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[WHO updates medical eligibility criteria for contraceptives] OMS reactualizeaza criteriile medicale de eligibilitate pentru utilizarea contraceptivelor.
Targu-Mures, Romania, Institutul Est European de Sanatate a Reproducerii, 2006. 15 p. (Actualitati in planificarea familiala No. 1)The World Health Organization (WHO) has issued new family planning guidance, including the following: Most women with HIV infection generally can use IUDs. Women generally can take hormonal contraceptives while on antiretroviral (ARV) therapy for HIV infection, although there are interactions between contraceptive hormones and certain ARV drugs. Women with clinical depression usually can take hormonal contraceptives. More than 35 experts met at WHO headquarters in Geneva, Switzerland, in October 2003 and developed this and other new guidance. The new guidance updates the 2000 Medical Eligibility Criteria (MEC) for Contraceptive Use. (excerpt)
FHI's quick reference chart for the WHO medical eligibility criteria for contraceptive use. To initiate or continue the use of combined oral contraceptive (COC), Noristerat (NET-EN), Depo-Provera (DMPA), copper intrauterine device (Cu-IUD).
[Research Triangle Park, North Carolina], FHI, 2004 Mar.  p.I/C (Initiation/Continuation): A woman may fall into either one category or another, depending on whether she is initiating or continuing to use a method. For example, a client with current PID who wants to initiate IUD use would be considered as Category 4, and should not have an IUD inserted. However, if she develops PID while using the IUD, she would be considered as Category 2. This means she could generally continue using the IUD and be treated for PID with the IUD in place. Where I/C is not marked, a woman with that condition falls in the category indicated - whether or not she is initiating or continuing use of the method. (excerpt)
Baltimore, Maryland, Johns Hopkins Bloomberg School of Public Health, Center for Communication Programs, Information and Knowledge for Optimal Health Project [INFO], 2004 Aug. 8 p. (INFO Reports No. 1; USAID Grant No. GPH-A-00-02-00003-00)The World Health Organization (WHO) has issued new family planning guidance, including the following: Most women with HIV infection generally can use IUDs. Women generally can take hormonal contraceptives while on antiretroviral (ARV) therapy for HIV infection, although there are interactions between contraceptive hormones and certain ARV drugs. Women with clinical depression usually can take hormonal contraceptives. More than 35 experts met at WHO headquarters in Geneva, Switzerland, in October 2003 and developed this and other new guidance. The new guidance updates the 2000 Medical Eligibility Criteria (MEC) for Contraceptive Use. (excerpt)
Criteria reaffirmed for broad-spectrum antibiotics and hormonal methods, cervical neoplasia and COCs, breastfeeding and progestins.
In: WHO updates medical eligibility criteria for contraceptives, by Ward Rinehart. Baltimore, Maryland, Johns Hopkins Bloomberg School of Public Health, Center for Communication Programs, Information and Knowledge for Optimal Health Project [INFO], 2004 Aug. 6. (INFO Reports No. 1; USAID Grant No. GPH-A-00-02-00003-00)Case reports have raised suspicions that broad-spectrum antibiotics in general might lower the effectiveness of hormonal contraceptives. Still, studies find that various broad-spectrum antibiotics do not lower hormone levels and, with one early exception, they have found no evidence of ovulation. Pregnancy rates are similar among women taking COCs alone and women taking both COCs and antibiotics. The 2003 Expert Working Group left broadspectrum antibiotics in MEC category 1 (use in any circumstances). The MEC previously categorized use of the antibiotics rifampicin and griseofulvin both as category 3 (not usually recommended) for most hormonal contraceptives because these drugs were thought to reduce contraceptive effectiveness. There are reports of pregnancies in users of hormonal contraceptives taking griseofulvin, and griseofulvin affects liver enzymes in mice, suggesting a possible impact on hormone metabolism. There are no published clinical or pharmacokinetic studies on interaction between griseofulvin and contraceptive hormones, however. The Expert Working Group reclassified use of griseofulvin to category 1 for users of combined or progestin- only injectables and category 2 (generally use) for users of other hormonal methods. (excerpt)
Nutrition and health policy in women and children. Report on a WHO workshop, Yerevan, Armenia, 2-5 July 1997.
Copenhagen, Denmark, WHO, Regional Office for Europe, 1998. , 30 p. (EUR/ARM/LVNG 02 01 11)A child's right to adequate nourishment, and the duty of society to ensure that a pregnant woman has access to good nutrition, have been matters of concern for over a century. Yet even in the 1990s, babies are still at risk of undernutrition before birth. Recent years have seen increasing evidence of the importance of nutrition for a satisfactory birth outcome. The Workshop was designed for health facility administrators, policy-makers and clinicians interested in nutrition and how food affects the health of women and infants, and was attended by gynaecologists/obstetricians, paediatricians and hygienists working in the saneped system. On the first day a short course for administrators and policy-makers on "Promoting breastfeeding in sanitary facilities" was held, and during the following three days the WHO/UNICEF training module on "Healthy eating in pregnancy and lactation" was pilot tested. Participants gained knowledge on providing health advice for women during pregnancy, birth and the postpartum period with a view to promoting WHO guidelines on healthy eating. The Workshop contributed to developing a national plan of action for Armenia to implement national dietary guidelines for pregnant and lactating women and their families. (author's)
[A review of breastfeeding in Brazil and how the country has reached ten months' breastfeeding duration] Reflexôes sobre a amamentação no Brasil: de como passamos a 10 meses de duração.
Cadernos de Saude Publica. 2003; 19 Suppl 1:S37-S45.In 1975, one out of two Brazilian women only breastfed until the second or third month; in a survey from 1999, one out of two breastfed for 10 months. This increase over the course of 25 years can be viewed as a success, but it also shows that many activities could be better organized, coordinated, and corrected when errors occur. Various relevant decisions have been made by international health agencies during this period, in addition to studies on breastfeeding that have reoriented practice. We propose to review the history of the Brazilian national program to promote breastfeeding, focusing on an analysis of the influence of international policies and analyzing them in four periods: 1975-1981 (when little was done), 1981-1986 (media campaigns), 1986-1996 (breastfeeding-friendly policies), and 1996-2002 (planning and human resources training activities backed by policies to protect breastfeeding). The challenge for the future is to continue to promote exclusive breastfeeding until the sixth month, taking specific population groups into account. (author's)
Development of a scale to assess maternal and child health and family planning knowledge level among rural women.
Health and Population: Perspectives and Issues. 2000; 23(1):37-52.This paper presents a tool specifically developed for assessing the knowledge of rural women in Rohtak district of Haryana regarding maternal and child health. This tool can also be used for (i) identification of high risk women groups in the community by the programme managers as well as by the researchers; (ii) quantitative analysis of the relationship between various decisions making variables and the knowledge level of women regarding MCH and FP and (iii) impact evaluation of the IEC programme on the knowledge of women regarding maternal and child health. (author's)
New York, New York, UNICEF, 2002.  p. (UNICEF Fact Sheet)Approximately one third of infants born to HIV-infected mothers will contract the virus. Without preventive interventions, transmission of the virus occurs during a mother’s pregnancy or during childbirth or breastfeeding. Without interventions, about 15 to 30 per cent of children become infected during pregnancy or delivery; about 10 to 20 per cent contract the virus through breastmilk if breastfed for two years. An estimated 800,000 children under the age of 15 contracted HIV in 2001, about 90 per cent of them through mother-to-child transmission (MTCT). The risks of HIV infection have to be compared with the risks of illness and death faced by infants who are not breastfed. Breastfeeding provides protection from death due to diarrhoea and respiratory and other infections, particularly in the first months of life. During the first two months, a child receiving replacement feeding is nearly six times more likely to die from these infectious diseases, compared to a breastfed child. Breastfeeding also provides complete nutrition, immune factors and the stimulation necessary for good development, and it contributes to birth spacing. (excerpt)
Lancet. 2003 Aug 16; 362(9383):542.An increasing number of mothers with HIV in Uganda are breastfeeding their babies after UNICEF stopped donating free infant formula. Doctors implementing the prevention of mother-to-child HIV transmission (PMTCT) project said on Aug 7 that most of the women could not afford infant formula. “They have a choice of whether to breastfeed or buy infant formula”, said Saul Onyango, national PMTCT coordinator. (excerpt)
Child mortality associated with reasons for non-breastfeeding and weaning: Is breastfeeding best for HIV-positive mothers?
AIDS. 2003 Apr 11; 17(6):879-885.Objective: To estimate child mortality associated with reasons for the non-initiation of breastfeeding and weaning caused by preceding morbidity, compared with voluntary weaning as a result of maternal choice. Methods: Demographic and Health Surveys were analysed from 14 developing countries. Women reported whether they initiated lactation or weaned, and if so, their reasons for non-initiation or stopping breastfeeding were classified as voluntary choice or as a result of preceding maternal/infant illness. Rates of child mortality and survival analyses were estimated, by reasons for non-breastfeeding or weaning. Results: Mortality was highest among never-breastfed children. Child mortality among women who never initiated breastfeeding was significantly higher than among women who weaned. Preceding maternal/infant morbidity was the most common reason for not breastfeeding (63.9%), and the mortality of children never breastfed because of preceding morbidity was higher than in children not breastfed as a result of maternal choice; 326.8 per 1000 versus 34.8 per 1000, respectively. Mortality among breastfed children who were weaned because of preceding morbidity was higher than among those weaned voluntarily; 19.2 per 1000 versus 9.3 per 1000, respectively. Failure to initiate lactation was significantly more frequent among women reporting complications of delivery and with low birthweight infants. Conclusion: Child mortality as a result of the voluntary non-initiation of breastfeeding or voluntary weaning was lower than previously estimated, and this should be used as a benchmark when counselling HIV-positive mothers on the risks of non-breastfeeding or weaning to prevent mother-to-child transmission of HIV. (author's)
Obstetrics and Gynecology. 2002 Jun; 99(6):1100-1112.The objective of this study is to review new evidence regarding 10 controversial issues in the use of contraceptive methods among women with special conditions and to present WHO recommendations derived in part from this evidence. The authors searched MEDLINE and PREMEDLINE databases for English-language articles, published between January 1995 and December 2001, for evidence relevant to 10 key contraceptive method and condition combinations: combined oral contraceptive (OC) use among women with hypertension or headaches, combined OC use for emergency contraception and adverse events, progestogen-only contraception use among young women and among breastfeeding women, tubal sterilization among young women, hormonal contraception and IUD use among women who are HIV positive, have AIDS, or are at high risk of HIV infection. Search terms included: "contraception," "contraceptives, oral," "progestational hormones," "medroxyprogesterone-17" acetate," "norenthindrone," "levonorgestrel," "Norplant," "contraceptives, postcoital," "sterilization, tubal," "IUDs," "hypertension," "stroke," "myocardial infarction," "thrombosis," "headache," "migraine," "adverse effects," "bone mineral density," "breastfeeding," "lactation," "age factors," "regret," and "HIV". From 205 articles, the authors identified 33 studies published in peer-reviewed journals that specifically examined risks of contraceptive use among women with pre-existing conditions. Combined OC users with hypertension appear to be at increased risk of myocardial infarction and stroke relative to users without hypertension. Combined OC users with migraine appear to be at increased risk of stroke relative to non-users with migraine. The evidence for the other eight method and condition combinations was either insufficient to draw conclusions or identified no excess risk. Of the 10 contraceptive method and condition combinations assessed, the evidence supported an increased risk of cardiovascular complications with combined OC use by women with hypertension or migraine. As a new evidence becomes available, assessment of risk and recommendations for use of contraceptive methods can be revised accordingly. (author's)
AFRICA HEALTH. 2001 May; 23(4):38.A newly published study from South Africa supports the view that breastfeeding is safer than mixed feeding for the babies of HIV-positive mothers. Research at the University of Natal involved 551 HIV-positive pregnant women who chose, for the first 6 months of their babies' lives, whether to breastfeed exclusively, formula feed exclusively or carry out mixed feeding. By 15 months of age, the infants who were breastfed were no more likely to have become HIV-positive than those who were formula-fed. The mixed-fed infants were the most likely to have become infected. The mechanism for the effect is unknown. The benefits of breast milk over formula feed are considerable, especially when mothers live in poor communities, but it has been argued that these benefits are not enough to justify breastfeeding when a mother is (or may be) HIV-positive. The study appears to contradict this view. However, WHO says that on the basis of one study it is not yet prepared to recommend that HIV-positive mothers breastfeed exclusively as a first choice. The worsening of the AIDS situation in South Africa is causing particular concern. The latest annual figures released by the government indicate that one in four pregnant women nationally are HIV-positive; 24.5% of 16,548 blood samples collected tested positive, up from 22.4% in 1999. In KwaZulu Natal the figure has reached 36.2%. About 4.7 million people in South Africa (population 40 million) are thought to have the virus, compared with 4.2 million in 1999. (full text)
JOURNAL OF THE INDIAN MEDICAL ASSOCIATION. 1994 Jan; 92(1):15-6, 38.In many countries, the human immunodeficiency virus (HIV) epidemic has become one of young people, mainly women, and children because of cultural values and the status of women and girls in society. In India and Southeast Asian countries, 80-90% of HIV infection results from heterosexual intercourse; men seek unprotected sex with multiple casual partners because of taboos concerning sexual intercourse during menstruation or after childbirth. Since a woman's status depends on her ability to bear sons, the use of barrier methods is precluded. Women are at greater risk of HIV infection, whether on a percent or per partnership basis. Because men tend to choose younger female sex partners, there is a tendency for the level of HIV infection to be higher in women than in men in the same age cohort. Although serosurveillance in India initially demonstrated a higher prevalence in men, the ratio is reversing. Lower levels of education among women lead to misconceptions about disease prevention, reduce receptivity to public health interventions, and limit access to health care. Repeated pregnancies, poor reproductive hygiene, a tradition of not seeking care, the use of multiple partners by men, and normal labor and operative procedures place women at greater risk of sexually transmitted disease (STD) and HIV infection. Regardless of HIV transmission rates, the World Health Organization recommends breast feeding. Women living in settings where the risk of the infant dying from infectious disease or malnutrition is high should breast feed, even if infected with HIV; in other settings, infected women should use an alternative. The choice of an artificial method and product should not be subject to commercial pressure. Counseling and family planning information and services should be provided to all infected adults. The first priority in all countries is to prevent women of childbearing age from being infected; education, access to condoms, and STD prevention and care are primary activities. The quality of care and access to maternal health and family planning services need to improve, especially with regard to pregnancy complications.
FAMILY PLANNING NEWS. 1994; 10(2):4.A World Health Organization (WHO) position paper reaffirms the organization's commitment to work with governments and others in the development community to ensure that health, particularly maternal and child health, becomes a cornerstone of development. The WHO estimates that 25% of the 400,000 babies born daily are unwanted. World population will grow to surpass the six billion mark by 1999, stabilizing around the year 2200 between 11 and 28 billion depending upon the size of fertility rates between now and then. These increases in population are definitely shaping the history of humanity and threaten the possibility of sustainable development, adequate health, and a good quality of life. The WHO therefore urges health systems to respond with programs to shape population change. Breast feeding is mentioned in the report as being the most cost-effective means of preventing malnutrition and infant mortality. Exclusive and frequent breast feeding provides nutrition for the child, protects the infant from infection, and prolongs lactational amenorrhea. This prolonged lactational amenorrhea helps child spacing and, in turn, reduces the incidence of infant mortality.
The promotion of the lactational amenorrhea method and child spacing through breastfeeding advocates, Contract No. OR-HO-001.
[Unpublished] . vii, 44 p. (HON-05)In Honduras, a decreasing prevalence of exclusive breast feeding, with over 50% of infants given supplemental liquids during the first 30 days, was causing health risks for the infants and pregnancy risks for the mothers (with 49% at risk within a year of giving birth). Therefore, La Leche League Honduras (LLLH) conducted an operations research study in the Las Palmas neighborhoods of San Pedro Sula to evaluate whether the combination of medical personnel and mother support groups trained in lactation and the lactational amenorrhea method (LAM) for child spacing would increase prevalence and duration of exclusive breast feeding, amenorrhea, and the reported use of LAM at 6 months postpartum over that found in a community served only by trained medical personnel. This project received financing in the amount of US $20,250 from Georgetown University and technical assistance from the Population Council. Specific objectives were to train at least 50 physicians, provide updated information to at least 50 nurses through a workshop, train and certify at least 36 community mothers to serve as breastfeeding advocates (BAs) with specific information on LAM and the ability to make referrals to complementary family planning (FP) services, and initiate at least 6 mother support groups which would meet monthly throughout the year-long study period of 1991. A nonequivalent pre/post-test design was used with the experimental group receiving BA training and support groups and both the control and experimental groups receiving identical training of medical staff. A July 1990 survey of the 6,794 households in the project area revealed 1083 mothers of babies less than a year old and 630 pregnant women. 848 women from this group were interviewed at baseline and 922 at endline to determine socioeconomic status, health system affiliation, reproductive history, breastfeeding and infant feeding practices, contraceptive use, and LAM knowledge and attitudes. Focus groups were held after 3 months of service delivery for qualitative evaluation, interviews were conducted, and 4 mother support groups were observed. BAs were given record-keeping forms, and referral stubs were collected. This report described the implementation of project activities and the impact of the intervention in great detail. The results suggest that training health professionals was partially successful in improving breastfeeding practices and that use of LAs was effective in promoting exclusive breast feeding and use of compatible FP methods and increasing LAM knowledge. However, analysis of women using LAM as a FP method revealed that only 6.5% correctly met all criteria. Lessons learned from this evaluation are cited and the following suggestions are made for further research: 1) develop materials to teach LAM to low-literacy women; 2) examine the role of provider bias and influence of exclusive breast feeding prevalence on LAM acceptance; 3) discover the relative effectiveness of LAM promotion by LLLH vs. FP agencies; 4) test the effectiveness of strategies which segment a target population for LAM education; and 5) determine whether LAM leads to subsequent use of other FP methods.
CENTRAL AFRICAN JOURNAL OF MEDICINE. 1992 Jul; 38(7):314-5.Participants at a 1992 WHO/UNICEF consultation meeting on HIV transmission and breast feeding weigh the risk of death from AIDS with the risk of death from other causes. Breast feeding reduces the risk of death from diarrhea, pneumonia, and other infections. Artificial or inappropriate feeding contributes the most to the more than 3 million annual childhood deaths from diarrhea. The rising prevalence of HIV infection among women worldwide results in more and more cases of HIV-infected newborns. About 33% of infants born to HIV-infected. Some HIV transmission occurs through breast feeding, but breast feeding does not transmit HIV to most infants HIV-infected mothers. Participants recommend that, in areas where infectious diseases and malnutrition are the leading causes of death and infant mortality is high, health workers should advise all pregnant women, regardless of their HIV status, to breast feed. The infant's risk of HIV infection via breast milk tends to be lower than its risk of death from other causes and from not being breast fed. HIV-infected women who do have access to alternative feeding should talk to their health care providers to learn how to feed their infants safely. In areas where the leading cause of death is not infectious disease and infant mortality is low, participants recommend that health workers advise HIV-infected pregnant women to use a safe feeding alternative, e.g., bottle feeding. Yet, the women and their providers should not be influenced by commercial pressures to choose an alternative feeding method. Health care services in these areas should provide voluntary and confidential HIV testing and counseling. Participants stress the need to prevent women from becoming HIV-infected by providing them information about AIDS and how to protect themselves, increasing their participation in decision-making in sexual relationships, and improving their status in society.
INTER-AMERICAN PARLIAMENTARY GROUP ON POPULATION AND DEVELOPMENT BULLETIN. 1990 Dec; 7(12):1-5.A lack of support for and information about breast feeding has contributed to the decline in its practice worldwide. The article provides support for the benefits of breast feeding and discusses existing and potential legislation affecting breast feeding and urges policy makers to provide accurate information per Article 4 of the WHO/UNICEF Code. A list of the benefits includes: infant protection against disease, excellent and inexpensive source of nutrition, no contamination of milk supply, lower maternal risk, financial savings, and a complement to family planning. It is noted that artificial formulas and bottles are perceived by poor women as the desirable modern way, and formula companies promote their product in such a manner as to restrict the possibility of breast feeding. It is suggested that effective national health policies include: 1) paid maternity leave with government support, 2) job security after delivery with no loss of seniority, 3) establishment of breast feeding facilities in the workplace or community, 4) provision for nursery breaks without loss of pay, and 5) flexible employment arrangements such as part-time or shorter shifts. Most countries in the Western Hemisphere have a maternity leave policy with the exception of Belize, Saint Vincent, and the US. 18 countries have statutory provisions for nursing breaks at work, and 19 countries require nurseries to be available. Worker satisfaction and lower absenteeism are some benefits to companies supportive of breast feeding practices. The WHO/UNICEF education code recommends information on 1) the advantages of breast feeding, 2) maternal nutrition and preparation for breast feeding, 3) negative effects of partial bottle feeding, 4) the difficulty of resuming breast feeding after stopping, and 5) the correct preparation of breastmilk substitutes made commercially or at home.
[Breastfeeding: a right of the mother and child] Aleitamento materno: um direito da mae e da crianca.
REVISTA PAULISTA DE MEDICINA. 1987 Mar-Apr; 105(2):103-7.The laws concerning the protection of working women who nurse and the outcome of the breast feeding program at the state university of Campinas (UNICAMP), Brazil, are discussed. The International Labor Organization (ILO) was founded in 1919 with the objective of improving the working conditions and lives of workers worldwide. At a 1952 convention, the right of women to interrupt work to nurse was accepted. In 1975, the declaration on the equal opportunity and treatment of working women was passed. ILO's recommendation was adopted in 30 countries which allowed working woman to nurse for 30 minutes or more. In Italy and Bulgaria, 60 minutes is assigned for nursing. A 1923 Brazilian law decreed that nurseries must be near the work place where mothers could nurse regularly. ILO's 1952 convention was ratified in 1966 in Brazil, and, in 1986, a paid nursery scheme was passed. UNICAMP has been dealing with nursing programs since 1975, focusing on education, breastfeeding techniques, presentations, and group discussions. The mothers were monitored until weaning or until the child reached 9 months of age. The program had a higher impact among women >25 and married, than among women >30 with less education. In a follow-up program, 100 women 7 months pregnant received prenatal assistance and were asked to fill out a questionnaire. 76 complied: 28 nursed their present child but not the previous one, and 22 nursed their first child (50% for less than 6 months). A 1977 survey in the city of Paulinia on breast feeding duration of children up to 2 years of age showed that 12.1% of 610 were never nursed. 57% were exclusively breast fed in the first month, but only 18% were nursed by the 6th month. In 1982, an infant center was inaugurated by UNICAMP where a child could nurse 5 times a day up to 6 months of age. In the first 4 years, 334 children attended and were nursed for 12 months, although 8.8 months was the expected duration, and the previous child had been nursed for only 6 months.
IN POINT OF FACT 1990 Sep; (70):1-4.About 50% of children <1 year old in developing countries die during the 1st month of life, and 97% of all infant deaths occur in developing countries. Major factors contributing to these deaths are the mother's poor health before and during pregnancy, unhygienic childbirth practices, and inadequate care after delivery. Low birth weight, linked to mother's health, is considerably related to survival and development and growth. >500,000 women in developing countries die annually due to pregnancy and childbirth. Maternal mortality risk in the poorest countries can be 200 times that of developed countries. Inappropriate timing and spacing, too many pregnancies, unsafe abortion, and insufficient prenatal care and care during delivery contribute to high maternal mortality in developing countries. Mothers <18 years old are at the highest risk of pregnancy complications, delivering a premature infant, and/or death. Postponement of marriage and better access to family planning would improve their and their infants chances of survival. Access to and acceptability of family planning promotes the health of women and children. Literate women and their children are healthier than those of illiterate women. A trained person attends only 20% of births in developing countries. Increasing the number of deliveries with a trained attendant and increasing immunizations of mothers with the tetanus toxoid will greatly reduce mortality. Infants leaving the uterus experience a drop in ambient temperature from 37 to 20 degrees Celsius. If they are not dried off, covered in a dry cloth, and/or allowed to be in physical contact quickly, they can experience considerable heat loss or even death. Further all infants should be exclusively breastfed for 4-6 months to ensure healthy growth and development and to provide protection against infections.
Socio-economic development and fertility decline: an application of the Easterlin synthesis approach to data from the World Fertility Survey: Colombia, Costa Rica, Sri Lanka and Tunisia.
New York, New York, United Nations, 1991. ix, 115 p. (ST/ESA/SER.R/101)The relationship between fertility decline and development is explored for Colombia, Costa Rica, Sri Lanka, and Tunisia. The study applies Richard Easterlin and Eileen Crimmins; theoretical and empirical approach to analyzing World Fertility Survey (WFS) data in a comparative context. The paper specifically questions the strengths and weaknesses of the Easterlin-Crimmins framework when applied to developing country data, and what the framework implies about comparative fertility in these countries. 3 stages in all, an analyst 1st decomposes a couple's final number of children ever born through an intermediate variables framework. Stage 2 emphasized understanding the determinants of contraceptive use, while stage 3 explains the remaining stage-1 and stage-2 variables. A model linking the supply of children, the demand for children, and the cost of contraceptive regulation results. Stage 1 results were promising, stage 2 results were less encouraging, while stage 3 revealed a theoretically incomplete approach employing empirically weak WFS data. While the Easterlin-Crimmins approach may be promising, econometric, theoretical, and data quality and collection improvements are necessary. Among stage-3 variables open to manipulation, higher socioeconomic status was associated with delayed age at 1st marriage, lower infant and child death rates, lower numbers of children desired, increased knowledge of contraception, and reduced levels of breastfeeding. Apart from regional differences, the educational and occupational roles of women in the countries studied were of primary importance in understanding differential fertility.
IN TOUCH 1987 Dec; 11(85):21-4.This paper discusses Bangladesh's overwhelming social, economic, and health obstacles to improving child health, and stands behind the UNICEF GOBI-FFF strategy as a low-cost alternative for rapid implementation. GOBI-FFF is an acronym for growth monitoring, oral rehydration, breastfeeding, immunization, food supplements for infants, female education, and family spacing. Specifically, the article endorses growth monitoring with the National Nutrition Council child health and nutrition card. The growth chart should be seen as an approach for the promotion of good health, prevention of malnutrition and infectious disease, and treatment of minor illnesses. The card has been designed for use among children 0-5 years of age at the primary health care level. The card includes messages and information on child health and nutrition. The actual process of growth monitoring requires a growth chart, growth chart manual, and a weighing scale. The paper describes growth measurement as the most scientifically effective measure of a child's nutrition and overall health. It is a simple and inexpensive manner of monitoring child health and nutritional status in the community.
NURSING JOURNAL OF INDIA. 1990 Oct; 81(10):322.Due to a deteriorating economic situation, India has adopted a policy of Selective Primary Health Care (SPHC), a strategy to target the population which can benefit the most from low cost health care--women and children in rural communities. India has set the goal of Health for All by the Year 2000. But the country has been grappling for a way to achieve long-run sustainability of accelerated health programs. Considering that economic conditions have reduced available resources, SPHC represents a realistic program that accurately reflects the health care priorities of the country. 80% of India's population lives in rural areas. Every year, 14 million people die from preventable diseases such as diarrhea, measles, and neonatal tetanus. In 1988 alone, diarrhea and measles cost the lives of 5 million children. SPHC program is goal-specific, and it follows the model by UNICEF's own selective intervention program -- GOBIFFF (Growth monitoring, Oral rehydration, Breastfeeding, Immunization, Female education, Food supplements, and Family planning). SPHC also emphasizes success. The programs has established targets and has monitored results. In 1981, less than 20% of all children were immunized, and less than 1% of all children were treated with oral rehydration solutions (ORS). But by 1987, 50% of all children were immunized against the 6 childhood immunizable diseases, and the number of children treated with ORS increased to over 50%. Although it would be better to combine SPHC with a Comprehensive Primary Health Care program, the current level of commitment and resources are not sufficient. Therefore, SPHC remains the realistic approach.
TRANSACTIONS OF THE ROYAL SOCIETY OF TROPICAL MEDICINE AND HYGIENE. 1989 Jan-Feb; 83(1):10-8.The main causes of infant mortality in 71% of the cases are diarrhea, measles, acute respiratory infection, and neonatal tetanus. A UN child survival strategy includes growth monitoring, oral rehydration, breast feeding, immunization, fertility, food and female literacy (GOBI-FFF). Previous research has shown a correlation between low levels of infant mortality and high levels of female literacy. Educated women are more likely to delay marriage, and childbearing. Child mortality is much higher for those born to women under 20 years old and also much higher for those born within 1 or 2 after the previous birth. Maternal mortality is also higher for mothers under 20 and with closely spaced births of 3 or more children. The majority of adults in developing countries have knowledge of family planning but teen pregnancy is a concern. Better nutrition during pregnancy would decrease infant deaths. Growth monitoring is another way to reduce infant mortality and morbidity. The difficulties are in the reluctance to adapt programs to local traditional methods of growth monitoring and going to direct recording scales. Immunization is estimated to have prevented over 3 million deaths from measles, tetanus, whooping cough and polio in 1984 alone. In spite of progress, only 50% of children in developing countries are immunized against diphtheria, pertussis, polio, and tetanus by the age of 1 year. these activities must be integrated into primary health care and community development projects to make better contact with people needing this service. oral rehydration therapy not only reduces mortality from diarrhea but can reduce morbidity by reducing the duration of the illness and by increasing the weight gain. Breast feeding has been shown in many studies to reduce the risk of deaths of infants. The promotion of breast feeding includes the issues of maternity leave, job security, and child care at the work place.
JORDEMODERN. 1987 Jun; 100(6):172-3.As long as breast-feeding in the developing and developed countries is threatened by bottle-feeding and too early introduction of supplementary diets, the discussion about how breast-feeding is best protected must be kept alive within the organizations and the mass media. Representatives of the Swedish private organizations' foreign assistance programs participated in a seminar on April 3, 1987 in Stockholm, arranged by the Nordic Work Group for International Breast-Feeding Questions in cooperation with International Child Health (ICH). Breast-feeding increased strongly in Sweden during the 1970s, but bottle-feeding is still the norm in large parts of Europe and continues to increase in the developing countries. 6 years have passed since the international code for marketing of breast milk substitutes (even called the child food code) was approved by WHO, in 1981. It contains rules that limit companies' marketing efforts and establish responsibilities and duties that apply to health personnel. The application of these rules is slow and differences between company policies and practice exist. In a larger perspective, we are dealing with the position and significance of woman and children within the family and society. During a WHO meeting in 1986, a resolution was adopted that reinforces the content of the code, e.g., it stops the distribution of free breast milk substitutes to the hospital, where free samples are often given to leaving mothers. The WHO countries also expressed negative feeling toward marketing child food during a period where breast-feeding may be affected negatively. How the resolution is going to be implemented in Sweden is not yet known. There are signs that even in Sweden the existence of the code is being forgotten. The seminar participants recommended that the Social Board issue a simplified and easily read reminder about the code for wider distribution in Sweden.
MCH NEWS PAC. 1987 Fall; 2(4):5, 11.Governmental policies and legislation aimed at validating the dual role of women as mothers and wage earners can significantly strengthen breastfeeding promotion efforts. Examples of such laws and policies are maternity leave, breastfeeding breaks at the workplace, allowances for pregnant women and new mothers, rooming-in at hospitals, child care at the worksite, flexible work schedules for new mothers, and a national marketing code for breastmilk substitutes. The International labor Organization (ILO) has played an important role in setting international standards to protect working mothers. The ILO defines minimal maternity protection as encompassing: a compulsory period of 6 weeks' leave after delivery; entitlement to a further 6 weeks of leave; the provision during maternity leave of benefits sufficient for the full and healthy maintenance of the child; medical care by a qualified midwife or physician; authorization to interrupt work for the purpose of breastfeeding; and protection from dismissal during maternity leave. In many countries there is a lack of public awareness of existing laws or policies; i.e., working women may not know they are entitled to maternity leave, or pediatricians may not know that the government has developed a marketing code for breastmilk substitutes. Overall, the enactment and enforcement of legislation can ensure the longterm effectiveness of breastfeeding promotion by raising the consciousness of individuals and institutions, putting breastfeeding activities in the wider context of support for women's rights, recognizing the dual roles of women, and institutionalizing and legitimating support for breastfeeding.