In honor of Mother’s Day, the Gender-Based Violence Task Force of the Interagency Gender Working Group (IGWG) held a May 10th event on “Maternal Health and Gender-Based Violence: Research on and Responses to Service Provider Abuse in Childbirth and Intimate Partner Violence During Pregnancy” at the National Press Club in Washington, DC. The event featured two panels; the first was an overview of Intimate Partner Violence (IPV) during pregnancy and of service provider abuse during labor and delivery, and the second panel focused on ongoing interventions and approaches to the issue.

Presenters on the first panel included Sunita Kishor of ICF International, Diana Bowser of the Harvard School of Public Health, and Neal Brandes of USAID’s Office of Health, Infectious Diseases, and Nutrition. Attendees learned the results of studies on IPV or caregiver abuse during labor and delivery. Providing a base of qualitative and quantitative data, the individual panelists were able to convey the prevalence and urgency of such frequently overlooked issues.

The second panel consisted of Michele Kiely of the National Institutes of Health, Kristin Savard of the White Ribbon Alliance, Nancy Termini of the Population Council, and Ariel Frisancho of CARE Peru. The presenters provided snapshots into current programs geared toward stopping and preventing IPV and abuse during labor and delivery, which included a mix of awareness campaigns and interventions.

Presentations and more information on the event are available on the IGWG website.

Check out a short video of the event with reflections from some of the presenters:

The loss of jobs, homes, and investment wealth that characterized the U.S. “Great Recession” (2007 to 2009) also took a personal toll. A number of researchers at the Population Association of America’s (PAA) 2012 annual meeting presented studies documenting the recession’s social impact.

Retirement Postponed: Following the Great Recession, 40 percent of older Americans decided to postpone retirement, reported Brooke Helppie McFall of the University of Michigan. The greater the loss, the more likely people were to delay their retirement, she found.

Her study is the first to link actual data on household wealth just before and after the downturn to the retirement plans of a nationally representative sample of Americans age 50 and older, using the Health and Retirement Study along with the Cognitive Economics Study.

The typical older household lost about 5 percent of its total wealth between the summers of 2008 and 2009, she found. The average older person would need to work between 3.7 and 5 years longer than they planned in order to make up the money they lost, according to her analysis.

But very few people told interviewers that they intended to work long enough to recoup their entire loss, instead trading financial security for leisure, McFall reported. The typical person surveyed who planned to work longer because of the recession only planned to work about 1.6 years longer than they had originally planned. Not included in the survey were people who were already laid off or those who had already retired.

More Depression Among Older Americans: Lauren Hersch Nicholas of the University of Michigan and Melissa McInerny and Jennifer Mellor of the College of William and Mary used the Health and Retirement Survey to explore the health consequences of the Great Recession on older Americans. Although many studies link higher incomes to better health, no other studies have examined the impact of sudden financial loss on health, they noted.

“Respondents with stock market wealth interviewed right after the crash reported significantly worse self-rated health than respondents interviewed pre-crash,” they write. They also found that post-crash, stock owners had more symptoms of depression and were 4 percentage points less likely to report feeling happy in the previous two weeks.

Loss of wealth is different from job loss, Hersch noted. An event such as becoming unemployed can have both positive and negative impacts on health. While the financial stress may bring physical symptoms, the additional free time may contribute to improved health. Job loss allowed more adults to be available to provide care for aging parents, she said.

Fewer Newborns: Every 1 percent increase in job loss among North Carolina’s working-age population (ages 25 to 64) was associated with a roughly 3 percent decline in black teen fertility, according to preliminary findings. Christina Gibson-Davis, Elizabeth Ananat, and Anna Gassman-Pines at Duke University examined North Carolina public records on all live births and all job losses for each community during each month between 1990 and 2009. They also found a link between the Great Recession and reduced fertility among married women with at least some college education, but no link between local job loss and fertility among this group. They suggest that more-educated women may have more acutely experienced the recession’s “ripple effects” including declining housing prices and decreases in the stock market.

Impact on Divorce Mixed: Did the economic stress of the Great Recession contribute to more divorce or did troubled couples stay together because divorcing became too costly? Any answer to this question is tempered by the fact that divorce has been on the decline in recent years. Preliminary results from Julie Brine and Brian Serafini of the University of Washington suggest that divorce filings in five states declined in the wake of local job loss and home foreclosure. But Phillip Cohen of University of North Carolina at Chapel Hill found some evidence of higher divorce in states with higher home foreclosure rates, but only among college-educated couples. He suggested that more-educated people are more likely to be the ones to own homes and to be impacted by foreclosure. This study, based on American Community Survey data, found no evidence that unemployment had much impact on divorce.

Demographics has played an important role in the Arab rebellions, said Joseph Chamie of the Center for Migration Studies during a recent panel discussion at the annual Population Association of America (PAA) meeting in San Francisco. But demographics can exacerbate other serious problems, including brutal repression, human rights violations, government corruption, poverty, unemployment, religious and tribal rivalries, and a large influx of migrants and refugees. The largest refugee population in the world is in the Arab region, he said. The panel’s speakers were John Casterline, Ohio State University; Richard Cincotta, the Stimson Center; Farzaneh “Nazy” Roudi, Population Reference Bureau; and Nasra Shah, Kuwait University.

In his presentation, “Potential Upheaval in the Arab Region—Impact on Reproductive Change?”, John Casterline focused on the consequences of the rebellions, while the following speakers outlined more of the determinants. Casterline illustrated his presentation with anecdotes from his visits to the region and conversations with people, concluding that while it’s still early, “a period of dashed hope seems to be settling in.” The rebellions seem to have brought a pronatalist movement into effect, with the rejections of a “Western agenda.” Demographic data and demographic analysis have lost legitimacy since the old regime, he said. The return of electoral politics has established a direct relationship between population and political weight. Still, he added, couples ultimately make their own decisions about their households.

A young Egyptian protester holding an Egyptian flag, Cairo, Egypt. Photo: Kim Eun Yeul / World Bank

Richard Cincotta discussed “Politicodemographic Forecasts of the Rite of Democracy in North Africa.” He presented a demographic model of the region and said that in his view, the era of democratization (in its third wave) is not over, yet.

Nazy Roudi, director of the Middle East and North Africa (MENA) Program at PRB, presented, “Numbers Don’t Lie: Youth in Egypt.” One in four Arabs is an Egyptian, she said, and unemployment among youth in the MENA region is the highest in the world—2.5 times higher than in East Asia and South Asia. And unemployment among women is far higher than among men. She cited the Survey of Youth in Egypt 2009 in which women said the reason they did not find a job was because they believed there was no job available for the qualifications they had. Meanwhile, men responded that they were unable to find a job because they did not think that an available job paid enough. Roudi echoed Casterline’s earlier point that while government policies are important, more important is the balance of gender roles within a family, and that women feel empowered to talk with their husbands about fertility decisions. “My prediction is that the TFR is going to become higher in Egypt,” Roudi said.

Nasra Shah rounded out the session with “Sociodemographic Changes in the GCC Countries and Their Implications.” GCC countries are those in the Gulf Cooperation Council: Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates. As Chamie mentioned in his introduction, migration and refugees are a huge source of strife with the Arab world—and the GCC countries, said Shah, are host to the largest non-natal population in the world. The largest group of non-natals are Asian—primarily sent from Bangladesh, Pakistan, the Philippines, Indonesia, Sri Lanka, and India. These sending countries want to increase emigration, while receiving countries want to reduce or maintain the existing numbers—and this incoherence is causing frustration within the labor force for nationals, particularly women and youth, who already have difficulties finding jobs.

“Family planning is a family business…and both men and women should be involved.”  This was one of the key points in the Malawian Vice President’s official opening remarks at Malawi’s first National Leader’s Conference on Family Planning, Population, and Development. Other speakers and presenters returned to the issue of male involvement again and again throughout the day, highlighting one of the main and most persistent barriers to contraceptive use in Malawi.

The objective of this conference is to reposition family planning as a sustainable development issue, not just a health issue. Repositioning efforts are frequently targeted to national leaders and policies, but there is a complementary shift that can and must happen at the family level. Just as national decisionmakers from all sectors must be encouraged to see the relevance of family planning to their own work, so must men (who are often the decisionmakers at the family level) be encouraged to see the benefits of family planning for all members of their family. And just as family planning must be reframed as more than a health issue, it must also be reframed as more than a women’s issue.

According to data presented at one of the afternoon sessions, husband’s opposition is one of the top two reasons that women do not use contraception. Depo-Provera is one of the most popular methods in this country, in part because it can be used clandestinely. Clearly, reaching out to men to increase their support for family planning is critical for women’s ability to use contraception. And indeed, research has shown that couples are more likely to use family planning when the male partner is involved in family planning and childrearing.

So how do we achieve the goal of increasing male involvement in family planning?  In her opening remarks, the Deputy Minister of Health, Halima Daud, MP, gave a special welcome to the chiefs and traditional leaders in attendance, noting that they are the “gatekeepers of culture” and have great influence at the community level. Vocal support from this group – local chiefs and leaders – will be key for reaching men at the individual and community level, where decisions about family planning are made, and in rural areas, where TFR is highest and contraceptive use lowest.

In addition to changing men’s attitudes, there must be improved services available for men and for couples. Another presentation noted that the negative attitudes and bias of family planning providers toward men who seek their services is a major deterrent to male involvement. Men frequently state that they do not feel comfortable in family planning clinics, where they may feel that they are trespassing into a woman’s domain. Better training for providers and expansion of services to target and welcome men, either alone or with their female partners, will complement attitude change to facilitate uptake of contraception.

As they welcome their first female President and the second female head of state in Africa, Joyce Banda, Malawi’s women are seeing their own worlds expand. Increased opportunities for women to become involved in public life, through political and civic engagement and greater labor force participation, will support Malawi’s progress towards its national development goals. At the same time, men must be involved as supportive partners on the national stage and in the home. Engaging men in family planning is in everyone’s interest.

As the National Leaders Conference on Family Planning, Population, and Development opens with all protocols observed, it’s quite inspiring to hear the comments of leaders who have made opening remarks. Lilly Banda of USAID/Malawi’s Health team spoke of the importance of addressing unmet need for family planning—making modern family planning information and services available to women who want to avoid pregnancy—as a key strategy to achieving Malawi’s development goals, including the Millennium Development Goals (MDGs). The high level of unmet need undermines achieving the MDGs. At the same time, slowing Malawi’s population growth and achieving sustainable levels of fertility will contribute to a higher quality of life for the people of Malawi. As such, family planning is an indispensable development issue, contributing to health and the economic development of Malawi.  There is a role for all stakeholders in the process, for together—the public and private sectors, traditional and public officials, government and civil society—all have a vital role to play.

As USAID Mission Director Doug Arbuckle pointed out, this is the first-ever conference in Malawi for population and development, signaling that the Government of Malawi is identifying these issues as a priority for the development and well-being of the nation. Population growth remains a tremendous development challenge: In the 2008 census, Malawi’s population was 13 million; it is currently close to 15 million. With such rapid population growth, addressing the issue is not just a matter of good development policy, it is a matter of life and death. So critical is the importance of addressing Malawi’s population growth, that the challenge of population growth can doom all other development policies.

UNFPA Representative Athanase Nzokirishaka offered insights into Malawi’s population situation. To make progress in lowering population growth, all women need to have information about family planning so that they can make informed decisions about the timing and spacing of their children. But it’s not just for women; men must also be positive contributors to the uptake and use of family planning. When the nation achieves the goal of slowing population growth, it will be in a better position to educate children and young people, bring relief to its overcultivated land, slow environmental degradation, and make advances toward Malawi’s development goals and strategies and the MDGs.

A final speaker in the opening session was the Vice President of the Republic of Malawi and Minister of Health, Right Honorable Khumbo Kachali, who observed that there has been increased focus on improving the health of women around the world, but there has been a sense that family planning is a women’s issue. “No!” according the Vice President, “If family planning is about planning families, then it must also include men as part of a modern perspective. Women and men both need to be involved in family planning decisionmaking and use.”

And when Malawi makes progress in the use of family planning and effectively managing fertility, it will make progress toward achieving the MDGs and other health and development outcomes.  Through family planning, Malawi can reduce maternal mortality, the number of unintended pregnancies, and unsafely performed abortions, and lower its total fertility rate.  At the same time, through slowing population growth, it can better address food security, natural resource management, and educational opportunities. Family planning can improve the quality of life in Malawi, improving not only the health of its people, but contributing to the economic development, thereby affecting all people’s lives. Repositioning family planning as a key part of the development agenda makes sense. It’s time for all partners to be involved. And as the Vice President said, the Government of Malawi is committed to family planning methods.

So, the conference is open, comments by decisionmakers have been made, and the importance of addressing population growth has been made. I am optimistic that today and tomorrow will provide further evidence about what Malawi needs to do to move forward.

It’s been 40 years since the 1972 U.S. Commission on Population Growth and the American Future submitted its final report to Congress and President Nixon. Chaired by John D. Rockefeller III, and known as the Rockefeller Commission, the final report concluded that further U.S. population growth offered “no substantial benefits” and argued that “gradual stabilization through voluntary means … would contribute significantly to the nation’s ability to solve its problems.” But Nixon, who originally called for the report, rejected it bowing to election-year political pressure.

“In retrospect, the report stands up well; the conclusions remain strong and the research solid,” said Charles Westoff, a Princeton University sociologist and the commission’s staff director. He acknowledged that the commission “totally failed” to anticipate the volume of immigration or to foresee the increase in out-of-wedlock child bearing. The report included more than 50 recommendations, some of which now appear naïve, such as calling for the establishment of a “National Institute on Population,” he noted.

The report’s carefully worded recommendations on legalizing abortion nonetheless led to its rejection, he said. Yet, the report’s emphasis on eliminating unwanted pregnancies and “enabling women to have the number of children they wanted” formed the basis for the consensuses that emerged from United Nations world population conferences beginning in Bucharest, Hungary, in 1974, according to Westoff.

Today’s debate on abortion and access to contraception “is not too far away from 40 years ago,” said Christine Bachrach, a researcher now affiliated with both the University of Maryland and Duke University. She pointed out that many of the report’s goals regarding raising women’s status and improving reproductive health have been achieved. Specifically, total fertility rates are now below replacement level, unintended births have declined, and women’s educational levels and labor force participation rates have both increased.

In Bachrach’s view, the commission underestimated the power of religion: Out of 100 papers, not one was on religion and she found only nine mentions of the word ‘religion’ in passing. Also, although contraceptive research led to the introduction of new methods, they have “barely made a dent in contraceptive practice,” she reported. Among the issues to address over the next 40 years is family investment in children and child well-being in the wake of nonmarital births, multi-partner fertility, unstable cohabiting relationships, and declining marriage, she said.

The commission’s report “did not have a lot to say about population aging,” noted John Haaga of the National Institute on Aging. This may be because old-age entitlements were proportionately less expensive in the 1970s and the rise in public-sector health care spending was not foreseeable, he suggested.

Continuing declines in residential segregation and in homogenous social networks—which can reduce prejudice and improve social cohesion—are not guaranteed as the United States moves toward a “majority-minority” population (projected for 2042), reshaped from the “bottom up” by high Hispanic fertility, said Daniel T. Lichter, a Cornell University sociologist and president of the Population Association of America (PAA).

In his address, “Integration or Fragmentation: Racial Diversity and the American Future,” at the 2012 PAA conference held from May 2-5 in San Francisco, he explored the challenges of growing diversity and the dynamics that create a “built-in momentum for increasing poverty.”

In Lichter’s view, the generational divide—created by a majority non-Hispanic white elderly population and a growing minority child population—raises a key question: “Will older non-Hispanic white people care enough about other people’s children to invest in them?” If not, past progress in reducing poverty and achieving racial equality is threatened.

Other threats to progress include the academic achievement gap between black and Hispanic students and their non-Hispanic white peers; the re-segregation of public schools; high rates of incarceration for blacks, which undermines the social fabric; undocumented immigration, which creates a barrier to mobility and integration of children; income inequality and slowed intergenerational social mobility; and neighborhoods with heavily concentrated poverty.

While intermarriage contributes to bridging racial and ethnic divisions and mixed-race children help blur racial distinctions, Lichter reported that interracial marriage appears to be slowing and online dating may be reinforcing same-race coupling.

Growing diversity has implications for the field of demography, according to Lichter. Making certain an ethnically and racially diverse group of researchers are trained is crucial, as their diverse perspectives can redefine research and reshape intellectual discourse, he said. A detailed article based on this address will appear in a forthcoming issue of the journal Demography.

Sitting in the conference hall of the Crossroads Hotel in Lilongwe, Malawi’s capital, as the National Leaders Conference on Family Planning, Population, and Development is about to open, I can feel a sense of optimism along with a sense of challenge at the same time. It’s a great feeling to return to Malawi after several months and see people again—knowing how hard many have worked to make this conference a reality. There is a sense of hope as President Joyce Banda has assumed leadership of the nation that issues of reproductive health and development will be prioritized in the administration. Yet there is also challenge. Yesterday, the Malawi currency was devalued by almost 50 percent, gasoline continues to  be difficult to find, and there are other indications that the situation is slow to improve.

Our colleagues have worked hard to make this meeting an opportunity to share information and evidence about advances in the health of Malawi. The conference will galvanize support for family planning and development. And it’s needed, because even though use of modern contraception is high, 42 percent of married women report using modern methods, fertility remains high. During her life, the average Malawian woman has almost 6 children. This situation poses a quandary that will be discussed: Though the use of effective contraception is high, fertility also remains stubbornly high. We will hear from a colleague at Kenya’s National Council on Population and Development (NCPD) on how they have disseminated evidence-based messages to national and subnational audiences to get family planning and population growth on the policy agenda. Tomorrow, I’ll be presenting on Malawi’s chances of reaping a demographic dividend—but only if the country first focuses its attention on the health and education of the poor, and subsequently enacts policies that can stimulate job creation and needed economic reforms.

So it’s an exciting time. Malawi is confronting the challenge of population growth and looking at how it is critical to advancing economic development. Over the next few days, I’ll be providing periodic updates of what comes from the conference.

HIV/AIDS in Cameroon. The preliminary report of the 2011 Cameroon Demographic and Health Survey/HIV (DHS/HIV) has been released (in French). This survey tested 13,503 women and men ages 15-49 and 699 men ages 50-59 for HIV infection. The results indicate that 4.3 percent of the 15-49 age group were HIV positive, 5.6 percent among females and 2.9 percent among males. The males ages 50-59 were 2.9 percent positive. The 2011 prevalence was lower than that reported in the 2004 Cameroon DHS, which was 5.5 percent for 15-49 year-olds, 6.8 percent among females and 4.1 percent among males.

Youth Tax in Germany. Germany is likely to impose a 1 percent additional income tax on workers over the age of 25 as a “demographic reserve” to prepare for the time when German baby boomers of the 1950s and 1960s will swell the ranks of pensioners. Official projections show that there will be 7 million fewer workers by 2025 to support retirees. Germany’s total fertility rate fell below the replacement level over 40 years ago and is currently about 1.35 children per woman.

Latest Data on the Sex Ratio at Birth (SRB) in India. Following up on an earlier blog post on this subject, progress on this measure has clearly stalled for a number of years. The national campaign against the abortion of female fetuses may be in for a difficult stretch. The graphs below update the Sample Registration System data to the period 2008-2010. Since there about 5 percent more male births than female births worldwide, a normal sex ratio at birth in India would be 950 female births per 1,000 male births. India’s SRB is the reverse of most other countries which typically show male births per 100 female births. Note particularly the two states with the lowest SRB, Punjab and Haryana. Improvement in their SRBs stopped three or four years ago. A somewhat similar trend can be seen in the five states in the second graph although their ratios are better. The national SRB in India is 905, 898 in urban areas and 907 in rural. More data from the new report will be in the next blog post.

Click on image for full-sized version.

Click on image for full-sized version.

Click on image for full-sized version.

The Bangladesh 2011 Demographic and Health Survey (DHS) is the ninth demographic survey taken in the country since 1975. Except for a few very small countries and city-states, Bangladesh is the world’s most densely populated country with about 1,100 people per sq. kilometer. The country’s area is about the same as the U.S. state of Arkansas and a bit more than Greece but is home to over 150 million people. The preliminary 2011 report has just been released and it shows that fertility has continued its decline to a low level. The total fertility rate (TFR) for the three-year period before the survey was 2.3 — 2.0 in urban areas and 2.5 in rural areas. The survey interviewed 17,842 ever-married women ages 12 to 49 and 3,997 ever-married men ages 15 to 54 from July to December 2011.* Rural women accounted for two-thirds of those interviewed. From 1975 to 1993-1994, the TFR in Bangladesh was in continuous decline. But the next three surveys showed a tendency for TFR decline to “stall” at a medium level (see graph). Desired family size has greatly decreased. In the survey, 76.2 percent of women with two living children said that they did not wish to have any more children and an additional 5.3 percent had been sterilized and 1.3 percent said they were incapable of conceiving.

The decline in infant and child mortality, as reported in earlier surveys, has continued. The infant mortality rate (IMR) in the five years before the 2011 DHS was 43 infant deaths below age 1 per 1,000 live births, down from 87 in 1993-1994 DHS. The decline in the death rate for children ages 1 to 4 was even greater, from 50 deaths per 1,000 five years before the survey in 1993-1994 to 11 in the 2011 DHS. The overall death rate for children ages 0 to 4 was 53, meaning that 1 in 19 newborns dies before their fifth birthday. Bangladesh is on target to achieve the UN Millennium Development Goal of child mortality of 48 by 2015.

Of children under age 5, 41.3 percent were stunted (height-for age) and 15.3 percent severely stunted (included in the 41.3 percent); 36.4 percent were underweight (weight-for-age). Mothers follow the WHO recommendation of supplementing breastfeeding with solid/mushy food at the child’s six months of age. At 6 to 8 months of age, only 7.3 percent continued to breastfeed exclusively with 62.6 percent supplementing with solid food. By 9 to 11 months, 87.2 percent had supplemented. While such proportions are good, many mothers should start supplemental foods earlier. The proportion of young children receiving all required basic vaccinations was quite high at 82.5 percent, including over 90 percent receiving polio drops. Urban and rural vaccination levels were virtually identical. Only 59.6 percent of mothers were able to produce vaccination cards.

Just over two-thirds of women who had had a live birth in the three years before the survey had some form of prenatal care, with 54.6 percent receiving it from a skilled provider (doctor, nurse, or other trained provider). Corresponding proportions in urban and rural areas were 74.3 and 48.7 percent, respectively. The percentage of women who have four or more prenatal visits increased to 26 from 22 in 2007.The proportion of women giving birth in the three years preceding that survey in a health facility was rather low at only 28.8 percent, but it is an improvement from 12 percent in 2004. In urban areas, slightly under half of women gave birth in a health facility.

The 2011 DHS is an important benchmark in the country’s demographic history. Bangladesh has nearly reached replacement level fertility (about 2.2 children per woman in this case) and could expect to see its population growth end about mid-century.

* Very few ever-married women ages 12 to 14 were interviewed in the survey and that age group is not included in report tables.