“Part of the outflow of migrants from rural areas of many Latin American countries has settled in remote rural areas, pushing the agricultural frontier further into the forest,” writes David López-Carr in a recent article in Population & Environment, “The population, agriculture, and environment nexus in Latin America.” In a May 4 presentation at the LAC Economic Growth and Environment Strategic Planning Workshop in Panama City, Panama, he discussed how to integrate family planning and environmental services in rural Latin America.

“Family planning is to maternal survival what a vaccination is to child survival,” said Johns Hopkins professor Amy Tsui, quoting Khama Rogo of the World Bank, at the Woodrow Wilson Center event Maintaining the Momentum: Highlights From the Uganda International Conference on Family Planning on March 16. Rogo made the strong statement during the landmark November 2009 conference in Kampala, which has renewed interest in family planning and reproductive health among African leaders and development partners. Rhonda Smith of the Population Reference Bureau and Sahlu Haile of the David and Lucile Packard Foundation joined Tsui, the director of The Bill & Melinda Gates Institute of Population & Reproductive Health, to discuss their impressions of the Kampala conference and what it means for the future of family planning in Africa.

“An event that happened at the right time”

“Kampala was the work of a community,” said Tsui. More than 50 organizations—the U.S. Agency for International Development, the UN Population Fund, the World Bank, the World Health Organization, and the Gates and Packard Foundations—convened in Uganda, which was chosen not only for its central location, but also to highlight the country’s soaring unmet need for contraception—41 per cent—and rapid 3.1 percent population growth rate.

Panels focused on key issues in family planning, including:

• Integrating family planning into HIV/AIDS care
• Integrating family planning in post-abortion, postpartum, child, and other primary health care
• Expanding contraception delivery services by community health workers
• Increasing outreach to youth and men
• Capitalizing on private and public innovations in service delivery and financing

The conference also made a splash in the media. “If you want it to get a lot of media hype, you have to have someone ready to say ‘I’m giving money to X,’” said Tsui. Thus, the Johns Hopkins Bloomberg School of Public Health, David and Lucile Packard Foundation, USAID, and the Bill and Melinda Gates Foundation announced a new three-year, $12 million Advance Family Planning project to advance reproductive health and family planning efforts in regions with the greatest need—particularly, sub-Saharan Africa and Asia. The conference generated palpable excitement and renewed energy for family planning. Uganda was “an event that happened at the right time,” said Tsui. Conference organizers, who have been asked to replicate it in other parts of the world, are already looking for locations for 2011. The conference was not just a success in theory, but also in action, and several developments emerged in its wake:

• The United States announced its foreign assistance budget will increase support for family planning from $450 million to $715 million for the next fiscal year.
• The Global Health Initiative identified maternal/child health and family planning as one of its main priority themes.
• Secretary of State Clinton positively discussed girls’ education, family planning, and reproductive health at the ICPD + 15 anniversary.
• The Women Deliver 2010 Conference, to be held in June, has identified family planning as a third pillar of maternal health.

Uganda on the Move

Rhonda Smith’s presentation “Uganda on the Move”—which she also presented in Uganda—is a prototype of the Population Reference Bureau’s new ENGAGE (Eliminating National Gaps—Advancing Global Equity) project, which is designed to “engage policy audiences and promote policy dialogue around issues of high fertility and high unmet need for family planning and their costs, consequences, and solutions,” she said. By using stunning, innovative graphics and avoiding confounding technical terms, ENGAGE’s products are designed to reach non-technical policy audiences and influential decision-makers.

As one of the Uganda conference’s most talked about presentations, “Uganda on the Move” wows audiences with visuals created using Hans Rosling’s Trendalyzer software. The presentation shows that although Ugandans are increasingly healthier, have a higher life expectancy, and are more educated, maternal health remains in jeopardy. Tellingly, 46 percent of pregnancies in the country are unplanned, 6,000 women die each year from complications related to pregnancy, and 1,200 women die each year from undergoing unsafe abortions.

Maternal deaths, however, do not tell the whole story: For every one woman dying, Smith said, 20-30 women suffer from short-term disability, which places a major strain on economic growth. From 2004 to 2013, maternal death will cost Uganda US$350 million in lost productivity; and disability will cost and additional US$750 million.

What Next? The African Perspective

“After 10 years of virtual clandestine work, [family planning] is just coming out of the closet,” said Sahlu Haile. Over the last few decades, family planning advocates have been struggling to: 1) keep family planning alive—without it being affected by political considerations 2) make family planning a health priority, without any associations with rights violations; and 3) be in solidarity with pioneering organizations of the family planning movement, like the International Planned Parenthood Federation, that were victims of discriminatory funding decisions.

The Uganda conference changed all that, said Haile. In Uganda, conference attendees were “talking about family planning…not reproductive health, not maternal/child health.” This, he said, was “probably the single most important lesson…that I took from the Kampala conference.”

Following the conference, Haile said that African government officials stressed family planning as a priority at meetings in Ethiopia and Nigeria—the first time he had witnessed such high-level attention to family planning from those countries in his 30-year career.

In Ethiopia, African leaders pledged to:

• Prioritize family planning, since family planning is one of the most cost-effective development investments;
• Ensure access to contraception, as 40 percent of maternal deaths are associated with unwanted pregnancies; and
• Integrate MDG 5b, universal access to reproductive health, into their international development plans and budgets.

In Nigeria, West African ministers of health agreed that making abortion safe was essential to reducing maternal mortality. Across the board, at each meeting, family planning was discussed as “an investment, not an expenditure,” said Haile.

Haile credited the Kampala conference for spurring these efforts. In December, he joined a task force of 14 Ethiopian organizations to plan the next steps. They will jointly develop research capacities, generate evidence, and strengthen monitoring and evaluation practices, especially with regard to integrating population, health, and environment efforts. In addition, they will engage with wider audiences via new tools such as the blog RH RealityCheck and Gapminder Foundation’s Trendalyzer program.

Haile believes we need to “work together to encourage national-level efforts…to make sure family planning stays where it is now and make sure it is not abandoned.”

To be a part of the new online family planning community, join the Kampala Conversation.

Photo 1: A women and her children in Jinja, Uganda. Courtesy Flickr user cyclopsr. Photos of Amy Tsui, Rhonda Smith, and Sahlu Haile courtesy of Dave Hawxhurst, Woodrow Wilson Center.

When the dust settled at the COP15 in Copenhagen, participating parties failed to reach a formal climate change agreement and old divisions between developed and developing countries intensified. Despite such setbacks, there may be a natural building block in formal climate change negotiations between the north and south in the future: water.

Luis Alberto Moreno, president of the Inter-American Development Bank, argues in a recent LA Times op-ed that economic interdependence and, more concretely, basic survival hinge on water in both developed and developing countries alike, most especially in Latin America.

With 31 percent of the world’s freshwater resources, Latin America enjoys a competitive advantage in agriculture and energy. But recently, drought has taken its toll. Repercussions were most acutely felt in Argentina in 2008, when 1.5 million head of cattle died and half its wheat crop was ruined. Meanwhile, hydroelectric output in the most populous part of Chile plunged by 34 percent and water-dependent states like Venezuela, Ecuador, Colombia, Paraguay, and Mexico rationed water, cut power, or both.

Water’s importance in the region is obvious, but why should developed countries care about it when negotiating a climate deal? The simplest answer, according to Moreno, is that developed countries can invest in projects that resolve near-term, climate-related problems such as water supply and sanitation as they look for ways to spend the billions in aid they have just pledged for climate adaptation in the developing world. And many international donors, particularly the UN Development Programme, World Bank, and World Wildlife Fund already have invested millions of dollars towards water management and sanitation adaptation projects.

On the other side of the coin, Latin American governments should “start treating water as a truly strategic resource instead of a free and limitless one.” Moreno claims this would mean “prioritizing investments and reforms in basic services in order to reduce waste, closing the coverage gap and eliminating waterborne diseases among the poor” in the short term and would also require “a willingness to make concessions in pursuit of global emission reductions that…could be crucial to ensuring reliable supplies of water.”

While it may seem that Latin America’s water problems are not pressing, it is undeniable that if not properly managed, essential components of the region—such as the vital agricultural economy, the health of the population, and political and economic stability—may be in jeopardy.

Photo: Man drinking water from a pipe in Ecuador. Courtesy Edwin Huffman and the World Bank.

“Family planning is one of the biggest success stories of development cooperation,” said Bert Koenders, Dutch Minister for Development Cooperation, via video at a Wilson Center roundtable discussion on the future of family planning funding. Koenders was followed by representatives of three of the field’s largest donors, Musimbi Kanyoro, director of the David and Lucile Packard Foundation’s Population and Reproductive Health Program; José “Oying” Rimon, senior program officer for Global Health Policy and Advocacy at the Bill and Melinda Gates Foundation; and Scott Radloff, director of USAID’s Office of Population and Reproductive Health.

Many see wind as a great source of green energy, but some local communities around the world are seeing red. Specific cases in the United States and Mexico—two countries that are now investing heavily in wind energy—highlight the potential for community opposition to wind farms in the rural areas where they are being built.

A graphic published recently in Le Monde reveals that companies from South Korea, China, Saudi Arabia, and the United Arab Emirates (UAE) are the top purchasers of foreign farmland. These corporations from water-strapped, land-starved, and/or densely populated countries often make bargain-basement deals with unsavory African and Asian governments—or even warlords—to increase their own profits and their home nations’ food security.

A case in point: The International Criminal Court’s indictment of Sudanese President Omar al-Bashir for human-rights abuses has not deterred Saudi Arabia’s Hail Agricultural Development Co. from developing 9,200 hectares of land in Sudan or the UAE from investing in agricultural projects in several Sudanese provinces, including a 17,000-hectare farm for wheat and corn.

As previous New Security Beat posts have pointed out, allowing foreign governments to purchase land could threaten food security within the host country, and around the world. The heads of the Food and Agriculture Organization and the International Fund for Agricultural Development raised eyebrows last weekend when they suggested that these deals could be “win-win” situations, if done right.

These business ventures can also have serious political consequences: Several months ago, seeing an opportunity to capitalize on increasing population growth and limited arable land in its homeland, South Korean conglomerate Daewoo signed a deal to buy more than half of the arable land in Madagascar to grow grain and palm oil. Widespread anger at the terms of the deal—from which the island’s people would gain little—contributed to then-President Marc Ravalomanana’s unpopularity. After weeks of riots, Ravalomanana was ousted by Andry Rajoelina, who immediately axed the deal. “In the constitution, it is stipulated that Madagascar’s land is neither for sale nor for rent, so the agreement with Daewoo is cancelled,” Rajoelina told BBC News.

Yet although Rajoelina’s actions may seem to have preserved Madagascar’s land for its people, the coup he launched has spurred unprecedented destruction of this land, in the form of deforestation. The breakdown of authority that accompanied the coup spread into Madagascar’s protected areas, where groups of thugs have been illegally felling valuable trees at a rapid rate since the coup. This environmental destruction is particularly tragic for a country like Madagascar, which possesses some of the richest biodiversity on the planet and relies heavily on ecotourism for jobs and economic growth.

Next month, a Wilson Center event will explore some of the motivations, patterns, and implications of this rush for farmland. Five Wilson Center programs are co-sponsoring this event—demonstrating the global, cross-sectoral implications of this issue.

Photo: Deforestation in Madagascar. Courtesy of Flickr user World Resources Institute Staff and Jonathan Talbot.