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Washington, D.C., Island Press, 1991. lxii, 272 p.In 1988, the World Meteorological Organization and the UN Environment Program established the Intergovernmental Panel on climate Change (IPCC) to consider scientific data on various factors of the climate change issue, e.g., emissions of major greenhouse gases, and to draw up realistic response strategies to manage this issue. Its members have agreed that emissions from human activities are indeed increasing sizably the levels of carbon dioxide, methane, chlorofluorocarbon (CFC), and nitrous oxide in the atmosphere. The major conclusions are that effective responses need a global effort and both developed and developing countries must take responsibility to implement these responses. Industrialized countries must modify their economies to limit emissions because most emissions into the atmosphere come from these countries. They should cooperate with and also provide financial and technical assistance to developing countries to raise their living standards while preventing and managing environmental problems. Concurrently, developing countries must adopt measures to also limit emissions as their economies expand. Environmental protection must be the base for continuing economic development. There must be an education campaign to inform the public about the issue and the needed changes. Strategies and measures to confront rapid population growth must be included in a flexible and progressive approach to sustainable development. Specific short-term actions include improved energy efficiency, cleaner energy sources and technologies, phasing out CFCs, improved forest management and expansion of forests, improved livestock waste management, modified use and formulation of fertilizers, and changes in agricultural land use. Longer term efforts are accelerated and coordinated research programs, development of new technologies, behavioral and structural changes (e.g., transportation), and expansion of global ocean observing and monitoring systems.
HYGIE. 1991; 10(2):3-4.A strategic plan for objectives and operations of the International Union for Health Education (IUHE) in the 1990s is presented. The IUHE's principal aims are to strengthen the position of education as a major means of protecting and promoting health, to support members of the IUHE, and to advise other agencies. Core functions will include advocacy/information services/networking, conferences/seminars, liaison/consultancy/technical services, training, and research. The objectives of the IUHE are to promote and strengthen the scientific and technical development of health education, to enhance the skills and knowledge of people engaged in health education, to create a greater awareness of the global leadership role of the IUHE in protecting and promoting health, and to secure a stronger organizational and resource base. These objectives will be achieved by developing an disseminating annual policy papers on key global issues, developing new procedural guidelines for the IUHE's world and regional conferences, clarifying the roles of the headquarters and regional offices, and developing recruitment incentives to boost membership. The corporate identify of the IUHE will be revised, formal U.N. accreditation will be sought, and mutually beneficial relationships will be fostered with selected U.N. and non-governmental organizations. Additionally, the scientific and technical strengths of the IUHE will be boosted, a resources referral service developed, a fund raising office created, worker achievements recognized, and a bursary fund established.
Report of an International Consultation on AIDS and Human Rights. Geneva, 26-28 July 1989. Organized by the Centre for Human Rights with the technical and financial support of the World Health Organization Global Programme on AIDS.
New York, New York, United Nations, 1991. iii, 57 p.In July 1989, ethicists, lawyers, religious leaders, and health professionals participated in an international consultation on AIDS and human rights in Geneva, Switzerland. The report addressed the public health and human rights rationale for protecting the human rights and dignity of HIV infected people, including those with AIDS. Discrimination and stigmatization only serve to force HIV infected people away from health, educational, and social services and to hinder efforts to prevent and control the spread of HIV. In addition to nondiscrimination, another fundamental human right is the right to life and AIDS threatens life. Governments and the international community are therefore obligated to do all that is necessary to protect human lives. Yet some have enacted restrictions on privacy (compulsory screening and testing), freedom of movement (preventing HIV infected persons from migrating or traveling), and liberty (prison). The participants agreed that everyone has the right to access to up-to-date information and education concerning HIV and AIDS. They did not come to consensus, however, on the need for an international mechanism by which human right abuses towards those with HIV/AIDS can be prevented and redressed. International and health law, human rights, ethics, and policy all must go into any international efforts to preserve human rights of HIV infected persons and to prevent and control the spread of AIDS. The participants requested that this report be distributed to human rights treaty organizations so they can deliberate what action is needed to protect the human rights of those at risk or infected with HIV. They also recommended that governments guarantee that measures relating to HIV/AIDS and concerning HIV infected persons conform to international human rights standards.
Sexually transmitted diseases research needs: report of a WHO consultative group, Copenhagen, 13-14 September 1989.
[Unpublished] 1991. Presented at the 1st International Course on Planning and Managing STD Control Activities in Developing Countries, Antwerp, Belgium, September 9-21, 1991. 31 p.In response to the growing needs for research into sexually transmitted diseases (STDs), the STD Program of the World Health Organization (WHO) in September 1989 convened a small interdisciplinary consultative group of scientists from both developing and more developed countries to review STD research priorities. The consultation was organized based upon the belief that a joint consideration of global STD research priorities and local research capabilities would increase overall research capacity by coordinating the efforts of scientists from around the world to get the job done. Participants considered the areas of biomedical research, clinical and epidemiological research, behavioral research, and operations research. However, research needs directly related to HIV were not considered except where they interfaced with research on other STDs. The above areas of research, as well as the expansion of interregional and interdisciplinary collaborations, the strengthening of research institutions, developing and strengthening research training, and facilitating technology transfer and the use of marketing systems are discussed.
In: Jornadas Multidisciplinarias sobre el Aborto, 25 de febrero al lo de marzo, 1991. Salon de Honor del Ilustre Colegio Abogados de La Paz. [La Paz], Bolivia, Sociedad Boliviana de Ciencias Penales, 1991. 45-63.The problems created by excessive population growth at the global level and in Bolivia, and the response of the UN Population Fund are summarized. Today's world population of 5.3 billion is projected to reach 6.25 billion in 2000. In many areas, population growth has outstripped carrying capacity. Over 90% of the growth is in developing countries, where urban growth is particularly rapid. Because balance between human population and resources and environmental protection are key elements in quality of life and for sustainable development, population concerns should be a fundamental part of development strategies. The mandate of the UN Population Fund since 1973 has been to acquire and disseminate in developed and developing countries a knowledge of population problems and possible strategies to confront them, and to assist developing countries, at their request, to find appropriate solutions to their population problems. National population goals and objectives should include reducing average family sizes, reducing the proportion of women not using contraception, reducing early marriage and motherhood, and achieving a contraceptive prevalence of at least 56% of fertile-aged women in developing countries by the year 2000. Infant and maternal mortality rates should be lowered, average life expectancy should be increased to at least 62 years, and geographic distribution of the population improved. Bolivia, with its annual population growth rate of 2.2% and total fertility rate of 5.1, per capita income of $633/year, life expectancy of 58 years, and infant mortality rate of 102, is a priority country for the UN Population Fund. No coherent program of cooperation between the UN Population Fund and Bolivia has yet been developed, but 32 projects have been assisted in Bolivia since 1972 with a total investment of approximately US$105 million, of which 44.7% was destined for maternal-child health services and 29.0% for data collection.
In: Earth summit. Conversations with architects of an ecologically sustainable future, by Steve Lerner. Bolinas, California, Commonweal, 1991. 237-48.The former secretary of the Brundtland Commission, now the executive director of the Center for Our Common Future, presents a historical overview of the international environment efforts since the formation of the independent Brundtland Commission. The 21-member commission held public hearings in Brazil, Canada, China, Europe, Indonesia, Kenya, and the USSR to get the common people's perspective. In fact, the commission used their quotes in the report, Our Common Future. The members organized regional presentations of the report to nongovernmental organizations and to governments. The UN Conference on Environment and Development (UNCED) emerged from the debate, which occurred on the day of the 1987 stock market crash, so it did not get much media coverage. The Center for Our Common Future was created to promote the messages of the commission's report and to increase the dialogue on sustainable development. The Center has set up a global network of 160 working partners in 70 countries. A key message of the report is forging a path from confrontation to cooperation. We all must accept part of the responsibility of working toward sustainable development. Participants in a 1990 meeting in Vancouver agreed that the UNCED process needs broad participation. 26 issues are on the UNCED agenda, including water, toxics, biodiversity, biotechnology, land management, ocean management, and acid rain, which are too numerous to manage at the UNCED. A North/South issue is no longer relevant because we are a global community and we must cooperate. The only way the North is going to advance is if it considers its economic self-interest. Much of the world is waiting for the US to lead, but it is not budging. Many suggest that Europe take the lead, e.g., Norway's climate fund. Grass roots groups need to organize and empower themselves to effect change.
In: Earth summit. Conversations with architects of an ecologically sustainable future, by Steve Lerner. Bolinas, California, Commonweal, 1991. 229-36.A senior associate with the World Resources Institute believes that it is more worthwhile to strengthen the UN Environment Program than to create a new international environmental organization. Another possibility would be to convert the UN Trusteeship Council's purpose from administering UN territories to dealing with environmental issues. The Council has an equal number of developing countries and developed countries and no country has veto power. She also favors ad hoc groups dealing with very specific issues, e.g., International Panel on Climate Change. We need an international debt management authority which purchases outstanding debt at real market prices to finance policies and programs that alleviate poverty and protect the environmental issues should lie with 1 organization. She dismisses suggestions that the Group of Seven industrialized nations serve as a group to propose international initiatives because developing countries would not accept the G-7 process plus the G-7 countries do not even agree on environmental issues. Citizens push US politicians to address environmental issues rather than the politicians leading on environmental issues. Some members of the US Congress have taken the initiative, however, including Senators Gore and Mikulski from Tennessee and Maryland, respectively. The President must have a vision for a transition to sustainable development, which he does not. In the 1973-74 oil crisis, industry took it upon itself to become more energy efficient and still had real growth in the gross national product, illustrating that the costs required to become more sustainable are not as great as many people claim. Sustainable agriculture would reduce the demand for fossil fuels, on which fertilizers and pesticides are based. It would require making institutional changes. USAID should change dramatically the system it uses to distribute foreign aid money and to dedicate considerably more money to the environment and development.
In: Earth summit. Conversations with architects of an ecologically sustainable future, by Steve Lerner. Bolinas, California, Commonweal, 1991. 25-38.The public debate on the environment leading to the 1992 Earth Summit in Brazil has been restricted to global climate change instead of global change. The Summit should be part of an ongoing process and not a framework convention followed by protocols. Separate conventions for biodiversity and deforestation are likely to emerge, even though one convention integrating both biodiversity and deforestation is needed. Many environmental and development issues overlap, suggesting a need for an international group to coordinate these issues. Negotiating separate conventions for the various issues is costly for developing countries. Rapid population growth contributes to environmental degradation, but no coordinated effort exists to reduce it. The US continues to not support the UN Population Fund which, along with threats of US boycotts and disapproval, curbs initiatives to reduce population. At present population and economic growth rates, an environmental disaster will likely happen in the early 2000s. Developing countries, which also contribute greatly to global warming, will not take actions if industrialized nations do not initiate reductions of greenhouse gases. Developed countries emit the most greenhouse gases, have been responsible for most past emissions, and have the means to initiate reductions. Of industrialized nations, the US stands alone in setting targets to reduce carbon dioxide. Unlike some European nations, the US does not have an energy policy. The US abandoned public transportation for the automobile while Europe has a strong public transportation system. The World Bank has improved greatly in addressing global environmental issues, but only 1% of its energy lending is for energy efficiency. The Bank knows that projects implemented by nongovernmental organizations are more successful than those implemented by governments, yet it continues to lend money to governments. Humans need to redesign existing linear systems to be like nature's circular systems in which by-products are starting products for another reaction.
In: Urban and rural development in Third World countries: problems of population in developing nations, edited by Valentine James. Jefferson, North Carolina, McFarland, 1991. 297-314.National security must be broadened to include national cultural survival in tandem with resource availability or scarcity, and tensions between developed and developing countries must be reduced. Budget priorities must accommodate a sense of fairness, humanness, and justice. Politics reflect priorities and values for scarce resources for US society and for the world. The needs of the Third World are described, followed by a presentation of a developmentalist alternative and a case study of Brazil and Central America. Attempts have been made to secure stability and harmony through unilateral armament, bilateral and multilateral treaty arrangements, and a European balance of power strategy. None of these strategies has been particularly successful. The UN Charter also provides for collective security arrangements and unilateral and regional defense systems. 9 objective and subjective criteria for a viable collective security system are listed. The US has never agreed on a definition of aggression or that it is totally undesirable. 157 nations are part of the UN, while others are still denied membership on ideological grounds. Confidence in the system and its members is lacking and nations have been unwilling to subordinate national behavior to UN standards. Collective security in the political world has not been realized. Nuclear deterrence has been used by the US since the 1950 for national security. Aristotle recognized that economic well-being is related to peace, and gross inequalities are related to conflict. The needs of developing countries are the reduction of poverty and of the gap between rich and poor nations. Poor nations are susceptible to corruption, capital flight, and increasing military expenditures. The US strategy has been to support corruptible repressive regimes. Budget priorities need to be reevaluated. An alternative developmentalist strategy would improve conditions to halt the spread of hostile ideologies and socioeconomic instability.
African debt crisis and the IMF adjustment programmes: the experiences of Ghana, Nigeria and Zambia.
In: Development perspectives for the 1990s, edited by Renee Prendergast and H.W. Singer. Basingstoke, England, Macmillan, 1991. 37-57.Sub-Saharan African countries suffer from rapidly growing external debt and the concomitant burden of its service; debt service in 1987 accounted for 40.6% of exports. Liberal and neo-Marxist rationales exist to explain the development and existence of the African debt crisis. The former view, however, drives the market-oriented development approach of the IMF and World Bank and has resulted in the development and imposition of structural adjustment programs (SAP). Main components of SAP are exchange rate reforms or currency devaluation; trade liberalization; export promotion; rationalization of public expenditure, capital, investment, and employment in the public sector; privatization and commercialization of public enterprises; producer price adjustment; wage restraints; withdrawal/reduction of subsidies; tax structure reform; and financial/administrative reforms. SAP, however, ignores that the narrow production base of post-colonial African states encourages unpredictable export earnings which in turn make it hard for countries to concurrently service debt and pay for imports to cushion the effects of SAP. Internally, programs also ignore the inflationary effect of devaluation while underestimating the social cost of domestic tightening on living standards. While national leaders are willing to take steps towards much-needed structural reform, they object to SAP policies which exacerbate Africa's dependence upon external financial flow. The African Alternative Framework to Structural Adjustment Programmes for Socio-Economic Recovery and Transformation therefore proffers that the IMF modify its policy to allow African states to strengthen and diversify production capacities. Recommendations are largely reflationary and would require substantial internal and external funding. In sum, donor and recipient states must recognize that both internal and external factors caused the present situation and that interested parties must continue to explore viable options for action; African nations need structural reform but with out paralyzing their productive bases; and that the social costs of SAP must be evenly distributed in order to be politically acceptable. The structural adjustment experience of Ghana, Nigeria, and Zambia are presented as examples of these realities and conclusions.
New York, New York, United Nations, 1991. xiv, 120 p. (Social Statistics and Indicators Series K No. 8; ST/ESA/STAT/SER.K/8)5 UN agencies worked together to develop this statistical source book to generate awareness of women's status, to guide policy, to stimulate action, and to monitor progress toward improvements. The data clearly show that obvious differences between the worlds of men and women are women's role as childbearer and their almost complete responsibility for family care and household management. Overall, women have gained more control over their reproduction, but their responsibility to their family's survival and their own increased. Women tend to be the providers of last resort for families and themselves, often in hostile conditions. Women have more access to economic opportunities and accept greater economic roles, yet their economic employment often consists of subsistence agriculture and services with low productivity, is separate from men's work, and unequal to men's work. Economists do not consider much of the work women do as having any economic value so they do not even measure it. The beginning of each chapter states the core messages in 4-5 sentences. Each chapter consists of text accompanied by charts, tables, and/or regional stories. The 1st chapter covers women, families, and households. The 2nd chapter addresses the public life and leadership of women. Education and training dominate chapter 3. Health and childbearing are the topics of chapter 4 while housing, settlements, and the environment comprise chapter 5. The book concludes with a chapter on women's employment and the economy. The annexes include strategies for the advancement of women decided upon in Nairobi, Kenya in 1985, the text of the Convention on the Elimination of All Forms of Discrimination against Women, and geographical groupings of countries and areas. During the 1990s, we must invest in women to realize equitable and sustainable development.
DIALOGUE ON DIARRHOEA. 1991 Sep; (46):4.Artificial feeds constituted with contaminated water and unclean bottles are the leading cause of diarrhea in infants. Companies market artificial feeds globally as infant formula (a substitute for breast milk) and follow-up formula (a complement to breast milk). Breast milk is best for all 0-12 month old infants. Breast-fed infants do not need any formula even follow-up formula. Indeed >6-month old infants require solid healthful foods and breast milk. Like infant formulas, follow-up formula made with contaminated water or bottles can cause the infant to become ill with an infection, and offering follow-up formulas to infants impedes weaning and is costly. Follow-up formulas do not complement breast milk, but instead tend to replace it. The 1986 WHO World Health Assembly has even declared that, in some countries, provision of follow-up formula is not necessary. WHO fears mothers could use follow-up formula instead of infant formula because it has a higher protein and mineral content thus increasing the risk of dehydration during diarrhea. Follow-up formula can result in an unbalanced diet. Since the International Code of Marketing of Breastmilk Substitutes does not address formulas marketed as a complement to breast milk, formula companies market follow-up formulas in both developed and developing countries. Most mothers do not know the risks of using follow-up formulas, however. Governments have several alternatives to stop the marketing of these formulas. They can design and implement a code that defines breast-milk substitutes as any formula perceived and used as a breast milk option even if promoted as a breast-milk complement. They can also amend an existing code. WHO offers technical assistance to any member government who wishes to design, implement, and monitor such a code.
PAKISTAN DEVELOPMENT REVIEW. 1991 Winter; 30(4 Pt 1):493-6.Comments on the UN paper on the Development Decade of the 1980s and the next decade of the 1990s by Gamani Corea are presented. Corea's statements about the future are considered fair, but negative and lacking in quantitative input. As an econometrician and a quantitative economist, the author feels that the shortterm and mediumterm economic prospects are that 1988 was a good year, 1989 all right, and 1990 was recessionary for some countries. Recovery is anticipated by 1992. The Gulf crisis of 1990-91 caused fluctuations in energy prices and uncertainty or fear in people, which is hoped to be transitory and without major impact on economic matters. Positive expansion in the world economy after 1992 is anticipated, in spite of the recessions in the UK and some Nordic countries. Western Europe slowed, but the advent of the Single Market is favorable to an upswing. The Asia/Pacific arena is strong, and achievements in South Korea are considerable. Mexico, Venezuela, Colombia, and Chile are promising. Other economic problems in Latin America are only temporary. South Asia has done well. The Middle East and North Africa may have more lasting consequences of the Gulf war. Sub-Saharan Africa is in trouble with the race between population growth and food supplies, and negative or near zero growth rates/capita. Developing countries are experiencing severe recessionary adjustment periods in world economic malaise. With the collapse of socialism, there is no viable "Second World," and there are industrialized and developing countries. Eastern Europe and the USSR have a skilled population with the potential for producing world class goods and services. Primary commodity markets are expected to rise again which will strengthen export earnings in the developing world. Macroeconomic visions of hope are based on contingencies: financial fragility, issues related to the Gulf crisis, poor financial conditions in the US and to a certain extent in Japan and other financial centers. Trade negotiations in the Uruguay Round are in difficulty, which restricts free trade, and dilutes strong and vigorous activity which helps development. The economic restructuring of Europe is moving more slowly, but the Arms race is still extant in Third World countries such as Iraq. Price stabilization efforts may be futile attempts when underlying behavior patterns of production and consumption take over. Europe is the primary growth area. The Peace Dividend has been reduced because of Iraq's postures. South/South trade may be an option for developing countries. There is potential for expansion in e.g., and electronics, medical care, telecommunications, bioengineering, metallurgy, software construction. Technology and economics and international cooperation and coordination are hopeful prospects for the future.
PAKISTAN DEVELOPMENT REVIEW. 1991 Winter; 30(4 Pt 1):497-501.Papanek's responses to the Gamani Corea paper on UN strategy for the 1990s in international development are presented. Corea's paper is considered as an evolution of thinking about development economies. Over 40 years, some issues have faded and others have taken prominence, and some issues have been ignored even though of considerable importance to development. 4 areas are identified for discussion: 1) the changing role of planning, and the market, poverty, and the environment; 2) north/south issues; 3) major changes in the world economic system; and 4) the world economic environment and the role of domestic policies. The greatest change has occurred in the emphasis on environmental consequences of development in contrast to past concerns with achieving a high rate of growth with some attention to land tenure issues. There is also an emphasis on the private sector and foreign private investment. Planning has taken a recessive role. Income distribution and poverty alleviation is also of concern. Although government intervention is no longer fashionable, it is not clear what provisions there are in the market for assuring that the poor have a reasonable share of the growth. The north/south issues are discussed in terms of the limited bargaining power of developing countries. Contributing factors are the multiplicity of objectives desired simultaneously. The UN resolutions on development strategy do not always reflect developing country's objectives. Suggestions are made to bargain 1) on objectives crucial to many developing countries, 2) on objectives that generate the least resistance among the industrialized countries, and 3) on those objectives where there is reasonable consensus on what needs to be done. Major changes in the world economic system that are not included in UN strategy but will affect policy are: 1) US leadership has declined as the principal supplier of capital; 2) US absorption of world exports is shrinking; 3) the peace dividend will insure stability if not an increase in transfers; 4) increased competition for markets and private investment will come from Eastern Europe and the Soviet Union; and 5) a response needs to be made to technology changes in the US, Japan, an Europe in order to stay competitive. There is recognition that countries shape their own destiny and can be successful with the appropriate policy mix.
POPULATION BULLETIN OF THE UNITED NATIONS. 1991; (31-32):89-103.International cooperation in population activities (69 of 73 countries reporting) is still needed according to the 6th UN Population Inquiry among Governments, 1988. There is a decline in need for consultants and priority requests for computer equipment and training. Difficulties have arisen due to funding decreases and slow implementation. The responding sample population involved 108 (79 developing and 29 developed) of 170 member and observer states. Questions pertained to attainment of policy goals, future needs and priorities, and government policies and programs. The questionnaire and response rate were similar to the 5th Survey conducted in 1983. Comparability to developing countries is uncertain since the response was only 60% of 132 developing countries. The population of the developing countries responding was 3.5 billion or 60% of the world's 5.1 billion. The results of the data aggregation are presented in terms of sources of past technical support, relative contribution of technical cooperation, need for technical cooperation on population issues, and statements of governments. The conclusions reached were that all had received support for population programs from international sources. 36 countries reported having 4-6 sources of support, of which 66% were in the UN system. In the Economic Commission for Africa (ECA) 80% of the countries assigned technical cooperation as the most important contribution to population progress. Slightly fewer countries from the Economic Commission for Asia and the Pacific (ESCAP) and the Economic Commission for Latin America and the Caribbean (ECLAC) reported similar impacts. However, >50% also experienced difficulties with technical cooperation. ECA countries had difficulties with reduced funding and slowness in implementation, and minor complaints about poor donor agency coordination, differences in priorities between the government and donors, and too narrow a technical focus. Compared with the last inquiry, family planning was now a priority. Computer equipment and training programs were ranked the highest in technical support. There was some regional variation. Only 8 expressed a negative response to technical cooperation.
WORLD HEALTH FORUM. 1991; 12(4):496-7.WHO estimates that the number of AIDS cases worldwide will grow from about 1.5 million to 12-18 million by 2000--a 10 fold increase. Further it expects the cumulative number of HIV infected individuals to increase from 9-11 million to 30-40 million by 2000--a 3-4 fold increase. Dr. Hiroshi Nakajima, the Director-General of WHO, points out that despite the rise in AIDS, there is something for which to be thankful--neither air, nor water, nor insects disseminate HIV and causal social contact does not transmit it. Further since AIDS is basically a sexually transmitted disease, health education can inform people of the need to make life style changes which in turn prevents its spread. In addition, Dr. Nakajima illustrates how frank health education and information campaigns in the homosexual community in developed countries have resulted in reduced infection rates. In fact, many of the people disseminating the safer sex message in the homosexual community were people living with HIV and AIDS. HIV has infected >7 million adults and children in Sub-Saharan Africa since the AIDS pandemic began. It is now spreading quickly in south and southeast Asia where at least 1 million people carry HIV. In fact, WHO believes that by the mid to late 1990s HIV will infect more Asians than Africans. Further Latin America is not HIV free and it can be easily spread there too. Heterosexual intercourse has replaced homosexual intercourse and needle sharing by intravenous drug users as the leading route of HIV transmission.
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.
The WHO Collaborative Study of Neoplasia and Steroid Contraceptives: the influence of combined oral contraceptives on risk of neoplasms in developing and developed countries.
CONTRACEPTION. 1991 Jun; 43(6):695-710.A hospital-based case-control study was conducted in 8 developing and 3 developed countries to determine whether use of combined oral contraceptives (OCs) alters risks of various cancers. An observed trend of increasing risk of invasive cervical cancer with duration of use may not represent a causal relationship and is the subject of further study. Decreased risks of ovarian and endometrial carcinomas in users likely indicate a protective effect of OCs, the degree of which was similar in developing and developed countries. A small increase in risk of breast cancer in recent and current users was found to be somewhat greater in developing countries. Both causal and noncausal interpretations of this finding have been offered. No associations were found between OCs and in situ cervical, hepatocellular, cholangio, or gallbladder carcinomas, or uterine sarcomas. However, the ability of this study to detect alterations in risks for these neoplasms in longterm users was low. (author's)
Common responsibility in the 1990's. The Stockholm Initiative on Global Security and Governance, April 22, 1991.
Stockholm, Sweden, Prime Minister's Office, 1991. 48 p.Common responsibility in the 1990s is the result of the working of the Stockholm Initiative on Global Security and Governance, which represents the interests of prominent members of 4 international commissions: the North-South Commission, established by Willy Brandt, West Germany; the Independent Commission on Disarmament and Security, established by Olaf Palme, Sweden; the World Commission on the Environment and Development or the Brundtland Commission, established by the Secretary-General of the UN; and the South Commission, established by developing countries and chaired by Julius Nyerere, Tanzania. The basic tenet of the April 22, 1991, initiative states that no nation can resolve its own problems without relying on others. The document is concerned with the following issues: peace and security which strengthens the UN and has regional security arrangements and arms trade limitations and the peace dividend; development which focuses on poverty and a conducive international environment; the environment, population, democracy, human rights; and global governance and international institutions, which provide universality in world economic cooperation, and follow in the spirit of San Francisco. Peace can be improved with a UN global emergency system and law enforcement arrangement with assured financial and organizational support, regional conferences outside Europe, monitoring world arms trade, government contributions to the peace dividend, and the commitment by the South to reduce armed forces and to invest in human development. Development has a set goal to end extreme poverty in 25 years with primary education for all children, equal participation of the sexes in education, and reduction by 33% of child mortality, and by 50% of maternal mortality. Commercial debt needs to be restructured. 1% of the gross national product is to be committed to international development. Also proposed is the levying of fees (e.g.; for carbon dioxide emissions), and promotion of more efficient use of energy resources and alternative and renewable energy replacement. Sustainable development is a primary focus. Also proposed is limiting population growth and stabilizing goals. Popular internal will to live up to human and democratic rights must be recognized by strengthening international observance of violations. The UN Security-Council, the Secretary-General, and social and economic fields must be strengthened. World summits on global governance need to continue.
[Unpublished] . 100 p. (WHO/MCH/MSM/91.6)The Maternal Health and Safe Motherhood Programme under WHO's Division of Family Health has compiled maternal mortality data in its 3rd edition of Maternal Mortality Ratios and Rates. The report contains data up to 1991. These data come from almost all WHO member countries. 1988 estimates reveal that 509,000 women die each year from causes related to pregnancy and childbirth. Most die from preventable causes such as aseptic abortions and lack of adequate health care. 4000 of these maternal deaths occur in developed countries. Thus developing countries, where 87% of the world's births occur, experience 99% of maternal deaths. In fact, the lifetime risk of death from causes related to pregnancy and childbirth in developing countries is 1:57 compared to 1:1825 in developed countries. Women in countries of western Africa have the greatest risk (1:18) and those in North America the smallest risk (1:4006). Even though the maternal mortality ratio for developing countries fell from 450-520 per 100,000 live births between 1983-1988, it increased in western African countries (700-760). This report consists mainly of tables of maternal mortality estimates for each country and in some cases certain areas of each country, for the world and various regions and subregions, and changes in maternal mortality since 1983 for the world and various regions and subregions. The world comparison table includes live births, maternal deaths, maternal mortality ratios and rates, lifetime risk, and total fertility. Country tables list year, data sources, maternal mortality ratio, indication if abortion deaths were included or not, and reference.
Weekly Epidemiological Record / Releve Epidemiologique Hebdomadaire. 1991 Nov 22; 66(47):345-8.Recent community studies and better information systems have made it possible for WHO to reassess maternal mortality and calculate new estimates. These new estimates indicate that pregnancy and childbirth are somewhat safer for women in parts of Latin America and most of Asia than they were in 1983. In Sub-Saharan Africa, however, a rise in births have resulted in an equal rise in maternal deaths. Further, it is in Sub-Saharan Africa where the only real increases in maternal mortality occurred since 1983. Thus deteriorating economic and health conditions in Sub-Saharan Africa have resulted in maternal mortality here being the worst in the world. Like in 1983, >500,000 women still die annually from pregnancy related causes and childbirth because there has been about a 7% increase in the number of births, but the risks are around 5% lower than in 1983. In developed countries, maternal mortality and number of maternal death have decreased 13% since 1983. In the Caribbean, the rise in maternal mortality is actually due to better information. In Latin America, maternal mortality in most countries, except Haiti and Bolivia, stand <200/100,000 live births. In fact, the number of maternal deaths has declined by almost 25%. A recent nationwide study in China reveals that the former maternal mortality figure of 50 was inaccurate and was actually almost 100. Except for China, however, declines in risks or pregnancy and number of deaths have occurred in all subregions of Asia. Country specific data, estimates, and explanations of how statisticians arrived at estimations appear in either 1 of 2 WHO reports entitled Maternal Mortality; A Global Factbook (US$45) and Maternal Mortality: A Tabulation of Available Information (free).
INTER-AMERICAN PARLIAMENTARY GROUP ON POPULATION AND DEVELOPMENT. BULLETIN. 1991 Dec; 8(11):1-3.The author indicts World Bank, International Monetary Fund, and overall developed country policy as responsible for Latin America's large impoverished and disenfranchised child and adolescent population. As an example of the magnitude of the problem, he notes that 1/3 of Brazil's 150 million population is comprised of youth and children. 8 million live on the streets, of which only 1 million receive official aid. Forced to fend for themselves, these youths fall into drug addiction, prostitution, and crime, suffering poor health, malnutrition, and widespread illiteracy. Many are sold, imprisoned, kidnapped, and exploited. Street children in Rio de Janeiro even suffer the added threat of being killed by the Squadrons of Death who consider the murder of juveniles a solution to delinquency. The state of affairs has deteriorated to such an extent in Peru that abandoned children are considered the most significant social problem. Argentina, Bolivia, Haiti, Honduras, Guatemala, and Nicaragua all suffer similar problems of impoverished youths, and claim some of the highest infant mortality rates (IMR) in the world. Cuba is the only country in Latin America with an IMR comparable to and often lower than many developed countries. Chile and Costa Rica follow closely behind in their achievements. Where Latin America already holds the largest gap between wealthy and poor, meeting adjustment demands of Northern economies and countries has only made conditions and inequities worse. Recession and poverty have worsened at the expense of youths. Attempting to pay down debt over the 1980s, improvements in Latin America's trade balance have gone unnoticed as the South has grown to be a net exporter of capital. Latin American nations need more than token charitable donations in times of emergency and particular duress. Development programs sensitive to the more vulnerable segments of society, and backed by the political will of developed nations, are called for. Unless constructive, supportive policy is enacted by Northern nations to help those impoverished in the South, social rebellion and continued, enhanced resistance should be expected from Latin American youths in the years ahead.
ANTIBIOTICS AND CHEMOTHERAPY. 1991; 43:1-13.Delphi techniques used by the World Health Organization predict more than 6 million cases of AIDS and millions more to be infected with HIV by the year 2000. In the absence of quick solutions to the epidemic, one must prepare to work against and survive it. The modes of HIV transmission are constant and seen widely throughout the world. Transmission may occur through sexual intercourse and the receipt of donated semen; transfusion or surgically-related exposure to blood, blood products, or donated organs; and perinatally from an infected mother to child. There are, however, 3 patterns of transmission. Pattern I transmission is characterized by most cases occurring among homosexual or bisexual males and urban IV-drug users. Pattern II transmission is predominantly through heterosexual intercourse, while pattern III of only few reported cases is observed where HIV was introduced in the early to mid-1980s. Both homosexual and heterosexual transmission have been documented in the latter populations. Significant case underreporting exists in some countries. Investigators are therefore working to find incidence rates of both infection and AIDS cases to better estimate actual present and future needs in the fight against the epidemic. Surveillance data does reveal a rapidly rising and marked number of reported AIDS cases. The cumulative number reported to the World Health Organization increased over 15-fold over the past 4 years to reach 141,894 cases by March 1, 1989. Large, increasing numbers of cases are reported from North and Latin America, Oceania, Western Europe, and areas of central, eastern and southern Africa. 70% of all reported cases were from 42 countries in the Americas. 85% of these are within the United States. Increases in the proportion of IV-drug users who are infected with HIV are noteworthy especially in Western Europe and the U.S. The epidemic in Italy is also specifically discussed.
NURSE EDUCATION TODAY. 1991 Aug; 11(4):245-7.The international aspects of midwife education are discusses: the 5 most pressing questions concerning midwife education, steps taken by world health bodies to improve midwife educationists. The most challenging issues are international health studies in all programs; including the role of WHO, and other international agencies; instruction analyzing influence of Western on developing nations; content on demographic, economic and political factors affecting health of developing countries; and how health care educationists can achieve health for all. In the light of the WHO Safe Motherhood Initiative embodied in the slogan "Health For All," midwives all over the world are committed to reduce maternal mortality 50% by 2000. ICM/WHO/UNICEF made an action statement in 1987, the World Health Assembly published a Resolution on Material Health and Safe Motherhood, and a Resolution on Strengthening Nursing Midwifery. In 1990 the Governments of 70 countries committed to safe motherhood, i.e., 50% reduction of maternal mortality, as part of the World Declaration and Plan of Action on Survival, Development and Protection of Children, at a meeting at the UN. 1990 40 midwife educationists met in Kobe, Japan at a Pre-Congress Workshop before the International Confederation of Midwives (ICM), of the WHO/UNICEF. They discussed ways to approach the 5 major causes of maternal mortality: postpartum hemorrhage, obstructed labor, puerperal sepsis, eclampsia and abortion. Each participant assessed the status of midwife education in her own country. Some of the factors affecting maternal and child health are illiteracy, low status of women, population growth, and inadequate food production and distribution. There is a shortage of midwife teachers and teaching materials, and curricula are usually based on inappropriate Western models. In Europe, midwives still have much work to do to reduce maternal morbidity.
NETWORK. 1991 Sep; 12(2):14-7, 27.Many unwanted births and pregnancies could be avoided by improving instructions for and comprehension of the use of oral contraceptives. Employed less than only the IUD, the oral contraceptive pill is the 2nd- most widely used reversible form of contraception, used by 8% of all married women of reproductive age. 6-20% of pill users, however, fall pregnant due to improper pill use. Improving instructions in the pill pack, ensuring that instructions are correct, and working to facilitate user understanding and motivation have been identified as priorities in maximizing the overall potential effectiveness of the pill against pregnancy. Since packets in developing countries may consist of pills in cycles of 21, 22, 28, or 35 days, providers must also be trained to instruct users in a manner consistent with the written instructions. Pictorial information should be available especially for semi-literate and illiterate audiences. The essay describes recommendation for instruction standardization and simplification put forth by Family Health International, and endorsed by the U.S. Food and Drug Administration. International Planned Parenthood Federation efforts to increase awareness of this issues are discussed.