W orld leaders have a disappointing record when it comes to crises that take decades to unfold. Much greater investment in the prevention of HIV/AIDS in the 1980s could have saved millions of lives and billions of dollars 20 years later, for instance. The western Sahel region of Africa lies between the Sahara Desert to the north and the Sudanian Savannah to the south. By 2050, the region's population is expected to more than double, to 450 million 1 , and temperatures there are expected to rise to about 3 °C above their 1950 level. Already, hunger and malnutrition are widespread in the Sahel. As droughts and other weather extremes make it even harder for farmers to produce the crops and livestock needed to sustain the growing population, conflict and terrorism will increase 2. As conditions worsen, millions of people could die in famines, and there is likely to be unprecedented levels of migration, including to Europe 3. Our analyses of population projections and the probable impacts of climate change on food security in this ecologically vulnerable zone indicate that four steps are needed to head off these effects. We call on governments worldwide, together with those Avert catastrophe now in Africa's Sahel Alisha Graves, Lorenzo Rosa, Abdoul Moumouni Nouhou, Fadji Maina, Djimé Adoum and 5 cosignatories Governments worldwide must invest in girls' education, family planning, agriculture and security in this vulnerable region. Women in Niger and other parts of the Sahel are among the least empowered globally, but various efforts are starting to provide solutions.

One determinant of peace is the role of women in society. Some studies suggest that a young age structure, also known as a "youth bulge" can facilitate conflict. Population growth and age structure are factors amenable to change in a human rights context. We propose that policies which favor voluntary family planning and the education of women can ameliorate the global burden of disease associated with conflict and terrorism.

The current paper examines the realities of women delivering in resource-poor settings, and recommends cost-effective, scalable strategies for making these deliveries safer. Ninety-five percent of maternal deaths occur in poor settings, and the largest proportion of these deaths are women who deliver at home, far away from health care facilities, and without financial access to skilled providers. This situation will improve only when policymakers and programme planners refocus their attention on service delivery and financing interventions, with the potential to reach the largest portion of women living in places where mortality is the highest. We suggest three feasible interventions that can potentially minimise both demand and supply side problems of safe delivery: (1) misoprostol to treat postpartum haemorrhage, an easy to use and heat stable technology to reduce the leading cause of maternal deaths; (2) alternative providers, such as clinical officers, trained to offer emergency obstetric care services; (3) financing safe delivery through vouchers or other mechanisms that can be implemented in poor settings and made attractive to the donor community through output-based assistance (OBA).