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Female genital mutilation as an issue of gender disparity in the 21st century: Leveraging opportunities to reverse current trends.
Ethiopian Medical Journal. 2016 Jul; 54(3):107-108.Add to my documents.
Bulletin of the World Health Organization. 2007 Nov; 85(11):822.Armed conflicts and natural disasters cause substantial psychological and social suffering to affected populations. Despite a long history of disagreements, international agencies have now agreed on how to provide such support. The Inter-Agency Standing Committee (IASC), established in response to United Nations General Assembly Resolution 46/182, is a committee of executive heads of United Nations agencies, intergovernmental organizations, Red Cross and Red Crescent agencies and consortia of nongovernmental organizations responsible for global humanitarian policy. In 2005, the IASC established a task force to develop guidelines on mental health and psychosocial support in emergencies. The guidelines use the term "mental health and psychosocial support" to describe any type of local or outside support that aims to protect or promote psychosocial well being or to prevent or treat mental disorders. Although "mental health" and "psychosocial support" are closely related and overlap, in the humanitarian world they reflect different approaches. Aid agencies working outside of the health sector have tended to speak of supporting psychosocial well being. Health sector agencies have used the term mental health, yet historically also use "psychosocial rehabilitation" and "psychosocial treatment" to describe nonbiological interventions for people with mental disorders. Exact definitions of these terms vary between and within aid organizations, disciplines and countries, and these variations fuel confusion. The guidelines' reference to mental health and psychosocial support serves to unite a broad group of actors and communicates the need for complementary supports. (excerpt)
Bethesda, Maryland, Abt Associates. Private Sector Partnerships-One [PSP-One], 2006 Dec. 48 p. (Technical Report No. 6; USAID Contract No. GPO-I-00-04-00007-00; USAID Development Experience Clearinghouse DocID / Order No. PN-ADI-754)Government health sectors in many countries face an uphill battle to reach the Millennium Development Goals (MDGs) set for 2015. In the last six years, Ministries of Health (MOHs) in many less developed countries (LDCs) have been unable to invest sufficiently in their health systems. To achieve the MDGs despite inadequate resources, new approaches for delivering critical clinical services must be considered. This paper explores the potential for private-sector midwives to provide services beyond their traditional scope of care during pregnancies and births to address shortcomings in LDCs' ability to reach MDGs. This paper examines factors that support or constrain private practice midwives' (PPMWs') ability to offer expanded services in order to inform the policy and donor communities about PPMWs' potential. Data was collected through literature reviews, stakeholder interviews, and field-based, semi-structured interviews in Ghana, Indonesia, Peru, Uganda, and Zambia. Ghana, Indonesia, and Uganda were chosen because they are countries where PPMWs provide expanded services. Peru and Zambia were selected as examples where midwives have struggled to develop private practices or they provide expanded services despite issues about midwives' roles and legal sanctions for private practices. (excerpt)
Lancet. 2007 May 26; 369(9575):1789-1790.Although pelvic organ prolapse is a significant problem in affluent countries, the situation in developing countries is far worse. This is mainly a result of high fertility with early marriage and childbearing, many vaginal deliveries, and in certain countries such as Nepal, frequent heavy lifting. In Nepal, fertility until recently was very high and most deliveries take place at home, with only 14% in a health facility and less than 3% by caesarean section. In developing countries, the extent and effects of morbidity associated with pelvic organ prolapse are seldom acknowledged, because of patients' embarrassment. However, studies in Nepal, supported by the United Nations Population Fund (UNFPA), have begun to identify the suffering of women with this disorder. Findings indicate that 10% of women have pelvic organ prolapse, of whom about half require operative management (30.9% with stage II, 12.6% with stage III, and 1.4% with stage IV or procidentia). Women report difficulty in sitting (82%), walking (79%), and lifting (89%), all of which affect their acceptance as full family and community members. The social consequences of prolapse are substantial, and include physical and emotional isolation, abandonment, divorce, ridicule, low self esteem, abuse, lack of economic support, and domestic violence. In Nepal, UNFPA is supporting efforts to identify women with pelvic organ prolapse through reproductive health camps and to contract gynecologists to treat these women at district hospitals. We suggest that more attention should be given to acknowledging the profound consequences of uterine organ prolapse and establishing programmes in developing countries to prevent and manage this frequently severely debilitating condition. (full text)
Revista de Saude Publica / Journal of Public Health. 2006 Apr; 40 Suppl:42-51.Items from the UNGASS Draft Declaration of Commitment on HIV/AIDS (2001) are analyzed. The Brazilian experience of new methods for testing and counseling among vulnerable populations, preventive methods controlled by women, prevention, psychosocial support for people living with HIV/AIDS, and mother-child transmission, is discussed. These items were put into operation in the form of keywords, in systematic searches within the standard biomedicine databases, also including the subdivisions of the Web of Science relating to natural and social sciences. The Brazilian experience relating to testing and counseling strategies has been consolidated through the utilization of algorithms aimed at estimating incidence rates and identifying recently infected individuals, testing and counseling for pregnant women, and application of quick tests. The introduction of alternative methods and new technologies for collecting data from vulnerable populations has been allowing speedy monitoring of the epidemic. Psychosocial support assessments for people living with HIV/AIDS have gained impetus in Brazil, probably as a result of increased survival and quality of life among these individuals. Substantial advances in controlling mother-child transmission have been observed. This is one of the most important victories within the field of HIV/ AIDS in Brazil, but deficiencies in prenatal care still constitute a challenge. With regard to prevention methods for women, Brazil has only shown a shy response. Widespread implementation of new technologies for data gathering and management depends on investments in infrastructure and professional skills acquisition. (author's)
Copenhagen, Denmark, World Health Organization [WHO], Regional Office for Europe, Health Evidence Network, 2006 Feb. 37 p. (Health Evidence Network Report)This is a Health Evidence Network (HEN) synthesis report on the effectiveness of empowerment strategies to improve health and reduce health disparities. The report shows that empowering initiatives can lead to health outcomes and that empowerment is a viable public health strategy. The key message from this review is that empowerment is a complex strategy that sits within complex environments. Effective empowerment strategies may depend as much on the agency and leadership of the people involved, as the overall context in which they take place. HEN, initiated and coordinated by the WHO Regional Office for Europe, is an information service for public health and health care decision-makers in the WHO European Region. Other interested parties might also benefit from HEN. This HEN evidence report is a commissioned work and the contents are the responsibility of the authors. They do not necessarily reflect the official policies of WHO/Europe. The reports were subjected to international review, managed by the HEN team. (author's)
Best Practice and Research Clinical Obstetrics and Gynaecology. 2006; 20(3):323-338.Access to modern contraception has become a recognized human right, improving the health and well-being of women, families and societies worldwide. However, contraceptive access remains uneven. Irregular contraceptive supply, limited numbers of service delivery points and specific geographic, economic, informational, psychosocial and administrative barriers (including medical barriers) undermine access in many settings. Widening the range of providers enabled to offer contraception can improve contraceptive access, particularly where resources are most scarce. International efforts to remove medical barriers include the World Health Organization's Medical Eligibility Criteria. Based on the best available evidence, these criteria provide guidance for weighing the risks and benefits of contraceptive choice among women with specific clinical conditions. Clinical job aids can also improve access. More research is needed to further elucidate the pathways for expanding contraceptive access. Further progress in removing medical barriers will depend on systems for improving provider education and promoting evidence-based contraceptive service delivery. (author's)
Children first... organisation and recovery in Latin America. [Los niños primero...organización y recuperación en América Latina]
Forced Migration Review. 2002 Oct; (15):12-13.In addressing forced displacement in Colombia, for example, UNICEF has implemented a number of creative initiatives, with a rights perspective, that are being replicated in other parts of the world. For more than 40 years Colombia has experienced armed conflict that, in a decade, has displaced more than two million people. 50% are children, the majority of whom have seen their parents killed, their homes destroyed and their neighbours massacred. Dysfunctions are clearly detectable in these displaced children: 80% show fear, cry, have nightmares, wet their beds, do not concentrate, have memory problems or are more dependent on adults. Many wish only to obtain a weapon, join a rebel group and take their revenge. Overcoming the impact of conflict is necessary for the children’s development and for building peace. (excerpt)
Initial steps to developing the World Health Organization's Quality of Life Instrument (WHOQOL) module for international assessment in HIV / AIDS. WHOQOL HIV Group.
AIDS Care. 2003 Jun; 15(3):347-357.This paper reports on the three initial steps taken to develop the World Health Organization’s Quality of Life instrument (WHOQOL) module for assessment of persons living with HIV/AIDS (PLWHA). First, a consultation of international experts was convened to review the suitability of the generic WHOQOL-100 for assessment of PLWHA. The experts proposed additional facets that are specific to the lives of PLWHA. Second, 42 focus groups (N=235) were conducted by six culturally diverse centres comprising of PLWHA, informal carers and health professionals to (1) review the adequacy of the WHOQOL for PLWHA, (2) review the additional facets proposed by the experts, and (3) write additional facets and items for a pilot instrument. Third, results of steps 1 and 2 were consolidated, and a total of 115 items, covering 25 new facets and sub-facets for assessment of QoL specific to PLWHA, were prepared for pilot testing. The new facets included symptoms of HIV, body image, sexual activities, work, social inclusion, disclosure, death and dying, and forgiveness. The implications of cross-cultural QoL assessment for PLWHA are discussed. (author's)
HIV-infected women and their families: psychosocial support and related issues. A literature review.
Geneva, Switzerland, World Health Organization [WHO], Department of Reproductive Health and Research, 2003. vi, 57 p. (Occasional Paper; WHO/RHR/03.07; WHO/HIV/2003.07)This review is divided into three sections. Section one provides a synthesis of the reviewed literature on prevention of mother-to-child transmission (PMTCT) of HIV, voluntary HIV testing and counselling (VCT), and other issues that impact on the care, psychosocial support and counselling needs of HIV-infected women and their families in the perinatal period. Section two provides examples from around the world of projects that focus on the care and support of women and families, with a focus on MTCT. The fi nal section contains recommendations on psychosocial support and counselling for HIV-infected women and families. (excerpt)
Psychoanalytic Review. 1998 Aug; 85(4):639-658.This article will explore some of the issues of resilience in the child population of Bosnia during the recent war there. It will also look at similar issues in the humanitarian aid workers who came from outside the country as representatives of relief agencies. I, myself, worked for UNICEF, and it was my job to train members of the local population to work with Bosnian children in an attempt to increase their resilience under intense wartime stress and to reduce the traumatic impact to those children already harmed. (author's)
Female circumcision: strategies to bring about change. Proceedings of the International Seminar on Female Circumcision, 13-16 June 1988, Mogadisho, Somalia.
Rome, Italy, AIDOS, 1989. VIII, 148,  p.This book contains the proceedings of the 1988 International Seminar on Female Circumcision in Somalia. The first part relays the introductory addresses presented by the Assistant Secretary General of the Somali Revolutionary Socialist Party, the Somali Minister of Health, the Italian Ambassador to Somalia, the World Health Organization's resident representative in Somalia, and the President of the Somali Women's Democratic Organization. Part 2 offers five reports on efforts towards international cooperation to eliminate female genital mutilation undertaken by North/South women's organizations, the Inter-African Committee on Traditional Practices Affecting the Health of Women and Children, the Foundation for Women's Health Research and Development, and the World Health Organization. Part 3 includes three reports on religious and legal aspects of female genital mutilation, and part 4 presents reports of eradication efforts ongoing in Egypt, Nigeria, the Gambia, and Sudan. The fifth part of the volume is devoted to six reports on aspects of the practice of female genital mutilation in Somalia as well as eradication efforts that involve an information campaign and training. Part 6 reprints the reports of the working groups on health, the law, training and information, and religion, and the final part covers the final resolutions and closing addresses by a UN Children's Fund representative, a representative of the UN Commission for Human Rights, and the Assistant Secretary General of the Somali Revolutionary Socialist Party. The Inter-African Committee's Plan of Action for the Eradication of Harmful Traditional Practices Affecting the Health of Women and Children in Africa, approved by the seminar, is contained in the first appendix, and a list of seminar participants is attached in the second.
In: International Conference on the Implications of AIDS for Mothers and Children: technical statements and selected presentations jointly organized by the Government of France and the World Health Organization, Paris, 27-30 November 1989. Geneva, Switzerland, WHO, Global Programme on AIDS, 1989. 30-2. (WHO/GPA/DIR/89.12)All social policies dealing with acquired immunodeficiency syndrome (AIDS) must be scrutinized in terms of their impact on the family, specifically enhancement of the family unit to cope with the impact of AIDS and promotion of an integrated approach in which families are kept together whenever possible. Thus, health and social welfare interventions should seek to support and complement the family as a functional unit rather than to replace it. Family counseling and self- help groups should be organized to enhance coping skills and prevent family disruption. Young families in particular lack the problem solving skills required to deal with the crisis of human immunodeficiency virus (HIV) infection and the marital conflict this diagnosis creates. Not only can infected individuals become isolated within their own families, but the family unit itself is often shunned by the community. The psychosocial stress is exacerbated by the poverty that results from the frequent loss of work and income. HIV-infected illicit drug users tend to isolate themselves from sources of medical care and are unable to provide infected offspring with the care required. The families of homosexual and bisexual men may become aware of the parent's sexual orientation at the time of diagnosis of HIV infection. Uninfected mothers become overwhelmed with dealing with unpredictable medical needs of family members under conditions of economic and emotional stress, and there is a need for respite care. Since women play a key role in maintaining the family unit, government policies should seek to empower women and children to express their own needs.
Statement by the chairman of the Technical Working Group on the Psychosocial Aspects of HIV Infection / AIDS in Mothers and Children.
In: International Conference on the Implications of AIDS for Mothers and Children: technical statements and selected presentations jointly organized by the Government of France and the World Health Organization, Paris, 27-30 November 1989. Geneva, Switzerland, WHO, Global Programme on AIDS, 1989. 33-5. (WHO/GPA/DIR/89.12)Sensitive attention to the psychosocial impact of human immunodeficiency virus (HIV) infection on mothers and children and the maternal-child bond must be an integral part of all health and social service programs. Comprehensive, community-based counseling services must be available to help family members deal with issues such as guilt, fear, rejection, and discrimination. Given the centrality of motherhood to the self- definition and self-esteem of many women, HIV-infected women often choose to bear children, yet may experience extreme guilt when HIV is transmitted to their infant. HIV-infected children face neurodevelopmental disabilities that my be exacerbated by family poverty, homelessness, malnutrition, a lack of access to adequate medical care, and serious physical and psychological problems in the parents. These children should receive early intervention from physiotherapists, speech and language therapists, psychologists, and social workers. Although HIV-infected children should have the opportunity to interact with other children with confidentiality maintained, parents must decide how and when to inform a child of his or her HIV status. A neglected group is the uninfected siblings, who may encounter stigmatization outside the home and inappropriate nursing care burdens in the home. Respite care for these siblings and HIV-infected children should be considered when a parent is acutely ill. Children orphaned by HIV disease should be guaranteed the potential of normal development through placement in foster care or adoption.
[Unpublished] 1985. 114 p.This document is a practical guide to help those Planned Parenthood Associations which want to establish contraception and counseling services for young people. It draws its examples from the considerable experience of selected European countries in what can be controversial and difficult areas. In the section devoted to adolescent sexuality and contraception, contributors cover culture and subculture, health and sexuality, sexual behavior and contraceptive services, the adolescent experience, the question of opposition to services for adolescents, and statistical indices. 1 section is devoted to examples of contraceptive counseling services for adolescents in Sweden, Italy, France, the UK, and Poland. Another section summarizes service provision examples. The 5th section presents methodology for the establishment of adolescents services and the final section discusses methodology testing of new projects. This report contends that the case for the rapid development of contraceptive/counseling services, tailored to the needs and desires of young people, is justified on moral as well as on sociological, psychological, and health grounds. It rejects totally the argument that any measure which could facilitate the sexual debut of the unmarried or legally dependent adolescent should be resisted. It does recognize public concern about family breakdown and the potential health risks of sexual activity but considers the examples given as measures designed to combat rather than ignore these. Taking into account sociological, psychological, and medical evidence, the contributors to this report challenge the following presumptions: sexual activity among the young is always and necessarily morally unacceptable and socially destructive; adolescents will resort to promiscuous sexual activity in the absence of legal deterrents such as refusal of access to contraceptive/counseling services; the potential health risks of sexual activity and use of contraceptives during adolescence provide sufficient justification for deterrent measures, including refusal of contraceptive/counseling services; and the scale of sexual ignorance and prevalence of unplanned pregnancy among adolescents can only be reduced by disincentives and deterrents to sexual activity itself. The case for the provision of contraceptive/counseling services rests on their potential to help adolescents to recognize and resist repressive forms of sexual activity, which are destructive of humanmanships. Evidence suggests that it is not difficult to attract a large cross-section of an adolescent public to use contraceptive/counseling services, where established.
World Health Organization Technical Report Series. 1981; (670):1-120.This report includes the collective views of a World Health Organization (WHO) Scientific Group on Research on the Menopause that met in Geneva during December 1980. It includes information on the following: 1) the endocrinology of the menopause and the postmenopausal period (changes in gonadotropins and estrogens immediately prior to the menopause and changes in gonadotropin and steroid hormone levels after the menopause); 2) the age distribution of the menopause (determining the age at menopause, factors influencing the age at menopause, and the range of ages at menopause and the definition of premature and delayed menopause); 3) sociocultural significance of the menopause in different settings; 4) symptoms associated with the menopause (vasomotor symptoms, psychological symptoms, disturbances of sexuality, and insomnia); 5) disorders resulting from, or possibly accelerated by, the menopause (osteoporosis, atherosclerotic cardiovascular disease, and arthritic disorders); 6) risks, with particular reference to neoplasia, of therapeutic estrogens and progestins given to peri- and postmenopausal women (endometrial cancer, breast cancer, and gallbladder disease); 7) fertility regulating methods for women approaching the menopause (fertility and the need for family planning in women approaching the menopause, problems of family planning in perimenopausal women, and considerations with regard to individual methods of family planning in women approaching the menopause); and 8) estrogen and the health care management of perimenopausal and postmenopausal women. At this time some controversy exists as to whether there is a menopausal syndrome of somatic and psychological symptoms and illness. There are virtually no data on the age distribution of the menopause and no information on its sociocultural significance in the developing countries. The subject of risks and benefits of estrogen therapy in peri- and postmenopausal women is of much importance in view of the large number of prescriptions issued for this medication in developed countries, which indicates their frequrnt use, and the different interpretations and opinions among epidemiologists and clinicians on both past and current studies on this subject. Specific recommendations made by the Scientific Group appear at the end of each section of the report. The following were among the general recommendations made: WHO sponsored research should be undertaken to determine the impact on health service needs of the rapidly increasing numbers of postmenopausal women in developing countries; uniform terminology should be adopted by health care workers with regard to the menopause; uniform endocrine standards should be developed which can be applied to the description of peri- and postmenopausal conditions and diseases; and descriptive epidemiological studies of the age at menopause should be performed in a variety of settings.
A prospective multicentre trial of the ovulation method of natural family planning. Pt. 2. The effectiveness phase.
Fertility and Sterility. 1981 Nov; 36(5):591-98.A 5 country prospective study was undertaken to determine the effectiveness of the ovulation method of natural family planning. 869 subjects of proven fertility from 5 centers (Auckland, Bangalore, Dublin, Manila, and San Miguel) entered the teaching phase of 3-6 cycles; 765 (88%) completed the phase. 725 subjects entered a 13-cycle effectiveness phase and contributed 7514 cycles of observation. The overall cumulative net probability of discontinuation for the effectiveness study after 13 cycles was 35.6%, 19.6% due to pregnancy. Pregnancy rates per 100 woman-years calculated using the modified Pearl index were as follows: conscious departure from the rules of the method, 15.4; inaccurate application of instructions, 3.5; method failure, 2.8; inadequate teaching, 0.4; and uncertain, 0.5. Cycle characteristics included: 1) average duration of the fertile period of 9.6 days, 2) mean of 13.5 days occurred from the mucus peak to the end of the cycle, 3) a mean of 15.4 days of abstinence was required, and 4) a mean of 13.1 days of intercourse was permitted. Almost all women were able to identify the fertile period by observing their cervical mucus but pregnancy rates ranged from 27.9 in Australia and 26.9 in Dublin to 12.8 in Manila. Continuation was relatively high ranging from 52% in Auckland to 74% in Bangalore.
[Unpublished] 1990 Jan 25. 83,  p.Although counseling plays a fundamental role in AIDS prevention and control, the systematic provision of counseling services represents a new concept in many parts of the developing world. The guidelines presented in this manual are intended to provide counselors, health care workers, and others involved in HIV/AIDS-related work with a model that can be adapted to local needs and circumstances. HIV/AIDS counseling had two objectives: 1) to prevent HIV infection and 2) to provide psychosocial support to those already infected. To achieve these objectives, counseling seeks to enhance self-determination, increase self-confidence about the potential for behavioral change, and improve family and community relations. When people are found to have HIV infection, the emphasis of counseling should be on both addressing the expectable psychological responses and providing a framework for living with HIV/AIDS. Among the specific issues addressed in this manual are the essential features of HIV/AIDS counseling, pretest counseling, counseling after a negative or a positive HIV test result, and the role of self-help groups. Finally, recommendations are outlined for HIV-infected persons, partners of HIV-infected persons, and health care providers.
The World Health Organization Quality of Life Assessment (WHOQOL): development and general psychometric properties.
Social Science and Medicine. 1998 Jun; 46(12):1569-85.The World Health Organization (WHO) Quality of Life Assessment (WHOQOL) instrument was developed through a process of extensive international collaboration to assess individuals' physical health, psychological state, level of independence, social relationships, and relationship to their environment. The initial version of the instrument emerged from an iterative process that included an agreed definition of Quality of Life, agreed definitions of its facets, generation of a large pool of items reflecting these definitions, and, finally, an agreed set of items for the pilot WHOQOL. This paper describes is subsequent psychometric evaluation. The pilot WHOQOL-100, comprised of 236 questions, was administered to a minimum of 300 respondents in each of the 15 participating field centers. Analyses of these data confirmed it is possible to develop a multicultural WHOQOL rather than to use different item, facet, and domain structures for each center. Although preliminary confirmatory factor analysis suggests the feasibility of a four domain solution (physical, psychological, social relationships, and environment), further field trials at new centers are necessary. Moreover, although a cross-culturally applicable model has been developed, add-on modules can be designed for specific populations (e.g., those with communication dysfunctions) or culture-specific diseases. Overall, the instrument is a reliable, valid, and responsive measure of the quality of life. Future tasks include investigation of the test-retest reliability of the WHOQOL-100 in populations who have not experienced significant life change, collection of longitudinal data from populations who have experienced life changes in order to assess the instrument's responsiveness to change, and further analyses of the discriminant validity of the WHOQOL-100.
[Prevention of female genital mutilation in Sweden] Forebyggande av kvinnlig konsstympning v Sverige.
NORDISK MEDICIN. 1996 Dec; 111(10):358-60.In Goteborg, Sweden, a 3-year project was carried out among immigrant women about female genital mutilation, which involved discussion, information, and training to improve the situation of the women afflicted. It is estimated that there are around 115 million such women in Africa alone. In Europe there an estimated 50,000 young women who come from areas where female genital mutilation is practiced. In Sweden there are 16,000 such women and in the Goteborg area there are 2000-3000 who are at risk of being subjected to this practice. There are no exact figures about the number of those who have undergone this operation. The procedure includes Sunna mutilation and Pharaonic mutilation. The consequences are hemorrhage, shock, damage to the urethra, sepsis, the risk of HIV infection because of scarification, urinary retention, psychological trauma, development of fistula, dyspareunia, and infertility. In recent years there has been more open discussion about this practice, which is rooted in the male domination of women in Arab and African countries. International organizations have also addressed the issue in order to prevent it: the Inter Africa Committee on Traditional Practices Affecting the Health of Mothers and Children, the World Health Organization, UNICEF, and UNESCO. The first European conference on the subject was held in 1992 in London, and preventive strategies were developed. In 1982 Sweden had already adopted a law banning the practice. In 1993 the Goteborg immigration authority initiated a 3-year project about the practice, stressing collaboration with the immigrant women and their families as well as the personnel in health facilities, social agencies, schools, and immigrant processing centers. Two working groups were formed: one for health personnel including some Somali women and one for social agency personnel. In February, 1995, the guidelines for information transferral for health personnel were presented, which are now used locally.
Geneva, Switzerland, World Health Organization [WHO], Special Programme for Research and Training In Tropical Diseases, 1993. ii, 14,  p.The World Health Organization's Special Programme for Research and Training in Tropical Diseases (TDR) is promoting research on women and tropical diseases and plans on distributing findings of this research to health services, communities, women, men, and children. Preliminary findings indicate that sex and gender can have important effects on the physical, social, economic, and psychological status of those afflicted with tropical diseases. These diseases include malaria, schistosomiasis, onchocerciasis, elephantiasis, African trypanosomiasis, Chagas' disease, leprosy, and leishmaniasis. Female adolescents and young women in a Nigerian forest may not develop blindness as a result of onchocerciasis (river blindness) but are bothered by the ugly skin the disease causes. They need treatment to improve their lives rather than to reduce blindness. Women's self-esteem often depends on their appearance. Almost all the tropic diseases disfigure their victims. Disfigured persons are often stigmatized. Women's lower status makes this stigmatization even more difficult. Sometimes disfigurement involves the external genitalia. According to local beliefs, blood in the urine (a sign of schistosomiasis) signifies virility in men but a sexually transmitted disease in women. Pregnancy changes women's resistance to diseases. Some tropical diseases manifest and progress rapidly during pregnancy. Parasitic diseases can cause or exacerbate anemia. Anemia makes women vulnerable to parasitic diseases, e.g., malaria. Poverty is associated with parasitic diseases and women tend to be poorer than men. Since women are the caretakers, health providers need to talk with women more to improve women's knowledge of parasitic diseases. TDR recommendations for research include sex differences in the clinical manifestations of diseases and different effects in men and women of the chemotherapy used against tropical diseases, especially on female hormonal status.
PLANNED PARENTHOOD IN EUROPE. 1989 Spring; 18(1):5-6.On January 27 and 28, 1989 a workshop and a meeting were organized in Paris by Mouvement Francais pour le Planning Familial (MFPF/France) and the IPPF Europe Region. The workshop was held on the first day. 24 staff and volunteers from Planned Parenthood Associations of 15 countries attended, reviewing abortion laws, the definition of therapeutic abortion, and the incidence and problems of second trimester abortion. Second trimester abortion is available in only a few European countries. Second trimester abortions are rare in France (about 2000 per annum), and in 1986 1717 French women travelled to England in order to seek an abortion. All late abortions are performed for serious reasons. Older women may mistake signs of pregnancy for the onset of the menopause; and women fearful of social or familial punishment, especially teenagers, may be reluctant to consult a doctor. The experiences of Denmark and Sweden, where the problem is partially solved, suggest some strategies: optimize accessibility of contraceptive services, particularly for women at higher risk of late abortion; diminish the taboo surrounding abortion, so that women are less frightened to seek help at an early stage of pregnancy; make abortion services available in all regions of the country; avert time-consuming enforced waiting periods or consent for minors; and stimulate public information campaigns on the importance of seeking help early. On January 28 a meeting involving about 200 participants took place at the Universite Paris Dauphine, Salle Raymond Aron. Speakers at the meeting discussed the issue of late abortion in Europe, the difficulties of obtaining late abortions, counseling, medical problems, the woman's point of view, and possible solutions. At the close of the meeting, the MFPF called on the French government to modify some of the articles in the Penal Code that restrict women's access to safe and legal abortion.
In: The population debate: dimensions and perspectives. Papers of the World Population Conference, Bucharest, 1974. Volume II, compiled by United Nations. Department of Economic and Social Affairs. New York, New York, United Nations, 1975. 105-9. (Population Studies No. 57; ST/ESA/SER.A/57)In 1974 World Population Conference in Bucharest, romania, WHO discusses degradation of the environment and population. In developing countries, poor sanitary conditions and communicable diseases are responsible for most illnesses and deaths. Physical, chemical, and psychosocial factors, as well as pathogenic organisms, cause disease and death in developing countries. Variations in individuals and between individuals present problems in determining universally valid norms relating to environment and health. Researchers must use epidemiological and toxicological methods to identify sensitive indicators of environmental deterioration among vulnerable groups, e.g., children and the aged. Changes in demographics and psychosocial, climatic, geographical, geological, and hydrologic factors may influence the health and welfare of entire populations. Air pollution appears to adversely affect the respiratory tract. In fact, 3 striking events (Meuse valley in France , Donora valley in Pennsylvania [US], and London  show that air pollution can directly cause morbidity, especially bronchitis and heart disease, and mortality. Exposure to lead causes irreparable brain damage. Water pollution has risen with industrialization. Use of agricultural chemicals also contribute to water pollution. Repeated exposure to high noise levels can result in deafness. Occupational diseases occur among people exposed to physical, chemical, or biological pollutants at work which tend to be at higher levels than in the environment. Migrant workers from developing countries in Europe live in unsafe and unhygienic conditions. Further, they do not have access to adequate health services. Nevertheless, life expectancy has increased greatly along with urbanization and industrialization. A longer life span and environmental changes are linked with increased chronic diseases and diseases of the aged.
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.
INFECTIOUS DISEASE CLINICS OF NORTH AMERICA. 1991 Jun; 5(2):403-16.In the context of the controversial conference at Alma Ata and the emergent plan of Health for All by the Year 2000 (HFA/2000), the role of academic institutions is discussed. At the risk of expanding the controversy over HFA/2000, institutional involvement facilitates the testing of principals against real world problems of health development. Views from both sides of the debate and controversy are considered with respect to the appropriateness of institutional involvement in HFA/2000. A consultative committee to the Director General of the World Health Organization (WHO) analyzing the successes and failures of primary health care development is 1st explored. Other views from technical discussions of WHO on the roles of universities in the strategy of HFA are then examined. Traditional and progressive arguments on the roles of university in society are reviewed, with an eye to how HFA fits in. The paper concludes that institutions capable of and willing to provide substantial, institution-wide commitment are appropriate candidates for involvement in HFA/2000. The Aga Khan University's commitment orientation and health services development is cited as an example of appropriate, positive institutional participation. The Network of Community-Oriented Educational Institutions for Health Sciences addressing problem-based teaching methods, community orientation, and partnerships with governmental health services is also exemplary. In closing, the paper queries the extent to which the movement will attract institutions around the world.