Half the Sky

by Nicholas D. Kristof

  99 psychological studies show that statistics: The research by psychologists on how we are moved by individual cases and not by large-scale suffering raises important issues for anyone trying to galvanize a public response to suffering. It certainly shapes the way we approach our work. See Paul Slovic, “‘If I Look at the Mass, I Will Never Act’: Psychic Numbing and Genocide,” Judgment and Decision Making 2, no. 2 (April 2007): 79–95. Remarkably, the human interest in helping victims seems to taper as soon as the number of victims rises above one.

  A Doctor Who Treats Countries, Not Patients

  103 Allan Rosenfield: Some of the quotes come from a brochure, Taking a Stand: A Tribute to Allan Rosenfield, a Legacy of Leadership in Public Health, published by Columbia University’s Mailman School of Public Health, 2006.

  CHAPTER SEVEN Why Do Women Die in Childbirth?

  113 two basic evolutionary trade-offs: The discussion of evolution borrows from a wonderful book about the history of childbirth: Tina Cassidy, Birth: The Surprising History of How We Are Born (New York: Atlantic Monthly Press, 2006).

  115 In one careful study: Nazmul Chaudhury, Jeffrey Hammer, Michael Kremer, Karthik Muralidharan, and F. Halsey Rogers, “Missing in Action: Teacher and Health Worker Absence in Developing Countries,” Journal of Economic Perspectives 20, no. 1 (Winter 2006): 91–116.

  116 “Maternal deaths in developing countries”: Mahmoud F. Fathalla, “Human Rights Aspects of Safe Motherhood,” Best Practice & Research: Clinical Obstetrics & Gynaecology 20, no. 3 (June 2006): 409–19. Dr. Fathalla is an Egyptian obstetrician who has championed maternal health issues.

  116 As The Lancet noted: The quote about the lack of interest in women’s issues reflecting an unconscious bias comes from Jeremy Shiffman and Stephanie Smith, “Generation of Political Priority for Global Health Initiatives: A Framework and Case Study of Maternal Mortality,” The Lancet 370 (October 13, 2007): 1375.

  117 Exhibit A is Sri Lanka: An excellent discussion of Sri Lanka’s success in curbing maternal mortality is found in Ruth Levine, Millions Saved: Proven Successes in Global Health (Washington, D.C.: Center for Global Development, 2004), especially chapter 5. Honduras is often touted as another example of how even poor countries can achieve astounding reductions in maternal mortality. In the early 1990s, the Honduran government targeted maternal health and the reported MMR in Honduras dropped by 40 percent in seven years. But nothing is as simple as it seems. In 2007, the UN used a new methodology to calculate a maternal mortality ratio for Honduras that was actually higher than it had been back in 1990. Were the improvements in Honduras real? The only lesson seems to be that reliable maternal death figures are exceptionally elusive in poor countries. The success—or possible success—in Honduras is discussed in Levine’s Millions Saved, and also in Jeremy Shiffman, Cynthia Stanton, and Ana Patricia Salazar, “The Emergence of Political Priority for Safe Motherhood in Honduras,” Health Policy and Planning 19, no. 6 (2004): 380–90. Kerala, India, is also often cited as an example of a place where political will reduced maternal mortality, and that is probably right. Kerala’s MMR is variously estimated as anywhere between 87 and 262, compared to a figure of 450 for India as a whole.

  119 study of a fundamentalist Christian church: The MMR of the fundamentalist Christian sect that eschews medical care is discussed in “Perinatal and Maternal Mortality in a Religious Group—Indiana,” MMWR Weekly, June 1, 1984, pp. 297–98.

  120 “keystone in the arch”: “Emergency Obstetric Care: The Keystone of Safe Motherhood,” editorial, International Journal of Gynecology & Obstetrics 74 (2001): 95–97.

  121 “Investing in better health for women”: Activists who argue that fighting maternal mortality is highly cost-effective cite various estimates about the productivity cost from maternal mortality and morbidity. USAID once claimed that the global impact of maternal deaths and neonatal deaths was about $15 billion in lost productivity, half for mothers and half for newborns. But that methodology was suspect, and we think it’s a mistake to try to justify maternal health expenses based on productivity. Men typically work in the formal economy, contributing to GNP, so their productivity is typically higher than that of women or children. So if you try to justify health interventions based on reducing lost productivity caused by sickness, you would prioritize middle-aged men over women or children.

  Edna’s Hospital

  123 Edna Adan: Edna’s name follows the convention in many Muslim countries. The pattern is for each person to get one name, then to tack on the father’s name afterward. If further clarification is needed, the paternal grandfather’s name can be added after that. So Edna herself was given only the one name. But since her father was named Adan, she calls herself Edna Adan. When needed for clarity, she adds her grandfather’s name and becomes Edna Adan Ismail.

  125 That’s when Ian Fisher wrote an article: The article about Edna that led Anne Gilhuly to try to help was Ian Fisher, “Hargeisa Journal; A Woman of Firsts and Her Latest Feat: A Hospital,” The New York Times, November 29, 1999, p. A4.

  CHAPTER EIGHT Family Planning and the “God Gulf”

  132 “contrary to its stated intentions”: The quote from Dr. Eunice Brookman-Amissah comes from “Breaking the Silence: The Global Gag Rule’s Impact on Unsafe Abortion,” a report from the Center for Reproductive Rights, New York, 2007, p. 4.

  133 Indeed, UNFPA achieved a major breakthrough: Li Yong Ping, Katherine L. Bourne, Patrick J. Rowe, Zhang De Wei, Wang Shao Xian, Zhen Hao Yin, and Wu Zhen, “The Demographic Impact of Conversion from Steel to Copper IUDs in China,” International Family Planning Perspective 20, no. 4 (December 1994): 124. See also Edwin A. Winckler, “Maximizing the Impact of Cairo on China,” in Wendy Chavkin and Ellen Chesler, eds., Where Human Rights Begin: Health, Sexuality and Women in the New Millennium (New Brunswick, N.J.: Rutgers University Press, 2005).

  134 For every 150 unsafe abortions: Hailemichael Gebreselassie, Maria F. Gallo, Anthony Monyo, and Brooke R. Johnson, “The Magnitude of Abortion Complications in Kenya,” BJOG: An International Journal of Obstetrics and Gynaecology 112, no. 9 (2005): 1129–35. See also David A. Grimes, Janie Benson, Susheela Singh, Mariana Romero, Bela Ganatra, Friday E. Okonofua, and Iqbal H. Shah, “Unsafe Abortion: The Preventable Pandemic,” The Lancet 368 (November 25, 2006): 1908–19; and Gilda Sedgh, Stanley Henshaw, Susheela Singh, Elisabeth Ahman, and Iqbal H. Shah, “Induced Abortion: Estimated Rates and Trends Worldwide,” The Lancet 370 (October 13, 2007): 1338–45. 134 “We’ve lost a decade”: Return of the Population Growth Factor: Its Impact Upon the Millennium Development Goals, Report of Hearings by the All Party Parliamentary Group on Population, Development and Reproductive Health, House of Commons, U.K., January 2007.

  134 one pioneering family planning project: Matthew Connelly, Fatal Misconception: The Struggle to Control World Population (Cambridge, Mass.: Harvard University Press, 2007), pp. 171–72.

  135 One carefully conducted experiment in Matlab: Wayne S. Stinson, James F. Phillips, Makhlisur Rahman, and J. Chakraborty, “The Demographic Impact of the Contraceptive Distribution Project in Matlab, Bangladesh,” Studies in Family Planning 13, no. 5 (May 1982): 141–48.

  135 Education Act of 1870: Mukesh Eswaran, “Fertility in Developing Countries,” in Abhijit Vinayak Banerjee, Roland Bénabou, and Dilip Mookherjee, Understanding Poverty (New York: Oxford University Press, 2006), p. 145. See also T. Paul Schultz, “Fertility and Income,” in the same volume, p. 125.

  135 crucial these days in fighting AIDS: A comprehensive article on the genetic origins of AIDS and the timeline of its spread is M. Thomas, P. Gilbert, Andrew Rambaut, Gabriela Wlasiuk, Thomas J. Spira, Arthur E. Pitchenik, and Michael Worobey, “The Emergence of HIV/AIDS in the Americas and Beyond,” Proceedings of the National Academy of Sciences 104 (November 2007): 18566–70.

  135 Women are about twice as likely: Ann E. Biddlecom, Beth Fredrick, and Susheela Singh, “Women, Gender and HIV/AIDS,” Countdown 2015 Magazine, p. 66; available online at www.popul
ationaction.org/2015/magazine/ sect6_HIVAIDS.php.

  136 AIDS to spread around the globe: An excellent resource on foreign aid efforts against HIV/AIDS is Helen Epstein, The Invisible Cure: Africa, the West, and the Fight Against AIDS (New York: Farrar, Straus and Giroux, 2007).

  136 A University of California study: Nada Chaya and Kali-Ahset Amen with Michael Fox, Condoms Count: Meeting the Need in the Era of HIV/AIDS (Washington, D.C.: Population Action International, 2002), p. 5. Much of the information about condoms comes from this booklet. More detail about the long history of condoms, and religious opposition to them, is in Aine Collier, The Humble Little Condom: A History (New York: Prometheus Books, 2007).

  136 began spreading the junk science: The evidence of the effectiveness of condoms against HIV and various STDs is discussed in “Workshop Summary: Scientific Evidence on Condom Effectiveness for Sexually Transmitted Disease (STD) Prevention,” National Institutes of Health, June 12–13, 2000; available online at www.ccv.org/downloads/pdf/CDC_Condom_Study.pdf.

  137 “Your body is a wrapped lollipop”: Camille Hahn, “Virgin Territory,” Ms. (Fall 2004). The lollipop formulation is widely used by abstinence enthusiasts, and abstinence lollipops are sold on www.abstinence.net.

  141 Poverty Action Lab: Esther Duflo, Pascaline Dupas, Michael Kremer, and Samuel Sinei, “Education and HIV/AIDS Prevention: Evidence from a Randomized Evaluation in Western Kenya,” manuscript, June 2006; and Pascaline Dupas, “Relative Risks and the Market for Sex: Teenage Pregnancy, HIV, and Partner Selection in Kenya,” manuscript, October 2007, www.dartmouth.edu/∼pascaline/.

  143 Pentecostal megachurch in Kiev, Ukraine: Information about Christianity in the developing world comes from Mark Noll, professor at Wheaton College, in an unpublished presentation to the Council on Foreign Relations, New York, March 2, 2005. See also the good discussion of Christianity’s role in nurturing women in the developing world in Philip Jenkins, The New Faces of Christianity: Believing the Bible in the Global South (New York: Oxford University Press, 2006), especially chapter 7.

  144 Arthur Brooks: There’s also a discussion of religious giving to the developing world in The Index of Global Philanthropy 2007, especially pp. 22–23 and pp. 62–65.

  Jane Roberts and Her 34 Million Friends

  146 But Jane Roberts: The story of the founding of 34 Million Friends is told in Jane Roberts, 34 Million Friends of the Women of the World (Sonora, Calif.: Lady Press, 2005).

  CHAPTER NINE Is Islam Misogynistic?

  149 a very large proportion are predominantly Muslim: Two books that give an excellent introduction to women in the Islamic world are Jan Goodwin, Price of Honor: Muslim Women Lift the Veil of Silence on the Islamic World (New York: Penguin, 2003), and Geraldine Brooks, Nine Parts of Desire: The Hidden World of Islamic Women (New York: Anchor, 1995).

  150 In contrast, opinion polls underscore: Arab Human Development Report 2005: Towards the Rise of Women in the Arab World (New York: UNDP, 2006), Annex II, pp. 249 et seq.

  150 Grand Mufti Sheikh Abdulaziz: “Saudi Arabia’s Top Cleric Condemns Calls for Women’s Rights,” The New York Times, January 22, 2004, p. A13.

  150 After the Taliban was ousted: Afghanistan in 2007:A Survey of the Afghan People (Kabul: The Asia Foundation, 2007).

  151 Amina Wadud, an Islamic scholar: Amina Wadud, Qur’an and Woman: Rereading the Sacred Text from a Woman’s Perspective (New York: Oxford University Press, 1999).

  152 A useful analogy is slavery: Rodney Stark, For the Glory of God: How Monotheism Led to Reformations, Science, Witch-Hunts and the End of Slavery (Princeton, N.J.: Princeton University Press, 2003), pp. 301–4. See also Bernard Lewis, Race and Slavery in the Middle East: An Historical Enquiry (New York: Oxford University Press, 1992), and Murray Gordon, Slavery in the Arab World (New York: New Amsterdam Books, 1990). For examples of how slaves were treated in different Islamic societies, see Shaun E. Marmon, ed., Slavery in the Islamic Middle East (Princeton, N.J.: Markus Wiener Publishers, 1999).

  153 a longtime adversary, Ali: The followers of Ali are the Shiites, and so even today Aisha is distinctly unloved by Shiites. Aisha is a common name for Sunni girls; it is almost unknown among Shiites.

  153 some Islamic feminists: Fatima Mernissi, The Veil and the Male Elite: A Feminist Interpretation of Women’s Rights in Islam, trans. Mary Jo Lakeland (New York: Basic Books, 1991). See also Fatima Mernissi’s other books, including Beyond the Veil: Male-Female Dynamics in Modern Muslim Society, rev. ed. (Bloomington: Indiana University Press, 1987). A pioneer within the Arab world in fighting for women’s rights was Nawal el Saadawi, author of The Hidden Face of Eve: Women in the Arab World (Boston: Beacon Press, 1980).

  153 Another dispute about the Koran: Christoph Luxenberg, The Syro-Aramaic Reading of the Koran: A Contribution to the Decoding of the Language of the Koran (Berlin: Hans Schiler Publishers, 2007). We corresponded with Luxenberg by e-mail but don’t know his true identity; he uses the pseudonym for safety, since fundamentalists might try to kill him.

  154 the complexity of gender roles: One way to understand the nuances of Islam in the West is to take a look at Muslim Girl magazine. Founded in 2006 by a Pakistani-American, Ausma Khan, it is unapologetic about Islam while also supporting human rights and projecting models of smart and assertive young women.

  154 “I’m a Nobel Peace Prize-winner”: Shirin Ebadi also explores these issues in her book, Iran Awakening: A Memoir of Revolution and Hope (New York: Random House, 2006).

  138 “For each percentage-point increase”: Henrik Urdal, “The Demographics of Political Violence: Youth Bulges, Insecurity and Conflict,” mimeograph, 2007. There is a rich and controversial literature about the tendency of all-male cohorts to be particularly violent. See David T. Courtwright, Violent Land: Single Men and Social Disorder from the Frontier to the Inner City (Cambridge, Mass.: Harvard University Press, 1998). For a biological take, see Dale Peterson and Richard Wrangham, Demonic Males: Apes and the Origins of Human Violence (New York: Mariner Books, 1997).

  159 In Yemen, women make up only 6 percent: Ricardo Hausmann, Laura D. Tyson, and Saadia Zahidi, The Global Gender Gap Report 2006 (Geneva: World Economic Forum, 2006), and Arab Human Development Report 2005, p. 88.

  159 As a UN Arab Human Development Report put it: Arab Human Development Report 2005, p. 24.

  159 “The status of women”: M. Steven Fish, “Islam and Authoritarianism,” World Politics 55 (October 2002): 4–37; quotations from p. 37 and pp. 30–31.

  160 “The economic implications of gender discrimination”: David S. Landes, The Wealth and Poverty of Nations: Why Some Are So Rich and Some So Poor (New York: W. W. Norton, 1998), pp. 412–13.

  CHAPTER TEN Investing in Education

  170 “The evidence, in most cases”: Esther Duflo, “Gender Equality in Development,” BREAD Policy Paper No. 011, December 2006.

  170 the state of Kerala: Amartya Sen and others have often held up Kerala as an example of what is possible for women in development. We share the enthusiasm for what Kerala has achieved in education, health, and gender but are deeply disappointed with its economic mismanagement and market-unfriendly investment climate. Kerala’s economy has stagnated and depends on remittances from Kerala natives who work in the Gulf. More information on Kerala is in K. P. Kannan, K. R. Thanappan, V. Raman Kutty, and K. P. Aravindan, Health and Development in Rural Kerala (Trivandrum, India: Integrated Rural Technology Center, 1991).

  170 the case for investing in girls’ education: See Barbara Herz and Gene B. Sperling, What Works in Girls’ Education: Evidence and Policies from the Developing World (New York: Council on Foreign Relations, 2004). There are many, many other studies and reports on the impact of girls’ education, but this is a useful summary of the findings. See also Girls Education: Designing for Success (Washington, D.C.: World Bank, 2007), and Dina Abu-Ghaida and Stephan Klasen, The Economic and Human Development Costs of Missing the Millennium Development Goal on Gender Equity (Washington, D.C.: World Bank, 200
4).

  171 Indonesia vastly increased school attendance: Lucia Breierova and Esther Duflo, “The Impact of Education on Fertility and Child Mortality: Do Fathers Really Matter Less Than Mothers?” unpublished manuscript, March 2002.

  171 Similarly, Una Osili: Una Okonkwo Osili and Bridget Terry Long, “Does Female Schooling Reduce Fertility? Evidence from Nigeria,” manuscript, June 2007.

  172 FemCare: Claudia H. Deutsch, “A Not-So-Simple Plan to Keep African Girls in School,” The New York Times, November 12, 2007, Special Section on Philanthropy, p. 6.

  172 Fetuses need iodine: Erica Field, Omar Robles, and Maximo Torero, “The Cognitive Link Between Geography and Development: Iodine Deficiency and Schooling Attainment in Tanzania,” manuscript, October 2007, www.economics.harvard.edu/faculty/field/files/Field_IDD_Tanzania.pdf.

  173 One of the pioneers is Mexico: Tina Rosenberg discusses Santiago Levy’s launch of Progresa, later renamed Oportunidades, in “How to Fight Poverty: Eight Programs That Work,” Talking Points memo for www.nytimes.com, November 16, 2006. See also World Bank, “Shanghai Poverty Conference Case Summary: Mexico’s Oportunidades Program,” 2004; Emmanuel Skoufias, “PROGRESA and Its Impacts upon the Welfare of Rural Households in Mexico,” International Food Policy Research Institute, Research Report 139, 2005; Alan B. Krueger, “Putting Development Dollars to Use, South of the Border,” The New York Times, May 2, 2002.

  174 the UN’s school feeding program: Food for Education Works: A Review of WFP FFE Programme Monitoring and Evaluation, 2002–2006 (Washington, D.C.: World Food Programme, 2007).

  175 A study in Kenya by Michael Kremer: Michael Kremer, Edward Miguel, and Rebecca Thornton, “Incentives to Learn,” manuscript, updated January 2007.