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Geneva, Switzerland, WHO, Department of Communicable Disease Surveillance and Response, 1999 Apr. 66 p. (WHO/CDS/CSR/EDC/99.1)This document has been prepared to assist medical and public health leaders to better respond to future threats of pandemic influenza. It outlines the separate but complementary roles and responsibilities for the World Health Organization (WHO) and for national authorities when an influenza pandemic appears possible or actually occurs. Specific descriptions are given of the actions to be taken by WHO as it assesses the risk posed by reported new sub-types of influenza, in advance of any epidemic spread. The responsibility for management of the risk from pandemic influenza, should it actually occur, rests primarily with national authorities. WHO strongly recommends that all countries establish multidisciplinary National Pandemic Planning Committees (NPPCs), responsible for developing strategies appropriate for their countries in advance of the next pandemic. In recognition of the individuality of countries, as well as the unpredictability of influenza, this document emphasizes the processes and issues appropriate for WHO and NPPCs, but does not provide a “model plan”. Furthermore, it is anticipated that NPPCs will confront new issues, which will call for additional international dialogue. For example, more consideration is needed about how scarce supplies of vaccines can be shared, and what might be the benefit of cancelling public gatherings to slow the spread of a pandemic virus among unvaccinated populations. (excerpt)
U.S. and industrialized world asked to show compassion and pragmatism to support population programs. Dr. Nafis Sadik speaks at the U.S. Congressional Women's Caucus.
ASIAN FORUM NEWSLETTER. 1999 Jun-Aug; 10-1.Dr. Nafis Sadik, Executive Director of the UN Population Fund, spoke at the Congressional Women's Caucus on July 20th in Washington, DC. In her speech, she asked for the compassion and pragmatism of the US and the industrialized world to support the population programs of developing countries. She stated that although the ICPD+5 Review confirmed the success of the Programme of Action, which has provided remarkable changes throughout the world, there are still many continuing problems and constraints. Some of these include high maternal mortality rate, high HIV/AIDS infection rates, the poor status of the youth, and prevalence of gender inequality issues. In addition, she emphasized the problem of funding, which is the major obstacle to the implementation of the Programme of Action. A total of $17 billion is needed to implement such program by the year 2000. Much is still needed for the execution and realization of the goals of the Programme of Action.
The World Health Organization multinational study of breast-feeding and lactational amenorrhea. IV. Postpartum bleeding and lochia in breast-feeding women.
FERTILITY AND STERILITY.. 1999 Sep; 72(3):441-7.The main purpose of this study was to compare the duration of postpartum lochia among 7 groups of breast-feeding women, and in addition, to investigate whether age, parity, birth weight, or the amount of breast-feeding affects this duration. The participants included 4118 breast-feeding women aged 20-37 years living in China, Guatemala, Australia, India, Nigeria, Chile, or Sweden. The duration of lochia, frequency of an end-of-puerperium bleeding episode, and frequency of post-lochia bleeding episodes within 56 days of delivery were measured. This study revealed that the median duration of lochia was 27 days and varied significantly among the centers (range, 22-34 days). In about 11% of the women, lochia lasted >40 days. An end-of-puerperium bleeding episode around the 40th day postpartum was reported by 20.3% of the women. Bleeding within 56 days of delivery (separated from lochia by at least 14 days) occurred in 11.3% of the women and usually was followed by a confirmatory bleeding episode 21-70 days later. This study was able to quantify the average duration of postpartum lochia at 3-5 weeks, with significant variations by population. Lochia durations of >40 days were not unusual. A separate and distinct end-of-puerperium bleeding episode occurred in 1 out of every 4-5 women, although it is unclear how this phenomenon is clinically, socially, or culturally significant.
The World Health Organization multinational study of breast-feeding and lactational amenorrhea. III. Pregnancy during breast-feeding.
FERTILITY AND STERILITY.. 1999 Sep; 72(3):431-40.This prospective longitudinal study aimed to determine the risk of pregnancy during lactational amenorrhea relative to infant feeding status. The participants included 4118 breast-feeding mother-infant pairs, with maternal age of 20-37 years, recruited from 7 study centers located in China, Guatemala, Australia, India, Nigeria, Chile, and Sweden. Infant feeding practices, menstrual status, and the number of pregnancies were recorded. The results revealed that in the first 6 months after childbirth, cumulative pregnancy rate during amenorrhea, depending on how the end of amenorrhea was defined, ranged from 0.9% (95% confidential interval (CI) = 0-2%) to 1.2% (95% CI = 0-2.4%) during full breast-feeding, and from 0.7% (95% CI = 0.1-1.3%) to 0.8% (95% CI = 0.2-1.4%) up to the end of partial breast-feeding. At 12 months, the rates ranged from 6.6% (95% CI = 1.9-11.2%) to 7.4% (95% CI = 2.5-12.3%) during full breast-feeding, and from 3.7% (95% CI = 1.9-5.5%) to 5.2% (95% CI = 3.1-7.4%) up to the end of partial breast-feeding. Regardless of the degree of supplementation, the pregnancy rate increased with time from 6th to the 12th month postpartum. Overall, the rate of pregnancy during amenorrhea was unaffected by variations in the return of menses. This large, multicenter study found that the cumulative 6-month rate of pregnancy during lactational amenorrhea was between 0.8% (95% CI = 0-1.4%) and 1.2% (95% CI = 0-2.4%). This is equivalent to the protection provided by many nonpermanent contraceptive methods as they are actually used and upholds the 1988 Bellagio Consensus.
DEVELOPMENT AND CHANGE. 1999 Jul; 30(3):653-83.This article explores the issues surrounding labor standards and international trade--specifically the interpretations of neo-classical, institutionalist, and feminist writers regarding women's incorporation into the export-oriented manufacturing sector. The neo-classical argument states that trade liberalization would deliver considerable benefits to women both in sheer quantity of employment and in terms of quality of working conditions. Institutionalist analyses, on the other hand, have been constructive in their emphasizing of the gendered nature of the labor contract, the relevance of looking beyond the boss/worker dyad, and the importance of listening to women workers' subjective assessments of their work. While the issue of improving the conditions of work continues to be an important item on the agenda, the question of the availability of jobs among labor-surplus developing countries may become a priority. It is important to avoid strategies that sacrifice quality of work for the sake of quantity.
PEOPLE AND THE PLANET. 1999; 8(1):18-9.In 1994, at the International Conference on Population and Development (ICPD) held in Cairo, the international community set the goal of ensuring universal access to reproductive health care by 2015 and agreed to finance its costs. Few governments and donor countries, however, have made good on commitments made at the ICPD. Reproductive health is not improving and may actually be getting worse. Specific goals to be reached by 2015 include meeting all unmet need for family planning, reducing maternal mortality by 75% compared with 1990 levels, and reducing infant mortality to lower than 35 deaths/1000 births. Reaching these and the related reproductive health goals of the ICPD was calculated to cost about US$17 billion/year until 2000, then to increase to $22 billion/year by 2015 (in constant 1993 US dollars). Developing countries agreed to pay 66% of the cost, while donor countries paid the remainder. Immediately after the ICPD, reproductive health funding increased substantially, then declined again, with most donor countries failing to meet their funding commitments. Failure to deliver on the promised financial support for the ICPD goals will result in higher levels of unintended pregnancies, induced abortions, cases of maternal mortality, and infant deaths. Governments need to be convinced that paying for reproductive health programs is an urgent priority and that developing countries, donor countries, and multilateral institutions all have much to gain from reaching the ICPD goals.