For 10 years, I have been working on marine conservation in Tanzania with the University of Rhode Island’s Coastal Resources Center. As part of that effort, I’ve helped forge links between HIV/AIDS prevention in vulnerable fishing communities and marine conservation. However, family planning and reproductive health (FP/RH) were relatively new to me. But a recent study tour of an integrated Population, Health, and Environment (PHE) program in the Philippines helped me understand that combining family planning services and marine conservation can help reduce overfishing and improve food security.

“Conflict-affected countries have some of the worst reproductive health indicators,” said Saundra Krause of the Women’s Refugee Commission at a recent Wilson Center event. “Pregnant women may deliver on the roadside or in makeshift shelters, no longer able to access whatever delivery plans they had. People fleeing their homes may have forgotten or left behind condoms and birth control methods.”

Joel Cohen, a renowned population expert and professor at Columbia and Rockefeller universities, recently gave a lecture simply titled “Meat.” As it was co-sponsored by the International Food Policy Research Institute and the Population Reference Bureau, I was hoping for an insightful discussion of meat eating and its implications for feeding a world of nine billion. While I think Cohen avoided the question of whether meat eating is ultimately sustainable, I was pleased that he included two key insights: the potential for family planning services to contribute to food security, and the importance of using multidisciplinary approaches to solve today’s global problems.

Family Planning for Food Security

In working to improve food security, Cohen said policymakers and practitioners need to focus on those who are most vulnerable. To this end, he identified five groups and suggested targeted policies for each:

While the healthy eating policies will not surprise food security experts, his recommendations on family planning might. He highlighted what should be–but is not always–apparent: that tackling food security without thought for family planning is like attempting to fill an empty bucket without first plugging the holes.

Feeding the one billion hungry people in the world today is an enormous challenge that cannot be met by any single policy. Instead, it will take an array of partial solutions, and offering family planning services to women and young people is an important part of the package. Such projects can help reduce the number of children being born into hunger by allowing women and couples to assess their economic and food situations and plan according to their needs and wishes. Voluntary family planning services and materials will not solve the food security challenge on their own, but they can make it more manageable, especially in the long run.

Family planning’s potential contribution to food security is just one part of Cohen’s larger take-home message: population, economics, environment, and culture all interact. To meet today’s multidisciplinary challenges, single-sector approaches are not up to task.

The Many Faces of Meat

Cohen offered two competing perspectives on meat eating. On the one hand, average global meat production generates a fraction of the calories and protein, per unit of land, that could be derived from plant sources. It is likely the “largest sectoral source of water pollution,” said Cohen, and is at least partly responsible for the spread of over a dozen zoonotic diseases. It contributes to only 1.4 percent of world GDP while comprising 8 percent of world water consumption.

These hidden “virtual water” costs made headlines in Britain the other week, when a study on global water security published by the Royal Academy of Engineering popularized the Water Footprint Network’s earlier findings that that an average kilogram of beef requires 15,500 liters of water–over eight times the volume needed to produce the equivalent weight in soybeans and greater than 10 times that needed for the equivalent amount of wheat.

On the other hand, Cohen pointed out that meat production provides livelihoods for an estimated 987 million of the world’s rural poor, and has important cultural significance in many societies. And it can provide many essential nutrients, even in small doses.

In one study he cited, children living in Kenya who were provided 1 ounce of meat a day received 50 percent of their daily protein requirements and showed greater increases in physical activity and development, verbal and arithmetic test scores, and initiative and leadership behaviors as opposed to students who received the calorie-equivalent in milk or fat.

The Four Factors: Population, Economics, Environment, and Culture

Clearly, Cohen’s four factors all come in to play when evaluating meat’s role in food security. An analysis of any global health issue that looks at only one factor would miss indispensable parts of the problem.

“Population interacts with economics, environment, and culture,” Cohen concluded. “If you use that checklist when somebody gives you a simple-minded solution to a problem, you can save yourself a lot of simple-minded thinking.”

Photo: Pigs on a farm, courtesy Flickr user visionshare.

The focus on food security on Capitol Hill continued with Wednesday’s House Hunger Caucus panel, “Feeding a Community, Country and Continent: The Role of Women in Food Security.” According to panel organizers Women Thrive Worldwide, “over half the food in developing countries – and up to 80 percent in sub-Saharan Africa – is grown by women farmers, who also account for seven in ten of the world’s hungry.”

The panel illuminated some of the inequities routinely faced by female farmers that often prevent them from using the same inputs as men (tools, fertilizer, etc.), bar their access to credit, and force them onto less productive land.

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

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.

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.

Yemen’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.