“Foundations” is a series of informal question-and-answer sessions with employees and others affiliated with The William and Flora Hewlett Foundation to give them an opportunity to explain their work.

Sara Seims is the director of the Foundation’s Population Program. Before joining the Foundation in 2003, she was president of the Alan Guttmacher Institute, a population research organization. Before that, Seims was associate director of population sciences at the Rockefeller Foundation in New York for six years, where she contributed to the expansion of international collaboration in reproductive health issues. She has served as deputy chief of two divisions of the U.S. Agency for International Development: the Office of Health, Population and Nutrition in Dakar, Senegal, and the policy division of the Office of Population in Washington, D.C. She currently is a board member of the National AIDS Fund and The National Campaign to Prevent Teen and Unplanned Pregnancy and is chair of the Development Committee of the Population Association of America. In 2007, she accepted an invitation to join UNESCO’s Global Advisory Group on HIV and Sex Education.

Seims received a B.A. in anthropology from Rutgers University and a Ph.D. in demography from the University of Pennsylvania. She is a Fellow of the New York Academy of Medicine.

Why is so much grantmaking in Hewlett’s Population Program focused on sub-Saharan Africa rather than on other parts of the developing world?

Sub-Saharan Africa is the poorest place on earth. It’s where 75 percent of the population lives on $2 a day or less. It’s also the region of the world with the highest unwanted fertility, the highest maternal death rates, the highest HIV/AIDS rates, the highest rates of unsafe abortion. It’s simply the area of greatest need.

How have the problems changed over the past decade?

There have been many changes in Africa, not all of them for the worse. That’s just what the media focus on. There’s also good news coming out of Africa-although it’s much less reported. At least until very recently, the economies in many countries were growing at a very consistent rate. And more donors have realized they need to focus on Africa, and that brings more opportunities to improve people’s lives. And even though we tend to hear more about leaders like [Zimbabwe President Robert] Mugabe and other disastrous leaders, there’s a clear, growing trend in Africa toward democracy.

And our grantees have benefited from that. We work in the most sensitive areas of human engagement: sexuality and procreation. It’s work that can entail challenging traditional power relationships between women and men. And as countries democratize and the voice of civil society gets stronger, much of that voice belongs to females. As women’s rights improve and girls-as well as boys-have more chances for education, that furthers the goals of our Program. As women become more educated, they have more choices in life. They have better health care and better access to contraception and tend to want fewer children. Good family planning also allows girls to stay in school in that it helps prevent unwanted pregnancies-a major reason for dropping out.

There’s also been progress in Africa in reducing unsafe abortion. Right now, about a third of all maternal deaths in that region of the world are a result of unsafe abortion. And the most effective way to combat unsafe abortion is to expand access to good-quality family planning.

Can you speak more specifically about the work of Hewlett grantees?

It’s quite a range. For starters, we support grantees who deliver family planning and reproductive health care services. Our grantees also work to strengthen links between HIV/AIDS prevention and family planning and reproductive health, reduce sexual violence, and provide medically accurate sex education. And they work to prevent unsafe abortion. This last includes both policy and clinical work.

We also help African countries learn from each other in these areas by encouraging collaboration among them. This is known as South-South collaboration, and we are the main funders in this area.

We are also major funders of research. We support the African Union and other African bodies in using their own resources to study population issues. Supporting indigenous research helps ensure that the work conducted is relevant to the countries’ needs.

We also work to strengthen African institutions in other ways. For example, we’re currently supporting work at five universities in sub-Saharan Africa to encourage post-graduate training in population science. That’s going very, very well. We also support African-based, African-run research institutes. We made two major grants for this work: to the African Population and Health Research Center in Nairobi, Kenya, and to the INDEPTH Network in Accra, Ghana. We provide general operating support to these African-run research networks to strengthen them. We’re also funding new research to examine the relationship between population trends and poverty.

The sheer magnitude of the problems that the Population Program addresses far outstrips the resources of any foundation to solve them. Would you discuss how the Program maximizes the impact of its grantmaking?

What foundations have traditionally done is to pour a lot of support into pilot projects to prove that on a small scale, with a lot of resources, something can work. And then, when funding ends, those projects fall apart. We have not done that.

We’ve looked for opportunities where our investments can help Africa figure out, in a broader sense, what works and what doesn’t. For example, the African Population and Health Research Center in Nairobi has been working for years in two of that city’s worst slums to collect data on the lives of its people. And that really can highlight what life is like for them and what can be done to make it better. By documenting the lives of the most poor and vulnerable citizens in these slums, our grantee was able to get health, HIV/AIDS prevention, education, and family planning organizations to provide services.

In terms of HIV/AIDS prevention, the only female-controlled method available now-and likely to be available for the next five to ten years-is female condoms. And these have not been well funded. There’s an enormous demand for them in Africa. So instead of doing a pilot program, we’re working with other donors and manufacturers to make female condoms cheaper and more available.

Supporting research universities is another example of high-impact grantmaking. Over the longer term, strengthening them will tremendously increase the quality and quantity of African-trained population scientists, and that’s something the region desperately needs.

You’ve now been doing this work for three decades. What have been the biggest surprises for you, and what’s changed the most?

The biggest and most unpleasant surprise has been HIV/AIDS. When I entered the field, that wasn’t an issue. That’s an example of how something can come out of nowhere and change everything.

But beyond that, I think what’s really changed is a very hopeful thing: the increase in civil society and in the ability of women’s voices to be heard. It’s still not where it should be, but it’s so much greater than it was twenty years ago. And that bodes well not just for women and their families, but for men. It’s very good for strengthening society. I lived in Africa in the 1980s, and an open civil society wasn’t there. People were dragged off in the middle of the night and never heard from again, and newspapers were too scared to react. And now, increasingly in countries in Africa, that no longer happens.

I think we can thank the information revolution and universal education for that. The barriers to getting information have fallen. People can see what happens elsewhere and learn from it. Together these advances have put in place the basis for a strong civil society.

Overall, how much progress has there been reproductive health and family planning issues? When you thought about it thirty years ago, is this where you expected to be today?

Yes and no. We’re further along in some areas. Women have more voice and status now. We’re less far along in combating real poverty. Quality of life and standards of living remain very low in Africa. There is enormous, unspeakable poverty. Death and illness are facts of life in ways we haven’t experienced since preindustrial times.

Much of this work can take a long time to come to fruition. How do you measure progress when it take years and even decades?

The measurement question is very important. You’re dependent on what data you can get. Ultimately we have two goals. One is to promote and protect reproductive health and rights. And the other is to achieve population stabilization in ways that promote well-being and protect the environment. In reproductive health, one measure we use is reducing unsafe abortion. Population stabilization can be measured by eliminating the unmet need for contraception. Those are key measures that we use. They’re not perfect, but they’re a start.

In terms of the uptake of family planning in sub-Saharan Africa, I think we’re talking about another thirty years before the demographic transition to a downward trend in fertility is well underway. It’s begun to take root in the cities, but not in rural areas. Time is not on our side. The population of sub-Saharan Africa is almost 1 billion people today but will be approximately 2 billion by 2050. What this means is that there is a constant struggle to provide health, education, and economic opportunities to an ever-increasing number of people-and it’s very difficult for countries to catch up.