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  1. 1
    Peer Reviewed

    Global health governance and the World Bank.

    Ruger JP

    Lancet. 2007 Oct 27; 370(9597):1471-1474.

    With the Paul Wolfowitz era behind it and new appointee Robert Zoellick at the helm, it is time for the World Bank to better define its role in an increasingly crowded and complex global health architecture, says Jennifer Prah Ruger, health economist and former World Bank speechwriter. Just 2 years after taking office as president of the World Bank, Paul Wolfowitz resigned amid allegations of favouritism, and is now succeeded by Robert Zoellick. Many shortcomings marked Wolfowitz's presidency, not the least of which were a tumultuous battle over family planning and reproductive health policy, significant reductions in spending and staffing, and poor performance in implementing health, nutrition, and population programmes. Wolfowitz did little to advance the bank's role in the health sector. With the Wolfowitz era behind it and heightened scrutiny in the aftermath, the World Bank needs to better define its role and seize the initiative in health at both the global and country levels. Can the bank have an effect in an increasingly plural and complex global health architecture? What crucial role can the bank play in global health governance in the years ahead? (excerpt)
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  2. 2
    Peer Reviewed

    Africa and globalization: marginalization and resistance.

    Gibson NC

    Journal of Asian and African Studies. 2004; 39(1-2):1-28.

    This chapter is a contribution to the ongoing debate about Africa and globalization and the interrelated issues of capitalism, marginalization, representation, and political leadership. Problematizing the discourse of Africa as "diseased" and "hapless," the World Bank's structural adjustment "cure-all" is presented as being much worse than the "disease" that preceded it. Proposing a critical ethics of globalization--which highlights the gap between globalization's miraculous, self-reflective images and the miserable conditions it creates--there is an attempt to uncover agents of change on the African continent. Social movements such as those fighting for water and electricity in Soweto, for land in Kenya, or against environmental destruction by oil companies in the Niger delta raise questions about the viability of globalization. Often led by women, these movements not only challenge the "male deal" that defines national governments and multinational corporations, but also call for a revaluation of subsistence economies and local democratic polities as alternatives to globalization. In short, this chapter offers important conceptual, as well as practical, challenges to globalization, indeed to the very nature of politics itself. (author's)
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  3. 3

    Africa and its diaspora: organizing and institutional issues.

    Akukwe C; Jammeh S; Foote M

    Chimera. 2004 Spring; 2(1):26-30.

    The need to organize a durable partnership between Africa and its people in the Diaspora is so obvious as to warrant little discussion. However, every partnership, even among blood relations, requires a clear raison d'etre. Why should a Brazilian-African become interested in South Africa's politics or economy? Why should a Nigerian unemployed university graduate believe that it is in his best interest to nurture a relationship with the Diaspora in the Caribbean? Why should a Senegalese-French citizen pay attention to the status of African-Americans in the United States? Why should a recent immigrant in the United States become involved in Africa-Diaspora partnership issues? Why should an inner city Diaspora family in the United States or Britain show interest in the political reforms in Kenya? These questions are neither rhetorical nor amenable to easy responses. At the core of the organizing issue in Africa-Diaspora partnership is the need to define a clear, unambiguous reason for this relationship. (excerpt)
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  4. 4

    [Women's initiatives] Las iniciativas de las mujeres.

    Kapur N

    In: Enfoques feministas de las políticas antiviolencia, [compiled by] Centro de Encuentros Cultura y Mujer [CECYM]. Buenos Aires, Argentina, CECYM, [1993]. 75-79. (Travesías: Temas del Debate Feminista Contemporáneo 1)

    I will make another comment on views in the first world of women from the third world. I sometimes believe that the perspectives are very simplistic. From a first world standpoint, it is very easy to say: "we will talk about development and violence, and we will help women from all types of countries who don't have or know anything better." It's not that simple, where you can merely state that a country "is backward as regards women, because it is a backward nation." Backward in the sense that this is a nation whose population is not sufficiently well educated. This is a simplistic notion that contributes to perpetuating many of the feelings of indulgence on the part of aid agencies in diverse donor countries, which encounter a large dose of skepticism and cynicism in the countries receiving that help. In these countries people want to know why they want to help us, what they want to know about our countries to use to their advantage. Then I think that it is necessary to keep in mind that you cannot have a simple notion about complex social problems and a complicated cultural situation about which you know nothing. (excerpt)
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  5. 5
    Peer Reviewed

    Health impact assessment in international development assistance: the World Bank experience.

    Mercier J

    Bulletin of the World Health Organization. 2003 Jun; 81(6):461-462.

    Large infrastructure construction and rehabilitation works are the obvious priorities for integrating health impact assessment into the environmental assessment process, because of the specific risks generated by the sudden surge in human presence from migratory workers and because of the intrinsic health and safety hazards associated with construction. However, other sectors may also generate serious health hazards, for example, tourism development, an activity which is typically funded by the World Bank’s sister organization the International Finance Corporation (IFC). (excerpt)
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  6. 6

    Complexity, morality, and policy at the population summit.

    Johansson SR

    POPULATION AND DEVELOPMENT REVIEW. 1995 Jun; 21(2):361-86.

    At the 1993 Population Summit in New Delhi, 60 scientific academies represented at the Summit signed a joint statement affirming that reducing population growth is a necessary part of ecological sustainable development and that action is needed now. As an explanation of this statement, the Summit produced a book of essays entitled Population--The Complex Reality. There is, however, little consensus among the contributors about the complex relationship between population, development, and the environment. Given that scientists remain uncertain about the causal relationships linking population growth to economic and ecological change, concerned governments must be equally uncertain as to which demographic policies to adopt for economic development. This review of selected essays from the Summit collection argues that the complexity of the relationships between population, development, and the environment should not be an excuse for unresolved uncertainty. Rather, this same complexity should inspire a new and comprehensive approach to explaining how human social systems work and how they can be managed to achieve outcomes that people value. Some of the contributors to the collection explore the concept of openly applying ethical reasoning to demographic policy. While their ethical reasonings may well be debated, they are right to openly discuss ethics as a normal part of social science discourse, rather than allowing unspoken, and thereby unchallenged, moral assumptions to covertly shape their policies. They also affirm the value of historical and case-oriented methods of research as a necessary corrective to the standard quantitative methods, which are given to minimizing complexity rather than coping with it.
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  7. 7

    The evolution of policy on fertility in Tanzania: drawing on, and influence of international experience.

    Kamuzora CL

    In: Population policy in Sub-Saharan Africa: drawing on international experience. Papers presented at the seminar organized by the IUSSP Committee on Policy and Population, in Kinshasa, Zaire, 27 February - 2 March 1989 / Echanges d'experiences internationales en matiere de politique de population en Afrique au Sud du Sahara. Communications presentees au seminaire organise par la Commission des Politiques Demographiques de l'UIESP, a Kinshasa, Zaire, 27 fevrier - 2 mars 1989. Liege, Belgium, International Union for the Scientific Study of Population [IUSSP], 1989. 333-60.

    The idea of adoption of population policies globally was associated with the unprecedented high population growth rates of over 2.5%/annum in most underdeveloped countries after World War II. The goal of Tanzania's population policy is to facilitate economic recovery. The policy, rooted in the Coale-Hoover model, is not viable because of the unrealistic assumptions of the model: 1) internal and international economic structures are not conducive to savings and their translation into investments; 2) old-age structures resulting from fertility decline do not bode well for a labor-intensive economy like that of Tanzania if economic expansion has to take place; and 3) no clear and consistent relationship between population and economic growth has been empirically observed. The evolution of population policy in Tanzania went through 2 significant phases: 1) opposition to family planning which was a spontaneous response to problems of socioeconomic development including maternal and child health and rural-urban migration; 2) the change toward working for an explicit population policy with central focus on reduction of population growth rate and fertility limitation. Since the mid-1980s efforts were exerted to reduce the population growth rate from the 1967-78 estimate of an annual 3.2-2.5% by reducing the total fertility rate from about 7.0 to 4.0. From the start of the new phase, a UN Population Fund project, executed by the International Labor Organization, was established in the Ministry of Finance, Economic Affairs and Planning to organize a Population Planning Unit. The main activities of the project have been population awareness seminars and coordination of the activities of the National Population Committee that drew up proposals on population problems.
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  8. 8

    Health economics in developing countries.

    Abel-Smith B


    This general discussion on health economics provides an historical overview as well as a discussion of some of the developments and deficiencies in health economics in developing countries, broadly focused on expenditure and financing studies, cost benefit and cost effectiveness, local costing studies and health planning. In 1963, it was found that as GDP rose so did health expenditures, that countries with similar per capita income spent different percentages of GDp on health services, that the private sector involvement was greater than the public, and that hospitals received most of the money. Countries were encouraged to conduct further studies. The World Bank has successfully stimulated discussion. However, lacking the expenditure studies, cost benefits are hampered by the availability of epidemiological data and poor cost information, and geared toward studies on how to cut costs for immediate goals, or specific diseases, rather than on practical advice to governments. 1 such study helped identify that most cost effective allocation of resources. The limited local cost studies are particular to understanding specific costs of immunization versus antenatal visits; however, the usefulness of such preliminary information reveals wide variability between countries. The Health for All initiatives and the limited resources in developing countries have placed health planning in a central position with Ministries of Health. Due to prior mistakes in planning an excess number of trained medical staff are underutilized and present needs have been defined as developing local PHC support staff. The WHO expectation of 5% of GNP for health service was unfulfilled because larger donor aid and local resources have not been sufficient even with strong posturing, and over ambitious plans were made unrealistically. Since 1987, WHO has provided economic strategies but the economic crises changed the needs. Many questions remain and consultants are too few, improperly trained, or unavailable for the appropriate time period: unacceptable solutions, coupled with a confusing World bank prospectus for action when more research is needed. Intersectorial collaboration has not provided answers to priorities or addressed the interactions among nutrition and agricultural policy, education and lifestyle, water and sanitation and the economy. The research agenda should include: the identification of the determinants of health, key elements of primary health care (PHC), cost of delivering PHC, hospital efficiency, health manpower mix, adequate procurement and distribution, appropriate technology, user charges for financing, health insurance, and community financing.
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  9. 9

    The effect of economic change on gender roles: the case of Tanzania.

    Swantz ML

    Development. 1988; (2-3):93-6.

    25-40% of households in East Africa are female-headed because women are either single, divorced, widows or made responsible for their families; there are other cases where women are de facto principal supporters of their families in spite of men retaining positions as figure heads. In Tanzania, unlike other African countries, the country has begun to prosper as a result of the structural adjustment policies of the World Bank and the International Monetary Fund. This article discusses 3 major points: 1) that the rapid social and economic changes have not been communicated to the majority of people causing resistance to new policies; 2) the changing role of women in a Tanzania with a stronger economy; and 3) the need for donor agencies to respond positively to people's self-reliance and initiation of new projects.
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  10. 10


    Ozal T

    In: Population perspectives. Statements by world leaders. Second edition, [compiled by] United Nations Fund for Population Activities [UNFPA]. New York, New York, UNFPA, 1985. 159.

    In the last past 30 years, the world has experienced an increase in its population, making the implementation of population programmes paramount concern worldwide. Population increase has had an alarming effect on the socioeconomic development of Turkey. The constitution of the Turkish government supports the principle of the rights of individuals to choose freely, the number and spacing of their children, as outlined in the World Plan of Action, 1974. Within the context of the constitution, the Turkish government looks to implement programmes designed to protest both mother and child and designed also, to reach the remotest parts of the country. The government hopes to maintain a population growth equal to its economic and social growth. However, the Turkish government feels that the implementation of population programmes should be on both an international and national scale. The government hopes that the Mexico Conference will be a success.
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  11. 11

    United States.

    Reagan R

    In: Population perspectives. Statements by world leaders. Second edition, [compiled by] United Nations Fund for Population Activities [UNFPA]. New York, New York, UNFPA, 1985. 168.

    It has been recognized by world leaders that increasing population trends have an effect on social and economic factors. The government of the United States works to combat population problems, globally, by providing multilateral and bilateral assistance to developing countries. The United States feels that emphasis should be placed on technological advances as a way of dealing with environmental and economic problems. However, the rights of the individual, regardless of religious or cultural values, have to be respected when implementing population programmes. The U.S., while concerned with change in demographic variables, feels that concern should also be shown for the welfare of children, allowing them the chance to develop both physically and mentally.
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  12. 12


    Kaunda KD

    In: Population perspectives. Statements by world leaders. Second edition, [compiled by] United Nations Fund for Population Activities [UNFPA]. New York, New York, UNFPA, 1985. 177-8.

    The government of Zambia has begun to concern itself with improving the living conditions of its people. Since the Bucharest Population Conference, countries in Africa have experienced a growth in population, in addition to declines in its various economies. The population of Zambia increased at a rate of 3.1% between 1969-1980. If this trend continues, the population will double in 23 years. Thus, the government seeks to implement population programmes which will deal with the rising population variables, while introducing programs which will stimulate economic growth. It is the policy of the government to provide free education, provide free health services, and work to improve the status of women in its society.
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  13. 13


    Seaga EP

    In: Population perspectives. Statements by world leaders. Second edition, [compiled by] United Nations Fund for Population Activities [UNFPA]. New York, New York, UNFPA, 1985. 89.

    Rapid population growth has impeded the efforts of the Government of Jamaica to provide adequate social services such as education and health care to all sectors of the population. Moreover, the population-related problems of high unemployment, widespread rural-urban migration, and an unequal distribution of income have hindered the country's development process. Jamaica's National Population Policy, adopted in 1983, seeks to establish a coherent set of goals in terms of achieving a population size that is consistent with sustained economic development. Targets of this policy include a population not exceeding 3 million by the year 2000; attainment of an average total fertility rate of 2 births/woman by the end of the 1980s; an increase in life expectancy from the current level of 70 years to 73 years by 2000; a reduction in the outmigration of skilled labor through increased employment opportunities; and improvements in the areas of housing, nutrition, education, and environmental conditions. Although fertility remains unacceptably high, the crude birth rate has declined in the post-Independence period, from 40/1000 in 1960 to 27/1000 in 1980. Crucial to the attainment of these goals is the involvement of all areas of government and the private sector.
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  14. 14

    Lao People's Democratic Republic.


    In: Population perspectives. Statements by world leaders. Second edition, [compiled by] United Nations Fund for Population Activities [UNFPA]. New York, New York, UNFPA, 1985. 94.

    Although the Government of the Lao People's Democratic Republic has not yet formulated a population policy, there is awareness of the centrality of population trends to economic production. Specific goals of the government are to bring population growth in balance with production needs, to raise the economic and cultural standards of ethnic minorities, and to increase life expectancy. A hindrance to development planning has been the lack of population statistics. 80% of the country's total area is covered by forests, mountains, and plateaus. The population density is only 18 people/square kilometer, and there is little transportation between regions. To remedy this situation, the government has ordered a population census for 1985, the results of which will provide the basis for the country's 2nd 5-year plan (1986- 90). Cooperation and assistance from the international community, especially the United Nations Fund for Population assistance, are expected.
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  15. 15


    Wangchuck JS

    In: Population perspectives. Statements by world leaders. Second edition, [compiled by] United Nations Fund for Population Activities [UNFPA]. New York, New York, UNFPA, 1985. 20.

    World leaders have come to recognize that increasing population trends have an effect on social and economic factors. However, most of the increases will occur in developing countries and lead to an increase in the number of the poor and the deprived. Bhutan, a land-locked developing country, does not have a population problem, at present. However, that has not prevented the Royal Government from initiating and implementing population oriented programs in the fields of health, education, agriculture, and communications. The International Conference on Population, Mexico 1984 allowed the government a clearer insight into challenges which face the world. As a result of this, the government will be able to better shape policies and programs dealing with population control.
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  16. 16


    Moi DT

    In: Population perspectives. Statements by world leaders. Second edition, [compiled by] United Nations Fund for Population Activities [UNFPA]. New York, New York, UNFPA, 1985. 92-3.

    In the 2 decades of independence, the Government of Kenya has used incomes generated for improvements in medical care, education, nutrition, and water sanitation facilities. The sum effect has been a general improvement in living standards and a significant reduction in mortality, especially infant mortality. However, a high rate of population growth and its structural and spatial implications have magnified problems in areas such as human resource development and expanded opportunities for income-generation. The current population, estimated at 19.4 million, is doubling every 18 years and expected to reach 35 million by the end of the century. Young people increasingly dominate the population's structure. Modern contraception has been adopted by only a minority of women and is applied to birth spacing rather than to limiting family size. In rural areas, Kenyan women continue to have high fertility aspirations. Even with declines in fertility, the decades ahead will see severe stresses on Kenya's health care, education, and employment sectors. The number of children served by the primary school system (ages 6-14 year olds) is expected to increase from 4 million in 1980 to 8.9 million by 2000, while the labor force (15-49 year olds) should rise from 6.8 million to 15.7 million in this period. It is only through the participation of rural and urban Kenyans in district development planning that Kenya's high fertility levels can be reduced and economic development sustained.
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  17. 17


    Jonathan L

    In: Population perspectives. Statements by world leaders. Second edition, [compiled by] United Nations Fund for Population Activities [UNFPA]. New York, New York, UNFPA, 1985. 97.

    The Government of Lesotho seeks to confer material and other benefits to its society members, with an emphasis on self-determination in family management. It has become increasingly clear in the 17 years since Independence, however, that population growth thwarts these objectives. Basic economic resources such as land, employment opportunities, and social services have been unable to keep pace with the demands generated by a rapidly growing population. The basic human needs of food, shelter, and good health cannot be met without sensitizing the population to the need for a responsible population management approach. At the same time, the Government retains a commitment to a voluntary population policy acceptable to families. The national maternal-child health system is being utilized to educate the population about the benefits of small family size, and the Government is forging alliances with nongovernmental organizations to address population-related issues.
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  18. 18


    Doe SK

    In: Population perspectives. Statements by world leaders. Second edition, [compiled by] United Nations Fund for Population Activities [UNFPA]. New York, New York, UNFPA, 1985. 98-9.

    Liberia is characterized by a high fertility rate; its current total fertility rate of 6.7 children/woman is one of the highest in Africa. Also quite high is the country's 18/1000 mortality rate. Until the 1980s, Liberia was able to maintain a favorable balance between an increasing population and the gross domestic product. In more recent years, however, the economic growth rate has fallen behind the population growth rate, with a subsequent sharp decline in the standard of living. Economic recovery is currently the cornerstone of Liberia's development policy, and the protection and enhancement of the population's welfare by proper planning is a key goal. Population policies that will accelerate the pace of achieving national economic objectives are under consideration. Of particular concern is the massive migration of rural residents to urban areas. In response to this trend, development projects in rural areas are being expanded.
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  19. 19


    Conte L

    In: Population perspectives. Statements by world leaders. Second edition, [compiled by] United Nations Fund for Population Activities [UNFPA]. New York, New York, UNFPA, 1985. 73.

    Under the First Republic, Guinea pursued a pronatalist population policy on the premise that a large labor force was necessary to develop the country's agricultural and industrial potential. By 1983, Guinea had a population of 6 million, 45% of whom were under 15 years of age. There were 24 inhabitants/kilometer. The annual birth rate of 2.5% was offset by an infant mortality rate of 159/1000, resulting in a life expectancy of only 45 years. The steadily growing population has led to a strain on permanently limited available resources and a new awareness that population growth is not necessarily synonymous with economic development. Thus, when the Second Republic was launched in 1984, the Government recognized the right of each citizen to decide freely on matters of family size based on the demonstrated relationship between population growth and family well-being. A central feature of this policy is education aimed at making couples aware of their responsibilities.
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  20. 20

    Challenge of the 1990s.

    Mahler H

    PEOPLE. 1989; 16(4):3-5.

    There is no real justification for being seriously concerned about family planning in the 1990s, except within the perspective of getting a 'new deal' for development. Such a deal has to break through the cynical noncommunication between north and south, a cynicism epitomized by the foot-dragging of the rich countries over debt crisis whereby, almost by design, millions and millions of people are being pushed deeper and deeper into poverty. There is no 'new deal' on the horizon, but there is, for example, the 'new' discovery that if people are merely pawns in the economic growth game then the game is lost for the underprivileged. It is of the greatest importance that institutions like the World Bank recognize that we must find a balance between social productivity and economic productivity--and understand how intimately these are intertwined. There will be a temptation in the 1990s, as demands for services grow, to think that International Planned Parenthood Federation (IPPF) should concentrate on what it knows and does best: family planning. But it must also advocate at every level: for women, for children, for the environment, and for all aspects of the fight against poverty. Looking more specifically at the challenges for family planning in the next decade, the real breakthrough has come on the demand side. Some 300 million families are out of reach of the services they need and mostly want, if they could only be performed. (author's modified)
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  21. 21


    Lamrani K

    In: Population perspectives. Statements by world leaders. Second edition, [compiled by] United Nations Fund for Population Activities [UNFPA]. New York, New York, UNFPA, 1985. 111-2.

    The 1974 World Population Conference called for the establishment of a world economic order based on equality and respect for the independence and sovereignty of every nation. This aspiration has been thwarted by the deadlock in the North-South dialogue, aggravation of the Third World debt, alarming increases in arms expenditures, and the continuous decrease in aid allocated to development in the Third World. The unequal relations between developed and developing countries continue to foster a lack of balance between population density and the concentration of wealth. There is thus a need to renew commitment to a new international order. In this spirit, it will be possible to reduce tension among blocs and to enable the international community to establish economic relations based on principles of justice and mutual interest, especially in terms of prices of industrial goods and raw materials. Until there is a more equitable distribution of wealth in the world, the welfare of the entire human race will be jeopardized. Thus, Morocco reaffirms the necessity of forming a comprehensive, effective policy to fight poverty and improve the standard of living of the world's peoples. Morocco believes that successful population policies will have to be humane, balanced, and integrated in the framework of a comprehensive world plan of action that respects national sovereignty and human rights.
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  22. 22


    Sodnom D

    In: Population perspectives. Statements by world leaders. Second edition, [compiled by] United Nations Fund for Population Activities [UNFPA]. New York, New York, UNFPA, 1985. 109-10.

    The fundamental concern of every society must be the right of people to work, to participate actively in productive and social life, and to improve their material and spiritual circumstances. This principle forms the basis of the population policy of the People's Republic of Mongolia. Toward this end, the government has carried out a cultural revolution to overcome the backwardness left behind by the previous feudal-theocratic regime and has created a modern system of health care, education, and social security based on the dynamic development of the country's economy. Among the country's goals for the year 2000 are a general plan for the development and deployment of labor and material resources; programs for food and agriculture, rational energy use, housing, and manpower allocation; and programs for scientific and technical progress. Increasing the size of the population remains a central focus of Mongolia's population policy. Imperialist economic policies and the consequent hunger, malnutrition, and poverty are the main obstacles to development in poor countries--not overpopulation. Despite successes in increasing life expectancy, improving school attendance rates, and increasing per capita income and social consumption, Mongolia has faced several problems in recent years. The increasingly young population has required large expenditures for social needs; in addition, industrialization and consequent urbanization have produced labor shortages in agriculture. The fact that the population is scattered over such a wide area creates obstacles for cultural and educational work. Mongolia is in full support of United Nations population activities aimed at removing obstacles to solving the problems of developing countries and views ensuring peace and security as a necessary 1st step.
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  23. 23

    Investing in women: the focus of the nineties.

    Sadik N

    POPULI. 1989 Jun; 16(2):4-19.

    Barriers that prevent women from reaching their full potential should be eliminated, especially in developing countries. Households headed by females are the poorest in the world. In many countries, women are not permitted to own land. Family planning services are essential to the development of women. About US $3 billion a year is spent on family planning services in developing countries. In many developing nations, discrimination against girls is ingrained. Small, weak babies are likely to come from underfed mothers. Childbirth has risks; these are especially so in developing countries. 3/4 of the developing world's health problems can be solved by prevention and cure. In 60 developing countries, women working outside the home tended to have fewer children than those working at home or in the fields. But studies in Turkey, Thailand, and other countries have shown the opposite. In 38 countries, research has shown that only at higher socioeconomic levels is employment an alternative to childbearing. Relying on women for cheap, unskilled labor is a waste of human and economic resources. Better education and higher employment levels could enable women to better contribute to development. Employment figures for women often misrepresent the actual amount of work that women do. Having women do less work and making what they do more profitable might help bring down family size. In almost every country studied recently educated women have had fewer children than less educated women. The families of these educated mothers are likely to be healthier, too. Recommendations addressed mainly to governments, are given in 6 areas: 1) equality of status; 2) documenting and publicizing women's contribution to development; 3) increasing women's productivity and lessening their double burden; 4) providing family planning; 5) improving women's health; and 6) expanding education. Goals for the year 2000 are given. For the last 20 years, the United Nations Fund for Population Activities (UNFPA) has emphasized women's role in population programs and projects. UNFPA has set up an internal Working Group on Women, Population and Development.
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  24. 24

    Migration and urbanization in sub-Saharan Africa: international agency influences.

    Becker CM

    [Unpublished] 1989 Mar. Paper presented at the Seminar on Population Policy in Subsaharan Africa: Drawing on International Experience, sponsored by the International Union for the Scientific Study of Population (IUSSP), Committee on Population and Policy, with the collaboration of Departement de Demographie de l'Universite de Kinshasa, Commission Nationale de la Population du Zaire (CONAPO), Secretariat au Plan du Zaire, held at the Hotel Okapi, Kinshasa, Zaire, 27 February to 2 March 1989. 36 p.

    The impact of policies pursued by international agencies in Sub-Saharan Africa have been to generally increase African city growth and the urban population's concentration in the largest cities. The World Bank is the dominant agency in Africa in determining the policy decisions of the international community. Since the African urban sector provides 40-50% of Africa's gross domestic product, all domestic and international efforts to increase economic growth are focused on urban activities, promoting urbanization. Factors such as education policy, government's consumption of modern sector goods, salaries of urban bureaucrats all encourage urbanization and depend on adequate infrastructures. Africa's rapid urbanization in the past 15 years is surprising in the absence of most of these factors. Investments in urban housing, transport and infrastructure assistance from international donors has contributed to Africa's rapid urbanization because funding has gone to the urban areas. Shifting from funding primary education in the rural areas to higher education loans has also had a strong urbanizing effect on countries since education imparts western values of desiring urban living. Donor funding and policy-making has also included influence on African governments to reduce their birth rates in order to reduce the share of the public sector budget that is committed to public services. The decline in crude death rates for the region as a whole went from 22 to 17/1000 between 1965 and 1983, while the decline in birth rates only went from 48 to 47 in 18 of the 45 countries. This has resulted in rising population growth rates in most African countries during the past 3 decades, promoting African urbanization. The Bank's microeconomic policies designed to improve market efficiency are: 1) greater emphasis on cost recovery; 2) financial profitability of the parastatal sectors; 3) development of small-scale enterprises; 4) deemphasis on urban, large-scale industries; 5) development of secondary cities. The introduction of structural adjustment programs in return for renegotiated loans is the most profound intervention by the international community in Africa during the past 15 years because it will involve shrinkage of urban growth by reducing tax burdens on rural areas and less demand for urban services.
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  25. 25

    The population problem in Turkey (as seen from the perspective of a foreign donor).

    Holzhausen W


    From the perspective of the UN Fund for Population Activities, Turkey has a population problem of some magnitude. In 1987 the population reached 50 million, up from 25 million in 1957. Consistent with world trends, the population growth rate in Turkey declined from 2.5% between 1965-73 to 2.2% between 1973-84; it is expected to further decrease to 2.0% between 1980 and 2000. This is due primarily to a marked decline of the crude birthrate from 41/1000 in 1965 to 30/1000 in 1984. These effects have been outweighed by a more dramatic decline in the death rate from 14/1000 in 1965 to 9/1000 in 1984. Assuming Turkey to reach a Net Reproduction Rate of 1 by 2010, the World Bank estimates Turkey's population to reach some 109 million by the middle of the 21st century. The population could reach something like 150 million in the mid-21st century. Some significant progress has been made in Turkey in recent years in the area of family planning. Yet, some policy makers do not seem fully convinced of the urgency of creating an ever-increasing "awareness" among the population and of the need for more forceful family planning strategies. Government allocations for Maternal and Child Health and Family Planning (MCH/FP) services continue to be insufficient to realize a major breakthrough in curbing the population boom in the foreseeable future. Most foreign donors do not consider Turkey a priority country. It is believed to have sufficient expertise in most fields and to be able to raise most of the financial resources it needs for development. The UNFPA is the leading donor in the field of family planning, spending some US $800,000 at thi time. Foreign inputs into Turkey's family planning program are modest, most likely not exceeding US $1 million/year. Government expenditures are about 10 times higher. This independence in decision making is a positive factor. Turkey does not need to consider policy prescriptions that foreign donors sometimes hold out to recipients of aid. It may be difficult for foreign donors to support a politically or economically motivated policy of curtailing Turkey's population growth, but they should wholeheartedly assist Turkey in its effort to expand and improve its MCH/FP services. Donors and international organizations also may try to persuade governments of developing countries to allocate more funds to primary education and to the fight against social and economic imbalances. Donors should continue to focus on investing in all sectors that have a bearing on economic development.
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