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Lancet. 2007 Feb 3; 369(9559):354-355.Return of the Population Growth Factor: its impact on the Millennium Development Goals, a report of hearings held in the UK Parliament in 2006, focuses on the devastating impact of population growth on the Millennium Development Goals (MDGs). The report was released on Jan 31. The Inquiry Chairman, Richard Ottaway, Member of Parliament (MP), concludes: "The evidence is overwhelming: the MDGs are difficult or impossible to achieve with the current levels of population growth in the least developed countries and regions." Experts from around the world who testified to the hearings described the beneficial effects of slowing rapid population growth, as did Cleland and colleagues recently in The Lancet. Slower population growth permits greater investment in education and health, helping to lift nations out of poverty (MDG 1). By contrast, high birth rates in sub-Saharan Africa have helped increase the number living in extreme poverty from 231 million in 1990 to 318 million in 2001. In Ethiopia, 8 million people already live on permanent food aid, and the projected population growth from 75 million today to 145 million in 2050 presents an insurmountable challenge. Rapid population growth has a detrimental effect on the hope of achieving universal primary education by 2015 (MDG 2). (excerpt)
[Unpublished] 1994. Presented at the 1994 Southern Demographic Association Annual Meeting, Atlanta, Georgia, October 20-22, 1994. , 40, 10 p.This analysis uses two different measures of the parity progression ratio (PPR) in a period analysis of fertility and the impact of the family planning program on fertility in Kenya. The study is part of a UNFPA project including 14 other developing countries. Survey data from the 1978 World Fertility Survey and the 1989 Demographic and Health Survey provide data for the analysis. PPR is calculated first by a life table technique using birth probabilities specific for parity and birth interval in a period. PPR in the second calculation is an age-parity-adjusted progression based on schedules produced by Feeney. Results are presented for marital unions, first birth, birth intervals, parity progression, the impact of the family planning program, and socioeconomic differences. The results show an increase in age at first birth during the 1970s and 1980s. There is also a decrease in first births among adolescents between the 1960s and the late 1980s. A new finding is a reverse trend; a 1 year decrease in median age at first marriage occurred in urban areas between 1981-85 and 1985-89. The decrease is attributed to an increase in adolescent marriage in the late 1980s. By the 1980s families were being built at older ages, and births were being spaced farther apart. Adolescent first births and high parity births declined between the 1960s and 1980s. The trends reflect a clear and consistent pattern of modernization and better health with decreased population growth. Fertility is expected to reach replacement level soon. The family planning program contributed to the decline in progression to 6th and higher parities by 5% over 30 years. Higher marriage age and later age at first birth were related to higher educational status, although rural marriage age was higher by 0.7 years than urban marriage age. There was a high rate of adolescent marital unions, particularly informal unions, in urban areas. Teenage births were higher in rural areas. Urban women had a lower PPR in all birth orders than rural women. Median birth interval did not vary with educational level. A shorter than 24 month birth interval for 2nd and low order births occurred among the most educated and those in urban areas.
BULLETIN OF THE WORLD HEALTH ORGANIZATION. 1990; 68(5):625-31.Lactational amenorrhea in many developing countries is still the most successful form of contraception, especially when modern forms of contraception are not available. In cultures where frequent or prolonged breast feeding is common, postpartum amenorrhea and suppressed ovulation are frequent and serve to space births. It is this spacing of births that leads to decreased infant and maternal morbidity and mortality. It must be remembered that lactational amenorrhea is not a completely reliable form of contraception. In fact the figures indicate that in cultures were family planning use is low, birth intervals are largely determined by the duration and intensity of breastfeeding. Studies indicate that an increase of 15% 32% in birth intervals can result from prolonged lactation. It would be to the advantage of health care planners and providers to examined more closely the causes and properties of lactational amenorrhea. Field directed education can provide women with the information necessary to help them control their child spacing. The WHO Breast-feeding Data Bank collects and analyzes information on breast-feeding and its effects on fertility regulation. Methods used to assess lactational infertility and how the information is used by the data bank are described in this article. There is a summary of relevant information gathered from published sources and post 1983 studies of the WHO. The practical implications to health policy that are associated with lactation-associated infertility are also mentioned.
Women's work and fertility, research findings and policy implications from recent United Nations research.
[Unpublished] 1986. Paper presented at the Rockefeller Foundation's Workshop on Women's Status and Fertility, Mt.Kisco, New York, July 8-11, 1986. 23 p.Using World Fertility Survey data from the developing countries, it has been found that the interval between 1st and last birth varies from roughly 14 years in several of the more developed countries of Latin America and Asia (Republic of Korea, Jamaica, and Trinidad and Tobago) to 20 years in several African countries (Kenya and Senegal). In most of these countries childbearing begins between ages 18 and 20 with the lowest median age of 1st birth found in Bangladesh (17 years old) and the highest in Yemen (22 years old). Ages at last birth vary more widely from 33 in Trinidad and Tobago to 40 in Yemen. At the age of last birth, life expectancy varies from 27 in Benin and Senegal to 44 in Trinidad and Tobago and 42 in Costa Rica, Jamaica, and Panama. Life expectancy at last birth varies with level of development with developing countries at the highest level of development having an average life expectancy at age of last birth of 40.5 ranging on down to 36.8 at a middle-high level of development, 32.6 at a middle-low level, and 29.7 at the lowest level of development. This is compared with a life expectancy at last birth which is now as high as 52.6 in Japan for women born in 1950-1959 and 51.6 in the Netherlands for women born in 1940-1949. Thus, the actual childbearing period is 2 to 5 times longer in the developing countries than it is in the developed countries. A life cycle approach to women's employment and childbearing is essential for a full understanding of the interrelationship between women's status and fertility. While work opportunities can improve women's status and create the motivation for low fertility, fertility control is essential to women's status. As long as the events of conception, pregnancy, and childbirth have a significant element of chance, the incentives for societal and individual investment in women's educational and job opportunities will remain limited.
In: The 1984 International Conference on Population: the Liberian experience, [compiled by] Liberia. Ministry of Planning and Economic Affairs. Monrovia, Liberia, Ministry of Planning and Economic Affairs, . 232-47.This paper summarizes those aspects of the 1984 World Development Report which deal with population prospects and policies in Liberia. Sub-Saharan Africa is the only area of the world where there has not yet been any decline in the rate of growth of the population, and Liberia with a population of 2 million and growing at the rate of 3.5%/year has 1 of the highest growth rates in that area. The birth rate is 50/1000 of the population, and the death rate is 14/1000. The fertility rate is nearly 7 children/woman and is not expected to decline to replacement level before year 2030. Infant mortality is 91/1000, and half of all deaths occur among children under 5. Projecting these demographic trends into the future leads to the conclusion that the population will double in 20 years and exceed 6 million by 2030. Although fertility will begin to decline in the 1990s, the population will continue to increase for a few years with the growth rate declining to 2%/year by 2020 and 1.2%/year by 2045. Such rapid population growth will cause great stress on the country's ability to provide food, schools, and health care. For the children themselves, large, poor families, with births spaced too close together, means malnutrition, poor health , and lower intellectual capacity. And the cycle of poverty continues over the generations as the families save less and expend more on the immediate needs of their children. In macroeconomic terms, a growth rate of l2%/year means a massive explosion of need for food, water, energy, housing, health services and education, with a gross domestic product (GDP) growth of only 2%/year; and this projection is probably optimistic. The rural sector will not be able to support the 23% additional rural labor force, which will migrate to the towns, adding to the already high urban growth rate of 5.7%/year from natural increase. In this society, where literacy is only 20% and secondary education completed by only 11% of the girls, it is estimated that only %5 of eligible couples practice birth control despite the fact that it costs less than $1.00 per capita. Government must step in to ensure that resources exist for population planning at county and local levels. Government is responsible for making demographic data accessible and for coordinating population program inputs. Government should also make sure that family planning programs can be implemented through integration with existing health services. A project including restructuring of health care management, financing and delivery, as well as development of a national population policy, has been proposed for World Bank and other international agencies' support.
WORLD HEALTH. 1987 Nov; 10-2.Breastfeeding is at times referred to as "nature's contraceptive." Intensive breastfeeding naturally stops the discharge of eggs from the ovaries, which commonly is experienced as a delay in the return of menses after the birth of a baby. An obvious limitation is that for breastfeeding to produce a contraceptive effect, a successful pregnancy and suckling are essential, and it is not possible to predict when the contraceptive protection might cease. Consequently, in terms of fertility regulation, breastfeeding is regarded as a birth spacing rather than as a contraceptive method per se. The sooner a woman starts to menstruate after a birth, the shorter the birth interval is likely to be, assuming the woman is sexually active, there are no miscarriages, and no contraceptives are used. In women who do not breastfeed, the menses usually returns within 2-3 months after delivery. For those who breastfeed intensively for 1 or 2 years, the menses generally return within 6-10 months or 15-18 months, respectively. The ideal way of prolonging the birth interval seems to be by combining prolonged breastfeeding with the commencement of contraceptive use at the appropriate time, provided this time were known. Without breastfeeding and contraceptive use, the birth interval averages 16 months, but with prolonged and intensive breastfeeding it potentially could be extended by another 18 months, giving an average interval of 34 months. This suggests that the fertility of women who do not breastfeed could be halved by breastfeeding alone. The tendency for fertility to increase during the early stages of modernization is observed in countries where the trend away from a traditional of prolonged breastfeeding is not accompanied by increased use of modern contraceptive methods. It is known widely that breastfeeding helps to postpone the next pregnancy, practices and beliefs vary by region and ethnic group. For a long time, the World Health Organization Special Program of Research, Development and Research Training in Human Reproduction has been involved in the study of natural methods of fertility regulation, and it is important that WHO continues to study breastfeeding in different ethnic and social group if it intends to give sound advice on this issue to family planning programs.
Studies in Family Planning. 1986 May-Jun; 17(3):153-60.Data from a prospective child health study conducted in Gaza by the WHO was used to examine the relationship between infant feeding and subsequent fertility. The study group consisted of 769 women living in 2 refugee camps in Gaza who gave birth in a 2-month period in 1978, and their index children, followed up for 23 months with monthly visits. Women who became pregnant within the 23 months were followed up until the end of their pregnancy. Women who practiced contraception after the birth of the index child were excluded. Life table analyses demonstrate a strong relationship between breastfeeding and 2 components of birth intervals, the postpartum anovulatory period and the waiting time from the end of the anovulatory period to conception. Duration of breastfeeding in this population averaged 12 months. Once menses have resumed, main factors related to waiting time to conception are age, husbands education, and measures of breastfeeding intensity and duration. Women who are breastfeeding when menstruation resumes and continue to do so are less likely to conceive than other women.
[Unpublished] 1978. Presented at the WHO Seminar on Public Health and Clinical Aspects of Human Reproduction, Sofia, Bulgaria, September 25-27, 1978. 25 p.At the 21st World Health Assembly (WHA) it was decided that the Director General of the World Health Organization (WHO) should give support to member countries in realizing the integration of fertility regulation into public health services. WHO does not endorse any particular population policy, but does fully recognize the health rationale of family planning in terms of adequate timing and spacing of pregnancies, avoidance of unwanted pregnancies, and limitation of the number of births. During the last decade WHO has rapidly increased its efforts to assist countires in the establishment of programs and services for family planning, with emphasis on the developing countries. The relationships between family building, family health, and socioeconomic and other variables are very complex, and a close correlation exists among these variables themselves as well as socioeconomic conditions. Attention is directed to risks of unplanned pregnancies (risks for the mother and maternal age); influences on children; birth intervals; genetic aspects; high risk groups; integration of family planning into the public health services; fertility regulating methods and their utilization; and organization and availability of services. The identification of, and concentration on, high risk groups in the community is of great importance for efficient utilization of scarce resources in integrated health and family planning services. Some examples of such high risk groups are pregnant adolescents, primigravida, grand multipara, newborns, and children during the weaning period. The success of fertility regulation depends on the acceptability of methods. It depends on attitude of users and of medical personnel, availability of counseling centers and contraceptives, information and education of the people, and legislation. Acceptance and practice of contraception essentially depends on the level of service for the people. One of the major thrusts of the health professions today should be increased involvement in family planning and not as a population control movement but as an integral part of the medical responsibility to improve the quality of human life and to guard the health of the people.
In: United Nations. Economic and Social Commission for Asia and the Pacific, World Fertility Survey, and International Institute for Population Studies. Regional Workshop on Techniques of Analysis of World Fertility Survey data: report and selected papers. New York, UN, 1979. 15-36. (Asian Population Studies Series No. 44)The World Fertility Survey provides data from national maternity history inquiries. Detecting trends and differentials is only as accurate as the data collected. Where evidence suggests error, the analysis may be restricted to obtaining only a measure of fertility level. The basic data is the date and order of birth of each live born child for a sample of women in the reproductive period, according to the current age of the women and their duration of marriage. The cohort marker is usually separated into 7 5-year classes determined by age at interview; sample of women is representative of the female population of childbearing age. Total births for each cohort are allocated to different periods preceding the survey date. Reading down the columns gives the births to different cohorts over different ranges in the same time interval preceding the survey. To detect omissions, check the overall sex ratio and the sex ratios by periods; examine the trends of infant mortality by cohorts and periods; an excess of male mortality over female indicates poor reporting of dead female children and/or of sex (a common omission). From data on age of mother and number of surviving children at the survey and estimates of mortality level, the numbers of births at preceding periods may be calculated.
Maternal and child health training material: a selected annotated bibliography for teachers of health and health-related workers in villages and peri-urban areas.
Geneva, World Health Organization, Maternal and Child Health Unit, March 1979. (MCH/79.1) 99 p.An annotated bibliography prepared for the Maternal and Child Health Unit of World Health Organization is directed at health teachers and workers in villages and peri-urban areas. It includes material on communication techniques; learning methods; evaluation of training programs for health personnel plus selections on obstetrics; childcare; immunization; and nutrition. A separate section lists references on birth spacing, family planning and subfertility and environmental health.
World Health Organization, Technical Report Series.. 1970; 50.Add to my documents.
IPPF News 2(5): 3. September-October 1977.The International Planned Parenthood Federation finances more than $100,000 in biomedical research grants annually. The grants, given to scientists around the world, are to finance research into better maternal and child health programs and safer and more effective contraceptives. Examples of current projects are cited, e.g., nutrition, IUD mode of action, contraceptive properties of plants, and child spacing.
Family Planning Digest. 1972; 1(3):13-15.According to a WHO report Health Aspects of Family Planning family planning is assumed to have beneficial health results. Although reproductive changes do not exist in economic and social isolation, there is a link between maternal mortality and morbidity with increasing parity. An interval of at least 2 years between pregnancies results in the lowest rates of fetal loss and neonatal mortality. The question remains of how family planning services may be integrated with existing health services, such as postpartum care. Personnel involved in other health services, such as auxiliary nurse-midwives, can assume increasing responsibility in handling family planning matters. Further research is needed to understand how family planning affects health.
Appropriate Technology for Health Newsletter. 1983; (12):1-22.Human nutrition is a dynamic science concerned with nutritional requirements, food composition, food consumption, food habits, the relationship between diet and health, and research in this field. This article touches on these aspects as they relate to prospective mothers and the care of their children, especially in the first 5 years of life, with a focus on developing countries. It deals with details of birth intervals, adequate breastfeeding, and adequate nutrition for both mother and child to help prevent malnutrition and deficiency diseases. Stress is laid on factors of children's growth such as body weight and height that primary health care workers must monitor while they work in the context of any culture. Programs for improved nutrition need to be drawn up with respect to the traditions and values of indigenous cultures. The article concludes with bibliographies dealing with 1) women, children and nutrition, 2) nutrition and primary health care, and 3) community development.
Ippf Medical Bulletin. 1983 Aug; 17(4):2-3.Recent evidence from developing countries indicates that there is a relationship between the length of the interval between consecutive births and the survival of the younger sibling. This relationship has long been observed in the developed world. A study conducted by the World Health Organization in 9 largely metropolitan locations in developing countries found a reverse J-shaped pattern, with mortality rates initially falling with increased intervals but showing an upturn for the longest intervals of 5-6 and 6 or more years. The birth interval-mortality link tended to be stronger for postneonatal rather than neonatal and child mortality. A World Fertility Survey (WFS) cross-national analysis found a longer birth interval substantially improved the survival chance of the youngest child in all 29 countries studied. This advantage persisted to 5 years of age. The ratio of the infant mortality rate of children born within an interval of less than 2 years to that of those born after an interval of 4 years ranged from 1.26 in Venezuela to 3.91 in Syria. A 2nd WFS study found that the birth interval-mortality link persisted when maternal education was controlled. More detailed analysis of data gathered for this study from Pakistan revealed that the association between birth interval and mortality of the younger sibling was unaffected by the early death of the older sibling. Although it has been hypothesized that competition between children for food and attention is the major causal mechanism in the birth interval-mortality link, this finding suggests that maternal depletion (giving rise to low birth weights and inadequate breast milk) plays a role. However, the additional finding that survivorship of order 5 and more births was unaffected by average spacing patterns once the length of the immediately preceding birth interval was controlled suggests that maternal depletion may not be cumulative. The data from Pakistan further show interval length to have the same effect on mortality of the older sibling, even when length of breastfeeding was controlled, suggesting that involuntary weaning because of the next pregnancy is the critical explanatory factor. This research points to the need for a renewed emphasis on contraception for spacing purposes.
In: Current problems in obstetrics and gynecology, Vol. 5, No. 6, edited by John M. Leventhal. Chicago, Illinois, Year Book Medical Publishers, 1982. 4-41.This article addresses the medical aspects of population growth, with specific focus on a demographic overview, population policies, family planning programs, and population issues in the US. The dimensions of the population problem and their implications for social and economic development are reviewed. The world's response to these issues is discussed, followed by an assessment of what has been accomplished, particularly as it relates to the record of national family planning programs in developing countries. The impact of population growth on such issues as education, available farm land, deforestation, and urban growth are discussed. Urban populations are growing at an unprecedented rate, posing urgent problems for action. From a public health perspective, data are reviewed which demonstrate that having children at short intervals (2 years) or at unfavorable maternal ages (18 or 35) and/or parity (4) has a negative impact on maternal, infant and childhood morbidity and mortality, particularly in developing countries. Increasing the age of marriage, delaying the 1st birth, changing and improving the status of women, increasing educational levels and improving living conditions in general also are important in reducing population growth. Probably the most important, but most controversial intervention, has been the development of national family planning programs aimed at increasing the public's access to modern contraceptive and sterilization methods. India was the 1st country to declare a formal population policy (in the 1950s) with the goal of reducing population growth. Currently, close to 35 countries have formal policies. The planned parenthood movement, with central support from the London office of the International Planned Parenthood Federation (IPPF), has played a most important role in making family planning services available. 2 population issues in the US today are reviewed briefly in the final section: teenage pregnancy and the changing age structure.
In: Proceedings of the Fourth Annual Scientific Meeting of the Sudan Fertility Control Association held at Friendship Hall, Khartoum, 23 February 1983, edited by Dr. A/Salam Gerais. [Khartoum], Sudan, Sudan Fertility Control Association, 1983. 47-8.This paper consists of narrations to accompany a slide show. The slide illustrating the I.F.F.H. concept of data collection presents an integrated approach. Another slide shows the FIGO recommended case record, which is accepted by the WHO. A family planning question arises before birth and after birth of the child, female sterilization, number of additional children wanted. The slide on birth interval behavior enables the study of current birth outcome as a function of breastfeeding, family planning and prenatal visits. The last birth interval can be studied with maternity care monitoring, breastfeeding, and the status of the last surviving infant, a key variable. Once you know how many children you have reached, you can go forward and study the next birth interval. The slide showing the model approach enables determination of the current perinatal death from knowledge of the last birth interval and loss of the last live birth. With the increase of education, breastfeeding is reduced; family planning before current conception increases, with education it doubles; prenatal care increases with education. The birth interval is prolonged in cases of breastfeeding without family planning. If family planning is used, there is a marked prolongation of the birth interval. 63% of women attending the 11 centers surveyed in Indonesia wanted additional children among those who had 3 living children postpartum. Only 38% of those with 4 children wanted additional ones. This 50% cut is known as the 50% LDC and varies according to geographic location. Using the LDC (developing countries), one can determine the proportion of women who do not want to protect themselves postpartum, and the relation of having more living children to seeking contraceptive protection.