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.
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.
In the turbulent days following the 2011 fall of Colonel Muammar Gaddafi’s government, Dr. Alaa Murabit found herself in Libya’s fragile capital, Tripoli, observing exchanges between parliamentarians and civil society over the future of the country. For over 40 years, this kind of discussion was unthinkable – not the least, for a young woman.
In this week’s podcast, Murabit, currently the United Nations high-level commissioner for health employment and economic growth, describes that delicate period and strategies for awakening and empowering a representative civil society, especially among young people.
To increase political participation of marginalized groups, Murabit started The Voice of Libyan Women at the age of 21 in August 2011. The organization was focused on economic empowerment and political participation of young women all over Libya, not just the capital or cities, she says.
At least 26 percent of the country’s population is between the ages of 10 and 24. Yet, Murabit argues that such a “youth bulge” is not the root of security problems. Rather, she argues the problem is relative deprivation, “where if I see that you have more and better than me, even though I have worked as hard and deserve as much, of course it's going to create resentment.”
“A lot of my academic work is in securitization,” she explains. “When we talk now about youth, peace, and security, everybody talks about young men who they're worried will pick up guns.” Meanwhile, those focused on women’s rights tend to focus on “older women who have influence networks, finances, and support.” The result is that young women are ignored by both youth and gender advocates.
Despite best intentions, the international community is sometimes guilty of contributing to this problem by characterizing youth as monolithic interest blocs. “If we're going to be very genuine and organic about the inclusion of youth,” says Murabit, “we have to be talking about the spaces in which we've created.” If we do not create space for everyone, certain voices who should have a say in their country’s future are silenced.
Alaa Murabit spoke at the Wilson Center on October 6, 2016.
Chaotic flows of refugees and migrants – the most since World War II – have challenged leaders in Western Europe and North America. “The reactions to those big flows are undermining our institutions in important ways and degrading our politics,” says Wilson Center Fellow Joseph Cassidy in this week’s podcast.
Before joining the Wilson Center this summer, Cassidy spent 25 years in the U.S. Department of State focusing on humanitarian and human rights issues and multilateral diplomacy. In a Wilson Council briefing taped before the close of the U.S. presidential election, Roger-Mark De Souza, director of population, environmental security, and resilience, talks with Cassidy about current humanitarian challenges.
The inability of governments and institutions to effectively cope with the influx of displaced peoples has caused the politicization of what was once a bipartisan issue, says Cassidy. We have seen “the rise of demagogues who have identified refugees and other migrants as people worth resenting and fearing.” As a result, it has “coarsened” our politics.
Anti-immigrant sentiment is not new, but Cassidy says it can be “mitigated by smart policies and principled politicians, [or] it can be exaggerated by bad policies and unprincipled politicians.”
Part of the problem is an aging legal regime that needs updating. The UN Refugee Convention was adopted in 1951. The nature of conflicts has changed, as have the armed groups involved, the extent to which civilians are targeted, and the opportunities for victims to flee. Additionally, the Refugee Convention does not provide legal protections to particularly vulnerable groups that any modern negotiations would address, says Cassidy, namely women, children, indigenous people, LGBT individuals, or the disabled. Nor is climate change considered.
However, many experts are concerned that re-opening the Refugee Convention in the current atmosphere of anti-immigrant sentiment would degrade the existing rights of victims, such as they are, and reduce the responsibilities of states. While acknowledging the risks, Cassidy noted there are numerous other frameworks to influence state behavior, including, international guidelines, regional arrangements, and national laws.
According to the United Nations High Commission on Refugees, there are three main reasons for the current increase in refugee populations: 1) protracted conflicts, 2) an increased frequency in the prevalence of conflicts, and 3) a decreased capacity to accommodate refugees and internally displaced individuals.
To reduce the number of displaced people and ultimately the pressure on Western institutions and politics, Cassidy believes “we we need to smooth the transition from humanitarian assistance to development assistance” and bring the two fields closer together. Many humanitarians worry development workers don’t take protection seriously enough, while development workers worry humanitarians do not think long term.
Asked about his expectations for the tenure of new UN Secretary-General António Guterres, Cassidy noted five major questions to watch. Humanitarians are excited to have a long-time high commissioner for refugees at the helm, someone who is “well respected for his competence and his principles,” he says. The international community, in general, does not do enough to “identify…enhance…and utilize refugee value.” Guterres may help change this, bringing attention to refugee conditions and humanitarian needs.
In September, the United Nations hosted two summits, the first of which launched a two-year negotiation aimed at addressing outstanding humanitarian problems, and the second of which collected pledges to increase humanitarian funding, refugee resettlement, and education and occupational opportunities. During his fellowship, Cassidy will be watching these processes closely and engaging with colleagues in related fields like environmental protection, economic migration, and conflict resolution.
Joseph Cassidy spoke during a Wilson Council briefing on November 1, 2016.
The fourth global Women Deliver conference in May brought nearly 6,000 experts and advocates to Copenhagen to address the health and rights and women and girls, including a small group of young midwives who attended a symposium beforehand. “I went in a little bit skeptical,” says Alix Bacon, president of the Midwives Association of British Columbia and one of 32 women under 35 who received a scholarship to attend, in this week’s podcast. “And I came home a changed woman and a believer.”
Bacon said the ability to escape the immediacy of the day-to-day clinical requirements of midwifery and think about how they can grow as a network was invaluable. “There isn't an advocacy component to your midwifery training,” she says, “And this is where the midwifery symposium really shined. It addressed our weaknesses, regulation, research, policy.”
In the context of regulation and public funding, midwifery in Canada is relatively new, Bacon says, which puts them in a unique position among wealthy countries to partner with developing countries facing some of the same challenges. They have developed a 30-year roadmap from “zero to functional that we can share with our partners,” for example, she says.
One such partnership is with South Sudan and the United Nations Population Fund (UNFPA). The “twinning” project matches midwives together with the aim of increasing capacity, “supporting a strengthened, enabled environment for gender-sensitive maternity care.” Partnerships like this are crucial for the world’s newest country, which has among the world’s highest maternal, newborn, and child mortality rates. “Only 15 percent of births are attended by a skilled birth attendant,” Bacon says.
The latest renewed violence and mass displacement has “had wide-reaching effects on our ability to implement this project,” she says. They had to pull Canadian staff out of the country in June, but Bacon still believes in the promise of the partnership. “It's about positioning midwives as experts in maternity care,” she says. “And when you're positioned as an expert and supported by the ideal partner, you grab the attention of policymakers locally.”
With a global standard of education and the proper policies in place, “midwives can meet 87 percent of the needs of women and children,” says Bacon. “We also happen to be terribly cost-effective, which really makes us a best buy when it comes to maternal newborn child health.”
Alix Bacon spoke at the Wilson Center on July 18, 2016.
Sources: Al Jazeera, Global Affairs Canada.
More and more we are hearing stories about “climate refugees.” U.S. Interior Secretary Sally Jewell used the term to describe the Biloxi-Chitimacha-Choctaw tribe, a community which this year became the first to receive federal funding to relocate in its entirety from their sinking island home on the Louisiana coast.
Yet climate change-induced migration and displacement actually “falls outside of the more traditional protection regimes like the refugee treaty,” says Maxine Burkett, a public policy fellow with the Wilson Center’s Environmental Change and Security Program, in this week’s podcast.
“Most of the migration that's going to happen as a result of climate change happens internally within countries,” Burkett says. Managing such movement is clearly the purview of national governments.
The harder question is how to deal with those who move across international borders. The UN Refugee Convention was agreed to by states in 1951 and establishes clear protections and specific circumstances under which those protections can be invoked, namely political persecution and the threat of violence.
Climate change – which researchers are finding can play a role in displacement, migration, and vulnerability, though not always as a clear, primary driver – cannot currently be invoked by asylum seekers in search of refugee status in another country. And since the legal definition isn’t codified, descriptive labels such as climate refugee do not bind states to any responsibilities.
This is “a yawning gap in our conversation,” Burkett says. “What are we asking the others to do in order to meet our rights?”
“Without the right name or legal nomenclature, the rights of those within country and especially those in foreign countries – their status rights – are uncertain...The importance of nomenclature in the advancing of human rights is significant.”
The Nansen Initiative, established by Switzerland and Norway in October 2012, was created in response to the lack of legal frameworks for climate change-induced cross-border migration and displacement. It began with the aim of creating protections for those displaced by climate change, but pivoted to address all disasters. Its successor is now simply the Platform on Disaster Displacement. “What is paramount, I think they would argue, is to meet the needs of those who are migrating by assigning and allowing them to exercise their rights,” Burkett says. “Nevermind why they had to move.”
Yet doing so has costs. Combining climate change-induced problems with other environmental issues, despite the difficulty in parsing causes, “scrubs” the downstream discussion of “significant rights language that would be more reparative than simply accommodating,” she says.
“Climate change is not a random, thoughtless act of God, but something other,” Burkett says. The systems of rights and reciprocations we agree on in response should reflect this.
In the meantime, the initial inequity of anthropogenic climate change – that those who are most vulnerable are by and large the least responsible for creating the problem – is perpetuated as, at best, the displaced can only hope that someone lets them in.
Maxine Burkett spoke at the Wilson Center on June 22, 2016.
Nearly six months after the Paris climate agreement, the international community’s attention has shifted from celebration to implementation. Governments have begun outlining climate pledges in the form of intended nationally determined contributions, or INDCs – which are fast becoming nationally determined contributions, or NDCs, as they begin influencing policy.
The composition and quality of individual INDCs and NDCs vary country to country. In this week’s podcast, Grzegorz Peszko, lead economist in the climate change group of the World Bank, outlines the types of plans submitted so far and how the World Bank is supporting implementation by individual governments.
The first type of INDC tends to be too qualitative and lacks the quantitative rigor expected, which Peszko says is often indicative of government capacity issues. “These countries usually request assistance in framing their targets,” he says. Additionally, mitigation is a common challenge for these governments, especially if they have developed a comparative advantage in fossil fuel exports or in energy-intensive industries.
The largest proportion of submitted plans, and the second type Peszko mentions, are the most aspirational in their objectives. They run the gamut of emission reductions, increasing renewables in the energy mix, energy efficiency, and energy transport. “What is common to them is they face a challenge of implementation,” he says. By including a laundry list of new technologies or aspirational goals without capacity or planning, these countries may struggle to reach their targets.
The last type has sophisticated targets that are also “investment ready” for financers like the World Bank, Peszko says. Yet, it’s also important these plans have an “incentive structure behind them,” with secondary regulations and an enforcement structure that “really changes the behavior of the people in a way that it makes sense to implement the law and behave in accordance to the law.”
Creating those incentives via regulations is the real challenge of harmonizing and strengthening climate pledges, says Peszko. The role of the government “is really to create this enabling policy framework” that is consistent with INDC and NDC targets.
“Governments never have one single instrument to achieve certain targets,” Peszko says. “There's always a bundle, a package of instruments that need to be tweaked on the margins to make a change.”
Grzegorz Peszko spoke at the Wilson Center on June 14, 2016.
In the months leading up to the United Nations conference on climate change in Paris last fall, expectations were high. And the result actually exceeded those expectations, in many respects, says Nick Mabey, director and chief executive at E3G, in this week’s podcast.
“We have stronger goals,” Mabey explains, and the agreement “puts adaptation and resilience on an equal footing to mitigation, so we like to say we now have a climate-risk management regime.”
After more than a decade monitoring the geopolitics and security implications of climate change and resource scarcity, Mabey and his colleagues at E3G believe this new regime to be more robust due to the “strong legal force and political backing of the agreement.”
However, the implications of climate-security issues remain under-examined in the foreign policy community. “Paris made us safer, but not safe,” Mabey says. “We've got a whole set of mixed drivers for complexity driving instability and social unrest.”
“There's not sustainable security without addressing climate and resource issues in forward planning,” he explains. “But I can tell you from talking to people in governments, none of that is in the current plans.”
One opportunity for improving the way climate-related security issues are accounted for may be the election of a new UN Secretary General. A successor to Ban Ki-moon will be chosen at the General Assembly later this year. Asking the candidates to address climate-security threats would continue the conversation and momentum.
The momentum created by Paris is fragile. Mabey says the core challenge is identifying and maintaining a coalition of countries who will continue to work toward a strengthened climate-security framework. “Unless we can point to a coalition of countries who want to see this happen, we will always be on the margins.”
Nick Mabey spoke at the Wilson Center on May 6, 2016.
As the dust settles on the newly minted Sustainable Development Goals (SDGs) and Paris climate agreement, countries have begun tackling operational questions aimed at limiting global warming to two degrees Celsius and ensuring peaceful, sustainable development.
“Paris and the SDGs really do define the landscape for better or for worse,” says Ken Conca, director of the Global Environmental Politics Program at American University, in this week’s podcast. In addition to operational questions at the country level, it remains to be seen how international institutions, like the United Nations, will adjust to the commitments and principles laid out in these agreements.
Conca said the existing United Nations mandate articulates a clear four-part mission: to promote peace, development, human rights, and international law. But “if you look at the history of environmental initiatives in the UN,” he says, “the UN really only stands on two of its four legs.” According to Conca, there is a lot of work on development and international law, but “until recently, there's been very little on peace and conflict and the environmental linkages.”
“If you really want to be able to do risk assessment in a whole of governance and strategic and forward-looking way, it requires a combination of institutional reform and political leadership,” Conca explains.
The few open, high profile conversations about climate change and security by the UN Security Council over the last decade were led by Britain (2007) and Germany (2011) as they rotated into the chairmanship. But those conversations, according to Conca have been highly contentious as well as rife with institutional jockeying and confusion. There is ongoing debate whether the responsibility for addressing climate-related security issues lies with the Framework Convention on Climate Change, a forum for climate negotiations, or the Security Council, which authorizes military actions and sanctions.
Regardless of which UN organization ultimately has primary responsibility, “it's going to be really important to have a capable and functional Security Council on the questions of climate change and international conflict,” Conca says.
Focusing on the ends rather than the means may help. Establishing and protecting rights could be a catalyst for effective implementation where institutional reform falls short. “To me, it's people as rights holders in the context of these challenges that really ultimately provides us with the political energy as opposed to the desired foresight of governments,” Conca says. “I think rights-based approaches really help us establish priorities.”
Ken Conca spoke at the Wilson Center on May 6, 2016.
Climate change has the potential to exacerbate conflict and political instability, and women will pay a steeper price than their male counterparts when it does, says Mayesha Alam, associate director of the Georgetown Institute for Women, Peace and Security, in this week’s podcast.
Alam, co-author of a report released late last year on women, climate change, development, and security, said “women face specific gender-based vulnerabilities during armed conflict.” These include sexual violence and loss of property when communities disintegrate and resources become scarce.
“As a cross-cutting issue, climate change and environmental degradation intersect with population growth, human mobility, urbanization, and food-water-energy insecurity,” Alam explains. All of these issues have specific gender dimensions and “require tapping the potential and leadership in women and girls to have sustainable and scalable solutions.”
In many communities around the world, “women are already having to adapt their lives to survive and care for their dependents,” she says. Yet, “women are forgotten in terms of climate change adaptation and mitigation initiatives all too often.”
Many community-based women’s groups are responding to environmental challenges on their own. One example is the Sinsibere cooperative, a group of 300 women from a village south of Bamako, Mali. They work to stop local deforestation and develop climate resilience “by providing environmental education and alternative livelihoods for women, setting up micro-credit systems, and providing training in other trades.”
Broader national efforts to address the gender dimensions of climate change have been slower. The International Union for Conservation of Nature has been promoting Climate Change Gender Action Plans as a way to encourage states “to address their climate change and environmental degradation needs but also to address political instability, women's empowerment, and economic sustainability.” So far, only a dozen or so nations have taken up the challenge.
Mayesha Alam spoke at the Wilson Center on April 29, 2016.