NK: I'm a huge fan of PSI, partly because you can't begin to chip away at poverty unless you deal with rapid population growth. And you can't empower women when they are obliged to churn out babies nonstop because they don't have access to birth control.
I also think PSI is very good at listening to local people and giving them ownership, which is crucial for any aid program. There are no silver bullets in development, and that includes family planning and health work. But we're getting better at figuring out what works and how to make it happen. And reproductive health is clearly part of the package of solutions.
AJ: You've been outspoken about the need to reduce unsafe abortions, one of the leading preventable killers of women globally, and you have come out as a proponent of expanded availability of medication abortion. Why?
NK: I think medications are going to transform abortions. Surgical abortion involves a measure of risk and is relatively easy for authorities to crack down on. If a woman shows up at a hospital after a botched surgical abortion, she can face legal consequences. But medications such as misoprostol are now available to induce a miscarriage early in pregnancy, and there's nothing to differentiate it from a regular miscarriage. The medications have other standard uses, for ulcers and for postpartum bleeding, so they can't be banned. They're also very cheap. My hunch is that surgical abortions in the first trimester will become much rarer and that abortion will become much harder for governments to control.
AJ: We often struggle to include men in family planning interventions, yet research shows that men significantly influence women's reproductive health decisions. What are the more successful strategies you have seen to engage men in supporting a woman's right to make her own decisions?
NK: We often try things like billboards and slogans to change attitudes, and it's not obvious to me that they work very well. The three things that seem most effective to change men's attitudes toward women—and women's attitudes toward themselves—are education, television and income generation.
Getting more boys in school helps women as well. Television tends to expose conservative rural families to middle class urban norms, where wives can come and go and aren't beaten. Income generation, microsavings and microlending give women more economic weight and more voice in the household.