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Geneva, Switzerland, WHO, 1990. v, 51 p. (WHO/HST/90.2)Some estimation of the magnitude of global health problems and trends is essential for the formulation of international health policies and strategies. Toward this end, in 1987, the World Health Organization published a document based on statistics available at the time on global health-related estimates. This document updates and refines the earlier report on the basis of more reliable data. State-of-the-art data are presented for 7 major categories: 1) demographic factors; 2) socioeconomic development; 3) general health problems (e.g., low birthweight, infant mortality, disability); 4) specific health problems (infectious and parasitic diseases, cancer, endocrine, metabolic, and nutritional disorders, anemia, mental and neurological disorders, circulatory diseases, respiratory diseases, occupational injuries and diseases, and oral health; 5) health-related issues (e.g., alcoholism, smoking, breastfeeding, and sanitation); 6) health services aspects (e.g., family planning, immunization); and 7) health resources (human resources, health expenditures, and pharmaceuticals). In most cases, statistics are presented for the 1985-90 period. It is emphasized in the introduction that, while these statistics provide orders of magnitude sufficient to support health policy planning, they lack the precision required for the formulation, implementation, and evaluation of disease-specific intervention strategies.
Current approaches to strengthening the management of national maternal / child health and family planning programs.
[Unpublished] . 7 p.This presentation provides an overview of past efforts by the WHO to support management development in health and to describe some of the specific methods being used in the Family Health Division. WHO has for many years recognized the importance of sound program management and has striven to support countries in practical ways to strengthen management skills, procedures and practices. Certain programs have designed and provided tailor-made management training for the improvement of specific types of services. Generally, WHO has attempted to develop and share methods in health planning and management which were felt of potential usefulness to national administrations. The current management strengthening activities discussed in this paper are the following: 1) rapid evaluation of maternal-child health/family planning (MCH/FP) programs; 2) district team problem-solving in MCH/FP; 3) application of patient flow analysis in clinics; 4) development of indicators for managing MCH/FP services; and 5) the national formulation of major UN Population Fund Projects in MCH/FP.
[Unpublished] 1990. 4 p.As of July 1990, 621 Norplant insertions and 185 removals were performed at 3 sites in Tunisia. In January 1988 the Association for Voluntary Surgical Contraception (AVSC) started to expand these services to 5 additional sites by training physicians and social personnel and by developing materials. The plan was to expand Norplant insertions to all 23 clinics by the end of 1991. The Norplant program was to be introduced in 2-3 years in 2 phases starting in 1990 and eventually to expand Norplant in the private sector and government facilities. During consolidation in 1991 clinical and acceptability research will be completed by July 1991 and services at the 8 sites will be strengthened by refresher training. During phase 1 participating agencies will have the following role: AVSC is to collaborate with the government family planning program in revising curricula and upgrading training for paramedical and social personnel, to help maintain service delivery at these 8 clinics, to develop flip-charts for education and training, and to review client record form for Norplant users and data collection for monitoring. The World Health Organization is to complete a comparative study and disseminate results. Phase 2 is the expansion phase from 1992 to 1993, when services will be expanded to the remaining 15 clinics. Once this is completed further promotion for information and education should be considered by AVSC to train medical personnel in Norplant insertion and removal, to train paramedical personnel, to assist expansion of services, and to review integration of Norplant into the medical and monitoring systems. The Population Council is to assist the evaluation of Norplant quality. Donor coordination should also be facilitated by in-country meetings with various agencies to review results of program activities. Special central funding must be secured because of lack of bilateral funding for Norplant and also supplies have to be secured for the expansion phase.
Washington, D.C., World Bank, 1990. xvi, 97 p. (World Bank Discussion Papers 107)The interactions within and between the determinants and consequences of rapid population growth in Kenya are analyzed with a view to fostering a research agenda and proving insights for the creation of a population strategy during the next decade. Despite Kenya's long-standing concern about checking its rapid population growth, annual growth rates reach 4%. However, Kenya may be entering a new demographic phase of declining growth rates. Population pressure, through both reduced benefits and increasing costs of children to the household, may be responsible for moderate demographic change. Fertility declines with an eventually sustainable balance between population numbers and the economy and the environment depend upon factors motivating parents to desire fewer offspring. These motivating factors, in turn, depend upon the interrelations among population growth, society, economy, and population policy and programming. While the time frame for demographic transition remains elusive, population programming undertaken thus far, though failing to effect change up to now, may hold the key to future successes. Health delivery and family planning systems are already in place and will influence the pace of population growth decline during future decades. Population and economic trends, population policies and programs for the period 1965-89, research, strategy, and recommendations are discussed at length.
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 email@example.com.
PEOPLE. 1990; 17(1):36-8.The major points in Worldwatch's plan involve 1) development of energy strategies which protect the climate, 2) expansion of forests, 3) a substantial increase in efforts to meet food needs, and 4) a halt to population growth. The consequence of "business as usual" is severe economic disruption, social instability, and human suffering. Energy strategies must be prioritized and reordered within 10 years. A safe, effective way to curb use of fossil fuels, which produce CO2 and account for 50% of the global warming, is to improve energy efficiency, to develop renewable energy sources, and to abandon use of nuclear power. Use of existing technology has the most immediate, largest effect. Solar, hydro, wind, and geothermal technologies are much slower to develop and implementation has greater initial costs. An internationally consistent fuel-based tax on carbon content is also recommended. Investment in energy efficiency will be offset by reduced fuel bills for consumers and businesses. Forests, which store 3 times the amount of carbon in the atmosphere, contribute to CO2 buildup when cut down. Expanding forest cover in tropical countries means finding other ways to earn quick foreign exchange, stimulate regional development, and expand settlement areas. 130 million hectares of trees need to be planted just to meet demands for fuelwood and industrial wood products and to stabilize soil and water resources. 15 billion trees need to be planted each year for the next 15 years. Large food production increases are still possible in India, Argentina, and Brazil, but few gains are expected in Japan, China, western Europe, and North America. Subsistence farmers can boost production by multiple cropping, intercropping, biointensive gardening, and composting of organic wastes. If food reserves tighten, redirecting grain from livestock, which amounts to 33% of a harvest, is the only option for feeding the poor. Family planning (FP) will be instrumental in assuring food security. Countries with high growth rates must follow China and Japan in curbing population growth rapidly. This entails government commitment and an active national population education program, widely available FP services, and widespread improvements in economic and social conditions, particularly for women. The several billion dollars/year needed from industrialized countries should be considered a "downpayment on the future."
Research Triangle Park, North Carolina, FHI, 1990. 45 p.This report describes the Family Health International's (FHI) efforts in the areas of access to contraceptive methods, reproductive health services, and AIDS prevention during 1988-90. Founded in 1971, FHI has developed into a major multidisciplinary organization whose program divisions include AIDSTECH (engaged in AIDS prevention efforts), Clinical Trials, Field Development and Training, Materials Technology, Program Evaluation, and Reproductive Epidemiology, and Sexually Transmitted Diseases. FHI has supported research into long-acting steroid systems such as NORPLANT, as well as research into sterilization and barrier methods. FHI has also established a programs to facilitate the introduction of new contraceptive methods and to improve the use of contraceptives. The organization has also devoted considerable efforts into AIDS prevention activities in 45 developing countries. Examples of FHI AIDS prevention efforts include the establishment of intervention programs among commercial prostitutes and blood screening programs. Other FHI activities include promoting the practice of breastfeeding, instructing policymakers as to the overall health effects of contraception, conducting pioneering research on maternal and infant mortality and morbidity, developing sustainable family planning, and developing new communication strategies. Finally, responding to the rising demand for family planning services and the increasing scarcity of resources, FHI has embarked on an initiative to examine the economics of family planning.
[Unpublished] 1990 Mar 6. vi, 71 p.Men may impede broader use of family planning methods by women in many countries. Efforts have therefore been made to reach men separately in order to promote greater acceptance and use of male or female contraceptive methods. Typically, programs may encourage men to allow partners to use contraception; persuade men to adopt a more active, communicative role in decision making on contraceptive use; and/or promote the use of male methods. This paper presents findings from male involvement program initiatives in 60 developing countries since 1980. Male involvement programs are clearly needed, and condom use should be encouraged for protection against both pregnancy and HIV infection. Given their relatively low cost per couple-year of protection, social marketing programs should be encouraged to promote condom sales. Employment-based programs, despite relatively high start-up costs, have also generated large increases in condom use. Both condom and vasectomy use have been increased through mass media campaigns, yet more campaigns should address AIDS. Clinic services and facilities should be made more attractive to men, and new print materials are warranted. Community-based distribution programs have been found to be great sources of information and supplies, especially in rural areas, and male adolescents are especially in favor of telephone hotlines. Little information exits on the effectiveness and costs of programs targeting organized groups. Further, youth-oriented programs generally reach their intended audiences, but are relatively expensive for the amount of contraceptive protection provided. Finally, a positive image must be promoted for the condom through coordinated media presentations, user and worker doubts of efficacy must be eliminated, and regular condom supplies ensured. Recommendations are included for policy, research, public education, the World Health Organization, national AIDS prevention programs, and family planning agencies.
In: Monitoring and evaluating family planning programmes in the 1990s, [compiled by] United Nations. Economic and Social Commission for Asia and the Pacific [ESCAP]. Bangkok, Thailand, ESCAP, 1990. 1-22. (Asian Population Studies Series No. 104; ST/ESCAP/945; UNFPA Project No. RAS/86/P09)The Seminar on Family Planning/Maternal and Child Health Programme Management Information Systems in the 1990s was held in Seoul, South Korea during June 20-26, 1990 organized by the UN Economic and Social Commission for Asia and the Pacific (ESCAP) and funded by the Un Population Fund (UNFPA) and the Korea Institute for Health and Social Affairs. Family planning (FP) and maternal and child health (MCH) programs have been in existence in the ESCAP region for 25 years. Some of them were quite successful in producing a decline in fertility. The changes required to adjust to developments over time affect management information systems (MIS) set up for program monitoring and evaluation. Initially FP/MCH programs collected data for service statistics systems such as performance indicators, number of acceptors, types of services, and contraceptives. Later more detailed and extensive statistics were generated: the number of continuous users and method- and age-specific patterns of use. The proliferation of information required the development of standardized forms and viable reporting systems that ESCAP helped set up in the late 1970s and early 1980s. UNFPA also carried out assessments of elaborate, overloaded FP MISs in order to streamline them. Differing definitions of identical concepts (new acceptors, married women accepting) often led to redundant data reporting. Immunization, antenatal, and postnatal care data were collected, however, data on completion of the full regime and dropout numbers were missing. The list of participants, opening statements, election of officers, agenda, documents, seminar report, and an overview of MISs are detailed.
Cambridge, Massachusetts, Harvard Institute for International Development, 1990 Jun. , 52 p. (Development Discussion Paper No. 344)Ideology of population control has fueled population research and fertility control programs. This ideology comprises the prochoice and prolife positions; the Roman Catholic doctrine on responsible parenthood and contraception; and fertility control professed by Marxists and environmentalists. The predominant ideology of demographic research and family planning (FP) from the 1950s to 1974 is examined. The solution of population was to be by voluntary action as demonstrated by knowledge-attitude-practice (KAP) surveys sponsored by the Population Council that was founded at the behest of John D. Rockefeller III in 1952. The Council also supported technical assistance and vigorously promoted (FP). The Ford Foundation developed a population control program in 1958, funding research with over $181 million during the period. In 1967 the Agency for International Development (USAID) joined population donors, and became the largest financier of FP programs that produced a decline of fertility from 6.1 children/woman to 4.5 in 28 countries. At the World Population Conference in 1974 held in Bucharest the claim of population growth inhibiting development was challenged, and the development of socioeconomic and health care conditions was advocated. The Project on Cultural Values and Population Policy was an 8-nation study on cultural values in FP program implementation whose utility was questioned by UNFPA staff. The World Development Report 1984 by the World Bank was influential and reiterated the danger of population growth checking economic development, although critics charged biases and distortions. The Lapham-Mauldin Scale devised for the evaluation of FP program success is replete with value judgments. FP program implementation difficulties and shortcomings are further examined in Latin America, China, India, and Indonesia.
[Program review and strategy development report: Tunisia] Rapport de la mission d'analyse du programme et d'elaboration de la strategie: Tunisie.
New York, New York, UNFPA, . v, 35 p.This report of the UN Population Fund's (UNFPA) program review and strategy development mission to Tunisia analyzes the current status and needs of population programs, evaluates the results of past population activities, and recommends measures to be taken by the national population strategy. The mission was in Tunisia in April 1990 to prepare recommendations in close cooperation with the Tunisian government for the 5th program of cooperation between the UNFPA and Tunisia, which will begin in 1992. The report contains chapters on Tunisia's demographic and development situation, the population policy, cooperation in the area of population by bilateral and multilateral organizations and private sector agencies, the strategy proposed for the population program, and the current and future role of the UNFPA. A final chapter containing conclusions and recommendations notes that control of population growth and reduction of regional disparities are central concerns of Tunisia's development policy. Family planning remains the principal component of the population policy. The population and family planning program has benefited from political and legislative support and has promoted contraceptive usage, but the rate of growth remains high and the government is determined to intensify its efforts. During the next economic and social development plan covering 1992-96, increased investment in the different areas related to population and especially family planning will be needed. The mission recommended that UNFPA assistance be concentrated in decreasing order of priority on maternal health and family planning, IEC, policy development, women in development, and study and research. In the area of maternal health and family planning, health services should be supported especially in the center-west and south of the country. Closer integration of family planning and maternal-child health services is needed to further the goal of providing high quality services in all health facilities. The UNFPA should participate in introducing new contraceptive methods and in training personnel in family planning and program administration. The UNFPA should support IEC activities and population education in and out of school, especially in the center and south. Activities permitting improved comprehension of demographic variables and their relations with development and reinforcement of regional planning should be supported, in order that relations between population and development be reflected in sectorial plans and regional development programs. Technical advice should be supplied in the areas of evaluation, data processing and analysis, and publication in order that data be exploited as fully as possible. Activities promoting the integration of women in development should be promoted. The UNFPA should offer support and technical advice to develop survey and operational research skills within tunisia in the areas of population and family health.
New York, New York, IPPF/WHR, 1990. 36,  p.This report describes the accomplishments of the International Planned Parenthood Federation/Western Hemisphere Region (IPPF/WHR) during 1990, and examines the challenges still present in the region. As IPPF/WHR President Fernando Tamayo explains, Latin American and the Caribbean have the highest use of family planning than any other developing region in the developing world: almost 45% of all married women use a modern contraceptive. However, many women still lack access -- or easy access -- to family planning services. Chairperson Jill Sheffield echoes Tamayo's view, noting that 30 million people in the region want family planning but cannot get it. She discusses the risks that unwanted or multiple pregnancies pose to a woman's health. The incidence of unsafe abortion, she notes, is highest in WHR than in any other region. The report goes on to describe the service expansion that took place in 1990 and the challenges that remain. Looking for innovative ways to reach marginalized communities, IPPF/WHR initiated a number of services for men and for adolescents. The organization also explored ways of reaching people living in remote rural areas or in urban slums, using traveling promoters or encouraging doctors to establish practices in areas that lack health services. In order to confront the growing threat of AIDS, the organization conducted a series of activities to raise public awareness. IPPF/WHR also introduced management information systems in 11 countries which helped increase productivity. The report goes on to discuss the following issues: the increasing gap between knowledge and use of contraception; clinical services and cost effectiveness; institution building; quality of care; strategic planning; the involvement of women; and financial support. A special feature, the report contains a pictorial section which describes the impact of family planning on the lives of indigenous women in Guatemala.
The population IEC operation in Eastern and Southern Africa. Operational research report one: inventory overview.
Nairobi, Kenya, United Nations Population Fund [UNFPA], 1990. 57 p. (Operational Research Report 1)In the context of rapid population growth in Africa, population information, education, and communication (IEC) programs and projects have been implemented in the region. An initial report was prepared describing population IEC operational research in Botswana, Ethiopia, Kenya, Lesotho, Malawi, Mauritius, Somalia, Swaziland, Tanzania, Uganda, Zambia, and Zimbabwe. Fieldwork on the research project was conducted by a small team of researchers who surveyed/inventoried population IEC program and project development. The study was conducted in resource terms, attempting to identify operational problems or deficiencies posing obstacles to improved field activity effectiveness and efficiency. 7 questionnaires were developed and presented to program and project directors, managers, and coordinators to find detailed answers to specific concerns and questions. Researchers wanted to know the extent to which population IEC programs and projects were part of any larger national effort of development support communication, the variety and frequency of different IEC activities within the operation, where programs were failing to meet objectives, and the quantity and quality of available program resources, especially for training and materials development. Personal views, perceptions, and opinions of the interviewees were also sought. Additional questions addressed the relevance and significance of population IEC research to fertility management and communication strategy development. Compiling directories of people and institutions involved in population IEC research, training, and materials production and dissemination was a final purpose of the questionnaires. Common program features are highlighted.
CEYLON MEDICAL JOURNAL. 1990 Dec; 35(4):136-42.The story of the Sri Lankan Family Planning movement is told from its inception in 1953, prompted by a visit by Margaret Sanger 1952. The Family Planning Association of Sri Lanka was founded with the health of women and children, and both contraception and infertility treatment as its policies. The first clinic, called the "Mothers Welfare Clinic," treated women for complications of multiparity: one woman was para 26 and had not menstruated in 33 years. The clinic distributed vaginal barriers, spermicides and condoms, but the initial continuation rate was <5% year. Sri Lanka joined the IPPF in 1954. In 1959, after training at the Worcester Foundation, and a personal visit by Pincus, the writer supervised distribution of oral contraceptives in a pilot project with 118 women for 2 years. Each pill user was seen by a physician, house surgeon, midwife, nurse and social worker. In 1958 Sweden funded family planning projects in a village and an estate that reduced the birth rate 10% in 2 years. The Sri Lankan government officially adopted a family planning policy in 1965, and renewed the bilateral agreement with Sweden for 3 years. In 1968 the government instituted an integrated family planning and maternal and child health program under its Maternal and Child Health Bureau. This was expanded in 1971 to form the Family Health Bureau, instrumental in lowering the maternal death rate from 2.4/1000 in 1965 to 0.4 in 1984. During this period IUDs, Depo Provera, Norplant, and both vasectomy and interval female sterilizations, both with 1 small incision under local anesthesia, and by laparoscopic sterilization were adopted. Remarkable results were being achieved in treating infertile copies, even from the beginning, often by merely counseling people on the proper timing of intercourse in the cycle, or offering artificial insemination of the husband's semen. Factors contributing to the success of the Sri Lankan planned parenthood program included 85% female literacy, training of health and NGO leaders, government participation, approval of religious leaders, rising age of marriage to 24 years currently, and access of all modern methods.
London, England, IPPF, 1990. 25 p.The International Planned Parenthood Federation (IPPF) is the largest voluntary family planning organization in the world. It consists of 107 member Family Planning Associations and is active in over 150 countries. This annual report describes future challenges, the plans to meet these challenges, the current activities around the world, the division of scarce resources, income, and expenditures for 1988-1990, and project funding. Problems of child survival, maternal mortality, and the unequal status of women are all problems facing the developing world and the IPPF, AIDS is another problem, especially in Africa, that is being addressed by the IPPF through programs of education and prevention. In Africa there are 210 clinics and 1526 non-clinical outlets for contraceptives. In the Arab world there are 638 clinics and 100 non-clinical outlets for contraceptives. In east and southeast Asia and Oceania there are 383 clinics and 13,565 non- clinical outlets for contraceptives. In Europe there are multitudes of activities that include training teachers in sex education, increasing awareness of population issues, education against AIDS and developing family planning programs in Eastern Europe. In South Asia there are 633 clinics and 13,457 non-clinical outlets for contraceptives. In the western Hemisphere there are 745 clinics and 22,328 non-clinical outlets for contraceptives. Total income for 1989 was $68,424,000 with total expenditures of $70,542,000 leaving a deficit of $2,118,000. Forecasts for 1990 indicate a total income of $74,317,000 with a total forecast expenditure of $74,705,000 leaving a forecast deficit of $388,000.
POPULATION TODAY. 1990 May; 18(5):6-7, 9.Maternal mortality in the developing world may be less of a concern since the avalanche of concern about high infant mortality. Some programs, such as family planning, can reduce both infant and maternal mortality, however causes for maternal death are different from those for child bearing. Information on the levels and trends of maternal mortality is of poor quality due to incomplete data and inconsistent definitions. The total number of maternal deaths is a function of 2 variables, fertility and maternal mortality, and a reduction of either one can effect the number of dying women. There are large differences in the rates between the developing and the developed world. Of the 500,000 maternal deaths each year only 6,000 occur in the developed world, or about 1%. In contrast 11% of the infant deaths take place in the developed world. There are 5 primary complications that lead to obstetric death: hemorrhage, toxemia, sepsis, septic abortions, and obstructed labor. Approaches that have been recommended by the Safe Motherhood Conference in 1987 include a stronger community based health care system that screens pregnant women, refers high risk cases for immediate help, and provides preventive services such as family planning. There should also be stronger referral services to backup community care. In addition, an alarm and transport system to get women with high risk pregnancies to a referral facility for effective treatment in time is needed.
In: Population policy: contemporary issues, edited by Godfrey Roberts. New York, New York/London, England, Praeger, 1990. 21-37.On the basis of the orthodox assumption that population growth constitutes an obstacle to economic development, most countries have established programs aimed at reducing fertility through contraception. The methods used by family planning programs, ranging from voluntary acceptance through educational and informational campaigns to financial incentives or disincentives to outright forced sterilization, raise complex ethical issues. Specifically, there are 5 ethical principles--freedom, justice, welfare, truth-telling, and security/survival--that can be used to evaluate deliberate attempts to control human fertility. Such an approach suggests that forced abortion, compulsory sterilization, and all other forms of heavy pressure on clients to accept a given means of fertility control violate human freedom, justice, and welfare. The violations inherent in financial incentives are demonstrated by the fact that they are attractive only to the poor and disadvantaged sectors of the population. Family planning programs that offer incentives to field workers to meet acceptor quotas often lead to a disregard of client health and welfare by subtly encouraging workers to withhold information on medical side effects, outright deceive clients about methods that are not being promoted by the family planning program, and fail to take the time for adequate medical counseling and follow-up. Even programs that provide free choice to clients are illusory if the methods offered include controversial agents such as Depo-Provera and acceptors lack the capacity to make an informed choice about longterm effects. Recommended is the establishment of an international code of ethics for population programs drafted by a broad working group that does not have a vested interest in the code's terms.
New York, New York, United Nations Population Fund [UNFPA], 1990. 40 p.The decade of the 1990's, the Fourth Development Decade, will be "critical" because of the world's demographic situation will determine the future for the 21st century in terms of population growth and the effect of growing populations in terms of damage to the environment. Despite the fact that government political support for population programs and activities rose from 97 countries in 1976 to 125 in 1988 (Africa rose from 16 in 1978 to 30 in 1988), the contraceptive prevalence rates in developing countries (excluding China) during the 1980's fell below 40%. Many countries encountered a "mix" of difficulties maintaining their family planning programs (FP) because of declining political support and the debt burden forcing governments to reduce investments in health and social welfare programs, including FP. By the year 2025 the UN expects 8,467 million people; 147 million (<5%) will be in the industrialized countries and 95% in the developing countries of Africa, Latin America and Asia. This report discusses human resource development during the Fourth Development Decade. FP and population programs must become integral components of countries' development process to achieve sustainable economic growth. 19 recommendations are offered on how to achieve sustained fertility declines. This UNFPA report includes the following sections: Introduction; Part 1 "The Challenges Ahead"; Part 2 "Keeping the Options Open"; Part 3 "Human Resource Development-A New Priority"; Conclusion and Recommendations.
INTEGRATION. 1990 Apr; (23):4-11.Since 1976, the Integrated Family Planning and Parasite Control (IP) has been conducted by the Population and Community Development Association (PDA) through the financial support of the Japanese Organization for International Cooperation in Family Planning (JOICFP). Family planning was integrated with other activities starting with parasite control and then environmental sanitation. In 1976, PDAs activities were focused on a community-based delivery (CBD) system for contraception in rural Thailand. In the IPs first years, the PDA conducted mass treatment campaigns using both the local plant "maklua" and modern medicines. Various motivational activities were included, such as letting children see the parasites under a microscope. Many villagers showed up for treatment. Later, however, they were reinfected and failed to get further treatment. Since 1981, the major emphasis of the IP rural program has been to push building of latrines and improved water resources. PDA has started a major project for safe storage of rainwater. Some 11,300 liter bamboo-reinforced concrete rainwater storage tanks are being built in northeast Thailand. Giant water jars for rainwater catchment with a 2000-liter capacity are produced. The financing of PDAs environmental sanitation construction activities is unique. Villagers pay back the cost of the raw materials of the tank, latrine, or jar they received. Repayments go into a revolving fund which can be lent to other families. Peer pressure has made repayment levels approach or exceed 100% in target districts. Villagers are trained to produce the casings, bricks, and other things needed for building. Individuals from building crews are selected and given special training in construction techniques and are taught the potential health benefits of each activity. These people become village sanitation engineers. Villagers can engage in income-generating activities and receive technical assistance from the PDA. The IP has taken on a community participation approach. The PDAs Family Planning (FP) Health Checkup Program is the urban version of the IP. In 1989, the PDA sold 11,109 cycles of pills and 2100 packages of 3-piece condoms through FP volunteers based in 459 enterprises. These FP volunteers also tell their co-workers about parasite control and other issues that they learned from the annual refresher courses. The PDA also does school health checkup services. The PDA generated funds to keep the programs ongoing. The Thai government actively supports the work of the nongovernmental organizations.