"Health Care Strategies for Combating Violence against Women in Developing Countries". Final report.
This paper attempts to give a background on violence against women and a review of existing health care strategies with the needs and constraints of the sector. It aims at 1) giving a state of the art of violence against women in developing countries, based on literature review, and 2) proposing strategies for health care sector for the prevention of violence against women (VAW) and policy recommendations to combat VAW, based on workshop discussions. This paper is divided into seven chapters. Chapter 1 differentiates between “gender-based violence” and “violence against women”. Chapter 2 gives an overview of the categories and the prevalence of VAW in the developing countries. The data found in literature are summarized in tables and an overview of some of the most common forms of violence is given. Chapter 3 discusses the risk factors and determinants of VAW, while chapter 4 briefly explores the health consequences of VAW. Chapter 5 gives a picture of the health care settings in developing countries and their strategies for tackling VAW. Chapter 6 outlines several policy recommendations to fight VAW in developing countries. Finally, chapter 7 presents the bibliography. Presented in the annexes 1 and 2 includes the report of the workshop “Health Care Strategies for Combating Violence Against Women in Developing Countries”, June 21-23, 1999, and the models for health sector interventions to address VAW in developing countries.
This study aims to identify the factors that facilitate and inhibit the sexual abuse disclosures of children, and to make recommendations for prevention programs in England. Three methods were used in this study. Firstly, characteristics of disclosures were examined using a sample of 524 sexually abused children. Emphasis was placed upon learning the characteristics of the abuse, the timing of the disclosure, the circumstances of the official discovery of the abuse and the characteristics of the children and the families. Secondly, interviewing 135 children after court appearance was involved. The response rate was 37%; non-responders were not remarkably different as a group from those who came back for an interview. Findings significantly indicated that disclosure profiles were the same. Those who participated in the interview were more likely to have an alcoholic parent, be Caucasian, and have suffered long-term abuse by someone with whom they were emotionally close. The average length of the penal sentences for those who came back was twice as long as for those who did not. Overall, no obvious response bias could be identified. The final component of the study involves the identification of variables, which have predictive validity for disclosure and their incorporation into a theoretical model of child disclosure.
Healthy relationships: a violence-prevention curriculum. A three-volume program. 2nd ed.
This document, “Healthy Relationships: A Violence Prevention Curriculum,” is designed to help teen-age youth understand the dynamics of both unhealthy and healthy relationships. This curriculum consists of three volumes. Volume 1 focuses on helping students learn how to deal with aggression. The lessons are designed to help recognize the range of emotions that can lead to violent outbursts, and to show them that there are non-aggressive alternatives. In volume 2 students are introduced to violent influences in the mass media--from television to comics. The intention is to give them tools that will empower them to stand back and take a critical look at the messages they are being fed, as opposed to absorbing them unaware. Volume 3 deals with the dynamics of relationships. The activities progress from an investigation of male violence against women, to an exploration of healthy relationships. Students learn a variety of communication skills within the context of small groups. This format enables them to explore the challenges of forming healthy relationships, and begin to work together more closely on issues of violence and gender equality.
This paper presents the outcome of the visit made by Dr. Thomas T. Kane, Senior Research and Evaluation Officer with the Johns Hopkins University Population Communication Services/Population Information Program in Bamako, Mali, from February 20 to March 1, 1994. The purpose of the visit was to assist the Association Malienne pour la Protection et la Promotion de la Famille (AMPPF) and the Center for Applied Research in Population and Development in 1) finalizing the Follow-up Survey Reports; 2) preparing for and participating in the dissemination seminar on the evaluation of the AMPPF project, “Traditional and Modern Promote Family Planning”. Overall, the objectives of the visit were satisfactorily met. Dr. Kane, together with CERPOD and AMPPF staff, was able to revise the reports of the Bamako Audience Follow-up Survey and the AMPPF Clinic Source of Referral Follow-up Survey. Also, major accomplishments were made after the implementation of AMPPF project.
Counseling skills: training, monitoring, and evaluation.
This manual is intended for those who are interested in developing and conducting training in basic counseling skills, monitoring and supervising counseling skills training, evaluating training impact on trainee counseling skills and on their clients. Presented in a chart form, it provides information relating to possible settings for counseling training, the objective of the course, the course content, criteria for course evaluation, and participant presentation. In addition, it enumerates and discusses the models for evaluating counseling service, including the organizational model, the case-process model, the consumer-evaluation model, the efficacy model, and the community-impact model. Moreover, a step-by-step guideline on how to conduct the training is presented, as well as a framework for counseling a training evaluation.
Policy statement for the integration of a gender perspective in humanitarian assistance.
In the 1998 Economic and Social Council's humanitarian affairs segment, the agreed conclusions requested the Emergency Relief Coordinator to ensure that a gender perspective is fully integrated into humanitarian activities and policies. This paper presents the policy statement of the Inter-Agency Standing Committee (IASC) for the integration of a gender perspective in humanitarian assistance. It is noted that the IASC is fully committed in taking the steps necessary towards this goal. In particular, it is committed to the principles embodied in international human rights instruments and it notes that the provisions of these instruments are applicable equally to men and women without discrimination. In the context of humanitarian assistance, several principles are embraced. These include: 1) gender equality and the equal protection of human rights of women and men in carrying out humanitarian and peace-building activities; 2) equal representation of men and women in peace mediation and decision making; and 3) integration of a gender perspective and participation of women's organizations in capacity building in a humanitarian response. In order to achieve such principles, further commitments to actions are adopted by the IASC.
Note on participation of the International Labour Organization in the session.
This article presents the note on participation of the International Labor Organization (ILO) in the UN General Assembly's 23rd Special Session. It lists the planned activities of the ILO during its participation in the Special Session to be held in New York on June 5-9, 2000. Overall, the ILO plans to organize a series of high-level panel discussions on decent work for women, women's empowerment and micro-finance, and galvanizing action for older women during the Special Session. Among the preparations for the Session, the ILO Bureau for Gender Equality has also issued a special report, which is a global proposal to accelerate the implementation of the Beijing Platform for Action. The topics to be covered in the discussions include Decent Work for Women; Women's Empowerment and Micro-Finance, Galvanizing Action: Older Women Workers; ILOs work on gender, ILO assessment of progress since Beijing, and the ILO response: The Decent Work Agenda.
Statement: International Labour Organization [ILO].
This paper presents the statement of Ms. Youyun Zhang, chairman of the International Labor Office, New York, addressed during the 23rd Special Session of the UN General Assembly. Zhang notes that in Beijing, the international community pledged a clear commitment to gender equality, development and peace, and developed a comprehensive agenda for the empowerment of women. After 5 years of its implementation, some progress has been made in the critical areas contained in the Beijing Platform for Action (PFA); however, much more remains to be done to fully achieve the goal set in Beijing. Zhang emphasizes that with the onset of globalization in the world, multi-faceted gender inequalities have emerged, highlighting the need to fully implement the Beijing PFA. To this effect, Zhang suggests that there should be a change in the attitudes of the whole society, and in particular of those responsible for public and private policy at all levels. In addition, strengthened political will and commitment are called for. Moreover, Zhang states that the International Labor Organization, with its tripartite structure, has developed a strategic agenda for a global vision of Decent Work, as contributions to an integrated framework and to the accelerated implementation of the Beijing PFA.
Mainstreaming gender in the humanitarian response to emergencies. Background paper.
This paper provides a summary overview of the differential impact of emergencies and crisis situations on women and girls, men and boys. It also discusses the policy issues and implications of a gender perspective. In addition, it presents options for the application of humanitarian principles as well as the appropriate responses needed to address the specific needs of women and girls in pre-conflict, emergency, natural disaster, and post-crisis settings. Divided into seven sections, the first and second sections discuss the background to which this paper is based and its purpose. The third section focuses on the challenges of gender analysis, while the fourth section defines gender analysis. The fifth section highlights gender relations in the context of violent social change. Moreover, operational implications for humanitarian agencies are noted in the sixth section. Finally, the seventh session discusses the process of coordinating what agencies are doing in mainstreaming gender into the humanitarian response system.
During the 23rd special session of the Ad Hoc Committee of the Whole, further actions and initiatives for overcoming obstacles to the implementation of the Beijing Platform for Action were drafted. This draft report presents the addendum to such actions and initiatives. It is noted that in the special session, the Committee considered paragraphs 114 (a), 116 (a), 117 (a), 117 (a), subparagraphs (c), (h), (i) and (k) of paragraph 118, paragraph 120 (e) and subparagraphs (a), (d), (e) and (g) of paragraph 121 of part IV of the report of the Commission on the Status of Women on actions and initiatives to overcome obstacles and to achieve the full and accelerated implementation of the Beijing Platform for Action. Amendments of such paragraphs were then approved and recommended by the Committee to the special session for adoption.
Pharmacists limit women's access to emergency contraception. ACOG news release.
During The American College of Obstetricians and Gynecologists (ACOG) Annual Clinical Meeting, experts stated that women need better access to emergency oral contraception (EC) through their local pharmacies. According to Luella Klein, vice-president of ACOG office of women's health issues, many pharmacies are unaware of EC, do not carry it in stock, or refuse to provide the drug based on the incorrect belief that it is an abortifacient. Results of a small informal telephone survey by ACOG of mostly independent pharmacies in Philadelphia indicate that 71% of these pharmacies did not carry Preven, the only prepackaged EC approved by the Food and Drug Administration. It is noted that EC is a specific regimen of ordinary birth control pills taken up to 72 hours after unprotected sex, which decreases a woman's chance of becoming pregnant by 75%. Contrary to speculations, it has no effect once pregnancy has occurred, when a fertilized egg has already implanted. The experts emphasized that all health care professionals, including pharmacists, have a responsibility to ensure that women have easy access to EC.
This paper explains briefly the role of the International Labor Organization (ILO) in maternity protection, the process of adopting and revising ILO standards on maternity protection and the main differences between the existing international standards and the draft Maternity Protection Convention. Presented in a questionnaire form, this fact sheet focuses on maternity protection. It answers questions as to what constitutes a maternity protection and how it is provided, and what ILO standards relate to maternity protection. In addition, it enumerates international labor standards and explains its effects; it explains the revision process of the Convention No. 103; and highlights some of the differences between Convention No. 103 and the Draft Convention.
The abortion debate in the world arena.
This book compares, contrasts and links the abortion debate globally by using multiple sources of evidence, including a study involving 162 elite interviews. Particularly, it examines the emergence and construction of the abortion debate beyond the Western liberal democracies and how the Catholic Church, the most visible transnational actor in this dispute, engages this issue worldwide. Divided into five chapters, chapter 1 outlines the key dimensions to “the policy conundrum” posed by abortion, the scope and purpose of the study, the issues and themes with which it is concerned, as well as the reasons for looking at Kenya, Mexico and Poland, respectively. In addition, it addresses a range of shared underlying concerns with a focus on what is salient in each country and its wider region. A description of “the tyranny of silence”, which is a characteristic of much of Africa is presented in chapter 2, while an explanation on how concerned parties are “negotiating a hidden reality” in order to seek alternative ways out of this situation is discussed in chapter 3. Chapter 4 shows how and why conflict over abortion at times upstaged the whole process of systemic transformation as political theater in Poland and East Central Europe. Finally, chapter 5 reviews the main findings and examines a number of major themes, which weave through the study. It provides a more focused comparison between the three countries and their regions, set within a broader international context.
Zimbabwe: reproductive tract infections. RTI screening methods for women are not cost-effective.
Reproductive tract infections (RTIs) are common in Zimbabwe. In 1998, the Zimbabwe National Family Planning Council (ZNFPC) conducted an operations research study to assess the feasibility of adding RTI diagnosis and treatment services to its menu of services. The study population consisted of 1634 clients at three ZNFPC clinics. Each client was asked about RTI symptoms, examined for clinical signs of RTIs, and given laboratory tests to confirm the accuracy of a diagnosis based upon signs and symptoms. Data show that existing methods for screening RTIs among family planning clinic clients are not cost-effective: laboratory tests are too costly, and syndromic case management often leads to missed infections and unnecessary treatment. Health programs should continue to emphasize preventive measures such as changing individual behavior and promoting condom use.
Mali: female genital cutting. FGC excisors persist despite entreaties.
Evidence indicates that about 94% of Malian women 15-49 years old have experienced female genital cutting (FGC). FGC is associated with serious gynecological and obstetric complications. In 1998, the National Center of Scientific and Technological Research of the Mali Ministry of Secondary and Higher Education and Scientific Research conducted an evaluation of programs to eradicate FGC. The study assessed the work of three nongovernmental organizations that attempted to persuade traditional practitioners of FGC to abandon the practice. In general, findings revealed that programs to persuade traditional practitioners to discontinue the practice of FGC are ineffective. Most excisors remained unconvinced that FGC is harmful to women. From the findings, this study recommends that interventions must address the demand for FGC rather than focusing on supply. FGC eradication programs must reach diverse audiences, including men, opinion leaders, religious leaders, and traditional midwives.
Burkina Faso: Upgrading postabortion care benefits patients and providers.
During 1996-98, the Reproductive Health Research Network conducted a study to introduce emergency care for women with complications from miscarriage and abortions. Within this project, physicians, nurses, and midwives at two large hospitals in Ouagadougou and Bobo-Dioulasso were trained to provide postabortion care (PAC), including manual vacuum aspiration (MVA), family planning methods, infection prevention, and communication with patients. Changes in knowledge and behavior were measured through an interview with 330 patients with abortion complications and 78 providers before the intervention, and 456 patients and 41 providers after the intervention. Overall, the study demonstrated that the improved emergency medical care for women with miscarriages and unsafe abortions leads to better patient care, shorter hospital stays, lower costs, and increased contraceptive use. However, when performing MVA, verbal assurance alone from the training staff is inadequate for pain control, but rather local anesthesia is essential. The study also revealed that providers switched to MVA as their preferred treatment for PAC, since MVA lowered costs for both hospital and patients due to shorter hospital stays, less anesthesia, and less staff time.
Senegal: Train more providers in postabortion care.
In 1997, the Center for Training and Research in Reproductive Health and the Obstetrics and Gynecology Clinic at Le Dantec University Teaching Hospital in Dakar, Senegal, introduced new clinical techniques to improve emergency treatment for women with complications from miscarriage and abortion. Under this project, physicians, nurses, and midwives at three teaching hospitals received training in manual vacuum aspiration, family planning, and counseling. The impact of the training was measured through interview with 320 women receiving emergency treatment and 204 providers before the intervention and 543 patients and 175 providers after the intervention. Information on service delivery costs was also collected. In general, improving postabortion care (PAC) services benefits patients and reduces costs. In particular, providing PAC services resulted in shorter hospital stays, decreased patients costs, better communication between providers and patients, and increased acceptance of contraceptive use by women treated for abortion or miscarriage. Certain policy implications are discussed.
Kenya: postabortion care. Offer family planning on hospital wards.
In Kenya, more than 1 in 3 women hospitalized for gynecological problems have complications from miscarriage or unsafe abortions. These women generally receive no information or services for family planning (FP) or other reproductive health services. During 1996-97, the Kenya Ministry of Health, Population Council and Ipas collaborated to test three models for providing postabortion care (PAC) and FP information and services in two areas of the hospital. The three models were: 1) having gynecology ward staff provide postabortion FP services on the ward; 2) having staff from the maternal and child health (MCH)/FP clinics provide contraceptives on the gynecology ward; and 3) providing FP at the MCH/FP clinic after PAC treatment, before hospital discharge. The effectiveness of these models was compared by using surveys given before (481 patients and 140 providers) and after the intervention (319 patients, 92 male partners of patients, and 106 providers). The study concludes that the most effective way to ensure that women being treated for incomplete abortion obtain family planning is to offer information and services in hospital gynecological wards. Having ward staff provide contraceptives on the ward is more convenient than having regular family planning providers visit the ward or having patients go to a separate clinic. The findings in this study have been key in informing the expansion plan for PAC in Kenya.
Peru: managers must monitor quality of care regularly.
In 1998, the Ministry of Health (MOH) in Peru changed its family planning program policies to ensure that services responded to individual reproductive health needs and wishes. It eliminated method quotas, ended voluntary surgical contraception campaigns, and issued norms to ensure quality of care and informed choice. In the following year the Population Council, in collaboration with the MOH, carried out a study to determine whether providers were complying with the new guidelines, and to develop a monitoring system to assess compliance over time. Overall, findings suggest that family planning providers in Peru's government health facilities conform to national care guidelines in that more than 90% of them treat their clients respectfully and offer them a wide choice of contraceptive options. Nevertheless, providers could further improve the quality of care by giving clients more information about correct use and possible side effects of their chosen method and by screening for contraindications. A 100% quality standard must be established to avoid violation of individual reproductive rights.
Egypt: family planning providers should encourage clients to discuss sexual problems.
This study examined the feasibility and impact of introducing discussions of sexuality during family planning consultations in Egypt. Nurses and physicians at four Ministry of Health and Population clinics and two private clinics attended a 2-day training session on contraceptives with an emphasis on barrier methods. Providers in three intervention site clinics also received a 3-day training on sexuality, gender, and counseling. The acceptability of sexuality counseling and the impact of training were assessed through interview with 25 providers and 503 clients, focus group discussions, and debriefing of 7 women who posed as clients. Overall, results revealed that both clients and providers welcomed the inclusion of discussions on sexuality during family planning counseling. Providers who were trained in sexuality counseling were more likely to discuss sexual matters with clients. Clients preferred to have the provider initiate the discussion. Sexuality issues, including potential effects of contraceptives, should be incorporated into family planning counseling. In addition, health education messages should encourage the public to ask family planning providers about concerns regarding sexuality.
Kenya: identifying RTIs remains problematic: prevention is essential.
Since 1990, the Nakuru Municipal Council has implemented a multifaceted program to reduce the incidence of reproductive tract infections (RTIs), especially those that are transmitted sexually, including HIV/AIDS. Its approach includes the use of syndromic management guidelines, based on client's reported symptoms and clinical signs, to identify clients with RTIs. In 1998, the Population Council conducted a study to assess the accuracy of syndromic management and determine the best ways to integrate RTI management into existing antenatal and family planning services. After an assessment of the existing RTI services, 18 nurses from 5 municipal clinics attended a 3-day refresher course in syndromic management. It was found that more than one-half of the family planning and antenatal clinic clients in Nakuru, Kenya had 1 or more RTIs, of which roughly one-third were sexually transmitted. Using syndromic management algorithms based on the woman's reported symptoms, providers correctly identified only 5-16% of women who later tested positive with laboratory results. Given the limitations of syndromic management, programs need to stress prevention of sexually transmitted infections.
Indonesia: institutionalization of OR. Coordinated studies are needed to assess trends.
In 1999, the Population Council/Indonesia conducted a critical review of 11 Indonesian surveys and studies that measured various indicators of maternal and child health (MCH). The aim was to explain how these studies came up with divergent findings. The key factors leading to the differences in findings were the timing of data collection activities and their geographical coverage. Attributing changes in MCH indicators to the country's economic crisis, which many of the studies did, may be misleading. This paper suggests that longitudinal studies with consistent indicators and representative study populations are needed to identify changes in MCH indicators. Tests of statistical significance are essential in order to identify true differences between groups.
Burkina Faso and Mali: female genital cutting harms women's health.
In 1998, the Population Council, in collaboration with the Ministries of Health of Burkina Faso and Mali, conducted two studies to describe the occurrence and severity of health problems related to female genital cutting (FGC). The prevalence of FGC was very high: 93% of the clinic clients in Burkina Faso and 94% in Mali had been cut. Women who had their genitals cut were more likely to have gynecological and obstetrical problems, including bleeding, internal scarring, vaginal narrowing, and complications during childbirth. Furthermore, severe cutting increases a woman's risk of other reproductive health problems. In addition to women's rights issues, information on the deleterious effects of FGC should be used in community education campaigns.
Mali: Empower health workers to advocate against female genital cutting.
This paper summarizes key findings in a study that assessed the use of health personnel to combat female genital cutting (FGC) in Mali. The study covered 14 urban and rural health centers in Bamako and Segou region. In the 8 health centers that served as experimental sites, 59 health providers, including physicians, midwives, nurses and aides, attended a 3-day training course on identifying and treating medical complications related to FGC and counseling clients about FGC. In the 6 centers that served as control sites, 48 providers were interviewed. Overall, findings revealed that 9 in 10 health providers are opposed to FGC and are willing to play an active role in educating their clients about FGC. Nevertheless, there are some providers that still support the medicalization of FGC. Training did change some providers' attitudes regarding FGC, and their knowledge of FGC increased significantly after training. However, providers acknowledge that they have limited competence in caring for FGC complications even after training. Several policy implications of the study are outlined.
How does family planning influence women's lives?
Several research efforts in the past decades have examined the relationships between family planning and women's lives, using different approaches. The data collected from these projects support the following conclusions: as women have smaller families, they spend less time on unpaid work in the home and more time in paid work; access to contraceptive services can improve educational prospects for young women; contraceptive use can improve family relations; and women still face difficult consequences in communities where family planning is not socially accepted. Clearly, research shows that women's ability to plan their families has altered their work experiences, educational prospects, and relationships with their husbands and families. It is suggested that policy-makers and program planners who want to expand women's choices and opportunities need to understand how family planning programs and other investments can help make women's aspirations a reality. Policy changes and investments to improve the range of choices and opportunities available to women, including adolescent women, are highlighted.
Meeting young women's reproductive and sexual health needs.
The sexual and reproductive lives of young women will have a dramatic effect on health, prosperity, and size of the world's future population. Despite women's better education, they still face obstacles in achieving their full potential. For example, complications from pregnancy, childbirth, and unsafe abortion are the major causes of death for women 15-19 years old in developing countries. Additionally, young people 15-24 years old have the highest infection rates of sexually transmitted infections, including HIV/AIDS, and teenage women are becoming infected at twice the rate of teenage men. In view of this, in 1994, governments agreed at the International Conference on Population and Development, “to meet the needs of adolescents and youth for information, counseling, and high-quality sexual reproductive health services,” as a way to, “encourage them to continue their education, maximize their potential, and prevent early marriage and high-risk childbearing.” Policy-makers and health providers need to remove legal and institutional barriers that impede young people's access to existing family planning and reproductive health services. Information and services need to be designed to accommodate the unique needs of adolescents and young adults, such as by providing sexuality education in schools; providing specially designed services for youth in clinics or community settings; and using popular entertainment, mass media and peer education to convey information on sensitive topics.
Making pregnancy and childbirth safer.
Globally, nearly 600,000 women die of pregnancy-related causes each year. 99% of these deaths occur in less developed countries. This paper gives a brief overview on the incidence of maternal deaths in the developing countries, its causes, and strategies for a safer pregnancy and childbirth. Maternal deaths have both direct and indirect causes. About 80% of maternal deaths are due to unsafe abortion and obstetric complications such as bleeding, infection, hypertensive disorders, and obstructed labor. The environment in which women live also influences maternal health. Maternal deaths are strongly associated with substandard health services and the lack of medical supplies at the time of labor, delivery, and immediately after birth. Interventions can improve the chances of women's survival as well as infants' lives. The basic steps for a safer pregnancy and childbirth are to: ensure recognition of complications of pregnancy and delivery, ensure access to essential obstetric care, provide postpartum care for mother and baby, and provide postabortion care. Implementing a safe motherhood program requires commitment from public and private health services. It is vital that researchers and program managers continue to search for ways to design programs that will reduce the burden of disability and death for mothers, their newborns and their families.
Plan B (levonorgestrel). The next generation of emergency contraception.
This paper provides information on a new-generation emergency contraceptive product called “Plan B” in the US. Plan B is the first progestin-only pill developed to prevent pregnancy after a contraceptive accident or unprotected sex. Plan B is highly effective, and nausea and vomiting are minimized as compared to other emergency contraceptive pills. The small Plan B package consists of two 0.75 mg tablets of levonorgestrel. The first pill needs to be taken within 72 hours of unprotected sex, while the second pill is taken 12 hours later. According to the FDA-approved labeling for the product, Plan B demonstrates a superior safety profile over the Yuzpe regimen for nausea and vomiting. Moreover, it reduces the risk of pregnancy from 8% to only 1%. This represents an 89% reduction in risk of pregnancy following a single act of unprotected sex. However, Plan B is not effective if a woman is already pregnant and will not terminate an existing pregnancy.
The Nutrition Service is the nutrition arm of the Department of Health (DOH) in the Philippines. It was formerly called the National Nutrition Program Office, created under the Office of the Secretary of Health, now the DOH. This Nutrition Service Brief was prepared to provide allies in health and nutrition from government and private sectors, international organizations, national and local government units, food industries and academies a ready reference on the important role of the Nutrition Service in the realization of nutrition goal and objectives of DOH. The brief presents the legal mandates of the Nutrition Service, its vision, mission, goal, objectives, programs, projects, accomplishments and organizational structure/staff composition. The aim is not only to create awareness among readers but more significantly to arouse and sustain strong active partnership with various sectors towards the upliftment of the nutritional well being of the Filipino population, specifically, the vulnerable groups.
Beyond our means? The cost of treating HIV / AIDS in the developing world.
Around the world, nearly 35 million people are living with HIV, the virus that causes AIDS. The disease is the primary cause of death in Africa and is the fourth highest cause of death worldwide. Treatment for HIV/AIDS ranges from the emotional support that comes from the presence of a carer, through provision of painkillers and treatment for opportunistic infections, to the antiretroviral drugs that suppress the virus and restore the immune system. Only in a few countries, however, do most people with AIDS have access to all levels of treatment. The vast majority receives either no medical treatment or only palliative care to reduce pain and suffering. A number of factors lie behind this failure to provide full treatment especially in the poor countries. One of these is poor infrastructure and the other is the high price of drugs. This booklet provides an overview of the issues surrounding access to treatment for AIDS in order to encourage informed debate, further research and considered action in those communities and nations most in need. Its conclusions are that widespread access to treatment is possible, although highly improbable in the foreseeable future, that a combination of approaches must be taken and that different perspectives on the problem often hinder progress.
This book is the outcome of a small project carried out in 1996 by the Thai-Australia Northern AIDS Prevention and Care Program (NAPAC), now the AIDS Network Development Project. The project is called the Children's Picture Project. It was an attempt to find out more about the impact of HIV/AIDS on the emotional and psychological well-being of the children in upper northern Thailand. It represents one of the significant contributions that NAPAC has given to face the AIDS epidemic in Thailand. It provides the children an opportunity to express and discuss their feelings in a series of camps. In these encounters, children used drawings more than words to describe their world. Those images are compiled in this book accompanied by their short stories. The book provides everyone the opportunity to deepen their understanding of how children react to the suffering of their loved ones and of the needs of this group of children. The different versions revealed in this book serves as a reminder that every child on earth has a unique potential and contribution to give to humanity.
Youth centres in Ghana. Assessment of the Planned Parenthood Association of Ghana programme.
The main objective of the study was to assess the overall performance, utilization, and effectiveness of the Planned Parenthood Association of Ghana (PPAG) youth centers in four regions in Ghana. 9 of 12 PPAG youth centers were assessed. The assessment used a variety of data sources including interviews with staff and volunteers at the centers, exit interviews with youth center clients, and retrospective analysis of center and clinic records. Findings revealed that PPAG youth centers are well designed and well performing. Most of the centers offer library services alongside with counseling and clinical services. This strategy was an effective means to attract young people to an environment that was neutral and acceptable to their parents. Moreover, staff and volunteers were extremely knowledgeable on reproductive health issues and PPAG had made important efforts to promote partnerships in its youth programs. Based on the assessment results, recommendations to further improve services offered at the youth centers are outlined.
This workshop for mid-level information, education and communication (IEC) managers was organized in response to the need for a major transition in the Reproductive and Child Health (RCH) sector in India. The National Institute of Design (NID) was requested by the Department of Family Welfare to organize a training curriculum for 22 candidates selected by the department, as a step toward strengthening national communication capacities for RCH. This report details the approach adopted toward curriculum development and implementation by NID. The 6-day workshop program was predicated on a sound understanding of research essential to identify client needs and to track the system's ability to satisfy them. The program began with a focus on research applied to IEC planning and action, drawing on experience of NID, Pulse Polio and other projects in which communication action had been founded on an investment in demand analysis. District and rural experience in communication and research was used to demonstrate practical applications of demand-centered IEC, and to reflect on reforms essential within the system if demonstrated experience could now be taken to scale. Furthermore, particular emphasis was placed on media planning and on procedures essential to accessing professional services successfully. The workshop concluded with reflection on the implications of what participants and resource persons had learned together during the 6 days. Recommendations were made for follow-up and next steps.
In response to the urgent need to articulate specific strategies to address the reproductive health needs of Nigerian adolescents, the National Conference on Adolescent Reproductive Health was held in Abuja, Nigeria, on January 26-29, 1999. This document highlights the main events and issues discussed during the conference. The conference aimed to provide all stakeholders with the opportunity to gain an understanding of the strategic issues involved in promoting adolescent reproductive health, sexuality and development. The major outcome of the conference was a plan of action--the National Strategic Framework for Promoting Adolescent Reproductive Health in Nigeria. In addition, the conference provided a forum for networking and forging of alliances among stakeholders in the field of adolescent reproductive health towards effective program implementation. It is hoped that the proceedings of this conference will serve as an important information source for planners and programmers alike, to seek innovative ways of meeting young people's needs in relation to their reproductive health and rights.
Policies, programs, and philanthropy for children and youth in Russia.
Over the last decade, Russia has been through one of the most turbulent decades in its history--beginning with glasnost and perestroika in the late 1980s and the break up of the Soviet Union in 1991. The end of the communist era and transitions to a market economy and democratic form of government have had strong effects on children and youth and the environments in which they live, learn, work, and play. Commissioned by the International Youth Foundation, this report assesses the youth needs and opportunities in Russia. It is organized into two parts: 1) the main issues for children and youth; 2) the programs, organizations, policies and philanthropy by which these issues can be addressed. The report is based on various sources, including interviews, documents, statistical data, research results, and expert opinions. Its findings have been discussed among leaders representing business, governmental and nongovernmental organizations in Russia. Their valuable input is also reflected in the report.
WHODOC concordance: English - French - Spanish.
This “WHODOC Concordance” presents a side-by-side alphabetical list of medical terms and phrases in English, Spanish, and French. A great percentage of the English descriptors are from the MeSH 2000 (the US National Library of Medicine's Medical Subject Headings). The French version of the list was prepared by the Institut National de la Sante et de la Recherche Medicale (National Institute of Health and Medical Research), while the Spanish version was prepared by the Centro Latinoamericano y del Caribe de Informacion en Ciencias de la Salud (Latin American and Caribbean Center of Health Science Information). Non-MeSH terms and phrases are from the UNBIS Thesaurus (Dag Hammarskjold Library, UN) or the WHOLIS (WHO Library Database).
HIV / AIDS brief information pack and talking points. Members of Parliament.
This document presents a brief information packet and talking points on HIV/AIDS in Kenya. It contains data on the HIV/AIDS situation in the country, the vulnerability of the youth, women, and children to HIV/AIDS, and its impact on the family. Overall, it is noted that nearly 50% of all Kenyan youth are sexually active and do not use any protection during sex, hence exposing themselves to the disease. Surveys evidenced that about 2 million people are infected with HIV/AIDS in the country, in which the younger population aged 10-24 years is most severely affected by the disease. In terms of women's vulnerability, it is found to be greater than men's because of the existing power imbalance in relationships and women's social and sexual subordination to men. Furthermore, rape, traditional rituals, and practices such as wife inheritance or wife cleanses increases women's risks. In the context of children's vulnerability, it is because they are left emotionally and physically vulnerable by the death of one or both parents. They suffer lingering emotional problems from attending to dying parents without any access to information, counseling or support. The high level of stigma and discrimination due to HIV/AIDS is a hindrance to successful prevention activities; care and support of those infected and affected. In breaking the silence, political leaders have to be in the forefront advocating laws and policies that safeguard youth, women, and children from violence and ensure their right to health care and education.
GAP [Gujarat AIDS Awareness and Prevention Unit].
This paper provides information on the program activities of Gujarat AIDS Awareness and Prevention (GAP) to fight the AIDS epidemic in India. The GAP unit of International Society for Research on Civilization Diseases and on Environment was established in 1990 envisaging the urgent need of working in the prevention and control of AIDS. GAP works to promote awareness about HIV/AIDS and thus prevent its spread by a variety of methods. A section of this paper presents the letter of appeal written by the trustees of the Health and Environment Public Charitable Trust. The letter calls attention to the growing HIV/AIDS epidemic in India and its impact on the private sector. It seeks help and support from GAP toward collaborative efforts in AIDS prevention. Another section presents the profile of Dr. Radium Bhattacharya, organizer of the first workshop on AIDS in Gujarat, her career background and contributions in HIV/AIDS prevention.
The challenge of AIDS, the expanding epidemic. The response of the Harvard AIDS Institute.
In far too many regions, nations are facing escalating rates of HIV infection, growing death tolls, and increased ranks of orphans whose parents have died of AIDS. HIV-infection rates are already high among all adults, particularly pregnant women. The severity of the epidemic can especially be seen in southern Africa, where AIDS may halve the population's life expectancy. In view of this, the Harvard AIDS Institute and its researchers are hard at work in Botswana and other hard-hit areas of the epidemic. In collaboration with experts throughout the world, Institute scientists are working to prevent mother-to-child transmission, improve clinical care, and better understand the biology of the virus. One of its efforts is the establishment of the Botswana-Harvard HIV Reference Laboratory. It serves as both a laboratory and a training center and is devoted exclusively to the advanced study of HIV. Overall, halting the spread of HIV continues to be the Institute's highest priority, and development of an effective vaccine remains the Institute's primary goal.
Together against HIV AIDS. NGOs and UNICEF in Pakistan.
According to the 1998 statistics of the National AIDS Prevention and Control Program (NAP), Pakistan has 178 cases of AIDS and 1395 HIV positive cases. Those thought to be at increased risk for HIV infection include persons who participate in risky sex behavior, drug addicts, blood product recipients, sexually transmitted disease patients, truckers, commercial blood donors, commercial sex workers, migrant workers, and immigrants. Several nongovernmental organizations (NGOs) and community-based organizations in Pakistan are working on AIDS issue with great enthusiasm and commitment, who are being supported by NAP, Joint UN Programme on HIV/AIDS UNAIDS and UN International Children's Emergency Fund (UNICEF). Among the UN agencies, UNICEF Pakistan has been the major supporter of the work of NGOs for HIV/AIDS in 1998-99. This booklet provides brief profiles of the NGOs who have worked closely with UNICEF-Pakistan. The NGOs included are AMAL Human Development Network, All Women Advancement and Resource Development, The Humanitarians Movement, MESSAGE Human Resource Development Organization, and Vite-N-Hope Front Line Organization Dedicated to Human Services.
This study examines the situation of children in especially difficult circumstances (CEDC) in Zimbabwe with a view to providing better programming for CEDC. Data were gathered through the Child Welfare Forum at district, provincial and national levels. Literature, including government reports, and interviews with key persons were also utilized. Nine categories of CEDC were identified: 1) orphans, 2) abused children, 3) working children, 4) street children, 5) children with disabilities, 6) children in institutions, 7) abandoned children, 8) children in remote areas, and 9) married children. Common risk factors of CEDC include age, gender, class and ethnicity, little or no formal education, being parentless, homelessness, family friction and dysfunction, family serostatus, and poverty. Overall, findings revealed that an unprecedented number of children have already been registered as orphans. Child sexual abuse has been recognized as a national problem ahead of physical and emotional abuse and neglect. The majority of working children are unpaid family workers, with their numbers reduced 10-fold between 1982 and 1992. It is noted that married children are more common in remote and rural areas, accounting for 3% of the 12-17 age group. New categories of CEDC that have emerged include child prostitutes, children of commercial farm workers, of absentee parents and blind beggars. A series of recommendations are presented.
This study investigated the impact of locational, sociocultural, economic and demographic factors in differentiating reproductive behavior between Communal and Resettlement lands in Zimbabwe. Primary data were obtained through interviews and focus group discussions, and secondary sources were also reviewed. The bivariate model underscored the importance of background, socioeconomic and demographic factors in controlling lifetime fertility, among women within the reproductive age group. Results indicate a lower fertility rate for the sub-region compared to the national average (6.9), with the total fertility rate of the Communal Area even lower (2.73). Further analysis, using a multivariate model, identified four direct determinants of CEB in the Resettlement areas, namely, age, duration of conjugal union, contraception, and desired family size. For the Communal Lands, the determinants were age, duration of conjugal union, desired family size, and duration of lactation. The direct determinants of lifetime fertility are influenced by the indirect ones, including age, number of male children, level of education, economic activity, and religious affiliation. Whereas the operation of certain fertility determinants is spatio-temporally generalizable for the nation and the sub-sectors of the study area, in some instances they tend to be area- and time-specific. The methodological and theoretical implications, as well as the policy implications of the findings are discussed.
Population growth, savings rates and economic development in Nigeria.
This study examined the relationship between population growth, savings rate and economic development in Nigeria with a view to providing a policy back up aimed at mitigating the undesirable consequences of rapid population growth. Overall, findings suggest that factors influencing demographic transition are high per capita income, high literacy rate and low death rate. The national savings rate tends to fall with an increasing dependency burden and increase in foreign capital inflows. In addition, an increase in per capita income may lead to a higher literacy rate and technological progress, while an increase in population growth leads to a decline in literacy rate. As the percentage of women engages in the modern industrial sector increases, the birth rate declines. However, engagement in agricultural activity favors a high rate of childbearing. A sub-optimal allocation of resources may occur in an environment of high birth rate and dependency burden. In general, high population growth depresses savings, inhibits investment and retards economic development. In view of this, the paper suggests several policy measures in order to eliminate poverty, stimulate food production and economic growth in Nigeria.
Turkish Demographic and Health Survey, 1998.
This document reports findings of the 1998 Turkish Demographic and Health Survey, designed to provide information on fertility levels and trends, infant and child mortality, family planning, and maternal and child health. Data were collected through interviews with 8059 households, 8576 women, and 1971 husbands. Survey results indicate that Turkish women can expect to have an average of 2.6 children. It is noted that knowledge of modern methods of family planning is almost universal; 64% of currently married women were currently using a method, with the IUD being the most commonly used method. 5 years prior to the survey, almost 1 in 4 pregnancies were terminated, 2 out of every 100 pregnancies ended in a stillbirth, and, of the 23 abortions per 100 pregnancies, 15 were induced. Furthermore, the survey shows that median age at first marriage is increasing, and two-thirds of married women do not want more children or are already sterilized. As to the infant and child mortality rates, they are estimated at 43 per 1000 and 10 per 1000, respectively, with significant variation between regions and rural and urban areas. The majority (68%) of women sought antenatal care from trained health personnel, and only 40% of children had complete vaccinations before age 1. Breast-feeding is widespread, but almost one-fourth of children are stunted. Finally, although AIDS and sexually transmitted diseases are widely known, knowledge of ways to avoid these diseases appears to be poor.
A resource book on adolescent health, sexuality and development: a youth to youth model.
This resource book documents the experiences of the “Capability-Building of Colleges and Universities in Metro Manila on Adolescent Health, Sexuality and Development” project, otherwise known as the “Campus-Based Model” implemented by the Foundation for Adolescent Development, Inc. in partnership with five universities and colleges in Manila, Philippines. It consists of two parts: 1) The Campus-Based Capability-Building Model, and 2) Appendices. The first part has three sections. Section 1, “The Project Concept”, describes in detail the campus-based model, its concept, objectives, and strategies. Section 2, “The Capability-Building Framework”, describes the components of the model and theoretical basis of this framework. Section 3, “Experiences in Implementing the Model”, discusses the application of the model to the particular settings of the participating colleges and universities, and the particular innovative strategy adopted by each and the lessons learned from that experience. The appendices contain the training modules, the action plans developed by the student leaders as a result of the training workshop, a directory of service providers, a summary of student-led activities implemented in the five partner schools, the highlights of the Student Congress, and a sample of the students' resolution.
U.S. international food assistance report 1999.
This report provides an overview of the US Government's food assistance activities through Public Law 480 and related statutes during fiscal year 1999. Divided into five chapters, chapter 1, “The Challenge: Global Hunger and Food Security,” analyzes the growing need for food aid resources in the face of limited global availability and the rising requirements for emergency food assistance among the 800 million people and more who are chronically undernourished, including over 180 million underweight children. Chapter 2, “The Response: Targeted Food Aid for Greater Food Security,” reviews the programs and activities through which the US Government provides food assistance in emergencies and helps food-insecure populations reach the point where they can feed themselves. Chapter 3, “Highlights: The Program in Numbers,” provides an overview of the US 1999 international food aid program in terms of resources allocated to each program component. Chapter 4, “Accomplishments 1999”, reports on improvements in food aid management by the US Agency for International Development and the Department of Agriculture. It also discusses progress on Title II program performance indicators that demonstrate people-level impact and improvements in technical capacity for managing and implementing food assistance programs. Finally, chapter 5, “US International Food Assistance: Impact on the US Economy,” offers a brief overview of the direct and indirect ways Americans benefit from food assistance programs.
Menstrual cycle variability and the perimenopause.
Menopause, the final cessation of menstrual cycling, occurs when the pool of ovarian follicles is depleted. The 1-5 years just prior to the menopause are usually marked by increasing variability in menstrual cycle length, frequency of ovulation, and levels of reproductive hormones. Little is known about the mechanisms that account for these characteristics of ovarian cycles as the menopause approaches. Some evidence suggests that the dwindling pool of follicles itself is responsible for cycle characteristics during the perimenopausal transition. Another hypothesis is that the increased variability reflects “slippage” of the hypothalamus, which loses the ability to regulate menstrual cycles at older reproductive ages. The authors examine the underlying cause of the increasing variability in menstrual cycle length prior to the menopause. A model of ovarian cycles is developed, based on the process of follicular growth and depletion. Under this model, the follicular phase of each menstrual cycle is preceded by an inactive phase, a period of time when no ovarian follicles have left the resting state and begun secreting steroids in response to gonadotropin stimulation. The model makes predictions about the variability in menstrual cycles across the reproductive life span based on the size of the surviving pool of ovarian follicles. The authors show that the model can explain several characteristics of the perimenopause in humans and macaques. (author's)
The institutional context of fertility and reproductive health in Madhya Pradesh, India.
This report describes the fertility and reproductive health situation and associated institutional context in three development blocks of Madhya Pradesh, India, based on a sample survey carried out between October and December 1999. Specifically, the report focuses on patterns of marriage, levels of fertility, practice of family planning, knowledge about reproductive health issues, attention and care during pregnancy, and women's health status. Overall, findings suggest a poor fertility and reproductive health situation in the three development blocks and five towns in Madhya Pradesh. Furthermore, the extent and nature of attention and care during pregnancy and at the time of delivery has also been found to be grossly inadequate. The disease burden among women, especially during pregnancy, was found to be very high, while women's knowledge about key fertility and reproductive health issues is, at best, imperfect. This situation has been found to be associated with an institutional context, which is traditional and orthodox at the level of the family and society and which is ill designed in terms of fertility regulation and reproductive health services delivery infrastructure. Orienting the existing family welfare and reproductive health services delivery system to the needs of the people and ensuring its availability to all settlements is a major challenge in improving the reproductive health situation in India.
Why aren't U.S. women using long-acting contraception?
The authors analyzed data from the 1993 and 1995 rounds of the National Survey of Women to examine the reasons given by women for not using implants or injectables, their use intentions of these two methods, and their attitudes toward these methods that are likely to influence their decision to use or not use these methods in the future. The authors used logistic regression models to identify the social and demographic characteristics of women that influence their decision not to use these methods. Less than 2% of the women in the authors' sample who were at risk of an unintended pregnancy were using the implant in 1995, and less than 3% were using the injectable. The three major reasons given by the women for not using either of these methods were 1) lack of knowledge; 2) fear of side effects/health hazards; and 3) satisfaction with the current method being used. Age, education, marital status, parity, and current method of contraception were strong predictors of fear of side effects, lack of knowledge, and satisfaction with current contraceptive method used as reasons for not using Norplant or Depo Provera. Not many women intended to use these methods in the next 12 months; 5% for the implant, and 10% for the injectable. Single women, women who had no college education, women who had children, women who wanted to have another child, and women who had positive attitudes toward the effect of using an injectable were significantly more likely to express an intention to use Depo Provera. Yet, substantial proportions of women reported quite negative attitudes about the use of these methods. The low prevalence of use and the low level of use intention for the implants and injectables do not hold much promise for the future of these methods. The somewhat more optimistic view that can be gleaned from the data the authors analyzed is that each method seems to appeal more to certain sub-groups of women. With proper interventions and social marketing targeted to such groups, it might be possible to disabuse them of their misperceptions regarding the properties of these methods and possibly increase their willingness to try these methods. While current use levels among these groups are higher than they are among others, there is still ample room for growth. (author's)
Metropolitan suburbanization of occupational groups among the non-Hispanic White population, 1990.
The end of the 20th century was marked by major changes in the spatial organization of US metropolitan areas. Central cities became increasingly characterized by pockets of severe poverty while undergoing economic upgrading of other neighborhoods. Suburban rings were also characterized by diverse patterns of change. This paper explores the ramifications of these changes for understanding variations in the central city versus suburban concentration of high status non-Hispanic White occupational groups across 153 large metropolitan areas. On the whole, the authors find that the traditional developmental model, emphasizing status distributions as a reflection of metropolitan age and population size, is not especially useful for understanding the status distributions. The authors' best model is one that places an emphasis on the economic role or function of the metropolis. In addition, the authors find that regional patterns of racial concentration are important in understanding the strong regional effects on the location of high status workers. (author's)
Group assimilation during periods of high immigration: methodological and theoretical issues.
Since 1965, immigration from Asia and Latin America has led to dramatic increases in the relative sizes of these groups within the US. Attempts to analyze how high levels of immigration affect the assimilation of “ethnic groups” have been hampered by the failure to properly distinguish between the native-born and foreign born in empirical analyses, as well as by the conflation of the processes of “immigrant acculturation” and “intergenerational assimilation” under the more general rubric of “ethnic group assimilation”. In this paper, the author demonstrates the need to measure not only how immigration has changed the size of ethnic groups within the US, but also how it has led to a shift in the international composition within these groups favoring the first generation. More importantly, the author shows the need to better theorize the link between immigration, group size, and assimilation. While many researchers point to the different social context immigrants face today, fewer note the changed status of native-born members of these “non-White” groups within the US, and how this in turn affects larger process of group assimilation. (author's)
Systems for delivering HIV / AIDS care and support.
This report is a part of a series of papers on HIV/AIDS care and support, which covers key issues related to systems for delivering HIV/AIDS care and support. It aimed to stimulate broad conversation on HIV/AIDS care that can help the US Agency for International Development define its future program activities in this area. In developing countries, many programs providing care to people affected by HIV/AIDS have been launched at the local level in response to local needs. However, these community-based interventions are being overwhelmed by the growing number of people living with HIV/AIDS who need care and support. Meeting this growing demand will require integrating such programs into systems that deliver other types of health care services, both in health care facilities and workplaces, and decentralizing them to adequately distribute resources to individual communities. The first section of this paper outlines how care is being delivered in many communities affected by HIV/AIDS, including some characteristics shared by many care programs and some examples of typical programs. The second section addresses the challenge of scaling up existing programs to create integrated systems of care and presents as models four programs that successfully expanded to the regional or the national level. The final section includes recommendations and a research agenda for further developing integrated systems of delivering care and support to HIV/AIDS-affected persons and their families.
5th Global Conference on Health Promotion, Mexico 2000.
During the 5th Global Conference on Health Promotion, held in Mexico in 2000, 87 Ministers of Health signed the Mexico Ministerial Statement for the Promotion of Health from Ideas to Action. The Statement maintained that health promotion must be a fundamental component of public policies and programs in all countries in the pursuit of equity and better health for all. During the 5-day Conference, the discussions and debates around the key health concerns of the Ministers of Health gave a strong message of their commitment to health promotion. Meanwhile, the plenary session was built around the priorities for health promotion set out in the Jakarta Declaration and the World Health Assembly Resolution on Health Promotion. Key issues arising from the Conference included the increasing aging population, the changing burden of communicable diseases, the underlying causes of inequity in gender and health, and the relevance of health promotion. Overall, the Conference focused on the challenge of improving health and bridging the equity gap. It made a strong political statement on the need for health promotion and provided a rich source of scientific papers, practical and informative case studies, networks, and a commitment to develop and implement sound evidence based on country plans of action.
In Barcelona, a population survey noted that 21% of youths aged 15-18 years ever had sexual intercourse and 71% used condoms. A school survey has also shown that 15% of 10th-grade students (mean age, 15.6 years) reported ever having sexual intercourse, with 79% reporting that they usually used condoms. Based on these reports, the city public health authorities promoted the development of the PRESSEC educational program. This school-based AIDS prevention program is grounded in the social cognitive theory and promotes a favorable modification of students' knowledge, attitudes, intentions and behaviors related to HIV transmission. This paper reports the evaluation of the pilot PRESSEC program among secondary school students during 1994. A total of 220 students in the intervention group, 593 in the information group, and 402 in the control group were included in this quasi-experimental study, with pre- and post-test measurements based in questionnaires. Results show that, at baseline, there were no differences among the three groups in attitudes, behavioral intentions or behaviors. However, AIDS knowledge and condom use were slightly higher among PRESSEC program students. Overall results suggest that the PRESSEC program may be effective in changing variables related to the risk of AIDS infection among secondary school students. Specific implications of the results are cited, and the widespread implementation of the program is recommended.
Family planning program effects on contraceptive use in Morocco, 1992-1995.
This study illustrates the use of panel data and a fixed-effects estimator to investigate the impact of family planning program inputs on contraceptive utilization in Morocco during the 1992-95 period. By controlling the potential bias resulting from common unobserved determinants of program resource allocation decisions and program outcomes, the methodology helps overcome an important constraint to the use of non-experimental study designs in undertaking meaningful impact assessments. Data from a panel of women interviewed in both the 1992 and 1995 Morocco Demographic and Health Surveys were used in the study, along with 'program' data from Service Availability Modules undertaken in conjunction with each survey round. The results indicate that changes in the family planning supply environment, in particular increased presence of nurses trained in family planning and the level of infrastructure at public clinics, played a significant role in the increased use of modern contraceptives during the study period. (author's)
Do incentives matter? -- Evaluation of a family planning program in India.
Indian Family Planning programs in the past have introduced a number of approaches such as providing monetary benefits, and motivational programs to improve contraceptive use among rural illiterate women. Under the Ammanpettai family welfare program, the Melatur Primary Health Care administered three program types involving a combination of monetary and motivational approaches to improve contraceptive use in three treatment areas. The program was introduced during January 1989 and was simultaneously discontinued after a period of 2 years. The present evaluation was conducted in 1994. Data from a random sample of 933 non-sterilized women at the time of social survey using a questionnaire approach is used in this study. The implementation of inventive programs in a socioeconomically homogenous population has resulted in an increase in the likelihood of current contraceptive use. The results of this study suggest that motivational programs are more likely to improve long-term use of temporary family planning methods than cash incentive programs. One implication of the authors' finding is that motivational programs should provide peer based family planning education and training in community work to contact persons who make door to door visits to promote family planning programs. (author's)
Unmet need for couples: an analytical framework and evaluation with DHS data.
While estimates of unmet need continue to be an important measure of the extent of demand for contraception and family planning programs success in developing countries, there are various reservations about the validity of these estimates. For instance, the traditional formulation of the measurement has relied solely on information from women while inferences from the findings are often drawn for couples. As more survey data have become available for both men and women in a number of countries, there is increasing evidence suggesting that husbands' preferences are indeed important determinants of the reproductive behavior of couples. This paper develops an analytical framework for measuring unmet need for couples. The approach 1) takes a fresh look at the classification of pregnant and amenorrheic women, and 2) incorporates the contraceptive use and fertility preferences of husband and wife in estimating the level of unmet need in six sub-Saharan African countries. The authors' findings show that taking these factors into account results in a 50-66% reduction in the level of unmet need in these countries. The importance of husbands' variables in determining the level of unmet need is clearly evident when examined among fecund couples in which the wife is neither pregnant nor amenorrheic. The implications of these findings for family planning programs and research are discussed. (author's)
Differential mortality risks from violent causes for foreign-and native-born residents of the USA.
This paper examines the differences in adult violent causes (homicide, suicide, vehicle accidents, and other accidents) for mortality risks between the American foreign- and native-born adult populations, while considering the length of time lived in the US and the influences of other sociodemographic characteristics. Data came from the National Health Interview Survey-National Death Index linked file for the years 1989-95. Cox proportional hazards models estimate the association between nativity, length of stay, and mortality risk for each violent cause. The results show that foreign-born persons differ in their risks of violent death vis-a-vis the native-born population by the amount of the time they have lived in the US. In particular, recent immigrants (less than 15 years) display higher risks from homicide, lower risks from suicide, and lower risks from other accidents (not vehicle) than the native-born individuals. This pattern is different for longer-term immigrants (15 or more years) who have, for the most part, similar risks from other causes of violent death compared to native-born residents. The findings suggest that there are compositional differences between immigrants by length of stay and that the process of acculturation may include the amplification or diminution of risks of various causes of violent death. (author's)
Despite significant progress achieved by the 1994 Cairo Programme of Action and the 1995 Beijing Platform for Action in women's rights, gender equality and reproductive health issues, the health care systems in Asia-Pacific remain insensitive to women's health needs. Women suffer inequalities in health status and treatment despite the availability of modern medical technology and overall increase in life expectancy. Moreover, male-female differences are evident in the health risks, health-seeking behavior, access to and utilization of health services and health outcomes. This paper discusses the shift in the approach to health care and the efforts of different international health organizations to promote such an approach particularly in the Asia-Pacific region. It emphasizes the need for gender-sensitive health care that considers the existence of gender differences, issues and inequalities and incorporates these into strategies, actions and services to improve women's health. Also, the factors that hinder effective promotion of such an approach are discussed.
Gender-sensitive and community-based programme for Mumbai slum women.
This paper details a 3-year action research initiative by the Mumbai-based Center for Enquiry into Health & Allied Themes to create a gender-sensitive and community-based program for Mumbai slum women in India. The project addresses violence against women, which includes domestic violence, as a serious health problem for women. It seeks to recognize the importance of gender differences in health care and women's right to quality health care; to empower women to take leadership roles as valued members of their community; and to value women's experiences in defining their health needs. Further, the project intends to increase the urban slum women's access to affordable and reliable reproductive health services through properly trained female community health workers.
Towards a model gender-sensitive reproductive health care programme for rural women.
This article details a 3-year action research project to create a model gender-sensitive reproductive health care program for rural women in Khon Kaen province in Northeast Thailand. The project began by conducting a survey and ethnographic study on women's experiences with health problems and the health services they utilized. The purpose was to identify women's sexual and reproductive health problems, which could be used to help formulate types of integrated reproductive health care, and guide health staff in their training needs. The data collected were used to guide the training of health staff in the improvement of communication skills, sexual counseling skills, technical competence in treating reproductive tract infections, and Pap smear exams. As a result of the training, health staff began to provide holistic and integrated services, cared for women's quality of life, involved men as target groups, use client-care approaches, became gender- and culturally sensitive to client's needs, and endeavored to integrate several aspects of reproductive health services into one visit.
For almost 3 decades, the US Agency for International Development (USAID) has invested and participated in the long-term process of developing Indonesia's family planning and population programs. Indonesia has experienced remarkable success; however, many challenges still lay ahead. During the next 5 years, the program will need to accommodate almost 4 million additional users and improvement is needed in the quality of care of existing services, notably in the provision and removal of Norplant. This effort will require participation of both private and public sector. Thus, USAID/Jakarta is challenged with the task to identify the most critical needs of the Indonesian program and to decide what are the most feasible and effective actions to address these needs. USAID needs to consider the capabilities of other donors and its own comparative advantage to determine activities for final investment. This paper describes policy development activities to build a sustainable context of support for USAID priorities and areas of continued investment. Specifically, policy activities intend to foster leadership commitment, a supportive regulatory context, and institutional capability to enable sustainable operational, financial and quality approaches. In all cases, attention is given to recognize peripheral pressures and agendas, and to obviate adverse impacts that would impinge on program development. Involvement and collaboration of other donors is actively sought to build a positive context of support.
This document provides an overview of potential POLICY Project contributions to overcome strategic challenges and foster long-term sustainability of the Indonesian Family Planning Program. It is noted that policy development is oriented in fostering the essential conditions of institutional sustainability, market segmentation and private-sector development, quality of care, and solidified demand for continued program success. In terms of institutional sustainability, the activities will be designed to strengthen the Indonesian family planning program's base to ensure the capacities of a sustainable institution. In order to successfully complement the public sector and ensure that public resources are most effectively and efficiently allocated, appropriate niches have to be identified for private sector providers and strategies must be developed to encourage the private sector to move into those niches. Moreover, a commitment of program leaders, responsiveness to providers' and consumers' concerns, and allocation of sufficient resources are needed for quality improvement initiatives. Finally, Indonesia's family planning program needs to distinguish and encompass the needs of all men and women of reproductive age.
Domestic violence: women's way out.
Violence against women and girls is a health and human rights problem of staggering proportions worldwide. It has been estimated that at least one of every five women will have been abused physically or sexually at some point of her life. In response, the Pan American Health Organization has spearheaded several efforts designed to understand the problem and measure its magnitude, as well as to advocate the development of strategies, policies, and initiatives to combat domestic violence. This protocol was developed to identify the services, organizations, and persons to which battered women can turn. It is the result of the cumulative work and commitment of numerous investigators, activists, and officials to address violence against women and improve the services available for women affected by it. Moreover, it is hoped that this research protocol will be an effective instrument of support in the effort to prevent and control violence in society, and especially violence against women and children.
Nature's place: human population and the future of biological diversity.
This report focuses on human population and the future of biological diversity. It surveys the world's highest-priority regions for biological conservation, the 25 biodiversity hotspots and three major wilderness areas. In addition, it quantifies each region's human population density and growth, aspects that will clearly figure in their biological future. Using geographic information systems technology, an approach to geography that uses digital information made possible by surveys, the results provide an idea of the complex connections between the threat to biodiversity and the size and growth of the human population. In general, it is noted that population growth is, and has clearly been, an important underlying cause of losses to biological diversity. This report's recommendations are addressed to policy-makers, to scientists and conservationists, and to the general public, exhorting them to take action to preserve the planet's wealth of living species.
Evaluating family planning programs with adaptations for reproductive health.
This manual provides guidelines relevant to developing an evaluation plan for a national family planning program, where the prime emphasis is on contraceptive services. It is noted that evaluation is the application of a social science research procedure to judge and improve the ways in which social policies are forged and programs are conducted. Its results inform program management, strategic planning, the design of new projects or initiatives, and resource allocation. This manual is directed to health professionals with varied levels of training and experience in program evaluation. The manual is divided into eight main chapters, in which each chapter addresses a section of the prototype evaluation plan. Chapter 1 provides an overview of evaluation, as well as basic information. A discussion on defining the scope of the evaluation is presented in chapter 2, while chapter 3 focuses on the methodological approach of program monitoring. Chapter 4 emphasizes the impact assessment methodological approach. It provides the rationale for labeling three specific methods as preferred and summarizes the statistical estimation approaches and procedures entailed by these methods. Chapter 5 outlines the issues to be covered in developing an implementation plan for either program monitoring or impact assessment. Chapter 6 covers the issue of disseminating and utilizing the results, while chapter 7 focuses on the adaptations to other reproductive health interventions. Finally, chapter 8 presents a checklist of steps in designing an evaluation plan.
Final report: third Cooperative Agreement, 1990-1997.
This document presents the final report of the Third Cooperative Agreement (CA3) supporting the Population Communication Services (PCS) and the Population Information Program (PIP) at the Johns Hopkins University (JHU) Center for Communication Programs. Signed in July 1990, the CA3 was extended twice, until July 1997, reflecting continuing high levels of field demand for information, education, and communication technical assistance and support from JHU/PCS. It notes that during the 7-year period from 1990 to 1997, JHU/PCS/PIP was able to build upon the experience and accomplishments of the second Population Communication Services Cooperative Agreement. This final report is divided into 15 sections, of which section 1 is an overview of the CA3. Sections 2-8 present division-specific reports of key achievements and key lessons learned over the period. These divisions include the Africa, Asia, Latin America, Near East, Newly Independent States, Research and Evaluation, and Training divisions. Section 9 presents the report of the Media/Materials Clearinghouse, while section 10 addresses the Population Reports. Sections 11, 12, and 13 focus on the Center Publications, POPLINE, and Administration divisions, respectively. Section 14 contains a report on the financial aspects of the Agreement, and section 15 presents the appendices.
In Jordan, religious leaders are intimately involved as opinion leaders in the social networks that influence the decisions and actions of the residents at the local level. The purpose of this survey was to gain a thorough understanding of the family planning knowledge, attitudes and teachings of Jordan's religious leaders. Conducted in the summer of 1997, the study is based on a complete census of 1655 religious leaders employed by the Government of Jordan. Overall, findings showed that the majority of religious leaders (82%) approved of family planning. These men and women leaders believe that family planning is permitted according to Islamic principles. In addition, approximately 36% of religious leaders reported having lectured about family planning during the 12 months prior to the study. However, knowledge about modern contraceptive methods and traditional methods is low among the respondents and there is a considerable uncertainty about the sanctioning of these methods by Islam. Moreover, the majority of religious leaders were noted to have agreed with statements advocating small families and joint decision-making. Based on the findings, several policy implications, program implications, and research implications are cited.
This final report presents the proceedings of the Young Reproductive Health Measurement Meeting, organized by the Division of Reproductive Health at the Centers for Disease Control and Prevention and the FOCUS on Young Adults Program. Its main objectives were to improve methodology and questionnaire content for young adult reproductive health (YARH) surveys and other quantitative data collection; identify key indicators that address YARH strategic and programmatic objectives of US Agency for International Development and partners; and advance the scientific base of knowledge of antecedents of YARH behaviors and outcomes. During September 28-30, 1999, 39 participants representing international agencies and those collecting data on YARH in Asia, Africa, Latin America, and the US discussed their experiences collecting data on YARH, methodological issues, ethical considerations, as well as data analysis and dissemination. Several major conclusions and recommendations are cited.
This study assessed the impact of health sector reform (HSR) programs on contraceptive logistics and product availability in four sub-Saharan countries: Zambia, Ghana, Kenya, and Tanzania. Using both quantitative and qualitative methods, the study analysis tested two hypotheses: 1) vertically, contraceptive logistics systems are effective means for improving service to clients by improving product availability; 2) health sector reform programs can disrupt contraceptive logistics operations. Overall, analysis results confirm that both hypotheses are valid. However, the relationships between HSR and public sector logistics operations are complex, since they are also associated with positive changes. In conclusion, 25 recommendations for policy-makers and health sector reform planners and implementers are presented. The purpose of these recommendations is to help governments and donors involved in developing HSR programs to plan the details of implementation with a specific focus on logistics.
Public education campaign 1997-1999.
This booklet presents a series of advertisements, appearing in major secular and Catholic publications, that reflect the sum and substance of Catholic support for access to contraceptive methods for all who want them. These advertisements, voiced by faithful Catholics, state the following: that the Catholic Church's ban on contraception is a barrier to women's advancement; that it increases maternal morbidity and mortality; and that it contributes to the need for abortion. The advertisements are part of a 3-year public education campaign, which is aimed at countering the actions of the Catholic hierarchy in shaping family planning public policies. In addition to the advertisements, this booklet provides facts that support that access to family planning helps women and families. Moreover, a discussion of the principal ways in which family planning faces constant threats of restricted access is presented.
Annual report on family health and welfare. 38-99.
This 1999 annual report of the Planned Parenthood Federation of Korea (PPFK) focuses on family health and welfare activities of the Federation. It is noted that various activities were conducted during the year for the nation to take a serious interest in global population and environmental issues and in the creation of strategies to cope with those issues. The major activities of 1999 included family health programs, public information and publication programs, youth programs, family welfare programs, resource development programs, production and distribution of audio video materials, and business cooperation. The training center of PPFK conducted training programs, both locally and internationally. The Korea Culture and Sexuality Research Center also conducted research programs and development of related materials based on the New Government Population Policy.
Kazakhstan: background information, objectives, and organization of the survey.
This paper discusses background information, objectives, and organization of the Kazakhstan Demographic and Health Survey conducted in 1999. The first section discusses the geography and population of Kazakhstan. Sections 2-6 present the history, the economy, the health care system and epidemiological profile, the family planning policies and program, and the demographic and health data collection system in Kazakhstan, respectively. Finally, section 7 focuses on the objectives and organization of the survey. The aim of the survey was to develop a single integrated set of data for the government to use in planning effective policies and programs in the areas of health and nutrition. The survey was designed to provide data on women's reproductive histories; knowledge and use of methods of contraception; breastfeeding practices; and the nutrition, vaccination coverage, and episodes of diseases among children younger than 5 years old. The survey also included the measurement of hemoglobin level in the blood to assess the prevalence of anemia, and measurements of height and weight to assess nutritional status. A total of 4800 women 15-49 years old, and 1440 men 15-59 years old were interviewed.
Characteristics of households and respondents.
This paper provides a descriptive summary of the demographic and socioeconomic characteristics of the household population and the individual respondents in the 1999 Kazakhstan Demographic and Health Survey. The first part gives the characteristics of the household population in terms of age-sex composition, household size and distribution, and educational background. The second part describes the housing environment in which the respondents and their children live. Finally, the third part discusses the background characteristics of men 15-29 years old and women 15-49 years old. Information presented in this paper is useful for interpreting the survey findings and serves as an approximate indicator of the representativeness of the survey and of the quality of the data.
This paper presents the findings of the 1999 Kazakhstan Demographic and Health Survey pertaining to live births in Kazakhstan. Fertility among urban women is lower than it is among rural women throughout all the childbearing years, resulting in a total fertility rate (TFR) among urban women that is one child lower than among rural women. Ethnic Kazakhs achieve a TFR of 2.1, and ethnic Russians achieve a TFR that is lower than the overall TFR. In the context of fertility trends, the data provide evidence of continual declines in fertility over the past decade. Results also show that the child survival level generally holds true for women 20-44 years old, since 10% of children born to women 45-49 years old at the time of the survey had not survived. Information is provided on the length of birth intervals, age at first birth, and pregnancy and motherhood among teenage women.
The primary function of family planning programs is to advocate conscious entry into parenthood for both men and women. The efficacy of family planning depends on people's knowledge of methods and on the availability of methods to meet the varying needs of a wide spectrum of potential users. This chapter of the 1999 Kazakhstan Demographic and Health Survey addresses family planning topics, including knowledge of contraceptive methods, sources of supply, use of methods in the past and present, reasons for nonuse, desire to use in the future, and exposure to family planning messages. Although the focus is on women, some results from the men's survey are also presented. This is because men play an important role in the realization of reproductive goals. These data can serve as an information base for the Agency on Health and family planning organizations to better define the need for contraception and the allocation of resources.
Induced abortion can adversely affect a woman's health, reduce her chances for further childbearing, and contribute to maternal and perinatal mortality. In Kazakhstan, approximately 22% of maternal deaths are associated with this practice. Information about induced abortion was collected in the reproductive section of the Women's Questionnaire for the 1999 Kazakhstan Demographic and Health Survey. Data revealed that women in all groups use induced abortion as a means of fertility control, but the extent to which they do so varies substantially. Overall, 40% of women of reproductive age in Kazakhstan have had at least one abortion, and a majority (64%) have had more than one. Rates of induced abortion peak among women 25-29 years old, with the total abortion rate (TAR) in the urban areas 33% higher than in the rural areas. The TAR is 1.4 abortions per woman. 52% of induced abortions were preceded by contraceptive failure. More than half of method failures that resulted in abortion occurred while using modern methods, primarily the IUD. A majority of abortions were performed at delivery hospitals and government hospitals through either dilatation and curettage or vacuum aspiration.
Other proximate determinants of fertility.
This chapter of the Kazakhstan Demographic and Health Survey addresses the principal factors, other than contraception and abortion, which affect a woman's risk of becoming pregnant in Kazakhstan. These include nuptiality, sexual activity, postpartum amenorrhea and abstinence from sexual relations. Data revealed that marriage is an overall indicator of exposure to risk of pregnancy, while the more direct measures of exposure are the age at first sexual intercourse and the frequency of intercourse. Moreover, postpartum amenorrhea and abstinence affect the interval between births, and the risk of pregnancy declines as women become menopausal. These factors determine the length and pace of reproductive activity and are therefore important in understanding fertility.
In the 1999 Kazakhstan Demographic and Health Survey, women and men were asked a series of questions about their fertility preferences. The data collected, in conjunction with the number of children that respondents currently have, allows the estimation of unwanted fertility in the population as well as of unmet need for family planning. Findings revealed that the majority of currently married men and women want no more children. In the case of currently married women, 63% either want no more children, are sterilized, or are infertile. Alternatively, those who want to have another child (30%) want to have a child within at least 2 years. The desire to limit childbearing increases sharply as the number of living children increases. The ideal family-size preference is 2.8 for all women and 3.0 for currently married women. Data also showed that 9% of currently married women have unmet need for family planning. Nevertheless, only little difference was found between actual total fertility rate (2.0 children per woman) and the wanted total fertility rate.
This chapter of the 1999 Kazakhstan Demographic and Health Surveys presents information on mortality among children below 5 years of age. The rates shown provide information on mortality levels, time trends, and differentials between population subgroups. Between 1994 and 1999, the estimate of infant mortality was 62 per 1000, the neonatal and postnatal mortality was 34 and 28 per 1000 births, respectively, and child mortality was 10 per 1000. The overall under-five mortality rate for the period was 71 per 1000. This estimate represents an increase of 55% in infant mortality, suggesting an increase in mortality risks in the past 5 years. The mortality estimates were higher for children in rural areas, children whose mothers had primary or secondary education, and children of Kazakh ethnicity. Finally, childhood mortality was also associated with demographic variables, including sex, birth order, and the length of preceding birth interval.
This chapter of the 1999 Kazakhstan Demographic and Health Survey presents findings on maternal and child health in Kazakhstan. Information is presented on usual sources of health care, maternal care during pregnancy and delivery, vaccinations of children, and child illnesses in the 2 weeks preceding the survey. Overall, 14% of women consider the hospital their usual source of care. A large proportion of mothers received prenatal care from professional health care providers (94%), including doctors, doctor's assistants, and nurses or trained midwives. Virtually all births (98%) were delivered at health care facilities, with the great majority of births occurring in a delivery hospital (89%). However, there were differences in the percentage of deliveries performed by a doctor, a doctor's assistant, or a nurse or midwife by residence or region and a woman's educational level. Information on characteristics of delivery and smoking tobacco during pregnancy are also presented. The vaccination coverage for children 12-23 months of age was high. Acute respiratory infection, fever, and diarrhea were suffered by 3%, 12%, and 13%, of children under 5 years of age, respectively.
Nutrition of women and children.
This chapter of the 1999 Kazakhstan Demographic and Health Survey covers infant feeding practices and the nutritional status of women and children in Kazakhstan. Infant feeding is described in terms of breast-feeding practices, supplementary feeding practices, and the use of bottles for supplementary feeding. Nutritional status is reported in terms of the height and weight of women and children. Infant feeding practices have important influences on both the child and the mother. These practices determine a child's nutritional status and susceptibility to morbidity. Moreover, they affect the health of a woman because of their influence on the return of ovulation after a birth and a woman's risk of another pregnancy. Mothers were asked questions concerning initiation and age patterns of breast-feeding and supplemental feeding. It is shown that 27% of children were breast-fed within an hour after birth and 62% within 24 hours of birth. During the early months of infancy (0-3 months), 38% of breast-fed children received plain water, and 14% received other foods and liquids. At 4-7 months, infants received supplemental foods such as meat, poultry, fish and eggs. Others received tea, baby formula, fruit juice, fresh milk products, and fermented milk products. The data also indicate that there was some variation in feeding patterns by residence, ethnicity, and region. In the context of the nutritional status of Kazakh children, 10% of children were moderately or severely stunted, 2% were moderately or severely wasted, and 4% were underweight for age.
Anemia is a condition characterized by a reduction in red blood cell volume and a decrease in the concentration of hemoglobin in the blood. This chapter of the 1999 Kazakhstan Demographic and Health Survey (KDHS) examined systematic differences in the rates of anemia between certain population groups; studied whether, based on assessment of hemoglobin distribution curves, negative iron balance is the main cause of anemia; and analyzed trends in the prevalence of anemia since the 1995 KDHS. Nearly half of the women (45%) and 54% of children under the age of five suffered from some degree of anemia. Ethnic women, women with lower educational status, and women living in rural areas, were frequently anemic. In the context of the hemoglobin distribution curves for pregnant women, breast-feeding women, and nonpregnant, non-breast-feeding women, the curves show that pregnant women tend to have lower hemoglobin concentrations than nonpregnant women. Most of the differences are primarily due to the increased iron requirements of the growing fetus, umbilical cord, and placenta, as well as the expansion of maternal red-blood-cell mass. In comparison with the 1995 KDHS anemia survey, there has been a decline in the prevalence of moderate-to-severe anemia among both women and children. This could be the result of the positive effects of the anemia control and prevention program, in particular, the intensive iron supplementation program.
HIV / AIDS and other sexually transmitted infections.
Globally, it is estimated that the number of cases of HIV/AIDS infection among adults is approximately 32.2 million, and among children, it is approximately 1.2 million. In Kazakhstan, however, compared to other parts of the world, HIV/AIDS has a relatively low prevalence, with an estimated cumulative number of 1000 cases reported. This chapter of the 1999 Kazakhstan Demographic and Health Survey summarizes information on the prevalence of relevant knowledge, perceptions, and behaviors of HIV/AIDS and its method of prevention. In the country, knowledge of the epidemic is almost universal among all population groups. Interestingly, a significant number of women and men are aware of the high risk of having sex with injecting drug users and the possibility of contracting HIV/AIDS through hemotransfusions and regular infections. One of the core HIV/AIDS prevention concepts is the knowledge that a person can contract HIV by having unprotected sex. Hence, a large proportion of the respondents know one or more valid ways to prevent HIV/AIDS infection, such as using condom and limiting the number of sex partners. Despite high prevalence of sexually transmitted diseases (STDs) other than HIV/AIDS, it is shown that there is a relatively low level of knowledge of STD. Background information on knowledge and attitudes towards HIV/AIDS and other STDs and the data on sexual behaviors can help to develop targeted programs that focus on those individuals and population groups most in need and most at risk of infection.
In Kazakhstan, the high prevalence of tuberculosis (TB) caused by strains of bacteria that are resistant to all major anti-TB drugs is of great public health concern. The breakdown in health services, the spread of HIV/AIDS, dramatic socioeconomic changes, increased poverty, income inequalities and the emergence of multi-drug resistant TB contribute to the worsening impact. This chapter of the 1999 Kazakhstan Demographic Health and Survey examines exposure to TB and knowledge of mode of transmission. It confirms the high prevalence of TB in the different regions of the country. The survey also showed that almost all women and men have heard of tuberculosis and more than 71% of them correctly identified the way TB is transmitted (via air when someone is coughing). A significant percentage of the respondents cited the symptoms of TB include coughing for more than 3 weeks, fever, blood in sputum, and night sweating. The country has adopted the Directly Observed Therapy Short Course, recommended by WHO, in preventing the further spread of infection. However, effective TB prevention and successful implementation of a TB treatment strategy depend on the background information on knowledge of symptoms and mode of its transmission, as well as understanding that TB is a treatable disease that can be treated in an ambulatory setting outside the hospital if properly observed by a health worker.
Promoting growth in sub-Saharan Africa. Learning what works.
This pamphlet presents the results of an empirical analysis of the factors affecting economic growth in sub-Saharan Africa, using data for the period 1981-97 and a sample of 32 countries. The empirical work involved the estimation of a growth equation to identify the key determinants of per capita real growth of gross domestic product, including economic variables that reflect the influence of economic policy changes as well as other explanatory factors. Both domestic and external factors contributed to sub-Saharan Africa's poor overall economic performance in the 1980s and early 1990s. However, since 1994 aggregate economic performance has been improving, reflecting the implementation of sound macroeconomic and structural policies, often in the context of comprehensive adjustment and reform programs. The region has given greater priority to public spending on health care, education, and other basic social services. In addition, there has been a growing movement toward more open and participatory forms of government that encourage cooperation between the state and civil society. Nonetheless, the economic and social situation in sub-Saharan Africa remains fragile and vulnerable to domestic and external shocks. Hence, reform efforts will need to be intensified to accelerate growth and reduce poverty in this region.
Sexuality, reproductive health and violence: experiences of migrants from Burma in Thailand.
Over 1 million migrants from Burma are currently residing in Thailand. The migrants are an ethnically diverse population coming from all over Burma and speaking many different languages. This book presents a study aimed at documenting the perceptions, concerns and realities of female migrants from Burma who live in Thailand to better understand their lives and reproductive health concerns. It also includes the voices of others, such as male migrants, employers, government officials, and service providers. The study has focused on three provinces in Thailand (Chiang Mai, Ranong and Samutsakhon) with larger and diverse migrant communities. Consistently emerging throughout the study was the issue of violence and safety, which strongly determines migrant's perceived choices and decision making. The increasing frequency and incidences of violence encountered in their country of origin, country of destination, communities and homes are critical factors in every migrant's life and have a direct impact on all aspects of their health, including reproductive health. This study has identified the need for collaboration between the government, nongovernmental organizations and other community groups in providing comprehensive policies and interventions to improve management of migrants, social status of migrants and health care services for migrants.
Performance monitoring for family planning and reproductive health programs: an approach paper.
The International Conference on Population and Development (ICPD) in Cairo shifted family planning program attention from a focus on achieving demographic targets to meeting individual needs of women for family planning and reproductive health services. Several governments in developing countries are responding by placing increased emphasis on program quality, meeting the expressed needs of clients, and placing less emphasis on achieving quantitative indicators of program performance. This report summarizes some of the changes in performance monitoring taking place in selected countries. There is considerable variability in how countries are making this transition. Indonesia has recently shifted the focus of its family planning program from target-driven to a concept of understanding and fulfilling the needs and preferences of the family. In the Philippines, focus is placed on improving maternal and child health and meeting the reproductive intentions of women. In Zimbabwe, greater attention is being paid to reproductive health service provision, particularly sexually transmitted disease treatment and prevention. Similarly, increased emphasis is being placed on reproductive health in Mexico. While experience is beginning to accumulate, shifting from advocacy for a reproductive health approach to program implementation at national, subnational and local levels will require much new work to obtain timely, accurate information for planning, implementation and monitoring of reproductive health and family planning programs.
Factors influencing the growth of the commercial sector in family planning service provision.
Using Demographic and Health Surveys data for 45 countries, this paper demonstrates that the commercial sector plays an important role in national family planning markets, even in countries where contraceptive prevalence is low, and that the commercial sector does not always develop coincidentally as prevalence grows or as the program matures. It also examines three sets of factors to explain variations in commercial market share across countries, namely: microeconomic or household factors, macroeconomic or business climate factors, and programmatic factors. Commercial market share for family planning is related to many factors. The cross-national analysis shows that broad-based purchasing power, improved knowledge of reproductive health, critical densities of population, and appropriate public policy are each associated with relatively strong commercial sectors. This paper recommends that public health policymakers take steps to integrate the commercial sector into their programs by developing economic and policy environments supportive of its expansion. Factors for which key policy support may be able to generate increased use of the commercial sector for family planning are also identified.
Long-range world population projections: based on the 1998 revision.
This report presents the long-range world population projections, prepared by the UN Population Division, which include several scenarios for population growth for the world and its major areas over the period 1995-2150. Three key scenarios are considered in these population projections. First, the medium scenario assumes that fertility in all major areas stabilizes at replacement level around 2050. Second, the low scenario assumes that fertility is half a child lower than in the medium scenario, and third, the high scenario assumes that fertility is half a child higher than in the medium scenario. Also considered for illustrative purposes are constant and instant-replacement scenarios. Constant scenario maintains fertility during 1995-2150 constant at the level estimated for 1990-95, while the instant-replacement scenario makes fertility drop instantly to replacement level in 1995 and remain at that level thereafter. The key findings yielded by these projection scenarios are discussed in detail.
World population prospects. The 1998 revision. Volume III: analytical report.
This book presents the analytical report for World Population Prospects: the 1998 revision, the official world population estimates, and projections. It begins by presenting the key findings of the 1998 Revisions and compares these from the 1996 Revision. It then discusses the transition to low fertility, reviews the situation in the past, and makes an assessment of future prospects. The transition to low mortality and the variation in projected levels of mortality at various levels of aggregation are discussed. Also, the demographic impact of HIV/AIDS and the estimates and projections of net migration are analyzed. There follows a discussion on the changing size and distribution of the population and the dynamics of aging populations. Lastly, the methodology used in producing the 1998 revision and the description of the sources of information used for revising the estimates for each country are presented.
Socio-demographic and ecological correlates of health among elderly population in an Indian society.
This paper identifies some of the socioeconomic, demographic, and ecological factors that play an active role in elderly people's health in Assam, India. The study sample was selected from Assamese- and Bengali-speaking populations of the Hindu and Muslim religions only. Along with detailed information of the socioeconomic and ecological characteristics of the households, data were collected on the elderly, their health problems, attitudes of family members and the community towards them, their economic status and potentiality, and their views regarding some societal changes. Findings revealed that due to low education, poor economic conditions and rural backgrounds, the scheduled caste people reported poor access to health. Moreover, elderly persons having sanitary latrines and tapped or tubewell water were healthier than those without proper sanitation and tapped/tubewell water. Use of electricity is also associated with good health among the elderly. In addition, elderly persons who have a separate sleeping room with their spouses have better health than the elderly who share sleeping quarters with other family members. Based on the findings, socioeconomic, demographic and ecological factors have an important role in the health of old people. Most elderly people could have better health if they received better health care and followed healthy life styles.
Religious differentials in desire for additional children and contraceptive use in Kerala.
Fertility differentials by religion have been observed in many parts of the world. In India the estimates have indicated fertility of Muslims to be higher and of Christians lower than of Hindus. Even in the state of Kerala where fertility is below replacement level, differentials by religion persist even after controlling for other socioeconomic factors. These differences may be attributable to differences in family size desires and in contraceptive practice. This paper examines religious differentials in these two crucial variables in the state of Kerala primarily on the basis of the data from National Family Health Survey (NFHS). In order to assess the effect of religion net of other socioeconomic variables logistic regression analysis is carried out for two factors, not desiring additional children, and use of contraception, separately for women with one, two, three and four living children. The results show that even after controlling for various socioeconomic and demographic factors Muslim women have less desire for not wanting additional children than Hindus, whereas Christians have higher desire. The regression analysis on the use of contraception also shows similar results. The difference in the use of contraception between Hindus and Muslims widens as the number of living children increases but then narrows at four living children. The tendency to use contraception is higher for Christians than Hindus but the gap closes at four children. Similar analyses are carried out separately for sterilization and use of reversible methods. The pattern of differentials in sterilization is similar to that in overall contraceptive use but in the case of reversible methods, religious differentials are generally not seen. In order to assess the religion effect on met need, the use of contraception is examined among women not wanting additional children. Though religion does show an effect on contraceptive use among women not desiring children, especially at two and three living children, this is not as strong as in the case of all women. Thus the religion effect on childbearing, and on the propensity to use contraception among those who have such a desire, but in Kerala the former effect is found to be stronger than the latter. (author's)
Factors affecting the work participation of elderly: an empirical investigation.
This empirical research examines the role of selected demographic, socioeconomic and health factors in the work participation of the elderly with the help of micro-level data gathered from Tamil Nadu state, India. Logistic regression analysis of 750 elderly persons (450 from rural areas and 300 from urban) was done to find out the determinants of the work status of the elderly. Overall, findings revealed that a substantial number of elderly persons continue to be in the labor force, with men in significant numbers. Those elderly who have large sums of monthly income from other sources (excluding wages/salaries) as well as the older among the elderly have a tendency to be out of the labor force, irrespective of their sex. On the other hand, the elderly may not be able to work for a very long period because of their growing age and deteriorating health. The results also show that education beyond primary school has a positive impact upon labor participation uniformly among all elderly. Based on the findings, policy implications are presented.
Economic development: employment and occupational diversification.
This paper examines employment and occupational diversification in India. The analysis is based on a comparison of the Industry/Occupation structure of the work force based on the 1961 Population Census and the 1993-94 National Sample Survey on Employment-Unemployment. The estimates of workers by Industry/Occupation groups are derived by applying the estimated shares of the relevant 2-or-3-digit Industry/Occupation groups per 1000 persons in the Usual (Principal plus Subsidiary) Status work force in each segments of the corresponding estimates of work force. The analysis of the industrial and occupational structure of the work force for 1961 and 1993-94 reveals that despite a significant reduction in its share, the agriculture sector in terms of industry, and farmers, fishermen, hunters and loggers in terms of occupation remain the dominant group. The tertiary sector (sales and clerical workers) comprises a large part of the decline in the share of the agricultural sector. It is shown that the high productivity sectors have not absorbed any significant part of the expanding work force. Consequently, many of the low productivity sectors, including agricultural and unorganized manufacturing, have had to act as residual absorbers of the large increase in the work force.
This paper basically summarizes the outcome of two valuable exercises conducted by official committees of the government of India on gendering population policy. It commends these two exercises as containing in them well debated, carefully researched women-sensitive approaches to a population policy for India. The author was a member of both these Committees. The paper then goes on to describing the particularly distressing if not devastating trends that are noticeable in the demographic profile of women in India in the millennium and suggest that while specific approaches and strategies and operational mechanisms can be designed to enable a gender-just and effective population policy for India, the crucial issue for transforming the particularly vicious situation that exists today, is for a change in the power relations, for a reduction in disparities--at the macro level as well as at the household level, not only in economic and social indicators, but in indicators of power. The paper suggests that these changes in power relations can be brought about by strengthening the presence of women in political structures not only by arrangements like quota, but by the affirmative, collective pressures of the women's movement. It argues that women as a social force, transforming power relations across the board is a crucial element in any population policy advice. (author's)
This paper highlights the need for the utilization of research findings in the formulation and implementation of health and population policies and program implementation in India. Data for discussion are based on the first 6-monthly reports pertaining to primary health care (PHC) and the maternal, new born and contraception indicators from district and facility reproductive and child health (RCH) survey research findings. The government of India has initiated a monthly exercise of district RCH surveys among its beneficiaries to understand the beneficiary perspective and level of awareness, perception, and utilization of various services rendered and to assess the implementation of RCH program in states. Several important service indicators at PHC level are considered, including indicators related to infrastructure, staff, equipment and supplies, and beneficiary perspectives. Relevant issues have emerged from the discussion and are summarized in this paper.
Relying on data from different secondary sources with estimates of population and its age distribution from existing UN estimates, this study highlights structural differences within the older population in India. Other objectives include: 1) to look into the past changes in age structure of the population and its future prospects; 2) to make assessments about the size of the aging population in the country over the next 50 years; and 3) to examine some of their socioeconomic consequences with an emphasis on old-age social security requirements. The study begins by discussing aging and its consequences to identify some trends from the past followed by the prospects for the future. It then shifts its focus to the critical issue of structural differences in the elderly status, which are important for devising means and making adjustments to meet changes in the (age-sex determined) composition of final demand. Some implications of aging are summarized and measures to face the problems of aging, in particular the central issue of old age security, are also discussed. The study concludes with several suggestions at the policy level.
India's demography and democracy.
India is experiencing demographic and political complexities that will challenge government management in the years to come. Projections show that the present demographic and democratic issues in India will remain the most formidable challenge in the next 40-50 years. Demographic challenges in the form of increasing numbers will threaten land, water, and other natural resources and bring about newer types of political demands. It is further assumed that the demographic challenge will come in the form of greater transfer of power, and the need for greater accountability and performance of the government. However, it will be a major achievement for India to develop a democratic political system, considering the country's diversity and complexity. The quality of leadership required for the management of the complexities of a modern democratic system and the transfer of power through emerging political demography will pose several challenges for India's social and economic development.
Health and nutrition challenges in the next decades.
According to the 1999 Human Development Report of the UN Development Project (UNDP), India ranked 132 out of 174 countries worldwide based on life expectancy at birth, education, and per capita gross domestic product. On the other hand, the Human Poverty Index has also showed that India ranked 59 among 150 developing countries based on the same criteria. In order for India to elevate its ranking, substantial nutrition and health inputs are needed in order to achieve the targets set by the Human Development Report of 1999. Furthermore, it requires raising nutrition levels, standards of living, and public health to ensure realization of the genetic potential of the population. This document discusses the health and nutrition challenges faced by the country of India in the next decades to achieve the goal set by UNDP.
Sustainable food and agricultural production including landuse and sustainable development.
India has witnessed an unprecedented population growth during the 20th century. From 238 million in 1901, the population increased to 846 million according to the 1991 census. During the first 50 years from 1901, the population added was 122.7 million. This increase is mainly due to rapid decline in mortality rates after 1921; the decline in fertility started much later, in 1971. Moreover, life expectancy at birth, which was supposed to be around 22 during the beginning of 20th century, has increased to around 60 during 1991-96. The birth rate has declined from over 45 to around 27. The old age population has increased, yet the most significant increase will be in the proportion of population in the 15-64 age group. This dimension, along with the increase in urban population, will determine patterns of demand for food, clothing, housing, education, and infrastructure. This paper briefly discusses the demand projections for food to meet the requirements of this growing population and strategies to overcome the challenges of meeting the food requirement of the ever-growing population.
Population policies and programmes since independence.
This paper presents an overview of the population policies and programs adopted in India since 1951. It begins by presenting a broad picture of the Indian population scene since 1901, followed by a discussion of population concerns before Independence, starting in the period of the Big Divide in 1921. Population concerns during the Big Divide fall under two categories: 1) Malthusian concerns; and 2) trigger factors for policy and action at the national level: Bengal famine enquiry and Bhore Health Committee Reports. The discussion is then followed by the policies and programs during 1951-76 (Independence period), highlighting the HITTS Approach (1962-76). Also, the discussion focuses on the periods of Emergency period or Coercive Approach (1975-77), Post-Emergency period or Recoil and Recovery Phase (1977-94), and Reproductive and Child Health Approach (1995 onwards), respectively. The political implications of sustained high differential growth of population in India and the major deficiencies and possible corrective measures of the population policies and programs implemented in India since 1951 were also highlighted.
Decomposition of disability-free life expectancy of the elderly of China.
Using the National Survey of the Handicapped in China, this paper examines the disability-free life expectancies of the elderly according to the type of disability and the severity of each type of disability. The survey covered 424 counties in all 29 provinces, autonomous regions and municipalities of China in 1987. The handicaps were divided into six categories: vision, hearing and speech, intellectual, physical, mental, and multiple. Descriptive analysis of the degree of disability and comparative analysis of the level of seriousness of the disability were undertaken. In the descriptive analysis of disability by degree, hearing and speech impairments were found to affect the remaining years of life more than other disabilities. Vision impairments ranked second, while physical impairments ranked third, in the proportion of remaining years of life affected at age 60. Intellectual and mental impairments were found to have no significant effect on the remaining years of life. In terms of the level of seriousness, the age comparison found that the disability status at age 80 is worse than the status at a younger age, with intellectual impairments showing the largest change. On the other hand, the gender comparison showed that the length of disability of females is longer than for males. These findings provide only a general description of the health status of China's elderly. Because of certain limitations, the causes of disability-free life expectancies were not explained. Further analysis requires data from a longitudinal survey to provide this explanation.
A study of factors associated with maternal mortality in Zambia, 1998.
The launching of the Safe Motherhood Initiative in 1987 raised attention regarding issues surrounding maternal health. The maternal mortality situation has become one of the most important indicators for assessing a country's health status of women. This study investigated the factors contributing to high maternal mortality using a retrospective case-control method in 18 districts of Zambia. Data were collected using questionnaires and focus group discussions among relatives, health workers and the community in general. Findings revealed that 18% of women in the reproductive age group (12-50) died from complications related to childbearing. The proportion of maternal mortality was highest in Eastern Province and lowest in Northwestern Province. 60% of maternal deaths occurred after delivery, while 13% died during labor. The most common causes of pregnancy-related deaths were hemorrhage, sepsis, HIV/AIDS, and obstructed labor. These findings point to the importance of antenatal and postnatal care. The need for communities to be better educated about the risks of maternal mortality also needs to be emphasized, as does the detrimental effect of some cultural practices. The role of men as policy-makers, chiefs, and fathers should also be improved so that women are better protected and supported.
Programme review and strategy development report, Zambia 1996.
The Programme Review and Strategy Development (PRSD) is a UN Population Fund exercise undertaken in close collaboration with the government concerned, with the aim of developing a coherent and comprehensive framework for a national population program. This issue of PRSD analyzes the current status and needs; assesses achievements of past population activities; and recommends future actions in terms of an overall population strategy in Zambia. The proposed national population program in Zambia for the period 1997-2001 aims to contribute to the achievements of the national objectives of reversing the declining trend in the quality of life of the people of Zambia and the achievement of equitable and sustainable human development. Specifically, the program aims to 1) strengthen the technical and managerial capacities of all institutions involved in the national population programs; 2) integrate population and gender concerns into all plans, policies, programs and strategies; 3) improve the scope and quality of the knowledge base for the design and implementation of the programs; 4) enhance the status of women and their contributions to sustainable development; 5) slow down the rate of decline in the health status of the population; 6) increase popular participation in the development process; 7) ensure quality in the distribution of, and access to, social services; and 8) enhance the achievement and sustenance of national consensus at all levels on critical population issues and strategies.
Using quality design to improve malaria rapid diagnostic tests in Malawi.
Malaria rapid diagnostic tests (MRDTs) have the potential of significantly improving the diagnosis of malaria in developing countries, especially where microscopic diagnosis is not available. However, in order for them to be effective, the informational inserts and product design must be clearly understood by the health workers in rural developing country facilities. This report summarizes a study in Malawi that led to the improvement of two different MRDTs. Using quality design principles, a research team, composed of technical experts and local researchers and sponsored by the Quality Assurance Project, developed and tested a user-friendly job aid that dramatically improved health workers' ability to use the tests properly without training. The team was able to recommend to the manufacturers some modifications to the kit design and packaging that would increase the likelihood that the kit would be used correctly every time.
Global challenges. Kenya: declares AIDS a national disaster but will curb epidemic without condoms.
The opening remarks of Kenyan President Daniel arap Moi during the 4-day AIDS awareness symposium declared the AIDS epidemic a national disaster. To counter the impact of the epidemic, Moi ordered that a National AIDS Control Council be established immediately. The Council would lead a concerted effort to coordinate AIDS prevention programs at the national, provincial, district and community levels and assume the lead in allocating funds for all AIDS programs nationwide. Council members will be given the task of devising solutions to cultural practices and beliefs that may enhance the spread of AIDS. Yet, despite the president's efforts, activists remained skeptical. They said that he failed to advocate condom use as a weapon to curb the spread of the disease. Furthermore, Moi still refused to change the government's opposition to advocating the use of condoms to prevent the disease. Defending his position against the use of condoms, Moi responded that youths must be made aware of the futility of promiscuous sex.
On November 10, 2000, the UN Population Fund welcomed the news that the Netherlands will contribute $39 million and the UK nearly $37 million to avert a crisis in contraceptive and other reproductive health supplies in developing countries. The total contribution amounting to around $76 million, will be used to purchase male and female condoms, other methods of contraception, obstetric and gynecological equipment, and drugs for the treatment of sexually transmitted diseases (STDs) in the world's poorest countries. Among the beneficiaries are sub-Saharan Africa, including Ethiopia, Chad, the Democratic Republic of Congo, Nigeria, Angola, and Namibia, the Russian Federation, Bangladesh, and Sri Lanka. The donations of the Netherlands and the UK show their commitment to the right of women and men around the world to have access to reproductive health care and especially safe and effective methods of family planning. In turn, there will be fewer unwanted pregnancies, fewer abortions and fewer maternal deaths in developing countries, and a reduction in the transmission of STDs and HIV/AIDS. UNFPA has pledged to make access to reproductive health care universal by 2015.
Women's status has received considerable attention as a significant factor in demographic behavior and outcomes in South Asia; however, little research has addressed the links between women's status and their investments in children. In this paper, the authors empirically investigate how women's status on multiple levels is associated with demographic outcomes. Using data from the Pakistan Status of Women and Fertility Survey in rural Punjab, the authors confirm that empowered women, or those with higher status, are better able to make positive investments in their children, thus increasing their children's chances of survival during infancy and increasing their likelihood of ever attending school. It is in examining these two outcomes in combination that the multiple dimensions of women's status at the micro and macro levels become most apparent. Overall, the data support the authors' hypotheses that improvements in women's status at the individual level, particularly in terms of improvement of women's position within the household, will enhance child survival, whereas improvements in women's status at the more general community level will improve the schooling chances of children of children, especially girls. Specifically, higher levels of women's status at the individual level, particularly in terms of access to financial resources and the absence of purdah restrictions and physical abuse by husbands, are associated with a lower likelihood of infant mortality. On the other hand, higher mean levels of women's mobility and lower levels of fear of disagreeing with husbands in a community are associated with higher likelihood that children, especially girls, will ever attend school. (author's)
Managing population-environment systems: problems of institutional design.
In population-environment systems human activity is inherently part of the system rather than something to be minimized in order to maintain or restore “natural” environmental conditions. Issues arising in managing such systems are discussed in this paper. Three preliminary sets of problems are first dealt with. The system's boundaries must be identified, defining its human participants and its ecological content. Procedures for monitoring demographic and environmental change in the system must be set up. And consensus must be reached on how to evaluate that change. Each of these tasks calls for technical knowledge of demographic and ecological relationships (and assessment of uncertainties); in addition each has important political and administrative dimensions. Unclear or contested boundaries, large numbers of participants, complex system dynamics and outcome indicators, and unequal stakes by participants complicate the management task. Among the general problems of designing governing institutions for large and complex population-environment systems are devising compensation arrangements to remedy major asymmetries in returns to participants, enforcing compliance to agreed access rules, and building in adaptability to changing knowledge and circumstances. (author's)
Socialization to gender roles and marriage among Egyptian adolescents.
Using nationally representative survey data, this paper explores gender role socialization and attitudes toward marriage among unmarried Egyptian adolescents aged 16-19 years. The authors examine the daily activities of adolescent boys and girls, views about age at marriage and desirable qualities in a spouse, and various indicators of gender role attitudes including opinions about whether wives should defer to husbands, about sharing household decision making, and about responsibility for domestic tasks. The authors findings reflect strong gender differentiation: girls have much less free time than boys, are much less mobile, are much less likely to participate in paid work, and have heavier domestic responsibilities regardless of whether or not they are in school. Girls favor a later age at marriage for both sexes, but particularly for boys. Boys are significantly more likely than girls to favor educational inequalities between spouses. While neither boys nor girls have particularly progressive gender role attitudes, girls are significantly more likely to express less traditional attitudes. Multivariate analyses indicate that girls' and boys' attitudes do not vary consistently and significantly by socioeconomic background; in particular, increased schooling does not always promote egalitarian attitudes. The implications of these findings for policies and programs are discussed. (author's)
Future trends in contraception in the developing world: prevalence and method mix.
The main objectives of this study are to review existing methodologies for projecting future trends in contraception, evaluate the validity of the assumptions underlying these projections, propose methodological improvements, and assess the prospects for new methods of contraception in the coming decade. The prevalence of contraception in the developing world has increased sharply over the past several decades from near zero in 1960 to around 60% in 2000. Demand for contraception can be expected to continue to rise rapidly for the next few decades as population size continues to grow and fertility declines further to near the replacement level. As a result of these trends, the number of users of contraception in the developing world is expected to rise from 549 to 816 million over the next 25 years according to the most recent UN projection. An examination of the projection methodology found it to be reasonable. The rate of growth in users will be much more rapid in Africa than in Asia or Latin America. Projecting the future distribution of specific contraceptive methods is more difficult. Method choice is affected by trends in several factors, including access to different methods, user characteristics, and technology. The procedures employed by the Futures Group to project the method mix were found to be less than optimally designed and a new methodology was therefore proposed. The general approach is one of slow and incomplete convergence toward a more balanced method mix in each country, with uniform reductions in the role of traditional methods. The new alternative projections to 2015 are quite different from those made by the Futures Group. For example, for the developing world as a whole the proportions relying on female sterilization are higher in 2015 (37% rather than 26%), and proportions using traditional methods are lower (7% instead of 14%). (author's)
This booklet deals with sexuality education from the perspective of religious institutions. Divided into seven chapters, it addresses the biological, psychological, social, and spiritual dimensions of human beings, survival, and reproduction. Moreover, it covers acquiring information and forming attitudes, beliefs and values about one's identity, relationships and intimacy. It also discusses sexual development, reproductive health, affection, intimacy and interpersonal relationships at various levels (individual to global). Specifically, this publication focuses on the silence of the Church regarding sex and sexuality. The strength and relevance of the Church and other religious institutions in the struggle against AIDS are also discussed. Furthermore, the booklet discusses the importance of accepting and involving people living with HIV/AIDS in the search for solutions and provides 11 practical hints for religious institutions and their health organizations in dealing with sexual issues in their communities. The principles religious institutions need to be aware of in teaching on sexual matters and discussing the efficacy and effectiveness of condoms in preventing diseases and unwanted pregnancies are discussed. Finally, the guidelines for comprehensive sexuality education in the context of the Church and theological institutions are outlined.
This paper outlines the life, work, and writings of Reverend Gideon Byamugisha as a person and priest living with HIV/AIDS. Reverend Gideon Byamugisha was the first practicing priest in Africa to declare publicly he was living with AIDS, which he contracted through several blood transfusions. A teacher by profession and a pastor by calling, he heads the health programs in the Diocese of Namirembe and was instrumental in initiating a truly Christian and truly scientific response to HIV/AIDS in the country. Moreover, he has written books, articles and papers concerning the basic facts about the HIV/AIDS situation, the main avenues of transmission, the Church leaders' and lay Christians' attitudes regarding the methods of stemming the HIV infection. Given his committed advocacy and activism, plus his publications and other writings, people at all levels were redeemed from the silence regarding the issues of sex, sexuality, and sexual health.
Potential barriers to demand for an AIDS / HIV vaccine in developing countries.
This paper outlines the potential barriers to the demand for an AIDS vaccine in developing countries; these barriers include 1) affordability, 2) effectiveness, 3) safety and 4) perceptions of risk. Studies conducted by the Liverpool School of Tropical Medicine showed that a significant minority of Kenya's population is unwilling to be vaccinated because of the high cost of the existing developed vaccines and partly because of their perception of the lack of safety of such a vaccine. Moreover, the notion that the individual is not at risk of contracting this disease has added to these barriers. Despite these barriers, however, many Kenyans still hope to be vaccinated and are willing to pay for such vaccinations. False perceptions of the possible dangers or side effects of AIDS vaccination should be corrected.
Sexual abuse and violence in sub-Saharan Africa.
Sexual abuse and violence are serious problems that transcend racial, economic, social and regional lines. This fact sheet notes that violence is frequently directed toward females and youths, who lack the economic and social status to resist or avoid it. Adolescents and young women, in particular, may experience abuses in the form of domestic violence, rape and sexual assault, sexual exploitation, and/or female genital mutilation. In sub-Saharan countries, sexual abuse and violence is a predominant problem. Surveys conducted in the region reveal that 46% of Ugandan women, 60% of Tanzanian women, 42% of Kenyan women, and 40% of Zambian women report regular physical abuse. Moreover, children in abusive households also suffer from the effects of violence, whether or not they are physically abused. Children who witness violence may experience many of the same emotional and behavioral problems that physically abused children experience, such as depression, aggression, disobedience, poor school performance and the like, as evidenced by many studies. Despite this, sexual abuse and violence is under-reported because of the cultural mores making it difficult to assess accurately. Few adolescent health programs in these countries address these critical issues.
This fact sheet discusses the impact of early pregnancy and childbearing on adolescent mothers and their children in Latin America and the Caribbean. Marriage and childbearing are often perceived as the premiere events of a young woman's life. But the medical, economic, and psychological impact of early childbearing can be significant, particularly for those who are unmarried. Studies have evidenced that mothers younger than age 17 face an increased risk of maternal mortality because their bodies are not mature enough to bear children. Moreover, teen mothers may not recognize the symptoms of pregnancy or may wish not to acknowledge a conception, delaying prenatal care and endangering the health of the child and mother. Children born to teenage mothers are more likely to be premature, be of low birth weight, and suffer from retarded fetal growth. Early pregnancies may also result in abortion complications.
Adolescent sexual and reproductive health in sub-Saharan Africa.
Many governments in sub-Saharan Africa view with concern the region's continued rapid population growth, high birth rates, and escalating rates of HIV infection. Unprotected adolescent sexual activity significantly contributes to these numbers. This fact sheet notes that by age 20 at least 80% of youths in sub-Saharan Africa are sexually experienced. The study shows that early sexual activity is linked to adolescent morbidity and mortality. In Nigeria alone, 42.1% of sexually active female adolescent participants had experienced either an abortion or a sexually transmitted disease (STD). In the region, adolescent reproductive health is affected by cultural, economic, and social factors. In this regard, many nongovernmental organizations and some governments are working to meet the reproductive health needs of adolescents by providing sexuality education and life skills development in the region. In particular, promoting contraceptive and condom use among youths can lead to decreases in morbidity and mortality due to unsafe pregnancy, abortion, and STDs and HIV/AIDS.
Greater than expected fertility decline in Ghana: an examination of the evidence.
In Ghana, it has been well established that a strong correlation exists at the national level between contraceptive use and fertility rates. The relationship can be summarized statistically using a linear regression of the contraceptive prevalence rate (CPR) on the total fertility rate (TFR). However, a recent version of this regression based on more than 100 observations indicate that for every increase of 15 percentage points in the use of contraception among married women a decline of one child in the TFR may be expected. This paper presents the findings of three surveys under the Demographic Health Surveys, which examined fertility decline that is larger than the expected on the basis of contraceptive use. Overall, an examination of various measures of the quality of birth history data did not reveal any major problems that would lead to overestimates of the fertility decline. On the basis of the differentials in reporting of contraceptive use among women and men, it seems probable that some under-reporting of method use, especially use of condoms, may have occurred among women. But for all three surveys the actual level of contraceptive prevalence lies somewhere between that reported by women and that reported by men, which may partially account for the TFR-CPR gap in the region. Moreover, a number of changes in the composition and dynamics of contraceptive use have occurred over the 10-year period that would contribute to an increasingly strong effect of contraceptive prevalence on fertility reduction.
A decade of unmet need for contraception in Ghana: programmatic and policy implications.
This paper presents the findings of a study, which focused on the unmet need for contraception in Ghana over a decade, using information gathered in the Ghana Demographic and Health Surveys conducted in 1988, 1993, and 1998. Overall, the level of unmet need for family planning has changed a little in the past 10 years, with 1 in 3 currently married women expressing a need for contraception. Although the proportion of demand satisfied has increased, use remains low, with family planning programs still not satisfying the demand for contraception of 3 in 5 persons. The need is particularly high among adolescents with almost 1 in 2 persons having unmet needs. Health concerns and fear of side effects of methods are paramount reasons for non-use among many women. At the same time, women themselves are increasingly opposed to the use of contraception. An increasing number of young women believe that they face little risk of conception due to infrequent sex. Based on the findings, family planning service providers should improve the provision of counseling both before and after a method has been adopted. Counseling should be accompanied by follow-up services to monitor discomfort and side effects that may arise. In addition, the media should be constantly engaged in dispelling misconceptions and misinformation about specific methods. Communication strategies should also reach out to more men to inform and educate them about the alternatives to a large family and encourage spousal communication on reproductive matters.
This pilot study was conducted during August 1996 to examine the extent to which refuse poses a hazard to the health of Mtendere community and the response of the community towards the situation. This study involved identifying and interviewing 30 heads of households, measuring pest levels in households, classifying and quantifying refuse and pests at sites. Overall, findings indicate that refuse is a problem in the area as this is a source of several pests known to cause disease in the community. The kind of refuse that most households appear to be generating are sweepings and vegetable matter, which are taken into piles and are not well disposed of. Flies and other insects are a nuisance both at the rubbish sites and in the homes. Clinical records obtained indicate there could be a relationship between diseases reported at the health centers and the links in transmission (pests). It is therefore recommended that a representative sample be taken up to obtain representative results.
This survey was conducted between September 1995 and March 1996 in Lusaka to establish the students' knowledge and attitudes about HIV/AIDS and their perceptions of the role of billboards in improving knowledge and attitudes about various facets of the disease. A total of 531 students responded to a survey questionnaire on knowledge and attitudes, while 36 billboards were visited for qualitative evaluation by 360 students for content, design, display and other factors. Overall, the survey found high knowledge on general information about HIV/AIDS, low knowledge on technical information, and misconceptions on selected aspects of the disease. The students' attitudes, particularly on people with HIV/AIDS were found to be generally positive. Furthermore, the survey indicated that students appreciate the need to use billboards among the media strategies in the prevention of the epidemic. However, the generally poor designs, inappropriate messages, and inaccessible locations tend to affect the students' exposure and attention to, and retention of, the billboard messages. Ultimately, the impact of billboards on knowledge and attitudes was found to be insignificant. Recommendations for enhancing the impact of billboards in improving knowledge and attitudes about various facets of HIV/AIDS are outlined.
User fees in the health sector: policy, practice and perceptions.
This study examined the four major aspects of user fees in the health sector; namely, policy, practice, effect, and people's perception. Its purpose was to fill an important information gap in the continuous process of updating and refining the draft national policy on health care financing. Data were based on qualitative analysis on the four district areas of Chongwe, Kabwe, Kitwe, and Senanga. Overall, findings revealed that in all areas covered, health personnel at the district level received the policy on user fees as a directive from the Ministry. Similarly, the communities were only informed about the implementation of the policy through the radio, TV, and newspaper, all of which are not accessible to the general public. Thus, communities displayed widespread ignorance about the rationale for introducing user fees. In addition, there was a general resentment of the user fees such that in a number of cases they were viewed as a new form of tax. Consequently, people resorted many coping mechanisms in the wake of user fees such as increased use of home remedies, self-diagnosis, self-prescription and procuring drugs from make-shift “drug stores” in community markets and people's homes. The study indicated that community ownership and hence empowerment was lacking in virtually all the study areas and there was not much help rendered to the core-poor to enable them access health care facilities easily.
Expression of Ki-67 in cervical epithelial cells in preneoplastic lesions of patients with AIDS.
The objective of the present investigation was to study the expression of the proliferation marker Ki-67 in cervical intraepithelial lesions in women with AIDS. The authors studied 18 low-grade cervical intraepithelial lesions (Lo-CIN) and 8 high-grade cervical intraepithelial lesions (Hi-CIN) in AIDS patients and 18 Lo-CIN and 14 Hi-CIN in patients from the general population. Positive Ki-67 nuclei were counted. A significantly higher number of Ki-67-positive cells (p < 0.001) was found in Lo-CIN of AIDS patients (mean, 29.18 +or- 10.44) as compared with Lo-CIN of general-population women (mean, 17.08 +or- 7.40), whereas no significant difference in positive Ki-67 nuclei was observed in the Hi-CIN of AIDS patients and of patients from the general population (p > 0.05). The authors concluded that the proliferative potential of cervical cells in Lo-CIN--as studied by the expression of the proliferation marker Ki-67--is higher in AIDS patients than in the general population. (author's)
Women's issues -- five years after Beijing: progress and drawbacks.
A Special Session was held in New York during June 5-9, 2000, to review the progress made by countries on women's issues 5 years after the declaration of the Platform for Action (PFA) of the World Conference on Women held in Beijing (Beijing+5) in 1995. It was attended by 2300 delegates from 178 member states and more than 1000 accredited nongovernmental organizations represented by 2000 delegates. Out of this meeting, a report that reviews and assesses the implementation of the Beijing PFA was formed. The report, containing the Political Declaration and the document on ‘Further actions and initiatives to implement the Beijing Declaration and Platform for Action’, was unanimously adopted by the final plenary. In the reports, governments reaffirmed their commitments to the goals and objectives of the Beijing+5 PFA and pledged further action to ensure its full accelerated implementation. This implies that the Beijing+5 declaration and PFA is extended for 5 more years, until 2005, as the single valid intergovernmental program for the advancement and empowerment of women.
From population to reproductive health: finding a new yardstick.
Building community services that cover the full range of people's reproductive health needs and choices, not just family planning, is still a new and complex idea for many developing countries. This places a premium on South-to-South experience exchanges about how to organize and manage such services, and on convincing many agencies both in developing and donor countries to support such cooperation. In this paper, Balla Musa Silla, Executive Director of Partners in Population and Development, discusses these needs and suggests responses in the context of the aftermath of the International Conference on Population and Development (ICPD). She states that developing countries by definition do not have the resources available that developed countries do to experiment with many different ways to provide high-quality, integrated health services in the time-frame specified at ICPD. Despite considerable progress made on the ICPD agenda, much remains to be done to meet reproductive health needs. To address them requires mobilizing considerable resources, strong institutions, capable and skilled professionals, political will and tackling sensitive social and cultural issues.
Challenge to African leaders on HIV / AIDS pandemic.
This paper presents the agenda for the “African Development Forum” conference held during December 3-7, 2000, in Addis Ababa. The forum aims to build a launching pad for more concerted action against HIV/AIDS in Africa and galvanize an African-led response to the pandemic. It hopes to mobilize the highest possible level of scientific, technological, traditional and intellectual leadership at all levels of society and the development community for dealing with the AIDS epidemic and mitigating its already devastating impact in Africa. Also, the forum will build on efforts already under way sponsored by African countries and their developing partners to combat HIV/AIDS and will address the remaining gaps. It is expected to yield country action plans and proposals on specific leadership roles at every level for the fight against HIV/AIDS and its impact in Africa. Six steps for the implementation of these goals are outlined.
Health, human rights, global trade and access to essential medicines.
The issue of access to life-saving, life-prolonging drugs by poor countries has recently been at the center of international financial news. On the one side, developing countries, particularly those in sub-Saharan Africa, desperately need cheaper sources of drugs to treat HIV/AIDS and other diseases such as malaria and tuberculosis. On the other side are the transnational pharmaceutical companies, claiming trade-related intellectual property rights (TRIPS) to secure patents and control prices under the rules currently governing global trade. As a result, African countries are still priced out of the market in essential medicines. This paper discusses the implications of TRIPS for the accessibility of essential drugs, particularly HIV drugs, in developing countries. The discussion focuses on the inter-relatedness among health, human rights, global trade and access to affordable essential medicines.
Breaking the silence on AIDS in Africa.
The closing statement made by former South African President Nelson Mandela during the 13th International AIDS Conference held in Durban on July 14, 2000, focuses on the impact of HIV/AIDS on Africa's society and economy. He said that AIDS in Africa is claiming more lives than the sum total of all wars, famines and floods. It has devastating effects on families and communities, is depleting health care services, and robbing schools of both students and teachers. In addition, statistics show that half of the young people will die of AIDS. However, Mandela added, there is still something that can be done to stop this epidemic. The experiences in a number of countries have taught that HIV infection can be prevented through investing in information and life skills development for young people. Promoting abstinence, safe sex and the use of condoms, and ensuring the early treatment of sexually transmitted diseases, are some of the steps needed. Other strategies to combat the HIV/AIDS epidemic are addressed, such as the importance of solving stigmatization and discrimination and of providing a safe and supportive environment for people affected by AIDS. The need for partnerships with the international community is also emphasized.
A relative risk-based, disease-specific definition of sexual abstinence failure rates.
Sexual abstinence programs have the potential to reduce the incidence of unplanned pregnancies and sexually transmitted diseases (STDs) among adolescents. Effectiveness measures are needed to help researchers assess the impact of sexual abstinence promotion programs on STD and pregnancy rates and to enable comparisons of abstinence effectiveness with other contraception and STD prevention methods. Abstinence “failure rates” have been proposed as one measure of program effectiveness. However, the concept of abstinence failure rates has not been adequately operationalized. The present study examines a novel mathematical framework for estimating abstinence failure rates, both theoretically and empirically. Examples are provided, and the advantages and disadvantages associated with the mathematical model-based approach are discussed. (author's)
Disease-specific sexual abstinence user rates: the role of science in policy making.
This article offers an innovative and relatively easy-to-use Bernoulli relative risk formula for calculating the annual probability of pregnancy and sexually transmitted diseases (STDs) under conditions of maximum possible risk. Developed by Steven D. Pinkerton, this calculation indicates that abstinence is probably most effective when the probability of STD transmission per contact is extremely low, as is the case for heterosexual HIV transmission. Pinkerton’s calculation was explained by comparing it with the existing data on condom use failure and how this calculation is used with abstinence education programs in comparison with condom promotion programs. Its findings suggest that 100% abstinence compliance may be necessary to obtain anywhere near the comparable STD protection achieved by consistent, correct condom usage. However, Pinkerton cautions that this statistical calculation is new and untested. Thus, more research is urgently needed using actual programs with detailed data on the number of sexual partners, number of acts per partner, and STD and pregnancy prevalence data, where available.
This paper examines the various institutions in Zambia involved in caring for people living with HIV/AIDS and those affected, as well as the type of care provided by each respective institution. Moreover, it discusses how HIV/AIDS has prompted family restructuring. Data were obtained from a randomly selected sample of 549 households, capturing 3828 household members and 1000 respondents aged 15 years and above. Overall, it is noted that in both rural and urban areas, nuclear and extended family members in most cases (60%) cared for AIDS patients. Other institutions include religious organizations (16%), government (10%), and community members (10%). The most common assistance provided was financial and material support. Other than financial assistance, nuclear family members provided material, moral, and all other needs. Furthermore, members of religious organizations offered prayers and counseling. In addition, the institutions have established many orphanages and assisted in the education and training of the orphans. Government assistance is more noticeable in rural than in urban areas, in the form mostly of food rations and medications channeled primarily through rural health centers and clinics, or through established mission hospitals and nongovernmental and community-based organizations.
Over the years, successes in HIV prevention using the risk-reduction approach have been documented. However, several limitations on the existing programs are observed, such as the lack of resources and irrelevancy of the programs to the changing needs of the communities. In view of this, the Joint UN Program on HIV/AIDS proposed a conceptual framework for the global expanded response of the HIV/AIDS epidemic. This paper presents this proposal and suggests the dimensions with which this response needs to proceed. It is noted that expanding the global response to the epidemic involves strengthening risk reduction efforts based on accumulated knowledge and innovations, combined with enhancing those that aim at vulnerability reduction by creating a social and economic climate in which risk behavior is likely to be minimized. This expanded response proceeds in several dimensions: expanding coverage; focusing action; expanding partnerships in the design, implementation, and evaluation of the epidemic; involving relevant sectors; increasing resources mobilized in support of HIV/AIDS prevention and care; and enhancing the sustainability of HIV/AIDs programs. Each of these dimensions necessitates the exchange of knowledge and experience gained in expanding the response to the epidemic by sharing information locally, nationally, and internationally, with emphases on documenting the effectiveness and the impact of innovative approaches and advocating evidence-based approaches.
This paper presents four international case studies of effective health promotion practice in HIV/AIDS as presented at the 11th International Conference on AIDS held in Vancouver, Canada, in July 1996. With the theme, “HIV Prevention Works,” the case studies of Australia, Canada, Thailand, and Uganda will address the partnership arrangements between community groups, government and research institutions, and look at how these relationships have developed and how they work in practice. In particular, these case studies will explore the impact of these partnerships on the ability of community groups to develop new initiatives and expand community efforts. Each country will describe its successes and the lessons learned in order to share its knowledge and experiences with others involved in HIV/AIDS prevention. Finally, the document draws together the commonalties, key issues and ideas from the different experiences and circumstances within each country in order to reflect on those aspects of the response that have contributed profoundly to the success in the prevention of HIV/AIDS.
This report describes the development, implementation and impact of three school-based AIDS preventive education programs in the state of Maharashtra, India. The programs were implemented by 1) Sevadham Trust, 2) Directorate of Health Services (DHS), and 3) Municipal Corporation of Greater Mumbai (MCGM). The Sevadham Trust program aims toward institutionalized AIDS awareness programs within the formal school system. The DHS project is designed to create a cadre of peer educators among students as well as create a cadre of nodal teachers at the school level, while MCGM aimed at educating the adolescents who were moving through a period of physiological and psychological change. Overall, the Sevadham model seems to be the most effective in terms of impact. It was observed that Sevadham Trust has been successful in institutionalizing the program within the formal school system. Similarly, the MCGM model has also achieved its planned objectives and completed its target. On the other hand, for DHS, greater efforts to create a cadre of peer educators and nodal teachers should be addressed and the need to strengthen interpersonal components of the information system should be emphasized. It can be concluded that the formal school system has a crucial role to play as a major institution for tackling the spread of HIV/AIDS. To replicate the AIDS awareness models in other communities, four stages for successful replications are identified; namely, inception, implementation, evaluation and sustainability.
Inventory of population projects in developing countries around the world, 1989/1990.
This document presents the inventory of population projects in developing countries around the world. It is an annual compilation of externally assisted projects and programs funded, initiated, or implemented by international organizations. Information in this book is organized by geographical categories and by the type of organization involved. Assistance included in this book covers grants, loans, technical and operational support, training, and provision of equipment and supplies. In addition, research projects are included whenever such research appears to provide valuable information for the donor community and governments of developing countries. Most of the information is based on the original materials--letters, computer printouts, annual reports, and informational leaflets-- provided to the UN Population Fund by organizations themselves. Basic demographic data were prepared by the Population Division of the UN Department of International Economic and Social Affairs. All of the data included in this document refer to the medium variant estimates and projections calculated by the Population Division from national censuses and surveys.
Presented at the Asia Literacy Regional Forum in May 5-9, 1997, this paper discusses a research and development approach to the delivery of comprehensive functional education and literacy in the Philippines. The discussion is organized into four parts. The first part deals with the interrelationship between informal, formal and nonformal education. The second part discusses the historical development of adult education in the Philippines in the context of the precolonial period, Spanish colonial period (1521-1898), revolutionary period (1892-1898), American colonial period (1899-1935), Commonwealth period (1935-1946), post-war period (1946-1972), martial law period (1972-1983), and EDSA and post-EDSA period (1986 to present). A discussion on the advantages and disadvantages of community-based literacy and functional education programs are presented in part 3, while part 4 provides the research-based development model for a community-based literacy and functional education program.
Reengineering literacy work in the Philippines.
The Medium-Term Philippines Development Plan has two major points of focus: people empowerment and global competitiveness. These serve as a basis for the overall planning efforts of the education sector. In terms of people empowerment, the planning agenda covers the provision of education services on a free, universal and compulsory basis; elementary education; and increase of the coverage of secondary education. On the other hand, global competitiveness is concerned with the basics of verbal and written communication in Filipino and English, as well as the necessary computational and reasoning skills. This paper presents the strategic Plan of Action for reengineering literacy work in the Philippines. The education plan involves three dimensions, namely, 1) improving access to and the quality of basic education, with elementary education as the first emphasis, 2) relaxing or liberalizing the restrictive regulatory framework for private education, and 3) rationalizing the roles and functions of the state tertiary system of education, more particularly the state colleges and universities. An outline of the literacy policies, the Plan of Action, and recommendations for future directions in the improvement of literacy programs in the Philippines are outlined.
USAID / Jordan: strategic overview, 1997-2001.
Dramatic changes in the parameters surrounding the US Agency for International Development (USAID) program in Jordan require a strategic reassessment. This strategic reassessment document takes its starting point at the central issue facing Jordan as it moves into the next century: how to turn a small, resource-poor country into a dynamic regional economic player that is more competitive and more efficient in the context of a global economy. Key constraints include rapid population growth, scarce water supplies, and lack of economic opportunity. These constraints thus affirm the USAID strategy of focusing on three main strategic objectives: 1) improved water resource management; 2) increased practice of family planning with an emphasis on modern methods; 3) increased economic opportunities for Jordanians. Issues and concerns related to the development and implementation of this strategy are addressed at length in this document.
Seasonality in carotene intake. Final report.
This report presents a review of the literature showing the importance of seasonal variation in carotene intake and carotene-rich foods. It also presents findings of the re-analysis of four data sets, using more recent data on carotene content to examine seasonality in carotene intake. The report covers factors that affect bioavailability, absorption and bioconversion of carotene. Existing data from the Philippines, Ghana, Malawi, and Nepal were re-analyzed using the revised food composition tables for carotene. Results showed large, statistically significant variations in vitamin A intake over seasons/time which, where possible to evaluate, differed with expenditure quintile and age group. Therefore, the report found very good studies of seasonal intake of carotene, and none that extended beyond a year. The finding from the Philippine study, that commercialization of agriculture may have had a negative impact on carotene intakes, needs to be further examined. Operational research is needed to see if seasonal abundance can indeed be used to increase protection, taking into account reduced absorption of carotene by retinol-replete individuals. Recommendations for further research are also included in the report.
"Partial-birth abortion" and the Supreme Court.
Abortion has long been, and remains, the most politicized medical procedure in the US. This paper explores issues concerning the constitutionality of partial-birth abortion in the context of the court case of Stenberg vs. Carhart in Nebraska. The controversies include 1) the process of describing the procedure and 2) circumstances for physicians to use partial-birth abortion to protect the health of a pregnant woman. The Nebraska law provides that no partial-birth abortion shall be performed in this state, unless such procedure is necessary to save the life of the mother, whose life is endangered by a physical disorder, illness, or injury, including a life-endangering physical condition caused by or arising from the pregnancy itself. Consequently, Dr. Leroy Carhart, a Nebraska physician who performed abortions, sued in federal court, has asked for the declaration of the unconstitutionality of the law. The US District court then ruled the unconstitutionality of the partial-birth abortion law with the affirmation of the Court of Appeals. This court decision strongly reinforces the belief that the decision for abortion should belong to the woman and her physician together. While the law can determine whether abortions are permitted or not, it is only the physicians, with their patients, who can determine how they may be performed safely.
Cervical cancer screening strategies for developing countries. Symposium.
In an earlier symposium ("Human papillomavirus and cervical cancer screening," in the November 2000 issue), the authors updated that topic and discussed the role of human papillomavirus DNA testing. This roundtable, like its predecessor, was taped in Barcelona, Spain, at the 18th Annual Meeting of the Human Papillomavirus Society. There the authors also talked with some experts on screening for cervical neoplasia in developing countries. This is an enormous problem because much of the world's cervical cancer occurs in low-resource populations--outside the US and in non-European countries. A magazine such as Contemporary OB/GYN seldom gets the chance to talk about problems related to countries and conditions other than their own. That's why the authors seized this unique opportunity to discuss issues like a scarcity of pathology services in some parts of the world, the frequently poor quality of labs where they do exist, and a woeful lack of, or outmoded, radiotherapy facilities--and to give readers an idea of what happens outside of New York, Chicago, and Los Angeles. (author's)
Indigenous women's values and contributions to development.
This paper summarizes the agenda for the consultative workshops convened by the Inter-American Development Bank (IDB) Indigenous Peoples and Community Development Unit. Workshops were organized in Bolivia, Guatemala, Panama, and Peru and attended by men and women leaders from indigenous organizations to present proposals regarding IDB operations. In the workshops, the core issue discussed by the participants was the contributions that indigenous women can make in the national development process. Despite the fact that they are faced with a three-tiered situation of discrimination and exclusion, it was recognized that indigenous women are making broad achievements in the organizational processes as well as at the political level. The participants also considered the barriers and constraints, particularly of the economic variety that affects their full-pledge participation. In view of this, the use of a participatory process by IDB to prepare projects was recommended by the participants in order to ensure the implementation of development with identity. This would include paying special attention to the specific needs of indigenous women and providing support to productive projects that generate sustainable income and operate on a basis of direct funding.
Upgrading slums: a key to urban poverty reduction.
Since 1995 the Inter-American Development Bank has approved 14 projects involving slum upgrading, reaching nearly US$4 billion in total project costs. This puts the Bank in a clear leadership position among multinational organizations in developing and adopting the Neighborhood Upgrading (NU) approach as a solution for the informal settlements problem. The demand for NU projects and the success that they have had demonstrates a model that can be successfully implemented to change the lives of thousands of families among the poorest living in Latin American cities. However, the model has evolved to combine targeted interventions with infrastructure investments and social development components, with special consideration to community education and participation. Some of NU projects' key features include 1) equalizing the level of services between rich and poor neighborhoods; 2) providing a minimum package of key infrastructure investments; 3) involving the local community in every stage of the project; 4) working through local governments and involving providers of complementary social services; and 5) addressing the regulatory issues and housing market distortions. These qualities have made NU a key strategy in combating urban poverty, an alternative for addressing low-income housing problems, and an effective social development tool.
Women's rights are international human rights.
This article summarizes the activities of the Inter-American Development Bank's educational project "Towards a Jurisprudence of Equality" in Latin America. This project offers judicial trainers the knowledge and skills necessary to apply international human rights norms concerning women in their respective jurisdictions. Since the project's inception, five planned workshops of the project have already trained 4 high-level trainers, selected among judges, academics, and others involved in justice administration in Argentina, Brazil, Chile, Ecuador and Uruguay. The goal of the workshops is to offer guidance in the following: 1) origin of the concept of human rights, in accordance with international public law; 2) human rights of women, with special emphasis on domestic violence; and 3) international and regional human rights instruments and their relationship to the internal laws of the country. Consequently, the project has met with some success in influencing court decisions and legal training. Judges who have attended the program have based their decisions and sentences with a concern of the international human rights. Similarly, program participants from academia have introduced changes in their law departments' curriculum and course proposals that deal with the human rights of women.
UN touts world health success stories.
In December 2000, the UN released a report detailing 20 infectious disease and reproductive health success stories from around the globe. This publication was produced in an effort to combat the perception that health problems in the developing world are incurable. It focuses on making available simple tools to fight disease and calls for increased political commitment and more international cooperation from the pharmaceutical industry and nonprofit organizations. One example is the role of the government in decreasing the incidence rate of tuberculosis (TB) in Peru. Similarly, in China and India, the report indicates progress in the fight against TB. Other stories include local production of insecticide-treated bednets and anti-malarial drugs in Vietnam that slashed the death toll from the disease by 97%; a 60% reduction in childhood deaths from diarrhea in Mexico; and a measles immunization campaign in Malawi that reduced cases and deaths to almost zero.
This study aimed to assess the effects of breast-feeding promotion on breast-feeding duration and exclusivity and gastrointestinal and respiratory infections and atopic eczema in infants. A total of 17,046 mother-infant pairs from 31 maternity hospitals and polyclinics in Belarus participated in the study. The criteria for the selection of the mother-infant pairs included infants weighing at least 2500 g, healthy mothers who intended to breast-feed, and mothers who had completed the entire 12 months of follow-up. Sites were then randomly assigned to receive an experimental intervention or a control intervention. In the results, infants from the intervention sites were significantly more likely than control infants to be breast-fed to any degree at 12 months; were more likely to be exclusively breast-fed at 3 months and at 6 months; and had a significant reduction in the risk of 1 or more gastrointestinal tract (GIT) infections and of atopic eczema. However, no significant reduction in respiratory tract infection was found in the intervention compared to the control group. Overall, it can be concluded that experimental intervention increased the duration and degree of breast-feeding and decreased the risk of GIT infection and atopic eczema in the first year of life. These results provide a solid scientific underpinning for future interventions to promote breast-feeding.
Breastfeeding in Belarus [editorial]
In this editorial, the findings of the Promotion of Breastfeeding Intervention Trial (PROBIT) study are discussed. The study involved more than 17,000 mother-infant pairs recruited from the maternity hospitals and polyclinics in the Republic of Belarus. Mother and infants were randomly assigned, cluster by cluster, to a breast-feeding promotion intervention or to control groups that received no such intervention. Overall, findings revealed that infants who were breast-fed were less likely to have gastrointestinal infections and atopic eczema in the first year of life than infants in the control group. However, there was no significant difference in respiratory tract infections between intervention and control groups. These findings suggest the need to promote breast-feeding for infants in Belarus.
HIV / AIDS and child care: facilitator's guide.
This Facilitator's Guide aimed to prepare parents and educators to welcome HIV-infected children into child care and to develop policies that serve the best interests of all children attending child care. The Guide is created to give professors of early childhood education and child care supervisors strategies for helping their students, staff and parents to assimilate facts about HIV/AIDS and come to terms with their feelings about HIV. Moreover, this guide is divided into six questions chosen to elicit discussion of the issues that most concern caregivers and parents. Because people learn most effectively when they discover the answers for themselves, the methodology is designed to encourage active participation. By brainstorming, debate and role-playing, participants can express their concerns and come to understand the material on a personal level, all under the careful guidance of the facilitator.
Accelerating an AIDS vaccine for developing countries: recommendations for the World Bank.
This paper presents the findings and recommendations of the World Bank AIDS Vaccine Task Force, formed in April 1998 to identify how institutions can accelerate the development of an AIDS vaccine for developing countries, as part of its broader program to combat AIDS, and in collaboration with its international and development partners. The World Bank has already taken important steps to reduce the impact of the AIDS epidemic through lending for AIDS prevention and care, analytic publications, participation in international partnerships, and launching of an anti-AIDS initiative in Africa. Nevertheless, progress on potentially one of the most important interventions--a preventive AIDS vaccine--is slow. This is caused by several barriers, such as the cost of the technology for an HIV vaccine, lack of financial investments from international agencies, and policy constraints. Based on existing studies of the economics of AIDS vaccine development and demand, review of a broad range of existing and potential mechanisms to promote an AIDS vaccine, and consultations with industry, international donors, and developing countries, the recommendations of the AIDS Vaccine Task Force for the promotion of international efforts in HIV vaccine development are highlighted.
Because of the profound economic impact of AIDS, the World Bank considers AIDS as a core economic development issue and has made a major commitment to continue and expand lending for AIDS prevention and care. In addition, an internal Task Force is exploring innovative ways that the Bank can stimulate rapid development of an AIDS vaccine that will be effective and affordable in low-income countries. Representatives of the Bank's AIDS Vaccine Task Force and the New Delhi Office met with Indian policy-makers on August 18 to share the findings of the Task Force and to solicit the policy-makers' views on how the Bank can accelerate AIDS vaccine development in India and globally. The participants felt that a strategic plan for development of an AIDS vaccine in India should be part of the overall national AIDS control strategy. The World Bank can assist in this program through future lending for vaccine research and development; International Finance Corporation financing of improvements and expansion of vaccine production; and technical assistance in the design of studies of Indian industry's perspectives on AIDS vaccines and of the potential public and private demand. (author's)
On July 27, 1999, the South African Medical Research Council hosted a consultative meeting on ways in which international agencies could accelerate development of an AIDS vaccine that is effective and affordable for developing countries. 37 senior policy-makers from South Africa and the region, South African researchers, and other stakeholders participated in the meeting. The issues paper, "Accelerating an AIDS vaccine for developing countries: Issues and Options for the World Bank," and the report of the European Union (EU) Brussels Vaccine Consultation served as background for the meeting. Issues regarding the global status and prospects of HIV/AIDS vaccine development, the South Africa AIDS Vaccine Initiative, the analysis of the business costs and response of a major South African employer, the results of the industry study and issues in estimating potential demand, and the options the World Bank and EU are considering were emphasized in the meeting.
This paper summarizes the findings of the Kaiser Family Foundation survey on abortion delivery in the US, based on a sample of 307 obstetrician/gynecologists (OB/GYNs). The survey on Physicians' Attitudes and Practices Related to Contraception and Family Planning was conducted between February 1 and March 21, 1995. The survey found that fewer than 3 out of 10 OB/GYNs aged under 40 perform abortions compared with 4 out of 10 of their colleagues aged 50 and older. Findings also revealed that the type and location of a practice are significant with regard to whether or not an OB/GYN will perform abortions. Overall, the Kaiser survey found that only one-third (33%) of OB/GYNs currently in practice perform abortions. These findings have some implications for how the performance of abortions may change in the future.
This paper presents charts depicting data and estimates of the 1995 Survey of Obstetrician/Gynecologists (OB/GYNs) on Contraception and Unplanned Pregnancy: Attitudes and Practices with Regard to Abortion in the US. Eight charts are included. Chart 1 gives a clear indication that there is a significant decline in the number of OB/GYNs who perform abortions. Charts 2-6 provide data on the characteristics of OB/GYNs performing abortions according to age, region and area, gender, and type of medical practice. Finally, charts 7 and 8 provide an estimate concerning the attitude of physicians towards nonsurgical abortion.
Thailand's response to AIDS: building on success, confronting the future.
This report was commissioned by the World Bank Office Bangkok to address two issues of interest to both internal and external audiences concerned with global AIDS epidemic: 1) the lessons learned from Thailand's response to the AIDS epidemic for other countries in the region and the world; 2) the highest priority activities adopted for improving the effectiveness of the response to AIDS in Thailand. The report team consulted widely with key informants in Thailand and drew on the existing literature and their own areas of expertise in response to the issues. Chapter 1 is an introduction and summary. Chapter 2 reviews the evolution of the HIV/AIDS epidemic in Thailand, the government response and its impact, and the lessons for the international community. The 3rd chapter reviews the status of the HIV/AIDS epidemic in Thailand, highlighting important trends in the spread of HIV and its impact that are of concern in the next phase of the response. Chapter 4 proposes a framework for setting priorities for the next phase of the national response. The 5th and final chapter summarizes the findings and gives recommendations.
It is estimated that one-sixth of the people in the world are in their early years of sexual maturity, and these adolescents and young adults have the highest rates of unwanted pregnancy and transmission of sexually transmitted diseases (STDs). This summary report presents findings and insights concerning the prevention of unplanned pregnancy among adolescents and young adults. The report includes interviews and group discussions with program organizers and developers, program directors, field workers, and young adult populations in Thailand, the Philippines, India, and Kenya. Insights gained from the study include: 1) education can substantially reduce population growth; 2) reproductive health is a much more accessible and compelling issue than world population; 3) the hunger for sex-related information is profound and universal; 4) reproductive health education enables informed choices, which can propagate hope for better future; 5) sex is considered a big taboo; and 6) most young people do not seek assistance because of the sexual taboo. Recommendations for the prevention of unwanted pregnancies in the younger population are outlined.
It is estimated that one-sixth of the people in the world are in their early years of sexual maturity, and these adolescents and young adults have the highest rates of unwanted pregnancy and transmission of sexually transmitted diseases (STDs). In this report, the findings and insights concerning the prevention of unplanned pregnancy among adolescents and young adults are presented. The report includes interviews and group discussions with program organizers and developers, program directors, field workers, and young adult populations in Thailand, the Philippines, India and Kenya. Insights gained from the study include: 1) education can substantially reduce population growth; 2) reproductive health is a much more accessible and compelling issue than world population; 3) the hunger for sex-related information is profound and universal; 4) reproductive health education enables informed choices, which can propagate hope for better future; 5) sex is considered a big taboo; and 6) most young people do not seek assistance because of the sexual taboo. Recommendations for the prevention of unwanted pregnancies in the younger population are outlined.
The overall goal of the final evaluation of the Child Survival IX, International Eye Foundation (IEF), is to assess the impact, effectiveness, and sustainability of the program in the Alta Verapaz province, Guatemala. Between April 16 and May 2, 1997, visits were made to four project communities randomly selected in order to observe educational activities, cooking demonstrations, and home gardens; and to conduct focus groups and interviews with community health volunteers (CHV), mothers, and religious and community leaders. A knowledge, practices and coverage survey was completed from March 31 to April 16, 1997, which provided data on mothers' knowledge and practices and coverage information, in addition to qualitative data collected during site visits. IEF has developed a network of CHVs, which provide education and some basic health services to mothers. The results of the efforts in almost all categories of workers are impressive. Specific accomplishments include: vaccination coverage of children 12-23 months old was 43%, excluding bacillus Calmette-Guerin, 44% of diarrhea cases in children 0-23 months old were treated with oral rehydration therapy, and 87% of children received vitamin A. The project has also implemented Quality Assurance methods, and project interventions were applicable to the needs of the community and well coordinated with collaborating institutions. The results of this evaluation have significant implications for the transfer of current activities, and they provide reinforcement for the counterparts that will include the recommendations in their program activities.
Kosovar men and boys against violence against women.
The White Ribbon Campaign is the largest effort initiated by men to end men's violence against women in Kosova. This paper begins by providing an overview of the concept of domestic violence, acquaintance or date rape, and sexual exploitation. It then presents some of the 70 incidents of violence against women reported to the police, as well as statistics on violence against women in Kosova drawn from a survey of 213 women in Spring 2000 throughout Kosova. Tips on how to help a victim of domestic violence were also provided. These interventions are directed towards women’s regaining power over their lives and encouraging them to act for their own well-being and safety.
Pushing and pulling HIV / AIDS vaccines.
This paper aims to provide a brief background of the economic issues that justify public sector intervention in the HIV/AIDS vaccine market, to provide a menu of options for "technology push" and "demand pull" interventions by the public sector, as well as to stimulate Internet Forum participants to contribute additional options to this menu. Technology research and development is driven by market forces. Demands for high return on investment result in a lack of investment capital for technologies for the poor, such as an HIV/AIDS vaccine. High fixed costs, high risks, and high barriers to market entry combined with intellectual property protection result in a lack of lower priced substitutes for HIV/AIDS vaccines. In addition, there is market failure due to positive externalities, natural monopoly, and information asymmetry. However, there are ways to address these market characteristics and market failures by the public sector through both technology push and demand pull. This Internet Forum is a chance to examine options, rate them, and propose a package of options to catalyze further progress in HIV/AIDS vaccine development.
The Ministry of Health of Brazil and the AIDS Vaccine Task Force of the World Bank (WB) convened a consultative meeting on September 14, 1999, to share the Task Force's findings regarding the mechanisms available to the Bank to accelerate the development of an AIDS vaccine and to solicit the views of Brazilian policymakers, scientists, and nongovernmental organizations on these issues. Over half a million people in Brazil are currently infected with HIV. It was evident that the country has many of the necessary elements for a successful vaccine development program--political commitment to fight AIDS, a sizeable and costly AIDS epidemic, capable scientists, good manufacturing capability, and key public support. However, no phase III trials have been conducted there. Researchers are divided regarding Brazil's readiness to engage in Phase III trials, and product development capability is lacking. Stringent ethical standards for product testing may be discouraging some firms from conducting Phase III trials in the country. Brazil is in the process of developing a more proactive vaccine development strategy. The WB can help by forging public-private partnerships for vaccine development.
Tools for service providers working with victims of gender-based violence.
This document contains a four forms currently being developed to address gender-based violence (GBV) in the context of sexual and reproductive health care. The forms are not final products, and International Planned Parenthood Federation, Western Hemisphere Region welcomes reader suggestions and comments. The Screening Tool assists service providers by giving simple and direct questions to ask clients about different types of violence. Designed to accompany the Screening Tool, the Sample Stamp for Client Intake Form allows providers to adapt their client intake forms easily to include information about gender-based violence. The Management Checklist is designed to help coordinators ensure that the most essential steps in the process of developing a GBV project are being carried out effectively. The last form, a Legal Guide for Service Providers, provides a legal framework for service providers treating clients who have faced gender-based violence.
Domestic violence against women and girls.
Violence against women and girls continues to be a global epidemic that kills, tortures, and maims--physically, psychologically, sexually, and economically. This paper focuses specifically on domestic violence, the most prevalent yet relatively hidden and ignored form of violence against women and girls. Studies estimate that from country to country, 20-50% of women have experienced physical violence at the hands of an intimate partner or family member. For the purpose of this paper, the term domestic violence includes violence against women and girls by an intimate partner, including a cohabiting partner, and by other family members, whether this violence occurs within or beyond the confines of the home. It attempts to illustrate the magnitude and universality of domestic violence against women and girls and its impact on the rights of women and children. It also emphasizes the need for coordinated and integrated policy responses; enhancing partnerships between stakeholders; setting up mechanisms for monitoring and evaluating programs and policies; implementing existing legislation; and ensuring greater transparency and accountability from governments in order to eliminate violence against women and girls.
Over the years, nongovernmental organizations (NGOs) have been working to develop and implement media advocacy strategies as an important way to inform the public and influence policy makers on critical issues. These coordinated media efforts have been designed to: ensure that internal family planning (IFP) issues are reported consistently, accurately and completely in a variety of media; inform journalists of newsworthy events and developments that affect IFP issues; counter the opposition by responding in a timely and collective manner to negative media on IFP issues; and develop initiatives to place the community's own message and positions before the press and the public on a regular basis. It is against this backdrop that the Communications Consortium Media Center and NGO partners are working to move media advocacy on IFP issues to a higher and more sophisticated level by developing an IFP Media Response Initiative (MRI). These efforts are being coordinated as a part of the PLANet campaign to include both the PLANet partners and a wider group of NGOs. In this report, the design and implementation of the MRI for IFP programs are outlined.
This annual report summarizes the activities carried out by the International Planned Parenthood Federation, Western Hemisphere Region (IPPF/WHR) during the year 1999. The 44 member affiliates of IPPF/WHR provided almost 10 million services, a 14% increase over last year. While family planning services continue to make up the bulk of the programs (45%), the number of other sexual and reproductive health services grew by 23% since 1998. These statistics reflect a commitment to integrating services, in addition to family planning, regarding other aspects of people's sexual and reproductive health. One of the most important initiatives that the Regional Office undertook in 1999 to address some of the underlying issues that affect sexual and reproductive health is a 3-year project to combat gender-based violence. With this initiative, IPPF/WHR is at the forefront of developing strategies and tools for incorporating screening, counseling and medical care and referrals for victims of violence into services provided by sexual and reproductive health clinics. It is hoped that IPPF/WHR will continue to take on projects like this in order to meet the diverse needs of the people being served.
In September 1994, the Cairo International Conference on Population and Development announced a significant change of paradigm in the topic of population and development. In the new paradigm, population policies and programs are no longer directed towards demographic targets but to the reproductive health of individual men and women. Consequently, the Population Research Center, University of Groningen, the Netherlands, and the Population Research Center, Institute of Economic Research, Dharwad, Karnataka, India, initiated joint research on reproductive health and child spacing. This report is a background paper for the research project. It adopts a process-context perspective, which states that reproductive health behavior involves a series of individual decisions and actions during a life course and within a social, economic, ecological and cultural context. Chapter 1 presents the introduction of the research study. Chapter 2 discusses the theoretical framework and background of the research project. Chapter 3 focuses on the demographic context of India and more particularly the state of Karnataka, and in addition, presents a short review of the history of Indian family planning programs. Chapter 4 describes the historical, ecological, economic, social, and cultural context in 11 villages of India. The Indian context of the reproductive career and child spacing behavior is discussed in chapter 5, while the proximate determinants of child spacing behavior in India are described in chapter 6. The seventh and final chapter reports the actual research project.
Reproductive health and child spacing in rural South India: survey basic report.
This report presents the survey results of the research project “Reproductive health and child spacing in rural South India,” carried out jointly by the Population Research Center, University of Groningen, the Netherlands, and the Population Research Center, Institute of Economic Research, Dharwad, India. The survey was conducted from January to April 1997 among 951 women who were married and had at least 1 living child. The report presents actual child spacing behavior such as the duration of birth intervals and the constitutive proximate determinants of postpartum amenorrhea and breast-feeding, postpartum abstinence, and the use of contraceptives. In addition, child spacing behavior is situated in the reproductive career and related to other reproductive events such as menarche, marriage and pregnancy outcomes. While earlier census reports focused on the socioeconomic status of the households in which women live and the demographic characteristics of the research population, this survey includes more information on the status, decision making power and autonomy of women. Moreover, perceptions and beliefs of women themselves regarding child spacing behavior are presented.
Evaluation of health care system: some guidelines.
Seven years have already passed since the Alma Ata Conference, and we are left with hardly 15 years for reaching the goal of “HEALTH FOR ALL BY 2000 A.D.” It is high time to conduct comprehensive studies based on all vital components of primary health care viz. community member, community leader, government health care programs, private medical practitioners, nongovernmental agencies and multisectoral development programs and their respective role in health care system, which in turn, will help the personnel on the health policy and administrative front to streamline their efforts for achieving the goal. (author's)
Health care system in India: need for comprehensive evaluation.
Health is not merely the absence of disease. It has been recognized that health is a function of the overall integrated development of the society, and health status is one of the indicators of quality of life. In India, the health care system is operationalized on a three-tier system: Central, State and District. Despite this three-tier system, studies conducted on the utilization of existing health care services evidenced the very poor image the government health centers have among the people. The unsatisfactory behavior of the staff at the health centers, the long distance, the non-availability of drugs and lack of faith in doctor's treatment are some of the major factors responsible for the poor utilization of government hospital services. Since the Alma Ata declaration was adopted by India, the country evolved its own policies and strategies on the basis of the primary health care concept to achieve the goal of “Health for All by 2000.” Primary health care with its elements of community participation, universal coverage and accessibility; appropriate health technology; and care by community health workers or by traditional health workers require effective implementation of multisectoral developmental programs. Moreover, maximum community participation and involvement of nongovernmental organizations are needed in achieving total health care.
Factors influencing differential utilisation of government hospitals.
This study examined the factors influencing differential utilization of government hospitals in two regions of Andhra Pradesh; namely, Coastal Andhra and Rayalaseema. Opinions from 600 heads of household were gathered on existing health care facilities at the government hospitals of their area due to their visit or other family member's visit. The study focused on hospital utilization variables such as: satisfaction derived from government hospitals, distance between the house and hospital, cost per trip to visit the hospital, time taken to visit the hospital, and service acceptability factors. It is found that distance, transportation, doctor-patient ratio, and type of service rendered differ significantly between the two regions. The analysis of service acceptability factors uniformly confirmed that the present pattern of health delivery at government hospitals is not satisfactory to a large majority of clients. Given the region-wise disparities in the existing health service facilities and its utilization by the public, it should be a policy concern for the government to strengthen infrastructural facilities.
Update: measles outbreak in Haiti.
Since its nationwide catch-up vaccination campaign against measles in 1994, Haiti remained free of measles for 6 years. However, level of routine immunization coverage remained low during these years, rendering the country at risk for a new measles epidemic, with over 1 million susceptible children. On March 8, 2000, an epidemic outbreak was reported in Haiti. By October 28, 2000, passive surveillance had reported 596 suspected cases; 467 of these have been confirmed as measles. The age-specific attack rates have been highest for children 1-4 years old (31/1000) and for infants 6-12 months old (29/1000). The early response to the outbreak was a door-to-door campaign of measles vaccination for all children 6 months to 14 years old, with coverage greater than 95%. In cities where the campaign was conducted, the epidemic ended in 2 weeks. In low coverage areas, however, cases have continued to be reported.
Measles outbreak in Venezuela.
From August through October 2000, four measles outbreaks have been reported in southeastern Venezuela. As of November 2, the total number of confirmed cases is 17; of these 16 have been confirmed by laboratory and 1 through epidemiological link. This article presents a preliminary summary report on these outbreaks. In outbreak 1, 6 cases were reported in the same family of the Cacique Mara parish, with ages ranging from 10 months to 12 years. All except 1 were unvaccinated. In outbreak 2, only 1 case was reported in a 10-month-old, unvaccinated child. In the 3rd outbreak, 9 cases between 11 months and 21 years were reported in a family and their contacts. 6 of them had never been vaccinated, 2 were vaccinated, and 1 had an unknown vaccination status. In outbreak 4, only 1 case was reported in a 2-year-old, vaccinated child. No epidemiological links between the four outbreaks have been identified so far.
Despite the extraordinary progress toward measles control since 1989, measles remains the leading cause of childhood vaccine-preventable deaths worldwide. Five strategies are recommended for measles reduction or elimination: 1) strengthening routine immunization, 2) ensuring that all children have a second opportunity for measles vaccination, 3) disease surveillance with integration of epidemiological and laboratory information, 4) vitamin A supplementation through immunization services, where appropriate, and 5) adequate case management for every measles case. It is recommended that the Global Alliance for Vaccines and Immunization (GAVI) support accelerated global measles control through explicit commitment and financial resources. The aim of GAVI to ensure that 80% of developing countries have routine coverage of at least 80% in all districts by 2005 is an important first step in reducing the disease burden of measles.
Types and patterns of later-life migration.
This paper refines previous typologies of later-life mobility by explicitly evaluating the spatial migration patterns and household characteristics of retired American migrants. Migrants' life-course attributes (economic status, disability, presence of spouse), large-scale migration patterns (internal migration) and household characteristics (living arrangements, economic independence, residential independence) are used to identify three types of post-retirement mobility. The first type, amenity migration, has a distinctive spatial pattern that suggests a search for attractive climate and leisure amenities. The second type of mobility, assistance migration, can be traced to low income and the absence of a spouse in the household. It often results in residential and economic dependence--specifically, in co-residence with adult children or other labor force members. The third type of mobility, migration in response to severe disability and spouse absence, tends to result in nursing home residence. While amenity migration has long been associated with good health and favorable economic status, this analysis reveals that many disabled and lower-income retirees share the in-migration pattern typical of amenity migrants. In fact, amenity migration is the predominant type of mobility among those migrants with fewer than two unfavorable life course attributes (low income, severe disability and spouse absence). Unlike previous life-course typologies, this study shows no clear relationship between moderate disability and co-residence with adult children. The results suggest that co-residence is primarily a strategy for reducing living costs rather than a means of coping with moderate disability. (author's)
Hospital utilization in rural areas.
This paper was undertaken to study the differential levels of utilization of health services in India, focusing on hospital utilization. In this study, hospital utilization factors, such as the distance between the house and hospital, cost per trip to visit the hospital, time taken to visit the hospital, satisfaction derived from government hospitals, and service acceptability, were determined in two regions and two cultural groups. Multi-stage random sampling technique was adopted for the selection sample, and a total of 600 respondents constituted the total sample size of the study. Distance, transportation, doctor-patient ratio, and type of service rendered differ significantly between the two regions and two cultural groups. Thus, it should be a policy concern to strengthen infrastructures, keeping in view the region-wise disparities in the existing health facilities. The analysis of service acceptability factors uniformly confirmed that the present pattern of health delivery at the hospitals is not satisfactory to a very large proportion of the clients. The dissatisfaction of clients would suggest that they do not attach importance to the advice of hospital personnel. To increase the credibility of the service personnel and also to increase the influence of these persons among the clients, better amenities may have to be provided.
On utilisation of maternity and child health services in rural Jammu, India.
This study examined the extent of utilization of family planning (FP) and maternal and child health (MCH) services in rural areas of Jamma, India. Information was collected on three types of villages: 1) villages with a Primary Health Center (PHC); 2) villages with a Sub-Center (SC); and 3) villages with no PHC or SC. Prevailing pattern of awareness and utilization of MCH services were assessed through information supplied by the sample of eligible women regarding the availability of MCH services, knowledge regarding home visits by health workers for MCH advice and guidance, prenatal, delivery, and postnatal care apart from the usual pregnancy histories and family planning. Overall, findings revealed that PHC is the most known governmental institution for health care, followed by district hospital, SC and government dispensary among respondents from SC villages and other villages. Respondents were mainly aware of availability of curative services in case of illness and preventive services at the government health institution. They were less aware of services and advice for maternity care and family planning. Knowledge regarding health workers providing medical advice and services at the village level through home visits is very poor, especially in PHC villages. It is also shown that despite a high level of registration for prenatal care; most of the deliveries were at home and were assisted by untrained persons. In addition, the immunization rate was low for children 0-3 years old.
A Primary Health Center (PHC) can be considered a basic unit of delivery of health care. An effective referral system can lead to savings in the tertiary care, and an interaction between the PHC personnel and personnel of the referral hospital will help develop common strategies for the benefit of the community. In this paper, an alternative strategy for the improvement of health care delivery, primary health care, and the referral system in India is discussed. This new suggested system would implement integrated, community-oriented teaching. Training to produce primary care physicians capable of developing a referral system would be flexible. In the alternate system, regulated, intensive physician training for all areas will be made available. Physicians with explicit minimal educational requirements will have access to training for service entry at the PHC.
Zimbabwe Demographic and Health Survey, 1999.
This report represents the major findings of the 1999 Zimbabwe Demographic and Health Survey (ZDHS) conducted by the Central Statistic Office between August and November 1999 in 10 provinces of Zimbabwe. This report provides up-to-date information on fertility levels, nuptiality, sexual activity, fertility preferences, awareness and use of family planning methods, breast-feeding practices, nutritional status of mothers and young children, early childhood mortality and maternal mortality, maternal and child health, and awareness and behavior regarding AIDS and other sexually transmitted diseases, including HIV/AIDS. Chapter 1 introduces the geographical location and economic situation of Zimbabwe. Chapter 2 presents information on some socioeconomic characteristics and an environmental profile of respondents, while some demographic and socioeconomic characteristics are discussed in chapter 3. Chapter 4 focuses on fertility differentials and trends. Chapter 5 discussed the need for family planning programs among sexually active women. Chapter 6 delineates other proximate determinants of fertility, while chapter 7 deals with fertility preferences of respondents. Chapter 8 presents information on levels, trends, and differentials in neonatal, postneonatal, infant and child mortality. Chapter 9 discusses reproductive and child health. Chapter 10 evaluates infant feeding and childhood and maternal nutrition. Chapter 11 assesses the prevalence of AIDS and other sexually transmitted diseases. Finally, chapter 12 presents adult and maternal mortality estimates.
USAID support for family planning and reproductive health programs in Brazil.
The US Agency for International Development (USAID) supported family planning and reproductive health programs in Brazil for more than 30 years. From 1992 to 2000, the program experienced shifts in overall strategy, program design, and funding, as well as successes and failures. USAID support for family planning and reproductive health programs in Brazil can be divided into three distinct periods. The first period was the longest phase of support, from the late 1960s until 1988. The program then had a transition phase from 1989 to 1992 as it began to reshape its focus. The final phase lasted from mid-1992 to September 2000. For the final period, USAID shifted its program emphasis and clearly stated the agency's intent to phase out program support for family planning in Brazil by September 2000. This report briefly summarizes the early periods of USAID support and highlights the major accomplishments during the final phase of the program. It is designed to provide program managers, policymakers, and international donors with insights on program achievements and lessons learned, and to identify opportunities and models for future replication and expansion both within Brazil and in other countries.
An annotated bibliography of: information on adolescent sexuality in Dar es Salaam.
This annotated bibliography synthesizes available information about the nature and extent of adolescent sexuality in Tanzania with particular reference and emphasis to the Dar es Salaam region. It reviews any available published or unpublished information that provides indications of sexual involvement by the youth. It is noted that boys and girls start experiencing sex early in life, hence, early childbearing appears to be quite common in the country. In one study, 53% of the women got married below the age of 16 years, and of these 31% could not finish their primary education due to pregnancy. Maternal mortality and pregnancy-related morbidity are very high in Tanzania, and several studies show that teenage motherhood significantly contributes to this situation. Studies attribute the high involvement in sex by the youth to many factors, including: poor housing leading to overcrowding; lack of employment and poor socioeconomic status, which attracts girls to sex for money; breakdown of traditional and cultural ways of life and norms and adoption of modern lifestyles; weak family structures and instability of marriages; lax parental, guardian, care, and institutionalized information/education about sex, bad behavior by adults; and peer pressure. In these perspectives, plans of action and programs geared towards addressing issues related to teenage sexuality must be instituted. The programs must address relevant issues to various identifiable youth groups, which will have different needs.
Any assessment of the general health of family life in the US and the well-being of family members, especially children, requires a look at what is known about demographic and socioeconomic trends that affect families. The latter half of the 20th century was characterized by tumultuous change in the economy, civil rights, and sexual freedom, and by dramatic improvements in health and longevity. Marriage and family life felt most of the impact in these societal changes. These changes include new emerging norms about the desirability of marriage, the optimal timing of children, and the involvement of fathers in childbearing and of mothers in bread winning. In this issue of the Population Bulletin, a description of the American family in the latter half of the 20th century and the socioeconomic changes it has undergone are discussed. Implications for the future of the American family are highlighted.
Population and vital statistics report. Data available as of 1 January 2000.
This report presents 1998 and 1999 estimates of world and continental population, as well as the corresponding 1998 estimates for 229 countries or areas of the world. Also reflected for each country or area are the results of the latest nationwide census of population (total male and female), and wherever possible, nationally representative statistics of live births, deaths, and infant deaths for the most recent year available. If no census has been carried out but the results of a nationwide sample survey are available, the survey results are shown in the "Latest population census" column. Countries or areas are arranged in alphabetical order within continents.
Community mobilization to mitigate the impacts of HIV / AIDS.
Not only do families and communities receive the greatest impact of HIV/AIDS, they are the front line response to the health and welfare problems caused by the epidemic. This article discusses development activities dealing with mitigating the disease's negative consequences in developing countries. It highlights the features of successful community mobilization. Other issues related to HIV/AIDS impact mitigation projects are also discussed, including scale and sustainability, linking care and prevention, and intersectoral partnering. The paper identifies challenges of community mobilization: how to scale up operations to match the scope of the HIV/AIDS epidemic, and how to sustain community mobilization over the long run. Guidelines are provided for catalysts and donors.
Africa continues to be the continent hardest hit by the AIDS epidemic. Worldwide, over 33 million people have been infected with HIV and nearly 12 million have died of AIDS; over two-thirds live in sub-Saharan Africa. African children and women have been particularly impacted by the epidemic. The Joint UN Programme on HIV/AIDS reports that 87% of the world's children living with HIV and 4 out of 5 HIV-positive women are in Africa. Many social and economic factors fostered the spread of HIV in the continent. These include migratory labor movements that encourage multiple partners; poverty and low skills base of women, which can lead them to sex work; and the widespread stigma and discrimination that slows down prevention effort resulting from ignorance. In this article, the social and economic impact of the AIDS epidemic across Africa are addressed. The article outlines strategies to help contain the epidemic, with emphasis on prevention through behavioral risk reduction, care and support for people living with AIDS, and efforts to mitigate the impact of AIDS on those infected and affected by this disease. It also highlights a number of success stories on HIV/AIDS prevention in Africa, and suggests potential actions ambassadors can take in promoting effective HIV/AIDS programming.
AIDS has the potential to create a severe economic impact in many African countries. It causes a reduction in the size and experience of the labor force, increases health care expenditures, raises the costs of labor, and reduces savings and investment. Economic effects will vary according to the severity of AIDS epidemic and the structure of the national economies. The major effects are a reduction in the labor supply and increased costs. This article looks at the economic impact of AIDS on households, agriculture, firms, and other economic sectors including health, transportation, mining, education, water, and civil servants and the military, as well as the macroeconomic impact of the disease. It also suggests measures to contain the epidemic and mitigate its negative effects. Among the responses necessary are preventing new infections, appropriately designing major development projects, programs to address specific problems, and mitigating the effects of AIDS on poverty.
USAID combatting AIDS: a record of accomplishment.
The US government continues to be the world leader in responding to the global AIDS pandemic. The US Agency for International Development (USAID) has dedicated over US $1.2 billion for the prevention and mitigation of this epidemic in the developing world. USAID is working in 46 of the hardest hit countries around the world, mostly through the nongovernmental organizations. USAID has achieved success in the following areas: educating people to prevent AIDS, reducing HIV prevalence in young adults in Uganda, maintaining low HIV prevalence, reducing sexually transmitted infections and increasing the distribution of condoms. USAID is also successful in supporting voluntary testing and counseling, involving communities in the fight against AIDS and supporting civil society groups in this effort, developing technologies to fight transmission, assisting children affected by AIDS, and collaborating with other major donors.
This USAID paper discusses accelerating the implementation of HIV/AIDS prevention and mitigation programs in Africa. It aims to: 1) share experiences in dealing with constraints to expanding and improving HIV/AIDS program implementation; and 2) identify issues in developing a bolder response commensurate with the gravity of the expanding HIV/AIDS pandemic in the region. It is understood that successful HIV/AIDS implementation programs in African countries require commitment, capacity, coordination, and cost. Addressing the implementation constraints necessitates establishing a rapid or emergency response team; forming donor consortia to ensure funding for a basic package of interventions; establishing a training fund; developing operational strategies to implement advocacy efforts; stimulating private sector interest; intensifying efforts to make multisectoral programs work; and formulating a well-defined agenda for analytical work.
Designing quality essential obstetric care services in Honduras.
This case study describes how quality design methodology was applied by three waves of teams to improve the quality and accessibility of obstetric care in the Comayagua and La Paz regions of Honduras. As part of the Latin American and Caribbean Regional Initiative to Reduce Maternal Mortality, the Quality Assurance Project is facilitating the design of quality obstetric care processes at hospitals and health centers in Honduras. Composed of health staff and community leaders from six Honduran municipalities, the teams applied the 10-step quality design methodology to improve a variety of hospital processes. These include reception and triage, transportation for obstetrical emergencies, referral and counter-referral, medical records, labor monitoring, normal delivery care, prenatal care, postpartum care, management of complications, and neonatal care. Overall, regional capacity to deliver quality obstetric care has been enhanced by the coordination and information sharing between quality design teams.
Authenticity of family planning performance statistics in Dharwad district, Karnataka.
This study investigates the extent of discrepancies in the performance statistics on family planning methods. It also verifies, in the field, the genuineness of the reported acceptors for the 2-year period from April 1997 to March 1999. Conducted in 6 Primary Health Centers (PHCs) in Dharwad district of Karnataka state, India, field investigations of 12 subcenters from the PHCs obtained data on discrepancies. Results show that there are variations in the reported performance in the family planning methods between district, PHC and subcenter levels. There is also a large-scale falsification of family planning performance, especially for the temporary method. The falsification has not reduced even after the introduction of a target-free approach. All efforts are needed to strengthen the management information system and to ensure the reliability of the program performance statistics.
This report presents the findings of the survey to evaluate the family welfare program under the target-free approach in India’s Bijapur district of Karnataka during the period of 1997-98. It intends mainly to communicate the basic findings of the rapid survey with regard to the coverage of maternal-child health and family planning services, as well as client satisfaction with the services provided by the government health infrastructure available in rural areas. The survey used a multi-state design and selected as respondents 1000 married women from a total of 25 primary health care centers. Results indicate that the general maternal and child health care services situation in the rural areas of the district can be described as poor. Rates are low for utilization of prenatal care and health facilities for delivery, and for child immunizations. Contraceptive prevalence and knowledge of family planning methods are moderate. The quality of family planning services is poor and client satisfaction is low. Based on these findings, several recommendations are cited.
This report presents the results of the rapid survey carried out in India’s rural areas of Bidar District, Karnakata, to evaluate the family welfare program under a target-free approach. The presented findings focus on the coverage of maternal-child health and family planning services, as well as client satisfaction with the services provided by the government health and family welfare system. A total of 1000 eligible women 15-44 years old were interviewed regarding maternal and child health, family planning, and quality of services and client satisfaction. It can be concluded from data on prenatal care, place of delivery and assistance during delivery, and immunization of children that maternal and child health services in the district are poor. In terms of family planning, it is important to emphasize that knowledge of methods is almost universal among the respondents. However, prevalence of family planning is moderate and the need for family planning services arose from the survey. Moreover, quality of services is poor and client satisfaction is low.
Demographic trends in Hubli-Dharwad corporation area: a study based on civil registration data.
The objective of this study was to analyze trends in fertility and mortality measures in Hubli-Dharwad corporation (HDMC) in India since its inception of the Municipal corporation in 1962 to the year of the study, 1992. The study is entirely based on the civil registration data secured from HDMC registers. Data show that there was a decline in crude birth rates (CBRs) and total fertility rates over the years, reaching the replacement level of 2.2 children per woman of reproductive age by 1992. The present CBR level is estimated at 21 per 1000 population. The level of infant mortality rate (IMR) ranged from 27 to 20 per 1000 live births for any year of the observation. Data also reveal that over 70% of births/deaths occurred in hospitals. However, time trend analysis shows that the proportion of births taking place in hospitals has declined and consequently home deliveries are increasing. Births attended by trained dai or doctors have increased over time. Deaths were caused primarily by degenerative diseases, followed by infectious diseases. Finally, seasonal fluctuations in births and deaths have been observed in the population.
Evaluation of Village Health Guide Scheme, Belgaum district, Karnataka.
This evaluation examined the functioning of the Village Health Guide (VHG) scheme in Belgaum District, Karnataka, India, and the community's knowledge and utilization of the scheme as well as the health functionaries' assessment of the functioning of the scheme. Semi-structured interviews were conducted with 94 VHGs, 500 community members, 87 health workers and 18 medical Officers. Findings strongly indicate that the VHG scheme is not functioning well in the district. A major limitation of the present functioning of the scheme is the lack of supply of medicine kits to the VHGs. They continue to receive their honorarium but are not equipped. In addition, the scheme seems to have failed significantly in encouraging community involvement in the provision of health care. The majority of the community was unfamiliar with the scheme. However, the VHGs have been assisting the local health workers in various health programs. While almost all the VHGs received the basic training, they have not been given any additional training since their selection as VHGs. Nonetheless, the majority of respondents feel that the scheme should be continued as VHGs play an important role in promoting immunization, family planning, and conveying health and family welfare messages to the community. Several suggestions were made for strengthening the VHG scheme, including the provision of medicine kit to VHGs, making their services permanent, providing reorientation/refresher training, and increasing their honorarium. Better training, monitoring, and incentives would certainly go a long way in improving the benefits of the scheme to the community.
Quality of life in a globalising world. Population and health. Fifth phase position paper.
Based on papers by Van der Veer (1999) on challenges of globalization and Bagchi (1999) on alternatives in development, this position paper looks at familiar topics in the research theme of Population and Health, such as reproductive health, infant and child health, and health of the elderly. Divided into two sections, this work illustrates the two perspectives of globalization and quality of life by presenting examples. Talking about people, rather than about population (without denying the need for information on population trends at the macro-level), the authors identify the life course as a major perspective in this research theme. Research topics are classified according to different stages in the life course, i.e. infancy and early childhood, late childhood, adolescence, adulthood, reproductive age and old age.
HIV / AIDS care and support for persons living in developing countries.
HIV/AIDS care and support reduce the effect of HIV on individuals by providing physical, psychological, and spiritual assistance, and on affected communities by reinforcing existing systems and creating new systems for coping with the impacts of the disease. Country experience shows that a combination of interventions is very effective in reducing the impact of HIV on affected individuals. These include protecting their human rights and reducing stigma and discrimination, providing psychosocial and socioeconomic support to them and their caregivers, providing palliative care, and preventing and treating opportunistic infections. Moreover, communities need to be empowered in order to identify and implement solutions and to create new community-based resources to respond to the epidemic. These strategies enhance disease prevention and sustainable development. Priorities for HIV/AIDS care and support in developing countries are identified, and the role of the US Agency for International Development in helping people living with HIV/AIDS is discussed.
This document presents the final report of the 30th Women in Management workshop, held from May 1 to June 2, 1995, in Washington, D.C. Organized by the Center for Development and Population Activities, the overall goal of the workshop was to further develop women's management and decision-making skills to build more effective institutions concerned with women's health, empowerment, and improved quality of life. Participants comprised 31 women managers from the fields of population, health, family planning, parent and youth education, economics, and community development from 8 countries in Africa, Asia, and Eastern Europe. The content and training methodologies are discussed in detail in this report, along with the evaluation findings. The main themes and content areas of the workshop were as follows: 1) women's leadership in organizations; 2) women managers; 3) project design; 4) networking; and 5) managing change.
This is the final report of the 29th Women in Management Workshop conducted by the Center for Development and Population Activities (CEDPA) from June 27 to July 29, 1994, in Washington, D.C. The workshop was intended to enhance the understanding of women managers on their leadership roles in the organizations they serve, and to increase their motivation and skills to support local institutional development. Participants comprised 38 women managers in the fields of population, health, family planning, parent and youth education, politics, law, and community development. They came from both public and private sectors from 13 countries worldwide. All activities were aimed at ensuring that the participants would develop the technical, interpersonal, and organization skills needed to play catalytic roles in strengthening local institutional capacity. Also, participants had the opportunity to interact with external resource persons, so that they were able to discuss issues on population and environmental linkages, poverty, sustainability, and women's empowerment. Throughout the workshop, daily post-session evaluations were made and a final workshop evaluation was undertaken by the participants to enable CEDPA to ascertain participant's perceptions of the extent to which session and workshop objectives had been met.
Women's health care and service utilization in Rajasthan.
Antenatal care (ANC) is one of the important indicators of maternal care and safe motherhood programs. This study aims to investigate the factors associated with the utilization of ANC services among women in Rajasthan, India. The data collected in the National Family Health Survey on these aspects during 1992-93 were analyzed using multivariate technique. The analysis focused on 2418 women mothers who had live births during the 4 years prior to the survey. Results indicate substantial differences in the utilization pattern of ANC among women by their socioeconomic characteristics. Furthermore, it is revealed that the acceptance of contraception among women is significantly higher for those who have utilized ANC care services than for those who did not use them. The findings have several policy and program implications that should be disseminated.
A study on recent marriage patterns in two less developed states in India, Rajasthan and Bihar.
This study on recent marriage patterns was conducted in two less developed states, Rajasthan and Bihar, India, during 1980-81. Data were collected through interviews with head of households and currently married women 12-50 years old for the 6 project districts in Bihar and 3 project districts in Rajasthan, covering a sample of 9000 households were used for analysis. Results show that a substantial number of marriages were taking place at a very low age in both states, which is indicative of a pattern of very early marriage among the female population. The average age at marriage and average age of consummation was considerably low in both states (13.4 years and 15.4 years in Rajasthan, respectively; and 13.5 years and 14.8 years in Bihar). There were differentials in mean age at marriage by religion, caste, literacy, occupational status and rural-urban setting of the population. However, literacy and caste play an important role in the determination of age at marriage of females in the states. Moreover, the findings support the negative association between age at effective marriage and fertility in both states. Awareness of the recently promulgated law on legal minimum age at marriage for boys and girls is extremely poor. The findings have important program and research implications for future planning as well as serving the purpose of benchmark data against which the impact of any future education program with regards to age at marriage can be measured.
Report on study of marital dissolution in India.
Various studies in the area of nuptiality analysis have focused mainly on nuptial unions of first marriages as one of the important determinants of the population growth. Relatively less attention have been given to the aspect of marital dissolution in the study of growth and structure of human population. This study aims to probe the levels, patterns, determinants, and consequences of marriage dissolution in India. The major sources of data are publications from Census of India, and some are taken from sample surveys conducted in Bihar and Rajasthan during 1980-81. The analysis indicates that widowhood has declined since the last few decades (1961-81). The mean age at widowhood, which was around 33 years in the decade 1941-51, went up to 36 years in last decade (1971-81). The reduction in the proportion of widowed, divorced, and separated families is due to rapid decline in adult male mortality and, to some extent, an increase in the female age at marriage. While estimates for widowhood differ between urban and rural areas, no significant differences in the proportions of widows by age was found among all religions except for the Sikhs. In all the states more widows have significantly higher participation in the work force than do currently married women. This study has important research and policy implications on the role of government in improving the social well-being of the widowed.
Integrated general health survey in India.
The collection of vital statistics is still not properly organized in India, although certain steps have already been taken in this direction. This paper provides an overview of the integrated general health survey in India. The overall objectives of the survey were 1) to draw a statistically representative sample of the population using the family as the basic unit; 2) to investigate all individuals included in the sample with regard to their biological and social characteristics, anthropometric measurements, state of health and disabilities at the time of the survey and during the previous 12 months and to support this investigation by rapid clinical and laboratory examinations with special reference to nutrition assessment; 3) to follow up the general survey with special surveys of married women, infants, children of preschool age, schoolchildren, and pregnant women; 4) to make a more thorough investigation of sick people aimed at diagnosis, and a special investigation of the circumstances in which the cases of notifiable diseases arise; 5) to investigate families with regard to socioeconomic and biological characteristics, including fertility studies in women; 6) to carry out a sanitary assessment of houses; 7) to investigate villages with respect to communications, environmental conditions, agricultural, industrial and marketing facilities and special institutions; finally, to include dietetic and malaria surveys. The design, methodology, scope and cost of the survey are briefly discussed.