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A newsletter from The John D. and Catherine T. MacArthur Foundation ’S0PRING7 .1 VOLUME WINTER VOLUME President’s Message India delivers new approaches to women’s health Sexuality education shows results in Nigeria Reaching out to rural Population and youth in Mexico Program Director’s Reproductive Health Message President’s Message Population and reproductive health espite historically low birth four interconnected components. We government to expand the project from rates in North America and assist international organizations that sus- three training centers to 20. much of the developed world, tain the infrastructure of the field, such MacArthur’s grantmaking also rec- global population is expected as the International Planned Parenthood ognizes the value that nongovernmental Dto increase by more than 40 percent to 9 Federation and the Population Council. organizations can contribute to government billion over the next 50 years. About 1.5 We support organizations that influence programs. In Nigeria, MacArthur grantees billion people between the ages of 10 and policy and resource allocation through are working directly with State Ministries 24 are currently living in the developing targeted advocacy. We fund research — of Education to implement a sexuality world, about to enter their childbearing programmatic, clinical, and social science curriculum in six states (see “Sexuality years. There are more young people in the investigations into key issues of effective- education shows results in Nigeria,” page world today than ever before. The deci- ness and policy. And we support field-level 8). In Mexico, our partners are working sions this generation makes about when programs in India, Mexico, and Nigeria — with a government program called IMSS to start their families, how many children three countries that account for about a Oportunidades to bring information and to have, and how far apart to space their quarter of all women of reproductive age, services to young people in rural Mexico births may determine whether the world’s as well as a quarter of all young people in (see “Reaching out to rural youth in poorest countries can advance toward the developing world. Mexico,” page 11). In both cases, these greater prosperity. In our focus countries, MacArthur’s nongovernmental organizations had the Pressure from this large cohort of grantmaking is designed to help reduce experience and specialized expertise that young people is only part of the demo- maternal mortality and to help educate government agencies needed to improve graphic challenge. Survey data suggest that young people about their reproductive and their work. about 120 million women in the Global sexual health. Reducing maternal mortality At the core of our grantmaking, South would prefer to avoid pregnancy is a worthy goal in itself, but it is also the we believe that proof of what works but are not using contraceptives. For those best indicator that women are receiving the should drive our efforts and help shape who do give birth, their risk of death is reproductive health services they need. the field. To this end, MacArthur has exponentially higher than for women in We believe that when they are, they will begun to invest in research that explores North America or Europe (one out of make sensible reproductive choices that the links between population dynamics every women in Africa will die due are right for them and for their families. and economic well-being. We hope MacArthur 16 Foundation to complications from childbirth, com- MacArthur focuses on educating young that researchers will be able to recom- Population and pared to one in 2,800 in the developed people because the choices they make today mend strategies to help governments take Reproductive Health world). There are more than half a million will help determine the size and well-being advantage of the opportunity that current maternal deaths in the developing world of the world’s population tomorrow. population trends may offer: a “bulge” in each year, most of which could be avoided We believe that by concentrating the number of people just entering their with even the most basic maternal health MacArthur’s limited resources on two most productive years, known as “the services and care. critical issues in three key countries, we demographic dividend.” Researchers note The MacArthur Foundation has can learn and demonstrate how a mix of that fewer births in developing countries been active in the field of population and civil society advocacy and action can be increase the proportion of adults able to reproductive health since 1986. During combined with sensible government policy contribute to the economy without the two decades in the field, MacArthur has to help take good work to scale. In order burden of additional dependents. The awarded $215 million to almost 1,000 to expand care and services to women and investment dollars freed up as a conse- organizations and individuals. young people, MacArthur is supporting quence of lower fertility may be able to be From the beginning, our approach carefully selected model projects in each of used to strengthen economic development has emphasized the importance of repro- our focus countries and providing assistance and social well-being. Evidence from East ductive rights and health. Since the 1994 to help scale them up where warranted. Asia suggests that as much as one-third of International Conference on Population For example, several MacArthur its growth in the 1990s may have been the and Development (ICPD) in Cairo, these grantees in India have developed training result of such dividends. Can this success issues have become central to poverty programs to expand the pool of health be replicated? Research MacArthur is sup- reduction and health care. In the early workers able to provide obstetric care to porting aims to provide an answer. years of MacArthur’s program, we offered India’s vast rural populations (see “India We realize that MacArthur’s contribu- support to individuals with strong lead- delivers new approaches to women’s tion to the field is small compared to the ership potential through the Fund for health,” page 3). Because of the promise challenges we face. But we hope this news- Leadership Development [see article on of one such effort by the Federation of letter illustrates how our current strategies page 14 of this newsletter]. MacArthur’s OB-GYN Societies of India (FOGSI), the take advantage of the best of research and investments in these leaders contributed to Indian government has asked them to adapt practice to develop approaches and policies the paradigm shift reflected in the ICPD’s their training programs for use country- that contribute to improving the health and “Programme of Action,” which was wide. Indeed, $450,000 from MacArthur well-being of the world’s population. endorsed by 179 countries. to train general medical practitioners in Today, MacArthur’s Population emergency obstetric care has stimulated an Jonathan F. Fanton and Reproductive Health program has additional $4.75 million from the Indian President 2 | MacArthur/Winter ’07 Training maternal caregivers: India delivers new approaches to women’s health Above: A group of mothers in India n organization that combines the philosophy of listens to a presen- tation on health. Mahatma Gandhi with the science of modern Cover: Nigerian stu- dents wait outside of their school. Nigeria medicine did what many considered impossible is one of three countries that are the focus of MacArthur’s A population and — dramatically reduced newborn deaths and improved reproductive health grantmaking. women’s health in one of India’s most impoverished regions. Founders Abhay and Rani Bang, physicians committed to working with India’s poor, demonstrated how in a region where 95 percent of all births take place at home, often hundreds of miles from a hospital, it was possible to reduce newborn death by 70 percent, complications from pregnancy and delivery by nearly 75 percent, and the need for MacArthur/Winter ’07 | 3 Right: SEARCH trains health care workers, like the woman on the left in the photo, who visit women at home during their pregnancies. They also assist during delivery and make post-partum visits. emergency obstetric care by more than the global maternal death toll. And for structure is a long-term process, and percent. They accomplished this by every maternal death in India, there are in the interim the government is looking MacArthur 30 Foundation training teams of women in rural vil- 10 newborn deaths — a total of 1.1 mil- for other ways to expand services and Population and lages — many of them illiterate and oth- lion, or one-quarter of all newborn deaths improve care. Reproductive Health ers with only a few years of education worldwide. “Delivering health services in India, — to provide home-based mother and Most of these deaths occur because especially in the rural areas, is a chal- newborn health care ranging from basic the women do not have access to ade- lenge the government cannot tackle on hygiene to treatment of pneumonia and quate medical care. In fact, nearly 50 its own,” says V. K. Manchanda, deputy infant resuscitation. percent of women in India deliver at director general of maternal and child “Most doctors tend to work in hospi- home with untrained birth attendants, health for India’s Ministry of Health tals in cities, so we don’t see the women which dramatically raises the risk of death and Family Welfare. “Many nongovern- and babies who are sick and die because for both mother and child. Recognizing mental organizations have the expertise they don’t make it to the hospital,” says this challenge, the Indian government and reach at the local level we need to Abhay Bang, who with his wife Rani has committed to increasing the number develop effective strategies.” The govern- founded Society for Education, Action of hospitals and clinics, especially in rural ment is now partnering with a number and Research in Community Health areas.

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