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This study exploits a natural experiment to investigate the impact of land reform on the fertility outcomes of households in rural Ethiopia. Public policies and customs created a situation where Ethiopian households could influence their usufruct rights to land via a demographic expansion of the family. The study evaluates the impact of the abolishment of these pronatal property rights on fertility outcomes. By matching aggregated census data before and after the reform with administrative data on the reform, a difference-in-differences approach between reform and non-reform districts is used to assess the impact of the reform on fertility outcomes. The impact appears to be large. The study estimates that women in rural areas reduced their life-time fertility by 1.2 children due to the reform. Robustness checks show that the impact estimates are not biased by spillovers or policy endogeneity.

Thirteen years after the last supplement on obstetric fistula, the authors challenge the progress achieved. Citing the ongoing need for a standardized classification system, uniform surgical training and certification, evaluation, follow‐up, and research, we emphasize the need for improved communication and coordination between government and nongovernment entities invested in ending obstetric fistula. Struck by the call by the United Nations to end obstetric fistula by 2030, we stress the need for increased and targeted funding of programs that are of the highest quality and impact., A call to action on the greatest needs for ending obstetric fistula.

Entre el 2 de marzo y el 28 de abril de 1995, CIESPAL con el auspicio de UNICEF, OPS/OM5, UNFPA, UNESCO, USAID y la Universidad Jobns Hophtns; realizó el primer curso nacional de comunicación y movilización social en salud. Sus características, contenidos y metodologías señalan pautas para reproducir la experiencia en otros países de la región. La organización de este curso respondió al compromiso adquirido por CIESPAL con UNICEF y la Escuela de Salud Pública y Medicina Tropical de la Universidad de Tulane, New Orleans, que con el apoyo financiero del PNUD, OMS y USAID, organizaron dos cursos prototipo mundiales, en esta ciudad, en 1993 y 1994. Estos estuvieron orientados a capacitar a profesionales de la salud, comunicación y educación, en la gerencia uso y desarrollo de programas que enfrenten los problemas de salud. En base a esta experiencia y adaptándolo a la realidad ecuatoriana, el departamento de Investigación de CIESPAL, diseñó y ejecutó el curso nacional.

Improved outcomes for women and children - more education, lower fertility rates, higher nutritional status, and lower incidence of illness, among other outcomes - have broad individual, family, and societal benefits. For nearly 15 years, the targets of the millennium development goals (MDGs) have been a bellwether for progress, particularly for maternal and child health (MCH) - a two-thirds reduction in under-five mortality in MDG 4 and a three-quarters reduction in the maternal mortality ratio in MDG 5. This systematic review by the Independent Evaluation Group (IEG) is a learning exercise that looks beyond World Bank experience. It is intended to be used a reference for practitioners in the Bank and elsewhere with an interest in interventions that have demonstrated attributable improvements in skilled birth attendance and reductions in maternal and child mortality. This review also identifies important gaps in the impact evaluation evidence for interventions that may be effective in reducing maternal and child mortality but whose impacts have not yet been tested using robust impact evaluation methods. The systematic review provides findings on what is known about the effects of interventions on skilled birth attendance, maternal mortality, neonatal mortality, infant mortality, and under-five mortality, as well as the effect of skilled birth attendance on these and other intermediate MCH outcomes. Finally, the review highlights the main gaps in the body of impact evaluation knowledge for maternal and child mortality.

This study examines the determinants of adolescent sexual behavior and fertility in Nigeria, with a special focus on knowledge, attitudes and behaviors of adolescents aged 10-19 years old in Karu Local Government Authority (LGA), a peri-urban area near the capital city of Abuja. Using the last three waves of Demographic and Health Surveys (2003, 2008, 2013), focus group discussions, stakeholder interviews, and a specialized survey of 643 girls and boys aged 10-19 years old in Karu LGA, the study narrows in on key challenges to and opportunities for improving adolescent sexual and reproductive health outcomes. The national median age at sexual debut for adolescent girls and boys is between 15 and 16 years of age. This is closely emulated in Karu LGA with a median age of 14.8 years for girls and 15.3 years for boys. While data on pregnancies was limited in the Karu sample, DHS data show that for girls, sexual debut is closely associated with marriage or cohabitation, which in turn is a strong predictor of adolescent fertility. Poverty is another strong predictor, with the odds of becoming pregnant being twice as high for adolescents in the lower wealth quintiles compared to their counterparts in the richest quintile in the country. While adolescents’ knowledge of contraception has increased from under 10 percent to over 30 percent, use of health services among adolescents for SRH (and contraception) is limited due to factors such as fear of stigma, embarrassment, and poor access to services, something also emphasized in focus group discussions. Challenges for improving adolescent SRH outcomes relate to: (i) the paucity of data, especially on the 10-14 year olds; (ii) availability and access to youth-friendly services and the Family Life and HIV Education (FLHE); (iii) reaching out-of-school adolescents with SRH information; and (iv) addressing ambiguities and gaps in Federal law and customs on age at marriage, and generating support for the legal age at marriage of at least 18 years old. Addressing these barriers at the State and sub-regional levels is going to be critical in improving adolescent well-being.

In 2000, the United Nations (UN) Member States pledged to work towards a series of Millennium Development Goals (MDGs), including the target of a three-quarters reduction in the 1990 maternal mortality ratio (MMR; maternal deaths per 100 000 live births), to be achieved by 2015. This target (MDG 5A) and that of achieving universal access to reproductive health (MDG 5B) together formed the two targets for MDG 5: Improve maternal health. In the five years counting down to the conclusion of the MDGs, a number of initiatives were established to galvanize efforts towards reducing maternal mortality. These included the UN Secretary-General’s Global Strategy for Women’s and Children’s Health, which mobilized efforts towards achieving MDG 4 (Improve child health) as well as MDG 5, and the high-level Commission on Information and Accountability (COIA), which promoted “global reporting, oversight, and accountability on women’s and children’s health”. Now, building on the momentum generated by MDG 5, the Sustainable Development Goals (SDGs) establish a transformative new agenda for maternal health towards ending preventable maternal mortality; target 3.1 of SDG 3 is to reduce the global MMR to less than 70 per 100 000 live births by 2030.

The authors investigate determinants of individual migration decisions in Vietnam, a country with increasingly high levels of geographical labor mobility. Using data from the Vietnam Household Living Standards Survey (VHLSS) of 2012, the authors find that probability of migration is strongly associated with individual, household and community-level characteristics. The probability of migration is higher for young people and those with post-secondary education. Migrants are more likely to be from households with better-educated household heads, female-headed households, and households with higher youth dependency ratios. Members of ethnic minority groups are much less likely to migrate, other things equal. Using multinomial logit methods, we distinguish migration by broad destination, and find that those moving to Ho Chi Minh City or Hanoi have broadly similar characteristics and drivers of migration to those moving to other destinations. The authors also use VHLSS 2012 together with VHLSS 2010, which allows us to focus on a narrow cohort of recent migrants, those present in the household in 2010, but who have moved away by 2012. This yields much tighter results. For education below upper secondary school, the evidence on positive selection by education is much stronger. However, the ethnic minority ‘penalty’ on spatial labor mobility remains strong and significant, even after controlling for specific characteristics of households and communes. This lack of mobility is a leading candidate to explain the distinctive persistence of poverty among Vietnam’s ethnic minority populations, even as national poverty has sharply diminished.

Finland is one of the donor countries that is most supportive in family planning (FP), Sexual and Reproductive Health and Rights (SRHR) and gender issues. This study examines Finnish ODA for FP and SRHR: its decision-making structure, other stakeholders and funding levels. Data consists of documents from the Ministry for Foreign Affairs (MFA) and interviews conducted at the MFA and with other experts. While Parliament decides on the overall level of ODA funding, the Minister for Foreign Trade and Development has considerable autonomy. Other stakeholders such as the All-Party Parliamentary Group on Population and Development and the Family Federation of Finland (Vestliitto) engage in advocacy work and have influenced development policy. Although the Development Policy 2007 mentions the importance of health and SRHR issues and HIV/AIDS is a cross-cutting issue, interviewees stated that the importance of health and SRHR in ODA has declined and that the implementation of cross-cutting issues is challenging. Multilateral funding for UNFPA, UNAIDS and GFATM, and thus the proportion of SRHR funding within the health sector, is however currently rising. Funding for population-related activities has increased and represented 4.8% of Finlands total ODA in 2009. Almost all of this funding is directed towards basic reproductive health and HIV/AIDS issues and the majority is directed through multilateral channels (78% in 2009), mainly UNFPA and UNAIDS. IPPF, Ipas and Marie Stopes International also receive support.

Traditional benchmarks to assess performance rely on unconditional rankings or regional averages. This paper uses a recently developed methodology based on quantile regressions and initial conditions to propose alternative benchmarks for social sectors in Kyrgyz Republic. Covering a wide set of indicators, the analysis reveals mixed results for Kyrgyz Republic. The country has made important strides in many social areas, with outstanding results in reducing child mortality and undernourishment. However, other areas are still key challenges and demand further attention and resources, as evidenced by the underachievement in maternal mortality, educational performance, and increasing informality in labor markets.

El Salvador’s development over the past decade has been dichotomous. On the one hand, economic growth has remained persistently low, employment and labor force participation have barely increased, and progress on poverty reduction has slowed. On the other hand, inequality has fallen, and shared prosperity improved together with advances in many social indicators, such as pre-primary enrollment rates, access to prenatal care, immunizations, and water and sanitation. The increase in the use of social spending, which now accounts for 12.4 percent of GDP, together with an improvement in the quality of social spending, explain at least part of this dichotomy of redistributive and social gains despite low growth, a tight fiscal situation and generally low government revenues and spending. Looking forward, the key challenges El Salvador faces are related to continuing improving the quality and efficiency in the social sectors, while maintaining the overall level of social spending within an increasingly constrained fiscal environment, where fiscal constraints, low revenues, and the need to cut the deficit by 3 percent of GDP are significant elements, as well. Priority will have to be given to reallocations and improvements within the spending envelope for the social sectors to maximize impact. This document analyzes social spending for El Salvador for the education, health and social protection and labor sectors in depth and explores a series of policy options for El Salvador to reallocate social spending for more effective impacts, to enhance and reform social policies and social service delivery, and to improve the management of public spending and budget execution in the social sectors.

Honduras has experienced moderate economic growth in the past decade, in line with the rest of the region. Despite this growth track record, limited opportunities for decent jobs for the majority of workers have resulted in stagnant poverty and inequality rates that are still the highest in Central America (CA). In parallel, progress in human development indicators has also been mixed in the last decade. In education, while primary enrollment has significantly increased, low coverage at all other levels of education, inequalities in access and low quality persist. In health, Honduras is close to achieving the 2015 child mortality Millennium Development Goals (MDGs), but maternal mortality, noncommunicable diseases (NCDs), and violence pose additional challenges. And despite advances in setting up a social protection system, fiscal sustainability and lack of coordination among interventions prevail, undermining poverty reduction efforts. The ability of the Honduras government to expand safety nets, to increase the access and quality of public education and health services, to engage in active labor market policies, and to improve human development indicators in general, remains limited for a number of reasons. First, overall real social public spending has been on the decline in the last few years. Second, low revenues and fiscal deterioration pose challenges to adequately financing needed social sector improvements. Third, challenges in budget formulation and execution (mainly due to institutional factors) also diminish the impact of social spending. But more importantly, Honduras needs to significantly improve the effectiveness and efficiency of its social spending. This note argues that moving forward Honduras should prioritize three main aspects: a) to rationalize and increase the effectiveness of social public spending by enhancing the pro-poor features of targeting mechanisms; b) to significantly redress the imbalance between recurrent spending, especially the wage bill, and capital expenditure; and c) to continue strengthening information systems tools, legislation, and institutions in an effort to consolidate programs into fewer and higher impact interventions. Sector-specific challenges aligned with these broad objectives are addressed below.

At the time of independence in 2002, Timor-Leste had a seriously weak health system with only a handful of doctors in the country. In this context, the governments of Timor-Leste signed an agreement and the Cuban Medical Brigade started to train medical students and deploy them in the country, particularly in rural areas. While the initial massive shortage has now been minimized, there are concerns over more complex issues including facility functionality, rural retention, motivation, preferences and competence of health workers. The objectives of this survey were to understand the labor market dynamics among health workers, to learn more about the preferences and concerns of health workers, and to assess the skills, competence and motivation of doctors.

El Salvador is the smallest country in Central America, and one of the most densely populated in the world. El Salvador is among the countries most affected by weather-related events and other hazards, incurring annual losses of around 2.5 percent of GDP. Worldwide, it ranks second highest for risk exposure to two or more hazards and highest for the total population at a relatively high risk of mortality. Furthermore, climate change is expected to increase the frequency and severity of weather, related events. The new Administration is committed to making El Salvador more ‘productive, educated, and safe’ by promoting inclusive growth and resilience. The World Bank Group’s (WBG) proposed new CPF intends to promote inclusive growth and to foster resilience, with a focus on policy levers that could contribute to break the vicious circles in a sustainable manner. The proposed CPF is aligned with the Government’s priorities and informed by the WBG’s recent SCD. To strengthen the mutually-reinforcing foundations of inclusive growth, the proposed WBG engagement would support objectives which seek to: (i) build capacity to create safer communities for economic development; (ii) improve secondary-school attainment; (iii) enhance youth employability and skills; and (iv) increase access to finance. To foster sustainability and resilience, the proposed CPF seeks to: (v) promote the efficiency of public spending; and (vi) build capacity to manage disasters and environmental challenges. Taking into account the challenges faced by El Salvador, the WBG wishes to provide a modest but catalytic role through the implementation of these six objectives.

Sex ratios at birth rose sharply in the South Caucasus countries after 1991, but recent data indicate that this trend is turning. What caused this rise, and what can be done to accelerate its normalization? Traditional kinship systems in the region are similar to those of other settings with sex-selection: structured for collaboration among male kin and dependence only on sons, not daughters. Yet it is anomalous to find sex-selection in a region that under the Soviet Union has for long been substantially urbanized and gender-equitable in public life — factors associated with declines in sex-selection elsewhere. Sex-selection manifested itself only after the sudden economic and governance meltdown following the dissolution of the Soviet Union in 1991. Jobs, basic services, and social protection mechanisms unraveled. People scrambled for coping mechanisms, and sons offer the traditional form of support under uncertainty. Basic services, pensions, and safety nets have been rebuilt, but the process involved years of policy changes. Strengthening these institutions, and maintaining credible continuity of expectations in them, is critical to accelerating normalization of sex ratios.

In mid-2014, the Government of Ukraine (GoU) requested technical assistance and financial support from the inter¬national community to assess and plan priority recovery and peacebuilding efforts in the conflict-affected regions of eastern Ukraine. Following these requests, and within the framework of the 2008 Joint Declaration on Post-Crisis Assessments and Recovery Planning, the EU, UN, and WBG agreed to support the government in undertaking a Recovery and Peacebuilding Assessment (RPA). This assessment follows the Post-Conflict Needs Assessment (PCNA) methodology. In view of the continuing conflict in eastern Ukraine, it was decided to undertake an initial rapid assess¬ment as a first phase of activity, which would provide an analytical and programmatic baseline for recovery efforts to inform urgent interventions and provide a basis for scaling up recovery plan¬ning and responses as the situation and needs evolve on the ground. This report summarizes the findings and recommendations of the first phase of the RPA, which was undertaken in the period November 2014 to February 2015. In light of the dynamic and fluid nature of the situation in eastern Ukraine, these findings should be considered as a snapshot in time. In particular, the assessment of infrastructure damage is limited to the damage that occurred on or before November 2014. Furthermore, the number of registered internally displaced persons (IDPs), utilized as a reference to estimate the needs of this affected population, corresponds to the official government estimates as of February 2015.

This report, Europe and Central Asia - Missing Women in the South Caucasus : Local perceptions and proposed solutions, discusses research conducted on skewed sex ratios in the South Caucasus. It discusses (i) the factors that encourage sex selection in Armenia, Azerbaijan and Georgia, (ii) whether and how these might be changing; (iii) public awareness of and attitudes regarding skewed sex rations; and to propose potential policy responses. The report examines the following: factors contributing to smaller families and unbalanced sex rations in the South Caucasus, the reasons for underlying son preference, attitudes toward daughters, factors that make women vulnerable to pressures to produce sons. It also describes how intergenerational and gender relationships are starting to change and proposes some recommendations for addressing the factors that underlie unbalanced sex rations.

This report summarizes findings from an allocative efficiency and financial commitment analysis conducted for the Government of Zambia by the World Bank and the University of New South Wales. It uses Optima, a mathematical model of HIV transmission and disease progression. Optima is a population-based and flexible model, which provides a formal method of optimization and determines optimal allocations of HIV resources across numerous HIV programs, target populations, and funding levels. It also provides epidemic, investment scenario and financial commitment analysis.

This paper lays out a roadmap to achieve social justice in healthcare by prioritizing areas related to service delivery, financial protection, and quality of care. The aim is to assist the Government of Egypt (GoE) in realizing the principle of social justice in the provision of healthcare. In doing so, the roadmap aims to prioritize key areas of focus for Egypt, including describing which existing programs to continue supporting and which new programs to consider for development, all under an integrated and interdependent structure. It is a focused assessment of how the overarching aim of social justice can be achieved in the healthcare sector through an emphasis on improving services for the most disadvantaged groups. This roadmap suggests recommendations that will result in incremental improvements in Egypt’s healthcare system in the short to medium term with a focus on disadvantaged groups. Achievement of these results should situate Egypt on the path to achieving social justice in healthcare in the long term.

Honduras has experienced moderate economic growth in the past decade, in line with the rest of the region. Despite this growth track record, limited opportunities for decent jobs for the majority of workers have resulted in stagnant poverty and inequality rates that are still the highest in Central America (CA). In parallel, progress in human development indicators has also been mixed in the last decade. In education, while primary enrollment has significantly increased, low coverage at all other levels of education, inequalities in access and low quality persist. In health, Honduras is close to achieving the 2015 child mortality Millennium Development Goals (MDGs), but maternal mortality, non-communicable diseases (NCDs), and violence pose additional challenges. And despite advances in setting up a social protection system, fiscal sustainability and lack of coordination among interventions prevail, undermining poverty reduction efforts. The ability of the Honduras government to expand safety nets, to increase the access and quality of public education and health services, to engage in active labor market policies, and to improve human development indicators in general, remains limited for a number of reasons. First, overall real social public spending has been on the decline in the last few years. Second, low revenues and fiscal deterioration pose challenges to adequately financing needed social sector improvements. Third, challenges in budget formulation and execution (mainly due to institutional factors) also diminish the impact of social spending. But more importantly, Honduras needs to significantly improve the effectiveness and efficiency of its social spending. This note argues that moving forward Honduras should prioritize three main aspects: a) to rationalize and increase the effectiveness of social public spending by enhancing the pro-poor features of targeting mechanisms; b) to significantly redress the imbalance between recurrent spending, especially the wage bill, and capital expenditure; and c) to continue strengthening information systems tools, legislation, and institutions in an effort to consolidate programs into fewer and higher impact interventions.

A low-income country, Ethiopia has made impressive progress in improving health outcomes. The Inter-agency Group for Child Mortality Estimation reported that Ethiopia has achieved Millennium Development Goal (MDG) 4, three years ahead of target, with under-5 mortality at 68 per 1,000 live births in 2012. Significant challenges remain, however, with the maternal mortality ratio at 420 out of 100,000 live births. The government has introduced a three-tier public health care delivery system to deliver essential health services and ensure referral linkages, with level three as specialized hospitals (one per 3.5 million 5 million population), level two as general hospitals (one per 1 million 1.5 million), level one as primary hospitals (one per 60,000 100,000) with satellite health centers (one per 15,000 25,000) and health posts (one per 3,000 5,000). One initiative contributing greatly toward universal health coverage (UHC) is the Health Extension Program (HEP) that provides free primary care services at health posts and communities. The country is at its early stage initiating insurance schemes to provide financial protection for its citizens: Social Health Insurance (SHI) for formal sector employees and Community-Based Health Insurance (CBHI) for rural residents and informal sector employees. Public facilities are expected to provide exempted services for free, and there is a fee-waiver system for the poor.

In Vietnam, as in many other countries of the Global South, ethnic minorities have a relatively high morbidity and mortality rate connected to reproduction, primarily explained by a high proportion of home deliveries. Due to the disparities in health, the United Nations People Foundation (UNFPA) and the Ministry of Health (MOH) have initiated a health promotion programme, where women from ethnic minorities are educated in midwifery skills to strengthen reproductive health locally. The aim of the thesis is to investigate from which health perspective the ethnic midwives implement UNFPA/MOH policies of reproductive health and how this health promotion initiative influences perspectives and practices of reproductive health. My focus is on a local context and on a specific group of Hmong women and ethnic midwives working in Meo Vac in Northern Vietnam, to examine the complexity of the field of tension between local birth culture and the state intervention. With point of departure in three levels, I investigate how the Hmong women perceive their reproductive health in relation to the Vietnamese health sector, which provides the education of the ethnic midwives and how the ethnic midwives approach this challenge. The three levels are 1) the state, represented by the UNFPA and the MOH 2) the ethnic midwives and the local health system and 3) the local Hmong women of Meo Vac. As the theoretical and methodological basis, I apply the reflexive, sociological apparatus of Pierre Bourdieu, including the concepts of field, position, habitus, capital, and practice. In the analysis, the field is constructed as a system of positions, which are interconnected and become meaningful in relation to other positions. Thereby, focus is on how certain positions come to dominate the field of reproductive health among the Hmong. The empirical foundation of the study evolves primarily around semi-structured interviews conducted in respectively Hanoi, Ha Giang (the provincial capital), and Meo Vac with official representatives, health personnel, including ethnic midwives, and Hmong women. Furthermore, I supplement my empirical data with relevant articles on the matter, although little has been written about it. I conclude that the political position to a large extent approaches reproductive health promotion among the ethnic minorities in correlation with a medical model, which also frames the education and work of the ethnic midwives. The ethnic midwives are to define independently how to include local culture and norms, which they to a large extent fail to embrace. My study identifies – as something new – that the Hmong women of Meo Vac primarily construct their birth perspectives and practices from the strong position of the ethnic midwife, distanced from local birth culture and norms.

The aim of this study is to explore if UNFPA’s work mission and methods direct for greater food security in the future. The analysis is based on one of UNFPA’s main frameworks; ICPD Programme of Action 1994. The analysis is based upon different themes that are recognized as tools for change; family planning, women’s empowerment and gender equality, education and child marriage. The theoretical frame of the analysis is liberalism which has been complemented with social constructivism, and has provided an insight to the discussion. The essay will also investigate whether the different theories can explain UNFPA’s framework, mission and methods. The method used is a describing qualitative content analysis. The research shows that UNFPA indirectly implement or propose a great deal that can have an impact on food security. In order to regulate population growth, which is one of the major trends threatening food security, different measures are proposed in the framework. Focus is on governments efforts and gender equality through SRH education. The liberal view put emphasis on human rights and the individuals right to freedom, as well as equality, which was obtained by a greater or lesser degree throughout the framework. Social constructivism could explain ICPD where liberalism failed to do so, such as the lack of emphasis on child marriage due to many societies identity and traditions.

Investments in education, health and social protection are the key to improving the state of human development in any society. In recent years, Nepal too has invested heavily in these sectors, particularly in education and health. This note provides an overview of the progress and current state of access and equity in these three sectors. It also presents evidence on some aspects of quality in the education and social protection sectors. While the country has made substantial improvements in different indicators of access at the aggregate level, disaggregated data show that disparities in access continue to exist across demographic and geographical dimensions. There is some evidence of improvement in the quality of educational inputs over the years, but the quality of outcomes remains poor.

In 2011, women and girls represented 50.6 percent of the total Montenegrin population (620,029 persons). Different aspects of gender inequality vary by region and ethnicity. The present World Bank country partnership strategy in Montenegro is based on two pillars that include supporting Montenegro s accession to the European Union (EU) through boosting institutions and competitiveness. The purpose of this report is to provide an overview of gender inequality in Montenegro. Using a number of data sources, gender differences in various outcomes are analyzed with the intention of highlighting gender inequalities in human wellbeing. Results are used to prioritize possible avenues for future research to better understand such inequalities and or suggest areas that require more focus from policymakers. This report operates under the premise that gender equality is both an issue of human rights and of critical economic consequence. In line with the world development report (WDR) 2012, the nomenclature of gender gaps in endowments, access to economic opportunities, and agency will be used to elaborate upon these arguments and their relevance to Montenegro. The findings of this diagnostic suggest that there are gender gaps in Montenegro, particularly in: (i) agency, although available data in this area is limited; (ii) access to economic opportunities; and (iii) human capital among some population subgroups. The structure of the report is as follows: section one gives introduction. Section two addresses gender disparities in endowments, including education, health, and assets. Section three presents disparities in economic opportunities in the forms of labor force participation, unemployment, employment and wages, and entrepreneurship. Section four focuses on agency and its implications for gender equality. Section five discusses relationships across issues and suggests areas for further research.

The study covered a wide range of topics, making data collection especially challenging. Key informants were sometimes new to their posts and were unable to provide details on specific programs, policies, or coverage rates. Few countries in Latin America and the Caribbean mainstream into their crisis and emergency plans protection of the nutritional status of mothers and children in the first 1,000 days of life. All countries should reinforce the promotion and protection of breastfeeding in emergencies, notably by providing an enabling space for mothers to safely breastfeed their children and by managing the provision of artificial milk formula. It is concerning that during emergencies most countries provide powdered artificial formula instead of ready-to-use artificial milk formula to infants that cannot breastfeed, greatly increasing the risks of illnesses and malnutrition as a result of inappropriate dilution and unsafe water. All countries need to reinforce their monitoring and evaluation systems, including surveillance of food and nutrition insecurity. While most countries have some form of monitoring system, few of those systems are computerized, which impairs timely and informed decision making. Systematic evaluations of emergency and crisis response are seldom performed. A number of countries would benefit from updating their nutrition policy and protocols based on the latest available evidence. Of particular importance are updates to the prevention and treatment of micronutrient deficiencies with micronutrient powders; treatment of acute malnutrition, notably with the use of ready-to-use supplements; and efficient treatment of diarrhea through the use of oral rehydration solution and zinc. Most countries will benefit from adapting the food and water rations given in emergencies to the specific nutritional needs of pregnant and lactating women and children

This section describes the priority nutrition interventions and cross-cutting approaches that are essential to promote and protect the nutritional status of mothers and children as well as a country's human capital in the short-, medium-, and long-terms. The main thrust of the guidance is that: (1) policies give special attention to the critical 'window of opportunity' represented by the first 1,000 days of life; (2) policies are aligned with the latest international recommendations in nutrition; (3) policies and interventions of key sectors are coordinated to provide synergy of action; and (4) resources allocated for disaster prevention and emergency management are invested in the most cost-effective way. Monitoring is a continuous process of collecting and analyzing information to better understand how well a program is operating against expected outputs and to allow remedial intervention to correct failures. Situation monitoring measures the change or lack of change, in a condition or a set of conditions and includes monitoring of the wider context. Performance monitoring, on the other hand, measures progress in achieving specific results in relation to an implementation plan. Evaluation is a systematic and objective assessment that attempts to determine the worth or significance of an intervention, strategy, or policy. It is used to appraise the effectiveness of an intervention to determine if it meets its goals, to estimate its results or impact, and to identify its costs vs. its benefits. Promote optimal breastfeeding practices. Provide all pregnant women with daily iron-folic acid supplements for at least six months. Provide deforming treatment to pregnant women, preschool-aged children, and school-aged children in areas where hookworms or soil-transmitted helminthes are prevalent. Establish strong links between agricultural, food security, social protection and nutrition policies that can be used to inform a robust communication program regarding maternal diet and critical infant and young child feeding practices. Support diversified agricultural production to increase availability of nutrient-dense foods, particularly those of animal sources.