Every minute, a woman dies in pregnancy or childbirth. But the overwhelming majority of these more than 500,000 deaths a year are avoidable.

“We know how to save women’s lives, we don’t need a cure…this is a political problem and political will is essential,” said Theresa Shaver, the director of White Ribbon Alliance.

Addressing longstanding issues like political will could jumpstart progress toward Millennium Development Goal 5, which seeks to reduce maternal deaths by 75 percent by 2015. We face daunting challenges, but there are some clear steps we can take to meet this critical goal. We must strengthen health systems in the developing world.

Increasing women’s access to quality health services during pregnancy, and ensuring they are attended by skilled providers during childbirth, can help to reduce preventable causes of death, such as hemorrhage, pre-eclampsia, and obstructed labor—which together account for 80 percent of maternal deaths.

Scaling-up family planning services are a cost-effective way of preventing unwanted pregnancies, delaying the age of first pregnancy, increasing the time between pregnancies, and facilitating important relationships between women and health care providers. However, many societal and cultural factors dissuade women and girls from seeking contraception. Culturally sensitive education programs can help overcome this barrier, especially if they include men and local leaders, in addition to women and girls.

We should recognize that improving the well-being of mothers is inseparable from the health of newborns. Efforts to reach Millennium Development Goal 4, reducing under-5 mortality by two-thirds, are integral to improving maternal health. Skilled birth attendants could decrease both maternal and child mortality.
In the United States and abroad, momentum is growing to make the investment necessary to scale up these interventions. In January, Secretary of State Hillary Clinton renewed a commitment of $63 billion for the Obama Administration’s Global Health Initiative, which will include significant resources for maternal and child health.

According to the U.S. Agency for International Development, maternal and newborn deaths cost the world $15 billion a year in lost productivity. Researchers conclude that maternal health services would cost only a $1 per day per woman. That’s a small price to pay for such a high return—saving not only dollars, but also women’s lives.

For more information about maternal health and the Global Health Initiative’s Advancing Policy Dialogue on Maternal Health Series please see this month’s issue of Centerpoint.

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In our latest video interview about PHE programs in Ethiopia, Zuna–a village elder from the Mettu Woreda region of Ethiopia—describes how an integrated intervention by the Ethio-Wetlands and Natural Resources Association (EWNRA) has benefited her community.

Bill Gates gave the PHE community a much-needed upgrade in his foundation’s 2nd Annual Letter, released this week. Unfortunately it still has a few bugs.

“In the long run, not spending on health is a bad deal for the environment because improvements in health, including voluntary family planning, lead people to have smaller families, which in turn reduces the strain on the environment,” concludes Gates.

This statement could dramatically raise awareness of and funding for population-environment programs. Any time Bill Gates talks, the world listens, as evidenced by the barrage of coverage from Reuters, AFP, and top IT newswires. For the public, it offers a rare glimpse into development strategy, so Gates’ thoughts (and financial commitments) could be seen as representative of the foundation community’s approach to global health problems.

Although it may seem obvious that fewer people place less strain on the environment, this connection has been largely absent from the environmental agenda, including the efforts to combat climate change. Some environmental leaders and organizations have dismissed population as an unimportant distraction from the real business at hand. Others have noted that population growth’s impact on climate change is far greater in the rich world than in poor countries, whose per capita emissions are a fraction of developed countries’.

Gates’ comment may cause those in the first camp to re-evaluate the importance of family planning, and it is likely to energize the converted. But it will have less impact on those focused on consumption. But if it encourages the environmental community to put population and family planning issues back on the table, it will have gone a long way.

However, Gates could have gone further, by explaining that family planning is a relatively inexpensive way to mitigate climate change, compared to complex and emerging technological solutions. He also could have pointed out that climate change is expected to increase the prevalence of vector-borne diseases such as malaria, or that sick or malnourished individuals may be forced to mismanage natural resources.

Because Gates didn’t make these explicit connections, many in the media missed his point. The wire headlines pit health against environment, when Gates was in fact pointing out how interdependent they are. This distortion is symptomatic of the media’s tendency to highlight the horserace. But maybe they would pay closer attention if the Gates Foundation put its money where its mouth is—and funded programs that integrate family planning and the environment.

Perhaps several years from now, we will look back and say that this letter marks the start of the Gates Foundation’s integrated approach to development. But we may need to wait for Letter 3.0 for a complete install.

Photo: Courtesy Flickr User World Economic Forum

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“Climate change seems to be eclipsing all other environment and security issues, but those issues haven’t gone away,” says Oli Brown, program manager at the International Institute for Sustainable Development (IISD). “There are still problems with illegal timber, still problems with mining, there are still problems with diamonds, there are still problems over land, water, and so on. Climate change encompasses a lot of those issues and makes some of them more difficult and more pressing.”

IISD is working with the United Nations Environment Programme on ensuring that these issues are addressed in UN peacekeeping missions. “What we do with UNEP is to coordinate a group of experts that help to advise the UN family on ways that it should do conflict prevention, post conflict reconstruction, peacekeeping, peace negotiations and peacebuilding more effectively,” says Brown.

According to the United Nations, 74 million acres of farmland in the developing world were acquired by foreign governments and investors over the first half of 2009 – an amount equal to half of Europe’s farmland.

In areas fraught with conflict, is it possible to advance conflict resolution through environmental discourse? A recent conference hosted by Tel Aviv University’s Porter School of Environmental Studies explored this question through an examination of existing peace parks, as well as possible future preserves.

The wide-ranging discussion sought to apply theories of conflict resolution and environmental peacemaking to local conflict in the Middle East. Touching on conservation, conflict resolution, local history, geography, ecology, and diplomacy, the participants underscored the importance of restoration efforts, local environmental maintenance, and the pursuit of peace through environmental cooperation.

“Services are not necessarily very adolescent-friendly, so when you get children who are HIV-positive they are likely to face discrimination,” says Harriet Birungi, an associate in the Reproductive Health Program with the Population Council in Kenya, in this interview with ECSP’s Gib Clarke following the Global Health Initiative’s Integrating HIV/AIDS and Maternal Health Services panel.

In a preview of his new book The Plundered Planet: Why We Must – and How We Can – Manage Nature for Global Prosperity, Paul Collier dispelled the common perception that Africa’s indentified resource reserves are the world’s largest. In actuality, it is estimated that up to four-fifths of the value of subsoil assets in the African continent are yet to be discovered. “That is the big story,” Collier remarked. “Here are assets which could finance transformation….but historically haven’t.” Instead, these resources have been plundered.

In a recent event hosted by the U.S. Institute of Peace, Paul Collier, professor of economics and director of the Center for the Study of African Economies at Oxford University, and Nancy Birdsall, president of the Center for Global Development, discussed how resource-rich environments in developing countries have been traditionally misused. The two also proposed strategies to disrupt these processes and transform resource “curses” into deeply needed support for peace and stable development.

Conflict and instability in countries whose economies are heavily invested in natural resource have often hindered local development and security. Many of these countries—including Cambodia, Angola, Indonesia, and DRC—have suffered from one of two forms of plunder:

Types of Natural Resources Plunder:

1. Where the few steal from the many:
Natural assets are, by definition, without natural owners, and therefore lie as easily taken common goods. “This process of expropriation opens up a whole array of dysfunctional variants, many of which are violent,” Collier noted.

2. Where the present steals from the future:
Intertemporal mismanagement is a possibility, as unlike man-made assets, natural assets belong to all generations.

Operating from a worldview of weak sustainability, where profits from natural assets are reinvested for the benefit of future generations, Collier suggested that natural resource rights are more akin to “rights of stewardship” than traditional property rights. “We may well transform that value into something that is more productive, but if we pull up natural assets from the ground, we should leave to the future something that is equivalently valuable.”

Collier argued that the successful harnessing of natural resources for stable and sustainable development depends on the application of a tenuous decision chain:

Natural Resources Decision Chain:

1. Discovery Process:
Failure in this phase stems from poor property rights, and the time consistency problem—uncertainty that conditions and regulations that make expensive upfront investments profitable today will remain in place in the future.

2. Appropriate Taxation:
Currently, as a result of poor negotiations or limited information regarding the status of resources, governments are unable to craft tax regimes which effectively capture resource rent.

3. Avoiding the Delta:
Sustainable management any discovered subsoil assets must avoid a local “Nigerian Delta” catastrophe. Clearly designating the government as the sole responsible agent for resource rents may limit such failures.

4. Saving the money:
To avoid plunder of the future by the present, Collier suggested that, though politically difficult, a proportion of revenue streams must be delineated from general accounts.

5. Building the capacity to invest in the country:
Collier deemed the inability of resource-rich countries to attract diversified investment as the “killer link.” Governments must use returns from subsoil assets to fund “investment in investment”—directing public capital toward transportation and utility infrastructure, education, health, and other short-term projects. Once in place, such projects encourage future public and private investments, thereby multiplying long-term returns.

As with many complex systems, Collier warned that the chain is only as strong as its weakest link. If one link fails, “the chain won’t pull the country from poverty to prosperity.” On the other hand, if each link holds, the value is tremendous. ”[Y]ou really can pull the country from poverty to prosperity over the course of a generation. There are no fixes in economics that are faster than that.”

Ultimately, Collier and Birdsall emphasized that success depends upon the development of an informed and competent “critical mass” of people. Even the strongest decision chain will fail if it is not underwritten by a majority of the population. Birdsall reiterated the need for public participation in the process, possibly through direct income distribution or responsible interventions by non-vested third parties.

Photo: Courtesy of Oxford University Press.