“It's not about counting how many times a mother interacts with antenatal services or comes to the facility,” says Dr. Mariam Claeson, the director of maternal newborn and child health at the Bill and Melinda Gates Foundation, in this week’s podcast. “But it's what happens in these encounters that matters.”
One month after the United Nations adopted the Sustainable Development Goals (SDGs), Claeson and her colleagues in the maternal health community met in Mexico City at the 2015 Global Maternal and Newborn Health Conference. The conference marked the first opportunity for health and development advocates to take stock of the successes and failures of the Millennium Development Goals and discuss a common strategy for implementing the maternal health targets of the SDGs.
Improving and measuring quality of care, and not only quantity, was a major focus. For Claeson, such a “woman-centered” approach is best achieved with an integrative model of care – one that combines primary care, family planning services, reproductive health, and other entry points into the health system so women do not need to go to separate facilities for each. “We know,” she says, “that there is a very strong evidence base for why one should do integrative care, integrative measurement, and quality delivery.”
Since Mexico City, Claeson says that global partners have been gearing up “to think more systematically about quality across the continuum” as well as a “systems approach to quality and countries wanting to make that part of their broader national quality movement.”
“This is the first time,” Claeson continues, “we have countries committed to actually reducing...maternal and newborn mortality in the SDGs.” And, she says, thanks to Every Woman Every Child, a roadmap created by UN Secretary-General Ban Ki-moon in 2010, “we have targets to monitor progress.”
In a month, many in the global maternal health community will descend on Copenhagen for Women Deliver 2016. The conference is a chance to further capitalize on momentum around the integrative model laid out in Mexico City.
Yet, Claeson warns that staying focused on women, girls, mothers, and newborns will require a larger effort. “It's not just the business of the health sector,” she says, “but how do we get other sectors to also stay focused when we talk about women and girls?”
Dr. Mariam Claeson spoke at the Wilson Center on April 13, 2016.
“Zika has made a long-standing public health crisis impossible to ignore,” says Chloë Cooney, director of global advocacy at the Planned Parenthood Federation of America, in this week’s podcast.
Latin America is home to some of the most restrictive abortion laws; nearly 95 percent of the procedures are unsafe, Cooney says. Additionally, “there's an estimated 23 million women who have an unmet need for contraception.” Zika, primarily spread through the bite of an infected mosquito, “demonstrates the critical need of government support for sexual and reproductive health care.” These issues are not new, she says, “but Zika makes the impact of them so much greater.”
The outbreak of the virus in Latin America and the Caribbean in 2015 has put women in the spotlight, as some governments urge them to avoid pregnancy. National level maternal and reproductive health indicators in the region are not as bad some places in the world, but mask deep inequalities. “Women with the least ability to plan their families, with the least access to health care,” Cooney says, “generally will feel the impact of this outbreak the most.”
Addressing the needs of vulnerable populations, especially women, is fresh on the minds of those in the global health community tasked with achieving the newly minted Sustainable Development Goals (SDGs). “The SDGs call on us to address inequities in development both across countries but also within countries,” says Cooney. “And I think that's so critical to Zika as we've been talking about where poor women face such a deep unmet need for sexual and reproductive health and rights.”
The virus continues to spread, and a study recently confirmed its link to microcephaly and other severe birth defects. The way countries in Latin America and North America respond in the coming months will be crucial. Family planning, Cooney says, should be a critical element.
“The U.S. response must include family planning and reproductive health,” Cooney argues, “along with maternal and child health support and attention to supporting families with children with microcephaly.”
The ability to decide if and when to have children is a basic human right, she says – “and yet it's not realized for so many women across the region, which this outbreak is making so crystal clear.”
Chloë Cooney spoke at the Wilson Center on April 12, 2016.
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Since its inception more than 60 years ago, USAID’s Office of Food for Peace has provided critical food assistance to billions of people around the world. Yet, despite its name, the office lacked an institutional strategy to address the effects of conflict on its work.
“Our last strategy, 10 years ago, noted the importance of addressing conflict shocks,” says Joan Whelan, a senior policy and learning officer at the office, on this week’s podcast. But “we struggled with how to integrate conflict into our framework. We are food security actors...We speak in a language of food security.”
Food for Peace’s funding reflects its core priorities. “The vast majority of our budgets,” according to Whelan, “are spent on meeting immediate, life-saving food nutrition needs of vulnerable populations in the midst of conflicts, natural disasters, other complex emergencies.”
“But,” says Whelan, “we also allocate approximately $400 million per year to longer-term resilience programs.” After a series of discussions with partners, both external and within USAID such as the Office of Conflict Management and Mitigation, a breakthrough began to emerge around this stream of funding and its potential to address conflict.
Food security – not peacebuilding – remains the program’s primary objective, according to Whelan. But a new framework allows Food for Peace to address issues that indirectly affect food security, including conflict prevention, livelihoods, financial inclusion, disaster risk-reduction, natural resource management, climate change adaptation, and more.
“Our new strategy is very resilience-focused,” says Whelan, which “means that we are carrying out work in ways that address food security risks that strengthen resilience capacities and create transformative opportunities.”
The strategy, she says, “gives us a space within our own universe to address conflict sensitivity and make sure that it's integrated into our work in ways that strengthen our ability to address conflict risk, that help to strengthen connectors in society, and reduce the dividers.”
Joan Whelan spoke at the Wilson Center on March 8, 2016.
Climate change is impacting the U.S. military in two major ways, explains Sharon Burke in this week’s podcast.
Burke, who served as the first assistant secretary of defense for operational energy from 2010 to 2014 and is now with the New America Foundation, says the Department of Defense has done a lot to consider how changing climate conditions will affect their equipment and facilities, but also their operations.
“The Department of Defense is a very large land owner in the U.S. and around the world,” Burke says. Facilities in arid climates such as those found in the Mojave Desert and the White Sands Missile Range in New Mexico are already seeing a variety of climate effects, including higher temperatures and drier conditions making it harder to train.
The military has also changed building codes, she says, “so that if you want to build new military construction, you have to take climate change into consideration.”
Beyond equipment and infrastructure, the other important way the U.S. military is adjusting to climate change is by planning for new missions. The Pentagon expects to be called on for more humanitarian and disaster relief operations; there may be new partnerships with allies to help their forces prepare; and new environments to deploy in.
The Arctic is a symbol of the military’s concerns, Burke says. The region is warming faster than anywhere else on Earth, opening up new sea lanes and access to resources, and prompting Russia to make territorial claims. “It’s an operating environment, it's facilities and equipment, it's also missions, it's also geopolitics, and a geo-strategic interest,” she says. The region “engages every interest they have and they take it very seriously.”
The Quadrennial Defense Review, the military’s signature strategic document, calls climate change a “threat multiplier,” reflecting this concern. But where there’s room for growth is in this priority trickling down the chain of command.
“There's been a high level commitment on the issue,” says Burke, “but then if you look at how are they actually incorporating it and how they plan for the future, I think there's a lot of room to travel there.”
Sharon Burke spoke at the Society of Environmental Journalists 2015 Conference on October 9, 2015.
“Migration is a risk management strategy,” says Susan Martin, the Donald G. Herzberg professor of international migration at Georgetown University’s School of Foreign Service, in this week’s podcast. “It's a way people have coped for millennia when the environment changes.” But climate change is forcing a new calculus on many households and communities who face a dynamic mix of economic, political, demographic, and environmental pressures.
“‘Migration’ can be a very positive thing for people,” says Martin, whereas “‘displacement’ may be positive in being lifesaving but not necessarily positive in terms of people's future wellbeing.”
Martin sees the dichotomy between migration and displacement through a series of climate-induced shifts in mobility patterns.
“Drought and rising sea levels are likely to lead to gradual movements of people,” she says. In fact, people manage these kinds of risks with anticipatory migration as environmental conditions decline. Often some family members “will stay and try to keep farming despite the drought,” while others “will move to cities or move to other countries in order to be able to diversify the sources of livelihood and sources of support for the family.”
Acute natural disasters and competition over dwindling resources “will more likely lead to emergency displacement,” Martin says, and it is during these events where community resilience and vulnerability play out in critical ways.
At-risk and vulnerable groups who cannot adapt as quickly will lose out on the positive aspects of migration as an adaptation strategy. “Research is showing only those with existing resilience possibilities and lesser levels of vulnerability are likely to benefit from even anticipatory migration,” Martin says.
Government policies have a part to play in building resilience – or, conversely, exacerbating vulnerabilities. National governments have been slow to adopt legal frameworks that address these issues. “If there are no legal ways you can move,” Martin says, “whether it's internal or international, the chances are people are going to be at significantly higher risk.”
Susan Martin spoke at a private event at the Wilson Center on August 31, 2015.
When it comes to climate change and environmental change, “policies and laws can have a very productive contribution toward positive adaptation, or they can subvert that and constrain options,” says Jon Unruh, associate professor of human geography and international development at McGill University, in this week’s podcast.
Access to resources can be governed by many different kinds of systems. From statutory law to customary rights, and religious tenets to rule of the gun, they can be “fluid, chaotic, or very much defined,” says Unruh.
Understanding variations in resource governance is critical to understanding migration, in particular. As people exercise migration as an adaptation option, they change the way resources are used, he says. Strong examples of what works to peacefully facilitate such movement, and the freedom to experiment in response, are what local institutions need most to reduce the possibility of negative outcomes, such as conflict.
In arguing the benefits of flexible, local institutional capacity, Unruh highlighted the conflict in Darfur, where the Sudanese central government did away with local land administration and made resource conflicts “unnegotiable.”
Droughts over the last 40 years have led to major movements of people in western Sudan and eastern Chad. “What we've seen in the decades coming up to the war is that the institutional relationship between the nomads, the migrants, and those that received them was able to adapt, and absorb, and adjust rights to resources for both groups to accommodate the incoming migrants,” says Unruh. “By and large, the local institutions were able to handle this form of adaptation.”
But the Khartoum government, seeking in part to weaken local independence movements, undermined these Darfuri institutions and tried to replace them with appointed officials. The response was a “clumsy, non-elastic, predictable” set of statutory laws “in an adaptation scenario where you needed quick thinking, elasticity in rights.”
Even if the state has “very well-intentioned laws and institutions,” Unruh explains, “generally, they move too slow for what goes on on the ground.” Migrants and host communities are negotiating access to resources at the local level. Support for flexible, local-level innovation and experimentation is therefore more useful in preventing the worst results, like the violence that erupted in Darfur, than rigid top-down national policies.
Jon Unruh spoke at a private event at the Wilson Center on August 31, 2015.
“There is more to education than the picture that you typically see in most reports,” says Parfait Eloundou-Enyegue, professor of development sociology at Cornell University, in this week’s podcast. “And this picture comes from looking at education not as an outcome but as an institution.”
Eloundou-Enyegue describes education as a potent force for development among countries poised to enter the demographic transition. Taking advantage of that transition – when fertility growth declines and the proportion of very young “dependents” shrinks in comparison to the working age population – can result in a “demographic dividend” where successive cohorts of the population move through their most economically productive years. Yet, the benefits of this dividend are not a given.
We ought not to view the demographic transition simply as a change in family size, Eloundou-Enyegue explains, but rather as a social transformation in three institutions of family, education, and work. “The challenge, as we document fertility transition,” he continued, “is to see how all these institutions evolve together to see the new economic opportunities that arise in that process, and to see how schools can capitalize on these opportunities.”
Creating enough jobs to meet the demands of an exploding workforce is especially difficult for many countries. More closely tailoring primary school education for marketable skills, as well as transformations in the expectations of parents with more focus on the quality of education, could make education more valuable and create new jobs.
Eloundou-Enyegue believes this broader understanding of education as an institution could help countries on the cusp of the demographic transition better leverage the economic benefits of their young populations.
Parfait Eloundou-Enyegue spoke at the Wilson Center on December 8.
"It has always surprised me actually how powerful this ‘demographic dividend’ framework seems to be,” says Ellen Starbird, director of USAID’s Office of Population and Reproductive Health, in this week’s podcast. But “for a lot of countries it's a long way off.”
When fertility levels decline quickly in fast-growing countries, the age structure changes and for a time, there is a disproportionate number of working aged people compared to dependents. Many countries have seen a boost in economic productivity during this period, a phenomenon known as the demographic dividend.
“This concept brings ministers of finance to the table; it brings ministers of health, ministers of education. It garners all of their interests,” Starbird says. The allure of the concept is in part because it is so broad. “It is integrated. It is a narrative framework. It has concepts of equity and universality built into it,” Starbird explains. But, most of all, “I think a lot of what brings everybody to the table are the benefits for society at large that you see from this, and many of those are economic.”
Fully reaping the benefits, however, requires a concerted and comprehensive effort – demographic changes are not enough on their own.
Starbird says empowering the current generation of young people, upon which future dividends rely, is a start. This includes strengthening access to family planning commodities and knowledge about reproductive health care. There are 225 million women who say they want to space or limit childbearing but are not using contraception, she explains. Investments in education, labor markets, and a social safety net are also needed to create a supportive environment. “Education systems,” Starbird explains, “have to be oriented toward the set of skills in the labor market in that country, and the labor market in the world, for this to lead to the kind of demographic dividend and growth we want.”
The policy work to prepare for the demographic dividend could be laid in many countries in sub-Saharan Africa, the Middle East, and South Asia within a generation. Yet, Starbird explains, “there's a lot of things that have to be gotten right for this to produce a demographic dividend in the end.”
Ellen Starbird spoke at the Wilson Center on December 8.
“The good news is clean energy has gotten much cheaper,” says Ethan Zindler, head of the Americas for Bloomberg New Energy Finance, on this week’s podcast. “The amount of stuff getting built for the same number of dollars has been going up. You’re getting more ‘bang for your buck’ when it comes to actual deployment.”
Speaking at the Wilson Center’s day-long conference on renewable energy in the developing world, Zindler shared insights from Bloomberg’s annual Climatescope report, which scores 55 countries in the developing world on their receptiveness to private clean energy finance. The report and online portal is an “effort to provide actionable data for those trying to make strategic decisions about where to build clean energy,” he says, “and how to craft policies that are related to clean energy.”
One of the big stories gleaned from the 2015 Climatescope is China’s staggering growth and innovation in renewable technologies over the last six years. China has been a major driver in lowering the price of solar by more than 80 percent, Zindler explains. “Of the 50 gigawatts of clean energy capacity built in 2014, about 35 gigawatts was in China.”
Yet, if China’s growth is set aside, the trend line shows lower local prices for clean energy around the globe. For Zindler, this means opportunities for investments in emerging markets such as Latin America and sub-Saharan Africa will continue to grow. “The private sector sees the opportunity to earn returns because it’s economically competitive at this point.”
Ethan Zindler spoke at the Wilson Center on October 27, 2015.
"In my view, we are 40 years into a 100-year transition to a clean energy economy," says Mike Eckhart, global head of environmental finance and sustainability at Citigroup, in this week’s podcast. “We're in the mainstream of building an industry."
Speaking at the Wilson Center’s day-long conference on renewable energy in the developing world, Eckhart outlined changes in technology, market structure, policy, and financial markets that amount to “four big waves of innovation” fueling the advancement of the renewable sector. Technological innovation may be the most apparent of the big waves, Eckhart says, helping to bring prices down, but “we’ve had great policy innovation in the renewable portfolio standards, the investment tax credit, and the production tax credit.”
Innovating “with intention” as Eckhart describes, is partly what fueled these waves of advancement. In terms of financing, one of the most successful ideas was separating high risk development phase projects from low risk operating assets, thus “optimizing investment products” and attracting more sophisticated private sector buy-in for renewable markets.
Eckhart says there are ways to tailor financing and market structure to expand renewable energy generation in the developing world. Yet, failure to acknowledge and tackle climate change can stall success. "I have never seen a country really move ahead on renewable energy,” says Eckhart, “until after it has made a full-blown commitment to address climate change.”
On the heels of the historic COP-21 treaty, this critical connection was echoed by President Obama in his address this week, in which he announced a budget that doubles funding for clean energy research and development by 2020. “Investors and business leaders including Bill Gates, Meg Whitman, and Mark Zuckerberg joined us,” Obama remarked, “pledging their own money to help advance new technologies to the market.”
Mike Eckhart spoke at the Wilson Center on October 27, 2015.