Showing posts from category maternal health.
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Emily Puckart, MHTF Blog
Maternal Health in Kenya From a Human Rights Perspective
›The original version of this article, by Emily Puckart, appeared on the Maternal Health Task Force blog. This is the second post about MHTF and the Woodrow Wilson Center’s trip to Nairobi, Kenya to host a cross-Atlantic web-cast meeting on “Maternal Health Challenges in Kenya: What New Research Shows.” The first is available here along with video of the conference.
“Do you want to be a pregnant woman or a prisoner in Kenya?” asked Dr. Margret Meme, one of speakers in Nairobi at the recent policy dialogue “Maternal Health Challenges in Kenya: What New Research Shows.” She explained that the last prisoner killed in Kenya through capital punishment was over 20 years ago, yet pregnant women continue to die of treatable causes not just in Kenya, but globally.
As Dr. Meme addressed maternal health through the lens of a human rights perspective she highlighted a number of recommendations in order to more adequately address maternal health challenges in Kenya. She was concerned that pregnancy was treated more like a medical disease with purely medical solutions. Dr. Meme urged maternal health advocates to also focus on the cultural, social, gender, and economic factors that influence maternal health and asked that these factors be addressed along with medical solutions in order to truly address maternal health challenges.
Naturally, addressing maternal health challenges can come with a monetary price. However, instead of viewing that cost as a cost that must come after more immediate government priorities such as infrastructure and defense, Dr. Meme argued that cost should be borne as the government would bear any other cost for public goods. As pregnancy builds a nation, Dr. Meme argued that maternal health is a public good, in the same vein as defense. Therefore maternal health should have a budget allocation that is just as important as the budget line for defense.
Of course, pushing for more public funding of maternal health can lead to other complications. If advocates successfully encourage politicians to increase funding for maternal health programs, the work of maternal health advocates cannot simply end there. Advocates should hold governments accountable; not just in putting aside funding for maternal health, but also for actually making sure that the money reaches the intended beneficiaries. Therefore budget accountability tracking mechanisms should go hand and hand with pushing for increased public funding to maternal health programs.
Finally, Dr. Meme addressed the need for men to be more involved in maternal health. As she clearly stated; the role of men in maternal health shouldn’t stop at conception. Men focused programs which clarify reproductive and sexual health rights, as well as educate men on issues of maternal mortality and morbidity should encourage men to respect the rights of women to space their pregnancies and deliver their babies safely.
Emily Puckart is a senior program assistant for the Maternal Health Task Force (MHTF).
Photo Credit: Jonathan Odhong, African Population and Health Research Center. -
Emily Puckart, MHTF Blog
Maternal Health Challenges in Kenya: An Overview of the Meetings
›The original version of this article, by Emily Puckart, appeared on the Maternal Health Task Force blog.
I attended the two day Nairobi meeting on “Maternal Health Challenges in Kenya: What New Research Evidence Shows” organized by the Woodrow Wilson International Center and the African Population and Health Research Center (APHRC). [Video Below]
First, here in Nairobi, participants heard three presentations highlighting challenges in maternal health in Kenya. The first presentation by Lawrence Ikamari focused on the unique challenges faced by women in rural Kenya. Presently Kenya is still primarily a rural country where childbearing starts early and women have high fertility rates. A majority of rural births take place outside of health institutions, and overall rural women have less access to skilled birth attendants, medications, and medical facilities that can help save their lives and the lives of their babies in case of emergency.
Catherine Kyobutungi highlighted the challenges of urban Kenyan women, many of whom deliver at home. When APHRC conducted research in this area, nearly 68 percent of surveyed women said it was not necessary to go to health facility. Poor road infrastructure and insecurity often prevented women from delivering in a facility. Women who went into labor at night often felt it is unsafe to leave their homes for a facility and risked their lives giving birth at home away from the support of skilled medical personnel and health facilities. As the urban population increases in the coming years, governments will need to expend more attention on the unique challenges women face in urban settings.
Finally, Margaret Meme explored a human rights based approach to maternal health and called on policymakers, advocates, and donors to respect women’s right to live through pregnancies. Further, she urged increased attention on the role of men in maternal health by increasing the education and awareness of men in the area of sexual and reproductive health as well as maternal health.
After these initial presentations, participants broke out into lively breakout groups to discuss these maternal health challenges in Kenya in detail. They reconvened in the afternoon in Nairobi to conduct a live video conference with a morning Washington, DC audience at the Woodrow Wilson Center. It was exciting to be involved in this format, watching as participants in Washington were able to ask questions live of the men and women involved in maternal health advocacy, research and programming directly on the ground in Kenya. It was clear the excitement existed on both sides of the Atlantic as participants in Nairobi were able to directly project their concerns and hopes for the future of maternal health in Kenya across the ocean through the use of video conferencing technology.
There was a lot of excitement and energy in the room in Nairobi, and I think I sensed the same excitement through the television screen in DC. I hope that this type of simultaneous dialogue, across many time zones, directly linking maternal health advocates around the globe, is an example of what will become commonplace in the future of the maternal health field.
Emily Puckart is a senior program assistant at the Maternal Health Task Force (MHTF).
Photo Credit: MHTF. -
Life on the Edge: Climate Change and Reproductive Health in the Philippines
›July 18, 2011 // By Hannah MarquseeHigh population growth and population density have placed serious stress on natural resources in the Philippines. No one lives far from the coast in the 7,150-island archipelago, making the population extremely dependent on marine resources and vulnerable to sea-level rise, flooding, and other effects of climate change. The coastal megacity of Manila – one of the most densely populated in the world – is beset by poor urban planning, lack of infrastructure, and a large population living in lowland slums, making it particularly vulnerable to increased flooding and natural disasters. [Video Below]
The Philippines is now home to 93 million people and by 2050 is expected to reach 155 million, according to the UN’s medium fertility variant projections. Development programs in the country have made great strides towards increasing access to family planning and reproductive health services as well as improving management of marine resources, but the underlying trends remain troubling.
The Battle Over Reproductive Health
Since 1970, the government’s Commission on Population has been addressing population growth, reproductive health, and family planning. “The impact of the high rate of population growth is intricately linked to the welfare and sustainable development for a country like the Philippines, where poverty drives millions of people to overexploit their resource base,” wrote the commission. As a result of these efforts and others, total fertility rate has dropped from 6.0 children per woman in 1970, to the present 3.2.
The Philippines has also made great gains towards achieving Millennium Development Goal targets, “particularly in the alleviation of extreme poverty; child mortality; incidences of HIV/AIDS, tuberculosis, and malaria; gender equality in education; household dietary intake; and access to safe drinking water,” according to the United Nations Development Program (UNDP). Yet, “glaring disparities across regions persist,” UNDP states.
One of the poorest regions in the country, the Autonomous Region of Muslim Mindanao, is also home to a violent separatist movement. With limited access to health services, fertility and population growth rates are the highest in the country. Women in Mindanao average 4.2 children per woman; one in four married women has an unmet need for contraception; and 45 percent of households live in poverty (compared to 24 percent nationally).
Nationally, “serious challenges and threats remain with regard to targets on maternal health, access to reproductive health services, nutrition, primary education, and environmental sustainability,” according to UNDP–in particular, indicators on maternal health are “disturbing” and of all the MDGs, are labeled “least likely to be achieved.”
Out of three million pregnancies that occur every year, half were unplanned and one-third of these end in abortions, according to a 2006 report of the Allan Guttmacher Institute conducted in the Philippines. Induced abortion was the fourth leading cause of maternal deaths, and young women accounted for 17 percent of induced abortions. Over half of births occurred at home and one-third of them were assisted by traditional birth attendants. Around 75 percent of the poorest quintile did not have access to skilled birth attendants compared to only 20 percent of the richest quintile.
The politically influential Catholic Church recently blocked passage of a reproductive health bill, despite support by President Benigno Aquino and a majority of Filipinos. The bill seeks to provide universal access to contraception and would make sex education required from fifth grade onwards, a provision that has angered Church officials.
Manila Under Water
The Philippines’ combination of high population growth and limited land area (nearly all of which is near the coast) makes the country extremely vulnerable to the effects of climate change. Sixty-five percent of Filipinos live in coastal areas and 49 percent live in urban areas. Paul Hutchcroft, in Climate Change and Natural Security, writes that “even in the best of times, the frequency of typhoons, floods, earthquakes, and volcanic eruptions makes the Philippines one of the most disaster-prone countries in the world” (p. 45).
Population growth, climate change, and deforestation will only increase the severity of these disasters, he concludes. Hutchcroft points out that by 2080, projected temperature increases of between 1.2 to 3.9 degrees Celsius could raise sea levels by an estimated 0.19 to 1.04 meters – a scary thought for the 15 million living within a one-meter elevation zone (p. 46).
In 2009, metropolitan Manila, currently home to 11 million people (18,650 per square kilometer) and projected to grow to 19 million by 2050, was hit by tropical storms that caused devastating flooding – at their peak, waters reached nearly seven meters, according to a World Bank report. “More than 80 percent of the city was underwater,” write the authors, “causing immense damage to housing and infrastructure and displacing around 280,000-300,000 people.”
“Even if current flood infrastructure plans are implemented, the area flooded in 2050 will increase by 42 percent in the event of a 1-in-100-year flood,” says the World Bank report. Climate change could also increase the cost of flooding as much as $650 million, or 6 percent of GDP. Only by considering climate-related risks in urban planning can the Philippines hope to mitigate the effects of climate change, the report concludes.
Integrated Development: One Piece of the Puzzle?
Population, health, and environment (PHE) programs that integrate family planning and natural resource management are one way to help the majority of Filipinos that live in densely populated and resource-stressed coastal areas.
In ECSP’s FOCUS Issue 15, “Fishing for Families: Reproductive Health and Integrated Coastal Management in the Philippines,” Joan Castro and Leona D’Agnes explain how Path Foundation Philippines, Inc.’s IPOPCORM project – which ran from 2000 to 2006 – helped “improve reproductive health and coastal resource management more than programs that focused exclusively on reproductive health or the environment – and at a lower total cost.” A recent peer-reviewed study, co-authored by Castro and D’Agnes and published in Environmental Conservation, proved the same point with rigorous analysis.
“When we started IPOPCORM, there was really nothing about integrating population, health, and environment,” said Castro in an interview with ECSP. IPOPCORM provided some of the first evidenced-based results showing there is value added to implementing coastal resource management and family planning in tandem rather than separately. In part due to the success of the IPOPCORM, the Philippines have become one of the major PHE development implementers in the world.
Creating sustainably managed marine sanctuaries while improving access to family planning provides a way forward for many coastal communities. However, the Philippines’ urban woes – 44 percent of urban dwellers live in slums, according to the Population Reference Bureau – internal divisions, and natural vulnerability will likely make it difficult to dodge considerable climate-related effects in the near future. Already the archipelago’s vast biodiversity is in crisis, according to studies over two thirds of native plant and animal species are endemic to the islands and nearly half of them are threatened; only seven percent of its original old-growth less than 10 percent of the islands’ original vegetation remains; and 70 percent of nearly 27,000 square kilometers of coral reefs are in poor condition.
Sources: CIA, Conservation International, Field Museum, The Guardian, The Huffington Post, Philippines National Statistics Office, Population Reference Bureau, United Nations, U.S. Census Bureau, World Bank, World Wildlife Fund.
Photo Credit: “Climate Risk and Resilience: Securing the Region’s Future” courtesy of Flickr user Asian Development Bank. -
Quality and Quanitity: The State of the World’s Midwifery in 2011
›Each year, 350,000 women die while pregnant or giving birth, as many as two million newborns die within the first 24 hours of life, and there are 2.6 million stillbirths. Sadly, the majority of these deaths could be prevented if poor and marginalized women in developing countries had access to adequate health facilities and qualified health professionals. In fact, according to the new UNFPA report, State of the World’s Midwifery 2011: Delivering Health, Saving Lives, just doubling the current number of midwives in the 58 countries highlighted in the report could avert 21 percent of maternal, fetal, and newborn deaths.Launched last week, the report is the first of its kind, using new data from 58 low-income countries with high burdens of maternal and neonatal mortality to highlight the challenges and opportunities for developing an effective midwifery workforce.
“Developing quality midwifery services should be an essential component of all strategies aimed at improving maternal and newborn health,” write the authors of the report. Qualified midwives ensure a continuum of essential care throughout pregnancy and birth, and midwives can help facilitate referrals of mothers and newborns to hospitals or specialists when needed:Unless an additional 112,000 midwives are trained, deployed, and retained in supportive environments, 38 of 58 countries surveyed might not met their target to achieve 95 per cent coverage of births by skilled attendants by 2015, as required by Millennium Development Goal 5.
There is a total shortage of 350,000 skilled midwives globally, with some countries, like Chad and Haiti, needing a tenfold increase to match demand, according to the report. But quantity isn’t the only issue; there has also been an insufficient focus on quality of care. Additionally, most countries do not have the capacity to accurately measure the number of practicing midwives, and national policies focusing on maternal and newborn health services often do not view midwifery services as a priority.
To help overcome these challenges, the report outlines a number of “bold steps” to be taken by governments, regulatory bodies, schools, professional associations, NGOs, and donor agencies in order to maximize the impact of investments, improve mutual accountability, and strengthen the midwifery workforce and services. Of course, the needs of each country are unique, and the report ends with individual country profiles that highlight country-specific maternal and neonatal health indicators.
While this report does much to highlight the critical importance of midwives in promoting the health and survival of mothers and newborns, real impact will only come when governments, communities, civil society, and development partners work together to implement these recommendations.
Sources: UNFPA.
Video Credit: UNFPA. -
Ecological Tourism and Development in Chi Phat, Cambodia
›Chi Phat is a single-dirt-road town nestled in the Cardamom Mountains of Southwestern Cambodia, one of the largest intact forests in Southeast Asia. The town is only accessible by two routes: a three-hour river boat trip up the Phipot River or, if the road isn’t flooded by the rainy season, an exhilarating 30-minute motorbike ride from Andoung Tuek, a blip on the one paved road that runs along Cambodia’s southwestern border. Since 2007, Wildlife Alliance has been running an ecotourism project in Chi Phat (full disclosure: I used to work for Wildlife Alliance in Washington, DC).
The project has been featured in The New York Times and since its inclusion in the Lonely Planet travel guide, has become a destination for backpackers looking to leave the beaten path. I recently visited the project after spending time in neighboring Vietnam and was struck by the contrast between the densely populated and urbanized Mekong Delta and the visibility of rural poverty in Cambodia.
“Cambodia’s contemporary poverty is largely a legacy of over twenty years of political conflict,” reads a 2006 World Bank Poverty Assessment. The Pol Pot regime’s agrarian collectivization forced millions into the countryside and as a result, even in today’s predominantly-urban world, Cambodia remains 78 percent rural. Today 93 percent of Cambodia’s poor live in rural areas, two thirds of rural people face food shortages, and maternal and reproductive health outcomes in the country lag far behind those in the cities. Chi Phat and the sparsely populated northeast have over ten or twenty times the rate of maternal deaths of Phnom Penh.
A Town Transformed
Before Wildlife Alliance began the Community-Based Ecotourism (CBET) project in Chi Phat, most villagers made a living by slash-and-burn farming, illegal logging, and poaching endangered wildlife. Wildlife Alliance Founder and CEO Suwanna Gauntlett described the ecological zone around the town as “a circle of death,” in an audio interview with New Security Beat last year.Now, Chi Phat is a rapidly growing tourism destination offering treks and bike tours. In 2010 they brought in 1,228 tourists – not huge by any means, but over twice the number from 2009. The town now boasts a micro-credit association, a school, and a health clinic that offers maternal and reproductive health services. The village is also visited by the Kouprey Express, an environmental education-mobile that provides children and teachers with lessons, trainings, and materials on habitat and wildlife protection, pollution prevention, sustainable livelihoods, water quality, waste and sanitation, energy use, climate change, and adaptation.
One villager, Moa Sarun, described to me how he went from poacher and slash-and-burn farmer, to tour guide, and finally, chief accountant:Since I have started working with CBET, I realize that the wildlife and forest can attract a lot of tourists and bring a lot of income to villagers in Chi Phat commune. I feel very regretful for what I have done in the past as the poacher…I know clearly the aim of CBET is to alleviate the poverty of local people in Chi Phat, so I am very happy to see people in Chi Phat have jobs and better livelihoods since the project has established.
It’s hard to imagine what the town would have looked like before Wildlife Alliance arrived. The visitor center, restaurant, and “pub” (really, a concrete patio with plastic chairs and a cooler filled with beer), together make up nearly half of the town’s establishments. For two dollars a night, I stayed in a homestay and lived as the locals do on a thin mattress under mosquito netting, with a bucket of cold water by the outhouse for a shower, and a car battery if I wanted to use the fan or light (but not both). These amenities place Chi Phat above average for rural Cambodia. According to 2008 World Bank data, only 18 percent of rural areas had access to improved sanitation and only 56 percent had access to an improved water source.
Poaching Persists
Real change has certainly hit Chi Phat, but illegal activities persist, as a Wall Street Journal review of the project noted. In one Wildlife Alliance survey, 95 percent of members participating in the project made less than 80 percent of their previous income and 12 percent of people made less than 50 percent. “That, to me, is a red flag,” Director of U.S. Operations Michael Zwirn acknowledged to me. Nevertheless, he said “it is well documented that it’s the most lucrative community-based ecotourism project in Cambodia. That doesn’t mean that everyone is making money, or that they’re making enough money, but the community is clearly benefiting.”
Harold de Martimprey, Wildlife Alliance’s community-based ecotourism project manager, told me in an email interview:We monitor closely the impact of the CBET project on the diminution of poaching and deforestation. We estimate that since the beginning of the project, the illegal activities have decreased by almost 70 percent.
As Chi Phat ecotourism continues to scale up, de Martimprey expressed hope that more and more villagers would participate in the project and stop destructive livelihoods.
After four years, Chi Phat has already developed enough to operate financially on its own. Wildlife Alliance will stop funding the project later this year and transition it towards total self-sustainability. The plan is to then ramp up efforts at a neighboring project in Trapeang Ruong, due to open to the public next month.
A Land of Opportunity
So far Chi Phat lacks much of what do-gooder tourists are hoping to find when they come in search of ecotourism. There is little to no information about the work of Wildlife Alliance and how ecotourism benefits the town, or the health, education, and economic benefits the villagers have received. A little more obvious justification for ecotourism’s inflated prices might appease the average backpacker used to exploitatively lower prices elsewhere in the country. The guides, staff, and host families for the most part speak little English, which does not bode well for its tourism potential. “This is a work in progress,” said de Martimprey.
Most of my time in Chi Phat, I felt like the only foreigner to ever set foot in the town – refreshing after witnessing much of the rest of Southeast Asia’s crowded backpacker scene. As Chi Phat continues to grow, hopefully it will “bring in enough people to support the community without the adverse effects of tourism,” said Zwirn. “They don’t want it to turn into the Galapagos.” Thankfully, de Martimprey told me, “Chi Phat is far from reaching this limit and can be scaled up to much bigger operation,” without negatively impacting the environment.
Luckily, plans to build a highly destructive titanium mine near the town were recently nixed by Prime Minister Hun Sen in what was an unexpected victory over industrial interests. However, soon after, the town was again under threat – this time by a proposed banana plantation nearby.
“The Cardamom Mountains are still seen as a land of opportunity for economic land concessions for some not-so-green investors looking at buying land for different purposes, and often disregarding the interest of the local people,” said de Martimprey.
Eventually Zwirn hopes that as more tourists come to the Cardamoms, they will become “a constituency for conservation,” he said. “We need to build a worldwide awareness of the Cardamoms as a destination, and as a place worth saving.”
Sources: BBC, IFAD, Phnom Penh Post, New York Times, United Nations, Wall Street Journal, Wildlife Alliance, World Bank, World Wildlife Fund.
Photo Credit: Hannah Marqusee. -
Watch: Catherine Kyobutungi on Monitoring the Health Needs of Urban Slums
›Addressing the maternal health needs of the nearly 60 percent of urban residents who live in slums or slum-like conditions will be a critical step to improving maternal health indicators of a rapidly urbanizing Kenya, said Catherine Kyobutungi, director of health systems and challenges at the African Population Health Research Center in Nairobi.
“In some respects, [the urban poor] are doing better than rural communities, but in other ways they are behind,” said Kyobtungi. But, she said, there are many unique opportunities to improve maternal health in slums: “With these very high densities, you do have advantages; with very small investments, you can reach many more people.”
Output-based voucher schemes – in which women pay a small fee for a voucher that entitles them to free, high-quality antenatal care, delivery services, and family planning – have been implemented to help poor, urban women access otherwise expensive services. But poor attitudes towards health care workers, transportation barriers, and high rates of crime still prevent some women from taking advantage of these vouchers, said Kyobtungi. -
Health Development: Providing Free Care and Overcoming Gender-Based Violence
›In The Lancet’s “How Did Sierra Leone Provide Free Health Care?,” author John Donnelly of the Ministerial Leadership Initiative attributes the unanticipated success of a free health care program for women and children in Sierra Leone to good organization, transparency, and a high degree of cooperation between the government, donors, and development partners. One distinctive factor that has contributed to the health system’s turnaround is the unusually high level of political will on the part of President Ernest Bai Koroma, writes Donnelly. Similar to Egypt’s health and population initiatives, Sierra Leone’s marked commitment, accountability, and investment as a host country has contributed highly to the success of its program and triggered further investment from donors.
In “Systematic Violence: A Barrier to Achieving the Millennium Development Goals for Women,” from the Journal of Women’s Health, authors Joia S. Mukherjee, Donna J. Barry, Hind Satti, Maxi Raymonville, Sarah Marsh, and Mary Kay Smith-Fawzi assert that the elevation of women is integral to the achievement of the Millennium Development Goals, to which structural violence serves as a significant barrier. Murkherjee et al. recommend community-based programs to combat structural violence and prevent disease, such as the Partners in Health (PIH) program in Haiti. PIH trains community health workers, expands health care as a public good, and bolsters social determinants, which include increasing access to family planning and education, providing compensation for medical workers, and improving health infrastructure. -
Isobel Coleman, Council on Foreign Relations
Report: Family Planning and U.S. Foreign Policy
›May 10, 2011 // By Wilson Center StaffThe original version of this brief, by Isobel Coleman of the Council on Foreign Relations, is based on the report, Family Planning and U.S. Foreign Policy: Ensuring U.S. Leadership for Healthy Families and Communities and Prosperous, Stable Societies, by Isobel Coleman and Gayle Lemmon.
Click here for the interactive version (non-Internet Explorer users only).
U.S. support for international family planning has long been a controversial issue in domestic politics. Conservatives tend to view family planning as code for abortion, even though U.S. law, dating to the 1973 Helms Amendment, prohibits U.S. foreign assistance funds from being used to pay for abortion. Indeed, increased access to international family planning is one of the most effective ways to reduce abortion in developing countries. Investments in international family planning can also significantly improve maternal, infant, and child health. Support for international voluntary family planning advances a wide range of vital U.S. foreign policy interests – including the desire to promote healthier, more prosperous, and secure societies – in a cost-effective manner.
Saving Lives of Mothers and Children
More than half of all women of reproductive age in the developing world, some 600 million women, use a form of modern contraception today, up from only 10 percent of women in 1960. This has contributed to a global decline in the average number of children born to each woman from more than six to just over three. Despite these gains, an estimated 215 million women globally – particularly in sub-Saharan Africa and southern Asia – are sexually active but are not using any contraception, even though they want to avoid pregnancy or delay the birth of their next child. With the world’s population poised to cross the seven billion mark later in 2011, and expected to grow by nearly 80 million people annually for several more decades, global unmet need for family planning is likely to increase.
Studies have shown that contraception could reduce maternal deaths by a third, from approximately 360,000 to 240,000; reduce abortions in developing countries by 70 percent, from 35 million to 11 million; and reduce infant mortality by 16 percent, from 4 million to around 3.4 million.
For a woman in the developing world, the lifetime risk of dying from pregnancy is still one of the greatest threats she will face. In developed countries, 1 out of 4,300 women will lose her life as a consequence of pregnancy, compared to sub-Saharan Africa, where that figure soars to 1 in 31, and Afghanistan, where the lifetime risk of dying from pregnancy is 1 out of 7.
Unsafe abortions are one factor contributing to high maternal death rates. As of 2008, 47,000 abortion-related maternal deaths occur annually, accounting for 13 percent of all maternal deaths. Filling the unmet need for modern family planning would lead to a reduction in mistimed pregnancies and a significant decline in abortions and abortion-related health complications. In 2000 alone, if women who wished to postpone or avoid childbearing had access to contraception, approximately 90 percent of global abortion-related and 20 percent of obstetric-related maternal deaths could have been averted.
Maternal mortality has a devastating and irreversible effect on children and families. Indeed, countries with the highest maternal mortality rates also experience the highest rates of neonatal and childhood mortality. When a mother dies, her surviving newborn’s risk of death increases to 70 percent.
Family planning presents an opportunity to curb maternal and under-five deaths not simply by giving women of all ages the ability to determine their family size, but by enabling women to delay pregnancy until at least age 18 and to space and plan their births. In this way, modern contraceptive methods help women avoid high-risk pregnancies. Studies suggest that short pregnancy intervals (when the pregnancy occurs less than twenty-four months after a live birth) are associated with an increased risk of maternal and under-five mortality. In fact, if all mothers were to wait at least 36 months to conceive again, it is estimated that 1.8 million deaths of children under five could be prevented annually.
Enhancing International Security
While much of the developed world is experiencing population stability or even decline, many countries in the developing world continue to see rapid population growth. Population imbalances have emerged as a serious issue affecting economic opportunity, global security, and environmental stability. Ongoing civil conflicts, radicalism, weak governance, and corruption are endemic problems for many fragile states. While high fertility rates are not the cause of their problems, they do complicate the challenges these countries face in trying to reduce poverty, achieve per capita income growth, provide education and productive opportunities for youth, and address increasing shortages of natural resources.With the world’s population poised to cross the 7 billion mark later in 2011, and expected to grow by nearly 80 million people annually for several more decades, global unmet need for family planning is likely to increase.
Yemen, for example, has the highest rate of unmet need for family planning of any country. Its population has doubled in less than 20 years, and it has the world’s second-youngest population. High fertility – around six children per woman – taxes Yemen’s infrastructure, education and health systems, and environment. In addition, its labor force is growing at a pace much faster than the growth of available jobs, resulting in high youth unemployment. Increasing access to family planning would help improve Yemen’s long-term prospects for achieving per capita growth and stability. Conversely, continued high fertility rates will only deepen Yemen’s current crises.
Many countries experiencing fast population growth – like Yemen – do not have the capacity to harness the potential of their young populations. In these cases, high fertility rates can lead to a vicious cycle of poverty at the community, regional, and national levels. Rapidly growing populations are also more prone to outbreaks of civil conflict and undemocratic governance. Eighty percent of all outbreaks of civil conflict between 1970 and 2007 occurred in countries with very young populations. Demographers have shown that the statistical likelihood of civil conflict consistently decreases as countries’ birth rates decline.
Countries with the highest population growth rates face real resource constraints, particularly arable land and clean water. As of 2010, 40 percent of populations in more than 35 countries have insufficient access to food, with the largest concentration in central and eastern sub-Saharan Africa. Given that many of these food-insecure countries will continue to experience significant population growth in decades ahead, malnutrition will remain a challenge.
Continue reading at the Council on Foreign Relations or download the full report, Family Planning and U.S. Foreign Policy: Ensuring U.S. Leadership for Healthy Families and Communities and Prosperous, Stable Societies.
Isobel Coleman is a senior fellow for U.S. foreign policy; director of the Civil Society, Markets, and Democracy Initiative; and director of the Women and Foreign Policy Program at the Council on Foreign Relations.
Sources: Council on Foreign Relations, Population Action International, Population Reference Bureau, UNFPA, World Health Organization.
Chart Credit: Arranged by Schuyler Null, data from UN Population Division, World Population Prospects, 2010 Revision.
