Showing posts from category global health.
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Day of 7 Billion Puts Future Generations in Spotlight
›This month, our small planet’s population will hit seven billion. Reproductive health and environmental groups worldwide are raising awareness about the exact day – the “Day of Seven Billion” – when we’re estimated to hit that number next week, calling for sustainability and women’s empowerment. But the future trajectory of the world’s population projections – and all that they entail for human and environmental wellbeing – depends on decisions we make now.
Let’s start with the more than 215 million women worldwide – including many in our home countries, the United States and Kenya – who do not want to get pregnant but are not using modern contraception. Our world looks very different in 2050 if these women’s needs are met.
Research from the Futures Group shows that meeting women’s needs results in a significantly slowed population trajectory, with world population topping out at eight billion in 2050. According to recently revised UN estimates, without this intervention population could rise to 10 or even 12 billion by century’s end. Meeting this need is also a smart investment: Our research estimates that access to modern contraception for all who want it would cost $3.7 billion per year. Others have estimated the savings in health care costs of providing contraception to all who want it at $5.1 billion per year. Family planning is cost-effective; it has been estimated that a dollar spent on family planning can save between $15 and $20 in education, health, housing, and other socio-economic support costs, making the achievement of the Millennium Development Goals cheaper for developing countries.
The health and environmental benefits are also enormous: a one-third reduction in maternal mortality; a one-fifth reduction in child mortality; a major reduction in the greenhouse gas emissions. Recent research shows that carbon emissions slow when we slow our population trajectory in an effect similar to increasing the world’s use of wind power forty-fold. In Nigeria it was recently estimated that providing universal access to family planning would result in a reduction of carbon emissions equivalent to eight years from current sources.
These investments also provide more than big numbers: By enabling couples and women to choose when and how many children they’ll have, women can continue their educations longer, participate more in the workforce, and contribute to household decisions that benefit the family.
Giving women what they want and need to plan their pregnancies is one of the most obvious, yet most overlooked solutions to many of the most pressing problems we face, from maternal and child mortality to climate change. International family planning funding has stagnated for over 10 years and the results have been predictable: In Kenya, and in many countries, unmet need – with all its human costs – has increased.
Today, the largest generation of young people ever is coming of age. The aspirations and health of the millennial generation – as well as all those in the future – are on the line.
Pamela Onduso, MPH, is a Kenyan reproductive health advocate and program adviser with Pathfinder International’s Kenya office based in Nairobi. Dr. Scott Moreland is a senior researcher at the Futures Group, and leads demographic work in countries around the world.
Sources: African Institute for Development Policy, Futures Group, Guttmacher Institute, Health Policy Initiative, PNAS, Population Services International, UN Population Division, World Health Organization.
Photo Credit: Adapted from “Tea picker and son,” courtesy of flickr user ROSS HONG KONG. -
Laurie Mazur, The Aspen Leaf
The Planet at 7 Billion: Lessons from Somalia
›October 28, 2011 // By Wilson Center Staff
The original version of this article, by Laurie Mazur, appeared on the Aspen Institute’s Aspen Leaf blog.
Listless, emaciated children wait for water to arrive by donkey. Their mothers rest nearby, too exhausted to speak. Tiny graves are chiseled out of bone-dry earth to hold the famine’s youngest victims. That is what Mary Robinson, then-president of Ireland, found when she visited Somalia 19 years ago. Images of suffering haunted her for years: “I never got Somalia out of my system,” she said.
Now, the Horn of Africa is again in the grip of famine. When Robinson returned to Somalia earlier this year, “Everything was even worse” than in 1992. At the National Press Club on Monday, October 17, Robinson issued an eloquent plea to address the crisis in Somalia, which has already claimed 40,000 lives. “How can we allow that to happen in the 21st century?” she asked. “It’s a black mark for all of us.” The event was part of a series of discussions organized by the Institute’s Aspen Global Health and Development program, titled “7 Billion: Conversations that Matter.”
Women, Reproductive Health, and Fertility.
It is not enough to respond to the current crisis, Robinson said. To prevent a recurrence, we must also address long-term health and development challenges. That means bolstering governance and security. And, perhaps most important, it means unleashing the power of women. Women are critical to the future of Somalia, said fellow speaker Walid Abdelkarim, principal officer and team leader for Somalia at the UN Department of Peacekeeping Operations. “The most important element is the ability of the household to grow,” he said, “and that’s about the woman who nourishes and runs the household.”
Continue reading on The Aspen Leaf.
Video Credit: Aspen Institute. -
How Did We Arrive at 7 Billion – and Where Do We Go From Here? [Part Two]
›October 26, 2011 // By Elizabeth Leahy MadsenThe world’s women will determine whether the global population in 2050 is as low as 8 billion or as high as 11 billion through their choices (or lack thereof) about the number and timing of their children. Women in developing regions of the world will have the greatest effect on these potential population trajectories. Even if fertility rates remain constant at current levels (which is unlikely), developing regions would grow from 5.7 billion in 2010 to 9.7 billion in 2050, but the total population of developed countries would remain essentially unchanged.
The UN estimates that the seven billionth person alive today will be born on October 31. Demographer Elizabeth Leahy Madsen explains how we got to that number, its significance, and where our demographic path might take us from here. Read part one here.
The world’s women will determine whether the global population in 2050 is as low as 8 billion or as high as 11 billion through their choices (or lack thereof) about the number and timing of their children. Women in developing regions of the world will have the greatest effect on these potential population trajectories. Even if fertility rates remain constant at current levels (which is unlikely), developing regions would grow from 5.7 billion in 2010 to 9.7 billion in 2050, but the total population of developed countries would remain essentially unchanged.
The way that people decide the timing and number of their children is not easily distilled into a simple formula with a single solution. Still, some basic and important facts are known. In the developing world, where more than 80 percent of the world’s population lives, women in rural areas, those who have little or no education, and those who are poor, have larger families. As demographers have shown in modeling the determinants of fertility, women tend to seek contraception once they are confident that their children will survive to adulthood and when socioeconomic development increases the “costs” of having children, for example by motivating parents to send them to school rather than to work.
One of the most direct reasons for past declines in fertility rates was the rapid expansion of family planning and reproductive health programs, supported by country governments and international donors, that enabled women and men to more effectively choose the size of their families. But today, about 215 million women across the developing world would like to delay or avoid pregnancy but are using ineffective contraception or none at all. Funding programs to meet the family planning needs of these women, which would cost about $3.6 billion annually, would both empower them and help fertility rates continue to decline.
Beyond Access: Gender Inequality Inhibits Contraceptive Use
While increasing support for family planning programs tops the list of demographers’ recommended policies, ensuring that contraceptives are available and accessible will not alone achieve the fertility declines projected in most of the UN’s range of possibilities. Many women who are having or planning to have large families know about family planning and where to find it, but are choosing not to use contraception for cultural reasons that are often deeply engrained.
In sub-Saharan Africa, the region with the highest global fertility rate, only 16 percent of married/partnered women of reproductive age are using effective contraception. In comparison, between 62 and 75 percent of their peers in Ireland, the United States, and Uruguay – countries whose fertility rates are almost exactly at replacement level – are using it.
Logically, sub-Saharan Africa needs similar levels of contraceptive use to bring its average fertility rate towards replacement level as the UN projects, so the region’s average prevalence rate for modern contraception would need to rise by at least 10 percentage points in each of the next four decades. However, contraceptive use in the region has grown by only 0.5 percentage points or less over the past 30 years.
What is inhibiting the use of contraception? Demographic and health surveys find in Nigeria, for example, that 10 percent of married women are using an effective contraceptive method, while twice as many have an unmet need for family planning. This low use of family planning demonstrates high potential for change in the country’s demographic future, which, as the most populous in Africa, will greatly influence global and regional trends. Yet among women who do not intend to use contraception, 39 percent report that they or their family members are opposed to family planning, and another 16 percent fear side effects or have other health-related concerns. If Nigeria’s fertility rate remains unchanged, the country will be home to 500 million people by 2050.
In Pakistan, where 24 percent of births are unintended, surveys show similar barriers. Ninety-six percent of married women know about effective contraceptive methods, but only 22 percent are using one. More than one-quarter of women who do not plan to use contraceptives report that their fertility is “up to God” and 23 percent report that they or their family members are opposed to family planning. Pakistan’s population would more than double from 174 million to 379 million by 2050 if current fertility trends hold constant.
Peak Planet? Population Growth and Consumption Strain Environmental Resources
Because Nigeria, Pakistan, and other countries’ demographic trajectories may not follow the path laid out in population projections, we can’t take a world of nine billion for granted. While human ingenuity and technological advancements have improved standards of living in many countries, scientists caution that the combination of rising human numbers and growing consumption has serious environmental implications. Already, the quantity and quality of fresh water supplies are under strain, and forests in many developing countries are being rapidly depleted.
Population projections are much more than wonkish speculation – they foreshadow the serious problems that lie ahead if health, environment, and development policies aren’t strengthened. If the UN projections of our demographic future are to bear any semblance of reality, we must move beyond the status quo. While improving physical access to family planning should remain a top priority, meeting unmet need will also require addressing the deep-seated challenges of women’s education and empowerment.
Elizabeth Leahy Madsen is a consultant on political demography for the Wilson Center’s Environmental Change and Security Program and former senior research associate at Population Action International.
Sources: Bongaarts and Sinding (2009), Bongaarts (2006), Futures Institute, Guttmacher Institute and UN Population Fund, Measure DHS, O’Neill, Dalton, Fuchs, Jiang, Shonali Pachauri, and Katarina Zigova (2010), UN Population Division, Washington Post.
Photo Credit: “Afghan Internally Displaced Persons,” courtesy of flickr user United Nations Photo. -
Carl Haub, Behind the Numbers
Rwanda’s 2010 Demographic and Health Survey Shows Remarkable Drop in Fertility and Child Mortality
›October 18, 2011 // By Wilson Center StaffThe original version of this article, by Carl Haub, appeared on PRB’s Behind the Numbers blog.
The Rwanda 2010 Demographic Health Survey is the latest in a regular series of DHS surveys that began in 1992, although hostilities had delayed the next survey until 2000. The 2010 survey interviewed 13,671 women ages 15 to 49 and 6,329 men ages 15 to 59 from September 2010 to March 2011. The total fertility rate (TFR – the average number of children would bear in her lifetime if the birth rate of a particular year were to remain constant) obtained in the survey was 4.6 for the three-year period preceding the survey. For urban women, the TFR was 3.4 and for rural women, who were 85 percent of the sample, 4.8.
Rwanda’s TFR saw its fastest decline in the 2010 DHS. From the 2007-08 Interim DHS to the 2010 survey, the TFR fell by 1.1 children nationwide – by 1.3 in urban areas and 0.9 in rural areas in a period of only four and a half years. This is sharpest drop in a sub-Saharan TFR I can ever remember seeing. As an indicator of future fertility plans, 56.2 percent of women with three living children said that they not wish to have any more children as did 76 percent of those with four living children. It is clear that the large family size of eight children per woman is truly a thing of the past.
In the survey, 51.5 percent of currently married women said that they were using some form of family planning, 45.1 percent a modern method. Injectables were by far the most frequently used, as such “spacing” methods are in much of Africa, with 23.1 percent of women saying that they used them. That method increased from 15.2 percent in the 2007-08 survey. The next two methods were implants (6.3 percent) and the pill (7.1 percent).
Continue reading on Behind the Numbers.
Image Credit: Arranged by Population Reference Bureau; data from the National Institute of Statistics of Rwanda, Ministry of Finance and Economic Planning, Ministry of Health Rwanda, MEASURE DHS, ICF Macro, Demographic and Health Survey 2010, Preliminary Report. -
Lisa Hymas on Envisioning a Different Future With Family Planning in Ethiopia
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ECSP caught up with Lisa Hymas, senior editor at Grist, last week during the first South by Southwest (SXSW) Eco conference and she spoke about her recent visit to Ethiopia to see the country’s community health extension program in action. “Ethiopia has a big challenge around population,” Hymas said, “but the government is committed to bringing that down.”
The government extension program places health-workers – young women, for the most part, who have received basic training – directly into each community, where they are able to give out immunizations, provide advice on nutrition, teach families how to properly hang bed nets to prevent mosquito-borne illnesses, and provide family planning services and advice.
Thanks to the program, these health workers and those in the communities they service can “envision very different lives for themselves than their mothers had,” Hymas explained. For instance, one woman recounted that her mother gave birth to 10 children, “and almost died giving birth to the last one, because there was no access to birth control, and there was no good access to health care.” In contrast, she is now able to have a career and to use family planning to delay and space her own childbearing.
For more on Ethiopia’s health extension program, see Schuyler Null’s report on visiting a village health clinic near the town of Fiche last spring. -
Silent Suffering: Maternal Morbidities in Developing Countries
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Maternal morbidities – illnesses and injuries that do not kill but nevertheless seriously affect a woman’s health – are a critical, yet frequently neglected, dimension of safe motherhood. For every woman who dies, many more are affected acutely or chronically by morbidities, said Karen Hardee, president of Hardee Associates at the Global Health Initiative’s September 27 panel discussion, “Silent Suffering: Maternal Morbidities in Developing Countries.” Hardee was joined by Karen Beattie, project director for fistula care at EngenderHealth, and Marge Koblinsky, senior technical advisor at John Snow, Inc., for a discussion moderated by Ann Blanc, director of EngenderHealth’s Maternal Health Task Force.
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Ben Ramalingam, Aid on the Edge of Chaos
The Complexity of Scaling Up
›October 11, 2011 // By Wilson Center StaffThe original version of this article, by Ben Ramalingam, appeared on Aid on the Edge of Chaos.
Despite increased prominence and funding of global health initiatives, attempts to scale up health services in developing countries are failing, with serious implications for achieving the Millennium Development Goals. A new paper argues that a key first step is to get a more realistic understanding of health systems, using the lens of complex adaptive systems.
Much ongoing work in development and humanitarian aid is based on the idea of “scaling up” effective solutions. Healthcare is one of the areas where this idea has played a central role – from the World Health Organization’s Health for All in the 1960s to UNICEF’s child healthcare programs, from rolling out HIV-AIDS, malaria and TB treatments to the package of interventions delivered to achieve the Millennium Development Goal on health.
However, despite the fact there are many cost-effective solutions to health problems faced in developing countries, many agencies are still frustrated in their attempts to deliver them at scale. This may be because of a widespread failure to understand the nature of health systems.
Continue reading on Aid on the Edge of Chaos.
Image Credit: Adapted from Table 1, “Understanding pathways for scaling up health services through the lens of complex adaptive systems,” Health Policy and Planning, Oxford University Press. -
SXSW Eco Panel: Three Great Ideas That Won’t Be On the Rio+20 Agenda
›September 30, 2011 // By Schuyler Null
South by Southwest (SXSW) – the popular music, film, and alternative showcase – is moving into the green space with its first ever “eco” conference, kicking off next week, October 4, with more than 50 panels on “solutions for a sustainable world.” There’s one in particular though you should tune into: “Three Great Ideas that Won’t Be On the Rio Agenda,” featuring Geoff Dabelko, director of the Wilson Center’s Environmental Change and Security Program; Roger-Mark De Souza, vice president of research and director of the climate program at Population Action International; and Aimee Christensen, CEO of Christensen Global Strategies.
The panel will feature discussion on three issues that will likely not be on the table at the Rio+20 UN Conference on Sustainable Development next year: integrated population, health, and environment development programs, climate adaptation as a path to peacebuilding, and how to get the private sector better involved in helping cope with climate change.
If you’re traveling down to Austin, “Three Great Ideas” is scheduled for Thursday, October 6 at 10am CST; if not, stay tuned for webcast information!
