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EQUILIBRES ET POPULATIONS. 2000 Jun-Jul; (59):4-5.A special UN session was held in New York during June 6-10, 2000, to evaluate the progress achieved since the Beijing Conference on Women. According to Françoise Gaspard, France’s representative to the UN Commission on Women’s Rights, negotiations at the special session were particularly difficult. It is always hard to create a satisfactory conference declaration when the rule of the day is consensus. A few countries always oppose such consensus. Latin American countries, however, abandoned their former position similar to that of Iran and the Vatican to instead adopt far more progressive stances upon reproductive rights. Progress is occurring slowly. While still not enough, the conference’s final statement marks a certain number of advances in the fight against violence, women’s role in decision-making, and education, with no steps back in the areas of contraception and abortion. The resulting declaration is therefore not regressive, even though it could have been stronger. It will hopefully serve as a reference statement which nongovernmental organizations will be able to cite when reminding countries of their obligations. Countries should get together to discuss the rising level of prostitution. The important roles of NGOs and French-country involvement were also recognized during the conference, as well as the priorities of education and funding.
SEXUAL HEALTH EXCHANGE. 1998; (3):4.Two decades of Family Planning Association of Hong Kong (FPAHK) advocacy of husband-wife communication and cooperation in family planning led Hong Kong's population to finally accept the notion of male responsibility in family planning. Recent surveys have documented high rates of male contraceptive use. The FPAHK established its first clinic to provide men with birth control advice and services in 1960, then set up a vasectomy clinic and installed condom vending machines. Working against prevailing traditional beliefs that childbearing is the exclusive domain of women and that vasectomy harms one's health, the FPAHK began campaigns to motivate men to take a positive and active role in family planning and to correct misinformation on vasectomy. Successful FPAHK efforts to stimulate male support for family planning include the 1977 "Mr. Family Planning" campaign, the 1982 "Family Planning - Male Responsibilities" campaign, and the 1986-87 "Mr. Able" campaign. Although these campaigns ended in the 1980s, men may now be counseled on contraception at 3 of the 8 FPAHK-run birth control clinics.
PLANNED PARENTHOOD CHALLENGES. 1994; (2):42-4.INPPARES, the International Planned Parenthood Federation affiliate in Peru, has provided family planning and other services to the Peruvian population since 1976. The organization concentrates upon interventions targeted to women of low socioeconomic status. One of the group's most important strategies has been to distribute contraceptives at the community level in rural and peri-urban areas of the country through a network of centers managed by promoters. These promoters are virtually all female. The organization in 1993 supplied 812 distribution centers. Promoters and their supervisors have received training in contraception, basic data recording, community work, and related topics. INPPARES, however, suspected that the quality of the project would be improved if promoters and supervisors were trained about the role of women in the community and their rights and identity as women. The personnel would then be able to better understand the role of contraception and reproductive health in women's lives. To that end, INPPARES in 1992-93 developed a project in coordination with the Manuela Ramos Association, a Peruvian women's organization. A questionnaire was given to forty promoters on issues related to women's roles, values, attitudes, the place of women in society and the family, family planning, sexual relations, and decision making. Their responses pointed to a real need to provide promoters and supervisors with more information through workshops on women in Peruvian society, women's identity and roles, women's sexual rights, and the quality of care in service provision. Four pamphlets were drafted from a seminar of fifty supervisors from both organizations to be used in a series of twelve workshops for 256 promoters. Post-intervention evaluation of the original forty participants confirm the significant effectiveness of both subjects covered and materials used in achieving desired project goals. Four workshops were subsequently held in which project results were presented to 261 promoters. Promoters and supervisors are now using flipcharts and pamphlets in their training activities.
[Unpublished] 1990 Mar 6. vi, 71 p.Men may impede broader use of family planning methods by women in many countries. Efforts have therefore been made to reach men separately in order to promote greater acceptance and use of male or female contraceptive methods. Typically, programs may encourage men to allow partners to use contraception; persuade men to adopt a more active, communicative role in decision making on contraceptive use; and/or promote the use of male methods. This paper presents findings from male involvement program initiatives in 60 developing countries since 1980. Male involvement programs are clearly needed, and condom use should be encouraged for protection against both pregnancy and HIV infection. Given their relatively low cost per couple-year of protection, social marketing programs should be encouraged to promote condom sales. Employment-based programs, despite relatively high start-up costs, have also generated large increases in condom use. Both condom and vasectomy use have been increased through mass media campaigns, yet more campaigns should address AIDS. Clinic services and facilities should be made more attractive to men, and new print materials are warranted. Community-based distribution programs have been found to be great sources of information and supplies, especially in rural areas, and male adolescents are especially in favor of telephone hotlines. Little information exits on the effectiveness and costs of programs targeting organized groups. Further, youth-oriented programs generally reach their intended audiences, but are relatively expensive for the amount of contraceptive protection provided. Finally, a positive image must be promoted for the condom through coordinated media presentations, user and worker doubts of efficacy must be eliminated, and regular condom supplies ensured. Recommendations are included for policy, research, public education, the World Health Organization, national AIDS prevention programs, and family planning agencies.
FAR EASTERN ECONOMIC REVIEW. 1992 Feb 20; 29-30.AIDS and HIV infection are in the early stages in Indonesia. 21 AIDS cases have been reported, and 30 persons have tested HIV-seropositive. Given the relatively low number of cases, and the presumed slow spread of HIV in the population, the government may yet be able to react in timely fashion to thwart epidemic spread. A rigorous education campaign and early detection of infected individuals are elements central to such intervention. The World Health Organization set a 1992 budget of US$500,000 for AIDS efforts in Indonesia. Research is young, awareness is minimal, and the campaign has barely commenced. AIDS cases have emerged in Jakarta, Surabaya, Bandung, and Denpasar. It is especially in cities that the government is concerned over checking the spread of AIDS. In these populations, many engage in extramarital sex, visible transvestite communities exist, and commercial sex districts thrive. Low condom use among sex workers, and relatively high rates of untreated STDs prevail in the general population. From March, blood donated in 15 cities, including these 4, will be compulsorily screened for HIV. Socially, moral and religious attitudes must be recognized and accommodated in mounting an effective AIDS prevention and education campaign in Indonesia. While religious sensibilities may be offended by the discussion of sex and sexual practices, such discussion is necessary and must be supported by the well-organized religious groups in this overwhelmingly Muslim country. Hopefully, Indonesia will bring to bear against AIDS the same cultural pragmatism exhibited to effect population control in the 1970s and 1980s.
[Unpublished] 1991. Presented at the Demographic and Health Surveys World Conference, Washington, D.C., August 5-7, 1991. 32 p.Brazil's National Survey of Maternal-Child Health and Family Planning, conducted in 1986 as part of the international program of Demographic and Health Surveys, consolidated and extended the findings of 9 previous state-level surveys. This work outlines the impact of survey data on Brazil's private sector family planning organizations, donor agencies, the press and opinion leaders, and the federal government and legislators. The finding of the survey that the rate of contraceptive usage among women aged 15-44 married or in union was much higher than expected at 65.4%, initially suggested that the family planning organizations and donors had completed their tasks, but more careful scrutiny pointed up serious problems. Family planning problems identified in the survey included low levels of knowledge and use of contraception in the impoverished northeast and among groups with low levels of income and education; a very high proportion of users (80%) of just 2 methods, oral contraceptives (OCs) and female sterilization; low rates of use of other effective and reversible methods; a large number of unnecessary caesareans performed only to give the woman access to sterilization services, with fully 72% of sterilized women undergoing the procedure during a cesarean delivery; low average age (31.4 years) of sterilization acceptors and low parity of a substantial proportion; use of pharmacies to obtain supplies by over 93% of OC users and OC use at inappropriate ages; low male participation in family planning; and lack of family planning services for adolescents. The survey demonstrated the reality of family planning in Brazil and prompted a rethinking of the aims and goals of family planning programs. Many aspects of maternal-child health and sexual and reproductive health in addition to provision of contraceptives should be included in a high quality family planning program. The survey findings did not completely resolve all the polemics and controversies that have beset the family planning program in Brazil, but they helped dispel some charges against the program. For the most part, only the most strongly ideological opponents have remained unmoved.
WORLD HEALTH. 1991 Nov-Dec; 22.The experiences of Romania show that legal decrees will not deter a woman determined to end her pregnancy, and that it is easier to switch from illegal to legal abortion than it is to introduce the practice of modern contraception. On Christmas Day 1989, Romania abrogated a 1966 that banned abortion and all modern contraceptive methods. Through the 1966 law, the former regime had hoped to raise the birth rate, which at the time stood at 15.6/1000. Succeeding briefly, the law ultimately failed to its objective, since by 1985 the birth rate had fallen to the initial 1966 level. If year following the abrogation of the decree, 992,265 abortions were carried out, 92% of them legally. The number of abortions is expected to top 1 million in 1991. Maternal death due to abortion has fallen by more than 60%. Romania has also witnessed the establishment of the Society for Education in Contraception, a private family planning association. UN and donor assistance has begun to arrive in Romania. 20,000 women attended family planning clinics in 1990, a figure that increased to nearly 50,000 in 1991. Nonetheless, the case of Romania illustrates the complexities involved in introducing the practice of modern contraception. In addition to commitment from national authorities, setting up a program of modern contraception will require the following: convincing physicians and clients as to the superiority of contraception over abortion; ensuring the training of health professionals; developing public information programs; creating acceptable conditions for women to seek services; and making contraceptives available and affordable. In order to facilitate the transition from abortion to contraception, UNFPA and the WHO have initiated an emergency family planning program.
INTERNATIONAL JOURNAL OF HEALTH SERVICES. 1991; 21(3):505-10.This article asks the reader to carefully consider the personal implications of AIDS were either he or close friends and relatives afflicted with the syndrome. We are urged to acknowledge the limited capabilities of personal and social response to the epidemic, and recognize the associated degree of social inequity and knowledge deficiency which exists. Summaries of 3 articles are discussed as highly integrated in their common call for global solidarity in the fight against HIV infections and AIDS. Pros and cons of Cuba's evolving response to AIDS are considered, paying attention to the country's recent abandonment of health policy which isolated those infected with HIV, in favor of renewed social integration of these individuals. Brazil's inadequate, untimely, and erred response to AIDS is then strongly criticized in the 2nd article summary. Finally, the 3rd article by Dr. Jonathan Mann, former head of the World Health Organization's Global program on AIDS, on AIDS prevention in the 1990s is discussed. Covering behavioral change and the critical role of political factors in AIDS prevention, Mann asserts the need to apply current concepts and strategies, while developing new ones, and to reassess values and concepts guiding work in the field. AIDS and its associated crises threaten the survival of humanity. It is not just a disease to be solved by information, but is intimately linked to issues of sexuality, health, and human behavior which are in turn shaped by social, political, economic, and cultural factors. Strong, concerted political resolve is essential in developing, implementing, and sustaining an action agenda against AIDS set by people with AIDS and those at risk of infection. Vision, resources, and leadership are called for in this war closely linked to the struggle for worldwide social justice.
[Unpublished] 1989.  p. (WHO/GPA/INF/89.21)In October 1989, WHO and the International Labour Office (ILO) organized a consultation on AIDS and seafarers. Participants included shipowners, public health professionals, physicians, seafarer organizations, and government representatives. They concluded that seafarers were not at particular risk since they work and live basically on ships for extended periods of time. Nevertheless conditions do exist that warrant special attention. For example, they are a geographically mobile young population living and working in a mixed cultural environment. This environment restricts their accessibility to health facilities and timely information and HIV and AIDS. Further, the nature of their profession limits social interaction on board ship and on shore. Therefore the consultation stated aims and objectives to help prevent HIV transmission and to promote the health of HIV positive seafarers on the job. Shipping owners and seafarer organizations should develop strategies together, and where appropriate, with governmental and other agencies to achieve these goals. The consultation recommended that WHO and ILO provide guidance AIDS health promotion, encourage its integration into overall health promotion, and support any regional pilot projects on AIDS health promotion. They should also establish a resource center and a network to disseminate resource packages with culturally sensitive material, such as video tapes and posters. In addition, these international organizations should reexamine current occupational health and safety regulations and medical guides for ships and the manner in which they are applied. Accordingly they should develop a seafarer's manual for physician use. WHO and ILO should widely distribute the consultation statement to relevant organizations. Finally, they should encourage national AIDS committees to tie in with individuals working on HIV/AIDS issues for seafarers.
INTERNATIONAL HEALTH NEWS. 1988 Apr; 9(4):4-5.In the effort to realize Universal Child Immunization by 1990, an active search is underway to find ways to raise immunization coverage levels. The World Health Organization's (WHO) Expanded Program on Immunization (EPI) has developed excellent systems that develop such program components as supply management, equipment maintenance, disease surveillance, clinical practice, and supervision. Program performance has shown a steady improvement over the years in those countries which have adopted such systems, yet the trend has not been as marked as expected. Coverage levels in many countries have remained below 60%, and figures show a "dropout" with the multi-dose vaccines. The dropout figures suggest that parental acceptance of immunization is difficult to sustain throughout the entire series, which is spread over the first 9 months of life. To reduce dropout and boost coverage levels still further, recent program directions have emphasized social mobilization to increase the public response to immunization. It is tempting to conclude that with the implementation of improved management systems the final success will come from persuading parents to avail themselves of immunization services, but field reports suggest that this may not be the case. Health records show missed immunizations despite numerous visits to clinics, suggesting widespread problems in the implementation of the WHO systems. A combination of causes seem to ensure that children attending with their mothers do not get immunized, including errors and omissions on the part of field staff which reduce the chances for immunizations by families making return visits to the clinics. Few programs incorporate immunizations in daily practice. In a series of immunization coverage surveys conducted recently in 1 African country, the most striking fact was that the limitations of the data collected meant that the calculated contribution of clinical error could only be a gross underestimation of true clinical error contribution. This suggests that social mobilization to improve clinical attendance is likely to be ineffective until problems with the provision of services have been solved, but improving services has the potential to increase coverage levels as well as the potential to motivate parents to bring their children to the clinics.
Politics and population. U.S. assistance for international population programs in the Reagan Administration.
[Unpublished] .  p.US support for family planning programs in developing nations has become more and more controversial as the existing consensus on the rationale for these programs has been lost. This article discusses the major issues of the current debate on international family planning assistance and some of the reasons why bipartisan support for the program has eroded in recent years. During the 1960s, 2 factors contributed to the advent of the international family planning movement: the development of modern contraceptive technology in the form of the oral contraceptive (OC) and the IUD, technologies which, it was believed, could be made readily available and used easily, even in the poorest developing countries; and the growing realization that as mortality rates were declining rapidly due to improved health care in developing countries, the rate of population growth was increasing at a pace never before achieved. After some initial reluctance, efforts to stabilize population growth rates came to be accepted as in the US national interest, and by the 1970s both Republican and Democratic administrations and bipartisan congressional coalitions supported regular increases in funding for population programs as part of the foreign aid program. The US, together with several European countries, was instrumental in the development and early support for the UN Fund for Population Activities and the nongovernmental International Planned Parenthood Federation. In general, US support for international population programs was not a controversial issue in foreign aid debates until last year. Since President Reagan took office in January 1981, both the advocates and opponents of population programs have become more active and organized. Foreign aid in general and international family planning programs in particular are a favorite target for conservative groups, which include several antiabortion groups. Consequently, early in the Reagan administration efforts were made to slash the foreign aid budget. These efforts went so far as to propose eliminating all funding for international family planning programs. These efforts failed, and the US maintained its position as preeminent donor for family planning until 1984. In its final version, the US policy paper for the 1984 Mexico City Conference made 2 important revisions regarding US international population policy: the explanation of population growth as a "neutral phenomenon," caused by counterproductive, statist economic policies in poor countries, for which the suggested remedy is free market economic reform; and the assertion that the US does not consider abortion an acceptable element of family planning programs and will not contribute to nongovernmental organizations that perform or actively promote abortion as a family planning method in other nations. How this controversy over US International population policy is resolved depends largely on how Congress defines the issue.
Development: Seeds of Change. 1984; 4:80-1.A strategy, developed by the Women's Programme of the Social Development Division of the Economic and Social Commission for Asia and the Pacific (ESCAP) to promote women's participation in the development process, is described. Although recommendations of international conferences invariably call for the inclusion of women in all levels of development planning, efforts to involve women in planning at the national level have met with little success. Even if women received sufficient training and education to qualify them as planners, their impact on development planning would be minimal due to deficiencies within the national planning process. Top planning units in most Asian and Pacific countries are composed of highly trained expatriots who lack an understanding of the needs of the population in general and of women in particular. The strategy developed by the Women's Programme is based on expanding the role of women in development planning at the local level and gradually sensitizing the planning hierarchy to women's needs and to women's abilities. This awareness building can be facilitated by developing links between government agencies and women's organizations. Application of this strategy revealed that it was much more difficult to build awareness among government officials and planners then to involve women in development at the local level. The planning process is constantly subject to personnel and policy changes because of changing political situations, and planners remain isolated from the public. At the community level, women's efforts to promote development are highly successful. Programs developed by women tend to benefit the entire community, and women's roles in these activities are highly visible. These successful efforts will contribute toward building an awareness of women's capacities to promote development. Conditions which are conducive to local level involvement of women include the political will to promote participation, the provision of appropriate training to prepare community members for participation, and the existence of an adequate infrastructure and sufficient resources to carry out programs.
Washington, D.C., Heritage Foundation, 1984 Aug 27. 16 p. (Backgrounder No. 376)The United Nations' 2nd World Population Conference (Mexico City, 1984) called for greatly expanding funding for family planning assistance worldwide. The United Nations Fund for Population Activities (UNFPA), the conference's chief sponsor, will no doubt receive the largest portion of any assistance increase. UNFPA plays a critical role in population-related programs worldwide. The central debate on population policy should be over the extent and adequacy of the natural resources base and how countries can humanely and voluntarily change family size preferences. In countries like Singapore and South Korea, success has been achieved by combining social and economic incentives to discourage large families. Although couples in developing countries report wanting contraceptive service programs, they also want families of 4 to 6 children. So far UNFPA has been ineffective in changing the population situation. This overview of its activities reveals that UNFPA loses ultimate reponsibility for implementation of many of its own programs. UNFPA does not advocate a reduction in population growth within a single country, but rather helps couples have the number of children they desire. UNFPA's specific population and family programs are divided into functional areas: basic data collection, population change study, formulation and implementation of population policies, support for family planning/maternal child health programs and educational and communication programs. UNFPA stresses the importance of using contraceptives but not of achieving the small family norm. UNFPA's projects in some of the largest less developed nations are described, illustrating how the UN agency spends its assistance funds. From 1971 to 1982, the UNFPA spent almost US $230 million in the 10 largest less developed countries without any significant change in population growth. UNFPA program administrators are far from resolving the serious population problems facing developing countries and generally oblivious to new directions in which population policies should move. No progress will be made until UNFPA recognizes the need to approach the problem from a different perspective, working to change attitudes toward small families.
World population and the United States: the development of an idea, statement made at the United States in the World International Conference, Washington, D.C. 28 September 1976.
New York, N.Y., UNFPA, . 20 p.A history of United States attitudes toward population problems is presented. In 1954, it seemed that the UN and its agencies were precluded from involvement in population action programs. In the US, the battles of Margaret Sanger and Abraham Stone were still fresh in the memory. The forces that would change this situation were already at work. American demographers, economists and campaigners articulated them. At the World Population Conference that year papers presented by Americans were crucial. Abraham Stone presented a paper on new developments in contraception. It has been feared that any discussion of contraception at the Conference could prevent its success. By the early 1950s, anxiety had grown that the prophecies of Thomas Malthus were about to be realized. In some Asian countries, notably India, death rates combined with high birth rates had caused some concern for years. Biologists, economists, agriculturists, and sociologists were also concerned with the quality of life in the US. During the 50s, the considerable resources of the US research and development began to turn toward improvements in contraceptive methods. By the end of the decade, a viable contraceptive pill had been developed and tested, and the earliest IUD had been considerably improved. At the same time, means of improving the delivery of contraceptive services were sought. Marketing and promotion were applied to family planning campaigns. In 1965-66, the US government finally turned around on the population issue. A firmly established action program within the UN system did not end the controversy over the place of population in development. The women's movement in this country has coincided with heightened consciousness in the international community of the importance of women as agents rather than mere recipients.
Communication activities that promote behavior change in clients of family planning programs: resources and constraints.
In: L. Saunders, ed. IEC Strategies: Their Role in Promoting Behavior Change in Family and Population Planning. Honolulu, East-West Communication Institute, July 1977, pp. 77-86Add to my documents.
Family Planning Perspectives. November-December 1977; 9(6):286-292.When Margaret Sanger initiated the American birth control movement in the early twentieth century, she stressed female and sexual liberation. Victorian views on morality have since combined with the compromises necessitated to achieve legitimacy for the movement to lead to a desexualization of the birth control movement. The movement's communication now concentrates on reproduction and ignores sex; it emphasizes family planning and population control but does not mention sexual pleasure. Taboos against publicity concerning contraceptives are more powerful even than laws restricting the sale or distribution of contraceptives themselves in many countries. The movement must recover its earlier revolutionary stance.
[Unpublished] 1982. Paper prepared for Conference on Vasectomy, Colombo, Sri Lanka, Oct. 4-7, 1982. 21 p.Discusses the factors responsible for the decline of male acceptance of vasectomy over the past decade. The Association for Voluntary Sterilization (AVS) is a nonprofit organization working in the United States which helps funding of similar programs in other developed and developing countries. Reasons for the decline of vasectomy acceptance include the lack of attention paid to male sterilization in countries with family planning programs, the introduction of new technology for female sterilization, the introduction of new effective methods of contraception, and the exaggerated sexual role of the male and the need to protect his virility. The author reviews successful vasectomy programs and finds that, to be successful, a program should have strong leadership, a focussed design, clinic hours that would not interfere with patients' working schedules, and should pay attention to the needs of men, e.g., emphasizing that vasectomy does not cause impotency. The program should also have a community-based orientation, since all the services are not hospital-based and can be brought to the client's home, thereby emphasizing the minor nature of the surgery. AVS believes that vasectomy as a means of family planning can be effective. It is safe, inexpensive, simple, and deliverable. A special fund was allocated in 1983 to stimulate the development of several pilot and demonstration projects in a variety of countries.