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[Child health in the states of Ceara, Rio Grande do Norte and Sergipe, Brazil: description of a methodology for community diagnosis] A saude das criancas dos estados do Ceara, Rio Grande do Norte e Sergipe, Brasil: descricao de uma metodologia para diagnosticos comunitarios.
Revista de Saude Publica / Journal of Public Health. 1991 Jun; 25(3):218-25.From 1987 to 1989, UNICEF collaborated with state and municipal health organs of the Brazilian states of Ceara (C), Rio Grande do Norte (R), and Sergipe (S) in order to realize a community diagnosis of maternal-child health care. The estimation of mortality required investigating women aged 15-49 visiting 8000 households, examining 4513 children <3 years old. In R and S, a sample of 1000 children <5 was used to estimate most common health problems. In these states, 1920 households were visited, and a questionnaire served for collection of demographic and socioeconomic data. Children were weighed, and a modified AHRTAG anthropometer served for measuring body length. About 1/4 to 1/3 of children were first-born. In C, 19.3% of children were seventh-born or higher, almost double the rate of the other 2 states. Income, literacy rate of parents, living conditions, and availability of running water indicators were much worse in C. 34.8% of the women in C had not received prenatal care; this figure was 15.7% in S an R, respectively. In C, only 24.3% of the mothers had received 6 or more prenatal care checkups vs. about 1/2 in the other states. Hospital deliveries reached 64.8% in C vs. almost 90% in the other states. In C, breast feeding was more prevalent: 83% were breast feeding for 1 month and 27.1% for 12 months. Malnutrition indicated by height and age was 27.6% in C vs. 16.1% in S and 14/2% in R. There was a clear association between family income and nutritional deficits of height/age and weight/age indicators. In C, malnutrition was higher in all income groups. Diarrhea incidence was 12% in C vs. 7.3% in S and 6/4% in R. A lower percentage used rehydration in C. 9.9% of children in C had been hospitalized in the previous 12 months vs. 6.2% in S and 6.9% in R. Coughing, fever and respiratory difficulties ran to 8.6% in C. Only 42.4% had full vaccination in C vs. 61.7% in S and 71.3% in R. 30/5% had been weighed in C in the previous 3 months vs. 45.1% in S and 44.2% in R.
Improving food security at household level; government, aid and post-drought development in Kordofan and Red Sea Hills.
In: To cure all hunger. Food policy and food security in Sudan, edited by Simon Maxwell. London, England, Intermediate Technology Publications, 1991. 218-31.The question whether government, assisted by aid, is capable of targeting interventions to those lacking food security is examined. Food security is a general concept which includes security against seasonal fluctuations, long-term declines in the natural resource base, and economic conditions which lead to destitution. Food security is analyzed at individual, household, community, regional, national, and international levels. Household interventions are also concerned with intra-household distribution and the level of community security. Food-insecure rural women and children in marginal drought-prone areas were the focus of programs funded by UNICEF in Sudan: the Joint Nutrition Support Project (JNSP) in Red Sea Hills (1983-88) and the Integrated Women's Development Program (IWDP) in Kordofan (1987-91). These multi-sectoral programs were carried out by departments of regional and provincial government along with the reactions to famine. In both Kordofan and Red Sea Hills extreme poverty is widespread, with high vulnerability to food insecurity which is even higher in Red Sea Hills. In Red Sea Hills, UNICEF/WHO had negotiated the 5-year JNSP to cover the province just as the famine broke in 1983/84. In Kordofan, UNICEF collected baseline data on such indicators and then returned after a two-year period to communities originally surveyed for monitoring. In Red Sea Hills, JNSP's target population were the food-insecure nomads. The Department of Health structure became sufficiently strong, at least partly due to 5 years of investment and development of primary health care personnel under JNSP. The department represents the best administrative mechanism in the province for the development of famine early-warning systems. Many food-security measures in Red Sea Hills are experimental and wrought with difficulty, thus the existence of a relatively strong administration will favor a food security strategy based on primary health care interventions.
Environmental and project displacement of population in India. Part I: Development and deracination.
UFSI FIELD STAFF REPORTS. 1991; (14):1-16.Official development projects in India have displaced at least 20 million persons since Indian independence in 1947, and the majority have not been relocated in planned resettlement. India is in a race to implement development projects needed to support the growth of its population, which increased from 361 million in 1951 to 840 million in 1990. Through the 1960s and 1970s about 1/4 of these oustees were minimally resettled and the rest had to find their own way to get reestablished. There is no international consensus on the rights of internally displaced persons, but most countries compensate people. Agricultural labor and construction labor are the most common types of work of the landless oustees. 1,589 large dams built since independence ousted the largest number of people. Dams, reservoirs, and canals displaced 11,000,000 people; 2,750,000 were rehabilitated and 8,250,000 found their own way. Mines displaced 1,700,000; 450,000 were rehabilitated and 1,250,000 found their own way. Industries displaced 1,000,000; 300,000 were rehabilitated and 700,000 found their own way. Parks and sanctuaries displaced 600,000; 150,000 were rehabilitated and 450,000 relocated on their own. Other projects displacing people are forest preserves, wildlife sanctuaries, military installations, weapons testing grounds, nuclear installations, and railroads and roads. The World Bank requires compensation for people displaced by 12 dam projects it is funding in India: the underestimated count is 610,500 persons. The Pong Dam, a 130 m high gravel dam, under the western Himalayas ousted 30,330 families, about 167,000 people, but only 16,001 families were found eligible for compensation. The Subarnarekha Project in southern Bihar is displacing 10,000 families, about 55,000 people. The state government estimates that 35% of these will not settle in suggested relocation sites because land is not available.
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.
POPULATION RESEARCH ABSTRACT. 1991 Dec; 2(2):3-11.An overview, objectives, implementation, and research and evaluation studies of 2 India Population Projects in Karnataka are presented. The India Population Project I (IPP-I) was conducted in Karnataka and Uttar Pradesh. India Population Project III (IPP-III) took place between 1984-92 in 6 districts of Karnataka: Belgaum, Bijapur, Dharwad, Bidar, Gulbarga, and Raichur, and 4 districts in Kerala. The 6 districts in Karnataka accounted for 36% (13.2 million) of the total national population. The project cost was Rs. 713.1 million which was shared by the World Bank, and the Indian national and regional government. Due to poor past performance, these projects were undertaken to improve health and family welfare status. Specific project objectives are outlined. IPP-I included an urban component, and optimal Government of India program, and an intensive rural initiative. The urban program aimed to improved pre- and postnatal services and facilities, and the family planning (FP) in Bangalore city. The rural program was primarily to provide auxiliary nurse-midwives and hospitals and clinics, and also supplemental feeding program for pregnant and nursing mothers and children up to 2 years. The government program provided FP staff and facilities. IPP-I had 3 units to oversee building construction, to recruit staff and provide supplies and equipment, and to establish a Population Center. IPP-III was concerned with service delivery; information, education, and communication efforts (IEC) and population education; research and evaluation; and project management. Both projects contributed significantly to improving the infrastructure. A brief account of the types and kinds of studies undertaken is given. Studies were grouped into longitudinal studies of fertility, mortality, and FP; management information and evaluation systems for health and family welfare programs; experimental strategies; and other studies. Research and evaluation studies in IPP-III encompassed studies in gaps in knowledge, skills, and practice of health and FP personnel; baseline and endline surveys; and operational evaluation of the management information and evaluation system; factors affecting primary health care in Gulbarga district; evaluation of radio health lessons and the impact of the Kalyana Matha Program; and studies of vaccination and child survival and maternal mortality. Training programs were also undertaken.
POPULATION. 1991 Aug; 17(8):1.UNFPA's Governing Council has authorized the Fund to spend up to US$201.3 million during 1992 on programs designed to strengthen the Fund's programs and country programs assisted by the Fund. The Council also adopted a resolution in support of the UNFPA 1992-95 intercountry program, as well as regional programs in sub-Saharan Africa, the Arab States and Europe, Asia and the Pacific, and Latin America and the Caribbean. Furthermore, the Council also gave approval to 15 country and sub-regional programs in the following places: Albania, Bangladesh, Bolivia, Burkina Faso, Cape Verde, Congo, Dominican Republic, Honduras, India, Malaysia, Mauritania, Morocco, Niger, Tunisia, and the English-speaking Caribbean sub-region. One of the resolutions adopted by the Council calls for an increase in the number of staff members active in the Fund's field activities. This resolution establishes 7 new posts for international professionals and 90 new regular posts. The Council also called for increased cooperation with other international agencies. Another significant decision, the Council has allocated US$130.3 million (or a sum not to exceed 13.8% of programmable resources) for technical support, administrative, and operational services for 1992-95. The Council praised UNFPA's efforts at promoting awareness of the connections between population, the environment, and development, Moreover, the Council has asked the Fund to help set up contraceptive factories in individual countries for the purpose of containing the spread of AIDS. Finally, the Council discussed funding for the 1994 International Conference on Population.
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: Korean experience with population control policy and family planning program management and operation, edited by Nam-Hoon Cho, Hyun-Oak Kim. [Seoul], Korea, Republic of, Korea Institute for Health and Social Affairs, 1991 Sep. 311-27.The Korean experience with collaboration in family planning (FP) is explored in this chapter. Attention is paid to the nature of the decision, external resources (International Planned Parenthood Federation (IPPF) in detail and the following in brief: the UN Economic and Social Commission (UNECOSOC) and the UN Fund for Population Activities (UNFPA), the Population Council of New York (PC), the Swedish International Development Authority (SIDA), the US Agency for International Development (USAID), and the Japanese Organization for International Cooperation (JOICFP)). Suggested criteria for FP projects include, community concern, prevalence, seriousness of unmet need, and manageability, but with external collaboration, consideration should be given to whether domestic resources are insufficient, the priorities of potential donors, expected problems with compliance with the grant, and government commitment to the project. External collaboration can take the form of moral support, technical cooperation, or financial support. The nature of the project as well as the expected achievements of the project need to be identified. Resources may be manpower, facilities, commodities, money, and/or time. The Korean experience with IPPF began with a visit by IPPF in 1960. In 1961, the Planned Parenthood Federation of Korea (PPFK) was accepted as a member of IPPF. Support which began in 1961 has reached over 16 million dollars cumulatively. At present about 25% of support for FP comes form IPPF. The author's experience as a representative of PPFK to IPPF and other groups is described. Tables provide information on commodities supplied by year and dollar amount, and allotment of UNFPA Assistance to Ministries and Institutions between 1973-86 by the number of projects and the dollar amount; types of program activity and dollar amount from UNFPA is also provided.
INTEGRATION. 1991 Sep; (29):6-7.Providing resources for family planning programs in the USSR, where an extremely high rate of abortions threatens the lives of women, will require a multi-sectoral approach involving the government, international agencies, and the private sector. Every year, some 10-13 million of the USSR's 70 million women of fertile age undergo an abortion (only 7 million of the abortions every year are considered legal). A recent report indicates that only 15-18% of Soviet women have not had at least one abortion in their lifetimes. A result of the high rate of illegal abortions, morbidity and mortality affects many Soviet mothers. Additionally, infant mortality rates is as high as 58.5% in some areas of the USSR, a figure similar to that found in developing countries. Knowledge of modern contraception is high, but use remains low. This is due primarily to the lack of contraceptive availability. IUD's injectables, implants, and oral contraceptives are scarce. And even when oral contraceptives are available, few women opt for this method, due to the rampant misinformation and exaggeration concerning its side-effects. While the USSR does produce condoms, their quality is poor. Part of the solution to the lack of available contraception rests in the transition to a market economy. As the demand for these services increases, the market will begin meeting this demand. The government also has a important role to play, which includes the provision of information, medical and paramedical education, sex education, and service delivery. And international agencies will need to provide the necessary technical assistance.
Washington, D.C., Population Crisis Committee, 1991. 52 p.Noting that US population assistance programs have suffered from ideological controversies and increasing bureaucratization, this publication outlines the actions needed to reinvigorate and redirect US population assistance programs, including the Agency for International Development (AIDS), the largest financial assistance provider and condom supplier to developing countries. The extent of family planning during the 1990s will have a definite impact on the years to come, since this decade represents the last opportunity to prevent the doubling of the world's population before it stabilizes during the 21st century. An example of the ideological controversies, the Reagan administration, prompted by anti-abortion groups, withdrew support from the UNFPA and the International Planned Parenthood Federation (IPPF). The publication makes recommendations at 3 levels -- for the President and Congress, for AID, and for the Office of Population. Recommendations for the President and Congress include: reasserting White House leadership on world population issues; increasing population assistance to $1.2 billion by the year 2000; resuming funding to the UNFPA and IPPF; and eliminating statutory restrictions relating to abortion. Concerning AID, the publication urges: broadening its birth control approach to include injectable contraceptives, safe abortion services, and adolescent and female education programs; increasing contraceptive distribution; improving quality of services; etc. Recommendation for the Office of Population include: taking responsibility for providing technical support to AID's country level population programs; coordinating the activities of private institutions and AID activities; and stressing long-term institution building needs of family planning programs.
INTER-AMERICAN PARLIAMENTARY GROUP ON POPULATION AND DEVELOPMENT. BULLETIN. 1991 Jan; 8(1):1-3.Calling for renewed activity to ensure equality between men and women in Latin America, the author designates the UN Convention on the Elimination of All Forms of Discrimination Against Women as the legal standard for equality. Although all Latin American constitutions include provisions of equal rights for men and women, these countries still adhere to a patriarchal society. Cultural forces leave women in a subordinate position within the family, the workplace, education, and politics. Not only does the current economic crisis make it difficult to fund programs to improve the social conditions of women, many politicians have no sincere commitment to doing so. Nonetheless, all Latin American Countries have ratified the Convention (adopted in 1979), which recognizes the fundamental rights of women and provides a basis for international law. This principle calls for absolute equality between men and women, and requires that the signatories work towards achieving that goal. The signatories must incorporate the principle of equality in all government sectors and in all development plans. The Convention also requires governments to create a special office or ministry of women's affairs. This office is in charge of monitoring and promoting change to achieve the following: equal representation in government offices, equal participation in the workforce (including executive positions), an end to social and cultural stereotypes, and a guarantee of reproductive rights. Although many obstacles remain in the way of achieving equality, the Convention can serve as a tool for achieving that goal.