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Climate change and planning: least-developed countries define the agenda Leo Bryant,a Louise Carver,b Colin D Butler c & Ababu Anage d

Abstract The links between rapid growth and concerns regarding have received little attention. Some commentators have argued that slowing is necessary to reduce further rises in carbon emissions. Others have objected that this would give rise to dehumanizing “population control” programmes in developing countries. Yet the perspective of the developing countries that will be worst affected by climate change has been almost completely ignored by the scientific literature. This deficit is addressed by this paper, which analyses the first 40 National Adaptation Programmes of Action reports submitted by governments of least-developed countries to the Global Environment Facility for funding. Of these documents, 93% identified at least one of three ways in which demographic trends interact with the effects of climate change: (i) faster degradation of the sources of natural resources; (ii) increased demand for scarce resources; and (iii) heightened vulnerability to extreme weather events. These findings suggest that voluntary access to services should be made more available to poor communities in least-developed countries. We the distinction between this approach, which prioritizes the of poor communities affected by climate change, and the argument that population growth should be slowed to limit increases in global carbon emissions. The paper concludes by calling for increased support for rights-based family planning services, including those integrated with HIV/AIDS services, as an important complementary measure to climate change adaptation programmes in developing countries.

الرتجمة العربية لهذه الخالصة يف نهاية النص الكامل لهذه املقالة. .Une traduction en français de ce résumé figure à la fin de l’article. Al final del artículo se facilita una traducción al español

Introduction reports of procedures being applied without full consent of the patient.6 Despite widespread general debate on climate change, the It is worth noting that, like much of the public debate on relevance of demographic trends remains a comparatively climate change, the links made with demographic trends have unexplored issue, especially at the policy-making level. Some been largely confined to their implications for 1–3 notable commentators have proved the exception. In es- emissions. The relevance of demographic trends to adaptation sence, the concern they raise is that growth of global popula- to climate change has meanwhile remained almost entirely tion – projected to rise from around 6.8 billion people today unexplored by the scientific literature. The main finding of 4 to 9.2 billion by 2050 – will inevitably to a significant this paper is that this deficit is in stark contrast to the con- increase of greenhouse gas emissions. This has led to calls for cerns of the governments of least-developed countries. universal access to voluntary family planning services to be Despite the high-profile concern for the reduction of included as one component of the range of policy responses greenhouse gas emissions, least-developed countries have to climate change. Indeed, some authors have pointed to the focused more predominantly upon adaptation to climate “win/win” of this intervention given the numerous an- change and thereby how they may limit the predicted damage cillary benefits of rights-based family planning programmes. of climate change.7 A literature review by two of this paper’s These include reducing maternal and deaths; women’s authors found that a large majority (93%) of the 40 least- empowerment; preventing unintended including developed countries who had submitted strategy documents among women living with HIV; preventing mother-to- to the Global Environmental Facility identified concern about transmission of HIV; improving access to ; lower- the impact of rapid population growth upon their ability to ing the incidence of sexually transmitted infections includ- adapt to climate change. ing those which facilitate HIV transmission; and This re-emergence of concern for demographic trends reduction.5 in least-developed countries 8–10 is striking because concern Nevertheless these calls have not to date achieved traction about “overpopulation” was led by high-income countries in among politicians nor even within the environmental lobby. the first decades after the Second World War. In addition, this It is possible that this is due to concern for an over-reaction re-emergence is being driven at least as much by a grassroots in the policy response, mindful as many are of the “popula- movement as by leadership from the governments of either tion control” policies of the 1960s and 1970s that, inspired low- or high-income countries or global organizations such by concern for global overpopulation, infamously led to some as The . This is illustrated by the case study of an

a Marie Stopes International, 1 Conway Street, , W1T GLP, England. b Population Network, London, England. c Australian National University, Canberra, ACT, . d Population, and Environment Network, Addis Ababa, . Correspondence to Leo Bryant (e-mail: [email protected]). (Submitted: 19 December 2008 – Revised version received: 28 August 2009 – Accepted: 31 August 2009 – Published online: 18 September 2009 )

852 Bull World Health Organ 2009;87:852–857 | doi:10.2471/BLT.08.062562 Special theme – Strengthening linkages between sexual and and HIV Leo Bryant et al. Climate change and family planning

Ethiopian project that has integrated Table 1. Extent and frequency of reference to rapid population growth among the 40 family planning into a conservation and National Adaptation Programmes of Action reports management programme. Impor- tantly, it suggests that voluntary fam- Rapid population Number of countries Countries ily planning services should be made growth (n = 40) more available to poor communities in Not mentioned 3 Eritrea, Liberia, Sao Tome and Principe least-developed countries to assist their ability to adapt to the harmful effects of Identified as pertinent 37 Bangladesh, Benin, Bhutan, Burkina Faso, climate change. We stress the distinction to at least one specific Burundi, Cambodia, Cape Verde, Central consequence of climate African Republic, Comoros, Democratic between this approach and arguing that change Republic of the Congo, Djibouti, Ethiopia, population growth should be slowed Gambia, Guinea, Guinea-Bissau, Haiti, in these countries to curb increases in Kiribati, Lesotho, Madagascar, , greenhouse gas emissions. It is perhaps Maldives, Mali, Mauritania, Mozambique, more conducive to a rights-based ap- Niger, , Samoa, Senegal, Sierra proach to implement family planning Leone, Solomon Islands, Sudan, Tuvalu, Uganda, United Republic of Tanzania, programmes in response to the welfare Vanuatu, Yemen, Zambia needs of people and communities rather than in response to international con- Identified as a main 6 Ethiopia, Gambia, Kiribati, Malawi, Samoa, priority Uganda cern for global overpopulation. National Adaptation fund, with aims to reach US$ 500 mil- The harmful consequences of cli- Programmes of Action lion before 2012. mate change identified by the 40 coun- The Framework Con- The NAPA reports are distinctive tries are many, though they vary be- vention on Climate Change was es- in that they were created by govern- tween countries and regions and also tablished on 21 March 1994 with two ments of least-developed countries in depend on the timescale involved. chief objectives. The first was to reduce a consultative way with civil For example, in Bangladesh, increased greenhouse gas emissions including and local groups and they avoid a flooding due to storms and rises in sea 12 . This is currently being “top-down” rationale; that is, they level are of concern, while in large parts implemented through the Kyoto Proto- avoid a one-way flow of information of sub-Saharan Africa there are more col and is by far the most recognized between donor and recipient, a rela- concerns about a decline in agricultural 13,14 component of the Framework Conven- tionship that characterizes and flaws production. Water insecurity is an- tion. Second, member states of the Or- much development assistance. Analysis other common anxiety. As illustrated ganisation for Economic Co-operation of the reports shows that, in addition in Table 1, 37 of the reports cited rapid and Development (OECD) have also to concerns regarding the impact of population growth as a detrimental committed to provide financial support changing weather conditions on factors factor affecting one or more of these – over and above existing aid flows – to such as vulnerability to flood, drought harmful consequences. Table 2 identifies developing countries that require assis- and decreased crop yield, 37 of the re- the different climate change adaptation tance to adapt to the impact of climate ports (93%) were found to cite “rapid issues that are identified as exacerbated change. This financial support is deliv- population growth” as a factor that by rapid population growth. ered through the Global Environmental compounds these problems. Facility. Many common themes emerge Demographic and climatic Between 2004 and April 2009, the regarding specific climate change ef- interplay first 40 governments submitted their fects. Almost all (38 of 40 countries) National Adaptation Programmes of identify the risk of increased flooding, Given the speed of demographic Action (NAPA) in response to a com- while 36 identify longer or more fre- change in many least-developed coun- mission by the Global Environmental quent periods of drought. Thirty three tries, it is perhaps no surprise that Facility.11 These reports represent a identify reduced crop yield, 35 fresh population growth is identified as significant step towards realizing the and 37 discuss threats to problematic in strategies concerned OECD pledge of support by providing . For the purpose of this pa- with natural . For a recognized process by which least- per however, we highlight the fact that example, the of Rwanda developed countries and small island 37 reports identify rapid population and Uganda are, respectively, projected developing states can identify and growth as a problem that either exac- to roughly double and triple by the year articulate their priorities for climate erbates the effects of climate change 2050.4,15 Modern contraceptive preva- change adaptation. The NAPAs set out or impedes the ability to adapt. Six of lence remains low in both countries; the proposed adaptation strategies that these identified rapid population growth in Uganda it is 18% and in Rwanda are eligible for funding from the Least as a priority issue to be addressed by the 10%.16 But these reports go beyond Developed Countries Fund adminis- NAPA strategy while only three of the simply citing this problem and offer a tered by the Global Environmental Fa- 40 reports did not mention population rich description of the interplay be- cility. At the time of writing, US$ 172 growth at all. Table 1 summarizes these tween the consequences of both demo- million had been dispersed through this findings. graphic and climate change.

Bull World Health Organ 2009;87:852–857 | doi:10.2471/BLT.08.062562 853 Special theme – Strengthening linkages between sexual and reproductive health and HIV Climate change and family planning Leo Bryant et al.

Food insecurity is a major and Table 2. Ten most-cited issues identified as linked to population growth by 37 National recurring theme. Coastal and small is- Adaptation Programmes of Action reports land states often highlight the impact of climate change and rapid popula- Population/adaptation issue National Adaptation Programmes of tion growth upon deteriorating fishing Action Reports (n = 37) stocks, while other nations are more concerned by the combined impact of degradation/erosion 21 climate change and rapid population Fresh water scarcity 18 growth upon crop yields, illustrated Migration 18 here by Vanuatu: 17 Inadequate farm land per capita 14 “With the increasing population, the Loss of biodiversity 11 fallow periods are being shortened, Disease and constraints 8 adding to the soil degradation. Climate Loss of natural habitat 8 variability and extreme events such as Diminishing fish stocks 7 droughts and floods will exacerbate the 5 impact on the land, and in turn on the agricultural productivity.”17 tation of lands and a vegetal cover will be significant on coastal agricul- In addition to the fear of worsening severely altered. Erosion and landslide ture and the availability of fresh water insecurity, natural resource deple- processes are advanced. This situation for public and industrial water supply tion is a central theme of all the reports. explains the present migratory dy- will fall.”20 While some point to the loss of such namic of people from the most densely resources consequent to environmental populated provinces in the North Other NAPA reports (the Gambia and change and extreme weather events, (Ruhengeri, Gisenyi, Byumba) and Solomon Islands) link the issues of others outline population growth as an the South (Butare, Gitarama) towards limited fresh water availability and high additional stressor. The consequences the least populated provinces especially to increased spread of these combined stressors are often in the East (Umutara, Kibungo) and of infectious disease: defined both in economic terms and as South East (Kigali Ngali) in search of a increased human vulnerability to the new land for agriculture and livestock. “…the risk of infectious disease trans- impact of climate change, as is the case These migrating populations are al- mission increases with overcrowding.”21 in Uganda regarding its natural forest ready economically vulnerable and this depletion: vulnerability is increased by the high While the concerns of the different risk of drought and desertification of NAPA reports regarding rapid popula- “Deforestation is caused by a number of the zone that receives them.”19 tion growth and climate change are factors, including population increase diverse, three key themes emerge: and poor agricultural practices... This This increased incidence of drought (i) reducing supply – rapid population high rate of deforestation and forest is echoed in many other countries’ degradation suggests that if nothing growth and climate change act cumu- reports. Fresh water shortage is clearly a is done, Uganda may lose her natu- latively to degrade the source of key critical concern of many countries and ral forests by the end of this century. natural resources, for example through This will be very expensive because is often linked in the reports to rapid soil erosion and deforestation; (ii) in- the consequences of deforestation are population growth. Here the issue is creasing demand – rapid population many; and include: desertification, usually one of diminishing supply (due growth is projected to escalate the de- loss of biodiversity, erosion of gene to climate change) in the face of increas- mand for resources that are diminished pools, increased vulnerability of local ing demand (due to population growth) by climate change, including fresh communities to climate extremes, and although some reports also point to the water and food; and (iii) vulnerability reduction of livelihood assets for rural effects of rising levels upon to natural disaster – rapid population communities.”18 fresh water. Bangladesh highlights growth heightens human vulnerability the twin effects of rising sea levels and to natural disasters caused by climate The Rwandan report links the same population growth on the relative avail- change, such as by forcing more people issue of heightened vulnerability with ability of fresh water: to migrate and settle in areas at risk of a second major demographic concern floods, storms, drought and infectious relating to climate change, that of mi- “The effect of saline water intrusion in disease. gration.19 Here the focus is upon the the and into the groundwater additional burden that climate change would be enhanced by low river flow, An integrated approach places upon communities already fac- sea level rise and subsidence. Pressure ing migratory challenges caused in part of the growing population and rising While many (37) of the NAPA reports by rapid population growth: demand due to economic development identify rapid population growth as im- will further reduce relative availability portant to our understanding of the im- “High density population zones are of fresh water supply in future. The pact of climate change, few (6) propose currently characterised by overexploi- adverse effects of saline water intrusion to address population growth directly

854 Bull World Health Organ 2009;87:852–857 | doi:10.2471/BLT.08.062562 Special theme – Strengthening linkages between sexual and reproductive health and HIV Leo Bryant et al. Climate change and family planning through the adaptation strategies they improve crop production and to mini- complemented by improved sexual and outline. This is perhaps unsurprising mize in a region con- reproductive health. given the fact that ministries for the taining almost 3000 rural households. environment were responsible for au- The region had been severely affected Conclusion thoring the NAPAs while “population” by increasingly dry weather conditions, is traditionally an issue for the ministry forcing inhabitants to cut back natural The NAPA reports, in their repeated of health. It is also an unfortunate re- forest for agricultural purposes, in turn emphasis of the relevance of demo- flection of the fact that, for most coun- responsible for extreme soil erosion. graphic trends, provide a strong col- tries, family planning remains within its The project had three implementa- lective case for the “mainstreaming” of reproductive health sector “silo” and has tion strands: (i) to train inhabitants and an integrated approach to adaptation yet to be addressed on a large scale with local organizations in sustainable land- efforts that is exemplified by the Ethio- the multisector approach it both merits management practices and “healthy pian case study. The Kiribati report puts and requires. But the fact that so many awareness”, including agro- it succinctly: ministries for the environment did men- , hand-pump , com- tion rapid population growth suggests a post preparation and environmental “Population size and growth rates… potential to weaken these “silos”. impact assessment; (ii) to rehabilitate have significant impacts on the state Government response notwith- uplands and wetlands through refor- of the environment, aggravating vul- standing, some civil society organiza- estation; and (iii) the project included nerability and adaptation needs. In tions concerned with the impact of promotion of modern family planning this respect, population policy is an climatic trends upon human welfare methods and HIV/AIDS awareness by important consideration of adaptation have taken the lead in implementing the inviting professionals from local heath strategies.” 24 integration of sexual and reproductive facilities to participate in the environ- health into environmental adaptation mental training sessions. This inclusion At the national level, incorporating this efforts. This trend both echoes calls to was based both upon the analysis that demographic perspective will require integrate reproductive health services rapid population growth was in part the integration of voluntary, rights- into HIV/AIDS programmes and also responsible for local deforestation, and based family planning programmes points to a need for even wider multi- also to further the overriding project into adaptation efforts, hence making sector integration. An example of such goal of improving health and welfare. climate change a priority that must be a multisector approach is offered by the Four years from project inception, shared by departments of health as well Watershed Management Project of the the Wichi province Watershed Manage- as environmental ministries. Ethio Wetlands and Natural Resources ment Project has achieved results that At the international level, rectify- Association and the Consortium for are immediately apparent to visitors ing the chronic global under-spend the Integration of Population, Health to the area. Improved irrigation, com- for family planning development as- and Environment Network in Ethio- post and tree-planting methods have sistance – including through integrated pia, the aims of which support specific reversed soil degradation trends and sexual and reproductive health and objectives identified in the Ethiopian improved local nutritional levels, hence HIV/AIDS programmes – should be NAPA, which is explicit on the need to reducing the need for cutting back the recognized as an important addition mainstream family planning into the forest. Furthermore, by integrating to international efforts to assist least- agricultural sector.22 family planning and HIV/AIDS aware- developed countries to adapt to climate The Watershed Management Proj- ness, the project has helped to ensure change. ■ ect in Wichi province of Metu Woreda that these environmental benefits in eastern Ethiopia ran between 2005 are sustainable, protected from being Competing interests: None declared. and 2007.23 Its aim was to sustainably eroded by rapid population growth and

Résumé Changement climatique et planification familiale : les pays les moins développés définissent l’ordre du jour Les liens entre croissance démographique rapide et changement l’environnement mondial par les gouvernements des pays les climatique ont bénéficié de peu d’attention. Certains ont avancé moins développés. Parmi ces documents, 93 % mettaient en qu’un ralentissement de la croissance démographique était évidence au moins un des trois modes d’interaction suivants nécessaire pour limiter davantage l’envolée des émissions entre les tendances démographiques et les effets du changement de carbone. D’autres ont objecté que cela supposerait la climatique : (i) accélération de l’épuisement des sources de mise en place de programmes de «contrôle démographique» ressources naturelles, (ii) accroissement de la demande en déshumanisants dans les pays en développement. Néanmoins, la ressources rares et (iii) accentuation de la vulnérabilité humaine perspective que ces pays soient les plus gravement affectés par le aux événements climatiques extrêmes. changement climatique a été presque totalement ignorée par la Ces résultats laissent à penser que l’accès volontaire aux littérature scientifique. services de planification familiale devrait être facilité pour les Le présent article tente de combler ces lacunes en communautés pauvres des pays les moins développés. Nous analysant les 40 premiers rapports des Programmes d’action insistons sur la distinction entre cette approche, qui donne la nationaux d’adaptation soumis pour financement au Fonds pour priorité au bien être des communautés pauvres affectées par le

Bull World Health Organ 2009;87:852–857 | doi:10.2471/BLT.08.062562 855 Special theme – Strengthening linkages between sexual and reproductive health and HIV Climate change and family planning Leo Bryant et al. changement climatique, et l’argumentaire selon lequel il faudrait de planification familiale respectueux des droits des populations, ralentir la croissance démographique pour limiter l’augmentation et notamment ceux intégrant des services liés au VIH/sida, en tant des émissions mondiales de carbone. que mesure complémentaire des programmes d’adaptation au L’article conclut en appelant à soutenir davantage les services changement climatique dans les pays en développement.

Resumen Cambio climático y planificación familiar: los países menos adelantados marcan la agenda No se ha prestado demasiada atención a la relación existente climático: (i) un más rápido deterioro de las fuentes de recursos entre el rápido crecimiento de la población y la preocupación que naturales, (ii) la mayor demanda de unos recursos escasos y (iii) el suscita el cambio climático. Algunos comentaristas han señalado aumento de la vulnerabilidad humana a fenómenos meteorológicos que la disminución del crecimiento demográfico es un requisito extremos. necesario para reducir el incremento de las emisiones de carbono Estos resultados indican que habría que ofrecer más en el futuro. Otros han objetado sin embargo que eso puede dar posibilidades de acceso voluntario a los servicios de planificación lugar a programas de crudo «control demográfico» en los países en familiar a las comunidades pobres de los países menos desarrollo. Sin embargo, las publicaciones científicas han ignorado adelantados. Destacamos la diferencia existente entre este casi por completo la perspectiva de los países en desarrollo que enfoque, que prioriza el bienestar de las comunidades pobres más gravemente se verán afectados por el cambio climático. afectadas por el cambio climático, y la postura de proponer que se Colmar esa laguna es el objetivo del presente artículo, que reduzca el crecimiento de la población a fin de limitar el aumento analiza los primeros 40 informes de Programas Nacionales de de las emisiones de carbono mundiales. Acción para la Adaptación presentados al Fondo para el Medio El artículo finaliza solicitando un mayor apoyo a los servicios Ambiente Mundial por gobiernos de los países menos adelantados de planificación familiar basados en los derechos, en particular para solicitar financiación. El 93% de esos documentos a los integrados con los servicios contra el VIH/sida, como identificaban al menos una de tres posibles formas de interacción una medida complementaria importante de los programas de entre las tendencias demográficas y los efectos del cambio adaptación al cambio climático en los países en desarrollo.

ملخص التغري املناخي وتنظيم األرسة: البلدان األقل ُّتطوراً تحدد برنامج العمل مليحظ االرتباط بني النمو الرسيع للسكان وبني الشواغل املتعلقة بالتغري )1( تهالك رسيع يف مصادر املوارد الطبيعية؛ )2( ازدياد الطلب عىل املوارد املناخي باهتامم كبري. ويناقش بعض املعلقني أن إبطاء النمو السكاين رضوري الشحيحة؛ )3( ازدياد ض ُّتعرالبرش لألحداث املناخية البالغة الشدة. لإلقالل من االزدياد يف انبعاثات الكربون. فيام يعارض آخرون بأن ذلك وتشريهذه املوجودات أن الوصول الطوعي لخدمات تنظيم األرسة سيؤدي إىل انتهاك اإلنسانية يف برامج تنظيم السكان يف البلدان النامية. ومع ينبغي أن يكون أكرث متاحاًللمجتمعات الفقرية يف البلدان األقل تطوراً. ذلك فقد تجاهلت النرشيات العلمية وجهة نظر البلدان النامية التي ستتأثر ِّويؤكد الباحثون عىل التفريق بني هذا األسلوب الذي يعطي األولوية لرفاهية اسوأ تأثري بالتغري املناخي ًتجاهال ًكامال تقريباً. املجتمعات الفقرية املتأثرة بالتغري املناخي، وبني االحتجاج بأن النمو السكاين وتعالج هذه الورقة هذه العيوب، فتحلل التقارير األربعني األوىل لربامج ينبغي أن يبطأ للحد من االزدياد يف االنبعاثات الكربونية. العمل للتكييف الوطني، والتي قدمتها الحكومات يف البلدان األقل تطوراً وتخلص الورقة بالدعوة إىل زيادة الدعم لخدمات تنظيم األرسة املرتكزة إىل املرفق العاملي للبيئة للحصول عىل التمويل. ومن بني هذه التقارير، عىل الحقوق والتي تشمل الخدمات املتكاملة مع خدمات اإليدز والعدوى تم التعرف يف 93% عىل األقـل منها عىل واحدة من ثالث طرق تتفاعل بفريوسه، كإجراء تكمييل هام لربامج التكيف مع التغري املناخي يف البلدان فيها االتجاهات الدميوغرافية مع تأثريات التغري املناخي، وهذه الطرق هي: النامية.

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