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Poverty in Focus. 2007 Oct; (12):6-7.Two years ago at Gleneagles, the G8 countries promised to double their aid to Africa. Since then, they have written off a substantial part of the external debt to the largest and oil-richest country, Nigeria. But new aid to the continent has stayed flat. In 2006, while Europe increased its aid, the two largest G8 economies, USA and Japan, reduced theirs. Africa, quite rightly, commands the growing attention of donors. But aid amount targets, both for Africa and globally, are often missed. Does that matter? This article makes four propositions: (i) traditional aid amount targeting is following a false scent in development terms; (ii) supply-driven aid has questionable value; (iii) aid should be more concerned with genuine country-based development goals; and (iv) rich countries should use aid as a means of facilitation, not as patronage. Targeting aid amounts is nothing new. In 1970, the UN set the target of 0.7 per cent of rich countries' Gross National Product (GNP) for Official Development Assistance (ODA). Since then a growing number of donor countries have stated their intention to reach it. The main purpose for setting such targets for aid is to create and sustain a momentum for ODA. While most donors haven't met the target, many have agreed that they should increase assistance to the poor countries. For the politicians of the rich countries and their constituents, therefore, aid volume targeting plays a useful role in reminding governments of their obligations. The two largest donors, however-USA and Japan-are exceptions. (excerpt)
Lewis questions results of G8 Summit; calls for independent, international women's agency; challenges scientists to engage in campaign of advocacy. Statement by Stephen Lewis, UN Envoy on HIV / AIDS in Africa, at the opening of the 3rd International AIDS Society Conference, Rio de Janeiro, Brazil, 24 July 2005.
AIDS Bulletin. 2005 Sep; 14(3):10-13.This is a meeting of scientists and experts in the world of AIDS. I am neither a scientist nor an expert. I'm an observer. I have spent the last four years, traveling through Africa, primarily southern Africa, watching people die. I think I understand, better than most, why your collective scientific and academic work can be said to be the most important ongoing work on the planet. But precisely because the work you do speaks to the rescue of the human condition, you carry an immense public and international authority. I beg you never to underestimate that authority. And I beg you to use it beyond the realms of science. What we desperately need in the response to AIDS today are voices of advocacy: tough, unrelenting, informed. The issues are so intense, the situation is so precarious for millions of people, the virus cuts such a swath of pain and desolation, that your voices, as well as your science, must be summoned and heard. (excerpt)
Lancet. 2005 Jul 16; 366(9481):177.This year people in bars and at football matches were asking about the Group of 8 (G8) nations summit in Gleneagles, Scotland. Such unprecedented popular interest was prompted by Bob Geldof’s Live 8 concerts and the Make Poverty History campaign. These initiatives were organised to raise awareness about African poverty and to pressure politicians into tackling the preventable global burden of disease afflicting billions of people living in low-income settings. When asked if his lobbying had paid off, Geldof said, “A great justice has been done”. He should have said “No”. While the concerts were successful as entertainment and the Make Poverty History campaign certainly raised awareness, they failed as political levers for change. What did the G8 achieve? One objective of the summit was to design policies to help Africa meet the UN Millennium Development Goals (MDGs) by 2015. The first MDG calls for the eradication of extreme poverty and hunger. The G8 achieved almost nothing new here, despite the impressive rhetoric of the final Gleneagles communiqué. The G8 pledged to forgive debt for many of Africa’s poorest countries and to increase total aid to developing nations by US$50 billion by 2010. But that investment is too little too late. (excerpt)
Tanzanian Journal of Population Studies and Development. 1996; 3(1-2):1-14.In the space of two and a half decades, documentation of African rural women's work lives has moved from state of dearth to plethora. Awareness of women's arduous workday, and the importance of women agriculturists to national economies are now commonplace among African policy-makers and western donor agencies. Throughout the dramatic upheaval in African development policy of recent years, as state and market forces realign, donor agencies have consistently espoused a concern to improve the material conditions and status of rural women's working day throughout sub-Saharan Africa overwhelm donor's scattered projects directed at alleviating women's workload. The central question posed is how external donor agencies can extend beyond localized project efforts to help provide the material foundation for widespread change in women's working day of a self-determining nature. Still local in scale and last on the agenda, will measures to address women's work be elevated to a more central position in international development program efforts in sub-Saharan Africa? (author's)
BMJ (CLINICAL RESEARCH ED.). 1998 Jul 4; 317(7150):11.While most industrialized nations and a handful of developing countries are seeing the spread of HIV infection level off or even decline, infection rates are reaching alarming new highs in much of the developing world, according to the first country by country analysis by the joint United Nations Programme on HIV/AIDS (UNAIDS). Along with the widening gap in infection rates, the report also reveals a looming divide between countries where rates of new AIDS cases and deaths from AIDS are falling and countries where they are rising as people infected with the disease succumb in greater numbers than before. The major reason is uneven access to newer antiretroviral drugs, which forestall the development of AIDS. Among the report's most striking findings was new information concerning 13 countries in sub-Saharan Africa, where at least 10% of all adults are infected with HIV, with the prevalence in many capital cities 35% or more. Botswana and Zimbabwe have each reached a prevalence of 25%, a new world high. (full text)
Lancet. 1998 May 23; 351(9115):1561.Leaders of the world's 8 major government powers who met at the Group of Eight (G8) Summit in Birmingham, UK, during May 15-17, endorsed an international initiative to control malaria and other parasitic diseases. The leaders agreed to improve mutual cooperation on infectious and parasitic diseases, and offered support for the new World Health Organization (WHO) initiative "Roll Back Malaria" to reduce levels of malaria-related mortality by 2010. UK Prime Minister Tony Blair was, however, the only leader to pledge new funding, in the amount of US$100 million, for the initiative. The other G8 countries fought the inclusion of specific targets in the final joint G8 document and made no new commitment to fund the malaria initiative. The Japanese government's report on global parasite control for the 21st century outlined 4 strategies for controlling malaria, soil-transmitted nematode infections, schistosomiasis, filariasis, and other parasitic infections. The strategies include international cooperation for implementing parasite control and research to provide a scientific basis for such control. Roll Back Malaria will begin in Africa. G8 support was less enthusiastic for France's Therapeutic Solidarity Initiative to establish a fund for HIV treatment regimens which are appropriate to conditions in the developing world.
HEALTH TRANSITION REVIEW. 1997; 7 Suppl 4:37-42.The onset of fertility decline in France during the late 18th century and broader decline during the last third of the 19th century in Western Europe and the English-speaking European colonies demonstrates that humans are willing to control their fertility. Fertility transition was a social phenomenon. It has also been observed that the idea of fertility decline can spread and be acted upon elsewhere. The events of the International Conference on Population and Development (ICPD) are described and the need to control population growth in sub-Saharan Africa is discussed. While the ICPD's advocacy of improving women's autonomy, status, education, and reproductive health is laudable, those goals are opposed to that of completing the demographic transition. The existence of this opposition indicates that there have been changes in longstanding intellectual and technical aid consensuses. In the wake of the ICPD, developed country governments may never again emphasize the need for family planning programs in developing countries. The largest effect of such a course will probably be upon the demographic transition in sub-Saharan Africa. However, those interested in improving reproductive health in the Third World may join forces with the population movement when they realize that well-funded family planning programs are the key to improving reproductive health services.
PEOPLE AND THE PLANET. 1997; 6(1):10-1.Dr. Nafis Sadik, Executive Director of the UN Population Fund, notes that in the wake of the 1994 International Conference on Population and Development (ICPD), governments have been persuaded to abandon demographic targets and instead set specific social goals such as reductions in maternal, child, and infant mortality, and improvements in education, especially for girls. Progress is being made with regard to health and education, with all countries having set target dates for the enrollment of all children in school. The meaning of basic health services for all remains unclear. Progress is also being made against female genital mutilation and sexual violence, and improving women's status and the delivery of reproductive health care. Most countries could, however, do a lot more, and greater public support and resources are needed for programs. India, Brazil, Egypt, and Peru are cited as examples of countries which have begun to change policy following the ICPD. Developing countries and donors, with the exception of the US in 1996, have made efforts to increase their levels of spending on reproductive health services; the US has reduced its aid budget by 35%.
CARRYING CAPACITY NETWORK FOCUS. 1997; 7(1):37-9.The subject of demographic entrapment is taboo in most UN agencies and in academia because of the upheaval that would occur if entrapment were acknowledged. Demographic entrapment occurs if a population has exceeded or is projected to exceed the combination of the carrying capacity of its own ecosystem and its ability to trade for its needs or to migrate to other ecosystems. Demographic entrapment leads populations to become progressively stunted physically (as is occurring in Malawi) or starve, die from disease, or implode in social chaos (Rwanda). Disentrapment can theoretically occur if communities increase the carrying capacity of their ecosystem, develop an export community, increase migratory opportunity, reduce population growth, or combine these measures. The major method of escaping entrapment seems to be reducing population growth by promoting one-child families. If developed countries urge developing countries to adopt this policy, developed countries should adopt it also because per capita consumption of natural resources in developed countries is perhaps 50 times greater than in developing countries. Discussion of demographic entrapment remains taboo because of fear that such discussion would challenge: 1) the materialistic, consumeristic, market economy that is the current foundation of global society; 2) the consumption and employment patterns of developed countries; 3) human rights notions about reproduction, anti-abortion attitudes, and pronatalist views; and 4) false assumptions about universal economic development. Countries (like Malawi) where entrapment is causing widespread malnutrition should receive interim food aid tied to population reduction. Developed countries should promote development of sustainable lifestyles that include having one-child families and consuming photon-efficient diets. UN agencies must face the uproar that will occur upon acknowledgement of entrapment in order to call for simultaneous reproductive and lifestyle changes throughout the world.
Highlights of interventions at meeting for 1994 International Conference on Population and Development.
POPULATION HEADLINERS. 1993 Jun; (219):4-5.The Preparatory Committee for the International Conference on Population and Development in Cairo, Egypt (September 5-14, 1994), has received recommendations for the conference's final document from various population and development organizations. UNFPA's Executive Director, who serves as Secretary-General of this Conference, recommends that the document should list goals for all countries to achieve over 20 years, particularly a goal of dedicating 20% of public sector expenditures to social programs. She also calls for developing countries to reach levels of developed countries in maternal and infant mortality, life expectancy, education, gender equality, and access to the entire spectrum of family planning services. The Conference should affirm reproductive rights. Population activities of official development assistance should increase from 1.5% to 4%. Representatives from other groups and/or countries echo her concerns, but some want to accord more emphasis to other issues as well, including development, demographic aging, employment, the disabled, and poverty. The Japanese representative informs the Committee that the Government of Japan, UNFPA, and the United Nations University are sponsoring an international conference on global population issues in Tokyo during the summer of 1994. The Nepalese representative hopes the Conference recommendations will be practical, affordable, and appropriate to the objectives of developing countries. The Pakistani representative wants the Cairo Conference to build on the Bucharest and Mexico City Conferences and on the UN Conference on Environment and Development rather than renegotiating them.
Baltimore, Maryland, Johns Hopkins University Press, 1990. lxxiii, 421 p.The World Bank's Population and Human Resources Department regularly publishes a set of world population projections based on its data files. This 1989-90 report has projections for the world and for regions, income groups of countries, and 187 countries. World Bank staff made projections to the point where populations reach stability. In almost all cases, they made only 1 projection. Projection tables for 1985-2030 exist for each country's population. Each country also has tables on birth rate, death rate, net migration, natural increase, population growth, total fertility rate, life expectancy, infant mortality rate, and dependency ratio. The report shows that from 1985-90 population growth was 1.74%, and projected 1990 world population size was 5.3 billion. By 2025, 84.1% of the world's population will be living in developing countries. 58% of the population now lives in Asia. The population of Africa is growing faster than that of Asia, however, (3 vs. 1.9%). By 2000, the population of Africa will be second only to that of Asia, yet in 1989-1990, it is behind that of Asia, Europe and the USSR, and the Americas. The current dependency ratio (67) is expected to decline to 53 by 2025. The highest current dependency ratio belongs to Kenya (120). In developed countries with aging populations, the dependency ratio will rise from 50-58. China will most likely to continue to be the most populous country for about 200 years. India will continue to contribute more to population growth than any other country in the world. Yet the Federal Republic of Germany loses 100,000 people yearly. Total fertility rates are the greatest in Rwanda, the Yemen Arab Republic, Kenya, Malawi, and the Ivory Coast (all >7.2). Afghanistan and 3 western African countries have the shortest life expectancies (about 40 years). These trends illustrate the need to alter population growth.
A reassessment of the concept of reproductive risk in maternity care and family planning services. Proceedings of a seminar presented under the Population Council's Robert H. Ebert Program on Critical Issues in Reproductive Health and Population, February 12-13, 1990, the Population Council, New York, New York.
New York, New York, Population Council, 1990. x, 185 p.Conference proceedings on reassessing the concept of reproductive risk in maternity care and family planning (FP) services cover the following topics: assessment of the history of the concept of reproductive risk, the epidemiology of screening, the implementation of the risk approach in maternity care in Western countries and in poorer countries and in FP, the possible effects on the health care system, costs, and risk benefit calculations. Other risk approaches and ethical considerations are discussed. The conclusions pertain to costs and allocation of resources, information and outreach, objectives, predictive ability, and risk assessment in FP. Recommendations are made. Appendixes include a discussion of issues involved in developing a reproductive risk assessment instrument and scoring system, and the WHO risk approach in maternal and child health and FP. The results show that the application of risk assessment warrants caution and usefulness in service delivery is questionable. The weaknesses and negative effects need further investigation. Risk-based systems tend toward skewed resource allocation. Equal access to care, freedom of choice, and personal autonomy are jeopardized. Risk assessment can accurately predict for a group, but not for individuals. Risk assessment cannot be refined as it is an instrument directed toward probabilities. The risk approach must be evaluated within a functioning health care system. Screening has been important in developed countries, but integration into developing country health care systems may be appropriate only when basic health care is in place and in urban and periurban communities. Recommendations are 1) to prevent problems and detect rather than predict actual complications when no effective maternity care is available; to provide effective care to all women, not just those at high risk; and to provide transportation to adequate facilities for women with complications. 2) All persons attending births should be trained to handle emergencies. 3) Risk assessment has no value unless basic reproductive health services are in place. Cost benefit analysis precludes implementation. Alternative strategies are available to increase contact of women with the health care system, to improve public education strategies, to improve the quality of traditional birth attendants, and to improve the quality of existing services. Women's ideas about what is "risk" and the cost and benefits of a risk-based system to women needs to be solicited. All bad outcomes are not preventable. Copies of this document can be obtained from The Population Council, One Dag Hammarskjold Plaza, NY, NY 10017. Tel: (212) 339-0625, e-mail firstname.lastname@example.org.
Tuberculosis control and research strategies for the 1990s: memorandum from a WHO meeting] Estrategias de control e investigacion de la tuberculosis en el decenio de 1990: memorandum de una reunion de la OMS.
BOLETIN DE LA OFICINA SANITARIA PANAMERICANA. 1993 May; 114(5):429-36.Mycobacterium tuberculosis, the pathogenic agent causing tuberculosis, is carried by one third of the world's population. Some 8 million new clinical cases of tuberculosis are diagnosed annually. Pulmonary tuberculosis is the most infectious clinical manifestation, tubercular meningitis is the principal form causing infant death, and tuberculosis may affect various other organs. Untreated tuberculosis has a fatality rate of over 50%. Chemotherapy greatly reduces the rate, but some 2.9 million persons die of tuberculosis each year because of the inadequacy of many national treatment programs. Tuberculosis is the most important cause of death from a single infectious agent in the world. An estimated one fourth of avoidable deaths to adults aged 15-59 in the developing world are attributed to tuberculosis. Tuberculosis is especially prevalent in Africa south of the Sahara and in Southern Asia. Two new obstacles threaten to aggravate the problem: the HIV epidemic and drug resistance. HIV infection is the most serious risk factor yet identified because it converts latent tuberculosis infection into active disease. In Africa almost half of all persons seropositive for HIV are also infected with tuberculosis. Ineffective treatment programs favor the formation of pharmacoresistent strains, and drug resistance has become a major problem in various parts of the world. Effective measures exist to control tuberculosis. Although it does little to protect adults against infectious forms of tuberculosis, the BCG vaccine prevents the most lethal forms. Coverage of infants the BCG is over 80% in the developing world as a whole, but under 60% in sub-Saharan Africa. Chemotherapy can cure almost all cases and convert cases with positive sputum into noninfectious cases, reducing transmission. Normal treatment must be administered over at least 12 months, straining the resources of health services in developing areas. The introduction of a shorter therapy has revolutionized treatment in some national programs, which have achieved cure rates of 80% in new patients. Evaluation of some national programs has demonstrated that well managed short duration chemotherapy is cost effective even under difficult conditions. Progress in controlling tuberculosis has been slower than expected in developing countries because of excessive optimism about the prospects for quick declines as occurred in the industrialized countries, and because of lack of resources. A well organized and vigorous international effort under World Health Organization leadership is required to bring the tuberculosis problem to the world's attention, mobilize assistance on a wide scale, and provide information and direct support to national programs. Research will be needed to adapt proven control techniques to local cultures, develop new drugs, shorten treatment regimens, and encourage greater patient compliance.
[Population policies: evolution of the position of the Sahelian countries since the Bucharest conference] Politiques de population: evolution de la position des pays Saheliens depuis la conference de Bucarest.
POP SAHEL. 1992 Jul; (Spec No):23-7.This work describes the evolution of population policies and attitudes toward them in the Sahel countries since the 1974 World Population Conference. Recommendations of several important international population conferences in which the Sahelian countries participated are then listed. The Bucharest Conference is widely regarded as the 1st serious attempt at coordinated action on population. The divergent approaches of the developed and developing countries toward population phenomena became obvious at the Conference. The developed countries of the north expected the less developed countries of the south to pledge greater efforts at controlling demographic growth, which they viewed as impeding economic development. The countries of the south on the other hand saw the problem as 1 of unequal distribution of wealth. Many African countries also believed their economic growth would be accelerated by the additional workers they would eventually gain through population growth. Reduced population growth in this view would result from rather than contributing to development. Despite these disagreements, Conference participants adopted the World Population Plan of Action which made 5 recommendations including establishment and promotion of family planning education and services. Numerous countries began to pay greater attention to population variables in their development planning after Bucharest. The Sahel countries participated in the Arusha Conference, a July 1984 meeting of African countries preceding the World Population Conference in Mexico City, and in the Mexico City Conference. The Arusha Conference adopted the "Program of Action of Kilimanjaro Concerning African Population and Autonomous Development", which contained 16 recommendations to governments to recognize the interdependence of demographic factors and development. By the 1984 Mexico City Conference, various events such as the drought, chronic economic problems, and rapid population growth combined to bring about a change in the positions of the Sahel countries. Only Senegal and Gambia described their fertility levels as unacceptably high; the remaining Sahel countries were much more concerned with very high mortality rates. The Mexico City Conference adopted 2 recommendations calling for adoption of mutually supportive demographic and development policies by governments, and for provision of sufficient resources to allow realization of demographic objectives. After Arusha and Mexico City, the Sahel countries held several conferences and seminars to study their demographic problems and the relationships between population variables and development. 1 such conference produced the "Program of Action of Ndjamena", considered the most important regional reference document for development of population policies and programs. The persistence of high fertility and mortality rates and of economic crisis in the Sahel have prompted continuing attention to population variables.
African debt crisis and the IMF adjustment programmes: the experiences of Ghana, Nigeria and Zambia.
In: Development perspectives for the 1990s, edited by Renee Prendergast and H.W. Singer. Basingstoke, England, Macmillan, 1991. 37-57.Sub-Saharan African countries suffer from rapidly growing external debt and the concomitant burden of its service; debt service in 1987 accounted for 40.6% of exports. Liberal and neo-Marxist rationales exist to explain the development and existence of the African debt crisis. The former view, however, drives the market-oriented development approach of the IMF and World Bank and has resulted in the development and imposition of structural adjustment programs (SAP). Main components of SAP are exchange rate reforms or currency devaluation; trade liberalization; export promotion; rationalization of public expenditure, capital, investment, and employment in the public sector; privatization and commercialization of public enterprises; producer price adjustment; wage restraints; withdrawal/reduction of subsidies; tax structure reform; and financial/administrative reforms. SAP, however, ignores that the narrow production base of post-colonial African states encourages unpredictable export earnings which in turn make it hard for countries to concurrently service debt and pay for imports to cushion the effects of SAP. Internally, programs also ignore the inflationary effect of devaluation while underestimating the social cost of domestic tightening on living standards. While national leaders are willing to take steps towards much-needed structural reform, they object to SAP policies which exacerbate Africa's dependence upon external financial flow. The African Alternative Framework to Structural Adjustment Programmes for Socio-Economic Recovery and Transformation therefore proffers that the IMF modify its policy to allow African states to strengthen and diversify production capacities. Recommendations are largely reflationary and would require substantial internal and external funding. In sum, donor and recipient states must recognize that both internal and external factors caused the present situation and that interested parties must continue to explore viable options for action; African nations need structural reform but with out paralyzing their productive bases; and that the social costs of SAP must be evenly distributed in order to be politically acceptable. The structural adjustment experience of Ghana, Nigeria, and Zambia are presented as examples of these realities and conclusions.
Geneva, Switzerland, World Health Organization [WHO], Division of Family Health, Maternal Health and Safe Motherhood Programme, 1992. 74 p. (Safe Motherhood; WHO/MSM/92.4)Women in Africa face a lifetime risk of maternal mortality 500 times greater than that of women in developed countries. This lifetime risk is also considerably higher for women in other developing regions compared to that for those in developed countries. Many health professionals believe that antenatal care in developing countries decreases the likelihood of women dying pregnancy and childbearing as well as significant maternal morbidity, yet no one has systematically assessed its potential to actually improve maternal health. The WHO Maternal Health and Safe Motherhood Programme plans to support research to examine antenatal care's potential. It has reviewed the effectiveness of antenatal interventions compared to poor maternal health in developing countries. The review reveals that good quality data are scarce and that health providers have not accurately tested many interventions. For example, the US, UK, and Sweden have all achieved low case fatality rates for eclampsia using a different anticonvulsant therapy for severe preeclampsia (magnesium sulfate; diazepam or other benzodiazepines; and hydralazine with at least chlorpromazine, pethidine, diazepam, and chlormethiazole, respectively), but few trails have compared the different treatments. This review begins with an overall look at antenatal care programs. It then examines interventions of the leading causes of maternal mortality and morbidity (hemorrhage and anemia, hypertensive disorders of pregnancy, obstructed labor, and puerperal sepsis and genitourinary). The most effective interventions are those that deal with chronic conditions rather than acute conditions which arise near delivery. The review concludes with a table of effective antenatal interventions and tables of research questions about potentially effective antenatal interventions against various maternal conditions.
WORLD HEALTH FORUM. 1991; 12(4):496-7.WHO estimates that the number of AIDS cases worldwide will grow from about 1.5 million to 12-18 million by 2000--a 10 fold increase. Further it expects the cumulative number of HIV infected individuals to increase from 9-11 million to 30-40 million by 2000--a 3-4 fold increase. Dr. Hiroshi Nakajima, the Director-General of WHO, points out that despite the rise in AIDS, there is something for which to be thankful--neither air, nor water, nor insects disseminate HIV and causal social contact does not transmit it. Further since AIDS is basically a sexually transmitted disease, health education can inform people of the need to make life style changes which in turn prevents its spread. In addition, Dr. Nakajima illustrates how frank health education and information campaigns in the homosexual community in developed countries have resulted in reduced infection rates. In fact, many of the people disseminating the safer sex message in the homosexual community were people living with HIV and AIDS. HIV has infected >7 million adults and children in Sub-Saharan Africa since the AIDS pandemic began. It is now spreading quickly in south and southeast Asia where at least 1 million people carry HIV. In fact, WHO believes that by the mid to late 1990s HIV will infect more Asians than Africans. Further Latin America is not HIV free and it can be easily spread there too. Heterosexual intercourse has replaced homosexual intercourse and needle sharing by intravenous drug users as the leading route of HIV transmission.
[Unpublished] . 100 p. (WHO/MCH/MSM/91.6)The Maternal Health and Safe Motherhood Programme under WHO's Division of Family Health has compiled maternal mortality data in its 3rd edition of Maternal Mortality Ratios and Rates. The report contains data up to 1991. These data come from almost all WHO member countries. 1988 estimates reveal that 509,000 women die each year from causes related to pregnancy and childbirth. Most die from preventable causes such as aseptic abortions and lack of adequate health care. 4000 of these maternal deaths occur in developed countries. Thus developing countries, where 87% of the world's births occur, experience 99% of maternal deaths. In fact, the lifetime risk of death from causes related to pregnancy and childbirth in developing countries is 1:57 compared to 1:1825 in developed countries. Women in countries of western Africa have the greatest risk (1:18) and those in North America the smallest risk (1:4006). Even though the maternal mortality ratio for developing countries fell from 450-520 per 100,000 live births between 1983-1988, it increased in western African countries (700-760). This report consists mainly of tables of maternal mortality estimates for each country and in some cases certain areas of each country, for the world and various regions and subregions, and changes in maternal mortality since 1983 for the world and various regions and subregions. The world comparison table includes live births, maternal deaths, maternal mortality ratios and rates, lifetime risk, and total fertility. Country tables list year, data sources, maternal mortality ratio, indication if abortion deaths were included or not, and reference.
Weekly Epidemiological Record / Releve Epidemiologique Hebdomadaire. 1991 Nov 22; 66(47):345-8.Recent community studies and better information systems have made it possible for WHO to reassess maternal mortality and calculate new estimates. These new estimates indicate that pregnancy and childbirth are somewhat safer for women in parts of Latin America and most of Asia than they were in 1983. In Sub-Saharan Africa, however, a rise in births have resulted in an equal rise in maternal deaths. Further, it is in Sub-Saharan Africa where the only real increases in maternal mortality occurred since 1983. Thus deteriorating economic and health conditions in Sub-Saharan Africa have resulted in maternal mortality here being the worst in the world. Like in 1983, >500,000 women still die annually from pregnancy related causes and childbirth because there has been about a 7% increase in the number of births, but the risks are around 5% lower than in 1983. In developed countries, maternal mortality and number of maternal death have decreased 13% since 1983. In the Caribbean, the rise in maternal mortality is actually due to better information. In Latin America, maternal mortality in most countries, except Haiti and Bolivia, stand <200/100,000 live births. In fact, the number of maternal deaths has declined by almost 25%. A recent nationwide study in China reveals that the former maternal mortality figure of 50 was inaccurate and was actually almost 100. Except for China, however, declines in risks or pregnancy and number of deaths have occurred in all subregions of Asia. Country specific data, estimates, and explanations of how statisticians arrived at estimations appear in either 1 of 2 WHO reports entitled Maternal Mortality; A Global Factbook (US$45) and Maternal Mortality: A Tabulation of Available Information (free).
NETWORK. 1991 Sep; 12(2):14-7, 27.Many unwanted births and pregnancies could be avoided by improving instructions for and comprehension of the use of oral contraceptives. Employed less than only the IUD, the oral contraceptive pill is the 2nd- most widely used reversible form of contraception, used by 8% of all married women of reproductive age. 6-20% of pill users, however, fall pregnant due to improper pill use. Improving instructions in the pill pack, ensuring that instructions are correct, and working to facilitate user understanding and motivation have been identified as priorities in maximizing the overall potential effectiveness of the pill against pregnancy. Since packets in developing countries may consist of pills in cycles of 21, 22, 28, or 35 days, providers must also be trained to instruct users in a manner consistent with the written instructions. Pictorial information should be available especially for semi-literate and illiterate audiences. The essay describes recommendation for instruction standardization and simplification put forth by Family Health International, and endorsed by the U.S. Food and Drug Administration. International Planned Parenthood Federation efforts to increase awareness of this issues are discussed.
The Integration of Population Variables into the Socio-Economic Planning Process. An International Seminar jointly sponsored by the UN Population Division, UNFPA and CICRED, and hosted by the Government of Morocco, Rabat, Morocco, 9-12 March 1987. Integration des Variables Demographiques dans le Processus de Planification Economique et Sociale. Seminaire International organise sous le patronage conjoint de la Division de la Population des Nations Unies, du FNUAP et du CICRED, et tenu a Rabat a l'invitation du Gouvernement du Maroc, Rabat, Maroc, 9-12 mars 1987.
Paris, France, CICRED, 1988. 159 p.Conference proceedings from an international seminar sponsored by the UN Population Division, the UN Fund for Population Activities (UNFPA), and the Committee for International Cooperation in National Research in Demography (CICRED) are presented in both French and english versions in one volume. Hosted by the government of Morocco, the opening speech is delivered by the Secretary General of the Ministry of Planning of Morocco. The statement from the UNFPA is then presented, followed by a message from the Director of the UN Population Division. The Coordinator of the Project next provides the foreword. Report of the Seminar is made, including annexes of the agenda and list of participating institutions, followed by discussion of possible areas of research and application. Research projects currently implemented or contemplated by participating centers are listed, with closing comments from the Vice-President and Bureau of CICRED. A list of documents prepared by the participants is included.
INTEGRATION. 1989 Dec; (22):14-7.Affirming that international cooperation along North-North, North-South, and South-South lines is essential for mutual survival, Mr. Waiyaki calls upon international understanding, good w ill, determination, and compromise in achieving mutually beneficial socioeconomic development for developing nations, while avoiding serious international confrontation and internal civil strife. He cites remaining instances of colonialism and the debate over Africa's debt repayment as potential conflict areas, then provides previously suggested resolving steps involving the Organization for Economic Cooperation and Development and the Economic Commission for Africa. Regarding internal strife, he discusses the hardships imposed upon African populations by structural adjustment programs. Should such exacerbatory measures be implemented in the hope of fostering development, negative international ramifications are possible. Specifically, the potential failure of measures to redress regional population and environmental problems should not be discounted. Improved communications and increasing interdependence continue to make the world seem smaller, allowing regional changes to affect the world on a broader scale. Key issues in high population growth, especially in Africa, Latin America, and Oceania, and environmental concerns are explored. The address includes specific mention of determinant factors and suggestions for Northern country interventions in finding solutions to these comprehensive concerns.
WORLD HEALTH FORUM. 1989; 10(3-4):397-402.Persons who line in developing countries are awarded fellowships for study abroad. They are given by many donors, the UN and the World Health Organization among them. It is important to know whether the money is used effectively. Many donor agencies have done evaluations, but difficulties arise. The recipient governments should evaluate the fellowships. The current selection process may be politicized, and fellowships are not officially advertised. There may also be irregularities in employing the returned fellows. It is hard to see what changes could be brought about by a donor's evaluation that hinted at a country's misuse of fellowships. Recipient countries have the right to run their own affairs. However, they should understand the advantages and responsibilities of this. Many donor's evaluations are not of much worth to recipients. Some criteria used by donors are not meaningful to recipients. There may be conflicting opinions about needs and technologies. Attempts may be made to get fellows from third world countries even if the courses are not terribly suitable. The influences that the fellows may be exposed to are very important. Many governments provide awards to their citizens for overseas training. It would be very useful for countries to analyze all fellowship activity. This could give information about overlapping. In Lesotho, too much emphasis was put on rural development. Recipient countries are in a better position to find former fellows. Donor studies tend to be bureaucratized, evaluated from habit rather than need. Occasionally reports have not come to the attention of authorities, which does no one any good. Oversimplified attempts may take place. Research should be adapted to standard methods. If recipient countries do not have the experience required to evaluate fellowships, it could be done jointly by donors and recipients.
INTERNATIONAL MIGRATION REVIEW. 1989 Fall; 23(3):579-98.This article examines the evolution of the current international system for responding to refugee problems and the climate within which the legal and institutional framework has developed. It reviews the background and handling of some of the key refugee movements since World War II and traces the legal and institutional adjustments that have been made to deal with new refugee movements that have occurred predominantly, but not exclusively, in the developing world. Finally, it assesses the adequacy of the present system to meet the challenges ahead. (author's)
POPULI. 1989 Dec; 16(4):4-17.Official Development Assistance (ODA) for population activities rose from US $100 to over US $400 million between 1968-72, again rising to US $500 million in 1985, then declining, representing 2% in the 1970's shrinking to 1.12% by 1982 and rising to 1.3% of all ODA by the mid- 80's. Of the 17 major donor countries, the US provides more than 1/2 of all population assistance, followed by Japan (10%). ODA reaches recipient countries through 3 channels: 1) direct bilateral aid; 2) the UN organizations and 3) non-governmental organizations. Most donors channel their funds to countries through the UN; however, Australia, Canada, Finland, the United Kingdom, the US, Germany and New Zealand use bilateral and NGO channels. The different funding mechanisms used between regions are due to specific political and cultural sensitivities of the region and of individual donors. For example, the UN provided the largest amount of money to Africa in the former years, but NGO contributions and bilateral assistance has now caught up with the UN while NGO's were the original major contributors to Latin America with bilateral funding catching up. From 1982-88 Asia received over 1/2 of all assistance declining from 58 to 42% while assistance to Africa increased from 13 to 27%; Latin America's 20% remained the same and the Middle East and North Africa received less than 10%. The major determinant of a country's population assistance is its population size, with larger countries receiving more money than the smaller, and the age of a country's program. Efforts to measure the impact of assistance has been difficult. For example, aid to India has had modest achievements while China's significant reductions in fertility were achieved before any assistance was provided. In spite of the lack of statistical evidence demonstrating the effects over time to population activities, such assistance is necessary and effective.