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[Geneva, Switzerland], WHO, 1997 Apr 24. 3 p. (Press Release WHO/33)A study conducted by the UNDP/UNFPA/WHO/World Bank Special Program of Research, Development, and Research Training in Human Reproduction confirmed that young women in both developed and developing countries with no predisposing risk factors for cardiovascular disease can use oral contraceptives (OCs) without increasing their risk of acute myocardial infarction. The study was conducted in 21 centers in 12 developing and 7 developed countries and involved 369 women with acute myocardial infarction and 941 healthy controls. The duration of OC use did not affect the risk of heart attack. In OC users under 35 years who smoke and use the pill, the incidence of heart attack increases from the 3.5 cases/million woman-years recorded in nonsmoking OC users to about 40 cases/million woman-years. The risk of heart attack rises substantially, however, in OC users over 35 years of age who smoke: to 500 cases/million woman-years. The overall risk of heart attack is 10 times higher in OC users with high blood pressure than in women with normal blood pressure or non-users of OCs. The data did not reveal consistent differences in heart attack risk according to the OC's estrogen dose; there were too few OC users enrolled in the study who were using pills containing gestodene or desogestrel to permit conclusions about the relative safety of second- and third-generation OCs. These findings indicate that the minimal heart attack risk associated with OC use can be avoided by screening women for potential risk factors for such disease, especially high blood pressure, diabetes, and smoking.
OUTLOOK. 1990 Jun; 8(2):7-9.This article summarizes the most recent data on WHO's multicenter clinical trial test of the low dose progestin-releasing vaginal ring as an effective contraceptive for women. The study involved 1005 women aged 19-34 and was carried out from 1980-86 at 19 centers in 13 countries, including 9 developing countries. The overall findings on vaginal ring use included: the ring's effectiveness was comparable to oral contraceptive (OC) effectiveness, pregnancy rates increased with increasing body weight, about 1/2 of the users had discontinued the ring by 1 year, the ring disrupted menstrual bleeding patterns in about 1/2 of all users, and about 1/4 of all users expelled the ring at least once but most continued to use it. The irregular bleeding pattern was the main reason for discontinuation. Part of the reason for having different ring contraceptive effectiveness in different countries could be due to differing average weights of the women. Increasing risk of expulsion was directly related to increasing age by approximately 3% with each year of age. For effective use of 90-day low-dose levonorgestrel-releasing vaginal ring, appropriate clients should have the following: a dislike for inserting and removing vaginal devices, low weight, counselling on potentially irregular bleeding, and counseling on how to deal with an expulsion. (author's modified)
POPULATION BULLETIN OF THE UNITED NATIONS. 1989; (27):108-24.This paper reviews recent new trends in population structure in the world and its major regions in order to access the determinants of those trends and explore issues regarding the recent and projected changes in the age structure of population and the relationships of those changes to social and economic development. In particular, the paper compares the change in age structure projected by the Population Division of the UN Secretariat in its most recent 3 series--namely, those completed in 1984, 1986, and 1988. By and large, the most recent UN assessment projects that a larger proportion of the world population will be aged 60 and over in 2000 and 2025 than was previously estimated. Those changes in projections can be observed for the world and for the more developed countries as a whole, and for the regions of Africa, Latin America, Northern America, East Asia, Europe, and Oceania. While the recommendations of the International Conference on Population called attention to the importance of changes in population structure, this paper recommends urgent government action in planning social programs for the aged because of the greater eminence of population aging in many settings. The case of Japan is used to illustrate the growing importance of increases in life expectancy as a determinant of age structure changes (in relation to fertility decline), a point that is reinforced through a cruder decomposition of UN estimates and projections for several European countries. (author's)
ACTA CARDIOLOGICA. 1988; 43(2):133-9.Age-adjusted mortality trends among men aged 35 to 74 in developed countries are analyzed for the last 35 years using WHO data for seven selected countries. "Mortality from all causes has shown the greatest decrease in Japan and the greatest increase in Hungary. From 1970 on cardiovascular mortality demonstrates a downward trend in all countries, except in Sweden where it remains virtually unchanged and Hungary where it rises markedly. Cancer mortality shows an upward trend which levels off during the last 15 years with the exception of Hungary. Changes in dietary and smoking habits and mass treatment of hypertension offer the most plausible explanation for the observed changes." (EXCERPT)
[Unpublished] 1984 Jun. 10,  p.105 developing country projects dealing primarily or exclusively with adolescent fertility were analyzed in an attempt to determine the nature and level of adolescent fertility programming in the developing world. There were 37 projects in Asia, 21 in Sub-Saharan Africa, 8 in North Africa and the Middle East, 22 in the Caribbean, and 17 in Latin America. About 27% of the programs were exclusively urban, 16% exclusively rural, and the remainder operated in both rural and urban settings. Various types of organizations sponsored projects, but the majority were sponsored by International Planned Parenthood Federation affiliates and other private organizations. There were marked regional differences in sponsorship. Only 11 of the 105 programs were conducted by government agencies, but 14 programs received some support from national governments and local governments also sometimes contributed support. Family life education for both in and out of school youth was the predominant project activity in 66 of the 105 projects. 20 projects focused on training of professionals in family life education such as educators, counselors, and health personnel. Curricula primarily concentrated on sex education, responsible parenthood, the importance of delayed 1st birth and child spacing, and general population concerns. 25 projects conduct youth training sessions and teach teams to serve as peer counselors and cators, motivating their peers toward acceptance of family planning and the small family and providing accurate information on sexuality. About 21 projects have a specific counseling component, with most counseling services teaching family planning, distributing condoms, or referring clients to clinics. Only 16 projects had as a stated objective provision for adolescents of diagnostic or clinical health services related to contraceptive use, family planning, or venereal disease. 18 projects offered training in vocational or income-generating skills integrated with family planning, sex education, and family life education. Over 20 projects described educational materials preparation and production as an activity. Innovative approaches observed in the 105 projects included adoption of the multiservice center concept, integration of family planning education with self-help initiatives to improve young women's socioeconomic status, participation of adolescents in program decision making, and innovative promotional activities. Factors contributing to program success identified by project staff include conducting a needs assessment survey, securing parental and community support, solid funding, a flexible program design, skilled personnel, availability of adequate materials, good cooperation with other community agencies, active participation of young people in planning and running the program, good publicity, and use of innovative teaching methods. Projects are increasingly tending toward less formal kinds of communication in family life education.
Mothers and Children. 1985 Nov-Dec; 5(1):5, 7.Currently standards from industrialized countries are used to assess the growth patterns of breastfed infants in developing countries. Infant growth faltering is interpreted as an indicator of insufficient lactational capacity on the mother's part. 2 recent articles suggest the need for a critical reappraisal of current growth standards and their use for evaluating the adequacy of infant feeding practices. The most commonly used standards to evaluate infant growth are derived from the US National Center for Health Statistics based on anthropometric data collected in the US population 3-month intervals up to the age of 3. During this period, infant feeding practices varied greatly. Many babies were bottle-fed and given supplemental feedings early in life. No large sample of exclusively breastfed infants has been studied from birth on, and thus a standard for breastfed infants is not available. A study of fully breastfed infants was done in England and suggests that there are differences in growth rates. Among a population of 48 exclusively breastfed boys and girls, for the 1st 3 to 4 months of life, growth of breastfed infants was greater than National Center for Health Statistics Standards, while after 4 months growth velocity decelerated more quickly than the standard. The growth of infants studied in Kenya, New Guinea and the Gambia appears to falter at 2-3 months of age using the NCHS standard. Findings suggest that current FAO/WHO recommended energy intakes may be excessive. Recent studies in the US support this assertion. The adequacy of the milk production for the infants in this US study done in Texas was illustrated by their growth rates. Length for age percentiles were higher than the NCHS standards throughout the study though at birth they did not differ significantly. 1 reason these breastfed infants were able to maintain growth despite less than recommended energy intakes is that the ratio of weight gain/100 calories of milk consumed was 10-30% higher among the breastfed infants compared to formula fed infants, suggesting a more efficient use of breastmilk than formula. There is a need for studies of exclusively breastfed infants with larger samples to determine what growth pattern should be considered the norm.
In: Population prospects in developing countries: structure and dynamics, edited by Atsushi Otomo, Haruo Sagaza, and Yasuko Hayase. Tokyo, Japan, Institute of Developing Economies, 1985. 115-40, 329. (I.D.E. Statistical Data Series No. 46)This paper reviews the various methods of projecting future numbers of households, summarizes prospective major trends in the numbers of households and the average household size among the developing countries prepared by the UN Population Division in 1981, and analyzes the size structure of households among the developing countries in contrast to the developed nations. The purpose of this analysis is to prepare household projections by size (average number of persons in a household) for the developing countries. The headship rate method is now the most widely used procedure for projecting households. The headship rate denotes a ratio of the number of heads of households, classified by sex, age, and other demographic characteristics such as marital status, to the corresponding classes of population. When population projections have become available by sex, age, and other characteristics, the projected number of households is obtained by adding up over all classes the product of projected population and projected headship rate. In addition to the headship rate method, this paper also reviews other approaches, namely, simple household-to-population ratio method; life-table method, namely the Brown-Glass-Davidson models; vital statistics method by Illing; and projections by simulation. Experience indicates that the effect of changes in population by sex and age is usually the most important determinant of the change in the number of households and it would be wasteful if the household projections failed to employ readily population projections. Future changes in the number of households among the developing countries are very significant. According to the 1981 UN projections, the future increase in the number of households both in the developed and developing countries will far exceed that in population. In 1975-80 the annual average growth rate of households was 2.89% for the developing countries as a whole while that for population was 2.08%. In 1980-85, the growth rate for households for the developing countries will be 2.99%, while that for population will be 2.04%. In 1995-2000 the figure for household growth will be 2.89%, whereas that for population will be 1.77%. The past trend of fertility is the most important factor for the reduction of household size and it would continuously be the central factor. The increasing headship rates will be observed among the sex-age groups, except the young female groups, as a result of increasing nuclearization in households.
Socio-economic development and fertility decline in Costa Rica. Background paper prepared for the project on socio-economic development and fertility decline.
New York, New York, United Nations, 1985. 118 p. (ST/ESA/SER.R/55)This summary of information on the development process in Costa Rica and its relation to fertility from 1950-70 is a revision of a study prepared for the Workshop on Socioeconomic Development and Fertility Decline held in Costa Rica in April 1982 as part of a UN comparative study of 5 developing countries. The report contains chapters on background information on fertility and the family, historical facts, and political organization of Costa Rica; the development strategy and its consequences vis a vis the composition of the gross domestic product, balance of trade, investment trends, the structure of the labor force, educational levels, and income; the allocation of public resources in public employment, public investment, credit, public expenditures, and the impact of resource allocation policies; changes in land tenure patterns; cultural factors affecting fertility, including education, women and their family roles, behavior in the home, women and politics, work and social security, and race and religion; changes in demographic variables, including nuptiality patterns, marital fertility, and natural fertility and birth control; characteristics and determining factors of the decline in fertility, including levels and trends, decline by age group, decline in terms of birth order, differences among population groups, how fertility declined, and history and role of family planning programs; and a discussion of the modernization process in Costa Rica and the relationship between demographic and socioeconomic variables. Beginning with the 1948 civil war, Costa Rica underwent drastic changes which were still reflected in national life as late as 1970. The industrial sector and the government bureaucracy have become decisive forces in development and the government has become the major employer. The state plays a key role in economic life, and state participation is a determining factor in extending medical and educational resources in the social field. The economically active population declined from 64% in 1960 to 55% in 1975 due to urbanization and migration from rural to urban areas, but there was an increase in economic participation of women, especially in urban areas. Increased educational level of the population in general and women in particular created changes in traditional attitudes and behavior. Although there is no specific explanation of why Costa Rica's fertility decline occurred, some observations about its determining factors and mechanisms can be made: the considerable economic development of the 1950s and 1960s brought about a rapid rise in per capita income and changes in the structure of production as well as substantial social development, increased opportunities for self-improvement for some social groups, and a rise in expectations. The size of the family became an aspect of conflict between rising expectations and increasing expenses. The National Family Planning Program helped accelerate the fertility decline.
New York, United Nations, 1984. 108 p. (Population Studies, No. 85; ST/ESA/SER.A/85)The 3 parts of this report on world, regional, and international developments in the field of population, present a summary of levels, trends, and prospects in mortality, fertility, nuptiality, international migration, population growth, age structure, and urbanization; consider some important issues in the interrelationships between economic, social, and demographic variables, with special emphasis on the problems of food supply and employment; and deal with the policies and perceptions of governments on population matters. The 1st part of the report is based primarily on data compiled by the UN Population Division. The 2nd part is based on information provided by the Food and Agriculture Organization of the UN (FAO) and the International Labor Organization (ILO), as well as that compiled by the Population Division. The final part is based on information in the policy data bank maintained by the Population Division, including responses to the UN Fourth Population Inquiry among Governments. In 1975-80 the expectation of life at birth for the world was estimated at 57.2 years for both sexes combined. The corresponding figure for the developed and developing regions was 71.9 and 54.7 years, respectively. In 1975-80 the birthrate of the world was estimated at 28.9/1000 population and the gross reproduction rate was 1.91. These figures reflect considerable decline from the levels attained 25 years earlier: a crude birthrate of 38/1000 population and a gross reproduction rate of 2.44. World population grew from 2504 million in 1950 to 4453 million in 1983. Of the additional 1949 million people, 1645 million, or 84%, accrued to the less developed countries. The impact of population growth on economic development and social progress is not well understood. The governments of some developing countries still officially welcome a rapid rate of population growth. Many other governments see cause for concern in the need for the large increases in social expenditure, particularly for health and education, that accompany a young and growing population. Planners are concerned that the rapidly growing supply of labor, compounded by a trend toward rapid urbanization, may exceed that which the job market is likely to absorb. In the developed regions the prospect of a declining, or an aging, population is also cause for apprehension. There is a dearth of knowledge as to the impact of policies for altering the consequences of these trends. Many policies have been tried, in both developed and developing countries, to influence population growth and distribution, but the consequences of such policies have been difficult to assess. Frequently this problem arises because their primary objectives are not demographic in character.
Aging population and development, statement made at the European Follow-up Forum on Aging, Castelgandolfo, Italy, 6-11 September, 1981.
New York, N.Y., UNFPA, . 7 p.UNFPA's concern over the issue of aging and the agency's ability to help alleviate some of the problems caused by aging, is discussed. Aging is a feature of both developed and developing countries. In the world as a whole, the number of older people has nearly doubled since 1950, and 1/2 of them live in the less developed countries. Such a shift in the balance of ages will have many profound consequences for the world a generation or more hence. The capacity to confront successfully the wide variety of issues raised by aging is not determined by a country's economic position or its status as a developed or developing country. Many of the economic and social systems which permit the elderly to make a positive contribution, and hold them in most esteem as valued members of the community, are among the economically less developed. All countries need to develop an economic structure which caters to the needs and abilities of older people, either through social security, living and working facilities for older people, or as is the case of the less developed countries, through extended family networks.
Revue Tiers Monde. 1983 Apr-Jun; 24(94):305-24.This article discusses methodologies for arriving at population projections and predictions and their limitations, and presents short-term predictions for 1980-2000, longterm projections for 2000-2025, and very longterm projections for 2025-2100, which are highly speculative. The UN population projections for 210 countries and territories are provided by age and sex and by rural or urban status. The UN projections are prepared in 3 phases: 1) analysis of the quality of the basic data in different regions; 2) development of hypotheses concerning the evolution of fertility, mortality, and migration; and 3) separate projection of each component of growth. 4 variants, the medium, high, low, and constant fertility versions are usually prepared, of which the medium projection is considered most likely and that of constant fertility is included only for comparisons. The world crude reproduction rate fell from 2.41 in 1950 to 1.96 in 1975-80, and is expected to fall to 1.34 during 2000-2010 and to almost unity in the mid 21st century. Only Africa and Latin America are expected to have crude reproduction rates above replacement level in 2025. According to the medium projection, the world population will each 6.2 billion in 2000 and 10.4 billion in 2075, when it will be nearly stationary. Future growth in already developed countries will be minimal, but Third World countries, which had a population of 1.7 billion in 1950 and 3.3 billion in 1980, will have nearly 5 billion by 2000 and will stabilize at about 9.1 billion, representing 87% of total world population. About 40% will live in South Asia. The population in 2075 will be 1.2 billion in Latin America, 2.2 billion in Africa, and 1.7 billion in East Asia. The age structure of the future population will undergo considerable aging and the trend toward urbanization will accelerate.