›Each year, 350,000 women die while pregnant or giving birth, as many as two million newborns die within the first 24 hours of life, and there are 2.6 million stillbirths. Sadly, the majority of these deaths could be prevented if poor and marginalized women in developing countries had access to adequate health facilities and qualified health professionals. In fact, according to the new UNFPA report, State of the World’s Midwifery 2011: Delivering Health, Saving Lives, just doubling the current number of midwives in the 58 countries highlighted in the report could avert 21 percent of maternal, fetal, and newborn deaths.Launched last week, the report is the first of its kind, using new data from 58 low-income countries with high burdens of maternal and neonatal mortality to highlight the challenges and opportunities for developing an effective midwifery workforce.
“Developing quality midwifery services should be an essential component of all strategies aimed at improving maternal and newborn health,” write the authors of the report. Qualified midwives ensure a continuum of essential care throughout pregnancy and birth, and midwives can help facilitate referrals of mothers and newborns to hospitals or specialists when needed:
Unless an additional 112,000 midwives are trained, deployed, and retained in supportive environments, 38 of 58 countries surveyed might not met their target to achieve 95 per cent coverage of births by skilled attendants by 2015, as required by Millennium Development Goal 5.There is a total shortage of 350,000 skilled midwives globally, with some countries, like Chad and Haiti, needing a tenfold increase to match demand, according to the report. But quantity isn’t the only issue; there has also been an insufficient focus on quality of care. Additionally, most countries do not have the capacity to accurately measure the number of practicing midwives, and national policies focusing on maternal and newborn health services often do not view midwifery services as a priority.
To help overcome these challenges, the report outlines a number of “bold steps” to be taken by governments, regulatory bodies, schools, professional associations, NGOs, and donor agencies in order to maximize the impact of investments, improve mutual accountability, and strengthen the midwifery workforce and services. Of course, the needs of each country are unique, and the report ends with individual country profiles that highlight country-specific maternal and neonatal health indicators.
While this report does much to highlight the critical importance of midwives in promoting the health and survival of mothers and newborns, real impact will only come when governments, communities, civil society, and development partners work together to implement these recommendations.
Video Credit: UNFPA.
›Practice, Harvest and Exchange: Exploring and Mapping the Global, Health, Environment (PHE) Network of Practice,” by the University of Rhode Island’s Coastal Resources Institute and the USAID-supported BALANCED Project, explores the successes and challenges of their global population, health, and environment (PHE) network (with a heavy presence in East Africa). In order to increase support of the nascent PHE approach, the network seeks to shorten the “collaborative distance” between “PHE champions,” so they can develop a stronger body of evidence for the links between population, health, and the environment. In their analysis, the authors write that the network has facilitated the development of independent, information-sharing relationships between “champions.” However, they also observed shortfalls in the network, such as its limited reach into less technologically advanced yet more biodiverse regions, its bias toward BALANCED meet-up event participants, and its exclusion of those experts unlikely to be included in published works.
In “Linking Population, Health, and the Environment: An Overview of Integrated Programs and a Case Study in Nepal” from the Mount Sinai Journal of Medicine, Sigrid Hahn, Natasha Anandaraja, and Leona D’Agnes provide both a broad survey of the structure and content of programs using the PHE method and an in-depth case study of a successful initiative in Nepal. Hahn et al. praise the Nepalese program for simultaneously addressing deforestation from fuel-wood harvesting, indoor air pollution from wood fires, acute respiratory infections related to smoke inhalation, as well as family planning in Nepal’s densely populated forest corridors. “The population, health, and environment approach can be an effective method for achieving sustainable development and meeting both conservation and health objectives,” the authors conclude. In particular, one benefit of cross-sectoral natural resource and development programs is the inclusion of men and adolescent boys typically overlooked by strictly family planning programs.
›June 29, 2011 // By Wilson Center StaffDownload FOCUS Issue 22: “Coffee and Community: Combining Agribusiness and Health in Rwanda,” from the Wilson Center.
Rwanda, “the land of a thousand hills,” is also the land of 10 million people, making it the most densely populated country in Africa. Rwandans depend on ever-smaller plots of land for their food and livelihoods, leading to poverty, soil infertility, and food insecurity. Could Rwanda’s burgeoning specialty coffee industry hold the key to the country’s rebirth, reconciliation, and sustainable development?
In the latest issue of ESCP’s FOCUS series, author Irene Kitzantides describes the SPREAD Project’s integration of agribusiness development with community health care and education, including family planning. She outlines the project’s successes and challenges in its efforts to simultaneously improve both the lives and livelihoods of coffee farmers and their families.
›Chi Phat is a single-dirt-road town nestled in the Cardamom Mountains of Southwestern Cambodia, one of the largest intact forests in Southeast Asia. The town is only accessible by two routes: a three-hour river boat trip up the Phipot River or, if the road isn’t flooded by the rainy season, an exhilarating 30-minute motorbike ride from Andoung Tuek, a blip on the one paved road that runs along Cambodia’s southwestern border. Since 2007, Wildlife Alliance has been running an ecotourism project in Chi Phat (full disclosure: I used to work for Wildlife Alliance in Washington, DC).
The project has been featured in The New York Times and since its inclusion in the Lonely Planet travel guide, has become a destination for backpackers looking to leave the beaten path. I recently visited the project after spending time in neighboring Vietnam and was struck by the contrast between the densely populated and urbanized Mekong Delta and the visibility of rural poverty in Cambodia.
“Cambodia’s contemporary poverty is largely a legacy of over twenty years of political conflict,” reads a 2006 World Bank Poverty Assessment. The Pol Pot regime’s agrarian collectivization forced millions into the countryside and as a result, even in today’s predominantly-urban world, Cambodia remains 78 percent rural. Today 93 percent of Cambodia’s poor live in rural areas, two thirds of rural people face food shortages, and maternal and reproductive health outcomes in the country lag far behind those in the cities. Chi Phat and the sparsely populated northeast have over ten or twenty times the rate of maternal deaths of Phnom Penh.
A Town Transformed
Before Wildlife Alliance began the Community-Based Ecotourism (CBET) project in Chi Phat, most villagers made a living by slash-and-burn farming, illegal logging, and poaching endangered wildlife. Wildlife Alliance Founder and CEO Suwanna Gauntlett described the ecological zone around the town as “a circle of death,” in an audio interview with New Security Beat last year.
Kouprey Express, an environmental education-mobile that provides children and teachers with lessons, trainings, and materials on habitat and wildlife protection, pollution prevention, sustainable livelihoods, water quality, waste and sanitation, energy use, climate change, and adaptation.
One villager, Moa Sarun, described to me how he went from poacher and slash-and-burn farmer, to tour guide, and finally, chief accountant:
Since I have started working with CBET, I realize that the wildlife and forest can attract a lot of tourists and bring a lot of income to villagers in Chi Phat commune. I feel very regretful for what I have done in the past as the poacher…I know clearly the aim of CBET is to alleviate the poverty of local people in Chi Phat, so I am very happy to see people in Chi Phat have jobs and better livelihoods since the project has established.It’s hard to imagine what the town would have looked like before Wildlife Alliance arrived. The visitor center, restaurant, and “pub” (really, a concrete patio with plastic chairs and a cooler filled with beer), together make up nearly half of the town’s establishments. For two dollars a night, I stayed in a homestay and lived as the locals do on a thin mattress under mosquito netting, with a bucket of cold water by the outhouse for a shower, and a car battery if I wanted to use the fan or light (but not both). These amenities place Chi Phat above average for rural Cambodia. According to 2008 World Bank data, only 18 percent of rural areas had access to improved sanitation and only 56 percent had access to an improved water source.
Real change has certainly hit Chi Phat, but illegal activities persist, as a Wall Street Journal review of the project noted. In one Wildlife Alliance survey, 95 percent of members participating in the project made less than 80 percent of their previous income and 12 percent of people made less than 50 percent. “That, to me, is a red flag,” Director of U.S. Operations Michael Zwirn acknowledged to me. Nevertheless, he said “it is well documented that it’s the most lucrative community-based ecotourism project in Cambodia. That doesn’t mean that everyone is making money, or that they’re making enough money, but the community is clearly benefiting.”
Harold de Martimprey, Wildlife Alliance’s community-based ecotourism project manager, told me in an email interview:
We monitor closely the impact of the CBET project on the diminution of poaching and deforestation. We estimate that since the beginning of the project, the illegal activities have decreased by almost 70 percent.
After four years, Chi Phat has already developed enough to operate financially on its own. Wildlife Alliance will stop funding the project later this year and transition it towards total self-sustainability. The plan is to then ramp up efforts at a neighboring project in Trapeang Ruong, due to open to the public next month.
A Land of Opportunity
So far Chi Phat lacks much of what do-gooder tourists are hoping to find when they come in search of ecotourism. There is little to no information about the work of Wildlife Alliance and how ecotourism benefits the town, or the health, education, and economic benefits the villagers have received. A little more obvious justification for ecotourism’s inflated prices might appease the average backpacker used to exploitatively lower prices elsewhere in the country. The guides, staff, and host families for the most part speak little English, which does not bode well for its tourism potential. “This is a work in progress,” said de Martimprey.
Most of my time in Chi Phat, I felt like the only foreigner to ever set foot in the town – refreshing after witnessing much of the rest of Southeast Asia’s crowded backpacker scene. As Chi Phat continues to grow, hopefully it will “bring in enough people to support the community without the adverse effects of tourism,” said Zwirn. “They don’t want it to turn into the Galapagos.” Thankfully, de Martimprey told me, “Chi Phat is far from reaching this limit and can be scaled up to much bigger operation,” without negatively impacting the environment.
Luckily, plans to build a highly destructive titanium mine near the town were recently nixed by Prime Minister Hun Sen in what was an unexpected victory over industrial interests. However, soon after, the town was again under threat – this time by a proposed banana plantation nearby.
“The Cardamom Mountains are still seen as a land of opportunity for economic land concessions for some not-so-green investors looking at buying land for different purposes, and often disregarding the interest of the local people,” said de Martimprey.
Eventually Zwirn hopes that as more tourists come to the Cardamoms, they will become “a constituency for conservation,” he said. “We need to build a worldwide awareness of the Cardamoms as a destination, and as a place worth saving.”
Sources: BBC, IFAD, Phnom Penh Post, New York Times, United Nations, Wall Street Journal, Wildlife Alliance, World Bank, World Wildlife Fund.
Photo Credit: Hannah Marqusee.
›June 27, 2011 // By Schuyler Null“Today we are in an era of unprecedented demographic divergence, with population trends moving simultaneously in different directions. Some countries are beginning to experience population decline, while others continue to grow rapidly,” says Elizabeth Leahy Madsen, formerly the senior research associate at Population Action International (PAI). In this primer video from ECSP, Madsen explains how global demographic trends affect economic development, national security, and foreign policy.
Three forces drive demographic change:
- Fertility, which is the average number of children born to each woman, and has the greatest impact on demographic trends;
- Mortality, which fortunately has declined enough worldwide, so now most children survive to reach adulthood; and,
- Migration, which has much lower global impact on population size than fertility and mortality, but can have a larger impact at the local level.
Demographic projections are based on this history but also assume some convergence toward a common fertility rate (at or below replacement level). The UN projects thousands of different scenarios to come up with high, medium, low, and constant-fertility estimates for each country. For example, the constant fertility estimate for Nigeria, which assumes no change in current total fertility rate (5.61), puts population in 2050 at 504 million. But the medium variant projection, which assumes total fertility rate will fall to 3.2 by 2050, estimates a population of 390 million.
Youth and Capacity Building
“These figures provoke an important question,” says Madsen. “Do these governments have sufficient resources and sufficient willpower to provide for populations that are growing this quickly? And if not, are they likely to reach that capacity in the coming decades?”
“Today we have the largest generation of young people in history, with more than half the world’s population under 30. The vast majority of youth live in developing countries where they will continue to comprise the largest share of the population. The opportunities that are available or not available to these young people will determine their country’s futures.”
Understanding age structure can help us understand trends in governance, democracy, and civil instability. “In a country with a large youthful population, there’s little opportunity cost to joining a rebel group because there are few other alternatives and this facilitates recruitment,” says Madsen.
Adding an Arrow to the Analytical Quiver
Madsen cites the work of demographer Richard Cincotta, who has developed a model for predicting when a country is more likely to start to transition to a liberal democracy based on a historical analysis of age structure and previous transitions. Cincotta’s model predicted that Tunisia would begin such a transition this year, but the still-youthful population age structure of other Middle Eastern countries agitating for change, such as Egypt and Yemen, make a successful transition less likely or very unlikely.
“Demographic analysis, in combination with other political and economic factors, helps identify countries at risk,” Madsen explains. PAI found that 80 percent of all new civil conflict between 1970 and 2007 occurred in countries with at least 60 percent of the population under age 30.
Though Madsen cautions that age structure is never a sole factor for conflict, it does encompass a great many other indicators. And “unlike other social sciences, demography allows for a fairly informed projection into the future,” she says, which makes it a very useful tool for analysts.
“Population trends pressure governments and can facilitate the opportunities and motivation for participation in insurgency,” Madsen concludes. “To counter this, governments needs to scale up the provision of education and jobs for young people. This will be a challenge for many countries, which suggests that demographic projections should be an important component of development and foreign policy planning.”
Sources: UN Population Division.
›June 27, 2011 // By Wilson Center Stafforiginal version of this article, by Tate Watkins, appeared on the blog Short Sentences.
The USDA routinely disburses $10 billion to $30 billion a year in farm subsidies. President Obama has allocated $47 billion for the State Department and USAID for the next fiscal year (not including proposed expenditures for Afghanistan, Iraq, and Pakistan).*
Why does the U.S. simultaneously fund domestic agricultural subsidies and foreign aid? The policies oppose each other. When it comes to promoting development opportunities for farmers around the globe, one of USAID’s ostensible goals, the left hand of the U.S. binds its right.
The origin of agricultural subsidies goes back at least to the first Agricultural Adjustment Act, enacted in 1933 as an attempt to help Depression farmers cope. Today farm interests justify subsidies in name of food security or, since 9/11, national security. But it’s widely acknowledged that the pastoral American family farmer, the image that farm interests present to the American people when the merits of subsidies are debated, do not benefit most from agricultural subsidies. Large corporate farmers do.
Continue reading on Short Sentences.
Photo Credit: Adapted from “YM009180,” courtesy of flickr user tpmartins, and “Badam Bagh Farm,” courtesy of flickr user U.S. Embassy Kabul Afghanistan.
›This week on Dialogue, host John Milewski discusses the role that women played in the Arab Spring and how these roles might evolve in the coming months and years with the enormous political changes sweeping the region. He is joined by Moushira Khattab, Lilia Labidi, and Haleh Esfandiari. [Video Below]
Moushira Khattab is a human rights activist who formerly served as Minister of Family and Population for Egypt. She also served as Assistant Minister of Foreign Affairs, Vice Chair of the UN Committee on the Rights of the Child, and was Egypt’s ambassador to South Africa during the Mandela era. Lilia Labidi is an anthropologist and professor at the University of Tunis who currently serves as Minister of Women’s Affairs in the Republic of Tunisia. Previously she was a visiting professor at the American University in Cairo and a fellow at the Wilson Center. Haleh Esfandiari is author of the book, My Prison My Home: One Women’s Story of Captivity in Iran. Haleh serves as the director of the Wilson Center’s Middle East Program.
Dialogue is an award-winning co-production of the Woodrow Wilson International Center for Scholars and MHz Networks that explores the world of ideas through conversations with renowned public figures, scholars, journalists, and authors. The show is also available throughout the United States on MHz Networks, via broadcast and cable affiliates, as well as via DirecTV and WorldTV (G19) satellite.
Find out where to watch Dialogue where you live via MHz Networks. You can send questions or comments on the program to email@example.com.
›June 23, 2011 // By Wilson Center Stafforiginal version of this article, by Scott Wallace, appeared on National Geographic News Watch.
Late last month the Brazilian Congress passed a bill that if it becomes law would ease restrictions on rain-forest clearing and make it easier than ever to mow down the Amazon. That same day, 800 miles north of the parliamentary chamber in Brasilia, assailants ambushed and killed a married couple whose opposition to environmental crimes had placed them in the crosshairs of those who most stand to gain from the new legislation.
It’s a nauseatingly familiar story. Over the past 20 years, there have been more than 1,200 murders related to land conflict in Brazil’s Amazon region. Most of the victims, like the married activists Zé Claudio Ribeiro and Maria do Espírito Santo, were defenders of the rain forest – people seeking sustainable alternatives to the plunder-for-profit schemes that characterize much of what passes for “development” in the Amazon.
The state of Pará – where Zé Claudio and Maria were ambushed on their motorbike as they crossed a rickety bridge – holds an especially notorious reputation for environmental destruction and organized violence. Pará is the bloodiest state in Brazil, accounting for nearly half of all land-related deaths in recent decades. It sprawls across an area larger than the states of Texas, Oklahoma, and New Mexico combined. Picture a tropical version of the Wild West, stripped of the romance, where loggers and ranchers muscle their way onto public land as though they own the place and impose a law of the jungle with their hired thugs. Those who have the nerve to protest soon find themselves the targets of escalating threats. If they persist, they find themselves staring down the gun barrels of those come to make good on the threats.
Continue reading on National Geographic.
Photo Credit: “Toras,” courtesy of flickr user c.alberto.
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