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St. John's, Antigua, CFPA, 1987. 39 p.In the 1920s 1/3 of the children in the Caribbean area died before age 5, and life expectancy was 35 years; today life expectancy is 70 years. In the early 1960s only 50,000 women used birth control; in the mid-1980s 500,000 do, but this is still only 1/2 of all reproductive age women. During 1987 the governments of St. Lucia, Dominica and Grenada adopted formal population policies; and the Caribbean Family Planning Affiliation (CFPA) called for the introduction of sex education in all Caribbean schools for the specific purpose of reducing the high teenage pregnancy rate of 120/1000. CFPA received funds from the US Agency for International Development and the United Nations Fund for Population Activities to assist in its annual multimedia IEC campaigns directed particularly at teenagers and young adults. CFPA worked with other nongovernmental organizations to conduct seminars on population and development and family life education in schools. In 1986-87 CFPA held a short story contest to heighten teenage awareness of family planning. The CFPA and its member countries observed the 3rd Annual Family Planning Day on November 21, 1987; and Stichting Lobi, the Family Planning Association of Suriname celebrated its 20th anniversary on February 29, 1988. CFPA affiliate countries made strides in 1987 in areas of sex education, including AIDS education, teenage pregnancy prevention, and outreach programs. The CFPA Annual Report concludes with financial statements, a list of member associations, and the names of CFPA officers.
ANNUAL REVIEW OF POPULATION LAW. 1987; 14:42.The United States Agency for International Development (USAID) withheld from the United Nations Population Fund (UNFPA) $25 million appropriated for the Fund by the United States Congress. This was the third year that funds had been withheld. As in earlier years, the Reagan administration objected to UNFPA support for China. It viewed China's family planning program, which emphasized the importance of limiting family size to one child, as sanctioning coercive abortions. (full text)
[Unpublished] . 27 p. (USAID Contract No. DPE-5927-C-00-5068-00)Health personnel in Niger report that malaria is the leading diagnosis in health facilities (1980-1984), about 380,000 cases/year), but just 19% of the population live within a 5 km radius of a health facility. A 1985 household survey reveals that 31.4% of children had a febrile illness (presumptive malaria) within the last 2 weeks and 22.1% of all child deaths were presumptive malaria related. The Government of Niger began developing a national malaria program in 1985 to reduce malaria-related deaths rather than morbidity reduction, because available data indicated that morbidity reduction was not feasible. There is no standard treatment regimen for presumptive malaria, however. Some studies indicate that an effective dose regimen is 10 mg chloroquine/kg body weight in a single dose. Some health workers use other antimalarial arbitrarily. Lack of uniformity can increase the risk of chloroquine and Fansidar resistant falciparum. Government officials are thinking about having only chloroquine available at first level facilities. It plans to set up national surveillance for chloroquine resistance. Niger has just 1 trained malariologist, indicating a need for training of more staff. To keep government costs to a minimum, it wants to set chloroquine at all points in the distribution network. The program's plan of action also includes chemoprophylaxis for pregnant women, limited vector control in Niamey, and health education stressing reducing breeding sites. A REACH consultant believes that it is possible for the program to reach its coverage targets within 5 years. Obstacles include limited access to health care, unavailable chloroquine in warehouses, and lack of untrained personnel (the main obstacle). The consultant suggests various interventions to help Niger meet its targets, e.g., periodic coverage surveys. The World Bank, WHO, the Belgian Cooperation, and USAID are either providing or planning to provide support to the malaria control programs.
Arlington, Virginia, John Snow, Inc. [JSI], Resources for Child Health Project [REACH], 1987. iii, 33,  p. (USAID Contract No.: DPE-5927-C-00-5068-00)Sudan is one of 8 USAID African child survival emphasis countries. This documents focuses upon linking the discrete areas of child survival to each other in efforts to achieve sustained reductions in national morbidity and mortality rates. The scope of the problem is briefly considered as background in the text, followed by a more in-depth presentation of government policy and programs. This section includes examination of the structure and organization of existing health services, child survival activities, and current progress and constraints. Child survival activities are listed as immunization, control of diarrheal diseases, nutrition, child spacing, malaria control, acute respiratory infections, and AIDS. The current strategy of USAID support for these activities is outlined, and includes mention of private volunteer organization and private sector participation. The role of UNICEF, WHO, and the World Bank in child survival in Sudan is also highlighted. Recommendations for child survival strategy in Sudan are presented and discussed at length in the text. Continued support to UNICEF, cost recovery and health care financing efforts through WHO, child spacing and population program support, and support to on-going USAID projects constitute USAID's priorities and emphasis in child survival strategy for Sudan. Detailed short- and long-term recommendations for immunization, control of diarrheal diseases, nutrition, child spacing, and child survival and health care financing are provided following the section on priorities. In closing, staffing and recommendations for malaria and other endemic disease, acute respiratory infections, AIDS, and management are considered. Appendices follow the main body of text.
Arlington, Virginia, John Snow, Inc. [JSI], Resources for Child Health Project [REACH], 1987.  p. (USAID Contract No. DPE-5927-C-00-5068-00)In 1987, consultants went to Niger to prepare the plan of operations for the national Expanded Programme on Immunization (EPI). US$ 6 million from the World Bank Health Project and around US$ 5 million from the UNICEF EPI Project were available for EPI activities. Low vaccination coverage prevailed outside Niamey. Outbreaks of diseases that EPI can prevent continued to kill children. The cold chain was not maintained, especially at the periphery. Mobile teams continued to use inadequate strategies. Record keeping did not exist. The central level did not supervise the periphery. EPI staff at departmental and division levels did not have current written guidelines. Not only did poor working communications exist between the central level and the periphery, but also between the EPI Director and the other Minister of Health divisions, between WHO and UNICEF, and between both UN agencies and EPI. The EPI Director did have a good relationship with the USAID office, however. No one took inventory of EPI resources or monitored temperatures at any point in the cold chain. Even though the World Bank Health Project intended to five EPI 50 ped-o-jets, 46% of the existing 88 ped-o-jets were in disrepair and no one knew how to repair and maintain them. Thus EPI should not routinely use ped-o-jets. The consultants recommended that USAID stay involved with EPI in Niger since the EPI Director considered it an acceptable partner. EPI staff at each level should take a detailed inventory of all material resources. Effective and regular supervision should occur at the central, regional, and peripheral levels. A health worker needs to record the temperature of the refrigerator twice a day. Technical grounds should determine the standardization and selection of all equipment. Someone should maintain an adequate supply of spare parts and technicians should undergo training in maintenance.
Baltimore, Maryland, JHPIEGO, 1987. iii, 23 p.The Johns Hopkins Program for International Education in Gynecology and Obstetrics (JHPIEGO) is a private, non-profit corporation affiliated with the Johns Hopkins University, and funded by the U.S. Agency for International Development (USAID). It aims to increase the availability of improved reproductive health services and the number of skilled and knowledgeable health professionals in developing countries, especially in the area of family planning. JHPIEGO has supported educational programs for over 55,000 health care professionals and students from 122 countries since 1974. In 1987, it supported 46 programs for 12, 981 participants in 26 countries. 12,821 were trained in-country, 160 attended regional programs open to professionals seeking training not offered domestically, and an additional 122 studies at the JHPIEGO educational center in Baltimore for an eventual total of 13,103 trainees. 1,719 participants were from Africa, 541 from Asia, 10,426 from Latin America and the caribbean, and 417 from the Near East. Additional accomplishments include the creation of a slide/lecture set on contraception and reproductive health for distribution to selected health care leaders with teaching responsibilities in developing countries. A French translation is being developed. Proceedings from a conference co-sponsored with the World Health Organization, Reproductive Health Education and Technology: Issues and Future Directions, should also be published in Fall, 1988. The report comprehensively describes training objectives and activities for the 4 regions and the educational center, and discusses program evaluation. It further presents training and program support statistics, trends, a financial report, and supporting figures and tables.
New York, New York, PPFA, 1987. 16 p.This brochure published by the Planned Parenthood Federation of America, (PPFA) tells the story of the dismemberment of the U.S. international family planning policy from 1961 to 1987. Official family planning policy began in the U.S. in 1961 with Kennedy's endorsement of contraceptive research. In 1968 Congress first allotted foreign aid funds for family planning. By 1973, the tide turned with Helms' amendment to the foreign assistance act prohibiting use of funds to support abortion. In 1983, USAID cut funds for the prestigious journal International Planning Perspectives, because the agency's review board chairman objected to an article on health damage of illegal abortion and mention of legal abortion. It took a court ruling to restore funds. In the same year, the Pathfinder Fund was pressured to accept the U.S. policy articulated in 1984 as the "Mexico City Policy." This ideology states that the U.S. would no longer support any program that performs, advocates, refers or counsels women about abortion, even if those activities are legal and funded by non-U.S. sources. Next, USAID pulled support from the International Planned Parenthood Federation (IPPF). The U.S. has multiplied support for natural family planning 10-fold to $8 million, and permitted organizations to counsel clients in this method without offering conventional alternatives. In 1986, the U.S. dropped support for the U.N. Fund for Population Activities, claiming alleged Chinese compulsory abortions as a reason. The PPFA has sued for a reversal of the policy of withholding USAID funds from FPIA, the international division of PPFA. The main arguments are presented, along with a list of typical FPIA projects.
ECONOMIC AND POLITICAL WEEKLY. 1987 Jul 11; 22(28):1099.India's family planning program has been restructured from a massive effort, using multimedia promotion and 2 million volunteers and designed to convey the "small family message" directly to the families concerned, to a smaller scale program emphasizing child survival, delayed marriage, village infrastructure, and birth spacing. The change is due to 2 factors: 1) The terminal approach failed to achieve lower birth rates because people will not accept the small family unless they can rely on the survival of the children; and 2) The terminal approach contained an element of coercion which caused the US to reduce support to the US Agency for International Development (USAID) and the UN Fund for Population Activities (UNFPA). The new scaled-down approach should be more effective, since more couples are now practicing family planning and birth spacing, oral contraceptives, IUDs, and longterm hormonal contraceptives are more appropriate than terminal methods to the present demographic picture.
FRONT LINES. 1987 Sep; 27(8):8-9, 11.The USAID's mission in Nepal is to assist development until the people can sustain their own needs: although the US contributes only 5% of donor aid, USAID coordinates donor efforts. The mission's theme is to emphasize agricultural productivity, conserve natural resources, promote the private sector and expand access to health, education and family planning. Nepal, a mountainous country between India and Tibet, has 16 million people growing at 2.5% annually, and a life expectancy of only 51 years. Only 20% of the land is arable, the Kathmandu valley and the Terai strip bordering India. Some of the objectives include getting new seed varieties into cultivation, using manure and compost, and building access roads into the rural areas. Rice and wheat yields have tripled in the '80s relative to the yields achieved in 1970. Other ongoing projects include reforestation, irrigation and watershed management. Integrated health and family planning clinics have been established so that more than 50% of the population is no more than a half day's walk from a health post. The Nepal Fertility Study of 1976 found that only 2.3% of married women were using modern contraceptives. Now the Contraceptive Retail Sales Private Company Ltd., a social marketing company started with USAID help, reports that the contraceptive use rate is now 15%. Some of the other health targets are control of malaria, smallpox, tuberculosis, leprosy, acute respiratory infections, and malnutrition. A related goal is raising the literacy rate for women from the current 12% level. General education goals are primary education teacher training and adult literacy. A few descriptive details about living on the Nepal mission are appended.
Arlington, Virginia, International Science and Technology Insitute, Population Technical Assistance Project, 1987 Jul 15. ix, 66,  p. (Report No. 86-099-056)This evaluation of the village family planning program in Indonesia is prepared for USAID, which has supported the program for 15 years, and is to complete support in 1986. It is in general a positive evaluation, prepared by interviews, and visits to 7 out of 27 Provinces, 14 out of 246 Kabupatens (Districts), and 16 Villages. Village distribution centers have increased 38%, new acceptors by 38%, continuing user levels by 57%, and overall contraceptive prevalence by 38%. Access to varieties of contraceptives, especially longer acting methods, has improved, and costs per capita have decreased. Some problems were pointed out, generating several recommendations: physical conditions of the clinics need attention; motivation by consciousness raising has not been matched by better knowledge; the surgical program needs to be expanded; self-sufficiency in cost recovery should be fostered; operations research is needed on payment for field workers and volunteers; and social marketing should be expanded. USAID should continue support for the Outer Islands. In a final list of recommendations were the suggestions that USAID assist clinical programs further, support training of field workers, do more statistical review, continue to support the IEC program, operations research on community-based distribution, and program integration.
SOUTH. 1987 Apr; (78):109-12.The prevalence of acquired immunodeficiency syndrome (AIDS) in East African countries is the topic of this news article. With the exception of Uganda, most countries' data are considered underreported. Highest estimates are 1 to 3 million cases in Africa; official counts reported to the World Health Organization (WHO) total 2561 cases. In Kenya, 250 cases and 400 infected prostitutes have been confirmed. Nigeria does not admit to any cases, officially. Uganda's officials estimate that 5-10% of urban adults are carriers. Testing is too expensive there, even of blood donors, as costs would bankrupt the health budget. USAID has contributed condoms, however. Infants born of or breast fed by infected mothers are at risk: many of babies have AIDS in Uganda, Zambia, Zaire and Rwanda. On the other hand, Rwanda has instituted a well-coordinated AIDS education campaign with the help of the Norwegian Red Cross, and Uganda, the first country to publicized AIDS, may be selected for the WHO AIDS center.
[Unpublished] 1987 Jun. 2 p.The provision of condoms is an integral part of the strategy for control of acquired immunodeficiency syndrome (AIDS) being developed by the US Agency for International Development (AID) in conjunction with the World Health Organization (WHO). Condoms are now available from USAID for AIDS prevention activities, and data are being collected to help prioritize condom requests and maximize effective distribution on a worldwide basis. It is expected that condom distribution will be most effective in cases where condoms are provided to those at highest risk of AIDS transmission through an effective service delivery system with adequate storage and logistical support. AIDS prevention efforts should be coordinated with WHO efforts whenever possible. Logistical support is especially important since AIDS is prevalent in many countries with weak public health infrastructures and limited experience in providing condoms. An AIDS technical support program now being developed by USAID will assist in this area. Further analysis is required to determine whether a distinction should be made at the programmatic level between distribution of condoms for AIDS prevention and for family planning; it may be that combination of these 2 aims will have a synergistic effect. Information is requested from countries on the number of condoms desired, the proposed distribution system, the logistical capacity available, and the strategy for reaching individuals at risk of AIDS infection.
GOVERNANCE. HARVARD JOURNAL OF PUBLIC POLICY. 1987 Winter-Spring; 9-14.The future of international population assistance is threatened by the emergence of a New Right coalition composed of conservative Republicans, Protestant fundamentalists, elements of the Catholic Church, and other right-to-life advocates. This coalition has advanced 3 main arguments against population assistance: 1) rapid population growth in developing countries does not hinder social and economic development; 2) contributing to population assistance links the US with the promotion of abortion and threatens traditional family values; and 3) population assistance facilitates coercion in family planning programs in developing countries. As a result of the coalition's efforts, the US has suspended contributions to the International Planned Parenthood Federation (IPPF) and the United Nations Fund for Population Activities (UNFPA). In addition, the US Agency for International Development (AID) is under pressure to define the preferred content and clientele of its services in accordance with the views of the New Right. As the US Government reduces population assistance, it will lose opportunities to debate population issues with other donors. Moreover, in the absence of strong US support for multilateral programs, other donors may become uncertain about their commitments. Although the Reagan Administration is unlikely to change its position, advocates of a strong international population policy may be able to protect programs from further erosion. They can remind policy makers that reducing birth rates in developing countries will yield significant social benefits; they can support efforts to integrate family planning with other health and development programs. Finally, the resources of agencies such as IPPF and UNFPA can be augmented by support to affiliated agencies or specific projects.