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EPI in the Americas. Report to the Global Advisory Group Meeting, Alexandria, Egypt, 22-26 October 1984.
[Unpublished] 1984. 15 p.This discussion of the Expanded Program on Immunization (EPI) in the Americas covers training, the cold chain, the Pan American Health Organization's (PAHO) Revolving Fund for the purchase of vaccines and related supplies, evaluation, subregional meetings and setting of 1985 targets, progress to date and 1984-85 activities, and information dissemination. All countries in the Region of the Americas are committed to the implementation of the EPI as an essential strategy to achieve health for all by 2000. During 1983, over 2000 health workers were trained in program formulation, implementation, and evaluation through workshops held in Argentina, Brazil, Cuba, El Salvador, and Uruguay. From the time EPI training activities were launched in early 1979 through 3rd quarter 1984, it is estimated that at least 15,000 health workers have attended these workshops. Over 12,000 EPI modules have been distributed in the Region, either directly by the EPI or through the PAHO Textbooks Program. The Regional Focal Point for the EPI cold chain in Cali, Colombia, continues to provide testing services for the identification of suitable equipment for the storage and transport of vaccines. The evaluation of solar refrigeration equipment is being emphasized increasingly. PAHO's Revolving Fund for the purchase of vaccines and related supplies received strong support from the UN International Children's Emergency Fund (UNICEF), which contributed US $500,000, and the government of the US, which contributed $1,686,000 to the fund's capitalization. These contributions raise the capitalization level to US $4,531,112. Most countries are gearing their activities toward the increase of immunization coverage, particularly to the high-risk groups of children under 1 year of age and pregnant women. To evaluate these programs, PAHO has developed and tested a comprehensive multidisciplinary methodology for this purpose. Since November 1980, 18 countries have conducted comprehensive EPI evaluations. 6 countries also have had followup evaluations to assess the extent to which the recommendations from the 1st evaluation were implemented. At each subregional meeting, participants met in small discussion groups to review each other's work plans and discuss appropriate targets for the next 2 years. Immunization coverage has improved considerably in the Americas over the last several years. Figure 2 plots the incidence rates of polio, tetanus, diphtheria, whooping cough, and measles from 1970-83 in the 20 countries which make up the Latin American subregion. If all countries meet their 1985 targets, immunization coverages for DPT and polio will range from 60-100%, with most countries attaining coverages of over 80%. For measles, 1985 targets range from 50-95%, and from 70-99% for BCG. The main vehicle for dissemination of information is the "EPI Newsletter," which publishes information on program development and epidemiology of the EPI diseases.
[Unpublished] 1984 Jun. 10,  p.105 developing country projects dealing primarily or exclusively with adolescent fertility were analyzed in an attempt to determine the nature and level of adolescent fertility programming in the developing world. There were 37 projects in Asia, 21 in Sub-Saharan Africa, 8 in North Africa and the Middle East, 22 in the Caribbean, and 17 in Latin America. About 27% of the programs were exclusively urban, 16% exclusively rural, and the remainder operated in both rural and urban settings. Various types of organizations sponsored projects, but the majority were sponsored by International Planned Parenthood Federation affiliates and other private organizations. There were marked regional differences in sponsorship. Only 11 of the 105 programs were conducted by government agencies, but 14 programs received some support from national governments and local governments also sometimes contributed support. Family life education for both in and out of school youth was the predominant project activity in 66 of the 105 projects. 20 projects focused on training of professionals in family life education such as educators, counselors, and health personnel. Curricula primarily concentrated on sex education, responsible parenthood, the importance of delayed 1st birth and child spacing, and general population concerns. 25 projects conduct youth training sessions and teach teams to serve as peer counselors and cators, motivating their peers toward acceptance of family planning and the small family and providing accurate information on sexuality. About 21 projects have a specific counseling component, with most counseling services teaching family planning, distributing condoms, or referring clients to clinics. Only 16 projects had as a stated objective provision for adolescents of diagnostic or clinical health services related to contraceptive use, family planning, or venereal disease. 18 projects offered training in vocational or income-generating skills integrated with family planning, sex education, and family life education. Over 20 projects described educational materials preparation and production as an activity. Innovative approaches observed in the 105 projects included adoption of the multiservice center concept, integration of family planning education with self-help initiatives to improve young women's socioeconomic status, participation of adolescents in program decision making, and innovative promotional activities. Factors contributing to program success identified by project staff include conducting a needs assessment survey, securing parental and community support, solid funding, a flexible program design, skilled personnel, availability of adequate materials, good cooperation with other community agencies, active participation of young people in planning and running the program, good publicity, and use of innovative teaching methods. Projects are increasingly tending toward less formal kinds of communication in family life education.
In: Third Asian and Pacific Population Conference (Colombo, September 1982). Selected papers. Bangkok, Thailand, Economic and Social Commission for Asia and the Pacific, 1984. 9-40. (Asian Population Studies Series No. 58)This report summarizes the recent demographic situation and considers prospective trends and their development implications among the 39 members and associate members of the Economic and Social Commission for Asia and the Pacific (ESCAP). It presents data on the following: size, growth, and distribution of the population; age and sex structure; fertility and marriage; mortality; international migration; growth and poverty; food and nutrition; households and housing; primary health care; education; the working-age population; family planning; the elderly; and population distribution. Despite improvements in the frequency and quality of demographic data collected in recent years, big gaps continue to exist in knowledge of the demographic situation in the ESCAP region. Available evidence suggests that the population growth rate of the ESCAP region declined between 1970 and 1980, as compared with the preceding decade, but that its rate of decline was slow. Within this overall picture, there is wide variation, with the most developed countries having annual growth rates around 1% and some of the least developed countries having a figure near 3%. The main factors associated with the high growth rates are the past high levels of fertility resulting in young age structures and continuing high fertility in some countries, notably in middle south Asia. The population of countries in the ESCAP region is expected to grow from 2.5 billion in 1980, to 2.9 billion in 1990, and to 3.4 billion persons by the year 2000. This massive growth in numbers, which will be most pronounced in Middle South Asia, will occur despite projected continuing moderation in annual population growth rates. Fertility is expected to continue its downward trend, assuming a more widespread and equitable distribution of health, education, and family planning services. Mortality is expected to decline further from its current levels, where life expectancy is often at or around 50 years. In several countries, more than 10 in every 100 babies born die before their 1st birthday. The extension of primary health care services is seen as the key to reducing this figure. Rapid population growth and poverty tend to reinforce each other. Low income, lack of education, and high infant and child mortality contribute to high fertility, which in turn is associated with high rates of natural increase. High rates of natural increase feed back to depress socioeconomic development. High population growth rates and their correlates of young age structures and heavy concentrations of persons in the nonproductive ages tend to depress production and burden government expenditure with high costs for social overhead needs. Rapid population growth emerges as an important factor in the persistence of chronic undernutrition and malnutrition. It increases the magnitude of the task of improving the educational system and exacerbates the problem of substandard housing that is widely prevalent throughout Asia.
The changing roles of women and men in the family and fertility regulation: some labour policy aspects
In: Family and population. Proceedings of the "Scientific Conference on Family and Population," Espoo, Finland, May 25-27, 1984, edited by Hellevi Hatunen. Helsinki, Finland, Vaestoliitto, 1984. 62-83.There is growing evidence that labor policies, such as those advocated by the International Labor Organization (ILO), promote changes in familial roles and that these changes in turn have an impact on fertility. A conceptual model describing these linkages is offered and the degree to which the linkages hypothesized in the model are supported by research findings is indicated. The conceptual model specifies that: 1) as reliance on child labor declines, through the enactment of minimum age labor laws, the economic value of children declines, and parents adopt smaller family size ideals; 2) as security increases for the elderly, through the provision of social security and pension plans, the elderly become less dependent on their children, and the perceived need to produce enough children to ensure security in old age is diminished; and 3) as sexual equality in job training and employment and the availability of flexible work schedules increase, sexual equality in the domestic setting increases, and women begin to exert more control over their own fertility. ILO studies and many other studies provide considerable evidence in support of these hypothesized linkages; however, the direction or causal nature of some of the associations has not been established. Development levels, rural or urban residence, and a number of other factors also appear to influence many of these relationships. Overall, the growing body of evidence accords well with ILO programs and instruments which promote: 1) the enactment of minimum age work laws to reduce reliance on child labor, 2) the establishment of social security systems and pension plans to promote the economic independence of the elderly, 3) the promotion of sexual equality in training programs and employment; 4) the promotion of the idea of sexual equality in the domestic setting; and 5) the establishment of employment policies which do not unfairly discriminate against workers with family responsibilities.
[Unpublished] 1984 Aug. Background note presented to the International Conference on Population held in Mexico City, August 6-13, 1984. 4 p.The United Kingdom's birth rate has been below replacement level since 1973. Average family size is becoming smaller; the most popular size is 2 children. Women are postponing births to a later date, and age at marriage has risen. Problems of providing support and services for the growing number of very elderly are being studied by the government. Size of population is of less concern than well-being to the government. They provide assistance with family planning through the National Health Service, but believe that decisions about fertility and childbearing are each couple's to make. Population figures are taken into account in making economic and social policy, but there is no attempt to influence overall size and components of change except in the area of immigration where they lose more people by emigration than they gain from immigration.
New York, United Nations, 1984. 108 p. (Population Studies, No. 85; ST/ESA/SER.A/85)The 3 parts of this report on world, regional, and international developments in the field of population, present a summary of levels, trends, and prospects in mortality, fertility, nuptiality, international migration, population growth, age structure, and urbanization; consider some important issues in the interrelationships between economic, social, and demographic variables, with special emphasis on the problems of food supply and employment; and deal with the policies and perceptions of governments on population matters. The 1st part of the report is based primarily on data compiled by the UN Population Division. The 2nd part is based on information provided by the Food and Agriculture Organization of the UN (FAO) and the International Labor Organization (ILO), as well as that compiled by the Population Division. The final part is based on information in the policy data bank maintained by the Population Division, including responses to the UN Fourth Population Inquiry among Governments. In 1975-80 the expectation of life at birth for the world was estimated at 57.2 years for both sexes combined. The corresponding figure for the developed and developing regions was 71.9 and 54.7 years, respectively. In 1975-80 the birthrate of the world was estimated at 28.9/1000 population and the gross reproduction rate was 1.91. These figures reflect considerable decline from the levels attained 25 years earlier: a crude birthrate of 38/1000 population and a gross reproduction rate of 2.44. World population grew from 2504 million in 1950 to 4453 million in 1983. Of the additional 1949 million people, 1645 million, or 84%, accrued to the less developed countries. The impact of population growth on economic development and social progress is not well understood. The governments of some developing countries still officially welcome a rapid rate of population growth. Many other governments see cause for concern in the need for the large increases in social expenditure, particularly for health and education, that accompany a young and growing population. Planners are concerned that the rapidly growing supply of labor, compounded by a trend toward rapid urbanization, may exceed that which the job market is likely to absorb. In the developed regions the prospect of a declining, or an aging, population is also cause for apprehension. There is a dearth of knowledge as to the impact of policies for altering the consequences of these trends. Many policies have been tried, in both developed and developing countries, to influence population growth and distribution, but the consequences of such policies have been difficult to assess. Frequently this problem arises because their primary objectives are not demographic in character.