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A cultural approach to HIV / AIDS prevention and care. Country assessment summary report. Handbook for culturally appropriate project design. Information / education / communication capacity building, networking, data collection and research.
Paris, France, UNESCO, Cultural Policies for Development Unit, 2000. 186 p. (Studies and Reports, Special Series No. 10; CLT.2000/WS/10; CLT.2000/WS/16)This document presents the two major achievements of Year I of the current UNESCO/UNAIDS joint project “A Cultural Approach to HIV/AIDS Prevention and Care”. This phase of the project was meant to identify the interactions between cultures and the HIV/AIDS issue and to adjust prevention and care accordingly. The first part is devoted to the Summary Report of 16 country assessments and shorter county papers carried out in Southern Africa, the Caribbean and South-East Asia. Assessment activities were twofold: 1) Review of the institutional action to date, in as much as it considers cultural aspects in prevention and care programs and projects; 2) In-depth case investigations of people’s reactions concerning the risk and the need for them to change their sexual and non-sexual behaviours accordingly, in relation with their cultural references and resources. (excerpt)
Gender and HIV / AIDS: leadership roles in social mobilization. Report of the UNFPA-organized break-out panel, African Development Forum, Addis Ababa, Ethiopia, 3-7 December 2000.
New York, New York, UNFPA, . , 32 p.The United Nations Population Fund (UNFPA) was responsible for the breakout session on gender and HIV/AIDS, entitled "Gender and HIV/AIDS: Leadership Roles in Social Mobilization." Held on 5 December 2000, this session took the form of a panel group discussion chaired by Ms. Virginia Ofosu-Amaah, Director, UNFPA Africa Division, New York. Panellists included Mr. Martin Foreman, Director, The Panos AIDS Programme, London; Ms. Ngozi Iwere, Nigeria; Ms. Jane Wambui Kiragu, Executive Director of the Federation of Women Lawyers, Kenya; Ms. Wariara Mbugua, Chief, UNFPA Gender Issues Branch, Technical Support Division, New York; and Ms. Marcela Villarreal, Chief, FAO Population Programme Service, Rome. The rapporteurs were Ms. Miriam Jato, Ms. Mere N. Kisekka and Mr. Opia M. Kumah, Advisers, UNFPA Country Technical Services Team in Ethiopia. The session was well attended, and many in the audience actively participated in the discussions by sharing their experiences and providing suggestions to deal with the issues. What follows is a summary of key points and recommendations that arose from the panel discussions on "'Gender and HIV/AIDS: Leadership Roles in Social Mobilization", together with the presentations made by the panellists, which form the major part of this report. Also included is an outline of issues related to youth perspectives on gender and HIV/AIDS presented by a young participant from Liberia. Each of the presentations includes conclusions and recommendations. (excerpt)
[Workshop on Sensitization of Communication Professionals to Population Problems, Dakar, 29 August, 1986 at Breda] Seminaire atelier de sensibilisation des professionnels de la communication aux problemes de population, Dakar du 25 au 29 Aout 1986 au Breda.
Dakar, Senegal, UNICOM, Unite de Communication, 1986. 215 p. (Unite de Communication Projet SEN/81/P01)This document is the result of a workshop organized by the Communication Unit of the Senegalese Ministry of Planning and Cooperation to sensitize some 30 Senegalese journalists working in print and broadcast media to the importance of the population variable in development and to prepare them to contribute to communication programs for population. Although it is addressed primarily to professional communicators, it should also be of interest to educators, economists, health workers, demographers, and others interested in the Senegalese population. The document is divided into 5 chapters, the 1st of which comprises a description of the history and objectives of the Communication Unit, which is funded by the UN Fund for Population Activities (UNFPA). Chapter 1 also presents the workshop agenda. Chapter 2 provides an introduction to population problems and different currents of thought regarding population since Malthus, a discussion of the utilization and interpretation of population variables, and definitions of population indicators. The 3rd chapter explores problems of population and development in Senegal, making explicit the theoretical concepts of the previous chapter in the context of Senegal. Topics discussed in chapter 3 include the role of UNFPA in introducing the population variable in development projects in Senegal; population and development, the situation and trends of the Senegalese population; socioeconomic and cultural characteristics of the Senegalese population; sources of sociodemographic data on Senegal; the relationship between population, resources, environment and development in Senegal; and the Senegalese population policy. Chapter 4 discusses population communication, including population activities of UNESCO and general problems of social communication; a synthesis and interpretation of information needs and the role of population communication; and a summary of the workshop goals, activities, and achievements. Chapter 5 contains annexes including a list of participants, opening and closing remarks, an evaluation questionnaire regarding the workshop participants, and press clippings relating to the workshop and to Senegal's population.
Washington, D.C., World Bank, 1995. xi, 112 p. (World Bank Technical Paper No. 298; Africa Technical Department Series)A review of the literature indicates that the access of girls and women to education in sub-Saharan Africa is being hindered by socioeconomic and cultural factors, aspects of the school environment, and political and institutional forces. Among these factors are direct and opportunity costs, parental attitudes toward investments in female schooling, social class, child labor demands, an emphasis on the woman's roles as wife and mother, scheduling of initiation ceremonies, Islamic beliefs, teachers' negative attitudes about girls' learning potential, early pregnancy, sexual harassment, and the overall low status of women. Strategies with the potential to increase female participation in education include: more flexible and efficient use of teacher and school resources to increase supply; increases in the number of female teachers, especially in science and mathematics; improvements in teachers' gender-stereotyped attitudes; widened curriculum choices for girls; introduction of simple technological innovations that reduce the demand for child labor; increased coverage through initiatives with nongovernmental organizations, religious groups, and families; and review of fiscal and administrative policies that restrict female educational and employment opportunities. Given the complexities of issues related to female education, multiple simultaneous interventions on both the supply and demand sides may be required. Also needed are stronger linkages between research findings, policy formulation, and program design and implementation.
The United Nations, human rights and traditional practices affecting the health of women and children.
Development. 1993; (4):44-8.In 1991, the UN Commission of Human Rights presented a detailed report on 3 of the traditional practices which are harmful to the health of women and children: female genital mutilation, traditional delivery practices, and son preference. Female genital mutilation has received the most attention, and the World Health Organization (WHO) has supported a number of initiatives to eradicate it. In addition, the WHO Safe Motherhood Initiative was launched in the late 1980s to reduce the number of maternal deaths. WHO has resolved to gear its programs toward the elimination of harmful traditional practices. In 1984, nongovernmental organizations (NGOs) held a seminar in Senegal and established the Inter-African Committee on Traditional Practices Affecting the Health of Women and Children which serves as a focal point of government and NGO activities. Meanwhile, a UN Working Group on genital mutilation, maternal practices, and son preference presented a report in 1986. Its tasks were then assumed by a Special Rapporteur who recommended that relevant UN agencies coordinate their work in this field more closely as they organize regional seminars, monitor the progress of work, and routinely include information on these practices in programs to improve the status of women. To date the UN's work has had few tangible results in preventing these practices and has failed to acknowledge the link between them and the more generalized problem of sexual discrimination. At one level, the problem is exacerbated by the difficulty of reconciling the competing concepts of universal human rights and cultural relativism. Also, human rights entitlements are sought from states and not in families. Despite these problems, the UN has given these matters international attention. The international community must affirm the universality of human rights norms and recognize the desirability of a culturally sensitive approach to the implementation of these norms. NGOs have also played a crucial role in bringing these issues to the consideration of the human rights community.
JOICFP NEWS. 1994 Jan; (235):1.An Information, Education, and Communication (IEC) Workshop for the Production of Video Script on Women's Health was organized by the United Nations Population Fund (UNFPA), the International Planned Parenthood Federation (IPPF), and JOICFP and held in Japan from November 29, through December 4, 1993. It produced 4 different prototypes for use in Asia that reflected the range of women's health issues and cultural differences involved. Representatives of family planning (FP) associations and nongovernmental organizations (NGOs), IEC experts, and health officials from both government and NGOs attended. Dr. Shizuko Sasaki spoke about various legal issues of women's health in Japan, while Colleen Cording spoke concerning the impact of social and policy changes on women's lives and health in New Zealand. Participants were then divided into 4 groups for discussion of target populations and their needs. 4 sets of illustrations were designed to stimulate discussion by instructors and were presented with 10-15 min scripts. The 4 videos included Christie and Me, Proud to Be a Girl, One Day at the Beach, and Happy to Be Me. The 1st film features a uterus as narrator who explains menstruation, sexually transmitted disease (STD), and contraception; the 2nd focuses on positive self images for girls; the 3rd, on a range of sexual topics discussed during a couple's seaside stroll; and the 4th, on a woman's love of self and cycle of life from puberty to old age. Participants are expected to produce similar material with adaptations to their specific countries from these prototypes. Participants also discussed their experiences in women's health education and methods of distributing and marketing educational materials.
In: Environmental management and urban vulnerability, edited by Alcira Kreimer, Mohan Munasinghe. Washington, D.C., World Bank, 1992. 93-106. (World Bank Discussion Papers 168)The analysis based on literature on droughts, floods, hurricanes, land slides, and famines presents 1) an understanding of adjustment mechanisms; 2) the mechanisms in use according to their hazard-related functions; 3) implementation issues; and 4) recommendations for a specific community's hazard-related adjustment mechanisms adopted by primarily rural communities in developing countries. A simple framework specifies 4 categories of adjustment mechanisms (social organization, economic relationships, technology use, and cultural arrangements) and 3 disaster intervention phases of the disaster life cycle (prevention, emergency/response, and recovery). Prevention activities include prediction, warning, mitigation, and preparedness functions. Local forecasting methods may be the reading of animal behavior and of weather patterns. Early warning systems in drought affected areas may include the monitoring of grain or animal stocks and behavior of people and price changes. When disaster occurs the outcome may be loss of life and property, environmental devastation, and mass movements of peoples. The affected community responds by evacuating and rescuing its people and animals, and providing emergency assistance and relief. Donated relief supplies may be distributed at the local school facility and the health clinic may provide shelter. Information and communication spontaneously centered itself in the village church after the 1976 earthquake in Guatemala. In Colombia, after the 1985 Armero Disaster, women prepared food and protected children, while men undertook search and rescue missions. As the emergency passes, people reconstruct their lives materially, socially, and culturally. Outmoded traditional agricultural practices, customary land tenure systems, and large families degrade the habitat and increase its vulnerability. Strengthening people's capacity to cope before a disaster strikes is crucial for disaster reduction programs. The analysis of a community's response to hazards examines the historical changes in its economic, social, and political relationships with society at large to inform about causes and consequences of disasters as well as the choices and mechanisms for community action.
FAR EASTERN ECONOMIC REVIEW. 1992 Feb 20; 28-9.As the AIDS epidemic and HIV transmission in India increasingly resembles that observed in sub-Saharan Africa, Indian society's arrogant perception of invulnerability to the pandemic is proving to be considerably ill-conceived. The dimensions of the epidemic have multiplied greatly since AIDS was 1st identified among prostitutes in Madras, with the trends observed in Maharashtra and Tamil Nadu being especially ominous. AIDS has forced Indian society and research professionals to acknowledge the existence of domestic prostitution, homosexuals, and drug users. While only 103 AIDS cases and 6,400 HIV infections have been officially identified, it is clear that these cases represent only a tiny fraction of the true extent of the epidemic in India. The government will therefore spend up to US$7.75 million on an anti-AIDS program aimed at ensuring secure blood supplies, and checking heterosexual transmission through education and the promotion of condoms. The program also targets IV-drug users and truck drivers for education and behavioral change. India is the 2nd country after Zaire to accept foreign loans for such a purpose. It will receive US$85 million over 5 years from the World Bank in addition to supplemental funds from the WHO and the U.S. Weak attempts, however, have been made to test blood supplies, with only 15% being tested in Tamil Nadu. A large gap also remains between health educators and needy target groups. Finally, while some top officials realize the need for immediate action against AIDS, broad public awareness and coping will come only after AIDS mortality begins to mount in the population.
FAR EASTERN ECONOMIC REVIEW. 1992 Feb 20; 29-30.AIDS and HIV infection are in the early stages in Indonesia. 21 AIDS cases have been reported, and 30 persons have tested HIV-seropositive. Given the relatively low number of cases, and the presumed slow spread of HIV in the population, the government may yet be able to react in timely fashion to thwart epidemic spread. A rigorous education campaign and early detection of infected individuals are elements central to such intervention. The World Health Organization set a 1992 budget of US$500,000 for AIDS efforts in Indonesia. Research is young, awareness is minimal, and the campaign has barely commenced. AIDS cases have emerged in Jakarta, Surabaya, Bandung, and Denpasar. It is especially in cities that the government is concerned over checking the spread of AIDS. In these populations, many engage in extramarital sex, visible transvestite communities exist, and commercial sex districts thrive. Low condom use among sex workers, and relatively high rates of untreated STDs prevail in the general population. From March, blood donated in 15 cities, including these 4, will be compulsorily screened for HIV. Socially, moral and religious attitudes must be recognized and accommodated in mounting an effective AIDS prevention and education campaign in Indonesia. While religious sensibilities may be offended by the discussion of sex and sexual practices, such discussion is necessary and must be supported by the well-organized religious groups in this overwhelmingly Muslim country. Hopefully, Indonesia will bring to bear against AIDS the same cultural pragmatism exhibited to effect population control in the 1970s and 1980s.
INTERNATIONAL JOURNAL OF HEALTH SERVICES. 1991; 21(3):505-10.This article asks the reader to carefully consider the personal implications of AIDS were either he or close friends and relatives afflicted with the syndrome. We are urged to acknowledge the limited capabilities of personal and social response to the epidemic, and recognize the associated degree of social inequity and knowledge deficiency which exists. Summaries of 3 articles are discussed as highly integrated in their common call for global solidarity in the fight against HIV infections and AIDS. Pros and cons of Cuba's evolving response to AIDS are considered, paying attention to the country's recent abandonment of health policy which isolated those infected with HIV, in favor of renewed social integration of these individuals. Brazil's inadequate, untimely, and erred response to AIDS is then strongly criticized in the 2nd article summary. Finally, the 3rd article by Dr. Jonathan Mann, former head of the World Health Organization's Global program on AIDS, on AIDS prevention in the 1990s is discussed. Covering behavioral change and the critical role of political factors in AIDS prevention, Mann asserts the need to apply current concepts and strategies, while developing new ones, and to reassess values and concepts guiding work in the field. AIDS and its associated crises threaten the survival of humanity. It is not just a disease to be solved by information, but is intimately linked to issues of sexuality, health, and human behavior which are in turn shaped by social, political, economic, and cultural factors. Strong, concerted political resolve is essential in developing, implementing, and sustaining an action agenda against AIDS set by people with AIDS and those at risk of infection. Vision, resources, and leadership are called for in this war closely linked to the struggle for worldwide social justice.
An agenda for action in sub-Saharan Africa. A collaborative initiative of the World Bank, UNFPA and IPPF.
INTEGRATION. 1991 Mar; (27):10-7.An Agenda for Action to Improve the Implementation of Population Programs in Sub-Saharan African in the 1990s is a joint project of the World Bank, the UN Population Fund, the IPPF, the WHO and the African Development Bank. The goals of the agenda are to build public consensus and commitment to population activities, to bring together beneficiaries, implementors and policy makers with these groups to improve population program implementation, to share country program experiences, to make African institutions responsible for ("Africanize") the Agenda, or ultimately to include demographic factors in development. 20 African countries are the focus of the Agenda, grouped by region and language. Major issues include socio-cultural and economic roadblocks, poor transportation infrastructure, lack of community participation, no alternatives to early marriage for women, poor political commitment by decision-making or health ministries. Family planning programs can be improved by better contraceptive technology, program design, and human and financial resources for implementing programs. The methods by which the Agenda proposes to reach its goals are to do literature searches of action strategies, in-depth country analyses, inter-country sharing of experiences, analysis of implementation capability based on case studies, and analysis of contraceptive technology assisted by WHO's Special Programme of Research, Development and Research Training in Human Reproduction and the Population Council. The Agenda will be managed by a Population Advisor Committee, which is an African "think tank," and regional Country Group Task Forces, coordinated by the World Bank's Africa Technical Department.
DEVELOPMENT COMMUNICATION REPORT. 1989; (66):4-5.An agency of the Indian government cooperated with a United Nations Children Fund to produce posters for the child survival and development program in India. To make the posters and other visual communications more effective a workshop was planned for the artists, visualizers, and copywriters. Previous experience had shown that some visual materials were not always oriented to the local contexts and villages often misinterpreted the messages of these materials. The 12 day workshop was designed to assist artists to better understand the audiences needs. there had been little pretesting of art work for health communication and no consideration of the visual literacy of the audience. The first project in the workshop consisted of artists and copywriters visiting villages to pretest posters presently in circulation. After some reservations they quickly found that the villagers perception of the posters was entirely different than the message being conveyed. By going back and getting the villagers perceptions of common sights related to maternal and child health, the artist could better prepare communication materials. They also collected basic sociological data at each village. New posters were then prepared with the help of inputs from midwives, nurses, and other health care workers. By pretesting these materials again they were able to clarify the messages, and repeated testing showed the posters were more understandable. The participants in the workshop found that visual communications materials demand proper understanding of the subject matter and the audience. Pretesting of materials is necessary before production, and changes should be made to reflect the local culture and surroundings. Posters for rural illiterate audiences should have the minimum written text needed and visual literacy must be assessed.
New York, New York, UNFPA, 1986 Jun. x, 66 p. (Report No. 81)A UN mission was sent to assess and recommend areas for assistance in the field of population assistance in Lesotho. The mission recommends a population unit be set up and staffed with personnel able to initiate, coordinate, and document population research. It also should assist in the integration of population data into the planning process. Data needed to accomplish these tasks includes current statistics on the size, demographic, and socioeconomic details of the population; migration and geographical distribution; general health and nutritional status, including adult and infant mortality; the size and distribution of the work force; and the employment market and manpower in the private sector. Research is recommended in the following areas: resource limitations on development and job growth; international migration; effects of infertility on population growth and distribution; religion and culture in family planning; women's status in work force; effects of land tenure, land use and distribution; teen pregnancy; resources available to women; and effects of returning migrants on households. Also recommended are expanding health facilities and increasing staff training for this network. Family planning should be integrated with maternal and child health services. The mission finds that the government needs to promote a longterm formal program on population education, and designate an agency to coordinate such a program. The mission suggests that women's role in agriculture and other employment be analyzed, and also laws that effect their rights and responsibilities. It also recommends more small projects in rural areas and designating funds to help women gain self sufficiency.
[Unpublished] 1987. 13,  p.Africa's colonial legacy is such that countries contain not only a multiplicity of nations and languages, but their governments operate on separate cultural and linguistic planes, remnants of colonial heritage, so that neighboring peoples often have closed borders. Another problem is poor demographic data, although some censuses, World Fertility Surveys, Demographic Sample Surveys and Contraceptive Prevalence Surveys have been done. About 470 million lived in the region in 1984, growing at 3% yearly, ranging from 1.9% in Burkina to 4.6% in Cote d'Ivoire. Unique in Africa, women are not only having 6 to 8.1 children, but they desire even larger families: Senegalese women have 6.7 children and want 8.8. This gloomy outlook is reflected in the recent history of family planning policy. Only Ghana, Kenya and Mauritius began family planning in the 1960s, and in Kenya the policy failed, since it was begun under colonial rule. 8 countries made up the African Regional Council for IPPF in 1971. At the Bucharest Population Conference in 1974, most African representatives, intellectuals and journalists held the rigid view that population was irrelevant for development. Delegates to the Kilimanjaro conference and the Second International Conference on Population, however, did espouse the importance of family planning for health and human rights. And the Inter-Parliamentary Union of Africa accepted the role of family planning in child survival and women's status. At the meeting in Mexico in 1984, 12 African nations joined the consensus of many developing countries that rapid population growth has adverse short-term implications on development. Another 11 countries allow family planning for health and human rights, and a few more accept it without stating a reason. Only 3 of 47 Sub-Saharan nations state pro-natalist policies, and none are actively against family planning.
MIGRATION WORLD. 1986; 14(1/2):50-7.The object of the end-of-the-decade Conference held in Nairobi was to appraise the achievements of the UN Decade for Women and to develop Forward Looking Strategies (FLS) to the year 2000 aimed at overcoming the remaining obstacles. The feminization of poverty is today a global phenomenon and 1 solution is women's empowerment of women's perspectives. The Strategies are a significant tool for women's empowerment through women's full participation in decision-making processes. Although the FLS is addressed to governments and organizations, it also recognizes the important role of individuals in bringing about changes. Strategies aimed at altering the root causes of migration are: 1) support of the movement for a new international economic order that will reduce the structural inequalities among countries, 2) the deemphasis of export-oriented development policies that accelerate migration and neglect the internal needs of developing countries, 3) the examination of the reasons behind the increase of female migration and a parallel creation of policies to benefit these women, 4) the encouragement of governments to examine implicit and explicit migration policies that may violate human rights, and 5) the examination of the role of the mass media and cultural models iported from the West in accelerating migration. Other strategies listed include: 1) legal strategies, 2) strategies addressing cultural identity, 3) strategies for women femaining in emigrant households in donor areas, 4) strategies for facilitating the organizing of immigrant groups by immigrants, 5) strategies for establishing a network of solidarity and self organized immigrant associations, and 6) strategies for linking research to action.
WHO CHRONICLE. 1986; 40(1):31-6.A traditional practice that has attracted considerable attention in the last decade is female circumcision, the adverse effects of which are undeniable. 70 million women are estimated to be circumcised, with several thousand new operations performed each day. It is a custom that continues to be widespread only in Africa north of the equator, though mild forms of female circumcision are reported from some Asian countries. In 1979 a Seminar on Traditional Practices that Affect the Health of Women and Children was held in the Sudan. It was 1 of the 1st interregional and international efforts to exchange information on female circumcision and other traditional practices, to study their implications, and to make specific recommendations on the approach to be taken by the health services. There are 3 main types of female circumcision: circumcision proper is the mildest but also the rarest form and involves the removal only of the clitoral prepuce; excision involves the amputation of the entire clitoris and all or part of the labia minora; and infibulation, also known as Pharaonic circumcision, involves the amputation of the clitoris, the whole of the labia minora, and at least the anterior 2/3 and often the whole of the medial part of the labia majora. Initial circumcision is carried out before a girl reaches puberty. The operation generally is the responsibility of the traditional midwife, who rarely uses even a local anesthetic. She is assisted by a number of women to hold the child down, and these frequently include the child's own relatives. Most of the adverse health consequences are associated with Pharaonic circumcision. Hemorrhage and shock from the acute pain are immediate dangers of the operation, and, because it is usually performed in unhygienic circumstances, the risks of infection and tetanus are considerable. Retention of urine is common. Cases have been reported in which infibulated unmarried girls have developed swollen bellies, owing to obstruction of the menstrual flow. Implantion dermoid cysts are a very common complication. Infections of the vagina, urinary tract, and pelvis occur often. A women who has been infibulated suffers great difficulty and pain during sexual intercourse, which can be excruciating if a neuroma has formed at the point of section of the dorsal nerve of the clitoris. Consummation of marriage often necessitates the opening up of the scar. During childbirth infibulation causes a variety of serious problems including prolonged labor and obstructed delivery, with increased risk of fetal brain damage and fetal loss. A variety of reasons are advanced by its adherents for continuing to support the practice of female circumcision, but the reasons are rationalizations, and none of the reasons bear close scrutiny. The campaigning against female circumcision is reviewed.
General lessons learned from evaluations of MCH/FP projects in Botswana, Malawi, Swaziland and Zambia.
New York, New York, UNFPA, 1984 Dec. iv, 41 p.4 maternal-child health/family planning (MCH/FP) projects were evaluated by the United Nations Fund for Population Activities (UNFPA) in the Southern Africa Region between 1981-1984. The projects were in Botswana, Malawi, Swaziland and Zambia. An overriding finding at the time of the Evaluation Missions was the acceptance of family planning (child spacing) by all 4 governments, when at the onset of the projects, family planning was either not included in the project documents or was included only as a minor contributant to the MCH programs. The intervention by UNFPA was very important for the acceptance and promotion of family planning activities by the governments. The Evaluation Missions concluded that there were 3 primary reasons for the successful intervention: UNFPA has a broad mandate to provide assistance in MCH and FP, a commitment to development projects in line with the governments' priorities, and the ability to fund projects very quickly, facilitating project implementation. Each of the 4 projects is assessed in terms of population policy changes, MCH/FP program strategy and serive delivery, organization of the MCH/Fp unit, health education, training, evaluation and research systems, and administration and management. Essential factors affecting the project are outlined and recommendations made. The last section discusses general lessons derived from the MCH/FP projects evaluated. 5 areas are identified where similar problems exist to varying degrees in all the projects evaluated. These are: training of medical personnel in FP (the main MCH/FP service provider in these projects was the nurse/midwife); supervision of personnel and the supply and distribution of contraceptives; research and evaluation, especially regarding the sociocultural setting of target populations and the inadequacy of existing service statistics and other sources of data; project monitoring (technical and financial) and finally project execution by the World Health Organization (WHO). Specifically in regard to the recruitment of experts, the provision of supplies and equipment, and the provision of funds for local costs, WHO execution has been deficient.
Social Science and Medicine. 1985; 21(12):1345-7.The author examines whether traditional medicine promotes biopsychosocial fulfillment in African health and argues that every society has its own method of managing illness and controlling the environment. In African societies, traditional medicine remains the major way of coping with illness; for some 80% of the population, primary health care is synonymous with traditional medicine. Just as any society would not negotiate its sociocultural imperatives for those of a borrowed culture, it is vital for societies to maintain their significant cultural 'idioms' such as African traditional medicine. It is a form of domestic health care based on general medical knowledge and practised within the family that represents a system of ordering, classifying, and explaining illness, as well as elaborate concepts of treatment. Often, traditional medicine is used as a "psychological opium" in the relief of pain or suffering by creating a sense of societal membership and self-awareness in the face of fear and death. Biopsychosocial health can be equated with the World Health Organization's definition of health as a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity; insofar as this is true, African traditional medicine promotes the biopsychosocial fulfillment of African health needs.
International Journal of Gynaecology and Obstetrics. 1985 Sep; 23(4):249-74.In many countries 60-80% of deliveries are assisted by traditional birth attendants (TBAs). Over the last several decades efforts have been made to regulate, upgrade through training or replace the TBA. The strength of the TBA comes from the fact that she is part of the cultural and social life of the community in which she lives. Her weakness lies in the traditional practices which may have dangers for her clients. With suitable training and supervision these dangers can be minimized and her potential used to improve the health of mothers and babies. Increasingly countries are recognizing that the TBA will represent a major resource where women do not have access to services for either cultural or geographic barriers. An understanding of the TBA's role and contribution by all health authorities is necessary. The TBA's role is always associated with the actual birth process, but in some instances her influence extends to prenatal and postnatal period. Based on suggestions from midwives, obstetricians, anthropologists and educators, WHO has issued guidelines, encouraged consultations, and held conferences and seminars all designed to widen the acceptance of this concept and disseminate the knowledge available on both traditional birth customs and on the training needed to effectively utilize the traditional practitioners. The WHO's approach has been successful in stimulating countries to undertake TBA training and utilization programs. There is overwhelming evidence that TBAs are acceptable to the population, accessible in numbers where they are needed, capable of absorbing training, cost effective and perhaps the surest means by which maternal and infant health in developing countries can be improved. TBAs still deliver most of the world's babies and will continue to do so for many years to come. Many of WHO's Member States are now collaborating with TBAs to extend health service coverage to unserved populations.
Social Science and Medicine. 1985; 21(1):41-53.This paper explores the emergence of an international fad aiding and monitoring community participation efforts and projects its future outcome based on lessons from previous experiences in other than the health sector. The analysis suggests that the promotion of community participation was based in all cases on 2 false assumptions. 1) The value system of the peasantry and of the poor urban dwellers had been misunderstood by academicians and experts, particularly by US social scientists, who believed that the traditional values of the poor were the main obstacle for social development and for health improvement. However, the precolumbian forms of organization that traditional societies had been able to maintain throughout the centuries were not only compatible with development but had many of the characteristics of modernity: the tequio guelagetza minga and even the cargo system stress collective work, cooperation, communal land ownership and egalitarianism. 2) Another misjudgement was the claim that the peasantry was disorganized and incapable of effective collective action. In Latin America historical facts do not support this contention. A few examples from more recent history show the responsiveness and organizational capabilities of rural populations. The Peasant Leagues in Northeastern Brazil under the leadership of Juliao is perhaps 1 of the best known example. The question is thus raised as to why international and foreign assistance continues to pressure and finance programs for community organization and/or participation. It is suggested that the experience in Latin America (except perhaps Cuba and Nicaragua) indicates that community participation has produced additional exploitation of the poor by extracting free labor, that it has contributed to the cultural deprivation of the poor, and has contributed to political violence by the ousting and suppression of leaders and the destruction of grassroots organizations. Information presented on community participation in health programs in Latin America illustrates that they have followed closely the ideology and steps of community participation in other sectors. A country by country examination indicates that health participation programs in Latin America in spite of promotional efforts by international agencies, have not succeeded. The real international motivation for participation programs was the need to legitimeize political systems compatible with US political values. Through symbolic participation, international agencies had in mind the legitimation of low quality care for the poor, also known as primary health care and the generation of much needed support from the masses for the liberal democracies and authoritatrian regimes of the region. Primary health care delivery can be successful without community participation, in contradiction to what international agencies and governments maintain.
New York, New York, United Nations, 1985. 52 p. (ST/ESA/SER.E/39)This monograph presents an overview of the content and direction of courses designed to prepare planning coordinators of developing nations to approach population and development policy making in a richly informed interdisciplinary manner. The conceptual framework for such a curriculum is presented 1st in a theoretical section on the links between the key concepts of population and development. Next, recommendations on curriculum design emphasize 2 main lines of focus: 1) understanding the cultural context in which developmental planning takes place; 2) exploring the available means of action in terms of strategies corresponding to explicit transitional goals in relation to the identified context. The emphasis, rather than on specific technical expertise, should be on providing information on the range of tools available for use in the field at a later stage. The 3rd section involves course orientation; the aim is to turn out planning coordinators capable of formulating integrated population policies. The curriculum should be geared to occupational groups, including senior management, middle-level staff, educators and researchers, and executing agents. Section 4 covers course admission requirements, criteria for teachers and locations. Section 5 presents recommendations for subject matter, presenting a 2 year curriculum, each year divided into 4 modules: 1) knowledge of the context; 2) the population component; 3) the instruments of change, involving developmental economics and planning; and 4) techniques of analysis, systems analysis, econometrics, forecasting and more. An outline of the curriculum detailing topics, course length, and general and specific goals for each course follows. A bibliography covering general works, works on economics, sociology, anthropology and systems concludes the document.
Fertility and the family: highlights of the issues in the context of the World Population Plan of Action.
In: United Nations. Department of International Economic and Social Affairs. Population Division. Fertility and family. New York, New York, United Nations, 1984. 45-73. (International Conference on Popualtion, 1984; Statements)This paper uses as its organizing principle 5 major themes which run through the sections of the 1974 World Population Plan of Action (WPPA) devoted to fertility and the family. The purpose of this paper it to assure that their discussion is comprehensive and that it reviews all the major research and policy concerns with respect to fertility and the family that have played an important role in the general debate about these issues since 1974. Summerized here are the contributions included in this volumen, as each deals with at least 1 of these issues. The 1st major theme focuses on fertility response to modernization as a facet of the interrelationship between population and development. Discussed are aspects of modernization leading to fertility increases, in particular the reduced incidence and shorter duration of breastfeeding, and those leading to fertility decline, namely the decline in the value of children as a source of labor and old-age support. Freedom of choice, information and education are the principal approaches within which childbearing decision making is discussed. Women's reproductive and economic activity during their life cycle, and the relationship of family types and functions to fertility levels and change are equally addressed. Finally, demographic goals and policy alternatives with respect to fertility change are discussed in terms of a number of policy options: family planning programs, economic incentives and disincentives and more global socioeconomic measures. Although primary attention is given to the problems and policies of developing countries, the special problems of certrain developed countries which view their fertility as too low are also considered. The issues raised in this paper are put forward as an aid to assist in the identification of emderging areas of policy concern and of fruitful new research directions.
In: United Nations. Department of International Economic and Social Affairs. Population Division. Fertility and family. New York, New York, United Nations, 1984. 1-44. (International Conference on Population, 1984; Statements)This volume is comprised of the reports of the 1st of 4 Expert Group Meetings, scheduled in preparation for the 1984 International Conference on Population. Individuals and organizations attending this meeting are listed. The central task of the meeting was to examine critical, high-priority issues relevant to fertility and family and, on that basis, to make recommendations for action that would enhance the effectiveness of and compliance with the World Population Plan of Action, adopted in 1974 at Bucharest. The 1st item on the agenda dealt with ways in which modernization elements in the socio-cultural and economic patterns and institutions of societies alter reproduction. The 2nd topic of discussion was the relationship between family structure and fertility. The view adopted was that family structure could be influenced by a variety of factors that would have implications for fertility (e.g., delayed at marriage, improvements in education). The deliberations on factors influencing choice with respect to childbearing focused upon the complexity of decision making in matters of reproduction. In question, too, was a possible conflict between the acknowledged rights to freedom of choice in respect to childbearing and to the rights and goals of society, as well the acceptability of incentives and disincentives as measures introduced by governments to achieve social goals. The 4th item, reproductive and economic activity of women, was discussed from several perspectives: the amount of reproductive lifetime available to women for productive pursuits other than childbearing; the introduction of social support programs and income-generating opportunities. In the discussion of demographic goals and policy alternatives, the 5th item on the agenda, the policy options considered were family planning programs, incentives and desincentives, social and economic development, and marriage and divorce laws. Particular attention was given to the importance of local institutional settings for the achievement of government policy goals. The Expert Group's recommendations on population policy, family planning, the conditions of women, adolescent fertility, IEC, management and training, international cooperation and areas of research (demographic data, determinants of fertility, operational research and bio-medical) are included in this introduction. Finally, presented in the form of annexes are the agenda for the meeting, the list of documents and the texts of the opening statements.
In: United Nations. Department of International Economic and Social Affairs. Population Division. Fertility and family. New York, New York, United Nations, 1984. 107-23. (International Conference on Population, 1984; Statements)The Expert Group Meeting on Fertility and Family was assinged the identification of those areas in current scientific knowledge and concerns regarding fertility and family that were of greatest salience for policy formulation and implementation. Particular attention was to be paid to shifts that had occurred since the 1974 World Population Conference in Bucharest. This article is mainly an overview of the work of the Group and is organized around 3 main themes: 1) advances in knowledge of fertility levels and trends; 2) advances in understanding the relations between development, fertility and the family; 3)theoretical advances and practical experience with regard to policy formulation and implementation. 1) Knowledge of existing patterns of fertility and their composition has increased markedly over the last decade as a result of more data, better estimation techniques for measuring fertility levels and of new approaches to studying the reporductive process and family formation (e.g., the development of analytical models that allow quantification of the role of the various proximate determinants of fertility). A far-reaching realization is that proximate determinants of fertility may respond to the same set of factors but their responses may exhibit different elasticities. 2) In the understanding the relations between development, fertility and family, 2 main areas of concern can be identified. He level and type of analyses to date, especially the empirical ones, have been carried out at the micro-level, focusing on the individual decision maker. Although such models are advances over earlier ones developed largely from classical demographic transition theory, yet, their use has not been entirely satisfying because of the common failure to adequately specify the concepts involved and/or to substitute for them broad socioeconomic indicators in empirical work. In addition, institutional supports for and interrelations with particular patterns of fertility and family have been neglected, resulting, theoretical and practical impoverishment. The 2nd area of concern is the identification of those dimensions of family structure and function that are most intimately interlocked with modernization and fertility change. The discussion focuses on the interplay between modernization, the relationship between the generations, and between the sexes. Finally, there is an increasing awareness that a number of aspirations regarding fertility and family may be contradictory with respect to general advances in policcy formulation and implementation. 4 important trends can be discerned: 1) assessment of the potential utility and effectiveness of policy and programmatic efforts; 2) trends in the definition of desirable goals; 3) new directions in terms of the institutiona means for achieving these goals; and 4) shifts in the perception of the individual's freedom of choice.
Geneva, Switzerland, World Federation of Public Health Associations, 1983 Jul. 20 p. (Information for Action Resource Guide)Women in developing countries have special nutritional needs because of the tremendous physical burdens they bear in daily tasks, pregnancy, and lactation. Poverty and custom often cause these needs to go unmet. Poor maternal nutrition affects not only the mother's health, but also that of her children. While some elements of maternal nutrition are well known, discussion and experimentation continue on important nutritional and delivery issues. This Resource Guide, aimed at field staff who are not nutritionists, summarizes recent literature on this important topic. The annotations discuss both the causes and effects of maternal undernutrition. They also describe simple monitoring techniques to gauge maternal nutrition status and short-term programmatic interventions such as food fortification, food supplementation, vitamin distribution, and health education. The documents chosen synthesize important issues and experiences. The documents included are highly selective; some important literature and projects are not mentioned as this guide is mainly designed for busy program officials. Readers are encouraged to consult the references cited thorughout the guide for in-depth studies. Non-technical language is used throughout the text to facilitate understanding of the main concepts and issues.