World Population Awareness

How to Attain Population Sustainability

End to Population Growth: Why Family Planning is Key to a Sustainable Future

April 13, 2011, The Solutions Journal

by Robert Engelman ... We are far from a world in which all births result from intended pregnancies. Surveys show that approximately 40% of pregnancies are unintended in developing countries, and 47% in developed ones.

Over 20% of births worldwide result from pregnancies women did not wish to occur.

It is estimated that 215 million women in developing countries are sexually active, but don't want to become pregnant; in other words, they have an unmet need for family planning. For various reasons they are not using contraception.

If all births resulted from women actively intending to conceive, fertility would immediately fall slightly below the replacement level; world population would peak within a few decades and subsequently decline.

It is not expensive to help all women to be in fully control of the timing and frequency of their childbearing. The key obstacles are religious, cultural, and political opposition to contraception or the possibility of population decline.

More research and a public better educated about sexuality and reproduction could engender a global social movement that would make possible a world of intended pregnancies and births. doclink

Before, we didn't know how to control pregnancy, we didn't have the education, and people in the area were having nine or ten children. We have 18 families and no one has more than three children. The health of the children and mothers has improved, and so has the spacing of babies. Everyone understands the importance of family planning now. Vincente Jarrin and Maria Juana Jarrin Malca, Husband and Wife Family Planning Promoters in Pasquazo Zambrano, Ecuador doclink

Population Progress

October 6, 2004, Boston Globe

A United Nations report says poverty perpetuates and is exacerbated by poor maternal health, gender discrimination, and lack of access to birth control. This holistic view has helped slow the increase in world population. The average family has declined from six children in 1960 to around three today. The world's population is expected to grow by 39% over the next 45 years and births in the 50 poorest nations are estimated to rise by 228%. Education and improved health for women and access to contraception are vital. Smaller families are healthier families and improve the prospects of each generation. 201 million couples do not have access to contraception and if they could practice family planning, 22 million abortions, 142,000 pregnancy-related deaths, and 1.4 million infant deaths each year could be prevented. Since 1994 more women have access to education and other rights, and more early-marriage traditions are being opposed. Most countries have laws prohibiting violence against women, female genital mutilation, and other violations of human rights. doclink

The Two Parts of Sustainability Are Consumption and Population

The world could possibly reduce consumption down to a very basic level, but if population keeps growing, eventually that will not be enough. Even today many are living on a sub-sustainable level, due in part to an uneven distribution of resources, but also because, in many regions, population has outgrown essential resources for that region.

When people feel threatened by a hand-to-mouth existence, they are more likely to look towards less-than democratic ways to reduce population, especially if they have the foresight to realize that population growth is like a run-away train, very difficult to slow and stop.

However, more and more evidence is showing that the methods that work the best towards reducing population growth, are the methods established by the principles of the Cairo Conference in 1994 (United Nations International Conference on Population and Development (ICPD) September 1994, Cairo, Egypt), which include: a. Empowering women and girls in the economic, political, and social arenas; b. Removing gender disparities in education; c. Integrating family planning with related efforts to improve maternal and child health; and d. Removal of 'target' family sizes. doclink

Carl Haub - Population Reference Bureau

It took the US 200 years to go from 7 babies per family to two. "Bangladesh has done that in 20. Iran has more than halved its fertility rate in a decade." doclink

Voluntary Family Planning

Contraception and Health

July 14, 2012, Lancet

Increasing contraceptive use in developing countries over the past 20 years has, by reducing the number of unintended pregnancies, cut the number of maternal deaths by 40%. Preventing high-risk pregnancies where women have many births, and those that would have ended in unsafe abortion, contraceptive use has reduced the maternal mortality ratio by about 26% in just over a decade.

30% more maternal deaths could be avoided by meeting the unmet need for contraception. The benefits of modern contraceptives to women's health, including non-contraceptive benefits of specific methods, outweigh the risks.

In addition, contraception helps lengthen the interval of birth spacing, improving perinatal outcomes and child survival. In developing countries, the risk of prematurity and low birth weight doubles when conception occurs within 6 months of a previous birth, and children born within 2 years of an elder sibling are 60% more likely to die in infancy than are those born more than 2 years after their sibling.

Greater-than-average risk to maternal, perinatal, and child survival is associated with pregnancies at very young (<18 years) and old (>34 years) maternal ages, at high parities, and with short interpregnancy intervals, and with pregnancies that would have ended in unsafe abortion.

In countries of low and middle income an increase in contraceptive use by 10% reduces fertility by 0.6 births per woman, decreases the proportion of all births to women with four or more children by 5%, reduces births to women aged 35 years or older by 1.5%, and lowers birth intervals of less than 2 years by 3·5%.

Increases in contraceptive use account for about 75% of fertility decline in developing countries in the past six decades and have substantially reduced the proportion of pregnancies in women of high parity, which pose a greater-than-average risk to maternal survival

In 2008, contraceptive use averted over 250,000 maternal deaths worldwide by reducing unintended pregnancies, which is equivalent to 40% of the 355,000 maternal deaths that occurred that year

If all women in developing countries who want to avoid pregnancy use an effective contraceptive method, the number of maternal deaths would fall by a further 30%

Because of its effect on births to women of high parity and on the need to resort to unsafe abortion, contraception also reduces the risk of maternal death per pregnancy; each 1% increase in contraceptive use reduces the maternal mortality ratio by 4·8 deaths per 100 000 live births

In rich and poor countries the risks of prematurity and low birth weight are substantially raised by short intervals, and in developing countries, risk of death in infancy (ages <1 year) would fall by 10%, and in ages 1 - 4 years by 21%, if all children were spaced by a gap of 2 years

There are four measures used to describe maternal mortality:

* The MMRate is the yearly number of maternal deaths per 1000 women of childbearing age (15-49 years). It ties directly to fertility rates and thus quantify the risk of maternal death per woman.

*The MMRatio has the same numerator, but is expressed per 100 000 livebirths. It is indicative of risk per pregnancy due to poor access to and quality of obstetric services. It also responds to fertility rates, which can affect the proportion of births to women with greater-than-average obstetric risk. MMRatios tend to be raised at parity 1, then become lowered at parities 2-3, then raised again at 4-5, and highest at parities greater than 6. Raised maternal mortality risks at high parities have been seen in Pakistan, Senegal, and west Africa.

*Lifetime risk of maternal death is the cumulative probability of a woman dying of maternal causes during her reproductive life, and is a measure of pregnancy-related female death. It also ties directly to fertility rates and thus quantify the risk of maternal death per woman.

*The number of maternal deaths. A fall in the number of pregnancies lowers the number of maternal deaths.

Maternal mortality risk is affected by the number and timing of pregnancies in a woman's reproductive lifespan, by the presence of comorbidities (other diseases or conditions that may increase the risk), and by obstetric care.

Another category of high-risk pregnancies are those that end in unsafe abortion.

Singh and colleagues reported that, in 2008, there were 185 million pregnancies occurring in developing regions, of which 40% were unintended, with 16% ending in livebirth, 19% in abortion, and 5% in miscarriage. In 2003 they estimated that 42 million pregnancies were aborted worldwide in 2003, of which 48% took place in unsafe conditions. 97% of unsafe abortions occur in developing countries, with increased rates in sub-Saharan Africa and Latin America since 2003. About 47 000 maternal deaths (13% of all maternal deaths) in developing countries are caused by complications of unsafe abortions. Contraceptive use can prevent recourse to induced abortion and eliminate most of these deaths.

Infant and child mortality and health: For infants (children younger than 1 year), the shorter the interval (18 months or less), the greater the mortality risk. Children born within 2 years of an elder sibling have a 60% increased risk of infant death, and those born within 2 - 3 years a 10% increased risk, compared with those born after an interval of 3 years or longer. Also, conservative interpretation of all major studies suggests that a preceding interval of less than 2 years raises risk of death at ages 1-4 years by about 40%. Other studies reported that the birth of a younger sibling within 2 years of the index child was associated with a doubling of mortality at ages 1 - 2 years, and smaller adverse effects at ages 2 - 4 years. If all children were spaced by a gap of at least 2 years, estimates suggest that the infant mortality rate would fall by about 10%, and mortality of children aged 1-4 years by 21%.

Children born to women younger than 18 years have an excess mortality risk of about 40% and are more likely to be stunted and anaemic than are those born to women older than 18 years.

The most prevalent method of contraception worldwide is surgical sterilisation. Female sterilisation (tubal sterilisation) and male sterilisation (vasectomy) have immediate surgical risks, but the risks of death and serious morbidity are very small with tubal sterilisation and even lower with vasectomy. Although the risk of pregnancy is low after tubal sterilisation, when pregnancy does occur, it is more likely to be ectopic; however, the absolute risk of ectopic gestation is lower than when no contraception is used.

Intrauterine devices (IUDs) are the most widely used modern method of reversible contraception. The risk of pelvic inflammatory disease is very low in women fitted with an IUD who have a low risk for sexually transmitted infections, but women with cervical chlamydial or gonococcal infections who have an IUD are at increased risk. IUDs have been associated with a reduced risk of endometrial cancer, and a pooled analysis suggests a possible reduced risk of cervical cancer. Levonorgestrel-releasing IUDs reduce menstrual blood loss. As with tubal sterilisation, pregnancies during use are very uncommon, but are more likely to be ectopic when they occur, but the absolute risk is lower than when no method is used.

Combined oestrogen-progestogen oral contraceptive pills (OCPs) are among the most widely used modern contraceptive methods in many countries and are also among the best studied drugs in history. An analysis of data from a large UK cohort study with long-term follow-up reported that use of OCPs slightly reduces all-cause mortality. OCPs are associated with very low relative and absolute risks of cardiovascular disease in young healthy women who do not smoke, although women aged 35 years or older who smoke are at increased risk. Whether OCPs have any effect on the risk of breast cancer is unclear. Studies suggest an increased risk of cervical cancer in OCP users who are positive for human papillomavirus (HPV) DNA, but not in those negative for HPV DNA. A pooled analysis showed that OCP users had a raised risk of cervical cancer that increased with duration of use and decreased after cessation of use, with the risk returning to that for never users after 10 years.

A 2012 WHO technical consultation concluded that the use of hormonal contraceptive methods by women with HIV or at high risk for HIV should not be restricted, but issued a detailed clarification for women receiving progestogen-only injections because of the inconclusive evidence about risk of HIV infection.

Although serious health risks associated with contraception are uncommon, side-effects are common, particularly with the most effective methods. For example, menstrual bleeding abnormalities are a frequent side-effect of hormonal contraceptives and IUDs, and the loss of regular menses might affect the acceptability of these methods in some regions. In general, although side-effects are minor, they can be unacceptable and are the most frequently cited reason for discontinuation. Typically, 30-50% of women discontinue use of OCPs or contraceptive injections within 12 months because of side-effects or health concerns, although most switch promptly to alternatives.

By freeing women from an incessant cycle of pregnancy, breastfeeding, and child care, contraception represents a huge step towards greater gender equality. The benefits to families of fewer children, in whom more resources can be invested, and the benefits to societies of reduced fertility and slowed population growth for social and economic advance and preservation of local environments are likewise important.

Two independent analyses using different methods came to the same conclusion: elimination of the unmet need for contraception in developing countries would reduce maternal deaths by about 30%. This estimate overstates the potential short-term contribution of contraception, because unmet need can never be eliminated; however, it understates the long-term contribution because need for contraception in high-fertility countries will inevitably increase over time. Especially in rural areas with poor health infrastructure, family planning is the most cost-effective and feasible way to reduce maternal deaths because it does not rely on complex technology, unlike some alternative interventions.

The relation between spacing and infant survival is well known and frequently given as a compelling reason for investments in family planning. Less well known is the persistence of the effect of short preceding intervals into early childhood (ages 1-4 years). Moreover, survival chances in early childhood are seriously jeopardised by the birth of a younger sibling within 2 years. This double jeopardy is of huge importance for child health programmes in high fertility countries of sub-Saharan Africa where about 60% of children have older and younger siblings and where deaths of children older than 1 year comprise 30-50% of all deaths in children younger than 5 years.

The substantial effect of contraception on health is often overlooked by medical specialists, perhaps because the evidence, with the exception of the important non-contraceptive health benefits of specific methods, has been generated largely by demographers and reported in non-medical journals. Another reason for neglect might be that contraceptive technology is well established and perceived as unexciting. Additionally, emphatic advocacy of family planning is linked to population control, which has become deeply unfashionable. One result of the long silence on these subjects has been the steep decrease in international funding of, and vocal support for, family-planning programmes. In terms of maternal and child health, a heavy price has been paid for this neglect, particularly in Africa. We believe that redress of this imbalance is long overdue. doclink

Conference Reaffirms Reproductive Rights

May 25, 2012, IPS Inter Press Service

Members of parliament meeting at the fifth International Parliamentarians Conference on Population and Development (ICPD) - held in Istanbul - agreed the economic crunch is no reason for governments to relax their commitment to women's reproductive rights and health, made 18 years ago.

Babatunde Osotimehin, executive director of the United Nations Population Fund (UNFPA) said 250 million women around the world do not have access to much-needed family planning services. "It is not acceptable because every life is worth more than the money that we talk about." he said.

"We have what it takes to make a difference," Osotimehin said, referring to the advances in global communications and medical science since 1994, when the world adopted the ICPD Programme of Action to empower women to claim their reproductive rights.

The conference aims at building on past commitments made in the first ICPD conference held in Cairo, Egypt in 1994. The Programme of Action adopted nearly two decades ago set a target of reducing maternal mortality by 75% by 2015; which is also one of the most urgent targets of the Millennium Development Goals (MDGs).

The good news is that maternal mortality has been reduced by 47% since 1990; still, governments are not doing enough to make reproductive health services widely available to women and young girls.

"Our work is not done," he said, "until we are able to reach out to that little girl out there drawing water five miles away from her house, who, when she has her regular menstrual period, is sent out of the house because it is unacceptable in (her) culture to be the house." Such girls are denied the opportunity to realise their full potential.

Safiye Cagar, of UNFPA, said reproductive health services, which are considered "soft issues" and therefore tend to be the first on the budgetary chopping blocks, unlike roads and schools. But building infrastructure will have little impact unless it is done in tandem with building a healthy population. "Full implementation of the Programme is not optional, it is essential, not just because of human rights but because so many other aspects of economic development hinge on its success."

She called for governments to allocate 10% of their national budgets to ICPD programmes.

Gita Sen, adjunct professor of global health and population at the Harvard School of Public Health, pointed out that the ICPD Programme is itself an unfinished agenda - the ICPD adopted in Cairo had talked about a comprehensive sexual and reproductive health package bolstered by a set of laws and regulations that would protect and promote the reproductive health rights of women, but family planning is still not integrated into issues like maternal mortality, and youth-specific sexual health needs are not being adequately addressed.

The best example of this fragmentation is the global HIV epidemic, which in most places is a "vertical silo sitting by itself" or, at best, running parallel to the rest of the health system. If a woman contracts HIV, she could simultaneously be suffering from domestic violence, she may well have a maternity problem and, most likely, her children will be in dire need of support, according to Sen. A woman probably has neither the time nor the capacity to go to different places to receive treatment, she said.

All the different sexual and reproductive health services need to be integrated as one package, which should give priority to family planning.

As far as youth are concerned, the work being done on the ground to protect and preserve their rights is "next to nothing", Sen said. doclink

Teens in the Tinderbox

April 18, 2012, Huffington Post

By Suzanne Ehlers, President, Population Action International

Next week, the 45th session of the Commission on Population and Development (CPD) will be held at the United Nations in New York. The Commission's work is to "monitor, review and assess the implementation of the ICPD Programme of Action at the national, regional and international levels."

The 2012 CPD outcome document will serve as a foundation for major upcoming international negotiations on sustainable development and population and this year's theme is "Adolescents and Youth."

The number of adolescents and young people in the world today is at an all-time high. Along with food, water and safe shelter, this huge share of the world's population needs access to contraception and a range of sexual and reproductive health services.

Many at the CPD will deny that young people are sexually active. They equate access to comprehensive sexuality education with a rise in sexual activity, when sex ed actually delays sexual initiation.

These deniers also conflate the basic tenets of good health care -- such as privacy, confidentiality, and informed consent -- with undermining cultural, religious and familial values. But young people are sophisticated enough to explore and define their values, and make informed decisions that help safeguard their well-being.

The lives of young people around the world literally depend on the success of our efforts at CPD 2012. We will seek to advance a visionary agenda for the full realization of young people's sexual and reproductive health and rights. doclink

Amy Coen, PAI, Vanity Fair LTE

What could we, should we actually do about human population growth? Can population trends be altered? If so, can they be altered without violating core human values about the worth of all human beings and the freedom of all to make decisions about their own childbearing? Does the idea of altering population trends lead inevitably to "population control," to walls erected to keep out immigrants, and to coercive policies on childbearing that punish poor women for environment problems that may be the fault of wealthy people living far away?

At the United Nations International Conference on Population and Development in Cairo in 1994, some 180 nations agreed with economist Amartya Sen that coercion has no place in any population program, whether it be a one-child policy, sterilization, forced marriage, forced childbearing, or forced sex. The Chinese, to their credit, are turning away from coercion and toward the approach that the United Nations Population Fund is the United Nations Population Fund is demonstrating, and groups such as Population Action International are advocating worldwide. This more democratic and comprehensive approach champions women's education and access to information and to reproductive-health to reproductive-health care. That care ideally includes not only contraceptives but also pre-natal and post-natal care, professional birth attendants, nutritional and child-care counseling, as well as H.I.V./AIDS prevention. doclink

The Cairo Program of Action

Acknowledges the complex personal and social contexts within which decisions about childbearing are made. It separates the problem of unwanted fertility, which can be addressed by access to family planning services, from other causes of population growth, including the desire for large families. Calls for other social investments -- such as the education of girls and the reduction of infant mortality -- to help make small families the norm.

  • Endorses a reproductive health approach to family planning.
  • Recognizes the central role of gender relations, with a link between high fertility and the low status of women, and offers strategies to empower women through access to education, resources and opportunity.
  • Addresses the harmful effects of northern consumption patterns, drawing the connection between consumption, population growth and environmentaldegradation.
  • Strikes a historic compromise on abortion. While declaring that "in no case should abortion be promoted as a method of family planning," the document asks governments to address unsafe abortion as a major public health concern. It also asks governments to ensure that abortion services are safe when they are not against the law, to provide reliable and compassionate counseling for all women who have unwanted pregnancies and to provide humane care for all women who suffer the consequences of unsafe abortion.
  • Stands on solid ethical ground. Coercion of all is rejected. The means it proposes to slow population growth are all desirable ends in themselves. It offers strategies to narrow the gaps between rich and poor, and between men and women.
  • doclink

    Meeting the Cairo Challenge

    Family Care International

    Policies based on population control are moving towards more people- oriented, reproductive health approaches. Although it takes time for policy and legal changes to benefit women and men at the community and household levels, such changes are a critical first step. Policies and laws are needed to hold health services courts, schools, and other institutions, as well as communities and families, accountable. As such, the policy and legal changes made since 1994 based on human rights, equity, and meeting people's needs--are central to fullfiling the Cairo Mandate. doclink

    The United Nations Population Conference

    It took 40 years to build consensus.

    1954 - The Club of Rome

    1960 - USAID family planning services in the developing countries increases contraceptive prevalence from 14% in 1965 to 57% today. "Population control" sometimes used.

    1974 - Bucharest UN World Population Conference. Industrial countries wanted to control population growth, while developing nations said that "development is the best contraceptive."

    1984 - Mexico City U.N. Conference on Population becamed emeshed in U.S. debates over abortion and contraception.

    1994 - Cairo International Conference on Population and Development (ICPD)- characterized by an extraordinary degree of international cooperation and consensus, by improving health, education, and access to opportunity doclink

    Why Family Planning is Good for People and the Planet

    May 22, 2018, Rewilding Institute   By: Suzanne York

    Balancing the existence of humanity and nature is a challenge. With worldwide population growth expected to grow to 10 billion by 2050, that balance harder will be more difficult to achieve. Attaining a healthy population number is key and may only be possible by finding the political and societal will.

    Supporting family planning globally and locally is imperative. In developing regions, approximately 214 million women want to delay or avoid pregnancy but are without a modern contraceptive. Additionally, in these same regions, 43% of pregnancies are unplanned. If family planning services were expanded to improve and address all women's needs for modern contraceptive the cost would be relatively low - an increase from a $6.3 billion currently to $12.1 billion annually.

    As an example, Uganda is a developing country that is in dire need of expanded family planning services. It is one of the fastest growing countries with its current population of 37 million growing to a projected 100 million by 2050. One in four girls between the ages of 15 and 19 is pregnant or has already given birth, and 75% of the population is under the age of 30. Education, outreach, and access to services are necessary and are currently being advocated for and offered by Reproductive Health Uganda.

    In the US 45% of pregnancies are unplanned. However, in Colorado, the Colorado Family Planning Initiative provides low or no cost long-acting reversible contraceptives to low-income women, especially teens. By doing this, teen pregnancies were nearly cut in half in their state.

    Family planning is often an overlooked path forward to deal with climate change. It has been shown that regions of high population growth, coupled with a high unmet need for family planning, frequently overlap with regions that are most vulnerable to climate change.

    When women's needs for family planning are met, their families are healthier, there is a reduced household demand on resources, and women have more time to devote to climate adaptation-related activities. Increasingly, though, climate researchers and activists are making the connection. It has been estimated that, just by educating girls and supporting family planning alone, emissions could be reduced by 120 gigatons of CO2-equivalent by 2050.

    Biodiversity can also be impacted by family planning. Recently the World Wildlife Fund found that the world's forests could lose more than half of their plant species by the end of the century. Indonesia has one of the highest deforestation rates in the world and, although its government has invested in education and awareness of contraceptives, its population is still increasing and is projected to be the world's seventh largest country by 2050. Today there are more that 1.5 billion people living in biodiversity endangered areas.

    New thinking about conservation, climate change, and communities is needed. One new model known as Population, Health, and Environment (PHE) is an integrated solution linking family planning, public health and conservation that recognizes the interconnectiveness of people and their local environment. Humanity must stop living beyond the carrying capacity of Earth.

    To help in this cause, readers are encouraged to become informed about policies that empower women, call on elected representatives to stop cuts on family planning assistance internationally and locally, urge congressional representatives to co-sponsor the Global Health, Empowerment, and Rights Act and the Women and Climate Change Act of 2018, protest cuts to environmental protections, involve men in family planning programs, and vote. doclink

    Karen Gaia says: more emphasis needs to be put on girls education. In many developing countries, it is equally important as family planning, especially in cultures where girls are married as children. Each year, 12 million girls are married before the age of 18. That is about 84 million girls of child-bearing age who are likely to become pregnant, and who many could have been helped by improved education opportunities, such as building schools within walking distance.

    Goat Cream: the Only Contraceptive We Know

    This method leaves experts with more questions on its efficacy.
    May 8, 2018, Daily Nation   By: Angela Oketch

    Some women of Turkana County in Kenya are turning to goat oil as a means of contraception and swear by its effectiveness. The average woman there gives birth to seven children on average, and only 10% of women (15-49 years) use modern birth control. Reasons given for the low usage are: opposition to contraceptives by husbands or partners, perceived religious prohibition, and fear of side effects..

    One woman, now 50 years old, never used contraceptives because, as a fifteen year old, her mother-in-law told her if she ever used government family planning methods, she would never have a baby when she was ready. The chemicals in birth control would destroy her womb, she was warned. Her husband, a pastoralist, would leave for long periods, tending to herds and seeking pastures, but when he returned their intimacy would result in a new pregnancy. She gave birth to five children, having one right after the other. When her husband left, it was her sole responsibility to care for her growing family. With each pregnancy, that burden grew. At the age of 38 she turned to goat cream.

    ​Scientists have not confirmed the goat cream claims of the Turkana woman. One doctor thought that, because the goal oil is not stored correctly, bacteria might grow in it and, when applied, it destroys the fallopian tubes.

    To prepare the cream, goat milk is put in a gourd and stored untouched for four nights. On the fifth day the cream is boiled and cooled. The naked woman then puts four drops in her mouth. Swirling the container of cream around her body, she chants "Don't give me a child, shut my womb." Then she puts the cream on her hair and body. The cream is then mixed with donkey feces and stored in the goat's shed untouched for four days.

    Many men of Turkana are adamantly against birth control and will not allow their wives or partners to use it. Children are seen as a source of wealth, and men want as many children as they can have. Some Turkana women are forced to go behind their husbands back to use birth control.

    As a result, Turkana's birth rate is 47.9 births for every 1,000, the eighth highest.

    In Kenya 18% of married women are considered to have an unmet need for contraceptives. Kenya wants to raise the number of women of reproductive age using contraceptives to 66% by 2030 and to 70% by 2050. Josephine Kibaru-Mbae, director general of the National Council for Population and Development, reports that Kenya is likely to meet its 2020 target of 58% by this year. Public awareness and education were the keys to its early achievement of its goal. doclink

    Want to Stop Climate Change? Educate Girls and Give Them Birth Control

    February 18, 2018, WIRED   By: Robin George Andrews

    Last year a coalition of scientists, economists, policymakers, researchers, and business people published Project Drawdown, a compendium of ways to prevent carbon dioxide from escaping skywards. Drawing from a plethora of peer-reviewed research, the document ranks 80 practical, mitigating measures-along with 20 near-future concepts-that could push back the oncoming storm.

    Ranked in order of carbon emissions locked down by 2050, a moderate expansion of solar farms was ranked #8, onshore wind turbines ranked # 2, and nuclear power (# 20), increasing the number of people on plant-rich diets (# 4) and using electric vehicles (# 26).

    Suprisingly, the top spot went to managing refrigerants like HFCs, which are incredibly effective at trapping heat within our atmosphere.

    Even more surprising, two lesser-known solutions also made this most practical of lists: the education of girls ranked #6 and family planning ranked #7).

    Getting more girls into school, and giving them a quality education, has a series of profound, cascading effects: reduced incidence of disease, higher life expectancies, more economic prosperity, fewer forced marriages, and fewer children. Better educational access and attainment not only equips women with the skills to deal with the antagonizing effects of climate change, but it gives them influence over how their communities militate against it.

    Poverty, along with community traditions, tends to hold back girls from education while boys education are prioritized.

    Then there's family planning. The planet is overpopulated, and the demands of its citizens greatly exceed the natural resources provided by our environment.

    Contraception for many of the women across the world is either not available, not affordable, or social and/or religious motives ensure that it's banned or heavily restricted. As a consequence, the world's population will rise rapidly, consume ever more resources, and power its ambitions using fossil fuels. Carbon dioxide will continue to accumulate in the atmosphere.

    The education of girls and family planning can be considered as a single issue involving the empowerment of women in communities across the world. Drawdown calculated that, by taking steps toward universal education and investing in family planning in developing nations, the world could eliminate 120 billion tons of emissions by 2050. That's roughly 10 years' worth of China's annual emissions as of 2014, and it's all because the world's population won't rise quite so rapidly.

    Project Drawdown isn't the only group that has recently tied population growth to climate change. A study published last summer also found that having just one fewer child is a far more effective way for individuals in the developed world to shrink their carbon footprint than, say, recycling or eating less meat. For women in wealthy countries, these decisions are often freely made, and fertility rates in those countries are already fairly low. In low-income countries, such individual agency - not to mention contraception - is frequently absent, and fertility rates remain high.

    Just as policymakers, climate advocates, and science communicators should pay attention to Drawdown's findings, individuals should also do what they can to make sure such a solution comes to pass. Non-government organizations, like Hand In Hand International, Girls Not Brides, and the Malala Fund aren't just uplifting women, but they're helping to save the planet too, and they deserve support.

    It's a grim assessment of civilization that, in 2018, humans are still grappling with gender equality. The world would clearly benefit if women were on par with men in every sector of society. doclink

    Karen Gaia says: "According to the United Nations Educational, Scientific, and Cultural Organization, by closing an annual financing gap of $39 billion, universal education in low- and lower-middle-income countries can be achieved. It could result in 59.6 gigatons of emissions reduced by 2050. The return on that investment is incalculable."

    A Male Contraceptive Pill Could Become Reality Using the Poison Ouabain

    How a rare poison could help bring the first male birth control pill to market
    February 5, 2018, Quartz   By: Gunda Georg, Jon Hawkinson, Shameem Syeda

    Ouabain - a plant extract that African warriors and hunters traditionally used as a heart-stopping poison on their arrows, shows promise as a non-hormonal contracetive for men that hinders the sperms' ability to move or swim effectively.

    While the birth control pill has been available to women in the United States for nearly six decades-and approved by the US Food and Drugs Administration (FDA) for contraceptive use since 1960 -- an oral contraceptive for men has not yet come to market. The pill has provided women with safe, effective and reversible options for birth control, while options for men have been stuck in a rut.

    Men curently have only two forms birth control: condoms or a vasectomy, which account for only 30% of contraception used, while women have 70%.

    Vasectomy is an invasive procedure to do that's also difficult and invasive to reverse. A male hormonal birth control pill option is in clinical human trials and likely closer to market, but it has potential side effects, such as weight gain, changes in libido, and lower levels of good cholesterol, which could negatively affect the heart health of users.

    For nonhormonal contraception methods work, researchers from the University of Minnesota and the University of Kansas have homed in on ouabain: a toxic substance produced by two types of African plants, which affects a type of transporter subunit called α4, which is found only in sperm cells. This protein is known to be critical in fertility -- at least in male mice.

    Ouabain by itself isn't an option as a contraceptive because of the risk of heart damage. So researches have designed ouabain derivatives - versions of the molecule that are more likely to bind to the α4 protein in sperm than other subunits in heart tissue. Once bound to those cells, it interferes with the sperms' ability to swim-essential to its role in fertilizing an egg.

    Because the α4 transporter is found only on mature sperm cells, the contraceptive effect should be reversible -- sperm cells produced after stopping the treatment presumably won't be affected. Ouabain may also offer men a birth control pill option with fewer systemic side effects than hormonal options.

    This new compound showed no toxicity in rats. The next steps are to test the effectiveness as an actual contraceptive in animals, then human clinical trials within five years.

    Reversible, effective male birth control is within sight. World Health Organization numbers suggest that reducing sperm motility by 50% or less is sufficient to temporarily make a man infertile. Our ongoing research brings us one step closer to expanding the options for male birth control, providing the world's 7.6 billion people with a much-needed option for safe and reversible contraception. doclink

    Why Marching for Life Now Means Attacking Contraception

    Poor Women Are Vulnerable as GOP Turns Up the Heat
    January 19, 2018, Who.What.Why   By: Kirsty Vitarelli

    Anti-abortion activists, emboldened by conservatives controlling the White House and Congress, and courts stacked with like-minded judges, are setting their sights on a new target: The elimination of federal funding for family planning services.

    For 45 years, the "pro-life" movement has gathered in Washington around the anniversary of the Supreme Court's Roe v. Wade decision to protest the legalization of most abortions in the US.

    Recently the Trump administration announced that it was strengthening protections for medical providers whose religious beliefs prompt them to refuse to perform abortions or to offer other contraceptive services.

    Title X, a provision in the Public Health Service Act of 1970 - is federal grant legislation that secures federal funding for family planning services. It is the only grant legislation approved annually, and is constantly under threat of defunding because of this status. Of the 38 million American women who use contraception, over half - 20 million - rely on publicly funded contraceptive care.

    "Without contraceptive coverage, many women would need to pay more than $1,000 out of pocket to start using a highly effective method such as a intrauterine devices (IUDs), a contraceptive implant or sterilization; that would amount to nearly one month's salary for a woman working full-time at the federal minimum wage of $7.25 an hour," reports the Guttmacher Institute, a reproductive health research organization. Other forms of contraception are less costly - as low as $9 a month from Target and Walmart. But, with the exception of emergency contraception, birth control pills require a doctor's prescription, an associated visit and insurance costs.

    The theory supporting threats to Title X is that life begins at the moment egg and sperm meet, which increasing numbers of anti-abortion advocates and lawmakers embrace. They equate highly effective, long-acting reversible contraception (LARC) like IUDs and contraceptive implants with abortion itself, believing these methods would dislodge a fertilized egg - a view which is not scientifically accurate.

    IUDs and implants primarily prevent fertilization, not implantation - there is no zygote, so there is nothing to abort. However, buoyed by the Supreme Court's ruling upholding Hobby Lobby's religious right to deny access to LARCs, and President Trump's seeming eagerness to please his base, anti-abortion advocates are seeking to promote their ideology in a number of ways, including going after Title X funding.

    Title X in the beginning was championed by both sides of the House - its main sponsor was George H.W. Bush and was signed into law by President Nixon." The idea was that women and couples - regardless of their employment or insurance status - should have the opportunity to plan whether and when they would start a family.

    However during Ronald Reagan's presidency, there was more anti-abortion ideology involved in the politics and policies of family planning.

    Three-quarters of all women in the US who underwent abortions in 2014 were either living in poverty or had low incomes of roughly between $11,000 and $22,000. If federal funding is removed, these low-income households would suffer the most, physically and financially.

    An amendment to the recent tax bill fostered the idea that personhood begins at conception by proposing that unborn children could be beneficiaries of college savings plans. The language was cut before the tax bill passed.

    House appropriators agreed to defund Title X entirely, eliminating the program - $286 million - from the 2018 budget, but Senate appropriators did not cut the program from their spending bill.

    Trump has appointed prominent anti-contraception advocates to his Department of Health and Human Services (HHS) in an attempt to keep a promise to his evangelical followers. Valerie Huber, an advocate of abstinence over contraception will continue the push to defund Title X.

    A rider in the House Labor, HHS, Education and Related Agencies spending bill would block Planned Parenthood from any federal money in 2018, and effectively "end the nation's family planning program.”

    President Trump signed a law last spring allowing states to withhold federal money from organizations that offer abortion services. Many of these organizations also provide important contraceptive services to the poorest in society, services which would also be threatened.

    60% of Americans believe abortion should remain legal. Some physicians remember the time before Roe v. Wade and worry that overturning it would slide the country back to the days when more than 200 women a year died from septic shock due to "back alley” abortions, or became infertile after suffering permanent injury inflicted by barbaric tools.

    45% of pregnancies in the US are unintended, and about 4 in 10 of those end in abortion, according to Guttmacher. Three-quarters of all women in the US who underwent abortions in 2014 were either living in poverty or had low incomes of roughly between $11,000 and $22,000. If federal funding is removed, these low-income households would suffer the most, physically and financially.

    Title X funding is intact - for now. But "the Trump administration in its first year and Congress under its current leadership have very openly hostile views and agendas against reproductive health and rights. doclink

    China's Birthrate Dropped Despite Allowing 2-child Families

    January 19, 2018, Associated Press

    The birthrate in China fell last year even though the country has changed its One Child policy to allow two children. Reasons given for the low birth rate were the trend toward later marriage, the desire for smaller families and concerns about the high cost of raising children.

    With almost 1.4 billion people, China has the world's largest population but it is aging fast even before reaching its expected peak of 1.45 billion in 2029.

    China's policy was changed in 2015 in an attempt to increase the size of the younger working population that will eventually have to support their elders. The number of births rose nearly 8% in 2016, with nearly half of the babies born to couples who already had a child. But that appears to have been a one-time increase.

    Experts have recommended the country increase its retirement age to address an expected labor shortage and declining economic vitality.

    One woman, a housewife in Beijing, pointed out that the burden of looking after aging parents is one reason not to have a second child. "They helped us look after one child, but we would have to babysit the second one ourselves."

    "Until the young one is 2, mother won't be able to work which means a big loss of income that we're not prepared for," another person said.

    China enacted its one-child policy in 1979, enforced with fines and in some cases state-mandated abortions.

    The expected future reduction in the working-age population is exacerbated by a skewed male-female birth ratio resulting from the traditional preference for male offspring. doclink

    Karen Gaia said: apparently China started its One-Child policy after it already started a successful family planning program. It is my belief that family planning would be far more widely supported if China had not imposed its oppressive policy.

    When a Woman Can Control When She Has Children, She Can Control Her Future

    In Australia we often take the access to contraception for granted. We have to talk about the right to reproductive choice for women globally
    November 27, 2017, Guardian   By: Chris Turner

    The author, who works for the NGO Marie Stopes, tells us that reproductive rights are not guaranteed anywhere.

    In urban areas people come to Marie Stopes clinics and in rural or remote settings Marie Stopes take their services to the people. In Papua New Guinea the author has spoken to women who were afraid for their lives because they knew someone who had died during childbirth. One woman had been told by a local health worker she would "probably die" if she became pregnant again. The author has met men who worried deeply about conflict in their villages as the population grew and land became scarce. In Cambodia he has met young factory workers who can only afford to keep their children in school as long as they can keep working. In Myanmar he has met aspirational students who are the first in their families to go to university and are not at all ready to get married. The need to control their own fertility, and the challenge to do so, binds this diverse group together.

    In Australia, senator Cory Bernardi recently introduced a motion intended to undermine abortion rights for Australian women. His series of proposals covered abortion funding, greater scrutiny of the activist group GetUp, and White Ribbon Australia's support for abortion, including late-term terminations. In the US, employee rights to contraception in their healthcare coverage have been rolled back and support to family planning programs in developing countries slashed.

    We need to fight to keep our current rights but should also fight to extend that franchise to others. Family planning is fundamental to both individual empowerment and national development and yet is somehow regularly overlooked by bureaucracies or targeted for elimination by conservative forces. There are 214 million women in the developing world who don't want to have a child right now but don't have access to family planning. As a result they are less able to control their futures. Their health, education, employment prospects and very standing in society will all be impacted by something Australians so often take for granted - the ability to choose. doclink

    World Vasectomy Day: How to Engage Men in Family Planning Efforts

    November 15, 2017, Devex   By: Ana Karina De La Vega Millor, Jonathan Stack

    It is appropriate that we focus on women and girls because of the persistent and debilitating gaps in global access to education, health care, and economic opportunity between the genders.

    However, there is also a gap in funding and research to engage men, which not only makes overall family planning objectives more elusive, but puts even greater stress and pressure on women to shoulder the burden of contraception on their own.

    The majority of family planning options are designed for women, and options for men are limited to condoms, vasectomies, and the withdrawal method of contraception.

    However, World Vasectomy Day has shown that. when provided thorough information through compelling stories, men will, in fact, participate in family planning, including opting for a vasectomy.

    DKT International, DKT Mexico, the National Center for Gender Equity and Reproductive Health and the Mexico City Ministry of Health, have joined forces to celebrate World Vasectomy Day on its fifth anniversary.

    With 1,200 vasectomists in 50-plus countries participating, World Vasectomy Day is the largest male-focused family planning event ever, using creative media to dispel vasectomy myths, raise awareness, and promote broader positive masculinity.

    The government has embraced this anniversary in tandem with their 40th anniversary celebrations of Mexico's Family Planning Program.

    Investing limited family planning resources in male options is not only good for family planning, but it is necessary for a healthy society. When men are involved in family planning and sexual health programs, men are more likely to participate in household work and childcare, financial resources are more readily allocated for female contraceptives, and domestic violence decreases.

    Research has shown that bringing men into the family planning conversation actually increases overall contraceptive use while making broader and critical strides toward increasing gender equality.

    Here are three tips for involving men.

    1. Instead of opening conversations by asking men whether they want to get a vasectomy, shoot for the big-picture: How important is it that the quality of life of your children be better than your own? From there, conversations naturally cover the impact of large family sizes on ability to provide, and their desire to be part of the decision-making process. When vasectomies are seen as a tool to achieve desired family sizes and a way to care for the children they already have, men are extremely receptive.

    2. DKT has found that using dynamic, open, and fun social marketing techniques dramatically increases the uptake of the nonprofit condom brand, Prudence, in Mexico and other Latin American countries. Emphasizing that good sex and being responsible lovers are not mutually exclusive might be considered scandalous by some - but it works.

    The makers of Prudence have eroticized their condom messaging, celebrated sexuality, and used humorous vernacular without any medical jargon. DKT also offers resources to men for questions about sexual health through major events such as concerts, school functions, and health care fairs, and through its social media, Red-DKT call center, and Whatsapp mobile chat service.

    3. The strategy of asking men to get a vasectomy as part of a public ritual celebrated globally transforms the common fear that a vasectomy leads to a loss of manhood into an increased sense of heroic purpose, all the while demystifying the procedure itself. World Vasectomy Day uses videos and media products to dispel myths while cultivating community through shared stories of real patients before, during, and after their vasectomies. Since adopting the World Vasectomy Day program, Mexico has seen an 18.1% increase in vasectomy acceptance.

    By involving men in family planning programs, raising awareness of vasectomies as a simple and effective method, and celebrating the men who take part, we can truly shake up the stagnant growth in contraceptive use and global gender equality. doclink

    The Power of Stories

    Entertainment that can #CHANGEHERSTORY
    November 1, 2017, Population Media Center

    PMC's TV and radio shows get more than top ratings. This is storytelling that changes lives.

    While being entertained, people's day-to-day experiences are changed by these stories. We all learn by watching role models. PMC's shows change ideas, self-perception, and self-confidence for millions of people at a time.


    U.S.: The Huge Hidden Costs of Trump's War on Contraception

    October 30, 2017, Newsweek   By: Mark Edwards

    The Trump administration's recent rule change makes it harder for women to obtain birth control, and the impact will reverberate far beyond simply inconveniencing women.

    All of us - our families, our communities, our economy - pay a price when there are barriers to contraceptive access and The Trump administration's recent rule change makes it harder for women to obtain birth control,

    Nearly half of all pregnancies in the United States are unplanned, resulting in 1.5 million unplanned births each year. Two-thirds of these births are paid for with public dollars at $21 billion a year, including public outlays for prenatal care, labor and delivery, postpartum care and years of infant care.

    Babies born as a result of unplanned pregnancy are significantly more likely to arrive preterm or at a low birth weight. This can lead to developmental problems and other health complications that often create lifelong issues and lead to pricey medical bills.

    When there is an unplanned pregnancy, young women often put their education on hold or leave the workforce, lowering earning potential and increasing the likelihood of poverty for them and their children.

    Almost 50% of all unplanned pregnancies occur to women using a contraceptive method that isn't working well for them. The places where many women get their healthcare make it very difficult to access the most effective methods of birth control, IUDs and implants.

    When women have same-day access to the full range of birth control methods, and can choose the one that works best for them without cost, we start to stem the tide of unplanned pregnancy.

    It is important that clinics offer free same-day access to all contraceptives. Helping women achieve their own goals and empowering them to decide when and if they want to become pregnant improves economic and health outcomes for parents, children, and communities.

    Delaware had the highest rate of unplanned pregnancies in the country - 57%. But then they worked to to reduce barriers and improve access to birth control. Today, any woman in Delaware can get access to the method of birth control she wants for free. Health centers now reach almost 80% of women in the state.

    When Colorado invested in their family planning programs, the state saw a savings of $5.85 for every $1 that was invested.

    Reducing access to birth control hurts women, families, and the economy. Our work is dedicated to ensuring providers offer all women - no matter where they live, their income, or their insurance status - easy, affordable access to the full range of birth control options. Doing anything less harms us all. doclink

    Solving Our Population Problems

    August 15, 2017, Population Matters

    Population growth can be slowed, stopped and reversed, even though it has rocketed in this century and last. A sustainable reduction in global population could happen within decades, according to the United Nations' most optimistic scenario. Its main population prediction is in the middle of that range - 9.8bn in 2050 and 11.2bn in 2100. But if there were just half-a-child less, on average, per family in the future than assumed, there woud be two billion fewer of us than expected by 2050 - and five billion fewer of us by the end of the century.

    Countries have had dramatic success in reducing their birth rates. Thailand reduced its fertility rate by nearly 75% in just two generations with a creative and ethical family planning program. Fertility rates in Asia have dropped by nearly 10% in 10 years.

    Over 200 million women who want to avoid pregnancy are not using modern contraception. Reasons for this include lack of access, concerns about side-effects and social pressure not to use it. Most of these women live in poor countries, where population is set to rise by 3 billion by 2100. Overseas aid support for family planning is essential - making sure supplies are adequate.

    People choose not to use contraception because they are influenced by assumptions, practices and pressures within their nations or communities. In some places, very large family sizes are considered desirable; sometimes the use of contraception is discouraged or forbidden.

    However programs that change attitudes towards contraception and family size have been very successful. Religious barriers may also be bypassed. In Iran the country's religious leader declared the use of contraception was consistent with Islamic belief and a very successful family planning campaign was initiated. Portugal and Italy have some of the lowest fertility rates in spite of the fact that they are predominantly Catholic.

    Escaping poverty is a vital way to bring birth rates down. Decreasing child mortality, improving education and providing people with economic opportunities all help to reduce fertility. International aid, fair trade and global justice will help bring global population back to sustainable levels.

    Where women and girls have economic empowerment, education and freedom, they normally choose to have smaller families. Greater freedom usually leads to greater uptake of family planning and ending child marriage pushes back the age at which women have their first child, which often reduces family size.

    African women with no education have, on average, 5.4 children; women who have completed secondary school have 2.7 and those who have a college education have 2.2. When family sizes are smaller, that also empowers women to gain education, take work and improve their economic opportunities.

    In the developed world, most of us have the power to choose the size of our families [Note: 50% of pregnancies in the U.S. are unintended]. We also have a disproportionate impact on the global environment through our high level of consumption and greenhouse gas emissions - in the UK, for instance, each individual produces 70 times more carbon than someone from Niger. doclink

    Karen Gaia says: 1) One of the biggest reasons people in poor countries do not use contraception is a language barrier which results in poor women not understanding about family planning benefits and side effects. In Tanzania, for example, only 10% of the population has Swahili, the national language, as their native language. Many of the rural people do not understand Swahili. This would be true in many African and Asian countries where the rural population speaks languages different from the national language. I wonder if Health surveys take that into account when they tabulate reasons women don't use contraception.

    2) The U.K. has a high unintended pregnancy rate, at 40%. The U.S. and Canada both have high unintended pregnancy rates at 40-50%. In the U.S. women below the poverty level have a five times the chance of having an unintended pregnancy than women well above the poverty level. It is not just a matter of 'choosing a smaller family'. as the article claims. It is likely a matter of having access to affordable and effective contraception.

    Population and Family Planning Programme: What We Achieved

    August 9, 2017, Daily Sun   By: Dr. Noor Mohammad

    Bangladesh has grown from 75 million people in 1971 to almost 160 million today, more than double in 46 years. The United Nations estimated in 2015 that the population of Bangladesh would be about 202 million in 2050.

    The last census (2011) showed an increase of more than 20% in a decade, which is higher than that of immediate past decade seen from 1991 to 2001 at 17%.

    Bangladesh has a population an average population density of 1,070 persons per sq. km, which is one of the highest in the world. The life expectancy at birth is 71 years, with women having slightly higher lifespan than men (72 years vs. 69 years).

    Bangladesh is now experiencing a demographic transition with the continuous decline trend of the natural growth rate. The population growth rate in Bangladesh was 1.37%. Bangladesh is an intermediate position between low-growth countries, such as Thailand, Sri Lanka and Myanmar and medium growth. Medium growth countries in the region are India and Malaysia.

    Bangladesh's Family Planning Program has had a tremendous role in slowing population growth over the last 50 years. Bangladesh's progress in the family planning movement has been cited as one of the role models to follow. Family Planning was introduced in Bangladesh (then East Pakistan) in the early 1950s through the voluntary efforts of social and medical workers. The government of Bangladesh, recognizing the urgency of its goal to achieve moderate population growth, adopted family planning as a government sector program.

    Beginning in 1972, the FP program received virtually unanimous, high-level political support. In 1976, the government declared the rapid growth of the population as the country's number one problem and adopted multi-sectoral FP program along with National Population Policy.

    From extremely high levels of 6.3 in 1975, to 3.3 in the year 2000, the Total Fertility Rate (TFR) now stands as 2.3 according to the Bangladesh Demographic and Health Survey 2014, which is still some distant away from replacement fertility levels. According to the Population Reference Bureau (PRB) in 2003, even if Bangladesh reached replacement level fertility, population stabilization would take another 15 years, and the growth is being fuelled by the large young population of the country. PRB predicted the replacement level fertility by 2010 which did not take happen.

    The 1980s saw a steep decline in TFR.This was followed by a decade-long plateau which was the consequence of a 'tempo effect'. The adoption of FP by Bangladeshi couples has always been after the first birth. The age at marriage did not change and there was no delay in age at first birth, and as such, no tempo effect was operating on first births. The 2004 Bangladesh Demographic and Health Survey showed a 9% reduction in fertility, from 3.3 to 3.0, over a decade. The 2011 BDHS confirmed a further decline in TFR to 2.3 children per woman but again it has stalled. Now, however, fertility levels are quite uneven - remarkably low in the west of the country (below replacement, on average) and worryingly high in the east (up to 1.5 children above replacement).

    In order to attain any of the reasonable population estimates projected for mid-century (which range from 194 to 222 million) a substantial increase in the contraceptive prevalence rate (CPR) will be required in the next five years by 2022. This target could theoretically be achieved if all current unmet needs for FP (12% in 2011) are met.

    Bangladesh has considerable built-in population momentum because of high fertility in the past, and even with reduced fertility, many young women will pass through reproductive ages over the coming decades. During the first decade of the 21st century, the number of women of reproductive age increased from around 32 million to 41 million as the children born in the higher fertility 1970s and early 1980s entered their childbearing years, according to UN estimates.

    Investments in female primary and secondary education in Bangladesh manifest themselves in improved opportunities for formal sector employment for young women, and parents will tend to favor smaller families, investing more per child in education-quality versus quantity. This trend will also be influenced by the saturation of the rural labour force and the fragmentation of agricultural land holdings such that there will be decreasing employment opportunities for unskilled workers.

    Having a huge mass in the youth age population is worrying. If they don't get the job on time or get the opportunity to have the skills for future earnings, some of the social menaces will continue, like dropping out from the schools, early marriages followed by early pregnancies. This vicious cycle will become the hindrances of our national programs that contribute to continue fertility decline and population growth.

    A stagnating CPR is a cause for concern. While the government through its new plans to expand the contraceptive mix by specially promoting permanent methods, it should also think of fertility awareness based methods, such as long acting methods (LAM), which mimic traditional methods and may be more acceptable to users of traditional methods.

    To increase levels of unmet need, the government, with help from its non-governmental partners, should continue with its family planning messaging and counseling services and try and match the demand for family planning services and supplies.

    Bangladesh has a high adolescent fertility rate, one of the highest amongst the south-east Asia region nations. Early initiation of child bearing leads to rapid increases in population by not only lengthening the productive period in the woman's life, but also by shortening the inter-generational span. As most of the adolescent child bearing occurs within the realm of marriage, it means that the law governing the age at marriage needs a much stricter reinforcement. It is heartening that the government plans to make special efforts to reach out to adolescents with family planning messages and individual and community level counseling services. doclink

    Karen Gaia says: One of the main reasons that fertility rates stalled at around 3.0 was because of male preference, and also because Bangladesh's education program had not yet produced a large cohort of girls going through high school. A woman who has a high school education will have two fewer children than her non-educated peers.

    This is How Many Women Get Pregnant on Birth Control - It's Shocking

    No birth control claims to be 100% effective and these alarming statistics reveal that's certainly true
    August 7, 2017, Daily Star   By: Laura Hampson

    No form of birth control is 100% effective, according to a study by the British Pregnancy Advisory Service.

    51.2% of women who have abortions were using birth control.

    24.1% of abortions performed were on women who were using a hormonal method of contraception like the pill, the implant, IUDs or a coil when they fell pregnant.

    27.1% of abortions were on women using a condom or a diaphragm.

    The pill is the most popular form of contraception but long-term forms are quickly catching up.

    The pill is estimated to be 91% effective while condoms are just 82% effective.

    Long-term contraceptives or the pill can also make periods irregular or stop them all together which can mask the symptoms of pregnancy.

    This could be why women are having late-term abortions (past 20 weeks) because they were using long-term methods so didn't take notice of pregnancy symptoms.

    BPAS' chief executive Ann Furendi said: "When you encourage women to use contraception, you give them the sense that they can control their fertility -- but if you do not provide safe abortion services when that contraception fails you are doing them a great disservice.

    The most effective forms of contraception available in the UK are the coils (IUD and IUS) and the implant, which are both 99% effective.

    Natika Halil, the Chief Executive of the Family Planning Association said: "The way they are typically used means that 6 in 100 injection users and nine in 100 people using the pill, patch or vaginal ring will get pregnant each year, but women may not always be aware of this.

    "If you forget your contraception or think it might have failed it's important to know how to access emergency contraception and that it's available for free from GP surgeries, contraception and sexual health clinics." doclink

    New Data Reveals the 1.6 Billion Reasons Contraception Matters

    July 11, 2017, Marie Stopes

    As policymakers, donors, and advocates gather for the Family Planning Summit in London, new data released by Marie Stopes International reveals the 1.6 billion reasons why we need to act now to ensure modern contraception and family planning services are an option for every woman.

    If all of the 69 FP2020 focus countries provided contraception to every woman who wants it by 2030, as agreed under the UN's Global Goals for Sustainable Development (SDGs), family planning would prevent:

    * 1.6 billion unintended pregnancies
    * Over 500 million unsafe abortions
    * 1.5 million maternal deaths

    Marjorie Newman-Williams, vice-president and director of international operations at Marie Stopes International said:

    "The goal of getting contraception to every woman who wants it is ambitious, but it is both possible and good value for money. Without access to contraception, women are likely to have more children than they want or can care for. Frequent births in quick succession imperils a woman's health, stresses her family's well-being and future prospects, and overwhelms countries' social and economic resources.

    "In the UK, it is easy to take contraception for granted, but for women in developing countries it can mean the difference between gaining qualifications or being kicked out of school, between dividing your evening meal between four people or twelve, or even the difference between life and death."

    Over the last five years, the world has made impressive progress in expanding access to modern contraception. Despite population increases, for the first time in history, unmet need for contraception has fallen, with a record 300 million women and girls across 69 of the world's poorest countries now using modern contraceptives. But huge numbers of women are still missing out, particularly the young, people in humanitarian crises and women in the most remote places on earth.

    Today, more than 60% of sexually active adolescents in developing regions who want to avoid pregnancy are not using modern contraception. With 1.2 billion adolescents - one of the largest generations in history - entering their reproductive years, our actions today could mean the difference between poverty and prosperity for entire nations.

    "Marie Stopes International provides contraception and safe abortion services to more than 28,000 women worldwide every day and we see with our own eyes the transformational effect these services have, not just on women's lives, but on their wider families and communities and national stability and security.

    "By prioritising contraception and safe abortion, countries can harness the largest working-age population of their history, fast-tracking their economic and social development and building their nations into better trading, investment and development partners."

    Expanding and improving services to meet all women's needs for modern contraception in developing regions would cost $11 billion per year, or $1.75 per person per year, with every additional dollar invested saving countries up to $120. doclink

    Contraceptive Usage: Bangladesh 8th, China Top in Asia

    April 1, 2017, The Daily Star

    China has the highest contraceptive prevalence in Asia, at 83% usage, followed by South Korea and Thailand, both at 78%.

    Next comes Vietnam 76%, Sri Lanka 71%, Bhutan 67%, Singapore 66% and Bangladesh 64%.

    Indonesia and India, both are among the fastest growing economies in the region and have 62% and 59% contraceptive users respectively.

    Laos, Nepal and Myanmar have the next-to lowest number of contraceptive users in Asia. All three countries have just over 50% contraception usage. Pakistan, though, has just 38% contraceptive prevalence.

    Growth in the number of contraceptive users is projected to be specifically high for south Asia. doclink

    Karen Gaia says: it is worth noting that Laos, Nepal, Myanmar, and Pakistan are mountainous countries, with many hard-to-reach roadless areas. Bhutan is similar, so it is amazing that its contraceptive prevalance is so high. I was also surprised that Myanmar had such a low ranking in view of its fertility rate of 2.15. Fertilty rates (2016) for these Asian countries in order of fertility rate are: Pakistan 3.8, Laos 2.76, Bhutan 2.5, India 2.45, Bangladesh 2.19, Nepal 2.18, Myanmar 2.15, Indonesia 2.13, Sri Lanka 2.1, Vietnam 2.1, Thailand 1.51, Singapore 1.2.

    Exploring the Unmet Need: Reasons for Not Using Family Planning Services

    March 31, 2017, Art Elphick

    Bill Ryerson, founding Director of the Population Media Center, has been gathering Demographic and Health Surveys on the reasons people in high-birthrate nations give for not using available Family Planning (FP) services. Some of the DHS surveys include women who would like to become pregnant, so the surveys taken in some nations show "desire for pregnancy." In fact, on surveys offering that option, wanting another child is the number one reason the survey takers gave for not using FP services.

    The surveys estimated that 225 million women in the surveyed regions had an "unmet need" for FP services. They defined unmet need as not wanting to be pregnant in the next two years, but not using any modern method of contraception. In most countries the most common reasons for not using contraception given by married women in this category were: fear of side effects, health concerns and inconvenience. These reasons were cited by 20-50% of married women at risk of an unintended pregnancy in 26 of the 36 countries with information on this question.

    Referring to a 2007 article published by several demographers concerning the studies, Mr. Ryerson quotes two excerpts stating reasons for non-use:

    "Only 0-2% of women with an unmet need indicated that they had no knowledge of contraception in 19 countries. Cost was not a frequently cited obstacle to use among married women with an unmet need: Fewer than 5% of married women in 28 countries indicated cost constraints. Also, fewer than 5% of married women at risk for unintended pregnancy did not have access to a source of contraception in 16 countries.

    "About 10-50% of married women with an unmet need cited infrequent sexual activity as a reason for not using a method of family planning across the countries represented. A substantial proportion of these married women were sexually active within the three months preceding the survey, including about half of women with an unmet need in Latin American and Caribbean countries."

    A June 2016 paper by two of the authors of the 2007 paper essentially came to the same conclusions.

    There is still need for expanded FP services, especially if the informational and cultural barriers to use of FP methods can be overcome. In 1960 surveys, when large numbers did not have access to FP services, only 10% of the world's couples used modern methods of contraception. Recent surveys show that 56% now do. However, because of population growth, the 44% non-users outnumber the 90% non-users from 1960. Today the reasons for non-use are quite different from those given in 1960. In most nations, over 95% can identify an accessible source of FP services, but many don't use them because they want more children, fear health effects, have male opposition, or have a fatalistic view. In Nigeria, where the rate of population growth has reached crisis proportions, less than 1% of non-users cite lack of access or cost as their reasons for non-use.

    The mission of the Population Media Center (PMC) is to use entertainment-education and mass media to promote social and cultural change. PMC sponsors dramatized communication campaigns that, without telling people what to do, provide attractive role modeling. PMC's soap opera-type programs focus largely on women's rights, including education for girls, and communication between husbands and wives about the future of their families - promoting more awareness that smaller families lead to better health and greater prosperity. doclink

    Karen Gaia says: my experience with the Maasai Harmonial project shows otherwise: many women in the project area do not want so many pregnancies but: a) their husbands would beat them if they took birth control, b) they did not know enough about birth control to trust it, c) they would have to travel a long way to get birth control and their husbands would be suspicious if they were gone overnight.

    It may be that the pastoral peoples in remote areas were not included in the survey. PMC serves people who have access to radio. The people in the Maasai Harmonial project area do not have access to radio. In addition, the pastoral Maasai culture is very different from the culture of the people who live in the areas where radio is available. The majority of the Maasai do not speak the national language of Swahili or English, so they would not benefit from a radio program produced in Swahili. See

    PMC has done wonderful things, but it must be recognized that a large part of population growth in Africa comes from hard-to-reach rural areas where a large variety of languages are spoken.

    The Colorado Family Planning Miracle

    Are Oregon and Washington next?
    March 23, 2017, Sightline Institute   By: Valerie Tarico

    The state of Colorado upgraded its family planning services between 2009 and 2014, and saw a return of $5.85 for every dollar spent.

    When Delaware governor Jack Markell saw Colorado's results, he kicked off a copycat process of retooling family planning services across his state, where over 60% of pregnancies were unintended. Oregon and Washington may follow suit.

    Around 50% of Colorado women who got pregnant in 2008 said that the pregnancy happened sooner than they wanted or that they hadn't wanted to get pregnant at all. The US average is similar: the rate of unintended pregnancy has been stuck around 50% since the 1960s.

    Global health experts call unintended pregnancy an epidemic because it's so common, and the toll on physical health, mental health, and child development so large. Reducing unsought pregnancies results in: better health and education for women, more financial security for families, healthier babies, and less strain on social services dedicated to helping families with lower incomes or wealth.

    After implementation of the Colorado Family Planning Initiative, teen births and abortions dropped by nearly half. They fell by nearly 20% among women aged 20-24. Ordinarily, over 80% of teen pregnancies and 70% of pregnancies among single women aged 20-29 are unintended. Second or third births to teens dropped by 58%. High-risk births, including preterm births, also diminished.

    Unsought pregnancy is four times as common and unsought birth seven times as common among poor women as among their more prosperous peers, so poor families benefited the most. With fewer families facing the dire circumstances triggered by an unexpected pregnancy or unplanned birth, the state saved $66-70 million in public assistance.

    In Colorado, much of the improvement came from switching away from error-prone family planning methods that require action every day or every time they have sex -- such as pills and condoms-- to long-acting IUDs and implants that make pregnancy prevention easy. These methods are "get it and forget it." They work 20-50 times better than the pill. When a woman wants to get pregnant, her healthcare provider can remove the implant or IUD, usually in a five-minute procedure, and normal fertility returns almost immediately.

    In St. Louis a study of 9,000 women called the Contraceptive Choice Project demonstrated that long-acting contraceptives dramatically reduce unplanned births and abortions. It also showed that most women prefer these technologies when high cost and other barriers are removed.

    The US Centers for Disease Control and Prevention (CDC) and the American Congress of Obstetricians and Gynecologists have declared these methods far more effective and safer than any other method and far safer than the risks from pregnancy itself. One of these methods, the hormonal IUD, has bonus health benefits, including protection against some cancers.

    The Colorado Family Planning Initiative (CFPI) increased access to quality services. Women were able to access services wherever they might encounter the healthcare system. All sorts of health care workers were trained in improved counseling and to insert (and remove) implants and IUDs. More flexible hours at these health centers improved access for working women. CFPI integrated family planning into primary care, labor and delivery, and post-abortion care.

    CFPI funding made all methods available with no co-pay, a standard that later would be incorporated into Obamacare (now on the chopping block, of course). Implants and IUDs are cheaper in the long run than other forms of birth control, especially if you include the costs associated with an unplanned pregnancy. But until recently, the up-front price of long acting contraceptives has made these methods unavailable to many women.

    CFPI worked to normalize conversations about sexual health and promote healthy decisions and planning. Young Latinas, who have a higher-than-average teen pregnancy rate, talked with each other in culturally proficient after-school programs. Social service agencies offered sexuality workshops or provided onsite access to educators. A website, BeforePlay, offered practical information about contraception and sexual health, as well as specific resources available across the state.

    Reimbursement policies were changed so that women could get an IUD or implant of their choice immediately postpartum in hospitals.

    Oregon Governor Kate Brown recently affirmed that she and the Oregon Health Authority "place a high priority on improving women's health and reducing unintended pregnancies by implementing pregnancy intention screenings and providing effective contraceptives to women who do not wish to become pregnant."

    The Oregon Foundation for Reproductive Health has developed a technique -- now a national model -- that makes it easier for primary care, chronic care, and mental health providers to open up conversations about family planning. It is called One Key Question, and the question is: Would you like to get pregnant in the next year? If a woman says yes, this leads to a conversation about preparing for a healthy pregnancy, called "preconception care". If she says no, she has an opportunity to explore contraceptive options, including top-tier methods that might not be familiar.

    A new Oregon law allows retail pharmacists to prescribe oral contraceptives or patches. A second law, the first in the nation, requires insurers to cover a 12-month supply of birth control at a single prescription fill. Oregon also has a mandate for comprehensive sexual health education in public schools and expansion of family planning coverage through Medicaid.

    Despite promising trends, the US teen pregnancy rate is far higher than any of the other 34 countries in the Organization for Economic Cooperation and Development.

    National funding cuts could make things worse: a reversal of Medicaid expansion, elimination of the ACA's contraceptive mandate, cuts to Title X, or defunding Planned Parenthood. But there will be opportunities to increase intentional parenthood through practice improvements and better public awareness.

    Oregon's One Key Question could make the state a national leader in healthcare integration. This will mean incorporating routine pregnancy-intentions screening into primary care, labor and delivery, chronic care, mental health, and drug treatment programs.

    Public officials in the state of Washington have paid close attention to the models in St. Louis, Colorado, and Delaware. Washington Governor Jay Inslee's office has voiced support for upgrading contraceptive care statewide. The governor's Results WA measures aim to reduce unintended pregnancy by 10% in five years. When Planned Parenthood showed that low reimbursement for IUD insertions had become an obstacle for clinics serving poor women, the state changed reimbursement rates.

    School-based clinics in Seattle now offer the full-range of birth control options to high school students, and Neighborcare Health, which runs several of these clinics, employs educators who help teens and their parents explore options.

    Washington's King County has seen a 55% drop in teen pregnancy over seven years. In 2008, King County Public Health secured a small grant to train and provide technical assistance to school-based health centers so they could offer IUDs and implants on-site, with follow-up support from Public Health. Three of these health centers hired half-time sexual health educators, who taught in biology and health classes, and provided contraceptive counseling to teens and their parents.

    One Washington State imperative addresses the epidemic of opioid addiction. Neonatal care units are overflowing with newborns suffering from Neonatal Abstinence Syndrome, a form of withdrawal. 86% of pregnancies in opioid-addicted women are unintended, suggesting that simply helping them to not get pregnant when they don't want to could prevent a significant part of this suffering.

    With long-acting methods offering years of protection and with each person in charge of his or her own fertility, children will come into the world by the mutual consent of two people who want to create a child together. doclink

    GOP Plan's Odd Side Effect: More Abortions

    March 17, 2017,   By: Robert J. Walker

    The Congressional Budget Office (CBO) estimates that defunding Planned Parenthood in the first year alone would increase the number of births by several thousands and increase, in turn, Medicaid expenditures by $21 million in 2017 and $77 million over the 2017-2026 period.

    By making contraception more affordable, Obamacare contributed to an 18% decline in unintended pregnancies since the reform was passed in 2010.

    But even if Planned Parenthood is spared, Trump's proposed rollback in Medicaid and contraceptive coverage will inevitably increase unintended pregnancies and the demand for abortion services.

    According to the Guttmacher Institute, the decline in unintended pregnancies contributed to a 14% decline in the US abortion rate between 2011 and 2014. The AHCA, on the other hand, by making contraception more expensive and less accessible, would roll back some or all of those gains.

    In addition Congress may also eliminate funding for comprehensive sex education in schools. The House of Representatives has been trying to do just that for the past four years, and this year it may be able to override Senate opposition.

    The Trump administration's budget, released just this week, calls for a $10.9-billion (29%) cut in funding for the State Department and international programs. Humanitarian programs, including international family planning, could face draconian cuts.

    USAID's family planning program helps parents better feed, educate and care for their children. In the 27 countries with the largest USAID-supported programs, modern contraceptive use increased from under 10% to 37%, and the average number of children per family dropped from over 6 to 4.5.

    US-supported family planning programs are slowing rapid population growth in some of the least stable countries in the world, including Afghanistan, Democratic Republic of Congo, Ethiopia, Mali, Nigeria, Pakistan, South Sudan and Yemen.

    Cutting international programs to pay for increased defense spending will undermine US security and likely increase the demands on the Defense Department.

    Defense Secretary James Mattis once declared: "If you don't fully fund the State Department, then I need to buy more ammunition."

    Two years after Texas slashed its support for family planning by two-thirds in 2011, Medicaid expenditures soared because of the increase in unplanned pregnancies. While the state was forced to do an about-face and re-fund family planning, it persisted in its attacks on Planned Parenthood, forcing dozens of clinics to close, leaving many women in Texas without access to family planning services.

    Unless Congress stands down on cutting contraceptive services, it will find itself in the perverse position of driving up teen pregnancy rates and Medicaid costs. doclink

    The First Steps Toward Over-the-counter Birth Control in the US Are Finally Underway

    A French pharmaceutical company will apply for FDA approval to make a progestin contraceptive pill available over the counter in the US. It's about time.
    December 30, 2016, VOX Media   By: Emily Crockett

    In most states, hormonal contraception requires a prescription. Getting that prescription takes time and money for doctor visits that some women just don't have. Oral contraceptive pills are well-studied, and The American College of Obstetricians and Gynecologists, the American Medical Association, and the American Academy of Family Physicians agree that they are safe for over-the-counter use. The idea even has bipartisan support in Congress, except on issues like whether insurance companies should have to pay the bills. The next step was to find a pharmaceutical company willing to go through the long and costly process of seeking FDA approval. That too has now been done. HRA Pharma in Paris is partnering with advocates and experts from Ibis Reproductive Health to start the process, which may take several years to complete.

    There are two major types of oral contraceptives, progestin-only and pills that contain both progestin and estrogen. Ibis and HRA plan to seek FDA approval for a progestin-only pill similar to others already approved for emergency contraception. Progestin-only pills present the fewest barriers for the broadest population, Ibis president Kelly Blanchard said. Both types of pills are equally effective, but combined pills with estrogen can cause potential problems for women who smoke or have high blood pressure. Blanchard said that after the first OTC pill is approved, it shouldn't be difficult to get other forms of birth control approved, too. That would allow women more than one over-the-counter option, since not every pill or every birth control method is right for every woman.

    The Affordable Care Act (ACA) requires health insurance to cover contraception at no added cost. Not making women pay extra on top of their insurance premiums makes birth control much more accessible. But repeal of the ACA may eliminate that benefit. Republicans proposed legislation in 2015 to speed up the FDA's over-the-counter approval process for contraception - but Democrats and women's health advocates called that bill a ploy to undermine the ACA while only appearing to support birth control and women's health. That bill would also have imposed an 18-and-over age restriction, which Blanchard says is completely unnecessary. As for whether Trump's appointees could cause political problems for approving over-the-counter contraception, Blanchard said she hopes that the FDA "will follow their process and judge it on its merits. And we think the merits are strong." doclink

    California's Birth Rate Hits Record Low Following Job, Housing Woes

    December 19, 2016, San Francisco Chronicle   By: Kurtis Alexander

    For at least a decade the national trend has been to put off having kids and have fewer of them. But in California, the lingering recession of the late 2000s and high real estate prices have created obstacles for young couples looking to have kids. While California's population grew to 39.4 million this year, its birth rate dipped to an all-time low. According to the state Department of Finance, between July 1, 2015, and June 30, 2016 Californians had just 12.4 births per 1,000 people, undermining the previous record low of 12.6 set during the Great Depression in 1933.

    "It's not like Millennials are all of a sudden different," said Dowell Myers, a demographer at the University of Southern California's School of Public Policy. "It's just been harder to get things in place before having kids." Today's job market is good, he said, but "the housing market stinks."

    The lowest birth rates occurred in California's small northern counties, where jobs for young families are scarce. But coastal spots, including the booming bay area and the central coast had affordability problems.

    Though the state figures don't specify ethnicity, U.S. census data suggest the trend holds among virtually all groups. Even among the Hispanic population, among the nation's fastest growing, birthrates have been falling since 2006.

    The rate of population growth has declined along with the birthrates. This year's 0.75% increase (July 2015 to July 2016) marks 12 consecutive years of growth below 1%. "In the '70s and '80s, we were pretty much a new state, with plenty of opportunity and open land, and many people came here," said Walter Schwarm, a demographer with the Department of Finance. That has changed. People continue coming, but since the late 2000s migration to California has been relatively low. Between July of 2015 and July of 2016, the state gained 188,000 people through migration from another country. But it lost 118,000 people due to migration between states. In all, about 70,000 more people arrived than left.

    Schwarm said that even if the state's fastest growth is in the past, California has plenty to lure the best and brightest. "To a certain extent," he said, "as long as we remain an attractive state and the jobs are here, people will come.” But if California's growth rate falls further, it will be hard to fill the state's jobs and pay for the social benefits of retiring Baby Boomers. doclink

    The Key to Sustainable Development: Investing in Urban Reproductive Health

    December 15, 2016, You Tube

    This video features key experts in the family planning field, including Melinda Gates, Ellen Starbird, Anju Malhotra, Latif Dramani, and Jason Bremner, making the case for investing in family planning in urban areas and explaining how this can impact the environment and economy of countries, as well as add to women's empowerment. doclink

    Want to Reduce Abortions? Help Reduce Unwanted Pregnancies

    November 17, 2016, Big Think   By: Dilys Walker

    Family planning delivers important benefits and shouldn't be controversial.

    The Zika virus outbreak in Brazil had some world class female athletes considered staying home from the 2016 Summer Olympics to avoid the disease that can cause profound birth defects in children of infected women.

    But what of the millions of Brazilian women of childbearing age, especially those in the poor and overcrowded neighborhoods, who were adviced by health experts: don't become pregnant? Unfortunately for women in Brazil and many other developing nations, birth control can be hard to obtain. And research shows that millions of people around the world want more access to family planning.

    Unplanned pregnancies can create severe economic hardships that perpetuate poverty, and they result in millions of abortions every year, many of them performed under unsafe conditions by untrained people. Having one baby after another often causes complications and even death. Inadequate pre-natal care and unsafe births and abortions are among the biggest killers of women globally.

    For women to exercise the right to decide when to get pregnant, they need access to contraception and information about family planning. About 137 million women worldwide who are either married or in a partnered relationships want to delay or stop having children, but aren't using contraception.

    Family planning supplies cost about $1.55 per user per year, according to the Population Reference Bureau, which means we could address the entire unmet need for about $212 million. But delivering those supplies to where they are needed would cost between $2 and $35 per year per person.

    A bigger obstacle is the lack of knowledge, particularly in developing nations, about family planning. Many women fear the potential side effects of contraceptives. They may not understand the risks that come with pregnancy and how to minimize them. They be worried about reactions from husbands or families, or religious leaders. Education and counseling go a long way toward overcoming these obstacles.

    For many women, the first opportunity to learn about family planning comes during a visit to a clinic to have a baby, an abortion or treatment for a miscarriage. It's essential to seize that opportunity and present information on how to delay or prevent another pregnancy to any woman who wants it.

    Women who become pregnant less than five months after giving birth are 2.5 times more likely to die during their next pregnancy than women who wait 18 to 23 months, especially among poor women. 99 percent of all maternal-related deaths happen in the developing world. 86% of these occur in sub-Saharan Africa and south Asia.

    Of the 210 million women worldwide who become pregnant each year, nearly 80 million do not intend to. About half of those unintended pregnancies end in abortion. Many of those abortions are performed under unsafe conditions, contributing to the deaths of nearly 67,000 women each year. Modern contraceptives could reduce unplanned births in developing countries by 22 million and maternal deaths by 90,000 each year, sccording to the Guttmacher Institute.

    Family planning also reduces gender inequality, enables girls and women to stay in school and find better employment. Better educated girls and women are better equipped to understand and make their own life choices and less dependent on their families and husbands. Children from planned families often benefit from greater parental attention, nutrition and other resources, helping them grow and develop into more productive adults with a better chance of breaking the cycle of poverty. Their communities, in turn, have reduced need for social services, allowing them to spend scarce resources on more productive development programs. doclink

    For Melinda Gates, Birth Control is Women's Way Out of Poverty

    November 1, 2016, New York Times   By: Celia W. Dugger

    Melinda Gates' mission has been to provide poor women in developing countries with access to contraception. The Bill & Melinda Gates Foundation has given over $1 billion for family planning efforts and will spend about $180 million more this year.

    Since 2012, she has helped lead an international campaign to get birth control to 120 million more women by 2020. A recent report tells that goal is proving tougher than expected.

    Allowing a woman to have a contraceptive tool with which she can space births unlocks the cycle of poverty for her. While Melinda Gates was talking to women about vaccines for their children, the women would ask about contraception. Statistics showed that contraception prevented tens of millions of unsafe abortions by preventing unwanted pregnancies.

    Melinda Gates is a Roman Catholic, and her Church doesn't believe in these forms of modern contraceptives. But she saw, while touring the slums,townships, and rural areas that women and children were suffering needless deaths because they literally didn't have contraception like what we use in the United States. Even 93% of married Catholic women report using contraceptives. The moral imperative is that we give these women what we believe in and actually use.

    She found that there is resistance among the leaders of countries who are overwhelmingly men and often don't want to give up control of a woman's fertility. Even in the United States, some men want to take control of women's health. We can't do the top-down planning that happened in the world in the 1970s, where we told women what to do. It was about population control, it was about coercion.

    Long-acting contraception such as IUDs and implants which are changing the face of family planning in the United States, particularly for poor women, didn't seem to be making it into developing countries because the funding had stagnated.

    So the partners, the philanthropists, have been investing in long-acting tools. There is now an injectable that's a tiny, little blister pack with a tiny, little needle, sort of like you'd give yourself a diabetes drug. We're working on a formulation that could go in a health community care worker's kit. When she goes out into these villages, she can give it to women. A woman doesn't have to go to a clinic and get it from a nurse or a doctor. And eventually, a woman could give it to herself. So you could give her a two-year supply, and she can just take it home and administer to herself every three months.

    This tiny, little injectable is very near-term. That's happening now and will continue to roll out over the next three to five years.

    Warren E. Buffett, who has has made a huge commitment to the Gates Foundation, is also very excited about this.

    If you can get contraception to 120 million women you will see the cycle of poverty broken. Look at what contraception did in the United States to women going into the work force. All over Africa, young girls getting pregnant early when they don't want to, keeps them out of school. So you'd keep more girls in school, and then you'd have educated girls who would go into the work force.

    When a girl or woman has economic means in her own hands, it shifts the whole power dynamic in the family, whether it's with her mother-in-law or her husband. It's the beginning thing that unlocks a woman's potential. doclink

    Why Two Plasters Give Me Hope for the Future

    From schoolgirls in Sierra Leone to mothers in Bolivia, women are showing what they can achieve if they are given the opportunity to thrive
    November 1, 2016, Huffington Post   By: Claire Morris

    Sierra Leone, one of the world's poorest nations, has the highest maternal mortality. But change is on the way. Two arm bandages may not look all that cool, but young girls in this rural clinic display them proudly. They want to postpone having children so they can finish their studies and start a career, and the bandages are the only sign of the contraceptive implant they have queued up to get.

    Raised in the UK, I learned in school about sexual and reproductive health in a non-judgmental way. This empowered me as a teenager to make good choices. I could access contraception when I needed it, knowing that I had exactly the same right as boys to study and work in the way I wanted. Many young girls don't have those options. Faced with early marriage and pregnancy, they are first to drop out of school. Nearly one in five adolescent girls in low or middle-income nations gets pregnant by age 17.

    As a long-serving team member and now a trustee of the Marie Stopes International (MSI) family planning NGO, I have seen first-hand the transformative effect that contraception can have. For over 40 years, from Bangladesh to Zambia, MSI has been helping nations expand their sexual and reproductive health services. Contraception has become more available and, in some countries at least, legal restrictions to safe abortion have started to ease. Today six out of ten married women in the developing world use contraception, up from around one in ten in 1960. This has helped contribute to a much lower percentage of women who die in pregnancy.

    From the girls in Sierra Leone excited about their future, to a woman in Zimbabwe who had walked for five hours to have an IUD fitted, and a mother of four in Bolivia whose baby I held as she had a tubal ligation, women and girls have told me how proud they feel about taking more control over their own lives. Although they had made different choices at different life stages in different countries, they all felt empowered by their choices.

    MSI has been taking contraceptive services to where women need them. Since opening our first clinic in London in 1976, we have expanded to serve 37 nations. From training private healthcare providers, to caring for some of the world's most under-served people, and being first to pilot outreach for family planning, we have pioneered ways to reach women and girls and help remove the policy and clinical barriers that prevent them from accessing services.

    This year we helped secure ten policy changes including: new national abortion guidelines in Vietnam, approval for midwives to insert contraceptive implants in the Philippines where a lack of trained doctors was restricting women's access, and the registration of Misoprostol in Sri Lanka where it now can be used to manage miscarriage and post-partum hemorrhaging or for medicinal abortions and the treatment of post-abortion complications. doclink

    Report: More Than 300 Million Women and Girls in World's Poorest Countries Using Modern Contraceptives at Midpoint of FP2020 Initiative

    November 1, 2016, Family Planning 2020

    Family Planning 2020 (FP2020) recently reported that 300 million women and girls now using modern contraception in the world's 69 poorest countries. This is 30 million more women and girls than in 2012. This milestone has taken the health and development sectors decades to reach. The FP2020 partnership has expanded to 38 of the 69 focus countries, accounting for almost 90% of women and girls in the 69 countries who want to avoid pregnancy but are not using an effective method of contraception.

    FP2020 was launched at the historic London Summit on Family Planning in 2012. The Summit called for global political commitments and resources to enable 120 million more women and girls to use contraceptives by 2020. 2015-2016 marks the halfway point of the FP2020 partnership.

    Over 30% of women and girls are now using a modern method of contraception in In Eastern and Southern Africa. In West Africa, where contraceptive use has been historically low, the Ouagadougou Partnership has surpassed its goal of reaching 1 million additional women and girls with modern contraception from 2011 to 2015, and is now aiming to reach 2.2 million additional users by 2020.

    Unfortunately, the FP2020 goal is short by some 19 million women and girls due to a sizable financing gap. The problem is how to ensure that enough contraceptives supplies are available for the unprecedented numbers of women and girls who need them.

    "While we have not reached as many people as we had hoped by this time, the richness of the data now available enables us to peel back the layers and study the situation on a country-by-country basis, revealing a strikingly varied landscape of progress," said FP2020 Executive Director Beth Schlachter.

    The amount provided by donor governments is down by 6% from US$1.3 billion for family planning in 2015. This is largely due to currency fluctuations and the appreciation of the US dollar.

    Afghanistan, Lao PDR, and Vietnam joined the FP2020 partnership in the past year.

    Margaret Pyke Trust, with the Population & Sustainability Network, Population Services International, and Chase Africa have made new commitments.

    The government of Germany, International Planned Parenthood Federation, Intrahealth International, and FHI 360 renewed their commitments this year, pledging to build on the contributions they have already made and go even further.

    In 2016, modern contraceptive use in the target area averted an estimated 82 million unintended pregnancies, 25 million unsafe abortions, and 124,000 maternal deaths.

    Access for women and girls to voluntary contraception will have ripple effects for families, communities and countries, and will help determine if countries are able to achieve the United Nations Sustainable Development Goals (SDGs) for health, human rights, prosperity, and the environment. doclink

    Note to Chandrababu: Family Planning is Not About Class but About Women's Rights and Choices

    Andhra Pradesh Chief Minister Chandrababu Naidu on Friday Asked Rich People in the State to Have More Than One Child.
    June 22, 2016,   By: Poonam Muttreja

    Every woman has the right to determine the size of her family. For any leader to say differently can push back the country's progress on many fronts.

    These fronts include India's goal for population stabilisation, FP2020 - an international partnership of more than 20 governments on family planning, and the UN's Sustainable Development Goals commitments.

    Andhra Pradesh has shown a significant reduction in population growth, due to the fact that the desired fertility rate for the state is 1.5.

    It is no longer a matter of numbers. It is an issue of respecting rights and choices and treating women with dignity. Family planning advances sexual and reproductive health, saves lives and empowers communities, especially women. More than 272,000 maternal deaths per year have been averted globally by family planning and children's health and economic outcomes of families have been positively affected.

    Reproductive choice is a fundamental human right - it frees women from incessant cycles of pregnancy, breastfeeding and childcare. Family planning and its voluntary use represent a giant step towards gender equality.

    The post-2015 world is moving away from the narrow prism of targets and numbers to enhance sustainability. The rights-based approach to family planning provides an overall framework and set of universal values including, equality, non-discrimination, participation and accountability, on which to base contraceptive service provision and delivery. FP2020's implementation is in alignment with the principles of the International Conference on Population and Development Program of Action held in Cairo in 1994. ICPD abandoned demographically driven population policies, asserting that people mattered more than numbers. Population is not just about counting people, but about making sure every person counts irrespective of the wealth quintile they represent.

    Although contraception has increased from 67% from in 2005-2006 to 69.4% in 2015-2016, female sterilization has contributed significantly to this rise..The state's emphasis within the Family Planning Program needs to move towards a choice and access to spacing methods as opposed to primarily terminal methods.

    Family welfare is a mutually shared responsibility where there is an imminent need for parliamentarians, policy makers, civil society organizations, the media and other stakeholders to work together towards the pursuit of a common vision. doclink

    Karen Gaia says: To get away from numbers is to get away from targets, which are distractions from the need to address unintended pregnancies and rights-based health and education. More articles like this one are needed.

    The Unsung Human Right: a Woman's Control Over Her Fertility

    Millions of women are barred either by cultural taboo, cost or availability from being able to decide for themselves when they have children. Empowering them to take control should be a basic objective of every human health project
    June 21, 2016, Guardian

    Next month marks the halfway stage of the Family Planning 2020 initiative, an attempt to get 120 million more women and girls in 69 countries using contraception. The initiative was launched at a London conference in 2012. According to the UN's population fund, there are twice that number who would like to be able to avoid getting pregnant if they could. But cost, availability and lack of knowledge as well as, in some countries, cultural taboos and social pressures that make pregnancy even for young teenagers a desirable objective, all contribute to making it impossible. Breaking down the barriers that stop women and girls having the right to choose should be at the heart of every development project.

    Unfortunately, the debate around immigration has damaged the campaign. In among a legitimate airing of anxieties about overstretched public services, crowded GP surgeries and full entry classes at primary school, problems whose causes lie at least as much in austerity as in migration, there has been a crude and distasteful attempt to undermine a compassionate response to the global humanitarian crisis and depict migrants as a threat.

    The same people who do this also criticize the British commitment to spending 0.7% of the UK's national income on international development. This is money would promote security and help economies to grow, building the essential foundations of global justice. Without it, life will remain so bleak and hopeless for hundreds of thousands of people that they will flee elsewhere. Some - often the better off or the better educated - take the terrible risk of getting into a small boat to cross the Mediterranean to try to reach Europe.

    In addition to war, climate change and corruption, population pressures are also part or the reason behind unprecedented movement of people around the globe, and also 65 million displaced people. Giving women and girls the power to choose for themselves when they get pregnant is not only a fundamental human right, but a big part of the solution.

    The family planning part of women's health often feels like the poor relation in development. In 2014, the Department for International Development's total budget was more than £10bn. Of that, just £200m was committed to family planning. The plan was to preventing hundreds of thousands of unwanted pregnancies and thousands of deaths. But the department's main focus in women's health tends to be on eradicating female genital mutilation and ending child marriage - important, of course, but only a small part of a much bigger story.

    Refugee camps are among the least safe places in the world for girls and young women. An unwanted pregnancy is one more nightmare for a displaced woman; campaigners argue that contraception and access to safe abortion should be treated with the same urgency as water, food and shelter.

    In many countries and many societies the status of women allows men to feel entitled to deny them control of their own fertility. The size of the task of breaking down the barriers that stop it being a universal right is daunting. But for women and girls everywhere, it must become a development priority. doclink

    The article downplays the importance of ending child marriage and eradicating female genital mutilation, yet one third of girls in the developing world are married before the age of 18 and 1 in 9 are married before the age of 15. Delaying marriage of these girls could not only prevent 2 or 3 pregnancies per each girl, but allow that girl to go to school and have a more empowered future. Eradicating FMG is part of the empowerment.

    Masai Harmonial Development and Sustainability

    April 6, 2016, WOA website

    Masai women at Embulbul village are asking for family planning. The Masai's other requests for development help included: improve the water supply, build a school house, and help for the women's bead coop.

    Masai Harmonial Development and Sustainability: promoting development, health, family planning, education, & conservation for Tanzanian Masai communities, but only in harmony with their culture & environment. doclink

    "Green Sex" for Climate's Sake

    March 30, 2016, Vimeo

    "Green Sex" For Climate's Sake? from Rising Up With Sonali on Vimeo.

    GUEST: Alisha Graves, is co-founder of The OASIS Initiative, A project of the University of California, Berkeley. She also serves as Vice President of the Population Program at Venture Strategies for Health and Development, a California-based non-profit organization, where she oversees the "Rebirth of Population Awareness" initiative. And she is a research fellow for Project Drawdown, analyzing the potential contribution of family planning for reducing greenhouse gas emissions.

    BACKGROUND: Climate change presents an existential threat to our species. There is no doubt left about that. Activists around the world are grappling with the issue in many ways - by protesting coal powered plants and blocking oil tankers, promoting renewable energy like solar and wind, or even changing ones own lifestyle with growing one's own food and adopting plant based diets. But, my guest has another idea altogether. She calls it "green sex" for the sake of the climate. doclink

    Unintended Pregnancy Reaches 30-year Low, but Racial and Economic Disparities Persist

    Low-income women and women of color are still more likely to experience an unintended pregnancy than women of higher economic status and white women.
    March 14, 2016, Rewire   By: Elizabeth Dawes Gay

    U.S. unintended pregnancy reached a 30-year low in 2011, falling from 51% in 2008 to 45%, according to the Guttmacher Institute.

    During the same time period, there was an increase in contraceptive, likely from expanded access to birth control, which is supported by the 2010 Affordable Care Act. More women have been able to delay or prevent pregnancy and build the families they want as a result of improved access to contraception, say the authors of the study.

    However, women living in poverty in 2011 were five times more likely to experience an unintended pregnancy than higher-income women. Black and Hispanic women were roughly 2.5 times more likely than non-Hispanic white women to experience an unintended pregnancy. And even when income was taken into account, Black women had higher rates of unintended pregnancy than both white and Hispanic women.

    Under the ACA, most private health plans are required to cover contraception without a co-pay, as Medicaid has done for years. But, in order to see progress for women of color, we must overcome social and systemic inequity that contributes to varying levels of health-care access, contraceptive use, and unintended pregnancy.

    Dr. Lawrence Finer, director of domestic research at the Guttmacher Institute, stated, "These disparities ... stem from broader and persistent economic and social inequities, including access to education, well-paying jobs, safe neighborhoods, and quality health coverage and care."

    Systemic change will require targeted efforts to expand Medicaid, improve health-care access and quality, and close racial disparities in income and wealth.

    Women of color, particularly low-income Black and Latina women, are still more likely to be uninsured, which may be attributed to lower incomes and lack of access to employer-sponsored health insurance. Also, most of the 17 states that have refused to expand Medicaid have a higher percentage of residents of color.

    Some women may be unable to afford the birth control of their choice or access the most reliable methods. Highly effective methods like the intrauterine device and implant are more expensive up front than other methods, and women without consistent access to birth control may rely on condoms, withdrawal, or emergency contraceptive pills, which are not as dependable.

    Medicaid expansion would dramatically increase access to birth control for low-income women, reaching people with an income level at or below 133% of the federal poverty level, which is $24,300 per year for a family of four. There is a Medicaid coverage gap for some childless adults that needs to be closed: these people are not eligible for Medicaid and do not earn enough to receive subsidies to purchase coverage through the health insurance marketplace. 14.9 million people of color were in that gap in 2015.

    In the past, women of color have been used as test subjects and mistreated by the medical establishment. And even today, when some women of color seek care, they are met with insensitivity, disrespect, and neglect from health-care workers. Films like The American Dream and No Más Bebés document these abuses.

    The disproportionate rates of unintended pregnancy among women of color, who are already more likely to live in poverty, may contribute to lower educational attainment and higher economic insecurity. Delaying, spacing, or avoiding pregnancy helps women to achieve their educational and career goals.

    When women of color lack health care and don't earn enough to make ends meet, they often find themselves choosing between things like paying the bills to keep the lights on or paying for birth control.

    The analysis, titled "Declines in Unintended Pregnancy in the United States, 2008-2011" was published in the New England Journal of Medicine. doclink

    Development: Slow Down Population Growth

    Within a decade, women everywhere should have access to quality contraceptive services, argues John Bongaarts.
    February 24, 2016, Nature magazine   By: John Bongaarts

    Earth's population is expected to grow by 50% from 7.3 billion today to 11.2 billion in 2100. Most of the growth will be in the least developed regions of south and west Asia (including in India and Pakistan), and Africa. The largest increase is projected in sub-Saharan Africa with a quadrupling of population - from just under a 1 billion today to 3.9 billion by 2100.

    Rapid population growth, with attendant consumption and waste, has pervasive adverse effects on societies and the world's ecosystems. Countries with lower population growth, such as the east Asian 'tiger' economies, including South Korea and Taiwan, have seen rapid increases in per capita incomes as birth rates declined.

    Programs to provide voluntary family planning education and services, along with investments to improve education and health, have been the main policy response to rapid population growth since the'60s. These programs address the substantial level of unwanted and unplanned pregnancy, as well as an unsatisfied demand for contraception. About 74 million unplanned pregnancies occur each year in the developing world. About half of these end in induced abortions.

    Low levels of female education, lack of knowledge about and access to contraception, insufficient supplies and services and cost and fear of side effects are the main reasons for unwanted and unplanned pregnancies. Additional reasons are opposition from spouses and family and traditional gender roles that support a desire for large families. Family planning programs must go beyond simply providing supplies and services; they must also reduce or eliminate these obstacles.

    Evidence that such programs work comes from field experiments, such as the one the Matlab region of Bangladesh that began in'77. People in the Matlab experimental area were provided with free services and supplies, home visits by well-trained female family-planning workers, and comprehensive media communication. Outreach to husbands, village leaders and religious leaders addressed potential social and familial objections.

    As a result, contraceptive use jumped from 5% to 33% among married women of reproductive age in the experimental area, and fertility declined rapidly. Among the long-term consequences of this reduction in births were that the children in the experimental area being educated to higher levels, families having greater household assets, and the greater use of preventive health services.

    Similarly, other countries that have suddenly implemented comprehensive family-planning programs (such as Iran in'89 and Rwanda in the mid-2000s) have seen rapid subsequent changes in reproductive behavior.

    Iran's fertility declined from 5.6 births per woman in the late'80s to 2.6 a decade later. In Rwanda, fertility dropped from 6.1 in 2005 to 4.6 in 2010, and the proportion of married women using contraception jumped from 17% to 52%. Both countries' information programs shifted norms by including messages about the benefits of smaller families, raising the demand for family-planning services.

    With major investments in family planning, the fertility trajectory could easily be reduced by 0.5 births per woman within a few years after the start of the intervention. This would lead to a population of 2.8 billion in sub-Saharan Africa by 2100. That is around 1 billion fewer people than the current projection.

    Education of girls is a powerful brake on fertility. Educated women marry later, tend to want smaller families and are more capable of overcoming obstacles to their use of family planning. However, educated women must have access to contraception to act on their reproductive preferences. Family planning, education (of women and men) and socio-economic development are mutually reinforcing, and should be pursued together.

    Support for family planning programs has fluctuated widely over the past 50 years. An initial surge of investment was made in the'60s and early'70s, as the UN and donor countries urged developing countries to address high fertility and rapid population growth.

    Several countries accused the industrialized nations of making neo-colonial and imperialistic efforts to keep them weak and impoverished. The Catholic Church, which had long opposed to artificial birth control and abortion, took an aggressive stance in opposition to government-sponsored family planning programs worldwide. And when Republicans have occupied the White House, US lawmakers have also generally been unsupportive of international family-planning programs - reducing funding and adding onerous restrictions.

    Despite these obstacles, contraceptive use rose steadily in Asia and Latin America during the'80s. Then, in the'90s, aid for family planning was diverted to fight the AIDS epidemic; also the fertility declines in Asia and Latin America led to optimism that population growth in Africa would soon slow.

    Some economists argued that voluntary family-planning programs are ineffective. Parents are thought of as people who choose the number of children that they have in the same way that they might choose how many televisions or bicycles to buy.

    The problem with this reasoning is that goods require an active purchase, whereas pregnancies occur unless an effort is made to avoid them. Another fallacy is the assumption that the cost (monetary, social and practical) of contraception is sufficiently low so as not to influence decision-making. From this perspective, the occurrence of unwanted pregnancies should be as rare as people having unwanted new televisions; thus they erroneously conclude that family-planning schemes should not be given priority.

    Even women who use relatively effective methods find avoiding unintended pregnancies difficult; total pregnancies resulting from failure of such methods number in the tens of millions each year.

    Fortunately the accumulating evidence of plummeting birth rates in a few countries (such as Ethiopia and Rwanda) has largely persuaded policymakers of the cost-effectiveness of these programs.

    To reduce high birth rates, each woman, wherever she may be, should have access to quality contraceptive services within a decade. Even in rural areas of poor countries, women should have the choice of multiple contraceptive methods - pills, injectables , barrier methods, even long-acting methods such as intrauterine devices and systems (IUDs and IUSs), implants and sterilization. Where legal, safe abortion services should be made available. Other obstacles to contraceptive use, such as incorrect rumors about side effects and conservative social attitudes, should be addressed by the education of women and men, media campaigns and collaboration with community leaders.

    Coercion of any kind should be ruled out. Women and men have the right to decide freely on the number, timing and spacing of children, and on the means to achieve their reproductive goals.

    Funding to achieve these goals has been lacking: only 1% of all overseas development assistance (ODA) is allocated to family planning. However, over the past decade, investments in the developing world have risen, especially after the 2012 London Summit on Family Planning, at which many donors and governments renewed or increased their commitments. The proportion of ODA allocated to family planning should be doubled to 2%. Such an increase of funding will be more than repaid by savings in other sectors such as education and health care in future years.

    At the international level, development agencies and donors should hire more population experts to write more reports that would include a discussion of the role of demographic shifts in relevant sectors, of the development benefits of reduced birth rates and of the options available to change these trends.

    At the national level, ministries of finance or planning commissions should examine alternative population trajectories. Family planning has been ranked by economists at the Copenhagen Consensus Center as one of the most cost-effective development interventions. doclink

    We're Falling Behind on Family Planning: Five Ways to Get Us Back on Track

    January 29, 2016, Medium   By: Melinda Gates

    Four years ago, I stood with an international alliance of family planning advocates to pledge that by 2020 our project would provide 120 million more women and girls with access to the family planning services. The good news is that our collective efforts over the last four years helped prevent tens of millions of unintended pregnancies. The bad news is that, at current rates of progress, we will miss our goal. But the following innovations make me feel optimistic that 2016 will be the turning point towards reaching that goal:

    1. A smartphone-based app called Performance Monitoring and Accountability 2020 (PMA2020) provides data about women's family planning needs and wants so governments can respond to them quickly.

    2. In Indonesia women and girls in a large Islamic women's organization now use interactive tablets to share advice and information and learn about family planning in an easy, modern way. The tablets are proving so effective that the government of Indonesia has committed to buy 22,000 more.

    3. An all-in-one injectable contraceptive increases women's access to safe and effective family planning. Rural community health workers can learn to administer it with minimal training, and women may soon be able to administer it themselves at home. It is small, discreet, easy to use, and it lasts three months, which is important if the nearest clinic is miles away. This contraceptive is proving particularly successful in reaching new users and women under 25.

    4. A record number of young people are now entering their reproductive years. Our project, along with the Children's Investment Fund Foundation, will work side by side with adolescents and young women to better understand what motivates or discourages them from using contraceptives. We will identify what works and what doesn't, test and scale up promising models, and enable young people to avoid unwanted pregnancies.

    5. Almost four billion people  --  more than half of the world's population --  now live in cities. Women in poor districts often have misconceptions about pregnancy   prevention. Together with other interventions, health workers in these areas use local radio phone-in shows to address suggestions that contraceptives might make women infertile or harm their children. doclink

    Population Growth in Africa: Grasping the Scale of the Challenge

    While population growth slows in the rest of the world, it continues to rise in Africa. What are the implications? Isn’t it Europe that is overpopulated, rather than Africa?
    January 11, 2016, Guardian   By: Joseph J Bish

    This article argues that resources normally given to infrastructure and education will have to be spent on people, as the African population explodes.

    By the year 2050, African population growth would be able to re-fill an empty London five times a year.

    Of the 2.37 billion increase in population expected worldwide by 2050, Africa alone will contribute 54%. According to some statistics, Nigeria will add more people to the world's population by 2050 than any other country.

    The dynamics at play are straightforward. Public health is getting better. The 12 million Africans born in 1955 could expect to live only until the age of 37. Encouragingly, the 42 million Africans born this year can expect to live to the age of 60.

    Meanwhile, another key demographic variable - the total fertility rate.

    In Niger, where GDP per capita is less than $1 per day, the average number of children a woman is likely to have in her life is more than seven. If fertility does not fall at all - and it has not budged in the last 60 years - the country's population projection for 2100 veers towards 960 million people.

    What has caught demographers off-guard is that African fertility has not fallen as expected. Precipitous declines in fertility in Asia and Latin America, from five children per woman in the 1970s to around 2.5 today, led many to believe Africa would follow a similar pattern.

    Unfortunately, since the early 1990s, family planning programmes in Africa have resulted in slow, sometimes negligible, fertility declines. In a handful of countries, previous declines have stalled altogether and are reversing.

    These dynamics create the opposite of a virtuous cycle. Rapid population growth helps overburden educational systems. Infrastructure is also compromised, with congested highways and stratospheric housing costs. The reality is that as the size of any populace expands, governments must keep apace.

    Failure to do so results in a drop in per capita living standards.

    Education an infrastructure are highly important to any country's development. With a burgeoning population, this is more difficult.

    There are some signs of success, such as Family Planning 2020. Recent figures from Kenya and Zambia show substantial strengthening of contraceptive use among married women. In Kenya, 58% of married women now use modern contraception, and in Zambia this measure has risen from 33% to 45% in the last three years.

    In both cases, the catalysts for improvements were government commitment and commensurate budget financing. The virtuous circle may not be completely out of reach, but it is attainable. doclink

    The Light of Knowledge: a Family Planning Counseling App for Community Health Workers in India

    December 14, 2015, K4Health   By: Anne Ballard

    Implemented by the Johns Hopkins Center for Communication Programs (CCP), Gyan Jyoti, which means "Light of Knowledge" in Hindi, is a self-learning, counseling, and monitoring app used by Accredited Social Health Activists (ASHAs), or government-trained frontline health workers, in India. The app couples persuasive audiovisual information on reproductive health and modern contraceptives with the power of interpersonal counseling to increase the adoption of modern contraceptive methods among couples in Bihar, India.

    The ASHA is able to bolster her knowledge of family planning and improve her counseling skills through the mobile learning feature. During counseling sessions, the app provides easy access to high quality, engaging, and educational content designed to support positive decision making for family planning. An added benefit is the platform's ability to monitor activities that occur within the app and provide a means for ASHAs to input, store, and access client information. Gyan Jyoti provides ASHAs with several resources to use during family planning counseling sessions with their clients, including the following:

    * Correct and credible technical information on available modern contraceptive methods
    *A mix of thoughtfully produced family planning films, including expert explanations by doctors, real testimonials, entertainment films, and TV advertisements
    *A list of frequently-asked questions and guidance on next steps for choosing a method doclink

    Empower Women for the Health of the Planet

    June 8, 2015, New York Times   By: Carmen Barroso

    We cannot deny that environmental and reproductive justice are intertwined, or that reproductive justice has influence on the quality of life of women and families and on the sustainable health of the entire planet.

    Providing family planning for those who want it could result in up to 29% of needed reductions in carbon emissions, scientists say. Voluntary family planning would also help our planet be more sustainable. However 225 million women lack access to modern methods of contraception.

    Empowering women and promoting their right to choose what is best for them and their families is also one of the most effective pathways to reduce unintended pregnancies and improve maternal and child health. Providing access to [and information about] contraception would reduce the number of unwanted pregnancies by 70%, according to the Guttmacher Institute.

    A woman who is able to decide if and when to have children and how many, tends to go further in school, is empowered as a decision-maker in her household and is more adaptable and resilient during times of hardship. She is more likely to invest money back into her family, her family is more likely to prosper and her community and our planet thrive because of it.

    Investments in these sexual and reproductive health services have been slow in coming from the international community, even though the cost would be low. For example, in Latin America and the Caribbean only $31 per year would provide a woman with these needed services.

    Upholding the human rights of women is essential in balancing both fears of so-called overpopulation and underpopulation. doclink

    Papua New Guinea's Young Women 'Desperate for Contraception'

    May 9, 2015, Syndney Morning Herald   By: Jo Chandler

    In a transient clinic in Joyce Bay, Marie Stopes PNG conducts a reproductive health outreach. In one tent a nurse collects histories, counsels, and provides information on the contraceptive menu on offer - injections, the pill and the new favorite, long-acting hormonal implants. In another tent, another nurse inserts or administers the contraception.

    Joyce Bay has no sewerage system servicing its best-guess 10,000 plus population, just pit toilets that overflow in the rainy season, with obvious health consequences. Clean water flows in some sectors but not all, and is often a mere trickle. There's electric power available for those who can afford it or can wrangle illegal connections.

    This is one of the oldest of the sprawling settlement neighborhoods that are home to nearly half of the Papua New Guinea capital's 1 million people. In common with similar precincts, A 2013 Asian Development Bank survey put Joyce Bay's average household size at nine, but observed that often more than 15 people were sharing each dwelling.

    An Australian National University survey found that in a large proportion of these households the only income is from women selling food, soap, cigarettes and betel nut in residential markets. They juggle this around looking after their children, collecting firewood, and queuing for water.

    One woman, 22, has two children, and she and her husband have decided that two is enough for now. She has decided to have an implant inserted in her upper arm. This device offers up to four years of contraception if she keeps it.

    10 years old official maternal health statistics in Papua New Guinea reported that 44% of women of fertile age and in a relationship had an "unmet need" for contraception. The 2011 national census figures, published last year, put the birth rate at 3.1%. The population is up 50% from 2000.

    The 2006 PNG survey revealed that maternal deaths in PNG were among the highest in the world. Mostly this is due to the scarcity of health services across the nation's vast, wild landscape. In rural areas - home to 80% of the population - the lifetime risk of dying in pregnancy is one in 25. In Australia the equivalent statistic is one in 9000.

    According to the World Health Organisation, up to 40% of maternal deaths could be eliminated if unplanned pregnancies were prevented. Deaths of infants, children, and rates of poverty and hunger would also decrease with benefits flowing into female education, empowerment and economic engagement.

    In a nation like PNG the barriers to women gaining access to family planning include remoteness; lack of roads, transport and infrastructure; a critical shortage of health workers: cultural taboos, complex ethnic diversity, religious restrictions (abortion is illegal), education, poverty, myths and misinformation, and women's lack of status and political voice.

    But in just the past year or two, outreach efforts like the Marie Stopes clinic, taking new contraceptive technologies out to where women live, appear to be gaining popularity and political support despite some powerful resistance.

    ​As a volunteer on women's health programs in far-flung corners of PNG, Sydney gynaecologist Philippa Ramsay is always overwhelmed by the reception she gets on the ground. "These women are desperate for contraception" she says.

    "They are often pregnant at 15, and having their fifth child at 25. The teenagers just want to finish school before they have children, and the women - subsistence farmers - don't want more children."

    Dr Ramsay opens the clinics with an information session, often delivered to large gatherings under trees where the branches are weighed with bags of sleeping babies swinging in the breeze.

    The Spacim Pikinini initiative, supported by Rotary Club, has an objective to allow women to space, delay or stop births. Wendy Stein, from NSW, has provided 28,000 women with long term contraceptive implants in PNG in the past two years., working under the initiative.

    "Initially we offered IUDs (intrauterine devices) but they require a very intimate procedure, lots of sterile equipment, decent light and maybe 30 minutes per patient. The women didn't like it, taking off their underpants and putting legs in stirrups for a stranger. And sterile supply is a problem where there is no power."

    Now the program only offers implants, which have proved both popular and practical. "Implants take away the fear factor. They can watch each other have the procedure," says Dr Ramsay. "We can do implants in villages with no power and no running water, and we might do 100 to 150 in a day."

    "We've gone back and surveyed women on Karkar Island a year after the implants went in, and only two out of 860 wanted them removed." One was a woman who wanted a baby sooner, the other preferred an alternative method.

    There is strong opposition to implants programsfrom some religious leaders in the overwhelmingly Christian and largely Catholic nation. Last May the Catholic bishops of PNG placed a full-page advertisement in the national newspapers condemning the "growing political ideology that links development with population control ... Hormonal implants are promoted and injected on a massive scale with little thought about the physical, emotional and social effects on young girls and women and on the community as a whole".

    Professor Glen Mola, University of PNG's head of reproductive health, wrote a response accusing the bishops of saying "emotional and unscientific things" about contraceptives of proven efficacy and safety. "The direct links between infant, child and maternal death and disability, and frequency and number of pregnancies, are indisputable."

    In September PNG Prime Minister Peter O'Neill endorsed the use of implants in parliament and said that correcting misconceptions about contraception was vital for sustainable population growth and reducing maternal deaths. doclink

    World's Population Projected to Grow From 7.3 Billion in 2015 to 8.4 Billion in 2030

    April 9, 2015, Population Media Center   By: Joe Bish

    The United Nation's Commission on Population and Development held its 48th annual session in early April at the UN Headquarters in New York City. Here are extracts of statements made during the session having to do with population.

    UN Secretary-General's message to the Commission on Population and Development (see ):

    "You meet as the international community strives this year to forge a set of sustainable goals and a meaningful new universal climate agreement. These twin priorities will be influenced by the profound demographic shifts taking place in our world, especially those related to youth, the elderly, urbanization and migration."

    "Our world now has the largest generation of young people in history. Countries experiencing a 'youth bulge' can reap a demographic dividend by optimizing conditions for youth to thrive. This requires enhancing education for both girls and boys, ensuring access to sexual and reproductive health care, and creating more decent jobs."

    "Workforces are shrinking and populations are greying."

    "Already more than half of the world's population lives in cities, and that proportion will grow over the next 15 years, adding urgency to efforts to optimize the benefits of urbanization and overcome its challenges."

    "Far too many migrants suffer from exploitation, discrimination and xenophobia. Addressing these violations of their rights will empower migrants to increase their contributions to development in both countries of origin and destination."

    "The 1994 International Conference on Population and Development Programme of Action as well as the 2014 operational review underscored the centrality of the rights and worth of every individual. We must be guided by this vision as we aim to help people meet their needs while protecting the environment for generations to come."

    Additional Reporting on Commission on Population and Development, Forty-eighth Session


    Babatunde Osotimehin, Executive Director, United Nations Population Fund (UNFPA), said that, as a post-2015 development agenda was designed, the Commission on Population and Development, by integrating population issues into sustainable development, could turn its timeless principles and commitments into reality. Investments in the rights and well-being of adolescents and youth, now and throughout their lives, would unleash a demographic dividend of inclusive, sustainable economic growth in many countries. Young people, especially adolescent girls, must be empowered to make informed decisions to have control over their bodies and to stay healthy.

    It was also important to reach young people early in life to foster positive life-long health behaviour. Investing in the health, education and employment of young people today was the best investment to improve the lives of older persons tomorrow. ... It was imperative to integrate population issues into development, as there could be no sustainable development without people, he said, stressing that "we cannot afford to wait, the time is now".

    John Wilmoth, Director, Population Division, Department of Economic and Social Affairs, said that, in Cairo, in 1994, the world had acknowledged the importance of the population dimension, but had also cautioned against efforts to manipulate aggregate trends, out of concern that such policies risked violating individual human rights.

    Continued rapid population growth would make it more difficult for some countries to improve health, provide adequate housing, achieve universal education, and provide adequate job opportunities over the next 15 years.

    The lesson of Cairo was that the collective concerns about current or future population trends should never become a justification for violating the fundamental rights and freedoms of individuals. Population trends mattered for all three pillars of sustainable development..

    Barney Cohen, Assistant Director, Population Division, Department of Economic and Social Affairs, introducing the report of the Secretary-General entitled "Integrating Population Issues into Sustainable Development, Including in the Post-2015 Development Agenda", said the world's population was projected to grow from 7.3 billion in 2015 to 8.4 billion in 2030, roughly equivalent to adding approximately 73 million people every year. By 2030, the global economy would need to support a population that was approximately 15% larger than it was today. In addition, while countries will experience different rates of growth, globally, 2 billion babies would be born over the next 15 years. If the world was to achieve the new sustainable development goals and leave no one behind, then every one of those new-born children, as well as their mothers, should have access to high-quality health services throughout all phases of life. In addition, all children should be able to attend school, and no child should have to grow up malnourished or live in extreme poverty.

    Over the next 15 years, he continued, the world would also need to prepare for the 1.9 billion young people who would turn 15, which was a 7% increase globally over the previous 15-year period. Underscoring that young people could be an important vehicle for economic development and social change, he said there must be greater investment in secondary and tertiary education, youth-friendly health services, and opportunities for young people in the labor market.

    He said that population projections also suggested that the number of women of reproductive age would increase globally by 9%, and in Africa, by 45% over the next 15 years. Thus, it was important to advance gender equality, ensure that women had a voice in the political process and were given the knowledge and tools to decide on the number and timing of their children. doclink

    Population + Solutions

    April 1, 2015, Global Population Speakout (GPSO)

    Note: this is a teaser only. Please click on the link in the headline to read the entire set of articles.

    There is good news -- in the 21st century, solutions to the population challenge are many. They are progressive. They strengthen human rights and improve human health. They are things we should be doing anyway. And they contribute toward solving some of today's most pressing social and environmental challenges.

    Improving the Stats of Women and Girls

    How well a society treats its women is one of the strongest indicators of the success and health of that society. Discrimination against women and girls occurs in many forms - through gender-based violence, economic discrimination, reproductive health inequities, and harmful traditional practices ....

    Primary and Secondary Education

    Education is not only an obvious human right - but it is also an important demographic variable, influencing global population growth trajectories. There is a strong correlation between fertility decline, education, and socioeconomic development. Girls' secondary education is especially important because, among other things, ....

    Family Planning Information and Services

    Family planning, one of the greatest public health achievements in human history, allows individuals and couples to anticipate and attain their desired number of children and the spacing and timing of their births. It protects the health of the mother and the outcome of .....

    Population, Health and Environment Programs

    Population, Health, and Environment (PHE) programs offer an integrated approach to solving human development and conservation challenges through improving access to health services - including family planning and reproductive health - while also helping people improve livelihoods, manage natural resources, and conserve the critical ...


    Entertainment-education (EE) is any form of communication that is designed to entertain and educate audiences simultaneously. Entertainment-education has existed for thousands of years in the form of parables and fables that promote social change. Modern forms of entertainment-education include television productions, radio soap-operas, and ....

    Public Discourse, Campaigning, & Activism

    "Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it's the only thing that ever has." So said Margaret Mead, a leading feminist whom Time magazine once named "Mother of the World." When it comes to the issue .... doclink

    India's Efforts to Control Its Population Are Still Stuck in the Past

    Women's deaths reflect mindset from 1975 state of emergency
    November 14, 2014, Financial Times Ltd   By: Amy Kazmin

    In June 1975, India's prime minister Indira Gandhi suspended democratic rights and instilled an aggressive mass sterilization program over a period of 21 months, when over 8 million people, mostly men, were cajoled, paid or forced to be sterilised, in order to control population.

    While this period is now history, the deaths this week (2014) of over a dozen women who participated in a mass sterilisation "camp" at an abandoned hospital in rural Chhattisgarh demonstrates how the 1975 mindset and methods still haunt India's official approach to family planning and population control.

    Sterilization is still India's most widely used contraceptive method. Although label as 'voluntary', sterilization is encouraged cash payments, and hard-sells from state health workers who are paid for each sterilization.

    Lack of other available forms of birth control, especially in rural areas, is a big reason that sterilization is turned to prevent pregnancy. About 4.6m women were sterilized in India last year,, and 77% of them had never previously used any other form of contraception.

    In the Chhattisgarh camp, 83 women were operated on in around five hours by a single doctor, who only briefly dipped his instruments in disinfectant between patients. The doctor - once praised for performing more than 50,000 tubal ligations -- has blamed the women's deaths on substandard including antibiotics given to them after the procedure.

    India's total fertility rate has dropped from 5.2 in the mid-1970s, to 2.4. But that is mainly a result of social and economic progress, rather than mass sterilizations.

    India's most prosperous states -- with the highest levels of female education and empowerment -- have the lowest fertility rates. In poorer northern Indian states, where fertility rates remain around 3.5, sterilization is most aggressively pushed.

    Even though New Delhi has recently promised to bring more modern birth control methods to its women - so couples can control their fertility, including planning when to have children, and spacing births - on the ground the dysfunctional public health system is not even up to the job of providing basic counseling, screening or follow-up care to facilitate women's use of modern, reversible birth control methods.

    India has doubled the incentive payments for women's sterilization in "high focus states."

    India has around 190 maternal deaths per 100,000 live births, compared with China, with 32 per 100,000. Over 309,000 of 26m babies born in India each year do not survive 24 hours. Women who do not have birth control are likely to have children in quick succession. Sterilization does not address this.

    It is time for India's government to jettison its sterilization fixation and offer family planning services worth the name. doclink

    Overpopulation and the 10 Billion Person Question

    With the world's population set to hit at least 10 billion by the end of this century, famine, poverty and climate change will become even more pressing concerns. Sustainability expert Bruce Edgerton says that it's not all doom and gloom, however, and outlines a plan for avoiding overpopulation
    September 8, 2014, ABC   By: Bruce Edgerton

    The authors father is a typical Malthusian, fearing for the planet, infested as it will be by 10 billion people by the end of this century. 'We will need a war to wipe them out, or famine, or both,' he says.

    These Malthusians claim we need to start by eating less beef and dairy and stop doing things that have an enormous environmental footprint compared to the simpler substitutes. Population has grown exponentially, and by and large, crop production has grown linearly, they say. And Earth's carrying capacity is limited and we are pushing its boundaries.

    The author claims that his fathers population fears require a genocidal solution, but the good news is that these visions need not eventuate because it is well within the capacity of humanity to feed the world.

    Tragically, while we have the necessary technology and wealth, the vision and compassion is sorely lacking.

    We need to ensure that the global population plateaus. In 2011, the UN's population division suggested global population could peak at seven to eight billion by the middle of the century, or, using the mid-range projection, plateaus by end of the century at around 10 billion people. However, if the growth rate stays the same, the global population surging past 15 billion in 2100.

    These are vastly different outcomes for the world my grandchildren will inherit.

    The author claims that wealth eventually stops procreation in its tracks, a fact demonstrated by countries as diverse as Italy and Japan. But we need to speed this up by addressing education for all girls, right now.

    We also need to follow this up with free contraception. This will contain the global population within 10 billion or less in a couple of decades.

    Of course, this course will result in more wealthy people who eat more, consuming food with a larger environmental footprint, such as meat and dairy. So we will face an enormous challenge to feed this world.

    Today, the poor are starving because they can't afford to pay, not because we don't have the capacity to feed them. So we are going to have to employ a great deal more capacity to feed 10 billion people, with a middle class of perhaps six billion.

    Unfortunately yields are likely to fall with climate change. The US averages around 10 tonnes per hectare per year of corn across the Midwest. This is likely to improve with climate change.

    So at present there is plenty of grain. The EU still pays farmers not to grow crops, while the US diverts its massive crop surpluses into biofuel production. However, by 2100 demand will comfortably outstrip supply. Thankfully, we are ready to deploy the next big step in agricultural production-microalgae.

    While it is difficult and expensive to turn this microalgae biomass into fuel, it is relatively easy to turn it into food. Carp, pigs and chickens are among the creatures that will feed on this food. "I understand that silver carp tastes divine, and the feed conversion rates for these creatures is less than two to one, with minimal greenhouse gas emissions".

    The manure and effluent by-products of intensive animal production and aquaculture are ideal for anaerobic digestion. This process converts much of the organic matter into methane and liberates the nutrients into the liquid phase. The methane can be burnt to generate heat and power. The nutrients can be shandied for fertigation into intensive horticulture. If the horticulture is undertaken in glasshouses then the 'waste heat' and CO2 rich exhaust gases can be used to further increase yields.

    So there you have it.

    Grow microalgae in the dry arid regions of the world where there is either sea water or non-potable water available for aquaculture ponds. Solar dry the biomass for transport to the peri-urban fringe. Formulate the microalgae with agricultural bio-products, vitamins and amino acids as required. Grow pigs, chickens and fish.

    Anaerobically digest the manures on site and fertigate the effluent into glass houses. Hey presto-10 billion people fed generously, with a system that is highly adaptable to future changes in the climate.

    If we can't fix global poverty we will be pounding past 15 billion people. doclink

    Karen Gaia says: OK, so his father had a genocidal solution. There are plenty of us that have a solution that is not genocidal. Meeting the unmet need for contraception is the best answer, followed by the education of girls. However, making people wealthy is not the answer. We all need to stop following the Western Dream and living a simpler life, especially if we reach 10 billion.

    10 Reasons Why Investing in Women and Girls is So Vital

    July 9, 2014, Global Citizen   By: Leticia Pfeffer

    70% of the 1 billion poorest people are female. These women are disproportionately affected by discrimination, violence, and exploitation. Too many are deprived the opportunity to an education and to basic health care services.

    The great news is that investing in girls and women makes economic sense. If the world educated, empowered, and kept all girls and women healthy, we would lessen extreme poverty and build healthier, wealthier, and more educated communities.

    1. Studies show that women reinvest up to 90% of their incomes back into their families, compared to just 30-40% by men. Mothers provide better nutrition and health care and spend more on their children. Investing in women and girls creates long-term social and economic benefits for all individuals, their communities, and the world as a whole.

    2. 31 million girls in the world don't have the opportunity to pursue an education. Every day, they are taken out of school and forced to work or marry. One out of five girls in the developing world doesn't even complete the sixth grade.

    Educated girls and women are healthier, have the skills to make choices over their own future and can lift themselves, their communities and their countries out of poverty. Even one more year in school makes a difference. A girl's income will increase by up to 25% every year she stays in school. If India enrolled 1% more girls in secondary school, the country's GDP would rise by $5.5 billion.

    3. 222 million women today lack access to family planning services, information and contraception. If we doubled investment in family planning, we could reduce unintended pregnancies by 68%; avert newborn deaths by 35%; reduce unsafe abortions by 70%.

    For every dollar spent on family planning, governments can save up to 6 dollars on health, housing, water and other public services. Family planning enables millions of girls to stay in school, saves lives and has the capacity to lift entire communities out of poverty.

    4. Each year, an estimated 16 million girls aged 15-19 give birth. Only 35% of unmarried girls and women in developing countries use a modern method of contraception -- so most teen pregnancies are unplanned. Girls who become pregnant are forced to leave school and are prone to high health risks, such as HIV, obstetric fistula, and complications during pregnancy. The number one cause of death for girls is childbirth.

    By delaying teen pregnancies, girls are able to stay in school, invest in their futures and have healthier children when they are ready. If all young girls completed primary school, we could save 900,000 of their children each year. And if those girls got a secondary education, we could save three million lives.

    5. In a given year, approximately 300,000 women die from complications related to pregnancy and childbirth. Maternal mortality is much higher in poor communities and rural areas. 99% of all maternal deaths occur in developing countries.

    When women have access to health services and information by skilled health professionals during pregnancy and childbirth, this can make the difference between life and death -- for the lives of women and their newborn babies.

    6. 14 million girls are married before the age of 18 every year. In the developing world, poverty and traditional gender roles magnify this problem. 1 in 7 girls is married before age 15, and some child brides are married as young as 9 years old.

    When girls have the opportunity to complete their education through secondary school, they are up to six times less likely to be married as children than girls with little or no education. Educated girls are also less likely to have unintended pregnancies as teenagers.

    7. Women work two-thirds of the world's working hours, produce half of the world's food, but earn only 10% of the world's income and own less than one percent of the world's property. On average, women earn half of what men earn.

    In order to achieve gender equality, women and men must have equal employment opportunities and receive equal pay.

    8. Women are a central part of the solution to ending hunger and poverty. Yet, female farmers face numerous constraints: they own less land, cultivate smaller plots of land, and have a harder time accessing credit.

    If we want to reduce poverty and end hunger, we must give women access to the resources they need for agricultural production and participation. This could: Increase farm yields by 20-30%; increase agricultural output by 4%; and reduce the number of hungry people in the world by 150 million

    9. 1 in 3 women and girls worldwide, one billion, will experience violence such as torture, rape, sexual trafficking, honor killings, beatings during pregnancy and domestic violence in their lifetime.

    Violence is a major cause of poverty. It prevents women from pursuing an education, working, or earning the income they need to lift their families out of poverty.

    10. 100 to 140 million girls and women around the world have undergone genital mutilation -- including 6.5 million in Western countries. This practice continues to be concentrated in Africa, where 90 million African women and girls have been victims. It is mostly carried out on young girls under 15, often with the consent of mothers, in conditions that lead to lifelong pain, infection and premature death. doclink

    Assessing Progress for Populations Worldwide

    April 3, 2014, United Nations

    Almost on the 20-year anniversary of the largest intergovernmental conference on population and development ever held -- the International Conference on Population and Development (ICPD) in Cairo in 1994, the meeting of the 47th session of the Commission on Population and Development will be held.

    In advance of that meeting, John Wilmoth, Director of UN DESA's Population Division, spoke about how the heart of what the Cairo conference was all about individuals and their rights and needs, and addressing those issues first and foremost.

    Cairo helped galvanize action that brought major improvements in the well-being of people around the world. In 2013 over 90% of governments provided either direct or indirect support for family planning programs. Life expectancy has increased from 65 years in the period 1990-1995 to 70 years in the period 2010-2015.

    At the upcoming April session, representatives and experts from a large number of UN Member States and NGOs will meet in New York to assess the status of implementation of the Programme of Action, adopted by 179 governments in 1994.

    Wilmoth said there was more to be done: continuing to improve life expectancy, reduce fertility, enhance access to education, and achieve gender equality.

    The world's population is expected to reach 8.1 billion in 2025 and 9.6 billion in 2050. In 1994 the world's population was growing at 1.5% a year, compared to only 1.2% in recent years.

    The combined population of the 49 least developed countries is projected to double by 2050. In contrast, in more than 40 other countries - many of them in Eastern Europe, East, South-East and Western Asia, other parts of Europe and Latin America and the Caribbean - the size of the population is expected to decline in the coming decades.

    Despite these advances, most countries will not achieve the ICPD Programme of Action target for life expectancy of 75 years (70 years for the countries with the highest mortality levels) by the target date of 2015. Worldwide, women live 4.5 years longer than men, a gap that has remained virtually unchanged since 1994. Similarly, the world as a whole will miss the Conference target of a 75% reduction in maternal mortality.

    The international community is increasingly recognizing the contribution of migration to global development. In 2013, the number of international migrants worldwide reached 232 million, up from 154 million in 1990. There are more people living outside their country of birth than ever before, and it is expected that the numbers will increase further.

    Lower fertility combined with higher life expectancy results in population ageing. Aging combined with rapid urbanization "creates challenges in terms of meeting the needs of the older population and also in managing the relationship between the generations as the working-age population inevitably has to provide a certain amount of financial and other forms of support for the older population," he said.

    The Commission will also be an important preparatory event for the special session of the General Assembly, which will take place on 22 September 2014 to commemorate the 20th anniversary of the Cairo conference. doclink

    Articles From the Last Day of ICFP 2013 Conference in Addis Ababa

    November 20, 2013, Degrees Live

    This is a series of articles and videos from the November 2013 International Conference on Family Planning , including:

    Girls' Globe Reports Live from ICFP: Coverage Archive -

    CFP 2013 Reflections: Maternal & Child Health, Family Planning... and NTDs

    Video: The Importance of Women Leaders in Family Planning - Ellen Starbird, USAID

    Connected Health Workers Key to Improved Healthcare

    Day Two of the ICFP and the Energy around Youth is Electric

    Latin America's Contraception Crisis

    Inspired by youth involvement: Kate Gilmore, UNFPA

    Family planning leads to health, education and income

    Video: The Importance of Involving Youth in Family Planning - Isaiah Olowabi

    The Challenge Ahead: Initiating a Demographic Dividend doclink

    Voluntary Family Planning Programs That Respect, Protect, and Fulfill Human Rights

    September 12, 2013, Futures Group

    Key points:

    In the orward to the 2012 State of World Population report, "By Choice, Not by Chance", Babatunde Osotimehin, UNFPA reaffirmed the right of the individual to freely and responsibly decide how many children to have and when to have thme has been the guiding principle in sexual and reproductive health, including family planning.

    The foundation for voluntary and human rights-based family planning can be traced to the 1968 International Conference on Human Rights, which included in its proclamation that "parents have a basic human right to decide freely and responsibly the number and spacing of their children." This right was reaffirmend at three subsequent international population conferences in Bucharest in 1974, Mexico in 1984, and Cairo in 1994.

    The landmark International Conference on Population and Development, which took place in Cairo in 1994, affirmed that ...reproductive rights rest on the recognition of the basic right of all couples and individuals to decide freely and responsible the number, spacing and timing of their children, and to have the information and means to do so; and the right to attain the highest standards of sexual and reproductive health. It also includes their right to make decisions concerning reproduction free of descrimination, coercion and violence, as expressed in human rights documents (UNFPA, 1994, Programme of Action para. 7.3)

    Amidst the positive response to FP2020 (London Family Planning Summit in July 2012), including a civil society declaration signed by more than 1,000 organizations worldwide, some civil society organizations expressed concerns that the numeric goal of reaching 120 million new users of contraception by 2020 could signal a retreat from the human rights centered approach that underscored the 1994 ICPD. Concern was also raised that the FP Summit goal could also lead to a focus on services for urban groups who may already have access to services, at the expense of marginalized women, men, and young people are are more costly to reach but who may face more financial, social, or other barriers preventing them from accessing such services.

    A focus on reaching more women with contraceptives will not negate the the broader reproductive health and rights focus of ICPD. instead, it will draw attention and resources to family planning, a key component of reproductive health that has received insufficient attention and resources for nearly two decades.

    The need for renewed attention to family planning has been highlighted, resources have been pledged, and political will is high, offering what Kingdon (1984) identified as a window of opportunity for transformational change. Taking advantage of this opportunity will require bringing together diverse stakeholders -- representing family planning, reproductive health, human rights, and public health to harness relevant approaches to programming and create the conditions for achieving the FP202 goal (120 million new voluntary family planning users) in ways that guarantee choice and respect, protect, an fulfill human rights.

    Few attempts have been made to link voluntarism and human rights into a comprehensive operational framework to guide family planning policies and programs.

    This conceptual framework was reviewed by more than 150 people from 25 countries through a series of in-person and web-based consultations and the World Health Organization (WHO) consulting on rights-based family planning held in April 2013. Ultimately, it is hoped that this effort and the resulting framework can contribute to the implementation of the FP2020 program.

    As rights violations related to reproductive health have tended to focus on some egregious cases - such as forced abortion in China, forced sterilizations in India, Peru, and more recently among HIV-positive women -- more subtle forms of rights violations have been missed. Some programs or providers pressure or coerce clients into using family planning methods they do not want, while others create barriers that prevent individuals from obtaining and using methods they desire.

    Programs that offer a limited choice of methods cannot really be said to offer a full choice.

    The principle of volunteerism has been integrated into all U.S. government assistance for family planning since 1968. USAID notes that its assistance is guided by the principles of voluntarism and informed choice:

    * People have the opportunity to choose voluntarily whether to use family planning or a specific family planning method.

    * Individuals have access to information on a wide variety of family planning choices, including the benefits and health risks of particular methods.

    * Clients are offered, either directly or through referral, a broad range of methods and services.

    * The voluntary and informed consent of any clients choosing sterilization is verified by a written consent document signed by the client.

    Follow the link in the headline to see the entire, very long paper. doclink

    World Population Day 2013 - Press Statement From John Kerry, Secretary of State

    July 13, 2013, U.S. State Department   By: John Kerry

    As the international community commemorates World Population Day, the current world population of 7.2 billion is projected to increase another 1 billion by 2025 and reach 9.6 billion by 2050.

    Continued population growth in many countries, as well as population aging, urbanization, and migration will have a profound impact on social and economic development and the environment in the years to come. Increasingly complex and interconnected population and demographic dynamics impact access to health, education, housing, sanitation, water, food, and energy, and influence the livelihoods of people and stability of nations around the world.

    Today's generation of 1.8 billion young people between the ages of 10 and 24 is the largest the world has ever seen, and will shape the future of the world we live in. They will drive the economic, political, social, and cultural development of their countries and will need greater and more equitable access to education, employment, and health information and services, including sexual and reproductive health services. Whether it's across the Greater Middle East or Africa, the sheer number of young people is striking, and demands leadership capable of meeting their demands for dignity and opportunity in addition to basic necessities.

    This changing global environment also highlights the need for our continued example of and commitment to protecting access to evidence-based comprehensive sexuality education and reproductive rights, so that young people are equipped with the information and the means to make informed decisions about their health and protect themselves from sexually transmitted infections and unintended pregnancy.

    We must also address the fact that millions of adolescent girls are too often vulnerable to discrimination, violence, and exclusion that prevent them from living their lives to their full potential. Too many young girls are forced to marry and leave school early, are at risk of sexual violence and coercion, and are subjected to harmful traditional practices, including female genital mutilation and cutting. Still today, complications from pregnancy and childbirth continue to be the leading cause of death among adolescent girls in low- and middle-income countries.

    The United States stands ready to work with other governments, multilateral organizations, civil society, and the private sector around the world towards a safer, healthier, more just world for all. doclink

    Women & Sustainability: Why They Need Each Other in a Post-MDG World

    May 27, 2013, Huffington Post   By: Carmen Barroso

    As the global economic crisis stumbles on, social services are cut worldwide, and the planet faces ever wilder weather, decreasing biodiversity, and shrinking natural resources, we need an even larger investment in girls and women for the sake not only of people, but also for the planet.

    Investing in girls and women -- and especially in family planning services -- is one of the smartest, safest, cheapest, most impactful decisions any nation can make. For example, in Texas, the state legislature is working hard funding for family planning services after the financial costs of 2011's funding cuts became apparent.

    With simple investments in basic technologies like condoms, the pill, and prenatal healthcare, there's a powerful ripple effect that emerges from women's empowerment. Women and children are healthier. We also see noteworthy dividends for our planet's ability to sustain us all. When we empower individuals and families with the information and services they need to decide on all aspects related to reproduction and sexuality, we create more sustainable and just communities. Give women choices about their children, and they make smart choices about their environment, too.

    Global funding for sexual and reproductive health and rights has decreased 65% from 1995 to 2007, leaving more than 200 million women and girls worldwide without access to the modern contraceptives they want and need, to delay or avoid a pregnancy.

    When parents are worried about how to bring home enough food for their family's next meal, they don't worry about whether they're taking too many fish from the sea, or cutting down too many trees to sell or to grow crops.

    And when the environment is threatened, women are threatened too. Women bear the brunt of the responsibility for providing food and water for their families, for collecting fuel to heat their homes and cook meals. A rapidly changing climate, increasing pressure on food prices brought about by drought, shrinking access to clean water, clean air and healthy forests -- all hit women and children hardest.

    It's time for us all to make these connections. We have an unparalleled opportunity to secure a sustainable world of justice, choice and well-being for all people, and without a doubt, we need healthy, empowered women and girls to ensure that our planet can continue to care for us all. doclink

    Karen Gaia says: Also, when population grows, supplies of safe water and cooking fuel are often threatened, and women and girls have to walk further and further for these things.

    UN to Hold Special Session in 2014 on Population

    February 21, 2013, Associated Press

    The UN General Assembly has decided to hold a special session on Sept. 22, 2014, on the anniversary of the 1994 Cairo population conference - when some 180 nations adopted a plan that focused on birth control, economic development and giving women more power over their lives - to assess implementation the 20 year-old plan to slow the global population explosion.

    The world's population has grown since the 1994 conference, from 5.7 billion to about 7 billion. The U.N.'s top population official, Babatunde Osotimehin recently said the world will add a billion people within a decade, further straining the planet's resources.

    Kenya's deputy U.N. ambassador Koki Muli said there will be no final document from the 2014 session, a move that will avoid contentious negotiations on issues such as reproductive rights for women, sex education, abortion and family planning.

    The Cairo conference changed the U.N. Population Fund's focus from numerical targets to promoting choices for individual women and men, and supporting economic development and education for girls. Underlying the shift was research showing that educated women have smaller families.

    At the heart of the 1994 action plan is a demand for equality of women through education, access to modern birth control, and the right to choose if and when to become pregnant. It also recognized that abortion is practiced around the world and should be treated as a major public health issue and indicated that affordable and acceptable family planning is central to achieving safe motherhood. doclink

    People's Rights, Planet's Rights

    December 20, 2012,   By: Suzanne York, Institute for Population Studies

    This comprehensive report suggests that the best way to discuss population growth and the myriad of problems confronting the planet today is through a rights-based, holistic approach that includes both people and the planet:

    Women's Rights - providing voluntary family planning services to the 222 million women in developing countries who want access to family planning services but do not have access to contraceptives;

    Youth Rights - providing comprehensive sexual and reproductive health education to the nearly 3 billion young adults under the age of 25;

    Rights of Nature - recognizing the legal right of ecosystems to exist; and

    Rethinking the Economy - accepting that endless economic growth is unsustainable and that more efficient global indicators of human and environmental well-being should be adopted.

    Click on the link in headline to read the entire report.

    Interesting points from the report:

    Norman Borlaug, the "father" of the Green Revolution, noted that this effort would only buy humanity a little bit of time. The New York Times wrote that he was frustrated throughout his life that governments did not do more to tackle population growth by lowering birth rates, and at one point said "If the world population continues to increase at the same rate, we will destroy the species."

    The approaches we can take go beyond numbers and require a holistic, rights-based approach to talking about population and producing positive changes. Calling it the 'Population Monster' or population control won't direct the conversation where it needs to be.

    While the global rate of population growth has slowed, there are still 80 million people added every year. Africa's total population is predicted to increase from approximately 1 billion today to 2.2 billion by 2050. Pakistan could see a population increase from 175 million people to 335 million in the same time.

    And it's not just numbers. In the developed world and emerging economies, it is about consumption, most of it occurring at unprecedented levels and still increasing.

    The keys to keeping population numbers closer to the low-end projections are promoting women's rights and empowerment, reducing poverty and inequality, curbing unsustainable consumption, rethinking how we define economic growth and living in balance with nature.

    When India and China implemented coercive policies as a means to reduce fertility rates, this gave a negative connotation to population issues for many years thereafter.It was not until the 1994 International Conference on Population and Development in Cairo that family planning issues came back to the forefront and in a more positive light. This time issues were framed around terms like reproductive rights and reproductive health, and moved away from population growth or too much focus on demographics.

    The history of colonialism, racism, globalization, oppression, and global inequality cannot be disregarded, and a focus only on numbers and statistics misses the bigger picture.

    And on the other hand, a focus only on human rights can overlook the needs of the rest of the ecosystem. A stable population of empowered people benefits the world, both people and the planet.

    Ultimately though, it's about understanding rights for all in the face of increasing environmental degradation. In a world where an estimated 222 million women in developing countries would like to delay or stop childbearing but are not using any method of contraception, we need to overcome different viewpoints and remove obstacles to talking about population growth and its impacts. Lack of access, information, education, poverty, and limited options are some of the main barriers.

    Christopher Elias of the Gates Foundation talked of the importance of understanding the three main drivers of population growth:

    1. continued high desired fertility by some families and the concurrent need to bring down child mortality;

    2. the existing unmet need for access to family planning services - 215 million women (ed.note: now updated to 222 million) in developing countries want access to family planning services but do not have access to contraceptives. "Women should be provided the means to do what they already want to do", said Elias;

    3. the largest driver of population growth is population momentum, the natural increase in population in a world where half of the population is under the age of 25 and are either in or will soon reach their peak reproductive years. The global community should focus on education for girls and women, and create opportunities for better livelihoods.

    The Guttmacher Institute found that fully meeting all need for modern contraceptive methods would cost $8.1 billion per year. This would mean that unintended pregnancies would decline by 2/3rds, from 80 million to 26 million; there would be 21 million fewer unplanned births; and there would be 1.1 million fewer infant deaths.

    The world should listen to what women want, for themselves and their families.

    The UN report State of the World Population 2009 addressed women and climate change. It emphasized that educating women about reproductive health and providing them access to family planning would do more to reduce greenhouse gas emissions than ending all deforestation.

    Women are on the frontlines, facing at times drastically changing weather patterns. In most countries around they world they are the main providers of food, water, and other resources for their families. Empowered women can better support their families and communities, take care of their local environment, and adapt to climate impacts.

    The Center for Reproductive Rights states that "The focus on population numbers at the expense of human rights is counter effective and even harmful to the goals of social and economic development." Consider the following statistics from Oxfam: Just 11% of the global population generate around 50% of global carbon emissions, while 50% of people generate only 11%;

    Americans trash 40% of their food supply every year, valued at about $165 billion. Some 25% of all the freshwater consumed in the U.S., along with 4% of the oil, goes into producing food that is never eaten. Uneaten food accounts for 23% of all methane emissions in the U.S.

    Writer Laurie Mazur said that inequality makes it difficult to address and even acknowledge the environmental impact of population growth. A sustainable balance between people and resources can be achieved by: 1) using resources better; 2) addressing equity/ensuring basic needs are met for all people; 3) choosing a slower growth path. doclink

    Beyond 7 Billion: Bending the Population Curve

    Population experts from around the globe explain some of the approaches they've seen work ' and the reasons others have not
    December 2, 2012, Los Angeles Times

    A Times five-part series in July ( ) documented the hunger, environmental degradation, and political instability which were among the consequences of rapid global population growth. To follow up, population scholars have been invited to explain some of the approaches they've seen work -- or why they have not.

    Malcolm Potts, professor in the School of Public Health at UC Berkeley, quoted the 9/11 Commission report, "A large, steadily increasing population of young men without any reasonable expectation of suitable or steady employment a sure prescription for social turbulence." He also talked bout the Sahel, that dry strip of land bordering the Sahara's southern edge, where the crisis is already acute. The region went from 30 million people in 1950 to 103 million today, and by 2050 -- when climatologists predict that global warming will have greatly exacerbated the region's problems -- is expected to a have totally unsustainable 340 million people if family planning continues to be neglected. Tens of millions of people will be forced to migrate in a humanitarian catastrophe.

    The answer is family planning, which is not only a universal need but also a basic human right. Potts has worked internationally for almost 50 years, and has learned that, whenever women are offered a range of family planning methods, backed up by honest information about side effects, family size always falls. Smaller families mean children can stay in school and there is enough food for the family. When birthrates fall, family planning helps countries grow more prosperous.

    But family planning can't be coercive or insensitive to culture or religion: one size doesn't fit all. The challenge is that there are still patriarchal individuals and institutions waiting to deny women their reproductive rights.

    Gopi Gopalakrishnan, program director for World Health Partners, tells of Kulanjan village in the Indian state of Uttar Pradesh, where a local entrepreneur, working with the World Health Partners network, had organized a day in which village women could obtain the birth control devices and have them inserted for just $3. While 80 women registered to come, only one had the IUD inserted because there was the unanswered question "Where do we go for medical attention if we experience excessive bleeding or backache?" There was no plan in place for what would happen subsequently.

    After arranging for a nurse to visit the village every two weeks to handle such problems, the program ended up providing eight times the IUDs and 31/2 times the number of sterilizations as comparable initiatives. Women require predictable follow-up care and sensitive communication that explains side effects, especially for methods such as IUDs and injectable contraceptives.

    J. Joseph Speidel and Kirsten Thompson, with UC San Francisco's Bixby Center for Global Reproductive Health, reported that, -- while about 40% of the pregnancies in developing countries are accidental, and contraception is the obvious way to address unplanned pregnancy -- the currently available contraceptives have limitations. 20% to 50% of married women in developing countries complained of unpleasant side effects, health concerns and inconvenience, and which, in half of those cases, prevented them from using contraception, even though they would like to avoid pregnancy. Even in the U.S., half of pregnancies are unplanned or mistimed, and about half of those are due to inconsistent or incorrect use of a contraceptive.

    Research shows that there is demand for a birth control method that is user-controlled and does not require daily action for effectiveness; one that would prevent the transmission of HIV; and one that can be used by women secretly.

    Leona D'Agnes and Joan Castro of PATH Foundation Philippines and the Integrated Population and Coastal Resource Management initiative worked on a project in a remote and impoverished coastal region of the Philippines where a rapidly expanding population was dependent on a badly depleted fishery and a coastal ecosystem that was being destroyed, resulting in sharply rising malnutrition and poverty. Their team worked closely with community members to establish community-based family planning services and marine protected areas for the regeneration of fish stocks and mangrove forests. Programs aimed at young people encouraged postponing early sex and childbearing and taught environmental stewardship. Some adults worked on intervening against illegal fishing activities and others to provide family planning information. Technological assistance and microloans were available to retrain in another livelihood. Fertility fell, family income rose and coastal ecosystems began to come back.

    Martha Campbell, a lecturer at UC Berkeley and the president of Venture Strategies for Health and Development, shed light on the strange silence that shadowed the topic of population and family planning for the last 20 years, when the world population grew from 5.5 billion people to more than 7 billion. It started at the "Earth Summit" in Rio de Janeiro in 1992. There, a number of activist women agreed that the International Conference on Population and Development, scheduled to be held in Cairo in 1994, should broaden its focus to include a wider range of women's concerns, including education, health and improved justice. However, a group of women's advocates devoted themselves to making the terms "population" and "family planning" politically incorrect, suggesting that focusing on numbers of people somehow invited coercive family planning that was aimed at preventing women in developing nations from having children they wanted. They seemed to overlook the fact that the vast number of family planning programs focused on enabling women to make their own decisions. Unfortunately, after the Cairo conference, international family planning budgets collapsed.

    Kenya, for example, had reduced average family size from eight children per woman to 4.5 children with a completely voluntary family planning program. But when funding began to dry up Kenya couldn't sustain its progress, which means Kenya will have 12 million more people in 2050 than it would if family planning support had remained stable.

    Fortunately, this year, exactly 20 years after the Rio summit at the London Summit on Family Planning, Melinda Gates and a number of world governments decided to break the silence and put family planning back on the agenda. Now sensible people can finally unite in condemning both coercive family planning and the coercive pregnancies that result when women are denied access to family planning. Due to the silence that began 20 years ago, hundreds of millions of women around the world have been forced to have larger families than they wanted, giving up on other goals for themselves and their children as a result.

    Djavad Salehi-Isfahani -- professor of economics at Virginia Tech and a nonresident senior fellow at the Brookings Institution -- told the story of Iran, which in the 1980s, had a fertility rate of seven children per woman, and after two decades, dropped to two children per mother, setting a world record for the speed of fertility transition. Iran's turnaround was completely voluntary and occurred under a conservative Islamic government. The government started by building rural clinics across the country. By the time the call came for smaller families 5 years later, women had come to trust their health providers and were thus more likely to accept family planning advice when it was offered. The government also trained and employed young local women as health workers. And if a married woman failed to show up at the clinic at least once a year, a health worker visited her at home.

    Unfortunately this fall, Iran's supreme leader, Ayatollah Ali Khamenei, begged forgiveness from God for having gone "too far with family planning."

    William N. Ryerson, president of the Population Media Center said surveys reveal that many couples in the developing world want far more than two children. Other reasons people don't embrace contraception are fear of health effects, spousal opposition, religious opposition and a belief that how many children a woman has is up to God.

    Population Media Center produces locally written radio and TV serial dramas which are gripping and entertaining, in which key characters embrace such things as family planning, schooling for girls and other social and health goals unique to each country. The idea is education to help people understand the health and economic benefits for them and their children in limiting and spacing births. It requires modeling good family planning and overcoming fears and cultural taboos. It requires getting husbands and wives to talk to each other. The programs have aired in 45 countries.

    In northern Nigeria, the PMC radio serial was heard regularly by more than 70% of the population. In a study, two-thirds of those seeking contraception cited the program as a motivating factor. Those who listened to the program also reported wanting fewer children. In Rwanda, listeners were 50% more likely than non-listeners to want three or fewer children. And during the 2 1/2 years a PMC program aired in Ethiopia, 40% of listeners reported using modern contraceptive methods, compared with 25% of non-listeners.

    John F. May, a visiting fellow at the Center for Global Development said that, to be truly effective, family planning efforts need a strong commitment from top leaders in the country. Some African leaders have claimed that Africa is underpopulated and that high fertility rates and larger populations make countries stronger.

    On the other hand, Rwandan President Paul Kagame understands the implications of rapid population growth for the development prospects of his country. Kagame has rekindled efforts to bring fertility levels down and the Rwandan people -- particularly women and children -- have reaped significant health benefits.

    East Asia has found that faster demographic transitions, including rapid declines in fertility, bring a demographic dividend: a period of fast economic growth. This economic growth occurs because declining fertility levels result in more productive people relative to dependents in a given population.

    This could be a transformative tool for African countries too. But first, African leaders will have to embrace sound population policies. Without support from the top, family planning efforts in Africa will continue to struggle.

    Rajiv Shah, administrator of the U.S. Agency for International Development, tells us that 6.9 million children under the age of 5 die each year. Worldwide, families have willingly chosen to have fewer children when they know each child will have a chance to survive and thrive. When East Asia and Latin America decided in the 1960s and 1970s to invest in voluntary family planning, they also reduced child mortality and educated girls and boys.

    Meeting the unmet need for women to have access to the contraceptives of their choice will only work if they have confidence that the children they have will live to adulthood. By focusing on a range of life-saving interventions -- from bed nets that protect against malaria to new vaccines against diarrhea and pneumonia -- we can make it far more likely that children will live to celebrate their 5th birthdays.

    Under the leadership of President Obama, USAID co-hosted a call to action on child survival that has resulted in more than 150 governments signing a new pledge to end preventable child death. doclink

    Task Force to Kick Start Cairo Population Goals

    October 12, 2012, IPS Inter Press Service   By: Becky Bergdahl

    In 1994 in Cairo, Egypt, the International Conference on Population and Development (ICPD) instituted a Programme of Action which is the guiding document for the United Nations Population Fund, UNFPA.

    Recently, at the Ford Foundation in New York, a new 26-member high-level task force assembled to galvanise support behind the goals of the International Conference on Population and Development (ICPD).

    Gita Sen is a professor of public policy at the Indian Institute of Management in Bangalore, and has worked on population policies for 35 years. She is a member of the new task force, and attended the conference in Cairo in 1994.

    "I would not say that the goals have not been fulfilled, but that they have only been partially fulfilled," she said. "One thing that has definitely happened in those 18 years is that there is a language of sexual and reproductive rights, which was never there before." "This language has scared some people in governments, some very religious people, some social conservatives," she said.

    "They think that if women are empowered, if young people get autonomy and choice, they are going to lose out in terms of their ability to control them. Which is probably true, to some extent. But in the end it is for a better life for everybody."

    Sen said "The spread of evangelical conservatism in Africa is funded heavily from" the U.S. ..."It is funded by very rich people who are pouring their millions into very poor countries, in order to ensure that they turn their agenda away from sexual and reproductive rights, against gender equality. And with that much money pouring in it is hardly surprising that we have faced so much trouble as we do."

    Yet Sen maintains a positive attitude. "We are going to win this one. You can not keep young people and women back forever. This is not the dark ages," she concluded.

    200 million women worldwide still lack access to effective contraception, resulting in 80 million unintended pregnancies each year, with 40 million ending in unsafe abortions, many with life-threatening consequences. 800 women who carry out their pregnancies, wanted or unwanted, die every day in childbirth - 99% of them in developing countries.

    Ishita Chaudhry, a member of the new task force and the leader of the youth organisation TYPF in India, highlighted the importance of banning child marriage in order to achieve the ICPD goals.

    Child brides, girls married before their 18th birthday, run especially high risks of unwanted pregnancy and also of abuse. And there are currently over 60 million child brides worldwide.

    One in seven women experience domestic or sexual violence in their lifetime. Up to one in four women experience abuse during pregnancy.

    "Women's sexual and reproductive rights are at the heart of sustainable development," said Tarja Halonen, a former president of Finland and co-chair of the new high-level task force.

    "Pregnancy should be one of the happiest times in our life... Girls pay the price of taboos and double standards," she said. doclink

    Karen Gaia says: "179 nations at the 1994 Conference in Cairo endorsed the right to decide freely and responsibly the number and spacing of one's children, and the right to a satisfying and safe sex life."

    Nine Population Strategies to Stop Short of 9 Billion

    July 11, 2012, World Watch Institute

    In the book State of the World 2012: Moving Toward Sustainable Prosperity, in the chapter titled "Nine Population Strategies to Stop Short of 9 Billion," Worldwatch Institute president Robert Engelman outlines a 9 step plan that assures declines in birthrates that would end population growth before 2050 at less than 9 billion people. "Unsustainable population growth can only be effectively and ethically addressed by empowering women to become pregnant only when they themselves choose to do so," Engelman writes.

    All over the world examples can be found of countries that demonstrate effective policies which not only reduce birth rates, but also respect the reproductive aspirations of parents and support an educated and economically active society that promotes the health of women and girls.

    Engelman opposes 'population control' and the idea that anyone should pressure women and their partner on reproduction. Instead he proposes the following:

    1. Provide universal access to safe and effective contraceptive options for both sexes. Nearly two in five pregnancies are reported as mistimed or never wanted. Each baby should be wanted and welcomed in advance by its parents.

    2. Guarantee education through secondary school for all, especially girls. Women who have completed at least some secondary school have fewer children on average.

    3. Eradicate gender bias from law, economic opportunity, health, and culture. Women who can own, inherit, and manage property; divorce; obtain credit; and participate in civic and political affairs on equal terms with men tend to have fewer children.

    4. Offer age-appropriate sexuality education for all students.

    5. End all policies that reward parents financially based on the number of children they have.

    6. Integrate lessons on population, environment, and development - refraining from advocacy or propaganda - into school curricula at multiple levels.

    7. Put prices on environmental costs and impacts. Couples may decide that the cost of having an additional child is too high..

    8. Adjust to an aging population instead of boosting childbearing through government incentives and programs. Population aging must instead be met with the needed societal adjustments, such as increased labor participation.

    9. Convince leaders to commit to stabilizing population growth through the exercise of human rights and human development, using rights-based population policies, which empower women to make their reproductive choices. doclink

    Karen Gaia says: I would add raising the age of marriage enough to get a girl through high school and the girl must consent to the marriage. Also on aging (#8), I would put the grandparents to work preparing young people for a future very different from the dream promised us in our childhood.

    Policymakers Recommit to Unfinished Agenda of Landmark International Consensus on Population and Development Adopted at 1994 Cairo Conference as 20-Year Marker Fast Approaches

    May 29, 2012,

    In late May in Istanbul some 400 delegates, including more than 200 parliamentarians, discussed a course of action over the coming years to implement the ICPD Programme of Action by 2014 and beyond. They also considered ways to influence any new development framework to follow the Millennium Development Goals (MDGs) in 2015.

    Congresswomen Carolyn Maloney and Jan Schakowsky from Chicago represented the United States at the parliamentarian conference.

    "ICPD is about human beings, respect, rights, and what we can do to ensure that every individual can make his or her own decisions," said Dr. Babatunde Osotimehin, Executive Director of UNFPA, the United Nations Population Fund.

    Delegates committed themselves to its unfinished Cairo agenda plan by unanimously adopting the Istanbul Declaration of Commitment. In it, and under the theme, Keeping Promises - Measuring Results, they determined to advocate for increased national and external funding for the entire implementation of the ICPD agenda in order to achieve access to sexual and reproductive health, including family planning. They committed to strive to "attain at least 10 per cent of national development budgets and development assistance budgets for population and reproductive health programmes." That includes HIV prevention and reproductive health commodities.

    They pledged to support policies that give special attention to the specific concerns and needs of young people by promoting and protecting their right to "access good quality education at all levels, health, sexual and reproductive services, including comprehensive sexuality education," and to adopt measures to prevent all types of exploitation and abuse against them.

    The conference followed four similar global conferences, in Bangkok in 2006, Strasbourg in 2004, Ottawa in 2002 and Addis Ababa in 2009. doclink

    For World's Developing Countries, Reducing Infant Mortality and Improving Family Planning Programs Work Together to Help Women Achieve Desired Family Size

    March 20, 2012, Guttmacher Institute

    A study found that social setting has a stronger effect than program effort on family size.

    According to the study, fertility falls as social setting (education, life expectancy, infant mortality and income) improves, from 5.9 children among countries with poor social settings to 3.2 among countries with good social settings. In comparison, a family's number of children declines with increases in the strength of family planning programs, from 5.3 children among countries with a weak program to 3.9 among those with a strong program.

    However, the income part of social setting is associated with large families because most poor people have a higher infant mortality, lower levels of education and less access to family planning services.

    The study also found:

    * A 10-point decline in a country's infant mortality rate would reduce the total fertility rate by 0.19 births per woman

    * An increase of 10 percentage points in the proportion of young women receiving some secondary education would reduce the total fertility rate by 0.26 births

    * An improvement of 10 percentage points in the strength of family planning program effort would reduce the rate by 0.32 births.

    * A combination of Improving levels of female education, reducing infant mortality and improving family planning services have mutually reinforcing effects on avoiding unwanted pregnancy and helping women achieve their desired family size.

    The analysis was taken from data in Demographic and Health Surveys conducted between 2003 and 2010 in 40 developing countries by researchers Anrudh K. Jain of the Population Council and John A. Ross, an independent consultant. It was entitled: "Fertility Differences Among Developing Countries: Are They Still Related to Family Planning Program Efforts and Social Settings? doclink

    The State of Women on International Women's Day

    March 7, 2012,

    Summarized from an article by Suzanne York,

    Worldwide, 215 million women want to avoid getting pregnant but do not have access to contraception, disheartening because approximately 1,000 women die every day from preventable causes related to pregnancy and childbirth. These 215 million women and their families represent roughly 1 billion of the earth's poorest residents.

    Nicholas Kristof, columnist with the New York Times, sees voluntary family planning "as a cost-effective strategy to reduce poverty, conflict, and environmental damage." Providing family planning is a win-win for people and the planet, and it is one of the easier and more inexpensive ways of helping both.

    Investing in women's education and health empowers them tend to marry later, have smaller families, educate both sons and daughters, become economically better off, and to be healthier, while significantly slowing population growth and improving lives. Increasing men's awareness of the issues is also critical.

    Until policies support women, we will continue to see dis-empowerment in terms of land rights, poverty, lower female literacy, higher rates of fertility in poor and marginalized communities and countries, more women dying in childbirth and more unwanted/unplanned pregnancies.

    Invest in programs that make a difference for women: education and job opportunities ; access to reproductive health: voluntary and global access to reproductive health care and a woman's right to choose; increase funding for international family planning initiatives by increasing U.S. assistance for family planning and reproductive health from $610 million in 2012 to the 40% more that will be needed in 15 years; promote gender equality, including property rights for women. doclink

    Africa's Birth Rate: Why Women Must Be Free to Choose

    November 8, 2011, CNN

    By Tewodros Melesse, IPPF Director-General and an Ethiopian national

    Nearly all of the growth in the world - 97% - is occurring in less developed countries. Africa's rapid population growth -- 2.3% a year, double the rate of Asia's -- puts pressure on its economies as governments struggle to provide education and health services.

    In sub-Saharan Africa the population issue is due to too many women lacking the freedom to exercise choice when it comes to childbearing. In remote locations women are forced to walk many kilometers to obtain contraceptives, and in some areas they are simply not available.

    Globally two in five pregnancies are unplanned. Clearly 'unmet need' for contraception is a wasted opportunity to boost development and stabilize population growth through something women want and need: the ability to decide when to become pregnant.

    Women are often required to have large families to improve their social standing and ensure their economic survival. In many countries girls marry at a very young age, become pregnant too early and cut short their education to take care of their young family. Poorly educated and unable to work they have no income, adding to the cycle of poverty. In addition, young mothers face terrible threats to their health such as fistula - a hole in the birth canal caused by prolonged labor without prompt medical intervention, leading to chronic incontinence and ostracization.

    Women must be empowered to be able to make their own decisions free from fear of coercion or pressure from partners, family, and society. Their sense of self-worth should not depend on the number of children they have. They must have easy access to a range of safe, effective, and affordable contraceptives and the information and counseling needed to use them.

    Contraceptive access needs to be backed by better health infrastructure - we have abundant evidence that when parents are confident that their children will survive, they will have fewer and invest more in each of them.

    Experience has shown us that education for girls, legal reform and access to family planning have made a difference in many countries. While it's true that economic and social development leads to women having smaller families, the converse is also true -- that the gains that contraception has made possible in women's health make family planning one of the most successful international development stories. doclink

    The World is Home to 7 Billion People but How Far Has it Come?

    October 31, 2011, The Guardian

    by Dr. Babatunde Osotimehin, executive director of the United Nations Population Fund

    The world's population reaching 7 billion on Monday is milestone reminding us that there is much work to do on sexual and reproductive health and HIV if we are to meet the millennium development goals by 2015

    To meet the right to the highest attainable standard of health, the international sexual and reproductive health and HIV communities are increasingly joining forces and reaching out to the most vulnerable and under-served populations.

    It is critical that sound policies are in place to support comprehensive approaches, whether on providing women with family planning services, delivering sex education for young boys and girls, preventing child marriage, eliminating gender-based violence, managing sexually transmitted infections, ensuring access to condoms for dual protection, or providing antiretroviral treatment alongside cervical cancer screening.

    These goals cannot be achieved without gender equality and empowerment of women.

    Sexual and reproductive ill-health and HIV have the same root causes. These include economic inequality, limited access to appropriate information, gender inequality, harmful cultural norms and social marginalisation.

    We must strengthen integrated services to improve their quality and accessibility, which means more people will use them. In turn, this improves health and behavioural outcomes, including condom use, and people's knowledge about HIV. Other benefits include reducing HIV-related stigma and discrimination, since addressing HIV will be part of normal core services within a facility. Forging partnerships between the sexual and reproductive health and HIV communities, including with networks of people living with HIV, is essential to reap sustainable benefits.

    The world's new population milestone is a reminder that there is still much work to do to improve people's lives and meet the millennium development goals by 2015.

    In a world of 7 billion people, every person should enjoy equal rights and dignity. And as our numbers grow in the years ahead, it is critical that we take actions to ensure that every pregnancy is wanted, every birth is safe, and that every young person is free of HIV and AIDS. doclink

    7 Billion Reasons to Invest in Women's Reproductive Health

    October 25, 2011,

    UN Foundation President Timothy E. Wirth, in recognition of the Oct 31 milestone of 7 billion people called for investment in international reproductive health and voluntary family planning as a means to achieving progress on all of the Millennium Development Goals.

    "In a world of 7 billion, it is more important than ever that we address fundamental issues of poverty and inequality. We know that investing in women's reproductive health and voluntary family planning is one of the most cost-effective means to tackling our most pressing global development challenges."

    Today there are 215 million women who want the ability to prevent pregnancy, but lack access to quality reproductive health care and voluntary family planning. Meeting this demand would have numerous benefits - not least of which is saving lives. Pregnancy-related complications are the leading cause of death among young women in developing countries. If the demand for family planning were met, maternal mortality would decrease by 32%, and infant mortality by 10%.

    Empowering women with the tools they need not only improves their health and ability to raise stronger, healthier families, but it also promotes more prosperous and stable societies, resource and food security, and environmental sustainability. doclink

    Pathfinder: World Population to Reach 7 Billion

    October 18, 2011, Pathfinder International

    On October 31, the world's population is projected to hit 7 billion. This milestone highlights both progress and setbacks. Pathfinder celebrates improvements in health care that are leading to increased life expectancy and lowered risk of maternal and child death, while at the same time calling for increased attention and funding for reproductive health and family planning.

    Worldwide, 40 percent of pregnancies are unintended because millions upon millions of women lack a basic human right: access to contraception. Never has there been a more critical time to invest in reproductive health and family planning.

    **Read Pathfinder's official statement: doclink

    Women's Rights Are Key to Slowing Population Growth

    October 3, 2011, Grist Magazine

    Laurie Mazur writes that human numbers are approaching 7 billion and poses the question "Where do we go from here?" The UN's low population projection is 8 billion by mid-century, then decline; the middle projection says 10 billion by 2100; and the high projection, nearly 16 billion.

    It would be difficult to establish and optimal size for the human population; greater equity and more efficient use of resources would greatly extend the planet's "carrying capacity." Yet, when you consider the resource challenges of the 21st century, 8 billion certainly looks more sustainable than 16 billion.

    While there is no global shortage of water, a growing number of regions are chronically parched. And many of those regions are also where population is growing most rapidly. In the world's most "water poor" countries, population is expected to double by 2050. Slower growth could ease pressure on scarce resources and buy time to craft solutions.

    We know how to slow population growth. Over the last half century, we've learned that the best way to slow growth is not through coercive "population control," but by ensuring that all people are able to make real choices about childbearing. But fertility rates remain high where women's status is low. Fewer than one-fifth of the world's countries will account for nearly all of the world's population growth this century and those countries are the least devloped and are also where girls are less likely to attend school, where child marriage is common, and where women lack basic rights.

    Nations can raise women's status by educating girls, by enforcing laws that prohibit child marriage, and by improving women's access to credit, land, training, and jobs. Where women enjoy these fundamental rights, smaller (and healthier) families become the norm.

    At the same time, women need the means to make choices: family planning and other reproductive health services. Around the world, some 215 million want to avoid pregnancy, but aren't using effective methods of contraception. Fulfilling that "unmet need" for family planning would require an additional $3.6 billion annually; the U.S. share of the cost (based on a formula developed by the U.N. Population Fund) is about $1 billion .

    And the potential benefits are huge: Improved access to family planning could prevent 53 million unintended pregnancies, 150,000 maternal deaths, and 25 million abortions each year. doclink

    Manuscript: Assessing Family Planning Use and Its Impact in Controlling Population Growth in Africa

    August 16, 2011, WOA website

    by Nyiko Tricia Maluleke, Africa Institute of South Africa


    The rate at which the world population is growing creates a great concern to the international community. It is this reason that the United Nations held a number of conferences to discuss the means to control world population growth. The most influential conference was the 1994 International Conference on Population and Development (ICPD) held in Cairo; the conference reached an agreement on the urgent need to control global population growth. Among others, the 20 year ICPD Program of Action declared family planning use as one of the critical approaches to be initiated by United Nations member states as a way of regulating world population.

    Different member states were urged to promote and make access to family planning a priority for the purpose of regulating world population growth. As such, the paper seeks to appraise the use of family planning in Africa; the paper is driven by the motive to examine the impact of family planning use on fertility patterns and population growth in the continent. It is strongly argued in the paper that, in order for Africa to successfully achieve the ICPD goal of slowed population growth, access to family planning needs to be critically looked at, as it remains the intermediate factor in the possibility of slowed population growth in the continent and the world at large.

    Click here for the entire article. doclink

    The Priority in Addressing Unsustainable Population Growth Should Be Providing Family Planning Services.

    July 11, 2011, Population Matters (OPT)

    It's contraception, stupid. The priority in addressing unsustainable population growth should be providing family planning services.

    World Population Day, 11 July, has a special resonance in 2011, when the world population will reach a record level of seven billion. With a record number of young people entering childbearing age, this growth is projected to continue, with world population reaching eight to ten billion by 2050. This growth is having consequences, including record resource prices, biodiversity loss and climate change.

    Alongside more sustainable lifestyles and technologies, slowing the growth rate in population is essential in addressing the big problems humanity faces. Many factors affect the birth rate, particularly in countries where this is still high. They include the level of social development, health services provision and the position of women.

    However, one of the easiest to address is the provision of modern family planning services, one of the UN Millennium Development Goals. It is estimated that meeting the unmet need for contraception of the 215 million who lack access to it would cost as little as $3.6bn per annum, a fraction of today's aid flows. This would contribute to poverty alleviation, women's empowerment and improved health, as well as laying the foundations for limiting humanity's impact on the environment. doclink

    Gore Promoting Fewer Children to Curb Pollution

    June 21, 2011, The Daily Caller

    When the world's top global warming activist - former Vice President Al Gore - is talking about the size of population and how that contributes to the choices societies make, it might be worth taking note.

    "One of the things we could do about it is to change the technologies, to put out less of this pollution, to stabilize the population, and one of the principle ways of doing that is to empower and educate girls and women.

    "When that happens, then the population begins to stabilize and societies begin to make better choices and more balanced choices.

    Also he said: "You have to have ubiquitous availability of fertility management so women can choose how many children have, the spacing of the children," and "You have to lift child survival rates so that parents feel comfortable having small families." doclink

    Africa: Family Planning Improves the Lives and Health of the Urban Poor and Saves Money

    April 23, 2010, Population Reference Bureau

    Urbanization is occurring so rapidly that cities are not able to keep up with increased demand for services, not to mention the employment, housing, and transportation needs of a population that may double in less than 25 years. Three-quarters of those living in the cities of the developing world live in slum-like conditions, often without access to sanitation and safe drinking water, associated with increased health problems. Urban slums have much higher rates of illness than nonslum areas of the same cities and health and social problems related to the environment, violence, injury, and noncommunicable diseases are more common.

    Family planning is often overlooked as an essential strategy to improve urban health. The poor who live in urban areas have more difficulty, for a variety of financial, social, and cultural reasons, accessing family planning services than do wealthier residents. Improving the access of the poor to family planning services in urban areas should be a high priority, especially since the majority of urban residents in many countries live on less than US$2 per day.

    The majority of urban population growth (60%) is because births among urban residents outpace deaths. As infant and child mortality has declined, this rate of "natural increase" has become especially high in urban areas of sub-Saharan Africa, some of which are growing at 4% per year. This has proven difficult for governments and the environment to accommodate.

    Urban families want to have fewer children than rural residents. Many urban women report that they have more children than they intended to have. While most wealthier urban women have access to contraception, poor women have less physical and financial access to high-quality reproductive health services and to an affordable range of contraceptives that meets their needs. As the growth of urban areas continues unabated, the value of reducing unwanted and unplanned births by enabling equitable access to contraception should not be underestimated.

    Because of past high fertility, rapid urbanization is likely to continue. In sub-Saharan Africa for example, the number of women of reproductive age will grow by 35% in the next 10 years. Unless women are able to limit their family size the number of births over this same period will increase by 33%. This will fuel even more rapid population growth.

    Poor women who desire to stop having children but are not using a modern method of contraception have an especially high "unmet need" for family planning. In Senegal and Ethiopia, for example, one in every three women ages 15 to 49 who live in urban areas has an unmet need for contraception.

    Nigeria has one of the lowest levels of unmet need in sub-Saharan Africa-13% among urban women and 17% among the poorest women. However, because Nigeria is by far the largest country in Africa, the number of women with unmet need, 4 million, is large and it is growing as the demand for family planning increases. The millions of women with unmet need for contraception contribute directly to rapid population growth as well as to high rates of maternal and infant death.

    Women in sub-Saharan Africa have a one in 22 lifetime risk of dying of causes related to pregnancy and delivery. While maternal mortality has declined since 1990, by 26% in Latin America and 20% in Asia, it has only fallen by 2% in sub-Saharan Africa. Women who give birth before age 18 or after age 35, or who have closely spaced pregnancies are at a greater risk of death.

    In many countries of sub-Saharan Africa, early marriage and childbearing is common. In Mali, Malawi, Mozambique, and Niger, for example, half of all women have given birth by age 18. Women who give birth before age 20 are twice as likely to die of pregnancy-related causes as are older mothers. Family planning can avert these deaths by enabling young, sexually active women to delay their first pregnancy until they are older and more physically and emotionally mature. However, contraceptive use among sexually active women, whether married or unmarried, is very low in most countries of sub-Saharan Africa. In Nigeria, just 3% of married women and 37% of unmarried women ages 15 to 19 use a modern method of contraception.

    In selected sub-Saharan African countries, including Nigeria and Kenya, between 25% and 41% of unwanted pregnancies are aborted, and in sub-Saharan Africa as a whole, 99% of the nearly 5 million abortions that occur each year are conducted by persons lacking the necessary medical skills or under unsafe conditions or both. Sub-Saharan Africa has the world's highest proportion of abortions performed among young women ages 15 to 19. As a consequence, abortion is a leading cause of death among young African women. In East Africa, including Kenya, unsafe abortions account for 17% of maternal deaths. Assuring that young people have the family planning information and services they need could significantly reduce deaths due to abortion as well as deaths from other maternal causes.

    Spacing births at least two years apart is one of the most important and successful strategies for improving birth outcomes and the survival of infants. Infants born less than two years after a previous birth are about twice as likely to die in the first year of life as an infant born three years after a previous birth.

    Infants and children born to mothers who are under age 20 are also much more likely to die in the first days, months, and years of life. In Senegal, for example, one of every 10 infants born to women under age 20 dies in the first year of life, as opposed to one in 17 among women who give birth between ages 20 and 29. In Senegal alone, family planning could avert 1.3 million unintended pregnancies, 400,000 abortions, and 200,000 deaths to children under 5 over a 10-year period.

    The importance of family planning to reducing mother-to-child transmission of HIV has not received sufficient attention. Each year, more than 577,200 unintended pregnancies among HIV-infected women in sub-Saharan Africa are prevented through the use of contraception, which already prevents more HIV infections among infants than antiretroviral therapy. While it is essential that all women in need of ART have access to it, more than half a million additional unintended pregnancies to HIV-positive women could be averted each year if all women in the region who did not wish to become pregnant had access to modern contraception.

    Investing in family planning results in large savings to the health, education, and environmental sectors. With fewer children to educate, governments can extend safe water and sanitation services to a greater share of their populations. This will in turn have benefits in terms of reduced water-born illnesses and deaths due to diarrhea. When population growth occurs more slowly, there is also less pressure on scarce land and water resources and less environmental degradation due to deforestation, salinization of soil, and air pollution.

    In Kenya, for example, meeting unmet need for family planning at a cost of $71 million can be expected to reduce expenditures on education by $115 million, on immunization by $37 million, on water and sanitation by $36 million, on maternal health by $75 million, and on malaria by $8 million. For every dollar spent on family planning, Kenya would recoup $3.79 in savings in these sectors alone.

    There is near universal agreement among governments that every child has a right to be wanted and women and couples have a right to decide freely on the number of children they will have. In most societies, poor women are the least likely to be able to exercise the right to use contraception, in part because they are the least able to pay for family planning services. Until poor women have the same ability to exercise that right as wealthier women, urban areas will grow not only in size but in level of inequality. The percentage of people living in poverty will continue to increase and income inequality between rich and poor will grow larger.

    Governments and urban planners should ensure that the poor are the recipients of public funds that subsidize and aim to improve the quality of reproductive health services. Without this assurance, subsidies and incentives are more likely to be utilized by those who do not need them as much. Investments in reproductive health and family planning are among the most cost-effective that governments can make. In Kenya and Nigeria, for example, the cost of protecting an urban couple from an unwanted pregnancy for a year through the provision of clinic-based services is only $4.27.

    This small investment is worthwhile for the benefit of individuals and families and for the greater society. doclink

    Success Stories: Family Planning Works - Growth is Slowing!

    Teen Birth Rate Drops to All-time Low in US

    June 30, 2017,   By: Susan Scutti

    In 2016, the teen birth rate dropped 9% compared to the previous year, and 67% since 1991, according to the National Center for Health Statistics.

    In 2016, the number of US births dropped 1% compared to 2015. The fertility rate of 62 births per 1,000 women is a record low for the nation.

    Dr. Elise Berlan, a physician in the section of adolescent medicine at Nationwide Children's Hospital. Berlan, said: "Data [from previous years] really suggests it is access to contraceptives and use of contraceptives that has really led to these kind of changes." ... "Most teens are using some form of birth control" and the top method is "the condom, followed by withdrawal and the pill."

    For women age 30-34, the birth rate increased by 1% over 2015, and birth rate for women 35-39 is up 2% over 2015. Women age 40-44, showed a birthrate increase of 4% over 2015.

    Nonmarital births fell 3% compared to the previous year.

    The percentage of women receiving prenatal care beginning in the first trimester of pregnancy ranged from 51.9% for non-Hispanic native Hawaiian and other Pacific Islanders women to 82.3% for non-Hispanic white women. Nearly 81% of Asian women also received prenatal care, while 72% of Hispanic and 67% of non-Hispanic black women did the same.

    Sarah Verbiest, executive director of the Center for Maternal & Infant Health in the University of North Carolina School of Medicine, said: "We know that the growth of the baby happens really fast, really soon. So in the first nine weeks, all of the key parts of the baby are formed," Prenatal care in the first trimester helps a pregnant woman learn what changes to expect and address any unhealthy factors in her life.

    The preterm birth rate -- when a baby is born more than three weeks before a full nine month pregnancy -- also rose 2% for American women overall. Preterm births can lead to poor health for babies. Unhealthy diets is the suspected cause. doclink

    India Approaches Replacement Fertility

    October 9, 2015, Population Reference Bureau blog

    This Population Bulletin updates a previous Bulletin from 2006, India's Population Reality: Reconciling Change and Tradition. India's population (currently at 1.3 billion) will exceed China's before 2025 to make India the world's most populous country. India's annual increase of about 19 million people contributes more to the annual world population growth of about 89 million than any other country.

    However, the most recent population data shows a country headed for replacement level fertility although with notable regional differences in fertility trends.

    India is a country of diverse ethnic, linguistic, geographic, religious, and demographic features. And, despite its emerging economic power and multiple megacities, Indian life remains largely rooted in its villages. Deep-rooted cultural traditions will have a bearing on the ability of different regions of the country to reach replacement level fertility. doclink

    India Approaches Replacement Fertility

    October 9, 2015, Population Reference Bureau blog   By: Carl Haub and O.P. Sharma

    This Population Bulletin updates a previous Bulletin from 2006, India's Population Reality: Reconciling Change and Tradition. Indias's population (currently at 1.3 billion) will exceed China's before 2025 to make India the world's most populous country. India's annual increase of about 19 million people contributes more to the annual world population growth of about 89 million than any other country.

    However, the most recent population data shows a country headed for replacement level fertilitybut with notable regional differences in fertility trends.

    India is a country of diverse ethnic, linguistic, geographic, religious, and demographic features. And, despite its emerging economic power and multiple megacities, Indian life remains largely rooted in its villages. Indeed, we argue in this Bulletin that deep-rooted cultural traditions will have a bearing on the ability of different regions of the country to reach replacement level fertility. doclink

    Pakistan: a Tough but Vital Place to Do Family Planning

    August 6, 2015, Impatient Optimists   By: Juan Enrique Garcia

    In the rural Sindh Province of Pakistan, Juan Enrique Garcia (of DKT Pakistan) met a woman so poor that she fed her six children three on one day, and three the next. This reaffirmed the importance of the programs giving Pakistani couples options for healthy spacing and timing of births. The 2012-13 Demographic and Health Survey for Pakistan found that only 26% of married women use a modern method of birth control - lower than the 66% who do so in Mexico and lower than in all neighboring countries, except Afghanistan.

    Pakistan has pledged to increase the contraceptive prevalence rate (CPR) for modern methods to 55% by 2020. That would double the CPR in only eight years. The authors job at DKT Pakistan is to help the government reach that goal.

    Although 20% of married women say they want contraception but cannot access it, it is difficult to discuss the subject openly in Pakistani society. At home women are told to have many children and at least one male child. The pressure can come from the husband, the mother-in-law, other family members or society at large. The reluctance to discuss contraception occurs even inside DKT Pakistan, a family planning NGO. When they hire new sales person, they spend time trying to make the new person feel okay about selling contraception. However some soon leave the job, forcing DKT to find and train a new person.

    DKT Pakistan has built up a social franchising network of 800 midwife-owned and operated Dhanak (rainbow in Urdu) clinics in a little less than three years. They aim to have 1,200 clinics operating in all parts of Pakistan by the end of 2015. Their mission is to provide couples with affordable and safe options for family planning and HIV prevention through social marketing and social franchising. They go to remote and rural areas with difficult access, where many other organizations do not go but where 65% of Pakistanis live. To help families understand the benefits, DKT sponsors tea parties for men and women to relax and converse about long-acting reversible contraceptives. DKT also hold mobile video shows in rural areas, with separate shows for women and men.

    DKT Pakistan, like the other 20 DKT International programs around the world, tries to push cultural boundaries, without violating them, in order to make the greatest impact possible (see their best TV spots from around the world). But still, DKT sometimes ruffles feathers. For example, in 2013, a TV spot featuring the provocative Pakistani model Mathira playing a newlywed trying to please her husband in the bedroom aired only 10 days before the censors banned it. Yet the spot has now been seen millions of times on YouTube and helped increase DKT's sales of Josh condoms.

    Although DKT clinics are in very different regions and cultural settings, they have a few things in common: They share a standard appearance, signage, advertising, quality standards, etc.; they offer training and refresher training to for their clinical staffs; they provide a full line of reproductive health services and products, most of which are offered through DKT Pakistan's parallel social marketing program.

    Since the Dhanak clinics are usually owned and operated by women, the clinics also empower women and provide a model of entrepreneurial self-sufficiency.

    DKT Pakistan has just joined the work led by Aman Health Care Services under the SUKH Initiative with support from the Bill & Melinda Gates Foundation and the David and Lucile Packard Foundation. Their goal is to increase modern contraceptive use by 15% among married women in selected, low-income communities of Karachi. DKT's role will be to identify and franchise 80 private sector clinics as Dhanak clinics and promote family planning. Due to political and ethnic violence, many health providers have abandoned their facilities in some of these areas, so our clinics will help fill that gap. The first 35 clinics are expected to be operational in 2015.

    In Pakistan, many obstacles block greater acceptance and use of family planning. But Pakistani women want it, and DKT's private-sector approach will bring it to them. doclink

    10 Things America Does So Much Worse Than Europe

    July 11, 2015, Salon   By: Alex Henderson

    1. Lower Incarceration Rates

    2. Less Violent Crime Than the U.S.

    3. Better Sex Education Programs, Healthier Sexual Attitudes

    For decades, the Christian Right has been trying to convince Americans that social conservatism and abstinence-only sex education programs will reduce the number of unplanned pregnancies and sexually transmitted diseases. The problem is that the exact opposite is true: European countries with comprehensive sex-ed programs and liberal sexual attitudes actually have lower rates of teen pregnancy and STDs. Looking at data provided by the Centers for Disease Control and Prevention (CDC), the Guttmacher Institute, Advocates for Youth and other sources, one finds a lot more teen pregnancies in the U.S. than in Europe. Comprehensive sex-ed programs are the norm in Europe, where in 2008, there were teen birth rates of 5.3 per 1000 in the Netherlands, 4.3 per 1000 in Switzerland and 9.8 per 1000 in Germany compared to 41.5 per 1000 in the United States. In 2009, Germany had one-sixth the HIV/AIDS rate of the United States (0.1% of Germany's adult population living with HIV or AIDS compared to 0.6% of the U.S. adult population), while the Netherlands had one-third the number of people living with HIV or AIDS that year (0.2% of the Netherlands' population compared to 0.6% of the U.S.' adult population).

    4. Anti-GMO Movement Much More Widespread

    5. Saner Approaches to Abortion

    Logic never was the Christian Right's strong point. The same far-right Christian fundamentalists who favor outlawing abortion and overturning the U.S. Supreme Court's Roe v. Wade decision of 1973 cannot grasp the fact that two of the things they bitterly oppose -- contraception and comprehensive sex education programs -- reduce the number of unplanned pregnancies and therefore, reduce the need for abortions. But in many European countries, most politicians are smart enough to share Bill Clinton's view that abortion should be "safe, legal and rare." And the ironic thing is that European countries that tend to be sexually liberal also tend to have lower abortion rates. The Guttmacher Institute has reported that Western Europe, factoring in different countries, has an average of 12 abortions per 1000 women compared to 19 per 1000 women in North America (Eastern Europe, according to Guttmacher, has much higher abortion rates than Western Europe). Guttmacher's figures take into account Western Europe on the whole, although some countries in that part of the world have fallen below that 12 per 1000 average. For example, the UN has reported that in 2008, Switzerland (where abortion is legal during the first trimester) had an abortion rate of 6.4 per 1,000 women compared to 19.6 per 1000 women in the U.S. that year. And Guttmacher has reported that countries where abortion is illegal or greatly restricted tend to have higher abortion rates than countries where it is legal: back-alley abortions are common in Latin America and Africa.

    Clearly, better sex education, easier access to birth control and universal healthcare are decreasing the number of abortions in Western Europe. So instead of harassing, threatening and terrorizing abortion providers, the Christian Right needs to examine the positive effects that sexually liberal attitudes are having in Switzerland and other European countries.

    6. More Vacation Time

    7. Universal Healthcare

    The U.S. made a small step in the direction of universal healthcare when Congress passed the Affordable Care Act in 2010, but the U.S. is so backwards when it comes to health care that implementing even the modest reforms of the ACA (which doesn't go far enough) has been an epic battle. Meanwhile, every developed country in Western Europe has universal health care, which is implemented in different ways in different countries.

    8.Greater Life Expectancy

    9. Mass Transit Systems

    10. Europeans More Likely to Speak Foreign Languages doclink

    Aggressive Efforts Underway to Abolish Child Marriage in Niger by the Year 2050   By: Priscilla Masilamani

    The country of Niger has the highest incidence of child marriages in the world, with 77% of the underage girls currently married. One in three girls is married before the age of 15, according to UNICEF.

    Religion, tradition and culture play a part while poverty, gender inequality and weak legislation add fuel to this violation of girl's rights.

    The UNFPA in Niger has been, since 2012, aggressively carrying out ground work in raising awareness to put an end to this practice. "By carrying out strategic development and empowerment training, and by collectively engaging the community leaders and grassroots people, the UNFPA is foreseeing a future where child marriages would be completely abolished by the year 2050," says Monique Clesca, UNFPA Representative. The goal is to abolish the practice by 2050.

    An eight-month educational training program for girls make them aware of the rights they have as children. "Training is provided about how their bodies work, hygiene, and also their reproductive and sexual health." said Clesca. For example, Amina, a 13 year old girl, learned that she, as a child, has her own rights. When she was forced by her parents to get married to a man three times older than her, she stood up for herself and refused to marry. She was beaten and ran away, but she did not bend to the demands of her family. Finally, she was able live in her uncle's house, where she now attends a special school, learning to read and write.

    The UNFPA hopes to reduce domestic and sexual violence, maternal and infant health risks, incidence of STDs and fistula, which are all a few of the direct results of child marriage.

    The UNFPA also targets the men in a program called 'The Husband School,' which brings together men from various communities to help them understand the health consequences of marrying a child.

    "With the husbands being schooled, we are seeing a tremendous change in the attitude of men. Now, girls tell us that the husbands themselves willingly take them to healthcare centers. The men are waking up," Clesca said.

    With success stories on the increase, Clesca hopes to see an enormous difference in the rate of child marriage in the next survey to be conducted by the UNFPA in 2017.

    Clesca tells of the importance of a huge social movement to see a visible change. "We need different sectors of the community to come together at a local, national and international level to make a large, lasting difference." doclink

    How Has the World Changed in the Last 20 Years?

    April 7, 2014, UNFPA - United Nations Population Fund

    Twenty years ago, the international community gathered in Cairo, Egypt, at the the International Conference on Population and Development (ICPD). There, 179 governments signed on to the ICPD Programme of Action, which recognizes that women, their rights and equality are global development priorities. The governments committed to: providing universal access to voluntary family planning, sexual and reproductive health services and rights; delivering gender equality and equal access to education; addressing the impacts of urbanization and migration; and supporting sustainable development.

    Ways our world is different:

    1. The world now has the largest generation of young people ever. Those between 10 and 24 years old accounted for 28% of the world population in 2010. The world must invest in the needs and rights of this group, supporting their access to quality health care and education, opportunities for safe paid work, and freedom from abuses such as early marriage and pregnancy.

    2. The proportion of people living on less than $1.25 per day has fallen from 47% in 1990 to 22% in 2010. But growing inequality could undermine these gains. 8% of the world's population has 82% of the wealth, and over a billion people do not have access to social protections, meaningful work, or public health or education services.

    3. In the last 20 years, the world's population grew by about a quarter, from 5.66 billion to 7.24 billion.

    4. The population growth rate has slowed from 1.52% annually to 1.15%. We can now expect the global population to reach 9.55 billion by 2050.

    5. Women are having fewer children. The average woman had about three children in 1994. Today, the fertility rate is around 2.5 children per woman. However, in 18 countries, fertility rates stand at five children or more per woman.

    6. Adolescent childbearing has fallen by 50% or more in many countries. However, each day 20,000 girls under age 18 give birth and every year, there are 70,000 adolescent deaths from complications of pregnancy and childbirth.

    7. Contraceptive use has increased. But between 2008 and 2012, the proportion of married women in the developing world using modern contraceptives only changed from 56% to 57%. There are about 222 million women without access to modern contraception.

    8. Maternal deaths have dropped by 47% since 1994. Today, 800 maternal deaths occur every day, and the leading causes - postpartum haemorrhage, sepsis, obstructed labour, complications from unsafe abortion, and hypertensive disorders - are all preventable.1,3

    9. Child deaths fell by nearly half. A major factor contributing to this decline is increased education for women and girls.

    10. The number of births occurring under the care of a skilled attendant - a doctor, midwife or nurse - has grown from 56% in 1990 to 67% in 2011. Skilled birth attendance is one of the most critical ways to ensure safe delivery for both mother and child. That, along with increased access to antenatal care, emergency obstetric care and family planning services, accounts for much of the decline in maternal deaths.

    11. Life expectancy has increased by 5.2 years.

    12. Abortion rates have declined, from 35 per 1,000 women in 1995 to 29 per 1,000 women in 2008. Addressing unmet family planning needs would avert 54 million unintended pregnancies and result in 26 million fewer abortions.

    13, 14, 15 - HIV/AIDS, SIDs, non-communicable diseases.

    16. Primary school enrolment rates have jumped from 75% in 1990 to about 90% in 2010. But gender inequality still exists.

    17. The global urban population rose by 1.6 billion between 1994 and 2014. More than half the world's people now live in towns or cities. But too much of this growth is taking place in slums.

    18. More people are migrating than ever before.

    19. The number of older persons increased from 490 million in 1990 to 765 million in 2010.

    20. Record numbers of people are displaced within their countries by conflict or violence, taking a disproportionate toll on women and girls.

    Much more work to be done

    Female genital mutilation/cutting (FGM/C) and child marriage remain prevalent in much of the world, even in countries where these practices have been outlawed.

    Gender-based violence continues to be a global epidemic. An estimated one in three women report experiencing physical or sexual abuse, most commonly by an intimate partner.

    Discrimination against women continues in every society in the world, and belief in gender equality is not yet universal. doclink

    Why it Takes Teens With Condoms to Encourage Family Planning in Africa

    Time magazine   By: Alexandra Sifferlin

    This year, Addis Ababa, the capital of Ethiopia, will host the annual International Family Planning Conference. Ethiopia's public health facilities offer several contraceptive options. Usage has grown from 8% in 2000 to 29% in 2011. Combining family planning with immunizations, antibiotics and other health services has reduced Ethiopia's maternal and child mortality rates. Minister of Health, Catherine Gotani Hara, says that women have fewer children when they expect them all to survive.

    The success of programs in Ethiopia, Rwanda, and Malawi show that even poor nations can make family planning work. Contraceptives are free at public health clinics in all three of these nations. Women tend to pick long-acting reversible and discreet contraceptives (like implants and IUDs) over condoms and pills. But clinics offer other options so users can decide for themselves which methods to choose.

    Women often fear their husband's reaction, so health workers often offer birth control outside the clinic so husbands won't know that their wives have visited the program. Where men resist family planning, Ethiopia sends male mentors to their homes to help convince them. Officials in Rwanda encourage male family planning methods such as vasectomies. In Malawi, village campaigns headed by community chiefs promote family planning for couples. They include the voice and perspective of as many men as possible, including respected elders.

    Some programs also focus on teens. Although many 18-year-old girls are already married with children, some national leaders fail to acknowledge that teens have sex. Ethiopian community health centers now include youth services and private offices to educate teens and offer them contraceptives. Boys even learn about family planning in primary school. Since teens may feel uncomfortable discussing sex with adults, some organizations use unconventional approaches to reach them. For example, Planned Parenthood partners with Mary Joy Aid Through Development to train Ethiopian teens as peer health promoters who can talk to other teens about sexual health issues and distribute pills and condoms.

    Ethiopia's constitution makes access to family planning a woman's right, which highlights the critical role it has in that nation. Rwanda also introduced strong policies in support of family planning. It improved access to contraceptives by stocking up all public health clinics and training more family planning providers. This resulted in a 10-fold increase in contraceptive use (from 4% of married women of reproductive age in 2000 to 45% by 2010).

    In Ethiopia and Malawi, health extension workers help get people to clinics. USAID helps these nations fund the Women's Development Army, which trains community mothers as extension workers. In addition to a hospital and small health center in every community, Ethiopia also staffs a health post with two extension workers. They go door to door and they host informal gatherings to promote family planning and answer questions. Before joining the Women's Development Army, Yenenesh Deresa had her first of five children at 15. Now she talks to women about family planning over coffee. She says this empowers women to make their own decisions and have safer pregnancies.

    Countries that lower their fertility rates often experience an economic boost known as the demographic dividend. Family planning allows more women to work and help grow the economy. Where girls can work and support themselves, the nation has fewer dependents, thus adding to its stability. The first step is to lower fertility rates, but for young people of both genders to join the workforce, they must be trained and jobs must exist. This is mainly a problem for girls in low-resource countries since about a quarter of them get pregnant and drop out of school. Roman Tesfaye, First Lady of Ethiopia, says to become a middle income nation, girls "need to be protected from unplanned pregnancies." Zewdtu Areda, who oversees health services in her area, sees significant progress. "You can see that things are changing now for women. I am a woman, and I am a leader here." doclink

    Art says: According to 2013 CIA World Factbook estimates, these three nations still have a long way to go. Ethiopia has 5.31 children per woman. Malawi has 5.26 children per woman, and Rwanda has 4.71 children per woman

    Why I Work on Family Planning and Reproductive Health: Reflections on World Population Day

    July 11, 2013, MSH - Management Sciences for Health   By: Fabio Castaño

    In the 1960s, during Columbia's demographic transition, Fabio's Castaño's father and mother came from large families and consequently never went to college, but instead had to work hard as teens to help their families. At that time Profamilia, a Columbian affiliate of International Planned Parenthood Federation (IPPF), was helping steer the country through successful demographic transition. Fabio's mother wanted an education for her children and convinced her husband that the best way out of poverty was hard work and having a small family.

    Out of their large extended family of 70-plus, Fabio was the first one to graduate from college and medical school. Fabio's two sisters also received an education. Fabio's story exemplifies how access to reproductive health and family planning in a low-income country can have tremendous economic and life-transforming impact for young people and a whole generation -- beyond the reduction in fertility and improvements in health.

    On July 11, World Population Day, we observed the one-year anniversary of the London Summit and the launch of the FP2020 initiative. The momentum for voluntary family planning and reproductive health is growing, However, globally more than 200 million females still have an unmet need. Many of them are adolescents.This unmet need leads to unintended pregnancies and unsafe abortions.

    This unmet need can be met through quality family planning and reproductive health (FP/RH) services. innovative public/private partnerships and high impact, evidence-based interventions, such as through integrating FP/RH with adolescent health and maternal, newborn, and child health services and HIV services, implementing community-based FP, encouraging healthy timing and spacing of pregnancy, and by ensuring contraceptive security.

    MSH - Management Sciences for Health - has over 40 years of experience in bolstering the capacity of local partners to dramatically expand community-based care, especially key maternal, neonatal, child health, adolescent, and family planning services. MSH has been actively engaged in helping end child marriage, such as through promoting equal access to health care for women and girls in more than 135 countries for over four decades.

    Choosing to have a small family-and having access to quality family planning services and information-can lead to a multitude of positive effects for people's health, education, and economic safety. doclink

    DKT International's Social Impact Entrepreneurs Are Transforming Family Planning

    April 25, 2013, Business Wire

    DKT uses social impact entrepreneurship as a tool to sell condoms and other contraceptives and provide reproductive health and family planning services, through innovative marketing and distribution channels, including the Internet, social media sites, midwives, clinics, drug and grocery stores. This approach differs greatly from traditional nonprofits by providing goods and services as normal commercial purchases that offer consumers a benefit at an affordable price.

    In its most recent fiscal year DKT's $130 million in total revenue was balanced by an equal amount spent on programs, with approximately 70% of program costs recovered through sales. The balance of revenue comes from donors, and DKT's revenue generating models greatly leverage donor funds. It's an entrepreneurial model that works. In 2012 DKT programs prevented an estimated 8.2 million unwanted pregnancies, 1.7 million abortions, and more than 14,000 maternal deaths.

    Christopher Purdy, Executive Vice President of DKT International says: "Our strategy depends on recruiting high performing people who are true social impact entrepreneurs. Many country directors have undergraduate or advanced business degrees, and some have served in corporate marketing or business capacities before joining us. They direct a field staff of 1,800 people and have wide autonomy to make decisions quickly."

    DKT International's use of social marketing for reproductive health products and services builds contraception and family planning demand through mass media and non-traditional messaging that reduce social stigma and target all socio-economic groups. Each country director runs his or her custom-tailored, culturally appropriate program designed to reach the maximum number of people in each market segment.

    "Our directors use new approaches in countries where tradition, religious restrictions, government censorship and politics complicate their task," Purdy added. "By providing people with an essential service that they value, and can afford, our country directors create real momentum for social change." doclink

    According to Wikipedia, DKT International is Washington, D.C.-based; was founded in 1989 by Phil Harvey and operates in Africa, Asia, and Latin America. In 2012, DKT sold over 600 million condoms, 76 million cycles of oral contraceptives, 16 million injectable contraceptives and 1.5 million intrauterine devices (IUDs). This is equivalent to 25 million couple years of protection (CYPs), making DKT one of the largest private providers of contraceptives in the developing world. The average cost per CYP was less than US$3.00. Charity Navigator has given DKT a four-star financial rating, with 98.3% of its budget going towards programs and 1.6% towards administration and fund raising in 2010.

    Why Family Planning Matters

    Population Information Program, Center for Communication Programs,John Hopkins


    Thailand: Thai Restaurant Offers Family Planning Advice with Meals

    December 20, 2012, Times of India

    Cabbages and Condoms Restaurant Years ago former politician and activist Mechai Viravaidya popularised condoms, family planning and AIDS awareness in Thailand and helped establish a restaurant called Cabbages and Condoms where condoms are distributed along with the bill. Eventually six such restaurants were established across the south east Asian country.

    Now the idea has been brought over to the UK with the new restaurant in Bicester, Oxfordshire, leading the way with all profits from merchandise sales donated to charitable causes in Thailand.

    Diners are given leaflets on protective sex at the end of the meal and even encouraged to buy condom-themed merchandise. The new restaurant even has the slogan 'and remember our food is guaranteed not to cause pregnancy.'

    The name of the eatery refers to the idea that people should buy condoms alongside everyday mundane items such as cabbages.

    Diners at the new restaurant will get the chance to sample traditional Thai food 'in a cosy atmosphere.' Later they are urged to buy unusual condom-themed merchandise such as mugs, keyrings and books and even a mascot made out of the contraceptive. doclink

    Karen Gaia says: I have eaten in the Bangkok Cabbages and Condoms. It is a very nice restaurant with a fun gift shop to browse. Thailand's fertility rate is 1.58 and it's population growth rate is 0.6% and still declining.

    Niger: Traditional Chiefs Sign Landmark Commitment

    November 26, 2012, Reproductive Health Supplies Coalition

    In a forum organized by UNFPA Niger, 80 traditional chiefs have signed a statement of commitment to raise awareness of the crucial inter-relationship between literacy, education and reproductive health. The high turnout included three influential Emirs of Niger - the Sultan of Zinder, the Sultan of Dosso, and the Sultan of Matame.

    The Declaration is committed to highlighting family planning, to all children receiving at least secondary school-level education, and to the need to end child marriage. It also recognizes the inter-relationship between demographic growth, development and poverty, and calls for boys and men to be involved in reproductive health issues, modelled on the "Husbands' School", a strategy to involve men in health promotion and foster change at community level. doclink

    In Morocco, More Modern Contraceptive Use Plays Key Role in Decreasing Maternal Deaths

    June 29, 2012, Population Reference Bureau blog

    In Morocco there has been a 60% decline in the numbers of women who die during pregnancy or childbirth and a rapid increase in modern contraceptive use by both rural and urban women and for relatively low levels of "unmet need" for family planning - defined as the share of women who wish to delay or avoid pregnancy but are not using contraception.

    Morocco's maternal death rate is now closer to the average for Central America (90 per 100,000) than the average for the North African region (270 per 100,000) or Africa as a whole (590 per 100,000).

    The share of married women ages 15 to 49 who want to postpone or avoid pregnancy was about 60% in 2004 and 80% by 2011, when 67% were using contraception.

    Farzaneh Roudi-Fahimi, Middle East and North Africa program director at the Population Reference Bureau said, "When a woman wants a smaller family and uses contraception effectively, she can have fewer pregnancies-reducing her lifetime risk of disability and death from complications during pregnancy and childbirth."

    The nation is poised to to be on track to achieve the United Nations Millennium Development Goal 5 - reducing maternal mortality by 75% between 1990 and 2015. Morocco has made safe motherhood a priority and invested in increased availability of voluntary family planning services, expanded and improved maternal health care, and ensured access to obstetric care (including Caesarian birth) in part by eliminating fees.

    The Moroccan government has been by focusing on household-based delivery of family planning services, making modern contraceptives available to low-income and rural women who would otherwise not have access to private-sector services.

    57% of Moroccan married women of reproductive age were using a modern contraceptive method in 2011, an increase from 36% since 1992. 10% were using traditional family planning methods, compared with about 6% in 1992.

    A 2011 PAPFAM survey found that Moroccan women were having 2.6 children on average in 2011. The change has been particularly dramatic among women living in rural areas, whose fertility declined from 6.6 births in 1980 to 3.2 births on average in 2011.

    Modern contraceptive use among married women in the poorest quintile rose from 18% to 55% - not far behind that of women in the richest quintile. Unmet need for family planning among the poorest women was cut by more than half during that time.

    The 2011 PAPFAM survey results also reflect dramatic increases in health care during pregnancy and childbirth, which research has linked to improved survival of both mothers and children. These changes are partly the result of policies that increased the number of trained midwives and removed the barriers that prevented rural women from accessing health care during pregnancy and delivery, including transportation.

    Between 1992 and 2011, the share of births delivered at home declined from 95 percent to 61 percent for women in the poorest fifth of the population and from 73 percent to 14 percent for women with incomes in the middle fifth.

    72% of women practicing family planning rely on the pill and 16 percent rely on traditional methods. Morocco's family planning program would benefit from expanding services to include more contraceptive choices, including condoms that prevent both pregnancy and HIV.

    Moroccan family planning and maternal health services tend to focus on the needs of married women and these programs should be expanded to serve unmarried couples who are sexually active. "The number of couples in such relationships is not high, but the fact that women in such relationships find it difficult to access family planning counseling and services puts their health and well-being in danger, particularly if they are young," Roudi-Fahimi said. doclink

    Democratic Republic of Congo and Madagascar Connect Family Planning with Environmental Health

    Population Reference Bureau

    Remote rural communities in developing countries typically face the related challenges of extreme poverty, poor health, and environmental degradation. And population growth often exacerbates these challenges. In communities that face environmental challenges along with high fertility and high maternal and child mortality, health programs that include family planing can have great benefits for the health and well-being of women and families, with positive influences on the local environment. Meeting the reproductive health needs of women and ensuring environmental sustainability by connecting family planning with environment programs has proven to be a "win-win" strategy. Yet this connection has often been seen as controversial or irrelevant to environmental policymaking.

    Developing countries, with their faster rates of population growth, are contributing a growing share of CO2 emissions, due to rapid deforestation which releases large amounts of carbon dioxide into the atmosphere.

    The UNDP says that developing countries face a double burden of being more vulnerable to wider environmental challenges such as climate change but also having to cope with immediate environmental problems such as resource depletion and poor water quality.

    Family planning is a response to an existing need, and it gives women autonomy and equity. A 2008 study found that unintended pregnancy accounts for up to 41% of all births worldwide and over 200 million women worldwide have an unmet need for family planning. Family planning is "the factor in population growth most amenable to program and policy interventions," according to the UNFPA.

    Researchers estimate that the demand for contraception will grow by 40% over the next 15 years. The context of family planning has shifted from population control decades ago to individual rights. And the impetus for programs is coming from local communities and developing countries.

    In Democratic Republic of Congo, the World Wildlife Fund, through partnerships with local nongovernmental organizations and the Ministry of Health in the Democratic Republic of Congo, is working to improve access to family planning in rural areas with existing conservation programs to give women more autonomy to limit their births and improve maternal and under-5 mortality.

    The family planning projects began with women reporting no access to family planning services in remote areas. The closest health center to either give birth or access other health services is up to 30 kilometers away and has few personnel, very limited equipment, and often no medicines. Because of this challenge, the programs focus on training community-based health workers who distribute contraceptives and provide guidance and counseling in rural villages. Public awareness campaigns, based on face-to-face dialogue, focuses on the benefits of family planning on women's health and income and how these benefits extend to children, families, and the entire community. Women with access to family planning services will know how to space births, have the time to recover from childbirth, and have the strength to work in their own businesses or in agriculture, leading to more income.

    Women also participate in land management training. With access to reproductive health, women are healthier to participate in conservation activities, decreasing the population pressure on the environment.

    Madagascar, off the coast of Eastern Africa, is home to 5% of global biodiversity and 80% of its flora and fauna are found nowhere else in the world. With a per capita GDP of only US$438, it is a "least developed country," . Its population of 21 million is projected to reach 29 million by 2025. Maternal mortality is extremely high, and only 29% of married women are using modern contraception.

    In a coastal area that depends on fishing, women average six to seven children each, the closest facility that provides reproductive health care is 50 kilometers away through a desert, and high fertility and unmet need for family planning is stressing the environment. The number of fishermen in some areas has almost tripled from 535 to 1,510 in 20 years. And in 2011, 60% of the fish caught were juveniles, a trend that points to unsustainable fishing practices.

    On the other hand, Blue Ventures, a UK-based marine conservation organization dedicated to conservation, education, and sustainable development in tropical coastal communities, started the Velondriake marine conservation program in a remote area on Madagascar to support sustainable resource use and in 2007, and opened regional family planning clinics serving 40 villages by 2011. The clinics focus on peer-led education campaigns, group discussions, educational films, and community events such as theater, sports, and cultural activities. The contraceptive prevalence has risen from under 10% in January 2007 to almost 35% by January 2011, and the fertility rate has fallen by about one-third since the start of the project. doclink

    Pathfinder Saves Lives

    November 24, 2011, Pathfinder

    Pathfinder tells the story of Georgette, a mother in the Democratic Republic of Congo had been pregnant 20 times and lost 7 of her babies to starvation. Then she met a Pathfinder-trained community health worker. Empowered with information about family planning, Georgette was finally able to make decisions about her body and her future. She told one of Pathfinder's staff, "family planning saved my life."

    In the first six months of 2011, Pathfinder was able to provide much-needed services through more than 9.4 million visits and contacts with Pathfinder-supported health providers.

    Pathfinder says: your generous support and continued involvement - whether by signing a petition, sharing a video, attending an event, or following us on Facebook - means a lot. doclink

    UN Meeting Calls for Secure Supply of Contraceptives in Developing Countries

    September 7, 2011, UN News Centre

    Representatives from 12 developing countries at a United Nations meeting declared today that voluntary family planning, secured by a steady supply of contraceptives, is a national priority for saving women's lives. The UN Population Fund (UNFPA) launched Global Programme to Enhance Reproductive Health Commodity Security in 2007 to support national efforts to ensure a reliable supply of reproductive health essentials. The 12 countries are: Burkina Faso, Haiti, Ethiopia, Laos, Mali, Madagascar, Mongolia, Mozambique, Nicaragua, Niger, Nigeria and Sierra Leone. They are the 'Stream One' countries in the Global Programme.

    More than 215 million women in developing countries want to avoid or space pregnancies but are not using modern methods of contraception, according to UNFPA.

    "As of 31 October, the world will have 7 billion people, of which 1.8 billion are young people, and 90% of them live in developing countries. That implies that 1 billion young women are actively seeking the information and service we are talking about here," UNFPA Executive Director Babatunde Osotimehin said in opening remarks to the meeting in New York.

    Participating countries have shown dramatic increases in the use of modern methods of contraception. In Niger, the contraceptive rate increased from 5% in 2006 to 21% in 2010. In Madagascar, it rose by 11% points from 2004 to 2009, up to 29.2%.

    Supplies are reaching more people in the right place at the right time. In Burkina Faso, the number of health clinics reporting no shortfalls or stock-outs increased from 29% in 2009 to 81% in 2010. In Nicaragua, the percentage of service delivery points offering at least three modern methods of contraception increased from 66.6% in 2008 to 99.5% in 2010. In Ethiopia, the increase was from 60%in 2006 to 98% last year.

    Dr. Osotimehin called on the 12 countries to put resources in their budget to meet the needs of their women and girls.

    The First Lady of Sierra Leone, Sia Nyama Koroma, noted that support through the programme has increased the uptake of family planning and other reproductive health programmes, such as fistula activities and the screening of patients for breast cancer.

    'Collectively, we are changing the face of maternal and child mortality in Sierra Leone,' she said. doclink

    Brazil's Girl Power: Machisma - How a Mix of Female Empowerment and Steamy Soap Operas Helped Bring Down Brazil's Fertility Rate and Stoke Its Vibrant Economy.

    August 23, 2011, National Geographic News

    Not counting the stillbirth, the 3 miscarriages, and the baby who lived less than 24 hours. Dona Maria had 16 pregnancies and said she should have more than a hundred grandchildren by now, but only had 26. Her son José Alberto Carvalho has been studying the Brazilian demographic phenomenon that lowered their fertility rate to 2.36 children per family to the national average of 1.9, which is below replacement level and lower than the U.S. fertility rate.

    Brazil is dominated by the Roman Catholic Church and no official government policy has ever promoted birth control. Abortion except for special circumstances is illegal there.

    The decline has occurred across every class and region of Brazil. Two children is typically the desired number. When a women is done having children, we might hear her say: "A fábrica está fechada," meaning the factory is closed.

    About half the world's population lives in countries where the fertility rates have dropped to below replacement rate, about two children per family. In most of the rest of the world they've rapidly fallen except for sub-Saharan Africa.

    Carvalho said "What took 120 years in England took 40 years here." Central to the reasons Brazil's fertility rate has dropped so far and so fast are tough, resilient women who set out a few decades back, without encouragement from the government and over the pronouncements of their bishops, to start shutting down the factories any way they could.

    Many women under 35 have already had sterilization surgery because pregnancy accidents happen too easily, pills make you fat or sick, and children are too expensive, too much work.

    Carvalho suggested a formula for quickly lowering a developing nation's fertility rate without official intervention from the government:

    1. Industrialize dramatically, urgently, and late; force the country into a new kind of economy, one that has concentrated work in the cities, where the housing is cramped, the favela streets are dangerous, babies look more like new expense burdens than like future useful farmhands, and the jobs women must take for their families' survival require leaving home for ten hours at a stretch.

    2. Make sure birth control is easily accessed: over-the-counter, without a doctor's prescription, if they can just come up with the money. Foster in these women a dismissive attitude toward the Catholic Church's position on artificial contraception.

    3. Improve infant and child mortality statistics so there is no longer the need to have extra for insurance. Add a pension program, so that a big family is not needed to support them when they grow old.

    4. Reward doctor for performing cesareans rather than waiting for natural deliveries and spread the word that a doctor who has already begun the surgery for a cesarean can probably be persuaded to throw in a discreet tubal ligation. Yes, the Catholic church would disapprove, but many women of faith felt in some matters the male clergy is perhaps not wholly equipped to discern the true will of God.

    5. Introduce electricity and television. Depict the modern Brazilian family as affluent, light skinned, and small in evening soap operas, or telenovelas. One study found that the spread of televisions outpaced access to education, which has greatly improved in Brazil. doclink

    Bangladesh: On Population and Policies

    July 19, 2011, The Financial Express

    by Abdul Bayes, Professor of Economics at Jahangirnagar University

    In the early days since Bangladesh's independence, the very high human to land ratio precluded any positive projection of socio-economic progress. But Bangladesh managed to thrive through thick and thin and, over time, population growth decelerated and food production accelerated to keep the country on an even keel. Thanks to the family planning movement and technological breakthrough in food production - two of the important advancements that Malthus possibly overlooked in delivering the doomsday thesis.

    The population of Bangladesh is estimated to be 142 - 150 million - roughly 20 million more than a decade ago and about double over 1974. The household size has shrunk to 4.4 compared to 5.5 in 1991. This could be due to migration and population control measures accompanied by growing awareness about small family size.

    Taking the census result at its face value, the population density in the country has increased to 964 people per square kilometre from 834 in 2001. The late Dr Mahabubul Huq's once said: if all the people of the world were accommodated in the USA, the population density there would not be as high as it is in Bangladesh. It is the third most populated country in Southeast Asia after India and Pakistan.

    Bangladesh's annual growth rate dropped from about 3.0% immediately after independence, to 2.3% in the 1980s, to 1.5% in the 1990s and now 1.34%. Still, every year about 2.0 million people are added to the total. The male-female gap has reduced. Now Bangladesh has 100.3 males against 100 females as compared to 106.4 males against 100 females in 2001. It may be due to preference for boys in South Asia. It is believed that boys will provide support to the parents in their old age.

    The population growth rate must be reduced further in the wake of dwindling cultivable land. An average Bangladeshi woman of child bearing age produces 2.15 children now as against 5.1 in 1981. The infant mortality rate has gone down from 111 per 1000 live births to 39 currently.

    The massive campaign against population expansion and for population control must firmly stand up shedding all sorts of complacency about declining growth rate. Fertility must be contained. Amartya Sen argues, when people "will know that, if they have a duty towards those who are not yet born, that duty is not to give them existence but to give them happiness".

    This type of reasoning buttressed by the expansion of education, especially female education would lead people to lower fertility rates and smaller families which people would choose voluntarily. Bangladesh has appreciably traveled through this process adopting the family planning movement and greater availability of knowledge and facilities that helped reduce the fertility rate from 5.1 in 1981 to 2.2 in 2009 to debunk the belief that people will not voluntarily adopt family planning in the less developed countries.

    At the end of the day, it is employment generation that raises opportunity costs of children and reduces family size. Another important area is health care facilities, particularly in rural areas. It is needed for income generation, to reduce infant mortality, and thus affect fertility choices. doclink

    Smart Planning for the Global Family

    April 12, 2011, Earth Policy Institute

    The United Nations has projected that world population will 9.2 billion by 2050. This is the middle projection, the most likely one. However, if fertility rates come down slower than expected, world population could reach 10.5 billion by 2050. If the goal is to eradicate poverty, hunger, and illiteracy, then we have little choice but to strive for the low projection of 8 billion (and peaking) by 2042, which assumes that the world will quickly move below replacement-level fertility.

    Slowing world population growth means ensuring that all women who want to plan their families have access to family planning information and services. 215 million women, 59% of whom live in sub-Saharan Africa and the Indian subcontinent do not have this access. These women, along with their families, represent about 1 billion of the world's poorest, for whom unintended pregnancies and unwanted births are an enormous burden.

    A former USAID official said that often "women live in fear of their next pregnancy. They just do not want to get pregnant." UNFPA and Guttmacher estimate that meeting the needs of these 215 million women who lack reproductive health care and effective contraception could each year prevent 53 million unwanted pregnancies, 24 million induced abortions, and 1.6 million infant deaths.

    A universal family planning and reproductive health program would cost an additional $21 billion in funding from industrial and developing countries. In Bangladesh analysts figures that it would cost the government $62 to prevent an unwanted birth and save $615 in expenditures on other social services.

    When countries move to smaller families, growth in the number of young dependents - those who need nurturing and educating - declines relative to the number of working adults. Removing the financial burden of large families allows more people to escape from poverty. At the national level, the demographic bonus causes savings and investment to climb, productivity to surge, and economic growth to accelerate.

    Japan, South Korea, Taiwan, China, Thailand, and Viet Nam have been helped by earlier sharp reductions in birth rates. Although this effect lasts for only a few decades, it is usually enough to launch a country into the modern era. No developing country (except for some oil-rich countries) has successfully modernized without slowing population growth.

    Many developing countries in Asia, Africa, and Latin America were successful in quickly reducing their fertility within a generation or so after public health and medical gains lowered their mortality rates. But others - including Afghanistan, Ethiopia, Iraq, Nigeria, Pakistan, and Yemen did not follow this path and have been trapped in the demographic cycle of poverty (Large families are a greater financial burden on both parents and governments, and more impoverished people and societies tend to produce larger families.) These countries face the compounding of 3% growth per year or 20-fold per century. Limited land and water resources are strained. With large "youth bulges" outrunning job creation, the growing number of unemployed young men increases the risk of conflict. This also raises the odds of becoming a failing state.

    Governments can help couples reduce family size very quickly when they commit to doing so. In just one decade Iran dropped its near-record population growth rate to one of the lowest in the developing world. Iran's success story involves: government's desire to lower population growth, raising public awareness through television, outreach to rural populations, health clinics, access to an array of birth control methods, female literacy and school enrollment. doclink

    India: Arunachal Pradesh: Govt Slashes Family Planning Incentive by Rs 300

    March 16, 2011, Times of India

    The incentive given to women for undergoing a family planning procedure has now been reduced from Rs 880 to Rs 580 now.

    State health authorities said that the government's `population stabilisation policy' will now focus on sustaining the current fertility rate at 1.8 children per woman. "After having met the targets, the government's efforts are now directed towards infant and maternal mortality reduction.

    The cash incentive for vasectomy (male sterilisation), however, remains unchanged at Rs 1,100. The considerably higher incentive for men, authorities said, has been left untouched to encourage more men to undergo the procedure, which accounts for only 4% of the total family planning procedures. Tubectomies account for 96%. doclink

    South American Transition to Low Fertility Spreads to Paraguay

    Population Reference Bureau

    Paraguay does not seem a likely candidate for rapid fertility decline: The population is poorer, more rural, and has lower educational levels than its neighboring countries. A large percentage of the population speaks Guarani, an indigenous language, rather than Spanish, the official language. Yet Paraguay recorded a remarkable increase in contraceptive use and a sharp decline in fertility over the past decade.

    Paraguay's fertility transition through 2004 documented a fall in the total fertility rate (TFR), from 4.3 in 1998 to 2.9 in the 2001-2004 period, and suggested continued decline because younger women said they wanted fewer children. A new survey shows the TFR down to 2.5 children per woman by 2008, a faster decline than projected. The percentage of married women ages 15 to 44 using contraception increased from 57% to 79% between 1998 and 2008.

    There is a wide gap in TFRs between the more modern and educated populations and the more traditional population groups. The TFR was down to 2.2 children per woman among urban residents, while it was still 3.0 among rural residents in 2002. Similarly, Spanish- speaking women averaged just 2.2 children, compared with 3.3 among Guarani- speaking Paraguayans. The most dramatic differences were by education: Women with less than five years of education averaged 3.6 children, while those with at least 12 years of education averaged just 2.0 children.

    Paraguay has seen improvements in the education of girls in recent decades. Enrollment in elementary school is nearly universal, and data from UNESCO show the percentage enrolled in secondary school rising from 59% to 68% between 1999 and 2002, the most recent year statistics are available. This is well below the regional average of 92%, but a marked improvement in just a few years.

    Recent increases in the education of women have been tied to greater contraceptive use up through 2004. The 2008 survey shows that acceptance of contraceptive use has spread among all education levels. Even among women with less than three years of formal education, 72% used a contraceptive in 2008, compared with just 36% in 1998. The gap in contraceptive use between urban and rural women disappeared by 2008. While there are still clear rural and education differences in actual childbearing, it seems likely that those differences will abate further in coming years. doclink

    Karen Gaia says: Let's hope that sufficient women's advancement has taken place to ensure that female babies are valued as much as male babies, otherwise the TFR will hover around 3 children rather than at replacement level.

    Strange but True: How Soap Operas Might Save Us From Overpopulation


    Daniela Perdomo interviews Bill Ryerson of Population Media Center (PMC).

    Human capacity was exceeded in the 1980s, bringing the planet into crisis. Global warming, food and water crises, even international conflict, can be traced to overpopulation. Natural resources are being consumed at a rate much higher than they can be replenished. Now at over 6.8 billion people in the world, we're expected to number 9 billion by 2050.

    Bill Ryerson is using media to change behaviors that contribute to global overpopulation by using melodramatic soap operas on radio and television throughout the developing world (and soon, the U.S.) to teach listeners and viewers important lessons about family planning, reproductive health, HIV/AIDS and environmental preservation, and women's and children's rights.

    Africa has the least media coverage, particularly with television. In Ethiopia over half have radios and listen to them on a regular basis. So it's a majority of the world's population that has access to broadcasting. Latin America and in Asia, television reaches almost everybody. 90% of the Vietnam population watches TV. In Pakistan maybe two-thirds of the population watches TV on a regular basis.

    Population Media Center uses the Sabido method, which used the Latin American version of soap operas, called telenovelas, or television novels. These are quite different from American soap operas because they are much shorter. They are the dominant prime-time format in Latin America and they are popular and engrossing. They are also melodramatic -- depicting the battle of good versus evil.

    Miguel Sabido was a vice president of Mexico's largest commercial network, Televisa. He began looking at ways in which he could use the telenovela to provide audiences with information that would improve their lives. Using research and theory from psychologists, the creation of serialized melodramas that has proven over and over again to be highly influential in changing social norms on all kinds of issues.

    Stanford psychologist Alfred Bandura is the world's authority on role modeling and how role models influence behavior and what makes a parent or a peer or a celebrity influence the people who are observing them. Using role models, the telenovela teaches self-efficacy, the confidence in the ability to accomplish some task.

    Where girls are denied education and are married off at puberty to older men in polygamous relationships and are not given the right to determine how many children to have and so on, changing the attitudes and behavior of the men as well as the women can be done through this strategy.

    Characters are created who start out in the middle of the road and sort through the conflicting advice they get from the positive and the negative characters and figure out who is right, and they evolve into positive role models for the audience. The negative characters always suffer the consequences of their behavior.

    The Sabido method is now in 24 countries around the world. In Brazil, a program called "Páginas da Vida," "Pages of Life,"contained a teenage pregnancy and parenthood storyline. This program influenced thirty-six% of the women clients of the family planning clinics to come because of that program. These women did not want to fall into the trap and the poverty and all the health problems that this teenage mother had fallen into. So they learned from that and they went to family planning. As a result of this program here was a 153% increase in condom distribution.

    In Tanzania a radio serial depicted an alcoholic truck driver with a girlfriend at every truck stop and a subservient wife waiting at home. His wife figured him out during the serial and told him she had heard about the AIDS epidemic and said that when he was home he was going to have to use condoms. She went on to become an entrepreneur and founded her own business, and she became a role model for female empowerment.

    The truck driver became sick. 58% of the adult population heard this program, with more men in the audience than women, and they found out the truck driver had made a fatal mistake. Originally the men identified with the truck driver because he was having a good time, but then he started dying from AIDS. 82% of the audience in a survey after the two years said they had changed their behavior to avoid HIV infection. Most of them reduced the number of sexual partners. The second most common change was condom use.

    Ryerson said: "This is the most cost-effective approach that I have found anywhere in the world." In the Tanzania project, the cost per person who adopted family planning was 32 cents. The cost per person to change behavior to avoid HIV infection was 8 cents. When you can save lives at 8 cents a person, it is worth doing something.

    In Sudan, PMC developed a program where the major emphasis was on female genital mutilation. Before the program, 28% of the adult population thought FGM was a bad idea. After the broadcast, 65% of the population thought the practice should be abandoned.

    The Global Footprint Network have determined is our ecological footprint is 40% over what is sustainable. We are taking resources out of the bank and not replacing them. Water is one of the key resources: India, China and the United States are the top grain-producing countries, all three using underground fresh water aquifers for irrigation, as well as using river water for irrigation.

    India, for example, is pumping out the water at twice the rate of replacement by rain water, and the water table is sinking by 10 feet a year. Large areas of farmland in India are turning into desert. With the melting of the glaciers in the Himalayas, the regular flow of the rivers in India and China are also threatened.

    Cheap oil is a key element in fertilizers and pesticides and in planting, harvesting, transportation to market, refrigeration, packaging, distribution to supermarkets and taking it home and serving it, but oil reached an all-time peak two years ago. The price of grain and of both rice and wheat tripled and quadrupled on the world market, and there were food riots all over the developing world. When production of oil goes into decline in the face of expanding demand, the price of oil is going to go way up. The billion people living on a dollar or less a day may not be able to buy enough food to survive.

    We have gotten all the easy oil there is to get. Now we are drilling 5,000 feet below the surface of the ocean, high-risk operations trying to get the last bits of oil. The increase from one billion to almost seven billion people on the planet has occurred since the discovery of oil. Terrorism is partly a population-related issue. In high-population growth countries people are spending all of their money on food, housing and clothing. They have nothing left over to save. That means there is no capital formation. That means businesses can't expand. Therefore, there is no growth in employment. So you have a rapid growth in the number of people trying to enter the labor force and no jobs.

    In urban centers like Karachi and Islamabad hundreds and thousands of unemployed men walking around angry and very concerned as to how they are going to survive.They are great prospects for recruiting into terrorism because they have nothing to lose.

    PMC is planning a project available online to serve the Hispanic population in the U.S. to address the issues of teenage pregnancy prevention and obesity prevention among Latino populations. doclink

    India: A Reproductive Health Communication Model That Helps Improve Young Women's Reproductive Life and Reduce Population Growth

    June 10, 2010,

    Implementation of a reproductive health communication model called PRACHAR could result in 64 million fewer people being added to the population of India. PRACHAR is a reproductive health communication model found to be successful in delaying age at marriage and onset of childbearing, increasing contraceptive use for spacing of pregnancies, and generating the most positive impact on contraceptive use among the socioeconomically least advantaged. The model was developed and tested in rural Bihar, India.

    Visit to see the report on the impact of implementing the model in the reproductive health and family planning programs in Bihar and Uttar Pradesh. doclink

    The Drum Beat 499 - Addressing Population Growth

    Drum Beat

    This news article evaluates the use of televised soap operas to shift attitudes, transform social mores, and shape behaviour around family planning in Brazil.

    It describes a study of population data stretching back to 1971 which revealed that "Brazil's popular and often fanciful soap operas have had a direct impact on the nation's divorce and birth rates, as the main channel that broadcast them extended its reach across the country." According to the report, the rate of marriage break-up rose and the number of children born to each woman fell more quickly in areas receiving the TV Globo signal for the first time. Women living in areas covered by the Globo signal were found to have "significantly lower fertility.

    Ruwan Dare (Midnight Rain) is a two-year radio serial drama being produced by Population Media Center (PMC) in Nigeria. The drama aims to enhance knowledge and use of existing health services, provide information about reproductive and general health issues, encourage family planning, and promote delaying marriage and childbearing until adulthood. It also aims to promote small family norms, provide information about HIV transmission, and motivate people to take actions to improve their health and the health of their families.

    The production of Ruwan Dare is based on the Sabido methodology, an entertainment- education technique which uses long-running serialised dramas, written and produced in participating countries in local languages.

    One report explores the last 40 years of contributions that contraceptive social marketing (CSM) has made throughout in Afghanistan, Bangladesh, India, Indonesia, Nepal, Pakistan, Sri Lanka, and Yemen. For example, a project centred around an open-air soap opera designed to teach women how to space births using the oral contraceptive pill. Approximately 200 people watch an outdoor soap opera in which a young mother quarrels with her husband and mother-in-law about whether to use contraceptives. Then a character playing a doctor enters and explains the truth about the pill.

    The Tanzania Marketing and Communication (T-MARC) Project produced a radio serial drama on reproductive health called Mama Ushauri. Every 6 to 10 episodes, there is a 10-minute "question and answer" show to allow listeners to ask questions about family planning. Each storyline focuses on women in different phases of their reproductive lives.

    Umurage Urukwiye is a Rwandan serial radio drama initiated by the Population Media Center.The drama is designed to raise awareness and discussion about issues such as reproductive health, HIV/AIDS, wildlife habitat and natural resource preservation, land conservation, and the promotion of civil harmony. This serial drama also uses the Sabido methodology, where audiences learn from the decisions of familiar, identifiable characters and the consequences they face because of their actions.

    A behaviour change communication (BCC) intervention, carried out by the PRISM project of Johns Hopkins Bloomberg School of Public Health Center for Communications Programs, began with advocacy interventions to build support among religious leaders for family planning (FP). Those religious leaders who believed Islam supports the use of FP for child spacing increased from 55% at baseline to 94% at follow-up.

    A 2005 evaluation report shares information from three case studies undertaken in countries that were identified as having been successful in increasing contraceptive use and lowering fertility - Ghana, Malawi, and Zambia. The research found that family planning programmes in these three countries were successful not just through supply side interventions, but also through effective and innovative efforts on the demand side, including both working with the communities and bringing services closer to rural populations.

    Key messages including radio jingles, posters, dramas, health talks, and community-based distribution activities were developed in consultation with the community to ensure that they were appropriate and meaningful.

    One case study describes how Population Services International (PSI) set up and managed a "hotline" in the Democratic Republic of Congo (DRC). It explores the lessons learned that may point to the use of cell phone technology as a powerful new tool for health education. Because a woman in DRC is 3 times more likely to adopt a modern method of family planning if she has a conversation with a knowledgeable person, the FPP launched la Ligne Verte, on which, by dialling a toll- free number, callers can get accurate information about birth spacing, the correct use of family planning methods, how to avoid unwanted pregnancy, and the location of the nearest Association de Sant Familiale (ASF) partner clinic.

    A 2-year project was designed to address the large population of married Nepalese adolescents with unmet needs for reproductive health information and services. It established a peer education network to disseminate reproductive health information to married couples; supported local health facilities to provide youth- friendly services; and fostered an enabling environment among parents, in-laws, and influential community members to increase married adolescents' access to, and use of, health services. The percentage of female respondents who thought there were benefits to delaying childbearing increased from 90% to 99%; for male respondents, the figure rose from 93% to 96%. 83% of female respondents and 71% of male respondents believed that the ideal age of motherhood was over 20, up from 50% and 53%, respectively.

    The 2-year Extra Mile Initiative (EMI), initiative, 2005-2007, in Madagascar, was designed to address spiraling tensions between environmental degradation, economic stagnation, and overpopulation - which led the government of that country to reverse its pronatalist stance and make family planning (FP) and health, one of 8 pillars of its development action plan. The project's name indicates the effort to reach - by motorcycle, canoe and, mostly, on foot - 6 remote communes that border conservation zones, where ecological resources are under pressure from a growing population. EMI trained commune health centre staff to use Cycle Beads (a tool to help those using the calendar or Standard Days method) and to organise and implement FP education and service provision in the communes. EMI guided a system of citizen volunteers in providing their own villages with information, and, in the case of Community Health Agents (CHAs), contraceptives, and provided Social Development Committees (SDCs) with basic information on FP and maternal/child health, capacity-building management and oversight actions, and tools for ensuring good governance through, by example, communicating responsibilities related to gender and human rights issues.

    A paper on the Contraceptive Use Among Married Couples in Bihar, India - from the December 2008 International Family Planning Perspectives - explores the impact of a Pathfinder International/India programme, the Promoting Change in Reproductive Behavior in Bihar (PRACHAR) Project, which aimed to promote contraceptive use for delaying and spacing births by involving the whole community.

    A favourable social environment was created through the orientation and training of reproductive health teams of community leaders and influential residents, and through group meetings with young couples' parents and in-laws; messages were disseminated through street theatre performances and wall paintings; and formal and informal rural health service providers were trained on reproductive health issues and contraception.

    In addition, unmarried adolescents received information through a 3-day workshop, and newlywed couples via infotainment parties; group meetings and at-home individual counselling sessions were held for young married women and, separately, young married men. Evaluators assert that the PRACHAR model is replicable throughout Bihar and has relevance in other contexts.

    The C-Change Picks website and e-magazine both feature selections of projects, resources, and events and meetings included on The CI website that have been highlighted by the C-Change programme. Funded by USAID, C-Change works with global, regional, and local partners to apply behaviour change and social change communication approaches in the health sector - HIV and AIDS, family planning and reproductive health, malaria, and primary health care - and is expanding to the environmental sector.

    Population Reference Bureau's World Population Data Sheet contains the latest population estimates, projections, and other key indicators for 200 countries, including births, deaths, natural increase, infant mortality, total fertility, life expectancy, urban population, contraceptive use, HIV/AIDS infection, land area, and population per square mile.

    The ECP Handbook provides comprehensive guidance to help managers of integrated reproductive health programmes, health care directors, and policymakers introduce emergency contraceptive pills (ECPs) within local and national family planning programmes.

    Operations research has demonstrated the feasibility and acceptability of ECPs as a way of preventing unintended pregnancy following unprotected sex or failure of an existing contraceptive method. The handbook presents a step- by-step process for introducing ECPs that can be adapted to each country's needs and resources. In addition, the handbook discusses ways to address the needs of specific segments of the population, including special groups, such as adolescents and rape survivors.

    Since September 1945, the Population Reference Bureau (PRB) has published a quarterly bulletin in hard-copy and electronic format that covers subjects related to domestic and international population research. Each Bulletin treats a specific topic - ranging from immigration to world health to gender. Issues are distributed to members of the PRB and include graphs and tables, references, and suggested resources.

    This electronic archive constitutes the legacy of the ACQUIRE Project - Access, Quality, and Use in Reproductive Health (2003-2008). ACQUIRE 's goal was to increase the use of reproductive health/family planning services, with a focus on facility-based services and clinical contraception, especially long-acting and permanent methods of contraception (LAPMs). The archive has been designed as a searchable knowledge resource for the RH/FP community.

    This 2007 Population Reference Bureau publication provides data and background information on the connections between population, health, and the environment in Central America. The guide provides key data and information as well as story ideas and information sources. Topics covered include the Millennium Development Goals (MDGs), pollution, human health, economic development, loss of natural resources, food production, natural hazards, and risks to vulnerable groups such as the economically poor, elderly, and women.

    This 2008 manual outlines an approach that integrates health and voluntary family planning into conservation projects, developing synergies that improve the health of both people and ecosystems. The approach, called the population-health-environment (PHE) approach, involves conservation organisations partnering with the health sector. According to the manual, taking advantage of synergies between human and ecosystem health can improve maternal and child health; enable couples to have the number of children they want, when they want them; reduce unsustainable pressures on the environment; promote sustainable ecosystem services such as reliable water supplies; and often improve community food security and livelihoods. The manual draws on the experiences, successes, and lessons from the last five years of PHE work in World Wildlife Fund/ Worldwide Fund for Nature (WWF) and other organisations.

    This 2008 United States Agency for International Development (USAID) Health Policy Initiative document describes progress in achieving the goals of the Uttar Pradesh (UP) Population Policy adopted in 2000. It includes the implications of alternative fertility and mortality trends during the next decade, and strategies and programme initiatives recommended by national and state policymakers and other experts. Following a project analysis, recommendations were presented in December of 2007 at the Lucknow, UP, India, roundtable as strategies for new initiatives in UP's Reproductive and Child Health Program to help move the state closer to the goal of population stabilisation.

    This advocacy brief, published in 2008 by the ACQUIRE Project, answers key questions about long-acting and/or permanent family planning methods, which include intrauterine devices (IUDs or IUCDs), implants, female sterilisation, and vasectomy. Written in a question-and- answer format, the brief is designed for policy and reproductive health decision-makers such as health ministers, but is written in a way designed to be accessible to anyone within the reproductive health sector. The brief gives a short overview of family planning in Southern Africa, emphasising the existing unmet need for family planning programmes and methods that are effective. doclink

    Moving to a Stable World Population

    January 21, 2008, Earth Policy Institute

    Some 43 countries have populations that are stable or declining slowly. A large group of countries has reduced fertility to the replacement level or just below. They are headed for population stability after young people move through their reproductive years. Included in this group are China and the United States. A third group is projected to more than double their populations by 2050. UN projections show growth under three assumptions about fertility levels. The medium projection has world population reaching 9.2 billion by 2050. The high one 10.8 billion. The low projection, which assumes fertility to 1.6 children has population peaking at just under 8 billion in 2041 and then declining. If the goal is to eradicate poverty, hunger, and illiteracy, we have little choice but to strive for the lower projection.

    This means that all women should have access to family planning services. At present 201 million couples cannot obtain the services they need. Filling the family planning gap may be the most urgent item on the global agenda. The good news is that countries that want to reduce family size can do so quickly.

    In one decade Iran dropped its population growth to one of the lowest in the developing world. It's annual population growth peaked at 4.2% in the early 1980s. As this growth began to burden the economy and the environment, the country's leaders realized that overcrowding, environmental degradation, and unemployment were undermining Iran's future.

    In 1989 the government restored its family planning program. The resources of education, culture, and health were mobilized to encourage smaller families. Some 15,000 clinics were established to provide rural populations with health and family planning services.

    Religious leaders were directly involved in appealing for smaller families. Iran introduced male sterilization, contraceptives such as the pill and sterilization, were free of charge. Iran became the only country to require couples to take a class on modern contraception before receiving a marriage license.

    In addition a broad-based effort was launched to raise female literacy, from 25% in 1970 to more than 70% in 2000. Female school enrollment increased from 60 to 90%. Television was used to disseminate information on family planning. As a result of this initiative, family size in Iran dropped from seven children to fewer than three. From 1987 to 1994, Iran cut its population growth rate to 1.3% in 2006, slightly higher than in the US.

    Soap operas on radio and television can quickly change attitudes about reproductive health, gender equity, family size, and environmental protection. It costs relatively little and can proceed while formal educational systems are being expanded.

    The U.S.-based Population Media Center has initiated projects in some 15 countries. Their radio dramas in Ethiopia, address issues such as HIV/AIDS, family planning, and the education of girls. A survey in 2004 found that 63% of clients seeking reproductive health care at 48 service centers reported listening to one of the dramas. Demand for contraceptives increased 157%.

    For Bangladesh, $62 spent by the government to prevent an unwanted birth saved $615 on other social services.

    When countries move quickly to smaller families, productivity surges, savings and investment climb, and economic growth accelerates. This lasts for only a few decades, but it is usually enough to launch a country into the modern era. Meeting the needs of the 201 million women who do not have access to effective contraception could each year prevent 52 million unwanted pregnancies, 22 million induced abortions, and 1.4 million infant deaths. doclink

    How Many Chinese Are Enough?

    October 25, 2007, New Zealand Herald

    Because China has worked hard over the last 30 years, we have 400 million fewer people. In the eyes of supporters, that justifies the infringements on people's freedoms. The end justifies the means, doesn't it?

    Not having more than two billion people in 20 years time is a desirable outcome for China. There is a limit to how many people China can support. But did the regime have to impose such a draconian birth-control policy?

    The Chinese government's "soft" birth-control policy, encouraging later marriage, fewer births and longer birth intervals - brought the fertility rate down from 5.7 in 1970 to 2.9 by 1979. And it happened before the one-child policy was introduced.

    Critics point to the Indian experience, where an early experiment with enforced birth-control measures created a backlash and yet, India's birth rate has also fallen to only 2.8 this year.

    The transition from high birth rate, high death rate societies to longer-lived communities works its magic eventually. But it does take its time.

    Compulsion does make a difference. By 1980 China's fertility rate was already down without compulsion to the rate that prevails in India today. With compulsion, it has fallen to little more than half the current Indian fertility rate. So China's population will level off at about 1.4 billion by 2020, while India's will go on growing to at least 1.7 billion.

    If China had taken India's approach, its population would probably reach two billion before it stopped growing. That could easily be the margin between success and disaster.

    China's economic miracle skates along the edge of environmental calamity. Breathing the air in Beijing is the equivalent of smoking 20 cigarettes every day. Dozens of cities are experiencing severe water shortages. It's bad enough but what would it have been like without the one-child policy?

    In large parts of the world, it is not acceptable to suggest that the number of people can be a problem. Population control is absent, for example, from discussions about how to minimise climate change. It's partly out of concern for the religious sensibilities, and partly because of the human rights issues.

    In addition there are demographic implications. The shrinking number of people in the working-age population who have to provide for an aged population. Another is a wave of selective abortions and female infanticide. In China girls are in such short supply that by 2010 there will be 37 million young Chinese men with no prospect of a wife.

    Almost two-thirds of Chinese families have only one child. And the Government is determined to retain the policy and intends to bring the population down whatever the collateral social damage.

    China is well beyond its long-term "carrying capacity" even with its present population. There are things worse than a one-child policy such as social disintegration and civil war. doclink

    India: Let Men Do Their Bit

    October 23, 2007, The Pioneer

    For 30 years, vasectomy has been taboo, and the burden of family planning has been on women. But modern vasectomy techniques are a success in the West. India needs to try them.

    India's most populous State, Uttar Pradesh, will account for 22% of India's population by 2026. Fertility rates here destined to take decades to reach replacement levels. Andhra Pradesh, Karnataka, Kerala and Tamil Nadu are forecast to jointly account for only 13% of the population increase during the same period.

    Currently, 42% of India's population produces three or more children. Of 188 million couples requiring contraceptive coverage, only 53% cent are using contraceptives. The percentage of women having more than three children is 57% in Uttar Pradesh, 54% in Bihar and 49% in Madhya Pradesh. Almost half the girls there are under 18 at marriage.

    There is urgent need to push up the age of marriage, delay the birth of the first child and widen the scope for spacing and limiting families. Vasectomy is a feasible way.

    Unfortunately, any efforts to limit population are attacked by critics as an invasion of "human rights". Given the culture of the northern States, such goals are dumped as "unacceptable" and "impossible" and invariably shunned by many politicians.

    The Millennium Development Goals do not envision family planning as the route to improving maternal and child health. This acts as a deterrent to organisations getting involved overtly.

    Concentration on maternal and child health services has excluded men. Counselling on vasectomy is just not their business. In India, men have ceased to be the object of family planning ever since eight million male sterilisations were conducted coercively and haphazardly during the draconian Emergency period.

    Even now horror stories of three decades gone by give shudders to politicians, especially in the Hindi belt. With no other terminal option available, millions of women have perforce to undergo tubal ligations having already borne the brunt of unwanted pregnancies and induced abortions.

    The recent resurrection of the vasectomy programme comes as a welcome surprise. Madhya Pradesh has doubled vasectomies in the span of just one year from 7,000 to over 15,000. Haryana has shown higher and higher performance each passing year. Punjab has quadrupled the number of vasectomies in a matter of one year. Rajasthan has upped the vasectomy performance from just 1,700 during 2003-04 by almost five-times.

    On October 6, in Vadodara, nearly 900 vasectomies were performed and hundreds of men had come willingly for this outpatient procedure.

    At every health facility, ANMs and village women togged up in their best attire escorted the "acceptors" for vasectomy. Surgeries progressed speedily and while the patients waiting their turn, paranthas, enthusiastic counselling and a bag full of condoms were kept in readiness to complete the day's work.

    Whether the carrot was the Rs 200 motivation money or the Rs 1,000 compensation for acceptors, an enormous response was evident. But India's annual vasectomy total remains less than a 10th of the pre-Emergency levels, despite hundreds of surgeons having acquired the Chinese non-scalpel skill.

    In India, vasectomies are treated as the poor man's option. In some Latin American countries vasectomy has been presented as an alternative to female sterilisation. What is needed is for decision-makers to stop worrying about resurrecting the ghost of 1975 and understand that our population growth is having a detrimental effect on maternal and infant mortality. doclink

    Senegal: What the Rest of Africa Could Learn About AIDS

    April 23, 2007, Chicago Tribune

    The HIV infection rate in Senegal is 0.9%, lower than in African countries such as Namibia (19.6%), South Africa (18.8%) and Botswana (24.1%).

    What is Senegal doing right? The Senegalese government has taken an active role in the sex education of its citizens. In 1986, the government launched a massive prevention program, pouring resources into AIDS education.

    The Senegalese brand of Islam dictates there is little opportunity for teenagers to be alone together. The lack of alcohol plays a role in disease prevention. Senegal's sex worker registration system, in place since 1969, provides prostitutes with weekly health care and free condoms, 100% of sex workers surveyed said they use condoms with every customer.

    But there are other reasons for the country's low AIDS rate, including the early and intensive efforts by the country's powerful imams to educate their congregations about AIDS. While imams limit their sermons to discussions of abstinence and fidelity, doctors are often on hand to handle practical instruction and clinical questions.

    Teaching people to use condoms is a contradiction of Islamic law. The imam teaches fidelity in marriage and abstinence before marriage. Outside the mosque, he said, he can discuss HIV and AIDS more directly and, like many Senegalese imams, he refers congregants to a local clinic or doctor.

    Imams enjoy enormous political and cultural power in Senegal. Senegal's anti-AIDS strategy provides a blueprint for other countries struggling to contain the spread of the disease.

    Another of Senegal's successful HIV/AIDS prevention techniques is frank, open and comprehensive sex education beginning at age 12, and AIDS awareness training starting as early as 1st grade.

    It provides peer counselors to students and sponsors family life education clubs in schools. Senegalese girls have delayed sex three years longer than their mothers' generation, and condom use has risen threefold from 10 years ago, to nearly 70%.

    Comprehensive sex education, including information about condoms and how to use them, is one of the most important weapons in the fight against AIDS.

    In Senegal and in Uganda, where the HIV rate has fallen to about 6%, the governments were quick to implement "Abstinence, Be Faithful and Use Condoms", approach. Senegal's policy of legalized prostitution means the country is ineligible for PEPFAR funding, so it relies on donations from the UNFPA and the Global Fund. That means Senegal's teachers and community leaders are free to discuss condom use as part of a larger prevention message. doclink

    Jamaica: Women Having Less Children, Owning More Businesses

    August 14, 2007, Jamaica Observer

    Once you educate and liberate your women, everything else takes off, and in several decades we have seen a dramatic increase in women opting to have careers, getting educated, and becoming liberated.

    Women are having one or two children, and later, due largely to Jamaica's family planning programme.

    The total fertility rate has fallen, reaching 2.5 children per woman in 2002. In 1997, the fertility rate stood at 2.8 children per woman. This number continued to decline to 2.21 in 2001, 2.05 in 2002, 1.99 in 2003 and 1.93 in 2004.

    20% of female-run businesses have been in existence for over 20 years, 57% are sole proprietorships or partnerships, 76% operate from well-defined business plans and 34% are college or university-educated.

    The Bureau of Women's Affairs monitors government policy on women. The Association of Women's Organisations of Jamaica (AWOJA) co-ordinates women's organisations islandwide. Women's Crisis Centres help those in dire straits. The Women's Political Caucus facilitates participation in politics. The Women's Construction Collective trains women in construction. Woman Inc runs a crisis centre and shelter. doclink

    Family Planning Helps Kon Tum Village Thrive

    September 26, 2007, Vietnam News Agency

    Kontum Ko Pang Village has 217 households with more than 1,000 people, most ethnic minorities. In the past, more than half of the families had between five and six children, and many suffered poverty. But recently, most young couples have one or two children. The village has about 60 young couples, and only three of them have more than two children. The others have used modern contraceptive methods, obeying the regulations of the village.

    This is due to the effort of the village's people who want to build a better life, for themselves and for their children.

    Every Monday the head of the village takes a few minutes to tell stories about family planning, effective contraceptives and the harms of having too many children. Collaborators visit each family to encourage newly married husbands and wives to use proper contraceptives.

    Y Lim is one of the women in the village praised for her family planning practise. She got married at 21, but didn't have her first child for another three years. She waited until they had a stable income. Now she has two children who are well-behaved and excel at their studies.

    They have been able to afford adequate accommodations and two family motorbikes. Y Lim is attending classes to improve her business skills.

    Y Lim's family is one of many in the village practising modern birth-control methods, ensuring that the children have a brighter future. doclink

    Fertility Rate Dips in Pakistan, Contraceptive Awareness Rises

    October 2, 2007, Indian Muslims website

    The fertility rate among women in Pakistan has dipped from 5.6% in 1990-91 to 4.1% in 2004-06, attributed to rising use of contraceptives. The trend is more in Punjab than other provinces.

    Women bear the brunt of controlling childbirth. Half of married women use contraceptives and few know about the use of condoms by males. Female sterilisation is on the rise and 84% children are breastfed in the first year of birth.

    The study was done by the research arm of the Population Welfare ministry, funded by USAID, to collect reliable estimates on pregnant women and family planning usage.

    The last such survey was done in 1990-91. doclink

    Family Planning Success Stories in Sub-Saharan Africa

    August 20, 2007, The Info Project

    Malawi, Zambia, and Ghana, with limited resources, have seen growth in contraceptive use and fertility decline, despite poverty and illiteracy in a predominately rural population. In Malawi, agencies worked through the Ministry of Health. Dedicated individuals maintain motivation and sustain programs. Research can lead to large-scale programs if there is involvement of stakeholders and if it is followed by action to implement recommendations. Improving the logistics for contraceptives is key to strengthening family planning. Mobilization of partnerships with the private and civil sector society can be an effective complement to the system. Bringing services to the doorstep via outreach is an effective way to get services to hard-to-reach, populations, but needs to be widespread. This is important for people living in rural areas. Community-based distributors (CBD) also raise awareness of family planning and refer women for services. The introduction of a range of methods into family planning has raised contraceptive use. Behavior Change is a necessary part of holistic programming; neglecting it will diminish program impact. Exposure to radio and TV was associated with increased contraceptive use in Zambia. Training must build clinical and counseling skills and also address biases. Clinical Officers as well as physicians can and do provide female sterilization. Registered Nurses and Nurse-Midwives can provide Depo-Provera(r) and intrauterine devices. Involving men proved to be an important factor in program success. doclink

    Pakistan: Population Welfare Programmes Achieve Success

    June 26, 2007, Associate Press of Pakistan

    In Pakistan the fertility rate is down to 4.0 and growth rate to 1.8% per year. The population had reached 156.26 million, 81.1 million male and 75.2 million female.

    The total fertility rate declined from 6.0 in 1984 to 4.0 in 2005. Maternal mortality declined from 500 in 1991 to 350-400 per 100,000 life births in 2005.

    The female population 15-49 years was 39.2 million which was 52.1% of total female population.

    Life expectancy of females had risen to 66 from 61 years in 1991, for male expectancy was 64 years.

    The population ministry was pursuing awareness campaign and rise in female' mean age at marriage from 21.7 years in 1991 to 23.4 years was a testament to its success.

    The contraceptive prevalence rate had risen from 11.8 in 1991 to 36.0.

    The credit also goes to media that had adopted an active role in creating awareness about over-population, especially at the grassroots level. The government was encouraging public-private partnerships to help achieve their targets. doclink

    Cuba Leads in Sustainable Development

    January 7, 2007, Canadian Dimension

    Cuba is the only country in the world with sustainable development, and registered a 12.5% increase in its GDP during the last 12 months. In 2007, Cuba will assign 22.6% of its GDP for public health and education. Spending for health, education, culture, sports, security and social assistance represent 69% of the 2007 budget.

    The progress of countries toward sustainable development can be assessed using the UN Human Development Index (HDI) as an indicator of well-being, and the ecological footprint as a measure of demand on the biosphere. As world population grows, less biocapacity is available per person. In 2003, Asia-Pacific and Africa regions were using less than world average per person, while the European Union countries and North America had crossed the threshold for high human development. Only Cuba qualified for sustainable development.

    The Havana government has organized a socialist society with a high level of literacy, education, long life expectancy, low infant mortality and low energy consumption.

    It is the world's leader in organic agriculture, and is making contributions to medical research, not to mention that Cuban doctors are serving the people in poor developing countries. Cuba has developed a considerable research capability.

    Castro declared: Humanity is going through difficult times, plus a non-stop consumption process typical of the globalized imperialist system. doclink

    Beijing Women Don't Have a Child Until They Are 29

    January 12, 2007, Xinhua General News Service

    The average childbearing age of Beijing women rose to 28.83 in 2005 from 27.24 in 2000. In 2005 for one hundred Beijing women, there were only 68 children.

    Before 1974, the fertility rate was around 2.6 children per woman but decreased when the family-planning policy was implemented in 1973. By the mid and late 1990s, the fertility rate of Chinese women had dropped to about 1.8.

    Employment pressures, delayed wedlock and longer life expectancy have all influenced women's childbearing age. In the 1990s, a Chinese woman would marry at 22 but now the age has climbed to 24. doclink

    Population Growth Rate Drops to 1.8%

    January 29, 2007, Daily Times

    Pakistan's population growth rate has dropped from 2.1% to 1.8% per year. Officials stated that they plan to bring the rate down to 1.3% by 2020. The Ministry credited the media for adopting an active awareness program about the implications of over-population. doclink

    Managed Birth Rate to Rein in Nation's Population Explosion

    January 10, 2007, Vietnam News Service

    Viet Nam's population will stabilise at about 115-120 million people by the middle of the 21st century.

    Family planning is an important part of reproductive healthcare. The lowering of the birth-rate will help improve living standards. Viet Nam has unveiled a programme that implements reproductive healthcare and family planning under the Cairo model.

    The country's population will face more difficulties, including how to improve living conditions. From the Human Development Index (HDI), Viet Nam ranks 107th out of 184 countries. From individual HDI criteria, the country's average income of US$650 per person per year places Viet Nam on the list of impoverished nations. Vietnam will come off the list if the country reaches an annual per capita income of $1,000.

    At the current development level and with a stable replacement birth-rate, Vietnam will reach this goal in the next 10 years. The country's GDP has been increasing at 8% annually, while population has gone up by 1.3-1.4%. When parents have children, expenses for feeding, housing and education are high. It takes time for children to become contributing members of society. Therefore, if we work on population, we will reduce the social burden. doclink

    Infant Mortality on Par with Developed Nations in Las Tunas, Cuba

    January 9, 2007,

    The Cuban province of Las Tunas has an infant mortality rate of 4.76 deaths per thousand live births in 2006, on a par with developed nations and 1.76 lower than last year. Among the factors that contributed is the expansion of the Infant-Maternal Program to the remotest communities. The services provided at the maternity homes, where future mothers with health problems are hospitalized, were also a key. Las Tunas is among the provinces with less qualified medical personnel and a weaker healthcare infrastructure, yet has equalled those that have traditionally had better results.

    Five years ago, Las Tunas reported 12.9 deaths per thousand live births. Cuba has achieved the best results to reduce infant mortality. Over the past few years the country's rate has ranged between five and seven, very similar to the statistics of many developed nations. doclink

    India: Just 0.8% Men Sterilised

    November 30, 2006, Times of India

    Only 19.3% children in Delhi under three were breastfed within one hour of birth while 34% children were only breastfed till five months of age. In family planning, 23% women had gone in for sterilisation while only 0.8% men were sterilised. Nearly 23.3% couples used condoms. Over 16% women have experienced spousal violence, nearly 70% women participated in household decisions.

    Men and women in Delhi are obese. The immunisation rate of children is low. Anaemia is a big problem.

    But Delhi's fertility rate stands at 2.13, which is perfect.

    Married women in Delhi seem to have accepted the two child norm. Over 92% live with two children and didn't want a third.

    Over 70.7% of mothers who had two daughters didn't want a third pregnancy in the hope of a male child. doclink

    Cuba: Addressing Aging Population

    December 8, 2006, Miami Herald

    Cuba has the highest life expectancy and lowest birth rates and a dwindling population. In 13 years the retired people will outnumber the labour force.

    The Cuban media has run a candid coverage of a phenomenon that promises to wreak havoc on a strained social service. The effort to sustain the socialist society is being constantly challenged by emigration, aging adults and childless women.

    Since 1978, Cuba's fertility rate can no longer sustain current population levels. During the 1960s and 1970s, Cuba's annual birth rate was about 250,000. In 2005, there were slightly more than 120,000. Seniors 60 and older make up about 16% of Cuba's population. By 2025, 26% of Cubans will be elderly and Cuba will join the 11 countries with the world's oldest populations.

    Among the causes are housing shortages, high cost of living, lack of day-care centres and goods like children's clothing and the migration of adults of child-bearing age. Advances for women in the workforce and availability of birth control also contributed.

    Cuba's population rate started to slip in the 1950s. If communism collapses Cuba is likely to witness a massive outward migration of youth.

    Cuba has about 300,000 people over the age of 80, but the government has focused its attention on infant mortality and educating children.

    The Cuban health system is not geared toward the catastrophic illnesses of older people.

    Elderly people earn less than $10 a month from pensions, so many are street vendors who say they were forced to return to the workforce because they could not survive on their incomes. doclink

    Karen Gaia says: Cuba is unique in that it has one of the best health care systems, best education system, lowest infant mortality rate, and lowest birth rate among the developing world. But Cuba is a poor country due to the trade embargo and the economic and brain drain resulting from the emmigration of the wealthier people of Cuba. If it were not so poor, perhaps it would not lose so many of its people. Perhaps it was a mistake for Cuba to send health care workers overseas to help other poor countries.

    Brazil's Population to Grow Older by 2030

    December 15, 2006, Xinhua

    A longer life expectancy and lower birth rates indicate the Brazilian population will grow older in the next 24 years.

    The country's demographic pattern started to change in 1991, when longevity became more common and birth rates fell.

    Brazil needs to get ready for the elderly population to come. doclink

    Institutional Delivery Brings Down Mortality Rate

    November 6, 2006, Telugo Portal

    By encouraging women to go to hospitals for deliveries, India has reduced maternal mortality from 398 per 100,000 births in 1997-98 to 301 in 2002-03. A total of 4,484 maternal deaths from 1.3 million births to 14.4 million females aged between 15 and 49 years were investigated during 1997-2003. Based on about 26 million births in 2004, nearly 78,000 maternal deaths are estimated in India in that year.

    The leading causes of death have been haemorrhage 38%, sepsis 11% and abortion 8%.

    Seven states, including Karnataka, are performing poorly. Uttar Pradesh leads in avoidable deaths during childbirth.

    Uttar Pradesh 517, Assam 490, Rajasthan 445, Madhya Pradesh 379, Bihar 371 and Orissa 368 with MMR ranging between 517 and 358 still remain a cause of concern.

    As in childbirths, India has managed to reduce rate of infant mortality from 80 per 100,000 in 1990-91 to 58 per 100,000 2004.

    Expectant mothers opting for institutional delivery will be given Rs.2,000 at the time of child birth.

    In the villages, the incentive is being provided through young women known as ASHAS. Incentives given to men and women opting for sterilisation is also being enhanced to Rs.800 to encourage people to have spaced out children and small families. doclink

    South Korea: 1 in 3 Married Women Rejects Motherhood

    March 23, 2006, Korea Herald

    One in three married Korean women say it is ok to have no children. Single men and women prefer to have only one child. Half of single women said it is better not to tie the knot at all. The study was based on interviews with 3,800 married women between the ages of 20 and 44 and 2,670 single women and men in 2005. The birth rate stood at 1.16 in 2004, lower than those of industrialized countries - the United States (2.04), France (1.89) and Japan (1.29). Couples avoid having more children because of high education and childcare expenses. On average, a Korean couple spends half their income on their children's education. Parents with one child spend 23.8% of their income on education, 59% for two children and 63.9% for three. The higher the children's grades are, the more money is spent on private education. Other reasons for Korea's low birth rate, including the change need for children and marriage, instability of employment, difficulty in meeting expenses. A whopping 61.2% of women quit their jobs before or after marriage and half of working women stopped working after delivering their first child. Korean women abandon all hope for having children because they find it hard to be society's ideal mother who excels at work and at home. Unless the patriarchal culture changes and men's behavior changes, it will be hard to curb the decreasing birth rate. Some 82% of single women said they want to have more than two children, but after marriage, they realize it is challenging to balance both work and family. A working woman spends twice as much time as her working husband taking care of children and doing housework. And 54% of working women said housework is divided 'unfairly.' doclink

    Is Too Few People the New Problem?

    December 14, 2005, Grist Magazine

    Around the world, people are having fewer children which could be our best hope for the salvation of the planet. Among the nations with the lowest fertility levels are relatively rich countries like Italy and Spain, but they are matched by still-developing nations like Romania and Ukraine. Even France and Ireland are only cranking out an average of 1.8 children per woman, well below the 2.1 that's needed to sustain current population levels. Populations are declining in seven of the 25 EU member countries, and the trend will continue. Population numbers will rise gradually over the next two decades to about 470 million, thanks mainly to immigration, before falling by 20 million people by mid-century, when immigration will no longer be able to offset rising death rates and falling birthrates. Demographer David Coleman dates declining birthrates in Europe to the social-welfare state that began in the 1930s. In a society veering away from agriculture, children were no longer worth it, and other explanations include women's rights, increasing female participation in the workforce, and birth-control programs. Outside Europe, depopulation is occurring in Japan and the government estimates that by 2050 there will be 25 million fewer Japanese. But birthrates are falling even in developing nations. People are having fewer babies and 20 developing countries have fertility levels below the 2.1 replacement level. China's policies have driven its birthrate from 5.9 in the 1970s to sub-replacement level. An even larger decrease occurred in Iran, which dropped from seven births per woman in the early '80s to around the replacement level today. Even though birthrates are falling, we're decades away from feeling the effects. Even where birthrates are below replacement level, populations continue to grow and there's a time lag before the effects are felt. China will add 260 million people by 2025. In much of Europe and Japan, while rural areas are emptying out and birthrates are plunging, cities are coping with an influx of newcomers. In Rome, squatters are angry about spiraling housing costs caused by overcrowding. Meanwhile, in the former East Germany, they're chopping up old communist apartment blocks to make nice low-density family homes. After 2050, the U.N.'s estimates say the world will grow more slowly, hitting 10 billion people in 2200 before stabilizing or entering a period of slow decline. In Europe, some of the effects are being felt. The decline in population is opening room for species that have been pushed back by humans with an increase in animals such as wolves and deer. A smaller population is a more sustainable one. A drop in numbers could lead to a drop in energy use and less strain on the environment. Shifting populations bring their own concerns. Europe's population is still rising due to immigration and demographers warn that Europe could fissure into two castes: childless Brahmins and the foreign underclasses who serve and shell out taxes to support them. A declining population is an aging one. Older people tend to have more disposable income, and consume more. And ultimately, aging societies will face budgetary pressures, Social Security and other pension plans, that will leave less resources for investment in environmentally friendly goods. With the global population zooming upward, it's hard to drum up much talk about future depopulation. Progressives haven't been able to blend commitments to reproductive choice with sustainability, so raising the banner for population control has been left up to a few lonely voices on the left and the anti-immigration right. Population control is unfashionable and taboo, and has fallen off of a lot of agendas because of political correctness. We have to think seriously about the world's population and what kind of levels can be sustained in the long term. In the playground of public policy, population decrease is seen as a problem, not an opportunity. Several countries offer generous pro-family benefits, while others are tinkering with their retirement systems to keep older residents working longer. But serious discussion about proper population levels doesn't really happen. The issue of population, once a key part of the green agenda, is today limited to a few demographers, think-tankers, and wonks. If countries can manage with fewer people, we could be onto something big. doclink

    Brazilian Birth Rate is Steady as Population Ages

    November 28, 2005

    Brazil's birth rate began falling in the mid-1960s, and is now more or less stable. The rate has been 2.1 children per woman for the last two years. In 1981, 58.2% of the population were 24 years of age of less. That number dropped steadily: in 1993 it was 52.4%; in 1999 it was 49%; and in 2004, it was 46%. Meanwhile there are more older people. In 1981, the population over 60 was 6.4% of the total; in 1993 it was 8%; and in 2004, it was 9.8%. In Brazil 51.3% of the population is female. But in the over-60-age group, females make up 56% of the population. In 1993, the average was 4 people per home; in 2004, it fell to 3.5. And between 1999 and 2004, the number of households with one inhabitant rose from 8.9% to 10.5%. doclink

    Vietnamese Woman Has 2.1 Children on Average

    December 2, 2005, Xinhua General News Service

    Each Vietnamese woman has, on average, 2.1 children, compared with 2.7 in other Southeast Asian countries. The average number of births a woman in urban areas has is 1.7, while in rural areas it is 2.3. The survey showed that the percentage of people using modern contraceptive methods increased to 65.7%, helping to reduce abortion. Vietnam plans to pour 221.5 million US dollars into curbing population growth from 2006 to 2010. The money will be mainly used to ensure that each couple have no more than two children so that the population will remain stable at around 88 million by 2010. Under a recent resolution of the Communist Party the country's population should grow gradually, and then remain stable at 115-120 million in mid-21st century. The resolution stresses that party members must be good examples in following population policies and family planning. doclink

    Once Population Time-bomb, Bangladesh Registers Fastest Declines in Fertility Rate

    November 17, 2005, Indian Express

    Bangladesh has eliminated the gender bias in primary and secondary education and attained dramatic declines in infant and maternal mortality. Bangladesh has achieved one of the fastest declines in fertility rates in the world. Bangladesh is at the top for low income, developing countries and for South Asia in particular. The reason is probably an amalgamation of history, accidents and policy choices beginning with the war of independence. The post-war construction saw the emergence of independent service providers through aid and self-help that catalysed community mobilisation. Mobilisation of a risk-taking population, has surely been an important contribution but two accidents have been important for the country's development. First, the oil-boom saw labour migration to the Middle East and a flow of remittances to the rural economy. Second, the arrival of the garment industry to Bangladesh, jumping over Sri Lanka then in the midst of ethnic tension and India immersed in import-substitution. Single rural women found employment in the formal sector. The remittances and garment industry saw an infusion of private income and wealth into the rural economy that should not be underestimated. The active choices made by policy-makers to capture the opportunities have been equally vital. The remittances allowed Bangladesh to manage the unification of its exchange system and provide incentives for the economy to become outwardly oriented. The remittances enabled it to be implemented at a faster pace. Garment exports were scaled up by the decision of government to provide "free trade zone" status to garment producers. Equally important has been a partnership between government and the non-government service providers. From education, health, to the provision of micro-credit, this has led to the scale-up of service to rural households. Public sector agencies were supported, but balanced by investment in alternative providers. This partnership was around community service delivery directly to rural households. Agricultural liberalisation coupled with the technological benefits of the Green Revolution enabled Bangladesh to shift from a food-deficit to a self-sufficient nation. Quietly, Bangladesh dismantled its "licence raj" in the 80s and the final boost to the rural sector has come from a sustained growth to stabilise around 5% through the 90s. The pace of change is impressive as Bangladesh had to address issues of post-conflict democracy for close to two decades. The lessons suggest that while economic growth is needed to support social development, it is not sufficient. The focus on growth was matched by an equal focus on service delivery. But service delivery was not simply more public sector expenditures, it was based on a willingness to engage in reform of service delivery that strengthened the accountability of providers to the citizens and communities. It was also based on the evidence that without the State as a partner, it would be difficult to support the innovations of communities. Changes in policy were not a result of a well-oiled policy but of political economy clashes between stakeholders within and outside the country. Donors have been an important player in Bangladesh's successes. Decades of gains can be erased if a country's political and administrative systems do not keep pace with the demands of its citizens and the global context. If the past decades have been a challenge for Bangladesh the next decade will be a test to sustain it. doclink

    The Causes of Stalling Fertility Transitions

    Population Council

    An examination of fertility trends in countries with multiple DHS surveys found that in the 1990s fertility stalled in mid-transition in seven countries: Bangladesh, Colombia, Dominican Republic, Ghana, Kenya, Peru, and Turkey. In each, fertility was greater than 6 births per woman in the 1950s, and then declined to fewer than 5 births per woman in the early or mid-1990s, before stalling. The level of stalling varied from 4.7 births in Kenya to 2.5 births in Turkey. By 2000, a number of these countries had reached the replacement level of 2.1 births per woman, and it was widely expected that countries that are still in transition will continue their declines until fertility drops to or even below replacement. This assumption has been incorporated into population projections made by the United Nations and the World Bank. Stalling is a neglected issue. A stall in fertility after democratic transition is underway has been rare in the past. A country is considered to have stalled if its fertility (TFR) failed to decline between two DHS surveys while the country is in mid-transition, that is, if its TFR is between 2.5 and 5 births per woman at the time of the most recent survey. By this definition, 20 DHS countries were mid-transitional and seven of these countries had experienced a stall. Findings suggest no major deterioration in contraceptive access during the stall, but levels of unmet need and unwanted fertility are relatively high and improvements in access to family planning methods would therefore be desirable. Socioeconomic development is considered the main cause of a decline over time in the benefits of children and a rise in their costs. These changes in the cost/benefit ratio lead parents to want fewer children, and mortality decline raises child survival so that families need fewer births to achieve the desired number of surviving children. These trends in turn raise the demand for birth control (i.e., contraception and induced abortion), and, to the extent this demand is satisfied, lower fertility results. Family planning programs facilitate this transition by reducing the cost of birth control (broadly defined to include social costs), thus raising the level of implementation of the demand for contraception and reducing the unmet need for contraception. Higher levels of socioeconomic development also reduce the cost of birth control. Other factors include real GDP per capita, child survival, and level of education, as well as the role of family planning programs as measured by a program effort index. In the mid-1990s, 36% of all pregnancies in the developing world were unplanned and 20% of all pregnancies ended in abortion (Alan Guttmacher Institute 1999). The existence of an unmet need for contraception, first documented in the 1960s, convinced policymakers that family planning programs were needed and would be acceptable and effective. It is widely believed that fertility is most responsive to improvements in human development, in particular in female education and child survival. This conclusion is strongly supported by the fact that replacement fertility has been achieved in some 17 very poor societies such as Sri Lanka and the state of Kerala in India. Although poor, these populations have high levels of literacy and female empowerment and low infant and child mortality. While the impact of GDP was not found to be a major factor, Kenya fertility has stalled at near 5 births per woman despite relatively high levels of literacy and schooling, but having low and deteriorating living standards. In some stalling countries (Kenya and Ghana) development indicators changed little, while in others socioeconomic development continued at a fairly rapid pace. However, the level of fertility relative to the level of development seems to play a role as a cause of stalls. In six out of the seven stalls, fertility was lower than expected for the level of development at the beginning. The reason for this is not known, but once this is the case fertility can subsequently be expected to move closer to the predicted level, thus making a stall more likely. Future research may show that the duration of a stall will depend on the pace of development following the stall onset. Stalls will be of shorter duration in countries where development proceeds rapidly than in countries where development has leveled off as well. Measures of unmet need and unwanted fertility showed no significant recent upward trend in the stalling countries, although Kenya experienced slight increases. In contrast to the near absence of change in the stalling countries, the non-stalling mid-transitional countries experienced substantial changes in fertility and its various determinants and these changes were all in the expected direction. That is, fertility and fertility preferences declined, while contraceptive use, the demand for contraception, and socioeconomic development indicators generally rose during the period between the two most recent DHS surveys. A country in which unwanted fertility is higher than a few tenths of a birth can especially benefit from further investments in family planning programs. It is difficult, however, to remove all unwanted childbearing because reasons other than access (e.g., fear of side effects and lack of spousal support) also play a role. Improvements in family planning services are most needed in countries such as Bangladesh, Ghana, Kenya, and Peru with the highest levels of unmet need and unwanted fertility. Countries in which wanted fertility has stalled well above the replacement level may need declines in preferences to complete their fertility transition. Such declines are usually achieved by improvements in socioeconomic conditions. Among the seven stalled countries, Kenya and Ghana have relatively high wanted fertility levels (3.6 and 3.7 births per woman, respectively), and their levels of development as measured by real GDP per capita, child survival, and proportion schooled are low and have leveled off. In these two countries improvements in development will almost certainly be needed for desired family size and actual fertility to fall substantially below current levels. In contrast, in Bangladesh, Colombia, Dominican Republic, Peru, and Turkey wanted fertility has already dropped to about two births per woman and any further declines in overall fertility are likely to come from reductions in unwanted fertility. doclink

    This study does not seem to mention the factor of male preference.

    Mongolia: BBC Film to Feature Changes in Rural Maternal Health

    March 11, 2005, TheUBPost

    Mongolia's strategies to reduce maternal mortality are to be featured in a BBC World documentary series. It showcases successful approaches to improving maternal health in developing countries. The film maps the progress made by Mongolia in improving maternal health since services collapsed in the 1990s, when maternal mortality rate was 214 deaths per 100,000 live births. Since then a strategic approach has resulted in a steady reduction. This has been developed and implemented through partnerships with world organizations. Improvements have the annual maternal mortality rate dropping from 169.3 in 2001 to 99.8 in 2004. As the film will show, an essential element is the use of specially-trained staff located at the local 'bag' and 'soum' levels to provide maternal health services for women in the countryside, early monitoring and assessment of pregnant women, allowing health interventions to be delivered, and ensuring that women at a risk of complications are referred to the center hospitals. This has achieved almost universal coverage, an impressive achievement for a country facing barriers of distance and poor transport. Home visits use whatever transport is available and suitable: the health nurse travels horseback. Two weeks before delivery, all women are taken to dormitories in the hospitals. Another important element has been training, essential drugs and equipment provided to doctors for preventing complications. This has resulted in a significant drop in the numbers of women dying due to blood loss. A final factor has been improved access and education about contraception and birth spacing. In Mongolia, the birth rate dropped from 5.3 live births per woman in 1980, to 2.6 in 2000. This has meant that more women have been able to space births and doctors rarely see cases of severe maternal anemia due to consecutive pregnancies and childbirth. Support is common throughout rural Mongolia; for example, almost every household donated one sheep towards the repair of the local hospital's heating system. Local governors also made their vehicles available for the transport of pregnant women when the hospital's own vehicle was unavailable. Where governors are supportive and funds available, money has been provided to attract and retain medical staff. However problems face Mongolia's remote communities. In one hospital the heating system was not working, there was no running water and poor hygiene facilities. This hospital had a doctor, but many do not, as rural hospitals find it difficult to attract and retain staff. Rates of abortion remain high in Mongolia and while the number of reported cases of HIV is low, the rates of STDs such as syphilis and gonorrhea are high and have risen since the early 1990s. doclink

    In Turkey, Muslim Women Gain Expanded Religious Authority

    April 27, 2005, Christian Science Monitor

    Women have brought change to Turkey's Muslim order in recent years. Two years ago, women were appointed for the first time to lead groups of Turks making the pilgrimage to Mecca. And last year,a government body that oversees mosques and trains religious leaders, added 150 women preachers and is selecting a group of women who will serve as deputies to muftis. They'll monitor imams in local mosques, particularly as it relates to women. While these changes come from a growing demand from women for more religious education and Islamic intellectuals say they are also being forced by a new class of educated religious women who are demanding more rights. They are learning by reading and asking; for many women who come from traditional homes, religious education becomes a path to a kind of independence. It's a path that more women seem to be exploring; for example, one mufti's office has 583 women teaching courses on the Koran to women. Women now also make up the majority of students in the theology departments of several Turkish universities. In Islamic doctrine, men and women are equal. There are signs of loosening in Turkey, but Muslim orthodoxy says that women cannot lead prayers, particularly in the Arab Muslim heartland. Sunni preacher of Qatar issued a religious ruling, saying leadership in prayer is reserved for men only, and a women leading prayers might arouse men. Teaching in an Istanbul neighborhood, Seker tells the head-scarfed women that not all of the traditions they have been taught are part of Islam. She brings up the murder of young women considered to have damaged a family's honor that still take place in Turkey. There is no such thing in Islam, and to kill someone is the biggest sin. Seker acknowledges that her work might not sit well with the husbands as they feel like their throne is being shaken. doclink

    Solomon Islands: Mothers Cry for Recognition

    March 14, 2005, Soloman Star (Soloman Islands)

    Solomons women have the responsibility for the health and education of their children and the living standards of their families. She is the foundation of Solomon Islands society. Yet she is the most vulnerable member of that society. When food is short she goes without; when there is no doctor she must deal with her frequent pregnancies and childrens crises; and when economies are mismanaged and incomes and quality of life indicators fall, she is the first to face the consequences. A substantial number of maternal deaths occur in the Solomon Islands each year. Beyond actions to ensure safe motherhood, Government (SIG) and the NGOs community must give greater emphasis to enhancing the role of women. There is no question that this is an area in which everyone must do more to provide women access to agricultural and small business credit and extension services, to remove legal obstacle to womens participation in economic life, and improve womens' access to education. An educated woman is better equipped to take advantage of opportunities; she is more likely to delay marriage to finish schooling and space her children. She is more likely to have fewer and healthier children. Womens and youth groups that have done an excellent job in bringing more knowledge to Solomons mothers and can play an even greater role. Let us create an environment in which Solomons mothers will not want so many pregnancies and give them a chance to be heard and participate in the decision making to shape a better future for our country and improve their role in the society with equality between men and women. This is a challenge to which all National Parliamentarians and people of Solomon Islands must respond. But the most critical players will be the Solomons mothers who are fighting to overcome poverty and gain more control over their destiny. doclink

    Come Gather Around Together: An Examination of Radio Listening Groups in Fulbari, Nepal

    April 8, 2005, John Hopkins CCP

    Messages via mass media-based entertainment can improve family planning; audience participation in the form of listening groups may enhance their impact. In Fulbari (Nepal), a partnership between local government agencies, community leaders, audience members and program staff are complementing a mass media family planning initiative. The study demonstrated a relationship between radio listenership and behavior beyond the association with the radio program. Use of contraceptives among respondents exposed to both radio and listening groups is twice that of respondents who are exposed to neither. doclink

    Pakistan: Government to Embark Upon Maternal and Child Health Plan

    April 2, 2005, Business Recorder (Pakistan)

    Pakistan prime minister Aziz said that the federal government and international agencies will embark upon a five-year programme at a cost of Rs 31.5 billion to achieve Millenium Development Goals (MDGs) for safe motherhood. The World Bank, USAID, DFID, Unicef and UNFPA have pledged to provide half of the cost. Under the MDGs the country has a target to reduce mortality by 75%, child mortality by 66% and extreme poverty by 50% by 2015. The statistics revealed that currently one mother dies every 20 minutes, while 350,000 annually bear the burden of maternal ill health and disability, 10 million children die every year. The high rates attributed to high fertility, low skilled birth attendance, low levels of female literacy, poverty, malnutrition and inadequate access to family planning services. The programme aims at gender equality, with an increase of lady health workers (LHW) to 100,000. Also 10,000 community-based Skilled Birth Attendants (SBA) to be trained and deployed nationwide during the next five years at an estimated cost of Rs 5,282 million. One SBA will serve a population of 10,000. Midwifery/LHW schools will be upgraded and a pool of tutors be trained. The government was focusing on literacy and empowerment of women where one-thirds of the representation has been given to women, while they represent 20% in Parliament. Emergency Obstetric Care services would be provided at an estimated cost of Rs 4,642 million. Another Rs 2,638 million would be spent on family planning services, Rs 7,770 million on child and neonatal health, Rs 1,813 million for management and organisation reforms, Rs 3,968 million on interventions and Rs 595 million on monitoring and evaluation framework. This amounts to Rs 34 per person per year, much below the international recommendation of Rs 180 per person per year for safe motherhood. The government expects a 50% contribution of donors. Mother is the nucleus of every society, and the ministry has needed over Rs 35 billion for improving mother and child health services across the country. doclink

    India: Muslim Women Opting for Family Planning

    March 15, 2005, Hindustan times

    More Muslim women across Bihar are opting for family planning and approaching state-run clinics and medical camps. Economic reasons and growing awareness propelled by education is credited with the change. Muslim leaders admit it is a major development for women who were until a few years ago shying away from even voicing their opinion on the subject. Most women breaking the earlier taboo are in the 22-35 year age group. Muslim women could not have thought of sterilisation until the 90s but the situation has changed now. Doctors and staff of health centres said the number of Muslim women going for family planning had increased in the last two to three years. But a large chunk of the Muslim population still views family planning as anti-Islam. The higher-income Muslims who have small families do not admit to practising family planning but the size of their family speaks for itself. In Bihar, the birth rate among Muslims is higher than among the general population. Muslims make up 16% per cent of the population of 83 million. In rural areas, only 10.8% of Muslim couples practise family planning compared to 22.9% among others. Almost half of Bihar's rural Muslims and 44.8% of urban Muslims are considered very poor. doclink

    Don't Lose Hope

    Richard Grossman

    The size of the family is shrinking all over the world because women want fewer children and have realized their advantages. Thirty-five years ago only one in seven women worldwide used contraception and they had an average of 6.1 children in developing countries. This has dropped to 3.1 and worldwide is just 2.8. Many developed countries are shrinking in population. A average of 2.1 leads to a stable population. If we establish an average Total Fertility Rate (TFR) of 1.96 now, in 50 years the world's population will decrease to 5 billion. If it is slightly higher, at 2.18, the earth will have to support over 20 billion people by the year 2050. People choosing to have smaller families for three reasons, the availability of contraception, reduction of child mortality and empowerment of women. Thanks to the media and family planning programs, most people have access to information on child spacing. Improving child survival can decrease the population growth rate. Historically, when child mortality rate is high, parents have more children to assure that some survive. Lowering child mortality result in a lower TFR and lower growth rate. School enrollment of girls has more than doubled over the last three decades. Education and literacy are important because they raise women's aspirations and their ability to find employment outside the home. Education also helps mothers learn about contraception and mothering healthy children. Because they don't need to have many kids to work the fields, people have fewer children as they shift from rural to urban economies. Older age at marriage is another factor in slowing growth and people are starting their families later. Better-educated and mature mothers are likely to have healthier and smaller families. More couples are relying on permanent surgical contraception when they have completed their families. A TFR of 2.1 or less is the goal. It is unlikely that we will reach it soon, however. Although we have not solved the problem of population, we have made great strides. There is reason to be optimistic that excess population growth can be restrained if we devote sufficient resources to the problem. doclink

    Vietnam to Curb Population Growth

    March 30, 2005, Xinhua General News Service

    Vietnam is encouraging each couple to have no more than two children. Under a recent resolution of the Communist Party its population should grow gradually, and then remain stable at 115-120 million in mid-21st century. State cadres and party members must be good examples in following population policies and family planning, as well as persuading local people to do the same. Each Vietnamese woman had 2.23 children in 2004, up from 2.12 children in 2003, according to surveys. Local women in the central highlands region had most children: 3.1 per mother, and those in the Mekong delta had fewest children: 2 per mother. Vietnam now has a population of 82.1 million, including 41.7 million women. Up to 74% of Vietnamese people live in rural areas. doclink

    Morocco: Moudawana Improving Women's Situation Further

    Morocco Time

    Morocco is moving to lifting of some of the reservations towards the Convention on the Elimination of All Forms of Discrimination against Women. Morocco has made the promotion of women's condition an objective and an inter-ministerial commission had been created in 2000 to carry through the government's strategy to the equality between men and women. The Moroccan government has also adopted a gender-oriented approach, particularly in the fields of education and health, the objective being to integrate this process in the preparation of annual state budgets. doclink

    Kerala Women on Top, Says State's Economic Review

    February 3, 2005, Indo-Asian News Service

    Women in Kerala have higher literacy, more access to money and a greater say in family matters. The sex ratio is 1058 females per 1000 males, higher than the country average of 933. Females make up 16.37 million of the state's 31.84 million population. The life expectancy of women is 75.9 years compared to the 61.8 Indian average. Crime against women dropped in 2003 by 3.7% Rape cases declined by 24% and molestation by 5.5%. Torture cases, showed an increase of 1.1%. Women marry later - at an average of 22, compared to the country at 19.5. Sixty-three percent of the women marry after 21 compared to 25.9% in the country. Almost half the 4.9 million enrollments in the schools are of girls, and the state also has more women, 68% up to high school and 54% in arts and science colleges. More than 66% of the state's women have access to money compared to the country average of 59.6%. Women head more than 22% households in the state compared to 10.3% in the country. doclink

    Developing World Births 'Falling'

    January 26, 2005, BBC News

    In the developing countries the average number of births has fallen from 5.9 in the 1970s to 3.9 in the 1990s. In 20 countries, births have fallen beneath the number needed to maintain current population and improved contraception is behind the fall. Planned families in China saw the most dramatic drop. Algeria, Iran, Mexico, Thailand, Tunisia and Turkey have also reported declines. But in 21 sub-Saharan African countries, fertility has declined slowly or not at all. The 20 developing countries where fertility is at or below the level needed to sustain the population include China, Hong Kong, Macao, North Korea, Iran, Kazakhstan, Singapore, Thailand, Armenia, Cyprus, Georgia, Barbados, Cuba, Guadeloupe, Martinique, Puerto Rico, Saint Lucia, Trinidad and Tobago and Chile. Countries recording large falls in birth rates have governments that promote the use of contraceptives. Over half of all women now use contraceptives, compared with 38% during the 1970s. The developing world has seen a sharp increase from 27% using contraceptives in the 1970s to 40% by the 1990s. doclink

    Tunisia: Illiteracy Rate Continues to Drop

    December 21, 2004, Al-Bawaba

    Data collected within the Tunisian census has indicated a slowdown in population growth and an improvement in the standard of living of the population. It showed that the rate of literacy is at present about 80% and the rate of illiteracy has continued to drop. From 84.7% in 1956, to 46% in 1984, and 22.9% in 2004. For those between 10 and 29 years of age, illiteracy has come down from 24.8% in 1984 to 6% in 2004. doclink

    UN Official Applauds Reproductive Health Advances in Cuba

    December 19, 2004, Xinhua General News Service

    "What I have seen in the island nation in terms of sanitary conditions, reproductive and sexual health, as well as education is something I have not observed in any other country I visited in the past," said Obaid, of Saudi Arabia, who is on a three-day visit to Cuba. She noted that nearly all Cuban children are in school, the health services have a universal character, and the dangerous pandemic of HIV/AIDS is kept at a low rate, thanks to a correct government strategy. Obaid said the authorities have paid special attention to all the aspects of sexual and reproductive health and the island reached the 2015 world targets. doclink

    Dip in Population Growth of 0-4 Years Age Group

    Hindu (The)

    The population of 0-4 years has gone up by 70.84 lakh between 1991 and 2001, less than half the increase of the preceding decade. The share of children below 4 in India's overall population has dropped from 12.55% in 1981 to 12.17% in 1991 and to 10.73% in 2001. Figures for Assam and Kashmir in 1991 have been left out. During 1981-1991, the fall was confined to Kerala and Tamil Nadu, in the subsequent decade, it spread to Andhra Pradesh, Karnataka, Punjab, Himachal Pradesh, West Bengal, Orissa, Tripura, Lakshadweep and Andaman & Nicobar Islands. Large parts of the country have diminishing toddler numbers who will form the parental base 15-20 years hence. Fertility rates have been coming down. Even if there is no clear-cut `demographic transition' for the country as a whole, something is underway in the southern States. The old model of setting up more and more primary schools may have little relevance in States such as Kerala, where evidence points to decreasing enrollment rates. Public delivery systems will have to shift emphasis from quantity to quality of services. doclink

    Sri Lanka: Population Growth Continues to Decline, Says Healthcare Minister

    Daily News

    Population growth in Sri Lanka has continued to decline, from 1.5% in the early 1990s to 1.1% today. Life expectancy is comparable to more developed countries, with 75.4 and 70.7 years respectively. Infant mortality has been reduced to 13 per thousand live births and the maternal mortality ratio is about 50 per 100,000 live/births. Per capita income has increased at a steady pace. Sri Lanka has consolidated on the achievements in the population, development and reproductive health fields with an acceleration of population and socio-economic change. Although HIV is relatively low, the Government is concerned of the potential threat and places high priority on the prevention and control of HIV and sexually transmitted diseases. A policy on blood safety was developed in 1999. Continued reliance on open economic policies with a humane face and greater emphasis on human resource development have enabled Sri Lanka to achieve an average economic growth rate of 5% during the past decade, despite the armed conflict in the North and East of the country. doclink

    Bangladesh Sets Target to Cut Population Growth Rate to One Percent by 2010

    October 19, 2004, Xinhua General News Service

    Bangladeshi cabinet approved the draft of Policy 2004 (NPP 2004) that focuses on bringing down population growth rate to 1% by 2010 from the present 1.54% and aims to stabilize Bangladesh's population at 216 million by 2060. It has seven strategies including empowerment of women, human development and decentralization of programs. The Maternal mortality rate (MMR) in Bangladesh is 320 women out of every 1,000 live births. Infant mortality rate (IMR) has 70 infants die out of every 1,000. The new policy emphasizes women's reproductive health for 100% safe motherhood, and provides emergency obstetric services. It gives attention to increased contraceptive use, expand clinical services and maks home family planning services available. The policy proposes reproductive education for young people and parents. The policy also focuses on late marriage for girls, spacing of childbirth and awareness of sexually transmitted diseases. It addreses malnutrition, decline in arable land, pollution of environment and water, poverty, urbanization and unemployment. The draft stresses equal rights of women and men, protection for the elderly and minimum calories for growing children. To prevent people from migrating from rural areas, the policy proposes to increase employment in the agriculture sector and seeks to develop satellite towns, healthcare and education and employment in the cities. The challenge of the policy is how to translate it into action. doclink

    Indonesia: Family Planning on the Right Track

    October 11, 2004, Jakarta Post

    In Indonesia family planning program has reached 96% of couples, compared to 86.3% in 1994, while the number of users rose to 60.3% from 52.1% in 1994. Indonesia joined 178 other countries in signing the ICPD in Cairo in 1994 and adopted the action plan that requires all countries to provide access to primary health and reproductive services by 2015. In a bid to reinvigorate the program, the government has deployed 73,000 midwives and 31,000 family planning workers to about 70,460 villages across the country. There are 44,000 doctors at clinics/hospitals, not to mention three million volunteers. However, the maternal mortality rate has declined from 397 per 100,000 births in 1994 to 307 in 2004, but remains worse than Thailand, which has only 44 per 100,000. Pregnant women go to midwives to get examined, but their delivery is by traditional midwives and they cannot deal with hemorrhage, the most common cause of maternal death. doclink

    Low Fertility Rate Reflects Well on South Africa; Improved Health Care, Education Key Factors

    October 7, 2004

    South Africa has the lowest fertility rate on mainland Africa, attributed to improved health care and education in the rural areas. The population is continuing to urbanise and HIV was a major factor influencing population trends. The fertility rate would be 2.77% this year, and reflects the positive impact of the reconstruction and development programme. A key element was to improve primary health care and reproductive health services, especially in the rural areas. One immediate challenge was to accelerate the economic and social integration of youngsters into society and provide them with the skills and opportunities to play a productive role in the development of the nation. It is necessary to combat drug abuse, crime and other social ills that are affecting many of the youth. doclink

    A Second Baby is Too Much to Bear; Shanghainese Can't Afford to Exploit Easing of One-child Policy

    September 21, 2004, Reuters

    An easing of Shanghai's one-child policy has failed to deliver the rush of applications from parents, with couples put off by the expense of raising a child. Only 40 couples from one district had applied since April, compared with 90 last year. An official put the reason down to the high cost of bringing up a child, together with competition for jobs on the mainland. Only better-off, well-educated couples were interested in having a second child and 4.48% were reluctant to have one child. People 18-30 wanted an average of 1.1 babies. The figure in 1983 was 2.04. After 11 years of falling population, Shanghai became the first mainland city to cancel subsidies for childless couples. The new regulation allows four different categories of remarried couples to have a second child, including married couples who were previously single parents and those who were themselves only-children. A court in Shenzhen fined a couple 780,000 yuan and sealed off their house for having more than one child. They were among nine couples fined "social fostering fees" for their extra children. The couple had their first boy in 1997. Last year the woman gave birth to twin boys. doclink

    Japanese Women Live, and Like It, On Their Own; Gender Roles Shift As Many Stay Single

    August 31, 2004, Washington Post

    Japan is undergoing a redefinition of gender roles as women enter the workforce and the result is the rise of financially independent Japanese women who are saying 'no' to men. Some luxury condos around Tokyo are being marketed strictly to women. The Tokyo Stock Exchange offered a workshop to get single women to invest. A jewelry firm is running advertisements where a single woman boasts she no longer needs a man to buy her gems. Women have discovered they can stay single and have fun without taking care of a man. In 2003, 54% of Japanese women in their late 20s were single, compared with 24% in 1980. 43% of Japanese men in their early thirties are unmarried. By 2020, 30% of Japanese households will be headed by singles. In Tokyo, it is more than 40%. The decline in marriage began with the economic slump in the 1990s, when men were were more reluctant to marry. But during the recession, Japanese women were courted by employers seeking cheaper labor. Japanese women lag behind women in other industrialized countries in the upper echelons of business and politics, but are well-established in the labor market. Last year, 40.8% of women were in the workforce compared with 35.9% in 1985. Japanese women have in the past been herded into marriage by tradition and financial necessity. But now a minority of single women are not waiting for marriage to build their dream houses. You can live comfortably as a single woman in Japan, but in the past it was difficult for women to have the income. The change is cited as a factor for the birthrate decline to 1.29 children, among the lowest rates in the world. Japan's population is expected to peak at 128 million in two years and then decrease 120 million by 2026 and 100 million by 2050. Will Japan have enough workers to run the economy and with fewer workers paying into the pension system that is on the verge of bankruptcy? Some Japanese men criticized women who refuse to retain their traditional roles one saying that that women who did not give birth should not receive pensions. One man said that "I want to come home and see my wife greeting me". Many single women say that traditional attitudes kept them from marrying. Single women do want to marry. One turned down a promising suitor because he expected her to quit her job to be a full-time wife and mother. doclink

    Brazil's Population Almost Doubles in 30 Years

    August 30, 2004, Associated Press

    Brazil's population nearly doubled over three decades, but the birthrate is slowing. The population has soared from 90 million in 1970 to 181.8 million in 2004, but shows a drop in the country's birth rate. In 1960 it stood at 6 children per woman and dropped to 2.89 in 1991 and to 2.39 in 2000. The population will continue growing but at a slower rate. In the 1950s and 1960s it grew at 3%; this year it dropped to 1.44%. The lower birthrate is due to the wider use of contraceptives and the growing number of women entering the job market. doclink

    Delaying Marriage, Early Marriage

    Why Girls Are the Solution to Overpopulation

    May 10, 2012, MENAFN - Arab News

    Overpopulation is at the core of many social, economic and environmental problems. It is estimated that the earth has the capacity to support and sustain approximately 4 billion people. The earth has 7 billion while the United Nations projects this to reach 9.3 billion by 2040.

    Population growth is destroying ecosystems, affecting climate change and causing loss of agricultural land to residential and industrial development.

    China has prevented more than 400 million births since the inception of its one child policy. However India increases its population every year by approximately 25 million. The Philippines is already beyond its carrying capacity, no longer able to feed its population, and has become the biggest rice importer on the planet.

    What the Philippines desperately needs is a government-supported family planning program, but there has been lack of progress on a reproductive health bill due to corruption and the Catholic Church and meanwhile 2 million Filipino babies are born every year.

    The Guttmacher Institute found that the cost of providing birth control to the 215 million women on the planet who have unintended pregnancies, is about $4.50 a year per woman. This could be the difference between having only 8 billion mouths to feed by the end of the century, instead of 15 billion.

    Food reserves are at a fifty-year low and the world will require 50% more energy, food and water by 2030, says the U.K.'s chief scientist.

    In Egypt, the Arab world's most populous nation, with an estimated population of 90 million, divorce is endemic; most re-marry and have more children they cannot support. And many girls are married off against their will as soon as they are old enough to bring in a dowry, usually to a much older man. Many of them are temporary, or 'seasonal' marriages, which are nothing more than a smokescreen for exploitation by wealthy married men. Within 3-6 months the girl is divorced, in most cases she is too ashamed to return home, often remaining and existing in abuse and enslavement by the first wife. This is also common practice in Yemen. While girls in developed countries have the freedom to go to school, raise their hands in class and share their opinions, girls in developing countries are burdened with chores and responsibilities from a very young age.

    This is one of the many reasons for high illiteracy amongst girls in developing countries. Too often cultural and religious practices such as female genital mutilation are the cause of such unbelievable suffering, that attending school is the least of a child's worries. Mothers do not allow their girls to study until housework and other chores such as collecting water are done. When the girl's family is poor, they have to marry early, work in the fields or as domestic laborers in order to help their families put food on the table.

    We need to break the vicious cycle of poverty, lack of education, lack of employment and incessant breeding which has left many aid organizations overwhelmed.

    The solution starts with a 12-year-old girl. Don't take her out of school when she's old enough to bring in a dowry, provide an incentive for her family (i.e. a cow, a goat or plough), keep her there through secondary school and then connect her to a decent job.

    By supporting girls, providing them with a safe environment to learn, giving them life skills, mentoring and nutrition we can affect not only the life of a child but the whole family, and whole community in the most positive way.

    We all have a social responsibility to provide an incentive to poor families to send their girls to school please visit or doclink

    A Population Antidote: High School for Girls

    April 4, 2012, New York Times

    High school for girls leads to smaller families. Experts such as Peter Ogunjuyigbe, a demographer in the city of Ile-Ife, Nigeria, who is studying population growth with financing from the Gates Foundation and the Bloomberg School of Public Health at Johns Hopkins University, Parfait M. Eloundou-Enyegue, a development sociologist at Cornell, and Babatunde Osotimehin, the executive director of the United Nations Population Fund all see population stabilization as tightly linked to female empowerment.

    "There are countries where the population is growing faster than the economy," Mr. Osotimehin, a former Nigerian health minister, said in an interview in New York. "We try to work with these countries to make sure girls have access to education to empower women to participate in politics and the economy."

    At some point along the population growth curve in much of Sub-Saharan Africa, too many people means not enough resources, marked declines in human health and the destruction of critical natural habitat.

    In many African nations, girls usually end their schooling around age 12 when they get ready to be married off and start having babies. Not surprisingly, low rates of education for women consistently correlates with high fertility rates. In West and Central Africa over all, 44% of girls are married before they turn 18, while it is 76% in Niger, where the fertility rate is the highest in the world (7.3 babies per woman) and many women marry in early adolescence. Going to high school gives girls skills that make them more likely to be employable and capable of attaining a measure of financial independence. They are more likely to make marriage decisions on their own rather than having their families rush to marry them off.

    In elementary school education on sex and family planning is less effective because girls at that age are be too immature physically and emotionally to process the information.

    "If you educate girls to the secondary level, then exposure to pregnancy doesn't happen until they are mature and can made choices," Dr. Osotimehin said.

    In Nigeria about 40% of the population is 14 or younger, so having having girls finish high school would have enormous benefits towards attaining a more sustainable population. doclink

    The Cost of Child Marriage

    Development experts have always measured the human costs of early marriage, but new data are shedding light on the practice's economic impact. As countries work to ban child marriage, advanced economies - led by the G7 - can help by financing programs proven to mitigate one of the most serious s
    May 30, 2018, Project Syndicate   By: Henrietta H. Fore , Natalia Kanem , Mabel Van Oranje

    The International Center for Research on Women and the World Bank have reported that, by 2030, $4 trillion would be saved on welfare expenditures if child marriage was stopped.

    In Indonesia, where 14% of girls are married before their 18th birthday, President Joko Widodo has recognized the human and economic costs and has vowed to end the practice. However, in most developing countries, change is not occurring fast enough and funding for this cause is inadequate. Worldwide, approximately one in five girls under 18 are married or in a union and many are already mothers. The world's highest rate of child marriage is in Niger at 76%.

    Now that the economic costs are clear, this is a good time to address the problem. Ensuring access to safe, quality education is a key to ending child marriage. Girls must be given the tools for success. In order for this cause to be successful rich countries must join the fight. Justin Trudeau, the Canadian Prime Minister, has vowed to make gender equality a theme in discussions with other G7 ministers.

    The World Bank estimates that, by banning child marriage, Niger would save $1.7 billion in welfare costs. Bangladesh's savings would be approximately $4.8 billion, and Nigeria's $7.6 billion.

    Even though the number of girls married is declining each year, change is occurring too slowly. If the world does not act now and invest more in this cause, population growth will overtake gains and the number of child brides will be on the rise again. doclink

    Population and Family Planning Programme: What We Achieved

    August 9, 2017, Daily Sun   By: Dr. Noor Mohammad

    Bangladesh has grown from 75 million people in 1971 to almost 160 million today, more than double in 46 years. The United Nations estimated in 2015 that the population of Bangladesh would be about 202 million in 2050.

    The last census (2011) showed an increase of more than 20% in a decade, which is higher than that of immediate past decade seen from 1991 to 2001 at 17%.

    Bangladesh has a population an average population density of 1,070 persons per sq. km, which is one of the highest in the world. The life expectancy at birth is 71 years, with women having slightly higher lifespan than men (72 years vs. 69 years).

    Bangladesh is now experiencing a demographic transition with the continuous decline trend of the natural growth rate. The population growth rate in Bangladesh was 1.37%. Bangladesh is an intermediate position between low-growth countries, such as Thailand, Sri Lanka and Myanmar and medium growth. Medium growth countries in the region are India and Malaysia.

    Bangladesh's Family Planning Program has had a tremendous role in slowing population growth over the last 50 years. Bangladesh's progress in the family planning movement has been cited as one of the role models to follow. Family Planning was introduced in Bangladesh (then East Pakistan) in the early 1950s through the voluntary efforts of social and medical workers. The government of Bangladesh, recognizing the urgency of its goal to achieve moderate population growth, adopted family planning as a government sector program.

    Beginning in 1972, the FP program received virtually unanimous, high-level political support. In 1976, the government declared the rapid growth of the population as the country's number one problem and adopted multi-sectoral FP program along with National Population Policy.

    From extremely high levels of 6.3 in 1975, to 3.3 in the year 2000, the Total Fertility Rate (TFR) now stands as 2.3 according to the Bangladesh Demographic and Health Survey 2014, which is still some distant away from replacement fertility levels. According to the Population Reference Bureau (PRB) in 2003, even if Bangladesh reached replacement level fertility, population stabilization would take another 15 years, and the growth is being fuelled by the large young population of the country. PRB predicted the replacement level fertility by 2010 which did not take happen.

    The 1980s saw a steep decline in TFR.This was followed by a decade-long plateau which was the consequence of a 'tempo effect'. The adoption of FP by Bangladeshi couples has always been after the first birth. The age at marriage did not change and there was no delay in age at first birth, and as such, no tempo effect was operating on first births. The 2004 Bangladesh Demographic and Health Survey showed a 9% reduction in fertility, from 3.3 to 3.0, over a decade. The 2011 BDHS confirmed a further decline in TFR to 2.3 children per woman but again it has stalled. Now, however, fertility levels are quite uneven - remarkably low in the west of the country (below replacement, on average) and worryingly high in the east (up to 1.5 children above replacement).

    In order to attain any of the reasonable population estimates projected for mid-century (which range from 194 to 222 million) a substantial increase in the contraceptive prevalence rate (CPR) will be required in the next five years by 2022. This target could theoretically be achieved if all current unmet needs for FP (12% in 2011) are met.

    Bangladesh has considerable built-in population momentum because of high fertility in the past, and even with reduced fertility, many young women will pass through reproductive ages over the coming decades. During the first decade of the 21st century, the number of women of reproductive age increased from around 32 million to 41 million as the children born in the higher fertility 1970s and early 1980s entered their childbearing years, according to UN estimates.

    Investments in female primary and secondary education in Bangladesh manifest themselves in improved opportunities for formal sector employment for young women, and parents will tend to favor smaller families, investing more per child in education-quality versus quantity. This trend will also be influenced by the saturation of the rural labour force and the fragmentation of agricultural land holdings such that there will be decreasing employment opportunities for unskilled workers.

    Having a huge mass in the youth age population is worrying. If they don't get the job on time or get the opportunity to have the skills for future earnings, some of the social menaces will continue, like dropping out from the schools, early marriages followed by early pregnancies. This vicious cycle will become the hindrances of our national programs that contribute to continue fertility decline and population growth.

    A stagnating CPR is a cause for concern. While the government through its new plans to expand the contraceptive mix by specially promoting permanent methods, it should also think of fertility awareness based methods, such as long acting methods (LAM), which mimic traditional methods and may be more acceptable to users of traditional methods.

    To increase levels of unmet need, the government, with help from its non-governmental partners, should continue with its family planning messaging and counseling services and try and match the demand for family planning services and supplies.

    Bangladesh has a high adolescent fertility rate, one of the highest amongst the south-east Asia region nations. Early initiation of child bearing leads to rapid increases in population by not only lengthening the productive period in the woman's life, but also by shortening the inter-generational span. As most of the adolescent child bearing occurs within the realm of marriage, it means that the law governing the age at marriage needs a much stricter reinforcement. It is heartening that the government plans to make special efforts to reach out to adolescents with family planning messages and individual and community level counseling services. doclink

    Karen Gaia says: One of the main reasons that fertility rates stalled at around 3.0 was because of male preference, and also because Bangladesh's education program had not yet produced a large cohort of girls going through high school. A woman who has a high school education will have two fewer children than her non-educated peers.

    A New Strategy to End Child Marriage

    June 27, 2017, National Public Radio   By: Nurith Aizenman

    By 2030 child marriage will cost developing countries billions of dollars in health-care and education costs as well as lost earnings potential, according to a new report by the World Bank and the International Center for Research on Women (ICRW). ICRW is a global research and advocacy group that analyzes the impact of child marriage on the national budgets and economic growth of 25 countries where at least one in three women marry before age 18.

    Suzanne Petroni, one the report's co-authors and a senior director at ICRW charged with expanding the evidence base on child marriage, is hoping the data will be a wake-up call for governments. "If we could document and show finance ministers, policy makers, donors and communities that child marriage has a cost to their bottom line budgets, we may finally be able to spur investments in solutions," she said.

    The report estimates that a girl marrying at 13 will have an average of 26% more children over her lifetime than if she were married at 18 or older. For the countries studied, ending child marriage would reduce total fertility rates by an average of 11%. In Niger, over three-fourths of women are married before age 18. Ending child marriage would slow population growth by 5% by 2030.

    The additional children that are being born as a result of child marriage drive up government spending. In the 18 countries analyzed, the study found that curbing the growth resulting from additional children born as a result of child marriage would save as much as $17 billion a year from the education budget.

    The theory that 'rising births can be a boon to a country with a larger workforce down the line' only works if the country provides its children with enough education to grow into economically productive adults. This generally does not happen in countries with high rates of child marriage.

    "Child marriage for the most part takes place in situations of poverty," she says. "And the offspring of child brides tend to be not just more children, but also children who less healthy, less educated and less able to contribute economically to their countries."

    The study finds that child marriage can also damage a country's overall economy because of the devastating impact that under-age marriage has on a girl's educational prospects, which, in turn determine her earning power.

    Studies indicate that child marriage and lack of education are closely entwined. Child marriage reduces the earnings in adulthood for women by an average of 9%. In Nigeria alone that amounts to $7.6 billion annually in lost earnings and productivity.

    The answer is to get more girls into high school. In those 15 countries analyzed in greatest depth, it was found that every year of secondary education reduces a girl's likelihood of marrying as a child from four to 10 percentage points depending on the country.

    "One of the biggest messages from this study is just how important education is," says Petroni. "It would be great if finance ministers would come away from this committed to invest in quality education for girls." doclink

    Karen Gaia says: In the Maasai Harmonial Sustainability and Development area in Tananzia, girls (and boys) are hampered because school is not taught in their native language. To get through high school they must learn both Swahili and English. Most do not make it into high school, especially girls. Girls who are not in school are married off. Efforts are now being made to beef up the children's early education so that they can make it through primary school and into school. Also children are being sent to government boarding school, which has the advantage of making sure children are fed, as hunger is also a problem. This takes the burden off of parents, who will now be less likely to marry off their daughters. See

    Malawi's Fearsome Chief, Terminator of Child Marriages

    Chief Kachindamoto has broken up 850 child marriages in three years, and banned the sexual initiations of young girls.
    March 31, 2016, AlJazeera   By: Hannah Mcneish

    Theresa Kachindamoto, the youngest of 12 siblings, a woman, and a mother of five, was elected chief of more than 100,000 people because she was "good with people." She donned the traditional beads, red robes and a leopardskin headband, toured the rows of mud-walled, grass-thatched homes to meet her people.

    She was shocked when she saw girls as young as 12 with babies and teenaged husbands, and was soon ordering the people to give up their ways

    "I told them: 'Whether you like it or not, I want these marriages to be terminated.'"

    As of 2012 more than half of Malawi's girls were married before the age of 18, according to the U.N. Malawi was ranked 8th out of 20 countries having the highest child-marriage rates in the world.

    Malawi had passed a law forbidding marriage before the age of 18, but Malawian children can still marry with parental consent.

    Malawi ranks 160th out of 182 nations on the human development index. Early marriage is more common in rural areas, where parents are eager to get girls out of the house to ease their financial burden.

    Emilida Misomali is part of a mothers group in the village of Chimoya, in Dedza district says: "We see a lot of complications, like cesarean births and girls cut as their bodies are too small to give birth."

    Sometimes girls bound for marriage are forced attend sexual initiation camps where they are are taught 'how to please men' by performing titillating dances and sex acts. Some girl's parents hire a "hyena" - men whose job is to take their girls' virginity. Some parents allow prospective grooms to impregnate the girls.

    These rites of passage can result in a STD or HIV infection, sentencing girls to a lifetime of trauma, and an early death.

    Kachindamoto has banned these kinds of cleansing rituals.

    There is also the local belief that sick men can cure themselves by having sex with virgins.

    One in five Malawian girls is a victim of sexual violence, as is one in seven boys, according to the UN Children's Fund, UNICEF. Its survey found that most abusers are people that children trust and are related to, such as uncles, stepfathers and fathers.

    Some traditions require that girl is required to have sex with her uncle or step-brother if she goes to a house to take care of an aunt or older sister when they are sick.

    Kachindamoto got her 50 sub-chiefs to sign an agreement to abolish early marriage under customary law, and annul any existing unions in her area of authority.

    Male chiefs were fired in areas where child marriages were still taking place. If the chiefs got the marriages undone, she hired the chiefs back.

    She then drew community members, the clergy, local committees and charities together to pass a bylaw that banned early marriage under the civil law.

    Over the past three years, Kachindamoto has broken up more than 850 marriages, and sent all of the children involved back to school.

    Kachindamoto says she often pays for, or finds other sponsors to pay for, the schooling of girls whose parents cannot afford to pay school fees.

    Through a network of "secret mothers and secret fathers" in the villages, Kachindamoto checks that parents aren't pulling girls out of school. She sends in outside allies to keep them there.

    Last year, this included sending Malawi's female MPs to rural schools. The girls in the community suddenly became eager to learn English - the language spoken in parliament. doclink

    Researching the Connections: Challenges and Opportunities

    December 1, 2015, Family Planning and Environmental Sustainability Assessment   By: Lori Hunter

    The Family Planning and Environmental Sustainability Assessment (FPESA) project has undertaken an important and challenging agenda, one with tremendous implications for the well-being of human populations and the planet.

    However there has been little scholarship directly linking family planning to environmental sustainability. This is due to a) research design challenges, b) complexity and intervening factors that challenge researchers' ability to isolate the effects of family planning on environmental conditions, since environmental change arises from myriad socio-economic and environmental processes, c) demographic theory that historically has not integrated environmental factors; because theory guides academic research, this is one reason that the population-environment connection is under-studied, d) disconnects between researchers, practitioners, and funding agencies that constrain collaboration.

    Recently, there have been several innovative approaches to research design:

    The Wolong Nature Preserve in southwestern China's Sichuan Province is home to 4,500 people while also providing critical habitat for the endangered giant panda. To simulate future habitat loss under a variety of family planning scenarios, researchers from Michigan State University linked population and household dynamics to land use and then estimated the amount of habitat change projected under different family planning scenarios. They found that increasing the maternal age at marriage would produce positive habitat impacts in only 10 years while overall fertility changes shape habitat loss only in the longer term (40 years).

    In a second example, Oregon State University researchers used mathematical modeling of the contribution of population to climate change by estimating the extra carbon dioxide (CO2) emissions caused by childbearing -- an individual's "carbon legacy" as related to fertility choices. When considering descendants across two generations, under current conditions in the United States, they found that each child adds over 9,000 metric tons of CO2 emissions for an average individual. This suggests that a reduction of one child would bring dramatically more emission savings than reducing driving miles, replacing single-paned windows, and replacing lightbulbs.

    In another example, Leona D'Agnes and colleagues determined that programs that integrated reproductive health and environmental conservation yielded greater reductions in the average number of children born and greater socio-environmental outcomes. By collecting pre- and post-project data in communities with different types of interventions, statistical models could be used to estimate the utility of linking family planning and conservation efforts.

    But FPESA's approach also considers the importance of focusing on research that examines the connection. Documenting what is known about the connection between family planning and population growth should help activists, practitioners and policymakers better make the connection between family planning, population growth, and, ultimately, environmental sustainability. doclink

    America's Child-Marriage Problem

    October 13, 2015, New York Times   By: Fraidy Reiss

    In the U.S. thousands of children under 18 have recently have been married - mostly girls married to adult men, often with approval from local judges.

    The minimum marriage age in most states is 18, but every state allows exceptions under which children under age 18 can wed. Most states allow children age 16 or 17 to marry if their parents sign the marriage license application, but state laws typically do not call for anyone to investigate whether a child is marrying willingly. In most states there are no laws that specifically forbid forced marriage.

    The second common marriage-age exception is for children marrying with judicial approval. This exception lowers the marriage age below 16 in many states, and many states do not specify a minimum age. Judges in those states can allow the marriage even of an elementary school student.

    In New Jersey, 16- and 17-year-olds may wed with parental consent, and children under 15 may marry with judicial approval. 3,499 children were married in New Jersey between 1995 and 2012. Most were age 16 or 17 and married with parental consent, but 178 were between ages 10 and 15, meaning a judge approved their marriages.

    91% of the children were married to adults, often at ages or with age differences that could have triggered statutory-rape charges, not a marriage license. In 2006 a 10-year-old boy was married to an 18-year-old woman. In 1996 a 12-year-old girl was married to a 25-year-old man.

    The Tahirih Justice Center, an NGO that provides services to immigrant women and girls, identified as many as 3,000 known or suspected forced-marriage cases just between 2009 and 2011, many involving girls under age 18. Tactics used against the victims included threats of ostracism, beatings or death.

    The survey found child marriage or forced marriage, or both, in families of many faiths, including Muslim, Christian (particularly Catholic), Hindu, Buddhist and Sikh. There have been child and forced marriage in the Orthodox Jewish community, and also in the Mormon and Unification Church backgrounds.

    Reasons parents force their children into marriage include controlling the children's sexuality and behavior and protecting "family honor." Often families use forced marriage to enhance their status or gain economic security.

    The New Jersey data show that 90% of the children married were girls, which is consistent with global trends. Across the world, child marriage and forced marriage disproportionately affect girls and women.

    Unchained at Last also requested health department data on the ages of people recently married in New York State, where 16- and 17-year-olds may wed with "parental consent" and 14- and 15-year-olds may wed with judicial approval. The data show that 3,853 children were married between 2000 and 2010.

    In New York, 2011 data shows that a 14-year-old married a 26-year-old, a 15-year-old was wed to a 28-year-old, another 15-year-old was wed to a 25-year-old and a 15-year-old married someone age "35 to 39."

    Globally, 88% of countries set 18 as the minimum marriage age, but over half allow minor girls to marry with "parental consent," according to the World Policy Center. More than 700 million women alive today were married before 18, including some 250 million who wed before 15, according to the United Nations Children's Fund. Most live in South Asia or sub-Saharan Africa, but as these new numbers show, too many live right here in the United States.

    A recent report found that child marriage "undermines girls' health, education and economic opportunities, and increases their risk of experiencing violence."

    State legislators should eliminate the archaic legal exceptions that allow children to wed. doclink

    Men Are Stepping Up to Fight Child Marriage in Pakistan

    Men make up the majority of a rights group working to protect girls and women.
    August 14, 2015, Take Part   By: Amber Dance

    A non-profit Pakistan-based organization named Sujag Sansar (SSO) focuses on human rights issues not often addressed by politicians, including women's rights, child marriage, educational access, environmental protection, and clean drinking water.

    To combat child marriage, they produced a play depicting a young girl forced into marriage and the struggles of life as a child bride. By the end of one performance, several were weeping openly and many resolved to protect their daughters from the same fate. In Dadu, one of the provinces where SSO operates, girls are often married off when they're as young as 10 -- even though legislators recently raised the age to 18 for women, according to Birhamani. SSO's research indicates 35 to 37% of marriages in Sindh province involve child brides. Families often offer their daughter as a bride in exchange for money. While Pakistan law requires that a woman consent to her partner, the law is rarely enforced and many women are unaware of that right.

    There are many problems associated with child marriage: teens are more likely to die in childbirth than older women. Young wives usually aren't allowed to attend school and have little hope of earning money to support their families. Women fall victim to domestic violence, or the families of the married couple may argue and feud, which could escalate into tribal battles and honor killings.

    Some religious leaders preach say it's against Islamic law for a girl to live with her parents after puberty.

    When families still attempt to pursue child marriages, SSO recruits community leaders to try to prevent the marriages. The organization also educates religious leaders about the consequences and so far, 35 locals have pledged to verify ages before performing a wedding. SSO has also organized villagers into committees that notify police and journalists if they become aware of an underage marriage being planned; since 2010, they've prevented 33 underage marriages in the district.

    Seven out of 10 SSO board members and 200 of the 300 volunteers are male. This is because cultural traditions discourage women from working outside the home, according to Mashooque Birhamani, SSO's chief executive officer. He hopes this will change in time. "These issues are basic issues that are keeping our society from progressing. The time will come when women will be empowered and they will replace men [in the organization] and work for their rights," he says.

    SSO has also opened primary schools and enrolled 547 girls since 2006. Graduates hope to gain admission to secondary schools in cities and eventually universities. Clean water is also a major issue-many citizens, usually women and children, must walk five or more miles in search of drinking water. The task often keeps children, particularly girls, out of school.

    SSO's theater performances encourages members of the audience to advocate peacefully for the government to provide a water supply. Other projects include advocating for preservation of forests and assisting people affected by flooding.

    "We are seeing that the future will be bright...with betterment and good hope for all," Birhamani said. doclink

    Ending Child Marriage by Moving in Waves: Video Message From Graça Machel

    July 29, 2015, Girls Not Brides Campaign

    As Girls Not Brides reaches 500 members, Graça Machel, champion and co-founder of Girls Not Brides, celebrates the global movement's achievements towards ending child marriage and emphasizes the urgent action that remains to be taken. doclink

    A Strange Map of the World's Child-Marriage Laws

    When it comes to statutes prohibiting minors from getting married, the U.S. is more like Latin America than Europe.
    March 9, 2015, Atlantic Monthly   By: Olga Khazan

    The Clinton Foundation recently released an article on child marriage. Russia, China, and Ethiopia prohibit marriage before the age of 18, but many countries in the Americas allow it with "parental consent and/or under customary law."

    Child marriage "limits the full potential of girls" and "undermines health, education, economic opportunity, and security." Early wedlock is most common among the world's poorest children

    One 2004 study found that teen marriage in the U.S. increased by nearly 50% in the 1990s thanks to "the spread of abstinence-only-until-marriage sex education at American schools, a shift toward cultural conservatism among some teens, and a growing fear among youngsters of contracting AIDS through promiscuity," according to the Chicago Tribune.

    Still, child marriage is much less of an issue in the U.S. than it is in other countries with similar laws. By 2002, only about 0.1% of American girls were married by 18. Meanwhile, in Niger,39% of girls are married by 18, and 22% in Bolivia.

    Some American child marriages are the result of attempts to prevent the imprisonment of the older partner for statutory rape.

    Even though American teens who get married might have more say in the matter than their counterparts in other countries, many advocates believe permissive child-marriage laws can still be harmful.

    Visit the article by clicking on the link in the headline to see the child marriage maps. doclink

    Hard-Working Nurses Go the Extra Mile to Bring Women Choice in Kenya

    February 19, 2015, Marie Stopes

    Marie Stopes International nurse Grace Okeyo tours rural Kenya, advising people steeped in superstition that family planing is not the devil so many make it to be.

    "The cultural belief in rural Kenya is that you should not have contraception until you have had your first child, which can mean being as young as 13 or 14. At this age, the risk of dying during pregnancy or childbirth is extremely high and once girls have had a baby they are unable to continue with their education," she said.

    "We need to give girls the information that they need to understand about sexual activity and its risks, and make sure that they can get a family planning method if they want to avoid getting pregnant," she said.

    One of the biggest challenges is the involvement of men, who play a huge part in decision-making in Kenya when it comes to contraception. "When you get a man and woman making a choice together on what is best for them - that is where you know that family planning will be a life-long choice." But "until there is more social and cultural change, we have to fit in around women and their requests for secrecy." That often means helping women to push the boundaries and be courageous. doclink

    Malawi Bans Child Marriage, Lifts Minimum Age to 18

    February 17, 2015,   By: Reuters

    Malawi is a southern African country where half of girls end up as child brides and nearly one in eight is married by 15.

    Women rights campaigners hailed the ban as "a great day for Malawian girls" and said the law would help boost development in one of the world's poorest countries.

    Child marriage is deeply entrenched in Malawi's society partly because of a belief that a girl should marry as early as possible to maximize her fertility.

    Women rights advocates warned Malawi would not end child marriage without concerted efforts to tackle poverty and end harmful traditional practices like early sexual initiations. doclink

    Child, Bride, Mother

    February 8, 2015, New York Times   By: Stephanie Sinclair

    In Guatemala the legal age of marriage is 14 with parental consent. In the Petén, in northern part of the country, the law seems to be more of a suggestion.

    In the villages of Guatemala, about 53% of women age 20 to 24 were married before age 18, and 13% before age 15, according to the Population Council. Many of these girls had withdrawn from their educations; were subject to physical and sexual violence; risked dangerous pregnancies and went without crucial medical care. Their lives were controlled by older men who considered the girls little more than sexual and domestic servants.

    These physically immature and psychologically unready young mothers were prone to complications during childbirth, which often took place at home. For girls in Petén villages, the journey to competent care could take hours and the consequences dire. Petén has the highest rate of maternal mortality in Guatemala. The infant mortality is also high.

    The Too Young to Wed transmedia project, a partnership with the UNFPA - United Nations Population Fund, produced poignant images and a video which can be seen by following the link in the headline. doclink

    Can Young People End Child Marriage?

    These seed grants were funded by Johnson & Johnson and WomanCare Global via the Women Deliver C Exchange Youth Initiative.
    November 4, 2014, Women Deliver   By: Yemurai Nyoni

    At ICASA 2013 the Minister of Health from Zimbabwe expressed doubt about the plan to end child marriage in Zimbabwe, saying "it's a deeply complicated issue..."

    However, in the last few months, the Rising Birds Team, under the rebranded Dot Youth Organization (formerly Bulawayo Youth Development), has taken up this challenge and exemplified the actions we need to take as young people to create the future we want. Our job has been to provide an experience-based answer to the question: 'Can young people end child marriage?'

    The Rising Birds project has reached over 100,000 people with information on child marriage through low-cost online platforms like Facebook and Twitter.

    Through collaboration with young leaders in different parts of the country nearly 500 signatures were collected to petition the House of Parliament to enact laws to end child marriage. There has been marching in the streets of the capital city to focus public attention on the urgent need to end child marriage.

    However, the movement lacked the reputation, resources, and expertise to follow through and yield significant change from the challenge, while experienced organizations with this capacity have reneged on their commitments to support us, or not committed at all.

    Changing the law won't do it. There is need to address the deeper social determinants of child marriage if we are to end the practice. There is a lot we can do despite the limitations of our credibility, experience, and resources.

    We can end the silence around child marriage by communicating widely through our online and offline social networks. We need to keep doing fun activities like marches, photo shoots, online activities, and other exciting actions.

    We need to be visible by inviting the media to cover our activities and by supporting the initiatives of better-established organizations. This will increase the odds of getting support for future projects.

    I still firmly believe that ending child marriage as young people in Zimbabwe is possible and I acknowledge Women Deliver and partners in the C Exchange Youth Initiative for giving us a great start to our pathway to change. doclink

    Karen Gaia says: Go Rising Birds!

    Khadija's True Story of Girl Power in Malawi

    October 5, 2014, Global Fund For Women

    Khadija writes her own not-so-comic book with a real girl hero. Flip through the pages of her graphic novella to find out how grantee partner, Nkhotakota AIDS Support Organization (NASO), uses the power of education to empower girls to protect themselves from early pregnancy and stay in school in Malawi.
    . . . more doclink

    Drive to End Child Marriage Stalls, but Fightback Begins

    March 4, 2014, CNN Freedom Project   By: Gordon Brown, U.N. Special Envoy for Global Education

    This month's plan by Iraqi parliamentarians to legalize girl marriage at nine follows the Pakistan Islamic Council's demand last month that Pakistan abolish all legal restrictions on child marriage, the revelation that Syrian refugee girls are being sold into marriage against their will and the increased pressure in many African countries to ease the restrictions on selling child brides.

    The U.N. says one in nine girls is a bride by the age of 15 and that by 2020 142 million - or one in three girls in developing countries - will be married before they are 18. For example, in Afghanistan 60% are married before they turn 16 and in Niger 74% of girls are married by the age of 18.

    India has 40% of the world's child brides.

    This year a worldwide emergency coalition for education was launched. It will show that the answer to ending child marriage is to uphold the right of all children to be free of exploitation and involved in education.

    An Iraqi women's network, Nepal's Common Forum for Kamlari Freedom, the Ugandan Child Protection clubs, the Ghanaian Upper Manya Krobo Rights of the Child Club and Indonesia's Grobogan Child Empowerment Group are participating and defying parents and authorities who try to marry 8, 9 and 10-year-old children off against their will.

    Child-marriage-free zones, where girls club together to refuse to be married off, often defying their families' wishes, are springing up in the Indian subcontinent. The first has been formed in Pakistan. In Bangladesh there are now several zones and they are soon to be started in countries like Malawi. doclink

    Child Brides -- We Cannot Afford to Ignore Their Plight

    September 18, 2013, Huffington Post   By: Jeffrey Edmeades, Senior Social Demographer, International Center for Research on Women

    Genet was 13, about the size of an American 7 year old, and had been married for 2 years. She had dropped out of school shortly before she wed her now-husband, whom she met on the day of her marriage ceremony.

    One in nine child brides today are married before age15. And over the next decade, an estimated 142 million girls worldwide will become child brides.

    In a program called TESFA that is run by CARE and evaluated by the International Center for Research on Women (ICRW) married girls in the remote Amhara region of Ethiopia are taught the important life skills they missed out on in part because of their marriage.

    It is imperative that global policy makers determining the next generation of Millennium Development Goals (MDGs) keep young married girls -- and those at risk of becoming child brides -- at the forefront of their agenda. Eradicating and addressing the effects of child marriage has the potential to influence the success of every single goal identified in a UN Secretary-General's high-level panel report as being crucial to success of the post-2015 development agenda.

    Child marriage perpetuates poverty. It hinders economic growth in emerging nations. It contributes to maternal and child mortality and illness. It guarantees that fewer girls are educated and that fewer women participate in the labor force. It ensures a less inclusive and less sustainable development process.

    Little girls like Genet are robbed of their childhoods when they are forced to wed. Children of child brides are more likely to have a limited education and to be poor and unhealthy, thereby further contributing to the intergenerational continuation of poverty. Traditionally, many child brides remain mostly invisible in government statistics. They are not in school, they're not officially registered as being married, they use very few government services and they have not accessed health services. doclink

    Meet the Wedding Busters: Stopping Child Marriage in Bangladesh

    September 6, 2013, Girls Not Brides Campaign

    In Bangladesh, 66% of girls are married before they reach the age of 18, often depriving them of a chance for an education and condemning them to ill health and economic


    A group of children is challenging this harsh reality.

    With the support of Plan Bangladesh, they are committed to turning their communities into child marriage free-zones. They call themselves "the wedding


    Watch them in action.

    We would also like to extend our congratulations to Keshob, a member of the group, who was recently awarded the UN Special Envoy's "Youth Courage Award" for his efforts to end child marriage. He's leading the way for youth-driven


    More on the subject:

    @@029369 Getting Girls to School -- and Keeping Them There @@029364 The Indestructible Spirit of Child Brides in Afghanistan @@029357 Child Marriage in the Arab World doclink

    'i Have Seen My Friends Die': Why We Need to Talk Frankly About Girls' Reproductive Health

    July 9, 2013, Huffington Post

    Last year at the London Family Planning Summit a global movement was catalyzed to ensure that 120 million more women and girls have access to contraception by 2020. World Population Day 2013 focuses on adolescent pregnancy. Complications in pregnancy and childbirth are the leading causes of death among adolescent girls ages 15-19 in low- and middle-income countries.

    One in three of girls under 18 in the developing world are married; many without their consent. 15% of all unsafe abortions in low- and middle-income countries are among adolescent girls aged 15-19 years.

    Because of these alarming numbers, we need to talk frankly and openly; we cannot shy away from tough conversations when girls are at risk.

    Young women face barriers when they seek contraception or access to information and commodities to practice safer sex. This must stop.

    A young woman in Ethiopia, Haregnesh, says girls she knows who were very young when they got married and starting having children and she has see some of them die. "I have seen educated people and I saw the difference in their lives. ... I watched as they had no food to eat or feed their children and they just kept getting pregnant and having babies. I could see that they were suffering and I wanted to go to school." A Pathfinder International program in Amhara, Ethiopia supports girls to continue their studies. Haregnesh's strength and resolve to stay in school, as well as talk openly about girls' education, early marriage, and childbirth, has shifted the approach to girls' education in her family and in her community.

    Haregnesh's father, who had not wanted her to attend school said. "Haregnesh is our third child and she made all the change happen in our family. My three younger children now attend school as well."

    We must commit to ensuring adolescent girls have the support and resources they need to delay marriage and childbirth, stay in school, and start their adult lives the way each of them want to. doclink

    Karen Gaia Pitts says: it is important to note that patriarchal attitudes can be changed. That is why I am such a fan of programs like PAI's or the Population Media Center soap operas.

    MPs Call for Attention to Adolescent Pregnancies on World Population Day

    May 7, 2013, UK All Party Parliamentary Group on Population, Development and Reproductiv

    On Wednesday 10th July 2013, politicians and leaders in adolescent, maternal and reproductive health from around the world will meet at the Houses of Parliament for World Population Day. They will discuss progress on last year's London Summit on Family Planning (FP2020) and look at integrating recent research findings on improving access to contraceptives and family planning information.

    The focus this year is adolescent pregnancy, in recognition of the fact that there are 16 million adolescent pregnancies worldwide every year. The UK has the highest teen pregnancy rate in western Europe, with over 38,000 adolescent girls getting pregnant in England per year. Teen pregnancies carry greater risks of complications, including serious injuries and conditions such as obstetric fistula, as well as higher incidences of stillbirth, miscarriage and maternal death. In Africa, complications in pregnancy and childbirth are the leading killer of adolescent girls.

    Justine Greening MP, Secretary of State for International Development, has said: "The UK Government is committed to putting girls and women at the centre of international development. Delaying first pregnancy can be a game changer for adolescent girls - enabling them to have greater opportunities in life. However, this requires that we understand what it is to be a girl in society and tackle holistically the factors that affect her sexual and reproductive health and rights - including, for example, child marriage, coerced sex, girls' education and access to family planning."

    Professor Joy Lawn, Director of the Centre for Maternal, Reproductive Adolescent and Child Health at the London School of Hygiene & Tropical Medicine, said: "Today's generation of 1.2 billion adolescents is more than ever before, facing more opportunities and yet still too often their lives are changed forever by early, risky pregnancies they did not choose to have - 16 million pregnancies a year, many unplanned. Programmes, funders and researchers need to deliberately include adolescents."

    Adolescents account for nearly one fifth of the world's population: 1.2 billion people are aged 10-19 years and 90% of adolescents live in developing countries

    About 16 million girls aged under 18 give birth each year and these young mothers are the most likely to experience disabilities such as obstetric fistula, die from complications or experience a stillbirth or newborn death.

    * 50,000 girls die of pregnancy related complications each year.

    * In Africa, complications in pregnancy and childbirth are the leading killer of adolescent girls.

    * Unsafe sex and lack of contraception are the main risk factors contributing to DALYs (disability-adjusted life year is a measure of overall disease burden, expressed as the number of years lost due to ill-health, disability or early death) in young women aged 10-24 years.

    3.2 million girls aged under 18 undergo unsafe abortions each year. Adolescents are more likely than adults to delay abortion and hence have a later, riskier procedure.

    90% of the pregnant adolescents in the developing world are married. For far too many of these girls, pregnancy is a consequence of discrimination, child marriage, inadequate education or sexual coercion.

    * Nearly one in every four girls aged 15-19 in the developing world (excluding China, where comparable data is not available) is currently married or in a union.

    * The South Asia (30%) and sub-Saharan Africa (24%) regions have the greatest proportion of girls aged 15-19 married or in a union. The percentage of boys the same age who are married or in a union is much lower (less than 5%) in these regions.

    An estimated 2.2 million adolescents, around 60 per cent of them girls, are living with HIV, and many do not know they are infected. New HIV infections in teenage girls are now also the major driver of the AIDS epidemic in Southern Africa.

    Many adolescent girls aged 15'19 have experienced sexual violence and domestic (intimate partner) violence is common among adolescent girls who are in relationships.

    The event is jointly organised by the UK All Party Parliamentary Group on Population, Development and Reproductive Health, the International Planned Parenthood Federation and the MARCH Centre of London School of Hygiene & Tropical Medicine. doclink

    In Ethiopia, Most Girls Who Marry Before 18 Have Never Been to School

    New Study Finds Girls Younger than 15 Especially Vulnerable to Arranged and Unwanted Marriage
    April 11, 2013, Guttmacher Institute

    Lack of educational opportunities for girls is fueling the Ethiopia's high level of early marriage, according to Annabel Erulkar, of the Population Council in Ethiopia. Of the 20-24-year-old women that she studied, 79% of those who had married before age 15 had never been to school and only 3% had attained any secondary schooling. Unschooled women had 9 times the risk of marrying before age 15 as women who had some degree of formal education and five times the risk of marrying at ages 15-17.

    Of those married before age 15, 97% had a mother with no education and 91% had a father with no education, compared to those who had not married during adolescence, 76% and 64%.

    89% of girls married before age 15 had arranged marriages, compared with 52% of those married at ages 18-19. 71% of girls younger than 15 had not met their spouse until the wedding day. and only 33% had known about the marriage beforehand, and just 31% wanted to be married at the time.

    Those who had married before age 15 were far less likely to have wanted to have sex than were those who had married at ages 18-19 (49% vs. 85%). The youngest brides were more likely than older brides to have recently experienced intimate partner violence at the hands of their husbands.

    Girls in rural areas - with high rates of poverty and where cultural beliefs and social norms uphold the practice - were found to be four times as likely as urban girls to marry before the age of 15. In the Amhara region, the median age at marriage among females is 14.4.

    Community-based programs that get girls into school and keep them there may be more effective at combating early child marriage than strategies that address girls already in school or seek to change community attitudes toward early marriage. doclink

    Early Marriage Has Consequences for Development

    December 29, 2012, Population Reference Bureau blog

    Fifty-eight million girls in developing countries were child brides in the last decade. This PRB ENGAGE Mini-Presentation highlights the consequences that early marriage can have for girls, such as poor health outcomes and lost opportunities for education and empowerment. But effective strategies to address early marriage do exist and can help millions of girls fulfill their potential and contribute to the development of their families and communities. doclink

    Developing nations: Ending the Curse of Child Brides, One $25 Goat at a Time

    November 27, 2012, Bloomberg Business Week

    The idea that girls should get the same education as boys seems to be gaining acceptance. However, in the developing world, there are impediments to keeping girls in school, the biggest being the stubborn persistence of child marriage.

    About 10 million marriages occur worldwide each year in which at least one spouse, usually the female, is younger than 18. In 16 countries, half of girls marry by that age. West Africa has the highest incidence of child marriage. In Niger, 36% of girls are wed before turning 15.

    High child-marriage rates are associated with weak indicators in maternal health, education, poverty, food security and HIV incidence, since badly informed and weakly connected mothers make poor decisions for themselves and their families.

    In the developing world, a baby born to a mother under 20 is 50% more likely to be stillborn or die in the first month than one born to a mother 20 to 29. Pregnant girls younger than 15 are five times more likely to die giving birth than women over 20 are.

    Often the birth canal is not large enough, causing obstructed labor, which results in obstetric fistula, a condition where there is constant leakage of urine or feces due to the damage of prolonged obstructed labor; such girls are often cast out of society.

    Girls who marry young also typically leave school. Their children are more likely than those of older brides to be undereducated and malnourished.

    Often the wife is much younger and her husband, which translates to a power imbalance that often leads to spousal abuse.

    While several countries have increased the legal marital age to 18 to comply with international conventions defining marriage as an agreement between consenting adults, legal change alone has made little difference. The prevalence of child marriage is decreasing -- but very slowly. Some countries even want to reverse the law and lower the marriage age.

    Parents often see educating a daughter as a waste of resources and think of early marriage as a way to eliminate an economic burden. But there are programs that seek to reverse this economic dynamic and have successfully reduced child marriages. In a rural area of Ethiopia, for example, parents of girls 10 to 14 were given $6 to pay for their daughter's school supplies plus a goat worth $25 if she remained enrolled for two years. As a result, girls in the program were one-tenth as likely to be married and three times as likely to be in school as their peers. Similar programs in Malawi and Bangladesh have also reduced child-marriage rates.

    When parents can afford to keep a daughter at home, they tend to see their daughters as children who will later give them a a return on investment in education for jobs. And schooling gives girls the skills, social networks and confidence to better negotiate their futures.

    But these interventions need to be expanded beyond the pilot stage. Funding is needed and governments need to make them part of national education policy. In Ethiopia, for example, the local authorities partnered with the Population Council, which received funding from the Nike Foundation, the United Nations and the U.S. Agency for International Development. doclink

    Bangladeshi Girls Call in 'Wedding Busters' to Tackle Child Marriage

    October 12, 2012, Guardian News

    In the poverty-stricken, deeply conservative northern districts of Bangladesh, children defer to elders. So when 13-year-old Rehana was faced with the consequences of early marriage - an end to school, isolation from her friends and a life of hard work at her in-laws, she knew outright rebellion was out of the question. Fortunately she knew exactly who to call: the district's "wedding busters", a movement consisting of 11 groups of around 20 youngsters, campaigning against child marriage.

    Rehana's mother argued. "Who will help us find a nice boy when she gets older?" ... "And who will protect Rehana on her way to school?" Antara, 16, one of the leaders of the child protection group could not argue. "All we can do is show them that child marriage is a curse."

    The intervention of such groups is a key reason why all of the areas' unions or local councils have been able to declare their respective localities "child marriage-free zones" - in a country where almost one -third the children is married off by age 15.

    Myrna Evora, country director of Plan Bangladesh, a children's charity that campaigns against early marriage said: "Early and forced marriage often drives girls into a cycle of poverty and powerlessness. They tend to miss out on an education, suffer from poor health and give birth to children who are also weak and malnourished."

    Shamsul Haq, a local council chairman, said "You can't defeat something like this with heavy-handed law enforcement." Although Bangladesh in 1984 made it illegal for males under 21 and females under 18 to marry, enforcement remains lax.

    There is widespread ignorance about the health consequences of early marriage. Child brides become part of a vicious cycle of chronic malnutrition and are at high risk of death during childbirth. Unicef's State of the World's Children 2011 report tells us that girls who become pregnant before the age of 16 are three to four times likelier to die giving birth than women in their 20s.

    Dr Mahbub Hasan, a surgeon, said "Because their bodies are not fully formed, they're at risk of prolonged or obstructed labour. This threatens the lives of both mother and child. Early marriage is hampering our efforts to bring down maternal and child mortality."

    In Bangladesh's entrenched and illegal dowry system - where a bride's family pays significant sums to the groom - encourages the marriage of adolescent girls, because younger brides typically require smaller dowries.

    The government, with support from the World Bank, has been giving small cash transfers or stipends to encourage girls to stay in school. According to a World Bank study, the overall proportion of females who married in stipend project areas declined between 1992 and 1995, from 29% to 14% for 13 to 15-year-olds, and from 72% to 64% for 16- to 19-year-olds.

    The wedding busters go from village to village, holding courtyard meetings and staging amateur plays. They can call on the aid of the local council chairperson and even the police chief. "The kids can stop 50% of child marriages by themselves. In the rest of the cases, we get involved," said Ehsan Chanu, former chairman of Mirganj local council. doclink

    In Niger, Child Marriage on Rise Due to Hunger

    September 16, 2012, Silicone Valley Mercury News

    51% of Niger children are stunted. One of three children die of hunger. Their graves dot the landscape.

    One of every three girls in Niger marries before age 15, one of the highest birth-rates in the world. By marrying off their daughters at such young age, it's one less mouth to feed and it brings in a dowry from the groom's family, money desperately needed to feed the mouths of the many other hungry souls.

    In the small hamlet of Hawkantaki (pop. 200), between the harvest of last year and this spring's planting, 9 of 10 girls between the ages of 11 & 15 were married or engaged. doclink

    Karen Gaia says: Girls whose bodies have not yet developed have many more problems giving birth to a healthy baby. The problem is greatly magnified by malnourishment.

    Sierra Leone: African Voices: Married and Pregnant at 12, a Wish for a Better Life for Her Daughters

    September 12, 2012, One   By: Kadiatu Blango

    Kadiatu was forced into marriage at age 12 and had a baby a year later. The baby's father left 6 months after she was married and she had no help from her mother or any other relative. She had her second child at age 18.

    Her father had died when she was 6 and she had to quit school and go live with her uncle, whose wife treated her like a servant while her other children were allowed to go to school. She was forced into the bondo society, a group that practices female genital cutting. She did not want to. She wanted to go to school, but her mother told her that she couldn't afford to pay school fees, even though she could afford to spend a lot of money on the initiation process. Once initiated, she was forced into marriage.

    Kadiatu supports herself and her children by selling wood, potato and cassava leaves. She doesn't want this kind of life for her daughters. "I want them to be free to get an education, and to not be worried about marrying too young or experiencing violence. I want them to grow up to be strong young women who can make their own choices, go to school, own land and control their own lives."

    Kadiatu says some of the main challenges faced by women are are: sexual assault and harassment, teenage pregnancy, gender based violence, lack of parental or family support, lack of finances to help support them on their day to day activities, and lack of access to land for farming and agricultural activities.

    She would like to see leaders promise to help tackle issues on poverty, teenage pregnancy and early marriage, HIV & AIDS; provide standardized free medical health services for all children and women; provide improved agricultural activities and revised land tenure systems for our community for suckling mothers to have easy access to backyard farming; and microfinance opportunities for women.

    She also wants to see help from world leaders in the areas of free education for girls at all levels; corruption, youth employment, and background information.

    About 34% of women aged 15 to 19 have either already had a baby or are pregnant. This also often leads to interrupted education, reduced earning potential, poor marital outcomes and reduced health outcomes for surviving children.

    In Sierra Leone about one-third of urban and one-sixth of rural 20- to 24-year-olds are out of work, and more than 17% of the urban populations aged 15 to 35 years are unemployed.

    Find out more at Restless Development is an agency that places young people at the forefront of change and development. It works in Africa and Asia to empower young people to take their lives into their own hand and trains, educates and inspires young people to be part of the solution. Find out more at doclink

    The British Child Brides: Muslim Mosque Leaders Agree to Marry Girl of 12... So Long as Parents Don't Tell Anyone

    September 9, 2012, Daily Mail   By: RYAN KISIEL

    In the U.K., Muslim clerics have been performing sharia marriages involving child brides as young as 12, an investigation found. Two imams have admitted they would be prepared to officiate at the wedding of an underage girl to a man in his twenties, despite fears the pair would later have sex.

    It is believed that 1,000 of the 8,000 forced marriages of Britons each year involve girls of 15 or under. In one case last year allegedly involved a girl of five.

    One Iman told an undercover reporter: 'Tell people it is an engagement but it will be a marriage,' ... 'In Islam, once the girl reaches puberty the father has the right, the parents have the right, but under the laws of this country if the girl complains and says her marriage has been arranged and she wasn't of marriageable age, then the person who performed the marriage will be jailed as well as the mother and father.'

    Islamic law allows a couple to have sex after marriage but, as the legal age of consent is 16, a husband can be prosecuted for rape if he has sex with an underage girl.

    Farooq Murad, of the Muslim Council of Britain, said: 'We are strongly opposed to it on the basis that it is illegal under the law of the land where we are living and even under sharia it is highly debatable.'

    The Home Office said: 'Child marriage is totally unacceptable and illegal. Perceived cultural sensitivities and political correctness cannot and will not get in the way of preventing and uncovering such abuse.' doclink

    Indian Girls Rebel Against Early Marriage

    September 3, 2012, Radio Australia

    Indian law prohibits marriage for children or women younger than 18. However, at least 200,000 underage girls in India are married off by their parents in India every year, in line with centuries of tradition. In the state of West Bengal some girls refused to marry until they finish their studies and are self-dependent.

    Bithika Das, is a 16-year-old child who stopped her marriage one and a half years ago. She lives in a small poor village. She has become an inspiration for many girls who don't want an early marriage, and dream of pursuing higher education and an independent career. When she was in ninth grade, her parents, because they were poor, fixed her marriage. She called Child Helpline and the helpline activists came to her house and stalled her marriage. Bithika says, by delaying marriage, she has chosen the path of self-empowerment.

    After marriage, young brides usually stop studying; become dependent on their husbands and end up doing nothing but housework.

    Illiterate parents do not understand that by educating their daughters they can empower the girls which can make their future brighter.

    Over the past two years in West Bengal, more than 100 under age village girls have thwarted their parents' plans to marry them off.

    Bithika said: Now I have got a first class in my high school leaving exam. I know I shall land a good job. After I marry in future, because of my job and strength, I shall get respect in my new family. No one will neglect me.

    Chandana Haldar is another local girl local who defied her parent's early marriage wishes. She said: "In this male-dominated society most women are subjugated into the typical role of producing children and work like a bonded labourer in the family. I shall force them to change their ideas about a woman. I shall show them that a woman too can match the strength of a man in many walks of life."

    Still close to half of women in India are being married when they are children. It is a violation of children's rights. It affects their health, their education, health of their children. Child marriage makes girls especially much more vulnerable to violence, to HIV etc. So, stopping their marriage and putting them back to school is key. doclink

    Battling Child Marriage in India

    August 26, 2012

    We hear the story of Sunitra, a 14-year-old child bride, as an example of the situation in India. She lives in a one room house in Delhi; the government doesn't know she is married, and her husband is more than twice as old as she is. Sunitra got pregnant a month after she got married "we don't have much money and life is hard," she said.

    A social worker named Amai, who herself was the victim of a child marriage when she was 15, says "We are working closely with the New Delhi government in order to give these girls more options," ... "I was lucky because I ran away and got help, but other girls are not so lucky and they don't know there are options."

    Minister Krishna Tirath reported "according to the National Crime Records Bureau, only about 60 incidents of child marriages were registered in 2010 and 113 in 2011." But Amai says that hundreds, if not thousands more go unregistered and young girls "are forced into marriages before they even know what is going on. People are poor and this is a way to get money." She feels that boosting the economic situation for the hundreds of millions of Indians who struggle on a daily basis is key to ending child marriages and pushing the country forward.

    Bihar and Rajasthan are the states with the highest rate of child marriages below the legal age of 18, according to an annual health survey for 2007-09; Bihar had 20.2% and Rajasthan had 21.9%. Most states have set up a Child Welfare Committee.

    But for young girls like Sunitra, being married is a safety net. She said that her parents had no other alternative than to marry her off. "They just wanted to give me a chance and being married is a start," she added. doclink

    Child Marriage Rising in Iran

    August 24, 2012, New Straits Times

    Farshid Yezdani of the Union for Protection of Children's Rights said some 713 marriages for children under 10 were registered in the country in 2010, twice than that recorded over the last three years.

    The number of marriages for girls in the 10-15 age range could be more, since only about 55% of child marriages are registered in cities and 45% in villages.

    Statistics for the 2005-2011 period revealed that 37,000 marriages for children aged 10 to 18 years old ended in divorce. doclink

    Child Marriage: Too Young to Wed

    August 5, 2012,

    Photographer Stephanie Sinclair has gone around the world documenting the issue of child marriage. doclink

    Early Marriage Robs Children of Their Opportunities

    August 1, 2012, Women Deliver

    The Elders, a group of independent leaders working for peace and human rights. One of their issues is child marriage, in a program called Girls Not Brides. Two of its members are Graça Machel, the first education minister of Mozambique and Desmond Tutu, archbishop emeritus of Cape Town and a Nobel Peace Prize laureate.

    In Bihar , a state in northeast India where, even though it is illegal by national law, 69% of girls are married before age 18. Child marriage have been arranged here for generations, because that is "the way things are." However, when people realize a tradition or practice is detrimental, they can and do change them.

    Wherever we visit as members of The Elders, girls and boys step forward and ask for their rights and dignity to be respected. Youths from the Jagriti campaign in Bihar, under the slogan "My life, my decision," have gathered more than 20,000 signatures from other teenagers, pledging not to marry early. In the rural Amhara region of Ethiopia, girls participating in the Berhane Hewan project told us they had formed clubs and were determined to support friends vulnerable to early marriage. The Berhane Hewan project is being scaled up across the Amhara region, where 80% of girls marry before age 18 and many marry at 12.

    Child marriage happens because adults believe they have the right to impose marriage upon a child. This denies children, particularly girls, their dignity and the opportunity to make choices that are central to their lives, such as when and whom to marry or when to have children. Choices define us and allow us to realize our potential. Child marriage robs girls of this chance.

    Child brides tend to drop out of school, making them far more vulnerable to a life of poverty, ill health and abuse. Child brides are more susceptible to death or injury in childbirth than are women in their 20s. They are particularly vulnerable to domestic violence.

    There was a rise in child marriages following the hunger crisis in Niger.

    100 million girls will marry as children in the next decade if current rates continue. Fortunately, momentum for change is building. There is the Berhane Hewan project in Ethiopia. Communities in Senegal are collectively pledging to end child marriage. Vice President Khumbo Kachali of Malawi recently committed to addressing by year's end inconsistencies in his country's laws related to the minimum age of marriage.

    The U.S. Senate passed, for the second time in two years, the International Protecting Girls by Preventing Child Marriage Act, which describes child marriage as a human rights violation and recommends an integrated approach to end the practice. Whether or not the House passes it, we urge the Obama administration to make eliminating child marriage a foreign policy goal.

    Without tackling child marriage, the U.S. government cannot hope to achieve its development ambitions.

    Girls Not Brides is a global partnership of more than 160 nongovernmental organizations. We are continually inspired by the individual girls, activists and community-based organizations courageous enough to stand up against child marriage, despite the opposition that challenging a traditional practice can bring. doclink

    Karen Gaia says: when young girls give birth before their bodies are ready, they can suffer an obstetric fistula, where they leak urine or feces and they are ostracized by their husbands and families.

    Former UK Prime Minister Gordon Brown Launches Campaign to Reduce Number of Child Brides

    March 9, 2012, Mail and Guardian

    Former prime minister Gordon Brown has made education in developing countries a campaigning cause since leaving office in May 2010. He said the issue has been "conspicuous by its absence" in the efforts to cut global poverty, bring down child and maternal death rates and get children into school, which are stated Millennium Development Goals to be achieved by 2015.

    Brown proposes a new global fund for education, similar to the existing global fund for Aids, TB and malaria, to support government programmes to help keep young girls and other marginalised children in school.

    Every year ten million girls under the age of 18 are married. Brown estimates that 1.5 million of them are under the age of 15. In Niger, 36% of girls are married by the age of 15. India, with 45% of under-18s married, has the highest number of child brides.

    Complications during pregnancy and childbirth are the largest killer of girls aged 15 to 19, accounting for 70,000 deaths a year. Girls 15 to 19 are twice as likely to die from complications during pregnancy and childbirth as those who give birth over 20, some suffer agonizing deaths from bodies too immature to give birth. 166,000 infant lives could be saved if their child mothers could delay birth until after age 20.

    "Coerced into lives of servile isolation and scarred by the trauma of early pregnancy, child brides are the victims of widespread and systematic human rights violations," he writes. "They represent a vast lost generation of children.

    Keeping girls in school will keep them out of early marriage he argues. Ten years ago, the numbers going to school and staying there rose sharply, but the early pace of change has not continued.

    "You are down to the children who are out of school because their family is so poor that they have to work, or they are an HIV orphan or a child bride." said Kevin Watkins, of the Brookings Institution in New York, who helped research the report. The drought in Kenya resulted in a surge in child marriage, the report notes. In Ethiopia "community conversations" with elders, adult female mentors for young girls and financial incentives to the family if a girl stayed in education all contributed to a successful program. Bangladesh provides stipends to 2.3 million girls conditional on staying in school, remaining unmarried and passing exams.

    Brown talks of "chronic under-financing of aid to basic education", which, at $3 billion a year, is only a fifth of what is needed to reach the millennium development goal target. He calls for an international summit on child marriage and reform of the international aid architecture to create a global fund capable of mobilising necessary resources, building partnerships and galvanising action... doclink

    Karen Gaia says: delayed marriage results in lower fertility rates and healthier families.

    It's All About the Wedding: How Preventing Child Marriage Can Help Eradicate Poverty

    February 3, 2012, Huffington Post

    American girls are lucky to grow up in a culture where girls can choose who and when they'll marry, that values women's contributions to the workplace and society; where motherhood is something a girl can aspire to (or not) when she's ready, not while she's still a child herself.

    But in the developing world 25,000 child brides get married every day, affecting 10 million girls every year. In the developing world, one in three girls under the age of 18 is married, one in seven is under 15 and it's not uncommon for 10 year-olds to marry men three times their age. Ask any girl's mother if early marriage and sex with an older man is what she hopes for her daughter and her answer might be similar to author Jeanne Faulkner's: "Oh, hell no." They just don't have any choice.

    As an advocate with CARE, the global humanitarian organization, Jeanne Faulkner lobbied hard in 2010 and 2011 for the passage of International Protecting Girls by Preventing Child Marriage Act, but the measure fell short in the House and failed. Some readers thought this legislation reflected American arrogance and disrespected the rights of other countries to live however they choose. But, this legislation would have protected the basic human rights of girls in countries where women are powerless. It would have gone a long way to eradicate poverty and protect America's foreign affairs investments.

    This year the act has been reintroduced as S. 414 and H.R.3357, providing Americans with a second chance to right a wrong. With 56 co-sponsors in the House, and strong support in the Senate, it would:

    * Express the sense of Congress that child marriage is a human rights violation, and undermines U.S. investments in foreign assistance to promote education and skills building for girls, reduce maternal and child mortality, reduce maternal illness, halt the transmission of HIV/AIDS, prevent gender-based violence, and reduce poverty.

    * Authorize the president to provide assistance, including through multilateral, nongovernmental and faith-based organizations, to prevent child marriage in developing countries, and to promote education, health, economic, social, and legal empowerment of girls and women.

    From an investment standpoint, preventing child marriage only makes sense. If our money goes to countries where girls get married, aren't educated, have limited job skills or control over their family size, health, finances and their human rights aren't protected, then we're not getting full value on our investment.

    When a girl in a developing country gets married, she drops out of school, quits working and has children. Children raised by uneducated, unemployed mothers grow up uneducated and unemployed too. Adolescent girls are five times more likely to die in childbirth than adult women. The children she leaves behind are 3-10 times more likely to die within the next two years.

    Eliminating child marriage will help girls, women and families rise above poverty. Without a basic education, girls are clueless about health issues that could save their lives and the lives of their children.

    Last week the World Economic Forum highlighted the movement led by The Elders to end child marriage. Chaired by Archbishop Desmond Tutu, The Elders is an independent group of global leaders brought together by Nelson Mandela, working for peace and human rights. Mary Robinson (the first woman president of Ireland and former U.N. High Commissioner for Human Rights), Jimmy Carter (former president of the United States), Kofi Anaan (former U.N. Secretary-General and Nobel Peace Laureat) and Gro Brundtland (first woman Prime Minister of Norway; a medical doctor who champions health as a human right) are among The Elders championing the end of child marriage as a human rights violation.

    Ask your senator to support passage of the Preventing Child Marriage Act. Support organizations like CARE who are on the ground in developing countries during times of crisis and stability, helping the world's most vulnerable citizens help themselves out of poverty. doclink

    Karen Gaia says: Girls who delay marriage also have fewer but healthier children, thus lowering fertility rates.

    World Must Wake Up to the Coming Crisis in the Sahel

    January 23, 2012, People & the Planet

    There is a zone of human pain in the failed, and failing states along the Sahel on the edge of the Sahara desert, and across to Somalia, Yemen and Afghanistan, says Professor Malcolm Potts.

    Rapid population growth, global warming, poor governance and a hideous mistreatment of women are combining in a perfect storm which could lead to unprecedented levels of environmental stress, starvation, escalating conflict and massive waves of migration. The scale of these problems goes beyond the usual response to a potential humanitarian disaster. Unless strong action is taken, the catastrophe now unfolding in the Sahel has the potential to kill as many tens of millions of people.

    This is a global problem and it needs a global understanding and a global response. New international strategies need to be built about food security, family planning, gender equity and governance that have major geopolitical implications for the rest of the twenty-first century. A proper response will require billions of dollars , which would likely come primarily from the World Bank, regional development banks and other traditional donors.

    Today's extremes of drought, caused by climate change, could become averages by 2050. Overgrazing, poor agricultural practices, lack of infrastructure and uneven governance could result in inefficient use of natural resources including soil, water and ecosystem-based services. Soil erosion and destruction of trees for firewood are about to collide with climate change turning serious problems into a catastrophe.

    From October to May there is no rain and temperatures can exceed 120° Fahrenheit (49° C). Tremendous dust storms cover huge areas of the Sahel and Northern Nigeria. Climate change will make a bad situation worse. Droughts that used to occur every 10 years are already happening every five and they will be interspersed with torrential downpours leading to flash floods that wash away homes and crops.

    Already agricultural output cannot keep pace with population growth. The UN Environment Programme sees the Sahel as "heading towards an environmental disaster" and feeding tens of millions of people as "mission impossible."

    44% of children in Niger are stunted and face a life-long penalty in stunted growth and inhibited brain development if they survive.

    The third largest city in Kenya, after Nairobi and Mombasa is now a refugee camp of drought victims in the north. It was built for 400,000 refugees, but every day an additional 1,500 women and children, fleeing from drought in Somalia and Ethiopia, arrive.

    The worst drought in 60 years is hitting the Horn of Africa; 13 million people are already hungry. "750,000 could die in the next six months unless aid efforts were scaled up" says the New York Times. But this is just a sign of things to come. We must recognize the nature and the scale of the problem and focus on outcomes not process.

    50 million people live in the Sahel. In Niger population is projected by the UN to rise from 16 million today to almost 60 million or possibly even higher in 2050 and an implausible 139 million by 2100 million, implausible since death rates may rise due to starvation or disease.

    Burkina Faso is projected to go from 16 to almost 50 million people by 2050, Chad from 11 to almost 30 million. Mali is projected to more than double from 15 to 35 million and Somalia from under 10 to over 20 million.

    Until recently, the UN's World Population estimates assumed that most countries would reach 2.05 children per women by 2050, and that least developed countries would fall to 2.41, but demographers have recently accepted that birth rates in the high fertility countries will not reach replacement level fertility any time soon. The highest world projection for the end of the century is now 15.8 billion ( the lowest 6.2 million) at the century's end. These few high fertility countries (averaging from 4 to over 7 children per woman) with a total population of 1.2 billion today, are projected to be the largest population block in the world by 2100.

    Delay in raising the age of marriage and in instituting family planning will be as lethal in a country like Niger, as was the delay in instituting HIV prevention in Africa in the 1980s. Today in Niger, only one in 1000 women completes secondary education. In the Sahlel, few people are educated, making non-agricultural employment virtually impossible. Few girls enter secondary school and virtually none complete it.

    Unless investments are made today in education, especially for girls, and in family planning in these high fertility regions then the world will become even more divided than it is today between rich and poor and between stable democratic nations and failed states. The Sahel presents the most immediate, and also the most easy to document, set of problems.

    We must make family planning easy to obtain. In the case of family planning we have half a century of robust evidence of what works. We must meet the unmet need for family planning. Even failed states have markets than can be tapped into. We must knock down uninformed medical barriers to family planning. We must recognize how common misinformation is leading women to believe family planning is dangerous.

    In Cambodia after the fall of Pol Pot, in refugee camps along the Thai border, neither UNICEF nor Doctors Without Borders were supplying contraception in the camps. But when this was done by another NGO, use of contraceptives jumped from zero to 52% of married women in one month.

    Sahlel countries see a very high rate of child marriage. Increasing the age of marriage by five years reduces population growth by 15 to 20%, according to demographers. High fertility countries will not slow population growth rate until the average age of the first birth is raised. In Niger, the average age of marriage is under 16.

    Under-age girls are married off to older men every day. Most child brides either never go to school, or drop out when they marry. Compared with mature women, these girls are twice as likely to be beaten by their husbands and five times as likely to die in childbirth.

    Poor soils and unpredictable weather are outside human control. We don't know how to ameliorate corruption in contemporary governments. Subsidies to American farmers depress African markets unfairly, but they are unlikely to change soon. But addressing population through access to family planning, eliminating forced marriage for young girls and raising the age of the first birth have more promising solutions.

    In a project involving a polygamous society on the border with Niger, where the average aged of marriage is 14.5, we found that a small educational grant of $196, spread over six years, had resulted in between 82% and 92% of girls remaining in school.

    We need to apply funds to pilot projects, such as the success keeping girls in school, on a nation-wide scale. We may need careful, random control trials to show that cash transfers work. doclink

    Ethiopia: Teje's Story: Child Marriage and Education

    November 9, 2011, Pathfinder

    Teje, a young Ethiopian girl, struggled to avoid early marriage and stay in school. With Pathfinder's help, she is now well on her way to making a better life for herself and her family. doclink

    Keeping Girls in School: Addressing Early Marriage and Breaking Barriers to Reproductive Health Care

    September 18, 2011, RH Reality Check

    This is the story of 20 year-old Haregnesh who was given away in a marriage when she was three. By the time she was 8 she was divorced. Her family wanted her to remarry, but she wanted to attend school.

    "I saw educated people and the difference in their lives. I also had friends who were in early marriages, who began having children very young. I watched as they had no food to eat or feed their children and they just kept getting pregnant and having babies. Some of them experienced prolonged labor and fistula. I could see that they were suffering and I wanted my future to be different," she said.

    Now Haregnesh has worked at Pathfinder for the last five years. She has seen that when girls have educational opportunities, they are empowered to improve their reproductive health and their lives. Conversely, when they are denied education, they are at a higher risk of poverty, HIV and AIDS, gender-based violence, and other harmful traditional practices. Getting and keeping girls in school is one of the best ways to foster later and chosen marriage, thus reducing the risk of maternal death from early child birth.

    Pathfinder International provides educational support intervention (scholarships) to girls like Haregnesh as an integral part of women and girls' empowerment efforts.

    Haregnesh has been able to buy sheep for her family, and rent land for her family to farm. She plans to go to college and become a nurse or a midwife.

    Last week, The Elders - an independent group of global leaders who work together for peace and human rights, brought together in 2007 by Nelson Mandela - announced a global initiative to end child marriage with organizations focused on these issues, including Pathfinder International, joining the Girls Not Brides initiative.

    About 10 million girls worldwide are forced to marry before their 18th birthdays -- more than 25,000 girls a day. Early marriage is a human rights issue and a barrier to health care, education, and prosperity. By keeping girls in school and changing this social norm, girls have an opportunity to change their future and that of their family and their community.

    See doclink

    Child Marriage a Scourge for Millions of Girls

    August 4, 2011, Reuters

    10 million girls each year are married under the age of 18 -- often without her consent and sometimes to a much older man, according to Marie Staunton, the head of the children's charity Plan UK head and author of "Breaking Vows," a recent global report on child marriage.

    Most of those marriages take place in Africa, the Middle East or South Asia.

    The legal age for marriage in India is 18, but weddings like these are common, especially in poor, rural areas where girls in particular are married off young. About 47% of women aged between 20 and 24 years old were married before the age of 18, according to the government's latest National Family Health Survey (India).

    From horrific childbirth injuries to the secret sale of "drought brides," the consequences of child marriage are explored in a multimedia documentary by TrustLaw, a legal news service run by Thomson Reuters Foundation (

    The U.N. Convention on the Rights of the Child considers marriage before the age of 18 a human rights violation, but there are more than 50 million child brides worldwide, a number that is expected to grow to 100 million over the next decade, according to the International Center for Research on Women (ICRW).

    Child marriage affects six of the eight U.N. Millennium Development Goals to be achieved by 2015 - the eradication of extreme poverty and hunger; achievement of universal primary education; promotion of gender equality and empowerment of women; reduction in child mortality; improvement in maternal health; and combating HIV/AIDS, malaria and other diseases.

    Girls forced into early marriage rarely continue their education, denying them any hope of independence, the ability to earn a livelihood or of making an economic contribution to their households. The practice also reinforces the concept of girls as worthless burdens on their families to be jettisoned as soon as possible.

    Girls who complete secondary school are six times less likely to become child brides than those with less or no education, but distance from schools and a lack of school fees make it difficult for the poorest girls to attend school

    In Niger, Chad and Mali over 70% of girls are married before the age of 18, the ICRW says. Bangladesh, Guinea, Central African Republic, Mozambique, Burkina Faso and Nepal have child marriage rates over 50%, and Ethiopia, Malawi, Madagascar, Sierra Leone, Cameroon, Eritrea, Uganda, India, Nicaragua, Zambia and Tanzania are all above 40%.

    Most people decide to marry off their daughters because they feel it's best for their daughters, to cement strategic alliances between families, or to ensure that their virginity, thus ensuring their economic value as brides and protecting the honor of the family.

    Meanwhile, debts and natural disasters, such as tsunamis and drought, can lead to girls being sold off as brides as families scramble for survival.

    USAID, the U.S. Agency for International Development, says the girls under 15 are five times more likely to die during pregnancy or childbirth than women over 20 because the bodies of younger girls are still developing and their pelvises narrow and lack of pre- and post-natal care and Caesarean sections makes pregnancy and childbirth far more risky in developing countries.

    In Africa 60% of women and girls give birth without a skilled medical professional present, says UNFPA, the U.N. World Population Fund. pregnancy the leading cause of death in the 15-19 age group. And babies born to mothers younger than 18 are more likely to be underweight or stillborn.

    Child brides are frequently unable to negotiate safe sex with their husbands, leaving them at an increased risk of contracting sexually transmitted diseases and HIV/AIDS.

    In 2010 The International Protecting Girls by Preventing Child Marriage Act, aimed at curbing global child marriage, that was unanimously passed in the Senate but blocked in the House of Representatives due to Republican concerns that it would help organizations supplying abortions, which "couldn't have been farther from the truth," McCollum. The bill will be reintroduced in the House this autumn

    It would require the State Department to report on child marriage in its annual human rights report and integrate efforts to prevent the practice into current development programs.

    It was blocked in the House last December primarily due to Republican concerns that it would help organizations supplying abortions, which "couldn't have been farther from the truth," the act's author Betty McCollum said.

    Not only will it make aid dollars more effective, she said, but "it's a win for the child, it's a win for the community the child lives in and it's a win for the international community."

    The Elders, an influential group of global leaders founded in 2007 by former South African President Nelson Mandela, gathered dozens of organizations for a two-day meeting in Ethiopia in June and have launched a campaign called "Girls Not Brides: the Global Partnership to End Child Marriage." doclink

    PRB Discuss Online, April 26, 2011: "Child Marriage in Yemen"

    April 21, 2011, Population Reference Bureau

    Take part in PRB's upcoming Discuss Online: "Child Marriage in Yemen" on Tuesday, April 26, 2011, 1-2 p.m. (EDT) (GMT-4), with Dalia Al-Eryani, Program Coordinator for the "Safe Age of Marriage Project" at Pathfinder International. Go to: One in three women ages 20 to 24 were married before their 18th birthday in Yemen, which still has the highest rate of early marriage in western Asia.

    The USAID-funded "Safe Age of Marriage Project" was designed to change social norms around early marriage, girls' education, and children's rights. Community educators work to increase awareness about the dangers of early marriage and early childbearing and to communicate the benefits of delaying marriage and keeping girls in school. doclink

    The Fight Against Child Marriage

    March 21, 2011, Glamour

    by Secretary of State Hillary Rodham Clinton

    Nujood Ali was a nine year old girl who was forced by her own family to marry a man three times her age. She had to drop out of school against her will, and was physically abused. To avoid further misery and suffering, Nujood boarded a bus and found her way to the local courthouse.

    Nujood told the judge she wanted a divorce. Female attorney Shada Nasser took Nujood's case and others like it. Today, thanks to Shada's work, girls across Yemen have been given their childhoods back. They are back in school, where they belong.

    More than half of the poorest one-fifth of girls in Yemen marry before the age of 18.

    Stopping child marriage is not just a must for moral or human rights reasons-it lays the foundation for so many other things we hope to achieve. Primary education. Improved child and maternal health. Sustainable economic development that includes girls.

    Child marriage is both a consequence and a cause of poverty. In some cases, girls are sold into marriage simply to resolve a debt. Once married, child brides often lack status and power within their marriages and households. Their youth leaves them even more vulnerable to domestic violence, marital rape and other sexual abuse. They become isolated from their family, friends and community. On average, child brides become less healthy, and their kids grow up less healthy and poorer.

    We are reaching out to women and girls, fathers and brothers, religious leaders and all who can help us to convince societies that this particular tradition is better left behind. Governments, too, are taking steps to raise the minimum age of marriage. We need to make our case far and wide to plant the seeds that will one day convince the rest.

    In some places rights of women means ensuring that daughters as well as sons have enough to eat. In others, it means demanding equal pay for equal work. Societies cannot flourish if half their people are left behind. They are leading the fight to protect and promote human rights and opening up the doors of opportunity for everyone.

    I often say that one of my goals as Secretary of State is to help people everywhere live up to their God-given potential. Few have fought as hard for it as Nujood Ali and Shada Nasser. I'm honored to know them. We all should share their cause. doclink

    India's Maternal Deaths Tied to Teen Moms' Anemia

    March 21, 2011, Women's eNews

    43 percent of adolescent girls in India are married off before the age of 18. Only Bangladesh, Niger and Chad have higher figures of adolescent marriages, according to UNICEF's report on The State of the World's Children 2011

    The Centre for Health Education, Training and Nutrition Awareness (CHETNA), a nongovernmental organization working in the slum works to improve the health and nutrition of children, youth and women, including socially- excluded and disadvantaged.

    "Girls in the age group 15-19 who marry early are most at risk of being caught up in a negative cycle of premature child-bearing, high rates of maternal mortality and child under nutrition," Karin Hulshof of UNICEF India said.

    The UNICEF report, which focuses on adolescents, finds that despite its rapid economic growth, India has not been able to significantly redress gender disparity. doclink

    Karen Gaia says: early marriage means more generations alive at the same time, more children per woman, and an unsustainable population growth.

    Child Marriage Still Prevalent: UNICEF

    March 3, 2011, United News of Bangladesh

    Two-thirds of female adolescents are still getting married before the age of 18 in Bangladesh, with 30% getting married before reaching the age of 15, says a new UNICEF report: 'The State of the World's Children 2011: Adolescence An Age of Opportunity'. The percentage of child marriage in Bangladesh is one of the highest in the world.

    One-third of teenage girls bear children, and the adolescent fertility in the poorest quintile is double that in the richest quintile of the population.

    90% of marriage to female adolescents in Bangladesh was per their parent's decision.

    According to the UNICEF global report, around 335 million adolescents live in South Asia while there are 33.9 million in Bangladesh, which is one fourth of country's population.

    Investing in the world's 1.2 billion adolescents aged 10-19 now "can break entrenched cycles of poverty and inequality," the report said.

    The 33% drop in the global under-five morality rate shows that many more young lives have been saved; in most of the world's regions girls are as likely as boys to go to primary school; and million of children now benefit from improved access to safe water and critical medicines such as routine vaccinations.

    On the other hand, more than 70% of adolescents of lower secondary age are currently out of school, and at the global level, girls still lag behind boys in secondary school participation.

    Without education,adolescents cannot develop the knowledge and skills they need to navigate the risks of exploitation, abuse and violence.

    Bangladesh is planning to eliminate child labour in the country and to set up 'Adolescents Clubs'. doclink

    Afghanistan: Girls Flee Homes to Avoid Forced Marriages

    August 29, 2010, Pajhwok Afghan News

    Many girls in northern Baghlan province opt to run away from their homes instead of accepting forced marriages, which are usually are often arranged by parents for monetary benefits.

    The situation has led to concern among women rights activists.

    In many cases, girls are forced to marry elderly people in exchange for money, with poverty and ancient customs playing a key role. For example, a 19 year old woman was forced to marry a 65-year-old man. Her father got 80,000 afghanis in exchange. Her husband, who had already three sons and 12 grandchildren, beat her on a daily basis. Her husband divorced her saying she had fled the house and she was sent to prison for six months, but she was happy with the verdict, saying imprisonment would give her protection from the cruel outside world.

    Rahima Zarifi, Baghlan women's affairs director, said 15 forced marriage cases were registered with her department this year.

    A religious scholar, Maulvi Ihsanullah, says forced marriages are against Islam. doclink

    Top Yemeni Clerics Oppose Ban on Child Brides

    March 22, 2010, Washington Post

    Some of Yemen's most influential Islamic leaders have declared supporters of a ban on child brides to be apostates.

    The religious decree imperils efforts to salvage legislation that would make it illegal for those under the age of 17 to marry.

    The practice is widespread in Yemen and has been hard to discourage in part because of the country's poverty - bride-prices in the hundreds of dollars are difficult for poor families to pass up.

    More than a quarter of Yemen's females marry before age 15. Tribal custom plays a role, including the belief that a young bride can be shaped into an obedient wife, bear more children and be kept away from temptation.

    A 2009 law set the minimum age for marriage at 17, but it was repealed and sent back to parliament for review after some lawmakers called it un-Islamic.

    The group behind the declaration includes Yemen's most influential cleric, Sheik Abdul-Majid al-Zindani, whom the United States has branded a spiritual mentor of bin Laden.

    Government officials are reluctant to challenge conservative tribal and religious figures whose support they need to hold power in the nation.

    The religious leaders organized a protest by a group of women who carried signs that read "Yes to the Islamic rights of women."

    The issue vaulted into the headlines three years ago when an 8-year-old girl went by herself to a courtroom and demanded a judge dissolve her marriage to a man in his 30s. She won a divorce, and legislators began looking at ways to curb the practice.

    In September, a 12-year-old Yemeni child-bride died after struggling for three days in labor. "The government has two options: to give girls in Yemen a chance at life or to condemn them to a death sentence," said the chairwoman of Sisters Arab Forum in Yemen.

    Yemen once set 15 as the minimum age for marriage, but parliament annulled that law in the 1990s, saying parents should decide when a daughter marries. doclink

    Afghanistan: The Tribulations of Child-Bearing Children

    December 11, 2009, IRIN News (UN)

    Many young women in Afghanistan die during pregnancy and at childbirth, but the number is unknown because most pregnant women are not allowed by their husbands to go to hospitals and doctors.

    Afghan law sets 16 as the minimum age of marriage for a girl and 18 for a boy, but many are married at a younger age and without the genuine consent of those concerned.

    60-80% of all marriages are forced and/or under-age marriages.

    Daughters are married at an early age because "everybody and all parents do the same," and that "it is not good to keep a daughter at home for long; it's better she goes to her husband's home as soon as possible." Parents are usually unaware of the serious health and psychological risks of early marriage. Also there it is thought that marrying off a daughter as early as possible is in line with Islam.

    Some suggest the government should train imams and other religious leaders to ensure marriage laws are upheld when they formalize marriages.

    According to UNFPA, Afghanistan has a fertility rate of 6.51%, the second highest in the world. Female life expectancy in Afghanistan is 44 - one of the lowest in the world. The maternal death rate is 800 deaths per 100,000 women, but much higher among mothers aged 15-19 than for women older than 19, according to UNICEF. Young mothers often lack awareness of the risks of pregnancy and child delivery. "Child mothers and their children are usually weak and vulnerable to diseases."

    Only 14% of births in Afghanistan are attended by skilled health workers, according to UNFPA. doclink

    India: High Newborn Death Rate Linked to Child Marriages

    January 16, 2009, Sydney Morning Herald

    The large number of child marriages on the Indian subcontinent is contributing to a high rate of maternal and newborn deaths. In South Asian countries, 22 mothers die in childbirth every hour and three newborns die every minute.

    South Asia has more child marriages than anywhere else in the world. Nearly half of all women between 20 and 24 were married before they turned 18.

    When children have children, their babies' risk of dying in the first year of life shoots up by 60% compared to an infant born to a mother older than 19. If that baby survives, he or she is more likely to be undernourished and uneducated.

    Bangladesh hasd the highest rate of child marriage in the world with 53% of girls married before the age of 15.

    This contributes to the cycle of gender discrimination, with poorer families being more willing to permit the premature marriage of daughters.

    The report calls for enforcing the age of 18 as the minimum legal age of marriage and urges religious leaders to discourage child marriages. doclink

    Africa: Teen Pregnancies Put Moms' Health at Risk

    January 16, 2009, UNICEF/Associated Press Worldstream

    Girls who give birth before 15 are five times more likely to die in childbirth than women in their 20s. Every year, 70,000 women between the ages of 15 and 19 die in childbirth or from pregnancy complications. The younger a girl is when she becomes pregnant, the greater the health risks for her and her infant.

    Worldwide, more than 60 million women were married before they were 18, most in South Asia and Africa.

    If a mother is under 18, her infant's risk of dying in its first year of life is 60% greater than an infant born to a mother older than 19.

    Adolescent wives are susceptible to violence, abuse and exploitation. In 2007, 9.2 million children died before reaching the age of 5, down from 9.7 million the year before.

    Africa is the continent with the highest rate of maternal deaths, with a one in 26 chance of dying during pregnancy or childbirth. About 80% of maternal deaths are preventable with basic maternity and health care.

    There have been some advances, particularly in reducing the number of children who die in their first month of life.

    Progress has been made in combating HIV and AIDS among women and children.

    About 33% of the 1.5 million HIV positive pregnant women received treatment to prevent the virus being passed on to their child, compared to 10% in 2005.

    The number of children receiving anti-retroviral treatment has increased from 75,000 in 2005 to 200,000 in 2007. doclink

    Afghanistan: Imams to the Rescue in Curbing Maternal Mortality

    January 12, 2009, IRIN News (UN)

    Islam does not allow the killing of the foetus but it oes not want mothers to face health risks because of constant pregnancies. Islam does not oppose delayed pregnancies if this helps the health and well-being of mothers. Religions wield strong influence among people in rural communities where high rates of illiteracy contribute to the deaths of thousands of mothers and children every year.

    Every year 17,000 women die due to pregnancy-related complications and one child in four does not reach his/her fifth birthday. Food insecurity and lack of access to health services are weakening the health and nutritional status of women, and multiple and short-spaced pregnancies often cause early deaths. Child marriage is also a major factor. Child marriage and forced marriage are in contradiction with Islam.

    The ministries of women's and religious affairs have been working to involve religious leaders to reduce maternal mortality.

    Dozens of imams participated in workshops in Kabul at which gender experts tried to convince them to spread the word on birth gaps and legal-age marriage.

    In the province of Badakhshan, which reportedly has the highest maternal mortality rate in the country, such efforts have borne fruit.

    However, in the volatile southern and eastern provinces, where Taliban insurgents have assassinated dozens of pro-government religious leaders, preaching about family planning is a risky and unattractive job. doclink

    Stemming Fistula: Social Contraception in Pakistan

    January 5, 2009, RH Reality Check

    According to UNFPA, which is leading a Campaign to End Fistula, nearly two million women - mostly in sub-Saharan Africa and parts of South Asia - have the condition called fistula, caused when the baby's head presses against the lining of the birth canal during prolonged labor, making holes in the walls of rectum or bladder, and producing loss of control in excretory functions.

    Each year 100,000 new cases occur, and of these an estimated 5,000 are in Pakistan.

    Specialists say fistula can be best avoided by stopping early marriages, delaying the age of first pregnancy and by timely access to good emergency obstetric care. Education and only education can get the Pakistani women out of this mire. Primary schools must provide quality education. It's a simple, workable formula which would put many other things right in the society.

    Promoting girls' and women's education is just as important in reducing birth rates in the long run as promoting contraception and family planning.

    UNFPA launched its campaign to end fistula in Pakistan in 2006. UNFPA is supporting efforts to surgically repair and rehabilitate fistula sufferers at seven regional centres - Karachi, Islamabad, Multan, Quetta, Larkana, Lahore and Peshawar - where surgery is carried out free of charge.

    Every 30 minutes a woman in Pakistan loses her life giving birth. doclink

    Helping Child Brides Break Free

    September 25, 2008,

    In Yemen, a deeply conservative Middle East Muslim nation, brides as young as age 10 marrying men 3 times their age are not uncommon. Extreme poverty leads some parents to marry off their daughters, while others do it to protect the girls from spinsterhood, or from potentially shaming the family by getting involved with a man out of wedlock.

    But young girls often end up beaten and raped. More than 50% of Yemeni women are married before they are 18; in some regions, 8- and 10-year-old brides are the norm.

    The 1992 law that set Yemen's marriage age at 15 was later amended to allow even younger girls to wed with arental approval. However, they are not supposed to have sexual relations until they are "mature," a stipulation that's difficult to enforce.

    Specialists believe that young girls giving birth at an early age has contributed to Yemen having one of the highest maternal mortality rates in the world, according to the United Nations Population Fund.

    Activists are hoping to raise the marriage age to 18. doclink

    Nigeria: Child Rape in Kano on the Increase

    January 16, 2008, UN Integrated Regional Information Network

    Officials in Nigeria's city of Kano reported an upsurge in child rape and said that young girls are now unsafe in the city.

    In the last six months, police in Kano recorded 54 cases of child rape and made 60 related arrests. The number of cases is two thirds higher than recorded in the first six months of 2007.

    Kano reintroduced a strict version of Islamic law in 2001 which prescribes the death penalty for rape, but the penalties have done little to solve the problem.

    The suspects are usually between 45 and 70 while their victims are mostly girls of between three and 11 years.

    Many are never reported because parents will want to save the honour of their daughters and protect their families from embarrassment.

    Experts gave a number of reasons. Some have this superstitious belief that they can cure themselves of HIV through rape, an Islamic scholar said.

    "Others believe that they can become rich if they commit this wanton act of irresponsibility. The most vulnerable victims are girls that hawk articles on the streets and alleys of this city. The situation has become so bad that you need to warn your daughter not to get close to a strange face and to run home if she is beckoned. doclink

    Niger: Where Childhood Ends on the Marriage Bed

    January 8, 2008, IRIN News (UN)

    In Niger the word paedophilia is only applied to men who have sex with girls outside of marriage. From the biological, physiological point of view, at 9, 10, 11 or 12 years old a girl is not ready for sex and child bearing. The effects can be long-lasting and extend beyond physical health, human rights workers and psychologists who have studied child brides say.

    Forced sexual intercourse, denial of freedom and domestic violence are "frequently" found in child marriages. Eventually, the girls are likely to be abandoned when their polygamous husbands take another young bride. In Niger, women have no rights after a divorce.

    The problem affects all the regions of the country. At least a third of girls are married by 15, and 75% before 18 say UNFPA

    In reality, 13 is a common age for marriage, and some girls are married off at 9 or 10. Negotiations over the Family Code, a legislation which would have defined the legal relationship between husbands and wives and children and parents, and included a legal minimum age for marriage and sexual intercourse - collapsed in 2006 after it was "vilified and abandoned" after mainstream Islamist associations lobbied against it.

    Women's NGOs sometimes compete with each other as the influence of religious leaders is indirect and the Family Code was a contentious issue to the point of being a taboo subject in certain circles. The government is reticent about tackling early marriage because of the religious reaction and if things are going to change the religious leaders will have to be involved.

    If there was a law against paedophilia it would be applied here but, Islam has legalised it by saying the Prophet had a nine-year-old wife, even though that marriage was not consummated.

    UNFPA wants the age of marriage to be 18, which would give girls longer in school, give their bodies time to develop, and allow them to reach adulthood. In Niger, only 15% of adult women are literate, and less than one-third of girls go to primary school.

    There is the chance that the girl will go to a better home or the marriage will be celebrated with a good party and food. There were some women who opposed the Family Code and publicly demonstrated against it.

    Reaching a compromise with religious officials is the most important part of ending the practice. The real problem is that the government is afraid to take certain measures. doclink

    State to Study Early Marriages

    November 13, 2007, Times of India

    The state government will develop an "intervention model" for adolescent married girls that aims at cutting the social and health risks attached to early marriage.

    The trial, is expected to cover 2,000 married adolescents. It is an extension of an earlier pilot project in the slums of Mundhwa in Pune.

    The trial is significant as early marriage is prevalent in India. About 49% of women 20-24 years of age are married before the age of 18. There is little evidence on the design of interventions for married adolescents. In Maharashtra, the prevalence of early marriage is 48.9% in rural and 28.9% in urban areas.

    There is need to build a base that can inform policy-makers and practitioners how to design and implement effective interventions for married adolescents. The consequences of early motherhood have a bearing not only on the reproductive health of adolescent girls, but also on the survival of their children.

    A pilot study showed that 85% of the married women below 19 conceived during the first year of marriage. The use of temporary contraceptive methods was dismal, and incidence of low birth weight was high. The intervention model that we designed had three basic components - community-based surveillance, behaviour change communication and primary level care and referral services.

    At the end of the study and implementation of the model, it was found that the median age at marriage increased from 15 to 16 years, and the age at first conception from 15.8 to 17 years.

    The mean interval between marriage and first conception increased from 6.6 to 10.3 months, while the current use of temporary family planning methods increased from 10.9% to 23.2%. The most compelling evidence was reduction in the prevalence of low birth weight babies from 35.8% to 25.3%.

    For a large proportion of young women, pregnancy occurs during adolescence before they are physically or emotionally prepared for motherhood. Many are exposed to risky sexual practices that heighten chances of acquiring STIs/HIV. Access to contraception is limited. Measures to delay marriage and support married girls to make a healthy transition into reproductive life were urgently required. doclink

    Traditional Birth Attendants Advocate Ending Harmful Practices

    October 30, 2007, Africa News Service

    Traditional birth attendants in Osun State are encouraging others to observe the recently passed law banning female genital mutilation (FGM).

    This is a result of involving the United Nations Population Fund (UNFPA), the Nigerian Ministry of Health and several local NGOs to end to the practice. UNFPA began its campaign in Osun State because it has the highest rate in the southwest 87%. The ritual can cause bleeding, infection, scar tissue that leads to complications during childbirth or sexual intercourse later in life, and even death.

    There is no national law banning the practice, so efforts were made to involve people from all parts of society. At first the campaign failed because legislators were reluctant to abandon part of their heritage.

    But In 2004, the Governor signed the law, which outlawed the practice throughout Osun State.

    Such a law is difficult to enforce because the ritual is carried out in private. If we don't provide the practitioners with alternative options for employment we will not succeed.

    A program is turning former practitioners into Community-Based Development workers, or CBDs who are trained in basic reproductive healthcare.

    CBDs monitor pregnancies, make sure pregnant women go to health clinics, give advice on diet and conduct during pregnancy, and sell contraceptives and basic medicines. Former practitioners of FGM now believe that it ought not to be performed and are willing to work to see that it stops.

    Others learn trades, such as tie-dying or soap-making. UNFPA and its partners run similar projects in other parts of Nigeria. doclink

    Afghanistan: Widespread Child Marriage Blamed for Domestic Violence

    October 23, 2007, IRIN News (UN)

    Elopement is unlawful and taboo for a married woman in Afghanistan. Sexual relations outside marriage are considered a serious offence in Afghan civil law, which is derived from Islamic Sharia law. Afghanistan recently ended a three-year moratorium on the death penalty. If sexual relations outside marriage are not proved, she could still face an unspecified sentence for running away from her home with a stranger. Children share deprivations of imprisoned mothers and women are reluctant to seek marital redress through the courts. UNICEF appeals for more aid to help women, children as war, poverty and ignorance fuel sexual abuse of children.

    Research by the Afghanistan Independent Human Rights Commission (AIHRC) shows that over half of marriages in southern Kandahar Province are child marriages.

    A vast majority of families in Kandahar wed their daughters before their legal age. Child marriage is prevalent, but the degree to which it is practiced varies from province to province. Conservative traditions, illiteracy among parents and nationwide poverty are some of the factors driving families to wed their underage daughters.

    Up to 70% of cases of violence against women have their origins in early marriages. Young children and teenagers do not realise the complexities of marriage and fail to comply with their wedding vows, leading to physical and mental violence. Child marriage is also contributing to the high maternal and child mortality rates.

    It can only be tackled by the long-term educational, economic and cultural development of the whole Afghan nation.

    Until widespread illiteracy is tackled, and viable protective mechanisms established, these predicaments will remain an unfortunate reality. doclink

    43 Percent of Manafwa Girls Pregnant Before 16

    October 10, 2007, Africa News Service

    At least 43% of girls in Manafwa District become pregnated before they are 16. Sex involving girls below 18 years is highest among families living under poverty.

    The girls drop out of school and their future ruined.

    The majority of the girls have unprotected sex, exposing them to the risk of contracting HIV/Aids.

    After getting pregnant, many of the girls are banished by their parents, rejected by the fathers of their children and end up living with their grandparents.

    Parents must instill morals in their children, provide for them and teach them about reproductive health and other health related issues.

    ARDI supports over 231 child mothers by engaging them in income generation activities and teaching them skills. The organisation, also pays fees for the child mothers who are willing to return to school and helps them look after the children whose fathers have denied responsibility.

    ARDI does HIV counselling and testing, home visits and care, treatment of STDs, child counselling and free distribution of condoms to help check the spread of HIV/Aids and unwanted pregnancies. Parents should take the lead role in mentoring children. doclink

    Mali: Child Marriage a Neglected Problem

    September 5, 2007, Irin News

    More than 60 million women globally were married before the age of 18. Child marriage is a problem that has been largely untouched by the international community. There hasn't been a really concerted effort to address the issue. In Mali a bill that would raise the legal age of marriage to 18 has been on the books for five years, but has yet to be passed.

    Malian law punishes the abduction of women for forced marriage by one to five years in prison. When the abducted girl is less than 15 years old, the sentence is up to 10 years of forced labour. Enforcing the law is difficult, because family members are often accomplices. According to the latest statistics from 65% of women aged 20-24 were married by the age of 18, 25% were married by 15, and one in 10 married girls aged 15-19 gave birth before age 15.

    The decline in early marriage in Mali has been attributed to the few education and awareness raising programmes.

    In the western region, where 83% of girls are married by 18, particular effort has been paid to informing people of the risks of early marriage.

    According to UNFPA, girls aged 15-19 are twice as likely to die during pregnancy or childbirth as women aged 20-24. Among girls aged 10-14, the risk is five times greater. Early onset of sexual activity has also been linked to increased risk of HIV/AIDS. In Kayes, between 2005 and May 2007, at least 10 girls lost their lives because of complications after their wedding nights, sometimes due to haemorrhaging after forced intercourse.

    CAFO joined with UNICEF, and the union of independent radio and TV stations, to organise the first public awareness campaign in the region of Kayes. It included a three-day workshop with religious and community leaders, helping them produce messages against early marriage to be broadcast in the local media.

    For the last two years, UNICEF has also been working with communities in three regions of Mali - Segou, Mopti and Kayes - to inform residents of the risks, help them abandon the practice, and set up committees that will intervene in cases of early marriage.

    UNFPA runs educational programmes focusing on reproductive health that include early marriage. Legal enforcement must be combined with programmes that provide alternatives to early marriage by increasing the levels of education and economic opportunities of girls.

    The Malian government does consider child marriage a form of violence, and there is a policy to fight against violence done to women. Making early marriage a political priority is a necessary first step for change. doclink

    India: Monetary Incentives for Family Planning

    August 28, 2007,

    Concerned with the growing population, the Satara Zilla Parishad has come up with a novel plan.

    On Independence Day, an offer from the Satara Zilla Parishad is put on the table.

    It's an offer for newly weds which says, delay the birth of your first child and get a gift for your honeymoon.

    If a couple has their first child after two years of marriage, the Zilla Parishad will give them 5000 rupees.

    If the first child comes after three years, the bonus increases to 7500 rupees.

    Even if 10% of the people take up the offer, the population will come down by one per cent.

    23-year-old Sagar Bhosale and his new bride who is 19, got themselves registered at the local health department.

    They have been married three months and do not want a child for the next three years.

    Different schemes of family planning have been tried and rarely has money been offered as incentive.

    If this effort on the part of the Satara Zilla Parishad proves successful, it will chart the path for others to follow. doclink

    Karen Gaia says: this plan sounds like a winner. Asking people to delay childbirth gets much less resistence than telling them they can only have one or two children. Then, having practiced birth control, they are more likely to have fewer children on their own.

    Uganda: Districts Asked to Use Scouts in Fighting AIDS

    August 28, 2007, Africa News Service

    Members of the Uganda Scouts Association have asked districts to help rejuvenate the movement in the fight against HIV/Aids.

    They recommended that part of the money for schools to finance co-curricular activities be used to fund scouting.

    The Chairman of the Uganda National Scouts Board, said since scouting helps to build character and teaches basic values, it's vital to use scouts and girl guides in disseminating information on HIV/Aids prevention. Although the prevalence of HIV/AIDS among the youth had reduced, there was need to sensitise them on the dangers of trans-generation sex.

    Recent statistics indicate that the prevalence of HIV/Aids is high among married adults. Some of these adults are having sexual affairs with young girls and boys. doclink

    Ghana: Girls and Early & Child Marriage

    August 13, 2007, Africa News Service

    In Ghana, a child below the age of eighteen is classified as a minor. The acceptable age for marriage is eighteen years and above.

    However, religious, traditional, and other values give way for such minors to be given in marriage.

    Early Child marriage is prevalent in Ghana. It is hard to know the exact number of child marriages as many are unregistered and unofficial.

    Child marriage occurs more frequently in rural settings than in urban ones. Women with primary education are less likely to be married as children than those with no education.

    Girls who marry young are more likely to live in poverty, experience violence and abandon school.

    In spite of legal provisions, child marriage is still practiced in many developing countries.

    If current patterns continue, over 100 million girls in the developing world will be married during the next 10 years.

    According to UNICEF, child marriage is a violation of human rights. In places where child marriage is practiced in Ghana, girls have no say on when and whom to marry and have no independence once married.

    Sex in child marriage is more frequent. Poor families regard early marriage as a tactic for survival.

    Some consider child marriage a protection for girls from the dangers of sexual assault. Girls enter child marriage with little information about contraception, safe motherhood, and sexually transmitted diseases, including HIV/AIDS.

    Pregnancy is the leading cause of death for adolescent girls coupled with health problems such as obstetric fistula.

    An Obstetric fistula is an injury of childbearing usually caused by several days of obstructed labour, without timely medical intervention.

    The risk that their babies will die in their first year of life is 50% higher than for children born to women in their 20s.

    The Universal Declaration of Human Rights recognizes the rights to "free and full" consent to marriage and determines that this standard is not met when a person is not mature enough to make an informed decision.

    The International Convention on the Rights of the Child upholds the rights of a child to be protected from harmful traditional practices.

    Yet, child marriage persists in developing countries because they lack resources and sometimes the political commitment to enforce such laws.

    In Ghana, Civil Society groups are working to discourage the practice by creating community awareness of the adverse consequences.

    Recently there were media reports of a 19-year old girl who had fled from early forced marriage, even though she is not a minor. She was rescued by the police in Accra after she was chained and concealed under the metal seats of a bus.

    Human rights activists have been fighting to put an end to early and forced marriages. doclink

    Ethiopia's Fistula Hospital - 30,000 Women Treated

    July 10, 2007, Radio Netherlands Worldwide

    Some 1400 Ethiopian women out of every 100,000 die because of complications related to pregnancy. Pregnant women in many countries in Africa face the risk of fistulas. Obstetric fistulas occur when a mother's pelvis is not big enough to allow the baby to pass through. The pressure of the baby's head causes a lack of blood supply and the mother is left with a hole or fistula through which urine and or stool leak uncontrollably via the vagina.

    Because the women constantly leak, they stink and their husbands generally abandon them. In many cases, because of the stench, they are separated from the rest of the family. Up to 8000 women in Ethiopia get a fistula every year and 1500 of them make their way to the Addis Ababa Fistula Hospital, the largest such institution in the world. In most cases, doctors are able to close the hole, and the women can lead a normal life again, though they are advised to return to the hospital to deliver their next baby. In some cases, the women are too badly damaged and the doctors have to create a stoma. doclink

    Karen Gaia says, fistulas are most common in young immature women and also malnourished women.

    Uganda: Kayunga Girls Sexually Active at 10 Years

    July 10, 2007, Africa News Service

    Girls in Kayunga district engage in sexual activities at the age of 10, and HIV in the district was higher among the youths. The HIV/Aids prevalence in the district rose from 6% in 2005 to 6.5% today.

    High poverty levels and failure by parents to instill discipline and morals in their children increased the number of youths who engage in sex at an early age.

    You should remain virgins until marriage because it will help you to remain safe and complete your education," the District Inspector of Schools advised. doclink

    UNFPA Awards Fistula Worker

    June 11, 2007, InterPress Service

    Salamatou Traor' will be awarded a five thousand dollar grant from the UNFPA in recognition of her work to assist women who suffer from fistulas. Poor, young women who do not have access to the caesarean procedures are often afflicted by this condition.

    Traor' heads Dimol, an NGO based in the capital of Niamey which helps women recovering from fistulas to rejoin society. Her father was in health care, and she admired the role that he played in the family and in society. She decided to create an NGO focused on the dignity of women. The prize will enable us to continue to raise awareness amongst vulnerable groups and lead the fight for respect for women's rights, and dignity. We will use this money to produce T-shirts, posters (and) awareness-raising tools, that will allow us to give a greater visibility to the abuse of human rights in general and of women in particular. doclink

    India's Underage Brides Wedded to Tradition

    May 29, 2007,

    Despite being illegal since 1929, child marriage is still rampant in parts of India mainly due to traditional views and poor law enforcement. Around 45% of girls in India are married before the legal age of 18. Almost 30% of boys are wed before they reach the compulsory 21.

    The impact of early marriages is devastating.

    Girls lose their childhood, education and even risk their health due to early pregnancy. Rajasthan has the highest rate of child marriage in India with 57% of girls marrying before 18.

    Village girls are taken out of school to serve their marriage apprenticeship: scrubbing floors, making dung cakes for fuel, collecting cattle fodder or carrying water.

    Daughters are considered a liability mainly due to the banned but rampant practice of dowry, where the bride's parents hand cash and goods to the groom's family.

    Parents also prefer to get daughters married early, concerned that as they grow into young women they could attract unwanted attention and bring scandal.

    Marrying younger children off at the same time as older ones also offers major savings for poor families.

    Girls who marry at a young age are more vulnerable to domestic violence and sexual abuse, and less likely to complete primary education.

    Early marriages contribute to high rates of maternal mortality. The government last year toughened laws to prosecute priests, police, wedding guests and local leaders involved in encouraging child marriages.

    Adult males marrying children and people involved in performing, abetting or attending a child marriage can face up to two years in prison and a fine of 100,000 rupees ($2,500).

    But it will be an uphill struggle to combat traditions. doclink

    Where Many Schoolgirls Miss Class Over Old, Harmful Ritual

    May 14, 2007, The Nation (Nairobi)

    Female circumcision is common in many parts of Rift Valley Province, leading to a high drop-out rate in schools among girls.

    In Kericho District, more than 1,200 girls leave school annually mainly after the ritual.

    In Kebeneti village, out of 100 girls who were circumcised, only 20 returned to school. The others were married off.

    A common belief in the Kalenjin community is that once initiated, girls are mature for marriage. Many girls under 15 succumb to pressure from their parents, peers and colleagues.

    Many parents encourage this vice. The Government has formed committees from the village, and district levels to tackle the problem.

    The role of the committees is to sensitise the society on the dangers of early marriages and female circumcision, besides telling parents it violates the law.

    Some men believe girls who have gone through the rite are free of the HIV.

    The practice contravenes the Children's Act and is punishable by law.

    Girls deserve opportunities equal to boys. Parents should not discriminate on the basis of gender.

    Traditional circumcisers should stop perpetuating the vice and turn to other income ventures to sustain themselves.

    The problem threatens girl child education, but women alone cannot stop the practice. Government and political leaders must crusade against the vice. Church leaders have appealed to join the fight against it.

    Some aspects of culture are barriers to civilisation and development.

    Many parents are not taking their daughters to school despite the free primary education. The Children's Act, does not deal firmly with offenders.

    The vice had declined temporarily, due to an offer by volunteers to protect girls who fled home and school when told to undergo the rite.

    The organisation would then apply for temporary orders from courts to restrain parents and guardians from circumcising the girls. doclink

    Karen Gaia says: we also need to pay attention to male circumcisim if it exists in the same cultures as female circumcision. It is unlikely that female circumcision will be stopped if its male counterpart is not also stopped.

    Preventing Teenage Pregnancy in Mexico

    May 14, 2007, IBN Live

    Baby simulators are being used in central Mexico to introduce teenagers to the trials of parenthood.

    A new program asks pairs of high school students to spend two or three days tending to the computerised babies, which are programmed to cry for food, burp and scream at night until they were rocked back to sleep. One student says, "It was an experience that showed us we are not ready be parents."

    The state of Chihuahua suffers from 20% of babies being born to mothers 19 or younger.

    Teachers say the dolls can help open up communication between adults and young people and this program should be obligatory in all schools. doclink

    Niger's Traditional Chiefs Condemn Child Marriage

    March 16, 2007, Reuters

    Niger's traditional chiefs have urged the government to draw up legislation which would stop girls being married off as young children, breaking ranks with Islamic groups in the mostly Muslim nation.

    Family matters are decided according to strict Islamic laws in the impoverished West African country and girls, sometimes under the age of 10, are commonly married off by families seeking wealth and social status.

    The girls are expected to have children, sometimes as many as 20, boosting the influence of their family.

    Niger's population is growing quickly, with each woman having on average 7.1 children. An estimated seven women in every 1,000 die during childbirth.

    The traditional chiefs urged the government to outlaw underage marriage.

    Given the strong demographic growth which has been aggravating economic, environmental and social problems for decades, we recommend the government block underage marriage, the chiefs said in a declaration broadcast on state television.

    They also called on the government to help educate rural populations about reproductive health. Muslim leaders have in the past fought against such campaigns, including those encouraging people to use condoms in the fight against HIV/AIDS.

    The country is one of the world's poorest, with many living as subsistence farmers on the edge of the Sahara.

    Some 95% of its nearly 13 million people are Muslims; Islamic law and tradition govern family life.

    Muslim traditionalists staged a protest against plans to ratify Africa's Maputo Protocol on women's rights, agreed in 2003 by African heads of state and aiming to enshrine women's equality in marriage and public life. doclink

    Rural Ethiopia Ignores Law Against Child Brides

    January 22, 2007, National Public Radio

    In the northern highlands of Ethiopia, the government is backing new family-planning policies, including a ban on marrying girls while they're still children. Some women are indifferent to the change. Others are welcoming it.

    There is a saying: "The world is producing more children, but the land is not expanding."

    Child marriages are prevalent in rural regions, and Amhara has the highest rate in Ethiopia. About 40% of girls are married by 15 or younger.

    In 1995, Ethiopia set the minimum age limit for marrying at 18, but early marriages haven't stopped.

    Marriages provide social and economic advantages for the families. The more land and cows a family has, the higher its standing in the community. Early marriage ensures that a girl hasn't had sex before marriage. Once a girl loses her virginity, it is virtually impossible to find a man who will marry her.

    Girls who are desirable or from good families risk being abducted and raped as a way of laying claim to them.

    Early marriage introduces her to heavy workloads in the fields and at home, and to bearing children at an age when complications are much more likely.

    Girls who marry early are more likely to be abused and infected with HIV. About one-third of women in developing countries marry as children. It happens in all regions of the world, especially in rural areas, across religions, with the highest rates occurring in Mali, Nigeria, India and Nicaragua. doclink

    Rural Ethiopia Ignores Law Against Child Brides

    January 15, 2007, NPR

    The world is producing more children, but the land is not expanding challenging age-old customs about marriage and the rights of women.

    The government is backing family-planning policies; some women in Ethiopia are indifferent to the change. Others welcoming it.

    Yinsa is a little more than a half-hour drive from the nearest town. Spreading out from a village center near the highway, tens of thousands of people live on the family compounds and farms scattered throughout eucalyptus forests and fields of corn and tef, a grain that goes into the making of the spongy bread, enjera.

    Ethiopia was once seen as enlightened and progressive, but its image has been tarnished by the government's suppression of dissent and opposition. Child marriages are prevalent in rural regions, and Amhara has the highest rate in Ethiopia. About 40% of girls are married by 15 or younger.

    Hardly any adults here know their age. In 1995, Ethiopia set the minimum age limit for marrying at 18, but early marriages haven't stopped.

    But many believe marriages are better when the man has the maturity to deal with a wife who is, in many ways, still a child. On average in Ethiopia, there is an eight-year age difference between partners.

    Marriages are alliances that provide social and economic advantages for the families. Early marriage ensures that a girl hasn't had sex before marriage with a man who does not meet the family's approval. Once a girl loses her virginity, it is impossible to find a man who will marry her.

    Girls who are desirable or from good families risk being abducted and raped as a way of laying claim to them.

    The decision to marry is under the family, father and mother.

    A local women's group is working with the Ethiopian government to end early marriages and improve the status of women.

    Those who join them know more about their health, how to protect themselves from HIV, and how to use birth control. They know to protect their own property, however small it is. In the old days, a man could abandon his wife and hold on to the property, even if part of it was her dowry. doclink

    Karen Gaia says: the article does not mention a couple of things: 1) Ethiopian men often have serial wives. 2) Ethiopians are multi-cultured: Christians, Muslims, and the various tribal religions. They all have their different life styles.

    Birth Spacing

    High Population Piles Pressure on East African Bloc

    April 10, 2017, Business Daily   By: Anita Chepkoech

    From data covering up to 2015, the latest United Nation's World Population Prospects report shows that Kenya, Uganda and Tanzania are among the 33 countries whose population is projected to increase at least five-fold by 2100. The growing population will exacerbate problems of ill health, poverty, environmental degradation, unemployment and declining agricultural productivity.

    The East African Community (EAC), comprised of Kenya, Uganda, Rwanda, Burundi and Tanzania, has a population of about 150 million people with land area of 1.82 million square kilometres and a combined gross domestic product of Sh7.4 trillion ($74.5 billion).

    Africa's population is currently estimated to be 1.4 billion while the world's is at seven billion.

    In the EAC, about 60% of pollution related deaths are due to contaminated water or poor hygiene, 40% due to indoor air pollution and one per cent due to outdoor air pollution.

    "Demographic changes are one of the most crucial long-term challenges that will have a grave influence on the economy....using a regression analysis, this paper found that population growth affects real economic variables on the negative side," says a 2014 World Bank report dubbed 'Impact of Demographic Changes on Inflation and the Macro-economy'.

    Ms Jesca Eriyo, the deputy secretary-general of the EAC, said: "If we don't control the number of children we are giving birth to, poverty levels will grow. This requires re-alignment of policies, processes and systems and sharing of resources for coordinated actions."

    She added that it was also life threatening for a woman to give birth to more than eight children.

    Changing human habitation patterns, overgrazing, bio piracy, deforestation, pollution, unsustainable exploitation of natural resources and introduction of invasive as well as alien species are some of the changing environmental characteristics that are associated with extremely negative impacts of climate change.

    Dr Matano, executive secretary of the Lake Victoria Commission, said that EAC's population growth rate of 6% is overburdening its resources.

    United Nations Environment Programme (Unep) executive director Christopher Cox says heavy metals deposits discharged from industries into water bodies including Lake Victoria pose a health hazards to the populace who consume contaminated fish.

    "Studies have shown that 95 per cent of waste go directly to the lake leading to nitrification and also health concerns. Micro-plastics are getting into the fish that we eat,” said Mr Cox during the Environmental Research and Scientific Conference to protect Lake Victoria basin from degradation in Mwanza, Tanzania in February.

    Experts also warned that huge chunks of forest cover have been transformed into farms leaving most land in the region bare.

    Poor farming methods lead to the deposition of nitrogen and phosphate fertilisers into the waters, one reason which has been blamed for the mushrooming of hyacinth and decline of fish in Lake Victoria.

    The EAC, once endowed with natural resources, now struggles to sustain water supply, food security and agricultural productivity. Other than health, tourism and livestock production are also threatened, risking sources livelihoods.

    Depletion of natural resources is to blame for poor health indicators and high levels of poverty, which is further compounded by the high dependent population ratio.

    The average life expectancy at birth is 57 years for the region. Diseases such as tuberculosis malaria, typhoid and bilharzia are widespread while malnutrition is rife among children.

    Access to healthcare services is hampered by inadequate and inaccessible medical facilities.

    A large number of children in East Africa often die due to starvation, malnutrition, diarrheal diseases and flooding, according to Intergovernmental Panel on Climate Change report.

    Nutritional status is still a big challenge with prevalence of low birth weight being a leading cause of neonatal mortality. This is as high as 7.1% in Rwanda, 8.0% in Kenya, 8.4% in Tanzania, 11.9% in Uganda and 12.9% in Burundi. Moderate to severe stunting is highest in Burundi at 57.7% and lowest in Uganda at 33.4%.

    The effects of climate change are already being felt by people in East Africa. In Kenya the ongoing drought has been declared a national disaster.

    Observable effects of climate change on water resources in East Africa include change in rainfall patterns, receding or drying up of rivers and flooding that has led to loss of life and destruction of property East Africa, worsening poverty conditions.

    Glaciers on Mount Kilimanjaro are disappearing and several rivers are now drying up. It is estimated that 82% of the ice that capped the mountain, when it was first recorded in 1912, is no more.

    Women spend days looking for food and water hence cannot engage in any other meaningful economic activities.

    Since early 90s, individual countries have made several attempts to control population including limiting the number of children to not more than three, keeping girls in schools to reduce the number of fertility years and step up family planning.

    Adoption of family planning services more than half a century ago has not helped much. Kenya, for instance, was the first sub-Saharan African country to adopt a national family planning programme in early 1970s. The slow uptake of the family planning means that there are unmet needs, especially for rural women and teenage pregnancies.

    Dr Obeth Nyamirimo, a member of the East African Legislative Assembly said Rwanda's bid to implement a Reproductive Health Bill, limiting the births by every woman to three had hit a snag.

    "We introduced the bill but had difficulty in limiting the number and even lacked penalties to spell for those who breached the rule,” she said.

    "We realised it is important for the governments and stakeholders to invest in empowering individuals and communities through dialogue and understand the contribution of a healthy environment to good health and manageable population,” she said.

    The five EAC partner states agreed to strengthen the integrated population, health, and environment (PHE) programme under Lake Victoria Basin Council so that players from the sectors which affect one another would plan, budget and work together as a strategy for sustainable development.

    The initiative involves government ministries and civil societies dealing in health, environment, water, forestry and wildlife for efficiency.

    The integrated approach means that if an NGO had pre-dominantly been implementing on HIV/Aids programme, they must adopt environmental conservation.

    Those involved in forestry could also educate the public about population control and its effects on environment.

    "The PHE approach is one of the key solutions to attaining Sustainable Development Goals in the region.

    Community champions in these areas have been trained to educate other community members about environmental conservation, family planning, reproductive health, HIV and Aids, malaria and control of communicable and non-communicable diseases.

    Kenya has 50 PHE champions, Uganda 86, Tanzania 42, Rwanda 44 and 34 in Burundi.

    Households are taught to have minimum requirements which include ensuring that all children under five are fully immunized, a couple does birth spacing or family planning, treat drinking water, have a dish rack, a clean latrine, a kitchen garden and also plant at least 50 fruit trees to promote agroforestry. doclink

    Karen Gaia: In this article: 'population control' gets the cart before the horse. They wonder why women don't limit their families. Most impoverished people in rural areas do not have access to contraception. Nor so they have the means to treat their drinking water, have a dish rack, or a clean latrine. The people who live in the Ngorogoro Conservation Area are also not allowed to plant a garden or fruit trees. I am finding, though, that if you give them family planning, education, and small business training, the rest comes later. However, if they do not have enough to eat, women stop breastfeeding early and consequently have children closer together, plus children are stunted mentally as well as physically and do not do well in school. If girls don't go to school, they are married off early.

    So: food first, education second (this often gets them into schools where they can be fed), family planning education, supplies and services third.

    'One Key Question' to Revolutionize Reproductive, Public Health

    August 26, 2015, Public Health Newswire

    In Oregon there is a movement where doctors ask every woman of reproductive age "Would you like to become pregnant in the next year?" The movement is called One Key Question.

    The Oregon Foundation for Reproductive Health (OFRH) believes this question "triggers a doctor-patient discussion that will keep women healthier, help eliminate health disparities and save taxpayer dollars."

    The goal is to ensure that more pregnancies are wanted, planned and as healthy as possible.

    This question brings pregnancy intention screening and preventive reproductive health directly in to primary care. It opens the door to providing either preconception, prenatal or contraceptive care in a novel fashion that goes beyond simply asking if she is pregnant or using contraception. One Key Question is a conversation starter, not a checklist. It can initiate a genuine conversation that empowers a woman to plan her health care needs in support of her goals for herself and her family.

    OFRH tested many variations of asking about prenatal care and pregnancy prevention before determining this question to be the most effective. Clinicians implementing One Key Question have found that the majority of women have a clear opinion about whether or not they would like to become pregnant in the next year.

    However, when a woman answers "maybe" or "I don't know," One Key Question often effectively leads to identifying urgent health needs that may otherwise go undetected - such as depression, violence in the home or substance abuse - and leads to negative pregnancy outcomes.

    Women are relieved to be able to talk about their reproductive health needs in a primary care setting rather than through a separate appointment with a specialist. This more streamlined approach can be invaluable for low income women, women of color and those in rural communities, in particular, who have decreased access to reproductive health care.

    OFRH is very aware of the need to establish reliable systems for measuring the impact of One Key Question as it is implemented in sites nationwide.

    Ultimately, because One Key Question encourages women to obtain preconception care, we expect to see a drop-off in public health care costs as earlier identification and management of conditions such as diabetes and hypertension improve pregnancy, delivery and post-natal care and lower long-term costs for all women, but particularly for those with decreased access to specialized care. doclink

    Karen Gaia says: After I gave birth to my first child 50 years ago, my doctor asked me if I wanted to get pregnant right away. Of course I said 'No'. That's when I was introduced to contraception. In Bangladesh, the health care worker tells the pregnant woman to come back after the birth and when she comes back, she is offered birth control to space her pregnancies. That is how Bangladesh lowered its fertility rate so quickly.

    At Niger's School for Husbands, the Lesson is 'Space Your Children'

    August 13, 2014, NPR National Public Radio   By: Marc Silver

    Niger is a country that depends on agriculture, but since much of it is a desert, it has only a limited amount of land that can be farmed. This is a problem for a country that has the world's highest birthrate -- more than seven children per woman on average. It's current population will double in 20 years at that rate.

    The United Nations Population Fund began the school for husbands program in 2011 to help bring down the birth rate. In different communities, men meet twice a month, under a tree or in an open-air classroom, to talk about maternal health and contraception.

    In this society you have to convince the men that it's OK because that's how the decision is going to get made.

    Contraception is fairly controversial in Niger so much of the time they talk about child spacing. In Niger, you're a big man if you have a big family, yet this is becoming a huge problem. Even the president talked about it being shameful this month for people to have 20 kids if they're not able to feed them.

    The government is going to make contraception available in all the health clinics and get the word out that not only is it OK for women to use contraception but that they should be using contraception. Male condoms, female condoms, IUDs, injections, the pill will be available. In fact they are now available.

    Younger men are expecting a smaller family than previous generations. So that change is happening.

    There is also a push to have women get married later, not at 12 or 13 or 14 but in their late teens, early 20s. That shortens the period when they would be having children. In one case a girl went to court to stop her family from forcing her to marry her uncle in Nigeria. Ultimately, she was successful.

    Infant mortality is going down, so kids are surviving longer. But people don't yet understand that they don't need to have as many kids because most of the kids are now going to survive to adulthood. doclink

    How Bangladesh's Female Health Workers Boosted Family Planning

    Contraception delivered through female community health workers has helped to reduce birthrates and infant mortality
    June 6, 2014, Guardian   By: Kenneth R Weiss

    This interesting article is somewhat long but worth reading in its entirety (by clicking on the link in the headline), so here is the gist of it:

    Bangladesh established Matlab -- an experimental village -- in the 1960s and there trained a cadre of female community health workers who have been carefully maintaining one of the longest-running and most detailed health and population data sets in the developing world.

    These health care workers make house calls to administer child and maternal health and are widely credited for demonstrating how poor Muslim women with little or no formal education can plan their families.

    Ubaidur Rob, the non-profit Population Council's Bangladesh director said "Women were employed as field workers in the 1970s, when fertility was very high and female employment was virtually zero. This is where change began."

    In the mid-70s researchers divided 149 villages into two groups. One half participated in the Matlab centre's maternal and child healthcare initiatives, including home delivery of modern contraceptives, while the other had access only to government services.

    At that time, contraception was denounced by Islamic clerics. Dr Mohammad Yunus, who ran the Matlab centre for nearly 40 years said that what worked "was a comprehensive doorstep service with trained female health workers making regular follow-up visits to help mothers pick a method of contraception that was best for them, treat side-effects and provide basic maternal and child healthcare."

    In the Matlab half, married women were more likely to use contraceptives and, over time, had an average of 1.5 fewer children than their counterparts in the comparison area. Their children were healthier, fewer women died of pregnancy-related causes, and child mortality fell. Parents accumulated more farmland, built more valuable homes and gained access to running water. Their children stayed in school longer, and women enjoyed higher incomes.

    By the early 80s, when other areas using the Matlab approach had experienced a similar increase in contraceptive use, the government trained tens of thousands of female health workers using the Matlab model.

    Since then, average birthrates have fallen from six children a woman to slightly more than two; projections for Bangladesh's population in 2050 (currently 160 million) have dropped from 265 million (forecast in 2000) to 200 million, and stabilizing soon after. Also Bangladesh has become one of the first impoverished countries to meet the UN millennium development goal of reducing child mortality by two-thirds. doclink

    Karen Gaia says: one of the things that helped this program work was that new mothers were asked to come back after the baby was born, and during that visit, were asked if they wanted to have another baby soon. If the mother said 'No', the health care worker was prepared to give here one of an assortment of contraceptives.

    Nigeria: Bundling Child Spacing and Immunization Into One Integrated Service

    TSHIP Advancing Health in Bauchi and Sokoto Targeted States High Impact Project
    October 9, 2013, Vietnam News Agency

    Child spacing is a crucial aspect of improving the overall health of women in developing countries - helping to reduce unwanted pregnancies and the health risks associated with giving birth to many children. For children under-five years, a critical live saving measure is immunization.

    Bundling these two services together as TSHIP is doing provides a continuum of care - from child spacing, antenatal and postnatal needs of women to the care of children under-5 years.

    Raising awareness of child spacing is a tricky issue, especially in communities where conservative values are still strong. In an area of Sokoto such "cultural sensitivity" has been softened by making it a community-led exercise. The members of the WDC help start the needed dialogue at the community level, bringing health education and the issue of child spacing to locations as diverse as markets, gathering places and even places of worship.

    Another approach is the practice of holding child spacing education at the same time as immunization or antenatal services in health facilities. This takes less time and money, with local people keen to make the most of the health services offered. Maryam Umar, a worker at the Shuni dispensary, said 'I provide immunization and child spacing services to women when they bring their children for immunization, because of fear that the women will not come back on the child spacing session day. Some will even report us to the WDC if we do not provide them with all necessary services'.

    The changes in Shuni are just a small drop in the sea of change happening in Sokoto. The state has over 70% of its health facilities holding integrated child spacing and immunization sessions. As more women bring their children for immunization, the opportunity to reach these women with child spacing messages and services has equally increased.

    TSHIP = Targeted States High Impact Project: increases the use of health services and strengthens health systems to be more responsive to the basic health needs of households in Northern Nigeria doclink

    India: Family Planning After Childbirth Is Critical to Women's Health

    April 15, 2013, Impatient Optimists

    In India, Anita Devi had five children in nine years of marriage; three of her children were born within a year of each other. As part of India's postpartum family planning effort, the nurse-midwife encouraged Anita to choose contraception after the birth of her fifth child. Anita chose intrauterine contraception.

    "My mother-in-law was against any form of contraception," Mrs. Devi explained when asked about her previous births. "Though my second child was a son, she said that I should try for more sons. But my next children were girls. I was tired and felt I had nothing left in my body."

    In Bihar province, families have on average 3.7 children, and only 32.4 percent of women use any family planning method.

    With the support and technical expertise of Jhpiego (affiliate of Johns Hopkins University) and under the PPFP (Post Partum Family Planning) initiative supported by the Bill and Melinda Gates Foundation, India's nurse-midwives are educating and counseling women about their family planning options during antenatal visits and introducing them to the intrauterine contraceptive device (IUCD). This long-acting method lasts for 10 years and can be inserted within 48 hours after giving birth. 16 states are participating in the program.

    She has seen firsthand the challenges women and their families face when burdened with too many children, often struggling to provide them with food and clothing. "Only if we have smaller families will we be able to have healthier families where the children will get better nutrition and opportunities to educate themselves. Only then can we ultimately have a better and healthier society." doclink

    South Sudan Women Choose Family Planning, Longer Lives

    November 8, 2012, Voice of America News   By: Hannah McNeish

    South Sudan has been cut off for nearly 50 years by Africa's longest running civil war, and, due to a lack of basic health and education, early marriage, and a culture that values big families have led to alarming child mortality rates, has seen the highest maternal mortality rate in the world. The average woman has seven children and at 1.7%, South Sudan has one of the lowest contraceptive availability rates in the world, plus early pregnancy has increased from one-fifth to one-third of teenagers in recent years.

    Now newly-independent South Sudan has been building a health service from scratch with the help of international aid agencies and South Sudanese women are getting the chance to improve their chances for a long life. South Sudan hopes to increase the contraceptive availability rate to 20% by 2015, as the new nation's population grows at three percent a year and it struggles to get a grip on providing basic services. Family planning charity Marie Stopes International (MSI) started programs in South Sudan's three southern states.

    One woman is getting a hormone implant that will space her children and give her a five-year break. Another woman has a husband earning a paltry and irregular salary, and she is determined to educate her children in a hope that one may someday lift the family out of poverty.

    Over 80% of South Sudan women have no education and 16% are married off by the age of 15.

    A clinical officer Jude Omal at one of the clinics said, "When we were beginning, we had a lot of resistance as people think when you provide family planning to a mother, or a lady of reproductive age, she may most likely turn into a prostitute. You say 'no, these services helps her to have children at a time when she thinks she's ready,' so this family planning is like an empowerment to women and girls of reproductive age."

    He said both men and women are increasingly aware about the links between a quick succession of pregnancies and lack of health care to high instances of maternal mortality. doclink

    Solutions to Poverty, Population Growth, Global Warming

    September 19, 2012, Los Angeles Times

    Experts from three continents convened last week at UC Berkeley to discuss rapid population growth, climate change and other intractable problems. Before the conference, the Los Angeles Times held an online video discussion with some of the conference attendees.

    The article in the Los Angeles Times newspaper explored such issues around the world in its recent five-part series on population growth in the developing world. Among other topics, the "Beyond 7 Billion" series examined chronic hunger and mass migration in East Africa -- trends that Dr. Malcolm Potts believes will soon extend across the Sahel, an arid region of Africa just below the Sahara desert.

    Malcom Potts, a UC Berkeley professor of public health who co-organized the conference said, "What you've been seeing from Somalia is going to happen in all those countries, all the way across from the Red Sea to the Atlantic Ocean." .. "You've just seen a fraction of what's going to happen in the next 10 or 20 years." The goal of the online broadcast before the conference was to discuss solutions to the problems facing this part of Africa and other impoverished nations with soaring populations. He was joined by Dr. Ndola Prata of UC Berkeley, William Ryerson of the Population Media Center and Fatima Adamu from Usmanu Danfodiyo University in Sokoto, Nigeria. Kenneth R. Weiss was the moderator.

    Dr. Potts: The Sahel is dry dusty region in Africa which is affected by climate change and has rapid population growth, and the status of women is low. It is where there are many cases of drought and famine. Other areas are also in trouble: Afghanistan will double by 2050; people there are growing poppies instead of food. Child brides are a problem in both areas.

    Dr. Prata: Women need control over number and timing of their births; Over 200 million women don't want to have a child in the next two years or don't want to have children at all. They need access to family planning. Family planning is very cost effective and has a beneficial impact on maternal and child mortality. Women want to be able to send their children to school, and family planning helps this.

    Ryerson - Only 1% of people who don't use contraception cite lack of availability as the reason. 40% of non-users cite religion, husband, or personal, 17% want as many children as possible, a sizable number cite fear of side effects, and another large number are fatalistic - 'God will determine how many children I have'. We must be very careful to avoid cultural imperialism. What is important is people's perception of what is normal. This can be changed. Population Media Center uses serialized entertainment mass media featuring role modes of various types of people. PMC models behavior such as delaying marriage and childbearing until adulthood, prevention of HIV, spacing births, and communication between husbands and wives concerning health and number of children. Of those who were interviewed, 67% of clients of a family planning clinic gave the PMC radio show as the reason for patronizing the clinic.

    Dr. Adamu - Agrees with the need to give women information and the culturally sensitive way that is needed to introduce these issues. There must be no coercion of any kind. Every woman wants to improve her life. It is important for the woman to have information of where to get services. The majority of our women lack basic information. We must invest in the woman and empower her. Many times religion allows women to space their births.

    Dr Potts: The best contraception is 'what the woman wants'. Even illiterate women can get family planning. A woman in the poorest countries have a 1 in 12 chance of dying in childbirth compared 1 in 5,000 for a developed country. Family planning could prevent most of these deaths. The current cost to Americans for international family planning funding is the cost of one hamburger. To provide adequate family planning and reproductive health for all the women who have an unmet need, it would take the cost of two hamburgers. It is shameful that we let so many women die for the cost of a hamburger. And what we avoid by family planning is the great cost of war and the cost of feeding so many people.

    Dr. Potts: Education has been considered one of the best contraceptives, but in the Sahel the population is growing so rapidly that schools cannot keep up. But education is not absolutely necessary. The women in Bangladesh were illiterate when they reduced their fertility rate so quickly.

    Dr Prada worked in Angola where the birth rate was 5 children per woman. Women want to improve their lives; they want to send their children to school; they want to feed their children. A family planning program will educate to allow women to make the best use of contraception. It is difficult to get contraception on a regular basis. Many want a long-acting injection but all they can get are condoms and pills. Dr. Prada suggests couple counselling before marriage.

    Dr. Adamu: Too many girls get married early. We must delay those marriages. The government must be working on poverty reduction and saving the woman's life. Let us not approach it in terms of 'population control' but more for saving lives. No husband wants his wife to die. Dr. Adamu works with adolescent mothers - some are age 12. They work in peer groups and involve the husbands and mother-in-laws. Giving them information on how to control their reproduction and get health care - and that there is a choice - empowers them and gives them the self-esteem to choose the number and the spacing of their children.

    Dr Potts: If you respect women and give them a choice, they will tend to have fewer children.

    Ryerson: Coercion is a terrible idea. However we must still realize that population is a key threat posing a real threat to human survival. Yet the U.S. Congress tried this year to stop all funding for international family planning.

    Dr Adamu: We have to understand the woman in the village where her respect lies in the number of children she has. There is still the question of how many children will survive, and so she values having many.

    Ryerson: People need to know that children will survive. Infant mortality rates are continuing to come down, but knowledge of that lags. Part of education must include the health of infants and ways they can survive.

    Dr Prada: The desired number of children does come down. Often the number of children a woman has is below the number she said she desired.

    Ryerson: The U.S. is not immune to population problems. It has the third largest population in the world and the highest per capita energy consumption. It promotes endless growth which is not possible. We need a whole new paradime for our economy. doclink

    U.S.: Early, Adequate Prenatal Care Linked to Healthy Birthspacing

    March 1, 2012, Guttmacher Institute

    The findings of a study called "Prenatal Care and Subsequent Birth Intervals," by Julien O. Teitler, "provide strong evidence that earlier and more intensive exposure to prenatal care during a first pregnancy is associated with more optimal spacing and thus, most likely, better fertility control."

    The authors used birth records from New Jersey women who had a first birth between 1996 and 2000, and examined the relationship between the timing and adequacy of prenatal care prior to a woman's first birth and the timing of her second birth. Most women (85%) had initiated prenatal care during the first trimester. However, 12% of women had initiated prenatal care in the second trimester, and 3% in the third; fewer than 1% had had no care. The later prenatal care was initiated, the more likely women were to have had a second birth within 18 months. Additionally, the likelihood of having a second birth soon after the first was greater if women had had inadequate rather than adequate prenatal care.

    The authors suggest that providers should take advantage of their encounters with women who initiate prenatal care later in pregnancy in particular, to ensure that these women receive family planning information and services during their prenatal visits. By doing so, providers could bridge the gap left by funding and service cuts to the family planning program; the potential impact on public health is large. doclink

    The Word on Women - Niger Starts to Tackle Soaring Population - with Help of Imams


    Until recently the subject of family planning in Niger was taboo, but commissioner Kristalina Georgieva, the European Union's top humanitarian-aid official, was pleasantly surprised this time to see a project teaching women about contraception and the importance of spacing births.

    The local Imam where she visited "was quoting the Koran saying there's a verse that says there has to be time between the birth of children so the children and mother can recover and be strong."

    The support of the local religious leaders at the health centre she visited in Bambey, in western Niger, was crucial for bringing down the high rate of population growth, she said. The growth was putting a strain on a country that is among the poorest in the world, that struggles with a harsh climate and is vulnerable to the effects of climate change.

    Since independence in 1960, Niger's population has risen from less than 2 million to 15 million plus.

    Now there is "remarkable openness to address family planning". "At the level of the president, prime minister, ministers and cabinet there's an openness to discussing family planning. There's an openness that 3.3-percent population growth is not sustainable," she added.

    "There are already activities on the ground (for) family planning in a very community-based and respectful manner ... The topic is not taboo anymore."

    Mothers need to space their children to avoid back-to-back pregnancies which contribute to malnutrition and keep mothers weak. "That's where there is potential to work hand in hand with community leaders and religious leaders. It has to be culturally acceptable to work."

    The annual hungry season in Africa's Sahel countries is expected to begin in late February or early March - several months earlier than usual. Aid agencies say between five and nine million people are at risk.

    Talking about population growth in relation to food shortages is a sensitive issue, partly because large families are considered important in many cultures, particularly where people rely on their children to help on the land and to support them in old age.

    Many argue that the real causes of food shortages are political and economic. Georgieva says a food crisis is looming in the Sahel due to poor rains, bad harvests, food-price hikes and the return of migrants from Libya, among other factors.

    But she also argues more generally that it is time for the world to pay more attention to managing population growth in fragile environments. When she visited Kenya last year she realised that in 1963 it had more or less the same population as her own country Bulgaria - well below 10 million. Today Bulgaria is at 7.5 million whereas Kenya's has soared to 40 million.

    The populations of other affected countries had also grown five times and this meant that when there were droughts the impact was all the more severe.

    For a very readable look at some of the arguments on why population growth is not the cause of famine, take a look at this article published by Al Jazeera: Famine in the Horn of Africa: Malthus beware. doclink

    Karen Gaia said: I looked at the Al Jazeera article and it kept comparing the Horn of Africa to the state of Oklahoma. Oklahoma, as most Americans recall, in the 1930s had huge desertification and a resulting 'dust bowl' that drove farmers out of the state. This was a time when Oklahoma's population was far less than today, and it lost 7% of its population due to the Dust Bowl.

    Other comments following the Al Jazeera article:

    Of course population growth is not the sole aspect of famine - bureaucratic and political incompetence and venality is there too. Factor in useless and ineffective donor-driven projects and lack of market infrastructure. But the comparison with Oklahoma is invidious - simply nonsensical unless one suggest that Okies are demographically youthful, illiterate, chronically sick, underfed (if not starving), corrupt and lack access to all the resources that those in the HoA clearly do. Technical change does indeed keep the developed world ahead of popu

    Time for Uganda to Prioritize Family Planning Investments

    The Monitor (Kampala)

    Facing severe budget shortfalls at home, many donor countries are cutting back their foreign aid programs, including support for crucial international family planning programs. The United States, the global leader in supporting contraceptive services in the world?s poorest countries, recently reduced its 2011 international family planning and reproductive health assistance by $33 million.

    Uganda must step up its own funding for family planning. The time to act is now. The country has experienced strong economic growth in recent years, but we should remember that social and economic progress is linked to improved access to quality family planning services. Such services save women's lives, save the country money, and create a healthier, more productive society. Failure to support these services now will only end up costing more down the line.

    Low levels of contraceptive use are already taking a toll. 70% women who want to avoid pregnancy are not using an effective contraceptive method. More than half of all pregnancies are unintended.

    In rural areas, where 85% of the population lives and where family planning services are scarce, the poorest women now have two more children, on average, than they want, increasing economic hardship among the most vulnerable families, leaving them with fewer resources to invest in education, health care and other basic needs.

    Unintended pregnancy is also a serious threat to the health and survival of women and newborns, often resulting in high-risk births occurring too soon after a previous delivery or when a woman is too young. This reality is starkly reflected in Uganda's high rates of maternal and newborn deaths. doclink

    Kenya: Melinda Gates: Discussing Family Planning with the Mothers of Korogocho

    March 7, 2011, Huffington Post

    Melinda Gates, philanthropist, talked with new mothers in Korogocho, a large slum in Nairobi, Kenya. She asked them "Why do you want to plan the number and spacing of your children?"

    One woman said she wanted to be able to feed all her children.

    Another woman added, "Where am I going to keep them? Under the bed?" It was funny until she explained she had only a single room in which to raise her children. "Our houses are toilets," she said. "Why bring so many kids into a toilet?" It was impossible for her to raise her children in a safe and healthy environment.

    One woman said if she had too many children, her husband would leave her.

    Finally a woman summed the whole conversation up in one sentence. "I want to bring every good thing to one before I have another," she said.

    "As different as many of their experiences are from mine -- fighting their husbands for the right to plan, struggling to put food on the table -- there is something universal in motherhood that unites us. We all want to bring every good thing to our children," Gates said.


    Singapore: Baby - Space Each One Out; Allowing One's Body Time to Rest Between Each Pregnancy Can Reduce Health Risks to Both Mother and Child, Research Shows

    January 22, 2009, The Straits Times

    Optimal birth spacing benefits both mother and child. Allowing an interval between births results in the best health and social outcomes for the family.

    It gives women time for their bodies to recover from a birth and return to a stable nutritional status. Conceiving another child within six months of delivery poses health risks. Of the 387 mothers polled in a survey in Singapore between June and September last year, 46% practiced optimal birth spacing of one to three years.

    Half had a gap of one to two years, while the other half waited two to three years.

    One in 10 mothers either had their next child after several years or too soon after a birth.

    Intervals of less than a year between births are linked to adverse fetal outcomes including miscarriages, slow fetal development, premature babies and babies with low birth weights.

    Waiting too long - five years or more - may give rise to decreased fertility, particularly if the woman is already in her 30s.

    Older women are also at higher risk of ailments like high blood pressure and diabetes during pregnancy.

    Effective birth control methods are central to birth spacing.

    In Singapore, the condom is the most commonly used birth control method, followed by the oral contraceptive pill.

    Another option is the intra-uterine system (IUS)that - releases hormones that help prevent pregnancies.

    Many women think that using the oral pill or the IUS will delay fertility, but such worries are unfounded. doclink

    Africa: Food for Breastfeeding Moms

    April 10, 2007, Africa News Service

    Food parcels are being offered to HIV positive mothers in KwaZulu-Natal who want to breastfeed their babies.

    The mothers, who are poor, tend to see the formula milk as an incentive. They then tend to opt to get the formula milk and feed their babies both breast and formula milk - the most risky feeding choice for passing on HIV.

    The food parcels help counsellors to offer HIV positive women either food packages if they choose to breastfeed or free formula if they have the resources to safely prepare and give formula.

    Government policy was weighted in favour of formula feeding, yet research shows that babies of HIV positive mothers who are exclusively breastfed are at far lower risk of getting HIV than babies who are mix-fed both formula and breastmilk. As breastmilk can transmit HIV, the government has been reluctant in the past to promote it. However, a number of studies show that exclusive breastfeeding posed a relatively small danger to babies.

    Their comprehensive study quantifies this risk at 4% by the time babies are six months old.

    The risk of HIV for babies who get formula and breastmilk is double this, while the risk for babies who get breastmilk and food is 11 times that of the exclusively breastfed babies.

    The new plan announced that HIV positive moms choosing to breastfeed would be offered "nutritional support".

    The food parcels consist of mielie meal, enriched porridge, rice, beans, soya mince, milk, peanut butter, tinned fish, sunflower oil, sugar and salt.

    HIV positive mothers had greater nutritional needs and tended to lose more fat than HIV negative mothers.

    The health of babies being exclusively breastfed is tied to the health of their mothers.

    Babies are most likely to get HIV when their mothers' levels of immunity is low so the food parcels will help to keep mothers healthy and less prone to infections particularly if boosted with antiretroviral treatment for their mothers.

    Researchers found that at least a quarter of the mothers sold the formula milk as they were desperate for money.

    There is a likelihood that the food will be used to feed entire families. But at least the benefit will be kept within the family, and the breastfeeding mothers will get some of the benefits. doclink

    Target Educated Mothers Too

    August 12, 2007, Africa News Service

    Breast milk is the best food for the baby for the first six months of life. It strengthens the baby's ability to fight childhood diseases and allergies and the mother's ability to fight diabetes and breast cancer.

    In Uganda, rural women breastfeed with no encouragement. Urban women lack social support and information on the benefits of breastfeeding and in a rush back to work or to their social lives, many resort to breast feeding supplements before the recommended six months.

    Some urban mothers do not get the support from their employers or spouses. Many employers do not give the mothers the stipulated 60 days' maternity leave. There is a risk that an HIV positive mother could pass on the virus to the child and should be sensitised on the options available.

    Babies born to young mothers in the urban centres are victims. We must support and educate our mothers to breastfeed anytime and anywhere even in public. doclink

    Birth Spacing: 2004 Evidence Supports 3+ Years

    June 11, 2007, MAQ web

    Global estimates of maternal and perinatal mortality have remained unchanged over the past 20 years. This study was to evaluate the association between inter-pregnancy interval and the occurrence of adverse outcomes. Participants: A total of 14,930 records of women who delivered single infants. Conclusions: Short inter-pregnancy intervals are associated with a higher risk of low birth weight and preterm birth, while long intervals are associated with a higher risk of premature rupture of membranes, and a lower risk of C-section. doclink

    Family Planning Key to Afghan Maternal Deaths - U.N.

    April 24, 2007, Reuters

    Afghanistan's maternal mortality rate of one mother for every 60 births would be reduced if mothers spaced their pregnancies.

    Bringing the toll down means that trained birth attendants are present, emergency hospital care is available and so is family planning.

    People have to understand that family planning was not against the rules of Islam but is well-enshrined in the Koran, that says that women should nurse for two years, it was a form of family planning.

    Spacing allows a mother to regain her health before becoming pregnant again and allows a family to devote more attention and resources to each child.

    The right to health, education, the right to income and the right to life can be achieved by planning the family. doclink

    Population Growth and the Millennium Development Goals

    February 3, 2007, Lancet (UK medical journal)

    Experts described the beneficial effects of slowing population growth that permit greater investment in education and health. High birth rates in sub-Saharan Africa have helped increase the number living in extreme poverty from 231 million in 1990 to 318 million in 2001. In Ethiopia, 8 million people live on permanent food aid, and the projected growth to 145 million in 2050 presents an insurmountable challenge. Girls in large families are less likely to begin school and more likely to drop out early.

    A child born less than 18 months after an older sibling has three times the death rate of a baby born after 36 months. 35 of all maternal deaths could be forestalled by preventing unintended births. Many unintended pregnancies occur in women who are HIV-positive, and improved access to family planning is the most cost-effective way of preventing transmission. Consumption in the developed world contributes to ecological problems, but rapid population growth in developing countries leads directly to deforestation, land degradation, and threats to water quality

    The need for family planning must be met among the women around the world who would like to limit or space their childbearing, and calls for greater investment in family planning, and breaking down the barriers to contraceptive use based on cultural beliefs, prejudices, and assumptions.

    There are shortages and Vice Minister of China's National Population and Family Planning Commission said that China was willing to share contraceptive commodities with developing countries.

    A decade of progress has been lost, and today the international family-planning budget is only 10% of that necessary in 2005. The donor community must once again place population and family planning at the centre of global efforts to fight poverty, improve education and health, and attain a humane standard of living for everyone. doclink

    U.S.: Large Families 'Bad for Parents'

    December 26, 2006, BBC News

    US researchers looked at 21,000 couples living in Utah between 1860 and 1985, who bore a total of 174,000 children.

    The data showed that the more children a couple produced, the higher their risk of early death.

    The situation was worst for women. Fathers' mortality risk increased the more children they had, but never exceeded that of mothers.

    Mothers were more likely than fathers to die after the last child was born.

    They found 1,414 women died within a year of the last child's birth, and 988 by the time the child was five.

    In comparison, 613 men died in the first year after their last child was born, with another 1,083 dying within five years.

    The larger the family, the more likely children were to die before the age of 18. The findings shed light on human reproduction which are still relevant today.

    The female goes through a menopause which ends her reproductive years and appears to allow mothers to live longer and rear more offspring to adulthood. doclink

    Nigeria: Visit Family Planning Clinics, PPFN Urges Couples

    November 30, 2006, The Tide Online

    Planned Parenthood Federation of Nigeria (PPFN) has enjoined people to seek information from family planning clinics in order to space their birth to improve the health of mothers and children.

    Family planning must be observed so that the health of the mother and child will be protected. It is essential to visit clinics in order to be informed on child spacing, reproductive health and the consequence of having many children.

    Family planning give couples the choice of when to have children and how many to have. One of the greatest threats to the health and growth of a child under the age of two is the birth of a new baby. Breast feeding stops too suddenly and the mother may not be able to give care and attention to the older baby.

    Having more than four children increase the health risks of pregnancy and child birth since a woman's body can become exhausted. Parents should wait until their youngest child is at least two before having another baby. doclink

    UNICEF Attributes One-Fifth of Child Deaths to Poor Nutrition

    August 4, 2005, The Post (Zambia)

    Around 5,500 children die everyday from inadequate breastfeeding and nutrition. Almost 50% of children in Zambia under five is stunted due to poor nutrition. An estimated 63% of children under six months in the developing world are not adequately breastfed. Millions are left to face chronic illnesses. The low rates of breastfeeding are currently at 37% worldwide. Mothers should be encouraged to have good nutrition during pregnancy and the first years of a baby's life when breastfeeding should be the staple food. Malnutrition accounts for child deaths, delayed mental development and impaired ability to good performance at school. Complementary foods are often inadequate, increasing the risk of illness. High poverty levels contribute to the lack of quality complementary foods. HIV aggravates the situation. The government strategy is aimed at giving options to mothers in various situations regarding young infant and child feeding. doclink

    Help Reduce Child Mortality Through Breastfeeding, Mothers Urged

    May 29, 2005, Ghana Web

    The Breastfeeding Promotion Committee has stressed the need for lactating mothers to adopt the exclusive breastfeeding policy to reduce under-five mortality rate. The WHO survey on Ghana showed that exclusive breast feeding for six months reduced under five mortality by 13%. Exclusive breast feeding was the surest way for reducing infant mortality and underscored the need for the policy to be enforced against the violation of the practice. The 2003 report on Ghana's infant and child mortality indicated a slowing of the mortality rate. Studies showed that for babies born to HIV-infected mothers, the use of niverapine combined with baby formulas to prevent mother-to-child transmission, could reduce child mortality to only 2% while the use of insecticide-treated bed nets could reduce it by 6%. Statistics showed that the infant mortality rate for children under-one was soaring because of mixed feeding with baby formulas. Exclusive breastfeeding in fighting mortality in children has become a serious issue and called for stringent measures in enforcing the ban on baby food companies to stop the promotion of their products to ensure that breastfeeding was practiced. doclink

    U.S.: The Only Child Stigma is Fading; More Families Are Opting to Have Just One

    May 15, 2005, Houston Chronicle

    For generations, only children and their parents have gotten a bad rap. But research suggests only children tend to be higher achievers, they get along with their peers, they aren't spoiled or lonely or aloof. From 2003, about 20% of U.S. children under 18 had no siblings at home. The country's birth rate has been deflating since 1960. A greater proportion of women have their first children at later ages. With couples delaying marriage and childbirth and mothers remaining in the workforce, single-child families are becoming more common. doclink

    The Effects of Birth Spacing on Infant and Child Mortality, Pregnancy Outcomes, and Maternal Morbidity and Mortality in Matlab, Bangladesh

    Using data from 145,000 pregnancies gathered over twenty years in Matlab, Bangladesh, we seek a better understanding of the effects of interbirth intervals on infant and maternal mortality and morbidity. Compared with intervals of 3-5 years interbirth, intervals of less than 24 months are associated with significantly higher risks of early neonatal mortality, and intervals of less than 36 months with higher risks of late, neonatal, post-neonatal, and child mortality. A short interval also increases the risk that the pregnancy will result in an induced abortion or a premature live birth. These effects persist when we control prematurity, breastfeeding, immunizations, and demographic and socioeconomic variables. Women with short interpregnancy intervals have a higher risk of preeclampsia, high blood pressure, and premature rupture of membranes compared to those with an interval of 27-50 months. Interpregnancy of less than 6 months is associated with an elevated risk of maternal mortality compared to 27-50 months, but the risk is not statistically significant. Women with interpregnancy intervals of 75+ months have a higher risk of pre-eclampsia, proteinuria, high blood pressure, and edema compared to women with intervals of 27-50 months. Very long interpregnancy intervals are also associated with higher risks of maternal mortality but do not increase the risk of child mortality. More than 57% of all intervals in our data are less than 36 months and are associated with higher levels of child mortality and some maternal morbidities. Rates of infant and child mortality would be 5.8- 9.4% lower if all intervals were 3-5 years. doclink

    Childbirth Complications, Maternal and Infant Mortality

    How Our Country Fails Black Women and Girls

    And why we need to talk about it.​
    April 28, 2016, ELLE   By: Melissa Harris-perry

    Maya Angelou is one of the most extraordinary Americans to live in the twentieth century. Born in 1928, she experienced childhood poverty and dislocation. She was raped when she only seven years old. Eventually she became an unwed teen mother. More than three generations after Maya's childhood, poverty, familial disruption, sexual violence, interrupted education, and teen pregnancy remain key barriers facing black girls in America's cities, towns, and rural communities.

    Maya Angelou was guided out of silence by the loving hand of an educator who saw the brokenness of a girl child who needed to be drawn gently back into the world. Because of her teacher, Maya encountered meaningful opportunities to learn, grow, and discover her talents while experiencing the care of her community. She became a fierce advocate for voting rights and human rights, working first with Dr. Martin Luther King Jr. and Malcolm X and later with both Coretta Scott King and Dr. Betty Shabazz. Recognizing the importance of race and gender health disparities, Maya Angelou's path was not always pretty or polite, but it always affirmed that Black Girls Rock and Black Women Matter.

    It is not safe to be a black girl in America. We less frequently discuss historical violence against black girls and don't adequately connect these stories to movements for social justice. As a result we think our daughters are safer than our sons. Black communities understand how unjust violence perpetrated against black boys is connected to our collective movements for racial justice and social change. We know how the horrific murder of Emmett Till galvanized the courage of black Americans in the battle against Jim Crow.

    Girlhood has never been a shield against the brutality of white supremacy. We cannot forget the vulnerabilities of black girls.

    We are even more reluctant to acknowledge the violence black girls and women suffer at the hands of black men. According to the Black Women's Blueprint, approximately 60% of black girls will experience sexual assault before they are 18. A leading cause of death for black women 15 to 34 is homicide by an intimate partner. Debilitating injury resulting from intimate partner violence is a health crisis for black women. Yet African American women are less likely to report rape and sexual assault than their white counterparts. When they do seek protection, black women face unique challenges in family and criminal court because many judges perceive African American women as less vulnerable, more hostile, more sexualized, and less worthy of official forms of protection.

    Black women also have less economic opportunity. They work more than all other women, but reap fewer economic rewards. Black women's wages range from 48 to 69 cents for every dollar paid to white men, according to the National Partnership for Women and Families. One in four black women live in poverty, double the rate of white women's poverty.

    The median wealth for a single white man age 18 to 64 was $41,410, but the median wealth for a single black woman in the same age range was $5, according to a 2010 study by Mariko Chang. Black women college graduates earn half of what the average White male college graduate earns.

    The number of women in American prisons is increasing at nearly double the rate of men according to The Sentencing Project, The rate of incarceration is almost twice as high for black as for white women. 60% of these women are mothers who were caring for minor children before their sentencing; causing a devastating effect on black children and communities.

    The overwhelming majority of incarcerated women are survivors of domestic abuse, sexual violence, childhood trauma, poverty, and broken foster care systems. When black women are guilty of being victims our response is to lock them away; strip them of parental rights; permanently damage their ability to seek educations, secure housing, start businesses, and choose their elected representatives. And it begins when they are girls. Black girls are suspended, criminalized, pushed out of school and into a juvenile system where they receive disproportionally harsh sentences often in the wake of severe emotional and sexual trauma.

    Black women have higher rates of hypertension and diabetes, HIV, fibroids, hysterectomies, and deaths from cancer. Babies born to black women are twice as likely to die before their first birthday as those born to white women. The gap is not closed by access to health insurance, prenatal care, or education.

    On the other hand, black women had the highest voter turnout of any category of voters in both 2008 and 2012, twice choosing an American president while no one asked a single black woman to moderate a presidential debate.

    Congress should not make any decisions about programs meant to help families living in poverty without people who know poverty firsthand at the decision-making table.... It's time to call in the experts.

    Black girls and Black women must be at the table. Not just the college professors, celebrities, business leaders, and elected officials, but our cousins, our sisters, our grandmas, the girls who didn't make it out, the ones we locked away, the voices that have been silenced. Let us be the ones who find today's Maya Angelou while she is yet mute, who remind her she has something to say, and then let us listen while she tells us her story. doclink

    Karen Gaia says: Women's empowerment is necessary for women to attain control over their own reproduction. Poor women are five times more likely to have an unintended pregnancy.

    Also see : African-American women are more than three times as likely to die as a result of pregnancy and childbirth than white women in the United States, according to the CDC.

    "We know that black women dying from pregnancy-related causes are younger, less educated, more likely to be unmarried, more likely to start prenatal care in the second (or) third trimester of pregnancy or not at all, when compared to white women, but except for that, we don't know a lot," said Creanga of the CDC.

    Companies offering more parental leave 04:03 Medical and nonmedical factors, such as poverty and insurance coverage, need to be considered as part of the research to figure out the reasons for this disturbing trend, she said.

    There is no question that lack of access to affordable and good quality care is playing a role in the overall increasing maternal mortality rate, said Turner, the associate professor of nursing.

    If a pregnant woman wakes up in the middle of the night with contractions at 28 weeks and isn't sure if she's in labor, she needs to go to the hospital, Turner said. No one can determine that over the phone. But even if you have private insurance, "You're still going to have a whopping co-pay for that hospital visit just to make sure you weren't really in preterm labor," she said. "So I know that people hesitate to seek care because there is an out-of-pocket expense every time you engage with the health care system."

    What Explains the United States' Dismal Maternal Mortality Rates?

    November 19, 2015, Wilson Center

    From 1990 to 2013, the maternal mortality rate more than doubled in the United States from 12 to 28 deaths per 100,000 live births. Globally, the United States ranks worse than most developed nations, at 65th in the world. Contributing to these dismal numbers are deep inequities in health across race, socioeconomic status, and geography. Black women die at a rate that ranges from three to four times the rate of their white counterparts, a difference that has remained largely unchanged over six decades. doclink

    Karen Gaia says: I watched the video that came with this article, and a big part of the problem is lack of sex education and not being able to get preventative health care (including contraception). Hopefully the latter problem will be solved by the ACA.

    Report Ranks U.S. Last Among Developed Countries for Maternal Health

    May 7, 2015, National Partnership for Women and Families

    An annual report by Save the Children provides a global ranking of the best and worst countries for maternal health and other motherhood-related measures, Time magazine reports. In addition to maternal health, the report considers economics, education, children's well-being, and women's political status.

    Averaging all measures, the U.S. ranked as the 33rd best country for mothers out of 179 surveyed countries, down from 31st the previous year (2014). But on maternal health the U.S. ranked 61st. One per 1,800 U.S. women experience a pregnancy-related death, 10 times the rates for Austria, Belarus and Poland. What's more, U.S. infant mortality (death of baby within the first year) is 6.1 per 1,000 live births. (compare to 2.13 in Japan). Washington, D.C. had the highest infant mortality rate among the 25 surveyed capitals of high-income nations, and some U.S. cities -- including Cleveland and Detroit -- had even higher rates. Time magazine correlated high infant mortality with premature births, inadequate prenatal care, low incomes, education, race, age and marital status. doclink

    Recognize Effective Ways to Save the World's Children

    November 23, 2013, Durango Herald

    Two of my recent columns dealt with child deaths. The sad fact is that, worldwide, 19,000 children die every day - mostly in poor regions, and mostly related to inadequate nutrition.

    The first column (Herald, Aug. 25) told the story of two boys I took care of in Nicaragua when I was in medical school. Miguel hadn't been fed enough protein and recovered with good food. Van was just skin and bones, and died from starvation.

    The second article (Herald, Oct. 27) mentioned that there is hunger in the United States. Our country doesn't have a universal safety net to catch people in need.

    Sending food to poor countries does not help in the long run because it increases people's dependence. Indeed, well-meaning people may do more harm than good. This is made clear (in a religious context) in the book When Helping Hurts. It points out that many actions that might seem helpful have the opposite effect.

    Unfortunately, despite the best of intentions, transferring technology from rich to poor countries can have bad effects. Supplanting breast-feeding with artificial formula is a good example. Contaminated water may be used to mix the formula, and poor parents cannot afford to buy the formula after breast milk has dried up.

    Nepal, where villages had an epidemic of deaths, provides another example of unintended consequences. Metal cookware appeared to be a boon to the Nepalese because food cooked more rapidly than in old-fashioned earthenware pots. This meant less denuding forests for firewood and less smoke from cooking fires. But it also meant that pork wasn't uniformly well-cooked. Pork tapeworms lodged in people's brains and killed them. Fortunately, cooking pork adequately can prevent this disease, cysticercosis. Sanitary toilets are also important in separating human waste from pigs. We must try to foresee and prevent unintended consequences when trying to help others.

    There are many examples of programs that are very effective in reducing child deaths. Brazil, which has experienced a remarkable transformation, is one.

    Nancy Scheper-Hughes first went to a favela (Brazilian shanty town) in 1964 as a Peace Corps volunteer. She is now a professor of medical anthropology. Her article "No More Angel-Babies on the Alto" is available at:

    Nancy found that many babies in the favela died, and she was shocked that their mothers didn't grieve their deaths. The average woman gave birth to eight children, of whom almost half died. One woman put it this way: "Why grieve the death of infants who barely landed in this world, who were not even conscious of their existence?"

    When Nancy returned to Brazil recently she was surprised to find that the under-5 death rate in that same city had decreased from 110 to 25 per 1,000. How had this radical drop been achieved? She cites several factors. Brazil's president's wife was a strong advocate for women's rights. They started a system of care for all, including "barefoot doctors" to identify children at risk. The "zero hunger" campaign provides food for the most vulnerable. Safe water supplies and prenatal clinics improved the health of pregnant women. Women's literacy is a universal theme in social change, especially for improving child survival.

    Along with the decrease in child mortality has come an amazing decrease in family size. The average number of children a Brazilian woman will bear is 1.8 - fewer than in the U.S., and less than replacement. Each child born can be expected to live to adulthood and is therefore valued from birth. This favela has gone through the demographic transition in less than 40 years!

    What is the difference between good aid programs and not so good? The best programs tune in to what the local people want rather than imposing agendas that are not culturally sensitive. They are sustainable - meaning that the aid recipients will be motivated to maintain the work with little or no help from donors.

    Back to Nicaragua. People there are still impoverished; it is the second poorest country in the Western Hemisphere, with 80 percent living on less than $2 per day. Less than 40 percent of people in rural areas have improved sanitation. Fortunately, the country is receiving sustainable assistance. El Porvenir (a nonprofit organization) partners with rural Nicaraguans to build sanitation and pure water infrastructure and protects the water supply through reforestation. Their school hand-washing facilities make kids healthier and increase school attendance by 20 to 30 percent!

    These improvements have raised the standards of living and health. Better-educated women have healthier and fewer children. Development has helped Nicaraguans in many ways, including reducing the average number of children a woman has from seven when we visited in 1968 to just 2.6 now.

    Note: this article was first published in the Durango Herald doclink

    Kenya's Maternal Death Rate May Fall Thanks to Free Services for Women

    July 15, 2013, Vietnam News Agency   By: Katy Migiro

    Wambui Waithaka, a doctor at Nairobi's Pumwani maternity hospital said the government is giving the hospital extra money each week to buy the things they need to treat patients. However, in Pumwani, there is a shortage of incubators.

    The next step is to educate women about their care. "The most critical thing in improving maternal health is educating the woman herself and the community around her," said Waithaka. "If she doesn't know that her labour is going a dangerous way, we are not going anywhere."

    Almost 28% of women give birth at home with the assistance of traditional birth attendants, the same percentage as are helped by a nurse or midwife. The region where the use of traditional birth attendants is highest - at 64% also has the highest maternal mortality rate, twice the national average.

    In Kenya, 43% of pregnancies are unwanted due to limited access to contraceptives, poverty and high rates of sexual violence. Unsafe abortions account for 35% of maternal deaths compared to the global average of 13%. Rich women easily access safe abortion in private facilities. But the poor and uneducated risk their lives using backstreet doctors as government hospitals are reluctant to treat them.

    A high proportion of maternal deaths are among adolescents. Shahnaz Sharif, the government's director of public health and sanitation said. "They tend to hide their pregnancies. They don't come to the clinic," ... "Or they'll go for abortion." Teenagers also tend to have more complications because their bodies and minds are not ready to give birth. doclink

    3 Unexpected Ways to Improve Food Security in Sub-Saharan Africa

    July 31, 2013, World Resources Institute - WRI   By: Tim Searchinger and Craig Hanson

    Sub-Saharan Africa would need to increase crop production by 260% by 2050 in order to feed its projected population.

    The UNs' new population growth projections say that the world will reach nearly 9.6 billion by 2050. Unless we control dietary shifts to more meat and reduce food loss and waste, the world will need to produce about 70% more food by 2050 to meet global demands. Plus we would need to do this without converting millions more hectares of forests into farmland if we don't wish to contribute to more climate change.

    The population of Sub Saharan Africa is expected to more than double by 2050 and quadruple to 3.9 billion people by 2100. Even today FAO says that over 25% of Sub-Saharan Africa's people are undernourished, and the region already imports roughly 20%of its staple calories. Yet Sub-Saharan Africa has the world's lowest grain yields and extensive areas of degraded soils.

    One way to help meet the food challenge would be to hold down population growth.

    Most of the world's regions have already achieved or are close to replacement level fertility, but Sub-Saharan Africa has a total fertility rate was 5.4 children per woman - double the fertility rate of any other region. While the regions fertility rate is projected to decline to 3.2 by 2050, this is not enough to avoid the large projections of population growth.

    Go to the link in the headline to see the interactive maps.

    What can be done?

    *Increase educational opportunities for girls. In general, the longer girls stay in school, the later they start bearing children, and the fewer children they ultimately have. In countries where 80-100% of the women have attained at least a lower secondary education level, total fertility rates are around 2.1

    *Increase access to reproductive health services, including family planning. Millions of women want to space and limit their births, but do not have adequate access to reproductive health services. The World Health Organization (WHO) found that 53% of women in Africa who wish to control their fertility lack access to birth control, compared with 21-22 percent in Asia and Latin America.

    *Reduce infant and child mortality. Reducing infant and child mortality assures parents that they do not need to conceive a high number of children in order to assure survival of a desired number. Better health care, sanitation, and food will accomplish this.

    Botswana has a country-wide, free system of health facilities that integrates maternal and child healthcare, family planning, and HIV/AIDS services. Mortality rates for children under five declined from 81 per 1,000 in 2000 to 26 per 1,000 in 2011. Contraceptive use increased from 28% in 1984 to 53% in 2007. Botswana has long provided free education to all, and still exempts the poorest from school fees, resulting in an 85% literacy rate and a rate of 88% of girls enrolled in lower secondary education. Botswana's fertility rate has fallen from 6.1 in 1981 to 2.8 by 2010.

    Advantages to achieving replacement level fertility in Sub Saharan Africa:

    *Gender equity will be advanced, giving people more control over life decisions, and save millions of lives.

    *About 9% of the gap between food available in 2006 and the amount needed in 2050 would be closed and and the projected growth in food demand in Sub-Saharan Africa would be reduced by 25% in the same period.

    *A "demographic dividend" could be achieved. During and after a rapid decline in fertility, a country simultaneously has fewer children to care for and a greater share of its population in the most economically productive age bracket. Researchers estimate that this type of demographic shift was responsible for up to one third of the economic growth of the East Asian "Tigers" between 1965 and 1990.

    *Agriculture's impact on the environment would be reduced since, according to FAO projections for yield gains in the region, Sub-Saharan Africa will need to add more than 125 million hectares of cropland from 2006 levels to meet the region's projected food needs in 2050. Achieving replacement level fertility would cut that needed cropland expansion in half, sparing from conversion an area of forest and savannah equivalent to the size of Germany. doclink

    Improving Child Health Through Healthy Timing and Spacing of Pregnancies in Rural Ethiopia

    July 1, 2013, Population Reference Bureau blog

    The UN Millennium Development Goal (MGD) 4 is to reduce child mortality by two-thirds by 2015. In Ethiopia, under-5 mortality declined dramatically by 47% in 11 years. Infant mortality also declined by 39% during the same period. Ethiopia has made progress in reducing child mortality, but still today, one of every 17 Ethiopian children dies before age 1.

    High fertility, inadequate birth spacing, as well as mother's age at the birth of her children, length of birth intervals, and the number of births a woman has already been shown to affect child health and survival. Family planning can improve child health and survival by preventing births to older and younger women (ages that carry increased risks to maternal health), reducing the number of births per woman, and lengthening the interval between births.

    A study from data in southwestern Ethiopia of 1,370 mothers who had 1,382 births in the two years before the survey date March 2012 found infant deaths high in the study area: 56 deaths per 1,000 live births, but twice as high in rural areas than in urban areas in the study (66 deaths compared to 31). Similarly, there were 75 deaths per 1,000 births among poor households compared to 37 deaths among wealthy households.

    It was also found that infant deaths were higher when the mother's age at birth was 35 years or older, or when birth intervals were shorter. When birth intervals were shorter than 36 months, the infant mortality rate was 66 deaths per 1,000 births compared to 46 deaths when the intervals were longer than 36 months.

    Fertility behavior also influences use of vaccination services. The percentage of children ages 12 to 24 months who received measles vaccination was 49%, and the vaccination rate was higher when the mother was younger (51%), when there are fewer children under 5 in the family, and when the pregnancy was intended. doclink

    Karen Gaia says: In other words, family planning results in healthier children.

    U.S.: Steep Rise of Complications in Childbirth Spurs Action

    December 10, 2012, Wall Street Journal   By: Laura Landro

    The federal Centers for Disease Control and Prevention have reported a 75% increase in severe complications from childbirth, such as cardiac arrest, respiratory distress and kidney failure, in the decade ending in 2009.

    Severe complications affect a total of about 52,000 women a year.

    A big reason for the increase is the number of pregnant women who are older, obese, or have chronic conditions such as diabetes and kidney disease that put them at higher risk. But healthy women, too, can experience major complications such as severe bleeding, or hemorrhage, which is the most common cause of death after childbirth. A nearly 60% increase in the rate of Caesarean-section delivery since 1996 is associated with a sharp increase in a condition known as placenta accreta, in which the placenta grows into the uterine wall through a surgical scar, and can cause severe hemorrhage after delivery.

    Obstetrics-related complications account for $17.4 billion in annual U.S. hospital costs, according to the federal Agency for Healthcare Research and Quality. Complications have recently led to several malpractice payouts of more than $20 million each, and obstetrics can account for 25% or more of a hospital's total for all malpractice claims resolved by payment, according to Premier Inc., a hospital purchasing alliance.

    Premier's Perinatal Safety Initiative has been working with hospitals, including Aurora West, in 12 states since 2006, training medical teams to follow protocols to prevent harm to mother and infant and respond rapidly in a delivery emergency. The training includes a military communication strategy known as SBAR, for situation-background-assessment-recommendation-to quickly get everyone on the team the same information about a patient's condition and the planned response. Since the project's inception, the rate of liability claims filed at participating hospitals has dropped by 39%, says Susan DeVore, Premier's chief executive.

    Many of the most common causes of death such as hemorrhage and pulmonary embolism can also take place in the first few days after delivery to seemingly low-risk patients, so it is important that hospitals follow standardized prevention measures, says Mary D'Alton, head of obstetrics and gynecology at New York's Columbia University Medical Center. To prevent blood clots, for example, Columbia gives the blood thinner heparin to all patients after a Caesarean delivery and asks them to get up and walk after 12 hours.

    Vivian von Gruenigen, system medical director for women's health services at Summa Health System says "People think pregnancy is benign in nature but that isn't always the case, and women need to be their own advocates." doclink

    Karen Gaia says: this article makes the point that pregnancy is a health issue, as is preventing pregnancy.

    New Study Shows Benefits of Misoprostol to Manage Post-Partum Hemorrhage

    August 22, 2012, Women Deliver

    A recent study showed that crushed misoprostol tablets put under the tongue was more effective than the injected oxytocin in preventing post-partum hemorrhage (PPH) - a high loss of blood after delivery. The skin under the tongue rapidly absorbs medications, especially if the drug is crushed. This means that the amount of misoprostol required to be effective is lower than in previous studies - and therefore the side effects are decreased. This new way of administering misoprostol significantly reduced the amount of blood loss after delivery, as well as the drop in hemoglobin (anemia) in the days following.

    The study appeared in the July 2012 issue of the International Journal of Obstetrics and Gynaecology.

    PPH is the leading cause of maternal deaths, killing more than 100,000 women per year globally. in some countries women have up to a 1 in 16 chance of dying just because they are pregnant or give birth. In developed countries, oxytoxin is given to prevent PPH, however, it requires a number of things that may not be available to women globally - safe needles and syringes, skilled attendants, and an ability to keep the medication refrigerated. Using misoprostol avoids these complications, and it can be taken as a tablet and is heat-stable. It is easily transported, and it requires simple training to administer. Until now, it was seen as inferior to oxytocin for preventing PPH. Clinical trials had shown the tablets to be less effective, with unwanted side effects like uncontrollable shivering. Appropriately, efforts have mainly been focused on making oxytocin more available to women globally.

    Though more work needs to be done before we can consider delivery of crushed misopristol under the tongue a practice-changing development. However, in a world where hope for women is a precious commodity, we should be ecstatic. Will this simple but highly effective change in medication administration make global equality in maternal care a closer reality? doclink

    U.S.: More US Mothers Dying Despite Expensive Care - Infographic

    We sink to 50th in maternal mortality
    August 26, 2012, Face the Facts USA

    The United States spends $98 billion annually on hospitalization for pregnancy and childbirth, but the US maternal mortality rate has doubled in the past 25 years. The U.S. ranks 50th in the world for maternal mortality, meaning 49 countries were better at keeping new mothers alive. Why the decline despite the high investment? doclink

    Family Planning Helps Save Mothers' Lives in Guinea-Bissau

    July 31, 2012, Friends of UNFPA

    In Guinea-Bissau, a country in West Africa, 98 of 114 health centers now offer family planning services and 10% of women use contraception, which, while low, is an improvement. As access to reproductive and infant healthcare improves and family planning messages start to sink in, the contraceptive rate rises.

    The birth control pill, condoms and contraceptive implants are offered.

    UNFPA helps fund the provision of free contraception nationwide, trains health workers on family planning and reproductive health and advises the Health Ministry.

    Health workers in San Domingos speak to teenagers in schools about the dangers of starting a family too soon and suggest contraception options to women who have come to the hospital with pregnancy-related or birthing problems.

    "Women want family planning here - we meet with very little resistance to our messages."

    But with inconsistent stocks the hospital cannot guarantee contraception to all who want it.

    Economics increasingly sways urban families' decisions to expand or not, said Alfredo Claudino Alves, director of health and reproductive services in the Ministry of Health. People in towns want fewer children because they understand life is expensive. But also improvements in reproductive and infant health give people more faith that medicine works, so they are starting to think their babies won't necessarily die.

    Maternal and under-five mortality is declining across the country. However the under-five death rates are still high in Guinea-Bissau; mothers still have a one-in-five chance of losing a child before the child reaches age five, according to UNICEF. This perpetuates high birth rates. doclink

    African Child Mortality - the Best Story in Development; Africa is Experiencing Some of the Biggest Falls in Child Mortality Ever Seen, Anywhere

    May 19, 2012, Economist

    According to Mr Demombynes and Karina Trommlerova, of the World Bank, 16 of the 20 African countries which have had detailed surveys of living conditions since 2005 reported falls in their child-mortality rates. Twelve had falls of over 4.4% a year, which is the rate of decline that is needed to meet the millennium development goal (MDG) of cutting by two-thirds the child-mortality rate between 1990 and 2015. Three countries - Senegal, Rwanda and Kenya - have seen falls of more than 8% a year, almost twice the MDG rate and enough to halve child mortality in about a decade. These three now have the same level of child mortality as India, one of the most successful economies in the world during the past decade.

    The average fall in infant mortality rate is faster than it was in China in the early 1980s, when child mortality was declining around 3% a year.

    The declines have happened in countries large and small, Muslim and Christian, and in every corner of the continent. The three biggest successes are in east, west and central Africa, and especially in Africa's two most populous countries, Nigeria and Ethiopia.

    Remarkably Kenya and Uganda, who also did well on child deaths, have seen their fertility declines stalled recently. Low-fertility places such as Namibia and Lesotho also did poorly on child mortality, showing the link between mortality and broader demographic change seems weak.

    Mr Demombynes argues the difference is made from some combination of broad economic growth and specific public-health policies, notably the increase in the use of insecticide-treated bednets (ITNs) which discourage mosquitoes, which cause malaria.

    Ethiopia, Ghana, Rwanda and Uganda have been among Africa's star economic performers recently, with annual GDP growth averaging over 6.5% in 2005-10. At the other end of the scale, Zimbabwe saw its GDP fall and mortality rise.

    But growth offers no guarantees. High-mortality Liberia actually saw impressive GDP increases whereas Senegal, whose record in child mortality is second to none, had a rather anaemic growth rate by recent African standards (3.8% a year, half that of Rwanda). That what Mr Demombynes calls "the miracle of low mortality" has taken place in different circumstances suggests there can be no single cause.

    Kenya has cut the rate of infant mortality by more than any other country. It has had healthy economic growth (4.8% a year in 2005-10) and is a functioning democracy. Kenya also increased the use of treated bednets from 8% of all households in 2003 to 60% in 2008. Half the overall drop in Kenya's infant mortality can be explained by the huge rise in the use of ITNs in areas where malaria is endemic. doclink

    Mozambique: Drug Given to Moms After Childbirth Sparks Controversy

    June 29, 2011, NPR

    In Mozambique, a woman has a 1 in 37 lifetime risk of maternal death. Most of those deaths will be from postpartum hemorrhage, with one woman dying from postpartum hemorrhage every seven minutes. In the U.S.,only 1 in 2,100 die of of maternal causes, according to the World Health Organization.

    Health experts say the drug misoprostol is saving women's lives around the world. It's also controversial because it can also be used to induce abortion.

    Mozambican OB-GYN doctor Cassimo Bique lead a year-long trial of the drug misoprostol designed and carried out by an American women's health nonprofit called Venture Strategies Innovations. Bique said a woman can die as early as two hours after childbirth.

    The traditional birth attendants use a brightly colored cloth called the capulana, typically worn as a skirt, shawl, or baby sling, to soak up blood loss from the mother. Before misoprostol, they would need three or four capulanas to soak up typical blood loss from the mother. After miso, they needed just one.

    When the traditional birth attendants are asked if they have watched women die because they were bleeding after giving birth, before miso was available, they nod and say yes. doclink

    MDG Poverty Goals May Be Achieved, but Child Mortality is Not Improving

    April 18, 2011, Guardian (London)

    The millennium development goal (MDG) targets for extreme poverty and hunger are close to being met by two-thirds of developing countries the World Bank IMF said.

    The number of people living in extreme poverty - on less than $1.25 per day - will drop to 883 million by 2015, from 1.4 billion in 2005 and 1.8 billion in 1990.

    This goal reflects rapid economic growth in China and India. By 2015, only 4.8% of China's population will be in extreme poverty compared with 36% in sub-Saharan Africa.

    Robert Zoellick, the World Bank president, said "If the food price index rises by just another 10% ... another 10 million people will fall into extreme poverty where people live on less than $1.25 a day. And a 30% increase would add 34 million more people to the world's poor."

    Zoellick's proposes a new code of conduct on export bans, improved information on the quality and quantity of food stocks, and preparing small stocks of humanitarian food in places like the Horn of Africa.

    Many developing countries are close to meeting targets on primary education completion and eliminating the gender disparity in education, as well as access to safe drinking water. However, no low-income country has reduced mortality for under-fives sufficiently and they are unlikely to meet that MDG target.

    Maternal and child mortality targets are doing poorly: 40% of developing countries are far from meeting health MDGs, despite all of the large amounts of aid put into the health sector in the past 10 years. And 45% of developing countries are far from meeting the notoriously neglected international targets on sanitation.

    Delfin Go, the World Bank's lead economist said "spending has focused largely on increasing the quantity of services, while not paying enough attention to quality." Go suggests improving incentives for health workers by, for example, paying on the basis of their performance, as well as "strengthening institutions". doclink

    Midwives Can Cut Deaths in Childbirth, but There Aren't Enough of Them

    April 1, 2011, Guardian (London)

    One-third of women worldwide give birth without trained help - and 2 million give birth entirely alone, according to a report from Save the Children. Many can't get to a health center with trained midwives or skilled healthcare workers and many have husbands or mothers-in-law who will not let them.

    Save the Children is campaigning for more midwives to be trained around the world, to fill some of the estimated 350,000 shortage. In Ethiopia 94% of women give birth without skilled help, compared to the UK, where it is only 1%.

    The numbers of skilled birth attendants has been creeping up. Save the Children reports it has helped in the tripling of the number of midwives in Afghanistan. An additional 300 to 400 midwives are now being trained every year, although still only 14% of births take place in the presence of a skilled birth attendant.

    Childbirth for many women means delivering their babies at home in an unsterile environment on a bed or on the floor, without running water, electricity or light."

    In Nigeria one in five women deliver their babies alone. A third of women in Nigeria said that one of their reasons for not going to a health facility was because their husband said it was unnecessary. doclink

    Get Men in the Delivery Room, Say Bangladesh's First Midwives

    March 21, 2011, Guardian (London)

    One out of 500 women die in childbirth in Bangladesh. Even though there is no law forbidding men to enter the delivery room, father's mother or another senior female member of the family provides the support, not fathers - an attitude that needs to change, say the country's first midwives.

    Bangladesh, which is still heavily reliant on community skilled birth attendants, who lack the skill and the authority to perform more complicated deliveries, has started training midwives, who say "Men need to be involved in the labour process if we are to reduce maternal mortality."

    "If could see firsthand the complications of childbirth, they would be more likely to send their pregnant wives to proper medical facilities and less likely to insist on early childbirth after marriage." 75% of deliveries take place at home, and the average age of women having their first child is just 16 years, according to the UN. doclink

    'Mobile Midwife' Helping Ghana's Poor

    March 16, 2011, KJ Online

    A system called Mobile Midwife that uses cell phones to improve the delivery of health care to pregnant women and newborns has been established in a poor agricultural region of Ghana. Parts of it may soon be replicated in India and other poor areas of the world.

    With the sysstem, nurses in northeast Ghana keep electronic medical records, fill out forms and retrieve patient information using cell phones. And pregnant women and new mothers get regular cell phone messages telling them about the importance of good nutrition or reminding them when they are due to get a pre-natal exam or to have their children immunized.

    Inexpensive cell phones -- and the towers to serve them -- have become common in remote, rural regions. In northeast Ghana, a poor, agricultural region where families live in rustic compounds, about 60% of households now have access to a cellular phone. Ghanaians even use them to do electronic banking and to check prices at the market.

    The Bill and Melinda Gates Foundation saw the potential for improving health more than two years ago, when it financed a project called the Mobile Technology for Community Health. Other partners included the Grameen Foundation, an anti-poverty organization, and the Ghana Health Service. doclink

    Nepal: Breaking the Taboo

    March 1, 2011,

    In Nepal, in 1996, a Maternal Mortality Rate (MMR) of 539 maternal deaths per 100,000 live births was reported. The number was reduced to 281 by 2006, representing a decline of 48% over a period of ten years.

    In September 2010, Nepal became the recipient of a UN Award from among 49 least developed countries for the significant MMR reduction and subsequent contribution towards achieving UN Millennium Development Goal 5, which aims to improve maternal health by reducing the MMR by three quarters and achieving universal access to reproductive health by 2015.

    The Nepal MMR is the outcome of coordinated efforts in executing various targeted programmes and projects by governmental and non-governmental organisations, but it also has coincided with the period when abortion was legalised in 2002, so many health sector stakeholders have linked the achievement to abortion policy reform.

    According the World Health Organisation (WHO), more than 19 million abortions worldwide are unsafe. And anywhere from 10%-50% of women undergoing these abortions requires medical care for severe complications later, with more than 68,000 dying each year.

    Unsafe abortion predominantly exists where abortion is illegal, or where it is legal but safe services are inadequate, particularly in Africa, the Middle East, Latin America and Asia.

    Because of the stigma attached to abortion, women and girls in rural areas prefer to use traditional remedies, which beyond being unsafe, sometimes can be fatal. Unsafe abortion causes half of the maternal deaths in Nepali hospitals even today. Statistics on abortion suggest that unsafe abortion in Nepal was widely practiced as a family planning method before its legalization.

    When abortion was legalised in 2002, a woman was allowed to terminate a pregnancy of up to 12 weeks of gestation, or longer (up to 18 weeks) in the event of rape or incest, or anytime if carrying the child puts the life of the mother at risk. There were a drastically increased number of registered abortions after abortion was legalised.

    Providing better and equitable access to safe abortion has become even more important considering the still high fertility rate among adolescents. About 21% of adolescent girls are already pregnant or become mothers of their first child by the time they are 15-19 years old.

    Empowering rural youth by providing formal and informal education on sexual and reproductive health and family planning would be an effective strategy to enable adolescent girls to make informed decisions on timely marriage, planned pregnancies and safe motherhood.

    An intervention strategy featuring additional service centers, increased awareness-raising and targeted advocacy initiatives and capacity-building of female community health volunteers will help limit not only the number of fatal cases from unsafe abortion but also reduce unplanned pregnancies. doclink

    More Pregnancy-Related Deaths to Happen in Philippines: WHO

    October 2, 2007, Sun Star

    The WHO warned that more pregnancy-related deaths will occur in the Philippines if no health program would be implemented by the government.

    WHO said 529,000 women die of birth-related causes, leaving one million children motherless, while 82% of Filipino children die every year.

    About 10 mothers a day die in childbirth, with almost 30 children being orphaned or having difficulty surviving. The country is one that accounted for 95% of global under-five mortality. Four out of five maternal deaths are the result of obstetric complications making maternal mortality highest during labor and the two days following birth. doclink

    Bill Gates - Saving the Lives of Children Reduces Population Growth

    Bill Gates at a TED (Technology, Entertainment, Design) conference

    While most of us assume that saving the lives of children will contribute to overpopulation, Gates said the contrary is true. "The key thing, the most important fact that people should know and make sure other people know: As you save children under 5, that is the thing that reduces population growth. That sounds paradoxal. The fact is that within a decade of improving health outcomes, parents decide to have less children."

    "As the world grows from 6 billion to 9 billion, all of that population growth is in urban slums," he said. "Slums is a growing business. It's a very interesting problem."

    He said no matter what we care about-the environment, schools, nutrition, conflict-the issues are insoluble at 3 percent population growth per year. "Nobody can handle that type of situation, so the best thing you can do is avoid those deaths." doclink

    Karen Gaia says: There are people who twist this very concept into accusations that Bill Gates is practicing eugenics with his vaccine. See In fact, it has been long known that reducing infant deaths by any means (treating diarrhea, and pneumonia, for example), have made mothers more confident about, and desirous of, having fewer children.

    Future Mothers Need Safeguards

    The Myrtle Beach Sun-News (South Carolina, U.S.)

    In the rich world, when a mother dies giving birth, we assume that something went wrong. For women in the developing world, by contrast, dying in childbirth is simply a fact of life.

    In poor countries, pregnant women must often fend for themselves; they may struggle to find proper nutrition and work long hours in factories and fields until the day they go into labor. They give birth at home, perhaps with the help of a midwife who most likely has no medical training.

    In the United States itself, just 100 years ago, women were roughly 100 times more likely to die in childbirth than they are today.

    Some simple blood tests, a doctor's consultation and someone qualified to help with the birth can make a huge difference. Add some basic antibiotics, blood transfusions and a safe operating room, and the risk of death can almost be eliminated. doclink

    August 28, 1999, Werner Fornos

    It is well-known that high infant and child mortality in poor countries, where 97% of world population growth occurs, is a principal reason that women in less developed regions give birth to two and three times as many children as do women in industrialized regions.

    Women in poor countries tend to believe that the more children they have, the greater their chances that the number they actually want will survive. It is a tragic commentary on the health risks to infants and children in developing regions, among them: births too closely spaced, air and water pollution, lack of nutritious food and a shortage of medical supplies and personnel. doclink

    India: Azad Announces Audit of Maternal Deaths

    August 30, 2010,

    An audit of maternal deaths will be conducted soon in all states, said the Health Minister. "This year, we have taken another new initiative on a national level and that is the introduction of maternal death audits at the community as well as the facility level," he said. Availability of accurate data on maternal mortality was a major concern for policy makers.

    "The lack of progress in improving maternal health presents itself a big global challenge," Azad said while inaugurating the three-day Global Maternal Health Conference in the national capital. doclink

    Australia Donates Birth Kits for Flood-hit Pregnant Pakistani Women

    August 19, 2010, Associated Press of Pakistan news agency, Islamabad

    Australia has donated 1,962 safe delivery kits to Pakistan to support maternal and reproductive health services to displaced pregnant women in the flood-affected areas.

    Community midwives and other skilled birth attendants will use these kits to conduct deliveries for women displaced by the floods. The UNFPA also has, in the area, mobile service vans which are fully equipped with doctors, paramedical staff and medical supplies being sponsored by UNFPA.

    Additional Secretary of Ministry of Health Agha Nadeem recognized that in emergency situations like this, some aspects of health care like provision of maternity services to pregnant women are neglected and their lives are endangered. doclink

    Let's Make Mother's Day a Global Reality

    The Huffington Post

    Progress is being made to save the lives of mothers and newborns around the world, but every minute, a woman dies of complications in pregnancy, leaving her baby more likely to die within two years. Most of these deaths could be prevented.

    There is a saying in Africa that to find out you are pregnant is to have one foot in the grave. It must sound strange since becoming a mother is so celebrated here. But in the developing world, more women die from pregnancy and childbirth than any other cause.

    Every minute, a woman dies in childbirth, mostly from preventable causes. Ninety-nine percent of those deaths occur in the developing world. Virtually every woman who dies giving birth lives in a poor country. For every woman who dies in childbirth, twenty more will suffer debilitating and often lifelong injuries such as fistula, literally a hole between the mother's vagina and her bladder or rectum that is caused by obstructed labor and avoided in the developed world through medical intervention. This often leaves women rejected by their communities and unable to support themselves. doclink

    Indonesia: Peer Educators Teach Traders About Reproductive Health

    May 14, 2009, Jakarta Post

    In Denpasar, 15 traders and laborers have become peer educators to persuade fellow female traders and laborers to get tested for signs of reproductive health problems.

    "Reproductive health is still an alien concept for us here," one of them said.

    The voluntary peer educator group was established by an NGO focusing on mitigating reproductive health problems among the city's low income population. It has also established a health clinic on the market's fourth floor, that offers affordable and free reproductive health services.

    Cervical cancer is currently at the top of the peer educators' list of reproductive health problems. doclink

    Commentary: Happy Mother's Day 2015


    This year, over 500,000 women will likely die in pregnancy and childbirth. Girls aged 15-20 are twice as likely to die in childbirth as those in their twenties, and girls under the age of 15 are five times as likely to die in childbirth. These women will leave more than 1 million children behind without a mother. Their lives are then put at even greater risk.

    UNFPA (the United Nations Population Fund) summarizes three key areas for action:

    . Give women and men access to reproductive health information and services to avoid unintended pregnancies;

    . Ensure that all pregnant women have access to skilled care at birth; and

    . Ensure that all women with complications in pregnancy have timely access to quality emergency obstetric care.

    Meeting unmet needs for contraception alone could reduce up to a third of maternal deaths globally.

    Meeting the education and reproductive health needs of adolescents, especially girls, is an important intervention to reduce maternal mortality.

    Girls receive education about their reproductive health, including how to prevent HIV. They also learn about setting goals, navigating interpersonal relationships, improving communication skills and understanding their legal rights.

    Graduates have improved their reproductive health knowledge and feel empowered to make better decisions about their futures. And, because the program is developed with local community leaders, parents and teachers, it is rooted in local values and builds more local champions for the education and empowerment of girls.

    Will our graduates still live in a world where one woman dies every minute in pregnancy and childbirth, as they do today? Or, will countries worldwide have met their target, having finally summoned the will to make motherhood safer? doclink

    U.S.: Representative Capps Introduces Global Moms Act

    May 11, 2002,

    Representative Lois Capps (D-CA) has introduced the Improvements in Global Maternal and Newborn Health Outcomes while Maximizing Successes Act, or "Global MOMS Act," to ensure that mothers around the world have access to quality health care from pre-conception through pregnancy, childbirth and post-partum care.

    The Global MOMS Act calls for:

    * Development of a strategy as part of the Global Health Initiative to reduce mortality and improve maternal and newborn health; * Improved coordination among U.S. government agencies and existing programs that are currently working to reduce maternal and newborn mortality; and * Authorization of assistance in proven interventions including family planning, access to skilled care at birth and training professionals in emergency obstetric care.

    The Global MOMS Act is being introduced as a lead up to the Women Deliver 2010 conference that will be held in Washington, DC June 7-9, 2010.

    This year's Women Deliver conference will be attended by nearly 3,000 leaders from 135 countries.

    The Global MOMS Act is endorsed by CARE, Amnesty International, Pathfinder International, Guttmacher Institute, Management Sciences for Health, Ipas, Marie Stopes International - US, Americans for UNFPA, National Council of Women's Organizations, White Ribbon Alliance, PATH, PSI (Population Services International), Population Action International, Elizabeth Glaser Pediatric AIDS Foundation, International Women's Health Coalition, Planned Parenthood Federation of America and CHANGE. doclink

    South Africa: Huge Surge in Maternal Deaths

    July 18, 2009, Health-e

    There has been a 20% increase in maternal deaths between 2005 and 2007, compared to the previous three-year period, with HIV and AIDS accounting for 43.7% of the deaths. Almost 38.4% were "clearly avoidable within the health care system".

    This is according to 'Saving Mothers 2005-2007', an analysis of all maternal deaths nationally, which was quietly released via the health department's website, 'maternal deaths' are "deaths of women while pregnant or within 42 days of termination of pregnancy from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes".

    Most deaths occurred in KwaZulu-Natal, which has the highest HIV/AIDS rate. Over 350 deaths were reported in this province in 2006, the highest recorded rate of any province since 1998. Only around 60% of the women who died had been tested for HIV, almost eight out of ten were HIV positive.

    Aside from AIDS-related infections, hypertension (15.7%), obstetric haemorrhage (12.4%), pregnancy-related sepsis (9%) and pre-existing maternal disease (6%) were the other main killers that could have been avoided. The report points to the need for better management of "complications of hypertension, obstetric haemorrhage, pregnancy related sepsis and non-pregnancy related infections".

    These factors were responsible for four out of five of avoidable deaths. Health care providers either failed to diagnose the problem or failed to follow standard protocols in treating it.

    There was a 14% decrease in women dying of complications of hypertension in health institutions. Women under 20 were at greater risk of dying from hypertension while those 35 years and older were at greater risk of dying of haemorrhaging, ectopic pregnancies, embolism, acute collapse and pre-existing medical disease. Deaths due to non-pregnancy related infections peak at 25-29 years and is mirrored in deaths due to complications of abortion and pregnancy following a viable pregnancy.

    The report recommends:

    Improving health care provider knowledge and skills in providing emergency care, and adequate screening and treatment of the major causes of maternal death; improving the quality and coverage of contraceptive and termination of pregnancy services; better management of staffing and transport and availability of blood for transfusion; community involvement regarding reproductive health. doclink

    Healthy Lives, Healthy Futures

    March 11, 2010, CEDPA

    Click on the headline to hear the voices of women on the frontline of the fight to make pregnancy and childbirth safer for women around the world. Leaders in reproductive health share their views on why countries should invest in family planning and reproductive health programs for the health and well-being of women, families and communities. doclink

    Maternal Deaths Decline Sharply Across the Globe

    April 13, 2010, BBC News

    A study published in the medical journal The Lancet cited a number of reasons for the improvement in lower pregnancy rates in some countries; higher income, which improves nutrition and access to health care; more education for women; and the increasing availability of "skilled attendants" - people with some medical training - to help women give birth. Improvements in large countries like India and China helped to drive down the overall death rates.

    But some advocates for women's health tried to delay publication fearing that good news would detract from the urgency of their cause. The advocates wanted the new information released only after meetings about maternal and child health had already taken place.

    People who have spent many years committed to the issue of maternal health were understandably worried that these figures could divert attention from an issue that they care passionately about, but these numbers help their cause, not hinder it.

    The new study was based on more and better data, and more sophisticated statistical methods than were used in a previous analysis that estimated more deaths. The WHO still reports about half a million maternal deaths a year, but is expected to issue new statistics of its own this year.

    It really is an important positive finding for global health.

    The researchers analyzed maternal mortality in 181 countries from 1980 to 2008, using whatever information they could glean from each country, and ultimately gathered about three times as much data as the previous researchers.

    Progress varied considerably. For instance, from 1990 to 2008, the maternal death rate dropped 8.8% a year in the Maldives, but rose 5.5% in Zimbabwe. Sub-Saharan Africa has the highest maternal death rates. Brazil improved more than Mexico, Egypt more than Turkey. Six countries accounted for more than half of all the maternal deaths in 2008: India, Nigeria, Pakistan, Afghanistan, Ethiopia and the Democratic Republic of Congo.

    India has made steady progress, and because its population is so large, its improvements have helped to decrease the worldwide rate of maternal deaths. In India, there were 408 to 1,080 maternal deaths per 100,000 live births in 1980, and by 2008, there were 154 to 395. In China, there were 144 to 187 deaths per 100,000 live births in 1980, and 35 to 46 in 2008.

    The number of pregnant women who died from AIDS was about 60,000. That's why maternal mortality is rising in eastern and southern Africa. doclink

    Afghanistan: The Tribulations of Child-Bearing Children

    December 11, 2009, IRIN News (UN)

    Many young women in Afghanistan die during pregnancy and at childbirth, but the number is unknown because most pregnant women are not allowed by their husbands to go to hospitals and doctors.

    Afghan law sets 16 as the minimum age of marriage for a girl and 18 for a boy, but many are married at a younger age and without the genuine consent of those concerned.

    60-80% of all marriages are forced and/or under-age marriages.

    Daughters are married at an early age because "everybody and all parents do the same," and that "it is not good to keep a daughter at home for long; it's better she goes to her husband's home as soon as possible." Parents are usually unaware of the serious health and psychological risks of early marriage. Also there it is thought that marrying off a daughter as early as possible is in line with Islam.

    Some suggest the government should train imams and other religious leaders to ensure marriage laws are upheld when they formalize marriages.

    According to UNFPA, Afghanistan has a fertility rate of 6.51%, the second highest in the world. Female life expectancy in Afghanistan is 44 - one of the lowest in the world. The maternal death rate is 800 deaths per 100,000 women, but much higher among mothers aged 15-19 than for women older than 19, according to UNICEF. Young mothers often lack awareness of the risks of pregnancy and child delivery. "Child mothers and their children are usually weak and vulnerable to diseases."

    Only 14% of births in Afghanistan are attended by skilled health workers, according to UNFPA. doclink

    Winds of Demographic Change in Afghanistan?

    Population Reference Bureau

    Afghanistan has maintained a high birth rate for many years, with an average of eight children per women, where one-fourth of the children likely to die before reaching their fifth birthday. Recently these trends appear to be changing.

    With no census since 1979, Afghanistan's population size is in doubt. The U.S. Census Bureau puts it at a little below 16 million.

    Females are underreported relative to males in the younger age groups (below age 15). It is thought that some girls are reported as boys since some stigma is attached to families who have only girl children and some families may not wish to report the presence of girls.

    The UN estimates the current total fertility rate (TFR) at 6.6 children per woman and the U.S. Census Bureau estimates 5.7. These TFRs represent quite a decline from the past. According to the U.N., if the TFR remains at 6.6, by 2050 the country's population would reach 111 million and be growing at 3.6% per year, a rate that would double a population in 19 years.

    In 2003, the government began a program, the Basic Package of Health Services (BPHS), which includes reproductive health services, essential for couples that wish to limit their family size. Consequently contraceptive use rates have increased.

    According to a survey, in 2000, 5.3% of married woman used some form of family planning, and 3.6% used a modern method. By 2006, the reported use of modern contraception had risen to 15.5%. Pills (8.1%), injectables (5.4%), and condoms (2.2%) are the three most commonly used methods - methods which require a continuing supply.

    For women who were less than two hours from a health clinic (about 60%), modern usage was 19.4%, but it drops to 9.1% for two hours or more hours. Most travel (75%) was on foot.

    Lack of antenatal care for pregnant women and low levels of child immunization have been major contributors to Afghanistan high rates (one of the world's highest) of infant, child, and maternal mortality. However, there has been an increase in the number of Afghan women who received antenatal care from a skilled attendant, rising from 5% in 2003 to 32% in 2006, likely due to the BPHS program which provided a health facility within two hours of travel to 61%.

    The program seems to be lacking, however, in institutional birth deliveries, preventative doses of tetanus toxoid, and childhood immunizations. doclink

    Australia: So Many Maternal Deaths, Just Across the Water

    September 9, 2009, Sydney Morning Herald

    Many women in East Timor have to walk hours before giving birth in order to get medical care. And just a few hours later, they have to walk with their babies back walk home. Women with an infection or infection or hemorrhaging have little chance of survival.

    In Papua New Guinea's western province mothers have to walk hours to get to the clinic, even while they are in labour. They also have to carry two buckets of water to be used in the delivery of their own babies.

    These places are just across the water from Australia.

    Maternity wards are decrepit, overcrowded and understaffed. For every 100,000 births, 733 women die. In Australia only eight women die for every 100,000 births.

    Women in East Timor, according to research by the United Nations Children's Fund, face a lifetime risk of death during pregnancy or childbirth of one in 35.

    Of all the millennium development goals, the goal of reducing maternal deaths that is the most off-track.

    Women in countries such as Niger and Afghanistan have the worse rate - one in seven die in childbirth.

    80% of deaths to poor women are preventable.

    A key reason for this is patriarchal. We too often ignore the discrimination directed against girls, who miss out in school, and on food or medicine. The girl gets to go to school or to get medical treatment after everyone else in the family has been looked after.

    Development is more successful in poor communities when women are put at the centre of decision-making.

    What is needed is access to midwives and better obstetric care, as well as educational opportunities for girls, overcoming damaging cultural practices such as child marriage and giving women opportunity to plan their families.

    Donor countries need to spend 15% of their aid on health if we are going to achieve the millennium development goals to halve poverty by 2015, and to cut maternal mortality ratio by three quarters.

    While the Australia government has pledged to increase aid to 0.5% of gross national income by 2015, that target is still short of the United Nations goal of 0.7%. doclink

    Passport to Ghana: Keys to Lasting Development

    June 30, 2009, Population Action International

    On June 30, in advance of President Obama's trip to Ghana to explore strategies to promote "lasting development" in the region, Population Action International (PAI) told the press about the development challenges facing Ghana, including access to reproductive health supplies, HIV prevention and the relationship between population dynamics and civil conflict.

    Ghana's fertility rate of 4.4, unchanged since 1998, is among the lowest in the region. Since independence in 1957, Ghana has maintained peace, since its independence in 1957, in a volatile region, with the latest democratic transition of power occurring between late 2008 and early 2009.

    However, the unmet need for family planning among married women ages 15-49 is high at 34%. Education and employment for growing numbers of young people is a pressing priority. Ghana is in the "high risk" category for women's sexual and reproductive health. The maternal mortality ratio (MMR), while comparatively low for a West African country, is very high by global standards at 560 deaths per 100,000 births.

    PAI said that "achieving the Millennium Development Goals, and Ghana's own development goals, will depend on fulfilling the country's high rate of unmet need for family planning." doclink

    Population Issues in the 21st Century; the Role of the World Bank

    April 21, 2007, World Bank

    This Discussion Paper was prepared as a background note for the 2007 World Bank Strategy for Health, Nutrition, and Population Results (the HNP Strategy). It covers, in greater detail than the HNP Strategy itself, recent changes in population trends, the relationship between reproductive health and poverty, and donor assistance to reproductive health programs in low- and middle income countries. It also proposes future directions for the Bank, making a case for expanding support to family planning and other reproductive health programs, to strengthen access to reproductive health services for the poor, for adolescents, and for other vulnerable groups.

    Reproductive health is central to human development, sustained economic growth, and poverty reduction. Neglecting critical areas such as family planning, sexual health, and maternal & newborn health would have catastrophic implications for countries. The current escalating HIV/AIDS epidemic, as well as the limited progress on MDG 5 bears testimony to this.

    The World Bank endorsed the 1994 Cairo Consensus coming out of the International Conference on Population and Development (ICPD). Since then, global attention and resources for population issues have been declining, and an urgent response is now required on the part of the Bank, as well as from other development partners, to reposition family planning within the ICPD agenda. Within this changing context, this discussion paper sets out approaches for the Bank to re-engage with countries and other partners to accomplish this.

    Going forward, a priority for the Bank will be the 35 countries that have the highest fertility rates, often showing little change over time. Analytical work is urgently needed to determine the cause of sustained high fertility, addressing, among others, unfavorable socioeconomic factors influencing household behaviors, as well as reproductive health services that do not adequately address needs. Such analytical work will be the basis for policy dialogue, to be reflected in key strategic documents, such as Country Assistance Strategies, Country Economic Memoranda, Public Expenditure Reviews, and Poverty Reduction Strategy Papers.

    This discussion paper is intended to stimulate the debate on the way forward for improving access to family planning and comprehensive reproductive health services in low- and middleincome countries. This debate will be an important input for upcoming sector work for developing a more strategic approach for the Bank in this area.

    Follow the link ABOVE for the entire paper. doclink

    This Mom Didn't Have to Die

    May 17, 2009, New York Times*

    One of the grimmest risks to human life in West Africa is deadlier than threats from warlords and exotic disease; it's motherhood.

    The World Health Organization says that Sierra Leone has the highest maternal mortality in the world, and in several African countries, 1 woman in 10 ends up dying in childbirth.

    Half-a-million women die annually from complications related to pregnancy or childbirth without attracting much interest because the victims are typically among the most voiceless people in the world: impoverished, rural, uneducated and female.

    For example Mariama, a 21-year-old pregnant woman with a 3-year-old child living in a village in southern Sierra Leone. Mariama started bleeding but her family had no money and was reluctant to seek medical care. When it looked like she would not survive without help, she was taken to the government hospital in Bo where it turned out there was no blood available for a transfusion. Mariama's mother was too fragile to donate blood for her.

    The only obstetrician, serving an area with two million people, was away, so nurses suggested Mariama receive a plasma expander for her blood, which cost $4, but Mariama and her mother had no money at all. Mariama continued to hemorrhage and died right there in the maternity ward.

    It's no mystery how to save the lives of pregnant women; what's lacking is the will and resources.

    Sierra Leone is now making progress with the help of the United Nations Population Fund, which is renovating hospital wards, providing free medicines and trying to ensure that poor women don't die because they can't pay for care. The Bush administration cut off all American funds for the U.N. Population Fund, but this year President Obama has moved to restore the money. Other organizations that are focused on this issue include the White Ribbon Alliance for Safe Motherhood, CARE and Averting Maternal Death and Disability.

    A bill introduced in Congress in March - the Newborn, Child, and Mother Survival Act - would establish American leadership in this area. But it has attracted pathetically little attention.

    If the lives of women like Mariama were a priority, they could routinely be given anti-malarials and deworming medicine during pregnancy to flush out parasites. They should also receive daily iron tablets to overcome anemia, and a bed net. All this would cost just a few dollars and would leave pregnant women far less likely to die of hemorrhages.

    Doctors and nurses often are harsh and contemptuous toward uneducated women so that patients stay away until it is too late. If doctors and nurses had as good a bedside manner as the birth attendants, hospitals would be better used and lives saved. doclink

    1 in 35 East Timor Women Die in Childbirth

    January 15, 2009, ABC Premium News (Australia)

    Women in East Timor are 300 times more likely to die during childbirth than women in developed countries.

    The situation is serious in some Pacific nations because of a lack of care services.

    Papua New Guinea has become worse over the past five years.

    East Timor has improved slightly, but 1 in 35 women giving birth will die. doclink

    Fight of Our Lives: UNICEF Uncovers the State of Maternal Mortality

    January 15, 2008, H Reality Chec

    Childbirth and pregnancy are dangerous for women in developing nations and especially for teen girls in developing nations. Lorraine Berry at My Left Wing writes about the conservative group Concerned Women for America's (CWFA) in their effort to make sure failed abstinence pledges are promoted over education and contraception. Lorraine writes:

    "If the CWFA doesn't believe that we need to be making an effort to provide women with pre-natal care, contraceptives, access to abortions, and assistance in leaving abusive marriages, I'd be happy to walk them through graveyards that have many graves for young women and their newborns." Pregnancy and childbirth are still dangerous for newborn babies and the situation for both are not improving.

    Fifteen hundred women die every day while giving birth. For every woman who dies from pregnancy or childbirth related causes, there are 20 who suffer pregnancy-related illness. Every year more than 70,000 girls between the ages of 15-19 die from pregnancy and child-birth related causes.

    There is a connection between the status of girls and women, opportunities for education, and access to critical health care services during pregnancy and childbirth. In addition to nutrition for women, birth spacing is central to avoiding preterm births, low birthweight in infants and neonatal deaths. Birth intervals of less than 24 months increase these risks. Unfortunately we have made the least progress to reduce maternal mortality by 75% by the year 2015. The root cause may lie in women's disadvantaged position in many countries. We must prioritize the health and well-being of women & girls even if what works is in opposition to what the political leaders of these anti-choice organizations want to see happen. doclink

    Maternal and Child Mortality Rates Decrease, Says UNICEF Report

    January 20, 2009, Turkish Daily News

    In Turkey, the maternal mortality rate dropped to 21.3 in 2007 and Turkey has witnessed a decrease by one-third in child mortality between 1990 and 2007. In the world, 530,000 maternal deaths occurred annually because of pregnancy and childbirth related reasons, representing 1,500 maternal deaths every day, while 3.7 million children died within 28 days of birth.

    Around 10 million women have died of maternal- and childbirth-related complications since 1990. The risk of death due to pregnancy and childbirth-related complications in the worlds least developed countries was 300 times greater than in developed countries. A child in a developing country is almost 14 times more likely to die during the first month of birth than a child born in a developed country

    About 99% of global deaths stemmed from pregnancy and childbirth-related complications in developing countries. Most occurred in Africa and Asia. The newborn and infant mortality rate in Turkey dropped from 52.9 per 1,000 live births in 1993 to 16.5 in 2008. The maternal mortality rate, which was 28.4 per 100,000 live births in 2005, dropped to 21.3 in 2007.

    The number of health centers has increased from 2,572 to around 5,000 in rural areas. The number of intensive health care units increased from 665 in 2002 to 2,918 in 2008. doclink

    On Course to Achieve MDG on Maternal Health

    January 13, 2009, IPS

    Nepal has reduced maternal mortality cases from 540 per 100,000 live births in 2001, to 280 today, chiefly due to the legalisation of abortion.

    Since 2002, abortion has been legal upon request during the first 12 weeks of pregnancy, when the woman's life or health is in danger, and in cases of rape, incest and foetal impairment. From early 2004, the Nepali government began training doctors and approving clinics all over the country where women could have abortion safely. Other interventions include immunisation, reduction in fertility rate, iron supplementation, better skilled birth attendance, and substantial increase in the coverage of antenatal care. Nepal's ministry of health and population is introducing free delivery service in all district hospitals, and healthcare centres.

    Nepal's MMR (maternal mortality rate) is better than that of India, Pakistan and Bangladesh. Sri Lanka has the best MMR in South Asia with a figure of 43 while, at the other end, Afghanistan has 1,600 deaths per 100,000 live births.

    Reduction of pre- and post-delivery hemorrhage and infection is the key to saving the lives of pregnant women, and it is crucial to have more doctors and health workers trained in delivery.

    Immunisation against tetanus is provided through the Nepal health service to all pregnant women who seek antenatal care. More expectant mothers are aware today about personal hygiene and more women are getting married later. A third of Nepali women are anaemic, down from 75% five years ago. Vitamin A supplements have reduced infections in new mothers.

    More women also aware of family planning. The network of village health workers has raised awareness of maternal health and care of pregnant women, and the growth of privately run health services for obstetric care has helped to reduce the mortality rate.

    The government only provides emergency obstetric care in the zonal hospitals. Patients either have to walk for days to reach them, or must drive or fly to Kathmandu. It is often cheaper for family members to take the pregnant woman to a private clinic in the nearest urban centre.

    Nepali public health experts say that in Dadeldhura, Bajura, Bajhang, Mugu and other districts in far-west Nepal, there is unlikely to have been much improvement. These are areas where there are no doctors, women deliver at home, and if they die their deaths are not registered.

    In conflict areas, routine services were not provided, health workers were confined to headquarters, not a single doctor was available, and services were not upgraded. The key to improvements lies in building the health workers and midwives at the village level. There is also a need to register pregnancies and to provide specialised obstetric and neonatal care beyond just the zonal hospitals.

    If the service is accessible, acceptable in terms of quality and affordable, then we can save more women. doclink

    Karen Gaia says: about of half of Nepal's population lives in mountainous areas where there are no roads.

    'Sense of Urgency' Needed to Cut Maternal Deaths, UNICEF Head Says

    January 15, 2009, CBC News

    Women in the least developed countries are 300 times more likely to die from pregnancy-related complications. A child born in a developing country is almost 14 times more likely to die during the first month and a woman has a one-in-76 chance of dying as a result of complications during pregnancy or childbirth. The UN has called for a 75% reduction in the maternal mortality rate by 2015. Deaths could be prevented by improving family planning, ensuring trained medics are available for deliveries, providing HIV drugs to infected women, and health services that integrates home, community, outreach and facility-based care.

    Canada's $105-million contribution to UNICEF for 2007 to 2012 will help deliver affordable health care in sub-Saharan Africa.

    Worldwide, more than 60 million women who are currently aged 20-24 were married before they were 18. Most in South Asia and Africa.

    If a mother is under 18, her infant's risk of dying in its first year of life is 60% greater than if the mother is older than 19. If young girls are not in school, they are more vulnerable. Progress has been made in improving child survival rates, but maternal mortality remains high. Niger and Malawi nearly cut their under-five death rates in half between 1990 and 2007.

    The 10 countries with the highest lifetime risk of maternal death were: Niger, Afghanistan, Sierra Leone, Chad, Angola, Liberia, Somalia, the Democratic Republic of Congo, Guinea-Bissau and Mali. doclink

    Sub Saharan Africa: Better Education Improves Health of Mothers and Children

    January 16, 2009, Age

    UNICEF reports there is much to be done to reduce infant and maternal mortality in sub-Saharan Africa. Newborn deaths account for up to 40% of under-five deaths around the world. Each year, more than four million babies die within four weeks of birth and 500,000 women die from complications in childbirth. Niger is the riskiest place to be a woman of reproductive age the risk is 1 in 7. Maternal mortality has five major causes, haemorrhage, unsafe abortions, infection, obstructive labour and hypertension and hypertensive disorders.

    These problems are closely related to the social status of women and a series of nutritional, water, sanitation and HIV related issues, also education, poverty, the state of the women and their rights to basic things such as the transport costs to get to a health facility.

    A key factor is the number of pregnancies a woman goes through in her lifetime. Education of women and girls is closely correlated with power over decision-making over finances and reproductive health questions. Women who are educated make better decisions about health care for themselves and their family.

    Niger has the lowest age of marriage in the world, the highest illiteracy rate among women and the lowest rate in secondary schools. There is a big push on primary school but we are also pushing to keep the girls in the education system because Niger has one of the highest drop-out rates between primary school and secondary school.

    Yet another factor is a shortage of health-care professionals. Some African countries have seen doctors and nurses leave the country for better pay and facilities. In many countries, there has been a complete break down in health care facilities due to conflict situations. People and families as well as communities can help to educate and inform those in vulnerable situations.

    The interventions are well established, and the challenge in Niger is to move them along more quickly. doclink

    Malawi: Transport Problems Contributing to High Maternal Mortality Rate

    May 14, 2007, Africa News Service

    Unfortunately for many children in Malawi, their mother died when they were very young. The hospital personnel attributed deaths to the late arrival at the hospital.

    Malawi's maternal mortality ratio of 984/100,000 live births is unacceptably high. These deaths result in problems in the homes considering the great role that mothers play. The loss of women's lives affects society as a whole since it has to cope with orphaned children. One of the reasons why the country still has a high maternal mortality ratio is failure to bring patients to the appropriate health facilities in time.

    The ministry's goal is to ensure that maternity cases be referred from Health Centres to Hospitals before complications arise.

    Government and its development partners are sparing no effort to bring in a transport system that will move patients from one facility level to another.

    Speedy handling is one of the strategies that has been recently launched by the ministry.

    The ministry has encouraged the use of motorcycle ambulances that are proving to be effective to the communities where most of the roads are in bad shape, and has donated 54 motorcycle ambulances for use in hospitals across the country.

    Most pregnant women prefer private health institutions which normally charge for their services. However, only a few can afford to pay for the services and are left with no option but go to the government hospitals.

    The Government and Christian Health Association (CHAM) recently signed an agreement that CHAM would be able to offer free services in some of it's institutions and government would then settle the bills.

    This is a relief to mothers and communities especially in areas where there are no government health institutions. doclink

    Nigeria: Why Health Care Delivery Should Target Rural Dwellers

    Daily Trust

    In terms of maternal mortality Nogeria is among the highest in the world. But in some places, it's twice as high in some places.

    Over half of women ever go to any health centre before they are delivered, and a third show up for delivery, in some places, much less. So most women are delivered outside health facilities and when complications arise, they die and are buried.

    We have got many health facilities spread all over the country, but many people stay at home because either the facilities are too far or they don't have the money. The reality is that the poor section of our population is the one more likely to visit primary healthcare facilities. The poorest of our population are the ones who rely on these primary health care facilities. Secondary and tertiary health facilities that serve the smaller population have more resources than the primary health care facilities that ought to serve the most of the population.

    A lot of families, especially the poor, when somebody is ill, there is a lot of cost on the household that makes them further impoverished. The impoverishing aspect is very important.

    The third problem is the fragmentation in the way we offer services. You see one doctor today, he gives you something, tomorrow, you go, you see another. There are concerns about the quality of care, while health workers are doing their best there's a gap between what the people get and what they should get.

    At a rural missionary hospital in one country, they had good buildings, they had maternity ward but the doctors told me that women refused to come and be delivered. Traditionally, they are delivered in huts, with a rope hanging from the top and they hold the rope and squat. They weren't comfortable coming to be delivered on flat bed facing up. doclink

    752,000 Nigerian Women Die Yearly, 145 Daily

    December 12, 2008, Vanguard Online (Nigeria)

    More than 52,000 Nigerian women die yearly from pregnancy complications, while 145 die daily. Disability and premature death due to sexual reproductive health is enormous and growing.

    Despite increases in access to contraceptives, an estimated 80 million women have unwanted pregnancies with 45 million ending in abortion, many of them unsafe and resulting in death. doclink

    UNFPA Tasks Nigeria on Maternal Mortality

    November 21, 2008, Afrique en ligne

    UNFPA has tasked Nigeria to address its high maternal mortality rate of 800 deaths out of 100,000 mothers at birth yearly. Although successes were being recorded in the area of HIV and AIDS, women empowerment and population, a lot still needs to be done. doclink

    Afghanistan: Marriage Practice Victimizes Young Girls, Society

    January 16, 2008, Radio Free Europe

    For thousands of Afghan girls, and millions more across Asia and Africa, marriage often comes before they are old enough for such dreams. One tells of becoming a wife at 13, forced to serve her husband's family, and having no say in her own life. She tried to escape -- by taking her own life.

    She survived and has been recovering at a local hospital. Child marriages affects more than 50 million girls worldwide and according to UNICEF are a reaction to extreme poverty. They mainly take place in Asian and African regions where poor families see daughters as a burden. The girls are given into the "care" of a husband, and many of them end up abused. They are under pressure to bear children, but the risk of death during pregnancy or childbirth for girls under 14 is five times higher than for adult women.

    Women's activists say up to 80% percent of marriages in Afghanistan are either forced or arranged. Many girls are forced into marriages when they are as young as nine or 10. Most marry far older men whom they meet for the first time at their wedding.

    In Afghan villages, it's considered dishonorable for daughters to date boys. Some parents try to marry their daughters as soon as possible to avoid such a prospect. Widespread poverty still compels many parents to get their daughters married to avoid the cost of caring for them.

    At 44, an Afghan woman's life expectancy is one of the lowest in the world.

    Shortly after being married, many young girls are admitted to hospital in a state of shock from serious physical injuries and psychological trauma. The country has changed the legal age for marriage for girls from 16 to 17, but many men simply do not bother with registering their marriages.

    There has been started an awareness campaign promote children's rights to education and self-determination.

    Parents, teachers, and local leaders take part in meetings in Afghanistan's remote towns and villages. But it will take years, perhaps a generation, to root out the tradition of child marriages. doclink

    Child Deaths Worldwide Fall Below 10 Million a Year for First Time, New UN Figures Show

    September 25, 2007, UN News Centre

    Child deaths worldwide have fallen to 9.7 million, down from almost 13 million in 1990, thanks mainly to campaigns to combat measles and malaria and promote exclusive breast-feeding.

    Of the 9.7 million children who perish each year, 4.8 million are from Sub-Saharan Africa and 3.1 million from South Asia. In the developing world, child mortality is higher among children living in rural areas and in the poorest households. In developed countries there are 6 deaths for every 1,000 live births.

    The Latin American and Caribbean region have 27 deaths for every 1,000 live births, compared to 55 per thousand in 1990.

    There has been significant progress in parts of Sub-Saharan Africa. Under-five mortality has declined 29% between 2000 and 2004 in Malawi. In Ethiopia, Mozambique, Namibia, Niger, Rwanda and Tanzania child mortality rates have declined by more than 20%.

    The highest rates of child mortality are still found in West and Central Africa. In southern Africa hard-won gains in child survival have been undermined by the spread of HIV and AIDS.

    Much of the progress is the result of the widespread adoption of basic health interventions, such as early and exclusive breast feeding, measles immunization, Vitamin A supplementation and the use of insecticide-treated bed nets to prevent malaria. doclink

    Her Body: Seven Ways to Save a Mother's Life

    August 7, 2007, Newsweek (US)

    Every minute a woman dies of complications of childbirth. The most common causes are uncontrolled bleeding, infection and obstructed birth. And for every woman who dies, another 30 become sick or injured. Childbirth is the leading cause of death and disability for women of reproductive age.

    What makes these numbers appalling is that modern medicine has the tools to make childbirth safe for all women. Women need to understand the trouble signs in pregnancy and access to skilled care is vital. Pregnant women do not get the help they need. Poverty is often the reason but also war and political upheaval.

    In the U.S., the maternal mortality rate among black women is four times the rate white women and black women are at higher risk of delivering prematurely and having low birth weight babies. Among American women, the most common complication is eclampsia, a condition that causes seizures. Women are at higher risk if they are obese, diabetic or have high blood pressure.

    Conferences like Women Deliver help by bringing together policymakers, but there's a lot you can do. :

    1. Tell policymakers that women count. 2. Educate yourself if you're pregnant. 3. Help educate other women. 4. Fight domestic violence. 5. Learn what's happening to women in the rest of the world. 6. Reach out to women in trouble. 7. Become an advocate for health care for women and children. You can help millions of women around the world whose stories need to be told. doclink

    Nigeria: One Out of Five Children Will Die Before Age Five

    August 28, 2007, Africa News Service

    Prof. Njokanma revealed that one out of every five Nigerian children will not live to 5 years

    More than half will succumb to death within their first day in the world. Malaria, malnutrition, respiratory diarroeal diseases and vaccine-preventable diseases, poliomyelitis and tuberculosis, still rank very high among them that maim and kill our children.

    Childhood mortality ranked 13th worst in the world with Nigeria behind Ghana and South Africa.

    He attributed high mortality rate to poor supervision of pregnant women. The state of facilities do not encourage professionals to put in their best to child-care delivering.

    Poor planning of basic health framework, poverty, ignorance, emigration of top ranking personnel in 1980s and 90s and continued emigration of young medical people as the major causes of children mortality in our country.

    The Federal Ministry of Health was aware of these problems but lacks the political will to put things in order.

    All health workers at the maternity to make efforts at seeing that children are taking proper care at birth.

    He called for increased allocation to primary health care from all tiers of government so as to boost child healthcare.

    He added that free and accessible health care is possible in the country, If only corruption is eradicated. doclink

    Ghana: Northern Region Records High Maternal Deaths

    February 12, 2008, Ghana News Agency

    The Northern Region recorded 112 maternal deaths during the floods that devastated parts of Northern Ghana and Brong Ahafo. At a seminar organised by UNFPA the theme was: "The floods disaster in the Northern Region: Response to the sexual and reproductive health needs". Dr. Tumasi said the floods rendered a lot of communities inaccessible to the health workers to give medical attention to the pregnant women. About 90% of the deaths could have been prevented.

    He said about 30% of pregnant women who attended health facilities were found to be anaemic because they could not get nourishment after the destruction of foodstuffs by the floods.

    Community health nurses and other medical personnel did their best during the floods but they had inadequate staff, logistics and supervision.

    The MOH was training staff on reproductive health with emphasis on antenatal care and contraceptive update and to galvanise district health communities to carry out more maternal deaths audits.

    The MOH would organise research on low update of reproductive health services and intensify supervision of districts and sub-districts.

    The District Director of Health (DDHS) for the Karaga District said out of 212 communities 93 were severely affected by the floods and her medical team was able to gain access to only 11 communities.

    Several acres of farmlands were submerged or washed away while fishing and farming came to a standstill.

    Malaria and diarrhoea were common, while the black fly attacked the people because of the closeness of the district to the Black Volta.

    There was also the fear of the spread of communicable diseases because of overcrowding and children were malnourished and had stopped going to school.

    She expressed concern about the activities of quack doctors and nurses who took advantage of the people. The Programme Officer of UNFPA said the Fund's response was focused on promoting safe motherhood, preventing HIV and addressing sexual violence to reduce, maternal mortality.

    The Fund provided kits with essential drugs, equipment and other consumables for some 75,000 people in the worst affected flood districts. The Fund had supported the training of staff and community mobilisation to enhance access to clean, safe deliveries and complications of pregnancies.

    It was also to ensure the management of rape and sexual abuses and management of sexual transmitted infections, including HIV/AIDS prevention. doclink

    Negligence Kills 1.3 Lakh Mothers a Year in India

    April 22, 2008,

    Maternal deaths in India are on the rise, every five minutes a woman dies due to complications from pregnancy and childbirth. One woman dies every minute in the world due to complications related to pregnancy or childbirth. In developed countries, the maternal mortality ratio is 27 per 1,00,000 live births, in India, it is 540.

    In developed countries a woman's lifetime risk of dying from pregnancy related complications is one in 1,800, in India, it is one in 48. In a developing country, one in every 3 deaths of women in their reproductive years is due to complications from pregnancy and childbirth, 15% of deaths of women of reproductive age in India are maternal deaths.

    50% who are 15-19 years die due to unsafe abortions.

    In India nearly seven million abortions take place annually. For every legal abortion, 10 are illegal abortions. Other major factors that cause mothers' deaths are hemorrhage, eclampsia, obstructed labor, sepsis and pre-existing conditions such as anemia and malaria.

    60% of all maternal deaths occur after delivery. Yet less than 17% of women in India receive any postpartum care.

    Health facilities are available to only 34% of women and in rural areas three out of every four babies are born at home with unskilled personnel.

    Only 52% of Indian women are involved in decision-making on their own health care.

    Add to these inadequate nutrition as the average weight of an Indian pregnant woman is nearly 50% less than in developed countries.

    Only 60% of rural women and 86% of urban pregnant women in India receive antenatal checkups, 67% receive two doses of TT vaccines and 48% receive 100 iron folic acid tablets.

    The negligence affects families and society. One in every four adult women in developing countries suffers long or short-term illness due to pregnancy and childbirth. 30% develop chronic debilitating conditions, resulting in death.

    Between 58-80% of pregnant women in developing countries develop acute health problems and 8-29%develop chronic health problems because of pregnancy.

    Children who lose their mothers suffer the most. In some developing countries, the risk of death for children under five doubles or triples if the mother dies.

    Children whose mothers have died are 3 to 10 times more likely to die within two years than those who have both parents alive. doclink

    Namibia: Maternal Death Rate Shoots Up

    February 6, 2008, New Era

    The data that the Nambian Ministry of Health and Social Services is analysing indicates that the maternal mortality rate increased from 227 per 100000 live births in 2000 to 449 in 2006. Child mortality rate increased from 62 per 1000 live births to 69 while infant mortality rate also went up from 38 per 1000 live births to 46.

    The Health Minister said HIV/Aids was at the core of these statistics.

    Child survival, and infant mortality rates is a barometer of a country's development goals. Many children die of preventable diseases such as pneumonia, malaria, malnutrition and diarrhoea.

    Infections such as TB, pneumonia and susceptibility to malaria were killing pregnant women and children whose immune systems are already weakened by the pandemic.

    Namibia rolled out an anti-retroviral treatment and prevention of mother-to-child transmission programme in 2006, but children born before that time might have been at risk of infection, said Kamwi.

    Today 45000 HIV patients have access to ARVs, while 39016 attend ante-natal clinics at PMTCT sites out of 57720 pregnant women that visit ANC countrywide. Despite these achievements, the supplement said, the attention of personnel in the Ministry was detracted from preventative care for childhood illnesses and routine maternal health services because the health care system is stretched beyond its capacity.

    "However, the critical shortage of health care professionals continues to hamper effective health services delivery," said Kamwi.

    The gains that Namibia made after independence, such as reducing infant and under-five mortality rates have been reversed despite the health sector enjoying the highest budgetary allocation.

    Not all hope is lost, however, as the supplement said Namibia could make up for lost ground if more money and personnel continue to be provided.

    Kamwi also made a plea for more funding for health systems support and not just limited to HIV/AIDS.

    Looking at the fact that Namibia surpassed World Health Organisation targets in rolling out ART in two years, as well as the success of the countrywide immunisation campaign against polio in 2006, Lwin said when the Ministry, civil society and the Cabinet put their minds to see results, "we can be sure to see results". doclink

    Breast-Feeding is Still the Best

    February 6, 2008, Africa News Service

    Thousands of infants are dying worldwide, due to not being breastfed.

    Breast milk contains the right balance of nutrients to help the infant grow into a strong and healthy toddler. Some protect against common childhood illnesses and infections.

    The (WHO) is recommending the colostrums, the yellow sticky breast milk produced at the end of the pregnancy, as the perfect food for the newborn. Feeding should be initiated within the first hour after birth. Breastfeeding is recommended up to six months of age.

    The KwaZulu-Natal Department of Health is promoting breastfeeding, as the natural and normal practice for nurturing babies, amongst the mothers in the province.

    The Department of Health spokesperson said health professionals and field workers have implemented the Baby-Friendly Hospital Initiative through the years, and contributed to the saving of babies.

    WHO stated on their website that their aim together with UNICEF was the promotion of breastfeeding and to give guidelines with appropriate information and support to mothers.

    Hospital practices cited for a decline in breastfeeding included mother and baby separation, rigid feeding regimes, administering pre-lacteal e.g. glucose water, uses of dummies, uses of analgesia or anesthetics.

    Breastfeeding helps babies grow normally and protects them from getting sick. Other baby foods do not give protection and can cause illness if not made up and fed properly. doclink

    'Let My Baby Live' Media Campaign a Success

    November 20, 2007, Turkish Daily News

    A campaign to lower Turkey's maternal and infant mortality rate reached 66% of the population.

    The "Let My Baby Live" media campaign is a joint project by the Ministry of Health and the EU and brought together celebrities from the theater, film and fashion world. The campaign was carried out in 16 provinces that have limited access to health care.

    Interviews were held with the households, adolescent girls, young mothers in the 15-49 aged group as well as their relatives and husbands. They were informed about the importance of the medical check-ups before, during and after pregnancy.

    Maternal mortality is one of the biggest problems in Turkey. Mothers, their husbands and relatives are unconscious of the fact that women should to undergo medical examination before, during and after the pregnancy. Approximately 387 maternal deaths occur every year in Turkey and 62% of them are preventable. doclink

    Country on Course to Achieve MDGs

    October 25, 2007, Africa News Service

    Botswana is on a good footing to achieve the MDGs by 2015. The UN is committed to supporting Botswana. Botswana is achieving most of the eight MDGs set by the UN to combat poverty, hunger, disease, illiteracy, environmental degradation and discrimination against women.

    The country has realised poverty reduction from an estimated 47% in 1992 to 30.3% in 2002.

    However, the country still faces income disparities and a wide gap between the rich and poor.

    From 1995-2000, the estimated net school enrollment for children 7-14 was consistently above 95%, peaking at 100% in 1999 and 2000.

    Botswana has eliminated gender disparities in most formal education with girls' enrollment in primary and secondary education at par with that of boys. However, Botswana women do not enjoy equitable treatment in control of productive resources. More financial institutions and government departments treat married women as de facto minors. Women account for only 39% of workers aged 12 and above.

    Botswana has reduced child mortality although HIV remains a challenge. The country is making strides on environmental sustainability with 97.7% of the population having access to safe drinking water by 2000 from 77% in 1996. However, the figure dropped to 95% in 2004 because of an increase in demand for water usage.

    There has been significant inroads for provision of AIDS services. Botswana has done well on antiretroviral drugs and mother to child treatment.

    The major challenge for Botswana in the fight against HIV prevention. If Botswana can mount a significant approach, there will be success in the fight against the virus. doclink

    Mozambique: Minister Calls for Change of Mentality About Maternal Health

    October 30, 2007, Africa News Service

    Mozambican Health Minister Garrido admitted that women's health, as well as that of newborn and infants, are not included in the priorities of many countries.

    There are large numbers of women dying of poor health care, and he urged the authorities to start acting rather than talking about these issues.

    Garrido urged Mozambican women to be more pro-active if they are to defend their rights.

    "Women should develop concrete actions and do the necessary advocacy to attain their goals."

    Garrido also talked about one of the primary actions we must take urgently is the change of mentality in our countries. We need to convince our political leaders that letting women die is a scandal, and that it is essential to create a solid and inclusive basis for women and children's health.

    He mentioned the integration of the mother-and-child health care in the primary health care as part of important actions to guarantee sustainability of the health system. He called for the allocation of more resources to this sector.

    In Mozambique, Women's health has been established as a priority, however, these women are still exposed to many adversities related to their poor social and economic condition, and the lack of information about how they can contribute to their own health, and how to counter the poor coverage of the health system.

    Garrido noted that many will spend on HIV rather than on mother-and-child issues. In many African countries funds are not primarily to fight against HIV, malaria, or tuberculosis, but to strengthen the national health systems. He suggests speeding up staff training, expansion of health infrastructures, particularly in the rural areas, and guarantee the supply of the necessary medicines.

    The New International Health Partnership recommends priority actions to be carried out in order to prevent that "the world continues loosing 1,000 women every day, whose objective is to celebrate life." doclink

    Namibia: Maternal Mortality Rate Up

    November 13, 2007, Africa News Service

    At the current rate of reduction of 2.1%, UNICEF says Namibia would require 40 years to reach the MDG's of reducing child mortality and improving maternal health. The maternal mortality rate has increased from 271 to 449 deaths per 100,000 births in six years. the most common causes severe eclampsia, hemorrhage, and obstructed and prolonged labour, could be treated if prompt access to emergency care was available.

    Indirect causes include anaemia, diabetes, malaria, domestic violence aimed at the mother, heart disease and HIV/AIDS which accounts for 37%.

    Few health centres have ambulances and all health centres lack the capacity to deliver EmOC facilities, forcing some mothers to travel long distances at short notice to find appropriate treatment. A study in 2006 of all 34 state hospitals and seven private hospitals, 32 health centres and 263 health clinics, found only four facilities capable of providing all eight functions. None met the criteria for Basic Emergency Obstetric Care (BemOC) accreditations. For a health facility to be classified as comprehensive EmOC, it should administer parenteral antibiotics, oxytoxic drugs and anticonvulsants for pre-eclampsia and also perform manual removal of placenta, retained products, assisted vaginal delivery, blood transfusions and Caesarean delivery.

    90% of the health centres had not conducted any Caesarean sections, blood transfusions, or manual placenta removals in the three months prior to the study, while 40% had administered parenteral antibiotics. The majority of all doctors are concentrated in Windhoek. By rolling out EmOC provisions to rural areas the delay in antenatal crisis will be averted and mortality reduced. doclink

    Nigeria: How to Battle Rising Maternal Deaths

    December 4, 2007, Africa News Service

    Gynecologists and Obstetricians have a resolve to put an immediate end to the increasing rate of maternal deaths in the country. About 529,000 women die annually globally, Nigeria is said to account for 10%.

    Many young women, particularly those from the northern parts of the country go through giving birth for one reason or the other. Some may be that she would not allow a male doctor to attend to her during delivery.

    This attitude and belief may have accounted for a good number of maternal and newborn deaths in Nigeria. Though, other factors can account for the high rate of maternal and newborn deaths. Some of those factors include bad roads, absence of health facilities, while the persistent electricity failure could also be said to have contributed to the death of mothers.

    Nigeria is the second highest, next to India, with a rate of maternal and infant death. "We have been interacting with Government, International and National donor agencies, the private sector and faith groups to find out why up to now Nigeria has not been able to fashion a way to deal with the high mortality".

    It was clear that the only way they can impact the figures was for the stakeholders to work together in a structure that will cover the whole country with their bases rooted in the existing health structure of the states, federal government and private health institutions.

    SOGON has come up with a National partnership plan and structure which have integrated all levels of Local State, Federal, Faith and Private health structures into a system that will be able to handle and overcome the high maternal and newborn death rates in the country.

    It was important to look at the socio-cultural milieu within which the people live. This, heavily influences not only the health of the population but also more importantly the ability of people to take decisions including decisions on health matters.

    "The Nigerian woman, like all African women, is primarily responsible for the health of children. This status of the woman is central to both maternal and infant health and mortality. Thus gender roles from conception, through childhood and adolescence affect this biologic responsibility" In Nigeria 44% of females are illiterates compared to 22% of males. Maternal mortality was the end result of social dynamics that starts way before pregnancy

    Maternal mortality is dependent on the age at which a woman gets pregnant, the number of wanted pregnancies as compared to unwanted pregnancies which are associated with high level of abortions, the financial situation of the woman and her ability and level of decision making about her health and those of her children. The ability of a woman to take decisions on issues affecting her and her children was determined by her educational status. Her ability to actualize her decision was determined to a large extent by her economic empowerment. doclink

    Nigeria: Country's Maternal Mortality Ratio Second Largest, Says Report

    November 6, 2007, Africa News Service

    Nigeria has the 2nd highest number of maternal mortality Ratio in the world, after India.

    The Maternal Mortality Ratio (MMR) is the number of maternal deaths during a given period per 100,000 live births. In Nigeria, this ratio ranges from 800 to 1,500 per 100,000 live births. It is estimated that 15% of pregnancies experience complications world wide. But in Nigeria, it stands at over 40%.

    The MMR in Nigeria results from poor primary health and emergency obstetrics care associated with still birth, ill-equipped and badly-managed hospitals, and carelessness on the part of medical and health personnel.

    Because of cost, many pregnant women are delivered at home by birth attendants and in the process many die. In most Nigerian villages, women still give birth with no running water, no sterilisation and no skilled birth attendant. Cultural and economic factors account for the MMR in Nigeria. With the current trend there is no way by which Nigeria can meet the MDGs of reducing maternal deaths by 75% by 2015.

    The solution lies in overhauling our National Health System. Sri Lanka reduced its MMR from 550 per 100,000 live births in the 1950s to 80 per 100,000 live births in the 1970s. This was achieved by ensuring skilled attendance even in remote rural areas. In Nigeria, the basic healthcare facilities are non-existent. Most Teaching Hospitals are a nightmare. Health centers are in appauling conditions. Any wonder most Nigerian women patronize traditional birth attendants and spiritual healers.

    There is an urgent need to prevent our women and their unborn children from dying through the provision of qualitative health care that is accessible, acceptable and affordable especially to the poor rural women. To encourage pregnant women to go to hospitals, ante-natal and post-natal care should be made free of charge. Public emergency ambulance services should be resuscitated.

    Health care and outpatient services should be decentralized to reach the women in every State, local government, ward community and village community. The Health Insurance Schemes should be strengthened. The local clinics and dispensaries in our villages and local government areas should be resuscitated. Corrupt local government officials caught embezzling the funds for the health projects must be prosecuted.

    The MMR landscape in Nigeria will begin to change for the better when government acquires the political will to do what is right at all times, and the courage to checkmate international agencies that are playing politics with the lives of our women and children. doclink

    UK Pledges £100 Million to UNFPA to Make Childbirth Safer and Promote Reproductive Health

    October 23, 2007, UNFPA

    Maternal deaths and unwanted pregnancies can be cut after the British Government pledged £100 million to UNFPA. Maternal health can be improved through commitment and increased resources, said the UNFPA Executive Director. "The U.K.'s generous investment will enable UNFPA to save mothers' lives. The £100 million over five years was announced today by the Secretary of State for International Development, who called on leaders of the world's poorest countries, especially in Africa, to make women's health a priority. "The death of a mother deprives a child, a family, a community and ultimately a country of one of its most valuable sources of health, happiness and prosperity," said Mr. Alexander. More than 10 million women have died in the last 20 years. These deaths could have been prevented."

    The UN included a new target to achieve universal access to reproductive health in MD Goal 5 that calls for the improvement of maternal health, and the reduction of maternal mortality ratio by three quarters by 2015.

    Although progress has been made maternal deaths remain high, particularly in sub-Saharan Africa and South Asia. A woman in Africa faces a 1 in 26 lifetime risk of maternal death compared to 1 in 8,200 in the U.K.

    An estimated 720,000 unwanted pregnancies could be averted, 300,000 abortions prevented and the lives of 1,600 mothers and 22,000 infants saved for every £1 million invested in family planning. doclink

    US Among Worst in World for Infant Death

    The Associated Press

    The rate at which infants die in the US has dropped over the past half-century, but disparities remain among racial groups. In 2004, roughly seven babies died for every 1,000 live births before reaching their first birthday, That was down from about 26 in 1960.

    Babies born to black mothers died at two and a half times the rate of those born to white mothers.

    The U.S. ranks near the bottom for infant survival rates among modernized nations. The U.S. had more neonatologists and newborn intensive care beds per person than Australia, Canada and the United Kingdom - but had a higher rate of infant mortality than any of those nations.

    Doctors blame disparities in access to health care among racial and income groups in the U.S.

    The picture is bleaker in poorer countries, particularly in Africa. A 2005 report found infant mortality rates as high as 144 per 1,000 births in Liberia. doclink

    Malawi: Role of Traditional Birth Attendants to Change

    October 30, 2007, IRIN News (UN)

    Malawi is planning to change the role of Traditional Birth Attendants (TBAs) in an attempt to reduce one of the world's highest rates of maternal and infant deaths.

    A Survey said the maternal and infant mortality rate was 984 out of every 100,000 live births.

    But such a move does not take into account the overburdened public health system, which would be overwhelmed if TBAs were removed. A lecturer in community health center said less than half the women in Malawi delivered their babies at recommended hospitals, yet the system is overtaxed.

    If government plans not to use TBAs, then an alternative must be identified. If 70% of all pregnant women were to deliver at the hospital, the system would not cope.

    The reason for government ending the licensing TBAs was that most maternal and infant deaths are caused by delays in transport from TBAs to clinics, and then to referral hospitals. Such delays ended up complicating cases which TBAs could not treat.

    The majority of deaths were a consequence of internal bleeding and high blood pressure, which required emergency medical attention only available at clinics.

    The government would not completely discard the TBAs, but they would no longer perform the duties of midwives.

    They have been given a new roles. One will be to arrange transport for expectant women to clinics and teach lactating mothers the importance of breast feeding. There is enough capacity in the hospitals to handle maternity cases. The problem is that most women are ill-informed by the same TBAs who were getting paid.

    Switching the TBAs from handling expectant mothers would be gradual. In their new roles they will help government to reach the rural poor who are ill-informed about childbirth and breast feeding.

    The government was also using traditional leaders to convince people to stop using TBAs. People tend to listen to what their traditional leaders tell them than anyone else. Chiefs must tell people the importance of coming to hospitals with problems affecting their health.

    The country's high maternal and infant mortality rate was a consequence of home births. But not all traditional leaders accepted that the high rate of maternal and infant deaths could be attributed to TBAs. Chief Kabunduli, said government should also shoulder some of the blame. Experience has shown that most maternal and child deaths occur in houses of TBAs, but it is government that accredits these people.

    A health official from the same region said in one district only 4,000 of the about 10,000 expectant mothers had visited a hospital. The UK Department for International Development (DFID), which has donated about US140 million to Malawi for 2006/07 - including $40 million for budget support, another $40 million for health and HIV/AIDS, and $14 million for education - said there were challenges in the health sector, as the maternal mortality rate had risen by more than 50% since 1992.

    At the same time, the under-five mortality rate had declined to 133 deaths per 1,000 live births in 2004 - a 43% reduction in 12 years - and was on target to reach the 2015 MDG in this category.

    UNICEF estimates that almost half of all births in developing countries occur without a skilled birth attendant present. Globally, 529,000 women die every year in pregnancy. doclink

    Too Many Women Dying in Childbirth

    December 11, 2007, IRIN News (UN)

    The United Nations Population Fund has launched a campaign in Burkina Faso to reduce maternal mortality.

    It aims to reach 80% of women at the age to procreate in rural areas, and 50% in the cities.

    In Burkina Faso, 63% of women see a doctor while they are pregnant, of whom only 23% do so regularly.

    Burkina Faso has one of the highest maternal mortality rates in the region, with 484 women dying per 100,000 deliveries.

    The three-month campaign will include radio and television programs, to educate people about the advantages of prenatal consultations and the advantages of delivering at health care centres.

    Discussions will also be conducted with men and traditional leaders.

    Each message displays also men because people should not think that assisted delivery concerns only women because men are most often the final decision-makers.

    Burkina Faso was revealed as being the least-developed country in the world among the 177 that UNDP evaluates.

    Niger jumped up four positions. Since 1990 it has registered a 10-year rise in life expectancy and an 8% increase in school attendance, and the level of adult literacy has improved by 17%.

    Niger ranks worse than Burkina Faso for birth and health related issues, 16% of births are in the presence of a health official compared to 38% in Burkina Faso.

    Burkina Faso is facing a shortage of qualified medical personnel. There are five physicians per 100,000 people. It is expensive to train medical staff and many people cannot afford to pay to use their services. doclink

    UN Says India Must Reduce Child Mortality Rates

    December 18, 2007, Voice of America

    The UN says India needs to reduce child mortality. India accounted for more than two million of the 9.7 million children who died in the world before their fifth birthday last year.

    Child mortality rates in India have declined over the last 15 years. But this has happened slowly, at an average rate of two-and-a-half percent a year.

    The pace of achievement need to increase over the next year. Malnutrition is a major challenge in India, and is the underlying cause of death among 50% of the children who die.

    Too many children in India are born with a very low birth weight, and the infant feeding practices in the first two years of life are sub optimal. Children are not always being breastfed, and children are not being provided with adequate foods.

    The India has the largest pool of children who have never been immunized, about 9.5 million. These children are vulnerable to diseases such as measles and diphtheria, pneumonia and diarrhea are other big killers.

    The U.N. reports some success stories. The number of children attending primary school in India is on the rise, about 84% of girls and boys between 6 and 10 are going to school. More children have access to improved sanitation.

    India is one of the youngest countries. Nearly one third of its population is under 15. India needs to provide far greater access to improved healthcare and education. doclink

    Child Mortality at Record Low

    September 13, 2007, New York Times*

    The number of deaths of young children around the world has fallen below 10 million a year. This has arisen, partly from campaigns against measles, malaria and bottle-feeding, and partly from improvements in the economies of most of the world outside Africa.

    The UN Goal is cutting the rate of infant mortality in 1990 by two-thirds by 2015. The new estimate comes from surveys done in 2005, so they barely reflect the huge influx of money that has poured into third world health. For that reason, the next five-year survey should show even greater improvement. The most important advances, UNICEF said, included:

    Measles deaths have dropped 60% due to vaccination.

    More women are breast-feeding rather than mixing formula or cereal with dirty water.

    More babies are sleeping under mosquito nets and are getting Vitamin A drops.

    The highest rates of child mortality are found in West and Central Africa, where more than 150 of every 1,000 children will die before 5. In the wealthy countries, the average is about six.

    The most rapid progress has been made in Latin America, the Caribbean, Central and Eastern Europe, and in East Asia and the Pacific.

    Two types of countries have worsened, those in southern Africa that have been hit by AIDS, and those that have been at war recently, like Congo and Sierra Leone.

    The improving economies of India and China have helped pull world figures upward. More girls are getting education and marry later and they have fewer children.

    Among countries that made progress since 2000 are the Dominican Republic, Vietnam and Morocco, which all cut child deaths by more than one-third.

    Madagascar cut its deaths by 4% despite going to the brink of civil war in 2002.

    So Tom and Principe's two islands in the crook of West Africa had bested the world.

    Credit was due to a national antimalaria campaign that had drained swamps, sprayed houses and provided mosquito nets. In Madagascar, the difference was Vitamin A drops, which reduce the chances that a child will die of measles, diarrhea or malaria.

    The countries that did best concentrated on simple measures to rural areas, and inexpensive prevention rather than expensive care.

    Ethiopia trained 30,000 community health workers for weighing babies, advising on breast-feeding, giving shots, testing for malaria and handing out mosquito nets. doclink

    London's Maternal Conference Ends on Hopeful Note

    October 30, 2007, Voice of America

    The three-day conference focused on maternal and infant mortality, and the organizers hope it will give new momentum to reduce pregnancy and birth-related deaths.

    This was a political meeting, but governments are ready to invest in making that work, ministers of finance, planning, local government and health were there. The majority of maternal deaths occur in Asia and sub-Saharan Africa.

    An obstetrician from Uganda explained that while the numbers are high in sub-Saharan Africa, maternal mortality is not given the priority it deserves. He added that while cholera or ebola provoke an immediate response, maternal mortality does not carry the same weight. If the people who have resources whether technology or money or advocacy to help the people in Africa they will make a difference.

    The United Nations goal is to reduce maternal mortality by 75% between 1990 and 2015.

    Women are at the heart of our families and our communities, they are also at the heart of the Millennium Development Goals.

    For example in Honduras the government succeeded in reducing maternal mortality by 40% and is proof that political will can tip the balance. doclink

    Egypt Makes the Most Progress and Iraq the Least in Reducing Child Deaths, Report Finds

    May 14, 2007, Save the Children

    Egypt has made the most progress since 1990 in saving the lives of children under 5. The Child Survival Progress Rankings of 60 developing countries, account for 94% of all child deaths. Iraq's child mortality rate has increased by 150% since 1990. Some 122,000 Iraqi children died in 2005 before reaching their fifth birthday. Egypt has achieved a 68% decline in child deaths in the past 15 years.

    Investments in health services have improved care for pregnant women, made childbirth safer and increased the use of family planning services. Iraq, Botswana, Zimbabwe and Swaziland emerge as the countries that are regressing the most. "More than 10 million children under age 5 still die each year. The interventions that can save these lives, such as vaccines, oral rehydration therapy and insecticide-treated mosquito nets are not expensive. Yet many mothers and children lack access to these lifesaving measures.

    Nine out of 10 mothers in sub-Saharan Africa are likely to lose a child during their lifetime. It doesn't have to be this way. We can prevent this tragedy. The three biggest killers of children under 5 are newborn disorders, pneumonia and diarrhea. By using existing interventions, the report notes, we can save more than 6 million of the 10.1 million children who die every year from easily preventable or treatable causes. Child and maternal death rates are highest in the poorest places. Nearly all under-5 and maternal deaths occur in poverty, where children are most vulnerable to diseases and malnutrition. AIDS affects child mortality trends, particularly in sub-Saharan Africa. Other key factors are the effects of armed conflict and social instability.

    Malawi, Bangladesh, Nepal, Tanzania and Madagascar are making great strides in child survival despite limited financial resources. They have invested in better health care for mothers, better nutrition for children, and services to prevent and treat deadly diseases. Among the 44 more-developed countries the US ranked 26th. Children's deaths in the industrialized world are most likely the result of traffic accidents, intentional harm, drowning, falling, fire and poisoning. American Indian, Alaska Native and African American children have the highest death rates in the US.

    Three key interventions are nutrition, skilled care during childbirth and access to voluntary contraception. Breastfeeding provides nutrition and improves immunity to often life-threatening illnesses common to infants. Immunizations protect children from measles and other diseases. Oral rehydration therapy can save a child from dying of dehydrating diarrhea. Antibiotics treat pneumonia. Insecticide-treated mosquito nets help prevent malaria.

    Childbirth can be safer if mothers and newborns receive care from trained health workers. In remote communities, diarrhea and pneumonia can be treated by training community-based health workers close to where children live.

    Basic health systems in developing countries are underfunded. Poor countries need new strategies to encourage family members to adopt lifesaving home-based practices.

    It only costs a few dollars to protect young children from conditions that disable or kill. With modest increases in funding, we can help countries reach the poorest with child survival and maternal health services. doclink

    Infant Mortality in Iraq Soars as Young Pay the Price for War

    May 14, 2007, The Independent

    Two wars and sanctions have led to a rise in the mortality rate among young children in Iraq. Since 1990 Iraq's child mortality rate has increased by 125%.

    Whether it's the impact of war, HIV or poverty, the consequences are devastating. Yet other countries such as Malawi and Nepal have shown that despite conflict and poverty child mortality rates can be reversed.

    Egypt, Indonesia and Bangladesh have made the most progress in tackling child mortality, while Iraq, Botswana and Zimbawe have regressed the most.

    Sanctions against Saddam Hussein's regime were imposed in 1990 and remained in place until after the coalition invasion in 2003. Precisely how many children died because of sanctions is unknown but a report in 1999 suggested that between 1991 and 1998 an additional 500,000 died.

    Kathy Kelly, an anti-war campaigner said: "The punishment of children through the economic and military war against Iraq has been the greatest scandal."

    Save the Children's report, State of the World's Mothers 2007, found the majority of child deaths occur in 10 countries, either those with large populations, or those with sparse health services. AIDs remains one the central factors affecting mortality rates.

    "More than 10 million children under age five die each year. Almost all in developing countries. Vaccines, oral rehydration therapy and insecticide-treated mosquito nets are not expensive. Yet, many mothers and children lack these life-saving measures. doclink

    Maternal, Infant, and Child Health Care

    After a Year of Trump Policies, Population Institute's Report Card on Reproductive Health/Rights for 2017 Lowers Overall U.S. Grade to a "D-"

    18 States Get Failing Grade Amid Attacks on Family Planning and Birth Control
    February 15, 2018, PR Newswire

    For 2017, the overall grade on U.S. reproductive health and rights assigned by the Population Institute fell from a "D" to a "D-." 18 states got a failing grade. Twenty-two states received a B- or higher in 2017. Eleven states (California, Washington D.C., Hawaii, Maine, Maryland, New Jersey, New Mexico, New York, Oregon, Vermont, and Washington) received an "A" in 2017. But 27 states received a "D" or lower. 18 of those states received a failing grade ("F"), including Alabama, Arkansas, Florida, Georgia, Idaho, Kansas, Louisiana, Mississippi, Missouri, Nebraska, North Dakota, Oklahoma, South Dakota, Tennessee, Texas, Utah, Virginia, and Wisconsin.

    Robert Walker, president of the Population Institute said: "The United States is in danger of becoming, in effect, the Divided States of Reproductive Health and Rights."

    The Trump budget proposal unveiled this week signals worse attacks to come. It would eliminate the Teen Pregnancy Prevention Program, invest in ineffective abstinence-only education programs, and block patients from seeing their preferred health care provider, Planned Parenthood. doclink

    A New Study Finds IUDs Dramatically Reduce the Risk of Cervical Cancer

    November 7, 2017, PRI - Public Radio International   By: Agence France-presse

    Women who get intra-uterine devices (IUDs) for birth control appear to face a one-third lower risk of getting cervical cancer, the third most common cancer in women worldwide, said the review in the journal Obstetrics and Gynecology, which included 16 previous studies spanning more than 12,000 women around the globe.

    Lead author Victoria Cortessis, associate professor of clinical preventive medicine at the Keck School of Medicine, part of the University of Southern California said: "The possibility that a woman could experience some help with cancer control at the same time she is making contraception decisions could potentially be very, very impactful."

    One theory as to why the risk of cervical cancer drops so much, is that the devices stimulate an immune response that helps fight off cancer-causing infections like the human papillomavirus (HPV).

    Another possibility is that when women have the devices removed, precancerous cells are scraped away that might otherwise grow into tumors.

    Cervical cancer kills about 270,000 women per year and infects more than 528,000, according to the World Health Organization (WHO).

    By 2035, those numbers are expected to rise to more than 756,000 infections and 416,000 deaths, the UN health agency warns. doclink

    Reproductive Health is Part of the Economic Health of Women and Their Families -

    The economic security of women and families is directly tied to a woman's access to reproductive health care. As the United States Supreme Court said,
    February 19, 2017, National Women's Law Center

    The decision whether or when to have a child is one of the most important economic decisions most American women will make. It has implications for a woman's financial well-being, job security, workforce participation, and educational attainment.

    Accessing reproductive health care can be costly for women, if available at all, because of ever-increasing government-imposed barriers that threaten their health and economic well-being. It is imperative to strike down these barriers and ensure every woman has access to safe and affordable reproductive health care services - the economic security of women and families could depend on it.

    What studies have shown:

    * The advent of oral contraceptives contributed to an increase in the number of women employed in non-traditional female occupations and professional occupations, including as doctors and lawyers.

    * An increase in women's wages is linked to the availability of birth control.

    * Children whose mothers had access to birth control have higher family incomes and college completion rates.

    * Women who were able to have an abortion had 6 times higher odds of having positive life plans -- most commonly related to education and employment -- than women denied an abortion.

    * Only 25% of women who request an IUD have one placed after learning the associated costs.

    * Over half of women who get abortions spend the equivalent of more than one-third of their monthly income on the procedure and its associated costs.

    According to the Guttmacher Institute, the average cost of a full year's worth of birth control pills is the equivalent of 51 hours of work for someone making the federal minimum wage of $7.25.

    The up-front costs of the IUD, one of the most effective birth control methods, is nearly a month's salary for a woman working full-time at minimum wage, says Guttmacher.

    Some employers want to take insurance coverage of birth control away from women because of their religious beliefs.

    Lower-income women in 19 states do not have comprehensive birth control coverage because their state refuses to expand Medicaid, and in seven of those states they have no birth control coverage whatsoever because their state does not have a family planning program.

    The Title X program - which provides birth control and other services to low-income, under-insured, and uninsured individuals - has been the target of recent cuts to funding that undermine its mission and make it impossible to meet the need for services.

    Women have reported other barriers to accessing birth control, such as running out of birth control and having problems resupplying, obtaining an appointment, or getting to a clinic.

    If a low-income woman does not have insurance coverage of abortion, she may need to raise money for the procedure, including forgoing basic necessities. Depending on how long it takes to raise the money, she may have to obtain the abortion at a later stage of pregnancy, when the procedure may be more expensive and more complicated.

    Half of the states have passed laws prohibiting women from purchasing a comprehensive private insurance plan in the health care marketplace that includes coverage of abortion.

    Restrictive state abortion laws that result in clinic closures and unnecessary hurdles, resulting in women having to travel long distances to obtain abortions. Women may have to miss work and pay for child care, travel, or lodging.

    Costs associated with birth control lead women to forego it completely, choose less effective methods, or use it inconsistently or incorrectly, increasing the risk for an unintended pregnancy.

    42% of women who have abortions are from families with income below the federal poverty line and an additional 26% from families earning less than 200% of the federal poverty line. Costs imposed on abortion or birth control due to government-imposed restrictions further entrench the economic instability of these women.

    Women denied an abortion were worse off financially one year later than women who terminated a pregnancy.

    Teens who give birth are much less likely to obtain a high school diploma than those who are not mothers until after their teen years, and few teenage mothers attend college.

    It can cost anywhere from $9000 to over $25,000 per year to raise a child. For a low-wage woman worker, this expense could put both her and her entire family's financial security at risk.

    Having a child creates both an immediate decrease in women's earnings and a long-term drop in their lifetime earning trajectory, studies show.

    Women who choose to delay having a child can invest in in education and obtain crucial early work experience. Women earn 3% more for each year of delayed childbearing.

    In a study asking women their reasons for wanting an abortion, among the primary reasons were "feeling not financially prepared" (40%), "not the right time" (36%), and "having a baby now would interfere with future opportunities" (20%). doclink

    Displaced and Disrupted: Closing the Gaps in Maternal Health in Conflicts and Crises

    December 21, 2016, New Security Beat   By: Nancy Chong

    The UN Refugee Agency estimates that the health services normally available to 65.3 million people have been disrupted by conflict. Several UN protocols note the special need for quality maternal health services in these places, including the International Conference on Population and Development Program of Action, adopted by 179 countries in 1994. Yet, according to a study by the Inter-Agency Working Group on Reproductive Health in Crises, between 2002 and 2011 conflict-affected developing countries received about 60% less official development assistance for reproductive health," even though most indicators suggest that their needs exceeded those of places not affected by conflicts.

    Syria is the largest source of displaced people. According to Massimo Diana of the UN's Population Fund, 30% of health facilities have been damaged, close to 50% of primary health care facilities are not working properly, life expectancy has dropped by 20 years, and maternal and child mortality rates have increased by one third. Diana said that while women and young girls are more likely to face sexual and gender-based violence in conflict settings, no set of clinical guidelines explain how health workers should care for survivors of sexual assaults from child marriage to rape, and program donors give low priority to family planning. Young girls have less control over whether they become pregnant in crisis settings, said Diana. "Adolescents who are married have both the lowest use of contraception in the highest levels of unmet needs."

    Conflict environments pose problems for randomized controlled peer reviewed studies. In acute and protracted conflict environments like Syria, Diana called for "fast data," that can keep pace with on-going changes and more clearly show what is needed. Mobile technology can help collect data and encourage community support for mothers and their newborns. Diana also noted that the private sector provides most services in conflict-affected settings. "We need to partner and establish a shared understanding of policies, procedures, recording, and management of pre-natal, post-natal care."

    Joy Marini of Johnson & Johnson agreed that the private sector can play a role in plugging some of the gaps. Private sector funding in conflict-affected states has increased in recent years, she said. The Sustainable Development Goals (SDGs) encourage businesses to get involved in the global development agenda, and it's important to encourage this shift to help offset the constrained resources of humanitarian organizations. But when making this case, Marini said she often faces resistance. "I am less of an expert in conflict and crises and more of an expert in being told no." She suggested appealing to businesses by noting opportunity and development, rather than risks and crises. When the Ebola epidemic broke out in West Africa in 2014, companies dropped everything they were working on to find a vaccine, said Marini. However, in conflict settings, companies have been weary of stepping in because of the perceived risk of failure and loss. Marini said that businesses should also view maternal and child health in conflict and crises as opportunities. Businesses can bring additional expertise on health service provision and a higher propensity for risk taking that may encourage innovation. "Our businesses can bring real value to these conflicts, in terms of creative ways of thinking and analyzing what can happen,” she said.

    Johnson & Johnson has already joined the Safe Birth Even Here Campaign, working to provide a full range of health services that protect women's health and rights in crisis settings. It has also worked with UNFPA to invest in emergency obstetric care and health system strengthening in Haiti and Liberia. And in Syria, it is working with Save the Children to support children's access to health care in resettlement settings. doclink

    Meeting the Sustainable Development Goals Leads to Lower World Population Growth

    July 12, 2016, IIASA - International Institute for Applied Systems Analysis

    An analysis by the International Institute for Applied Systems Analysis (IIASA) quantitatively illustrates that demography is not destiny and that policies - such as the recently agreed Sustainable Development Goals (SDGs), particularly in female education and reproductive health, can greatly contribute to reducing world population growth.

    In September 2015 the leaders of the world under the umbrella of the United Nations in New York subscribed to an ambitious set of global development goals, the Sustainable Development Goals (SDGs) which unlike earlier goals give specific targets which apply to all countries of the world. If pursued, several of these targets, particularly in the fields of health and female education will have strong direct and indirect effects on future population trends mostly working in the direction of lower population growth.

    Based on a multi-dimensional model of population dynamics that stratifies national populations by age, sex and level of education with educational fertility and mortality differentials, we translate these goals into SDG population scenarios resulting in population sizes between 8 and 9 billion in 2100.

    Today, the future of world population growth looks more uncertain than a decade ago, due to a controversial recent stall of fertility decline in a number of African countries and a controversy over how low fertility will fall below replacement level, particularly in China.

    In 2008 projections by Lutz, Sanderson, et al. gave a 95% interval for the global population ranging from 5.2 to 12.7 billion in the year 2100.

    In 2015 a different approach by the UN Population Divisiongave a much narrower 95% interval ranging from 9.5 to 13 billion in 2100.

    Another recent set of world population projections defined in the context of the work of the IPCC (Intergovernmental Panel on Climate Change) showed in the medium scenario a peaking of world population around 2070 at 9.4 billion, followed by a decline to 9 billion by the end of the century with high and low scenarios reaching 12.8 and 7.1 billion respectively (Lutz et al. 2014; O'Neill et al. 2015).

    In this paper the most relevant of these goals were translated into SDG population scenarios to quantify the likely effect of meeting these development goals on national population trajectories. This method shows the world population peaking around 2060 and reaching 8-9 billion by 2100, depending on the specific variant of the SDG scenario.

    World population growth is sometimes called the elephant in the room due to its capability to cause environmental degradation as well as in making adaptation to already unavoidable environmental change more difficult (Ehrlich & Ehrlich 1990; O'Neill et al. 2001; The Royal Society 2012).

    Population is widely perceived as a politically sensitive topic: the 1994 International Conference on Population and Development explicitly opposed the setting of "demographic targets" saying that the role of the state is to assure reproductive rights and to provide reproductive health services. It is presumably for this reason that the new SDGs do not mention population growth or fertility explicitly in any of the 169 targets.

    There is increasing evidence that education, particularly in countries in demographic transition, has a direct causal effect on lowering desired family size and empowering women to actually realize these lower fertility goals with availability of reproductive health services also helping to enhance contraceptive prevalence. Universal primary and secondary education of all young women around the world is a prominent goal in its own right (SDG 4) and is politically unproblematic.

    Lowering child mortality and decreasing adult mortality from many preventable causes of death are also politically unproblematic policy priorities. For child mortality the SDGs give precise numerical targets which could be directly translated into demographic trajectories and could be complemented through estimates of the indirect effects of better education of survival at all ages.

    The population growth trajectories that would result from the successful implementation of the SDGs will come to lie far outside the 95% uncertainty range given by the 2015 UN probabilistic population projections.

    The extrapolation model used by the UN gives all national fertility trends given equal weight, irrespective of whether they summarize the experience of just a few thousand couples or hundreds of millions of couples. In fertility, couples and not states are the relevant units of decision making and couples rather than countries should be given equal weight, which would greatly change the projection results.

    The world community under the leadership of the UN launched an unprecedented global effort to strongly accelerate global efforts in development within the framework of the SDGs. Many of these goals, if reached, will have important effects in lowering future fertility and mortality rates, particularly in the least developed countries. Leaders of all countries and the entire UN system have committed themselves to do whatever it takes to reach the specified targets. This new global effort is a discontinuity of past trends and hence cannot be captured by statistical extrapolation of past trends.

    Policies in the field of reproductive health and female education can have very significant longer term impacts on global population growth. Progress towards reaching the SDGs can result in accelerated strictly voluntary fertility declines that could result in a global peak population already around mid-century. These strong effects of the SDGs on lowering global population growth in a politically unproblematic and widely agreed way provides an additional rationale for vigorously pursuing the implementation of the SDGs. doclink

    What the US Can Learn From Ethiopia About Birth Control

    May 20, 2016, VOX Media   By: Sarah Frostenson

    Dr. Mengistu Asnake, country representative for Pathfinder International in Ethiopia, has spent 25 years working to increase contraceptive access for women in Ethiopia. Recently use of modern contraceptives has essentially tripled over a decade.

    That's because, starting in 2000, the Ethiopian government began to train and employ thousands of women to deliver effective, modern birth control straight to women's doorsteps. Consequently the fertility rate fell from an average of 6.5 children per woman in 2000 to 4.6, maternal deaths are in decline, and more women are staying in school longer.

    More women are opting for long-acting reversible contraceptives (LARCs) instead of more traditional short-term methods like birth control pills or condoms. Also the number of health centers has mushroomed from 600 to 3,500 and the health extension program now reaches every rural village in the country.

    Ethiopia's experience could prove instructive in showing what works in reducing obstacles to birth control. Access to local health care providers plays an important role in increasing knowledge around family planning while simultaneously removing barriers.

    Women in the United States have generally relied on birth control pills and condoms to prevent pregnancy. Unfortunately condoms can break, and women can forget to take the Pill at the exact same time each day. 90% of birth control pill users become pregnant annually, according to the Centers for Disease Control and Prevention.

    Long-acting, reversible contraceptives (LARCs) like implants and intrauterine devices (IUDs) fail less than 1% of the time. But they can be expensive and only 12% of contraceptive use is with a LARC method.

    In contrast, countries like Guinea-Bissau and Burkina Faso, where many people live on less than $1 a day, large percentages of contraceptive users rely on longer-acting methods of contraception.

    Inventory shortages are not uncommon, so for doctors on the ground, it's not hard to see why women would prefer longer-acting methods. Once placed, implants and IUDs last for at least three years without any action on the part of the patient.

    "They don't have to go to the clinic every month or remember to take the Pill every day," said Asnake. "It's easier."

    Implants also have the advantage of providing a convenient way to conceal from their partners their use of birth control.

    "Using contraception can be subversive for women," said Lester Coutinho, the family planning deputy director at the Bill & Melinda Gates Foundation. "Sex is not always happening within the context of volition and choice. Someone with an implant may have a partner that might not know."

    Ethiopia's health extension workers are women with a minimum of a 10th-grade education level who receive one-year training on issues such as hygiene and sanitation, disease prevention, and family health services and are then assigned to work in the community where they are from.

    Since 2005, over 34,000 women have been trained as health extension workers, and starting in 2009 health extension workers received training on how to insert implants in addition to providing pills, condoms, and injectables to community members.

    "In the past, most women had to travel long distances to the nearest clinic, maybe walking three or four hours," said Asnake. "For a woman with lots of household responsibilities, it is difficult to travel so much." But by visiting community members' homes, health extension workers are able to bridge the service gap between clinics and communities.

    Nearly 95% of all family planning needs are provided for free by the public sector.

    This initiative is truly remarkable - women are trained and paid to provide contraception to other women.

    "There is a lot of stigma against adolescents using contraceptives and about having sex," said Dr. Candace Lew, a senior technical adviser for contraception at Pathfinder International. "But like teens in the US they are going to have sex whether you give them something to protect them or not." So many of the women impacted are young teenage women, who have some of the highest rates of birth complications and maternal deaths.

    Often a young woman will ask a health provider about contraceptives but will instead get a lecture, said Dr. Aben Ngay, the country representative for Pathfinder International in the Democratic Republic of Congo (DRC). "If I give you this method, I'm promoting a loose life. I don't want young people to become loose," the provider will say.

    "Once you insert something like an IUD, you get rumors that you will get cancer or never bear a child again, or that it reduces sexual pleasure," Ngay said.

    But the prevalence rate of IUDs in Ethiopia increased from less than 1% in 2011 to 6% in 2014.

    In most of sub-Saharan Africa, condoms, pills, and injectables remain the most prevalent contraceptives because inserting the implant or the IUD requires a different skill level and facility-based care.

    When modern contraceptives are not completely subsidized by the government, implants can cost as much as $20, which is unattainable for most, as many make less than $1 a day.

    Studies have shown that increasing the types of modern contraceptive methods a country offers matters. Generally, countries that offer more types of modern contraceptives have higher overall percentages of contraceptive use. doclink

    Shanni and Chat

    March 14, 2014, Rex Taylor's Blog   By: Rex Taylor

    Note: This is from a blog by Rex Taylor and it is worth visiting the site for the pictures.

    Shanni Wreford-Smith is a force of nature. She has changed the lives of literally thousands of people living in rural Kenya.

    In the 1990s, Shanni was living, at least part of the time, with her family on Mpala Ranch, a 50,000 acre cattle ranch and wildlife conservancy in the Laikipia district of central Kenya. Her father was the ranch manager George Small. George was an American who got to Kenya only twice a year for about three weeks at a time, to "watch the elephants come through". George loved the elephants. But he also loved the people, and he tried to treat them well. Hundreds lived and worked on or near Mpala.

    Shanni is a Kenyan. She grew up with Africans, went to school with them, worked with them. One day she approached George and told him that he really had to do something about the state of health care of the people, especially the women and children, who lived on and around Mpala. Apart from the obvious human suffering, she (and George) knew that the incredibly high birth rate was going to lead to huge problems, not just for Mpala but for all of Kenya. There were never enough jobs and many people were desperately poor. In drought years, food and water were scarce and people, again especially the women and the children, went hungry. In rural areas in particular, there was pretty much a complete absence of government health care, leading to a host of problems. For instance, most children went without any immunizations, and many sickened and died from illnesses that most of us living in the West have never seen.

    There are lots of reasons for high birth rates in developing countries. A few:

    High birth rates are a function of high infant mortality rates: people have lots of kids in the hopes that some will live.

    In rural places in particular, large families are a source of labor, for instance, to look after livestock.

    Big families are a form of old age security when you are too old to work.

    High birth rates can also occur, at least in part, from a lack of available family planning resources and information. In many parts of Africa many women lack any kind of control over their reproductive health, something we take more or less for granted in the West. Girls were, and still are, frequently married off at a very tender age, often right after the onset of puberty. They are expected to have many, many children, and they do. It's not uncommon to encounter 13 year olds nursing their first child. Nor is it unusual to meet women who at 30 have had six, seven, even eight children, and are old and enfeebled well before their time.

    Early and too frequent pregnancies are not good for mothers or the children. There is less food to go around, less money for things like education. And abortion and infanticide rates, the dirty little secrets of rural Africa, jump.

    And, as George understood, more people also means more goats and sheep, overgrazing and competing with the wild animals for land. And George loved the wildlife.

    Shanni was, and remains, passionate about the issue. She explained to George that if the people of Mpala, especially the women and children, were healthier, they would have fewer kids. This had to be better for the mothers, their families, their communities, and the land.

    So George asked Shanni what should be done, and Shanni told him that Mpala should launch a mobile health clinic to travel around to the small communities and dispense health care. Shanni made the business case to George, who helped her raise the initial funds, and in 1999, the Mpala Mobile Clinic was born. Today, 15 years later, the clinic is formally called Community Health Africa Trust (CHAT) and its reach extends far beyond the range of Mpala Ranch, well into the far north of the country.

    From the get-go, the clinic has had five main "interventions":

    * Basic curative care (for example, the treatment of wounds or burns or infections)
    * Immunization of infants and children
    * HIV/AIDS testing and counseling
    * Education and counseling about female genital mutilation
    * Provision family planning including contraception

    Of these, family planning is by far the most important. Over the years, tens of thousands of women and their families have been able to access affordable reproductive health care. In 2013 alone, over 16,500 women received family planning from CHAT, and over 9,000 of them chose three to five year long term implants.

    When she started the clinic in 1999, Shanni never dreamed that it would the far-reaching impacts that it enjoys today. Because of her vision and her determination, many, many lives have been profoundly changed for the better.

    It is possible to make a difference. doclink

    How SRHR Has Become Central to Achieving the SDGs

    November 30, 2015, Devex   By: Ann Starrs

    In September the United Nations presented the Sustainable Development Goals (SDGs). Sexual and reproductive health and reproductive rights issues are now recognized explicitly as integral to achieving those goals.

    In contrast the Millennium Development Goals, adopted in 2000, completely omitted reproductive health, but not this time. The ability to decide whether and when to have children is critical for women, not only for their own health and social and economic well-being, but also that of their children, their family, and, more broadly, the community as a whole. SRHR is inextricably linked with larger development goals like reducing poverty, achieving better health and ensuring equal rights for women and girls.

    The recognition of SRHR within the SDGs is just a milestone, not the finish line. It would cost on average just $25 per reproductive-age woman - roughly double the current level of spending - to provide a complete package of essential sexual and reproductive health services to all women in developing regions each year. This includes contraceptive services, pregnancy and newborn care, services for pregnant women living with HIV, and treatment for four other sexually transmitted infections.

    Many countries have already made strides in expanding the coverage and quality of these essential services, which in turn have contributed to significant reductions in maternal, newborn and child mortality. But much more remains to be done.

    Linking people with the services they need is critical, and measuring progress is key in guiding implementation and verifying success in achieving the 17 SDG goals and 169 targets. To that end, the U.N. Statistical Commission will formally approve a global monitoring framework, including a set of indicators, for the SDGs in March 2016.

    The Guttmacher Institute has developed a list of recommended indicators relating specifically to SRHR. These indicators fall under three different SDG goals: those on health (SDG 3), education (SDG 4) and gender equality (SDG 5).

    The scope of SRHR issues the SDGs address is limited, partly because of the necessary brevity given the many issues covered by the SDGs, but also because of ongoing ideological and religious opposition to a broad-based SRHR agenda from a global coalition of conservative governments and activists. As a result, the SDG indicators are unlikely to include certain critically important elements of SRHR, including safe abortion care, nondiscrimination based on sexual orientation or gender identity, and the need for high-quality, confidential and timely sexual and reproductive health services.

    To address these likely gaps, Guttmacher has partnered with The Lancet to establish a commission on SRHR in the post-2015 world to articulate a vision, define priorities, and produce a set of SRHR recommendations on the basis of the best available evidence.

    Even though the U.S. has been the single largest donor to the developing world - for family planning and reproductive health assistance, as well as more generally - it is still not meeting its fair share of donor contributions. The U.S. government should increase its financial commitment to family planning and reproductive health abroad to at least to $1 billion annually, from the current $610 million.

    Another recommendation is that USAID (U.S. Agency for International Development) could help refine existing data collection systems, such as the demographic and health surveys, and help create a new monitoring framework that more closely reflects current priorities in the field. doclink

    Publicly Funded Family Planning Services in the United States

    Guttmacher Institute

    The typical American woman, who wants two children, spends close to three years pregnant, postpartum or trying to become pregnant, and 30 years trying to avoid pregnancy.

    50% of all pregnancies in the United States each year -- over 3m -- are unintended. By age 45, more than 50% of all American women will have experienced an unintended pregnancy, and 30% will have had an abortion.

    Of the 67 million U.S. women of reproductive age (13-44) in 2013, 38m of these women were sexually active and able to become pregnant, but were not pregnant and did not wish to become pregnant and thus they were in need of contraceptive care. 20m of these were below 250% of the federal poverty level and in need of publicly funded services and supplies or they were younger than 20 and in need of publicly funded services and supplies. 77% were low-income adults, and 23% were younger than 20. 9.8 million were non-Hispanic white, 3.6 million were non-Hispanic black and 4.9 million were Hispanic.

    The need for publicly funded services grew 17% between 2000 and 2010. With inflation is taken into account, public funding for family planning client services increased 31% from FY 1980 to FY 2010.

    Public expenditures for family planning services totaled $2.37 billion in FY 2010, with Medicaid accounting for 75%, state appropriations 12%, and Title X 10%.

    The joint federal-state Medicaid program reimburses providers for contraceptive and related services delivered to enrolled individuals. The federal government pays 90% of the cost of these services.

    Title X of the Public Health Service Act, the only federal program devoted specifically to supporting family planning services, subsidizes services for women and men who do not meet the narrow eligibility requirements for Medicaid, maintains the national network of family planning centers and sets the standards for the provision of family planning services.

    More than half of centers (57%) report that they are unable to stock certain contraceptive methods due to cost.

    The availability of long-acting reversible contraceptive methods increased significantly between 2003 and 2010. IUD provision increased from 57% to 63%, and the implant, which was unavailable in 2003, was offered by 39% of centers in 2010

    Centers with a reproductive health focus offer a greater range of contraceptive methods on site and are more likely to have protocols that help clients initiate and continue using methods, compared with those that focus on primary care

    Virtually all safety-net health centers provide pregnancy testing, and the vast majority offer STI testing (97%) and treatment (95%), HIV testing (92%) and HPV vaccinations (87%).

    More than six in 10 women who obtained care at a publicly funded center that provides contraceptive services in 2006-2010 considered the center their usual source of medical care

    In 2013, publicly funded family planning services helped women to avoid 2 million unintended pregnancies, which would have resulted in about 1 million unintended births and nearly 700,000 abortions. Without these services, the number of unintended pregnancies, unplanned births and abortions occurring in the United States would have been 60% higher.

    The services provided at publicly funded family planning visits in 2010 resulted in a net savings to the federal and state governments of $13.6 billion. The services provided at Title X-supported centers alone accounted for $7.0 billion of that total. Every $1.00 invested in publicly funded family planning services saved $7.09 in Medicaid and other public expenditures that otherwise would have been needed.

    There is much more to this report. Follow the link in the headline to read it. doclink