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Family planning in South Asia: Improving equity of access

Julie McLaughlin's picture

On July 11, World Population Day, while global health leaders  meet in London to discuss giving greater priority to family planning, World Bank health staff in South Asia will be thinking about how to more effectively support women and families in this region to space births and avoid unwanted pregnancies. 

 

While the countries of South Asia have made progress in increasing access to modern family planning, and reducing total fertility rates, the region still accounts for the second highest burden of maternal deaths. Poor, marginalized and uneducated households do not have access to the reproductive health services they need, including family planning.

 

In India, Nepal and Pakistan in particular, the differences in fertility and use of contraception across socioeconomic groups are striking: In India, the fertility rate among the wealthiest part of the population is only 1.8, while it remains 3.9 among the poorest. In Nepal, educated women have on average 1.9 children while the least educated have an average of 3.7.In Pakistan, contraceptive prevalence is 32% among wealthier couples and yet only 12% among poor couples. In the Indian state of Meghalaya, 36% of couples who want to practice family planning lack access to effective contraception.

U.S. health reform – The cartoon version

Owen Smith's picture

Health Care Reform, by Jonathan GruberIn a landmark decision, the U.S. Supreme Court today upheld the main provisions of President Obama’s Affordable Care Act, including the individual mandate (i.e., everyone must buy health insurance). It represents a major step towards universal coverage for health care in the U.S., something that many countries around the world are striving to achieve.

For those interested in gaining a better understanding of this complex legislation, you can do no better than to start with a graphic novel about the law written by Jonathan Gruber, a professor at MIT and one of the main architects of the Affordable Care Act (and, for that matter, of the Massachusetts health reform that it closely resembles). It’s a great introduction to the policy issues surrounding market failure in health insurance, without having to wade through a dry textbook or World Bank report.

South Asia's nutrition marketplace

Julie McLaughlin's picture

Malnutrition in South Asia is the worst in the world (yes, worse than that of sub-Saharan Africa). It undermines the efforts of countries to reduce poverty, increase educational attainment and productivity, expand innovation and entrepreneurship, and reduce maternal and child mortality. It’s also why, for the past two years, 21 organizations from India, Nepal, Afghanistan, Pakistan, Sri Lanka and Bangladesh have implemented community-based innovations for improving infant and young child nutrition, financed by a unique World Bank small grants initiative known as the Development Marketplace.

Intersectoral work for health: Mirage or oasis?

Patricio V. Marquez's picture

It is common to hear officials from countries and international agencies talk about the multiple challenges that impede intersectoral work for health. The concern is valid: while ministries of health and related institutions are organized and funded to improve the “health” of the population, other ministries do not have such a mandate. In most cases, this has led to a certain paralysis characterized by lofty aspirations in the health sector about the potential benefits of intersectoral action, but with little collaboration and action involving other sectors.

Survie de l’enfant: Un impératif des systèmes de santé

Cristian Baeza's picture


La semaine dernière, l’Inde, l’Éthiopie et les États-Unis organisés un Sommet pour des actions concrètes en faveur de la survie de l’enfant, avec la participation de représentants venus du monde entier. Cet événement est à la fois opportun et fondamental : l’enjeu est de renforcer davantage les engagements pris sur le plan national et international ainsi que la responsabilité des pays dans la réalisation du quatrième objectif du Millénaire pour le développement (OMD), qui vise à réduire la mortalité infantile. Si de nombreux progrès ont été accomplis dans ce domaine, il est des pays qui risquent de ne pas remplir cet objectif à l'horizon 2015 et qui ont le plus besoin de notre soutien et de notre coopération.

Supervivencia infantil: Un imperativo de los sistemas de salud

Cristian Baeza's picture

Child Survival Call to Action

La semana pasada, los Gobiernos de India, Etiopía y Estados Unidos organizaron una Cumbre de Llamamiento a la Acción para la Supervivencia Infantil, con la participación de líderes mundiales y nacionales. Se trata de un evento oportuno y fundamental, destinado a fortalecer aún más el compromiso mundial y de los países y la responsabilidad de estos en el logro del objetivo de desarrollo del milenio (ODM) 4: reducir la mortalidad infantil. Aunque hemos observado una mejora sustancial en esta meta, los países que requie renmás de nuestro apoyo y asociación podrían no alcanzarla para 2015.

Child survival: A health systems imperative

Cristian Baeza's picture

Child Survival Call to Action

This week, the governments of India, Ethiopia and the United States will host a Child Survival Call to Action summit, with the participation of country and global leaders. This is a timely and critical event, aimed at further strengthening global and country commitment and country accountability for MDG4, to reduce child mortality. Though we’ve seen substantial improvement on this goal, the countries that need our support and partnership most may not reach it by 2015.

ICTs to transform health in Africa: Can we scale up governance and accountability?

Meera Shekar's picture

Uganda man sends health SMS.

Start-up eHealth innovations are popping up all over Africa, providing a glimpse of how ICTs can transform the delivery and governance of health services in the region. Many of these pilots show promise, but their rapid growth also poses challenges: At an eHealth conference held in Nairobi in May and co-organized by the World Bank, health professionals and development partners discussed how to identify the best of these evolving tools and bring them to scale.

Circumcision and smoking bans: Can policies nudge people toward healthy behaviors?

Patricio V. Marquez's picture

Walking through river. Mali. Photo: © Curt Carnemark / World Bank

The scaling up of voluntary medical male circumcision, particularly in high HIV prevalence settings, is a highly cost-effective intervention to fight the epidemic—randomized controlled trials have found a 60% protective effect against HIV for men who became circumcised.

But, the supply of this medical service is just one part of the picture. Without active involvement from individuals and communities to deal with social and cultural factors that influence service acceptability, the demand for this common surgical procedure will be low.

Indeed, on a recent visit to Botswana, a country with high HIV prevalence and low levels of male circumcision, my World Bank colleagues and I had a good discussion with the National HIV/AIDS Commission about ways to address the low uptake of voluntary, safe male circumcision services in spite of a well-funded program by the government.  It was obvious to all that if the demand for, and uptake of, this service were not strengthened through creative mechanisms that foster acceptance, ownership, and active participation of individuals and community organizations, the program would not help control the spread of HIV through increased funding of facilities, equipment, and staff alone.

So, what do we need to do to ensure that need, demand, utilization, and supply of services are fully aligned to improve health conditions?

Food and nutrition: How do we balance the equation?

Leslie Elder's picture

Although the world produces a surplus of food, we have yet to achieve the right balance between the production of food and achievement of good nutrition. A new World Bank-hosted knowledge platform will generate better understanding of the links between agriculture, food security and nutrition, to help countries reach the Millennium Development Goal on hunger (MDG 1). Read more on the SecureNutrition blog.

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