Showing posts from category *Blog Columns.
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Water as a Strategic Resource in the Middle East
‘Clear Gold’ Report From CSIS
›“The real wild-card for political and social unrest in the Middle East over the next 20 years is not war, terrorism, or revolution – it is water,” begins the CSIS Middle East Program’s latest report, Clear Gold: Water as a Strategic Resource in the Middle East, by Jon B. Alterman and Michael Dziuban.
The authors contend that with growing populations, groundwater depletion, not the more traditional questions about transboundary river governance, poses a “more immediate and strategically consequential challenge,” particularly because many Middle Eastern governments have deflated the true cost of water to help spur growth and garner popularity.
In the accompanying video feature above, much-troubled Yemen is outlined as one of the most at-risk countries for water-induced instability. The narrator notes that “with Yemen’s population growing fast and almost half of agricultural water going towards the narcotic leaf qat instead of food, experts think that Sanaa [the capital] could run out of water in seven years or less and the rest of the country may not be far behind.”
In an interview with Reuters in 2008, Yemeni Water and Environment Minister Abdul-Rahman al-Iryani said the country’s burgeoning water crisis is “almost inevitable because of the geography and climate of Yemen, coupled with uncontrolled population growth and very low capacity for managing resources.”
Yemen is a particularly abject example because water availability is only one contributor in a long list of domestic problems, including a large youth population, gender inequity, immigration from the Horn of Africa, corruption, ethnic tensions, and terrorism.
The narrator concludes that “Yemen is the most worrisome example but clearly not the only one.” Alterman and Dziuban also point to Jordan and Saudi Arabia as states vulnerable to groundwater depletion.
For more on the Middle East’s current and future environmental security issues, be sure to check out The New Security Beat’s “Crossroads” series, with features on Iraq, Israel, Jordan, Lebanon, Syria, and Yemen.
Video Credit: “Clear Gold: Water as a Strategic Resource in the Middle East,” courtesy of CSIS. -
Paradise Beneath Her Feet: How Women Are Transforming the Middle East
›Isobel Coleman, senior fellow for U.S. foreign policy at the Council on Foreign Relations, said she believes demographic changes are intensifying the notion that women’s empowerment is key to the growth and prosperity of the economies of Arab and Muslim-majority countries.
Coleman, author of the book Paradise Beneath Her Feet: How Women Are Transforming the Middle East, spoke at the Wilson Center in October, with Haleh Esfandiari moderating.
In addition to the Middle East’s demographics, Coleman also discussed how women in these traditional societies face challenges expanding their roles because women’s rights are often seen in a negative light. Coleman noted that things are changing, however, because women in the Muslim world are turning towards an Islamic discourse, which allows them to expand their rights within society’s religious framework. With this tactical shift and gradual gains in education, Coleman explained how women are slowly yet steadily transforming their societies.Coleman began her talk by focusing on the demographic changes in the region, noting that 50 percent of the Arab world’s population is under the age of 22. Furthermore, education was once the exclusive preserve of men in many Arab and Muslim states (in some cases, only decades ago). Today, however, women often constitute the majority of those enrolled in these countries’ educational institutions: Females outnumber males in Jordan’s secondary schools and constitute 70 percent of all university students in Iran. While the levels of educational attainment and achievement among women are increasing, normative and legal restrictions on their socioeconomic mobility remain. Coleman indicated that this contradictory scenario has led to greater opposition to impediments to women’s equality.
Coleman went on to address the tactics being used by the latest generation of reform-minded women in the Muslim world. She said today’s reformist women are more cognizant of the religious conservatism in their societies and are taking on religion in a way earlier feminists did not. By making feminist arguments from an Islamic perspective they avoid being “slandered” by conservatives and traditionalists as pro-Western or anti-Islamic. Coleman noted that some women adopt such a stance out of deep religious conviction, while others do it in the name of expediency. She indicated this new strategy of compromise has given more women influence in social affairs and led to significant engagement with governments.
With the advent of new social media and technology, women have become more visible and able to express their opinions about previously taboo gender-related issues. Female journalists and bloggers are more stridently supporting feminist discourses. Coleman mentioned Sweet Talk, the Arabic language equivalent of the American television show, The View, on which the female co-hosts have addressed topics such as polygamy, rape, incest, and the Saudi prohibition on women driving.
According to Coleman, these factors of change – demographic transitions, the role of media, and an awareness of growing extremism in society – are contributing to women making strides in the region and a “wearing away” of gender inequality in the Muslim world. Given the gains women have made so far, Coleman said she is “cautiously optimistic” for the future.
Luke Hagberg is an intern with the Middle East Program at the Wilson Center; Haleh Esfandiari is the director of the Middle East Program.
Photo Credit: Yemeni women in computer class, courtesy of flickr user World Bank Photo Collection, and David Hawxhurt/Wilson Center. -
New Insights Into the Population Growth Factor in Development
›“We have not found any country that has developed or gotten out of poverty while maintaining high birth rates,” said Martha Campbell, president of Venture Strategies for Health and Development. “Family planning is not a cost to a Ministry of Finance – it’s an investment,” said Malcolm Potts of the University of California Berkeley.
Campbell and Potts were joined by panelists Eliya Msiyaphazi Zulu, director and founder of the African Institute for Development Policy, and Jotham Musinguzi, director of the African Region at Partners in Population and Development, for a Wilson Center discussion of the implications of rapid population growth on human and economic development. [Video Below]
Africa’s Key Population Growth Challenges
“Africa’s population of one billion can reach between 1.8 and 2.3 billion by 2050, depending on how well the continent actually does in reducing fertility,” Zulu said. In 2010, Africa accounted for 15 percent of the total world population, but current estimates suggest this will grow to 23 percent by 2050.
“Rapid growth, young age structures, and urbanization are Africa’s main population challenges,” said Zulu. “Addressing these concerns is increasingly seen to be the key to the continent’s development prospects and realization of the Millennium Development Goals.” With 40 to 50 percent of populations in Africa under the age of 15, there is “high momentum for further population growth,” he said.
“Africa has a very high demand for fertility control, and the demand will undoubtedly increase,” said Zulu. “The main challenge, therefore, is not that of demand, but how to ensure those who are in need actually have access to contraception.” In many African regions, current rates of contraception use are as low as seven percent. In some areas, as many as 97 percent of women cannot afford the full cost of contraception, he said.
“It’s not just about reducing fertility,” said Zulu. Improving education and increasing labor force opportunities will not only help populations develop economically, but will also allow African countries to take full advantage of the demographic dividend, he said.
“The international development community should build on Africa’s success stories and support efforts to achieve universal access to family planning, expand public education on reproductive matters, improve the status of women, and improve the situation in urban settings,” Zulu concluded.
Family Planning and the MDGs
“Women are dying; children are dying. They shouldn’t be,” said Musinguzi. “By investing US$1 million in family planning, you can prevent 800 maternal deaths, 11,000 infant deaths, 14,000 deaths in children under five, and 360,000 unwanted pregnancies.”
“Women are clearly saying they have a need for family planning,” Musinguzi said. Presenting statistics from sub-Saharan Africa, he noted that 31 countries have a total fertility rate of more than five. Fourteen million unintended pregnancies occur each year, but only 25 percent of women use family planning. In Uganda, for example, the population has more than doubled in less than 20 years; women on average have more than six children each; and only 18 percent of married women use modern contraception.
“For a country trying to achieve the MDGs…the question of addressing total fertility rate is very important,” said Musinguzi. Reducing unmet need for family planning services can help African countries reduce the costs of achieving several of the Millennium Development Goals, including offering universal primary education; reducing child mortality; improving maternal health; combating HIV/AIDS, malaria, and other diseases; and ensuring environmental sustainability.
Policy Implications
“This is an urgent message – waiting 10 years to get family planning back on the international agenda will be enormously costly,” Potts said. “Of all the medical interventions that exist, contraception is the single most powerful. It is the only one that can have an impact on maternal and infant mortality, on the autonomy of women, on economic progress, on social stability and the rate at which we destroy the environment,” he said.
“Education and family planning are the driving mechanisms of development – they’re synergistic,” said Potts. “One of our needs is to get economists, family planning, and development experts on the same page.”
Sources: Guttmacher Institute, Population Action International, Population Reference Bureau.
Photo Credit: Untitled, courtesy of flickr user stttijn. -
End of the Year Edition: Top 10 Posts for 2010
›The New Security Beat’s 2010 top ten (measured by unique pageviews) included guest contributions from Marc Levy, Todd Walters, and the UK’s Royal Society, a post by West Point Cadet Marie Hokenson, a video feature with Peter Gleick, and posts on global enviro-security hot spots Afghanistan, India, the Democratic Republic of the Congo, and Yemen:
1. Watch: Peter Gleick on Peak Water
“The concept of ‘peak water’ is very analogous to peak oil…we’re using fossil groundwater. That is, we’re pumping groundwater faster than nature naturally recharges it,” says Peter Gleick in this short expert analysis from the Environmental Change and Security Program. Gleick, president and co-founder of the Pacific Institute and author of the newest edition of The World’s Water, explains the new concept of peak water.
2. Copper in Afghanistan: Chinese Investment at Aynak
Will new investments by the Metallurgical Corporation of China (MCC) in the Aynak copper mine break Afghanistan out of its poverty trap? Will future revenues from the subsoil assets in Logar Province bring peace and stability to the ongoing conflict?
3. DRC’s Conflict Minerals: Can U.S. Law Impact the Violence?
Apple CEO Steve Jobs, in a personal email posted by Wired, recently tried to explain to a concerned iPhone customer the complexity of ensuring Apple’s devices do not use conflict minerals like those helping to fund the civil war in the Democratic Republic of Congo. However much one might be tempted to pile on Apple at the moment, Mr. Jobs is on to something with regard to the conflict minerals trade – expressing outrage and raising awareness of the problem is one thing but actually implementing an effective solution is quite another.
4. India’s Maoists: South Asia’s “Other” Insurgency
The Indian government’s battle with Maoist and tribal rebels – which affects 22 of India’s 35 states and territories, according to Foreign Policy and in 2009 killed more people than any year since 1971 – has been largely ignored in the West. That should change, as South Asia’s “other” insurgency, fomenting in the world’s largest democracy and a key U.S. partner, offers valuable lessons about the role of resource management and stable development in preventing conflict.
5. On the Beat: Climate-Security Linkages Lost in Translation
A recent news story summarizing some interesting research by Halvard Buhaug carried the headline “Civil war in Africa has no link to climate change.” This is unfortunate because there’s nothing in Buhaug’s results, which were published in the Proceedings of the National Academy of Sciences, to support that conclusion.
6. Guest Contributor Todd Walters: Imagine There’s No Countries: Conservation Beyond Borders in the Balkans
International peace parks have captured the imagination of visionaries like Nelson Mandela, who called them a “concept that can be embraced by all.” Such parks—also known as transboundary protected areas—span national boundaries, testifying to the peaceful collaborative relationship between neighboring countries and to the co-existence of humans and nature.
7. Restrepo: Inside Afghanistan’s Korengal Valley
Restrepo, the riveting new documentary film from Tim Hetherington and Sebastian Junger, follows a platoon of U.S. soldiers deployed in the dangerous Korengal Valley of Afghanistan. As a cadet at West Point majoring in human geography, I was fascinated to watch the ways the soldiers confronted and adapted to the challenges posed by the local culture of the remote Afghan community surrounding their outpost.
8. UK Royal Society: Call for Submissions: “People and the Planet” Study To Examine Population, Environment, Development Links
In the years that followed the Iranian revolution, when Ayatollah Khomeini returned from exile to Tehran and the country went to war against Iraq, the women of Iran were called upon to provide the next generation of soldiers. Following the war the country’s fertility rate fell from an average of over seven children per woman to around 1.7 children per woman – one of the fastest falls in fertility rates recorded over the last 25 years.
9. Demographics, Depleted Resources, and Al Qaeda Inflame Tensions in Yemen
A second spectacular Al Qaeda attack on Yemeni government security buildings in less than a month is a worrisome sign that the terrorist group may be trying to take advantage of a country splitting at the seams. U.S. officials are concerned that Yemen, like neighboring Somalia, may become a failed state due to a myriad of challenges, including a separatist movement in the south, tensions over government corruption charges, competition for dwindling natural resources, and one of the fastest growing populations in the world.
10. Eye on Environmental Security: Visualizing Natural Resources, Population, and Conflict
Environmental problems that amplify regional security issues are often multifaceted, especially across national boundaries. Obtaining a comprehensive understanding of the natural resource, energy, and security issues facing a region is not fast or easy.
Photo Credit: Collage from individual posts (left to right, top to bottom): Peter Gleick courtesy of ECSP’s Youtube channel; “Yemen pol 2002,” via Wikimedia Commons courtesy of the U.S. Federal Government; “Mutual support,” courtesy of flickr user The U.S. Army; “KE139S11 World Bank,” courtesy of flickr user World Bank Photo Collection; “Mineral and Forests of the DRC” from ECSP Report 12, courtesy of Philippe Rekacewicz, Le Monde diplomatique, Paris, and Environment and Security Institute, The Hague, January 2003; IPPE/Cory Wilson; “Environmental Issues in the Northern Caspian Sea,” courtesy of the Environment & Security Initiative; “Wandering Aesthetic” courtesy of flickr user Wen-Yan King; and “River and Mountains of Logar,” courtesy of flickr user AfghanistanMatters. -
Top 10 Posts for December 2010
›Pop Audios from Roger-Mark De Souza and John Bongaarts, water conflict on the Mekong river, a take on Restrepo from one of this summer’s West Pointers, and demographic security on the Hill topped the list last month:
1. Pop Audio: From Cancun: Roger-Mark De Souza on Women and Integrated Climate Adaptation Strategies
2. Managing the Mekong: Conflict or Compromise?
3. Pop Audio: John Bongaarts on the Impacts of Demographic Change in the Developing World
4. Restrepo: Inside Afghanistan’s Korengal Valley
5. Demographic Security Comes to the Hill
6. The Future of Sub-Saharan Africa’s Tentative Fertility Decline
7. On the Beat: Where Have all the Malthusians Gone?
8. Bringing Cambodia Back from the Brink: Audio Interview with Suwanna Gauntlett
9. COP-16 Cancun Coverage Wrap-up: An Integrated Climate Dialogue
10. India’s Maoists: South Asia’s “Other” Insurgency -
Minister Izabella Teixeira at the Wilson Center
A Review of Brazil’s Environmental Policies and Challenges Ahead
›Stressing the need for concrete, tangible institutional policies, Izabella Teixeira, Brazil’s Minister of the Environment, discussed the challenges and goals of her ministry at the Wilson Center on October 20. Sustainable development, not just conservation, must be the focus, and that requires bringing lots of different players to the table, taking into account not only environmental but also social and economic agendas. To do this, she argued, one must take the rather ephemeral and hypothetical notions of environmental stewardship and put them into the realm of a practicable, institutionalized framework, built on a social pact that engages all sectors of society.The foundation of sustainable development and environmental policy must be biodiversity, according to Teixeira. Central concerns, such as food and energy security and combating climate change, all rely on a diverse array of natural resources. These need to be conserved, but they must also be developed in a responsible, sustainable way. A legal international framework toward this end, covering access to biodiversity and genetic resources, has yet to be implemented. Developing and developed countries need to find a middle ground on allocating the benefits that accrue from the use of genetic resources found in areas such as the Amazon, and this agreement must then be linked into existing political institutions.
Teixeira noted the strides Brazil has made toward protecting its environment – including having set aside the equivalent of 70 percent of all protected areas in the world in 2009 and the establishment of the Amazon Fund. Nevertheless, Brazil must continue to protect and maintain these nature preserves, not just establish them. Creating a program that pragmatically implements international goals in a national context is an ongoing process, and countries like Brazil now need to focus on the “how” of implementing these goals, rather than just the “what.”
Teixeira also highlighted the complexity of formulating environmental policy that integrates all the various points of view that must be taken into consideration. At recent meetings to discuss transitioning to a low-carbon economy, 17 different cabinet ministers had to be present to coordinate government positions and policies. The complexity is due in part to the need to create alternatives, not just to prevent certain activities. For example, one must not only use legal enforcement to stop illicit deforestation, but also create paths to legal, sustainable logging. Once again, attempting to balance environmental, social, and economic concerns is difficult, to say the least, but crucial for long-term effectiveness.
Also a unique challenge for Brazil is the natural diversity that exists within such a large country. While much of the attention paid to the environment goes (rightly so) to the Amazon, there are many other biomes and local environments that must be taken into consideration, Teixeira observed.
The cerrado, Brazil’s enormous savanna, requires a different strategy than the Amazon, which is different than the coastal Atlantic forest. Furthermore, urban areas need their own environmental policies that can take into account issues of human development and population density.
To illustrate the need for an inclusive, well-thought-out policy, Teixeira discussed–rather frankly–the controversy surrounding the recent proposed amendments to the Forest Code. She argued that the proposal makes blanket changes that do not take into consideration differences in biomes, differences between large agribusinesses and family farms, and between historic, settled communities and recent developments. The implications of this proposal, according to the minister, could have enormous social costs. Teixeira said she believes that it would be virtually impossible to enforce the amended Forest Code if it was approved by Congress. She used this example to underscore her role in offering legislative alternatives that seek to provide a more nuanced, and ultimately more effective, institutional framework that can use Brazil’s many natural resources to help its population to the greatest extent possible.
J.C. Hodges is an intern with the Brazil Institute at the Wilson Center; Paulo Sotero is the director of the Brazil Institute.
Photo Credit: “Rio Jurua, Brazil (NASA, International Space Station Science, 05/29/07),” courtesy of flickr user NASA’s Marshall Space Flight Center, and David Hawxhurst/Wilson Center. -
The Cholera Quandary
›The original version of this article first appeared in the Stimson Center Spotlight series, November 19, 2010.
Cholera is usually seen as one of the most devastating infections of the 19th century. Trade routes carried cholera from India to the great cities of Europe and the United States. Disease, fear, and political unrest spread in great waves that cost millions of lives. After much destruction, it was only with science and resources that certain populations were able to curb the epidemic.One of the most celebrated lessons in the history of public health involves a cholera outbreak in London in 1854 and efforts by John Snow – celebrated as the father of epidemiology – to control it. At the time, it was not clear that cholera was a waterborne bacterial infection that caused severe diarrhea and vomiting, and sometimes fatal dehydration. Snow proved that the outbreaks decimating communities spread from contaminated water. Water and sanitation services had virtually eliminated cholera epidemics in the developed world by the early 1900s.
Today, cholera has been nearly eradicated in the developed world, but continues to be endemic in poorer countries. Risks seem to be rising as larger populations are crowded into unsanitary conditions. The World Health Organization (WHO) estimates three to five million illnesses and 100,000-200,000 deaths from cholera each year. If caught early, infections are treatable with inexpensive oral rehydration solutions. For much of the world, these options are unavailable or underused – the mere presence of cholera serves as an indicator of a country’s socioeconomic status and health system capabilities.
The cholera epidemics that are currently menacing countries on three different continents – Asia, Africa, and North America – raise tough questions about what is required to protect the world’s vulnerable populations. We know how to predict the crisis of cholera, prevent outbreaks, and contain them when they occur. To control cholera, what is needed is not cutting-edge technologies, but will, transparency, and resources – and where cholera appears, at least one of these three factors has failed.
Currently, cholera outbreaks in Pakistan, Haiti, and Nigeria are piling misery upon misery. Cholera in post-flood Pakistan comes as no surprise. When floodwaters left millions homeless and without access to clean drinking water in a region where cholera remains endemic, health officials could have reasonably assumed infected human waste would seep into water supplies and spread disease. The inability of health networks on the ground to prevent and then detect cholera demonstrates cracks in the country’s health system. What is apparent here is a lack of will and resources. Disease surveillance is especially vital in a post-disaster scenario where steps can be taken, such as treating water with chlorine, to prevent an outbreak.
Haiti had been free of cholera for at least 50 years, but the disease struck and spread rapidly 10 months after the devastating January 2010 earthquake. It reached Haiti’s capital and spread to its neighbor, the Dominican Republic. Since October, more than 114,000 people have become ill and more than 2,500 have died (Editor’s note: updated since original publication).
Haiti lacked resources for basic infrastructure even prior to the earthquake; the cholera crisis is not only costing lives, but also diverting aid from “building back better.” But regardless of the source of the cholera strain, if basic infrastructure and resources to protect Haiti’s vulnerable populations had been in place, cholera’s re-emergence would have been far less devastating.
This particular outbreak draws attention to the practical and political challenges of identifying health risks in humanitarian workers and peacekeepers, many of whom come from developing countries themselves. Evidence suggests that peacekeepers from Nepal, housed at a UN base, may have been the source of the outbreak clustered around the Artibonite River. Cholera outbreaks frequently exacerbate frictions between communities and aid workers – suspicions that have led to riots and murder more than once in recent years. At least two people were killed in Haiti in riots with peacekeepers during November.The delayed decision by the UN to investigate whether the outbreak originated with peacekeepers may have conserved resources for the race to stave off more cases, but did little to build trust between communities and foreign workers. Further violence and protests surrounding the recent disputed presidential election in Haiti do little to ease the devastation and in fact, threaten the relief effort. There has been discussion in Congress of cutting direct aid and suspending visas for Haitian officials until the dispute as been resolved. The Organization of American States is now reviewing the results.
In Africa, Nigeria is experiencing its worst cholera outbreak since 1991, and the disease is crossing borders. An onslaught of cases raised the 2010 death toll to more than 1,500 fatalities out of 40,000 cases. This mortality rate is three times higher than the seasonal cholera outbreaks of 2009, and seven times higher than 2008. Despite Nigeria’s oil wealth, most of the population is impoverished. Two-thirds of rural Nigerians lack access to safe drinking water and fewer than 40 percent of people in cholera-affected areas have access to toilet facilities, according to the Nigerian Health Ministry. A combined lack of will, transparency, and resources mean that cholera epidemics occur annually, and in clusters throughout sub-Saharan Africa.
A century and a half after John Snow’s discovery, we know how to control cholera. Globally, the resources exist, but the question of a collective will remains. For those who lack clean water to drink, to wash, or even proper toilets, the gap between knowing and doing is not easily closed. The international community has shown repeatedly that it can confront cholera outbreaks like those in Haiti, Pakistan, and Nigeria in the midst of crisis. The question remains as to how those efforts can eliminate the conditions that fostered outbreaks in the first place. The answer is not as riveting as the causes that often receive funding: basic infrastructure and resources. Roads, wells, clean water, toilets, education, and the willingness to recognize that if the foundation is not sound, nothing will be able to stand. Sometimes the simplest problems are the most difficult to solve.
Sarah Kornblet is a research fellow at the Global Health Security Program at the Stimson Center. Her research focuses on the International Health Regulations, health systems strengthening, global health diplomacy, the intersection of public health and security, and the potential for innovative and dynamic health policy solutions in developing countries.
Sources: Agence France-Presse, BBC, Washington Post, World Health Organization.
Photo Credit: “UN Peacekeepers Provide Security During Port-au-Prince Food Distribution,” courtesy of flickr user United Nations Photo. -
Evidence, Links, and Solutions
Maternal Undernutrition
›“Maternal undernutrition is often overlooked as a strategy for reducing poverty and as a key intervention to reduce maternal mortality and morbidity,” said Mary Ellen Stanton, senior maternal health advisor at the U.S. Agency for International Development. Stanton was joined by Dr. Doyin Oluwole, director of the Africa’s Health in 2010 program, and Amy Webb Girard, assistant professor at the Emory University School of Public Health, in the final meeting of the Advancing Policy Dialogue on Maternal Health series on December 15 where they addressed the linkages between poverty, undernutrition, and poor maternal health outcomes.
The Cycle of Malnutrition and Poverty
Many factors contribute to a woman’s nutritional status, including lack of capital, access to land, and poverty; thus, said Oluwole, “we must adopt a multi-pronged and multi-sectoral response.”“General malnutrition is usually associated with iron-deficiency anemia, which leads to poor cognitive function and educational achievement, poor health, and fatigue.” Oluwole said. “These three factors lead to low worker productivity, and low worker productivity leads to income poverty.”
“All of these aggravate malnutrition and so the vicious cycle of malnutrition and poverty continues,” said Oluwole. To break this cycle, she pointed out that countries like Malawi and Mexico have implemented various multi-sectoral interventions that have “stimulated economic growth; implemented targeted social, health, and nutrition programs; and put in place safety nets.”
“In the window of opportunity during pregnancy and the first two years of life, we can make a big difference,” Oluwole said. She advocated for an “integrated anemia package” that provides anti-malarials, de-worming medicine, iron folic acid tablets, and extra food during pregnancy. She also noted the importance of family planning and targeted high-coverage interventions, such as salt iodization, vitamin A supplementation, and breastfeeding promotion.
In conclusion, Oluwole provided several recommendations for the development community to improve maternal mortality rates and undernutrition of women:
Maternal Undernutrition: Our Global Disgrace- Promote universal primary and secondary education, especially for girls
- Stimulate economic growth with a focus on gender and equity
- Invest in infrastructure to reduce transportation time to hospitals
- Postpone age of marriage and of first pregnancy
- Provide targeted and effective nutrition and health interventions
- Encourage private sector participation and government leadership
- Integrate the maternal health and nutrition communities and services
“We don’t tend to look at maternal nutrition and its impacts on the woman herself,” said Girard. The lack of data on the relationship between nutrition and maternal health outcomes “hampers our ability to move maternal nutrition onto the health and development agenda,” she added.“Anemia is widespread; worldwide, it is a significant public health burden, both in women of reproductive age as well as in pregnant women,” said Girard. Studies have shown that moderate anemia increases risk of hemorrhage and may also increase the risk of sepsis, while severe anemia has been shown to directly contribute to maternal mortality. Targeted interventions can help reduce these risks greatly. “For every one gram per deciliter increase in hemoglobin level, you can reduce maternal mortality by approximately 25 percent, but the mechanisms by which this occurs are not well elucidated,” noted Girard.
“We need to include women not as just targets of nutritional interventions, but as beneficiaries in their own health,” said Girard. Key nutritional interventions such as micronutrient supplementation, fortification, and behavior change communication can help to improve not only fetal, infant, and child health, but can also reduce maternal morbidity and mortality. In addition, Girard recommended the following strategies to achieve greater impact:
Together, these strategies can help improve access to nutrition and health services, as well as adequate food for women throughout their lives. “We need to integrate health and nutrition – they are actually the same pillar, complementing each other,” Girard concluded.- Improve nutrition throughout the life cycle, not just during pregnancy
- Look for alternate strategies for micronutrient delivery
- Integrate maternal nutrition into food security and agricultural strategies
- Collect indicators specific to women’s health impacts
- Recognize and address gender bias
Photo Credit: “Bangladesh mothers, kids,” courtesy of flickr user Bread for the World.
