
Now it seems likely like that Harper will go to the G8 summit in Ontario with a foreign aid plan for maternal health that makes no reference to issues of contraception. According to Canada’s International Co-operation Minister Bev Oda, “saving lives” of women and children is a higher priority than family planning.
But most international maternal health advocates don’t agree. “Maternal mortality rates are high among women who do not have access to family planning services. Contraception can reduce the number of unplanned pregnancies,” said Calyn Ostrowski, program associate for the Wilson Center’s Global Health Initiative. “For example, at a recent event on our Maternal Health series, Harriet Birugni of the Population Council in Kenya described how integrating reproductive health services such as family planning can reduce maternal mortality rates, particularly for poor young women who have the least access to contraception.”
In response to Canada’s announcement, U.S. Secretary of State Hilary Clinton said that the United States will be promoting global health funding, including access to contraception and abortion, at the G8. “You cannot have maternal health without reproductive health,” she said during a news conference with other G8 ministers. Britain has also agreed with this position, which has led Canadian Liberal Party Leader Michael Ignatieff to say that Canada’s G8 position goes against the international consensus.
Laura Pedro is the program assistant for the Canada Institute, and a graduate of the University of Vermont.
Photo.: Prime Minister Stephen Harper, courtesy Flickr user Kashmera -
VIDEO: Nicholas Kristof On Comprehensive Approaches to Family Planning
October 2, 2009 // By Wilson Center Staff“Poor countries can’t begin to deal with food issues, with economic pressures, with conflict and shortages of water and grassland that may lead to social conflict, unless they begin to deal with population problems,” journalist Nicholas Kristof tells ECSP Director Geoff Dabelko in a video interview.MORE
But “the single most effective contraceptive isn’t any kind of device,” Kristof says, “it’s girl’s education. And that has the most extraordinary impact on birthrates.” Unfortunately, this approach to family planning has “been neglected in the last 20 years.”
Empowering women and girls may be our best strategy for fighting poverty, claim Kristof and WuDunn in their new book, Half the Sky: Turning Oppression into Opportunity for Women Worldwide, which was launched at the Wilson Center.
Half the Sky tells the transformational stories of women and girls who are the “face of statistics” on four appalling realities: maternal mortality, sexual violence, and lack of education and economic opportunities. -
Dot-Mom // On the Beat
Championing Women’s Rights and Population Issues in Kenya With the ‘Reject’
MORE“We find that politicians play around with [population] numbers when it comes to the common man and the common woman,” says Jane Godia in this short video interview. Godia writes for Reject, an African Woman and Child Feature Service biweekly news publication that won a Global Media Award from the Population Institute for its issue on family planning and politics in Kenya.
Godia says that politicians “use these numbers for their gain, they tell women not to use family planning because they want more children so that…they can have more voters, but nobody thinks about if this woman will be able to feed these children, if this family will be able to have their next meal, or even accommodation, or even land to till.”
The Reject’s name comes from the paper’s early practice of running stories – often about underserved groups, like women, children, and the poor – that had been rejected from mainstream publications. Population and environment issues have been highlighted since the first issue came out in September 2009, when “we were talking about families moving on to Mount Kenya…to look for pasture and water for their animals,” says Godia.
“When there’s no water and when there’s no food, people migrate,” she says. “And when people are migrating they’re moving with their animals, they’re moving with their families, and they end up going to places” that eventually become overcrowded and resource-stressed, sometimes introducing the same problems that led people to migrate in the first place.Topics: Dot-Mom, environment, family planning, food security, Kenya, media, On the Beat, PHE, population, video, water -
Eye On
‘Marketplace’ and ‘NewsHour’ Highlight Population, Health, and Environment Program in the Philippines
The Danajon reef is the only double barrier reef in the Philippines, “one of the richest marine biodiversity hot spots in the world,” and it’s being devastated as the country’s exploding population depends on its waters for their food and livelihoods, reported Sam Eaton in a recent two-part series on population, health, and environment issues in the Philippines broadcast last month for American Public Media’s Marketplace and the PBS NewsHour.MORE
The report is part of joint project called Food for 9 Billion, with Homelands Productions, the Center for Investigative Reporting, APM, and PBS. Previous reports examined food security in East Africa and Egypt.
The Philippines “import more rice than any other country on the planet,” said Eaton. The “highest population growth rates in all of Southeast Asia” as well as dwindling natural resources – nearly 100 million people live in a land area the size of Arizona – have created a cycle of poverty. The first step to breaking that cycle, he said, is improving access to family planning.
Growing Families, Growing Poverty
The Canayong family, living on the edge of a garbage dump in a Manila slum, offers a vivid example of what poverty means in the Philippines. Clarissa Canayong has had 14 children – 4 died from measles and dengue fever, the remaining 10 spend their days alongside Clarissa, sifting through the dump for things they need and things they can sell. At the end of a good day, the family has earned around $7 to survive on. All in all, Clarissa’s “inability to provide enough food, and to pay for her children’s education, all but guarantees she and her family will remain poor,” said Eaton.
The archipelago adds about two million people every year, putting population on track to double in size sometime around 2080. “And that’s only if something is done to close the birth control gap,” said Eaton, as those projections build in an expectation that growth will slow.
“As cities all across the country expand, the displaced often end up migrating to urban slums,” he said. “Population growth among poor Filipinos is twice the national average,” meaning that once a family enters poverty, they end up in a cycle “that’s nearly impossible to break.”
The Difference Family Planning Can Make
If Clarissa had had access to family planning, she told Eaton, she would have wanted to have only two children. In Humayhumay, where residents have access to a community-based family planning distribution program started by PATH Foundation Philippines, Inc., families have that luxury of choice.
Working through local partners, the PATH Foundation identifies and trains community-based vendors to sell contraception – both pills and condoms, said Dr. Joan Castro, who began the program in Humayhumay. The idea is to make buying contraceptives “as easy as buying soft drinks or matches.”
Both Jason Bostero, a farmer and fisherman in Humayhuay, and his wife, Crisna, grew up in large families – so large, in Crisna’s case, that “sometimes, we would only eat once a day because we were so poor. We couldn’t go to school. I did not finish school because there were just so many of us,” she told Eaton.
Now that they have access to contraceptives, a smaller family size means their income is “just right” to feed everyone three times a day. For the community as a whole, smaller family sizes mean that the nearby fish stocks that provide the community with food and income have a chance to replenish themselves in the absence of overfishing.
“In just six years since the program was first established here,” reported Eaton, “family sizes have plummeted from as many as 12 children to a maximum of about 4 today.”
Exception to the Rule
Humayhumay is an exception to the rule in the Philippines. There is no state funding for birth control in the country, and over the past few years, major international donors like USAID and the United Nations have ended their family planning work in the country. More than a quarter of poor Filipinos have no access to any type of family planning service, and more than half of all pregnancies are unintended, said Eaton.
Family planning has long been a contentious issue in the country. Eaton spoke to Congressman Walden Bello, who has spent more than a decade trying to pass legislation to establish universal access to birth control and improve other family planning and reproductive services. The Catholic Church, said Bello, is a powerful (80 percent of Filipinos are Catholic) and consistent opponent. In October 2010, the Church went so far as to threaten President Benigno Aquino with excommunication after he voiced support for access to contraception.
Rather than limit population growth, the Church argues the country should increase food production. But land is limited, rice imports are already the highest in the world, and, “according to the World Bank, every major species of fish here shows signs of severe overfishing,” said Eaton.
Looking Forward and Abroad
Eaton pointed to the Philippines’ neighbors as examples to emulate: “A long history of government-supported family planning has…paved the way for Thailand to become one of the world’s biggest rice exporters” and helped to cut back poverty in the country, said Eaton.
Indonesia too, he pointed out, has largely avoided the population growth-resource depletion-poverty cycle, thanks in part to a state- and faith-backed family planning program. (As Elizabeth Leahy Madsen wrote in a recent New Security Beat post, the decision of Indonesia’s religious leaders to throw their support behind family planning in the 1960s was a key factor in success there.)
Considering the obstacles, the Philippines face an uphill battle before family planning services become similarly universal. But the political tides may already be turning: last April, the President said he would support the reproductive health legislation even if it meant excommunication.
Meanwhile, PATH Foundation’s Castro is hopeful that Humayhumay’s success story will lay the seeds for widespread public support for family planning. “The vision of the project is in this community you see more children educated who are able to become leaders and speak out for themselves in the future and be able to become stewards of their own sexuality and the future environment,” said Castro. “This is the legacy.”
Sources: BBC, Bloomberg News, Catholic News Agency, The Guardian, Population Reference Bureau, TIME Magazine, US Agency for International Development, U.S. Catholic.Topics: environment, Eye On, family planning, food security, global health, natural resources, oceans, PHE, Philippines, population, poverty, video
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