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Tanzanian Journal of Population Studies and Development. 1996; 3(1-2):1-14.In the space of two and a half decades, documentation of African rural women's work lives has moved from state of dearth to plethora. Awareness of women's arduous workday, and the importance of women agriculturists to national economies are now commonplace among African policy-makers and western donor agencies. Throughout the dramatic upheaval in African development policy of recent years, as state and market forces realign, donor agencies have consistently espoused a concern to improve the material conditions and status of rural women's working day throughout sub-Saharan Africa overwhelm donor's scattered projects directed at alleviating women's workload. The central question posed is how external donor agencies can extend beyond localized project efforts to help provide the material foundation for widespread change in women's working day of a self-determining nature. Still local in scale and last on the agenda, will measures to address women's work be elevated to a more central position in international development program efforts in sub-Saharan Africa? (author's)
[World Health Organization (WHO) eligibility criteria for oral contraceptive use. Part 2] Criterios de la OMS de elegibilidad para el uso de anticonceptivos(segunda parte).
BOLETIN INFORMATIVO. 1996 Nov-Dec; (26):4-9.New medical criteria for IUDs and barrier methods defined by the World Health Organization in 1995 to reflect development of safer methods are presented. Health conditions are classified into four categories. Category 2 conditions need not restrict use of a method but should be considered when a method is chosen. Category 3 conditions require careful consideration of the gravity of the case, the availability of alternative methods, and access to emergency services, as well as careful follow-up. Many conditions that had been considered contraindications to IUD use are no longer regarded as risk factors with copper IUDs. Use is unrestricted for women over 20, smokers, the obese, lactating women, those with a history of preeclampsia, ectopic pregnancy, epilepsy, diabetes, and many other conditions. Age under 20 and nulliparity are category 2 conditions because of the risk of expulsion. Severe menstrual bleeding, under 48 hours postpartum, uterine-cervical abnormalities not deforming the uterus, and a few other conditions are in category 2. Category 3 conditions in which risks outweigh advantages include 48 hours to 4 weeks postpartum, benign gestational trophoblastic disorders, elevated risk of HIV/AIDS or HIV infection. Category 4 conditions precluding use of IUDs include pregnancy; puerperal sepsis or septic abortion; uterine abnormality incompatible with insertion; vaginal bleeding of unknown cause; gestational trophoblastic malignancy; cervical, endometrial, or ovarian cancer; pelvic tuberculosis; and sexually transmitted disease within three months. Almost all conditions are in category 1 and none are in category 4 for use of barrier methods, but their relatively high failure rates should be kept in mind. Allergy to latex is a category 3 condition for condoms and diaphragms and history of toxic shock syndrome is a category 3 for diaphragms.
[World Health Organization (WHO) eligibility criteria for contraceptive use] Criterios de la OMS de elegibilidad para el uso de anticonceptivos.
BOLETIN INFORMATIVO. 1996 Sep-Oct; (25):8-10.Two World Health Organization expert working groups reviewing eligibility criteria for use of various contraceptive methods defined new medical criteria which were published in 1995. Contraceptive usage has increased greatly in recent decades, but many couples have no access to modern methods, in part because of overly restrictive policies of family planning programs. The reduction of estrogen doses, development of progestin-only methods, widespread use of copper IUDs and declining use of nonmedicated IUDs, and results of clinical and epidemiological studies created a need for reexamination of prescription practices. The resulting four-part classification is based on evaluation of health risks and benefits, ranging from category 1 with no restrictions, through categories 2 and 3 in which advantages exceed risks or vice versa, to category 4 in which the risk is unacceptable and the method should not be used. The study concluded that many criteria restricting use of high estrogen OCs are not applicable to low dose combined OCs. Eligibility criteria for progestin-only methods are generally less restrictive than for combined OCs. Most of the medical conditions reviewed did not contraindicate use of IUDs. The advantages of contraceptive use generally exceeded the theoretical or proven risks associated with a method, regardless of the woman’s age. Vaginal bleeding of unknown cause was considered to correspond to category 3 or 4. No restrictions on use of any method studied existed for many specific medical conditions, such as thyroid disease or epilepsy. Clinical and laboratory examinations are unnecessary if the medical history is correctly recorded. Women using hormonal methods or IUDs who are at risk of contracting sexually transmitted diseases should be advised to use condoms in addition to the regular method.
New York, New York, United Nations, 1996. iv, 218 p. (A/CONF.177/20/Rev.1)The report of the Fourth World Conference on Women held in Beijing in September 1995 contains materials on conference preparations, agenda, and proceedings. The report's first chapter presents the full texts of the Beijing Declaration and Platform for Action. The Platform includes a mission statement, sections describing the global framework and critical areas of concern, 12 strategic objectives and accompanying lists of actions to be taken by specified agencies, and descriptions of institutional and financial arrangements. The strategic objectives concern women and poverty, education and training, health, violence, armed conflict, the economy, power and decision-making, institutional mechanisms for advancement of women; human rights, the media, the environment, and the girl child. Chapter 2 provides information on pre-conference consultations, attendance, conference opening and election of officers, adoption of rules of procedure and agenda, and organization of work. Chapter 3 lists statements of conference participants and the sessions at which they occurred. The report of the main committee regarding organization of work and consideration of the draft platform for action and declaration is presented in chapter 4. Chapter 5 describes adoption of the Declaration and Platform for Action and presents the statements of reservation and interpretation made by several countries. The final three chapters concern the report of the credentials committee, adoption of the conference report, and closure.
FAMILY PLANNING NEWS. 1996; 12(2):2.This article is based on a speech presented at an International Planned Parenthood Federation (IPPF) seminar to volunteers and staff. The speech was given by the secretary general of the IPPF, Mrs. Ingar Brueggemann. She stressed that complacency was not appropriate. The concepts of sexual and reproductive health need to be implemented. IPPF must act as the conscience of the people and the voice for the underprivileged. IPPF must ensure that governments understand the concept of reproductive health and its importance. IPPF's "Vision 2000" published in 1992 emphasizes the empowerment of women, a focus on youth needs, reductions in unsafe abortion, prevention of sexually transmitted diseases, greater attention to safe motherhood, and increased programs in sexual and reproductive health. All women must have the basic right to make free and informed choices regarding their sexual and reproductive health and the satisfaction of unmet need for quality family planning services and sexual and reproductive health services, particularly for the disadvantaged groups in society. Africa has the greatest needs. Estimated maternal mortality is over 600 maternal deaths per 100,000 live births. The maternal death rate in some countries may be close to 1200 per 100,000 live births. Africa also practices female genital mutilation, and the practice is widespread. Average life expectancy is around 50 years of age. The average African modern contraceptive use rate is about 10%. Botswana, Kenya, and Zimbabwe have recently made progress in rapidly increasing the modern contraceptive use rates. Africa may also have about 66% of the world's HIV/AIDS cases. Funding will be needed to advance programs in sexual and reproductive health. However, the shift of funds from supporting one soldier would pay for the education of 100 children. The cost of one jet fighter would pay for equipping 50,000 village pharmacies.
In: Proceedings of the Expert Group Meeting on Innovative Techniques for Population Censuses and Large-Scale Demographic Surveys, The Hague, 22-26 April 1996, [compiled by] Netherlands Interdisciplinary Demographic Institute [NIDI], United Nations Population Fund [UNFPA]. The Hague, Netherlands, NIDI, 1996. 261-8.Measures must be taken to properly plan the year 2000 round of population and housing censuses. Enough time remains to propose questions which will improve the possibility of obtaining information on some population characteristics. However, collecting accurate data is only the first step in the process of census or survey taking. In order for a census to be useful, census data must be processed immediately and quickly disseminated and analyzed. Most of the programs that national and international agencies are implementing throughout the world will largely benefit the upcoming 2000 round of censuses, but only if questions are properly formulated and data quickly processed, disseminated, and analyzed. The following topics, mostly proposed by the UN, should be included in census questionnaires for most developing and some developed countries: disability, education, countries with educational registration systems, countries without educational registration systems, family structure and housing characteristics, fertility, labor force, internal and international migration, morbidity, mortality, and the special case of mortality and fertility.
New York, New York, Oxford University Press, 1996. x, 229 p.This 1996 UN Human Development Report identifies human development as an outcome of economic development. The report explores the relationship between economic growth and human development. Several findings give pause for thought. 1) Growth declined over the past 15 years in about 100 countries with almost 33% of global population. 2) Unbalanced development is occurring where there is sufficient growth but little human development or where there is good human development and little or no growth. Economic growth is needed, but an understanding of the structure and quality of growth helps determine whether poverty is reduced, the environment is protected, and sustainability is ensured. Economic decline over the past 15 years has reduced the income of 1.6 billion people. 70 countries in 1996 had less income than in 1980, and 43 countries had less income than in 1970. The declines in depth and duration far exceeded the declines of the Great Depression of the 1930s in industrialized countries. The world was more polarized. $18 trillion out of a $23 trillion gross domestic product occurred in industrialized countries. The poorest 20% of world population had their share of global income decline, from 2.3% to 1.4% in the past 30 years. The share of the richest rose from 70% to 85%. Declines and recovery occurred during various periods by region. Eastern European countries and many Arab countries suffered sharp declines during the 1980s, but African declines began in the 1970s. A turnaround in policy and political will is needed to prevent growth that is "jobless, ruthless, voiceless, rootless, and futureless." Chapter topics focus on trends, growth as a way to achieve human development, links between growth and development, and creation of employment opportunities. Special articles focus on intergenerational equity, humanizing growth, and the South African example. The report presents the 1996 statistical indicators and the balance sheets.
In: AIDS in the world II: global dimensions, social roots, and responses. The Global AIDS Policy Coalition, edited by Jonathan M. Mann and Daniel J.M. Tarantola. New York, New York, Oxford University Press, 1996. 375-89.This book chapter reports on the current state of international funding for AIDS programs in developing countries. The chapter opens by discussing the development assistance provided by the developed countries which are members of the Organization for Economic Cooperation and Development and notes that development assistance is declining and that no published summaries on development assistance provide detailed information on the allocation of funds to HIV/AIDS programs. The data for this chapter, therefore, were drawn from an international financing survey conducted for this publication. The nature of the survey and complications involved in this type of data collection are then reviewed. Adequate survey responses were received from Australia, Canada, Denmark, France, Germany, Japan, Luxembourg, the Netherlands, Norway, Sweden, the UK, and the US. The data are tabulated to display bilateral, multilateral, combined multi- and bilateral, and total funding. To reveal the trends exhibited by the major donors and to track funds donated to developing countries, tables present 1) total contributions to the Global AIDS Strategy for 1986-93 according to these funding channels, 2) multilateral contributions by country for 1987-93, 3) multi- and bilateral contributions by country for 1987-93, and 4) bilateral contributions for 1986-93. Pie charts show donor contributions by country and recipient countries. The increase in World Bank loans for HIV/AIDS prevention and care is covered as is the reduced supply of donors, increasing demand for development assistance, and evidence of donor fatigue. It is concluded that it will be critical for the UN AIDS Program to improve the financial accountability of both donor and recipient countries so that HIV/AIDS resources can be evaluated. Unless this occurs, such resources will likely continue to decline in proportion to needs.
CONTRACEPTION. 1996 Jan; 53(1):1-7.In the year 2000, world population will exceed 6200 million and life expectancy will be over 68 years. The UN population projections for the coming 20 years after 1996 range from a low of 7100 million to a high of 7800 million. Between 1950 and 1992, in developing countries, life expectancy at birth increased by 29 years in China, by 24 years in India and Indonesia, by 21 years in Bangladesh, and by 16 years in Brazil. The gender difference in life expectancy is only 1 year in India, but 6 years in a number of developed countries. Corresponding increases in Australia were from 12.2 to 14.7 years for men and from 14.9 to 18.8 years for women. By the year 2025, the UN projects that the elderly (65 years and older) will constitute 10% of the population in Asia and more than 20% in North America and Europe, whereas 1.8% of the population of Asia, 4.6% of North America, and 6.4% of Europe will be very old (80 years and older). By the year 2030, there may be 1200 million postmenopausal women around the world, 76% of them in the developing countries. During the period 1990-2025 the elderly population of Sweden will increase by 33%, whereas that of Indonesia will increase by 414%. Between 2000 and 2100, the global population aged 15 years or younger will gradually decrease from 31.4% to 18.3%, while the population aged 65 and over will increase from 6.8% to 21.6%. The persistence of poverty in developing countries combined with aging poses a formidable challenge because the majority of old people receive little special support. The epidemiological dimension of aging embraces mortality and morbidity. Each year 39 million people die in the developing world mainly from infectious and parasitic diseases, noncommunicable and communicable diseases, and injuries. In the developed countries 11 million die primarily from cardiovascular diseases and malignant neoplasms. In the developing countries noncommunicable diseases represent 87% of the disease burden resulting in increased isolation of the elderly. The ethical dilemma facing health care is poverty among the elderly.
SCIENCE. 1996 Jun 28; 272:1855.There are an estimated 21 million people infected with at least one of the 10 known subtypes of HIV worldwide, with more than 8500 people newly infected daily. The US Centers for Disease Control and Prevention estimate that 40,000 US citizens became infected last year with HIV. In heavily affected countries in Africa and Asia, where 33% of urban adults may be infected, AIDS deaths among young and middle-aged adults are threatening health systems, economies, and national stability. Global travel facilitates the spread of HIV worldwide. For the first time, however, a number of developing countries are registering a drop in new HIV infections, suggesting that prevention efforts focused upon safer sexual and drug-related behavior are working. Recent scientific breakthroughs are encouraging. Combination therapy with antiretroviral drugs may be able to not only defer the progression of disease and improve the quality of life, but turn HIV infection into a chronic nonprogressive condition. Furthermore, it has been determined that zidovudine can interrupt mother-to-child transmission of HIV. Research, however, remains central to preventing future HIV transmission. The development of accessible vaccines and vaginal microbicides are especially needed. The author notes that although 90% of HIV infections worldwide are in developing countries, AIDS intelligence and research and development are overwhelmingly concentrated in the industrialized world. In this context, efforts must be made to ensure the development of vaccines and therapies which are accessible and effective against AIDS in the developing world. The new Joint United Nations Program on HIV/AIDS (UNAIDS) has an important role to play in establishing a much needed partnership between developing and developed countries.