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  1. 1

    Child Malnutrition in Pakistan: Evidence from Literature.

    Asim M; Nawaz Y

    Children. 2018 May 4; 5(5)

    Pakistan has one of the highest prevalences of child malnutrition as compared to other developing countries. This narrative review was accomplished to examine the published empirical literature on children’s nutritional status in Pakistan. The objectives of this review were to know about the methodological approaches used in previous studies, to assess the overall situation of childhood malnutrition, and to identify the areas that have not yet been studied. This study was carried out to collect and synthesize the relevant data from previously published papers through different scholarly database search engines. The most relevant and current published papers between 2000(-)2016 were included in this study. The research papers that contain the data related to child malnutrition in Pakistan were assessed. A total of 28 articles was reviewed and almost similar methodologies were used in all of them. Most of the researchers conducted the cross sectional quantitative and descriptive studies, through structured interviews for identifying the causes of child malnutrition. Only one study used the mix method technique for acquiring data from the respondents. For the assessment of malnutrition among children, out of 28 papers, 20 used the World Health Organization (WHO) weight for age, age for height, and height for weight Z-score method. Early marriages, large family size, high fertility rates with a lack of birth spacing, low income, the lack of breast feeding, and exclusive breastfeeding were found to be the themes that repeatedly emerged in the reviewed literature. There is a dire need of qualitative and mixed method researches to understand and have an insight into the underlying factors of child malnutrition in Pakistan.
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  2. 2

    Report of a WHO Technical Consultation on Birth Spacing, Geneva, Switzerland, 13-15 June 2005.

    Marston C

    Geneva, Switzerland, World Health Organization [WHO], 2006. 37 p.

    Recommendations for birth spacing made by international organizations are based on information that was available several years ago. While publications by the World Health Organization (WHO) and other international organizations recommend waiting at least 2-3 years between pregnancies to reduce infant and child mortality, and also to benefit maternal health, recent studies supported by the United States Agency for International Development (USAID) have suggested that longer birth spacing, 3-5 years, might be more advantageous. Country and regional programmes have requested that WHO clarify the significance of the USAID-supported studies. With support from USAID, WHO undertook a review of the evidence. From 13 to 15 June 2005, 37 international experts, including the authors of the background papers and WHO and United Nations Children's Fund (UNICEF) staff , participated in a WHO technical consultation held at WHO Headquarters in Geneva. The objective of the meeting was to review evidence on the relationship between different birth-spacing intervals and maternal, infant and child health outcomes and to provide advice about a recommended interval. Six background papers were considered, along with one supplementary paper. Prior to the meeting, the six main papers were sent to experts for review. Thirty reviews were received: 10 from staff in international organizations and 20 from experts from 13 countries. The reviews were compiled and circulated to all meeting participants. At the meeting, the authors of the background papers presented their work, and selected discussants presented the consolidated set of comments, including their own observations. Together, the draft papers and the various commentaries formed the basis for the discussions of the evidence and for the recommendations made by the group at the meeting for spacing after a live birth and after an abortion. (excerpt)
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  3. 3

    Birth spacing -- report from a WHO technical consultation.

    World Health Organization [WHO]. Department of Reproductive Health and Research; World Health Organization [WHO]. Department of Making Pregnancy Safer

    Geneva, Switzerland, WHO, 2006. [4] p. (Policy Brief)

    The World Health Organization (WHO) and other international organizations recommend that individuals and couples should wait for at least 2-3 years between births in order to reduce the risk of adverse maternal and child health outcomes. Recent studies supported by the United States Agency for International Development (USAID) suggest that an interval of 3-5 years might help to reduce these risks even further. Programme managers responsible for maternal and child health at the country and regional levels have requested WHO to clarify the significance of the new USAID-supported findings for health-care practice. To review the available evidence, WHO, with support from USAID, organized a technical consultation on birth spacing on 13-15 June 2005 in Geneva, Switzerland. The participants included 35 independent experts as well as staff of the United Nations Children's Fund (UNICEF), WHO and USAID. The specific objectives of the meeting were to review evidence on the relationship between different birth-spacing intervals and maternal, infant and child health outcomes, and to provide advice on recommended birth-spacing intervals. (excerpt)
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  4. 4
    Peer Reviewed

    The evolution of population policies in Kenya and Malawi.

    Chimbwete C; Watkins SC; Zulu EM

    Population Research and Policy Review. 2005 Jan; 24(1):85-106.

    Our case studies of the evolution of population policies in Kenya and Malawi offer insights into the interaction between the global population movement and national governments. The comparison is useful because it permits identifying the common strategies of a global movement, strategies that are likely to be evident elsewhere; it also permits identifying differences in national responses related to particular domestic contexts. We find a common repertory of movement strategies to influence the governments of Kenya and Malawi to adopt a neo-Malthusian population policy and to implement a family planning program. However, these strategies were promoted more or less aggressively depending on the national response and the chronological period. National responses were related to differences in the governments' approaches to nation-building, their willingness to accept foreign influence and the importance they placed on preserving cultural traditions, and to their assessment of benefits they would gain from responding favorably to movement proposals. The data come from written accounts and from interviews with international actors and Kenyan and Malawian elites who participated in the policy development process. (author's)
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  5. 5

    U.N. data show two-thirds of world's couples use contraception.

    Population 2005. 2002 Jun-Jul; 4(2):13.

    About two-thirds of all couples around the world – or some 650 million people – use some form of contraception, according to new statistics released by the United Nations. Worldwide, 62 percent of the more than 1 billion married or “in-union” women of reproductive age are using contraception, but there are great variations among regions. In Africa, only 25 percent of married women use contraception, while in Asia and Latin America and the Caribbean that figure is between 66 and 69 percent. These statistics are featured on a new wall chart entitled “World Contraceptive Use 2001,” issued by the UN Population Division as part of its ongoing monitoring of world use of family planning. “These data continue to show good news in terms of couples being able to choose the number and spacing of their children,” according to Joseph Chamie, director of the Population Division. “We’ve seen dramatic increases and our best projections for the future indicate that these trends will continue,” he said. (excerpt)
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  6. 6

    Fourth Champions Meeting on Optimal Birth Spacing, September 2, 2003, Washington, DC. [Cuarto Encuentro de Campeones para el Espaciamiento Óptimo entre Nacimientos, 2 de septiembre de 2003, Washington, DC]

    Donaghy M

    Washington, D.C., CATALYST Consortium, 2003 Oct. 37 p.

    On September 2, 2003 CATALYST brought together professionals from USAID, USAID cooperating agencies and nongovernmental organizations for the “Fourth Champions Meeting on Optimal Birth Spacing.” This Champions Meeting represented an important step in transforming current research on birth spacing into concrete actions towards achieving the benefits that birth intervals of three to five years have for women, men and children. The objective of the meeting was to present service delivery models for integrating OBS into health and non-health programs and to discuss the operationalization of OBS recommendations within ongoing and new FP programs. Dr. John Townsend, Senior Program Associate to the International Programs Division and Director of the FRONTIERS program at the Population Council, and Dr. Taroub Harb Faramand, Activity Director of the CATALYST Consortium, presented their perspectives on implementing OBS programming. Dr. Townsend urged program and policy administrators to address the many opportunities and barriers that couples face in terms of birth spacing. Dr. Faramand followed by providing examples of how CATALYST’s integrated approach works to translate new research findings into programmatic actions in health and non-health settings. Through partnerships with other organizations, CATALYST is maximizing resources and efforts to encourage awareness and adoption of OBS practices. Participants made numerous commitments for action during the meeting. Many planned to share the information with colleagues to determine how to integrate OBS messages into their own programs and research. CATALYST will continue to serve as the global secretariat, while increasingly focusing attention and resources on field programs on optimal birth spacing. (excerpt)
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  7. 7

    A participatory evaluation of the life-skills training programme in Myanmar.

    UNICEF; Population Council

    [New York, New York], Population Council, 2000. viii, 28 p.

    In 1993 UNICEF/Myanmar launched an innovative project aimed at preventing the further spread of HIV/AIDS in Myanmar through the promotion of reproductive health. One of the activities undertaken was life-skills training for women and youth, conducted in collaboration with the Myanmar Red Cross Society (MRCS) and the Myanmar Maternal and Child Welfare Association (MMCWA). The objective of the life-skills training activities was to encourage and promote informed decision making and care-seeking behavior among youth and women. The training aims to provide detailed and accurate information concerning sexuality, birth spacing, sexually transmitted diseases (STDs), and HIV/AIDS, and to provide skills for youth and women to enable them to cope with their daily lives and become proponents of community mobilization. This report presents findings of a participatory evaluation of the life-skills training activities implemented in late 1997 and early 1998. At the time of the evaluation, life-skills training had been conducted in 27 project townships. MRCS activities targeted youth aged 15-25 years, and MMCWA worked primarily with married women aged 20-40 years. Eight project townships were identified as project evaluation areas and one township was selected as a comparison township for each of the implementing organizations. In each of the selected project townships in-depth interviews and focus-group discussions were conducted with trained and non-trained individuals in urban and rural areas. The evaluation used a highly participatory approach in order to encourage self-reflection among the local implementing agencies. This report summarizes the findings and recommendations resulting from the participatory evaluation. (excerpt)
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  8. 8

    Plan of action for the eradication of harmful traditional practices affecting the health of women and children in Africa.

    Inter-African Committee [IAC]

    [Unpublished] 1987. 14 p.

    The traditional and harmful practices such as early marriage and pregnancy, female circumcision, nutritional taboos, inadequate child spacing, and unprotected delivery continue to be the reality for women in many African nations. These harmful traditional practices frequently result in permanent physical, psychological, and emotional changes for women, at times even death, yet little progress has been realized in abolishing these practices. At the Regional Seminar of the Inter-African Committee on Traditional Practices Affecting the Health of Women and Children in Africa, held in Ethiopia during April 1987, guidelines were drawn by which national governments and local bodies along with international and regional organizations might take action to protect women from these unnecessary hazardous traditional practices. These guidelines constitute this "Plan of Action for the Eradication of Harmful Traditional Practices Affecting the Health of Women and Children in Africa." The plan should be implemented within a decade. These guidelines include both shortterm and longterm strategies. Actions to be taken in terms of the organizational machinery are outlined, covering both the national and regional levels and including special support and the use of the mass media. Guidelines are included for action to be taken in regard to childhood marriage and early pregnancy. These cover the areas of education -- both formal and nonformal -- measures to improve socioeconomic status and health, and enacting laws against childhood marriage and rape. In the area of female circumcision, the short term goal is to create awareness of the adverse medical, psychological, social and economic implications of female circumcision. The time frame for this goal is 24 months. The longterm goal is to eradicate female circumcision by 2000 and to restore dignity and respect to women and to raise their status in society. Also outlined are actions to be taken in terms of food prohibitions which affect mostly women and children, child spacing and delivery practices, and legislative and administrative measures. Women in the African region have a critical role to play both in the development of their countries and in the solution of problems arising from the practice of harmful traditions.
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  9. 9

    WHO warns that population growth "will shape history".

    FAMILY PLANNING NEWS. 1994; 10(2):4.

    A World Health Organization (WHO) position paper reaffirms the organization's commitment to work with governments and others in the development community to ensure that health, particularly maternal and child health, becomes a cornerstone of development. The WHO estimates that 25% of the 400,000 babies born daily are unwanted. World population will grow to surpass the six billion mark by 1999, stabilizing around the year 2200 between 11 and 28 billion depending upon the size of fertility rates between now and then. These increases in population are definitely shaping the history of humanity and threaten the possibility of sustainable development, adequate health, and a good quality of life. The WHO therefore urges health systems to respond with programs to shape population change. Breast feeding is mentioned in the report as being the most cost-effective means of preventing malnutrition and infant mortality. Exclusive and frequent breast feeding provides nutrition for the child, protects the infant from infection, and prolongs lactational amenorrhea. This prolonged lactational amenorrhea helps child spacing and, in turn, reduces the incidence of infant mortality.
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  10. 10

    The promotion of the lactational amenorrhea method and child spacing through breastfeeding advocates, Contract No. OR-HO-001.

    Rivera A; Canahuati J; Lopez C; Phillips A; Lundgren R

    [Unpublished] [1993]. vii, 44 p. (HON-05)

    In Honduras, a decreasing prevalence of exclusive breast feeding, with over 50% of infants given supplemental liquids during the first 30 days, was causing health risks for the infants and pregnancy risks for the mothers (with 49% at risk within a year of giving birth). Therefore, La Leche League Honduras (LLLH) conducted an operations research study in the Las Palmas neighborhoods of San Pedro Sula to evaluate whether the combination of medical personnel and mother support groups trained in lactation and the lactational amenorrhea method (LAM) for child spacing would increase prevalence and duration of exclusive breast feeding, amenorrhea, and the reported use of LAM at 6 months postpartum over that found in a community served only by trained medical personnel. This project received financing in the amount of US $20,250 from Georgetown University and technical assistance from the Population Council. Specific objectives were to train at least 50 physicians, provide updated information to at least 50 nurses through a workshop, train and certify at least 36 community mothers to serve as breastfeeding advocates (BAs) with specific information on LAM and the ability to make referrals to complementary family planning (FP) services, and initiate at least 6 mother support groups which would meet monthly throughout the year-long study period of 1991. A nonequivalent pre/post-test design was used with the experimental group receiving BA training and support groups and both the control and experimental groups receiving identical training of medical staff. A July 1990 survey of the 6,794 households in the project area revealed 1083 mothers of babies less than a year old and 630 pregnant women. 848 women from this group were interviewed at baseline and 922 at endline to determine socioeconomic status, health system affiliation, reproductive history, breastfeeding and infant feeding practices, contraceptive use, and LAM knowledge and attitudes. Focus groups were held after 3 months of service delivery for qualitative evaluation, interviews were conducted, and 4 mother support groups were observed. BAs were given record-keeping forms, and referral stubs were collected. This report described the implementation of project activities and the impact of the intervention in great detail. The results suggest that training health professionals was partially successful in improving breastfeeding practices and that use of LAs was effective in promoting exclusive breast feeding and use of compatible FP methods and increasing LAM knowledge. However, analysis of women using LAM as a FP method revealed that only 6.5% correctly met all criteria. Lessons learned from this evaluation are cited and the following suggestions are made for further research: 1) develop materials to teach LAM to low-literacy women; 2) examine the role of provider bias and influence of exclusive breast feeding prevalence on LAM acceptance; 3) discover the relative effectiveness of LAM promotion by LLLH vs. FP agencies; 4) test the effectiveness of strategies which segment a target population for LAM education; and 5) determine whether LAM leads to subsequent use of other FP methods.
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  11. 11

    Influence of village level health and birth spacing conducted by religious leaders on contraceptive acceptance and continuation rates.

    Save the Children; Gambia Family Planning Association; Gambia. Ministry of Health; Population Council

    In: Operations research family planning database project summaries, [compiled by] Population Council. New York, New York, Population Council, 1993 Mar. [2] p. (GAM-02)

    Although awareness of family planning (FP) in rural Gambia is relatively high for West Africa, contraceptive use remains low because of the belief among many in this strongly Islamic country that Islam opposes the practice of FP. To increase the acceptability of FP, a social mobilization project using Islamic religious leaders (Imams) was launched by Save the Children Federation USA (SCF), in collaboration with the Africa operations research/technical assistance (OR/TA) project at a cost of US $68,114. The OR study tested whether village meetings led by local Imams can overcome perceived religious objections to FP and increase the acceptability of contraceptive services. Specific objectives were to: 1) orient village Imams to the benefits of birth spacing through the use of modern contraceptives; 2) hold 2 meetings in each of the 22 villages, over a year, on FP health topics led by Imams; and 3) measure the effect of these activities on the awareness and use of FP services by rural Gambians. The campaign identified and promoted the ways in which Islam clearly supports birth spacing for maternal and child health (MCH). Local and national Imams joined with SCF staff to present talks and films about FP. Baseline and impact sample surveys and focus group discussions were conducted. Immediately after each round of village meetings, a mini-survey and focus group discussions were carried out. This approach raised the awareness of both Imams and villagers about the relevance of teachings in the Koran and other holy texts about MCH. In particular, the open discussion of fertility regulation, which was previously regarded as taboo, encouraged more women to seek FP advice and services from community health nurses. In the post-intervention survey, almost all respondents were aware of FP, and more than 90% of the respondents (both men and women) were able to define the term correctly. After the village meetings, levels of contraceptive knowledge rose considerably for virtually all methods. On average, prompted knowledge was higher than unprompted knowledge (by 25% for men and 18% for women). At the initial survey, 20% of men and 13% of women knew of Islamic teachings related to FP. At the post-intervention survey, these proportions had risen to 50%. Focus group discussions revealed many qualitative data regarding attitudes towards FP, with noticeable shifts in reasons for using and not using contraception. Current use rose from 11% for both sexes to 24 and 30% for males and females, respectively. The project is being expanded, and SCF is continuing to support Imam village meetings about FP. As recommended at the dissemination seminar, a delegation of scholarly Imams from Egypt visited local Imams to provide leadership. Some local Imams are still skeptical about the use of contraception by unmarried couples, but, on the whole, this project generated a great deal of support for the use of FP.
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  12. 12

    Integrating community based family planning education and services with primary health care in two rural areas of Cameroon.

    Save the Children; Population Council

    In: Operations research family planning database project summaries, [compiled by] Population Council. New York, New York, Population Council, 1993 Mar. [2] p. (CMR-01)

    Cameroon has a relatively high maternal and infant mortality rate coupled with an equally high fertility rate. This was the first study of alternative strategies for improving knowledge, availability, and use of family planning (FP) services in a rural area, especially the integration of FP for birth spacing into existing child survival interventions in a community health program. The Cameroon Field Office of Save the Children Federation (SCF), working with the Ministry of Health, designed and implemented a series of activities in the far north (Doukoula) and central provinces (Ntui). FP information, education, and communication (IEC) activities were integrated into an on-going child survival program and linked with increased availability of and access to birth services. This project, which cost US $227,394, combined a series of measuring and training activities over a 3-year-period using combined intervention and data collection activities. During the first 6 months, personnel were trained. Intervention was implemented over the next 18 months. Data include service statistics from existing government hospitals, health centers, and interviews with traditional birth attendants (TBAs). A family registration system ensured that each family was enrolled and that data were complete and up-to-date. A baseline KAP survey was conducted among a sample of 2600 women. Data were routinely collected on study intervention activities (including village level meetings, individual and home visits, community meetings) and on delivery of health and FP services. The trained TBAs had considerable success in raising FP awareness. Group and individual meetings were organized, condoms and spermicides were disseminated, and referrals were made to health centers for other FP services. Results from the baseline and KAP surveys administered to 2604 women before and 1257 after the intervention indicated an increase of FP knowledge from 9.8 to 65.2%. In addition, more people were able to name a modern contraceptive spontaneously. Interviews with villagers revealed that 80% of the women were satisfied with the FP services they received from the TBAs. 96.2% of the TBAs were enthusiastic about continuing activities and receiving additional training and a constant supply of contraceptives. Nevertheless, the prevalence rate for modern contraceptives remains very low, 0.2% for the IUD and 4.8% for the condom among women. There were many factors that might have contributed to this: false rumors, a constant change in key project staff, a lack of systematic incentives to motivate TBAs, and the inadequate management of contraceptive stock. The results indicate that TBAs can promote FP in rural areas, if they receive adequate training, and the government can now provide FP services in rural regions without first having to formulate a national policy.
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  13. 13

    Population and human rights in Africa.

    United Nations. Economic Commission for Africa

    In: The population debate: dimensions and perspectives. Papers of the World Population Conference, Bucharest, 1974. Volume II, compiled by United Nations. Department of Economic and Social Affairs. New York, New York, United Nations, 1975. 416-28. (Population Studies No. 57; ST/ESA/SER.A/57)

    Human rights relating to population questions in Africa cannot be divorced from the meaning and implications of human rights in all other spheres. In developing Africa, many important population issues implicate human rights: the welfare of children, youths, the aged, and women; regulation of the levels and patterns of fertility; mortality, morbidity; and migration, internal as well as external, including refugee movements; family welfare and marriage; problems of employment, wages, equal pay, and working hours; access to adequate education and means for cultural expression and identity; and problems of family planning in relation to mother and child care. The relationship between human rights and fertility involves: 1) the rights relating to marriage and the family, specifically to enhance the legal status of women in the home, community, and in national development; and 2) the rights to freely and responsibly decide the number and spacing of children, including the increase, as well as the decrease in fertility. Migration, population distribution, and human rights have been promoted and respected in varying degrees, depending on each country's internal and external policies. Internal migration, distribution, and settlement in nearly all the independent African countries have resulted in rapid urbanization despite inadequate infrastructure. To counter the overurbanization, many support the spreading of development projects throughout the entire country promoting balanced development between rural and urban areas. Historically international migration was customary; with the advent of sovereignty, crossing borders even among related ethnic groups has come under close scrutiny. The international community has come to accept responsibility for protecting and caring for refugees. Human rights, morbidity, mortality, and health care include the right to good health and freedom from disease and sickness, the right to food and freedom from hunger and malnutrition. Increased action at national and international levels is necessary to encourage the governments of Africa to promote the realization of human rights with respect to current and projected population trends.
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  14. 14

    African women. A review of UNFPA-supported women, population and development projects in Gabon, Guinea-Bissau, Zaire, and Zambia.

    de Cruz AM; Ngumbu L; Siedlecky S; Fapohunda ER

    New York, New York, United Nations Population Fund [UNFPA], 1991 Jan. 45 p.

    In the late 1980s, UNFPA-supported women, population, and development projects in 4 African countries were reviewed during their early stages of implementation. The Gabon project aimed to identify pressing needs of rural women who worked in agroindustries or participated in agricultural cooperatives so the government could know how to integrate rural women into national development and in developing programs benefiting women. It realized that providing women with information about family health and sanitation did not meet their needs unless they first had a minimum income with which to implement what they learned. The Guinea-Bissau project chose and trained 22 female rural extension workers to inform women about sanitation and maternal and child health, nutrition, and birth spacing to improve the standard of living. It also hoped to strengthen the administrative, planning, and operational capacity of the women's group of a national political party to improve maternal and child health. Yet the women's group did not have the needed knowledge and experience in project development to operate a successful extension-based program. Further, it was unrealistic to expect women to train to become extension works when the government would not hire them permanently. In Zaire, women at local multiservice women's centers in 3 rural regions imparted information and education to modify traditional beliefs and behavior norms to increase women's role in development. In Zambia, Family Health Programme workers provided integrated maternal and child health care and family planning services through local health centers countrywide. The projects used scientific field surveys and/or interviews with villagers, local leaders, and organizations to conduct needs assessments. They did not assess the institution's strengths and weaknesses to determine its ability to be a development agency. The scope of all the projects as too limited. The duties of the consultant in 2 projects were not delineated, causing some confusion.
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  15. 15

    Mothers remembered in flower ceremony.

    IPPF OPEN FILE. 1992 Jun; 1.

    On may 8, 1992, IPPF's Western Hemisphere Regional Office exhibited, at UN headquarters in New York City, 500,000 flowers representing the same number of women who die each year from pregnancy complications. Indeed 99% of these maternal deaths occurred in developing countries, especially Africa. 50 UN ambassadors and representatives attended this event which was endorsed by 40 health and development organizations. Film celebrity Lauren Hutton also attended to show her support. IPPF hoped this event would bring attention to the ongoing need to reduce unwanted pregnancy by providing family planning information and services. The Regional Director of IPPF noted that family planning is the most cost effective means to do so. The Regional Office's Programme Support Director also emphasized the need for trained birth attendants, emergency obstetric care, and proper nutrition. In 1990, the number of unwanted births was about 30 million. For each maternal death, 10-15 women are disabled during childbirth and 25 million pregnant women face serious childbirth complications. A World Bank study showed that if governments would invest just US$1.50/person/year to include prenatal care and family planning into primary health care programs, maternal deaths would fall considerably within 10 years. This amount had been invested during the last 15 years, IPPF would have only needed to display 167,000 flowers. If governments do not take action soon, IPPF will need to display 650,000 flowers in 2000. The Western Hemisphere Regional Office of IPPF has therefore established the Planned Motherhood Fund to expand and strengthen family planning and appropriate health services for women at highest risk of pregnancy-related death, especially teenagers and women in rural areas and urban slums.
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  16. 16

    Child survival strategy for Sudan, USAID/Khartoum.

    Harvey M; Louton L

    Arlington, Virginia, John Snow, Inc. [JSI], Resources for Child Health Project [REACH], 1987. iii, 33, [22] p. (USAID Contract No.: DPE-5927-C-00-5068-00)

    Sudan is one of 8 USAID African child survival emphasis countries. This documents focuses upon linking the discrete areas of child survival to each other in efforts to achieve sustained reductions in national morbidity and mortality rates. The scope of the problem is briefly considered as background in the text, followed by a more in-depth presentation of government policy and programs. This section includes examination of the structure and organization of existing health services, child survival activities, and current progress and constraints. Child survival activities are listed as immunization, control of diarrheal diseases, nutrition, child spacing, malaria control, acute respiratory infections, and AIDS. The current strategy of USAID support for these activities is outlined, and includes mention of private volunteer organization and private sector participation. The role of UNICEF, WHO, and the World Bank in child survival in Sudan is also highlighted. Recommendations for child survival strategy in Sudan are presented and discussed at length in the text. Continued support to UNICEF, cost recovery and health care financing efforts through WHO, child spacing and population program support, and support to on-going USAID projects constitute USAID's priorities and emphasis in child survival strategy for Sudan. Detailed short- and long-term recommendations for immunization, control of diarrheal diseases, nutrition, child spacing, and child survival and health care financing are provided following the section on priorities. In closing, staffing and recommendations for malaria and other endemic disease, acute respiratory infections, AIDS, and management are considered. Appendices follow the main body of text.
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  17. 17

    Patterns of fertility behaviour among female students at the University of Zambia.

    Munachonga M; Johnston T

    In: African research studies in population information, education and communication, compiled and edited by Tony Johnston, Aart de Zeeuw, and Waithira Gikonyo. Nairobi, Kenya, United Nations Population Fund [UNFPA], 1991. 83-100.

    Researchers studied 62 pregnant women intending to not terminate their pregnancy and to continue their studies and 27 nonpregnant women to learn about female student fertility related behavior. They were all enrolled at the University of Zambia either during the 1987-1988 or 1989-1990 academic years. Methodology consisted of interviews, questionnaires, and focus group discussions. 68% of all women were single with 40% of them having at least 1 child. 75% of the women were sexually active. 42.7% knew traditional family planning methods with friends, grandmothers, and social aunts telling 25.9% of all the women about such methods. Yet mass media provided most women (49.4%) with knowledge about modern methods. 50.6% thought the pill to be the most effective method. >65% considered the 24-26 as the ideal age at marriage. The mean ideal family size was 3.5, somewhat less than family size for urban women in Zambia. 71.9% considered children to be assets since children are a means to social security (33%), self fulfillment (8%), and companionship (7%). 94.4% approved of family planning mainly for purposes of child spacing (29.2%), limiting (23.6), and spacing and limiting (32.6%). Even though they knew about and approved of family planning and claimed modern attitudes concerning ideal age at marriage and ideal family size, 62% of single pregnant students and 59% of married pregnant students did not use or regularly use contraception. This suggested that they considered early childbearing to be an asset. The leading reasons for contraception nonuse included perception of low pregnancy risk (40%) and desire for a child (28%). Only 3.2% claimed method failure. 64% of all women said partners did not approve of contraceptive use. Access to family planning and cost were not a problem. Only 22% of pregnant students said pregnancy would reduce their chances of marriage. In conclusion, many women became pregnant surreptitiously.
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  18. 18

    Pakistan. South Asia Region.

    International Planned Parenthood Federation [IPPF]

    IPPF COUNTRY PROFILES. 1992 Jan; 19-24.

    A country profile of demographic/statistical data, social and health aspects, and government policies and program in Pakistan particularly as they relate to family planning is presented by the International Planned Parenthood Federation (IPPF). Finding current population growth too high and impeding of development, the government enacted a population policy in 1991 aimed at reducing population growth to 2.5% in 10 years. An integrated approach will stress population education in secondary schools, the use of mobile services to promote birth spacing and provide maternal-child health care, and the provision of services through government facilities and family welfare centers. The Family Planning Association (FPA) of Pakistan was created in 1953, and became a member of the IPPF in 1954. It promotes family planning through education, clinics, and the use of male community institutions, and is the main provider of services. The organization also campaigns for both more government involvement in family planning and improvements in the status of women. 16% of married women practice contraception. Female sterilization is the most popular method, followed by condoms. with husband's consent, sterilization is permitted for married women with at least 2-3 children. Abortion is legal only to save a woman's life. Family planning constraints, education, demographic trends, health issues, status of women, contraceptive availability and accessibility, and the operations and funding of the family planning association are fully discussed.
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  19. 19

    Programme review and strategy development report: Viet Nam.

    United Nations Population Fund [UNFPA]

    New York, New York, UNFPA, [1991]. ix, 81 p.

    Rapid population growth is an obstacle to Vietnam's socioeconomic development. Accordingly, the Government of Vietnam has adopted a population policy aimed at reducing the population growth rate through family planning programs encouraging increased age at 1st birth, birthspacing of 3-5 years, and a family norm of 1-2 children. TFR presently holds at 4, despite declines over the past 2 decades. Current mortality rates are also high, yet expected to continue declining in the years ahead. A resettlement policy also exists, and is aimed at reconfiguring present spatial distribution imbalances. Again, the main thrust of the population program is family planning. The government hopes to lower the annual population growth rate to under 1.8% by the year 2000. Achieving this goal will demand comprehensive population and development efforts targeted to significantly increase the contraceptive prevalence rate. Issues, steps, and recommendations for action are presented and discussed for institutional development strategy; program management and coordination and external assistance; population data collection and analysis; population dynamics and policy formulation; maternal and child health/family planning; information, education and communication; and women, population, and development. Support from UNFPA's 1992-1995 program of assistance should continue and build upon the current program. The present focus upon women, children, grass-roots, and rural areas is encouraged, while more attention is suggested to motivating men and mobilizing communities. Finally, the program is relevant and applicable at both local and national levels.
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  20. 20

    Growth monitoring in Bangladesh: a hope for child survival.

    Talukder MQ

    IN TOUCH 1987 Dec; 11(85):21-4.

    This paper discusses Bangladesh's overwhelming social, economic, and health obstacles to improving child health, and stands behind the UNICEF GOBI-FFF strategy as a low-cost alternative for rapid implementation. GOBI-FFF is an acronym for growth monitoring, oral rehydration, breastfeeding, immunization, food supplements for infants, female education, and family spacing. Specifically, the article endorses growth monitoring with the National Nutrition Council child health and nutrition card. The growth chart should be seen as an approach for the promotion of good health, prevention of malnutrition and infectious disease, and treatment of minor illnesses. The card has been designed for use among children 0-5 years of age at the primary health care level. The card includes messages and information on child health and nutrition. The actual process of growth monitoring requires a growth chart, growth chart manual, and a weighing scale. The paper describes growth measurement as the most scientifically effective measure of a child's nutrition and overall health. It is a simple and inexpensive manner of monitoring child health and nutritional status in the community.
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  21. 21

    The surge of new interest in breastfeeding. Why now?

    Shelton J

    In: Lactation education for health professionals, edited by Rosalia Rodriguez-Garcia, Lois A. Schaefer, Joao Yunes. Washington, D.C., Pan American Health Organization [PAHO], 1990. 113-20. (USAID Contract No. DPE-3040-A-00-5064-00)

    The practice breastfeeding has begun receiving increased interest, generated in part by better a understanding of its beneficial consequences. Evidence shows that breastfeeding greatly reduces level infant mortality and morbidity. A 1989 study in Brazil concluded that a breastfed child has 14.2x less likely to die from diarrhea, 3.6x less likely to die from respiratory infection, and 2.5x less likely to die from other infections. Besides its well-documented immunological properties, studies have shown that breastmilk can adapt, over time, to meet the changing needs of an infant. The practice of breastfeeding has also demonstrated contraceptive effects. Women who are fully or nearly fully breastfeeding, amenorrheic, and less than 6 months postpartum have 98% protection against pregnancy. Furthermore, longer birth spacing results in healthier mothers and infants. The renewed interest in breastfeeding is also the result of breastfeeding promotion campaigns, the successes of other child survival intervention programs, and the collaboration of international agencies. A study in Honduras indicates that promotional campaigns (involving the education of the public and the medical community) significantly increases the average duration of breastfeeding. And a study in brazil shows that the use of mass media can increase the prevalence of breastfeeding. Health care professional have also been encouraged by the success of oral dehydration and immunization campaigns, which have a natural link to breastfeeding, and the establishment of the Interagency Group of Action on Breastfeeding, a collaborative effort by 5 international agencies. With the increasing interest, health care officials hope to reverse the decline in the practice of breastfeeding.
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  22. 22

    A new wave of population policies.

    May J

    PEOPLE. 1991; 18(1):7-8.

    This article attributes Sub-Saharan national population policy change to the attendance at the 2nd African Population Conference (APC) in Arusha in 1984, preliminary to attendance at the World Population Conference (WPC) in Mexico City in 1984, and the socioeconomic crises which precipitated the disparity between population growth and resources. Demographics are better understood. Family planning is now seen as reflecting traditional African values of birth spacing. Consequently countries have developed specific national policy statements. Liberia, Nigeria, Senegal in 1988, Zambia in 1989, and the Sudan in 1990, have developed comprehensive population policies in addition to those already established in Kenya and Ghana. Zaire and Zambia policies are in the process of endorsement; others formulating policy are Botswana, Burkina Faso, Cameroon, Chad, Cote d'Ivoire, Niger, Tanzania, Togo, and Zimbabwe. Policies are based on APC and WPC documents as well as the N'Djamena Plan of Action (1989). These guidelines tend to include detailed action and implementation plans, including targets for fertility reduction. Approaches to fertility reduction among specialists are still being debated. The significance of national population policy is as a public endorsement in addition to providing an analytical framework.
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  23. 23

    [Family planning and diverse declarations of human rights] Planification familiale et diverses declarations des droits de la personne humaine.

    Gakwaya D


    Human beings have always desired to claim their rights, even in times when only a small proportion of the population was considered fully human and the rest were slaves, servants, uncivilized, colonized, underdeveloped, or, in the recent euphemism, "developing". The French Declaration of the Rights of Man of 1789 marked the 1st time in history that rights for all people were publicly affirmed. The rights in question were essentially constitutional and political, but the idea of claiming rights had been born. In 1948, the international community approved the Universal Declaration of Human Rights which encompassed all types of rights. Other international acts on civil and political rights and the rights of women and children have complemented and interpreted the 1948 document. The Universal Declaration of Human Rights affirmed that all human beings are born free and equal in dignity and rights and that all persons have a right to satisfaction of economic, social, and cultural needs. The convention on elimination of all forms of discrimination against women referred in its preamble to the particular disadvantages of women living in poverty and affirmed the right of all women to education in health and family welfare, including family planning, as well as to medical and family planning services. Women were affirmed to have the same rights as men to decide freely and in an informed manner on the number and spacing of their children and to have access to the information, education, and means to exercise these rights. The United Nations has demonstrated its interest in Population Commission in 1946 and of the UN Fund for Population Activities in 1969, and through decennial worldwide population conferences in 1954, 1965, 1974, and 1984. UN demographic goals include reduced fertility on a worldwide basis, a reduced proportion of women not using reliable contraception, a substantial reduction of early marriage and adolescent pregnancy, reduction in infant and maternal mortality, a life expectancy of at least 62 years in all countries, and a better geographic distribution of population within national territories permitting rational use of resources. Governments which subscribed to the declaration and conventions on human rights should respect their promises. Population growth which outpaces increases in production will make it increasingly difficult to satisfy the rights and needs of all population sectors. A government confronted with this problem is obliged to explore every possible means of increasing production but must also seek to control population growth. Contraception is a legitimate means of achieving this end.
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  24. 24

    Targeted interventions and infant mortality.

    Lovel H


    The main causes of infant mortality in 71% of the cases are diarrhea, measles, acute respiratory infection, and neonatal tetanus. A UN child survival strategy includes growth monitoring, oral rehydration, breast feeding, immunization, fertility, food and female literacy (GOBI-FFF). Previous research has shown a correlation between low levels of infant mortality and high levels of female literacy. Educated women are more likely to delay marriage, and childbearing. Child mortality is much higher for those born to women under 20 years old and also much higher for those born within 1 or 2 after the previous birth. Maternal mortality is also higher for mothers under 20 and with closely spaced births of 3 or more children. The majority of adults in developing countries have knowledge of family planning but teen pregnancy is a concern. Better nutrition during pregnancy would decrease infant deaths. Growth monitoring is another way to reduce infant mortality and morbidity. The difficulties are in the reluctance to adapt programs to local traditional methods of growth monitoring and going to direct recording scales. Immunization is estimated to have prevented over 3 million deaths from measles, tetanus, whooping cough and polio in 1984 alone. In spite of progress, only 50% of children in developing countries are immunized against diphtheria, pertussis, polio, and tetanus by the age of 1 year. these activities must be integrated into primary health care and community development projects to make better contact with people needing this service. oral rehydration therapy not only reduces mortality from diarrhea but can reduce morbidity by reducing the duration of the illness and by increasing the weight gain. Breast feeding has been shown in many studies to reduce the risk of deaths of infants. The promotion of breast feeding includes the issues of maternity leave, job security, and child care at the work place.
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  25. 25

    Family planning promotes safe motherhood.

    Kumar R

    POPULATION EDUCATION NEWS. 1989 Mar; 15(3):2-4.

    The perspective that advocates family planning as a method of insuring maternal health is rightly justified; the interdependence of family planning and safe motherhood is becoming increasingly realized. It has been established that both morbidity and mortality in younger women can be decreased if contraceptive information and facilities are accessible. Other factors such as socioeconomic status, chronic illness, and prenatal care affect maternal health. Obstetrical problems such as hemorrhage, pregnancy-induced hypertension, and sepsis account for most of the maternal mortality in developing countries. Malnutrition, anemia, and uterine prolapse are also conditions which threaten a mother's health; closely-spaced pregnancies, poor diet, and over-work cause a decrease in nutritional status. If a woman can not fully recover from her last pregnancy, than each successive pregnancy will cause her to deteriorate more rapidly. Other determinants of maternal mortality are behavior, environment, age and genetic make-up.
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