Showing posts from category *Blog Columns.
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Sex and Sustainability on the Road to Rio+20
›When it comes to the public conversation about sustainable development, we can’t tell the story with only half the world’s population. Women’s voices are key – and women must have a seat at the table. Earlier this week I was honored to join Musimbi Kanyoro of the Global Fund for Women and Carmen Barroso of International Planned Parenthood Federation to brief bloggers and reporters about the linkages between sex and sustainability. The three of us are heading down to the landmark Rio+20 conference to track the inclusion of reproductive health and rights in the sustainable development agenda.
Some highlights from our call:- Musimbi noted that though the linkages between the environment – particularly climate change – and reproductive health issues can be contentious, we must remember that we are talking about real people with real needs – not abstract ideas.
- Carmen argued that women’s health and rights should be included in the upcoming Sustainable Development Goals, because health is intrinsic to sustainability, and reproductive rights are intrinsic to health.
- Musimbi remarked that climate change, urbanization, energy, and food security are all connected to population, our planet, and reproductive health. She highlighted the need for an open discussion about these linkages, especially for the 200 million women who want access to family planning.
- I pointed out that development projects that address population, health, and environmental issues are making a difference in remote communities around the world.
Follow me to Rio+20 here on the blog and the New Security Beat Twitter feed.
Image Credit: Adapted from UNSCD 2012 official logo. -
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. -
Gidon Bromberg at TEDx on Peacebuilding Through Water in the Middle East
›“Cooperation over water is not a privilege, it’s a necessity,” said Gidon Bromberg, co-director of Friends of the Earth Middle East, in a TEDx talk at Yale. He sees the shortage of water in Jordan, Israel, and Palestine as an opportunity to bring these contentious communities together – even more so during this period of upheaval in the region.
Water woes have long contributed to regional tensions, said Bromberg. Water rights between Israel and Palestine were supposed to be settled during the Oslo accords in 1993, but negotiations were unsuccessful and water discussions were consequently left unfinished. The lack of formal negotiations caused each side to seize whatever resources they could Although Jordan was not part of the negotiations, it does share water resources with Israel and the West Bank and thus has been impacted by the lack of formal allocation processes. Both Jordan and Israel have diverted flow of the Jordan River into dams and irrigation projects. As a result, the Jordan River has lost 98 percent of its historic flow and the Dead Sea has lost one-third of its surface area.
Today, Israel has restricted Palestinian water use such that Palestinians have access to water only once a week in winter and once every three weeks in the summer, leading them to store water in containers on their roofs, Bromberg said. Though mismanagement is as much to blame as conflict, he notes, Palestinians chafe under the limitations.
Yet Friends of the Earth Middle East has used this difficult situation to educate the public, propose reforms, and build trust between Palestinian, Jordanian, and Israeli communities. Bromberg highlighted “fear of a small but vocal minority on both sides” as a key factor in preventing dialogue between the communities, but insists that water can bring people together. Neighboring communities have to work together, he said, “not because they’re best friends,” but to improve their own water situations.
Friends of the Earth provides that opportunity with their Good Water Neighbors project and hopes the trust built between communities extends beyond water issues as well. Since communities have strong motives to solve these problems, they work together more effectively than high-level politicians who may not be as apt to collaborate.
A positive update on the state of the Jordan River given in an interview with ECSP in October suggests that Bromberg may be on to something.
Sources: Amnesty International, Friends of the Earth.
Video Credit: TEDx. -
PHE and Community-Based Adaptation to Climate Change: Stronger Together
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Over the past several years, community-based adaptation has emerged alongside national and regional climate change initiatives as a strategic, localized approach to building resilience and adaptive capacity in areas vulnerable to climate change.
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Re-Thinking Price Shocks and Conflict?
›“Conflict, Food Price Shocks, and Food Insecurity: The Experience of Afghan Households,” a paper prepared for presentation at the Agricultural and Applied Economics Association’s annual meeting, examines the relationship between conflict and food prices, using Afghanistan during the 2008 global food crisis as a case study. By examining per capita food intake, numbers of fatalities and injuries, and the number of violent incidents in a given area, authors Anna D’Souza and Dean Jolliffe, of the U.S. Department of Agriculture and World Bank, respectively, determine that “at least in the case of Afghanistan, conflict does not seem to be the predominant driver of food insecurity.” Instead, inhabitants of conflict-prone regions, namely southern Afghanistan, consume more food, on the whole, than their northern compatriots. Residents of conflict areas do seem to be more affected by major food price increases, however these are fairly uncommon. D’Souza and Jolliffe speculate that this may be due to “interruptions in market access, inability to trade and barter, and worse food production and distribution systems.” These findings may be somewhat counterintuitive, but are an important resource for those seeking to reduce food insecurity in both conflict-prone and peaceful regions.In a working paper for the Center of Global Development, Samuel Bazzi and Christopher Blattman upend much of the established thinking on the relationship between commodity prices and conflict onset. Past researchers have found that lower prices of agricultural commodities lead to conflict as civilians have less to lose by rebelling against the government, and higher prices of resources like oil and minerals can lead to conflict as rebel groups have greater incentive to seize control. Contrary to these explanations, however, Bazzi and Blattman find “no evidence of a consistent, robust relationship between commodity price shocks and political instability.” Even when examining states with higher risks of conflict, like those which are particularly fragile, ethnically polarized, economically unequal, especially poor, and/or located in sub-Saharan Africa, they find no correlation between price shocks and conflict. The only evidence of a relationship they find is that rising prices lead to rising incomes, which can hasten the end of a conflict, but even this correlation is weak and varies from state to state. Though currently only a working paper, Bazzi and Blattman’s research provides an intriguing counter-narrative: “We argue that errors and publication bias have likely distorted the theoretical and empirical literature on political instability,” they write. -
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. -
Top 10 Posts for May 2012
›Laurie Mazur, Elizabeth Leahy Madsen, Tim Hanstad, and Musimbi Kanyoro topped the list last month. Integrated looks at development and security issues were popular in general, with looks at hotspots like Nigeria, Uganda, Yemen, Pakistan, Ethiopia, and India, and topics like land and water security all represented in the top 10.
1. Taming Hunger in Ethiopia: The Role of Population Dynamics
2. India’s Maoists: South Asia’s “Other” Insurgency
3. Yemen: Revisiting Demography After the Arab Spring
4. Guest Contributor Tim Hanstad: Poor Land Tenure: A Key Component to Why Nations Fail
5. Guest Contributor Musimbi Kanyoro: Women’s Rights and Voices Belong at Rio+20
6. The Global Water Security Assessment and U.S. National Security Implications
7. Uganda’s Demographic and Health Challenges Put Into Perspective With Newfound Oil Discoveries
8. Nabeela Ali on How PAIMAN Is Improving Maternal Health in Pakistan
9. In Search of a New Security Narrative: The National Conversation Series Launches at the Wilson Center
10. Nigeria Beyond the Headlines: Demography and Health [Part One] -
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.
