Showing posts from category family planning.
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Women Deliver: Real Solutions for Reproductive Health and Maternal Mortality
›The landmark Women Deliver conference, which concluded last week, reinvigorated the global health community’s commitment to improve reproductive health at both the grassroots and global levels. Providing a major boost was the Gates Foundation’s announcement that it will commit an additional $1.5 billion over the next five years to support maternal and child health, family planning, and nutrition programs in developing countries.
“We haven’t tried hard enough,” said Gates Foundation co-founder Melinda Gates. “Most maternal and newborn deaths can be prevented with existing, low-cost solutions.” Examples of these efficient and effective solutions were presented at the three-day conference’s dozens of panels on a wide range of issues, including climate change, contraceptive commodities, fistula, gender inequities, adolescent family planning, communications and technology, and much more.
Empowering Young Girls to Access Family Planning
“When we speak about adolescents we typically think of prevention. However, we must also think about providing access to safe abortions and supporting young women who want to be mothers and empower young women to make choices,” said Katie Chau, a consultant at International Planned Parenthood Federation.
In Nigeria, “there is not much attention on adolescent sexual and reproductive health, even though a majority of rapes occur before the age of 13, and the rate of teenage pregnancy and abortions is high,” said Bene Madunagu, chair of the Girls’ Power Initiative (GPI) in Nigeria. GPI teaches girls about their rights to make decisions, including those regarding sex and reproductive health, as well as improving their critical thinking skills, self-esteem, and body image. “Girls develop critical consciousness and question discriminatory practices, while also learning about the legal instruments to take up their concerns,” he said.
Sadaf Nasim of Rahnuma Family Planning said child marriages are common in his country, Pakistan. “Marriage is an easy solution for poor families. Once a girl is married she is no longer the responsibility of the family,” he explained.
While laws in Pakistan and other parts of the developing world condemn child marriage, the prevalence of child marriage remains high: 49 percent of girls are married by age 18 in South Asia, and 44 percent in West and Central Africa. Nasim said birth registration at the local and national levels should be improved to prevent parents from manipulating their daughter’s age.
In Kyrgyzstan, “community-based efforts worked to galvanize media attention and disseminate information to demonstrate the need for improved adolescent family planning,” said Tatiana Popovitskaya, a project coordinator with Reproductive Health Alliance of Kyrgyzstan. Such community-based approaches use grassroots education to mobilize community leaders, which is a critical step in overcoming child marriage and other harmful traditions.
Cell Phones and Maternal Health
“There is a lot of information being collected, but it is not necessarily going where it needs to because of fragmentation,” said Alison Bloch, program director at mHealth Alliance. In developing countries, the people most in need are often the most isolated, but mobile technology is emerging as a way to bridge the gaps.
According to a recent report by mHealth Alliance, 64 percent of mobile phone users live in developing countries and more than half of people living in remote areas will have mobile phones by 2012. The potential for improving global health with cell phones and PDAs is significant, and can address a wide range of health issues, such as human resource shortages and information sharing problems between clinics and hospitals.
“Mobile technology provides benefits to individuals, institutions, caregivers, and the community. It reduces travel time and costs for the individual, improves efficiency of health service delivery, and streamlines information to health workers to reduce maternal mortality,” said Elaine Weidman, vice president of sustainability and corporate responsibility at Ericsson.
“Mobile technology is the most rapidly adopted technology in history and represents an existing opportunity to reach the un-reached,” said Fabiano Teixeira da Cruz, a program manager for the Inter-American Development Bank, speaking of the benefits of using mobile technology to train field-based healthcare workers in Latin America.
While mobile phones are indeed reaching parts of the world not currently equipped with quality healthcare, the lack of systematic coordination and infrastructure at the district and regional levels must also be addressed, as highlighted during a recent Wilson Center event, Improving Transportation and Referral for Maternal Health.
Read about our first impressions of Women Deliver 2010 here.
Calyn Ostrowski is program associate with the Wilson Center’s Global Health Initiative
Photo credit: Woman and child in South African AIDS clinic, courtesy Flickr user tcd123usa. -
The Feed for Fresh News on Population
›June 9, 2010 // By Wilson Center StaffChanging Chinese demographics of labor force connected to worker protests from today’s
New research on desired family size and child mortality in Reading Radar on @NewSecurityBeat. From #USAID and The #Lancet http://ow.ly/1UgYj
Congrats to Suzanne Ehlers as new head of #PAI. Hoping for cont’d demography & security and population-environment work http://ow.ly/1TAzA
Practical maternal health lessons in transportation and referral w/ examples from #India, #Bolivia, & #Ghana @MHTF #UNFPA http://ow.ly/1TzQZ
Columbia University’s Grace Kodindo on @NewSecurityBeat with video interview on family planning in conflict zones http://ow.ly/1TzQg
Grace Kodindo of “Grace Under Fire” talks family planning in conflict zones. #Chad #refugees #conflict #WilsonCenter http://ow.ly/1TuN1
Follow Geoff Dabelko on Twitter for more population, health, environment, and security updates -
Women Deliver 2010: First Impressions
›Delivering Solutions for Girls and Women
“We know how to intervene; there does not need to be a magical solution,” said Søren Pind, Denmark’s minister for development cooperation, at the June 7 opening ceremony of Women Deliver 2010.
In its second year, the conference has gathered delegates from 146 countries representing hundreds of non-governmental organizations (NGOs), governments, and civil society organizations under the theme “Delivering Solutions for Girls and Women.” Delegates are working to share projects, policies, successes, and innovations in the field of maternal health and to develop strategies to meet Millennium Development Goal 5.
“Recent trends show great progress and this is very encouraging,” said Gamal Serour, president of the International Federation of Gynecology and Obstetrics (FIGO), speaking of a recent study by the Institute of Health Metrics and Evaluation (IHME). The study found that annual maternal mortality has dropped 34 percent–from 526,000 to 342,900–between 1980 and 2008. Nevertheless, Serour maintained that “we are far away from our goal for 2015.”
Overcoming Tradition and Religious Barriers
Investing in women’s health is not only the right thing to do, it is also economically advantageous. When women are healthy, they provide tremendous benefits to their families, communities, and countries. Women contribute to a majority of the small businesses and agricultural activities of developing countries and their unpaid work at home accounts for almost 33 percent of the world’s GDP. Unfortunately, over 215 million of these women do not have access to family planning services, resulting in unwanted pregnancies, childbirth, and maternal deaths.
There are many barriers to family planning in developing countries, not the least of which are cultural and social traditions that can uphold negative gender-based norms. Tailoring campaigns to address these gender inequities was the subject of discussion at the “Cultural Agents of Change Delivering for Women” session, where panelists acknowledged that collaboration and partnership with a wide-range of actors–from members of the local legislature to civil society organizations and actors in the health sector–are necessary to facilitate change.
Graciela Enciso of the Centro de Investigaciones y Estudios Superiores en Antropología Social-Sureste in Mexico, added that advocacy campaigns to increase support for family planning should be “linked with research.” In many traditional societies, strict interpretations of religion are used to control and disempower women; donors and NGOs “need to think outside the religious box at every point,” said Mary E. Hunt, co-director at the Women’s Alliance for Theology, Ethics, and Ritual.
Male Contraception, Gender Roles, and Family Planning
“I think it is important not to hide behind our cultures and religion,” said Ngozi Okonjo-Iweala, managing director of the World Bank. “We need to work with men and work together to overcome gender inequality.” “Male participation” has been a key theme echoed throughout Women Deliver and is often highlighted as a strategy for reducing maternal mortality.
At the “Men Deliver: Men’s Role in Family Planning” breakout session, experts addressed how new and existing technologies in male contraception and shifting gender roles can help to scale up family planning interventions. “Reducing unwanted pregnancies can also be carried out through male contraception,” said John Townsend, vice president of the reproductive health program at the Population Council.
Condoms are traditionally the main method of contraception for men, but usage rates quickly fall over time and to wear a condom “becomes the women’s responsibility,” said Townsend. To address issues around condom usage, development of alternative family planning technologies, such as gels and implants, is underway. As these technologies are being developed, however, it is important for program managers and donors to consider existing gender norms and the willingness of men to utilize new methods.
In researching gender roles in family planning in Zambia, Holo Hochanda, the chief technical administrator of the Planned Parenthood Association of Zambia, determined that there are many entry points for male intervention and increased family planning. “Men are clients, policymakers, and service providers. Each of these roles provides an opportunity to discuss utilization of male contraception and gender inequities in family planning,” he said. “Men can be key mobilizers and agents for change.”
For more coverage on Women Deliver 2010 click here and to learn more about the Wilson Center’s Maternal Health Dialogue Series visit the Global Health Initiative’s website here. -
Shrinking Desired Family Size and Declining Child Mortality
›Desired Number of Children: 2000-2008, a report prepared by Charles Westoff of Princeton University for USAID, reviews family size preferences in 60 countries. Taking its data from a series of Demographic and Health Surveys (DHS), the report found that “the number of children desired is declining in most of the developing world.” The noted exception is western and middle sub-Saharan Africa where, in some countries, 6.0 children remains the desired number. The report found that desire for smaller family sizes, rather than a reduction of unwanted births, was the primary factor behind the declining Total Fertility Rates (TFR) exhibited in most of the countries studied. It noted that men’s preference is close to, but larger than, that of women, and that preference sizes were declining even among women without formal education. The report concluded that preferred family size broadly depended upon “child mortality, Muslim affiliation, women’s education and empowerment, and exposure to the mass media.”
In an article appearing in the latest The Lancet, researchers from University of Washington and University of Brisbane found that global child mortality has declined 35 percent since 1990, outpacing initial forecasts. Neonatal, Postneonatal, Childhood, and Under-5 Mortality for 187 Countries, 1970—2010: A Systematic Analysis of Progress Towards Millennium Development Goal 4 found that 31 developing countries are on track to achieve Millennium Development Goal 4 and that in certain regions, including sub-Saharan Africa, declines in mortality are actually accelerating. The report concludes that the positive trends in child mortality “deserve attention and might need enhanced policy attention and resources.” -
VIDEO: Family Planning in Conflict Areas
›“Displaced people are like every other human being, they want, they need the advantage of family planning. They are asking only for services to be available for them, affordable for them, and acceptable for them,” said Dr. Grace Kodindo in a recent interview with ECSP about the challenges of family planning in conflict regions. The OB/GYN from Chad calls for family planning services to be included in the provisions made for displaced and refugee communities.
Kodindo identified five key barriers to family planning for displaced people, including a lack of coherent policies for displaced people in host countries and a lack of awareness and attention by donors to family planning. Other barriers include the lack of access in remote areas, and a lack of knowledge and therefore demand.
However, in many cases family planning services are very much in demand. One refugee mother compared herself to a “hen being followed by many chicks,” said Kodindo, who “ask[s] the government and the donors to give and to make policy that can really facilitate the provision of services and to provide funding so that services can be available to all these people.”
Kodindo, who recently spoke at a Wilson Center panel on “Family Planning in Fragile States,” is also speaking in DC on Thursday, June 3 at a showing of the documentary about her work in the Democratic Republic of the Congo, Grace Under Fire. -
‘Frontlines’ Interviews John Sewell: “Promoting Development Is a Risky Business”
›May 31, 2010 // By Wilson Center Staff
Q: Foreign assistance has had major achievements over the past 50 years. What are some examples?
SEWELL: There have been many but off the top of my head I can think of three. First, the Green Revolution where the combined efforts of American aid and private foundations revolutionized agriculture in Asia. As a result, many more people lived a much longer time. Second, the efforts put into improving education, particularly of women and girls. The third is population growth. When I started working on development, the best predictions said that global population would rise to over 20 billion at the end of the 20th century. Now we know it will not go much above 9 billion and perhaps lower. That wouldn’t have happened without American leadership and funding.
Q: What are the major failures of foreign assistance?
SEWELL: Failures have occurred either because countries were not committed to development, or because aid agencies designed ineffective programs. But most major failures came about because aid was provided for political reasons— for Cold War purposes in Southeast Asia or the Middle East, not for economic and social development. And we should remember that promoting development is a risky business. If there were no failures, development agencies were being too cautious.
But the more important failures are at the strategic level. Assistance really is only effective when governments and leaders want to speed economic growth, improve health and education, and address poverty. When the government isn’t committed to development, a lot of aid is wasted.
That’s why the choice of countries is so important. Korea is one example. Korean leaders knew how to use foreign aid effectively to build agriculture and industry. Part of that assistance funded investments in health and education. We all know the result.
Egypt, on the other hand, also has received large amounts of American assistance since 1979. But its growth rates are low and they still have one of the highest rates of adult illiteracy in the world.
Perhaps the largest failure has been in Africa. Except for a small number of countries, Africa lags far behind other regions. The blame lies not just with African leaders but also with aid donors who have continued to provide assistance in ways that hinder development.
Q: In what ways can global poverty be reduced quickly in the next three to four years?
SEWELL: In the short term, it won’t happen. The global financial crisis makes that a certainty.
The best estimates are that up to 90 million people will fall back into poverty because they will have lost jobs and livelihoods. The most important thing the U.S. can do in the near term is to continue to lead the reform of the international financial systems that are essential to restarting global economic growth, particularly in the developing world.
Q: That’s the way to reduce poverty?
SEWELL: In the short term, yes. But the U.S. can target aid to build poor peoples’ capacities and can make a great difference. That means aid for education, especially women, and to enable poor people to improve their health. And jobs are critical.
I think the right goal is to empower people to move into the middle class.
That means helping to provide technical assistance and in making low-cost credits for both farmers and small scale entrepreneurs. They will be the generators of jobs that enable men and women to move out of poverty.
Q: Why do you say in one of your papers that economic growth alone will not eliminate poverty?
SEWELL: Because it’s true. Growth does not automatically diminish poverty; it has to be complemented by government actions to share the gains from growth by investing in better health and education. For this you also need a competent state. That’s how the East Asian countries managed to develop so successfully. On the other hand, many Latin American countries have grown at decent rates but have lousy income distribution. But now countries like Brazil are starting to change. For instance, the Brazilian government now pays mothers to keep their children in school where they can get education and health care.
Q: USAID has restrictions that inhibit advertising. How can the public and Congress be informed about the successes and importance of development assistance?
SEWELL: USAID has been very timid about educating the public and Congress. I am not even sure that the earlier successful programs of development education exist anymore. Some steps are easy.
USAID staff knows a lot about development. Why not send them out to talk to public groups around the country? USAID staff doesn’t even participate actively in the yeasty dialogue on development that goes on in the Washington policy community and they should be encouraged to do so. Other changes may require funding and perhaps legislation and the administration should work with the Congress to get them.
Informing the public is particularly important now when there are two major processes underway to modernize U.S. development programs and Congress is rewriting the development assistance legislation.
Q: Since China and Vietnam have both developed without democracy, how important is it to push for democracy and good governance? Are they really necessary?
SEWELL: We need to separate democracy and governance. Very few of the successful developing countries have started out as democracies; India is the big exception. On the other hand, all of the successful countries have had effective governments to do what governments should do: provide security and public goods like health and education, establish the rule of law, and encourage entrepreneurship.
We need to face the fact that no outsider, including the U.S., can “democratize” a country. But it can play an important role in helping to improve governance in committed poor countries. And one of the important parts of successful development is what a Harvard economist calls “conflict mediating institutions” that allow people to deal with the inevitable conflicts that arise within successful development.
Q: You have said that we need to make markets work. How can we help poor people begin to trade when Europe, Japan, and the United States either block imports or subsidize exports?
SEWELL: If you are serious about development, you have to give high priority to trade policy. Unfortunately, USAID seems to have very little voice in trade decisions.
The U.S. needs to focus its development trade policy on the poorest countries. The highest priority should be dropping the remaining subsidies for U.S. production of highly subsidized agricultural products like cotton that can be produced very competitively in very poor countries.
But many of these countries have difficulty selling goods in the U.S., not only because of subsidies, but also because they are not equipped to export. Transport costs are high as are the costs of meeting U.S. health and quality standards, and knowledge of marketing in America is scarce.
Here’s where USAID can play an important complementary role. U.S. companies are already providing technical assistance, some with USAID support. But USAID can expand its trade capacity building programs and focus them on the poorer countries.
Q: What about microcredit?
SEWELL: Microcredit is a very important innovation, especially for empowering poor people, particularly poor women. It’s part of the solution to ending poverty.
But there are other needs. In most poor countries, there are large groups of poor entrepreneurs who are not poor enough to get microcredit but who can’t get commercial banks to lend to them. These are people who produce products for sale— handbags, for instance—that employ 10 to 20 people, but they need capital and advice in order to grow. In the U.S., small businessmen used to borrow money from local banks.That’s how America grew. But similar institutions don’t exist in many poor countries.
Q: We are involved in so many different programs—20 or 30 different federal agencies do some sort of foreign assistance— why not just invest in education and health and let each country figure out what their own development plan should be?
SEWELL: A very good idea. I have long advocated that the U.S. should focus its programs on a few major development issues but I would go beyond just health and education. I add climate change and dealing with global health threats. We dodged the bullet on SARS [severe acute respiratory syndrome] and avian flu but we may not be so lucky in the future. And strengthening governance and strengthening weak states is essential.
The real need now is for some mechanism that oversees and coordinates the multiplicity of agencies that have programs and expertise on these critical issues. Let’s hope that emerges from the current administration’s reviews of development policy
John Sewell a senior scholar at the Woodrow Wilson International Center for Scholars, was interviewed by FrontLines Editorial Director Ben Barber. Originally published in USAID FrontLines, April 2010.Urbanization, Climate Change, and Indigenous Populations: Finding USAID’s Comparative Advantage
›May 26, 2010 // By Kayly Ober
“Part of the outflow of migrants from rural areas of many Latin American countries has settled in remote rural areas, pushing the agricultural frontier further into the forest,” writes David López-Carr in a recent article in Population & Environment, “The population, agriculture, and environment nexus in Latin America.” In a May 4 presentation at the LAC Economic Growth and Environment Strategic Planning Workshop in Panama City, Panama, he discussed how to integrate family planning and environmental services in rural Latin America.
Latin America is one of the most highly urbanized continents in the world, with an average of 75 percent of the population living in cities. However, “there are two Latin Americas,” said López-Carr at the workshop, which was sponsored by the Woodrow Wilson Center’s Environmental Change and Security Program and Brazil Institute, as well as the U.S. Agency for International Development. Largely developed countries like Chile, Argentina, and Uruguay are close to 90 percent urbanized, while Guatemala, Ecuador, and Bolivia are about 50 percent. In less urbanized countries, rural-rural migrants in search of agricultural land remain a major driving force behind forest conversion, he said.
Between 1961 and 2001, Central America’s rural population increased by 59 percent, said Lopez-Carr. The increasing density of the rural population had a negative impact on forest reserves: a 15 percent increase in deforestation totaling some 13 million hectares.
“Rural areas of Latin America still have high fertility rates but (unlike much of rural Africa, for example) also have a high unmet demand for contraception, meaning that improved contraceptive availability would likely result in a rapid and cost-effective means to reduce population pressures in priority conservation areas,” he said. Additionally, remote rural areas with high population growth rates tend to be associated with indigenous populations located in close proximity to protected forests.
For example, in Guatemala, communities surrounding Sierra de Lacandon National Park have, since 1990, grown by 10 percent each year, with birthrates averaging eight children per woman. Larger communities and larger households have led to agricultural expansion, which infringes on the park and accelerates deforestation in one of the most biologically diverse biospheres in the world, said López-Carr.
Based on these demographic and environmental trends, López-Carr suggested USAID’s work in the region should focus on rural maternal and child health, and education – especially for girls. Not only does USAID already invest in such programs, but they only cost pennies per capita and could reduce the number of rural poor living in Latin American cities by tens of millions.
Given the strong links between population density and deforestation in Latin America, expanding access to family planning would also be a smart investment in forest conservation and climate mitigation, López-Carr concluded.
Source: Population Reference Bureau.
Photo Credit: Dave Hawxhurst, Woodrow Wilson Center.Coffee and Contraception: Combining Agribusiness and Community Health Projects in Rwanda
›“Population pressures and diminishing land holdings – due to high fertility rates, war and genocide, and subsequent migration – have caused a rapid decrease in the forested and protected areas and increased soil infertility and food insecurity” in Rwanda, USAID’s Irene Kitzantides told a Wilson Center audience.
Kitzantides, a population, health, and environment advisor and global health fellow, said “the population is projected to reach over 14 million by 2025” – nearly one-third more than today, due to the country’s high fertility rate of nearly 5.5 children per women–which could continue to negatively impact forests and food supplies.
In response to these challenges, USAID supported the Sustaining Partnerships to Enhance Rural Enterprise and Agribusiness Development (SPREAD) Project. SPREAD uses an integrated population-health-environment (PHE) approach to develop the coffee agribusiness and bring family planning, HIV/AIDS, and reproductive health services to coffee workers.
Combining income generation with health services was thought an effective way to “fulfill the overall SPREAD goal of improving lives and livelihoods,” said Kitzantides.
A SPREADing Mandate: Integrating Health and Agribusiness
SPREAD follows USAID’s PEARL I and II Projects, which focused exclusively on agricultural development. Coffee is still at the center of SPREAD’s activities, with $5 million of the project’s $6 million USAID budget earmarked for agricultural development.
However, a broader mandate to include health services emerged after recognition that greater income alone does not ensure greater quality of life. The additional health funding leverages SPREAD’s already established relationships with farming cooperatives to bring health services to traditionally underserved rural communities.
“We really tried to build on the existing assets of the cooperative,” said Kitzantides. “We also really tried to complement local and national public health policy and partners.”
The integration of health with agricultural goals, and the use of already established in-country health programs, has made SPREAD extremely cost-effective, with HIV/AIDS prevention education costing less than $2 per person.
Examples of SPREAD’s integrated work include:Combined health and agricultural lessons: Kitzantides and her colleagues trained nearly 400 animateurs de café, cooperative employees running the agricultural education programs, to incorporate public health objectives into their activities. Combining health and agricultural education into one session takes advantage of workers already trained during previous USAID programs. The combination also attracts more male participants, who traditionally shunned HIV/AIDS, family planning, and reproductive health campaigns and services.
Radio programming: SPREAD worked with the agricultural radio program Imbere Heza (“Bright Future”) to incorporate health messaging at the end of each program.
Mobile clinics: SPREAD works with cooperatives and local health centers to bring convenient services to farmers when they gather at sales or processing stations during harvests.Community theater: SPREAD hires local theater groups to perform skits on health. The farming communities “really love community theater and always ask for it,” said Kitzantides.
In its relatively short existence, SPREAD’s health activities have reached over 120,000 people with HIV/AIDS prevention messages; nearly 90,000 with messages discussing family planning/reproductive health; and almost 40,000 about maternal and child health. The project counts 347 women as new users of family planning services.
Lessons learned – which will be examined in more detail in an upcoming issue of Focus – include the importance of using community-based approaches to overcome perceived social barriers; the advantages of integrating cross-cutting activities at the outset of a program; and the need for strong monitoring and evaluation systems to measure the effort’s outcomes.
Jason Bremner of the Population Research Bureau said PHE projects such as SPREAD go “beyond what the health sector itself can do and find new ways of reaching underserved remote populations.” He presented a soon-to-be-released PRB map plotting the location of more than 40 PHE projects in Africa.
The success of SPREAD and similar projects demonstrates the potential for PHE approaches to bring reproductive health and family planning services to rural areas, Bremner noted, but there is still much work to be done to scale up this integrated approach – and to document its successes.
Sustaining SPREAD
Kitzantides said it took several years to integrate health activities with the already established agricultural programs. Since USAID funding for the program is scheduled to end in 2011, she is uncertain that the time remaining will be enough for SPREAD’s health partners to develop the logistical and financial capacities to become self-sustaining. But SPREAD has changed attitudes and beliefs, two key objectives that do not require sustained funding.
“We used to talk about growing coffee, making money, buying material things like bikes – not about problems like malaria, HIV/AIDS, etc.,” said one SPREAD agricultural business manager during the program’s evaluation. “Someone could have 5 million Rwandan francs in the house but could suffer from malaria where medicine costs 500 Rwandan francs, due to ignorance. You have to teach people about production, you have to also think of their health to improve their lives.”
Photo Credits: Irene Kitzantides, courtesy David Hawxhurst; condom demonstration, courtesy Nick Fraser; community theater group, courtesy SPREAD Health Program; Jason Bremner, courtesy David Hawxhurst.
