For the past four decades, urbanization in Latin American and Caribbean countries has been on the rise. Today it’s one of the most urbanized regions of the world with 79 percent of the population living in towns and cities. By 2050, 9 out of 10 residents are expected to live in cities. This density and movement of people is critical to understanding the region’s water and climate change issues, says ECSP’s Roger Mark De Souza in this week’s podcast.
As Latin American cities have grown, infrastructure hasn’t necessarily kept up. There is a natural variability in access to water across the region, and inequality within urban areas in terms of access to services and infrastructure is quite high as well. Women are disproportionately impacted, as they are often responsible for fetching household water by hand. The ratio of women to men in poor households increased eight percent between 1997 and 2012. What’s more, 150 million people are expected to be added to the region by 2050, says De Souza.
Many Andean countries rely on glaciers for freshwater, and others require vast amounts of water to sustain booming agricultural industries. But by some projections, between 12 and 81 million people will face water shortages by 2020 as glacial melt and saltwater infiltration affect drinking water availability, agricultural production, and tourism.
He calls for an approach to building resilience that cuts across and addresses natural environmental factors (e.g., water sources), man-made environmental factors (infrastructure, politics), and demographic factors (gender, socioeconomic characteristics).
Migration patterns, density, and gender dynamics can provide critical insights into how water is being used, and provide helpful lenses for policies that make a sustainable impact. Conversely, analyzing how climate change is straining natural resources can help policymakers understand certain demographic repercussions that result from that stress, like political and social stability.
Countries should look to understand the broad range of source options within a water system as well as what sources can serve as alternatives if others are disrupted. Connectivity between cities and countries is also critical to building climate resilience, says De Souza, as it can help smooth out variability. “There have been attempts to think of how we could encourage water companies to share or trade water. Are there ways that we can get different groups of users to trade water allocations so that patterns of use could shift as water availability changes?”
But De Souza said all of this work must circle back to one critical theme. “Can water keep up with these population dynamics in the region?”
In May 1855, Dr. James Marion Sims opened the first obstetric fistula hospital in New York City. Just 40 years later, it closed, reflecting a sharp decline in maternal morbidity rates in the United States and other Western countries. The Waldorf Astoria Hotel now stands on the site of the former hospital. “We know that we have eradicated obstetric fistula in high income countries; it happened at the turn of the 20th century,” says Dr. Lauri Romanzi, project director of Fistula Care Plus, in this week’s podcast.
That timing is crucial, says Romanzi, because there is a narrative that argues certain social determinants must be changed to eradicate fistula in developing countries today, such as forced marriage, teen pregnancy, women’s education and suffrage, antenatal care, and gender-based violence. Yet at the turn of the 20th century in the United States and Europe, many of these “mandatory” determinants were far from modern progressive standards (teen pregnancy remains substantially higher in the United States than other industrialized nations to this day).
Speaking at a Wilson Center Maternal Health Initiative event, Romanzi says the turning point for fistula eradication in Western countries coincided with the advent of crude anesthetics, such as chloroform on cloth, which revolutionized surgical practices and made Caesarian sections more feasible for mothers. “Possibly that was a catalyst at that time, in those cultures,” she says. “We need to figure out what today’s catalyst is.”
Beyond the “Truffle Hunt”
Obstetric fistula is a childbirth injury caused by prolonged obstructed labor, often leading to incontinence, social stigmatization, infection, and even mental illness. Though fistula is almost entirely preventable and largely eradicated in high-income countries, it is stillwidespread in the developing world. Prevention and treatment is very simple says Romanzi, yet progress is moving slowly, leading some to question existing approaches.
Romanzi notes that in countries where fistula is more common, Cesarean section rateshover around 5 percent, whereas the ideal rate to prevent maternal morbidities is about 15 percent. But increasing the Cesarean section rate without regard to quality of care may cause further complications such as iatrogenic fistula, which is a form of genital fistula unintentionally caused by a health care provider. Iatrogenic fistula is often much more complicated than obstetric cases and is more likely to damage the kidneys, says Romanzi.
The “invisibility” of fistula and maternal morbidity care in general is often reflected in funding streams. A bigger budget for one West African hospital increased the number of deliveries the maternity ward could handle from 5,000 to 15,000 a year. Yet there was still only one operating theater, and poor quality of care caused many women to develop complications. “It’s an obstetric fistula factory,” says Romanzi. Patients are often funneled to a fistula clinic literally down the hill from the hospital to treat these maternal morbidities.
“Fistula has gotten a lot of attention, and deservedly so,” she says. “But there are many other morbidities as well.” Romanzi proposes implementing an obstructed labor screening program that would utilize many existing resources to address the multiple needs that obstructed labor patients have, rather than simply focusing on the “truffle hunt” of targeting fistula.
It’s important to look at the many factors that make eliminating maternal morbidities such a stubborn challenge in many places – patient to midwife ratios, midwifery education programs, waste management, water security, medical supply chains, and others, says Romanzi. She suggests focusing on localized, multi-sectoral, and self-sufficient systems that target disparities between the poor and wealthy to improve all areas of women’s health.
“The goal is that every woman, every time, has access to a facility that is outfitted and staffed to meet a minimum standard of care, within which both the health outcomes of the baby and the mother are optimized,” she says, “and that that care is rendered in a humane, kind, and caring fashion.”
“Perhaps I’m a case study for what happens in the federal government when we start on a tough problem,” says Alice Hill, the senior director for resilience policy and the National Security Council and former senior counselor to the secretary of homeland security, in this week’s podcast.
In 2009, President Obama issued an executive order requiring all agencies to conduct climate change adaptation and environmental sustainability planning. “We turned very seriously to the question, ‘should an agency like DHS even care about climate change?’” says Hill, who was also a judge before joining the government. “In 2009 that was a serious question. We did not have a definite, consensus view within the department.”
“We had the hard work of answering that question and looking at all of our mission spaces to determine that, in fact, we should care deeply,” she says. “That threat multiplier of climate change could knock aside all of the important work – or much of the important work – that we are doing.”
Once the threat was recognized, determining a plan of action proved just as difficult. “What do you do about it? How do you start really making choices that will make a difference to better prepare a nation, a fragile state, or even the United States to the impacts of climate change?” she asks. “This is new territory for many people across the federal government.”
Since 2009, Hill has moved on to the White House where she helps coordinate responses to climate change across the U.S. government. The security community has increasingly emphasized the potential risks of climate change in strategy and planning documents. Hill references the 2010 and 2015 National Security Strategies, the Quadrennial Defense Report, and the Quadrennial Homeland Security Report for example, which call climate change a “threat multiplier.”
In 2013, an executive order created a task force to engage senior officials from more than 30 agencies, as well as state and local leaders to give domestic recommendations on climate preparedness and resilience.
Seeing support for these initiatives, the international agencies signaled their desire to do more climate work abroad, says Hill, inspiring a more recent executive order that requires all new U.S. international development projects to be screened for climate risks by October 1, 2015. The White House also launched a public-private partnership with the American Red Cross, Asian Development Bank, Esri, Google, Inter-American Development Bank, Skoll Global Threats Fund, and U.K. government to pilot climate resilience projects in Colombia, Ethiopia, and Bangladesh.
Still, “when you get down to actually doing this there are still major challenges,” says Hill. Two issues are lack of routinely available data that’s useful at the local scale and experts who can translate science-based findings into policy objectives. “We simply don’t have that cadre built yet of knowledgeable people can consult and offer the advice,” she says.
Building resilience to climate change is still novel. “I don’t think there is any consensus on how to do it well,” says Hill. She cites A New Climate for Peace: Taking Action on Climate and Fragility Risks, a report commissioned by G7 foreign ministers and authored by an international consortium including the Wilson Center, as a resource that “brings together and synthesizes many of the challenges that we’ve seen.”
“If we don’t think through how we are helping a country through the climate lens – think through their fragility risks posed by climate change and by independent factors, we really are at risk for not being able to achieve our goals.”
“Compare those societies that respect women and those who don’t,” says Texas A&M Professor Valerie Hudson, quoting former USAID Deputy Administrator Donald Steinberg, in this week’s podcast. “Who’s trafficking in weapons and drugs? Who’s harboring terrorists and starting pandemics? Whose problems require U.S. troops on the ground? There’s a one to one correspondence.”
The idea that the treatment of women and girls should play a major role in U.S. security and foreign policy is explored in Hudson and Patricia Leidl’s new book, The Hillary Doctrine: Sex and American Foreign Policy. The Hillary Doctrine gets its name from then-First Lady Hillary Clinton’s 1995 speech in Beijing in which she famously declared, “human rights are women’s rights and women’s rights are human rights.” Clinton’s term as Secretary of State led to important changes at the Department of State, but the framework for looking at the world has also taken on a life of its own. As Hudson and Leidl define it, the doctrine is based on two pillars:
Hudson, who has spent the majority of her career researching the treatment of women and its effect on nation states, notes gender has appeared as a topic in U.S. foreign policy since the Nixon years. But Clinton’s rise to the role of Secretary marked a crucial moment in foreign policy where women not only became an intentional policy focus, they also played a role in shaping it, she says.
Reviews of how successful Clinton was in implementing her namesake doctrine have been mixed. Leidl, who spent years working for development organizations including UNFPA and USAID, says Clinton was successful in making gender a principal topic at the Department of State and other federal agencies, as well as creating frameworks that integrated the issue into existing work. But when it came to implementing initiatives to help women on the ground, the doctrine fell short.
In interviews with USAID employees, contractors, and other workers in the field, Leidl found that gender and women’s rights were more often viewed as a “pet rock.” “It was something that was an add-on,” says Leidl, “It was considered to be an expendable; considered to be something of an indulgence; something that was being done to please the higher-ups in Washington who didn’t actually know what they were doing.”
This was in part due to the attitudes of those who implemented the programs, including former military personnel who were not well equipped to navigate complex gender dynamics, says Leidl, as well as local contractors who were raised in patriarchal societies where the idea of gender equality and women’s empowerment was alien. Leidl and Hudson also point out that many women’s empowerment initiatives lacked concrete benchmarks, metrics, or goals, making it easy for programs to slip through the cracks.
Leidl and Hudson say Clinton’s four years at the Department of State yielded much better results for women than an alternative in which they were not considered at all. But their book concludes with recommendations for future administrations on how to further champion the rights of women and girls around the world.
“It may take a Hillary Clinton to get the ball rolling, but it’s up to everyone, including the president, vice president, the State Department, and other players, to keep the momentum up,” says Leidl.
With dangerous levels of climate change already in the pipeline, countries across the world are tasked with adapting to a drastically changing Earth. The Wilson Center and a consortium of international partners recently released an independent report commissioned by the G7 that examines the risks to stability from climate change.
In this week’s podcast, Alexander Carius, contributing author to A New Climate for Peace, offers an overview of the report, which examines “how climate impacts intertwine with structural components of fragility and conflict.”
The report is unique because it looks beyond “fragile states” to examine fragility itself and the full spectrum of societal mechanisms that feed into it, Carius says. Though A New Climate for Peace offers numerous case studies, it primarily focuses on the drivers and risks that can propel any country into fragility.
Though the report identifies seven compound climate-fragility risks, it emphasizes the cross-cutting nature of many of these vulnerabilities. Climate change is also interacting with environmental degradation, economic inequality, urbanization, population growth, and increasing resource demand. For example, Carius mentions widespread droughts and natural resource scarcity in Syria, which has destabilized livelihoods and caused widespread rural-urban migrations into cities already strained by sudden influxes of new residents. “Migration was not meant to be a centerpiece of our report because it cuts across many of the compound risks that we have identified,” says Carius.
Beneath these climate-fragility risks lies the interplay of shock and resilience. Whether it’s volatile food prices, exogenous resource shocks, or extreme weather and natural disasters, resilient societies are better equipped to “bounce back” to normality after these shocks, whereas fragile countries may be crippled and permanently set back in terms of human development, security, or stability.
However, interventions to bolster resilience must also be carefully scrutinized, says Carius. “Emergency responses, if they are well designed, can help to overcome existing political and ethnic conflicts, but ill-designed rehabilitation measures can deepen inequality and contribute to social unrest.” He mentions several examples of well-intentioned climate policies gone astray, sometimes exacerbating the problems they are attempting to alleviate.
Carius calls for humanitarian aid to be “climate-proofed” by integrating across silos, like health care or poverty reduction. Likewise he suggested finding ways to better coordinate humanitarian relief with long-term development efforts, climate change adaptation, and peacebuilding. The report shows that there is still much progress to be made in this area. “Both domestically and internationally, we are far away from breaking down the sectoral barriers and silos that exist,” says Carius.
A New Climate for Peace underscores the need to bring these sectors together by placing a cross-cutting goal – resilience – at the forefront of the global agenda. By strengthening institutions, countries and communities will be better prepared for the increased variability and risk that comes from living in a changing world.
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Sources: IPCC, A New Climate for Peace.
The stakes are high for the UN climate conference in Paris later this year, so high in fact, some scholars feel it’s foolish to be putting all our eggs in one basket.
“Let’s face up to calling climate change an issue of human survival,” says Ruth Greenspan Bell, public policy scholar at the Wilson Center, in this week’s podcast. “Warming to this level changes everything…there really is no precedent in human history of what we’re going through right now.”
She and a number of other scholars have been pushing for more creative ways to address the risks at hand than relying on the UN Framework Convention on Climate Change (UNFCCC) process. “Climate has been stuck in what I call the environmental ghetto,” says Bell. “It’s consigned to an environmental stovepipe.”
The tendency to view climate change in isolation impedes cross-cutting policy responses. “Climate change will continue to make every other issue more difficult – disease, food security, poverty, conflict, and our own security and safety,” says Bell. She points to Syria as an example of climate change’s “threat multiplier” effect. “A persistent drought devastated the farm community in the northeast part of the country – more than 1 million people were affected since 2008,” she says. “Lots of these people were forced to move into urban slums, the government didn’t do much for these people, [and] they became angry and defected.”
Despite these complexities, global climate governance operates around “one big solution” based on consensus. “No rational person would put her entire retirement savings into a single stock but that’s what we’re doing betting on the UNFCCC process,” says Bell. Rather than focus on a single, comprehensive treaty, she suggests policymakers should build momentum by coming to agreement on small things first through bilateral agreements and small coalitions. She likens this approach to weapons negotiations during the Cold War, where “progress was made when issues were broken out and resolved, even when particular agreements didn’t solve everything.”
“Do we really need 196 parties to deal with [the] issue?” asks Bell. The greatest emitters can make headway in separate negotiations. The U.S.-China agreement reached last fall that puts both countries on track to cap their emissions is an example that should be repeated, she says.
“I actually think that breaking things out and starting to see more opportunities is the direction we are going,” says Bell. “We must align the political tools with the problems, we must consider climate change as the threat multiplier that it is, and we must engage the best people and give climate the attention it deserves.”
By Linnea Bennett
After Typhoon Haiyan ripped across the Philippines in 2014 leveling nearly every building in site, 4 million people – mostly poor and from coastal regions – were displaced. In response, the government set up “no build” zones in vulnerable areas and worked to move people to new land. But many of the newly relocated people discovered this land came with no access to water, electricity, or other services.
“There’s a hasty effort to get people out of tents and move them somewhere else, but it’s done in a way that creates more vulnerabilities and undermines human rights,” says Alice Thomas, manager of the Climate Displacement Program at Refugees International, in this week’s podcast. “It’s probably one of the most profound human right impacts of climate change, and one for which there is currently no solution.”
Loss of Identity
“It’s been widely recognized by the Human Rights Council, by governments, by human rights experts, that climate change will directly and indirectly undermine the realization and enjoyment of a wide range of human rights,” says Thomas.
Flooding, for example, can impact disease rates, while drought can affect food security, and major storms threaten housing and infrastructure. Meanwhile, warming temperatures are melting glaciers and decreasing snow pack, upon which one sixth of the world’s population relies on for fresh water.
Climate change also threatens people’s right to self-determination, says Thomas. This is particularly relevant to low-lying islands, some of which are facing the prospect of complete inundation. Much of the international community has moved away from discussions about helping communities adapt and is instead focusing on relocation efforts. But Thomas argues that relocation deprives islanders of their right to self-determination as they are stripped of their homes and, subsequently, their identity.
A Different Model?
To understand how climate change affects marginalized and already vulnerable groups more intensely, consider fragile and conflict-affected states, says Thomas. Somalia experienced an intense drought in 2011, causing a famine that killed a quarter of a million people and displaced another million, many of which fled to other countries. When refugees tried to return afterwards, they found the country’s other vulnerabilities, such as poor governance and decades of civil conflict, had been exacerbated, making it dangerous or impossible to come home. “The lack of a functioning government meant that, unlike California, there was no one to help these people when they needed water and food,” says Thomas.
Because climate change is experienced in conjunction with other challenges, like poor governance, poverty, and insecurity, it can’t be addressed in isolation. Thomas says breaking down silos in the funding community could be a more effective approach. By pooling resources for disaster risk reduction, humanitarian relief, and development, governments and relief organizations could help people prepare and adapt to climate change while respecting their rights.
But barriers persist. Only one percent of overseas development aid is dedicated to disaster risk management, Thomas says. The third international Financing for Development conference in July represents an opportunity for governments and donors to change this. “I urge development and humanitarian and [disaster risk reduction] funders to look for opportunities to channel this funding in a way that promotes rights,” she says.
“The Sahel faces huge problems,” says Jack Goldstone, Virginia E. and John T. Hazel professor of public policy at George Mason University and Wilson Center global fellow, in this week’s podcast. “It is facing massive population growth. It is facing environmental decay. It has a history of violent conflict.”
In the coming decades, Africa will have the only growing working age population in the world, says Goldstone. “The education, the socialization, the stability of young people in this region of the world is going to be, I think, the dominant issue for conflicts in the years ahead.”
As governments struggle to meet the needs of growing populations, young people and marginalized groups have become vulnerable to recruitment by extremists. In states already experiencing conflict or displacement, youth populations can be an even greater source of frustration as their potential is capped by limited livelihood options and their schooling is often cut short.
Effective governance can overcome these challenges through investments in education and health that allow fertility rates to decline and empower young people, giving them productive pathways to integrate with society. “As young people grow up feeling more in control of their own destinies,” Goldstone says, “they are more likely to turn to constructive group activities and less likely to be drawn to deviant or extremist movements out of anger and frustration.”
Goldstone says education, health, and security policies must be viewed as part of a holistic process. Improving secondary education requires many steps, including raising incomes so families can afford it, investing in tertiary schools to train teachers, and creating administrations that can secure and coordinate school supplies. Conflict undermines development as women and children are unable to attend health clinics and school for fear of violence. Likewise, displaced children “do not get the same educational progress that children do who grow up in their own home.”
“Population growth, education, and security are all deeply intertwined,” says Goldstone. “The cycle of stopping conflict requires a combination of investment not only in education and contraception but also in building governments that are inclusive, effective, and legitimate.”
“If people come to trust the state and public institutions, they have less need to work through private networks to get around the state or to protect their group at the expense of others.”
Jack Goldstone spoke at the Wilson Center on May 12.
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Rapid population growth, which many Sahelian countries are experiencing, is often associated with an increased risk of sociopolitical violence. But in this week’s podcast, Cornell University Professor Parfait Eloundou-Enyegue argues there is another factor related to demographic change that governments and development organizations should account for: inequality.
It’s not so much overall inequality rates that are important in this context, he says, but comparisons between peers. The richest among African youth often live very different lives than the rest of their generational compatriots. Things like how likely parents are to invest in their children, how much they have to invest, and family size vary greatly, creating different opportunities which can have life-long repercussions. “Class differences and demographic behavior translate into inequality among children, and these inequalities work their way up through adulthood,” Eloundou-Enyegue says.
“If you look at sub-Saharan Africa in particular, including the Sahel region, you find many countries in Africa have higher levels of inequality than the U.S. at a time when the U.S. was at its own historical high,” says Eloundou-Enyegue. “That’s quite impressive.” What’s more, there seems to be a connection between inequality and demographic change. When comparing countries within the Sahel, he points out that inequality, measured in a variety of ways, is higher among countries where women on average have less than six children apiece than those where they have more.
This suggests countries are experiencing an “uneven demographic dividend,” as he calls it, which may lead to violence as inequality follows young people from childhood to adolescence, especially when young people seek work for the first time. “It’s especially at the nexus of this transition from school to work that it can actually trigger violence,” Eloundou-Enyegue says. “Young adults are going to remain unemployed after they leave school and that is one of the contributors, in my estimation, to violence.” Recruitment for Boko Haram in Nigeria, which has some of the highest regional levels of inequality in the region, has been linked to unemployment and disillusionment among young men, for example.
To fight inequality among youth, Eloundou-Enyegue proposes an emphasis on job training and employment opportunities to help level the playing field. But he adds it won’t be as simple as “just getting a job,” as a push towards civic engagement and behavior change will also be important to change things like family size and propensity to invest in children that lead to such inequalities in the first place.
In the Sahel, one of the most food-stressed regions of the world, “women bear the brunt in terms of coping mechanisms that are employed at the community level,” says Sylvia Cabus, gender advisor for USAID’s Bureau for Food Security, in this week’s podcast.
Women are the traditional guardians of family health and nutrition. But because of this responsibility, they often reduce their own food intake and make unimaginable sacrifices, including selling personal assets and even engaging in sexual bartering to pay for food. They may also take their children out of school or encourage early marriages in order to reduce household size and receive an injection of assets from bridal dowries.
“We are operating in a context of scarcity,” says Cabus, as rapid population growth stresses resources and the region has borne several major droughts.
The most common coping mechanism among males – to migrate in search of work – may actually hurt households as “the flow of remittances is often irregular or nonexistent,” says Cabus. World Bank data shows that sub-Saharan Africa (including Sahel countries) receives the lowest amount of remittances worldwide, while being the costliest region from which to send them. Male out-migration also puts women in a difficult position as they frequently become the de facto heads of household without the same rights to own property and manage resources that men have.
It’s a “very patriarchal culture where women and girls have low status” and “very limited decision-making,” Cabus says. Of the 10 worst countries to be a mother or a child, four – Mali, Niger, The Gambia, and Chad – are located in the Sahel, according to Save the Children’s latest State of the World’s Mothers report.
Still, Cabus maintains a positive attitude. “The Sahel is a very lucky region in the sense that it’s been studied and over-studied over decades now,” she says. But “it’s important to ask the right questions.” In one instance, a USAID program in Mali distributed an improved type of millet seed. When asked for feedback, women said the new millet took significantly longer to cook. At the household level, this simple change can mean a lot. More time over the fire means more firewood and more exposure to smoke. It also means higher costs for fuel and more time spent by women and girls traveling to further places for fuel, which can be dangerous.
New development strategies to diversify rural economies are working to create new livelihood pathways for women. For example, Cabus and her USAID team visited a group of women in Burkina Faso who saw a niche market for parsley and began growing it their rural community to sell in the capital, Ouagadougou. And men can help too. In Niger, the UN Population Fund began “Ecole des Maris,” or “husband’s schools,” that bring together groups of men to discuss reproductive health matters and promote the empowerment of women at the community level.
In the Sahel, as elsewhere, the status of women, their health, and household food security are deeply intertwined. “We know that agricultural production is highly gendered,” says Cabus. “We help farmers…and their husbands.”