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American Journal of Public Health. 2008 Oct; 98(10):1737.The 1994 Cairo International Conference on Population and Development helped governments, the organs and agencies of the United Nations system, and nongovernmental organizations move beyond the confines of traditional family planning approaches. This watershed event fostered and defined subsequent international and national reproductive and sexual health policies and programs as well as global efforts to realize reproductive and sexual rights. However, moving beyond history, or the "archeology of Cairo" (as a participant at a meeting I recently attended called it), are we now simply using the language of the Cairo conference with little attention to the conceptual and operational implications of its words? Has the politically charged notion of rights with its attendant government responsibility and accountability succumbed to the less controversial notion of health? As the public health community recognized even before the Cairo consensus, barriers to reproductive and sexual health operate on a number of levels-including legal, social, cultural, political, financial, attitudinal, and practical -- and interact in complex ways. What rights add to this mix is a framework for programming and for action and a legal rationale for government responsibility-not only to provide relevant services but also to alter the conditions that create, exacerbate, and perpetuate poverty, deprivation, marginalization, and discrimination as these affect reproductive and sexual health. By fixing attention on the responsibility and accountability of governments to translate their international-level commitments into national and subnational laws, policies, programs, and practices that promote and do not hinder reproductive and sexual health, the actions of governments are open to scrutiny to determine their influences-both positive and negative-on reproductive and sexual health, including barriers that affect the availability, accessibility, acceptability, and quality of reproductive and sexual health services, structures, and goods. Despite the framework that the Cairo conference helped put into place, work falling under the rubric of reproductive and sexual rights now includes everything from the provision of abortion services to the reduction of maternal mortality -- as though simply working on these issues is equal to working on rights. Consequently, one has to ask this: Are reproductive, and even sexual, rights becoming synonymous with reproductive, and sexual, health? Those who understand their work to be in the area of reproductive and sexual rights sorely need to discuss whether their efforts are aligned with the politics that underlie the words of the Cairo conference or whether, bluntly speaking, the politics are a historical artifact and it is simply time to move on. Bringing the political back into reproductive and sexual rights would require going beyond the technical dimensions of addressing reproductive and sexual health issues to the application of the norms and standards that are engaged by a human rights discourse. This includes attention to the basics of reproductive and sexual rights: the efforts that exist to ensure the sustained participation of affected communities; how discrimination that affects both vulnerability to ill health and access and use of services is being tackled; the extent to which any legal, political, and financial constraints are being addressed; how rights considerations are brought into policy and program design, implementation, and evaluation; and the existence of mechanisms that require government as well as intergovernmental and nongovernmental institution accountability. And so yes, in a word, words do matter. And they matter for the actions they inspire. (full-text)
Cambridge, Massachusetts, Belknap Press, 2008. xiv, 521 p.Rather than a conspiracy theory, this book presents a cautionary tale. It is a story about the future, and not just the past. It therefore takes the form of a narrative unfolding over time, including very recent times. It describes the rise of a movement that sought to remake humanity, the reaction of those who fought to preserve patriarchy, and the victory won for the reproductive rights of both women and men -- a victory, alas, Pyrrhic and incomplete, after so many compromises, and too many sacrifices. (Excerpt)
In: SexPolitics: Reports from the front lines, edited by Richard Parker, Rosalind Petchesky and Robert Sember. [Rio de Janeiro, Brazil, Associacao Brasileira Interdisciplinar de AIDS (ABIA), Sexuality Policy Watch, 2008]. 277-309.Globally, both the disjunction between sexual and reproductive health and HIV/AIDS, and the fact that HIV/AIDS has taken over the political and funding agenda, are well noted. A recent editorial in the journal, Reproductive Health Matters, summed up this trend, noting that although HIV/AIDS has been with us for more than two decades, "now, suddenly, following rapid shifts in political leadership, priority setting, power brokering, and funding policies in international health and development circles, it is widely considered an unassailable fact that in the global 'competition' for resources and attention, sexual and reproductive health has less priority and has lost out to AIDS, as if addressing the one had no connection with addressing the other". Has this trend been realized in Vietnam? If so, what are some of the factors that have shaped this trend and which of its characteristics should Vietnam take into account moving forward? (excerpt)
Sexual and reproductive health of women living with HIV / AIDS. Guidelines on care, treatment and support for women living with HIV / AIDS and their children in resource-constrained settings.
Geneva, Switzerland, WHO, 2006.  p.The sexual and reproductive health of women living with HIV/AIDS is fundamental to their well-being and that of their partners and children. This publication addresses the specific sexual and reproductive health needs of women living with HIV/AIDS and contains recommendations for counselling, antiretroviral therapy, care and other interventions. Improving women's sexual and reproductive health, treating HIV infections and preventing new ones are important factors in reducing poverty and promoting the social and economic development of communities and countries. Sexual and reproductive health services are uniquely positioned to address each of these factors. (excerpt)
Geneva, Switzerland, WHO, 2007. 8 p. (WHO/RHR/07.7)Faced with the challenge of putting into practice the ideals of the Millennium Development Goals, the International Conference on Population and Development (ICPD), and other global summits of the last decade, decision-makers and programme managers responsible for sexual and reproductive health ask how they can: improve access to and the quality of family planning and other sexual and reproductive health services; increase skilled attendance at birth and strengthen referral systems; reduce the recourse to abortion and improve the quality of existing abortion services; provide information and services that respond to young people's needs; and integrate the prevention and treatment of reproductive tract infections, including HIV/AIDS, with other sexual and reproductive health services. (excerpt)
Obstetrics and Gynecology. 2007 Nov; 110(5):999-1002.Family planning plays a pivotal role in population growth, poverty reduction, and human development. Evidence from the United Nations and other governmental and nongovernmental organizations supports this conclusion. Failure to sustain family planning programs, both domestically and abroad, will lead to increased population growth and poorer health worldwide, especially among the poor. However, robust family planning services have a range of benefits, including maternal and infant survival, nutrition, educational attainment, the status of girls and women at home and in society, human immunodeficiency virus (HIV) prevention, and environmental conservation efforts. Family planning is a prerequisite for achievement of the United Nations' Millennium Development Goals and for realizing the human right of reproductive choice. Despite this well-documented need, the U.S. contribution to global family planning has declined in recent years. (author's)
In: The global family planning revolution: three decades of population policies and programs, edited by Warren C. Robinson and John A. Ross. Washington, D.C., World Bank, 2007. 155-174.In Jamaica, as in many countries, the pioneers of family planning were men and women who sought to improve the well-being of their impoverished women compatriots, and who perhaps were also conscious of the social threats of rapid population growth. When, eventually, population control became national policy, the relationship between the initial private programs and the national effort did not always evolve smoothly, as the Jamaican experience shows (see box 10.1 for a timeline of the main events in relation to family planning in Jamaica). A related question was whether the family planning program should be a vertical one, that is, with a staff directed toward a sole objective, or whether it should be integrated within the public health service. These issues were not unique to Jamaica, but in one respect Jamaica was distinctive: it was the setting for the World Bank's first loan for family planning activities. Family planning programs entailed public expenditures that were quite different from the infrastructure investments for which almost all Bank loans had been made, and the design and appraisal of a loan for family planning that did not violate the principles that governed Bank lending at the time required a series of decisions at the highest levels of the Bank. These decisions shaped World Bank population lending for several years and subjected the Bank to a good deal of external criticism. For that reason, this chapter focuses on the process of making this loan. (excerpt)
Program scan matrix on child marriage: A web-based search of interventions addressing child marriage.
[Washington, D.C.], International Center for Research on Women [ICRW], . 25 p.The international community and U.S. government are increasingly concerned about the prevalence of child marriage and its toll on girls in developing countries. One in seven girls in the developing world marries before 15. Nearly half of the 331 million girls in developing countries are expected to marry by their 20th birthday. At this rate, 100 million more girls-or 25,000 more girls every day-will become child brides in the next decade. Current literature on child marriage has primarily examined the prevalence, consequences and reported reasons for early marriage. Much less has been analyzed about the risk and protective factors that may be associated with child marriage. Also, little is known about the range of existing programs addressing child marriage, and what does and does not work in preventing early marriage. The work presented here investigates two key questions: What factors are associated with risk of or protection against child marriage, and ultimately could be the focus of prevention efforts? What are the current programmatic approaches to prevent child marriage in developing countries, and are these programs effective? (excerpt)
Improving access to quality care in family planning: WHO's four cornerstones of evidence-based guidance.
Journal of Reproduction and Contraception. 2007 Jun; 18(2):63-71.The four cornerstones of guidance in technique service of family planning are established by WHO based on high quality evidences. They have been updated according to the appearing new evidences, and the consensuses were reached by the international experts in this field. The four documents include Medical Eligibility Criteria for Contraceptive Use, Selected Practice Recommendations for Contraceptive Use, Decision-making Tool for Family Planning Clients and Providers and The Global Handbook for Family Planning Providers. The first two documents mainly face to the policy-makers and programme managers and were treated as the important references for creating the local guideline. The other two documents were developed for the front-line health-care and family planning providers at different levels, which include plenty of essential technical information to help providers improve their ability in service delivery and counselling. China paid great attention to the introduction and application of WHO guidelines. As soon as the newer editions of these documents were available, the Chinese version would be followed. WHO guidelines have been primarily adapted with the newly issued national guideline, The Clinical Practical Skill Guidelines- Family Planning Part, which was established by China Medical Association. At the same time, the WHO guidelines have been introduced to some of the clinicians and family planning providers at different levels. In the future, more special training courses will be introduced to the township level based on the needs of grass-root providers. (author's)
Targeting access to reproductive health: Giving contraception more prominence and using indicators to monitor progress.
Reproductive Health Matters. 2007 May; 15(29):186-191.Unmet need for contraception represents a major failure in the provision of reproductive health services and reflects the extent of access to services for spacing and limiting births, which are also affected by personal, partner, community and health system factors. In the context of the Millennium Development Goals, family planning has been given insufficient attention compared to maternal health and the control of sexually transmitted infections. As this omission is being redressed, efforts should be directed towards ensuring that an indicator of unmet need is used as a measure of access to services. The availability of data on unmet need must also be increased to enable national comparisons and facilitate resource mobilisation. Unmet need is a vital component in monitoring the proportion of women able to space and limit births. Unmet need for contraception is a measure conditioned by people's preferences and choices and therefore firmly introduces a rights perspective into development discourseand serves as an important instrument to improve the sensitivity of policy dialogue. The new reproductive health target and the opportunity it offers to give appropriate attention to unmet need for contraception will allow the entry of other considerations vital to ensuring universal access to reproductive health. (author's)
Evaluation of the World Health Organization's family planning decision-making tool: Improving health communication in Nicaragua.
Patient Education and Counseling. 2007 May; 66(2):235-242.The World Health Organization has led the development of a Decision-Making Tool for Family Planning Clients and Providers (DMT) to improve the quality of family planning counseling. This study investigates the DMT's impact on health communication in Nicaragua. Fifty nine service providers in Nicaragua were videotaped with 426 family planning clients 3 months before and 4 months after attending a training workshop on the DMT. The videotapes were coded for both provider and client communication. After the intervention providers increased their efforts to identify and respond to client needs, involve clients in the decision-making process, and screen for and educate new clients about the chosen method. While the DMT had a smaller impact on clients than providers, in general clients did become more forthcoming about their situation and their wishes. The DMT had a greater impact on sessions in which clients chose a new contraceptive method, as compared with visits by returning clients for a check-up or resupply. The DMT proved effective both as a job aid for providers and a decision-making aid for clients, regardless of the client's level of education. Job and decision-making aids have the potential to improve health communication, even or especially when clients have limited education and providers have limited training and supervision. (author's)
WHO training course for TB consultants: RPM Plus drug management sessions in Sondalo, Italy, September 28 - October 1, 2006: trip report.
Arlington, Virginia, Management Sciences for Health, Center for Pharmaceutical Management, Rational Pharmaceutical Management Plus, 2006 Oct 18. 26 p. (USAID Cooperative Agreement No. HRN-A-00-00-00016-00; USAID Development Experience Clearinghouse DocID / Order No. PN-ACI-323)WHO, Stop-TB Partners, and NGOs that support country programs for DOTS implementation and expansion require capable consultants in assessing the capacity of countries to manage TB pharmaceuticals in their programs, developing interventions, and providing direct technical assistance to improve availability and accessibility of quality TB medicines. Beginning in 2001, RPM Plus, in addition to its own formal courses on pharmaceutical management for tuberculosis, has contributed modules and facilitated sessions on specific aspects of pharmaceutical management to the WHO Courses for TB Consultants in Sondalo. The WHO TB Course for TB Consultants was developed and initiated in 2001 by the WHO Collaborating Centre for Tuberculosis and Lung Diseases, the S. Maugeri Foundation, the Morelli Hospital, and TB CTA. The main goal of the course is to increase the pool of international level TB consultants. As of December 2005, over 150 international TB consultants have participated in the training, a majority ofwhom have already been employed in consultancy activities by the WHO and international donors. In 2006 fiscal year RPM Plus received funds from USAID to continue supporting the Sondalo Course, which allowed RPM Plus to facilitate sessions on pharmaceutical management for TB at four courses in May, June, July, and October of 2006. RPM Plus Senior Program Associate, Edgar Barillas, traveled to Sondalo from September 28 to October 1 to facilitate the TB pharmaceutical management session at the WHO course for TB Consultants in Sondalo, Italy. (excerpt)
Notes from the Field. 2001 Sep; (9): p..Representatives from the Asociación Pro-Bienestar de la Familia Colombiana (PROFAMILIA) in Colombia visited the Family Guidance Association of Ethiopia (FGAE) in the second half of a technical assistance exchange project. FGAE is expanding its institutional focus from family planning to sexual and reproductive health with a special emphasis on young people. Representatives from the Family Guidance Association of Ethiopia (FGAE) and the IPPF Africa Regional Office visited PROFAMILIA/Colombia in March 2001 to see PROFAMILIA's youth programs and services first-hand. The exchange was the first half of a technical assistance project that is funded by the IPPF "i3" Youth Program (Innovate, Indicate, Inform). IPPF/WHR had identified PROFAMILIA as a "best practices" FPA which could offer its expertise in developing youth programs to the FPA in Ethiopia. Zhenja, the IPPF/WHR Communications Manager, was there to facilitate the visit and identify needs for technical assistance. (excerpt)
China: Helping the People's Republic of China introduce a gender perspective in its 'reoriented' family planning program.
Notes from the Field. 2001 Aug; (8): p..International Planned Parenthood Federation, Western Hemisphere Region staff traveled to China to provide technical assistance to the Ford Foundation project "Gender Perspective in Quality of Care in Family Planning." They reviewed some basic concepts of gender and quality, and then examined the six instruments in the manual that is being adapted for China. In July 2001, Judith H., director of IPPF/WHR's Sexual and Reproductive Health Unit, visited with members of the China Population Information and Research Center and the All-China Women's Federation in Beijing to provide technical assistance to the Ford Foundation-supported project, "Gender Perspective in Quality of Care in Family Planning." (excerpt)
Notes from the Field. 2001 Jul; (6): p..International Planned Parenthood Federation, Western Hemisphere Region staff visited Belize in June 2001 to work with the Belize Family Life Association (BFLA) on sustainability and management aspects of its strategic plan for sexual and reproductive health care. The slogan they developed was Efficient Services with a Human Face." IPPF/WHR Senior Program Advisors Lucella and Humberto were in Belize in June 2001 to work with IPPF/WHR's affiliate there, the Belize Family Life Association (BFLA), on the sustainability and management aspects of its strategic plan. BFLA recently received a grant from the Summit Foundation to construct a new headquarters that will allow for expanded services. (excerpt)
Guatemala: Orienting affiliates on the design and implementation of a state-of-the-art management system.
Notes from the Field. 2001 Jun; (5): p..A three-person team from International Planned Parenthood Federation, Western Hemisphere Region conducted a training workshop in Guatemala for several affiliates on the design and implementation of the Integrated Management System and also received feedback on the system. A three-person team from IPPF/WHR recently conducted a training workshop in Antigua, Guatemala for several IPPF/WHR affiliates on the design and implementation of the highly anticipated Integrated Management System (IMS). The workshop was an opportunity both to orient the participants to the new system as well as to get their feedback on the IMS and the extent to which it meets their needs. WHR team members included Leslie, Director of MIS, María Cristina, Regional Supplies Officer, and Rupal, Evaluation Officer. (excerpt)
Notes from the Field. 2001 May; (4): p..A team from International Planned Parenthood Federation, Western Hemisphere Region traveled to Trinidad to conduct a Proposal Writing Workshop for ten affiliates who have programs on HIV prevention and youth. Then they went to Guyana to provide technical assistance and training for a sustainability model. Lucella, IPPF/WHR's Senior Program Advisor for the Caribbean, was recently in Trinidad as a member of a team conducting a Proposal Writing Workshop for ten IPPF/WHR affiliates. The following week she traveled to Guyana with another team from WHR, one that provided training in the use of the S2000ä Financial Model, a cash flow forecasting tool developed by the EFS (Endowment Fund for Sustainability). (excerpt)
Notes from the Field. 2001 Apr; (3): p..Representatives from the Family Guidance Association of Ethiopia (FGAE) and the International Planned Parenthood Federation, Africa Regional Office visited the Asociación Pro-Bienestar de la Familia Colombiana (PROFAMILIA) in March 2001 to see PROFAMILIA's youth programs and services. The exchange was the first half of a technical assistance project; PROFAMILIA was identified as a "best practices" organization that could offer its expertise to FGAE. Representatives from PROFAMILIA/Colombia visited the Family Guidance Association of Ethiopia (FGAE) in August 2001 for the second half of a technical assistance exchange project. The project, which in March 2001 allowed for FGAE representatives to visit Colombia, is funded by the IPPF "i3" Youth Program (Innovate, Indicate, Inform). FGAE is expanding its institutional focus from family planning to sexual and reproductive health with a special emphasis on young people. PROFAMILIA was identified as a "best practices" organization to provide technical assistance on youth programs. (excerpt)
Notes from the Field. 2001 Apr; (2): p..A four-person team from International Planned Parenthood Federation, Western Hemisphere Region visited Haiti to provide technical assistance, focusing on project management and reporting, logistics and budgeting. A four-person team from IPPF/WHR was in Haiti on March 4th - 9th to work with two of the country's largest family planning organizations, PROFAMIL and FOSREF. Team members included Eva, a Program Advisor and resource development specialist; Rebecca, an Evaluation Officer; María Cristina, the Regional Supplies Officer; and Marcos, a Financial Advisor. IPPF/WHR monitors PROFAMIL's IPPF Vision 2000 Project to improve quality of care and increase access to SRH services. On this technical assistance visit, the IPPF/WHR team focused on project management and reporting, logistics, and budgeting. (excerpt)
Notes from the Field. 2001 Mar; (1): p..IPPF/WHR Evaluation Officer Rebecca was in Nicaragua February 11 - 17, 2001 to provide technical assistance for the UNFPA/UNFIP project, Sexual and Reproductive Health for Adolescents -- A Three Country Approach: Haiti, Nicaragua and Ecuador. "The great thing about this project is that it integrates the concept of adolescent SRH into the municipal governments' role in their communities and really institutionalizes an adolescent perspective. Working with local partners and the local municipal governments -- giving them a stake, a sense of ownership -- greatly increases the chance of this project carrying on after the initial funding ends. "This trip was interesting because we got to see a lot of the country in our visits to two of the participating municipalities. Jalapa is about six hours north of Managua. We had to leave our hotel at five o'clock in the morning. The country is still recovering from [Hurricane] Mitch [which struck Nicaragua in 1998]. The roads are really bumpy. While many towns that we passed through are made up of small adobe huts with a water pump in the center of town where people line up to get their water, we also passed towns with small concrete houses built with funds from international relief efforts after the hurricane. One village had a series of concrete UNICEF latrines." (excerpt)
New York, New York, International Planned Parenthood Federation [IPPF], Western Hemisphere Region [WHR], 2002 May 15.  p.On April 3, 2002, Steven Sinding, director-general designate of the International Planned Parenthood Federation, delivered a speech to the Commission on Population and Development in New York. The speech summarizes priorities for evaluating progress made in the implementation of the Program of Action adopted at the International Conference on Population and Developement in Cairo in 1994. I am making this statement today as director-general designate of the International Planned Parenthood Federation, the world's leading voluntary family planning organization. IPPF and its member associations are committed to promoting the right of women and men to decide freely the number, timing, and spacing of their children and the right to the highest possible level of sexual and reproductive health. Founded in 1952, it is a federation linking autonomous national Family Planning Associations working in more than 180 countries around the world, initiating, promoting and providing sexual and reproductive health and rights-based services. Celebrating its 50th anniversary this year, IPPF is proud to have an opportunity to address this meeting of the Commission on Population and Development (CPD). (excerpt)
Notes from the Field. 2002 Feb; (13): p..Several NGOs and government agencies, including IPPF/WHR's affiliate PROFAMIL, are working hard to address the sexual and reproductive health needs of women, men, and youth in Haiti. Recently, IPPF/WHR has sought to support these efforts by strengthening the capacity of PROFAMIL and other agencies to develop and implement results-oriented projects that can become sustainable. A four-person team from IPPF/WHR traveled to Haiti in January 2002 to conduct a project design and proposal writing workshop with representatives from several local NGOs, including PROFAMIL, FOSREF, VDH, UNFPA, and the ministries of Health and Education. Participants came armed with statistics and other information on a specific problem that their organization would like to address, as well as intervention ideas. First, participants developed conceptual models for their project ideas; then they wrote actual proposals to seek funding. Participants used tools, such as a conceptual model and a logical framework, to assist them in the project design and proposal-writing process, with a particular emphasis on integrating monitoring and evaluation plans into their proposed interventions. (excerpt)
United States. Exploring the environment / population links and the role of major donors, foundations and nongovernmental organizations.
In: No vacancy: global responses to the human population explosion, edited by Michael Tobias, Bob Gillespie, Elizabeth Hughes and Jane Gray Morrison. Pasadena, California, Hope Publishing House, 2006. 103-196.The mission of the World Bank is to fight poverty and improve the living standards of people in the developing world. It is a development bank which provides loans, policy advice, technical assistance and knowledge-sharing services to low- and middle-income countries to reduce poverty. It also promotes growth to create jobs and to empower poor people to take advantage of these opportunities. The World Bank works to bridge the economic divide between rich and poor countries. As one of the world's largest sources of development assistance, it supports the efforts of developing countries to build schools and health centers, provide water and electricity, fight disease and protect the environment. As one of the United Nations' specialized agencies, it has 184 member countries that are jointly responsible for how the institution is financed and how its money is spent. There are 10,000 development professionals from nearly every country in the world who work in its Washington DC headquarters and in its 109 country offices. The World Bank is the world's largest long-term financier of HIV/AIDS programs and its current commitments for HIV/AIDS amount to more than $1.3 billion --half of which is targeted for sub-Saharan Africa. (excerpt)
Washington, D.C., World Bank, 1977 Nov. 18 p.The attached paper provides the most up-to-date and authoritative statement that is available on World Bank lending policies in the population sector. The paper parallels closely an official Bank statement that was recently distributed to staff as an internal document. Since the paper is concerned only with the Bank's lending operations, it does not deal with other aspects of the Bank's population activities, such as the coverage of population in Bank economic reports or Bank research in the field. The paper defines the "population sector" as the Bank sees it and then describes the Bank's lending objectives, the range of fertility-reducing interventions possible in the light of current understanding of fertility determinants, the types of delivery systems available for the provision of family planning services, typical project content in the sector, and the use of "population components'' in non-population projects. The paper also explains how a number of general Bank policies -- e.g., on procurement, project justification, user charges, local-cost financing, co-financing, and project monitoring and evaluation -- are applied in this sector. (author's)
[Washington, D.C.], World Bank, 1977 Nov.  p.The Bank entered the population field because its experience drove it to the conclusion that attempts to raise the standard of living in a great many developing countries were being seriously hindered, if not thwarted, by the growth of population. The Bank has no fixed idea how large the population of any particular country ought to be, but it is convinced that, in most developing countries, the faster population grows, the slower will be the improvement of living standards. In many countries "population drag" is not just a minor element in the picture; it is one of the main explanations of why living standards are improving so slowly. In the mid-1960's, about two-thirds of total annual investment in a sample of 2.2 developing countries was required to maintain per capita income constant, leaving only about one-third to increase it. The corresponding figures for a representative sample of 19 developed countries were one-quarter and three quarters. The cost of rapid population growth is therefore large, and it falls most heavily on the poorest. High rates of fertility increase the number of children the labor force must support. Some of these costs are borne by the individual household, while others, such as education, are borne primarily by society. Without a decline in fertility, increased expenditures are necessary merely to provide the same inadequate instruction to larger numbers of students. Rapid population growth is an important cause of inequality of incomes. The expansion of the labor force exerts downward pressures on wages and creates unemployment; in agriculture, the effect is often the fragmentation of landholdings and growing landlessness. (excerpt)