Showing posts from category family planning.
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Maintaining the Momentum: Highlights From the Uganda International Conference on Family Planning
›“Family planning is to maternal survival what a vaccination is to child survival,” said Johns Hopkins professor Amy Tsui, quoting Khama Rogo of the World Bank, at the Woodrow Wilson Center event Maintaining the Momentum: Highlights From the Uganda International Conference on Family Planning on March 16. Rogo made the strong statement during the landmark November 2009 conference in Kampala, which has renewed interest in family planning and reproductive health among African leaders and development partners. Rhonda Smith of the Population Reference Bureau and Sahlu Haile of the David and Lucile Packard Foundation joined Tsui, the director of The Bill & Melinda Gates Institute of Population & Reproductive Health, to discuss their impressions of the Kampala conference and what it means for the future of family planning in Africa.
“An event that happened at the right time”
“Kampala was the work of a community,” said Tsui. More than 50 organizations—the U.S. Agency for International Development, the UN Population Fund, the World Bank, the World Health Organization, and the Gates and Packard Foundations—convened in Uganda, which was chosen not only for its central location, but also to highlight the country’s soaring unmet need for contraception—41 per cent—and rapid 3.1 percent population growth rate.Panels focused on key issues in family planning, including:
- Integrating family planning into HIV/AIDS care
- Integrating family planning in post-abortion, postpartum, child, and other primary health care
- Expanding contraception delivery services by community health workers
- Increasing outreach to youth and men
- Capitalizing on private and public innovations in service delivery and financing
- The United States announced its foreign assistance budget will increase support for family planning from $450 million to $715 million for the next fiscal year.
- The Global Health Initiative identified maternal/child health and family planning as one of its main priority themes.
- Secretary of State Clinton positively discussed girls’ education, family planning, and reproductive health at the ICPD + 15 anniversary.
- The Women Deliver 2010 Conference, to be held in June, has identified family planning as a third pillar of maternal health.
Uganda on the Move
Rhonda Smith’s presentation “Uganda on the Move”—which she also presented in Uganda—is a prototype of the Population Reference Bureau’s new ENGAGE (Eliminating National Gaps—Advancing Global Equity) project, which is designed to “engage policy audiences and promote policy dialogue around issues of high fertility and high unmet need for family planning and their costs, consequences, and solutions,” she said. By using stunning, innovative graphics and avoiding confounding technical terms, ENGAGE’s products are designed to reach non-technical policy audiences and influential decision-makers.
As one of the Uganda conference’s most talked about presentations, “Uganda on the Move” wows audiences with visuals created using Hans Rosling’s Trendalyzer software. The presentation shows that although Ugandans are increasingly healthier, have a higher life expectancy, and are more educated, maternal health remains in jeopardy. Tellingly, 46 percent of pregnancies in the country are unplanned, 6,000 women die each year from complications related to pregnancy, and 1,200 women die each year from undergoing unsafe abortions.
Maternal deaths, however, do not tell the whole story: For every one woman dying, Smith said, 20-30 women suffer from short-term disability, which places a major strain on economic growth. From 2004 to 2013, maternal death will cost Uganda US$350 million in lost productivity; and disability will cost and additional US$750 million.
What Next? The African Perspective
“After 10 years of virtual clandestine work, [family planning] is just coming out of the closet,” said Sahlu Haile. Over the last few decades, family planning advocates have been struggling to: 1) keep family planning alive—without it being affected by political considerations 2) make family planning a health priority, without any associations with rights violations; and 3) be in solidarity with pioneering organizations of the family planning movement, like the International Planned Parenthood Federation, that were victims of discriminatory funding decisions.
The Uganda conference changed all that, said Haile. In Uganda, conference attendees were “talking about family planning…not reproductive health, not maternal/child health.” This, he said, was “probably the single most important lesson…that I took from the Kampala conference.”
Following the conference, Haile said that African government officials stressed family planning as a priority at meetings in Ethiopia and Nigeria—the first time he had witnessed such high-level attention to family planning from those countries in his 30-year career.
In Ethiopia, African leaders pledged to:- Prioritize family planning, since family planning is one of the most cost-effective development investments;
- Ensure access to contraception, as 40 percent of maternal deaths are associated with unwanted pregnancies; and
- Integrate MDG 5b, universal access to reproductive health, into their international development plans and budgets.
Haile credited the Kampala conference for spurring these efforts. In December, he joined a task force of 14 Ethiopian organizations to plan the next steps. They will jointly develop research capacities, generate evidence, and strengthen monitoring and evaluation practices, especially with regard to integrating population, health, and environment efforts. In addition, they will engage with wider audiences via new tools such as the blog RH RealityCheck and Gapminder Foundation’s Trendalyzer program.
Haile believes we need to “work together to encourage national-level efforts…to make sure family planning stays where it is now and make sure it is not abandoned.”
To be a part of the new online family planning community, join the Kampala Conversation.
Photo 1: A women and her children in Jinja, Uganda. Courtesy Flickr user cyclopsr. Photos of Amy Tsui, Rhonda Smith, and Sahlu Haile courtesy of Dave Hawxhurst, Woodrow Wilson Center. -
Family Planning and Reproductive Health
›Adding it Up: The Costs and Benefits of Investing in Family Planning and Maternal and Newborn Health, a report by the Guttmacher Institute, asserts that “sustained and increased investment in sexual and reproductive health services in developing countries” would “contribute to economic growth, societal and gender equity, and democratic governance.” The report presents cost-benefit analyses of family planning and maternal and newborn health strategies in an effort to “guide decision makers, at the global, regional and country levels, in making investments that would reap the greatest returns for individuals and societies.”
The Interagency Gender Working Group recently released Gender Perspectives Improve Reproductive Health Outcomes: New Evidence, argues for the importance of taking gender into consideration when developing interventions related to unintended pregnancies, maternal health, STIs, harmful practices (e.g. early marriage, genital cutting, and gender-based violence), and youth. The report, a follow-up to 2004’s The “So What?” Report: A Look at Whether Integrating a Gender Focus into Programs Makes a Difference to Outcomes, includes 40 specific examples of programs successfully integrating gender to improve reproductive health. -
Point of View: Investing in Maternal Health
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Every minute, a woman dies in pregnancy or childbirth. But the overwhelming majority of these more than 500,000 deaths a year are avoidable.
“We know how to save women’s lives, we don’t need a cure…this is a political problem and political will is essential,” said Theresa Shaver, the director of White Ribbon Alliance.
Addressing longstanding issues like political will could jumpstart progress toward Millennium Development Goal 5, which seeks to reduce maternal deaths by 75 percent by 2015. We face daunting challenges, but there are some clear steps we can take to meet this critical goal. We must strengthen health systems in the developing world.Increasing women’s access to quality health services during pregnancy, and ensuring they are attended by skilled providers during childbirth, can help to reduce preventable causes of death, such as hemorrhage, pre-eclampsia, and obstructed labor—which together account for 80 percent of maternal deaths.
Scaling-up family planning services are a cost-effective way of preventing unwanted pregnancies, delaying the age of first pregnancy, increasing the time between pregnancies, and facilitating important relationships between women and health care providers. However, many societal and cultural factors dissuade women and girls from seeking contraception. Culturally sensitive education programs can help overcome this barrier, especially if they include men and local leaders, in addition to women and girls.
We should recognize that improving the well-being of mothers is inseparable from the health of newborns. Efforts to reach Millennium Development Goal 4, reducing under-5 mortality by two-thirds, are integral to improving maternal health. Skilled birth attendants could decrease both maternal and child mortality.
In the United States and abroad, momentum is growing to make the investment necessary to scale up these interventions. In January, Secretary of State Hillary Clinton renewed a commitment of $63 billion for the Obama Administration’s Global Health Initiative, which will include significant resources for maternal and child health.
According to the U.S. Agency for International Development, maternal and newborn deaths cost the world $15 billion a year in lost productivity. Researchers conclude that maternal health services would cost only a $1 per day per woman. That’s a small price to pay for such a high return—saving not only dollars, but also women’s lives.
For more information about maternal health and the Global Health Initiative’s Advancing Policy Dialogue on Maternal Health Series please see this month’s issue of Centerpoint. -
Gates: More Money for Global Health Is Good for the Environment
›January 28, 2010 // By Gib Clarke
Bill Gates gave the PHE community a much-needed upgrade in his foundation’s 2nd Annual Letter, released this week. Unfortunately it still has a few bugs.
“In the long run, not spending on health is a bad deal for the environment because improvements in health, including voluntary family planning, lead people to have smaller families, which in turn reduces the strain on the environment,” concludes Gates.
This statement could dramatically raise awareness of and funding for population-environment programs. Any time Bill Gates talks, the world listens, as evidenced by the barrage of coverage from Reuters, AFP, and top IT newswires. For the public, it offers a rare glimpse into development strategy, so Gates’ thoughts (and financial commitments) could be seen as representative of the foundation community’s approach to global health problems.
Although it may seem obvious that fewer people place less strain on the environment, this connection has been largely absent from the environmental agenda, including the efforts to combat climate change. Some environmental leaders and organizations have dismissed population as an unimportant distraction from the real business at hand. Others have noted that population growth’s impact on climate change is far greater in the rich world than in poor countries, whose per capita emissions are a fraction of developed countries’.
Gates’ comment may cause those in the first camp to re-evaluate the importance of family planning, and it is likely to energize the converted. But it will have less impact on those focused on consumption. But if it encourages the environmental community to put population and family planning issues back on the table, it will have gone a long way.
However, Gates could have gone further, by explaining that family planning is a relatively inexpensive way to mitigate climate change, compared to complex and emerging technological solutions. He also could have pointed out that climate change is expected to increase the prevalence of vector-borne diseases such as malaria, or that sick or malnourished individuals may be forced to mismanage natural resources.
Because Gates didn’t make these explicit connections, many in the media missed his point. The wire headlines pit health against environment, when Gates was in fact pointing out how interdependent they are. This distortion is symptomatic of the media’s tendency to highlight the horserace. But maybe they would pay closer attention if the Gates Foundation put its money where its mouth is—and funded programs that integrate family planning and the environment.
Perhaps several years from now, we will look back and say that this letter marks the start of the Gates Foundation’s integrated approach to development. But we may need to wait for Letter 3.0 for a complete install.
Photo: Courtesy Flickr User World Economic Forum -
Watch: Harriet Birungi: Challenges Facing HIV-Positive Adolescents in Kenya
›“Services are not necessarily very adolescent-friendly, so when you get children who are HIV-positive they are likely to face discrimination,” says Harriet Birungi, an associate in the Reproductive Health Program with the Population Council in Kenya, in this interview with ECSP’s Gib Clarke following the Global Health Initiative’s Integrating HIV/AIDS and Maternal Health Services panel.
According to Birungi, medical service censoring and targeted exclusion from schools are among the top challenges facing Kenyan adolescents living with HIV/AIDS. She hopes better support systems and intervention strategies, especially for pregnant individuals, will help medical personnel more quickly identify HIV-positive young adults needing critical medical services. -
Welcome Back, Family Planning
›January 8, 2010 // By Gib Clarke
“When women and girls have the tools to stay healthy and the opportunity to contribute to their families’ well-being, they flourish and so do the people around them,” Secretary of State Hillary Clinton declared today in a speech renewing U.S. support for universal access to reproductive health services and supplies around the world. “Investing in the health of women, adolescents, and girls is not only the right thing to do; it is also the smart thing to do.”
Introduced by Melanne Verveer, the first ever ambassador-at-large for global women’s issues, Clinton’s much anticipated statement marked the 15th anniversary of the International Conference on Population and Development (ICPD) and reconfirmed a U.S. commitment to meeting Millennium Development Goals 4 (reducing child mortality) and 5 (reducing maternal mortality and increasing the proportion of births attended by skilled health personnel). Reproductive health and development luminaries Nafis Sadik, UN Foundation President and former Senator Tim Wirth, and newly installed USAID Administrator Rajiv Shah were also in attendance.
Clinton began with a look back to the ICPD—which she called the “first ever global forum that recognized the connection between women’s health, the quality of women’s lives, and human progress on a broader scale”—and the progress since. Declaring that “we have made measurable progress since 1994 in improving the health and the lives of women and children, especially girls,” she cited a number of improvements, including higher child survival rates, use of modern contraceptives, and female education enrollment.
Switching from the past to the present, Clinton described how women and girls continue to bear the brunt of a variety of social ills: they have higher rates of poverty, illiteracy, and malnutrition, and are the most adversely affected by conflict, “from the Congo to Bosnia to Burma.”
After reciting the data on unsafe abortions, STDs and HIV/AIDS, fistulas, and female genital cutting, she declared that “these numbers are not only grim…they are intolerable.” She added, “We can not accept it morally, politically, socially, economically.”
But Clinton’s remarks were not solely focused on health and family planning issues. Echoing arguments made by Nicholas Kristof and others, Clinton described how women’s health and women’s rights directly and significantly impact most major problems in the world, including economics, natural resource conflicts, and national security.
These challenges will require sustained effort and funding, said Clinton, adding that the Obama Administration’s $63 billion Global Health Initiative would address the health challenges of HIV/AIDS and maternal and reproductive health in an integrated manner. All of the administration’s programs would seek to help countries strengthen their own health systems to meet their unique needs—both of their women and girls, but also their populations in general. In all of these efforts, she said including men and boys as “advocates and allies” remains important.
Praise for the speech has been swift—a letter of commendation from a number of foundations was sent to the secretary immediately afterwards.
Maternal and reproductive health have experienced elevated and perhaps unprecedented funding and attention in recent years, especially over the last few months. Secretary Clinton’s impassioned speech is almost certain to keep this momentum alive.
Photo: Courtesy SEIU International -
Making the Connections: An Integration Wish List for Research, Policy, and Practice
›January 3, 2010 // By Geoffrey D. DabelkoNew York Times columnist Nick Kristof is likely a well-known voice to New Security Beat readers. His ground-level development stories from around the world expose a range of neglected issues that usually struggle for mainstream media coverage: maternal health, microcredit, human trafficking, family planning, sanitation, micronutrients, and poverty, among others.
Kristof brought many of these threads together Half the Sky, a book he coauthored with his wife Sheryl WuDunn. I asked about the challenges of addressing these connected problems when I interviewed the couple and two frontline White Ribbon Alliance maternal health practitioners this fall at the Wilson Center.
Now Kristof is asking readers to suggest topics for him to cover in 2010. My suggestions to him are actually a wish list for the wider development community. In short, how can scholars, policymakers, practitioners, and communities better research and analyze these connected topics and then fashion integrated responses? I posted my comment on Kristof’s blog, On the Ground (and I ask your indulgence for the less than polished writing):I’d love for you [Kristof] to explore the challenge of integration from both problem and response perspectives. People in poverty lead integrated lives (just like we wealthier folks do), face connected challenges, and need integrated or multiple responses. Single-sector programs may deliver quicker, more obvious, and/or more countable impacts (or parallel advantages for single-discipline research endeavors). Yet time and time again we see such approaches only partially meeting needs or not meeting them sustainably. There is also a persist danger of undercutting others’ efforts and/or creating high opportunity costs.
These questions topped my wish list to Kristof last night while procrastinating on other writing. What would be on your wish list for Kristof, the development community, or even just New Security Beat? We at the Environmental Change and Security Program (ECSP) would love to hear from NSB readers so we can keep covering the questions that interest you.
So which integrated research, policy analysis, or field-based programs explicitly recognize that trends that appear to be on the periphery are hardly peripheral? At the same time, if programs try to be all things to all people, they can become bloated, unrealistic, and/or unsustainable.
For example, are the Millennium Villages examples of the former or the latter? How about the much smaller programs under the population-health-environment grouping? What went wrong with Campfire programs to cause so many to abandon the approach? Have the loosened restrictions on what constitutes an appropriate PEPFAR intervention addressed this integration problem, or will politics (exclusion of family planning in PEPFAR, for example) mean we cannot capture the full benefits of integration?
And the big Kahuna: how is the rhetoric and analytical argument around the 3Ds (defense, development, and diplomacy) made real and practicable in the field (as in the United States we anticipated early this year the results of the Quadrennial Defense Review (QDR), Quadrennial Diplomacy and Development Review (QDDR), and Presidential Study Directive on Global Development Policy (PSD))?
And finally, does our (read donors’) penchant for measuring impact and quantifying results force us to narrow interventions to the point of missing key connections in cause and effect of the problems we are trying to address? Is there a better mix of defining and measuring success that captures the challenges and benefits of integration? -
‘DotPop:’ Copenhagen’s Collapse: An Opportunity for Population?
›December 22, 2009 // By Gib ClarkeWhile the negotiators failed to reach a comprehensive agreement in Copenhagen, the population and reproductive health community might find a silver lining in the stormclouds that derailed COP-15.
Developing countries’ strong protests of their lack of culpability for the climate problem, on one hand, and the dramatic examples of their vulnerability on the other, have focused the world on the problems of poor people—and on potential solutions, including family planning.
The Case of the Missing “P”
The New York Times’ Andrew Revkin complained that population was the “The Missing ‘P’ Word in Climate Talks,” but PAI’s Kathleen Mogelgaard argues in New Security Beat that “there is encouraging evidence that voices of those advocating for increased attention to the role of population and reproductive health and rights in climate change responses are being heard” in Copenhagen, including new funding from the Danish government for family planning.
At a breakfast last week, luminaries including Gro Harlem Brundtland and IPCC Chairman Rajendra K. Pachauri discussed UNFPA’s latest report, Facing a Changing World: Women, Population and Climate in Copenhagen.
According to lead author Robert Engelman, the report is “helping many more people to see population and climate in a more hopeful light, linked as they are through the right of women to equal standing with men and access to reproductive health care for all.”
Women, Population, and Climate
“Climate change is ultimately about people,” declared Congresswoman Carolyn Maloney at the recent Washington, DC, launch of the report. Though the issues are complex and multi-faceted, Engelman said that the report’s message is “stark and optimistic”: that “women in charge of their own lives” can have positive impacts on change climate mitigation and adaptation.
“Women are more sustainable consumers,” said UNFPA’s José Manuel Guzmán at the launch, noting that in many cases women make buying decisions for their families, so empowering them with information and tools is a wise approach to combating climate change.
Inequitable Impacts
Women – especially poor women – contribute fewer greenhouse gas emissions than men, yet are more vulnerable to the impacts of climate change. Unfortunately, this fundamental inequality is difficult to quantify, since most data sources are not disaggregated by gender. The report recommends improving data quality to better informing policy decisions.
Tim Wirth, president of the UN Foundation and the Better World Fund, noted that women face a “double whammy”: they are already less likely to go to school and to have access to paying livelihoods, and more likely to have HIV. Climate change will only increase the inequity.
People Power
PAI’s Karen Hardee called on the population community to focus their efforts on the next phase of negotiations – adaptation. A recent PAI report found that while 37 of 41 National Adaptation Plans of Action say that population pressures exacerbate the effects of climate change, only six include slowing population growth or addressing reproductive health and family planning as a key priority.
“The focus has been on where and what the impacts of climate change will be,” said Guzman, but the conversation needs to shift to who will be affected, and an analysis of their vulnerabilities and their capacities to adapt.
For real progress to occur, said Engelman, “climate needs to be seen through a more human lens.”
