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WHO Programme in Maternal and Child Health and Family Planning. Report of the second meeting of the WHO Programme Advisory Committee in Maternal and Child Health, Geneva, 21-25 November 1983.
[Unpublished] 1984. 95 p. (MCH/84.5)The objectives of the 2nd meeting of the Program Advisory Committee (PAC) for the World Health Organization's (WHO's) Program in Maternal and Child Health, including Family Planning (MCH/FP) were to 1) assess the MCH/FP program's achievements since the 1st PAC meeting in June, 1982, 2) determine the level of scientific and financial resources available for the program, and 3) to examine the role of traditional birth attendants (TBAs) in the delivery of MCH/FP services. The committee reviewed the activities and targets of the program's 4 major areas (pregnancy and perinatal care, child health, growth, and development, adolescent health, and family planning and infertility), and developed a series of recommendations for each of these areas. Specific recommendations were also made for each of the major program areas in reference to the analysis and dessimination of information and to the development and use of appropriate health technologies. Upon reviewing the role of TBAs in the delivery of MCH/FP services, PAC recommended that all barriers to TBA utilization be removed and that training for TBAs should be improved and expanded. PAC's examination of financial support for MCH/FP activities revealed that for a sample of 26 countries, the average annual amount allocated to MCH activities was less than US$3/child or woman. This low level of funding must be taken into account when setting program targets. International funding agencies did indicate their willingness to increase funding levels for MCH programs. The appendices included 1) a list of participants, 2) an annotated agenda, 3) detailed information on the proposed activities of the program's headquarters for 1986-87, and 4) a description of the the function, organizational structure, and technical management of the MCH/FP program. Also included in the appendices was an overview of the current status of MCH and a series of tables providing information on infant, child, and maternal health indicators. Specifically, the tables provided information by region and by country on maternal, child, and infant mortality; causes of child deaths; maternal health care coverage; contraceptive prevalence; infant and child malnutrition; the number of low weight births; adolescent health; teenage births; breast feeding prevalence and duration; and the proportion of women and children in the population.
Geneva, Switzerland, WHO,  27 p.This is the 1st interim report issued by the Diarrhoeal Diseases Control (CDD) Programme, summarizing progress in its main areas of activity during the previous calendar year. Most of the information is presented in the form of tables, graphs and lists. Other important developments are mentioned briefly in each section. The information is presented according to major program areas; health services; research; and program management. Within the health services component, national program planning, training, the production of Oral Rehydration Salts (ORS), health education and promotion are areas of priority activity. Progress in the rate of development of national programs, participants in the various levelsof training programs, and the countries producing their own ORS packets and developing promotional and educational materials are presented. An evaluation of the health services component, based on a questionnaire survey to determine the impact of Oral Rehydration Therapy (ORT), indicates significant decreases in diarrheal admission rates and in overall diarrheal case-fatality rates. Data collected from a total of 45 morbidity and and mortality surveys are shown. Biomedical and operational research projects supported by the program are given. Thhe research areas in which there was the greatest % increase in the number of projects funded were parasite-related diarrheas, drug development and management of diarrheal disease. Research is also in progress on community attitudes and practices in relation to diarrheal disease and on the development of local educational materials. The program's organizational structure is briefly described and its financial status summarized. The report ends with a list of new publications and documents concerning health services, research and management of diarrheal diseases.
INFECTION CONTROL. 1984 Nov; 5(11):538-41.In 1978 the Ministry of Health and Social Welfare (MHSW) of Liberia launched the Expanded Program on Immunization (EPI) with the 5-year objective of establishing an 80% reduction in child mortality and morbidity from measles, polio, diphtheria, neonatal tetanus, pertussis, and tuberculosis. The program at first adopted a strategy of using 15 mobile units in 11 operational zones to deliver vaccinations throughout the country. However, by 1980, despite support from the Baptist World Alliance, the UN International Children's Emergency Fund (UNICEF), and the World Health Organization (WHO), it became evident that the mobile strategy was neither economically feasible nor practical. Therefore, with support from the US Agency for International Development (USAID), the EPI shifted to a strategy of integrating immunization activities into the existing network of state health facilities. After 5 years, in 1982, the Program was evaluated by a team from the MHSW, WHO, USAID, and the Centers for Disease Control. The evaluating team felt that the EPI's strategy was good, but its goals were not being achieved due to deficiencies in funding, clinic supervision, and rural community outreach, as well as shortages of kerosene and spare parts needs to keep the essential refrigerators in operating condition. Measles remains endemic; in the capital, Monrovia, only 9% of the children have been vaccinated against it. Immunization coverage is particularly low in the capital the countries. Other reasons for low vaccination coverage in Liberia are lack of community awareness of existing facilities and the importance of vaccination and lack of coordination at the community level to use the existing facilities efficiently. International assistance is still needed, especially to develop heat-stable vaccines, so that maintenance of refrigerators will not be necessary.
In: Third Asian and Pacific Population Conference (Colombo, September 1982). Selected papers. Bangkok, Thailand, Economic and Social Commission for Asia and the Pacific, 1984. 9-40. (Asian Population Studies Series No. 58)This report summarizes the recent demographic situation and considers prospective trends and their development implications among the 39 members and associate members of the Economic and Social Commission for Asia and the Pacific (ESCAP). It presents data on the following: size, growth, and distribution of the population; age and sex structure; fertility and marriage; mortality; international migration; growth and poverty; food and nutrition; households and housing; primary health care; education; the working-age population; family planning; the elderly; and population distribution. Despite improvements in the frequency and quality of demographic data collected in recent years, big gaps continue to exist in knowledge of the demographic situation in the ESCAP region. Available evidence suggests that the population growth rate of the ESCAP region declined between 1970 and 1980, as compared with the preceding decade, but that its rate of decline was slow. Within this overall picture, there is wide variation, with the most developed countries having annual growth rates around 1% and some of the least developed countries having a figure near 3%. The main factors associated with the high growth rates are the past high levels of fertility resulting in young age structures and continuing high fertility in some countries, notably in middle south Asia. The population of countries in the ESCAP region is expected to grow from 2.5 billion in 1980, to 2.9 billion in 1990, and to 3.4 billion persons by the year 2000. This massive growth in numbers, which will be most pronounced in Middle South Asia, will occur despite projected continuing moderation in annual population growth rates. Fertility is expected to continue its downward trend, assuming a more widespread and equitable distribution of health, education, and family planning services. Mortality is expected to decline further from its current levels, where life expectancy is often at or around 50 years. In several countries, more than 10 in every 100 babies born die before their 1st birthday. The extension of primary health care services is seen as the key to reducing this figure. Rapid population growth and poverty tend to reinforce each other. Low income, lack of education, and high infant and child mortality contribute to high fertility, which in turn is associated with high rates of natural increase. High rates of natural increase feed back to depress socioeconomic development. High population growth rates and their correlates of young age structures and heavy concentrations of persons in the nonproductive ages tend to depress production and burden government expenditure with high costs for social overhead needs. Rapid population growth emerges as an important factor in the persistence of chronic undernutrition and malnutrition. It increases the magnitude of the task of improving the educational system and exacerbates the problem of substandard housing that is widely prevalent throughout Asia.
[Unpublished] 1984 Jul. , 520, 20 p.This 2-volume, 520-page report represents the 1st attempt at a situation analysis of Ghana. Its focus is the effect of Ghana's economic crisis on women and children. Volume I characterizes the macroeconomic situation in Ghana, the dimensions of poverty in the country, recent demographic trends, and the factors affecting infant, child, and maternal nutrition and mortality. Volume II discusses environmental sanitation, Ghana's health sector, education, general living conditions of families, and social services available for children. It is concluded that external assistance is needed to address the massive and widespread problems created by poverty in Ghana. Since the immediate problems of children and mothers are social, assistance is particularly needed in the form of outright grants or official development assistance. It is suggested that UNICEF should support both local and national interventions. There must be clear indications that all projects or programs are within government priorities. In the case of area-specific projects, local support should be assured and the main beneficiaries should be women and children. Finally, 4 possible areas of interventions are outlined: health, water and sanitation, education, and programs for slums. In the area of health, it is recommended that UNICEF devote particular attention to nutrition, immunization, oral rehydration, growth monitoring, and infection control within the context of general support to the development of primary health care.
Operational responses to the World Population Plan of Action in programmes of the UNFPA in the areas of fertility, family and family planning.
In: United Nations. Department of International Economic and Social Affairs. Population Division. Fertility and family. New York, New York, United Nations, 1984. 439-66. (International Conference on Population, 1984; Statements)This paper reviews briefly the experience of UNFPA supported programs related to family, fertility and family planning in developing countries, through the analysis of recommendations of the 1974 World Population Plan of Action and corresponding UNFPA programs. The paper also identifies some programmatic areas that need emphasis in the further implementation of the recommendations of the Plan. Among the Plan's many recommendations, those dealing with the protection of the family, with the improvement of the status of women, with modernization and fertility and with the right of individuals and couples to plan their families, are of special importance to family and fertility. With the accumulation of experience throughout the last decade, the Fund has moved from its original projects approach to a program approach comprising a set of complementary population activities. More recently a needs assessment approach has been adopted. Many UNFPA activities touch upon the reduction of infant, child and maternal mortality, and the improvement of the role and status of women. The Fund takes family planning to include those practices that help individuals or couples to avoid unwanted births, to bring about wanted births, to control the timing of births and to determine the number of children in a family. The Fund supports a broad spectrum of activities in family planning. Among the most important are education and communication programs, activities to strengthen service delivery and to expand population coverage; program management and evaluation, operational, behavioral, and clinical research. Collaboration between UNFPA and individual countries has led to changes in ways of thinking about population. The most important finding, perhaps, relates to the perception of the many dimensions of the population problem. Issues which need further action in the implementation of the Plan include the urgent need to formalize national commitment to fertility, family and related population activities. To improve the link between population and development activities, greater efforts should be made to involve women in the design, implementation and management of population and family planning projects. In general, there is an urgent need to improve family planning services. In spite of an impressive number of research studies on fertility behavior, there is a need for a policy-oriented analysis of fertility decline. Finally, in view of the increased interest in natural family planning as a method of fertility regulation, there is an important need to collect data on the subject, to train natural family planning teachers and to develop teaching materials. Appendices list UNFPA assisted projects in fertility, family and family planning.
[Unpublished] 1984 Aug 13. 40 p. (E/CONF.76/L.3; M-84-718)This report of the International Conference on Population, held in Mexico City during August 1984, includes: recommendations for action (socioeconomic development and population, the role and status of women, development of population policies, population goals and policies, and promotion of knowledge and policy) and for implementation (role of national governments; role of international cooperation; and monitoring, review, and appraisal). While many of the recommendations are addressed to governments, other efforts or initiatives are encouraged, i.e., those of international organizations, nongovernmental organizations, private institutions or organizations, or families and individuals where their efforts can make an effective contribution to overall population or development goals on the basis of strict respect for sovereignty and national legislation in force. The recommendations reflect the importance attached to an integrated approach toward population and development, both in national policies and at the international level. In view of the slow progress made since 1974 in the achievement of equality for women, the broadening of the role and the improvement of the status of women remain important goals that should be pursued as ends in themselves. The ability of women to control their own fertility forms an important basis for the enjoyment of other rights; likewise, the assurance of socioeconomic opportunities on a equal basis with men and the provision of the necessary services and facilities enable women to take greater responsibility for their reproductive lives. Governments are urged to adopt population policies and social and economic development policies that are mutually reinforcing. Countries which consider that their population growth rates hinder the attainment of national goals are invited to consider pursuing relevant demographic policies, within the framework of socioeconomic development. In planning for economic and social development, governments should give appropriate consideration to shifts in family and household structures and their implications for requirements in different policy fields. The international community should play an important role in the further implementation of the World Population Plan of Action. Organs, organizations, and bodies of the UN system and donor countries which play an important role in supporting population programs, as well as other international, regional, and subregional organizations, are urged to assist governments at their request in implementing the reccomendations.
[A possible objective from now to the year 2000: reduce infant mortality in the third world by half] Un objectif possible d'ici 1' an 2000: reduire de moitie la mortalite infantile dans les pays du tiers-monde
Hygiene Mentale. 1984 Jun; 3(2):41-9.Every day 40,000 children die throughout the world, most of them in developing countries. There is a close relationship between infant mortality, life expectancy at birth, the adult literacy rate and national income per capita. Why such huge differences between the infant mortality rate of 7/1000 (live births) in Sweden and 208 in Upper Volta? The 4 scourges which afflict developing countries: hunger (malnutrition), disease, ignorance and poverty are responsible for this state of affairs. The author suggests that coordinated action by governments and International Agencies should be taken to halve the infant mortality rate by the year 2000. He notes that in the past 3 mistakes were made which should not be repeated. The 1st was to improve the living conditions of the population. The green revolution in India provides a striking example of an important progress which benefited only the wealthier farmers. A 2nd mistake was to believe that only a medical approach reduces the infant mortality rate. A 3rd error was to overlook the importance of health education and not to seek the active participation of the people concerned. The author recalls that the International Union for Health Education carried out a sanitary and social program from 1975 to 1978 in Africa, south of the Sahara. To this effect, the IUHE had to find out what the people really wanted, whether they could be motivated to increase the welfare of the villagers by measures adapted to existing possibilities, and to study how the people could recruit health workers among the villagers and train them to create village health committees. 4 weapons used together should reduce the infant mortality rate by 1/2 in the developing world before the end of the century. They are: the promotion of breast feeding, the extended coverage of vaccinations, the early detection of malnutrition and the treatment at hoem of diarrheic diseases thanks to oral rehydration. (author's modified) (summaries in ENG, SPA)
New York, New York, United Nations, 1984. ix, 476 p. (International Conference on Population, 1984; Statements)The Expert Group on Fertility and Family was one of 4 expert groups assigned the task of examining critical, high priority population issues and, on that basis, making recommendations for action that would enhance the effectiveness of and compliance with the World Population Plan of Action. The report of the Expert Group consisted of 6 topics: 1) fertility response to modernization; 2) family structure and fertility; 3) choice with respect to childbearing, 4) reproductive and economic activity of women, 5) goals, policies and technical cooperation, and 6) recommendations. Contained in this report are also selected background papers with discuss in detail fertility determinants such as modernization, fertility decision processes, socioeconomic determinants, infant and child mortality as a ddeterminant of achieved fertility in some developed countries, the World Fertility Survey's contribution to understanding of fertility levels and trends, fertility in relation to family structure, measurement of the impact of population policies and programs on fertility, and techinical cooperation in the field of fertility and the family.
Australian Society. 1984 Jun 1; 3(6):27-8.An estimated 15 million infants, largely from Africa, Asia, and Latin America, died in 1983. Many countries in the Third World have infant mortality rates of 150-200/1000 live births. UNICEF has outlines 7 steps that could significantly reduce the infant mortality rate: 1) use of growth monitoring charts, 2) oral rehydration therapy, 3) breastfeeding for at least 1 year, 4) a massive immunization campaign, 5) food supplementation for pregnant women and children at risk, 6) a family spacing education campaign, and 7) extension of female education. 2 other measures not emphasized by UNICEF but important for the health and survival of children are a government system of welfare for the care of the aged to partially solve the need for children and the equal valuation of male and female children. Concerned Australians are urged to spread the word about the UNICEF report, provide funds, and influence the Australian government to offer help through UNICEF to developing countries. Technically qualified people can go to Third World countries and work for better conditions. It should be noted, however, that Australia has its own Third World sector. The Aboriginal population is severely disadvantaged in terms of all the major indicators of quality of life. The infant mortality rate among Aboriginals is 25/1000 live births, which is 2.5 times the Australian national average. Life expectancy at birth is 53 years, or 20 years less than the national average. 80% of Aboriginals have no educational qualifications, and 80% are unemployed. Aboriginal households have less than 60% the average income available to non-Aboriginal households and the housing of the majority of the Aboriginal population is substandard.
Planned Parenthood Review. 1984 Spring-Summer; 4(1):9-10.The Planned Parenthood Federation of America supports international family planning efforts through its affiliation with the International Planned Parenthood Federation (IPPF) and the activities of its own International Division, Family Planning International Assistance (FPIA). FPIA is founded on the beliefs that family planning is a basic human right; family planning programs benefit individuals, families, communities, and nations; and family planning along with other needed socieconomic programs can have a major impact on development. Careful timing, spacing, and limiting of births is directly and causally related to improved infant and maternal survival through readily observed and easily explained mechanisms. Mothers in developing countries are anywhere from 10 to 20 or 30 times as likely to die in childbirth as mothers in developed countries. Risks are greatest for mothers under 18 years old, over 30, for those having births within 2 years of a previous birth, and 4th or later deliveries. The differences occur for women at all levels of affluence and access to medical care in all societies, but are particularly sharp in developing countries. Among the poorest countries, 200 or more of every 1000 liveborn infants may die in their 1st year compared to fewer than 10/1000 live births in some wealthy egalitarian countries. The infant mortality rate is so closely related to the overall level of well-being in a country or region that it is regarded as 1 of the most revealing measures of how well a society is meeting the needs of its people. Many of the risk factors for maternal mortality also contribute to infant mortality. Infant mortality in developing countries drops appreciably when women practice family planning and reduce the number of high risk pregnancies. Throughout the developing world, the higher risk infants born to very young or older mothers, mothers with recent previous pregnancies, and mothers with 3 or 4 previous births are 3-10 times more likely to die in their 1st year. Too short birth intervals may threaten the life of the older child through early weaning and resulting increased susceptibility to malnutrition and infection. Careful planning of births through contraception can result in a population better able to contribute economically and less likely to strain the medical resources.
International Conference on Population, 1984. Mortality and health policy. Proceedings of the Expert Group on Mortality and Health Policy, Rome, 30 May to 3 June 1983
New York, N.Y, United Nations. Department of International Economic and Social Affairs, 1984. vi, 320 p. (no. ST/ESA/SER.A/91)These are the proceedings of the Expert Group on Mortality and Health Policy convened in preparation for the International Conference on Population, held in Mexico City in August 1984. The aim of the expert group was to examine critical, high-priority population issues and to make recommendations for revisions to the World Population Plan of Action. The present publication contains a report of the discussions and a list of recommendations concerning mortality and health goals, health and development, social policies and programs, mortality and reproductive behavior, data collection and research, and technical cooperation. The report also includes a selection of background papers. These papers deal with mortality and health policy in the context of the World Population Plan of Action and of policies and programs affecting mortality and health, the costs of developing a child survival package in developing countries, financial analysis to assess the viability of health programs, technical cooperation in mortality and health policy, and United Nations Fund for Population Activities (UNFPA) assistance in this area.
[Unpublished] 1984 May 3. Presented at the 1984 Annual Meeting of the Population Association of America, Minneapolis, Minnesota, May 3-5, 1984. 26 p.The paper summarizes the health strategy of the US Agency for International Development (AID). The goal of the strategy is to assist developing countries to 1) reduce mortality among infants and young children, and 2) to reduce disease and disability among selected population groups. The main strategy elements include: 1) improved and expanded use of available technologies; 2) development of new and improved technologies; and 3) strengthening human resource and institutional capability. A more in-depth look is taken at how AID implements its strategy in Asia emphasizing the primary goal of infant mortality reduction. The paper provides a demographic overview of the 9 AID-assisted Asian countries. A summary of AID's program support in Asia showing levels and trends by subcategory is provided. Particular attention is paid to projects supporting selective primary care. Finally, the paper discusses the difficulties of implementing the strategy in Asia and speculates on the chances for success. (author's)
New York, New York, UNICEF, . 42 p.In the last 12 months, world-wide support has been gathering behind the idea of a revolution which could save the lives of up to 7 million children each year, protect the health and growth of many millions more, and help to slow down world population growth. This document summarizes case studies which illustrate the techniques which make this revolution possible. These techniques are: oral rehydration therapy (ORT); growth monitoring; expanded immunization using newly improved vaccines to prevent the 6 main immunizable diseases which kill an esitmated 5 million children a year and disable 5 million more (measles, whooping cough, neonatal tetanus, polio, diphtheria and tuberculosis); and the promotion of scientific knowledge about the advantages of breastfeeding and about how and when an infant should be given supplementary foods. Results are summarized from Guatemala, Papua New Guinea, Brazil, Egypt, Indonesia, Barbados, the Philippines, Nicaragua and Honduras, Malawi, China, Nepal, Bangladesh, Colombia, and Ethiopia. The impact of economic recession and female education on childrens' health is discussed, and basic statistics for developed and underdeveloped countries are given.