The Center for Global Development’s latest report, Start With A Girl: A New Agenda For Global Health, sheds light on the risks of ignoring the health of adolescent girls. Like other reports in the Girls Count series, it links broad social outcomes with adolescent health. “Adolescence is a critical juncture for girls. What happens to a girl’s health during adolescence determines her future–and that of her family, community, and country,” state coauthors Miriam Temin and Ruth Levine.

Between childhood and pregnancy, adolescent girls are largely ignored by the public health sector. At the same time, programs and policies aimed at youth do not necessarily meet the specific needs of girls. Understanding the social forces that shape girls’ lives is imperative to improving their health.

Like recent books by Michelle Goldberg and Nicholas Kristof, the report argues for increased investment in girls’ education to break down the social and economic barriers that prevent adolescent girls from reaching their full potential. Improving adolescent girls’ health will require addressing gender inequality, discrimination, poverty, and gender-based violence.

“For many girls in developing countries, well-being is compromised by poor education, violence, and abuse,” say Temin and Levin. “Girls must overcome a panoply of barriers, from restrictions of their movement to taboos about discussion of sexuality to lack of autonomy.” The report points to innovative government and NGO programs that have successfully changed negative social norms, such as female genital cutting and child marriage. However, the authors urge researchers to examine the cost-effectiveness and scalability of these programs.

In the last five years, the international community has become increasingly aware of the importance of youth to social and economic development. Some new programs are focused on investing in adolescent girls, such as the World Bank’s Adolescent Girls Initiative and the White House Council on Women and Girls, but significant additional investment and support is needed.

“Big changes for girls’ health require big actions by national governments supported by bilateral and multilateral donor partners, international NGOs…civil society and committed leaders in the private sector,” maintain Temin and Levin. They offer eight recommendations:
1. Implement a comprehensive health agenda for adolescent girls in at least three countries by working with countries that demonstrate national leadership on adolescent girls.
2. Eliminate marriage for girls younger than 18.
3. Place adolescent girls at the center of international and national action and investment on maternal health.
4. Focus HIV prevention on adolescent girls.
5. Make health-systems strengthening and monitoring work for girls.
6. Make secondary school completion a priority for adolescent girls.
7. Create an innovation fund for girls’ health.
8. Increase donor support for adolescent girls’ health.

“We estimate that a complete set of interventions, including health services and community and school-based efforts, would cost about $1 per day,” say the authors of Start With a Girl. There is no doubt in my mind that this small investment would indeed have a high return for the entire global community.

In a meeting with business leaders in Lahore in late October, Secretary of State Hillary Rodham Clinton pointedly warned of the potential economic impacts of Pakistan’s rapidly growing population: “There has to be…in any plan for your own economic future, a hard look at where you’re going to get the resources to meet these needs. You do have somewhere between 170 and 180 million people. Your population is projected to be about 300 million as the current birth rates, which are among the highest in the world, continue,” she said.

Pakistan is ranked 141 (out of 182 countries) in the Human Development Index. High rates of unemployment are compounded by low levels of education and human capital. Clinton noted that Pakistani women are more vulnerable to poverty; only 40 percent are literate, compared to 68 percent of men.

The Secretary’s emphasis on the need to provide adequate education, jobs, and resources to motivate economic growth and improve well-being is welcome. But demography also has important political consequences. U.S. policymakers and the Pakistani government should consider the impact of population dynamics on the country’s intensifying instability.

As Pakistan’s population grows rapidly, it is maintaining a very young age structure: in 2005, two-thirds of its population was younger than age 30. Research by Population Action International has shown that countries with very young age structures are three times as likely to experience outbreaks of civil conflict than those with a more balanced age distribution.

The members of a “youth bulge” are not inherently dangerous, but when governments are unable to foster employment opportunities or the prospects of stability, a young age structure can serve to exacerbate the risks of conflict, as recently noted by John O. Brennan, assistant to the president for Homeland Security and Counterterrorism, in a speech on “A New Approach to Safeguarding Americans.”

As Secretary Clinton and her colleagues consider the complex barriers to achieving peace and stability for Pakistan’s people, their humanitarian and development strategies should include demographic issues. When couples are able to choose the number and timing of their children, very young age structures like Pakistan’s, can change.

Family planning and reproductive health services are fundamental human rights, but remain out of reach for many in Pakistan, where one-quarter of all married women (and 31 percent of the poorest) have an unmet need for family planning.

Greater access to family planning would lower fertility rates and increase the share of working-age adults in the population. In this transition, countries can harness the “demographic dividend”—a change that could turn Pakistan’s age structure into an economic opportunity.

However, funding from the United States—the world’s largest single donor for international family planning—has declined by one-third over the past 15 years. The foreign assistance funding priorities of the Obama administration should reflect this recognition of the linkages between population, development, and stability.

By addressing the high unmet need for family planning and reproductive health services of women in countries like Pakistan, the United States could help to create a more balanced age structure in future generations—and promote stability at the same time.

Elizabeth Leahy Madsen is a 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..

“Family planning is one of the biggest success stories of development cooperation,” said Bert Koenders, Dutch Minister for Development Cooperation, via video at a Wilson Center roundtable discussion on the future of family planning funding. Koenders was followed by representatives of three of the field’s largest donors, Musimbi Kanyoro, director of the David and Lucile Packard Foundation’s Population and Reproductive Health Program; José “Oying” Rimon, senior program officer for Global Health Policy and Advocacy at the Bill and Melinda Gates Foundation; and Scott Radloff, director of USAID’s Office of Population and Reproductive Health.

“We have a new administration that places a priority on family planning and reproductive health,” Scott Radloff, director of the Office of Population and Reproductive Health at the U.S. Agency for International Development (USAID), tells ECSP Director Geoff Dabelko after a discussion on the future of family planning at the Woodrow Wilson Center.

“The downward trend, in terms of donor funding for international family planning, since the middle of the 1990s to around 2006 has been reversed,” José Rimon II, senior program officer for global health policy and advocacy at the Bill and Melinda Gates Foundation, told ECSP Director Geoff Dabelko following a discussion on the future of family planning at the Woodrow Wilson Center.

Population and climate change get short shrift in the media—that is, until Rush Limbaugh urges you to commit suicide. It’s a disturbing sign that this extremely complex topic only gets play when the knives come out. And as this summer’s health care circus demonstrates, the blogosphere is often more interested in covering the shouting than the issues at hand.

“Covering Climate: What’s Population Got to Do With It?”—webcast live from the Wilson Center—will analyze the challenges facing science and environmental reporters as they prepare to cover what New York Times reporter Andrew Revkin calls “the story of our time.” Cosponsored by the Society of Environmental Journalists and the International Reporting Project, the panel—including Dennis Dimick of National Geographic and the Nation’s Emily Douglas—will discuss the significant barriers to nuanced reporting, including stovepiped beats, the shrinking news hole, and old-fashioned squeamishness.

However, in the past month, there’s been a veritable baby boom of news coverage on climate change and population. Spurred by three high-profile reports—the study commissioned by the Optimum Population Trust, research in the Bulletin of the WHO, and an editorial in the Lancet—the mainstream media and some key bloggers finally got some condoms in their climate change.

It’s gratifying to finally see this issue pop up in the media, almost a year to the day after the 2008 SEJ conference panel on population and climate change moderated by Constance Holden of Science that attracted a respectable (but not remarkable) audience of 40. The panelists decried the media’s relative silence on the impact of population growth and other demographic dynamics on environmental issues.

NPR’s Steve Curwood pointed out that while it’s “something we don’t talk about at all in America,” U.S. population growth increases emissions faster than developing-country population growth, due to our larger per capita consumption. A lone AP article, “Population growth contributes to emissions growth,” reported on the discussion.

In contrast, a population-climate panel at last week’s SEJ conference drew an overflow crowd of more than 100 people. Former SEJ President Tim Wheeler read off recent headlines demonstrating that the media does mention population. However, he noted that “most of the instances I cited are op-ed opinion pieces, not news coverage or feature stories.” In recent climate coverage, he said, “population gets mentioned as an undercurrent and afterthought; our attention intends to be on the immediate. And it has those challenges of so, what do you do about it, how do you deal with it.” But it is “our constant challenge to continue to wrestle with these issues.”




Here’s a short list of recent coverage:

Associated Press: “Birth control could help combat climate change”
Reuters: “Contraception vital in climate change fight -expert”

Bloomberg: “African Condom Shortage Said to Worsen Climate Impact”

Matt Yglesias: “Population and Climate Change”

The Nation: “Factoring People Into Climate Change”

Inter Press Service: “POPULATION: Where’s Family Planning on Climate Change Radar? Zofeen Ebrahim interviews noted social demographer KAREN HARDEE”

The New Republic’s The Vine: “Abortion: The Third Rail of Climate Policy?”

Treehugger.com: Contraception Five Times Less Expensive Than Low-Carbon Technology in Combating Climate Change

Washington Post: “When It Comes to Pollution, Less (Kids) May Be More”

Inter Press Service: “CLIMATE CHANGE: Rising Seas Demand Better Family Planning”

LA Times Booster Shots blog: “Can condoms combat climate change?”

Here in Morocco, where I am attending the IUSSP conference on population, if you never went to elementary school or if you married at a young age, you are likely to have more children.

A Bangladeshi couple is more likely to have a third child if they have 0-1 sons, but a European couple is increasingly likely to prefer daughters because they take better care of their aging parents.

Globally, a forthcoming Harvard study shows that the “Reproductive Health Laws Index”—which includes the legal framework governing abortion, condoms, IUDs, and birth control pills—can predict fertility (more liberal laws = fewer children) and potentially increase female participation in the labor force.

Such causes of population growth are favorite topics for demographers and family planning experts here at the conference, and were quite well attended. However, perhaps due to the large number of European attendees, the panels on this popular topic were empty in comparison to those examining aging, fertility decline, and migration—issues at the forefront of European policymakers’ agendas.

A Message From His Majesty

“One of the characteristic features of our population policy stems from our firm belief that [its] impact … cannot be determined in isolation from economic, social, cultural and political factors,” wrote Morocco’s King Mohammed VI in a welcome letter delivered to the conference, which also discussed aging, climate change, food security,natural resource scarcity, the economic crisis, and growing levels of income inequality.

Morocco is taking steps to tackle this complicated set of problems. The government has launched a National Initiative for Human Development to fight poverty and social inequalities, and help Morocco meet the Millennium Development Goals (MDGs). He also notes that the country’s “political and social reforms aimed at increasing the scope of democratic participation and ensuring the advancement of women.”

Like all leaders, Morocco’s will be measured not by his words—eloquent as these may be—but by his deeds and the country’s progress. Morocco has some work to do to reach the MDGs and other social and economic goals.