“Family planning is to maternal survival what a vaccination is to child survival,” said Johns Hopkins professor Amy Tsui, quoting Khama Rogo of the World Bank, at the Woodrow Wilson Center event Maintaining the Momentum: Highlights From the Uganda International Conference on Family Planning on March 16. Rogo made the strong statement during the landmark November 2009 conference in Kampala, which has renewed interest in family planning and reproductive health among African leaders and development partners. Rhonda Smith of the Population Reference Bureau and Sahlu Haile of the David and Lucile Packard Foundation joined Tsui, the director of The Bill & Melinda Gates Institute of Population & Reproductive Health, to discuss their impressions of the Kampala conference and what it means for the future of family planning in Africa.

“An event that happened at the right time”

“Kampala was the work of a community,” said Tsui. More than 50 organizations—the U.S. Agency for International Development, the UN Population Fund, the World Bank, the World Health Organization, and the Gates and Packard Foundations—convened in Uganda, which was chosen not only for its central location, but also to highlight the country’s soaring unmet need for contraception—41 per cent—and rapid 3.1 percent population growth rate.

Panels focused on key issues in family planning, including:

• Integrating family planning into HIV/AIDS care
• Integrating family planning in post-abortion, postpartum, child, and other primary health care
• Expanding contraception delivery services by community health workers
• Increasing outreach to youth and men
• Capitalizing on private and public innovations in service delivery and financing

The conference also made a splash in the media. “If you want it to get a lot of media hype, you have to have someone ready to say ‘I’m giving money to X,’” said Tsui. Thus, the Johns Hopkins Bloomberg School of Public Health, David and Lucile Packard Foundation, USAID, and the Bill and Melinda Gates Foundation announced a new three-year, $12 million Advance Family Planning project to advance reproductive health and family planning efforts in regions with the greatest need—particularly, sub-Saharan Africa and Asia. The conference generated palpable excitement and renewed energy for family planning. Uganda was “an event that happened at the right time,” said Tsui. Conference organizers, who have been asked to replicate it in other parts of the world, are already looking for locations for 2011. The conference was not just a success in theory, but also in action, and several developments emerged in its wake:

• The United States announced its foreign assistance budget will increase support for family planning from $450 million to $715 million for the next fiscal year.
• The Global Health Initiative identified maternal/child health and family planning as one of its main priority themes.
• Secretary of State Clinton positively discussed girls’ education, family planning, and reproductive health at the ICPD + 15 anniversary.
• The Women Deliver 2010 Conference, to be held in June, has identified family planning as a third pillar of maternal health.

Uganda on the Move

Rhonda Smith’s presentation “Uganda on the Move”—which she also presented in Uganda—is a prototype of the Population Reference Bureau’s new ENGAGE (Eliminating National Gaps—Advancing Global Equity) project, which is designed to “engage policy audiences and promote policy dialogue around issues of high fertility and high unmet need for family planning and their costs, consequences, and solutions,” she said. By using stunning, innovative graphics and avoiding confounding technical terms, ENGAGE’s products are designed to reach non-technical policy audiences and influential decision-makers.

As one of the Uganda conference’s most talked about presentations, “Uganda on the Move” wows audiences with visuals created using Hans Rosling’s Trendalyzer software. The presentation shows that although Ugandans are increasingly healthier, have a higher life expectancy, and are more educated, maternal health remains in jeopardy. Tellingly, 46 percent of pregnancies in the country are unplanned, 6,000 women die each year from complications related to pregnancy, and 1,200 women die each year from undergoing unsafe abortions.

Maternal deaths, however, do not tell the whole story: For every one woman dying, Smith said, 20-30 women suffer from short-term disability, which places a major strain on economic growth. From 2004 to 2013, maternal death will cost Uganda US$350 million in lost productivity; and disability will cost and additional US$750 million.

What Next? The African Perspective

“After 10 years of virtual clandestine work, [family planning] is just coming out of the closet,” said Sahlu Haile. Over the last few decades, family planning advocates have been struggling to: 1) keep family planning alive—without it being affected by political considerations 2) make family planning a health priority, without any associations with rights violations; and 3) be in solidarity with pioneering organizations of the family planning movement, like the International Planned Parenthood Federation, that were victims of discriminatory funding decisions.

The Uganda conference changed all that, said Haile. In Uganda, conference attendees were “talking about family planning…not reproductive health, not maternal/child health.” This, he said, was “probably the single most important lesson…that I took from the Kampala conference.”

Following the conference, Haile said that African government officials stressed family planning as a priority at meetings in Ethiopia and Nigeria—the first time he had witnessed such high-level attention to family planning from those countries in his 30-year career.

In Ethiopia, African leaders pledged to:

• Prioritize family planning, since family planning is one of the most cost-effective development investments;
• Ensure access to contraception, as 40 percent of maternal deaths are associated with unwanted pregnancies; and
• Integrate MDG 5b, universal access to reproductive health, into their international development plans and budgets.

In Nigeria, West African ministers of health agreed that making abortion safe was essential to reducing maternal mortality. Across the board, at each meeting, family planning was discussed as “an investment, not an expenditure,” said Haile.

Haile credited the Kampala conference for spurring these efforts. In December, he joined a task force of 14 Ethiopian organizations to plan the next steps. They will jointly develop research capacities, generate evidence, and strengthen monitoring and evaluation practices, especially with regard to integrating population, health, and environment efforts. In addition, they will engage with wider audiences via new tools such as the blog RH RealityCheck and Gapminder Foundation’s Trendalyzer program.

Haile believes we need to “work together to encourage national-level efforts…to make sure family planning stays where it is now and make sure it is not abandoned.”

To be a part of the new online family planning community, join the Kampala Conversation.

Photo 1: A women and her children in Jinja, Uganda. Courtesy Flickr user cyclopsr. Photos of Amy Tsui, Rhonda Smith, and Sahlu Haile courtesy of Dave Hawxhurst, Woodrow Wilson Center.

Worldfocus recently featured two pieces on the Arab world’s burgeoning population. “Demographics of the Arab World,” a radio broadcast, brings together Magda Abu-Fadil of the American University in Beirut and Bernard Haykel of Princeton University for a look at the region’s demographic trends. Despite possessing different political systems and being at different levels of economic development, demographic challenges of youth bulges, emigration, and gender gaps are common to countries across the Arab world. “Arab World Experiences Rapid Population Explosion,” a written interview with demographer Patrick Gerland of the United Nations Population Division, tackles similar issues. Topics of discussion include demographic variations between Middle Eastern nations, fertility rates, the consequences of the region’s youth bulge, and best- and worst-case scenarios for the Arab world’s future.

Nearly two months after the devastating 7.0 magnitude earthquake in Port-au Prince, Haiti, the country still needs assistance to provide basic healthcare and shelter, in addition to rebuilding Haiti’s economy, government, and institutions. As the international community and NGOs make the transition from emergency disaster relief to long-term reconstruction and capacity-building efforts, donor coordination and long-term commitment are crucial. Recently, on Capitol Hill, a panel of experts organized by Wilson Center on the Hill and the Wilson Center’s Latin American Program  discussed Haiti’s continuing problems and challenges.

USAID’s Gloria Steele offers written testimony on the FY2011 Global Health and Child Survival (GH CS) budget request before the House Appropriations Subcommittee on State, Foreign Operations

Andrew Revkin gives a shout-out to family planning and notes the lack of population discussion at Copenhagen in his blog post, “From Wishful Thinking to Real-World Action on Climate“

Video of Secretary of State Hilary Clinton addressing the Commission on the Status of Women in which she discusses the Global Health Initiative, maternal mortality, family planning, and “gendercide“

Family planning-environmental connections headline PATH‘s March edition of Outlook

Youth bulges and social conflict are noted in Nicholas Kristoff’s recent article on child marriages in Yemen

Follow Geoff Dabelko on Twitter for more population, health, environment, and security updates

“I believe right now that energy is a vulnerability and constraint on our deployed forces,” said Department of Defense nominee and CNAS Vice President Sharon Burke yesterday morning at her confirmation hearing before the Senate’s Armed Services Committee. She described the tremendous cost—in lives, capital, and operational flexibility—of meeting the current fuel needs of troops in Afghanistan. Leading DOD’s efforts to account for the “full cost and full burden of energy,” she said, will be one of her priorities if she is confirmed.

“The committee and Congress have shown an acute interest in operational energy by creating this position,” said Burke, who would be the first person to serve as Director of Operational Energy Plans and Programs (DOEPP). “Sharon Burke has a deep understanding of the energy and climate change challenges facing the Department of Defense,” according to Geoff Dabelko, director of the Wilson Center’s Environmental Change and Security Program. “She would be able to hit the ground running if confirmed.”

In his opening remarks at the Security Council of the Russian Federation’s meeting on climate change last week, Russian President Dmitry Medvedev framed climate change as a force for increased competition and “disputes between countries.” Unsurprisingly, he focused on the Arctic region and what he called the “inadmissible” and “unfair” threats to Russia’s access to the region’s resources:

We must not forget either that climate change can give rise not only to physical change, change in the nature around us, but can also see the emergence of disputes between countries over energy exploration and extraction, the use of marine transport routes, bioresources, and shortages of water and food resources. The countries bordering the Arctic region are already actively engaged in expanding their research, economic, and even military presence in the Arctic. Unfortunately, in this situation, we are seeing attempts to limit Russia’s access to exploring and developing Arctic energy deposits, which is inadmissible from a legal point of view and unfair in terms of our country’s geographical location and very history.

“It’s not every day you find an issue where effective diplomacy and development will allow you to save millions of lives, feed the hungry, empower women, advance our national security interests, protect the environment, and demonstrate to billions of people that the United States cares. Water is that issue,” declared Secretary of State Hillary Clinton at a World Water Day event hosted by the National Geographic Society and Water Advocates.

Alongside speeches by representatives from government and the non-profit sector, Secretary Clinton repeatedly emphasized America’s support for water issues. “As we face this challenge, one thing that will endure is the United States’ commitment to water issues,” she asserted. “We’re in this for the long haul.” Beyond simply highlighting the importance of the issue, Secretary Clinton also affirmed commitment to new programmatic, cross-cutting initiatives that will target water as a keystone for development and peace.

ECSP Director Geoff Dabelko, who attended the event, noted that Secretary Clinton’s speech ran counter to the much publicized notion that water scarcity is an unavoidable catalyst for conflict.

She came down squarely on the side of inclusion by identifying water as both a ‘human security’ and ‘national security’ issue. At the same time, she did not fall prey to the common pitfall of arm-waving about water wars. She flagged conflict and stability concerns, but also raised solutions through meeting needs associated with water and development. She went out of her way to emphasize water’s potential for peace and confidence-building, reflecting a commitment to capturing opportunities rather than merely identifying threats.

Secretary Clinton highlighted five crucial areas that comprise the United States’ whole-of-government approach to water issues:

1. Building capacity:
Through efforts with international partners, the United States hopes to strengthen the abilities of water-stressed nations to manage vital water resources. Agencies such as the Millennium Challenge Corporation and USAID are implementing initiatives that will enhance national ministries and encourage regional management cooperatives.

2. Elevating diplomatic efforts:
A lack of coordination between the numerous UN agencies, governments, and multilateral funding organizations hinders global water progress. By bringing this work together, the United States can act as a leader, demonstrating a positive diplomatic precedent for fragile and water-stressed nations.

3. Mobilizing financial support:
Relatively small grants have achieved large impacts. Work by the United States to strengthen capital markets in the water sector shows that it is possible to earn large returns on water investments. Successful examples range from educational and awareness-building programs, to desalinization and wastewater treatment plants.

4. Harnessing the power of science and technology:
Although there is no silver technological bullet to solve the global water crisis, simple solutions, such as ceramic filters and chlorine disinfection systems, do help. Additionally, sharing government-accumulated technological knowledge can have significant impacts, as demonstrated in a recent NASA-USAID project establishing an Earth-observation monitoring and visualization system in the Himalayas.

5. Broadening the scope of global partnerships:
By encouraging partnerships and elevating water in its global partnership initiatives with NGOs, non-profits, and the private sector—all of which are increasingly engaged in water issues—the Department of State hopes to maximize the effectiveness of its efforts.

The holistic approach advocated by Secretary Clinton reflects a distinct evolution of American diplomacy within this area, which is strongly supported by the water community. “The policy directions outlined in the speech, the five streams, represent a victory for those in and outside of government who have argued for a broad, rather than narrow, view of water’s dimensions,” said Dabelko. “The diversified strategy focuses on long-term and sustainable interventions that respond to immediate needs in ways most likely to make a lasting difference.”

In her concluding remarks, Secretary Clinton sounded a positive note, noting that for all of the press and attention devoted to the dangers of the global water crisis and the possible dark and violent future, dire predictions may be avoided through a smart, coordinated approach. “I’m convinced that if we empower communities and countries to meet their own challenges, expand our diplomatic efforts, make sound investments, foster innovation, and build effective partnerships, we can make real progress together, and seize this historic opportunity.”

Among the many initiatives that have recently been launched to strengthen health systems in the developing world, there is little consensus on execution. Traditional strategies for improving the health system, such as the vertical approach, which prioritizes communicable diseases, or the horizontal approach, which prioritizes non-communicable diseases, are limited in scope and fail to include a comprehensive gender lens.

To overcome the shortcomings of these two health financing approaches, the “diagonal” strategy combines them by “clearly defining priorities and utilizing these priorities to drive general improvements of the health system,” said Julio Frenk, dean of the Harvard University School of Public Health, at the Global Health Initiative’s third event in the “Advancing Policy Dialogue on Maternal Health” series.