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Andhra Purdesh and a Crisis in Microfinance

February 16th, 2011

In October 2010, Andrha Purdesh, one of the largest states in India, enacted a law that had sweeping ramifications for microfinance as a sector. Owing partially to a spate of some 75 suicides related to individuals unable to repay loans to MFI’s (Micro-Financial Institutions) (http://headlinesindia.mapsofindia.com/state-news/andhra-pradesh/microfinance-firms-fear-andhra-pradesh-law-will-hurt-them-70584.html), the state has legislated a series of hurdles designed to reduce the ability of microfinance organizations to take advantage of the state’s poorest citizens. Some of these policies include requiring MFI’s to register with the state and obtain specific permission when loaning to citizens with other outstanding debts, banning MFI’s from manually collecting debts on a weekly basis, and preventing MFI’s from accessing bank loans themselves or making new loans to borrowers. As a consequence of these laws, repayment rates have plummeted in the region from 90% to 10-15% (http://www.livemint.com/2011/02/14222236/AP-insists-it-won8217t-repe.html?atype=tp).

This series of laws has had wider ripples in the MF industry, adding a political component of risk to an already risky practice. With such instability, potential loaners willing to accept lower rates of return in exchange for potentially helping to alleviate poverty might be less willing to invest. Further, Andhra Purdesh is likely to suffer a poor reputation with MFI’s, leaving the state’s poor with no option but dealing with traditional moneylenders, who can charge rates exceeding 80% (http://www.guardian.co.uk/global-development/poverty-matters/2011/jan/26/microfinance-regulations-india).

But some good has definitely emerged from the standoff. In response to MFI concern over the Andhra Purdesh laws, as well as growing political pressure to better regulate the industry, the Reserve Bank of India has asserted its authority over the industry, and it has issued a series of rules for priority-status MFI’s that are designed to protect the rights of both the consumer. Among these (quoted from http://www.microfinancefocus.com/content/rbi-releases-malegam-committee-report-microfinance):

a. The NBFC-MFI will hold not less than 90% of its total assets (other than cash and bank balances and money market instruments) in the form of qualifying assets.

b. There are limits of an annual family income of Rs.50,000 and an individual ceiling on loans to a  single borrower of Rs.25,000

c. Not less than 75% of the loans given by the MFI should be for income-generating purposes.

d. There is a restriction on the other services to be provided by the MFI which has to be in accordance with the type of service and the maximum percentage of total income as may be prescribed.

Additional recommendations include preventing more than two MFI’s from loaning to any one consumer, and there must be a minimum period of time between issuing the loan and recovering it. Already, prominent MFI’s are heralding the RBI’s new laws for regulating an industry badly in need of reform, but Andhra Purdesh has yet to put aside its own rules in favor of the RBI’s. Because in Andhra Purdesh the RBI’s policies are seen as less stringent, and because popular sentiment still runs so counter to microfinance, it is unlikely politicians there can safely reverse policy anytime soon. This could spell the end of microfinance in a region that could stand most to benefit from a well-regulated industry (http://economictimes.indiatimes.com/markets/stocks/stocks-in-news/malegam-committee-report-sks-stock-up-13/articleshow/7325232.cms).

Interview with Matt Bannick, Managing Partner at the Omidyar Network (Part Two)

February 10th, 2011

Last week, I posted the first half of my conversation with Matt Bannick, Managing Partner for the Omidyar Network, which so far has invested over $330 million in both for-profit and non-profit organizations designed to help elicit positive social change. In the first part, I focused particularly on what he called “flexible capital,” wherein the Omidyar Network can invest in nonprofit or for-profit organizations, primarily on the basis of which strategy is likely to have the most successful outcome.

This week, I want to focus on some of the organizations Mr. Bannick and the ON have been excited to give grants to, namely D.Light, a project out of Stanford, and the Bridge Academy International schools set up in Nairobi. Said Mr. Bannick:

D.Light is a solar lantern company. The problem they’re trying to address is that in many parts of Africa and India, people in the rural areas have no light in the evenings. And what they use typically is kerosene. And the problem with kerosense is that it creates noxious fumes, so it’s a health hazard. It’s also expensive and it obviously has a pretty high carbon footprint. D.Light has developed a solar lantern that’s down to eight dollars. And the solar lantern, you charge it for six hours and it gives you six hours of light. So all of a sudden, you don’t have to buy kerosene, you’re healthier, and you can read and get a better education, and it can transform the life of a household. So that’s one company that we’ve invested in, and I think they’ve now sold more than a million units worldwide.

There’s another example in Nairobi in a chain of schools called Bridge Academy International, and what they’ve been able to do is to get the cost of creating a fabulous education (and by the way, as background, in Kenya, everyone is entitled to schooling, but in reality the teachers don’t show up. And to show up frequently they expect bribes, and so the system fundamentally doesn’t function. And so Bridge Academy has come in, they’ve developed a very low-cost model where they can provide a fabulous education to children in the slums of Nairobi for $4 a month. It’s truly exceptional. They’re now bringing even on their first schools and their hope and their desire is to build out thousands of schools across Africa that could deliver very high-quality education at very low cost to the poor.

I do wonder a bit about the discrepancy between the eight dollar cost to manufacture the solar lamps and the thirty dollar pricetag mentioned on the D.Light website for an American to buy a light and give it to an impoverished person in East Timor, but profit or not, it’s clear that solar-powered lights can be incredibly helpful. And maybe, as Mr. Bannick explained in Part One, using for-profit organizations can effect quicker change, as having a margin of profit can add more fuel to growth and allow for the quicker spread of disruptive technology. In impoverished nations, there does continue to be the spectre of abuse that can occur when labor is cheap and desperate, but when money is given to people concerned with doing good first, then making profit (more as a means of sustaining growth than an end in itself) second, it can still have massive positive impact.

Read the full interview below for more on what kinds of entrepreneurs the Omidyar Network tends to invest in, for the breakdown of international vs. local and male vs. female entrepreneurs, and for his analysis of the nonpayment movement. And immediately below are some of the organizations he mentions.

  • D.Light: low-cost, Stanford-based solar-powered light manufacturer.
  • Bridge International Academies: Low-cost, high-quality education for underprivileged African children.
  • Endeavor Global: An organization fostering high-impact entrepreneurship.
  • Omidyar Network: A philanthropic organization that gives to both nonprofit and socially conscious for-profit organizations.

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KW: What’s an organization that you’ve invested in that has been for-profit that you’ve been most excited about?

MB: Well, since you’re at Stanford now, I’ll use a Stanford example. Have you heard of the “Design for Extreme Affordability” program at Stanford?

KW: I actually have, yeah.

MB: Have you heard of D. Light?

KW: The name sounds familiar.

MB: So D.Light is a solar lantern company. The problem they’re trying to address is that in many parts of Africa and India, people in the rural areas have no light in the evenings. And what they use typically is kerosene. And the problem with kerosense is that it creates noxious fumes, so it’s a health hazard. It’s also expensive and it obviously has a pretty high carbon footprint. D.Light has developed a solar lantern that’s down to eight dollars. And the solar lantern, you charge it for six hours and it gives you six hours of light. So all of a sudden, you don’t have to buy kerosene, you’re healthier, and you can read and get a better education, and it can transform the life of a household. So that’s one company that we’ve invested in, and I think they’ve now sold more than a million units worldwide.

There’s another example in Nairobi in a chain of schools called Bridge Academy International, and what they’ve been able to do is to get the cost of creating a fabulous education (and by the way, as background, in Kenya, everyone is entitled to schooling, but in reality the teachers don’t show up. And to show up frequently they expect bribes, and so the system fundamentally doesn’t function. And so Bridge Academy has come in, they’ve developed a very low-cost model where they can provide a fabulous education to children in the slums of Nairobi for $4 a month. It’s truly exceptional. They’re now bringing even on their first schools and their hope and their desire is to build out thousands of schools across Africa that could deliver very high-quality education at very low cost to the poor.

KW: OK. Now, this class is for International Women’s Health, so I have to ask this question, which is, what’s the breakdown been of entrepreneurs who have been male versus female?

MB: Oh gosh. I think it varies. I’d have to go through. I mean, there have been terrific entrepreneurs, both male and female. Many of our organizations we support do have a gender focus on women. So for example there’s an organization in Seattle called Landessa that works on rural property rights, and they have a whole area that focuses on women and land, women and property rights. The schools in Nairobi, one of the exciting things about them is that about fifty percent of the kids attending those schools are girls, and that may not sound remarkable until you realize that in most places, when school becomes expensive, the families send boys first, and then if they have money left over they send girls. So one of the positive impacts here is that you’re able to actually to get the cost down to a point to where the girls can go to school. And there are implications of educating girls—they tend to marry later, and they tend ot have fewer children. And their children tend to be healthier and better educated. So there’s huge returns, and you probably studied this in the women’s health class, there are huge returns on educating girls. So we have a bit of a bias toward those organizations, those companies that disproportionately benefit women and girls.

KW: Backing up and talking a little bit more about the entrepreneurs that you tend to invest in, what do you use to identifiy which entrepreneurs are going to succeed? Do you have any sort of bias toward people who are working in their own countries, or people who are going to other countries?

MB: Yeah, you really want people with local knowledge, and sometimes, like in the case of Bridge Academy, they’re Americans but they’ve been in Nairobi for some time, and they have been successful entrepreneurs. [We look at] the caliber of the entrepreneur, their reputation, their track record, their knowledge of the market, they’re looking to serve, then you look at the quality of the idea, the market size, the competitive environment. You know, many of the same things that you would tick through when you’re looking at an investment for [a company] would be the exact same criteria that we’d be looking at as well.

Now the added dimension for us is that we’re looking for investments that will create opportunity for hundreds of thousands. Whereas the objective at [an investment firm] would be, OK, well what is the return on investment?, we absolutely would look at return on investment, but we also look at social impact and we’d be willing to have a little lower return on investment in exchange for a higher social impact.

KW: That’s awesome. I did want to ask whether the non-payment movement that’s been affecting a few different countries has been affecting you guys at all.

MB: So we’re not directly invested in MFI’s [Micro-Finance Institutions] in [any of the affected regions], but we are invested in funds that are invested in MFI’s in India, so yeah, I think the whole sector has been affected by the challenges in [that region], and unfortunately I think that microfinance institutions should have done a better job in the areas of consumer protection and in the area of establishing effective credit bureaus to guard against over indebtedness. I also hope that people recognize that microfinance is delivering tremendous value to the poor, and we need to figure out how to strengthen the industry, rather than do things that inhibit people who don’t have the means from receiving credit.

KW: The final question that I have is how do you think you can foster a more entrepreneurial spirit in the third world, and as a follow-up, do you think that it should be encouraged.

MB: Well absolutely. I think that entrepreneurship is key to ideas, to job creation, to economic development, and I think people inherently want to make a better life for themselves and their families. Entrepreneurship, in addition to helping societies progress economically, also gives people hope, and also taps their creative spirit, and I think it’s absolutely essential that societies support entrepreneurship. One of the organizations that you might take a look at is a group called Endeavor Global, and I’m on the board there. Endeavor is very much focused on fostering entrepreneurship in the developing world, and they have a lot of good facts and figures on their website that you can check out. But I think that it’s absolutely critical.

KW: Thank you so much, I really appreciate the time that you took for this, and I hope that you’re getting as much satisfaction out of the work that you’re doing as you should be.

MB: It’s fabulous, and who I am, and the work I do, and the values I want to pass onto the kids are all the same thing, which makes it very gratifying.

Bangladesh: Looking forward

February 3rd, 2011

Araceli Y. Flores

In my last blog entry, I discussed a few positive economic and social victories won by Bangladeshi nongovernmental organizations in the struggle for women’s rights. However, that said, the economic and social empowerment of women cannot truly be advanced until Bangladeshi women can participate actively and freely within political institutions. While the accomplishments of the formal government undoubtedly lag behind those of Bangladesh’s civil society, I wanted to address several fairly recent legal provisions made toward promoting gender equity within the country.

In 1997, Bangladesh made a formal commitment to women’s political participation by adopting several recommendations from the United Nations. Union Parishads are the lowest branch of government in Bangladesh, which work on a local level within the country. In 1997, Bangladesh amended its Union Parishad Ordinance to include provisions for the direct election of women to one-third of the body’s reserved seats. While women are still vastly underrepresented in local government, the amendment created a definite shift in women’s political participation in the country [1].

On a national level, provisions from the original 1972 Constitution reserved fifteen seats for women in the Bangladeshi Parliament. In 1979, this quota was raised to thirty. In 2004, yet another amendment was passed, and the number of parliamentary seats reserved for women was set at forty-five [2]. While this number is still woefully low, the quota amendments show an increased commitment to ensure women’s representation in Bangladeshi political life. Moreover, the government of Bangladesh has established a unique “Ministry of Women Affairs” to facilitate the discussion of gender equity and women’s role within the greater development and advancement of Bangladesh. Bangladesh is one of the few countries in the world with such a ministry.

Often overlooked, Bangladesh has accomplished the rare feat of having three successive women prime ministers — Begum Khaleda Zia (1991-1995), Sheikh Hasina (1996-2000), and Begum Khaleda Zia (2001-2006). Though these remarkable women are more an “exception” than the “norm,” the fact that women could occupy such high levels of government in Bangladesh demonstrates an increased amount of cultural respect and acceptance of women as decision makers in political life.

On the most basic level, perhaps the most reassuring sign of political progress in Bangladesh is the motivation and commitment of women to make sure their voice is heard. In 1996, over seventy percent of women voted in parliamentary elections, with many women participating in the electoral process as campaigners. Furthermore, women have contributed significantly to the political process by organizing public meetings, processions, and rallies [3]. Women often lead the effort in mobilizing other women voters. As further encouragement and protection of women voters, the Bangladeshi government and women’s groups have worked together to promote separate polling stations for women: Police men, among other security measures, were employed to ensure order and safety of these polling stations, which are often staffed by women themselves— both of these measures have reduced risk of political violence toward women voters and have further motivated women’s participation in the Bangladeshi electoral process.  Such trends are definitely encouraging as they demonstrate a verifiable commitment on the government’s end to ensure a more democratic and representative political process.

Bangladesh is home to some of the most brutal violations of women’s human rights: the practices of acid throwing, human trafficking, and other violent crimes against women demonstrate the lack of “universally” guaranteed rights— even ones as basic as freedom from danger or equal protection under the law [4]. In Bangladesh’s health, economic, and social sectors, women are discriminated against and denied equal access to the same quality educational and financial opportunities as men.

Still, despite these heart-wrenching realities, progress has been made. While governmental efforts toward promoting women’s rights have often been nominal or limited in scope, Bangladesh hosts a flourishing civil sector comprised of women’s rights groups and activist organizations. These agencies have brought not only awareness to Bangladeshi women’s issues, but also actively lobby national government and work with international partners to bring tangible results to the country. Ultimately, much still needs to be done in Bangladesh to promote the respect and empowerment of women. Hopefully the seeds of hope planted by these organizations can take root and bring about the type of system-changing reform that Bangladesh needs.

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Citations:

[1] “Women and Politics in Bangladesh,” Kamal Uddin Ahmed, Asiatic Society: http://www.asiaticsociety.org.bd/journals/Golden_jubilee_vol/articles/H_446%20(Kamal%20Uddin).htm

[2] “Political Participation of Women in Bangladesh: The Issue of Constitutional Representation,” The United Nations Public Administration Network:  http://unpan1.un.org/intradoc/groups/public/documents/APCITY/UNPAN021439.pdf

[3] “Women’s Rights in Bangladesh,” Online Women In Politics: http://www.onlinewomeninpolitics.org/womensit/bd-w-sit.pdf

[4] “Bangladesh,” Oxfam Australia: http://www.oxfam.org.au/about-us/countries-where-we-work/bangladesh

Interview with Matt Bannick, Managing Partner at the Omidyar Network (Part One)

February 3rd, 2011

Matt BannickThis afternoon I had the distinct pleasure of interviewing Matt Bannick, current Managing Partner at the Omidyar Network and former President of PayPal and eBay International, as well as formerly serving as a diplomat to Germany. The conversation ran long (there’s plenty to talk about in microfinance!), so I’ll post some highlights here at the top, and the full transcript of the first half of our conversation below for anyone interested.

The Omidyar Network, for those who are new to this thread, is a philanthropic organization begun by eBay founder Pierre Omidyar that uses a combination of grants and investments to try to effect the most positive change globally that it can. Said Mr. Bannick:

One of the things that distinguishes us is an approach that we call “flexible capital.” Most philanthropic organizations are set up just to do grants, and we do grants and we do investments. And by flexible capital we look at what the problem is first, and who’s addressing that problem, we focus on the entrepreneur that’s trying to address that problem, and then and only then do we determine what’s the most effective type of capital to deploy…

We’ve actually done 14 not-for-profit deals and 12 for-profit deals. And in total we’ve probably invested more than $100 million. So we see the two kinds of investments as complementary—you may do a not-for-profit investment to help develop infrastructure for a sector, and then you’d do a for-profit investment in a company in that sector that can really drive scale. One of the problems with not-for-profits is that they find it really difficult to scale. For example, in the US in the last 40 years, there have only been 150 not-for-profits that have scaled to $50 million in revenue or more. In that same period, there have been thousands and thousands of for-profit companies that have scaled to $50 million in revenue or more.

This model feels unique and exciting, and I’m interested in where it goes. As any money they make is subsequently funneled into future philanthropy, the potential impact of the Omidyar Network is enormous. Next week, I’ll include the second half of the interview, where we talked about some of the specific organizations Mr. Bannick was particularly excited about.

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FULL TRANSCRIPT BELOW:

KW: What drove you to switch to being interested in philanthropy versus the private sector?

MB: I’ve long had an interest in having a positive impact in society. I started out early in my career, I was actually an American diplomat. I was in Germany when the wall came down. I found that deeply rewarding work. And the issue of that age was the Cold War and the battle between a system that created opportunity for individuals and celebrated potential and freedom of the individual and a Communist system that oppressed the individual. And so I did feel at that stage that I was actually engaged in working on an issue of the greatest import.

I went to business because I loved the action orientation of business. In diplomacy there was a lot of talk on really important issues, but as a young diplomat you couldn’t have an immediate impact on issues of great import. I went into business and initially into business school and consulting because I liked what I perceived to be the action orientation of business, and I had been in banking before I’d gone into diplomatic service, and in my career I was really fortunate most particularly at eBay to both be working to build a fabulous business, but also a business that delivered positive social impact. For me it also had an international dimension. I ran eBay International and I ran PayPal, and PayPal is now building their international footprint as well. I was able to do the things I really liked to do in terms of running a successful business. I really liked the leadership component of that and I also was able to do the international piece and feel like we were creating opportunity for individuals at eBay, we were creating social impact.

All of that said, the thing that led me to philanthropy was really a desire that the bottom line for me, the objective of my work to be positive social impact, rather than at eBay where we were having positive social impact but the bottom line ultimately was about dollars and cents. So meeting with Pierre and learning about the Omidyar Network, the real draw for me was saying, “Look. I can use the skills I learned in business,” because Pierre had a very expansive view of having impact, which included business, I can use the skills I learned in business in an environment where the bottom line was social impact, and that was very, very compelling to me. I do think as I go back to my reflections of the Cold War and that being the issue of our age, I think the issue of our age in our contemporary global society is that you have billions of people around the world who lack opportunity, and who inherently capable.

One of our lessons at eBay was that people are inherently good, inherently capable, and we created a tech platform where they could use tap their skills and do fabulous things. And what’s lacking in the world today is opportunity for billions of people to realize that potential. And where ON is centered on supporting entrepreneurs who create opportunity for millions. So that’s how it’s come arund for me and in a sense it’s new, but in a sense it’s back to where I was grounded back when I was a diplomat in Germany.

KW: That’s very cool. How would you describe your role in the Omidyar Network?

MB: I am the managing partner here, so I am responsible for finding and executing against Pierre’s vision on how to have massive positive social impact. That would be my high-level job description. I’m responsible for the results of the entire organization.

KW: How many people are in the organization?

MB: We have probably now about 44, 45. We have one in London, 8 in India, and the rest here in Redwood City.

KW: One of the things that made the Omidyar Network stand out to me is that most microfinance organizations invest in people who will be employing one person, which is themselves. What led the Omidyar Network to start investing in bigger sized organizations? Because that’s really what differentiates it from a lot of the things I’ve seen, looking at microfinance.

MB: Microfinance is one of six investment areas. One of the things that distinguishes us is an approach that we call “flexible capital.” Most philanthropic organizations are set up just to do grants, and we do grants and we do investments. And by flexible capital we look at what the problem is first, and who’s addressing that problem, we focus on the entrepreneur that’s trying to address that problem, and then and only then do we determine what’s the most effective type of capital to deploy. So that’s really what defines us in many ways, is focus on the entrepreneur, focus on the ability of the entrepreneur to scale, and then figuring out what the right type of capital is to deploy.

Most philanthropists focus on grants of about $100,000 to $200,000; our average deal size is in the $2-4 million range, so in that sense we focus on bigger ticket deals, and so I think this for profit and not-for-profit model is more distinguishing.. Within the realm of microfinance, we see them—for-profit and not-for-profit—as very complementary, and in the realm of microfinance, we’ve actually done 14 not-for-profit deals and 12 for-profit deals. And in total we’ve probably invested more than $100 million. So we see the two kinds of investments as complementary—you may do a not-for-profit investment to help develop infrastructure for a sector, and then you’d do a for-profit investment in a company in that sector that can really drive scale. One of the problems with not-for-profits is that they find it really difficult to scale. For example, in the US in the last 40 years, there have only been 150 not-for-profits that have scaled to $50 million in revenue or more. In that same period, there have been thousands and thousands of for-profit companies that have scaled to $50 million in revenue or more.

So for for-profit, it’s not about making money, because whatever money we make on our for-profit investments goes back into our philanthropy, but the point is that for-profit businesses are all about getting big. And because they’re generating revenue, that provides them with the ability to have a bigger scale impact.

Mud, Mobile Phones, and Maternal Mortality: Physical Barriers to Maternal Health

February 3rd, 2011

A recent theme I’ve noticed in our class discussions and readings is the divide that sometimes exists between the theory and policy on what needs to be done to improve health, and the actual concrete issues on the ground. A couple weeks ago I discussed some more conceptual barriers to reducing maternal mortality rates. This week I’d like to focus on a very practical, concrete, and real problem that keeps maternal mortality high in so many developing countries. That problem is lack of physical access to emergency obstetric care. In order to inject a dose of hope into these blog posts, I’ll start with the barriers and problems but conclude with some hopeful interventions or possibilities.

I’ll begin with a case study. The NGO CARE, which works to improve maternal health in less developed countries, published a report on their work which includes some compelling examples of the problems women face regularly. In Peru, the maternal mortality rate is 240 deaths per 100,000 live births. However it’s crucial to note that this rate varies drastically “across the landscape” (1). Simply put, location is a huge factor in whether or not Peruvian women receive care. The report gives the example of a woman named Antonia who, at age 40, gave birth to her 8th child 3 weeks early in the remote and mountainous town of Tococori Choquiecambi. Her husband, Lorenzo, who had assisted at her previous births, was concerned that she had given birth so early and wanted to get her to a hospital. However, there are no phones or two-way radios in the small village, and it would take too long to reach help before the birth. When she began to bleed heavily after delivery, he decided to make the trip to get a doctor. (Although there was a local health post, the worker there wasn’t equipped to handle such an emergency, and beyond that, it was closed for Good Friday). In order to reach the doctor, Lorenzo had to borrow a motorcycle, which broke down on the heavily flooded roads, so he borrowed a bicycle to make the rest of the trip. He finally found the doctor and they headed back in a truck, only reaching Antonia after walking the last half hour when the vehicle became stuck in the mud. She had died an hour earlier, surrounded by family. (1)

I related this story in so much detail because I think it’s a profound example of the physical barriers which contribute to maternal mortality. Antonia died of hemorrhaging followed by cardiac arrest—a treatable condition. The real cause of her death was lack of access to emergency obstetric care. The cause of her death was the lack of a phone or radio, the lack of a well-trained, available local health worker. The cause of her death was mud.

Lack of geographic access to emergency obstetric care is an under-recognized problem contributing to maternal mortality and facing many women worldwide. Researchers from Germany and the London School of Hygiene and Tropical Medicine published a study this month on the availability of emergency care to women living in rural Zambia. They found that “only a third of births in rural Zambia occurred at a health facility, and half of all mothers lived more than 25 km from a health facility that provided basic emergency obstetric care. As distance to the closest delivery facility doubled, the odds of a woman giving birth in a health facility decreased by 29%” (2).

Like most serious problems, this one needs to be addressed on a variety of levels. One is simple infrastructure—bad roads, susceptible to the caprices of weather, make it a lot harder to access rural areas. Another is the availability of healthcare workers and their ability to handle emergency obstetric complications. The video we all watched last week about the surgeon-midwives being trained in Mozambique is a heartening example of an intervention to that problem, and I plan to explore it further in a future post focusing on health workers and traditional birth attendants.

Another potential solution lies in technology: specifically, cell phones. I spent this summer in Ghana and was amazed at the number of mobile phones being used in very rural locations—not to mention the omnipresent advertisements for service providers like Vodafone and Movistar plastered on the sides of buildings and on billboards. Indeed, the presence of cell phones has increased dramatically in the developing world in recent years. In 2008, there were 280.7 million cell phone users in Africa—roughly 30% of the population (3). Combining mobile technology and health is an established idea, but what about in terms of maternal mortality, specifically? I came across a study which found that maternal deaths were reduced when remote health units and traditional birth attendants were given radio receiver sets. This resulted in a shorter response time in receiving care—exactly what Antonia, in the first example, lacked (4). Cell phones could be an invaluable tool to help reduce maternal mortality in very rural areas, but only if the infrastructure exists there.

In order to help women like Antonia many things are needed—starting with recognition that simple physical barriers result in preventable maternal deaths, and continuing (though not ending) with creative and institutional solutions to overcome those barriers.

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1. http://www.care.org/campaigns/mothersmatter/downloads/Peru-Case-Study.pdf

2. http://biomedme.com/general/emergency-care-for-childbirth-complications-out-of-reach-for-rural-women-in-zambia_31570.html

3. http://www.w3.org/2008/MW4D/wiki/images/9/9c/FrontPage$Africa_Mobile_Fact_Book_2008.pdf

4. http://www.scielosp.org/pdf/bwho/v83n8/v83n8a17.pdf

Wonder-drugs and Wetsuits: Innovations in Maternal Health

February 3rd, 2011

For this week’s blog I decided to focus on two tools in maternal health: Misoprostol and the LifeWrap. Both tools represent different approaches to tackling the persistently high rate of postpartum hemorrhage (PPH) in the developing world.  Misoprostol, a pharmaceutical, was originally created to treat gastric ulcers, and has since been applied to PPH. The LifeWrap, a more recent invention, it is a neoprene body suit designed to stabilize women with postpartum bleeding long enough for them to be transported to a hospital for further treatment.

Before delving into the details of this intervention, let me begin with a bit of background on postpartum hemorrhage. Postpartum hemorrhage accounts for approximately 24% of all maternal death[1].  Normally, postpartum bleeding is controlled by (1) contraction of uterus, which constricts the surrounding blood vessels, and (2) by a variety of factors in your blood (called decidual hemostatic factors) that help to promote coagulation.[2] 80% of postpartum hemorrhage arises from a disruption in the ability of the uterus to contract. The remaining 20% of cases result from a lack of coagulation (there are lots of underlying causes) or trauma during labor. In the US, most cases of postpartum hemorrhage (which is to say, hemorrhage resulting from uterine atony) is treated with oxytocin, an IV drug which stimulates uterine contraction.

The main problems with using oxytocin in the developing world are that it must be administered intravenously and it needs to be refrigerated. The difficulty of using oxytocin in more rural areas has provoked investigations into the use of alternative therapies, including misoprostol and, more recently, the LifeWrap. Both of these interventions have their relative strengths and weaknesses.

Misoprostol remains arguably the most promising tool for combating maternal mortality. Misoprostol has 4 major advantages over alternative therapies. First, unlike oxytocin, misoprostol is heat stable, and can be administered orally. This means that misoprostol can be provided in areas with considerably less expertise and physical infrastructure than oxytocin. Secondly, misoprostol can be used as a preventative therapy in addition to a curative one. While the use of misoprostol as a preventative tool has not been widely studied in the developing world, the possibility remains an exciting one. The third advantage of misoprostol is that it is relatively cost-effective. A relatively recent study on optimal dosage for PPH treatment with misoprostol found that reducing the dose of sublingual misoprostol from three to two tablets did not significantly reduce its efficacy.[3] This finding means that cost of treating postpartum hemorrhage with misoprostol has been reduced by 1/3, down to roughly $0.67. Finally, misoprostol is a highly desirable intervention because in most cases follow-up treatment is not necessary. If misoprostol distribution could be extended into more rural areas, this could further improve the cost-effectiveness of the drug by eliminating the transportation costs associated with seeking treatment.

Like all interventions, however, misoprostol faces considerable challenges. Principal among these is the political challenge faced by the drug. Because misoprostol can also be used to induce abortion, some countries may be reluctant to promote its widespread distribution. This is true in Kenya, when concerns over abortion have led to access to misoprostol being largely confined to hospitals.[4] In additional to political concerns, misoprostol interventions are also constrained by the need to train individuals how to administer the drug. Like any prescription drug, misoprostol has the potential to cause harm if used incorrectly. This has led to concern over who should be permitted to distribute treatment. Finally, since misoprostol is a pill, stocks must be periodically replenished. As we have seen in past campaigns to distribute condoms, the issue of restocking can pose a barrier to ongoing use.

The LifeWrap technology attempts to respond to some of the challenges faced by misoprostol by providing a non-pharmaceutical solution for post-partum hemorrhage. While still requiring some training to use correctly, the LifeWrap does not suffer the same regulatory pressures as misoprostol. This means that the LifeWrap can be more easily distributed to traditional birth attendants and community health workers in rural areas. Unlike misoprostol, the LifeWrap can be used to respond to all type of PPH, including cases not caused by uterine atony. The LifeWrap is also reusable, meaning that is avoids the restocking issues faced by misoprostol.

Unfortunately, LifeWrap technology suffers from serious drawbacks of its own. The wrap remains very expensive: currently it cost about $175 dollars per wrap. On top of the considerable upfront cost of the wrap, further costs are imposed each time it is used, because women must still be transported for further treatment at a hospital.

LifeWrap is still a very new product and further development could substantially reduce its cost. Likewise, further legal and lobbying efforts could result in improved distribution of misoprostol. Given their respective strengths and weaknesses, which intervention do we push: Misoprostol or the LifeWrap?  I suspect that, as with contraceptive options, the answer is that we should push both. The more tools available to combat the issue, the more likely we are to improve the situation.


[1] “Causes of Maternal Mortality.” Maternity Worldwide. <<http://www.maternityworldwide.org/pages/causes-of-maternal-mortality.html>>.

[2] Jacobs, Allan. “Overview of Postpartum Hemorrhage.” UptoDate. September 2010. <<http://www.uptodate.com/contents/overview-of-postpartum-hemorrhage>>

[3] Fiala, Chrisitan and Andrew Weeks. “Misoprostol Dosage Guideline for Obstetrics and Gynecology.” October 2005. <<http://www.misoprostol.org/File/dosage_guidelines.pdf>>.

[4] Anyangu-Amu, Susan. “Kenya: Misoprostol Can’t Shake Bad Reputation.” Global Geopolitics and Political Economy. 5 August 2010. <<http://globalgeopolitics.net/wordpress/2010/08/05/kenya-misoprostol-cant-shake-bad-reputation/>>.

Bangladesh: Planting the seeds of change

January 27th, 2011

Araceli Y. Flores

In last week’s blog, I presented Bangladesh as a case study in examining the difficulties women confront in accessing the “rights” guaranteed to them. Despite being a democracy with the “promise” of equal rights written into its laws, Bangladesh still faces many challenges in translating these laws into tenable action— as seen by the culturally prevalent subjugation of women to extreme violence, human trafficking, and forced early marriage.

Thankfully, these harsh realties paint only one side of the picture: Bangladeshi civil society has made significant strides in empowering women in both economic and social life [1].

Economic: Bangladesh has made extraordinary progress in advancing human and economic development in recent years. Started by Muhammad Yunus in 1976, the Grameen Bank has served as the pioneer lending institution for the poor in Bangladesh through its elimination of collateral as a credit prerequisite.  Yunus reasoned that extending financial resources to the poor would allow them to break the poverty cycle and “create the biggest development wonder.” With 2,565 branches, the Grameen Bank provides services to 81,376 villages, covering more than 97 percent of the total villages in Bangladesh. As the birthplace of Grameen Bank, Bangladesh has long internalized the concept of microcredit, which has given Bangladeshi women almost unprecedented access this financial resource. As of December 2010, the Grameen Bank reported 8.34 million borrowers, 97 percent of whom are women. [2]

Social: The triumphs of the women’s rights movement in Bangladesh can be most readily observed in the vibrancy of Bangladesh’s nongovernmental organization. The United Nations High Commissioner for Refugees (UNCHR) recently published the findings of a Refugee Review Tribunal on Bangladeshi women’s rights organization. The report states “Bangladesh has a long tradition of women’s organizations… Women’s groups include the women’s wings of political parties as well as independent non- government organizations, professional bodies, student associations and trade unions… These have traditionally been focused on issues such welfare, education, skills, income generation and childcare.” [3]

Despite being often targeted by Islamic fundamentalist groups, these women’s organizations remain firmly planted in Bangladeshi society, demonstrating their resilience and determination in championing women’s rights. One such organization is Naripokkho, an NGO involved in research, lobbying and advocacy campaigns regarding gender justice and equal rights. [4] Founded in 1983, Naripokkho focuses on four pressing issues facing Bangladeshi women:

  • Violence against women and human rights
  • Reproductive rights and women’s health
  • Gender issues in environment and development
  • Representation of women in media and cultural politics

Naripokkho works at the grassroots level to create issue-based campaigns and bring this content to national awareness. Among their varied programs and activities– such as targeted public protests– Naripokkho also convenes an “International Women’s Day Committee” that works in conjunction with other Bangaldeshi NGOs to discuss women’s issues.

Steps Toward Development, established in 1993, is another Bangladeshi nongovernmental organization that campaigns and advocates for “policy interventions to establish gender equality and mainstreaming women into development”. [5] Steps Toward Development focuses on creating accountability measures for equality and respect for human rights in Bangladesh. Like many other grassroots organizations in Bangladesh, Steps Toward Development networks with other NGOs to build solidarity in the women’s rights movement and to present a united front when advocating these rights on local and national policy levels.

These two organizations provide a glimpse into the dynamic response that nongovernmental organizations have adopted to bring women’s issues to the forefront of Bangladeshi political life. Next week, I plan to look at other solutions – both governmental and civil sector based— that have been pursued in order to remedy and rectify the disregard for Bangladeshi law in practice, as well promote gender equity in society.

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Citations:

[1] “Bangladesh: Human Rights and the Rule of Law in Crisis?” United States Institute of Peace, May 2005: http://www.usip.org/publications/bangladesh-human-rights-and-rule-law-crisis

[2] Grameen Bank, Bank for the Poor: http://www.grameen-info.org/index.php?option=com_content&task=view&id=16&Itemid=112

[3] “Bangladesh— Women’s rights organizations”, United Nations High Commissioner fore Refugees, 2007: www.unhcr.org/refworld/pdfid/4b6fe12d0.pdf

[4] “Naripokkho (Women Activists Group in Bangladesh), People’s Solidarity for Participatory Democracy, 2002: http://blog.peoplepower21.org/English/5763

[5] “Bangladesh— Women’s rights organizations”, United Nations High Commissioner fore Refugees, 2007: www.unhcr.org/refworld/pdfid/4b6fe12d0.pdf

Bangladesh: Gender equity, far from a reality

January 20th, 2011

Araceli Y. Flores

Carved into the northeastern region of India, the People’s Republic of Bangladesh was established in December 1971, after decades of political crisis between India and Pakistan in border wars. As a newly independent nation, Bangladesh drafted its first constitution in 1972 and declared itself a parliamentary democracy [1 ].

Indeed, the Bangladeshi constitution had the markers of democratic ideals, such as principals of equality and civic inclusion for all citizens. Section II of the Constitution, Article 10 states that “steps shall be taken to ensure participation of women in all spheres of national life.” The nascent Bangladeshi government based this precept on what the Constitution later describes as “Fundamental Rights” under Section III, Article 28: Sub-clauses (1) and (2) proclaim that “the State shall not discriminate against any citizen on grounds only of religion, race, caste, sex or place of birth. Women shall have equal rights with men in all spheres of the State and of public life” [2]. This provision, along with Article 27 “Equality before law”, legally guarantees women access to, and protection of, all the rights therein contained within the Constitution– right to life, right to personal liberty, right to property, freedom of movement, and freedom of speech, to name a few.

Beyond its Constitution, the Bangladeshi legislature has passed a series of laws to further define abuses against women and provide additional protections for women’s rights. The Dowry Prohibition Act (1980), the Suppression of Immoral Trafficking Act (1993), and the Prevention of Repression against Women and Children Act (2000) form the basis of the women’s rights legal framework in Bangladesh [3]. On paper, these laws create a “normative” environment that upholds women’s rights and provides mechanisms to prevent violations of these fundamental freedoms. However, reality depicts the current struggle of Bangladeshi women to access the protections supposedly “guaranteed” to them by the law. The Asian Pacific Human Rights Information Center provides an incisive look at the multitude of violations against women’s rights in Bangladesh [4]. I have categorized these human rights offenses into the following umbrella categories:

  • Violence Against Women
    • Domestic Violence: According to reports published in 2000 by Bangladeshi NGOs, 30% of women living in urban areas are battered by their husbands; 33% are victims of other forms of domestic violence.
    • Extreme Physical Violence: Another report looked at the types of extreme physical violence suffered by these women: 22% were victims of acid-throwing, 10% were burn victims, and 5% were victims of poisoning, forced abortion, or other egregious attacks on women’s human rights. ODHIKAR, a Bangladeshi NGO, published a report in 2002 that showed the rising trend of acid throwing as way to “punish” women by disfiguring them: in 1998, 101 cases were reported; in 2002, that number was up to 247. Rape cases are also increasing: there were 3,189 reported rapes in 2002.
    • Fatwas: Several traditional practices, such as the issuing of fatwas, continue to infringe upon women’s rights in Bangladesh. Women who are charged with “moral offenses” are subject to fatwas, or religious decrees, that allow for punishment outside the formal judicial system. These punishments include public whipping, stoning, beating or other degrading and violent measures.
    • Human Trafficking and Forced Prostitution: Drawing on numbers provided by the US State Department’s “Trafficking in Persons Report (2002)”, the rate of Bangladeshi human trafficking is as follows:
      • 200 – 400 women and children are smuggled and trafficked every month from Bangladesh to Pakistan and Arab countries;
      • 10,000 – 15,000 are trafficked to India annually;
      • On average at least 70-80 women and children are trafficked daily from Bangladesh to other countries;
      • An estimated 200,00 women have already been trafficked to different countries, including girls as young as 9 years old.
  • Constraints in Self-Determination
    • Forced Early Marriages: While the law provides that a woman must be at least 18 years old to marry, this legal provision often goes unenforced, especially in rural areas of Bangladesh. The practice of marrying off one’s daughter without her “free consent” continues to pervade Bangladeshi society.
    • Gender inequity in educational attainment and financial access: The enrollment ratios of girls to boys in Bangladeshi primary and secondary education are still far from being equitable. Currently, girl enrollment in primary education is only 70% that of boy enrollment. In secondary education, this ratio is even more skewed: Girl enrollment constitutes only 40% of boy enrollment at this educational level. As for access to credit, Bangladeshi women have long struggled against the gender discriminating practices of bank lending. The fact that women often do not own properties and need male consent in order to receive a loan further widens the gender divide in financial sectors and creates a self-perpetuating cycle of financial dependence.

This week’s blog paints a grim picture of women’s rights issues in Bangladesh in efforts to underscore the pervasive divide between legal promises and human reality. However, in recent years, Bangladesh has seen tangible improvement and gains in its advancement of women’s human rights. Next week’s blog will focus on the successes of Bangladeshi civil society and non-governmental organizations in championing the women’s movement.

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Citations

[1] US State Department, Country Profile: People’s Republic of Bangladesh: http://www.state.gov/r/pa/ei/bgn/3452.htm

[2] Bangladesh Constitution, Bangladesh Embassy: http://www.banglaembassy.com.bh/Constitution.html

[3] UN.Gift: Global Initiative to Stop Human Trafficking, “Interview: Human Trafficking in Bangladesh” (2009): http://www.ungift.org/ungift/en/humantrafficking/interview_-human-trafficking-in-bangladesh.html

[4] The Asian Pacific Human Rights Information Center, “Rights in Law and in Practice: The Case of Bangladesh” (2003): http://www.hurights.or.jp/archives/focus/section2/2003/06/rights-in-law-and-in-practice-the-case-of-bangladesh.html#4

Translating Political Ideals into Human Reality: Bridging the Gap Between Law and Practice in the Promotion of International Women’s Rights.

January 13th, 2011

“Millions of women throughout the world live in conditions of abject deprivation of, and attacks against, their fundamental human rights for no other reason than that they are women.” Human Rights Watch [1]

On December 10, 1948, the General Assembly of the United Nations adopted the Universal Declaration of Human Rights (UDHR), a landmark text which proclaimed the inherent dignity and inalienable rights of all members of the human family. The document asserted a firm belief in certain fundamental freedoms that every government should both respect and protect, among them: the right to life and liberty; health and wellbeing; education and self-expression [2].

On December 18, 1979, the General Assembly added a new dimension to the canon of international treaties on human rights: The Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW) reiterated the “truths” upheld in the Universal Declaration of Human Rights; however, it took this conviction a step further by underscoring the urgent need to conceptualize the vision of fundamental human rights in the context of both men and women. The convention’s opening preamble “affirms the principle of the inadmissibility of discrimination and proclaims that all human beings are born free and equal in dignity and rights and that everyone is entitled to all rights and freedoms… without distinction of any kind, including distinction based on sex” [3].

These declarations put forth by the preeminent international body, the United Nations, seem to speak to some form of universal consensus on, and commitment to, women’s rights. However, the global reality offers a much starker depiction of the story: women’s continued struggle to actually claim these freedoms and access the rights guaranteed to them. These rights are being systematic denied in two ways. The first form, one we are most familiar with, is blatant government transgression of human rights: In 2009, Afghanistan – a signatory of both the UDHR and CEDAW– ratified “Shia Family Law,” allowing for marital rape and child marriage in Shiite populations [4]. In Pakistan, a woman is raped every two hours and gang-raped every eight hours, according to the country’s independent Human Rights Commission [5]. Pakistani laws and customs, which punish the victims of rape instead of the perpetrators, exacerbate this tragedy: Who report rape are often accused of adultery, an offense punishable by flogging and stoning [6].

The second form, however, is more insidious. Despite government efforts to internally promote ideals of women’s rights, their laws lack teeth in the face of societal norms or adverse socioeconomic conditions: In 2002, the People’s Republic of China passed the “Population and Family Planning Law,” prohibiting sex-selective terminations of pregnancy for nonmedical purposes [7]. However, a culture that traditionally espouses the value of sons over daughters, combined with often extreme poverty, has effectively crippled the law and prevented its enforcement. These forces often act as superseding powers, acting informally to constraint well-intentioned policies from taking root.

Through the course of this blog, I intend to grapple with the apparent disconnect embedded in international laws and domestics constitutions that often offer the promise of equality, but not the reality of its achievement. Using case studies of various countries, I will demonstrate how culture, tradition, and socioeconomic conditions act as de facto institutions that redefine the law and direct its enforcement, often to the detriment of women. While exposing the failures and shortcomings of these governments, I also hope to applaud the victories won by external actors – transnational corporations, grassroots organizations, the media—in grounding the law and making its goals tangible within disparate societies. On the individual level, I also hope to analyze how education, access to health care, and financial independence can inform and empower women to become champions of their own rights and to succeed.

Universal human rights cannot be achieved until their realms of influence extend beyond words and into deeds:

“Gender equality must become a lived reality” – Michelle Bachelet, Former President of Chile.

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Citations:

[1] Women’s Rights Division, Human Rights Watch: http://www.hrw.org/en/category/topic/women

[2] The Universal Declaration of Human Rights, United Nations: http://www.un.org/en/documents/udhr/index.shtml

[3] Convention on the Elimination of All Forms of Discrimination Against Women, United Nations: http://www.un.org/womenwatch/daw/cedaw/text/econvention.htm

[4]“Afghan Women Protest Marital Rape Law, Men Spit and Stone Them,” Revolutionary Association of the Women of Afghanistan (RAWA) News (2009): http://www.rawa.org/temp/runews/2009/04/16/afghan-women-protest-marital-rape-law-men-spit-and-stone-them.html

[5] “Pakistan Votes to Amend Rape Laws,” BBC News (2006): http://news.bbc.co.uk/2/hi/south_asia/6148590.stm

[6] “Pakistan: Women’s Rights Unchanged, IRIN News (2001): http://www.irinnews.org/report.aspx?reportid=13844

[7] Population and Family Planning Law of the People’s Republic of China (Order of the President No. 63): http://www.gov.cn/english/laws/2005-10/11/content_75954.htm

The Media's Role in Advocating for Women

January 13th, 2011

The Media’s Role in Advocating for Women

I will be blogging about the role the media play in telling stories about critical issues that affect women, particularly in the developing world. Should they remain aloof and objective, or should reporters and media organizations advocate for certain causes? I am a journalist who has covered these issues for years, particularly in Africa and Asia. I’m a Knight Journalism Fellow working on a project at Stanford to create a digital platform for The Associated that aims to take AP content in all formats – narrative writing, TV, video, audio, interactive graphics, social networking and Twitter – and tell stories about global issues from a woman’s perspective.

For example, when the next elections are held in Zimbabwe, our site might complement our political reporting with details of the rapes perpetrated against women in the opposition as a political tool, working with the AIDS-Free World report discussed by Prof. Kathleen Kelly in class.

Big and respected media outlets such as The New York Times and the Washington Post understand that there is great public interest in stories about the empowerment of women and girls, or the atrocities inflicted upon them. The Times last year undertook a yearlong project called The Female Factor (www.nytimes.femalefactor) publishing more than 60 stories about women around the world, trends and issues that affect women. The stories included wonderful video stories, as well as Twitter and Facebook feeds. The Washington Post was a 2009 Pulitzer finalist in international reporting for its series of stories about how females in the developing world are oppressed from birth to death. And NPR currently is running a series, The Hidden World of Girls:

http://www.npr.org/series/125026905/hidden-world-of-girls

But do these stories make a difference? They may win awards and praise, but do they change policy, promote change or help the lone woman on the ground? These are the questions I will explore.