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African Population Studies/Etude de la Population Africaine. 2006; 21(1):19-36.Relatively scant knowledge is available on the situations of older persons in sub-Saharan Africa. Reliable and accessible demographic and health statistics are needed to inform policy making for the older population. The process and outcome of a project to create a minimum data set (MDS) on ageing and older persons to provide an evidence base to inform policy are described. The project was initiated by the World Health Organization and conducted in Ghana, South Africa, Tanzania and Zimbabwe. A set of indicators was established to constitute a sub-regional MDS, populated from data sources in the four countries; a national MDS was produced for each country. Major gaps and deficiencies were identified in the available data and difficulties were experienced in accessing data. Specific gaps, and constraints against the production and access of quality data in the subregion are examined. The project and outcome are evaluated and lessons are drawn. Tasks for future phases of the project to complete and maintain the MDS are outlined. (author's)
Washington, D.C., World Bank, Human Development Network, 2007 Apr.  p. (HNP Discussion Paper)The objective of this paper is to discuss some obstacles and opportunities presented by population processes in order to prioritize areas for investment and analytical work as background information for the 2007 HNP Sector Strategy. Within HNP, two areas fall within population: (1) reproductive, maternal, and sexual health issues, and the health services that address them; and (2) levels and trends in births, deaths, and migration that determine population growth and age structure. Many of the aspects of delivery of sexual and reproductive health services are addressed in the overall sector strategy. This paper, therefore, focuses on the determinants and consequences of demographic change, and on policies and interventions that pertain to fertility and family planning. Fertility has declined in most of the low- and middle-income countries, with TFRs converging toward replacement level, except in 35 countries, mainly in Sub-Saharan Africa, where a broad-based decline in fertility has not occurred. As the priorities of donors and development agencies have shifted toward other issues, and global funds and initiatives have largely bypassed funding of family planning, less attention is being focused on the consequences of high fertility. Reproductive health is conspicuously absent from the MDGs, and assistance to countries to meet the demand for family planning and related services is insufficient. The need for Bank engagement in population issues pertains to economic growth and poverty reduction, as well as inequities in terms of the impact of high fertility on the poor and other vulnerable groups. Evidence indicates that large family size reduces household spending per child, possibly with adverse effects on girls, and the health of mothers and children are affected by parity and birth intervals. Equity considerations remain central to the Bank's work as poor people are less likely to have access to family planning and other reproductive health services. Other vulnerable groups that are less likely to be served by reproductive health services include adolescents and rural populations. Additionally, improved education for girls, equal opportunities for women in society, and a reduction of the proportion of households living below the poverty line are necessary elements of a strategy to achieve sustainable reductions in fertility. The Bank has a comparative advantage to address these issues at the highest levels of country policy setting, and its involvement in many sectors can produce synergies that will allow faster progress than a more narrow focus on family planning services. (author's)
Revista de Saude Publica / Journal of Public Health. 2006 Apr; 40 Suppl:5-8.Recognizing the HIV/AIDS pandemic as an unprecedented worldwide emergency and one of the greatest challenges to life and the enjoyment of human rights, the United nations called on member states to reflect on this matter. In June 2001, around 20 years after the first AIDS cases were recorded, the United Nations General Assembly Special Session on HIV and AIDS (UNGASS HIV/AIDS) was held in New York. The Session culminated in the drafting of the Declaration of Commitment on HIV and AIDS: a document that reflected the consensus between 189 countries, including Brazil, and stated some essential principles for an effective response to the epidemic. The Declaration recognized that economic, racial, ethnic, generational and gender inequalities, among others, were factors that boosted vulnerability and, whether acting separately or in synergy, favored HIV infection and the onset and evolution of AIDS. The Declaration of Commitment on HIV and AIDS has become transformed into a tool for reaffirming the urgency and necessity of promoting the solidarity that the epidemic demands. It aims towards better management of the actions and resources destined for controlling HIV and AIDS and towards social control over public HIV/AIDS policies. (excerpt)
PLoS Medicine. 2006 Apr; 3(4):e211.One of the most unsettling images for newcomers to many parts of Africa is the sight of undernourished women bearing unfeasibly large vessels of water long distances over rough terrain to supply the needs of their families. A sense of outrage that anyone should have to live like this in the 21st century forms the basis of the humanitarian imperative that drives development programs, especially those that focus on basic needs such as access to safe water. When such a program reduces from three hours to 15 minutes the time that women spend fetching water each day, surely it can be described as a success, without the need for any "scientific" assessment of what has been achieved? In this issue of PLoS Medicine, we publish a study that did assess such a program. Mhairi Gibson and Ruth Mace (DOI: 10.1371/journal. pmed.0030087)--from the University of Bristol, United Kingdom--compared villages in Ethiopia that benefited from a tapped water supply with other villages that did not. Outcome measures included the nutritional status of women and children, mortality rates, and birth rates. There were a number of surprising findings, most notably the large increase in birthrate in the villages where the water supply intervention took place. (excerpt)
Normal CD4+ T lymphocyte levels in HIV seronegative individuals in the Manya / Yilo Krobo communities in the eastern region of Ghana.
Viral Immunology. 2006; 19(2):260-266.The goal of this study was to determine the normal levels of CD4+ T lymphocytes in healthy individuals who were HIV seronegative in the Manya and Yilo Krobo Districts of Ghana's Eastern Region. This enabled comparisons with normal CD4 count ranges established by the World Health Organization (WHO). The study population consisted of 249 HIV-seronegative clients from a mobile free Voluntary Counseling and Testing (VCT) service in communities of the two districts during a one-month period. The mean CD4 count of these individuals was 1067 cells/µl with women demonstrating higher baseline CD4 counts than men. This study found a WHO comparable HIV seronegative baseline CD4 count as well as gender-based differences in the CD4 count and CD4/CD8 ratio. Establishment of the adult baseline for the country provides important demographic data and indicates the appropriateness of current global treatment guidelines with regards to CD4 levels in Ghana. (author's)
Development and testing of the South African National Nutrition Guidelines for People Living with HIV / AIDS.
SAJCN. South African Journal of Clinical Nutrition. 2003 Feb; 16(1):12-16.Malnutrition is a common consequence of HIV infection, and weight loss is used as a diagnostic criterion for HIV/AIDS. The relationship between HIV/AIDS and malnutrition and wasting is well described, with nutritional status compromised by reduced food intake, malabsorption caused by gastrointestinal involvement, increased nutritional needs as a result of fever and infection, and increased nutrient losses. Malnutrition contributes to the frequency and severity of opportunistic infections seen in HIV/AIDS and nutritional status is a major factor in survival. Failure to maintain body cell mass leads to death at 54% of ideal body weight. The effectiveness of nutrition intervention has been documented and dietary nutrition counselling is considered critical in the treatment of HIV/AIDS, especially in view of the fact that drug treatment is inaccessible to many people living with the virus in Africa. (excerpt)
Genus. 2005 Jul-Dec; 61(3-4):167-184.This paper intends to comment on some of the connections between demographic patterns and poverty reduction that have been sufficiently tested, and are now widely accepted. The first section of it gives an overview of the different conceptions of poverty that are currently considered. The second deals with poverty measurement, and with the availability of data, both in developed and developing countries, pointing at some of their problems and limitations, particularly for their use in international comparisons and macro-economic analysis. The third describes briefly how theories relating demography and poverty have evolved from the time that this issue was aroused by Malthus, and reviews the current state of the art. In the following section, some aspects of the incidence of poverty on fertility and mortality are explored. The dynamics of the demographic changes and their effects on economic development are the subject of the fifth section. Finally, the last section is devoted to the controversial role that the massive migration inflows that are a trait of our times can play in the eradication of poverty. (excerpt)
Geneva, Switzerland, UNAIDS, 2005 Dec.  p. (UNAIDS/05.19E)Acquired Immunodeficiency Syndrome (AIDS) has killed more than 25 million people since it was first recognized in 1981, making it one of the most destructive epidemics in recorded history. Despite recent, improved access to antiretroviral treatment and care in many regions of the world, the AIDS epidemic claimed 3.1 million [2.8--3.6 million] lives in 2005; more than half a million (570 000) were children. The total number of people living with the human immunodeficiency virus (HIV) reached its highest level: an estimated 40.3 million [36.7--45.3 million] people are now living with HIV. Close to 5 million people were newly infected with the virus in 2005. There is ample evidence that HIV does yield to determined and concerted interventions. Sustained efforts in diverse settings have helped bring about decreases in HIV incidence among men who have sex with men in many Western countries, among young people in Uganda, among sex workers and their clients in Thailand and Cambodia, and among injecting drug users in Spain and Brazil. Now there is new evidence that prevention programmes initiated some time ago are finally helping to bring down HIV prevalence in Kenya and Zimbabwe, as well as in urban Haiti. The number of people living with HIV has increased in all but one region in the past two years. In the Caribbean, the second-most affected region in the world, HIV prevalence overall showed no change in 2005, compared with 2003. (excerpt)
Connections. 2006 Feb;  p.Nearly 5 million people worldwide were infected with HIV in 2005, marking the largest jump in new cases since the disease was first recognized in 1981, according to the AIDS Epidemic Update 2005 released by UNAIDS last December in conjunction with World AIDS Day. The virus claimed the lives of 3.1 million people in 2005, with more than half a million of these deaths occurring among children. Although sub-Saharan Africa and Southeast Asia continue to remain the hardest hit areas, the report clearly indicates that the virus is continuing to spread at alarming rates within Eurasia, bringing the region to the brink of a full-blown epidemic. The number of people living with HIV in Eastern Europe and Central Asia reached 1.6 million in 2005, a 20-fold increase from 2003. Even more striking, AIDS claimed the lives of 62,000 people there last year-nearly double the mortality rate attributed to the virus 2003. (excerpt)
New York, New York, UNICEF, 2005 Nov.  p.FGM/C is a fundamental violation of human rights. In the absence of any perceived medical necessity, it subjects girls and women to health risks and has life-threatening consequences. Among those rights violated are the right to the highest attainable standard of health and to bodily integrity. Furthermore, it could be argued that girls (under 18) cannot be said to give informed consent to such a potentially damaging practice as FGM/C. FGM/C is, further, an extreme example of discrimination based on sex. The Convention on the Elimination of All Forms of Discrimination against Women defines discrimination as "any distinction, exclusion or restriction made on the basis of sex which has the effect or purpose of impairing or nullifying the recognition, enjoyment or exercise by women, irrespective of their marital status, on a basis of equality of men and women, of human rights and fundamental freedoms in the political, economic, social, cultural, civil or any other field." Used as a way to control women's sexuality, FGM/C is a main manifestation of gender inequality and discrimination "related to the historical suppression and subjugation of women," denying girls and women the full enjoyment of their rights and liberties. (excerpt)
New York, New York, UNICEF, 2005 Feb. 32 p.The objective of this study is to present available empirical evidence obtained through household surveys in order to estimate levels of registration and to understand which factors are associated with children who obtain a birth certificate, and thus realize their right to a name and legal identity. The paper presents a global assessment of birth registration levels, differentials in birth registration rates according to socio-economic and demographic variables, proximate variables and caretaker knowledge, as well as a multivariate analysis. Statistical associations between indicators regarding health, education and poverty can reveal potential linkages in programming to promote the registration of children. By analysing levels of birth registration in the context of other health, education and poverty indicators, the study points to opportunities to integrate advocacy and behaviour change campaigns for birth registration with early childhood care and immunization. By linking birth registration to early childhood programmes, a legal hurdle can become a helpful referral to promote improved health, education and protection for disadvantaged children and their caretakers. (excerpt)
[Immunization coverage survey: empirical assessment of the cluster sampling method proposed by the World Health Organization] Inquérito de cobertura vacinal: avaliação empírica da técnica de amostragem por conglomerados proposta pela Organização Mundial da Saúde.
Revista Panamericana de Salud Pública / Pan American Journal of Public Health. 2005; 17(3):184-190.Objective: To analyze the representation of the sample and the precision of estimates obtained using the conglomerate methodology (30 of 7) proposed by the World Health Organization via their application to inquiries of vaccination coverage realized in Diadema and São Caetano do Sul, state of São Paulo, Brazil, in 2000. Methods: The representation of the samples was evaluated by comparing the tax-paying sector, sorted by their inquiries, to other sectors in two municipalities in terms of socio-demographic characteristrics (age structure of the population, schooling, proportion of families with women at the head, monthly income of the head of the family, and sanitation conditions). The precision of the estimates of coverage by the vaccines in the basic vaccination scheme (BCG; diphtheria, Pertussis and tetanus or DPT, poliomyelitis, hepatitis B; measles, mumps, and rubella or viral triplice) was analyzed through the measurements of the effect of the design and range of the confidence intervals. Precision was considered satisfactory when the effect of the design was less than 2.0 and the range of the confidence intervals was less than 10%. Results: In both municipalities, the comparison between the sorted and non-sorted sectors showed similar distributions for the socioeconomic and demographic variables. With regard to the precision of the estimates, the effect of the design was less than 2.0 for all the vaccines as much as in Diadema as in São Caetano do Sul. In Diadema, the confidence intervals were less than 10% for all vaccines, except viral triplice. In São Caetano do Sul, as the included children were a bit more than 10% for the vaccine against poliomyelitis (10.3%), for the vaccine against the hepatitis B virus (11.8%), for the vaccine against measles (10.4%), for the viral triplice (12.9%) and for the complete scheme (11.2%). Conclusion: The inquiry method of vaccination coverage proposed by the World Health Organization is capable of providing representative facts about the population since the methodological proceedings of selection are followed rigorously in the countryside. (author's)
Menlo Park, California, Henry J. Kaiser Family Foundation, 2004 Jul.  p. (HIV / AIDS Policy Fact Sheet)Young people continue to bear the brunt of the global HIV/AIDS epidemic, with youth under age 25 accounting for more than half of all new HIV infections each year. Those between the ages of 15-24 are particularly hard hit, especially girls and young women who comprise the majority of young people living with the disease. Young people face particular vulnerabilities that put them uniquely at risk for HIV, but they are also critical to the response to the epidemic; where HIV transmission has been reduced, the greatest reductions are often seen among young people. (excerpt)
Washington, D.C., World Bank, AIDS Campaign Team for Africa, 2000 Sep. 16 p.HIV/AIDS is a major development crisis. Not since the Black Death devastated medieval Europe has humankind observed infectious disease deaths on such a scale. Life expectancies, which rose steadily before the onset of the HIV epidemic, are decreasing in nearly all the 25 countries where the adult prevalence rate exceeds 5 percent. In the countries most heavily affected by HIV/AIDS, life expectancy is projected to fall to about 30 years by 2010– a level not seen since the beginning of the 20th century. Various factors related to poverty, inequality, gender inequality, sexually transmitted infections, social norms, political and social changes, including labor migration, conflicts and ethnic factions have facilitated the rapid spread of HIV. But what has enabled HIV/AIDS to undermine economic and social development is its unprecedented erosion of some of the main determinants of economic growth such as social capital, domestic savings and human capital. For these reasons, the HIV epidemic has been transformed from a health issue into a much wider issue impairing economic and social development. Because it prevents an increasing share of the population from participating in economic growth, the HIV/AIDS epidemic increases poverty. The result is a vicious circle whereby HIV/AIDS reduces economic growth and increases poverty, which in turn accelerates the spread of HIV. Preventing further spread of HIV/AIDS, in addition to providing care and support programs to those both affected and infected by this epidemic, requires early intervention and the mobilization of external resources. The purpose of this paper is to discuss and quantify the economic rationale that underlies such an effort. (excerpt)
Geneva, Switzerland, WHO, Department of HIV / AIDS, .  p.Adherence, “the extent to which a person’s behavior – taking medication, following a diet, and/or executing lifestyle changes, corresponds with agreed recommendations from a health care provider”, is a crucial element for the implementation of the HIV treatment scale-up initiative. Properly taken, HAART (highly active anti-retroviral therapy) has been shown to reduce viral loads, but the requirements for adherence are high – most studies suggest that it has to be higher than 90% to avoid the risk of resistance. (excerpt)
New York, New York, United Nations, 2001.  p. (ST/ESA/SER.A/207)The Population Division of the United Nations has a long tradition of studying population ageing, including estimating and projecting older populations, and examining the determinants and consequences of population ageing. From the groundbreaking report on population ageing in 1956, which focused mainly on population ageing in the more developed countries, to the first United Nations wallchart on population ageing issues published in 1999, the Population Division has consistently sought to bring population ageing to the attention of the international community. The present report is intended to provide a solid demographic foundation for the debates and follow-up activities of the Second World Assembly on Ageing. The report considers the process of population ageing for the world as a whole, for more and less developed regions, major areas and regions, and individual countries. Demographic profiles covering the period 1950 to 2050 are provided for each country, highlighting the relevant indicators of population ageing. (excerpt)
Educational aspects of developmental programmes leading to lower fertility: the renewal of education as a population action programme.
[Unpublished] 1972. Presented at the Interregional Workshop on Population Action Programmes, Manila, Philippines, November 15-25, 1972. 11 p. (ESA/P/AC.1/15)Population is not an isolated variable in the development process; it is one of the many socio-economic variables affecting developing countries in their efforts to attain a higher quality of life. Education must respond to the total socio-economic situation if it is to be expected to contribute to the promotion of change. In order to respond effectively, education must be integrally and relevantly renovated. This integral renovation implies innovation in educational planning and administration, and in curriculum contents and teaching and learning methodologies. Within this framework of renovation population-related issues become important components which must be included in educational activities because of their present and future effect on individuals and society. Population education will then be one of the obvious products of an integral and relevant educational response to the challenges proposed by the process of change. (excerpt)
Eastern Mediterranean Health Journal. 2001 Nov; 7(6):956-965.The infant mortality rates for 1978 and 1998 of 16 Arab countries in the Eastern Mediterranean region were studied. The data were extracted from World Health Organization and United Nations Children’s Fund sources. The impact of demographic, social, perinatal care and economic indicators on infant mortality rates in 1998 was studied using Spearman rank coefficient to detect significant correlations. All countries, except Iraq, showed a sharp decline in rates from 1978 to 1998. Infant mortality rates were directly related to population size, annual total births, low birth weight and maternal mortality ratios. Also, infant mortality rates were inversely related to literacy status of both sexes, annual gross national product per capita and access to safe drinking water and adequate sanitation facilities. (author's)
[Cairo and the Catholic Church: A common language] El Cairo y la iglesia católica: Un lenguaje común.
Washington, D.C., Catholics for a Free Choice, 1999. 58 p.Every ten years since 1974, the United Nations has held a conference on population and development. Past conferences were held in Bucharest (1974) and Mexico City (1984). In 1994, 180 governments sent delegates to Cairo, Egypt, to attend the Third International Conference on Population and Development (called the "Cairo Conference" for short). The governments of the world agreed on a list of actions for the future in the form of the Program of Action. The document is 100 pages long and is divided into 16 chapters. The quantitative and qualitative goals agreed on are described from Chapters 3 to 16. Chapter 2 is of particular interest for Catholics and members of other faiths, which presents the ethical aspects of the vision of the Cairo Conference with regard to population and development. (excerpt)
The effect of structural characteristics on family planning program performance in Cote d'Ivoire and Nigeria. [Effet des caractéristiques structurelles sur les performances du programme de planning familial en Côte d'Ivoire et au Nigeria]
Social Science and Medicine. 2003 May; 56(10):2123-2137.This paper uses Côte d’Ivoire and Nigeria survey data on both supply and demand characteristics to examine how structural and demographic factors influence family planning provision and cost. The model, which takes into account the endogenous influence of service provision on average cost, explains provision well but poorly explains what influences service cost. We show that both size and specialization matter. In both countries, vertical (exclusive family planning) facilities provide significantly more contraception than integrated medical establishments. In the Nigeria sample, larger facilities also offer services at lower average cost. Since vertical facilities tend to be large, they at most incur no higher unit costs than integrated facilities. These results are consistent across most model specifications, and are robust to corrections for endogenous facility placement in Nigeria. Model results and cost recovery information point to the relative efficiency of the International Planned Parenthood Federation, which operates large, mostly vertically organized facilities. (author's)
New York, New York, United Nations, Department of Public Information, 2001 Jun 9.  p. (DPI/2214/F)This fact sheet presents five priorities for action, six key factors to achieve these goals, and recommends partnering to carry out the campaign.
[New York, New York], United Nations, 1990.  p. (ST/ESA/STAT/SER.K/8/Add.1/Rev.1)Selected indicators of equality, development, and peace are charted for 178 countries and regions of the world for the most recent year available. The data were obtained from the UN Women's Indicators and Statistics Data Base for microcomputers (Wistat) maintained by he Statistical Office of the UN Department of International Economic and Social Affairs. The chart updates the prior 1986 publication and supplements the UN publications, Women and Social Trends (1970-90). Population composition and distribution measures include total population in 1990 by sex, percentage of the population >60 years of age by sex, and percentage of rural population by sex (1980/85). Educational measures are provided for the percentage of illiterate population aged 15 years and older (1980-85) by sex, primary and secondary enrollment by sex (1985/87), and post-secondary enrollment by sex. Economic activity is measured by the percentage of women in the labor force. Other measures include the population aged 45-59 not currently married (1980-85) by sex, the total fertility rate (1985-90), maternal death rate (1980/86), and percentage of female contraceptive use 1980/88). The percentage of female legislators is given for 1985/87 where data is available. Definition of terms is briefly and generally given.
In: European Population Conference / Conference Europeenne sur la Population. Proceedings / Actes. Volume 2. 23-26 March 1993, Geneva, Switzerland / 23-26 mars 1993, Geneve, Suisse, [compiled by] United Nations. Economic Commission for Europe, Council of Europe, United Nations Population Fund [UNFPA]. Strasbourg, France, Council of Europe, 1994. 67-71.The country statement of Azerbaijan related population growth of 15.7% to 7.3 million between 1982 and 1992. The population below working ages declined from 38.2% to 24.6%. Working age population increased by 2.6%. The aged increased by 1%. The total birth rate coefficient declined by 33.4% for women aged 20-34 years by 1992. Average family size declined from 5.1 to 4.8. Women's employment increased 14.5%. The sex ratio and selected age groups have been adversely affected due to the war with Armenia. State support of involuntary migrants and refugees is estimated at 600,000 persons. Child mortality declined and recently increased to 25.0, mainly due to acute pneumonia, sepsis, congenital defects, and birth injuries. There are shortages of hospital beds, pediatricians, medicinal drugs, and medical equipment. Marriage has declined only slightly from 10.5 to 9.8, and divorce increased slightly from 1.2 to 1.5. The marriage rate in all age groups has declined; this is attributed to poor economic prospects. Unemployed persons numbered 320,000, of whom 80% are females and 60% are young people. Demographic policy should be prepared to encourage average sized families and to support larger families. Mortality rates need to be reduced for infants, mothers, workers, and the aged. The entire health care system needs to be improved, including health and social services for the elderly. Quality of life improvements and social and economic development, particularly in areas with recent population accumulation or influx, must be addressed. The conditions for women must be improved to balance women's work with domestic roles and assuring reproductive health and rights. The government of Azerbaijan looks to the world for considerable assistance in attaining a higher quality of life in a market economy.
National report on population. Prepared for the International Conference on Population and Development, September 1994.
[Tunis], Tunisia, Ministry of Planning and Regional Development, 1994 Aug. 57 p.Tunisia's country report for the 1994 International Conference on Population and Development opens with a brief discussion of the country's history and development achievements (the population growth rate has been reduced from 3.2% in the beginning of the 1960s to less than 2%, and Tunisia has achieved significant improvement over the past 2 decades in human development indices). Tunisia's population policy has gone through 3 stages: the establishment of an important legal framework during the 1950s and 60s, the creation of a National Family and Population Board and establishment of basic health care facilities during the 1970s, and an emphasis on environmentally-responsible development with an attempt to strengthen the integration of population policies into development strategies beginning in the 1980s. The report continues with an overview of the demographic context (historical trends and future prospects). The chapter on population policies and programs covers the evolution and status of the policies; sectoral strategies; development and research; a profile of the family health, family planning (FP), IEC (information, education, and communication), and data collection and analysis programs. This chapter also provides details on policies and programs which link women and families to population and development and on those which concern mortality, population distribution, and migration. The third major section of the report presents operational features of the implementation of population and FP programs, in particular, political support, program formulation and execution, supervision and evaluation, financing, and the importance and relevance of the world plan of action for population. Tunisia's national action plan for the future is discussed next in terms of new problems and priorities and a mobilization of resources. This section also includes a table which sets out the components, goals, strategies, and programs of action of the population policy. In conclusion, it is stated that Tunisia's population policy fits well with the world program of action because it promotes human resources and sustainable development and respects international recommendations about human rights in general and the rights of women in particular.
Government of Sierra Leone. National report on population and development. International Conference on Population and Development 1994.
Freetown, Sierra Leone, National Population Commission, 1994. , 15,  p.The government of Sierra Leone is very concerned about the poor health status of the country as expressed by the indicators of a high maternal mortality rate (700/100,000), a total fertility rate of 6.2 (in 1985), a crude birth rate of 47/1000 (in 1985), an infant mortality rate of 143/1000 (in 1990), and a life expectancy at birth of only 45.7 years. A civil war has exacerbated the already massive rural-urban migration in the country. Despite severe financial constraints, the government has contributed to the UN Population Fund and continues to appeal to the donor community for technical and financial help to support the economy in general and population programs in particular. Sierra Leone has participated in preparations for and fully supports the 1994 International Conference on Population and Development. This document describes Sierra Leone's past, present, and future population and development linkages. The demographic context is presented in terms of size and growth rate; age and sex composition; fertility; mortality; and population distribution, migration, and urbanization. The population policy planning and program framework is set out through discussions of the national perception of population issues, the national population policy, population in development planning, and a profile of the national population program [including maternal-child health and family planning (FP) services; information, education, and communication; data collection, analysis, and research; primary health care, population and the environment; youth and adolescents and development; women and development; and population distribution and migration]. The operational aspects of the program are described with emphasis on political and national support, FP service delivery and coverage, monitoring and evaluation, and funding. The action plan for the future includes priority concerns; an outline of the policy framework; the design of population program activities; program coordination, monitoring, and evaluation; and resource mobilization. The government's commitment is reiterated in a summary and in 13 recommendations of action to strengthen the population program, address environmental issues, improve the status of women, improve rural living conditions, and improve data collection.