“One of the reasons why population grows very rapidly in Bangladesh is women get married very early and have children very early,” the Population Council’s Sajeda Amin told ECSP in a recent interview. “So even though they are only having two children, they are having them at an average age of around 20. As demographers would say, women ‘replace’ themselves very rapidly.”

Largely through the promotion of contraceptive use, family planning programs implemented over the past 35 years by the Bangladeshi government and a variety of NGOs have helped lower the country’s total fertility rate to 2.7 from 6.5 in the mid-1970s. To build on this progress, the Population Council has joined a consortium of other organizations – including the Bangladesh Legal Aid and Services Trust, Marie Stopes International, and We Can End All Violence Against Women – to launch the Growing Up Safe and Healthy (SAFE) project in Amin’s native Dhaka and other Bangladeshi cities.

“Does Family Planning Bring Down Fertility” in Science’s special July issue on population, author Jocelyn Kaiser engages various experts to explore whether family planning programs actually help to reduce high fertility. Social demographer Amy Tsui of Johns Hopkins University argues that surveys indicating “unmet need” in family planning “don’t tell us anything about causation.” On the other hand, Martha Campbell, a lecturer at the University of California, stressed that in countries such as Niger where the population could soar from 16 million today to 58 million by 2050, “You can’t expand [schools] fast enough.” Thus, focusing on family planning is indispensable and “the benefits [will] far outweigh the costs.”

“Quality of life, human health, food security, and biodiversity are all connected,” said Elin Torell, research associate for the BALANCED Project and the University of Rhode Island Coastal Resource Center. Torell was joined at the Wilson Center on July 19 by Patrick Kajubili from the Tanzania Coastal Management Partnership, and Alice Macharia, director of the East Africa Program at the Jane Goodall Institute to discuss the importance of integrated population, health, and environment (PHE) initiatives that work to simultaneously improve health and livelihoods, manage natural resources, and conserve ecosystems in Tanzania.

“Although there have been improvements in the recent past, the status of maternal health care has not met the required international standards,” said Professor at the University of Nairobi Geoffrey Mumia Osaaji during a live video-conference from Nairobi on July 12.

As part of the 2011 Maternal Health Dialogue Series the Woodrow Wilson Center’s Global Health Initiative is partnering with the African Population and Health Research Center to convene a series of technical meetings on improving maternal health in Kenya. The 20 Kenyan experts attending the workshop in Nairobi also shared their strategies and action points with a live audience in Washington, DC during a video conference discussion. [Video Below]

“By reducing population growth, we are going to have a better chance of sustaining the gains of an environmental conservation project,” said Leona D’Agnes in this interview with ECSP. D’Agnes, a technical advisor to PATH Foundation Philippines, served as lead author on a research article published late last year in Environmental Conservation titled, “Integrated Management of Coastal Resources and Human Health Yields Added Value: A Comparative Study in Palawan (Philippines).” The study provided concrete statistical evidence that integrated development programming incorporating population, health, and the environment (PHE) can be more effective in lowering population growth rates and preserving critical coastal ecosystems than single-sector development interventions.

High population growth and population density have placed serious stress on natural resources in the Philippines. No one lives far from the coast in the 7,150-island archipelago, making the population extremely dependent on marine resources and vulnerable to sea-level rise, flooding, and other effects of climate change. The coastal megacity of Manila – one of the most densely populated in the world – is beset by poor urban planning, lack of infrastructure, and a large population living in lowland slums, making it particularly vulnerable to increased flooding and natural disasters. [Video Below]

The Philippines is now home to 93 million people and by 2050 is expected to reach 155 million, according to the UN’s medium fertility variant projections. Development programs in the country have made great strides towards increasing access to family planning and reproductive health services as well as improving management of marine resources, but the underlying trends remain troubling.

The Battle Over Reproductive Health

Since 1970, the government’s Commission on Population has been addressing population growth, reproductive health, and family planning. “The impact of the high rate of population growth is intricately linked to the welfare and sustainable development for a country like the Philippines, where poverty drives millions of people to overexploit their resource base,” wrote the commission. As a result of these efforts and others, total fertility rate has dropped from 6.0 children per woman in 1970, to the present 3.2.

The Philippines has also made great gains towards achieving Millennium Development Goal targets, “particularly in the alleviation of extreme poverty; child mortality; incidences of HIV/AIDS, tuberculosis, and malaria; gender equality in education; household dietary intake; and access to safe drinking water,” according to the United Nations Development Program (UNDP). Yet, “glaring disparities across regions persist,” UNDP states.

One of the poorest regions in the country, the Autonomous Region of Muslim Mindanao, is also home to a violent separatist movement. With limited access to health services, fertility and population growth rates are the highest in the country. Women in Mindanao average 4.2 children per woman; one in four married women has an unmet need for contraception; and 45 percent of households live in poverty (compared to 24 percent nationally).

Nationally, “serious challenges and threats remain with regard to targets on maternal health, access to reproductive health services, nutrition, primary education, and environmental sustainability,” according to UNDP–in particular, indicators on maternal health are “disturbing” and of all the MDGs, are labeled “least likely to be achieved.”

Out of three million pregnancies that occur every year, half were unplanned and one-third of these end in abortions, according to a 2006 report of the Allan Guttmacher Institute conducted in the Philippines. Induced abortion was the fourth leading cause of maternal deaths, and young women accounted for 17 percent of induced abortions. Over half of births occurred at home and one-third of them were assisted by traditional birth attendants. Around 75 percent of the poorest quintile did not have access to skilled birth attendants compared to only 20 percent of the richest quintile.

The politically influential Catholic Church recently blocked passage of a reproductive health bill, despite support by President Benigno Aquino and a majority of Filipinos. The bill seeks to provide universal access to contraception and would make sex education required from fifth grade onwards, a provision that has angered Church officials.

Manila Under Water

The Philippines’ combination of high population growth and limited land area (nearly all of which is near the coast) makes the country extremely vulnerable to the effects of climate change. Sixty-five percent of Filipinos live in coastal areas and 49 percent live in urban areas. Paul Hutchcroft, in Climate Change and Natural Security, writes that “even in the best of times, the frequency of typhoons, floods, earthquakes, and volcanic eruptions makes the Philippines one of the most disaster-prone countries in the world” (p. 45).

Population growth, climate change, and deforestation will only increase the severity of these disasters, he concludes. Hutchcroft points out that by 2080, projected temperature increases of between 1.2 to 3.9 degrees Celsius could raise sea levels by an estimated 0.19 to 1.04 meters – a scary thought for the 15 million living within a one-meter elevation zone (p. 46).

In 2009, metropolitan Manila, currently home to 11 million people (18,650 per square kilometer) and projected to grow to 19 million by 2050, was hit by tropical storms that caused devastating flooding – at their peak, waters reached nearly seven meters, according to a World Bank report. “More than 80 percent of the city was underwater,” write the authors, “causing immense damage to housing and infrastructure and displacing around 280,000-300,000 people.”

“Even if current flood infrastructure plans are implemented, the area flooded in 2050 will increase by 42 percent in the event of a 1-in-100-year flood,” says the World Bank report. Climate change could also increase the cost of flooding as much as $650 million, or 6 percent of GDP. Only by considering climate-related risks in urban planning can the Philippines hope to mitigate the effects of climate change, the report concludes.

Integrated Development: One Piece of the Puzzle?

Population, health, and environment (PHE) programs that integrate family planning and natural resource management are one way to help the majority of Filipinos that live in densely populated and resource-stressed coastal areas.

In ECSP’s FOCUS Issue 15, “Fishing for Families: Reproductive Health and Integrated Coastal Management in the Philippines,” Joan Castro and Leona D’Agnes explain how Path Foundation Philippines, Inc.’s IPOPCORM project – which ran from 2000 to 2006 – helped “improve reproductive health and coastal resource management more than programs that focused exclusively on reproductive health or the environment – and at a lower total cost.” A recent peer-reviewed study, co-authored by Castro and D’Agnes and published in Environmental Conservation, proved the same point with rigorous analysis.

“When we started IPOPCORM, there was really nothing about integrating population, health, and environment,” said Castro in an interview with ECSP. IPOPCORM provided some of the first evidenced-based results showing there is value added to implementing coastal resource management and family planning in tandem rather than separately. In part due to the success of the IPOPCORM, the Philippines have become one of the major PHE development implementers in the world.

Creating sustainably managed marine sanctuaries while improving access to family planning provides a way forward for many coastal communities. However, the Philippines’ urban woes – 44 percent of urban dwellers live in slums, according to the Population Reference Bureau – internal divisions, and natural vulnerability will likely make it difficult to dodge considerable climate-related effects in the near future. Already the archipelago’s vast biodiversity is in crisis, according to studies over two thirds of native plant and animal species are endemic to the islands and nearly half of them are threatened; only seven percent of its original old-growth less than 10 percent of the islands’ original vegetation remains; and 70 percent of nearly 27,000 square kilometers of coral reefs are in poor condition.

Sources: CIA, Conservation International, Field Museum, The Guardian, The Huffington Post, Philippines National Statistics Office, Population Reference Bureau, United Nations, U.S. Census Bureau, World Bank, World Wildlife Fund.

Photo Credit: “Climate Risk and Resilience: Securing the Region’s Future” courtesy of Flickr user Asian Development Bank.

Download FOCUS Issue 23: “To Live With the Sea: Reproductive Health Care and Marine Conservation in Madagascar,” from the Wilson Center.

Christine does not know how old she is. She has 16 children and lives on a remote island off the southwestern coast of Madagascar. She and her children, like other members of the Vezo ethnic group, depend entirely on the ocean for their survival. Her husband, a fisherman, struggles to catch enough to feed his family.

“Practice, Harvest and Exchange: Exploring and Mapping the Global, Health, Environment (PHE) Network of Practice,” by the University of Rhode Island’s Coastal Resources Institute and the USAID-supported BALANCED Project, explores the successes and challenges of their global population, health, and environment (PHE) network (with a heavy presence in East Africa). In order to increase support of the nascent PHE approach, the network seeks to shorten the “collaborative distance” between “PHE champions,” so they can develop a stronger body of evidence for the links between population, health, and the environment. In their analysis, the authors write that the network has facilitated the development of independent, information-sharing relationships between “champions.” However, they also observed shortfalls in the network, such as its limited reach into less technologically advanced yet more biodiverse regions, its bias toward BALANCED meet-up event participants, and its exclusion of those experts unlikely to be included in published works.