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UN Chronicle. 1991 Jun; 28(2): p..The United Nations Children's Fund (UNICEF) has made a "promise to children"--to try to end child deaths and child malnutrition on today's scale by the year 2000. The Fund estimates that a quarter of a million children die every week from common illnesses and one in three in the world are stunted by malnutrition. That broad goal, declared on 30 September 1990 by 71 Presidents and Prime Ministers attending the first World Summit for Children, includes 20 specific targets detailed in the Plan of Action for implementing the World Declaration on the Survival, Protection and Development of Children in the 1990s, adopted at the Summit. Among them are: one-third reduction in under-five death rates; halving maternal mortality rates; halving of severe and moderate malnutrition among the world's under-fives; safe water and sanitation for all families; and measures covering protection for women and girls, nutrition, child health and education. Other goals include making family planning available to all couples and cutting deaths from diarrhoeal diseases--which kill approximately 4 million young children annually--by one half, and pneumonia--which kills another 4 million a year--by one third. (excerpt)
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.
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.
IN POINT OF FACT 1991 Jun; (76):1-3.This paper describes the serious effect of diarrheal and acute respiratory (ARI) disease upon children under 5 years old, and international efforts undertaken by the World Health Organization (WHO) to reduce such mortality. Combined, these diseases account for more then 1/2 of all deaths in this age group, and constitute the most serious threat to their health. WHO estimates for 1990 that diarrheal illnesses caused 3.2 million childhood deaths and that ARI caused 4.3 million. While some child deaths are due to measles and pertussis, the majority is caused by pneumonia and the consequences of diarrheal illnesses. These deaths could be readily averted through the timely, effective treatment of trained health workers with essential drugs. Immunization as well as improved nutrition, particularly through the practice of exclusive breast feeding of the child's 1st 4-6 months of life, are addition weapons potentially employed against child mortality. WHO programs for diarrhea and ARI control focus upon simplified treatment guidelines, training, communication messages, drug supplies, and evaluation methodology. Despite obstacles such as the marketing of useless and/or potentially dangerous anti-diarrheal drugs and cough and cold remedies, and inappropriate breastmilk substitutes and unnecessary foods, widespread progress in program development and implementation has been made over the past decade. Increased amounts of oral rehydration therapy and solutions are available and used, while many health workers have benefited from training programs.
Dietary management of young children with acute diarrhoea: a manual for managers of health programmes. 2nd ed.
Geneva, Switzerland, World Health Organization, 1991. iii, 29 p.This WHO manual is appropriate for use by managers of health programs in controlling the dietary intake of young children with acute diarrhea. diarrhea is a major cause of malnutrition because of the low food intake during the illness, reduced nutrient absorption, and increased nutrient needs from the infection. Those most at risk are young infants 4-6 months old, who are not breastfed, and older infants and children (4-6 months to 2 years old). The introduction presents the causes of diarrhea, causes of malnutrition, and recent findings on nutrition in young children and mothers and on the digestion and absorption of nutrients during diarrhea. The selection of foods to be given during and after diarrhea is discussed in terms of the following variables which affect the choice of foods: age of the child, availability of foods, resources needed for food preparation, nutritional value of food, stage of illness, consistency of food, and frequency of feeding. The role that traditional beliefs and practices play in treatment is also mentioned as is the nature of the beliefs. Foods are classified as food and nonfood, appropriate and inappropriate foods, cultural superfood, special occasion foods, and foods related to ideas concerning physiology. Common treatments for diarrhea are starving the child for a short time; partial food restriction; continuation or restriction of breastfeeding; the feeding of certain foods, at certain times, and in specified amounts; the administration of herbal drinks and plant infusions; and the use of purgatives, emetics, or magical potions. It is important to collect information from several sources in communities and to gather data from discussions, written records, and observation. Methods to prevent diarrhea include following good feeding practices, washing hands after defecation, and keeping the children clean. Monitoring children on a growth chart to diagnose specific nutrient deficiencies, particularly of vitamin A and iron, helps in determining malnutrition. The multimix principle in introducing weaning foods is given, and a table provides a list of important nutrients as well as a list of foods rich in these nutrients. It is of particular importance during diarrhea to consume potassium-rich foods, carotene-rich foods, and milk and to avoid sweetened drinks.
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.
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.
ANNALS OF THE NEW YORK ACADEMY OF SCIENCES. 1991; 626:1-10.WHO defines reproductive health as people having the ability to reproduce, to regulate fertility, and to practice and enjoy sexual relationships. It also means safe pregnancy, child birth, contraceptives, and sex. Procreation should include a successful outcome as indicated by infant and child survival, growth, and healthy development. 60-80 million infertile couples live in the world. Core infertility, i.e., unpreventable and untreatable infertility, ranges from 3% to 5%. Sexually transmitted diseases, aseptic abortion, or puerperal infection are common causes of acquired infertility. Sub-Saharan Africa has the highest prevalence of acquired infertility. In 1983, the world contraceptive use rate stood at 51% with the developed countries having the highest rate (70%) and Africa the lowest rate (14%). About 40 countries in Africa and the Arabian Peninsula practice female circumcision. The percent of low birth weight infants is greater in developing countries than in developed countries (17% vs. 6.8%). Intrauterine growth retardation is responsible for most low birth weight infants in developing countries while in developed countries it is premature birth. About 15 million infants and children die each year. Maternal mortality risk is highest in developing countries especially those in Africa (1:21) and lowest in developed countries (1:9850). Sexually transmitted diseases continue to be a major problem in the world especially in developing countries. Chlamydia afflicts 50 million people each year. The proportion of women with AIDS is growing so that between the 1980s and 1990s it will grow between 25% and 50%. More available contraceptive choices enhance safety in fertility regulation. Socioeconomic conditions that determine reproductive health are poverty, literacy, and women's status. Sexual behavior, reproductive behavior, breast feeding, and smoking are life style determinants of reproductive health. Availability, utilization, and efficiency of health care services and level of medical knowledge also determine women's reproductive health.
HEALTH FOR THE MILLIONS. 1991 Dec; 17(5):24-5.While there may be no documented evidence that mortality decline is a causative factor in demographic transition, there is a close association between reductions in mortality and fertility. The Indian experience of more than 40 years shows that consistent efforts in the promotion of family planning will be rewarded with demographic transition. In the Indian state of Kerala, population 30 million, improving child survival, female literacy, strict child labor laws, and effective high coverage primary health care reduced mortality and fertility. Its infant mortality rate is 22/100 births, which is 25% of the national average. Its birth rate is 20/1000 and is continuing to fall. In the past decade population growth was only 14% compared to 25% nationally and 28% in the northern states. If Kerala's figures were applied to all of India, there would be 2 million less infant deaths and 8 million less births. The impact of reducing infant mortality on population growth in raw numbers in insignificant. With a mortality rate of 150/1000 there are 850 survivors. If the mortality rate is cut in half there will be only a .18% increase in population, but with a 50% reduction in infant suffering and death. Historically such mortality declines are associated with a 25% or more decline in fertility. This is the reason that UNICEF has been a long-time advocate of child survival programs as an integral part of population control measures. Euthanasia is surely not the solution to the population problem. The daily loss of 40,000 childhood lives is a tragic part of the human experience. However, helping these children to become and stay healthy is the best method of reducing population.
New York, New York, UNICEF, 1991. 60 p.The 1991 UNICEF annual report contains an introduction written by the Executive Director, James P. Grant. In it he outlines the goals of the World Summit for Children which include: initiatives to save an additional 50 million children, reduce childhood malnutrition by 50%, reduce female illiteracy by 50% , and eradicate polio and guinea worm from the planet. The report discusses the programs conducted during 1991 including: the World Summit for Children, child survival and development, basic education, water supply and sanitation, sustainable development, urban basic services, childhood disability, women in development, social mobilization, emergency relief, monitoring and evaluation, inter-agency cooperation. The report also outlines UNICEF's external relations, resources, and provides several profiles including Africa's AIDS orphans. Income for 1990 totaled US$821 million for 1990, and estimated at US$858 million for 1991. Expenditures for 1989 were US$633 million, US$738 million for 1990, and estimated at US$847 million for 1991.
Oxford, England, Oxford University Press, 1991. , 128 p.The State of the World's Children for 1991 begins with a promise by world leaders to adopt an ambitious series of goals for 2000 with an objective to end child death and child malnutrition at today's levels. Keeping the promise will not be easy since raising the resources to meet this goal will mean giving children a new, higher priority. Success will only be achieved by following certain principles, for example, reaching the immunization goals for the year 2000 will require almost every organization and person in both developing and developed countries to work hard. In order to succeed in only 10 years, a new ethic must develop which gives children a number 1 priority even in bad times. Reducing child deaths by 33% during this decade will mean essential steps must be taken in the process of reducing births and slowing population growth. The current generation will be charged with caring for the largest generation of children ever. Their performance will ultimately be judged according to the outcome of the children of the 1990s.
HEALTH FOR THE MILLIONS. 1991 Dec; 17(5):28.UNICEF advocates the reduction of infant/child mortality because it feels that such an action will reduce both fertility and human suffering. It was feared in the beginning, and today as well, that increasing the survival rate for children would cause rapid population growth. However, there is a large body of evidence to the contrary. When such measures are combined with measures to promote and support family planning there are even greater reductions in fertility levels. This is why such organizations as UNFPA, WHO, and UNICEF have advocated this course of action. This strategy is also present in the Declaration of the World Summit for Children. Anyone advocating the reduction in support for programs designed to enhance child survival as a method of population control is confusing the issues, misdirecting environmental attention, and stirring up the debate about international mortality. The evidence clearly shows that family planning without family health, including child health, is much less successful. Further, child mortality, even at high levels does little to slow population growth while such death and suffering greatly burden women and families. While rapid population growth and high population densities in developing countries present serious problems, both are much less important than the high levels of consumption in developed nations. Each child in the industrialized world will, at present levels of consumption, be expected to consume 30 to 100 times more than a child born in the poorest nations. Such suggestions in a time of instant global communication only attempt to set back international morality and tempt those in the international intellectual community to embrace ideas similar to the eugenic principles that led to the holocaust.
HEALTH FOR THE MILLIONS. 1991 Dec; 17(5):25-7.The article on human entrapment in India by Maurice King is just another example of the dogmatic, simplistic and reckless way in which the white scholars of the North formulate their ideas. It is these people who are responsible for the opium wars, programs against Jews, and carpet bombing, defoliation, and massacres in Vietnam. King's idea os using UNICEF and the WHO to kill the non white children of the South is just another example of this kind of racist brutality. It is based only upon the written opinions of other white scholars. In 1991 King produced no data about human entrapment in India. King ignores the writing of non whites like Ashish Bose who presided over the International Population Conference in 1989. Other mistakes that King makes include a failure to understand the applications of immunization (EPI) and oral rehydration programs (ORT). The EPI was implemented without ever taking baseline data, so that its effectiveness is impossible to determine with any accuracy. And nowhere in the world has ORT worked as well as UNICEF claimed it would. Further proof that King advocates genocide is his labeling of the insecticide-impregnated bednets as a dangerous technology in increasing entrapment. King fails to acknowledge the overwhelming influence of white consultants on the policies and planning strategies of family planning programs in India. Their list of failures includes: the clinic and extension approach, popularization of the IUD, mass communication, target orientation, sterilization camps, and giving primacy to generalists administrators. They should be held accountable for the 406 million people added to the base population between 1961-91 It should also be noted that India had the ability absorb this large number people while still maintaining a democratic structure, gather a substantial buffer stock of food grains, consistently increasing its per capita income while decreasing its infant mortality and crude death rates, increase its life expectancy at birth and improve the level of literacy, especially for females.
ICCW NEWS BULLETIN. 1991 Jul-Dec; 39(3-4):12-5.In 1924, the League of Nations adopted the 1st international law recognizing that children have inalienable rights and are not the property of their father. The UN Declaration on the Rights of the Child emerged in 1959. 1979 was the International Year of the Child. In 1990 there was the World Summit on Children and the UN General Assembly adopted the Global Convention on the Rights of the Child. The convention included civil, economic, social, cultural, and political rights of children all of which covered survival, development, protection, and participation. At the end of 1990, 60 countries had ratified the convention, thus including it into their national legislation. Even though India had not yet endorsed the Convention by the end of 1991, it expressed its support during the 1st workshop on the Rights of the Child which focused on girls. India has a history of supporting children as evidenced by 250 central and state laws on their welfare such as child labor and child marriage laws. In 1974, India adopted the National Policy for Children followed by the establishment of the National Children's Board in 1975. The Board's activities resulted in the Integrated Child Development Services Program which continues to include nutrition, immunization, health care, preschool education, maternal education, family planning, and referral services. Despite these laws and actions, however, the Indian government has not been able to improve the status of children. For example, between 1947-88, infant mortality fell only from 100/1000 to 93/1000 live births and child mortality remained high at 33.3 in 1988 compared with 51.9 in 1971. Population growth poses the biggest problem to improving their welfare. Poverty also exacerbates their already low status.
Maternal mortality and the right of the child to survival, protection and development. Perspectives on southern and eastern Africa in light of international law.
In: The effects of maternal mortality on children in Africa: an exploratory report on Kenya, Namibia, Tanzania, Zambia, and Zimbabwe, [compiled by] Defense for Children International-USA. New York, New York, Defense for Children International-USA, 1991. 97-143.How international law documents such as the Convention on the Rights of the Child establish a legal framework within which to promote child survival in Southern and Eastern Africa, emphasizing the documents' significance for maternal mortality, the most important factor affecting child survival, is examined. In November 1989, the UN General Assembly unanimously adopted the Convention, a comprehensive treaty that establishes the rights of children and their families, outlining the responsibilities of governments and adults in securing those rights. By September 1990, most countries in Southern and Eastern Africa had ratified the treaty; the remaining countries had pledged to approve it. The Convention not only obligates governments to allocate greater resources to the most vulnerable members of society, but also requires a higher level of international cooperation, including greater commitment from industrialized countries and greater participation at the grassroots level. The economic, social, and cultural dimensions of maternal mortality and its impact on child survival are discussed, as well as the maternal and child survival issues addressed by the Convention: 1) maternal-child health services; 2) traditional practices harmful to the mother and child (in this case, female circumcision and child marriage); and 3) survival and development through international cooperation. The implications of the Convention on the primary health care model are also discussed. The impact of other international documents on maternal mortality and child health is examined.
[Unpublished] 1991. Presented at the 119th Annual Meeting of the American Public Health Association [APHA], Atlanta, Georgia, November 11-14, 1991. 7,  p.Maternal health affects child survival in many ways. For example, and infant in Bangladesh whose mother has died during childbirth has a 95% chance of dying in the 1st year. Further children <10 years old in Bangladesh, especially girls, who have lost their mother are 4 times as likely to also die. In addition, there is a relationship between protein energy malnutrition in mothers and low prepregnancy weight and meager wait gain during pregnancy which retards fetal growth resulting in a low birth weight (LBW) infant, LBW infants die at a rate 30 times that of adequate weight infants. In fact, child survival depends on maternal health even before the mother is able to conceive. Daughter as well as mothers in developing countries often eat last and smaller amounts of food than male family members. Females who remain poorly nourished often experience obstructed labor which causes several complications for the infant such as respiratory failure. Maternal infections such as malaria and sexually transmitted diseases are also closely linked to LBW. Some can also bring about preterm birth and congenital infections. Pregnancy and labor complications are responsible for about 500,000 maternal deaths annually. Hemorrhage, sepsis, eclampsia, and obstructed labor cause most of these deaths. A woman's fertility pattern also contributes to child survival. The high risk birth categories include too young, too old, too many children, and too closely spaced. In fact, the median mortality rate for infants born <2 years after the older sibling is 71% greater than that for those born 2-3 years apart. The World Bank recommends improved community based health care, improved referral facilities, and an alarm and transport system to improve maternal health. The World Bank, UNDP, UNFPA, UNICEF, WHO, IPPF, and the Population Council support the Safe Motherhood Initiative which aims to reduce maternal morbidity and death by 50% by 2000.
[Unpublished] 1991. Presented at the Demographic and Health Surveys World Conference, Washington, D.C., August 5-7, 1991. 8 p.The maternal and child health/family planning (MCH/FP) program at WHO specifies the priorities for MCH/FP in the 1990s. Results of the Demographic and Health Surveys (DHS) in many, but not all, developing countries have shown overall improvement in fertility and maternal and child health, especially in the family planning and child survival movements. Maternal mortality did not change, however. Moreover, maternal mortality in some countries exceeded natural maternal mortality. These elevations sparked a 3rd movement in the late 1980s, safe motherhood. These results confirm that the public health community cannot become complacent. Indeed it must strengthen the infrastructure, management, and performance of the health system to maintain gains. This involves identifying a novel strategy to priority setting and program development which are adapted to the changing needs and circumstances of each country, and even within each country. In fact, firm program strategies and policies need to concentrate on maternal health and morbidity, newborn care, breast feeding, perinatal infections, and HIV/AIDS. Based on DHS data and on evaluations of MCH/FP programs, WHO lists crucial principles for successful programs. The 1st principle includes equity in access and use of social resources which includes disaggregating data according to geographic and population subgroups to find appropriate strategies to close the widening gap within and between countries. The next principle is community and health care provider participation and ownership. Indeed successful MCH/FP programs are those where the community identifies problems and needs and evaluates the program. The 3rd principle encompasses quality data collection to assess quality of care and program effectiveness. WHO has proposed 5 priorities for organization and management of MCH/FP programs. 1 priority which WHO suspects will generate the most debate is integration of family planning, child survival, and safe motherhood programs.
HYGIE. 1991; 10(3):16-22.The Executive Director of UNICEF stresses at the 14th World Conference on Health Education held in Helsinki, Finland the importance of grabbing new opportunities in our changing world. An important boost to health educators is the World Summit for Children which witnessed for the 1st time world leaders committed to comprehensive and specific resolutions to improve the quality of life for children--a true opportunity to solve a global problem. Health educators can play a key role in solving global problems by showing leaders how health education can help solve these problems. Indeed political will as demonstrated at the World Summit for Children provides the needed impetus to launch a revolution of improved health for all. Now they can help convert the growing international consensus for human centered development into reality. He also points out that the success of the campaigns for universal child immunization and for oral rehydration therapy are due to health educators. Health educators should apply these successful techniques that simplifies modern medical knowledge into basic health messages which in turn empowers families and communities to save and improve lives to further improve the health of the world. A challenge that remains is promoting healthy life styles, especially among adolescents whose health problems include pregnancy, sexually transmitted diseases, and alcohol abuse. AIDS presents another challenge. Health educators need to encourage hospitals to promote breast feeding and to provide maternity services centered around the infant. Improvement in child and adult health cannot occur, however, if the people do not demand changes in society. Health educators can lead this movement by communicating and advocating healthful changes.
USAID HIGHLIGHTS. 1991 Fall; 8(3):1-4.This article considers the epidemic proportion of AIDS in developing countries, and discusses the U.S. Agency for International Development's (USAID) reworked and intensified strategy for HIV infection and AIDS prevention and control over the next 5 years. Developing and launching over 650 HIV and AIDS activities in 74 developing countries since 1986, USAID is the world's largest supporter of anti-AIDS programs. Over $91 million in bilateral assistance for HIV and AIDS prevention and control have been committed. USAID has also been the largest supporter of the World Health Organization's Global Program on AIDS since 1986. Interventions have included training peer educators, working to change the norms of sex behavior, and condom promotion. Recognizing that the developing world will increasingly account for an ever larger share of the world's HIV-infected population, USAID announced an intensified program of estimated investment increasing to approximately $400 million over a 5-year period. Strategy include funding for long-term, intensive interventions in 10-15 priority countries, emphasizing the treatment of other sexually transmitted diseases which facilitate the spread of HIV, making AIDS-related policy dialogue an explicit component of the Agency's AIDS program, and augmenting funding to community-based programs aimed at reducing high-risk sexual behaviors. The effect of AIDS upon child survival, adult mortality, urban populations, and socioeconomic development in developing countries is discussed. Program examples are also presented.
IN TOUCH 1991 Jun; 10(99):21-2.Despite obstacles to expanding immunization coverage (EPI) in developing countries, progress has been made in Bangladesh and is described. A February, 1991, World Health Organization cluster evaluation survey indicates that government efforts during the 1980s, with the cooperation and assistance of non-governmental organizations (NGO), have increased the degree of immunization coverage in Bangladesh. 80% coverage for BCG, measles, and DPT-3 antigens is realized in the Rajshahi division, 1 of 4 divisions sampled in the survey. Use of existing FWAs and HA as vaccinators; DC, UNO, and upazila chairmen involvement; partner recruitment for mobilization efforts; steam sterilization of needles; maintenance of an effective cold chain; and monthly vaccination sessions at more than 108,000 sites throughout the country worked together to successfully yield greater immunization coverage. Sustained efforts are, however, required to ensure vaccine protection of the 4 million children born into the population each year. 80% or greater universal coverage in Bangladesh is the focus of continued efforts. Eradication of polio, measles, and neonatal tetanus is possible in the 1990s, while Vitamin A distribution and more effective promotion of family planning services are also objectives. Government and NGO workers must promote awareness of EPI, monitor EPI service delivery, and encourage HAs, FWAs, UHFO Civil Surgeons, UNOs, DCs, and upazila chairmen to provide regular EPI services.
New York, New York, United Nations Population Fund [UNFPA], 1991. , 48 p.Developing countries increased their commitment to implement population policies in the late 1980s and early 1990s with the support and guidance of UNFPA. These policies focused on improving, expanding, and integrating voluntary family planning services into social development. 1985-1990 data revealed that fertility began to fall in all major regions of the world. For example, fertility fell most in East Asia from 6.1-2.7 (1960-1965 to 1985-1990). This could not have occurred without strong, well managed family planning programs. Yet population continued to grow. This rapid growth hampered health and education, worsened environmental pollution and urban growth, and promoted political and economic instability. Therefore it is critical for developing countries to reduce fertility from 3.8-3.3 and increase in family planning use from 51-59% by 2000. These targets cannot be achieved, however, without government commitments to improving the status of women and maternal and child health and providing basic needs. They must also include promoting child survival and education. Further people must be able to make personal choices in their lives, especially in contraceptive use. Women are encouraged to participate in development and primary health care in Kerala State, India and Sri Lanka. The governments also provide effective family planning services. These approaches contributed significantly to improvements in fertility, literacy, and infant mortality. To achieve the targets, UNFPA estimated a doubling of funding to $9 billion/year by 2000. Lower costs can be achieved by involving the commercial sector and nongovernmental organizations, building in cost recovery in the distribution system of contraceptives, operating family planning services efficiently, and mixing contraceptive methods.
Lancet. 1991 Feb 2; 337(8736):307-8.Dr Taylor (Jan 5, p 51) observes that my paper (Sept 15, p 664) revisits issues much discussed 2 or 3 decades ago. As 1 of the original proponents of the child survival hypothesis, he cites the article on which it was based. This 1967 paper makes no reference to ecological destruction, the plight of huge cities in the tropics, the grave constraints on the resources needed for the socioeconomic gains that would bring down the birthrates--or to the demographic trap, although the paper does mention that "progress is overwhelmed by people". Nor does it discuss conditions under which family planning is too late to prevent the trap closing, a point which Dr Potts and Professor Rosenfield do not mention either in their 2 papers (Nov 17, p 1227; Nov 24, p 1293). There seems to be a conspiracy not to mention the trap, which is Lester Brown's term not mine. Since nearly 1/4 of a century has passed since publication of the main paper on which the child survival hypothesis is bases and since major changes have taken place, including a 60% growth in world population, might it not be time to review some aspects of that hypothesis and the UNICEF programs which follow from it? The several meanings of sustainability are causing much confusion. Could we use "ecosustainability" for the "maintenance of the capacity of an ecosystem to support life in quantity and variety", and leave "sustainability" for "able to be continued"? If something is able to be continued for long enough, it has to be ecosustainable, so that the 2 meanings do ultimately converge; even so the distinction would reduce confusion. Health should therefore be "an ecosustainable state". (full text)