Webinar: Institutionalizing the Population-Health-Environment Approach for Sustainable Development in East Africa

(June 2016) Population, Health, and Environment (PHE) program implementers are increasingly considering how to best scale up their efforts. This webinar featured Pathfinder International staff who work on the Health of People and the Environment in the Lake Victoria Basin (HoPE-LVB) project, who spoke about leveraging advocacy and “beginning with the end in mind” to scale up and institutionalize their PHE project (PHE) in East Africa. The webinar was co-hosted by Population Reference Bureau (PRB) and the community of practice on Systematic Approaches for Scale Up of Family Planning/Reproductive Health Best Practices, led by Evidence to Action (E2A). PRB has provided technical assistance to HoPE-LVB on advocacy and capacity building since 2012.

Since 2011, HoPE-LVB has been working to model and extend their PHE approach to address the interrelated challenges that marginalized, rural communities in Uganda and Kenya face. HoPE-LVB addresses food security, unmet need for family planning, environmental degradation, high risk of maternal and infant mortality, water and sanitation, and lack of economic/livelihood opportunities. HoPE-LVB reaches underserved communities with much needed information and services in an integrated way.

Kristen P. Patterson of PRB and Stembile Mugore of E2A welcomed participants to the webinar. Pamela Onduso of Pathfinder International provided a comprehensive overview of how HoPE-LVB began with the end in mind: They considered the role of advocacy and scale-up plans in the initial design phase of the project. Next, Charles Kabiswa, Millicent Kodande, Antony Omimo, Caroline Nalwoga Ssekikubo, and Dorah Anita Taranta—all HoPE-LVB staff implementing the project in Kenya and Uganda—answered questions moderated by Laura Ghiron of ExpandNet. They spoke about some of the factors that have been critical to uptake and scale up of the PHE approach, such as careful design of the project, local and subnational advocacy, and effective monitoring and evaluation. The webinar concluded with ample time for interactive Q&A from webinar participants.

The webinar is the second in the quarterly series of Africa PHE webinars implemented under the Policy, Advocacy, and Communication Enhanced for Population and Reproductive Health (PACE) Project.

For regular updates about PHE news, opportunities, resources, and other events, sign up for the Africa PHE Updates newsletter via AfricaPHE@prb.org and follow @AfricaPHE on Twitter. To join the scale-up community of practice, please go to: https://knowledge-gateway.org/scale-up.

Fisherman in canoe plowing through the waters of Lake Turkana

Webinar: Why PHE? Linking Conservation and Reproductive Health in Tanzania

(May 2016) What are Population, Health, and Environment (PHE) programs and why should reproductive health and conservation organizations use a PHE approach? This webinar featured Pathfinder International and The Nature Conservancy, partners that have linked environmental conservation and reproductive health—in the Tuungane Project.

Presenters Craig Leisher and Mustafa Kudrati explored how their organizations implement and integrate activities, successes and challenges of the project, and the value of the PHE approach in today’s development context. Both presenters discussed the benefits of the Tuungane Project, beyond health and conservation outcomes and practices, to local communities, including improved nutrition, economic empowerment, and livelihoods. The webinar was moderated by Kristen P. Patterson, PHE program director at PRB.

The webinar serves as an introduction to PHE for audiences such as African policymakers, practitioners, and advocates of PHE.

The presentations were followed by 30 minutes of Q&A. A list of introductory PHE resources is available for download.

Population Reference Bureau hosted the webinar, the first in a quarterly series of Africa PHE interactive webinars implemented under the PACE Project.

To get updates about PHE news, opportunities, resources, and other events, sign up for the Africa PHE Updates newsletter via AfricaPHE@prb.org and follow @AfricaPHE on Twitter.


Ending Child Marriage in Egypt

Product: Video

Author: PRB

Date: March 7, 2016

Ending Child Marriage in Egypt

Ending Child Marriage in Egypt (Arabic)

Every year, millions of girls in developing countries marry before their 18th birthday. In Egypt, it is one in six girls. Child marriage is a violation of human rights and can cause a lifetime of consequences for girls and their families. In order to address the problem, government agencies, civil society, and research organizations must do more to encourage girls to stay in school and change cultural expectations of this practice. This video is also available in Arabic.


  • Ministry of Health and Population and El-Zanaty and Associates, Egypt Demographic and Health Survey (EDHS) 2014 (Rockville, MD: ICF International, 2014).
  • United Nations (UN) Population Division, World Population Prospects: The 2015 Revision (New York: UN, 2015).
  • World Health Organization, “Adolescent Pregnancy,” accessed at www.who.int/mediacentre/factsheets/fs364/en/, on Aug. 15, 2015.
  • Special tabulation of EDHS 2014 by PRB consultant.
  • National Population Council – Egypt, “The National Strategy for Prevention of Early Marriage,” accessed at www.npc.gov.eg, on Oct. 17, 2015.

Sustainable Development Indicators: The Last Missing Piece of the 2030 Agenda

The 2015 adoption of the Sustainable Development Goals (SDGs) was a major milestone for United Nations (UN) Member States seeking to jumpstart efforts to improve people’s lives and maintain a healthy planet. The “last missing piece” to complete the architecture of the 2030 sustainable development agenda according to Stefan Schweinfest, director of the UN’s Department of Economic and Social Affairs Statistics Division, is to adopt a comprehensive framework of progress indicators to guide countries’ efforts to reach the Goals by 2030.1

Launched in September 2015 and in effect as of January 2016, the 17 SDGs and the 169 targets that support them build on the progress of the previous Millennium Development Goals that focused on social issues like poverty and health (with eight goals and 21 targets). The SDGs go further in some respects to include economic and environmental dimensions of sustainable development (see website).

The United Nations Statistical Commission and the Inter-Agency and Expert Group on Sustainable Development Goal Indicators (IAEG-SDGs) have developed the indicator framework that will be used to measure progress toward the global goals and serve as the primary monitoring mechanism for identifying both achievements and gaps. From March 8-11, at the 47th Session of the UN Statistical Commission, experts will review and adopt the proposed framework and submit it to the UN Economic and Social Council and the General Assembly for adoption, likely in June. The remaining work will be done at country level, where governments will develop their own national indicators based on country context and capacity for collecting data.

Indicators will help countries prioritize what they need to do to meet the goals and will allow them to monitor their progress, but the indicators are only as good as the data to track them. According to a number of experts, many countries are not equipped to do so. In the health sector, for example, the World Health Organization has been working to develop country-level capacity in gathering health statistics, but progress has been slow because national governments may not have seen vital statistics systems as a priority or because donor agencies have not seen such systems as an integral part of the development infrastructure.2 All this is changing, but will it happen quickly enough to supply data for the 2030 targets of the SDGs?

What To Expect

The development of the SDG indicator framework has been a consultative process with numerous meetings, conferences, and brainstorming sessions. In December, when the preliminary framework was submitted, it included a larger number of indicators (229), since some were still in review: 149 “green” and 89 “gray.” The green indicators were those where there was general agreement, and the gray were indicators that require further discussion and refinement.3 With two weeks before adoption of the framework by the UN Statistical Commission, a final list of indicators has been proposed.

Global indicators will form the core, but countries will develop indicators at regional, national, and subnational levels to complement the core indicators. Some thematic indicators are also being developed.

The IAEG-SDGs is encouraging and providing guidance for data to be disaggregated, where possible, by sex, age, residence (urban vs. rural), and other relevant characteristics, in order to ensure that the indicators cover vulnerable populations and other issues called for in the SDG targets. Reporting will be annual and data will be collected by national statistical agencies. In the fall of 2016, a UN World Forum on Sustainable Development Data will be held.

At a follow up meeting in Mexico City from March 30-April 1, the IAEG-SDGs will take the first step in implementation of the framework as they classify all the indicators into three tiers:

  • Tier I: An established methodology exists and data are widely available.
  • Tier II: A methodology has been established but data are not easily available.
  • Tier III: An international agreed methodology has not yet been developed.

What the World Needs Now Is Data

In a Lancet interview, Amina Mohamed, the special adviser to the UN secretary-general on Post-2015 Development Planning, admits that she is most worried about the monitoring, and that without good baseline data, monitoring progress is nearly impossible. According to her, even the most basic data is still challenging in some 100 countries that don’t have a dependable vital statistics system.4 For example, the World Bank estimates that around the world almost 230 million children under age 5 are not registered.5 Moreover, according to a Brookings Institution gap analysis of financing for data needs, a number of countries have fallen behind on the universal standard of 10-year population census-taking.6

Countries like India present a different challenge. The data collection systems exist, but the scale is vast given the country’s population. Some experts feel that the success of the SDG goals depends in large part on their success in India, where almost 18 percent of the world’s population lives.7 India has already expressed reservations about its ability to monitor the indicators, noting the country has already been struggling to monitor 25 core indicators for India’s five-year planning cycles.8 In a country of 1.3 billion people, effectively collecting data presents a huge burden.

Take the example of noncommunicable diseases (NCDs), collectively the leading causes of death as well as the biggest burden of disease in India. For SDG 3 on health, Target 3.4 is: By 2030, reduce by one third premature mortality from NCDs through prevention and treatment and promote mental health and well-being. For this target, the proposed indicators are:

  • Probability of dying of cardiovascular disease, cancer, diabetes, or chronic respiratory disease between ages 30 and 70.
  • Suicide mortality rate.
  • Harmful use of alcohol defined according to national context as alcohol per capita (15+ years old) consumption within a calendar year in liters of pure alcohol.9

India lacks the resources to monitor such metrics in a meaningful way. There are no comprehensive information systems to collect morbidity and mortality data from all sectors that might have it, so the country uses modelling to estimate burden of disease from NCDs. India’s national Health Management Information System covers only government facilities. National programs meant to monitor NCD prevalence and provide treatment services have barely gotten off the ground after eight years. Although some states have taken on initiatives to monitor and treat NCDs, this doesn’t help the national effort. And there is virtually no information on services for substance abuse or per capita alcohol consumption. Clearly, the lack of rigorous data to monitor progress will be a big challenge for India. Data systems that might be created will be huge, so that the required disaggregation can be done; in addition, intersectoral cooperation will require increasing human and financial capital.10


Data Systems Must Be Strengthened


The UN Statistical Commission will be discussing these and other challenges in March. The provisional agenda calls for a discussion of both how to address the need for funding statistical capacity-building, as well as how to harness any opportunities provided by the data revolution that might support SDG implementation. To date, there are several bodies that exist for statistical capacity and technical assistance—such as PARIS21, a partnership that aims to reduce poverty and improve government in developing countries by promoting the integration of statistics and reliable data in the decisionmaking process.11 But much work remains.


  1. “SDG Indicators: The Last Missing Piece of the 2030 Agenda,”YouTube video with UN assistant secretary-general for Economic Development Lenni Montiel; director of UN Department of Economic and Social Affairs (DESA)’s Statistics Division Stefan Schweinfest; and chief of the Statistical Service Branch in UN DESA’s Statistics Division Francesca Perucci, accessed at www.youtube.com/watch?v=XC_Ye6SEGak, on March. 3, 2016.
  2. Prasanta Mahapatra et al., “Civil Registration Systems and Vital Statistics: Successes and Missed Opportunities,” Lancet 370, no. 9599 (2007): 1653-63.
  3. UN Inter-Agency and Expert Group on Sustainable Development Goal Indicators (IAEG-SDGs), “Update on the Work of the IAEG-SDGs: Informal Briefing on the Global Indicator Framework for the SDGs,” (January 2016), accessed at http://unstats.un.org/sdgs/files/ga-briefing-28-Jan-2016/PGA-Briefing–Status-of-IAEG-SDGs-work-on-global-SDG-indicators-28-Jan-2016.pdf, on Feb. 26, 2016; and Elizabeth Lockwood, “Update on Global SDG Indicator Framework,” (January 2016), accessed at http://deliver2030.org/?p=6706, on Feb. 26, 2016.
  4. John Maurice, “UN Set to Change the World With New Development Goals,” Lancet 386, no. 9999 (2015): 1121-4.
  5. World Bank and World Health Organization (WHO), “Global Civil Registration and Vital Statistics: Scaling Up Investment Plan 2015-2024,” (May 2014), accessed at www.who.int/healthinfo/civil_registration/WB-WHO_ScalingUp_InvestmentPlan_2015_2024.pdf?ua=1, on Feb. 12, 2016.
  6. Laurence Chandy and Christine Zhang, “Stuffing Data Gaps With Dollars: What Will it Cost to Close the Data Deficit in Poor Countries?” (August 2015), accessed at www.brookings.edu/research/opinions/2015/08/31-data-deficit-poor-countries-chandy-zhang, on March 2, 2016.
  7. Swati Srivastava, “India and the SDGs: Can We Really Monitor Our Progress?” (January 2016), accessed at www.internationalhealthpolicies.org/india-and-the-sdgs-can-we-really-monitor-our-progress/, on Feb. 26, 2016.
  8. Srivastava, “India and the SDGs.”
  9. UN Stats, “Results of the List of Indicators Reviewed at the Second IAEG-SDG Meeting,” (November 2015), accessed at http://unstats.un.org/sdgs/files/meetings/iaeg-sdgs-meeting-02/Outcomes/Agenda%20Item%204%20-%20Review%20of%20proposed%20indicators%20-%202%20Nov%202015.pdf, on Feb. 26, 2016.
  10. Srivastava, “India and the SDGs.”
  11. PARIS21.org, “Our Mandate,” accessed at www.paris21.org/our-mandate, on Feb. 26, 2016.

Making the Case for Investing in Adolescent Reproductive Health

(January 2016) Solid evidence on the links between preventing adolescent childbearing and alleviating poverty can motivate policymakers and donors to invest in reproductive health and family planning programs for youth. Research that documents the clear cause-and-effect relationship between program interventions and outcomes, such as better health and delayed childbearing among teens, can guide decisions about investments in research or programs.

This report examines the evidence for investing in adolescent reproductive health and family planning programs from the perspective of making an evidence-based argument to guide the investment or spending decisions of public or private organizations. Key steps in developing such an argument—a business case—include:

  • The consequences of relevant trends.
  • Evidence on the potential of particular actions or interventions to change the status quo.
  • The costs associated with different actions.

This report highlights new research from the Population and Poverty (PopPov) Research Initiative that bolsters the case for these investments and identifies knowledge gaps where research is still needed.

Recent research shows that adolescent childbearing and early marriage are detrimental to girls’ health, school completion, and long-term earning potential, and to their babies’ health and development—contributing to poverty at the household and national level. This report surveys evidence on the effectiveness of several types of interventions:

  • School-based programs.
  • Peer education.
  • Youth-friendly services.
  • Sexuality education.
  • Youth development and life skills training.
  • Social marketing and behavior-change communication.
  • Cash transfers and other financial incentives.
  • Multipronged interventions.

Climate Change, Health, and Population Dynamics: A View From Tanzania

This article was originally posted on Cool Green Science, a blog by the Nature Conservancy.

As people around the world celebrate the remarkable Paris Agreement to address climate change, there’s a genuine opportunity for countries to act on their financial pledges to help the world adapt to climate change—especially people in developing countries who are most vulnerable.

One progressive way of helping at-risk people adapt to climate change is to improve their health. Voluntary family planning, which greatly improves women’s health, could play a part in a rights-based strategy that advances adaptive capacity and women’s health simultaneously. In addition, more scientists and governments have made the connection between population growth and global carbon emissions and have recognized the multiple benefits that family planning provides.

Research supports the linkage by showing that slowing global population growth could lead to substantial long-term climate-related benefits by lowering carbon emissions. From a rights-based perspective, approximately 225 million women in the world have an unmet need for family planning, meaning they would like to plan the number and spacing of their children, but currently are not using modern contraception. Meeting their needs through providing voluntary, rights-based family planning information and services could be a global hat trick—for women, their children and the climate.

Family Planning and Climate Change: A Ground-Level View in Tanzania

Far removed from the negotiations that took place in Paris, some 900 million vulnerable rural people around the world —including resource-dependent communities along the shores of Lake Tanganyika in western Tanzania—are relying on decisions made at the negotiation table to pave the way for policies that will help them adapt to the realities of climate change.

Tanzania is acutely vulnerable to climate change: mean annual precipitation has decreased significantly across the country from 1960 to the present, and seasonal rainfall patterns have already changed. With 80% of the population relying on agriculture and pastoralism for their income, livelihoods, and employment, ensuring that the country and its people are able to adapt to a changing climate is essential. And family planning is a critical component of building resilience.

In August 2011, I visited the Buhingu regional health center in western Tanzania to meet the head doctor and see the facilities. Despite its magnificent location on a promontory overlooking a beautiful bay on Lake Tanganyika, the health center seemed more like a low-level clinic than a referral center. The empty operating room had a fancy light, but no electricity. The walls were crumbling, shelves were bereft of medical supplies, and the rooms were empty. Except for one, where two women lay on metal beds with decrepit foam mattresses; one of the women was nursing a newborn.

The doctor said that he’d done Cesarean surgeries on both women the night before. One baby survived; the other didn’t. The empty-handed young woman had walked, while in labor, for almost two days to reach the hospital; unfortunately, by the time she arrived, it was too late to save her baby. I took a deep breath, crossed the room to grasp the grieving woman’s hand, and spoke the only Kiswahili I knew how to say, “pole sana.” I’m sorry.

The moment encapsulated why projects that address health and voluntary family planning as well as conservation and natural resource management in remote regions are not so far-fetched after all.

Twenty-four villages are now participating in the Tuungane Project (Kiswahili for “Let’s Unite), a partnership between TNC and Pathfinder International that holistically address reproductive health, the environment and livelihood needs of these communities in this region.

Western Tanzania: Tops for Biodiversity, Poor Health, and Rapid Population Growth

Lake Tanganyika is the world’s second largest lake by volume, and the lake and surrounding forest are mega hotspots of global biodiversity, from a freshwater and terrestrial perspective, boasting endemic cichlids and chimpanzees. It’s all contained within an environment that is still, remarkably, largely intact—a blessing for conservation and a bit of a curse for local people, whose only highway is the lake. And when women face health emergencies, such as obstructed labor, getting a boat and fuel to travel to the nearest hospital, several hours away in Kigoma, is a real challenge. Furthermore, inaccessible western Tanzania is not an appealing placement for most government health workers, extension agents, and teachers, and the communities struggle to develop without adequately staffed and supplied facilities.

Tanzania is a large country; it’s about the size of Texas and Colorado combined. Tanzania’s population is quite young: as of 2014, 45% of the population was under the age of 15. It’s the 6th most populated country in Africa, with 52.3 million people. By 2030—only 15 years from now—the population is projected to rise to 79.4 million, and by 2050, unless the birth rate slows substantially, there will be 2.5 times as many people in Tanzania as there are today, 129.4 million, which would make it the 15th largest country in the world.

What is driving the rapid population increase? Only 26% of married women use modern contraception, compared with 53% next door in Kenya. In the Kigoma region of western Tanzania, the rate falls to 14%, among the lowest in the world. Forty one percent of women in Kigoma have an unmet need for contraception. The total fertility rate in western Tanzania is 7.1, among the very highest in the world. Having babies in rapid succession is often accompanied by high maternal mortality. There is an urgent need to make voluntary contraception more available in places like rural western Tanzania so that women and their families are able to live healthier, productive lives and space and plan their families.

Early marriages also play a key role in birth rates by extending the length of childbearing years, and they pose high health risks for adolescent girls. In Tanzania, girls have a higher chance of being married than completing school by their 18th birthday: almost 40% of girls in Tanzania are married before the age of 18, whereas only 33% of girls are enrolled in secondary school.

Western Tanzania’s intertwined challenges of population dynamics, natural resource management, and climate change adaptation need to be addressed in an integrated way.

I hope that additional headway will be realized as the goals of the Paris Agreement are translated into actions that tangibly help vulnerable people adapt to climate change. Jointly addressing climate adaptation, reproductive health, and conservation would build resilience and help countries achieve the new Sustainable Development Goals in an integrated way. Acknowledging the compound benefits of rights-based voluntary family planning for women and children at the individual level and for the planet would benefit millions of people—in Tanzania and around the world.


Exploring Climate and Population Linkages

(December 2015) As the world turns its attention to Paris and the global climate talks, decisionmakers are increasingly making the connection between population and climate change. Research is expanding on the contribution of population size, growth, and composition to climate change.

Experts are also showing the connection between these population dynamics and vulnerability and resilience to the impacts of climate change. The topic, however, remains challenging and at times controversial for many policy advocates. Some argue that linking population growth, particularly family planning, to climate change is the same as blaming parents of large families in developing countries for the climate changes that are caused by smaller high-consuming families in developed countries.

The relationships are far more complex. Over the last two years, the Population Reference Bureau (PRB) has worked with scientists and policy experts to explore these connections and create spaces for thoughtful discussion of policy opportunities. We have found innovative ways to communicate the complexity of the connections through interactive graphics, policy briefs, and reports, interviews with the media, and events with policymakers and climate negotiators. Through this careful and evidence-based work, we have learned that we can make the link, remove the controversy, and constructively contribute the word “population” to climate talks.



Early marriage (before age 18) undermines the rights and livelihood opportunities of adolescent girls by leaving them vulnerable to the health risks of early pregnancy and childbearing, and prematurely ending their schooling. Rates of early marriage have declined broadly in the past 20 years, particularly among girls who are under age 15. Part of the overall decline reflects improvements in girls’ access to education: As girls educational attainment improves, the proportion marrying early tends to fall.

Better employment opportunities for women and girls also can help delay marriages. In Bangladesh, expanded employment in the garment industry is linked to notably lower rates of marriage among rural migrants under age 15. The percentage of Bangladeshi girls married by age 18 has declined much more slowly as the youngest potential brides tend to postpone marriage by only a few years. The majority of Bangladeshi girls continue to marry before age 18.

For more data and trends, visit World Population Data 2015: Focus on Women’s Empowerment.


Check-in on World Toilet Day: Adding Toilets in India

Shortly after he was elected in 2014, Indian Prime Minister Narendra Modi pledged to provide access to a toilet at every school and home in the country by 2019, the 150th anniversary of Mahatma Ghandi’s birth. His campaign, called Clean India, means the government will have to build 60 million toilets in that timeframe. So far, about 9.5 million toilets have been built, according to the Indian Ministry of Water and Sanitation.

Modi’s approach is to use improved sanitation as a tool to combat poverty, develop the economy, and make India more attractive to business investment. The proposition is not an easy one: Half of India’s population, at least 620 million people, defecate outside. Cultural norms are hard to change and according to some, open-air defecation is seen as more sanitary by those who prefer to relieve themselves in the open rather than share a toilet.

Share and Spread the Word on World Toilet Day

(Right-click on the images above to save).

Another reason to make the shift is child health. In India, almost 48 percent of children across all income groups are stunted, a form of malnutrition in which children are shorter than normal for their age. Stunting happens over time and can be caused by a variety of factors—inadequate maternal nutrition, poor feeding practices, substandard food quality, and frequent infections that can lead to diarrhea. Learn more about the connections between stunting and sanitation at “Water, Sanitation, Hygiene, and Malnutrition in India.”


  1. “Narenda Modi’s Most Popular Move So Far: Sending Millions of Indians to the Toilet,” Quartz India, Sept. 15, 2015, accessed at http://qz.com/505276/narendra-modis-most-popular-move-so-far-sending-millions-of-indians-to-the-toilet/, on Nov. 17, 2015.
  2. “95 Lakh Toilets Constructed Across Country Within One Year of Launch of Clean India Mission,” Oct. 9, 2015, accessed at 95 lakh toilets constructed across country within one year of launch of Clean India Mission, on Nov. 18, 2015.
  3. Jeff Chu, “Indian PM Narendra Modi Brings Vision of ‘Toilets Before Temples’ to a U.S. Audience,” Fast Company, Sept. 29, 2015, access at http://www.fastcompany.com/3036343/most-creative-people/indian-pm-narendra-modi-brings-vision-of-toilets-before-temples-to-a-us, on Nov. 17, 2015.
  4. Unicef, Improving Child Nutrition: The Achievable Imperative for Global Progress (New York: Unicef, 2013).

Family Planning Rights and Climate Change: Connecting the Two Is the Right Thing to Do

Jason Bremner, associate vice president of International Programs, and program director, Population, Health, and Environment at the Population Reference Bureau, was interviewed on MSNBC’s Greenhouse program by host Tony Dokoupil. Bremner discussed a recent report from PRB and the Worldwatch Institute focusing on the work of an expert working group that identified opportunities to advance the goal of achieving universal access to family planning as part of climate compatible development.

“There is an opportunity with the right framing of these issues, to connect family planning, population, and climate change issues, and to advance to a world in which  we are giving women the universal access, or universal right to determine the number and spacing of children…It’s critical that we address these issues,” Bremner said.

The new Global Goals for Sustainable Development discussed at the UN General Assembly in September included family planning and access to women’s health care and ENGAGE Snapshot presentation