Research Briefs on the Sahel Resilience Learning Project

Warrantage and FMNR are two farmer-led practices to help mitigate impacts of climate change on agriculture in the Sahel. In late 2016, the OASIS Initiative released two reports on these practices. The two comprehensive literature reviews were commissioned by USAID’s Sahel Resilience Learning Project. We are now disseminating the findings to local partners and organizations to assist them in making evidence-informed decisions based on the experiences of communities and experts in the region.

We are excited that the next phase of this effort will build on our “Sister School” partnership with the University Abdou Moumouni (UAM) in Niamey, Niger. Several graduate students from UAM will be focusing on these topics for their masters theses, providing them with valuable experience conducting community-level research as well as gathering and building the evidence base on perspectives of communities who are practicing Warrantage and FMNR in the region.

Cultural debate over harassment is a step in human evolution

Let’s begin not with dreams but by going to the zoo. Penguins are monogamous. Females lay a large egg and then return to the sea to feed. The male incubates the egg for many weeks. When he is nearly dead from hunger and cold, the egg hatches and his mate returns. She regurgitates food to feed the fledgling while he goes to sea to feed. Many bird species are monogamous because the two sexes can share in bringing up the next generation.

Women's Empowerment and Global Health: A Twenty-First-Century Agenda

What is women’s empowerment, and how and why does it matter for women’s health? These are questions that the University of California Global Health Institute’s (UCGHI) Center of Expertise (COE) on Women’s Health, Gender, and Empowerment aimed to answer with this book. Since 2009 the COE has brought together a multidisciplinary network of experts from across the University of California (UC) campuses and departments, along with their global partners, to advance research and education on what has become a capstone theme in the global health and development agenda: women’s and girls’ empowerment and health. Women’s Empowerment and Global Health demonstrates the outcomes of COE's commitment to advance pedagogy and present the work of thought leaders in this domain.  

Getting family planning and population back on track

After a generation of partial neglect, renewed attention is being paid to population and voluntary family planning. Realistic access to family planning is a prerequisite for women's autonomy. For the individual, family, society, and our fragile planet, family planning has great power.

Population and climate change: who will the grand convergence leave behind?

For many developing countries, investments in health have proved a great success. The LancetCommission “Global health 2035: a world converging within a generation”1 and the 2014 Gates annual letter2 envision the possibility of a “grand convergence” by which more countries will have a child mortality rate as low as 15 per 1000 livebirths in 20 years time. We wish to draw attention to the special case of the least developed countries, which on present evidence are likely to be excluded from such a convergence.

Training Traditional Birth Attendants on the Use of Misoprostol and a Blood Measurement Tool to Prevent Postpartum Haemorrhage: Lessons Learnt from Bangladesh

A consensus emerged in the late 1990s among leaders in global maternal health that traditional birth attendants (TBAs) should no longer be trained in delivery skills and should instead be trained as promoters of facility-based care. Many TBAs continue to be trained in places where home deliveries are the norm and the potential impacts of this training are important to understand. The primary objective of this study was to gain a more nuanced understanding of the full impact of training TBAs to use misoprostol and a blood measurement tool (mat) for the prevention of postpartum haemorrhage (PPH) at home deliveries through the perspective of those involved in the project. This qualitative study, conducted between July 2009 and July 2010 in Bangladesh, was nested within larger operations research, testing the feasibility and acceptability of scaling up community-based provision of misoprostol and a blood measurement tool for prevention of PPH. A total of 87 in-depth interviews (IDIs) were conducted with TBAs, community health workers (CHWs), managers, and government-employed family welfare visitors (FWVs) at three time points during the study. Computer-assisted thematic data analysis was conducted using ATLAS.ti (version 5.2). Four primary themes emerged during the data analysis, which all highlight changes that occurred following the training. The first theme describes the perceived direct changes linked to the two new interventions. The following three themes describe the indirect changes that interviewees perceived: strengthened linkages between TBAs and the formal healthcare system; strengthened linkages between TBAs and the communities they serve; and improved quality of services/service utilization. The data indicate that training TBAs and CHW supervisors resulted in perceived broader and more nuanced changes than simply improvements in TBAs’ knowledge, attitudes, and practices. Acknowledgeing TBAs’ important role in the community and in home deliveries and integrating them into the formal healthcare system has the potential to result in changes similar to those seen in this study.

Population and Climate Change: Empowering 100 Million Women

Meeting the world’s need for family planning is a human right and a climate imperative. Wherever women have been given information and access to family planning, birth rates have fallen – even in poor, low-literate societies like Bangladesh or conservative religious countries such as Iran.

"Big issues deserve bold responses" Les grandes questions meritent des responses audacieuses: la population et le changement climatique au Sahel

Parts of Africa have the most rapid population growth in the world. Recent studies by climatologists suggest that, in coming decades, ecologically vulnerable areas of Africa, including the Sahel will be exposed to the harshest adverse effects of global warming. The threat hanging over parts of sub-Saharan Africa is extreme. Fortunately, there are evidence-based achievable policies which can greatly ameliorate what would otherwise be a slowly unfolding catastrophe of stunning magnitude. But to succeed such measures must be taken immediately and on a large scale.

Big issues deserve bold responses: Population and climate change in the Sahel

Parts  of  Africa  have  the  most  rapid  population growth in the world. Recent studies by climatologists  suggest  that,  in  coming  decades, ecologically vulnerable areas of Africa, including the Sahel will be exposed to the harshest adverse effects of global warming. The threat hanging over parts of sub-Saharan Africa is extreme. Fortunately,  there are evidence-based achievable policies which can greatly ameliorate what would otherwise  be  a  slowly  unfolding  catastrophe  of stunning magnitude. But to succeed such measures must be taken immediately and on a large scale.

New hope: community-based misoprostol use to prevent postpartum haemorrhage

The wide gap in maternal mortality ratios worldwide indicates major inequities in the levels of risk women face during pregnancy. Two priority strategies have emerged among safe motherhood advocates: increasing the quality of emergency obstetric care facilities and deploying skilled birth attendants. The training of traditional birth attendants, a strategy employed in the 1970s and 1980s, is no longer considered a best practice. However, inadequate access to emergency obstetric care and skilled birth attendants means women living in remote areas continue to die in large numbers from preventable maternal causes. This paper outlines an intervention to address the leading direct cause of maternal mortality, postpartum haemorrhage. The potential for saving maternal lives might increase if community-based birth attendants, women themselves, or other community members could be trained to use misoprostol to prevent postpartum haemorrhage. The growing body of evidence regarding the safety and efficacy of misoprostol for this indication raises the question: if achievement of the fifth Millennium Development Goal is truly a priority, why can policy makers and women’s health advocates not see that misoprostol distribution at the community level might have life-saving benefits that outweigh risks?

The Sahel: A Malthusian Challenge?

The population of the least developed countries of the Sahel will more than triple from 100 million to 340 million by 2050, and new research projects that today’s extreme temperatures will become the norm by mid-century. The region is characterized by poverty, illiteracy, weak infrastructure, failed states, widespread conflict, and an abysmal status of women. Scenarios beyond 2050 demonstrate that, without urgent and significant action today, the Sahel could become the first part of planet earth that suffers large-scale starvation and escalating conflict as a growing human population outruns diminishing natural resources. National governments and the international community can do a great deal to ameliorate this unfolding disaster if they put in place immediate policies and investments to help communities adapt to climate change, make family planning realistically available, and improve the status of girls and women. Implementing evidence-based action now will be an order of magnitude more humane and cost-effective than confronting disaster later. However, action will challenge some long held development paradigms of economists, demographers, and humanitarian organizations. If the crisis unfolding in the Sahel can help bridge the current intellectual chasm between the economic commitment to seemingly endless growth and the threat seen by some biologists and ecologists that human activity is bringing about irreversible damage to the biosphere, then it may be possible also to begin to solve this same formidable problem at a global level.

 Published in Environmental & Resource Economics 2013: 55(4), 501-512.

Do Economists Have Frequent Sex?

Last year a member of the World Bank professional staff gave a lecture on development in Africa on the UC Berkeley campus. His audience asked him about rapid population growth in that continent. He immediately dismissed the question, saying that population growth did not need any special attention. It would look after itself. He was voicing an uncritical interpretation of the demographic transition, a “theory” which has as much evidence to support it as the fictitious Da Vinci Code, and like the Da Vinci Code it remains perennially popular.

Crisis in the Sahel: Possible Solutions and the Consequences of Inaction

A report following the OASIS Conference (Organizing to Advance Solutions in the Sahel) hosted by the University of California, Berkeley and African Institute for Development Policy in Berkeley on September 21, 2012.
The goal of this report is to start building a network of scientists and policy makers committed to helping the Sahel address its population, environment, and food security challenges. A compelling body of evidence is needed to inform people in governments and relevant local institutions, humanitarian organizations, foreign aid agencies, philanthropic institutions, and national security agencies concerning the startling challenges facing this neglected and highly vulnerable region.

Why Bold Policies for Family Planning are Needed Now

Last spring at a Technology, Entertainment, Design (TED) talk in Berlin, Melinda Gates used this phrase, “The most transformative thing you can do is to give people access to birth control.” She expressed similar sentiments at the London Summit on Family Planning on July 11, 2012, as did the British Prime Minister David Cameron, and Andrew Mitchell who was then Secretary of State for the Department for International Development, the British equivalent of United States Agency for International Development. The London Summit represented a new focus on international family planning after nearly 20 years of collapsed budgets. It set the goal of halving the number of women with an unmet need for family planning in the world’s poor counties in the next 8 years — that is, helping 120 million out of an estimated 222 million women worldwide with an unmet need for family planning. Donor governments and foundations pledged US$2625 million dollars over the next 8 years to reach this goal. Governments of the target countries, especially India, committed another US$2 billion. This renaissance in international family planning is exceedingly welcome, but if it is to succeed, it must pay particular attention to the least developed countries (LDCs).

Published in: Contraception (Article In Press) 

The Impact of Freedom on Fertility Decline

Although fertility decline often correlates with improvements in socioeconomic conditions, many demographers have found flaws in demographic transition theories that depend on changes in distal factors such as increased wealth or education. Human beings worldwide engage in sexual intercourse much more frequently than is needed to conceive the number of children they want, and for women who do not have access to the information and means they need to separate sex from childbearing, the default position is a large family. In many societies, male patriarchal drives to control female reproduction give rise to unnecessary medical rules constraining family planning (including safe abortion) or justifying child marriage. Widespread misinformation about contraception makes women afraid to adopt modern family planning. The barriers to family planning can be so deeply infused that for many women the idea of managing their fertility is not considered an option. Conversely, there is evidence that once family planning is introduced into a society, then it is normal consumer behaviour for individuals to welcome a new technology they had not wanted until it became realistically available. We contend that in societies free from child marriage, wherever women have access to a range of contraceptive methods, along with correct information and backed up by safe abortion, family size will always fall. Education and wealth can make the adoption of family planning easier, but they are not prerequisites for fertility decline. By contrast, access to family planning itself can accelerate economic development and the spread of education.

Criticism of misguided Chu et al. article

Chu, Brhlikova and Pollock’s article suggests the WHO rethink its decision to include misoprostol on the Essential Medi- cines List. Their paper is a sad example of workers in an elite setting advocating policies with the potential to endanger the lives of thousands of vulnerable women in low-resource settings.

Training traditional birth attendants to use misoprostol and an absorbent delivery mat in home births.

A 50-fold disparity in maternal mortality exists between high- and low-income countries, and in most contexts, the single most common cause of maternal death is postpartum hemorrhage (PPH). In Bangladesh, as in many other low-income countries, the majority of deliveries are conducted at home by traditional birth attendants (TBAs) or family members. In the absence of skilled birth attendants, training TBAs in the use of misoprostol and an absorbent delivery mat to measure postpartum blood loss may strengthen the ability of TBAs to manage PPH. These complementary interventions were tested in operations research among 77,337 home births in rural Bangladesh. The purpose of this study was to evaluate TBAs' knowledge acquisition, knowledge retention, and changes in attitudes and practices related to PPH management in home births after undergoing training on the use of misoprostol and the blood collection delivery mat. We conclude that the training was highly effective and that the two interventions were safely and correctly used by TBAs at home births. Data on TBA practices indicate adherence to protocol, and 18 months after the interventions were implemented, TBA knowledge retention remained high. This program strengthens the case for community-based use of misoprostol and warrants consideration of this intervention as a potential model for scale-up in settings where complete coverage of skilled birth attendants (SBAs) remains a distant goal.

Global warming and reproductive health

The largest absolute numbers of maternal deaths occur among the 40–50 million women who deliver annually without a skilled birth attendant. Most of these deaths occur in countries with a total fertility rate of greater than 4. The combination of global warming and rapid population growth in the Sahel and parts of the Middle East poses a serious threat to reproductive health and to food security. Poverty, lack of resources, and rapid population growth make it unlikely that most women in these countries will have access to skilled birth attendants or emergency obstetric care in the foreseeable future. Three strategies can be implemented to improve women’s health and reproductive rights in high-fertility, low-resource settings: (1) make family planning accessible and remove non-evidenced-based barriers to contraception; (2) scale up community distribution of misoprostol for prevention of postpartum hemorrhage and, where it is legal, for medical abortion; and (3) eliminate child marriage and invest in girls and young women, thereby reducing early childbearing.

The remarkable story of Romanian women’s struggle to manage their fertility

In 1957, along with many countries in Eastern Europe, Romania liberalised its abortion law. The Soviet model of birth control made surgical abortion easily available, but put restrictions on access to modern contraceptives, leading to an exceptionally high abortion rate. By the mid-1960s there were 1 100 000 abortions performed each year in Romania, a lifetime average of 3.9 per woman, the highest number ever recorded. In October 1966, 1 year after coming to power, in an attempt to boost fertility, Romania’s communist leader Nicolae Ceausescu made abortion broadly illegal, permitting the procedure legally only under a narrow range of circumstances: for women with four or more children, over the age of 45 years, in circumstances where the pregnancy was the result of rape or incest or threatened the life of the women, or in the case of congenital defect.

Published in Journal of Family Planning and Reproductive Health Care 2013: 39(1), 2-4.