Monthly archive for January 2012. Show all posts
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Building Commitment to Family Planning:
Indonesia: Pioneering Community Outreach Creates Success Story
›By Elizabeth Leahy Madsen // Tuesday, January 31, 2012This 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.MORE
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. -
Eye On:
Richard Black: Future Climate-Migration Interactions Will Stress Cities, “Trap” Vulnerable Populations
›By Kayly Ober // Monday, January 30, 2012
“In a 50 year time span, climate change, in particular, is likely to have a quite a strong impact on the drivers of migration,” said Richard Black, professor of human geography at University of Sussex and lead author of Migration and Global Environmental Change: Future Challenges and Opportunities. “But in a way that is different to what has been understood until now.”MORE
The report, produced by the UK Government Office for Science’s Foresight Programme, makes some important distinctions, however. First, Black said, we must understand that “migration is already occurring in the world, and whilst many people are likely to leave areas that are of environmental risks, many millions of people are currently moving towards areas of environmental risk,” particularly in Asia but also in Africa where many urban centers are in low-elevation coastal zones.
Second, “many millions of people do not migrate…and indeed are sometimes unable to do so,” Black pointed out. “One of the consequences of climate change is that it will be likely that poorer people in many parts of the world will be even less able to move.” These “trapped” populations are often located in dryland areas which “dominate many of the world’s poorest countries, including Africa and Central Asia,” the report reads.
What does this mean for policymakers? According to Black, there are two key implications of the report:- Given there continues to be movement of people to areas of environmental risk, the policy community, particularly the international development community, should begin to focus more on large urban cities. “Cities in poor countries are already failing their citizens in the provision of water and adequate shelter,” he said, and migration will only intensify these problems.
- “Not only is it difficult to stop migration, but [it] is actually part of the solution,” said Black. In fact, as noted by others, migration may be a useful adaptation mechanism for climate change.
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From the Wilson Center:
Call for Papers: Reducing Urban Poverty
›By Lauren Herzer // Friday, January 27, 2012The Woodrow Wilson Center’s Comparative Urban Studies Project, USAID, the International Housing Coalition, the World Bank, and Cities Alliance are teaming up a third time to co-sponsor an academic paper competition for graduate- and PhD-level students focused on challenges facing urban centers in the developing world.
The themes of this year’s competition are land markets, global climate change, and youth.MORE
Land Markets: The absence of efficient land and housing markets and lack of secure tenure for both renters and owners are impediments to urban and economic development in developing cities. Papers on this topic should explore strategies and approaches that would enable property markets to function better and would provide increased security of tenure and strengthened property ownership rights.
Global Climate Change: Papers should examine how urban populations, especially the poor, are coping with the impacts of climate change, and provide strategic policy analysis to better understand how cities can become more resilient to climate change impacts.
Youth: Most of the youth of the developing world are now or will soon be living in urban areas. Unfortunately, they are often growing up in the poorest urban areas – informal settlements and slum communities where their opportunities for advancement are limited by a variety of negative factors. Papers focused on youth should explore ways to build capacity so that you can develop knowledge and skills, find gainful employment, and participate more fully in society to advance economic growth and social development.
Winning papers from each category will be published and the authors invited to Washington, D.C. in the fall of 2012 for a policy workshop with subject matter experts. Additionally, one grand prize winner will be asked to present his or her work at the World Urban Forum (WUF). WUF was established by the United Nations to examine rapid urbanization and its impact on communities, cities, economies, climate change, and policies. The sixth WUF will be held from September 1-7, 2012 in Naples, Italy and will be focused on “The Urban Future.” In addition to the Washington conference and publication of his or her paper, the grand-prize winner will be invited to present his or her winning paper on a panel at the World Urban Youth Assembly at WUF on September 1st and 2nd.
The deadline for the submission of abstracts is February 20, 2012.
For detailed competition guidelines and requirements, and further information on the sub-topics, please see the full call for papers.
Image Credit: “Split by yelowcap,” courtesy of flickr user yelowcap (Vladimir Kaštier). -
‘New Security Beat’ Is Five Years Old
›By ECSP Staff // Thursday, January 26, 2012
Five years ago, in January 2007, we launched New Security Beat. Since then we’ve established a strong editorial focus on a key but neglected niche: where population, environment, and security meet.
Too little attention is given to this complex nexus. To fill that gap, we’ve worked to create a safe space for discussing the connections between these diverse topics. New Security Beat brings members of different disciplines – health, natural sciences, and international relations – together to find common ground at the intersection of their issues.MORE
Five years ago, in January 2007, we launched New Security Beat. Since then we’ve established a strong editorial focus on a key but neglected niche: where population, environment, and security meet.ECSP’s Sean Peoples, Meaghan Parker, and Schuyler Null accepted the Population Institute’s Global Media Award for Best Online Commentary at a January 12 ceremony in New York City.
Too little attention is given to this complex nexus. To fill that gap, we’ve worked to create a safe space for discussing the connections between these diverse topics. New Security Beat brings members of different disciplines – health, natural sciences, and international relations – together to find common ground at the intersection of their issues.
As the planet becomes more crowded and we become more connected, it is ever more important that we understand:- How gender and reproductive health are connected to the environment and development;
- How the environment and natural resources are linked to conflict and cooperation; and
- How population and demography impact war and peace.
Dozens of experts present their research and expertise at Wilson Center events each month. But capturing their insights and sharing them with those of you outside the room is difficult. Our series of short, embeddable video interviews, posted on YouTube and the blog, brings these experts’ work to a wider audience and serves as an online archive for researchers, students, and teachers. Some recent examples include:- Elizabeth Leahy Madsen explains the basics of demographic security
- Peter Gleick finds population dynamics key to sustaining water supplies
- Janani Vivekananda on how climate change exacerbates social, economic, and political stresses
If you’re working on new research, policies, or projects on population, environment, and security, we invite you to join us and contribute your thoughts on these important and often overlooked connections. Email a brief pitch to our web editor, and help us make the next five years as informative as the first.
Photo Credit: Population Institute. -
Move Beyond “Water Wars” to Fulfill Water’s Peacebuilding Potential, Says NCSE Panel
›By Schuyler Null // Thursday, January 26, 2012One of the best talks of last week’s NCSE Environment and Security Conference was the water 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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Most of the audience raised their hands. The panelists – as one might expect with a set-up like that – proceeded to explain why they were mistaken.
What Makes a Water War
Carl Bruch, who co-directs international programs at the Environmental Law Institute, started by saying history shows that inter-state “water wars” are “highly unlikely.” He pointed to Aaron Wolf’s and Peter Gleick’s work cataloguing the role of water in conflict throughout human history that shows it is difficult to find even a single conflict that was fought solely over the fundamental resource.
For example, climate change may bring changes in rainfall, and some studies have found a correlation between lack of rainfall and conflict, but there is no causation, said Bruch. “It’s a question of governance,” he said. If lack of rainfall caused conflict, there would have been war across the Sahel in 2003; instead, it only happened in Darfur, which lacked a government able to deal with the challenge (similar observations have been made about the relationship between drought and famine in the Horn of Africa).
Kent Butts, professor and director of the National Security Issues Group at the U.S. Army War College, said that some things have changed that might make conflict over water more likely in the near future. In light of water’s relatively fixed supply, he cited growing human population – the UN median projection is now more than nine billion people by 2050 – and consumption as a key challenge, as well as the uncertain condition of key treaties. The Nile Basin Initiative is on rocky ground – with Ethiopia agitating for a greater share of flow and both Egypt and South Sudan dealing with new governments – and the Himalayan watershed is under stress as demand increases across the region. Butts also pointed to the tremendous number of new dams – many of which no longer need to abide by World Bank conditions as they can get Chinese loans and other bilateral funding – as an emerging challenge that may upend the positive historical trend.
Climate change, too, will likely bring water to the forefront in many areas of the world. “The changing climate changes the dynamics of security in a country,” Butts said. How able a country is to adapt to those changes will quickly expose weak, fragile, or corrupt regimes, threatening stability in some places.
Butts also warned that, though vehemence over water sharing has mainly been confined to rhetoric between countries up until now, that’s no reason to give it short shrift – it’s possible some countries may become trapped by their own public posturing, narrowing their responses to more bellicose options.
Jaehyang So, manager of the Water and Sanitation Program at the World Bank, pointed out the sheer number of people affected by water issues – nearly one-third of all people on Earth lack access to safe drinking water, she said – as evidence that water should be given more credence as a security issue, if perhaps as human or community security, rather than national or international security.
Similarly, Sandra Ruckstuhl, senior specialist for sustainable development at Group W Inc., said that though it’s true that international conflict over water has been rare, “conflict over water at the local level is something that’s been going on for a long time and has been a real divisive force.”
Coordination Can Create Pathways to Peace
If water can be a contributing factor to conflict in some places, it’s also a pathway to peace, the panelists agreed.
“This is a great opportunity,” said Bruch. “We see water as incredibly cross-cutting in the peacebuilding process.” He pointed to water programs’ effects on health, food, energy, gender issues, and economic development as reasons to make them a priority in post-conflict settings.
“The peacebuilding value of water is tremendous,” agreed Butts. “Water quality, as opposed to quantity, can be a major peacebuilding issue,” he said, as it’s a shared benefit.
More than material aid, Salzberg said that people in post-conflict settings most frequently ask the State Department for expertise. Because water issues cut across so many sectors, that’s difficult to provide, said Bruch, but the environment and security community needs to find ways to better coordinate. “In post-conflict countries, one of the highest priorities, if not the highest priority, is access to clean water,” he said.
Paul Faeth, senior fellow at CNA, pointed to the start of funding for the Senator Paul Simon Water for Poor Act, which provides at least $125 million in aid to sub-Saharan Africa alone, as a good policy step towards acknowledging water’s role in human security.
Another barrier to sustainable water management, said Jaehyang So, are subsidies: “There is no water system in the world that doesn’t have some subsidy attached to it,” she said. This creates incentives for misuse, which – though the human right to water should always be preserved – appropriate pricing schemes for industrial and agricultural use might go a long way towards curbing. (Of course, resolving that tension is easier said than done.) An infamous example is groundwater pumping in Yemen – primarily for the non-food crop, qat – which has gone on unsustainably for years, agitating internal divisions and prompting experts to predict that the country will become the first in the modern world to literally run out of water.
In concluding remarks, Butts called for moving beyond simple labels for conflict to better understand the complexity of water systems, create prosperity and stability, and better advance U.S. interests around the world.
The excerpts above are only a small slice of the conference; see the full agenda for panelists and topics covered, and follow the conversation on Twitter (#NCSEconf). We also posted thoughts on some of the previous panels and a gallery of pictures from around the conference to flickr.
Photo Credit: Jaehyang So and Carl Bruch, courtesy of Sean Peoples/Wilson Center. -
Eye On:
UNEP Maps Conflict, Migration, Environmental Vulnerability in the Sahel
›By Kate Diamond // Wednesday, January 25, 2012A new set of maps from the United Nations Environment Programme (UNEP) identifies “climate hotspots” – areas vulnerable to instability exacerbated by climate change – in 17 sub-Saharan countries in and bordering the Sahel region. The maps reflect the fact that, more often than not, the impact of climate change on local populations is compounded by changes in migration, conflict, or both. According to Livelihood Security: Climate Change, Migration and Conflict in the Sahel, the UNEP report accompanying the maps, understanding “the exacerbating effect of changes in climate on population dynamics and conflict in the region” will be essential to developing successful adaptation strategies throughout the region.
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UNEP’s maps analyze 40 years of data to pinpoint where the region’s most at-risk populations are located based on environmental, population, and conflict trends dating back to 1970. In a single map pinpointing the Sahel’s 19 hotspots, UNEP synthesizes subnational data from four environmental indicators over time – rainfall (from 1970 to 2006), temperature changes (1970 to 2006), drought (1982 to 2009), and flooding (1985 to 2009) – which are then layered on top of population trends (1970 to 2010) and conflict data (1970 to 2005) in order to identify the region’s most insecure areas.
Composite Vulnerability
At first glance, the map can appear hard to decipher; it is flooded with different colors and symbols, each indicating something different about the extent of climate change, migration, and conflict in the region. A Google Earth version of the map (available for download here) makes all this information easier to process by allowing users to select which indicators they want to see mapped out, cutting back on the number of lines, dots, colors, and pie charts the user has to decode.
Given the vast amount of the information being condensed into these maps, the report is a helpful and worthwhile read. For instance, eight hotspots are in places with growing populations and another seven are located in places that have experienced conflict; altogether, 4 of the 19 hotspots have both past conflict and growing populations. The report digs deeper into the confluence of climate, conflict, and migration by discussing case studies that highlight how the three intersect in local communities (at the same time, the report is careful to avoid suggesting that there is a causal relationship between the three issues.). In Niger, Nigeria, and Chad, for example, tensions have been mounting between northern pastoralists and southern farmers as each group has moved further and further afield in search of water and arable land to sustain their livelihoods.
Holes In the Data
While the hotspot maps include a wealth of information, the report makes clear that it is by no means exhaustive. Rising sea levels are, for instance, a major impending threat to coastal populations in the Sahel, but only the downloadable Google Earth map – not the hotspot map in the report or the Google Earth map as presented online – incorporates this factor. Compounded with a skyrocketing population in the coastal areas – the coast between Accra and the Niger delta is expected to be “an urban megalopolis of 50 million people” by 2020, according to the report – an increase in sea levels could have a huge impact on the region’s stability.
The report also readily admits that the datasets for population trends and conflict have shortcomings. Population data is largely based on censuses, which both the report and its data sources (UNEP’s African Population Database and the Gridded Population of the World, version 3) acknowledge can be inconsistent in their accuracy. Additionally, after 2000, population data is based on projections rather than estimates, which, as last year’s update from the UN Population Division showed, have often proven inaccurate, particularly in sub-Saharan Africa.
Regarding conflict, the UNEP report is straightforward in admitting its limits. The report lacks data on small-scale conflict (fewer than 25 battle deaths, following the Uppsala Conflict Data Program’s threshold that separates conflicts from lower-level violence), even as it acknowledges that such conflict is “often the first to occur” when climate change threatens communities’ access to resources and livelihoods.
Ultimately, however, these maps give valuable data on specific locations that are uniquely vulnerable to trends in population, climate, migration, and conflict. They add focus to the conventional wisdom that climate change will impact the region’s stability, and, taken together, the maps and the report provide a valuable resource for scholars and policymakers attempting to craft adaptation policies that take into consideration these complex links.
Sources: Socioeconomic Data and Applications Center at Columbia University’s Earth Institute, UNEP, Uppsala Conflict Data Program.
Image Credit: UNEP. -
Securing a Sustainable Future: The Military Takes On a New Mission
›Ethan Goffman, SSPP Blog
By ECSP Staff // Wednesday, January 25, 2012The original version of this article, by Ethan Goffman, appeared on the Sustainability: Science, Practice, and Policy blog.
In a time of polarized politics in the United States, over the environment and just about everything else, an overlooked development is how much the military, as well as the national security apparatus, has taken on climate change and other environmental challenges. “Environment and Security” was thus a profoundly important choice of theme for the 2012 National Conference on Science, Policy, and the Environment, held last week in Washington, DC. With the early effects of climate change apparently already occurring, notably in an increase in natural disasters and in a new northwest passage through the Arctic, those responsible for our security can’t afford to sit around and engage in speculation that climate change is caused by sunspots or isn’t really occurring. It is the military’s job, after all, to take action against potential threats rather than getting immersed in domestic politics.MORE
The concern with climate change is the next step in a widening of the concept of security from strict military matters, to include such interrelated strands as food and water access, public health, and the environment. Much of the military has already acknowledged that armed force alone won’t make us safe. “Energy security, economic security, environmental security, and national security are all inextricably linked. Address one and you need to think of the others,” explained Vice-Admiral Dennis McGinn at the conference.
One obvious linkage is the connection of our oil dependency with security risks that can easily draw us into conflict in politically unstable parts of the world. Just how much the recent wars in the Middle East are about oil, and how much about a clash of civilizations, is a matter of considerable debate, although undoubtedly both factors play a part. The Iranian threat to close the Strait of Hormuz, choking outgoing oil deliveries, underscores vulnerability on the energy issue. From another angle, in Afghanistan, the military experienced the fragility of supply lines for a force strongly dependent on large quantities of oil. The Air Force, in particular, is working on algal jet fuel to free us from such reliance. And the Navy’s need for more icebreakers and other capacity shows concern regarding shipping and resource exploitation enabled by the melting of Arctic ice and the new passage.
Continue reading on the SSPP blog.
Photo Credit: Sherri Goodman and Rear Admiral Neil Morisetti, courtesy of Sean Peoples/Wilson Center. -
Dot-Mom / From the Wilson Center:
Delivering Solutions: Advancing Dialogue to Improve Maternal Health
›By Emily Malkin // Tuesday, January 24, 2012“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:- Calyn Ostrowski presentation
- Video
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From the Wilson Center:
New Research on Climate and Conflict Links Shows Challenges for the Field
›By Theresa Polk // Monday, January 23, 2012“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.
Levy spoke at a December 19 panel at the Wilson Center on new research on the linkages between climate change and conflict. He was joined by Joseph Hewitt, technical team leader for USAID’s Office of Conflict Management and Mitigation; Joshua Busby, assistant professor at the Lyndon B. Johnson School of Public Affairs, University of Texas at Austin; and Solomon Hsiang, postdoctoral research associate at Princeton University’s Woodrow Wilson School of Public and International Affairs.MORE
Linking El Niño to Civil Conflict
Princeton University’s Solomon Hsiang recently co-authored a study published in Nature that used statistical analysis to link observable changes in the global climate to conflict outcomes on the ground. The researchers looked at countries strongly impacted by the El Niño/Southern Oscillation and compared the onset of civil conflict in those countries during El Niño, relative to the La Niña state.
“[El Niño] is the single dominant pattern of the entire planet’s climate on annual timescales,” said Hsiang. “So what is convenient here from a statistical standpoint is that the climate is going back and forth very rapidly…so there haven’t been major socio-political changes over that time horizon.”
The study found that conflict risk for a given region doubled during the hotter and drier El Niño state, from an average of around three percent to six percent. “You can make a variety of different assumptions about what kind of statistical model you are using and you generally always get the same estimate,” said Hsiang. “The correlation between the global climate and conflict seems to be very, very robust to a variety of choices…It’s one of the most robust results I have seen in any of the statistical literature.”
Nevertheless, “our study doesn’t say anything about why El Niño might be linked to conflict,” Hsiang clarified. “We are just showing an association. Climate is not the only thing driving conflict in these countries…it exacerbates an existing problem.”
Identifying Chronic Vulnerability in Africa
Working at the University of Texas at Austin, Josh Busby presented the Climate Change and African Political Stability program, a composite index mapping climate security vulnerability in a region with rising strategic significance and low adaptive capacity. The index incorporates not only physical exposure but also demographic, socio-economic, and political indicators.
“We focus on situations where large numbers of people could be exposed to mass death from climate-related hazards,” said Busby. He identified southern Somalia, South Sudan, and much of the Democratic Republic of the Congo as among the most vulnerable regions, relative to the rest of Africa.
These areas might not necessarily appear as the most vulnerable from a strictly climatic point of view, Busby said, but the composite analysis brings them into focus. For instance, many factors, including governance and a strong La Niña year, contributed to the famine Somalia experienced this year. Although the precise role of climate change is unclear, from a chronic vulnerability perspective, southern Somalia remains an area of concern, he said.
Understanding Pre-Existing Conditions in Vulnerable States
The Office of Conflict Management and Mitigation at USAID has commissioned research looking at the relationship between countries that are conflict affected, countries that are fragile, and countries that are highly vulnerable to climate threats, said Hewitt: “We wanted to better understand which countries are likely not to have the capacity, or likely not to have the ability, to manage the stresses and strains of climate threat.”
“[Fragile states] are already characterized by many, many different challenges that contribute to causes of conflict, just aside from climate change itself,” Hewitt pointed out. “Any understanding of the relationship between climate change and conflict needs to understand how climate change is in some sense filtered through all of these existing characteristics.”
On the other hand, many countries identified as highly vulnerable to climate change are not necessarily considered fragile. Despite the predicted changes in climate for these places, they have sources of conflict mitigation and resilience that will likely be able to handle the strains posed by climate change, Hewitt said. “We really want to try and understand what is happening in these countries. How are those countries positioned to confront those stresses, identify coping strategies, and adapt?”
“Any programming that is done to address the consequences of climate threats needs to be attentive to the connections between the program and any pre-existing characteristics that either mitigate conflict or in some sense make the society more vulnerable to conflict” said Hewitt.
Projecting Into the Future
Columbia University’s Marc Levy noted that a strong case for linking climate stress to increased risk of conflict can be made by better explaining the causal chain that leads from environmental change to societal stress. According to the 4th IPCC Assessment, climate change will increase stress on a number of biophysical processes and systems relevant to human societies, such as agriculture, water, ecosystems, and disease. A body of research shows that these natural stresses make societies more vulnerable, consequently increasing their risk of conflict.
Nevertheless, these conclusions are limited by data, according to Levy. Referencing Hsiang et al.’s study, he noted that “there are very few other things that you could measure in a large-end statistical global time series test than inter-annual variability and civil war.” And, importantly, climate change will alter the conditions that the study focused on. “By focusing on variability we know what happens to societies when you get variations around a mean, but we have almost no basis for figuring out what happens when the mean changes,” he said.
“I think we need to firm up our knowledge base by looking more explicitly at how these things operate in high-risk countries. And perhaps start thinking about some customized approaches that might be relevant in high conflict risk countries that wouldn’t necessarily be on the radar outside of those countries,” Levy concluded.
Event Resources:
Image Credit: Joshua Busby/Climate Change and African Political Stability Program. -
A Call for Young People to “Get Angry” About Global Warming
›John Donnelly, Global Post
By ECSP Staff // Wednesday, January 18, 2012The original version of this article, by John Donnelly, appeared on Global Post.
The elder called on the younger generation to speak up.
At a session on climate change and family planning Thursday, Mary Robinson, the former president of Ireland, said that she keeps hoping that more young people will demand action on global warming.MORE
“Maybe there’s a need to link the more thoughtful aspects of the Occupy movement with this, to get some of that more radical thinking,” she said. “As younger people increasingly understand the issues, I would say, ‘get angry’ so that we feel the need to do something more urgent. Let us know this is your future and for goodness sake it is absolutely urgent.”
She spoke at a session called “The Road to Rio: Climate Change, Population and Sustainability,” part of the Aspen Institute’s “7 Billion: Conversations that Matter” roundtable series (watch above). The discussion, organized by Aspen Global Health and Development, focused on strategies leading up to the Rio+20 United Nations Conference on Sustainable Development Summit in June – as well as what should be happening beyond Rio.
Continue reading on Global Post.
Video Credit: The Aspen Institute. -
ECSP at the 12th Annual NCSE Environment and Security Conference
›By Schuyler Null // Tuesday, January 17, 2012The National Council for Science and the Environment’s 12th annual Environment and Security Conference starts tomorrow at the Ronald Reagan Building with a high profile line-up of speakers and participants, including Rajiv Shah, Gro Harlem Brundtland, Lisa Jackson, Marcia McNutt, Amanda Dory, Sherri Goodman, and more.
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If you are attending, be sure to see ECSP’s own Geoff Dabelko on the opening plenary, “Integrating Climate, Energy, Food, Water, and Health,” at 9:30 a.m. tomorrow and the “Water and Conflict” symposium at 2:00 p.m.. We will also have a booth on the floor which we’d encourage you to swing by for more information on our work at the Wilson Center and upcoming events.
There are a host of panels on essentially every environment-security topic you can think of at the conference, so be sure to check out the full agenda for details. Follow our Twitter feed for updates and watch here for any news or interviews in the coming days too.Topics: NCSE 2012 -
Eye On:
Jon Barnett: Should Climate Change Be Addressed by the UN Security Council?
›By Schuyler Null // Thursday, January 12, 2012
For a small island state like Tuvalu, climate change is an enormous security issue and they have told the UN Security Council as much, said Jon Barnett, professor of resource management and geography at the University of Melbourne, in an interview with ECSP. But, despite debate in 2007 and 2011, the Council has been unable to reach agreement on whether climate change is an international security issue or not.MORE
“Eighty centimeters of sea-level rise, ocean acidification, and the warming of oceans is certainly a considerable threat to [Tuvalu’s] territorial integrity and would, within 50 or 60 years, significantly undermine…their ability to sustain the population of that country,” Barnett said.
But other countries are less willing to see climate change framed as a security issue because they believe there are higher order security issues to be worried about, he said. In addition, “they don’t necessarily believe that mobilizing the institutions of the Security Council is going to get an appropriate response to climate change.”
“There’s a lot of truth in the different arguments of different countries,” said Barnett. But “I think it is symbolically very important that the UN Security Council does recognize climate change as a security issue because it is for many countries in the UN system.”
“The question then becomes what are the practical applications of the Security Council recognizing climate change as a security issue?” Barnett said. “You have to ask if an additional workload into the Security Council is going to come at cost to the existing workload – weapons of mass destruction, keeping a watching eye on civil conflicts and issues of genocide…it would be a pity if adding climate change into the work of the Security Council would undermine its effectiveness on those other very important issues.”
One solution, said Barnett, would be to create an institution that is appended to the Security Council or General Assembly that has responsibility for strategic thinking about climate change and security issues around the world and informs the General Assembly and the Security Council about ongoing trends and thinking. This proposal would provide support for those member states that are facing climate-related security issues while freeing the Security Council to focus on other things for the time being. -
Building Commitment to Family Planning:
Iran: A Seemingly Unlikely Setting for World’s Fastest Demographic Transition
›By Elizabeth Leahy Madsen // Wednesday, January 11, 2012This is the second post in a series profiling the process of building political commitment in countries whose governments have made strong investments in family planning. Read the first post, on Rwanda’s recent rapid demographic changes, here.
To date, only 11 countries outside of the developed world, China, and a handful of small island states have reached the end of the demographic transition, with fertility rates declining from more than four children per woman to replacement level or lower.* Of these, only two countries have completed the transition in 15 years or less – and both might surprise you. One is Cuba, whose government dispensed family planning services to its relatively small population in the 1970s through accessible primary health care facilities and legalized safe abortion eight years before the United States did. The other: Iran.MORE
Following the 1979 revolution, Iran’s new theocracy adopted a socially conservative, pro-natalist outlook. Half of the population lived in rural areas, which typically constrains access to health services. In addition, abortion was illegal in most circumstances. According to the UN, Iranian women had an average of 6.5 children each in the early 1980s and the population was growing nearly four percent annually, a rate high enough for it to double in 19 years.
But, by the early 2000s, Iran’s fertility rate had dropped below two children per woman. The swift changes can be attributed to the efforts of government officials concerned about meeting the employment needs of a growing population, supported by public health experts who wanted to rebuild the eroded family planning program.
A Dramatic Policy ShiftThe turning point came after the end of Iran’s eight-year war with Iraq in 1988. With military demands high – several hundred thousand people were killed during the war – population growth was viewed positively. But as the war ended, policy directives did an about-face.
Although public health officials had framed the need for reinvigorated family planning programs in health-related terms for years, the motivation for government officials to change policy appears to have been economic. The national budget agency informed the prime minister that after nearly a decade of conflict, the country lacked adequate funding to both rebuild and to meet the needs of its people. The prime minister responded quickly, directing that demographic factors be integrated into the new development plan and stating that “Iranians’ standard of living was being eroded by the growth of the country’s population.”
“Pragmatism Has Prevailed Over Pure Ideology”
After convincing their superiors, Iranian government officials who supported family planning faced the added challenge of garnering the backing of the influential religious establishment. Shortly after the revolution, Ayatollah Khomeini officially sanctioned the use of contraception, though his perspective was not universal among clerics. Once the prime minister decided to introduce a national family planning program, officials sought support from additional religious authorities. Opposition was minimal after two key institutions offered endorsements. The High Judicial Council determined that there was “no Islamic barrier to family planning” in late 1988, and the Expediency Council approved the government’s plans soon after.
By late 1989, a new family planning program had been officially introduced. The program’s aims were to lengthen spacing between births; limit pregnancies in the early and late reproductive years; and lower fertility by educating the population and ensuring access to free and diverse contraceptive methods. By the mid-1990s, the government had fully integrated family planning into the existing primary health system.
Iran thus followed the example of other majority-Muslim countries where religion was not an impediment to family planning, including Egypt, Indonesia, Jordan, and Oman. Just as in countries where highly Catholic populations have low fertility rates (Italy, Poland, Spain, and many others), religious guidance has been interpreted in varying ways in different settings and is not necessarily a central factor in individual fertility decisions. As Akbar Aghajanian and Amir H. Merhyar write in a summary of Iran’s family planning program, “Pragmatism has prevailed over pure ideology when necessary.”
The Contributions of Women’s Education and a Strong Health System
A new policy orientation was the critical first step, but successful implementation was necessary for Iran’s demographic trajectory to change in response. Fortunately, the government had some advantages in rolling out its new program, namely a strong existing health system, a history of past efforts to promote family planning, and an educated female population among whom demand for contraception was high.Rural development became a priority of the government after the revolution and resulted in improved access to an array of services. In rural areas, community health workers receive two years of training to provide family planning services along with other preventative care and treatment. Services are also available at rural health “houses,” urban clinics, and higher-level centers around the country.
The status of women has also played a major role. A research exercise conducted by IIASA estimated that improvements in educational attainment among women were responsible for about one-third of Iran’s fertility decline between 1980 and 2005. Women’s literacy was already rising during the period of the revolution and reached 74 percent by 1996, while attitudes toward female employment became more supportive. By the late 1990s, new classes of university students included more women than men. The response to the 1989 program indicated that women clearly had an unmet demand for family planning. Use of modern contraception jumped from 31 percent in 1989 to 51 percent just five years later, then rose more slowly over the subsequent decade.
A Dividend Squandered?
The rapid changes in Iran’s age structure, thanks to declining fertility, have opened a window of opportunity for the country to boost economic growth through lower dependency ratios – a phenomenon called the demographic dividend. However, the dividend is not an automatic bonus, and Iran’s capacity to capitalize on its demographic change is questionable.
The unemployment rate among young people today is over 20 percent, indicating that the economy is not generating sufficient jobs, which is a prerequisite to improving productivity. This inopportune climate may even contribute to a further decline in the fertility rate: Some observers have suggested that the country’s economic troubles and rising costs of living have motivated young people to delay marriage and have smaller families. “Unemployment and high costs of living, coupled with social and political restrictions, have made [life] increasingly difficult for young Iranians,” Farzaneh Roudi of the Population Reference Bureau (PRB) explained in a blog post last year.
Given Iran’s challenges in producing adequate jobs and other economic benefits for its population, President Mahmoud Ahmadinejad’s recent unusual pronouncements on population issues are especially puzzling. Last year, Ahmadinejad introduced a pro-natalist policy offering direct payments to each child born, continuing until they reach adulthood, and later suggested that girls should marry at age 16 or 17.
But despite a high level of international media attention, most observers expect the policy to have little impact. Widespread adoption of family planning has become entrenched in society: 60 percent of Iranian women now use a modern contraceptive method. As PRB’s Roudi wrote in response to Ahmadinejad’s proposal, “Iranian women and men have gotten used to exercising their reproductive rights and would expect to be able to continue to do so.”
*The 11 countries that have achieved replacement fertility or lower outside of developed regions, China, and small island states are Brazil, Chile, Costa Rica, Cuba, Iran, Lebanon, Myanmar, Thailand, Tunisia, and the United Arab Emirates.
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.
Look for related analysis on the political implications of Iran’s changing age structure by Richard Cincotta on New Security Beat soon.
Sources: Abbasi-Shavazi, Lutz, Hosseini-Chavoshi and Samir (2008), Abbasi-Shavazi (2002), Aghajanian and Merhyar (1999), Christian Science Monitor, GlobalSecurity.org, The New York Times, Noble and Potts (1996), Population Reference Bureau, Roudi-Fahimi (2002), UN Population Division, World Bank.
Image Credit: “بیست و پنجم خرداد ۸,” courtesy of flickr user Recovering Sick Soul (Nima Fatemi); charts arranged by Sean Peoples and Elizabeth Leahy Madsen. -
Assessing Africa’s Youth Bulge
›Marc Sommers, Woodrow Wilson Center
By ECSP Staff // Monday, January 9, 2012The original version of “Governance, Security, and Culture: Assessing Africa’s Youth Bulge,” by Marc Sommers, first appeared in the International Journal of Conflict and Violence, Vol. 5 (2), 2011.
Although Africa has a youth-dominated population, African government policies are often not youth-centered and African governments and their international supporters are frequently under-informed about the priorities of most youth. Reliance on the “youth bulge and instability thesis” leads to distorted assessments of everyday realities. Examination of the lives, priorities, and cultural contexts of African youth, and the cases of youth in Rwanda and Burundi in particular, shows that the nature of relations between the state and massive populations of young, marginalized, and alienated citizens directly impacts the governance, security, and development prospects of African nations.MORE
Learning from Liberia
If ever there was a youth-dominated conflict in modern times, it was Liberia’s long and grueling civil war (1989-1996 and again in 2000-2003). Ignited by Charles Taylor’s Christmas Eve incursion from neighboring Côte d’Ivoire late in 1989, together with perhaps one hundred other men, the conflict soon took the form of youth-led chaos. “What initially was seen as a revolution…fought with sticks and cutlasses,” Mats Utas writes, “was eventually transformed into a war of terror where young people started fighting each other” (2005: 55). In fact, some youth continued to view the war as their revolution, for as long as they were able to take advantage of the opportunity that armed conflict afforded. The civil war provided them with “a chance to become someone in a national system that had marginalized them, but also a chance to get rid of the load of work and expectations that the parental generation had laid on them” (65). Some of the more successful young soldiers, sometimes goaded by their girlfriends, “felt so affluent that they could wash their cars in beer – a beverage most could not even afford to drink prior to the war – and that they could drive a car until it ran out of gasoline and then just dump it for another one” (66). The result was a war that wreaked colossal destruction. By 1997, civil war had already left a nation of perhaps two and a half million with up to 200,000 dead, 700,000 refugees, and much of the remaining population internally displaced (Utas 2008: 113).
The region of sub-Saharan Africa has the most youthful population in the world. Of the 46 countries and territories where at least 70 percent of the population is under the age of 30, only seven are not in sub-Saharan Africa. With this in mind, one of the most striking aspects of contemporary Africa is how male African youth have so frequently been viewed as threats to their own societies. However, the view from below differs dramatically from the largely quantitative analyses from above and from outside the continent. Again, the Liberian example is illuminating. A nation long renowned for grasping leaders and withered government institutions has more recently provided truly upbeat signs of forward movement. That said, most youth continue to be left far, far behind. Fieldwork in rural Liberia uncovered a widespread fear of “rebel behavior youth” – youth who had assumed the attitudes of wartime combatants and became socially sidelined. Liberia’s post-war youth unemployment has been estimated at the astonishing rate of 88 percent. Taking all of this into account – a widespread sense of estrangement and social distance felt by many youth and an economic recovery that is passing most of them by – one could certainly argue that Liberian youth are among the world’s most peaceful populations.
Continue reading in the International Journal of Conflict and Violence.
Marc Sommers is a fellow with the Woodrow Wilson Center’s Africa Program and visiting researcher at Boston University’s African Studies Center.
Sources: Government of Liberia, Population Action International, Sommers (2007), Utas (2005 and 2008).
Photo Credit: “RPF rally in Gicumbi, Rwanda,” courtesy of flickr user noodlepie (Graham Holliday). -
Eye On:
Jon Barnett: Climate Adaptation Not Just Building Infrastructure, But Expanding Options
›By Kayly Ober // Friday, January 6, 2012
“I think it’s appropriate to think about [climate change] adaptation or investments in adaptation as investments to open up the range of choices available to people to deal with an uncertain future,” said Jon Barnett, associate professor of geography at the University of Melbourne, in an interview with ECSP. “In some circumstances it might be appropriate to build infrastructure and hard options where we’re very certain about the nature of the risk…but in other cases, expanding the range of choices and freedoms and opportunities that people have to deal with climate change in the future is perhaps the better strategy.”MORE
For example, providing education, especially for girls, would allow individuals to better negotiate the world and labor markets; installing renewable energy systems in areas lacking electricity would greatly expand the choices for remote households; and altering immigration laws would allow more fluid movements of people.
“Communities and families where people are able to move have higher levels of consumption through remittances that people send back, they have greater connections through the world through the information that migrants send back, [and] they have very reliable forms of income,” he pointed out.
Barnett cited small-island states as positive examples of mobility as adaptation. On Tuvalu, remittances from young male seafarers on crewing missions for international shipping companies from North America and Europe account for three-quarters of the consumption of households, he said. They send home some $4 million a year in remittances or around 10 to 14 percent of Tuvalu’s entire Gross Domestic Product.
Kiribati has an innovative nursing program which provides a way towards “migration with dignity,” said Barnett. Australia’s foreign aid organization, AusAID, sponsors a special scholarship called the Kiribati Australia Nursing Initiative (KANI) which helps provide i-Kiribati people with marketable job skills and, unlike other job training programs, does not require the trained nurses to go back home – they are welcome to stay in Australia.
“Matching skills training with providing that to vulnerable populations in ways that matches gaps in labor markets is a smart strategy of improving capacity to adapt to climate change,” said Barnett. “And it’s a lot cheaper and likely to be much more effective than trying to pick winners in investing in significant infrastructure developments.”
Sources: Islands Business International.
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