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Review of further developments in fields with which the Sub-Commission has been concerned. Study on traditional practices affecting the health of women and children. Final report.
[Unpublished] 1991 Jul 5. , 39 p. (E/CN.4/Sub.2/1991/6)In late 1990, representatives of the Sub-Commission on Prevention of Discrimination and Protection of Minorities of the UN Economic and Social Council's Commission on Human Rights went to Djibouti and the Sudan to explore steps the governments and women's groups are taking to eliminate traditional practices adversely affecting women and children, especially female circumcision. The missions allowed the consultants to examine the problem with women and groups directly affected by the practices and within their cultural contexts. In 1991, the Centre for Human Rights and the Government of Burkina Faso organized the first regional Seminar on Traditional Practices Affecting the Health of Women and Children which considered the effects of female genital mutilation, son preferences, and traditional delivery practices, and facilitated the exchange of information on these practices to fight and eliminate them. The UN reviewed reports from governments, nongovernmental organizations, and UN agencies on these traditional practices. All these activities led the UN to make various observations and recommendations. The degree of public awareness about the harmful effects of female circumcision, nutritional taboos, and delivery practices have improved significantly. Governments and organizations have neither studied nor dealt with son preference and its effects adequately. More African governments were willing to address the problems of traditional practices, e.g., legislation against these practices. The Centre for Human Rights, WHO, UNICEF, and UNESCO should work together more closely to effectively take action on traditional practices. The Centre needs a full time professional staff to gather information, write reports, organize seminars, distribute documents, and network with appropriate organizations. The Sub-Commission should continue to have traditional practices on the agenda to keep it in the fore. No less than two more regional seminars on the issue should take place in Africa to discuss it and increase public awareness.
Social Science and Medicine. 1991; 33(8):959-62.An investigation on the "jidda," the traditional birth attendant (TBAs) of Yemen, was undertaken in 1989 because WHO training of TBAs in Yemen was regarded to have had mixed results. Information was collected through semistructured interviews between July and November 1989 in villages in the Anis region of the central highlands of Yemen: Taalibi, Hamaan Ali, Dhi Hud, Al Mashahidhah, and Al Masna'ah. Taalibi and Hamaan Ali were two of the original training sites, at which all 16 TBAs were trained. Of these, 14 TBAs plus approximately 28 untrained TBAs and village women were selected at random and interviewed. Quantitative data on the number of deliveries made before and after the training by 7 of the TBAs were made available. The term "jidda" was designated as the appropriate Yemini Arabic name for TBA and was generally accepted within the Primarily Health Care (PHC) terminology within Yemen. The term literally means grandmother. WHO policy assumes that the training of one or two TBAs in each village will provide all women with basic mother and child health care. Initially a confusing mixture of terms was used in the villages to refer to women who assist at deliveries. These terms included references to the woman who cut the cord. A final understanding was reached that the term "jidda" will mean WHO project-trained women. Nontrained women are called "those who cut the cord." The term "jidda" as a person with specialized knowledge and experience with deliveries is not connected to traditional terms for women, who of old, assisted at deliveries. Assistance at delivery is provided by variety of kin, neighbors, and related women living proximate to the women delivering. Remuneration is the promise of rewards in the afterlife. The job is not a fulltime occupation. The delivery process is describe, and it is clear that the assistant provides emotional support and literally cuts the cord. Providing an image of professionally and specialization and the bag of instruments to a few "jidda" has lead to inequality and confusion. "Jidda" still cut the cord, and the 7 trained "jidda" have not expanded their area outside if their neighborhoods. It is suggested that training be given to midwives and that research into the local situation occur prior to training activities in order for objectives to be achieved. In this situation less sophisticated training should be given to all women assisting in deliveries.
IPPF MEDICAL BULLETIN. 1991 Jun; 25(3):1-3.The Safe Motherhood Initiative calls for improved maternity care for all women, essential obstetric services at the nearest place possible, and access to and acceptance of family planning services adapted to the needs of individual couples. Central to this effort is the midwife, who can serve as a link between community health workers and physicians. However, an International Planned Parenthood (IPPF) review of 29 countries that utilize midwives in their health systems found that half had a shortage and that a collective total of 61,000 additional midwives is needed to create a midwife:live birth ratio of 1:200. The regions with the worst ratios are generally those with lowest prenatal coverage and contraceptive prevalence rates and the highest incidence of maternal mortality. This situation could be remedied, in part, by greater utilization of auxiliary nurse midwives or specially trained traditional birth attendants. In countries where trained community health workers are permitted to distribute condoms, barrier methods, and the pill, an intermediate-level health worker should be authorized to provide injectables and IUDs. In many countries, even midwives are not permitted to provide family planning services, and their education does not include family planning content. Experiments in Indonesia, Turkey, Thailand, and the Philippines have demonstrated that midwives can be trained to insert Norplant and IUDs, and even perform sterilizations, as effectively as physicians. In Chile, a core of 300 physicians and midwives were selected for training in family planning methods and education and went on to train others. It is important that midwives themselves take the lead in restructuring and upgrading their profession and form strong partnerships with women's organizations at the grass-roots and policy-making levels.
BRITISH JOURNAL OF OBSTETRICS AND GYNAECOLOGY. 1991 Apr; 98(4):345-8.Discusses dual concerns of the Royal College of Obstetricians and Gynaecologists (RCOG): that a widening gap between obstetric standards in Britain and those in the developing world exists and that the RCOG is unable to meet the needs of Third World doctors who come to the RCOG for postgraduate study. A meeting sponsored by Birthright and held at the Royal College of Obstetricians and Gynaecologists (RCOG) in June 1989 which explored aspects of Third World obstetric care reflects these concerns. The proceedings of the meeting have been published and verbatim recordings of the discussions are available on tape from the RCOG. Reports on maternal mortality/morbidity in the Third World indicate persistence of poor obstetrical practices and of common obstetrical complications. Suggestions for improvement include the redeployment of and the replanning of services within countries and an increase in health education for women. Access to care at the first referral institution level is seen as the key to the improvement of care. Problems of transport and communication create serious obstacles to the link between community care and the first referral institution. The goal of the World Health Organization (WHO) is to cut the Third World maternal mortality in half by the year 2000. To reach this goal WHO plans to field obstetric teams in Latin America, Africa and South Asia; to train nurse-midwives to perform life saving measures on their own initiative; and to employ community resources by training indigenous midwives to function as extensions of the health team. The RCOG will sponsor training designed for doctors who will work in developing countries.