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  1. 176

    United Nations/World Health Organization Meeting on Socio-Economic Determinants and Consequences of Mortality, Mexico City, 19-25 June 1979.

    United Nations. Department of International Economic and Social Affairs. Population Division; World Health Organization [WHO]

    Population Bulletin. 1980; (13):60-74.

    The objectives of the United Nations/World Health Organization (WHO) Meeting on Socioeconomic Determinants and Consequences of Mortality, held in Mexico City in June 1979, were the following: to review the knowledge of differential mortality and to identify gaps in the understanding of its socioeconomic determinants and consequences; to discuss the methodological and technical problems associated with data collection and analysis; to consider the policy implications of the findings presented and to promote studies on the implications of socioeconomic differentials in mortality on social policy and international development strategies; to formulate recommendations and guidelines for the utilization of the 1980 round of population censuses for in-depth studies of mortality differentials; and to stimulate national and international research on differential mortality. Participants discussed the state of knowledge of socioeconomic differentials and determinants of mortality and described the socioeconomic measures available, the methods of data collection and analysis used, and the findings themselves. A number of characteristics had been employed in the study of differential mortality, and these could be grouped under the following headings: occupation; education; housing; income, wealth; family size; and place of residence. The techniques or methods used to analyze mortality were direct and indirect methods, and these are examined. Inequalities in mortality were found to be closely associated with inequalities in social and economic conditions. Any effort to reduce or remove those inequalities would have to be based on a clear understanding of their causes and interrelationships in order to succeed. Participants indicated a desire to see a resurgence of mortality research, and some research suggestions are outlined.
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  2. 177

    United Nations/United Nations Fund for Population Activities Expert Group Meeting on Population-Development Modelling, Geneva, 24-28 September 1979.

    United Nations. Department of International Economic and Social Affairs

    Population Bulletin. 1980; (13):80-4.

    The objective of the Expert Group Meeting on Population-Development Modelling, held in Geneva during September 1979, was to make a critical review of existing population-development models and to assess their practical value in policymaking and planning. Of particular concern was the treatment of population-related issues in these models and their adaptability to the needs of developing countries in terms of such factors as conceptual and methodological problems and the availability of accurate and diverse data and technical and computer infrastructure. Several aspects of the problems were examined at the meeting. 6 areas were covered: the value of population-development model-building, achievements of existing population-development models, population-development submodels, the identification of research priorities concerning population-development interrelationships, perspective and alternative approaches to integrating demographic components into existing development planning frameworks, and an institutional framework for building and using population-development models. The Working Group developed and adopted a set of recommendations for future research and actions and these are presented. The recommendations made are in the following areas: role of population-development models, types of population-development models, institutional framework, and priorities for future research. The following were included among the recommendations: 1) efforts to contrast and apply models of various types relating to social, economic, and demographic processes should be encouraged; and 2) a need exists to support the development of research-oriented models.
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  3. 178

    Re: Depo Provera: a critical analysis, Stephen Minkin, Women & Health, Vol. 5:49-69, Summer, 1980 [letter]

    McDaniel EB

    Women and Health. 1980 Winter; 5(4):85-7.

    The readers of "Women and Health" and the American public deserve to hear the other side of the argument in regard to Depo Provera. This physician, who has been responsible for the operation of a large family planning program in northern Thailand for 17 years, has been personally responsible for the administration of over a million injections of Depo Provera to almost 100,000 women, for a total usage of over 240,000 woman years. Many of these women have used this method for 10 years or longer. Surveillance of all family planning patients goes on continuously, with particular emphasis on the users and former users of depomedroxyprogesterone acetate (DMPA), the active component in Depo Provera. A large and unbiased component of this surveillance is the Chian Mai component of the worldwide, multicentered, 5-year case control World Health Organization study of homronal steroid contraception. At McCormick Hospital in Chiang Mai, clinic records have been maintained on every family planning acceptor since the program began in 1963, and every DMPA acceptor since the start of this method in 1965. The research shows the following: a method failure rate on the average of only 1 unintended pregnancy in every 142 women using the DMPA 3-month injection method for a full year; a good return to fertility rate with the outcomes of pregnancies and deliveries being normal; and a rate of congenital anomalies not significantly different from that observed in former pill or IUD users or in non-contracepting mothers. There has been no increase in endometritis, endometrial cancer, inhibition of milk supply of nursing mothers, or detectable harm to the infants of mothers receiving DMPA injections. The alleged "marked increase in breast and cervical cancer rates in Chiang Mai, Thailand," as indicated by Minkin in his testimony before the Congressional Committee on September 9, 1980, is a misinterpretation of a WHO report and is contrary to fact. There has been no indication that women on DMPA or their nursing infants suffer an increased incidence of infections or cancers of any kind.
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  4. 179

    Constitution of the World Health Organization.

    World Health Organization [WHO]

    In: World Health Organization. Basic documents. 30th ed. Geneva, Switzerland, WHO, 1980. 1-18.

    This document provides the text of the constitution of WHO (World Health Organization) which was adopted by 61 nations at the International Health Conference held in New York in 1946. The constitution sets forth the principles and goals of the organization and defines its organizational structure. The constitution recognizes the principle that all individuals have the right to attain their maximum health status and that governments have a responsibility to ensure that this right is realized. The constitution calls for the establishment of 3 bodies within WHO. These bodies are 1) the World Health Assembly, composed of delegations from all member nations; 2) the Executive Board, composed of 30 members from 30 countries designated by the Assembly; and 3) the Secretariat, composed of the Director General and his administrative staff. The Assembly is charged with the responsibility of making policy decisions, reviewing the activities of the other 2 bodies, supervising financial policies, and promoting the activity of the organization. The Executive Board serves as the executive arm of the Health Assembly and the Secretariat carries out the policies of the Assembly. The constitution also defines budgeting, voting, and reporting procedures.
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  5. 180

    Population policy briefs: current situation in developing countries and selected territories, 1979.

    United Nations. Department of International Economic and Social Affairs. Population Division

    New York, UN, 1980 May 28. 57 p. (ESP/P/WP.67)

    This report presents a brief summary of governments of developing countries and selected territories' population policies in relation to population growth, fertility, mortality, international migration, and spatial distribution. The information is based on replies to the Third and Fourth Population Policy Inquiry Among Governments, material contained in the Population Policy Data Bank of the Population Division. Summaries of policies are presented for the following countries: Afghanistan; Algeria; Angola; Argentina; Bahamas; Bahrain; Bangladesh; Barbados; Benin; Bhutan; Bolivia; Botswana; Brazil; Burma; Burundi; Cape Verde; Central African Republic; Chad; Chile; China; Colombia; Comoros; Congo; Costa Rica; Cuba; Cyprus; Democratic Kampuchea; Democratic People's Republic of Korea; Djibouti; Dominica; Dominican Republic; Ecuador; Egypt; El Salvador; Equatorial Guinea; Ethiopia; Fiji; Gabon; Gambia; Ghana; Grenada; Guatemala; Guinea; Guinea Bissau; Guyana; Haiti; Honduras; India; Indonesia; Iran; Iraq; Israel; Ivory Coast; Jamaica; Jordan; Kenya; Kuwait; Lao Peoples' Democratic Republic; Lebanon; Lesotho; Liberia; Libyan Arab Jamahiriya; Madagascar; Malawi; Malaysia; Maldives Mali; Mauritania; Mauritius; Mexico; Mongolia; Morocco; Mozambique; Nauru; Nepal; Nicaragua; Niger; Nigeria; Oman; Pakistan; Papua New Guinea; Paraguay; Peru; Philippines; Qatar; Republic of Korea; Rwanda; Saint Lucia; Samoa; Sao Tome and Principe; Saudi Arabia; Seychelles; Sierra Leone; Singapore; Solomon Islands; Somalia; Thailand; Togo; Turkey; Uganda; Uruguay; and others.
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  6. 181

    Working Group on Adolescent Fertility Management, Manila, Philippines, October 13-17, 1980. Final report.

    World Health Organization [WHO]. Regional Office for the Western Pacific

    Manila, Philippines, WHO Regional Office of the Western Pacific, 1980 Dec. 42 p.

    The objectives of the Working Group on Adolescent Fertility Management, meeting in Manila during October 1980 under the World Health Organization (WHO) Regional Office for the Western Pacific, were the following: to review the current situation in the Region with regard to adolescent pregnancies, use of contraception on the part of adolescents, and the services available; 2) to identify the biological, social and psychological aspects of adolescent fertility management; and 3) to recommend appropriate approaches and programs in relation to the problems created by adolescent pregnancies. For working purposes, it was decided that adolescence covered the age period 10-19 years. The country-specific information provided by participants representing 11 countries regarding the size and the nature of the problems related to adolescent sexuality and fertility are summarized. In discussing the possible preventive approaches and programmatic solutions to the problems related to adolescent sexuality and fertility, the Working Group identified the following gaps and problems: 1) a significant lack of relevant and country-specific data regarding the adolescent population and their current sexual and reproductive behavior; 2) a lack of awareness by responsible government bodies of the increasing problem and of commitment to seek appropriate solutions; 3) a lack of knowledge about health and health-related issues of the adolescent development period; and 4) a lack of appropriate and acceptable services regarding fertility management for adolescents. Education and information constitute a major need in the area of adolescent sexuality and fertility.
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  7. 182

    Two years' experience with minilaparotomy tubal ligation in a freestanding clinic.

    Whitaker KF

    Advances in Planned Parenthood. 1980; 15(3):77-81.

    In 1977 the PPAN (Planned Parenthood Association of Nashville) began providing minilaparotomy sterilization services on an outpatient basis. The experience of 218 women who received sterilizations at the clinic between 1977-1979 indicated that it was feasible and safe to provide this service on an outpatient basis. The historical development of the program, the procedures and instruments used to perform the sterilizations, and the sterilization outcomes for the 218 patients were described. Prior to program initiation, the Medical and Executive Directors of PPAN attended a workshop on outpatient female sterilizations conducted by AVS (Association for Voluntary Sterilization) and the Planned Parenthood Federation of America. Subsequently a protocol for minilaparotomy sterilization was submitted to the National Medical Office of the Federation by the PPAN. The protocol was approved and the program was implemented. Based on the success of the 1st 18 months of operation PPAN received a grant from AVS to train personnel from other clinics to provide similar services. During the 1st clinic visit patients are thoroughly counseled and given a pelvic examination. During the 2nd visit the patient is given a complete physical examination and laboratory tests, including a pregnancy test, are performed. During the 3rd visit the patient receives additional counseling and the sterilization is then performed. A modified Pomeroy procedure is performed under local anesthesia. Patients were discharged 2 hours after surgery. 96% of the patients returned for suture removal and 50% returned for a later recommended check-up. A follow-up survey indicated that more than 90% of the patients were satisfied with the service. For 4 of the 218 patients the sterilization was not completed. In 2 cases the round ligament was mistaken for the tube and sterilization was not achieved, in 1 case the patient became upset and the procedure was halted, and in another case adhesions prevented ligation. At the time of the operation it was discovered that 2 patients had luteal phase pregnancies. There were no major immediate complications but there were 1) 2 cases of subcutaneous hematomas; 2) 1 brief episode of postoperative thrombophlebitis, 3) 2 cases of wound abscesses; and 4) 3 cases of mild cystitis and endometritis.
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  8. 183

    [Morocco: report of Mission on Needs Assessment for Population] Maroc: rapport de Mission sue l'evaluation des besoins d'aide en matiere de population.

    United Nations Fund for Population Activities [UNFPA]

    New York, UNFPA, June 1980. 111 p. (Report No. 29)

    In December 1979 a mission sponsored by UNFPA visited Morocco in order to evaluate the need for population assistance. Morocco experiences a high population growth rate, a high rate of malnutrition, infant mortality, and illiteracy, and low availability of health care in rural areas. The economy is in crisis, and population growth undermines the efforts toward development. It is suggested that population policy must be introduced along with social and economic development as part of an integrated development plan. The mission recommends exterior aid in cooperation with the government with the inception of the next Development Plan, and in particular the participation of UNFPA in data collection and research. In addition, the government of Morocco is urged to determine which agency is best suited to coordinate development and population activities, and cooperation with outside agencies.
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  9. 184

    Relationships and roles in providing health-system assistance: donor/contractor relationships.

    OConnor RW

    In: O'Connor RW, ed. Managing health systems in developing areas: experiences from Afghanistan. Lexington, Massachusetts, D.C. Heath, 1980. 117-20.

    Most donor/contractor relations within the health care field in Afghanistan have been excellent. Primary interaction and responsibility was with USAID (U. S. Agency for International Development). The nature of the project, however, required cooperation with other donors, e.g., UNICEF, UNFPA, and the World Bank. The USAID team gave the project staff a great deal of freedom of management. When more than 1 donor happened to be involved with a particular rural health project, none tried to take over control of the project. Locally knowledgeable personnel should be used for program development instead of USAID relying on outside contractors with minimal knowledge of the country.
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  10. 185

    Income generating activities with women's participation: a re-examination of goals and issues.

    Hoskins MW

    Washington, D.C., Agency for International Development, Office of Women in Development, 1980 Dec. 45 p. (Contract AID/otr/147-80-76)

    Of all of USAID's various projects, income generating programs attract the most interest. Women's income generation includes any self-supporting project where benefits accrue to women participants from sale of items for money, from employment for wages, or increased produce. Projects which include planting trees to increase fuel or fodder supply, conserving soil, using appropriate technology, or eliminating waste, may benefit participants either in income or in acquisition. Poor women in India are paid in precooked food. Selecting the right project for the right group of people is the key to success. Specific considerations include the following: 1) products being supplied to the market; 2) available economic, natural, and skill resources; 3) any social organization which includes the identified group of women; 4) what social welfare needs have the highest priority; and, 5) how can the political structure help or hinder the identified group's economic participation and/or success? An insufficient resource base, market and management skills have been identified by many developers as the weakest aspect in women's projects. For small businesses the most important questions are as follows: what is the market; why is the project needed by the market; what are the steps from obtaining raw materials until the profits are distributed or reinvested; what are the potentials for growth; what is the outside expertise needed; and, how will the outside expertise be obtained and paid?
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  11. 186

    Health is a way of life.

    Bland JH

    World Health. 1980 Feb-Mar; 36.

    The point was made recently in an article in "World Health" in December 1980 that hospitals continue to risk becoming breeding grounds for disease unless people take the right precautions. Florence Nightingale, writing 120 years ago, noted her horror upon seeing the cholera and dysentery infested hospitals of the British army during the Crimean war of 1853-1856. She suggested that hospitals may have actually increased, rather than diminished, the rate of mortality. She identified 5 essential points for securing "the health of houses": pure air; pure water; efficient drainage; cleanliness; and light. If by pure air and light she meant good environment, her message was the same as the message of the World Health Organization (WHO) today. Nightingale also stressed the need for a sensible diet. By primary health care is meant the need for health care to reach all the millions of people who are still without access to doctors or hospitals or drugs.
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  12. 187

    Health for all by the year 2000.

    Mahler H

    World Health. 1980 Feb-Mar; 3, 5.

    The World Health Assembly, in launching the movement for health for all by the year 2000, has identified health for all as the attainment by all the people of the world of a level of health that will allow them to lead socially and economically productive lives. The definition implies that the level of health of all individuals should be such that they are capable of working productively and of actively participation in the social life of the community in which they live. To bring this about will necessitate reforms in the health sector as well as reforms of a political, social and economic nature. A more equitable distribution of resources for health can be the 1st of several of such reforms in all sectors. The health infrastructure needs to be reorganized in order to play a leading role in forging together the different health programs into a single unified system. The International Conference of Primary Health Care held in Almata of the Union of Soviet Socialist Republics in 1978 issued a Declaration. This Declaration stated that primary health care is the key to realizing health for all by the year 2000. Also identified were 8 essential elements of primary health care. These include the following: education concerning prevailing health problems and the methods of preventing and controlling them; promotion of food supply and proper nutrition; an adequate supply of safe water and basic sanitation; and maternal and child health care, including family planning and immunization against the major infectious diseases.
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  13. 188

    [Women and development: ideas and strategies of international organizations] Femmes et developpement: idees et strategies des organisations internationales.

    Mignot-Levebvre Y

    Revue Tiers Monde. 1980 Oct-Dec; 21(84):845-62.

    The International Year of the Woman, which marked the beginning in 1975 of the Decade of the Woman organized by UNESCO, had as its goal the sensibilization of the public to the problems of women, the diffusion of results of studies conducted on women in several countries, and the elaboration of new strategies to improve women's status worldwide. Factors which played a role in advertising worldwide discrimination against women were external to UNESCO, such as the birth of radical feminist movements in the 1960s and the diffusion of new feminist ideas by the mass media, and internal to UNESCO, such as the great number of studies sponsored and financed by UNESCO on the condition of women, and especially of third world women. The revision of strategies within UNESCO is visible in the changing themes of the studies sponsored from 1965 to 1980. Studies done between 1960-70 dealt essentially with the importance of primary, secondary, and university education for women. Studies done between 1970-75 investigated the relation between formal education and actual probability of women's employment. Studies sponsored between 1975-80 investigated the right of women to equal participation in the national economy and development. Unfortunately, the global budget dedicated to women's studies is only of 13.5 million French francs. Ongoing studies examine whether feminist ideas are applicable to third world countries, or if they are to be reviewed according to different societies and cultural environments.
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  14. 189

    Injectable contraceptive synthesis: an example of international cooperation.

    Crabbe P; Diczfalusy E; Djerassi C

    SCIENCE. 1980 Aug 29; 209(4460):992-4.

    WHO (World Health Organization) has sponsored a multinational cooperative research project in drug chemical synthesis outside the established pharmaceutical company channels. It is a model of particular relevance to developing countries and 1 that could be followed for development of drugs and pesticides. This particular program was launched because the pharmaceutical companies in developed countries were not interested in developing contraceptives that would be applicable for developing areas. The WHO-sponsored program involved synthesis of novel steroid compounds and thorough biological evaluation of the new substances. Approximately 220 steroids were synthesized in 12 laboratories in both developed and developing countries. The administrative and supervisory system of the program is explained. Quality control of the synthesized compounds took place at City University, London, and bioassay at the National Institute of Child health and Human Development in Bethesda, Maryland. The bioassay to determine the duration of long-acting progestogens was the suppression of estrus in rats. The test for androgenic activity was carried out in castrated male rats. Work on potential male contraceptives is being discontinued for financial reasons. However, 6 compounds of possible use in female contraception have been selected for further work.
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  15. 190

    Family planning programs and fertility decline.

    Cuca R

    Journal of Social and Political Studies. 1980 Winter; 5(4):183-90.

    A recently completed World Bank statistical study of family planning in 63 developing countries indicated that countries which experienced a large decline in birth rates between 1960-1977 were more likely to have a family planning program, an official population policy aimed at decreasing the birth rate, and a relatively high level of development than countries which experienced smaller or no decline in birth rates. The 65 countries represented 95% of the population of the developing world. Birth rate declines of 10% or more between 1960-1977 were experienced by: 1) 10 of the 26 countries which had a family planning program and a policy aimed at reducing the birth rate; 2) 6 of the 19 countries which had a family planning program but lacked clearly defined population objectives; and 3) 2 of the 18 countries without any population policy or program. Furthermore, the implementation of a family planning program and the adoption of a population policy were directly related to the development level of the country. This finding suggested that countries need to reach a certain level of development before they have the capacity to develop population programs and policies. When a country is sufficiently advanced to collect population data, awareness of population problems increases and they are more likely to adopt a population policy. In addition, government efficiency increases as development proceeds and governments must have a certain level of efficiency before they can implement effective programs.
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  16. 191

    Rome: a personal view.

    Johnson S

    Populi. 1980; 7(4):2-8.

    The Conference on Population and the Urban Future, arranged by the United Nations Fund for Population Activities (UNFPA) and held in Rome, was quite exceptional. The 1st factor worthy of comment is that the choice of Rome itself to hold the Conference was inspired. A 2nd distinguishing factor was that in some respects it was not actually a United Nations Conference at all, for it was not a heavy intergovernmental conference. It seems that this Conference worked and that the Rome declaration will in future years prove useful to politicians, planners, and the populations throughout the world. The declaration clearly points out that it is now not rural urban migration but the excess of births over deaths which contributes the major part of the growth of cities. When the declaration calls upon the United Nations and particularly the UNFPA to help with the implementation of the Conferences recommendations, it is explicitly and implicity endorsing the actions of the United Nations and its subsidiary bodies in the population field, including efforts to control fertility. In sum, the Rome Declaration launched an appeal and did elicit a response. Rome was the 1st step of a process; it helped to move the problems of the cities to center stage of international concern. Over the next 20 years there will be increased understanding of the potential catalytic role of cities in the development process. There is a need to be able to view urbanization as part of the solution as well as part of the problem.
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  17. 192

    Informing social change.

    Alan Guttmacher Institute [AGI]

    New York, Alan Guttmacher Institute, 1980. 44 p.

    The activities, aims and achievements of the Alan Guttmacher Institute are described in this report of its first decade. The AGI was created to foster research and public education so as to effect changes in public policy that would make fertility-related health care accessible to low income women. The Institute utilizes existing research and generates new data to pinpoint the need for subsidized family planning services in the U.S. The growing acceptance of birth control and significant developments in the area over the AGI's history are detailed, including its own activities. The series of AGI-sponsored publications which disseminate the findings of social and scientific research relating to population and family planning are described and the specific purposes of each are differentiated. Efforts of the AGI to promote equal access to abortion for all women, to keep the field informed so as to mobilize public and congressional efforts on behalf of abortion rights, and to provide reliable information on abortion are discussed. Educational activities concerning the extent and seriousness of the problems of teenage pregnancy are another AGI priority, as is the focussing of attention on limitations of current methods of contraception and the need for increased government support of reproductive research. Future goals of the AGI which build upon past accomplishments and respond to new challenges are detailed.
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  18. 193

    Acceptability of contraceptive methods and services: a cross-cultural perspective.

    Shain RN

    In: Shain RN, Pauerstein CJ, eds. Fertility control: biologic and behavioral aspects. Hagerstown, Maryland, Harper and Row, 1980. 299-312.

    The results of recent cross-cultural contraceptive acceptability studies conducted by WHO and by other investigators were briefly reviewed. The studies demonstrate that contraceptive acceptability is influenced by cultural and personal beliefs and attitudes. WHO multinational studies undertaken to examine the acceptability of hypothetical contraceptives revealed 1) males are willing to use contraceptives but would prefer using a form of oral contraceptive which could be self-administered, which would not reduce sexual desire, and which would be reversible; 2) females in many countries would be unreceptive to a contraceptive which produced amenorrhea; and 3) women in a number of countries indicated that the route of administration was not a major determinant of contraceptive acceptability. In conection with clinical trials, WHO conducted acceptability studies of daily pills and monthly injectables for males and of depot-medroxyprogesterone acetate or norethisterone oenanthate injectables and prostaglandin vaginal suppositories for women. WHO conducted contraceptive preferences studies in free choice situations among women in India, Korea, Philippines, and Turkey. Results indicated that preferences varied by clinics within countries and that education was highly correlated with choice. WHO also conducted discontinuation studies in Bangkok, Santiago, and Mexico City and studies of the acceptability of indigenous antifertility agents in Egypt and Malaysia. Other investigators have assessed the acceptability of specific attributes and side effects, such as the gender of the user, routes of administration, duration of effectiveness, color, reversitility and found that acceptabilty varied cross-culturally. Several investigators examined the acceptability of a number of service delivery attributes such as waiting time, privacy during clinics visits, and convenience.
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  19. 194

    A warning to Latin America.

    Trueman P

    In: Santamaria J, Richards P, Gibbon W, eds. The dignity of man and creative love: selected papers from the Congress for the family of the Americas, Guatemala, July 1980. New Haven, Connecticut, Knights of Columbus, 1980. 188-95.

    The USAID (U.S. Agency for International Development) has since 1960 promoted abortion worldwide, without concern for the laws, customs, or mores of foreign lands. USAID still promotes the sale and the use of Depo-Provera in Latin America. Depo-Provera, a drug that acts as a contraceptive and abortifacient, is considered by the U.S. Food and Drug Administration to be unsafe for birth control in the U.S. USAID also promotes the sale and the use of the Dalkon Shield type of IUD, which was recalled in the U.S. in 1975 for its hazardous side effects. Moreover, USAID supports abortion research worldwide; for example, there are 3 main USAID funded university research projects in the U.S., beside the London-Based IPPF, and the Boston-based Pathfinder Fund. It is about time that the American people, and the Prolife movement in particular, realize USAID's abortion activities, and act to have Congress pass the Helms Amendment of 1973, which intented to rid USAID of any involvement in abortion related activities.
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  20. 195

    Activities of the Special Program of Research, Training and Development in Human Reproduction, World Health Organization in the field of long acting contraceptives.

    Annus J

    In: Bangladesh Fertility Research Program. Workshop on Injectable Contraceptives: Noristerat, Dacca, Bangladesh, April 25, 1980. [Dacca, Bangladesh, BFRP, 1980]. 70-80.

    Following a brief introduction to the World Health Organization (WHO) Special Program of Research, Development and Research Training in Human Reproduction, established in 1972, focus is on what has been achieved thus far with long-acting injectable fertility regulating agents based on steroidal hormones and possessing a duration of action of at least 1 month. Over the last 20-year period, several estrogen-progestin combinations have been developed as monthly injectable contraceptives. The Special Program has initiated a series of clinical pharmacological studies aimed at developing new and improved estrogen progestin injectable formulations. 1 preparation, composed of norethisterone enanthate (50 mg) plus 5 mg of estradiol valerate, has shown promise in preliminary clinical studies. 3 progestogen only preparations with a duration of action of several months have been tested clinically: clormadinone acetate, depo-medroxyprogesterone acetate and norethisterone-enanthate. The 1st clinical trials utilizing the heptanoic acid ester of norethisterone raised considerable hopes, for no pregnancies were observed in 70 highly fertile women given the drug every 90 days. In a WHO trial preliminary data on Depo-Provera (DMPA) bleeding irregularities were responsible for the discontinuation of 9.3 subjects/100 women-years; prolonged amenorrhea accounted for the termination of 11.5 subjects/100 women years. There are several ongoing studies to evaluate the effects of the injectables on users. Norethisterone enanthate, although not possessing the same degree of effectiveness as DMPA, when adminstered every 3 months, remains an attractive injectable because of its lower incidence of amenorrhea.
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  21. 196
    Peer Reviewed

    A preliminary pharmacokinetic and pharmacodynamic evaluation of depot-medroxyprogesterone acetate and norethisterone oenanthate.

    Fotherby K; Saxena BN; Shrimanker K; Hingorani V; Takker D; Diczfalusy E; Landgren B-M

    Fertility and Sterility. 1980 Aug; 34(2):131-9.

    2 populations attending WHO centers, one in Sweden and one in India, participated in a comparative, pilot trial of 2 increasingly popular injectable progestin-only female contraceptives, Depo-Provera and Norigest. The purpose of the study was to assess the pharmacokinetic and pharmacodynamic properties of the 2 formulations (depot medroxyprogesterone acetate and norethisterone enanthate). Differences were found between Swedish women and Indian women in their reactions to the 2 drugs: 1) Norigest was detectable in blood samples a significantly shorter time after injection of the agent in Indian women than in Swedish women; this difference was not apparent with Depo-Provera. 2) Although there was no difference at the 2 centers in the time of ovulation return for subjects receiving Norigest, 0 of 4 Swedish women ovulated more than 156 days after Depo-Provera injection, whereas all 4 Indian women ovulated within 73 days of Depo-Provera injection; in the Swedish women, the levels of medroxyprogesterone were undetectable at time of return to ovulation, whereas Indian women had levels of .6 ng/ml when ovulation resumed. 3) In both cultures, Depo-Provera users had significantly more episodes of bleeding and spotting than Norigest users. This preliminary report emphasizes the variety of responses possible to injection of different contraceptive progestins among various populations and points to the need for further culturally comparative studies.
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  22. 197

    Programmes and services on adolescent fertility and sexuality in ESEAOR.

    Catindig JB

    Concern. 1980 Jul-Sep; (18):1-2.

    The reproductive health needs and behavior of adolescents have been neglected by many health services until recently. The inclusion of adolescent fertility and sexuality in the East and South East Asian and Oceania regions of IPPF initially prompted uneasiness by workers who considered the inclusion of adolescents to be a sensitive issue given prevailing mores. The Singapore seminar/workshop on adolescent fertility and sexuality helped educate family planning workers and executives to the new realities of adolescent life, and many Family Planning Associations in the region made delivery of services to adolescents a major program emphasis. Family life education strategies have improved and IEC efforts are now geared to particular age and sociocultural groups. FPAs have stressed training of dormitory and hostel matrons and supervisors in counseling, adopted policies to "desensitize" the parents of teenage clients, and supported peer group counseling programs in order to deal with adolescent girls without violating the sociocultural norms of the community. The region's developing countries, particularly Indonesia, the Philippines, and Thailand, have large proportions of young people, and their governments welcome the initiatives of FPAs in providing programs and services.
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  23. 198

    Female sterilization: guidelines for the development of services. 2nd ed.

    World Health Organization [WHO]

    Geneva, Switzerland, WHO, 1980. 47 p. (WHO Offset Publication No. 26)

    This report outlines the World Health Organization's guidelines for female sterilization techniques. The following conclusions and recommendations concerning individual techniques are discussed: 1) laparotomy, particularly immediately postpartum, is the basic sterilization technique since it can be made available in any surgically equipped facility without extra requirements. 2) minilaparotomy is more demanding in skills and training requirements. However, it is a simple procedure on outpatient basis which makes it suitable for large-scale programs. 3) Colpotomy requires specialized training in obstetrics and gynecology. It has the same advantages as minilaparotomy, but it cannot be used postpartum. 4) Laparoscopy is the most complex sterilization form, and the most expensive. It can be used for sterilization, but its primary role is in diagnosis. 5) Culdoscopy costs slightly less than laparoscopy but has all of the same limitations as laparsocopic method (i.e., expensive, sophisticated university of facilities and training. 6) Hysterectomy is not recommended for sterilization. The need for adequate counseling services in addition to technical expertise is underlined.
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  24. 199

    Closing address: research on the management of population programs: some thoughts on the future.

    Salas RM

    In: Files LA, ed. Research on the management of population programs: an international workshop. Chapel Hill, NC, Univ. of NC, School of Public Health, Dept. of Health Administration and the Carolina Population Center, 1980. 34-6.

    The evolving role of the UNFPA (United Nations Fund for Population Activities) was described. the UNFPA, which began operating in 1969, has gradually extended the scope and extent of its funding activities during the past decade in response to the changing needs expressed by developing countries. The fund was initially established to provide family planning assistance in response to the needs expressed by many Asian countries. Gradually, the UNFPA's core program in population was expanded to provide funds for programs in data collection, population policy, population dynamics, and population education, and communications. Recently the UNFPA was asked by the government of the Socialist Republic of Viet Nam to support a program in population redistribution. Sri Lanka and Yemen also requested support of population redistribution programs. Funding policies of the UNFPA are determined by the Governing Council composed of members from 48 countries. The council will meet in June and support for population redistribution programs will be discussed. In accordance with the demonstrated responsiveness of UNFPA to the expressed needs of the developing countries, the UNFPA welcomes suggestions from the developing nations for ways in which the UNFPA can help promote the effective delivery of population services, enhance the managerial expertise, and encourage self-reliance in program management.
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  25. 200

    Recommendations of the Expert Group Meeting on Population-Development Modelling: report of the Secretary-General.

    United Nations. Economic and Social Council. Population Commission

    New York, UN, 1980 Nov 20. 9 p. (E/CN.9/353)

    This document contains the recommendations of the Expert Group Meeting on Population-Development Modelling organized by the Population Division and the United Nations Fund for Population Activities (UNFPA). The meeting was held September 24-28, 1979 at Geneva. The Expert Group developed and adopted a set of recommendations for future research and action in the following areas: role of population-development models; types of population-development models; institutional framework; and priorities for future research. These recommendations are presented to the Population Commission for its consideration and appropriate action, within the context of the future work program in population. The Secretary-General recommended a project be launched which would involve the preparation of manuals for several existing comprehensive population development models and certain prototype partial models. The documentation should include purposes of the model, assumptions, data requirements, institutional factors, and computer hardware and software requirements. A second series of manuals should be prepared which would describe the way existing models could be applied to particular areas of concern in development planning. Another project should construct a standardized accounting framework, similar to the national income accounts, which would be appropriate for population development models at the micro level.
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