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Research Findings and Programmatic Implications
Gender-Based Violence in the DRC
›In the Democratic Republic of the Congo (DRC), “armed conflict has resulted in mass displacement and widespread sexual violence; the problem is that it hasn’t always been quantified,” said Dr. Lynn Lawry, senior health stability and humanitarian assistance specialist at the U.S. Department of Defense. Presenting findings from the first cross-sectional, randomized cluster study on gender-based violence in the DRC, Lawry was joined at the Wilson Center by Heidi Lehmann, director of the Gender-based Violence Unit at the International Rescue Committee, and Dr. Nancy Glass, associate professor at the Johns Hopkins School of Nursing and associate director at the Johns Hopkins Center for Global Health. “We found that sexual violence in these areas is conflict-related, prevalent, systematic, and widespread,” said Lawry. [Video Below]
Study Finds “Female Perpetrators”
The first of its kind in the region, the population-based, quantitative study covers three districts in the DRC and a total of 5.2 million adults. It comprehensively assesses gender-based violence, including its prevalence, circumstances, perpetrators, and physical and mental health impacts.
Overall, the study found that 2.1 million women and 1.3 million men in the region had suffered sexual violence. Nearly three-quarters of all sexual violence reported was a direct result of conflict. In the study region, 20 percent of the population fought in conflicts, and 48 percent of these combatants were female.
Further, 39 percent of female survivors and 15 percent of male survivors reported female perpetrators. “These findings challenge the paradigm of male perpetrator and female victim,” said Lawry. “Policymakers and donors should adjust societal paradigms of sexual and gender-based violence and also direct attention to female perpetrators and male survivors.” Survivors of sexual violence in conflict, both male and female, are more at risk of later becoming perpetrators, particularly if unrecognized and untreated. To “break the cycle of violence,” prevention and response programs should address the needs of survivors and combatant perpetrators of both genders.
“Community-related violence is a general crime; conflict-related violence is a war crime,” Lawry said. While many efforts have focused on the Congolese military, she called for the DRC government and the International Criminal Court to also investigate and prosecute members of rebel groups, who were found to be the main perpetrators of sexual violence and other human rights abuses in this study.
Prevention: The Best Response
“Meeting the immediate consequences of violence is not enough,” said Lehmann. To effectively address gender-based violence, programs must provide medical and social services, promote social empowerment, respond to emergencies, and take part in advocacy and coordination efforts.
In the DRC, programs supported by the International Rescue Committee serve approximately 350 to 400 survivors per month, 75 percent of whom report that the perpetrators are members of armed groups.
Scaling up is a major challenge. “Providing essential services alone require enormous investment, and there is no common understanding of comprehensive programming,” said Lehmann. “We recognize that a program alone cannot solve all of these problems, especially in the DRC.”
“Good response is about prevention,” concluded Lehmann. She recommended supporting robust, long-term programming; integrating gender-based violence prevention efforts into other sectors; and investing in partnerships. “We are not going to end the violence unless Congolese women and girls are part of the conversation.”
Pigs for Peace: A Holistic Approach
Health care, economic development, and social programs should be integrated “to provide a holistic and comprehensive approach” to the problem of gender-based violence, said Glass. “Rape destabilizes families and communities,” she said.
Survivors rarely get immediate treatment for their injuries and trauma, or the risk of HIV, STIs, and infertility. “Many rural primary health centers and hospitals have been looted of medicines and materials by rebels and soldiers,” said Glass. Conflict in the DRC has also caused health care professionals to leave unstable rural areas, and poor roads and limited transportation make it unsafe and expensive to seek care.
To rebuild families and communities, “women and men need to regain their economic resources to provide for the future of their family and community,” said Glass. Pigs for Peace, for example, has supplied more than 100 women — many of them rape survivors — and their families with pigs to set them on the path to recovery through psychological, social, and economic empowerment. This program aims not only to supplement household income, but to reduce the stigma of rape as survivors become productive parts of their families and communities.
Photo Credit: “Congo kivu,” courtesy of flickr user andré thiel. -
New Insights Into the Population Growth Factor in Development
›“We have not found any country that has developed or gotten out of poverty while maintaining high birth rates,” said Martha Campbell, president of Venture Strategies for Health and Development. “Family planning is not a cost to a Ministry of Finance – it’s an investment,” said Malcolm Potts of the University of California Berkeley.
Campbell and Potts were joined by panelists Eliya Msiyaphazi Zulu, director and founder of the African Institute for Development Policy, and Jotham Musinguzi, director of the African Region at Partners in Population and Development, for a Wilson Center discussion of the implications of rapid population growth on human and economic development. [Video Below]
Africa’s Key Population Growth Challenges
“Africa’s population of one billion can reach between 1.8 and 2.3 billion by 2050, depending on how well the continent actually does in reducing fertility,” Zulu said. In 2010, Africa accounted for 15 percent of the total world population, but current estimates suggest this will grow to 23 percent by 2050.
“Rapid growth, young age structures, and urbanization are Africa’s main population challenges,” said Zulu. “Addressing these concerns is increasingly seen to be the key to the continent’s development prospects and realization of the Millennium Development Goals.” With 40 to 50 percent of populations in Africa under the age of 15, there is “high momentum for further population growth,” he said.
“Africa has a very high demand for fertility control, and the demand will undoubtedly increase,” said Zulu. “The main challenge, therefore, is not that of demand, but how to ensure those who are in need actually have access to contraception.” In many African regions, current rates of contraception use are as low as seven percent. In some areas, as many as 97 percent of women cannot afford the full cost of contraception, he said.
“It’s not just about reducing fertility,” said Zulu. Improving education and increasing labor force opportunities will not only help populations develop economically, but will also allow African countries to take full advantage of the demographic dividend, he said.
“The international development community should build on Africa’s success stories and support efforts to achieve universal access to family planning, expand public education on reproductive matters, improve the status of women, and improve the situation in urban settings,” Zulu concluded.
Family Planning and the MDGs
“Women are dying; children are dying. They shouldn’t be,” said Musinguzi. “By investing US$1 million in family planning, you can prevent 800 maternal deaths, 11,000 infant deaths, 14,000 deaths in children under five, and 360,000 unwanted pregnancies.”
“Women are clearly saying they have a need for family planning,” Musinguzi said. Presenting statistics from sub-Saharan Africa, he noted that 31 countries have a total fertility rate of more than five. Fourteen million unintended pregnancies occur each year, but only 25 percent of women use family planning. In Uganda, for example, the population has more than doubled in less than 20 years; women on average have more than six children each; and only 18 percent of married women use modern contraception.
“For a country trying to achieve the MDGs…the question of addressing total fertility rate is very important,” said Musinguzi. Reducing unmet need for family planning services can help African countries reduce the costs of achieving several of the Millennium Development Goals, including offering universal primary education; reducing child mortality; improving maternal health; combating HIV/AIDS, malaria, and other diseases; and ensuring environmental sustainability.
Policy Implications
“This is an urgent message – waiting 10 years to get family planning back on the international agenda will be enormously costly,” Potts said. “Of all the medical interventions that exist, contraception is the single most powerful. It is the only one that can have an impact on maternal and infant mortality, on the autonomy of women, on economic progress, on social stability and the rate at which we destroy the environment,” he said.
“Education and family planning are the driving mechanisms of development – they’re synergistic,” said Potts. “One of our needs is to get economists, family planning, and development experts on the same page.”
Sources: Guttmacher Institute, Population Action International, Population Reference Bureau.
Photo Credit: Untitled, courtesy of flickr user stttijn. -
Minister Izabella Teixeira at the Wilson Center
A Review of Brazil’s Environmental Policies and Challenges Ahead
›Stressing the need for concrete, tangible institutional policies, Izabella Teixeira, Brazil’s Minister of the Environment, discussed the challenges and goals of her ministry at the Wilson Center on October 20. Sustainable development, not just conservation, must be the focus, and that requires bringing lots of different players to the table, taking into account not only environmental but also social and economic agendas. To do this, she argued, one must take the rather ephemeral and hypothetical notions of environmental stewardship and put them into the realm of a practicable, institutionalized framework, built on a social pact that engages all sectors of society.
The foundation of sustainable development and environmental policy must be biodiversity, according to Teixeira. Central concerns, such as food and energy security and combating climate change, all rely on a diverse array of natural resources. These need to be conserved, but they must also be developed in a responsible, sustainable way. A legal international framework toward this end, covering access to biodiversity and genetic resources, has yet to be implemented. Developing and developed countries need to find a middle ground on allocating the benefits that accrue from the use of genetic resources found in areas such as the Amazon, and this agreement must then be linked into existing political institutions.
Teixeira noted the strides Brazil has made toward protecting its environment – including having set aside the equivalent of 70 percent of all protected areas in the world in 2009 and the establishment of the Amazon Fund. Nevertheless, Brazil must continue to protect and maintain these nature preserves, not just establish them. Creating a program that pragmatically implements international goals in a national context is an ongoing process, and countries like Brazil now need to focus on the “how” of implementing these goals, rather than just the “what.”
Teixeira also highlighted the complexity of formulating environmental policy that integrates all the various points of view that must be taken into consideration. At recent meetings to discuss transitioning to a low-carbon economy, 17 different cabinet ministers had to be present to coordinate government positions and policies. The complexity is due in part to the need to create alternatives, not just to prevent certain activities. For example, one must not only use legal enforcement to stop illicit deforestation, but also create paths to legal, sustainable logging. Once again, attempting to balance environmental, social, and economic concerns is difficult, to say the least, but crucial for long-term effectiveness.
Also a unique challenge for Brazil is the natural diversity that exists within such a large country. While much of the attention paid to the environment goes (rightly so) to the Amazon, there are many other biomes and local environments that must be taken into consideration, Teixeira observed.
The cerrado, Brazil’s enormous savanna, requires a different strategy than the Amazon, which is different than the coastal Atlantic forest. Furthermore, urban areas need their own environmental policies that can take into account issues of human development and population density.
To illustrate the need for an inclusive, well-thought-out policy, Teixeira discussed–rather frankly–the controversy surrounding the recent proposed amendments to the Forest Code. She argued that the proposal makes blanket changes that do not take into consideration differences in biomes, differences between large agribusinesses and family farms, and between historic, settled communities and recent developments. The implications of this proposal, according to the minister, could have enormous social costs. Teixeira said she believes that it would be virtually impossible to enforce the amended Forest Code if it was approved by Congress. She used this example to underscore her role in offering legislative alternatives that seek to provide a more nuanced, and ultimately more effective, institutional framework that can use Brazil’s many natural resources to help its population to the greatest extent possible.
J.C. Hodges is an intern with the Brazil Institute at the Wilson Center; Paulo Sotero is the director of the Brazil Institute.
Photo Credit: “Rio Jurua, Brazil (NASA, International Space Station Science, 05/29/07),” courtesy of flickr user NASA’s Marshall Space Flight Center, and David Hawxhurst/Wilson Center. -
Evidence, Links, and Solutions
Maternal Undernutrition
›“Maternal undernutrition is often overlooked as a strategy for reducing poverty and as a key intervention to reduce maternal mortality and morbidity,” said Mary Ellen Stanton, senior maternal health advisor at the U.S. Agency for International Development. Stanton was joined by Dr. Doyin Oluwole, director of the Africa’s Health in 2010 program, and Amy Webb Girard, assistant professor at the Emory University School of Public Health, in the final meeting of the Advancing Policy Dialogue on Maternal Health series on December 15 where they addressed the linkages between poverty, undernutrition, and poor maternal health outcomes.
The Cycle of Malnutrition and Poverty
Many factors contribute to a woman’s nutritional status, including lack of capital, access to land, and poverty; thus, said Oluwole, “we must adopt a multi-pronged and multi-sectoral response.”
“General malnutrition is usually associated with iron-deficiency anemia, which leads to poor cognitive function and educational achievement, poor health, and fatigue.” Oluwole said. “These three factors lead to low worker productivity, and low worker productivity leads to income poverty.”
“All of these aggravate malnutrition and so the vicious cycle of malnutrition and poverty continues,” said Oluwole. To break this cycle, she pointed out that countries like Malawi and Mexico have implemented various multi-sectoral interventions that have “stimulated economic growth; implemented targeted social, health, and nutrition programs; and put in place safety nets.”
“In the window of opportunity during pregnancy and the first two years of life, we can make a big difference,” Oluwole said. She advocated for an “integrated anemia package” that provides anti-malarials, de-worming medicine, iron folic acid tablets, and extra food during pregnancy. She also noted the importance of family planning and targeted high-coverage interventions, such as salt iodization, vitamin A supplementation, and breastfeeding promotion.
In conclusion, Oluwole provided several recommendations for the development community to improve maternal mortality rates and undernutrition of women:
Maternal Undernutrition: Our Global Disgrace- Promote universal primary and secondary education, especially for girls
- Stimulate economic growth with a focus on gender and equity
- Invest in infrastructure to reduce transportation time to hospitals
- Postpone age of marriage and of first pregnancy
- Provide targeted and effective nutrition and health interventions
- Encourage private sector participation and government leadership
- Integrate the maternal health and nutrition communities and services
“We don’t tend to look at maternal nutrition and its impacts on the woman herself,” said Girard. The lack of data on the relationship between nutrition and maternal health outcomes “hampers our ability to move maternal nutrition onto the health and development agenda,” she added.
“Anemia is widespread; worldwide, it is a significant public health burden, both in women of reproductive age as well as in pregnant women,” said Girard. Studies have shown that moderate anemia increases risk of hemorrhage and may also increase the risk of sepsis, while severe anemia has been shown to directly contribute to maternal mortality. Targeted interventions can help reduce these risks greatly. “For every one gram per deciliter increase in hemoglobin level, you can reduce maternal mortality by approximately 25 percent, but the mechanisms by which this occurs are not well elucidated,” noted Girard.
“We need to include women not as just targets of nutritional interventions, but as beneficiaries in their own health,” said Girard. Key nutritional interventions such as micronutrient supplementation, fortification, and behavior change communication can help to improve not only fetal, infant, and child health, but can also reduce maternal morbidity and mortality. In addition, Girard recommended the following strategies to achieve greater impact:
Together, these strategies can help improve access to nutrition and health services, as well as adequate food for women throughout their lives. “We need to integrate health and nutrition – they are actually the same pillar, complementing each other,” Girard concluded.- Improve nutrition throughout the life cycle, not just during pregnancy
- Look for alternate strategies for micronutrient delivery
- Integrate maternal nutrition into food security and agricultural strategies
- Collect indicators specific to women’s health impacts
- Recognize and address gender bias
Photo Credit: “Bangladesh mothers, kids,” courtesy of flickr user Bread for the World. -
Too Few or Too Many? Joel E. Cohen on How Education Can Address Both
›December 17, 2010 // By Wilson Center Staff“So which is it: Is it too many people or is it too few people?” asks Joel E. Cohen of the Rockefeller University in this interview with ECSP. “The truth is, both are real problems, and the fortunate thing is that we have enough information to do much better in addressing both of those problems than we are doing – we may not have silver bullets, but we’re not using the knowledge we have.”
Cohen has studied the population-resources equation, trying to determine how best to support global demographics in a sustainable, equitable way. He points to the cross-cutting power of education to both curb rapid population growth in the developing world and ease the cost of aging populations in the developed.
“On continuing rapid population growth, we know that more education is associated with reductions in fertility,” said Cohen. And when combined with voluntary family planning, it’s also cheap “compared to the costs of having children that are not well cared for – the opportunity costs,” he said.
On aging, “we know that people who are educated well in their youth – both at primary, secondary, and especially tertiary levels – have better health in old age,” said Cohen. “So the costs of an aging population are diminished when people are educated. They take better care of themselves and they have options – they can use their minds as their bodies mature.”
Education is a long-term solution, but shorter-term policy options, like France’s bump of the retirement age to 62 that prompted rioting this fall, will also be necessary. “Sixty-two is only a way station,” Cohen said. “The retirement age has to move up, because people are living longer, they’re more productive, they’re in better health, and they’re going to have to keep working to take care of themselves.” -
Rebuilding Stronger, Safer, Environmentally Sustainable Communities After Disasters
The GRRT Toolkit for Humanitarian Aid
›Natural disasters present an immediate humanitarian crisis but are also an opportunity to rebuild societies to be more resilient and environmentally sustainable than they were before. The “Green Recovery and Reconstruction Training Toolkit” (GRRT), created by World Wildlife Fund (WWF) and the American Red Cross and launched at the Wilson Center on November 19, will help future humanitarian efforts integrate principles of environmental conservation into their disaster recovery strategies. This strategic partnership has been “an incredible effort and marriage between organizations that have different operating styles, different approaches to situations,” said WWF Chief Operating Officer Marcia Marsh. While implementing the GRRT may not be easy, “we need integrated solutions for integrated problems,” said Erika Clesceri, bureau environmental officer at USAID.
A Critical Partnership
In the midst of a crisis, humanitarian workers on the ground often do not have the time, skills, or funding to incorporate environmental concerns into relief efforts, said Robert Laprade, senior director for emergencies and humanitarian assistance at CARE. Humanitarian workers are “going a hundred miles an hour, they’re going on adrenaline and they’re there to save people’s lives – and the environment is just of secondary importance,” he said.
But “environmental sustainability is critical to the achievement of long-lasting recovery results,” said Roger Lowe, senior vice president of communications at American Red Cross. The Red Cross Principles of Conduct state that “relief aid must strive to reduce future vulnerabilities to disaster as well as meeting basic needs” and “avoid long-term beneficiary dependence upon external aid,” he said.
From Damnation, Purgatory, and Armageddon to Redemption
For many crisis-stricken regions, lack of an emphasis on environmental sustainability during disaster recovery efforts can mean “damnation in the present, purgatory in the near future, and Armageddon in the long term,” said Peter Walker, director of the Feinstein International Center at Tufts University. Stress on the environment caused by climate change or unsustainable resource consumption can often contribute to conflict, he explained.
In Darfur, “the environmental change was part and parcel of what led to that conflict,” Walker said. At one time an “environmental Eden” of diverse ecological zones, Darfur gradually became an environment that could not support a society of livestock herding. As the environment changed, some former herders became salaried, armed gunmen, known as the Janjaweed who felt they faced “a choice of no choice,” Walker said, to either “die as pastoralists or become pariahs as mercenaries.”
The challenge for humanitarian aid organizations is to not only help communities recover from disasters, but help them adapt to future environmental stress caused by globalization, climate change, or other factors. “If you cannot adapt,” Walker said, “that’s going to lead to violence.” To avoid aid dependency or resurgence in conflict it is critical to integrate environmental sustainability into disaster relief efforts from the beginning, he said:We used to believe that our world in the aid business was divided between relief on the left and long-term development on the right, and one would gradually go into the other in this relief-development continuum. But the reality is that you have a significant population – a population of millions of people – who are effectively trapped in a form of aid purgatory. They’re basically on a drip feed. Humanitarian assistance does not get you forward, it keeps you alive.
The GRRT offers organizations guidelines for implementing integrated disaster relief to provide a sustainable solution. While every crisis is different, the GRRT’s guidelines should be as applicable to “flooding in Boston as they are to flooding in Aceh,” said Walker.
Implementing Integrated Solutions
Securing funding for this integrated approach will be a challenge, as a significant portion will go towards staffing and training people on the ground, said Clesceri. A stand-alone, dedicated budget for environmental issues within humanitarian assistance programs must “be fought and re-fought for on a continual basis,” she said.
Local partnerships are essential. “Replicate” should be “stricken from the lexicon,” said Marsh. “You can’t replicate, and this toolkit isn’t meant to be a one-size-fits-all.” Instead, she said, the goal of the GRRT is to “create very practical approaches with communities.”
The key to helping communities recover from disasters is to form the kinds of strategic partnerships demonstrated by WWF and the American Red Cross in the creation of the GRRT. “Interdisciplinary groups are always, in my mind, going to get you a better solution in the end, but the risk is that they take more time…but it’s absolutely worth it,” she said.
Photo Credit: “Dark Clouds from Haiti’s Hurricane Tomas Loom over Camps,” courtesy of flickr user United Nations Photo. -
Watch: Joel E. Cohen on Solving the Resource-Population Equation in the Developing World
›December 14, 2010 // By Wilson Center Staff“It’s very hard to put a number on a quantity that depends on future events, processes we don’t understand, and values that may change over time,” said Joel E. Cohenof the Rockefeller University in this interview with ECSP. “That doesn’t mean we have no problems and it doesn’t mean there’s nothing we can do.”
There are three schools of thought or proposed “panaceas,” when it comes to balancing natural resources and population, said Cohen: a bigger pie (new technology to increase productivity), fewer forks (reduced consumption), and better manners (reduced irrational market inequities and better governance).
In the 15 years since his book How Many People Can the Earth Support? was published, Cohen’s approach has changed. While the 1996 book lacked a definitive policy recommendation, he is now analyzing options. “The evolution of my thought has moved from ‘how many people can the Earth support?’ to ‘what do we need to solve problems?’” he said.
You need adequate child and maternal nutrition to produce potential problem solvers and you need education to give them the tools to do it with, said Cohen, who studied the impact of universal primary and secondary education with colleagues at the American Academy of Arts and Sciences.
“If you look at a map of stunting in the world, there are parts of South Asia and sub-Saharan Africa where more than half the children are stunted – that means two standard deviations [of] height below normal for their age,” said Cohen. “Those populations are handicapped at the starting gate because they don’t have the problem solvers.” -
Whither the Demographic Arc of Instability?
›December 14, 2010 // By Richard CincottaAfter the Berlin Wall came down in 1989, the demand for geostrategic mapping went up. Pentagon geographers revised maps almost monthly in order to keep pace with the rapid sequence of events – the toppling of Eastern Europe’s communist regimes, the rise of pro-Western liberal democracies in their place, and the reunification of Germany. Then came more borders, and even more maps: the breakup of the Soviet Union and the withdrawal of forces from former Warsaw-Pact states, the splintering of Yugoslavia and Czechoslovakia, and requests for accession to NATO. When, in the late 1990s, it became apparent that the end of the Cold War would have little effect on the emergence of civil and ethnic conflicts in Africa, Asia, and Latin America, and that a network of militant Islamist organizations had coalesced across Muslim Asia and Africa, strategic mapmaking shifted focus to identifying conditions in the Global South.
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