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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 -
From the Wilson Center
Political Demography: How Population Changes Are Reshaping International Security and National Politics (Book Launch)
MORE
“The world’s population is changing in ways that are historically unprecedented,” said Jack Goldstone, George Mason University professor and co-editor of the new book, Political Demography: How Population Changes Are Reshaping International Security and National Politics. [Video Below]
Topics: Africa, aging, conflict, demography, development, economics, family planning, From the Wilson Center, global health, Middle East, military, population, security, South Asia, U.S., video, youth -
Pop at COP: Population and Family Planning at the UN Climate Negotiations
February 8, 2012 // By Wilson Center StaffMOREThe original version of this article, by Kim Lovell, appeared on the Sierra Club’s activist network.
“Population, development, and climate should be a single discussion,” explained Jacques van Zuydam of South Africa’s National Population Unit. Van Zuydam, speaking to a sparsely filled room at the United Nations Framework Convention on Climate Change (UNFCCC) in Durban last month, centers his work around the concept that climate matters because people matter.
Given the focus on the Green Climate Fund, climate change adaptation, and the effects of sea-level rise and changing weather patterns on some of the world’s most vulnerable populations, it would have made sense for discussions about population to play a central role at the 17th Conference of Parties (COP-17). Yet despite these obvious links – and lead negotiator Jonathan Pershing’s admission to the U.S. youth delegation that population plays a central role when discussing climate impacts – the issue gained little traction in the formal negotiations.
Pershing said he considers population “too controversial” to play a role in the international climate talks, and recommended raising the issue elsewhere. But where better to talk about the need for increased access to voluntary family planning services than among a group of world leaders considering solutions to mitigate and adapt to climate change?
As Brian O’Neill and his colleagues at the National Center for Atmospheric Research explained in a 2010 paper, meeting the unmet need for contraceptive services worldwide could reduce emissions in 2050 by 1.4 to 2.5 billion tons of carbon per year, or 16 to 29 percent of the emissions reductions necessary to avoid dangerous changes to our climate. And beyond the potential effects on carbon, increasing access to education and family planning resources will have a huge impact on the ability of women and families to adapt to the effects of climate change that are already altering weather patterns, water availability, and agricultural production around the globe.
Continue reading at Sierra Club.
Sources: Amplify.
Image Credit: UNFCCC/Climate Change Information Center of Armenia.Topics: adaptation, agriculture, climate change, COP-17, development, education, environment, family planning, food security, population, U.S., UN, water -
From the Wilson Center
Is Foreign Aid Worth the Cost?
MORE“Is foreign aid worth the cost? That’s not really the question unless you’re Ron Paul,” quipped Carol J. Lancaster, dean of the School of Foreign Service at Georgetown University, at the Wilson Center on January 23. “The real questions are: What do we want to accomplish with our foreign aid? Where should it go? And in what form?” [Video Below]
Lancaster noted that following World War II, foreign aid became “a two-pronged instrument – one as an instrument of the Cold War and the other as an extension of American values.” It has been a very “intense marriage” between the two, he said, “with one side up and the other side down at different times, as any marriage tends to be.” Truman convinced Congress to provide aid to Greece and Turkey in 1948 to combat communism, and he was able to gain approval for the Marshall Plan by “scaring the wits out of Congress” about the communist threat.
Aid Under Fire
Congressman Donald Payne (N.J.), who is the ranking Democrat on the House Foreign Affairs Committee’s Subcommittee on Africa, agreed that the Cold War was the principal reason for our foreign aid programs after World War II, as we provided hundreds of billions of dollars in aid to our supporters around the world. But, “It’s different today,” he added. “Since the end of the Cold War, more funds are going for humanitarian and development assistance, but it is still directly linked to our national interests. One in five American jobs are tied to U.S. trade, and the growth of our trading partners is our growth as well.”
Payne cautioned that there is “a new group in the House of Representatives who think we should step out of the world. They’ve told their constituents they are going to cut the budget, and foreign aid is an easy target.” Payne noted that polls show the American people think one-quarter or more of the federal budget goes to foreign aid when it is little more than one percent.
Nevertheless, there has been bipartisan support for former President Bush’s HIV/AIDS initiative in Africa which is showing remarkable results in reducing deaths from the disease. Payne added that aid to Africa is showing results in the number of economies that are doing well despite the global economic downturn.
Payne expressed frustration with the inability to enact a foreign aid authorization bill in the last several Congresses because the measures became weighted down with all manner of policy riders that were both partisan and controversial. Consequently, our foreign relations operations are solely dependent on the annual appropriations bills which tend to become encumbered as well with troublesome riders.
The Dangers of “Nation Building”
Charles O. Flickner, Jr., a 28-year Republican staff member on the Senate Budget Committee and then the Foreign Operations Appropriations Subcommittee in the House, presented a more skeptical view, saying foreign aid is not worth the $35 billion it is costing us each year, even though some of the programs have been successful and should be continued. The biggest problem in recent years, he said, has been the amount of money wasted on projects in Iraq and Afghanistan without adequate planning or execution. Money was being virtually shoveled out the door in amounts the host countries did not have the capacity to absorb, said Flickner, and as a consequence we have witnessed a lot of failed projects and corruption.
Smaller projects, which the U.S. government and private aid donors are better at, have a greater chance for success because they do not overwhelm the capacities of host countries. He cited some of the scholarships and technical training programs available for foreign nationals as being among the most worthwhile in building internal leadership capacity for the future in developing countries.
Rajiv Chandrasekaran agreed on the amount of wasted aid dollars being spent in Iraq and Afghanistan, which he has covered as a foreign correspondent for The Washington Post. He told the story of a small, dirt-poor town in Afghanistan he visited in where the bazaar was bustling with new shops and goods, and people were freely spending money on modern electronics, motor bikes, and clothes. The town was the beneficiary of a massive U.S. aid program that provided seed money for farmers to grow crops and created day labor jobs for the residents of the area. A contractor was authorized to spend $30 million on the economic development of the town during the U.S. counterinsurgency surge and that came to roughly $300 per person. It was clear to the USAID official on the ground and to the reporter that the experiment would not be sustainable over the long-term, even though there was a temporary sense of economic activity and prosperity.
Future Vulnerabilities
The panel seemed to agree that it was unfair to blame USAID for these failures since they were thrown into situations overnight they were not prepared to manage in countries that were not capable of absorbing the assistance being directed at them – all in the midst of ongoing conflict. The real test of whether the new directions being charted by the Obama Administration will work will be on the smaller, more manageable projects in which the host countries have a greater role in shaping and implementing.
Lancaster listed four vulnerabilities in the future course of U.S. foreign aid that should be avoided, including trying to merge our various interests through the State and Defense Departments with our aid programs in countries like Pakistan, where the institutions are weak and corrupt; the danger of creating an entitlement dependency through funding of HIV/AIDS drugs, where we will be guilty of causing deaths if we reduce funding; the danger of attempting to undertake too many initiatives at once, such as food aid, global health, climate change, and science and technology innovations, while simultaneously trying to reform the infrastructure of USAID; and trying too hard to demonstrate results from aid given the difficulty of disentangling causes and effects and gauging success over too short a time frame.
Event Resources:
Don Wolfensberger is director of the Congress Project at the Wilson Center.Topics: Afghanistan, development, economics, From the Wilson Center, funding, humanitarian, Iraq, military, Pakistan, security, State, U.S., USAID, video -
Indonesia: Pioneering Community Outreach Creates Success Story
January 31, 2012 // By Elizabeth Leahy MadsenMOREThis is the third post in a series profiling the process of building political commitment in countries whose governments have made strong investments in family planning. Previous posts have profiled Rwanda and Iran.
While the two other countries profiled in this series, Rwanda and Iran, have only reinvigorated their family planning programs within the past 20 years, Indonesia’s story begins in the 1960s. In this respect, the world’s fourth most populous country is classified among the pioneers of family planning in the developing world and has been described as a “world leader” and “one of the developing world’s best.” An extensive community outreach program combined with a centralized government that made family planning a priority were key to Indonesia’s success story.
Jakarta Pilot and Religious Support Motivates National Scale-up
For a decade and a half after the struggle for independence from the Dutch ended in 1949, the government of President Sukarno ruled out any government support for family planning. According to a Demographic and Health Survey (DHS) report, the rate of contraceptive use among married women at the time was essentially zero. Fertility rose slightly during this period, from an average of 5.5 in the early 1950s to 5.6 children per woman a decade later. However, in 1965, Sukarno was overthrown, and the next year, a military general named Suharto assumed power in an uprising that left as many as half a million people dead.
Suharto’s regime would last until 1998. Though he operated with a “heavy hand” amidst personal corruption, Suharto also aggressively pursued economic development and brought about a policy shift towards promoting family planning. Despite initial reservations – Suharto believed that the people would oppose family planning on religious grounds – various domestic and international advisers convinced him otherwise.
General Ali Sadikin, the governor of Jakarta – a city of three million even then – was particularly influential in convincing Suharto. According to Australian demographer Terence H. Hull, who has written extensively about population issues in Indonesia, Sadikin was “quickly learning demographic lessons in his attempts to renovate a city with poor housing, schooling, transport, and basic services,” and he began to regularly speak out about the challenges that rapid population growth posed to his goals of urban development.Sadikin decided to support the Indonesian Planned Parenthood Association, which had a network of clinics offering family planning, but lacked the funding to meet more than a small amount of demand. With the public support of Sadikin, a Jakarta-wide pilot program was operational in 1967.
Hull reports that a second integral event in the early years was a 1967 meeting between government officials and Muslim, Protestant, Catholic, and Hindu leaders representing four of the country’s major religions. Following the meeting, a pamphlet called “Views of Religions on Family Planning” was published, representing “a tipping point when national consensus around the morality of birth control was turning from strongly negative to strongly positive.”
A Strong Coordinating Board Reaches out to Communities
By late 1968, efforts were in place to scale up the family planning program in Jakarta to the national level. The National Family Planning Coordinating Board (BKKBN in Indonesian) was created and quickly became entrenched throughout the country thanks to generous funding, including from international donors.
The BKKBN’s emphasis on the community level, which ensured that family planning services and awareness-generating activities were reaching people around the country through multiple channels, was a key factor in the program’s achievements. The organizations involved in promoting family planning messages at the community level included youth, women’s and religious groups, employers, and schools, with high-level support reiterated regularly by the president. Hull described the BKKBN’s efforts as “a true collaboration because the program emphasized institutions not normally associated with family planning, but did so in a way that was both socially acceptable and socially invigorating.”
In the program’s first two decades, the contraceptive prevalence rate for modern methods rose from almost nonexistent to 44 percent, and fertility subsequently fell from 5.5 to 3.3 children per woman. These changes are widely attributed to robust government sponsorship from the highest levels, together with effective grassroots implementation that fostered support from nearly all sectors of society.
In subsequent years, Indonesia experienced rapid economic and social development. Per capita income increased more than 20 times over between 1966 and 1996, with initial growth largely due to oil revenues. Other development indicators also improved dramatically. The literacy rate is now over 90 percent, nearly all girls attend school, and half of women are members of the labor force. However, Hull cautions against proclaiming the family planning program the primary causal factor in these successes. Family planning and other development programs would not have been as effective, he says, without changes in the political structure, which steadily became more centralized and stable in its oversight of a very heterogeneous society.
A Recent PlateauAs Indonesia continued to develop and its political system evolved, the family planning program has faced some challenges in the past 15 years. Suharto resigned in the face of widespread opposition in 1998, after more than 30 years in power. While this brought positive movement towards democracy, the ensuring political uncertainty shifted the government’s energies away from reproductive health and other aspects of social development.
In the early 2000s, the family planning program was decentralized to district and municipal levels, in line with political reforms aimed at diminishing the role of central hierarchy nationwide. District leaders were charged with planning, budgeting, and implementing family planning and other primary health services. In accordance, BKKBN modified its strategies to become even more community-oriented. Still, observers judge the family planning program to have “weakened” following decentralization.
With strong logistics, popular support, and donor assistance, contraceptive use continued rising during the years of political transition. By 2002-2003, 57 percent of married women were using a modern contraceptive method and the fertility rate had reached 2.6 children per woman. However, these indicators remained unchanged in the next national survey, conducted in 2007. Fertility in Indonesia is at the median for Southeast Asia – higher than Thailand and Vietnam and lower than Cambodia and the Philippines.
The Program Moves Forward
As democracy became more secure in the early 2000s, the country’s next generation of leaders kept sight of demographic issues. In 2005, President Susilo Bambang Yudhoyono stated, “High population growth without rapid economic growth will result in poverty and setbacks … Large numbers of children and high populations will only bring advantages if they are skilled.” BKKBN and the Ministry of Health worked with USAID, public health researchers, NGOs and others to develop national family planning standards for quality of care, which were devised and implemented in the early 2000s.
Judging the program’s achievements to have been substantial and its momentum sustainable, USAID graduated Indonesia from population assistance in 2006, after 35 years. Though gaps remain, women’s fertility preferences are largely being met.
Today, 80 percent of all births are intended, and unmet need for family planning – the share of married women who wish to delay or prevent pregnancy but are not using contraception – stands at nine percent, two percentage points below the average for Southeast Asia and all developing countries. Meanwhile, Indonesia’s demographic profile looks much different than it might have. At the time of graduation, USAID reported that without its long-standing and well administered family planning program, Indonesia’s 2006 population would have been larger by 80 million people, or 35 percent.
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: Demographic and Health Surveys; Hull (2007); Management Sciences for Health; New York Times; UN Population Division; USAID.
Photo Credit: “Jakarta,” courtesy of flickr user frostnova. -
Move Beyond “Water Wars” to Fulfill Water’s Peacebuilding Potential, Says NCSE Panel
January 26, 2012 // By Schuyler NullMOREOne of the best talks of last week’s NCSE Environment and Security Conference was thewater security plenary on Friday. Moderator Aaron Salzberg, who is the special coordinator for water resources at the Department of State, led with a provocative question: how many in attendance think there will be war over water in the future?
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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
New Research on Climate and Conflict Links Shows Challenges for the Field
MORE“We know that there will be more conflicts in the future as a result of climate change than there would have been in a hypothetic world without climate change,” said Marc Levy, deputy director of the Center for International Earth Science Information Network (CIESIN) at Columbia University’s Earth Institute, although existing data and methodologies cannot predict how many additional conflicts there will be, or which causal factors will matter most. [Video Below]
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