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[From family planning to reproductive health and beyond. Draft] De la planificacion familiar a la salud reproductiva y mas alla. Borrador para libro.
[Unpublished] 1997 Mar. 155,  p.This work traces the evolving orientation of institutional family planning at the international level, from the beginning of the birth control movement in the US around 1915 to the recent consensus that family planning should be considered in the broader framework of reproductive health. The opening chapter discusses the origins of the antinatalist movement in the birth control, eugenics, and population control movements and the beginning of US government involvement in family planning. Family planning and its objectives are defined, and the growing view of family planning as a right is discussed in chapter 2. The pressures and achievements of the 1974 World Population Conference in Bucharest, which led to a broadening of the focus to encompass issues of development, are assessed. The impact of the environmental movement and the international decade of women, and the economic crisis of the 1980s in Latin America and its consequences for family planning are discussed. The attitudes expressed at the 1984 World Population Conference in Mexico City and the decline of US support for international family planning activities are then examined. Beginning around the mid-1980s, a series of shortcomings in family planning programs were noted at the same time that worldwide survey programs demonstrated impressive gains in family planning in developing countries. The gathering movement for reproductive health was embraced by foundations, and reflected in changes of emphasis in the most important international organizations. The focus on reproductive health prevailed at the 1994 International Conference on Population and Development in Cairo, but doubts have arisen since then over the future of support for family planning and other reproductive health services.
U.S. and industrialized world asked to show compassion and pragmatism to support population programs. Dr. Nafis Sadik speaks at the U.S. Congressional Women's Caucus.
ASIAN FORUM NEWSLETTER. 1999 Jun-Aug; 10-1.Dr. Nafis Sadik, Executive Director of the UN Population Fund, spoke at the Congressional Women's Caucus on July 20th in Washington, DC. In her speech, she asked for the compassion and pragmatism of the US and the industrialized world to support the population programs of developing countries. She stated that although the ICPD+5 Review confirmed the success of the Programme of Action, which has provided remarkable changes throughout the world, there are still many continuing problems and constraints. Some of these include high maternal mortality rate, high HIV/AIDS infection rates, the poor status of the youth, and prevalence of gender inequality issues. In addition, she emphasized the problem of funding, which is the major obstacle to the implementation of the Programme of Action. A total of $17 billion is needed to implement such program by the year 2000. Much is still needed for the execution and realization of the goals of the Programme of Action.
In: La population du monde: enjeux et problemes, edited by Jean-Claude Chasteland and Jean-Claude Chesnais. Paris, France, Institut National d'Etudes Demographiques [INED], 1997. 435-60. (Travaux et Documents Cahier No. 139)The author clarifies the conceptual framework of the study of populations health in an attempt to understand the notions of demographic transition and epidemiological transition. World Health Organization (WHO) statistics are then noted, followed by the presentation of WHO data on the global health situation. Estimated numbers of all cases of morbidity and mortality worldwide by cause are presented for 1993. Where possible, the prevalence, incidence, and number of long-term handicaps caused by each ailment are presented in addition to the number of deaths caused. According to data collected by WHO, approximately 51 million people died worldwide in 1993, of which almost 24% were in developed countries and 76% were in developing countries. The most important groups of illnesses were infectious and parasitic diseases, and causes of maternal, perinatal, and neonatal mortality, responsible for about 40% of all mortality during the year. 99% of these latter deaths occurred in the developing world. Then, circulatory system diseases, chronic lower respiratory system illness, and cancer were together responsible for about the same number of deaths, with the numbers of such deaths divided almost equally between developed and developing countries. External causes, such as accidents, suicides, and homicides caused near to 4 million deaths, or 8% of the overall total. These causes of morbidity and mortality are discussed, followed by consideration of likely future trends for the world s predominant ailments.
The World Health Organization multinational study of breast-feeding and lactational amenorrhea. IV. Postpartum bleeding and lochia in breast-feeding women.
FERTILITY AND STERILITY.. 1999 Sep; 72(3):441-7.The main purpose of this study was to compare the duration of postpartum lochia among 7 groups of breast-feeding women, and in addition, to investigate whether age, parity, birth weight, or the amount of breast-feeding affects this duration. The participants included 4118 breast-feeding women aged 20-37 years living in China, Guatemala, Australia, India, Nigeria, Chile, or Sweden. The duration of lochia, frequency of an end-of-puerperium bleeding episode, and frequency of post-lochia bleeding episodes within 56 days of delivery were measured. This study revealed that the median duration of lochia was 27 days and varied significantly among the centers (range, 22-34 days). In about 11% of the women, lochia lasted >40 days. An end-of-puerperium bleeding episode around the 40th day postpartum was reported by 20.3% of the women. Bleeding within 56 days of delivery (separated from lochia by at least 14 days) occurred in 11.3% of the women and usually was followed by a confirmatory bleeding episode 21-70 days later. This study was able to quantify the average duration of postpartum lochia at 3-5 weeks, with significant variations by population. Lochia durations of >40 days were not unusual. A separate and distinct end-of-puerperium bleeding episode occurred in 1 out of every 4-5 women, although it is unclear how this phenomenon is clinically, socially, or culturally significant.
The World Health Organization multinational study of breast-feeding and lactational amenorrhea. III. Pregnancy during breast-feeding.
FERTILITY AND STERILITY.. 1999 Sep; 72(3):431-40.This prospective longitudinal study aimed to determine the risk of pregnancy during lactational amenorrhea relative to infant feeding status. The participants included 4118 breast-feeding mother-infant pairs, with maternal age of 20-37 years, recruited from 7 study centers located in China, Guatemala, Australia, India, Nigeria, Chile, and Sweden. Infant feeding practices, menstrual status, and the number of pregnancies were recorded. The results revealed that in the first 6 months after childbirth, cumulative pregnancy rate during amenorrhea, depending on how the end of amenorrhea was defined, ranged from 0.9% (95% confidential interval (CI) = 0-2%) to 1.2% (95% CI = 0-2.4%) during full breast-feeding, and from 0.7% (95% CI = 0.1-1.3%) to 0.8% (95% CI = 0.2-1.4%) up to the end of partial breast-feeding. At 12 months, the rates ranged from 6.6% (95% CI = 1.9-11.2%) to 7.4% (95% CI = 2.5-12.3%) during full breast-feeding, and from 3.7% (95% CI = 1.9-5.5%) to 5.2% (95% CI = 3.1-7.4%) up to the end of partial breast-feeding. Regardless of the degree of supplementation, the pregnancy rate increased with time from 6th to the 12th month postpartum. Overall, the rate of pregnancy during amenorrhea was unaffected by variations in the return of menses. This large, multicenter study found that the cumulative 6-month rate of pregnancy during lactational amenorrhea was between 0.8% (95% CI = 0-1.4%) and 1.2% (95% CI = 0-2.4%). This is equivalent to the protection provided by many nonpermanent contraceptive methods as they are actually used and upholds the 1988 Bellagio Consensus.
DEVELOPMENT AND CHANGE. 1999 Jul; 30(3):653-83.This article explores the issues surrounding labor standards and international trade--specifically the interpretations of neo-classical, institutionalist, and feminist writers regarding women's incorporation into the export-oriented manufacturing sector. The neo-classical argument states that trade liberalization would deliver considerable benefits to women both in sheer quantity of employment and in terms of quality of working conditions. Institutionalist analyses, on the other hand, have been constructive in their emphasizing of the gendered nature of the labor contract, the relevance of looking beyond the boss/worker dyad, and the importance of listening to women workers' subjective assessments of their work. While the issue of improving the conditions of work continues to be an important item on the agenda, the question of the availability of jobs among labor-surplus developing countries may become a priority. It is important to avoid strategies that sacrifice quality of work for the sake of quantity.
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.
Lancet. 1998 Jul 18; 352(9123):210.Marking World Population Day, the International Planned Parenthood Federation (IPPF) held a seminar in London on July 11, during which participants reviewed achievements made since the 1994 International Conference on Population and Development (ICPD) held in Cairo, Egypt. The seminar was part of a program of Cairo+5 events which will end in a special session of the UN General Assembly in June 1999, to review and assess the implementation of the ICPD Program of Action. The 20-year Program of Action aims to give all couples and individuals the right to freely and responsibly decide the number, spacing, and timing of their children, and to have the information and means to do so. Women's education and equality are at the program's core. Since the ICPD, the provision of family planning services has increased by 33.6%, and family planning associations reached about 9.4 million people in 1997. Lack of funding by developed nations is the main obstacle to the implementation of the Program of Action.
PEOPLE AND THE PLANET. 1999; 8(1):18-9.In 1994, at the International Conference on Population and Development (ICPD) held in Cairo, the international community set the goal of ensuring universal access to reproductive health care by 2015 and agreed to finance its costs. Few governments and donor countries, however, have made good on commitments made at the ICPD. Reproductive health is not improving and may actually be getting worse. Specific goals to be reached by 2015 include meeting all unmet need for family planning, reducing maternal mortality by 75% compared with 1990 levels, and reducing infant mortality to lower than 35 deaths/1000 births. Reaching these and the related reproductive health goals of the ICPD was calculated to cost about US$17 billion/year until 2000, then to increase to $22 billion/year by 2015 (in constant 1993 US dollars). Developing countries agreed to pay 66% of the cost, while donor countries paid the remainder. Immediately after the ICPD, reproductive health funding increased substantially, then declined again, with most donor countries failing to meet their funding commitments. Failure to deliver on the promised financial support for the ICPD goals will result in higher levels of unintended pregnancies, induced abortions, cases of maternal mortality, and infant deaths. Governments need to be convinced that paying for reproductive health programs is an urgent priority and that developing countries, donor countries, and multilateral institutions all have much to gain from reaching the ICPD goals.
Sexually transmitted diseases research needs: report of a WHO consultative group, Copenhagen, 13-14 September 1989.
[Unpublished] 1991. Presented at the 1st International Course on Planning and Managing STD Control Activities in Developing Countries, Antwerp, Belgium, September 9-21, 1991. 31 p.In response to the growing needs for research into sexually transmitted diseases (STDs), the STD Program of the World Health Organization (WHO) in September 1989 convened a small interdisciplinary consultative group of scientists from both developing and more developed countries to review STD research priorities. The consultation was organized based upon the belief that a joint consideration of global STD research priorities and local research capabilities would increase overall research capacity by coordinating the efforts of scientists from around the world to get the job done. Participants considered the areas of biomedical research, clinical and epidemiological research, behavioral research, and operations research. However, research needs directly related to HIV were not considered except where they interfaced with research on other STDs. The above areas of research, as well as the expansion of interregional and interdisciplinary collaborations, the strengthening of research institutions, developing and strengthening research training, and facilitating technology transfer and the use of marketing systems are discussed.
In: La explosion demografica y la regulacion de la natalidad, edited by Jose Botella Llusia and Salustiano del Campo Urbano. Madrid, Spain, Editorial Sintesis, 1997. 71-82.This work expresses strong disapproval of the antinatalist policies of the UN system, the nongovernmental organizations with which it cooperates, and the developed countries which support them. World population has grown at an unprecedentedly rapid rate in the latter half of the 20th century, with the greatest growth occurring in the poorest regions. Projections of huge future populations in poor regions are the pretext for population policies which rich countries, acting through the UN system, impose on poor ones. The author suggests that the UN has accomplished much in maintaining peace and fostering international collaboration in data collection, but he sees the UN primarily as a political system controlled by a few wealthy countries, whose main demographic export is an implacable antinatalist policy. On the other side of the "war against population," allied with the Vatican, are "millions of persons of all races and creeds" who are faithful to pronatalist traditions but disorganized, dispersed, and unaware of the dangers to future generations. The author suggests that any difficulty caused by population growth can be conquered by the talent and effort of the affected population, which will enable it to find new ways of exploiting resources and utilizing space to support higher population densities.
WORLD HEALTH FORUM. 1998; 19(3):298-9.During the recent Round Table on "Ethics, equity and renewal of WHO's health-for-all strategy," eminent scholars from developed countries provided a framework of thinking based on their version of the world. The contributions showed a lack of academic rigor, even in the definition of WHO terms, such as "primary health care" and "health for all"; numerous WHO publications on the subject were not examined. Contributors ignored ethical issues raised by Ivan Illich in "Limits to medicine." The presentation and discussions revolved around issues relevant to conditions in developed countries. Bryant, Khan, and Hyder spoke of inequities that should be corrected with available resources; they, with others at the presentation, ignored the considerable body of work that has been done in developing countries on the actions taken to correct inequities with available resources. This body of work can be called "another public health," which is different from the "new public health" or "new approaches to public health." "Health for all through primary health care," which was launched at Alma-Ata in 1978, was WHO's action to correct inequities in developing countries with available resources. The concept of selective primary health care appeared shortly after the Alma-Ata Declaration; it was followed by two Bellagio Conferences which unleashed many ill-fated international initiatives. The basic tenet of public health, that people, rather than the medical establishment, are the prime movers of health and health service development, has been forgotten. Community self-reliance, social control over health services, intersectoral action on health, coverage of unserved and underserved populations, integration of health services, use of traditional systems of medicine, and essential drugs came from this thinking; it was reiterated that "health for all" required action at political and social levels. Before speaking of renewing the "health for all" strategy, WHO and Round Table participants should realize that the strategy has never been completely implemented and should elicit the reasons for this.
BMJ (CLINICAL RESEARCH ED.). 1998 Jul 4; 317(7150):11.While most industrialized nations and a handful of developing countries are seeing the spread of HIV infection level off or even decline, infection rates are reaching alarming new highs in much of the developing world, according to the first country by country analysis by the joint United Nations Programme on HIV/AIDS (UNAIDS). Along with the widening gap in infection rates, the report also reveals a looming divide between countries where rates of new AIDS cases and deaths from AIDS are falling and countries where they are rising as people infected with the disease succumb in greater numbers than before. The major reason is uneven access to newer antiretroviral drugs, which forestall the development of AIDS. Among the report's most striking findings was new information concerning 13 countries in sub-Saharan Africa, where at least 10% of all adults are infected with HIV, with the prevalence in many capital cities 35% or more. Botswana and Zimbabwe have each reached a prevalence of 25%, a new world high. (full text)
Report on the Bellagio conference on urban health challenges for the 21st century, 9-13 October 1995.
URBANISATION AND HEALTH NEWSLETTER. 1995 Jun; (25):56-8.Delegates were invited from 13 developed and developing countries, as well as the World Health Organization, to attend a conference held at the Bellagio Study and Conference Center during October 9-13, 1995, to discuss the health challenges facing the world's urban areas in the 21st century. The goal of the conference was to identify and describe successful models for delivering health services to large urban populations and to share that knowledge. Conference themes were urban health care, the intersectoral dimensions of urban health, the delivery of integrated health care from selected developing countries, and resources for the sustainable growth and development of urban health services. Small group discussions were held in which a range of issues were considered and many recommendations developed for eventual release to the public. Conference participants were enriched by their experience.
GHANA OFFICIAL NEWS BULLETIN. 1997 May 1-31; 2(8):6.In a message attached to the World Health Organization's (WHO) 1997 report, WHO Director-General Dr. Hiroshi Nakajima argued that developing countries must stop trying to handle infectious diseases and chronic diseases sequentially. Rather, they must address them simultaneously with help from the international community. At the same time, developed countries cannot focus solely upon chronic diseases and ignore the dangers of infectious diseases, for the latter will return to developed countries should they be ignored. The world should expect a global increase in the level of premature morbidity from chronic diseases due to prevailing socioeconomic circumstances, including unhealthy lifestyles, labor-saving technologies, unsatisfactory diets, and misleading information about consumer products. While most infectious diseases are preventable, they are not yet curable.
LIVING MARXISM. 1994 Jul; (69): p.In September 1994, hundreds of family planners, population experts, government officials, and charities from around the world will meet in Cairo to debate population concerns during the International Conference on Population and Development (ICPD), a platform for population experts who believe that the world's problems can be explained in terms of population statistics. These people believe that the poverty and hunger which are endemic throughout the world exist because there are too many people trying to get their share of limited resources. However, rather than critically examine the prevailing global economic system which causes poverty and food shortages, and trying to increase the amount of resources available for distribution, attendees at the 1994 ICPD will search for ways to check population growth. Conference delegates are also concerned about mass international population movements from poor countries to more affluent nations. Careful to not offend Third World leaders, populations, and sensitivities, and in an attempt to garner support for colonial-style interference in domestic population matters, population control is now being sold as a way of safeguarding people's health in developing countries and something positive for the reproductive health rights of women. In reality, however, all funds spent upon family planning in and for the Third World simply propagate the message that more Black children is bad and fewer Black children is good.
[Geneva, Switzerland], WHO, 1997 Apr 24. 3 p. (Press Release WHO/33)A study conducted by the UNDP/UNFPA/WHO/World Bank Special Program of Research, Development, and Research Training in Human Reproduction confirmed that young women in both developed and developing countries with no predisposing risk factors for cardiovascular disease can use oral contraceptives (OCs) without increasing their risk of acute myocardial infarction. The study was conducted in 21 centers in 12 developing and 7 developed countries and involved 369 women with acute myocardial infarction and 941 healthy controls. The duration of OC use did not affect the risk of heart attack. In OC users under 35 years who smoke and use the pill, the incidence of heart attack increases from the 3.5 cases/million woman-years recorded in nonsmoking OC users to about 40 cases/million woman-years. The risk of heart attack rises substantially, however, in OC users over 35 years of age who smoke: to 500 cases/million woman-years. The overall risk of heart attack is 10 times higher in OC users with high blood pressure than in women with normal blood pressure or non-users of OCs. The data did not reveal consistent differences in heart attack risk according to the OC's estrogen dose; there were too few OC users enrolled in the study who were using pills containing gestodene or desogestrel to permit conclusions about the relative safety of second- and third-generation OCs. These findings indicate that the minimal heart attack risk associated with OC use can be avoided by screening women for potential risk factors for such disease, especially high blood pressure, diabetes, and smoking.
Lancet. 1998 May 23; 351(9115):1561.Leaders of the world's 8 major government powers who met at the Group of Eight (G8) Summit in Birmingham, UK, during May 15-17, endorsed an international initiative to control malaria and other parasitic diseases. The leaders agreed to improve mutual cooperation on infectious and parasitic diseases, and offered support for the new World Health Organization (WHO) initiative "Roll Back Malaria" to reduce levels of malaria-related mortality by 2010. UK Prime Minister Tony Blair was, however, the only leader to pledge new funding, in the amount of US$100 million, for the initiative. The other G8 countries fought the inclusion of specific targets in the final joint G8 document and made no new commitment to fund the malaria initiative. The Japanese government's report on global parasite control for the 21st century outlined 4 strategies for controlling malaria, soil-transmitted nematode infections, schistosomiasis, filariasis, and other parasitic infections. The strategies include international cooperation for implementing parasite control and research to provide a scientific basis for such control. Roll Back Malaria will begin in Africa. G8 support was less enthusiastic for France's Therapeutic Solidarity Initiative to establish a fund for HIV treatment regimens which are appropriate to conditions in the developing world.
HEALTH TRANSITION REVIEW. 1997; 7 Suppl 4:1-5.The consensus achieved at the 1994 International Conference on Population and Development (ICPD) signaled a move away from discussing population issues in the context of demographic targets, toward global recognition that the problems associated with rapidly growing human populations are part of a broader human development agenda. Devoid of demographic targets, the ICPD program of action instead challenges countries to change their approach to population programs, family planning, and reproductive health. World Fertility Survey and Demographic and Health Survey data indicate a high level of unwanted fertility in almost all countries covered. The lack of availability or inaccessibility of family planning services is but one reason why there is so much unmet need. There would be greater uptake of family planning if services were planned with community involvement and oriented toward clients, offering them real choices and paying more attention to them as individuals and their overall circumstances. That expansion in concept and of services is at the core of the Cairo agenda. A number of countries around the world have started taking steps to broaden existing family planning and related programs to include other reproductive health information and services. Mexico and India are examples of two developing countries which are making program and structural changes in order to implement the ICPD recommendations, while most African countries have welcomed the approach and are looking for technical and resource help for implementation.
HEALTH TRANSITION REVIEW. 1997; 7 Suppl 4:7-31.With the support of the international women's movement, the ideology and methods of traditional population policy were effectively attacked at the 1994 International Conference on Population and Development (ICPD). The author discusses some of the complaints about population policy and family planning programs, then considers the substantive, ethical, and feasibility issues of population and reproductive health policy. The majority of the international population movement's (IPM) new agenda is motivated by goals which tend to be more sensitive to individual needs and human rights than earlier, more impersonal versions of population policy in the developing world. Critical academic examination of the old IPM forced the discussion of the meaning of population policy and population research as they relate to the new reproductive health approach. However, the new population policy approach is now itself ready to be examined internally with regard to its practical recommendations and its assessment of the population problem. An internal critique developed by the movement but drawing upon the experience of mainstream population research and policy will strengthen the movement and hone its ability to match methods to goals. Internal dissent within the movement needs to be aired.
HEALTH TRANSITION REVIEW. 1997; 7 Suppl 4:37-42.The onset of fertility decline in France during the late 18th century and broader decline during the last third of the 19th century in Western Europe and the English-speaking European colonies demonstrates that humans are willing to control their fertility. Fertility transition was a social phenomenon. It has also been observed that the idea of fertility decline can spread and be acted upon elsewhere. The events of the International Conference on Population and Development (ICPD) are described and the need to control population growth in sub-Saharan Africa is discussed. While the ICPD's advocacy of improving women's autonomy, status, education, and reproductive health is laudable, those goals are opposed to that of completing the demographic transition. The existence of this opposition indicates that there have been changes in longstanding intellectual and technical aid consensuses. In the wake of the ICPD, developed country governments may never again emphasize the need for family planning programs in developing countries. The largest effect of such a course will probably be upon the demographic transition in sub-Saharan Africa. However, those interested in improving reproductive health in the Third World may join forces with the population movement when they realize that well-funded family planning programs are the key to improving reproductive health services.
AIDS ANALYSIS AFRICA. 1998 Feb; 8(1):3, 6.In recent years, HIV/AIDS funding has gone largely to prevention measures, drug therapy for people who are already infected with HIV, and basic related science. HIV/AIDS vaccine development has been of only low priority, and almost no effort is targeted toward vaccines appropriate for use in developing countries. A vaccine, however, is theoretically the only way to end the epidemic. An attempt was made at the Abidjan AIDS Conference to reinvigorate the AIDS vaccine research program, but because the potential market for such a vaccine is in the poorer developing countries, it will be difficult to convince the pharmaceutical industry to renew investment in vaccine research. Pharmaceutical companies see no profit potential in vaccine development and marketing. The World Bank's suggestion on how to encourage the pharmaceutical industry to invest again in vaccine research is discussed. The gp120(E) vaccine is undergoing an early-stage trial in Thailand, and another trial is scheduled for later in 1998 in Uganda. However, none of the 25 possible vaccine types which have been developed in the laboratory and tested for safety on humans has gone into efficacy trials. Experts calculate that even if more intensive work were to begin now, a vaccine could not become generally available before 2005, due to the 8-year product evaluation cycle. Whether a vaccine based upon one HIV subtype will be effective against other subtypes, and the need for governments and donors to invest in the development of a vaccine are discussed.
WORLD HEALTH FORUM. 1997; 18(2):107-15.In 1996, the World Health Organization (WHO) identified the following issues for consideration as it designed its new strategy to achieve "health for all" in the 21st century: the determinants of health, health patterns in the future, intersectoral action, essential public health functions, partnerships in health, human resources for health, and the role of the WHO. Because ethical considerations play a vital role in developing the strategy, the WHO sought the input of the Council for International Organizations of Medical Sciences in this regard. As understanding of the role and nature of medical ethics has deepened in the past decades, new ethical questions are continually being raised by changing patterns of disease and health care and by technological advances. The new health-for-all strategy must, therefore, give prominence to the consideration of equity, utility, equality, and human rights. In order to attain justice, the equilibrium between equity and equality should be maintained. Cultural diversity will also inform notions of equity. The principles of primary health care contained in the WHO's Alma-Ata Declaration also need to be strengthened to place proper emphasis on the need for information systems, decision-making mechanisms, and support systems. The most important activities the WHO is applying to its effort to renew its "health for all" strategy are 1) clarifying the concepts; 2) strengthening links to related fields; 3) working in partnership with countries, regions, and organizations; and 4) promoting the dissemination of information and ideas. The WHO's renewed strategy must bring clarity, practicality, and effectiveness to global health activities while fostering an understanding of the moral issues that contribute to human well-being.
VOX SANGUINIS. 1994; 67(4):377-81.As part of an effort to monitor the safety of global blood transfusion services, the World Health Organization circulates a questionnaire for use in a database on blood safety. In 1992, 67% of countries responding to the survey (100% of developed, 66% of developing, and 46% of less developed countries) were screening all blood donations for HIV antibodies and 87% of these countries (100% of developed, 92% of developing, and 63% of less developed countries) carried out supplementary testing to confirm positive results. All developed countries, 72% of developing, and 35% of less developed countries screen blood for hepatitis B surface antigen and 94%, 71%, and 48%, respectively, screen for syphilis. The primary reasons for inadequate blood testing are the cost of test kits and reagents and the unreliability of supplies. The proportion of safe donors is highest in systems where all donors are voluntary and nonremunerated--conditions that exist in 85% of developed countries but only 15% of developing and 7% of less developed countries. Blood safety would also be improved by more appropriate use of transfusions and the provision of alternatives such as saline and colloids. Other problems include insufficient blood supply (e.g., none of the less developed and only 9% of developing countries collect 30 units or more per 1000 population per year) and inadequate quality assurance in all aspects of preparatory testing.
PEOPLE AND THE PLANET. 1997; 6(1):10-1.Dr. Nafis Sadik, Executive Director of the UN Population Fund, notes that in the wake of the 1994 International Conference on Population and Development (ICPD), governments have been persuaded to abandon demographic targets and instead set specific social goals such as reductions in maternal, child, and infant mortality, and improvements in education, especially for girls. Progress is being made with regard to health and education, with all countries having set target dates for the enrollment of all children in school. The meaning of basic health services for all remains unclear. Progress is also being made against female genital mutilation and sexual violence, and improving women's status and the delivery of reproductive health care. Most countries could, however, do a lot more, and greater public support and resources are needed for programs. India, Brazil, Egypt, and Peru are cited as examples of countries which have begun to change policy following the ICPD. Developing countries and donors, with the exception of the US in 1996, have made efforts to increase their levels of spending on reproductive health services; the US has reduced its aid budget by 35%.