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State of world population 2017. Worlds apart: Reproductive health and rights in an age of inequality.
New York, United Nations Population Fund [UNFPA], Division of Communications and Strategic Partnerships, 2017. 140 p.In most developing countries, the poorest women have the fewest options for family planning, the least access to antenatal care and are most likely to give birth without the assistance of a doctor or midwife. Limited access to family planning translates into 89 million unintended pregnancies and 48 million abortions in developing countries annually. This does not only harm women’s health, but also restricts their ability to join or stay in the paid labour force and move towards financial independence, the report argues. Lack of access to related services, such as affordable child care, also stops women from seeking jobs outside the home. For women who are in the labour force, the absence of paid maternity leave and employers’ discrimination against those who become pregnant amount to a motherhood penalty, forcing many women to choose between a career and parenthood. The UNFPA report recommends focusing on the furthest behind first, in line with the United Nations blueprint for achieving sustainable development and inclusive societies by 2030. The 2030 Agenda for Sustainable Development has “envisaged a better future, one where we collectively tear down the barriers and correct disparities,” the report states. “Reducing all inequalities needs to be the aim. Some of the most powerful contributions can come from realizing...women’s reproductive rights.” (excerpt)
Paris, France, UNESCO, 2015. 47 p.Comprehensive sexuality education (CSE) has attracted growing interest and attention over recent years. This is demonstrated and reinforced by increased political commitment globally and the development of expert guidance, standards, curricula and other tools to strengthen the implementation of CSE in practice. Across the world, there are a wide range of different approaches to delivering sexuality education; at this stage in the evolution of the field, it is timely to take stock of the evidence, practice and lessons learned to date. This report provides an overview of the status of CSE implementation and coverage on a global level, drawing on specific information about the status of CSE in 48 countries, generated through analysis of existing resources and studies. Best practice in terms of providing CSE continues to develop. The current report examines the evidence base for CSE and, through a series of case studies from every region, explores initiatives that are setting the standard and pioneering new practices in the delivery of CSE. It represents the first in a series of periodic reports that aims to monitor the global implementation of CSE. Comprehensive life skills-based sexuality education helps young people to gain the knowledge and skills to make conscious, healthy and respectful choices about relationships and sexuality.
Lancet. 2017 Jul 01; 390(10089):1.Add to my documents.
Lancet. 2016 Aug 20; 388(10046):743-4.Add to my documents.
Washington, D.C., World Bank, 2005.  p. (World Bank Working Paper No. 68)In recent years, Europe and Central Asia has experienced the world’s fastest growing HIV/AIDS epidemic. Yet, in the Western Balkan countries the HIV prevalence rate is under 0.1 percent, which ranks among the lowest. This may be due to a low level of infection among the population—or partly due to inadequate surveillance systems. All major contributing factors for the breakout of an HIV/AIDS epidemic are present in the Western Balkans. HIV/AIDS disproportionably affects youth (80 percent of HIV-infected people are 30 years old or younger). Most of the Western Balkan countries have very young populations, which have been affected by the process of social transition, wars, unemployment and other factors. Among youth, there is generalized use of drugs and sexual risk behavior. Therefore, the number of cases of HIV has been increasing, especially in Serbia, and the incidence of Hepatitis C has clearly increased, which suggests that sharing of infected needles is practiced by injecting drug users. Apart from human suffering, an HIV/AIDS epidemic can have a significant impact on costs of care for individuals, households, health services and society as a whole. This study has found weak public health systems and gaps in financing and institutional capacity necessary to implement evidence-based and cost-effective HIV/AIDS Strategies. Political commitment must increase for action to occur promptly. Prevention interventions are cost effective and, in the short term, affordable with own-country resources. Medium- and long-term interventions would require donor assistance. Longer-term interventions would aim at preventing poverty, exclusion and unemployment, for example, by empowering young people to participate in the regional and global labor market.
Multistakeholder partnerships with the Democratic People's Republic of Korea to improve childhood immunisation: a perspective from global health equity and political determinants of health equity.
Tropical Medicine and International Health. 2016 Aug; 21(8):965-972.Objective To examine the current partnerships to improve the childhood immunization programme in the Democratic Peoples’ Republic of Korea (DPRK) in the context of the political determinants of health equity. Methods A literature search was conducted to identify public health collaborations with the DPRK government. Based on the amount of publicly accessible data and a shared approach in health system strengthening among the partners in immunization programmes, the search focused on these partnerships. results The efforts by WHO, UNICEF, GAVI and IVI with the DPRK government improved the delivery of childhood vaccines (e.g. pentavalent vaccines, inactivated polio vaccine, two-dose measles vaccine and Japanese encephalitis vaccine) and strengthened the DPRK health system by equipping health centers, and training all levels of public health personnel for VPD surveillance and immunization service delivery. Conclusion The VPD-focused programmatic activities in the DPRK have improved the delivery of childhood immunization and have created dialogue and contact with the people of the DPRK. These efforts are likely to ameliorate the political isolation of the people of the DPRK and potentially improve global health equity.
A number of factors explain why WHO guideline developers make strong recommendations inconsistent with GRADE guidance.
Journal of Clinical Epidemiology. 2016; 70:111-122.Objective: Many strong recommendations issued by the World Health Organization (WHO) are based on low- or very low-quality (low certainty) evidence (discordant recommendations). Many such discordant recommendations are inconsistent with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidance. We sought to understand why WHO makes discordant recommendations inconsistent with GRADE guidance. Study Design and Setting: We interviewed panel members involved in guidelines approved by WHO (2007e2012) that included discordant recommendations. Interviews, recorded and transcribed, focused on use of GRADE including the reasoning underlying, and factors contributing to, discordant recommendations. Results: Four themes emerged: strengths of GRADE, challenges and barriers to GRADE, strategies to improve GRADE application, and explanations for discordant recommendations. Reasons for discordant recommendations included skepticism about the value of making conditional recommendations; political considerations; high certainty in benefits (sometimes warranted, sometimes not) despite assessing evidence as low certainty; and concerns that conditional recommendations will be ignored. Conclusion: WHO panelists make discordant recommendations inconsistent with GRADE guidance for reasons that include limitations in their understanding of GRADE. Ensuring optimal application of GRADE at WHO and elsewhere likely requires selecting panelists who have a commitment to GRADE principles, additional training of panelists, and formal processes to maximize adherence to GRADE principles. Copyright: 2016 Elsevier Inc.
New York, New York, UNICEF, 2015.  p.This report from A Promise Renewed – a global partnership initiative aimed at ending preventable child and maternal deaths – features updates and analyses of global, regional and national child mortality levels and trends. It also provides current information on causes of child and maternal deaths, and coverage of key interventions to prevent them, as well as projections for the 2015-2030 period. The report highlights impressive progress towards our commitment to increase child survival during the Millennium Development Goals era, which has saved the lives of some 48 million children under the age of 5 since 2000. Finally, it calls for intensified action in the context of the Sustainable Development Goals.
Developing and implementing global gender policy to reduce HIV and AIDS in low- and middle-income countries: policy makers' perspectives.
African Journal of AIDS Research. 2014 Sep; 13(3):197-204.Gender inequalities have been recognised as central to the HIV epidemic for many years. In response, a range of gender policies have been developed in attempts to mitigate the impact and transform gender relations. However, the effects of these policies have been less than successful. In March 2010 the Joint United Nations Programme on HIV/AIDS (UNAIDS) launched the Agenda for accelerated country level action on women, girls, gender equality and HIV (the Agenda), an operational plan on how to integrate women, girls and gender equality into the HIV response. This paper explores the perspectives of those involved in developing and implementing the Agenda to understand its strengths and limitations. In-depth one-on-one interviews were conducted with 16 individuals involved in the development and implementation of the Agenda. The data were analysed using thematic network analysis. Facilitators of the Agenda centred on the Agenda's ability to create political space for women and girls within the global HIV/AIDS response and the collaborative process of developing the Agenda. Barriers to the implementation and development of the Agenda include the limited financial and non-financial resources, the top-down nature of the Agenda's development and implementation and a lack of political will from within UNAIDS to implement it. We suggest that the Agenda achieved many goals, but its effect was constrained by a wide range of factors.
Guttmacher Policy Review. 2015 Spring; 18(2):27-33.The U.S. overseas program for family planning and reproductive health has been under attack from policymakers who are antiabortion and increasingly anti-family planning. The two most notorious of these attacks are the blocking of U.S. funding for the United Nations Population Fund and the enforcement of the global gag rule, which prohibits aid to foreign nongovernmental organizations that engage in abortion services or advocacy with non-U.S. funds. In an ongoing counterproductive cycle, these restrictions have come in and out of effect depending on the political party in power -- a struggle that is expected to heat up again with a socially conservative Congress.
Chapel Hill, North Carolina, University of North Carolina at Chapel Hill, Carolina Population Center, MEASURE Evaluation, 2015 Apr.  p. (SR-15-118C; USAID Cooperative Agreement No. AID-OAA-L-14-00004)This publication is one of eight case studies that were developed as part of a broader review entitled Family Planning in Latin America and the Caribbean: The Achievements of 50 Years. As its title implies, the larger review documents and analyzes the accomplishments in the entire region since the initiation of U.S. Agency for International Development (USAID) funding in the early 1960s. El Salvador has made enormous progress in terms of family planning over the past five decades. It has reduced fertility rates; it has developed a robust legal and regulatory framework for FP; it has allocated resources for procuring contraceptives for its population; it now offers information and contraceptive services to the entire population of the country with the active participation of civil society organizations, especially women’s organizations.
Chapel Hill, North Carolina, University of North Carolina at Chapel Hill, Carolina Population Center, MEASURE Evaluation, 2015 Apr.  p. (SR-15-118F; USAID Cooperative Agreement No. AID-OAA-L-14-00004)This publication is one of eight case studies that were developed as part of a broader review entitled Family Planning in Latin America and the Caribbean: The Achievements of 50 Years. As its title implies, the larger review documents and analyzes the accomplishments in the entire region since the initiation of U.S. Agency for International Development (USAID) funding in the early 1960s. Nicaragua has made significant progress in improving its macro-level primary health care indicators, reducing maternal mortality and increasing contraceptive prevalence. There has also been increased participation by the Instituto Nicaragense de Seguridad Social (INSS) in providing family planning services and commodities, thus reducing the burden on health ministry facilities. The government has shown its strong commitment to comprehensive services to improve the health of the population.
Journal of Ethnic and Migration Studies. 2014 Jun; 40(6):924-941.This article investigates the complex relationship between the practices of the United Nations High Commissioner for Refugees (UNHCR) in the field of refugee protection and the more recent political rationality of 'migration management' by drawing from governmentality studies. It is argued that the dissemination of UNHCR's own refugee protection discourse creates certain 'figures of migration' allowing for justifying the build-up and perfection of border controls, which in turn enable any attempt to 'manage' migration in the first place. Conversely, the problematisation of population movements as 'mixed migration flows' allows UNHCR to enlarge its field of activitiy despite its narrow mandate by actively participating in the promotion, planning and implementation of migration management systems. Based on ethnographic research in Turkey and Morocco, this article demonstrates, furthermore, that UNHCR's refugee protection discourse and the emerging migration management paradigm are both based on a methodological nationalism, share an authoritarian potential and yield de-politicising effects. What UNHCR's recent embracing of the migration management paradigm together with its active involvement in respective practices then brings to the fore is that UNHCR is part of a global police of populations.
Population Policy in Sub-Saharan Africa: A Case of Both Normative and Coercive Ties to the World Polity.
Population Research and Policy Review. 2014 Jun 15;During the 1980s and 1990s, two-thirds of sub-Saharan African countries adopted national population policies to reduce population growth. Based on multivariate statistical analysis, I show that countries with more ties to the world polity were more likely to adopt population policies. In order to refine world polity theory, however, I distinguish between normative and coercive ties to the world polity. I show that ties to the world polity via international nongovernmental organizations became predictive of population policy adoption only after the 1994 United Nations International Conference on Population and Development institutionalized reproductive health as a global norm to which countries could show adherence through population policies. Ties to the World Bank in the form of indebtedness, presumed to be coercive, were associated with population policy adoption throughout the time period observed. Gross domestic product per capita, democracy, and religion also all predicted population policy adoption. The case of population policy adoption in sub-Saharan Africa thus demonstrates that ties to organizations likely to exert normative pressure are most influential when something about international norms is at stake, while ties to organizations with coercive capacity matter regardless of time, but may be easier for wealthier countries to resist.
Global Public Health. 2014 Jun 3; 9(6):607–619.On the twentieth anniversary of the International Conference on Population and Development (ICPD), activists, governments and diplomats engaged in the fight for sexual and reproductive health and rights (SRHR) are anxious to ensure that these issues are fully reflected in the development agenda to succeed the Millennium Development Goals after 2015. In inter-governmental negotiations since 1994 and particularly in the period 2012-2014, governments have shown that they have significantly expanded their understanding of a number of so-called ‘controversial’ issues in the ICPD agenda, whether safe abortion, adolescent sexual and reproductive health services, comprehensive sexuality education or sexual rights. As in the past and in spite of an increasingly complex and difficult multilateral environment, countering the highly organized conservative opposition to SRHR has required a well-planned and determined mobilization by progressive forces from North and South.
Just Development. 2014 Jan; (1):1-4.Our first feature, Four Cardinal Questions [and answers of a sort] toward Just Development in FCS, by Deborah Isser, Doug Porter and Louis-Alexandre Berg, takes on the hardest cases: countries plagued by fragility, violent conflict, extremely low capacity and poor governance. The Note proposes an analytical framework, illustrated by case examples that can be used to design effective interventions.
Ensuring the inclusion of sexual and reproductive health and rights under a sustainable development goal on health in the post-2015 human rights framework for development.
Reproductive Health Matters. 2013 Nov; 21(42):61-73.Since the 1994 International Conference on Population and Development (ICPD) in Cairo placed reproductive health and rights firmly on the international agenda, civil society and other advocates have worked ceaselessly to ensure that they remain central to women's empowerment and have taken all opportunities to expand the framework to include sexual health and rights. When the development process changed with the introduction of the Millennium Development Goals (MDGs) in 2000, sexual and reproductive health and rights were excluded, and only in 2007 was universal access to reproductive health added back in. In 2014 and 2015, the future of ICPD Beyond 2014, the MDGs and the post-2015 development framework will be decided, following consultations and meetings across the globe. This paper takes stock of the key influences on efforts to achieve the ICPD agenda and summarises the past, current and planned future events, reports and processes between 1994 and 2014, leading up to the determination of the post-2015 development framework and sustainable development goals. It concludes that the one thing we cannot afford to allow is what happened with the MDGs in 2000. We must not leave the room empty-handed, but must instead ensure the inclusion of sexual and reproductive health and rights as a priority under a new health goal.
Dark sides of the proposed Framework Convention on Global Health's many virtues: A systematic review and critical analysis.
Health and Human Rights. 2013 Jun; 15(1):117-134.The costs of any proposal for new international law must be fully evaluated and compared with benefits and competing alternatives to ensure adoption will not create more problems than solutions. A systematic review of the research literature was conducted to categorize and assess limitations and unintended negative consequences associated with the proposed Framework Convention on Global Health (FCGH). A critical analysis then interpreted these findings using economic, ethical, legal, and political science perspectives. Of the 442 documents retrieved, nine met the inclusion criteria. Collectively, these documents highlighted that an FCGH could duplicate other efforts, lack feasibility, and have questionable impact. The critical analysis reveals that negative consequences can result from the FCGH’s proposed form of international law and proposed functions of influencing national budgets, realizing health rights and resetting global governance for health. These include the direct costs of international law, opportunity costs, reducing political dialogue by legalizing political interactions, petrifying principles that may have only contemporary relevance, imposing foreign values on less powerful countries, forcing externally defined goals on countries, prioritizing individual rights over population-wide well-being, further complicating global governance for health, weakening the World Health Organization (WHO), reducing participation opportunities for non-state actors, and offering sub-optimal solutions for global health challenges. Four options for revising the FCGH proposal are developed to address its weaknesses and strengthen its potential for impact. These include: 1) abandoning international law as the primary commitment mechanism and instead pursuing agreement towards a less formal “framework for global health”; 2) seeking fundamental constitutional reform of WHO to address gaps in global governance for health; 3) mobilizing for a separate political platform that completely bypasses WHO; or 4) narrowing the scope of sought changes to one particular governance issue such as financing for global health needs.
American Journal of Public Health. 2013 Apr; 103(4):623-31.The low priority that most low-income countries give to neonatal mortality, which now constitutes more than 40% of deaths to children younger than 5 years, is a stumbling block to the world achieving the child survival Millennium Development Goal. Bangladesh is an exception to this inattention. Between 2000 and 2011, newborn survival emerged from obscurity to relative prominence on the government's health policy agenda. Drawing on a public policy framework, we analyzed how this attention emerged. Critical factors included national advocacy, government commitment to the Millennium Development Goals, and donor resources. The emergence of policy attention involved interactions between global and national factors rather than either alone. The case offers guidance on generating priority for neglected health problems in low-income countries.
Global policy and programme guidance on maternal nutrition: what exists, the mechanisms for providing it, and how to improve them?
Paediatric and Perinatal Epidemiology. 2012 Jul; 26 Suppl 1:315-25.Undernutrition in one form or another affects the majority of women of reproductive age in most developing countries. However, there are few or no effective programmes trying to solve maternal undernutrition problems. The purpose of the paper is to examine global policy and programme guidance mechanisms for nutrition, what their content is with regard to maternal nutrition in particular, as well as how these might be improved. Almost all countries have committed themselves politically to ensuring the right of pregnant and lactating women to good nutrition through the Convention on the Elimination of all Forms of Discrimination Against Women. Despite this, the World Health Organization (WHO) has not endorsed any policy commitments with regard to maternal nutrition. The only policy guidance coming from the various technical departments of WHO relates to the control of maternal anaemia. There is no policy or programme guidance concerning issues of maternal thinness, weight gain during pregnancy and/or low birthweight prevention. Few if any countries have maternal nutrition programmes beyond those for maternal anaemia, and most of those are not effective. The lack of importance given to maternal nutrition is related in part to a weakness of evidence, related to the difficulty of getting ethical clearance, as well as a generalised tendency to downplay the importance of those interventions found to be efficacious. No priority has been given to implementing existing policy and programme guidance for the control of maternal anaemia largely because of a lack of any dedicated funding, linked to a lack of Millennium Development Goals indicator status. This is partly due to the poor evidence base, as well as to the common belief that maternal anaemia programmes were not effective, even if efficacious. The process of providing evidence-based policy and programme guidance to member states is currently being revamped and strengthened by the Department of Nutrition for Health and Development of WHO through the Nutrition Guidance Expert Advisory Group processes. How and if programme guidance, as well as policy commitment for improved maternal nutrition, will be strengthened through the Nutrition Guidance Expert Advisory Group process is as yet unclear. The global movement to increase investment in programmes aimed at maternal and child undernutrition called Scaling Up Nutrition offers an opportunity to build developing country experience with efforts to improve nutrition during pregnancy and lactation. All member states are being encouraged by the World Health Assembly to scale-up efforts to improve maternal infant and young child nutrition. Hopefully Ministries of Health in countries most affected by maternal and child undernutrition will take leadership in the development of such plans, and ensure that the control of anaemia during pregnancy is given a great priority among these actions, as well as building programme experience with improved nutrition during pregnancy and lactation. For this to happen it is essential that donor support is assured, even if only to spearhead a few flagship countries. (c) 2012 Blackwell Publishing Ltd.
[Washington, D.C.], World Bank, Development Research Group, Poverty and Inequality Team, 2012 Nov.  p. (Policy Research Working Paper No. 6259)The paper presents an overview of calculations of global inequality, recently and over the long-run as well as main controversies and political and philosophical implications of the findings. It focuses in particular on the winners and losers of the most recent episode of globalization, from 1988 to 2008. It suggests that the period might have witnessed the first decline in global inequality between world citizens since the Industrial Revolution. The decline however can be sustained only if countries’ mean incomes continue to converge (as they have been doing during the past ten years) and if internal (within-country) inequalities, which are already high, are kept in check. Mean-income convergence would also reduce the huge “citizenship premium” that is enjoyed today by the citizens of rich countries.
Contemporary Politics. 2012 Jun; 18(2):186-199.Capacity-building has become a mainstay of many AIDS and public health programmes. This article examines its impact on civil society organisations and claims-making around citizenship, as these have been articulated through heterogeneous policy networks doing HIV prevention work. Drawing on a growing literature on the Foucauldian notions of biopower and governmentality, the genealogy of capacity-building as a globalised technology of governmentality is traced, examining its uses both at the international level and in Brazil. Brazilian civil society organisations have undoubtedly been transformed by their participation in networks carrying out capacity-building projects. While recognising these effects, the conflicts and productive tensions inherent to such networks are highlighted.
Washington, D.C., Population Action International, 2011.  p. (Policy and Issue Brief)The United Nations Population Fund (UNFPA) supports family planning and reproductive health programs in developing countries that save women’s lives. UNFPA provides international leadership on population issues and is a key source of financial assistance for these important programs. Maintaining U.S. funding for UNFPA programs is crucial to improving the health of women and their families, addressing demographic trends, and promoting sustainable development.
Development in Practice. 2012 Apr; 22(2):202-215.Empowerment has become a mainstream concept in international development but lacks clear definition, which can undermine development initiatives aimed at strengthening empowerment as a route to poverty reduction. In the present article, written narratives from 49 international development organisations identify how empowerment is defined and operationalised in community initiatives. Results show a conceptual framework of empowerment comprising six mechanisms that foster empowerment (knowledge; agency; opportunity; capacity-building; resources; and sustainability), five domains of empowerment (health; economic; political; resource; and spiritual), and three levels (individual; community; and organisational). A key finding is the interdependence between components, indicating important programmatic implications for development initiatives.
Geneva, Switzerland, World Health Organization [WHO]. 2011.  p.This recently published book highlights actions to improve health equity based on findings from the nine global Knowledge Networks that were established during the WHO Commission on Social Determinants of Health. Their task was to synthesize existing evidence and identify effective and appropriate actions to improve health equity in nine thematic areas: globalization; gender; social exclusion; early child development; urban settings; employment conditions; health systems; public health programs; and measurement and evidence. The evidence reinforces the fundamental impact of social determinants on health outcomes and in creating health inequities.