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The “Condom King” speaks at TEDxChange on Poverty Reduction and a “9th MDG”
›“We have now found the weapon of mass protection,” said Mechai Viravaidya (a.k.a. the “Condom King”) at the recent TEDxChange event in New York. Viravaidya is the founder and chairman of the Population and Community Development Association and a former senator of Thailand. He spoke about his innovative approaches to addressing Thailand’s once high rates of poverty, child mortality, and HIV through the promotion of family planning and condom use.
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Misguided Projections for Africa’s Fertility
›By assuming that sub-Saharan Africa’s total fertility rate will decrease to 2.5 children per woman by 2050, the most recent population projections issued by the Population Reference Bureau likely continue to underestimate fertility for Africa. Though northern Africa has significantly lowered fertility, sub-Saharan Africa’s TFR is still 5 children per woman. Achieving the levels projected by PRB or the United Nations will largely depend on whether the conditions that led to past fertility declines for other states can be established in sub-Saharan Africa.
Demographers have identified numerous factors associated with fertility decline, including increased education for females, shifting from a rural agricultural economy to an industrial one, and introduction of contraceptive technology. Sub-Saharan Africa is only making slow progress in each of these areas.
Surveying Obstacles to Development
Primary school enrollment is up, but the pace of improvement is declining. Meanwhile, gender gaps persist: Enrollment for boys remains significantly higher than for girls. Girls’ education is associated with lower fertility, partly because education helps women take charge of their fertility and also because education influences employment opportunities. Increased female labor force participation has been shown to increase the cost of having children, and is therefore associated with initial fertility declines.
Disease is one wildcard for Africa that limits the utility of past models of demographic transition in the African context. HIV/AIDS is decimating sub-Saharan Africa’s adult workforce and creating shortages of teachers that will impede future efforts to boost primary school enrollment. According to the United Nations, the number of teachers in sub-Saharan Africa needs to double in the next five years to reach Millennium Development goals.
Development that would shift the region’s economies from agriculture to industry is also lagging. While several West African countries are seeing some gains, the African continent on the whole faces major structural impediments to development. In The Bottom Billion, Paul Collier points out that many of these countries may have “missed the boat” to attract investment and industry that would pull the region out of poverty, partly because the least developed countries are still not cost-competitive enough when compared with current centers of manufacturing, like China.
Finally, there remains a high unmet need for family planning. One in four women aged 15 to 49 who are married or in union –- and who have expressed an interest in using contraceptives — still do not have access to family planning tools. In general, maternal mortality remains high and adolescents in the poorest households are three times more likely to become pregnant and give birth than those in the richest households, according to the most recent UN Millennium Development Goals report.
Sub-Saharan Africa: Off the Radar?
Sub-Saharan Africa suffers from a lack of attention by the international community and lack of political capacity at home. Many countries in the region are plagued by civil strife and poor governance, and developed countries continue to fall short of development assistance pledges. There is not the same sense of urgency today among developed countries about the global population explosion as there once was. Cold War politics and the environmental and feminist movements motivated much of the study of fertility and funding of population programs during the second half of the 20th century. Attention by governments and NGOs sped the fertility transition among many countries.
Today, the world’s wealthiest countries are not concerned primarily with Africa’s problems, but rather are more concerned with their own population decline and with the national security implications of population trends in areas associated with religious extremism. The recession has further hindered the flow of development funds.
Fertility is the most difficult population component to predict, and demographers must draw on the experiences of other regions to inform assessments of Africa’s population patterns. Demographers seem to be overconfident that Africa’s fertility will follow the pattern of recent declines, particularly in Latin America, which were more rapid than Western Europe’s decline due to the diffusion of technology and knowledge.
Once states begin the demographic transition towards lower fertility and mortality, they have tended to continue, with few exceptions. Therefore, most projections for Africa assume the same linear pattern of decline will hold. Yet, the low priority of Africa’s population issues among the world’s wealthiest states, combined with shortfalls in education, development, and contraception, may mean that the demographic transition in Africa will be slower than predicted.
Projections are useful to give us a picture of what the world could look like if meaningful policy changes are made. In the case of sub-Saharan Africa, prospects for these projections are dim.
Jennifer Dabbs Sciubba is the Mellon Environmental Fellow in the Department of International Studies at Rhodes College in Memphis, Tenn. She is also the author of a forthcoming book, The Future Faces of War: Population and National Security.
Photo Credit: “Waiting,” ECWA Evangel Hospital, Jos, Nigeria, courtesy of flickr user Mike Blyth. -
Boosting the U.S. Role in the Global Health Arena
›A new video from the Commission on Smart Global Health Policy, which was established by the Center for Strategic & International Studies, reviews the commission’s progress towards its goal of encouraging the U.S. government to embrace global health as a pillar of U.S. foreign policy.
The video reviews the recommendations from the commission’s March 2010 report, A Healthier, Safer and More Prosperous World: 1) Maintain robust U.S. support for the fight against HIV/AIDS, malaria, and tuberculosis; 2) Prioritize maternal and child health, especially in sub-Saharan Africa and South Asia; 3) Help other nations improve their capacity to prevent and respond to outbreaks of contagious disease; 4) Expand U.S. capacity to fund future global health initiatives by securing long-term investments for such efforts; and 5) Step up U.S. funding for multilaterals engaged in the global health field, including the World Health Organization, Global Fund, UNICEF, the World Bank, and the GAVI Alliance.
In the months ahead, commission members will be participating in public forums throughout the United States to discuss and promote the recommendations included in the report, before gathering in January to review the Obama administration’s progress on global health as the administration begins its third year. To date, the centerpiece of the administration’s health outreach efforts has been the six-year, $63 billion Global Health Initiative, designed to promote an enhanced U.S. role in addressing public health issues overseas.
The CSIS Global Health Policy Center will also be launching a year-long debate series called “Fault Lines in Global Health,” focusing on controversial topics in the global health field. The series’ kick-off event will center on U.S. AIDS funding, and is scheduled for Friday, August 6, 2010, from 9:30-11:00 a.m. -
Addressing Gender-Based Violence to Curb HIV
›July 28, 2010 // By Marie HokensonAt the recent International AIDS Conference in Vienna, Austria, an astonishing development in the campaign to stem the spread of HIV/AIDS was unveiled—a microbicide with the ability to reduce the risk of transmission of HIV. This welcome development coincides with an intensified focus on women’s health and security needs among donors, especially the United States.
At the conference, the “Gender Programming and Practices: Practical Approaches with HIV and AIDS” session took an integrated approach, examining the links between gender-based violence and HIV/AIDS infection. Women are more vulnerable to gender-based violence and HIV infection than men, particularly in parts of sub-Saharan Africa where “girls and women aged 15 to 19 are three times more likely” to become infected with HIV than men in the same age group, according to the World Bank.
Michelle Moloney-Kitts, with the Office of the U.S. Global AIDS Coordinator, said that gender-based violence “affects not only public health, but [also] the ability of women and girls to contribute to developing their countries.” Since women play integral roles in supporting their families and communities in developing nations, their absence or weakened capacity due to HIV infection, injuries, or unwanted pregnancy can have larger repercussions for economic development and community health.
Deep Roots: Changing Minds About Gender-Based Violence
Elizabeth Mataka, the UN Secretary-General’s special envoy for AIDS in Africa, described the obstacles facing female victims of gender-based violence as “deep-rooted social, economic, legal, and cultural affairs” in their communities. Mataka asserted that “communities must be engaged” through a “change in mindset” in order to allow these women to “claim their basic human rights.” Scrutinizing the paucity of women’s organizations, she cited a “serious shortage of women’s leadership at the grassroots level” as a problem that must be overcome to empower and protect women.
Pamela Barnes, a co-leader of the Partnership to End Sexual Violence Against Girls, highlighted the extent of this “deep-rooted societal issue.” She pointed out that a 2007 Swaziland study found the most “common venue for sexual violence was…within the homes of the victims.”
Rui Bastos, representing Mozambique’s Ministry of Health, added that there is a pressing need to “change relationships between men and women,” and called for a shift in the current relationship dynamic to “give power to the women.” Noting the low number of men receiving HIV treatment, he called on men to “increase demand in treatment” in order to stem the spread of the disease.
Silent Voices: Talking About Sexual Violence Against Minors
Since the Swaziland survey found that “30 percent of the respondents indicated that they had experienced some form of sexual violence prior to the age of 15,” Barnes said greater efforts must be made to educate children about how to protect themselves from sexual violence. She added that efforts to protect children should also address other “risk factors for abuse [which] include lack of education, exposure to emotional abuse, and witnessing sexual assault.”
At a recent Wilson Center event on sexual violence against minors, Jama Gulaid of UNICEF Swaziland said that while talking about sexuality is not easy, “when you bring in violence it is even more difficult.” For that reason, Gulaid said, “you have to do two things—you have to share information and you have to present it in certain ways.” He explained that Swaziland was addressing the issue by relying on school-based interventions, which include trained community-child protection groups, toll-free telephone lines, case investigation services, and personal counseling.
Prevention First: Scaling Up to Stop Rape
While the new microbicide might help female victims of sexual violence avoid HIV infection, it will not stop the problem of gender-based violence. That is why Moloney-Kitts called on donors and NGOs to “scale up gender-based violence programs,” but in a way that goes beyond simply improving “post-rape care” and instead places greater emphasis on prevention efforts.
Not only would better rape prevention help reduce HIV and STD infection rates, but it would also help women avoid psychological damage and unwanted pregnancies—and, as Moloney-Kitts pointed out, improve economic development and enhance public health at the same time.
For more on gender-based violence, see these Wilson Center events:- Gender-Based Violence in Sub-Saharan Africa: A Review of Demographic and Health Survey Findings and Their Use in National Planning
- From Relief to Development: Gender-Based Violence Interventions in Conflict and Post-Conflict Contexts
- Dynamics Of Sexual Violence In The Eastern Democratic Republic Of Congo: Perpetrators, Community Response, and Policy Implications
Photo Credit: “Congo Kivu Violences Panzi,” used courtesy of flickr user andré thiel. -
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. -
Integrating HIV/AIDS and Maternal Health Services
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Integrating maternal health and HIV/AIDS services “includes organizing and providing services that meet several needs simultaneously…focusing not only on the condition, but also the individual,” argued Dr. Claudes Kamenga, Senior Director of Technical Support and Research Utilization at Family Health International, during the first event of the Advancing Policy Dialogue on Maternal Health series co-convened by the Wilson Center’s Global Health Initiative, Maternal Health Task Force (MHTF), United Nations Population Fund (UNFPA), and technical support from U.S. Agency for International Development (USAID). Joined by Michele Moloney-Kitts, assistant coordinator at the Office of the U.S. Global AIDS Coordinator, and Harriet Birungi, a program associate with the Population Council in Kenya, the panelists discussed how integration of HIV/AIDS and maternal health services not only improves health outcomes, but also increases program efficiencies, strengthens health systems, and saves money.
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Start With A Girl: A New Agenda For Global Health
›November 16, 2009 // By Calyn OstrowskiThe 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. -
How Family Planning Meets Development Goals
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“Knowing is not enough; you must act and let your government know that family planning is a right and saves lives,” said Maurice Middleberg of the Global Health Council at a recent event in Chapel Hill.
The other panelists at “How Can Family Planning Efforts Help Us Achieve the Millennium Development Goals?” (Dr. Martha Carlough of UNC, Dr. Ward Cates of Family Health International, and Pape Gaye of IntraHealth International) all provided compelling statistics demonstrating the effectiveness of family planning as an intervention that addresses the Millennium Development Goals (MDGs).
MDGs 4, 5, and 6 – reducing child mortality; improving maternal health; and combating HIV/AIDS, malaria, and other diseases, respectively – all have obvious connections to health and woman’s reproductive health. An unmet need for family planning, which is measured as the percentage of women of reproductive age who desire to space or limit their births but are not using contraception, can undermine the achievement of these goals.
For example, very early motherhood not only increases the risk of dying in childbirth, it also jeopardizes the well-being of surviving mothers—and their children, too. A child born to an adolescent mother has a greater risk of dying in infancy or childhood.
“Contraception is the best-kept secret in HIV prevention,” said Dr. Cates, who cited research that found that “current contraceptive use in sub-Saharan Africa prevents an estimated 577,200 unplanned births to HIV-infected mothers” and thus prevents the birth of an estimated 173,000 HIV-infected infants each year.
Family planning can help meet the other MDGs, including ending poverty and hunger (Goal 1); providing universal primary education (Goal 2); and promoting gender equity (Goal 3). Young mothers frequently miss out on education and socio-economic opportunities. Being able to make their own decisions about family planning and reproductive health can empower women and improve gender equity. When women are given equal opportunities for education, health, and employment, they are more likely to invest in the education and care of their children. This helps them break the cycle of poverty, hunger, and disease.
Although the MDGS don’t include any formal targets for sexual and reproductive health, the UN Millennium Project has stated that the MDGs cannot be achieved in low-income countries without access to sexual and reproductive health services, including family planning. The panelists agreed that family planning is a cost-effective intervention that provides broader positive benefits for development.
But the real strength of their presentations lay in the personal stories behind the statistics. Middleberg closed the discussion with a story about a woman in Latin America who told him that she loves her husband but was afraid of him every time he touched her. Now, after having undergone sterilization, she no longer worries and can love her husband with no fear of becoming pregnant.
A mother of six interviewed in a 2009 news article about the Philippines’ new family planning bill said, “How can one keep on having children? We don’t earn enough to feed them, much less send them to school.” New York Times columnist Nicholas Kristof interviews a Haitian woman with 10 children in a dramatic video interview, “Saving Lives with Family Planning.”
Underlying all of these facts and stories is the belief that one’s health and well-being, including access to family planning, is a right. But as Middleberg said, believing is not enough.
EngenderHealth, an international reproductive health organization working to improve the quality of health care in the world’s poorest communities, is asking Americans to create a video explaining why we should care about international family planning. Contribute your thoughts on YouTube’s Video Volunteers project.
Lisa Basalla, MPH, is a research associate with the Carolina Population Center. She graduated from Case Western Reserve University with a MPH focusing on reproductive and adolescent health. She has worked with Johns Hopkins University’s Center for Communications Programs on its reproductive health knowledge management project as well as a HIV-prevention behavior change communication project in Malawi.
Photo: A billboard promoting family planning in Phnom Pehn, Cambodia. Courtesy flickr user olerousing.
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