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  1. 1

    Staff appraisal report: Bangladesh, Fourth Population and Health Project.

    World Bank. Population and Human Resources Division

    [Unpublished] 1991 May 20. [4], ix, 145, [2] p. (Report No. 9400-BD)

    This staff appraisal report was based on the findings of a mission visiting Bangladesh in November 1990, representatives from a number of developed countries and international organizations. An overview was provided of past development activities in health and family planning, followed by a detailed description of the Fourth National Population and Health Program (1992-96): objectives, activities, environmental considerations, costs and financing, and implementation. The benefits of the plan were identified as improved welfare of women and children through greater spacing of births and improved health status. Family planning and health services were expected to be enhanced by integration of services, reorientation of medicine to community services, and improvement in quality of services. The main risk identified was the inability to fully implement the extensive reform in the health subsector and the potential weakness of management of the health subsector. The plan incorporated features to address the risks. Agreements were reached that the Bangladesh government would hire at least 4500 qualified women as health assistants by March 31, 1992, provide transportation for family planning and health workers to attend satellite clinics, and implement the following surveys: a fertility survey in 1994, a contraceptive prevalence survey by March 31, 1993, a facilities utilization survey by September 30, 1992, a feasibility study of storage requirements for family planning and health supplies by December 31, 1992, a comprehensive baseline survey of maternal and neonatal health care in the districts of Kushtia, Tangail, Feni, and Sirajganj/Pabna. 25 other recommendations were listed. The reason for low levels of human resource development has been inadequate past and present expenditures. In order to increase the contraceptive prevalence rate government and donors must expand programs for primary health care, family planning, and primary education as quickly as possible. Long-term sustainability will depend on government and donor resources, the role of nongovernmental organizations, and cost-sharing arrangements. The failures of the past have been in the government's concern with short-term political concerns rather than long-term development. Remediation will involve sector self-reliance and not individual project initiatives.
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  2. 2

    Strengthening nutrition through primary health care: the experience of JNSP in Myanmar.

    World Health Organization [WHO]. Regional Office for South-East Asia [SEARO]

    New Delhi, India, WHO, SEARO, 1991 Dec. [3], 35 p. (Regional Health Paper, SEARO, No. 20)

    The Joint WHO/UNICEF Nutrition Support Programme (JNSP) began operations in Myanmar in 1984 and expanded nationwide in three phases. A detailed situation analysis of nutrition conditions and nutrition programs in primary health care (PHC) were conducted prior to JNSP activities. They served as the rationale for the decision to implement JNSP activities nationally. These activities are almost entirely administered through the Ministry of Health. JNSP redesigned nutrition training for village workers, their supervisors, and district health personnel. It has strengthened nutrition units at the central and regional levels. All JNSP-technical activities revolve around nutrition monitoring and counseling. JNSP participated in the establishment and operations of a food and nutrition surveillance system. It facilitated implementation of the nutrition and nutrition-related aspects of the People's Health Plan. The JNSP was evaluated in 1989. During the JNSP period, mortality among children less than 3 years old fell. 3-year-old children grew at a faster rate than prior to JNSP. Improvements were also noted in young child feeding practices, health seeking behavior of mothers, counseling by voluntary workers, and health staff performance. The evaluators concluded that JNSP directly benefitted the health and nutrition of children less than 3 years old. External costs of JNSP added up to US$5.63 million. The government put in another US$5.43 million. The communities contributed US$2.9 million. JNSP covers 30% of the total population. Per capita annual costs were US$1.67. These low per capita costs suggest that JNSP is sustainable and replicable. JNSP's further expansion depends on expansion of the health delivery system. All levels regularly provide support and supervision. Planned evaluation and feedback is the norm.
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  3. 3

    NGO's Role and Involvement in the Prevention and Control of AIDS, New Delhi. Report of a regional workshop, 30 October - 1 November 1990.

    World Health Organization [WHO]. South-East Asia Region

    [Unpublished] 1991 Feb 19. [2], 19 p. (SEA/AIDS/22; WHO Project: ICP GPA 511)

    This regional workshop aimed to exchange information, inform nongovernmental organizations (NGOs) on the epidemiology and control of AIDS, share the experience of NGOs, identify improvements in the involvement of NGOs in AIDS control programs, and understand the impact of discriminatory measures. Topics for discussion were the global and the southeast Asian regional AIDS/HIV situation and control, the role of NGOs in control, the legal, ethical, and human rights issues in AIDS prevention and control, and the involvement of NGOs in prevention and control of AIDS. participants represented Bhutan, India, Indonesia, Maldives, Mongolia, Myanmar, Nepal, Sri Lanka, Thailand, India, and the WHO secretariat. NGOs provide information, education, policy advocacy, training, counseling, and assistance to those affected by HIV/AIDS. The methods used were culturally-sensitive mass media; a positive, holistic, and flexible approach; promotion of self esteem and confidence in target groups; target group representation; maintenance of direct contact and education for specific groups; policy advocacy; research and monitoring functions; peer group formation support; public awareness creation; and provision of medical services. Recommendations were made to NGOs to collaborate with one another and with governments, to help strengthen international and national cooperation for AIDS prevention and control, to monitor media information for reliability and uniformity and contextual relevance and lobby for necessary changes, and to set an example of human and compassionate treatment and respect the rights of AIDS/HIV and marginalized groups to medical and social services and treatment, education, employment, housing, social life, freedom of movement, freedom of choice on blood testing, and freedom from discrimination. NGOs involved need to mobilize other NGOs in AIDS prevention. Governments should include NGOs on national AIDS committees, particularly those which are community-oriented, and not politically affiliated and those which work with women and marginalized groups. Governments need to update curricula and provide family life education including education on AIDS for formal and informal groups and government officials. Governments should also set an example of responsible behavior which respects the human rights of people with AIDS, fund NGOs to train trainers, and use mass media. WHO should be more sensitive to the needs of NGOs and work to keep NGOs in the information loop of international and national governments.
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  4. 4

    Strengthening maternal and child health programmes through primary health care. Guidelines for countries of the Eastern Mediterranean Region. Based on the deliberations of the Intercountry Meeting on the Integration of MCH into Primary Health Care, Amman, Jordan, 11-15 December 1988.

    World Health Organization [WHO]. Regional Office for the Eastern Mediterranean [EMRO]

    Alexandria, Egypt, WHO, EMRO, 1991. 75 p. (WHO EMRO Technical Publication No. 18)

    All countries in the WHO Eastern Mediterranean Region (EMRO) have had maternal and child health (MCH) programs for many years, yet maternal mortality and morbidity and infant mortality remain high. The EMRO office in Jordan, recognizing this dilemma, convened a meeting of national managers from the 22 EMRO member states to discuss how to integrate MCH programs with primary health care (PHC). The meeting resulted in the publication of guidelines and goals to help each country integrate MCH into PHC which would strengthen MCH services and improve MCH status. The managers noted the need to switch from a pregnancy-oriented approach to a holistic approach in which MCH/PHC programs and society consider women as more than childbearers. MCH/PHC programs and society need to be concerned about the well-being of females beginning with infancy and should place considerable health promotion for girls during the pubertal spurt and adolescence. They should also promote prevention of iron deficiency anemia in women. Since maternal mortality is especially high is EMRO, the national managers clearly laid out approaches for health services to reduce maternal mortality caused by obstetrical complications. They also recognized the need for a practical alternative to obstetric care provided by health workers--training traditional birth attendants in each village. They also provided guidance on improving prenatal care to reduce perinatal and neonatal mortality such as vaccination of every pregnant woman with the tetanus toxoid. Since the causes of death in the postneonatal period, MCH/PHC programs need to take action to reduce malnutrition and infection. For example, they must promote breast feeding for at least the first 6 months of life. The managers suggested the implementation of the Child Survival and Development Strategy which includes growth monitoring.
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  5. 5

    Diarrhoeal Diseases Household Case Management Survey, Dhaka Division, October 1990.

    Bangladesh. Directorate General of Health Services. Control of Diarrhoeal Diseases; World Health Organization [WHO]. Dhaka Office

    [Unpublished] 1991 Apr 24. [2], 28 p. (SEA/DD/43; Project: ICP CDD 001)

    Physicians collected data on 4319 households and 3766 0-5 year old children living in rural areas of Dhaka Division in Bangladesh to determine the prevalence of diarrhea among the children, the percentage of diarrhea cases treated with various forms of oral rehydration therapy and with drugs, and caretaker awareness of when to refer children with diarrhea to a health facility. 60.3% received no treatment at all. The 24-hour point prevalence of diarrhea stood at 5.2%. Blood accompanied the diarrhea of 22.3% of these children. Yet only 12% of bloody diarrhea cases received appropriate antibiotic therapy. 13.4% of the children had experienced a diarrheal episode during the 2 weeks before the interview. Mean duration was 7 days, but 22.4% of the children had diarrhea for at least 14 days. The adjusted annual diarrhea incidence rate was 2.3 episodes/child. 33.7% of caretakers asked others for help in treating diarrhea. The advisers tended to be village doctors or quacks (21%), government health workers (17%), and homeopaths (17%). 75% of advisors, except family and friends, suggested drugs. Only 27% and 16% recommended administering oral rehydration solution (ORS) and various home fluids, respectively. Only 22% and 17% suggested caretakers to continue feeding and breast feeding, respectively. The ORS use rate during the previous 24 hours was only 11.9% and just 3.6% of cases drank properly prepared ORS. Yet 93.8% knew about ORS. Most caretakers did not use enough water or all the contents of the ORS packet. Use rate for home fluids was 16.5%. 97.5% of lactating mothers continued to breast feed during the diarrhea episode. 36.1% of children received drugs compared with 25.8% for use of oral rehydration therapy. 70.7% of caretakers gave ill children at least the same amount of solid or semisolid foods during the episode. 70% of caretakers preferred ORS to drugs. The leading reasons for referring cases to a health facility included too many stools (79.7%), failure to improve (28.3%), and fever (26.7%). The researchers deemed only 23.5% to have adequate referral knowledge (=or> 3 reasons).
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  6. 6

    Review and evaluation of national action taken to give effect to the International Code of Marketing of Breast-Milk Substitutes: report of a technical meeting, The Hague, 30 September - 3 October 1991.

    World Health Organization [WHO]. Division of Family Health. Programme of Maternal and Child Health and Family Planning

    [Unpublished] 1991. 24 p. (WHO/MCH/NUT/91.2)

    The report of the national actions in marketing breast-milk substitutes includes a review and evaluation summarized in the accompanying annex and the results of a meeting. Participants found the evaluation helpful, that progress had been made, and that the International Code of Marketing of Breast-milk Substitutes must be viewed in a broad context. Lessons learned and recommendations are given for the development and implementation of national measures, as well as the training and education in the health sector, the information to the general public and mothers, monitoring and enforcement, and manufacturers and distributors of products within the scope of the Code. Successful implementation depends on a clear international perspective, on all concerned parties' involvement in development and monitoring, and a continuing commitment to a complex process. Difficulties encountered were lack of 1) political commitment, 2) integration of sectors, and 3) recognition that the Code applied to all counties; there were also questions about the scope of products included in the Code. There is no limit to age group. Partial adoption is not sufficient and has a negative impact. The Code was being ignored in countries moving toward a market economy. Health professionals were unaware of new developments in infant feeding practices. The Code assumes a compatible relationship between manufacturers and health personnel, which is not the case. Manufacturers used mass media and formal and informal educational sectors to disseminate information about their products with the approval of authorities who considered the use consistent with the Code. The expanding international telecommunications systems have proved to be a crippling challenge to some countries without the tools to know how to regulate programming. The feeding bottle is an inappropriate child care symbol for breast feeding, which is frequently found in public places. Monitoring has been uneven. Enforcement is hampered by an absence of, inadequacy in, and inability to apply sanctions. Joint health and industry provisions are weaker than the Code, and marketing strategies do not conform to the Code. Manufacturers apply the Code differently in developed and developing countries. Not enough attention has been paid to feeding or pacifier products. Retail stores sell infant formula next to other infant food products which is misleading.
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  7. 7

    Strengthening of management of maternal and child health and family planning programmes. Report of an intercountry workshop, New Delhi, 27-31 August 1990.

    World Health Organization [WHO]. South-East Asia Region

    [Unpublished] 1991 Feb 14. [2], 20 p. (SEA/MCH/FP/99; Project No. ICP MCH 011)

    >20 participants from UNFPA/UNICEF/USAID and 23 participants from 10 countries from the WHO Southeast Asia Region attended the Workshop on Strengthening of Management of Maternal and Child Health (MCH) and Family Planning (FP) Programmes in New Delhi, India in August 1990. The workshop consisted of presentations and discussions of country reports, technical papers, dynamic work groups, and plenary consensus. The WHO/SEARO technical officer for family health presented a thorough overview on strengthening MCH/FP services in a primary health care setting. Issues addressed included regional status on population growth, urban migration and development. MCH status, management of MCH/FP services, strategic planning, and management information. In Bangladesh, the government integrated MCH services with FP services, but other child programs including immunization, control of diarrheal disease program, nutrition, acute respiratory infection remained with the health division. Obstacles of the MCH/FP program in the Maldives were shortage of trained human resources, preference of health providers to work in urban areas, inadequate logistics, and insufficient supervision in peripheral health centers. A nomadic way of life among the rural peoples posed special problems for the delivery of MCH services in Mongolia where large family size was encouraged. Other country reports included Bhutan, India, Myanmar, Nepal, and Sri Lanka. A case study of the model mother program in Thailand and the local area monitoring technique in Indonesia were shared with participants. District team work groups identified key MCH/FP management problems including organization, planning, and management; finance and resource allocation; intersectoral action; community participation; and human resource development. The workshop revealed the national health leaders with hopes for WHO technical assistance were developing a rapid evaluation methodology.
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  8. 8

    Household survey of diarrhoea case management. Enquete dan les menages sur la prise en charge des cas de diarrhee.

    World Health Organization [WHO]. Diarrhoeal Disease Control Programme

    Weekly Epidemiological Record / Releve Epidemiologique Hebdomadaire. 1991 Sep 13; 66(37):273-6.

    The Diarrheal Disease Control (CDD) Program in Nepal conducted surveys in the Midhills and Terai regions of Nepal (9033 <5-year-old children) to determine the extent of diarrhea and knowledge and practices related to diarrhea case management and to evaluate the effectiveness of its activities. 11.7% of the children in Midhills and 7.4% of those in Terai had had diarrhea within 24 hours before the survey. Incidence rates stood at 3.5 and 3.1 episodes/child/year, respectively. 99% of all mothers who were breastfeeding continued to breast feed during the episode. 75% of mothers in Terai an 61% in Midhills also gave at least the same amount of food during the episode as they did before the episode. But only 28% in Terai and 9% in Midhills increased fluid amounts during diarrhea. Even though almost 66% of the mothers knew about oral rehydration solution (ORS), only 8% of cases in Terai who had had diarrhea in the preceding 24 hours and 10% of those in Midhills received ORS or sugar salt solution (SSS). Moreover, only 1.5% received properly prepared ORS. 6.3% of cases in Terai and 4.2% of cases in Midhills received SSS, but only 7 mothers prepared it correctly. The leading reason for improper mixing was addition of too little water. The mean amount of ORs and SSS given during the preceding 24 hours was 362 and 253 ml in Terai and 453 an 424 ml in Midhills, respectively. >51% of all mothers received ORS packets from a government physician or health worker. 21.8% of cases were treated with antidiarrheals some of which were provided by physicians and health workers. Only 19.6% of mothers in Terai and 25% in Midlands knew at least 3 correct reasons to take their child to a health worker. The CDD program should increase access to ORS, train mothers in its correct use, and promote an appropriate homemade SSS. It should also step up training of health workers concerning diarrhea case management.
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  9. 9

    Annual report 90/91.

    Family Planning Association of Sri Lanka

    Colombo, Sri Lanka, Family Planning Association of Sri Lanka, 1991. [4], 54, [1] p.

    This report describes the accomplishment of the Family Planning Association of Sri Lanka (FPASL) during the 1990-91 year. The report opens with a section describing 1990 highlights, a year that witnessed great strides in clinical, contraceptive retail marketing, rural motivational, and AIDS education activities. In June, FPASL hosted the Regional Council Meeting of the South Asia Region, a meeting attended by IPPF Secretary Dr. Halfdan Mahler, who praised the efforts of the association. Designed to coincide with the regional meeting, FPASL organized a national seminar on "Family Planning Research and the Emerging Issues for the Nineties." IPPF invited FPASL to be one of the 6 countries do develop a new strategic plan for the 1990s. Other FPASL highlights included: increased AIDS education, Norplant promotion campaigns, and the establishment of a counselling center for young people. Following the highlight section, the report provides an overall program commentary. The report then examines the following components of FPASL: 1) the Community Managed Integrated Family Health Project (CMIRFH), which is the associations' major family planning information, education, and communication (IEC) program; 2) the Nucleus Training Unit, established in 1989, whose primary emphasis is to organize and conduct AIDS education programs; 3) the Youth Committee, whose activities include populations and AIDS education; 4) the Clinical Program, whose attendance increased by 15% (this section describes the types of services provided); and 5) the Contraceptive Retail Sales Program. While condom sales increased by 5%, the sales of oral contraceptives and foam tablets decreased -- a declined explained by the turbulent situation of the country.
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  10. 10

    Dramatic spread of AIDS virus in Africa and Asia.

    Steinbrook R

    Weekly Mail. 1991 Jun 21-27; [1] p..

    Dr. James Chin, the head of surveillance and forecasting for the WHO Global Program on AIDS, presented the statistics on the global spread of HIV infections. It is reported that by mid-1990s, 3 million HIV infections are projected for Asia. In Africa, the number of HIV individuals was projected to increase from 6 million to 10 million over the next years, leading to increases in mortality and decreases in life expectancy. Furthermore, in the US and all other western nations combined, it was estimated that fewer than 2 million people are infected with the AIDS virus. A key reason for the lower rate is that AIDS education and prevention programs in industrialized nations are far more extensive, and therefore more effective, in triggering behavior changes to minimize the risk of infection. In addition, reported intensive educational programs in Thailand and Zaire have significantly lowered the number of new HIV infections.
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  11. 11

    Bangladesh: the Chandpur irrigation project.

    Tuttle LW; Anderson MB

    In: Gender analysis in development planning: a case book, edited by Aruna Rao, Mary B. Anderson, Catherine A. Overholt. West Hartford, Connecticut, Kumarian Press, 1991. 23-31, 101-2. (Kumarian Press Library of Management for Development)

    This monograph chapter describes the Chandpur Irrigation Project (CIP), which benefits a population of about 700,000 along the east bank of the Meghna River. A circular embankment was constructed to create arable land for agriculture. Pump houses regulate flows of the Dakatia River for irrigation and flood control and drainage into the Meghna River. CIP was begun in 1963 and completed in 1977. CIP aims to improve agricultural production, agricultural employment, and living conditions. A Bangladesh Water Development Board is in charge of operations. Villagers are organized into irrigation groups to facilitate water distribution, operation of pumps, and collection of user fees. CIP allows farmers to grow rice during the summer and winter. Farmers grow two summer rice crops of high yielding varieties. Vegetable gardens were shifted after the irrigation project to home gardens or to outside the irrigation areas. Winter crops include a high yielding variety of rice, vegetables, wheat, spices, pulses, and oil seeds. Households include landless tenants and small, mid-size, and large landowners. All families invest in their children's education. Male labor is in high demand during transplanting, weeding, and harvesting. Female labor is in high demand post-harvest. Male farmers receive 25 takas per day, while females earn 1 kg of rice per day. Diet varies with the wealth of the household; all families had higher food intake after CIP. CIP increased crop yields. Employment of family labor increased by 25% after CIP. Income increased for all types of families. Patterns of food distribution within families did not change.
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  12. 12

    Norplant levonorgestrel implants: expansion to ten new countries.

    United Nations Population Fund [UNFPA]

    [Unpublished] [1991]. 26, [2] p.

    In 1991 Norplant was used in 46 countries by more than 1 million women. In 20 countries regulatory approvals for Norplant had been received, including by the US Food and Drug Administration in December, 1990. In 1988 the United Nations Population Fund provided a grant to the Population Council (PC) to expand Norplant to 10 new countries. A Starter Pack of materials was prepared for countries wishing to introduce Norplant. In October 1990 a PC staff associate and a consultant visited Burkina Faso, Mali, and Togo to discuss Norplant preintroduction trials. In both Mali and Togo presentations were made. In May 1991 the regional medical associate received a request to conduct a seminar on Norplant in Burundi. Three physicians were trained in Chile and the PC regional medical associate visited Chile in October 1990 to supervise the first training program. In Bolivia a trial started at the Hospital Obrero No. 1 and services began in September 1990. A project also aimed to compare the acceptability of Norplant with other methods. In Jamaica a study was undertaken to assess the acceptability of Norplant and to plan for its use at 3 clinics, and 5 physicians were trained in its use with 300 women enrolled. Southeastern Asian regional activities in 1990 involved a project training paramedical personnel on Norplant counseling. Three nurse/midwives from each of about 100 hospitals attended a 2-day training session. Nine trained teaching personnel implemented 15 sessions covering 292 nurses and midwives; and 14 visits to provinces for evaluation. India's introduction of Norplant may not be completed in time because of caseload requirements. A preintroduction trial was finalized in April 1991 in Vietnam with about 400 acceptors for 2 years. West Asia and North Africa regional activities concerned consultation in Algeria and plans to introduce Norplant at 2 sites in Rabat, Morocco.
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  13. 13

    Analysis of a development programme.

    Mehta M

    In: Changing perceptions: writings on gender and development, edited by Tina Wallace with Candida March. Oxford, England, Oxfam, 1991. 141-8.

    In this essay in a book of writings on gender and development, the author relates her experience as the first Woman Project Officer hired by the Oxfam West India office in 1984. The previously all-male staff decided to hire a woman with development experience to tackle gender issues and to attempt to involve women in development programs, especially in decision-making processes. The strategy used was to create structures which would enable women to form groups and, eventually, to define their own development activity priorities and needs. This strategy failed, largely because it was not relevant to the position of the women in their society. It became apparent, however, that women's development must be integrated in all aspects of Oxfam's work at the organizational, office, and program levels. In 1985, therefore, a group of women project officers formed a group called Action for Gender Relations Asia (AGRA) to work toward this goal. AGRA first concentrated on the organization of Oxfam and its staff but found its abilities limited by the fact that it was comprised solely of Oxfam staff. Studies of the impacts of various projects on women have been undertaken to develop awareness of appropriate strategies. The shift in strategy required that, instead of forming separate women's groups, women be incorporated in development efforts. These attempts were blocked by patriarchal male leaders. Thus, women were appointed as organizers of women's development. Since many of these women were inexperienced, the patriarchal set-up was reinforced. Also, whereas most of the development programs had economic goals, the work with the women emphasized conscientization and organization, which was difficult for some group leaders and staff members to accept. These attempts are part of a process of change that is constantly evolving. It is hoped that what was learned from them will contribute to an understanding of gender issues.
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  14. 14

    Psychosexual aspects of natural family planning as revealed in the World Health Organization multicenter trial of the ovulation method and the New Zealand Continuation Study.

    France MM

    In: Natural family planning: current knowledge and new strategies for the 1990s. Proceedings of a conference, Part II, Georgetown University, Washington, DC, December 10-14, 1990, edited by John T. Queenan, Victoria H. Jennings, Jeffrey M. Spieler, Helena von Hertzen. Washington, D.C., Georgetown University, Institute for International Studies in Natural Family Planning, [1991]. 118-20.

    Successful natural family planning (NFP) use depends upon the day-to-day sexual decision making of users. Given the important role of psychosexual factors in this decision making, they are an important influence in both the effectiveness of natural methods as well as in their acceptability as a means of family planning. The World Health Organization (WHO) Multicenter Study of the ovulation method was conducted in Auckland, New Zealand; Bangalore, India; Dublin, Ireland; Manila, the Philippines; and San Miguel, El Salvador with the secondary objective of obtaining psychosexual information to identify factors leading to the successful use of NFP. Findings were reported in 1987. This paper reviews some of the WHO findings and compares them with some preliminary findings of the current study in New Zealand on continuation rates of NFP users following the symptothermal method with the goal of determining rates of continuation and reasons for acceptability. The WHO study found that the more satisfied people were with NFP and the less difficulty they reported with abstinence, the more likely they were to be successful users, as measured by their avoidance of pregnancy. The New Zealand Study, however, indicates that for many couples abstinence may not be the main difficulty in using NFP, and that long-term acceptance is not necessarily influenced by pregnancy. The authors notes that the two studies involved different NFP methods. The challenge for the future of NFP services is to learn more about what leads to acceptability in different countries and cultures, remembering that for a natural method of family planning, success depends very much upon the decisions, attitudes, and resulting behavior of the couple involved.
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  15. 15

    An overview of AIDS interventions in high-risk groups: commercial sex workers and their clients.

    Lamptey P

    In: AIDS and women's reproductive health, edited by Lincoln C. Chen, Jaime Sepulveda Amor, and Sheldon J. Segal. New York, New York, Plenum Press, 1991. 151-63.

    Persons at high risk of sexually acquiring HIV are divided into 2 groups: 1) the primary risk group (prostitutes and their clients, homosexual and bisexual men with multiple partners, and sexually active IV drug users or IVDUs), and 2) the secondary risk group (spouses or boyfriends of female prostitutes, sexual partners of clients of prostitutes, and sexual partners of IVDUs). In the epidemiology of AIDS in high-risk groups, risk factors are genital ulcers caused by chancroid, syphilis, and herpes; lack of circumcision in males; and the presence of other STDs. The US Bureau of Census has compiled an HIV/AIDS surveillance database with over 4300 data entries for Africa. Rates of 50-90% are common among prostitutes in the urban centers of Tanzania, Uganda, Malawi, Rwanda, and Kenya. Thailand has a commercial sex worker population of over 100,000, and HIV prevalence rates of 30% have been reported among some groups. Similar rates have also been found in India. In Haiti and the Caribbean, HIV rates among prostitutes range from 0% to 60%. Strategies for targeted intervention aim at preventing high-risk group from becoming infected; and preventing infected primary risk groups from spreading the infection to secondary groups. To date Family Health International (FHI) has developed over 40 interventions for prostitutes and their partners in 21 countries in Africa, Asia, Latin America, and the Caribbean. The intervention strategies should contain behavior research (to investigate the subculture of prostitution and their clients to induce them to use condoms); AIDS education to modify high-risk behaviors in order to reduce transmission of HIV; STD treatment, control, and prevention at health clinics; condom distribution to target groups; program monitoring and evaluation; and capacity building by training staff to ensure sustainability. Case studies of targeted intervention programs for prostitutes and clients in Zaire, the Philippines, Zimbabwe, and Nigeria are detailed.
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  16. 16

    Safe motherhood: priorities and next steps. Forward-looking assessment on the reduction of maternal mortality and morbidity within the framework of the Safe Motherhood Initiative: (SMI).

    Law M; Maine D; Feuerstein MT

    [New York, New York], United Nations Development Programme [UNDP], 1991 Apr. [3], viii, 40, [31] p.

    Women in Development is one of six key policy areas for the UN Development Program's (UNDP) next programming cycle. UNDP acknowledges the hazards of pregnancy and childbirth that rob society of women society at the height of their productivity. It has supported the Safe Motherhood Initiative (SMI) from its inception to reduce maternal mortality and morbidity in developing countries. UNDP reviewed its contributions at the global, regional, and national levels within the framework of SMI to determine its contributions during the 1990s. A three-person, multidisciplinary team conducted a forward-looking assessment which included interviews with 200 persons in UN and bilateral donor agencies and nongovernmental organizations, a survey of UNDP staff in developing countries, and visits to Senegal and Indonesia. The team assessed progress that has been made in policies, programs, resources, coordination, research, technical cooperation, and information. UNDP support helped initiate SMI. Its support of SMI conferences has increased awareness and political commitment. UNDP contributes funds to WHO's Safe Motherhood Operations Research Programme. Some of its SMI projects will likely achieve significant improvements in maternal health. UNDP support in Senegal and Indonesia allowed the first national needs assessments and action plans in the SMI. The team found that funding of needs assessments and action plans is constructive. It agreed with UNDP's policy of pooling its support with that of other donors. It found the present organization and structure through which UNDP funds are implemented to be appropriate. It recommended that UNDP continue to contribute to SMI. It suggested that UNDP take the lead role in establishing the International Partnership to Prevent Maternal Deaths and Disability as a mechanism to take the SMI into its next phase of translating the increased concern and technical know-how into increased safe motherhood activity at the country level.
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  17. 17

    Review of further developments in fields with which the Sub-Commission has been concerned. Study on traditional practices affecting the health of women and children. Final report.

    Warzazi HE

    [Unpublished] 1991 Jul 5. [2], 39 p. (E/CN.4/Sub.2/1991/6)

    In late 1990, representatives of the Sub-Commission on Prevention of Discrimination and Protection of Minorities of the UN Economic and Social Council's Commission on Human Rights went to Djibouti and the Sudan to explore steps the governments and women's groups are taking to eliminate traditional practices adversely affecting women and children, especially female circumcision. The missions allowed the consultants to examine the problem with women and groups directly affected by the practices and within their cultural contexts. In 1991, the Centre for Human Rights and the Government of Burkina Faso organized the first regional Seminar on Traditional Practices Affecting the Health of Women and Children which considered the effects of female genital mutilation, son preferences, and traditional delivery practices, and facilitated the exchange of information on these practices to fight and eliminate them. The UN reviewed reports from governments, nongovernmental organizations, and UN agencies on these traditional practices. All these activities led the UN to make various observations and recommendations. The degree of public awareness about the harmful effects of female circumcision, nutritional taboos, and delivery practices have improved significantly. Governments and organizations have neither studied nor dealt with son preference and its effects adequately. More African governments were willing to address the problems of traditional practices, e.g., legislation against these practices. The Centre for Human Rights, WHO, UNICEF, and UNESCO should work together more closely to effectively take action on traditional practices. The Centre needs a full time professional staff to gather information, write reports, organize seminars, distribute documents, and network with appropriate organizations. The Sub-Commission should continue to have traditional practices on the agenda to keep it in the fore. No less than two more regional seminars on the issue should take place in Africa to discuss it and increase public awareness.
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  18. 18

    Women's savings groups and contraceptive use under Save Program: final report.

    Barkat-e-Khuda; Hadi A; Barkat A

    Bethesda, Maryland, University Research Corporation, 1991 Apr. ix, 77, [20] p. (BAN-14; USAID Contract No. DPE-3030-C-00-5043-00; TvT No. BAN-SAS-04-10)

    Save the Children has a women's savings program (SAVE), which is an integral part of its comprehensive integrated rural development program. Women's savings groups were introduced in Bangladesh on an experimental basis in 1982. Over the years, these indigenous small groups have evolved from simple "savings" groups to dynamic forums to improve women's economic and social horizons and enable them to gain greater control over their lives and those of their children. An operations research study was undertaken, at a cost of US $35,874, to examine and document the impact of womens' savings groups on contraceptive use. The study was undertaken in 8 villages in Nasirnagar Upazila where SAVE programs were in operation: 5 villages where programs were initiated in 1982 (old villages) and 3 villages (new villages) where programs were begun in 1989. 2 comparison villages (without SAVE programs) were also selected at random from among the villages in the same geographic area. The experimental and comparison villages were similar in terms of household size, age, parity, and total fertility of the married women of reproductive age. The study employed a quasi-experimental design. Data were collected using a baseline survey and a mini-contraceptive prevalence survey conducted in both experimental and comparison villages as well as 2 rounds of individual and group interviews with selected savings group members and nonmembers in the experimental villages. Relevant cost data were obtained from SAVE/Dhaka. Selected variables from the SAVE project management information systems (PMIS) were also used for comparison with similar variables obtained in the baseline survey. Womens' savings groups, combined with family planning (FP) motivation, supplies, and services can be an effective strategy of raising contraceptive prevalence in rural Bangladesh. Contraceptive use, both ever and current, was higher in the experimental than in comparison villages and was higher in the old than in the new villages. Contraceptive use was higher among savings group members than among nonmembers, and contraceptive use was higher among the latter group than in the comparison villages, suggesting that the SAVE program helped raise contraceptive use among both members and nonmembers in the project villages. Current use at the baseline among members was 30.9 and 16.9% among members in old and new villages, respectively, and 7.3% in the comparison villages. Among nonmembers, current use was 17.9% in the old villages and 12.9% in the new villages. Current contraceptive use declined from 30.9 to 25.4% in the old villages over the life of the project. One of the main reasons reported for discontinuation was nonavailability of FP methods.
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  19. 19

    Interview: Mr. Tevia Abrams, UNFPA Country Director for India.

    ASIA-PACIFIC POPIN BULLETIN. 1991 Dec; 3(4):10-2.

    The government of India set up a population program 25 years ago, yet the population is expected to surpass that of China in the near future. The current UN Population Fund (UNFPA) program for India covers the period 1991-95 with coordination, implementation, and evaluation. Improved services focus on states with high fertility and mortality, high infant mortality, self-reliance in contraceptive production, models for maternal health care and traditional health care, national communication strategy, public awareness enhancement, and raising women's status by female literacy expansion and employment generation. UNFPA trains, provides equipment and contraceptives, and nongovernmental organization participation. The bulk of the $90 million cost of the program will come from UNFPA: maternal-child health, family planning (FP), and information, education, and communication (IEC) will receive the most funding. Ethnic and tribal areas will get attention under a decentralized scheme in accordance with the concept of a multicultural society where early age at marriage and high economic value of children are realities. The Ministry is responsible for IEC and FP targets and allocation of funds. Government institutes and universities carry out population research. The creation of India POPIN patterned after the Asia-Pacific Population Information Network is under development under IEC activities. The status of women is varied throughout India, in the state of Kerala literacy reaches 100%, and the birth rate of 19.8%/1000 women is below the national average of 30.5. In contrast, the states of Bihar and Rajasthan with female literacy of 23% and 21%, respectively, have birth rates of 34.4% and 33.9%.
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  20. 20
    Peer Reviewed

    India: HIV banks.

    Kandela P

    Lancet. 1991 Aug 17; 338(8764):436-7.

    The professional blood donor organizations in Bombay, India, face difficulties, since many donors have become infected with the human immunodeficiency virus (HIV). Professional donors meet more than half of the demand from hospitals for blood. More than 5 million liters of blood are bought every year at an annual cost of more than 29 million pounds. The government suspended the manufacture of blood products, and a blood screening program was launched, yet up to 95% of donated blood is unsafe. In a WHo study, it was disclosed that 80% of Bombay's blood sellers are infected with HIV, and 1/3 of them show signs of AIDS or AIDS-related complex. India is expected to have 250,000 HIV carriers and at least 60,000 cases of AIDS by 1995. Medical organizations like the Indian Health Organization (IHO) and the WHO are educating blood donors and prostitutes about AIDs and are promoting safe sex. An IHO team consisting of a doctor, social worker, and health educator regularly visits the district of Bombay where 200,000 prostitutes ply their trade. Team members distribute literature, organize slide shows, and hand out free condoms to prostitutes and their clients.
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  21. 21

    Covenant on Economic, Social, Cultural Rights. [Additional parties and location].

    United Nations

    In: Multilateral treaties, index and current status, 8th cumulative suppl., compiled by M.J. Bowman and D.J. Harris. Nottingham, England, University of Nottingham Treaty Centre, 1991. 158.

    Since 1983, the International Covenant on Economic, Social, and Cultural Rights has been ratified by the following countries: Algeria, 12 September 1989; Argentina, 8 August 1986; Burundi, 9 May 1990; Cameroon, 27 June 1984; the Congo, 5 October 1983; Equatorial Guinea, 25 September 1987; Ireland, 8 December 1989; the Republic of Korea, 10 April 1990; Luxembourg, 18 August 1983; Niger, 7 March 1986; the Philippines, 23 October 1986; San Marino, 18 October 1985; Somalia, 24 January 1990; Sudan, 18 March 1986; Togo, 24 May 1984; Democratic Yemen, 9 February 1987; and Zambia, 10 April 1984. Provisions of the covenant guarantee equal rights for men and women, pay equity, maternity benefits, social protection for children and the family, and the rights to housing, education, and health care, among other things.
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  22. 22

    Convention on the Rights of the Child. [Summary].

    United Nations

    In: Multilateral treaties, index and current status, 8th cumulative suppl., compiled by M.J. Bowman and D.J. Harris. Nottingham, England, University of Nottingham Treaty Centre, 1991. 81-2.

    The Convention on the Rights of the Child was ratified by Belize on 2 May 1990, Ecuador on 23 March 1990, Ghana on 5 February 1990, Guatemala on 6 June 1990, Sierra Leone on 18 June 1990, and Viet Nam on 28 February 1990. The text of the convention is reproduced in the Annual Review of Population Law, Vol. 16, 1989, Section 510.
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  23. 23

    Equal Remuneration Convention (ILO 100). [Notice of additional parties].

    International Labour Office [ILO]

    In: Multilateral treaties, index and current status, 8th cumulative suppl., compiled by M.J. Bowman and D.J. Harris. Nottingham, England, University of Nottingham Treaty Centre, 1991. 125.

    On 2 November 1990 China ratified this treaty providing for equal remuneration for the employment of women and men.
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  24. 24
    Peer Reviewed

    IAP-IPA-WHO-UNICEF Workshop on Strategies and Approaches for Women's Health, Child Health and Family Planning for the Decade of Nineties, 22nd-23rd January 1991, Hyderabad.

    Bhargava SK; Hallman N; Shah PM

    INDIAN PEDIATRICS. 1991 Dec; 28(12):1481-2.

    In 1991, health professionals attended a workshop to develop strategies and approaches for women's health, child health, and family planning for the 1990s in Hyderabad, India. The Ministry of Health (MOH) of India should improve and strengthen existing health facilities, manpower, materials, and supplies. It should not continue vertical programs dedicated to 1 disease or a few problems. Instead it should integrate programs. The government must stop allocating more funds to family planning services than to MCH services. It should equally appropriate funds to family planning, family welfare, and MCH. The MOH should implement task force recommendations on minimum prenatal care (1982) and maternal mortality (1987) to strengthen prenatal care, delivery services, and newborn care. Health workers must consider newborns as individuals and allot them their own bed in the hospital. All district and city hospitals should have an intermediate or Level II care nursery to improve neonatal survival. In addition, the country has the means to improve child health services. The most effective means to improve health services and community utilization is training all health workers, revision of basic curricula, and strengthen existing facilities. Family planning professionals should use couple protection time rather than couple protection rate. The should also target certain contraceptives to specific age groups. Mass media can disseminate information to bring about behavioral and social change such as increasing marriage age. Secondary school teachers should teach sex education. Health professionals must look at the total female instead of child, adolescent, pregnant woman, and reproductive health. Integrated Child Development Services should support MCH programs. Operations research should be used to evaluate the many parts of MCH programs. The government needs to promote community participation in MCH services.
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  25. 25

    Environmental and project displacement of population in India. Part I: Development and deracination.

    Maloney C

    UFSI FIELD STAFF REPORTS. 1991; (14):1-16.

    Official development projects in India have displaced at least 20 million persons since Indian independence in 1947, and the majority have not been relocated in planned resettlement. India is in a race to implement development projects needed to support the growth of its population, which increased from 361 million in 1951 to 840 million in 1990. Through the 1960s and 1970s about 1/4 of these oustees were minimally resettled and the rest had to find their own way to get reestablished. There is no international consensus on the rights of internally displaced persons, but most countries compensate people. Agricultural labor and construction labor are the most common types of work of the landless oustees. 1,589 large dams built since independence ousted the largest number of people. Dams, reservoirs, and canals displaced 11,000,000 people; 2,750,000 were rehabilitated and 8,250,000 found their own way. Mines displaced 1,700,000; 450,000 were rehabilitated and 1,250,000 found their own way. Industries displaced 1,000,000; 300,000 were rehabilitated and 700,000 found their own way. Parks and sanctuaries displaced 600,000; 150,000 were rehabilitated and 450,000 relocated on their own. Other projects displacing people are forest preserves, wildlife sanctuaries, military installations, weapons testing grounds, nuclear installations, and railroads and roads. The World Bank requires compensation for people displaced by 12 dam projects it is funding in India: the underestimated count is 610,500 persons. The Pong Dam, a 130 m high gravel dam, under the western Himalayas ousted 30,330 families, about 167,000 people, but only 16,001 families were found eligible for compensation. The Subarnarekha Project in southern Bihar is displacing 10,000 families, about 55,000 people. The state government estimates that 35% of these will not settle in suggested relocation sites because land is not available.
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