SOURCE: The Guardian
Blue Ventures has increased contraception use from 10% in 2007 to 55% today. What can the global health community learn?
Significant increase in contraceptive use
The national contraception use rate in Madagascar is 29%. Yet in Velondriake, a remote area in the southwest of the country, it is 55%. Just 10% of the community were using contraceptives in 2007 when the marine conservation organisation Blue Ventures launched Safidy, its family planning programme. So how did Blue Ventures do it?
Safidy, which means choice in Malagasy, was born out of a desire to help the communities Blue Ventures was working with. The area had virtually no health infrastructure and a focus group revealed a huge need for family planning. Agathe Lawson, the United Nations Population Fund representative in Madagascar, who supports Blue Ventures and a number of other family planning initiatives in the country, says that asking the community for what it wanted was instrumental to Safidys success. Sometimes we can pre-empt what people want but qualitative research is essential.PHE success storyWhat is less obvious is why a conservation organisation would take on the work of a health NGO. We took it on because no one else would, and because it would benefit our work, says Dr Vik Mohan, Blue Ventures medical director and the brain behind Safidy.
The case for population, health and environment (PHE) initiatives isn't new: population growth puts pressure on natural resources. Mohan says that around 20% of the worlds population lives in biodiversity hotspots. Population growth in these hotspots is 40% higher than in other areas because they are often remote and with few health or education services. Yet there are plenty of conservation organisations working in biodiversity hotspots whose resources or networks could be used to provide additional services to local communities. Lawson says that programmes that combine environment or livelihood issues with population services create what she calls a chain of connectivity whereby people are much more aware of the balance between humans and their environment.
Filling the gap in healthcare provision
Blue Ventures initially sought to partner with Marie Stopes to provide family planning services in Velondriake but the area was too remote for it to provide its usual services. So instead it decided to train community-based distributors (CBDs), local women who would be able to counsel and prescribe contraceptives. It was a cost-effective method, which promoted local capacity and built on the community-based approach Blue Ventures was championing in its conservation work.
Jennifer Pope, the deputy director of the Sexual Health and Tuberculosis Department at PSI, says that with a general shortage of healthcare workers in developing countries, the CBD model is an attractive option because it fills a gap whilst allowing the few medical professionals to focus on more complicated issues.
CBDs in Velondriake received training from PSI and Mohan, a practicing GP in the UK. All CBDs can prescribe the pill and sell condoms but only the more senior CBDs can do contraceptive injections (which last three months).
Longer-acting methods such as implants and coils are provided by Marie Stopes four times a year at a mobile clinic. Pope says that this chain of referral is essential to uphold women's free and informed choice and ensure they have access to the contraceptive method that best suits their circumstances. She adds that the pricing structure must also be set so that cost doesnt influence the patients choice.
Fertility rate reduction
Velondriake now has 32 CBDs who cover about 40 villages. CBDs buy contraceptives at cost from PSI (Blue Ventures pays for the transport) and sell them at a small profit. The service is highly valued by the community and since 2007, the fertility rate has dropped by 40%.We chose to do everything in-house but there is no reason it has to be that way, says Mohan. You could partner with a health provider but if you can integrate effectively, you can get great synergies between these different activities.
Blue Ventures initially thought Safidy would be integrated into the health system (the health ministry has been involved since the start) but with the political crisis that followed the 2009 coup, it is unlikely to happen in the near future. Some 400 primary health care centres have closed in Madagascar since 2009, according to Lawson.
Pope says that there are many ways CBD initiatives can cut costs down by piggybacking on the private sector for their supply chain or working with other organisations – be they private, public or non-profit – to lower overheads and build sustainability.
Expanding service provision
For the time being, Blue Ventures is expanding Safidy to Belo-sur-Mer, another area in southwest Madagascar and as a result of its experience in Velondriake, the programme was up and running in just four months.
We do not have the contraception prevalence rate that Blue Ventures has anywhere else in Madagascar, says Lawson. It means that their strategy works and we must continue to give them support.
This article, published by The Guardian, has been reproduced by PSN. Minor changes, cuts and additions may have been made for the purpose of brevity and relevance.
PSN welcomes the focus on global population dynamics that has resulted from Hans Roslings exposure in the BBC TV programme, Dont Panic: the truth about population, on 7th November. Yet disappointingly it lacked appreciation of the critical role that family planning has played in reducing population growth, which cannot be taken for granted in the future.
The missing link
Using state of the art graphics, Hans Rosling’s BBC programme, Don’t Panic: the trust about population, provided a statistical rundown of the state of the world’s population, and asked us to “upgrade our world view”.
There is no question that his graphic presentation of global population growth trends tells a dramatic story, and that part of that story – that world population growth is slowing - is true.
However, much of this is due to the success of family planning programmes, the funding for which is not secure in a global environment within which international development funding is threatened.
It is estimated that, in 2012, an estimated 645 million women of reproductive age (15–49 years) in the developing world were using modern methods of contraception; and it was estimated that this contraceptive use prevented 218 million unintended pregnancies, which, in turn, averted 55 million unplanned births, 138 million abortions (40 million of them unsafe), 25 million miscarriages and 118,000 maternal deaths (Guttmacher Institute, 2012).
We welcome Rosling’s analysis, but would emphasize the importance of continuing to fund family planning programmes, and of advancing sexual and reproductive health and rights.
How else are we to reach the 222 million couples in the world who say they do not want a child in the next two years, but are not using a modern method of contraception, in many cases because they do not have access to family planning services.
SOURCE: Huffington Post
The sun is setting on the Millennium Development Goals (MDGs). In 2015, the world will shift its focus toward a new development agenda. Support for family planning must be strengthened if broader development goals are to be achieved.
The importance of a focus on family planning
We know that family planning improves the health and well-being of women and families around the world.
Now, as the next-generation goals expand the focus from social and human development to also include economic and environmental objectives, we should not underestimate the positive ripple effects of family planning across all three areas.
Let's first remind ourselves of family planning's connection to all eight MDGs.
Looking to the future
Moving beyond 2015, the three health-related MDGs are likely to be condensed into one goal (Ensuring Healthy Lives). It is reassuring to see that "ensuring universal sexual and reproductive health and rights" is among the five sub-targets proposed within this goal.
Moreover, exciting new support for family planning has been generated by passionate champion Melinda Gates and through global movements like Family Planning 2020.
This promising momentum will not realize its full potential, however, without bold, outside-the-box approaches that reach people with family planning information and services.
Given family planning's wide-ranging benefits, we must now strengthen support for it in development sectors beyond health.
Sharing the evidence on the extensive reach of family planning's positive effects is a first step.
Yet, equally important is raising awareness of the close linkages between challenges presented by lack of access to family planning, rapid population growth, food insecurity, environmental changes and stalled economic growth.
The fastest growing regions of the world have the highest unmet need for family planning and high projected declines in agricultural production, and are the most vulnerable to climate changes.
At the community level, this perfect storm presents a complex set of pressures, producing simultaneous higher demands for food, effective contraception and climate adaption.
At the national level, most developing country policies acknowledge that rapid population growth inhibits their efforts to reduce extreme poverty, ensure food security, preserve the environment and improve overall standards of living.
Policymakers must acknowledge importance of family planning
Unfortunately, many policymakers ignore the critical role that family planning can play in tackling these obstacles. It is an oversight that could eventually be quite costly.
Without investing in improved access to family planning, many fast-growing countries could erase important gains made in environmental conservation, impede preparations for climate change and reduce the returns on improvements made in education and gender equality.
And, they could miss the opportunity to leverage the same "demographic dividend" that helped East Asian countries rapidly accelerate economic growth and development.
As we enter a new development era, we need to continue showing how investments in typical family planning programs can help achieve broader development goals.
Furthermore, we need to work harder to promote new and innovative entry points for family planning information and delivery.
Through embracing integrated, multi-sectoral development solutions such as family planning, we can accelerate progress and fulfil our promises to the next generation.
This article, published by FHI 360 for Huffington Post, has been reproduced by PSN. Minor changes, cuts and additions may have been made for the purpose of brevity and relevance.
SOURCE: David Johnson Too Much Too Many
Too Much Too Many follows David Johnson's six month South African road trip. This article provides a taster of the 100 articles hes writing from 100 locations, each highlighting a different population or consumption impact on South Africa's diverse communities, breathtaking landscapes and iconic wildlife.
Personal stories, population and consumption impacts
At a Soweto landfill site a "waste picker" uses his iPhone. His meagre livelihood is generated by salvaging food and other items from the dump. He found the working discarded iPhone amongst "trash". He’s not alone; many of the waste pickers have smartphones discarded by far wealthier people believing only the most recent model will do. A few kilometres north, a black eagle soars above suburban Johannesburg's Walter Sisulu Botanical Gardens. Rapid urbanisation around the gardens threatens the eagle’s ability to hunt. The ridge system is suitable not only for the eagle’s prey but also those wanting to live in the rapidly multiplying homes of the new build security estates. These are the realities of increasing, and unequal, consumption in South Africa, as well as population growth. Yet population and consumption growth do not gain much media coverage. Many issues remain taboo. Much of the writing is academic.
In April 2013, David commenced a six month nationwide journey seeking to write 100 articles on how population and consumption growth affect the country. He’ll look at the impacts on communities and their living standards, wildlife and landscapes. Too Much Too Many seeks to increase awareness by highlighting personal stories rather than focusing on statistics and theories.
A chance to save wilderness, benefit people
Findings from the 2011 South African census showed that there were 51.7 million people living in South Africa, an increase of eleven million in fifteen years. Yet South Africa has neither a particularly high population growth rate nor, given its geographical size, a notably high total population. Compared with the UK for example, South Africa is five times the size of the UK, with 11 million less inhabitants. South Africa therefore has a remarkable opportunity to address consumption and population impacts, for the benefit of both the country’s people and the natural environment upon which they depend. One such instance is the opportunity to save some of the country’s remaining wilderness areas.
The loss of wilderness is an obvious side effect of population and consumption impacts, but wilderness is not only important for the preservation of landscapes, migration routes and biodiversity. The Square Kilometre Array (SKA) is a €1.5 billion global science project to build the world’s largest and most sensitive radio telescope, the core region of which will be in South Africa. Radio telescopes need sites lacking man-made radio interference, such as that created by cell phones. Scottish Astronomer Russell Johnston explains “the unpopulated Northern Cape of South Africa is one of the few places left on earth where we can do this. There’s no area left in Europe without man-made radio interference which is large enough to host something like the SKA”. That’s worth repeating. The SKA which seeks to establish the nature of dark-matter, investigate the validity of Einstein's theory of relativity and perhaps even detect life elsewhere in the universe could not be undertaken anywhere in Europe, where the Soweto waste pickers’ iPhones would have reception pretty much continent-wide. The impact of increased cell phone coverage could have prevented South Africa (and the world) from being able to construct the planet’s most important telescope.
It is through highlighting a broad range of diverse and surprising population and consumption impacts like this that David hopes to increase awareness.
Keep up to date
South Africa’s unique situation makes looking at its population and consumption impacts controversial. David intends to highlight how these impacts are threatening not only South Africa's wildlife and landscapes but also the health and well-being of South Africa's people, particularly the poor. The solutions he is searching for must be systemic and for the benefit of the people as well as the landscapes and wildlife.
On 30th October 2013- UNFPA launched the State of the World Population report 2013 entitled “Motherhood in childhood: facing the challenge of adolescent pregnancy”.
Adolescent pregnancy widespread
The report spotlights the high rates of teenage pregnancies in developing countries – 7.3 million every year – and calls on Governments to help girls achieve their full potential through education and adequate health services.
The State of World Population 2013, produced by the UN Population Fund (UNFPA), notes that out of the 7.3 million births, 2 million are to girls who are aged 14 or younger, which means that 20,000 girls give birth everyday.
Many young mothers suffer grave long-term health and social consequences from pregnancy such as obstetric fistula, and an estimated 70,000 adolescents in developing countries who die each year from complications during pregnancy and childbirth.
“Too often, society blames only the girl for getting pregnant,” said UNFPA Executive Director Babatunde Osotimehin.
“The reality is that adolescent pregnancy is most often not the result of a deliberate choice, but rather the absence of choices, and of circumstances beyond a girl's control. It is a consequence of little or no access to school, employment, quality information and health care.” he said.
Re-examinging the causes and effects
The report seeks to offer a new perspective on teenage pregnancy, looking not only at girls' behaviour as a cause of early pregnancy, but also at the actions of their families, communities and Governments.
Early pregnancy takes a toll on a girl's health, education and rights. It also prevents her from realizing her potential and adversely impacts the baby. A country's economy is also affected by teenage pregnancies as adolescent mothers are prevented from entering the workforce.
In Kenya, for example, if the more than 200,000 teenage mothers had been employed instead of becoming pregnant, $3.4 billion could have been added to the economy.
Similarly, if girls in Brazil and India had been able to wait until their early 20's to give birth, the countries would have greater economic productivity equal to more than $3.5 billion and $7.7 billion, respectively.
The report notes that countries must not only increase efforts to prevent teenage pregnancies, they must also invest more in girls as the currently the global community directs less than two cents of every dollar spent on international development to adolescent girls.
Holistic approach needed to tackle issue
In addition to funding, the report stresses that to tackle teenage pregnancy, countries must adopt a holistic approach which does not dwell on changing girls' behaviour.
Instead it should seek to change attitudes in society so girls are encouraged to stay in school, child marriage is banned, girls have access to sexual and reproductive health including contraception, and young mothers have better support systems.
“We must reflect on and urge changes to the policies and norms of families, communities and governments that often leave a girl with no other choice, but a path to early pregnancy,” said Mr. Osotimehin.
This article, by UN, has been reproduced by PSN. Minor changes and cuts may have been made for the purpose of brevity and relevance.
The Population and Sustainable Development Alliance (PSDA) has published a new briefing, Population Dynamics, Reproductive Health and Sustainable Development: Critical Links and Opportunities for Post-2015.
Critical links for post-2015
The publication by The Population and Sustainable Development Alliance highlights the importance of population dynamics and sexual and reproductive health and rights (SRHR) for the post-2015 international development agenda, setting out the links between population dynamics and SRHR and key sustainable development issues.
The development priorities that a focus on population and SRHR can help advance include: gender equality, education, poverty alleviation, health, food, water and energy security, environmental sustainability and biodiversity preservation.
According to the briefing;
“Population dynamics set the scale and determine the shape of the development challenges we face, reflecting the number and location of people requiring access to water and sanitation, food, health and education services. Yet an estimated 222 million women in developing countries are at risk of and want to avoid pregnancy, but have an unmet need for contraception. Demography is not destiny; achieving universal access to reproductive health, including access to voluntary family planning services offers opportunities to reduce population growth and pressures, while advancing women’s rights and improving human health and wellbeing.”
The briefing makes a number of recommendations for ensuring the necessary focus on population dynamics and SRHR in the post-2015 agenda, alongside other necessary interventions, including those addressing unequal and unsustainable patterns of consumption and other pressing drivers of social inequalities and environmental degradation.
To address population dynamics in ways that respect and protect human rights, the post-2015 international development framework must:
Prioritise universal access to sexual and reproductive health and rights, including family planning, as part of a Sustainable Development Goal (SDG) on health: Complete the unfinished business of MDG5 and the full implementation of the Programme of Action of the International Conference on Population and Development.
Devise forward-looking goals: SDGs, targets and indicators must be forward-looking, based on projected changes in population size, location and age structures which influence demand for and supply of key resources and essential services.
Sectorial planning should utilize population data: Planning for water and sanitation facilities, food security, health and education services etc., and overall development strategies, must be informed by systematic use of population data and projections.
Use population data to address inequalities: Monitoring and reporting mechanisms should use data and indicators disaggregated by sex, age, rural/urban location, educational background and economic quintile, to ensure development goals benefit all.
Invest in the cross-cutting issues of health, education, gender equality, empowerment of youth and human rights:The critical investments offer opportunities to improve human health and well-being and advance each of the three dimensions of sustainable development.
Launch at EuroNGOs conference
The briefing was launched at the 2013 EuroNGOs conference which took place on 24th October in Berlin, on the theme of SRHR in the post-2015 development agenda.
At the conference, PSDA hosted an interactive ‘Market Place’ stand and discussions, including a quiz on population, and SRHR and sustainability linkages. As well as launching the briefing and a new PSDA leaflet, resources were shared from PSDA’s Southern members about integrated Population Health Environment approaches.
Read the briefing: Population Dynamics, Reproductive Health and Sustainable Development: Critical Links and Opportunities for Post-2015.
PSN has published a Population and Climate Change Fact Sheet, updated with the latest UN population data and projections, and those of the Intergovernmental Panel on Climate Change.
Population and climate change: interlinking pressures
The UN has published revised population projections which state that the world population is expected to increase by around 3.7 billion by the end of the century, and the vast majority of growth will be concentrated in developing countries.
The Intergovernmental Panel on Climate Change (IPCC) has also published new data on climate change which states that scientists are now 95% certain that human influence on the planet is the cause of global climate change. Despite having contributed the least to climate change, developing countries are the most vulnerable to climate change, the impacts of which are likely to be exacerbated by population pressures.
These are just some of the complex, yet critical linkages addressed by the fact sheet.
The fact sheet presents key statistics and analysis on the following links and issues:
The impact of climate change on development objectives is illustrated by the following quote by Ban Ki Moon, UN Secretary General, April 2013 -
"Climate change is the greatest threat to all our development objectives and the health of economies large and small in all regions. The poor and vulnerable will be hit first and worst, but no nation will be immune."
On 15th October 2013, PSNs board member, Professor Judith Stephenson, gave a lunch time lecture on population growth, global health, economic development and climate change at University College London.
The lecture focused on population growth, global health, economic development and climate change, which are some of the big challenges we face in the 21st century. The talk took a historical look at how they are interconnected, and called for a "second age of enlightenment" to guide us through different solutions to these issues in the future.
Professor Stephenson's presentation was based on her paper published this past summer which was a follow-up to Population Footprints.
Population Footprints was a major international symposium which took place in 2011, hosted by UCL and Leverhulme Trust, it brought together academics and activists to stimulate new thinking in the area of population dynamics and global carrying capacity. PSN played an active role helping to shape the event; Karen Newman, PSN Co-ordinator and John Guillebaud, PSN Board member were members of the UCL Advisory Committee for the symposium.
Read Professor Stephenson's presentation: Global growth versus human health finding the balance.
Further information can be found on the UCL website.
SOURCE: The Huffington Post
On todays UN International Day of the Girl Child, Executive Director of the United Nations Population Fund (UNFPA), Dr. Babatunde Osotimehin, calls for women and girls to be kept at the heart of Development.
We still have a long way to go
As world leaders reviewed progress towards achieving the Millennium Development Goals (MDGs) at the United Nations General Assembly last month, some observers and development experts rightly reminded us that we still have a long way to go. This is particularly true for efforts to save women's and girls' lives and to fulfil their reproductive rights -- the aim of MDG 5 on maternal and reproductive health.
In the 21st century, no woman should die bringing new life into the world, especially since we know how to prevent maternal deaths. With just over 800 days remaining to the MDGs deadline, we must combine our efforts to tackle the top causes of maternal death and prevent unintended pregnancies.
Preventable interventions have fallen short
Just four conditions are responsible for 70% of maternal deaths: post-partum bleeding, high blood pressure, general infection and complications due to unsafe abortion. Thousands of women's and girls' lives could be saved by just providing access to medicines and health supplies.
Although the leading causes of maternal death are largely known, effective interventions to prevent such deaths have fallen short of current needs. Increasing access to basic medicines and clean health supplies, for instance, could save the lives of tens of thousands of women every year. And many more deaths could be averted if women and girls could access contraceptives to plan their pregnancies. Yet, over 200 million women still lack access to this basic need.
We know much more than we did just a few years ago about these conditions and how to prevent them. We also know that achieving MDG 5 -- and its two targets, to reduce maternal mortality and increase access to reproductive health -- will help achieve other development goals.
Moreover, it's smart economics: Evidence suggests that investment in reproductive, maternal, newborn and child health has a potential return of more than $20 for every dollar spent. However, commodities alone cannot solve the problem of maternal death. Substantial investment will also be required to ensure that these supplies can actually reach the women who need them.
UNFPA is working hard to promote sexual and reproductive health in more than 150 countries, and to ensure that women and girls have the information, services and supplies they need to have a safe, healthy and fulfilling life. They are also working to make key drugs and health supplies universally available and to increase access to family planning.
UNFPA will further step up its initiatives so that all women and girls who want to use safe and effective family planning methods receive relevant information and high-quality services. The aim is to prevent an additional 120,000 girls and women from dying unnecessarily, the target set by MDG 5.
When reproductive health services are provided to women, many newborn deaths are also prevented. For both mothers and their newborns, the period of delivery and the hours immediately afterwards are critical.
Likewise, when women and girls are given the means to prevent unwanted pregnancies and space births, maternal and child deaths can be significantly reduced.
60% of all maternal deaths take place in 10 countries
Just 10 countries account for more than 60 percent of all maternal deaths worldwide. By implementing key interventions in these priority countries, we will be able to achieve MDG 5 on time. This will provide the impetus we need as we move beyond 2015 to push for the end of all preventable deaths and ensure the health and human dignity of all women and their families.
But we must collectively recommit to achieving MDG 5 and make it happen everywhere. To do so, we need to decide that women's and girls' lives are worth saving, and that they have the right to equal access to health care. It's a political decision that can make a huge difference in the lives of women and girls.
Addressing the persistent inequalities that negatively affect women's and girl's health is our unfinished business. It's also the key to truly equitable, sustainable development. That's why we believe that women and girls must be at the heart of any future development policies.
This article, by Dr. Babatunde Osotimehin and published by The Huffington Post, has been reproduced by PSN. Minor changes and cuts may have been made for the purpose of brevity and relevance.
SOURCE: HelpAge International
HelpAge International's Global 'AgeWatch' Index 2013 is the first index of its kind to measure the quality of life and wellbeing of older people around the world. Its development will help contribute towards the creation of the next International Development framework, ensuring that older people are included and better represented.
Can the 'post-2015' International Development framework embrace us all from our cradles to our graves? Can we be inclusive enough to bring all age groups into the 'post-2015' agenda? What would this mean? These questions were some of the many debated at the UN Secretary General’s special event on the Millennium Development Goals in New York last week.
The point was made that the next International Development framework has to look at population dynamics and meet the needs of young people but also of older people (60+), who by 2030 will make up 16% of the world’s population and outnumber children under 10.
First-ever ageing index
HelpAge International launched the Global AgeWatch Index 2013 on UN International Day of Older Persons on Monday. It is the first ever index to measure the quality of life and wellbeing of older people around the world. The Index shows the need for better policies and programmes to improve responses to ageing, especially in developing countries. Absence of data on ageing is one of the biggest obstacles to understanding and successfully managing the speed and rate of the world’s ageing population.
The Index measures the social and economic wellbeing of older people in 91 countries in terms of their income security, health status, their work and education opportunities, and enabling social environments. The 91 countries of the Index provide results for a diverse group of countries at different stages of development and with different proportions of older people. They cover 89% of people over 60 in the world.
What can the index tell us?
The Index emphasises the need for better data to track, monitor, and implement specific policies that are necessary for older people to live securely, in good health, with dignity and free from fear and discrimination. It responds to Ban-Ki Moon's call for a "data revolution" to ensure no one is left behind in the ‘post-2015’ International Development framework. If this is to be achieved older populations must be included among those who are counted. Currently the shortage of data on older people is systematically excluding them from development plans and public policy provision.
Countries that have a record of progressive social welfare policies for all their citizens across the life-course are more likely to age well. Investments in pensions, education and healthcare, employment and training in the long term and throughout the life-course pay social and economic dividends for individuals and for societies, helping to break the cycle of poverty that is passed from one generation to the next.
Over the past decades, a number of governments in Asia, Africa and Latin America have introduced non-contributory basic pensions. Such programmes have enormous and long lasting impact as they provide secure incomes and better health for people in old age and long-term benefits too, through investments by older people in family and community, which lead to a more secure and healthier older age.
HelpAge International say that the Global AgeWatch Index represents a beginning. It takes the first steps in establishing a full understanding of the lives of older people around the world.
Read the full report: The Global AgeWatch Index 2013 report.
This article by Jane Scobie, published by HelpAge International, has been reproduced by PSN. Minor changes, cuts and additions may have been made for the purpose of brevity and relevance.