Showing posts from category From the Wilson Center.
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Urban Resilience: What Is It and How Can We Promote It?
›A new study on the intersection of violence and economic development in cities breaks new ground by examining how communities respond to and cope with extant violence, rather than focusing on the root causes of violence in a given area. Authors Diane Davis, Harvard professor of urbanism and development, and John Tirman, executive director of MIT’s Center for International Studies, spoke at length about the origins, methodology, and findings of the report, Urban Resilience in Situations of Chronic Conflict, at the Wilson Center on July 12. The report was supported by USAID’s Office of Conflict Management and Mitigation.
“We made the decision that we weren’t going to produce yet another research project or study on the root causes of violence, because there is a lot of incredibly good work on that [already],” said Davis. “We wanted to take a totally different angle…to try to think about taking a more pragmatic approach that builds on how everyday people, who live with violence, respond.”
To do this, Davis and Tirman focused their research on seven cities around the world with histories of chronic violence, creating a case study for each and then comparing results. (An eighth city, Karachi, was jettisoned because it was deemed too unsafe for research.) The comparative process allowed Davis and Tirman to develop a basic theoretical framework for how different factors increase or decrease a community’s resilience to violence.
Defining Resilience
The term “resilience” lies at the heart of the new study. “The idea of ‘bouncing back,’ or returning to normalcy, is [generally] the measurement standard for looking at resilience,” Davis said.
However, she was quick to point out the problems with such a simplistic definition. “[In] cities of the developing world…things are in flux. So it’s really hard to know what a ‘bouncing back’ is if things are constantly changing.”
“Also,” she added, “in many of the environments we were looking at, violence is a consequence of the way things were under normal conditions. So you don’t necessarily want to bounce back to those conditions that were producing the violence in the first place.”
Davis and Tirman sidestepped these problems by letting their research define successful resilience, rather than trying to fit their results to a prefabricated definition of the word. In doing so, they were able to identify several important commonalities in the cities and communities that displayed the most positive resilience to violence.
“Our findings suggest that resilience appears at the interface of civilian and state action,” Davis writes in the report. She underscored the significance of civilians as facilitators in both developing and implementing better security policies: “People who live in violence know more than academics or policymakers about what they can and can’t do to deal with the problem of violence,” she said.
Focus on Community
Davis and Tirman pointed out that the most successfully resilient cities they studied – Mexico City, Managua, and especially Medellín – seemed to have a number of civilian/state relationships defined “from below,” rather than the more problematic “top down” approach. This means that civilians and communities were participating on their own terms, collaborating with city planners and with law enforcement agencies to get their needs met rather than simply being what Davis called “yes men” to higher authorities.
Physical space – what Davis referred to as “the weight of the spatial” – also played a very significant role in Urban Resilience. She and Tirman made the conscious decision to incorporate physical planning and design into their research, eschewing the more typical sectoral approach to violence and security.
This methodological break from the existing literature was particularly useful in demonstrating that violence-plagued communities are often themselves the most important agents of resilience. “Citizens have to be able to make real decisions on their own,” Davis stressed in the Q&A; session that followed her and Tirman’s presentation. “[They] have to feel that ownership, that autonomy of the decisions in their neighborhood, even if they’re bad [decisions], because that’s what ties them to each other.”
“We think the starting point for generating resilience is really supporting and enabling communities to make dense horizontal relationships with others in their neighborhood, across sectors, that allow them to push back against perpetrators of violence.”
In other words, while the state can play a significant role in helping communities to mitigate violence, successful resilience ultimately requires the commitment and participation of the communities in question.
“The state might have a security program, it might have a planning program, but every decision has to be made with an understanding of what’s good for that particular neighborhood,” Davis said.
Places People Want to Protect
Davis was very succinct in offering recommendations based on the study. For policymakers and urban planners, she said resilience is formed by “a combination of good governance, security reform, and…inclusive urban planning.” Citing examples from Mexico City, Medellín, and elsewhere, Davis pointed to planning policies like mixed land use, greater pedestrian accessibility, and more parks and public spaces as ways that authorities could engender the kind of community pride so crucial to the development of positive urban resilience.
“[Focus on] generating vibrant public areas where people feel invested in protecting [them] and making them better,” she advised.
While many scholars have tended to look either at the state or local communities in isolation when considering violence and resilience, Davis argued that reducing violence was “a shared objective.” She thus stressed the importance of “co-production of security,” reiterating the overall notion that state and community actors need to work side-by-side in a form of what Davis and Tirman called “cooperative autonomy.”
In addition to Urban Resilience in Situations of Chronic Violence, Davis also authored the supplementary Toolkit for Urban Resilience in Situations of Chronic Violence. Both documents can be found on the MIT’s website. Davis and Tirman hope to add the seven individual case studies to the site soon.
Event Resources:Photo Credit: “Bogota at night,” courtesy of flickr user WanderingtheWorld (Christopher Schoenbohm); charts courtesy of Davis and Tirman. -
USAID Turns to Crowdsourcing to Map Loan Data
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The original version of this article, by Aaron Lovell, appeared on the Wilson Center’s Science and Technology Innovation Program Commons Lab blog.
On June 28, officials from USAID met at the Wilson Center to discuss a recent experiment in using crowdsourcing to help clean up and map data on development loans. The agency had 117,000 records on private loans made possible by their Development Credit Authority, which theoretically could be mapped and made available to the public. The problem? Location data for the loans was not standard and was difficult to parse. USAID decided to turn to “the crowd” and recruit interested volunteers from the Standby Task Force and GISCorps – two online volunteer communities – to help clean the data, making it available for additional analysis.
Shadrock Roberts, Stephanie Grosser, and D. Ben Swartley – all with USAID – discussed the results of the project. They were able to clean up the information at virtually no cost to the government, noting that they hope it will be an example for further collaboration between government and engaged volunteers.
“Our hope is that the case study will provide others in government with information and guidance to move forward with their own crowdsourcing projects. Whether the intent is opening data, increased engagement, or improved services, agencies must embrace new technologies that can bring citizens closer to their government,” the officials wrote in a recently released case study focused on the exercise. While the exercise resulted in high-quality output, Roberts et al. did provide advice for other agencies considering similar work. Grosser stressed the need to “crawl, walk, [then] run” – that is, start small with a few hundred records and then expand on that, as the system is refined.
But USAID sees crowdsourcing becoming a key part of improving government data. “We need to be working as hard to release relevant data we already have as we are to create it,” Roberts concluded, when discussing how the experience could apply more generally. “The crowd is willing to do research, data mining, and data cleanup.”
Sources: USAID. -
IPPF and Partners Connect Reproductive Rights With the Environment and Development
›A new framework for sexual and reproductive health is needed, argued panelists in a recent event at the Wilson Center, and the Rio+20 conference on sustainable development would have been the place to start. An international consensus around women’s human rights was developed at the International Conference on Population and Development in Cairo in 1994, but Carmen Barroso, director of the International Planned Parenthood Federation’s Western Hemisphere Region, said there has been slow implementation, little funding, and furthermore the world has changed significantly since then.
Barroso was joined by Latanya Mapp Frett, vice president of Planned Parenthood Global, as well as two representatives of Planned Parenthood partner organizations, Marco Cerezo of FUNDAECO and Ben Haggai of Carolina for Kibera.
New challenges to the reproduce rights landscape include the rapid spread of HIV/AIDS and decreased funding for international programs. But new opportunities include rapid dissemination provided by the internet and globalization and a subsequent mobilization of youth. “Young people are the largest cohort in history,” Barroso said in an interview with ECSP, both in absolute numbers and in percent of the population. “We have a historical opportunity [to incorporate] them in these decision-making processes.” Additionally, gender and health issues are incresaingly seen by many as linked with the environment and development.
Intersection of Health and the Environment
Marco Cerezo’s FUNDAECO (Foundation for Ecodevelopment and Conservation) is an example of Planned Parenthood’s partnership with other organizations. Based, in rural Guatemala, they shifted from primarily focusing on conservation and sustainable development to incorporating women’s health after finding a vicious cycle of poverty, high fertility, and environmental degradation in the places they worked.
Women’s health was so dire it was holding development back, Cerezo said. “Sustainable community development will not be possible without the education, empowerment, and support to rural women,” they write in their mission statement.
FUNDAECO now acts as a model for the intersection between reproductive health and the environment. Cerezo reported that once women are healthy and empowered through clinics established by FUNDAECO, they become more active in all aspects of the community, including ecological preservation.
Building Healthy Communities
Ben Haggai, who works in Nairobi’s biggest slum, Kibera, further reiterated the need for integrated programs. Carolina for Kibera has a number of programs to improve the quality of life for residents, he said, and has a particular focus on youth with sports associations and education programs.
Youth are the best reproductive health educators, Haggai said, as they are able to talk frankly with their peers. The NGO trains peer youth educators to reach out to community members about reproductive health and other issues like substance abuse. Since the young people work as volunteers, Haggai said, they are motivated only by a desire to improve their communities.
A Natural Intersection
Latanya Mapp Frett agreed that sexual and reproductive health aligns quite naturally with issues of sustainability. “We try to work in the countries overseas in Latin America and Africa where we focus particularly on non-traditional health sectors,” she said in an interview with ECSP following the panel. “One of those sectors is the environment.”
While emphasizing that contraceptive use is a cost-effective way to ensure sustainable development, Mapp Frett cautioned against framing sexual and reproductive health only in the context of reducing fertility. While this may have been common in the past, she noted, it’s important to ensure that women have the right to make childbearing choices for themselves.
Mapp Frett also urged policymakers in the United States to look to developing countries for intersections between development, the environment, and reproductive health. She said that Planned Parenthood’s partner organizations, including FUNDAECO and Carolina for Kibera, have found these connections and successfully partnered with already existing networks like churches to more effectively reach the community.
Translating Into Effective Action
Each member of the panel spoke about the challenge of articulating the need for sexual and reproductive health programs to people outside the field. Barroso mentioned research conducted by Brian O’Neill which found that meeting the current unmet need for contraception would slow population growth enough to reduce emissions by 17 percent.
Cerezo emphasized the importance of consensus among the staff of a given organization, saying it is difficult to make a case to agronomists and farmers if a culture clash exists within the institution. Haggai agreed, adding that focusing on reproductive issues is an important measure of prevention which helps protect both the environment and the health of women in a community.
For Mapp Frett, women’s reproductive and sexual health is indivisible from other aspects of development. “As you talk about sustainable development, you talk about ensuring that women are empowered to make sure that our earth is sustainable,” she said.
Assessing Rio+20
The panel took place before the UN Conference on Sustainable Development got underway in Rio. Participants had high hopes for a renewed focus on gender and reproductive rights at the conference. Unfortunately, language on reproductive rights was first weakened and then omitted entirely from the final outcome document (see the account written by ECSP’s Sandeep Bathala at Rio for more on the conference).
While pressure from the Vatican and the G-77 kept reproductive health out of the outcome document, it was not entirely forgotten at the conference. A number of side events highlighted the importance of reproductive rights, especially in the context of the environment and development.
Hillary Clinton also re-affirmed U.S. commitment to access to contraception and reproductive health care. “Women must be empowered to make decisions about whether and when to have children,” she said at the conference on Friday. “And the United States will continue to work to ensure that those rights are respected in international agreements.”
Clinton shared the urgency expressed by the panelists at the Wilson Center. “There is just too much at stake, too much still to be done,” she said. “We simply cannot afford to fail.”
Event Resources:Sources: FUNDAECO, UN Conference on Sustainable Development, U.S. Department of State.
Photo Credit: Sean Peoples/Wilson Center. -
Population Projections: Breaking Down the Assumptions
›“The seventh billion [person] was added in 12 years, and that could be the story for the eighth billion – and that gets people who think that growth has stopped,” said Carl Haub, senior demographer at the Population Reference Bureau. Haub was joined by Hania Zlotnik, former director of the UN Population Division, and Rachel Nugent of the University of Washington’s Department of Global Health on June 5 to speak about the assumptions behind the UN population projections. While each of the panelists noted the utility of projections, they also cautioned against seeing them as inevitable. [Video Below]
Meeting the Projections
As a former top official in the UN’s Population Division, Zlotnik spoke about how much is riding on the projections. “The experts tell me that to feed nine billion people, living better than the standards of living that we have today, one needs to increase agricultural production or all the production of food by about 70 percent and that is a challenge, but it might be feasible. But if the numbers go higher…I think it’s impossible,” she said.
The medium variant projection by the UN that gets the world to that nine billion figure is not a given – it builds in expected action on and improvement of many demographic indicators. Zlotnik pointed to the global unmet need for family planning, for example, which “is especially high in the high fertility countries,” and suggested that the current rate of increase in contraceptive use is insufficient.
She calculated the number of years it would take many of these countries to meet their unmet need at their current rate of uptake and found “the number of years for a lot of these poorer countries that have high fertility would be very long – 40 years, some of them, 80 years, 100 years – because the increased contraceptive prevalence has been so small.” At that rate, population growth in these countries will far surpass the UN medium variant.
The perception that population growth is no longer an issue contributes to the problem, Zlotnik said. People see that only 18 percent of the world population lives in countries with high population growth and assume “there’s no longer a population problem.” But she emphasized the power of exponential growth, arguing that even a small proportion growing at a rapid rate can have a large impact.
Questioning Assumptions
Haub pointed out several instances where assumptions in the methodology behind the projections create uncertainty.
For example, there is a lack of data in many low-income countries. “A date, let’s say 2000, 2005 – it’s the past, but it may be a projection. It may be based on a census in 1990,” he said. If it’s wrong, that error may not be corrected until another census, but it will still be relied on for country-level projections.
He also noted that certain assumptions about desired family size sometimes do not bear out on the ground. One of the key methods to slowing population growth is to provide women and couples with the means to choose how many children they wish to bear. But in many fast-growing countries, women wish to have large numbers of children. In Niger, for example, women say their ideal family size is over nine children. Such women are less likely to use contraception, no matter how accessible it is, as they value larger families.
“It has been – I guess conventional is a good word – to assume that birth rates are going to come down the way they did in the rich countries,” Haub noted. But there has been a “stall” for many developing countries, which he suggests is caused by fast initial uptake from urban women followed by much slower uptake by rural women. These dynamics, however, are relatively new and therefore are not always well incorporated into current projections.
The Economic Impact of Population Changes
While Haub and Zlotnik looked at the assumptions made before the projections are made and the importance and means to reach these projections, Nugent focused on the economic implications of lower fertility and the demographic transition.
She suggested that increased control over fertility can positively impact a country’s economy. Women are given the opportunity to “invest their time in acquiring skills and investing time in the labor market and that affects their earnings…[and] their ability to control resources and make decisions within the household” as they spend less time caring for children, she said.
The labor market changes as well, as fewer children are born into a given generation. This can reduce “demand on economic resources [and] demand on environmental resources,” and the increased investment in human capital allowed by smaller family sizes can lead to a healthier population.
Nugent concluded by pointing out key areas of intervention most likely to decrease both fertility and mortality and allow countries to reap the positive economic benefits of fertility decline. She suggested a focus on “complementary investments in education and health,” especially with regard to “poor and marginalized populations,” which can in fact impact the country as a whole. Finally, she recommended focusing on proven “evidence-based programs [and] service-delivery programs.”
Educating Policymakers
Each of the panelists cautioned against relying on population projections without taking action to make them come true.
“Maybe the best thing to do if you’re giving a presentation is to show the UN’s constant fertility variant first and scare people half to death and then say, ‘but if 117,000 things go right, [the medium variant projection] is what will happen,” said Haub, addressing the common tendency to view the UN projections as destiny.
Similarly, Nugent warned against viewing the demographic transition as inevitable. “There’s a certain sense…that [the demographic dividend] is kind of an automatic thing that happens, and that really has to be addressed,” she said, adding that “it’d be quite interesting to show some scenarios of what would need to be done…in order to get some benefits from that dividend.” (See also Elizabeth Leahy Madsen’s recent article on achieving the dividend.)
Zlotnik reiterated that the UN does not in fact know what the future will bring. “It’s not that we know what the world is going to do, but we hope that [the projections] will get the message out – if this doesn’t happen, you’re in trouble.”
Event ResourcesPhoto Credit: Sean Peoples/Wilson Center. -
Royal Society Launches ‘People and the Planet’ Study
›“This is a time of rapid and multifaceted change in both population and the planet,” said Parfait Eloundou-Enyegue, a member of the U.K. Royal Society’s People and the Planet working group and contributing author to the report of the same name launched at the Wilson Center on June 4. “The question that the report is trying to address is whether we can actually envision a world in which we can sustainably and equitably meet the consumption needs of seven billion people, and the more to come.” [Video Below]
The Royal Society is a self-governing fellowship of scientists that fosters research to address pressing social issues and better inform policy on a global scale. Eloundou-Enyegue, also an associate professor of development sociology at Cornell University, was joined by fellow working group member and African Institute for Development Policy Director and Founder Eliya Msiyaphazi Zulu to discuss their assessment of growing population and consumption pressures on global wellbeing.
Current Trends Are Unsustainable
“The current trends of global population growth and material consumption and the concomitant changes in the environment are unsustainable,” said Zulu.
On the population side, “you have changes that are affecting not just the size, the growth of the population, but also changes in family structure, in the population distribution, [and] population movement,” said Eloundou-Enyegue.
On the consumption side, “beyond the increase in consumption itself, there’s also a dramatic rise in aspiration,” he continued. “People are in greater contact and this tends to encourage…an increasing aspiration to mimic or to emulate the consumption standard of the more industrialized countries.”
Limits to Equitable Growth
When measuring consumption, which itself tends to be a misplaced barometer of wellbeing, according to Eloundou-Enyegue, there is a “disproportionate focus on GDP.”
Using GDP growth as a measure of consumption and wellbeing both “misses a lot of the economic production that’s not mediated through the market,” and “counts as positive things that are damaging to the planet,” he said.
The People and the Planet report marks a departure from the traditional consumption framework by asking “about the relevance of growth – is growth what we ought to be after?”
“The report tried to make a distinction between two types of consumption – the consumption of material resources and the consumption of goods and services – that are all relevant to wellbeing but have different implications for the environment,” Eloundou-Enyegue said. “So there is a need to think about how to shift or to favor consumption that is less damaging to the environment.”
Not an “Either-Or” Proposition
There is “a tendency to look at population and consumption when you’re addressing the impact of the environment in an either-or format, as if you had to choose either population as being the main culprit or consumption,” said Eloundou-Enyegue. “The reality is that they all have to be integrated and considered jointly.”
At the same time, there is “a tendency to shy away from population issues when you set development goals because they tend to be controversial,” he said. And yet, said Zulu, “there’s no question about it, the global population growth needs to be slowed down and ultimately stabilized for both people and the planet to flourish.”
The vast majority of future population growth is expected to come from Africa. Based on the United Nation’s medium variant projection, 70 percent of global population growth over the rest of the century will come from the continent.
That projection, however, belies a big assumption: “that the high fertility countries now will follow the same pattern in decline in fertility as the countries that have [already] achieved lower fertility had [in the past],” said Zulu, which “may actually not be the case.”
“You might actually find a situation where fertility might stabilize around three to four children in some of the…least developed countries,” he said, “and if that happens, it means that actually we stand a much, much bigger chance of getting to the high variant [of 15.8 billion by 2100] than we often tend to assume.”
In spite of that dire warning, however, Zulu said that “we should recognize that demography is not destiny, that through…appropriate socioeconomic and health policies and investment, we can actually slow down population growth.”
The report concludes that voluntary and non-coercive “reproductive health and family planning programs are urgently required,” said Zulu. “There is also a need for strong political leadership and financial commitment to make sure that these programs and services reach out to all women around the world who need them.”
Have We Missed the Boat Again?
Part of the urgency from the working group is because, so far, commitments to reproductive health appear to be falling short. It is the international community’s responsibility “to make sure that women have the contraceptives that they need in order to achieve their fertility aspirations,” said Zulu, but some of the most important agenda-setting events in global development over the past 20 years have sidelined population, reproductive health, and family planning.
The Millennium Development Goals, for instance, “tried to stay clear of population,” said Eloundou-Enyegue, even though “all the indicators that I see are either intrinsically demographic or have a strong demographic component.”
“If you think about stratification and the reproduction of inequality and poverty across generations and the role that differential fertility and reproduction plays, there’s no way you can sidestep population,” he continued. “If you’re talking about maternal mortality and child mortality…it doesn’t make sense to set population aside.”
Now, as the international community prepares for the upcoming Rio+20 summit, “there’s been a big struggle to get…consideration of population issues” on the agenda, said Zulu.
“Population is at the peripheral of all those discussions,” said Zulu. When in Nairobi for a preparatory conference earlier this year, Zulu said UNFPA Executive Director Babatunde Osotimehin “told me that he was quite alarmed that there was hardly any mention of population in all those discussions. And he asked me the question, ‘have we missed the boat again?’”
That concern reinforces the main argument of People and the Planet, said Zulu: there is an “urgent need to reduce material consumption of the richest, and increase consumption and healthcare for the poorest 1.3 billion people.”
“We’re talking about having the majority of people in the world being able to flourish, being able to lead decent lives.”
Event Resources:Photo Credit: “Market_Kampala, Uganda,” courtesy of the Hewlett Foundation. -
Africa on the Move: The Role of Political Will and Commitment in Improving Access to Family Planning
›Excerpted below is the adapted abstract, by lead authors Eliya Msiyaphazi Zulu and Violet Murunga. The full report is available for download from the Wilson Center’s Africa Program.
Despite commitments to the program of action for the 1994 International Conference on Population and Development and Millennium Development Goal 5 (focused on maternal and reproductive health), little progress has been made in improving access to family planning and slowing rapid population growth in Africa. Lack of political will has been highlighted among the key factors behind the lackluster performance in addressing these sensitive development issues. However, the situation is changing with some African governments embracing family planning as a key tool for improving child and maternal health, slowing population growth, preserving the environment, and enhancing broader efforts to alleviate poverty.
This study examines factors that have propelled the change in attitudes of some political leaders to champion family planning, assesses how such political will has manifested in different contexts, and explores how political will affects the policy and program environment. Mixed policy analysis methods were employed, including desk review of policy and program documents and stakeholder interviews conducted in Ethiopia, Malawi, and Rwanda – three countries that have made phenomenal progress in increasing contraceptive use in the recent past.
Lessons from this study will help galvanize efforts to improve access to reproductive health services in countries where little progress is being made. The results provide useful insights on the dawn of a new Africa where strategic political leadership is playing an increasingly valuable role in overcoming the continent’s longstanding development shackles. The study shows that political will is mainly changing due to increased availability of evidence showing that high population growth undermines efforts to alleviate poverty and hunger as well as investments in the quality human capital that least development countries desperately need in order to transform their economies.
The high sensitivity about childbearing and suspicions regarding the intentions of western development partners in promoting family planning in order to slow population growth are dissipating as more Africans are opting to have fewer children and demanding family planning. This study points to the need for global development partners to be much more cognizant of the drivers of Africa’s emerging success and focus their development assistance on enhancing, nurturing, and highlighting local leadership traits, capacities, and systems that are producing positive results, as well as support governments that have embraced family planning to ensure that no woman has an unwanted pregnancy due to lack of family planning.
Download the full report from the Wilson Center. -
Family Planning and Results-Based Financing Initiatives
›“Family planning means healthier moms and kids – and it’s good for development too,” said Lindsay Morgan, a senior health analyst at Broad Branch Associates, a healthcare advocacy group. But any number of hurdles can keep women from accessing family planning services. Morgan spoke at a May 21 discussion about results-based financing (RBF) programs, which aim to address hurdles on both the supply and demand sides of the equation in developing countries by incentivizing the provision of a variety of quality services while removing barriers to access for women in need of those services.
Removing Barriers to Providing and Using Family Planning Services
Incentives in RBF programs can come in a variety of forms – like subsidies or fees paid to clinics or vouchers sold to women, said Morgan. In Burundi, for example, under a pilot program rolled out across three provinces in 2006, health facilities receive payments for each patient that uses a modern method of contraception. In 2009, the government and international partners began scaling up the program to a nationwide level. In addition to expanding the program’s geographic reach, the scale-up incorporated new payment criteria to better incentivize quality of care (as opposed to just quantity) and longer-lasting methods of contraception.
Since the RBF pilot began, maternal and child health indicators have improved. The number of children being fully immunized is up, as is contraceptive prevalence, said Morgan. Additionally, those immediate results can lead to a slew of additional benefits down the line. For instance, improving modern contraceptive prevalence is one of the most cost-effective interventions available for reducing maternal death, she said.
In nearby Kenya, the health ministry leads a voucher system across four districts and two Nairobi slums to help some of the country’s poorest women afford maternal healthcare, family planning, and gender-based violence services.
The program is “written into large policy documents [and] strategic pieces,” including Vision 2030, a long-term government-wide strategy document “unveiled in 2008 as a way to reach middle-income country status by 2030,” said Ben Bellows, a reproductive health associate at Population Council Kenya. The government’s emphasis on the voucher program as more than just a health initiative is an acknowledgment of the downstream impact that improved maternal and reproductive health can have on the country’s development, he said.
“An Equity Gap in Family Planning”
However, the fact that the voucher program is needed at all is evidence of “an equity gap in family planning,” Bellows said. Access to family planning services can be significantly skewed depending on a woman’s income level, he said, pointing to a recent article in The Lancet assessing health inequalities in 12 different maternal and child health services across 54 priority Millennium Development Goal countries.
The equity gap reflects “an interesting problem with development,” said Bellows: Though low-income countries are converging with higher income countries, in terms of economic growth rates and income levels “the benefits of growth aren’t being evenly distributed.” The Africa Progress Panel’s annual report, released last month, echoes that point, he said.
“Governments are failing to convert the rising tide of wealth into opportunities for their most marginalized citizens,” the report concludes, and “unequal access to health, education, water and sanitation is reinforcing wider inequalities.”
Kenya’s voucher system is designed to help shrink that gap. Among the poorest of the poor – those benefitting from the system – inequalities are dropping, even if on a broader scale, inequity still exists between poor and wealthy Kenyans. “We’re seeing lower inequalities of service in areas exposed to the voucher,” said Bellows.
“RBF supports progress on a path towards universal health coverage,” said Beverly Johnston, the senior policy advisor at USAID’s Office of Population and Reproductive Health. And within the context of family planning “the whole idea is to level the playing field” so that all contraceptive methods are equally readily available to the women seeking them.
“A Catalyst for Change” in Family Planning
In addition to addressing equal access concerns, RBF programs can serve as “a catalyst for change…to stimulate quality of care and quality of family planning counseling in particular,” said Johnston.
A commonly cited hurdle to better family planning access is social norms that support large family sizes or otherwise limit a woman’s ability to space or limit her pregnancies. Given community health workers’ unique roles within their communities – “often on the front lines…where many of these social taboos and barriers exist,” as Morgan described – simply strengthening their training, and in turn improving the quality of care that women receive, can help counter norms that might otherwise prohibit access to family planning.
As more women receive higher quality care, norms dissipate even further, said Morgan. “There is evidence that [quality of care] is strongly associated with a woman’s decision to choose a method to use, to continue to use it, and to recommend it to others.”
“Rights Are Tantamount”
One trap RBF programs need to be aware of is over-incentivizing expansion of coverage to the detriment of quality or individual women’s concerns about what makes sense for them, said Johnston.
“Rights are tantamount,” she said. In order to ensure that rights are upheld, programs must reflect and be sensitive to local histories and local needs – particularly given the fact that some countries have had “a history of coercive programs and policies.”
Ultimately, “we really look at RBF as just one tool,” said Johnston. “RBF is not for every place and every context,” and neither is family planning’s place in RBF programming.
As one tool of many, RBF programs are gaining prominence as a way to meet MDGs related to maternal and child health. Bellows sees RBF’s importance lasting long past that 2015 deadline, though.
“The high inequity that we witness across many low-income countries, and the ability of targeted mechanisms [like Kenya’s voucher program] to address that, suggest that this may be a kind of generalized solution,” he said. “Obviously it will be context specific in the way in which it is rolled out, but the strategy of incentivizing clients and providers suggests that there’s some sort of globalized solution that could be considered for this widespread challenge.”
Event Resources
Photo Credit: Sean Peoples/Wilson Center. -
Comparing Urban Governance and Citizen Rights in China and India
›Today, according to Xuefei Ren, 129 cities in China and 45 in India have populations of over a million people. Such large-scale urbanization has created major governance challenges. Speaking at a May 23 Asia Program event co-sponsored with the Kissinger Institute on China, United States Studies, and the Comparative Urban Studies Project, Ren, a Wilson Center Fellow, examined two case studies of urbanization-driven governance in China and India and their effect on citizen rights.
Her first case study involved housing demolitions and urban re-development in Shanghai and Mumbai. In Shanghai, nearly a million households were relocated between 1995 and 2008 to make way for hotels, airports, and luxury apartments. City regulations in 1991 and 2001 legalized forced demolitions, and no prior consent from residents was needed.
However, Ren noted that displaced residents “are not quite powerless.” She highlighted the case of a woman who sued the city government after being relocated and was eventually granted the compensation she had requested. In 2003, China’s central government ordered a freeze on large-scale demolitions. Several years later, it passed a “landmark” property rights law.
Meanwhile, in Mumbai, local officials in the early 2000s had their own re-development plans. The Indian city is rife with overcrowded, low-income housing; slums are populated by seven million citizens (40 percent of the city’s total population), and comprise up to 10 percent of Mumbai’s total land area.
In 2004, aware that most of the slums were located in desirable areas – near airports or in central business districts – city planners recognized a major development opportunity. Over the next two years, officials launched a demolition campaign that left 400,000 people homeless. According to Ren, certain categories of residents were theoretically entitled to compensation, but with “legal protections carrying little weight,” most of them received nothing.
Yet, as in Shanghai, Mumbai’s city dwellers successfully fought back. Housing activists staged acts of “direct agitation,” including a series of street protests and road blockages. Such tactics, said Ren, were “disruptive but effective.” The Mumbai courts sided against the activists in 2006, but India’s Supreme Court later issued a ruling in their favor.
Fighting Land Acquisitions: A Comparison
Ren’s second case study compared land acquisition efforts outside the slums.
Last year, residents in Wukan, a village along China’s southeast coast in the province of Guangdong, launched a protest movement against land seizures. They alleged that government officials had sold their land to developers and failed to provide residents with appropriate compensation. The protestors made two demands: the return of their land and the holding of local elections.
Notably, Ren said, protestors in Wukan affirmed their support for the Communist Party, and never framed their movement as an anti-government effort. In March 2012, local elections were in fact held, with two leaders of the protest movement voted into office (one as village chief, the other as his deputy).
Ren also discussed an attempt by India’s Tata Motors corporation to acquire land in Singur, a village about 100 miles from Calcutta in the state of West Bengal. The company wanted to use this land to construct a factory for the Nano, a small, cheap car marketed to India’s urban middle class. In 2005, the West Bengal government, which had been controlled by the Communist Party of India-Marxist (CPI-M) for nearly 30 years, actively wooed the firm. State authorities “went overboard” in offering Tata Motors subsidies and highly fertile land, said Ren. Small landowners were obliged to surrender their plots at low prices, and in 2006 the corporation formally took over the land (nearly 1,000 acres altogether), despite heavy opposition from peasants.
However, violent protests continued and after several months, Tata Motors was forced to pull out of West Bengal. Then, in a state election in May 2011, the Trinomool Congress Party, led by the populist leader Mamata Banerjee, swept the CPI-M from power. Banerjee had run her campaign on a promise to restore the land to Singur’s farmers.
Just weeks after the new government assumed power, West Bengal passed a law that would allow for about 400 acres from the Tata Motors project to be returned to farmers who had refused government compensation for their land.
Ren acknowledged that in both countries, citizenship rights are not enjoyed by all and tend to be unevenly distributed across social groups. Still, she concluded, Chinese and Indian cities “have become strategic sites for reassembling citizen rights.” By asserting their land and housing rights, city denizens “are becoming active citizens.”
Michael Kugelman is a program associate with the Wilson Center’s Asia Program. He can be reached at michael.kugelman@wilsoncenter.org and on Twitter @michaelkugelman.
Photo Credit: Mumbai pipes, courtesy of flickr user lenskap.
