Larry Diamond looks at the global and domestic threats to the principles of liberal democracy for The Brian Lehrer Show. Listen here.

In the honor of publication of Larry Diamond's "Ill Winds: Saving Democracy from Russian Rage, Chinese Ambition, and American Complacency" Foreign Affairs are providing past the paywall article "Democracy Demotion: How the Freedom Agenda Fell Apart" by Larry Diamond. Read here. 

A new study by Stanford economists shows that giving fathers flexibility to take time off work in the months after their children are born improves the postpartum health and mental well-being of mothers.

In the study, slated for release by the National Bureau of Economic Research on June 3, Petra Persson and Maya Rossin-Slater examined the effects of a reform in Sweden that introduced more flexibility into the parental leave system. The 2012 law removed a prior restriction preventing a child’s mother and father from taking paid leave at the same time. And it allowed fathers to use up to 30 days of paid leave on an intermittent basis within a year of their child’s birth while the mothers were still on leave.

The policy change resulted in some clear benefits toward the mother’s health, including reductions in childbirth-related complications and postpartum anxiety, according to their empirical analysis.

“A lot of the discussion around how to support mothers is about mothers being able to take leave, but we often don’t think about the other part of the equation — fathers,” says Rossin-Slater, an assistant professor of health research and policy.

“Our study underscores that the father’s presence in the household shortly after childbirth can have important consequences for the new mother's physical and mental health,” says Persson, an assistant professor of economics.

Rossin-Slater and Persson are both faculty fellows at the Stanford Institute for Economic Policy Research.

Among their main findings of effects following the reform: Mothers are 14 percent less likely to need a specialist or be admitted to a hospital for childbirth-related complications — such as mastitis or other infections — within the first six months of childbirth. And they are 11 percent less likely to get an antibiotic prescription within that first half-year of their baby’s life.

There is also an overall 26 percent drop in the likelihood of any anti-anxiety prescriptions during that six-month postpartum period — with reductions in prescriptions being most pronounced during the first three months after childbirth.

What’s more, the study found that the average new father used paid leave for only a few days following the reform — far less than the maximum 30 days allowed — indicating how strong of a difference a couple of days of extra support for the mother could make.

“The key here is that families are granted the flexibility to decide, on a day-to-day basis, exactly when to have the dad stay home,” said Persson. “If, for example, the mom gets early symptoms of mastitis while breastfeeding, the dad can take one or two days off from work so that the mom can rest, which may avoid complications from the infection or the need for antibiotics.”

These indirect benefits from giving fathers workplace flexibility are not trivial matters when you consider the health issues mothers often face after childbirth and after they get home from the hospital, says Rossin-Slater, who is also a faculty member of Stanford Health Policy.

Infections and childbirth complications lead to one out of 100 women getting readmitted to the hospital within 30 days in the United States, according to the study.

Meanwhile, postpartum depression occurs for about one out of nine women, and maternal mortality has also been a rising trend over the past 25 years in the U.S.

The study comes as a growing number of lawmakers in the United States vocalize support for paid family leave but have failed to pass federal legislation.

Washington, D.C., and six states have adopted various paid family leave laws, but the U.S. remains the only industrialized nation in the world that does not have a national mandate guaranteeing a certain amount of paid parental leave.

Some federal lawmakers are working on family leave measures and have proposed such legislation over the past few years — including The Family Act, The New Parents Act — but none of them have ever gained enough traction to proceed in Congress.

This new study can help broaden the policy discussions, the researchers say.

The larger context around paid family leave policies is often framed today as a way to help narrow the gender wage gap by giving women more workplace flexibility and fewer career setbacks.

This study, however, shines a light on maternal health costs and how a policy on paid family leave — that includes workplace flexibility for the father — offers more benefits than previously thought, Rossin-Slater says.

“It's important to think not only about giving families access to some leave, but also about letting them have agency over how they use it,” she says.

And when it comes to concerns that fathers might use paid parental leave to goof off instead of spending the time as intended, the researchers say their study should assuage those worries.

“It's not like fathers are going to end up using a whole month to just stay home and watch TV. We don't find any evidence of that,” Rossin-Slater says. “Instead they only use a limited number of days precisely when the timing for that seems most beneficial for the family.”

“For all these reasons,” Persson says, “giving households flexibility in how to use paternity leave makes a lot of sense.”

As China and Russia attack free governments and push strongman rule, the U.S. has gone silent—and a new tide of authoritarianism is gathering, writes Larry Diamond. Read here.

Two former U.S. ambassadors to Russia recently shared the stage at the Freeman Spogli Institute, where they discussed the Arab Spring, their mutual respect for former President Barack Obama, and of course, Russian President Vladimir Putin.

William Burns — the Russian ambassador from 2005 to 2008 — told Freeman Spogli Institute Director Michael McFaul — who was in the position from 2012 to 2014 — that Putin is a “combustible combination of grievance and ambition and insecurity all wrapped up together.”

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Standing at about 5 feet and 6 inches tall, Putin is not the most physically intimidating person in the world, but he carries himself with self-assurance, Burns said.

“He told me, ‘You Americans need to listen more — you can’t just have everything your own way,’” Burns said of his first meeting with Putin. “That was vintage Putin…it was not subtle, it was defiantly charmless, but it was quite direct.”

Burns talked about his experience in the Foreign Service, which began at the height of the Cold War in the early ‘80s. Because most of his research in graduate school focused on the Middle East, Burns said he spent two years perfecting the Russian language at the beginning of his career.

“You can’t operate in a place like Russia unless you speak the language well,” Burns said. “Moscow in those days was one of the biggest embassies we had in the world. As creepy as the relationship can be, Russia is still a place that matters.”

Burns said that while former President George H.W. Bush, his Secretary of State James Baker, and his National Security Advisor Brent Scowcroft made their share of mistakes during Bush’s tenure in office, the former president and his team deserve a lot of credit for what they accomplished in Russia and the Middle East.

“In hindsight, Germany’s reunification within less than a year after the end of the Cold War and the fall of the Berlin Wall — and ensuring that the reunification of Germany would remain within NATO — was not a small achievement,” he said. “That took real skill, and it was not inevitable.”

When asked by McFaul whether the U.S. should have been more aggressive in pushing the burgeoning Russian leaders in a more democratic direction after the collapse of the Soviet Union, Burns said he thinks Russia would have been resistant to an “intrusive” American role in their economy at that time.  

“Russians — at the end of the Cold War, and the disintegration of the Soviet Union — had suffered a real crisis in their own confidence,” he said. “I’ve never really bought the argument that a Marshall Plan-scale set of assistance for Russia or the former soviet states in that period would have been that productive. Russia’s future after the end of communism was something that only Russia could shape in the end.”

Shifting focus to the past decade, Burns said that he “always had huge respect for President Obama’s long game in the Middle East,” adding that he thought the former president was unfairly criticized for wanting to disengage the U.S. from the Middle East during his time in office.

“The Arab revolts unfolding in Tunisia, Egypt, Libya and Syria were on a scale and at a pace which would have been hard for any president to adapt to,” Burns said. “On the surface they looked very similar, but they were unfolding in different societies, in different ways … a concern with which I deeply sympathized was not getting dragged into another big military intervention in the Middle East.”

U.S. government aid for treating children and adults with HIV and malaria in developing countries has done more than expand access to lifesaving interventions: It has changed how people around the world view the United States, according to a new study by researchers at the School of Medicine.

Compared with other types of foreign aid, investing in health is uniquely associated with a better opinion of the United States, improving its “soft power” and standing in the world, the study said.  

Favorability ratings of the United States increased in proportion to health aid from 2002 to 2016 and rose sharply after the implementation of the President’s Emergency Plan for AIDS Relief in 2003 and the launch of the President’s Malaria Initiative in 2005, the researchers report.

Their findings were published this week in the American Journal of Public Health. The lead author is postdoctoral scholar Aleksandra Jakubowski, PhD, MPH. The senior author is Eran Bendavid, MD, associate professor of medicine and a core faculty member at Stanford Health Policy.

“Using data on aid and opinions of the United States, we found that investments in health offer a unique opportunity to promote the perceptions of the United States abroad, in addition to disease burden relief,” the authors wrote. “Our study provides new evidence to support the notion that health diplomacy is a net win for the United States and recipient countries alike.”

The Trump administration, however, has proposed a 23% cut in foreign aid in its 2020 budget, including large reductions to programs that fight AIDS and malaria overseas.

The Stanford researchers believe their study is the first to add heft to the argument that U.S. health aid boosts the “soft power” that wins the hearts and minds of foreign friends and foes.

“Our study shows that investing in health aid improves our nation’s standing abroad, which could have important downstream diplomatic benefits to the United States,” Jakubowskisaid. “Investments in health aid help the United States accumulate soft power. Allowing the U.S. reputation to falter would be contrary to our own interests.” 

A Policy Debate

Many politicians and economists consider spending U.S. tax dollars on foreign aid as an ineffective, and possibly harmful, enterprise that goes unappreciated and leads to accusations of American meddling in other countries’ national affairs.

The U.S. government, for the past 15 years, has contributed more foreign health aid than any other country, significantly reducing disease burden, increasing life expectancy and improving employment in recipient countries, the authors wrote. Still, this generosity has historically constituted less than 1% of the U.S. gross domestic product.

“Our results suggest that the dollars invested in health aid offer good value for money,” the researchers wrote. “That is, the relatively low investment in health aid (in terms of GDP) has provided the United States with large returns in the form of improved public perceptions, which may advance the U.S. government’s ability to negotiate international policies that are aligned with American priorities and preferences.”

The researchers used 258 Global Attitudes Surveys, based on interviews with more than 260,000 respondents, conducted by the Pew Research Center in 45 low- to middle-income countries between 2002 and 2016.

Their analysis focused on the health sector, which includes several large programs for infectious disease control, but also support for nutrition, child health and reproductive health programs. They compared health aid to other major areas of U.S. investment: governance, infrastructure, humanitarian aid and military aid. They also constructed a database of news stories that mentioned the President’s Emergency Plan for AIDS Relief or the President’s Malaria Initiative by crawling through the online archives of the top three newspapers by circulation in each of the 45 countries.

They found that the probability of populations holding a very favorable opinion of the United States was 19 percentage points higher in the countries where and years when U.S. donations for health care were highest, compared with countries where and years when health aid donations were lowest. Using another metric, the researchers found that every additional $100 million in health aid was associated with a nearly 6 percentage-point increase in the probability of respondents indicating they had a “very favorable” opinion of the United States. 

In contrast, the researchers found, aid for governance, infrastructure, humanitarian and military purposes was not associated with a better opinion of the United States.

Bendavid, an infectious diseases physician and core faculty member of Stanford Health Policy, said that when he set out to conduct this research, he believed it would result “in a resounding thud” — that the “soft power” of health aid would have no impact on public opinion.

“For me, the notion that this program — hatched and headquartered in D.C. — would have impacts among millions in Nairobi and Dakar, seemed farfetched,” Bendavid said. “I was incredulous until all the pieces were in place.”

The ‘America First’ Agenda

The Trump administration’s “America First” agenda is calling for significant cuts to global health aid, particularly to the highly successful AIDS relief program, which was established by President George W. Bush. The administration’s budget, released in March, proposed a $860 million cut to the program; the President’s Malaria Initiative is facing a $331 million reduction in federal funding. That’s a decline of 18% and 44%, respectively.

The U.S. contribution to the Global Fund to Fight AIDS, Tuberculosis and Malaria would also decline by 17%, or $225 million, according to the Kaiser Family Foundation.

Yet beyond the reputational damage to the United States, such cuts could be a major setback to improving health outcomes in developing countries, the researchers said. After all, HIV knows no borders, and having more resilient health care systems is instrumental when facing public health crises, such as the Ebola outbreak in the Democratic Republic of Congo, Jakubowski said.

“The most direct impact of cutting the United States’ health aid allocations is the potential to undermine or reverse the progress that has been enabled by U.S. aid in curbing mortality and the spread of disease,” Bendavid said. “However, this study suggests there are also repercussions to the United States: the relationships the U.S. has built with recipient nations could also be undermined.”            

Other Stanford co-authors are Steven Asch, MD, MPH, professor of medicine, and former graduate student Don Mai.

Stanford’s Department of Medicine supported the work.

China is making a risky bet in the Middle East. By focusing on economic development and adhering to the principle of noninterference in internal affairs, Beijing believes it can deepen relations with countries that are otherwise nearly at war with one another—all the while avoiding any significant role in the political affairs of the region. This is likely to prove naive, particularly if U.S. allies begin to stand up for their interests.

In meetings I attended earlier this month in Beijing on China’s position in the Middle East, sponsored by the Carnegie-Tsinghua Center, Chinese officials, academics, and business leaders expressed a common view that China can avoid political entanglement by promoting development from Tehran to Tel Aviv. China may soon find, however, that its purely transactional approach is unsustainable in this intractable region—placing its own investments at risk and opening new opportunities for the United States.

Over the past three years, China has charted an ambitious future in the Middle East by forging “comprehensive strategic partnerships” with Iran, the United Arab Emirates, Saudi Arabia, and Egypt. This is the highest level of diplomatic relations China can provide, and Beijing believes these four countries anchor a neutral position that will prove more stable over the long term than that of the United States. China has also made massive investments in infrastructure throughout the region, including in Israel, where China is now the second-largest trading partner behind the United States.

China’s interests in the Middle East are both structural and strategic. Structurally, China needs the natural resources of the region, whereas the United States—now the world’s largest oil producer—does not. China is also seeking new markets to absorb its excess industrial capacity, and sees the Middle East poised for growth after decades of wars, woeful infrastructure, and popular discontent. Strategically, together with Russia, China is taking advantage of the uncertainty produced by ever-shifting U.S. policies, including zero-sum prescriptions for Iran and Syria that are unlikely to produce desired outcomes anytime soon. Regional governments in turn have welcomed China’s embrace, and its offer of investment without pressure to politically reform or respect human rights.

China’s President Xi Jinping previewed this more assertive Middle East strategy in a landmark address in Cairo three years ago. There, he declared that China does not seek a “sphere of influence” in the region—even while sinking nearly $100 billion in investments there through ports, roads, and rail projects. He alleged China rejects “proxy” contests—even while concluding a strategic partnership with Iran, the main sponsor of proxies in the region. And he warned against “all forms of discrimination and prejudice against any specific ethnic group and religion”—even while reportedly forcing 1 million Muslims into reeducation camps in China’s Xinjiang province.

Such contradictions can be maintained only so long as traditional U.S. allies in the region now welcoming Chinese investment allow them to be maintained. These U.S. allies do not shy from asserting their broader interests with Washington or expressing disagreement where policies diverge, and it is time they do the same with Beijing.

As the United States questions Chinese investment and intentions, particularly in the areas of technology and ports such as Israel’s Haifa, it can also challenge traditional allies as to whether they are granting China a free ride on what remains a largely U.S.-led security architecture. Such an arrangement should be as unacceptable to American partners in the region as it is to Washington. At the very least, these partners, together with Washington, can demand that Beijing utilize its emerging influence—particularly with Tehran and Damascus—to pursue measures that promote longer-term stability.

Read the rest at The Atlantic.

By Hal Benton, Seattle Times staff reporter

Karl Eikenberry is a retired Army officer whose two tours of Afghanistan duty — and later service as ambassador to that nation — left him keenly aware of the limits of U.S. military power.

As a soldier, Eikenberry launched the still-ongoing effort to build an Afghan military force capable of fending off the Taliban. As a diplomat, he was stationed at the Kabul embassy during President Barack Obama’s surge that would eventually push American troop strength in Afghanistan to more than 100,000 service members in an attempt to improve security.

“Americans and the world have rightly been disappointed with the results of our costly military campaigns in Iraq and Afghanistan in the 21st century. Hugely expensive, protracted … and damaging to our country’s prestige abroad,” Eikenberry said Thursday to a Town Hall audience in Seattle.

Read the full article in The Seattle Times.

In this New York Times opinion piece on the global implications of Trump's leadership, columnist Thomas L. Friedman quotes Larry Diamond who points out that Trump's presence in the White House encourages leader's in African countries, such as Museveni in Uganda, to rule as long and as brutally as they want.  

Read it here.