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[Unpublished] . 10 p.This document presents an assessment of the health problems faced by Nigeria and describes the assistance given to Nigeria's health sector by the international agency Africare. The first section of the report provides background information about Nigeria. Section 2 describes the current state of maternal and child health and family planning (FP). Nigeria has one of the highest maternal mortality rates in the world, immunizations are not delivered effectively, FP services are weak, and large families are the norm. The third section covers HIV/AIDS which is reported at relatively low but rapidly increasing levels which could make AIDS a leading cause of death by the year 2000. Prevention efforts are made by the national AIDS program and by several nongovernmental organizations. Section 4 details the effect of river blindness, which is a serious constraint to development in Nigeria. Africare has been involved in organizing the safe administration of the drug ivermectin, which keeps onchocerciasis infection from progressing to blindness. Section 5 looks at the administration of essential drugs and notes that while Nigeria shares the problems seen in other developing countries such as poor manufacturing, irrational prescribing, and patient noncompliance, the situation is exacerbated in Nigeria by the manufacture of fake drugs. The final section outlines Africare's work in Nigeria which began in 1978 with the donation of hospital equipment and has expanded to three field offices which oversee such activities in the areas of 1) FP, 2) training programs, 3) research, 4) river blindness control, 5) village development, 6) drug storage and supply, 7) AIDS prevention, 8) agricultural development and water supply, and 9) child survival.
TIDSSKRIFT FOR DEN NORSKE LAEGEFORENING. 1991 May 30; 111(14):1729-33.The 4 cornerstones of reproductive health according to the WHO are family maternal care neonatal and infant care, and the control of sexually transmitted diseases. In recent years, the AIDS epidemic has caused concern in the world. The world's population doubled to 4 billion from 1927 to 1974, and it will reach 6 billion by the year 2000. The rate of growth is 1.4% in China and 2% in India vs. .3% in Europe. Contraceptive prevalence is 15-20% in Africa, 30% in South Asia, and 75% in East Asia. Shortage of contraceptives leads to abortion in eastern Europe. In 1985 in the USSR, there were 115.7 abortions/1000 women (mostly married) aged 15-44; and 6.4 million abortions for 5.5 million births in 1989. RU-486 or mifepristone combined with prostaglandin has produced abortion in 90% of first trimester pregnancies. After approval in France in 1987, it was used in 40,000 abortions in the following year. 90% of the estimated annual 500,000 maternal deaths occur in developing countries. In Norway, the rate is fewer than 10/100,000 births vs. 100/100,000 in Jamaica. In the mid-1980s, 26% of rural women in Thailand, 49% in Brazil, 54% in Senegal, and 87% in Morocco went without maternal care. In Norway, infant mortality is 6-8/1000 live births vs. 75-150/1000 in developing countries. A WHO investigation on causes of infertility in 25 countries found a 31% rate of tubal pathology in 5800 couples. In Africa, over 85% f infertility in women was infection related. Venereal diseases and infertility are associated with premarital sexual activity in young people. Various donor agencies and the WHO Special Program of Research, Development, and Research Training in Human Reproduction are providing help and resources including AIDS research.
WASHINGTON POST. 1991 May 14; A1, A10.The Annual Report of the UN Population Fund (UNFPA) shows an increase in contraceptive usage among married couples to 51% in 1991 from 45% in the 1980s. This provides strong evidence that family planning does work. The current world population is 5.4 billion, and increases of 85 million/year and 850 million/10 years are expected. Desired family size has also declined as reported in numerous household surveys. In Latin America and Asia, birth rates have declined from an average of 6 to 3- 4/woman. Thailand, Indonesia, and South Korea have birth rates that have dropped precipitously. In Africa, which has the highest fertility rate and the lowest rate of contraceptive usage, there was only a modest decline from 6.6 in the 1960s to 6.2 currently. The declines in family size and birth rate are viewed by a demographer at UNFPA as the result of families seeing the advantages of smaller size. In spite of declines, the rate of growth is still higher than the replacement rate and is a root cause of environmental degradation and mass poverty. Rapid growth (even with fertility reduced from 6 to 4 children/women) in the presence of increased life expectancy and lower mortality means the population will not stabilize until it reaches 10.2 billion in 1085. Stabilization requires contraceptive usage of 75% worldwide. Over the next 100 years, demographers project that the ceiling will be 12.5 billion, with increases primarily in the developing world. Slow growth means widespread use of birth control (59%) in developing countries by the 2000. Contraceptive usage is unevenly distributed. China's usage is 72%, while west Africa's is 4%. The US figures are approximately 70%. There has been greater acceptance of family planning worldwide. Only Saudi Arabia, Iraq, Cambodia, and Laos actively restrict access to family planning services. UNFPA needs to increase spending on family planning to 9 billion US dollars by the year 2000 in order to increase birth control use. The US cut off support for UNFPA, but there is hope that the funding will be restored.
[Social preconditions of founding and developing the family planning movement] Drustveni preduslovi osnivanja i razvoja pokreta planiranja porodice u svetu.
STANOVNISTVO. 1991 Jan-Jun; 18-19(1-2):245-67.Family planning, as a broader social movement, is of a recent date, although biological reproduction, as part of social reproduction, has been in the focus of human interest since the beginning of the human race. The great thinkers of the past have endeavored to find a connection between social trends and the population movement. Thus, they shaped population theories which, in the earlier stages of social development, were primarily an integral part of the economic approach towards social development. Contrary to the belief that population problems have received attention only in recent research, it has been demonstrated historically that these have attracted the attention of the great thinkers in the course of the development of human thought. Development of family planning, in its modern sense, shows that it had usually been considered as a remedy for overpopulation until the UN proclaimed it one of the basic human rights in 1966. Primary accumulation in England, implying accelerated growth of an army of the unemployed, is part of the core of the current family planning concept, the cradle of family planning in its modern sense. The Malthusian League which accepted Malthus's economic doctrine on population was founded in 1877. Reaction to their activities came at the very beginning from an ever-increasing revolutionary stream of the socialist movement. Socialist-oriented working class leaders pronounced an anathema on the Malthusian League's doctrine segments of the English society. The Neo-Malthusian leagues were founded in some European countries, but they were particularly strong in Denmark and Holland; later on, they emerged in the Far East as well. The Malthusian League held its last conference on its 50th anniversary in 1927. The First International Conference on Planned Parenthood was held in Stockholm in August 1946. "Each child has the right to be wanted by both parents and all parents have the right to decide on the number of children to be born..." is the basic message of this Conference. At this Conference, the First International Committee was established. The International Conference on Family Planning prepared by the International Committee for Family Planning, together with the National Organization for Family Planning in India, was held in Bombay in 1952. Thus, the International Planned Parenthood Federation was "born". (author's modified) (summaries in SCR. ENG)
New York, New York, United Nations Population Fund [UNFPA], . , 44 p. (Evaluation Report)UN Population Fund (UNFPA)-supported projects and programs are evaluated to provide information needed in planning, programming, and decision making. Such information helps allow the improvement of current and future program activities, greater effectiveness in utilizing UNFPA financial assistance, and country government participation in improving projects and programs. This document reports results of an evaluation of UNFPA-funded regional and country projects carried out by the WHO/Western Pacific regional office (WPRO). The evaluation was conducted by a team of 4 independent consultants and 2 UNFPA officers working on-site in China, Vietnam, Papua New Guinea, the Solomon Islands, and Fiji. Discussions were held with government officials and field staff from UNDP/UNFPA and WHO/WPRO country offices. Broadly, positive UNFPA/WPRO collaboration exists in maternal-child health/family planning, and should be continued and strengthened. WPRO execution of UNFPA-funded projects is then discussed in detail in sections covering the regional project, support to country projects, issues in WPRO/UNFPA collaboration, the role of women, and important factors affecting performance. WPRO support units and procedures are then addressed, and include personnel matters, human resource development, financial matters, supply and equipment procurement, and communication issues. Recommendations are presented in a closing section.
BMJ. British Medical Journal. 1991 Nov 9; 303(6811):1194-7.World population reached 5 billion on July 11, 1987. Current UNFPA projections predict world population stabilization at 10 billion by 2050. However, the current population is already exerting a tremendous amount of pressure on the carrying capacity of the planet. Ozone depletion, global warming, and acid rain are all the result of human activity at a level of half the current projection. World food production stabilized in 1988 and fell 5% in both 1987 and 1988. In both those years, world population grew 3.6% annually. Every year 14 million tons of grain production are lost to soil erosion, irrigation damage, poor land management, air pollution, flooding, acid rain, and increased ultraviolet radiation. Controlling population growth is not an easy task because of the complexities involved. Increasing female literacy and reducing infant mortality rates are very powerful means of controlling growth. China has served as the best example by reducing its growth rate from 4.75 in the early 70s to 2.36 in just 10 years. They accomplished this in a homogeneous society by making population control a civic duty. They provided rewards for small families and penalties for large ones. Family planning need is still very high, although it ranges from 12% in the Ivory Coast to 77% in the Republic of Korea. The UNFPA goal is to make family planning available to 59% os the world is couples by 2000. To do this, an additional US$9 billion needs to be spent which is a tiny fraction of total development aid to the 3rd world. In 1990 .9% of the total amount of development aid went to population and family planning programs.
Contraceptive source and the for-profit private sector in Third World family planning. Evidence and implications from trends in private sector use in the 1980s.
[Unpublished] 1991. Presented at the Annual Meeting of the Population Association of America, Washington, D.C., March 21-23, 1991.  p.Estimates by Family Health International and UNFPA predict that the annual cost of modern family planning in meeting the target overall contraceptive prevalence level of 52% will be between $5-9 billion by the year 2000. The number of couples using modern methods of contraception will increase dramatically in future years, incurring great cost to donors, governments, and users. Urbanization, rising incomes, and higher education levels are generally seen as positive factors in permitting an expanded private sector role in the provision of modern contraceptives, providing an alternative source to donor and government programs. The for-profit concerns within the private sector of developing countries, were studied using available 1978-89 data from 26 countries to examine private family planning sources of contraceptives. Also, hypothetical determinants of private family planning use are established and their interrelationship with the use of for-profit family planning services, is investigated. Contrary to result expectations, it was found that use of the major provider for-profit private sector is declining in the face of rising incomes, urbanization, and better education. Government services are crowding out the private sector. Additionally, results indicate a strong user desire for longer-term methods. Full comprehension of the private sector and the factors governing choice of contraceptive source should lead to more effective use of donor and government funding in efforts to achieve set population objectives. Policy and program development will more accurately reflect social needs. Policy implications of the results are discussed.
In: African research studies in population information, education and communication, compiled and edited by Tony Johnston, Aart de Zeeuw, and Waithira Gikonyo. Nairobi, Kenya, United Nations Population Fund [UNFPA], 1991. 1-12.40 couples participated in separate focus group discussions each with 10 single sex individuals either in the city of Harare, Zimbabwe or at a rural center. Researchers also conducted indepth interviews with 25 couples. The wanted to examine husband-wife communication concerning fertility management. Only younger married women, especially those in Harare, included family planning issues as topics of occasional communication. Urban young married women tended to be more educated than older and rural women. Older rural women tended to avoid discussions concerning marital interpersonal relationships. Men believed that women had much opportunity to talk and to make decisions about family welfare such as household management and child care. Yet women did not feel that they had the opportunity to discuss issues. In fact, they believed that the men made fertility decisions while the men believed these decisions were mainly up to the women. Some men did mention, like urban young married women, that ideally these decisions should be made jointly, however. Men were uncomfortable talking to the researchers about fertility management decisions. Both men and women were reluctant to discuss who initiates discussions on family planning. Basically women do not because they are afraid and men only initiate discussion when things go wrong. Women did have a tendency to use inference or indirect inference to initiate family planning discussions. For example, the neighbors' children have new school uniforms actually means they have a small family and can afford them. Women also used repetitional offhand reminders and bargaining or negotiating position. Men's fear that the male command structure within the family (the status quo) will not be maintained and women's fear that making fertility management decisions would threaten their marriage were barriers to husband-wife communication concerning family planning.
[Unpublished] . 10,  p.Based upon United Nations medium population projections, the population of developing countries will grow from 4,086 million in 1990, to 5,000 million by the year 2000. To meet this medium-level projection, 186 million contraceptive users must be added for a total 567 million in addition to increased contraceptive prevalence of 59% from 51%. This study estimates the number of contraceptive users, acceptors, and cost of contraceptive commodities needed to limit growth to this medium projection. Needs are estimated by country and method for 1990, 1995 and 2000, for medium, high, and low population projections. The number of contraceptive users required to reach replacement fertility is also calculated. Results are based upon the number of women aged 15-49, percent married, number married ages 15-49, and the proportion of couples using contraception. Estimation methodology is discussed in detail. Estimated users of respective methods in millions are 150 sterilizations, 333 IUD insertions, 663 injections, 7,589 cycles of pills, and 30,000 condoms. Estimated commodity costs will grow from $399 million in 1990 to $627 million in 2000, for a total $5.1 billion over the period. Pills will be the most expensive at $1.9 billion, followed by sterilizations at $1.4 billion, condoms $888 million, injectables $594 million, and IUDs $278 million. Estimated costs for commodities purchased in the U.S. show IUDs and condoms to be significantly more expensive, but pills as cheaper. With donors paying for approximately 25% of public sector commodity costs, developing country governments will need to pay $4.2 billion of total costs in the absence of increased commercial/private sector and donor support.
[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.
PEOPLE. 1991; 18(4):33.Never before has the World Bank (WB) spent more money than the United States Agency for International Development (USAID) on population and family planning programs (FP). The WB's budget calls for US$340 million dollars for FP compared to USAID which has budgeted US$322 million, some of which may not be allocated. The 1991 WB figure is double the 1990 of US$169 million which was an increase of 40% over the 1989 figure. Total international FP in 1989 was US$757 million including WB and USAID. In the last 25 years the US has Contributed over US$4 billion to FP. Japan contributes about 8% (they announced they will increase their spending on FP by 1.8% for 1991). Norway, Sweden, the Netherlands, Canada, Germany, and the United Kingdom each provide about 4-6% of the total. However, FP accounts for only 1.3% of all total official development assistance. In 1991 the WB has 13 new programs and loans which will be given to Nigeria and Rwanda for the 1st time. The United Nations Population Fund (UNFPA) estimates that a total of US$4.5 billion is needed by 2000 just for FP, with developing countries contributing the same amount. The US house of Representatives recently voted to increase spending with US$300 million for FP in addition to USAID's budget bringing the total up to US$400 million for 1992. Estimates suggest the US should increase spending to $600 million in 1992 and US$1.2 billion by 2000.
CONSCIENCE. 1991 Sep-Oct; 12(5):6.When IPPF was formed in 1952, its driving force was concern for women, for women's health and women's reproductive rights. 40 years on, those same issues are still at the heart of IPPF's policies and programs. Marge Berer has made a plea for a feminist approach within international family planning, and IPPF is in complete agreement that women's needs and choices should be paramount. All individuals and couples must have the basic human right to decide freely and responsible the number and spacing of their children. Women must also have the right to receive full information and counselling to choose their contraceptive method. Our secretary general, Dr. Halfdan Mahler, stresses that if family planning is to be effective, it must always begin with the individual, taking the whole issue of reproductive health into consideration. Men must share the responsibility for sexual behavior and family planning, and real equality will only be attained when women are empowered to regulate their own fertility. As nongovernmental health care organizations, IPPF's member associations offering services in 133 countries are able to work towards the principles of informed choice and voluntary family planning--even where governments may not be giving women the choices they deserve. (full text)
New York, New York, UNFPA, . 31 p.The UN Population Fund (UNFPA) knows the linkages between women's status and execution of sustainable development initiatives. This booklet has taken the next step and explains how to include women in development, especially population initiatives. Women specific projects are 1 primary approach to realize women's participation. They include projects designed to improve their situation (education, skill development, training, or economic activities) or those designed to increase awareness of women's issues among policy makers, the media, and the public. These projects are often successful in motivating women to use family planning services. The 2nd approach involves mainstreaming women into development projects in all work plan categories. This approach provides women opportunities to work with men, to draft policy, and to take part in national development and is pivotal to the long term success of population efforts. One must 1st recognize obstacles to designing projects and programs that include women, however. 1 such obstacle is few discussions with women to learn their perceptions of national priorities and needs. The booklet features how one can be an advocate for maternal-child health/family planning (MCH/FP) and information, education, and communication (IEC) programs, research, policy, planning, special programs (e.g., those that train women in environmental management), and basic data collection and analysis. For example, statistics that prove that demand for family planning services exceed supply of those services allows an advocate to promote MCH/FP programs. UNFPA also recommends a gender impact statement be prepared for all development projects. For IEC programs, it may include questions about specific cultural, legal, financial and time constraints for females in having full access to education and how a project may change these traditional obstacles.
STUDIES IN FAMILY PLANNING. 1991 Jan-Feb; 22(1):1-18.A study investigative the pros and cons of financial payments for sterilizations to clients, medical personnel, and agents who motivate and refer clients was conducted by the government of Bangladesh in conjunction with the World Bank. Results indicate that Bangladeshi men and women opt to be sterilized both voluntarily and after consideration of the nature and implications of the procedure. Clients were also said to be knowledgeable of alternate methods of controlling fertility. A high degree of client satisfaction was noted overall with, however, 25% regret among those clients with less than 3 children. Money is a contributing factor in a large majority of cases, though dominating as motivation for a small minority. Financial payments to referrers have sparked a proliferation of many unofficial, self-employed agents, especially men recruiting male sterilization. Targeting especially poor potential clients, these agents focus upon sterilization at the expense of other fertility regulating methods, and tend to minimize the cons of the process. Examples of client cases and agents are included in the text along with discussion of implications from study findings.
PLANNED PARENTHOOD IN EUROPE. 1991 May; 20(1):27-8.The Tbilisi Declaration of 13 October 1990 approved by participants at an international conference supported by UNFPA, WHO/Europe, PPF/Europe, and the Zhordania Institute is printed in its entirety. The original conference document was altered inspite of IPPF Europe Regions' protestations and final approval that the conference document remain intact. In dispute was the last sentence in the "contraception reduces abortion" section, which originally left out the modifiers and stated that with appropriate backup, simple safe inexpensive ... procedures exist for use in PHC settings. ILPPF urged government agencies to change participant's views; a position expressed and agreed with in Tbilisi. The document itself is concerned with the right to reproductive health, a major public health problem, contraception reduces abortion, and the impact of legislation. The UNFPA formal position on abortion is stated as "not a means of family planning;" government support does not imply endorsement of national policy. UNFPA is concerned with increases in the availability of family planning. Participants agreed that couples and individuals have the right to decide freely, responsibly and without coercion the number and spacing of children, the right to reproductive health, self-determination, and that every child should be a wanted child. Recognition was given to unwanted pregnancy and unsafe abortion as major public health and social problems. Also, it was recognized that abortion rates are highest in countries with weak education in FP and sexuality and constraints on women. Criminal sanctions have no impact on the abortion or birth rates, but are associated with unsafe abortion. Abortion can be reduced through family planning. There is need for 1) high quality reproductive health services that respect women's autonomy and dignity; 2) early sex education; 3) lifestyle changes to place responsibility also on men for contraception, family formation, and rearing; 4) increased government funding for service and training. Central and East Europe are in greatest need. The goal of the document was to insure life which contributes to one which is rich and joyful.
Study cites unmet world demand for contraceptives..House panel votes to increase Pop Aid funding, rescind program restrictions.
WASHINGTON MEMO. 1991 May 20; (8):1-2.In addition to increasing overseas family planning aid, the House Foreign Affairs Committee has voted to reverse restrictive policies begun during the Reagan administration. This decision comes after the publication of a UNFPA annual report entitled "The State of World Population," which indicates that the world's population could double to 10.2 billion with 60 years. Despite the Bush administration's opposition to earmarking funds for specific programs within the Agency for International Development (AID), the committee allocated funds specifically for population programs. For population assistance, it reserved $300 million for 1992 and $350 for 1993, up from $250 million the previous year. The committee also made available $100 million for family planning under the Development Fund for Africa, doubling the amount from the previous year. Besides increased funding, the committee also voted to renew funding to UNFPA and to reverse the "Mexico City" policy. In 1985, the Reagan administration ended all aid to UNFPA because the organization contributed money to China's family planning program. The administration viewed this as condoning coercive abortion practices. The Mexico City policy, named after the host city of the 1984 International Conference on Population, banned any US aid to family planning organizations in developing countries which provided abortion-related services or information, even if these programs were being funded without US money. Although just beginning to prepare its reauthorization bill, the Foreign Relations Committee in the Senate also appears ready to increase its support of population activities, including the reversal of the 2 policies. But critics of UNFPA and defenders of the Mexico City policy have threatened with a presidential veto if the measures are eventually adopted.
JOICFP NEWS. 1991 May; (203):1.The Japanese government has approved an increase in both financial and technical assistance for family planning in developing countries for FY1991. Japan's contribution to the United National Population FUnd (UNFPA) will total US$56.8 million, a 1.83% increase from the previous year, and it will be the largest donation by any country. Japanese support of UNFPA has skyrocketed from an initial contribution of US$1.5 million to today's level. Besides its multilateral assistance through UNFPA, the country will also provide bilateral technical assistance through the Japan International Cooperation Agency (JICA). Increasing by 7.8% from 1990, technical assistance will total US$8.54 million, and it will go to the following countries: Colombia, Egypt, Indonesia, Kenya, Mexico, Nepal, Peru, the Philippines, Sri Lanka, and Turkey. Japan will provide the equipment and supplies needed for transferring technical expertise from Japanese experts to personnel from the recipient countries. Japan will also host an international family planning seminar for developing countries. Japan's pledge of assistance reflects the country's desire to improve the social conditions and quality of life for people living in developing countries, and it indicated the growing awareness of the Japanese public concerning population and family planning issues.
PEOPLE. 1991; 18(1):7-8.This article attributes Sub-Saharan national population policy change to the attendance at the 2nd African Population Conference (APC) in Arusha in 1984, preliminary to attendance at the World Population Conference (WPC) in Mexico City in 1984, and the socioeconomic crises which precipitated the disparity between population growth and resources. Demographics are better understood. Family planning is now seen as reflecting traditional African values of birth spacing. Consequently countries have developed specific national policy statements. Liberia, Nigeria, Senegal in 1988, Zambia in 1989, and the Sudan in 1990, have developed comprehensive population policies in addition to those already established in Kenya and Ghana. Zaire and Zambia policies are in the process of endorsement; others formulating policy are Botswana, Burkina Faso, Cameroon, Chad, Cote d'Ivoire, Niger, Tanzania, Togo, and Zimbabwe. Policies are based on APC and WPC documents as well as the N'Djamena Plan of Action (1989). These guidelines tend to include detailed action and implementation plans, including targets for fertility reduction. Approaches to fertility reduction among specialists are still being debated. The significance of national population policy is as a public endorsement in addition to providing an analytical framework.
PEOPLE. 1991; 18(1):9-13.The World Resources Institute article provides a discussion of some of the problems facing African farmers, the interaction between population growth and environmental degradation and food production, and the solution in terms of an Environmental Action Plan (EAP) with the specific example of Rwanda. Data were based mainly on the World Bank's The Environment, Agriculture, and Environmental Nexus in Sub-Saharan Africa. The population increased 3.1% in 1980-87 from 2.6% in 1967-73. Deforestation is exceeding reforestation by a factor of 30; expansion of land under cultivation has increased to a rate of 3% a year. Africa is the only developing region with a decline in per capita food production. Yields are declining. 80% of land is affected by decertification, and the production of cereal grains lags behind population needs by 10 million tons with the projection to 2020 of 245 millions tons, an amount greater than the total world trade in cereals. A solution, for example, lies in the restoration of lost resources and increasing crop yields with better resource management techniques (reclaiming swamp land) - all in tandem with the promotion of family planning. It is also important to address the root cause of malnutrition, poor health status, low incomes and lack of educational opportunity. The integrated approach in the case of Rwanda's EAP involved multi-disciplinary groups.
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)