Showing posts from category family planning.
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Healthy People, Healthy Ecosystems: Results From a Public-Private Partnership
›“A lot of people probably don’t think that an organization with a name like ‘World Wildlife Fund’ would have a program on population, health, and the environment,” said WWF’s Tom Dillon at the Wilson Center, but actually it is very natural. “Most of the people we work with are in rural areas, and they depend on their natural resources for their own livelihoods and for their own well-being. Of course, if you are in that situation, in order to be a steward of the environment, you’ve got to have the basics. You have got to have your own health.”
Dillon was joined by staff from WWF, as well as Scott Radloff, director of USAID’s Office of Population and Reproductive Health, and Conrad Person, director of corporate contributions at Johnson & Johnson, to talk about the results of a three-year partnership between USAID, WWF, and Johnson & Johnson. The joint effort, a formal Global Development Alliance, provided health and family planning services, clean water, and sanitation to communities in three of WWF’s priority conservation landscapes: The Salonga National Park in the Democratic Republic of Congo (DRC), the Lamu Archipelago in Kenya, and the Terai Arch Landscape in Nepal.
By creating an innovative public-private partnership that linked health objectives, particularly related to family planning and maternal and child health, to environmental and conservation activities, “this alliance was ahead of its time,” said Radloff.
Human Health Linked to Environmental Health
The project had four objectives, said Terri Lukas, WWF’s population, health, and environment (PHE) program manager: improve family health; reduce barriers to family planning and reproductive health services; improve community management of natural resources and habitat conservation; and document and promote successful approaches.
“Human health cannot be separated from environmental health anywhere,” Lukas said, “but most especially when we are working with very poor people who live very close to nature.”
Projects Provide Integrated Services
The Salonga National Park in the DRC is home to many endangered species, including the bonobo, one of the four great apes. Local communities are very isolated, and lack access to safe drinking water and sustainable livelihoods, as well as basic health and family planning services, according to Lukas. The PHE project was able to train 135 voluntary community health workers in family planning and maternal and child health care, including 55 women. One year after the training, health workers were distributing contraception to more than 300 new users per month, Lukas said.
The alliance has also integrated health and family planning services into conservation programs in Kenya’s Kiunga Marine National Reserve, in part, “to demonstrate to the people that we care about them as well as the environment, and also to show them the synergies that exist between the health issue and the environment issue,” said WWF Program Coordinator Bahati Mburah. The region has been suffering through a year-and-a-half-long drought, and has one of the highest population growth rates in east Africa, placing considerable pressure on natural resources.
“We talk to [the fisher folk] about health and family planning, and how they are related to the management of fisheries,” said Mburah. With improved transportation and mobile outreach services provided by the project, 97 percent of women are now able to access family planning services within two hours of their home, she said.
The third site is in the Terai region along the southern border of Nepal. In this lowland region, the alliance is attempting to safeguard and restore forest areas in order to allow wildlife to move and breed more freely, while at the same time improving the health and economic prospects of the people. By linking these goals, support for conservation efforts increased from 59 percent to 94 percent of households, with 85 percent attributing positive attitude changes to increased access to health services and safe drinking water, according to Bhaskar Bhattarai, project coordinator for WWF-Nepal.
Documenting and Promoting Successful Approaches
Cara Honzak, WWF’s senior technical advisor on population, health, and environment, said the global objective of the alliance was to document and promote successful PHE approaches. Comprehensive baseline and endline surveys provided critical evidence that integrated PHE programming increases family planning use in remote areas, improves conservation buy-in within communities, and leads to increased participation of women in community leadership and decision-making.
“We have played a key role in producing some of the evidence that has been used throughout Washington [D.C.], especially to provide information to government bodies that are making decisions about bringing more money into family planning, health, and particularly in the environmental sector,” said Honzak.
“After two decades in the field, and working in this area, I wasn’t expecting many surprises. I couldn’t have been more wrong,” Lukas said. “These three years have changed almost everything about the way I now view health development…I have long called myself a conservationist, but now I say to my international health colleagues: we are all conservationists, and if we aren’t, we should be.”
Event Resources- Bhaskar Bhattarai presentation
- Cara Honzak presentation
- Terri Lukas presentation
- Bahati Mburah presentation
- Photo gallery
- Video
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Rwanda: Dramatic Uptake in Contraceptive Use Spurs Unprecedented Fertility Decline
›November 8, 2011 // By Elizabeth Leahy Madsen
With over 400 people per square kilometer, the highest rate on the African mainland, population density is perhaps the most widely-discussed factor of Rwanda’s demography. Some scholars, notably Jared Diamond, have argued that it played a primary role in sparking the 1994 genocide through competition for land (although others present a more complex theory based in policies and governance).
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Watch: Ann Blanc on Finding Unique Partnerships to Address Maternal Health Needs
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In the last five years, maternal health has begun to take a front seat within the larger global health agenda, but when it comes to a neutral space for broader focusing and prioritizing efforts there is still a void. In 2008 the Gates Foundation created the Maternal Health Task Force (MHTF) in an effort to fill that void. In this interview with ECSP, former MHTF Director Ann Blanc discusses how collaboration with the Wilson Center and the United Nations Population Fund has created an ideal space for addressing the technical, programmatic, and policy sides of neglected maternal health issues.
“Part of our mandate,” Blanc noted, “is to bring in the perspective of what we call ‘allied fields.’” The Wilson Center’s Advancing Policy Dialogue to Improve Maternal Health series focuses on engaging with neglected and emerging topics and experts, finding connections and encouraging partnerships with other fields, such as those working in water, sanitation, or HIV/AIDS services.
For instance, a two-day conference last year with private meetings and public dialogues focused on the neglected issue of transportation for women seeking maternal health services. The conference brought together non-traditional actors, including transportation engineers and mobile technology experts, to identify common barriers mothers commonly face like lack of infrastructure, poor security, or limited access to emergency communications.
“We’re constantly trying to push those barriers and look for interconnections between different development sectors and maternal health,” Blanc concluded. -
STATcompiler: Visualizing Population and Health Trends
›World population is growing – earlier this week, the global community symbolically marked the arrival of the seven billionth person. But the unprecedented growth in global population over the last few decades has not affected everyone equally – in 1950, 68 percent of the world’s population lived in developing regions; today that number is 82 percent. MEASURE’s latest version of their STATcompiler tool helps visually highlight areas simultaneously experiencing the most demographic change and poor health indicators.
The revised STATcompiler – released in September – provides new ways for users to visualize data by generating custom data tables, line graphs, column charts, maps, and scatter plots based on demographic and health indicators for more than 70 countries. Users can select countries or regions of interest, and relevant indicators, including for family planning, fertility, infant mortality, and nutrition. Tables can be further customized to view indicators over time, across countries, and by background characteristics, such as rural or urban residence, household wealth, or education. In some cases, sub-national data is available. User-created tables and images are then exportable so that they may be easily used in papers or presentations.
Since STATcompiler is still in active development, certain functions are still being added. HIV data has not yet been integrated into the program, nor has the express viewer function, with customizable, ready-made tables for quick access. Additionally, updated information is not available for all countries, in all categories – for instance, the most recent data available for Mexico comes from a 1987 survey. If preferred, the legacy version remains available to users in the meantime.
MEASURE DHS – the Monitoring and Evaluation to Assess and Use Results Demographic and Health Surveys project – provides technical assistance for data collection on health and population trends in developing countries. Their demographic and health surveys, funded by USAID, provide data for a wide range of monitoring and impact evaluation indicators at the household level in the areas of population, health, and nutrition. They have become a staple data source for researchers, and the addition of better analysis functions and dissemination tools, via STATcompiler, will hopefully help advance understanding of demographic and health trends.
Image Credit: Map from STATcompiler, arranged by Schuyler Null. -
Day of 7 Billion Puts Future Generations in Spotlight
›This month, our small planet’s population will hit seven billion. Reproductive health and environmental groups worldwide are raising awareness about the exact day – the “Day of Seven Billion” – when we’re estimated to hit that number next week, calling for sustainability and women’s empowerment. But the future trajectory of the world’s population projections – and all that they entail for human and environmental wellbeing – depends on decisions we make now.
Let’s start with the more than 215 million women worldwide – including many in our home countries, the United States and Kenya – who do not want to get pregnant but are not using modern contraception. Our world looks very different in 2050 if these women’s needs are met.
Research from the Futures Group shows that meeting women’s needs results in a significantly slowed population trajectory, with world population topping out at eight billion in 2050. According to recently revised UN estimates, without this intervention population could rise to 10 or even 12 billion by century’s end. Meeting this need is also a smart investment: Our research estimates that access to modern contraception for all who want it would cost $3.7 billion per year. Others have estimated the savings in health care costs of providing contraception to all who want it at $5.1 billion per year. Family planning is cost-effective; it has been estimated that a dollar spent on family planning can save between $15 and $20 in education, health, housing, and other socio-economic support costs, making the achievement of the Millennium Development Goals cheaper for developing countries.
The health and environmental benefits are also enormous: a one-third reduction in maternal mortality; a one-fifth reduction in child mortality; a major reduction in the greenhouse gas emissions. Recent research shows that carbon emissions slow when we slow our population trajectory in an effect similar to increasing the world’s use of wind power forty-fold. In Nigeria it was recently estimated that providing universal access to family planning would result in a reduction of carbon emissions equivalent to eight years from current sources.
These investments also provide more than big numbers: By enabling couples and women to choose when and how many children they’ll have, women can continue their educations longer, participate more in the workforce, and contribute to household decisions that benefit the family.
Giving women what they want and need to plan their pregnancies is one of the most obvious, yet most overlooked solutions to many of the most pressing problems we face, from maternal and child mortality to climate change. International family planning funding has stagnated for over 10 years and the results have been predictable: In Kenya, and in many countries, unmet need – with all its human costs – has increased.
Today, the largest generation of young people ever is coming of age. The aspirations and health of the millennial generation – as well as all those in the future – are on the line.
Pamela Onduso, MPH, is a Kenyan reproductive health advocate and program adviser with Pathfinder International’s Kenya office based in Nairobi. Dr. Scott Moreland is a senior researcher at the Futures Group, and leads demographic work in countries around the world.
Sources: African Institute for Development Policy, Futures Group, Guttmacher Institute, Health Policy Initiative, PNAS, Population Services International, UN Population Division, World Health Organization.
Photo Credit: Adapted from “Tea picker and son,” courtesy of flickr user ROSS HONG KONG. -
Laurie Mazur, The Aspen Leaf
The Planet at 7 Billion: Lessons from Somalia
›October 28, 2011 // By Wilson Center Staff
The original version of this article, by Laurie Mazur, appeared on the Aspen Institute’s Aspen Leaf blog.
Listless, emaciated children wait for water to arrive by donkey. Their mothers rest nearby, too exhausted to speak. Tiny graves are chiseled out of bone-dry earth to hold the famine’s youngest victims. That is what Mary Robinson, then-president of Ireland, found when she visited Somalia 19 years ago. Images of suffering haunted her for years: “I never got Somalia out of my system,” she said.
Now, the Horn of Africa is again in the grip of famine. When Robinson returned to Somalia earlier this year, “Everything was even worse” than in 1992. At the National Press Club on Monday, October 17, Robinson issued an eloquent plea to address the crisis in Somalia, which has already claimed 40,000 lives. “How can we allow that to happen in the 21st century?” she asked. “It’s a black mark for all of us.” The event was part of a series of discussions organized by the Institute’s Aspen Global Health and Development program, titled “7 Billion: Conversations that Matter.”
Women, Reproductive Health, and Fertility.
It is not enough to respond to the current crisis, Robinson said. To prevent a recurrence, we must also address long-term health and development challenges. That means bolstering governance and security. And, perhaps most important, it means unleashing the power of women. Women are critical to the future of Somalia, said fellow speaker Walid Abdelkarim, principal officer and team leader for Somalia at the UN Department of Peacekeeping Operations. “The most important element is the ability of the household to grow,” he said, “and that’s about the woman who nourishes and runs the household.”
Continue reading on The Aspen Leaf.
Video Credit: Aspen Institute. -
How Did We Arrive at 7 Billion – and Where Do We Go From Here? [Part Two]
›October 26, 2011 // By Elizabeth Leahy MadsenThe world’s women will determine whether the global population in 2050 is as low as 8 billion or as high as 11 billion through their choices (or lack thereof) about the number and timing of their children. Women in developing regions of the world will have the greatest effect on these potential population trajectories. Even if fertility rates remain constant at current levels (which is unlikely), developing regions would grow from 5.7 billion in 2010 to 9.7 billion in 2050, but the total population of developed countries would remain essentially unchanged.
The UN estimates that the seven billionth person alive today will be born on October 31. Demographer Elizabeth Leahy Madsen explains how we got to that number, its significance, and where our demographic path might take us from here. Read part one here.
The world’s women will determine whether the global population in 2050 is as low as 8 billion or as high as 11 billion through their choices (or lack thereof) about the number and timing of their children. Women in developing regions of the world will have the greatest effect on these potential population trajectories. Even if fertility rates remain constant at current levels (which is unlikely), developing regions would grow from 5.7 billion in 2010 to 9.7 billion in 2050, but the total population of developed countries would remain essentially unchanged.
The way that people decide the timing and number of their children is not easily distilled into a simple formula with a single solution. Still, some basic and important facts are known. In the developing world, where more than 80 percent of the world’s population lives, women in rural areas, those who have little or no education, and those who are poor, have larger families. As demographers have shown in modeling the determinants of fertility, women tend to seek contraception once they are confident that their children will survive to adulthood and when socioeconomic development increases the “costs” of having children, for example by motivating parents to send them to school rather than to work.
One of the most direct reasons for past declines in fertility rates was the rapid expansion of family planning and reproductive health programs, supported by country governments and international donors, that enabled women and men to more effectively choose the size of their families. But today, about 215 million women across the developing world would like to delay or avoid pregnancy but are using ineffective contraception or none at all. Funding programs to meet the family planning needs of these women, which would cost about $3.6 billion annually, would both empower them and help fertility rates continue to decline.
Beyond Access: Gender Inequality Inhibits Contraceptive Use
While increasing support for family planning programs tops the list of demographers’ recommended policies, ensuring that contraceptives are available and accessible will not alone achieve the fertility declines projected in most of the UN’s range of possibilities. Many women who are having or planning to have large families know about family planning and where to find it, but are choosing not to use contraception for cultural reasons that are often deeply engrained.
In sub-Saharan Africa, the region with the highest global fertility rate, only 16 percent of married/partnered women of reproductive age are using effective contraception. In comparison, between 62 and 75 percent of their peers in Ireland, the United States, and Uruguay – countries whose fertility rates are almost exactly at replacement level – are using it.
Logically, sub-Saharan Africa needs similar levels of contraceptive use to bring its average fertility rate towards replacement level as the UN projects, so the region’s average prevalence rate for modern contraception would need to rise by at least 10 percentage points in each of the next four decades. However, contraceptive use in the region has grown by only 0.5 percentage points or less over the past 30 years.
What is inhibiting the use of contraception? Demographic and health surveys find in Nigeria, for example, that 10 percent of married women are using an effective contraceptive method, while twice as many have an unmet need for family planning. This low use of family planning demonstrates high potential for change in the country’s demographic future, which, as the most populous in Africa, will greatly influence global and regional trends. Yet among women who do not intend to use contraception, 39 percent report that they or their family members are opposed to family planning, and another 16 percent fear side effects or have other health-related concerns. If Nigeria’s fertility rate remains unchanged, the country will be home to 500 million people by 2050.
In Pakistan, where 24 percent of births are unintended, surveys show similar barriers. Ninety-six percent of married women know about effective contraceptive methods, but only 22 percent are using one. More than one-quarter of women who do not plan to use contraceptives report that their fertility is “up to God” and 23 percent report that they or their family members are opposed to family planning. Pakistan’s population would more than double from 174 million to 379 million by 2050 if current fertility trends hold constant.
Peak Planet? Population Growth and Consumption Strain Environmental Resources
Because Nigeria, Pakistan, and other countries’ demographic trajectories may not follow the path laid out in population projections, we can’t take a world of nine billion for granted. While human ingenuity and technological advancements have improved standards of living in many countries, scientists caution that the combination of rising human numbers and growing consumption has serious environmental implications. Already, the quantity and quality of fresh water supplies are under strain, and forests in many developing countries are being rapidly depleted.
Population projections are much more than wonkish speculation – they foreshadow the serious problems that lie ahead if health, environment, and development policies aren’t strengthened. If the UN projections of our demographic future are to bear any semblance of reality, we must move beyond the status quo. While improving physical access to family planning should remain a top priority, meeting unmet need will also require addressing the deep-seated challenges of women’s education and empowerment.
Elizabeth Leahy Madsen is a consultant on political demography for the Wilson Center’s Environmental Change and Security Program and former senior research associate at Population Action International.
Sources: Bongaarts and Sinding (2009), Bongaarts (2006), Futures Institute, Guttmacher Institute and UN Population Fund, Measure DHS, O’Neill, Dalton, Fuchs, Jiang, Shonali Pachauri, and Katarina Zigova (2010), UN Population Division, Washington Post.
Photo Credit: “Afghan Internally Displaced Persons,” courtesy of flickr user United Nations Photo. -
How Did We Arrive at 7 Billion – and Where Do We Go From Here? [Part One]
›October 26, 2011 // By Elizabeth Leahy MadsenThe United Nations Population Division has estimated world population will reach seven billion on Monday. Which changes in demographic trends led us to this milestone? What do the past and present tell us about how human numbers will change in the future?
The “Day of Seven Billion” was announced this spring following the release of the latest revision of UN population projections. Although the seven billionth person will not be precisely identified, this estimate is based on careful demographic modeling. Every two years, the UN revises its projections to incorporate the latest trend data and modify its assumptions, as seemingly small changes can make a huge difference demographically.The UN estimates that the seven billionth person alive today will be born on October 31. Demographer Elizabeth Leahy Madsen explains how we got to that number, its significance, and where our demographic path might take us from here. Read part two here.
The United Nations Population Division has estimated world population will reach seven billion on Monday. Which changes in demographic trends led us to this milestone? What do the past and present tell us about how human numbers will change in the future?
The “Day of Seven Billion” was announced this spring following the release of the latest revision of UN population projections. Although the seven billionth person will not be precisely identified, this estimate is based on careful demographic modeling. Every two years, the UN revises its projections to incorporate the latest trend data and modify its assumptions, as seemingly small changes can make a huge difference demographically.
Demography Is Driven by Fertility and Population Momentum
Since world population reached three billion in 1959, the rate of growth has increased, peaked, and begun to slow. Each succeeding milestone was reached more quickly than the last: It took 15 years to reach four billion, 13 years to hit five billion, and only 11 years to get to six billion at the end of 1998. The interval leading to seven billion was slightly longer, at 13 years, as the global rate of population growth has slowed.
Although mortality and migration also affect population trends, the factor with the greatest influence by far is fertility – the average number of children born to each woman. The decline in the global fertility rate from an average of nearly 5 children per woman in the early 1960s to 2.5 children today has in turn slowed the pace of world population growth. However, demographic momentum from previous generations of high fertility can drive population growth for decades to come. Even if Nigeria reached replacement-level fertility today, its population would still grow by one-third by 2050 as the number of births continued to exceed the number of deaths.
Assumptions Matter
Population projections consider: 1) current data about fertility and 2) assumptions about the ways fertility will change in the future. These assumptions vary depending on the source, so how much of a difference do they make? As it turns out, quite a lot.
Projections of world population in 2050 range from 8.1 billion (if fertility rates fall to a global average of 1.7 children per woman) to 10.9 billion (if they remain unchanged). The gap of nearly three billion between those possibilities is greater than the combined populations of China and India today.
Estimates vary even more widely for the end of the century, with the UN projecting that by 2100 world population could total anywhere between 6 billion (if total fertility falls to an average of 1.55 children per woman) and 27 billion (if every country’s fertility rates remain constant at today’s levels).
While demographers parse the details of the projections, policymakers would like to know which of these scenarios is more likely. After all, the economic, environmental, and political consequences of a population of 8 or 11 billion two generations hence are not the same, and a world of 27 billion is difficult for anyone to fathom.
If we simply projected past trends into the future at a steady rate, the population estimates on the low end of the fertility spectrum seem more likely. The global fertility rate has fallen from 4.5 children per woman in the early 1970s to 2.5 today, a decline of 43 percent, so the 14 percent decline projected in the medium-fertility variant between now and 2050 seems reasonable at first glance, perhaps even conservative. The medium-fertility variant assumes that all countries’ fertility rates will begin moving towards replacement level, around 2.1 children per woman, regardless of whether they are currently above or below that number.
However, even a 14 percent decline in fertility assumes that areas where fertility rates remain stalled at high levels will soon begin rapid declines, paralleling the past experience of other regions. As Population Reference Bureau demographer Carl Haub writes, “the assumption that the developing world will necessarily follow the path of the industrialized world…is far from a sure bet.”
In the last 40 years, fertility rates in the Caribbean, northern and southern Africa, Latin America, and all of Asia declined by 50 percent or more. The pace of decline in sub-Saharan Africa, while still notable, was much slower, at 23 percent. In order to meet the UN medium-variant projections, the region’s fertility rate would need to fall by nearly 40 percent by mid-century.
Some of the largest, fastest-growing populations in the developing world would need to experience a major acceleration from recent trends. In Nigeria, fertility edged down by 15 percent between 1970 and 2010, but the medium variant projection depends on a decline of 37 percent over the next four decades; Ethiopia’s fertility rate will need to fall by half.
Gender Matters, Too
The great irony of fertility trends is that gender inequities play an important role at both ends of the scale. In countries with the highest fertility rates, women tend to have less education than men and less autonomy. Their fertility choices may be greatly affected by the preferences of their husbands or other family members. In Niger, which has the highest fertility rate in the world, married men would, on average, like three more children than married women. In Uganda, where women average more than six children each, 60 percent of men report that domestic violence is justified.
By contrast, in countries with the lowest fertility rates, women have achieved equal access to education and the labor market, with more autonomy about how to earn income and what to do with it. Yet cultural expectations that place the burden for child and elder care and housework almost entirely on women can make marriage an unappealing option. In Japan, which is among the 10 lowest fertility countries in the world, more women are choosing to stay single: The marriage rate has fallen by almost half since the 1970s. Japanese women who do marry are waiting until their late 20s and tend not to give birth until they are 30, both of which result in lower average family size.
Even at this end of the demographic spectrum, the assumptions embedded within population projections seem optimistic. Japan’s fertility rate was last above replacement level in the early 1970s; it has fallen steadily to 1.3 children per woman today. The UN projections assume that fertility will immediately reverse track and begin rising to over 1.8 children per woman in 2050, rebounding above two children per woman before the end of the century.
The stalled high fertility rates in much of sub-Saharan Africa and parts of the Middle East, together with unprecedented low fertility in Eastern Europe and parts of East Asia, indicate that we are currently in an era of remarkable demographic diversity, despite the UN’s projection of future convergence.
Continue reading part two here.
Elizabeth Leahy Madsen is a consultant on political demography for the Wilson Center’s Environmental Change and Security Program and former senior research associate at Population Action International.
Sources: Boling (2008), Haub (2011), Japan Statistics Bureau, Measure DHS, UN Population Division, UN Population Fund, Washington Post.
Image Credit: Chart data from UN Population Division, arranged by Elizabeth Leahy Madsen.
