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Expanding Concern for Women's Health in Developing Countries. The Case of the Eastern Mediterranean Region.
Women's Health Issues. 2010 May-Jun; 20(3):171-177.Background: Women's health is still largely associated with the notion of reproduction in developing countries despite a more varied disease burden, including noncommunicable conditions resulting from consequences of changing epidemiologic and demographic patterns on women's health. Methods: The World Health Organization (WHO) Global Burden of Disease data base is used to derive for the Eastern Mediterranean Region (EMR) cause-specific rates of death and of disability-adjusted life-years (DALYs) by age for adult women, and percent of total deaths and total DALYs for women in the reproductive ages, as related to maternal conditions and to three selected noncommunicable conditions, namely, cardiovascular disease, cancer, and neuropsychiatry conditions. Inequalities by country income category are examined. Results: Maternal health conditions still form a substantial component of the disease burden, with an increasing burden of cardiovascular disease and cancer starting in the late reproductive years and beyond. The burden of neuropsychiatric conditions is also high during the reproductive years, reflecting possibly the stress of multiple roles of women as well as stress of war and conflict that permeate the EMR. Women in low- to middle-income countries suffer more from maternal health conditions and less from neuropsychiatry conditions than women in high-income countries. Conclusion: The wider disease burden of women should be addressed making use of available reproductive health services taking special account of interactions between reproductive and noncommunicable conditions for better health of women during and beyond reproduction. Better measures of the burden of illness should be developed. There is a special need for improved health information systems in the EMR.
Forced Migration Review. 2007 Dec; (29):42-44.The international community has been mandated to mainstream gender into humanitarian response ever since the landmark Beijing conference in 1995. The current humanitarian reform process provides unique opportunities to accelerate this integration. Taking gender issues into consideration in planning and implementing emergency responses is not only a question of protecting the human rights of the persons affected. It is also a means to make emergency aid more effective. It is thus natural that ensuring gender-sensitive responses should be at the heart of humanitarian reform. Gender has been identified as a crosscutting issue to be mainstreamed into the Cluster Approach. The IASC Task Force on Gender and Humanitarian Assistance has been transformed into an IASC Sub-Working Group (as of December 2006), expanding its mandate to become more operational. (excerpt)
Reliability of self reported form of female genital mutilation and WHO classification: cross sectional study.
BMJ. British Medical Journal. 2006 Jul 15; 333(7559):124.The objective was to assess the reliability of self reported form of female genital mutilation (FGM) and to compare the extent of cutting verified by clinical examination with the corresponding World Health Organization classification. Design: Cross sectional study. Settings: One paediatric hospital and one gynaecological outpatient clinic in Khartoum, Sudan, 2003-4. Participants: 255 girls aged 4-9 and 282 women aged 17-35. Main outcome measures: The women's reports of FGM the actual anatomical extent of the mutilation, and the corresponding types according to the WHO classification. All girls and women reported to have undergone FGM had this verified by genital inspection. None of those who said they had not undergone FGM were found to have it. Many said to have undergone "sunna circumcision" (excision of prepuce and part or all of clitoris, equivalent to WHO type I) had a form of FGM extending beyond the clitoris (10/23 (43%) girls and 20/35 (57%) women). Of those who said they had undergone this form, nine girls (39%) and 19 women (54%) actually had WHO type III (infibulation and excision of part or all of external genitalia). The anatomical extent of forms classified as WHO type III varies widely. In 12/32 girls (38%) and 27/245 women (11%) classified as having WHO type III, the labia majora were not involved. Thus there is a substantial overlap, in an anatomical sense, between WHO types II and III. The reliability of reported form of FGM is low. There is considerable under-reporting of the extent. The WHO classification fails to relate the defined forms to the severity of the operation. It is important to be aware of these aspects in the conduct and interpretation of epidemiological and clinical studies. WHO should revise its classification. (author's)
Geneva, Switzerland, WHO, 2004.  p.Every year some eight million women suffer pregnancy-related complications and over half a million die. In developing countries, one woman in 16 may die of pregnancy-related complications compared to one in 2800 in developed countries. Most of these deaths can be averted even where resources are limited but, in order to do so, the right kind of information is needed upon which to base actions. Knowing the statistics on levels of maternal mortality is not enough—we need information that helps us identify what can be done to prevent such unnecessary deaths. Beyond the numbers presents ways of generating this kind of information. The approaches described go beyond just counting deaths to developing an understanding of why they happened and how they can be averted. For example, are women dying because: they are unaware of the need for care, or unaware of the warning signs of problems in pregnancy?; or the services do not exist, or are inaccessible for other reasons, such as distance, cost or sociocultural barriers?; or the care they receive is inadequate or actually harmful? (excerpt)
New York, New York, United Nations, 2003. ix, 101 p. (ST/ESA/SER.A/218)The primary objective of the present report is to examine the levels and trends of population migration to selected countries in Asia using available statistics as a guide, and focusing primarily on changes that have occurred since 1970. The report discusses the burgeoning of labour migration during the past decades, in response to the development of strong economies in Eastern, Southeastern and Western Asia. It also touches on permanent settlement of people and refugee flows that have characterized several countries in Asia. (excerpt)
Making safe motherhood a reality in West Africa. Using indicators to programme for results. [Pour que la maternité sans risque devienne une réalité en Afrique de l'Ouest. Le recours à des indicateurs nécessitant d'être développés en vue de l'obtention de résultats]
New York, New York, UNFPA, 2003. 31 p.For too long, maternal mortality reduction efforts stalled, in large part because the facts underlying the problem—and the best strategies to address it—were poorly understood. That is why we are so proud to present this report as the first outcome of a collaborative effort between UNFPA and the Governments of Cameroon, Côte d’Ivoire, Mauritania, Niger and Senegal. This report is a tangible reflection of our determination to address maternal mortality using a strategic and practical evidence- based approach in a region where data has been scarce, and where too many women have died. This document represents the first careful assessment of obstetric services in these five countries using emergency obstetric care process indicators. Process indicators assess the critical emergency obstetric care functions that should be made available to all women experiencing complications of pregnancy. These indicators are sensitive, relatively easy to collect, and therefore suitable for monitoring progress in our collective fight against maternal mortality and morbidity. Most important, they can identify problems and suggest their amelioration within a fairly short period of time. This can help programme managers stay on track and save women’s lives. In the countries surveyed, Ministries of Health collaborated with UNFPA and played leadership roles during national workshops aimed at sharing the assessments with other agencies involved in safe motherhood programmes, including WHO and UNICEF. This kind of collaboration and knowledge sharing is extremely useful for strengthening programmes. It not only ensures full ownership of the process but also spotlights those services that need urgent attention by all partners. Malawi and Morocco, which earlier carried out similar initiatives, contributed to the process by sharing their experiences in collecting and using process indicators at the methodology workshop that launched this project. Since then, word of these studies has spread to other countries, and The Gambia, Gabon and Guinea-Bissau are replicating this exercise, with UNFPA support. This phased approach means we can continue to build on past efforts and to use our resources effectively as we move forward. Our hope is that many other partners will support the respective Governments in their efforts to reduce maternal mortality rates as part of our commitment to the Millennium Development Goals. The Maternal Mortality Update 2002, which is published as a companion piece to this report, documents other efforts of UNFPA to make childbearing safer for women around the world. Together these documents underscore UNFPA’s larger commitment to fulfilling women’s right to life and reproductive health. (excerpt)
[The Permanent Household Survey: provisional results, 1985] Enquete Permanente Aupres des Menages: resultats provisoires 1985
Abidjan, Ivory Coast, Ivory Coast. Ministere de l'Economie et des Finances. Direction de la Statistique, 1985. 76 p.This preliminary statistical report provides an overview of selected key economic and social indicators drawn from a data collection system recently implemented in the Ivory Coast. The Ivory Coast's Direction de la Statistique and the World Bank's Development Research Department are collaborating, under the auspices of the Bank's Living Standards Measurement Study, to interview 160 households per month on a continuous basis for 10 months out of the year. Data are collected concerning population size, age structure, sex distribution, family size, nationality, proportion of female heads of household, fertility, migration, health, education, type of residence, occupations, employment status, financial assistance among family members, and consumption. Annual statistical reports based on each round of the survey are to be published, along with brief semiannual updates.
New York, UNFPA, 1980 Jul. 77 p.An overview of the examples of project types funded by the United Nations Fund for Population Activities (UNFPA) are presented along with a list of approved projects on women, population development, and a partial list of pending projects with particular reference to women. In choosing these examples of the UNFPA supported projects, the primary objective was to provide the reader with an indication of the wide range of project activities supported by the Fund. The following projects are reviewed: maternal and child health care and family planning; special programs for women; basic population data collection; population dynamics; formulation and evaluation of population policies and programs; implementation of policies and programs; communication and education; and related population and development activities in the 1980's. The UNFPA is increasingly working to include women in the development and strengthening of maternal and child health family planning systems--their management and evaluation, and including the development and application of fertility regulation methods. It is helping countries find ways and means for the reeducation of men and women on the importance of shared responsibility and authority in family planning decisions. Examples of approved maternal and child health care and family planning projects in Algeria, Bahrain, Bangladesh, Brazil, Costa Rica, Egypt, Jordan, Kenya, Morocco, Somalia, and the People's Democratic Republic of Yemen are briefly described. To ensure increased participation of women and their contribution to population/development related activities, the Fund created a new category of special programs for women. Programs in this category are generally classified as "status of women."
ECONOMIC AND SOCIAL COUNCIL OFFICIAL RECORDS. 1991; Suppl 1:24-5.This document contains the text of a 1991 UN resolution on refugee and displaced women and children. After reviewing previous UN action on this issue, the resolution recommends that: 1) member states cooperate with UN agencies and nongovernmental organizations to address the root cases of refugee migrations; 2) women and children be protected from violence and abuse; 3) the specific needs of refugee women and children be considered in planning; 4) refugee women be given sufficient information to make decisions on their own future; 5) women and, when possible, children, be given access to individual identification documents; 6) refugee women participate fully in the assessment of their needs and in the planning and implementation of programs; 7) the UN Secretary-General review the ability of its organizations to address the situation of refugee women and children; and 8) international organizations increase their capacity to respond to the needs of refugee women and children through greater coordination of efforts. The resolution commends member states which receive large numbers of refugees and asks the international community to share the resulting burden and further recommends that all pertinent organizations adopt an appropriate policy on refugee women and children, female field staff be recruited, staff be trained to increase awareness of the issues related to refugee of women and children and skills for planning appropriate actions, and the collection of refugee statistics be disaggregated by age and gender.
[Unpublished] 1990 Aug 30. Issued by World Health Organization [WHO]. Division of Family Health. , 77 p.This set of guidelines was developed to help researchers determine the extent and nature of reproductive morbidity in developing countries. After presenting definitions for obstetric morbidity (direct, indirect, and psychological), gynecological morbidity (direct, indirect, and psychological), and contraceptive morbidity, possible sources of existing information are considered (health providers, health care service records, previous studies, and other sources). Guidelines are given for generating morbidity data from community-based studies, and the following types of community-based prevalence studies are detailed: 1) those involving the clinical examination of eligible women, 2) those involving the clinical examination of symptomatic women only, 3) whose involving women who use local health services, and 4) those which consider perceived reproductive morbidity. The next section discusses the use of a pregnancy follow-up approach to study reproductive morbidity, and the final section considers the use of a combination of methods and the necessity to include a means of validating results. Appended information provides 1) suggestions for developing and pretesting data collection instruments, 2) information on interviewer selection and training, 3) an example of an interview for a community prevalence study, 4) notes on the interview schedule, 5) an example of a clinical examination record, 6) an example of a laboratory results record, and 7) operational definitions of some reproductive morbidities.
New York, New York, United Nations, 1991. xiv, 120 p. (Social Statistics and Indicators Series K No. 8; ST/ESA/STAT/SER.K/8)5 UN agencies worked together to develop this statistical source book to generate awareness of women's status, to guide policy, to stimulate action, and to monitor progress toward improvements. The data clearly show that obvious differences between the worlds of men and women are women's role as childbearer and their almost complete responsibility for family care and household management. Overall, women have gained more control over their reproduction, but their responsibility to their family's survival and their own increased. Women tend to be the providers of last resort for families and themselves, often in hostile conditions. Women have more access to economic opportunities and accept greater economic roles, yet their economic employment often consists of subsistence agriculture and services with low productivity, is separate from men's work, and unequal to men's work. Economists do not consider much of the work women do as having any economic value so they do not even measure it. The beginning of each chapter states the core messages in 4-5 sentences. Each chapter consists of text accompanied by charts, tables, and/or regional stories. The 1st chapter covers women, families, and households. The 2nd chapter addresses the public life and leadership of women. Education and training dominate chapter 3. Health and childbearing are the topics of chapter 4 while housing, settlements, and the environment comprise chapter 5. The book concludes with a chapter on women's employment and the economy. The annexes include strategies for the advancement of women decided upon in Nairobi, Kenya in 1985, the text of the Convention on the Elimination of All Forms of Discrimination against Women, and geographical groupings of countries and areas. During the 1990s, we must invest in women to realize equitable and sustainable development.
[Unpublished] 1984 Jan. 13 p.The UN Development Program (UNDP) began a special drive in the mid-1970s to ensure that women would enjoy greater benefits from its programs of technical cooperation. Efforts have increased steadily since 1975 when UNDP's Governing Council declared that "the integration of women in development should be a continuous consideration in the formulation, design, and implementation of UNDP projects and programs." They involve: promotion to create a greater awareness of women's needs and approaches which can meet them effectively; orientation and training to enhance skills in developing, implementing, and monitoring programs of benefit to women; improving the data base to provide better information on women's productive roles; programming to address women's concerns and generate self-sustaining activities, replicable nationally, regionally, and interregionally; and personnel action to increase the number of women professionals within UNDP. A number of projects supported by UNDP are directly benefiting women, especially those in rural and poor urban areas of developing countries. Among other things, these projects are helping to reduce women's workloads; addressing needs for clean water, health care, and education; providing training in basic skills; and helping to develop income-earning potentials. Examples are cited for the countries of Indonesia, Mali, Mexico, Yemen Arab Republic, Nepal, Rwanda, Honduras, Papua New Guinea, Liberia, Bolivia, and the Philippines.
Populi. 1985; 12(2):57-66.The UN Statistical Office is endeavoring to improve the collection and analysis of statistical information on women. Accurate statistical information is a prerequisite for assessing the current status of sexual inequality in the world and for monitoring responses to policies aimed at removing sexual inequalities. The Statistical Office in conjunction with several other UN agencies is 1) seeking to improve methods of collecting and analyzing information on women, 2) developing a computerized data base for statistical information on women at the international level, 3) conducting workshops for researchers and users of statistical in formation on women, and 4) helping countries develop systems for collecting relevant information. The Office publishes 3 documents on methodological problems. The 1st document, "Sex-based Stereotypes, Sex Biases and National Data System," identifies cultural factors which impede information gathering on women and suggests strategies for overcoming these obstacles. The 2nd publication, "Compiling Social Indicators on the Situation of Women," describes available data on women, discusses how this data can be most effectively used, and identifies indicators which can be developed from the available data. The 3rd document, "Methods for Statistics and Indicators on the Situation of Women," describes and evaluates the concepts and methods currently used in collecting and a analyzing information on women and makes a series of recommendations for improving the collection of data on women. In 1984, the Office began developing a data base for statistical information on women. At the present time, the data is available in a form which can be appropriately utilized only by individuals with sophisticated statistical skills. The information will eventually be available on diskettes. The Office is helping to develop workshops for the dual purpose of informing researchers about the information needs of planners and of teaching potential users, unfamiliar with statistical techniques, how to interpret and effectively use statistical information on women. The 1st workshop was held in early 1985 for participants from 11 English-speaking countries in Eastern and Southern Africa. A 2nd conference of Portuguese-speaking Africa countries is currently being organized, and workshops in other developing regions are anticipated. The UN helps countries develop census and registration systems and expand their survey capabilities. Although the original goal of these activities was not to collect data on women, efforts are now being made to ensure that data collecting instruments include a component for eliciting information on women. The Statistical Office's activities are guided by recommendations made by experts at a UN-sponsored meeting held in New York in 1983. These recommendations called for 1) methodological improvements, 2) the use of available data to develop indicators women's situation at the national and international level, 3) increased interaction between data collectors and data users, and 4) improved data collection of information on women at the national level. The Office has made considerable progress in pursuing these goals, but much remains to be done.
Population Bulletin of the Economic Commission for Western Asia. 1980; (19):69-80.The author cites problems in the definitions of different categories of economic activity and employment status which have been made by the UN. The term "casual workers" has never been clarified and these people were described as both employed and unemployed on different occasions; there is also no allowance for the term underemployed in the UN classification. The latter term, he concludes, is not included in most censuses. The UN in its Principles and Recommendations for Population Censuses, discusses sex-based stereotypes which he states are based on a set of conventions that are arbitrary, irrational, and complex. However on the basis of the UN rules it is possible to divide the population into 3 categories: 1) those who are economically active (black), 2) those who are not active (white), and 3) those whose classification is in doubt (gray). In developed countries most people are either in the black or the white area and the amount in the gray area is small, but in developing countries the gray area may be the majority of the population. In the Swaziland census no attempt was made to provide a clear picture of employment. In view of the complexity of the underlying concepts, the decisions as to whether a person should be classified as economically active or not should be left to the statisticians, not the census enumerators.
New York, UNFPA, 1978 Jun. 53 p. (Report No 3)The present report presents the findings of the Mission which visited Afghanistan from October 3-16, 1977 for the purpose of assessing the country's needs for population assistance. Report focus is on the following: the national setting (geographical, cultural, and administrative features; salient demographic, social, and economic characteristics of the population; and economic development and national planning); basic population data; population dynamics and policy formulation; implementing population policies (family health and family planning and education, communication, and information); and external assistance (multilateral and bilateral). The final section presents the recommendations of the Mission in detail. For the past 25 years Afghanistan has been working to inject new life into its economy. Per capita income, as estimated for 1975, was $U.S. 150, a relatively low figure and heavily skewed in favor of a very small proportion of the population. The country is still predominantly rural (85%) and agricultural (75%). In the absence of reliable data, population figures must be accepted tentatively. According to the 7-year plan, the population in 1975 was 16.7 million and the rate of growth around 2.5% per annum. The crude birth rate is near 50/1000 and the crude death rate possibly 25/1000. The Mission endorses the priority given by the government to the population census and recommends continued support on the part of the United Nations Fund for Population Activities (UNFPA) to help the Central Statistical Office in the present effort and in building up capacity for future work. The Mission recommends that efforts be concentrated on the reduction of infant, child, and maternal mortality levels and that assistance be continued to the family health services and to programs of population education. Emphasis should be on services to men and women in rural areas. The Mission also recommends a training program for traditional birth attendants.
Populi. 1979; 6(1):37-41.Since the function of the World Fertility Survey (WFS) is to help countries collect unbiased, cross-culturally comparable data on fertility, it is imperative that comprehensive and systematic training of survey personnel be undertaken. The first step in the initiation of a survey is to hold a discussion between WFS personnel and the organization sponsoring a survey in a particular country in order to determine personnel and training needs. WFS provides training assistance for all phases of data collection from sampling to coding, but the training of field supervisors and interviewers is viewed as the most crucial factor in conducting a quality survey. Most of the data collected in these surveys is done through interviewing a national sample of women of childbearing age in reference to marriage and birth patterns, contraceptive use, desired family size, and socioeconomic factors. The questionaires are fairly structured, but given the sensitive nature of the questions and the wide variation possible in responses, it is necessary to thoroughly train interviewers and their supervisors. Only women are recruited as interviewers. In the ideal situation only one center is used for training all personnel, and training time is approximately 5 weeks for supervisors and 3 weeks for interviewers. The training consists of a series of classroom lectures and role playing by the trainees, followed by practical field experience in which teams are sent out each day to nonsample areas to conduct interviews and then in the evening the results of the interviews are analyzed by the group. This intensive and prolonged training is costly, however, given the small sample size of most of the surveys, high quality data is essential. The long training period engenders in the participants a long lasting enthusiasm and interest in the work and the final training week is generally associated with a marked increment in the acquisition of interviewing skills. This intensive training has proved invaluable in the 30 countries where these surveys have been conducted.
In: Staudt KA, Jaquette JS. Women in developing countries: a policy focus. New York, Haworth Press, 1983. 125-8.Increasingly the UN Statistical Office and the UN agencies are becoming more aware of the need to collect and analyze their data by sex and to seek out new ways to collect data which will more fully reflect women's labor force participation and women's role in the houshold economy. At this time there are few databases in existence at the macro level for the primary purpose of studying the role and status of women. This report reviews databases and projects based on collection and analysis of census and special survey data under the auspices of the UN or the US Census Bureau in cooperation with the Women in Development Office of the US Agency for International Development (USAID). The information was compiled at a workshop on the collection and use of macrodata of women in development held at the Population Council in New York in May 1981. The Center for Population Research has a tape designed to correlate trends on women's labor force participation with other economic development indicators over time (using data from 1960, 1970, and 1975). The purpose of the USAID and US Bureau of the Census Project was to collect disaggregated data for use in development planning. The 1st stage compiled census data from the most recent censuses for the 69 countries which are recipients of funds from USAID. 31 tables of demographic, economic, and educational data on men and women, are broken down where available and appropriate by urban and rural residenc. The 2nd stage of this project will compile data for all countries with populations over 5 million (130 countries) for use in aggregate analysis. The project will eventually produce regional handbooks with hard copy printouts of the tables and regional analyses. A list of data reports and statistical publications is available from the UN Statistical Office. A number of UN agencies offer technical assistance to countries on request of increase their household survey capacities. A number of countries have specifically requested assistance to improve their women in development data, which should produce better national data and eventually have an impact on standard census items. Most unive*rsity libraries hold human relations area files. Additional resources are listed.