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New York, New York, UNFPA, 1991. iv, 73 p.Nigeria has more people within its boundaries than any other nation in Africa. Since it total fertility rate is so high (6.6) and the modern contraceptive prevalence rate is so low (3.5%), its population is growing considerably (3.3%). April 1989, the Government of Nigeria officially launched its National Policy on Population which set several goals, e.g., family planning (FP) coverage to 80% of women of reproductive age and reducing the population growth rate to 2% by 2000. Part of the national overall strategy for implementing the population policy in 1992-1996 includes giving priority to activities in maternal and child health (MCH)/FP; information, education, and communication (IEC); and women's role in population and development. It also stresses collection of population data, demographic analysis, and research. For example, the last population census was in 1963 so the Government plans a census in late 1991. Nigeria has integrated FP into the MCH program within the context of primary health care. Specifically, it centers on training and using traditional birth attendants to deliver infants in a safe manner, to provide FP services (e.g., as distribution of nonprescription FP methods), and to educate women about women's health and FP using IEC techniques. Further the Government intends to institutionalize the IEC strategy at all levels. For example, the Nigerian Educational Research and Development Council and its corresponding State Committees have integrated population education into secondary school curricula. In addition, IEC population education activities have been extended to nonformal and adult education, such as the organized labor sector and counseling at clinics and other health facilities. The Government has set up the National Commission for Women to integrate women's issues into all sectors of national development. Donor agencies active in population activities in Nigeria include UNFPA, UNICEF, UNICEF, USAID, the World Bank, the European Economic Community, Japan, and the Netherlands.
LINKS. HEALTH AND DEVELOPMENT REPORT. 1991 Fall; 8(3):11-2.The authors respond to Tony Dajer's critique of their study concerning the trend in Nicaraguan infant mortality and its possible explanations. It is pointed out that the sharp decline in Nicaragua's infant mortality in the mid-1970s is an intriguing phenomenon, since it began to occur at a time of economic slump, civil disturbance, and under a government that gave low priority to the social sector. It is contended that a number of factors (among them the Managua earthquake) prompted the government to shift its allocation of resources from hospital-based health care in the capital city to ambulatory health care throughout the country. After the revolution, the Sandinista government continued this process. Dajer's characterization of USAID-funded clinics as "notoriously ineffective" is rejected; arguing that although operating under overt political guidelines, these projects are well-advised by experts. Dajer's question as to the importance of health care within the Sandinista government is considered. It is maintained that the revolution was not fought in order to reduce infant mortality, and that health was not the primary concern of the Government of National Reconstruction. It was the international solidarity movement, not the Sandinista government, which focused so intently on infant mortality, hoping to find good news to report. The issue of health care had the added advantage of being politically noncontroversial. It is also maintained that since the mid-70s, the country's health policy has remained stable, despite the radical changes in government because the international arena helps determine national health policy.
Maternal mortality and the right of the child to survival, protection and development. Perspectives on southern and eastern Africa in light of international law.
In: The effects of maternal mortality on children in Africa: an exploratory report on Kenya, Namibia, Tanzania, Zambia, and Zimbabwe, [compiled by] Defense for Children International-USA. New York, New York, Defense for Children International-USA, 1991. 97-143.How international law documents such as the Convention on the Rights of the Child establish a legal framework within which to promote child survival in Southern and Eastern Africa, emphasizing the documents' significance for maternal mortality, the most important factor affecting child survival, is examined. In November 1989, the UN General Assembly unanimously adopted the Convention, a comprehensive treaty that establishes the rights of children and their families, outlining the responsibilities of governments and adults in securing those rights. By September 1990, most countries in Southern and Eastern Africa had ratified the treaty; the remaining countries had pledged to approve it. The Convention not only obligates governments to allocate greater resources to the most vulnerable members of society, but also requires a higher level of international cooperation, including greater commitment from industrialized countries and greater participation at the grassroots level. The economic, social, and cultural dimensions of maternal mortality and its impact on child survival are discussed, as well as the maternal and child survival issues addressed by the Convention: 1) maternal-child health services; 2) traditional practices harmful to the mother and child (in this case, female circumcision and child marriage); and 3) survival and development through international cooperation. The implications of the Convention on the primary health care model are also discussed. The impact of other international documents on maternal mortality and child health is examined.
CONSCIENCE. 1991 Sep-Oct; 12(5):22-3.Congressional legislation seeking to overturn US government restrictions on international family planning assistance face a possible presidential veto. Dating back to the Reagan years, the 1984 Mexico City Policy prohibits foreign nongovernmental organizations (NGO) receiving US money from performing or actively promoting abortion as a family planning method. Even if abortion is legal in that particular country, the agency involved may not even discuss abortion as one of the medical options of a pregnant woman. In line with the Mexico City Policy, the US has withdrawn funding from both the International Planned Parenthood Federation, the largest NGO in the population field, and the Family Planning International Assistance, the international division of the Planned Parenthood federation of America. One of the effects of the Mexico City Policy has been to make family planning more controversial, and to increase opposition to birth control. In addition to the Mexico City Policy, the Reagan years also saw the implementation of a policy that denies funding to the UNFPA, charged by the US of "co-managing" China's population program that engages in coercive abortion and involuntary sterilization. The UNFPA has denied such charges. So far, President George Bush -- previously a supporter of family planning programs -- has sided with opponents of abortion, and has threatened a veto threat may soon be tested, since Congress has drafted a foreign aid appropriations bill that has includes a measure saying that NGOs should be treated in the same manner as their governments, which are exempt from the Mexico City Policy so long as US funds are not used to support abortions.
[Unpublished] 1991. Presented at the Demographic and Health Surveys World Conference, Washington, D.C., August 5-7, 1991. 22 p.A supply-demand approach is used to estimate total and unmet demand for family planning in Indonesia over the last decade. The 1976 Indonesia Fertility Survey, the 1983 Contraceptive Prevalence Survey, and the 1987 National Contraceptive Prevalence Survey form the database used in the study. Women under consideration have been married once, are aged 35-44, have husbands who are still alive, have had at least 2 live births, and had no births before marrying. High demand was found for family planning services, with the proportion of current users and women with unmet demand accounting for over 85% of the population. Marked improvement in contraceptive practice may be achieved by targeting programs to these 2 groups. Attention to unmotivated women is not of immediate concern. Women in need of these services are largely rural and uneducated. Programs will, therefore, require subsidization. The government should gradually and selectively further introduce self-sufficient family planning programs. User fees and private employer service provision to employees are program options to consider. Reducing the contraceptive use drop-out rate from its level of 47% is yet another approach to increase contraceptive prevalence in Indonesia. 33% drop out due to pregnancy, 26% from health problems, 10% because of method failure, 10% from inconveniences and access, and 21% from other causes. Improving service quality could dramatically reduce the degree of drop-outs.
AIDS CARE. 1991; 3(4):395-8.While scientists demonstrated that they have pushed ahead in developing treatment and a vaccine for AIDS, comparatively little was voiced regarding AIDS as a development issue at the 7th Conference on AIDS. In the context of socioeconomic development, President Museveni of Uganda and others spoke on AIDS, recognizing the need for behavioral change in preventing HIV infection. The family was also recognized as a basic unit of caring, important in fostering global solidarity. Topics discussed included the fusion of technology and human response in the fight against AIDS, NGO-government integration, community home care, and the need for an difficulty of measuring behavior change. In research, evidence was presented attesting to the cost-effectiveness of home care, while other types of research interventions, the effectiveness of audiovisual media in message dissemination, evaluation methods, and ethnographic methods for program design and evaluation were also explored. Where participants addressed psychosocial factors in development, little was presented on training. Informal discussions were robust, and covered the need for academic research, the process of an international conference, program principle transferability, and counseling. There was, however, an overall realization at the conference that progress is slow, AIDS challenges human nature, and coordinated international efforts may be incapable of effecting more rapid positive change. Even though sweeping solutions to AIDS did not emerge from this conference, more appropriate programs and conferences may develop in the future, with this conference opening AIDS in the arenas of community, development, hope and science.
HEALTH FOR THE MILLIONS. 1991 Aug; 17(4):20-3.Until recently, the only sustained AIDS activity in India has been alarmist media attention complemented by occasional messages calling for comfort and dignity. Public perception of the AIDS epidemic in India has been effectively shaped by mass media. Press reports have, however, bolstered awareness of the problem among literate elements of urban populations. In the absence of sustained guidance in the campaign against AIDS, responsibility has fallen to voluntary health activists who have become catalysts for community awareness and participation. This voluntary initiative, in effect, seems to be the only immediate avenue for constructive public action, and signals the gradual development of an AIDS network in India. Proceedings from a seminar in Ahmedabad are discussed, and include plans for an information and education program targeting sex workers, health and communication programs for 150 commercial blood donors and their agents, surveillance and awareness programs for safer blood and blood products, and dialogue with the business community and trade unions. Despite the lack of coordination among volunteers and activists, every major city in India now has an AIDS group. A controversial bill on AIDS has ben circulating through government ministries and committees since mid-1989, a national AIDS committee exists with the Secretary of Health as its director, and a 3-year medium-term national plan exists for the reduction of AIDS and HIV infection and morbidity. UNICEF programs target mothers and children for AIDS awareness, and blood testing facilities are expected to be expanded. The article considers the present chaos effectively productive in forcing the Indian population to face up to previously taboo issued of sexuality, sex education, and sexually transmitted disease.
IN TOUCH 1991 Jun; 10(99):21-2.Despite obstacles to expanding immunization coverage (EPI) in developing countries, progress has been made in Bangladesh and is described. A February, 1991, World Health Organization cluster evaluation survey indicates that government efforts during the 1980s, with the cooperation and assistance of non-governmental organizations (NGO), have increased the degree of immunization coverage in Bangladesh. 80% coverage for BCG, measles, and DPT-3 antigens is realized in the Rajshahi division, 1 of 4 divisions sampled in the survey. Use of existing FWAs and HA as vaccinators; DC, UNO, and upazila chairmen involvement; partner recruitment for mobilization efforts; steam sterilization of needles; maintenance of an effective cold chain; and monthly vaccination sessions at more than 108,000 sites throughout the country worked together to successfully yield greater immunization coverage. Sustained efforts are, however, required to ensure vaccine protection of the 4 million children born into the population each year. 80% or greater universal coverage in Bangladesh is the focus of continued efforts. Eradication of polio, measles, and neonatal tetanus is possible in the 1990s, while Vitamin A distribution and more effective promotion of family planning services are also objectives. Government and NGO workers must promote awareness of EPI, monitor EPI service delivery, and encourage HAs, FWAs, UHFO Civil Surgeons, UNOs, DCs, and upazila chairmen to provide regular EPI services.