Showing posts from category family planning.
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The Role of Population Dynamics in Climate Adaptation
›December 21, 2010 // By Wilson Center StaffThis post is a synthesis of a panel discussion at the UNFPA Population Dynamics and Climate Change conference in Mexico City with Marcia Castro, of the Harvard School of Public Health; Heather D’Agnes, of USAID; and Lori Hunter, of the University of Colorado at Boulder.
It is well-known that environmental change — including climate change — has important impacts on human health. However, it is less well understood how health systems shape the responses of individuals and households to environmental change. Population dynamics — such as fertility, migration, and mortality and morbidity — influence community health and greatly affect community resilience in the face of environmental changes, including the capacity to adapt to climate change.
Mortality and Morbidity
Morbidity and mortality dramatically shape a household’s ability to adapt its livelihood strategies to a changing climate. For example, in areas of high HIV prevalence, such as sub-Saharan Africa, adult mortality seriously undermines livelihood options. In the face of such loss, the household’s reliance on local natural resources intensifies. If environmental change reduces the amount of available resources, the household has fewer options for energy and sustenance.
Morbidity also affects adaptive capacity, and morbidity itself can be shaped by environmental change. For example, environmental scarcity can increase poverty, which can lead to an increase in risky transactional sex, further fueling the HIV pandemic. Malnutrition resulting from drought and environmental shocks can suppress the immune systems of HIV-positive people, making them more vulnerable to illness and less able to adapt to other external changes.
Fertility and Family Planning
Healthier households are more resilient households, so increasing access to health services, including reproductive health services, is essential for building adaptive capacity. High fertility poses challenges to a family’s livelihood and has negative health effects on women and children. Providing reproductive health services is an effective way to improve the capacity of these vulnerable groups to adapt to climate change. For example, a recent study argues that lowering fertility rates in the Himalayan region could increase community resilience to the predicted fluctuations in water quantity.
However, there is a high level of unmet demand for contraception across the globe. How can community adaptation programs help meet this need? Importantly, research from the Philippines suggests that integrating population, health, and environment programs in a package approach to community development is more effective than single-sector interventions. Including family planning and reproductive health services in community-based climate adaptation programs could not only more effectively meet the community’s needs, but could also improve its adaptive capacity better than health or climate programs alone.
Migration
Another population process, migration, can both impact health and affect the capacity for adaptation. For example, internal migration in the Brazilian Amazon appears associated with the spread of malaria, which negatively impacts the adaptive capacity of households. To mitigate climate change’s health impacts, states should more effectively plan settlements and health systems, including health impact assessments for infrastructure and development projects. (Editor’s Note – northern Nigeria and Niger present another example of similar climate-related migratory patterns that significantly impact health and economic resilience.)
In summary, the scientific evidence is clear that population dynamics — such as mortality, fertility, and migration — and environmental trends are linked. Projects intended to improve a community’s ability to adapt to a changing climate should consider and address these linkages in their design and implementation.
Sources: Foundation for Environmental Conservation, UNFPA, USAID.
Photo Credit: “Toureg family in Niger,” courtesy of flickr user ILRI. -
Too Few or Too Many? Joel E. Cohen on How Education Can Address Both
›December 17, 2010 // By Wilson Center Staff“So which is it: Is it too many people or is it too few people?” asks Joel E. Cohen of the Rockefeller University in this interview with ECSP. “The truth is, both are real problems, and the fortunate thing is that we have enough information to do much better in addressing both of those problems than we are doing – we may not have silver bullets, but we’re not using the knowledge we have.”
Cohen has studied the population-resources equation, trying to determine how best to support global demographics in a sustainable, equitable way. He points to the cross-cutting power of education to both curb rapid population growth in the developing world and ease the cost of aging populations in the developed.
“On continuing rapid population growth, we know that more education is associated with reductions in fertility,” said Cohen. And when combined with voluntary family planning, it’s also cheap “compared to the costs of having children that are not well cared for – the opportunity costs,” he said.
On aging, “we know that people who are educated well in their youth – both at primary, secondary, and especially tertiary levels – have better health in old age,” said Cohen. “So the costs of an aging population are diminished when people are educated. They take better care of themselves and they have options – they can use their minds as their bodies mature.”
Education is a long-term solution, but shorter-term policy options, like France’s bump of the retirement age to 62 that prompted rioting this fall, will also be necessary. “Sixty-two is only a way station,” Cohen said. “The retirement age has to move up, because people are living longer, they’re more productive, they’re in better health, and they’re going to have to keep working to take care of themselves.” -
Demographic Security Comes to the Hill
›December 16, 2010 // By Hannah Marqusee“We are now in an unprecedented era of demographic divergence,” said Population Action International’s Elizabeth Leahy Madsen at a September briefing held by Congressman John Tierney’s Subcommittee on National Security and Foreign Affairs and Congressman Russ Carnahan’s Subcommittee on International Organizations, Human Rights and Oversight.
Eighty percent of the world’s conflicts occur in places where 60 percent or more of the population is under 30, and 90 percent of countries with young populations have weak governments, said Chairman Tierney in his opening remarks. He said that while such demographic trends “appear to be issues for the future…it is important that we start this dialogue today, so that we can make steps to address [them].” ECSP Director Geoff Dabelko and the Stimson Center’s Richard Cincotta joined Madsen on the panel titled, “The Effects of Demographic Change on Global Security,” at the Capitol Visitor Center.
Youth Bulges and National SecurityThe countries of greatest security threat to the United States are also those with the youngest age structures and rapidly increasing populations, said Madsen. By next year, the world’s population will have reached seven billion, with 95 percent of that growth occurring in the developing world.
Large youthful populations can be a source of national strength because they provide innovation and manpower, said Dabelko, but without significant investment they may also contribute to state instability. When there are often few opportunities to obtain a job or an education for young people, there are low “opportunity costs” to joining a rebel group, said Madsen.
State instability can be affected by youth bulges, shifting religious or ethnic compositions, or food and water insecurity, but age-structural transitions are the strongest indicator of state performance, said Cincotta. Despite conventional wisdom, there is actually little evidence to link state failure with premature adult mortality due to AIDS or a high male-to-female ratio, he added.
It is not only developing countries with high fertility rates that face demographic difficulties, Cincotta noted. Countries such as Japan and Germany will soon have reached a “post-mature” age structure in which their aging populations and comparatively small workforces will tax state institutions and threaten economic stability.
Population Policies: Using “Soft Tools” to Improve National Security
Recently, leaders in the U.S. government have been paying increased attention to the linkages between demography and security through the “three Ds:” diplomacy, development, and defense. In 2008, the National Intelligence Council’s Global Trends 2025 included demographic assessments to analyze security trends, and this year, the National Security Strategy featured demographic trends along with the environment and other non-traditional areas.
Dabelko said that while this growing recognition signals progress, the “hard tools” of the traditional security community must be bolstered with “soft tools” commonly used by the international aid community, such as female empowerment, education, health services and youth employment.
Madsen argued that empowering the 215 million women with an unmet need for family planning worldwide through increased funding for voluntary family planning programs is a cost-effective way to shape population trends and ultimately reduce security threats.
“Demography is not destiny,” said Madsen. “Family planning has been an unsung signature of U.S. foreign assistance for decades.”
Similarly, Cincotta said that policies should help states transition out of youth bulges, and help countries with aging populations reform social institutions to protect older people.
Dabelko added that while progress has been made in acknowledging the linked nature of population trends and national security, there is significant room for improvement. Pointing to the successes of integrated population, health, and environment (PHE) programs, which provide environmental conservation and family planning services simultaneously, he called for similar programs to address population dynamics and conflict prevention. Long-term solutions call for coordinated resources and integrated strategies, he said.
Read the speakers’ full remarks: Chairman John F. Tierney, Richard Cincotta, Geoff Dabelko, and Elizabeth Leahy Madson (slides).
Sources: Guttmacher Institute, Population Action International, National Intelligence Council.
Image Credits: “World Age Structure 2005” and “Risk of Civil Conflict by Age Structure Type, 1970-2007,” courtesy of Population Action International. -
Expanding Access to Maternal Health Commodities
›“This is not just about getting quantities of drugs out, this is about saving women’s lives with really simple products that work,” said Julia Bunting, team leader of AIDS and reproductive health at the UK Department for International Development and coalition chair of the Reproductive Health Supplies Coalition, at the ninth meeting of the Global Health Initiative’s 2009-2010 Advancing Policy Dialogue on Maternal Health series. Joined by panelists Melodie Holden, president of Venture Strategies Innovations (VSI), and Elizabeth Leahy Madsen, senior research associate at Population Action International (PAI), the panel discussed the challenges and strategies for expanding access to maternal health commodities.
Integrating Maternal Health and Family Planning Supply Chains“It is often said that the family planning and the maternal health communities have very different views of supplies… but actually [both communities] recognize that we need to explore the continuum,” said Bunting, addressing the need to integrate maternal health commodities into existing reproductive health supply chains. “I really think the stars are aligned right now for advancing this agenda,” added Bunting.
“Many of the commodities that we talk about in terms of reproductive and maternal health cost tiny amounts to deliver, but actually save lives and are some of the most cost-effective interventions we have both in public health and in broader development,” said Bunting.
No Product, No Program
“Supplies are a key element in programs to improve maternal health and they are also a tangible and visible hook to increase awareness and commitment,” said Madsen. “Policymakers whose eyes glaze over when they hear the term ‘health systems strengthening’ can grasp… much better when they learn that supply shelves in clinics are bare and that women are making great efforts to reach facilities, only to leave empty- handed,” said Madsen.
Presenting research conducted by PAI, Madsen discussed the availability of four key maternal health medicines and products in Bangladesh and Uganda including:
By focusing on supplies that target the three leading causes of maternal mortality, Madsen and her colleagues identified factors that inhibit access to these commodities and developed recommendations for strengthening maternal health supply chains.- Oxytocin: used to prevent post-partum hemorrhage
- Misoprostol: used to prevent post-partum hemorrhage
- Magnesium Sulfate: used to treat pre-eclampsia
- Vacuum Aspirators: used for treatment of early and incomplete abortion
Madsen identified several strategies to strengthen supply chains for maternal health commodities including forecasting and preparing for growing demand, advocating for government and donor support, encouraging scaling-up of community-based approaches, promoting family planning, and focusing on human resource training.
“In maternal health, if a supply to prevent or treat a life-threatening complication is in stock, there must also be a way for a woman to reach it in time… and in most cases a provider who knows how to administer it,” said Madsen.
“This research is intended to lay the groundwork for future advocacy and policy initiatives by providing an evidence base that is informed by local expertise,” said Madsen. “We hope that this information will inform program implementation, funding decisions, and awareness raising.”
Getting the Product to People: The Case of Misoprostol
“The story of Misoprostol is still being written. The goal is to invest in creating access to interventions that are low-cost and relatively simple to use,” said Holden. By sharing lessons learned, Holden described VSI’s experience registering and procuring Misoprostol and demonstrated how community mobilization is imperative to overcoming major challenges for large-scale implementation.“Making products available is not without challenges,” said Holden. To increase access to Misoprostol in rural communities, maternal health experts must work to “engage communities, educate and mobilize women, train providers at all levels of the health care system, and provide support to distributors to jump start sales,” said Holden. “By looking holistically across entire health systems, bringing in great interventions, addressing the components of supply and demand, and working with local partners, we can have lasting impact.”
While the price of Misoprostol has decreased significantly, Holden stressed the need to identify creative ways along the supply chain that reduce costs to the end user. Additionally, “establishing policies around this new intervention not only establishes its reach, but also makes its use institutionalized, which means it will be part of the system even if governments or individuals change,” said Holden.
“If there is a gap between what could be achieved with Misoprostol and what is being achieved, we need to go back to the model and figure out what pieces aren’t working,” concluded Holden. “The work is complex and takes time, but it’s worth it.”
Photo Credit: “Rapid HIV testing,” courtesy of flickr user DFID – UK Department for International Development. -
From Cancun: Roger-Mark De Souza on Women and Integrated Climate Adaptation Strategies
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“When you look at the negative impacts of climate change, the impacts on the poor and the vulnerable – particularly women – increase, so investing in programs that put women at the center is critical,” said Roger-Mark De Souza, vice president of research and director of the climate program at Population Action International (PAI), speaking to ECSP from the UN Climate Change Conference in Cancun, Mexico. “There are a number of missed opportunities here in Cancun and in climate change deliberations overall that are not including women and are missing an opportunity to have a bigger bang for the buck, or power for the peso, as we say in Mexico.”
PAI hosted a side session with five panelists from Denmark, Ethiopia, Kenya, Suriname, and Uganda on “Healthy Women, Healthy Planet: Women’s Empowerment, Family Planning, and Resilience.” The session attracted more than 100 attendees and prompted incisive, informative questions, said De Souza.
“There was a call for additional research that is policy relevant that identifies some of the key entry points and added benefits at a country level,” said De Souza. “And there is a very strong call for youth partnerships from a number of youth advocates who are looking at medical and public health interventions and are desirous of including reproductive health programming as part of that.”
“One concrete next step for Cancun is to work with other civil society partners who are here who are tracking how gender is being integrated into the negotiating language, particularly with regard to financing mechanisms,” De Souza said.
Besides financing and the need for more research, De Souza said the key issues that emerged from the panel were: the importance of linking programs of different scales; ensuring women’s empowerment and ownership; and recognizing and replicating effective partnerships.
For more from Roger-Mark De Souza, see ECSP Focus Issue 19, “The Integration Imperative: How to Improve Development Programs by Linking Population, Health, and Environment.”
The “Pop Audio” series is also available as podcasts on iTunes. -
IGWG’s K4Health Gender and Health Toolkit Is a One-Stop Shop for Integration
›November 30, 2010 // By Ramona Godbole
Addressing and analyzing gender norms, roles, and relations is increasingly viewed as critical in the development of equitable, effective, and sustainable health care. However, there has been relatively little integration of gender into health policies, programs, and systems.
The Interagency Gender Working Group (IGWG) – founded in 1997 as a way to bring together NGOs and parts of USAID to share best practices – has partnered with K4Health to create a Gender and Health Toolkit specifically designed to bridge this gap.IGWG’s Gender and Health Toolkit provides access to hundreds of tools, databases, training modules, websites, and publications in one place. Broadly divided into sections including program design, implementation approaches, capacity building, monitoring and evaluation, health systems, best practices examples, and even country-specific case studies, the toolkit provides nearly everything needed to begin integrating gender into new or existing public health programs.
Practitioners can also post questions and comments about the toolkit through an integrated discussion board. The toolkit even has a database to share gender-related photos.
While designed primarily for gender and health specialists and practitioners, the scope of the toolkit extends beyond typical public health issues like maternal health, family planning, HIV/AIDS, and reproductive health. The toolkit links to resources and training modules covering a wide range of cross-cutting topics including gender-based violence; nutrition and food security; integrated population, health and environment; and conflict/post-conflict humanitarian assistance.
The accumulated wealth of knowledge presented in the IGWG Gender and Health Toolkit is an impressively comprehensive resource, and it should be bookmarked by environment, health, and gender specialists and interested policymakers alike.
Image Credit: K4Health. -
Climate-Proofing Development: An Interview With Karen Hardee
›November 29, 2010 // By Hannah Marqusee
While expectations are deflated for broad international consensus at the UN Climate Change Convention in Cancun, the need to “climate-proof” development efforts has been gaining ground in recent years as a necessary preventative measure to help developing countries adapt to the adverse effects of climate change.
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PRB’s Jay Gribble at Kenya’s National Leaders Conference on Population and Development
›November 29, 2010 // By Wilson Center StaffJay Gribble, vice president of International Programs at the Population Reference Bureau (PRB), recently attended the Kenya National Leaders Conference on Population and Development, November 15-17, at the Kenyatta International Conference Center in Nairobi. During the conference, he produced a series of posts for PRB’s Behind the Numbers on some of his impressions. Gribble focuses on Kenya’s resurgent interest in integrating population issues into the development agenda, the country’s ongoing HIV/AIDS epidemic, and the importance of family planning.
Below are the introductory excerpts from his posts; to read the full posts, please visit Behind the Numbers.
“Anticipating Change in Kenya”
Sitting in the hall where Kenya’s National Leaders Conference will be starting in a few minutes, I can’t help but feel that there is an opportunity to refocus national attention to development…to the goal that I have heard repeatedly of becoming a Middle Income country. And to achieve this goal, they must first recognize that population is an underpinning development issue that cannot be ignored.
In the 1980s and 1990s, Kenya was a leader in reproductive health and maternal health, really setting a pace for the continent. But during the 2000s, Kenya turned its attention to other pressing issues – namely HIV/AIDS – and began to give less attention to population issues. Though HIV continues to be a plague, it is now time to return to the importance of slowing population growth, for until this fundamental issues is addressed, there will be less opportunity for education, jobs, and better health. At the same time, as a predominantly rural country with agriculture representing a major part of the economy, smaller families will be critical to maintaining farms that are large enough to feed families and the country.
Continue on PRB.
“As the Rich Get Richer, the Poor Get Children”
The Kenya National Leaders Conference has begun, representing the first time since 1989 that Kenya’s national population policy has been discussed in a large, open forum. With a new national constitution, Kenya is poised to redress many of the social and economic inequalities that have stood in the way of its development. In fact, the current population policy expires in December, 2010, and one of the purposes of this conference is to gather the input from leaders throughout the country on how a new policy should be framed. I find it impressive that such a large conference is convened to ensure that a new policy reflects the needs of the nation. The conference is also a forum for reaching leaders with important information about the need to address population growth through family planning if Kenya is to achieve its Vision 2030 development plan.
Continue on PRB.
“In Kenya, Prioritizing Population…and Family Planning”
As Kenya’s National Leaders Conference on Population and Development winds down today, it offers leaders an opportunity not only to think and talk about how population growth is an issue that underlies the country’s development, but to act on it too. Whether thinking about business, agriculture, or the environment, it is impossible to be strategic about Kenya’s future without also considering how rapid population growth will affect it.
In talking with Kenyans who grew up in the 1970s and 1980s – back when family planning and population growth were a priority – they remember the messages that were at the tips of people’s tongues – smaller families live better. Before the HIV/AIDS epidemic, family planning and slowing population growth was a priority and a source of national pride because it put Kenya on track for prosperity and development.
Continue on PRB.
Photo Credit: Adapted from “King Kenyatta?” courtesy of flickr user rogiro.
