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The MacArthur Strategy: Helping save lives of new mothers and providing information to young people <>

- Population Momentum

The International Perspective <>

- Buying Time: The Anti- Shock Garment

The MacArthur Foundation in Mexico <>

The MacArthur Foundation in Nigeria <>

- Sexuality Curriculum in Nigerian Schools

The MacArthur Foundation in India <>

- Reducing Infant Mortality and Maternal Morbidity One Village at a
Time


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Population and Reproductive Health

Just over 10 years ago, at a meeting in Cairo of 179 member states of
the
United Nations, an agreement was reached on a strategy for linking
economic
development and the slowing of population growth by focusing on womens
reproductive health and rights and education. It was a bold step that,
despite a world in continued turmoil, is workingat least at the global
level. Where the worlds population was growing by 93 million people per
year in 1995, the growth today is 77 million per year, a decline of 17
percent.

This reduction is not due to a worldwide focus on simply reducing the
number of people. It has come primarily through the growing reality
that
people will make wise choices if they have information and access to
adequate health care and if womens well-being is squarely at the center
of
population policy.

It is hard to imagine an issue in which individual decisions and the
large
forces that shape the course of a nations well-being are more closely
connected. Research now shows that when women have access to good
information and health care, they are in a position to make sensible
choices about the size of their family. The better a womans education,
the
longer she delays her age of marriage. Such individual decisions can
add
up to
better lives for women and their families, a more robust job market,
and,
ultimately, stronger national economies.

In this issue of the MacArthur Foundations newsletter, we will discuss
its
grantmaking related to population and reproductive health, an area
central
to our international efforts for almost 20 years. It is an area of work
that
is done through our offices in Chicago as well as in three countries of
special focus-Mexico, Nigeria, and India-where the Foundation has
in-country
offices. The strategy that guides our current work is clear. The
research
underway explores new aspects of this important issue.

As always, we welcome your comments <mailto:4answers@macfound.org> .


Jonathan F. Fanton
President John D. an
d Catherine T. MacArthur Foundation


The MacArthur Strategy: Helping save lives of new mothers and providing
information to young people



AT A GLANCE:
MACARTHUR'S POPULATION AND REPRODUCTIVE HEALTH AREA
Number of organizations receiving support: 259
Focus countries: Mexico, Nigeria, India
Total grants authorized, 2004: 67


There are many points of entry to an issue as vast as population and
reproductive health. The challenge to is find ways in which grant
support by
the Foundation can be useful in the short run and help in building
strategies that can ultimately be national or international in scope.
It is
an ambitious goal, recognizing always that one foundations resources
are
small compared to the need.

We have chosen two themes to shape our grantmaking, internationally
and
within our three focus countries. They are:


* Reducing maternal mortality and morbidityin other words, helping
save
the lives of new mothers
* Advancing young peoples sexual and reproductive health and rights by
ensuring that they have good information as well as access to services

The Foundation carries out its work relating to population in two
ways. It
has offices in three focus countries-Mexico, Nigeria, and India-chosen
because of the urgency of the population issue and the potential to
make
progress, given the right conditions. MacArthur also provides grants to
international organizations in a position to address the population
issue on
a global scale.

Providing support for efforts to increase the chances that women in
the
developing nations of the world will have safe pregnancies and
deliveries is
a worthy objective in its own right. But we also believe that changes
in the
rate of maternal mortality and morbidity tells a larger story. If the
rate
is going down, it is an indication that the services and information
needed
for women to make informed reproductive choices are available.

When young people are able to obtain reproductive health information
and
services, they increase their chances to make a successful transition
to
adulthood. There is a greater likelihood that they will make the type
of
decisions that will delay their becoming parents. It is a particularly
important decision in countries where there has traditionally been
great
pressure on young people to marry early and have children while still
very
young, and where access to information about sexuality has been
minimal.




POPULATION MOMENTUM

An important consideration in the population issue is population
momentumthe fact that the worlds population will continue to grow even
after
the point of replacement-level fertility (two children per couple) has
been
reached. It happens when there is a high concentration of people who
are in
their childbearing years, like now, when an estimated half of the
worlds
population is under the age of 25. So even though rates of population
growth
might slow down, because there are so many more young people having
children, the numbers of people will continue to rise. Once the current
generation of young people moves through its childbearing years,
population
growth rates will slow down. But population momentum will push the
worlds
population to an estimated 9.2 billion people by 2075, compared to 6.1
billion in 2000. Any delay in childbearing will have a major impact on
population growth rates. So reproductive health information and
services for
young people are vital in addressing population issues.





The International Perspective



At the same time it supports work in three focus countries (India,
Nigeria, and Mexico), the Foundation allocates approximately $4 million
each
year for grants of three types to international organizations.


* Organizations sustaining the infrastructure of the population and
reproductive health field
* Organizations reinforcing work in the three focus countries on
maternal
mortality and young people
* Organizations that can offer new ideas and directions through
research

INFRASTRUCTURE
The Foundation believes that institutions matter, so each of its
grantmaking areas provides support to a number of groups it considers
important to build knowledge and advance a particular field. They are
organizations that can give a field like population and reproductive
health
much of its intellectual leadership, research, advocacy on policy
issues,
and capacity-building services.

Some grants don't precisely fit the Foundation's strategy, but when
special situations arise, having the flexibility to respond to them is
valuable. A recent example is a grant to the Population Council
/www.popcouncil.org/> in support of an Arabic language website
that
provides information on reproductive health matters. It is seen as a
way of
providing information and stimulating discussion and debate among
Arabic-speaking health and population professionals on reproductive
health
and rights matters.

REINFORCING WORK IN THE FOCUS COUNTRIES
With the Foundation-supported work in Mexico, Nigeria, and India
focused
on addressing maternal mortality and morbidity and helping ensure that
young
people have access to reproductive health and rights information and
services, it makes sense to provide grants to international
organizations
that parallel these themes. It is a way of seeing lessons learned in
the
three countries move up to the regional and international levels and to
bring state-of-the-art approaches back down. Researchers at the
University
of California, San Francisco, for example, are field testing a
promising
device called the anti-shock garment ( see below <> ) that can give a
woman
experiencing life-threatening hemorrhaging in childbirth extra time to
reach
a medical facility. Because of MacArthur support, the researchers were
able
to field test and document the results of the garments use in two of
the
focus countries, Mexico and Nigeria.




Buying Time: The Anti-Shock Garment

The Foundation is supporting the testing of an "anti-shock" garment in
Egypt, Mexico, and Nigeria, through a grant to the University of
California,
San Francisco's Women /www.wghi.org/> 's Global Health
Imperative
Project. The garment is a neoprene suit used to slow hemorrhaging in
women
who experience problems in childbirth. Use of the anti-shock garment is
a
low-cost way of giving women critical travel time to seek medical care
during childbirth emergencies. The testing is still in its early
stages, but
early indications are encouraging. In Nigeria, a significant number of
successful uses of the garment have been documented. In one case a
woman
whose life was saved by the garment was showing what hospital personnel
called the last physical signs before death when she reached the
hospital. A
total of 180 cases in Mexico, Nigeria, and Egypt will be documented.
This
data will help develop a plan for use of the garment on a larger scale.
Dr.
Paul Hensleigh, one of the coordinators of the study, has published a
paper
/www.macfound.org/board_news/Edition_32/hensleigh.pdf> on use
of the
garment in Pakistan.



RESEARCH
A fairly new direction for the Foundations work in population and
reproductive health are research grants exploring topics such as the
relationship among population age, economic growth, and reducing
poverty.
The basis of this relationship is the concept of the demographic
dividend,
the idea that fertility decline leads to larger proportions of
working-age
people. The result of this change in age structure is being studied to
determine what its influence would be on economic growth and lower
rates of
poverty.

The consensus among scholars is that the evidence developed to date
about
the demographic dividend is not sufficient to overcome the doubts that
skeptics have raised about the validity of the hypothesis. These
doubts
exist both about the macro or national-level research, comparing one
country
to another, and about the micro or household-level research, analyzing
the
impact of individuals' behaviors over time. MacArthur is supporting
research at each level. The Harvard University School of Public Health
/www.hsph.harvard.edu/> is exploring the demographic dividend
at the
macroeconomic or national level. George Washington University
/www.gwu.edu/~cih/> 's Center for Global Health is examining
ways in
which population and fertility are linked to poverty at the household
level.
Results of this research will help identify and influence policy
decisions
that might emerge from a fuller understanding of this intriguing link
between population and economic growth.

The research by George Washington University, for example, is
examining
longitudinal data to examine questions such as how early childbearing,
having many children, or maternal mortality in a household influences
the
health and educational prospects of that family. For example, does a
young
mother drop out of school? Does having many children reduce the
investment
in schooling for some of them (especially girls)? Does the death of a
mother
have adverse health and educational effects on the children left
behind,
and, if so, what kind and to what degree? The answers are likely to
help
weigh alternative reproductive health investments in economic terms.



_____

The MacArthur Foundation in Mexico


When a foundation decides to work in a country as large and diverse as
Mexico, it confronts the question of how best to focus its grantmaking.
For
the theme of reducing maternal mortality and morbidity, the emphasis is
on
three states in that country, Chiapas, Guerrero, and Oaxaca, where the
worst
reproductive health indicators and the highest maternal mortality
ratios are
found. The Foundation has a particular interest in contributing to
development of a comprehensive referral system involving doctors,
midwives,
community leaders, and public health officials. The strategy is
supported by
work at the national level and in Mexico City to improve policies and
programs and to bring attention to the causes of serious problems women
face
in childbirth.

In the state of Oaxaca, for example, a grant has been given to the
Oaxaca
chapter of the National Forum of Women and Population Policy
/www.laneta.apc.org/foropob/> to increase the availability of
emergency obstetric care at primary health care facilities. Assuring
access
to emergency obstetric care is one of the principal international
strategies
for reducing maternal mortality. In Mexico there have been no
concerted
efforts to train primary health care professionals in rural areas to
manage
basic obstetric situations such as hemorrhage, infection, and
hypertension
and to ensure linkages between primary and secondary health facilities.
Foro Oaxaca also facilitates the training of more than 200 nurses and
doctors at 38 health centers in the region about the reasons that
indigenous
women do not trust public health care and services, and about how to
build
that trust.

With regard to young people's sexual and reproductive health and
rights,
the Foundation is supporting work that focuses on strengthening the
policy
and program structure that brings information on these topics to young
people. One key strategy is supporting the work of nongovernmental
organizations to help government agencies refine their service delivery
to
be more appropriate for youth. This includes grants to organizations
such
as Afluentes /www.afluentes.org/> and THAIS
/www.thais.org.mx/> , to help the Mexican agency that offers
health
services to poor people in 17 states, and IMSS Oportunidades
/www.imss.gob.mx/IMSS/IMSS_SITIOS/IO/home.htm> , to both improve
its
outreach to youth in communities and to prepare its providers to treat
young
people in a more welcoming manner. It also includes a grant to Salud y
Genero /www.saludygenero.org.mx/> to ensure that Ministry of
Health
officials in seven states are trained to respond to the needs of young
people and to counter the criticisms that can arise from the government
serving them as clients.

One grantee, Letra S /www.letraese.org.mx/> , works with
journalists to get correct information and compelling stories out about
young people, while another, CIMAC, /www.cimac.org.mx/> does
the
same on the topic of maternal mortality.



_____

In Nigeria


The maternal mortality ratio in Nigeria, according to Population
Action
International, /www.populationaction.org/> is 1,000 deaths per
100,000 live births-among the highest in the world. According to the
Nigerian Demographic and Health Survey, less than ten percent of women
use
family-planning methods, and less than 30 percent receive prenatal care
and
delivery by a qualified service provider. As for young peoples sexual
and
reproductive health and rights, more than 26 million young people
between
the ages of 10 and 19 have limited access to information to help stop
or
reduce what are seen as epidemic levels of complications from
abortions,
sexually transmitted infections, and HIV/AIDS. An estimated 60 percent
of
rural women have given birth by age 20.

Designing a grantmaking strategy to address such needs is a daunting
task,
one that MacArthur has embraced since opening its Nigeria office in
1994. As
in its other focus countries, the Foundation geographically
concentrates
much of its support in six states: Cross River, Enugu, Lagos, Kano,
Borno,
and Plateau.

With a focus on those states and related national-level activities,
the
Foundation supports:


* Implementation of Nigerias national sexuality education curriculum
* Model programs designed to alleviate maternal mortality and
morbidity
and to demonstrate the feasibility of reproductive health services that
young people will use
* Implementation of Nigerias national reproductive health policy and
strategy
* Implementation of laws that improve the reproductive health and
rights
of young people at the legal and social status of women

> At the national level, the MacArthur Foundation provides grants to
organizations such as Campaign Against Unwanted Pregnancy and the
Centre for
Development and Population Activities /www.cedpa.org/> .

SEXUALITY CURRICULUM IN NIGERIAN SCHOOLS

As a nation, Nigeria has taken impressive steps to develop a national
sexuality education curriculum for its schools. In 1996, with
Foundation
support, a National Task Force on Sexuality Education developed
guidelines
for such a curriculum. In 2001, the Nigerian government, through its
National Council on Education, adopted the curriculum. MacArthur
grantees
such as Action Health Incorporated /www.actionhealthinc.org/>
in
Lagos State and Girls Power Initiative
<http://portal.unesco.org/en/ev.php-URL_ID=20372&URL_DO=DO_TOPIC&URL_SECTION
=201.html> in Cross River were instrumental in the drafting of the
document. Sexuality education is also endorsed in the National
Reproductive
Health Framework and Plan adopted in 2002.
>
> There is, however, considerable distance between national policy and
its
implementation at the state and local levels. With Foundation support,
Nigerian nonprofits are working with the Ministries of Education and
Health
to help them understand the importance of the curriculum. Others are
engaged
in teacher training and work with parents and community and religious
leaders. There is special emphasis on this work in the six priority
states
where MacArthur is focusing its population and reproductive health
grantmaking efforts. Success there is expected to provide models for
implementation in other states.


In India


The two main themes of the Foundations work in population and
reproductive
health in India are consistent with Indias National Population Policy
2000,
which reaffirms the Indian governments commitment to achieve rapid
stabilization of the countrys population. The policy's goals include
reducing the maternal mortality ratio to less than 100 per 100,000 live
births, delaying the age of marriage for young girls, achieving 80
percent
institutional deliveries and 100 percent deliveries by trained birth
attendants, and addressing the unmet needs for basic reproductive and
child
health services.
>
> The Foundation, consistent with its approach in Mexico and Nigeria,
focuses its work in three states, Rajasthan, Maharashtra, and Gujarat.
The
three were chosen because of the significant unmet need for information
and
service. Geographically they are adjacent to one another, and there are
nongovernmental organizations in place with the capacity to work on
reproductive health and rights issues.
>
> At the national level, the Foundation provides grants to institutions
engaged in training, research, and policy-related information
activities
designed to encourage national discussion of population and
reproductive
health issues.
>
> A grant to the Federation of Obstetrics and Gynecological Societies
of
India (FOGSI), a professional organization with a membership of 18,000
obstetricians throughout India, addresses maternal mortality and
morbidity
reduction. FOGSI develops the capacity of non-specialist medical
providers
to provide quality emergency obstetric care in rural areas of India to
prevent maternal deaths. This project is a major step forward to
address the
key bottleneck in providing 24-hour emergency obstetric services in
underserved areas.
>
> A grant to the International Institute for Population Sciences (IIPS)
/www.iipsindia.org/> assesses young people's reproductive and
sexual
health in six states. The data can then be used for evidence-based
advocacy
and also to inform national-level policies and programs. The specific
outcomes would be a) a national database on young people's knowledge,
attitudes, and behavior pertaining to reproductive and sexual health,
b)
national-level and focus state-specific dissemination workshops with
government participation, and c) guidelines for standardized indicators
for
future studies and advocacy for inclusion of select indicators in the
National Health and Family Surveys (NFHS). In fact, the technical
advisory
committee constituted by IIPS a year and half ago has also been
advising the
government in the design of the next NFHS. One major achievement has
been
the inclusion of unmarried adolescents in the national survey for the
first
time.
>
>
>
>
> REDUCING INFANT MORTALITY AND MATERNAL
> MORBIDITY ONE VILLAGE AT A TIME
>
> A husband-and-wife team of doctors in India is making a difference in
helping reduce that country's infant and maternal mortality ratios. Dr.
Abhay Bang and Dr. Rani Bang lead the Society of Education, Action and
Research in Community Health (SEARCH) in the Gadchiroli district of
India.
Their Home-Based Neonatal Care Program, which trains village women to
diagnose and treat newborns, reduced incidents of infant mortality over
a
one-year period from 120 to 30 in 39 villages in their district. During
the
same period, postpartum maternal morbidity in the intervention area was
reduced by more than 50 percent. This program is now being replicated
at
seven sites in Maharashtra, one of the Foundation's priority states in
India, through NGOs working under the guidance of SEARCH. The
Government of
India is piloting the approach in five states with the view to scaling
it up
into the national reproductive and child health program. In a country
like
India, where state-of-the-art medical care at modern hospitals is not
accessible to millions of villagers, this program holds great hope.
SEARCH
received a MacArthur grant of $300,000 in 2001. The program is also
funded
by the Gates Foundation as one of two potential models for reducing
infant
mortality and maternal mortality and morbidity in developing countries.


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_____

The John D. and Catherine T. MacArthur Foundation
140 S. Dearborn Street, Chicago, IL 60603-5285 USA
Phone: (312) 726-8000 TDD: (312) 920-6285 4answers@macfound.org
Copyright 2005


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