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  1. 151
    Peer Reviewed

    Management of acute diarrhea in children: lessons learned.

    Richards L; Claeson M; Pierce NF


    Each year diarrheal disease causes an estimated 3.2 million deaths worldwide in children under 5 years of age. Reported attack rates in developing countries range from 1 to 12 episodes per child per year, with a global average of 3 episodes per child per year. Diarrhea is associated with 1/4 of all deaths in children under 5 years in developing countries. Oral rehydration therapy (ORT) is the cornerstone of global efforts to reduce mortality from acute diarrhea. The World Health Organization (WHO)/UNICEF ORS formula contains glucose and sodium in a molar ratio of 1.2:1. Potassium chloride is added to replace potassium lost in the stool. Trisodium citrate dihydrate (or sodium bicarbonate) corrects metabolic acidosis caused by fecal loss of bicarbonate. The WHO case management strategy for children with diarrhea consists of: prevention of dehydration through early administration of appropriate fluids available in the home; treatment of dehydration with ORS solution; treatment of severe dehydration with an intravenous electrolyte solution; continued feeding during, and increased feeding after the diarrheal episode; and selective use of antibiotics and nonuse of antidiarrheal drugs. The WHO/UNICEF formula is also suitable as a maintenance fluid when given with equal amounts of water, breast milk, or low carbohydrate juice. Despite the unquestioned success of ORT in developing countries, physicians in the United States, the United Kingdom, and other industrialized countries have been slow to adopt ORT. Guidelines for case management call for patient assessment. The physician evaluating a child with diarrhea should inquire about clinical features including its duration and the presence of blood in the stool. Thus, a reliable treatment plan can be made without need of laboratory tests. Most diarrheal episodes are self-limited and do not benefit from antimicrobial therapy. Children with bloody diarrhea should be treated for suspected shigellosis with an oral antibiotic.
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  2. 152

    New world order and West's war on population.

    Wilson A

    ECONOMIC AND POLITICAL WEEKLY. 1994 Aug 20; 29(34):2,201-4.

    The aim of US-promoted population policies is maintaining and securing the economic and political dominance of capitalist states. Governments of developed countries blame overpopulation in developing countries for destroying the planet and those of developing countries blame overconsumption, waste, and industrial pollution in the capitalist countries to be responsible. Developed countries and the UN profess that population control is in the interests of development and for the sake of women's rights. Many women's groups protest planned and already existing population policies and bear witness to the suffering women from developing countries experience, raising the question of choice of these policies. Sexism served as the smokescreen behind which US strategies of population control were implemented. The concept of sustainable development is also used to advance population policies in developing countries. Developed countries use this concept to maintain the status quo, agricultural countries as such, cash crop economies, dependency on food, foreign aid, and loans and to continue their exploitation in developing countries. USAID, UNFPA, and the World Bank are the major moneylenders for population control. The US targets Africa for population control because it produces 90-100% of four minerals vital to US industry. The new phase of capitalist development has shifted the state's role from its function as a nation state to facilitator of global capital. Population control policy, national security laws, and anti-trade union laws are used to create a docile and immobile pool of labor. The World Bank, the IMF, and the WTO, through their structural adjustment policies, provide the infrastructure to implement population policies and targets. Population policies focusing on targets take control away from women. People in developing countries will not accept these population policies until they have control of their lives. They need assurance of child survival and to be in a position to plan their future. The population control lobby now uses deception to thwart resistance.
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  3. 153

    World population 1994. [Wallchart].

    United Nations. Department for Economic and Social Information and Policy Analysis. Population Division

    New York, New York, United Nations, Dept. for Economic and Social Information and Policy Analysis, Population Division, 1994 Aug. [2] p. (ST/ESA/SER.A/142)

    This wall chart tabulates data from the medium variant of the UN population estimates and projections as revised in 1994. Figures are given for the world as a whole and for more developed, less developed, and least developed areas. Data are also provided for regions and for individual countries within those regions. The mid-year population is shown in thousands for 1994, 2015, and 2050. Figures are then detailed for percentage annual growth rate, crude birth rate, crude death rate, total fertility rate, life expectancy at birth, and infant mortality rate for 1990-95. Age distribution (under age 15 years and 65 years or older) and density data are also provided for mid-1994. In addition to the main table, a listing is given of the 10 largest countries in 1994, and bar graphs show world population in millions for 1950-2050 as well as the average annual increase in millions for 1950-2050.
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  4. 154

    World contraceptive use 1994. [Wallchart].

    United Nations. Department for Economic and Social Information and Policy Analysis. Population Division

    New York, New York, United Nations, Dept. for Economic and Social Information and Policy Analysis, Population Division, 1994 Aug. [2] p. (ST/ESA/SER.A/143)

    This wall chart shows the 1994 level of contraceptive use (percentage) for the entire world. Data are presented for less developed and more developed regions and for individual countries grouped according to region. The number of couples of reproductive age is given in millions, and the data are broken down into year; age range represented; and percentage of the total, of female sterilization, of male sterilization, of oral contraceptive use, of IUD use, of condom use, and of use of other supply and non-supply methods. In addition, trends are indicated by showing the time period and the annual increase in percentage using any method. These data are further illustrated in pie charts indicating the entire world, more developed regions, and less developed regions as a whole and for Africa, Latin America and the Caribbean, Eastern Asia, and other countries in Asia and Oceania.
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  5. 155
    Peer Reviewed

    Quinacrine sterilisation revisited.

    Kessel E

    Lancet. 1994 Sep 10; 344(8924):698-700.

    Benagiano of the World Health Organization's (WHO) Special Program of Research, Development, and Research Training in Human Reproduction (HRP) stresses that the high standards of safety demanded in the testing and use of contraceptives should apply whether the subjects recruited to the studies are from developed or developing countries. The author of this commentary, however, with particular regard to transcervical quinacrine pellet research for nonsurgical female sterilization, criticizes the ethical and professional stand of Benagiano and HRP. He instead argues that the only sensible global standard for contraceptive research is a risk-benefit one which will vary according to the circumstances of the country involved in the research. Benagiano's September 3 letter is criticized as omitting an historical perspective and failing to discuss the differences of opinion concerning the appropriateness of proceeding with current and expanded clinical trials concurrently with additional toxicology testing. The author argues that in applying a developed country standard for contraceptive research to a developing country, HRP is making a value judgement based upon neither science nor logic. To support his argument, the author points to a difference between HRP guidelines and those of the WHO Special Program for Research and Training in Tropical Disease (TDR). TDR, unlike HRP, favors a risk-benefit guideline which takes account of the circumstances in which research is conducted. Although both programs follow accepted procedures for phase I, II, and III clinical studies, TDR is more likely to encourage these to proceed concurrently when the benefits seem to outweigh the risks of the trial. Feminist concerns discussed in Geneva, the self-imposed regulations of donor agencies such as the US Agency for International Development, the use of quinacrine as an anti-malarial drug, and North-South differences in contraception research are discussed.
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  6. 156

    Family planning: a basic development need.

    IPPF OPEN FILE. 1994 Jun; 1.

    The 1994 Human Development Report from the United Nations Development Program (UNDP) proposes a 20-20 Human Development Compact based on shared responsibilities between poor and rich nations, whereby poor and rich nations would help unmet basic human development needs such as primary education, primary health care, safe drinking water, and family planning over the next 10 years. This would require an additional US $30 to US $40 billion annually. Developing countries would commit 20% of their budgets to human priority concerns instead of the current 10% by reducing military expenditure, selling off unprofitable public enterprises and abandoning wasteful prestige projects. Donor countries would increase foreign aid from the current average of 7% to 20%. The report will propose a new concept of human security at the World Summit for Social Development to be held in March 1995, calling widespread human insecurity a universal problem. On average, poor nations have 19 soldiers for every one doctor. Global military spending has been declining since 1987 at the rate of 3.6% a year, resulting in a cumulative peace dividend of US $935 billion from 1987 to 1994. But this money has not been expended on unmet human needs. India ordered fighter planes at a cost that could have provided basic education to the 15 million Indian girls now out of school. Nigeria bought tanks from the UK at a cost that could have immunized all 2 million unimmunized children while also providing family planning to nearly 17 million couples. UNDP proposes a phasing out of all military assistance, military bases, and subsidies to arms exporters over a 3-year period. It also recommends the major restructuring of existing aid funds, and proposes a serious study on new institutions for global governance in the next century.
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  7. 157

    What is at stake at the world conference on population and development: women's rights and responsibilities.

    de Oliveira RD

    PEOPLE'S PERSPECTIVES. 1994 Mar; (8):4-8.

    Planetary democracy is necessary and possible. T he world's citizens must participate in decision-making on global issues like the environment, development, and population. There is a recognition at the international level that almost everything in politics and culture has been decided by men. Women must speak out on the problems that afflict humanity in an endeavor to democratize human relationship and politics. At the UN Conference on Population and Development, women must fight to have their reproductive rights respected. Planeta Femea, the women's event during ECO'92, was a demonstration of this new stance taken by women. The Coalition of Brazilian Women that coordinated Planeta Femea addressed two issues: population and ethics. The Rio Conference unmasked the simplistic notion that it was the populous nations of the South that degraded the environment, polluted water, and burned forests, when the North's patterns of production and consumption were the principal culprits of environmental degradation and the depletion of natural resources. The North's technological innovations drive all those denied access to these resources further into underdevelopment. The majority of mankind is becoming less and less competitive. According to UNDP figures, worsening terms of international trade, the burden of foreign debt, and trade protectionism deprive developing countries of 500 billion dollars in resources every year. To continue with present policies that perpetuate disparities among countries is to increase poverty worldwide and risk making our planet unsustainable. Improving the quality of life for all mankind requires a global alliance, a shared responsibility by all nations in confronting squalor and inequality. Modifying patterns of consumption and lifestyle in the North as well as reviewing global patterns of use of capital, resources and technology are needed to implement a common North-South agenda to salvage the planet.
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  8. 158

    Hard realities of a crowded world.

    Mann J

    WASHINGTON POST. 1994 Aug 24; E13.

    The Turner Broadcasting's People Count programming is focusing attention on the global population explosion and the September 1994 United Nations Conference on Population and Development in Cairo. The documentary "The Facts of Life" presents a tour of overpopulated regions in both the developed and developing world. Los Angeles, once the city of citrus groves, is now a city of too many cars, too many people, stifling smog and not enough water. Its air quality is expected to violate federal standards for 20 more years. In a Sub-Saharan African village, a couple has 10 children. In such villages, children help families survive. Women in Ghana have an average of 6 children each. In Bangladesh women still have an average of 4 children each, despite the successes of Concerned Women for Family Planning, a group that has trained 30,000 health care workers for that country. Mexico City has run out of water. It has one of the lowest birth rates in the developing world--3 children per woman--yet thousands of people live in garbage dumps. 93 million people are added to the world's population each year. At the present rate of growth, the world total of about 5.6 billion is expected to double by the year 2035. The UN conference centers on a document that delineates how to curb population growth: give women and men access to contraceptives and good health care; educate girls so they will delay childbearing and so they will be able to provide for their children; and shore up the environment so people can support their families. Muslim interests have joined the Vatican in condemning the language that asserts women's rights to regulate their fertility and to terminate pregnancy. Nonetheless, Indonesia's family planning success story was accomplished with the support of the Muslim leaders. The media, a new and modern force, may erode ecclesiastical authority, as evidenced by CNN's examination of the population crisis to help find answers.
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  9. 159

    [UNICEF. Children's new world order] UNICEF. Bornenes ny verdensorden.

    Neertoft S

    SYGEPLEJERSKEN. 1992 Mar 18; 92(12):15-6.

    UNICEF's 1992 report about the situation of children called for increased efforts to overcome malnutrition, disease, and illiteracy in poor countries. Developing countries were criticized for devoting only 12% of their budgets to health care and education of the poorest. Rich countries were criticized for setting aside only about 10% of their development assistance for health care, education, and family planning. One billion people do not have access to adequate food, clean water, health care, and schooling. After half a century of wars and ideological conflict, it is time to solve conflicts in the world peacefully and concentrate on social needs to blaze the trail towards a new world order. According to James Grant, the executive director of UNICEF, every week 250,000 perish because of hunger and disease, and of those who survive, many millions subsist in malnutrition and disease. This is a crisis situation that requires priority attention. However, there are signs of change, as evidenced by the World Summit on Children in September 1990. This was the largest such gathering, with 71 state and government leaders and other representatives from 159 countries. Its results included a program to prevent 4 million child deaths a year, put an end to malnutrition, eradicate poliomyelitis, and provide clean water, family planning methods, and basic education for all. In 1990 a goal was set to vaccinate 80% of the children of developing countries within 10 years, but only 1 out of every 10 children has been vaccinated so far, which still amounts to 3 million lives saved every year. Hitherto 60 countries have drafted national plans, which should increase to over 100 by early 1992. Mexico decided to boost the budget of health care and education for the poorest fifth of the population. The need of developing countries for 12-13 billion dollars could be secured from reducing their military outlays by 10%, while the share of developed countries of 6-7 billion dollars to reach all the goal of the Summit could be obtained from reducing their military expenditures by only 1%. Only 1% of developing country assistance allocation is needed for establishing basic health care service that could prevent 80% of diseases and the consequences of malnutrition. Only about 1% is needed for family planning and even less for elementary schools.
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  10. 160

    Governments urged to integrate environmental and population concerns in development planning.

    AFRICAN POPULATION NEWSLETTER. 1992 Jan-Jun; (62):2-3.

    Governments were asked to coordinate their policies and programs regarding development, population, and environment and to take into account demographic trends and patterns of production and consumption by the UN Expert Group Meeting on Population, Environment, and Development (New York, January 20-24, 1992). The meeting urged developed countries to make technologies, which were designed to achieve sustained economic growth and sustainable development, available to developing countries at a reasonable cost. International organizations were advised to increase their assistance in the fields of population, sustainable development, and environment. Governments were encouraged to undertake projects that were ecologically beneficial and labor intensive (reforestation, contour leveling, terracing small scale irrigation); to enhance the access of the rural poor to employment opportunities, credit, and social services (health, education, and family planning); to place emphasis on popular education, especially for women; to provide additional resources to local authorities for city management, particularly those experiencing rapid population growth; to provide adequate training in municipal management, including provisional environmental services; and to emphasize the participation of women as environmental managers in community-based population and environmental programs.
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  11. 161
    Peer Reviewed

    Surveillance for the Expanded Programme on Immunization.

    Cutts FT; Waldman RJ; Zoffman HM


    Public health programs and activities are based on surveillance. The WHO Expanded Programme on Immunization (EPI) has designed and used different surveillance methods to improve disease control. It uses various methods of data collection. Routine reporting includes immunization coverage and cases of EPI target diseases (measles, neonatal tetanus, and poliomyelitis). Surveillance through sentinel sites and community-based reporting are other methods of data collection. Immunization programs should like their ongoing surveillance data with data supervision of immunization practices, health facility assessments, population surveys, and outbreak investigations. Program managers and other public health decision makers should use surveillance data to determine public health priorities, to decide on appropriate immunization schedules and strategies, to target populations at high risk, to implement immunization programs, and to evaluate program effectiveness. The US Centers for Disease Control have developed guidelines for evaluating surveillance systems. Surveillance system evaluations should examine the degree to which public health officials use data for policy-making and program improvement. They should also consider the timeliness, completeness, simplicity, accuracy, and cost of surveillance data. Public health decision makers should strengthen existing routine systems for surveillance of infectious diseases instead of instituting parallel systems for EPI target diseases. The district level should manage these systems. Countries with immunization coverage of infants greater than 80% should concentrate on areas and population groups with increased risk of disease. This high-risk approach is needed to eradicate the wild poliovirus. EPI's goals of reducing measles cases by 90%, eliminating neonatal tetanus, and eradicating poliomyelitis offer countries an opportunity to allocate resources to improve disease surveillance so as to achieve an effective disease surveillance system.
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  12. 162

    Environmental sustainability in economic development -- with emphasis on Amazonia.

    Goodland R

    In: Race to save the tropics. Ecology and economics for a sustainable future, edited by Robert Goodland. Washington, D.C., Island Press, 1990. 171-89.

    Sustainability denotes well-being, intergenerational equity, minimal use of exhaustible mineral reserves, slow depletion of nonrenewable energy resources allowing an orderly societal transition to renewable energy sources, and agricultural sustainability. Many parts of the world have already surpassed their carrying capacity. To effectively apply environmental management to economic development, decision makers must understand the fundamental relationship among growth, equality, and ethics. Liberation of women and reduction of excess consumption by the rich are needed to achieve environmental sustainability. We have been able to solve some environmental problems once they have reached a crisis stage by investing money into their solution. Prevention is the only means to address irreversible environmental effects, however. The major reason for biodiversity loss is destruction of tropical forests which support 50% of the world's 5-30 million species on 7% of the land area. A large percentage of the biodiversity in the Philippines, Haiti, El Salvador, Sri Lanka, Bangladesh, and parts of India is already gone. Some corporations have begun to respond responsibility to the environment. In 1987 the largest investor in economic development in developing countries, the World Bank, implemented environmental policies for all programs. The Bank normally refuses to finance projects designed to convert wildlands of special concern, e.g. to national parks. Projects concerning wildlands other than those of special concern should only occur on already converted land. A more open decision making process is required to justify any deviations from the above policies. If wildlands development is defended, the project should just convert less valuable wildlands. Financing preservation of another wildland is required for any conversion of wildlands not of special concern. If a project does not involve conversion of wildlands, the Bank requires the preservation of wildlands for their environmental services alone.
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  13. 163

    Health for all: how it looks now.

    WORLD HEALTH FORUM. 1993; 14(4):333-44.

    WHO evaluated the implementation of the health-for-all strategy using data from 151 countries. 110 countries still endorsed the strategy. 95 have either completely implemented or further developed community involvement. Just 33 countries had more equitable distribution of resources. The percentage of gross national product (GNP) that the government dedicated to health rose in the least developed countries. Developed countries spent a higher proportion of their GNP on health than did developing countries (3.3% vs. 0.9%, 1991). Maldistribution of health personnel continued to be a major problem. Between 1985 and 1990, the proportion of people in developing countries with access to safe water rose from 68 to 75%. Adequate sewage disposal coverage rose from 46 to 71% (1985-1991). Prenatal care coverage by trained personnel increased from 58 to 67%. Tetanus toxoid coverage of pregnant women only increased from 24 to 34%. Most maternal deaths were a result of inadequate prenatal care, inadequate care during childbirth, pregnancies spaced too closely, multiparity, and poor health and nutritional status before the first pregnancy. Immunization coverage rose considerably in every region (e.g., 47-83% for diphtheria). Nevertheless, substantial differences in coverage existed between countries. A substantial trend towards more integrated primary health care occurred. Child survival rates improved, but the gap in infant mortality rates between developed countries and the least developed countries widened. The gap in health status between the poor and the wealthy had become larger. Developing countries in the process of the epidemiological transition continued to be burdened with both infectious and degenerative diseases. GNP and adult literacy rose, but less so in the least developed countries. These findings suggested that governments must sustain the commitment to reduce inequities, realign health systems, improve health financing systems, improve coordination between health sectors, and improve linkage between health and development.
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  14. 164
    Peer Reviewed

    External assistance to the health sector in developing countries: a detailed analysis, 1972-90.

    Michaud C; Murray CJ


    The examination of the external assistance to the health sector quantified the sources and recipients of such assistance in 1990 by analyzing time trends for external assistance to the health sector over the preceding two decades, and, by describing the allocation of resources to specific activities in the health sector. The health sector external assistance data were collected through a questionnaire and follow-up visits to all major bilaterals, multilaterals, and large nongovernmental (NGO) agencies. The three major databases on development assistance were also used: the Organization for Economic Cooperation and Development (OECD) Development Assistance Committee (DAC) annual tables, the Creditor Reporting System (CRS) from OECD, and the Register of Development Activities of the United Nations system. From 1972 to 1980, there was a sustained increase in external assistance by 14% per year. Beginning in 1986, the pace of increase was lower than in the 1970s but had averaged 7% per year in both bilateral and multilateral agencies. In 1990 in developing countries, health external assistance totaled $4800 million, or only 2.9% of total health expenditures in developing countries. 82% of this sum originated from public coffers in developed countries and 18% from private households. Resources to the health sectors of developing countries included: 40% through bilateral development agencies, 33% through United Nations agencies, and 8% through the World Bank and banks such as the Asian Development Bank. Nongovernmental Organizations (NGOs) accounted for 17%, and 1.5% came from foundations. The USA accounted for 27.5% of all assistance, France for 12.9%, and Japan for 11.5%. One quarter of all health sector assistance was paid for by Sweden, Italy, Germany, and the United Kingdom. The study confirms prior findings that health status variables per se are not related to the amount of aid received. Comparing investments to the burden of disease shows tremendous differences in the funding for different health problems. A number of conditions are comparatively underfinanced, particularly noncommunicable diseases and injuries.
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  15. 165

    [Plan International Guatemala] Plan Internacional Guatemala.

    Castillo E

    HABLEMOS DE VITAMIN A. 1994 Aug-Nov; 3(2):5.

    Plan International is a nonsectarian, nonprofit international organization that provides assistance to needy children, their families, and their communities through ninety-eight local offices in twenty-seven developing countries. Donors from Australia, Belgium, Canada, Germany, Holland, Japan, the United Kingdom, and the United States sponsor children in the countries. Communication between the child and the sponsor is a vital element of Plan International. Sponsored children always remain with their families, which are fortified by health, educational, community development, and income-generating programs. Plan projects are designed to assure community participation, long-term sustainability, and tangible results. Plan International is a consulting member of UNICEF and is recognized by UNESCO. Plan International was created in 1937 to provide food, housing, and educational services to children victimized by the Spanish Civil War. During World War II the program provided assistance in England to expatriate children from throughout Europe. After the war, the organization extended its assistance to children in several other European countries and for a short time to Poland, Czechoslovakia, and China. As Europe recovered from the war, Plan International gradually withdrew from these countries and began new programs in developing countries. In Guatemala, Plan International began work in Amatitlan in 1979 and in Villa Nueva in 1990. It promotes measures to prevent diarrhea, respiratory disorders, and nutritional problems, and to encourage growth monitoring and vitamin A supplementation. The Child Survival Project provides vitamin A to children under five in educational visits made twice yearly through the community health committees, with participation of health volunteers and promoters and Ministry of Health and Social Security Institute personnel. Home visits are made to provide health information, Mebendozole, ferrous sulfate, and vitamin A.
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  16. 166

    [And after Cairo? It is now that the difficulties begin] Le Caire, et apres? C'est maintenant que les difficultes commencent.

    Speidel J


    The international community and the UN should be congratulated for adopting a strategy and a very clear action plan at the International Conference on Population and Development in Cairo. The process leading up to and during the conference allowed all member nations, even the most conservative members, to communicate their interest in problems associated with population and development and their approaches to solving the problems. The members reached consensus and adopted the program of action. Conference delegates finalized the program of action by concentrating on a global vision of population policy. They recognized the need for unrestricted access to high quality family planning services and the right of women. The document calls for improved reproductive health in developing countries. Specifically, it pronounces the need for improved sanitary conditions during childbirth, access to safe abortion where it is legal, and successive steps to reduce sexually transmitted diseases, including AIDS. Implementation of the program of action poses some difficulties, however. Will the most developed countries provide the necessary financial resources to meet the needs of family planning and reproductive health? Many such countries have promised to contribute US$ 17 billion to meet these needs in developing countries. The US plans to contribute US$ 600 million in 1995. Japan will contribute US$ 3 billion over the next 7 years, 33% of which will go to family planning. Germany plans to give US$ 2 billion over the same period. The European Union plans to give US$ 400 million each year. Other countries also plan to contribute (UK and Belgium). We must make sure that the words adopted in Cairo become reality for the men and women of the planet.
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  17. 167

    Population, environment and development.

    Karkal M

    HEALTH FOR THE MILLIONS. 1994 Jun; 2(3):8-10.

    Western development models label subsistence economies, which do not participate in the market economy on a grand scale and do not consume commodities produced for and distributed through the market, to be poor. Yet, subsistence does not always indicate a low quality of life. The Western development process has destroyed wholesome and sustainable lifestyles. In India, the Green Revolution caused many small farmers to lose their land. In comparison to traditional economies, industrial economies have longer technological chains dependent on higher energy and resource inputs and exclude large numbers of people without power to buy goods. Further, they generate new and artificial needs, necessitating increased production of industrial goods and services. They erode resource bases for survival. This erosion is marginalizing people who were traditionally in nature's economy. Developed countries did not deliver 0.15% of their GNP to development projects in developing countries as promised. The US made population growth in these countries its cause. The UN and other multinational agencies during 1962-1972, at the US's request, began to support population and family planning programs in developing countries. These countries opposed the 1st draft at the 1974 Bucharest Population Conference, but by the conference in Mexico City, most supported the need for family planning. Yet, the US politicized this conference and had a greater say in the recommendations than did developing countries. Structural adjustments and external debt repayments required of developing countries in the 1980s set them back. In fact, the number of developing countries increased from 31 to 42. The UN recognizes the right to development, but social inequalities are barriers to this right. If environmental degradation continues, poverty will only increase. Women's groups are playing a great role in preparations for the International Conference on Population and Development in Cairo in September 1994.
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  18. 168

    From comparison to choices. The voice of the voiceless.

    Geary J

    ORGYN. 1994; (4):10-3.

    The International Planned Parenthood Federation [IPPF] was established in 1952. It promotes and supports family planning services in more than 130 countries worldwide. It also educates people and governments about the benefits of family planning. IPPF's Assistant Secretary General, Dr. Pramilla Senanayake, will be chairing the FIGO symposium entitled From Comparison to Choices. An advantage of her chairing the symposium is that, being a pediatrician, she approaches family planning from the child's point of view, while obstetrician/gynecologists approach it from the woman's point of view. Contraceptive choice is very important since no method is ideal for all couples and one's contraceptive needs change at each life stage. New contraceptive methods and improved service delivery of both existing and new methods are essential to bring effective contraceptives to everyone who needs them. The newer oral contraceptives (OCs) provide better cycle control and efficacy and fewer side effects than the most recent older OCs. Breast feeding women need a contraceptive 4-6 months after childbirth and one that does not decrease lactation. No current contraceptive fits the lifestyle of female teens because they have intercourse irregularly and are most in need of contraception. No really effective reversible method exists for men. Family planning methods are crucial to women and children's health and to achieving zero population growth. They are essential to avert environmental catastrophe, since population growth is straining natural and social resources. IPPF is a pioneer in targeting marginalized populations (refugees, males, migrants, and adolescents). IPPF serves as an advisor to local staff and volunteers who know the problems and needs of their own people, so they develop programs that are culturally sensitive and culture-specific. People in the US consume 15 times more natural resources than do Indians. Family planning is a way to prevent war, famine, and disease.
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  19. 169

    A bill of health for the IUD: where do we go from here?

    Chi IC

    ADVANCES IN CONTRACEPTION. 1994 Jun; 10(2):121-31.

    The World Health Organization's prospective IUD study at 47 centers in 23 (mostly developing) countries among 22,908 women found an elevated IUD-related risk of pelvic inflammatory disease (PID) during the 1st 20 days after IUD insertion. It also showed that the likely major determinant of PID among IUD users is the risk of exposure to sexually transmitted diseases (STDs). Long-term IUD use is related to a uniformly low PID risk. These findings support measures already practiced by most service providers: aseptic conditions and techniques during IUD insertion, close monitoring of women for signs of infection during the early stage of IUD use, IUDs not recommended for women at risk of STDs, use of long-lasting IUDs, and removal before the end of the IUD's life span. Additional research is recommended to strengthen the validity of the findings, to further reduce IUD-related PID incidence, and to expand indications for IUD use. Cohort IUD studies should ascertain women's sexual behavior at baseline and during the study period. Other cohort studies should examine the natural history of IUD insertion-related PID. Clinical trials should examine the protective effects of antibiotics administered during IUD insertion against PID. IUD use in nulliparous and nulligravid women should be studied. Studies should clarify the link between IUD use and nongonorrheal infections (chlamydial infection, HIV infection, and actinomycosis). Research is needed to examine IUDs that claim to protect against PID (e.g., levonorgestrel-releasing IUDs). After family planning researchers clear IUD use from its alleged association with PID and its sequelae, they can advance to studies on how to improve the quality of life of IUD users (e.g., reducing distressing symptoms such as bleeding) and to increase access to IUDs by removing the programmatic and medical barriers.
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  20. 170

    Global burden sharing.

    Brundtland GX

    INTEGRATION. 1994 Jun; (40):11-3.

    The Prime Minister of Norway discusses issues of population growth and sustainable development. Months before the 1994 International Conference on Population and Development, she establishes the basis upon which a global compact on population and development can be built. Individuals and groups in developed countries increasingly implore people in developing countries to reduce their levels of fertility in the interest of environmental protection and sustainable development. People in developing countries, however, point out that the industrialized developed countries have a disproportionately large role in polluting the environment. Fertility declines, lower consumption levels in the North, and less waste are all needed to safeguard the long-term health and survivability of the planet. The world simply cannot sustain a Western level of consumption for all. Accordingly, a commitment by the South to reduce population growth should be coupled with an equal commitment from the North to reduce the strain of consumption and production patterns on the global environment. Individual attitudes and habits must change while internationally coordinated political decisions are also made about the course and content of the world economy. Norway hosted a meeting January 1994 to address changing consumption patterns in hopes of launching a qualitatively new debate on sustainable consumption in the North and to demonstrate to the South that we are serious about our responsibility. As we move ahead, the author stresses the need to recognize the importance of providing education to both men and women, and paying the bill for necessary global reforms.
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  21. 171

    Donors promise increased support for population, reproductive health.

    ICPD 94. 1994 Aug; (18):3.

    Increased support is needed from the international community to implement the actions proposed in the 1994 International Conference on Population and Development (ICPD) program of action. Some countries have already indicated their willingness and plans to provide additional funds for population-related programs. For example, the Group of Seven major industrial nations strongly endorsed the ICPD at their July 8-9 summit in Naples. The group called on the World Bank and regional development banks to reinforce private capital flows to developing countries while providing growing resources for health, education, family policies, and environmental protection. The summit in 1995 will focus specifically upon the challenge of providing sustainable development and prosperity for the world's peoples and nations. Most striking, however, is the European Union pledge to increase by fifteen-fold the amount of aid it already gives for population-related development activities in developing countries. Its contribution will total a pledged $347 million/year by the year 2000, with an increased percentage going to sub-Saharan Africa.
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  22. 172

    [The World Conferences on Population] Les Conferences mondiales sur la population.

    Tabah L

    Population et Societes. 1994 May; (290):1-3.

    The first international population conference was organized in 1927 by the League of Nations, and led to creation of the International Union for the Scientific Study of Population. At the time, the concept of family planning as an exercise of individual freedom was controversial in countries such as France which were intent on raising their low birth rates. After the war, the UN created a Population Commission and a Population Division for demographic study. The first director general of UNESCO, Julian Huxley, recommended that each country develop a population policy to be integrated into a world policy. His proposed World Population Conference finally was held in Rome in 1954. It was a conference of experts, not of government representatives, but the debates were as much political and ideological as scientific. The concept of population explosion was at the time replacing the notion of overpopulation. In 1962, Sweden announced that it would include family planning in the population programs it financed. The willingness of the UN to respond to all requests for population and family planning assistance was announced at the 1965 World Population Conference in Belgrade. The idea that rapid population growth had negative effects on economic development was becoming prominent. In December 1966, twelve heads of government signed a Population Declaration affirming the right of couples to knowledge and means of family planning. The UN Fund for Population Activities was created; its annual budget has grown from $5 million in 1969 to $240 million at present. The 1974 World Population Conference at Bucharest was a meeting of governments and not of experts. The Plan of Action finally adopted declared demographic variables to be dependent on development and social justice. Fertility regulation was related to family welfare and contraception to maternal and child health, female education, and regulation of age at marriage. The Bucharest Conference legitimized the concept of population policies. By the 1994 World Population Conference in Mexico City, a deceleration of demographic growth was occurring in many countries due to the combined effects of economic progress and family planning programs. The gap between countries better integrated into the world economic system and those especially in sub-Saharan Africa that were failing to achieve integration was widening. The European countries began calling attention to their own population problems of aging, low fertility, and international migration. Abortion was debated but did not appear in the final conference document. The eighty-eight recommendations were adopted by acclamation. The upcoming 1994 Cairo Conference, like the Bucharest and Mexico City conferences, was preceded by expert meetings and regional conferences. The proposed World Population Plan of Action is more elaborate than its predecessors, and the range of problems to be addressed is daunting. The Cairo Conference will have been useful if it advances international cooperation even slightly.
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  23. 173

    Should we re-invent WHO, or bury it?

    Nyakunu T


    By restructuring the World Health Organization (WHO) and instituting some basic changes in policy priorities, the effectiveness of the organization would be increased. Instead of assigning resources to combating the health-related issues of individual choice which exist in rich nations, such as wearing seat belts, smoking, or consuming alcohol, WHO should concentrate its funding on developing countries which continue to suffer from preventable diseases like cholera, typhoid, and malaria. Providing public health assistance to third-world countries was the original mission of WHO, but the organization was given great flexibility when it was set-up. Therefore, while WHO dollars address such issues as the medical effects of nuclear war or developing essential drug lists for circumpolar regions, people in developing nations die from preventable communicable diseases. Like other large bureaucracies, WHO is mired in a cycle of "talk, talk, talk," instead of simply tackling the problems which are pressing and evident. The resources devoted to endless meetings, conventions, and coordinating sessions prove that talk is no longer cheap, and WHO must respond positively to the demands of its poorer member states that it reorient its efforts to help those who really need help. WHO's scarce resources can no longer be stretched to fund "fashionable" issues in countries which have already achieved a longer life span and better health than is possible for citizens of African nations. By abolishing its European office and programs, WHO could increase the country budget for Africa by two-thirds. Proper use of its 1994-95 budget of approximately US $1.8 billion would go a long way towards fulfilling the goal of vaccinating every child in the world against the major childhood diseases. Instead of continuing to help those who can help themselves, WHO should direct its efforts to saving lives in the Third World.
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  24. 174

    Expert Group Meeting on Population Distribution and Migration.


    As part of the preparation for the up-coming International Conference on Population and Development, an expert group meeting on population distribution and migration was held in Santa Cruz, Bolivia, in January 1993. Participants considered the scope of migration which included a net internal migration of between 75 million and 1 billion people during 1975-85 and international migration which census data put at 77 million in the 1970s and early 1980s. World economic trends during the 1980s were reviewed, as were changes in the nature and configuration of various countries. The following topics were explored: patterns of population distribution and development, policies affecting internal migration and population distribution, internal migration and its implications for development, economic aspects of international migration, international migration in a changing world, international migration between developing countries, and refugees and asylum-seekers. 37 recommendations were prepared for governments, social institutions, and the international community. The first 10 urge that population distribution be an integral part of development policies, that government policies and expenditures be evaluated for their contribution to social and economic goals, that the capacity and competence of municipal authorities to manage urban development be increased, that government funding be decentralized, that economic and institutional links be developed between urban centers and surrounding rural areas, that alternatives to out-migration from rural areas be created, that the income-earning capacities of migrants be improved, that group mobilization by and for people affected by migration be encouraged, that adequate access to health services and family planning be assured, and that the underlying causes of environmental degradation, natural disasters, and war be addressed with mechanisms developed to protect victims. 13 recommendations deal with international migration and call for appropriate policies, cooperation, protection of human rights, an end to discrimination toward women, the normalization of family life among documented migrants, the promotion of good community relations between migrants and the rest of society, the guarantee of equal economic and social rights to longterm foreign residents and facilitation of their naturalization, the provision of legal information to potential migrants, the provision of equal educational and training opportunities to the children of migrants, and the institution of sanctions against the organizers of illegal migration. The next 7 recommendations urge that the causes of forced migration be addressed, that refugees receive assistance and protection, that the responsibility for refugees be shared equitably, that the right to asylum be protected, that appropriate repatriation programs be supported, that long-standing refugee populations be helped to achieve self-sufficiency, and that the specific needs of refugee women be addressed. The final 7 recommendations cover data and research needs regarding population distribution and migration and urge support for research on population distribution, the collection of national statistics, a review of existing standard definitions and classifications of rural and urban populations and of international migration, cooperation in the registration and monitoring of refugee populations, and the promotion of an exchange of information on trends and policies of international migration.
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  25. 175

    Expert Group Meeting on Population Growth and Demographic Structure.


    As part of the preparation for the forth-coming UN International Conference on Population and Development, an expert group met in Paris, France, in November 1992 to discuss population growth and demographic structure. As part of the demographic background for the meeting provided by the UN Population Division, participants were informed that although the world population growth rate began to decline in the late 1970s, this decline has not yet resulted in declining absolute numbers, and the annual increment to the world population was not expected to decline to the level that existed in 1985 until the period 2020-25. World population increased from 2.5 billion in 1950 to 5.3 billion in 1990. The medium variant population projection of the UN shows world population at 6.3 billion in 2000 and 8.5 billion in 2025 (the high variant shows 9.4 billion in 2025 and the low variant shows 7.6 billion). Population aging is expected to reach unparalleled levels in 2010-20. The meeting then considered the topics of population growth and socioeconomic development, confronting poverty in developing countries, demographic impacts of development patterns, demographic and health transitions, population growth and employment, social change and the elderly in developing countries, and social development and ageing in developed countries, The expert group meeting then prepared 19 recommendations aimed at governments, social institutions, and the international community. The recommendations call for political commitment to human resources development and population and development programs, especially in least developed countries, alleviation of poverty and social inequality, and equality of access to social and health resources that will lead to reduced mortality and fertility. Governments are urged to place a high priority on education and on increasing women's access to education and to remove barriers to economic independence for women. Health-sector priorities should be reassessed to provide the most cost-effective and efficient means of providing health care, reproductive health-care programs should receive high priority, and efforts should be made to minimize the effects of HIV infection and reduce the spread of AIDS. The needs of the elderly should be met with a "safety net," which should be developed in countries with no social security programs. The elderly should be recognized as an important human resource for development, and intergenerational equity should exist to accommodate their needs, with special efforts made to help them remain in their own homes and communities. Governments should collect accurate, comprehensive, and regular data on population characteristics and trends, and the international community should facilitate the comparative analysis of such data. Training should be provided to professionals in demography and related fields in developing countries.
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