POVERTY: Smart family planning improves women's health and cuts poverty

Lester Brown, 14 April 2011
Smart family planning improves women's health and cuts poverty
The costs to society of not filling the family planning gap may be greater than we can afford


  China Newsphoto/Reuters
A woman in rural China inspects a condom. Slowing world population growth means ensuring that women who want to plan their families have access to family planning services. This will help to cut poverty.
When it comes to population growth, the United Nations has three primary projections. The medium projection, the one most commonly used, has world population reaching 9.2 billion by 2050. The high one reaches 10.5 billion. The low projection, which assumes that the world will quickly move below replacement-level fertility, has population peaking at 8 billion in 2042 and then declining.
If the goal is to eradicate poverty, hunger, and illiteracy, then we have little choice but to strive for the lower projection.
Slowing world population growth means ensuring that all women who want to plan their families have access to family planning information and services. Unfortunately, this is currently not the case for 215 million women, 59% of whom live in sub-Saharan Africa and the Indian subcontinent.
These women and their families represent roughly 1 billion of the earth's poorest people, for whom unintended pregnancies and unwanted births are an enormous burden.
Former US Agency for International Development (USAID) official J Joseph Speidel notes that "if you ask anthropologists who live and work with poor people at the village level … they often say that women live in fear of their next pregnancy. They just do not want to get pregnant."
The United Nations Population Fund and the Guttmacher Institute estimate that meeting the needs of these 215 million women who lack reproductive healthcare and effective contraception could each year prevent 53 million unwanted pregnancies, 24 million induced abortions, and 1.6 million infant deaths.
Along with the provision of additional condoms needed to prevent HIV and other sexually transmitted infections, a universal family planning and reproductive health programme would cost an additional $21bn in funding from industrial and developing countries.
Shifting to smaller families brings generous economic dividends. In Bangladesh, for example, analysts concluded that $62 spent by the government to prevent an unwanted birth saved $615 in expenditures on other social services. For donor countries, ensuring that men and women everywhere have access to the services they need would yield strong social returns in improved education and healthcare.
Slowing population growth brings with it what economists call the demographic bonus. When countries move quickly to smaller families, growth in the number of young dependents – those who need nurturing and educating – declines relative to the number of working adults.
At the individual level, 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, which cut its population growth in half between 1951 and 1958, was one of the first countries to benefit from the demographic bonus. South Korea and Taiwan followed, and more recently China, Thailand and Vietnam 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. Indeed, except for a few oil-rich countries, no developing country has successfully modernised without slowing population growth.
Though 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, many others did not follow this path and have been caught in the demographic trap – including Afghanistan, Ethiopia, Iraq, Nigeria, Pakistan and Yemen. (Large families are a greater financial burden on both parents and governments, and more impoverished people and societies tend to produce larger families. Thus they become "trapped" in a cycle of poverty and high fertility.)
Countries that do not succeed in reducing fertility early on face the compounding of 3% growth per year or 20-fold per century. Such rapid population growth can easily strain limited land and water resources. 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.
Put simply, the costs to society of not filling the family planning gap may be greater than we can afford.
The good news is that governments can help couples reduce family size very quickly when they commit to doing so. My colleague Janet Larsen writes that in just one decade Iran dropped its near-record population growth rate to one of the lowest in the developing world.
When Ayatollah Khomeini assumed leadership in Iran in 1979 and launched the Islamic revolution, he immediately dismantled the well-established family planning programmes and instead advocated large families. At war with Iraq between 1980 and 1988, Khomeini wanted to increase the ranks of soldiers for Islam. His goal was an army of 20 million.
Fertility levels climbed in response to his pleas, pushing Iran's annual population growth to a peak of 4.2% in the early 1980s, a level approaching the biological maximum. As this enormous growth began to burden the economy and the environment, the country's leaders realised that overcrowding, environmental degradation and unemployment were undermining Iran's future.
In 1989, the government did an about-face and restored its family planning programme. In May 1993, a national family planning law was passed. The resources of several government ministries, including education, culture and health, were mobilised to encourage smaller families.
Iran Broadcasting was given responsibility for raising awareness of population issues and of the availability of family planning services. Television was used to disseminate information on family planning throughout the country, taking advantage of the 70% of rural households with TV sets. Religious leaders were directly involved in what amounted to a crusade for smaller families.
Some 15,000 "health houses" or clinics were established to provide rural populations with health and family planning services. Iran introduced a full panoply of contraceptive measures, including the option of vasectomy – a first among Muslim countries. All forms of birth control, including the pill and sterilisation, were free of charge. Iran even became the only country to require couples to take a course on modern contraception before receiving a marriage license.
In addition to the direct healthcare interventions, Iran also launched a broad-based effort to raise female literacy, boosting it from 25% in 1970 to more than 70% in 2000. Female school enrolment increased from 60% to 90%. Women and girls with more schooling are likely to have fewer children, making their education a smart investment.
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 by half, an impressive achievement.
The bad news is that in July 2010, the Iranian president, Mahmoud Ahmadinejad, declared the country's family planning programme ungodly and announced a new pronatalist policy. The government would pay couples to have children, depositing money in each child's bank account until age 18. The effect of this new programme on Iran's population growth remains to be seen.
Nevertheless, Iran's history shows how a full-scale mobilisation of society that incorporates public outreach, access to family planning resources, and gender equality in education, can accelerate the shift to smaller families.
http://www.guardian.co.uk/global-development/2011/apr/14/smart-family-planning-reduces-poverty

MALNUTRITION: NIGER: it's still a problem

 Photo: Jaspreet Kindra/IRIN
Ayesha Yaou with her family’s evening meal

MAGARIA, 6 April 2011 (IRIN) - The evening meal will be stewed leaves tasting somewhat like spinach, which the women pick every morning, yet crops were standing tall before the leafhoppers flew into Zinder in Niger and devoured anything green. The official response to a region on the edge of survival has been slow, but then the women went to see the Prefect.
It is after 6.30 in the evening in sandy and hot Dan Gouchy Haoussa, a village about a 1,000km east of Niamey, capital of Niger, and about 20km from the border with Nigeria. Nine children - the youngest about four years old and the oldest a teenager doing his homework - sit around a pot that Salamatou, one of their two mothers, has placed on the fire.
The stewed leaves of a wild bush called leptadenia hastate will be served when the tenth child, who is queuing at the only tap in the village, returns with water. It will be the family's first meal of the day.
More than 200,000 people in the district of Magaria have been living on meals like this for almost six months, but aid agencies warn that the worst is yet to come.
The traditional lean season, when farmers run out of previously harvested stocks of staple cereals like millet and sorghum, only starts in May, said Sylvain Musafiri, humanitarian officer at the UN Office for the Coordination of Humanitarian Affairs (OCHA).
It will be some time before the rains come, new crops can be planted, then harvested, and there will be food again. Help will not be on the way anytime soon. Pleas for assistance, sent to Niamey by a variety of local authorities, have so far gone unanswered.
The national administration is in transition - a military junta-backed government makes way for an elected civilian government this week - but Musafiri said he was concerned that an adequate response by the authorities would take longer.
Mamamadou Baraze, governor of Zinder Region, where Magaria is located, told aid workers he feared the situation could get worse than the crisis in 2010 if help did not arrive in time.
How did Salamatou's family and the residents of Dan Gouchy Haoussa end up in this situation? IRIN found a chasm between the people of rural Niger and the policy-makers and implementers in Niamey, but also discovered a group of people led by women fighting enormous odds for the right to food.
There is a strong case for the incoming government to address the structural causes of food insecurity in Niger: a rapidly expanding population, lack of rural infrastructure and agricultural support to boost food production in a country increasingly affected by uncertain weather.
A recent food security conference in Niamey discussed the gap that needs to be bridged if the nation's development goals are to be achieved, but which keeps getting wider because the country constantly has to tackle emergencies.

Was it the rains?
Niger produces about four million tons of cereals, so it has to import about 20 percent of its cereal needs, 10 percent of which is brought in by traders and the remainder by aid agencies, said Prof Maxime Banoin, an agronomist.
Magaria district is a tiny green belt in the Zinder Region along Niger's border with Nigeria, where the people, mainly small-scale farmers, produce crops of millet and sorghum that account for most of the semi-arid region's cereal production when rain falls for the expected two-month period.
"In 2010, the rains were good our crops were going very well," said Abdou Gibada, the headman of Dan Gouchy Haoussa. The men in the villages constructed additional storage bins in anticipation of a bumper harvest.
When my father was alive, the produce from the land was sufficient to feed all of us [including my two wives and five children], but when he died, the small patch of land I inherited was not adequate
Banoin noted that in 2010 the country had produced five million tons of cereals, including millet, sorghum and cowpeas - more than enough for its needs until the next harvest in 2011.
Gibada holds his composure as he talks about the misfortune that struck them in August 2010, when hordes of leafhoppers (of the family cicadellidae) flew in and ate the standing crops in more than 300 villages across the district.
Nouri Habsou, the agricultural extension worker based in the neighbouring village of Dan Tchiou, had not seen crop destruction on this scale in more than 20 years of experience. "I was helpless; I had no pesticides to offer." She informed her superiors in Magaria town, who alerted Niamey.
Disbelieving authorities in the capital dismissed the calls for help. "They said this particular species of the insect, which usually attacks sorghum plants, is never known to have attacked millet," said Ahmadou Ama, head of agriculture in Magaria.
Months later, towards the end of 2010, an agriculture official turned up to make an assessment. "He was shocked by what he saw, and in subsequent investigations agriculture scientists in Niamey have offered us a possible explanation for the change in the behaviour of the insect," said Ama.
"They said the rains were unseasonably heavy, which led to a very good millet crop attracting the insects, who would have usually gone for the sorghum crops, which would normally have been standing then." The explanations made their way back to Magaria, but no aid.

 Photo: Jaspreet Kindra/IRIN
Elders of Dan Gouchy Haussa: the villagers have struggled to be heard

Ayesha Yaou and the women
In the affected villages people had already eaten the previous harvest's reserves and started crossing the border to Nigeria in search of food. In October 2010 an assessment by local authorities found that more than 15 percent had fled with their families, and the household head of almost 50 percent of families had migrated.
By December all the able-bodied men in Dan Gouchy Haoussa had gone to Nigeria. The women, children and elderly, left behind, struggled on until February 2011.
"We just could not sit and wait to die, we had to get help," said Ayesha Yaou, 33, who has seven children. She decided to organize the women.
"Each family contributed 50 CFA [about US$0.11] towards the fare to hire a taxi to Magaria [town] to make representation to the Prefect [administrative head] of Magaria district." They warned him that mass migration might be imminent.
"We were moved by the plight - we calmed the people, tried to convince them not to leave,"´ said the Prefect, Inoussa Garba. "I then managed to get some rice, maize and millet for the people, but it was not enough."
In March 2011, Garba approached UN agencies and international and national NGOs working in the neighbouring town of Zinder for help. He said Care International, the aid NGO, would begin a cash-for-work programme in a few villages in April, and the World Food Programme (WFP) intended to start blanket feeding in the area but only in May, when the traditional lean season began.
Staple grains are readily available in the markets along the road between Magaria and Zinder, but few farmers have the money to buy. Most have eaten or sold their livestock, although some still have a few goats, chickens or ducks.
The children in Magaria village were healthy because the medical NGO, Médecins Sans Frontières-Switzerland, had been treating them, said Ayesha Yaou.
Olivier Bonnet, project manager of MSF-Switzerland in Magaria, said their organization, whose mandate was to respond to emergencies, had been forced into a developmental role because of a lack of resources at the local level and was providing some free essential medicines, and training personnel at primary healthcare centres.

Returning men
Violent flare-ups linked to the upcoming elections in Nigeria forced some of the men to return at the beginning of April 2011, but they brought little or no money.
In Nigeria many saved rice or millet from their meals, or odd bits of food they received while begging. The food was dried in the sun and sent back to their families with returning Nigeriens. At home the dried food is soaked in water and cooked with the leaves.
"There is no charge for this service [carrying food]," said Zakaria Yaou, 25, who came back to his village, Kinoma, in the last week of March. "One day the carrier might need to ask me to take food for his family." He spent three months in Nigeria ferrying water in a cart, but managed to bring home only about 3,000 CFA (almost $7) for his five children and two wives.
A big family has its drawbacks - one with 12 members would need at least 1,000 CFA (about $2) worth of millet every day. "When my father was alive, the produce from the land was sufficient to feed all of us [including my two wives and five children], but when he died, the small patch of land I inherited was not adequate," said Yaou.
Sanousi Atta, a professor of agriculture who led discussions on food supply at the conference in Niamey, identified large families, which split the limited ancestral agricultural land into plots as small as two hectares, as the biggest obstacle to achieving food insecurity in Niger.
The villagers in Kinoma do not want to talk about family planning, but IRIN met a group of women from Yaouri Kaba, a village near Magaria town, who said their local primary health centre was offering information on contraception.

Next season?
Ama, the head of agriculture in Magaria, said the rainy season was approaching and they needed a supply of seeds and fertilizer as incentives to make the demoralized men stay to plant for the next season, "otherwise we will enter a cycle of endless emergency".
The UN Food and Agriculture Organization said it intended distributing seeds ahead of the rainy season, which usually starts sometime in May or June.
Fertilizers are imported into the land-locked country mainly from Nigeria. The price of a 50kg bag used for growing millet is about 13,000 CFA ($30) and the ideal amount is about 100kg per hectare, but in Niger affordability limits the average application to just 2kg per hectare.
But for now, if anyone is listening, said Garba, the Prefect of Magaria, "We need food most urgently."
http://www.irinnews.org/report.aspx?reportID=92387