The Mombasa ART Program proposal document, jointly proposed by a partnership of FHI/IMPACT Project, Population Council/Horizons Project and MSH/RPM Plus already contains the outline of the overarching monitoring and evaluation framework and some indicators. This document is intended to supplement the original proposal to describe in detail the monitoring and evaluation (M&E) of pharmaceutical and laboratory capacity building activities for which RPM Plus is responsible. This document outlines the M&E procedures and indicators for monitoring the pharmaceutical and laboratory capacity building activities and also the link with the envisaged unified M&E system of the program. Although this is a supplemental document, primary program goals and objectives are repeated below so that the document can serve as a stand alone reference. (excerpt)
Community-based solutions for effective malaria control: lessons from Mozambique.
Despite being a preventable and treatable disease, malaria continues to rank as a leading cause of mortality in much of the developing world, causing 1.2 million deaths annually. Ninety percent of these deaths occur in sub-Saharan Africa. Pregnant women and young children bear the overwhelming burden of malaria. One in five child deaths in Africa is attributed to malaria; those who survive may suffer recurrent fever, malnutrition, cognitive delays, and in cases of severe malaria, neurological damage. Pregnant women and infants are also highly vulnerable to malaria-induced anemia, premature delivery and low birth weight. Beyond its high contribution to mortality and morbidity, malaria impacts social and economic structures, costing African nations an estimated $10–$12 billion in lost gross domestic product each year. Mozambique is among the ten nations most affected by malaria. Stable transmission rates make malaria Mozambique’s primary cause of morbidity and mortality, resulting in an estimated 44,00–67,000 malaria-specific deaths each year, across all age groups. Because the entire country is malaria endemic, approximately 682,000 pregnant woman and 2.8 million children under age five are at risk. Well known as a disease that both causes and is caused by poverty, malaria significantly burdens Mozambican families, communities, the health system, and national resources. Controlling malaria is one of the nation’s greatest challenges. Country specific data indicate that malaria contributes to 15% of the disease burden in the general population with higher figures for children under 2 years, accounting for 40% of outpatient consultations, 60% of pediatric inpatients, and a third of hospital deaths. (excerpt)
Madagascar Demographic and Health Survey 2003-2004. Key findings.
In Madagascar, almost half of people are under age 15; the proportion of people age 15 to 64 (economically active ages) varies between 50 and 52 percent, and very few (around 3 percent) are over 65. A Malagasy household is made up, on average, of 4.6 people and this mean size varies slightly from 4.7 in rural areas to 4.4 in urban zones. Very few households have 9 or more people (7 percent) although this is more common in rural areas and least common in the capital. Nearly one household in four (22 percent) is headed by a woman. This proportion varies from 21 percent in rural areas to 26 percent in the urban zone. Among children under age 15, two thirds live with their parents (66 percent). Only a very small proportion of children (less than one percent) are orphaned by both father and mother. Despite certain recent improvements, one in five men and about a quarter of women (24 percent) have no education. By comparison, these proportions were 25 percent for men and 29 percent for women in 1997. The proportion of people with no education is higher in rural areas (23 percent for men and 28 percent for women) than in urban zones (9 and 11 percent, respectively). It is in the capital that these proportions are the lowest for both sexes: 2 percent for men and 3 percent for women. Differences are also noted at the provincial level. The proportion of women with no education varies from a minimum of 11 percent in the province of Antananarivo to a maximum of 43 percent in Toliara; for men, this proportion varies from a minimum of 7 percent in the province of Antananarivo to a maximum of 43 percent in Toliara. (excerpt)
USAID / Caucasus / Azerbaijan primary health care assessment, Baku, Azerbaijan.
The health status of Azeri citizens has declined dramatically since independence from the Soviet Union. Survey data indicate that the infant and under five mortality rates have increased to 81 and 92 per 1000 live births, respectively, the highest rates in the E&E region. The leading causes of death in children are acute lower respiratory infections (particularly pneumonia), diarrhea, and neonatal conditions. Malnutrition is widespread with a reported 13 percent of children stunted (low height for age) and 2.4 percent wasted (low weight for age). Anemia in women (40%) and children (32%) is substantial, the prevalence of iodine deficiency disorders is as high as 50-60%, and vitamin A deficiency was found in over 80 percent of children. Fertility is low, but only 12% of couples use modern family planning methods, and abortion remains the major fertility control method. The health of adults has also suffered, and life expectancy has decreased. The leading causes of mortality among adults in Azerbaijan are cardiovascular diseases, cancers, diabetes, and injuries, and these are increasing. A significant portion of the non-communicable disease burden is related to sedentary life styles, obesity, and cigarette and alcohol consumption. According to the World Health Organization (WHO) 2003 World Development Report, life expectancy is 65.8 years, 63 for males and 68.6 for females. The nearly six year lower life expectancy for males indicates serious issues related to their lifestyles, their burden of non-communicable diseases, and poor quality of health care. These issues have an important impact on economic growth and the future productivity of the workforce, as well as on the increased burden of health care financing. (excerpt)
Youth participation guide: assessment, planning, and implementation.
Section I. Conceptual Overview: This short essay provides an overview of the key conceptual issues regarding youth participation. It addresses why youth participation is important, both from a “human rights” perspective put forward by UNICEF and others and from an “impact on program results” perspective. Section II. Background Handouts: This section provides in-depth information on the subtopics involved in youth participation in the form of background reading and handouts for facilitators and participants. Section III. Institutional Assessment and Planning Tool (IAPT): This section helps organizations evaluate the level of youth participation in their institutions and plan for greater youth participation in the future. It assumes that organizations want to explore meaningful youth participation but need guidance. This section includes a tool for conducting an assessment of institutional youth participation and a process to utilize the assessment results to develop a work plan for involving youth at the institutional level. Section IV. Youth-Adult Partnership Training Curriculum: The training curriculum is designed to build the skills of individuals and organizations to engage and involve youth and adults more fully in youth RH and HIV/AIDS program design, development, implementation, and evaluation. The curriculum emphasizes how youth-adult partnerships strengthen youth RH and HIV/AIDS programming by facilitating a process that builds a better understanding of the different needs and styles of youth and adults in the workplace. For those groups with sufficient time, it includes a section on planning specific activities for greater youth involvement. It includes PowerPoint slides, which are on the CD-Rom in the binder sleeve. (excerpt)
2004 world population data sheet of the Population Reference Bureau.
For the first time, the United Nations has produced a time series for the country estimates of HIV/AIDS prevalence. UNAIDS. country-level estimates are reworked every two years based on updated information from sentinel sites, where samples of groups such as patients at STD clinics and women at antenatal care clinics are tested for the disease; and from surveys and other research. UNAIDS estimates that, globally, 1.1 percent of adults ages 15-49 were living with HIV/AIDS at the end of 2003, up from 1.0 percent two years before. In sub-Saharan Africa, the estimates provide hope for that region, the world’s hardest-hit. Prevalence declined from 7.6 percent to 7.5 percent over the 2001-2003 period. Looking at the trend over that period, 14 African countries are estimated to have had a decline in their HIV/AIDS prevalence, led by Kenya and Uganda. In contrast, 24 African countries are believed to have shown either no decrease or a rise in HIV/AIDS prevalence. UNAIDS estimates that about 2.9 million adults and children died of AIDS in 2003, and that the number of children orphaned by the disease rose from 11.5 million in 2001 to 15.0 million in 2003. (excerpt)
In May 2002, following the recommendations made at a meeting of experts held in New York in July 2001, WHO and UNICEF recommended the use of a new, low sodium, low glucose, low osmolarity oral rehydration salts (ORS) solution in place of the previous formulation for use in the treatment and prevention of dehydration due to diarrhoea in all age groups and for all causes. Although the safety data in patients with cholera, while limited, was reassuring, it was recommended that the safety of this new formulation be monitored in a post-marketing surveillance study, measuring the incidence of symptomatic (seizure/altered consciousness) hyponatraemia (serum sodium <130 mmol/L) during treatment with the new formulation of ORS. The objective was to measure the incidence of symptomatic hyponatraemia (seizure/altered consciousness) during treatment of diarrhoea with the newly recommended ORS formulation. The study was conducted at the ICDDR, B hospitals in Dhaka and in Matlab over a complete year (from December, 2002 to November 2003 in Dhaka hospital and from February, 2003 to January 2004 in Matlab hospital). In the two hospitals, a total of 53,280 patients were admitted to the rehydration ward with uncomplicated watery diarrhoea to be treated with the new ORS solution for at least for 8 hours. Patients with associated severe illnesses, or patients directly admitted to the special care unit of the hospitals were excluded from the study. During treatment in the rehydration ward, patients developing symptoms (seizure/altered consciousness) were immediately transferred to the special care unit for treatment and clinical and laboratory investigations to identify the cause of the symptoms. Patients’ records were analysed to find out if the symptoms were associated with hyponatraemia, and if the development of hyponatraemia was due to intake of the new ORS. As this study was not a controlled clinical trial, we reviewed also the records of the Dhaka hospital for the corresponding previous year (from December, 2001 to November, 2002) to compare our findings with the situation when the old ORS formulation was the only ORS solution in use. In both hospitals, a total of 53,280 patients were monitored (22,536 were less than 60 months old, 6,093 were 6 to 15 years of age, and 24,651 were more than 15 years old). In patients less than 60 months of age, on admission 51% had signs of some dehydration and 10% signs of severe dehydration. In patients 6 to 15 years old, 46% had signs of some dehydration and 46% had signs of severe dehydration. Finally, among patients older than 15 years of age, 48% had signs of some dehydration, while 45% had signs of severe dehydration. No single adult patient experienced any symptoms (seizure/altered consciousness) associated with hyponatraemia. A total of 31 patients less than 60 months of age experienced seizure/altered consciousness during treatment with the new ORS formulation. Among those, 24 presented symptoms (seizure/altered consciousness) associated with hyponatraemia (serum sodium <130 mmol/L). Overall the incidence rate of symptomatic hyponatraemia was 0.05% per year in the Dhaka hospital, and 0.03% per year in the Matlab hospital. The review of the hospital records from the Dhaka hospital showed that the incidence rate of symptomatic hyponatraemia was 0.09% per year (47 cases of symptomatic hyponatremia) for the year prior to the initiation of this study. Concerns about the safety of the new reduced osmolarity ORS centers on its use in patients with cholera especially adults. As no single adult diarrhoea patients experienced symptoms (seizure/altered consciousness) associated with hyponatraemia, this finding should be reassuring for the clinicians, policy makers and producers of ORS. In addition, the results of this study demonstrates that the occurrence of seizure/altered consciousness associated with hyponatraemia in patients treated with the new ORS formulation is rare and that the incidence rate of symptomatic hyponatremia associated to the use of the new ORS is less than the incidence rate observed with the old ORS formulation. Based on the results of this study, we can conclude that the new reduced osmolarity oral rehydration salts solution recommended by WHO and UNICEF is safe and that it can be used for the treatment of acute diarrhoea of all etiologies and in all age groups. (author's)
Battling HIV's deadly co-epidemic: improving and expanding care and treatment for tuberculosis.
Few public speakers get the undivided attention that former South African President Nelson Mandela does – and what he says can have a huge impact internationally. At the 2004 International AIDS Conference in Bangkok, he urged conferees to focus renewed energy on a threat powerful enough to undermine global AIDS treatment efforts. “Tuberculosis is too often a death sentence for people with AIDS,” said Mandela, who himself had TB when he was a political prisoner in the 1980s. “Today we are calling on the world to recognize that we can’t fight AIDS unless we do much more to fight TB as well.” Breaking the deadly synergy between TB and HIV is one of the great challenges facing public health programs worldwide. The two diseases are very different: TB is spread primarily by airborne bacteria coughed up by a person with active infection, while HIV is a retrovirus transmitted in blood or other body fluids, most often through sexual contact. Yet each disease – both prevalent in many of the same regions throughout the developing world – accelerates progression of the other, leading to crippling illness and early death. Most people infected by the TB bacteria – as much as a third of the world’s population – have dormant tuberculosis: an inactive, symptom-free, nontransmissible form of the disease that is kept in check by a healthy immune system. But TB carriers who become infected with HIV, which destroys immunity, are 30 to 50 times more likely to develop active tuberculosis. As a result, millions of people throughout the world who might have remained in the dormant stage of TB for life have progressed rapidly to the active disease, which can kill within months if left untreated. (excerpt)
Driving HIV away: helping taxi drivers protect themselves and others.
Semere is a handsome, 24-year-old Ethiopian. He has a girlfriend but occasionally has sex with other women. He says he mostly uses condoms, but does not want to be seen buying them. He has chosen not to learn his HIV status. He is also a taxi driver in Addis Ababa, which makes him a prime audience for a new program introduced by the Implementing AIDS Prevention and Care Project (IMPACT), which is managed by Family Health International (FHI). Working with local partner Save Your Generation- Ethiopia (SYGA) and the Addis Ababa HIV/AIDS Prevention and Control Office, IMPACT aims to bring messages of HIV prevention and behavior change to the 28,000 men who work as taxi drivers , taxi assistants or taxi inspectors in the city. Their blue-and-white mini-buses, a familiar site on the streets of Addis Ababa, are a major form of transportation in this city of about five million. Most taxi drivers are young, unmarried men who have received little education and little information about HIV. They are further vulnerable to infection because they travel throughout the city during their work, encounter many different people, receive money—and sometimes find themselves pursued by women who hope the drivers will spend money on them. The primary goal of the program, which is funded by the Office of the Global AIDS Coordinator through the U.S. Agency for International Development (USAID), is to educate drivers about HIV so they can better protect themselves and their families. “There must be a behavior change in this community. People are dying,” says Mekte Game, a taxi inspector. The behavior change is approached through peer education, augmented by drama presentations at taxi stations where drivers gather and by condom distribution. The condoms are provided by DKT-Ethiopia, the Addis Ababa Health Bureau and local HIV/AIDS Prevention and Control Desks. (excerpt)
The Expanded and Comprehensive Response: a framework for action.
Policymakers and health officials in countries threatened by the HIV pandemic increasingly use strategic planning to guide national prevention, care and treatment programs. Many of these broad-scale AIDS strategies include projects to scale-up targeted prevention, VCT, home-based care, clinical treatment and other key interventions. Yet too often national strategies have limited impact at the local level—the real front line of the epidemic—where authority is decentralized and where conditions, resources and community capacity influence how and whether programs are implemented. The absence of adequate local action frameworks and networking systems may further fragment the response. The problem is exacerbated when community leaders, program partners and other stakeholders don’t communicate effectively with each other. And with the dramatic increases in AIDS funding that have occurred in the past few years, local authorities are struggling to absorb new resources efficiently and distribute them equitably. Few countries, provinces or districts have implemented mechanisms to build a rational, organized and locally coordinated response. (excerpt)
Handbook on paediatric AIDS in Africa.
HIV/AIDS is a major cause of infant and childhood mortality and morbidity in Africa. In children under five years of age, HIV/AIDS now accounts for 7.7% of mortality worldwide. AIDS already accounts for a rise of more than 19% in infant mortality and a 36% rise in under-five mortality. Together with factors such as declining immunisation, HIV/AIDS is threatening recent gains in infant and child survival and health. Yet, for the most part, HIV infection in children is preventable. In industrialised countries in North America and Europe, paediatric HIV infection has largely been controlled. In these settings, HIV testing as part of routine antenatal care, combinations of antiretroviral (ARV) drug regimens, elective caesarean section, and complete avoidance of breast-feeding have translated into mother-to-child transmission (MTCT) rates of less than 2%. In Africa, on the other hand, high rates of maternal HIV infection, high birth rates, lack of access to currently available and feasible interventions, and the widespread practice of prolonged breast-feeding translate into a high burden of paediatric HIV disease. The transmission risk for a child born to an HIV-infected mother in an African setting without interventions for prevention of mother-to-child transmission (PMTCT) is about 30–40%. The other 60–70% of children, although not HIV-infected, still have a 2- to 5-fold risk of mortality as a direct consequence of the mother’s HIV disease, when compared to children born to uninfected mothers. (excerpt)
Globally, an estimated 20.5 million people are currently living as refugees, asylum seekers, or internally displaced persons (IDPs), with 4.5 million of those in Africa. Such emergency situations affect a disproportionately large number of women and children; according to the United Nations Population Fund, more than 75% of all refugees and other displaced persons are women or children. Displacement brings with it a host of political, economic, social, and health-related problems. While many of these problems are addressed by humanitarian assistance programs, reproductive health is often overlooked. In the context of basic survival, family planning and reproductive health (FP/RH) services are not usually considered a priority. “Family planning” is often viewed as a method of fertility reduction rather than as a health intervention. However, without access to FP/RH services, displaced women are at risk of unwanted pregnancies, dangerous births, and sexually transmitted infections. FP/RH services are as critical to preserving the health and well-being of IDPs as food and shelter. (excerpt)
In the Democratic Republic of the Congo (DRC), contraceptive prevalence is low. According to the Multiple Indicator Clusters Survey (MICS2), it is estimated at 4.6% for the entire national territory. According to a recent study conducted by the nongovernmental organization Association Régionale d’Approvisionnement en Médicaments Essentiels (ASRAMES [Essential Medications Regional Supply Association]) in May 2003, the percentage is even lower —2.5%— in the eastern part of the DRC. This situation necessitates support for family planning services. In response, Advance Africa proposed to conduct a study in the tenth ecological corridor, or Graueri Landscape, to obtain information that will assist in establishing a program that meets the community’s needs. This program will be one component of a wider nature conservation program in collaboration with the Jane Goodall Institute. A qualitative study using interview, focus group, and direct observation techniques was performed at three sites: Kasugho (Tayna gorilla reserve), Walikale (Utundu and Wassa gorilla reserve), and Butembo (location of the Tayna Gorilla Reserve [TGR] and Maiko Park offices). The results of the study were complemented with literature review. Interviews involved political administrative officials, community leaders and officials from the nongovernmental organizations (NGOs); Focus group sessions involved service providers and the beneficiaries; The direct observation involved care facilities; Documentation was reviewed at the Provincial Reproductive Health Coordination Office, Central Offices of the Health Zones, and with national and international NGOs. (excerpt)
Repositioning family planning: an Advance Africa project strategy.
“The steep drop in worldwide family planning funds from wealthy nations contributed to more than 300 million unintended pregnancies and the death of an estimated 700,000 pregnant women between 1995 and 2000” (Study Report, Global Health Council, September 2002). Maternal and child mortality rates in sub-Saharan Africa (SSA) are among the highest in the world. Maternal mortality is over 900 deaths per 100,000 live births in more than half of sub- Saharan African countries. Infant mortality is estimated to be 91 per 1,000 live births for sub- Saharan Africa (Population Reference Bureau 2002). World attention to the HIV/AIDS pandemic and to high maternal and child mortality rates has moved donor focus away from family planning and reproductive health (FP/RH) programs. As a result, funding for family planning programs has stagnated. Many health care and human resources formerly dedicated to improving access to and quality of FP/RH services have been redirected to HIV/AIDS prevention and treatment. National reproductive health programs have succumbed to budget cuts and staff reductions. For decades, family planning has been presented as a means to simply control the world’s population size. The current global situation, particularly in sub-Saharan Africa, requires a different approach. With the dramatic reduction in the world’s population growth rates—due in part to lower fertility in some regions and to higher mortality caused by HIV/AIDS and other infectious disease—family planning must be considered a health intervention, not a means of population control. Advance Africa and other family planning groups across the globe must enhance decision makers’ appreciation of family planning in this capacity and work to reposition family planning in a new light. (excerpt)
Advance Africa project's Mozambique program: knowledge, practices, and coverage survey report.
The third strategic objective (SO3) of USAID/Mozambique calls for “increased use of MCH/FP services.” The Mission aimed to achieve this objective through close collaboration with cooperating agencies (CAs), private voluntary organizations (PVOs) and non-governmental organizations (NGOs). In 2001, the Health Services Delivery Support (HSDS) project was launched, and the project subsequently conducted a baseline survey. In July 2003, the Advance Africa project took over from HSDS and provided technical assistance in FP/RH, managed the sub-awards to six NGO/PVOs working in 34 districts, coordinated CA and NGO/PVO activities, and assisted with monitoring and evaluation until 30 September 2004. In July 2004, Advance Africa facilitated the implementation of a Knowledge Practices and Coverage (KPC) endline survey. Advance Africa coordinated the data collection and provided technical guidance for data entry and analysis using Epi-Info 3.22, and then pooled and analyzed the data from all provinces. Survey preparations, including data collectors’ training and questionnaire pre-testing, took place in May, with data collection in June and data entry in July. Advance Africa received and integrated the last database in early August and prepared this consolidated report, which presents the findings and indicators of this endline survey, and compares them with the baseline findings and across provinces. Detailed reports of each province are also being prepared by the respective NGO/PVOs, but were not available at the time this report was prepared. (excerpt)
Advance Africa project proceedings report: Repositioning Family Planning in Africa Working Assembly.
The objectives were to: 1. Review the current status of family planning in sub-Saharan Africa, the key achievements, and the challenges that remain at the regional and country levels. 2. Based upon the WHO Framework for Repositioning, identify strategies for enhancing and sustaining the family planning programs in the African region: innovative activities to better address the challenges and more appropriately use the existing and forthcoming resources and opportunities. 3. Determine the role of African regional organizations and their partners in implementing activities to support the WHO Framework for Repositioning. 4. Outline the expected outcomes of Repositioning Family Planning activities. (excerpt)
Advance Africa’s umbrella approach in Senegal aims to strengthen the public (Ministry of Health [MOH], Ministry of Education [MOE]) and private (Forum for African Women Educationalists [FAWE], Pan-African Regional Technical Assistance Group [PARTAGE], Association Sénégalaise pour le Bien Être Familial [ASBEF], Santé de la Famille [SANFAM]) sectors, and also to improve inter-sectoral collaboration, linkages, and integration into the educational sector of family planning and reproductive health (FP/RH) services within health and non-health sectors. Such endeavors call for a strategic approach bringing together health institutions, NGOs, and community-based organizations. The Advance Africa program in Senegal is comprised of three different components: 1. Integration of family planning within postabortion care (PAC); 2. Strengthening the primary health care (PHC) system through performance monitoring and improvement (PMI); 3. Extending the fight against female genital cutting (FGC) in Senegal through integration into the formal education sector. (excerpt)
Conference on Repositioning Family Planning in West Africa: Rapporteur-General’s report.
A 4 – Day Regional Conference on Repositioning Family Planning in West Africa Conference was held from February 15 – 18 in Accra, Ghana to address the question of the declining international focus on family planning and recognition of its impact on health and development. It was also geared towards reviving the interest of donors and governments in the domain and the rising unmet need for family planning. The main conference agenda was to provide a forum for key stakeholders in the West Africa sub-region to focus on repositioning family planning as a means of combating the impact of unmet need. Its goal was to set the grounds for the increase in commitment to repositioning of family planning as a strategic objective of a country's health and development goals. The detailed Conference objectives as outlined were as follows: Provide comprehensive data on the expressed need for family planning in the West Africa sub-region; Identify key factors underlying the gap between expressed need for family planning and use of family planning; Discuss the health and development consequences of this gap; Explore solutions for addressing the gap; Demonstrate how advocacy can be used to implement solutions; Develop strategies that participants will undertake after the conference to advance repositioning family planning efforts in their respective countries. (excerpt)
Progress on global access to HIV antiretroviral therapy: an update on "3 by 5".
The estimate of approximately 1 million people now on treatment falls short of the milestone of 1.6 million set in the WHO/UNAIDS “3 by 5” strategy for June 2005. Current data and trends indicate that providing ART to 3 million people by the end of 2005 will be unlikely. However, there is reason to be hopeful that growth rates will continue to increase in the remainder of 2005 and beyond. Although less than what is needed, an estimated US$27 billion are available or have been pledged for HIV/AIDS globally from all sources for the three-year period 2005-2007. At the same time, substantial political commitment to moving forward is evident in the many countries that have translated the global “3 by 5” target into ambitious but feasible national treatment targets. This interim report on global efforts to increase access to ART focuses primarily on understanding the reasons for the successes and failures of scaling up HIV/AIDS interventions in different settings. The report also makes recommendations concerning the approaches needed to overcome major bottlenecks, as well as the need for sustainable financing mechanisms and greater harmonization of effort by technical and financing partners at country level. A comprehensive report and country-specific analysis of access efforts and obstacles that remain will be released at the end of 2005. (excerpt)
Strategic communication changes norms, intentions related to FGC in Nigeria.
In Nigeria's Enugu State, girls typically have some of their genitalia removed during infancy, a cultural practice, known as female genital cutting (FGC). Various cultural factors and beliefs influence the practice including the fact that women who have not undergone the procedure are believed to be promiscuous, unclean, and not likely to get married. The cutting of the clitoris is thought to reduce the natural tendency for promiscuity in women. Another important belief that supports the practice is that FGC makes female genitals more beautiful. While considerable efforts have been made in Enugu, support for FGC persists in many parts of the state. Against this background, the Health Communication Partnership (HCP) in collaboration with two Nigeria-based nongovernmental organizations -- the National Association of Women Journalists (NAWOJ) and Women Action Research Organization (WARO) -- designed a multi-tiered, multimedia program aimed at helping eliminate FGC in Enugu State. Entitled Ndukaku (Igbo for "Health is better than wealth"), the program focused on three local government areas (LGAs) in Enugu State: Uzo-Uwani, Isi-Uzo, and Enugu South. After one year, researchers found that both support for discontinuing FGC in Enugu State and the intention not to perform FGC on daughters increased significantly when compared to a control area. (excerpt)
The impact of childhood mortality on fertility in six rural thanas of Bangladesh.
This paper examines the causal structure of the relationship between child mortality events and subsequent fertility with an analysis of prospective longitudinal data on births and childhood deaths occurring to nearly 8,000 mothers observed in Bangladesh over the 1982–93 period, a time of rapid decline in fertility. Generalized hazard-regression analyses are employed to assess the effect of infant and child mortality on the hazard of conception, controlling for birth order and maternal age and educational attainment. Results show that childhood mortality increases the hazard of birth-interval closure if the death occurs in the index interval, representing the combined effect of biological and volitional replacement. Substantial birth-interval effects are also evident if the death occurs during a prior birth interval, signifying a volitional replacement effect alone. Moreover, mortality effects in prior birth intervals are consistent with the hypothesis of insurance effects. Interaction of replacement with elapsed time suggests that the volitional impact of child mortality increases as the demographic transition progresses. This volitional effect interacts with sex of the index child. Investigation of higher-order interactions suggests that this gender-replacement effect has not changed with time. (author's)
This report presents the child mortality impact of a trial of primary health-care service-delivery strategies in rural Ghana. After adjustment for sociodemographic factors, under-five mortality in areas with village-based community-nurse services fell by 16 percent during the five years of program implementation compared with mortality before the intervention. Reductions were observed in infant (6 percent), early child (20 percent), and late child (41 percent) mortality. Community involvement and training of a local health volunteer were associated with an 11 percent increase in mortality, primarily driven by a 124 percent increase in early child mortality. Areas with both nurses and volunteers experienced a 7 percent increase in mortality, with small increases in all age groups. In a comparison area, under-five mortality fell by 5 percent during the same time period. These results suggest that convenient, accessible professional medical care can reduce child mortality in impoverished African settings. They raise questions, however, about the benefits to children’s survival of relying on community volunteers. (author's)
HIV / AIDS at the 48th U.N. Commission on Narcotic Drugs (CND): a Human Rights Watch brief.
The Commission on Narcotic Drugs (CND) is the central agency in the United Nations system responsible for setting international drug policy. At its 48th session from March 7-14, 2005 in Vienna, the Commission will focus on HIV/AIDS. This year the U.N. Office on Drugs and Crime (UNODC) chairs the consortium of U.N. agencies that makes up the Joint U.N. Programme on HIV/AIDS (UNAIDS), making the Commission’s focus on HIV/AIDS particularly timely. Of the approximately five million new HIV infections in 2004, an estimated 10 percent stemmed from injection drug use. In some countries, such as Russia, injection drug use accounts for up to 75 percent of reported HIV cases. HIV/AIDS among injection drug users is spread chiefly through the sharing of blood-contaminated syringes. This makes it critically important for drug users to have access to noninjected drug opiate substitutes (such as methadone and buprenorphine), as well as sterile injection equipment, until such time as they can stop using drugs. This is especially true given the chronic and relapsing nature of drug addiction and the worldwide scarcity of effective drug treatment. (excerpt)
Out of reach. Why money for HIV and AIDS related care is still not reaching those who need it most.
ActionAid International is campaigning for the right and access to HIV&AIDS related care for poor and excluded people, especially women and children. An essential part of this is making the money work: ensuring that the increasing global resources for HIV&AIDS actually result in tangible benefits for those in whose name the money is raised. In this paper we highlight the voices of those at the centre of the struggle, and examine the major blocks standing in their way. All of the case studies presented are rooted in ActionAid International’s everyday experience, working with communities and partners worldwide. We focus on seven major barriers to HIV&AIDS related care: 1. Resources are not reaching the poorest. 2. Women, who bear the heaviest burden in caring for others, are often last in line to receive care themselves. 3. Children’s needs are being ignored. 4. Those already excluded by society face additional barriers. 5. Stigma and ignorance among health care staff remain widespread. 6. Governments and international donors are not earmarking or tracking resources for women, children and excluded groups. 7. There is a lack of civil society participation, in particular by HIV-positive people, in decision-making about care and treatment. (excerpt)
Square pegs, round holes, and why you can't fight HIV / AIDS with monetarism.
How to get a square peg through a round hole? How can poor countries invest in the doctors, nurses, and teachers needed to meet the Millennium Development Goals (MDGs) when current International Monetary Fund (IMF) loan conditions limit the spending of recipient country governments? There is a fundamental contradiction between the need to greatly scale-up social spending to fight HIV/AIDS and what can actually be spent under the IMF’s current low-inflation monetary policy. How can significantly more money be spent in these economies without producing higher levels of inflation than the IMF’s low-inflation policy permits? In order for many poor countries to receive foreign aid from the World Bank or any of the rich countries, borrowing countries must first be given the “green light” by the IMF, an action that signals to other lenders that their national macroeconomic policies are sound. Because it opens the door to all the other major foreign aid donors and creditors, this “signaling effect” gives the IMF tremendous leverage over many aid-dependent countries in terms of the economic policy reforms it attaches as loan conditions. Unless a borrowing country is satisfactorily implementing the IMF’s preferred economic reform policies, it risks getting the “red light” – and being cut off from access to the major sources of foreign aid, credit, or debt relief programs. Of particular concern among the IMF’s binding loan conditions are economic policy reforms related to monetary policies (policies in which a central bank attempts to regulate the money supply and interest rates in order to control inflation and stabilize the currency). (excerpt)
Writing off a generation? Why the G8 must prioritise AIDS treatment and commit to universal access.
The devastating impact of the HIV and AIDS crisis is reversing development gains in worst-affected countries. Current trade, debt and aid policies present obstacles to the ability of developing countries to confront the HIV and AIDS crisis. A commitment to fight AIDS must prioritise the rapid scale up of access to treatment for all people living with HIV and AIDS with clinical need for these medicines. A failure to provide the necessary funding for treatment now will condemn a generation of people to death. ActionAid calls on G8 countries to ensure that debt relief, trade rules and aid quantity and quality work to support developing country efforts to strengthen health systems, including the delivery of antiretroviral drug therapy. Treatment must be part of a comprehensive healthcare system encompassing HIV prevention, counselling and testing and AIDS care. The availability of treatment has been shown to have a significant positive effect on prevention, testing and reducing stigma associated with this communicable disease. The hope provided by the availability of treatment, creates greater incentive to people living in high prevalence areas to change behaviours that can stem the spread of HIV. (excerpt)
As an input to today’s panel discussion, the Center for Global Development and the International AIDS Economic Network (IAEN) conducted a global survey of perceptions of bottlenecks in the disbursement of funds to respond to the HIV/AIDS pandemic. This note summarizes the main findings. The full results will be available soon on the CGD and IAEN Web sites. Survey Methodology and Demographics: An invitation to complete the survey was e-mailed to about 9,000 people who subscribe to IAEN e-mail updates. Potential respondents were thus people who had demonstrated interest in the intersection of HIV/AIDS and economics. The 353 responses received included about a third each from Africa, Western Europe and North America, and the rest of the world. About 80% of the respondents indicated that they held a master’s degree or higher. Respondents included people working for bilateral donors, developing country governments, local and international NGOs, academia and think tanks, and multilateral organizations. (excerpt)
Estimates of U.S. abortion incidence in 2001 and 2002.
After abortion was legalized nationwide in 1973, the U.S. abortion rate peaked in 1980. From 1990 onward, the rate declined substantially, and by 2000, it was at its lowest level since 1974. Information on abortion incidence since 2000 is limited, however. To assess whether the downward trend has continued, additional analyses are necessary. Since 1973, The Alan Guttmacher Institute (AGI) has estimated the number of abortions performed in the United States by conducting a periodic census of all known abortion providers. The most recent such survey took place in 2001, collecting data covering 1999 and 2000. Abortion incidence is also tracked by the U.S. Centers for Disease Control and Prevention (CDC), which aggregates reports from state statistical agencies (usually health departments) for its annual abortion surveillance reports, the most recent of which covered the year 2001. The CDC reports are incomplete, however, because the state reports collected by the agency vary in completeness, with some lacking information on as many as 40–50% of the abortions that occur in the state. In addition, Alaska, California and New Hampshire have no abortion reporting system at all and are not included in the CDC totals. The purpose of this report is to provide estimates of U.S. abortion numbers, rates and ratios for 2001 and 2002, projected from AGI’s total for 2000, using state health department data that are reasonably complete and comparably reported over time. (excerpt)
66 million U.S. women are of reproductive age (i.e., aged 13–44). More than one-half of these women (34 million) need contraceptive services and supplies: They are sexually active; believe they are fertile; are not pregnant, postpartum or trying to get pregnant; and have not undergone sterilization. Nearly 17 million women need subsidized contraceptive services and supplies; these women include all 4.9 million teenagers who are in need of contraceptive services and may require confidential care; 4.2 million women aged 20–44 who are in need and whose family income is lower than the federal poverty level (less than $18,100 for a family of four in 2002); and 7.6 million women aged 20–44 with incomes between 100% and 250% of the federal poverty level (less than $45,250 for a family of four in 2002). Of the 17 million women in need of subsidized contraceptive services and supplies, more than half (55%) are non-Hispanic white; 18% are non-Hispanic black; and 20% are Hispanic. (excerpt)
Between the late 1980s and mid- 1990s, at a time when HIV/AIDS was well on its way toward ravaging Sub- Saharan Africa, Uganda achieved an extraordinary feat: It stopped the spread of HIV/AIDS in its tracks and saw the nation’s rate of infection plummet. As word of the “Uganda miracle” spread, journalists, researchers, policymakers and advocates all descended to try to ascertain how it was accomplished. By now, Uganda’s success story has become virtually synonymous with the so-called ABC approach to HIV/AIDS prevention, for Abstain, Be faithful, use Condoms. And, indeed, it is clear that some combination of important changes in all three of these sexual behaviors contributed both to Uganda’s extraordinary reduction in HIV/AIDS rates and to the country’s ability to maintain its reduced rates through the second half of the 1990s. Beyond that, however, the picture becomes considerably less clear. ABC refers to individual behaviors, but it also refers to the program approach and content designed to lead to those behaviors. Researchers and public health experts continue to study both and to delve into the many and varied complex relationships among them. This information is critical to determining to what extent the Uganda experience really is replicable and what from that experience productively might be exportable to other countries. At the same time, much more research is needed into the relevance of the ABC approach for the prevention of other sexually transmitted diseases (STDs) as well as unintended pregnancy and the abortions or unplanned births that inevitably follow, both in Sub-Saharan Africa and in other parts of the world. (excerpt)
62 million U.S. women are in their childbearing years (15–44). 43 million women of reproductive age, or 7 in 10, are sexually active and do not want to become pregnant, but could become pregnant if they or their partners fail to use a contraceptive method. The typical U.S. woman wants only 2 children. To achieve this goal, she must use contraceptives for roughly 3 decades of her life. Virtually all women (98%) aged 15–44 who have ever had intercourse have used at least one contraceptive method. Overall, 62% of the 62 million women aged 15–44 are currently using a contraceptive method. 31% of the 62 million women do not need a method because they are infertile; are pregnant, postpartum or trying to become pregnant; have never had intercourse; or are not sexually active. Thus, only 7% of women aged 15–44 are at risk of unwanted pregnancy but are not using contraceptives. (excerpt)
Induced abortion in the United States.
49% of pregnancies among American women are unintended; Almost 1/2 of these are terminated by abortion. 24% of all pregnancies (excluding miscarriages) end in abortion. In 2002, 1.29 million abortions took place, down from an estimated 1.36 million in 1996. From 1973 through 2002, more than 42 million legal abortions occurred. Each year, 2 out of every 100 women aged 15–44 have an abortion; 48% of them have had at least one previous abortion. 52% of U.S. women obtaining abortions are younger than 25: Women aged 20–24 obtain 33% of all abortions, and teenagers obtain 19%. Black women are more than 3 times as likely as white women to have an abortion, and Hispanic women are 2 1/2 times as likely. (excerpt)
Family planning annual report: 2004 summary. Part 1.
All grantees receiving funding under the federal Title X program are required to submit annual service data. The responsibility for collection and tabulation of annual service data from Title X grantees rests with the Office of Population Affairs (OPA), Department of Health and Human Services (DHHS), which is responsible for administering Title X funds. The Alan Guttmacher Institute (AGI), under a grant from DHHS, has tabulated the grantee reports and prepared this report summarizing the regional and national totals. Part I of the summary report begins with a presentation of the methodology used in both collection and tabulation of grantee reports. Included here are the definitions developed and provided by OPA to the grantees for use in completing data requests. The body of the report presents the demographic characteristics of family planning users, contraceptive methods used, selected services and staff, and funding sources. In each section of the report, national totals and regional highlights are discussed and, in some cases, trends between 1995 and 2004 are mentioned. Tabulations by state for female users by age and for total users by poverty status are included in Appendix B. Also included in Part I of the report are general notes and comments provided by grantees to describe variations or clarifications of the data provided. (Appendix C). Part II of this report provides detailed national and regional tables. (excerpt)
Where sex and politics meet: sustaining behavior change.
Initiating behavior change can be difficult enough. Making the decision to quit smoking, switch to a healthier diet or start an exercise regimen are familiar cases in point. Sustaining behavior change, however, can be even harder. That so many people eventually revert to their old habits is a testament to this fact. Because adherence over long periods of time to virtually any kind of behavior regimen is difficult for most people, even the most well-intentioned may experience prevention “fatigue,” gradually losing the will to keep away from cigarettes, stay on a diet or continue exercising. Prevention fatigue is certainly a factor when it comes to women’s ability to use contraceptives correctly and consistently over decades to prevent unintended pregnancy or men’s willingness to use a condom “every time” to reduce the risk of transmitting or contracting HIV. If fatigue were not enough of a challenge when seeking to understand and influence positive health behaviors, the related but separate phenomenon known as “disinhibition”— the notion that the perception of reduced risk itself makes risk-taking more attractive—further complicates the picture. Taking an anticholesterol drug, it could be argued, might “disinhibit” an individual at risk of heart disease from eating high-fat foods. Birth control pills and condoms could be seen as “disinhibiting” because they reduce the fear of pregnancy or a sexually transmitted infection (STI) that otherwise might be present when a couple is having sex. (excerpt)
Medicaid: a critical source of support for family planning in the United States.
Medicaid is now the nation’s largest health care program and the largest source of federal support to states. Medicaid expenditures comprise approximately 17% of all state spending. With so many dollars at stake, Medicaid’s future has been the subject of widespread debate. Over the last few years, many states confronting serious budget shortfalls have cut back on Medicaid eligibility and services in a variety of ways; a recent study found that all 50 states implemented Medicaid cost-control strategies in 2004 and planned additional action in 2005.1 Similarly, at the federal level, cuts in Medicaid spending and major program restructuring have been proposed and are under consideration. Together, these developments underscore the importance of understanding the role of Medicaid to the provision of publicly funded family planning services and especially for the individuals who need this preventive health care. This Issue Brief reviews: the extent to which women of reproductive reviews: the extent to which women of reproductive age rely on Medicaid for their care; the special status that family planning has long had under Medicaid; the range of services covered under the rubric of family planning; the 21 state-initiated Medicaid family planning expansions that have extended eligibility for Medicaid-funded family planning to millions of men and women who otherwise would not be covered; and, the effectiveness and cost-effectiveness of subsidized family planning in reducing unintended pregnancies and births, as well as abortions, especially among teenagers and unmarried women. (excerpt)
Critical role of Medicaid in financing family planning services -- state-level data [memorandum]
Between 2001 and 2003, there was a 14% increase in the number of women of reproductive age (15–44) covered by Medicaid, and a 10% increase in the number of women that age who are uninsured. Today, more than one in 10 women of reproductive age rely on Medicaid for her health care, while another one in five have no health insurance at all. Meanwhile, spending on Title X and other programs dedicated to family planning has decreased or leveled off, and the burden of meeting women’s needs has shifted to Medicaid. Medicaid funding for contraceptive services has tripled since 1980, and the program now accounts for almost two-thirds of all federal and state family planning funding nationwide. The attached table highlights the critical role of Medicaid in providing family planning services and supplies for low-income women, nationwide and in each state. It shows: the amount spent for contraceptive services and supplies under the Medicaid program in FY 2001; the percent of total public spending on contraceptive services attributable to Medicaid; the percent of women of reproductive age who are covered by Medicaid; and the percent of women of reproductive age who are uninsured. (excerpt)
Assessing costs and benefits of sexual and reproductive health interventions.
In this current climate of financial constraints coupled with competing priorities among developmental goals, it becomes ever more critical for policymakers and others responsible for allocating resources to have first-rate tools available as a guide for effective decision making. The overall aim of this report is to inform such decision makers about the key findings of existing studies about the costs and benefits of investments in sexual and reproductive health, to identify what factors the studies encompass and what they leave out, and to provide a complete picture of what the costs and benefits would look like, including benefits that are hard to measure. This report is a technical companion to a shorter monograph. It has three parts: (1) a review and synthesis of what is known about the costs and benefits of investments in sexual and reproductive health; (2) a comprehensive outline that can be used by researchers and policymakers to view the gamut of costs and benefits, which, it is hoped, will lead to improvement in the measurement of costs and benefits of sexual and reproductive health investments; and (3) in order to demonstrate the advantages of taking a more comprehensive approach to measuring costs and benefits, a partial application of the framework in the reproductive and maternal health field, namely in the area of contraceptive services and supplies. (excerpt)
Adolescent sexual and reproductive health in Uganda: a synthesis of research evidence.
Despite recent successes, the AIDS epidemic in Uganda still poses a serious threat to the future of the country’s youth. Females remain at higher risk of contracting HIV/AIDS during adolescence because of the social and cultural factors that lead many to experience early initiation of sexual activity. While youth in Uganda constitute nearly 50% of the total number of those infected, the vast majority of those cases are female— the male-to-female ratio of HIV infection is 1:4 for teenagers compared to 1:1 for adults. This report provides a comprehensive overview of current knowledge on adolescent sexual and reproductive health issues in Uganda with a focus on HIV prevention. It draws upon the existing body of social science research and includes both quantitative and qualitative studies. Its goal is to communicate key findings from existing research to a wide audience concerned with sexual and reproductive health in Uganda. The specific objectives are: to synthesize key findings from previous studies on adolescent sexual and reproductive health in Uganda; to identify information gaps in order to inform the development of future research in this area; and to highlight priority areas for programs and policies aimed at improving the sexual and reproductive health of youth. (excerpt)
Qualitative evidence on adolescents' views of sexual and reproductive health in sub-Saharan Africa.
This qualitative study examines how young people in Sub-Saharan Africa view sexual and reproductive health issues, such as abstinence, condom use and sexually transmitted infections (STIs), and what they think about sources of sexual and reproductive health information and services. The data come from 55 focus group discussions (FGDs) conducted in Burkina Faso, Ghana, Malawi and Uganda in 2003. Focus groups included in- and out-of-school youth aged 14-19 who lived in rural and urban areas. (excerpt)
Women in Uganda today give birth to almost seven children, on average—two more children than they would prefer. In fact, nearly half of all births in 2000 were unwanted or mistimed, up from one-third of births only five years earlier. Only 23% of married women were using contraceptives in 2000, although this proportion was about five times that in 1988. Given such facts about the gap between their desired family size and their actual fertility, as well as their low likelihood of using contraceptives, it is not surprising that many women turn to abortion. Abortion is illegal in Uganda unless a woman’s pregnancy endangers her life. As a result, the procedure is performed in secrecy and often under dangerous conditions. There are no official statistics even on abortion complications, but what data are available indicate that unsafe abortion in Uganda is a leading cause of maternal morbidity and mortality. Reliable, current data are needed, both to inform debate about the problem of unsafe abortion and to improve women’s care. This report presents results from two surveys. One is a survey of health professionals, in which 53 experts on abortion in Uganda were asked their opinions and perceptions about abortion provision and postabortion care. The second is a survey of health facilities, in which senior professionals from a nationally representative sample of facilities that treat postabortion complications were interviewed about their own perceptions and actual service provision. (excerpt)
Adolescent sexual and reproductive health in Malawi: a synthesis of research evidence.
The primary goal of this report is to summarize what is known about adolescent sexual and reproductive health in Malawi and to identify knowledge and program gaps requiring further research and program action. Drawing from a wide range of studies carried out in the country since 1990, the synthesis reviews the social, cultural and economic context in which adolescents live; their sexual and reproductive health experiences; sources of information and services related to sexual and reproductive health; knowledge and attitudes about HIV/ AIDS and personal risk assessment; and policies and programs on adolescent sexual and reproductive health in the country. The studies reviewed include the Demographic and Health Surveys (DHS) conducted in Malawi in 1992, 1996 and 2000, and other small-scale studies carried out in different parts of Malawi to inform the development of specific programs. (excerpt)
Reducing unintended pregnancy and unsafe abortion in Uganda.
This report examines key changes since the late 1980s in the reproductive and contraceptive behavior and preferences of Ugandan women, assesses the extent to which births are unplanned and summarizes what is known about unsafe abortion in the country. To capture recent trends, the report provides information for 1988, 1995 and 2000—years for which comparable national survey data on these issues are available. To highlight the large differences across the country and the need for attention to variations in policies and programs, it includes measures for the four major regions of Uganda, and for urban and rural residents. The purpose of the report is to increase awareness of, and attention to, Ugandan women’s reproductive health care needs. We hope that policymakers, public health advocates and health care professionals will use the report’s findings to develop informed policies and programs that could help reduce unintended pregnancies and lessen the negative impact of unplanned births and unsafe abortions on the health and lives of Ugandan women. (excerpt)
Adolescents in Uganda: sexual and reproductive health.
Nearly one-quarter of Uganda’s population is between the ages of 10 and 19. Many of these young people are at risk or already struggling with the consequences of an unplanned pregnancy or a sexually transmitted infection (STI), including HIV/AIDS. To minimize these risks and secure a healthy future for adolescents, it is necessary that policymakers, journalists, service providers and advocates have solid evidence regarding the sexual and reproductive health needs of Ugandan youth. This Research in Brief summarizes key research findings on Ugandan adolescents’ sexual and reproductive health behaviors and needs, with particular emphasis on HIV/AIDS, and points the way forward toward improving policies and programs. (excerpt)
Adolescents in Burkina Faso: sexual and reproductive health.
Half of the population in Burkina Faso is under the age of 15. Many of these young people will become sexually experienced in their teens and, thus, will be at risk of or experience an unplanned pregnancy or a sexually transmitted infection (STI), including HIV/AIDS. To minimize these risks and secure a healthy future for adolescents, it is necessary that policymakers, journalists, service providers and advocates have solid evidence regarding the sexual and reproductive health needs of Burkinabè youth. This Research in Brief documents what is known about Burkinabè adolescents’ sexual and reproductive health behaviors and needs, with particular emphasis on HIV/AIDS, and points the way forward toward improving policies and programs. (excerpt)
Adolescents in Malawi: sexual and reproductive health.
More than one-fifth of Malawi’s population is between the ages of 10 and 19. Many of these young people are at risk or already struggling with the consequences of an unplanned pregnancy or a sexually transmitted infection (STI), including HIV/AIDS. To minimize these risks and secure a healthy future for adolescents, it is necessary that policymakers, journalists, service providers and advocates have solid evidence regarding the sexual and reproductive health needs of Malawian youth. This Research in Brief summarizes key research findings on Malawian adolescents’ sexual and reproductive health behaviors and needs, with particular emphasis on HIV/AIDS, and points the way forward toward improving policies and programs. (excerpt)
Abortion reporting requirements. State policies in brief as of July 1, 2005.
For the last three decades, the federal Centers for Disease Control and Prevention (CDC) has partnered with the states to collect aggregate statistics on abortions in the United States. States are not required to submit abortion data to the CDC, but the overwhelming majority do. Providers typically use a state form that is based on a federally designed standard. The form generally asks for information about the facility, the patient’s demographic characteristics and medical history, and the abortion procedure itself, including the method used and gestational age. After the FDA’s approval in 2000 of the abortion drug mifepristone, most states adjusted their forms to include questions about medical (nonsurgical) abortion. (author's)
Bans on 'partial-birth' abortion. State policies in brief as of August 1, 2005.
Since the mid-1990s, a majority of states have enacted laws prohibiting “partial-birth” abortions, although that term is not recognized by the medical community. Overwhelmingly, these laws permit the procedure only when necessary to preserve the woman’s life but not to protect her health. In 2000, the U.S. Supreme Court, in Stenberg v. Carhart, struck down a Nebraska statute as unconstitutional because it did not include an exception for the woman’s health and because it found the language used to define a “partial-birth abortion” to be so broad as to potentially outlaw a range of abortion procedures, including the most common form of second trimester previability abortions. Nonetheless, President Bush in 2003 signed into law a federal ban that was virtually identical to the Nebraska law. In 2004, the ban was declared unconstitutional by three district court judges on the grounds that it shared the same constitutional flaws identified in Stenberg; appeals are currently underway. (excerpt)
'Choose life' license plates. State policies in brief as of August 1, 2005.
In recent years, a handful of states have established specialty “Choose Life” license plates. The plates cost anywhere between $25 and $70 on top of standard fees. In some cases, money generated from their sale directly supports the activities of specific antichoice organizations or crisis pregnancy centers (CPCs), which often provide biased and medically inaccurate counseling to women seeking a pregnancy test or counseling with regard to an unintended pregnancy. In other cases, the funding goes to organizations that provide services related to adoption. Many of the states with “Choose Life” license plates explicitly prohibit organizations that offer a full range of services, including abortion counseling or referral, from receiving the funds. Reproductive health activists have challenged some of these policies, arguing that it is unconstitutional for a state to endorse one political viewpoint over another, and that the funding of agencies affiliated with churches or religious organizations amounts to establishment of religion. (excerpt)
Emergency contraception. State policies in brief as of August 16, 2005.
Emergency contraception (EC)—a concentrated dose of the hormone found in many regular birth control pills—can prevent pregnancy when taken shortly after unprotected intercourse (most effectively, within 72 hours). Like regular birth control pills, EC prevents pregnancy by stopping or delaying ovulation, inhibiting fertilization or preventing implantation of a fertilized egg. State policymakers have focused on two approaches to promoting access to EC requiring the provision of EC-related services in hospital emergency rooms to women who have been sexually assaulted; and allowing pharmacists to provide EC without a prescription under the aegis of a specific collaborative practice agreement with a physician or in accordance with a state-approved protocol. A few states have moved to limit access to EC by restricting state Medicaid family planning eligibility expansions or contraceptive coverage mandates. In addition, some states allow medical professionals, including pharmacists, to refuse to provide contraceptive services. (excerpt)
Insurance coverage of contraceptives. State policies in brief as of August 1, 2005.
While almost all insurance plans cover prescription drugs, many still do not provide coverage for the range of U.S. Food and Drug Administration(FDA)-approved prescription contraceptive drugs and devices. A number of states, however, require insurance policies that cover other prescription drugs to also cover all FDA-approved contraceptive drugs and devices, as well as related medical services. Some of these policies allow employers or insurers to refuse to cover contraceptives on religious or moral grounds. In addition, several states have limited mandates that apply to either specific types of insurers, such as health maintenance organizations (HMOs), or to coverage written for a segment of the insurance market. (Federal law requires insurance coverage of contraceptives for federal employees and their dependents; a few specific religious insurers are exempt from the requirements.) (excerpt)
Minors' access to contraceptive services. State policies in brief as of August 1, 2005.
Over the past 30 years, states have expanded minors’ authority to consent to health care, including care related to sexual activity. This trend reflects U.S. Supreme Court rulings extending the constitutional right to privacy to a minor’s decision to obtain contraceptives and concluding that rights do not “come into being magically only when one attains the state-defined age of majority.” It also reflects the recognition that while parental involvement is desirable, many minors will remain sexually active but not seek services if they have to tell their parents. As a result, confidentiality is vital to ensuring minors’ access to contraceptive services. Even when a state has no relevant policy or case law, physicians may commonly provide medical care to a mature minor without parental consent, particularly if the state allows a minor to consent to related health services. (excerpt)
Minors' access to prenatal care. State policies in brief as of August 1, 2005.
Over the past 30 years, states have expanded minors’ authority to consent to health care, including care related to sexual activity. The great majority of states and the District of Columbia currently allow a minor to obtain confidential prenatal care, including regular medical visits and routine services for labor and delivery. Some of these states, however, allow physicians to inform parents that their minor daughter is seeking or receiving services when they deem it in the best interests of the minor. In states that lack relevant policy or case law, physicians may commonly provide medical care to a mature minor without parental consent, particularly if the state allows minors to consent to related health services. (excerpt)
Minors' access to STD services. State policies in brief as of August 1, 2005.
Over the past 30 years, states have expanded minors’ authority to consent to health care, including care related to sexual activity. All 50 states and the District of Columbia allow most minors to consent to testing and treatment for sexually transmitted diseases (STDs), and many explicitly include testing and treatment of HIV. Many states, however, allow physicians to inform parents that the minor is seeking or receiving STD services when they deem it in the best interests of the minor. (excerpt)
Minors' rights as parents. State policies in brief as of August 1, 2005.
Many states require parental involvement in a minor’s decision to terminate a pregnancy. In sharp contrast, states overwhelmingly consider minors who are parents to be capable of making critical decisions affecting the health and welfare of their children without their own parents’ knowledge or consent. Nearly every state permits minor parents to place a child for adoption, although some require an adult to be involved in the process in some capacity. Moreover, most states authorize minor parents to make health decisions for their children, and some allow minor parents to authorize surgery. (excerpt)
Mandatory counseling and waiting periods for abortion. State policies in brief as of August 1, 2005.
Most states require state-directed counseling for women seeking an abortion. Counseling provisions vary from state to state, but they often include information designed to discourage women from obtaining an abortion, such as telling them that the father of the fetus is liable for child support, providing a list of abortion-alternative and adoption agencies, or offering to show photographs of fetuses at various stages of development. Most of the states that require counseling also require women to wait a specified period—typically 24 hours—after the counseling before obtaining the abortion. A few states mandate that the counseling be given in person, instead of over the phone or via the internet, thus requiring women to make two trips to the health care provider. (excerpt)
Protecting access to clinics. State policies in brief as of August 1, 2005.
While the handful of murders of abortion doctors and clinic staff have attracted much media attention, family planning clinics report that they frequently experience other serious forms of antiabortion violence. These include bombings, arson and vandalism, as well as violent protests and blockades. In 1994, the federal government enacted the Freedom of Access to Clinic Entrances (FACE) Act, which prohibits intentional property damage and the use of “force or threat of force or…physical obstruction” to “injure, intimidate or interfere with” someone entering a health care facility. States have taken two approaches designed to protect abortion providers. Some states prohibit specific activities, while others have created floating “bubble zones” of several feet around a person who is within a specific distance of a clinic; protesters are prohibited from crossing into that “bubble zone” without the person’s consent. (excerpt)
Parental involvement in minors' abortions. State policies in brief as of August 15, 2005.
A majority of states require parental involvement in a minor’s decision to have an abortion. In light of two U.S. Supreme Court rulings that prohibit parents from having absolute veto over their daughters’ decision to have an abortion, many states require the consent or notification of only one parent, usually 24 or 48 hours before the procedure. Many parental involvement requirements also include a medical emergency exception and a judicial bypass procedure, through which a minor may receive court approval to obtain an abortion without parental involvement. Not all states adhere to this model. On the more stringent end of the spectrum, a handful of states require the consent or notification of both parents, and one lacks a judicial bypass. On the other end, several states allow grandparents or other adult relatives to be involved in place of the minors’ parents; in cases of neglect or abuse, some states waive the consent or notification requirement altogether. State court decisions have also contributed to the diversity in requirements: Some state courts have enjoined laws they conclude violate their states’ constitutions; at the same time, similar or even more restrictive laws remain in effect in other states. (excerpt)
Restricting insurance coverage of abortion. State policies in brief as of August 1, 2005.
Compared with abortion issues that have grabbed significant media and public attention, state requirements governing private insurers’ coverage of abortion have, by and large, remained below the radar screen. A handful of states prohibit private insurers from covering abortion services, except in cases of life endangerment; more extensive coverage may be purchased at an additional charge. Lawsuits challenging these restrictions have had mixed results: In 1986, a federal appeals court invalidated Rhode Island’s requirement that private insurers exclude coverage of most abortions; in 1992, however, a federal district court upheld a similar Missouri statute. More often, states have banned abortion coverage in public employees’ insurance policies or in other cases where public funds are used to insure employees. These policies range from prohibiting coverage for abortion services altogether to offering coverage only when necessary to preserve the woman’s health and life or in cases of rape, incest or fetal abnormality. (excerpt)
Restrictions on postviability abortions. State policies in brief as of July 1, 2005.
In its landmark 1973 abortion cases, the U.S. Supreme Court held that a woman’s right to an abortion is not absolute and that states could restrict or ban abortions after fetal viability, provided their policies meet certain requirements. In these and subsequent decisions, the Court has held that even after fetal viability, states may not prohibit abortions “necessary to preserve the life or health of the mother”; “health” in this context includes both physical and mental aspects; only the physician, in the course of evaluating the specific circumstances of an individual case, can define what constitutes “health” and when a fetus is viable; and states cannot require additional physicians to confirm the physician’s judgment that the woman’s life or health is at risk. Although the vast majority of states restrict late-term abortions, many of these restrictions have been struck down. Most often, courts have voided the limitations because they (1) do not contain a health exception, (2) contain an unacceptably narrow health exception that does not include the woman’s mental health or (3) do not permit a physician to determine viability in each individual case but rather rely on a rigid construct based on either specific weeks of gestation or trimester. (excerpt)
State funding of abortion under Medicaid. State policies in brief as of August 1, 2005.
First implemented in 1977, the Hyde Amendment, which currently forbids the use of federal funds for abortions except in cases of life endangerment, rape or incest, has guided public funding for abortions under the joint federal-state Medicaid programs for low-income women. At a minimum, states must cover those abortions that meet the federal exceptions. Although most states meet the requirements, one state is in violation of federal Medicaid law, because it pays for abortions only in cases of life endangerment. Some states use their own funds to pay for all or most medically necessary abortions, although most do so as a result of a specific court order. (excerpt)
Public expenditures for reversible contraceptive services totaled $1.26 billion in FY 2001. Medicaid accounted for 61% of the total, whereas Title X and state only sources each accounted for 15%. Inflation-adjusted funding for contraceptive services increased by 37% between FY 1994 and FY 2001, but was still marginally lower than in FY 1980. During that time, Title X’s share of total funding fell from 44% to 15%, while Medicaid’s share increased from 20% to 61%. The importance of each funding program for contraceptive services varied substantially by state in FY 2001, and several programs were dominated by the spending of a handful of states. Seven states decreased their spending in actual dollars between FY 1994 and FY 2001, and only two had cuts since FY 1980. Accounting for inflation, 22 states reduced their spending since FY 1994, and 30 since FY 1980. The amount that each state spends relative to the number of women in the state in need of publicly supported contraceptive services varied widely across states in FY 2001. (excerpt)
Widespread of AIDS in Bangladesh is a must, if we fail to prevent of spreading HIV virus.
Social, ethical and religious educations, social including political leadership and family have the enormous impact on the nation’s moral, but their control is on its last legs in Bangladesh. Education and Religion should have positive effects on morals, but it is failing to fulfill that responsibility due to economical conditions of the country. Although HIV/AIDS is still largely concentrated in at high-risk groups, including migrant workers, commercial sex workers, injecting drug users, and moveable population mainly truck/bus drivers. The surveillance data indicates that the epidemic is affecting outside these groups in some regions and into the general population. Also, HIV/AIDS no longer affects only high-risk groups or urban populations, but is gradually spreads into rural areas and the general population. So, these risks will influences from urban to rural. In some groups, particularly among the Drug Users through Needle sharing (IDUs) those are reporting the higher prevalence, but there is absolutely no doubt that the virus will affects into the general population. It’s also a matter of great concern regarding HIV issues that our neighboring countries- India, Myanmar and Nepal are considered to be the focal point of HIV epidemic in this region. Currently, about 5 million people in India are having HIV. The epidemic of HIV/AIDS in India is following the same pattern as that of sub-Saharan Africa in the 1980s and it could become just a devastating unless preventive action is taken now. It is an expert assumption that the number of people infected with HIV in India will rise to 15-20 million by 2010. The Bangladesh has a breachable porous boarder with India and its economy depends a large number of migrant workers mostly to India and Myanmar, including maid servant, truck drivers, businessmen and laborers. These migrants, who spend many months away from their families, are known to be at increased risk of contracting HIV. (excerpt)
Emerging issues of health and mortality in the Asian and Pacific region.
The Asian and Pacific region has recorded a remarkable increase in life expectancy at birth in the last 50 years. Particularly in Asia in the period from 1950-1955 to 2000-2005, the average life expectancy soared from 41 years to 67 years. Infant mortality rates dropped from 182 to 53 per 1,000 live births during the same period. While the trend of falling mortality rates is a universal demographic feature across the Asian and Pacific region, there is nonetheless a large disparity in the health and mortality situations among countries, with some having continuously very high mortality rates, especially those for infant, child and maternal mortality. However, such countries tend to be in the earlier stages of development and thus are struggling to manage health-related mortality problems linked to poorer socio-economic conditions. (excerpt)
Decisions denied: women's access to contraceptives and abortion in Argentina.
In Argentina as in many other countries, the public debate on abortion and even contraceptives and sex education has sometimes included arguments and accusations that are unworthy of a democratic society. Decisions related to contraceptives and abortion are complicated and socially contested. They are, however, also a question of human rights. It is almost twenty years since Argentina joined the international community of democratic states after a painful military dictatorship and on that occasion ratified some of the most important international human rights treaties. It is more than ten years since these treaties gained constitutional force in Argentina. It is time to have a debate about contraceptives and abortion, and to have it in a civilized manner. Human Rights Watch intends this report to further such debate. As this report was being finalized, in late May 2005, important reforms—such as the distribution and implementation of new guidelines on humane post-abortion care—were about to commence. This report illustrates the urgent need for these reforms, and the essential nature of further government action in the area of reproductive rights. This report is based on field research in Argentina in September and October 2004, as well as prior and subsequent research. A Human Rights Watch staff member conducted in-depth interviews with more than forty women and one girl who had experienced problems in accessing contraceptives or who had undergone illegal and unsafe abortions. These interviews took place in the provinces of Buenos Aires, Tucumán, and Santa Fe. All names and identifying information of the women interviewed have been changed to protect their privacy. These persons were identified largely with the assistance of Argentine NGOs and grassroots organizations providing services and support to low income women, women affected by domestic or sexual violence, and women living with HIV/AIDS. (excerpt)
Trends in delivery care in six countries.
Increasing the proportion of deliveries with skilled attendants present is being advocated as the most important step in preventing maternal deaths worldwide. The indicator most commonly used as a proxy for skilled attendance at delivery is the percentage of deliveries attended by a health professional, which has been selected as one of the Millennium Development Indicators for measuring reductions in maternal mortality. The objective of this study is to provide an in-depth understanding of trends in delivery with a health professional over the last decade, across a range of developing countries: Bangladesh, Bolivia, Ghana, Indonesia, Malawi, and the Philippines. In particular, the study analyzes trends in the types of professionals providing services, the place of delivery, and some composite indicators of skilled attendance. Throughout the report, emphasis has been placed on identifying subnational variation in trends by socioeconomic and obstetric characteristics of the women. The proportion of deliveries with a health professional has increased over the last decade in all six countries. The national trends were statistically significant in three countries—Bangladesh, Bolivia, and Indonesia—with the largest absolute increases in Bolivia and Indonesia. National trends, however, mask variations between different groups of women. Urban-rural residence, economic status (wealth index), parity, maternal education, and age were all associated with delivery with a health professional. The results suggest that inequities among women of different backgrounds may be increasing, emphasizing the importance of subnational analyses to ensure that the women least likely to seek care are not marginalized. (excerpt)
Recent trends in abortion and contraception in 12 countries.
This report is an analysis of recent trends in abortion and contraception in 12 countries of central Asia and eastern Europe—Armenia, Azerbaijan, Georgia, Kazakhstan, the Kyrgyz Republic, Moldova, Romania, Russia, Turkey, Turkmenistan, Ukraine, and Uzbekistan—where abortion had long been a major if not the principal method of birth control. All of these countries have experienced sharp declines in the number of children desired and in fertility rates. Despite increasing preferences for small families, abortion rates in eight of these countries have recently declined, while the use of modern contraceptive methods has steadily increased. Two of the remaining four countries experienced little change in the prevalence of modern contraceptive methods and witnessed an increase in abortion, while in the two other countries, the number of children desired is very low and unintentional pregnancies have increased. Most abortions are associated with pregnancies that occurred as a result of contraceptive failure—particularly the use of traditional methods such as withdrawal—and pregnancies of women who were not using contraception despite not wanting any (more) children (the “unmet need for family planning” category). In two-thirds of the countries, contraceptive failure accounts for most abortions, while in the other third, unmet need for family planning contributes most of the abortions. A cross-sectional analysis of 18 countries shows a very high negative correlation between abortion and the use of modern contraceptive methods but a moderately high positive correlation between abortion and the use of traditional contraceptive methods. (excerpt)
Advocating for adolescent reproductive health in Eastern Europe and Central Asia.
Advocacy is the effort to change public opinion and influence programs, policy decisions and funding priorities. This effort can occur at the local, national or international level. Advocates educate about an issue and suggest a specific solution. All advocacy efforts involve making a case in favor of a particular issue, using skillful persuasion and strategic action. Simply put, advocacy means actively supporting a cause and trying to get others to support it as well. Advocacy can look really different depending on the issue. In a small advocacy campaign, a group of young people may persuade school officials to allow a peer education program in the school; A club for youth may seek a traditional leader's approval to use office space in a community building; Several organizations may work together to ask that a local clinic adopt policies and procedures that make services more accessible to young people; A peer education program may ask a religious leader to speak out for more HIV/AIDS prevention efforts; A group of nongovernmental organizations (NGOs) may collaborate to propose changes to national policies affecting young people, such as ensuring that family life education curricula address reproductive health, persuading health clinics to provide services to unmarried youth, or promoting young women’s improved access to education. These are just some of the many ways that you and other young people can advocate for sexual and reproductive health information and services. (excerpt)
People under the age of 25 represent nearly half of the world’s population, giving them a powerful role in the world’s health and future. Despite youth’s diversity in culture, background, language, and socioeconomic status, their lives reflect similar, intersecting issues and events. For youth ages 15 through 24, life sometimes seems to be overshadowed by sexual health issues, including unintended pregnancy and HIV as well as other sexually transmitted infections (STIs). Youth under age 25 have never known a world without HIV and AIDS. Worldwide, about 6,000 youth ages 15 to 24 are infected with HIV each day; Young people experience over 100 million new cases of STIs each year. Several STIs are associated with easier transmission of HIV between sexual partners; Young women experience high rates of unintended pregnancy. Each year, about 15 million young women, ages 15 to 19, give birth. In some countries in Africa, Latin America and the Caribbean, over 50 percent of teenage pregnancies are unintended. Youth’s decisions about their sexual and reproductive health affect not only their lives, but also the health of the global community. Thus, there is an urgent need for programs and policies to address the complex sexual and reproductive health needs of earth’s one billion youth ages 15 to 24. This paper discusses integration and offers case studies, lessons learned, and tips for integrated approaches to preventing HIV, STIs, and unintended pregnancy among youth. (excerpt)
Let's Talk Month planning guidebook. Revised ed.
Each year, Let’s Talk Month emphasizes the importance of conversations about sex between young people and the adults they trust. Schools, communities of faith, community-based agencies, media, and businesses, can take the leadership in providing activities, resources, and educational programs to support: 1) parents or other care-givers and youth in talking together about sex; and 2) youth in making healthy, responsible decisions about sex. Working together, parents and other adults in the community can provide the information and skills to prepare young people to become healthy adults … and the parents of tomorrow’s children. Providing children and youth with accurate, reliable sex education is an important responsibility. Studies reveal that most kids prefer learning about sex from their parents. But many parents are uncomfortable with this particular responsibility and need support and encouragement to take it on. Parents need to know that they do not need to be experts in order to talk with their children about sex. Parents also need to know that they do indeed share their values and beliefs about sex with young people. By talking, parents can be sure their kids receive accurate messages about the parents’ values. By not talking, parents also share values, but not necessarily the ones they want to share. (excerpt)
Integrating efforts to prevent HIV, other STIs, and pregnancy among teens in Minnesota.
In the United States, many youth-serving professionals and activists focus on preventing some particular negative health outcome among teens, such as unintended pregnancy or sexually transmitted infections (STIs). In other words, youth-serving professionals often focus on one facet or another of the lives of youth, instead of serving youth more holistically. Integrating their efforts may provide a number of benefits, both for the young client and for youth-serving organizations. This document discusses the what, why, and how, the benefits, and the challenges of approaching youth holistically and of integrating the sexual health information and services they receive. (excerpt)
Youth's reproductive health targets must be included in the Millennium Declaration.
In 2002, the leaders of 189 countries came together at the Millennium Summit and pledged to: eliminate poverty; create a climate for sustainable development; and ensure human rights, peace, and security for the entire world’s people. To measure progress towards this vision, the Millennium Development Goals (MDGs) were created. While many of the MDGs come from previously agreed upon declarations, none explicitly references youth’s reproductive health, even though its relationship is integrally linked to poverty and to meeting the vision of the summit. Investments made by governments to improve youth’s reproductive health can have a positive long-term impact on the productivity of a nation’s workforce, per capita income, health care expenditures, and social capital. (excerpt)
Youth's reproductive health: key to achieving the Millennium Development Goals at the country level.
Five years ago, the leaders of 189 countries came together at the Millennium Summit and pledged to: eliminate poverty; create a climate for sustainable development; and ensure human rights, peace, and security for the entire world’s people. Eight overarching Millennium Development Goals (MDGs) measure progress towards this vision. None of the MDGs explicitly references youth’s reproductive health, even though its relationship to alleviating poverty cannot be overlooked. (excerpt)
National Teen Pregnancy Prevention Month (NTPPM) planning guidebook. Revised ed.
National Teen Pregnancy Prevention Month (NTPPM) is an educational campaign designed to help communities recognize that the effects of unintended teen pregnancy and early childbearing are far-reaching. The campaign increases the public’s awareness of and commitment to teen pregnancy prevention. The campaign mobilizes communities to help young people develop responsible, positive behaviors and attitudes regarding sexuality. In the past few years in the United States, rates of adolescent sexual activity, teen pregnancy, and teen births have fallen. More specifically, between 1990 and 2000, the teen pregnancy rate declined by 28 percent and the teen birth rate declined by 21 percent. Sexually active teens use contraception more frequently and effectively than teens in earlier years, and experts attribute decreased birth and pregnancy rates mostly to teens’ improved use of contraception. Part of the decrease is also due to delays in initiation of sex. Programs that provide young people with age-appropriate, accurate sex education and access to confidential sexual health services contribute to the improved rates. Despite these improvements, the United States continues to have the highest adolescent pregnancy and birth rates in the industrialized world, although U.S. teens initiate sex at about the same time as their European counterparts. Clearly, Americans need to empower young people to make healthy decisions about sex. Efforts to support and expand the current positive trends must involve all parts of communities—youth, parents, teachers, policy makers, health professionals, businesses, the media, and faith communities, among others. Since becoming the national sponsor of NTPPM, Advocates has received thousands of inquiries about NTPPM, inquiries that demonstrate the level of interest and need for such a campaign. NTPPM emphasizes the importance of strong partnerships between communities and families to encourage young people to develop responsible, healthy attitudes and behaviors about sex. Faith communities, media, businesses, schools, and community agencies can assume leadership roles by providing activities, information, resources, and educational programs to help improve the health and well-being of young people nationwide. (excerpt)
Creating safe space for GLBTQ youth: a toolkit.
Some organizations and programs are intentional about serving gay, lesbian, bisexual, transgender, and questioningµ (GLBTQ) youth. However, many youth-serving programs in the United States—including educational, health care, youth development, sports, recreational, and employment programs, among others—ignore, overlook, or reject the presence of GLBTQ youth among those they serve. A recent survey of high school youth found that less than six percent self-identify as gay, lesbian, or bisexual and/or report same-sex sexual contact. This percentage probably does not include transgender and questioning youth or those who are fearful of sharing information about their sexual orientation or gender identity. Consider then, that six to 10 percent of the young people in your program may be GLBTQ. Unless your program positively acknowledges their presence and actively affirms their rights and dignity, these young people may feel compelled to keep their sexual identity a secret. Having to keep secret such an essential part of life puts these youth at risk of negative mental and physical health outcomes. Advocates for Youth and Girl’s Best Friend Foundation approach all their work with youth from a firm belief that every young person is of great value, irrespective of race/ethnicity, biological sex, health status, socio-economic background, sexual orientation, or gender identity. Indeed, valuing youth provides an ethical imperative to acknowledge and serve GLBTQ youth equally and positively along with straight youth and those who conform to society’s gender role expectations. (excerpt)
South-to-South collaboration to improve programs for youth.
There are about 1.8 billion people in the world between the ages of 10 and 24, and the vast majority live in developing countries. High rates of unintended pregnancy, unsafe abortion, and sexually transmitted infections (STIs), including HIV, jeopardize the sexual health and the future of these youth. Thus, it is crucial to develop and implement programs and policies that meet young people’s reproductive and sexual health needs. One important strategy for improving reproductive and sexual health policies and programs is south-to-south collaboration—the sharing of experience between developing countries and between individuals, nongovernmental organizations (NGOs), and/or governments and their agencies in developing countries. The central premise of south-to-south collaboration is that, by sharing information and strategies, organizations in developing countries can improve programs, pool scarce resources, and advance mutually held goals. Moreover, developing countries can achieve these gains with little reliance on developed countries. Although today, south-to-south collaborations are often initiated and guided by donor NGOs; in the future, they may be initiated and guided almost entirely by NGOs in developing countries. Finally, the solutions and strategies—devised to reflect the particular social, cultural, and economic conditions of one developing country—may more easily be adapted for use in another developing country, especially when compared to programs devised in developed nations with dissimilar social, cultural, and economic conditions. (excerpt)
National honor and practical kinship: unwanted women and children.
In the well-known novel Mitro Marjani, by Krishna Sobti (1969), Mitro, the protagonist, reflects on the strangeness of a world in which the same sexual act is seen as a religious deed when a woman is impregnanated by her husband and as a sin if the man is a stranger. Acting as the interlocutor for the voice of the mother, who feels boundless joy when she discovers that her son's wife is pregnant, Mitro, the rebel, says, " Ye kaisi reet -- apne ladke beej dalen to pun aur doosra koi dale to pap " ("What is this custom that when your own son puts the seed it is religious merit and if another man puts it, it is sin"). In this chapter I shall try to amplify Mitro's reflections and examine the relation between codes of honor in the sphere of kinship and national codes of honor, to ask what happens when women get impregnated by "other" men and give birth to "wrong" children. My reflections are based on the events consequent to the partition of India in 1947, including the experiences of Muslims, and especially the sexual violation of women. In some of my earlier work I have described how women came to be the locus of tension in incidents of collective violence during the partition. The woman's body, I argued, became the sign through which men communicated with each other. The lives of women were framed by the notion that they were to bear permanent witness to the violence. Thus the political program of creating two nations of India and Pakistan was inscribed on the bodies of women. The sexual and reproductive violence cannot be understood as part of the discourse of family alone. It has to be understood as doubly articulated in the domain of kinship and in the domain of politics. The formal and informal discourses imposed upon women, pregnancies, and children born to "wrong" fathers were marked by ruptures and by uneven folds on surfaces rather than by a smooth gliding from one surface to another. (excerpt)
Power and visibility: tales of peasants, women and the environment.
This chapter follows the displacement of the development gaze across the terrains in which these three social actors move. The gaze turned peasants, women, and the environment into spectacles. Let us remember that the apparatus (the dispositif) is an abstract machine that links statements and visibilities, the visible and the expressible. Modernity introduced an objectifying regime of visuality -- a scopic regime, as it has been called -- that, as we will see, dictated the manner in which peasants, women, and the environment were apprehended. New client categories were brought into the field of vision though a process of enframing that turned them into spectacles. The "developmentalization" of peasants, women, and the environment took place in similar ways in the three domains, a reproduction of new discourses, however, is not a one-sided process; it might create conditions for resistance. This can be gleaned in the discourse of some peasants, feminists, and environmentalists; it is reflected in new practices of vision and knowledge, even if these resistances take place within the modes of the development discourse. (excerpt)
Postmodern procreation: a cultural account of assisted reproduction.
This chapter takes as its starting point, then, a recognition of the changing landscape of reproductive politics and the consequent need for a redefined feminist engagement with it. I argue that an appreciation of the specifically cultural dimensions of the changing construction of reproduction is critical to the maintenance of effective feminist challenges. Anthropology has a particular role to play in regard to this dimension of reproductive politics, and the work of several contributors to this collection has been exemplary in defining this approach. So too has the work of cultural historians been important in the attempt to address the cultural implications of reproductive politics. (excerpt)
The impact of population growth is a source of endless debate. There is a vast literature on the subject, by demographers and economists, sociologists and development planners. The subject not only involves the impact of population growth per se, but problems of population distribution between urban and rural areas and imbalances in the age structure of populations. What emerges most strongly from the literature is the difficulty of generalizing on a global level; the impact of population growth differs from country to country and is influenced by a variety of factors. Yet the complexities of demographic research and the wide variation in scientific opinion have largely been screened from public view. Instead, Malthusian alarmists, who range from environmentalists like Paul Ehrlich to senior international technocrats like former World Bank president Robert McNamara, command the widest public audience. While the population bomb briefly went out of fashion in the 1980s, it is very much back in vogue today. There are several reasons why the alarmist message enjoys such credibility. It not only makes good shock headlines in the press, but also draws on deep undercurrents of parochialism, racism, elitism, and sexism, complementing the Social Darwinist "survival of the fittest" view. The most extreme Malthusians even advocate that famine relief be cut off to poor overpopulated countries: Let the unfit starve until their numbers are brought under control. In 1985, at the height of a major African drought, Colorado Governor Richard Lamm wrote in The New York Times that the United States should stop giving emergency relief to African countries that failed to reduce their population growth, since such aid would "merely multiply empty stomachs." (excerpt)
An art historian turns to me at a party: "You're writing a book on population control? My field is aesthetics, and I feel that over-population is destroying the beauty of great cities like Paris. Ugly immigrants' housing is springing up all over the place." The babysitter turns off the TV. "I've been thinking about it," he says. "If they don't force people to be sterilized in India, how are they going to cope with the population explosion?" An accounting professor explains how pharmaceutical companies could develop cures for many of the basic diseases that afflict poor people, but don't because the people who need them are too poor to pay. "Maybe it's not such a bad thing," he adds. "After all, if more poor people survive, it will only exacerbate the population problem. An economist, known for his radical views on the United States economy, surprises me by saying that many Third World countries have no choice but to initiate harsh population control measures. "Their economic survival is at stake," he asserts. (excerpt)
Bangladesh -- survival of the richest.
Soon after my arrival in the Bangladesh village of Katni in 1975, I experienced firsthand what the population establishment calls the "unmet need" for contraception. The village women were extremely curious about why I had no children at the ripe old age of twenty-four, and I told them about my use of birth control. Within a few days, women who had already borne a number of children started approaching me for help -- many were desperate to avoid another pregnancy. I succumbed to the pressure and visited the government family planning office in the nearby town, setting in motion a chain of events that dramatically altered my perception of Bangladesh's "population problem." Three days after my visit to the family planning office, a government jeep sputtered down the path toward the village. Inside were two young women, who were later ushered into a small, dark house, where they were handed bamboo fans and seated in wooden chairs as a gesture of respect. About fifteen village women assembled, not only to learn about birth control but also to see the strange town women with their educated accents and fine clothes. The family planning workers spoke about the concept of birth control but did not encourage the women to ask questions. They promised they would return in a few days with IUDs and Pills for any women who wanted them. After they left, the villagers asked me if they were my sisters from America. A week passed, then two, then three. There was no sign of the family planning workers. "When will they come back?" women asked. "We want some pills. All government officers care about is their salary. They sit in their offices and drink tea. What do they care about us?" (excerpt)
International health researchers are directing increased attention to a major and widespread problem defined as maternal mortality. The World Health Organization (WHO) estimates that half a million deaths occur annually among women who are or have been pregnant during the previous forty-two days. According to the July-October 1992 volume of WHO's Safe Motherhood Newsletter about 94 percent of these deaths, which are by definition attributed to pregnancy and child-birth, take place in the economically disadvantaged southern part of the global divide, the so-called developing countries. As researchers began to respond to a call to action on this problem by WHO, the prior "neglect" of maternal mortality was attributed to the underestimation, or even absence, of information about this serious health issue. With increased interest, a variety of groups with different political agendas have expressed concern. These groups range from feminist nongovernmental organizations such as those associated with the international Maternal Mortality and Morbidity Campaign (Women's Global Network for Reproductive Rights, 1992) to the United States Agency for International Development (USAID). Well known for its protracted commitment to population control in the Third World, USAID is a cosponsor, with the World Bank, of the Safe Motherhood Initiative. (excerpt)
The introduction of biomedical technologies such as Norplant draw into relief broader issues such as changing gender relations between rural men and women. For one, the Bengali woman is not a simple repository of ideological constructions, as she creates her own self construction as a woman in purdah, which highlights the malleability of 'traditional' ideologies.' Speaking about decisions to use Norplant, some of the women expressed the view that the community has changed and their narratives reveal transformations in their medical world view, and in their economic and social life. The women will go to significant lengths to control their fertility. They defy their family and societal standards at times, obtain the cooperation of kin and family planning workers to procure services, and ingeniously avail themselves of Norplant services. A majority of the women are proud of their ability to take the initiative in seeking Norplant services, as one woman explained, 'I decided to take it, Norplant is good, it is for five years.' They perceived that by limiting their family size, they would be able to give their children better food, clothing and improved education. Shifting discourses on 'modernity' and 'tradition' are revealed as women try to situate their bodies and themselves in the world, and as they negotiate conflicts between the 'traditional' and the 'modern'. Figuring importantly in the narratives are ideas about the creation of their 'new modern' identities which is seen as an inevitable fact of the 'new era'. However, this new sense of self exists in collaboration with a substantial inability to negotiate, as the lives of these women continue to be largely controlled by patriarchal structures and norms. (excerpt)
The production of fertility and infertility: East and West, South and North.
The production of fertility and infertility, that is, the ways in which both are created and commodified as medical problems, is very much linked with the production of distinctively different technologies developed for use in different parts of the world. The ideology of infertility in the West is based on a double standard. Children who are technologically conceived at high cost in the industrialized world -- a staggering cost to women's well-being and a high economic cost -- are the potential children whose conception is thwarted in the Third World, through sterilization, harmful contraceptives, and sex predetermination, not to mention the existing children who die of poverty, malnutrition, and other causes. Keeping First- Third World connections in view enables us not to lose sight of the global picture of technological reproduction. (excerpt)
Oral lesions in infection with human immunodeficiency virus.
This paper discusses the importance or oral lesions as indicators of infection with human immunodeficiency virus (HIV) an as predictors of progression of HIV disease to acquired immunodeficiency syndrome (AIDS). Oral manifestations are among the earliest and most important indicators of infection with HIV. Seven cardinal lesions, oral caniiasis, hairy leukoplakia, Kaposi sarcoma, linear gingival erythema, necrotizing ulcerative gingivitis, necrotizing ulcerative periodontitis and non-Hodgkin lymphoma, which are strongly associated with HIV infection, have been identified an internationally calibrate, an are seen in both developed an developing countries. They may provide a strong indication of HIV infection and be present in the majority of HIV-infected people. Antiretroviral therapy may affect the prevalence of HIV-related lesions. The presence of oral lesions can have a significant impact on health-related quality of life. Oral health is strongly associated with physical an mental health an there are significant increases in oral health needs in people with HIV infection, especially in children, and in adults, particularly in relation to periodontal diseases. International collaboration is needed to ensure that oral aspects of HIV disease are taken into account in medical programmes and to integrate oral health care with the general care of the patient. It is important that all health care workers receive education and training on the relevance of oral health need and the use of oral lesions as surrogate markers in HIV infection. (author's)
Shaping contraceptive technology.
Technological innovations are not "neutral"; instead, they em-body the values of their creators. It is no accident that at the end of the twentieth century billions of dollars are spent every year on weapons of destruction and luxury goods, while technologies that could dramatically improve people's lives-nonpolluting energy sources, sustainable agricultural systems, basic health and sanitation measures-receive minimal funding at best. Those who hold the reins of power exercise power over technological choice. Contraceptive technology is no exception. The contraceptive revolution of the second half of this century has been influenced more by the pursuit of population control, prestige, and profit than by people's need for safe birth control. Millions of dollars have flowed into the development, production, and promotion of technically sophisticated contraceptives such as the pill, injectables, and implants, despite their health risks, while the improvement of safer and simpler barrier methods has been virtually neglected, with tragic consequences in this era of the AIDS epidemic. The misdirection of contraceptive technology begins in the re-search phase and culminates in its use as a destructive and even deadly weapon in the war on population. It is mainly women who bear the cost, many paying dearly with their health and lives. (excerpt)
Hormonal contraceptives and the IUD.
To millions of women throughout the world, hormonal contraceptives and the IUD have been presented as liberating technologies. In the West they were heralded as the key to the so-called sexual revolution, and in the Third World as the answer to unwanted pregnancies and high birth rates. The enthusiasm which accompanied their introduction helped to obscure, and still obscures, their drawbacks. In population control programs particularly, many women have been denied vital information about the risks of these contraceptives and have not received medical screening or follow-up care while using them. The result makes a mockery of informed consent. (excerpt)
Today sterilization is the world's most widespread form of birth control, accounting for over a third of contraceptive use worldwide, and almost half in developing countries. Female sterilization is much more common than male-by 1992 an estimated 140 million women of reproductive age had been sterilized, as opposed to 42 million men. Female to male sterilization ratios are higher in developing countries than in developed ones. The concentration on female sterilization raises troubling concerns, since it is a more complicated and riskier operation than vasectomy and can take longer to recover from. The most common complications of female sterilization are anesthesia-related problems, internal injury, and infection, and there may be long-term side effects such as heavier menstrual periods or lower back pain. The mortality rate probably differs significantly depending on where the operation is done. According to Population Reports, in the U.S. the rate is approximately one death in every 70,000 procedures, but it is likely to be much higher in mass sterilization camps and clinics in countries like India and Bangladesh. Nevertheless, new female surgical methods are often billed as easy and safe -- Planned Parenthood, for example, calls the "minilap" technique "Band-Aid surgery" -- although they all require a high degree of technical competence. (excerpt)
Barrier methods, natural family planning, and future directions.
The contraceptive revolution of the 1960s and 1970s brought the pill, the IUD, the injectable, and the implant, all extremely effective forms of reversible contraception if used correctly. Yet despite the millions of dollars poured into research, that revolution did not bring many improvements in contraceptive safety. On the contrary, the health risks of these methods are considerable and are compounded by their misuse in population programs. They also do not guard against sexually transmitted diseases such as HIV/AIDS. Today there is a need for a second contraceptive revolution. "Without giving up the high effectiveness, convenience, and relatively low cost of today's contraceptives," write Judith Bruce and S. Bruce Schearer, "tomorrow's contraceptives must be safe in both the short- and long-term; fully reversible and free of effects on future fertility ... on breast-feeding infants and on lactation." The irony is that such methods already exist, in the form of barrier contraceptives -- spermicides, condoms, diaphragms, cervical caps -- though there is great need and scope for their improvement. Yet with the exception of the condom, these safe, simple, reversible contraceptives are unavailable in many, if not most, Third World family planning programs, and in Western countries people are also often discouraged from using them. Less than 2 percent of contraceptive users worldwide use female barrier methods, and only 6 percent use condoms. (excerpt)
From Norplant to the contraceptive vaccine.
They told us this and they told us that about the Norplant and I'm going through all these changes and I'm trying to have it removed." Yvonne Thomas, a thirty-year-old Baltimore mother, was describing her experience with Norplant, a new, long-acting contraceptive implanted in her arm at a family-planning clinic. When she began suffering from side effects, Thomas returned to have the device removed. But the clinic staff balked at her request. "Then they tell me that it's not putting me in bed, as if they know how I feel on the inside of my body...I feel like because I'm a social service mother that's what's keeping me from getting this Norplant out of me. Because I've known other people that has the Norplant that spent money to have it put in and spent money to have it put out with no problems....That's how they make me feel, like 'you got this Norplant you keep it'." (excerpt)
Race and the new reproduction.
A friend of mine recently questioned my interest in a custody battle covered on the evening news. A surrogate mother who had agreed to gestate a fetus for a fee decided she wanted to keep the baby. "Why are you always so fascinated by those stories?" he asked. "They have nothing to do with Black people." By "those stories" he meant the growing number of controversies occupying the headlines that involve children created by new methods of reproduction. More and more Americans are using a variety of technologies to facilitate conception, ranging from simple artificial insemination to expensive, advanced procedures such as in vitro fertilization (IVF) and egg donation.* In one sense my friend is right: the images that mark these controversies appear to have little to do with Black people and issues of race. Think about the snapshots that promote the new reproduction. The always show white people. And the baby produced often has blond hair and blue eyes -- as if to emphasize her racial purity. The infertile suburban housewife's agonizing attempts to become pregnant via IVF; the rosy-cheeked baby held up to television cameras as the precious product of a surrogacy arrangement; the complaint that there are not enough babies for all the middleclass couples who desperately want to adopt; the fate of orphaned frozen embryos whose wealthy progenitors died in an airplane crash: all seem far removed from most Black people's lives. Yet it is precisely their racial subtext that gives these images much of their emotional appeal. (excerpt)
Youth Speak Out provides new information and practical ideas generated by young people themselves for further coordinated advocacy and immediate action for and with young people affected by armed conflict based on experience gained about what is needed and what works. It is for decision-makers at all levels: governmental and other donors; United Nations headquarters and field representatives; international and local nongovernmental organizations (NGOs); adolescents and youth; academics; and others with responsibility or concern for refugee young people. It shows how actions many of these groups have taken so far with and for young people affected by armed conflict have made significant constructive differences in their protection and well-being and that of their communities. It also identifies the serious gaps that remain. It describes how young people view their own protection environment. Their diverse perspectives point to the need for a new conceptual framework informed by them, explaining why and how refugee young people’s rights should be supported. Finally, Youth Speak Out identifies specific and practical steps that can and should be taken now to expand on good program experiences and improve on policy guidelines for young people’s protection and care. Supporting the rights of adolescents and youth, especially their participation, is not only an obligation, it is essential good practice. (excerpt)
Our common interest. Report of the Commission for Africa.
Our recommendations are based on two things. We carefully studied all the evidence available to find out what is working and what is not. And we consulted extensively, inside and outside Africa, with governments, civil society, the academic world and with those in the public and private sector. We have met individuals and groups from each region and 49 individual countries in Africa, and from every G8 country, China, India and across Europe. We have received nearly 500 formal submissions and have made a particular effort to engage with the African diaspora. We are enormously grateful to all these individuals and groups for their contributions. Our report is in two parts. The first, The Argument, addresses itself to that wider audience and succinctly sets out our call to action. The second part, The Analysis and Evidence, lays out the substance and basis of our recommendations so these can be held up to public scrutiny. Our Recommendations are set out between these two sections. Our report is written for many audiences. We address ourselves to decision-makers in Africa who must now drive forward the programme of change they have set out. We address ourselves to the rich and powerful nations of the world, whose leaders meet as the G8 in Gleneagles in Scotland in July 2005 where they must take a strong lead for action of a different order. We address ourselves to the international community, which must commit to greater and faster action on the Millennium Development Goals at the United Nations in September – and must also act boldly at the World Trade Organisation talks in Hong Kong in December. And we address ourselves to the people of Africa and the world as a whole. For it is they who must demand action. It is only their insistence which will determine whether their political leaders take strong and sustained action. (excerpt)
In Chennai, women's vulnerability exposed by tsunami.
Last December's Indian Ocean tsunami devastated the 44 coastal villages and fishing livelihoods of Chennai, one of India's oldest cities and capital of the Indian state of Tamil Nadu. And in the wake of this destruction, rehabilitation efforts on Chennai's coastline have been stalled by the traditional marginalization and vulnerability of the women who live and work there. The tsunami has exposed the contradictory position of these women: economically essential, yet politically powerless and excluded from economic decision-making. Before the tidal wave hit, men in coastal Chennai were the sole fishers, while the women did everything else to support family livelihoods: processing fish; mending nets; caring for households, children, and the elderly; and even arranging finance and loans from middlemen and moneylenders for consumption and business. Today, while most men are still fearful to return to sea, women are providing almost 100 percent of the household income for Chennai's 40,000 fishing families, working as domestic servants, boat painters, net menders, shop-minders, and tailors. And in the first days following the tsunami, women's self-help groups were key to relief and recovery efforts. (excerpt)
Restrictions on AIDS activists in China.
In recent years, China’s government has lifted some of its tight restrictions on the country’s long-dormant civil society. Senior Chinese officials have shown a growing awareness about the need to mobilize civil society in order to combat a range of social problems, ranging from humanitarian relief to education and legal defense. As a result, many nongovernmental organizations (NGOs), grass-roots groups, and non-profit websites have sprung up around the country. But the Chinese state remains deeply ambivalent about these groups, as it does of any institution that is outside of direct state control. Continuing restrictions on civil society, free expression and free association, along with a general lack of accountability for government officials, have hindered the growth of grass-roots groups. Local activists and NGOs are also hampered by the Chinese government's sporadic harassment and detention of activists whose public criticism threatens the interest of some segments of the government. Even as NGO activity generally increases, activists and NGO staff continue to report constant state surveillance, a web of bureaucratic obstacles, and even open harassment in the course of doing their daily work. (excerpt)
Clean water's historic effect on U.S. mortality rates provides hope for developing countries.
The introduction of water filtration and chlorination in major U.S. cities between 1900 and 1940 accounted for about one-half of the 30 percent decline in urban death rates during those years, according to research published in the February 2005 issue of the journal Demography. And the study's authors argue that their findings have relevance today in the developing world, where access to safe drinking water is growing but often still inadequate. "Inexpensive water disinfection technologies can have enormous health returns in poor countries, even in the absence of sanitation services," says David Cutler, a Harvard economist and co-author of the study. Cutler and co-author Grant Miller, a Harvard graduate student, found that clean water was responsible for cutting three-quarters of infant mortality and nearly two-thirds of child mortality in the United States in the first 40 years of the 20th century—the most rapid health improvements in the nation's history. "Nearly all the mortality decline is accounted for by reductions in infectious disease, which today is only a small share of total mortality," write the authors. (excerpt)
With a view to facilitating the scale-up of access to antiretroviral therapy (ART) in the African Region the present document outlines recent revisions made by WHO to the clinical staging of HIV/AIDS and to case definitions for HIV/AIDS disease surveillance. These interim guidelines are based on an international drafting meeting held in Saas Fee in June 2004 and on recommendations made by experts from African countries at a meeting held in Nairobi in December of the same year. The revisions to the clinical staging target professionals ranging from senior consultants in teaching and referral hospitals to surveillance officers and first-level health care providers, all of whom have important roles in caring for people living with HIV and AIDS (PLWHA), including children. It is proposed that countries review, adapt and repackage the guidelines as appropriate for specific tasks at different levels of health service delivery. It is hoped that national HIV/ AIDS programmes in African countries will thus be assisted to develop, revise or strengthen their ART guidelines, patient monitoring and surveillance efforts. The interim clinical staging and revised definitions for surveillance are currently being reviewed in the other WHO regions and will be finalized at a global meeting to be held in September 2005. (excerpt)
Small fishing and farming villages dot the rural landscape along the Indian Ocean on Tanzania 's northern coast. Local men have fished for subsistence in this area for generations, while women have traditionally managed households and acted as primary caregivers. But over the past several decades, the fish trade has lured greater numbers of nonlocal fisher-folk, brokers, and entrepreneurs to the region. And this influx of a highly mobile male population has combined with chronic poverty, the low status of women, and a growing sense of hopelessness to generate a culture of high-risk behavior—particularly regarding sex—in these communities. As a result, HIV prevalence rates in northern coastal Tanzania are said by health workers there to be two to three times higher than the country's national rate of 7 percent for sexually active adults ages 15 to 49. Women who now must contribute significantly to their household incomes but who lack options to do so have turned in increasing numbers to sex work —a practice that has facilitated the spread of the epidemic. HIV/AIDS is now an important part of a vicious spiral of poverty, natural resource degradation, and ill health in these communities. Interventions to address these issues must deal with their integrated nature—especially with how indigenous gender roles place both men and women at heightened risk for contracting HIV. (excerpt)
Targeting the Fur: mass killings in Darfur. A Human Rights Watch briefing paper.
Since February 2003, Darfur has been the scene of massive crimes against civilians of particular ethnicities in the context of an internal conflict between the Sudanese government and a rebel insurgency. Almost two million people have been forcibly displaced and stripped of all their property and tens of thousands of people have been killed, raped or assaulted. Even against this backdrop of extreme violence against civilians, several incidents in March 2004 stand out for the extraordinary level of brutality demonstrated by the perpetrators. In one incident, Sudanese government and “Janjaweed” militia forces detained and then conducted mass executions of more than 200 farmers and community leaders of Fur ethnicity in the Wadi Saleh area of West Darfur. In a second incident in neighboring Shattaya locality, government and militia forces attacked Fur civilians, detained them in appalling conditions for weeks, and subjected many to torture. To date, the Sudanese government has neither improved security for civilians nor ended the impunity enjoyed by its own officials and allied militia leaders. Immediate action including an increased international presence in rural areas of Darfur is needed to improve protection of civilians and reverse ethnic cleansing. International prosecutions are also essential to provide accountability for crimes against humanity and ensure justice for the victims in Darfur. The Sudanese government is clearly unwilling and unable to hold perpetrators of atrocities to account: a presidential inquiry into abuses recently disputed evidence of widespread and systematic abuses and instead of prosecutions, recommended the formation of a committee. The United Nations Security Council, following receipt of the January 25th report of the international commission of inquiry’s investigation into violations of international humanitarian law and human rights law and allegations of genocide in Darfur, should promptly refer the situation of Darfur to the International Criminal Court for prosecution. (excerpt)
Since early 2003, Sudanese government forces and government-backed ethnic militias known as “Janjaweed” have committed war crimes, crimes against humanity and ”ethnic cleansing” in the Darfur region of Sudan. They have targeted for abuse civilians belonging to the same ethnic groups as members of two rebel movements, the Sudan Liberation Army (SLA) and the Justice and Equality Movement (JEM). More than two million people of the region’s estimated population of 6 million have been directly affected by the conflict through attacks on villages, killings, sexual violence, looting of livestock and household goods, destruction of property, and other abuses. An additional two million people have been affected by the near total collapse of the region’s economy. According to recent United Nations figures, the attacks have led to the deaths of at least 180,000 people and the displacement of more than 2.5 million others. Most of the displaced people remain in Sudan as “internally displaced persons,” but an estimated 200,000 have sought refuge in Chad and are refugees as defined by the 1969 OAU Convention on the Specific Aspects of Refugee Problems in Africa; many are also considered prima facie refugees who are entitled to the protections of the 1951 Refugee Convention until their status can be determined. (excerpt)
Seeking justice: the prosecution of sexual violence in the Congo war.
In the past women and girls who had been raped generally kept silent, fearing stigmatization by those who blame the victim. Many feared reprisals from perpetrators if they reported the crimes. But in the last two years, a small number of victims of sexual violence have sought justice from the Congolese judicial system. This report documents such efforts and the reasons why they often failed, including deficiencies in the law, the unwillingness of military and other officials to treat sexual violence as a serious offense, lack of protection for the victims, and various logistical and financial impediments linked to the dilapidated state of the judicial system. The report also examines the handful of prosecutions that ended in the conviction of persons accused of crimes of sexual violence and describes deficiencies that resulted in violations of the rights of the accused to a fair trial. In addition, there was insufficient attention to the needs of the victim, and no protection for victims and witnesses. The report also addresses the failure of military prosecutors to examine the culpability and command responsibility of superior officers when sexual violence was part of ongoing crimes under their command. (excerpt)
Learning in a war zone: education in northern Uganda.
In September 2004, staff from the Women’s Commission for Refugee Women and Children went on a mission to northern Uganda. One focus of the mission was to look at the education situation in the north given that the region has been and is currently in a situation of violent conflict. With 1.6 million people displaced, learning systems and structures have been altered significantly, even with the Ugandan government’s pledge of Universal Primary Education (UPE). This report is a snapshot of education in two districts, Gulu and Kitgum, based on interviews with representatives from NGOs, youth groups, teachers and heads of schools, local government officials, multinational actors and the children themselves. For a more extensive historical perspective and information on a wider geographical region in the north, see “Global Survey on Education in Emergencies,” published by the Women’s Commission for Refugee Women and Children. In addition to these interviews, the team from the Women’s Commission visited four night commuter centers in northern Uganda and talked with children and adolescents. In response to the question “How many of you are in school during the day?”; almost every child in an informal sample raised their hands. When asked what they wanted, what would make their lives better at the night commuter centers, at least 50 percent of the children who replied stated that they wanted scholastic materials or light at night to read or study. Young people also stated that education was perhaps the most important way to prevent recruitment and re-recruitment into armed groups. (excerpt)
Field-friendly guide to integrate emergency obstetric care in humanitarian programs.
In any new emergency setting 15 percent of pregnant women can be expected to develop complications during pregnancy or delivery and will require emergency obstetric care. Therefore, while some humanitarian actors are focusing on prioritizing displaced populations access to adequate shelter, food, water and sanitation and on preventing of infectious disease outbreaks, attention must also be given to the needs of pregnant women and infants from the earliest days of a new emergency to prevent maternal and perinatal morbidity and mortality. Emergency preparedness for safe motherhood should include planning for the rapid distribution of clean delivery supplies, essential medicines and equipment for obstetric care at health facilities as well as ensuring the presence of personnel qualified to provide EmOC to existing or new temporary health facilities. The focus of care in the early days and weeks of new emergencies is to ensure all visibly pregnant women receive clean delivery supplies; midwives and health facility have adequate equipment and supplies for safe deliveries and emergency obstetric care; and women have safe access to an emergency referral system 24 hours per day, 7 days per week. (excerpt)
A dose of reality: women's rights in the fight against HIV / AIDS.
The global HIV/AIDS pandemic is taking a catastrophic toll on women and girls. The number of HIV infections among women and girls has risen in every region in recent years, and in sub- Saharan Africa, women and girls constitute nearly 60 percent of those living with HIV. In some countries, the HIV infection rates for girls are many times higher than for boys. The rising number of HIV infections among women and girls is directly related to violence against women and their unequal legal, economic, and social status. Abuses of women’s and girls’ human rights impede their access to HIV/AIDS information and services, including testing and treatment. Those who do obtain HIV services sometimes face disclosure of their confidential HIV test results by public health officials without the women’s consent. This heightens women’s risk of being ostracized by their communities and abused by their intimate partners. Governments around the world have done far too little to combat the entrenched, chronic abuses of women’s and girls’ human rights that put them at risk of HIV. Misguided HIV/AIDS programs and policies, such as those emphasizing abstinence until marriage, ignore the brutal realities many women and girls face. By failing to enact and effectively enforce laws on domestic violence, marital rape, women’s equal property rights, and sexual abuse of girls, and by tolerating customs and traditions that subordinate women, governments are enabling HIV/ AIDS to continue claiming the lives of women and girls. (excerpt)
1995-2003: Have women progressed? Latin American Index of Fulfilled Committment.
The history of women’ s organizations in Latin America can be understood as a permanent process of broadening their citizenship and extending their rights as members of the political community in their countries. The 20th century is marked by their citizenship efforts and achievements, whit the approval of an international law that protects their rights, the Convention on the Elimination of all forms of Discrimination Against Women (CEDAW), the development of the Women’s Decade (1975-1985) and different Conferences devoted to favor governmental actions that foster equality between men and women. When the governments of the world committed to improving women’s situation, a new scenery for citizen action was opened. It meant taking a leading role in the supervision of the fulfillment of these committments. 1995 set a turning point for the women’s organizations of Latin America and the Caribbean as a result of the preparation, implementation and supervision processes of the United Nations´ IV Conference on Women (Beijing, 1995). Women’s organizations attempted to bring their own diagnoses and evaluation of women’s situation to China, so they coordinated and debated at the national and regional levels. They met at Mar del Plata, Argentina (1994) and prepared their participation in the Women’s Tent in Huairou, China. The inclusion of some of their members in the official delegations and their contribution as specialists, led governments to the incorporate many of the proposals that the women’s movement had been rising for over two decades across the region. (excerpt)
The Women’s Commission for Refugee Women and Children (Women's Commission) conducted an assessment of the Minimum Initial Service Package (MISP) of reproductive health in February 2005 in Aceh province. Aceh is on the island of Sumatra, Indonesia, the area closest to the epicenter of the earthquake that triggered the devastating tsunami in the region in December 2004. The assessment team visited the districts of Aceh Besar in northern Aceh and Aceh Utara on the northeastern coast. Over all, despite some gaps, findings demonstrate that attention to and funding for reproductive health during the earliest days of an emergency can ensure that displaced populations have access to life-saving reproductive health services. The MISP is a coordinated set of priority activities designed to prevent excess neonatal and maternal morbidity and mortality; reduce HIV transmission; prevent and manage the consequences of sexual violence; and plan for comprehensive reproductive health services. (excerpt)
A central role of the supra-regional project “Promotion of Initiatives to End Female Genital Mutilation (FGM)”, is to support and evaluate initiatives against FGM in East and West African countries. From the outset, it was clear that the local partners – often small Non-Governmental Organisations (NGOs) – had little experience with participatory monitoring. However, such methods are a basic means enabling organisations to record and evaluate the impact of the activities and strategies that are being promoted. In addition, developing monitoring tools also promotes sustainability by helping to strengthen the structural capacity of the various organisations involved. Since 1999, the FGM-project has provided financial and technical support to several NGOs in Guinea. These NGOs operate through a network and are supervised by a coordinating team comprising of various groups addressing health, education, reproductive health and women's rights. It is increasingly recognised that programmes to abandon or prevent FGM have to respond to the manifold socio-cultural aspects of the topic. Approaches which promote social change by empowering women and establishing dialogues with men, are widely seen as having the best chances of achieving effective change. However the main question here, is how to measure the impact of such interventions i.e. the changes at individual and societal levels. (excerpt)
Reporting manual on HIV / AIDS.
What is HIV? HIV stands for Human Immunodeficiency Virus. HIV destroys certain blood cells called CD4 or T cells. These cells are crucial to the normal function of the immune system which defends the body against illness. When the immune system has been compromised by HIV, a person typically develops a variety of cancers and viral, bacterial, parasitic, and fungal infections. What is AIDS? AIDS stands for Acquired Immunodeficiency Syndrome. It occurs when the immune system is weakened by HIV to the point where a person develops any number of diseases or cancers. A person without these diseases or cancers can still be diagnosed with AIDS if a laboratory test shows a severely damaged immune system. How is HIV detected? It is impossible to look at someone and know whether he or she is HIV-positive. The only sure way to determine this is through an HIV test. A blood sample can reveal the presence of the virus. If the blood sample contains HIV antibodies—proteins the body produces to fight off the infection—the person is HIV-positive. (excerpt)
In the early 80s various studies proposed that family planning and fertility control could significantly reduce infant mortality through greater birth spacing, limitation of high parity births, and reductions in the number of births among women 35 years and older. In subsequent years, the focus of attention has been on a series of issues related to birth spacing and its association with infant survival: nature of the relationship and mechanisms involved. Doubts have been cast on the existence of a causal relationship, and if a relationship exist, whether the magnitude of the relationship is as great as once suggested. Attention directed at this issue has been primarily on the relationship between duration of breastfeeding, which tends to elongate birth intervals, and the possibility that length of breastfeeding may explain the association between birth intervals and infant survival. More recently questions have been raised about positive changes in health related behavior associated with changes in fertility behavior that may explain these observed associations, namely: the use of contraceptive methods, resulting in greater birth spacing and fertility limitation, and greater exposure to, and use of, health care services. This paper evaluates the potentially confounding effects of breastfeeding, and use of health care services on the relationship between birth spacing and infant survival in eight countries surveyed by the Demographic and Health Surveys (DHS). (excerpt)
Demand aspects: population growth and economic development as major water need determinants.
Demand-supply aspects of disputed water needs can afford multiple insights into their major proximate determinants, comparative regional likelihoods and past-prospective contrasts. This paper focuses primarily on the freshwater demand effects to be expected under varying demographic and development transition stages in both the industrialized and third world regions. Observed and projected population size increases, indicating how water need levels could be affected by rising human numbers alone, can be combined with developmentally related enhancements of per capita water use levels to identify total water need or use increase prospects. (excerpt)
Rapid population growth effects on Third World development: recommended UNFPA research perspectives.
A great deal needs to be learned, therefore, not only about how past major welfare advances have been achieved (or obstructed) under variable demographic growth and developmental changes, but also how future advances may best be gained under oncoming such circumstances, in particular when rapidly decelerating numbers are compared with slower decelerations or increasing uptrend slopes. Researched confirmations of such comparative interrelations, if convincingly demonstrated, could be expected to provide much needed further impetus to third world adoptions of intensified family planning and female empowerment initiatives, both for their own sake and as integrated life style as well as quality-of-life aspects of national development strategies. This would not only be especially the case for national-level poverty-stricken areas (Bangladesh, Haiti and effectively all of sub-Saharan Africa, for example), but often also for subnational sectors with still high added annual numbers despite sustained total-country decelerations (e.g. in selective rural parts of China, Brazil and even the Pacific Rim area grouping, among others). (excerpt)
Malthus redux -- opposing views.
Two enduring demographic puzzles: Why should a population "law" which was announced to be universal two centuries ago, was soon significantly disowned by its own creator, and still again, persistently refuted throughout the next 150 years by dozens of actual case histories, continue to attract major critical, research and policy-making attention to this day? And why do the leading "revisionist" sources so often engaged today give persistent short shrift to the welfare-destructive, hence anti-development, influences so patently associable with sustained rapid growth in numbers and high-fertility behavior in half or more of the world's nations? (excerpt)
Demographic impediments to international welfare and development goals have never been more widespread than they are today, whether considered in terms of the population sizes involved or the numbers of their national groupings. Meanwhile and ironically, opportunities for implementing remedial policy and behavioral initiatives have never been more expansive. Thus, estimates from responsible sources indicate that no less than 10 to 15 million global deaths of children under 5, surely a record such number, could be avoided annually by feasible health programs. The requisite costs involved, moreover, some 25 billion dollars per year, are obviously a pittance when set beside the outlays internationally committed to comparative frivolities, whether by households or governments. Here as often, the main strategic obstacles are no longer technological shortcomings or scarce resources. Political will and lagging social mobilizations, above all, are the effective causal constraints. Analogous major examples abound if we consider the newly developing regions ("NDRs") of the third world, here defined to include all of Africa, Asia less Japan mainly, all of Latin America and Oceania less Australia and New Zealand. Here well over a billion individuals at least, if not more nearly 2 billion, cannot be accommodated at even elemental nutritional, housing, health, sanitary, educational, employment, infrastructural, community service and family-level (female as well as male) mobility quality-of-life standards. Major gains could be achieved in all of these respects, with no more than a fraction of the funds and material resources allotted each year for military purposes alone. Such re-allocations, appropriately re-directed to advance levels of living and developmental prospects, could with political will be implemented so as to have neutral effects on relative national defense statuses everywhere. (excerpt)
Freshwater supply-demand imbalances are rapidly reaching crisis or potentially unsolvable dimensions, both globally and among widespread regional population groupings. Although the alarming welfare and development impacts of such imbalances are widely recognized, the quantitative extents of the imbalances involved receive little or no explicit attention. Effectively ignored as a result are arrays of central issues. Are oncoming imbalances soon likely to imply demands exceeding planetary water supply ceilings? What corresponding imbalance differences are to be expected among significant demographic and development groupings of nations or populations? How can main imbalance-causing factors be separably identified quantifiably? What significant comparisons in all of these respects may distinguish alternative longer-run oncoming periods, specifically the recently begun 1995- 2020 quarter-century and the about to begin 2000-2050 half-century? The purpose of this paper is to address such questions by a measurement approach which provides indicative insights in all of these connections. (excerpt)
Since 1993, up to 2000 Tonga from the Gwembe valley have begun migrating on a seasonal basis to pick marigolds and paprika on a commercial farm developed in Chiawa on the lower Zambezi river. The paper shows how this unusual rural-to-rural migration figures in the spread of STDs and HIV. It relates the findings of two anthropological studies--the famous longitudinal study of the Gwembe Tonga begun in 1956 by Colson and Scudder, and a current wide-ranging study of the factors involved in community capacity to prevent, manage and survive HIV/AIDS begun in 1991 in Chiawa. Using life histories constructed from data from these two projects, the authors are able to speculate on individual exposure to STDs and (in more recent years) to HIV, in relation to the migrants' contact with various workplaces and urban centres and in relation to their marriage and mortality patterns. Current data (1993-1996) on the Tonga migrants' sexual practices and strategies--as well as on the prevalence, treatment and prevention of STDs and HIV--on the commercial farm where they work, helps to confirm the significance of these migrants in the spread of STDs and HIV. In addition, the paper assesses the potential influence of their exposure to health education and health care from the work settings where some have worked in the past. (author's)
Demographic dimensions of an inter-village land dispute in Nubri, Nepal.
High in a remote valley of Nepal, Tibetans from the villages of Sama and Lho gathered on opposite sides of a raging alpine torrent. Separated by the cascading barrier of water, men from either side attempted to breach the others' defenses by rushing the wooden bridge dividing them. A rain of rocks kept the antagonists at bay. The battle raged for hours, ending in a stalemate at nightfall when the participants in this grudge match reluctantly returned to their respective villages. In the final tally, there were no human casualties. Yet the social consequences were far from negligible. The escalation of this inter-village dispute resulted in contentious relations between the residents of Lho and Sama, people who for centuries have been linked through affinal ties, economic interdependence, and religious affiliation. What had gone wrong? The myth that Tibetan societies are devoid of internal strife persists in the western imagination. Such a caricature ignores the simple fact that Tibetans, like all humans, compete among themselves and against others for economic resources such as land, bovines and pastures, or even trade routes. In the case of the Sama-Lho conflict, the villagers were fighting over a small stretch of forested land that lay between their two villages. The purpose of this paper is to examine demographic differences between the two villages that may be held accountable, or at least can be considered as contributing factors, to the arising of the dispute. (excerpt)
Treatment of HIV/AIDS with highly effective combination antiretroviral therapy is now being scaled up in most highburden countries in line with the WHO 3 by 5 initiative, which sets a global target of 3 million people in need of therapy living in resource-limited countries on ART by the end of 2005. Treatment is now an integral component of all HIV/AIDS programmes and will help accelerate and reinvigorate prevention efforts. The new focus on care and treatment provided by 3 by 5 is a further impetus to consider the main preventable and treatable causes of morbidity and mortality in HIV-infected adults and children globally. Malaria and HIV/AIDS are both diseases of poverty and causes of poverty and they share determinants of vulnerability. Given the wide geographical overlap in occurrence and the resulting co-infection, the interaction between the two diseases clearly has major public health implications. WHO convened a technical consultation in Geneva from 23 to 25 June 2004 with researchers, policy-makers and programme managers to review evidence on interactions between malaria and HIV and the implications of such interactions on prevention and control of both diseases. The technical consultation included presentations of working papers, group and plenary discussions as well as recommendations that form the basis of this report. (excerpt)
DREAM: an integrated faith-based initiative to treat HIV / AIDS in Mozambique. Case study.
Drug Resources Enhancement against AIDS and Malnutrition (DREAM) was created by the Community of Sant’Egidio to fight AIDS in sub-Saharan Africa. The project takes a holistic approach, combining Highly Active Anti- Retroviral Therapy (HAART) with the treatment of malnutrition, tuberculosis, malaria, and sexually transmitted diseases. It also strongly emphasizes health education at all levels. DREAM aims to achieve its goals in line with the gold standard for HIV treatment and care. DREAM was launched in Mozambique in March 2002, following two years of groundwork. However, the idea for the project was born in 1998 when the Sant’Egidio Community— a Christian movement founded in Rome in the late 1960s that has a strong base in Africa—decided to fight the devastating impact of HIV/AIDS. (excerpt)
This document provides guidance to governments, international organizations and NGOs in the monitoring and evaluation of the national response for children orphaned and made vulnerable by HIV/AIDS. It includes methods and tools for measurement at the national level. The indicators in this guide supplement the UN General Assembly Special Session on HIV/AIDS (UNGASS/AIDS) and MDG ‘orphan school attendance’ indicator with a set of recommended standardized core indicators that each country could monitor to assess the effectiveness of its national response and thereby inform programming. While monitoring should be an integrated activity conducted from the global to the local level, this guide does not cover the much more detailed monitoring and evaluation needs of individual projects for children orphaned and made vulnerable by HIV/AIDS. Some of the indicators may remain relevant at the level of monitoring and evaluating a specific intervention by one community-based organization, but they will certainly not cover the full range of project monitoring and evaluation needs. Also, at project/community level the indicators will probably need to be adjusted to the situation of the beneficiaries and the response for specific communities for which an intervention is programmed. Neither does this manual attempt to cover in detail the more general aspects of monitoring and evaluation. (excerpt)
Roe v. Wade and the right to choose.
When Roe v. Wade was decided in January 1973, abortion except to save a woman’s life was banned in nearly two-thirds of the states. Laws in most of the remaining states contained only a few additional exceptions. An estimated 1.2 million women each year resorted to illegal abortion, despite the known hazards of frightening trips to dangerous locations in strange parts of town, of whiskey as an anesthetic, doctors who were often marginal or unlicensed practitioners, unsanitary conditions, incompetent treatment, infection, hemorrhage, disfiguration, and death. During the half century leading up to Roe, the Supreme Court decided a series of significant cases in which it recognized a constitutional right to privacy that protects important and deeply personal decisions concerning bodily integrity, identity, and destiny from undue government interference. Citing this concern for autonomy and privacy, the Court struck down laws severely curtailing the role of parents in education, mandating sterilization, and prohibiting marriages between individuals of different races. (excerpt)
Protecting women's health is essential to the right to choose.
Roe v. Wade stands as a milestone to women’s freedom and equality. Yet more than thirty years after the Supreme Court recognized the right to choose and the paramount importance of women’s health, attacks on women’s privacy and on health protections in particular continue. Despite the Court’s clear rulings protecting women’s health, anti-choice activists, legislators and jurists continue to attack legal safeguards for women’s health. Time after time, anti-choice lawmakers vote down proposed health exceptions to abortion restrictions, and prominent antichoice leaders openly state their opposition to protecting women’s health as required by law. (excerpt)
A needed transition: lessons from Illinois about teen parent TANF rules.
When Congress overhauled the nation’s welfare system and created the Temporary Assistance for Needy Families (TANF) welfare program in 1996, it put a lifetime limit on aid of 60 months; policymakers also put in place rules for minor parents. Under these rules, in order to get welfare assistance, young parents typically would be linked with responsible adults and participate in education. In the TANF legislation, Congress included two rules specific to minor parents (parents under age 18). One rule requires that minor parents live in an approved arrangement. Generally it is expected that minor parents live with their parents, adult relatives or guardians, although the state has discretion to approve other living arrangements. The other rule requires that minor parents typically participate in education leading to a high school diploma or GED. Although the new requirements reflected desirable goals related to well-being, initial implementation by states has resulted in serious unintended consequences. Living arrangement and education rules have been too frequently misunderstood or misapplied by local TANF office staff, causing eligible young parents, including both minors and older teen parents, to be turned away from the very resources they need to be able to live in safety and finish their high school education. Those teen parents who are turned away are often in greatest need of help in achieving self-sufficiency. For example, a homeless minor parent or one who has dropped out of school might be asked if she lives at home or is attending high school; when she says “no” the receptionist at the welfare office might tell her she cannot submit an application. The overarching goal of the minor parent provisions was to improve young parents’ chances of reaching economic selfsufficiency— it was not to shut them out of engaging in the program and its requirements. (excerpt)
Effect of increasing age on the trend of dengue and dengue hemorrhagic fever in Singapore [letter]
Guzman et al reported in this journal a retrospective study of the outcome of secondary dengue virus serotype 2 infections in Cuba during 1977 and 1981. It was observed that the morbidity and mortality rates in such secondary dengue infections were different in different age groups, the highest rates being observed in the 3-14-year age group. Within this age group, the death rate was higher in the younger children, and this rate progressively decreased with increasing age. Among adults, dengue hemorrhagic fever/dengue shock syndrome did occur, but at a much lower rate than in children. In Singapore, the age of the reported dengue cases has increased steadily over the last four decades, since dengue first became a public health concern here in the 1960s. There are several possible reasons for this, among which are lowered immunity and adaptation by the Aedes mosquitoes, both as consequences of the vector control program in Singapore. The results of our study are described to determine whether or not the epidemiology of dengue in Singapore, which, unlike Cuba, is hyperendemic for dengue, supports the observations reported by Guzman et al. (excerpt)
New approaches for reducing the impact of cervical cancer.
With hundreds of thousands of the world's women dying of cervical cancer every year, a new report highlights innovative approaches for reducing the impact of this preventable disease—particularly in developing countries, where 83 percent of the world's new cases and 85 percent of all cervical cancer deaths occur. In developing countries, women face many barriers to early detection and treatment of the disease—and in many of these countries, cervical cancer is the leading cause of cancer deaths among women, according to the report. Titled Preventing Cervical Cancer Worldwide, the 24-page report highlights research conducted by the five-agency Alliance for Cervical Cancer Prevention (ACCP) on the safety, reliability, and cost-effectiveness of new prevention and treatment techniques. "Cervical cancer has a major impact on women, particularly women in developing countries," says Jacqueline Sherris of PATH. PATH is an international nongovernmental organization based in Seattle and one of the ACCP partners working on the new prevention approaches. Sherris adds: "An important reason for the higher incidence in developing countries is the lack of effective screening programs to detect precancerous conditions and treat them before they progress to cancer." (excerpt)
Objectives: To determine the seroprevalence of herpes simplex virus type (HSV-2) antibodies and the relation between the history of clinical herpes and the presence of type-specific HSV-2 antibodies in three different populations from the city of Campinas City, Brazil. Population and methods: One hundred and one college students, 96 patients with sexually transmitted diseases (STD), and 102 women at delivery were interviewed and blood samples were collected. Total HSV (HSV-1 and HSV-2) antibodies were screened by enzyme-linked immunosorbent assay (ELISA) and type-specific HSV-2 antibodies were detected by Western blot assay. Results: Herpes simplex virus antibodies were detected in 66.3% of the students, 97.1% of the women at delivery, and 99.0% of the STD patients. Type-specific HSV-2 antibodies were detected in 6.9% of the students, 22.6% of the women at delivery, and in 53.1% of the STD patients. History of genital herpes was reported by none of the students, by one of the women at delivery, and by 11 of 51 (21.6%) STD patients who were HSV-2 seropositive. Four of the 45(8.9%) seronegative STD patients reported a history of genital herpes. Conclusion: The prevalence of HSV-2 infection in Campinas City can be significantly affected by the characteristics of the population studied, as was shown in previous studies. The sensitivity of the history of genital herpes was low in the present series, stressing that prophylactic measures for vertical and horizontal transmission of HSV-2 should not be based only on a positive history of genital ulcers. (author's)
Imported malaria in a Singapore hospital: clinical presentation and outcome.
Objective: To evaluate the clinical presentation and outcome of imported malaria. Methods: A retrospective chart review was conducted of patients with imported malaria admitted to the Communicable Disease Centre (CDC), Singapore (a 130-bed tertiary referral center) from January 1992 to December 1993. An imported case was defined as a smear-positive infection that was acquired in another country. Results: Among 200 malaria patients hospitalized at CDC, 168 imported cases (137 males and 31 females, 131 nonresidents and 37 residents) were studied. The mean age was 31.6 ± 10.5 years. The countries visited were India (49.4%), Indonesia (16.7%), and Bangladesh (13%). Five patients had chemoprophylaxis and 36 patients had experienced previous malaria infection. The predominant symptoms were fever (97.6%), chills (79.2%), and rigors (67.9%). Hepatomegaly was detected in 56 (33.3%) and splenomegaly in 49 patients (29.2%). Plasmodium vivax was present in 132 patients, Plasmodium falciparum in 29, and mixed P. vivax and P. falciparum in 7 patients. Parasitemia ranged from 0.1% to 8.0%. Of the vivax cases, 130 were treated with chloroquine, followed by primaquine in 123 patients. Quinine was given to 36 patients (29 falciparum malaria and 7 mixed infections). Median time to fever defervescence was 2 days. Complications occurred in three patients (2 with shock and 1 with pulmonary edema). According to World Health Organization gravity criteria, body temperature over 40°C was detected in six patients, bilirubinemia higher than 50 µmol/L in nine, parasitemia over 5% in five, glycemia less than 2.2 mmol/L in two patients. There were five relapses. No death was recorded. Conclusion: Plasmodium vivax is the most common cause of imported malaria, with the majority acquired from the Indian subcontinent. Only a few patients presented with severe malaria. (excerpt)
Objectives: The study compared nasopharyngeal carriage of resistant pneumoniae in human immunodeficiency virus (HIV)-seropositive and –seronegative children. Methods: Nasopharyngeal colonization with Streptococcus pneumoniae was investigated during May 1996 in 162 HIV-negative infants and children (age range, 1-38 mo) and 40 HIV-infected children (age range, 39-106 mo) living in an orphanage in Iasi, northeastern Romania. The HIV-infected children lived separated from the other children and were cared for by a different staff. Streptococcus pneumoniae was isolated from 12 of 40 (30%) HIV-infected and from 81 of 160 (50%) HIV-negative children. Antimicrobial susceptibility to penicillin and ceftriaxone was determined by E-test, and to another five antibiotics by disk diffusion. Serotyping was performed by the Quellung method on 81 of 93 (87%) isolates. Results: Serotypes 6A, 6B, 19A, and 23F together represented 98% of all isolates. Ninety-nine percent of S. pneumoniae isolates were resistant to penicillin, and 74% were highly resistant to penicillin (minimum inhibitory concentration [MIC] > 1 µg/mL); MIC(-50) and MIC(-90) to penicillin of the isolates were 2 µg/mL and 8 µg/mL, respectively. Eighty-nine of ninety-one isolates were susceptible to ceftriaxone; 99%, 87%, 87%, 48%, and 21% of the isolates were resistant to trimethoprim-sulphamethoxazole, erythromycin, clindamycin, tetracycline, and chloramphenicol, respectively. Eighty-two (89%) isolates were multidrug resistant (resistant to =3 antibiotic classes); 37 of 92 (40%) isolates were resistant to 5 or more antibiotic classes, and 16 of these 37 (43%) belonged to serotype 19A. All serotype 19 isolates were highly resistant to penicillin. Conclusions: No significant differences were observed in the resistance rates of S. pneumoniae in HIV- infected children compared to HIV-negative children. Multidrug-resistant pneumococci were highly prevalent in this Romanian orphanage in both HIV-negative and older HIV-infected children. The observed high prevalence of multidrug-resistant pneumococci (coupled with high penicillin resistance) with a limited number of circulating serotypes emphasizes the need to further evaluate the conjugate vaccines in children at risk for invasive pneumococcal infection. (author's)
Epidemiology and management of diarrheal disease in HIV-infected patients.
Diarrhea is the most common gastrointestinal symptom in human immunodeficiency virus (HIV) infection. It affects up to 90% of patients, becoming more frequent and severe as the immune system deteriorates. It often is associated with significant morbidity and mortality particularly in the developing countries. Gastrointestinal infections, some of which are attributable to inadequate sanitation and poor hygiene are the predominant cause of diarrhea, although multiple medications, including traditional herbs, also may be causes. The basic principles of management include detection of treatable causes, relief of symptoms, prevention of malnutrition, and psychosocial support. In up to 60% of cases, no cause can be identified, partly because of inadequate investigative facilities. Symptomatic treatment is the mainstay of management particularly when no cause can be identified. Unfortunately this can be extremely difficult when the patient is severely immune-suppressed. There is poor response to motility control drugs, such as loperamide, and others, such as octreotide, are too expensive. Fluid replacement should be started early to prevent excessive dehydration. This should be combined with nutritional support to prevent malnutrition. Psychosocial support, including counseling, for both the patient and the caring relatives, is required to alleviate anxiety, particularly when the diarrhea becomes intractable. (author's)
Background: The search for the cause of chronic hepatitis among individuals with non-A to G hepatitis has led to the discovery of a post- transfusion hepatitis-related DNA virus, designated TT virus (TTV), which, based on viral sequences, belongs to a new virus family. The principal modes of infection with TTV are poorly understood, and its role in human immunodeficiency virus type 1 (HIV-1) infection is unclear. Objective: To determine if injection drug use (IDU) and high-risk heterosexual activity (HRHA), principal modes of acquiring HIV-1 infection, place individuals at greater risk of acquiring TTV. Methods: The authors analyzed DNA, extracted from sera or filter paper-blotted whole blood, obtained during August 1997 and June 1998 from 324 Vietnamese (148 male; 176 female), for TTV sequences by hot-start, heminested polymerase chain reaction. Results: Prevalence of TTV viremia was similar among individuals engaging in IDU or HRHA (23.4% vs. 20.2%; P > 0.5), with no age- or gender- specific differences. No association was found between TTV viremia and co- infection with HIV-1 or hepatitis C virus (HCV). Phylogenetic analysis of 30 TTV sequences revealed two distinct genotypes and four subtypes that did not segregate according to gender, HIV-1 and HCV risk behaviors, or geographic residence. Conclusions: Among HIV-1 or HCV-infected Vietnamese, who presumably acquired their infection by either the parenteral or nonparenteral route, the data indicate no clear association between acquisition of TTV infection and risk behavior for HIV-1 or HCV infection, suggesting that the usual route of TTV transmission in Vietnam is other than parenteral or sexual. (author's)
Objectives: To evaluate the prevalence of intestinal parasitic infections and to investigate the possible associations of clinical status and laboratory findings with the different parasites found in stool samples. Methods: Each patient was provided with one standard fecal collection vial containing 10% formalin for detecting ova, larvae, and cysts. To detect Cryptosporidium parvum and Isospora belli, the acid-fast Kinyoun stain and fluorescent auramine-rhodamine stain was used. Results: A total of 200 patients with acquired immunodeficiency syndrome participated in this study; 40% were infected with at least one pathogenic species. The total prevalence of parasites was 16% for Giardia lamblia, 13% for Entamoeba coli, 7% for Cryptosporidium parvum, 3.5% for Endolimax nana, 2.5% for Ascaris lumbricoides, 2.5% for Strongyloides stercoralis, 2% for Isospora belli, and 0.5% for Blastocystis hominis. Results showed that diarrhea was significantly associated with cryptosporidiosis, giardiasis, and isosporiasis. However, no association was observed between the CD4+ cell counts and the manifestation of any particular parasite. Conclusions: The data support the value of standard fecal examinations in human immunodeficiency virus-infected patients, even in the absence of diarrhea, since these examinations easily can be performed, with low costs, and frequently disclose treatable conditions. (author's)
Limited effectiveness of home drinking water purification efforts in Karachi, Pakistan.
Objective: In many developing-country urban areas, municipally supplied water is not microbiologically safe. This study evaluated drinking water quality and effect of home water purification efforts in Karachi, Pakistan. Methods: Members of 300 households, including 100 households who used the Aga Khan University Hospital Laboratory and 200 of their neighbors were interviewed. In 293 consenting households, structured observations were performed and drinking water was analyzed for the presence of coliforms, using the multiple tube fermentation technique. Results: Although 193 of the 293 households (66%) reported using some method to purify their drinking water, including 169 (58%) who boiled their water, only 48 (16%) of the drinking water samples were free of coliforms. Although a combination of boiling and filtering was the most effective method of purification, only 38% of samples that had been boiled and filtered were free of coliforms. Conclusions: Further refinements and evaluations of home-based efforts to purify and store water are needed. (author's)
Fatal dengue hemorrhagic fever in Cuba, 1997.
Objectives: After more than 15 years without dengue activity, a dengue II epidemic was reported in Cuba in 1997. Three thousand and twelve serologically confirmed cases were reported, with 205 dengue hemorrhagic fever/dengue shock syndrome (DHF/DSS) cases and 12 fatalities. This report presents the clinical, serologic, and virologic findings in the 12 fatal DHF/DSS cases. Methods: Serum and necropsy samples were studied by viral isolation in C636 cell line and polymerase chain reaction. Serum samples were tested by IgM capture enzyme-linked immunoassay (ELISA) and ELISA inhibition method (EIM). Results: All 12 cases were classified as DHF/DSS according to the Pan American Health Organization Guidelines for Control and Prevention of Dengue and Dengue Hemorrhagic Fever in the Americas. All patients were older than 15 years. Women were more frequently affected. The symptoms and signs presented by these patients were similar to those previously described in DHF/DSS cases. Clinical deterioration occurred on average at day 3.75. Abdominal pain and persistent vomiting were the earliest and most frequent warning signs. Dengue infection was confirmed in all cases. IgM antibodies were detected in 11 of 12 cases, all of them with a secondary infection. Dengue II virus was detected by viral isolation in 12 samples and by polymerase chain reaction in 17. Virus or RNA was detected in various tissues, including kidney, heart, lung, and brain. Conclusion: The clinical, pathologic, and laboratory features of 12 cases of fatal dengue hemorrhagic fever were reviewed. The results obtained demonstrate that adults with a primary dengue infection are at risk of developing the severe disease (DHF) if they are infected with a different serotype. (author's)
Biomass cooking fuels and prevalence of tuberculosis in India.
Objectives: To examine the relation between use of biomass cooking fuels (wood or dung) and prevalence of active tuberculosis in India. Methods: The analysis is based on 260,162 persons age 20 and over in India’s 1992-93 National Family Health Survey. Logistic regression is used to estimate the effects of biomass fuel use on prevalence of active tuberculosis, as reported by household heads, after controlling for a number of potentially confounding variables. Results: Persons living in households that primarily use biomass for cooking fuel have substantially higher prevalence of active tuberculosis than persons living in households that use cleaner fuels (odds ratio [OR] = 3.56; 95% confidence interval [CI] = 2.82-4.50). This effect is reduced somewhat when availability of a separate kitchen, house type, indoor crowding, age, gender, urban or rural residence, education, religion, caste or tribe, and geographic region are statistically controlled (OR = 2.58% 95% CI = 1.98-3.37). Fuel type also has a large effect when the analysis is done separately for men (OR = 2.46; 95% CI = 1.79-3.39) and women (OR = 2.74; 95% CI = 1.86-4.05) and separately for urban areas (OR = 2.29; 95% CI = 1.61-3.23) and rural areas (OR = 2.65; 95% CI = 1.74-4.03). The analysis also indicates that, among persons age 20 years and over, 51% of the prevalence of active tuberculosis is attributable to cooking smoke. Conclusions: Results strongly suggest that use of biomass fuels for cooking substantially increases the risk of tuberculosis in India. (author's)
Epidemic cholera in Guinea-Bissau: the challenge of preventing deaths in rural West Africa.
Objective: An epidemiologic investigation was conducted to identify factors associated with cholera mortality in a rural African setting and interventions likely to prevent deaths in future epidemics. Methods: The authors reviewed surveillance data from rural Biombo, Guinea-Bissau, interviewed family members of persons who died of cholera, and conducted a case-control study in the catchment area of a health center with a high case: fatality ratio (CFR). Results: Forty-three deaths occurred among the 1169 persons who reported to health centers with cholera during the epidemic (CFR = 3.7%). Delayed rehydration and over-hydration probably contributed to 10 of these deaths. An additional 19 cholera deaths occurred outside health centers. In the case- control study, persons with cholera who died were 5.4 times (95% CI = 1.0-53.4) more likely to be in poor health or intoxicated at illness onset than persons with cholera who survived. Fatal cases were 6.0 times (95% CI = 1.1-60.8) more likely to not attend the health center than survivors. Conclusions: The low overall CFR in Biombo, compared to CFRs reported during other epidemics in sub- Saharan Africa, suggests that medical care provided at rudimentary rural health centers prevented numerous deaths. Additional deaths may be prevented by strengthening the infrastructure of health services in the rural areas and by enhanced public education regarding the need for persons with cholera to promptly seek medical care. (author's)
Use of itraconazole in the treatment of mucocutaneous Leishmaniasis: A pilot study.
Objectives: Mucocutaneous leishmaniasis is widely distributed in Brazil, with Leishmania (Viannia) braziliensis being the major etiologic agent. The currently recommended therapy is limited by its parenteral use, high toxicity, and variable efficacy. A clinical pilot study was conducted to analyze itraconazole as an oral alternative for the treatment of mucocutaneous leishmaniasis. Methods: Ten patients were enrolled to receive 4 mg/kg per day (up to 400 mg/d) itraconazole for 6 weeks on an outpatient regimen. Diagnosis was based on clinical otorhinolaryngologic examination, followed by a specific serologic reaction, the Montenegro test and pathologic analysis with immunohistochemical reaction. Healing of the lesions was confirmed by clinical otorhinolaryngologic examination. Side effects were monitored by general clinical assessment, hemoglobin determination, leukocyte counts, and liver function tests, all performed before, during, and 1 month after the end of treatment. Results: Six of 10 patients presented healed lesions 3 months after treatment, with a sustained therapeutic response for at least a median period of 14.5 months (range, 12-18 mo). Side effects were not observed. Conclusions: This pilot study demonstrated that itraconazole can be an effective and well-tolerated alternative for the treatment of mucocutaneous leishmaniasis. Further randomized studies and double blind controlled trials are needed to assess the benefits of this drug in the treatment of mucocutaneous leishmaniasis. (author's)
HIV heterosexual transmission: a hypothesis about an additional potential determinant.
Transmission rates of human immunodeficiency virus (HIV) during heterosexual intercourse vary dramatically around the world. In Asia and South America, they are extraordinarily high, whereas in the United States and Europe, rates are much lower even after a large number of unprotected contacts. The transmission rates in Africa also probably are high, but the available studies unfortunately are weak. In Thailand, female-to-male transmission rates per contact were estimated at .056 (1 in 81) compared to .0002 to .0015 (1/5000- 1.5/1000) for male-to-female transmission in the United States and Europe. Male- to-female transmission in Thailand appears to show, as expected, even greater transmission likelihood compared to female-to-male rates. In general, in the United States and Europe, transmission rates within heterosexual couples range from less than 10% to 22%, whereas in Thailand and Brazil, the rates exceed 40%. The much lower transmission rate per contact in the United States and Europe is based on an assumption that HIV transmitters are a homogeneous group. Wiley and colleagues argue that transmitters are likely to be a heterogeneous group with a large percentage of very low frequency transmitters and a small percentage of high frequency transmitters. That hypothesis is given some support by a cluster of cases in rural New York State in which one man appeared to infect 31% of his many contacts. (excerpt)
Objectives: To describe the effects of various short zidovudine (ZDV) prophylactic regimens on vertical transmission of human immunodeficiency virus type 1 (HIV-I) infection, especially the effect of immediate neonatal ZDV prophylaxis. Materials and Methods: The study included children of HIV-1- infected mothers who were born at a teaching hospital in Bangkok. The ZDV prophylaxis regimens varied by time periods that included: (1) no ZDV (1991- 1996); (2) antenatal oral ZDV, 250 mg given twice a day starting at 34 to 36 weeks’ gestation and continued until labor (1995-1998); (3) antenatal oral ZDV plus immediate neonatal oral ZDV, 6 mg/0.6 mL/dose started within the first 2 hours after birth and continued at 6-hour intervals for 4 to 6 weeks (1997- 1998); and (4) intrapartum intravenous ZDV given in addition to regimen 3 (1998- 1999). Neonatal ZDV was administered within 2 hours after birth in 95% of the neonates. Results: In a cohort of 136 children born at least 9 months before the analysis date, the HIV-1 vertical infection rates were: (1) no ZDV, 11 of 48 (22.9%, 95% confidence interval [CI] = 12.0-37.3); (2) late antenatal ZDV, 10 of 47 (21.3%, 95% CI = 10.7-35.7); (3) late antenatal ZDV plus immediate neonatal ZDV, 0 of 28 (0%, 95% CI = 0-12.3); (4) late antenatal, intrapartum intravenous ZDV, plus immediate neonatal ZDV, 0 of 13 (0%, 95% CI = 0-24.7). An estimated 0% (95% CI = 0-8.6) of the infants who received immediate neonatal ZDV with or without intrapartum ZDV were infected, as compared with 22.1% (95% CI = 14.2- 31.8) of those who received no ZDV or only late antenatal ZDV (P < 0.001). Conclusion: The results of this study suggests high protective effect of immediate administration of neonatal ZDV. Perinatal components of antiretroviral prophylaxis provided the best results for protecting against vertical HIV-1 transmission. (author's)
Counterpoint on food irradiation [editorial]
Dr. Steele’s extensive argument illustrates well one side of the food irradiation controversy. The proponents and opponents are involved in a heated debate. I am not opposed to the technology, but I am opposed to food irradiation as public policy until the proponents and the manufacturers are willing to answer some important questions. I would make three points: 1. In defining the extent of the problem to be solved, it would probably be a good idea to use a recent analysis by Paul S. Mead and colleagues in Emerging Infectious Diseases. They estimate 76,000,000 food borne diarrheal episodes a year, of which four of five are of unknown cause; two-thirds of the estimated 5,200 deaths also are of unknown causes. The illnesses for which the cause is know result in 60,000 hospitalizations and 1,800 deaths, with most of the deaths attributable to Salmonella, Listeria, and Toxoplasma. The potential benefits of food irradiation in regard to known causes is clear; the benefits for those of unknown cause are much less certain; and of course food irradiation will not affect the almost two-thirds of all diarrheal episodes that are not food related. (excerpt)
Surveillance of bacterial pathogens associated with acute diarrhea in Lima, Peru.
Objectives: A study was conducted in Lima, Peru, from January to April 1995, to determine the bacterial pathogens associated with acute diarrhea in adults, their susceptibility to common antimicrobials, the risk factors involved in cholera transmission, and the best clinical predictors of cholera. Methods: A random sample of adult patients with acute diarrhea was studied. Epidemiologic and clinical data and risk factors to acquire diarrheal diseases were evaluated. Identification of bacteria and susceptibility to antimicrobials were determined. Results: The study included 336 patients. Vibrio cholerae O1 (52.7%), Shigella spp. (4.8%), and Salmonella spp (2.7%) were the pathogens most commonly isolated. No resistance to antimicrobials was observed. Patients with cholera had less access to municipal water (P = 0.0018) and were less likely to have homes connected to a sewage system (P = 0.0003) or to have indoor toilet facilities (P = 0.0001) than those without cholera. Liquid stools (odds ratio [OR] = 16.51; confidence interval [CI] = 13.71-19.02; P = 0.003), severe dehydration (OR = 2.48; CI = 1.57-3.38; P = 0.0083), generalized cramps (OR = 4.63; CI = 3.10-6.17, P < 0.0001), and washerwoman’s hands (OR = 2.45; CI = 1.55-3.34; P = 0.017) were the best clinical predictors of cholera in this setting. Conclusions: Cholera is still prevalent in Lima, and people living in environments with low sanitary conditions are especially at risk. Clinical signs of severe dehydration and liquid stools were the best predictors of cholera. (author's)
Food irradiation: a public health opportunity [editorial]
Public health scientists have had an interest in food irradiation for hundred years and more. The first investigations occurred within a few years of the discovery of x-ray and short wavelength by the German physicist Roentgen, in 1895. German and French scientists carried on studies on pasteurization of food by radiation until 1914 and the war years. The problem was an unacceptable taste following irradiation. In 1921, the x-ray was reported by the scientists of the United States Department of Agriculture (USDA) to be effective in killing Trichinella cysts in pork and that it could kill disease-causing organisms and halt food spoilage. A recent review states that food irradiation was the first entirely new method to preserve food since thermal canning and pasteurization of fluids, such as wine, beer, and milk in the nineteenth century. These methods of food preservation were all considered to be processes, but in 1958 the Food and Drug Cosmetic Act designated food irradiation as an additive, under pressure from protesters. Scientific research has never found evidence to call radiation an additive that remained in food. (excerpt)
Brucellosis in a mother and her young infant: probable transmission by breast milk.
Brucellosis, although primarily a zoonotic infection, is also a threat for human health. Infection can be transmitted to humans through direct contact with infected animals, products of conception, or animal discharges, and through consumption of potentially infected milk, milk products, or meat. Human-to-human transmission is rare. There have been case reports of transmission via blood transfusion and bone marrow transplantation from infected donors. Sexual intercourse is a possible means of transmission. Neonatal infection can be acquired transplacentally or during delivery. This report describes a mother with brucellosis who probably transmitted the infection to her 3-month-old baby by breast milk. (excerpt)
Background: Endemic diarrhea and its associated malnutrition remain leading causes of childhood morbidity and mortality in developing countries. This study was undertaken to describe changes in the incidence of diarrhea and prevalence of malnutrition among children in an urban Brazilian shantytown from 1989 to 1996. A secondary purpose was to examine associations between malnutrition and increased incidence and duration of diarrhea. Methods: From August 1989 through December 1996 a dynamic birth cohort of 315 children was followed for surveillance of diarrhea and nutrition. Study homes were visited twice of thrice weekly to assess the occurrence of diarrhea. Length and weight of the subjects were measured quarterly. Poisson regression was used to test for associations between prior nutritional status and subsequent diarrhea during a quarter. Multiple regression was used to test for an association between nutritional status and episode duration. Results: Declines in both age-adjusted attack rates (6.0 episodes/child-year in 3-year-olds to 2.5 episodes/child-year in 8-year-olds) and days with diarrhea per child-year (30.8 days/child-year in 3-year-olds to 8.5 days/child-year in 8-year-olds) were highly correlated with yearly improvements in mean nutritional status (R(2)= 0.84, P < 0.05, for mean length-for-age with mean number of episodes/child-year). Both length- and weight-for-age were significant predictors of diarrhea incidence, including persistent episodes (=14 d), but not duration. Conclusions: These results demonstrate marked changes over time in the diarrhea burden and nutritional status of children in this population and provide further evidence of a significant association between malnutrition and increased incidence of diarrhea. (author's)
Treatment of visceral leishmaniasis (kala-azar): a decade of progress and future approaches.
In 1990, there was essentially one treatment regimen in use for visceral leishmaniasis (kala-azar) around the world: 20 to 28 days of daily injections of pentavalent antimony (Sb). During the past 10 years, however, new agents have been tested alone or in combination, in more than 50 studies carried out worldwide. This renewed clinical effort was spurred by a variety of factors, including the emergence of large-scale Sb unresponsiveness in India, where up to one-half of the world’s cases of kala-azar now are found. As this new decade opens, the success of this clinical research effort is tangible: three additional, highly effective parenteral regimens now are available (amphotericin B, lipid formulations of amphotericin B, amino-sidine), and an active oral agent, a long sought after objective in kala-azar, has been identified (miltefosine). This report reviews the evolution of treatment of visceral leishmaniasis, considers the interaction of the immune response and chemotherapy, highlights therapeutic successes and failures, examines advantages and disadvantages of current treatments, and looks at future therapeutic approaches to the management of this disseminated intracellular protozoal infection. (author's)
Food irradiation labeling [letter]
My commentary was intended to initiate a dialogue on an important issue. Dr. Käferstein’s response is appreciated. Although the study on chromosome damage in malnourished children fed irradiated wheat in India has been severely criticized, and also vigorously defended by the authors, it has not been refuted. The only way to do that would be by carrying out properly designed studies that do not confirm the findings. To my knowledge, there is only one such study, in China. An examination of published data from that allegedly negative study suggests that, in fact, those fed irradiated foods experienced chromosomal damage. I do not believe the issue is settled; it will not be, until a careful short-term (4-month) study is carried out on diverse subgroups. Dr. Käferstein is correct that nutritional loss is reduced by carrying out irradiation in the cold in the absence of oxygen--reduced, but not eliminated; and the adverse nutritional effects are dose-related. Furthermore, reducing damage during the irradiation process does not alter the possibility of accelerated vitamin loss during normal processing (cooking, freezing and thawing, etc). Every food item that is proposed for irradiation should be tested for nutrient loss, using the irradiation process and dosage that will be applied to the food item that will be sold to the public. Nutrient status must be analyzed before and immediately after irradiation, and after the usual food processing (such as cooking). The results should then be recorded on the label. (excerpt)
Objective: To identify the epidemiologic characteristics of human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) in Lebanon during the period between January 1, 1984, and December 31, 1998. Materials and Methods: This report presents a descriptive analysis of HIV and AIDS surveillance data. The subjects of this study were all notified HIV and AIDS cases in Lebanon reported to the Epidemiological Surveillance Unit of the Department of Preventive Medicine at the Ministry of Public Health in Lebanon. Results: The HIV epidemic started in Lebanon in 1984 with the first diagnosed AIDS cases. The number of cases slowly but steadily increased, to reach, by 1998, 529 cases, of which 147 were AIDS cases. The average age of infected persons was 31 years, with a ratio of men to women close to 3.6:1. The most frequent mode of transmission is sexual (71.9% of all cases; heterosexual 53.9% of all cases), which consequently increases the perinatal transmission of the disease (4.3% of all declared cases). Data on high-risk groups (intravenous drug users, homosexuals, prostitutes, and prisoners) are incomplete, although the problem does exist. The safety of blood products is relatively well controlled in the country. No new cases of HIV infections through blood transfused in Lebanon have been reported since 1993 (8.5% of all cases). Conclusion: The continuously increasing number of HIV and AIDS cases shows an urgent need for targeted interventions in the general population to stop any further spread of HIV infections in the years to come. (author's)
Food irradiation dialogue [letter]
Dr. D. B. Louria, in his Counterpoint on Food Irradiation, supports the application of food irradiation”…to protect people from the contamination by microorganisms in some food items…. But if used, it should be only under well- defined and limited circumstances.” This proposal allows for a constructive dialogue. Food regulatory agencies in the United States and elsewhere have clearly defined the rules that have to be applied if and when irradiation is chosen for the processing of food. Regarding the “limited circumstances,” this too is an acceptable proposal. From a public health point of view, those circumstances should be defined by epidemiologic evidence. The public health community should direct the application of irradiation to those foods. Their role in the causation of foodborne illness is particularly important, as shown by foodborne disease surveillance data. (excerpt)
Background: Human immunodeficiency virus (HIV) and hepatitis B and hepatitis C viruses have emerged as major blood-borne infections. Several cases of infections through the use of unsterile injection needles also are on record. Kala-azar, or visceral leishmaniasis, is a hemoparasitic disease caused by Leishmania donovani. All the anti-kala-azar medications require multiple intramuscular injections of the anti-leishmanial drugs. To find whether these patients were at higher risk of contracting blood-borne infection, than those who where not on medication, a community-based study was conducted in the kala- azar-endemic state of Bihar, India. Methods: Five villages (4050 families) of three highly endemic districts of Bihar were included in this study. The sociodemographic data of the affected families and their annual income were determined as per Government of India guidelines. The diagnosis of kala-azar and its sequelae, post-kala-azar dermal leishmaniasis (PKDL), was made, and their therapeutic details were noted. All the leishmania-infected patients, their spouses, family members, and villagemates were tested for hepatitis B surface antigen, hepatitis C virus antibodies, and anti-HIV (1 + 2) antibodies, using commercially available kits. Results: Of the 4050 families, 61 (1.5%) were found affected with kala-azar of PKDL. These 61 families had 77 cases of leishmaniasis, of which 64 (83%) had kala-azar and 13 (17%) PKDL. The most affected (4.5%) age group was 11 to 40 years. Of the 61 families, 57 (93.4%) families belonged to so-called untouchable castes, and 9 of them could not afford to have any anti-kala-azar treatment. Only 64 patients received treatment in the form of injectables. The number of injections received by these patients ranged from 3 to 120. Hepatitis B and C viral infections were found to be significantly more prevalent in those who received multiple injections. Compared to their male counterparts infected with L. donovani, females who received injectable medicines were at higher risk of contracting hepatitis B infections (20% vs. 11.3%) and hepatitis C virus infection (26.7% vs. 18.9%). Overall, hepatitis C virus infections were more common (20.6%) than hepatitis B virus infection (13.2%) in this group of patients. Villagemates with a history of injections for other ailments also were found to have a high rate of infection with hepatitis viruses. One patient with kala-azar was found to be co-infected with HIV, although probably not related to injections. Conclusions: The treatment of Indian kala-azar and post-kala-azar dermal leishmaniasis consists of multiple intramuscular injections of sodium stibogluconate, pentamidine, or amphotericin B. Though the original disease gets cured, all these therapeutic regimens were found to carry a significantly high risk of transmitting yet more dangerous blood-borne infections, such as HIV and hepatitis B and C viruses, through the shared use of unsterile injection needles. All needles should be appropriately sterilized, if they are to be re-used. (author's)
Marriage still protects pregnancy.
Objective To assess the risk factors and outcome of pregnancy outside marriage in the 1990s, in conditions of a high percentage of extramarital pregnancies and high standard maternity care, used by the entire pregnant population. Design Hospital-based cohort study. Setting A university-teaching hospital in Finland. Population The 25,373 singleton pregnancies of known marital and cohabiting status. Methods Odds ratios (ORs) with 95% confidence intervals were calculated to estimate the effect of extramarital childbearing on pregnancy outcome. Multiple logistic regression analyses were conducted to control for confounding maternal risk factors. Main outcome measures Small-for- gestational age (SGA) infants, preterm birth (less than 37 completed weeks), low birth weight (LBC; under 2500 g). Results Of the study population, 67.5% were married and 32.5% were unmarried; 24.2% of all mothers were cohabiting. Unmarried status was strongly associated with social disadvantage and particular risk factors, specifically unemployment, smoking and previous pregnancy terminations, which in turn had an impact on obstetric outcome. There were significantly more SGA infants among unmarried mothers (P < 0.001), with an absolute difference of 45%; more preterm deliveries (P = 0.001), with an absolute difference of 17.5%; and more LBW infants (P < 0.001), with an absolute difference of 26%. The difference in adverse pregnancy outcomes between study groups (i) all unmarried women, (ii) cohabiting women and (iii) single women, remained significant after multivariate analysis at adjusted ORs of 1.11, 1.11 and 1.07 for SGA, 1.17, 1.15 and 1.21 for LBW and 1.15, 1.15 and 1.29 for the preterm births, respectively. Conclusion Even in the 1990s when cohabitation was already common, pregnancy outside marriage was associated with an overall 20% increase of adverse outcomes, and free maternity care did not overcome the difference. (author's)
Objective To review our experience with selective feticide in complicated monochorionic (MC) twin pregnancies, using ultrasound-guided cord coagulation with a bipolar forceps. Design Retrospective analysis. Setting All consecutive umbilical cord coagulations performed at our institution in the second trimester of pregnancy between November 1999 and 2003. Population Consecutive cases of complicated MC pregnancies with an indication for selective termination. Methods ultrasound-guided coagulation of the umbilical cord with a 2.5-mm bipolar forceps under local anaesthesia. Main outcome measures Indications, gestational age at the procedure, perinatal outcome and neonatal follow up. Results Forty-six patients with MC twin pregnancies underwent this procedure. Indications included twin reverse arterial perfusion sequence (n = 17), severe malformation in one twin (n = 7) and agonal presentation or cerebral anomalies of one twin in twin-to-twin transfusion syndrome (TTTS) after laser treatment or serial amniodrainage (n = 22). The procedure resulted in six intrauterine fetal demise (IUFD, 13%), with a rate of 41% and 3% when performed at 16-17 weeks or later, respectively (Fisher P = 0.002). Preterm rupture of the membranes (PROM) before 28 weeks and between 28 and 34 weeks occurred in 9% and 14% of the cases, respectively. All neonatal deaths (four) occurred in cases with PROM at 28 weeks or earlier. Paediatric follow up showed that all infants discharged alive but one were neurologically normal at 3-42 months, which corresponds to 70% of the 46 cases. Conclusions This technique is effective when the natural history is likely to severely affect the development of the normal co-twin. The overall intact survival rate was 70% and our results support justification of later surgery. Prematurity remains a significant complication of the procedure. (author's)
Forced migration: the slave trade still flourishes.
The refugee era reminds us all too forcibly that there are two kinds of migration. One is voluntary, involving immigrants who move of their own free will. The other is involuntary, where people are forced to move by outside forces or circumstances. Usually we think of forced migration as being the flight of refugees, which it generally is. But there is also another kind which almost unbelievably still exists--the slave trade. Unfortunately, this cruel anachronism lingers on in certain parts of the world even though human slavery has been abolished, starting with England in 1772, followed by the United States in 1865 and Brazil in 1889. The slave trade goes back to the dawn of time, when men used other men as a source of free energy and power. All the ancient civilizations we know about were tainted with the inhumanities of slavery and the slave trade, but to find them persisting today is a reminder that some cultures lag flagrantly behind in the march toward human dignity. Slavery countenanced by law or custom may be found today in Africa, Asia, and Asia Minor. Specific sites include Aden, Kuwait, Muscat, Oman, Qatar, Saudi Arabia (which has announced is “termination”, but whether that means that their 500,000 old slaves are freed or no new ones may be purchased is not clear), parts of the Sudan, and Yemen. (excerpt)
Migrant adjustment to city life: the Egyptian case.
Migration from rural areas has been chiefly responsible for Egypt’s soaring rate of urbanization, even though natural increase, still as high in cities as in rural areas, accounts for half the annual rate of urban growth. This migration has favored the largest cities of the country, bypassing those of moderate and small size. Consequently there has been a tendency for cities to conform to the principle of allometric growth, with high growth rates correlated positively with rank as to size. Indeed, for the last three decades, cities of highest rank size have sustained average rates of growth which are more than twice the rate of natural increase, while smaller towns, of between 20,000 to 30,000, have failed to keep pace with rates of natural increase, i.e., have actually experienced net losses of population. Migration, then, has had its prime impact on the largest cities, and the towering giant of Cairo, with a present population of close to three and one-half million, has been the most important recipient of the newly urbanizing population. This article, therefore, concentrates on the adjustment of Egyptian villagers to life in Cairo, inquiring into its nature and exploring the elements which mediate any dramatic transition between rural and urban life. (excerpt)
South Africa: migration trends and the coming chaos.
South Africa would like to increase her white population from 3,000,000 to some 10,000,000 by the end of this decade. This is not principally because of economic benefits that might ensue but in the frenetic attempt to raise the white elements of her population up to a level with the black, in order that the latter may be more easily dominated. To this end South Africa has embarked upon a policy of enticement for immigrants. With bureaus and offices across those parts of Europe which she considers racially acceptable, her propagandists hope to stimulate a flow of migration to South Africa. Strangely enough in 1962 these measures met with some success, and the net immigration rose from the previous year’s total of 1,200 to 12,000 or so. While this is a dramatic increase in terms of percentages it will take a great deal more than this to reach the population goals aimed at by the adherents to apartheid. Contradictory trends of migration do not bode well for the white cultural commandos. Many Negro tribes, of necessity, cross the borders of South Africa regularly to work, as do the Basutos; hence borders cannot be hermetically closed. Refugees regularly slip out to tell the world of the increasing tensions and repressions associated with apartheid. To force the Negro elements in the population onto reservations or “Bantustans” seems unrealistic and impossible. What to do with the “coloured” or mixed elements is still another vexing problem. There are also East Indians, a sizeable block in their own right. (excerpt)
International migration statistics. Uganda.
To those not acquainted with the recent changes in Africa, the statement that the area of Uganda is comparable in size to that of Great Britain and Northern Ireland, comes as a surprise. In fact, the area of the country covers 239,640 square kms. whereas that of the United Kingdom with Northern Ireland covers 244,030 square kms. But contrary to Great Britain, Uganda has no access to the sea as the territories of Tanzania and Kenya lie in between. The capital city, Kampala, is over 800 miles from Mombassa, the seaport of Kenya. To compensate the country for this lack, nature has endowed Uganda with innumerable rivers and a large share of the waters of the great Lake Victoria, together with Kenya and Tanzania. The country has reserved for itself, however, the pride of starting off the river Nile on its 3,800 mile long journey to the Mediterranean Sea. About 1/6 of the whole area of Uganda is thus composed of open water and swamp. Because the country’s average altitude is between 1,400 and 1,800 metres, its reputed pleasant climate is often described as being like “a perpetual European summer.” The neighbourhood of the Equator does not influence this situation. Uganda has been an independent country for only 3 years: formerly under British rule, it became a new African country on October 8, 1962. Because of common features and close relationship with its neighbours in East Africa, already 2 years after its erection, Uganda looked for a closer association with Kenya, Tanganyika and Zanzibar. In fact there were important population exchanges between these four countries, and in April 1964, a tentative was made to establish a federation. This tentative failed however, and only resulted in the close association of Tanganyika and Zanzibar under the name of Tanzania. (excerpt)
The significance of internal migration for social change is a sociological theme highly debated in Latin America today. The article that follows briefly examines internal migration in Brazil. These migrations are not new, but they are increasing at the present because of a rapid process of urbanization. The author analyzes inter-regional, inter-State and intra-State population movements and assesses the causes underlying them: droughts and inundations, latifundia and limited opportunities in rural areas. He concludes by pointing out the social and economic consequences of internal migrations and the Government’s reaction to them. (excerpt)
Migration policy and ethnic conflict in British Guiana.
British Guiana is presently an unhappy land of grave ethnic conflict and dubious political future. Among the factors making for conflict, past migration policy is not the least. About the size of Kansas, British Guiana has roughly only a fourth of her population, or around 650,000 by most recent estimates. Most of the people are confined to the small coastal belt, which is less than five percent of the total area. The rest of the country, largely forest land with some savannas, holds few people but vanishing South American Indians. These Amerinds, as anthropologists call them, tell the story of British Guiana’s troubles, in a sense, for they are where they are, deep in the interior, because of past migration policies. Guiana’s early colonial history, like that of much of the America’s was marked by the struggle of white colonial powers, each vying with the other, but all doing their best to push the native Indian off the good land and back into the interior if not to extinction. The British, French and Dutch all did a thorough job, and by the time the British gained final control the Amerinds were so decimated and so repressed that there were few left to be used as laborers. (excerpt)
International migration statistics. African migrant workers in Europe.
France is the most important recipient of African workers in Western Europe both for those settled in the country (Fig. 1) and new admissions during the last three years (Fig. 2). Algerians are by far the most numerous among these African groups working in Western Europe. The other groups include mainly Moroccans and Tunisians and eventually Senegalians and Malians, but their total number is only a small proportion in comparison with that of the Algerians. The major difficulty as regards statistics of Algerians is that until the Evian Conference in 1963, they were considered as French citizens. Therefore, outside of France, only estimate can be made for the years 1961 and 1962. (excerpt)
Despite the importance of rural-urban migration of Latin America urban development, scholarly attention has been concentrated on this phenomenon in only the last dozen years; in fact, the Santiago “Seminar on Urbanization in Latin America,” held in 1959, perhaps marked the start of intensive research on the significance of migration to the demographic and socioeconomic development of the continent. However, only very recently has substantial progress been made beyond the conclusions of the Santiago Seminar; only now are enough case studies available for satisfactory comparative analysis of rural-urban migration streams. Within the past year, the publication of two significant articles has illustrated some of the possibilities and difficulties inherent in any comparative analysis of the available data on migrants to Latin American cities. On the one hand, Balán performs a structural analysis of migrant-native socioeconomic differences based upon four variables: (1) the rural-urban continuum (here dichotomized), which is used to reflect community characteristics such as degree of social differentiation, inter-dependence, and ease of communication; (2) the rate of economic development in communities, both rural and urban; (3) the rate of creation of jobs in sectors of high productivity, within the cities of destination; and (4) the degree of “credentialism” within cities of destination; that is, the degree to which formal entry requirements (e.g., high school diplomas, letters of recommendation) are built into a city’s occupational structure. He concludes that we need to know much more about the communities of origin and destination, rather than individual migrants, in order to help better explain differential success of migrants in the city. (excerpt)
Migration policy and ethnic confederation in Malaysia.
The Federation of Malaysia came into being on August 31, 1963, with the approval of Great Britain. The United Nations Secretary General, U Thant, expressively certified that the investigating team of the U.N. found that the people of Sarawak and North Borneo approved fully of the merger. However, in the last few months we have witnessed the constant spurning and sabotaging of the new Federation by the President Sukarno of Indonesia, who was the one who asked the U.N. to investigate the feelings of the people of Sarawak and North Borneo in regard to the Federation of Malaysia. This new union then consists of Malaya, the free city of Singapore, British, North Borneo and neighboring Sarawak of White Rajah fame. The motives behind the Federation are many. It will preserve a political and economic relationship existing under British rule. It will create larger industrial and agricultural markets than if the component states went their several ways alone. It will be another barrier to the expansionism of Red China. It will ultimately serve to control the power and the migration potential of Chinese elements in the population of the member states. (excerpt)
The refugee: a search for clarification.
For many years, the spectre of the refugee has been threateningly apparent. This presence has not only been evident to the individual populations, but it has also been of concern to the assembly of nations. Many resolutions and attempts at “good offices,” have been made, calling for either the reintegration of the refugee into the economic life ... by repatriation or resettlement, or the addition of capital and resources to meet the ever mounting problem. Have these measures been enough or have they merely served to maintain a status quo? We will attempt a critical evaluation of at least one of the major problem areas evident in present refugee policy: the entity of the refugee proper. A re- appraisal of the definition of a refugee, with an emphasis and concentration on the “entity” rather than the contributing causes to that entity will serve as a tool for further significant judgment and recommendations. The term ‘refugee’ has been vividly present to the international community for many years, and still is today, a time of repeated international crises and armed conflicts. (excerpt)
What about Angolan and Congolese refugees?
In northeastern Angola refugees, escaping the red terror, have been coming in from Kwilu province. A majority of the Kwilu refugees are Congo natives, but they include a fair proportion of white missionaries, traders and technicians. Many of these refugees are merely in transit in Angola. They are returning to the Congo to a quieter area west of Kwilu, or to Leopoldville. Portuguese local authorities, and Catholic and Protestant missions, have been caring for these people. In central Angola another refugee problem has been created because of the famine and administrative disorganization in Katanga. Northeastern Katanga is populated by the Lunda tribe, which overflows into Angola. Since mid-1963, between 2,000 and 3,000 Lunda tribesmen have crossed the border near Cainda, which is southeast of Teixeira de Sousa. These are native civilians. The Lundas were collected in emergency relief stations near the border, and transferred to Vila Luso. However, facilities there were inadequate. They are now in a camp at Cazage, 100 miles northeast of Vila Luso. The camp has been inspected by M. Hoffman, an official of the International Red Cross, who reported that conditions were exemplary. Crops are now being grown by the refugees at Cazage. Only a few have returned to their homes as tribal warfare and anarchy continue in Katanga. (excerpt)
The first large-scale Oriental immigration into the United States occurred between 1850 and 1860 with the active recruitment of Chinese laborers for the development of the trans-Mississippi frontier. Although nearly half of the early Chinese immigrants did not stay, a total of 408,493 persons born in China were admitted into the mainland United States as visitors, students, immigrants, and returning aliens between 1850 and 1960. The majority of the immigrants prior to 1940 were males and tended to reside near Western ports of entry. The reaction initially was favorable to the Chinese who provided badly needed manpower. However, opposition to their presence and continued immigration soon developed in the Western states in response to the economic competition of the Chinese with white workers for wage levels and jobs, and the distrust of the different cultural ways of the Chinese. The Chinese Exclusion Act of 1882 by the United States Congress was the culmination of nearly three decades of anti- Chinese agitation at local, state, and federal levels. The Act did not stop immigration but did upgrade the socioeconomic status of new immigrants by refusing entrance of unskilled laborers. The Act was renewed after the stipulated 10 year period expired in 1892 and was made a permanent enactment in 1904. It was followed by the Immigration Act of 1924 which stopped large-scale Oriental immigration. In comparison with their cousins residing on the United States mainland, early Oriental immigrants to Hawaii had little de jure and de facto opposition to their entry and modes of employment. The lack of opposition reflected both the pattern of racial equality established by early trading contacts between Polynesians and Caucasians, and high rates of intermarriage which resulted in the presence of a considerable group of people with mixed racial ancestry. (excerpt)
Psychological aspects of the social isolation of refugees.
The purpose of this paper is to draw a picture of the social status of a special group of Refugees and to illustrate their individual and group mechanisms of adjustment to the conditions of environmental stress to which they are exposed. This exercise is not purely a descriptive one. I think it is possible to view these people in terms of a wider frame of reference than the exclusive Refugee situation. Their efforts, successful and unsuccessful, are illustrative of similar mechanisms of reaction to stress of other minority groups in other comparable social situations and, if we can extract the essential psycho-dynamic interrelationships that are set up, we are in a position to hazard a few generalizations about some aspects of human social behaviour. A few general words should be said about the World Refugee situation of which my study concerns only a relatively small but special aspect. Refugees are persons who have left their country of origin for political, racial or religious reasons and cannot or do not wish to avail themselves of the protection of that country. Such refugees are the concern of the international community and fall within the mandate of the United Nations High Commissioner for Refugees. In addition, some countries of first asylum receive a continuous flow of persons whose motives for leaving their country of origin are less clearly defined and frequently appear to be of an economic nature. These are considered to be refugees in the broad sense. (excerpt)
Migration and language in the U.S.S.R.
“God alone can count the multilingual peoples who live in the mountains of the Caucasus” it has been said, and the Caucasus region is only a small reflection of the vast complex of nationalities, ethnic groups and different linguistic communities which make up the U.S.S.R. today. Since the criteria employed in interpreting the ethnic affiliations of the population have been changed, it is difficult to relate estimates of the number of nationalities and of their sizes which have been produced at different times. In 1926 it was claimed that there were upward of 169 nationalities. In 1949, only 70 were claimed. The 1959 census identifies 109 nationalities. Apart from a decline between 1926 and 1939 of over 3 millions in the number of Ukrainians, of over 900 thousand Kazakhs because of extreme economic stringency and the depletion of their cattle stock, and of an almost equal number of Jews between 1939 and 1959 for well recognised and tragic reasons, all the major nationalities have increased in size, the highest ratio of growth between 1926 and 1939 being among the Russians, Uzbeks, Azeri, Tatars, Georgians, Armenians, Chuvash and Tadzhiks. Between 1939 and 1959 the Azeris, Georgians, and Armenians maintained their rates of growth, being joined in this category in the second intercensal period by Turkmen, Kazakhs, Ukrainians and Belorussians. (excerpt)
Language use in relation to the growth of towns in West Africa-a survey.
It is my aim in this paper to survey the published information available to me on language use in relation to the growth of towns in West Africa. The average annual increase of population in Africa is about 2.5%, but the increase of population in towns has been far more rapid, especially since World War II. The relative rate of increase in towns being far higher than that due to natural increase caused by the birth-rate, urban immigration is seen to be an important factor. Basic information in relation to this, as to most other aspects of development in Africa, is hard to come by, being not only scarce but spread out over a great number of publications. (excerpt)
The survival of the village in urban America: a note on Czech immigrants in Chicago to 1914.
In a penetrating article published in 1964, Rudolph J. Vecoli, referring exclusively to the experience of South Italian immigrants in Chicago, persuasively challenged the conclusion of Oscar Handlin’s famous work The Uprooted that immigration was an alienating process, a traumatic experience, the central fact in the lives of immigrants, and a process which disorganized all previous social forms and role relationships. On the contrary, Vecoli found that the South Italians migrated as groups of villagers, settled in tenements on the basis of village of origin, contracted themselves as railroad workers on the same basis, preserved original familial role arrangements, duplicated forms of Italian group life, and created mutual aid societies to serve the needs of the transplanted villagers. (excerpt)
The adjustment of Hungarian refugees in New York.
About eleven years ago the world witnessed what may have been the most unpremeditated mass exodus in history. On October 2, 1956, the Hungarian revolution was touched off when security forces and Soviet tanks fired on students and workers gathered for a protest meeting. The revolution was over by November 3rd when the Soviet army moved in. During the interim, hardly more than a three week period occurred in which to seize the opportunity to escape, but 200,000 individuals are estimated to have fled Hungary. About 38,000 of them came to the United States; the rest resettled in other free countries around the world. The United States immigration laws at that time had no basic provision for admitting refugee since the Displaced Persons Act had expired and new legislation was still to be passed. Therefore, a somewhat inconspicuous provision called the “Parolee Provision” was invoked in order to grant the Hungarian refugees admission into the country. The United States government provided the transportation for the refugees from Austria to a vast reception center at Camp Kilmer in New Jersey. Overseas, private agencies joined forces in Austria to shelter, feed and clothe the refugees and to help them move to free countries. (excerpt)
Cuban refugees in the United States.
On October 3, 1965, President Lyndon Johnson stated that “those who seek refuge here in America will find it.” President Johnson was replying to an earlier statement by Fidel Castro asserting that any person who wished to leave Cuba was free to do so. The Department of State was directed by the President to seek an agreement with the government of Cuba concerning the establishment of procedures for moving refugees from Cuba to the United States. The position of the United States was that any movement should be orderly, in keeping with our laws, and in order of priority. Once again the United States was demonstrating its traditional policy of open asylum and its consistent concern for the reuniting of families. President Johnson had stressed the fact that priority should be given to the movement of immediate relatives of Cubans already in the United States. In the “Memorandum of Understanding” worked out between the Swiss Embassy in Havana, which represents the interests of the United States in Cuba, and the Cuban Foreign Ministry it was stipulated that priorities would be defined as follows: parents of unmarried children under the age of 21, spouses, unmarried children under the age of 21 and brothers and sisters under the age of 21. It was further agreed that the first priority would include other close relatives living in Cuba of persons now in the United States who reside in the same household as the immediate relatives, when such inclusion is required for humanitarian considerations. These cases of close relationship were designated as Priority A cases for processing purposes. Cases of more distant family relationship became known as Priority B cases. (excerpt)
Inter-state migration and subsidiary-language claiming: an analysis of selected Indian census data.
The people as well as the policy planners of India have been confronted with a variety of language problems. The official language policy of the federal government has attempted to solve the problem of the language of the official transactions at the national level. At the state level each of the states has laid down its own official language policy. By general agreement the language of inter-state transaction is to be Hindi or English, depending on the convenience of the states involved. For most Indians the communicational need is taken care of by the regional languages which in most cases coincide with the respective state languages. The reorganization of states in India undertaken after independence in order to make the states relatively homogeneous language areas, however, left substantial minority language groups in a number of states. Some of the minority languages were indigenous to the states while others were brought in by migrants from other states. It is the language problems of these minority groups which has received relatively little attention from the policy makers and scholars. (excerpt)
Immigration recommendations of the Commission on Population Growth and the American Future.
The single word that best characterizes the handling of the topic of immigration by the Commission on Population Growth and the American Future is surprise. The commission and its staff were left floundering when they realized the possible impact of current levels of immigration on population growth. The Interim Report of the Commission, issued in March, 1971, stated: Right now about 80 percent of our annual population growth results from natural increase--the amount by which births exceed deaths. About 20 percent of our current growth is due to net immigration; the number has been averaging about 400,000 annually. Historically speaking, that is not many. In the years just before World War I, the figures ran to twice that, at a time when the United States had less than half the number of people it has now. Even so, the long-term effects of immigration are large. This is partly because most immigrants enter the country in young adulthood, at an age when their childbearing is at its peak. If the average family (including immigrants) had two children, and immigration continued at 400,000 per year, the survivors and descendants of immigrants in the next 30 years would number 16 million in the 2000, and would have accounted for one-fourth of the total population increase during that period. Over the next 100 years immigrants and their descendants would account for nearly half of the increase in population from 204 to 340 million. (Commission on Population Growth and the American Future, Interim Report, 1971, 8-9.) At the annual meeting of the Population Association of America held in Washington, D.C. in April of 1971, Charles F. Westoff, the Executive Director of the Commission’s staff, frankly admitted that the reported finding came as a surprise and the staff and Commission were somewhat unprepared to deal with such an unexpected state of affairs. (excerpt)
Migration, natural increase and city growth: the case of Rio de Janiero.
The processes associated with the demographic transition from high to low vital rates developing countries are progressively being understood as divergent from those prevailing during the chronologically earlier transitions occurring in the developed Western nations. The purpose of the present paper is to examine the nature of those demographic relationships which culminate in the unprecedented city growth of developing areas. In this particular domain, the dearth of reliable information has led to diametrically-conflicting positions concerning the relative weights of the various components of urbanization (an increase in the proportion of urban population) and of city growth (an increase in the number of persons classified as “urban”) (Weller, et al, 1971). Moreover, although several studies have concentrated on apportioning the relative contribution of natural increase and migration, few have paid systematic attention to the factor of migrant natural increase. Such an oversight can assume considerable proportions since, depending upon the dimensions of prior migratory moves, migrant natural increase could conceivably play a commanding role, even to the point of competing with either native natural increase or net migration. In an effort to illustrate the manner in which components of urban growth can concretely interact in an urban developing area, the growth processes operating in Rio de Janeiro during the period 1920-1970 are presented here. The data which have been collected on migration-related topics there are, in many ways, exceptional and hence provide us with an opportunity of clarifying the interconnected etiology of city growth, whether or not the substantive findings are strictly applicable to other developing areas. (excerpt)
Some directions for further work on internal migration in Latin America.
The following broad areas are suggested for further work: 1. Analysis of Census Materials 2. Special Surveys 3. Migration Theories. 1. Analysis of Census Materials. a) Published census reports. The publication of the 1970 censuses together with existing censal materials offer opportunities for analysis. The United Nations manual, Methods of Measuring Internal Migration, concerns itself with the evaluation of basic statistics and is a systematic presentation of tested and feasible analytic procedures. This manual will hopefully encourage the analysis of censal materials especially since it brings together the various methods of measuring internal migration. Full exploitation of duration of residence, place of previous residence at a fixed date in the past, and place-of-birth data, as well as the various indirect measures, will fill many of the gaps regarding our knowledge of internal migration in Latin America. (excerpt)
Japanese postwar migration to Brazil: an analysis of data presently available.
In March 1968 the Japan Emigration Service (JEMIS) reported that more than 615,000 Japanese and their descendants were residing in Brazil. The figure represented a considerable increase over the 250,000 members of Japanese families living in Brazil at the end of the World War II. The rapidity of population growth which these figures would indicate represents a marked departure from the experience of the first half of the century. Japanese migration to Brazil resumed in 1952 after a ten year pause occasioned by the war. The Brazilian government had conceded quotas for the importation of migrants to two Japanese-Brazilians. The late Mr. Yasutaro Matsubara was authorized to settle 4,000 Japanese families in central Brazil (southern Brazil was approved later) and Mr. Kotaro Tsuji was authorized to settle 5,000 Japanese families in the Amazon region. In practice, the two quotas were administered in Brazil by an agent, Mr. Akira Ohtani, the former sub-manager of the Yokohama Specie Bank’s Rio de Janeiro branch. In Japan the “Federation of Japan Overseas Associations” was created (1954), for the purpose of recruiting and screening emigrants. The Federation also provided some training and loans of passage money for migrants. Mr. Ohtani became head of the Rio de Janeiro branch of the Federation. (excerpt)
Inquiry into the fertility of immigrants.
Immigration into Britain from Commonwealth countries, on any appreciable scale, is a phenomenon of very recent years. It is a result of the economic attraction of good wages and the welfare services coupled with the freedom of citizenship within the Commonwealth. Birmingham has been a point of attraction because of its prosperity and the diversity of its trades. Within Birmingham: Sparkbroad, Soho, Balsall Heath, Handsworth, Lozells, are all wards with more than 5,000 immigrants. As shown in Table 1A Sparkbrook includes the highest total number. Upon arrival most immigrants are not accompanied by their families. Some will send for them later and others may set up permanent or semi- permanent liaisons with members of the indigenous population or with other immigrants. In any case their pattern of fertility becomes a matter of sociological interest and of inspiration for future service provisions. (excerpt)
Refugee migration behind the Iron Curtain.
A sardonic commentary upon Communist society is that political infighting between Communist allies can make for Communist refugees from Communism! Refugee migrations behind the Iron Curtain have long taken place, though little known to the Western world. For some time Albanians have been fleeing into Yugoslavia. The most recent example is the exodus of refugees from Sinkiang province of Red China to Russian territory nearby. The province of Sinkiang has long been a prize struggled over and alternately occupied by both Russians and Chinese, though the native population is ethnically distinct. In the 1870’s Russia controlled the area for about a decade before relinquishing it to Chinese suzerainty under the Treaty of 1881. In the 1920’s the new Russian Communism, eschewing its petty principle of racial tolerance, helped local Chinese warlords in Sinkiang maintain their independence from the central Chinese government. In doing so the Russians aided them in their repression of Moslem minorities. In this period Russian colonists moved in as did Russian political advisors, aides and secret police. (excerpt)
Return migration: its significance in an industrial metropolis and an agricultural town in Mexico.
Return migration, the movement back to some previous place of residence, always has been one of the more shadowy features of the migration process. Its existence is of course known, but its incidence has not been documented for a variety of contexts and so its significance is had to ascertain. Probably the main reason for this state of affairs has been the difficulty in obtaining satisfactory data for this phenomenon. The nets cast out in national censuses to obtain data on migration allow return migration to slip through. Reliance upon state of birth or state of residence “x” years ago versus state of current residence, the customary census procedures, are unsuited to get at the incidence of return migration. The most reliable way to obtain information on return migration is through the use of migration life histories administered in the course of sample surveys by specially trained interviewers. This technique was used to interview 1640 men aged 21-60 in Monterrey, Mexico in 1965, and again in 1967, when 380 men aged 15-64 were interviewed in Cedral, a small agriculturally-oriented community in the state of San Luis Potosi. A novel feature of the questionnaire schedule was a life-history form in which was systematically recorded for each year of the respondent’s life any changes in educational, marital, or employment status, and all changes of residence involving six months or more duration (Balan et al., 1969: 105-120). (excerpt)
American immigration and population growth.
During 1970 the population of the United States increased by about 2.2 million persons. This increase was the result of 3.7 million births, 1.9 million deaths and a net immigration of about 400,000 persons. Immigrants thus accounted for nearly one-fifth of the total growth during the year. Without contributions of the immigrants, our rate of growth would have been 0.9 percent instead of the increase of 1.1 percent which was recorded. In the 1950’s net civilian immigration amounted to about 11 percent of the population increase for the country. In the following decade the number of immigrants was increased and amounted to almost 4 million persons. At the same time there was a reduction in the number of babies born and therefore a reduction in the total growth. The direct share of immigration in the increase during the 1960’s was about 16 percent, up from the smaller percentage observed during the 1950’s. Numerically, immigrants contribute directly to immediate growth in the population. The fact that they tend on the whole to be a relatively young group means also that they will contribute to population growth through the children they have after their arrival on these shores. (excerpt)
Rural urban destinations of migrants and community differentiation in a rural region of Chile.
Empirical surveys of rural-urban migration in Latin America have often tended to treat the rural communities of origin as essentially identical. Systematic distinctions among rural communities have not often been made, except perhaps by regions within a nation, in part because most of the important internal migration surveys have been conducted in the capitals or major cities and, consequently, have only the information provided by the immigrants concerning their rural communities of origin. (For the major immigration study conducted in Chile, the country of interest in this paper, see Elizaga, 1966 and 1970). Rural based surveys are necessary to allow one to distinguish among rural communities of origin and to provide information on rural-rural and non-migrants as well as rural-urban migrants. In another paper (Conning, 1971), using data from a survey conducted in various rural communities of less than 2000 population located in a small rural region of Chile, the author found that the most rural category of communities had an age standardized rural-urban out migration rate to places of 10,000 population or more that was 57 percent that of the least rural communities (for persons of both sexes exposed to the risk of migration between the ages 12 and 29). When considering only moves for employment the most rural communities had a standardized rural-urban rate even less, only 41 percent of the least rural communities. (excerpt)
Migration, mobility, and occupational achievement: the case of Santiago, Chile.
This study has been planned essentially in two parts. The first is descriptive, attempting to determine differentials in mobility of migrants and non-migrants (e.g. what differences occur in upward and downward mobility or in inter- and intragenerational mobility). Also part of this initial analysis is an investigation of the process of occupational achievement that has been occurring and how migrants have been affected as compared to the natives, using education and social origins as controls. The second part of the study consists of an analysis of four factors that should be considered as potential independent variables: age at arrival, length of residence in Greater Santiago, size of community at birth, and importance of a farm background. (excerpt)
Trends in family planning: the American-Egyptians' case.
This is the first demographic study on Egyptian immigrants in the United States, and is exploratory in nature. Although many studies have been done by Egyptian and foreign demographers on the Egyptian family in Egypt, (Little, 1967; Shanawany, 1969; Crowley, 1969; El-Badri, 1965; Rizk, 1963; … etc.), none dealt with Egyptian families in the United States. The main purpose of this study is to discover whether there is a significant change in the Egyptian family size in the United States in comparison with that in Egypt and to compare the family size of the present adult generation with that of their own parents and grandparents irrespective of location. (excerpt)
A schema for indirect international migration.
The earth is a closed system for human migration. Within the system all terrestrial areas of the world have been claimed by political states. Except for boundary disputes the universal exclusiveness of these territorial rights means that mankind is divided into political spaces so that one may not migrate to another territory without the receiving-state’s consent. Furthermore in numerous countries citizens may not even emigrate without governmental consent. These controls mean that extra-territorial migration is now a tightly-controlled flow. Since migration regulations vary in time and space the migration flow is often indirect i.e., migrants may move to countries of second or third choice because the country of their first choice rejects their application. Indirect migration also occurs when an immigrant is dissatisfied with his choice and moves again. Migration models such as Lee’s and Mangalam’s do not focus on this type of occurrence (1966; 1970). Zelinsky has hypothesized that there is a mobility transition which parallels the demographic transition (1971). As a result of modernization man becomes increasingly more mobile. A consequence of this is that mobility becomes more complex as the combinations and permutations of movements between countries increases. (excerpt)
Mobility and the fertility of wives in an urban neighborhood: a research note.
This paper examines the relationship between mobility and fertility among women in a low income urban neighborhood. It compares recent movers with long-term residents in one neighborhood with a view toward clarifying the relationship between fertility and intra-urban migration or mobility. Mobility and migration are most often studied on the basis of census data tabulated for the nation as a whole and for the various political subdivisions. Consequently, we know a great deal about the patterns and correlates of moves between and among regions, states, and counties, from rural to urban areas, and from cities to suburbs. The relationship between migration and fertility tends to be discussed in these terms, e.g., the fertility of rural to urban migrants. Although increased attention has been paid to patterns of intra-urban mobility in recent years, the number of studies is limited, (Simmons, 1968; Speare, 1970; Chevan, 1971; Long, 1972) and no well-articulated body of theory has been developed such as that which explains migration in terms of economic “push-pull” factors. (excerpt)
Recent Soviet experience and Western 'laws' of population migration.
The change in Soviet policy also offers the opportunity to compare recent Soviet population movement with generalization about internal migration phenomena observed for some time now in Western nations. Probably the most famous set of generalizations is E. G. Ravenstein’s pioneering “The Laws of Migration” based on the British Census of 1881 and subsequent observations concerning the experience of more than twenty countries. Ravenstein concluded that most migrants proceed short distances, that females are numerous in short distance moves, that when migrants do move great distances, they tend to travel to large urban centers, and that the economic motive predominates. In addition he generalized that migration proceeds by stages and that for each stream of migration, a counter-stream or reverse flow develops. Ravenstein also surmised that migration occurs more frequently in rural than in urban areas and that the level of population movement increases as an economy becomes more complex. Taking into account more current research, Everett S. Lee formulated a set of laws in “A Theory of Migration,” which summarizes much of what demographers know concerning the volume of internal migration, streams and counter-streams, and the characteristics of migrants. It is the purpose of this paper to determine the degree to which recent Soviet migration can be adequately described by generalizations concerning Western experience. Rather than adhering to the letter of the ‘laws’ of either Ravenstein or Lee, this survey and comparison proceeds according to an outline based on both works. (excerpt)
The impact of international migration on Venezuelan demographic and social structure.
The “Brain Drain” or the migration of higher status persons such as scientists, doctors and engineers to a country which is “more developed than their country of origin is the one component of international migration which is receiving some research attention. These studies have generally found that high- income countries such as the United States, Canada and Great Britain are the major recipients of brain drain migration. However not all emigration from low- income countries fits the brain drain model. In several sending countries such as Algeria, Jamaica, the Philippines, Mexico and the Dominican Republic, unskilled migrants are included in the emigration stream. In view of the continued importance of international migration for countries of varying levels of economic development, further research on the demographic, economic, and social implications of such movements should be undertaken. This paper will attempt to contribute to this understanding by accomplishing two tasks. First, the theoretical implications of international migration in low-income countries will be reviewed in order to identify the likely impact of either a policy of immigration or emigration. Second, the Venezuelan immigration during the 1940’s and 1950’s will be examined in order to identify the sources of support for the immigration policy; the ethic, demographic and social composition of the immigrants; and their location in the Venezuelan social structure. (excerpt)
Immigrant fertility: behaviour and attitudes.
Census studies are important in establishing fertility differentials but explanations require intensive investigations which examine motivations and attitudes as well as demographic behaviour; hence the Melbourne Family Formation Survey, carried out by the Demography Department of the Australian National University in 1971. In interviews averaging two hours women were led through a full discussion of family size ideals, contraceptive practice, aspirations for children, life-cycle histories, the effect of female employment upon fertility, and a range of special questions to be used in constructing psycho-social indices for fertility behaviour. The fully self-weighting sample, designed by the ten Commonwealth Bureau of Census and Statistics, was a three-stage a really stratified sample with a chance of selection proportional to size of population in each area and no clustering at the tertiary stage of selection. Eligible respondents in each of the 5,398 dwelling units selected were all once-married women under 60 years of age and still living with their husbands. A total of 2,652 women completed the interview, representing a non-response and non-completion rate of 12.7 percent. (excerpt)
Urban interlude: some aspects of internal Malay migration in west Malaysia.
The question of rural-urban migration in a country in whose population the dimensions of residence, occupation and political power are strongly congruent with ethnicity, both offers the researcher a rich corpus of material for analysis and the development policy-maker a severe challenge. Rural-urban migration in the Federation of Malaysia inevitably calls particular attention to the disparities between two major segments of the population, viz. the predominantly urban, commercially-oriented and economically modernised Chinese, and the heavily rural, agriculturally based Malays in whose hands, however, is concentrated much of the political power. This represents a division of labour imbalance which it is the avowed aim of the government to modify. Much of this paper will be devoted to current trends of migration among the Malays, and to the nature and role of government politices explicitly designed to modify the “natural” migration and urbanisation process in the interests of more equitable development. In Malaysia, as in many developing countries, government intervention in such processes is a variable which cannot be ignored, and in it is enshrined a whole outlook and ideology of social and economic development. (excerpt)
The refugee in flight: Kinetic models and forms of displacement.
After the publication of Fairchild’s early Immigrant Backgrounds, in which he emphasised the importance of such immigrant characteristics as race, culture and nationality, it became an axiom of immigration studies that the immigrant’s background affects his future as settler. Work following in the next decades confirmed Fairchild’s observation and enlarged on it. By 1958 Petersen listed the “emigrants’ motives and the social causes of emigration” as an important background factor affecting aspirations and migrant outcomes. The growing recognition that the refugees’ motivation to seek a new place of settlement differs from that of the voluntary migrant, was also accompanied by mounting evidence that the refugees’ experiences may vary one from the other, the variance resulting in different refugee outcomes. However, observations on individual refugee groups were neither compared nor operationally utilised in any comprehensive way. Such a comprehensive study cannot be undertaken without the existence of a workable theory of refugee movements, based on a fruitful refugee typology and resting on suitable conceptual categories. This study intends to help lay these foundations. (excerpt)
International migration in tropical Africa: a bibliographical review.
This paper reviews recent literature and research that has been concerned primarily with international migrations within Africa, identifying major foci of attention and controversy rather than attempting a statistical presentation of past or current movements. It concerns stocks of migrants as well as flows, i.e. the foreign born or non-nationals established in independent countries and also recent migrants, for many of the major current issues arise as a result of movements that occurred during the period of colonial control. The presence of a foreign-born population can create problems for the independent states of the present day, and can directly affect current patterns of international migration. (excerpt)
Foreign migrant labour for South Africa.
The character of the system for recruiting and employing foreign labour if of intrinsic interest as an example of a strictly controlled international movement of a selected group of migrants. The labourers’ presence in South Africa is by law impermanent and there is no prospect of these movements contributing to international migration in the strict sense of them resulting in permanent settlement. Furthermore, the migration of foreign labourers into South Africa provides interesting comparisons and contrasts with movements of labour in other parts of Africa, in respect of operational control and associated political social/economic factors influencing movements. (excerpt)
There have been long-distance ‘international’ migrants in West Africa throughout its history. Fulani pastoralists move their cattle with the seasons in patterns which ignore international borders. Mende and Hausa traders have settled wherever opportunities seemed promising. In more recent times, the cocoa farms in Ghana and Ivory Coast have drawn large numbers of seasonal laborers, especially from Upper Volta. Ghanaians provide skilled labor in the mines of Sierra Leone and Liberia. Enterprising Nigerians have set themselves up as traders over a very wide area and have participated in diamond digging (not always legally) in Ghana and Zaire. Ghanaians fish along most of the coast and inland as far as Mopti in Mali. Farmers and pastoralists hit by the present drought in the Sahel have moved south into northern Ghana and Nigeria for survival. These examples might indicate a “Common Market” mentality where nationality is unimportant, but this is unfortunately not always the case. While there was occasional evidence of friction between “strangers” and “locals” during the colonial period, the position of ‘aliens’ has often become much more difficult as various states have achieved their independence (Skinner 1963). Ghanaian fishermen have been deported from Guinea, Ivory Coast and Nigeria; Nigerian traders have had to leave Cameroon, Ivory Coast, Ghana and Zaire; Dahomean civil servants have been deported from Ivory Coast and Niger; Togolese farmers and workmen have been expelled from Ghana and Ivory Coast. Work permits are being used increasingly to limit scarce employment to nationals. (excerpt)
Humanitarianism versus restrictionism: the United States and the Hungarian refugees.
The waning days of October 1956 marked the start of what President Dwight David Eisenhower referred to in his memoirs as “the most crowded and demanding three weeks of my entire Presidency.” The presidential election was entering its final, most hectic stage, a severe drought was menacing agriculture in the Southwest, the Suez War was raging and threatening to cut off vital oil supplies to Western Europe, and the President’s chief foreign policy advisor, Secretary of State John Foster Dulles, had been taken to Walter Reed Army Hospital to undergo a serious emergency operation for cancer of the intestine. Finally, to further compound this domestic uncertainty and foreign turmoil, American policymakers were confronted with the Russian suppression of a revolution which had erupted in the Soviet Eastern European satellite of Hungary. Despite some hawkish saber-rattling in the American press and in the Congress, the United States, says Eisenhower, “could do nothing” to aid the rebels because of the danger of a war with the Soviet Union. However, the President felt that it was imperative for the United States to help “in every way possible,” those refugees fleeing from “the criminal action of the Soviets.” (excerpt)
Philippine migration: internal movements and emigration to the United States.
The purpose of this article is to present a summary and overview of three major Philippine population movements: namely, the two internal movements of (1) urbanization and (2) the southern migration to Mindanao; and (3) the emigration to the United States which has increased sizably since the 1965 amendments to the Immigration and Nationality Act. (excerpt)
The Palestinian refugees: an uprooted community seeking repatriation.
The two million and a half Palestinians can be classified as either refugees outside their country, Palestinians under occupation, or refugees under occupation in their own country. About 600,000 are living in camps; 313,000 are accorded second class citizenship in Israel; and about one million are under occupation in the West Bank and Gaza. The rest, whether established or not, are living like all other Palestinians in a state of exile and uprootedness. To some, the existence of Palestinian refugees is a legend; to several nations, associations, and groups, the Palestinians are mere abstract numbers. To themselves, the Palestinians are an uprooted community who see repatriation as the only solution to their problem. In this paper, an attempt will be made to discuss the Palestinian refugees problem, which arose as a result of the 1947-48 and 1967 wars, and the socioeconomic background and the conditions under which the refugees have been living, the reasons for their exodus, the obstacles to their repatriation, and their prospects for the future. The author will rely on United Nations documents and Arabic and Israeli sources, but most essentially on two sociological surveys in which he participated. (excerpt)
Refugee movements: important factor of present European migration.
A fact emerged from the 35th session of the Council of the Intergovernmental Committee for European Migration (ICEM) is the importance of the Refugee Migration, although a slight increase in the National Migration Programme is foreseen for 1973. As of November 30, 1972, 56, 368 Refugees had already been moved by ICEM to countries of resettlement and this number was close to 58,000 by the end of the year. A similar number of Refugee Migration movements is estimated for 1973. The ICEM Refugee Programme for 1972 and 1973 comprises: the Jews emigrating to Israel; they will be at least 36,000 in 1972 (32,000 from the USSR and 4,000 from other countries) and it is estimated that another 36,000 will migrate in 1973; the other Eastern European refugees emigrating to other countries; some 4,600 have departed or are being processed for resettlement in Austria and 3,300 in Italy. Movements in 1973 are estimated at about the same level as in 1972, but could be higher because of an increase in newly arriving refugees during the last quarter of 1972; the Cuban refugees from Spain; also more than 6,000 have migrated in 1972 (mainly to USA), another 25,000 are still awaiting resettlement overseas and some 1,000 new refugees continue to arrive each month in Spain. This influx represents a problem since it is foreseen that only 6,000 will depart to immigration countries in 1973; the refugees emigrating from the Middle East, mainly Armenians, whose number is about 1,000 per year for 1972 and 1973; the non-Europeans from the Far-East concern yearly about 3,000 refugees from countries in South East Asia, many emigrating to the USA. (excerpt)
Immigrants and development in Zambia.
There are two principal types of data sources on immigrants in Zambia: censuses, taken almost decennially since 1911, and annual statistics of immigration and emigration. From these sources four indices of immigrant status in Zambia may be derived for various years: data on birthplace, nationality, citizenship and country of last permanent residence. Of these, birthplace data are the most useful for this study. The other three measures present certain legal and practical difficulties. For example, nationality and citizenship laws are complicated and, as acknowledged in the 1951 population census, “…nationality and citizenship analysis…reflects individual preferences rather than the true position” (Northern Rhodesia, 1951, p. 15). In the Zambian context it is particularly helpful to consider birthplace data differentiated by three racial categories normally designated European, Asian and African. Thus, “European immigrants” are not necessarily those people who were born in Europe, but are individuals of Caucasian race born outside Zambia. (excerpt)
The structural assimilation of in-migrants to Lima, Peru.
The rate of urban growth is extremely high in many less developed countries, particularly in Latin America, and tends to be more pronounced in the large metropolitan areas than in the smaller urban centers. This rapid growth is attributable to three factors: the growth and subsequent reclassification of previously smaller communities, a positive rate of reproductive change among the already existing urban population, and massive in-migration (Weller et al., 1971). The magnitude of the latter factor, rural-urban migration, may be seen in Ducoff’s (1965:202-204) estimate that between 1950 and 1960 there was a net rural-urban migration in Brazil of 6.8 million persons and that there was a rural-urban net migration of over 14 million persons in all of Latin America during that same decade. There appears to be two effects of in-migration upon metropolitan growth. The direct effect can be seen in the number of additional persons that the migrants themselves represent. An illustration of this may be found in the metropolitan area of San Salvador, where Ducoff (1962) estimates that 42 percent of the total population were not born there. Other indications of the strength of the direct effect of in-migration upon metropolitan growth may be found in Republica del Peru (1966:23), Simmons and Cardona (1970; 1972), and Browning and Feindt (1968). The indirect effect of in-migrants refers to any children born to in-migrants after they have migrated. Thus, Martine (1969; 1972) estimates that female in-migrants account for 45-50 percent of all pregnancies in Guanabara, Brazil. (excerpt)
The contribution of immigration to United States population growth: 1790-1970.
There is currently widespread interest in the size and rate of increase of the United States population and in the demographic requirements for achieving zero population growth. This interest has focused attention on the implications of current immigration trends for growth. Surprisingly, no attempt has been made to estimate the contribution of immigration to the growth of the United States population up to the present time. The primary purpose of this paper is to present such estimates for the 180-year period covered by the decennial censuses of population (1790-1970) and for all intercensal segments of this span, which range in length from one decade to 170 years. Given deficiencies in the pertinent demographic data as well as methodological limitations, these estimates of course are subject to error. The secondary purpose of this paper is to indicate the relevance of these findings to the contribution of future immigration to United States population growth. (excerpt)
The planter class and the debate over Chinese immigration to Brazil, 1850-1893.
As the nineteenth century witnessed the implementation of one measure after another which led inexorably to the abolition of Brazilia slavery in 1888, the planters and landowners found themselves compelled to seek alternative sources of manpower. During the second half of the nineteenth century, the recruitment of Amerindians and Asians and the compulsion of Europeans or poor Brazilians into long-term contracts appeared to be a viable solution. But the planters, long accustomed to treating even free laborers as slaves, proved their own worst enemies: free laborers in time evaded their grasp only to have the labor shortage exacerbated. (excerpt)
There are over 1 million refugees in Africa. This is a formidable number even when measured on a global scale, and is matched only by the apparently perennial presence of 1,500,000 Palestinian refugees (Barakat 1973) and such temporary problems as the estimated 10 million Bengalis who fled to India in 1971 at the height of the civil war in Pakistan, but were repatriated when Bangladesh was declared an independent state. The Office of the United Nations High Commissioner for Refugees, charged with the responsibility for providing protection and material assistance to refugees in the country of asylum, has consistently over the last few years allocated over 50 per cent, and exceptionally over 60 per cent, of its total budget to its operations in Africa. Refugees constitute one of the greatest but least well-appreciated and least well-documented tragedies of present-day Africa. (excerpt)
The changing nature of Central and Southeast Asian immigration to the United States: 1961-1972.
Immigration to the United States from Asia in general, and from Central and Southeast Asia in particular, is of interest to students of race relations, immigrant adaptation and absorption, manpower recruitment and immigration policy. The interest has intensified since the adoption of the United States Immigration Act of 1965 which not only facilitated the immigration of increasing numbers of Asia-born to a record high of 119,072 persons in 1972 but also led to a shift in the composition of the total immigration stream to the United States. In 1961, less than one tenth (8%) of United States immigrants were born in Asiatic countries; by 1972 the proportion had risen to nearly one-third (31%). The majority of these immigrants were born in Central or Southeast Asian countries, of which China (including Taiwan and Hong Kong), India, Japan, Korea, and the Philippines were the major sending countries of birth. Since place of birth is highly correlated with race, the increasing numbers of Asian-born immigrants imply the increasing visability of persons of Oriental race in American society. (excerpt)
Rural-urban migration in Africa: theory, policy and research implications.
It is the aim of this paper to examine from a theoretical standpoint the process of rural-urban migration in Africa and its role in economic development with a view toward proposing a research agenda to address key policy issues. We do this in three stages. First, the large body of theoretical and empirical knowledge of the rural-urban migration process in Africa is briefly reviewed emphasising those characteristics which are most important in Africa and the deficiencies in our present understanding of rural-urban migration. Second, this knowledge is synthesized into a theoretical framework for analyzing rural-urban migration with emphasis on economic variables. This framework is then used to explore some of the policy implications of present-day rural-urban migration for economic development in Africa. Finally, priority areas for future migration research are discussed with particular reference to improve theory, improved methodology and the integration of migration research and policy analysis. (excerpt)
The estimation of the immigration component of population growth.
The Population Commission Reports (1971, p. 8; 1972, p. 114) focused attention on the size and impact of recent immigration. The Commission expressed concern because about 20 percent of population growth was being contributed by immigration. The same theme was taken up by Leslie Westoff (1973) in her New York Times article where she reported that 23 percent of the population growth in 1972 was due to immigration. There are serious questions about the appropriateness and interpretation of the measure used by the Commission and Westoff. Estimating the size of a component of population growth is an exercise in manipulating the elements of one form of the basic population equation: P(-2) = P(-1) + B – D + I – E where the population size at a point in time 2 (P(-2)) equals the population size at a previous point in time 1 (P(-1)), plus all the births (B) and immigration (I) minus all the deaths (D) and emigration (E) in the interval between time 1 and time 2. (excerpt)