Opinion

Why Does Childbirth Still Kill?

Each year, more than 5.6 million women and newborns around the world die during pregnancy, childbirth, or in the first month of life. What is more shocking is that the vast majority of these deaths should never happen. Since 1990, maternal deaths have decreased by 44% and the rate of newborn deaths has fallen as well, though more slowly. Still, 99% of maternal deaths and 80% of newborn deaths can be prevented with known interventions.


We know that giving birth in a health facility with a skilled clinician should mean better care and better outcomes. In many places, however, encouraging women to deliver in health facilities rather than at home has not resulted in reduced mortality. The problem is low-quality care. To make progress on reducing mortality, we now need to focus on improving and strengthening the frontline primary-care facilities where the majority of births worldwide are happening.

For the last three years, we ran one of the world’s largest maternal-newborn health trials in the Indian state of Uttar Pradesh, to see if we could reduce deaths by improving the quality of care in frontline facilities. These facilities had on average 1,200 deliveries per year, or 3-4 per day. Before the intervention started, less than 1% of staff washed their hands prior to delivery. Only 25% of women received the right medications to prevent post-partum bleeding. Overall adherence to standard practices was 40%.

Using bedside peer-coaching of birth attendants and facility managers, along with the WHO Safe Childbirth Checklist, we focused on the basics: hand washing to prevent infection, monitoring and treatment of women’s blood pressure to prevent eclampsia, uterine massage and appropriate medication to prevent hemorrhages. We saw marked improvement in care. Birth attendants completed 70% of the known life-saving steps during childbirth.

Yet it wasn’t enough. We saw no reduction in mortality rates.

We knew that in order to impact maternal and newborn mortality, we had to address the whole health system. Effective systems must be able to address all gaps in care, including gaps in supplies and equipment, skills and capabilities, the relationships between clinical leaders and frontline providers and the relationships between providers and the families they serve. These relationships must be based on respect and trust. This is true everywhere in the world.

However, in the rural clinics in this part of the world, coaching leaders and teams in using a checklist solved some of these problems but not enough of them. We are closer than we have ever been to closing the gap on maternal and newborn mortality. We know what is needed to make childbirth safer.

Now we must determine how to make that happen in every facility around the world.

It is time we deliver for women and their newborns.

Katherine Semrau, Assistant Professor of Medicine at Harvard Medical School and Associate Epidemiologist at the Brigham and Women’s Hospital in the Division of Global Health Equity, is Director of the Ariadne Labs BetterBirth Program.

Vaccinating Against Poverty

GENEVA – For most people, the choice between a life-threatening disease and a lifetime of crippling debt is no choice at all. Yet every year, hundreds of millions of people around the world are forced to make it, owing to the prohibitive cost of medical treatment. And, paradoxically, the hardest-hit people are not those with the largest medical bills, but rather those living in the poorest parts of the world.


Although countries like the United States have notoriously high treatment costs, with medical debt being one of the leading causes of personal bankruptcy, people living in poor countries actually spend more on health care costs relative to their income. And, because medical insurance is unavailable or too expensive, and because bankruptcy protection is not usually an option, too often they and their families end up being pushed into poverty.

But this tragedy – befalling some of the world’s most vulnerable people – could in many cases be entirely avoided. A new study, published in February in the journal Health Affairs, suggests that there is another option: in many cases, the medical bills can be preempted by prevention, through the widespread and affordable use of vaccines.

We already know that vaccines are one of the most cost-effective ways to prevent disease and death, and the new study provides additional supporting evidence. By modeling the health and economic impact of childhood vaccines for ten diseases in 41 of the poorest countries, the researchers estimate that from 2016 to 2030, these vaccines will prevent 36 million deaths. But their analysis found something else: during the same period, vaccination will also prevent 24 million people from falling into poverty because of the cost of medical treatment.

The World Bank defines “poverty” as household income of less than US$ 1.90 a day. According to the World Health Organization (WHO), health-care costs push as many as 100 million people below this line every year, with 150 million others facing “catastrophic health-care costs,” defined as healthcare spending that consumes 40% of the household budget after basic needs have been met.

All of this highlights the important role vaccination has to play in helping to reduce poverty. The fact that the study found that the greatest benefits of vaccination were among the poorest suggests not only that poorer people are more vulnerable and have a higher risk of developing preventable diseases, but also that the impact on their lives is potentially greater.

For the governments of low-income countries, this is an opportunity, because it shows what they could achieve in terms of improving health equity and reducing poverty by targeting higher vaccination rates in poorer and more marginalized communities. Moreover, by making affordable, quality health care available to everyone, regardless of their income, governments can take an important step toward universal health-care coverage (UHC).

That is because national immunization programs can act as a platform upon which to build a primary-care system. With childhood immunization come supply chains, cold storage, trained health-care staff, medical record keeping, data monitoring, disease surveillance, and much more. So, when a community gets access to childhood immunization, it is often not long before it also gets access to other services, such as neonatal and maternal care, nutritional supplements, malaria prevention measures, and sexual and reproductive health and education.

In addition to this, immunization programs provide immense reach. Thanks to global health organizations like the WHO, UNICEF and Gavi, the Vaccine Alliance, vaccination is already one of the most widely available health interventions ever. With 80% of the world’s poorest children now getting access to routine immunization – meaning three shots of a diphtheria-tetanus-pertussis-containing vaccine – we already have a health platform upon which to build UHC, even in the most challenging of countries.

And now, as this new study implies, immunization has an additional, indirect role to play. In the absence of a government-backed national health service or affordable health insurance, routine immunization has a profound financial impact, by saving millions of people from needing health care in the first place, through disease prevention.

This study builds on a growing body of evidence that vaccines not only save lives, but also build economies. Previous studies have estimated that every dollar invested in vaccines saves $16 in terms of health-care costs, lost wages, and lost productivity due to illness, or $44 if the broader benefits of people living longer, healthier lives are taken into account.

What this new study now shows, however, is the tangible impact this has on people’s lives. Over the next decade and a half, vaccines will save millions of families from the grinding misery of extreme poverty. We now have yet another reason to work hard to realize the enormous potential of immunization.

Seth Berkley is CEO of Gavi, the Vaccine Alliance.

By Seth Berkley

Improving the Sustainability of Development Finance

WASHINGTON, DC – To achieve the United Nations Sustainable Development Goals by 2030, trillions of dollars in state spending, investment, and aid will be needed annually. Although estimates vary widely, one UN report from 2014 suggests that total investment of as much as $7 trillion will be required for infrastructure improvements alone. But whatever the final tally, these sums are far beyond the means of governments, and leaders working to implement the 17 SDGs will expect their domestic banking sectors to provide much of the funding.


This is a reasonable expectation. In emerging markets, banks hold assets estimated at more than $50 trillion, meaning that they could impact dramatically how sustainable development is financed.

At the moment, however, many lenders don’t have the capacity to evaluate properly the financial, environmental, social, and governance-related risks associated with these types of projects. If the international community is to meet its SDG targets, sustainable finance practices will need to be strengthened.

Fortunately, collaboration is already producing results. In May 2012, banking regulators from ten countries asked my organization, the International Finance Corporation (IFC), to help them establish the Sustainable Banking Network (SBN) to fund initiatives that are “greener, environmentally friendly, and socially inclusive.” Since its formation, the network has grown to include 34 countries, accounting for $42.6 trillion in bank assets – equivalent to more than 85% of emerging markets’ total bank holdings.

Today, the SBN connects regulators, bankers, and agencies in emerging economies to improve finance practices for sustainability projects. These efforts, though entirely voluntary, are already having a measurable impact. For example, in 2016, the SBN became a key partner to the G20’s Green Finance Study Group, which helped advance the bloc’s global “green finance” agenda, and underscored the importance of environmental risk management within financial systems.

Moreover, many of the network’s biggest economies have developed policies for sustainability financing that are in line with international best practices. Together, these efforts are encouraging regulators in member and non-member countries to deepen their support for socially conscious lending.

To maintain this momentum, the SBN needs tools to measure progress accurately, which is why the IFC has just released its first annual SBN Global Progress Report. The report’s measurement framework, designed to track the adoption and impact of policies by member organizations and states, was developed by and agreed upon by all SBN participants, with support from the IFC. It represents a remarkable level of global consensus and breaks new ground for financial-sector analysis.

In the report, eight SBN countries (Bangladesh, Brazil, China, Colombia, Indonesia, Mongolia, Nigeria, and Vietnam) received high marks for innovation. Reforms in these countries included the introduction of large-scale and transparent monitoring programs, and new regulations that require banks to include environmental and social risk assessments in their decision-making processes. These countries also introduced market incentives to entice banks to finance more environmental projects.

One motivation for compiling an annual report is to document insights and lessons learned, and thereby help banking sectors engage in more productive reforms. In this regard, the IFC views this inaugural report largely as a blueprint to accelerate and streamline change.

Much work remains to be done to improve practices for financing sustainability in the world’s emerging economies. For example, the SBN is now focused on helping developing countries capitalize on climate-related investment opportunities, which are estimated to be valued at some $23 trillion. The network is also working to accelerate growth in the green bond market, which would help push other parts of the global financial system participate in planning and initiatives.

Still, SBN members have much to celebrate. In just five years, the organization has grown from an ambitious idea into a network of committed regulators, bankers, policymakers, and international development organizations. As I have noted before, with the support of the SBN, countries committed to building better finance frameworks are putting their ideas to work.

Ending poverty, protecting the planet, and building a more equitable future for humanity – the overarching goals of the SDGs – will be costly. But with the right financial frameworks in place, and with new ways to measure progress–, the investments we make today don’t need to break the bank.

Ethiopis Tafara is Vice President for Corporate Risk and Sustainability and General Counsel at the International Finance Corporation.

By Ethiopis Tafara

African Women on Top

TORONTO – Africa has a long history of female leadership. Yet leadership can be a challenging aspiration for the continent’s young women, owing to enduring barriers to success. If African countries – and Africa’s women – are to meet their potential, this must change.


Women were leaders on the frontlines of Africa’s decolonization struggle. Queen Anna Nzinga, the monarch of the Ndongo and Matamba Kingdoms in what is now Angola, spent decades fighting to protect her people from the Portuguese and their expanding slave trade. In 1900, Yaa Asantewaa, queen mother of the Ashanti Empire (part of modern-day Ghana), led a rebellion against British colonialism. Nearly three decades later, women in southeastern Nigeria organized a revolt, known as the Aba Women’s Riots, against British colonial policies.

More recently, President Ellen Johnson Sirleaf – a Nobel Peace Prize laureate – led her country to reconciliation and recovery following a decade-long civil war, managing a devastating Ebola epidemic along the way. Former Rwandan Minister of Health Agnes Binagwaho has dedicated her career to achieving equitable access to health care in her country and beyond. As a young teenager, Kakenya Ntaiya agreed to undergo female circumcision (a traditional Maasai rite of passage) in exchange for the opportunity to get an education. After earning a PhD in education, she founded Kakenya’s Dream, which focuses on educating girls, ending harmful traditional practices, and uplifting rural communities in Kenya.

Yet barriers to women’s leadership in Africa today remain systemic, widespread, and they begin early. They start at home, where girls are expected to take on more responsibility, including chores like childcare, cooking, and laundry. This, and other factors, undermines African girls’ educational attainment: 47% either do not complete school or never attend at all.

Girls’ paths are no easier when they grow up. From limited land rights to the enduring expectation that they perform the majority of unpaid household labor, women in Africa face major economic, legal, and cultural barriers to advancement. According to the World Economic Forum’s Gender Gap Report, Sub-Saharan Africa has closed the disparity in economic empowerment by only 68%, with women still far more likely to be unemployed, underemployed, or hold precarious employment in the informal sector.

But while the barriers to women’s leadership are formidable, they are not insurmountable. Whether in politics or health, law, or engineering, African women are showing the world how to unleash their fellow women’s leadership potential.

In Uganda, Favourite Regina is keeping refugee girls out of early marriage and pregnancy, as part of an initiative led by CIYOTA, a youth-led, volunteer-based organization established in the Kyangwali refugee settlement. In Nigeria, Blooming Soyinka employs a half-dozen economically disadvantaged and disabled artisans at Africa Blooms, creating conditions for those employees and their families to thrive and educate their children. In Kenya, Fanice Nyatigo is developing MammaTips, an app that will provide timely information on pregnancy, breastfeeding, immunization, and other important health matters to new mothers. These are young people – all Mastercard Foundation Scholars – to watch, as they are only just beginning to demonstrate the breadth of their potential as leaders.

Africa needs more such remarkable woman leaders. And, though research on how to champion female African leadership is sparse, early findings from the scholars program suggest that there are several pathways that young African women can take – and that we can support – to assume their rightful place among the continent’s leaders.

For starters, while education plays an important role, experience shows that it is not enough. Deliberate investment in leadership programs for young women are also essential. Young women need opportunities to practice leadership, whether in school, the workplace, or the community. And they need supportive spaces where they can hone these skills, build networks, and obtain support.

Moreover, recognition of young women’s talent and potential is needed to nurture their confidence and self-esteem, and to raise their profile beyond their immediate community. Mentors and role models – especially female ones – are also extremely valuable.

This is a job not only for African governments or local NGOs. All global policy discussions concerning education, the environment, science, and health must explicitly address how to develop woman leaders.

Africa’s aspiring young women are often motivated by the desire to give back to their communities. We should empower them to do just that.

If we provide young women with the right support, they will transform their communities, their continent, and the world. They will provide ethical leadership inspired by shared values, passion for community, and a commitment to a brighter future. For those of us who believe in their potential, it is a privilege to accompany them on this journey.

Shona Bezanson is Senior Manager of Education and Learning at the Mastercard Foundation. Peter Materu is Director, Education and Learning and Youth Livelihoods at the Mastercard Foundation.

By Shona Bezanson and Peter Materu

Trump’s Tax on America


BERKELEY – Mitch McConnell, the US Senate’s Republican Majority Leader, recently proclaimed that “2017 was the best year for conservatives in the 30 years that I’ve been here,” not least because President Donald Trump’s administration “has turned out to be … very solid, conservative, right of center, pro-business.”


One would undoubtedly hear Republican donors express similar sentiments over their shrimp hors d’oeuvres. After all, the Trump administration has rolled back environmental regulations and cut taxes for the rich. What’s not to like?

Sure, Trump and his family are aspiring kleptocrats. But that means they are against the government taking “their” wealth. They are natural allies for those who think that America’s income and wealth gap could stand to be even wider than it already is.

And never mind that the Trump administration is utterly inept, or that last year’s tax legislation was the most poorly drafted bill in living memory. Trump’s cluelessness, if anything, affords congressional Republicans even more opportunities to create legislative loopholes and ensure preferential treatment for their donors. It would seem that for the Republican Party, an incompetent, erratic kleptocracy might just be the best form of government.

Or at least it was until March 1, 2018, the day Trump signaled his intention to impose across-the-board import tariffs of 25% on steel and 10% on aluminum. That decision, notes Pat Roberts, a Republican senator from Kansas, “is not going to go down well in farm country.”

As Roberts points out, Trump’s move toward protectionism this year is at odds with his earlier policy achievements. “We have a tax reform package that’s bringing a lot of benefits to the business community,” Roberts told the Kansas City Star, “and this is a policy move that is contrary to that.” His worry now is that Trump will pursue “a trade policy that will basically result in all the benefits of the tax reform being taken away by higher manufacturing costs being passed on to consumers.”

He’s right. In the end, American consumers will pay for Trump’s tariffs. Such broad protectionist measures will affect every sector of US manufacturing in one way or another, and manufacturers certainly will not eat the full costs of higher-priced steel and aluminum inputs. At the same time, other countries will introduce tariffs of their own against US exports. The European Union, for example, is now planning to slap tariffs on such American staples as Harley-Davidson motorcycles, bourbon whiskey, and Levi’s jeans.

So, Trump has essentially proposed a new tax on US consumers and export industries, the costs of which will be borne largely by his own supporters in the American heartland and Rust Belt. Moreover, Trump seems to have arrived at his decision almost out of the blue. Stock markets were caught off guard, and immediately fell by around 1.5%. And according to the Kansas City Star report, “[Roberts] and other Republican senators received no formal heads-up from the White House.”

And yet the Republicans have been so cowed by Trump that the best response Paul Ryan, the speaker of the House of Representatives, could muster was that he “is hoping the president will consider the unintended consequences of this idea and look at other approaches before moving forward.”

It turns out that Trump’s decision was taken against the advice – indeed, over the objections – of not just his chief economic adviser, Gary Cohn, but also his national security adviser, General H.R. McMaster, his treasury secretary, Steven Mnuchin, and his defense secretary, James Mattis.

On the other hand, Secretary of Commerce Wilbur Ross apparently favors the tariffs. But it is not at all clear why. The Department of Commerce itself surely recognizes that more Americans benefit from lower steel and aluminum prices than from higher prices.

Another supporter of the tariffs is Peter Navarro, who was recently promoted to Director of Trade and Industrial Policy and Director of the White House National Trade Council. That comes as no surprise. Navarro has written a number of alarmist books about America’s trade relationship with China, including one titled Death by China. Nevertheless, Navarro has not yet been able to explain how creating a larger domestic steel industry through tariffs will yield a net benefit for the US economy.

A final key supporter of the tariffs is US Trade Representative Robert Lighthizer, who formerly worked as a lawyer for the steel industry. As with Ross, it is not entirely clear what Lighthizer is thinking. He has to know that Trump’s tariffs will have little to no chance of boosting the US steel and aluminum industries without also imposing substantial costs on the economy. Doesn’t he realize that his own reputation will ultimately depend on whether the administration has a successful trade policy or an obviously stupid one?

Now that Trump has set a match to the global trading system, one wonders if America’s plutocrats and their congressional lapdogs will soon realize that a bungling government chained to the unpredictable whim of a labile president is not, in fact, ideal for sustaining and creating wealth. In a kleptocracy, predators often discover that they are the prey.

J. Bradford DeLong, a former deputy assistant US Treasury secretary, is Professor of Economics at the University of California at Berkeley and a research associate at the National Bureau of Economic Research.

By J. Bradford DeLong

Will Circumcision Survive in the West?

WASHINGTON, DC – A bill to ban non-medical circumcision in Iceland has predictably provoked outrage from Jews and Muslims. They have every reason to be concerned: There have also been calls to outlaw ritual circumcision in the Netherlands and Scandinavia; doctors in the United Kingdom are under pressure to support a ban as well; and few have forgotten that the practice’s legality was challenged in Germany in 2012.


Circumcision has increasingly come under fire in Europe, because the definition of human rights has expanded to include children’s bodily integrity, while the definition of religious freedom has narrowed to include primarily worship and association. But if this emerging hierarchy of rights isn’t managed carefully, the legitimacy of the entire human-rights project could be imperiled.

According to Silja Dögg Gunnarsdóttir, the Progressive Party parliamentarian who introduced the Icelandic bill, the central issue is “children’s rights, not … freedom of belief.” Gunnarsdóttir accepts that “everyone has the right to believe in what they want,” but she insists that, “the rights of children come above the right to believe.”

For his part, Imam Ahmad Seddeeq of the Islamic Cultural Center of Iceland has countered that circumcision is a part of the Muslim faith, and that Gunnarsdóttir’s bill amounts to “a contravention [of] religious freedom.” And Agnes M. Sigurðardóttir, the Bishop of Iceland, has warned that the ban would effectively turn Judaism and Islam into “criminalized religions,” because anyone practicing circumcision could be subject to six years in jail.

Complicating matters further, both sides base their arguments on human rights. For example, some supporters of the ban have argued that circumcision violates Article 5 of the Universal Declaration of Human Rights (UDHR), which states that, “no one shall be subjected to torture or to cruel, inhuman, or degrading treatment or punishment.” The term “treatment,” supporters argue, applies to circumcision.

At the same time, some of those defending the practice have also pointed to the UDHR, particularly Article 18, which holds that, “everyone has the right to freedom of thought, conscience, and religion.” Moreover, Article 18 defines this right broadly: everyone has the “freedom, either alone or in community with others and in public or private, to manifest his religion or belief in teaching, practice, worship, and observance.” The term “practice” would seem to include circumcision.

Confronting questions of human rights requires that one consider context, in order to balance the rights and obligations of inhabitants of increasingly diverse societies. In the matter of circumcision, there are obvious tensions not just between religious freedom and individuals’ physical integrity, but also between parental rights and the authority of the state, multiculturalism and nationalism, and religious and secular moral perspectives.

Moreover, different communities prioritize human rights differently. For some, the moral framework offered by human rights is sufficient in itself; but for others, as William Galston of the Brookings Institution notes, “the language of human rights hardly exhausts the realm of moral and spiritual goods.”

In other words, culture plays a much larger role in shaping interpretations of human rights than many realize, which implies that human-rights practitioners should be wary of passing judgment on any practice with deep cultural or religious roots. As the cultural psychologist Richard Shweder notes, circumcision has featured in conflicts between Europeans and Middle Easterners for centuries. The Jewish revolt against Greek rule in the second century BCE, which Jews now commemorate annually as Hanukkah, was caused in part by a decree banning circumcision under penalty of death.

In Western countries, meanwhile, interpretations of human rights have evolved alongside a larger cultural shift toward individualism and secularism, prompting opposition to a broad set of religious practices. The circumcision issue is one gauge for measuring whether Western societies still value religious freedom enough to accommodate and appreciate a diversity of beliefs and practices. Circumcision has been an integral part of the cultural identity and religious faith of a large portion of the world for thousands of years. The current movement to abolish it in the West augurs a further narrowing of the scope of religious freedom.

The danger in this is that cherry-picking certain rights to enforce secular norms will not just undermine the overall project of human rights, which aims to unite the world’s peoples and improve lives through a shared understanding of the minimum conditions necessary to advance the “inherent dignity” and equality of “all members of the human family.” It will also undercut the credibility of the liberal order, which was founded on tolerance for diversity and minority groups.

Banning circumcision would represent a marked shift away from that tradition in the West. As the United States has historically shown, tolerance means upholding a broader definition of people’s right to practice religion, or otherwise express their cultural identity, according to their beliefs, while withholding judgment on whether such beliefs are “right” or “wrong.”

Seth D. Kaplan is a professorial lecturer in the Paul H. Nitze School of Advanced International Studies at Johns Hopkins University and the author of a forthcoming book on the future of human rights in varied cultural contexts.

By Seth D. Kaplan

Nigeria’s Schoolgirls Are Under Attack Again

LONDON – They lie about 150 miles apart in the vast brushlands of northern Nigeria, but the towns of Chibok and Dapchi have a tragic bond: both have been targets of large-scale kidnappings of schoolgirls by the Islamic extremist group Boko Haram. Following a three-year global campaign to free the 276 girls kidnapped from Chibok in 2014 – an event that brought Boko Haram’s sadistic agenda to the world’s attention – 110 girls in Dapchi vanished last month under identical circumstances.


In both cases, members of Boko Haram, which in the Hausa language translates roughly to “Western education is a sin,” sprayed a school with bullets as they invaded the grounds to steal food and other supplies. The group’s quest to establish a hardline Islamic state in northeast Nigeria has already left at least 20,000 dead and made more than 2.6 million homeless since 2009.

Another commonality between the two attacks is that the fate of the schoolgirls was a source of confusion for days. In Chibok, it was eventually learned that the 276 girls had been herded into trucks and taken away. A grainy black-and-white photo of the group after their abduction, taken by one of the terrorists, incited global outrage, sparking the movement Bring Back Our Girls.

In Dapchi, it was initially reported that 50 girls were unaccounted for after terrorists stormed the Government Science and Technical College. A follow-up statement by the Yobe state government announced that the Nigerian army had rescued the girls. But cheers turned into tears when a retraction was released, declaring that the girls not been found. Worse, according to an aide to the state governor, the “government has no credible information yet as to whether any of the schoolgirls were taken hostage by the terrorists.”

Nigerian President Muhammadu Buhari has called the incident a “national disaster,” and promised the deployment of troops and surveillance aircraft to search for the missing girls, as well as a full review of the circumstances of the raid. The children’s parents – such as the father of Fatima Manzo, who is just 16 years old – have formed their own association to track them.

Four years ago, I was part of the campaign to free the Chibok girls. In a petition that secured one million signatures almost immediately, we called on Western governments to support surveillance and reconnaissance missions, in order to locate and rescue the victims, who were being hidden in Nigeria and neighboring countries.

At that time, the Global Business Coalition for Education published a report on safe schools in Nigeria. The coalition also created a partnership among Nigerian business leaders, the Nigerian government, and international donors, in cooperation with UNICEF, to establish programs aimed at making schools safe for Nigerian children. As part of the coalition’s Safe Schools Initiative, community groups were formed; infrastructure reforms were implemented; and girls were provided with safe school options. Last May, 82 Chibok girls were released, in exchange for five Boko Haram commanders.

After years of being too afraid even to cross a school playground, girls had started to return to the classroom. The doctrine of safe schools – a rare new idea in a region beleaguered by the confrontation with Boko Haram – seemed to be gradually taking hold. Fences and other physical security were built to keep raiders out, and mobile telecommunications were used as early warning systems.

But the reality was that more than 100 Chibok girls remained in captivity, their whereabouts unknown. Moreover, six million of Nigeria’s school-age girls still don’t go to school. The abduction of yet another 110 schoolgirls is likely only to make matters worse, not just for them and their families, but for all whose fears about the safety of schools have now been reawakened.

As for the new abductees, we know their likely fate if they are not rescued quickly. Chibok girls who escaped or were released have said in interviews that abductees were whipped to persuade them to marry. Some were taken as concubines by group members. Many who were married off may never escape captivity.

The international community must do everything possible to support the Nigerian government’s efforts to save the Dapchi girls, including by providing aerial surveillance to help locate them and their captors. It has said that it will redouble its efforts to prevent the recurrence of such abductions. That must mean more international support to defeat Boko Haram and its destructive ideology, and a revamped Safe Schools Initiative, with an eye to ensuring that it is sustainable in the long term. Schoolchildren deserve nothing less.

Gordon Brown, former Prime Minister and Chancellor of the Exchequer of the United Kingdom, is United Nations Special Envoy for Global Education and Chair of the International Commission on Financing Global Education Opportunity. He chairs the Advisory Board of the Catalyst Foundation.

By Gordon Brown

The ABCs of Doing Business

NEW YORK – The World Bank’s annual Doing Business (DB) report is probably its most-cited publication. It is also the Bank’s most contentious, and with the release of Doing Business 2018 last October, the controversy surrounding the report has reached new heights, with some critics accusing it of obfuscation, data rigging, and political manipulation.


I was closely involved with the DB report from 2012 to 2016, so I had to restrain myself from jumping into the debate on the topic. But now, a review of the DB index and annual report seems worthwhile.

I first became familiar with the DB report when I was an adviser to the Indian government and would look to it for ideas about how to cut India’s notoriously cumbersome bureaucratic red tape. So, when I moved to the World Bank and learned that I would be overseeing the DB team, it was like a regular restaurant patron suddenly being asked to supervise the kitchen. The upshot was that I learned all that went on behind the scenes. And although I had some conceptual disagreements, I was impressed by the integrity of the process.

The DB index aims to measure, across countries, the ease of starting a business, obtaining the relevant permits, accessing essential infrastructure, and so forth. It comprises ten indicators, each of which is based on various sub-indicators, and all of which are aggregated, according to a fixed rule, into a final score that determines a country’s ranking among 190 economies. According to the 2018 report, New Zealand and Singapore are the world’s best and second-best places to do business, and Eritrea and Somalia are the worst, at 189 and 190, respectively.

Although there were aspects of the DB rankings that I did not like, I do not find the recent charges of data rigging to be credible. Having personally supervised much of the process, which involves a very large team compiling economic data from around the world, I can vouch for the multiple layers of checks and balances that are in place.

Nevertheless, there certainly are ways to influence the rankings without cooking up data. With any big operation – whether it is the DB or an effort to measure GDP – one occasionally discovers conceptual flaws. For example, when I first took over the process, I disagreed with the prevailing assumption that a higher tax rate is necessarily worse for an economy.

After all, the same logic dictates that the lower the tax rate, the better, which implies that a tax rate of zero is optimal. But that is obviously absurd. Even if one ignores the moral dimensions, a very low tax rate leaves a country more exposed to the threat of severe fiscal crises, which are a nightmare for business. Steps were taken to make some minimal corrections that would not be too disruptive.

Still, recognizing such problems poses a dilemma. It is never ideal to have to change a yardstick that has been used to track changes over time; but nor is it right to rely on an assumption that one knows to be flawed. At the end of the day, it’s a judgment call. For my part, I mitigated against possible biases by not even looking at the final result until I had first decided, using abstract reasoning, which changes were essential.

In this year’s DB, the two big controversies concern India’s rise and Chile’s fall. Between 2016 and 2017, India moved from 130th to 100th place. I no longer have inside information on the data, but I can see two reasons why this could occur. First, if a country is determined to move up the ranking, it can do so by focusing on the ten indicators that determine the final score, though this is not a national economic strategy that I would recommend.

Second, any change in ranking can be driven either by what a country does relative to other countries, or by measurement changes that the DB may have instituted in a given year – changes like those mentioned above. For example, when India moved from 142nd to 130th place between 2014 and 2015, the DB team and I computed that only four of the 12 positions that India had climbed reflected changes India had made, with the remainder attributable to changes in the DB methodology.

As for Chile, which slipped from 48th to 57th place between 2015 and 2016, and is now ranked 55th, it is worth noting that there is a lot of cheek-by-jowl competition at the higher end of the ranking. Small changes by countries that neighbor one another in the index can result in a sharp reordering.

But it is also true that Chilean President Michelle Bachelet’s government has placed greater emphasis on social indicators than on economic indicators. To my mind, that is a cause for praise, not criticism. Having worked with Bachelet on the World Bank’s 2018 World Development Report on education, I know that she is that rare politician who is genuinely committed to improving social welfare.

Many countries and political leaders make the mistake of equating the DB ranking with overall welfare. But the DB merely measures what it says it measures: the ease of doing business. That is certainly important for an economy, but it isn’t everything. In fact, one of the first lessons of economics is that all good things in life involve tradeoffs. It would be a pity to see more countries focusing only on “doing business” to the exclusion of other indicators of wellbeing.

Kaushik Basu, former Chief Economist of the World Bank, is Professor of Economics at Cornell University and Nonresident Senior Fellow at the Brookings Institution.

By Kaushik Basu

The ABCs of Doing Business

NEW YORK – The World Bank’s annual Doing Business (DB) report is probably its most-cited publication. It is also the Bank’s most contentious, and with the release of Doing Business 2018 last October, the controversy surrounding the report has reached new heights, with some critics accusing it of obfuscation, data rigging, and political manipulation.


I was closely involved with the DB report from 2012 to 2016, so I had to restrain myself from jumping into the debate on the topic. But now, a review of the DB index and annual report seems worthwhile.

I first became familiar with the DB report when I was an adviser to the Indian government and would look to it for ideas about how to cut India’s notoriously cumbersome bureaucratic red tape. So, when I moved to the World Bank and learned that I would be overseeing the DB team, it was like a regular restaurant patron suddenly being asked to supervise the kitchen. The upshot was that I learned all that went on behind the scenes. And although I had some conceptual disagreements, I was impressed by the integrity of the process.

The DB index aims to measure, across countries, the ease of starting a business, obtaining the relevant permits, accessing essential infrastructure, and so forth. It comprises ten indicators, each of which is based on various sub-indicators, and all of which are aggregated, according to a fixed rule, into a final score that determines a country’s ranking among 190 economies. According to the 2018 report, New Zealand and Singapore are the world’s best and second-best places to do business, and Eritrea and Somalia are the worst, at 189 and 190, respectively.

Although there were aspects of the DB rankings that I did not like, I do not find the recent charges of data rigging to be credible. Having personally supervised much of the process, which involves a very large team compiling economic data from around the world, I can vouch for the multiple layers of checks and balances that are in place.

Nevertheless, there certainly are ways to influence the rankings without cooking up data. With any big operation – whether it is the DB or an effort to measure GDP – one occasionally discovers conceptual flaws. For example, when I first took over the process, I disagreed with the prevailing assumption that a higher tax rate is necessarily worse for an economy.

After all, the same logic dictates that the lower the tax rate, the better, which implies that a tax rate of zero is optimal. But that is obviously absurd. Even if one ignores the moral dimensions, a very low tax rate leaves a country more exposed to the threat of severe fiscal crises, which are a nightmare for business. Steps were taken to make some minimal corrections that would not be too disruptive.

Still, recognizing such problems poses a dilemma. It is never ideal to have to change a yardstick that has been used to track changes over time; but nor is it right to rely on an assumption that one knows to be flawed. At the end of the day, it’s a judgment call. For my part, I mitigated against possible biases by not even looking at the final result until I had first decided, using abstract reasoning, which changes were essential.

In this year’s DB, the two big controversies concern India’s rise and Chile’s fall. Between 2016 and 2017, India moved from 130th to 100th place. I no longer have inside information on the data, but I can see two reasons why this could occur. First, if a country is determined to move up the ranking, it can do so by focusing on the ten indicators that determine the final score, though this is not a national economic strategy that I would recommend.

Second, any change in ranking can be driven either by what a country does relative to other countries, or by measurement changes that the DB may have instituted in a given year – changes like those mentioned above. For example, when India moved from 142nd to 130th place between 2014 and 2015, the DB team and I computed that only four of the 12 positions that India had climbed reflected changes India had made, with the remainder attributable to changes in the DB methodology.

As for Chile, which slipped from 48th to 57th place between 2015 and 2016, and is now ranked 55th, it is worth noting that there is a lot of cheek-by-jowl competition at the higher end of the ranking. Small changes by countries that neighbor one another in the index can result in a sharp reordering.

But it is also true that Chilean President Michelle Bachelet’s government has placed greater emphasis on social indicators than on economic indicators. To my mind, that is a cause for praise, not criticism. Having worked with Bachelet on the World Bank’s 2018 World Development Report on education, I know that she is that rare politician who is genuinely committed to improving social welfare.

Many countries and political leaders make the mistake of equating the DB ranking with overall welfare. But the DB merely measures what it says it measures: the ease of doing business. That is certainly important for an economy, but it isn’t everything. In fact, one of the first lessons of economics is that all good things in life involve tradeoffs. It would be a pity to see more countries focusing only on “doing business” to the exclusion of other indicators of wellbeing.

Kaushik Basu, former Chief Economist of the World Bank, is Professor of Economics at Cornell University and Nonresident Senior Fellow at the Brookings Institution.

By Kaushik Basu

The EU’s Seven-Year Budget Itch

PARIS – It’s theater season in the European Union. The play, called budget negotiations, is performed every seven years. It pits the EU’s spenders against its savers, donors against receivers, and reformers against conservatives. After the actors have exhausted themselves with bluffs, bullying, blackmail, and betrayal, everybody agrees on minimal changes. Each government claims victory and EU public spending is set in stone until the next performance.


Drama aside, however, watching the negotiation of the multiannual financial framework, as it is called, is a deeply depressing experience. All countries view it from the perspective of net balances – how much they receive, less how much they pay – without regard for the intrinsic value of spending. And, because wasting money at home is regarded as better than usefully spending it elsewhere, the composition of expenditures bears no relation to the EU’s stated priorities. In 2003, the Sapir report on Europe’s economic system called the EU budget a historical relic. Things haven’t improved much since then.

Theater season opened on February 23, when EU leaders held their first talks on the 2021-2027 framework. Optimists hope that it will end before the European Parliament election in June 2019. Realists expect it to last until the actors run out of time – that is, the end of 2020.

Seasoned European observers play down the significance of the show. They note that it is not primarily money, but regulatory policies – governing competition, subsidies, consumer protection, financial safety, or trade – that define the EU. Its budget represents about 2% of total public spending in the EU, and it has actually decreased over time, from 1.25% of GDP in the 1990s to about 1% in the current period. The US federal budget, by contrast, amounts to 20% of GDP. So why bother with a budget that remains small and misused? The EU has bigger problems to solve, critics say.

But this time, there are four reasons why the discussions matter, and why complacency would be misplaced.

The first is Brexit. Because the United Kingdom was a net contributor, it will leave a €15 billion ($18.5 billion) funding gap and force the EU to decide whether to substitute missing revenues or to cut spending. Adding to the drama, the misers’ bloc to which Britain belonged has fractured, with Germany indicating a willingness to be generous, while the Netherlands and Sweden are adamant they will not contribute a penny more.

Second, there is a growing gulf between money and politics. Poland’s net receipts from the EU amount to €10 billion annually, making it the leading beneficiary of the EU budget. But the Polish government’s priorities, and even values, are increasingly at odds with those of the EU. It opposes taking in asylum-seekers, it faces a European Commission-initiated procedure for threatening the independence of the judiciary, and it has shocked Europe with a law criminalizing allegations concerning Poles’ complicity in the Holocaust.

These actions have led German Chancellor Angela Merkel to suggest that conditionality be imposed for access to EU funds. This potentially explosive discussion can be avoided only if the EU is willing to shut up and pay, as some in Poland (and also in Hungary) demand. In that case, however, the EU would risk a different explosion. After all, for how long will citizens in the rest of Europe be willing to open their wallets only to be slapped in the face?

The third reason this theater season is so important is that Europe’s strategic environment calls for new priorities. From Ukraine to the Middle East, Libya, and the Sahel, the EU’s immediate neighborhood is either unstable or in turmoil. Meanwhile, the United States no longer provides the reliable shield to which Europeans had grown accustomed. The EU grew up in a world where it could safely concentrate on its own prosperity. That world is gone.

What we are facing is a redefinition of EU public goods, and this must entail deep budgetary consequences. The European Commission has bravely put some numbers on the table. It proposes to spend about €3-4 billion per year more on border security and a still-modest €5 billion per year on defense, as well as increases for research, innovation, and the Erasmus program. It also envisages annual spending cuts for regional aid and agriculture that could reach €30 billion.

Numbers, at this stage, merely flag issues. But the Commission’s boldness is justified. Regional policy and agriculture comprise nearly three-fourths of the EU budget, and both are questionable. Regional policy fueled eurozone booms in the pre-crisis years, but provided little help to struggling countries afterwards. And it is not granular enough to address the consequences of trade opening for local communities. The Common Agricultural Policy is increasingly ill-suited to guide the transformation of a much more diverse EU farm sector. To recalibrate them and thereby finance new priorities would be fully justified.

The last reason why budget issues matter this time around is that French President Emmanuel Macron has opened a new discussion about establishing a specific eurozone budget. The prime justification for creating one is not that certain public goods should be reserved to the EU’s eurozone members, but that a common fiscal instrument would cushion country-specific shocks and complement the European Central Bank’s monetary policy when facing common shocks. Whereas the EU budget performs no significant macroeconomic role in cross-country stabilization or in aggregate terms, as it does not record surpluses or deficits, the opposite would be expected from a eurozone budget.

There is no agreement yet on the contours of such a budget, especially as Germany is wary of creating a channel for cross-country transfers and joint borrowing. But this does not mean that the discussion has no future. If the EU27 prove unable to agree on sensible reforms of their budget, the eurozone’s 19 members (which include neither Poland nor Hungary) could gradually move toward creating their own. The EU budget would eventually morph into it, or become a small relic.

Understandably, citizens do not care much about the EU budget, especially if they do not directly benefit from it. But they do care about the new challenges Europe must confront, its ability to cope with them, and its willingness to devote resources to financing its priorities. The outcome of the budget discussion will tell Europeans what the EU is really up to. That is why this year’s theater season is not to be missed.

Jean Pisani-Ferry, a professor at the Hertie School of Governance (Berlin) and Sciences Po (Paris), holds the Tommaso Padoa-Schioppa chair at the European University Institute and is a senior fellow at Bruegel, the Brussels-based think tank.

By Jean Pisani-Ferry

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