by Jay Gribble, vice president, International Programs
It’s especially interesting to have a reproductive health advocate and activist offer keynote comments at a meeting of researchers, mainly economists who have a high standard of evidence. Yet Professor Fred Sai, an extraordinary man whose international experience spans decades, offered his insights into the movement of reproductive health transitions on a global scale and within sub-Saharan Africa. And drawing on a combination of his observations and experiences, Professor Sai made the case to the audience of economic demographers that an understanding of the policy environment is critical to the development of evidence-based policies. Given that one of the key reasons for the creation of the PopPov network is to support an evidence base to better understand the relationship between reproductive health, population growth, and economic development, Professor Sai’s message helped set the tone for the 6th annual PopPov network conference and reinforced the importance of strong evidence that can be explained to policymakers.
One of Sai’s observations was related to the use of family planning in the continent. In Eastern and Southern Africa, about 40 percent of married women use modern family planning; in contrast, use in West Africa is much lower—in Ghana, one of the regional leaders in family planning, fewer than 20 percent of women use modern family planning; in other countries, such as Mali, only about 4 percent of married women use family planning.
Fred Sai speaking at the 6th Annual PopPov Network Conference in Accra, Ghana. Photo: PRB.
In spite of low prevalence, many leaders and advocates argue that family planning is a woman’s right—a point that most people take for granted and about which few would argue. Although the language of human rights is used, Professor Sai made a point that is vital to understanding what having a right really means. “A right is not a right if the citizenry is unaware nor can they be fulfilled without government provision to the people.” Professor Sai makes a keen distinction that separates the language that many policymakers use and the reality of millions of women and couples around the world. If people don’t know about family planning, then how can they be expected to exercise their right to decide on the timing and spacing of having children? Similarly, if governments do not work to make family planning information and services available to the public, than it is complicit in not holding up the rights of their citizen. Without both knowledge of and access to family planning, the rights of millions of women and men cannot be achieved.
So, you’ve spent the past couple of years narrowing down your research question, developing your research model, collecting and analyzing data, conducting field work, and writing. Now your paper, with some major findings that can have a big impact on policy, is about to be published. Now what? How do you reach policymakers with your research? How can you affect change? These are fundamental questions being addressed by the PopPov network’s annual conference. The Honorable Joy Phumaphi, former minister of health of Botswana and vice president at the World Bank, focused her discussion on what to do and what not to do when approaching policymakers to be effective in her commentary on the close of the third day of the conference.
“You have to communicate in the same way they are thinking,” she said. Above all, policymakers, especially in low-income countries, are concerned with economic growth. In her experience, Phumaphi explained, they don’t see population growth as a major concern. In fact, since they want a larger market size to develop their economies, population growth can actually be beneficial. So framing the need for family planning services by connecting it population will not address their concerns. “You need to highlight benefits that address policymakers’ concerns, not your concerns,” said Phumaphi.
She gave a couple of examples from her own career.
Navrongo, a rural district in northern Ghana that faced high infant and under-5 mortality and where women averaged over 5 children each 20 years ago, was the focus of an innovative and influential public health project from the early 1990s to 2002. Based on the network and infrastructure of an existing vitamin A supplementation program that had started in 1989, the project was ambitious and wide-ranging. It included providing bed nets for malaria prevention, treating and preventing anemia in pregnancy, restructuring the way health services were delivered, combating Female Genital Mutilation, providing family planning services, and more. In a few years, quality health services were available for the first time and the fertility rate and under-5 and infant mortality rates had declined sharply.
Dr. Fred Binka, the former director of the Navrongo Health Research Centre and current professor at the School of Public Health at the University of Ghana joined a panel of Ghanian Ministry of Health officials and researchers at the PopPov conference to discuss the Navrongo project and its wide-ranging effects. Three points struck me from the panel presentation and discussion:
This week, a bunch of us from PRB are in Accra, Ghana for the 6th Annual Research Conference on Population, Reproductive Health, and Economic Development as part of the PopPov Research Network. The Population and Poverty Research Network (PopPov) was created in 2005, when the William and Flora Hewlett Foundation formed partnerships with funding agencies and program implementers, bringing together researchers from leading higher education institutions worldwide. PopPov’s goal is to provide clear evidence that investing in reproductive health can provide economic benefits at both the household and country level, and how to reach policymakers and donors with these messages. This week, conference participants will present their ongoing and completed research on population, reproductive health, and economic development; identify gaps in evidence and methods that inhibit the development of sound policies on population and economic development; and discuss examples of the influence of research on policies and how to communicate research findings to policymakers.
We’re honored to be co-hosting the conference with the University of Ghana. Fred Sai, Former Presidential Advisor on Reproductive Health and HIV/AIDS, will give the keynote address tomorrow. I’m excited to hear his perspective on the progress and challenges since the International Conference on Population and Development (the “Cairo conference”) in 1994. (Dr. Sai was the chair of the conference’s Main Committee.) Since then, the focus of global family planning efforts has shifted to women’s rights and empowerment, for women to be able to decide the family size they desire and have control over their fertility. Donor funding and programming for family planning is increasing, but the links to economic development is not as clear. And with many other public health and development issues competing for donor and policy attention, strong evidence is needed. I expect Dr. Sai, and the conference in general, to discuss many of these issues.
Throughout the week, I’ll be blogging from Accra and interviewing researchers on various population and economic issues and their implications for public policy. Stay tuned for more posts from Accra and quite a few videos on the PRB site over the coming weeks. Want to learn more about the conference? Visit the PopPov website for the agenda, conference paper abstracts, and more.
The Cameroon 2011 Demographic and Health Survey – Multiple Indicator Cluster Survey is the fourth DHS in a series that began in 1991. As so often observed in sub-Saharan countries, the birth rate decline has “stalled” at a high level and, in Cameroon’s case, for quite some time. The survey interviewed 15,426 women ages 15 to 49 and 7,191 men ages 15 to 59 from January to August, 2011. The total fertility rate (TFR — the average number of children would bear in her lifetime if the birth rate of a particular year were to remain constant) obtained in the survey was 5.1 for the three-year period preceding the survey. For urban women, the TFR was 4.0 and, for rural women, who were a 46.1 percent of the sample, 6.4. The TFR in the 2010 DHS was actually slightly higher than that obtained in the 2004 survey, when it was 5.0 nationally, and 6.1 for rural women while that of urban women remained unchanged. TFR decline came to an end in Cameroon from 1998 onwards as can easily be seen in the figure below. In the survey, 49.3 percent of women with five living children said they did not wish to have any additional children and 64.9 percent of those with six or more children also said that they wished to cease childbearing. Of those two groups, the percentage who declared themselves to be sterile or who were sterilized was 5.1 percent and 5.9 percent, respectively.
In the survey, 23.4 percent of currently married women said that they were using some form of family planning, with 14.4 percent using a modern method. Use of the male condom accounted for more than half of modern use at 7.6 percent, followed by 3 percent using injectables, and 1.9 percent using the contraceptive pill. Reported contraceptive use was similar to that in the 2004 DHS, which was 26 percent for all methods and 12.5 percent for modern methods. (In the 2007 MICS, contraceptive use was reported as 39.7 percent for all methods and 17.6 for modern methods. TFR data were not collected.)
by Mark Mather, associate vice president, Domestic Programs
In the U.K., they are called NEETS, people who are “Not in Employment, Education, or Training.” In Spain and Mexico, they have been called Generation Neither-Nor. We have them in the United States too, and their numbers have increased since the onset of the recession—especially among men. A new report by PRB shows that the percent of young men ages 25 to 34 who are neither working nor attending school increased sharply between 2007 and 2010, from 14 percent to 19 percent. During the same period, the share of women who were not working and not in school remained steady at 26 percent. Part of this gender difference can be explained by women’s earlier age at marriage, compared with men.
Percent Distribution of Young Adults Ages 25-34 by School Enrollment and Employment
Status, 2007 and 2010
Men (%)
Women (%)
School Enrollment, Employment Status
2007
2010
2007
2010
In school, working
8
8
10
10
In school, not working
3
4
4
5
Not in school, working
75
69
61
58
Not in school, not working
14
19
26
26
Source: U.S. Census Bureau, American Community Survey.
A new United Nations Environment Programme (UNEP) report, Women at the Frontline of Climate Change: Gender Risks and Hopes, released at COP-17, says that women, particularly those living in mountainous regions in developing countries, “face disproportionately high risks to their livelihoods and health from climate change, as well as associated risks such as human trafficking.”…
"Climate change vulnerability," courtesy of Riccardo Pravettoni, UNEP/GRID-Arendal.
It is the poorest people whose lives are most undermined by changes in the weather, said Chair of the Global Leaders Council for Reproductive HealthMary Robinson at a side event on “Healthy Women, Healthy Planet” during COP-17 in Durban, South Africa. “When farmers don’t know how to predict the seasons, when there is more flooding than there was, when there are longer periods of drought and then flash flooding,” she said, people need more resilience. “They have to be even stronger in being able to cope with the drought and flooding.”…
by Jason Bremner, program director, Population, Health, and Environment
This past week at the 2011 International Conference on Family Planning, four practitioners from the field traveled from remote parts of Democratic Republic of Congo, Ethiopia, Madagascar, and Tanzania to Dakar, Senegal to share their successes and challenges in reaching remote communities with an integrated package of health, livelihood, and environment services. Together they made up the panel, “Reaching the Hardly Reached: Delivering Family Planning Through Population, Health, and Environment Integration.”
Left to right: Didier Mazongo, WWF; Vik Mohan, Blue Ventures; Baraka Kalangahe, Tanzania Coastal Management Partnership; and Jason Bremner, PRB at the "Reaching the Hardly Reached" panel discussion.
The panelists came from four environmental organizations whose starting point for working in these remote places was the protection of the biodiversity and natural resources upon which all life depends. Dr. Vik Mohan, physician and medical director for Blue Ventures, talked about how he and his organization transitioned from focusing initially on the conservation of coastal marine reserves and coral reefs to now working to improve health care, including access to family planning. Blue Ventures, in response to community and women’s needs, opened a family planning clinic, and on the opening day 20 percent of the women of reproductive age in the community came out to request contraceptives. Today they offer a whole spectrum of short- and long-acting contraceptive methods through partnerships with Marie Stopes International, Population Services International, and various funders. Blue Ventures reported that contraceptive prevalence had risen from 8 percent when they began in 2007 to 35 percent today.
Another of our panel participants, Dr. Didier Mazongo, had traveled from the remote jungles of the Congo Basin where he’s been working with World Wildlife Fund (WWF) to improve the lives of some of the most underserved people in the world. WWF-DRC has been working with communities in and around Salonga National Park in central Democratic Republic of Congo to improve community wellbeing, decrease dependency on unsustainable use of forest resources, improve reproductive health, and ensure the long-term conservation of the biodiversity of the Salonga National Park. Dr. Mazongo shared the experiences from WWF-DRC’s program and Jane Goodall Institute’s (JGI) program in the conflict-torn North Kivu Province. In both areas the projects began with women reporting absolutely no access to family planning services because they were completely beyond the reach of government and other development organizations services. Both WWF and JGI face extreme transportation challenges just to reach these communities and ensure consistent contraceptive supplies, but their dedication to the communities and their responsiveness to people’s needs has opened new opportunities for them to work more closely with communities on conservation.
by Jay Gribble, vice president, International Programs
ICFP 2011 has ended and now we are heading on to our next destination, some back home, some to conferences in Ougadougou and Durbin, and others on to places to continue their work. But as I think back on the past few days, I am struck by how complex our field is. I think the conference did a great job not only of drawing out the range of issues that fall within this expanding field of family planning and reproductive health, but also in showcasing some of the most interesting research and programmatic experiences to help us understand how the field is advancing.
One of the conference topics that caught my attention was contraceptive security. In Uganda, I hardly remember a session addressing these issues, but in Dakar, I saw several sessions that focused on innovative financing approaches, the total market approach, social franchising models for family planning, and tracking funding for family planning. The fact that this topic is so visible at ICFP 2011 is encouraging and reflects the great work that groups such as the Reproductive Health Supplies Coalition and others are making on focusing attention on the fact that commodities don’t just magically appear in facilities. Their being there is the result of in-country and international donor policies, forecasting and supply chain processes that work, and funding available to pay for supplies, not to mention the trained personnel who counsel clients and provide services.
by Jay Gribble, vice president, International Programs
As part of World AIDS Day, ICFP 2011 included a special session on the recently published The Lancet article that found an increase—a two-fold increase—in the risk of contracting HIV among women who use injectable contraceptives. One of the speakers, a professional journalist, focused her comments on how she covered the study and how responsible journalists might cover such studies. I found her comments especially interesting given PRB’s longstanding work in training journalists to better understand health and population issues.
One of her points that stood out in my mind is the weighing of risks and benefits—a critical aspect of the ethical considerations of undertaking a study that involves human subjects. Evaluating risks and benefits is useful in helping an individual decide whether to participate in a study. While there isn’t necessarily an algorithm that can help individuals estimate their own risks and benefits, risks and benefits are frequently expressed at an aggregate level, based on the experience of all people participating in the study.
by Jay Gribble, vice president, International Programs
