Population Matters

The War on Women Continues

July 28th, 2011

The war on women marches on.  Planned Parenthood was not defunded, but the attack on women around the world has not let up. Last week the House Foreign Affairs Committee marked-up and passed a State Department authorization bill that would seek to legislatively reinstate the global “gag rule”.  The gag rule, which President Obama repealed by executive order in January of 2009, prevents the U.S. from funding any group internationally that even supports abortion rights, a restriction that has severely hurting family planning providers working overseas.

Yesterday the House State-Foreign Operations Subcommittee marked-up and passed the appropriation bill for the State Department and U.S. foreign assistance programs for FY2012. The bill included language that would reinstate the gag rule. According to Ranking Member Nita Lowey (D-NY):

The global gag rule – which would be unconstitutional in the United States – inserts a controversial policy into private and deeply personal conversations between a woman and her healthcare provider.  It muzzles doctors and nurses throughout the world who work for entities receiving any U.S. assistance – even in places were abortion is legal.  In real world terms, that means an expectant mother who has walked six hours while bleeding to reach the only health clinic in the region may not get the life-saving care she needs – or even a referral.  Or consider the village where the only health provider must close without U.S. assistance, denying a full range of care – including, for example, HIV screenings and treatment – to the entire local population.

However, the committee did not stop with just imposing the global gag rule; they also reduced U.S. funding for international family planning programs by $154 million, a 25% cut, and eliminated all funding for the United Nations Population Fund (UNFPA). Both of these actions would have very devastating real world consequences to the lives of women around the world.

According to the Guttmacher Institute a 25% cut in international family planning funding would result in:

  • 9.4 million fewer women and couples receiving contraceptive services
  • Almost 3 million more unintended pregnancies
  • 1.3 million more abortions (mostly unsafe)
  • 1.3 million more unplanned births
  • 7,700 more maternal deaths
  • Over 35,000 more orphans

Both of these bills still need to be voted on by the full House and Senate so there is time to tell Congress that the lives of women around the world are not something to fight ideological battles over.

Make your voice heard. Tell Congress that you support women and international family planning funding by signing the “Million for a Billion” petition, which tells Congress that the U.S. needs to boost its appropriation to at least $1 billion this year if the UN’s  goal of universal access to family planning and reproductive health programs is to be achieved by 2015: http://www.millionforabillion.com

Posted by Jennie Wetter, Program Manager

Contraception is Prevention: At Home and Abroad

July 25th, 2011

Last week, the Institute of Medicine (IOM) released a report recommending that health insurance plans should include contraceptives at no cost to patients.  This “historic” report, as HHS Secretary Kathleen Sebelius termed it, looks at contraception as a basic preventative public health measure.  The preventative benefits are straightforward: fewer unintended pregnancies improve infant and maternal outcomes.

Short birth-to-pregnancy intervals (under 2 years) are associated with a significantly increased risk of negative health outcomes including miscarriages, stillbirths, preterm births, and both higher infant and maternal mortality.  With nearly half of all pregnancies in the United States unwanted or unintended, it should come as no surprise that the country suffers from lagging infant and maternal mortality rates.

Even as one of the wealthiest countries in the world, the United States ranks below the vast majority of developed nations in both maternal and infant mortality.  Infant mortality rates in the US are comparable to those of Bahrain and Belarus and below those of countries such as Hungary, Poland, and Slovakia.  Ranked 28th in the world, the United States falls behind countries such as Slovenia, Estonia, the Czech Republic, Cyprus, and Cuba.  As for maternal mortality, the United States ranks 41st in the world according to a WHO report.

The United States also struggles with high adolescent birth rates.  Adolescent birth rates are dramatically higher in the U.S. than in other developed countries—a disparity attributed in part to the fact that birth control methods are easier and cheaper to get in these other countries.  Among sexually active teens in the United States, only 61% use some form of birth control compared to 80% in Sweden and 88% in the U.K. and France.  While these low rates of contraception in the U.S. stem in part from lack of individual ability or willingness to pay (especially for the longer-term, more effective options,) these low rates ultimately dramatically increase the financial burden on society.

From a global perspective, a report by the Guttmacher Institute and the UNFPA found that combining maternal and newborn health services AND fulfilling the unmet need for family planning would yield $1.5 billion in savings.  Fulfilling the current global unmet need would lower the cost of maternal and newborn health services by $5.1 billion.

As the U.S. already spends large amounts of money on maternal and newborn health care ($86 billion), reducing the unmet need for family planning within the United States would be expected to yield sizable financial savings.  In fact, the CDC estimates that pregnancies among adolescent girls cost U.S. taxpayers $9 billion per year.  Overall, according to the Guttmacher Institute, U.S. taxpayers spend around $11 billion per year on unintended pregnancies.

In this economically trying time, saving money while improving health seems almost too good to be true.  But if Secretary Sebelius accepts and incorporates these IOM recommendations into insurance regulations, insurance companies will start covering this vitally important preventative care, and both money and lives will be saved.  As Congress continues to look for ways to cut spending, doesn’t it make sense to protect items that actually save money both at home and abroad?

Lack of access to family planning is a global problem.  Women in the U.S. need improved access, not just women in the developing world.  Tell Congress that women everywhere should have access to family planning and reproductive health care.  Sign the Million for a Billion petition at: http://www.millionforabillion.com.

Posted by Hannah Ellison, Public Policy Fellow

Urbanization’s Effects on Dengue Fever and Malaria

July 19th, 2011

As the world population approaches 7 billion, our global society faces new challenges.  Rising energy and food prices as well as increasing water scarcity can be directly linked to a larger population and ever rising consumption levels.  However, crowding our planet may also have less obvious, although not necessarily less direct, effects on humans, including implications for urbanization and deforestation.  And the effects of such activities may extend farther than initially observed.

The percentage of people living in urban areas in Latin America has jumped from just over 41% in 1950 to 75% in 2000.  By 2025, 82% of the people in the region are projected to live in urban areas.  While cities have the potential to provide economic opportunities for more people, when infrastructure does not keep pace with this rapid pace of urbanization, slums or shantytowns often result, leading to poor living conditions.  In Latin America, 150 million people, or 40% of the urban population, lack adequate sanitation, due in large part to this rapid urbanization.

Without adequate infrastructure, urban residents are put at a much higher risk of contracting many diseases, ranging from cholera to tuberculosis.  One of these diseases is dengue fever, which is spread by mosquitos.  This incapacitating and, at times, deadly disease has been on the rise in Latin American cities since the 1980s.  While the population of the particular mosquito vector was controlled in many places in Latin America from the 1950s until the mid-1970s, as the vector found more and more breeding grounds in the low-quality city conditions in which they thrive, disease rates increased.  In Mexico, by 1998, more than 75% of the population (around the regional average) lived in urban areas.  In the decade or so that followed, the number of dengue cases in the country increased by more than 600%.

Similarly, deforestation, which is driven by urbanization and the growing demand for cropland, has had negative impacts on human health—impacts that extend beyond the effects of reduced carbon sequestration and overall climate change.

While deforestation has slowed in recent years, dropping from an annual loss of 8 million hectares to 5 million hectares between 1990 and 2011, Brazil experienced a 27% jump in deforestation in the 8 month period between August 2010 and April 2011.  As trees are cut in order to accommodate a larger population and the land and timber are used for farming, development, building, or the production of biofuel, it is not simply the plant and animal life that suffers.

Deforestation and urbanization have not only driven dengue rates higher but have also increased rates of malaria.  Malaria, a disease that infects 250 million people every year, has been found to increase in deforested areas.  In fact, a Brazilian study published in the journal Emerging Infectious Diseases found that a 4.2% increase in deforestation yielded a 48% increase in malaria incidence.  The malaria mosquito vector thrives in the open pools of water that collect in deforested areas, while their growth is not nearly as efficient in the water that collects under the rainforest canopy.

As the pressures of urbanization and continued population growth stretch the current capacities of our society, it is important to anticipate new and re-emerging challenges, like malaria and dengue fever, before they reach epidemic proportions.

Fortunately, fertility rates in many parts of Latin America have fallen sharply in recent decades as family planning services and information have become more widely available.  Latin America, however, still suffers from widespread income inequalities, and health services for the poor still lag in many areas.  Without a greater commitment to meeting the reproductive health needs of poor women, Latin America will continue to suffer from unacceptably high maternal and infant mortality rates, while also wrestling with dengue, malaria, and other diseases that accompany urbanization and deforestation.

Posted by Hannah Ellison, Public Policy Fellow

Birth of a Nation

July 14th, 2011

After struggling for over 50 years to gain independence, a fight that has cost millions of lives, the Republic of South Sudan on Saturday July 9th became an independent country and today was made the 193rd member state of the United Nations. That is the good news; unfortunately the bad news is very bad. South Sudan will now become one of the least developed countries in the world with many development indicators even well below the levels in northern Sudan, as illustrated by an interactive map on the Guardian website.

South Sudan is facing many challenges and will need assistance in many areas for the foreseeable future. One of those areas where the need is urgent is in the area of maternal and reproductive health. In northern Sudan 638 women die per 100,000 live births, however in South Sudan the maternal mortality rate is triple that level with 1,989 women dying per 100, 000 live births.  Last week, Nicholas Kristof pointed out that a girl in South Sudan is three times more likely to die in childbirth as become literate. This is a tragedy.

The good news is we know what works. We need to prevent mothers from dying in childbirth by investing in maternal health care and family planning. Around the world we have seen that by investing in family planning services and information we can prevent unintended pregnancies, abortion, and save children and mothers. It is one of the most cost effective interventions that can save women’s lives. 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. It works elsewhere and it can work in South Sudan.

So while South Sudan is celebrating the birth of their nation, let us not forget all the women in South Sudan who lose their lives giving birth.

Posted by Jennie Wetter, Program Manager

7 Billion and Counting

July 11th, 2011

Today, on July 11, World Population Day, the United Nations made it official:  world population will cross the 7 billion mark on October 31, 2011, just twelve years after the 6 billion mark was attained. But there was no ribbon cutting or popping of champagne corks to commemorate the occasion.  In a world suffering from climate change, water scarcity, and the rising price of food and energy, population growth is a challenge, not a cause for triumphal celebration.

Population quadrupled in the 20th century, and despite the escalating demands that humanity was placing on the planet, the human enterprise prospered. Food production quadrupled, mortality rates dropped dramatically, human longevity doubled, and living standards soared.  Best of all, as the century came to a close, the costs of oil, minerals, and basic food commodities fell to near historical lows.  Malthusian fears were virtually extinguished.

Today, as the world approaches the 7 billion mark, confidence in the human enterprise is not so high.  After decades of progress in reducing hunger and severe poverty, a global recession and two global food crises have slowed and, in some cases, reversed recent gains.  Even more worrisome is an almost decade long trend of higher and higher commodity prices for energy, minerals and basic food stuffs.

At a minimum, the eras of cheap energy and cheap food appear over.  If so, the fight against hunger and severe poverty will get a lot harder.  It already has.  While significant progress continues to be made in India, China, and other parts of East Asia, gains in the rest of the developing world are grudging at best.  A report released earlier this month on the U.N. Millennium Development Goals indicated laudable progress in areas like education, access to safe drinking water, and infant and child mortality. But the U.N. warned that “we still have a long way to go in empowering women and girls, promoting sustainable development, and protecting the most vulnerable from the devastating effects of multiple crises, be they conflicts, natural disasters, or volatility in prices for food and energy.”

Thus far, the 21st century has not been kind to the world’s least developed countries.  When the 2007-8 food crisis hit, the price of rice tripled, the World Bank warned that 33 countries were at risk of political upheaval, and over 100 million people slipped back into poverty.   During the latest food crisis, corn and wheat prices doubled, food importing countries in North Africa and the Middle East were hit hard, governments began toppling in the ensuing unrest, and an estimated 44 million were pushed into poverty.

The critical question, the one that really matters, is whether the food situation is becoming a chronic food crisis.  Oxfam International, a leading hunger relief organization, issued a report last month suggesting that due to climate change and other factors, food prices—which are already high by historical standards–could double or more by 2030. 

In order to feed a hungry world, the FAO estimates that food and grain production will have to increase by 70 percent in the next forty years to keep pace with rising population and a global shift to more meat-intensive diets.  In a world afflicted by rising temperatures, increasing droughts and floods, shortages of arable land, water scarcity, loss of topsoil, and the escalating costs of fertilizer and fuel, that’s a tall, if not impossible, order.  In its recent report, Oxfam international warned that “a new age of crisis” could force “the collapse of our global food system.”

Every day another 200,000 people are added to the world’s dinner table, and unless fertility rates drop faster than expected, that trend will continue for some time to come.  And many of those additional mouths to feed are being born in countries that are already heavily dependent on external food aid for survival.  Some countries, like Niger and Burkina Faso, could triple their populations by mid-century unless fertility rates drop faster than now projected. 

When the number of hungry in the world increases, so does the challenge of providing emergency relief. Even today, the World Food Programme, the UN’s emergency relief agency, is not able to raise the money it needs to feed an estimated 10 million people now affected by the near record drought in the Horn of Africa.

And it’s not just poor countries in sub-Saharan Africa that are struggling with bad harvests and high food prices.  A leading Pakistan authority, Dr. Abid Suleri, recently told reporters that food insecurity in his country is leading to political instability.  With the percentage of “food insecure” people in Pakistan rising from 37 percent in 2003 to 49 percent before last year’s devastating floods, he warned that the Pakistani people “can be easy prey for terrorism, including suicide attacks. If we are going to fight terrorism we need to provide food security.”

Unless we successfully address the 21st century challenges posed by population growth, food insecurity and water scarcity, many of the 20th century gains that we made in improving the human condition could be reversed.  In addition to assisting developing nations with food production and water conservation, we urgently need to keep girls in school, empower women, and make sure that family planning services and information are more widely available.  Then we can celebrate, not just observe, World Population Day.

 Posted by Robert J. Walker, Executive Vice President