Despite historically low birth rates in North America and much of the developed world, global population is expected to increase by more than 40 percent to 9 billion over the next 50 years. About 1.5 billion people between the ages of 10 and 24 are currently living in the developing world, about to enter their childbearing years. There are more young people in the world today than ever before. The decisions this generation makes about when to start their families, how many children to have, and how far apart to space their births may determine whether the world's poorest countries can advance toward greater prosperity.
Pressure from this large cohort of young people is only part of the demographic challenge. Survey data suggest that about 120 million women in the Global South would prefer to avoid pregnancy but are not using contraceptives. For those who do give birth, their risk of death is exponentially higher than for women in North America or Europe (one out of every 16 women in Africa will die due to complications from childbirth, compared to one in 2,800 in the developed world). There are more than half a million maternal deaths in the developing world each year, most of which could be avoided with even the most basic maternal health services and care.
The MacArthur Foundation has been active in the field of population and reproductive health since 1986. During two decades in the field, MacArthur has awarded $215 million to almost 1,000 organizations and individuals.
From the beginning, our approach has emphasized the importance of reproductive rights and health. Since the 1994 International Conference on Population and Development (ICPD) in Cairo, these issues have become central to poverty reduction and health care. In the early years of MacArthur's program, we offered support to individuals with strong leadership potential through the Fund for Leadership Development [see article on page 14 of this newsletter]. MacArthur's investments in these leaders contributed to the paradigm shift reflected in the ICPD's "Programme of Action," which was endorsed by 179 countries.
Today, MacArthur's Population and Reproductive Health program has four interconnected components. We assist international organizations that sustain the infrastructure of the field, such as the International Planned Parenthood Federation and the Population Council. We support organizations that influence policy and resource allocation through targeted advocacy. We fund research - programmatic, clinical, and social science investigations into key issues of effectiveness and policy. And we support field-level programs in India, Mexico, and Nigeria - three countries that account for about a quarter of all women of reproductive age, as well as a quarter of all young people in the developing world.
In our focus countries, MacArthur's grantmaking is designed to help reduce maternal mortality and to help educate young people about their reproductive and sexual health. Reducing maternal mortality is a worthy goal in itself, but it is also the best indicator that women are receiving the reproductive health services they need.
We believe that when they are, they will make sensible reproductive choices that are right for them and for their families. MacArthur focuses on educating young people because the choices they make today will help determine the size and well-being of the world's population tomorrow.
We believe that by concentrating MacArthur's limited resources on two critical issues in three key countries, we can learn and demonstrate how a mix of civil society advocacy and action can be combined with sensible government policy to help take good work to scale. In order to expand care and services to women and young people, MacArthur is supporting carefully selected model projects in each of our focus countries and providing assistance to help scale them up where warranted.
For example, several MacArthur grantees in India have developed training programs to expand the pool of health workers able to provide obstetric care to India's vast rural populations. Because of the promise of one such effort by the Federation of OB-GYN Societies of India (FOGSI), the Indian government has asked them to adapt their training programs for use country-wide. Indeed, $450,000 from MacArthur to train general medical practitioners in emergency obstetric care has stimulated an additional $4.75 million from the Indian government to expand the project from three training centers to 20.
MacArthur's grantmaking also recognizes the value that nongovernmental organizations can contribute to government programs. In Nigeria, MacArthur grantees are working directly with State Ministries of Education to implement a sexuality curriculum in six states. In Mexico, our partners are working with a government program called IMSS Oportunidades to bring information and services to young people in rural Mexico. In both cases, these nongovernmental organizations had the experience and specialized expertise that government agencies needed to improve their work.
At the core of our grantmaking, we believe that proof of what works should drive our efforts and help shape the field. To this end, MacArthur has begun to invest in research that explores the links between population dynamics and economic well-being. We hope that researchers will be able to recommend strategies to help governments take advantage of the opportunity that current population trends may offer: a "bulge" in the number of people just entering their most productive years, known as "the demographic dividend." Researchers note that fewer births in developing countries increase the proportion of adults able to contribute to the economy without the burden of additional dependents. The investment dollars freed up as a consequence of lower fertility may be able to be used to strengthen economic development and social well-being. Evidence from East Asia suggests that as much as one-third of its growth in the 1990s may have been the result of such dividends. Can this success be replicated? Research MacArthur is supporting aims to provide an answer.
We realize that MacArthur's contribution to the field is small compared to the challenges we face. But we hope this newsletter illustrates how our current strategies take advantage of the best of research and practice to develop approaches and policies that contribute to improving the health and well-being of the world's population.
Jonathan F. Fanton
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