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Friday Podcasts From ECSP and MHI
At the nexus of global environmental change, security, development, and health
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March 16, 2017 01:47 PM PDT

Does global water stress matter for U.S. national security, and if so, how? That’s a major focus of the next CNA Military Advisory report, says Julia McQuaid of the CNA Corporation in this week's podcast. She talks about the preliminary findings of the report and how the national security community views water.

Understandably, the primary focus of much of the U.S. national security apparatus has been terrorist organizations like ISIS and Al Qaeda. “Most of these groups and these threats are operating in areas where there is deep instability and/or are hot conflict zones,” says McQuaid. “Incidentally many of them are also experiencing the conditions of water stress.” The correlation has made water a natural point of interest.

But while there is an implicit sense that water stress and conflict are connected, there is little comprehensive research that defines and articulates the link. Speculative work predicting “water wars” that do not come to pass has led many in the military to question, “when the rubber hits the road, how do these conditions lead to conflict?” says McQuaid, who has worked closely with Pentagon personnel in her time at CNA.

She explained that the conflicts predominant in the Middle East and North Africa – insurgencies, civil wars, and terrorism – are always the result of multiple factors. “Many involve governments and non-state actors competing or vying for the support and acquiescence of population, and/or they’re trying to control physical territory. And in most cases, the entities opposing the groups are trying to overthrow the government and replace it ultimately. That’s the end goal.” No single factor can be isolated as the source of conflict in these cases, including water.

Should water be considered among the most important factors, however? “The answer is a resounding, yes,” McQuaid says. “Our research shows that it is a factor, and that as water stress gets worse, as it’s projected to do, it will likely play an increasing role as a factor in instability and conflict.”

“We know it’s not a straight line,” she says. “What water stress conditions can do and tend to do is to act as an additional stressor or multiplier on top of preexisting challenges that in many cases are also not being addressed.” She points to Northern Nigeria and Libya as regions where longstanding issues of corruption, lack of economic opportunity, and migration have combined with water problems in dangerous ways.

Migration in particular has complex and compounding effects of its own. McQuaid explains that when people move, they usually move to areas already occupied, which can lead to economic stress and resource shortages if not well managed. “The migration in and of itself isn’t a problem, but it triggers the second and third order affects that can be and often are.”

Good government can mitigate these stresses and help solve grievances before they become violent; overwhelmed or bad governments can make things worse. “It can be an issue of political will in areas that don’t matter to central governments…and also it can be a resource and capacity issue where they know it’s happening but they simply don’t have the tools, the technology, the know-how to respond.”

Early warning systems and analytical tools could help to a certain degree, says McQuaid. The difficult question for the military though is what does a warfighting organization do about water stress?

“Killing bad guys and working with partners to kill bad guys will only get us so far in this fight,” she tells the Wilson Center’s Sherri Goodman. “At some point we’re going to have to find effective measures to deal with these underlying things that are contributing to the types of environments that are allowing these types of groups to take hold.”

Julia McQuaid spoke at the Wilson Center on March 1, 2017.

Friday Podcasts are also available for download on iTunes and Google Play.

March 09, 2017 01:44 PM PST

Unintended consequences from climate interventions are often the result of not understanding decision-making at a granular enough level, says Ed Carr this week’s “Backdraft” episode.

How people construct their identities and their perception of how the world works can make or break an intervention, says Carr, professor and director of the Humanitarian Response and Development Lab at Clark University and former AAAS policy fellow at the U.S. Agency for International Development.

“That sounds all fuzzy and soft, but if you don’t have that information you really can’t understand how people are making decisions, and if you don’t understand how they’re making decisions…and who gets to make the decisions…you have no idea how the interventions are interacting with that.”

For example, in research conducted for USAID in southern Mali, Carr found that climate-smart agriculture projects could have unforeseen effects on gender dynamics. Farming staple grains is largely considered the responsibility of men in the region, so a project focused on increasing yields among these crops could widen income gaps between men and women. Conversely, if the project took steps to promote production by female farmers, it could undermine men’s status and cultural identities in a significant way, potentially leading to increased rates of domestic violence.

Carr stressed the importance of ethnographic research to help policymakers understand differences in context from place to place that could affect results.

How projects are monitored and evaluated, or “M&E” in development parlance, can also hide inadvertent consequences. “What gets measured gets managed,” says Carr. If a climate project has a significant impact that was unintended, it may not get recorded or addressed because the M&E plan was written to look for specific results only. The opportunity to build on or mitigate unexpected results – good or bad – is lost in such an inflexible system.

These challenges are not unique to climate responses, but symptoms of how development is carried out generally, Carr says, often in a targeted manner, sector by sector. “Sectoral development focuses on particular issues as if they’re not parts of complex systems, and as a result it narrows our monitoring and evaluation, it narrows our understanding of the world, it narrows our understanding of the problems we’re addressing.”

Carr stresses the need for more flexibility generally. “We need innovative contract and funding mechanisms for work that allow people to pivot really hard when we learn something new or when a project starts doing something bad or good that we didn’t expect.”

He admits there are challenges to scaling up the kind of household and sub-household research he and colleagues have been doing in West Africa, but says they are working on it. It might be possible to bring lessons learned from their experience to other ethnically and “agro-ecologically” similar communities, he says.

“We, the qualitative research community [and] interpretive social science community, have not worked as much to think about generalization and how to get to generalization as we could have, so I’m actually excited to try and do that.”

The “Backdraft” podcast series is hosted and co-produced by Lauren Herzer Risi and Sean Peoples, a freelance multimedia producer based in Washington, DC.

Friday Podcasts are also available for download on iTunes and Google Play.

March 02, 2017 12:05 PM PST

Experts predict that climate change will spur some people to leave their homes and countries. How will national security be affected as a result?

In this week’s podcast, ECSP’s Roger-Mark De Souza leads a Ground Truth Briefing at the Wilson Center on this question. De Souza was joined by Maxine Burkett, a Wilson Center global fellow and associate professor of law at the University of Hawaii at Mānoa; Joseph Cassidy, a Wilson Center fellow and former director for policy, regional, and functional organizations at the U.S. Department of State; and Sherri Goodman, a Wilson Center fellow and former deputy undersecretary of defense for environmental security at the U.S. Department of Defense.

One of the fundamental problems when talking about climate change and migration is a lack of universal definitions and international frameworks, says Burkett.

The term “refugee” has a legal definition and obligations that go with it that do not apply to people displaced by climate change. A more appropriate term for most situations is climate-induced migration or displacement, yet “climate refugees” is commonly used by advocates and critics alike. Further, determining how climate change has factored into displacement or a person’s decision to migrate is an inexact science.

Cassidy pinpoints three categories of risk associated with climate-induced migration and displacement: direct risks, indirect risks, and third-order risks from how we respond.

On the one hand, Cassidy says, it can be difficult to mobilize high-level officials and policymakers to address many of the direct and indirect risks related to climate-induced migration, like increased demand for humanitarian assistance (a direct risk) or disruptions to the global economy from new flows of people (indirect). U.S. policymakers tend to be focused on immediate crises and hard power, he says, a byproduct of how the national security apparatus is structured.

On the other hand, hasty or poorly thought out responses could cause even more problems, Cassidy says, citing the recent U.S. visa restrictions as an example. “People and governments [make] poor choices under stress that have unintended consequences,” he says – an idea explored in ECSP’s “backdraft” work on the peace and conflict consequences of climate responses.

The United States military has, for its part, recognized climate change as a “threat multiplier” for several years, says Goodman, repeatedly noting the associated risks of climate change and displacement in strategic documents. New Secretary of Defense James Mattis has acknowledged climate change as a driving force for instability in both fragile and stable regions of the world.

The military has taken note for good reason, Goodman says. As the country’s “911 force,” it is often first on the scene for humanitarian disasters, public health emergencies, and other crises. Goodman says the Pentagon now needs a long-term strategic approach to working with other U.S. agencies and civilians to address climate-related issues like migration and displacement, as many associated problems cannot be solved by the military alone.

Climate-related impacts on migration and political instability are expected to get worse, especially in hotspots with dense populations, like South Asia and Southeast Asia, says Burkett. But there is a lot we don’t yet know.

“If we get a better sense of the scope of the issue, we can at least plan for it,” says Burkett. “But right now, we don’t even exactly know how many individuals [or] communities are going to be affected.” Such uncertainty makes it difficult to create policy responses that will actually reduce or mitigate violent conflict.

International frameworks, such as they are, are not well structured to deal with this nexus of issues, says Cassidy. He notes that the many government, non-government, and multilateral organizations that make up the global climate and humanitarian regime each has their own “particular, parochial” perspective, resulting in a lack of cohesion. The international community needs to solve the underlying long-term issues that force people to move, he says, and this includes climate change but also conflict.

In a guide for policymakers released last year, Navigating Complexity, ECSP outlined several core principles to preventing violence related to climate change and migration, including strengthening local institutions that handle land and other resource rights, avoiding sensationalizing migrants as security risks, and adopting a “do no harm” (though not “do nothing”) approach to climate and humanitarian interventions.

These principles, in conjunction with enhancing predictive capabilities, would help the United States and partners better prepare for associated national security risks.

This Ground Truth Briefing was recorded at the Wilson Center on February 28, 2017.

Friday Podcasts are also available for download on iTunes and Google Play.

Sources: United States Joint Forces Command.

February 28, 2017 09:18 AM PST

A “green economy,” an energy sector composed entirely of renewables, is the goal of many. But we haven’t thought out the full implications of that change, says Stacy VanDeveer, professor at the University of Massachusetts Boston, in this week’s “Backdraft” podcast.

In the latest episode in our series on the peace and conflict consequences of climate change responses, VanDeveer discusses how cleaner energy can still be a dirty business and what de-carbonization could mean for petro states.

Meet the New Economy, Same as the Old Economy?

The promising growth of renewable energy – which includes wind, solar, and hydropower – is expected to continue, spurred by technological improvements and supportive policies in key markets.

However, warns VanDeveer, though these produce less carbon during generation, “the high-tech economy is not that different at the mining end of the stream than the old one.”

Clean energy still requires extensive mining and, in particular, large quantities of rare earth minerals. Extraction of rare earth minerals primarily takes place in vulnerable communities around the world, where people lack labor rights and are exposed to environmental hazards.

This has repercussions beyond the immediate impacts on mining communities. If you haven’t addressed inefficiencies and waste throughout the supply chain, you won’t see the expected reductions in carbon emissions, says VanDeveer. It can also undermine efforts to build democratic governance.

“The first thing,” says VanDeveer, “is to acknowledge that while we have one global climate change conversation, when people are actually dealing with energy issues – who has it, who doesn’t have it, how much it costs – those decisions are much more local and much more national.” India and South Africa are going to look different from the United States and Europe in their coal use, for example, because their needs and economies are different.

Understanding the energy needs of people at different levels of decision-making and in different contexts is important to developing climate policy that decreases emissions but also provides benefits to affected communities – or at a minimum, doesn’t introduce further stress.

VanDeveer suggests the best climate policies will involve more input from people directly affected by energy decisions and will be designed with their outcomes in mind. Yes, we want to see a reduction in carbon emissions, he says, but we also want people to have more economic opportunities and to benefit from stronger democracies.

A Shared Responsibility

VanDeveer also recommends speaking more openly about what climate and energy policies will mean for oil-dependent economies.

If oil sales decrease, there will be real consequences for petro states like Nigeria, Chad, Russia, and Saudi Arabia. “Many of these states have very poor governance, a lot of corruption, a lot of environmental hazards from the oil industry, and people in those places have not been allowed to have democratic articulation, they can’t get control of the negatives in the oil company,” says VanDeveer.

There’s a very real possibility that if the oil money dries up, these nations will be even less capable of delivering basic goods. After the collapse of oil prices in recent years, some African states slashed domestic spending on health care, for example. Such a collapse could contribute to instability, migration, even violent revolution.

“At the end of the day, that’s much of our money,” VanDeveer says. “That money is flowing from some countries to others, so we have some sort of shared responsibility for these very undemocratic and corrupt outcomes.”

Whether driven by government policy or market fundamentals, changes to the energy economy are not just an international concern, says VanDeveer. Already, shifts away from coal are affecting communities across the United States.

“If we haven’t thought about what happens to these people when the economy changes, we haven’t done them a service of good government and we haven’t been good citizens,” he says. “Yes, there are millions of jobs in the new energy economy, but they may not be in the same states, they are not in the same communities, they are not for people with the same skills.”

The “Backdraft” podcast series is hosted and co-produced by Sean Peoples, a freelance multimedia producer based in Washington, DC.

Friday Podcasts are also available for download on iTunes and Google Play.

February 24, 2017 06:53 AM PST

“If we think sustainable development is the goal we want to achieve, we have to be radical in elevating those who have been traditionally excluded,” says Kimberly Marion Suiseeya in this week’s “Backdraft” episode. “We have to approach conservation and global environmental governance from the perspective of the invisible and the marginalized people.”

Climate interventions are often developed and implemented from the international perspective first and foremost, leading to unanticipated consequences for affected communities. Interventions like REDD+ (Reducing Emissions from Deforestation and Forest Degradation) can alter informal land use practices and undermine traditional forms of conflict resolution.

Suiseeya saw this firsthand with a cluster of villages in the Kiet Ngong wetland of southern Laos. When efforts to delineate land use and boundaries were introduced by development agencies ostensibly to improve conservation, they inadvertently caused conflict by assigning most of the previously collectively managed wetland and its resources to one village.

“If you’re not understanding how people manage a resource, who gets privileged through these processes, who gets marginalized, you really have the potential of backdraft and conflict and that’s a much longer-term development problem that you’ve just exacerbated,” says Suiseeya.

To do this this requires more listening and less prescribing by intervening parties, whether they are a national government, international development actor, or NGO. Interventions developed without an understanding of the needs and wants of the affected people run the risk of, at a minimum, failing, or worse, causing conflict.

Suiseeya recommends taking steps to understand how projects “either reify or shift the power dynamics in communities.” Different ways of living and understanding the world affect how natural resources are managed, she says. Intervening actors must understand this and build it into their project, or risk poor outcomes. You get there through a justice lens, she says, and by thinking about who is at the table and who is not.

“Decolonizing methodologies” encourage the researcher or practitioner to meet people where they are and understand the ways that a community may or may not want to be engaged. This can lead to better buy-in from the community, the empowerment of local leaders, and better conservation results in the long term.

All of these approaches require better listening. “If we’re not paying attention to that voice component, we’re actually seeing some disempowerment,” says Suiseeya. “It’s a question of how can we use our projects to put people in the driver’s seat of their own futures.”

One good sign: In September of last year, the International Union for Conservation of Nature, the world’s largest environmental network, added a new membership category for indigenous peoples’ organizations. “The vote to allow indigenous people to represent themselves through their own organizations is a huge change that we would not have seen 5 or 10 years ago,” Suiseeya says.

The “Backdraft” podcast series is hosted and co-produced by Sean Peoples, a freelance multimedia producer based in Washington, DC.

Friday Podcasts are also available for download on iTunes and Google Play.

February 16, 2017 12:24 PM PST

There has been great progress in anticipating famines in recent years, with most predicted six or more months ahead of time, says Richard Choularton, senior associate for food security and climate change at Tetra Tech, in this week’s podcast. But action to address their humanitarian impacts has lagged. Responses need to be more consistent and faster, he says, happening “almost without human intervention.”


Choularton outlines three areas with the greatest potential to improve response time and reduce the effect of famines.


The first are financial mechanisms to insure countries and communities against the risk of famine. These programs use climate and agricultural data to release emergency funds either right at the end of a bad growing season or, in some cases, even before the end of the season. The African Risk Capacity scheme, for example, is an African Union project that provides emergency funding to seven member states. Humanitarian organizations, such as the Red Cross and World Food Program, are going even further, “using climate forecasts to trigger financing before a potential disaster strikes,” says Choularton. This offers the flexibility to help farmers switch to drought tolerant seeds and initiate supplemental feeding programs for children so they are in a better position to weather a lean season.


In addition to saving lives, such measures save “significant costs,” says Choularton. While no forecast is perfect, analysis by the UK Department for International Development found that early responses to drought in Kenya could save approximately $20 billion over a 20 year period, enough to offset the costs of up to six unnecessary interventions due to incorrect forecasts.


The second area for improvement is investing more at the community level. The regions that suffer most from the major famines that get international attention often also experience recurring, smaller bouts of food insecurity. Investments in social protection systems that can provide food and income support to poor households during times of need, along largescale landscape transformation to conserve soil and water, can foster greater adaptiveness and resilience.


The R4 Initiative by the World Food Program and Oxfam America, for example, provides drought insurance and microcredit to farmers in Ethiopia, Malawi, Senegal, and Zambia in exchange for their labor on anti-drought infrastructure. After three years, impact evaluation showed participating farmers had more savings than non-participants, invested more in agricultural labor, owned more plough oxen, and were more likely to keep their kids in school when droughts occurred, says Choularton.


The third area Choularton highlights is mobile technology. In Ethiopia, Project Concern International, Google, and USAID are creating pasture maps from satellite images and dispersing to them herders. For just the cost of a sheet of paper, daily print-outs help agro-pastoralists make informed decisions about where to graze their herds. In the pilot project, three quarters of households surveyed used the maps to inform their migration decisions, and herd mortality declined 47 percent.


A common thread among these anti-famine measures is that they use climate and agricultural data to empower countries, communities, and individuals to understand and manage risk, says Choularton. “Simple things, like getting the right information to people so they can make better decisions about how to manage the risks they face, have tremendous potential to help in these circumstances.”


Richard Choularton spoke at the Wilson Center on January 26, 2017.


Friday Podcasts are also available for download on iTunes and Google Play.


Sources: UK Department for International Development.

February 02, 2017 10:27 AM PST

Since 2014, Central America has experienced a dramatic lack of rainfall, destroying grain crops and killing cattle. As of last summer, 2.8 million people were impacted by drought and 900,000 were at risk of malnutrition in Guatemala alone. The effects of environmental change have been especially acute in Guatemala because they are layering on top of existing dysfunction and instability, says Former Vice-President of Guatemala (2004-2008) Eduardo Stein in this week’s podcast.


Concerns that the Guatemalan government is not functioning in the face of crisis miss the nature of the problem, Stein says. “The state is working, but in favor of a chosen few.” Particularly when it comes to ensuring equitable access to water and other natural resources, the government “has failed to provide the services the constitution mandates to all of the people.”


Guatemala, like Nicaragua and El Salvador, suffered from an extended civil war over the second half of the 20th century, which has led to successive dysfunctional and exploitive governments. Stein identified three ways this violent legacy undermines the capacity of the government to address challenges like the drought.


First, political turnover is frequent, with parties only expecting to be in power for four. This leads to an emphasis on short-term results rather than long-term goals, such as building norms, strengthening institutions, and expanding infrastructure.


Guatemala also suffers from deep racism, with Spanish speakers ruling over Mayan-speaking groups and only offering government services in Spanish for many years. As a result, many rural areas where ethnic Mayan populations live have poor access to water resources and other state services, like health care.


Finally, naturally resources are treated as a specialized field that only takes on political significance in times of crisis, says Stein. By constitutional mandate, water is controlled by the national government as a strategic resource rather than devolving responsibility to local communities. These communities resent the centralized decision-making over resources they traditionally cared for themselves. “They claim to be of a tradition and a culture that knows how to care better for their natural resources,” he says.


Centralization also makes it easier for corporate actors to take advantage. Sugar, palm, and banana plantations often use a disproportionate share of water resources, even diverting rivers in some cases, a crime the government is too weak to find and punish.


In light of the ongoing drought, Stein sees the potential for violence. Already there is more internal migration as villagers leave dry areas and create friction with host communities.


But the struggle of local communities to regain control of their water is also gaining momentum in Guatemalan society. The spread of digital communications and social networks is helping communities work together, identify key sources of water inequity, and push for change.


“This is an agenda open to many groups to participate,” says Stein. “Of course environmentalists are very happy to support this, churches are very happy, social activists of different organizations are very happy, and opportunistic political parties as well.”


Eduardo Stein spoke at the Wilson Center on January 25, 2017.

Friday Podcasts are also available for download on iTunes and Google Play.

January 26, 2017 07:46 AM PST

The science is clear: to prevent major disruption, the global community must take steps to address climate change. But it is also increasingly clear that efforts to address climate change can have major effects on societies that are not always anticipated.


The “backdraft” initiative at the Wilson Center is an effort to understand how policies and programs intended to help us adapt to or mitigate climate change can unintentionally do harm. In a new podcast series, we speak to experts from around the world about the potential peace and conflict consequences of climate change responses, from the pitfalls of the “green economy” to the geopolitical challenges posed by geoengineering.


In our first episode, we speak to ECSP Senior Advisor and Former Director Geoffrey D. Dabelko, now at Ohio University. He discusses the history of backdraft and what lessons from natural resource management and environmental peacebuilding can help prevent the worst outcomes.


In the early 2000s, the connection between climate change and security became a primary area of focus in the environmental security community, says Dabelko. The question of how climate change might contribute to conflict was dominant, with research primarily looking at direct climate impacts, like temperature and rainfall change, and immediate effects such as migration and changes in agricultural productivity.


In 2010, the Wilson Center held a workshop to examine a third category: Could responses to climate change – both adaptation and mitigation strategies – unintentionally exacerbate existing conflicts or cause new ones? The workshop and subsequent research was published in the 2013 report, “Backdraft: The Conflict Potential of Climate Change Adaptation and Mitigation.”


Now, we are beginning to see backdraft effects playing out on the ground, says Dabelko. Wind farms and hydroelectric dams require large areas of land that are sometimes already occupied, sparking conflict with communities in the way. The Reducing Emissions from Deforestation and Forest Degradation Program (REDD+) is upending traditional forest governance models around the world, sometimes disrupting existing dispute and conservation mechanisms.


These “are big transitions – necessary transitions – but they’re big transitions,” says Dabelko. There will be winners and losers, and there can be adverse effects that exacerbate existing conflicts and even create new ones.


Despite the “temptation to see climate as new and distinct from other natural resource and environmental management practices,” Dabelko recommends looking to the guiding principles that have developed around natural resource management for a start. A conflict-sensitive approach that applies the “do no harm” principle is critical to anticipating the wider social and political impacts of climate adaptation and mitigation projects.


Climate responses will touch on so many different sectors – from energy policy to land rights to development and humanitarian responses, and health and gender programs – that “any effort to do climate work has to be part of a larger discussion,” says Dabelko.


Building resilience will require stronger institutions at all levels of governance, from the hyper local to the global, and an inter-disciplinary, integrated approach. “If one walks into a room and you know everyone already, you’re not doing your job on this topic,” says Dabelko. “You need to get out and connect with folks you aren’t accustomed to working with.”


Stay tuned for more interviews in the “Backdraft” series, coming every other week on Friday Podcasts.


The “Backdraft” podcast series is hosted and produced by Sean Peoples, a freelance multimedia producer based in Washington, DC.

Friday Podcasts are also available for download on iTunes and Google Play.

December 22, 2016 05:35 AM PST

There may be more women and girls at risk of maternal health complications in fragile and conflict-affected settings today, but attention to the issue is not new and the international community has made important strides over the last 20 years, says Sandra Krause, program director for reproductive health at Women's Refugee Commission, in this week’s podcast.

The rights of refugees and internally displaced persons to reproductive health were first widely recognized by governments in 1994 at the International Conference on Population and Development in Cairo, she says.

That formal recognition sparked the creation of Inter-Agency Working Group on Reproductive Health in Crisis (IWAG) a year later to build a set of guidelines and best practices for sexual and reproductive health care in crisis contexts. “In those guidelines,” Krause says, “it established a set of priority interventions to be put in place at the same time humanitarian actors were trying to meet basic and survival needs and prevent infectious diseases.”

The widespread recognition of these standards was central to improving care for women and children around the world, according to Krause. “There were to be these coordinated activities to prevent excess maternal and newborn mortality, to prevent the transmission of HIV, and to address sexual violence.”

One of the tools created by the IWAG is the Minimum Initial Service Package, or MISP. The MISP is a practical guide for disaster and humanitarian response workers to help them prevent and appropriately respond to sexual violence, address maternal and newborn health, reduce HIV transmission, and plan for the eventual resumption of full health services.

Thanks to these efforts, “the capacity to address reproductive health and crisis has increased,” says Krause. “Development agencies have jumped in to participate in humanitarian relief and that's helped quite a bit.” Sixty-eight percent of development agencies report they have an internal policy or mandate for reproductive health in humanitarian emergencies, and funding for reproductive health increased 298 percent between 2002 and 2011, Krause says.

Yet, clearly, as demonstrated by the dire situations in Syria, South Sudan, and elsewhere, gaps remain. Funding has largely gone to “lower hanging fruit,” Krause says – to things like nutrition programs, but not as much to “life-saving emergency obstetric and newborn care that's so critical and probably more costly as well.”

One of the most glaring needs illustrated by several evaluations is clinical care for survivors of sexual assault. “It's consistently a gap in almost every humanitarian emergency I go to,” Krause says. “It's not a difficult intervention, but you have to have the protocol and then you need nurses, doctors, midwives, and people trained in it.”

Sandra Krause spoke at the Wilson Center on December 8, 2016.

December 01, 2016 09:46 AM PST

Exactly one year after the adoption of the Sustainable Development Goals in September 2015, The Lancet published a special series on achieving maternal health priorities in the SDG era, with a focus on quality, equity, strengthening entire health systems, sustainable financing, and collecting better evidence.

“The series certainly serves as an inspiration for advocates on the ground,” explains Elena Ateva of the White Ribbon Alliance in this week’s podcast. Yet, these priorities “cannot happen without a commitment and continued and sustained resources for social accountability.”

For Ateva, improving quality and equity of care means prioritizing the experience of the individual. Women should be “at the center of care, at the center of policies, and at the center of advocacy efforts,” she says.

In some places, the treatment of women by health providers is as much or more of a problem than traditional capacity issues. “Evidence suggests that in countries with high maternal mortality, the fear of disrespect and abuse that women often encounter in facility-based maternity care is a more powerful deterrent to use of skilled care than commonly recognized barriers such as cost or distance,” according to the White Ribbon Alliance.

To combat the stigma, Ateva’s message is clear: go local. “[It] starts with the conversation a woman has with her provider,” she says, “then with the community and the providers and policymakers coming together and discussing the vital changes that need to happen at that level, and then it happens when communities come together to advocate for improved services.”

Ateva shares the insights of three mothers on various barriers to equitable care they encountered in Uganda, from lack of privacy in delivery wards to no handicap accessible ramps at the hospital entrance. To achieve the Sustainable Development Goals, she says, the voices of women like these “must be the starting point and not the afterthought.”

Elena Ateva spoke at the Wilson Center on October 6, 2016.

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