There's been a slowdown in HIV/AIDS donations from rich countries to developing nations, according to a new report from the Kaiser Family Foundation and UNAIDS.

An analysis released this week found that donors disbursed $6.9 billion last year for HIV prevention and treatment funding, down from $7.6 billion in 2009. The bulk of the decrease is attributed to a slow down in U.S. funding distribution -- but not an actual budget cut.

The United States appropriated $5.5 billion for international AIDS relief in 2010, which was in line with the 2009 disbursement, but new logistical requirements under the President's Emergency Plan for AIDS Relief slowed the pace, and $3.7 billion was actually distributed. The United States is the largest international donor, accounting for 54 percent of total funding in 2010.

"With U.S. funding delayed but not eliminated to this point, this year's drop in spending may be a temporary blip, though its impact on services may be real," Drew Altman, Kaiser Family Foundation President and CEO said in a statement.

Seven of 15 governments included in the analysis had a decrease in funding distributions in 2010, including Australia, Germany, the Netherlands, Norway, Spain, Sweden. U.S. Currency exchange fluctuations were also a factor in some of the decreases.

Nandini Oomman, director of the HIV/AIDS Monitor, which tracks effectiveness of AIDS funding at the Center for Global Development, said it's possible international contributions to the epidemic in the developing world may have seen their peak. But the current levels of commitment are still very high, she said.

"It is still a lot of money. You always need more money and resources for programming but the issue going forward is we need to spend the money we have more effectively," Oomman said.

She warned that the biggest funding challenge could be the climate in Washington and the threat of looming government budget cuts.

"We don't have the same support in Congress that we did when PEPFAR was authorized and reauthorized," Oomman said. "I don't think the U.S. is going to renege from a commitment it's made to keep people alive, but it's under a lot more pressure to demonstrate how they are making this happen."

The UNAIDS/Kaiser analysis found that the U.S. ranks seventh in AIDS funding as a share of GDP, with Denmark ranking first, followed by the Netherlands, Ireland, the United Kingdom, Sweden and Norway.

Helen Branswell for the Pulitzer Center

An army of vaccination teams working in high-risk areas of India are helping fight the crippling polio virus.

Firozabad, INDIA -- A team of women picks its way down narrow laneways and up steep stone staircases, stepping over the occasional indifferent goat along the way. They are multi-denominational, the bright saris of the Hindus a contrast to the black hijabs of their Muslim colleagues.

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The practice of "female circumcision" is widespread, affecting an estimated 140 million women worldwide. It is also unspoken. Even its euphemisms evoke images too uncomfortable to talk about in some social settings.

The societies in which the practice occurs -- a swath of Africa from Senegal to Egypt, plus pockets of west and south Asia -- are traditional, patriarchal and conservative. They also are predominantly, but only coincidentally, Islamic. The partial or complete removal of the clitoris, female genital mutilation in United Nations parlance, dates back 2,000 years, and it is practiced in both faiths in the region.

Attempts have been made from time to time to stamp out the practice: by missionaries in colonial times, U.N. proclamations, even laws to ban it, all to little effect. From all this history, Molly Melching, founder of an organization in Senegal called Tostan, derived a lesson.

"Tostan found that using approaches that shame or blame people really was just the opposite of what would work in changing social norms," Melching said.

In the two decades since Tostan -- which means "breakthrough" in the local Wolof language -- began using a human rights education approach, almost 5,000 villages in Senegal have abandoned the practice of female genital cutting, she said.

Melching is a Danville, Ill., native, who has lived in the west African nation for more than three decades. Her words are carefully chosen to be neutral. The practice of cutting, not mutilation, has been largely abandoned, but not totally eradicated. The latter also implies that local communities themselves make this decision on their own initiative.

Tostan's staff and volunteers, all drawn from local communities, hardly mention cutting, certainly in the outset. Instead, they rely on an expansive education program of seminars conducted in the villages on human rights, including the right to good health. In time, people learn about germ transmission and how complications suffered by so many women during childbirth can be traced back to the cutting that occurred during their childhood, Melching explains. All this leads to community discussions that examine the origins of the practice, with surprising results in most cases.

For one thing, people learn there's no religious requirement for cutting. It is thought to have originated in the concubines of ancient rulers as a sign of a woman's "virtue" or a means of controlling her fidelity and sexual appetite. The procedure has always been performed by women "circumcizers."

Melching says religious leaders, many of whom have personal recollections of a female relative who suffered, have been supportive in all but the most conservative regions. They are especially appreciative of being consulted first.

Tostan's message to the communities is respectful, non-judgmental and simple: we know you want to do what's best for your daughters' future. It is sensitive to the fact that from the community's perspective, girls who are not cut are likely to be ostracized and unable to find marriage partners. That makes it critical that large numbers of communities -- the marriage pool -- abandon the practice collectively. Tostan helps coordinate, organize and raise the funds for such declarations -- gala events attended by thousands of people from hundreds of villages:

"One part of bringing about a change like this is to get everyone to change at once, what we call coordinated abandonment. Everyone has to see that everyone else sees that everyone is changing," says University of California, San Diego, professor Gerry Mackie, who has closely studied Tostan.

There are instances in history for this kind of massive shift in social norms. Women's feet were once bound in China, but the practice was abandoned in barely a generation. And there's a more recent example Melching notices when she returns to America: cigarette smoking was common and widespread when she left in the 1970s, but with increasing awareness of the health consequences, it has become widely unacceptable today.

Watch This Segment

Girl Up is helping adolescent American girls make a difference in the lives of peers around the globe.

JUDY WOODRUFF: Finally tonight, a story about adolescent Americans making a difference in the lives of girls around the globe.

Ray Suarez has that.

RAY SUAREZ: The flashing lights outside say Chicago, but the girls inside are learning about the heavy burden of life a world away.

WOMAN: So, these are jerry cans. And, in Ethiopia, girls have to walk to get water. And they get very heavy. So, you want to try it and see how heavy they are?

RAY SUAREZ: The lesson isn't easy, but that's the point.

GIRL: Oh, it's hard.

RAY SUAREZ: A new United Nations Foundation campaign is spanning cultures and continents to promote girl power.

Tamara Kreinin is from the U.N. Foundation.

TAMARA KREININ, United Nations Foundation: Girls in Ethiopia might carry water for eight hours a day. They might walk eight hours to get water to bring back to their family. They might walk eight hours to get fuel for firewood and cooking.

And that's the reality of their lives. So, we want girls in the United States to carry those water jugs, get a sense of how heavy they are. They get a sense of these girls' lives.

GIRL: One, two, three.  

(CHEERING AND APPLAUSE)

RAY SUAREZ: It's a campaign by girls and for girls called Girl Up. The idea is to build grassroots support among American teens and tweens to help peers in developing countries stay in school, stay free from child labor, and safe from violence.

DORY GANNES, Girl Up, United Nations Foundation: If we educate one girl, she educates her community. If we inspire one girl with Girl Up, she inspires her community to get involved.

RAY SUAREZ: Less than one-year-old, the girl movement caught the attention of first lady Michelle Obama, who recently invited Girl Up girls to the White House.

MICHELLE OBAMA, first lady: All right, you guys keep it up.

TAMARA KREININ: If we get millions of girls around this country engaged, pretty soon, we hope they're going to be the next generation of women leaders.

RAY SUAREZ: So far, 200,000 girls across the U.S. have signed up. And almost all the money they have raised is already helping to fund U.N. programs for girls in Liberia, Ethiopia, Malawi and Guatemala.

TAMARA KREININ: Most of them live in abject poverty. They're lacking in education. Many of those girls don't learn how to read. They don't how to write or do their numbers. And, oftentimes, they're married by age 15 and then pregnant soon after.

RAY SUAREZ: On this day in Chicago, Project Girl performers tackled Girl Up's most recent effort: to stop child marriages.

EMILY RUPP, Project Girl Collective: The United Nations considers child marriage a violation of human rights.

RAY SUAREZ: Emily Rupp wrote a piece based on phone interviews about a 14-year-old girl from Africa who was forced into marriage and pregnancy, who then died in childbirth.

EMILY RUPP: His poison had flourished. And my body was changing. I grew big and round while my husband was nowhere to be found.

These women in other countries are literally left by themselves and fending for themselves. And a lot of times, they don't have the stamina and the strength to be able to make it.

TAMARA KREININ: For the girls in the United States, if they have a sense that they can really touch a girl in another country, it motivates them to learn more, to stay connected, and to raise more funds.

RAY SUAREZ: Girl Up encourages pen pals.

GIRL: You should never give up in what you believe in. I'm from Chicago. My name is Ashley.

WOMAN: She says you, all of you, are going to change the world.

RAY SUAREZ: The letters are read by Girl Up staff in Liberia, where 45 percent of girls have no formal education, a statistic the campaign is hoping to change.

Suburban Chicago residents and Girl Up member Isabella Solimene is one of the many volunteer advisers for the campaign.

ISABELLA SOLIMENE, Girl Up: I can be with other girls my age, and we can decide together how we can help. We can start a fund-raiser, do events to raise awareness.

RAY SUAREZ: And for Isabella, the movement is also very personal.

She's a typical 12-year-old American girl, a competitive soccer player, and a good student entering the seventh grade. Isabella is also from Vietnam, adopted at the age of 4. Her Vietnamese mother gave birth to twin girls, couldn't afford both and sent Isabella to an orphanage.

Isabella has never meant her identical twin sister, still living in Vietnam, named Ha.

ISABELLA SOLIMENE: I just wanted to help, not just her, but other adolescent girls around the world.

RAY SUAREZ: Although Isabella has learned something about her identical twin, she believes she and her sister are likely to have very different futures.

ISABELLA SOLIMENE: There's a huge difference between our lives. I go to school. I play with my friends. I hang out with my friends. She doesn't get to hang with her friends. She gets to do chores. And she's got to work 24/7. It's not what a normal teenager would do.

RAY SUAREZ: Isabella hopes to attend UCLA Medical School and play college soccer.

TAMARA KREININ: It's very similar girls. If they had the same opportunity, they'd probably have the same trajectory. They'd both be going to UCLA, both think about being doctors or having dreams. And then, sadly, the girl in Vietnam, you can't get there. And we'd like to get all the girls globally to the same spot, to real -- real success.

RAY SUAREZ: For the American girls, success for girls globally is a win for them, too.

That "viral" metaphor for social media just got a little more bona fide. According to a recent slate of independent studies, Twitter can accurately track the spread of a virus or disease -- and do it much faster than traditional surveillance methods.

From Iowa to Brazil, researchers are discovering there is a distinct association between complaints, worries and random rants on the social media site and the spread of medical issues as wide-ranging as the flu, dengue fever and pollen-induced allergies.

"By looking at the Twitter stream, we were able to track the public concern in real time about vaccination issues, travel issues and responses to public health," said Dr. Philip Polgreen, an associate professor at the University of Iowa Carver College of Medicine who used Twitter to track the progression of the H1N1 influenza outbreak in 2009.

"But that not only helps us track the progression of something like the flu, it can provide a way of determining the effectiveness of communication about public health and what messages should be reinforced."

Researchers from the University of Iowa discovered the association for influenza by following Twitter keywords commonly linked with H1N1, such as "swine flu" and "influenza." The team began collecting the messages in April 2009, shortly after the first wave of H1N1 struck the United States. Not only did they find that tweets from people experiencing flu-like symptoms tracked closely with the information collected by the Centers for Disease Control, they also discovered they were highly accurate in terms of both time and location. The CDC results were much slower -- arriving two to three weeks after the patients began feeling sick.

"From a clinical standpoint, data is one of the cornerstones of public health and it's important to have that data in a timely fashion," Polgreen said. "If we can get information faster, we can perhaps intervene sooner."

Previous studies have shown that search engines like Google and Yahoo can be effective at correlating outbreaks with key search phrases like "symptoms of the flu," but the Twitter method excites researchers more because it provides more context.

Twitter users often don't shy away from complaining about their exact ailments and when they developed. Their profiles often list their location, and increasingly, other users can pinpoint their whereabouts even more precisely thanks to GPS devices. That kind of rich data can help health professionals find the epicenter of the outbreak, understand how it's being passed from person to person and estimate how quickly it will spread to other parts of the country.

The researchers themselves underestimated the potential depth of the treasure trove the social network could provide when they began the study.

"It's easy to dismiss Twitter," said Alberto Segre, an author of the report and a computer scientist at the University of Iowa. "It's like, 'Who's going to tweet about the flu?' I personally don't see what's in it for the person who's tweeting. I was as surprised as the next guy that there actually was good information. It can be very noisy, but there's still a signal."

In a separate study, Mark Dredze and Michael J. Paul, computer scientists at the Center for Language and Speech Processing at Johns Hopkins University, came to a strikingly similar conclusion after analyzing 1.6 million tweets related to 15 different health conditions.

Using a new algorithm, they trained their computer to sift through more than 2 billion public tweets that were posted between May 2009 and October 2010. They separated ones complaining of legitimate ailments - such as "I just want to be able to drink water - #stupidstomach #flu" - from the ones proclaiming, "I've got Justin Bieber fever!"

Their study found that the national flu rate calculated through Twitter has a 96 percent correlation with the rate as reported by the CDC. The tweets also revealed allergy patterns, cancer rates, self-medication behavior and over-the-counter drug misuse.

But the data have their limits.

"It's not accurate enough to replace traditional methods," Paul said. "We won't be able to use this to determine the exact percentage of people who have the flu, but we can use it to see the flu rate is going up suddenly and we should investigate this. There's a lot of potential to learn so much about people that they don't necessarily share with their doctors."

And as Twitter spreads throughout the globe, that potential will likely grow. In fact, software created recently by a computer scientist at Brazil's Federal University of Minas Gerais has been used to identify a high correlation between official dengue fever statistics and the time and place Brazilians send a tweet saying they've contracted the virus.

Polgreen of the University of Iowa finds the Brazil report among the most interesting - perhaps because it could be a game-changer for worldwide disease control -- especially in developing countries.

"Social media is emerging as an important source of information in Middle East politics, in entertainment, in science," Polgreen said. "Why not for health?"

Chantal Anderson, PRI's The World

C-section rates are skyrocketing in some of the world's poorest countries for reasons that may have little to do with the health of the mother or the child.

Dhaka, BANGLADESH—It's one of the most common surgical operations in the United States and many say it's performed far too often: the Caesarean section.

Almost one-third of American babies are now delivered surgically, and the trend is not limited to the United States. The C-section rate in Thailand has reached 34 percent, in Vietnam, it is 36 percent, and in China, nearly half of all births are by C-section.

Listen to the full report below, and visit PRI's The World for more global news coverage:

In Bangladesh, many women who choose C-sections say they do so for convenience and to avoid the pain of childbirth. It is primarily the middle and upper classes that opt for C-sections, but the rate is also rising among the poor.

"That is a complete change," said Sister Gillian Rose, who runs Bollobhpur Hospital in West Bangladesh.

Rose sees the growing rate of C-sections as a troubling trend. She said one of the reasons more women are having Caesareans is that private doctors at private clinics are telling women they need the surgery when they do not.

"Private clinics are just springing up like the plague with no government regulation, and the doctors basically are getting rich quick," said Rose.

And while doctors may be profiting, some women may be suffering.

"In settings where surgery is not safe, what we have been seeing is increased risk of hysterectomy and other severe complications," said João Paulo Souza, an obstetrician for the World Health Organization who has studied the ballooning number of C-sections in developing countries.

Dr. Shams El Arifeen, a senior health researcher in Dhaka, said there is another downside to the booming rate of C-sections in poor countries like Bangladesh. These countries have a limited capacity to provide safe surgical births, so when women undergo unnecessary C-sections, "those who actually need [them] are… being pushed out of that system," he said.

El Arifeen said in Bangladesh the problem is not the overall rate of C-sections, which stands at 12 percent and falls within WHO recommendations. The problem, he said, is that many women who have C-sections do not need them, and many who do need them go without.

Chantal Anderson, a journalist with the Common Language Project, reported this story for PRI's The World.  Find more of her stories from Bangladesh at clpmag.org.

Most of the earth is covered by water, yet more than a third of the global population experiences periodic shortages of the kind used for drinking and agriculture. So why not convert seawater into tap water?

Desalinization of ocean water has been a dream and goal of scientists for decades, but the project takes on more urgency as the fast-growing world population's water needs outstrip supply. The technology is developing, but not without costs.

Menachem Elimelech, director of the environmental engineering program at Yale University, who co-authored a new Science Magazine review of desalination technology, spoke to the NewsHour about the progress and drawbacks of these tools. Read excerpts from our conversation below:

NewsHour: Where does the world's fresh water supply stand at this point?

Elimelech: We face a global water shortage. There is plenty of water, but unfortunately it is either in glaciers or seawater, so the fraction, the amount of [fresh] water available for people is relatively very low. About 10 or 15 years ago the supply of water was adequate to meet the world population's needs but the world's population has increased dramatically.

In some countries like in sub-Saharan Africa and other developing countries they hardly have any water. So for some places it's very acute and these are water-scarce countries. Many countries are what is called water-stressed; even in the U.S., Arizona and California are water-stressed states. So this is why people talk about water as the next oil.

NewsHour: How widely is desalination of seawater used currently?

Elimelech: Sea water desalination has been used for many, many years in the Gulf countries, Saudi Arabia, Bahrain, Kuwait. And they were using the older technology called thermal desalinization in which you boil the water, condense it and get [potable] water but it uses a lot, a lot of energy. You need to burn a lot of oil or electricity to do this. They have been using it for many years because they have no other source of water.

Recently, several countries went into ambitious plans to build desalination plants. Israel, they just are finishing the fifth desalination plant along the Mediterranean. Each desalination plant, which uses the new reverse osmosis technology, is huge. They will be producing in Israel 500 million cubic meters per year, and 1 cubic meter is 1,000 liters, so just imagine how much. For them, there was no choice because they were already reusing all the waste water and the only way to provide water for people in agriculture was through seawater desalinization.

Another example is Singapore. They are just finishing their second desalination plant. They are doing it because they are already recycling all their waste water and in Singapore the problem is not that there is not water, the problem is they are getting 50 percent of their water from Malaysia. The relationship between the countries was not the best, since the early '60s, so they wanted to be independent.

And the last country I mention is Spain. They have 1 billion cubic meters per yer, twice as much as Israel and mostly to meet the demand of agriculture, consumption, tourism and so on. So it's becoming now a solution for global water shortages for some countries.

NewsHour: Can you walk me through how the reverse osmosis desalination plants work?

Elimelech: I will take you through the tour if you were a water molecule, what steps you would go through until you are tap water.

First you start with an intake -- you suck the water from the ocean. And you need to be careful so you will not kill some fish and small organisms that get into the system, so there are some minor environmental impacts. Then you go into what we call pre-treatment. We want to get only the freshwater and separate it from the salt, but seawater also has some suspended matter like suspended particles, organic matter, algae. We call it pretreatment: you add some chemicals, you filter out all this stuff, and then you have mostly water and salt.

Then you get to the heart of the process. Most of the plants, except the ones in the Gulf countries, use reverse osmosis desalination. You have a membrane and the membrane is a very thin plastic film with some some very, very molecular, small holes. Then you apply very, very high pressure.

This is a special membrane that will let only the water molecules go through and will retain all the salt. But some salt will go through; you can remove 99.5 percent, so very little will stay in the water.

The last step before distributing the water you do what we call post treatment where you add some minerals because you removed all the minerals from the water.

Then you get fresh water to drink.

NewsHour: What are the environmental drawbacks of the process?

Elimelech: Desalination uses about three times more energy, electricity, than conventional ways to treat water. For example, if you take water from a lake or a river and treat it, it would be one third of the electricity cost that you need for seawater desalination. So it uses a lot of energy.

The best desalination plants now consume about 3 to 4 what we call kilowatt-hours per cubic meter of fresh water (1,000 liters). So if you have 30 light bulbs, and each consumes 100 watts and you let them run for one hour, this is the total electricity equivalent used to get 1,000 liters of freshwater.

The other concern is when you desalinate seawater -- the technology nowadays -- you get half of it as freshwater and the other half would be much more concentrated. Also we use a lot of chemicals to clean the membranes to pre-treat, and you add them all to this stream of this concentrated salt water, and then you dump it back into the ocean.

So if you dump into the ocean a very concentrated solution with salt and some chemicals, if you don't spread it wisely in the seawater....there are many techniques: you can put it through a pipe that goes farther from the coast, you can put it in an area where there is a lot of natural mixing, you can spray the water to mix it well. But if it's not mixed well it can impact some marine organisms and unfortunately its not well-studied. There is no long-term study, but we worry that it might have an impact on the marine environment.

NewsHour: Given both the environmental costs and the fact that some countries are already water stressed, what are your conclusions about the future of this technology?

Elimelech: Desalination of seawater, because it is energy intensive should always be as a last resort. You need to try all options, water conservation, reuse of waste water, which is cheaper than desalination Transfer of water from one region to another region, as long as there is no ecological impact of transferring the water it is also a solution.

So you need to try all of these. But if you try all of these and still you don't have enough water, we think desalination could be a really critical component of what is called the water portfolio. Some of the advantages of desalination -- you get very high quality water and you take it from a source that is practically infinite. It can be and should be part of the portfolio for water supply but only after all other measures are done.

Watch This Segment

In India, parental surrogacy is often less complicated and costly than having a surrogate in the United States. Special correspondent Fred de Sam Lazaro explores the ethics of outsourcing surrogacy in the second of two reports about Indian women who are paid to bear children for infertile Western couples.

JEFFREY BROWN: And finally tonight: the second of two reports on Indian surrogate mothers who are paid to bear children for infertile Western couples. The money lifts the women out of poverty, but the transactions also raise many ethical issues.

Special correspondent Fred de Sam Lazaro traveled to western India to explore those issues. The surrogate in this story asked that we not reveal her name.

FRED DE SAM LAZARO: Minutes after delivering a slightly premature infant by C-section, Dr. Nayna Patel, was back in the office and on the phone to the parents.

DR. NAYNA PATEL, Akanksha Infertility Clinic: Congratulations. It's a baby girl. Where are you, in Mumbai, right now?

FRED DE SAM LAZARO: They were en route from their home in England and didn't reach the small town of Anand, India, in time to watch a surrogate mother give birth to their child.

DR. NAYNA PATEL: Surrogate is also fine. Yes, the baby is also fine. And we have taken the pictures.

FRED DE SAM LAZARO: Dr. Patel has delivered some 400 surrogate babies since 2004. Her clinic implants embryos in surrogates she recruits from the area and pays around $7,000 for a pregnancy carried to term. Biological parents come from across India and around the world.

Kirshner Ross-Vaden came here from Colorado to pick up her baby girl named Serenity. She was born four weeks premature, but after a week in neonatal intensive care, she was ready to be discharged.

MAN: And here's all reports.

KIRSHNER ROSS-VADEN, Mother: OK. Good.

FRED DE SAM LAZARO: Serenity's 46-year-old mother traveled here with her 9-year-old son. She had tried unsuccessfully in recent years to conceive. Surrogacy was her last hope and India her first choice.

The cost, $10,000 to $15,000 all told, is a fraction of what it is in the U.S. And, in America, she added, surrogacy contracts are not always airtight

KIRSHNER ROSS-VADEN: You can sign 100 documents. It doesn't matter. If that surrogate changes her mind, she can sue you for that child. And, oftentimes, she will win. And coming here to India, these women, they don't want my child. It's very cut and dry. They do not want my child. They want my money. And that is just fine with me.

FRED DE SAM LAZARO: It's not fine with everyone.

DR. ARTHUR CAPLAN, Director, University of Pennsylvania Center for Bioethics: And the contracts are usually written, to be blunt, to protect the wealthy people who are commissioning the baby, so that if the woman suffers an injury, if the woman has a health problem due to childbirth, if there's a long-term chronic condition, then what?

FRED DE SAM LAZARO: University of Pennsylvania ethicist Arthur Caplan worries the relationship is inherently lopsided between poor, minimally literate women and well-heeled couples who commission them to have their children.

For example, surrogates in India are routinely implanted with up to five embryos to improve the chances of a pregnancy. In the U.S., clinics usually implant no more than two, sometimes three.

DR. ARTHUR CAPLAN: Why would you use three, four, five embryos in India? Because you don't want the couple to have to come back. It's expensive, even for a rich person. So you're trying to maximize the chance of pregnancy, even if it might compromise the interests of the babies.

FRED DE SAM LAZARO: Dr. Patel concedes that implanting five embryos heightens the risk for infants and mother and says she is now lowering that number to three or four. But she says the downside of fewer embryos is a lower pregnancy success rate.

When multiple embryos develop into viable pregnancies, Dr. Patel's policy is to reduce them by selective abortion. Aside from possible religious concerns, this process could present medical risk to the surviving fetuses.

DR. NAYNA PATEL: Parents, yes, there are some who say right from the beginning that, Doctor, put less embryos because we are not for reduction and we don't want this to happen.

So, in those cases, we definitely never transfer more than two. But there are certain parents who don't have any objection to this. And surrogates, we don't allow them to carry more than two.

FRED DE SAM LAZARO: Dr. Patel insists that her facility protects the interests of surrogates as much as the clients of her commercial surrogacy program and the infants she delivers.

DR. NAYNA PATEL: We do a lot of psychological counseling to the surrogate and the family before we recruit them. We explain to them the procedure of IVF, what all they will have to undergo.

If she has had any complications during her previous pregnancy, we will ask her not to become a surrogate, because the same can repeat this time, to make it very sure and safe for her.

FRED DE SAM LAZARO: The moment their pregnancies are confirmed, surrogates are required to move into this home run by Dr. Patel. They're offered skills training in things like tailoring, but mostly it's a quiet, sedentary life.

The women who spend nine months in this surrogate hostel have all experienced childbirth with their own biological children. It's a prerequisite for becoming a surrogate. What very few of them have experienced with those previous pregnancies is any kind of prenatal care. And that's in sharp contrast to the pampering they get here, with meals provided and medical attention, should they need it, round the clock.

Dr. Patel acknowledges the irony, but says its part of a thorough surveillance to ensure smooth pregnancies for both surrogate and parents' sakes.

DR. NAYNA PATEL: We have a fetal medicine specialist who checks all the surrogates every three weeks. We have been able to detect minor congenital malformations, which we inform the couple that this can be treated post-delivery without any impact on the baby.

We have had patients whose surrogate had babies with Down syndrome, which was detected, which was confirmed with amniocentesis, and we aborted those babies after the consent of the couple.

FRED DE SAM LAZARO: Well in advance, she says parents are consulted on decisions like pregnancy termination. Similarly, parents must accept their babies, once born, whether healthy or not.

Surrogates we spoke to talked about building a new home and using their money for their children's education. The money, $7,000 to $8,000, would otherwise take them decades to earn. Most say they were happy to have helped infertile couples.

The woman who bore baby Serenity, whom we met earlier, admitted to some sorrow at her separation.

SURROGATE MOTHER (through translator): You can't help it when you have carried a baby for nine months. I would like to see how she does in the future.

KIRSHNER ROSS-VADEN: I do have her address, so I can get a hold of her. And I hopefully will be able to maintain some kind of a relationship with her.

FRED DE SAM LAZARO: We caught up with Serenity's mother in Mumbai, an hour's flight from Dr. Patel's clinic. She and son Brandon were holed up in a hotel, awaiting DNA test results and myriad documents to satisfy the Indian and U.S. governments that the infant could leave the country.

KIRSHNER ROSS-VADEN: Am I living happily ever after now? I certainly hope so. I hope that I can get her home, and I hope that she is a happy, healthy little baby, and that -- that is what I will have, that she will remain such and grow up as such, a happy, healthy little girl.

FRED DE SAM LAZARO: But will every surrogacy story end happily? Right now, India has only voluntary guidelines, and it's not clear whether future laws will be adequately enforced. And standards vary widely.

For example, Dr. Patel says she only serves infertile patients. But some clinics offer surrogates to healthy parents who, for career or convenience, want to avoid pregnancy.

Ethicist Caplan worries about where all of this is leading.

DR. ARTHUR CAPLAN: We may get into situations where people start to say, as genetic knowledge improves, you know, I'm not infertile, but I would like to make a baby with traits and properties that I want to avoid or that I desire.

And that day is coming. And I think it's important to keep in mind, as we watch the evolution of surrogacy as an international activity, what is really something that a tiny handful of people use who suffer from infertility tomorrow can be what more people are interested in because they have a more eugenic or perfectionist interest in making their children.

FRED DE SAM LAZARO: For her part, Dr. Patel plans a major expansion of her one-stop surrogacy shop, a leader in what's now a half-billion-dollar industry in India. She makes no apologies for making a lucrative living and insists that, for her, for surrogates, for new parents, it's win-win-win.

JEFFREY BROWN: A version of Fred's story can be seen on the PBS program "Religion & Ethics Newsweekly." And his reporting is a partnership with the Under-Told Stories Project at Saint Mary's University in Minnesota.

Watch This Segment

In "Made in India," filmmakers Rebecca Haimowitz and Vaishali Sinha follow the journey of an infertile Texas couple and the Indian surrogate who gives birth to their children. This excerpt is part of The Economist Film Project series of independently produced films aired in partnership between The Economist and the NewsHour.

JUDY WOODRUFF: And to another in our film project collaboration with The Economist magazine to take us places we don't ordinarily go.

Tonight, the filmmakers Rebecca Haimowitz and Vaishali Sinha come from the United States and India. Together, they weave a very human story that crosses international boundaries. It's about an American couple, Lisa and Brian Switzer, who travel halfway around the world to fulfill their dream of having a baby.

A reproductive outsourcing company matches them with an Indian surrogate mother named Aasia. Her last name isn't given to protect her - her identity.

Here is an excerpt now from "Made in India."

LISA SWITZER, San Antonio, Texas: You know, a woman a lot of times defines herself by her ability to have children. I just can't imagine being without kids. I wanted to be a mother since I was about 25 years old, and here I am turning 40. I have been trying for seven years to get pregnant. And it hasn't been an easy task by anybody's stretch of the imagination.

We don't really have the luxury of waiting or the luxury of seeing if there's other alternatives. This is something that's -- this is our one and final shot.

When I went to the gynecological oncologist, he did a biopsy on my uterus. I was really shocked. They were just, like, we want to do a hysterectomy, you know? We -- right now, you're pre-cancerous. And my doctor was just, like, I know you want this, and I will leave your ovaries there, but your uterus has got to come out.

That was just -- that was...

BRIAN SWITZER, San Antonio, Texas: That was a hard day that day...

LISA SWITZER: That was...

BRIAN SWITZER: ... when I told her they wanted to take the uterus out, because that was -- that was them saying, you will never carry a child. So that's when we starting looking at surrogacies.

LISA SWITZER: I don't have a surrogate. I don't -- you know, I can't afford a surrogate. They want $25,000 to $35,000 just for the mother. My best friend, Jennifer, sent me an article about couples going to India to do IVF and surrogacy.

I found PlanetHospital.

RUDY RUPAK, PlanetHospital: I'm the co-founder of PlanetHospital. And what we do is, we help people get affordable health care from around the world, including surrogacies.

Yes, yes, sure. OK. Bye. Bye.

It was going to happen anyways with or without us. I just want to put the same quality of protection and comfort and safety in surrogacy as I have been doing on everything else that we do medically.

Yes. Hi. It's Rudy. Hello. It's Rudy.

We have all the answers, I mean, the whole process, from, you know, which surrogate clinician they go to, all the way to, you know, what's our legal problems and how do I bring my babies back? If the surrogate changes their mind and wants to keep the baby, what's the legal recourse? Is this considered baby-buying, or is it legitimately surrogacy?

LISA SWITZER: Five hundred dollar advertising for the surrogate. The preparation of the surrogate and embryo transfer stage is $2,500, because they have to do all her drugs to get her caught up with me and ready to receive a baby. And then the IVF is $500. The surrogate actually gets $7,000 for her carrying our baby.

This woman is carrying a life that I can't carry. She's giving me the family I can't create. You know, I will never, never be able to thank her enough.

AASIA, surrogate mother (through translator): What should I say about myself? I used to clean people's homes before. I'm not educated. I don't know how to read or write. So this is my life. I have had three children. All my children were born normally. I have never done anything of this sort.

My sister-in-law, Sanno, had told me about it, but I didn't believe her, that this can happen with medication. Now, how should I say it? A child without a man.

(LAUGHTER)

AASIA: How could a child be conceived without a man? When there's a relationship, only then can...

(LAUGHTER)

AASIA (through translator): That day was kind of good. Suddenly, I found out that I was pregnant. I was happy.

LISA SWITZER: No freaking way.

BRIAN SWITZER: What?

LISA SWITZER: Congratulations?

Yes!

(LAUGHTER)

LISA SWITZER: We got a baby. We got a baby.

BRIAN SWITZER: We did it.

LISA SWITZER: We got a baby. We got a baby.

(LAUGHTER)

BRIAN SWITZER: I told you.

MAN: With low cost and high quality, medical tourism is a trend that's likely to grow.

MAN: The lay press has been interviewing couples who got babies from here, and putting out photographs of these couples with babies in American newspapers and magazines. So this has sort of really given the whole thing a big boost.

We have new companies. Like, you know, every month, we have a new inquiry, a new medical tourism company. Suddenly, we are seeing a whole lot of patient reference from North America coming down to India.

N.B. SAROJINI, Sama Resource Group for Women and Health: There are many, many surrogate women. We don't know what is happening to them, and the particular diet and the particular regime, when to go, what to do, you know?

Suppose if she has a miscarriage. What will happen? And we have a lot of questions. The focus for Sama is the larger framework. You know, what is the role by the commissioning parents or the intended couple, whatever we call them? What is the role of the state? Our demand was, they should understand the fact that the surrogate mother has a bodily integrity and an autonomy.

BRIAN SWITZER: I started showing my co-workers the "Today Show" website. They got this section here called discuss. What do you think? And I thought, oh, well, let's see what everybody else thinks. And the first two started out very nice. You know, what's the legal status, you know, is there any immigration issues, things of that nature. And then it got ugly.

People started saying things like the use of surrogates is a disgusting and immoral practice to begin with, but then to farm it out like cheap labor to women in India, we should be disgusted and ashamed.

And then you get the, oh, hey, it's all about saving money, you know? What about adopting? There were more people telling us, you should have adopted. You should have adopted. Well, that's placing the entire orphan issue on the shoulders of infertile couples.

By their argument, anybody who has ever proactively tried to get pregnant together and succeeded and had their own children has robbed an orphan of a loving home, plain and simple. So don't place that burden on the infertile couples out there. And what kills me is everybody screaming about the surrogacy issue. Oh, it's a baby mill, you know, it's a puppy farm.

And it's not. I felt I had to defend Lisa and I, as well as every other non-Indian that's going to India to have this done.

So here's what I wrote to all these people that were just spewing this hateful talk: "The surrogates are well-compensated in line with their local economy. I have seen poverty unlike anything I could have imagined. And knowing what this process is going to do for the surrogate and her family in the long run makes me realize that this is a very good thing for all parties involved."

AASIA (through translator): The contract had details about payment and the child would go to them, that you should have no right to it, and that later you shouldn't change your mind, like some women do, because their hearts melt as they think, no, I will not give the child. That shouldn't happen.

So, I said, no, that won't happen. They just said that this is how much the payment will be. They told me $2,000. I'm doing this for my children. A son can earn anywhere, but I want to save this for my daughter.

JUDY WOODRUFF: Aasia gave birth to twin girls. And after navigating some legal hurdles, Brian and Lisa brought them home to Texas.

"Made in India" is being screened at film festivals here in the U.S. and abroad. You may find a link on our website for a list of dates and cities.

Tomorrow, special correspondent Fred de Sam Lazaro explores the ethical questions surrounding international surrogacy.

Thursday on the NewsHour, you'll see an excerpt of the film "Made in India," which documents the journey of an infertile American couple and their Indian surrogate. It's part of our collaboration with The Economist Film Project.

Then on Friday's NewsHour, Fred de Sam Lazaro looks at some of the ethical questions surrounding this thriving industry. Read his reflections below:

India's medical tourism industry has long pitched "first world-quality medical care at third world prices." In the booming business of assisted reproduction and surrogacy -- reported to rake in nearly half a billion dollars annually -- the industry goes one compelling step further: legal peace of mind.

An Indian surrogate mother cannot challenge the commissioning parents for custody of the child. Economic realities also make it less likely she'll want another mouth to feed. That's in sharp contrast to the United States, where disputes surrounding parental rights have led a dozen states to restrict or ban surrogacy. In Britain, a surrogate mother can, by law, assert full parental rights, should she choose and surrogacy is banned altogether in several European nations.

In India, surrogacy is much less complicated and costly than adopting a healthy infant and contracts typically require a surrogate to sign away any rights to the child she will bear. She will receive a lump sum at the end of the pregnancy that can range from U.S. $2,500 to $10,000, depending on the clinic, and all related medical expenses. That kind of money is many times the annual household salary of the typical surrogate and in theory can lift her family out of poverty. Women we spoke with at the surrogacy clinic in the small town of Anand said they would use their windfall to educate their children and to build new homes.

Whether most surrogates do call the shots on such decisions in a tradition-bound society is an open question. Stories abound of young women being coerced into surrogacy by their families. Indeed much of our information about this emerging industry in India is based on anecdotes and worries University of Pennsylvania medical ethicist Arthur Caplan on many levels.

He feels the relationship is inherently lopsided between women of marginal education and impoverished backgrounds and the well-heeled patients looking to rent their wombs. Surrogates also have little recourse should they ever develop long-term health consequences from their pregnancies.

"The contracts usually are more on the order of 'you're going to turn over the baby, you're going to get the money, and goodbye,'" Caplan said.

The arrangements also raise complex questions, he said, like will commissioning parents be required to accept a child that is born deformed? What if the parents divorce before their baby is born?

The 2008 case of a baby girl named Manji is a sobering example of unforeseen complications. The infant was "commissioned" by a Japanese couple. Unable to produce viable eggs of their own, the couple used a donor egg from an Indian woman and the intended father's sperm. The commissioning parents then divorced during the surrogate pregnancy.

Manji's intended mother dissociated herself from the entire transaction. The intended, and biological, father got a rude shock when he tried to get the child a passport to take her home: Japanese law did not recognize the baby girl as a citizen since her mother was not Japanese. They suggested that the father legally adopt the child. This required a birth certificate, which Indian authorities said they could not issue because the document requires a mother's name. Even though three women were involved in her creation, Manji legally had no mother; the egg donor, surrogate and intended mother all renounced or never had that right. It took months of legal and legislative wrangling to sort out the case.

Dr. Nayna Patel, who founded Anand clinic says she anticipated or learned from such problems and insists the contracts she draws up are equitable. But Dr. Patel concedes that surrogacy is largely unregulated and even though laws are in the offing, there's no telling how strictly they could be enforced.

Until medicine perfects a uterus transplant, Dr. Patel says the business of surrogacy is certain to be in strong demand and a legal and ethical work in progress.

Caplan anticipates more questions will emerge in future, and one popped into my own head, for which I've yet to receive a clear answer. Perhaps it's out there in the NewsHour audience: Is a child born to American parents but also to a surrogate in India eligible to be president of the United States?

A tropical storm bearing down on Haiti threatens to make daily life more miserable for tens of thousands homeless still living in tent camps and could deepen the cholera epidemic that has already killed more than 5,800.

Tropical Storm Emily was on a path toward the Dominican Republic and Haiti Wednesday, and forecasts predicted heavy rains and possible flooding -- perfect conditions for the spread of water-borne diseases like cholera.

"[The weather service] is talking about possibly 10 inches in Haiti. That's a huge amount of water," said Julie Sell, spokesperson for the Haiti mission at the American Red Cross. "In a country where people are frequently using the same water sources to bathe, [such as] as a toilet, and to drink, the last thing you want is standing water."

About 389,000 Haitians have been sickened since the outbreak began in October 2010, according to the Pan American Health Organization. Just as health workers thought new cases were stabilizing this spring, heavy rains in June caused a second spike.

The number of cases in some regions doubled, and the need for hospitalized care increased 79 percent in and around Port-au-Prince.

A tropical storm is dangerous for many reasons in Haiti, where tens of thousands of people are still living in tent camps more than a year and a half after a massive earthquake on January 12, 2010. The rainy conditions make containing sewage to specific areas very difficult, and cholera bacteria thrive in poor sanitation conditions.

As part of an ongoing disaster preparedness program implemented after the earthquake, the Red Cross has been hiring local teams to dig drainage ditches and sandbag hillsides near camps and affected communities. These efforts are meant to help prevent flooding and mudslides during the annual rainy season, but they now will serve the dual purpose of moving water and preventing disease.

Sell said the organization is prepared to treat more cholera cases as well, including supplies of re-hydration salts that can save the lives of severely dehydrated patients. While groups like the Red Cross and Partners in Health have had to scale up their cholera response, others have had to leave Haiti entirely.

"There are some aid organizations that have had to pull out of Haiti or dramatically reduce their activities due to lack of funding. That's been a concern for the Haitians," Sell said.

Paul Farmer, co-founder of Partners in Health, talked to Ray Suarez about the problem last week on the NewsHour.

"We feared back in January right after the quake, that there would be some groups that would come in and out, and part of what has been called the crisis caravan, that all came to pass," he said. "They have come in. They're gone."

The epidemic has also spread beyond Haiti's borders to the Dominican Republic, where it has sickened 13,200 and killed 87. This week, the Centers for Disease Control also released a report linking 23 cases of cholera in the United States to the strain from Haiti.

All of the patients in the United States had recently traveled to Hispaniola, except for one who had eaten conch brought home by family visiting Haiti, and were successfully treated with antimicrobials and re-hydration.

"The risk for cholera transmission in the United States is low because of improved water and sanitation, and there is no evidence of secondary transmission," the authors wrote.

But, the authors warned, "until cholera in Haiti and Dominican Republic resolves," health workers in the United States need to be prepared to handle more cases.

Editor's note: An earlier version of this post incorrectly reported the date of the January 12, 2010 quake.

Watch This Segment

In a new effort to alleviate the suffering in famine-stricken Eastern Africa, the U.S. government eased its restrictions on providing aid to Somalia -- aimed at sanctioning al-Shabab -- in hopes of getting more food to starving people. Margret Warner discusses the change in policy with USAID Administrator Rajiv Shah.

JEFFREY BROWN: And finally tonight, a new step to help ease the suffering in Somalia.

Margaret Warner has our update.

MARGARET WARNER: For weeks, the world has seen heart-wrenching pictures of starving children and adults seeking refuge from drought and hunger in the Horn of Africa.

As many as 12 million people in five countries are at risk. But the hardest-hit and most vulnerable are in southern Somalia. There, civil conflict has combined with the regional drought to produce famine. Tens of thousands of Somalis have died and more than half-a-million children are on the brink of starvation.

Yet, Western aid isn't flowing to where the worst of the famine is. That's because much of southern Somalia is controlled by the Islamic insurgent group al-Shabab. Shabab has threatened and killed international aid workers there.

What's more, U.S. antiterrorism restrictions make it a crime for any American charity to provide support directly or indirectly to al-Shabab. Today, at the urging of major aid groups, the U.S. government eased that threat.

USAID Administrator Rajiv Shah is here to explain. He's just back from the region.

And, Administrator Shah, thank you for joining us.

DR. RAJIV SHAH, United States Agency for International Development: Thank you.

MARGARET WARNER: You are just back from visiting Somali refugees at camps in Kenya who fled from these al-Shabab-controlled regions. How bad was the situation?

DR. RAJIV SHAH: Well, it's tragic. And it's worse than I think most people believe.

I met a young woman named Habiba who had walked for 33 days with her two children and what little belongings she had, showed up at the Dadaab refugee camp, like tens of thousands of her country mates, needing food, needing medicine, her children needing health interventions just to survive.

And it is a sign of what has happened. We have known for more than 10 months, thanks to a famine early-warning system that we helped set up, that this region is going through the worst drought in more than 60 years. And it is leading to a real famine, where children, in particular, are vulnerable and are dying every day from preventable causes, because they are acutely malnourished.

MARGARET WARNER: Now, what difference -- what will be the practical effect of what you announced today? In other words, what will aid groups who want to operate in southern Somalia be able to do that they can't do now legally?

DR. RAJIV SHAH: Well, you know, the United States has been on the forefront of the response to the drought and famine throughout the Horn of Africa for the past 10 months.

But even on the emergency front, and especially in south and central Somalia, the real issue is humanitarian access. And, right now, and as has been the case for years, the al-Shabab and other authorities have limited access by humanitarian groups. And, in fact, partners like the World Food Program had to leave Somalia in January of 2010 after suffering 14 casualties.

So, we hope that -- and we are working hard to make sure that authorities in Somalia allow access for humanitarian organizations and NGOs. And the United States has been supporting those organizations and will continue to support those organizations going forward.

MARGARET WARNER: But what the aid groups were saying, the NGOs, was, also, we feel we're in legal jeopardy. And that was the basis, I thought, of today's announcement.

What -- can you be more specific about what -- give us an example of something an aid group could now do, if they were operating in good faith, that they couldn't do five days ago?  

DR. RAJIV SHAH: Sure.

Well -- well, you know, now -- now humanitarian groups and NGOs can operate without the concern of legal risk, should their convoys of food be appropriated by local authorities or should they be taxed or in a position where they are forced to provide some material support to those authorities.

But the -- I would just point out that the real issue is not the legal restriction and has not been any set of legal restrictions placed by our government or any other government. The real issue for the past year has been humanitarian access. And we see, regularly, food convoys getting attacked, humanitarian workers being threatened and asked to leave.

And, as a result, despite the fact that the drought affects 12.5 million people in five countries, the famine actually affects only al-Shabab control areas in south and central Somalia, about 2.8 million people.

MARGARET WARNER: So, what evidence is there that, in fact, at least maybe some local Shabab commanders are willing to let Western aid groups in? Because, as you said, they -- they actually kicked out Western aid groups a year ago. Then they have sent mixed signals since then about whether they are welcome back.

DR. RAJIV SHAH: Well, we have actually seen some positive signals from a range of partners in and a range of authorities in Somalia that indicate that there is going to be some improvement in the access for humanitarian organizations.

It's based on those signals that we have worked with the United Nations and with a broad range of NGOs and organizations, including European partners, partners from the Gulf states, and local community-based organizations that do have some ability to operate, and we're seeking to work with them.

We know how to save lives right now, and we have been well-positioned for more than 10 months in most of the Horn of Africa, and we're counting on improved humanitarian access to help save lives in south and central Somalia, and working in a very focused way to make that happen.

MARGARET WARNER: And if that humanitarian access doesn't get better, what -- how great are the chances that the officially designated U.N. famine zones are going to actually expand?

DR. RAJIV SHAH: well, the consequences of this drought and famine will get worse before they get better.

And President Obama launched, when he first took office, a major effort to bring the world together to address food insecurity and precisely these types of problems through a program we call Feed the Future, because we know that, by investing in agricultural development, by investing in creating safety nets for vulnerable communities, by supporting countries to create the protections from these kinds of problems, we can avoid these types of famines.

It doesn't have to be this way. And it is cheaper and safer for America to make those investments now than to deal with the consequences, the tragic consequences, of famines, of failed states and of food riots, when we see what's happening now transpire throughout parts of Africa.

MARGARET WARNER: Rajiv Shah, administrator of USAID, thank you so much.

DR. RAJIV SHAH: Thank you.

Every two minutes, somewhere around the world a woman dies in childbirth. Often, a lack of access to care, technology or medications causes these fatal complications.

In an effort to reduce deaths of both mothers and infants at birth, teams from across the globe are competing in an innovation challenge held by the U.S. State Department and funded in part by the Bill and Melinda Gates Foundation.*

The field was narrowed from 77 finalists to 19 award nominees Friday at the Saving Lives at Birth conference. The remaining nominees will learn if they receive a cut of the $14 million research pot up for grabs by the end of 2011.

Check out five of the nominated innovations below and see a complete list here.

Preventing low birth weight with chewing gumBaylor College of Medicine in Houston, Texas

Did you know that gum disease in pregnant women is linked to preterm birth and low birth weight infants? Neither did we, but the team at Baylor College of Medicine has a possible solution straight off the grocery store shelves. Some chewing gums contain sugar alcohols, called polyols, that prevent gum disease, but to date they have not been utilized for this particular purpose.

The team hopes to roll out chewing gum or gummy snacks containing polyols to try to reduce early births in Malawi, and will evaluate the logistics of acceptability of this concept in the community.

Stopping HIV transmission with a vacuum packDuke University from Durham, N.C.

Antiretroviral drugs have helped cut HIV transmission from mother to child in developing countries and nearly eliminate it in the United States. In sub-Saharan Africa, some women have to travel great distances to obtain medical care and often give birth at home. Duke University developed a foil, polyethylene pouch -- much like a fast-food ketchup pouch -- that can store medicine for months so that ARVs can be administered as soon as a child is born, even if a health practitioner is not present. The pouch preserves the medication better than syringes or bottles.

Mobile heart monitoring and data gatheringSave the Children Federation from Westport, Conn.

A baby's heart rate is the most important sign of distress during labor, but in many poor-resource settings, these warnings go unheard because of a lack of heart rate monitoring technology. Save the Children will test a combination of technologies in Uganda to cut these complications.

A mobile fetal heart rate monitor powered by human energy, which won a 2009 Index award, and a mobile phone based data gathering platform will be tested together to improve monitoring.

An innovative alternative to forcepsThe World Health Organization in Geneva, Switzerland

Forceps and vacuum extractors are used during delivery when labor is not progressing normally and there are signs the baby is in distress. The WHO proposed testing the experimental Odon Device in South Africa and Argentina. The devices is a film-like polyethylene material that looks like an open plastic bag wrapped around the head of the baby, sealed and used to help extraction during complications.

WHO says Odon could be safer and easier than forceps, and would require less training. It could even be a possible alternative to caesarean sections in settings without trained surgeons.

Diagnosing with paper stampsDiagnostics for All, Inc. from Cambridge, Mass.

In the rural communities of low-income countries, cheap and portable diagnostic equipment is desperately needed for many health problems. Diagnostics for All will create two postage stamp-sized paper tools that can detect anemia and hypoglycemia and hypertensive disorders, all indicators of high-risk pregnancy.

The stamps would provide quick diagnosis, on location, allowing recommendations to be put in place immediately as opposed to requiring a follow up for results.

*For the record, The Bill & Melinda Gates Foundation is a NewsHour underwriter.

Watch This Segment

There is growing desperation in the Horn of Africa amid drought and famine. International Television News' Martin Geissler reports from the Dadaab camp, located just over the Kenyan border.

JUDY WOODRUFF: And to the growing desperation in the Horn of Africa.

More than 11 million people are at risk from hunger in Somalia, Kenya, Ethiopia and Djibouti. Somalia is the worst-hit by famine, drought and a civil war with Islamic militants. Nearly half-a-million refugees have left Somalia to go to Kenya. Most are headed to the Dadaab camp just inside the border.

We begin with a report from Martin Geissler of Independent Television News. He's spent a week reporting from the camp.

And a warning: Some of the images are distressing.

MARTIN GEISSLER: The patients just keep on arriving. There is no weekend for the staff at Hagadera's children's unit. Time here is measured in bed space.

Today, as ever, the ward is packed, but the doctors are happy. Two of the babies causing most concern are improving. When Manaj was admitted on Monday, he was close to death. At seven months old, he weighed just 6.5 pounds. Five days on, he's improving, still weak and still frail, but still alive.

MAN: Surviving nearly a week. We have also given him the best of care so far.

MARTIN GEISSLER: He's had quite a week, hasn't he?

MAN: Yes, quite a week. Yes, that's great.

MARTIN GEISSLER: At the start of the week, 3-year-old Aden was struggling, too. He wasn't responding to treatment. Doctors feared the worst. Now he's eating solid food, a huge step in the right direction.

ABDILE BRAHAM YERE, father (through translator): It's been a dreadful time. I didn't know if my child would live or die. His mother's dead, but I will do my best to look after him. I'm not going home, though. I would rather die in Kenya than try to live in Somalia again.

MARTIN GEISSLER: Abdi Rachman, though, is not doing so well. Admitted yesterday with severe malnutrition, he developed hypothermia over night.

The camp that feeds the hospital is already overcrowded, and almost 1,500 more Somali refugees arrive here every day. The staff at the clinic are bracing themselves.

DR. MILHIA KADER, Hagadera Hospital: When you look at the weather, it's about to rain. That comes with other dangers: communicable diseases like cholera. Right now, we're in the midst of a measles outbreak. So with more people coming into a camp that's already bursting at its seams, all this, I mean, it's a very precarious situation for us here in Hagadera.

MARTIN GEISSLER: This is the equipment doctors used to bring little Manaj here back from the brink. According to hospital supply lists, it costs under a pound.

Now, clearly there's more to fighting off a disaster than just a syringe and a drip. There's staff, transport, food, shelter to pay for on a massive scale for a long time. But it's proof, if proof were needed, that every little helps.

They're setting up a tent this evening to cope with the overspill of children. It's far from ideal, but needs must -- the pressures here grow hand in hand with this crisis. And, sadly, there's no letup in sight.

[View the story "Weekly Twitter Round Up" on Storify]

This week marks one year since historic flooding submerged a fifth of Pakistan and displaced more than 4 million people. In one of Asia's poorest nations, many of those affected are still without homes or means of income.

United Nations agencies say millions need vital aid to rebuild their livelihoods, and 800,000 are still without proper houses, according to a new report by Oxfam International. The emergency tent camps that sprung up outside the flood zones still house 37,000 people, and the displaced are becoming frustrated with the pace of recovery.

When the U.N. called for $2 billion in flood aid last year, it was the largest U.N. natural disaster appeal ever, but so far only $1.3 billion has been collected. Aid agencies say the shortfall threatens the ongoing recovery efforts.

The United States has been one of the largest contributors, providing $924 million for relief, including transitional shelters, agricultural assistance and disease surveillance, with about $764 million funneled through USAID, a spokesperson said.

But U.S. aid to Pakistan has been under a microscope in Congress and elsewhere since Osama Bin Laden was killed while living in Pakistan in May, raising questions about the government's knowledge of his presence and commitment to fighting terrorism.

A bill approved Wednesday by a House Appropriations subcommittee proposes new restrictions on several countries, including Pakistan, requiring the State Department to first verify cooperation in combating terrorism before aid can be committed.

Secretary of State Hillary Rodham Clinton wrote a letter to the House Foreign Affairs committee earlier this week, saying she would urge a veto if the measure made it to the president because it "would be debilitating to my efforts to carry out a considered foreign policy and diplomacy, and to use foreign assistance strategically to that end."

It's unlikely the bill would make it that far through the Senate, which has a Democratic majority, but a USAID spokesperson said in a statement the agency would "respect Congress's role in making appropriations on foreign assistance and their role as stewards of American tax dollars."

The spokesperson said the agency has not changed its approach to aid in Pakistan since bin Laden's death. One program in particular that came under fire -- a $190 million contribution to a Pakistani government program for cash assistance to flood-affected families.

As questions continue to swirl about the future of U.S. aid in Pakistan, the timing of assistance from the international community and the gap in U.N. funding is critical, said Javeria Afzal, Oxfam's coordinator for disaster risk reduction. She spoke to the NewsHour from Pakistan, where it is the rainy season once again.

"Unless this money comes it will be very very hard to meet the needs of these families," said Afzal. "There is a monsoon right now in the country...it's very important that the country invest in disaster reduction as a priority so people are safe from reoccurring disaster over and over."

Pakistan did have an emergency response plan in place last year, and is credited with keeping the death toll lower than it could have been at 2,000, but the flooding also revealed the country's weak points in responding to a chronic flood threat.

Afzal said Pakistan lacks disaster preparedness at a community level, there is a lack of coordination higher up at the provincial level, and parallel structures that result in work being duplicated and time wasted exist throughout the system.

The severe flooding hasn't scared people off their land for good though, said Afzal. People want to be gainfully employed and want to be back in their communities.

"They very much want to go back to their villages and rebuild their homes and lives," she said.

Injection drug users are particularly vulnerable to the disease and new data out in the Lancet Wednesday estimates 67 percent of injection drug users are infected with hepatitis C, a strain most often transmitted through infected blood.

Unsafe drug injection is a major risk factor for hepatitis, a blood-borne virus which attacks the liver and kills about one million people each year, yet surveillance among users is spotty and the issue has not received enough attention, public health experts say.

To mark World Hepatitis Day Thursday and draw attention to the issue, the Lancet published the first ever global estimates of hepatitis among injections drug users. Researchers found that more than 10 million are infected with hepatitis C, and more than 1.3 million have been also been exposed to hepatitis B.

There are five strains of the disease. Hepatitis B and C are passed through bodily fluids, and together cause nearly 80 percent of liver cancers. Hepatitis A and E are typically caused by ingestion of contaminated food or water.

The research, done by a team from the University of New South Wales and funded by the National Institutes of Health and the World Health Organization, used data from 77 countries for the hepatitis C estimates, and 59 for B estimates. They determined infection based on the presence of antibodies in the blood.

"The public-health response to blood-borne virus transmission in [injection drug users] has mainly centered on HIV," the authors wrote. While HIV prevention efforts need to be maintained, "the significance of viral hepatitis needs to receive greater attention than it does at present," with better access to effective vaccinations and treatment, as well as harm reduction measures like needle exchange programs.

Eastern Europe and Asia have the largest populations of injections drug users infected with hepatitis, researchers found, but more than 70 percent of injections drug users in the United States, France, Germany, Norway and Spain were also infected with hepatitis C.

"If you look at many countries around the world [injections drug users] are extremely marginalized," said Joseph Amon, director of health and human rights at Human Rights Watch, who wrote an accompanying comment for the Lancet.

Russia, for example, has a growing injection drug use problem but has outlawed methadone substitution therapy, Amon said, and the country has done little to address the health needs of injected drug users.

"Drug users for the most part, many of them know they are at risk for hepatitis B and C so its not stigma that's preventing them from getting access to care," he said. "It's the failure to put in place those programs and to fund them."

Drug addiction is a powerful and dangerous disease in its own right, so any effective intervention for injection drug users for a particular disease must also address substance abuse treatment and mental health counseling, Amon said.

Photo courtesy the World Health Organization.

More than 2,500 contract workers, lured by the promise of guaranteed work during an economic downturn, brave dangerously high radiation at the Fukushima Dai-ichi plant.

IWAKI-YUMOTO, Japan — Most residents of Iwaki-Yumoto are still fast asleep when the first stirrings of human activity join the din of crows picking through garbage bags.

The men who emerge from their hostels and inns, blinking when confronted by the dazzling early-morning sun, say little as they board waiting buses, the only traffic around at 6 a.m. in this hot-spring town of 30,000 people, located just 30 miles from the Fukushima Dai-ichi power plant.

Within a couple of hours they will be doing jobs that few others would be prepared to even consider; yet it is to the hundreds of workers in Iwaki-Yumoto whom Japan is looking to help solve the worst nuclear accident in its history.

Prime Minister Naoto Kan announced last week that the plant has been stabilized and will be prepared for a cold shut down within the next six months. Though there have been conflicting messages in the past as to what constitutes progress in the clean-up effort, this appears to be the best news in some time.

In addition to 373 staff employed by the plant's operator, Tokyo Electric Power (TEPCO), the Fukushima Dai-ichi plant is teeming with 2,529 contract workers, all braving dangerously high radiation on what must be the most hazardous industrial site on earth.

Many of them have taken up temporary resident in Iwaki-Yumoto, lured by the promise of guaranteed work during another economic downturn, and wages that, while not high, are better than average.

They are the modern day "nuclear gypsies," as described in Kunio Horie's 1979 book of the same name — largely unskilled and untrained laborers on whom Japan's utilities have depended for cheap labor since the nuclear power plant building boom of the 1970s.

Ariyoshi Rune isn't altogether comfortable with that description. The 47-year-old truck driver began working at the Fukushima plant at the beginning of June after answering an ad in a recruitment magazine in his native Kyushu in Japan's southwest.

He is phlegmatic as he describes the conditions at Fukushima Dai-ichi between gulps of beer and long drags on a cigarette. His daily wage of 12,000 yen is, he says, fair remuneration for his efforts, even though skilled TEPCO employees earn an average of 7.6 million yen a year. "I think my wage is fair for the kind of work I do. It's more than I used to get driving a truck."

Besides payment, Rune and the 24 other men on his cleanup crew receive free accommodation, three meals a day and transport to and from their hotel.

Like many of the other contract workers, he has not been totally honest about the nature of his work with members of his family. "When I told my children about my work the first thing they said was, 'Please don't get irradiated,' said Rune, who is part of a team that is removing and packing 23,000 firefighters uniforms, dumped near Fukushima Dai-ichi's crippled reactors in the first days of the crisis.

"They worry, but they also think that what I'm doing is kind of cool." His 73-year-old mother knows he is working in the Fukushima area, but has no idea his job takes him to the power plant for several hours a day.

The president of a construction firm based in Hokkaido in Japan's far north says about half his 40 employees refused to work in Fukushima, citing opposition from families worried about the long-term effects of prolonged exposure to radiation.

"Our employees can earn about double their 350,000 yen salary working at the plant," said the president, who asked for the name of his firm to be withheld. "As a company, we have lots of extra overheads, such as transport and accommodation, so we're not going to make much money from this, however long it drags on."

The laborers' working day begins at 8 a.m., and ends at about 1 p.m., their two 90-minute shifts separated by a break of similar length when they are served a lunch of curry and rice, bottled water and tea, jelly and candy.

"There isn't enough room to get your head down for an hour during breaks," says Rune, "But there are more toilets and drinks and more space for relaxing."

The estimated 9,000 men and women who have worked at the Fukushima plant since it was badly damaged by the March 11 tsunami have more reason than anyone to worry about their exposure to dangerously high levels of radiation.

At least nine have exceeded the annual exposure limit of 250 mSv, an unusually high threshold introduced in the wake of the disaster to allow TEPCO engineers more time in the most hazardous parts of the complex. According to international guidelines, in normal circumstances nuclear workers must not be exposed to more than an average of 20 mSv a year.

But with Japan now well into the hot and uncomfortably humid months of summer, it is the heat, not contamination, that contract workers say they fear most.

"Radiation doesn't bother me, but I am worried about falling ill because of the heat," says one man, a 34-year-old from the western city of Osaka who declined to give his name. "It is unbelievably hot inside those suits. I know of several people who've been taken ill on the job."

Last week TEPCO conceded that as many as 31 workers had fallen sick with heatstroke. The utility has attempted to improve conditions at the site, including the introduction of shorter shifts, more resting spaces and the distribution of coolant vests and refrigerant packs.

"We are very concerned about the health of all the workers on site and have taken appropriate measures to protect them against the heat," said Yoshikazu Nagai, a TEPCO spokesman.

But the measures do little to mitigate the effects of working in high temperatures dressed in masks, protective suits sealed with tape at the ankles, wrists and neck, gloves and personal radiation monitors they must carry with them at all times.

Experts have also warned of the psychological impact of being engaged in such high-risk work, often in defiance of anxious relatives, along with the relentless pressure to complete the cleanup and bring the reactors to a safe state known as cold-shutdown by TEPCO's self-imposed deadline of January.

"Their level of stress is unimaginable," said Takeshi Tanigawa, a professor of public health at Ehime University, adding that, without counseling, some were at risk of developing post-traumatic stress syndrome. TEPCO has since acknowledged that the risk of radiation exposure and concern among relatives has created "multiple" sources of stress for Dai-ichi workers.

At this time of year, local hoteliers and inn owners would normally be inundated with tourists and weekend visitors eager to soak in the area's therapeutic spring waters.

But due to radiation fears, and an influx of about 1,000 nuclear refugees and 2,000 contract workers, tourism has dried up.

"The inn owners are pleased to be fully booked for months ahead, but they are beginning to worry about how long this will go on for," said Katsue Takahashi, an Iwaki city official. "With the evacuees here, too, no one wants to come here for a holiday."

Koichi Ando, whose traditional-style inn has been home to hundreds of railway engineers and police officers since the tsunami, said: "We reckon the situation will stay like this for at least another three years, and that it will be 10 years before we see the first tourists arriving."

But Japan's prime minister, Naoto Kan, has since said it may be 10 years before work can even begin decommissioning the reactors, a dangerous process that could last several more decades.

Rune's daily brush with radiation could force his departure well before the cleanup has ended. After about five weeks on the job, checks revealed he had been exposed to 5 mSv a year; company rules dictate that contract workers who are exposed to 15 mSv — or 30 mSv for full-time staff — can no longer work at the plant.

"I have about two months left before I reach my limit, but I'm hoping they'll make an exception and let me work for longer. I've never thought my job was dangerous."

Visit GlobalPost's health news site for more from their reporters in the field.

View a slide show of the harrowing conditions Somalis face to find food below, and a complete list of ways to help, via InterAction:

CARE Donation phone: 800-521-2273

Oxfam America Donation phone: 800-776-9326

UNICEF Donation phone: 800-4UNICEFText "FOOD" to UNICEF (864233) to donate $10

Mercy Corps Donation phone :800-852-2100

Doctors Without Borders Donation phone: 888-392-0392

International Medical Corps Donation phone : 800-481-4462Text "AFRICA" to 80888 to give $10

International Rescue Committee Donation Phone : 877-REFUGEE (877-733-8433 )

Save the Children Donation Phone : 800-728-3843Text "SURVIVE" to 20222 to donate $10

USA for UNHCR Donation Phone: 202-296-1115

World Vision Donation Phone: 888-56-CHILD (24453)Text "4AFRICA" to 20222 to donate $10

Catholic Relief Services Donation phone :800-736-3467

Islamic Relief USADonation Phone: 888-479-4968

Action Against Hunger Donation Phone: 877-777-1420

ActionAid Donation phone : 202-835-1240

Relief International Donation phone : 800-573-3332

The PBS NewsHour does not certify the fund allocations of the charities listed here or intend this list as an endorsement of their work. This is intended as a tool to help those interested in contributing to relief efforts start their research.

Watch This Segment

The United Nations warned Friday that the famine threatening Somalia could cause some 800,000 children to die from starvation. International agencies want to send more food but al-Qaida-linked militants vowed to block aid. Jonathan Rugman of Independent Television News reports.

JIM LEHRER: And to the crisis in Somalia, which is facing the worst famine in decades. The United Nations warned today 800,000 children could die from starvation. International agencies want to send in more food, but al-Qaida-linked militants vowed to block the aid.

Jonathan Rugman of Independent Television News traveled to a refugee camp just outside the capital, Mogadishu.

A warning: Some of the images in this report are very disturbing.

JONATHAN RUGMAN: Ahmed is eight months old and close to dying of hunger. He lies in the lap of his father, Abdi. The pair have traveled for four perilous days to Mogadishu from the famine zone of South Somalia in what Abdi knows is a desperate race against time.

These 1-year-old twins, Avshir and Nasir, have just arrived, just two of the half-a-million children the U.N. says are seriously malnourished. The boys' mother says she walked to the capital because there's nothing to live on outside. And she's smiling because she is lucky to have made it this far.

Over 1,000 infants have been brought to this emergency nutrition center since it opened just a few days ago. Their mothers are so busy trying to save their children's lives, that there's barely time to grieve for the dead children they have left behind.

This feeding center is just a few hundred meters from the front line of Somalia's never-ending civil war. And these refugees have risked everything to come here, to cross that front line, to escape from the famine zone in the countryside, where tens of thousands of people have already died.

This is how our journey begins, in the only safe mode of transport U.N. aid workers have, in the backs of armored vehicles manned by peacekeepers from Burundi wielding machine guns -- through the window, glimpses of the failed capital of a failed state. On the road out of Mogadishu, we can see some of the 400,000 refugees living in makeshift camps.

First, they fled the fighting. Now it's famine and drought.

ROZANNE CHORLTON, UNICEF: If you have one of those and you want to travel, what do you do?

JONATHAN RUGMAN: We reach the Badbaado camp, where UNICEF's director for Somalia is dressed as if for battle. She can't know how many in this teeming tent city are sympathizers with militants linked to al-Qaida. And everywhere, there are men with guns, militiamen from squabbling rival clans, as well as Burundian forces keeping watch in case food queues turn into riots.

How old are you?

On this pickup truck, there's what looks like a child soldier. He says he's 18. His cousin says he's 13, the latest recruit to Somalia's decades-old cycle of violence. And if delivering aid amid Mogadishu's ruins is difficult, imagine how hard it may prove where famine has been declared.

ROZANNE CHORLTON: We're hopeful that we can push further into southern Somalia in the coming days and weeks. We have to try. We can't not try. It's just too serious.

JONATHAN RUGMAN: And here's the proof: little boys like Saad, age 7, listless in his mothers arms. She says the Islamists tried to stop them from reaching the capital, the fighters apparently in denial about what the U.N. calls the worst humanitarian disaster in the world.

Tens of thousands are seeking sanctuary in this camp, yet what we have filmed cannot capture the scale of this crisis, with millions of Somalis beyond the reach of anyone's help.

[View the story "The Week in Global Health " on Storify]

Mobile phones are pervasive in the developing world, and now a new wave of mobile technology is dramatically changing the way health care workers provide services to rural communities in these regions.

With just a text message, retailers can now inform local clinics when their shops are getting low on life saving supplies, such as bed nets treated with insecticide that ward off malaria-carrying mosquitos.

Bed nets have been a crucial weapon in the fight against malaria, and more than 300 million have been distributed since 2008 in sub-Saharan Africa, according to the Global Fund to Fight AIDS, Tuberculosis and Malaria.

In Tanzania, where almost 2 million cases of malaria are reported each year, a new voucher program provides the treated nets to pregnant women and children -- who are especially vulnerable to malaria -- at a discounted price of 500 Tanzania Shillings (about $0.35). The scheme is gaining popularity -- instead of giving out nets for free every few years, the program builds up a more sustainable system by integrating clinics, wholesalers, retailers and net manufacturers.

Health workers have also found that when a family makes a small investment in the net, it becomes a more valued commodity.

The mobile technology feature allows for quick communication about stock levels and use of nets by the community. Once a woman takes a voucher to the local retailer she exchanges it for a bed net. The retailer then uses his or her cell to send a text message back to a Canadian organization, MEDA, which helps run the program. That text provides vital data,  including the number of bed nets provided to the community and how many are needed in their next shipment.

Each shipment contains a predetermined number of bed nets for a specific region based on their unique needs. Once the bed nets are delivered and the vouchers are collected, the retailers receive monetary compensation.   

While the voucher system has been in existence for almost a decade, it used to be paper based. By incorporating mobile technology, the organization has been able to operate more efficiently. They are currently in the process of developing text message based vouchers to expedite the process of reimbursing retailers for participating in the program.

Watch a MEDA employee give a tour of the technology hub of the program:

Hunger activists used to argue that the world produces more than enough food for all of its people -- it's the transportation, storage, and waste that cause the problem.

Now, that food surplus adage is no longer true, or even up for debate, Josette Sheeran, executive director of the World Food Program, recently told me. The problem has become more critical.

"We're living in a post-surplus era now," she said.

Production today is so tight that a bad growing season in one of the world's breadbaskets -- the United States, Canada, Brazil, Australia -- leads to increased poverty and hunger among millions of the world's most vulnerable people.

The NewsHour's Global Health Unit was in Indonesia in the past several weeks, looking at the economics of food, and its intimate connection with health. I know -- obvious, right? No food, bad health?

Watch the full episode. See more PBS NewsHour.

It is more complicated than that.

The globalization of the world economy has extended from manufactured products to food. Over the last several decades countries have been reassured that the world market is a smooth-working and efficient place, that they shouldn't devote too much labor and resources to growing staple food items if their people can make money doing something else.

It would make more sense, they believed, to buy from more efficient producers than to produce high-cost food themselves.

Then came 2008, when the soaring price of oil had a shocking impact on the price of food. Costs of staples shot up, setting off food riots, forcing governments to spend much more money on subsidies, and making exporters suddenly reluctant to ship out their surpluses. It was a wake-up call about a lot of things, and the sudden leap in food prices pushed an estimated 140 million people into poverty.

Indonesia was a perfect place to examine this new reality. Its people are still working and living on the land in millions -- an estimated half of the workforce. The fields are intensely cultivated, well-watered, and productive. But Indonesia, producing the world's third-largest rice crop every year, still has to import rice to feed its 240 million people. When things are good, food might represent 30-40 percent of the family budget. When the price of just one commodity, rice, shoots up, it can push food prices up enough to soak up 70 percent of the family food budget.

People we spoke to named food prices as one of the reasons life is hard in Indonesia. Food prices can be politically sensitive anywhere, but in a country with a high poverty rate (60 percent of Indonesians live on less than $2 a day), they can change everything. In a teeming slum outside the capital, Jakarta, we visited a regional hospital's emergency feeding center, where Dr. Saptarini, the director, said she sees more malnourished children whenever the price of food starts to rise.

Mothers try to adapt by using cheaper ingredients and less nourishing foods when prices outpace income. As uncomfortable as skipping meals can be for an adult, it's real impact can be seen in children, like 15 month-old Ahmad, who arrived at the hospital a few weeks earlier tipping the scales at 15 pounds. The average weight for boys in the United States at that age is almost 24 pounds.

His mother said there just wasn't enough food in the house these days, because there just wasn't enough money to buy it.

Her little boy has been getting emergency feeding since he arrived, and he's already gained two pounds. From birth to three years children's brains hungrily absorb nourishment, growing and laying down connections that will carry a child through life. Bad food makes bad students and bad workers.

The people we encountered were very open about the day-to-day realities of their lives, explaining how food was acquired, prepared and eaten in the family home. Women spoke of skipping meals to feed their children, or of making sure husbands heading out to work got more food to give them the strength to get through long days of physical labor.

People welcomed us into their homes to see the tiny kitchens, water buckets in lieu of plumbing, the lack of space for storing food. Without fail, they offered us tea and soft drinks, chips or cookies.

Along with the disappearance of the surplus worldwide, the advantages for rural people have vaporized as well. Farmers used to grow for themselves and families, and their ability to make food provided insurance against times of want.

Increasingly, though, farm workers are simply hired labor, with little access and almost no stake in the land. When food gets more expensive their prices go up with everyone else's, even though it's their own labor that pulls food from the soil.

Mercy Corps has helped launch a business in the slum quarter we visited, making healthier foods for kids under five that supply more protein and micronutrients.

Get the price right, get the selection right, and bingo, the women of this tough neighborhood are willing to watch out for the cart to make sure their kids are properly fed.

Concerned mothers have little to say about the world price of oil. And along with tightened supply, the cost of energy has been a huge driver of prices.

Transportation, fertilizer and processing, all need energy, but a power-hungry world adds another complication: you can process a lot of different foods to make fuel instead of meals.

Indonesia is by far the world's number one palm oil producer, and much of it used as cooking oil. When the price of crude oil jumped, biofuel producers swooped in, trying to buy a big share of the palm oil crop for processing.

The Indonesian government responded by slapping export duties on the oil, trying to keep it inside the country. Palm oil shortages would push Indonesian consumers to import more expensive cooking oils, pushing food prices even higher.

We in the West paid so much attention to the effort to push Suharto out of the president's office in the late 1990s, but many haven't paid much attention to Indonesia since. It was interesting to hear nostalgia for the Suharto era from ordinary Indonesians, who are living with food inflation in this era of rapid economic and population growth. "It was a better time," they remember wistfully, "we could afford to buy food."

Condoms or a vasectomy? Those are the choices for sexually active men who want to control their own fertility -- at least for now.

Those two options are currently the only available contraceptive methods for men, and both have well-documented drawbacks, according to Dr. Joseph Tash, director of the Center for Male Contraceptive Research and Drug Development at the University of Kansas.

"Clearly there is a gap in the available contraceptive methods for men," Tash said.

But a new wave of research into broadening male contraceptive options is looking at a variety of approaches, including hobbling sperm production and motility and its egg-penetration abilities.

Wednesday on the NewsHour Ray Suarez looks at a promising new daily male birth control pill under investigation in Indonesia that makes sperm incapable of entering an egg. You can watch that report online now in a special web preview.

Another male contraceptive method -- albeit a more invasive one -- that has been receiving a lot of attention lately: reversible inhibition of sperm under guidance, or RISUG

The procedure is currently in Phase III human trials involving several hundred men in India, while a parallel development track is just beginning in the United States.

RISUG involves injecting a synthetic substance into the vas deferens, the tube that carries sperm from the testes and the same tube that is cut in a vasectomy. In animal trials it has been shown to be reversible, a crucial selling point for some men on contraceptive methods.

"It mostly blocks the tube, but also kills any sperm that get past. It's almost like a filter," said Elaine Lissner, director of the nonprofit Male Contraception Information Project.

She felt the procedure was so promising, she formed another foundation to purchase RISUG rights outside of India.

So far, the injections have shown 100 percent efficacy in men who were injected correctly in the India trials, she said. On a few subjects, the needle went through the tube and inhibited the injection so those men were warned they did not receive a complete injection. Some of the men who received RISUG when research first began have had no pregnancies for 20 years after the injection.

"Of the data that's been reported it looks like it could be a very promising alternative," said Tash. But he warned that the results of the Phase III trial are critical, and more data on the subjects needs to be made available. Tash also cautioned that a pill form of contraceptive is an easier sell than an injection in a very sensitive area.

RISUG has been reversed in rat and monkey trials with an injection of a baking soda solution at the same site. The solution dissolves the initial synthetic substance in the tube and sperm counts "spring back over a couple months," Lissner said.

She is pushing to make RISUG available to U.S. consumers as soon as possible, and they plan to enter human trials next year in the U.S. They are seeking a device registration instead of drug registration, and Lissner said the foundation will not claim reversibility at first in order to get the procedure to market as soon as possible. Doing the trials to show reversibility in humans will take time, and money, so will be added down the line.

RISUG has a good chance of being the next available contraceptive method for men in the United States, but other options could be close on its tail. It's good news for a field that has been looking for its next big break for a long time.

"It's really over the last five to 10 years that the progress in the field has accelerated, a combination of new collaborations and people with experience in drug development," said Tash. "I think we are at the beginning stages of seeing a whole host of approaches coming in to development."

Photo courtesy National Institutes of Health.

A plant that reduces fertility, long used by Indonesian men, is being tested as a possible daily male birth control pill.

RAY SUAREZ: It doesn't look like much: six-feet tall, a leafy shrub growing amid the lush foliage of an Indonesian forest.  But a chemical locked in these leaves could become a useful tool for limiting population growth, here in Indonesia and potentially around the globe.

To get to the plants, it's a one-hour hike, or a white-knuckled motorcycle ride up a steep mountain path and across two rickety wooden bridges.

The plant is called gandarusa and its medicinal qualities have been known to people here for centuries.

Traditionally, its leaves have been brewed into an herbal remedy for stress, something to soothe the nerves. But people have talked about an unexpected side effect: reduced male fertility.

Now researchers in Surabaya, on the eastern edge of the island of Java, are drying the leaves, chopping them up, extracting the active chemical, and putting it in capsule form to see if it works as a reliable form of male contraception.

There's growing confidence that this is a find that's eluded scientists for decades: a cheap, easy-to-make, over the counter daily birth control pill, for men.

Bambang Prajogo directs the project at Airlangga University.

BAMBANG PRAJOGO, Airlangga University: Since 1987, when we began doing research using mice, all of the testing has shown it is safe, it is effective and it has few side effects. So now we are undergoing testing in human beings.

RAY SUAREZ: Doctors are especially excited because gandarusa doesn't alter male hormones but rather changes the chemistry on the tip of each individual spermatozoon, making them unable to pierce the outer wall of a female egg, or oocyte.

Dr. Dyan Pramesti is working on the clinical trial.

DR. DYAN PRAMESTI, Airlangga University:  It interferes with the enzyme which is located on the sperm head. The enzyme is needed to perforate the wall of the oocyte. If the enzyme is not active, or reduces the activity, the sperm cannot perforate the wall of the oocyte.

RAY SUAREZ: So no pregnancy?

DR. DYAN PRAMESTI: No pregnancy.

RAY SUAREZ: Dr. Pramesti and her colleagues have made another crucial finding: the pill's effect is not permanent. On average, men were fertile again just two months after they stopped taking the pill.

Bambang says the testing on just over 100 couples has shown impressive results. 

BAMBANG PRAJOGO: We've done two rounds of testing on humans and so far, no pregnancies have resulted. We are now starting Phase 3 testing with 350 couples and we are hoping we will continue with our 100 percent success rate.

RAY SUAREZ: The third phase of testing isn't expected to be complete until the end of the year.

If gandarusa works, and works safely, there's still one important question. Will men use it? Today in Indonesia, fewer than two percent of men participate in contraception.

Sugiri Syarief directs the country's family planning board.

DR. SUGIRI SYARIEF, director of the Population and Family Planning Board: Mostly men say that family planning is responsibility just for woman.

RAY SUAREZ: They think that?

DR. SUGIRI SYARIEF: Yes. They think that. Family planning, oh that is the woman's responsibility. Right now we try to make awareness among the men that family planning is not only for women, but it is a decision made by couples, husbands and wives.

RAY SUAREZ: But Health Minister Endang Rahayu Sedyaningsih says the low participation rate is because right now men have only two options: using condoms or getting a vasectomy. 

DR. ENDANG RAHAYU SEDYANINGSIH, Minister of Health, Indonesia: They don't like those choices. But here if we can find a pill that they can just swallow and no affect to their—

RAY SUAREZ: Desire?

DR. ENDANG RAHAYU SEDYANINGSIH: Yes (laughing). Libido. So I think they would be very happy to take that.

RAY SUAREZ: So far, none of the men in the studies have reported a diminished libido. In fact, thirty-six year old Panca Ariansyah, says he's experienced a slight increase.  He's an enthusiastic supporter.

PANCA ARIANSYAH: I would recommend to my friends that they try gandarusa. It's easy and there are no side effects.

RAY SUAREZ: He and his 29-year old wife Mujiasri live in one of the poorer areas of Surabaya, where many families have four or more children. They decided to take part in the gandarusa trials because they already have three daughters and they say that's enough. 

MUJIASRI: I've used birth control pills before but I still ended up getting pregnant.

RAY SUAREZ: So now it's your turn to take the pills?

(Husband nods)

RAY SUAREZ: Indonesia, with a population of 240 million people, is the world's fourth most populous country, so limiting growth has been a top priority for the government. And it’s had a fair amount of success over the last four decades, says Dr. Sugiri.

DR. SUGIRI SYARIEF: We have already changed from big family to small family right now. In 1970s our fertility rate was 5.6 children per woman. Now it is already 2.6 children per woman. It's very good in terms of decreasing fertility. But it is not enough. Fertility should be 2.1.

RAY SUAREZ: 2.1, that's replacement rate?

DR. SUGIRI SYARIEF: Yes.

RAY SUAREZ: Even after that success, the population isn't expected to level off until it reaches some 350 million.

And there's one other big question about how much of a role gandarusa will play in lowering that fertility rate: whether or not it gets the approval of Islamic religious leaders. 

Some fundamentalist groups are opposed to any form of birth control. But Dr. Sugiri says most mainstream imams approve of family planning methods if they are not permanent and do not harm the body. 

He is optimistic gandarusa will be available in Indonesian stores as early as next year.  He's less confident the drug will be sold in the United States any time soon since strict food and drug regulations would require years of additional testing.

Indonesia is an evolving, prospering democracy, but the country continues to struggle with corruption. Watch the piece before it airs on Tuesday's PBS NewsHour.

RAY SUAREZ: Two hundred forty million people living on 6,000 islands strung along the equator. An old, complex culture melding influences from across Asia.

They belong to hundreds of ethnic groups, speak hundreds of languages and make up the largest Muslim population of any country in the world.

After years of fast economic growth, Indonesia now has one of the 20 largest economies in the world. But think, how often does this huge, dazzlingly diverse, increasingly wealthy place break through onto the world's news agenda?

Not often.

There have been terrorist bombings of western-related targets, hotels in the capital Jakarta, and on the island of Bali. The tsunami in the western province of Aceh, and in the 1990s, rising resistance to the decades-long rule of Suharto, whose departure paved the way for democracy, and reform.

In fact, many people now point to Indonesia as a model for Egypt as it tries to move from dictatorship to democracy.

RIZAL MALLARANGENG, political reformer with the Freedom Institute: It is some kind of experiment. Is it possible a very large country, Islamic country, can push the democratic path. But the last ten years we proved that we did ok.

RAY SUAREZ: Rizal Mallarangeng, a political reformer, and sometimes candidate, runs a think tank in Jakarta.

RIZAL MALLARANGENG: We got our freedom, basic freedom, basic guarantees of our basic rights. The economy is moving forward, 5 percent, 6 percent, which is very good. But of course, democracy is messy stuff. We're not that rich yet. Our GDP is just far below the United States. But we are striving. We are going to right direction.

RAY SUAREZ: Talk to people in government, in positions of influence, they, too, applaud the political reforms. ... But say more must be done if Indonesia is to join a surging group of economies that includes China and Brazil.

DEWI FORTUNA ANWAR, aide to Indonesia’s vice president: We have to admit that Indonesia has performed much better in advancing the cause of our democracy -- political democracy -- than advancing the cause of real economic democracy.

RAY SUAREZ: Dewi Fortuna Anwar is the deputy chief in the office of the vice president.

DEWI FORTUNA ANWAR: But in the economic sector, you still have to have the capital, the connections and so on, and it is still not yet a level playing field. And some people are born with silver spoons in their mouths and others have to scrape for their living.

RAY SUAREZ: It's a short drive from crowding, open sewers, and a daily struggle to get by to a new class of Indonesians thronging shopping malls that rival any in the world for opulence and selection. Rank and file Indonesians are clear about the difference between democracy and economic progress.

Sophia runs a market stall in the Javanese city of Surabaya.

SOPHIA, market merchant: In the time of Suharto, life was much better. Now, life is getting worse. Prices are too high. Poor people like me can't afford things.

RAY SUAREZ: Ahmad drives a pedicab.

AHMAD, pedicab driver: I often can't afford to buy the things I need. I have to be selective in the things I buy.

RAY SUAREZ: A 16-year-old nursing student, sure she will live better than her parents, is less confident about today:

STUDENT: Life is getting worse because our government doesn’t 't pay attention to the lives of people, especially poor people. They only think about themselves. Every time a new president is elected, they say things will be different. But they aren't.

RAY SUAREZ: Over the last 15 years this country has accomplished some pretty important national goals. It’s moved from authoritarianism to democracy, with freer, fairer and more open elections. It’s put together solid years of back to back to back high levels of economic growth. But one thing Indonesia hasn’t managed to do is root out the legendary levels of corruption that discourages foreign investment and  handicaps future economic growth

Sidney Jones watches Indonesia for the International Crisis Group.

SIDNEY JONES, International Crisis Group: In some ways almost because of substantial economic growth, people see income inequalities increasing and the corruption has just gotten completely out of hand. One of the concerns is that you now have a parliament that's trying to cut away at the powers of the only institutions with integrity in Indonesia. One of those is the anti-corruption commission, another one is the constitutional court here,

RAY SUAREZ: When we visited the anti-corruption commission, it was crowded with civil servants arriving to have their contracts audited, checked that government money is being spent in a clean, legal, and verifiable way.

Upstairs, Commissioner Umar Haryono is concentrating on putting parliament members and government officials in jail, and trying to transform Indonesia.

UMAR HARYONO, Corruption Eradication Commission head: We arrest one corruptor and will become more maybe two, three more corruptors here because the problem here, the big problem, is our democracy system. Because in order to get elected as a government official as a parliament member, sometimes they need to pay a lot of money."

RAY SUAREZ: Protests against corruption are almost a daily occurrence in Jakarta. Everyone we spoke to said it’s the cost of running for office that’s the root of it all. Winners have to pay off the people who paid to get them elected.

SIDNEY JONES: This is one concrete example, a district head called in his minister, his local head of education and said, we need, I need you to provide x amount of money to get that. You get it any way you like, but I need you to produce that amount of money. That individual then goes to the heads of schools that he runs and says I need x amount of money in order to collect the pot of money that I have to give the candidate who appointed me to this position. Because if I don't pay he's going to transfer me somewhere else. The head of the schools then puts the, the onus on the teachers to come up with the money. The teachers then put the onus on the parents and children end up having to pay in order to graduate from one class to another or to get report cards.

RAY SUAREZ: The international corruption monitor transparency international rates Indonesia in the bottom half of the world's nations when it comes to official corruption. Its score has hardly moved in years.

Indonesia has had more success in targeting terrorist violence. It has a strong track record finding, arresting, and trying religious extremists.

DEWI FORTUNA ANWAR: It is important to remember that Indonesia is probably one of the few countries that has been able to arrest a lot of terrorist activists and bring them to justice, due process of law and imprison them. Some of them have been executed. We do not have rendition. We do not have secret prisons we do not have military tribunals, everything is done properly according to due process of law.

IMAM H. ALI HANAFIA, Istiqlal Mosque: In Indonesia Islam is very tolerant of other religions. Islam doesn’t recognize violence. That might be hard for people outside of Indonesia to understand but that is Islam in Indonesia.

RAY SUAREZ: Imam H. Ali Hanafia leads the largest mosque in Southeast Asia, where stadium-sized crowds of worshippers pour inside for Friday prayers. The country has had a secular government since the first days of independence from the Netherlands in 1949.

The Imam said relations between mosque and state are good.

IMAM H. ALI HANAFIA: Islamic society in Indonesia has connected to the government and the other way around. Muslims are represented in the government and I think Muslims feel very free to give input.

RAY SUAREZ: A surging economy, and millions waiting to feel the gains, an assault on stifling corruption, with a long way to go, a government that acknowledges the role of Islam in the society, and is trying to protect religious minorities ... for all the worries about getting through today, belief in the future is strong.

AHMAD: I didn't go to school so I have this job. But my kids will finish at least high school so they will be able to get a better job.

NURSING STUDENT: God willing. I believe that I will have a better life than my parents.

SOPHIA: I’m convinced my children will have a better life.

RAY SUAREZ: The government in Jakarta will have to deliver and soon to keep Sophia’s hope alive

The price of rice has risen 25 percent in less than a year in Indonesia, and more families have stunted or malnourished children as a results of soaring costs.

RAY SUAREZ: Travel across indonesia's most populous island -- Java -- and it's hard to imagine going hungry here.

The intensely cultivated fields are bursting with green -- rice, potatoes, bananas, tea.

But head to one of the many slums in Jakarta, and it gets easier to understand how vulnerable poor people can be.

WOMAN IN SLUM: Food prices have been going up sharply. Rice, eggs, oil...it's all going up.

Back in 2008 when food prices soared worldwide, people in the developing world who had been moving ahead economically were pushed back into poverty, and hunger.

Josette Sheeran heads the united nation's world food program.

JOSETTE SHEERAN, U.N. World Food Program: We saw the number increase by 140 million people, virtually overnight in 2008. So we went from about 900, 860 million hungry people in the world to a billion in about a year's time span. The world bank says that 44 million people were added to the ranks of the extremely poor and hungry in the past year because of the rise in food prices.

RAY SUAREZ: Sheeran says the food price indexes in 2011 are even higher than they were in 2008. In Indonesia, rising food costs means more expensive rice, a three-times-a-day staple food here. Its cost has risen 25 percent in just the past year.

When poor people have to pay more, the share that food takes from the family budget soars. Muhammad Chatib Basri is an Indonesian economist.

MUHAMMAD CHATIB BASRI, economist: If you look at the basket of consumption for average people, the proportion of food is about 40 percent. But if you're talking about the basket of poverty, in the poor people, the proportion of food is almost 70 percent.

RAY SUAREZ: Sapta Mega Pratiwi has brought her 15-month old son Ahmad to a regional hospital.

Is there enough food in your house?

SAPTA MEGA PRATIWI: Sometimes there's food, sometimes there's not. We don't earn enough money to always afford food.

RAY SUAREZ: When doctors first saw him, just a few week ago, he was a little over 15 pounds…far too light for a child that age. He has a belly, skinny legs, brittle hair, all classic signs of poor nutrition.

 Dr. Saptarini Nurul Jamil runs the emergency nutrition center at the hospital. She sees more children like Ahmad when food prices are high.

 DR. SAPTARINI NURUL JAMIL: Yes, the situation is parallel with the situation in the country. There are always basic problems of poverty, but it becomes a bigger problem when food prices go up and ultimately leads to malnutrition. When the economy goes down, more people lose their jobs or their salary is reduced and so they no longer can afford nutritious food.

RAY SUAREZ: Dr. Saptarini said Ahmad will get better. In just a few weeks of supplemental feeding, he's up to just over 17 pounds.

Other children aren’t so lucky. One out of every four Indonesian children doesn't get even 70 percent of the daily recommended allowances for nutrients. That means suffering today, and it robs the future.

JOSETTE SHEERAN: There's scientific consensus that when a child is born about 60 percent of their brain is formed. And the next three years in life, if they don't have adequate nutrition their brain will not form properly. I actually carry with me to show world leaders this chart. It shows two brains. This one of a child who was properly nourished, a three year old, this one of one that was malnourished. The actual volume of the brain is reduced about 40 percent.

RAY SUAREZ: Which leads to students who can't learn as much, and workers who can't work as hard.

DR. SAPTARINI NURUL JAMIL: If a malnourished child doesn’t get treatment early he can lack energy. He can have learning issues in school. And if a pregnant woman is malnourished, her baby will be born unhealthy and it will start a terrible cycle.

RAY SUAREZ: Even if you can afford to put some food on the table, many people -- especially those with large families -- face challenges.

One international aid group found that families were literally driven onto the street by tiny kitchens and even tinier food budgets. They found that they were giving their children food that was cheap and filling, but not necessarily nutritious.

On a cluster of streets in a poor neighborhood in West Jakarta, bright new colorful food carts are offering a healthier alternative.

USYE UMAYAH, Mercy Corps: In our cart, we provide food: healthy, nutritious but also affordable for the family -- especially for the low income.

RAY SUAREZ: Usye Umayah runs a Mercy Corps program that sends food carts out every morning with popular foods, but with added protein and vitamins.

USYE UMAYAH: We develop a menu, which is affordable by these families, but also we adding some more nutrition. It's really dense, nutritious for the children. And this is meeting 29 percent calories for a children under five.

RAY SUAREZ: Twenty-four year old Anisa Fihria says she knows she's feeding her 18-month-old son healthier food now.

Does being involved in that program also teach basic nutrition?

ANISA FIHRIA: Yes, he shares information about what nutrition is in the food. Like carrot contains Vitamin A and beans are good for Vitamin B12 and coconut is good for the bones.

RAY SUAREZ: The benefits don't end there. The carts provide steady employment and profit for the sellers, and work for kitchen staff preparing the food for sale.

It's a win all around, and changes the lives, and prospects of poor kids.

But it's a band aid, really, since the forces that drive rising food prices are far beyond the control of hard-working food sellers.

There are so many factors that influence food prices. One key one is energy, which is used not only to grow and transport the food, but increasingly food is being used as energy.

You can see the effect with palm oil. When crude oil got expensive, there was a run on the indonesian palm oil supply to use as biofuel instead of food.

MUHAMMAD CHATIB BASRI: I think we are entering a new era of high commodity prices and high energy prices. In the last 10 years we see evidence that higher energy prices means also higher commodity prices. Because people use commodity not only for cooking, for example, but also for substitute for energy.

RAY SUAREZ: Food production is also a problem. Although Indonesia is the world's third largest grower of rice, it still has to rely on imports of the grain. The government is trying to implement self-sufficiency polices. But so far there's a limit to how much food can be produced. It's a problem around the world.

JOSETTE SHEERAN: For the first time in most people's memory we're in a post-surplus world. There is no surplus of food in the world and you have one bad drought or one bad flood as we're seeing in the Midwest in America, it will impact the price of food globally.

RAY SUAREZ: Those rising prices are going to continue to make it more difficult for babies like Ahmad Maulana and other chronically malnourished children around the world.

Indonesia is fast becoming an economic power and has the fourth largest population in the world, behind the United States. A growing number of Indonesians can afford to shop in malls and eat Western food, but not everyone has benefited from Indonesia's growth. The diverse nation has a wide range of living standards and many families still live in poverty:

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