Showing posts from category development.
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Accessing Maternal Health Care Services in Urban Slums: What Do We Know?
›“Addressing the needs of urban areas is critical for achievement of maternal health goals,” said John Townsend, vice president of the Reproductive Health Program at the Population Council. “Just because there is a greater density of health services does not mean that there is greater access.”
Townsend moderated a discussion on the challenges to improving access to quality maternal health care in urban slums as part of the 2011 Maternal Health Dialogue Series with speakers Anthony Kolb, urban health advisor at USAID; Catherine Kyobutungi, director of health systems and challenges at the African Population Health Research Center; and Luc de Bernis, senior advisor on maternal health at the United Nations Population Fund (UNFPA). [Video Below]
Mapping Urban Poverty
“Poverty is becoming more of an urban phenomenon every day,” said Kolb. With over 75 percent of the poor in Central Asia and almost half of the poor in Africa and Asia residing in cities and towns by 2020, “urban populations are very important to improving maternal health,” he added.
Collecting accurate data in informal settings such as slums can be very challenging, and there is often a “systematic undercounting of the urban poor,” said Kolb. Data often fails to capture wealth inequality in urban settings, and there is often a lack of attention to the significant variability of conditions between slums.
Kolb also warned about the risk of generalization: “Slums and poverty are not the same.” In practice, there is not a standardized definition of what constitutes a slum across countries, he said. “It is important to look at different countries and cities individually and understand how inequality is different between them.” Slum mapping can help to scope out challenges, allocate resources appropriately, and identify vulnerability patterns that can inform intervention design and approach, he said.
Maternal Health in Nairobi Slums
Addressing the maternal health needs of the nearly 60 percent of urban residents who live in slums or slum-like conditions will be a critical step to improving maternal health indicators of a rapidly urbanizing Kenya, said Kyobtungi.
Only 7.5 percent of women in Kenyan slums had their first antenatal care visit during their first trimester of pregnancy and only 54 percent had more than three antenatal care visits in all – rates significantly lower than those among urban women in non-slum settings.
“In some respects, [the urban poor] are doing better than rural communities, but in other ways they are behind,” said Kyobtungi. But, she said, there are many unique opportunities to improve maternal health in slums: “With these very high densities, you do have advantages; with very small investments, you can reach many more people”
Output-based voucher schemes – in which women pay a small fee for a voucher that entitles them to free, high-quality antenatal care, delivery services, and family planning – have been implemented to help poor, urban women access otherwise expensive services. But poor attitudes towards health care workers, transportation barriers, and high rates of crime still prevent some women from taking advantage of these vouchers, said Kyobtungi.
The majority of maternal health services in slums are provided by the private facilities, though size and quality vary widely. “There is a very high use of skilled attendants at delivery, but the definition of skilled is questionable,” said Kyobtungi
“Without supporting the private sector,” Kyobutungi said, “we cannot address the maternal health challenges within these informal settlements.” Combined with an improved supervision and regulation system, providing private maternal health facilities with training, equipment, and infrastructure could help to improve the quality of services in urban slums, she concluded.
Reducing Health Inequalities
“While we have evidence that health services, on average, may be better in urban areas than in rural areas, this often masks wide disparity within the population,” said de Bernis. “Reducing health inequities between and within countries is a matter of social justice.”
When it comes to family planning, total fertility rates are lower in cities, but “the unmet need…is still extremely important in urban areas,” explained de Bernis. Many poor women in cities, especially those who live in marginalized slum populations, do not have access to quality reproductive health services – a critical element to reducing maternal morbidity and mortality rates.
Economic growth alone, while important to help improve the health status of the poor in urban settings, will not solve these problems, said de Bernis. To reduce health disparities within countries, de Bernis advocated for “appropriate social policies to ensure reasonable fairness in the way benefits are distributed,” including incorporating health in urban planning and development, strengthening the role of primary health care in cities, and putting health equity higher on the agenda of local and national governments.
Event Resources:Source: African Population Research Center, United Nations Population Fund.
Photo Credit: “Work Bound,” courtesy of flickr user Meanest Indian (Meena Kadri). -
Watch ‘Dialogue’ TV on Integrating Development, Population, Health, and the Environment
›Last week on the Wilson Center’s Dialogue radio and television program, host John Milewski spoke with Geoff Dabelko, director of ECSP, Roger-Mark De Souza, vice president for research and director of the Climate Program for Population Action International, and George Strunden, vice president of Africa programs for the Jane Goodall Institute. They discussed the challenge of integrating population, health, and environmental programs (PHE) to address a broad range of livelihood, development, and stability issues. [Video Below]
“Many times that we tackle development or poverty and human well-being challenges…we do it in an individual sector – the health sector, or agriculture sector, or looking at issues of water scarcity – and it makes sense in many respects to take those individual focuses,” said Dabelko. “But of course people living in these challenges, they’re living in them together…so both in terms of understanding the challenges…and then in responding to those challenges, we have to find ways to meet those challenges together.”
De Souza noted that the drive for integrated development stems from the communities being served, not necessarily from outside aid groups. “We’ve seen that there’s a greater impact because there’s longer sustainability for those efforts that have an integrated approach,” he said. “There’s a greater understanding and a greater appreciation of the value that [PHE] projects bring.”
Strunden said that the Goodall Institute has found similar success in tying health efforts with the environment in places where previously conservation work alone had been unsuccessful.
The panelists also discussed the role of population in broader global challenges, including energy, water, and food scarcities, and women’s rights.
Dialogue is a co-production of the Woodrow Wilson International Center for Scholars and MHz Networks. The show is also available throughout the United States on MHz Networks, via broadcast and cable affiliates, as well as via DirecTV and WorldTV (G19) satellite.
Find out where to watch Dialogue where you live via MHz Networks. You can send questions or comments on the program to dialogue@wilsoncenter.org. -
Population Growth and its Relation to Poverty, the Environment, and Human Rights
›“Population, Poverty, Environment, and Climate Dynamics in the Developing World,” in the Interdisciplinary Environmental Review, by Jason Bremner, David Lopez-Carr, Laurel Suter, and Jason Davis, attempts to illuminate and clarify the complex relationships between environmental degradation, population dynamics, and poverty. Population growth is a key driver for the degradation of ecosystem services which has a direct impact on livelihoods and human well-being, write the authors, especially for the poor. They argue that “population growth itself, however, remains an insufficient explanation of the relationship between population, ecosystems, and poverty.” While the field has a come a long way since its “original Malthusian roots,” they write, the relationships between these dynamics differ greatly depending on the area in question, and much work remains to be done on the less well-studied ecosystems.In “An End to Population Growth: Why Family Planning Is Key to a Sustainable Future” from the Solutions Journal, Robert Engelman reminds us that population projections are not set in stone and that the widespread belief that population has to reach nine billion before leveling off is wrong. Nor is coercive “population control” necessary, he writes: “Population growth rates and average family size worldwide have fallen by roughly half over the past four decades, as modern contraception has become more accessible and popular.” Unfortunately, there remains a large number of people around the world without access to family planning, the majority of whom live in developing countries. Engelman points out that while the number of people of reproductive age has steadily increased in these countries over the last decade, donor support has declined. He argues that research, courage, and creativity are needed to reverse this situation, but in a world where most of all pregnancies were intended, population growth would slow long before reaching nine billion. -
Overcoming Pakistan’s Demographic Challenges
›Download Reaping the Divided: Overcoming Pakistan’s Demographic Challenges from the Wilson Center. Excerpted below is the introductory essay, “Pakistan’s Demographics: Possibilities, Perils, and Prescriptions,” by Michael Kugelman.
On July 11, 2010, Pakistani Prime Minister Yousaf Raza Gilani delivered a speech in Islamabad to commemorate World Population Day. He announced that in order to highlight the crucial connection between demographics and economic growth, 2011 would be designated “Population Year” in Pakistan. “All hopes of development and economic prosperity would flounder if we as a nation lose the focus and do not keep [the] population issue in the spotlight,” he declared.
Hopefully that spotlight comes with a long shelf life. Pakistan faces acute population challenges. If they are to be overcome, they will need to be illuminated for far more than a year.
Yet, there are exciting opportunities here as well. A long-term approach to managing the challenges presented by Pakistan’s burgeoning population, if accompanied by effective policies and sustained implementation, could spark a monumental transformation: one that enables the country to harness the great promise of a large population that has usually been viewed as a hindrance to prosperity. Indeed, demographers contend that Pakistan’s young, growing, and rapidly urbanizing population can potentially bring great benefits to the country. If birth rates fall substantially, and if young Pakistanis are properly educated and successfully absorbed into the labor force, then the nation could reap a “demographic dividend” that sparks economic growth, boosts social well-being, and promotes the rejuvenation of Pakistan.
The Young and the Rising
Because Pakistan has not conducted a census since 1998, estimating the country’s total population size is a highly inexact science. The Pakistani government lists the current figure at about 175 million people, while the United Nations believes the number is closer to 185 million. However, while the precise figure may be in doubt, the population’s rapid rise is not. Though no longer increasing at the 3 percent-plus rate seen in the 1980s, Pakistan’s population is still growing at a 2 percent pace. According to the UN Population Division’s latest mid-range demographic projections, released in 2009, the population will rise to 335 million by 2050. More than 60 million people are expected to be added in just the next 15 years.
This explosive increase, however, merely represents the best-case scenario, and will prevail only if the country’s fertility rates drop from the current average of about four children per woman to two. Should fertility rates remain constant, the UN estimates the population could exceed 450 million by 2050, with a total population of nearly 300 million as early as 2030.
Pakistan’s population is not only large and growing, but also very young, with a median age of 21. Currently, two-thirds of Pakistanis are less than 30 years old. As a percentage of total population, only Yemen has more people under the age of 24. Additionally, given that more than a third of Pakistanis are now 14 years old or younger, the country’s population promises to remain youthful over the next few decades. In the 2020s, the 15-to-24 age bracket is expected to swell by 20 percent. Pakistan’s under-24 population will still be in the majority come 2030. And as late as 2050, the median age is expected to be only 33.
Pakistan’s demographic profile contrasts with what is happening in much of the rest of the world. Sub-replacement level fertility rates (about two births per woman) prevail not only throughout the developed world, but also across much of Southeast Asia, the Middle East, and Latin America. As one commentator has noted, “the twenty-first century’s hallmark [demographic] trend appears to be a fertility implosion.” South Asia, along with sub-Saharan Africa, is one of the last regional bastions of youthful, rapidly proliferating populations. Yet even within South Asia, Pakistan stands out. Excluding Afghanistan, of all the member states of the South Asian Association for Regional Cooperation – Bangladesh, Bhutan, India, Maldives, Nepal, and Sri Lanka – Pakistan has the highest population growth, birth, and fertility rates; the youngest median age (tied with Nepal); and the largest percentage of people 14 years old or younger.
Continue reading “Pakistan’s Demographics: Possibilities, Perils, and Prescriptions,” or download the full report from the Wilson Center.
Michael Kugelman is a program associate with the Asia Program. -
Integrating Development: A Livelihood Approach to Population, Health, and Environment Programs
›Rural communities in developing countries understand that high population growth rates, poor health, and environmental degradation are connected, said Population Action International’s Roger-Mark De Souza at a recent Wilson Center event. An integrated approach to development – one that combines population, health, and environment (PHE) programs – is a “cost-effective intervention that we can do very easily, that responds to community needs, that will have a huge impact that’s felt within a short period of time,” said De Souza. “This is how we live our lives, this makes sense to us – it’s completely logical,” community participants in PHE projects told him.
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Climate Adaptation, Development, and Peacebuilding in Fragile States: Finding the Triple-Bottom Line
›“The climate agenda goes well beyond climate,” said Dan Smith, secretary general of International Alert at a recent Wilson Center event. “In the last 60 years, at least 40 percent of all interstate conflicts have had a link to natural resources” and those that do are also twice as likely to relapse in the five years following a peace agreement, said Neil Levine, director of the Office of Conflict Management and Mitigation at USAID. [Video Below]
Development, peace, and climate stability are “the triple-bottom line,” said Smith. “How would you ever think that it would be possible to make progress on one, while ignoring the other two?” Levine and Smith were joined by Alexander Carius, managing director of Adelphi Research, who pointed out that climate change is both a matter of human security and traditional security. For example, as sea-level rise threatens the people of small-island states, “it also affects, in a very traditional sense, the question of security and a state’s sovereignty,” he said.
The Triple-Bottom Line
Conflicts are never attributable to a single cause, but instead are caused by “a whole pile-up, a proliferation, a conglomeration of reasons” that often include poverty, weak governance, traumatic memory of war, and climate change, said Smith. “Climate adds to the strains and the stresses that countries are under,” and works as a “risk-multiplier, or conflict multiplier,” he said.
Focusing development and peace-building efforts on those regions experiencing multiple threats is both a “moral imperative” and a “self-interested imperative,” said Smith. “We benefit from a more prosperous and a more stable world.”
There are currently one and a half billion people in the world living in countries that face these interlinked problems, said Smith, “and interlinked problems, almost by definition, require interlinked solutions.” Responding to the needs of these people requires developing resiliency so that they can respond to the consequences of climate change, which he called “unknown unknowns.”
“What we need are institutions and policies and actions which guard us not only against the threats we can see coming… but against the ones we can’t see coming,” said Smith. The strength and resilience of governments, economies, and communities are key to determining whether climate events become disasters.
Interagency Cooperation
“Part of making the triple-bottom line a real thing is to understand that we will have to be working on our own institutions, even the best and most effective of them, to make sure that they see the interlinkages,” said Smith.
But even though individuals increasingly understand the need to address security, development, and climate change in an integrated fashion, “institutions have only limited capacities for coordination,” said Carius. Institutions are constrained by bureaucratic processes, political mandates, or limited human resources, he said. “Years ago, I always argued for a more integrated policy process; today I would argue for an integrated assessment of the issues, but to…translate it back into sectoral approaches.”
Levine expressed optimism that with “a whole new avalanche of interagency connections” being established in the last few years, U.S. interagency cooperation has become “the culture.” However, if coordination efforts are not carefully aligned to advance concrete programs and policies, they run the risk of “getting bogged down in massive bureaucratic exercises,” he said. “‘Whole of government’ needn’t be ‘all of government,’ and it needn’t be whole of government, all of government, all the time.”
Building Political Will
Europe has a “conducive political environment to making [climate and security] arguments,” said Smith, but the dialogue has yet to translate into action. In 2007, the debate on climate and security was first brought to the UN and EU with a series of reports by government agencies and the first-ever debate on the impacts of climate change on security at the UN Security Council, said Carius. However, none of the recommendations from the reports were followed and “much of the political momentum that existed…ended up in a very technical, low-level dialogue,” he said.
More recently, the United Kingdom included energy, resources, and climate change as a priority security risk in their National Security Strategy. And Germany, which joined the UN Security Council as a rotating member this year, is expected to reintroduce the topic of climate and security when they assume the Security Council Presidency in July. These steps may help to regain some of the political momentum and “create legitimacy for at least making the argument – the very strong argument – that climate change has an impact on security,” said Carius.
Sources: AFP, UK Cabinet Office, Telegraph, United Nations
Image Credit: “Trees cocooned in spiders webs after flooding in Sindh, Pakistan” courtesy of flickr user DFID -
John Warburton, China Environment Series
UK Helping to Relieve Climate-Related Stress on China’s Agriculture
›The UK and China have been working together since 2001 to better understand how China is going to be impacted by climate change, particularly in the agriculture sector. But understanding must also lead to action, with adaptation needing to be integrated into the development process at both national and local levels. This work, which is ongoing, will increasingly provide a model for how to approach adaptation in other countries.
In my opinion, this work has also contributed to the realization among top-level Chinese officials that it is important to take global action on climate change as part of the international negotiation process; until very recently, most of the international engagement with China has focused on mitigation, with the result that the very real and urgent challenges that China faces in regards to its own adaptation needs have been sidelined.
Another Stressor for Chinese Agriculture
China’s Polices and Actions for Addressing Climate Change, issued in October 2008, state:The impacts of future climate change on agriculture and livestock industry will be mainly adverse. It is likely there will be a drop in the yield of three major crops — wheat, rice and corn; …enlarged scope of crop diseases and insect outbreaks; [and] increased desertification.
Even though assessing the likely impacts of climate change on crop yields is a complicated process, with some evidence showing that in some areas crops may benefit if agricultural technology can keep pace, the overall picture is grim for China.
Potential climate impacts are very worrying for a country which already faces so many other challenges within the agricultural sector, among them the facts that it has to feed nearly one quarter of the world’s population (1.3 billion people) with only seven percent of the world’s arable land; that it has only one-quarter of the world’s average per capita water distribution (one-tenth in large parts of northern China, which are heavily dependent upon agriculture); and that the agricultural land base is fast diminishing due to urbanization, industrialization, and the conversion of arable land to grasslands and forest.
Collaboration on Adaptation
Much of the evidence that supports the understanding of the likely adverse impacts on Chinese agriculture from climate change stems from collaborative work between the UK and China which started in 2001. A joint project, Impacts of Climate Change on Chinese Agriculture (ICCCA), has combined cutting-edge scientific research with practical development policy advice. Although national in scope, the project included pilot work to develop a stakeholder based approach to adaptation in the Ningxia region of northcentral China. ICCCA was successfully completed in December 2008. The UK-China collaboration is now continuing with a major new project which is going beyond agriculture and looking at additional socioeconomic sectors and geographic areas.
Continue reading in the China Environment Forum’s China Environment Series 11, from the Wilson Center. Other articles in the series can be found on CEF’s website.
John Warburton is a DFID senior environment adviser and is currently based in Beijing.
Photo Credit: “Field,” courtesy of flickr user totomaru. -
What “Lost” Cultures Can Contribute to Management of Our Planet
›“Climate change is not a technical problem for indigenous people – it’s a psychological and spiritual problem,” said Wade Davis, explorer-in-residence at National Geographic, at a recent Wilson Center event, the third in a series co-sponsored by George Mason University and the Environmental Change and Security Program. Indigenous people are “being driven out of existence,” as climate change alters landscapes and weather patterns that they have carefully adapted to over centuries, he said. These people are not “failed attempts at being modern…they are unique answers to the fundamental question, ‘what does it mean to be human and alive?’” he said. “It behooves us to pay attention to how they choose to live upon the earth.” [Video Below]
