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African Health Sciences. 2004 Dec; 4(3):144-145.In Africa alone, over 1600 infants become infected with human immunodeficiency virus (HIV) each day despite the advances in prevention of mother to child transmission (PMTCT). WHO recommends the 4 pronged approach to PMTCT that includes primary prevention of HIV, prevention of unintended pregnancies in HIV infected women, PMTCT and care and support for HIV infected women, infants and families. The complete PMTCT package includes comprehensive antenatal (ANC) care, modified obstetric practices, antiretroviral therapy and infant feeding counseling and support. This editorial will focus mainly on the advances made in antiretroviral regimens for PMTCT. (excerpt)
In: An agenda for people: the UNFPA through three decades, edited by Nafis Sadik. New York, New York, New York University Press, 2002. 24-46.The solemn commitment that was made in Cairo in 1994 to make reproductive health care universally available was a culmination of efforts made by the United Nations Population Fund (UNFPA) and all those concerned about a people-centred and human rights approach to population issues. The commitment posed important challenges to national governments and the international community, to policy makers, programme planners and service providers, and to the civil society at large. The role of UNFPA in building up the consensus for the reproductive health approach before Cairo had to continue after Cairo if the goals of the International Conference on Population and Development (ICPD) were to be achieved. UNFPA continues to be needed to strengthen the commitment, maintain the momentum, mobilize the required resources, and help national governments and the international community move from word to action, and from rhetoric to reality. Reproductive health, including family planning and sexual health, is now one of three major programme areas for UNFPA. During 1997, reproductive health accounted for over 60 per cent of total programme allocations by the Fund. (excerpt)
The role of the traditional midwife in the family planning program. Report of National Workshop to Review Researches into Dukun Activities related to MCH Care and Family Planning.
[Jakarta], Indonesia, Department of Health, 1972. 83 p.A number of studies conducted already have revealed that there are possibilities of using dukuns as potential helpers in the family planning programme. Bearing in mind that the number of dukuns at the present time is large, it is easy to imagine that they are capable of contributing a great deal towards progress in our family planning programme provided that the dukuns are assigned a role which is appropriate. In this respect, I am only referring to dukuns whose prime function is helping mothers during pregnancy and immediately afterwards, and who have close contact therefore, with the target of the family planning programme, i.e. the eligible couples. It would indeed be very helpful, if we could find out from the available data and from the results of applied research what exactly is the scope and usefulness of dukuns in the family planning programme. It seems to me that in this project we have to consider a twofold problem. The first aspect of the problem is that the dukuns are mostly of an advanced age and they are illiterate. The second aspect is that in spite of relationships with MCH centers extending over a period of years most of the dukuns still prefer their own way of doing things and they remain unaffected by modern ways of thinking. (excerpt)
[Elsa Zylberstein emphasizes information for safer motherhood] Elsa Zylberstein insiste sur l'information pour une maternite plus sure.
Equilibres et Populations. 2001 May; (68):4.During a trip organized by Equilibres & Population to Senegal and Mali, Elsa Zylberstein, UNFPA ambassador, met with Central and Western African presidents’ wives. Although she already knew about maternal mortality-related problems, Zylberstein began to truly understand them once in Africa visiting field projects conducted by local organizations. Information is essential to improving maternity conditions in Africa. In particular, Mrs. Zylberstein stresses the need to provide young girls with professional training, and encourage the professionalization of midwives. For many maternal mortality- related problems, women and their husbands must be directly convinced of the importance of ensuring mothers’ access to primary healthcare services during pregnancy and motherhood. They must also be convinced that family planning can contribute to their well-being and the fight against maternal mortality involves recognizing women’s status. Following pregnancy, mothers have the right to rest and be cared for. They also have the right to earn personal and familial income. Finally, women also need to learn to respect themselves.
Progress in Reproductive Health Research. 2001; (56):1.Due to the poor implementation of antenatal care programs, women in developing countries are more than 400 times as likely to die from complications during pregnancy as women in southern Europe. To make matters worse, many components of these programs have not been subjected to rigorous scientific evaluation to determine their effectiveness. This lack of "hard" evidence has impeded the optimal allocation of scarce resources in developing countries. Thus, this issue of a bulletin called Progress in Reproductive Health Research provides a comprehensive review of antenatal care research in developing countries conducted by the Special Programme of Research, Development and Research Training in Human Reproduction, a global program of technical cooperation among several UN agencies, WHO and the World Bank. This introductory article explains that the first article in the bulletin is based on a systematic review of what is known about antenatal care and shows why this area has been difficult to study. Then, the major causes of maternal mortality and morbidity are described in the proceeding article. Finally, the next two articles describe the randomized controlled trial for the evaluation of the existing WHO antenatal model and discuss the findings.
SAFE MOTHERHOOD NEWSLETTER. 1993 Feb; (10):3.The health of mothers is a critical element in the health of families. All activities within the WHO Division of Family Health, such as family planning, child health and development are very closely related to the whole issue of safe motherhood and women's reproductive health. The Director of WHO's Division of Family Health identifies WHO's priorities for the Maternal Health and Safe Motherhood Program in response to questions on the importance and priorities of safe motherhood in the overall work of WHO's Division of Family Health and on the needs of countries with high maternal mortality. WHO and its partners in the Safe Motherhood Initiative have done an enormous amount of work in alerting the world, particularly policymakers, to the problem of maternal mortality. However, WHO and the Safe Motherhood Initiative need to be more active at the country level, since countries need help in developing and implementing programs, and need to monitor and evaluate their effectiveness in improving maternal health. They also need a set of tools to identify, quantify, and deal with the weaknesses in maternal health care. In this way they will be able to continue to ensure safe delivery and safe motherhood.
Maternal anthropometry for prediction of pregnancy outcomes: memorandum from a USAID/WHO/PAHO/MotherCare meeting.
BULLETIN OF THE WORLD HEALTH ORGANIZATION. 1991; 69(5):523-32.The memorandum is an abbreviated version of a prepared report on maternal anthropometry which summarizes the general recommendations of a consensus of 50 experts on field applications and priority research issues in developing countries. Consensus was reached at a meeting on Maternal Anthropometry for Prediction of Pregnancy Outcomes held in Washington, D.C. in April 1990. 15 general recommendations are identified for field applications and research priorities. Specific recommendations differentiating field applications from research priorities are provided for prepregnancy weight, weight gain in pregnancy, height, arm circumference, and weight for height and body mass index. For example, the discussion of arm circumference indicates that it is useful as an indicator of maternal nutritional status in nonpregnant women because of its correlation with maternal weight or weight for height. During pregnancy, it is useful as a screen for risk of low birth weight (LBW) and late fetal and infant mortality. Maternal arm circumference has been found to be stable during pregnancy in developing countries and is independent of gestational age. Field applications involve the use 1) to assess the nutritional status of pregnant and nonpregnant women, 2) to screen women at risk of poor maternal stores postpartum because it reflects maternal fat and lean tissue stores, for instance, 3) to screen women and refer to facilities for a more thorough assessment of nutritional risk, and 4) to assess the extent of undernutrition in an area, particularly for surveillance. Community level workers, especially birth attendants (TBA's) should be trained and have access to arm circumference tapes. The technology is simple enough also for use by women in the home. Cutoff points for assessing biological risk are fairly consistent across developing country populations, and range between 21-23.5 cm. Routine monitoring during pregnancy is not necessary because the changes are too small to detect. Where prepregnancy weight is unavailable and weight is monitored, arm circumference may serve as a proxy for prepregnancy weight. All women of childbearing age should be measured. Research priorities are to explore the functional significance with women of difference body compositions (fat versus lean upper arm), the relationship to pregnancy related outcomes, arm changes relative to stages throughout the reproductive period and to weight changes, different instruments such as color-coded tapes or 1 tape for arm measurement and uterine height, combinations of different measurements, the relationship with prepregnancy weight, and the development of arm circumference in weight gain charts as a proxy for prepregnancy weight.
POPULATION EDUCATION NEWS. 1989 Nov; 15(7):3-6.The 1989, UN Population Fund report has recommended 7 broad interventions, with suggested detailed actions to place population at the forefront of development for the 1990s. Family planning is a development priority: it should compare 1% of each country's GNP. Women should empower themselves to shape their own lives. The recommendations are: 1) women's contributions should be documented. 2) Women's productivity should be increased, and their double burden lessened, by giving them credit, ownership of resources, equal pay, better domestic technology and child care at the workplace. 3) Family planning should be ensured with a variety of choice and full information. 4) Women's health should be improved by training birth attendants and all women for decision-making in health, and supplementing food for girls, and young pregnant teens and mothers. 5) Female education should be expanded to at least 4:5 ratio in primary and a 1:2 ratio in secondary schools, and pregnant teens should be allowed to continue their education. 6) Women should be given equal opportunity in all sectors. 7) Goals for 2000 are: international assistance for family planning of $2.5 billion annually; family planning services for 500 million; at least 1 prenatal visit for all; maternal mortality should be reduced 50%; and infant mortality to 50/1000.
BRITISH JOURNAL OF OBSTETRICS AND GYNAECOLOGY. 1991 Apr; 98(4):345-8.Discusses dual concerns of the Royal College of Obstetricians and Gynaecologists (RCOG): that a widening gap between obstetric standards in Britain and those in the developing world exists and that the RCOG is unable to meet the needs of Third World doctors who come to the RCOG for postgraduate study. A meeting sponsored by Birthright and held at the Royal College of Obstetricians and Gynaecologists (RCOG) in June 1989 which explored aspects of Third World obstetric care reflects these concerns. The proceedings of the meeting have been published and verbatim recordings of the discussions are available on tape from the RCOG. Reports on maternal mortality/morbidity in the Third World indicate persistence of poor obstetrical practices and of common obstetrical complications. Suggestions for improvement include the redeployment of and the replanning of services within countries and an increase in health education for women. Access to care at the first referral institution level is seen as the key to the improvement of care. Problems of transport and communication create serious obstacles to the link between community care and the first referral institution. The goal of the World Health Organization (WHO) is to cut the Third World maternal mortality in half by the year 2000. To reach this goal WHO plans to field obstetric teams in Latin America, Africa and South Asia; to train nurse-midwives to perform life saving measures on their own initiative; and to employ community resources by training indigenous midwives to function as extensions of the health team. The RCOG will sponsor training designed for doctors who will work in developing countries.
In: Women's health and apartheid: the health of women and children and the future of progressive primary health care in Southern Africa, edited by Marcia Wright, Zena Stein and Jean Scandlyn. New York, New York, Columbia University, 1988. 84-9.There is a large discrepancy between maternal mortality rates in developed and developing countries, with maternal mortality as a leading cause of death of young women in poor countries. There has been renewed interest in maternal mortality among international agencies and major foundations quite recently. Women and children form up to 2/3 of the population of many developing countries, and over 1/2 of primary health care resources are devoted to maternal and child health programs. Nevertheless, little of this is directed at maternal mortality; most goes to immunization, oral rehydration for diarrhea, monitoring children's growth, and promoting breastfeeding. While some of the international health community attribute the long neglect of maternal mortality to not knowing the extent and severity of the problem before, prior data existed demonstrating the alarmingly high rates. Low maternal mortality in the West may have distracted attention from the international problem. Sexism may have been a major factor, as even today efforts to reduce maternal mortality need to be justified in terms of the implications for the family, children and society as a whole. The reasons for the current concern are not clear, but may relate to an interest in concrete issues after the United Nations Decade for Women, or real surprise in the international community once the problem was pointed out. As various agencies rush to establish maternal mortality programs, it is imperative to evaluate which approaches will be really effective. Critical evaluation of programs is necessary to capitalize on the current interest.
Geneva, Switzerland, WHO, . 16 p.This report discusses the important place of women in health and development as perceived by WHO and as formulated in various World Health Assembly resolutions, particularly those concerned with the UN Decade for Women. Underlying all objectives is that of increasing knowledge and understanding about how the various socioeconomic factors that make up women's status affect and are affected by their health. The aim of WHO's Women, Health and Development (WHD) activities, is the integration or incorporation of a women's dimension within on-oing programs, specifically as part of "Health for All" strategies. Chief among WHD objectives and groups of activities are the improvement of women's health status, increasing resources for women's health, facilitating their health care roles and promoting equality in health development. Overall WHD activities stress the importance of data on women's health status, the dissemination of this and related information, and the promotion of social support for women. The WHD component of ongoing WHO programs focuses mainly on managerial and technical support to national programs of maternal-child health/family planning care. The present report also includes an update on the incorporation of women's issues within WHO's on-going programs in human reproductive research, nutrition, community water supply and sanitation, workers' health, mental health, immunization, diarrheal diseases, research and training in tropical diseases and cancer. Women's participation in health services is discussed mainly within the context of primary health care and is based on their role as health care providers. The results of a multi-national study initiated in 1980 on the topic of women as health care providers should be ready in early 1984 and are expected to contribute a basis for further action.
World Conference of the United Nations Decade for Women: equality, development and peace, Copenhagen, Denmark, July 14-30, 1980.
New York, UN, 1980. 32 p. (A/CONF. 94/9)This report reviews and evaluates efforts at the national level to implement the world Plan of Action for the Implementation of the Implementation of the Objectives of the International Women's Year and is based on replies of 86 governments to questionnaires prepared by the Advancement of Women Branch in the Centre for Social Development and Humanitarian Affairs. It contains an analysis of the progress made and obstacles overcome in the field of health. Using as indicators increases in female life expectancy and declines in maternal and infant mortality rates, improvements have occurred in the health status of women. However, wide disparities are seen between high and low socioeconomic groups, between rural and urban women, and between minority groups and the rest of the population. Lack of financial resources is a major obstacle, compounded by inflation. The excessive physical activity of working rural women not only precludes their participation in health programs but also adversely affects their health. Additional problems are inadequate training and supervision of health administrative personnel, a lack of defined policies, and a lack of coordination between agencies. Social, religious, and cultural attitudes that no longer have validity, lack of political commitment, and an inadequate perception of the long-term health benefits of family planning, rather than its demographic aspects, restrict access to family planning for many groups of women.
In: Jelliffe DB, Jelliffe EF, Sai FT, Senanayake P, eds. Lactation, fertility and the working woman. London, International Planned Parenthood Federation, 1979. 39-44.The International Labor Organization's (ILO) conventions and recommendations that apply exclusively to women are of 2 main types: promotional and protective. The protective standards are concerned with providing them with the special protection they need because of their sociological and social function of maternity. Maternity protection is most important for both working mothers and society as a whole. This is becoming a more significant problem because of the increase in the number and proportion of women. The protection of working women in connection with their role as mothers was dealt with in 2 ILO conventions, the Maternity Protection Conventnion and the Maternity Protection Convention (Revised), and 2 recommendations. The 1919 instrument was ratified by 28 States and the 1952 instrument by 17 States (on January 1, 1977). The ILO policy on maternity protection is that maternity must be recognized as a social function and the protection of this function must be recognized as a basic human right. In relation with maternity, women and men require full and free access to information and facilities concerning family planning and the right to decide on family size and the spacing of births. The 1919 Convention provides that the working woman be allowed time to nurse her child. In a large majority of countries, rules provide for rest periods to allow a mother to feed her child during working hours. A number of legislations stipulate explicitly that the pauses for feeding must be allowed in addition to the normal rest periods. The 1952 Recommendation refers to the establishment of facilities for nursing or day care.
London, International Planned Parenthood Federation, 1979. 163 p.Focus in the proceedings of the joint International Planned Parenthood Federation and the International Union of Nutritional Sciences Conference on lactation, fertility, and the working woman is on the following: 1) perspectives of the International Planned Parenthood Federation (IPPF) and the International Union of Nutritional Sciences (IUNS); 2) lactation and infertility interaction; 3) United Nations appraoches; 4) the social context (breastfeeding and the working woman, breast feeding in decline, and women's liberation and breastfeeding); and 5) case studies for the countries of France, Egypt, Ghana, Scandinavia, Chile, Indonesia, Lebanon, Yugoslavia, Singapore, and Sri Lanka. Breastfeeding supplies nutrition specifically adapted to the human infant's needs, mother/child interaction important to emotional development, and biological birth spacing resulting from maternal hormonal changes brought about by sucking. Over the last 50 years, there has been a marked decline in breastfeeding, originally in industrialized countries. Since the end of World War 2, there has been a decline in breastfeeding in developing nations. Recent scientific research has shown increasing evidence of the unique value of human milk and breastfeeding for infants in industrilized countries and developing areas. As women have become more emancipated, conflicts have arisen between their biological family reproductive role and their role as salaried workers outside the home.
World Health. 1979 Aug-Sep; 6-9.The United Nations General Assembly adopted and proclaimed in their Universal Declaration of Human Rights that everyone has the right to a standard of living adequate for the health and well-being of himself and his family, including food, clothing, housing and medical care and necessary social services. Also, motherhood and childhood are entitled to special care and assistance. Under certain conditions in developing countries food is not available for each child or adult to receive minimum requirements. Women often labor long hours in the field, which, coupled with the responsibility of family raising, leaves them tired and susceptible to disease affecting the entire family. 1975 was offically declared the International Year of the Woman by the United Nations. The objectives were equality of men and women, women's full involvement in societal development, and women's contributions to world peace. Economic development has become the top priority in the last 2 decades, but development cannot be accomplished by unhealthy individuals. The World Plan of Action of 1975 calls for governments to pay special attention to women's special health needs by provideng prenatal, postnatal, and delivery services; gynecological and family planning services during the reproductive years.
WHO CHRONICLE. 1979 Dec; 33(12):435-43.At the WHO/UNICEF meeting on infant and young child feeding which was held in Geneva during October 1979, urgent action was called for to promote the health and nutrition of infants and young children by governments, international agencies, nongovernmental organizations and the infant-food industry. The primary concern of the meeting was with the development of practical measures to improve infant and young child feeding practices. The themes for discussion at the meeting included the following: 1) how to encourage and support breastfeeding; 2) promotion and support of appropriate weaning practices; 3) promotion of information, education and training of health workers concerning breastfeeding; 4) the health and social status of women in relation to infant and young child feeding; 5) appropriate marketing and distribution of breastmilk substitutes; and 6) suggested actions for governments and other groups. A statement which was adopted by consensus is included. It highlights poor infant feeding practices and their consequences as a major problem in the world and as a serious obstacles to development. The full text of the recommendations made is also provided.
New York, UNFPA, June 1979. (Report No. 13) 151 pThis report is intended to serve, and has already to some extent so served, as part of the background material used by the United Nations Fund for Population Activities to evaluate project proposals as they relate to basic country needs for population assistance to Thailand, and in broader terms to define priorities of need in working towards eventual self-reliance in implementing the country's population activities. The function of the study is to determine the extent to which activities in the field of population provide Thailand with the fundamental capacity to deal with major population problems in accordance with its development policies. The assessment of population activities in Thailand involves a 3-fold approach. The main body of the report examines 7 categories of population activities rather broadly in the context of 10 elements considered to reflect effect ve government action. The 7 categories of population activities are: 1) basic data collection; 2) population dynamics; 3) formulation and evaluation of population policies and programs; 4) implementation of policies; 5) family planning programs; 6) communication a and education; and 7) special programs. The 10 elements comprise: 1) decennial census of population, housing, and agriculture; 2) an effective registration system; 3) assessment of the implications of population trends; 4) formulation of a comprehensive national population policy; 5) implementation of action programs integrated with related programs of economic and social development; 6) continued reduction in the population growth rate; 7) effective utilization of the services of private and voluntary organizations in action programs; 8) a central administrative unit to coordinate action programs; 9) evaluation of the national capacity in technical training, research, and production of equipment and supplies; and 10) maintenance of continuing liason and cooperation with other countries and with regional and international organizations.
Presented at the National Conference on Population Management as a Factor in Development including Family Planning, Maseru, Lesotho, April 26-29, 1979. 7 pWomen in many parts of Africa have low status, low literacy levels, feel isolated, and are not recognized for their contributions to national development. If programs can be designed to offer women in developing countries an alternative to motherhood, their status can be raised and the birth rate dropped at the same time. Women should be included in all development planning. Family planning programs should be integrated into other, broader programs. Women should be provided with family planning education, allowed to discuss with and motivate each other, and taught the skills and knowledge to communicate family planning to young people. Family planning programs could be integrated with maternal and child health, nutrition, and literacy programs. The work of women's organizations in these areas is cited. Examples of programs which have successfully integrated family planning into other development areas are cited. The International Planned Parenthood Federation has long been involved in promoting the role of women in family planning development.
Lexington, Massachusetts, Women's International Network News, 1982 Nov. 338 p.This report documents the existence and prevalence in Africa and in other regions of the world of the cultural practice of female circumcision and genital mutilation (FC/GM). This serious problem is examined so that it can be abolished. Until recently the problem was hidden from the public, and most health, government and international agency officials denied that the practices were widespread. In 1979 at a World Health Organization (WHO) seminar on traditional health practices, the problem received international attention. Recommendations made by the seminar participants urged nations to adopt policies to abolish FC/GM, to establish commissions to coordinate activities aimed at abolishing the practices, and to intensify efforts to educate the public and health professionals about the problem. In 1984 it was estimated that 79.97 million women in Africa had FC/GM operations performed at some time during their life. The proportion of women who have had FC/GM operations was almost 100% in Somalia, 90% in Ethiopia, 80% in Sudan, Mali, and Sierra Leone, and 60% in Kenya, Ivory Coast, and Gambia. Information is provided on 1) the extent of the practices, 2) the health problems associated with FC/GM, 3) the 1979 WHO seminar, 4) the history of FC/GM, and 5) the cultural beliefs supporting the practices. Case histories provide detailed information on the practices in 11 African countries, 4 countries on the Arab Pennisula, and 2 Asian countries, including Sudan, Somalia, Egypt, Ethiopia, Kenya, Nigeria, Mali, Upper Volta, Senegal, Ivory Coast, Sierra Leone, People's Democratic Republic of Yemen, Oman, United Arab Emirates, Bahrain, Indonesia, and Malaysia. The existence of FC/GM practices in many other countries, including Western nations, is also documented. These practices are also discussed in reference to the depressed status of women in many African countries, and the role of women in these countries is examined in regard to legal matters, education, employment, agriculture, family planning, development, and urbanization. Political factors hindering the abolition of the practices and the hesitancy of international agencies such as WHO, US Agency for International Development, and the UN Children's Fund, to deal with the problem are discussed. There is some evidence that FC/GM operations are being conducted in hospitals in a number of African countries, and efforts must be made to prohibit the introduction of these practices into the modern health care system. Suggestions are provided for action and education programs aimed at abolishing FC/GM practices. An annotated bibliograpy, containing 78 references, is also provided.