Ecosystems and human well-being : health synthesis

This report synthesizes the findings from the Millennium Ecosystem Assessment's (MA) global and sub-global assessments of how ecosystem changes do, or could, affect human health and well-being. Main topics covered are: Food, fresh water, timber, fibre, and fuel, nutrient and waste management, pollution, processing and detoxification, cultural, spiritual and recreational services, climate regulation, and extreme weather events.

Maternal health in Lao PDR : repositioning the goal posts

This paper reviews attempts made in the Lao People's Democratic Republic (PDR) to achieve Millennium Development Goal (MDG) 5: Improve Maternal Health and its two targets: (1) to reduce by three quarters the maternal mortality ratio and (2) to achieve universal access to reproductive health. It will be shown that significant strides have been made in relation to both the targets, especially in the province of Xayaboury where the contraceptive prevalence rate is the highest and maternal mortality is the lowest in the country. That said, it is unlikely that either target will be realised by 2015 for the nation as a whole. Some of the reasons for this are canvassed such as problems with the existing health infrastructure and its personnel, the cost of health care, the demographic profile and cultural expectations of women of childbearing age, geographic barriers, the absence of communication and transport infrastructure and the influence of international donors on how monies are expended. As discussions now begin to set the framework for the post-MDG compact of the international community to address poverty and well-being, it would be valuable to consider the multiplicity of factors which directly impact maternal and infant mortality rates (such as family planning, age at first birth, access to antenatal care and government expenditure on maternal health care) and explain what causes change, over non-contextualised statistics that simply report changes.

The MDGs in Myanmar : relevant or redundant?

MyanmarMyanmar is a developing country with significant humanitarian needs. It is therefore a country for which achieving the Millennium Development Goals (MDGs) should be a high priority. While exact data are difficult to obtain, Myanmar is performing poorly across most of the MDG targets. This is partly an unintended but direct consequence of the international sanctions and concomitant reduced aid flows into Myanmar. Myanmar receives the lowest level of aid per person of any of the 50 Least Developed Countries, raising the very direct question of whether the MDGs are relevant or achievable in Myanmar. Failure to achieve the MDGs could have serious implications in 2015 on future international funding and on reform programmes in the country. This paper considers how the political goals of the international community negatively impact upon the ability to achieve the MDGs and proposes a way forward by increasing aid and by tailoring theMDGs to theMyanmar context, as several regional neighbours have done.

Aid allocation and fragile states

This chapter summarizes research on aid allocation and effectiveness, highlighting the current findings of recent research on aid allocation to fragile states. Fragile states are defined by the donor community as those with either critically poor policies or poorly performing institutions, or both. The chapter examines the research findings in the broader context of research and analysis on how aid should and is being allocated across all developing countries. Various aid allocation models and their implications for aid to fragile states are considered. The chapter also looks at types of instruments and their sequencing in fragile states.

Researching maternal, neonatal and child health service use in rural and pastoralist Ethiopia: A key informant research approach

Like many nations in sub-Saharan Africa, Ethiopia has both a high neonatal mortality rate and maternal mortality ratio and is unlikely to meet Millennium Development Goals 4 and 5 by 2015. This working paper examines how Key Informant Research (KIR) in rural and pastoralist Ethiopia will identify facilitators and barriers to the use of maternal, neonatal and child health services. The methodology is informed by Participative Ethnographic Evaluation Research (PEER) and Key Informant Monitoring (KIM). Key Informant Research (KIR) training will provide research skills to Health Extension Workers (HEWs) and Non-government organisation (NGO) staff to enable them to develop research questions, collect data and participate in preliminary data analysis. This will enable the identification of strategies that improve the identification of risk, enhance early referral, increase access, affordability and acceptability of skilled birthing services in rural and pastoralist Ethiopia.

Health cosmopolitanism: melding universality and difference – the case of childbirth in post-conflict Timor Leste

ABSTRACTThis study will consider the case of TBAs (traditional birth attendants) under the health cosmopolitan banner. Fifteen interviews with health administrators, obstetricians, midwives, traditional birth attendants and women in Timor Leste, provide evidence : (1) that the WHO (1992) directive to dismiss the inclusion of TBAs within the formal maternity care system has been precipitous (2) that TBAs could, with adequate training in emergency obstetric techniques and hygienic practices, assist in meeting MDG No 5, and (3) that TBAs may assist in sustaining hybrid cosmologies and serving other cultural aims. Although Millennium Development Goals embrace the idea of the universal right to health, a human rights framework remains abstract and legalistic. I argue that health cosmopolitanism offers a more inclusive lens. Applied to maternity care it shifts childbirth to a central focus of government policy, obliges all nations to contribute international aid yet recognises the interpretation of complex needs at the local level. It defines a philosophy of care that is person-centred (not professional or institution-centred), ensures equal access to quality care (based not on ability to pay or other obstacles such as geographical distance) and choice of carer and modality (Western, traditional or hybrid). It underlines the argument here that TBAs trained in emergency obstetric care and hygiene and funded by international agencies would ensure every woman has a known carer, plus choice of location, modality and provider. Health cosmopolitanism thus embraces universality, individual autonomy, reciprocal respect and global responsibility.

Pluralist risk cultures: the sociology of childbirth

Western medical approaches to childbirth typically locate risk in women’s bodies,making it axiomatic that ‘good’ maternity care is associated with medically trainedattendants. This logic has been extrapolated to developing societies, like Vanuatu, anIsland state in the Pacific, struggling to provide good maternity care in line with theWorld Health Organization’s Millennium Development Goals. These goals include thereduction of maternal mortality by two-thirds by 2015, but Vanuatu must overcomechallenging hurdles – medical, social and environmental – to achieve this goal.Vanuatu is a hybridised society: one where the pre-modern and modern coincide inparallel institutions, processes and practices. In 2010, I undertook an inductive study of30 respondents from four main subcultures – women living in outer rural communitieswith limited access to Western-trained health workers; women from inner urbancommunities with ease of access to medical clinics; traditional birth attendants whoare formally untrained but highly specialised and practised mainly in remote communities;and Western-trained medical clinicians (obstetricians and midwives). I invitedall the participants to comment on what constituted a ‘good birth’. In this article, Ishow that participants interpreted this variously according to how they believed theuncertainties of childbirth could be managed. Objectivist approaches that define risk asan objective reality amenable to quantifiable measurement are thus rendered inadequate.Interpretivist approaches better explain the reality that social actors not only findrisk in different sites but gravitate towards different practices, discourses and individualsthey can trust especially those with whom they feel a strong sense of community.Strategies are, therefore, formed less through scientific rationality but according tofeelings and emotions and the lived experience. The concept of risk cultures conveysthis complexity; they are formed around values rather than calculable rationalities. Riskcultures form self-reflexively to manage contingent circumstances.

The return of the traditional birth attendant

The World Health Organization has noted much progress towards the realisation of Millennium Development Goals related to maternal and child health. Eighty percent of women in many developing economies now receive at least one visit during pregnancy by a skilled birth attendant (although only 52% had the recommended four visits), and 68% of women across developing regions receive skilled health attendant care (up from 56% in 1990). However, disparities follow regional and urban-rural gaps. Sub-Saharan Africa and Southern Asia lag behind other regions in the provision of antenatal care and skilled attendance at birth (although typically attended by a family member or villager) and over 32 million of the 40 million births not attended by skilled health personnel in 2012 occurred in rural areas. Overall, one-quarter of women in developing nations still birth alone or with a relative to assist them. While increased numbers of medically-trained midwives and health workers or midwife assistants would increase coverage by up to 40%, these are longer-term solutions. In the short term, gross disparities in services in some resource-poor areas have been alleviated by recruiting Traditional Birth Attendants (TBAs) re-trained in emergency obstetric skills to deal with emergency situations and to refer women onto health facilities when necessary. Samoa and Bangladesh are examples. For many women for a range of reasons TBAs are preferable to hospital care. It therefore makes sense to recognise their place within maternity care, to offer basic and ongoing training and to set up registration procedures thus better ensuring the monitoring of outcomes. Incorporating TBAs into the formal healthcare system would meet both physiological and relational components of birth. In terms of the latter, TBAs would act as cultural brokers between Western and traditional cosmologies and provide women with continuity of care from a known carer; in the West a demonstrably simple but effective intervention promoting physiological safety and reducing the need for higher level medical interventions.

New visions for addressing sustainability

Attaining sustainability will require concerted interactive efforts among disciplines, many of which have not yet recognized, and internalized, the relevance of environmental issues to their main intellectual discourse. The inability of key scientific disciplines to engage interactively is an obstacle to the actual attainment of sustainability. For example, in the list of Millennium Development Coals from the United Nations World Summit on Sustainable Development, Johannesburg, 2002, the seventh of the eight goals, to "ensure environmental sustainability," is presented separately from the parallel goals of reducing fertility and poverty, improving gains in equity, improving material conditions, and enhancing population health. A more integrated and consilient approach to sustainability is urgently needed.

Approaches to urban heritage, development and sustainability

More than half of the world’s population now live in urban areas, and cities provide the setting for contemporary challenges such as population growth, mass tourism and unequal access to socio-economic opportunities. Urban Heritage, Development and Sustainability examines the impact of these issues on urban heritage, considering innovative approaches to managing developmental pressures and focusing on how taking an ethical, inclusive and holistic approach to urban planning and heritage conservation may create a stronger basis for the sustainable growth of cities in the future.This volume is a timely analysis of current theories and practises in urban heritage, with particular reference to the conflict between, and potential reconciliation of, conservation and development goals.

Urban heritage, development and sustainability : international frameworks, national and local governance

This volume is a timely analysis of current theories and practises in urban heritage, with particular reference to the conflict between, and potential reconciliation of, conservation and development goals.

Urban heritage, development and sustainability: international frameworks, national and local governance

More than half of the world’s population now live in urban areas, and cities provide the setting for contemporary challenges such as population growth, mass tourism and unequal access to socio-economic opportunities. Urban Heritage, Development and Sustainability examines the impact of these issues on urban heritage, considering innovative approaches to managing developmental pressures and focusing on how taking an ethical, inclusive and holistic approach to urban planning and heritage conservation may create a stronger basis for the sustainable growth of cities in the future.This volume is a timely analysis of current theories and practises in urban heritage, with particular reference to the conflict between, and potential reconciliation of, conservation and development goals. A global range of case studies detail a number of distinct practical approaches to heritage on international, national and local scales. Chapters reveal the disjunctions between international frameworks and national implementation and assess how internationally agreed concepts can be misused to justify unsustainable practices or to further economic globalisation and political nationalism. The exclusion of many local communities from development policies, and the subsequent erosion of their cultural heritage, is also discussed, with the collection emphasising the importance of ‘grass roots’ heritage and exploring more inclusive and culturally responsive conservation strategies. Contributions from an international group of authors, including practitioners as well as leading academics, deliver a broad and balanced coverage of this topic. Addressing the interests of both urban planners and heritage specialists, Urban Heritage, Development and Sustainability is an important addition to the field that will encourage further discourse.

International development : issues and challenges

This comprehensive and broad-ranging introductory text examines the key aspects of contemporary international development from both a practical and theoretical perspective. It addresses the fundamental question of what 'development' actually is and examines social, economic and environmental development across the globe.Written by experts with extensive field experience across a range of development settings, the book addresses key issues in the development debate. These issues include definitions of development, global influences on development, measurements of development, the contribution of international aid, the relationship between global development and gender equality, the idea of development as 'modernization', theories of underdevelopment, and regional variation.The third edition has been revised and updated to include discussion of recent events and challenges in the field, as well as coverage of the rise of new economic powers, the impact of new security challenges, and the increasing importance of sustainable development goals.