Determinants of income inequality over family development cycle: the case of Taiwan.
Migration and the urban labor market: a case study of Taipei.
Changing attitudes toward work and marriage: Turkey in transition.
Spatial aggregation in gravity models; pt. 3, two-dimensional trip distribution and location models.
St. Vincent and the Grenadines: yesterday, today and tomorrow.
Squatters, collective action, and participation: learning from Lusaka.
Forever gained: resettlement and land policy in the context of national development in Zimbabwe.
A socio-economic overview: Zimbabwe women.
Recommendations for a population research library in developing countries.
Selected annotated bibliography of population studies in the Netherlands, 1979.
Spatial structure of the population in a metropolitan area.
Rural nonfarm population: a guide to the literature.
Selected bibliography: international maternal and child health.
A bibliography on refugees; a selection with comments.
An annotated bibliography of rural development in Senegal: 1975-1980.
Community impacts of rapid growth in nonmetropolitan areas: a cross-disciplinary bibliography.
Sexuality and the disabled: an annotated bibliography.
The politics of sex education: bibliography of useful resources.
Selected annotated bibliography of population studies in the Netherlands, 1981.
Refugees: social, educational, and legal perspectives.
Food politics: a bibliography.
The politics of sexuality education: bibliography of useful resources, rev. ed.
Sexuality education programs for parents: bibliography of selected resources.
Religion and family life education; a selective, annotated bibliography.
Social and social-psychological consequences of migration: an annotated bibliography.
Labor mobility: a bibliography.
Selected annotated bibliography of population studies in the Netherlands, 1982.
Evaluating sexuality education programs: an annotated bibliography.
Adolescent fertility: an annotated bibliography of selected resources.
Thailand population research inventory, 1983.
Reading profile on population policy.
Reading profile on population law.
Legal abortion in Italy: 1980-1981.
In 1980 and 1981, there were 446,430 legal abortions performed in Italy. There were about 345 legal abortions/1000 live births in 1980 and 363 in 1981. About 1.6% of women aged 15-49 obtained abortions in both years. An analysis of the characteristics of Italian women who obtained abortion indicates that most were married (about 70%), aged 18-36 (74%) and had had at least 1 previous live birth (70-75%). In 1981, 88% of abortions were obtained in public hospitals; 58% were carried out at 8 or fewer weeks of gestation; and 78% were performed under general anesthesia. Only 20% were performed without an overnight stay in the hospital; and over 40% of women were hospitalized for 2 day or longer. Infection after the abortion was reported in only 0.3% of cases in 1981, and hemorrage was reported in only 0.27%. In 1981, between 43% and 84% of gynecologists (depending on the region of the country) declined to perform abortions on grounds on conscience. While almost 1/3 of all abortions are obtained by teenagers in the US, in Italy, only 3-4% are. This is closely associated with the fact that about 3/4 of legal abortions in Italy are obtained by married women, whereas in the US, the comparable proportion was only 22% in 1981. Because of legal requirement of a week's waiting period and written parental consent for minors in Italy, teenagers may be compelled to resort to illegal abortion or delivery of an unwanted child. Minors who do obtain abortions do so at a more advanced gestational stage than older women and this is even more pronounced in Italy than in the US. An outpatient procedure lasting only a few hours, the norm in the US, is still very much the exception in Italy. The goal of performing safer abortions at earlier stages of gestation has taken almost a decade to achieve in the US. It is logical to assume that such progress will be just as gradual in Italy.
The effect of legal abortion on teenage fertility in Trieste, Italy.
Abortion has been legal and publicly funded in Italy since 1978. However, unmarried women under 18 must obtain parental consent or written permission from their legal guardian or from a judge to undergo the operation. In this study an assessment is made on whether the recent law has had a particular impact upon the fertility of teenagers living in Trieste, a city of 250,000 inhabitants, located in northeast Italy. Data were obtained on 1st births among women aged 15-19 for the years 1977-81. 1st births were classified as: premaritally conceived, uncertain or postmaritally conceived. During the study period, the total number of births to Trieste residents fell from 1878 to 1326, a 29% decline. The number of out-of-wedlock births remained quite stable and the number of postmarital cenceptions fluctuated. Marital births resulting from premarital conception declined appreciable from 66% to 51%. It seem s likley that the most relevant factor accounting for the overall decline in teenage fertility is the availability of legal abortion. The very high legal abortion ratios for all women of reproductive age further confirms this hypothesis. The ratios are particularly high among younger teenagers, who had just over 2 abortions, an average, for every live birth in 1980 and 1981. The estimated age-specific abortion rates for woman aged 15-19 living in Trieste are very much higher than the 1981 rate for Italy as a whole. The historical and geographical nature of Trieste may, to some extent, help explain why Trieste women resort to abortion more frequently than other Italian women. When it was an important seaport, Trieste was an affluent city, but today most citizens view its decline as irreversible and consequently try to enjoy the present. Couples have only 1 child not expecting life to improve for the future generation. The trend also probably reflects the enhanced capability of young women to assume control over their reproductive lives. Voluntary interruption of pregnancy is sought by those who feel not yet ready to start a family or to marry the father.
Public funding of contraceptive, sterilization and abortion services, 1983.
In 1983, the federal and state governments spent US$340 million to provide contraceptive services--4% more than they spent during the previous year. Title X of the Public Health Service Act, still the leading source of funding accounted for US$117 million, or 34% of all public expenditures. Almost as important was the US$108 million (32% of total expenditures) provided through Title XIX of the Social Security Act (Medicaid). 2 block-grant programs--Social Services and Maternal and Child Health--provided US$38 million and US$19 million, respectively; together the 2 were responsible for 17% of public support for contraceptive services. State governments, which spent US$58 million of their own revenues, provided an additional 17% of funding. Some public expenditures for contraceptive services were made in all states. Nearly all of the 4% increase in total public funds between 1982 and 1983 was due to a 15% rise in Medicaid reimbursements. The federal and state governments together spent US$69 million to provide about 73,000 sterilizations in 1983. 90% of sterilization expenditures were made by the federal government--86% through the Mediciad program. In addition, the states and the federal government spent US$71 million to provide 216,000 abortions in 1983. Unlike public funding for either contraceptive services or sterilization, almost all of the funding for abortion came from the states rather than from the federal government. (author's modified)
Anthropological research methods were used to elicit valid data on health beliefs and practices concerning diarrhea among a rural population in Swaziland. Indigenous health practitioners were relied on heavily as sources of information and to observe behavior 1st-hand whenever possible. A general description of Swazi health beliefs is presented, followed by a detailed look at the 3 traditionally recognized forms of childhood diarrhea. Participant-observation research indicates that most Swazis believe the traditional explanantion for disease causation (sorcery-induced), yet many or most refer to modern explanations in survey interview situations. Open-ended interviews with healers revealed 3 traditionally recognized types of infant diarrhea. Although their symptoms overlap, they are viewed as separate syndromes with different causes, cures, and potentials for prevetion. "Umsheko" is regarded as natural, of brief duration, nondehydrating, and caused by diet, teething or mild fevers. Diarrhea initially diagnosed as "umsheko" can later be diagnosed as "kuhabula" or "umphezulu" if it persists and if symptoms such as sunken fontanelles appear. Enema is used as a treatment method for the more serious form of diarrhea, thereby contributing to dehydration. Most healers recommended that babies be brought to them by at least the 2nd or 3rd day of diarrhea and implied that a clinic should be a last resort when and if traditional medicines fail. A minority of mothers take their children directly to a clinic at the 1st signs of diarrhea, a behavior encouraged by a minority of healers. Implications for health education efforts are offered. In particular, 2 groups should be primary targets for such efforts: traditional healers and mothers. Finally, it is argued that adoption of oral rehydration whould not be met with great obstacles in view of the similarity between oral rehydration solutions and traditional anti-diarrheal herbal teas.
Population policy and trends in China, 1978-83.
The period 1978-83 saw swift escalation of earlier policies to promote rapid fertility decline in China. The government tried to remove earlier pronatalist economic incentives and replace them with economic benefits to 1 child families and penalities for those bearing 2 or more children. China's family planning program became increasingly compulsory in tone and coercive in methods. Beginning in 1983 most provinces required women with 1 child to be fitted with IUDs and couples with 2 children to undergo sterilization of either the husband or wife. Local birth plans stipulate who is to have a baby each year, and abortion is used extensively to prevent births outside the plans. In January, 1983, 3.58 million sterilizations were accomplished nationwide, along with 3.25 million IUD insertions and more than 1.7 abortions. The lowest fertility rate, just over 2 births/woman, came in 1980. According to the 1982 national fertility survey, 1st children accounted for 47% of 1981 births, 2nd children 25%, 3rd and higher order births 28%. A reconstruction of China's population trends shows a natural increase rate of 13/1000 population for most years 1978-82, dropping to 11 in 1983, equivalent to a population growth rate decline from 1.3% annually to 1.1% far lower rates than found in almost all other developing countries. The urban population went from 17.9% in 1978 to 23.5% in 1983. 6% of the urban labor force was estimated to be unemployed in 1982. Rural unemployment is still not reported. Prospects for the 80's suggest that China's young population will keep the crude death rate below 9/1000, while the birth rate could drop to as low as 10/1000 if the government fully succeeds in attaining a total fertility rate of 1 birth per woman by 1990. If the rate in 1990 is 2 births per woman, the population will be growing at 1% per year. An appendix offers a computer reconstruction of population dynamics for China for the years 1949-84.
Value judgments and world views in sexuality education.
This essay argues the need for making distinctions between facts, values as subject matter (values as facts), value judgements, and world views when addressing the goals and methods of sexuality education. Facts are defined as empirically verifiable, but yesterday's facts, after new observations, can become today's myths. The study of a plurality of behaviors, historical contexts, and social standards in sexuality education makes values a portion of the factual base which the educator must consider and incorporate. Value judgments are personal and subjective, and underlie the selection and treatment of facts in a curriculum. The question is how to incorporate value judgment fairly. Value judgments often reflect world views--coherent bodies of belief which contain fundamental conceptions of self, society, and the purpose of existence. Since a world view is assumed to constitute reality, it is generally not questioned or articulated. The Shornack and Shornack/Scales debate on sex education exemplifies a conflict stemming less from factual sources than from fundamentally divergent world views. Examining such a debate reveals how each side has an opportunity to see its own unreflected assumptions about reality by noting the different metaphysical basis behind the other's argument. As with educati on in general, sexuality education should aim to develop skills of critical inquiry, to understand the hidden assumptions behind values and motivations, and to consider how authority in matters of sex is established and changes. Value judgments are an inevitable part of sex education, but a fair presentation of a plurality of viewpoints can help students begin to think critically about their own assumptions and to make efforts to forge their own point of view. This should be the primary goal shared by all sexuality educators, regardless of their own specific value judgments or world views.
[Family planning: political and social aspects]
[The fertility of young women in three survey areas]
Legal abortion examined: facts, figures and graphs for the United Kingdom and Europe.
The history of abortion in the Catholic Church: the untold story.
Final report: study of legislators' attitudes toward induced abortion.
Personhood, property rights, and the permissibility of abortion.
The purpose of this paper is to argue that the tactic of granting a fetus the legal status of a person will not, contrary to the expectations of opponents of abortion, provide grounds for a general prohibition on abortions. I begin by examining two arguments, one moral (J. J. Thomson's A Defense of Abortion) and the other legal (D. Regan's Rewriting Roe v. Wade), which grant the assumption that a fetus is a person and yet argue to the conclusion that abortion is permissible. However, both Thomson and Regan rely on the so-called bad samaritan principle. This principle states that a person has a right to refuse to give aid. Their reliance on this principle creates problems, both in the moral and the legal contexts, since the bad samaritan principle is intended to apply to passive refusals to aid; abortion, however, does not look like any such passive denial of aid, and so it does not seem like the sort of action covered by the bad samaritan principle. In defense of the positions outlined by Thomson and Regan, I argue that the apparent asymmetry between abortion and the usual type of case covered by the bad samaritan principle is only apparent and not a genuine problem for their analyses. I conclude with a defense of the morality of the bad samaritan principle. As several of my footnotes indicate, I have profited from conversations on this paper with many people. I owe particular thanks to Susan Appleton, Sonya Meyers Davis, Larry Davis, and Richard Wasserstrom for their comments on earlier drafts. (author's)
Minor consent in birth control and abortion: part 1.
Sex guilt and attitudes toward sex in sexually active and inactive female college students.
Pregnancy and parenting among runaway girls.
Ethnic variation in adolescent use of a contraceptive service.
This paper compares black, Hispanic, and white teenagers' experiences with a contraception service in New York City. Data were obtained from 3858 patients who made nearly 12,000 visits to the program during its first 3 years of operation. Patients' reasons for using the contraception facility, their visit patterns, clinic continuation rates, methods accepted, patterns of method utilization, as well as their pregnancy rates and intentions for pregnancy resolution are examined. Black patients had more clinic visits than white and Hispanic patients, and their duration of program contact was the longest. Several method preference differences existed among the three ethnic groups. Pregnancy rates while the patients were in contact with the program were highest among blacks, followed by Hispanics and then whites. Service delivery directions suggested by these findings are discussed. (author's)
1983 Congressional rating chart.
Statistical sources and resources.
Abortion experience overseas: a personal assessment.
The long-term effects of human sexuality training programs for public school teachers.
'Morality', class interests, and the population dilemma: the Sierra Leone case.
American family building strategies in 1900: stopping or spacing.
Contemporary populations frequently space the births of children, and also attempt to stop childbearing after achieving a desired family size. While stopping behavior was evident in European populations in the late nineteenth century, little is known about the degree to which they attempted to space their children at specific interval lengths. This paper compares spacing patterns among various groups of white U.S. women in 1900, who were distinguished by varying family sizes and levels of fertility control. On the whole, there is little evidence of childspacing differences among native white populations, except for some very low parity women. The findings support the continued analysis of age patterns of fertility as the major means for determining the onset of conscious family limitation. (author’s)
The laws enacted in 1982 are typical of the general legislative trend toward increasing the availability of, and support for, fertility-related services. Almost all legislative action taken in recent years regarding contraception and sterilization has been affirmative, and most states have repealed the numerous birth control restrictions and prohibitions that were so common before the mid-1960s. Even so, a significant number of state-imposed limitations on the availability of sterilization and contraception as well as abortion are still in effect. (excerpt)
The role of maternal diabetes in repetitive spontaneous abortion.
Improved fertility following ectopic pregnancy.
The limited moral significance of 'fetal viability'.
Bioethics in the People's Republic of China.
The incidence of intrauterine adhesions following spontaneous abortion.
Ectopic pregnancy early diagnosis limitations.
Sex education by school teachers.
Perceived barriers to sex education: a survey of professionals.
[The demographic conjuncture: Europe and the developed countries overseas]
Provides a brief text to accompany a set of international tables dealing with population totals, births, deaths, fertility, divorce, and abortion. (author's)
[Cultural demands and school attendance among Italians in France]
Rupture of the uterus after midtrimester prostaglandin abortion.
A new prospective on dysmenorrhea: the role of prostaglandins and prostaglandin inhibitors.
China's 'one-child' population future.
Induced abortion and fertility: a quarter century of experience in Eastern Europe.
[Surgical sterilization failure: a study of 290 cases]
Note on typology of abortion practitioners.
The international population-control machine and the Pathfinder Fund.
The psychodynamics of natural family planning and instructor- training.
Federal and state courts in the United States are in the process of making policy decisions about questions like the following: Should minors have the legal right to make their own family planning decisions? May states legislate parental consent requirements or some other form of parental involvement? Although some of Cruthfield's passages are tortuous, and although his argument is cloudy, it is clear that he favors fewer rights for minors and more rights for parents than the courts have allotted. It is also clear that he objects to the decisions by the United States Supreme Court (henceforth, the Court) in Danforth and Bellotti, although he approves of some of the commentary in the decisions. Because the Court is likely to be the final arbiter of policy disputes about minors' family planning rights, I will confine my remarks to Crutchfield's comments about the Court, especially as they pertain to minors' abortion rights. (excerpt)
Teen and preteen pregnancies in North Carolina, 1981.
Attitudes of religious leaders toward family planning and abortion in Thailand.
[National Survey of Family Planning 1976-1978]
[Evolution of the principal characteristics of contracepting women from 1964 to 1977]
Teenage pregnancy and adolescent sexuality: a partially annotated bibliography.
A description is given of a training program for rural community health promoters by the nurse trainer. 50 community members were selected by their communities to train and work as volunteer health promoters. Both sexes and numerous occupations were represented, including some traditional birth attendants. A practical training course lasting 2-3 days was held in the town of Santarem and several villages. The role of the promoters is to include promoting use of home rehydration for treatment if infant diarrheas, to prepare and administer oral rehydration solution and teach mothers to do the same, to encourage breastfeeding, to identify malnourished infants, to teach the community simple nutrition and sanitation measures, and to support the work of the Rural Health Attendant. Training methods include demonstrations, socio-drama, discussions and posters. Topics covered include identifying danger signals and cases of diarrhea and dehydration, solution recipe, local ingredients and measuring instruments, administration of solution, follow-up measures, and discussion of traditional practices and their potential dangers. Use of home rehydration of health promoters is appropriate technology in this geographic area; monitoring of the project reveals that home use of oral rehydration solution is safe, acceptable and effective.
[Travelling together: an experience in sex education in the area surrounding Sao Paulo]
This study describes group discussions of female sexuality held in a Sao Paulo Mothers' Club for the purpose of educating participants and producing educational pamphlets for publication. The participant research methodology is an attempt to integrate feminism with academic practice; the research is to be used to improve the condition of the research subjects and the research process itself is seen as educational. Participants were 8-15 low-income housewives 25-33 years old, with low level reading skills. In a series of discussion meetings, topics of interest identified included the physiology of the human body, sex education of children, and methods of contraception. Drafts of pamphlets and illustrations were presented for the immediate feedback of the group. Additional topics included the role of women in the family and society, women's rights, traditional class beliefs and myths about sexuality, medical care and examinations, and self-examination. 5 pamphlets and an accompanying manual for their use were produced for distribution to women's groups throughout Brazil. These include: Understanding Our Body; Do I want to be a Mother?; When Children Ask Certain Things; A gynecological Exam; and Much Pleasure.
The energy trap: work, nutrition and child malnutrition in Northern Nigeria.
This monograph is based on a doctoral research thesis presented to Sussex University (U.K.) and on additional material generated while the author was a Visiting Fellow at the Institute of Development Studies at the University in the latter part of 1981. It examines the distribution and determinants of worker energy expediture, household energy availability from farm product, household and individual energy intake and protein-energy malnutrition (PEM) in children. It is based on data collected in the village of Dayi in Northern Nigeria. These aspects of energy production and allocation are integrated into the concept of an "energy trap" using the determinants of family structure and asset holdings as suggested by various models of peasant and household economics. A sample of households is classified expost using the position of the household head in the farm labor market, asset ownership and occupational class. Poor workers, compared to the rich, had a higher seasonal energy expenditure and produced a smaller quantity of available energy from farm product/unit of their energy input. Energy intake of poor male household heads when related to seasonal energy expenditure was lessthan that of the rich heads: analysis of 2ndary information shows that richer families had higher energy intake year round on a per family member basis. Energy intake within the family was found to be unequal, with male adults receiving higher intakes than female adults, and adolescents receiving more than infants and children. The nutritional status of rich and poor children was similar; economic advantages for the rich children may be mitigated by the fact that they were, on average, later birth order children and, in polygamous households, more exposed to infection. The extent and existence of an "energy trap," whereby workers and families might be denied accumulating surplus, so keeping them poor, is discussed with implications for rural development policy. The 'trapped' perceive that they cannot, on their existing production function, transform enough energy into income to create surplus over subsistence, and that they will never do so without a major structural change. An energy trap may operate seasonally. Increasing farm production and rural incomes is an essential part of stabilizing food security. Policy interventions should consider the cropping patterns of the poorer farmers in the village. A higher income for women is expected to lead to higher rich food consumption by children. Health clinics, and a good water supply are important in rural communities.
Improving the coordination of care: a program for health team development.
This workbook of task-oriented activities is aimed at helping any group of health workers and/or administrators responsible for the delivery of health care to do its job in the most effective way possible. The program focuses on specifically defining tasks and procedures for doing them. It requires 7 3-hour periods to complete and requires no outside consultants, facilitators or specially trained helpers. This book contains an introduction, guidelines for administrators regarding its use; guidelines for users, and 7 recommended task-oriented modules. Topics include: defining and clarifying goals; setting measurable performance objectives; defining and allocating responsibilities; negotiating day-to-day conflicts; making more efficient and effective decisions and referral procedures; and increasing results for time spent in meetings and case conferences. Each module is designed around a common format which specifies desired outcomes expected from a session and the pre-meeting preparation required. Each gives an overview of major activities, provides an introduction to the module, an outline of the team meeting and a series of summary comments. 6 optional modules cover specific work issues: 1) bringing a new member into the team; 2) running a better meeting; 3) improving leadership and team interaction; 4) identifying and eliminating behavioral habits that hinder the team's work; 5) improving interaction with the rest of the organization; and 6) obtaining feedback from patients.
The twinning of institutions: its use as a technical assistance delivery system.
This paper presents the concept of "twinning" of institutions and its use as a technical assistance delivery sytem. Twinning is the professional relationship between an operating entity in a developing country and a similar but more mature organization in another part of the world. It is a very effective way to transfer know-how, train staff, and build up management capabilities. An operating entity offers advantages of complementarity and flexibility by supplying technical assistance and using its own resources to offer services to its twin, as needed, in the functional areas in which they both work. Design issues are discussed such as the substance of the assignment, design of the services, logistical and administrative support and behavioral factors. The paper also reviews factors to be considered in determining whether twinning is the most appropriate technical assisatance delivery system in a given situation, and provides an outline of possible contractual arrangements. The effectiveness of twinning depends on understanding what it has to offer and what its limitations are. Included is a description of the twinning concept, administrative design and staffing, and a list of things to consider in a twinning arrangement. Annexes list preliminary inventory of sources of technical assistance through twinning and on outline of possible contract provisions. (summaries in ENG, FRE, SPA)
Accelerated development in Sub-Saharan Africa. An agenda for action.
This report highlights the severity and complexity of the problems facing many of the countries of Sub-Saharan Africa in their efforts to raise the living standards of their people. It accepts the longterm objectives of African development as expressed by the heads of state of the Organization of African Unity in the "Lagos Plan of Action." If these objectives for the year 2000 are to be achieved, actions must be taken to reverse the stagnation and possible decline of per capita incomes which are projected for the 1980s. More efficient use of scarce resources--human and capital, managerial and technical, domestic and foreign--is essential for improving economic conditions in most African countries. The World Bank proposes a number of incentives and institutional supports for production, particularly in agriculture. The public sector will have to meet the extensive needs for infrastructure, education and health. The efficient provision of these services will place enormous demands on administrative and managerial capacity. African governments should not only examine ways in which public sector organizations can be operated more efficiently, but should also examine the possibility of placing greater reliance on the private sector. The managerial capacities of private individuals and firms can respond well to local needs and conditions, particularly in small-scale industry, marketing and service activities. The report includes: 1) a general introduction on the present economic crisis, the sources of lagging growth, new priorities, adjustments in policy, longrun strategies and donor policy; 2) basic constraints; 3) external factors such as balance of payments deterioration, terms of trade, export growth and prospects for 1980s; 4) policy and administrative framework in trade and exchange rate, economic decision making, organization and management, and the size of a government; 5) policies and priorities in agriculture indicating trends in agricultural development, action for rural development, improved incentive structures, reform of price, marketing and input supply policies, agricultural research and extension, and irrigation policies. Human resources and other productive sectors are examined such as industry, nonfuel minerals, energy, transport and communication. Longer term issues are population, urban growth, resource planning and regionalism. Also discussed is external assistance including the need for increased aid, donor policies, and the effect of higher aid and policy reform on economic prospects.
Toward sustained development in sub-Saharan Africa: a joint program of action.
This report recommends domestic policy reforms to accelerate growth in sub-Saharan Africa. Better use of investment--both domestic and foreign is the key issue. This requires an accurate management capacity in the government supplemented by technical assistance. The growing debt services burden of Sub-Saharan Africa is analyzed in the context of overall requirements for foreign exchange. Attention is drawn to the longterm constraints on development and population growth, human resource development, technological change, and the erosion of natural resources. Needed are proposed national economic management programs for the formulation of rehabilitation and development by African governments; donor programs and aid coordination, consultative groups, United Nations Development Program roundtables, and other similar meetings should aim for more explicit and monitorable commitments by recipient governments and donors to implement their respective responsibilities under an agreed program of action. Other recommendations for action include external support for reform programs, especially provision of adequate, timely, and sustained financial assistance to program of major economic reform. Public expenditure programs should give greater emphasis to rehabilitation and maintenance of existing infrastructure in support of policy reform rather than to investment in new capacity. Development should emphasize of formulation of low-cost, efficient and well-targeted programs in education, health, population and agriculture and forestry. The prospective decline in net capital flows to sub-Saharan Africa from US$11 billion to US$5 billion is inconsistent with the program of action for tackling the crisis in Africa, with the need for reorientation of policies, and with the resumption of sustained development. Charts and tables provide data on: 1) the deepening crisis in view of per capita output, the deteriorating external environment, debt servicing problems and external capital flows; 2) the roots of the problem, in particular the growth of per capita income, the proliferation of nonviable projects and reasons for low returns on investments; 3) longterm constraints on population, health, education, human resources, agricultural research and conservation. Also discussed is managing policy reform with a program of incentives, public sector reforms, public expenditure programs, and an assessment of recent progress.
Breastfeeding versus infant formula: the Kenyan case.
An Infant Feeding Practices Study (IFPS) in 1982 in Kenya, which included a cross-sectional survey of a weighted sample of 980 low and middle income Nairobi mothers who had given birth in the previous 18 months, found that most women breastfeed their infants for long periods, but many introduce alternate feeding, especially infant formula, in the 1st 4 months (86 and 50% of the infants were breastfed at 6 and 15 months respectively, but 50% of the 2 month-olds and 63% of the 4 month-olds were receiving substitutes, mostly formula). This is done largely out of the belief that infant formula is an additional health benefit. A workshop to discuss the findings of the IFPS and other available data, and to make policy recommendations urged the adoption of a policy of protection, support and promotion of breastfeeding. Since breastfeeding is already widely prevalent in Kenya, protection of breastfeeding should receive the 1st priority in policy related to infant feeding. Attention should be directed at at least 2 influences which help undermine breastfeeding: widespread availability and promotion of breast milk substitutes. Support for breastfeeding is viewed as the 2nd policy priority. Situations where support can play a helpful role are, women's paid employment outside the home, hospital practices, maternal morbidity, and difficulties in breastfeeding. Since promotion is the least cost effective of the 3 options, and most Kenyan women are already motivated to breastfeed, this should be the last priority. Promotion includes reeduction of mothers to make them better aware of the benefits of breastfeeding. The workshop recommended the dissemination of appropriate information, consisting of standarized messages based on clearcut guidelines, using mass media techniques.
Use of microcomputers for preparation, execution and analysis of surveys: a review and a proposal.
Preparation and execution of surveys is usually a labor intensive task which requires extensive training, conscientious workers and experienced supervision if the error rate is to be kept within acceptable bounds. Once entered into the computer, the data analyzed using statistical software. Until recently the size of data sets and the availability of suitable software have forced the researcher to use main frame computers. Problems arise because the computer resource is usualy outside the control of the users. The microcomputer promises to remove some of these problems. Microcomputer refers to the single user machines currently presented by Apple, IBM PCs, Sirius, DEC Rainbow. This paper discusses the role of specialized user groups in facilitating development of user skills. A Special Interest Group (SIG) was set up in Canbarra, Australia by those interested in using microcomputers for the preparation, execution, and analysis of surveys, or for other statistical analysis. SIG would act as a clearinghouse for information, and undertake preparation of a standard format of statistical packages, followed by transcription of information from available sources. A list of 36 statistical packages compiled from their suppliers is included.
The objective of this study is to determine the effect of cause specific death rates on age specific death rates for Tamil Nadu rural females during the period 1970-75 in various age groups. 2 regression lines have been fitted. The age specific death rates were taken as dependent variables and time as an independent variable; the age-cause specific death rates were dependent variables and time was an independent variable. In the analysis, the ratio of regression coefficients of 2 regression lines gives the effect of age specific death rates due to the j-th cause in the i-th group. The trend of mortality in the age groups (0-4) and (5-14) declines over the period 1970-75 and increases in the age groups (15-34), (34-54) and 55 and older. The causes of declining mortality in the 0-4 age group are cough, fever, other clear symptoms and other causes. The %s of contribution for this decline are respectively 14%, 41%, 21% and 72% to the overall decline in that age group. The cause group violence and injury, digestive disorders and causes peculiar to infancy have contributed to increase in the 0-4 age group death rates. Digestive disorders, coughs and other causes have contributed to declining mortality in the 5-14 age group. The cause group accidents and injury, digestive disorders, other clear symptoms, child births and pregnancy and other causes are promoted to increase the mortality of the 15-34 age group. The causes contributing to the increasing trend of mortality in the 35-54 age group are violence and injury, digestive disorders, coughs, other clear symptoms, child births and pregnancy. Digestive disorders and other causes contributed to the mortality increase in the over 55 age group.
A future perspective of one-child family norm in China.
In 1967 zero population growth (ZPG) was 1st mentioned as a population policy goal. 12 years later in 1979, China put the 1-child mode into practice to achieve the goal of ZPG. This paper discusses: the reasons for adopting the 1-child family norm in China; differentials in carrying out 1-child family policy; estimating the controlled age specific fertility rates under 2-child family norm and its variety; identifies some implications of the 1-child after obtaining the ZPG goal in terms of the changing population size, the sex ratio at birth, the age structure, the loneliness of the child and kinship relations and some ensuing economic implications. The paper also highlights the main difficulties in adopting 1-child policy and visualizes a possible time for stopping it. It is concluded that the fertility of women must be at the replacement level after the attainment of ZPG for China's population. The introduction of the 1-child family by 1985 would produce a peak population of 1.054 billion by the year 2004 and would reduce the population to 960 million (the 1980 figure by 2028, and to 370 million by 2080. These figures suggest that the 1-child model may be an expedient model to arrest population growth in the future. If it is carried out indefinitely, however, the population will ultimately become extinct. Preference for male children is predominant in China, especially in the rural areas. There is, however, a general tendency for gender balance. The sex ratio at birth is higher for the 1-child model. The sex ratio at birth not only depends on birth order, but also on age and other characteristics of the couple. The 1-child model is a partial solution to the world resource problem. Another advantage of the 1-child model is reduction in expenditure on consumption. Nationwide surveys in the USA indicated that 76% of respondents felt that being an only child is a disadvantage as far as the child's psychological disposition.
This article gives numerous examples of bombings of abortion clinics all over the country illustrating that the controversy over abortion has taken a destructive turn. The National Abortion Federation (NAF) reports that in 1984, there were 24 incidents of arson and bombings of abortion facilities in 7 states and in the District of Columbia. Since 1982, damage from bombings and fires has cost well over US$2 million, and that does not include damage resulting from vandalism. Clinic bombings have become so frequent that President Reagan, despite his strong antiabortion position, issued a statement condemning "in the strongest terms those individuals who perpetrate these and all such violent, anarchist activities." He asked the attorney General to see that "all federal agencies with jurisdiction pursue the investigation vigorously." Currently, the Bureau of Alcohol, Tobacco and Firearms is in charge of the investigations of the clinic bombings. Just as the violence has escalated, so have picketing and harassment of abortion clinics and patients. According to NAF, 157 clinics reported being targets of antiabortion demonstrations in 1984 compared with 61 in 1983. Many protesters engage in what they call 'sidewalk counseling' which involves such activities as displaying color photographs of dismembered fetuses, screaming at the women not to murder their babies, displaying gruesome placards covered with doll's arms, legs and torsos splattered with red paint and labeled 'Pro-choice Meats' and photographing women entering the clinics. The approach is sponsored by Catholics United for Life (CUL). Antiabortion groups insist that such tactics are necessary because abortion providers fail to give women complete information about abortion. Abortion clinic executive staff, however, claim that patients are given extensive counseling to ensure they make correct decisions. According to a recent poll, 72% of Americans think antiabortion picketers should not stand in front of clinics and interfere with women entering. Despite the freedom of speech provisions in the 1st Amendment giving protesters the right to picket and conduct peaceful demonstrations on public property, clinics in at least 13 states have obtained injunctions prohibiting protesters from engaging in activities not protected by the Constitution, including harassing patients, or photographing or videotaping them. Court orders restricting such activities are based on the recognition that the right to free speech sometimes conflicts with patients' rights to privacy and providers' rights to conduct business without undue interference. Some activist leaders say they have a religious duty to disobey the laws of man that conflict with the laws of God.
Welfare effects of international migration.
Impact of a regional infant dispatch center on neonatal mortality.
Preovulatory follicular size: a comparison of ultrasound and laparoscopic measurements.
In vitro fertilization: the challenge of the eighties.
Subclinical abortions in patients treated with clomiphene citrate.
Immigration law and the revitalization process: the case of the California Sikhs.
The political history of Kampuchea in the decade of the 1970s is characterized by successive waves of civil war, revolution, and invasion. The demographic history of this same period is characterized by excess mortality from war, from massacres and executions, and from famine; by forced migrations and flight of refugees; and by greatly reduced birth rates. Focusing on the period since the defeat of the Lon Nol government by the Khmer Rouge in 1975, this article pieces together available data on the impact of the years of political and social upheaval on demographic trends in the country. The end-of-year 1979 Kampuchean population is estimated at between 5 and 6 million inhabitants--5 million less than the figure projected for 1979 in 1970, assuming normal conditions. (author's)
Children's work activities in Malaysia.
[Observations on the evolution of rural and urban population in Brazil in the period 1940-1980]
[Profile of the female labor force in the state of Sao Paulo-- 1950 to 1976]
[Recent aspects of population dynamics in urban Amazonia]
Family planning clinic services in the United States, 1983.
Almost 5 million women were enrolled in family planning clinics in the US in 1983, 8% more than in 1981. The number of family planning provider agencies declined slighty, from 2504 to 2462, but the number of clinic sites that could be identified increased slightly, from 5124 to 5174. Family planning clinics operate in 3/4 of US counties; in 1975, the last time county coverage was checked, 4/5 of the counties had clinics. About 1 in 20 women who are exposed to the risk of unintended pregnancy and live in unserved counties are teenagers or low-income women. Nonmetroploitan counties are more likely to be without clinics than are metropolitian counties. Overall, there are 417,000 low income women and 249,000 teenagers at risk of unintended pregnancy living in counties where there are no family planning clinics. In 1983, health departments constituted 6 in 10 of all family planning clinic patients; Planned Parenthood affiliates accounted for fewer than 1 in 10 agencies and served more than 1/4 of all patients. Hospitals and all other agencies served about 1/3 of the total 1983 caseload. These patterns were similar to those reported for 1981. Family planning clinics continue to serve primarily low-income women: 4/5 of the nearly 5 million clinic patients in 1983 had family incomes below 150% of the federally defined proverty level. About 1.6 million women aged 19 and younger were served, representing 1/3 of all clinic patients in 1983. Overall, 44% of all low-income women and 31% of teenage women exposed to the risk of unintended pregnancy are served by organized family planning programs. The majority of women who obtain contraceptive services from family planning clinics choose the most effective medical methods: nearly 3/4 of the 1983 patients were using the pill or the IUD at the time of their most recent clinic visit. (author's modified)
Margaret Sanger, as a young public health nurse, witnessed the sickness, disease and poverty caused by unwanted pregnancies. She spent the rest of her life trying to alleviate these conditions by bringing birth control to America. During the early 20th century, the idea of making contraceptives generally available was revolutionary. Contraceptive usage was considered a distinguishing feature of the 'haves.' In recent years, some revisionist biographers have portrayed Sanger as a eugenicist and a racist. This view has been widely publicized by critics of reproductive rights who have attempted to discredit Sanger's work by discrediting her personally. The basic concept of the eugenics movement in the 1920s and 1930s was that a better breed of humans would be created if the 'fit' had more children and the 'unfit' had fewer. This concept influenced a broad spectrum of thought, but there was little consensus on the definitions of fit and unfit. In theory, the movement was not racist--its message intended to cross race barriers for the overall advancement of mankind. Most eugenicists agreed that birth control would be a detriment to the human race and were opposed to it. Charges that Sanger's motives for promoting birth control were eugenic are not supported. In part of her most important work, "Pivot of Civilization," Sanger's dissent from eugenics was made clear. By examining extracts from her books, the author refutes the notion that Sanger was a eugenicist. Another unsupported argument raised by the anti-Sanger group was that Sanger, in her position as editor of "Birth Contol Review," published eugenicists' views. It would be more accurate to say that the review covered a wide range of opinions and research; the eugenicists views were included because they conferred respectability. David Kennedy, author of "Birth Control in America," does Sanger a grave injustice by falsely attributing to her the quotation: 'More children from the fit, less from the unfit--that is the chief issue of birth control.' This quotation should be attributed to the editors of "American Medicine." The only area Sanger is in agreement with the eugenicists is in her belief that severely retarded people should not bear children. Several authors, including Linda Gordon, argued that Sanger's interest in providing contraceptives to black Americans was motivated by racism. This notion is entirely misconstrued by distortions of language quoted by Sanger. Rather than wanting to exterminate the Negro population, Sanger wanted to cope with the fear of some blacks that birth control was the white man's way of reducing the black population.
Fecundity and infertility in the United States, 1965-82.
In 1982, about 1/2 of all American married couples with wives in the childbearing ages were currently sterile or had some childbearing impairment. Almost 8 million of these couples were voluntarily sterilized because they had had all the children they wanted. However, another approximately 6 million couples were unable or unlikely to have additional births. This figure includes about 1.4 million couples who were childless. These and related statistics on fecundity and infertility in the US are from the National Survey of Family Growth (NSFG), most recently conducted in 1982 by the National Center for Health Statistics. This report presents preliminary nationwide statistics on the fecundity status of all women of reproductive age in the US regardless of marital status and reports the latest data on trends in fecundity and infertility among married couples. The 1982 NSFG was based on personal interviews with a national sample of 7969 women (15-44 years of age) in the noninstitutionalized population of the US. 3201 black women and 4768 nonblack women were interviewed. Focus was on the respondent's fecundity; past and current use of contraception; marital and pregnancy history; use of family planning and infertility services; labor force participation; and a wide range of social, demographic and economic characteristics. Women were classified into 3 major categories: surgically sterile, impaired fecundity and fecund. Surgically sterile women were further divided into contraceptively and noncontraceptively sterile. 8% of women were classified as surgically sterile for noncontraceptive reasons, 2%, as nonsurgically sterile and 5% as subfecund. Women who were continuously married, did not use contraception and did not become pregnant for 36 months or more were classified as having a 'long interval' and constituted 1% of all women. 8% had impaired fecundity (women classified as nonsurgically sterile, subfecund or having a 'long interval'). 94% of never married women were classified as fecund compared with about 51% of currently married and 55% of formerly married women. In 1982, the proportions of couples in both categories of surgical sterilization increased with age and both were greater among couples with children than among childless couples. The % of married couples who were contraceptively sterile increased by 1/2 from 1976 to 1982. Changes in the % of infertile women between 1976 and 1982 generally were not statistically significant, except for the decline among women 40-44 years of age. However, during the period 1965 and 1982 there was a decline from 11 to 8%. The decline in infertility among older women and overall is the result of the increase in surgical sterilizations.
Populism and health policy: the case of Community Health Volunteers in India.
The Indian Community Health Volunteer (CHV) scheme is a major large-scale experiment in people's participation in primary health care. This study explores the origins, formulation and decision making process, and implementation of this program. The evolution of the CHV program is a particularly striking example of the contradictions of participation policies in a populist regime. Data supplied for assessment shows serious discrepancies between the initial objectives of the reform and the actual functioning of the systems it set up. Popular participation has not been fully realized; the priority given to collective preventive action seems to have fallen aside in the day-to-day work the volunteers do. Political awakening of the rural masses makes it absolutely necessary to take action so as to redirect a portion of state interventions for their benefit. But the determining influence of the dominant classes, in both political apparatuses and intermediate level bureaucracy of the state apparatus, tends to divert most of the state resources from their initial object, while inevitable reforms are constantly delayed. The development of a popular participation policy would seem to be the necessary complement to reform policies for the health center. Yet the implementation of this policy can be realized only through the intermediary apparatuses which must be verified and reoriented. Participation policy is thus distorted in order to reinforce the patronage capacities of existing political apparatuses. In the case studied, this vicious circle of participation was triggered and reinforced by 3 distinct types of factors: the weakness of the health center's impetus, the federal structure of the Indian State, the weakness of the political organizations and their lack of coherent political strategy in social matters. In its present configuration, the CHV program would appear 1st as an effort to constitute a poor-people's medicine circuit, answering the aspirations awakened by a populist political system, and much less the springboard for collective mobilization of communities in order to master their own development. As a whole, the order of priorities has been deeply altered in the course of implementation. The curative action took precedence over the preventive, and individual action over the collective. This distortion could be explained both by the prevalence of clientelism and patronage as modes of political control and by the nature of people's demand. The CHV program does not appear to be the 1st step towards radical transformation of health institutions, nor is it the beginning of active popular participation. It is a very limited answer to the populist demand of front line health care.
This book provides information and guidelines for health professionals on men's reproductive health concerns. A broad definition of men's reproductive health is adopted encompassing the anatomy and physiology of the reproductive system itself, whether or not the individual wishes to reproduce; sexuality, sex roles, and the male self-image; sexual and reproductive health-related behaviors; and fertility control. Urology, traditionally being the medical specialty dealing with men's sexual and reproductive health concerns, offers an important contribution to the work. This book is also aimed at the generalist; it brings together in 1 volume information on men's needs collected from areas of urology, nursing, occupational health, family planning, sexuality, psychology and sociology. Although this book mainly addresses men's reproductive health, it does not exclude women entirely. The information presented in many instances concerns women as well as men, since sexual and reproductive health, by its nature, involves a partner. Sexual, contraceptive, and reproductive concerns, disorders, or discontentment may well have effects on partners, relationships and families. As part of the section on the male reproductive system and its disorders, the following areas are discussed: sexual development during adolescence; sexually transmitted diseases; male infertility; sexual and reproductive effects of pharmacologic agents; and environmental and occupational reproductive hazards. A social and historical update is presented on men and family planning. Condoms, withdrawal and vasectomy are discussed as contraceptive methods. Male socialization and sexual malaise, diagnosis and management of organic male sexual dysfunction, behavior treatment and counseling on disability illness and aging are given consideration in the final section.
Abridged life tables for Pakistan based on the 1971 population growth survey.
A new set of abridged life tables for Pakistan is presented. Data from the 1971 Population Growth Survey were 1st analyzed to estimate the degree of completeness of the reporting of male and female deaths; female deaths were substantially more underreported than male deaths. Age-sex specific mortality schedules were adjusted accordingly. Life expectancy was around 50 years at birth, but increased by 8-9 years for those surviving the substantial risks of dying in the 1st year of life. No significant sex differential in mortality could be discerned from the life tables. The present life tables exhibit mortality levels which are very similar to those observed in the life tables based on the 1962-64 Population Growth Estimation data. The only exception in the present life tables is the lack of a significant improvement in female mortality beyond the reproductive ages possibly because the extent of underreporting of femal deaths found in the 1971 Population Growth Survey was substantially higher than that for males.
An assessment of community health workers in Nicaragua.
In 1981, the Ministry of Health of Nicaragua began a series of health campaigns whose front-line workers were vlounteers from the community called "brigadistas." Theses volunteers have since evolved into a type of community health worker with a multi-disciplinary role and are now called primary health care (PHC) brigadistas. They were formed with the intention of encouraging local community involvement in health and as a means of overcoming rural health manpower shortages. This paper describes the brigadista program from the perspective of research done in 2 communities in 1983. 2 weeks' observation of the program in an urban site gave the impression that it was an excellent way in which to supplement the overworked staff of the health center with voluntary labor. However, these brigadistas did not seem to be fulfilling the goals of the community health worker (CHW) model and appeared to be more nurse auxiliary extenders. In the same vein, the brigadista presence in the rural site studied appeared to be a very positive force in the village communities. Field research in both sites reveals that the PHC brigadistas studied have rather limited roles. Although they were found to be performing many important functions, particularly in the clinic setting, they seemed to do little community work on their own and their role appeared to be primarily that of nurse auxiliary extenders. A new scheme of PHC brigadistas has been developed which includes 6 different classifications of brigadistas and appears to amplify this role as a whole. Unresolved questions remain concerning the degree of administrative decentralization in this new scheme and the specific roles of the Popular Organizations and the Ministry of Health within it. Although underutilized at present, increasing training and expanding the role of brigadistas may be necessary to adequately meet rural health care needs. Needed changes would be implementation of longer training periods, referral mechanisms, on-going education and supervision and source of funding to pay the brigadistas. The full utilization of the brigadistas' potential is likely to play a key role in assuring health for the Nicaraguan people by the year 2000.
Birthweights in a rural Solomon Island population.
Records of 1088 consecutive hospital births in a rural unacculurated Melanesian population in the Solomon Islands were studied. The mean birth weight for single liveborn infants was 3100 gm (S.D. 453), and for all live births was 3065 gm (S.D. 486). The incidence of low birth weight as determined by 2 different standards; = to or than 2500gm and than the Mean--2 Standard Deviations, was 8.9% and 2.9% respectively for single liveborn infants and 11.5% and 3.2% for all liveborn infants. A high twinning rate of 1:33 and a high incidence of multiparity was found. Only 25% of births were primiparous. The birth weight was shown to increase significantly with increasing parity. (author's modified.
The Bulacan nutrition and health study: a summary report of a longitudinal study in infants.
A longitudinal study conducted from 1975-79 on 544 infants in the Bulacan Province in the Philippines to measure impact of health and nutrition interventions reveals that the choice of a nutritional index is important in evaluating the effectiveness of interventions, (education, and education with immunization, food, or sanitation). The food intervention consisted of Nutripak (rice, milk powder, bean powder, or fish powder) and was provided to furnish 1/4 of the energy and protein requirements. The sanitation intervention consisted of safe water for the infant through furnishing of a chlorine solution with instructions on proper use. Immunization consisted of BCG, DPT, and measles at appropriate age. Education consisted of lessons to the mother on a 1-to-1 basis. Subjects included malnutrition, breastfeeding, supplementary foods, feeding the sick child, meal planning, 1st aid, personal hygiene and sanitation. When % of standard weight for age alone was the index, food with education was most effective during weaning (5-11 months) followed by immunization with education. Education alone was effective throughout the intervention period (5-17 months) and follow-up (18-26 months) but education with sanitation was no more effective than education alone. When both height and weight were used in a nutritional index which best describes their relationship during normal growth in infants, food as an intervention proved highly effective as did immunization. The impact of education alone was less than noted when weight alone served as the index. In terms of cost-effectiveness, the index describing proper height and weight relationships during infancy revealed food to be the most cost-effective in early life (up to 11 months). The importance of body weight in early infancy as a good indicator of later performance was noted in Guatemalan infants. The socioeconomic impact on the height of infants is steady and persistent. The results confirm the importance of food and education.
Priorities in dealing with nutrition problems in Indonesia.
The objectives of this study of literature on the past and current nutrition situation in Indonesia are 1) to review the nutrition situation; and 2) to attempt to outline the priorities which should be adopted in dealing with nutrition problems in Indonesia. Until now there has been no comprehensive published report concerning the nutrition problem in Indonesia. Reports on nutrition problems from international agencies were based on limited data, short periods of observation, and often incomplete. Policy makers who have a growing interest in Indonesia's nutrition problems may be assisted by a comprehensive report on food and nutrition problems in this country. A major restriction in preparing this monograph was the limited time and data which were available. Many opinions expressed have been based on assumptions rather than on complete statistical data analysis. The 1st part of this study describes the nutrition problems and activities in the pre independence period (1888-1945). Nutrition problems encountered during this period are typical of the present situation: Protein Calorie Malnutrition (PCM), vitamin A deficiency, and goitre. Although Indonesia's independence was proclaimed in 1945, it was not until 1950 that public health and nutrition activities could be properly begun. Early independence days saw Indonesia's health condition as among the worst in the world. With the aid of various U.N. agencies (WHO, FAO, and UNICEF), nutrition research and applied programs have been instituted in Indonesia. Progress has been made particularly in reducing infant mortality. Today in Indonesia preschool children are most likely to be affected by PCM, vitamin A deficiency and nutritional anemia. In rural areas, 40-85% of women show signs of nutritional anemia, compared with 30-40% of men. Food supply in Indonesia has remained a serious problem. Food production has not kept up with population growth and there is an accelerating demand for rice. Heavy allocation of resources designed to promote rice production is shown to result in a neglect of the importance of other commodities. Priorities must be set and may be determined by 1)community concern for the problem; 2) public health significance; and 3) vulnerability to poor management.
This monograph was carried out in the state of Maranhao in Northeast Brazil. The document tells of problems in many areas of life and death. In Maranhao's total of all deaths, 47% occur before 5 years of age. Maranhao is also suffering a serious problem of malnutrition which is not recognized as a solvable problem and therefore has become an accepted way of life. People living in conditions like those of Maranhao have been reduced to "objects" by their situation. In order to regain their humanity they must cease to be "things;" nutrition education has a part to play in this humanizing process. Rather than coming from the top down, nutrition education starts with the people, growing out among them. The problem of using the education methods of Paulo Freire is discussed. Such educational methods reject communiques and embody communication, and regard dialogue as indispensible to the act of cognition which unveils reality and stimulates true reflection and action upon reality. Fieldwork was done in Brazil in 1974 to see if Freire's method, divided into investigation, outline of themes and codification and decoding of themes, could be applied to nutritional work in the small villages of Northeast Brazil. There were several disadvantages to this study: 1) there was no team to observe, examine and discuss; 2) there was no study to discover the thematic universe of the people, due to lack of personnel time; and 3) the coding of themes was limited by time. It is thought that projects such as this, as with all types of nutrition education in developing nations, are only interim solutions, providing slight alleviation while one waits for the real problems to be solved. The study showed that simple unlettered people can be involved in meetings about nutrition, becoming aware of the problem of malnutrition and determining to do something about it. A large proportion of homes in the village were represented at meetings. Posters used as coded situations led to discussion and realization that change can take place. The problem was recognized as a community problem and one which they could work on together. Responses did not seem to depend on previous experience with community organization or meetings.
In the wake of ever increasing world population, food shortages remain the world's most pressing and urgent problem. Although a nation may be self sufficient in its own domestic food production, nutritional problems cross social, economic, and political borders. Hence, policy and planning in the area of nutrition requires interdisciplinary international cooperation and a global approach. Efforts are limited, however, by lack of a coordinating body. While governments dedicate themselves to economic development, they must also dedicate themselves to improve the well-being of their people, including their nutrition, their health, and their quality of life. This paper is a summary report of a seminar held in Kenya at the Institute for Development Studies of the University of Nairobi in 1976, sponsored by USAID. The report includes short summaries of the sessions conducted by the seminar staff members. Some sessions were devoted to the salient nutritional problems of Africa and their complex causes, to sociocultural factors that influence the condition and its alleviation and to basic economic consideration relating to the cause and control of malnutrition and food shortages. More time, however, was devoted to planning and policy relating to nutrition. Participants formed working groups and prepared short reports on nutrition planning for Tanzania's Ujamaa villages, on nutrition activities and goals in Kenya, on increased wheat consumption and the trend toward bottle feeding in West Africa, and on nutrition activities in the Sudan.
Nutrition problems and policy in Tanzania.
This monograph provides a review of food and nutrition problems in Tanzania and a discussion of policies designed to deal with these. Protein Energy Malnutrition (PEM) has been recognized as a serious problem in the country and up to 30% of the children under 5 years of age suffer from its various forms. Additionally, endemic goiter, due to iodine deficiency, is common in some parts of the country. Iron deficiency is a common form of anemia in the country. Today, Tanzania places emphasis on prevention of disease and eradication of poverty. Nutrition improvement has been accepted as a priority in development. An essential element of such efforts is to have a well-defined national policy for food and nutrition. The purpose of this study is to put together available information and describe it in such a way that an understanding of the current situation can be obtained. The need for a National Food and Nutrition Policy has been discussed and a review of present national policies and their possible impact on nutrition is examined. A broad range of activities is being undertaken in Tanzania directed at the problems of malnutrition. Support is needed at all sectors. Malnutrition is closely related to poverty, hence, an increase in per capita real income of the poor can be expected to result in the improvement of their nutritional status. While pursuing programs to improve overall socioeconomic status, direct nutrition and health programs will benefit a sizeable proportion of the population. Still, the ability to execute the right programs requires that all concerned are well informed and that we keep vigil of the nutritional situation.
Nutrition in policy planning for the rural sector.
This mongraph addresses the need to include nutrition in development planning and attempts to describe the interaction between agricultural and food policies on family nutrition. In this study, malnutrition is defined as 1 of 2 possibly concurrent manifestations: 1) undernutrition, the lack of sufficient food; or 2) deficiency, an inadequate amount of one or more essential nutrients. Historically, nutrition has been considered to have 3 different relationships to development: 1) as a problem that would be solved by the process of development; 2) when it became clear that malnutrition was still severe and perhaps exacerbated by development efforts, the economic consequences of malnutrition were emphasized; and 3) since this relationship is not clear cut, more emphasis was placed on the contribution of nutritional well-being to national welfare and to development. In the past nutritional impact of development policies has generally been ignored. There are 3 options for interfacing nutrition and economics: 1) to ascertain the direct economic effects of malnutrition; 2) to use nutrition as a tool to measure the welfare effects of policies; or 3) to integrate nutrition goals into development planning. This monograph also discusses the specifics of policy interactions on the nutrition of subsistance farmers in an attempt to illustrate the need for explicit consideration of nutrition in the choice of policies. Methods of describing the nutritional situation of groups of people is presented. The nutrient consumption model is chosen to illustrate its descriptive capabilities. An application of this model is summarized using data on the rural south of the US in 1965-66. The total nutrient model illustrated is an important method for possibly determining intra household distribution of nutrients. It also illustrates the low income elasticities of nutrients. Nutritional well-being will not be achieved by efforts solely to increase income. Therefore, nutrition must be included either specifically or implicitly in the planning process. Probably the best way to take account of nutritional impacts is to consider the general consequences of development plans. What is needed most is a desire and ability on the part of planners to pursue a holistic interdisciplinary approach to development.
This mongraph has 3 objectives: to report the physical growth of rural Kenyan children living in 2 fertile coffee growing villages in machakos district; to compare the growth of this kenyan population with sets of reference values for growth derived from healthy, predominantly Caucausian or East African Bantu populations and also with 2 studies of growth in rural Kenyan children; to compare different commonly available sets of growth references with each other, to determine the degree to which they differ, and to discuss the implications of these differences for the use of various growth charts. The anthropometric measurements include weight, height, mid upper arm circumference, and triceps skinfold thickness. The study sample consisted of preschool and primary school children 1-18 years of age who lived in 2 villages in Machakos between December 1975 and January 1980. The degree of growth stunting is remarkable and consistent for all age groups. The achieval growth of the rural Kenyan children was compared to reference values from the New National Child Services (NCHS) growth charts, with the Denver increments and with 3 studies on well-to-do East African Bantu children. Of more general importance to international nutrition is the comparison of various available growth references with each other. These include the Harvard Standards, the NCHS and the WHO growth charts. The data strongly support the view that ethnic differences are very much less important than other factors as causes of growth failure in children. Poverty, poor food intake, infectious and parasitic diseases and other environmental factors are some examples. The analysis shows that the WHO published references are not identical to the NCHS percentiles, but the differences may only be of some importance for research. The comparisons of the Harvard and NCHS references show relatively small differences and the differences in mean and median weights and heights of the Harvard, NCHS and WHO references are small. The Denver references provide growth increments whereas the Harvard and NCHS do not. All 3 studies show that priviledged children have weights and heights which are remarkably similar to the NCHS references at ages 3-13 years. In contrast, Bantu children from underpriviledged families show marked growth defects from 2 to 17 years of age. As far as East Africa is concerned, growth deficits in children appear to be a feature of deprivation and poverty rather than of ethnicity.
Household survey experience in Africa.
The purpose of this paper is to briefly examine the African household survey experience as well as the new plans for future surveys in relation to the prospects for improving the measurement of levels of living. The African Household Survey Capability Program (AHSCP) constitutes a major concerted effort to ensure an adequate flow of integrated data from the household sectors of the region. The technical and practical arrangements of the AHSCP proposed by the Conference of African Statisticians at its 8th session in 1973 were formulated by a regional working group in 1974 and since then has been elaborated and modified in the light of subsequent developments. Other bodies including the United Nations Statistical Commission supported the program. Its broad aims are to ensure that participating countries develop permanent field survey organizations and the necessary supporting facilities to obtain continuous supplies of integrated data on employment, other productive activity, income, consumption and expenditure, and related demographic and social characteristics. National priorities determine selection of topics. Topics which countries intend to investigate through household surveys are all directly relevant to levels of living and an integrated analysis of survey results is required to examine the interrelationships of household characteristics and variables. Special short term needs such as identification of groups of households affected by poverty can be met by data collection for selected indicators. However, such limited data should not be regarded as a substitute for more comprehensive information. Limited information does not identify vulnerable population groups and provide a basis for remedial action. Described are the attempts made in Kenya to collect and process data on a wide range of measures classified as social indicators and to disseminate the results in a manner that enables the analysts and policymakers to take into account the essential implications of development. The Experimental Survey of Household Budgets and Consumption in Senegal, conducted between 1973 and 1975 is reported on. The various problems of the survey, its methodology, questionnaires, field work, data processing and results are discussed briefly.
The FWV's [Family Welfare Visitor] register system.
The paper describes the recording process for the Matlab MCH/FP Project, based on clinical and field observations. Every working day the Family Welfare Visitor (FWV) writes on a sheet of paper all clinical services provided as well as pertinent information on clients. This information is transcribed into different registers. There is no formal recording process. The FWV decides on which recording process best suits her time constraints. Each fortnight the Child Health Workers (CHW) attend a meeting at the Subcenter Clinic at which time they request and receive medicines, contraceptives and other supplies. The supplies received are recorded at the back of the CHW's register as well as in some FWV's registers. Also, CHW's provide information on pregnant mothers and Family Planning (FP) droupout cases. This infornation is transcribed in FWV registers. Because of time constraints during the meeting, the FWV transcribes information after the meeting. Every working afternoon, except on CHW's meeting days, the FWV goes into the field. The different kinds of recording processes observed are discussed, followed by a list of compulsory and non compulsory registers, as well as a list of control registers on supply distribution and field supervision. Also included is a list of Paramedical Services Reg isters with a brief description of information recorded and the process by which it is recorded.
CHWs' meeting at the subcentre clinic.
This paper describes the working day at the Subcenter Clinic. The morning session is mostly reserved for data collection from the CHWs and completion of progress reports. Data collection includes collecting forms on each pregnant mother, lists of pregnant mothers, lists of complaints and side effects, lists of needed contraceptives, lists of contraceptive users, monthly family planning progress report, lists of family planning drop-out cases and lists of needed vaccines. Bi-weekly progress reports on maternal child health/family planning services are made using data from the CHWs' register and drom the forms completed for each pregnant mother. A bi-weekly progress report on oral therapy is made using information from Bari mothers and their register. A monthly contraceptive progress report gives a monthly picture of the subcenter performance on family planning motivation. The CHWs' register maintenance is supervised and technical and administrative problems are discussed among the staff as a peer review of family planning services. Preplanning of the bi-weekly working program for each FMV is undertaken. Supply distribution of iron supplement, aspirin supply, office and auxiliary supplies and contraceptives are recorded, each in a different register maintained by the FWV. The CHW takes 2 or 3 days to distribute the supply to her clients. After the distribution process, the CHW goes back to her normal routine of work.
Drug supply for the subcentre clinics and field program: Matlab MCH/FP project.
This paper contains 2 lists of the available drugs administered at 1) the subcentre clinic, and 2) the Matlab Clinic for the Matlab MCH/FP Project, Bangladesh. A list of 23 drugs, giving names, indications for use, person prescribing, and person administering, describes the drugs available at the subcentre clinics. The names of 46 antibiotics, 26 of which are for parasite cases (amobiasas and giadiosis), are listed as drugs available at the Matlab Clinic, with no supplementary information given regarding their administration. A brief description of procedures involving submission of requisitions, supply delivery, record keeping, and control over supply, precedes the 2 lists of drugs.
Instruments, equipment, miscellaneous supplies and stationary: Matlab MCH/FP project.
This paper contains information on the actual inventory and record keeping for clinical instruments, general equipment, and stationery supplies at each subcentre clinic as well as the Matlab Central Clinic, Bangladesh. Sources of information for control of instruments include files maintained by workers at each site plus an instrument register. 2 lists of actual clinical instruments available are provided. Instructions for the sterilization of instruments including storage, and information on the control via registers of other equipment and stationery supplies, supplements 2 additional lists of these supplies. A list of physical facilities and furniture in the subcentre clinics follows, including a brief description of building layout, plumbing (minimal), and electrification (none).
Forms used in the field program: Matlab MCH/FP project.
This paper lists, describes, and provides actual samples of 8 forms used in the field program of the Matlab MCH/FP Project, Bangladesh: 1) Biweekly Progress Report on MCH/FP, 2) ORS Biweekly Progress Report, 3) Contraceptive Monthly Progress Report 4) Monthly FP Performance Form, 5) Family Planning Clinical Record Form, 6) Maternity High Risk Index, 7) MCH/FP Referral Form, 8) Hospital Referral Form (for diarrhea). Information provided also includes person responsible for completing form, persons or agencies to whom forms are distributed, and, in some cases, purpose of the form when clarification is necessary.
File system at the subcentre clinics: Matlab MCH/FP Project.
The number of files is subject to the Family Welfare Visitor's (FWV) initiative. None of the files are used for employee evaluation. The official correspondence file is maintained at each Subcenter clinic. The field program file or working program keeps information on bi-weekly programs and are found at each subcenter clinic. At the Matlab Station the immunization file is kept and at the Subcenter Clinic this information may be recorded in a special register. Other files at the Subcenter Clinics are: the consent file; the family planning clinical record file; the diarrhea surveillance file; the referral file; the training program file; the administrative leave file; the instrument and furniture file; the attendance of boatman file; and the division of the working unit file. The referral file contains completed referral forms by the CHWs and are found at each Subcenter Clinic. The training program file includes a list of programs given to CHWs during their bi-weekly meetings and is prepared once a year. The administrative leave file contains written leave requests by CHWs. The file on division of the working unit contains information recorded under the name of each CHW.
Communications channel: Matlab MCH/FP project.
This paper describes the communications channels between 1) subcentre clinics and the Matlab Station Office, and 2) MCH/FP referrals, in the Matlab MCH/FP Project, Bangladesh. The former channel operates via field visits, speedboat transportation, biweekly meetings, monthly review meetings, and official correspondence from the Matlab Station Office. The latter channel operates via actual clinic visitation or home visits arranged for in the meetings mentioned above. Complicated cases are referred directly to the Matlab Central Clinic, severe cases to Diarrhea Hospital. Matlab Central clinic provides services to 10-15 women per day from a population living up to 10 miles distant from the clinic. The Matlab Sterilization Clinic usually handles 2-5 cases per week, 1 day per week, whose clients are kept 3 days at the hospital following sterilization.
Environment or intervention? Improvement in Australian aboriginal infant and childhood mortality.
Social factors are seen as having had the greatest influence in reducing the incidence of stillbirths and deaths of infants in the post neonatal period, while improved chances of survival of infants in the neonatal period are ascribed to a combination of social factors and improvements in neonatal care. 1 problem in untangling the relative influence of environment and medical intervention is that improvements in the social environment and health generally go together. During the 1960s, statistics of aboriginal infant mortality showing rates of more than 100/1000 live births caused an increase in community concern and a rapid increase in Australian government funding for aboriginal health programs in the 1970's. The results of this medical intervention must be perceived as impressive, as long as it is assumed the changes can be ascribed to the medical intervention alone. Tables illustrating the dramatic decrease in mortality probabilities are shown. It should also be noted that government expenditure decreased throughout the years, as Aboriginal Medical Services managed by the aboriginal community grew. The question of hypothesis validity arises, since the aboriginal social environment was changing at the same time as the fetal, infant, and early childhood mortality was falling; fertility of the aboriginal women fell precipitally at the same time as the mortality decline. If both fertility and mortality fell together, it is reasonable to suspect a common factor, although the evidence is circumstantial. Still, there is telling evidence of the persistence of social influences on early aboriginal mortality. Given the background, it is clear that in general terms, it is possible to regard reduction in aboriginal fetal, infant, and childhood mortality as being attributable to medical intervention to a large degree. If true, it is worthy to note that the relatively cheap component of medical care provided in the post neonatal period has had the greatest impact. 3 areas need further research: 1) cause of death changes in aboriginal infants and children over the period; 2) substantiation of the general contentions by comparison of the history of delivery of health services in individual communities with child survival data from medical records; and 3) relevancy of these findings to the delivery of health services in developing countries.
Some determinants of effectiveness of sub-centre services in Uttar Pradesh.
World demographic patterns 1980.
Government positions on population growth and family planning in developing countries, 1979.
Postcensal estimates of population.
Population dynamics of the world.
Teach about U.S. population trends] (with the U.S. population data teaching package).
UNFPA: What it is--what it does.
Growing old in America: a kit of readings and activities.
Statistics on race and ethnicity.
Recent patterns of population change in America's urban places.
Fertility of American women: June 1983.
This report examines current fertility patterns, delayed childbearing and birth expectations, supplemented by detailed tables and charts. The birth expectations and fertility data are based on the June 1983 supplement to the Current Population Survey (CPS) which obtained information from women about their childbearing to date as well as their anticipated childbearing. Among women who had a child in the year preceding the 1983 survey, 43% were in the labor force, compared with only 31% in 1976. A continuing increase in childlessness is noted among ever-married women 25 to 29 years old, implying a greater tendency to postpone motherhood; only 16% of these women in 1970 were childless, compared with 27% in 1983. American women 18 to 34 years old in 1983 expected to have an average of 2.1 births in their lifetimes, only slightly below the 2.2 births expected/woman in 1976. 9% of currently married women 18 to 34 years old in 1983 reported uncertainty in future childbearing plans. This represents a slight decline from 12% reported by women in 1976. The 1983 fertility rate for the US was an estimated 73.2 births/1000 women 18 to 44 years. About 38% of the births to women 18 to 44 years old were 1st births, resulting in a 1st birth rate of 27.6/1000. Women 18 to 24 years old recorded a higher 1st birth rate (52.6). Fertility differences by race are still evident, with a higher rate among Black women (85.4) than among White women (71.4). The fertility rate in 1983 for married women with husbands present was 101.5/1000, significantly higher than that recorded for married women with husbands absent (75.5), single women (30.5), or widowed or divorced women (31.3). An examination of the changes in labor force participation of women with young children indicates the potential demand for maternal and child social service programs. There are numerous reasons for delayed childbearing, including changes in women's attitudes in the 1970s toward marriage and the family, improvements in contraceptive technology, and an expansion of employment opportunities. The average number of lifetime births expected by American women 18 to 34 years old in June 1983 was 2079/1000 women, comprising 1096 births to date plus 983 future births expected.
St. Kitts/Nevis: yesterday, today and tomorrow.
State of the world's children report, 1982-1983: press coverage and statements of support.
Incentives and population policy: ethical considerations.
To reduce population growth, governments have utilized many policy measures, including incentives and disincentives. Some of these are: information and motivation; providing economic benefits for families under a specified size; compensating acceptors (usually of sterilization) for time lost from work and transportation; paying motivation or health personnel by the case; rewarding communities that achieve certain fertility or contraceptive prevalence levels; paying acceptors of a family planning method; utilizing extreme pressure to induce people to have abortions or be sterilized; and penalizing individuals, or their children, who have more than a specified number of children. The ethical issues involved can best be understood if viewed in the context of the tension between competing governmental and individual interests. Articulating the nature of these competing interests and attempting to weigh them furnishes a framework for making ethical and policy judgements. The tensions are: between the right of individuals to freely and responsibly determine the number and spacing of their children and the governmental right to limit population growth in its role of protecting the health and welfare of this and future generations; between national sovereignty and universal rights of individuals as established by international conventions, declarations, and treaties. The following guidelines are suggested: the right of an individual to have children or not is fundamental and can be infringed only in those rare cases where the government demonstrates the necessity and urgency of reducing population growth; governments have the burden of demonstrating the necessity and urgency of reducing population growth; governments should exhaust less restrictive measures with respect to voluntary choice before moving to more restrictive ones; penalties that punish children for being the nth child should be utilized only as a last resort, if at all, since they affect innocent people for behavior not of their doing; and coercion (the direct use of force) cannot be justified by any governmental interest. The guidelines do not provide a definitive answer to the issues of incentives. Rather, they represent an attempt to advance a rational examination of an important, complex, and often emotional public policy issue. (author's modified)
Child fosterage in West Africa.
Ethnographic studies in West Africa show that the practice of sending children away to be raised by relatives and nonrelatives is widespread among ethnic groups. This paper explores the demographic relevance of the practice. The fostering information is obtained from 2 sources: the responses given by women to the question on children away from home, and by linking all children to their mothers, with the unmatched children being treated as fosters. The characteristics of these children, their surrogate mothers, and those of the biological mothers are explored, and the determinants of child fostering are discussed as correlates of these attributes. The results are indicative of high incidence of child fosterage in Ghana, Sierra Leone, Liberia and Nigeria. Child fostering facilitates female laborforce participation, and may affect the fertility decisions of both natural and foster parents, mainly because it serves to reallocate the resources available for raising children within the society. It may also have consequences for child survival, depending partly on how the culture treats children outside of their maternal homes. West African child fostering, or relocation, is distinguished not only by its high prevalence but by the young age at which it begins. It is partly the consequence of a need to reallocate resources within the extended family or related kin group, ensuring maximum survival for the unit and strengthening kinship ties. In many societies in West Africa, child fosterage is simply an accepted means of raising children. Even West African immigrants in America and Europe a reported to send their children to foster homes. 1 of the major reasons fostering starts early is the practice of sending children away for weaning when the parents want to resume sexual relations. Sending children away steadily increases with age up to the age of about 5 and then increases are much slower. Male children constitute 45% of all fosters. Urban residence seems to increase the dominance of female fosters over male fosters. Urban nonfosters clearly attend school more than urban fosters. The number of surviving children is positively related to fostering out of children. Maternal educational attainment appears to be negatively related to fostering children out. (summaries in ENG, SPA, FRE)
The United Nations Population Division's population projections for Indonesia.
This publication presents a consolidation of UN Population Division figures for a number of important projections of the Indonesian population. These include the population by sex, age group and dependency; by specific age groups, urban-rural population and density; and by 5-year age group and median age. Readers are advised to refer back to the 1982 Assessment of World Population for details on the methods used by the UN in preparing their projections. A few discrepancies exist because of rounding errors. The projections are based on certain assumptions which may not, in the future, occur. The eventual trends in population will heavily depend on the policies pursued by the government and the fertility and health care behavior of the population. Projections are useful in showing the implications of actions. The UN series should be compared with the projections prepared by the Central Bureau of Statistics to see the differences varying assumptions and methods of calculation can make to the outcome. The UN projections will be useful to policymakers and researchers. The difficulty in interpreting data for Indonesia is minor since the relative population sizes imply that proportions based on Indonesia alone and those of Indonesia with East Timor are virtually identical.
Evaluation of transformations in forecasting age specific birth rates.
The value of power transformations in forecasting age specific birth rates is expressed in terms of a relative mean squared forecast error for 5 powers and 2 ARIMA models. Of the transformations studied, the reciprocal of birth rates appears to be of greatest value, but the gains from using the transformation are modest, even when the model fitted to the data is chosen with care. The data used were annual numbers of births/1000 women in age groups 15-19, 20-24, 25-29, 30-34, and 35-39 in the US, 1948-1980. 1 problem of looking at postwar data is that the time series are short (33 observations) and the data will not support the construction of elaborate models or great precision in parameter estimates. Details of the univariate and multivariate models are included, along with their respective transformations and forecast evaluations. The clearest conclusion drawn is that power transformations studied here contribute very little to point forecast accuracy. In the context of the univariate models, the superiority of the reciprocal transformation is neither consistent nor overwhelmingly large. Logistic transformations, however, may be very useful in the production of sensible forecast intervals, for example, with intervals that do not encompass impossible values o f the observations.
Analysis of low birth weight rates and associated factors in a rural and urban hospital in Thailand.
From the Mother and Child Health Center (MCHC) in Khon Kaen in the northeast of Thailand, 1178, and from the Vajira Hospital in Bangkok, 1372 singleton consecutive birth rates were analyzed. Low birth rates (< or = to 2500g) were slightly but significantly higher in Khon Kaen (13.4%) than in Bangkok (10.5%). Low birth weight rates were common for primegravida. This relationship was pronounced in Khon Kaen. Mean birth weights measured 2952 + or - 416g in Khon Kaen and 3028 +or- 444 g in Bangkok. A test of interaction including the location of the hospital, occupation and parity on birth weights was positive but failed to be significant for single factors or combinations with the exception of parity. (author's modified.
Anaemia in children: a survey in (Obadan) a rural community in the rain forest zone of Nigeria.
Using a table of random numbers, 552 children representing 58% of all clinic registered children from birth to 15 years were selected for this study to define the pattern of childhood anemia in Obadan, a rural community of Bendel State, and to identify public health measures that may be applied to control anemia in the community. For this study, anemia of childhood was defined as packed cell volume (PCV) less than 33% in a child aged 1 day to 15 years. Physical examinations included nude weight and standing height. Standard hemotological techniques were used for determination of PCV. The survey shows that anemia is still a common problem of childhood in rural communities in Nigeria and that iron deficiency is the commonest cause of anemia in children, perhaps caused by hookworm or other parasitic diseases. The study does not show a striking role for malaria in anemia of children. Hemoglobinopathy was not a major cause of anemia in children of this community, although the methods used in this survey did not permit detection of thalassemia. A national survey to assess the prevalence of anemia in Nigeria is recommended.
The advantages of human milk in the feeding of the premature infant.
The effects of 2 feeding regimens, expressed breast milk and cow's milk formula, were studied in 458 premature infants born between 1969 and 1978 at the University of Brasilia Teaching Hospital. The group fed expressed breast milk showed a lower incidence of diarrhea in the neonatal period. Larger prematures weighing between 2001 and 2500 g at birth had less initial weight loss and faster recovery of birthweight when fed only human milk. The importance of human milk in the feeding of the premature infant was shown in the overall trend of less initial weight loss and faster recovery of birthweight in prematures of all birthweights. (author's)
Marriage and first intercourse, marital dissolution, and remarriage: United States, 1982.
Findings on timing of 1st sexual intercourse, marriage, marriage dissolution and remarriage based on preliminary data from the National Survey of Family Growth (NSFG), Cycle III, are presented in 3 detailed tables and discussion. Technical notes on survey design, reliability of estimates and definitions of terms are included. The NSFG is conducted periodically by the National Center for Health Statistics to collect data on fertility, family planning, and related aspects of maternal and child health. Previous cycles were conducted in 1976 and 1973. The 1982 interviews were completed between August 1982 and February 1983 with a probability sample of 7969 women ages 15-44 in the noninstitutional population of the contermenous US. The sample included 4651 ever married women (EMW) and 3318 never married women. Black women and women aged 15-19 were oversampled. About 2/3 of all EMW between 15-44 years old had intercourse before marriage. Hispanic women were least likely to experience intercourse before marriage (45%), compared to white women (65%) and black women (91%). The proportion of women who delayed 1st sexual intercourse until marriage declined from 48% among women marrying during the period 1960-64, to 21% among women marrying during the years 1975-79. In 1982, approximately 30% of 1st marriages (FM) had been disolved by divorce, separation, or death. The proportion of FM disolved within 5 years was twice as high for women married 1975-79 (20%) as for women married in the years 1960-64 (10%). Nearly 60% of women whose FM were disolved by death or divorce had remarried by the time of the survey.
Evaluating the impact of prenatal nutritional supplements on birthweight.
Dr. Kenneth Edelin, Boston University School of Medicine, reports that during his site visit to a Strengthening Health Delivery Systems (SHDS) project in Abidjan, Ivory Coast, he consulted with Mrs. Grace Walla, midwife and public health nurse, regarding her proposed research evaluating effective means of attacking the problem of malnutrition and iron deficiency anemia in high risk mothers through prenatal iron and vitamin supplements, health education, increased access to malaria treatment and elimination of hookworm. Citing a high incidence of Intrauterine Growth Retardation (IUGR) among low birth weight (LBW) infants in the population of recent immigrants from rural Ivory Coast communities and surrounding countries which frequent a maternal child health center on the outskirts of Abidjan, an applied research project is proposed to evaluate the impact of prenatal nutrition supplements on birth outcomes. Dr. Edelin draws upon his experience in researching IUGR and LBW problems among inner city Boston residents in advising Mrs. Walla, and hopes for future cooperation in a comparative study of Boston and Abidjan populations and program impacts.
WHO/AFRO-SHDS Health Services Research Course recommended for worldwide use by WHO consultation.
The WHO/Geneva sponsored program for Strengthening Health Delivery Systems (SHDS) hosted an international "Consultation of International Collaboration for Health Systems Research Training" in Yaounde Cameroon, July 23-27, 1984. Participants from 14 nations, representing all 6 WHO regions, reviewed a preliminary package for Health Systems Research (HSR) training which included a "Guide for Planning HSR Training Programmes" and the "WHO/AFRO-SHDS HSR Course" developed by the Boston University Health Policy Institute's SHDS project. Participants emphasized the importance of regional and national case studies in the training program, and recommended further adaptation, implementation and review of the HSR training program package by member nations. The final report from the Consultation, and information regarding the Training Package may be requested from Dr. Yvo Nuyens, SHDS, WHO, 1211 Geneva 27, Switzerland.
The adequacy of the Nigerian free health program declared in Oyo state on October 1, 1979 is open to question because census data is unreliable. The only officially certified census figures used for planning are from the 1963 census. It yielded Oyo state a population of 5,208,884, but the National Population Bureau assumed a 12% overcount, and Olusanya estimated a 16% overcount. Thus 3 sets of population estimates exist, with projected growth rates of 2.7% for 1963-73, and 3.1% for 1973-83. Tables present measures of health status for the years 1979-82 for the 3 sets of estimates. The 4 indices of health status examined are: 1) doctor/population ratio: in 1979, 1 to 58,327 (high census estimate), 1:48,995 (low estimate); in 1982, 1:33,770 (high) and 1:28,367 (low); 2) nurse-midwife/population: for 1979, 1:7575 (high), 1:6362 (low); in 1982, 1:5336 (high), 1:4483 (low); 3) pharmacist/population: for 1979, 1:166,649 (high), 1:139,986 (low); for 1982, 1:175,473 (high), 1:147,396 (low); and 4) per capita health expenditure: for 1979 US $1.71 per person (high), US $2.03 (low); for 1982 US $3.25 (high) and US $3.86 (low). 1 conclusion is that efforts to improve health have had modest impact because of the probable underestimation of the population. The uncertainty of the number of people for whom plans or programs are intended has adversely affected the implementation of such programs as the UPE, OFN, and the Basic Health Service Program. Greater attention to human resources is needed, since the use of an unreliable population data base can impose constraints on how development plans proceed, even when adequate financial resources are available.
The Reagan administration's health policy is designed to reduce federal involvement in health care by reducing both the quantity and quality of direct services and by decreasing the resources available to pay for services to the poor. The policy assumes that the country's economic security assures the well-being of its citizens, but evidence suggests that health status is not necessarily linked to economic well-being. Large segments of the maternal and child population may be at increased risk. 3 long term monitoring methods which demonstrate the impact of policy on health status are: 1) surveys; 2) tracking health conditions for which data are routinely collected over long periods; and 3) replications of MCH program evaluations. Short term effects can be measured by noting reductions in human resources, reorganization, changes in modes of decision making, and reduced capability for oversight and consultation. Changes in service availability, accessibility, comprehensiveness and quality can be monitored at the local level. Data bases already existing in some form in every state can be useful for making assessments. Notable data sources include a 1980 Dept. of Health and Human Services report, and activities of the National Center for Health Statistics. New monitoring efforts include those of the MCH Block Data Committee, the National Public Health Reporting System, the National MCH Resource Center, the Foundation for Child Development, the Children's Defense Fund, the Univ. of North Carolina Child Health Outcomes Project, and the American Public Health Association Survey and the Ambulatory Pediatric Association. Urgently needed data depend upon action at the state level by official state agencies, advocacy groups, colleges and universities, professional organizations, and other concerned parties.
Anticipated influences on sexual decision-making for first intercourse.
The purpose of this study was to establish the basic underlying factors that virgins perceive as influences in the decision to have 1st sexual intercourse. An inventory of potential influences was administered to 195 college students, 52 males and 139 females, with a mean age of 19.6 years. Factor analysis derived 3 interpretable factors: 1) physical arousal, experienced at different stages during the date prior to intercourse; 2) relationship--the degree of positive affect and commitment at the time of sexual intercourse; 3) circumstances, including preplanning and arousal prior to the date. The quality of the relationship is seen as more important for those participants who foresee 1st coitus occurring while seriously dating, at engagement, or at marriage. Physical arousal and circumstances play a larger role for those who foresee 1st coitus while casually dating. Relationship factors were rated as significantly more important by females than by males. No gender difference was found on the anticipated influence of physical arousal. This may reflect a growing trend of equality in sexual fulfillment in our society.
Toward migration management: a field experiment in Thailand
The results of an information program developed in northeast Thailand to encourage migration to nearby urban centers rather than to the capital, Bangkok, are presented. Data were collected in two sets of interviews in six study villages; one set was carried out in 1978, before the program had begun, and the other was carried out in 1979, seven months after the program's initiation. The results suggest that the project significantly increased migration to nearby urban places without substantially affecting the flow of migrants to Bangkok. (ANNOTATION)
Alternative projections of net annual legal, illegal, and total immigration to the United States from 1982 to 2005 are presented by age and sex. The assumptions on which these alternative projections are based concern variations in U.S. immigration policy. Consideration is given not only to total numbers, but also to the impact of immigrant fertility, mortality, and household formation on the characteristics of the U.S. population as a whole. (ANNOTATION)
Immigration to the United States: its volume, determinants, and labor market implications
"This report is a review of the existing scholarly and research literature on immigration to the United States. It has four major objectives. The first is to discuss what is known about the volume of immigration in recent years, particularly illegal immigration....The second objective is to discuss factors influencing immigration to the United States, including factors affecting emigration from less developed countries....The third major objective is to discuss the labor market implications of legal and illegal immigration to this country....The fourth objective is to discuss the implications that seem to be suggested by the results of [this] inquiry for the future pattern and magnitude of immigration to the United States." (EXCERPT)
[Concentration and distribution of city sizes in Mexico, 1940-1980]
The authors examine changes in the concentration and distribution patterns of city size in Mexico for the period 1940-1980. Theoretical and empirical data are analyzed, with a focus on the dynamics of demographic growth and the effects on the decentralization of urban development. (ANNOTATION)
The quality of mortality data collected in the 1974 Bangladesh Retrospective Survey of Fertility and Mortality is evaluated. Possible effects of errors in data collection and reporting on subsequent estimates of mortality are examined. (ANNOTATION)
This paper is concerned with evaluating alternative methods of estimating adult mortality in populations of the past. The authors first provide some estimates of the level of orphanhood in The Hague, Netherlands, from 1850 to 1880, orphanhood being defined as including the death of one or both parents before the marriage of the child in question. Data are taken from official marriage certificates. The different techniques developed by Henry, Brass and Hill, and Hill and Trussell for estimating adult mortality are then compared with death rates derived from direct observations, and the factors responsible for the deviations observed are discussed.
"The marital status life table is a multistate (or increment-decrement) life table which describes the life histories of members of a synthetic cohort as they age and move between marital states. The life table provides the analytical framework for life cycle and life course analysis. The paper, which may serve as an introduction to the multistate life table, reviews several life table measures (probabilities, sojourn times, number of passages) and shows how these measures can be calculated from age-specific transition probabilities, which are estimated from the data." (EXCERPT)
[Health policy and mortality in the industrialized countries]
Recent trends in mortality in developed countries are examined, and prospects for the future are assessed. Developments indicate that the maximum life expectancy that prevailed until the mid-1960s has risen in the West, in sharp contrast to the overall stagnation of the mortality rate in the East. The infant mortality rate, which remained at an absolute low, has continued to decrease. The decrease in cardiovascular diseases has been greater than that of cancer; the data show that the 1950 mortality rate for cardiovascular diseases was double that of cancer, but in the following years the rate decreased until it was equal to that of cancer. The findings also indicate that excess male mortality, which was expected to decrease as behavior patterns became less differentiated between the sexes, has, on the contrary, increased sharply. In addition, the last 30 years have been marked by a decline in mortality due to infectious diseases. The need for further efforts to eradicate cancer and to ameliorate social inequalities in mortality is discussed. (summary in ENG)
[Adult mortality from cancer in North America]
Cancer mortality among adults in the United States and Canada is analyzed using data from official and unofficial sources, including the Canadian Cancer Register. Mortality levels and trends during the 1970s are first examined, and differentials by sex, age, geographic area, and social group are described. The proportion of mortality attributable to various risk factors, including diet and tobacco smoking, is then assessed. The findings indicate that adult mortality caused by malignant neoplasms varied little during the 1970s, since the decrease in deaths due to stomach and cervix uteri cancers was canceled out by the increase in lung cancer, caused primarily by tobacco use. The highest mortality rates were found in the eastern part of the continent, which was industrialized and urbanized earlier. The poorest social groups had higher death rates due to the most frequent forms of cancer, except for breast cancer. (summary in ENG)
This paper is based on the hypothesis that exposure to chemical or physical agents is the main cause of cancer. The authors test the effects of working environments on the cancer mortality rate in Quebec, Canada, using official data for 1974-1978. The data concern men aged 35-64. The links between industrial activity and mortality are analyzed, after dividing the population into work areas. An excessive mortality caused by cancers of the respiratory system is observed in the areas where heavy industry and mining predominate. (summary in ENG) (ANNOTATION)
[Mortality from cardiovascular diseases in industrialized countries]
In the first part of the article, trends in cardiovascular mortality rates in developed countries during the first half of the twentieth century are analyzed, and some hypotheses are offered on the causes of increased mortality. Following this, cardiovascular mortality rates since 1950 are discussed. The author considers overall trends, as well as trends for three different kinds of cardiovascular diseases. Differences by country and by sex are examined. (summary in ENG) (ANNOTATION)
[The level and impact of road accident fatalities in North America, 1960-1982]
Road accident fatality rates in North America during 1960-1982 are analyzed, along with their effect on society. It is noted that during this period, these accidents were responsible for an average of 55,000 deaths per year. Estimates of the economic cost to society of fatal road accidents in Canada and the United States in the year 1980 are presented. The importance of implementing both active and passive road safety programs is underlined. (summary in ENG) (ANNOTATION)
[A tragic and badly known type of mortality: road accidents in France]
An analysis of recent data on road accident fatalities in France is presented. According to statistics taken from police records, nearly 12,000 people were killed on French roads in 1983. The author compares French mortality rates with those of neighboring countries and notes that improvements are possible and necessary. Variations in road accident mortality by geographic area, time period, and sex and age are analyzed. (summary in ENG) (ANNOTATION)
[Factors of social differentiation in mortality]
This paper focuses on the widening of social differentials in mortality during the past 30 years in industrial countries. The author argues that in the context of increased life expectancy, differences in working conditions and behavior, on the one hand, and differences in access to health care, on the other hand, account for these differentials in mortality and their increase. It is suggested that reduction of these differentials through improving the lot of the underprivileged could increase life expectancy in important ways. (summary in ENG) (ANNOTATION)
This study, which is based on Hungarian data for the years 1972-1973 and 1982, is an attempt to explain the developments in mortality in Eastern European countries following World War II, with particular reference to changes over time and differences between the two sexes. The role of two factors is considered: the structure of mortality by causes, and mean life expectancy at different ages for deceased persons by causes. The double standardization method is used to arrive at an understanding of the separate roles of these two factors. (summary in ENG) (ANNOTATION)
[Regional adult mortality in Belgium: 1969-1972]
Regional differences in adult mortality in Belgium are analyzed. The article is based on studies that were carried out by the Demographic Center of the Free University of Brussels and that have resulted in regional life tables for 1969-1972. These tables show overall mortality and individual causes of death. The regions have been defined using the crude death rates from 1968-1973 for the 2,379 communes of Belgium in 1970. The author bases this analysis on the life expectancy figures for 15, 35, and 60 years of age, as well as the quinquennial quotients of mortality from 45 to 69 years of age. The article concludes with a discussion of regional variations caused by diseases of the circulatory system and by tumors. Tables are furnished to measure the effects of these causes. (summary in ENG)
[The reduction of adult mortality in Belgium]
The decline in adult mortality in Belgium is analyzed for the period 1892-1977. Tables are included showing the number of survivors and expectation of life at ages 25, 50, and 75, with the data shown separately for males and females. Mortality among young adults, mature adults, and the aged is discussed. (ANNOTATION)
This article contains a selection of charts and maps showing data on mortality in France for various years from the nineteenth century to the 1980s. The article is part of a special issue of Espace, Populations, Societes devoted to adult mortality in industrialized countries. Information is included on the increase in life expectancy and decline in mortality rates, infant mortality, mortality by age and sex, causes of death, social inequalities in mortality, and geographic differentials in mortality by sex and age group. (ANNOTATION)
Mortality in the Paris metropolitan area is first compared with that in France as a whole, and the marked geographic differentials in mortality within the Paris area are analyzed. Trends between 1962 and 1975 are then examined. It is noted that in 1962, the mortality rate for the Paris area was 9.5 per 1,000 population as compared with 11.3 for France as a whole; in 1975, these figures were 8.8 and 10.6 respectively. Reasons for the observed differences are discussed. (ANNOTATION)
"This article will examine several interventions that have been proposed to increase longevity. Attention will be given to studies in laboratory animals, since in many cases the results of such studies have been interpreted as justifying application to human beings. The issue of life extension in general and the prospects for developing future interventions aimed at modulating specific aging processes will also be briefly discussed." (EXCERPT)
Prospective study of social influences on mortality: the study of men born in 1913 and 1923.
Social influences on mortality in Sweden are analyzed using data on nearly 1,000 middle-aged men from the population register of Goteborg who were followed-up over a nine-year period. Social factors examined include persons per household unit, home activities, activities outside the home, and social activities. "The association between these variables (except for home activities) and mortality was significant even when age, risk factors for coronary heart disease, and health status measured at the baseline examination were taken into consideration. Social activities may have a modifying effect on life stresses and risk factors associated with mortality." (EXCERPT)
The inverse relation between fish consumption and 20-year mortality from coronary heart disease.
The relationship between fish consumption and coronary heart disease mortality is examined for a group of men living in Zutphen, Netherlands. "Information about the fish consumption of 852 middle-aged men without coronary heart disease was collected in 1960 by a...dietary history obtained from the participants and their wives. During 20 years of follow-up 78 men died from coronary heart disease. An inverse dose-response relation was observed between fish consumption in 1960 and death from coronary heart disease during 20 years of follow-up. This relation persisted after multiple logistic-regression analyses. Mortality from coronary heart disease was more than 50 per cent lower among those who consumed at least 30 [grams] of fish per day than among those who did not eat fish." (EXCERPT)
Urbanization and population redistribution trends in Cameroon.
Laboratory identification of sexually transmitted diseases.
The most accurate and economical laboratory tests for 9 sexually transmitted diseases (STDs) are described and information on the microorganisms involved is provided. A presumptive diagnosis of gonorrhea in men may be made from a smear of urethral discharge, but Gram's staining of an endocervical specimen is not always diagnostic in women because of the resemblance of the Neisseria gonococcus to normal vaginal flora. The combination of rectal and endocervical cultures raises the detection rate to 92-94% in women. Chlamydia trachomatis infection in women is commonly followed by acute salpingitis, and transmission to the neonate can occur; in men nongonococcal urethrtis is milder than gonorrhea and is 1 of the most common STDs. Laboratory diagnosis depends on Gram's staining of the smear of the exudate for detection of inclusion bodies. The most widely used serologic test for chlamydia is the complement fixation test. Gardnerella vaginalis vaginitis is diagnosed with a combination of Gram's staining, wet mount examination, and culture. The specimen should be collected from the posterior vaginal pool rather than the cervix. "Clue cells", vaginal epithelial cells covered with small gram-negative rods, are indicators of Gardnerella infection. For culture, specimens are incubated and the plates examined for colonies showing diffuse beta hemolysis; sugar fermentation completes the diagnosis. Collection of specimens for diagnosis of granuloma inguinale requires scraping or biopsy of the ulcer for microscopic examination to determin the presence of characteristic Donovan bodies. The simplest method of making a laboratory diagnosis of Trichomonas vaginalis is by preparing a wet mount of the vaginal discharge taken from the posterior fornix. Culture techniques are time-consuming and require special materials, but they increase positive results by 80% and should be used when feasible. Candida albicans and other yeasts can be seen on microscopic inspection of infected areas. Culturing the yeast on Sabaroud's agar is most accurate. In comprehensive viral diagnostic laboratories, herpes simplex virus isolates are identified on the basis of their reaction with a specific serum after culturing. The clinician has ultimate diagnostic responsibility for syphilis because of the number of false-positive and false-negative serologic tests. Nontreponomal tests such as the VDRL, Wasserman, and Kahn tests are of greatest value in screening for syphylitic antibodies and for following antibody titers during therapy, but they lack specificity and can become reactive to a variety of clinical entities. They must be confirmed by the more specific treponemal tests in the absence of clinical data suggesting syphilis. Diagnosis of chancroid can be based on finding of Hemophilus ducreyi on culture or in an aspirate of the bubo, demonstration of the bacteria in chains or clumps, or the clinical picture of a chancroid ulcer.