PSN has contributed to parliamentary hearings on maternal morbidity being undertaken by the All Party Parliamentary Group (APPG) on Population, Development and Reproductive Health.
Maternal morbidity: common yet overlooked
Maternal morbidity refers to illness and injuries related to pregnancy and childbirth. While maternal morbidity leaves 10 - 20 million women and girls every year with long-term physical, psychological, social and economic problems, many conditions and complications are treatable and preventable.
For this reason, in July 2008 the APPG on Population, Development and Reproductive Health launched an inquiry to increase understanding of this injustice, and to promote action to address this common yet overlooked health issue.
In September PSN and roughly fifty other individuals and organisations responded to the APPG's call for evidence and submitted written evidence to the hearings. On 8 December PSN’s Karen Newman also provided oral testimony to the hearings at Westminster.
PSN’s input to the hearings argued that the high incidence of preventable maternal morbidity in developing countries must be viewed as a violation of women’s rights, and focused on the opportunities that exist to significantly reduce maternal mortality by increasing access to voluntary family planning programmes.
UPDATE May 2009
The APPG’s report of the maternal morbidity hearings Better off Dead? has been published and is available here.
SOURCE: The Guardian
Cities such as Mumbai and Dhaka are referred to as metacities: cities so big that they stretch the megacity definition.
Rise of the metacity
Dhaka has seen its population double in the past 15 years, Mumbai in the past 25. Both are chasing the magic 20 million mark, when they become "meta", and both have swelling slums cramming the inner city, and extending around the periphery. Over half Mumbai's population lives in slums. In some parts they say there are 50,000 people living to one square kilometre. People living this close get sick, and pregnant.
Mehrunisa and Zosna, two women in their 30s living a country apart, are both expecting babies. It's Zosna's second, and Mehrunisa's fifth. Zosna, who lives in a Dhaka slum, is apprehensive about giving birth. Mehrunisa just wishes the whole thing wasn't happening. She lives in Shivaji Nagar, a slum on the outskirts of Mumbai, 12 miles and a world away from the cool marble of the mayor's residence. It's built on the city's biggest dump and crawls with flies and goats. The huts seem to grow out of the filth and trash, flapping with loose plastic and Vodafone adverts torn from walls to make roofs. Scraps of tarpaulin wave like flags in the wind. She is sanguine about her new child: "I have no choice now."
Choice is a rare commodity here. Shivaji Nagar is a socially conservative, predominantly Muslim slum, where husbands and mothers-in-law rule and an unwritten code says that women should be having children. Contraception and abortion are viewed with profound suspicion.
Nasimbee, a neighbour of Mehrunisa, lets rip. "Why should I have another child?" She's already had five and now does her family planning on the sly. It's not hard, she says, since her husband "lost his brain" to drink and drugs: "He won't find out, he can't find out." These women are conducting a covert operation, fighting their husbands, their culture, the system. And once they've battled with the family, problems await.
Mehrunisa has stomach pains and wants to get an ultrasound, but can't afford it. Even if she could, the machine in the municipal hospital has been broken for years. Anita Shenoy, a tired-eyed doctor at the single public clinic that serves the 600,000-strong slum admits they struggle to meet demand: "There is a big queue here in the morning ... people can't wait." Instead they go to private clinics but these, she adds, are often bogus — fake doctors with made-up qualifications trying to make a quick buck by selling sham drugs.
A thousand miles north, the Dhaka slum rises out of water, not rubbish. Shacks are built on bamboo stilts, and black streams froth with pollution beneath. The local ward commissioner Anhaj Mahmud has a mantra for what's happening on his patch: "Population and corruption, corruption and population." His brother Mohammed, a wealthy property developer, is more specific: "Me? I have one son, one daughter. Look over there, they have six ..." But Zosna and her neighbours have a different take: "We all know that two children is a happy family." After two, they have an injection or go on the pill. Their mothers, they say, had five or six children. Not them. These women are lucky though — they live within reach of a Marie Stopes clinic that doles out contraception and advice.
Everyone agrees with the ward commissioner on one thing. Corruption is everywhere, from the party leaders banged up on corruption charges, to the forestry department official who was busted with wodges of cash stuffed in his pillowcases. Department for International Development health adviser Fran McConville describes the country as a "paradox". Bangladesh has made extraordinary social progress, especially in health. But this is thanks to what she describes as a "phenomenally strong NGO community": in other words, despite the government, not because of it. It's a picture the director general of family planning seems happy to endorse.
She says the government has a "lack of manpower" in the slums and that it's up to the NGOs.
Masudus Salehin, a Marie Stopes programme manager working in the Dhaka slums, feels the weight of this responsibility, and questions whether the government shouldn't carry more of it. "We're not able to reach all the houses ... there are lots of gaps." He knows there are still women who have no idea how much easier they can make their lives by choosing how many children they have, and when. In Mumbai, Dr Shenoy echoes his frustration. If there could be another public clinic, if services could be made more available, it would be different.
But in the Victorian corridors of the Municipal Corporation of Mumbai, the agenda seems to be elsewhere. Dr Phatak raises his voice: "The slum dwellers aren't as poor as you think. They can easily earn 100 rupees [a little over a pound] a day." He claims they have "the easiest interface with the municipal health structure" and that the corporation's focus is not on primary healthcare and local clinics where women like Mehrunisa could get vital family planning advice, but on rural services and the hospitals in central Mumbai.
His solution for the slums is to wish them away. It's a policy of repulsion. "We don't give them facilities. We make it difficult for them to live here. But we can't remove them and throw them away because our country today allows people from anywhere to go anywhere so it is very difficult to uproot these people." He looks almost wistful.
Awaiting prosperity and recognition
Mehrunisa does not want to be uprooted. This is home, dump and all. And the slums will never magically vanish; Mumbai is a magnet to people all over India. They're going to keep coming, and they're going to keep having children.
Dr Phatak hopes that Mumbai's "prosperity" will match its population. It might. But the women in the slums won't see much of it. For that to happen the corporation must first recognise them, then accept that this city is their home, and then provide them with the services they so desperately need.
PSN Co-ordinator Karen Newman recently addressed delegates at the EuroNGOs annual meeting in Lyon, France as part of a debate examining the the capacity to approach population growth issues and their interface with climate change, from a rights-based perspective.
The EuroNGOs AGM held in Lyon France was attended by over 40 NGOs, funding bodies and academics working in the field of sexual and reproductive health and rights, development and population issues.
The conference theme was The interface between Population, Environment and Poverty Alleviation. The event therefore provided an opportunity to address the relationship between climate change and population growth, at the same time as discussing possibilities and challenges for sexual and reproductive health and rights advocacy against the background of the 1994 UN International Conference on Population and Development (ICPD) and the Millennium Development Goals (MDGs).
Preparing for ICPD at 15
Building upon the strategy workshop held earlier in the year, EuroNGOs used the conference agenda to extend the debate on the relationship between climate change and population growth, to other organizations and stakeholders.
The event also presented an opportunity for members to coordinate efforts in the forthcoming year over the ICPD at 15 strategy and the planned international events to mark the date.
Considering the ethical issues
At the event PSN's Karen Newman delivered a presentation on Ethical Dimensions of Addressing Population Growth Issues.
Karen's presentation is available here.
SOURCE: Irin News
Being an exhausted mother of 10 children by your early thirties is not unusual in rural Madagascar, but a PSN-backed movement is now underway to try and provide women with a contraceptive choice.
Balancing family planning and conservation
"I often get women in the clinic who have had eight or more children and are desperate to stop," said nurse Rebecca Hill, who has been running a family planning clinic in Andavadoaka, a remote village in southwest Madagascar, for the past six months. "They are all too pleased to have a break, and family planning can allow that to happen. But there is a huge unmet need for these facilities here, and that needs to change."
Madagascar, an island renowned for its unique biodiversity, is struggling to balance the demands of conservation with the needs of a rapidly growing population that has doubled in the last 25 years, reaching 19.6 million in 2007, according to UN figures. It is expected to hit 43.5 million by 2050.
Urgent need for family planning in rural areas
Family planning initiatives in the cities have met with some success, but there is still a significant lack of contraceptive services in rural areas. "Reaching isolated communities is the real issue," Andre Damiba, country director for Marie Stopes International (MSI), a reproductive health agency, told IRIN.
According to the government, in some parts of the country 70 percent of 16-year-old girls have already given birth to their first child. In recognition of the problem, the Ministry of Health has taken the unusual step of changing its name to include family planning.
The government has also made family planning one of the eight pillars of the Madagascar Action Plan (MAP), an ambitious economic and social development strategy recently launched by President Marc Ravalomanana.
The MAP sets two ambitious goals for family planning: reducing the average size of the Malagasy family "to improve the wellbeing of each family member, the community and the nation"; and comprehensively meeting the demand for contraceptives and family planning. It plans to do this by making contraceptives more widely available, providing educational programmes and reducing unwanted teenage pregnancies.
But the impact of the government's efforts is yet to be felt in the remote villages of southwest Madagascar. Here, isolated coastal communities - among the poorest in the country - depend on dwindling marine resources that are under direct pressure from population growth in the villages, and health care and family planning services are extremely limited.
"A woman in the village of Andavadoaka who wanted to access contraceptive services faced a 50km journey on foot to Morombe, the nearest town, or would have to pay for passage on a passing ship," explained Dr Vikram Mohan, founder of the clinic in Andavadoaka. "In cities there are good contraceptive services available; in remote areas like ours most organisations can't offer a service."
''We are raising awareness not just about women's rights, but about their economic and social interests and about how they can take control of their lives''
Efforts to ameliorate pressure on the fragile ecosystems
The Andavadoaka clinic is funded by a British charities, Blue Ventures Conservation (BVC) and Population and Sustainability Network. The link between population growth, the lack of family planning facilities and the increasing pressure on fragile natural resources prompted the organisations to establish the small clinic.
"The work being done by BVC to enable coastal communities to manage their resources sustainably ran the risk of being undermined by the mushrooming population of the community," said Mohan. "In addition, an awareness of sexually transmissible infections and a willingness to take precautions was low."
A recent UNAIDS survey in Madagascar found that only 12 percent of young men aged between 15 and 24 used a condom the last time they had sex with a casual partner. For women, the figure stood at 5 percent.
Damiba believes that intensive awareness raising campaign are needed, especially in rural areas where conservative traditions prevail. "It is only through the sensibilisation of communities that we can get behavioural change," he explained. "As long as people's behaviour doesn't change there is no way of reaching the goals laid out by the government in the Madagascar Action Plan."
For this reason, family planning is about more than just promoting the use of contraception; it is also about empowering women to make fundamental decisions that affect their health and lives. "Society here still lacks some understanding of what women's rights are," said Damiba. "We are raising awareness not just about women's rights, but about their economic and social interests and about how they can take control of their lives."
The women are learning fast. "Family planning is good for us," said Veleriny, a member of the Andavadoaka women's association. "It allows us to control when we give birth. Here some women become pregnant every year."
The government uses the media to promote contraception, and international partners have become more active. "Access to family planning facilities is improving," Lalah Rimboloson, deputy director of US-based Population Services International (PSI) in Madagascar, told IRIN. "Between 2004 and 2006 we saw a significant increase in the use of family planning. The government is encouraging organisations like PSI to increase their work."
But national statistics do not always reflect the situation in remote areas. In 2007 the UN Population Fund (UNFPA) estimated the national fertility rate was 4.94 children per family. At the Andavadoaka clinic, nurse Hill estimates that in the remote coastal villages of the southwest it is as much as 8 to 12 children per family.
"We must have services made available permanently to those people who need them," urged Damiba. "Services must be permanent, not just available once in a while," otherwise real progress risks being limited to urban areas.
But the ambitious goals will be hard to meet. "I think that the targets of the MAP are reachable," said Rimboloson, "but not with the government's efforts alone; it has to be with all partners involved in family planning in Madagascar."
Damiba agreed. "Even a small impact in a remote community can have a ripple effect in terms of helping to spread understanding and raise awareness of the issue. Everything counts. Family planning is really needed here."
Population and Sustainability Network was pleased to join other international organisations co-sponsoring this years World Population Day event held at the Houses of Parliament on the 14th July 2008.
The event which was hosted by IPPF and the All Party Parliamentary Group on Population, Development and Reproductive Health marked World Population Day with addresses by Gillian Merron, MP, Parliamentary Under Secretary of State for International Development, and Sarah Brown, Chair of the White Ribbon Alliance.
The event was attended by organisations working in the field of sexual and reproductive health and rights, Ministers, Parliamentarians and Peers, Ambassadors and other high level decision makers and sought to raise the profile of population growth issues and the implications for poverty alleviation efforts and international development.
Other Co-Sponsors included FPA, Action Aid , Human Rights Watch, Marie Stopes International, White Ribbon Alliance and Women and Children First.
Transcripts of speeches made at the event are on the IPPF website.
SOURCE: U.S. Census Bureau
The world population is projected to reach 7 billion in 2012, according to updated world population estimates and projections released today by the U.S. Census Bureau.
The US Census Bureau's International Data Base (IDB ) provides information on population size and growth, age and sex composition, mortality, fertility and net migration. The data are available for 226 countries and other selected geographies.
This revision to the IDB includes updated projections for 34 countries and compared to previous estimates, and indicates that the world population will be 146 million larger in 2050.
The Census Bureau's latest projections show world population growing at a slower pace during the first half of the 21st century than the latter half of the 20th century. The world population doubled from 3 billion in 1959 to 6 billion in 1999, but is projected to increase by only 50 percent between 1999 and 2040.
Global population growth, about 1.2 percent per year, is projected to decline to 0.5 percent by 2050. However, this growth will be concentrated in less-developed countries.
About 1.5 percent of the current global population is 80 or older, with more than half living in developed countries. By 2050, about 5 percent of the world's population is projected to be 80 or older, with about three in four likely to be living in less-developed countries. For developed countries, the percentage of the population 80 or older will grow to about 10 percent in 2050.
The impact of HIV and AIDS
World population estimates and projections include the impact of HIV and AIDS. Of the 34 countries updated in this revision, nine are hard hit by this pandemic (Benin, Côte d'Ivoire, Eritrea, Ethiopia, Guinea, Nigeria, South Africa, Zimbabwe and the Central African Republic).
The International Data Base offers online users a choice of ways to retrieve demographic data, including:
Population and Sustainability Network was pleased to participate at a conference on Sexual and Reproductive Health and Rights, Environmental Degradation and Climate Change, co-hosted by the EuroNGOs network and the European Parliamentary Forum (EPF) in Istanbul.
An international event
The event which took place on May 15th and 16th brought together 32 representatives from the Sexual and Reproductive Health and Rights (SRHR), humanitarian and environmental sectors from the EU member States, the USA and Africa in order to further understanding on the linkages between population issues, climate change and the environment.
Representatives from UNFPA, WHO, IPPF, Population Action International, DSW, World Watch Institute and Global Footprint Network were some of the international delegates at the two day event.PSN discusses ethical considerations of population issues
PSN’s new coordinator, Karen Newman, spoke in the same session as Frances Kissling, Former President and founder of Catholics for Free Choice, whilst addressing the ethical considerations implicit with SRHR and population related issues.Cross-sector partnerships are needed
PSN also led a workshop with delegates to examine the links and further discussion about the impact of the population factor on environmental degradation and the links between climate change and population.
With the combined knowledge from the SRHR and environmental sector, lively discussion ensured, and stimulated by a diverse range of presentations, concluded that there is pressing need for further partnership between the two sectors.Examining the implications
The findings also emphasised that this relationship is multifaceted and densely nuanced with a great need for further research, since while experts agree that there is a connection between population and environment, with the current paucity in empirical findings the exact relationship will remain contested territory.
Given the emerging interest in the relationship between population growth, other general demographic trends, and climate change the strategic workshop was an important initial step within Europe to encourage discussion and examine the implications for donors and policy makers.Moving Forward
PSN plans to build upon this initiative with a proposal to hold an International Forum with government specialists, academics, policy makers and NGO personnel in order to map out key target areas for research and subsequently appropriate policy responses.
Further information about the conference and the presentations is available on the EuroNGOs website.
PSN is delighted to announce that Karen Newman is taking over coordination of the Network from Catherine Budgett-Meakin from the beginning of May, 2008.
Karen worked for IPPF from 1982 till 2003, focusing in the later part of that time on policy and governance issues, with a special responsibility for sexual and reproductive health and rights. She was one of the main architects of the IPPF Charter on Sexual and Reproductive Rights.
Since 2003 she has carried out a range of consultancy work, including assignments for DFID, WHO, UNFPA, Interact Worldwide, Amnesty International and IPPF Arab World, East and South East Asia and Western Hemisphere Regions. Her breadth of experience in terms of subject area and regional knowledge will be of considerable value.
More staff developments
PSN is also delighted to announce that Louise Carver has been appointed to help develop our communications strategy. Louise has been working with us for some time but now we are able to formally consolidate the appointment.
Catherine Budgett-Meakin will continue to work actively alongside the new team.
In a special addition of the Bulletin of the Atomic Scientists on Population and Climate change, Martin Desvaux and PSN Board member John Guillebaud discuss the issue of peak oil.
Population and consumption: not an either-or
Joe Chamie calls targeting unintended fertility a "delay tactic" that hinders the immediate pursuit of reducing resource consumption. Again, we want to reiterate that we don't view this as an either-or proposition. Instead, to avoid catastrophic climate change, we believe that the international community should pursue the methods that Fred Meyerson describes below to reverse population growth and ways in which to reduce resource consumption.Diminishing oil reserves
The time we have available to achieve both of these goals is key. As stated previously, the United Nations currently projects (pdf) that world population will reach about 9 billion by 2050. Meanwhile, David Rutledge at the California Institute of Technology recently looked at projections for the depletion of conventional oil, gas, and coal reserves based on the application of M. King Hubbert's technique for determining peak oil and estimated that, by 2076, 90 percent of these reserves will be gone.
This is a much shorter timescale than previously believed--especially for coal, where mainstream predictions had indicated up to a 250-year supply. Rutledge's projections for coal production take into account new assessments of the recoverability of coal reserves, which may not be as accessible as once thought, and it's possible that earlier coal forecasts were based on current usage rates and didn't factor in acceleration from population growth and increased affluence. Several countries have already severely downgraded their reserves: In 2004, Germany, the largest coal producer in the European Union, reduced its estimated black coal reserves by 99 percent and its brown coal reserves by 80 percent.Rising energy costs and scarcity
Aside from the devastating climate effects of burning all our fossil fuel, if demographers and Rutledge are correct, in less than 70 years, humankind will number 9 billion and energy will be scarce and expensive. Assuming that current growth in renewables and nuclear energy could provide 60 percent of the current world energy needs by 2075, Rutledge lays out the stark challenge facing humankind: Cut energy demand to 40 percent less than it is today and reduce global population to around 5 billion. We think this population target is still too high, given that Routledge doesn't take into account attrition in agriculture and land availability by that time.Family planning must be prioritised
Because nearly one-half of the world's population is under the age of 25, placing them in the midst or still ahead of their childbearing years, reversing population growth cannot be achieved before 2050. Only a catastrophic die-off could make it happen sooner. The alternative is Fred's top-tier prioritization of voluntary family planning, plus education and media outreach now. Further delay means that we must contend with nearly a billion extra humans to feed and clothe every decade.Developing countries deserve a better deal
It's all very well and good to say, as Joe does, that in Africa, "per-capita emissions are already so low that lower birthrates would not make a noticeable dent in total global emissions." But this implies tolerating an appalling status quo: Who among us doesn't passionately want to see the poorest people of the world escape their unacceptable poverty? It's not difficult to understand that one less person born into poverty is one less person who needs to be helped out of poverty--a development process that cannot occur without increased energy consumption and (in the medium term) more carbon-dioxide emissions per person.
The data we gave in our first post showed that in 2003, Africa had a per-capita ecological footprint of 1.1 global hectares (gha) against an available bio-capacity of 1.3 gha per person. In other words, more than a 17.6-percent increase in Africa's population will make it impossible for even underdeveloped states to sustain their current populations due to space, energy, and (especially) water constraints. As Africa doesn't have the same buffer of wealth as the developed countries possessed when they crossed the line of unsustainability, that process will have a much harsher impact on Africans. One of us (John Guillebaud) was born and brought up in Burundi and Rwanda, and from recent visits, he knows firsthand how many sub-Saharan African countries are already on the verge of demographic entrapment. Once the environmental carrying capacity is grossly exceeded, the only likely outcomes are starvation, disease, inter-ethnic violence and genocide, migration (and to where?), and/or dependence on aid from the international community.
In a special addition of the Bulletin of the Atomic Scientists on Population and Climate change, Frederick A. B. Meyerson argues that the are many reasons why increasing access to voluntary family planning should be a top international priority.
Family planning protects climate and human wellbeing
There is agreement in our discussion about the need to provide family planning, reproductive health services, and related education to everyone on the planet in a non-coercive way.
There's also general agreement that doing so would reduce unintended births, slow population growth, and reduce greenhouse gas emissions, thereby helping with climate change mitigation and adaptation. One difference is that several of us, myself included, feel that stopping emissions growth and climate change will be unattainable without universal, effective family planning programs and population stabilization.
The international community should restore the goal of universal access to family planning as a top-tier priority, to protect both the climate and human wellbeing. How can we satisfy current unmet need for contraception and reproductive health services? It is a matter of both political will and money.
About 200 million women in developing countries would like to prevent or delay pregnancy but can't because they lack access to effective contraception. Reaching and helping these women and their partners is critical for climate and human development policy. A consensus of population and health care scientists and organizations estimates that developed nations would need to donate $5 billion per year (almost ten times the current levels) to reach these women with family planning services. (See " Family Planning and Reproductive Health: The Link to Environmental Preservation" [PDF] for more). While this is a significant amount, it's small in comparison to other expenditures. For instance, the United States spends more than $5 billion on the Iraq war every two weeks, and the same amount on Medicare programs every few days.
Looking to the United States
The United States should take the lead. The largest and most effective international family planning program in history was pioneered by the United States Agency for International Development (USAID) in the 1960s. The United States continues to be the largest donor globally to international family planning efforts. However, since the 1980's, decay in funding levels, quality of programs, and political support-along with inflation--has caused the U.S. international family planning programs to fall behind in constant dollar terms and in relation to the needs of a global population growing by more than 75 million people per year.
If the United States were to increase its assistance for population programs by $1 billion annually, and other donor countries contributed their share, it should be possible to satisfy the global unmet need for family planning within five years. As a result, the population growth rate could be reduced by about 30 percent, with a similar decrease in the growth of greenhouse gas emissions.
Much of the technical knowledge about family planning resides in U.S. institutions (nongovernmental organizations, foundations, and universities), and U.S. political and technical leaders could quickly revitalize this field. The United States could work closely with the U.N. Population Fund; the World Bank; European organizations, and other donor countries; as well as NGOs such as the International Planned Parenthood Federation, the Planned Parenthood Federation of America,Pathfinder, and the Population Council to quickly and strongly push forward on international family planning. Past efforts have shown how effective noncoercive programs can be, even in extremely poor countries such as Bangladesh and Kenya; and these programs have many other social and developmental benefits.
Developed countries, beginning with the United States, also need to improve their reproductive health services and education. For instance, the United States should be able to lower its unintended pregnancy rate from nearly 50 percent to around 20 percent, the current rate in several European countries, as discussed in my earlier comments. If the Netherlands can do it, the United States can, too. Decreasing unintended pregnancy rates in America would slow population growth and greenhouse gas emissions.
Universal access to family planning is no panacea, nor is it sufficient on its own to achieve population stabilization. We should discuss population education and media programs that affect the demand for services and their effectiveness in subsequent rounds of this debate. But lowering unintended fertility is the necessary first step toward population stability-and the climate mitigation and adaptation benefits that come with it.