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‘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.Look Beyond Islamabad To Solve Pakistan’s “Other” Threats
›After years of largely being ignored in Washington policy debates, Pakistan’s “other” threats – energy and water shortages, dismal education and healthcare systems, and rampant food insecurity – have finally moved to the front burner.
For several years, the Woodrow Wilson Center’s Asia Program has sought to bring these problems to the attention of the international donor community. Washington’s new determination to engage with Pakistan on its development challenges – as evidenced by President Obama’s signing of the Kerry-Lugar bill and USAID administrator Raj Shah’s comments on aid to Pakistan – are welcome, but long overdue.
The crux of the current debate on aid to Pakistan is how to maximize its effectiveness – that is, how to ensure that the aid gets to its intended recipients and is used for its intended purposes. Washington will not soon forget former Pakistani president Pervez Musharraf’s admission last year that $10 billion in American aid provided to fight the Taliban and al-Qaeda was instead diverted to strengthen Pakistani defenses against archrival India.
What Pakistani institutions will Washington use to channel its aid monies? In recent months, the U.S. government has considered both Pakistani NGOs and government agencies. It is now clear that Washington prefers to work with the latter, concluding that public institutions in Pakistan are better equipped to manage large infusions of capital and are more sustainable than those in civil society.
This conclusion is flawed. Simply putting all its aid eggs in the Pakistani government basket will not improve U.S. aid delivery to Pakistan, as Islamabad is seriously governance-challenged.
Granted, Islamabad is not hopelessly corrupt. It was not in the bottom 20 percent of Transparency International’s 2009 Corruption Perceptions Index (Pakistan ranked 139 out of 180), and enjoyed the highest ranking of any South Asian country in the World Bank’s 2010 Doing Business report.
At the same time, the Pakistani state repeatedly fails to provide basic services to its population – not just in the tribal areas, but also in cities like Karachi, where 30,000 people die each year from consuming unsafe water.
Where basic services are provided, Islamabad favors wealthy, landed, and politically connected interests over those of the most needy – the very people with the most desperate need for international aid. Last year, government authorities established a computerized lottery that was supposed to award thousands of free tractors to randomly selected small farmers across Pakistan. However, among the “winners” were large landowners – including family members of a Pakistani parliamentarian.
Working through Islamabad on aid provision is essential. However, the United States also needs to diversify its aid partners in Pakistan.
For starters, Washington should look within civil society. This rich and vibrant sector is greatly underappreciated in Washington. The Hisaar Foundation, for example, is one of the only organizations in Pakistan focusing on water, food, and livelihood security.
The country’s Islamic charities also play a crucial role. Much of the aid rendered to health facilities and schools in Pakistan comes from Muslim welfare associations. Perhaps the most well-known such charity in Pakistan – the Edhi Foundation – receives tens of millions of dollars each year in unsolicited funds.
Washington should also be targeting venture capital groups. The Acumen Fund is a nonprofit venture fund that seeks to create markets for essential goods and services where they do not exist. The fund has launched an initiative with a Pakistani nonprofit organization to bring water-conserving drip irrigation to 20,000-30,000 Pakistani small farmers in the parched province of Sindh.
Such collaborative investment is a far cry from the opaque, exploitative foreign private investment cropping up in Pakistan these days – particularly in the context of agricultural financing – and deserves a closer look.
With all the talk in Washington about developing a strategic dialogue with Islamabad and ensuring the latter plays a central part in U.S. aid provision to Pakistan, it is easy to forget that Pakistan’s 175 million people have much to offer as well. These ample human resources – and their institutions in civil society – should be embraced and be better integrated into international aid programs.
While Pakistan’s rapidly growing population may be impoverished, it is also tremendously youthful. If the masses can be properly educated and successfully integrated into the labor force, Pakistan could experience a “demographic dividend,” allowing it to defuse what many describe as the country’s population time bomb.
A demographic dividend in Pakistan, the subject of an upcoming Wilson Center conference, has the potential to reduce all of Pakistan’s threats – and to enable the country to move away from its deep, but very necessary, dependence on international aid.
Michael Kugelman is program associate with the Asia Program at the Woodrow Wilson International Center for Scholars.
Photo Credit: Water pipes feeding into trash infected waterway in Karachi, courtesy Flickr user NB77.Food Security Comes to Capitol Hill, Part One
›April 30, 2010 // By Schuyler NullThis week, the CSIS Task Force on Global Food Security released its latest report, Cultivating Global Food Security: A Strategy for U.S. Leadership on Productivity, Agricultural Research, and Trade.
According to the report, “the number of people living with chronic hunger has jumped to more than 1 billion people – one sixth of the world’s population – and those trends show no signs of reversal: between 2007 and 2008, the number of people suffering from chronic hunger in the developing world increased by 80 million. In 2009, as many as 100 million additional people were pushed into a state of food insecurity.” The riots and instability during the 2008 food crisis vividly illustrate the consequences of failing to address this problem.
The report outlines six broad recommendations for policy makers:1. Develop an integrated, comprehensive approach to food security;
At the report’s Capitol Hill launch, CSIS President John Hamre compared releasing think tank studies to “casting bread on the water, most of it disappears.” However the high profile Congressional presence—including co-chairs Representative Betty McCollum and Senators Richard Lugar and Bob Casey—proves that awareness of the global food security problem is growing.
2. Empower leadership (USAID) and ensure cross-agency coordination;
3. Support country-led (and country-specific), demand-driven plans for agriculture;
4. Elevate agricultural research and development in the United States utilizing the land-grant university system;
5. Leverage the strengths of the private sector to encourage innovation and give farmers better access to credit and markets; and
6. Renew U.S. leadership in using trade as a positive tool for foreign policy and development in order to improve stability and economic growth at home and abroad.
“We are summoned to this issue by our consciences but we also know this is a security issue,” said Sen. Casey. Along with Sen. Lugar, Casey introduced the “Global Food Security Act of 2009,” which seeks to “promote food security in foreign countries, stimulate rural economies, and improve emergency response to food crises, as well as to expand the scope of the Foreign Assistance Act of 1961 to include conservation farming, nutrition for vulnerable populations, and economic integration of persons in extreme poverty.”
Representative McCollum introduced a similar bill in the House, but neither has made much headway. Senator Lugar said that he hopes the bipartisan and bicameral nature of their bills will help this issue stay afloat during a particularly toxic political atmosphere in Washington.
The release of the CSIS report and its Congressional support is particularly timely, as USAID just announced the 20 focus countries for the “Feed the Future” Initiative, which are Ethiopia, Ghana, Kenya, Liberia, Mali, Malawi, Mozambique, Rwanda, Senegal, Tanzania, Uganda, and Zambia in Africa; Bangladesh, Cambodia, Nepal, Tajikistan in Asia; and Guatemala, Haiti, Honduras, and, Nicaragua in Latin America. The White House pledged an initial $3.5 billion over three years for the Feed the Future Initiative, with additional pledges from other G-8 and G-20 members to total $18.5 billion.
In addition, the State Department is in the midst of preparing its first-ever (and long-delayed) strategic doctrine for diplomacy and development, the QDDR, in which agricultural development is expected to have a major role.
Speaking on behalf of the State Department, Acting Deputy Assistant Secretary for Trade Policy and Programs William Craft echoed the previous testimony of Deputy Secretary of State Jacob Lew on Feed the Future, saying that the United States believes development should be on par with diplomacy and defense, and is both a strategic and moral imperative.
Next up: “Food Security Comes to Capitol Hill, Part Two” on the particular role women can play in increasing global productivity, if given the chance.
Photo Credit: “World Food Day,” courtesy of flickr user JP.Event Update: Sustainable Urbanization
›April 21, 2010 // By Julien KatchinoffThe newfound American engagement on international urban issues lauded by UN-HABITATS’ Christopher Williams and the Wilson Center’s Blair Ruble last week has been formalized in legislation introduced today by Senator Benjamin L. Cardin (D-MD), Senate Foreign Relations Committee Chairman John Kerry (D-MA), and Senator Dick Durbin. (D-IL)
From Modernize Aid:The Sustainable Urban Development Act of 2010 (S. 3229) seeks to deal with unprecedented growth from enlarging slums, increasing levels of pollution, overburdened transport systems, and the lack of affordable housing. The bill would direct the USAID Administrator to: 1) develop a strategy to foster sustainable urban development; 2) consider establishing a senior advisor for urban development; and 3) establish a pilot urban strategies initiative that will help a select number of cities create a policy framework for future growth and development.
In a statement for the release of the legislation, Senator Kerry echoed Williams’ thoughts on the subject of urbanization and U.S. foreign policy. “There is an explosion of urban growth around the globe – already the majority of the world’s population lives in urban areas, with approximately one billion people residing in slums. The phenomenon of urbanization will be ignored at our own peril. Responsible citizens of the world must consciously harness their creativity and ingenuity to increase the livability, economic viability, and environmental sustainability of our cities,” Kerry said.
Facts about the Sustainable Urban Development Act of 2010:(From the Press Release, COMTEX)
(Summary Courtesy Congressional Documents and Publications/ContentWorks via COMTEX)
* The bill includes a statement of policy that recognizes urban development as an objective of United States foreign policy and overseas development assistance, particularly programs that foster improved urban governance, management, and planning, promote the formal provision of and access to essential urban services and infrastructure, expand access to basic shelter, affordable urban housing, promote economic growth and alleviate poverty, and respond to and prepare for environmental and climatic challenges.
* It directs the Administrator of USAID to develop a strategy to foster sustainable urban development that will update the Making Cities Work Urban Strategy. Specifically:
– Assess the feasibility of establishing a senior advisor for urban sustainable development at USAID, who would provide leadership for coordinated programming, technical support for urban development, disseminate best practices, guide urban programming, and help build the capacity of government officials in developing countries to more effectively manage urbanization
– Consider establishing a pilot urban strategies initiative that would support, through technical and financial assistance, a select number of cities in developing countries by identifying, developing, and implementing long-term sustainable urban development strategies to provide a framework for future growth and development in identified countries
– Review and assess existing or past U.S. programs and foreign assistance strategies designed to improve urban development and ensure that strategies to address urban development and slums in developing countries are integrated into the broader strategic foreign assistance plans of USAID and the Department of State
– Develop a strategy for providing long-term United States support for sustainable urban growth and development initiatives that draws upon the expertise of U.S. city and regional elected officials and professionals, private foundations, NGOs, policy, education and research organizations, United Nations organizations, and multilateral development banks.
Photo Credit: “US Capitol” courtesy Flickr User ehpienSustainable Urbanization: Strategies For Resilience
›April 19, 2010 // By Julien KatchinoffUrbanization is both an opportunity and a challenge,” argued Christopher Williams from UN-HABITAT during a panel discussion at American University’s School of International Service. “Sustainable Cities: A discussion on the social, economic, and environmental strategies contributing to urban resilience” brought together sustainability experts to discuss innovative strategies for urban resilience in the face of the 21st century’s looming challenges.
Urbanization “is an opportunity in the sense that there’s a tremendous amount of innovation that’s going to take place with a concentration of ideas and economies and cultures in these urban spaces,” said Williams. “It’s a challenge in the sense that many of these cities are ill-equipped to handle this large influx of population.”
Williams outlined the principal challenges of an urbanizing world:
Land and shelter: New policies are needed for creating affordable housing for new urban citizens, securing land tenure, and limiting forced evictions of future urban dwellers.
Infrastructure: Finding solutions for fragile water, transportation, and sanitation systems requires thoughtful planning, solid investment, and demand management. Investors must be cognizant that many cities have limited resources and institutional capacity.
Municipal planning, management, and governance: Managing decentralization and interfacing with communities and the private sector are critical to success.
Innovative finance: Future sources of investment will increasingly be limited to private funds and community savings. Official Development Assistance (ODA) will have to be used in strategic ways to trigger such investments.
Williams noted that existing conceptions of urban challenges–that they are “messy, complex, interlinked”–paint an unflattering picture for policymakers, dramatically reducing their willingness to engage with these environments. The implied heavy transaction costs of operating in urban areas can discourage investors. Development agencies often look for opportunities where they can get in and out quickly; historically, most aid has focused on rural areas, usually with relatively short planning windows (5-10 years).
Today, decisions regarding the movement of urban populations are linked to extremely contentious power relations. Williams posited that by couching programs within the frame of adaptation and resilience, mayors and municipal governments may be able to tackle issues of social inequality that have plagued some cities for years.
Citing a 2008 seminar on community resilience, the Wilson Center’s Blair Ruble argued that the world’s increasing attention to urban challenges holds the risk of creating programs and institutions that are blind to the rich complexity of these systems. Although the theme of last month’s World Urban Forum 5 in Rio de Janeiro was “The Right to the City,” he said that many organizations were redefining “resilience” in top-down terms, silencing the variety of vulnerable voices that make up urban centers.
The visible commitment by the United States delegation to the World Urban Forum was noteworthy, said Williams, as it represents a dramatic departure from status quo. American foreign policy and development assistance have predominantly focused on agricultural policy, with varying degrees of interest on water and sanitation. Surprisingly, little attention has been paid to land tenure issues, and even less to urban issues.
This shift, Williams said, may be due to a change in perspective under the Obama administration. For the first time, many staffers have experience working on urban issues. The newly created Office of Urban Affairs, within the Domestic Policy Council, is headed by Obama advisor Valerie Jarrett. This new high-level engagement and issue integration demonstrates that urban issues are important to the White House, which has trickled down to the EPA, the Department of Agriculture, and the Department of State.
Domestic urban centers have received new initiatives and funding through the Reinvestment Act, spurring the creation of projects targeting transportation, urban planning, and regional economic growth. Many observers hope, however, that this newfound engagement will translate into solid action internationally, as many urban and rapidly urbanizing centers cope to adapt to the future.
Photo Credit: “Favela no de Rio,” courtesy flickr user kevin.j.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.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.
