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Reading Radar
Benefits of Integrating Population, Health, and Environment
MORE“Mainstreaming Environment and Climate Change: Health,” a joint publication from the International Institute for Environment and Development and Irish Aid, is part of a series that aims to show the links between the environment, climate change, and key development sectors, while suggesting key solutions to move into national policies. This health-focused briefing asserts that “nearly one quarter of the global disease burden can be attributed to the environment.” While anyone is prone to the negative effects of climate change, the poor are especially vulnerable because they often live in some of the most precarious environmental conditions. Consequently, the briefing argues that “improving environmental health – raising its profile at national, state and local levels, and integrating environmental health issues into development plans and activities – is critical if we are to reduce poverty and meet the Millennium Development Goals.”
In An Assessment of the Benefits of Integrating Family Planning and Environmental Management Activities in the Visayas Region of the Philippines, a study from the University of Rhode Island’s Coastal Resources Center, authors Richard B. Pollnac and Kira Dacanay argue that benefits can be reaped from integrated population, health and environment (PHE) development, but only under certain conditions. Factors influencing the level of benefits include “levels of participation in integrated projects [both by individuals and communities], and how NGOs implement these projects.” Thus, it is important to “tailor strategies based on place-based context and personal characteristics of different participants,” write Pollnac and Dacanay. In the Philippines, the authors suggest that one of the actions future PHE initiatives should take is to “stimulate more project participation, with special efforts in larger, less dense communities and tailor strategies better to different targeted populations within the community.” -
Dot-Mom
Fistula, Stigmatization, and Development
MOREAlthough obstetric fistula may not be as widely recognized as other maternal health issues, the Fistula Foundation estimates that over two million women and girls in developing countries suffer from this condition today. The World Health Organization has labeled it as “the single most dramatic aftermath of neglected childbirth.”
Obstetric fistula is a devastating condition often resulting from obstructed labor that can cause infections, incontinence, and even paralysis. The condition largely afflicts poor, rural, and illiterate women in developing countries who lack resources and access to emergency care and surgery, and sufferers often face an additional burden of social stigma.
Economic Development and Social Standing
Poor infrastructure and poverty significantly increases the occurrence rate of obstetric fistula. Lewis Wall, in an article for The Lancet, writes that “poverty is the breeding-ground where obstetric fistulas thrive.” Wall cites early marriage, low social status of women, malnutrition, inadequately developed social and economic infrastructures, and lack of access to emergency obstetric services as being major contributors of fistulas in developing countries.
Additionally, “postponing the age of marriage and delaying childbirth can significantly reduce the risk of subjecting young women to the arduous labor that induces fistulas,” wrote Sonny Inbaraj of Inter Press Service News Agency (IPS) in an article about how fistula makes social outcasts of child brides.
In most developing societies where child marriage is common, the social standing of women is defined largely in terms of marriage and childbearing. Child marriages are typically arranged without the knowledge or consent of the girls involved. The norms emphasize a girl’s domestic roles and de-emphasize investments such as education.
Stigmatization of Fistula
There is an undeniable link between fistula and social stigmatization. Rather than receiving assistance from their families and communities, women are often ostracized and in many instances exiled from their communities. This is especially true in developing countries where “the role of women is merely limited to providing sexual satisfaction for their husbands, [and] producing children,” said Dr. Catherine Hamlin, founder of the Addis Ababa Fistula Hospital, in an interview with IPS.
“Many women and girls with fistula endure lives of shame, misery, violence, and poverty,” said Agnes Odhiambo, Africa women’s rights researcher and author of ‘I Am Not Dead, But I Am Not Living‘: Barriers to Fistula Prevention and Treatment in Kenya, in a Human Rights Watch article. Human Rights Watch has focused on fistula, recognizing that birth is a human rights issue. Ignoring the issues of women and girls only diminishes progress on human rights and sends a message that says the rights of women do not deserve adequate attention.
Prevention Efforts
Thus far the fight to end fistula has attracted various government agencies and organizations including USAID, UNFPA, EngenderHealth, Maternal Health Task Force, and the Human Rights Watch. Outstanding individuals have also played a key role in fistula prevention efforts, like Drs. Reginald and Catherine Hamlin, Australian gynecologists who came to Addis Ababa in 1959 for temporary medical work, but after hearing heart-breaking stories from fistula patients, they decided to move to Ethiopia permanently and open the Addis Ababa Fistula Hospital. As the only hospital dedicated exclusively to women with obstetric fistula, the hospital provides care free of change, and has done so since 1974.
Although fistula has gotten some support and attention, the need to scale-up the prevention initiatives has never been greater. As a result of the “poverty and the stigma associated with their condition, most women living with fistulas remain invisible to policy makers both in their own countries and abroad,” wrote Inbaraj on IPS.
“Preventing fistula and restoring women’s health and dignity requires more than good policies on paper,” said Odhiambo at Human Rights Watch. Seriously tackling the issue will require much more than traditional medical and public health interventions – prevention efforts must also take into account underlying social issues, food and economic security.
Sources: The Addis Ababa Fistula Hospital, Campaign to End Fistula, The Center for Global Development, The Fistula Foundation, Human Rights Watch, The Lancet, World Health Organization.
Photo Credit: “Hauwa’u, 25, mother from Rogogo community,” courtesy of flicker user DFID-UK Department for International Development.Topics: development, Dot-Mom, Ethiopia, gender, global health, humanitarian, livelihoods, maternal health -
Friday Podcasts
Sajeda Amin on Population Growth, Urbanization, and Gender Rights in Bangladesh
MORE“One of the reasons why population grows very rapidly in Bangladesh is women get married very early and have children very early,” the Population Council’s Sajeda Amin told ECSP in a recent interview. “So even though they are only having two children, they are having them at an average age of around 20. As demographers would say, women ‘replace’ themselves very rapidly.”
Largely through the promotion of contraceptive use, family planning programs implemented over the past 35 years by the Bangladeshi government and a variety of NGOs have helped lower the country’s total fertility rate to 2.7 from 6.5 in the mid-1970s. To build on this progress, the Population Council has joined a consortium of other organizations – including the Bangladesh Legal Aid and Services Trust, Marie Stopes International, and We Can End All Violence Against Women – to launch the Growing Up Safe and Healthy (SAFE) project in Amin’s native Dhaka and other Bangladeshi cities.
Currently nearing the completion of its first year, the four-year initiative has several aims, among them increasing access to reproductive healthcare services for adolescent girls and young women and bolstering social services to protect those populations from (and offer treatment for) gender-based violence. The project also looks to strengthen laws designed to reduce the prevalence of child marriage – a long-standing Bangladeshi institution that keeps population growth rates high while denying many young women the opportunity to pursue economic and educational advancement.
A Focus on Gender and Climate
Amin says the SAFE project boasts several qualities that collectively set the initiative apart from similar-minded programs in Bangladesh dealing with gender and poverty. These include a strong research component incorporating quantitative and qualitative analysis; the holistic nature of the program, which incorporates educational outreach, livelihood development, and legal empowerment; a commitment to working with both male and female populations; and an emphasis on interventions targeting young people, with the hope that such efforts will allow adolescents to make better-informed decisions about future relationships and reproductive health, thus reducing the likelihood of gender-based violence.
Finally, while many existing gender-based programs focus exclusively on rural communities, Amin points out that the SAFE project also stands apart because of its focus on the country’s rapidly expanding urban areas. To date, the initiative is focusing many of its early interventions in a Dhaka slum that has seen an influx of rural migrants in recent years due to climate-change impacts in the country’s low-lying coastal areas.
“A lot of the big problems in Bangladesh now are climate-driven in the sense of creating mass movements out of areas that are particularly vulnerable or have been hit by a major storm,” Amin said. “Usually these are people who, once they lose their homes and their livelihoods, will have no choice but to move to urban areas, and that’s a process that is kind of a big outstanding issue in Bangladesh now.”
By building programming around girls and young women in such communities, the SAFE project is looking to spark change from the bottom up, prioritizing the unmet health and social needs of some of Bangladesh’s most vulnerable populations.
The “Pop Audio” series is also available as podcasts on iTunes.
Sources: Global Post, Ministry of Health and Family Welfare (Bangladesh), Shaikh and Becker (1985).Topics: Asia, Bangladesh, climate change, education, family planning, Friday Podcasts, gender, podcast, population, urbanization, youth -
Watch: Alecia Fields on Population, Health, and Environment Advocacy with the Sierra Club
July 29, 2011 // By Roza EssawMORE“The issues of population, health, and environment are pretty foreign to a lot of people,” said Alecia Fields, a recent University of Kentucky graduate who participated in a Sierra Club Global Population and Environment Study Tour of Ethiopia last summer as a student fellow.
“I learned about the program, how to be an effective advocate, and I took those tools back to my university on campus and shared it with young people,” said Fields in this interview with ECSP.
Fields came from a women’s health background but found the connections between population, health, and environment (PHE) compelling enough that she wanted to become an advocate on campus. “At first, people don’t think they have a connection to the issue, but once you start talking with people, they really start to see how they are central to a larger issue,” said Fields.
“It is challenging in the United States to see some of the population and environmental issues…but when you go to a developing country, you see the effects right in front of you,” explained Fields. The Sierra Club’s Global Population and Environment Study Tours bring a select group of student advocates abroad to see PHE projects in the field with the aim of creating pro-active messengers of the importance of integrated development in the United States.
Fields visited various sites and organizations in Ethiopia including the Gauraghe People’s Self-help Development Organization (GPSDO), located in the southwest region. “People in Ethiopia have had tremendous success in connecting population, health, and environment within communities and starting integrated programs that work towards development,” said Fields.
Going to Ethiopia provided Fields with concrete examples of the importance of PHE and allowed her to share her experience with young people through meaningful illustrations and moving stories.
“A lot of it deals with figuring out where people are in their attachment to the subject…and try to figure out how that program can connect to them,” she said. -
Dot-Mom
Maternal Health Challenges in Kenya: An Overview of the Meetings
MOREThe 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. -
On the Beat
Farahnaz Zahidi Moazzam on the Population Reference Bureau’s “Women’s Edition” Trip to Ethiopia
The original version of this article, by Farahnaz Zahidi Moazzam, appeared on the Population Reference Bureau’s Behind the Numbers blog.MOREMy name is Farahnaz Zahidi Moazzam, and I’m a freelance journalist, writer, and editor from Pakistan. My passion is writing about human rights with a special focus on gender issues and reproductive health. Blogging is a personal joy to me, as I put my heart into my writing and blogging allows for a more personalized style. Digital journalism is a sign of evolution – one I happily accept. My pet peeve is marginalization on any grounds. I am a mother of a teenage daughter and live in Karachi.
As part of the Population Reference Bureau’s (PRB) group of journalists in Women’s Edition 2010-2012, I recently had the chance to travel to Ethiopia on a visit that was unforgettable. The visit inspired a series of seven brief travel-blogs, based on my seven days there. Women’s Edition is a wonderful opportunity to connect with other like-minded female journalists from developing countries around the world, and learn solutions to the problems from this interaction. The program has reaffirmed my belief that our commonalities are more than the differences.
Read Farahnaz Zahidi Moazzam’s posts from her trip to Ethiopia on her blog, Impassioned Ramblings, and view photos from the trip on PRB’s Facebook page.
Photo Credit: PRB. -
Eye On
Failed States Index 2011
MORE“The reasons for state weakness and failure are complex, but not unpredictable,” said J.J. Messner, one of the founders of the Fund for Peace’s Failed States Index, at the launch of the 2011 version of report in Washington last month. The Index is an analytical tool that could aid policymakers and governments seeking to prevent and mitigate state collapse by identifying patterns of underlying drivers of state instability.
The Index ranks 177 countries according to 12 primary social, economic, and political indicators based on analysis of “thousands of news and information sources and millions of documents” and distilled into a form that is meant to be “relevant as well as easily digestible and informative,” according to the creators. “By highlighting pertinent issues in weak and failing states,” they write, the Index “makes political risk assessment and early warning of conflict accessible to policymakers and the public at large.”
Common Threats: Demographic and Natural Resource Pressures
The Index reveals that half of the 10-most fragile states are acutely demographically challenged. The composite “Demographic Pressures” category takes into account population density, growth, and distribution; land and resource competition; water scarcity; food security; the impact of natural disasters; and public health prevention and control. Additional population indices are found in “Massive Movement of Refugees or Internally Displaced Persons (IDPs),” and health indicators, including infant mortality, water, and sanitation, are spread across several categories.
Not surprisingly, some of the most conflict-ridden countries show up at the top of the list. The Index highlights some of the lesser known issues that contribute to their misery: demographic and natural resource stresses in Afghanistan, Iraq, Nigeria, Pakistan, and Yemen (a list that would include Palestine, if inclusion in the Index were not contingent on UN membership); the DRC’s conflict minerals; and Somalia and Sudan’s myriad of environmental and migration problems, which play major roles in their continued instability.
Haiti, with its poor health and lack of infrastructure and disaster resilience, was deemed the Index’s “most-worsened” state of 2011. The January 2010 earthquake and its ensuing “chaos and humanitarian catastrophe” demonstrated that a single event can trigger the collapse of virtually every other sector of society, causing what Messner termed the “Humpty Dumpty effect” – while a state can deteriorate quickly, it is much harder to put it back together again.
The inclusion of natural resource governance within the social and economic indicators would render the Index a more complete analytical tool. In a 2009 report, the UN Environment Program (UNEP) found that “since 1990, at least eighteen violent conflicts have been fueled by the exploitation of natural resources,” and that effective natural resource management is a necessary component of conflict prevention and peacebuilding operations.
The Elephant in the Room: Predicting the Arab Spring
Why did the Index fail to predict the Arab Spring sweeping the Middle East and North Africa? Many critics assert that the inconsistent ranking of the states, ranging from Yemen (ranked 13th) to Bahrain (ranked 129th), demonstrates that the Index is a poor indicator of state instability. Particularly, critics argue that many of the countries experiencing revolutions were ranked artificially low.
“Of course, the Failed States Index did not predict the Arab Spring, and nor is it intended to predict such upheavals,” said Messner at the launch event. “But by digging down deeper into the specific indicator analysis, it was possible to observe the growing tensions in those countries.” The Index has consistently highlighted specific troubling indicators for the region, such as severe demographic pressures, migration, group grievance, human rights, state legitimacy, and political elitism.
Blake Hounshell, a correspondent with Foreign Policy (long-time collaborators with the Fund for Peace on the Index), wrote that the Index was never meant to be a “crystal ball” – even the best statistical data cannot truly encapsulate the complex realities that lead to inherently unpredictable events, such as revolutions. “It’s thousands of individual decisions, not rows of statistics, that add up to political upheaval,” Hounshell continued.
Demographer Richard Cincotta’s work on Tunisia’s revolution illuminates how the Index’s linear indicators can mask a complex reality. Whereas the Failed States Index simply measures “demographic pressure” as a linear function of how youthful a population is, Cincotta pointed out at a Wilson Center event that it was actually Tunisia’s relative demographic maturity that paved the way for its revolution and gives it a good chance of achieving a liberal democracy. Other countries in the region are much younger than Tunisia (Yemen being the youngest). The Arab Spring demonstrates that static indicators alone often do not have the capacity to predict complex social and political revolutions.
Sources: Foreign Policy, The Fund for Peace, UNEP.
Image Credit: Failed States Index 2011, Foreign Policy.Topics: conflict, demography, disaster relief, DRC, environment, Eye On, Haiti, natural resources, PHE, population, security, Somalia -
Friday Podcasts
Leona D’Agnes on Evaluating PHE Service Delivery in the Philippines
“By reducing population growth, we are going to have a better chance of sustaining the gains of an environmental conservation project,” said Leona D’Agnes in this interview with ECSP. D’Agnes, a technical advisor to PATH Foundation Philippines, served as lead author on a research article published late last year in Environmental Conservation titled, “Integrated Management of Coastal Resources and Human Health Yields Added Value: A Comparative Study in Palawan (Philippines).” The study provided concrete statistical evidence that integrated development programming incorporating population, health, and the environment (PHE) can be more effective in lowering population growth rates and preserving critical coastal ecosystems than single-sector development interventions.MORE
“What set this research apart from earlier work on integrated programming was the rigorous evaluation design that was applied,” said D’Agnes. “What this design aimed to do is to evaluate the integrated approach itself. Most of the previous evaluations that have been done on integrated programming were impact evaluations — they set out to evaluate the impact of the project.” This most recent research project, on the other hand, sought to evaluate the effectiveness of cross-sectoral interventions based on “whether or not synergies were produced,” said D’Agnes.Although it took her team six years to generate statistically significant findings in Palawan, D’Agnes reports that the synergies of PATH Foundation Philippines’ PHE intervention took the form of reduced income poverty, a decreased average number of children born to women of reproductive age, and the preservation of coastal resources, which helped bolster the region’s food security.
Going forward, D’Agnes said, an integrated approach to environmental conservation should also prove appealing because of its cost effectiveness. “This has huge implications for local governments in the Philippines, where they are struggling to meet the basic needs of their constituents in the face of very small internal revenue allotments that they get from the central government,” she said. “They can really pick up on this example to see that at the local level, if somehow they can do this integrated service delivery that was done in the Integrated Population and Coastal Resource Management (IPOPCORM) model, that they’ll be able to achieve the objectives of both their conservation and their health programs in a much more cost-effective way, and, in the process, generate some other [positive] outcomes that perhaps they didn’t anticipate.”
D’Agnes expects the study’s results will prompt a fresh look at cross-sectoral PHE programming. “I hope that this evidence from this study will help to change the thinking in the conservation community about integrated approaches to conservation and development,” she said.
The “Pop Audio” series is also available as podcasts on iTunes.
A Publication of the Stimson Center.
