Women's labor, fertility, and the introduction of modern technology in a rural Maya village.
The introduction of mechanized technology into a rural Maya agricultural community in the mid 1970s markedly increased the technology with which maize could be ground and water collected, which in turn introduced a possible savings in the time spent working. This study investigated the response of female fertility to the introduction of this labor-saving technology. Using two proximate determinants of female fertility, the association between the advent of modern technology and changes in the age at which women give birth to their first child and the length of mothers' birth intervals was examined. Analyses showed that women begin their reproductive careers at a younger age after the laborsaving technology was introduced. Estimate of the median age at first birth from the distribution function dropped from 21.2 years before the introduction to 19.5 years after the introduction of the technology. In addition, modeling results show that the probability of a woman giving birth to her first child doubles for any age after the introduction of laborsaving technology. However, changes in birth intervals are less conclusive since the differences of smoothed probability distributions are not significant. Moreover, findings indicate that women who initiate reproduction at a younger age can potentially have longer reproductive careers and larger families.
Peers may help reduce teen pregnancy. Programs bring sex education to underserved areas.
Pregnancy has become the leading cause of death among adolescent girls in the Dominican Republic, according to the UN Population Fund (UNFPA). Nearly one-quarter of girls aged 15-19 years are either pregnant or have already given birth; yet access to reproductive health services is limited outside the major cities, putting these young mothers at risk. To help solve the problem, UNFPA is working with nongovernmental organizations to develop peer-education programs, expanding young people's access to sexual education and services in 36 neighborhoods of Santo Domingo and in three smaller cities. The project has trained some 360 adolescents as volunteer peer counselors, who distribute educational material and--with parental consent--condoms, spermicides, and contraceptive pills (if girls have prescriptions from a physician). "Teens are encouraged to postpone their first sexual encounter or to maintain a faithful relationship with one partner," according to the UNFPA report, The State of the World Population 1999. In addition to reducing unwanted pregnancies, the program aims to cut infection rates of AIDS and other sexually transmitted diseases. "In 2 years, the project has counseled nearly 9000 young people, 30% of whom are not in school," says the report. By reducing the rate of early childbearing, the project could help expand the life opportunities of girls; in many countries girls who become pregnant are not permitted to return to school--if they were in school in the first place. (full text)
The facts. Medical abortion: an alternative for women.
Medical abortion is a nonsurgical method of ending pregnancy using oral or injectable medications. Two methods of medical abortion are available to date: mifepristone, which is sometimes referred to as RU 486, and methotrexate. Mifepristone is a synthetic chemical substance that blocks progesterone, a hormone responsible for continuing pregnancy. This method is effective for up to 63 days from the first day of the last menstrual period of the woman. On the other hand, methotrexate, available for "off-label" use, induces abortion by blocking cell division and multiplication. Both require misoprostol, a substance that stimulates contraction of the uterus to expel the product of conception. Clinical trials of the 2 methods indicate that both are safe and effective means of terminating pregnancy during the first 7 weeks. In addition, studies suggest that more women favored medical abortion as an alternative to early surgical abortion. In the US, the approval of mifepristone-misoprostol regimen may increase access to abortion services for American women; it is currently available at only 12 clinical trial locations.
Abortion debate spreads to pharmacy counter.
Pharmacy counters are becoming a new front in the fight against abortion in the US. Rising demands for emergency contraception, the so-called morning-after pill like Preven, created a crisis of conscience for some pharmacists who look at it as a form of chemically induced abortion. While pharmacists need to follow what is dictated by their conscience, they do have the obligation to dispense a particular medication, including birth-control pills, to a woman in need. Several pharmacist associations across America have addressed these concerns about emergency contraception, assisted-suicide drugs, and the abortion drug RU-486 by adopting "conscience-clause" guidelines that promote their right to refuse prescription of pills, based on moral, ethical or religious grounds. They also have pushed for legislation that protects pharmacists from retribution for conscientious refusal to dispensed medications, which they believe are abortifacient or used for assisted suicide or mercy killing. Conflicts over conscientious decline, however, could get even hotter as drug manufacturers are developing two more effective emergency contraceptive pills, with lesser side effects.
"Creating awareness about HIV / AIDS, the only solution".
HIV/AIDS prevalence in the US is increasing rapidly and society needs to be aware and take responsible steps to solve it. At Rainy Hospital in Tondiarpet alone, 60 HIV positive patients have been treated since 1996, 48 of which were treated in 1998. According to Mr. Dalit Ezhilmalai, the Union Minister of State for Health, creating awareness about HIV/AIDS and protecting oneself was the only solution to this problem. Citizens in the country should be aware that HIV/AIDS is going to be a major problem in the future and nobody else can protect them except themselves. Denial and moralization among common people were major obstacles in assessing one's risk from the disease. As the only weapon against HIV/AIDS, awareness should lead to behavior change among the population.
Namibia launches new AIDS programme.
Namibia has launched an expanded national response to HIV/AIDS called the National AIDS Co-ordination Program, which aims to decrease HIV infection to below the current epidemic levels. The program serves as the second medium-term plan of the country on HIV/AIDS and will replace the National AIDS Control Program which was started in 1990 in response to the new challenges for which the Namibia is facing, with AIDS threatening to spread like the "proverbial bush fire". The program is being coordinated by the Ministry of Health while a national AIDS Committee will develop appropriate policy for HIV/AIDS control and will ensure a national commitment to fight the AIDS epidemic. Critics, however, say that this new body will only promote bureaucracy and not reach people at grassroots level.
Birth control distribution will be allowed in schools, board decides.
The St. Paul School board has decided to allow the distribution of birth control pills, condoms, and spermicides directly to its high school students. The clinics in its 7 public high schools, under its long-running policy, can prescribe birth control pills and give teenagers vouchers for condoms, but the students shall redeem them off-site. This, however, became a hotly debated issue. Some people believed that schools are taking the power from parents on a volatile social concern. Still others believed that lessons for abstinence and birth control cannot exist together. Many saw this decision as the board shoving a divisive issue off onto schools. While parents and the community do not want it, teenagers believe that birth control is not a parental decision and they were mature enough to assume responsibility over it.
Abortion issue returns but world has changed.
A renewed campaign for yet another referendum on abortion is well underway in Ireland. However, the abortion issue revisits not the same country, which it left embittered following the original referendum of 1983 or shocked after the X case and its many political and psychological repercussions in the early 1990s. Experience has taught the people that an absolute prohibition on abortion can be enforced only by repressing the issue such as limiting the right of pregnant women to travel and prohibiting information materials that contain information about abortion methods which are contrary to the preservation of a functioning democracy. Absolute prohibition on abortion would demand an authoritarian revolution that is not going to happen. Although the political logic of the first abortion referendum in 1983 was the hope that a victory on this issue might be an initial step to bringing back a world of unquestioning obedience and celibate marriage, this kind of world is no longer coming back.
Here's the rub: a potentially deadly allergin is in everything from condoms to balloons.
Allergic reactions to latex, a soft, impermeable, thin material in condoms, gloves, and balloons, are uncommon and vary in severity, but can happen to anybody. Clinical manifestations of latex allergy differ according to type. The more common rashes are classified under Type IV and occur 12-36 hours after exposure at the point of contact or in other areas of the body and are reactions to chemicals used in processing the latex. Type I reactions, on the other hand, can kill. They are triggered by an antibody reaction throughout the body, and can happen in minutes with itching, swelling, hives, sneezing, and anaphylaxis that can lead to loss of blood pressure. Reports of Type IV reactions increased through the 1980s. By 1997, 1700 cases of severe allergic reactions were reported. People at most risk for this type of allergy include medical workers, persons working in the rubber industry, and others who are using latex equipment. Although condoms contain less latex and the length of exposure to it is generally less than that of health workers wearing gloves, those who regularly use latex condoms should be aware of any allergic symptoms after coitus such as localized swelling, flushing, hives, or difficulty in breathing.
Report: Tuberculosis control programs inadequate in developing countries.
Johns Hopkins researchers report that increasing HIV infection rates continue to drive a tuberculosis (TB) epidemic in sub-Saharan Africa, and world health policymakers need to better account for the intertwining of the two diseases. TB in the HIV-infected is much different from TB among the HIV-negative, but current efforts to control TB do not address these differences. Symptoms of TB are most often the first clinical signs of AIDS since HIV-infected individuals have weaker immune system and are more susceptible to TB. Moreover, TB is much more deadly among HIV patients and is the leading cause of death in that population. If health policy makers continue to ignore the clear trends in sub-Saharan Africa and persist with the current approaches, the TB situation in countries with high rates of HIV is likely to worsen. It was suggested that similar measures, which decreased the incidence of TB in New York and Baltimore, could be used to reduce the rate of TB transmission among the vast HIV-infected population of Africa. Specific recommendations from the report include: preventive isoniazid treatment of all identified HIV-positive patients except those with symptomatic TB; screening of TB in hospitals, clinics, and HIV testing and counseling centers; and specialized care to separate HIV-positive patients from TB patients.
On July 17, 1999, the world population is expected to cross the 6 billion mark. The world population is predicted to stabilize at approximately 11.6 billion by the year 2220, but achieving zero population growth will be complex. There are many factors that have profound effect on population size such as age, AIDS, international migration, and health. Joseph Chamie, director of the UN population stated that stabilization could occur because people make a conscious decision to have fewer children. Moreover, as a country goes through demographic transition, the process by which a population experiences a decline in mortality and a subsequent decline in fertility, it undergoes rapid population growth before finally stabilizing. This dramatic rise in the world population will cause major changes, making population an extremely important issue and a priority in discussions, regardless of the country and its level of development.
Thailand wins a round in fight against HIV. Program frees many babies from inheriting virus.
A 2-year study conducted in Thailand found that short-course azidothymidine (AZT) treatment coupled with no breast-feeding can reduce HIV transmission by 50%. This has become one of the most dramatic victories in the history of the AIDS epidemic worldwide as it prevents millions of children from inheriting the virus from their HIV-infected parents. The short-course AZT treatment is cheaper and easier compared to the regimen used in Europe and the US. Despite its financial crisis, the Thai government is 100% committed to finance the drug treatment for pregnant women. So far, seven provinces in one northeastern region currently have 61% coverage of AZT for HIV-positive pregnant women, and about 100 children in Chotpitayasunondh's clinic have benefited from the AZT short course.
In Senegal, common sense spells success.
This paper presents the success of an aggressive prevention campaign conducted in Senegal in the 1980s, which included counseling on the benefits of practicing safer sex. Only 45 AIDS cases were reported in Senegal in 1987 during the initiation of the prevention program, and the estimated number of AIDS cases have reached 60,000 since the start of the program. There has been a low prevalence of HIV among prenatal women although increase in HIV incidence was noted among sex workers. One report estimated a decline in HIV prevalence among sex workers from 45% in 1991 to 20% in 1996. Religious and other nongovernmental organizations were enlisted to aid in program implementation with an agreement that different organizations must not be a barrier to the others. Change in sexual behavior was observed among the people since the implementation of the program. Women who have been tested positive of HIV were given consultations on the effects of HIV such as weakened immune system and eventual death. In conclusion, the need to heed the wisdom of countries with successful modest program implementation is suggested.
Tipping the scales: the Christian Right's legal crusade against choice.
This report reviews the connection, supporters and influence of legal advocacy organizations on their efforts to prohibit abortion as a family planning method. Legal advocacy organizations form the foundation of the Christian Right's efforts to eliminate the right to reproductive choice among women. These legal advocacy organizations provide litigation, develop public policy, conduct outreach, legal education, training and support, and reaches out to future lawyers. Since the passing of the US Supreme Court s decision in Roe vs. Wade 25 years ago, the constitutional rights of women to make choices about their pregnancies and abortion were established. A string of court cases on Roe guaranteed exceptions to two groups of women: the young and the poor. Following the lead of the Supreme Court, ban on federal Medicaid payment for abortion, cut back on family planning funding and denial of health care coverage on abortion. Another view on the impact of legal advocacy groups manifests the decline in doctors trained in abortion procedures. The collective efforts of all these groups redefine the constitutional rights and affect the fundamental concepts of liberty and equality that forms the bill of rights. With the consideration of abortion as a constitutional right, this report calls for those committed to preserving and advancing all reproductive choices to safeguard the right to choose abortion.
Malawi AIDS assessment study annexes. Volume II.
The second volume of the Malawi AIDS assessment study presents the annexes used in the Malawi AIDS assessment study. These include: 1) terms of reference used during the Malawi AIDS assessment study; 2) the impact of AIDS on demographic projections; 3) the prevalence of HIV and AIDS in Malawi; 4) the impact of AIDS compared to other leading causes of illness and death in Malawi; 5) the 1996 total expenditure on AIDS control by donor, government and activity category; 6) the identification of cost-effective interventions; 7) attitudes and practices among youth in consecutive surveys; 8) the inclusion of school children in the AIDS prevention program; 9) the evaluation of the efficacy of voluntary HIV counseling and testing; 10) distribution of extension staff in the districts; 11) comparison of neighboring epidemics; 12) evaluation of in-service training in syndromic management of sexually transmitted diseases; 13) the increased health cost from the AIDS epidemic; 14) study on blood safety in Malawi; 15) the study on the health care condition in Malawi; 16) evaluation of community-based care in Malawi; 17) the 1996 expenditures for 8 home-based care programs by input category; and 18) the description of 6 home-based care programs.
Malawi AIDS assessment study. Volume I.
This Malawi AIDS assessment study presents the increasing number of deaths due to AIDS among income-generating adults in the public and private sectors--a deterrent factor in the developmental efforts of the country. The first chapter, which focuses on the magnitude of the epidemic, highlights HIV/AIDS incidence as the most severe in the region particularly among the adolescent women and young adults, and would lead to a dramatic increase in annual number of AIDS cases, pediatric AIDS cases and maternal AIDS orphans by the year 2005. The second chapter presents the national response, which includes financial support, human and institutional capacity support through policy development, strategy and operation. The study proposes 5 priority actions to address the management of human, institutional and financial resources through the creation of cabinet committee, empowerment and reorganization of the National AIDS Committee (NAS), independence of NAS, launch of national AIDS planning exercise, and allocating, pooling and monitoring of resources. Chapter 3 discusses the change in sexual behavior as the priority intervention and action proposals include NAS strengthening and behavior change strategy development. Chapter 4 focuses on the provision of sexually transmitted diseases (STDs) and AIDS care as another important intervention with suggestions on the development of national STD and HIV/AIDS care policies and strategies, strengthening of STD and HIV/AIDS care leadership and the AIDS coping capacity of the community. The fifth and last chapter presents the national action plan in response to the problem.
Access to reproductive health services of sex workers in Ho Chi Minh City.
This pilot study examined the reproductive health issues of sex workers in Ho Chi Minh (HCM) City with emphasis on reproductive health services accessibility and sexual health risks. Using qualitative methods of group discussions and in-depth interviews, the study was conducted on September 8-18, 1997, among 33 sex workers and health care physicians in HCM City. Results of the study include the resumption of work among prostitutes despite arrest and reeducation, increased risk for sexually transmitted diseases (STDs) and HIV/AIDS, non-use of condoms, increased rate of unwanted pregnancy, abortion and post-abortion complications, irregular medical treatment and counseling, and influenced by rumors of negative side-effects. It was observed that different treatment methods are practiced by sex workers, and although information on the prevention of STDs and HIV/AIDS has been received, there still exists minimal condom use among clients. The following recommendations are suggested for the development of STD and HIV/AIDS prevention programs: 1) development of intensive STD and HIV/AIDS prevention training courses; 2) integration of new courses into existing HIV/AIDS programs; 3) increase communication, education and awareness on condom use, risk of infection and STD prevention; 4) provision of medical management and monitoring of infected sex workers; and 5) initiation of comprehensive measures to minimize prostitution. In conclusion, this pilot study proposes protection programs for sex workers and communities through safe sex education programs and accessible reproductive health care services.
Data assessment for the National Information Center for Health and Population, Egypt. Draft.
This technical report presents the results and recommendations of a quality assessment of collected and archived data resources of the National Center for Health and Population. Chapter 1 presents the comments on data needs and framework for evaluation needs with emphasis on the framework of information needs. Chapter 2 focuses on data sources and flows, particularly the flow of the Ministry data from its own units and other Ministry sources. Chapter 3 discusses the National Information Center for Health and Population (NICHP) data quality assessment while focusing on data consistency and reliability and the timeliness of the data resulting from the flow. Chapter 4 lists several recommendations for the improvement of NICHP-provided information value. Included in this chapter are recommendations on data quality improvement strategy, clarification of quality and value needs concept, recommendations on partnering for accountability on quality issues with the sectors, and internal NICHP data flows and data checking and quality improvement initiative recommendations. Chapters 5 and 6 present the recommendations for additional technical assistance and the reform pilot in Alexandria. Several data quality problems were encountered which resulted to unidentified incomplete, inconsistent and inaccurate data. This report suggests the promotion of a more aggressive improvement of the Ministry of Health and Population data quality through the adoption of a five-point program.
This is a technical report on the feasibility assessment of a monthly reporting system on key indicators for the data gathered by the National Information Center for Health and Population in Egypt. The first chapter lists the objectives and summary measures used in the indicator reporting system. The second chapter presents issues on data consistency and reliability; unavailability of Management Information System for indicators and the skills and data system used for sustained, monthly chart production, graphs and tables. Chapters 3 and 4 list the indicators and indicator data, respectively. Chapter 5 presents the implementation plan for indicators which includes the 4 phases of plan for indicator system implementation involving the assignment of manager and staff for implementation process, convene workgroup of Ministry of Health and Population, creation of indicator extract file, continuation of presentation templates design, identification of issue methodology in a technical report, final selection of indicators, delivery of first indicator batch to the minister, preparation of indicator for monthly production, distribution of indicators via Internet, preparation of indicators for distribution and planning for decision-making phase. The sixth and last chapter presents the need for technical assistance for future implementation.
This 1996 UN Population Fund report presents the winning entries and excerpts from the International Youth Essay Contest under the theme "Promoting Responsible Reproductive Health Behavior: The Youth Perspective." The first chapter presents the 17 winning entries in full, written by the youth from China, Egypt, Guatemala, Jamaica, Kazakhstan, Kenya, Republic of Moldova, Mongolia, Morocco, Nepal, Peru, Philippines, South Africa, United Republic of Tanzania, Tunisia, Uganda and Zaire. The second chapter presents the excerpts from other entries on their view on early marriage and teenage pregnancy, sexuality and sexuality education, gender equality and equity, sexually transmitted diseases (STDs) and HIV/AIDS and their prevention, role of parents/family, peers/friends, mass media, and the government and community. This contest allowed young people to relate in moving terms the increased risk of maternal death and infant mortality and morbidity among teenage mothers, increased incidence of premarital sexual activity and early marriage, inadequate information on unwanted pregnancy, STD and HIV/AIDS prevention, increased practice of responsible sexual behavior after sex education programs. This paper aims to provide ideas on the global quest to eradicate sex discrimination, promote human and reproductive rights, and freedom.
HIV / AIDS prevalence among males with sexually transmitted diseases in Kuwait.
This cross-sectional survey presents the prevalence and the source of HIV infection among male patients with sexually transmitted diseases (STDs) in Kuwait. In a random selection among new STD patients who visited the Family Planning Clinic in 1996-97, 1984 patients were screened using a specially designed questionnaire and personal structured interviews. Included in the questionnaires are sociodemographic characteristics, medical history, and results of clinical examination. Among the subjects, none were infected with HIV/AIDS, 45.2% had nonspecific urethritis, 42.0% had gonorrhea, 6.7% had chancroid, and 2.5% had herpes. The majority of the subjects were 15-34 years old (76.2%); 53% were married and 37.5% were illiterate. The most common types of sexual partner were female prostitutes, 49.8% and 48.1% among Kuwaitis and non-Kuwaitis, respectively. With the absence of HIV infection, contradictory to studies conducted elsewhere, this study suggests that continuation of mandatory screening must be implemented to make identification of virus carriers easier as well as continuous surveillance to maintain and prevent sexual transmission from high-risk groups.
USAID's vitamin A program: saving the lives of children worldwide, 1965-1998.
This paper presents an overview on the multifaceted efforts of the US Agency for International Development (USAID) to address vitamin A deficiency (VAD) worldwide during 1965-98. The aim of the USAID is to mobilize the creation of domestic and global alliances, and coordinate efforts to save the lives of children worldwide. Applied research in child health and survival and maternal health, operations research, and technology development has been conducted in developing countries. The USAID also provides assistance for global and regional activities designed to increase public awareness on VAD, mobilization of resources, and development and implementation of policies and guidelines. Global assistance includes technical information exchange and dissemination; vitamin A field support; and strengthening private voluntary association/nongovernmental organization technical capacity. The regional programs on the other hand are the Sustainable Approaches to Nutrition in Africa Project; the Greater Horn of Africa Initiative; and the Central America Regional Micronutrient Initiative. Several country programs have been supported by the USAID in the implementation of policies and strategies for promotion of increased access and intake of vitamin A.
Estimating the efficacy of medical abortion.
This article reviews the existing efficacy literature on medical abortion with emphasis on the differences in the analysis of efficacy. The paper also proposes a standard conceptual approach and a statistical method for the analysis of clinical-trial abortion and the implementation of this approach. Review of literature reveals that medical abortion is closely associated with conceptual model used for the analysis of surgical abortion. Surgical abortion is a discrete event that lasts for a few minutes, while medical abortion is a process that takes place within several days to several weeks. There are two events that occur during medical abortion: 1) discontinuation of the process before a fair determination of efficacy can be made; 2) the process of medical abortion provides time for surgical interventions that are convenient for the physician. Medical abortions require different waiting periods giving drugs less time to work before determination of efficacy can be made. It is suggested that the efficacy of medical abortion be more appropriately analyzed by life table procedures developed for the study of another fertility regulation technology--contraception. As with medical abortion, a contraceptive can fail, usually with the risk of failure depending heavily on whether or not the woman follows the protocol for that method. The proper information to collect for a multiple decrement life table analysis of medical abortion includes data on compliance with the protocol, timing of the event of interest, and a typology of any surgical interventions that are conducted during the study.
Influence of cycle variability and coital frequency on the risk of pregnancy.
This article highlights the influence of cycle variability and coital frequency on the risk of pregnancy using data from the completed female condom trial. Daily diaries of women, which include coital frequency and menstrual cycle, were reanalyzed to evaluate the factors that affect the probability of pregnancy. A higher probability of pregnancy was reported among noncompliant women, women with less variable menstrual cycles, and women engaging in frequent intercourse during a 6-month trial. The adjusted hazard ratios and 95% confidence intervals for these three covariates were 6.1 and 2.0-18.7 (noncompliant women), 7.2 and 1.0-54.3 (less variable menstrual cycles), and 2.0 and 0.7-5.3 (frequent intercourse), respectively. The overall pregnancy rate obtained in this study represent average effects for a population with the particular mix of characteristics. This study appears to demonstrate a much lower risk of pregnancy for women with menstrual cycles outside the range of 17-43 days.
This article presents a prospective study on the relationship between pregravid oral contraceptive use and the risk of pregnancy-related hypertensive disorders. Oral contraceptives have been known to increase the risk to hypertension, dyslipidemias and insulin resistance, which characterize hypertensive disorders of pregnancy. This study examines this presumption by employing 3973 nulliparous women with pregnancies lasting >6 months during 1991-95. Data were taken from the results of biennial questionnaires and examination of prenatal records. Follow-up for the past 4 years identified 133 (3.3%) women with gestational hypertension and 62 (1.6%) with preeclampsia. Recent oral contraceptive use within 2 years of pregnancy was inversely associated with the development of gestational hypertension but was directly associated with preeclampsia. Compared with never users and past users, multivariate relative risk among recent users for the development of gestational hypertension was 0.7 (95% CI, 0.4-1.0) and of preeclampsia was 1.3 (95% CI, 0.8-2.4). Recent use of oral contraceptives (8 or more years) predisposes to a 0.6 risk for gestational hypertension and a 2.1 risk for preeclampsia. Thus, recent use of oral contraceptives was associated with a reduced risk for developing gestational hypertension. In contrast, there was a suggestion that recent use was associated with an increased risk of developing pre-eclampsia, but only among women who had used these agents for 8 or more years.
This article presents an evaluation of the effects of a low-dose ethinyl estradiol-desogestrel oral contraceptive on endometrial histology. The oral contraceptive regimen contained fixed doses of ethinyl estradiol (20 mcg) and desogestrel (150 mcg) for days 1-21, placebo on days 22 and 23, and ethinyl estradiol alone (10 mcg) on days 24-28. Endometrial histology was assessed in tissue samples obtained during treatment cycles 13 and 14. All endometrial samples were sent to a central laboratory processing and evaluation. No endometrial hyperplasia or metaplasia was found in the endometrial biopsy specimens obtained during cycles 13 and 14 in a subset of 12 women participating in a multicenter efficacy and safety study. Findings showed that this oral contraceptive regimen, including 5 days of unopposed ethinyl estradiol, is indirectly associated with endometrial hyperplasia or metaplasia. The endometrial histologic findings were similar to those observed during the use of a 21-day combination oral contraceptive regimen.
Analysis of client characteristics that may affect early discontinuation of the TCu-380A IUD.
This article presents a secondary analysis of the relationship between client characteristics and reasons for TCu-380A IUD discontinuation. The information gathered in this study served as a guide in the counseling process to ensure better user satisfaction and continuation rates. Data from the international multicenter trial among 2748 women from Africa, Asia, and Latin America were used to assess the continuation/discontinuation status 1 year after device insertion. The 12-month life table rates of reasons for discontinuation were used in the assessment of data. Participants were 18-40 years old, sexually active, with application of the contraceptive device 42 or more days after the last pregnancy. After a year, the rate of discontinuation was 13.3% for all reasons, 4.5% for bleeding/pain, 4.3% for personal reasons, and 3.1% for expulsion. Specific characteristics related to age, parity, religion and study site had significant effects on the discontinuation of IUD use. Women under age 20 were reported to have had a higher expulsion rate than older women, particularly those living in Africa. Removal due to bleeding and pain was found significantly higher among Muslim women compared to women from other religions.
This article presents a prospective, randomized clinical trial concerning the outcome of levonorgestrel-releasing subdermal contraceptive implants on bone density and bone metabolism during a 1-year study in China. A total of 61 women of childbearing age received either Norplant or domestic implants from July to November 1997. A dual energy x-ray absorptiometry before and 12 months after implant insertion was performed to assess the bone mineral density (BMD) and bone mineral content (BMC) of lumbar 2-4 and proximal femur. A significant increase in BMD and BMC (p < 0.01) was observed in both groups, with an increase of 2.40% and 3.34%, respectively, in the Norplant group and 2.75% and 4.47%, respectively, in the domestic implant group. Included in the analysis was the measurement of the urine hydroxyproline and creatinine ratio, which was observed to decrease (p < 0.01) in the domestic implant group. Insignificant changes in BMD and BMC on lumbar spine and femur were noted among women 35 years of age or older. This study concludes that levonorgestrel releasing contraceptive subdermal implants are not deleterious to the osseous framework of women in childbearing age.
Mifepristone-misoprostol medical abortion: home administration of misoprostol in Guadeloupe.
This paper presents a prospective study of home administration and a one-treatment-visit regimen of mifepristone-misoprostol for medical abortion in Guadeloupe. The administration of this contraceptive method usually requires a standard 3-clinic visit regimen, which would sometimes lead to discontinuation of the abortion process. The study consisted of 92 medical abortion cases conducted over a 13-month period. The intervention involved a 1-day treatment visit with patients receiving 600 mg of mifepristone and instructions on ingesting 2 tablets (400 mcg) of misoprostol orally after 2 days and another 200 mcg misoprostol if bleeding had not occurred within 6-12 hours. A follow-up was conducted among these women after 10-15 days of initial clinic visit and contraceptive administration. The total success rate was 95.4% in comparison with those who received a 3-clinic visit regimen and the statistical result of a study conducted in the US. Several adverse effects have been associated with the administration of abortive methods, which include bleeding (19.6% in mifepristone users and 68.2% in misoprostol users) and vomiting. Strict monitoring of mifepristone and misoprostol distribution and patient follow-up was ensured by French legislators. The authors conclude that home administration of misoprostol must be made available to women in developing countries.
Adenomyosis is the major cause of menorrhagia, dysmenorrhea, and an enlarged uterus, which causes great distress to the patient. Surgical hysterectomy has been used in the past as a treatment option for adenomyosis, but acceptability of this intervention is minimal due to an increased risk in morbidity and mortality. This article presents the successful medical treatment of an enlarged adenomyotic uterus with the levonorgestrel-releasing intrauterine system (LNG-IUS) using a case report of a 42-year-old woman with adenomyosis who received the LNG-IUS as a long-term therapy for menorrhagia and dysmenorrhea. Regular menstruation without pain was reported after 3 months of treatment with a 27% decrease in uterine size after 9 months. The effectiveness of the LNG-IUS was hypothesized to be due to two factors: 1) decidualization and subsequent marked atrophy of the endometrium; 2) direct action of the hormone on the foci of the adenomyosis. A reported side effect of the LNG-IUS is the irregularity of bleeding during the initial treatment. The study suggests that use of the LNG-IUS is a viable option and could greatly advance the treatment of adenomyosis.
This paper investigates the fertility patterns of adolescent and older women in the Pacific Island countries. Using the age-specific fertility rate for females aged 15-19 years old, an attempt to measure the overall rate of fertility pattern among adolescents was made. It was observed that adolescent fertility has declined over the years in the Pacific Island countries at a time when overall fertility was declining for all women, particularly in Polynesia. Another determinant for fertility pattern includes the rate of childbearing among older women. Although a decrease in childbearing rate was noted, fertility among women 35 years and older remain significantly higher compared with adolescents. Despite these extensive problems, the public sector and the nongovernmental organizations have neglected to address the unmet needs of these women. Several reasons have been mentioned that has caused the problem, which include: inconvenience or unsatisfactory services; ignorance or lack of information; and the unavailability of reliable contraceptive methods and services. This report suggests the need to implement programs aimed at addressing the unmet needs of fecund older women in current and future reproductive health and family planning programs.
The importance of field-workers in Bangladesh's family planning programme.
This study explored the importance of field-workers in Bangladesh's Family Planning Programme. Three separate sources of data were used to develop the analysis. The first data set provides information that was collected as part of a study to calculate the costs of both clinic and home service delivery program of the government. The second data set provided information on the perspective of the field-workers' clients to determine the level of knowledge, attitudes and practices concerning specific issues of oral contraceptive compliance. The third source of data provided information on the willingness and ability to pay for doorstep delivery of contraceptives in two rural areas. Using the three independent studies, it was shown that the length of client-provider interactions was short, and that the percentage of visits in which various family planning, and maternal and child health topic discussion was low. Furthermore, clients lack important information on contraceptives and do not put a high value on interactions with field-workers. The vast majority of clients view the field-worker program as a convenience and not as an important source of information. Furthermore, the studies show even poorer quality of care services, and the reported visits of the field-workers often do not involve discussions on family planning methods. The results indicated that field-workers are not doing a good job in motivating women to adopt contraceptive use. In addition, the high cost and low quality of services indicate that other models of service delivery need to be considered.
Unmet contraceptive need is defined as the percentage of currently married women in their reproductive ages who do not want additional children and yet do not practice contraception. This analysis examined the extent of unmet need in Bangladesh and differentials in unmet need by selected characteristics of the respondents. Data were obtained from the 1993-94 and 1996-97 Bangladesh Demographic and Health Surveys (BDHS), which employed nationally representative, two-stage samples of 8842 (7510 rural ad 1332 urban) and 8306 (6995 rural and 1311 urban) currently married women of reproductive age. In this analysis, the dependent variable "unmet need" includes pregnant women whose pregnancy was mistimed, amenorrheic women whose last birth was mistimed, and women who were neither pregnant nor amenorrheic and who were not using any method of family planning. In addition, several independent variables were also considered in the analysis. According to the BDHS data, 1 out of every 6 women in Bangladesh has an unmet need--8% each for spacing and limiting the birth of children. The extent of unmet need was found to be higher in rural than in urban areas, and was higher in Sylhet and Chittagong divisions compared to the country's other divisions. The main predictors of unmet need were found to be ever use of family planning, husband-wife communication on family planning matters, number of living children, and place of residence. Furthermore, unmet need was slightly lower among women with some secondary schooling than among those with little or no education.
Return migration: changing roles of men and women.
This article addresses changes in gender roles among returning migrant families. It focuses on Greek returnees from the Federal Republic of Germany and explores changes in task sharing behavior and gender role attitudes resulting from changes in the sociocultural environments. A group of return migrants was compared with a group of non-migrants, both living in villages in the District of Drama, Greece. Groups were interviewed to investigate the extent to which each spouse shared house tasks, as well as their attitudes towards sharing and gender role in the family. The t-test for independent samples was used to determine mean differences between the two groups. In addition to demographic variables, those concerning the "time lived abroad" and the "number of years in Greece" after return were inserted into a series of regression analyses. Findings showed that migrants' task sharing and gender role attitudes were influenced differently by the migration-repatriation experience and subsequent cultural alternation. Results also suggest that migrant couples either take on new patterns of behavior or maintain traditional ones only when these were congruent with the financial aims of the family or can be integrated into living conditions in Greece upon return. Furthermore, migrants seem to adopt a more "traditional" attitude than non-migrants toward the participation of women in family decision making. From the study, it is suggested that gender role change is an on-going process influenced by the migration-repatriation experience, as well the factors, which accompany movement between the two countries.
Teenage mothers and their peers: a research challenge.
This pilot study was undertaken to identify practical problems in studying the effects of teenage motherhood, and compare the assessments of perceived health status and social networks of teenage mothers with those of their nulliparous peers. A total of 55 teenage mothers with one child were matched with the control group of nulliparous teenagers with no history of pregnancy concerning the date of birth, type of house, and postcode. Different results between the groups were manifested despite the comparable characteristics. Upon initial analysis, Vitality and Mental Health sub-scales of the short form 36 mean scores on mothers were significantly lower than the control. Mean scores on the B subscales were significantly higher in the General Health Questionnaire, showing high levels of insomnia/anxiety. With regard to self-assessed health status, the number of people providing support or the degree of satisfaction felt with the support in both groups did not have any significant differences. Although findings in this study highlights some practical problems related to teenage motherhood, detailed screening interviews of a large number of respondents is required to obtain a closely match in the control group.
Factor V Leiden and pulmonary embolism in a young woman taking an oral contraceptive.
This article presents a case report of a 34-year-old woman with a known medical history of asthma and oral contraceptive use who died suddenly from a massive pulmonary embolus. This woman had no underlying malignancy, trauma, recent surgery, or other predisposing factors putting her at risk of venous thromboembolism except for her use of oral contraceptives. Upon autopsy, a large saddle embolus was found occluding the main pulmonary arteries with bilateral extension into the smaller arteries. An acute pulmonary embolus obliterating the lumen of the main pulmonary artery was found during the microscopic examination. Molecular studies of blood DNA using polymerase chain reaction and restriction fragment length polymorphism revealed a coagulation factor V Leiden mutation. Female carriers of factor V Leiden mutation who take oral contraceptives have a more than 30-fold increased risk of developing deep venous thrombosis. This case demonstrates that the woman had an underlying predisposition that was further potentiated by oral contraceptive use. The incidence of venous thromboembolism in patients with factor V Leiden mutation and associated activated protein C resistance is discussed.
Exploring the concepts of intended, planned, and wanted pregnancy.
This qualitative study using in-depth semistructured interviews determined how women define the intention status of current, past, and hypothetical pregnancies. The study population included 18 women, primarily in their first trimester, seeking prenatal care, elective abortion, or pregnancy testing. Findings demonstrated three major themes emerging from the interviews: 1) definition of terms related to pregnancy varied substantially among women and seemed to be highly correlated to social and cultural influences; 2) the concepts of wanted and unwanted pregnancy were qualitatively distinct from the concepts of planned and unplanned pregnancy and seemed to be more relevant to the decision to continue or abort the pregnancy; and 3) attitudes of male partners toward the pregnancies were very influential in how women defined their pregnancies.
Decreased plasma tissue factor pathway inhibitor in women taking combined oral contraceptives.
This article reports the findings of a study that determined whether use of oral contraceptive (OC) is associated with significant changes in plasma tissue factor pathway inhibitor (TFPI), which may contribute to thrombotic risk. Plasma TFPI antigen and activity, factor VIIa, prothrombin fragments 1 and 2, von Willebrand antigen, fibrinogen, and low density lipoprotein cholesterol were measured by standard assays in 40 women aged 16-45 taking OCs and 40 age-matched women not taking OCs. Results revealed that the plasma TFPI antigen did not vary significantly across the menstrual cycle in controls. Women on OCs had a 25% reduction in plasma TFPI antigen (median, 51.0 ng/ml; 95% confidence interval (CI), 37.5-85.5; controls, 68.0 ng/ml; CI, 61.0-95.0) and a 29% reduction in TFPI activity (78.5 U/ml; CI, 57.5-107.5; controls, 111.0 U/ml; CI, 79.5-171.0) compared to controls. Plasma factor VIIa activity and prothrombin fragments 1 and 2 were also significantly increased in women using OCs, indicating activation of the extrinsic coagulation pathway. These results demonstrate that normal cyclic variations in estrogen and/or progesterone do not significantly alter plasma TFPI levels. However, estrogens and/or progesterone in OCs result in activation of the extrinsic coagulation pathway and significantly reduce plasma TFPI, its major circulation inhibitor. In conclusion, reduced plasma TFPI levels may underlie the thrombotic effects of OCs.
Combined oral contraceptives (OCs) have been implicated with an increased risk of a number of illnesses, particularly vascular conditions such as stroke, ischemic heart disease, venous thrombosis, and peripheral vascular disease. This study assessed the balance of risk of serious illness among a cohort of OC users followed for up to 28 years. Data from the Royal College of General Practitioners' Oral Contraception Study were examined to determine the rate of such conditions during 335,181 woman-years of observation for ever-users and 228,727 woman-years for never-users. The rates were standardized for age, parity, social class, and smoking. Results of the study indicated that in comparison with never-users, ever-users had a small increased risk of any serious disease. Ever-users had an excess risk of cerebrovascular disease, pulmonary embolism, and venous thromboembolism, and reduced risk of ovarian and endometrial cancer. The increased risk was seen only in younger women; by the age of 50, ever-users had the same risk as never-users. The risk appeared to be confined to women using OCs containing 50 mcg or more of estrogen. In conclusion, past users of higher-dose OCs can be reassured that the small increased risk of serious disease seen during current use does not persist after stopping and that latent effects do not appear later in life. Currently available OCs containing less than 50 mcg of estrogen, accompanied by the progestogen, levonorgestrel, or norethisterone acetate, do not appear to be associated with an increased net risk of serious disease.
This retrospective case-control study examined the association between the unsuccessful use of abortifacient misoprostol during the first trimester of pregnancy and Mobius syndrome in the infant. This study compared 96 infants with Mobius syndrome (cases) with 96 infants with neural tube defects (controls). The study was conducted in Brazil by the Motherisk Program at the Hospital for Sick Children of Toronto, Ontario. Findings demonstrated that almost half (49%) of the mothers with Mobius syndrome infants had used misoprostol during their first trimester compared with 3% of the mothers with neural tube defect infants. Several of the mothers (20/47) had taken misoprostol orally; 20 had used it both orally and vaginally. Comparison of the baseline characteristic showed that mothers of infants with neural tube defects had low-birth-weight babies and were delivered through cesarean section. Both groups were statistically the same in educational level, gravidity, parity, number of previous miscarriages and induced abortions, rate of consanguinity, use of alcohol and cigarettes, and presence or absence of hyperthermia in the first trimester. The study suggests a strong association between unsupervised unsuccessful use of misoprostol for attempted abortion and Mobius syndrome in the infant.
Medicolegal file. Tell everything you know about birth control pills.
This paper presents a case in Quebec in 1976 concerning the alleged failure of the doctor to divulge everything he knew about the use of birth control pills to the patient. Nearly every oral contraceptive monograph in the Compendium of Pharmaceuticals and Specialties contains a statement that the pill should be stopped for a month before a major elective surgery. This information was available to the doctor, but evidence revealed he did not pass it on to the patient. The judge found that the doctor had failed to meet the standard required of him when did not advise the patient about this warning. The doctrine of informed consent requires that patients be given all the reasonable information a person would want in order to decide on a course of action. The case did not raise new issues of law, but should serve to raise awareness of the need to inform patients fully not only about the specific procedures patients would undergo but also about the effects that coexist with the conditions or medications.
This paper aims to develop a life history theory model that integrates environmental and contextual influences, as well as heritable variation. Discussion departs from the argument that deleterious environments, particularly those causing both physical and psychological stress, retard maturation and the onset of reproductive competence. Taking into account the importance of the social context in human reproductive behavior, discussion focuses on the opportunity for upward social participation as a contextual influence that results in delaying reproduction and adopting a low-fertility, high-investment life history intervention. Other than the environmental and contextual influences, variation in life history measures is also influenced by heritable variation. Finally, the paper discusses the differential effects of social controls on sexual behavior on high- versus low-investment strategies.
Women, empowerment, and economic development.
Development policies and programs tend to ignore the value of women in the economic development. This uneven progress in the well being of women reflects the emphasis of development policies that focused mainly on their reproductive rather than their productive roles. Yet, women in developing countries participate in the labor force, working primarily in agriculture and informal sectors, as well as in formal wage employment. Since the 1950s, development agencies responded to the need of low-income women by making small investments in income-generating projects. However, these projects often fail because they are motivated by welfare rather than development concerns that provide women with temporary and part-time jobs in traditionally feminine skills. On the contrary, over the past 20 years, some nongovernmental organizations, including the Self-Employed Women's Association in India, have been successful in promoting the economic status of women because they operate on the premise that women are key components of economic development.
Female genital mutilation: implications for social work.
This article examines the different aspects of female genital mutilation (FGM) which is more commonly known as "female circumcision." It also discusses the Women-at-Risk Program in Canada, mental health issues, and Canadian laws and bans on this practice. Implications of FGM for the social work are also addressed. FGM is a global issue, occurring across different cultures and ethnic groups. It is estimated that between 85 and 14 million women have been mutilated worldwide. There are three forms of FGM: circumcision, excision, and infibulation. Despite the many serious risks arising from these procedures, the practice still continues for reasons that are often based on myths, tradition, and beliefs that religion requires it. Females can suffer from severe consequences of FGM. Various fields, which address health needs, however, failed to recognize the physical and psychological impact of the practice, and have not effectively trained health workers to confront this issue. Putting an end to FGM requires a global action from professionals in mental health, social work, medicine and nursing to challenge laws and lobby for new policies; advocate for the human rights of women and children; negotiate for changes in the health care system to address the needs of women have been mutilated; and create educational literature, thus, increasing awareness on FGM.
This comparative study on the two rural drinking water supply and sanitation projects in the state of Kerala, India, was conducted to determine the impact of community participation on the project outcomes. Both were piped water schemes delivered by the Kerala Water Authority (KWA); one had adopted community participation by the beneficiary community, the other contained no community participation component. Project 1 was served by the Dutch/Danish project and Project 2 was served by KWA alone. A total of 160 respondents were involved in the study, 80 individuals belonged to each project. Technological outcomes, particularly in terms of water quality, were found to be better in project 1 than in project 2. 40% of the people in Project 1 villages and 25% in Project 2 villages switched over completely to the "safe" water supply provided by the project. It was also found that the health habits of the beneficiaries in project 1 were far better compared to project 2, specifically in covering drinking water containers and use of latrines. In addition, there was more continued community involvement in project 1 than in project 2. Satisfaction-wise, the majority (75%) of respondents in project 1 areas claimed satisfaction with the project as compared to 30% of project 2 respondents.
Determinants of migration values and expectations in rural Thailand.
Moving from the argument that values and expectations underlie behavioral motives, this study examined the determinants of migration values and expectations in rural Thailand. Data were obtained from the 1992 National Migration Survey of Thailand as well as from interviews of 7550 households. A large variation was found in the proportion of respondents expressing high expectations of attaining valued aims. Of the migration-related value-expectancy dimensions, expectations were lower for attaining stimulation (26%) and income (36%) and higher for comfort (57%) and affiliation (75%). Of the total respondents, 16% indicated intention to migrate in the next 2 years; single, younger adults, males with secondary education and friends, in Bangkok, had greater intentions to move. Logistic regression analysis demonstrates that land ownership and being married were associated with higher expectations, while a diversified village economy, a village economic development program, and a younger and extended family structure were linked with lower expectations of attaining valued goals. Finally, value-expectancy concepts were only partial intervening explanations to migrate or to remain at home.
Socio-economic status and clustering of child deaths in rural Punjab.
This paper explores alternative models to test for clustering and apply them to the 1984 data for Punjab villagers categorized by socioeconomic status, education of the mother, and the sex of the child and age at death. Interviews were later conducted with mothers and other members of some households with history of multiple child deaths and with matched families with similar socioeconomic status in which there had been no child deaths. The study showed that significant clustering of child deaths was found only among households with lower socioeconomic status and education. Improvements in socioeconomic condition and education appear to decrease child mortality. The extent of clustering is high among the total population were 23% of child death can be attributed to being born into a high-risk family. Improved health care services offer a major contribution to the reduction in deaths among the children in the area. In addition, birth intervals seem to be an effect rather than a cause of greater familial susceptibility to child loss. The result also exemplifies a considerable potential for reducing and preventing child death by targeting on high-risk families to receive extra attention in health care. Finally, researchers suggest the use of negative binomial model when clustering child mortality in populations in which families are successful in focusing their behavior towards a given number of surviving children.
A decreasing trend in mortality and morbidity has been observed among adult AIDS patients in Sao Paulo, Brazil, from 1995 to 1997. Deaths in adults with AIDS declined significantly from 29% in 1995 to 23% in 1997 (P < 0.001). The average length of hospital stay declined by 13 days, from 33 days in 1996 to 20 days in 1997. Moreover, opportunistic infections that necessitate daily hospital care fell dramatically, from a total of 198 cases in 1995 to 150 in 1996 and to 75 in the following year. This declining trend was attributed to the highly active antiretroviral therapy provided by the Brazilian government, awareness of physicians of HIV/AIDS diagnosis, early management and prophylaxis for opportunistic infections, and more efficient hospital administration.
The menace of the AIDS-tuberculosis combo: any solutions [editorial]
AIDS and tuberculosis (TB) have become the leading causes of death in the developing world, particularly in Africa and Asia. Many people have died from TB, without even the knowledge that the underlying cause of the disease was infection with an AIDS virus. TB/HIV coinfection increased from 5.4% in 1989 to 40% in 1997. Control of TB infection has been hindered by certain factors, such as stigma attached to TB, lack of financial resources along with inadequate understanding on the rationale of prolonged treatment. As a result, patients often terminate therapy before completing the prescribed 6-month treatment, causing the development of deadly multi-drug-resistant Mycobacterium. HIV/AIDS compounds the problem of multi-drug resistance. As the problem of TB rises from the effect of HIV, the likelihood of infection among noninfected individuals will also increase and pose a serious threat to the global community. This should instruct an urgent and united effort to control TB and HIV infection worldwide. Research to assist in designing vaccines and therapies to reduce the burden of TB infection in HIV-infected individuals, with the potential of decreasing the spread of multi-drug resistance worldwide is essential to curb these infectious diseases.
This comparative study examined the relationship between self-efficacy theory and contraceptive practices in male and female adolescents enrolled in Midwestern University. A survey method was employed to obtain data from 101 female and 106 male subjects aged 18-20, sexually active, single, and who had one sexual partner for at least 3 months. Findings suggest that both genders need to develop the necessary communication skills in sexual matters and contraceptive issues. Females scored low on several self-efficacy statements that involve the ability to communicate about sexual matters and securing the use of contraception. They also obtained a low score in statements that require assertiveness in preventing sexual intercourse in highly involved situations. Meanwhile, male subjects scored low in items involving communication skills. Finally, contraceptive self-efficacy was found to be significantly different for males and females in the following areas: females need to learn how to assume responsibility and to become more effective in securing contraceptives; and males need to learn to be assertive about avoiding sexual intercourse when not using contraception and to develop the ability to talk about using contraceptives.
This cross-sectional survey was conducted to examine the relationship between postpartum sexual abstinence and increased incidence of extramarital sexual contacts by husbands in West Africa. Data gathered from male subjects on their extramarital sexual relationships in the past 12 months were associated to the data on postpartum abstinence during the same time period reported by wives. Multivariate analysis was employed to determine the association. Findings revealed that approximately one half of the married men experienced postpartum abstinence in the past 12 months. About 32% of the subjects in this group and 20% of those who experienced no postpartum abstinence reported nonmarital sexual contacts (P < 0.001). Age, income, and wealth were found to be important predictors of the probability of extramarital sex. However, the effects of both predictors disappeared when attention was focused to extramarital sex without condom use in most recent situations. Given the increased likelihood of extramarital sexual intercourse resulting from postpartum sexual abstinence, family planning service providers in this region should encourage early resumption of sex and recommend suitable methods of postpartum contraception for women who express concern about their husbands.
South African government seeks reasssurances on AIDS initiative.
South Africa's Minister of Health, Nkosazana Zuma, announced that she has not rejected the $100 million offered by Bristol-Myers Squibb (BMS), a US drug company, towards fighting AIDS in the region. She further explained that the offer must be modified to conform to the health care policy of the government before its endorsement. In a meeting with BMS representatives, Zuma outlined four areas of concern: 1) sending South African physicians to the US for training in HIV treatment; 2) financing clinical trials in South Africa; 3) the fact that only preclinical studies by the South African Medicine Research Council were acceptable; 4) the fact that funding to community outreach projects should focus on home health care and care of orphans.
BMS offers some relief for Africa's AIDS crisis. [Bristol Myers Squibb].
Bristol Myers Squibb pharmaceutical company has pledged a $100 million, 5-year initiative aimed at developing long-range measures to address the HIV/AIDS epidemic in southern Africa. The money shall be used to finance clinical trials, physician training, and community education programs in five countries: South Africa, Botswana, Namibia, Lesotho, and Swaziland. The clinical studies will examine various combinations of drug therapies, vitamins, and feeding formula. It will also be used to fund the Secure the Future: Care and Support for Women and Children project, which aims to find effective measures to fight the epidemic in the region. Moreover, it shall also support community outreach and education programs, whose integral component includes a fellowship scheme to train 125 African doctors and nurses in HIV treatment and research. In addition, 25 Americans will work in the region in order to have an actual experience of the epidemic.
A personal look at the AIDS crisis in South Africa.
This article presents a personal perspective on the AIDS crisis in South Africa. According to the Joint UN Program on HIV/AIDS, more than 33 million people are infected with HIV. Throughout the world, 11 people become victims of AIDS every minute, 95% come from developing countries, and a staggering 80% are from Africa. The HIV/AIDS pandemic is not merely a medical problem, it is also a fundamentally moral problem that affects the whole world. As part of the global AIDS community, Third World countries should take actions to put an end to this worldwide problem. Efforts should include effective education, promoting condom use and ensuring easy access, and encouraging behavior change including safe sex. The churches and other faith communities should move forward and participate in all endeavors against HIV/AIDS. Even poor countries can begin to have a rigorous and a systematic approach to prevent and control the spread of sexually transmitted diseases.
Global challenges of the AIDS epidemic: perspectives. Introductory remarks.
AIDS has now been recognized as the leading cause of adult mortality worldwide. New cases of HIV infection rose by 10% from 1996 to 1997. AIDS has affected all economic classes including the armed forces. Despite the medical advances achieved, there is no indication that this trend will reverse. This epidemic remains a global public health emergency. The new millennium is projected to present a worst scenario for AIDS. By the year 2001, 100 million people will be incubating a virus that mutates at least one of its genes each time it multiplies, a capability that suggests an unfathomable reservoir for new AIDS viruses and new viral epidemics should the world fail to address this condition. The costly treatment of AIDS should not permit us to surrender, wait, and be passive. Vaccine development should be a priority. Moreover, there is proof that early diagnosis and treatment of sexually transmitted diseases with less expensive medications such as penicillin and sulfa drugs stops the spread of HIV. Studies in Thailand and New York showed that a few dollars worth of azidothymidine could significantly decrease mother-to-fetus transmission of the virus. Finally, early education of women and attention to basic civil rights play a key role in the prevention and control of this deadly disease.
Preventing mother-to-child transmission of HIV in Africa.
This article comments on the methods of reducing mother-to-child transmission of the HIV disease in the countries of Africa. Well-known interventions such as Cesarean sections, alternative feeding options, and antiretroviral drugs (zidovudine, lamivudine and nevirapine) have brought vertical transmission of HIV under a reasonable level of control where financial resources, technical infrastructure, and HIV testing exist. In sub-Saharan Africa, these effective interventions are beyond the current capacity of the country. However, the report explains that Africa is far from powerless to prevent vertical transmission of the disease. The countries already have commitment of political leaders, increased technical and financial resources, coordination of international support, integration into existing health services, and a combined approach to the problem. In addition, pilot projects and effective interventions have been implemented in the countries. Nevertheless, two strategies need urgent investigation. These include the use of a combination of nevirapine and zidovudine/lamivudine and an investigation of different approaches to the problem of HIV transmission through breast-feeding.
This paper comments on the extent of the public health benefit of perinatal zidovudine treatment and breast-feeding replacement initiatives in the poorer developing countries. This kind of intervention may prevent many infants from getting HIV infection. However, additional funds, as well as additional staff, staff training, and improved capacity and resources are needed to integrate this intervention successfully into antenatal and delivery care. In addition, replacement feeding methods must be accessible and there should be support in using them safely, not only for HIV-positive women but also for untested women who fear that they may be infected with the disease, and for those at risk of infection in the breast-feeding period. However, a more comprehensive, broad-based approach to HIV prevention and care in relation to pregnancy that include treatment for both women and infants is presented. It promotes prolonged health and survival in women, which would consequently contribute to improved infant and child health and survival.
A pragmatic intervention to promote condom use by female sex workers in Thailand.
This paper presents an overview of a multifaceted intervention project to promote consistent condom use by female commercial sex workers in Thailand. This project is in context of the government's 100% condom use policy for preventing the spread of HIV. It involves a succession of stages including preprogram needs assessment, intervention design, project implementation and evaluation. A total of 222 cases involving equal proportions of high-income and low-income commercial sex workers were classified into intervention and control groups and completed the pre-test and post-test surveys. The intervention consisted mainly of video scenarios and discussions coordinated by health personnel and of video-depicted open-ended narratives. These methods were aimed at helping sex workers' self-esteem and perceived future with a view to strengthening their motivation to take preventive action against HIV infection. Using a combination of qualitative and quantitative methods in the evaluation process, significant increases in consistent condom use were noted among the intervention groups but not among the control groups.
Anaemia during pregnancy in Burkina Faso, West Africa, 1995-96: prevalence and associated factors.
This article presents the findings of a cross-sectional study conducted in 1995-96 to determines the prevalence of and the risk factors associated with maternal anemia and the effect of HIV infection on the severity of maternal anemia in Burkina Faso. A total of 2308 pregnant women attending two maternal and child health centers in Bobo Dioulasso were tested and counseled. The seroprevalence of HIV was 9.7% (95% CI: 8.6-10.8) and overall prevalence of anemia, defined as hemoglobin level, was 66% (95% CI: 64-68%). The prevalence rate was 30.8% for mild anemia, 33.5% for moderate anemia, and 1.7% for severe anemia. The prevalence rate among HIV-infected women was 78.4%, compared with 64.7% (P < 0.001) for HIV-seronegative women. This statistic confirms the high prevalence of anemia during pregnancy in Burkina Faso. The study showed a close correlation between HIV infection and anemia among pregnant women. However, there were no significant associations between the degree of anemia and HIV serostatus among the study population. In addition, the prevalence of anemia was independently related to HIV infection, advanced gestation age, and low socioeconomic status. Findings on gestation time reflect the progressive collapse of weak reserves of iron and folic acid during pregnancy. Thus, antenatal care must include systematic supplementation with iron and folic acid, chemoprophylaxis of malaria, and screening and treatment of intestinal parasitic infections.
This study examined the prevalence of anti-hepatitis Bc virus (HBc) and anti-hepatitis C virus (HCV) antibodies in a random sex- and age-stratified sample of 1006 individuals aged 25-64 years in the Seychelles. The anti-HBc and anti-HCV antibodies were detected using an enzyme-linked immunosorbent assay, followed by a Western blot assay in the case of a positive result for anti-HCV antibodies. Findings revealed that the age-adjusted prevalence of anti-HBc antibodies was 10.4% and 5.8%, respectively, among men and women aged 25-63 years. The presence of anti-HBc antibodies was associated significantly with employment, educational level, and alcohol intake, marginally with economic status, and not at all with ethnic origin. 2 men and 3 women were positive for anti-HCV antibodies, with an age-adjusted seroprevalence of 0.34%. 2 out of these 5 subjects who were positive for anti-HCV antibodies were also positive for anti-HBc antibodies. The age-specific seroprevalence of anti-HBc antibodies in this population study conducted in 1994 was approximately 3 times lower than in a previous patient-based survey carried out in 1979. Although there were methodological differences between the two surveys, it is likely that the substantial decrease in the anti-HBc antibody prevalence during the last 15 years may be due to significant socioeconomic development and the systematic screening of blood donors since 1981.
This study evaluated the impact of an in-service training course for physicians on diarrhea and acute respiratory infection (ARI) management in children under age 5 in Tlaxcala, Mexico, between January 1993 and April 1994. The training consisted of a 5-day course of in-service practice, during which physicians diagnosed and treated sick children attending a center and conducted clinical discussions of cases under guidance. Each training course was limited to 6 physicians. Clinical performance was evaluated by observation before and after the courses. The evaluation of diarrhea case management covered assessment of dehydration, hydration therapy, prescription of antimicrobial and other drugs, advice on diet, and counseling of mothers. The evaluation of ARI case management, on the other hand, covered diagnosis, decisions on antimicrobial therapy, use of symptomatic drugs, and counseling of mothers. The study revealed that the performance of public physicians before and after the intervention was better compared to those of private doctors. Most aspects of case management of children with diarrhea improved among both groups of physicians after the course. The proportion of private doctors who had 5 or 6 correct elements out of 6 increased from 14% to 37%, while for public doctors the corresponding increase was from 53% to 73%. As for the ARI case management, decisions taken on antimicrobial therapy and symptomatic drug use improved in both groups. The proportion of private physicians with at least 3 correct elements out of 4 increased from 13% to 42%, while among the public doctors, the corresponding increase was from 43% to 78%.
This meta-analysis of randomized controlled trials compared an antibiotic prophylaxis (either oral doxycycline or azithromycin) with placebo or no treatment on risk of pelvic inflammatory disease (PID), incidence of unscheduled return visits to the clinician, and IUD discontinuation within 3 months of insertion. The analysis demonstrated that the use of prophylaxis significantly reduced the frequency of unscheduled return visits. The protection against PID was smaller and was not statistically significant. Furthermore, the analysis showed that no significant effect on premature IUD discontinuation was evident. Use of either oral doxycycline or azithromycin before IUD insertion offered little observable benefit in the US. Prophylaxis reduces unscheduled visits and possibly PID in developing countries, where rates of sexually transmitted diseases are higher compared to the US. A more important finding in these trials was the low incidence of PID with or without prophylactic antibiotics.
This phase II/III randomized, open-label, parallel group, active control study of 841 women at risk for pregnancy was carried out to compare the safety and contraceptive effectiveness of FemCap and Ortho All-Flex, both with 2% nonoxynol-9 spermicide, for 28 weeks. A subset of 42 women at one site underwent colposcopy. The authors aimed to determine whether the probability of pregnancy during 6 months of typical use of the FemCap was within 6 percentage points of that of the Ortho All-Flex. The 6-month Kaplan-Meier cumulative unadjusted typical use pregnancy probabilities were 13.5% for FemCap users and 7.9% for diaphragm users. The adjusted risk of pregnancy among FemCap users was 1.96 times that among diaphragm users, with an upper 95% confidence limit of 3.01. Noninferiority of the FemCap compared with the diaphragm, as defined in the study, would mean the FemCap users had 1.73 times or less the pregnancy risk of diaphragm users. The probability of pregnancy among FemCap users compared with that among diaphragm users did not meet the definition of clinical equivalence used in this study because the observed upper 95% limit exceeded 1.73. The FemCap was believed to be safe and was associated with significantly fewer urinary tract infections. However, more women reported problems with regard to insertion, dislodgment, and removal, although their general assessments were positive. The two devices were comparable with regard to safety and acceptability, but a 6-point difference in the true 6-month pregnancy probabilities of the two devices could not be ruled out.
Once-a-month injectable contraceptives, Cyclofem and Mesigyna, in Egypt.
This randomized comparative clinical trial assessed the efficacy, related side effects, and acceptability of two once-a-month injectable contraceptives, Cyclofem and Mesigyna, over a period of 1 year among 2252 women in Egypt. Women were randomly assigned to one of two study groups and followed a standard protocol for a comparative assessment. Findings demonstrate that both contraceptives proved to be highly acceptable, with continuation rates of 63.2/100 woman-years for Cyclofem and 61.6/100 woman-years for Mesigyna at the end of 12 months of use. The cumulative discontinuation rates per 100 women-years for method failure were 0.19 for Cyclofem users and 0.41 for Mesigyna users. Menstrual problems were the leading complaint among users, followed by nervous symptoms. Furthermore, the discontinuation rates for amenorrhea were 2.74 for Cyclofem and 1.38 for Mesigyna, while discontinuation due to bleeding problems was higher among Mesigyna users (11.45) than Cyclofem users (7.39). There was no significant difference between the two groups regarding the discontinuation rates from other medical and personal causes. However, insignificant changes in the systolic and diastolic blood pressure values were recorded at follow-up. On the other hand, a constant weight gain averaging 0.33 kg/month was observed in both groups. However, it was not considered a major cause of method discontinuation. In conclusion, this study showed that once-a-month injectable contraceptives can be part of the contraceptive choices offered to Egyptian women.
This longitudinal study examined the effect of 1 year of use of the Cu-T 380A IUD and of oral contraceptives (OCs) on the hemoglobin (Hb) content, serum ferritin, and percent iron concentration of women with an initial Hb level of 9-12 g/dl. A total of 256 IUD initiators and 202 contraceptive pill initiators in seven participating centers in Egypt comprised the study population. Hb content was measured after 3, 6, 9, and 12 months, and the serum ferritin, serum iron, and total iron binding capacity after 6 and 12 months of contraceptive use. Findings revealed that the use of Cu-T 380A IUD produced a statistically significant drop in the Hb content and percent iron saturation levels after 12 months of use, as compared with the use of OCs for the same period. The drop was greater with longer IUD use, initial high Hb levels, and among urban and semiurban residents. It is recommended that iron supplementation be part of the IUD services provided in family planning units in view of the high prevalence of anemia among women of childbearing age in Egypt. Moreover, mass media campaigns should be carried out to improve the nutritional status of women, especially in the poorer population.
Abortion complications in Abidjan (Ivory Coast).
A retrospective study was undertaken to assess the effect of various abortion practices on maternal health. The study was based on the medical files of all 472 women admitted to an obstetrics department in Abidjan, Ivory Coast, for abortion complications during a 3-year period (1993-95). The medical records of the sociodemographic and medical characteristics of women upon admission were assessed. Results demonstrated that the introduction of plant stems into the uterus was the most frequently used abortion method (31%), followed by herbal pessaries (23%) and plant infusions (20%). About 17 maternal deaths were registered, giving a maternal mortality rate of 3.6%. A high number of previous pregnancies and the ingestion of plants to provoke abortion were the factors associated with the highest risk of maternal death. Furthermore, complications resulting from local abortion methods accounted for a high proportion of maternal deaths. From the results, it was found that the potential lethal risks associated with local abortion methods were high. These results suggest that more rapid and efficient hospitalization in abortion cases and greater access to family planning would reduce the rate of maternal mortality in Ivory Coast.
Fertility preferences in Thailand.
This study examined the fertility preferences of currently married women and its variations across a range of variables using data from a completed national survey of contraceptive use in Thailand. Results of this study showed that fertility is below the replacement level, indicating a total fertility rate of 2.0. The main factor in the decline has been the acceptance of contraception and the couples' desire to have two children in the family. Furthermore, there is a variation in the number of desired children among women living in different areas, and among women with different levels of education and occupations. The findings also indicated that the desire for families with a balanced sex composition has resulted in a desire for 2 children, thus lowering the limit for marital fertility. However, while it is clear that most women do desire a balanced sex composition, a significant proportion of women have no sex preferences for the children they desire, thus resulting in the possibility of further lowering the desired number of children.
Factors associated with sexual behavior and attitudes of never-married rural Thai youth.
This study examined the factors associated with sexual behavior and attitudes of never-married youth in Thailand. Data obtained from 577 never married males and 517 never married females aged 15-24 years were analyzed. Multivariate analyses using a logistic regression revealed that there was a difference in male-female sexual attitudes and behavior bearing important consequences. More than half of the Thai male adolescents were sexually active and the majority of their sexual encounters appeared to be with commercial sex workers. In contrast, the majority of young sexually active Thai female adolescents engaged in sexual acts with their boyfriends. The results suggested that although family variables had no effect on never-married youths' sexual behaviors, it had an influence in the formation of their attitudes. The factors that were most likely to affect the probability of having premarital sex were related to loosening constraints, especially parental and community control. In terms of cultural norms pertaining to sexuality in Thailand, differences in attitude and behavior between males and females can be explained by the impact of early socialization on the patterns of sexual behavior. Young women in this study expressed more nonpermissive attitudes about premarital sexuality and had much lower rates not only of sexual intercourse but also of all types of sex-related behaviors compared to their male counterparts.
Social aspects of mortality in young and middle adulthood in Thailand.
This study examined the characteristics of adults who died during young-to-middle adulthood and identified the differences that may be associated with social roles during the 12-month follow-up period. Studies evidenced that mortality risks were closely associated with certain social characteristics. There are two explanations for these findings: the traditional explanation is that a bad state of health restricts entry into the states of marriage, employment and parenthood, while the less traditional explanation is that valued social roles are associated with lower morbidity and mortality because participation in the social process reduces the likelihood that adults will expose themselves to risk. The results presented in this paper resolve some of the issues surrounding the social roles and selection hypotheses on mortality differentials. The most important contribution were findings indicating that marital status differentials, except those associated with widowhood, represent higher mortality risks for both unmarried and married adults. Furthermore, people who were unemployed had a considerably higher mortality risk during young-to-middle adulthood for the ensuing 12 months than employed people. However, this difference did not apply to the external causes of death. The findings provide support to a more specific theory that control over aspects of everyday life has a protective effect against ill-health leading to mortality.
Breastfeeding in rural northern India: levels and differentials.
This paper presents the findings of a study conducted in India, which utilized both the retrospective reporting and the current status reporting of breast-feeding for studying the levels and differentials in the duration of breast-feeding. This study confirms the known differentials of the mean duration of breast-feeding with some explanatory variables and investigates some new differentials. Using data collected from 5 villages in Uttar Pradesh in 1995 and both univariate and multivariate statistical techniques, findings showed an almost universal pattern of breast-feeding in a rural part of northern India. However, compared to past Indian studies, a slightly lower mean duration of breast-feeding was seen. Older mothers with the highest parity were most likely to breast-feed longer compared to others. Education, socioeconomic status, and survival status of the child had significant impacts on the duration of breast-feeding. Overall, this study demonstrates that mothers living in upper strata of the society breast-feed for a shorter duration than their counterparts.
Factors affecting satisfaction of Thai senior citizens living with their children.
Globalization has greatly affected both socioeconomic and cultural changes. It has affected family structures, faiths, values, and living arrangements of the people in Thailand, especially senior citizens that are familiar with the old ways. In this article, a study analyzing living arrangements, living satisfaction, and factors affecting satisfaction for senior citizens living with their children is presented. Using descriptive and inferential statistics, data from the 1994 Survey of the Elderly in Thailand were analyzed. Findings of the analysis showed that a large majority of Thai senior citizens lived with their children (73%), indicating that co-residence between senior citizens and their children is a prominent phenomenon in Thai society. Indicators of high living satisfaction included obedience of the children and happiness, while neglect and child complaints were negative indicators. In addition, presence of a spouse could affect the satisfaction of senior citizens. Factors affecting living satisfaction included support from children, income sufficiency, marital status of senior citizen, health status, need to be cared for by children, and education. Sustained filial duty of children, social participation of senior citizens, and further studies on the factors affecting satisfaction are recommended.
This randomized, double-masked, placebo-controlled trial study examined the role of respiratory infections and diarrhea in modifying the growth response to vitamin A supplementation. A total of 1405 children aged 6-48 months were given a single high dose of vitamin A or placebo every 4 months, and 4430 child treatment cycles were used in this analysis. The study was conducted in two rural subdistricts located on the southern coast of central Java, Indonesia. Analytic findings indicate that vitamin A supplementation resulted in a modest improvement in the linear and not in the ponderal growth of children. Those who had an adequate intake of 400 RE/day and were free of respiratory infection grew 0.22 cm/4 months (95% CI: 0.08, 0.37) more in height. Conversely, there were no significant growth responses to vitamin A supplementation among children with 21.5% of days or higher of respiratory infection. In addition, children who experienced no respiratory infection and had vitamin A intake below the normative requirement (<400 RE/day) gained 0.31 cm/4 months (95% CI: 0.10, 0.52) more in height than the placebo group. Moreover, diarrhea was associated with poorer growth but did not modify the effect of vitamin A supplementation on growth. In conclusion, vitamin A supplementation improves linear growth in children but not among those with a high prevalence of respiratory infections.
Can accurate data on birthweight be obtained from health interview surveys?
This study explores the accuracy of birth weight information in 6 demographic and health surveys in Latin America conducted in the early 1990s. The quality of birth weight reports was assessed by using data from 6 demographic and health surveys in Latin America: 2 in Guatemala, 1 each in Bolivia, Costa Rica, El Salvador, and Peru. The study examined the plausibility of estimates of newborns reported to have been weighed and estimates derived from the numerical weights by characteristics of delivery and maternal education. Study estimates suggest that a substantial proportion of women report birth weights for children that were probably never weighed, primarily those delivered at home without modern medical assistance. In addition, a higher percentage of birth weights than expected are recorded because most of the reported weights were obtained from a postpartum check-up in lieu of a birth weight. Moreover, heaped responses are prevalent where birth weights are reported in rounded numbers of pounds or kilograms. Overall, the surveys conducted in Guatemala, Bolivia, El Salvador and Peru had anomalous patterns of reported birth weights. However, Costa Rica probably had a fairly accurate data than others. In conclusion, underestimates of low birth weight from surveys administered in developing countries are likely to portray an overly optimistic picture of health for children and women.
American cutaneous leishmaniasis in southeast Brazil: space-time clustering.
This paper presents the results of an ecological study on American cutaneous leishmaniasis (ACL) cases carried out in Caratinga municipality, Southeast Brazil. The study aimed to estimate the incidence rates of ACL from 1966 to 1996, to test for space and temporal patterns in the rates and to correlate them to sociogeographic factors. Findings of the study showed an increase in the incidence rates of reported ACL cases. A total of 1712 ACL cases were reported in Caratinga during 1966-96, with a yearly incidence rate of 48/100,000 inhabitants. Evidence of spatial clustering was noted during 1986-93. Higher incidence rates were detected in 1968 (100 cases/100,000 inhabitants), 1974 (160/100,000), and 1988 (190/100,000). In addition, an observation noted that explosive outbreaks of ACL are followed with very low incident rate cases in the subsequent period. This observation indicates a lifelong resistance for treated individuals following clinically apparent infection. Moreover, prevalence of ACL infection was associated with rural areas, lack of sanitary disposal, and exposed garbage.
Street foods in developing countries: the potential for micronutrient fortification.
In developing countries, street foods are widely consumed by millions of people. These foods provide an affordable source of nutrients to various sectors of the population, including the urban poor. Street foods include commercially produced snacks that are retailed by street food vendors, as well as food items made by vendors. As micronutrient deficiencies are major public health concerns in these countries, fortification should be considered to prevent and control micronutrient malnutrition. Fortification with micronutrients could improve the nutrient profile of these foods and serve as a means of introducing micronutrient-rich foods to consumers. Street foods present two fortification opportunities: 1) ingredient-based fortification of universal ingredients like flour or sugar; 2) food-based fortification of specific processed foods or drinks, particularly with vitamins A and C, as well as with iron and iodine. A fortification program will be most successful if it concentrates on foods that sold through a target group and delivers the appropriate micronutrient for that population. But before such a program can be launched, there is a need to undertake studies that assess the potential for micronutrient fortification of street foods, including analyses of their ingredients.
HIV and infant feeding. A guide for health care managers and supervisors.
This guide focuses on breast-feeding as a significant and preventable mode of mother-to-child (MTCT) HIV transmission. The text is divided into three sections. Section 1 offers an overview on the factors that increase the risk of HIV transmission from the mother to the child. Transmission through the breast milk is enhanced by HIV infection, AIDS, infection with sexually transmitted diseases, vitamin A deficiency, breast conditions, and duration of breast-feeding. This section also presents strategies for preventing or reducing the incidence of MTCT. Section 2 explores feeding options for HIV-positive mothers and discusses unsuitable breast-milk substitutes. Section 3 outlines steps in organizing health services to promote proper infant feeding in the context of HIV; namely, assessing the situation, assessing health services and resources, considering activities for implementing services, deciding what needs to be done in order to implement services, and preparing a budget.
HIV and infant feeding. Guidelines for decision-makers.
The issue of HIV transmission through breast-feeding is considered of public health importance, especially in countries where both fertility rates and HIV infection rates among women are high. In some areas, AIDS has doubled the mortality of children under 5 years of age. Although only a part of this increase is the result of breast-feeding, there is already a pressing need for countries to develop and implement sound public health policies on HIV and infant feeding. This paper presents several guidelines that 1) summarize knowledge of HIV transmission through breast milk; 2) define the context into which infant feeding policy should be integrated; 3) identify and discuss issues to be addressed by decision-makers; 4) outline steps to implement policy, including monitoring and evaluation; and 5) list useful reference materials and resources.
This study assesses the cost-effectiveness of reimbursement schemes for community-based distribution (CBD) programs in Tanzania. Data were collected from four CBD programs, which vary in remuneration schemes and status of CBD agents, size, geographical coverage, the range of activities undertaken by the agents, and supervision and management structures. The results of the study indicate that CBD agents who receive monetary remuneration see more clients and generate more Couple Years of Protection than those provided with non-monetary incentives. Furthermore, the study found that the program, which relies on part-time volunteer agents who receive non-monetary remuneration in the form of income-generating activities, is the most cost-effective. Moreover, results suggested that, in addition to remuneration, there are a number of other programmatic factors that account for variances in program output performance and cost effectiveness. Understanding these factors is necessary in guiding decision making on future family planning, resource allocation, and technical assistance for CBD programs in Tanzania.
"Morning after" kit gets FDA approval.
The Preven Emergency Contraceptive Kit, which is considered the first "morning after" birth control kit from Gynetics Inc., has recently been approved by the US Food and Drug and Administration. The birth control kit, which can prevent pregnancy if used within three days after sexual intercourse, includes a pregnancy test and four birth control pills to be taken in two dosages 12 hours apart. The pregnancy test is needed because the pills, which function by blocking or delaying ovulation, do not work if a woman is already pregnant. Physicians have long prescribed high doses of commonly used oral contraceptives as an emergency pregnancy prevention measure but drug companies, fearing legal or political fallout, have not included label instructions for postcoital use as emergency contraceptives, and many women have not known such a method was available.
Aiding the poorest. The Philippines: Children and Youth Foundation.
"Tuloy sa Don Bosco," one of the programs supported by the Children and Youth Foundation of the Philippines (CYFP), gives a number of Filipino street children the chance to escape a life of exploitation. The project covers 118 boys between the ages of 8 and 18 years, with a further 100 that arrive for their classes daily. These children come from a variety of problem backgrounds, including domestic violence and abuse. CYFP operates by identifying effective partners such as the "Tuloy sa Don Bosco" project, arranging funds, and enhancing the partner's capabilities to implement programs. In northern Luzon, CYFP supports projects dealing with child labor, prostitution, out-of-school girls, and entrepreneurial training. CYFP aims to place children and youth on the government agenda, international funding institutions, the private sector, and nongovernmental organizations.
Fortification basics: choosing a vehicle.
This article discusses the basic facts of choosing a vehicle for food fortification. Fortification of foods with essential vitamins and minerals can be an effective approach in fighting micronutrient deficiencies in developing countries. One of the very important areas to be considered in developing a fortification program is identifying a suitable food vehicle. This requires knowledge of food consumption patterns of the target population, data on food production, imports, and exports as well as its economic and technical feasibility. Sugar, wheat flour, corn flour, salt, fats and oils, and milk are some of the foods, which have been successfully fortified in the developing world. Moreover, decision on the type of food fortification should take into account the stability of micronutrients in the fortified food on ambient storage conditions at different points in the marketing and distribution chain.
Fortification basics: wheat flour.
This paper presents basic information on wheat flour fortification. Being the most widely produced cereal worldwide, wheat contribution to energy intake is especially remarkable in the US and Middle East countries. The widespread geographic distribution, acceptance, stability, and versatility of wheat flour make it a suitable vehicle for food fortification. In its natural state, wheat is a good source of vitamins B1 (thiamine), B2 (riboflavin), niacin, B6 (pyridoxine), and E, as well as iron and zinc. However, since most of these nutrients are concentrated in the outer layers, a significant amount is lost during the milling process. Vitamins generally added to wheat flour include vitamins A, D, B1, B2, niacin, iron, calcium and folate. The technology involved for fortifying flour as well as the methods for establishing quality control is briefly discussed in this paper. The ability of micronutrients to remain stable under different processing and storage conditions contributed to the appropriateness of the wheat flour as vehicle for food fortification. Finally, the low cost and the simplicity of technology involved in wheat flour fortification have made it one of the most sought after methods for fighting micronutrient deficiencies.
Fortification basics: principles of assay procedures.
This paper discusses basic facts concerning the principles of micronutrient assay procedures. Analysis of micronutrients added to foods involves various procedures depending on their nature and property. Procedures can range from simple calorimetric methods to more sophisticated technologies such as high-pressure liquid chromatography. The following must be accomplished before starting a micronutrient assay program: 1) a quality assurance system must be set up; 2) food samples must be representative and selected randomly; 3) personnel conducting the analysis should be trained in the assay methods; and 4) appropriate equipment must be available on-site in working condition. This paper specifically discusses assay procedures of the following micronutrients: vitamins A, B complex, C, D, E, iodine, and iron.
Fortification basics: oils and margarine.
This paper discusses the fortification basics of vegetable oils and their derivatives, particularly margarine. Being highly produced and increasingly consumed product worldwide, vegetable oils are suitable vehicles for vitamins A, D, and E fortifications. Fortification of vegetable oils and margarine is technologically feasible. Moreover, studies show that the stability of vitamins A, D, and E in the fortified vegetable oils under certain processing and storage condition is good. However, vitamin E losses occur during prolonged heating. The addition of these micronutrients to vegetable oils and their derivatives does not alter the flavor, making it highly acceptable to the consumers. A high-pressure liquid chromatography method is used in determining vitamins A, D, and E in oils and margarine. This paper also cited several successful intervention programs on fortification of oils and margarine in different countries.
Fortification of wheat flour with vitamin A: an update.
Food fortification is recognized as the most reliable, safe, and cost-effective means to eradicate and control micronutrient deficiencies and deliver nutrients to the population at large. The challenge for developing nations, however, is to determine the appropriate food vehicles, as well as micronutrients that remain stable and biologically available after processing, during storage, and during ordinary food preparation. This paper specifically concentrates on the fortification of wheat flour with vitamin A. It presents pilot trials on wheat flour fortification with vitamin A and the addition of vitamin A to food aid commodities. It also discusses the general considerations in wheat flour fortification with vitamin A, particularly those relating to technology, stability, double fortification with vitamin A and iron, other nutrient interactions, sensory characteristics, quality assurance and control, cost of wheat flour fortification with vitamin A, international trade, and other food vehicles.
Rice fortification for developing countries.
This paper provides an overview of the value of rice as a staple food and food vehicle for fortification in countries where micronutrient deficiency is prevalent. There are two types of rice enrichment technology currently available in commercial use: powder and whole grain enrichment. In powder enrichment, a pre-blended mixture of vitamins and minerals is added to the rice. The grain type, generally referred to as premix, involves the application of vitamins and minerals to the rice grain followed by coatings of water insoluble substance to prevent them from rinsing off. Nutrient stability, bioavailability of nutrients, feasibility and consumer acceptability should be taken into account when making a decision on fortification. Despite substantial evidences that demonstrate the benefits of rice fortification to improve the micronutrient status of the rice-consuming population, constraints exist in developing countries where micronutrient deficiencies are common.
Gender and the south China miracle. Two worlds of factory women.
This book presents a comparative ethnography of women workers in Hong Kong and Guandong province in China that describes how these two radically different factory cultures have emerged from this era of profound economic change. The book is divided into eight chapters. Chapter 1 is an overview of the two different worlds of labor in South China. Chapter 2 situates the present study in three major sociological debates: labor process theories, feminist theories of gender and work, and studies of Chinese women. Chapter 3 depicts the formation in the past decades of the South China political economy that forms the context of industrial production of the two plants. It also documents the institutional contingencies for the meeting of mobile capital from Hong Kong and mobile labor from rural China, and the ways by which enterprise management maintains autonomy under diverse state apparatuses in Hong Kong and Guandong. Chapters 4 and 5 focus on the distinct structures and processes of local labor markets from which the two factories draw their labor forces. Chapters 6 and 7 present the comparative ethnography of the two worlds of factory women, "localistic despotism" and "familial hegemony". Furthermore, they illustrate how gender works in constituting regimes of production. Finally, chapter 8 sums up the empirical findings of the study and discusses their relevance to theories and methodologies. The methodological appendix reflects the ethnographic fieldwork in South China. It also describes the political, moral, and human landscapes of the "field", as well as critical events and dilemmas encountered.
Women, work, and economic reform in the Middle East and North Africa.
This book explores the labor force participation of women in the Middle East and North Africa (MENA). The book is divided into three parts. Part 1 presents an introduction and overview about the political economy of women employment and shows how failure of both raising the education of women to the same level as that of men and improving the quality of education imposes a substantial cost on development initiatives. Part 2 examines several case studies of economic reforms involving working women in different countries including Morocco and Tunisia, Turkey, Egypt, Jordan and Syria, Iran, and Algeria. Part 3 describes the organized response of women to economic and political issues in MENA, which has taken the form of a spread of nongovernmental organizations (NGOs), a number of research activities, and conference participation both in the regional and international levels. It studies the factors which contributed to the rise of women NGOs in Arab nations, Iran, and Turkey, the types of organizations that have been developed, and the priority issues for the Arab region. The book concludes by summarizing the findings and recommendations in enhancing women participation in changing the political economy of MENA.
Malaria in the African highlands: past, present and future.
This article explores the past, present and future trends of malaria in the African highlands. Over the last 50 years, there has been a progressive increase in the incidence of malaria in the region, particularly in the highlands. This trend is brought primarily as a consequence of agroforestry development and the scarcity of health resources. In these areas of fringe transmission where malaria pattern is unstable, outbreaks may be precipitated by certain climate and biological factors that favors the growth and development of mosquito vector and parasite. Since there is little immunity against the disease in these communities, epidemics can be devastating, resulting in a significant rise in morbidity and mortality among children and adults. This paper outlines the results using a mathematical model designed to determine epidemic-prone regions in the African highlands and the differences that are expected to occur as a product of projected global climate change. These communities should be recognized as an area of special attention. A regional modeling approach is recommended to examine the extent of severity of the problem and to improve disease surveillance and the quality of health care services.
Latina adolescent childbearing in East Los Angeles.
This book discusses teenage pregnancy and motherhood among economically disadvantaged Latina adolescents aged 17 and under in east Los Angeles. The text is divided into nine chapters. Chapter 1 describes the characteristics of Latina teen mothers, and a clinic-based project that tried to help these women. Chapter 2 discusses the problem of teenage pregnancy in America with an overview of Latino cultural attitudes and values, which are relevant to understand teenage pregnancy and childbearing. This chapter also provides an overview of the research on Latino adolescent sexual and reproductive behavior in the US. Chapters 3 and 4 focus on the history of the East Los Angeles Repeat-Pregnancy Prevention Project, the research methods and procedures, and the research setting. Chapter 5 describes the Latina teen mothers and the social context of pregnancy and motherhood. Chapters 6, 7 and 8 focus on prenatal care and birth outcomes, the evaluation of the Teen Project, and patterns of contraceptive use and the intervening variables, respectively. The effects of acculturation on the life options of women are discussed throughout these chapters. Statistical methods, case studies and interviews were used to illustrate Latina adolescent motherhood and to identify pathways leading to motherhood in this group. Moreover, it also discusses how social and cultural norms and realities in the area tend to support teenage pregnancy in the east part of Los Angeles. Finally, chapter 9 highlights the implications of the study for America's efforts against teenage pregnancy.
This document presents the 8th technical report of WHO concerning the use of essential drugs. The report is divided into 18 distinct sections. Following the introductory information are the second and third sections reviewing guidelines for establishing a national program for essential drugs and the criteria for the selection of the essential drugs. Section 4 reviews guidelines for the selection of pharmaceutical dosage forms, respectively. The fifth section focuses on different areas of ensuring drug quality assurance, including the certification scheme of the WHO on the quality of pharmaceutical products, bioavailability, the international pharmacopeia, and counterfeit drugs. Section 6 discusses on reserve anti-infective agents and the need for monitoring of drug resistance. The seventh, eighth, and ninth sections focus on applications of essential drug concept, essential drugs, and primary health care, and drug donations, respectively. Section 10 presents post-registration drug studies, while the section 11 discusses the pharmaceutical, clinical and epidemiological, and educational aspects of research and development. Sections 12-18 deal with nomenclature, drug information and educational activities, selection and updating of lists of essential drugs, model list of essential drugs, considerations and changes made in revising the model list, glossary, and an alphabetical list of essential drugs.
Demography deals with all those important events that people have either experienced, hope to experience, or try to postpone for as long as possible. This article is divided into 7 sections. Section 1 explores the relatedness of demography to one's everyday life, private fears, hopes and aspirations. Section 2 offers a definition of demographic novel and section 3 describes the current and expected world population dynamics. Sections 4-6 present three demographic novels demonstrating the kind of imaginative thinking required to explore the kind of surprises which are never there in a professional but surprise-free projection efforts. Finally, section 7 features a comparative population dynamics based on the three demographic novels discussed in the preceding sections.
Vision, future, forecaster: on demons and soothers in long-range demographic prediction.
This article compares recent assessments of the prospects of the world population in the 21st century with the long-term predictions stemming from the close of the 19th century and the opening of the 20th century. The similarities described, hereafter, relate to the following: 1) to the demons evoked by either visions imbedded in long-term predictions and the population theories accompanying these predictions; 2) to the relief long-range population forecasts can bring. The paper concludes with a discussion on the role of the forecaster and his responsibility with respect to the infliction of anxieties upon the larger society.
Changing ways of leaving the parental home: with a partner or alone.
In the Western world, the timing of leaving the parental home has gone through substantial changes over the past few decades. The changes and the way they vary from one country to another can only be understood by referring to individuals' decisions to leave home. This paper departs from these two arguments. The first is that the understanding of the timing of leaving the parental home can be greatly enhanced by distinguishing between two ways of nest leaving: with a partner or alone. These two ways of nest leaving are viewed in this paper as distinct, operating independently and following from different causes and are thus, treated as competing risks. The second argues that behavior is the product of interaction between individual motives and the force of external circumstances. Following an analysis of the overt behavior, a two-stage analysis of the decision to leave the parental home and the success in acquiring a place of one's own. Section 2 of the paper presents a brief overview of the changes in the timing of leaving parental home in the Netherlands as compared to other countries in Europe and the US. Section 3 distinguishes the two ways of nest leaving and develops a theoretical notion on the timing of both ways. Section 4 presents empirical analyses of the data for the Netherlands. The 5th section contains concluding statements.
Helena, Lotte, Luisa and Wiktoria: average women in Europe?
Using data from Fertility and Family Surveys, this paper explores the demographic behavior of average women in four different European countries who were born at the end of the 1950s or in the beginning of the 1960s. The surveys showed that the age of home leaving was youngest in Sweden. The majority of Swedish women (90%) had left home before the age of 21, while Italian and Polish women had not reached this proportion at the age of 30. Swedish women also entered into a union, either a formal marriage or a consensual union, at a much younger age as compared with other European countries. As to the dissolution of unions, about 6% of the first union of Italian women ended up in dissolution within 10 years, while about 40% of Swedish women born at the end of the 1950s eventually experienced a break-up of their first union. Moreover, the youngest mothers were found in Poland, where half of Polish women had entered motherhood by the age of 20. In the Netherlands, motherhood was postponed the most, to the age of 28.
European planning: an intellectual pleasure trip.
The strategy which Dutch planners developed in the past was one of fast forward defense, of bringing Dutch planning concept to the European Community. There is indeed a wide range of striking differences between the favorable context in which Dutch planners operate and the mine field, conceptually and politically, of European integration. To explore issues of European planning, this paper uses the European Spatial Development Perspective (ESDP) as its example. Both the Commission and the German agree that ESDP needs to be formalized. The challenge, however, was the blueprint in which the European planning process shall be based. The main concept of what has come to be called the "Monnet method" was to develop mutual trust and a European technocratic elite that in the fullness of time would create a momentum towards a federation. This article explores the planning context at a national and European level by looking at the building blocks for an architecture of European planning. It describes the strategies of national as well as European planners and policy-makers for addressing the exigencies of the situation, and explains the inner logic of the integration object of European Spatial Planning.
The ostrich factor in Dutch demography.
This article discusses the ostrich factor in the demographic development of Netherlands. It focuses on the years between 1970 and 1980 when this behavior was most dominantly displayed by Dutch demographers with regard to international migration. Section 1 offers an overview of the "ostrich policy" and the immigration situation in the Netherlands. Section 2 describes the population problems in Netherlands paying particular attention on Dutch population studies available during this period. Section 3 discusses the four factors, which when combined would explain the neglect of international migration in Dutch demographic studies. These include the secular rational bias, the nationalist bias, the policy involvement bias, and the academic prestige bias. Section 4 deals with forecasting issues and section 5 presents concluding statements concerning "ostrich" response of Dutch demographers to international migration.
This article focuses on the generation contract of the "king-child" and its effect on the support given to older parents who need help. Other than the macroeconomic aspects of support, such as pensions and formal care facilities, the willingness of family members, friends, neighbors and acquaintances to offer informal care to older people is a very important issue. The findings of the 1994 European Community Household Panel indicated that there was a high degree of adult children involvement in the informal care of the older generation. Women and the older-generation of care providers spent longer hours in providing informal care. But whether or not older parents can actually count on receiving support from their children, depends on a number of factors, including the geographical proximity of their children and how many of them are still alive. Altered relationships between generations are expected in situations where parents had caused discontinuous changes in the lives of their children. Studies showed that widowed adults are able to depend on their children for support more easily than ever-divorced adults can. Having demonstrated that the generation of the "king-child with parents" will be characterized by reciprocity between the two involved parties in terms of degree of support, it is also clear that specific categories within this generation assume no obligation to support their older parents when they need help, such as the case of children of ever-divorced parents.
Gender, work and family: towards a new equilibrium?
This paper analyzes the implications of the emancipation process--social development towards better equality between genders--which individuals and communities in the industrialized world will not have been oblivious to over the past 30 years. It also examines the changes the family has undergone partly as a result of this process, and tackles the reproductive function of the family and the difficulties involved in making the decision to have children. Since 1960s, women status has changed dramatically in many aspects. Despite the achievements in many areas, however, attempts to attain greater equal relationships between men and women have not yet been fully successful. The increasing participation of women in higher education and labor force caused their traditional exclusive role of family orientation and motherhood to become increasingly debated. Emancipation created a double-edged impact on the private lives of people. While men and women achieved a greater degree of freedom in their primary relationships, their privacy has also been invaded by social institutions including the government. Developments of family policies, where legislation is individual- rather than family-oriented, have made the family especially vulnerable, affecting the sustainability of the family and its reproductive function.
A joyful century: one hundred years of association between demography and planology.
This article focuses on the association between demography and planology to describe the past, present and future demographic trends in Netherlands. The nature and extent of the applications between demography, planology, and other relevant disciplines has evolved over the years. At first, it was plainly a matter of answering questions related to population growth, providing statistical evidences, and predictions. The more researches are being conducted, the more demography began to provide insight in population problems and to recommend solutions to address these problems. Similarly, that population studies can even be considered at one time had been directly inducing spatial policy. Following the mid-1960s, exchange of knowledge and information became more selective due to social, demographic, and planological changes. Finally, co-operation between the disciplines has come to be directed at underpinning negotiations, developing scenarios, and measuring uncertainties. There are, however, planological/demographic problems which future demographers may well think should have given greater attention in the 1990s.
This article offers some thoughts about female-dominant reproduction as a demographic consequence. It analyzes what consequence a shortage of young unmarried men will have for the marriage behavior of men and women. Despite the inability of traditional models for fertility or nuptiality to allow for the simultaneous analyses of the behavior of men and women, childbearing and marriage are events for which the interaction between genders should be taken into consideration. Data from Norway indicates that competition in the marriage market at other ages, as well as those for women, as a consequence of male shortage are equally small. This observation on competition effects holds true in other settings. These findings suggest that age is not a significant variable in the marriage market. Rather, more important variables, like social class, region of residence, and cultural background have to be considered when studying marriage market mechanisms. Finally, the model projects that a 50% drop in the number of newborn boys as a result of female-dominated fertility, would lead to an increase in marriage chances of the men if low sex ratio lasts forever.
This article presents some demographic forecasts for Europe, more specifically for the Netherlands, should the total fertility rate remain at 2.1 children per woman, thus achieving zero population growth in the future. A retrospective forecast indicates a decrease in the Dutch population from 17.2 million in 1996 to 15.7 million in 1999. This population decline is attributed to the changes in the demographic landscape of Europe, which presently is in its "second demographic transition." Technological advancements enabled the development of effective contraception methods, giving individuals a greater degree of sexual and reproductive freedom. Personal autonomy and modern contraception enhanced the emancipation of women leading to further postponement of marriage. On top of these demographic and technological transitions, biological transitions occur at a much lower pace. The second demographic transition is characterized by changes in primary relations in which the extent of cohabitation becomes more frequent. The Dutch population is projected to reach 10.8 million by 2050, and the age pyramid will become inverted. This would result in a large proportion of individuals aged 65 years and older. However, the working age population would still constitute 51% of the total population. It is therefore clear that even an inverted age pyramid would not likely result to a demographic evolution.
The latest demographic transition?
Birth postponement remains a common trend in the Netherlands and other countries in Europe. The phenomenon of late fertility is also a very significant issue in the second demographic transition of Europe. Statistical evidences indicate that since the 1960s, family size has decreased in all European states reaching even below-replacement level. This trend, however, reflects a different a pattern from country to country. In Sweden, for instance, the fertility rate began to increase the moment the rise in age at first birth stagnated and declined again as soon as the age at first birth began to rise. In other countries such as France, Italy and the UK, the fertility rate declined between the 1960s and 1970s and constantly rose thereafter. The data in Portugal is different in the sense that it reflects a drop until the late 1980s, followed by an increase. The Netherlands is presently the world champion in late motherhood. These evidences suggest a strong association between the age at first birth and the fertility behavior of women in Europe. Age at first birth affects the number of children people have during their lives and the total fertility rate of the country as a whole. The extent to which the observed patterns in the age at first birth in Europe results from certain changes in attitudes and preferences as to the best age for a woman to have her first baby.
Monitoring demographic change: theoretical foundations.
Monitoring demographic variations involves the measurement, explanation, and prediction of changes in the population. In most instances, patterns can be seen in the way populations change and these patterns can be illustrated through trend models. This article is presented in five sections. Section 1 offers a general overview of the material, while section 2 distinguishes the two approaches to the monitoring of demographic change, the first focusing on empirical regularities and the other on the causal mechanisms that served as building blocks for observed regularities. Sections 3 and 4 discuss theories which are useful in monitoring demographic changes. The biographic theory explains how demographic events are embedded in the life course and affected by other life experiences and events. The generation theory describes how life histories are embedded in a historical context. Section 5 contains the concluding statements of the contribution.
North-South connections: a tribute to Dirk van de Kaa.
This article offers a tribute to Dirk van de Kaa who established the concept of "North-South Connection" in Flanders and the Netherlands. In Flanders, "North-South Connection" has two meanings. For the young people, it means a contrast between developed and developing countries and the variations in their demographic, economic and ecological dynamics. In older generations, this concept is often referred to as connecting the cultural, economic, and political ties between the Netherlands in the north and Flanders in the south. Presented into two sections, this paper explores the work of van de Kaa in both settings. The first section talks about his successes in establishing the Dutch-Flemish connections as exemplified in the joint Flemish-Dutch publication series. This co-operation gave a positive impact both in the field of publications as well as in research. Section 2 describes the global connection initiatives of van de Kaa, particularly in the context of population policy. It specifically discusses his roles during the World Population Conferences of Bucharest and Mexico.
International migration: demographic, sociological and political aspects.
This article focuses on the demographic, sociological, and political aspects of international migration today and its potential future. Section 1 offers a quick glance at the state and development of the world population, which is estimated to be passing the 5.8 billion mark in 1996. Section 2 presents a sociological and theoretical analysis of the background of worldwide migration, partly taking into account its political framework. Section 3 provides a conceptual and political discussion on the past and present migration state of Europe. Section 4 concludes the contribution with a look at the future of global migration.
When demography meets policy-making: demography in an area of tension.
This article focuses on demography in the context of policy-making. The paper is presented in 5 sections. Section 2 unravels the mystery of international meetings, particularly the meeting of the Council of Europe on fertility chaired by Dirk van de Kaa. On this occasion, van de Kaa opened another chapter of successfully advising policy-makers about the semantics of draft recommendations. Section 3 provides insights on the approach of van de Kaa on advising governments and policy-makers on populations issues, including fertility and population aging. Section 4 describes the mortgage on demography in Germany wherein the giving of demographic advice to policy-makers would mean entering a field of high tension. Section 5 focuses on population as a political issue, largely taking into account five related reasons why politicians do not react to, and act on the very dramatic population projections or other significant demographic information. These include lobbies and heterogeneity, voting behavior, knowledge and action, uncertain legitimacy of governmental intervention in population issues, and different characteristic views of society.
Dirk van de Kaa and the Australian National University.
This article focuses on the work of Dutch demographer Dirk van de Kaa with the Australian National University (ANU) on March 1996 to take up a research post under the aegis of the Economic Commission for Europe. The paper is divided into three sections. Section 1 relates how van de Kaa became connected with the ANU demography, touching in part on the history of the department and his 5-year tenure in the university as the Deputy Director of the Demographic Research Project in Western New Guinea. Section 2 recounts his career in studying the demographic situation of the entire island of New Guinea whose population reached only a total of 6.4 million in 1996, a relatively small number. Section 3 discusses the papers van de Kaa had written on fertility trends in advanced countries. Review of these works indicate that they are based on a carefully compiled range of highly pertinent demographic indicators for a wide range of countries, linked to surveys of attitudes and values undertaken in these countries, and located within the full range of theories, or anchored narratives, concerning fertility transition.
A demographic analysis of RDASL membership.
This article presents demographic calculations and analyses of the Royal Danish Academy of Sciences and Letters (RDASL) membership. Founded in 1972, RDASL offers a life membership to Danish and foreign members who are divided into humanities and science classes. Changes, however, occurred over time giving upper and lower limits to the number of members in both classes. This paper aims to provide a basis from which to examine the consequences of removing the upper and the lower limits on the number of members in the two classes. It illustrates the changes in the number of members of the two classes and aggregate membership figures from 1970 to 1995, during which membership size almost doubled, from 115 to 227. Average age of members and level of mortality are factors recognized as crucial to the number of members in a class. Finally, the paper shows the results of RDASL projection membership from 1995 to 2050.
Demography, serendipity, and teenage pregnancy in Sweden.
This article presents the findings of inter-related simulations on the demography, serendipity, and teenage pregnancy in Sweden. It was noted that no assumptions were made regarding change in the level of sexual activity of teenage girls between the late 1960s and early 1980s. The best-fitting simulations employed a distribution of the age at first intercourse with a median lying between the 17th and 18th birthdays, and a distribution across teenagers of their subsequent sexual activity. The first distribution was based on data drawn from the 1992 Swedish Family Survey. This complex event history survey obtained interviews from more than 3000 women born in 1949, 1954, 1959, 1964, and 1969. The second distribution was based on surveys conducted between the later half of the 1960s and the earlier half of the 1980s. Overall analyses of the results in the two distributions indicated that relaxing the regulations governing the provision of abortion will not increase the abortion rate, and providing teenagers with contraceptive information and supplies will not increase their level of sexual activity.
When flat lines are remarkable: an essay in honour of Dirk van de Kaa.
This article outlines flat lines of happiness as a tool of information concerning the human condition. This line of happiness can be found when applied to the trends in subjective well being. An examination of data for the Netherlands from 1973 to 1989 indicated that living levels in the country rose by about one-fourth over the 16-year period; however, this improvement left no imprint on subjective well being. Data for the US from 1972 to 1991 shows the same flat regression line, indicating that no improvement in the average level of happiness over almost half a century, a period in which real per capita income more than doubled. Additional evidence comes from data for Japan after its recovery from World War II. Although there were unprecedented 3 decades advance in level of living in Japan, there was no improvement in mean subjective well being. Cohort trends in subjective well being show how happiness changes over the entire adult life cycle by putting together the data from different cohorts. Using the US data, it was concluded that while a cohort typically experiences a substantial improvement in material living level up to the retirement ages, there was no corresponding advance in feelings of well being. In conclusion, feelings of well being remain constant over time, despite increased abundance of goods brought about by economic growth.
The pleasures of the past and the joy of history.
This article presents the relevance and pleasure of studying history in the context of past literature. This is in response to the argument of Jo Tollebek and Tom Verchaffe who based their book, "The Pleasures of Houssaye," on the thesis that history should only be studied for the pleasure of studying it and not because it has any relevance for the present day. Books by Bertus Schaper and Theo Locher manifest the relevance by demonstrating that valuable lessons can be derived by studying the past. In addition, historians like Carlo Ginzburg and Robert Darnton have illustrated that in studying strange and obscure documents and other relics of the past, they can draw surprising conclusions and insights, which obviously give them much pleasure. Moreover, not only is this pleasure found within professional historians, it can also be found within the public at large. Books by very serious historians on very serious subjects have become popular. Thus, not only is doing history fun but also reading history is fun. Overall, studying history is important since much can be learned from it and bringing the past back to life can bring much joy to the historian.
A demographic monster: Quetelet's homme moyen.
This article outlines the "homme moyen" (average person) created by Adolphe Quetelet as a statistical entity, a vector of demographic indicators. It has been treated during the past years as a sociological reality, an ideal believed to provide the example of beauty, greatness, virtue, mediocrity, as well as the sentiments and needs of the human being. However, the characteristic of the Average Person gradually shifted following modern ideas. It can be adequately featured as the principal subject of cognitive science in the context of contemporary behavioral science. It is taken to be a cognitive system embodied in a highly flexible and adaptive biological architecture. This embodiment admits the full range of propensities and behaviors that humans are able to display on the basis of a generic model of their mental apparatus. As a result, the average person already has a dynamic, generative quality not manifested in its earlier incarnations.
This article presents the genetic technology and reproduction issues in wealthy countries as well as in developing countries. Technological progress has widened the scope of genetic diagnosis in wealthy countries. Developments in laboratory technology have enabled an early and accurate diagnosis of an increasing number of congenital/genetic disorders even before clinical symptoms become apparent. In addition, better education schools and information via media have disseminated information about these medical technologies including prenatal diagnosis by fetal DNA analysis and ultrasound investigations for fetal anomalies. However, in developing countries, clinical genetics does not play much of a role in health care systems; other priorities come into perspective, such as high infant mortality and morbidity due to malnutrition and infectious diseases. Furthermore, costs of these genetic technologies are out of reach for developing countries. In conclusion, the gap between the wealthy countries and the Third World is likely to increase in the future due to their socioeconomic differences.
This master's thesis examines the ability of women-centered and community-based reproductive health programs to fulfill the reproductive health needs of poor and marginalized women and lead to their empowerment. The ReproSalud project in Peru serves as a case study. ReproSalud is a US Agency for International Development funded project being implemented by the Peruvian feminist organization Movimiento Manuela Ramos. Field research was conducted using participant observation and qualitative interviewing for 4 months. The findings provide an in-depth description of the project, outcomes from the implementation process of ReproSalud's model, participant's perceptions of the project and its preliminary impact. By presenting a concrete example from the field, this research contributes to building the body of knowledge on community-based and women-centered reproductive health programs, a necessary step to implement the commitments made at the International Conference on Population and Development. (full text)
The minority population in the People's Republic of China (PRC) increased by 35% between 1982 and 1990, while certain minority nationalities more than doubled in population in the same period. This appears to result from changes in official ethnic identification by individuals of flexible identity (e.g., children of mixed marriages) in response to affirmative-action type policies benefiting minorities, particularly provincial and local exceptions to the One Child Policy. The Crude Index of Net Ethnic Reidentification (CINER) was created in order to compare the degree of shifting ethnic identification among minority nationalities in the PRC. These comparisons indicate shifting ethnic identification is more common in northeastern and southwestern areas of the PRC where mixed households (Han and minority) are also more common. Shifting ethnic identification can distort socioeconomic indicators, such as educational attainment, so CINER can be used to indicate which data should be treated with caution. (full text)
Diffusion of contraceptives among Hispanic female adolescents [abstract]
One of the greatest challenges for the American public health agenda is the reduction of teenage pregnancy rates, especially for those ethnic groups with higher teenage birth rates such as Hispanics. Through communication strategies, adolescents' family planning behavior may be influenced so as to reduce teenage pregnancies. The goal of the present study is to answer three research questions: 1) How much do Hispanic female adolescents know about contraceptives? 2) What mass media and interpersonal communication channels do Hispanic female adolescents use to obtain information about contraceptives? 3) What attitudes do Hispanic female adolescents have toward receiving contraception information and toward contraceptive use? The present research was based on diffusion of innovations theory. Nine nonparenting Hispanic female adolescents and nine parenting Hispanic female adolescents in Albuquerque, New Mexico, were interviewed individually. Analysis of the interviews reveals about contraceptives, they have a positive attitude toward the use of contraceptives, and they believe that adolescents must receive contraceptive information to avoid pregnancy. (full text)
Limited research has been conducted on the coping strategies used by women with unplanned pregnancies who are planning to place their children with adoptive families. To further explore this area of research, clients (N = 33) of a north Texas adoption agency completed self-report measures relating to coping strategies, perception of control over their situation, psychological symptoms, locus of control and client satisfaction. Several hypotheses of the study could not be tested as 100% of respondents perceived control in their current situation. However, it was confirmed that the clients of this study used both problem-focused and emotion-focused coping strategies. Further, on the BSI dimensions of Interpersonal Sensitivity, Anxiety, and Phobic Anxiety, the mean scores were significantly higher for respondents who used more problem-focused strategies. Undoubtedly, more research is needed regarding coping for this population as the results are limited by the study's design and sample size. (full text)
This quasi-experiment study tested the effectiveness of a simulation program on African American adolescent females' attitudes toward having a baby and their knowledge of risk factors associated with premarital sex. The experimental group (n = 15) participated in Baby Think It Over, a program using infant simulators (computerized dolls) and a didactic program--Saving Ourselves and the Next Generation. The control group (n = 15) was selected from a Black church. The experimental group didn't significantly increase their attitude or knowledge scores and was not significantly more knowledgeable than the control group on post-testing. They did have significantly more realistic post-test attitudes toward teen pregnancy than the control group (t = 2.02, p = 0.025). Experimental group journal entries reflected clear indication that having a baby was more trouble than anticipated. While the design and sample were limitations, use of simulators proved a useful teaching strategy in the African American community. (full text)
This study evaluated the effects of the Guide of HIV/AIDS Teaching, "Learning to be Healthy", published by the Agricultural Extension Service of the University of Puerto Rico, among the second and third graders of Barceloneta. The study consisted of 32 children for the experimental group and 30 children for the control group; they were residents of rural and urban zones. Each group was exposed to a different teaching method, with the experimental group being exposed to the Guide of HIV/AIDS Teaching and the control group being exposed to a general discussion of HIV/AIDS prevention. Both groups were given an examination after the treatment. Measurement of the knowledge and attitudes of participants toward HIV/AIDS was carried out through questionnaires. Results revealed insignificant statistical differences in knowledge and attitudes acquired about HIV/AIDS in relation to age, place of residence, and educational level. This study found greater knowledge and attitude about HIV/AIDS prevention among children exposed to the HIV/AIDS Prevention Guide than among those exposed only to the discussion.
This research examines gender relations by focusing on women's work in an environmentally degraded area in southeastern Morocco where the nomadic population has been sedentarizing. Evidence from the literature suggests that as land becomes overused and privatized, women often are left with no recourse other than walking further to gather the fuel with which to cook. The increased distance that women must walk to collect fuelwood for food preparation is assumed to have a negative impact on women's standards of living; however, the findings of this study indicate that not all women are adversely affected by environmental degradation. Furthermore, findings indicate that changes in fuel collection must be analyzed beyond physical implications of the additional labor. Although technologies that ease the burden of fuel collection may increase material wealth and decrease physical labor, evidence from this research suggests that they can have negative effects on gender relations as women lose power over a once independent domain in their lives. (full text)
Premised upon the idea that a global population crisis does not exist, it is the purpose of this paper to uncover the primary agenda of participants in the design and distribution of contraception, and more importantly, to discover what is the true nature or essence of contraceptive technologies. It is through an examination of the relationship between technology and ideology that the essence of technology will be revealed. Contemporary thinkers such as Jacques Ellul, Herbert Marcuse and Martin Heidegger have formed a foundational philosophy concerning the relationship between the technological artifact and ideology or the idea. A brief investigation into the ideological roots from which the technology emerges will reveal the essence of contraception. Through a comparative analysis of Western thought and Western technology consistent patterns will be examined, serving to uncover a reality of the current system of contraceptive development and distribution. By looking closely at the framework of ideas from which the technology was fostered, and how the idea co-exists with the technology, clarity of purpose of the technological system being examined will come to light. (full text)
Coping with the abortion experience: restoring wholeness --tending the garden [abstract]
The grounded theory method was employed to generate a substantive theory of the coping process with the abortion experience. The core process of restoring wholeness, which included 3 stages--1) surviving the struggle, 2) beginning the process of healing, and 3) becoming whole--was identified. To represent this process, the metaphor of "Tending the Garden" was used as a central image. This metaphor is emblematic of the effort of bringing closure to the abortion experience, which resulted in personal growth as demonstrated by each participant. Data were collected from 13 unstructured individual interviews with 12 women and 1 focus group consisting of 3 women. All respondents were between 23 and 67 years of age and had abortions between the ages 18 and 32. Coping with the abortion experience was demanding and complex. Confronting the decision to abort, which initiated the coping process with such an experience, constituted the most difficult challenge. Despite the reasonableness of the decision, the struggle with unattainable social ideals continued until the moment preceding the abortion. For the majority of the participants, the period following their abortions brought a sense of relief. However, this sense of relief also brought other challenges. Abortion was associated with loss. Healing which involved the expression of grief will help nurses create an environment conducive to healing and personal growth for women coping with the abortion experience. (full text)
Women, development and social change. The women of rural Malawi: a case study [abstract]
This study explores the contradictions that arise between global market driven development and the lived reality of Malawi's rural women with respect to the critical elements of peasant life which are usually defined as land, labor and social regime. Policy makers and planners design programs and projects to integrate the peasantry into the free market economy, which emphasizes productivity, technology, and cash returns. On the other hand, peasant farmers, particularly women, with their primordial responsibility for domestic reproduction, are faced with the need to feed their families and provide social supports not available through the market system. Poor women have little or no influence over the impact of the application of administrative policies that produce strain on the subsistence system, with which the population must cope by calling on the social regime which sustains them, albeit inadequately in the face of a restructured economy. (full text)
Development, women's employment and fertility in Latin America [abstract]
In this thesis, the relationship between women's work and fertility is examined in an attempt to evaluate the implications of these variables for development in Latin America and possibly other developing regions. To this end, the paper begins with a discussion of current demographic and socioeconomic realities of developing countries. The study utilizes a two level approach due to the positioning of productive work and fertility between family structures and societal socioeconomic structures. The first, a macro level analysis of the Latin American region uses UN data available from 1970, 1980 and 1990 time periods. Here the association between development, fertility, and women's labor force participation for twenty South American countries is examined by employing bivariate and partial correlation techniques. The data for the second analysis is taken from a 1997 Demographic Health Survey conducted in Peru. The focus of this analysis is to investigate whether the predicted negative relationship between work and fertility at the individual level is found when theorized role incompatibility factors between mother and worker are included in the models. (full text)
Sexuality and desire in the Generation X population [abstract]
The thesis entitled Sexuality and Desire in the Generation X population will address the issues below, based on the tenets of the following sociologists, Francesco Alberoni, Erving Goffman, George Simmel, Emile Durkheim, Anne Oakley among others. The first chapter will include namely a theoretical perspective, which includes a discussion of sexuality that situates this realm between two discourses namely that of biological and of social determinants, and concludes with a discussion of sexuality and commodity fetishism. Through the use of Anthony Gidden's text, sexuality will be placed in a political context. The second chapter's main focus is on the psychoanalytic perspective of how our sexualities are formed and come to determine our heterosexual object choices. In the third chapter we will turn our attention to the voices of ten respondents interviewed in the city of Toronto and their reflections on sexuality and the difficulties that plague these social actors. It is in this chapter that we find the main argument, namely that sexuality is not the major concern in the lives of these ten individuals. The final chapter's main perspective is the use of Erich Fromm's and Anthony Gidden's reflections on love and the types of relationships that are found in the latter half of the 20th century. The conclusion serves to highlight the sections of the thesis and points to the need for continued research and literature in the field of sexuality and desire. (full text)
Norplant and Depo-Provera are two new hormonal-based contraceptives that have recently been approved for use in Canada. Together and individually, these types of drugs present disturbing ethical issues: they are technologies that further situate control over women's reproduction in the hands of physicians, and each can be applied without requiring consent or active participation by the woman. In this thesis, I explore some of the political, social, and economic factors that influence the development and distribution of subdermally implanted and injected hormonal-based contraceptives. Inspired by the methodology of popular education, the critique of these particular technologies creates a place to explore both the notion of "choice" and the histories of women's unequal relationships within reproductive health care. But this interrogation is not only a forum for critiquing these technologies; I hope it will also be a process that catalyzes critical thinking which can then be applied to other situations. For as I outline, understanding the abuses that occur with these technologies is best pursued by examining the larger social frameworks in which they are imbricated, and in doing so, I hope to develop strategies for change. (full text)
Ending violence against women.
This issue of Population Reports focuses on ending violence against women. It tackles primarily two types of violence: 1) abuse of women within marriage and other intimate relationships; and 2) coerced sex, whether it takes place in childhood, adolescence, or adulthood. The first part contains the editor's summary and an article entitled The World Takes Notice. Intimate partner abuse is discussed thoroughly and is supported by tables presenting various statistics on relevant issues such as help seeking by physically abused women. A framework for understanding partner violence is also presented. The article on sexual coercion deals with forced sexual initiation and sexual abuse in childhood. The impact of violence on the reproductive health of women and its threat to health and development are also discussed. The last part focuses on specific strategies in detecting, preventing, and stopping the abuse. An agenda for change is then presented.
The primary way of preventing HIV infections is to change behaviors that enable transmission of the virus, specifically those behaviors relating to sex and drug injection. Realistic public health workers have focused on encouraging adoption of safer sexual practices, primarily condom use. The fundamental way to persuade people to engage in preventive practices is through targeted education aimed at particularly at-risk communities. Other effective behavioral interventions against HIV infections are: testing and follow-up counseling; comprehensive sex education; peer influence and community action; advertising and marketing; easing access to condoms; physician-patient dialogue; drug treatment; access to clean needles; and direct outreach. On the contrary, interventions that do not work are the following: one-time exposure to information; delivering a single message; abstinence-only programs; and coercive measures to identify people with HIV or their sexual partners.
Information for health. Annual report of the Director, 1998.
The 1998 Information for Health Annual Report of Pan American Health Organization (PAHO) Director, analyzes the salient activities of the Pan American Sanitary Bureau and Regional Office of the WHO technical cooperation program during 1998. PAHO is an international health agency with goals of creating technical and stimulating cooperation among Member Countries, maintaining a healthy environment and implementing strategies to sustainable human development. The first section presents the health situation in the region of the Americas and the continuous improvement in the health situation through a combination of favorable social, environmental, cultural and technological factors. The second section highlights the implementation of programs for health and health development which includes the creation or maintenance for the production, storage, analysis and dissemination of information activities. This is followed by a report on the health systems and services development. The following sections present projects on health and environment, disease prevention and control, and disaster preparedness and mitigation. Also included in this report are the major technical cooperation accomplishments at country level.
The Kenya Youth Initiatives Project (KYIP) was initiated in 1994 through the collaborative efforts of 26 Kenyan youth-serving organizations to address the issue of youth reproductive health. This paper illustrates the KYIP interventions and evaluates the effect on Kenyan youth and parents. There are two key components of the project: 1) the advocacy and networking component designed to reach national and district decision makers; 2) the education component designed to inform youth about reproductive health, encourage appropriate counseling and services, and foster better communication between children and parents. KYIP activities included conventions with national and District Development Committee leaders to increase their knowledge on unintended pregnancies, sexually transmitted diseases, HIV/AIDS and urge for support on sex education, counseling and services for the Kenyan youth. Nearly 10,000 leaders were reported to support the implementation of program. The project also implemented television, radio and other mass media programs to encourage discussions among young people.
UNAIDS plan spurs sale of millions of female condoms.
This article presents the success of the Joint UN Programme on HIV/AIDS (UNAIDS) in market distribution of female condoms, particularly in South Africa, Uganda, Zambia, Zimbabwe and Thailand. The project has sold 4 million female condoms in 16 developing countries in 1998, which proved to be an efficient barrier against sexually transmitted diseases (STDs). Female condom, a sheath that is inserted inside the vagina, offers protection from unwanted pregnancies and intensifies the choice of women in protecting herself. Since its introduction in 1992, more than 18 million female condoms have been sold worldwide. In industrialized countries, they are sold at US$2-3, while their cost is US$0.50-0.90 per condom in developing countries to encourage their use and provide better access. A study conducted among sex workers in Thailand in 1997 by UNAIDS reported a decrease of 34% and 25% in the incidence of STDs and the number of unprotected sexual acts, respectively, after the introduction of female condoms. The meeting in Pretoria has been organized to discuss strategies in advocating female condom use among women in developing countries.
This article highlights the result of a research on the value of condoms presented during the 2nd Annual National Symposium on Overcoming Barriers to Condom Use in Los Angeles on February 19-20, 1998. Reports revealed that condoms cost less than US$0.10 wholesale and US$0.31-1 retail. Despite these prices, consumers still purchase condoms to prevent sexually transmitted diseases (STDs) and unwanted pregnancies. Statistics show that there are 12 million new STD cases and about 40,000-60,000 new HIV infections annually. In response to this, governmental and nongovernmental agencies have spent a substantial amount of money to cover the medical expenses of these victims. This also causes a decline in national income, since victims being infected are in their productive years. An estimate of US$982,000 is spent on an individual HIV case. The use of condoms has greatly decreased the possible health costs of newly infected persons, with estimated net savings of US$1800/condom. This study confirms that promotion of condoms for STD prevention proves to be a good investment.
Oral contraception and health [editorial]
This article focuses on the Royal College of General Practitioners' oral contraceptive study, which observed 46,000 women (half of whom were using oral contraceptives) for several years to obtain information on various health outcomes. The study recorded a total of 1599 deaths over a period of 25 years. Oral contraception did not increase or decrease total mortality during this entire period. As with other studies, women using oral contraceptives had a lower death rate from ovarian cancer and higher mortality from circulatory diseases and cervical cancer. The benefits of oral contraceptives include reductions in incidences of menstrual problems, iron deficiency anemia, pelvic inflammatory disease, functional ovarian cysts, and benign breast disease. Moreover, the study suggests that women who do not smoke, who have their blood pressure checked, and who do not have hypertension have no increased risk of myocardial infarction and little increased risk of stroke when they use combined oral contraceptives. The challenge is to maximize benefits and minimize risks by giving appropriate advice to women about oral contraception and alternative contraceptive methods.
This study investigated the association between migraine and ischemic or hemorrhagic stroke in young women from 5 European centers participating in the WHO collaborative study of cardiovascular disease and steroid hormone contraceptives. Subjects included 291 women aged 20-44 years with ischemic, hemorrhagic, or unclassified arterial stroke and 736 age- and hospital-matched controls. Findings showed that adjusted odds ratios associated with a history of migraine were 1.78 for all strokes, 3.54 for ischemic stroke, and 1.10 for hemorrhagic stroke. Several risk factors, including oral contraceptive usage, showed a more than multiplicative effect on odds ratios for ischemic stroke associated with migraine. The odds ratios for both ischemic and hemorrhagic stroke, whether with or without migraine, were higher in women who used high dose oral contraceptives than those who used low dose oral contraceptives. Change in the frequency or type of migraine on using oral contraceptives did not predict succeeding stroke. Moreover, 20-40% of strokes in women with migraine appeared to develop directly from a migraine attack. In conclusion, migraine in women at childbearing age significantly increases the risk of ischemic but not hemorrhagic stroke.
Separate obstetricians from abortionists [letter]
This article presents four letters to the editor discussing different issues. The first letter focused on doctor-patient relationship and offered some suggestions toward a better doctor-patient relationship. The second letter pointed out that obstetrics and abortinology should be separated at the postgraduate level stating that a doctor cannot play two different roles at the same time. The third letter described a case of hypothyroidism with multiple serous effusions that was manifested by a 50-year-old woman. Lastly, the fourth letter was a response to an editorial regarding distance learning for health professionals' education. This letter acknowledged the thought-provoking article, which gave much insight into distance learning.
Abortion among adolescents in Cuba.
This study aims to understand which adolescents seek abortion in Havana, Cuba, and reasons for pregnancy termination. The study sample consisted of 248 adolescents under the age of 20 years who sought pregnancy termination over a 1-month period in 1995. Participants were given questionnaires to be completed. Findings showed that three-fourths of all adolescents who aborted a pregnancy were students, majority of whom cited interruption of studies as a major reason for such termination. More than half of the participants sought termination in clinics outside their community. Main reason for pregnancy termination among students is the interruption in their studies and wanted to continue schooling. Other reasons include being a single mother and due to poor socioeconomic conditions. In conclusion, due to the legalization and availability of abortion in Cuba, a sufficient stigma of over half of the young women seeks abortion.
Health-care camps for the poor provide mass sterilisation quota [letter]
This article presents a letter to the editor discussing the World Bank-financed India Population Project VIII in the urban slums of four cities in India (Delhi, Calcutta, Bangalore and Hyderabad). The project aimed to provide a full range of reproductive and child health services to the urban poor. The author mentioned the Bank s concern about allegations of forced sterilization and the use of incentives. But the state government had already assured that the practices of targets and incentives for sterilization had not been reinstated and that appropriate necessary actions would be taken. The Bank is a strong advocate of the International Conference on Population and Development (ICPD). The ICPD shifted from demographic targets and controls to a people-centered, rights-based approach. India was one of the first countries to adopt this approach. The World Bank has provided its support to the national and state government's shift. In addition, the Government of Andhra Pradesh plans to reduce its population growth by increasing women's literacy and by total commitment to reproductive and child health.
An assessment of nicotine dependence among pregnant adolescents.
This study assessed nicotine dependence among pregnant adolescent smokers in order to enhance the efficacy of smoking-cessation programs. This study analyzed baseline data from a sample of 94 pregnant teen smokers who had volunteered to participate in a smoking cessation study. Nicotine dependence was measured by adapting Fagerstrom Tolerance Questionnaire (FTQ), and by a 6-item withdrawal symptom scale. The overall FTQ score found among pregnant adolescents was 3.10 (SD = 2.3) compared to the mean overall FTQ score among vocational-technical students of 4.27 (SD = 2.2). Duration of smoking in years was significantly correlated with the overall FTQ score. Quantity of smoking, as measured by average number of cigarettes smoked, significantly correlated with overall FTQ scores. Lighter smokers were more likely to have previously attempted to quit. However, among the attempters to quit, those who smoked 10+ cigarettes per day reported greater severity of withdrawal symptoms than those who smoked fewer per day. Prenatal education and smoking cessation programs for pregnant teenagers, and pregnant women in general, need to consider that nicotine dependence is an important issue. Early pregnancy may be an opportune time to intervene among pregnant smokers; incentives may be necessary to attract those women who are heaviest smokers, and possibly the most dependent on nicotine.
Spontaneous otoacoustic emissions in heterosexuals, homosexuals, and bisexuals.
Click-evoked otoacoustic emissions (CEOAEs) were previously shown to be significantly less strong in homosexual and bisexual females than in heterosexual females. This article reports that the spontaneous otoacoustic emissions (SOAEs) among 60 homosexual and bisexual females and 57 heterosexual females showed the same basic pattern as did the CEOAEs. That is, the SOAEs of the homosexual and bisexual females were intermediate to those of heterosexual females and heterosexual males. The SOAE and the CEOAE data both suggest that the cochleas of homosexual and bisexual females have been partly masculinized, possibly as part of prenatal processes and of whatever brain structures are responsible for sexual orientation. For male sexual orientation the SOAEs were less numerous and weaker than for the females, and there were no significant differences among the 56 heterosexual, 51 homosexual, and 11 bisexual males. All subjects passed a hearing screening test. When all SOAEs above 300 Hz were excluded (as a control against incipient, undetected hearing loss) the same results were obtained as with the full range of data (550-9000 Hz). The differential use of oral contraceptives by the heterosexual and nonheterosexual females also could not explain the differences in their otoacoustic emissions.
Partner condom use among adolescent girls with sexually transmitted diseases.
This research explored the associations of self-reported condom use with sexual knowledge and behaviors, perceptions of peer condom use, and communication with sexual partners about condom use among adolescent girls with sexually transmitted diseases (STDs). A total of 24 adolescent girls, 13 with cervicitis and 11 with pelvic inflammatory disease, were given a 62-item self-administered questionnaire. A total of 22 respondents had complete data for analysis. Compared with girls who reported low frequency of condom use, girls who reported condom use all or most of the time were younger, were less likely to have a prior history of STDs and were more likely to think that all or most of their friends use condoms. Compared with girls who had not used a condom with last sexual intercourse, girls who had used a condom were younger, had fewer lifetime partners and had higher mean scores in condom use negotiation, and were more likely to think that all or most of their friends used condoms. Knowledge about condoms and STD prevention was high but was not associated with condom use. This study concludes that STD interventions for partner condom use among high-risk adolescent girls must recognize the decrease in condom use with increasing age and focus on maintaining safer sex behaviors, building condom use negotiation skills, and promoting the perception of condom use by friends.
Chang et al. reported that the odds ratios for ischemic stroke in young women with classical migraine (with aura) and simple migraine (without aura) were similar. These findings are at odds with earlier studies, which reported increased risk primarily in migraine with aura. It has been noted that the 95% confidence interval for ischemic stroke in migraine without aura included unity, unlike that for migraine with aura. Therefore a lesser risk in migraine without aura is not excluded. Another possible reason for the apparent discrepancy is that the authors failed to identify true aura. Although their questionnaire was based on diagnostic criteria proposed by the International Headache Society, their questions were too nonspecific. It is important to distinguish between the different types of migraine because, according to the Faculty of Family Planning and Reproductive Health Care, migraine with focal aura absolutely contraindicates combined oral contraceptives. However, most young women with migraine of any type can be assured that the absolute risk of ischemic stroke is minimal. It is suggested though that those at specific risk should be identified and counseled so that they may choose an appropriate contraceptive and avoid other risk factors.
Ethical foundations of client-centered care in family planning.
Biomedical ethics provides the foundation for a model of client-centered care that can assure the good quality of family planning and other reproductive health services in developed and developing countries. Client concerns reflect the four ethical principles of autonomy, justice, beneficence, and nonmaleficence. Autonomy reflects client's desire for full information and respect from providers so that they can exercise their right to make their own informed decisions. Justice, for clients, means fair treatment and ready access to services, regardless of one's socioeconomic status, education, ethnic group, or residence. Beneficence means that providers possess the technical competence and understanding needed to act in the best interest of their clients, as clients expect. Nonmaleficence translates into client concerns about safety--that no harm will come to them as a result of seeking services. Application of these ethical principles requires changing providers' attitudes from paternalistic to client centered. Assessments of client satisfaction can help family planning programs identify and respond to client values and even raise client expectations about the care that they should receive. Managers also can contribute to good quality care by meeting providers' professional needs for training, supervision, supplies, record keeping, and so on. Family planning programs around the world are focusing on these ethical concerns to emphasize respect for client values, appropriate decision making, broader access to services, and basic safety issues. Although they use a variety of techniques, all these quality assurance and improvement initiatives share an ethically based, client-centered philosophy.
Teen pregnancy prevention: do any programs work?
The US has the highest teen birth rate in the developed world, about 4 times higher compared to countries in Europe. Broad social and environmental factors, such as poverty and social disorganization, high residential turnover, high divorce rates, and poor parental support and supervision put teens at greater risks of pregnancy. Individual characteristics, such as poor school performance, low expectations for the future, high aggression, difficulty getting along with peers, and early pubertal development make particular teens additionally vulnerable. New developments described in this document include: 1) renewed emphasis on abstinence; 2) moving toward a more positive view of teen sexuality; 3) development of new prevention initiatives, such as sexually transmitted disease (STD) and HIV/AIDS prevention programs, community-wide teen pregnancy prevention collaboratives, broad-based youth development programs, and state and local government initiatives; 4) launching of the National Campaign to Prevent Teen Pregnancy. An analysis of the different ways in which the problem can be framed and the implications for solutions of the problem follow. Furthermore, this study presents several examples of STD and HIV/AIDS prevention programs. This paper ends with a recommendation for an eclectic approach to framing the problem and possible solutions.
Predictors of increased condom use following HIV intervention with heterosexually active drug users.
This study determined the predictors associated with an increase in condom use following an HIV intervention among 3357 heterosexually active injection drug users (IDUs) in nine cities. Subjects were interviewed using the Risk Behavior Assessment, and re-interviewed approximately 6 months later using the Risk Behavior Follow-up Assessment. Findings revealed that participants reported using condoms during 15% of their sexual encounters prior to the HIV intervention and during 22% of their sexual encounters 6 months later. A logistic regression analysis indicated that individuals who increased their condom use were likely to be HIV seropositive [odds ratio (OR) = 2.49], to have received AIDS information prior to the intervention (OR = 1.28), to have multiple sex partners (OR = 2.14), to be single with multiple sex partners (OR = 1.34), or to have exchanged drugs or money for sex (OR = 1.33). The discussion focuses on the generally low incidence of condom use and the need for increased intervention, particularly among drug users in monogamous relationships and sex workers. Findings indicate the need for a more effective means of inducing change in the sexual behaviors of IDUs.
Review of newer contraceptive agents.
This paper reviews the latest developments in oral contraceptives (OCs), long-acting contraceptives such as injectable progesterone, subdermal progestin implants, progesterone-releasing IUDs, emergency contraception, and male contraception. Latest developments of OCs contain much lower doses of estradiol than the older preparations and uses newer progestins with less androgenic activity, thus causing fewer side effects. Depot-medroxyprogesterone acetate injections every 3 months prevent conception by suppressing the luteinizing hormone surge, thereby inhibiting ovulation. These contraceptive options are good for women in whom compliance may be low. Subdermal progestin implants have a failure rate of 0.8/100 woman-years for the first 5 years of use, increasing to 2/100 woman-years by the 6th year. They acts primarily by rendering the cervical mucus impenetrable to sperm. The progesterone-releasing IUDs, on the other hand, induce decidualization of the endometrium, thus inhibiting implantation. Among the postcoital contraceptives briefly discussed in this paper are the combined OCs (ethinyl estradiol and norgestrel), progestin-only compounds, the copper IUD, and mifepristone. The new developments of condoms, which are the mainstay of male contraception, include the new polyurethane condom, which is thinner, stronger, and less allergenic.
Does an acidic medium enhance the efficacy of vaginal misoprostol for pre-abortion cervical priming?
This study determines whether an acetic medium can enhance the efficacy of vaginal misoprostol, in comparison with a water medium, for pre-abortion cervical priming. A total of 120 nulliparous women requesting legal termination of pregnancy between 6-12 weeks gestation were allocated randomly to either of the study groups. Vacuum aspiration was performed 3-4 hours after insertion of the misoprostol tablet. Using Hegar's dilator, the degree of cervical dilatation before operation was measured. Results demonstrate that of the 60 women, 14 (23%) achieved a cervical dilatation of 8 mm or more when the misoprostol dose was dissolved in acetic acid; 12 (20%) achieved a similar cervical dilatation when the dose was dissolved in water. The mean cervical dilatation for the acid and water media used was 6.3 mm and 6.2 mm, respectively. The differences in both of these parameters were not statistically significant. Similarly, there was no statistically significant difference between groups in terms of pre-operative and intra-operative blood loss. About 24 (40%) and 4 (7%), respectively, of women in the group in which a water medium was used experienced vaginal bleeding and abdominal pain, compared with 20 (33%) and 0 women, respectively, who used acetic acid. These differences in side effects were not statistically significant. The study showed that the use of acetic acid to dissolve vaginal misoprostol does not improve the efficacy in achieving successful cervical dilatation for pre-abortion cervical priming.
The results of the reanalysis of the MediPlus database concerning the relative risks of venous thromboembolism (VTE) associated with distinct formulations of combined oral contraceptives (COCs) are discussed in this paper. The study population included women aged 15-49 years, who had VTE during 1992-97, which was treated with anticoagulant, and who were exposed to a COC. A total of 366 controls were matched to the 99 cases carrying the same criteria. Conditional logistic regression was carried out and odds ratios (OR) with 95% confidence intervals were calculated for individual COC formulations. Both crude OR and OR adjusted for body mass index, smoking status, diastolic blood pressure, and non-oral contraceptive prescription were calculated. A crude incidence of idiopathic VTE of 4.6/10,000 exposed woman-years was found among COC users. Using levonorgestrel 150 mcg + ethinyl estradiol 30 mcg as reference, a nonsignificant OR of 1.1 (0.5-2.6) for desogestrel 150 mcg + ethinyl estradiol 30 mcg and 1.1 (0.5-2.4) for gestodene 75 mcg + ethinyl estradiol 30 mcg was found. The results of this study showed no significant difference in risk between the different formulations of COCs.
The differential risk of oral contraceptives: the impact of full exposure history.
This transnational study examined the risk of venous thromboembolism (VTE) associated with combined oral contraceptives (OCs). The study analyzed data on 502 women aged 16-44 years with VTE and 1864 controls from 10 centers in Germany and the UK from 1 January, 1993, to 20 October, 1995. Information on lifetime exposure history from all subjects was added to the data set used in previous analyses and entered into a Cox regression model with time-dependent covariates. Based on 17,622 continuous exposure episodes comprising 47914 person-years of observation, the adjusted hazard ratio of VTE for the comparison of current users of third-generation versus current users of second-generation combined OCs was 0.8 (0.5-1.3). The OR obtained in standard case-control analysis had been 1.5 (1.1-2.1). Adjustment for past exposures includes more information and appears more valid than the standard cross-sectional analysis. Using this approach, the transnational study data show no evidence for an increased risk of VTE with third-generation compared with second-generation combined OCs.
Laparoscopic tubal anastomosis and reversal of sterilization.
This study examined the reliability of laparoscopic tubal anastomosis, a commonly used birth control method. The study was conducted between January 1996 and December 1997 in 16 patients who underwent laparoscopic microsurgical tubal anastomosis. A technique requiring 3 stitches with tubal cannulation was used. Within a period of 6 months, there were 5 reported pregnancies, 1 ectopic and 4 ongoing. These showed a 31.2% overall pregnancy success rates. Mean age in the occurrence of pregnancies was 33.4 years. An association of infertility factors was found in 5 patients. Infertility factors included sperm abnormalities, tubal endometriosis, and salpingitis. From these findings, it was concluded that the surgical outcome depended on the patient's age, method of tube interruption and length of Fallopian tube segments to be anastomosed. Moreover, the study confirms the feasibility of laparoscopic tubal sterilization, as well as its offered benefits.
This paper presents issues regarding the risk of venous thromboembolism in association with the combined oral contraceptives (COCs). The constant negative drip of unbalanced information from the lay press makes it impossible for professionals and consumers to interpret the true risks and benefits of drugs. In considering the total benefit-risk profile of a drug usually a single indication for a drug has to be compared with a number of adverse reactions of differing frequency, duration and seriousness. It is then essential that all data on which the benefit-risk judgments are made should be available for peer scrutiny. The Erice Declaration states in its preamble: "monitoring, evaluating, and communicating drug safety is a public health activity with profound implications that depend on the integrity and collective responsibility of all parties--consumers, health professionals, researchers, academia, media, pharmaceutical industry, drug regulators, governments and international organizations--WO WOMENrking together". To communicate the overall situation with respect to the COCs, the following are essential: content of the message; purpose of the message and state of mind of the intended recipient; general context or climate in which the message will be perceived; communication media to be used; feedback mechanisms; and monitoring and evaluation.
Gynecologic care of medically complicated adolescents.
This paper discusses issues on gynecologic care of medically complicated adolescents. Gynecologists and health personnel should give special attention to the chronic medical illness or disabilities of adolescents throughout their development. They must understand the interactions of the normal endocrinology of development and the pathophysiology of the medical illness. Chronically ill and disabled adolescents are least likely to receive information and guidance on sexual issues. They need to know the potential impact of their illness on pregnancy; genetic risk of their illness, treatment, and disability pose to their unborn children; and their limitations on both sexual function and fertility. In addition, it s important that these adolescents be given counseling addressing social and judgmental skills in cases of social isolation. Illnesses related to pubertal developments include: diabetes mellitus; cystic fibrosis; renal insufficiency and failure; gynecologic issues with various other chronic illnesses; sickle cell disease; seizure disorders; asthma; tuberculosis; inflammatory bowel disease; chronic yeast infections; menstrual abnormalities and coagulopathies or thrombocytopenia; adolescent and childhood malignancies; and developmental delayed and physical disability.
Adolescent gynecology in the office setting.
This paper discusses adolescent gynecologic experiences in health care provider clinics. Pediatricians in this study deal with problems that are not encountered by their predecessors. Traditional pediatric practice 20-30 years ago differ from that in the modern adolescent practice. Medical practitioners providing care to adolescents need to ensure that their practices are able to meet the demands of the patient. Incorporating general pediatric setting implies a change in one's practice to be more receptive to adolescents. This involves having appropriate staff, philosophy, decor, expertise, and equipment. They should be prepared to handle multiple issues related to pubertal development, sexuality, self-esteem, and body image. Office services must choose comprehensive scope of services and develop policies or guidelines acceptable to all providers in the practice. Practitioners and staff must be able to possess and understand the importance of confidentiality and its limitations. It is necessary to have complete, useful, and essential office equipment and supplies. Lastly, it is also the role of pediatricians to educate and counsel adolescents and parents regarding adolescents' gynecologic health. Among the common gynecologic problems encountered are the following: menstrual disorders; vaginitis and vulvar disorders; breast disorders; sexually transmitted diseases; and adolescent pregnancy and contraception.
This paper presents data from the first large US clinical trial of Lunelle monthly contraceptive injection, which is a combination of 25 mg of medroxyprogesterone acetate (MPA) and 5 mg of estradiol cypionate (E2C). The lead article reports that there was no occurrence of unintended pregnancies and no contraceptive discontinuation among more than 700 women using the MPA/E2C in a 60-week clinical trial. Most women experienced regular monthly cycles the same as those women using the nonhormonal method. The second article reports the results of a separate trial that studied return ovulation after three monthly injections of MPA/E2C in surgically sterile women. Serum progesterone determinations found that return of ovulation was documented as early as 63 days after the third (final) intramuscular injection of MPA/E2C. Two articles in this issue assess the pharmacokinetics of MPA/E2C injections. Findings indicate that MPA/E2C represents a contraceptive option that combines the advantages of oral contraceptives with the convenience and effectiveness of monthly administration. Accordingly, a US Food and Drug Administration approval should play an important role in helping women achieve effective birth control in the US and worldwide.
This open-label, nonrandomized, parallel, controlled study compared the efficacy, safety, and cycle control of a monthly injectable contraceptive containing 25 mg of medroxyprogesterone acetate (MPA) and 5 mg of estradiol cypionate (E2C) (Lunelle monthly contraceptive injection) to that of a nonethindrone 0.5, 0.75, 1.0 mg/0.035 mg ethinyl estradiol (NET/EE) triphasic oral contraceptive (Ortho-Novum 7/7/7). A total of 1103 women provided data for the efficacy and safety analyses. A higher proportion of women in the NET/EE group (65.1%) than in the MPA/E2C group (43.7%) had used hormonal contraception during the month before the study. During the first year, one pregnancy occurred in the NET/EE group, while none occurred in the MPA/E2C. In the 15th treatment, another pregnancy occurred in the NET/EE group. After the first treatment cycle, women in both groups experienced regular menses, with an average of 28 days in MPA/E2C and 27 days in the NET/EE, respectively. Only 2.5% of the MPA/E2C users experienced metrorrhagia as a reason for discontinuation. Adverse events reported in both treatment groups were consistent with the use of combined hormonal contraceptives. The study concluded that MPA/E2C has high contraceptive efficacy and safety.
This study assessed the pharmacodynamic effects of medroxyprogesterone acetate (MPA) and estradiol cypionate (E2C) (MPA/E2C) (Lunelle monthly contraceptive injection) through changes in serum progesterone concentrations. A total of 16 surgically sterile women with regular menstrual cycles were studied for one control cycle, three consecutive treatment months, and 3-5 months of follow-up. Serum progesterone levels and, consequently, ovulation were suppressed beyond the entire dosing interval, indicated by the absence of any luteal-like progesterone peaks. The first normal ovulatory cycle, based on progesterone concentrations of 4.7 ng/ml or higher, was noted in 11 women between days 63 and 112 after the third injection. Select MPA parameters were correlated with return of ovulation. The correlation coefficients were 0.757 and 0.492 for area under the curve and minimum concentration, respectively, indicating that return of ovulation is dependent, in part, on area under the curve and on the magnitude of the serum MPA trough level. Generally, the higher the minimum concentration levels, the longer the time to return of ovulation. This study concluded that the return of ovulation, as confirmed by serum progesterone concentrations of 4.7 ng/ml or higher, was observed as early as 63 days after the third and final monthly intramuscular injection of MPA/E2C. This indicates that consistent suppression of the hypothalamic-pituitary-ovarian axis is reversible after discontinuation of dosing.
A nonrandomized, open-label, multicenter study assessed the effects of body weight and injection site on the pharmacokinetics of medroxyprogesterone acetate (MPA) and its progestin medicating contraceptive efficacy among 77 healthy, fertile women aged 18-47 years. For determination of serum MPA concentration-time profiles, blood samples were collected before the 6th and 7th injections (day 0) and on days 3, 7, 14, 21, and 28 after the 6th and 7th monthly administrations. For injection site effects, MPA pharmacokinetics were compared at the injection sites of the arm, hip, and leg; there was no significant finding. For effects of body mass, no significant differences were noticed in the pharmacokinetics of MPA among the 3 body mass indices (thin/normal, obese, highly obese). However, a difference (p = 0.0387) was found between normal and obese women (<20%). The findings suggest that minor differences observed in MPA pharmacokinetics have no impact on the contraceptive efficacy of MPA/E2C, may it be due to injection sites or body weight, since trough concentrations are well above the threshold levels required to suppress ovulation.
This paper characterized the pharmacokinetics and pharmacodynamics of medroxyprogesterone acetate (MPA) and estradiol cypionate (E2C) in 14 healthy, surgically sterile women. These women ranged in age from 28 to 43.4 years, in body weight from 47.6 to 68.9 kg, and in height from 150 to 175 cm. The results of this study demonstrate that steady-state conditions are achieved after the first injection of MPA/E2C; no further MPA or E2C accumulation occurs beyond the first injection. Moreover, the E2 peak observed after injection of MPA/E2C is similar to the nontreated preovulatory E2 range and returns to baseline levels by approximately 14 days after insertion.
The results of a user satisfaction questionnaire, treatment assessment questionnaire, and global well being schedule questionnaire administered to women participating in an open-labeled, nonrandomized, parallel, controlled study is reported in this paper. The study compared a new monthly injectable contraceptive containing 25 mg medroxyprogesterone acetate (MPA) and 5 mg estradiol cypionate (E2C) with a triphasic norethindrone (0.5, 0.75, 1.0 mg)/0.035 mg ethinyl estradiol (NET/EE) oral contraceptive. Approximately 85% of 1103 women enrolled in the comparative trial completed their initial and final questionnaires. Despite the inherent inequalities in comparing an injectable to oral contraception, few treatment assessment and satisfaction outcomes were significantly different when comparing MPA/E2C users to new NET/EE users. More women in the MPA/E2C group reported discomfort with their method compared to the women in either the new or previous NET/EE user group. However, only 19.4% of MPA/E2C users rated the administration of their contraceptive to be moderately uncomfortable or worse, compared to 11.7% of new NET/EE users and 13.4% of previous NET/EE users. Among MPA/E2C users, 86.3% reported no interference with social activities compared with 90.4% of new NET/EE users. MPA/E2C and new NET/EE users were also similar in their responses recommending their respective contraceptive method to friends. These data support the premise that MPA/E2C may become the well-accepted, first-line contraceptive option for women in the US.
A five-part study was conducted to gauge knowledge, attitudes, and practices about emergency contraception (EC) among policymakers, family planning providers and clients, and university students in Nairobi, Kenya. Government and professional association policy documents, and clinic guidelines and service records were searched for references to EC. In-depth interviews were conducted with 5 key policymakers, and with 93 family planning providers randomly selected to represent both the public and private sectors. Furthermore, 282 family planning clients attending 10 clinics were also surveyed and four focus groups were conducted with university students. Although one specially packaged EC was registered in Kenya, the method was scarcely known or used. No extant policy or service guidelines address the method specifically, although revisions to several documents were planned. Yet policymakers felt that expanding access to EC would require few overt policy changes, as much of the guidance for oral contraception was already broad enough to cover this alternative use of those same commodities. Participants in all parts of the study generally supported expanded access to EC in Kenya. They did, however, want additional detailed information, particularly on the health effects of EC. They also differed on who should have access to EC and how it should be provided.
An interview was conducted to ascertain knowledge, attitudes, and practices concerning emergency contraception (EC) among health care providers and potential EC users in metropolitan Mexico. Findings showed that there was a limited knowledge about EC per se and its method, but nevertheless, most of the participants were cautious to support EC in Mexico. Health care providers and clients greatly overestimated the negative health effects of EC, although clients overwhelmingly reported that they would use or recommend it if needed. Although providers typically advocated medically controlled distribution, clients believe EC should be more widely available, including in schools and vending machines, with information prevalent in the mass media and elsewhere.
This study evaluated the efficacy of postcoital contraception by matching menstrual data with hormonal measurements. A total of 483 consecutive women requesting postcoital contraception were included in a prospective observational trial. A blood sample was obtained at the moment of consultation to measure serum luteinizing hormone, estradiol, and progesterone concentrations. An ethinyl estradiol/levonorgestrel combination (100 mcg/500 mg, 2 doses 12 hours apart) was then prescribed. The fertile period was estimated according to previous hormonal studies in the normal cycling population. Of the 483 women, 382 remained until the follow-up, 2 of which became pregnant. Following Wilcox's and Trussell's methods, 21.2 and 17.75 pregnancies should be expected, yielding an overall treatment effectiveness of 90.52% and 88.73%, respectively. Hormonal data were available for 356 women, 303 of whom presented with regular cycles. Hormonal information in this group restricted the number of exposed cases to 88 women. Of the women included in Trussell's method of analysis, only 51 were at risk using hormonal data. About 56% of women with luteinizing hormone levels >20 IU/L were not between days -1 and +1 of the cycle. Hormonal studies suggest that methods based on pregnancy risk calculated by cycle day do not faithfully reflect the real exposure.
Fourteen years' experience in voluntary female sterilization through minilaparotomy in Jos, Nigeria.
Female sterilization through minilaparotomy was performed in 2913 clients between January 1985 and December 1998. The mean age was 36.4 +or- 4.2 years, and 68% of the women were between the ages of 30 and 39 years. The mean parity distribution was 8.0 +or- 2.0; 59.5% were para 8 or higher and the mean number of living children was 6.8 +or- 1.6. Only 32.9% had 8 or more living children at the time of the procedure. Completed desired family size was the indication for the tubal occlusion in 95% of the patients. The predominant surgical technique was the Pomeroy's method (97%). Tubal ligation as an interval procedure was performed in 93.6% and local anesthesia was given in 83.7%. The study showed a yearly increase in voluntary surgical contraception at the institution, made possible by trained personnel.
Determinants of use of maternal-child health services in rural Ghana.
This paper examined the relative importance of selected characteristics on the use of maternal-child health (MCH) services in rural Ghana. Logistic regression models were used to estimate the factors associated with the use of a doctor for prenatal care, soliciting four or more antenatal check-ups, delivery at hospitals for the last birth in the 3 years preceding the 1993 Ghana Demographic and Health Survey, and participation in family planning. The analyses demonstrate that the use of MCH services tends to be shaped mostly by the level of education, religious background, and region of residence, and partially by ethnicity and occupation. The findings suggest that improvement of MCH services in Ghana would require the promotion of education for women up to at least secondary/higher level, adoption of intersectoral planning and problem solving, incorporation of safe traditional maternal and child care practices, and imposition of the proposed National Health Insurance Scheme that ensures the availability and acceptability of health services.
Women's work and fertility in a sub-Saharan urban setting : a social environment approach.
This study presents and tests a new conceptualization of the relationship between the type of social environment in which women work and their fertility and contraceptive use using data from three separate studies conducted in Maputo, Mozambique, in 1993. Studies demonstrated that women who work in more collectivized environments are associated with lower fertility and higher contraceptive use than women in an individualized work environment or not working outside the home. Most of these differences persist in multivariate tests. However, it is argued that collectivized work environment are most conducive to diffusion and legitimization of reproductive innovations. In contrast, individualized work environment tends to isolate women and therefore may retard their acceptance of innovative fertility-related behavior.
This paper studies the interactions between breast-feeding practices, household environmental sanitation and diarrhea-related diseases in Ghana and Nigeria, employing the data collected from the Demographic and Health Surveys conducted in Ghana in 1993 and Nigeria in 1990. Results showed that mixed-fed infants aged between 0 and 11 months tend to have a higher risk of diarrhea than fully breast-fed children, while the risk of diarrhea among the weaned infants is twice that of mixed-fed infants. The probit regression models employed in the analysis were used to predict the probability of diarrhea associated with each breast-feeding pattern for both poor and good sanitation areas. Furthermore, it was found that the risk of diarrhea among mixed-fed infants in the poor sanitation areas tends to be high, while the same risk among fully breast-fed infants tends to be minimal. In conclusion, health risks of mixed feeding are substantial, particularly for infants aged under 7 months, and are even worse for those weaned before 6 months of age.
The impact of co-resident spouses and sons on elderly mortality in rural Bangladesh.
This study uses a prospective data with a large sample size from rural Bangladesh to examine the impact of co-resident spouses and sons on the subsequent mortality of old people, with significant differences depending on the sex of the elderly person and the age of the son. Findings revealed that spouses significantly reduce mortality by similar magnitudes for both elderly men and women. On the other hand, co-resident adult sons reduce mortality for elderly women much more than for elderly men, with younger sons being more beneficial than older sons. Furthermore, both married and unmarried females appear to benefit equally from co-resident adult sons. In conclusion, it is clear that in the study population, the presence of co-resident sons and spouses acts in a complex way to affect mortality in old age, with elderly women being particularly vulnerable to these effects. No single mechanism can fully explain the varying impact of spouses and sons. Not only may different mechanisms (protection through increased social integration/enhanced stress buffering/improved information networks, protection through improved economic status, and selection into co-residences on the basis of health status) be operative in the case of spouses versus son, but more than one mechanism may be responsible in each case.
Provider knowledge about emergency contraception in Ghana.
In 1996, the Ministry of Health in Ghana included emergency contraception (EC) in its newly issued National Reproductive Health Service Policy and Standards. This paper reports a short survey conducted to evaluate the success of these early efforts to introduce EC into Ghana and evaluate health providers' knowledge of EC. Short structured interviews were conducted with health care providers at a sample of family planning outlets in two regions of Ghana. Findings revealed that health providers' knowledge about EC is low. Out of the 325 people interviewed, only about one-third (34%) had heard of EC. Furthermore, no provider had sufficient knowledge to prescribe EC correctly. Two policy implications can be drawn from this research: 1) well coordinated training of providers will have to precede a successful introduction of EC in Ghana; 2) a dedicated product may be critical for the successful introduction of EC, where providers' knowledge is low.
Fertility and population policy in two counties in China 1980-1991.
This survey examined the diversity in reproductive behavior and contraceptive practice to determine whether their differentials are influenced by area or those between individuals within the areas. Data were collected from three separate surveys of women in two highly developed rural counties of China, Sichuan and Jiangsu Provinces carried out in late 1991. The main findings established were: 1) the pattern of fertility and contraceptive use was found at the individual level rather than in policy differences between administrative units; 2) the association between income and number of children was negative, as that between income and propensity for uniparous women to remain unsterilized; 3) the ideal family size differentials were largely absent, showing that social and economic characteristics were not responsible for differences in reproductive motivations, and implying that the nature of the demand for children was very different from that in most rural areas of the Third World; 4) data on ideal family size by sex of the existing offspring indicate only a weak preference for sons.
Shrinking societies favor procreation.
Low birth rates and unprecedented improvements in life expectancy had brought a shrinking society to a rapidly expanding retirement-age population. In 1999, people aged 65 and older make up 15% or more of the populations in 19 countries. Furthermore, 14 country populations are already experiencing natural decrease, and a lot more will start to decline early in the 21st century. Due to this predicament, concerned countries have created policies that may encourage more childbearing by easing the opportunity costs of raising children. Among the policies are: 1) paid maternity and paternity leaves until a child is 2-3 years; 2) free child care; 3) tax breaks for large families; 4) family housing allowance; 5) cash paid to parents for raising a child. Governments of the shrinking societies believed that these policies could influence fertility because it affects the socioeconomic setting in which childbearing decisions are made. This paper also discusses Hungary, Japan, and Sweden fertility policies.
Support growing for eradicating female genital cutting.
Female genital cutting (FGC), a prevalent practice in most African countries not just seriously endangers a girl's lifetime health, but it is also considered a human rights violation. In June 1999, the Intra-Agency Working Group on FGC held a symposium with US Agency for International Development (USAID) staff to explore ways of incorporating into USAID program activities to eradicate the practice of FGC. One of the presentations at the symposium concerned "circumcision with words". This ceremony is an alternative rite of passage; it is conducted through a 5-day seclusion, culminating in a 1-day celebration including feasting and gift giving. The alternative rites include 1) self-esteem and coping with criticism; 2) responsibility for one s own decision; 3) dating and courtship; 4) coping with peer pressure; 5) personal hygiene; 6) marriage; 7) pregnancy and sexually transmitted disease and AIDS prevention; 8) contraception; 9) FGC, early marriage, and gender empowerment, including the rights of the girl child; 10) respect for community; and 11) respect for elders. Alternative rites of passage are gaining community acceptance and by Kenya Medical Association. None of the girls who participated in the ceremony were circumcised later.
In many situations, political decisions, which are often made without concern for their demographic impacts, have repercussions upon the spatial distribution of populations. The authors attempt to demonstrate the existence of such relationships and to make political decision-makers aware of the potential demographic risks of their actions. They examine the cases of Mauritania and Belgium. With regard to Belgium, they distinguish the political decisions made by national figures from those taken by local administrators. The paper explores the spatial distribution of Mauritania s population; rural development and the spatial distribution of Belgium s population, with particular attention to the district of Dinant; and local management and demographic consequences. Specific subjects discussed regarding Mauritania include population growth experienced in the country during 1977-88 and the diversity of that growth. Local administrators play key roles at the local level. The impact of rural tourism and the arrival of young retirees, residential concerns, and the myth of population growth are considered with regard to the urban areas of Dinant district.
[Poverty and effectiveness of population policies and their relationships with urbanization]
When studying the relations which exist between population growth and urbanization, one must also understand urbanization in terms of its relationships with the country s population and spatial distribution policies. Urban growth and dynamics are indistinguishable from a country s population and spatial distribution policies. Upon first examination of these policies and strategies, one does not always see the clear associations which exist with urbanization. Moreover, when one closely examines the various situations, one finds, in most cases, that population problems are only rarely imagined as they actually are, independently. Rather, they tend to be considered as an element of social policy or economic development. In all cases, population problems and urbanization do not seem to be important concerns of governmental policy. One could even argue that the phenomena of population dynamics and urbanization have not always been considered to be real problems in need of solutions, but rather as data in need of corrections or adjustments. One way or another, population policies have often led, in developing countries, to chaotic urbanization which responsible decision-makers subsequently attempt to manage using often authoritarian measures in the interest of maintaining security and social order. These issues are explored among countries in Africa, Latin America, Asia, and Europe.
[The urban population policy in Venezuela]
Venezuela s national system of urban centers was not born from any sort of global concept. Rather, it developed over a period of almost 40 years and was structured in a fragmentary and ongoing manner, parallel to the promulgation of legal instruments which gave birth to new planning bodies. The multiplicity of urban planning laws, agencies, and instruments in the country reflect both the development of the planning system and its overly complex nature. The various plans of the system are reviewed, followed by an explanation of the movement of planning to the regional development level, development priorities, and actual urban spatial problems in Venezuela. The country s urban planning institutions and their respective roles are examined, as well as the new administrative regionalization. Venezuela s large cities were consolidated through the creation of concrete development priorities. The centralization of power in the country affects the manner in which its population is distributed, with populations migrating internally to find employment, better salaries, and better living conditions. The former urban planning approach of building housing and related facilities is no longer viable. The characteristics of Venezuela s cities are described.
[The population of Algiers. Spatial analysis and demographic projections]
Although the population of Algiers doubled during 1962-77 to approximately 1.3 millions inhabitants, the total number of housing units did not change over the period. Demographic projections were made for metropolitan Algiers, a region covering 1500 sq. km in which 2 million inhabitants reside. The projections were made based upon the homogeneous subpopulation with regard to their socioeconomic characteristics. Each of 30 different population subgroups was identified according to type, with each type corresponding to a different population subgroup. The goal was to limit the typology of demographic behaviors by aggregating the basic units whenever they could be considered as being homogeneous enough. The statistical analysis, classification without geographic consideration, results, and classification with geographic consideration are presented, followed by a section of demographic projections through 1987. While it remains too early to project with absolute precision, less than 1.5 million people are projected to inhabit the core of metropolitan Algiers by 1997. Census data received from basic geographic units will help refine the ultimate projection.
When demographers make projections, they are created upon the basis of existing populations with specific characteristics and account for both plausible natural and migratory movements. However, the projection task grows more complex in the case of planned, but not yet created urban areas, because the relevant demographic rates and characteristics of the population of origin must be determined before the population s actual arrival. Such determination can be made only with regard to housing units. In order for this theory of household determination by residence to be operational, one must determine which housing criteria will have the greatest influence upon the characteristics of future households. But in the context of a defined urban area, migrations are in large part the result of housing availability, which is closely associated with natural population dynamics. Natural and migratory population movements cannot be treated independently from one another. An original projection method is described for the new city of Marne-la-Vallee, in the Paris region, which takes into consideration the interaction of these two movements.
[A model of demographic projection by neighborhood]
In order to describe population characteristics in fine detail, one should proceed in a 2-step process. After having established the characteristics by age at a somewhat disaggregated level, such as that of a city, one can then further disaggregate the available data down to the neighborhood level. This 2-step process was used by Quebec s Bureau of Statistics with the assistance of a simple method which makes the growth of a region depend to a certain extent upon its age structure. The author proposes an approach which is more complex, but nonetheless offers interesting applications. The method allows the formulation of hypotheses upon the evolution of the demographic weight of neighborhoods with regard to the city. Neighborhood development-related factors such as major building projects, changes in the layout of the neighborhood, or important changes to the transportation system must be considered. The model is described, followed by a test in order to verify its practical merits. Some results and conclusions are presented. The model is appropriate to the extent that its estimation of parameters leads to plausible results which offer a certain stability over time. With regard to the test, there were only small differences between the calculated results and the actual situation.
[A dynamic model of the evolution of the French urban system]
Theoretical urban research has had little impact upon shaping actual urban centers. Even so, empirical studies have shown highly important regularities in the evolution of urban populations over both the medium and long terms. Local and relatively unpredictable fluctuations in the populations of each city are in contrast with the considerable stability of the hierarchical organization of cities. Urban population projection methodologies must consider such long-term stability while incorporating the short-term fluctuation characteristics of urban dynamics. The temporal instability of growth rates makes it highly difficult to count upon past growth in the formulation of projections. The projection of migration rates is particularly problematic. The authors describe the dynamics of French cities of more than 50,000 inhabitants through their population growth using their model which takes into consideration the roles of cities distances and attractiveness with regard to the determination of individual probabilities of migrating. The model was used to make population projections over a 20-year period, through 2002. The results of these projections are presented.
[The topodynamic approach applied to the United States case: description and results]
Almost all developing countries are experiencing rapid urbanization which is vastly changing the localization of activities, employment, and populations. However, the prospective study of such localizations and urbanization is often compromised by the rarity of censuses, the weak degree of data disaggregation, and questionable data quality. Given these problems within the framework of a prospective study of urbanization in Cameroon, the author used a methodological approach previously employed in other theoretical research. The topodynamic approach was applied to 1950 and 1960 US census data in order to assess how the method worked in minimal conditions. The quality of the projections was then measured against data from the 1970 and 1980 censuses. The foundations of the topodynamic approach, descriptive indices related to localization, and the determination of a mid-term scenario are presented, as well as a number of projections. The application of the topodynamic approach to the case of the US suggests that it is capable of producing projections with spatial characteristics both compatible with those of formerly observed schemas and reflective of actual observed population trends. This approach merits use.
[A migratory model of provenance-destination]
Although urbanization is above all a phenomenon of migration, it is also at the same time a phenomenon of attraction which demographic models of migration pay inadequate attention. The author presents 3 basic approaches which consider all migratory flows specified by regions of departure and regions of arrival. The model of emigration used in multiregional demography, a model of provenance associated with the population of arrival and applying especially to retroprojection, and a third model comprised of a combination of the first two introduce the concept of the redistribution of potential migratory flows. Only the base models are considered, with no addition of phenomena such as fertility or mortality. While gravitational models produce good results from a synchronic perspective, they inflate the probabilities of migrating and usually lead to systems of absorption in which either one or several regions absorb the entire population. It is a question of placing the observer at the point of departure and at the point of arrival at the same time. The model presented in this paper will have to be further developed and adapted to actual models such as the multiregional approach.
[Two decades of unprecedented urbanization in Algeria]
Over the past 2 decades, Algeria s urban system changed radically, both through a process of progressive restructuring and a rising degree of urbanization. 31.4% of Algeria s population lived in urban centers in 1966, compared to 49.6% in 1987. The country s urbanization remains the major phenomenon of overall growth and population change over the period. Changes in the urban system are examined, including the strong attraction of large urban centers to potential migrants. Among almost all Third World country capitals, Algiers sets itself apart by its size and its growth during the period of time considered. During 1966-87, its population grew from 943,000 to 1.5 million inhabitants, a growth of 59%. The city s spatial expansion is discussed, followed by consideration of the growing shortage of housing, underemployment, and chronic drinking water shortages in the face of Algeria s urbanization. Despite efforts implemented in Algeria to restructure the urban fabric and to influence traditional population movements by redistributing activities and services, the most important problems have yet to be effectively managed. More than ever, population growth in Algeria is incompatible with the country s resources and capacities.
With the Turks, the people of the Maghreb comprise a Muslim community of more than 4.3 million people living in Europe. They represent more than half of all the non-European foreigners in the region, and in some countries such as France, Holland, and Belgium, their proportion reaches or surpasses 70%. Following the economic recession of the 1970s and the wave of familial immigrations, Europe began to increasingly realize the permanent nature of its coexistence with culturally different population groups and to set about facilitating their stabilization and integration while checking further immigration. Most Muslim countries have fertility rates which are among the highest in the world. Nonetheless, there have been fertility declines in Turkey and the Maghreb in recent decades, as well as a rise in marriage ages for both men and women, high stability of first unions, disappearing polygamy, and the use of contraception. These factors in the countries of origin are examined, followed by consideration of the situation in the destination countries, an exploration of the influence of both countries of origin and destination, and fertility decline among Turks and people from the Maghreb in their destination countries. These populations demonstrate a tendency toward having smaller families in both their countries of origin and their host countries.
The countries of Eastern Europe, with a total estimated population of 37 million inhabitants, are characterized by a high level of educational status, an adequate stock of medical and paramedical personnel, and a well-developed, basic healthcare infrastructure. Fertility is declining in the region, while infant and maternal mortality rates remain very high. Eastern Europe has the highest abortion rates in the world, together with a rapid increase in the prevalence of sexually transmitted diseases and a growing incidence of AIDS. In most of these countries, legal abortion is women s main mode of fertility control; approximately 7 million abortions were completed in the region in 1996. Everywhere in Eastern Europe, except for Hungary, contraceptive prevalence rates are very low. Demography and reproductive health, abortions, contraception, and the movement from abortion to modern effective contraception are discussed. Strategies for the future should focus mainly upon securing political involvement and gaining the rights of couples and individuals in sexual and reproductive matters, investments in the health of adolescents and youth, improving access to relevant information and education, and the more extensive integration of family planning services into actual healthcare systems.
[In-service training standards]
While searching for a better quality of healthcare, Morocco s Ministry of Health adopted a vision of high-quality health services delivered through a capable and valued staff realized through in-service training. The National Strategy of In-Service Training will effectively implement that vision while focusing upon the establishment of a functional and decentralized training system, an improved coordination of training activities, and the strengthening of the ministry s capacity to manage quality in-service training activities at all levels. In-service training standards comprise part of the means necessary to realize the ultimate objectives of this strategy. The standards presented in this document are the result of a consensual process in which trainers, program managers, and resource personnel on the ground participated. They are based in actual experiences and take into consideration problems encountered at the field level. The first part of this document reviews the steps of the in-service training cycle, while the second part examines the standards with regard to the results anticipated from such training activities, as well as providing an extensive list of necessary tools.
[Objectives and strategies of the national family planning program]
Senegal s national family planning program (PNPF) attempts to implement a family health strategy with the goal of reducing levels of maternal and infant mortality, and extending the birth intervals among women giving birth. This approach is supported by information, education, and communication (IEC) measures. The general objectives of the PNPF are to improve the quality of life and encourage familial well-being; reduce morbidity and mortality, especially among mothers and children; reduce the fertility rate and rhythm of population growth through the adoption of appropriate measures; and create a sociocultural environment favorable to changing the behavior of individuals and couples towards accepting modern contraception. Specific program objectives are presented, followed by a discussion of the IEC strategy. Personal communication rests at the heart of the overall program strategy. Specific strategies are presented, as well as particular activities and areas of IEC intervention, essential activities to support the PNPF, the evaluation system, the responsibilities and roles of the ministers, the role and place of nongovernmental organizations in the private and parapublic sectors, and modes of governmental and multilateral organizations assistance.
[Gender and development: socioeconomic and cultural aspects of sexual difference]
The social, political, and economic integration of the women remains problematic in Morocco, with a cultural system which resists any open access of women into the higher social strata. Key positions and tasks in Moroccan society remain the reserved for men. In order to perpetuate this unequal distribution of tasks, roles, and spaces between the sexes, Moroccan society argues the existence of biological differences between the sexes in both social and cultural competencies. Male and female categories are therefore charged with the physical and mental attributes of the sexes. The studies which comprise this document attempt to shed light upon certain aspects of the troubled relationships between the sexes and its impact upon Morocco s social and economic development. Focus is given to certain sociodemographic and cultural facts relative to the process of distinguishing between the sexes. This gender-based approach allows the debate to be over gender relations to be moved from the biological to the cultural. The following subjects are examined with regard to gender: social roles and the social perception of the sexes, education, demographic changes, rural development, decision-making, and women s legal and actual statuses in Morocco.
[Reproductive health in Morocco: demographic and sociocultural factors]
This paper begins with an introductory chapter describing the issue of reproductive health in general. The field of reproductive health is first described, then followed by consideration of the goals, priorities, and indicators of reproductive health programs; reproductive health; maternal health and obstetrical care; gynecological morbidity; contraceptive-related morbidity; and the cultural context and qualitative methods. The first part of the document explores the sociodemographic aspects of reproductive health in several studies. One study investigates the preferences, behaviors, and unmet needs related to family planning, while another study considers abortion, prenatal consultations, and unwanted pregnancy. The tendencies, causes, and risk factors for neonatal mortality are then explored in a subsequent chapter. The final chapter in this part explores the levels, variations, and determinants of infertility in Morocco. The country s sex education policies, the fields of sex education, and women s reproductive knowledge are then examined in the second part of the text on the anthropological and sociological aspects of reproductive health.
The Family Planning Division of Morocco s Ministry of Health conducted a study during summer 1998 to learn about men s perceptions on birth spacing and family planning, evaluate men s knowledge of family planning methods, explore effective contraceptive practice and related attitudes, explore the contraceptive decision-making process among couples, identify typical channels and sources from where men obtain their family planning information, and determine how many children men desire to have, as well as their views on descendance. The focus group approach used to collect the data is described, followed by the presentation of study results. 8 groups of men participated in each of the following regions: Grand Casablanca, Meknes/Tafilalet, and Marrakech/Tensift. The participating men ranged in age from under 30 years to 55 years old. They came from both urban and rural areas, with some married and others single, of varied levels of educational status. Some used contraception, while others did not. Overall, the men who participated in this study have many deficits in the areas of reproduction and family planning. These deficiencies are directly associated with the family planning communication approaches used for decades which routinely regarded men as only secondary target populations.
[Qualitative study on the intrauterine device (IUD) in Morocco]
Morocco s National Family Planning Program (PNPF) offers a range of contraceptive methods to its population and the Ministry of Public Health encourages the informed, voluntary choice of couples in contraceptive matters. However, the success of this approach depends upon the involvement of service providers to help people decide which contraceptive option is best for them. While the overall level of contraceptive prevalence rose from 20% in 1980 to 50% in 1995, a larger proportion of urban women compared to rural women use contraception, women use especially short-term methods, and there remains unmet need for family planning. Moreover, there exists a large gap between the level of contraceptive knowledge and method use. The IUD, introduced in Morocco in 1965, remains the second most widely used contraceptive method in the country behind the oral pill, at 4.3% and 32.2%, respectively. The PNPF plans to promote the IUD to both health professionals and the general population. This study examines the attitudes, behaviors, and perceptions of family planning service providers and the population with regard to the IUD. The goal was to identify rumors about the IUD, the population s expectations, the competence levels of service providers, and the quality of services. Relations between service providers and the population were also evaluated.
Created in 1976 by Canadian women following their participation in the UN s International Conference on Women held in Mexico, the MATCH International Center is a women s organization guided by a feminist perspective of viable development which recognizes women s diverse realities and respects their efforts to attain self-determination. MATCH is the only such organization in the world which compares the resources and needs of Canadian women with those of women in developing countries. It is a development agency directed both by and for women. The organization believes that only solidarity on the global level can truly help improve women s status. MATCH works together with women s groups in Africa, Asia, the Caribbean, and Latin America to accomplish that goal. MATCH also tries to educate the Canadian public on issues of development and strengthening the women s women both nationally and internationally. Case studies on eliminating violence are presented from Nepal, Zambia, Cuba, Cameroon, and Peru. Each author of the articles included in this document belongs to a MATCH partner organization.
Morocco s Ministry of Health is developing a distance learning program with the goal of improving knowledge, competence, and performance among healthcare professionals who will be able to learn at their own pace in keeping with their other professional and private commitments. A distance training tool was developed including didactic materials as well as a follow-up and monitoring system of the student in the field. Nurses and other healthcare providers interested in the practice and management of reproductive health and family planning activities in both outpatient and hospital facilities will benefit from this distance learning tool. This text describes the development of competencies in contraceptive technology and in managing family planning activities. It prepares the student to offer quality care and to efficiently manage reproductive health and family planning services. This first of 2 volumes discusses reproductive health; family planning consultations; service delivery for injectables, oral contraception, the IUD, and surgical contraception; and preventing infection. Upon completing this training module, the student will be able to provide quality family planning care, promote the prevention of infection at his or her facility, and perform other key tasks related to the delivery and management of services.
At the World Summit on Social Development convened in Copenhagen, the Beijing Conference, and the African Women s Summit in Dakar, the world mobilized to promote women s economic, social, and political statuses. Nongovernmental organizations around the world are therefore now in the process of developing and implementing a number of actions corresponding to that global objective. A subregional seminar on female genital mutilation (FGM) was held in Ziguinchor during January 29-31, 1996, with the specific theme of exchanging experiences and strategies in the battle against FGM. Organized by Enda-Acas and the Djoliba Center of Bamako, the event brought together participants from Guinea-Bissau, Guinea-Conakry, Gambia, Burkina Faso, Niger, Mali, Mauritania, and Senegal. The goal of the seminar was to analyze the facts and consequences of FGM in each participating country, share results obtained from the field, and develop a subregional plan of action. The experiences of the participating countries with FGM are described, as well as a summary of work groups progress on national policies regarding FGM and the exchange of experiences and approaches. Conference recommendations are presented in both French and English.
Doctors Diene and Drabo spent January 4-13, 1998, in Benin conducting preliminary activities to launch BASICS interventions in the country. Throughout their mission, these individuals worked with Pr. Fakambi, a consultant to BASICS. Their visit came after others undertaken to identify existing needs in the field of child survival, especially regarding nutrition. Diene and Drabo visited Benin to choose a Benin-based BASICS project coordinator together with Borgou departmental authorities; make initial contacts related to organizing the workshop on developing information, education, and communication (IEC) messages for the same department; collect data on the experience of including vitamin A in national vaccination days (JNV); and finalizing the contract with Pr. Fakambi. Dr. Paul Adovohekpe was chosen to be local project coordinator, the proposed IEC plan of action includes a data collection phase and a workshop phase to develop messages and produce educational materials, including vitamin A during JNV was found to be feasible, and the contract with Pr. Fakambi was reviewed, amended, and signed. The authors make recommendations about the coordinator, IEC, and vitamin A. Several annexes conclude the report.
The Koran and the Sunna are the 2 reference sources of Islamic law to which all other sources refer. However, the Koran is the most important of the 2 sources, stipulating the principles and rules which allow people to effectively govern their lives. As such, the Koran protects the rights of both individuals and groups, permits the general rule of justice, encourages people to live together in good faith, and distinguishes between people only in terms of their religious practices. This study explores the Koran s teachings on child care, as well as what the Sunna says upon the issue. The position and rights of children in Islam, child survival and development, nutrition and its impact upon physical and mental health, child education in Islam, and personal and environmental hygiene are discussed. An index of Koranic verses, Hadith and Sunna, is presented listing the best citations and messages by theme on these subjects.
This training document was written to initiate trainees to the underlying rationale behind social marketing, its origins, methods, and application in the healthcare field in developing countries. After having completed this training manual, trainees will be able to identify areas in which social marketing can be effectively applied, define basic marketing concepts and their significance in society, appreciate the importance of such marketing and its potential contribution to the planning of a health program, recognize the specific characteristics of marketing services, analyze an organizational situation of health programs from a marketing perspective and develop a marketing plan in relation to the internal and external environments of an organization, develop and implement a marketing communication strategy suited to a given situation, and understand how to take some critical distance from the approach and its applications in family health. Appendices and complementary references are included in the document.
Morocco s Ministry of Health is developing a distance learning program with the goal of improving knowledge, competence, and performance among healthcare professionals who will be able to learn at their own pace in keeping with their other professional and private commitments. A distance training tool was developed including didactic materials as well as a follow-up and monitoring system of the student in the field. Nurses and other healthcare providers interested in the practice and management of reproductive health and family planning activities in both outpatient and hospital facilities will benefit from this distance learning tool. After a first volume which discusses contraceptive technology and behavior in a number of chapters, this volume considers the management of reproductive health and family planning programs. The chapters of this document examine the information system of the National Family Planning Program, supply management, the evaluation of family planning activities, and supervision.
Morocco s Ministry of Health is developing a distance learning (DL) program with the goal of improving knowledge, competence, and performance among healthcare professionals who will be able to learn at their own pace in keeping with their other professional and private commitments. A distance training tool was developed including didactic materials as well as a follow-up and monitoring system of the student in the field. Nurses and other healthcare providers interested in the practice and management of reproductive health and family planning activities in both outpatient and hospital facilities will benefit from this DL tool. A first volume discusses contraceptive technology, while the second volume examines the management of reproductive health and family planning programs. Each volume includes several chapters on their respective topics. This guide introduces the training module to trainees. It was created to help students understand the principles and mechanisms of DL, its benefits, the selection of trainees, the goal of these DL modules, their presentation, the trainee s role, and learning and evaluation tools. 40 trainees were chosen from family planning facilities in Fes and Marrakech according to a number of criteria.
Morocco s Ministry of Health is developing a distance learning program with the goal of improving knowledge, competence, and performance among healthcare professionals who will be able to learn at their own pace in keeping with their other professional and private commitments. A distance training tool was developed including didactic materials as well as a follow-up and monitoring system of the student in the field. Nurses and other healthcare providers interested in the practice and management of reproductive health and family planning activities in both outpatient and hospital facilities will benefit from this distance learning tool. A first volume discusses contraceptive technology, while the second volume examines the management of reproductive health and family planning programs. Each volume includes several chapters on their respective topics. This guide was developed for the trainer of family planning personnel, a healthcare professional chosen on the basis of his or her expertise, communication skills, and the position occupied. This individual is charged with helping and supporting a group of trainees as needed. The guide develops a number of teaching tools suited to help the trainer accomplish his/her tasks in the distance learning context.
[National Study on the Causes and Circumstances of Infant and Child Mortality, 1988-1989]
Since Morocco s independence, the Ministry of Health has led an active policy to improve health status throughout the country. One goal of that policy is to reduce the rate of infant mortality. In order to achieve that goal, a certain number of priorities are established. The infant mortality rate has declined considerably, but the actual extent of related problems to be encountered by relevant programs remains poorly understood, as well as their impact. This national study of the causes and circumstances of infant and child mortality (ECCD) was conducted in Morocco during 1988-89 to better understand the main causes of mortality among children aged 0-4 years as well as the circumstances of their deaths. Study findings are based upon a representative sample of 382 deaths of children under age 5 years over the course of 1 year. Causes and circumstances of death were determined through verbal autopsies. Main causes of neonatal death were tetanus, fetal complications, prematurity, hypotrophy, and pneumopathy. Causes of death were more diverse for death among children under age 5 years, with diarrhea being a major cause (31%). Malformations and accidents were responsible for death in about 3% of cases. About 33% of cases were malnourished, 39% had diarrhea, and 16% had pneumopathy. Health system deficiencies were noted.
[Medical training: projection of supply and an attempt at estimation of need]
During the early 1960s, Morocco had only an inadequate medical system, causing many medical needs to go unsatisfied. The already major medical personnel deficiencies needed to overcome were only exacerbated by the outflow of foreign physicians. The creation in Rabat of the first medical faculty in 1962 and in 1975 of a second training facility in Casablanca facilitated the progressive development of national medical personnel training capacities to satisfy the country s needs. Now given the number of currently trained health personnel, cohorts being trained, and the decision to build new medical schools to extend medical training beyond Rabat and Casablanca, it became necessary to review the current state of medical training and define the medium- and long-term needs for physicians in the country with an eye to deciding how many training sites are needed and how many students should be enrolled annually to student medicine. Results are presented from an estimation of Morocco s current and future need for physicians. This estimation of need is tied to a desired optimal density of 10 physicians per 10,000 population.
Until the end of the 1960s, environmental degradation in Moungo, a forest region of southern Cameroon, occurred in stride with an exponential growth in population size. The solution would therefore be for the population to adhere to a strict and effective policy and practice of family planning. Such simplistic and catastrophic Neo-Malthusian logic formed Cameroon s public population policies during the 1960s and 1970s, leading to the adoption of an ineffective system of family planning. However, population pressure is not the direct cause of environmental problems, but is rather an aggravating factor. The failure of family planning policy only aggravates the adverse developments which are already seen in Moungo and elsewhere in the country. In Cameroon, as in all other developing countries, environmental problems are especially tied to the direct use and management of natural resources. Physical contexts, population placements, and social and economic development are discussed with regard to Moungo. The author then considers actual population pressure, as well as environmental deterioration, its causes, and its consequences.