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Sajeda Amin on Population Growth, Urbanization, and Gender Rights in Bangladesh
›“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). -
Reducing Health Inequities to Better Weather Climate Change
›In an article appearing in the summer issue of Global Health, Dr. Margaret Chan, director-general of the World Health Organization (WHO), brings to light what she calls the starkest statistic in public health: the vast difference in the mortality rates between rich and poor countries. For example, the life expectancy of a girl is doubled if she is born in a developed country rather than in a developing country. Chan writes that efforts to improve health in developing countries now face an additional obstacle: “a climate that has begun to change.”
Climate change’s effect on health has increasingly moved into the spotlight over the past year: DARA’s Climate Vulnerability Monitor measures the toll that climate change took in 2010 on human health, estimating some 350,000 people died last year from diseases related to climate change. The majority of these deaths took place in sub-Saharan Africa, where weak health systems already struggle to deal with the disproportionate disease burden found in the region. The loss of “healthy life years” as a result of global environmental change is predicted to be 500 times greater in poor African populations than in European populations, according to The Lancet.
The majority of these deaths are due to climate change exacerbating already-prominent diseases and conditions, including malaria, diarrhea, and malnutrition. Environmental changes affect disease patterns and people’s access to food, water, sanitation, and shelter. The DARA Climate Vulnerability Monitor predicts that these effects will cause the number of deaths related to climate change to rise to 840,000 per year by 2030.
But few of these will be in developed countries. With strong health systems in place, they are not likely to feel the toll of a changing environment on their health. Reducing these inequities can only be achieved by alleviating poverty, which increases the capacity of individuals, their countries, and entire regions to adapt to climate change. It would be in all of our interests to do just this, writes Chan: “A world that is greatly out of balance is neither stable nor secure.”
Sarah Lindsay is a program assistant at the Ministerial Leadership Initiative for Global Health and a Masters candidate at American University.
Sources: DARA, Global Health, The Lancet, World Health Organization.
Image Credit: Henry J. Kaiser Family Foundation and the World Health Organization. -
Maternal Health Challenges in Kenya: What New Research Evidence Shows
›“Although there have been improvements in the recent past, the status of maternal health care has not met the required international standards,” said Professor at the University of Nairobi Geoffrey Mumia Osaaji during a live video-conference from Nairobi on July 12.
As part of the 2011 Maternal Health Dialogue Series the Woodrow Wilson Center’s Global Health Initiative is partnering with the African Population and Health Research Center to convene a series of technical meetings on improving maternal health in Kenya. The 20 Kenyan experts attending the workshop in Nairobi also shared their strategies and action points with a live audience in Washington, DC during a video conference discussion. [Video Below]
Osaaji was joined by panelists Lawrence Ikamari, director of Population Studies and Research Institute (PSRI), and Catherine Kyobutungi, director of Health Systems and Challenges at the African Population and Research Center to discuss new maternal health research in Kenya. Panelists also shared recommendations for moving the maternal health agenda forward that came out of discussions during the two-day, in-country workshop with Kenyan policymakers, community health workers, program managers, media, and donors. Following the panelists’ presentations, Dr. Nahed Mattta, senior maternal and newborn health advisor at U.S. Agency for International Development (USAID) and John Townsend, vice-president of reproductive health program for Population Council provided reflecting remarks from the Woodrow Wilson Center during the live webcast.
Maternal Health Challenges in Rural Kenya
“Maternal mortality in rural Kenya is still very high,” said Ikamari. “Rural women in Kenya need to have increased access to maternal health services.” Ikamari discussed a number of factors that contribute to high rates of maternal mortality in rural Kenya, including lack of access to quality care and skilled birth attendants, the high burden of HIV/AIDS, and an unmet need for family planning.
Though nearly 90 percent of women in rural Kenya seek antenatal care, according to the UNFPA, many wait until the second or third trimester, limiting the benefits. Additionally, a majority of women in rural Kenya give birth outside of health facilities, oftentimes without the care of a skilled birth attendant, said Ikamari. In a recent survey, many rural women indicated that transportation to often distant health facilities prevented them from seeking adequate maternal health care, he added.
Additionally, “the burden of HIV is really felt in rural Kenya,” said Ikamari. Survey results show that HIV/AIDS prevalence is about seven percent in rural Kenya and because the majority of the Kenyan population lives in rural areas, this adds yet another layer of complications.
“Family planning saves lives,” said Ikamari, stressing the importance of contraception on maternal health outcomes. Only 35 to 40 percent of currently married Kenyan women use family planning, according to the last demographic and health surveys, and unmet need remains particularly high in rural areas. Promoting institutional delivery systems, improving antenatal and postnatal care, and finding other ways to increase access to family planning can help to improve maternal health outcomes and reduce preventable deaths in rural Kenya, concluded Ikamari.
Comparison of Urban and Rural Areas
“The interventions to address maternal health are well known: family planning, increased access to safe abortion services, skilled health workers, health facilities that are accessible, as well as referral systems that work,” said Kyobutungi. “Yet urban averages [of maternal mortality] are becoming either close or worse than rural averages.”
“As much as we appreciate the rural-urban divide that exists for most health indicators, the urban-urban divide (the fact that there are huge intra-urban differences) needs attention”
“Teenage pregnancy is a failure of family planning,” said Kyobutungi. Studies indicate that there are three times more teenagers that are pregnant among the urban poor, compared to the urban rich.
As in rural Kenya, access to quality health facilities and care is also limited in cities. “Health facilities are few and far between and the referral systems are weak,” said Kyobutungi, and “when you remove Nairobi from the numerator, the number of skilled physicians per population is in the decimals.”
Moving forward, there is a need to promote effective integration and improvement of health worker training and monitoring but also development of performance-based incentives to ensure successful programs are properly funded. “It’s not all gloom and doom in urban areas,” concluded Kyobutungi.
Innovative Ideas for Better Results
“By year 2025 there will be 25 percent more people [in Kenya],” said Townsend. “What that means is, when we are planning…we have to think about the scale of solutions that we are proposing in 2025 and 2050.” Therefore, it is essential to acquire new models of data and evidence to better predict future population growth and maternal needs, he suggested.
In addition to expanding services to meet the needs of a growing population, the panelists in Washington emphasized the need to support integration at all levels. Trends are moving in the right direction: Within the Obama administration’s Global Health Initiative, “there is a strong push and recommendation for integration among the health sectors,” said Matta.
But integration is not a magic bullet to improve maternal health, warned the panelists. “Integration is a terrific issue, but when the health sectors are weak, putting more burden on a local community health worker does not usually make sense; we have to think about smart integration,” said Townsend.
Focusing on Kenya’s health sector from all aspects, both at the private and public level, and improving family planning, institutional delivery care, as well as antennal care will help Kenya overcome its maternal health barriers. Additionally, thinking of ways to utilize new models of data and integrating the various sectors will yield substantial benefits, concluded Matta and Townsend.
Following the technical meeting, a public dialogue was held on July 13 in Nairobi to share the recommendations and knowledge gaps identified with members of Kenya’s Parliament, including Hon. Sofia Abdi, parliamentary health committee member; Hon. Ekwee Ethuro, chair of the parliamentary network for population and development; and Hon. Jackson Kiptanui. They joined a group of more than 50 maternal health experts, program managers, members of the media, and donors – such as the UK Department for International Development (DFID) – to identify real solutions and action points for improving maternal health in Kenya.
The formal report from the in-country technical meeting will be available in the near future.
See also the Maternal Health Task Force’s coverage of the event, here and here.
Sources: Kenya National Bureau of Statistics, UNFPA.
Photo Credit: Jonathan Odhong, African Population and Health Research Center. -
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. -
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.
My 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. -
Robert Jenkins, OpenDemocracy.net
Women, Food Security, and Peacebuilding: From Gender Essentialism To Market Fundamentalism
›July 5, 2011 // By Wilson Center StaffThat women’s engagement in resolving and recovering from conflict is crucial to sustainable peace has been an article of faith, and an element of international law, since the UN Security Council passed Resolution 1325 in 2000. It took a decade of missed opportunities, however, for the UN to develop a systematic action plan for redeeming the promise of 1325. The September 2010 Report of the Secretary-General on women’s participation in peacebuilding contains a concrete set of commitments for UN actors working in post-conflict settings.
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Watch ‘Dialogue’ TV on the Future of Women and the Arab Spring
›This week on Dialogue, host John Milewski discusses the role that women played in the Arab Spring and how these roles might evolve in the coming months and years with the enormous political changes sweeping the region. He is joined by Moushira Khattab, Lilia Labidi, and Haleh Esfandiari. [Video Below]
Moushira Khattab is a human rights activist who formerly served as Minister of Family and Population for Egypt. She also served as Assistant Minister of Foreign Affairs, Vice Chair of the UN Committee on the Rights of the Child, and was Egypt’s ambassador to South Africa during the Mandela era. Lilia Labidi is an anthropologist and professor at the University of Tunis who currently serves as Minister of Women’s Affairs in the Republic of Tunisia. Previously she was a visiting professor at the American University in Cairo and a fellow at the Wilson Center. Haleh Esfandiari is author of the book, My Prison My Home: One Women’s Story of Captivity in Iran. Haleh serves as the director of the Wilson Center’s Middle East Program.
Dialogue is an award-winning co-production of the Woodrow Wilson International Center for Scholars and MHz Networks that explores the world of ideas through conversations with renowned public figures, scholars, journalists, and authors. The show is also available throughout the United States on MHz Networks, via broadcast and cable affiliates, as well as via DirecTV and WorldTV (G19) satellite.
Find out where to watch Dialogue where you live via MHz Networks. You can send questions or comments on the program to dialogue@wilsoncenter.org. -
Women in Agriculture: Closing the Gender Gap for Development and World Hunger
›June 22, 2011 // By Kellie FurrProviding women with equal access to productive resources and opportunities may be the key to bolstering the struggling global agricultural sector and feeding communities living in extreme hunger, according to the UN Food and Agriculture Organization’s (FAO) latest State of Food and Agriculture report, which this year is sub-titled, “Women in Agriculture: Closing the Gender Gap for Development.”
“Women are farmers, workers, and entrepreneurs, but almost everywhere they face more severe constraints than men in accessing productive resources, markets, and services,” write the authors. “This ‘gender gap’ hinders their productivity and reduces their contributions to the agriculture sector and to the achievement of broader economic and social development goals.”
Barriers to Productivity
Globally, women comprise 43 percent of the agricultural labor force, ranging from 20 percent in Latin America to 50 percent in southeastern and eastern Asia and sub-Saharan Africa, according to the report. But despite their significant global presence, female farmers face gender-specific constraints that hinder access to productive resources, financial support, information, and services required to be viable and competitive. “The yield gap between men and women averages around 20 to 30 percent, and most research finds that the gap is due to differences in resource use,” write the authors.
Generally, women are more likely than men to hold lower-wage, part-time, or seasonal positions and tend to get paid less even when they are more qualified. Furthermore, domestic and occupational lines are blurred for women, who are often not compensated for work that is closely related to domestic food preparation. Most significantly for agricultural productivity, women across the developing world often lack access to quality land, sometimes being barred from land ownership. This ban precludes female farmers from exercising managerial discretion over farming activities, such as entering contract farming agreements. Women also generally own less livestock and contract for less labor – two crucial assets for marketable agricultural production in many developing countries. Moreover, because of insufficient land and resources, women farmers are also more vulnerable to climate shocks.
Resource barriers for female farmers extend to education, finance, and technology as well. The authors observe that “female household heads in rural areas are disadvantaged with respect to human capital accumulation in most developing countries, regardless of region or level of economic development,” which represents a historical bias against females in education. Despite notable success observed in finance projects involving female farmers, gender bias exists in the financial system, which prevents women from bearing initial financial risk in order to increase long-term productivity gains. Sources of gender bias in the financial sector include legal barriers, cultural norms, lack of collateral, and institutional discrimination by public and private lenders. Due to the aforementioned lack of credit, labor, and education, women farmers are deficient in all aspects of technology, such as the acquisition of new equipment, information about new seed varietals and animal breeds, pest control measures, and management techniques.
Global Implications
Closing the gender gap could have profound implications for easing world hunger. According to the FAO, approximately 925 million people are currently undernourished, most of whom live in developing countries. If women were given all the inputs and support as men, agricultural output could increase by 2.5 to 4 percent in developing countries, potentially reducing the world’s hungry by 100 to 150 million people. “This report clearly confirms that the Millennium Development Goals on gender equality (MDG 3) and poverty and food security (MDG 1) are mutually reinforcing,” FAO Director-General Jacques Diouf argues in his introductory remarks.
Increasing the economic viability of women farmers may also translate into better infant and child health indicators – when women control additional income, they tend to allocate more of their earnings toward the health and well-being of their children. Closing the agricultural gap is “a proven strategy for enhancing the food security, nutrition, education, and health of children,” Diouf asserted. “Better fed, healthier children learn better and become more productive citizens. The benefits would span generations and pay large dividends in the future.”
Finally, the FAO notes that in addition to reducing child mortality rates, increasing female education and economic prosperity helps lower fertility rates, which over time increases human capital and can help drive a demographic transition towards lower dependency rates and higher per capita growth.
Closing the Gender Gap
“The conclusions are clear,” write the authors:1) Gender equality is good for agriculture, food security, and society; and
Though they note that “no simple ‘blueprint’ exists for achieving gender equality in agriculture,” the authors do recommend some basic principles to the development community, including working towards eliminating discrimination against women under the law, strengthening rural institutions and making them gender-aware, freeing women for more rewarding and productive activities, building the human capital of women and girls, bundling interventions, improving the collection and analysis of sex-disaggregated data, and making gender-aware agricultural policy decisions.
2) Governments, civil society, the private sector and individuals, working together, can support gender equality in agriculture and rural areas
Recognizing that “women will be a pivotal force behind achieving a food secure world,” the U.S. Agency for International Development (USAID) has actually launched initiatives aimed directly at closing the gender gap. The Feed the Future initiative, announced last spring, includes a heavy focus on gender equity and integration with small-scale farming initiatives. For example, the Office of Women in Development is supporting a three-year project in Liberia, “Integrated Agriculture for Women’s Empowerment,” that aims to train and support 1,500 small farmers in Lofa county, two-thirds of whom are women. And in Rwanda, USAID helped the Ministry of Agriculture and Animal Resources – headed by Dr. Agnes Kalibata – develop a national investment plan, which has been successful in bringing in donor support.
However, the FAO report does not offer specific feedback on programs like Feed the Future, which is arguably a crucial component of a truly comprehensive assessment on the current state of agriculture. Though they write that the State of Food Agriculture series is intended to simply be “science-based assessments of important issues,” the infancy of these food security efforts and the immediacy of the problems examined (see recent food price instability) creates an excellent opportunity for critical input. “Women in Agriculture” offers perhaps the most comprehensive report on the gender gap and development to date, but more specific critiques on the current efforts of USAID and others might make more of an impact in a field where the issues at play have been fairly clearly enumerated many times before.
Sources: Food and Agriculture Organization, The Hunger Project, International Fund for Agricultural Development, Population Action International, USAID.
Photo Credit: Adapted from “Ngurumo Village-Ntakira (Kenya),” courtesy of flickr user CGIAR Climate.
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