Today’s Women International Network (TWIN) s’implique pour l’accès à la santé sexuelle et reproductive en Guinée
La santé sexuelle et reproductive pour tous en Guinée
La Guinée est un pays plein de ressources et de potentiel. Pour assurer la santé et l’avenir de sa population, il doit continuer à investir dans l’accès aux soins de santé sexuelle et reproductive. La population de la Guinée est jeune, et commence la vie sexuelle depuis un bas âge. En Guinée, 1 sur 6 jeunes femmes âgées de 15 à 19 ans a déjà eu un enfant. La basse utilisation de la contraception en Guinée contribue à des grossesses non désirées et l’avortement non sécurisé. Quand les femmes ont recours aux avortements non sécurisés, elles mettent leur santé et leurs vies en danger en courant le risque des hémorrhagies, des infections, la stérilité, ou même la mort.
Today’s Women International Network/Réseau International des Femmes d’Aujourd’hui (TWIN/RIFA) est un réseau fondé en Guinée qui milite pour les droits de la femme, y compris l’accès aux droits de la santé sexuelle et reproductive. En collaboration avec le PRB, TWIN a produit une fiche d’information et une vidéo de plaidoyer pour communiquer les enjeux de l’accès aux soins complets de la santé de la reproduction en Guinée, notamment la planification familiale et les soins après avortement. Avec un meilleur investissement dans la couverture sanitaire des soins au pays, surtout pour les jeunes, la Guinée peut assurer l’avenir et le bien-être de sa population.
S’implique pour l’accès à la santé sexuelle et reproductive en Guinée
August 11, 2021
SAFE ENGAGE is pushing the envelope in applying new evaluation methods to test theories of policy change. Under this project, we are using contribution tracing to determine the causes, or likely causes, of observed policy outcomes related to safe abortion in Lagos State, Nigeria, and Côte d’Ivoire. To our knowledge, this is the first time that contribution tracing is being applied to evaluate policy reform related to reproductive health.
An enabling policy environment is a critical step to ensuring that women and girls have access to comprehensive health care, including safe abortion and postabortion care, but too often conversations around abortion are ideological and divisive. The SAFE ENGAGE project supports constructive, data-driven policy dialogue, works with partners to co-create compelling, evidence-based materials, and offers training and technical support to enhance partners’ policy communication skills to reduce unsafe abortion and expand access to safe abortion.
The SAFE ENGAGE project partnered with Coalition de Lutte Contre les Grossesses Non Désirées to provide fact sheets they can use to inform judges, police chiefs, doctors, associations of medical professionals, and other decisionmakers of the 2018 changes governing legality of abortion in the DRC. These materials are intended to empower these key groups with the information needed to follow both the letter of the law and their own professional obligations.
However, the challenge now is to spread awareness of this change to legal and medical authorities across a vast and politically decentralized nation the size of Western Europe.
Dialogue politique entre jeunes leaders et décideurs politiques sur le maintien de l'utilisation de la contraception chez les jeunes en Afrique de l'Ouest
PACE s'efforce également de mettre en relation les journalistes, les décideurs et les jeunes leaders présents au webinaire, afin de promouvoir des reportages de qualité sur l'utilisation durable de la contraception.
Dans de nombreux pays, les jeunes âgées de 15 à 24 ans présentent des taux d’abandon de la contraception plus élevés que les femmes plus âgées. Afin d’en discuter les causes et d’identifier des solutions au niveau politique, PACE a organisé, le 26 mai, un dialogue politique virtuel de deux heures sur l’abandon de la contraception chez les jeunes en Afrique de l’Ouest, en collaboration avec le Réseau des femmes sénégalaises pour la promotion de la planification familiale et Knowledge SUCCESS. L’événement visait à renforcer l’engagement des décideurs politiques régionaux pour traiter les obstacles à l’utilisation durable de la contraception chez les jeunes et à créer des opportunités de collaboration entre les organisations dirigées par des jeunes, les journalistes et les jeunes chercheurs.
Ce dialogue politique innovant a permis de tirer trois grandes leçons sur l’engagement significatif des jeunes dans les politiques et les programmes de planification familiale :
- Bien que les organisations dirigées par des jeunes offrent des idées novatrices sur la prise de décision en matière de planification familiale, leur rôle dans l’amélioration de l’utilisation des contraceptifs par les jeunes est souvent limité à la sensibilisation. Les jeunes doivent être inclus dans le processus d’élaboration des politiques et des programmes.
- L’environnement juridique et politique est généralement évalué sur l’existence de textes et de documents. Or il convient d’accorder une plus grande attention à l’application des lois et des politiques et à leur effet sur les utilisateurs.
- La poursuite de la contraception doit être prise en compte en même temps que l’accès en tant que tel afin d’optimiser le retour sur investissement des efforts déployés par les gouvernements pour élargir l’accès aux informations et aux services de planification familiale volontaire.
Fatou Diop (Alliance nationale des jeunes pour la santé de la reproduction et la planification familiale – Sénégal) et Rachid Awal (African Youth and Adolescents Network – Niger) – représentant des organisations de jeunes – ont présenté des résultats clés sur l’abandon de la contraception par les jeunes, en s’appuyant sur une note de politique de PACE. Ils ont souligné, entre autres, que les jeunes peuvent être particulièrement sensibles aux effets secondaires et qu’ils sont confrontés à des obstacles importants, tels que les préjugés des prestataires, pour accéder à des services de planification familiale de qualité. Ils ont exposé sept recommandations politiques pour surmonter ces obstacles, telles qu’un counseling de qualité incluant des mécanismes de suivi actif entre les rendez-vous et l’accès effectif à la gamme complète des méthodes contraceptives.
Hervé Bassinga (Institut supérieur des sciences de la population), a présenté les résultats d’une analyse par les étudiants du premier programme de communication pour les politiques de PACE en Afrique de l’Ouest, sur l’ouverture des contextes et des programmes nationaux pour l’utilisation durable de la contraception chez les jeunes au Bénin, au Burkina Faso, en Guinée, au Mali et au Togo. Sa présentation a montré que plusieurs bonnes pratiques de soutien à l’utilisation durable de la contraception chez les jeunes ne sont actuellement pas reflétées dans les politiques des pays et qu’une attention accrue est nécessaire, au niveau politique, pour soutenir la continuation contraceptive. Par exemple, quatre de ces cinq pays n’ont ni loi ou politique favorisant l’accès des jeunes aux soins de planification familiale sans le consentement des deux parents ou du conjoint.
Au cours d’une table ronde animée par les jeunes leaders, plusieurs décideurs politiques de haut niveau, dont l’Honorable Assoupi Amèle Adjeh, parlementaire togolaise, le Dr Siré Camara, fonctionnaire du Ministère de la Santé de Guinée Conakry, Fatimata Sanou Touré, magistrate burkinabè, et Angelo Évariste Ahouandjinou, maire de la plus grande commune du Bénin, ont approuvé les recommandations de la note de politique. Ils ont insisté sur l’importance d’impliquer les jeunes dans les discussions, depuis le niveau communautaire jusqu’au niveau national, sur la manière de soutenir la poursuite de la contraception chez les jeunes. Fatou Diop a insisté sur le fait que les jeunes ne doivent pas être vus comme de simples bénéficiaires de services à informer, mais être considérés comme des égaux ayant des idées novatrices sur la manière d’améliorer la continuation contraceptive.
Fatimata Sanou Toure et l’Honorable Assoupi Amèle Adjeh ont établi le lien entre l’abandon de la contraception chez les jeunes et la question des grossesses non désirées chez les jeunes scolarisées. Le Dr Siré Camara a indiqué qu’en Guinée, les infirmeries des écoles et des universités sont en mesure d’offrir des services de planification familiale.
Fatimata Sanou Touré et le Dr Siré Camara ont également souligné que, même lorsque de bonnes politiques sont en place, leur mise en œuvre demeure problématique. Par exemple, alors que les contraceptifs sont gratuits dans le secteur public dans de nombreux pays, les jeunes préfèrent souvent se les procurer dans le secteur privé. L’Honorable Assoupi Amèle Adjeh a suggéré que les prestataires refusant de fournir des services aux jeunes devraient en supporter les conséquences juridiques. Angelo Évariste Ahouandjinou a également indiqué qu’une ligne budgétaire pour les contraceptifs existe dans sa municipalité et que des informations sur la planification familiale sont disponibles pour les jeunes.
Cet événement a réuni plus de 85 participants, dont plusieurs journalistes ouest-africains. PACE soutient la participation d’organisations de jeunes pour traduire les recommandations en actions politiques: une table ronde sur l’utilisation des données mettra en relation les jeunes leaders et des jeunes chercheurs formé en communication pour les politiques; une formation sur mesure sera mise en œuvre pour renforcer les capacités de communication stratégique des organisations de jeunes afin de soutenir leur implication croissante pour une redevabilité quant à la mise en œuvre des engagements politiques dans leurs pays respectifs. PACE s’efforce également de mettre en relation les journalistes, les décideurs et les jeunes leaders présents au webinaire, afin de promouvoir des reportages de qualité sur l’utilisation durable de la contraception.
July 13, 2021
In many countries, youth ages 15 to 24 have higher rates of contraceptive discontinuation than older women. To explore the factors behind this challenge and identify policy solutions, PACE convened a two-hour virtual policy dialogue on youth contraceptive discontinuation in West Africa on May 26, in collaboration with the Réseau des Femmes Sénégalaises pour la Promotion de la Planification Familiale and Knowledge SUCCESS. The event aimed to increase regional policymakers’ commitment to addressing the barriers to sustained contraceptive use among youth and forge collaboration opportunities for youth-led organizations, journalists, and young researchers.
This innovative policy dialogue provided three major lessons about meaningful youth engagement in family planning policies and programs:
- While youth-led organizations offer innovative insights about family planning decision-making, their role in enhancing youth contraceptive use tends to be limited to youth sensitization. Youth should be included in the policymaking and program design process.
- The legal and policy environment is generally assessed based on the existence of texts and documents, and greater consideration needs to be given to how laws and policies are applied and experienced by users.
- Contraceptive continuation must be considered alongside contraceptive access in order to optimize the return on investment of governments’ efforts to expand access to voluntary family planning information and services.
Fatou Diop (Alliance Nationale des Jeunes pour la Santé de la Reproduction et la Planification Familiale – Senegal) and Rachid Awal (African Youth and Adolescents Network – Niger), representing youth-led organizations, presented key findings about youth contraceptive discontinuation, drawing on a PACE policy brief. They highlighted that youth may be particularly sensitive to side effects and face significant barriers, including provider bias, to accessing quality family planning services. They outlined seven policy recommendations to address these obstacles, such as providing high-quality counseling, including active follow up mechanisms between appointments, and ensuring access to the full range of contraceptive methods.
Hervé Bassinga (Institut Supérieur des Sciences de la Population), alumnus of PACE’s inaugural policy fellows program in West Africa, presented results of the alumni’s analysis of the favorability of national country and program contexts for sustaining youth contraceptive use in Benin, Burkina Faso, Guinea, Mali, and Togo. His presentation revealed that many best practices for sustaining youth contraceptive use are not currently reflected in countries’ policies, and that more attention is needed at the policy level to sustain youth contraceptive use. Of the five countries, four do not have a law or policy that supports youth access to family planning care without consent from both parents and spouses.
During a moderated panel discussion featuring youth leaders, several high-level policymakers, including Honorable Assoupi Amèle Adjeh, a parliamentarian from Togo, Dr. Siré Camara, an official from the Ministry of Health of Guinea Conakry, Fatimata Sanou Toure, a magistrate from Burkina Faso, and Angelo Evariste Ahouandjinou, the mayor of the largest municipality of Benin, endorsed the policy brief recommendations. They emphasized the importance of involving young people in discussions, from the community to the national level, about how to support contraceptive continuation among youth. Fatou Diop emphasized that young people shouldn’t just be considered as recipients of services who need to be reached with information but should be seen as equals who have innovative ideas about how to enhance contraceptive continuation among young people.
Fatimata Sanou Toure and Honorable Assoupi Amèle Adjeh linked youth contraceptive discontinuation to the issue of unintended pregnancies among youth who are in school. Dr. Siré Camara mentioned that in Guinea, nurses’ offices in schools and universities are able to offer family planning services.
Fatimata Sanou Toure and Dr. Siré Camara also emphasized that even when good policies are in place, implementation issues occur. For example, while contraceptives are free in the public sector in many countries, youth often prefer to access contraceptives in the private sector. Honorable Assoupi Amèle Adjeh suggested that providers who refuse to provide services to young people should face legal consequences. Angelo Evariste Ahouandjinou noted that a budget line item for contraceptives is in place for his municipality and that information about family planning is available to youth.
This event included more than 85 participants, including several West African journalists. PACE is supporting the participation of youth-led organizations to translate recommendations into policy action, through connecting youth leaders and policy fellow alumni for a roundtable discussion about data utilization and provide a bespoke policy communication training to the youth-led organizations to support their increased involvement in ensuring accountability for implementation of policy commitments in their respective countries. PACE is also working to connect journalists who attended the webinar with participating decisionmakers and youth leaders, to promote high-quality reporting on sustained contraceptive use.
July 8, 2021
Population age structure—or the relative size of a population across age groups—is important for national policy agendas and resource allocation. Although mortality and migration play a role, a country’s age structure is primarily driven by its past fertility trends, which have important economic, social, and political implications. Whereas countries with sustained, low fertility of less than two children per woman typically experience a relatively large share of middle-aged and older adults, countries with high fertility generally have a large share of children and, to develop, must invest sufficient resources to adequately address their health and educational needs.
As fertility declines from high to low levels, the share of its young dependent population declines relative to those in the working-ages. With a higher proportion of wage earners and fewer dependents to support, a country has a window of opportunity for sustained economic growth—or a demographic dividend—when complementary investments in health, education, and infrastructure are maintained, and policies encourage an open and stable economy.1 The window is time-limited, however, eventually closing as the age structure matures and older adults account for a greater share of the population. Our analysis explores the timing and duration of countries’ window of opportunity in the 24 USAID family planning priority countries (see annex) under different future fertility scenarios.
Countries With Moderate Child Dependency Have Economically Favorable Age Structures
Demographers use a variety of measures to assess the age structure of a population. One such measure is the dependency ratio, or the number of people in the dependent age groups per 100 working-age people. The two principal dependency ratios are the child dependency ratio and the old-age dependency ratio:
Child dependency ratio: Number of children (ages 0 to 14) per 100 working-age adults (ages 15 to 64).
Old-age dependency ratio: Number of older adults (ages 65 and over) per 100 working-age adults (ages 15 to 64).
In practice, not all individuals ages 15 and 64 are working, nor is everyone less than age 15 or 65 and older dependent, economically or otherwise. Nonetheless, these categories help assess the potential burden age structure places on a country and help classify countries in a way that sheds light on the potential challenges and opportunities they face with any given age structure.
Using these two dependency ratios, we developed a typology of age structures consisting of six summary categories defined as follows:
- High child dependency: Countries with a high child dependency ratio (≥45) and low old-age dependency ratio (<15).
- Moderate child dependency: Countries with a moderate child dependency ratio (≥25 and <45) and low old-age dependency ratio (<15).
- Double dependency: Countries with a moderate child dependency ratio (≥25 and <45) and high old-age dependency ratio (≥15).
- High old-age dependency: Countries with a low child dependency ratio (<25) and high old-age dependency ratio (≥15).
- Low overall dependency: Countries with both a low child dependency ratio (<25) and low old-age dependency ratio (<15).2
- High overall dependency: Countries with both a high child dependency ratio (≥45) and high old-age dependency (≥15).
The timing and pace of a country’s age structure shifts depend on the timing and speed at which its fertility rate changes. This article presents future country-level trajectories for age structural transitions under three fertility scenarios—high, medium, and low fertility—between 2020 and 2100 in the 24 countries. Population projections are generated using assumptions about the future and therefore always include an element of uncertainty and variability that should inform their interpretation. This note of caution is particularly relevant for projections looking far into the future. Even in view of these important limitations, comparing the projected trajectories over the next eight decades across three fertility scenarios enables us to highlight the impact that differences in fertility levels can have on age structure changes over time.3
Our analysis explores when and for how long countries are projected to be classified in the moderate child dependency category under each fertility scenario. Based on the few available definitions of the demographic window of opportunity, the moderate child dependency category is the age structure category that is most aligned with the existing definitions.4
Countries in the moderate child dependency category have experienced a decline in child dependency from a high level (45 or more children less than age 15 per 100 people ages 15 to 64) to a moderate level (between 25 and 44 children less than age 15 per 100 people ages 15 to 64), yet old-age dependency still remains low (less than 15 older adults ages 65 and over per 100 people ages 15 to 64). In this category, working-age adults comprise a larger share of the population than any other age group. Assuming the growing working-age population can find gainful employment in the labor markets, savings, production, and income grow, increasing countries’ capacity to invest in social and economic infrastructure and boost sustainable development. When the old-age dependency ratio reaches higher levels, countries increasingly experience pressure to divert resources towards supporting the older population, for example through pensions and long-term care services. This pressure can exist in both double-dependency and high-old age dependency countries. In countries with a limited pension system, working-age adults still provide a source of informal support to older family members. While the low overall dependency category (where both child and old-age dependencies are low) is also an optimal time for investments that boost economic growth, it is common only in a limited number of countries, typically with sustained immigration of working-age adults.
To identify when and for how long countries are projected to be in the moderate child dependency category under each fertility scenario, our analysis identifies which age structure category the countries are projected to occupy for each five-year period between 2020 and 2100 per scenario. We use population projections produced by the United Nations Population Division (UNPD) based on the high-, medium-, and low-fertility scenarios.5 The assumptions in the three fertility scenarios differ by a half-child per woman; that is, compared to the average woman under the medium-fertility scenario, a woman has a half-child fewer under the low-fertility scenario and a half-child more under the high-fertility scenario. The differences in the age structure trajectories across different scenarios therefore reflect the impact of having a half-child more or a half-child less than the medium fertility assumptions made by the UNPD.
Most Priority Countries Will Retain High Child Dependency for Decades
If fertility decline follows the medium fertility scenario—a pattern similar to past transitions—only half of the USAID family planning priority countries will enter the moderate child dependency category by 2050.
Almost all of the countries analyzed—21 out of 24, with Bangladesh, India, and Nepal as the exceptions—were in the high child dependency category in 2020 (see the 2020 map in Figure 1). Under the medium-fertility assumptions, seven of those 21 countries are projected to make the transition from high child dependency to moderate child dependency between 2020 and 2050.6 Twelve more countries are projected to make the transition between 2050 and 2075, and the last two countries, Mozambique and Zambia, are projected to do so between 2075 and 2100. For countries with late transitions, the time spent in the moderate child dependency category is projected to be brief: By 2100, all 24 countries are projected to have transitioned out of the moderate child dependency category and be in the double dependency or high old-age dependency categories.
The projected timing of the transition from high to moderate child dependency varies substantially across and within regions. Some countries in South Asia have already made the transition and the rest are expected to do so by 2045. The transition is projected to take place between 2050 and 2080 for the 10 countries in East Africa and between 2055 and 2075 for the five countries in West Africa according to the medium-fertility scenario.
Figure 1. Age Structure Categories for the 24 USAID Family Planning Priority Countries (Medium Fertility Scenario): 2020, 2050, 2075, and 2100
Variations in the pace of fertility decline can accelerate or stall age structural transitions by over two decades.
The timing of country transitions across each age structure category and each country’s duration within each category also vary substantially under different future fertility scenarios. Under the high-fertility scenario, in which fertility declines slowly, countries are projected to make the transition into the moderate child dependency category 10 to 25 years later compared to the medium-fertility scenario. In contrast, countries could make the transition five to 20 years earlier under the low-fertility scenario with accelerated fertility decline. Youthful, high-fertility countries, such as those in sub-Saharan Africa, are also projected to spend five to 20 years longer in the moderate child dependency category under the low-fertility scenario compared to the medium-fertility scenario. Extending the duration spent in the moderate child dependency category would give countries more time to invest in the health and education of children and young people and to implement policies for economic growth that are key ingredients for attaining a demographic dividend.
Kenya provides an example of the range of possible transitions from high child dependency to moderate child dependency: Kenya could enter the moderate child dependency category around 2035, 2050, or 2065 under the low-, medium-, and high-fertility scenarios, respectively (see Figure 2). Likewise, Kenya could remain in the moderate child dependency category for as long as 25 years in the low-fertility scenario, compared to just five years in the high-fertility scenario. Our analysis indicates that by accelerating the pace of fertility decline, Kenya could enter the optimal moderate child dependency category 15 years earlier and stay in the category for a decade longer. On the other hand, if fertility declines more slowly than assumed in the medium-fertility scenario, Kenya is projected to enter the moderate child dependency category around 15 years later and spend approximately 10 fewer years in the category.
Figure 2. Age Structure Trajectories for 2020-2100 Under High-, Medium-, and Low-Fertility Scenarios for the 24 USAID Family Planning Priority Countries
Nigeria, which has a higher current fertility rate than Kenya, is projected to enter the moderate child dependency category around 2075 under the medium-fertility scenario but would not reach this category until around 2095 under the high-fertility scenario (see the Nigeria graph in Figure 2). In the low-fertility scenario, Nigeria would enter the moderate child dependency category much earlier, around 2060. Nigeria’s time in the optimal moderate child dependency category could be as short as around 10 years under the high-fertility scenario, or as long as around 30 years under the low-fertility scenario. By accelerating fertility decline to the low-fertility scenario level, Nigeria could enter the moderate child dependency category 15 years earlier and spend five additional years in the category compared to the medium-fertility scenario.
Sound Policy Investments Can Extend the Window of Opportunity
Our findings underscore the need for countries to intentionally plan and allocate resources based on the realities of age structure in their contexts and when they will enter the window of opportunity. Forward-looking planning is essential given the time-limited nature of the window of opportunity. Further, our analysis shows that high-fertility countries that experience faster fertility decline will benefit from a longer-lasting favorable age structure, while slow and gradual fertility decline will compress the window of opportunity and hasten the transition to double dependency burden. As countries anticipate the window of opportunity, the likely duration of that window could influence their policy choices and help policymakers prioritize certain investments.
Countries with a youthful age structure, where a large share of the population is under age 15, should prioritize efforts to expand access to and use of voluntary family planning and reproductive health services. In addition to the benefits of family planning to women and couples, these investments may accelerate the pace of fertility decline and entry into the moderate child dependency category. Investments in family planning programs, as well as efforts to create an enabling environment for young entrepreneurs and job-seekers and ensure an open and stable economy—such as building reliable financial and legal institutions—should continue during the window of opportunity.7 These efforts should go hand-in-hand with investing in developing youth’s human capital, addressing barriers to women’s participation in the formal labor force, and ensuring services and opportunities reach vulnerable, neglected populations. Finally, countries should prepare for the transition to the doubled dependency and high old-age dependency age structures by addressing the spectrum of gender, cultural, and economic barriers that lead to tradeoffs between women’s workforce participation and attaining their desired family size. Further research is warranted on policy priorities that may have the greatest impact in countries projected to experience a comparatively short window of opportunity.
These findings demonstrate how current and future trends in fertility can significantly shift the opening of demographic window of opportunity. The pace of fertility decline in a high-fertility country can impact not only the timing of when the window of opportunity opens, but also the duration the window will stay open. With investments that increase access to and use of voluntary family planning and improve educational attainment for women and girls, countries may be able to open the demographic window of opportunity earlier than projected and have more time to position themselves to achieve the greatest possible benefits from the demographic dividend.
Annex: USAID Family Planning Priority Countries
USAID currently prioritizes 24 countries across Africa, Asia, and Latin America and the Caribbean with support for voluntary family planning and related health services to enable women and couples to have the number of children they want when they want them.
Democratic Republic of Congo
Latin America and the Caribbean
PRB would like to acknowledge Automata Studios for their development of the charts and visuals in this web article.
- Kaitlyn Patierno, Smita Gaith, and Elizabeth Leahy Madsen, “Which Policies Promote a Demographic Dividend? An Evidence Review,” 2019, www.prb.org/resources/which-policies-promote-a-demographic-dividend-an-evidence-review/.
- Both the low overall dependency and high overall dependency categories are rare and occur more often in countries with unique fertility and migration patterns.
- The impact of any errors in the assumptions underlying population projections compounds over time, so the longer the projection period, the greater the chance the projection results will not hold. However, the long-term projections up to 2100 allows us to explore how different fertility scenarios result in remarkably different age structures for countries.
- United Nations (UN), Department of Economic and Social Affairs, World Population to 2300 (New York: UN, 2004); Richard Cincotta, “Opening the Demographic Window: Age Structure in Sub-Saharan Africa,” New Security Beat, 2017, www.newsecuritybeat.org/2017/10/opening-demographic-window-age-structure-sub-saharan-africa/.
- UN, Department of Economic and Social Affairs, World Population Prospects: The 2019 Revision (New York: UN, 2019).
- We assume age structure transitions take place in the middle of the given five-year period.
- Patierno, Gaith, and Madsen, “Which Policies Promote a Demographic Dividend?”
The Annie E. Casey Foundation’s KIDS COUNT Data Book is an annual assessment of how children are faring in the United States and in each state. The 2021 Data Book—the 32nd edition—was published on June 21, 2021. In addition to providing annual state rankings, this edition includes information on the challenges children and their families are facing during the pandemic to present the most up-to-date picture of child well-being in the United States.
Members of PRB’s U.S. Programs staff have played an essential role in the production of the Data Book since its inception, providing feedback on the design and measurement of the KIDS COUNT index and compiling the data presented in the Data Book.
The annual assessment of child well-being in the 2021 Data Book is based on the most recent data available (2019 data for most indicators) and documents key trends since 2010. These data provide information about child well-being just prior to the COVID-19 pandemic. Eleven of the 16 key indicators showed improvement, and only one indicator—the percent of babies born with low birth weight—worsened. The 2021 Data Book also highlights persistent racial and ethnicity disparities and shows that children of color continue to face steep barriers to success.
The 2021 Data Book draws on data from the U.S. Census Bureau’s Household Pulse Survey and shows that households with children faced substantial challenges in 2020 because of the pandemic, including food and housing insecurity and access to a computer and the internet for educational purposes. However, the data also show the start of a recovery in the first few months of 2021. These experimental data provide the most comprehensive information on well-being during the pandemic for all 50 states.
For more information on the life disruptions and emotional and behavior consequences of the pandemic for children in California, the KidsData program at PRB provides quick access to data from responses to the “Family Experiences During the COVID-19 Pandemic” questionnaire.
June 16, 2021
Wildfire. Drought. Lead Exposure. Oil spill.
Environmental events and changes can have profound effects on our health and jobs and help shape our decisions on where we live.
A new, special issue of the journal, Population and Environment, explores the ways that environmental forces shape people’s lives and behaviors, and identifies policy approaches community leaders can use to plan, adapt, and mitigate risks in specific settings worldwide.
The featured studies draw on the expanding availability of environmental data, which reflects growing interest in the human implications of climate change and the increasing frequency of extreme weather events, report Katherine Curtis, Marcy Carlson, and Malia Jones of the University of Wisconsin-Madison, editors of this special issue.
Much of the research in this journal issue grapples with the impact of dynamic forces in the natural environment on child health and migration:
- U.S. children exposed to air pollution and household lead face a higher risk of incarceration and lower incomes in adulthood.1 The study also linked high levels of air pollution—disproportionately found in Black and Latino neighborhoods—to a greater likelihood of teen childbearing. White children were much less likely to be exposed to either air pollution or household lead, suggesting that efforts to clean up neighborhood toxins could increase social mobility and decrease inequality. Policy Summary.
- Children whose families lost income or jobs related to the BP Deepwater Horizon oil spill were more likely to have persistent health problems.2 Children affected by the oil spill had poorer health compared with their peers, whether they had physical contact with toxins or their household lost jobs or income because of the disaster. While the effects of physical exposure to the oil spill dissipated over time, the effects of related job or income loss persisted. These findings underscore the need for policies and programming that better support the long-term health of children who have experienced a disaster. Policy Summary.
- Climate change-related declines in water availability impact child health and growth in West Africa’s Sahel region.3 Child health and growth suffer in Burkina Faso, Mali, and Senegal when the quality and quantity of surface water (waterholes) declines, analysis shows. These countries are already experiencing chronic food insecurity and childhood malnutrition, and their rapidly growing populations are dependent on livestock and crops in a region predicted to experience hotter and drier conditions. Research results highlight the potential importance of monitoring waterholes and ensuring clean drinking water is available locally for the health of people—especially children—and livestock. Policy Summary.
- Better rainfall linked to more time farming and less time breastfeeding among Ethiopian mothers.4 More favorable rainfall conditions for crop production may impact mothers’ time use, possibly reducing the time they have available to breastfeed their babies, the study finds. This information can help policymakers develop targeted interventions that reflect the dynamic needs of farming households, such as suppling technologies that make planting and harvesting more efficient. Policy Summary.
- Climate change-induced extreme heat and wildfire dampen migration in U.S. regions high in natural amenities.5Rural counties with outdoor recreation and environmental features such as ample sunshine, dramatic topography, warm and dry climates, and forests are most affected by these migration shifts, researchers find. Policymakers and planners have relied on migration models that predict more people moving to U.S. counties rich in amenities, but climate change is likely to alter migration trends, impacting economic development. Policy Summary.
- Repeated droughts in rural Thailand and Vietnam trap poorer households, reducing migration.6 Both household assets and consumption shrink in rural areas that have experienced two years of drought, analysis shows. Particularly among poorer households, this decrease creates an obstacle to those who would migrate for income-earning opportunities. As extreme weather events like drought become more frequent and severe, the need for safety nets and social protection programs, such as cash transfer and insurance programs, becomes crucial, especially when targeted to poorer households. Policy Summary.
Extreme Weather Hits Under-Resourced People Hardest; Research to Support Climate Adaptation Crucial
“Environmental shocks and stressors expose and often exacerbate existing inequalities, taking the greatest toll on the most disadvantaged people,” note Curtis, Carlson, and Jones. They point to the tsunami in Southeast Asia (2004) and Hurricane Katrina in New Orleans (2005) as examples.
The resources and infrastructure needed to plan and adapt to climate events are unevenly distributed around the globe, underscoring the importance of linking scholars with policymakers, they argue.
Recent technological advancements mean that the data and tools needed to identify ways to mitigate climate-related risks are available, notes Barbara Entwisle of the University of North Carolina at Chapel Hill in a piece in the special issue.7 Demographers are poised to “contribute significantly to a larger and deeper understanding of environmental change and its consequences, locally, regionally, and globally,” she writes.
But as researchers work with data linked to specific geographic locations, they must strike a balance between privacy and accuracy so that confidentiality is not breached, Lori Hunter of the University of Colorado, Boulder and colleagues assert in another article in the journal.8 The authors compare unaltered data from surveys and vegetation information from rural South Africa with similar data generated by a series of geomasking techniques designed to reduce the likelihood that individual respondents can be identified. They find that geomasking approaches that use buffers and account for population density produce the most accurate results. But they also show that higher levels of accuracy increase the likelihood that potential respondents can be identified.
Yet the challenges of this research should not be an obstacle, argue Curtis, Carlson, and Jones. “Environmental change is happening. Environmental events are occurring,” they write. “These environmental forces have demonstrable consequences for human lives and livelihoods and, by extension, for the welfare” of the entire human family.
The special issue of Population and Environment is based on a conference supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) (Grant HD 096853).
- Robert Manduca and Robert J. Sampson, “Childhood Exposure to Polluted Neighborhood Environments and Intergenerational Income Mobility, Teenage Birth, and Incarceration in the USA,” Population and Environment 42, no. 4 (2021).
- Tim Slack et al., “Deepwater Horizon Oil Spill Exposure and Child Health: A Longitudinal Analysis,” Population and Environment 42, no. 4 (2021).
- Kathryn Grace and Frank Davenport, “Climate Variability and Health in Extremely Vulnerable Communities: Investigating Variations in Surface Water Conditions and Food Security in the West African Sahel,” Population and Environment 42, no. 4 (2021).
- Heather Randell, Kathryn Grace, and Maryia Bakhtsiyarava, “Climatic Conditions and Infant Care: Implications for Child Nutrition in Rural Ethiopia,” Population and Environment 42, no. 4 (2021).
- Richelle L. Winkler and Mark D. Rouleau “Amenities or Disamenities? Estimating the Impacts of Extreme Heat and Wildfire on Domestic US Migration,” Population and Environment 42, no. 4 (2021).
- Esteban J. Quiñones, Sabine Leibenehm, and Rasadhika Sharma, “Left Home High and Dry–Reduced Migration in Response to Repeated Droughts in Thailand and Vietnam,” Population and Environment 42, no. 4 (2021).
- Barbara Entwisle, “Population Responses to Environmental Change: Looking Back, Looking Forward,” Population and Environment 42, no. 4 (2021).
- Lori Hunter et al., “Working Toward Effective Anonymization for Surveillance Data: Innovation at South Africa’s Agincourt Health and Demographic Surveillance Site, Population and Environment 42, no. 4 (2021).
Appalachia’s Low-Income Young Adults, Disabled Older Adults, Students Without Internet, and Rural Residents Vulnerable to Hardship During the Pandemic
Prior to the COVID-19 pandemic, Appalachia’s median household income was on the rise, residents of nearly all ages were more likely to have health insurance than other Americans, and unemployment rates were on par with national levels.
But longstanding vulnerabilities suggest that some groups in the Region risk greater hardship related to the pandemic, including low-income young adults, disabled older adults, students without internet access, and residents of the Region’s rural counties (that is, counties not part of or adjacent to a metropolitan area).
The Appalachian Region: A Data Overview From the 2015-2019 American Community Survey, a new PRB report for the Appalachian Regional Commission, provides a comprehensive picture of social and economic conditions in Appalachia immediately before the onset of the COVID-19 pandemic. Because detailed data for the pandemic period (2016-2020) will not be available until the end of 2021, this report can help program planners and policymakers pinpoint areas and population subgroups most at risk and target assistance.
Many Appalachian Young Adults Were Not Doing Well Before the Pandemic
Before the pandemic began, many young adults ages 18 to 34 were already at a disadvantage in Appalachia. Nearly one in four of those ages 18 to 24 were poor, with income below $25,926 for a family of two adults and two children. This poverty rate is higher than for any other age group in Appalachia. While some individuals in this age group may have low incomes because they are in training programs or college, the high poverty rate also reflects a lack of employment opportunities for young adults in the Region—particularly in rural counties where nearly one in three young people is poor.
One-sixth of adults ages 26 to 34 in the Region lacked health insurance, and this share exceeded 25% among young adults in 79 Appalachian counties—predominately in South Central and Southern Appalachia (see Figure 1). In fact, 26-to-34-year-olds were the only Appalachian age group less likely to have health insurance than their peers living elsewhere in the United States.
Figure 1. Percent of Appalachian Residents Ages 26 to 34 Without Health Insurance, 2015-2019
“Some young adults in Appalachia were struggling before the pandemic began,” says co-author Linda A. Jacobsen, PRB’s vice president for U.S. Programs. “We know that workers without college degrees were hit hardest with income and job losses because of the pandemic and are now having the hardest time getting hired. Many young adults in Appalachia are parents so the economic hardships they face are affecting their children too.”
The Pandemic May Have Heightened Isolation Among Disabled Adults
Among all age groups, the share of Appalachian residents who reported a disability (difficulty with hearing, vision, cognition, walking or climbing, self-care, or independent living) in 2015-2019 was above the national average—with the widest gap among 35-to-64-year-olds (more than four percentage points: 17% in Appalachia versus 12.6% nationwide). In Appalachia’s rural counties, nearly one in four adults ages 35 to 64 and two in five ages 65 and older reported having at least one disability.
In Central Appalachia (counties in eastern Kentucky, southwestern West Virginia, and parts of southwestern Virginia and northeastern Tennessee), nearly half of adults ages 65 and older were disabled, considerably higher than the national average of 34.5% (see Figure 2).
Figure 2. Percent of Appalachian Residents Ages 65 and Older With a Disability, 2015-2019
“Isolation related to stay-at-home orders during the pandemic may have been especially difficult in the Region for disabled residents, particularly those ages 65 and older,” Jacobsen points out. “They may have not been able to get the assistance they needed from agencies because of pandemic shutdowns, and family and friends may have reduced contact to protect them from exposure.”
Appalachia’s Digital Divide Is Most Acute in Rural Counties
Just over 86% of Appalachian households had access to a computer device, more than four percentage points below the national average. The share of households with broadband internet access, at 78%, was nearly five points below the national average. The report found that the digital divide was particularly acute in Appalachia’s rural communities: One in four rural Appalachian households lacked internet access compared with one in five households in rural counties outside the Region. (See Figure 3).
Figure 3. The Digital Divide Is Wider in Rural Appalachia Than in the Rest of Rural America
Source: U.S. Census Bureau, 2015-2019 American Community Survey.
“With most schools closed throughout 2020 due to the COVID-19 pandemic, this rural digital divide has likely made online education and maintaining learning virtually impossible for a large share of children in rural Appalachian counties,” says Kelvin Pollard, PRB senior demographer and report coauthor.
“With high-speed internet access being credited as enhancing economic growth and development, these are signs that many communities in the Region may be at risk of being left behind,” argues Pollard. “The wide use of remote work, online shopping, and telemedicine during the COVID-19 pandemic has put a spotlight on these discrepancies.”
Rural Appalachia Is at a Disadvantage Compared to Elsewhere in Rural America
The report also compares Appalachia’s 107 rural counties to the 840 rural counties outside the Region. It shows that rural Appalachia lagged behind the rest of rural America on a variety of measures such as educational attainment, household income, and population growth.
Labor force participation rates are lower in rural counties within the Region than in rural counties elsewhere in the United States (see Figure 4). Workers in rural Appalachia are also much more likely to work outside their county of residence and have commutes of 30 minutes or more. Levels of disability and poverty are higher across all age groups in rural Appalachia than in rural counties outside the Region.
Figure 4. Rural Appalachia Has Lower Labor Force Participation Rates, Longer Commutes Than the Rest of Rural America
Source: U.S. Census Bureau, 2015-2019 American Community Survey.
“These comparisons suggest that conditions were already more challenging in rural counties within Appalachia than in rural counties outside the Region even before the pandemic brought job and income losses,” says Jacobsen.
The Appalachian Region encompasses 205,000 square miles along the Appalachian Mountains from southern New York to northern Mississippi, including portions of 12 states and all of West Virginia. The Appalachian Regional Commission report uses data from the 2015-2019 American Community Survey and the Census Bureau’s vintage 2019 population estimates—the most recent data available for the characteristics studied. It includes detailed tables and county-level maps covering state- and county-level data on population, age, race and ethnicity, housing occupancy and tenure, housing type, education, computer ownership and internet access, labor force participation, employment and unemployment, transportation and commuting, income and poverty, health insurance coverage, disability status, migration patterns, and veteran status. It also includes a detailed comparison of characteristics in rural Appalachian counties with those outside the Region.
ABOUT THE APPALACHIAN REGIONAL COMMISSION
The Appalachian Regional Commission is an economic development agency of the federal government and 13 state governments focusing on 420 counties across the Appalachian Region. ARC’s mission is to innovate, partner, and invest to build community capacity and strengthen economic growth in Appalachia to help the Region achieve socioeconomic parity with the nation.