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Coffee and Contraception: Combining Agribusiness and Community Health Projects in Rwanda
›“Population pressures and diminishing land holdings – due to high fertility rates, war and genocide, and subsequent migration – have caused a rapid decrease in the forested and protected areas and increased soil infertility and food insecurity” in Rwanda, USAID’s Irene Kitzantides told a Wilson Center audience.
Kitzantides, a population, health, and environment advisor and global health fellow, said “the population is projected to reach over 14 million by 2025” – nearly one-third more than today, due to the country’s high fertility rate of nearly 5.5 children per women–which could continue to negatively impact forests and food supplies.
In response to these challenges, USAID supported the Sustaining Partnerships to Enhance Rural Enterprise and Agribusiness Development (SPREAD) Project. SPREAD uses an integrated population-health-environment (PHE) approach to develop the coffee agribusiness and bring family planning, HIV/AIDS, and reproductive health services to coffee workers.
Combining income generation with health services was thought an effective way to “fulfill the overall SPREAD goal of improving lives and livelihoods,” said Kitzantides.
A SPREADing Mandate: Integrating Health and Agribusiness
SPREAD follows USAID’s PEARL I and II Projects, which focused exclusively on agricultural development. Coffee is still at the center of SPREAD’s activities, with $5 million of the project’s $6 million USAID budget earmarked for agricultural development.
However, a broader mandate to include health services emerged after recognition that greater income alone does not ensure greater quality of life. The additional health funding leverages SPREAD’s already established relationships with farming cooperatives to bring health services to traditionally underserved rural communities.
“We really tried to build on the existing assets of the cooperative,” said Kitzantides. “We also really tried to complement local and national public health policy and partners.”
The integration of health with agricultural goals, and the use of already established in-country health programs, has made SPREAD extremely cost-effective, with HIV/AIDS prevention education costing less than $2 per person.
Examples of SPREAD’s integrated work include:Combined health and agricultural lessons: Kitzantides and her colleagues trained nearly 400 animateurs de café, cooperative employees running the agricultural education programs, to incorporate public health objectives into their activities. Combining health and agricultural education into one session takes advantage of workers already trained during previous USAID programs. The combination also attracts more male participants, who traditionally shunned HIV/AIDS, family planning, and reproductive health campaigns and services.
Radio programming: SPREAD worked with the agricultural radio program Imbere Heza (“Bright Future”) to incorporate health messaging at the end of each program.
Mobile clinics: SPREAD works with cooperatives and local health centers to bring convenient services to farmers when they gather at sales or processing stations during harvests.
Community theater: SPREAD hires local theater groups to perform skits on health. The farming communities “really love community theater and always ask for it,” said Kitzantides.
In its relatively short existence, SPREAD’s health activities have reached over 120,000 people with HIV/AIDS prevention messages; nearly 90,000 with messages discussing family planning/reproductive health; and almost 40,000 about maternal and child health. The project counts 347 women as new users of family planning services.
Lessons learned – which will be examined in more detail in an upcoming issue of Focus – include the importance of using community-based approaches to overcome perceived social barriers; the advantages of integrating cross-cutting activities at the outset of a program; and the need for strong monitoring and evaluation systems to measure the effort’s outcomes.Jason Bremner of the Population Research Bureau said PHE projects such as SPREAD go “beyond what the health sector itself can do and find new ways of reaching underserved remote populations.” He presented a soon-to-be-released PRB map plotting the location of more than 40 PHE projects in Africa.
The success of SPREAD and similar projects demonstrates the potential for PHE approaches to bring reproductive health and family planning services to rural areas, Bremner noted, but there is still much work to be done to scale up this integrated approach – and to document its successes.
Sustaining SPREAD
Kitzantides said it took several years to integrate health activities with the already established agricultural programs. Since USAID funding for the program is scheduled to end in 2011, she is uncertain that the time remaining will be enough for SPREAD’s health partners to develop the logistical and financial capacities to become self-sustaining. But SPREAD has changed attitudes and beliefs, two key objectives that do not require sustained funding.
“We used to talk about growing coffee, making money, buying material things like bikes – not about problems like malaria, HIV/AIDS, etc.,” said one SPREAD agricultural business manager during the program’s evaluation. “Someone could have 5 million Rwandan francs in the house but could suffer from malaria where medicine costs 500 Rwandan francs, due to ignorance. You have to teach people about production, you have to also think of their health to improve their lives.”
Photo Credits: Irene Kitzantides, courtesy David Hawxhurst; condom demonstration, courtesy Nick Fraser; community theater group, courtesy SPREAD Health Program; Jason Bremner, courtesy David Hawxhurst. -
New Maternal Mortality Statistics: A Catalyst for Increased Investment
›Maternal mortality rates in many low income countries, such as India, are declining, according to a recent study by researchers at the Institute of Health Metrics and Evaluation (IHME) at the University of Washington. According to the report, maternal deaths have fallen from 526,000 a year in 1980 to 342,900 in 2008. This news, while welcoming, has caused dissent among some global health activists who fear donors and policymakers will dismiss the issue and call into question the higher maternal mortality rates last reported by the United Nations. While concerns over monitoring and evaluation raise important methodology questions, this news must also serve as catalyst for world leaders and donors to take action and recognize that investing in women pays.
The data reported by IHME only concludes what maternal health advocates already know. “We know how to save women’s lives, we don’t need a cure…this is a political problem and political will is essential,” said Theresa Shaver, director of White Ribbon Alliance, at a Wilson Center event in December 2008. Greater funding for family planning and access to emergency obstetric care and HIV/AIDS services should all be included in a scaling up resources for improved maternal health programs. “Without HIV, annual maternal deaths would have been 281,500 in 2008,” said Richard Horton, editor of The Lancet, in last week’s Lancet comments.
Investing in contraception and family planning services through vertical funding mechanisms can reduce maternal mortality rates by addressing all of a woman’s health needs at the time of service. To widen the platform of comprehensive services for women and their families, efforts to link public health services and offer more at one location should be expanded. “Many women have expressed a need for contraception and family planning services…when you offer family planning services on-site with HIV services, you have a huge uptake in family planning use,” shared Michelle Moloney-Kitts, assistant coordinator at the Office of the U.S. Global AIDS Coordinator at a the Wilson Center in December 2009.
Yet political will remains in short supply. “Despite strong advocacy efforts, political leaders have either ignored the call or failed to make the health of women in pregnancy a priority,” stated Horton. Six countries–Afghanistan, Democratic Republic of Congo, Ethiopia, India, Nigeria, and Pakistan–account for over half of all maternal deaths worldwide, and increased investment in these countries will improve maternal health targets, such as Millennium Development Goal (MDG) 5 seeking to reduce maternal deaths by 75 percent.
Progress is possible and “policymakers are more likely to act on issues that they think they can do something about,” said Jeremy Shiffman, associate professor of public administration at Syracuse University, at the Wilson Center in March 2009. The maternal health community must rally around these positive findings and galvanize support for greater financial contributions. “Two decades of concerted campaigning by those dedicated to maternal health is working,” said Horton.” “[G]reater investment in that work is likely to deliver even greater benefits.”
Calyn Ostrowski is the program associate for the Wilson Center’s Global Health Initiative.
Photo Credits: A woman in India safely delivers her baby in the hospital through the Madhya Pradesh Health Sector Reform program. Courtesy Flickr user Department for International Development -
Population and Environmental Challenges in Rwanda
›“Population, Health and Human Settlements” is the second chapter in the Rwandan government’s Rwanda State of Environment and Outlook. The chapter highlights the Rwandan government’s recognition of the interconnections between population, health, and environment, noting that population “can influence the state of the environment” and pose strains “on available public infrastructure, limited land, and natural resources.” The chapter examines Rwanda’s population growth and distribution, the state of “environmental health” in rural and urban areas, and health indicators relating to child and maternal health and HIV/AIDS. It goes on to describe government strategies to “improve settlements and human welfare.” “As population pressure is one of the key drivers of environmental degradation and poverty,” the chapter’s authors write, “the implementation of the population policy, especially aspects that address high fertility rates, gender and reproductive health, migration and human settlements” is increasingly important.The Des Moines Register‘s “Renewal in Rwanda” site hosts a series of articles by IRP Fellow and former Wilson Center Public Policy Scholar Perry Beeman “examining Rwanda’s efforts to build an eco-friendly economy.” Accompanied with interactive maps, photos, and videos, the materials highlight government efforts, share the country’s successes, and describe the vast challenges that lay ahead.
“Renewal in Rwanda” is particularly focused on Gishwati Forest, an area Beeman visited while in Rwanda, and the impacts of its ongoing conservation program on local communities. “Gishwati Area Conservation Program has as much to do with saving the lives of villagers—by sparing them from deadly mudslides and providing them jobs—as it does restoring a once-mighty forest,” writes Beeman in the article “Fighting for an African Forest.” Beeman also calls attention to the program’s more controversial aspects, noting that reforestation efforts would require relocating an estimated 5,000 families. -
New Research on Population and Climate: The Impact of Demographic Change on Carbon Emissions
›“Policies that have the effect…of leading to lower fertility and to slower population growth can be considered ‘win-win’ from the climate point of view,” said Brian O’Neill of the National Center for Atmospheric Research (NCAR) at a recent Wilson Center event on his latest research. Yet while the connection between demographic change and CO2 emissions is implicitly understood among both researchers and policymakers, it “has not really caught on,” he added.
In response to critiques of earlier studies looking at demographic change and CO2 emissions—which the climate research community has faulted for their lack of sophistication, use of unfamiliar analytic approaches, and failure to clearly demonstrate the magnitude of the connection—O’Neill is using a novel, more rigorous approach that he hopes will provide a clearer understanding of the links between demography and climate change.
The Population Factor
To generate CO2 emissions scenarios for the next 100 years, O’Neill’s team used the Population-Environment-Technology (PET) Model, originally created by Lawrence H. Goulder and Michael Dalton of Stanford. The PET Model takes its basic assumptions on regional economic growth, technological development, change in population characteristics, and other factors from the IPCC’s A2 and B2 scenarios, but replaces each scenario’s singular population growth curve with high and low alternatives from the United Nations Population Division.
Like other climate models, the PET Model divides the world into nine regions. “You don’t want to treat economies—or the demography, the consumption patterns, the energy system, and so on—of sub-Saharan Africa the same as you do for the U.S. or EU,” he said.
What makes the O’Neill’s approach unique, however, is his attention to the sub-regional level. “Typically in these models…you break the world up into nine regions, but then you treat everyone in sub-Saharan Africa the same, everyone in China the same,” said O’Neill.
By drawing on data from detailed surveys of 800,000 households from 35 countries, O’Neill and his team demonstrated that the distinctions between urban and rural, older and younger, and smaller and larger households hold important implications for carbon emissions. This inclusion of demographic sub-factors allows a deeper degree of analysis than models that treat all households the same. They found that age structure, household size, and urbanization all altered emissions outputs.
Could Bending Population Growth Curves Reduce Emissions?
In the long run, the potential for demographic shifts to reduce CO2 emissions “is a big number,” said O’Neill. In the medium term, for example by the middle of the century, results are less clear. To compare population-related emissions reductions to other carbon-reduction opportunities, he evoked Socolow and Pacala’s “stabilization wedge” framework. The wedge framework posits 15 opportunities, or wedges, to eventually reduce CO2 emissions by 1 billion tons of carbon equivalent per year. They contend that implementing any 7 of the wedges could stabilize CO2 emissions by 2050 and, if followed by additional measures reducing emissions below today’s levels, would stabilize the atmospheric concentration of CO2 at 550 ppm and forestall the worst impacts of climate change.
Would reducing population growth equal a wedge? The full results, currently under review at a scientific journal, will seek to answer this question. “Slower population growth can’t solve the climate problem,” he concluded. “But it can certainly help.” -
Want to Model Climate Change? There’s an App for That
›C-Learn, developed by the coalition group Climate Interactive, is a three-region climate simulator that allows users to input targets for fossil fuels emissions, emissions from deforestation, and reductions from afforestation. The app then outputs the expected results for atmospheric CO2 concentrations and global temperature. The simulator is a free, public version of the more complicated C-ROADS, a tool designed to help policymakers compare the predicted effects of particular climate change mitigation policies.
Although interesting, C-Learn notably lacks the option to input assumptions regarding population growth rates, let alone those concerning more nuanced factors such as age structure, urbanization rates, or household size, the importance of which were recently discussed at the Wilson Center by the National Center for Atmospheric Research‘s Brian O’Neill. Population is a significant factor in determining what can be expected as reasonable emission targets and the failure to include space for demographic assumptions is a significant short-coming. -
The Food Security Debate: From Malthus to Seinfeld
›Charles Kenny’s latest article, “Bomb Scare: The World Has a Lot of Problems; an Exploding Population Isn’t One of Them” reminds me of a late-night episode of Seinfeld: a re-run played for those who missed the original broadcast. Kenny does a nice job of filling Julian Simon’s shoes. What’s next? Will Jeffrey Sachs do a Paul Ehrlich impersonation? Oh, Lord, help me; I hope not.
I’ve already seen the finale. Not the one where Jerry, George, and Kramer go to jail — the denouement of the original “Simon and Ehrlich” show. After the public figured out that each successive argument (they never met to debate) over Malthus’s worldview was simply a rehash of the first — a statement of ideology, rather than policy — they flipped the channel.
Foreign Policy could avoid recycling this weary and irrelevant 200-year-old debate by instead exploring food security from the state-centric perspective with which policymakers are accustomed. While economists might hope for a seamless global grain production and food distribution system, it exists only on their graphs.
Cropland, water, farms, and markets are still part and parcel of the political economy of the nations in which they reside. Therefore they are subject to each state’s strategic interests, political considerations, local and regional economic forces, and historical and institutional inefficiencies.
From this realistic perspective, it is much less important that world population will soon surpass 7 billion people, and more relevant that nearly two dozen countries have dropped below established benchmarks of agricultural resource scarcity (less than 0.07 hectares of cropland per person, and/or less than 1000 cubic meters of renewable fresh water per person).
Today, 21 countries—with some 600 million people—have lost, for the foreseeable future (and perhaps forever), the potential to sustainably nourish most of their citizens using their own agricultural resources and reasonably affordable technological and energy inputs. Instead, these states must rely on trade with–and food aid from–a dwindling handful of surplus grain producers.
By 2025, another 15 countries will have joined their ranks as a result of population growth alone (according to the UN medium variant projection). By then, about 1.4 billion people will live in those 36 states—with or without climate change.
For the foreseeable future, poor countries will be dependent on an international grain market that has recently experienced unprecedented swings in volume and speculation-driven price volatility; or the incentive-numbing effects of food aid. As demand rises, the poorest states spend down foreign currency reserves to import staples, instead of using it to import technology and expertise to support their own economic development.
Meanwhile, wealthier countries finding themselves short of water and land either heavily subsidize local agriculture (e.g., Japan, Israel, and much of Europe) or invest in cropland elsewhere (e.g., China, India, and Saudi Arabia). And some grain exporters—like Thailand—decided it might be safer to hold onto some of their own grain to shield themselves from a future downturn in their own harvest. All of this is quite a bit more complex than either Malthus could have imagined or Kenny cares to relate.
It hardly matters why food prices spiked and remained relatively high—whether it is failed harvests, growing demand for grain-fed meat, biofuels, profit-taking by speculators, or climate change. Like it or not, each has become an input into those wiggly lines called grain price trends, and neither individual states nor the international system appears able or willing to do much about any of them.
From the state-centric perspective, hunger is sustained by:1. The state’s inability or lack of desire to maintain a secure environment for production and commerce within its borders;
In some countries, aspects of population age structure or population density could possibly affect all three. In others, population may have little effect at all.
2. Its incapacity to provide an economic and trade policy environment that keeps farming profitable, food markets adequately stocked and prices reasonably affordable (whether produce comes from domestic or foreign sources); and
3. Its unwillingness or inability to supplement the diets of its poor.
What bugs me most about Kenny’s re-run is its disconnect with current state-centric food policy concerns, research, and debates (even as the U.S. administration and Congress are focusing on food security, with a specific emphasis on improving the lives of women.—Ed.).
Another critique of Malthus’s 200-year-old thesis hardly informs serious policy discussions. Isn’t Foreign Policy supposed to be about today’s foreign policy?
Richard Cincotta is a consultant with the Environmental Change and Security Program and the demographer-in-residence at the H.L. Stimson Center in Washington, DC.
Photo Credit “The Bombay Armada” courtesy of Flickr user lecercle. -
Pop-Up Video: Cable News Covers PHE Connections
›It was a bit of a shock to hear population-environment connections being discussed on television, including the Most Trusted Name in News (aka Jon Stewart’s Daily Show), as well as CNN’s Amanpour, late last month.
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Population and Sustainability
›“The MAHB, the Culture Gap, and Some Really Inconvenient Truths,” authored by Paul Ehrlich and appearing in the most recent edition of PLoS Biology, is a call for greater participation in the Millennium Assessment of Human Behavior (MAHB). MAHB was created, he writes, because societies understand the magnitude of environmental challenges, yet often still fail to act. “The urgent need now is clearly not for more natural science…but rather for better understanding of human behaviors and how they can be altered to direct Homo sapiens onto a course toward a sustainable society.” MAHB aims to create an inclusive global discussion of “the human predicament, what people desire, and what goals are possible to achieve in a sustainable society” in the hopes of encouraging a “rapid modification” in human behavior.The BALANCED Project, lead by the Coastal Resource Center at the University of Rhode Island, released its first “BALANCED Newsletter.” To be published biannually, the newsletter highlights recent PHE fieldwork, unpacks aspects of particular PHE projects, and shares best practices in an effort to advance the BALANCED Project’s goal: promoting PHE approaches to safeguard areas of high biodiversity threatened by population pressures. The current edition examines the integration of family planning and reproductive health projects into marine conservation projects in Kenya and Madagascar, a theater-based youth education program in the Philippines, and the combining of family planning services with gorilla conservation work in Uganda. The newsletter also profiles two “PHE Champions,” Gezahegh Guedta Shana of Ethiopia and Ramadhani Zuberi of Tanzania.
“Human population growth is perhaps the most significant cause of the complex problems the world faces,” write authors Jason Collodi and Freida M’Cormack in “Population Growth, Environment and Food Security: What Does the Future Hold?,” the first issue of the Institute of Development Studies‘ Horizon series. The impacts of climate change, poverty, and resource scarcity, they write, are not far behind. Collodi and M’Cormack highlight trends in, and projections for, population growth, the environment, and food security, and offer bulleted policy recommendations for each. Offering greater access to family planning; levying global taxes on carbon; introducing selective water pricing; and removing subsidies for first-generation biofuels are each examples of suggestions advanced by the authors to meet the interrelated challenges.
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