Showing posts from category global health.
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Carl Haub, Behind the Numbers
Republic of Congo Demographic and Health Survey Shows High Maternal Health, But No Fertility Decline
›June 5, 2012 // By Wilson Center StaffThe original version of this article, by Carl Haub, appeared on the Population Reference Bureau’s Behind the Numbers blog.
The Congo (Brazzaville) 2011-2012 Demographic and Health Survey (DHS) is the second DHS taken in the country and the preliminary report has just been released. The survey interviewed 10,819 women ages 15-49 and 5,145 men ages 15-59 from September 2011 to February 2012. A major finding of the survey was that fertility has not declined in the country since the previous DHS in 2005. The total fertility rate (TFR) report in the recent DHS for the three year period before the survey was 5.1 children per woman, 4.5 in urban areas, and 6.5 in rural areas. This appears to represent an increase in the TFR since 2005 but the survey report cautions that there is likely to have been some understatement of the actual level of childbearing in the 2005 survey, particularly among women ages 25-29.
Rural women accounted for two-thirds of those interviewed in the most recent survey. The rather high TFR is reflected in the desire for large families. Among women with five living children, only 37.3 percent said they did not wish to have additional children. An additional 9.8 percent of that group said they were incapable of conceiving, however.
In the survey, 44.7 percent of currently married or in-union women said that they were using some form of family planning and 20 percent were using a modern method. The most common type of modern method was the male condom at 12.3 percent, a rather unusual pattern of contraceptive use in Africa. That was followed by the pill at 2.9 percent and injectables at 2.8 percent. This continues the often-observed preference in sub-Saharan Africa for methods to space births, not necessarily to limit them. The use of modern contraception was 24.6 percent in urban areas and 11.7 percent in rural areas. Modern contraception rose since the 2005 DHS when it was reported at 12.7 percent and the condom was also the most frequently used method at that time. The prevalence of HIV was reported in the 2009 AIDS Indicator Survey at 4.1 percent for women ages 15-49 and 2.1 percent of men of the same age group.
Continue reading on Behind the Numbers.
Sources: MEASURE DHS.
Image Credit: Carl Haub/Population Reference Bureau. -
Bringing Environment and Climate to the 2012 Population Association of America Annual Meeting
›June 5, 2012 // By Sandeep BathalaOver 2,100 participants attended the 2012 Population Association of America (PAA) annual meeting in San Francisco this May. PAA was established in 1930 to research issues related to human population. This year, for the first time, the meeting featured a notable contingent of demographers, sociologists, and public health professionals working on environmental connections.
I followed as many of the environment-population discussions on newly published or prospective research papers as possible (about 20 in total). I found four papers particularly noteworthy for the connections made to women, family planning, and climate change adaptation.
Samuel Codjoe of the University of Ghana spoke about adaptation to climate extremes in the Afram Plains during one of the population, health, and environment (PHE) panels organized by Population Action International. Although developed nations are historically the major contributors of greenhouse gases due to comparatively high levels of consumptions, developing countries are the most vulnerable to the consequences of climate change – in part because of continued population growth. As a result, adaptation strategies in countries like Ghana are particularly important; and given women’s often-outsized role in water and natural resource issues, a focus on gender-specific adaptation even more so.
Codjoe presented an analysis of preferred adaptation strategies to flood and drought, broken down by gender and three common occupations – farming, fishing, and charcoal production). He said he hopes his assessment – part of a collaborative research effort with Lucy K.A. Adzoyi-Atidoh of Lincoln University – will aid in the selection and implementation of successful adaptation options for communities and households in the future.
“Understanding differences in the priorities that women place on adaptation may prove to be important in the effectiveness of climate change adaptation – and the sustainability of communities,” he said.
David López-Carr of the University of California, Santa Barbara, speaking on behalf of a group of researchers with World Wildlife Fund, teased out the gender dynamic further when he presented on ways to help the conservation sector determine next steps for existing PHE projects. Practitioners from seven of the eight PHE projects currently implemented by conservation organizations (defined by having been involved for at least three years in bringing family planning to local communities) recently said the links to women’s empowerment were among the most important aspects of successful projects.
López-Carr therefore emphasized the need for additional research on how PHE projects can support and empower women, both economically and socially. He also noted, like Codjoe, the potential impact women often have on the management of their community’s natural resources, saying this was another area where research on the empowering effect of PHE programs can provide further backing for integrated programs.
Karen Hardee of Futures Group spoke about how the experiences of integrated PHE projects, despite most not being designed to respond to climate change specifically, have lessons to offer climate change efforts. Her work was done in partnership with the Population Reference Bureau, Population Action International, and U.S. Agency for International Development. She concluded that community-based adaptation approaches should consider population dynamics in vulnerability assessments. Meeting unmet need for family planning, she said, can assist communities adapting to climate change by building resilience. And as result, “PHE approaches should be able to qualify for funding under community-based adaptation programs.”
Shah Md. Atiqul Haq of the City University of Hong Kong presented research he conducted in Bangladesh that found that women tended to feel that a large family size was not advantageous during floods. This, he said, was indicative of their increased understanding of vulnerability and an endorsement of providing knowledge and access to family planning services as part of climate change adaptation strategies.
The inclusion of more environment, and particularly PHE, related presentations at this year’s conference was good to see – perhaps a sign that demography is becoming a more complex and comprehensive field, with a focus more on population structure and its interactions with other issues, rather than a singular fascination with growth.
In particular, panelists showed that the nexus between demography, gender equity, and climate change continues to grow in importance, both in the research and practitioner communities.
Photo Credit: Tribal women and children in Kerala state, India, courtesy of flickr user Eileen Delhi. -
USAID’s New Global Health Framework and Delivering Equity in Health Interventions
›USAID’s new Global Health Strategic Framework, Better Health for Development, lays out the agency’s major health priorities for the next five years. “Core global health priorities” include reducing maternal mortality, ensuring child survival and nutrition, fostering an “AIDS free generation,” and fighting infectious diseases. Family planning and reproductive health is listed as a key area for bilateral engagement. In particular, the strategy hopes to continue to “graduate” countries from the agency’s family planning program, which since the 1980s has transitioned 21 countries into local ownership of family planning support. The strategy also takes stock of the shifting global health environment, noting the rise of the “BRICS” countries as new donors and the need to strengthen public health systems in developing countries. “Already, private payments account for 50-80 percent of total health spending in Africa and Asia, leading to system inefficiencies, inequitable access, and health costs that prove catastrophic to individuals and families,” the report reads. In order to achieve its priorities within this context, the document sets out a number of strategies, including a focus on program sustainability, the empowerment of women, and integrated approaches to development. Health, it says, “cannot be isolated from other development challenges.”Speaking of health interventions, a team of researchers led by Aluisio Barros of the Federal University of Pelotas, Brazil, recently compared coverage data from more than 50 countries against an index of household wealth to estimate the most and least equitable interventions. The study, “Equity in Maternal, Newborn, and Child Health Interventions in Countdown to 2015: A Retrospective Review of Survey Data From 54 Countries,” published in The Lancet, found that “interventions with similar levels of overall coverage often have very different degrees of inequality.” According to the data, “the most inequitable indicator was skilled birth attendant, followed by four or more antenatal care visits, whereas the most equitable was early initiation of breastfeeding.” For example, though the average for attendance by a skilled birth attendant was 53.6 percent across the entire sample, the wealthiest fifth had an 84.4 percent coverage rate and the poorest stood at 32.3 percent. “Interventions that are usually delivered in fixed health facilities…tend to be the most inequitably distributed,” write the authors, with geographical access, financial barriers, and discrimination appearing as likely obstacles for the poor. The authors conclude that, although “concern about inequalities in maternal and child health in poor countries was conspicuously absent from the global agenda in the past,” the availability of new, intervention-specific data provides a means of targeting equity issues in health delivery more successfully. -
Philippines’ Bohol Island Demonstrates Benefits of Integrated Conservation and Health Development
›In March 2012, I participated in a study tour to the island of Bohol, near the unique Danajon double barrier reef ecosystem – the only one of its kind in the Philippines and one of only three in the Indian and Pacific Oceans. Nowhere is the connection between population dynamics and biodiversity more evident than in the Philippines, one of the most densely-populated countries on the planet, with more than 300 people per square kilometer. Nearly every major species of fish in the region shows signs of overfishing, according to the World Bank.
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“Afghanistan, Against the Odds: A Demographic Surprise” Launches ECSP Report 14
›A few months ago, Elizabeth Leahy Madsen broke down Afghanistan’s first-ever nationally representative survey of demographic and health issues in a two-part series here on the blog. Now, we’ve published her analysis in a rich new policy brief format. It is the first issue of Environmental Change and Security Program Report 14, the latest volume of ECSP’s flagship publication.
In “Afghanistan, Against the Odds,” Madsen examines the surprising results of this fall’s demographic survey and how the country’s statistics compare to neighboring Pakistan.
“Just as Afghanistan and Pakistan’s political circumstances have become more entwined,” writes Madsen, “their demographic paths are more closely parallel than we might have expected. For Afghanistan, given its myriad socioeconomic, political, cultural, and geographic challenges, this is good news. But for Pakistan, where efforts to meet family planning needs have fallen short of capacity, it is not.”
The publication of this brief marks the re-launch of ECSP Report as an online-only volume, with individual issues scheduled to be released throughout the year. Forthcoming ECSP Report 14 briefs will address the demographic roots of the Arab Spring; the links between population dynamics and environmental resources like water, biodiversity, and food; and the potential impact of climate change mitigation efforts on conflict.
Published since 1996 in hard copy and online, the new ECSP Report will now be available on the Wilson Center website, New Security Beat, and Issuu. You can read the previous 13 volumes of the ECSP Report on the Wilson Center website.
Download ECSP Report 14: “Afghanistan, Against the Odds” from the Wilson Center. -
Adenike Esiet: Building Support for Improving Adolescent Sexual and Reproductive Health in Nigeria
›“In Nigeria, young people under the age of 25 are driving the HIV epidemic…and that’s been the opening place for people to begin to say, ‘let’s address the issues of young people’s sexual and reproductive health,’” said Adenike Esiet, executive director of Action Health Incorporated in Lagos, during an interview with ECSP.
On any number of health indicators, girls suffer disproportionately. “For every one boy in the age bracket of 10 to 24 who is HIV positive, there are three girls who are HIV positive,” Esiet said. “Over 60 percent of cases of complications from unsafe abortion reported in Nigerian hospitals are amongst adolescent girls. In fact in literature, 10-15 years ago, this was described as ‘a schoolgirl’s problem’…and it’s still an ongoing problem.” She added: “And for girls too, the issue of sexual violence is huge. It goes largely unreported but it’s occurring at epidemic levels.”
Esiet spoke on an adolescent health panel during the April 25 “Nigeria Beyond the Headlines” event at the Wilson Center. Progress is slow on these issues, in large part because “there’s a whole lot of silence about acknowledging young people’s sexuality,” she said.
Adults “want to believe [adolescents] shouldn’t be sexually active.” But turning a blind eye to adolescent sexuality can mean that efforts “to provide access to education or services is hugely resisted by practitioners who should be doing this.”
Action Health works to fill the gap that emerges. “Our work covers advocacy, community outreach, and service provision for young people,” said Esiet.
“Our primary entry road in to work with young people is creating access to sexuality education and youth friendly services. And in the course of trying to do that, we have to do a whole lot of advocacy with government and also with ministries or education and ministries of health and youth development.”
The group has worked with government officials and agencies to establish a nationwide HIV education curriculum and paired with local healthcare providers to increase access to “youth-friendly” sexual and reproductive health services. Funding shortages and insufficient resources have hampered the curriculum’s success, though, and the pervasive attitude against youth sexuality has limited the reach of services, she said. Ultimately, “there are a whole range of issues that truly need to be addressed” for outreach efforts to be successful.
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John May, Center for Global Development
‘People and the Planet’ Study Re-Introduces Demography to Sustainability Debate
›May 15, 2012 // By Wilson Center StaffThe original version of this article, by John May, appeared on the Center for Global Development’s Global Health Policy blog.
Population issues have been conspicuously absent from the discussions on the environmental sustainability of our globalized economy in the run-up to the Rio+20 Conference on Sustainable Development, which will take place in Brazil, June 20-22, under the auspices of the United Nations.
Fortunately, the new report, People and the Planet by the Royal Society, should help change this woefully shortsighted approach. The report demonstrates clearly and convincingly that demographic trends cannot be separated from consumption patterns, and that there is no chance to achieve a path of equitable and sustainable development without tackling population growth and consumption at the same time. In short, population and the environment cannot and should not be considered as two separate issues.
This strong and long overdue pitch to bring back the “p” word into the environmental debate is most welcome. In recent decades, international attention has shifted from rapid population growth to other urgent issues, such as the HIV/AIDS epidemic, humanitarian crises, climate change, and good governance. But reproductive health and voluntary family planning programs are still very much needed, especially in high fertility countries, and they require political leadership and long-term financial commitment. Broader access to family planning services will be needed to accelerate the decline of high fertility rates, particularly in countries where unmet needs for contraception are high.
Continue reading at the Center for Global Development.
Image Credit: People and the Planet cover, courtesy of the Royal Society. -
Nigeria Beyond the Headlines: Demography and Health [Part One]
›“Nigeria is a country of marginalized people. Every group you talk to, from the Ijaws to the Hausas, will tell you they are marginalized,” said Peter Lewis, director of the African Studies Program at the Johns Hopkins University School of Advanced International Studies. Lewis spoke at an April 25 conference on Nigeria, co-hosted by ECSP and the Wilson Center’s Africa Program, assessing the country’s opportunities for development given its demographic, governance, natural resource, health, and security challenges. [Video Below]
