Showing posts from category family planning.
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Maternal Health Solutions in Peru
›Media reports on the neglected discussion of maternal and child health often focus on the problems and projects in sub-Saharan Africa or South Asia, which is understandable, as a disproportionate 90 percent of global maternal deaths occur in these two regions. Last month, however, PBS correspondent Ray Suarez reminded us that maternal and child mortality affects countries all over the world, including Peru, where “maternal death rates has historically been unusually high,” he noted in a report for NewsHour.
“Few people in the highlands of central Peru own automobiles and it’s hard to know exactly when the next bus is going to rumble by,” said Suarez. “Villagers are a long way from the nearest health clinic, even further from a fully equipped clinic.” Unfortunately, this scene could describe most developing countries struggling to reach the Millennium Development Goal (MDG) 5 target of reducing maternal deaths by 75 percent by 2015. Maternal health advocates argue that MDG 5 does not require a cure, but rather increased political willpower.
“Health officials, obstetricians, nurses, and community activists looked for ways to make better use of existing resources and connect expecting mothers with them,” said Suarez, reporting from the remote town of Vilcashuaman. At the Casa Materna, or “mother’s house,” nurses plot on a felt, bulls-eye map the names, due dates, geographical proximity, and travel times of pregnant women in nearby villages. Utilizing two-way radio communication, Casa Materna stays in contact with these remote villages and can signal the regional hospital, hours away in Ayacucho, for ambulance assistance for women needing emergency obstetric care.
Delivery teams at the Ayacucho hospital are familiar with indigenous languages and cultures, and welcome traditional practices, such as displaying herbs and giving figurines to new mothers. “The medical professionals in the area know bringing delivering mothers to the hospital can mean the difference between life and death and are prepared to be as accommodating as possible to lure women from home delivery,” reports Suarez. In the Ayacucho district, maternal mortality rates have decreased by 50 percent in five years.
While Suarez said “cultural competence, a welcoming atmosphere, and low-cost, high-result treatment strategies” may seem “pretty smart and straightforward,” it is important to evaluate the regional health system at a larger level, and consider additional factors, such as access to family planning, that may have contributed to Ayacucho’s success in reducing maternal mortality.
Another part of the solution is improving transportation and referral strategies, but increased research is needed to evaluate best practices and scalability of programs such as the one in Ayacucho. On May 19-20, as part of the Maternal Health Dialogue Series, the Wilson Center’s Global Health Initiative will host a two-day conference on “Improving Transportation and Referral for Maternal Health.” Speakers working on transportation and referral strategies in Bolivia, Ghana, and India will share their experiences and best practices.
Calyn Ostrowski is the program associate for the Wilson Center’s Global Health Initiative.
Photo Credits: Mothers in Peru learn to identify risk factors during pregnancy. Courtesy of Flickr user International Women’s Health Coalition -
Cassie Gardener
Integrating Population, Health, and Environment in Ethiopia’s Bale Mountains
›Ethiopia suffers from vast deforestation, rapid population growth, and high rates of maternal mortality. But development programs that address these issues in an integrated fashion may help end that suffering. As part of my two-month internship with the PHE-Ethiopia Consortium, I recently visited the Movement for Ecological and Community Action (MELCA) Project in the rural Bale Zone of southeastern Ethiopia to witness these programs in action.
Ethiopia’s Spectacular Bale Mountains
The little-known Bale Mountains are national and global treasures of biodiversity, teeming with dozens of endemic mammal, bird, and plant species. Ethiopia’s most important region for migrating birds, the rivers and streams in the Bale watershed flow to more than 12 million people in southern Ethiopia and western Somalia. Bale Mountains National Park hosts half of the world’s population of its rarest canid, the Ethiopian wolf, which has dwindled to a mere 250 individuals due to human interaction. When I toured the park, I was lucky enough to spot bushbucks, mountain nyalas, molerats, and several Ethiopian wolves.
As in many parts of the country, rural communities around the park face grave livelihood and health challenges, and their unsustainable use of land to eke out a living is threatening its conservation efforts. Due to diminishing agricultural land and an average total fertility rate of 6.2 children per mother in the region, people are increasingly forced to cut trees for fuel and timber in order to feed and house their families.
If Bale’s resources continue to be exploited in an unsustainable way, more mammal species would become extinct here than in any other area of equivalent size in the world. Even worse, MELCA Project Manager Tesfaye Teshome told me that if deforestation and impending climate change dry up Bale’s precious watershed, drought and famine could lead to the displacement or death of millions of Ethiopian citizens.
Raising PHE Awareness in the Community
Since 2005, MELCA, a member organization of the PHE-Ethiopia Consortium, has been working to protect biodiversity and culture in the Bale region through research, advocacy, and their award-winning youth environmental education program called SEGNI, or “Social Empowerment through Group and Nature Interaction.” In March 2008, with funding from Engender Health and the Packard Foundation, MELCA launched an integrated population, health and environment (PHE) project that provides culturally sensitive training at the community, school, and government levels.I was impressed that after just seven months of raising awareness, I met dozens of community members and key stakeholders who strongly believe in both the conceptual and operational benefits of PHE integration. For example, the Health Extension Workers and beneficiaries explained to me that community members in the Bale region, most of whom are conservative Muslims, held negative perception of family planning, which contributed to the area’s large family sizes and maternal mortality. But by involving Islamic community leaders in the project’s discussions, MELCA helped convince religious leaders that family planning is an important part of improving the health and livelihoods of the community.
“After the PHE training, we have improved awareness of population, family planning, health and environmental issues, and we understand that child spacing is better. Even my wife is now using family planning services, and as a result our lives are improved,” said Shihase, a religious leader in the community.
Join the Club: PHE Goes to School
Inspired by training sessions at schools, the SEGNI nature clubs, women’s clubs, and anti-AIDS clubs joined together to form new “PHE Clubs.” With the support of MELCA, PHE Club students plant indigenous tree seedlings in school nurseries for distribution to the community. They also create dramas, songs, poems, and illustrated storyboards about population, health, and environment issues, and use modest “mini-media” equipment such as a stereos and microphones to share these stories with their peers and other community members.
When I arrived at Finchaa Banoo Elementary School, hundreds of students greeted me with a PHE song, wearing traditional costumes with PHE banners strewn across their chests. They led me to their nursery site where they had planted 60,000 indigenous tree seedlings. A beautifully decorated cultural hut was filled with 10 PHE storyboard panels, painted by a local PHE-trained artist.
Fatiye, a 21-year old PHE club leader in 8th grade, proudly told me, “Before the coming of PHE, I’d been working only on SEGNI and knew only about biodiversity and culture. But now, I clearly understand health and population issues, including HIV/AIDS, taught to me by my peers. By having the integration of clubs, we’ve strengthened our power to accomplish more.”
Working Together to Save Time and Improve Health
MELCA’s PHE trainings also helped government officials and development workers who had previously operated in isolated sectors to integrate their work at the planning and implementation levels. Health Extension Workers and experts from the Agricultural and Rural Development Office said that collaboration is beneficial to them and the community, because it saves time and accomplishes greater results. Shankore, one of the Health Extension Workers, told me that integrating efforts across sectors allows them to help more households adopt both family planning and better sanitation, by more consistently and efficiently delivering services at the same time.
And their efforts are paying off: “Previously, we were giving birth just like chickens, our forest coverage was diminishing, and we were damaging our resources. We had cattle in our homes, and our children had health problems. Now, we understand how to improve these issues,” Khasim Sheka, a male member of the community, told me. “Health Extension Workers are teaching us about cleaning our home gardens and homes, and we separate our house from our cattle, liquid, and solid waste. My wife wasn’t using any family planning before, and now she’s using five-year Norplant.”
Although MELCA’s PHE project is still in its early stages, it appears capable of being scaled up with a little investment in additional training and by building the capacity of its staff and community members. In particular, the reproductive health component of the project needs to be strengthened, since Health Extension Workers are not trained on simple long-term family planning methods like IUDs, and are afraid they will lose clients if they continue to have to refer them to the distant health clinic.
With these improvements, MELCA could more successfully implement the integrated PHE approach, which will not only reduce the impact of population growth and deforestation on Bale Mountain Natural Park, but will improve the health and livelihoods of its neighbors, and ultimately protect its biodiversity for Ethiopia and the global community.
For more information about PHE-Ethiopia, please contact phe-ethiopia@gmail.com or visit their website at http://www.phe-ethiopia.org. For more information about MELCA, please contact melca@ethionet.et or visit their website at http://www.melca-ethiopia.org.
Cassie Gardener was the National Campus Organizer for the Sierra Club’s Global Population and Environment Program from 2006-2010, and is currently traveling around the world and volunteering for integrated health and development programs like PHE-Ethiopia and GoJoven prior to beginning her Masters in Public Health Program at UCLA in the fall.
Photo Credits: Morgennenbel034_31a, courtesy of flickr user Agoetzke Practitioners, courtesy of Cassie Gardener. -
Shape of Things to Come: Uganda’s Demographic Barriers to Democracy
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In March, Uganda’s cultural landmark, the Kasubi Tombs, were destroyed in a suspicious fire. Tensions spilled over when Ugandan President Yoweri Museveni paid a visit to the Bugandan site and found his entrance blocked by an angry crowd. According to an independent newspaper, soldiers accompanying the president opened fire, killing three civilians.
With ethnic-tinged unrest and student protests in Kampala, as well as cross-border conflicts in the north and east, Museveni, who has led Uganda since 1986, is facing a potentially serious test as elections approach early next year. The country’s demographic profile, and in particular the lack of opportunities for growing numbers of young people, will add to the country’s challenges, as I argue in a new case study of Uganda’s demography.
Uganda has the youngest population in the world, with 77 percent of its people younger than age 30. Women in Uganda have an average of 6.7 children each and 41 percent of married women have an unmet need for family planning. The population of Uganda is currently growing by about one million people per year, and given the force of its demographic momentum, Uganda’s population is likely to almost double by 2025 even if fertility declines.
Population Action International has found that countries with age structures like Uganda’s are the most likely to experience internal strife and autocratic governance. Between 1970 and 2007, 80 percent of outbreaks of civil conflict occurred in countries in which 60 percent or more of the population was younger than age 30.During that same period, 90 percent of countries with an age structure like Uganda’s had autocratic or only partially democratic governments.
Demography alone does not cause conflict. Most governments, even those with youthful populations, do not become entrenched in internal violence and upheaval. But age structure affects a country’s vulnerability to conflict, due to the demands a government faces in providing for its growing numbers.
In Uganda, young people face diminishing prospects in agriculture, the primary industry, as plot sizes shrink with each successive generation. At projected population growth rates, land density may increase 350 percent by 2050, from 122 inhabitants per km2 to a possible 551 inhabitants per km.
Only one-quarter of students who enroll in primary school reach the final grade, and even those with university degrees find few jobs. A reported youth unemployment rate of 22 percent is even higher in urban areas.
After 25 years in power, President Museveni will stand for a fourth official term in 2011. Despite growing dissent among his constituents, he appears confident of keeping his seat. Regardless of what happens next year,Uganda’s leaders must firmly commit to addressing their country’s demographic issues.
Age structure can become a window of opportunity if youth are engaged in society and couples can choose the number of children they can support. But in Uganda, that window remains far out of reach.
Three new case studies from Population Action International on Haiti, Yemen and Uganda examine the challenges specific to countries with very young age structures and recommend policy solutions.
Elizabeth Leahy Madsen is a senior research associate at Population Action International (PAI). She is the primary author of the 2007 PAI report The Shape of Things to Come: Why Age Structure Matters to a Safer, More Equitable World.
Photo Credits: “Atanga.pater.uganda,” courtesy of flickr user Kcarls. -
‘The Shape of Things to Come:’ Yemen
Why Women Matter for Demographic Security›April 12, 2010 // By Elizabeth Leahy MadsenYemen’s struggles with terrorism and political instability appeared on American radar screens with the bombing of the Navy destroyer USS Cole in 2000. The small country’s notoriety increased in 2008, following attacks against the U.S. Embassy, and again last Christmas, when a would-be terrorist trained in Yemen attempted to bomb a Northwest Airlines flight. Since then, Yemen has again slipped out of the headlines. But the deeply embedded problems the country faces deserve more sustained attention, as I argue in a new case study of Yemen’s demography.
Youth represent three-quarters of Yemen’s population, which has the youngest age structure outside sub-Saharan Africa. Population Action International has found that countries with age structures like Yemen’s are the most likely to experience internal strife and autocratic governance. Between 1970 and 2007, 80 percent of outbreaks of civil conflict occurred in countries in which 60 percent or more of the population was younger than age 30. During that time, an average of more than 75 percent of these countries had undemocratic governments.
While students of security, stability, and foreign policy may focus on the role of male-dominated terrorist and rebel groups, demographic dynamics in Yemen and the status of women may be a better indicator of broader challenges. A country’s demographic picture is driven primarily by its fertility trends. Women in Yemen average six children each, a rate that would lead the population to double in fewer than 25 years.
Unfortunately, many women in Yemen lack access to the health care that would allow them to determine their own family size. A 2003 survey found that 51 percent of married Yemeni women would like to prevent or delay their next pregnancy but are not using contraception, the highest measured rate of unmet need for family planning in the world.
Yemen has also received the lowest rating in the world in a survey of gender equity, based on women’s professional, political, and educational achievements relative to men. Unfortunately, this inequality is not surprising, given many of the structural barriers in place in Yemeni society. Only 41 percent of women are literate, compared to 77 percent of men, and there is a strong link between girls’ education and fertility later in life. Girls can legally be married at age 15, and pregnancies that occur too soon and too frequently are in part responsible for the country’s maternal mortality ratio, which is 39 times greater than that of the United States.
The key to a country’s future–at the political, economic and the social levels–is the young people who comprise the next generation. Youth in Yemen continue to face barriers to economic opportunity and democratic political engagement. With the size of the labor force growing faster than the number of jobs each year, youth unemployment could reach 40 percent in a decade. The demographic foundation to such economic pressures can combine with political marginalization to create an environment conducive to instability.
Yet at the social level, there is perhaps more promise. Literacy rates among young people 15 to 29 exceeded 90 percent in a recent survey, and youth also display more flexible and equitable attitudes in gender issues. Nearly three-quarters of young people report unconditional approval of contraception, a major determinant in whether Yemen’s high unmet need for family planning, and thus its very young age structure, are likely to change.
Although these issues may be rarely addressed in the political dialogue, it is critical that the efforts of Yemen’s government and its partners to promote peace and stability also incorporate policies that promote the legal rights and economic opportunities for women, together with access to reproductive health services.
Three new case studies from Population Action International on Haiti, Yemen, and Uganda examine the challenges specific to countries with very young age structures and recommend policy solutions.
Elizabeth Leahy Madsen is a senior research associate at Population Action International (PAI). She is the primary author of the 2007 PAI report The Shape of Things to Come: Why Age Structure Matters to a Safer, More Equitable World.
Photo: Yemeni youth. Courtesy Flickr user kebnekaise. -
Population, Health, and Environment
›The WWF and Equilibrium Research released a report on the interplay between the environment and human health. Vital Sites: The Contribution of Protected Areas to Human Health documents the environmental-human health connection, provides case studies from both the developed and developing worlds, and offers recommendations to enhance the health outcomes that can be gained from environmental good governance. “[P]rotected areas are not a luxury but are key sites to protect not only biodiversity, but also ecosystem services and our wider well-being,” the World Bank’s Kathy MacKinnon writes in the foreword.
“Family Planning and the Environment: Connected Through Human and Community Well-Being,” part of PATH‘s Outlook series, details the importance of family planning-environmental projects to communities living in remote and ecologically vulnerable areas. Designed for practitioners, the article aims to promote cross-discipline dialogue and offers case studies from the Philippines and Uganda. The article concludes that “more collaborative family planning and environmental efforts aimed at reducing inequities would better ensure sustainable community development as well as the right of individuals to achieve what they value.” -
To Invest in a Sustainable Future, Fund Voluntary Family Planning
›President Obama’s proposed federal budget for FY2011 includes $715.7 million for international family planning and reproductive health assistance—10 percent ($67 million) more than what was included in the FY2010 budget that Congress approved last December. If approved, the FY2011 allocation would be 54 percent more than the FY2008 budget, which was equivalent to the amount allotted in 1974 when adjusted for inflation. The recent increases mark the end of more than 30 years of stagnation in U.S. funding for voluntary family planning—and herald a new investment in a sustainable future.
Over the last 20 years, the number of women of reproductive age in the developing world has increased by 465 million. Today, the Guttmacher Institute estimates that 201 million women in developing countries want but lack access to modern contraceptives. “Satisfying the unmet need for contraceptive services in developing countries would avert 52 million unintended pregnancies annually, which, in turn, would save more than 1.5 million lives and prevent 505,000 children from losing their mothers,” the Institute reports.
Rapid population growth in some of the world’s most economically disadvantaged countries poses a significant threat to their natural resources and the environment. Currently, more than 1 billion people live in ecological hotspots—areas that are both rich in plant and animal diversity and highly threatened by human activity. Although these areas comprise just 12 percent of the Earth’s land surface, they hold nearly 20 percent of the global population and possess a population growth rate nearly 40 percent greater than the world average. The cumulative impact of a growing global population, which demands more natural resources and exacerbates already unsustainable patterns of consumption, degrades the most basic foundations of life—air, water, croplands, forests, and fisheries—and contributes to climate change.
Improving access to voluntary family planning not only contributes to smaller, healthier families, but also eases the strain on natural resources. By giving couples the information and supplies to plan the number and timing of their children, U.S.-funded population and reproductive health programs have helped countries slow population growth and reduce population pressures on finite natural resources, including local habitats and wildlife. In addition, the success of USAID’s population, health, and environment programs also offers important lessons for climate change adaptation and building resilience in local communities.
In our interconnected environment, the impacts of natural resources use, management, and protection around the world are felt here in the United States. Despite the difficult budgetary and economic environment our country faces, the president’s request for approximately $716 million in international family planning and reproductive health assistance funding is a wise long-term investment. These resources are an important step toward the broader goal of investing $1 billion in these critical programs to create a healthier, more sustainable future for our world.
Rebecca Wadler Lase is the program associate for the Sustainability Education Program at the Izaak Walton League of America.
Map: “Poverty-Biodiversity Mapping Applications.” Courtesy UNEP/Grid Arendal. -
Canada Flip-Flops on Family Planning, Will the G-8 Follow?
›April 5, 2010 // By Laura Pedro
“The Canadian government should refrain from advancing the failed right-wing ideologies previously imposed by the George W. Bush administration in the United States, which made humanitarian assistance conditional upon a ‘global gag rule’ that required all non-governmental organizations receiving federal funding to refrain from promoting medically-sound family planning,” said the Canadian Liberal Party about the country’s Conservative government in a Parliamentary motion last week.
Though Prime Minister Stephen Harper had pledged to include a voluntary family planning initiative in Canada’s foreign aid plan at last year’s G8 meeting in Italy, the Conservative government recently said that the initiative will not be part of its G8 plan at the upcoming meeting in Canada this June.
This move has surprised both Canadians and Americans. U.S. President Obama overturned the Mexico City policy last year, and has fully supported the inclusion of family planning methods as part of foreign aid.
Harper’s government has maintained that maternal and child health services, such as vaccinations and nutrition, will be a priority, but various components of family planning, including birth control and abortion, will not be included in the Canadian initiative.
The Tories, as along with three Liberal MPs, voted down the Liberal motion 138-144, which requested clarification of Harper’s maternal health initiative and pushed for the inclusion of the full range of family planning options. The Tories focused solely on what they called “anti-American rhetoric” in the motion, which drew attention away from the divisive issue of abortion.
The issue has got caught up in domestic Canadian politics, with opposition Liberals trying to equate the Conservatives with the George W. Bush administration and the Conservatives trying to avoid discussion of intra-party debates on the contentious issue of abortion.
Now it seems likely like that Harper will go to the G8 summit in Ontario with a foreign aid plan for maternal health that makes no reference to issues of contraception. According to Canada’s International Co-operation Minister Bev Oda, “saving lives” of women and children is a higher priority than family planning.
But most international maternal health advocates don’t agree. “Maternal mortality rates are high among women who do not have access to family planning services. Contraception can reduce the number of unplanned pregnancies,” said Calyn Ostrowski, program associate for the Wilson Center’s Global Health Initiative. “For example, at a recent event on our Maternal Health series, Harriet Birugni of the Population Council in Kenya described how integrating reproductive health services such as family planning can reduce maternal mortality rates, particularly for poor young women who have the least access to contraception.”
In response to Canada’s announcement, U.S. Secretary of State Hilary Clinton said that the United States will be promoting global health funding, including access to contraception and abortion, at the G8. “You cannot have maternal health without reproductive health,” she said during a news conference with other G8 ministers. Britain has also agreed with this position, which has led Canadian Liberal Party Leader Michael Ignatieff to say that Canada’s G8 position goes against the international consensus.
Laura Pedro is the program assistant for the Canada Institute, and a graduate of the University of Vermont.
Photo.: Prime Minister Stephen Harper, courtesy Flickr user Kashmera -
On the Air With Arab Demographics
›A recent radio interview on the “Demographics of the Arab World” should be a must listen for those in the World Bank, where discussions of the Arab youth bulge are largely off the table.
The interview with Magda Abu-Fadil of the American University of Beirut and Bernard Haykel of Princeton University suggests that scholars of the Arab world are not so timid, as also evidenced by UNDP’s 2009 Arab Human Development Report.
However, during the interview with Abu-Fadil and Haykel, Worldfocus’ Martin Savidge falls victim to two significant misconceptions that are worth mentioning for their pervasiveness among political science and economics communities:- Savidge believes that countries tend to risk political violence when their percentage of young adults is above 35 percent. This is close, but not quite correct. It’s the proportion of young adults in the adult population – i.e., the working-age population, as opposed to the population in general – that indicates a risk of fractious politics. Children (those below the age of 14) should not be counted in this indicator, yet in much of the literature they mistakenly are.
- Savidge believes that large numbers of youth are an economic “good deal.” Here, Abu-Fadil and Haykel set him straight, noting that a bulge among the young adult population produces a demographic bonus only when fertility has significantly declined; the childhood cohorts are small and the subject of increased investment; and the youth moving into adulthood are educated.
Big changes could occur along the edges of the Arab world in the coming decade. Fertility decline, more recently, has made its way to the Gulf Cooperation Council (GCC) states, although they still need a champion for women’s rights. Turkey had Ataturk, Iran had Reza Shah, and Tunisia had Habib Bourguiba. It’s no accident that these countries were the first to experience fertility decline and age structural changes—their leaders laid the groundwork decades ago.
Can a leader, however, with that amount of political guts and conviction emerge from the Saudi royal family? I’m doubtful.
Richard Cincotta is demographer-in-residence at the H.L. Stimson Center in Washington, DC.
Photo: Yemeni children courtesy Flickr user kebnekaise.
