Institute Insights: March 2017

Contents:

Grannies waiting for health check up in Jinja, Uganda. Photo: Laura Pohl / Bread for the World

From the Director

Spring is just around the corner! On March 8, we will celebrate International Women’s Day once again, and in the United States, March is Women’s History Month. Of course women’s history is also half of “regular” history, the history being made year-round. But until women are fairly represented in Congress and parliaments, other decision-making bodies, and the media and public life, we also set aside this day and this month to ensure that women’s contributions are not overlooked.

This issue of Institute Insights illustrates how “women’s issues” are simply human issues, while also putting a special emphasis on women and girls. Ending hunger and malnutrition requires women’s empowerment and gender equality, and the Institute includes gender in our analysis as the critical factor it is. See our 2015 Hunger Report, When Women Flourish … We Can End Hunger, for much more on the connections between hunger and unequal treatment on the basis of gender.

In the global effort to end hunger and malnutrition, women’s roles of giving birth to and raising children generally receive more attention than other roles. The 1,000 Days nutrition initiative focuses on the crucial time between pregnancy and age 2. Of course, the well-being of pregnant and lactating women is essential to humanity’s future, and many developing countries continue to work to reduce high maternal mortality rates. Mothers are also key to the survival and well-being of their young children. But there is another group whose good nutrition is of paramount importance — for themselves, of course, but also future generations. This group is adolescent girls, many of whom will be expectant mothers in a few short years and need to be well-nourished to have safe pregnancies and healthy babies.

What about women who have completed their childbearing and mothering roles, with grown children and perhaps grandchildren? In many developing countries, women now live to the age of 70 or older. Of course it is impossible to generalize about hundreds of millions of women all over the world. But we can say that we know less about hunger and malnutrition among women at midlife and later than among pregnant women and young mothers.

Some older women are no doubt respected for their rich life experiences, while others, particularly widows, are at risk of being cast aside as no longer useful. Some who had thought their years of raising children were over have stepped back into parenting roles, taking the places of far too many mothers and fathers lost to HIV/AIDS. Some older women benefited from the early years of the movement for girls’ equal access to education. Others were kept at home while their brothers went to school. On International Women’s Day and every day, we can and should lift up the hard work and achievements of midlife and elderly women along with those of younger women and girls.

Women are bearing the brunt of global climate change. At the same time, more and more women have roles as elected leaders and senior officials. Will an increasing representation of women in senior positions make a difference in how governments view and respond to global problems? Only time will tell, but later in this issue, we take a brief look.

Every March in the United States, we celebrate women’s contributions to building the society we want and envision. Some women are part of the history that has brought us to this point, while others — by the millions — are speaking out now, in 2017, on issues they care about. These issues may have direct connections with gender, or they may be part of the broader effort to ensure that everyone is included and no one is left behind as the country moves forward. We honor the contributions, courage, and persistence of women in the U.S. past and present. 

Asma Lateef is director of Bread for the World Institute

Asma Lateef is director of Bread for the World Institute.

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Tohomina Akter picks amaranth in Barisal, Bangladesh. Photo: Laura Elizabeth Pohl / Bread for the World

Adolescent nutrition demands much more attention

By Jordan Teague

At Bread for the World Institute, we talk a lot about maternal and child nutrition, especially within that critical 1,000-day window between a woman’s pregnancy and her child’s second birthday. The concept of the 1,000 days has garnered a lot of attention: good nutrition for pregnant women and children under 2 has ramifications that extend throughout the child’s entire lifetime and even to future generations.

But what happens if a woman is already malnourished at the time she becomes pregnant? We don’t think about this nearly as often as we should — in fact, there’s an urgent need to devote more attention to the nutritional needs of adolescent girls. Why? One main reason, of course, is to bolster the nutritional status of girls so they can learn and be active as healthy young adults. Adolescents also have greater nutritional needs, due to puberty and the rapid development that follows.

Another reason is that many adolescent girls are heading quickly toward marriage and pregnancy. One in every three girls in low- and middle- income countries is married by her 18th birthday, and 17 million girls under age 19 give birth each year. Malnourished adolescent girls start and continue their pregnancies while remaining malnourished, and the generational cycle continues.

Development and nutrition specialists have developed a set of top-priority nutrition actions. They are all both cost-effective and ready to scale up immediately. One of these is iron and folic acid supplementation for adolescent girls. It is a logical place to start doing more to promote good nutrition for this group, because iron deficiency is a major cause of anemia among adolescent girls and pregnant women — and anemia causes about 20 percent of all maternal deaths. If a pregnant woman has a folic acid deficiency, meanwhile, there’s a greater risk of severe neural tube defects.

Anemia affects 500 million women worldwide. In addition to causing the deaths of so many women during and soon after childbirth, it increases the risk that babies will be born already showing signs of malnutrition. Anemia also affects cognitive function and causes fatigue. In fact, it carries global economic consequences because it reduces women’s productivity at work or school. The global community has set an initial goal of reducing anemia by 50 percent among women of reproductive age (defined as ages 15 to 49 and thus including most adolescent girls) by 2025.

Another risk factor for maternal mortality is “short stature,” which is alarming since a study in The Lancet, a respected medical journal, found that in some countries, as many as half of all adolescent girls are stunted. Researchers say that pregnancy and childbirth are more dangerous for women who are shorter than 4’10.” Since very few girls continue to grow past their early teens, it is more important than ever to address those risks that can be mitigated, such as nutritional deficiencies.

And yet, very few nutrition programs target adolescent girls. One reason is that adolescent girls are a hard-to-reach population. Programs at school make sense — for those who are in school. But about 31 million adolescent girls around the world are not. The World Bank reports that 16 million girls between the ages of 6 and 11 will never even start school. Innovative and creative ideas are needed to reach adolescent girls with the nutritional support essential both for themselves and for their future children.

There may be opportunities to provide this nutritional support in places where platforms and delivery channels already exist and girls who are not in school, particularly those who are married, may gather. These include health facilities, scheduled clinics with community health workers, or other social protection programs. Once nutrition workers are in touch with girls, they need to deliver not only iron and folic acid supplementation, but additional nutrition interventions and information tailored to their specific needs.

The global health and development community is coming to realize that the issue of adolescent nutrition, and the issues of adolescent girls more generally, has been neglected. One result is that the Center for Strategic and International Studies will release a report on March 20 that proposes a U.S. development assistance initiative focused on adolescent girls, entitled "Her Health, Her Lifetime, Our World: Unlocking the Potential of Adolescent Girls and Young Women." Nutrition of adolescent girls, anemia in particular, is a major focus of the proposal.

National governments, local communities, and donors alike must go further. Adolescent girls can no longer be ignored. We must ensure that their nutritional needs are met, for their own sake and for that of future generations.

Jordan Teague is international policy analyst at Bread for the World Institute.

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Dabora Nyibol, a returned refugee in South Sudan, prepares sorghum, a staple in her country. Photo by Stephen H. Padre/Bread for the World

Ambassador Nikki Haley: Opportunities to Stand with Women, Confront Climate Change

By Faustine Wabwire

Former U.S. Secretary of State John Kerry underscored the gravity of the threat posed by climate change by likening it to that of terrorism. Secretary Kerry made another important but often overlooked point: the cost of inaction will be overwhelming unless the global community takes a more serious stand against climate change now. There is no default “wait and see” option — only a choice.

As the new U.S. Ambassador to the United Nations, Nikki Haley can make a significant contribution to the world by stepping up U.S. leadership on climate change. This is an urgent issue where U.S. support — political, economic, and moral — has been critical and is becoming even more critical.

Respected scientists have come to a consensus on the evidence: the planet is warming, and it is not a normal cycle. Industrialization brought many benefits to our country and others. The early developers of fossil fuel sources of energy could not have known, of course, that worldwide demand would grow so strong that, a couple of hundred years later, the increased emissions would begin to change the planet itself. 

Without a viable, healthy planet, humanity cannot survive. This is why responding quickly and effectively to climate change is a necessity. It’s no longer a choice. For quite some time, people could not believe what the data was telling us, and then, what our own eyes were telling us. We could never change the weather… or could we? Once it began, a cascading domino effect meant that climate change gathered strength and momentum and quickly accelerated. Not too long ago, people thought we had time. That perhaps our grandchildren would need to find solutions.

Now all we have to do is look at satellite images or visit one of the places that were affected earliest — a generation ago or more. In many parts of the developing world, climate change is already making people who were already struggling even worse off. Their food, nutrition, and water security are all threatened. There are more floods, more severe storms, and more droughts. New crop diseases and new pests also arrived with the change in the weather.

People who depend on rain-fed agriculture to eat are suffering most. Poor communities in poor countries bear the brunt of the damage, largely because they have so few options. It is especially unfair, because of all the people on earth, they have done the least to cause the problem. Since their communities are far less industrialized than the “developed” world, they produce only a very small fraction of the greenhouse gas emissions that drive climate change.

Women are central to agricultural production in the developing world; they are indispensable when it comes to putting food on the table. But when resources are scarce, it is also women who go without. Cultural, social, and economic barriers make them more vulnerable to climate change than men from the same struggling communities. Because of their responsibility to secure water, food, and energy for cooking and heating, they are likely to experience significant hardships as climate change causes their communities to suffer growing resource scarcities.

They have limited access to productive assets such as land, credit, and extension services. Progress on women’s empowerment is changing a lot of things — for example, female literacy rates have skyrocketed. But these changes take time, and we do not have time given the pace of climate change. Women’s hard work, willingness to experiment, and creativity in finding workarounds when the strategies they know fail are simply not enough to adapt to what is happening around them.

Rural women need supplies, knowledge, and techniques that may not even exist yet. In many ways, “climate smart agriculture” and other mitigation strategies remain in their infancy. Research in labs, and the on-the-ground evidence base that farmers are building themselves, have begun. But they are not keeping pace with the changes in the climate and their impacts.

This reality demands a gender analysis approach toward mitigation and adaptation measures, so that both women’s and men’s specific needs and roles are identified and addressed. Agricultural research and extension programs, for example, should pay attention to the unique duties and responsibilities of women as primary caregivers in the community. Investments in strengthening women’s capacity to create and implement informed, effective adaptation measures can help poor communities become resilient in the face of climate shocks.

Developing countries are not the only sites of damage from climate change — it just became evident sooner in less industrialized, more rural areas. The 2012 U.S. drought, which covered almost 62 percent of the land area of the 48 contiguous states, was said to be second in size only to the Dust Bowl of the 1930s. Also in 2012, Superstorm Sandy wreaked havoc on the East Coast, causing about $30 billion in damage and killing more than 100 people.

Ambassador Haley has a real opportunity now to build on recent U.S. efforts to respond to climate change. In December 2015, U.S. leadership helped achieve a key milestone, the Paris Climate Agreement. At this time, a large majority of the world’s countries made commitments to help implement a global action plan. The plan puts the global community on track to limit Earth’s temperature increase to less than 2°C, considered essential to preventing the most catastrophic consequences.

National governments, donors, and the private sector are committed to improving access to new technologies, knowledge, and skills for climate change mitigation, as well as developing new adaptation strategies. Efforts must focus on increasing women’s adaptive capacity to deal with the shocks, while also providing the necessary support — such as social protection and financial and technical assistance — to cushion their communities against additional stressors.

Ambassador Haley’s commitment is critical at this pivotal moment when the world is looking to the United States for continued leadership in addressing climate change, the biggest threat to all of us.

Faustine Wabwire is senior foreign assistance policy analyst at Bread for the World Institute. 

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Yaretzi Calero holds the hand of Antonia who led a group from Michigan to Washington DC to demonstrate support for DAPA in front of the Supreme court.

Women’s Empowerment Sparks Global Progress

By Marlysa D. Gamblin

On January 21, 2017, millions of women all over the world marched in solidarity to lift up the truth:  women’s rights are human rights. The Women’s March attracted more than 440,000 marchers to Washington, DC, alone. Women and male allies also held more than 670 sister marches all over the United States and worldwide. Marches took place on all seven continents — in Nigeria, Spain, Saudi Arabia, Mexico, India, Colombia, France, Finland, and more.  Altogether, the marches attracted nearly 5 million people.   

This coordination was very impressive, to say the least. But why is it important? And why did I choose to highlight this for our celebration of International Women’s Day on March 8? This march was the first of its kind — coordinated with worldwide support and presence for justice and equality. The Women’s Empowerment March in Washington, DC, and its allied marches had a broad commitment to women’s rights, racial justice, reduced inequalities between communities, and peace around the world.

If we look more closely, the march and its commitments are all grounded in the Sustainable Development Goals, a set of 17 global goals that make up the 2030 Agenda. The Agenda has been adopted by 193 countries, including the United States. When fully realized, it will end chronic hunger and extreme poverty in our country and worldwide. It is ambitious but perfectly feasible to do this by 2030 — coming up in just 14 years.

The Women’s March organizers may not have thought of it this way, but the three global goals emphasized most heavily at the march were Goal 5, gender equality; Goal 10, reduced inequalities; and Goal 16, peace and strong institutions. These women leaders recognized that families and communities — and the world — are unable to move forward and make progress with the continued presence of discrimination based on gender, race, ethnicity, or religion.

We know that without gender equality and women’s empowerment, families and communities all over the world will continue to be left behind. In Bread for the World Institute’s 2015 Hunger Report on Women’s Empowerment, we explain how discrimination against women is a major cause of hunger and persistent poverty, both for them and for their children. The report notes that in the United States, discrimination is the source of lower wages, less education, fewer assets, and less support for raising children — all factors that contribute to women’s continuing struggles to earn enough income to support and build a strong future for their families. We know the same to be true of racial discrimination and other types of discrimination.

What is even more impressive is the shared acknowledgement among these women that discrimination and inequality will not enable global progress. Moreover, this march mobilized global support for ending discriminatory and unequal practices that harm women, people of color, and other vulnerable groups anywhere in the world.  The fact that millions of women and allies around the globe acknowledged and stood behind this truth can inspire and encourage others and open very promising opportunities for more people. This is an opening for communities everywhere to make the global goals their own, and for governments to adopt policies and practices that reflect the ideals of the goals and the 2030 Agenda’s mantra, “to leave no one behind.” In short, this is a very strong testament to how women’s empowerment can lead to progress and a better world.  

Marlysa D. Gamblin is a domestic advisor for policy and programs for specific populations at Bread for the World Institute.

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Photo by Joseph Terranova for Bread for the World.

Block Granting Medicaid Would Betray America’s Core Values

By Cynthia Woodside

To explain why block granting Medicaid is the antithesis of honoring American values, let’s look briefly at how we adopted these values.

In the 400 years since Europeans first settled in North America, Americans have come to a broad consensus on the kind of country we want to be: a country where hunger, malnutrition, and extreme poverty are problems of the past, and a country where everyone has opportunities, whether rich, poor, or middle class; African American, white, Latino, Native American, or Asian; men or women.

Leaders and reformers from all walks of life have led and continue to lead efforts to shape our society and government to better reflect our ideals.

Caring for each other has been a bedrock of our country from the beginning. In 1630, John Winthrop told his group of English Puritans in the Massachusetts Bay Colony, "We must bear one another's burdens.”

The Declaration of Independence has more to say about equality in a passage familiar to most of us: “We hold these truths to be self-evident, that all men are created equal, that they are endowed by their creator with certain inalienable rights; that among these are life, liberty, and the pursuit of happiness.”

Of course, a more modern interpretation includes women, African Americans, and others who were not included in the original “all men are created equal.” Opportunity for all is also part of our modern understanding of American values: the zip code where people were born and raised should not dictate the rest of their lives. Benjamin Franklin gets some of the credit for moving us toward this understanding. For example, his concern for people who were less educated and therefore had less opportunity led him to found the country’s first subscription library.

This is March, so we are celebrating Women’s History Month. But the story of American values during the other 11 months (the ones emphasizing men’s history) includes many mentions of women who led the way to improving the lives of others. Harriet Tubman, who escaped from 30 years of slavery in 1849, continued to jeopardize her freedom while saving more than 300 others. Clara Barton, after working as a nurse in the dreadful conditions of makeshift battlefield hospitals in the Civil War, founded the American Red Cross. In the late 19th century, seeing the grim conditions in the tenements where urban poor people lived, Jane Addams started the settlement house movement by founding Hull House in Chicago. Many other women were leaders in “benevolent societies” dedicated to solving social problems.

Medicaid is another important example of these American values in practice. However, this core support program is now under attack from the administration and the majority party in Congress, whose proposals to make Medicaid a “block grant” would leave millions of people entirely without health insurance. Block granting would also crack the program’s fundamental structure in ways that will ultimately cause it to shatter. It is hard to imagine such a proposal meeting with approval from our country’s founders, later leaders of social change, or most Americans today.

Medicaid provides essential healthcare coverage for low-income pregnant women, children, and families. Roughly 33 million children — more than a third of all the children in the country — are covered by Medicaid. Medicaid also covers nearly half of all births in the United States. The program is particularly important for children of color. Because they are more likely than white children to come from low-income families, Medicaid helps reduce racial and ethnic disparities in children’s health insurance coverage.

Medicaid also serves a large share of children with special needs, from families of all incomes. In addition, the program covers the nursing home expenses of many frail elderly people. Nursing home care costs so much that a person’s own savings can be depleted in a matter of weeks or months, after which Medicaid will pay for their care. 

Proposals to eliminate the current structure of Medicaid and replace it with a block grant or a program using per capita caps would end the current guarantee of healthcare coverage for everyone who is eligible. A block grant would instead give each state a fixed amount of Medicaid funding. When those funds have been spent, people who are both in need and eligible for Medicaid — mothers, children, elders, and people with special needs alike — would have to be turned away.

According to a recent analysis by the Urban Institute, an estimated 14 million to 21 million women and children would ultimately lose their Medicaid coverage as a result of state restrictions on funding. That is in addition to the 11 million people who will lose Medicaid coverage if congressional proposals to repeal the Medicaid expansion under the Affordable Care Act (ACA) are approved.

Why do some elected officials want to block grant Medicaid? The reason is simple: proponents want to significantly reduce federal spending. They would accomplish that by shifting substantial costs to the states. But states, lacking the funds to make up for the cuts in federal funding, would have little choice but to restrict eligibility, reduce benefits, and make it more difficult for people to enroll.

In addition, proponents will often claim that a block grant would give states more flexibility. After all, everyone is in favor of flexibility, right? But proponents don’t say why states need more flexibility, and states already have the ability to tailor Medicaid services and models of care to meet local needs, streamline delivery, and improve health. How would “greater flexibility” benefit Medicaid patients?  

The ill-conceived proposal to block grant Medicaid runs counter to many decades of collective effort to build the country that our people envision. It would force millions of our fellow Americans onto shaky ground. They would be forced to spend their time and money in an unending, often fruitless, pursuit of health care that they can afford. They would be forced to make impossible “choices” among seeing a doctor, filling a prescription, buying food, or paying their rent. They would be robbed of opportunities not only to pursue their potential and contribute to their communities, but also to use their talents to improve life for all of us. The prospects of reaffirming our American values and achieving the global 2030 Agenda goals of ending hunger, malnutrition, and extreme poverty would be far dimmer.

Cynthia Woodside is senior domestic policy analyst at Bread for the World Institute.

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Graphic by Doug Puller / Bread for the World

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