Today, Census Bureau Director Robert Groves is headed to Noorvik Alaska to kick off the 2010 Census enumeration of the U.S. population. By mid-March, the Census Bureau will have mailed out more than 120 million questionnaires to residential addresses around the country. Earlier this month, the Census Bureau also launched its $133 million advertising campaign to boost awareness of the census and why it’s important.

A report released last week by the Pew Research Center showed that 9 in 10 people know about the census and understand that it’s important, but getting everyone to send back their completed forms is another matter. Nearly one in five people are ambivalent about participating in the once-a-decade enumeration of the U.S. population. Among those who said they won’t participate, most reported they are either too busy, not interested, or don’t know much about the census. But more than one-fourth of the census doubters—those that keep Census Bureau staff up at night—said they either don’t trust the government, don’t think the census is important, or have concerns about invasion of privacy.

There is more at stake here than the accuracy of the data. For every 1-percentage-point increase in the initial mail-back response rate, taxpayers save up to $90 million in costs associated with in-person, follow-up interviews to collect the missing information. For more information about the 2010 Census and why it’s important, visit PRB’s website.

“16 Days of Activism Against Gender Violence” began on the International Day for the Elimination of Violence Against Women (November 25th) and ended on International Human Rights Day (December 10th). The theme of this year’s campaign, “Commit, Act, Demand: We Can End Violence Against Women,” was well-addressed in an event that PRB and PATH, co-chairs of the Gender-based Violence Task Force of the Interagency Gender Working Group, organized on December 3rd. “Working with Men to Stop Violence,” featured several of the most prominent leaders in the field: Gary Barker, Director of Gender, Violence and Rights at the International Center for Research on Women; Pat McGann, Vice President for Communications for Men Can Stop Rape; Todd Minerson, Executive Director of the White Ribbon Campaign  and Dean Peacock, Co-Director of Sonke Gender Justice, based in South Africa. Each of these organizations works internationally on issues related to men and violence. Gary and Dean also co-chair the MenEngage Alliance, an international network of more than 400 groups promoting the positive engagement of men in reproductive health.  Gary’s presentation and others from this symposium are available on the IGWG website.

Gary Barker, Director of Gender, Violence, and Rights at the International Center for Research on Women, speaks at the PRB and PATH-organized event, “Working with Men to Stop Violence.”

Photo credit: Charlotte Feldman-Jacobs, PRB.

Why all the attention to violence against women? WHO’s 2005 Multi-Country Study on Women’s Health and Domestic Violence Against Women provided the first cross-cultural documentation that gender-based violence is pervasive and pernicious, affecting women in every social and economic strata and during every stage of their lives. The evidence that between 15 percent and 71 percent of women in 10 countries have ever experienced physical or sexual violence by an intimate partner has enabled a greater focus on gender-based violence and interventions to prevent it.

With gender-based violence more prominent on the development agenda than ever before, Gary Barker asked, “How do we take advantage of the interest in violence prevention?” Barker noted that early results from the new the International Men and Gender Equality Survey (IMAGES), which is documenting the extent of violence against women in at least nine countries, support the need for a “relational approach” to gender and gender-based violence, to counteract the expectations that men and women share and reinforce for one another, that men must be dominant and aggressive and that women must be submissive.

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Secretary of State Hillary Clinton’s speech on Friday, Jan. 8 commemorated the 15th anniversary of the International Conference on Population and Development (ICPD) in Cairo but could reasonably be called the “No Woman Left Behind” speech.

The Secretary extolled the Cairo Conference as a milestone in proclaiming that “women’s health is essential to the prosperity and opportunity of all, to the stability of families and communities, and the sustainability and development of nations.”  She reminded us that the 1994 Conference set specific targets to be met by 2015—to provide evidence of improvement in women’s health care; reductions in infant, child, and maternal mortality; of education for all, but especially for girls and women. These improvements will lead to sustainable development and economic growth — all the while contributing to gender equality, equity, and the empowerment of women. It’s a short time frame with a tall order, especially given the lack of progress in reducing maternal mortality in the last 15 years.

Secretary Clinton listed some of the great achievements that have been made towards these 2015 targets in the increased use of contraceptives, in reducing the spread of HIV/AIDS from mother to child, in improving neonatal and child health, in the number of girls in school, and in the widespread realization that gender needs to be mainstreamed into the entire range of global programs.

However, she rightly pointed out, “vast inequities remain:” Women and girls are the majority of the world’s poor - too many unschooled, unhealthy, underfed, and bearing the brunt of gender-based domestic abuse as well as brutally violent national and regional conflicts.

The statistics Clinton threw down to illustrate that woman are the downtrodden of the earth are very familiar to many of us: one woman dies every minute of every day in pregnancy or childbirth, and “for every woman who dies, another 20 suffer from injury, infection, or disease every minute;”  215 million women lack access to modern contraceptives to prevent unplanned and unwanted pregnancies, a contributing factor in “the nearly 20 million unsafe abortions that take place very year.”  And she noted that millions of women and girls suffer the pain and indignity of such crippling conditions as obstetric fistula and of sexually transmitted infections which they have neither the power nor the information to prevent. Calling specific attention to Female Genital Mutilation (by its “gentler” term Female Genital Cutting), Clinton noted the resulting serious infections and injuries during child birth, but she might have added that it also robs women of their sexual pleasure and indeed  has been outlawed in many countries where it occurs. But, Madame Secretary, far more than 70 million girls and women have been subjected to this cruel tradition. The latest figures show that 100-140 million girls and women worldwide have undergone FGM/C and more than 3 million girls are at risk for cutting each year on the African continent alone.

Moving from the problems to the solutions, Secretary Clinton emphasized “Investing in the health of women, adolescents, and girls is not only the right thing to do; it is also the smart thing to do.” She said the Administration’s commitment and actions will be guided by Cairo’s excellent “roadmap” through:

• New funding to achieve Millennium Development Goal Five (improving maternal health and achieving universal access to contraception)
• The re-funding of UNFPA
• Working with the Congress to appropriate nearly $650 million to family planning and reproductive health programs worldwide
• The Global Health Initiative (GHI), the crown jewel in this administration’s “women-centered approach.”

While the exact strategy of the GHI has not been revealed, $63 billion will be committed over the next six years to prevent millions of new HIV infections; reduce maternal and child mortality; avert millions of unintended pregnancies; eliminate some neglected tropical diseases, and integrate women and girls into all health programs.

If this blogger were to change just one thing about this important speech, it would be to elevate the one sentence that came near the end about the importance of engaging men and boys in the societal changes that will need to take place to achieve better health and equity for women and the world.  “Men are presented as the abusers and HIV vectors,” the Secretary said, adding that we need to reach out to men and boys to encourage them to be active partners in working toward better reproductive health and equality.  This important point deserves to have been made more than once; lack of progress over the last decade in achieving gender equity shows it needs to be raised early and often if our work is to be successful.

Nevertheless, even though I was watching the speech on a TV monitor, I wanted to stand up and cheer her statements that:

• It is a national security issue to pay attention to women and girls.
• It is a matter of equity and fairness.
• It is not just the elite women in societies but also “ the women who live down the street or care for their children or clean their homes or plant their crops” that need our attention.”  Rights must be protected for women everywhere.

Secretary Clinton exhorted the leaders in the august Ben Franklin Room of the State Department (and maybe even those watching on the ICPD2015 simulcast), “Do Not Grow Weary.” She might have borrowed a line from Robert Frost:  For we have promises to keep, and miles to go before we sleep.”?

Russian Prime Minister Vladimir Putin has long advocated a rise in Russia’s very low birth rate. In 2007, with his bidding, the government took the dramatic step of providing women with a $9,000 payment for the birth of a second child. The incentive certainly seems to have worked. In 2007, births jumped nearly 9 percent over 2006 and, in 2008, by 6.4 percent over 2007. Russia’s total fertility rate (TFR) now stands at 1.49 (2008), up from its nadir of 1.16 in 1999. And several other developments may combine so that Russia’s population size avoids the decline begun in 1995. This was not lost on Mr. Putin, who has been widely quoted celebrating the prospect of a year with no decrease.

Photo used under Creative Commons from Sangudo

Official demographic data have been released by the state statistical bureau, GOSKOMSTAT, for January 2009 through November (Russia releases vital statistics very quickly). Those show an increase in births for the January-November 2009 period of 2.8 percent, lower than the previous two years but still an increase. At the same time, deaths dropped by 3.7 percent so that natural decrease, birth minus deaths, was “only” -224,310. I say only because that figure was an astounding -958,000 in 2000. So for population to grow in 2009, net international migration will have to offset that -224,310. That certainly seems to be well within reach since net immigration from January to October was reported as 210,446, much of it from Central Asia and other former Soviet republics which the Russians often refer to as the “near abroad.” Based on typical migration patterns in Russia in November and December, about 250,000 net immigration can be expected. So, population-watchers, look for some celebrations in Russia later this month.

But, hold the phone. The Russian TFR, at about 1.5 is still very low and the country still depends upon non-Russian migration to keep its head above water. But there’s more and it’s even more important. Russia’s age-sex pyramid took a body blow during the period of high natural decrease. The number of young people moving up the age ladder into the prime childbearing ages is much less than those now in the childbearing years. As of January 1, 2009, there were 6.2 million females in the age group 20-24. The 15-19 age group was only 4.5 million and both the 5-9 and 10-14 age groups taken together totaled 6.5 million. As those younger age groups begin childbearing, births will certainly decline even if the TFR rises. Beyond that, deaths will rise as the elderly population grows significantly in size.

It may be a short party.

My mind is often flooded with indicators: population size, percent of the population living on less than a dollar per day, landholdings per household, average family size, and unmet need for family planning are a few that often float around in my head. Statistical research, however, never replaces the wealth of insight that can be gained through visiting communities, talking to people, and connecting faces and stories with indicators, results, and statistical associations. 

I recently had such an opportunity while visiting the Southern and Oromia regions of Ethiopia, where PRB is building policy communications capacity with several organizations implementing integrated population, health, and environment projects. 

During this field visit I came to the realization that a field visit is probably as intimate a communications opportunity as a project can have.  People aren’t reading a one-pager or watching your perfectly crafted video.  They’re actually there, talking with project staff, listening to beneficiaries, and seeing your efforts with their own eyes.  Will you ever have a more captive audience? Probably not.  Thus, while visiting the projects and talking with community members, I was constantly reflecting on the process itself, and this set of visits presented a whole spectrum of different experiences to reflect upon. So here are a few of my initial quick thoughts on field trip best practices.  

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One has only to read a single issue of The Washington Post to be painfully reminded of the tremendous toll that violence against women takes, both in the U.S. and across the globe. On a single day, the Post’s Metro section referenced the violent deaths of seven women in the DC metro area:

• “Doctor gets 30 years for killing wife”
• “Kensington man [who] killed his wife’s elderly aunt with a 40 lb dumbbell” sentenced
• “Man convicted of killing his teenaged girlfriend over $2 three weeks after she had given birth to his child.”
• “Man who strangled his girlfriend and hid her body…. sentenced.”
• “Virginia woman [who] predicted her death had dropped the restraining order against her husband the day before she was found dead.”
• “Investigators in Rockville stabbing look at relationship with husband”
• “Man convicted of killing wife in Montgomery.”

The front section of the same paper referenced both national and international violence against women:

• A Colorado man convicted of “kidnapping, raping, and murdering a 25 year old woman” gets a new sentence hearing
• In Chicago, “the boyfriend…was charged with murder after he admitted beating her the night she died”
• According to the General Accounting Office, sexual abuse of women and girls “is pervasive and present in almost all refugee settings” in which millions of women and children live
• In Afghanistan, “hundreds of human rights organizations report that women and girls who dare to walk the streets alone are subject to harassment and violence.”

This issue of the Post was not atypical. Globally, violence accounts for 7 percent of deaths among women ages 15 to 44, and the World Health Organization (WHO) reports that nearly half of all women who die by homicide are killed by a current or former spouse or boyfriend. But deaths from homicide do not begin to reflect the contribution that violence makes to women’s death from other causes, including suicide, maternal deaths, and HIV/AIDS. Nor does it convey the tremendous emotional and physical toll on women of experiencing physical, sexual and emotional violence throughout their lives, including during pregnancy.

Violence against women is generally more prevalent in societies in which women have little power and where rigid gender norms condone controlling behavior among men and submissive behavior among women, but the United States does not stand up well in comparison to most of the developed world or even to some developing countries. In the United States, eight times as many women are victims of homicide each year as is true in Great Britain.

A new survey underway or completed in a number of countries, the International Men and Gender Equality Survey (IMAGES), is shedding light on men’s attitudes and behaviors on a wide range of issues, including gender-based violence. Initial findings from IMAGES show that among the factors associated with men’s perpetration of violence against women are a childhood experience of violence, men’s belief in inequitable gender norms, and men’s economic disempowerment, stress or shame due to underemployment or unemployment.

The first two factors are actionable by parents, to assure that children of either sex do not experience or witness verbal or physical abuse in their own homes, and that daughters are raised on an equal footing with sons. Teachers, coaches and communities can implement gender equitable practices and zero tolerance for disrespectful treatment of girls. The third factor, men’s economic disempowerment, requires structural change, whether in developing countries or here in the United States. While perpetration of violence crosses all boundaries of race, income and social class, black men are clearly at greater risk based on economic disempowerment. Official unemployment among black men age 20 and above in the U.S. is nearly 17 percent  and more black men are in prison here than are in college. Early investment in helping boys succeed in school and emerge with marketable job skills is a big part of the investment needed to reduce future violence against women. 

On December 3, as part of the international 16 Days of Activism Against Gender Violence, PRB and PATH sponsored an event at the National Press Club. An upcoming blog post will focus on strategies offered by the four presenters, champions of work with men to stop violence against women in the United States and globally. �

I was recently asked whether I thought Optimum Population Trust’s Carbon Offsets Program was akin to “population control” by rich countries on poor countries. I felt the question mischaracterized the program and population and climate change relationships in general, and this was my response:

Optimum Population Trust’s (OPT) carbon offsets program as well as a recent study they commissioned from the London School of Economics on population and climate change advocate for increased financial support for family planning programs that meet the needs of women regardless of their location in the context of climate change. Some have argued that this amounts to “population control” of developing countries. 

The idea of “Population control” referred to ideas and programs that were being implemented from the 1960’s to the early 1990’s that largely argued that national governments should address high fertility for various developmental, economic, and environmental reasons. The 1994 International Conference on Population and Development (ICPD), however, led to a transformative change in the views, goals, and approaches to family planning, and all efforts since then have been focused on the individual needs of women, their reproductive desires and rights, and voluntary access to family planning for those who wish to space births or limit their number of children. Currently, there are approximately 200 million women worldwide who want to space their births or not have more children but are not using a modern method of contraception. Research indicates that this large “unmet need for family planning” is primarily due to inadequately financed voluntary family planning and girls education.   

The most recent research available from OPT and others indicates that adequately financing voluntary family planning programs and therefore meeting the existing need of 200 million women would benefit individual women and reduce future carbon emissions – a potential win-win. Unintended pregnancies occur throughout the world in both developing and developed countries and thus efforts should be focused where there is a recognized need by individual women (the U.S. for example has a very high rate of unintended pregnancies). 

Efforts to reduce emissions must start with developed or rich nations changing their energy and consumption patterns.  The amount of emissions reductions that are needed to avert the worst climate change scenarios, however, is daunting and will require efforts beyond anything we’ve yet seen. Adequately financing voluntary family planning programs is not a panacea but rather is a contribution to these efforts. 

The Intergovernmental Panel on Climate Change’s (IPCC) climate change models depend on population size in their emissions scenarios. The research that I have read, including some very well done and sophisticated research that should come out sometime later this year, indicates that reducing unintended pregnancies through voluntary programs would result in reductions of at least 1 billion tons of carbon annually by 2050. For those of you familiar with the idea of carbon stabilization wedges, you’ll note that 1 billion tons annually is significant.     

I’d like end by pointing out the just-released UNFPA State of World Population 2009 report that deals with family planning and climate change from the perspective of women’s rights: Facing a changing world: Women, Population, and Climate.

Over the past few days, I’ve had the opportunity to attend the International Family Planning Conference, held at the Speke Conference Center in Uganda.  This meeting has given me the chance to learn a lot about Uganda and get updated on what has been happening in the field.  While the selection of Uganda as the venue for this meeting of approximately 1,200 participants has focused the eyes of the world on the country’s need to better address the reproductive health of its women, Uganda is not alone in needing to increase its commitment—both political and financial. 

A few statistics about Uganda have really stuck in my head: Ugandan women have on average about 6 to 7 births per women, which is not much less that it was 25 years ago. Only about 18 percent of women of reproductive age use a modern family planning method and more than 40 percent of women don’t want to have any more children in the next two years – or at all – but are not using a family planning method.  Maternal death and disability robs the country of its women as well as hundreds of millions of dollars of lost productivity.  As seen in many countries, provider attitudes can undermine women’s interest and willingness to use family planning, and poor women are again at an inherent disadvantage because of they have limited access to services, poorer understanding of family planning methods, and hold on to traditional beliefs and values that undermine gender equity.

Though there is much work to be done to improve access to and use of family planning, this opportunity to bring together representatives of the global family planning movement has had some real benefits.  Over the couple of decades I’ve been working in this field, I don’t remember attending a meeting that has reenergized people with new evidence, new messages, and new acquaintances. Could the funds used to support the conference have been channeled into the field to support efforts? No doubt it could have been.  Yet just as people who attend a global AIDS conference look forward to learning the new science and being recharged to go back to work, this meeting has given those of us who work in family planning a new, broader perspective on what’s going on and what needs to be done. Through learning new information, sharing what PRB has to offer to the field, and  meeting new people from around the world, I am recharged—and I think many others are, too.  Will things change tomorrow?  Probably not.  But by bringing ministers of finance, health, and planning together; by exposing Ugandan parliamentarians to some of the lost opportunities to national health and development because of inadequate political and financial commitments; by sharing evidence-based research results to better figure out what else needs to be done—I am optimistic about getting things on track and moving forward.

As I leave Uganda and look back on what has happened over the past few days, I think the global family planning movement has been galvanized in a way that hasn’t happened before. Driving forward, the way will certainly have its bumps, but I am optimistic that we are on the right road.

As the International Family Planning Conference, held in Uganda, comes to a close, Dr. Ward Cates, president of Family Health International, summarized the content, tenor, and tone of the conference in 10 “pearls.” I found his reference to pearls to be an appropriate comparison; while Uganda is referred to as the “Pearl of Africa,”pearls are formed by a grain on sand creating an irritation within an oyster.

1. Policies related to family planning need to be better implemented so that they reach those women who either don’t want any more children or want to postpone having children for a few years, but are not using family planning.  Linked to meeting this need is the importance of family planning in achieving the Millennium Development Goals.
2. Long acting and permanent methods are increasingly playing a more important role in programs because short-acting methods pose challenges in correct use and are subject so supply shortages.
3. New contraceptive technologies are needed—including low-cost methods and products that provide dual protection from HIV/AIDS and unplanned pregnancy.
4. Service delivery needs to gain better community buy-in and involvement in distribution, including community-based participation and increased awareness through media.
5. Commodities are in stock more often because of better collaboration between partners—and this results in better service delivery; creative multi-tier pricing strategies are also contributing to a wider range of service delivery points to meet the need of women and couples.
6. The integration of family planning and HIV services appears to be reaching a tipping point in some countries as local, national, and international decisionmakers recognize its value. 
7. The integration of family planning into other types of services—postpartum care, immunizations clinics, and primary health care—provide important strategies for expanding access to family planning services.
8. The financing and costs associated with family planning programs remains a challenge.  However, the total cost of addressing family planning and reproductive health on a global basis is less that what is spent over 10 days on military actions worldwide. 
9. Youth and men need to be addressed more explicitly. Vasectomy is becoming more popular, but there are still many taboos to overcome for it to be accepted more broadly. Similarly, language associate with family planning needs to be reconsidered so that it better appeals to men’s ways of looking at issues.
10. We know what we need to do—we need to do more of it.  Better collaboration, better harmonization, and less duplication of efforts are all part of the way forward.

Ward’s pearls resonate with what has been discussed at the conference.  His comments came at the beginning of last day of the conference, which focuses on using research findings to improve programs.  For many of these pearls to come to fruition, advocates, program manages, policy makers, media, and the public will need to be vocal, use evidence to make their case, and hold governments accountable. Just like the grain of sand in the oyster, we need to better raise awareness about the health and development benefits of family planning to make sure these pearls fully develop.

On the first day of the International Family Planning Conference, held at the Speke Conference Center outside of Kampala, Uganda, ministers of health, finance, and planning assembled to discuss financing the health-related Millennium Development Goals.  The day-long session included representatives from more than a dozen countries and raised a number of interesting and relevant questions.  The first question, perhaps asked rhetorically, was “Is family planning back?”

As competing priorities for scarce resources have led to less attention being paid to family planning, this question is relevant also because of the stagnation in contraceptive use in many countries throughout sub-Saharan Africa.  HIV/AIDS has taken both the spotlight and the majority of funds.  Even though the region continues to struggle with the epidemic, ministers discussed the need to focus on family planning, especially as a way of reducing maternal mortality.

The speaker who posed this question, Dr. Khama Rogo of the World Bank, acknowledged the challenges to getting family planning back as a priority: country leadership, donor coordination, overcoming the inadequacies of government budgets to address family planning, the large out-of-pocket expenditures that individuals pay for services and commodities, and innovations in policies, strategies, and financing—which require finding new ways to get family planning into national development priorities. 

Each of these challenges can be addressed through the efforts of skilled advocates and committed policymakers.  However, as Dr. Rogo pointed out, if family planning is an “externally funded mandate, then it is not back at all.”  While donors and outside organizations have a role to play in addressing family planning needs, unless the issue is owned by local stakeholders and governments, family planning will not get the traction that it needs to move forward.

He went on to suggest recommendations to help ensure that family planning is back—including having national governments follow through with their commitment to allocate 15 percent of national budgets to the health sector; the development of country-led strategies that respond to local issues and that do not rely on donors; increasing community participation in family planning service delivery—especially through community-based distribution; a policy environment that promotes public-private partnerships so that the challenge for responding to family planning needs is spread throughout other sectors; and improving stewardship—national and local leadership—in addressing the family planning needs of women and couples.

Dr. Rogo made a comparison that was perhaps the most memorable line from the ministers’ seminar: family planning is to maternal health what vaccination programs are to child health.  This insight places family planning squarely where it belongs: as a health intervention, family planning is central to reducing maternal mortality and disability.  Given the importance of this way of looking at family planning within sub-Saharan Africa, Rogo’s insight should  be used by advocates to refocus attention on family planning and make sure that it is back to stay.