Population Matters

International Day of Action for Women’s Health

May 27th, 2010

When I learned that tomorrow is the International Day of Action for Women’s Health, I thought of my own experience last summer teaching health education in Marangu, Tanzania.  In my first week of teaching, I had asked a group of young women, aged eleven to thirteen, who their role models were.  One by one, each of the girls pointed to their mothers or their grandmothers, the strong and robust women you saw on the street dressed in colorful cloth, balancing buckets on their heads.  They were the mothers, the wives, the farmers, and the teachers that form the backbone of Tanzanian society.  They are robust, flamboyant, easy to talk to, yet demanding of respect.  But, despite their social autonomy and powerful demeanor, these women lack reproductive rights.  They are empowered in so many ways, except when it comes to controlling their own fertility.  Time and time again they will be subject to complicated pregnancies, risk of obstructed labor, and other adverse health effects, all consequences of an inability to access family planning techniques. 

Unfortunately, this is a story we have all heard before.  Over the next few weeks, I asked their daughters about their own knowledge of family planning.  I wanted to know what information mothers and grandmothers were giving these young women as they enter adolescence and become sexually active individuals. 

I found that the girls knew about HIV/AIDS, malaria, and malnutrition.  They cited facts about diarrhea, dental care, and tuberculosis.  But they didn’t know about birth control pills, how to chart their menstrual cycle, or how to combat social pressures.  They were equipped with the knowledge to pass a classroom exam, but not with the understanding that would allow them to control their fertility and their reproductive health.  Education needs to go beyond the textbooks.  It needs to be personal and practical.  As Cherisse Scott, a Health Educator for Black Women for Reproductive Justice, said during a congressional briefing earlier this week, “How can you be held responsible for something you have never been taught?”  How can we expect these women to make responsible family planning decisions if they lack the knowledge to do so?  Once they are equipped with knowledge and access to contraceptives and services, these women can then make a difference in their own lives.  They are the workers and the planners of so many other aspects of society, and they have the right to become the planners of their own fertility and family size. 

For more than 20 years, USAID has recognized women for their critical role in society by celebrating the International Day of Action for Women’s Health. Today we celebrate women across the globe, across all demographics, who serve as the foundation behind strong families and communities.  But while we celebrate, we also recognize that women suffer disproportionally from inadequate health care.  Today, we join with USAID in reminding others that voluntary family planning and reproductive health services can save women’s lives in developing countries, and enable them to be good mothers and strong role models. 

Posted by Sarah Chapin, Stanback Fellow

It’s Not Time to Declare Victory

May 25th, 2010

Whether it’s aging societies or population growth, Fred Pearce wants, as Sen. Aiken famously suggested during the Vietnam War, to “declare victory, and go home.”  He has an article in the Washington Post today suggesting that the “aging” of Japan and other economically advanced nations may not be as challenging or threatening as commonly feared.  That may be true, but in the same article he suggests that the problem of global population growth is going away soon.  He says, for example, that the population of India could soon be contracting. Not so fast.  The 2009 World Population Data Sheet, released last year by the Population Reference Bureau, projects that India’s population will grow from 1.17 billion in 2009 to 1.74 billion by 2050.  Some demographers, in fact, believe that India’s population could peak at close to two billion before declining later in this century.

The challenges posed by population, both aging and growth, are real.  They need attention, not premature declarations of victory. With respect to aging societies, particularly in Europe, it’s critically important to increase the level of personal savings; simply working longer will probably not suffice to pay the bills.  The problems of an aging society are manageable, but they must be addressed or aging may not end up being “the best thing that has happened in the modern world.”

With respect to global population growth, world population is still on target to add another 2.5 billion people by 2050, and unless we do more to promote voluntary family planning, the numbers could be higher. Pearce’s optimism notwithstanding, in parts of sub-Saharan Africa and South Asia fertility rates are not falling as fast as once projected.

Unless we do more to empower and educate women in the developing world and increase access to contraceptives, the health and economic welfare of these women and their families will continue to suffer. Unless we do more to prevent unwanted pregnancies in developed nations, including the U.S., the world challenges posed by climate change and resource depletion will grow even larger.

This is no time to declare to victory.

Posted by Robert J. Walker, Executive Vice President

Kristof on Family Planning in Africa

May 21st, 2010

New York Times columnist Nicholas Kristof is on the road again, and this time his travels are taking to him Central Africa, “…where it’s easy to see firsthand how breakneck population growth is linked to poverty, instability and conflict.”  Kristof, who is traveling between Liberville, Gabon, and Luanda, Angola, is on the road with a 19-year-old university student, Mitch Smith, who won a contest that permitted him to accompany Kristoff on his journey.

I don’t know how much Mitch is learning, but Kristof ‘s most recent New York Times column, written from the Congo, gives his readers some idea of the challenges facing family planning in Africa.  Here are some of his observations: 

In almost every village we stop in, we chat with families whose huts overflow with small children — whom the parents can’t always afford to educate, feed or protect from disease.

Here in Kinshasa, we met Emilie Lunda, 25, who had nearly died during childbirth a few days earlier. Doctors saved her life, but her baby died. And she is still recuperating in a hospital and doesn’t know how she will pay the bill.

“I didn’t want to get pregnant,” Emilie told us here in the Congolese capital. “I was afraid of getting pregnant.” But she had never heard of birth control.

In rural parts of Congo Republic, the other Congo to the north, we found that even when people had heard of contraception, they often regarded it as unaffordable.

Most appalling, all the clinics and hospitals we visited in Congo Republic said that they would sell contraceptives only to women who brought their husbands in with them to prove that the husband accepted birth control.

As Kristof’s column makes clear, a lack of contraceptives is not the only reason why fertility rates have remained high in some of the least developed nations in the world.  Women who may want to have fewer children still have to overcome a host of obstacles including lack of information, misinformation, and husbands who see children as a sign of their virility.  That’s why the education of girls and the empowerment of women is just as important as the supply of contraceptives. 

He concludes that, “What’s needed is a comprehensive approach to assisting men and women alike with family planning — not just a contraceptive dispensary.”  None of this should detract from efforts to expand U.S. international family planning assistance; the need is certainly there.  But it also points to the importance of keeping girls in schools and changing social norms, like child marriage. 

Kristof today is still boucing over “impossible roads in the region,” but when he returns from Africa, he should start walking the halls of Congress and alerting members to the fierce urgency of what needs to be done for family planning in developing countries.

Posted by Robert J. Walker, Executive Vice President

Wanted: A “Pro-Life*” Movement

May 19th, 2010

Since its appropriation by the anti-abortion movement more than three decades ago, the term “pro-life” has been confined to the survival of the human fetus. The term “life,” on the other hand, is much broader than that, and extends to all forms of life, including extraterrestrial life, if such a thing exists.

The time has come for a “pro-life*” movement, one that puts the protection of biodiversity as one of our highest priorities. [The “*” is intended to clarify that we mean “all life on Earth.”]

This past week, the world received a report card on terrestrial life from the Convention on Biological Diversity, and except for human population, which continues to expand briskly, other forms of terrestrial life are not doing so well. In its third Global Biodiversity Outlook report (GBO-3), the CBD noted that the population of wild vertebrate species (what we commonly think of as animals, including birds and fish) “fell by an average of nearly one- third (31%) globally between 1970 and 2006, with the decline especially severe in the tropics (59%) and in freshwater ecosystems (41%).”

As distressing as those number are–and for anybody who is concerned about the fate of the planet or humanity those numbers are very distressing–the worst is yet to come. Ahmed Djoghlaf, executive secretary of the CBD warned in a statement: “The news is not good. We continue to lose biodiversity at a rate never before seen in history.” The GBO-3 report put it more bluntly: “swift, radical and creative action” must be taken, or “massive further loss is increasingly likely.”

 If you are not yet alarmed, consider some of the other findings in the GBO-3: 

  • Farmland bird populations in Europe have declined by on average 50% since 1980.
  • Bird populations in North American grasslands declined by nearly 40% between 1968 and 2003, showing a slight recovery over the past five years; those in North American drylands have declined by nearly 30% since the late 1960s.
  • Of the 1,200 water bird populations with known trends, 44% are in decline.
  • 42% of all amphibian species and 40% of bird species are declining in population.

These findings are consistent with warnings by biologists, like Harvard’s E.O. Wilson, that the rate of plant and animal extinction is running 500 to 1,000 times faster than before human activity began altering the planet. They are also consistent with warnings by Wilson and others that half of all animal and plant species could be endangered by the end of the century…or much sooner.

The GBO-3 report also warns that the loss of biodiversity in many critical inhabitants is approaching possible tipping points. Not surprisingly, the Amazon forest is approaching its tipping point:

 The Amazon forest, due to the interaction of deforestation, fire and climate change, could undergo a widespread dieback, with parts of the forest moving into a self-perpetuating cycle of more frequent fires and intense droughts leading to a shift to savanna-like vegetation. While there are large uncertainties associated with these scenarios, it is known that such dieback becomes much more likely to occur if deforestation exceeds 20 – 30% (it is currently above 17% in the Brazilian Amazon).

In its efforts to prevent the loss of biological diversity, the CBD puts primary emphasis on the “direct drivers” of species loss. They are: habitat loss or change, overexploitation, pollution, invasive alien species, and climate change. Each of these direct drivers is a byproduct of two “indirect” drivers, namely population growth and rising per capita consumption of natural resources.

If, however, all we do is address the “direct” drivers, without dealing with the “indirect” drivers, the cause of preventing the loss of biological diversity is almost certainly lost. Without some reduction in population pressures or a change in global consumption patterns, virtually no one expects any let up in the “direct” drivers, including climate change.

That leaves us with the “indirect” drivers. Let’s take the issue of consumption first. I do not know of a single national government that is actively pursuing a policy of lowering per capita consumption. Indeed, most countries, including our own, are engaged in a headlong campaign to boost economic output, and by implication, the consumption of material goods. Given the effects of the Great Recession, that’s understandable, but absent some serious effort to slow the human consumption that is endangering wildlife, that only leaves us with the other “indirect” driver (i.e. population). Unless we can do a more (a lot more) to avoid unwanted pregnancies, in developed and developing countries alike, the “pro-life*” movement that I am proposing will never have much success.

That’s not to say that we don’t need action on all the “direct” drivers, particularly climate change. A “pro-life*” movement, if such a movement is to be effective, should do everything in its power to preserve biological diversity–but let’s start by empowering women everywhere and giving them the information and means to avoid unwanted or unintended pregnancies. Anything less means that the Sixth Mass Extinction, which biologists warn is already under way, could be as devastating as scientists fear.

Posted by Robert J. Walker, Executive Vice President

Fifty Years of “The Pill”

May 11th, 2010

This year Mother’s Day coincided with the 50th anniversary of the birth control pill.  To say the pill has changed women’s lives is an understatement.  The pill was the first birth-control method that a woman could take without a man’s participation.  It has helped women advance in their careers and education, and has enriched their lives by giving them the power to make choices in their fertility and reproduction.

Time magazine this week writes:

By the 1970s the true impact of the Pill could begin to be measured, and it was not on the sexual behavior of American women; it was on how they envisioned their lives, their choices and their obligations. In 1970 the median age at which college graduates married was about 23; by 1975, as use of the Pill among single women became more common, that age had jumped 2.5 years. The fashion for large families went the way of the girdle. In 1963, 80% of non-Catholic college women said they wanted three or more children; that plunged to 29% by 1973. More women were able to imagine a life that included both a family and a job, which changed their childbearing calculations.

The pill has helped to lower the average family size, which has gone from 3.6 children in 1960 to 2.1 today.  After the inception of the pill, women slowly stopped identifying themselves as housewives and began moving into the workforce.  In 1970, 70% of women with children under 6 were at home, with 30% working.  Today, it’s the reverse.

Time also writes that although Title IX enacted in 1972 helped end discrimination against women in education, the pill played a large role in getting colleges and graduate schools to enroll more women.  Universities were no longer rejecting applicants for fear they would have to drop out due to pregnancy.

The pill has given way to numerous methods of birth control.  Women today do not have to remember to take a pill every day.  They now have a variety of different options, some offering more permanent protection against unwanted pregnancies.

But we still have a long way to go.  The U.N. estimates that there are over 200 million women worldwide today who want to avoid a pregnancy, but are not using a modern method of contraception.  Even here in the U.S., half of all pregnancies are still unintended.  The LA Times writes that this hasn’t changed since 1994, and that the U.S. rate of unintended pregnancy surpasses many other developed countries.  For some in the U.S. “the pill remains unaffordable and inaccessible.”

Women everywhere should be able to control their own fertility.  Girls need comprehensive sex education, and women need access to safe and affordable contraceptives.  Both domestically and abroad, the  U.S. government needs to increase funding for family planning and support efforts aimed at improving the status of women.  That would be the best Mother’s Day gift of all.

Posted by Emily Pontarelli, Program Associate

Remembering Mothers on this Mother’s Day

May 8th, 2010

On this Mother’s Day millions of flowers and cards will be sent and phone calls made by children telling their mothers’ how special they are, and what a difference they have made in their life. It is the one day a year devoted to taking time out of our lives to thank our mothers for the role they played in nurturing us.

In the U.S., most of us take for granted that our mother was there for us, however in developing countries that is not a given. Every birth brings with it risks, and many children lose their mother.

As Dr. Rajiv Shah, Administrator of the U.S. Agency for International Development (USAID), pointed out in his recent blog on the Huffington Post :

“More than half a million women lose their lives in childbirth, and many more suffer complications each year. The one-in-16 chance over a lifetime that a woman in sub-Saharan Africa has of dying as a result of pregnancy is more than 150 times greater than the one-in-2,500 risk of a woman in the United States.

…But with so many women in danger merely because they are mothers-to-be, it’s clear there is a lot more to be done. USAID has contributed to significant reductions in maternal mortality and, with continued support for family planning and maternity services, more than a million women could be saved in the years ahead.”

This high maternal mortality rate is unacceptable. The good news is that it can be lowered, a recent study released by the Lancet suggests that progress is being made in several countries, and a larger study due to be released later this year may give us a clearer view of how we are doing on reducing maternal mortality. The bottom line is that we know how to lower maternal mortality in developing countries. We know what works.

By investing in family planning internationally we can prevent unintended pregnancies, abortion, and save children and mothers. For every $100 million invested in family planning 2.1 million unintended pregnancies are prevented, 825,000 abortions are prevented, 70,000 infant deaths are prevented, and 4,000 mother lives are saved.  Investing in family planning saves lives.

That is why on this Mother’s Day I will not only take time to thank my mother for raising me to be the woman I am today, but I will also think of the woman who dies every minute due to maternal mortality. I will remember that we know what needs to be done to prevent these deaths, and I will add my voice to those demanding that the U.S. take a stand in preventing these deaths by increasing its funding for family planning and reproductive health services.  If we do that, more mothers will be able to celebrate next Mother’s Day with their children.

Posted by Jennie Wetter, Program Manager