Showing posts from category Pakistan.
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Women Deliver: Real Solutions for Reproductive Health and Maternal Mortality
›The landmark Women Deliver conference, which concluded last week, reinvigorated the global health community’s commitment to improve reproductive health at both the grassroots and global levels. Providing a major boost was the Gates Foundation’s announcement that it will commit an additional $1.5 billion over the next five years to support maternal and child health, family planning, and nutrition programs in developing countries.
“We haven’t tried hard enough,” said Gates Foundation co-founder Melinda Gates. “Most maternal and newborn deaths can be prevented with existing, low-cost solutions.” Examples of these efficient and effective solutions were presented at the three-day conference’s dozens of panels on a wide range of issues, including climate change, contraceptive commodities, fistula, gender inequities, adolescent family planning, communications and technology, and much more.
Empowering Young Girls to Access Family Planning
“When we speak about adolescents we typically think of prevention. However, we must also think about providing access to safe abortions and supporting young women who want to be mothers and empower young women to make choices,” said Katie Chau, a consultant at International Planned Parenthood Federation.
In Nigeria, “there is not much attention on adolescent sexual and reproductive health, even though a majority of rapes occur before the age of 13, and the rate of teenage pregnancy and abortions is high,” said Bene Madunagu, chair of the Girls’ Power Initiative (GPI) in Nigeria. GPI teaches girls about their rights to make decisions, including those regarding sex and reproductive health, as well as improving their critical thinking skills, self-esteem, and body image. “Girls develop critical consciousness and question discriminatory practices, while also learning about the legal instruments to take up their concerns,” he said.
Sadaf Nasim of Rahnuma Family Planning said child marriages are common in his country, Pakistan. “Marriage is an easy solution for poor families. Once a girl is married she is no longer the responsibility of the family,” he explained.
While laws in Pakistan and other parts of the developing world condemn child marriage, the prevalence of child marriage remains high: 49 percent of girls are married by age 18 in South Asia, and 44 percent in West and Central Africa. Nasim said birth registration at the local and national levels should be improved to prevent parents from manipulating their daughter’s age.
In Kyrgyzstan, “community-based efforts worked to galvanize media attention and disseminate information to demonstrate the need for improved adolescent family planning,” said Tatiana Popovitskaya, a project coordinator with Reproductive Health Alliance of Kyrgyzstan. Such community-based approaches use grassroots education to mobilize community leaders, which is a critical step in overcoming child marriage and other harmful traditions.
Cell Phones and Maternal Health
“There is a lot of information being collected, but it is not necessarily going where it needs to because of fragmentation,” said Alison Bloch, program director at mHealth Alliance. In developing countries, the people most in need are often the most isolated, but mobile technology is emerging as a way to bridge the gaps.
According to a recent report by mHealth Alliance, 64 percent of mobile phone users live in developing countries and more than half of people living in remote areas will have mobile phones by 2012. The potential for improving global health with cell phones and PDAs is significant, and can address a wide range of health issues, such as human resource shortages and information sharing problems between clinics and hospitals.
“Mobile technology provides benefits to individuals, institutions, caregivers, and the community. It reduces travel time and costs for the individual, improves efficiency of health service delivery, and streamlines information to health workers to reduce maternal mortality,” said Elaine Weidman, vice president of sustainability and corporate responsibility at Ericsson.
“Mobile technology is the most rapidly adopted technology in history and represents an existing opportunity to reach the un-reached,” said Fabiano Teixeira da Cruz, a program manager for the Inter-American Development Bank, speaking of the benefits of using mobile technology to train field-based healthcare workers in Latin America.
While mobile phones are indeed reaching parts of the world not currently equipped with quality healthcare, the lack of systematic coordination and infrastructure at the district and regional levels must also be addressed, as highlighted during a recent Wilson Center event, Improving Transportation and Referral for Maternal Health.
Read about our first impressions of Women Deliver 2010 here.
Calyn Ostrowski is program associate with the Wilson Center’s Global Health Initiative
Photo credit: Woman and child in South African AIDS clinic, courtesy Flickr user tcd123usa. -
New Security Challenges in Obama’s Grand Strategy
›June 4, 2010 // By Schuyler NullPresident Obama’s National Security Strategy (NSS), released last week, reinforces a commitment to the whole of government approach to defense, and highlights the diffuse challenges facing the United States, including international terrorism, globalization, and economic upheaval.
Following the lead of the Quadrennial Defense Review released earlier this year, the NSS for the first time since the Clinton years prominently features non-traditional security concerns such as climate change, population growth, food security, and resource management:Climate change and pandemic disease threaten the security of regions and the health and safety of the American people. Failing states breed conflict and endanger regional and global security… The convergence of wealth and living standards among developed and emerging economies holds out the promise of more balanced global growth, but dramatic inequality persists within and among nations. Profound cultural and demographic tensions, rising demand for resources, and rapid urbanization could reshape single countries and entire regions.
By acknowledging the myriad causes of instability along with more “hard” security issues such as insurgency and nuclear weapons, Obama’s national security strategy takes into account the “soft” problems facing critical yet troubled states – such as Pakistan, India, Afghanistan, and Somalia – which include demographic imbalances, food insecurity, and environmental degradation.
Not surprisingly, Afghanistan in particular is highlighted as an area where soft power could strengthen American security interests. According to the strategy, agricultural development and a commitment to women’s rights “can make an immediate and enduring impact in the lives of the Afghan people” and will help lead to a “strong, stable, and prosperous Afghanistan.”
The unique demographic landscape of the Middle East, which outside of Africa has the fastest growing populations in the world, is also given intentional consideration. “We have a strategic interest in ensuring that the social and economic needs and political rights of people in this region, who represent one of the world’s youngest populations, are met,” the strategy states.
Some critics of that strategy warn that the term “national security” may grow to encompass so much it becomes meaningless. But others argue the administration’s thinking is simply a more nuanced approach that acknowledges the complexity of today’s security challenges.
In a speech on the strategy, Secretary of State Clinton said that one of the administration’s goals was “to begin to make the case that defense, diplomacy, and development were not separate entities either in substance or process, but that indeed they had to be viewed as part of an integrated whole and that the whole of government then had to be enlisted in their pursuit.”
Compare this approach to President Bush’s 2006 National Security Strategy, which began with the simple statement, “America is at war” and focused very directly on terrorism, democracy building, and unilateralism.
Other comparisons are also instructive. The Bush NSS mentions “food” only once (in connection with the administration’s “Initiative to End Hunger in Africa”) and does not mention population, demography, agriculture, or climate change at all. In contrast, the 2010 NSS mentions food nine times, population and demography eight times, agriculture three times, and climate change 23 times – even more than “intelligence,” which is mentioned only 18 times.
For demographers, development specialists, and environmental conflict specialists, the inclusion of “new security” challenges in the National Security Strategy, which had been largely ignored during the Bush era, is a boon – an encouraging sign that soft power may return to prominence in American foreign policy.
The forthcoming first-ever Quadrennial Diplomacy and Development Review by the State Department will help flesh out the strategic framework laid out by the NSS. It is expected to provide more concrete policy for integrating defense, diplomacy, and development. Current on-the-ground examples like USDA embedding in Afghanistan, stepped-up development aid to Pakistan, and the roll-out of the administration’s food security initiative, “Feed the Future,” are encouraging signs that the NSS may already be more than just rhetoric.
Update: The Bush 91′ and 92’ NSS also included environmental considerations, in part due to the influence of then Director of Central Intelligence, Robert Gates.
Sources: Center for Global Development, CNAS, Los Angeles Times, State Department, USAID, White House, World Politics Review.
Photo Credit: “Human, Food, and Demographic Security” collage by Schuyler Null from “Children stop tending to the crop to watch the patrol” courtesy of flickr user isafmedia, “Combing Wheat” courtesy of flickr user AfghanistanMatters, and “Old Town Sanaa – Yemen 49” courtesy of flickr user Richard Messenger. -
Can Food Security Stop Terrorism?
›May 28, 2010 // By Schuyler Null
USAID’s “Feed the Future” initiative is being touted for its potential to help stabilize failing states and dampen simmering civil conflicts. Speaking at a packed symposium on food security hosted by the Chicago Council last week, USAID Administrator Rajiv Shah called food security “the foundation for peace and opportunity – and therefore a foundation for our own national security.”
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Look Beyond Islamabad To Solve Pakistan’s “Other” Threats
›After years of largely being ignored in Washington policy debates, Pakistan’s “other” threats – energy and water shortages, dismal education and healthcare systems, and rampant food insecurity – have finally moved to the front burner.
For several years, the Woodrow Wilson Center’s Asia Program has sought to bring these problems to the attention of the international donor community. Washington’s new determination to engage with Pakistan on its development challenges – as evidenced by President Obama’s signing of the Kerry-Lugar bill and USAID administrator Raj Shah’s comments on aid to Pakistan – are welcome, but long overdue.
The crux of the current debate on aid to Pakistan is how to maximize its effectiveness – that is, how to ensure that the aid gets to its intended recipients and is used for its intended purposes. Washington will not soon forget former Pakistani president Pervez Musharraf’s admission last year that $10 billion in American aid provided to fight the Taliban and al-Qaeda was instead diverted to strengthen Pakistani defenses against archrival India.
What Pakistani institutions will Washington use to channel its aid monies? In recent months, the U.S. government has considered both Pakistani NGOs and government agencies. It is now clear that Washington prefers to work with the latter, concluding that public institutions in Pakistan are better equipped to manage large infusions of capital and are more sustainable than those in civil society.
This conclusion is flawed. Simply putting all its aid eggs in the Pakistani government basket will not improve U.S. aid delivery to Pakistan, as Islamabad is seriously governance-challenged.
Granted, Islamabad is not hopelessly corrupt. It was not in the bottom 20 percent of Transparency International’s 2009 Corruption Perceptions Index (Pakistan ranked 139 out of 180), and enjoyed the highest ranking of any South Asian country in the World Bank’s 2010 Doing Business report.
At the same time, the Pakistani state repeatedly fails to provide basic services to its population – not just in the tribal areas, but also in cities like Karachi, where 30,000 people die each year from consuming unsafe water.
Where basic services are provided, Islamabad favors wealthy, landed, and politically connected interests over those of the most needy – the very people with the most desperate need for international aid. Last year, government authorities established a computerized lottery that was supposed to award thousands of free tractors to randomly selected small farmers across Pakistan. However, among the “winners” were large landowners – including family members of a Pakistani parliamentarian.
Working through Islamabad on aid provision is essential. However, the United States also needs to diversify its aid partners in Pakistan.
For starters, Washington should look within civil society. This rich and vibrant sector is greatly underappreciated in Washington. The Hisaar Foundation, for example, is one of the only organizations in Pakistan focusing on water, food, and livelihood security.
The country’s Islamic charities also play a crucial role. Much of the aid rendered to health facilities and schools in Pakistan comes from Muslim welfare associations. Perhaps the most well-known such charity in Pakistan – the Edhi Foundation – receives tens of millions of dollars each year in unsolicited funds.
Washington should also be targeting venture capital groups. The Acumen Fund is a nonprofit venture fund that seeks to create markets for essential goods and services where they do not exist. The fund has launched an initiative with a Pakistani nonprofit organization to bring water-conserving drip irrigation to 20,000-30,000 Pakistani small farmers in the parched province of Sindh.
Such collaborative investment is a far cry from the opaque, exploitative foreign private investment cropping up in Pakistan these days – particularly in the context of agricultural financing – and deserves a closer look.
With all the talk in Washington about developing a strategic dialogue with Islamabad and ensuring the latter plays a central part in U.S. aid provision to Pakistan, it is easy to forget that Pakistan’s 175 million people have much to offer as well. These ample human resources – and their institutions in civil society – should be embraced and be better integrated into international aid programs.
While Pakistan’s rapidly growing population may be impoverished, it is also tremendously youthful. If the masses can be properly educated and successfully integrated into the labor force, Pakistan could experience a “demographic dividend,” allowing it to defuse what many describe as the country’s population time bomb.
A demographic dividend in Pakistan, the subject of an upcoming Wilson Center conference, has the potential to reduce all of Pakistan’s threats – and to enable the country to move away from its deep, but very necessary, dependence on international aid.
Michael Kugelman is program associate with the Asia Program at the Woodrow Wilson International Center for Scholars.
Photo Credit: Water pipes feeding into trash infected waterway in Karachi, courtesy Flickr user NB77. -
Family Planning in Fragile States
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“Conflict-affected countries have some of the worst reproductive health indicators,” said Saundra Krause of the Women’s Refugee Commission at a recent Wilson Center event. “Pregnant women may deliver on the roadside or in makeshift shelters, no longer able to access whatever delivery plans they had. People fleeing their homes may have forgotten or left behind condoms and birth control methods.”
