Developing strategies to end hunger
 

Sad Statistics for the United States on Maternal Mortality

As a policy analyst, my life revolves around data related to hunger, poverty and nutrition of mothers and their children. Statistics are the tool of my trade. I use them to report, to convey information, and often to advocate on issues. A few stay with me: 805 million hungry people in the world (one person in nine); 165 million stunted children who will never reach their full potential in life.

In my research for the Institute’s series celebrating Women’s History Month, I came across another statistic that will stay with me for a long time. A study by the respected British medical journal The Lancet found that the United States is one of only eight countries where maternal mortality (death from complications of pregnancy or childbirth) is on the rise. The other countries are Afghanistan, Greece, and several countries in Africa and Central America.

In this country, 18.5 mothers died for every 100,000 births in 2013—almost 800 women died here that year alone. This is double the rate of Canada and triple the rate of the United Kingdom! What is going on here? How is it that women in the United States are dying at a faster rate from causes related to pregnancy and childbirth than in almost any other place in the developed world?

There seem to be several contributing factors. Some of the reported rise in mortality is likely due to more rigorous data collection; the United States is one country where data on almost anything is readily available. Another factor is the rise in the number of pregnant women here who have conditions—such as hypertension and diabetes—that contribute to making their pregnancies “high risk.” More girls with heart or neurological diseases are surviving to adulthood—good news, but they remain at higher risk during pregnancy and childbirth.

Perhaps the most shocking statistic is that American women of color – particularly African Americans -- are three times more likely to die as a result of pregnancy or giving birth than their white counterparts. Higher poverty rates, which carry numerous consequences such as more chronic health problems and less access to prenatal care, are a major reason that women of color in our country run much higher risks in becoming mothers. 

There is a parallel between efforts to end maternal mortality and efforts to end global hunger. We know that a lack of available food is not the problem. It is getting access to nutritious food — a particular problem for pregnant women and children – that is a major problem. Affording food and reaching a place where it is available pose the biggest challenges. Researchers have found the same to be true in efforts to end maternal mortality -- particularly during or shortly after childbirth. The major problems are affordability and access to skilled care. This is true in the United States as in many developing countries.

The situation is even worse in “fragile states,” developing countries suffering armed conflict or civil war while also confronting high rates of food insecurity. 

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Mothers and small children line up at a health clinic. Credit: UN

In its State of the World’s Mothers 2014 (SOWM) report, the international organization Save the Children says: “These countries and territories (more than 50 in number) lack resilience to emergencies and face chronic underlying challenges, including extreme poverty, weak infrastructure, and poor governance. In these settings, children and mothers face an everyday emergency, whether or not a humanitarian crisis is officially recognized by the international system.”

During this Women’s History Month, I encourage you to read Save’s SOWM report and take a look at the statistics on maternal mortality compiled by the World Bank and the United Nations World Health Organization. As a result of a concerted effort by governments, international donors, and civil society, we are making remarkable progress toward the goal of ending hunger.  Much less progress has been made toward the fifth Millennium Development Goal of reducing maternal mortality by three-fourths. An equally concerted and collaborative effort, accompanied by sustained funding for healthcare programs in the United States and overseas, particularly in fragile states, is needed to help women survive as they secure humanity’s future by bearing children.

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Women's History Month: Where We're Coming From

Global women's movement photo

Carrying firewood in Bangladesh. To help end gender discrimination, unpaid chores must be more equitably shared. Photo by Todd Post/Bread for the World.

Welcome back to Bread for the World Institute's March series celebrating Women's History Month by illustrating the many ways women's empowerment and gender equity are intertwined with our mission: ending hunger, malnutrition, and food insecurity. (For more on what we mean by "women's empowerment," see yesterday's series opener).

Our 2015 Hunger Report, When Women Flourish ... We Can End Hunger, identifies three components of efforts to achieve gender equity and the progress against hunger that comes with it: more bargaining power, more equitable sharing of unpaid work such as household chores, and greater representation in government and civil society.

Progress in redressing the power differential between men and women has made it possible for women to take many steps forward. Ending gender discrimination is a necessity if women are to gain enough bargaining power to live their lives as equal and equally valued members of their society. In 1979, the United Nations General Assembly adopted the Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW). As of 2014, all but seven countries have ratified the convention: the United States, Sudan, South Sudan, Somalia, Iran, Palau, and Tonga.

Women perform many more hours of unpaid labor than men -- often burdensome tasks such as fetching water from faraway wells and pounding grains so that they can be cooked. At the same time, most must also grow food or participate in the informal or formal paid economy.

A third area of "women's work" is, of course, to ensure humanity's future by bearing children. It was this area -- workplace rights for pregnant and nursing women -- that saw the first international effort to recognize and try to ease the difficult balancing act between work and family responsibilities required of most women. In 1919, the International Labor Organization adopted the Maternity Protection Convention, under which new mothers are entitled to 12 weeks of paid leave and, once they return to work, two breaks each day to nurse their babies. The most recent update, adopted in 2000, provides for 14 weeks of paid leave. There are just four countries that require no paid maternity leave at all: the United States, Papua New Guinea, Lesotho, and Swaziland.

Finally, equality for women requires that a fair share of their society’s leadership reflects and represents their experiences and perspectives. One of the most basic indicators of the ability to help lead is whether a person has the right to vote. In 1893, New Zealand became the first country to make women's suffrage the law of the land. By 1994, women had the right to vote in 96 percent of the world's countries. When women in Saudi Arabia are allowed to vote for the first time later this year, there will be only one remaining jurisdiction in the world where men can vote but women cannot -- Vatican City.

For more on the history of the global women's movement, see the timeline in the introduction, "Women's Empowerment: A Moral Imperative," of our 2015 Hunger Report.

 Michele Learner

 

What do we mean by "women's empowerment"?

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Editor’s note: This post kicks off our celebration of Women’s History Month (March). Throughout our 2015 Hunger Report, When Women Flourish … We Can End Hunger, as well as in much of the Institute’s other analytical work, we emphasize the necessity of women’s empowerment and gender equity – not only as a matter of individual rights, but also as an absolute necessity for further progress against hunger and malnutrition. The link between gender discrimination and hunger has proven persistent both in the United States and globally. This month we present stories, graphics, and analysis to help show the way forward on both fronts – gender equity on one hand, and ending hunger, malnutrition, and food insecurity on the other.

Consider two children from poor households living in an Indian city. They are both 7 years old. They live in the same neighborhood and are both excelling in mathematics at the same primary school, showing every sign of a bright future. But one of these children is more likely than the other to still be in poverty as an adult, simply because she is a girl.

People are born into or fall into poverty for many reasons. But the reason a bright young girl is more likely to remain there than a bright young boy has everything to do with empowerment. Empowerment is what is needed when members of a society lack bargaining powerthe ability to negotiate favorable economic outcomes for themselves. When women and girls lack bargaining power, they are denied the opportunity to develop and use their gifts so they can support themselves and their families.

Some of the most common ways of increasing one’s bargaining power include getting more education, participating fully in the economy (which requires, for example, access to financial services such as a bank account or credit), and benefiting from basic social services such as health care. The availability of such “bargaining power builders” varies widely from country to country, but disempowerment means that women and girls almost always have less access to them than men and boys. In fact, our schoolchildren example may be overly optimistic, because it ignores the likely possibility that, even at age 7, the schoolgirl has already encountered home- or community-level barriers to her health, nutrition, and/or education.

It’s worth noting that neither women nor men living in poverty have much economic bargaining power, especially in developing countries where the vast majority of the population does low-paying, low-productivity work. But even within the constraints of poverty, working conditions for men and women are far from equal: women suffer many more forms of discrimination, which worsen the effects of poverty on their lives.

Empowering women is not only the right thing to do—it is an economic no-brainer. Excluding women from an economy is forgoing the efforts and talents of half the workforce. Studies consistently show that increasing women’s and girls’ bargaining power is one of the most effective ways to lift families out of poverty and boost economic growth, because women are more likely than men to invest their earnings back into the well-being of their families.

Discrimination that establishes and reinforces women’s lower status in society starts within the family and extends through social norms and national laws. Women all over the world have struggled for many years to empower themselves by creating change in all of these areas, sometimes aided by their governments and/or male allies – and there have been many improvements. Check back on Institute Notes later this week for a look at what has been achieved so far and what remains to be done.

Derek Schwabe

Good News: Africa Marks Six Months Without a Single Case of Wild Polio

Polio victory 2

Eradication of an infectious disease is one of the absolutes in the field of medicine: the disease can re-emerge so long as there is a single case anywhere in the world. It's all or nothing.

An unprecedented global effort deserves credit for dramatic progress against polio -- an age-old threat to children's lives and health -- in a single generation. It is a true example of the power of global organizations, governments, civil society, and billions of parents dedicated to a single goal.

The world reduced the number of polio cases by more than 99 percent since the late 1980s by vaccinating between 3 and 4 billion children. The list of countries where the virus is endemic has grown shorter and shorter, with India removed from the list last year. Only three endemic countries remain: Pakistan, Afghanistan, and Nigeria.

For several years now, the world has seemed to be on the very brink of eradication. Polio would be only the second major disease, after smallpox in 1977, to be eradicated by human effort.

But conflict and politics continually threaten to undo progress. Nigeria saw an alarming resurgence a couple of years ago, due partly to civil unrest and persistent rumors that polio vaccination teams were, in reality, seeking to make children ill or sterile. And just last week, four members of a polio vaccination team were kidnapped and later found dead in Pakistan -- the latest of at least 70 health workers in Pakistan in the past four years alone to give their lives to help eradicate polio.

There is very good news from Africa, however. In late January 2015 -- January 24 to be exact -- Nigeria celebrated six months with no cases of wild polio. This is a first for Africa's most populous country. The Global Polio Eradication Initiative credits the victory to "increased political commitment, programmatic innovations, and determination from a huge number of stakeholders."

And on February 24, 2015, the Global Polio Eradication Initiative reported that it has been six months since the last reported case of wild polio anywhere in Africa -- an 18-month-old boy from a nomadic community in Somalia who had received his first dose of polio vaccine but missed subsequent ones. Polio teams in Somalia have improved their coverage by studying travel patterns, working with community elders, and focusing on the children of nomads. Somalia eradicated the virus in 2002, but has been reinfected twice by wild poliovirus originating in Nigeria.

Global health officials caution that the victories are fragile. Vigorous vaccination campaigns must continue. Still, it's the first time in Africa's history that no one has wild polio -- and that's something to celebrate.

Photo credit: Margie Nea for Bread for the World

 Michele Learner

 

 

One in Three Women Still Endures Gender Based Violence

One in three women around the world has experienced violence at the hands of an intimate partner

The World Health Organization recently updated its international estimates on violence against women, once again confirming the appalling truth: one in three women (35 percent) experiences violence.  Thirty percent of women worldwide experience violence at the hands of an intimate partner. The 2015 Hunger Report, When Women Flourish…We Can End Hunger, explains how violence against women perpetuates hunger:

Gender-based violence is one of the clearest manifestations of women’s disempowerment, and it is directly associated with hunger. When a farmer is beaten so badly that she ends up physically disabled or with a severe mental illness, the household has lost farming skills that are crucial to ensuring its food security.

Gender-based violence occurs throughout a woman’s lifetime, though it’s more likely to take certain forms at certain ages. Women aged 15-44 are more at risk from rape and domestic violence than from cancer, motor accidents, war, or malaria.  Armed conflict, as we would expect, puts women at greater risk of gender-based violence. In the war-torn Democratic Republic of Congo, 29 of every 1,000 women were raped in 2006 and 2007 alone.

Social norms that treat gender-based violence as normal may well be the greatest barrier to progress toward ending it. The fact that violence against women is socially acceptable is one of the main reasons that survivors do not seek help and support. They are afraid to, knowing that they can expect little or no support from families, friends, or even authorities whose responsibility it is to protect them if they report cases of rape or domestic violence. As in many other contexts, victims are frequently blamed for provoking the violence.

Police officers who investigate a woman’s charge of abuse belong to their own societies, after all, and they reflect their communities’ beliefs. Thus, in a survey of male police officers in India, all of those interviewed admitted that they believe a husband has a right to rape his wife.

Changing centuries-old social norms takes time, and must be locally driven if it’s going to work. But U.S. development assistance can play a catalyzing role by building the capacity of local people to speak up and step out. The Hunger Report offers some sound examples of instances when this has worked. One is the story of Changu Siwawa of Botswana, who participated in the Mandela Washington Fellowship for Young African Leaders—a U.S. led initiative that brought together 500 exceptional young African leaders to share solutions to the continent’s most pressing social ills.  You can read Changu’s full story here on the 2015 Hunger Report website. 

Derek Schwabe

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