Tuesday, September 29, 2009
Marrakech presents itself as laid back and fast-paced all at once. Men lounge at cafes drinking sugary mint tea while motor scooters whiz by, nearly crashing into pedestrians and each other at every turn. Horns honk and donkeys bray, trying to be heard over the calls to prayer which blare throughout the city over loudspeakers five times a day. Still, everyone has a smile and is eager to help the tourists from France? England? No, USA! Ah, USA! New York? No, Washington, DC. Ah, Washington, welcome my friends!
I spent the last two days playing hooky to conference sessions and instead visiting various agencies and organizations around Marrakech and the surrounding towns. Yesterday, my bus got a police escort and a royal welcome at the reproductive health clinic about an hour southeast of the city. Town residents lined up along the streets for miles, waving us in. Doctors and staff at the clinic were eager to show us their beautiful facility at the foot of the Atlas mountains. Women who had just given birth proudly showed us their newborn babies. We were all impressed to hear that all services at the clinic, from family planning to safe delivery, are free. Perhaps clinics like this are the reason why Morocco has been so successful at reducing its fertility rate from over 7 to 2.4 in just four decades. The urban fertility rate in Morocco is just an even 2, lower than the U.S. rate.
Today I visited an intake center at the hospital for women and children victims of violence. Doctors were sensitive to the victims' privacy and did not allow us to tour the center, but were happy to answer many of our most pressing questions in the courtyard outside.
This afternoon, I went to a local orphanage for kids 5-18 years old. Many of the 80 residents were plucked from the streets where they had been abandoned by their parents and were begging for a living. They now attend school full time and share a loving home with dedicated staff.
I always expect program directors to exaggerate the success of the work they're accomplishing, but all three of these operations truly did seem to be improving the lives of the most vulnerable women and children who live in and around Marrakech.
Tomorrow it's back to the grind with back-to-back research sessions all day. Publications are flying off my info table too, which is a very good thing, not least because it means I won't have to lug them back to good old Washington, DC.
Sunday, September 27, 2009
Greetings from Marrakech! I am here for the International Union for the Scientific Study of Population (IUSSP) conference, which happens in a different location every four years. This is the first time that the conference has been held in an African and/or Arab nation, and King Mohammed VI has been a very gracious host so far. He even invited the participants to a special dinner on Tuesday evening. Of course, there are 2,300 of us, so I'm guessing it won't be an intimate affair with lots of photo ops one-on-one.
The conference started today with side meetings, rather than typical research presentations. My first session was a follow-up to the research conference I attended in Ghana last September. It was fun seeing friends that I made a year ago and hearing about the success many of them have had in getting their papers published. There was also a request for more research in the future that could be translated into policy, which I was happy to hear.
The next session I attended featured our expert Board member, Duff Gillespie, as a panelist. The topic was training a new generation of reproductive health specialists and how to do that most effectively. Duff told the story of his own career (I learned that he actually trained in criminology before becoming a USAID career professional!). He criticized donors for neglecting population studies and identified this as the core reason why the field of demography is not sustainable. He called for a renewed interest in population studies by private donors and governments in order to keep the field alive.
The day ended with the official opening ceremony. We heard from IUSSP president, John Cleland; UNFPA director Thoraya Obaid; and several other panelists (who spoke in Arabic so I could not understand their addresses, unfortunately). Berber percussionists rounded out the evening with their energizing chanting, dancing, and drumming.
I got my information table set up this morning and by the end of the day all of the tote bags and pens that I brought were gone! Hopefully now that the "fun" freebies are gone, people will feel compelled to pick up a copy of The Reporter or some of our educational materials.
More tomorrow, after I visit a local reproductive health clinic...
Wednesday, September 16, 2009
Several newspaper articles have covered the release of a report about family planning and climate change from Optimum Population Trust (OPT), an organization in the UK. I have been posting those articles on our website's "News" page. The attention has reached a critical mass and now it's time to comment.
The study claims to prove that meeting all unmet need for family planning is a more cost effective way of reducing carbon emissions than are other "green" technologies. To do this, the researchers calculated how many tons of carbon will be emitted between now and 2050 without meeting unmet need. They also determined how many tons of carbon would be emitted if unmet need were met (i.e. if there were fewer people emitting carbon). Then they subtract the latter from the former to calculate the difference in tons of carbon emitted between the two scenarios. Finally, they divided the total cost of providing family planning to the women with unmet need for the next 40 years by the number of tons of carbon that would be avoided by meeting unmet need. This is the cost per ton of carbon mitigated, which they estimate is $6.46.
The press releases have all stated that OPT commissioned the London School of Economics (LSE) to do the research, which leads one to believe that world-class faculty researchers are behind the paper. This is not the case. The research paper was actually written by a student at the LSE with the help of a non-faculty supervisor.
While population stabilization is obviously crucial to solving the climate crisis, there are a few methodology issues in this study that must be addressed. Here are the biggest ones, in descending order of importance:
- The figure used for current unmet need--201 million women--refers only to women in the developing world. The authors calculate the proportion of people in the world with unmet need by dividing 201 million by the current world population--6.8 billion (the result is 3%). They assume that this proportion of "unmet need" equals "demand for family planning," which they hold constant for each year between now and 2050 for their cost-benefit analysis. Of course, demand for family planning is not actually the same as unmet need, and is much greater than 201 million women worldwide.
- Then they take a figure from Guttmacher Institute, again for developing countries only, that unintended births could be reduced by 72% if all unmet need in the developing world were met. They apply this figure to every country in the world, including developed countries. Meaning, for example, that they assume that women in the United States who have unintended births would have 72% less if only they had access to contraception. The problem with this methodology is that in most developed countries, most women do have access to family planning if they want it. So spending an additional $22 per woman (the estimated cost of providing contraception to a woman in the developing world each year) on contraceptive supplies will probably not actually reduce the percentage of unintended births by very much. In the United States especially, more money must be spent on teen pregnancy prevention and reproductive health education. Indeed, the most prevalent answers women give in the U.S. for becoming pregnant accidentally are that they didn't expect to have sex and they didn't think they could become pregnant. Spending more money on birth control pills would not help these women. Education and better preparation would.
- It is not clear which population projection was used for the scenario in which unmet need is not met. The authors simply state that the projection came from the UN. The UN produces several projections based on different fertility and mortality assumptions and it would be helpful to know which one was used for this study. * Correction: the author directed me to a footnote that I overlooked, which stated that the medium UN population projection was used.
Is it even possible to have a more equitable distribution of emissions with a decent standard of living in a world of 12 billion people or more? It will already be hard enough in a world of 8 or 9 billion. Right now, in our world of 6.8 billion people, too many are not using enough carbon to sustain healthy, productive lifestyles. Yet, we are still raising the concentration of carbon in the atmosphere to dangerous levels.
The per capita emissions in wealthy countries have to be dramatically reduced. But, at the same time, in some developing countries, per capita emissions will have to increase if people are to meet their most basic needs. Reaching that balance that allows everyone a healthy quality of life while protecting the environment will be a challenge made even more difficult by a growing population.
Meeting the existing unmet need for family planning is an important and cost-effective way to help meet the climate crisis. But, it alone will not solve the problem. In fact, the author found that only 9.3 gigatons of carbon emissions would be averted over the next 40 years, which is just a little more than what we currently emit globally in one year. But it must be part of any thorough discussion on mitigation strategies and any rational discussion on climate justice.
Tuesday, September 8, 2009
Texas once again shows the folly of allowing right wing ideology to substitute for good health policy. It has one of the highest rates of teen pregnancy in the country and the highest rate of repeat births to teenagers. It is also a state where it is very difficult for teenagers to get birth control.
According to a report in the Dallas Morning News, many doctors in the Dallas region refuse to prescribe contraceptives to teenagers without parental consent. Experts believe that Dallas policy requiring parental consent for birth control at ten school based health centers also applies to them – even though it doesn’t.
Not even young parents can get birth control confidentially – leading to the fact that Dallas leads the nation in repeat teenage pregnancy. Here is real evidence that parental consent rules are utterly counterproductive.
Sadly, a number of conservative organizations and lawmakers are pushing for federal legislation imposing this failed approach on the entire nation. When, and if, health reform comes to the full House and Senate, you can expect many amendments to limit access to reproductive health services for young people – and indeed for all Americans.
Those lawmakers need to hear from you that ideology can’t substitute for evidence when it comes to health policy and that young people need access to confidential family planning services.