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Food and Nutrition Bulletin. 1982 Jan; 4(1):7-16.This study describes 3 nutrition intervention programs in Sri Lanka; Lanka Jathika Sarvodaya Samgamaya; Redd Barna, the Norwegian Save the Children Program; and the US Save the Children fund. The Sarvodaya Shramadana Sangamaya is a private, nonprofit organization that began in 1958 devoted to mobilizing voluntary labor for village reconstruction. It is now engaged in a series of development projects in over 2,000 villages. One of its main objectives is to mobilize community resources for development. The children's service now integrates pre-school, nutrition, and community health services. There are an estimated 86 day care centers. The main service available in these day care centers, apart from physical care, is the provision of nutrition. Pre-school nutrition programs are also administered. The program costs about Rs230/beneficiary per year. The International Council of Educational Development from the United States was invited to review the program. Recommendations are given. The Norwegian Save the Children (Redd Barna) program in Sri Lanka was started in 1974. Projects are of 2 types: 1) settlement projects; and 2) integrated community development projects which aim to improve the standard of living with particular attention to child welfare. The US Save the Children Fund (SCF), a private, nonprofit voluntary organization, began its 1st project in Sri Lanka in urban community development in a slum and squatter settlement within Colombo. It focused on housing, but also includes other programs such as health and nutrition. These activities are carried out through a pediatric clinic, a home visits register, a nutritional status survey, a supplementary feeding program, nutrition, education, and a day care center. The approximate cost of the nutrition program would be Rs7700/month for an average of Rs13/month, or Rs156/year/beneficiary.
Multinational comparative clinical trial of long-acting injectable contraceptives: norethisterone enanthate given in two dosage regimens and depot-medroxyprogesterone acetate. A preliminary report.
Contraception. 1982 Jan; 25(1):1-11.A multicenter phase 3 clinical trial compared norethisterone enanthate (NET-EN) given by 2 different treatment regimens and depot-medroxyprogesterone acetate (DMPA). After 18 months of observation, preliminary findings are reported for 790 women who received NET-EN 200 mg every 60 days; for 796 women who recieved NET-EN every 60 days (200 mg) for 6 months, then 200 mg every 84 days, and for 1589 women who received DMPA 150 mg every 90 days. Overall discontinuation rates and discontinuation for bleeding and personal reasons were similar for all 3 groups after 18 months observation (61.8-63.5/100 women). Terminations due to amenorrhea were significantly higher among DMPA users (12.1 and 17.4/100 women at 12 and 18 months) than among both NET-EN groups (6.8-8.2/100 women at 12 months and 10.4-10.9/100 women at 18 months). The only significant difference in pregnancy rates observed among the 3 groups was a higher rate at 18 months among NET-EN (84 days) users (1.6/100 women), than among DMPA users (0.2/100 women). There was no overall significant difference between the 2 NET-EN groups, although between the 6 and 18 month follow-ups when the 2 NET-EN regimens diverged, the NET-EN (84 days) users' pregnancy rates rose significantly, whereas in the NET-EN (60 days) group, the pregnancy rate did not change. Weight gain was significantly higher in those subjects using NET-EN at 60 day intervals than at 84-day intervals. (author's modified)
[Unpublished] 1982. Presented at the 51st Annual Meeting of the Population Association of America, San Diego, California, April 29-May l, 1982. 35 p.The purpose of this paper was to consider the estimates and projections produced by the UN Population Division about infant mortality (IM) worldwide between 1950-2025. 46 countries were selected and estimates of IM were based on registered data on births and infant death. The data in developed countries posed few problems and thus IM estimates are considered to be accurate. In developing countries where vital registration is complete and where no independent sources of information are available to check completeness, registered data were used. Where adequate registration statistics were lacking, other sources of data had to be used to estimate IM. For other countries data relevant to IM were nonexistent. Direct and indirect methods have been used to estimate these rates. The direct method is characterized by measures of births and infant deaths during a given period of time; the primary indirect method transforms the proportions of children dead by age of mother into probabilities of dying before a given age. Projections of IM in the UN Infant Mortality Project (UNIMR) were based on the overall methods of mortality projections prepared at the UN Population Division. To prepare mortality projections, an estimate of life expectancy at birth is established for a given date and then assumptions are made concerning future trends. IM rates have declined dramatically; for the less developed regions it declined from 164 to 100/1000. The most rapid mortality decline was seen in East Asia. The Soviet Union had the most rapid decline among the developed nations. Projections presuppose that the 1980 ranking of countries will be maintained in the future; the likelihood, however, is that the regions will be markedly different by 2000. 5 examples are presented relevant to the substantive and methodological issues encountered in the UNIMR Project. These included: Sweden, Turkey, Tunisia, Bahrain, and Swaziland, Togo, and Kenya. Results clearly indicate that impressive declines have occurred since 1950 and these are likely to continue into the future. However, IM will remain high in certain less developed countries unless greater effort is expended in these areas to bring the rate down to 50/1000 by 2000. From a methodological perspective, the results of this project emphasize base data. Good data clearly result in more accurate estimates. Future research should examine these results and more attention should be paid to past declines in overall mortality. Also, analyses for some past trends in IM are necessary.
In: Ross JA, ed. International encyclopedia of population. Vol. 1. New York, Free Press, 1982. 58-64.This discussion reviews the birth control movement over the period 1800-1952, highlighting the activities of many individuals and organizations. Early advocates of birth control in England included the Reverend Joseph Townsend, the freethinker and radical publisher Richard Carlile, and Francis Place, a social reformer and trade unionist credited with writing handbills on contraception that were first distributed to working class people in 1823. English birth control advocates reportedly gained their knowledge of contraceptive methods from France, where coitus interruptus and the sponge appear to have been widely used from the 1700s onward by all strata of society. America's 1st book on birth control was published in 1831 by Robert Dale Owen. Charles Knowlton, a Massachusetts physician, has been called America's 2nd birth control pioneer. He published "Fruits of Philosophy" in 1832, a treatise on contraceptive techniques that argued for birth control for social and medical reasons. During the mid-1800s interest in birth control grew slowly but steadily in Great Britain and the U.S. Charles Bradlaugh, a reformist publisher and freethinker, proposed the 1st Malthusian League in 1861. Birth control was termed Malthusianism from 1860 and the New Malthusianism and Neo-Malthusianism from the late 1870s. The dominant lasting social movements for birth control were based in England and the U.S., but physicians, scientists, and political economists in many European states were concerned with the subject. A turning point in open public discussion of birth control took place in England when prosecution of publishers of birth control booklets resulted in lively debate in the press. In outrage over the suppression of free speech and in support of the subject of birth control, Charles Bradlaugh and Annie Besant printed their own version of Knowlton's book and challenged the authorities to suppress its publication. The highly publicized case brought against Bradlaugh and Besant under the Obscene Publications Act of 1857 ended with victory for the defendants. In light of the trial publicity, the Malthusian League began to develop international connections. In the early 1900s activities of the national Malthusian leagues grew. The major force after World War 1 was Margaret Sanger who opened the 1st birth control clinic in the U.S. in 1916. Sanger founded several organizations devoted to promoting birth control. During the 1920s and the 1930s birth control activities began to spread throughout the U.S. There are significant parallels in the development of birth control in the U.S. and Great Britain. Marie Stopes may be considered as the British counterpart of Margaret Sanger. Stopes advocated birth control as a means of improving woman's control over her own body, as an aid to the fulfillment of marriage, and as a means to prevent excessive, unwanted childbearing. Economic, demographic, and social conditions after World War 2 stimulated renewed growth of the international birth control movement. Shortly after its establishement the UN began to pay attention to demographic issues, and the international ranks of those concerned with population as a problem swelled. The birth control movement has continued, but 1952 may be considered as a major turning point in its development. Many countries began to consider offering family planning services and to study population phenomena with a view toward reducing population growth rates.
In: Ross JA, ed. International encyclopedia of population. Vol. 1. New York, Free Press, 1982. 374-82.In the field of population, international assistance has a brief but spectacular history. Population activities covered by international assistance have been broadly classified by the UN organizations concerned into the following major subject areas: basic population data; population dynamics; population policy formulation, implementation, and evaluation; family planning; biomedical research; and communication and education. All of these areas involve a wide spectrum of data collection, training, research, communication, and operational activities. The UN began in the early 1950s to assist developing countries with census taking, training in demography, and studies on the relationships between population trends and social and economic factors. It also supported some action-oriented research activities. In 1958 Sweden became the 1st government to provide assistance to a developing country for family planning. The barriers that had handicapped the UN system in responding directly to the needs of developing nations for assistance in the population field, and particularly family planning, began to be lifted after the mid-1960s. Total international assistance for population activities amounted to only about $2 million in 1960 and $18 million in 1965. It increased to $125 million in 1970 and to an estimated net amount, excluding double counting, of around $450 million in 1979. The marked increase in population assistance is an indication of a growing commitment on the part of governments and international organizations to deal with the urgent population problems of the developing countries. More than 80 governments have at 1 time or another contributed to international population assistance, but the major shares come from fewer than 12 countries. The U.S., the largest contributor, spent around $182 million on population assistance in 1979, or 3.9% of its total development assistance. Sweden and Norway are the 2 largest donor governments after the U.S. By 1890, 121 developing countries, or nearly all, had received population assistance. Most of this number had received assistance from the UN Fund for Population Activities. About 47 developing countries also received assistance from bilateral donors. Almost all donors make their contributions to population assistance in grants, but a few governments also make loans available. From the limited data available, it appears that more and more developing countries are carrying increasing shares of the costs of their population programs. Most donors of population assistance continue to give high priority to support for family planning activities designed to achieve fertility reduction, health, social welfare, or other socioeconomic development objectives.
Geneva, Switzerland, WHO, 1982. 33 p. (WHO/HS/NAT.COM/82.373)This WHO publication contains information on the vital and health statistical activities engaged in by member countries between 1978-80. The information, received upon request by WHO, focused on the following issues: 1) changes in organization, function, and utilization of vital and health statistics information services; 2) work engaged in by the national committees on vital and health statistics or equivalent organizational bodies which coordinate and advise; and 3) current and newly undertaken activities and developments in such special areas as training and medical and health records. The U.S. section includes information on the National Center for Health Statistics, the National Committee on Vital and Health Statistics; cancer and tumor registries, and the Bureau of the Census. The countries in Europe with information included are: Finland, France, Federal Republic of Germany, Greece, Hungary, Netherlands, Norway, Portugal, Romania, Switzerland, and Turkey. Registers, national surveys, hospital morbidity, health status of populations, catalogues of official demographic and health statistics, training in health statistics, morbidity and mortality statistics, and birth statistics are some of the many activities engaged in by these countries. The Nordic Medical Statistics Commission (NOMESCO) is presented, an organization which was formed for the purpose of developing, coordinating, and standardizing health-related statistics in order to increase their inter-country use and comparability. Denmark, Finland, Iceland, Norway, and Sweden are represented and since 1978, NOMESCO has functioned under the Secretariat of the Minister Board of the Nordic Council with its own budget. Its working groups composed of experts from the participating countries are listed along with their appropriate subject area specializations. 13 conclusions arrived at by the Committee on "Planning of Information Services for Health, Decision-Simulation Approach" are presented. The final document should be useful to consumers and producers of such information in Scandinavian countries and it includes concrete examples of real life situations with definitions of system concept.
In: Ross JA, ed. International encyclopedia of population. Vol. 2. New York, Free Press, 1982. 578-82.This discussion of refugees reviews definitions, the various estimates of the number of refugees in the contemporary world, and the efforts to develop an international system of refugee rescue, relief, and resettlement. A refugee is defined as an individual who is seeking asylum in a foreign country. Asylum refers to protection granted or afforded by a state to an individual in its territory. At present international law and practice recognizes that each state has the right to grant asylum. The refugee has no recognized right of asylum vis-a-vis the state. Estimates of the number of refugees vary widely, depending on sources. 2 sets of refugee figures are presented in a table. 1 set focuses on the area of origin and the other on the area of asylum. In 1981, of the 12.6 million refugees, 8.1 million, or 64% were persons outside their country and the remaining 4.6 million or 36% were the estimated number of persons displaced within their own country. The majority of the estimated refugees (slightly more than 50%) were located in Africa. In 1981, Asia had about 2.2 million estimated refugees, 2 million of whom were outside their country. The Latin American refugees are widely dispersed. Of the 189,600 estimated for 1981, the largest group was in Mexico. The Middle East estimated total refugee populations increased from 3.3 to 3.6 million. Within the developing countries, the poorest bear a disproportionate burden. Since World War 1 there has been coordinated international attention directed to refugees. Before that time, the plight of refugees was seen as depending on a solution to the political problem that caused the displacement. The United Nations General Assembly passed a resolution in 1950 creating a United Nations High Commissioner for Refugees (UNHCR) to take over the legal protection of refugees and displaced persons from the International Refugee Organization, created in 1947. The UNHCR uses its "good offices," moral persuasion, and position as a politically neutral body focuses on humanitarian concerns. It negotiates with sending governments, countries of asylum, international relief organizations, voluntary agencies, and others to relieve suffering and to resettle refugees in their original country or elsewhere. International and national voluntary organizations and the governments in countries of asylum handle most of the actual care and resettlement of refugees. There is an increasing belief that refugee movements will be a permanent fact of international life.
World Health Forum. 1982; 3(2):236-8.Only 3 of Turkey's 44 socialized provinces have been able to meet the demand for midwives. Currently there are 28 midwifery colleges but there is widespread feeling that the midwife is not being adequately prepared for her role and is unable to provide the quality of services required under the present health system. The following are lacking: 1) task analysis, 2) sufficient supervision systems, 3) training curricula, 4) trained teachers, 5) postgraduate training facilities, and 6) teaching materials. To solve the last problem the Center for Medical Education Technology prepared a manual for midwives. A committee of professionals including midwives, nurses, pediatricians, gynecologist/obstetricians, educators, health administrators, family planning experts, and nutritionists collaborated in the effort. A problem-based approach was used and the role of the midwife as an agent for preventive measures and health communicator was stressed. The language of the text was kept simple and the contents were divided into 2 groups: maternal care/family planning and child care. The contents reflect the major health problems encountered by midwives: among children, disorders of the respiratory and digestive tracts, malnutrition and accidents, and among women, disorders relating to pregnancy and diseases of the urogenital tract as well as dental problems. Illustrations of processes inside the body are included. The manual is printed in type large enough to be read in poor light.
Population. 1982 Dec; 8(12):1.New population projects in 5 countries will be financed by Italy under an agreement by which project funds will be held in trust and admistered by UNFPA. The agreement will provide additional project funding for the 5 countries, Colombia, Ethiopia, Nicaragua, Peru and Somalia, over and above UNFPA ceilings. Similar agreements, known as "multi-bi" because they combine some of the features of both multilateral and bilateral assistance, have been made with Denmark, Finland, Netherlands, Norway and Sweden, which have made available over $US14 million. In addition, the OPEC (Organization of Petroleum Exporting Countries) Development Fund has provided $US1.5 million for projects in Pakistan. Multi-bi is an arrangement under which extra financing can be channelled to developing countries with maximum efficiency and minimum administrative cost. Projects prepared and agreed with governments, but which are beyond UNFPA's funding capabilities, are offered to donor governments which have funds available for population projects over and above their regular contribution to UNFPA. On acceptance, the projects are administered by UNFPA in the same way as the regular country program, but with special accounting and reporting provisions. This procedure has the advantage for donor countries of bypassing the costly and time-consuming processes of project preparation and approval and later of administration. For recipients the arrangement provides extra funding without additional administrative workload. Italy has already made available $US250,000 for population awareness programs in Africa through the African Information Network. Projects to be supported under the new agreement include mother and child health and family planning in Colombia, Nicaragua and Peru, communication support in Ethiopia, and the census planned for 1985 in Somalia. UNFPA was prepared a compendium of population projects offered for multi-bi support. Distributed in October, the listing includes some 66 projects in 31 countries totalling $US52.6 million. (full text)
Summary of significant findings from visits to United Kingdom, Sweden and Norway: September 22-30, 1982.
[Unpublished] 1982 Oct. 11 p.There were 2 objectives for the visits to UK, Sweden, and Norway: to discuss current policies relating to and for population and family planning programs, the current levels of funding for multilateral and bilateral programs for population, the relationship of population funding to other sectors of development aid, and the degree of public support for current policies and levels of funding; and to discuss possibilities for referring to these agencies Special Projects submitted to Population Crisis Committee (PCC) but which cannot be funded within the criteria or which have been funded in the initial stages but require more support for expansion or replication. Significant findings from these visits are summarized. All 3 agencies reported wide popular support for development assistance, including assistance in the solution of population problems. There is little debate on the kind of issues that arise in the US Congress and administration. UK officials attribute this to general public understanding of the need to raise standards of living in the 3rd world countries but also to the work of the British Parliamentary Committee on Population and Development. The 2 Scandinavian countries also testified to the popular support for development and population assistance which reflects itself in these governments and parliaments. There is some debate on priorities and levels of financing for particular countries, but these occur primarily within the party caucuses. Regarding levels of funding, it was gratifying to hear that all 3 countries, despite current economic problems, have increased funding for the International Planned Parenthood Federation (IPPF) and the UN Fund for Population Activities (UNFPA) in 1982 and project additional increases for 1983. Sweden will provide about US$10 million and Norway about US$6 million. These 2 countries are also increasing bilateral contributions to the health and population programs of a limited number of countries. Preference for multilateral channels over bilateral channels for population aid is most marked in UK where 77% of aid in this fiscal year will go through multilateral channels. The Norwegians are at about a 50-50 ratio and the Swedes at a 1/3 multilateral and a 2/3 bilateral. In all 3 visits, greater interest and favorable policies were found toward the use of NGO channels for population assistance. In addition to their contributions to IPPF which are directed toward the voluntary family planning associations, all 3 countries use nationally based private voluntary agencies to provide assistance to their counterparts in 3rd world countries.
London, England, IPPF, Europe Region, 1982. 62 p.The final report of the Migrants and Planned Parenthood (MPP) Project, a cooperative effort between the European Region of International Planned Parenthood Federation (IPPF), Pro Familia, and other European Planned Parenthood Associations (PPA), is presented. Increasing contact with migrant clients stimulated Pro Familia to ask IPPF to evaluate existing family planning services for migrants and consider transnational coordination and sociopolitical action in this area. 13 countries were represented in this project: 4 donor countries (Italy, Portugal, Turkey, and Yugoslavia); 7 recipient countries (Belgium, Federal Republic of Germany, Luxembourg, Netherlands, Norway, Sweden, and the United Kingdom); and 2 through correspondence (France and Ireland). 2 questionnaires were administered. The 1st was aimed at detailing European migratory movements and the ethnicity of target groups in each country; the 2nd explored PPA attitudes toward migrant clients and the need for migrant-specific services. Project conclusions were based on a series of plenaries and sub working group meetings held during 1981-82. (Reports of these meetings are included as Appendices to the final report.) It is recommended that the MMP Project continue until a Regional Policy Statement can be produced. The Regional Council is requested to develop a handbook of general guidelines for migrant work and should nominate a nonsalaried regional migrant ombudsperson. Each PPA is requested to select a liaison person for migrant work. Other tasks proposed for PPAs include: personnel training, production of educational materials for migrants, and cooperation with migrant's organizations. Family planning and health should be integrated into general migrant services offered by other institutions. PPAs in donor countries should consider special programs for groups affected by migration, e.g., wives remaining behind and returning migrants. Discussions are to be held on how to reach illiterate migrants and develop wider channels of materials distribution. Future workshops may be scheduled to train family planning personnel to work with migrants. In terms of services, PPA personnel are warned that problems outside the scope of family planning are likely to be encountered in work with migrants. Attention should be given to making services more accessible. Possible measures include mobile clinics, domiciliary services, provision of interpreters, and child care. The need for sex segregation and use of female personnel is also stressed.