This Los Angeles dinner started in a limo. This is not my usual transport when dining with my Ethiopian colleague Boge Gebre. But tonight I was introducing friends from different worlds. Our Los Angeles hosts generously provided the transportation. The car's black velvet interior with blinking lights on the ceiling gave a surreal setting to our conversation about stopping the unbearable practice of female genital mutilation (FGM).

Boge is a modern hero. As a successful catalyst for change she (through her NGO, the Kembatta Women's Self Help Center) has virtually wiped out the practice of FGM in several districts in Southern Ethiopia. A decade ago she returned to her country with one burning goal, "to stop even one girl from being cut!" I asked her how many girls have been spared and she grabbed my hands beaming, paused, and said with great satisfaction, "I don't know the exact number but in 7 of the 8 districts where we work, there is no mutilation of any girl!" Many thousands I told our hosts! In 2006 I was at one of her rallies where some 15,000 people -- from several villages -- came together to celebrate the end of the practice. I've never seen anything like it!

Continue reading Amy's blog entry on The Huffington Post!

Last week I had the good fortune of being in Mexico for a PAI study tour of the country's family planning and reproductive health (FP/RH) programs. Thanks in part to twenty years of U.S. FP/RH assistance (from the mid-1970s to the late-1990s), Mexico has made major improvements in the health of women and children and its demographic situation.  Although challenges on these issues certainly remain, particularly in terms of the needs of its adolescent and indigenous populations, Mexico is a clear success story when it comes to the effectiveness of investments in voluntary family planning programs.  

Consider a few statistics that underscore the progress Mexico has made.  In 1970, a few years before Mexico initiated its national family planning program -- with significant assistance from the United States and the United Nations Population Fund (UNFPA) -- less than a quarter of women used contraceptives, average fertility rates were about seven children per woman, infant mortality rates were 69.0 per 1,000 live births, and average life expectancy was 62 years of age. 

Christine Bixiones is a Development Associate at PAI.

Mexico City, with its bustling streets, vibrant public art, and mixture of progress and need turned out to be an excellent location for an educational “tour” of a society’s public health challenges and success stories. Population Action International’s Friends’ Study Tour to Mexico gave its participants the opportunity to speak with passionate Mexican women leaders about their work to advance women’s status and health in a conservative “machista” culture and to see first-hand what these amazing leaders have accomplished and what challenges lie ahead.

Our group was particularly impressed with a dynamic group of youth leaders who work as community health promoters with the organization Mexfam (the Mexican Foundation for Family Planning).  At Mexfam clinics, sexual and reproductive health services are offered at a subsidized cost and are targeted to youth; outreach activities also reach youth in their schools and neighborhoods.

I've been in Mexico for almost a week. There's a growing behavior change challenge here: persuading Mexicans to change the way they eat and the way they have sex.

Why change the way they eat? Diabetes is on the rise in Mexico. Currently 9% of the population has type 2 diabetes and 18% are intolerant to carbohydrates. This is quite a challenge when the dietary staples are beans, rice and tortillas and more Coca-Cola is consumed here than anywhere on earth. It's VERY cheap.

Continue reading Amy's blog entry on The Huffington Post.

Wendy Turnbull is PAI's Sr. Policy Research Analyst. She is in Kenya with other colleagues working on PAI's latest documentary.

The small, one-room primary school building in Kibera has broken windows in a few spots, but is otherwise in good shape.  Located in the heart of Nairobi, Kibera competes with Soweto, South Africa to lay claim to being Africa’s second largest slum: it is home to more than one million people.

Colleagues from PAI and Pathfinder International and I are in Kibera to film and participate in a Muslim bridal shower.  We’re here in Kenya for the week producing a short documentary about the vulnerability of married women to HIV/AIDS.  Because the bridal shower is a women-only event, our male filmmaker, Nathan, is unable to attend, so we’ve lined up a local female camera-person. We women have been advised to “bling up” and wear as much gold, sequins, and makeup as possible.  We do our best to comply but we’re utterly out of our league in this crowd.  Jeans are a no-no.

Tamar Abrams is PAI's Vice President of Communications.  She is in Kenya with other colleagues working on PAI's latest documentary.

On a cool Saturday afternoon, the day before Kenya celebrates Madaraka Day (June 1, 1963 -- the date the country attained internal self-rule), I and several colleagues from PAI are having lunch at the home of Rosemarie Muganda-Onyando in Nairobi. Rosemarie, the director of the Centre for the Study of Adolescence and a dear friend of PAI's, has been instrumental in arranging logistics and interviews as we film our latest documentary. She has gathered over a dozen people in her lovely living room for a traditional Kenyan meal, many of whom work in reproductive health. Our conversations span topics from our children to USAID to Nairobi's biblical traffic jams.

It is only after many of the guests have left and there are just six women remaining that the conversation turns to the presidential elections in the U.S. There is such passion as the Kenyan women talk about Barack Obama. "He is our son," one states emphatically. They speak with awe of his father's birthplace in Nyanza Province, more than five hours away from where we are sitting in Nairobi. Barack's father was "brilliant," a woman says. "Everyone talked about how smart he was. It is the fish they eat there. You eat the head of the fish and all the wisdom goes straight to your own head." The women nod in agreement, assuming the senior Obama ate a lot of fish heads.

Carolyn Vogel, Vice President of Programs, and Karen Hardee, Vice President for Research, report on the Strategic Workshop "SRHR-Population-Environmental Degradation-Climate Change" in Istanbul, Turkey.

We met in Istanbul for two more or less unstructured days of discussion around the emerging issue of population, environmental degradation and climate change. Coming together as like-minded organizations in support of sexual and reproductive health and rights (SRHR), including voluntary family planning, we struggled to get our heads around the complicated linkage between these pressing and timely issues. That we all felt compelled to talk and needed to voice our ideas, confusions, and brainstorms was evident when at the end of each and every session, facilitators struggled to close and wrap-up (we wouldn’t stop talking). Those discussions then dominated our “out of meeting time” in local restaurants and cobbled streets of the Sultanahmet. In Istanbul, every conversation and presentation was completely new territory for many of the participants.

Our car has absolutely no business driving this rocky (small boulders, really) dirt/mud road—loaded down with four passengers, no less. A sagging bridge up ahead taunts us to attempt the crossing. But we make it across in order to reach the Palabana district rural health center, surrounded by fields of corn and pumpkins, with a few tethered goats thrown in for good measure. A mere 45 kilometers from downtown Lusaka, we could be in far off Western Province in this beautiful rural landscape.

We arrive at the center and are led to a circle of benches under the generous shade of the large acacia tree. We’re meeting with assembled village leaders and health workers to discuss the loss of the five-year sexual and reproductive health (SRH) project that ended in 2006.

“Unplanned pregnancy is feared more than HIV/AIDS among young people,” comments Nthazie Nalungwe, a striking young woman leader within Youth Vision Zambia, a sexual and reproductive health and rights (SRHR) advocacy group here in Lusaka. This comment is reflected among many young Zambian advocates, peer educators and health workers we’ve talked with, including those with organizations promoting abstinence-only. Perhaps it’s a good thing that condoms seem far more plentiful than other contraceptives in Zambia: dual protection by default.

The rainy season is coming to an end here in Zambia and the early morning sun floods the car as we pull through the front gate of Professor Nkandu Luo’s house in Lusaka to join her for breakfast. Luo is the former (and outspoken) Minister of Health who now leads two Zambian nongovernmental organizations (NGOs) tackling HIV/AIDS and women – the Society of Woman Against AIDS in Zambia (SWAAZ) and Tasintha, the only local organization focused on helping women leave commercial sex work. It is a survival strategy for many women in countries like Zambia with weak economies and high unemployment.

"Reproductive health has been left behind. We can’t fight HIV/AIDS unless we center it within sexual and reproductive health. The majority of those affected by and living with HIV/AIDS are women, especially young women in Zambia,” she thunders. Zambia’s draft reproductive health policy—first proposed ten years ago by Luo during her tenure leading the Ministry—remains untouched. It was never finalized nor implemented by her successors.

The haze of pollution that shrouds Mexico City, obscuring views of the mountains that surround the sprawling city, lifted on our first morning, giving us clear views of the hills that lie just outside of the city limits.  However, as soon as Michele Duryea, the Vice President of Development, and I were seated in the back of Hugo’s red “Chevy,” making our way through dense early morning traffic, my eyes began to burn.  It quickly became clear that Mexico City’s pollution is there to greet every newcomer, and that urbanization was not a subject we had to seek out; we could simply sit amidst thousands of cars, exhaust fumes and blaring horns and observe.  

On our way to the first of several meetings in our whirlwind trip to check out the many organizations that we will visit on PAI's Friends Study Tour to Mexico (in February), I was impressed by the diversity of scenery that passed by the car window:  enormous artistic sculptures, small stores with hand-painted signs, 17th century buildings, and expensive clothing stores all formed the eclectic mix.

Thirty minutes outside Arusha on the way to Nairobi and then 3km along a dirt road is the Selian Lutheran Hospital. One of 20 Lutheran hospitals across the country, the Selian facility serves the primarily Maasai population in the surrounding area. This morning the PAI team visited the reproductive health (RH) unit of the hospital and learned of the important role it plays in meeting family planning needs despite the ongoing challenge of securing a consistent supply of contraceptive methods.

Ms. Florah Kyara, a nurse in the RH unit, opened a cabinet and showed us the shelf containing all of the contraceptive supplies in stock, which was less than half full. Selian Hospital offers its clients a range of family planning methods, including condoms, three types of oral contraceptives, injectables, implants, IUDs and male and female sterilization; but only after each new client has received a complete medical examination and counseling about her contraceptive choices.      

Here in lush, tranquil Arusha, Tanzania, a boisterous chorus of roosters greets you far too early in the morning as if to announce, "Welcome to the 5th African Population Conference!" Team PAI is here amidst the vast coffee and tea plantations surrounding Arusha – and under the watchful gaze of magnificent Mt. Meru – at this week-long gathering of largely African researchers, demographers, advocates and policymakers who’ve assembled to discuss family planning/reproductive health, HIV/AIDS and overall population trends in Africa.

 

Introduction: Staff from Population Action International are presenting “The Shape of Things to Come: Why Age Structure Matters to a Safer, More Equitable World” at several events in Europe.  Join Tyler LePard, PAI’s Media Manager, for an inside look!

After the journalist workshop, the PAI team headed for lunch with DSW (Deutsche Stiftung Weltbevolkerung). Along the way, we passed the “Memorial for the Murdered Jews of Europe” (Denkmal fur die Ermordeten Juden Europas). It’s an eerie grid made with concrete blocks of differing heights that takes up a whole city block.  The somberness of the subject contrasted sharply with children running and playing among the rows.

Our next stop after the Naguru was another innovative teen center in Kampala: the Kitebi Teenage Centre.  The Kitebi Teenage Centre sits at the end of a bumpy, winding dirt road, a bit more difficult to get to than Naguru.  However, the team of 150 volunteer staff has solved that problem by bringing their services directly into the communities they serve. 
 
Kitebi has a variety of outreach programs, all designed to reach young people who wouldn’t ordinarily go to a clinic.  Their drama team holds well-attended productions throughout Kampala where clients come for some free entertainment and are encouraged to get tested for HIV or receive counseling while they are there.  Other outreach programs target young men, including the predominantly male ranks of bora bora drivers (one of the fastest -- and most dangerous -- ways to get around Kampala is to sit on the back of a hired motorcycle where the driver, called a bora bora driver, weaves in and out of the heavy traffic to take their passengers to their destination) and bricklayers.  The Kitebi team distributes condoms in local bars and hosts sporting events where the participants can also receive HIV testing.  These programs make the prospect of counseling and testing more tolerable and convenient than expecting these men to go out of their way to visit a clinic.

 

Now that the Eastern Africa Reproductive Health Network (EARHN) meeting is closed and the group is armed with a draft strategic plan, the PAI team here in Kampala has finally had the opportunity to explore the city.  Carolyn Vogel, PAI VP of Programs, and I had a full day of meetings today to help us gain an understanding of the realities facing men, women and youth in Uganda who need of reproductive health and family planning supplies and services. 
 
Our first stop was Naguru Teenage Centre, widely recognized as one of the best equipped youth centers in Kampala.  Young people from age 10 to 24 are willing to travel for hours to utilize the services here, as evidenced by the long line of people waiting outside the building.  In fact, the clinic is so popular that they had to stop advertising their services because the numbers of clients grew overwhelming.  The center’s advocacy manager, Henry Ntala told us, “It can be so hard to see young people sitting outside, but there’s nothing to do.”  Even as Carolyn Vogel and I sat outside the center talking to Mr. Ntala, we watched dozens more women and children stream toward the center to join the ever growing line.  The number of young people needing reproductive health services and supplies seems endless.

Introduction: Staff from Population Action International are presenting “The Shape of Things to Come: Why Age Structure Matters to a Safer, More Equitable World” at several events in Europe. Join Tyler LePard, PAI’s Media Manager, for an inside look!

On Thursday morning, the PAI team and DSW colleagues walked to the first event through the heart of Berlin. Eastern Berlin is full of newly constructed and restored or rebuilt buildings. The past couple of decades have brought many changes to Berlin, leaving little sign of The Wall that divided the city. We walked along Friedrichstrasse and Unter den Linden (two main thoroughfares), past several embassies, the Reichstag and the Brandenburg Gate to reach the building of the Representative of the Federal State Lower Saxony for our morning event.

It’s the end of our third and final day at the Eastern Africa Reproductive Health Network’s (EARHN) Annual Coordination Meeting and I’m proud to report that the delegates have come to a general consensus on a draft strategic plan.  There is still refining that will be done by the EARHN Strategic Plan Drafting Team, but we walked out of the meeting this evening with a two page document that summarized three days of lengthy, passionate discussion.  This strategic plan should help EARHN focus its work and be as effective as possible.

The network decided that they needed to focus on three areas: program development and expansion (bringing their work in line with partner organizations so that work is not duplicated and EARHN can make more of an impact), advocacy and coalition building (supporting members’ ability to advocate for sexual and reproductive health and rights in their own countries) and institutional strengthening (establishing a more efficient institutional structure, developing annual workplans as well as developing a resource mobilization plan).  Of course, this brief summary just scratches the surface of the discussion and each member will return to their respective country with pages of notes about the next steps.

Introduction: Staff from Population Action International are presenting “The Shape of Things to Come: Why Age Structure Matters to a Safer, More Equitable World” ” at several events in Europe. Join Tyler LePard, PAI’s Media Manager, for an inside look!

The Population Action International team left The Hague on Wednesday morning, excited about the success of “The Shape of Things to Come” at the Peace Palace. After the panel briefing, a senior ministry official told us that he was going to use the report in a briefing for Parliament and encourage them to make demographics a key priority in development assistance and to increase funding for sexual and reproductive health programs and services. Hooray!

In the Netherlands, I was particularly impressed by the number of bicycles I saw. A couple of us in the PAI office bike to work, but it looks like everyone in the Netherlands rides bicycles. It’s an environmentally friendly way to get around – and fun too!

Bula! (hello in Fiji). I am here in Fiji, taking part in a regional advocacy training for young people from the Pacific, put on by the Youth Coalition for Sexual and Reproductive Rights, a sub-grantee of PAI's. I arrived yesterday (Tuesday) and have been very busy working with the other YC facilitators (Nino from Indonesia and Fred from Sweden) to finalize the week's agenda and develop the sessions for the training.

There are 10 participants, representing Fiji, new Zealand, Samoa, Papua New Guinea, Vanuatu and Nieu. I'll be facilitating sessions on analyzing UN texts, understanding the MDG framework, mapping international advocacy opportunities, and a session on research-based advocacy that will center on A Measure of Survival.

It is a very dedicated and knowledgeable group of young people, so I am looking forward to a productive week. The training began today, with presentations from participants on the key SRR issues in their countries and communities.

Sarah E. Haddock, Research Assistant

I’m excited to be reporting back from Kampala, Uganda, where a team from PAI is participating in the Eastern Africa Reproductive Health Network’s (EARHN) Annual Coordination meeting. This unique network consists of six member states (Uganda, Kenya, Tanzania, Ethiopia, Rwanda and Burundi) who have come together to influence policies and funding for reproductive health in their respective countries.

On our first day here, Dr. Peter Njoroge from the East African Community told a story about visiting a rural village in Tanzania where people were so desperate for contraceptives that they were using plastic baggies as condoms – even though condoms were available in the capital, they didn’t have any way to get them to the country. When I looked around the room, nearly every head was nodding knowingly. This is the sort of unbelievable story that you hear all the time in this region. Men and women throughout Eastern Africa can’t access the reproductive health supplies that stock the shelves of nearly every convenience store in the United States. EARHN is part of the effort to make stockouts like this a thing of the past.

On a trip to Ethiopia, Amy Coen, President/CEO of Population Action International, had the opportunity to meet Dr. Bogaletch Gebra -- affectionately called "Boge" -- who is spearheading a national campaign to end the practice of female genital mutilation (FGM). They participated in a rally of over 15,000 girls, mothers, fathers and village elders who demonstrated their commitment to ending FGM in their communities. It takes a commitment from every level of a society to triumph over a traditional practice that has been performed for centuries in some communities and rallies like this one bring the world even closer to ending to this form of human rights abuse.

Watch the video after the jump!