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Contraception. 1984 Dec; 30(6):505-22.The World Health Organization (WHO) conducted a randomized comparative trail of th effects of hormonal contrception on milk volume and infant growth. The 341 study participants, drawn from 3 obstetric centers in Hungary and Thailand, were 20-35 years of age with 2-4 live births and previous successful experience with breastfeeding. Subjects who chose oral contraception (OC) were randomly allocated to a combined preparation containing 150 mcg levonorgestrel and 30 mcg ethinyl estradiol (N=86) or to a progestin-only minipill containing 75 mcg dl-norgestrel (N=8). 59 Thai women receiving 150 mg depot medroxyprogesterone (DPMA) intramuscularly every 3 months were also studied. An additional 111 women who were using nonhormonal methods of contraception or no contraception served as controls. Milk volume was determined by breast pump expression. No significant differences in average milk volume were noted between treatment groups at the 6 week baseline visit. However, between the 6th and 24th weeks, average milk volume in the combined OC group declined by 41.9%, which was significantly greater than the declines of 12.0% noted in the progestin-only group, 6.1% among DMPA users, and 16.7% among controls. The lower expressed milk volume among combined OC users did not impair infant growth. No significant differences were observed between treatment groups in terms of average infant body weight or rate or weight gain. Users of combined OCs may have compensated for their decreased milk volume by providing more extensive supplementary feeding or more prolonged suckling episodes. These results suggest that the estrogen content of combined OCs adversely affects the capacity of the breast to produce milk; thus, family planning programs should make nonestrogen-containing methods available to breastfeeding mothers. Although no effects on infant growth were noted in this study, the possibility of such efects cannot be excluded in populations where infant growth largely depends on the adequacy of unsupplemente d lactation.
[Nairobi, Kenya], United Nations Environment Programme [UNEP], 1990. , 42 p. (UNEP Regional Seas Reports and Studies No. 123)The UN Environment Programme (UNEP) ocean program is studying global marine environments to form a policy to protect the oceans. This report examines the marine environment of the Indian Ocean, Bay of Bengal, the Arabian Sea, and the Andaman Sea. Bacteria and viruses comprise the most important contaminants in the South Asia seas. They enter marine life which humans eat and then develop diarrhea. Pathogens enter the seas through untreated sewage which causes much eutrophication. Zooplankton contain considerable concentrations of heavy metals and pesticides. None of the zooplankton samples drawn from seas around India in 1978, 1981, 1983, and 1985 contained mercury, however. Yet mercury and other heavy metals are present in fish species in at least the Ganges River estuary, Andaman Sea, the Karachi harbor in Pakistan, and seas around Bangladesh. Common chlorinated pesticides found off the coast of India include DDT, aldrin, dieldrin, and BHC. Industrial development is increasing the levels of other contaminants such as solid waste and synthetic detergents. Coastal erosion is common in South Asia. Considerable siltation occurs at the head of the Bay of Bengal. Several urban areas are reclaiming the sea using materials from solid wastes and garbage, but these materials leach which causes public health problems. In India, nuclear power plants operate near the coast where they release 50% of the generated heat to the coastal environment. Dredge materials from harbors in India are dumped offshore which resulted in almost complete depletion of fisheries near these harbors. Tourism poses a threat to coastal environments due to the increase in nonbiodegradable solid waste such as cans, plastics, and empty bottles. Oil tanker disasters, bilge washings, and discharge of ballast water contribute to the sizable amount of oil pollution in the Indian ocean. Exploitation damages coral reefs, mineral deposits, mangroves, and marine life.
[London, England], IPPF, 1986 Jan 31. 5, 13 p.This report provides a brief description of the International Planned Parenthood Federation's (IPPF) involvement in and contributions to International Youth Year (IYY). IYY reinforced an IPPF priority program area for the 1980s--meeting the needs of young people--and all member family planning associations were encouraged to establish links with IYY national coordinating committees. IPPF was also instrumental in the formation of a nongovernmental Working Group on Family Life Education comprised of representatives from a range of organizations involved in youth work and is preparing a resource book on family life education for these groups. The guidelines for action for IYY, prepared by a United Nations Advisory Committee in which IPPF was a major participant, urge governments to promote culturally appropriate family life education, encourage young people and their organizations to be active in the implementation of population programs, promote social policies to strengthen the family, encourage community education to counteract adolescent pregnancy, and ensure that family life and sex education are available to young people. Where necessary, family planning information and services can be made available to adolescents within a country's sociocultural context. There is a need to sustain the global interst in youth concerns generated by IYY and to translate into action the recommendations and resolutions on youth that were developed. It is essential that such action consider factors such as the promotion and protection of the rights and responsibilities of young people, sensitivity to local traditions, identification and mobilization of local resources, interagency cooperation, and involvement of young people in decision making. The document concludes with progress reports from 30 countries on family planning association activities in support of IYY.
World Health. 1985 Nov; 13-15.In November 1980, Dr. Halfdan Mahler, Director-General of the World Health Organization (WHO), and James Grant, head of the UN Children's Fund (UNICEF), drafted a joint program to improve the nutritional status of children and women through developmental measures based on primary health care. The government of Italy agreed to fund in full the estimated cost of US$85.3 million. When a tripartite agreement was signed in Rome in April 1982, the WHO/UNICEF Joint Nutrition Support Program (JNSP) came into being. It was agreed that resources would be concentrated in a number of countries to develop both demonstrable and replicable ways to improve nutrition. Thus far, projects are underway or are just starting in 17 countries in Africa, Asia, Latin America, and the Caribbean. In most of these countries, infant and toddler mortality rates are considerably higher than the 3rd world averages. Program objectives include reducing infant and young child diseases and deaths and at the same time improving child health, growth, and development as well as maternal nutrition. These objectives require attention to be directed to the other causes of malnutrition as well as diet and food. JNSP includes nutrition and many other activities, such as control of diarrhea. The aim of all activities is better nutritional status leading to better health and growth and lower mortality. Feeding habits and family patterns differ from 1 country to another as do the JNSP country projects. Most JNSP projects adopt a multisectoral approach, incorporating varied activities that directly improve nutritional status. Activities involve agriculture and education as well as health but are only included if they can be expected to lead directly to improved nutrition. A multisectoral program calls for multisectoral management and involves coordination at all levels -- district, provincial, and national. This has been one of the most difficult things to get moving in many JNSP projects, yet it is one of the most important. Community participation is vital to all projects. Its success can only be judged as the projects unfold, but early experiences from several countries are encouraging.
Who Chronicle. 1984; 38(3):109-15.The theme of the 1984 World Health Day--children's health, tomorrow's wealth--provides an occasion to convey to a worldwide audience the message that children are a priceless resource, and that any nation which neglects them does so at its peril. World Health Day 1984 spotlights the basic truth that the healthy minds and bodies of the world's children must be safeguard, not only as a key factor in attaining health for all by 2000, but also as a major part of each nation's health in the 21st century. An investment in child health is a direct entry point to improved social development, productivity, and quality of life. Care of child health starts before conception, through postponement of the 1st pregnancy until the mother herself has reached full physical maturity, and through spacing of births. It continues from conception on, through suitable care during pregnancy, childbirth, and childhood. In the developing countries the child must be protected by all available means, particularly from the killer diseases. What happens in the immediate family and community around the mother and child, and even far away in the world, can have a direct impact on the health and security of both of them. The mother and child need to be placed in an environment that will ensure their health by protecting the overall setting in which they live. This means providing clean water, disposing of waste, and helping to improve shelter. Nothing can diminish the importance of good food, enough food, and proper nutrition for children and their mothers. Beyond the immediate physical needs are the equally important needs for love and understanding which stimulate the healthy development of the child. The emergence of new health problems of mothers and children in developing and developed countries should be kept in mind. Better health services must be made available to all who need them. The World Health Organization (WHO) provided resource material on World Health Day issues for dissemination throughout the world. Extracts from 4 articles on this year's theme are reproduced. The articles report on the success of the Rural Health Center in Ballabhgarh (India) in reducing maternal and infant mortality, the value of breastfeeding as 1 of the simplest and safest ways of ensuring adequate spacing of births, Tunisia's integration of a program of immunization into the routine activities of the health care system, and the needs of the healthy child.
Alternative approaches to meeting basic health needs in developing countries: a joint UNICEF/WHO study.
Geneva, World Health Organization, 1975. 116 p.Based on the failure of conventional health services and approaches to make any appreciable impact on the health problems of developing populations, this study examined successful or promising systems of delivery of primary health care to identify the key factors in their success and the effect of some of these factors in the development of primary health care within various political, economic, and administrative frameworks. In the selection of new approaches for detailed study, emphasis was placed on actual programs that are potentially applicable in different sociopolitical settings and on programs explicitly recognizing the influence of other social and economic sectors such as agriculture and education on health. Information was gathered from a wide range of sources; including members, meeting reports, and publications of international organizations and agencies, gathered country representatives, and field staff. The 1st section, world poverty and health, focuses on the underprivileged, the glaring contrasts in health, and the obstacles to be overcome--problems of broad choices and approaches, resources, general structure of health services, and technical weasknesses. The main purpose of the case studies described in the 2nd part was to single out, describe, and discuss their most interesting characteristics. The cases comprised 2 major categories: programs adopted nationally in China, Cuba, Tanzania, and, to a certain extent, Venezuela, and schemes covering limited areas in Bangladesh, India, Niger, and Yugoslavia. Successful national programs are characterized by a strong political will that has transformed a practicable methodology into a national endeavor. In all countries where this has happened, health has been given a high priority in the government's general development program. Enterprise and leadership are also found in the 2nd group of more limited schemes. Valuable lessons, both technical and operational, can be derived from this type of effort. In all cases, the leading role of a dedicated individual can be clearly identified. There is also evidence that community leaders and organizations have given considerable support to these projects. External aid has played a part and apparently been well used. Every effort should be made to determine the driving forces behind promising progams and help harness them to national plans.
New York, UNICEF, 1984 May. 280 p.The data in this set of 135 country profiles for 1981 are made up from 9 major sources and cover the countries and territories with which the UN International Children's Emergency Fund (UNICEF) cooperates. In terms of infant morttality, countries are divided into 5 infant mortality groups: a very high infant mortality (a) group of countries, with a 1981 infant mortality rate (IMR) estimate of 150 (rounded) or more deaths per 1000 live births; a very high infant mortality (b) group of countries with a 1981 IMR estimate between 110 (rounded) and 140 (rounded); a high infant mortality group of a middle infant mortality group of countries, with a 1981 IMR estimate of between 26 and 50 (rounded); and a low infnat mortality group of countries, with a 1981 IMR estimate of 25 or less. For each country data are also presented on nutrition, demographic, education, and economic indicators.
Economic and Political Weekly. 1983 Dec 10; 18(50):2099.This article summarizes World Health Organization (WHO) guidelines on breastfeeding issued in 1982 and discusses their policy implications for India. The WHO document notes that early use of combined oral contraceptives (OCs) after childbirth may both decrease breast milk production and cause women to abandon the pill, denying them the contraceptive protection they would have had if lactation had proceeded uninterrupted. The WHO paper further notes the possible adverse effects on infants exposed to synthetic sex steroids secreted in the breast milk of users of hormonal contraception. This suggests that family planning programs should consider the special needs of breastfeeding women in determining the contraceptive methods to be promoted. Grassroots family planning wokers are in special need of intensive instruction in this area. WHO additionally calls for social and health support systems which encourage breastfeeding and urges that such initiatives form an integral component of family planning programs. WHO's emphasis on breastfeeding as a means of averting births rather than strictly as a means of improving child health is expected to attract the interest of policymakers.