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[Unpublished] 1978 Oct.  p.The objective of Botswana's "Our Land" project was to involve the public, and particularly the rural population, in both learning about and voicing their opinion on land-use policies. Initiated in 1975, the media involved were radio, print, flipcharts, and interpersonal communication. The government had developed a land-management policy based on the practices of stock controls, fencing, paddocking, early weaning, salt-and-bonemeal feeding supplementation, and rotational grazing to reverse land degradation. A supplementary goal was to preserve some of the values and features of the traditional land-tenure system as well as to protect the interests of the individuals who own few or no cattle. This educational campaign was created to explain and obtain feedback on land zoning policies and other aspects of the land-management program. There were 4 phases to the "Public Consultation:" a 2-month national speaking tour in the autumn of 1975 with the President and his ministers attending more than 100 community meetings to explain public policy and to field questions from villagers; briefings and seminars for government officers and others held over the July 1975-February 1976 period; a trial-run, the "Radio Learning Group Campaign," and analysis and use of the public responses culled during the Radio Learning Groups, which took place in 1976 and 1977. The Radio Learning Group Campaign included a pilot project, leadership courses, materials preparation, radio broadcasts, and followup radio programs based on responses to earlier broadcasts. Some vital information on the land-zoning proposals and their implications was broadcast to roughly 3200 listening groups averaging 16 members each. Each group, which had a discussion leader, met twice weekly for 5 weeks to discuss the broadcasts and the specially prepared materials. Following each program, group leaders sent a report about the group discussion to the campaign organizers who used the information to develop land-use plans to prepare "answer" programs for broadcast. 3510 groups were established, falling short of the goal of between 4000-5600 groups. The "Public Consultation" revealed that Botswana's population recognizes the problem of overgrazing, identifying the presence of too many cattle as the major cause. A large majority favor the principle of granting exclusive leasing rights to grazing land and want such grazing land situated in the sand-velds where population density is low.
Plano, Texas, Instructional Aides, 1984. 78 p. (A Guide on Current Topics)This document provides readers with a review of the history of the controversy regarding abortion, a summary of the major positions on both sides of this debate, and an assessment of public opinion regarding abortion. It draws heavily on research materials from the Centers for Disease Control, the Alan Guttmacher Institute, and the Population Council. Chapter 1 sets the abortion issue in historical perspective. Chapter 2 focuses on US Supreme Court decisions, while Chapter 3 discusses Congressional activities. Chapter 4 presents statistical data on the abortion rate in the US, demographic characteristics of abortion seekers, abortion techniques, and abortion-related mortality. Chapter 5 surveys the status of abortion around the world. Chapter 6 presents survey results on public attitudes toward abortion. Chapters 7 and 8 include statements from national leaders who believe abortion should not and should, respectively, be outlawed, while Chapters 9 and 10 present statements on both side of the debate as to whether the moment human life begins can be determined. Appendix I presents excerpts from Vatican position papers on abortion. Appendix II summarizes US laws, state by state, that limit access to abortion. Appendix III cites federal laws restricting abortion funding. Appendix IV presents proposed abortion legislation. And finally, Appendix V lists addresses of organizations that support abortion, organizations that oppose abortion, and institutions that maintain statistics on abortions in the US. Instructional Aides provides similar documents on a number of social issues, including aging, health, immigration, minorities, and women.
[Qualitative study on the intrauterine device (IUD) in Morocco] Etude qualitative sur le dispositif intra uterin au Maroc.
Rabat, Morocco, Ministere de la Sante Publique, Direction de la Population, Programme de Planification Familiale, 1996 Nov. 80 p.Morocco s National Family Planning Program (PNPF) offers a range of contraceptive methods to its population and the Ministry of Public Health encourages the informed, voluntary choice of couples in contraceptive matters. However, the success of this approach depends upon the involvement of service providers to help people decide which contraceptive option is best for them. While the overall level of contraceptive prevalence rose from 20% in 1980 to 50% in 1995, a larger proportion of urban women compared to rural women use contraception, women use especially short-term methods, and there remains unmet need for family planning. Moreover, there exists a large gap between the level of contraceptive knowledge and method use. The IUD, introduced in Morocco in 1965, remains the second most widely used contraceptive method in the country behind the oral pill, at 4.3% and 32.2%, respectively. The PNPF plans to promote the IUD to both health professionals and the general population. This study examines the attitudes, behaviors, and perceptions of family planning service providers and the population with regard to the IUD. The goal was to identify rumors about the IUD, the population s expectations, the competence levels of service providers, and the quality of services. Relations between service providers and the population were also evaluated.
HIV / AIDS care and support projects. Using behavior change communication techniques to design and implement care and support projects.
Arlington, Virginia, AIDSCAP, . 73 p. (USAID Contract No. HRN-5972-C-00-4001-00)This manual explains how organizations can use behavior change communication techniques in HIV/AIDS care and support projects. After an introductory section, section 2 describes HIV/AIDS care and support projects, their benefits, and their target audiences. The third section lists examples of care and support activities, and section 4 covers whether a particular organization should engage in care and support efforts. The remaining sections explore each of the important steps in instituting and carrying out such a project. Section 5 deals with choosing a target audience, and section 6 describes how to use segmentation techniques and a situation analysis to understand a target group. The seventh section details the planning and design of care and support interventions, and section 8 looks at choosing effective communication approaches. Section 9 discusses meeting training and education needs of health workers. The next two sections delineate the role of leaders, institutions, and the media in influencing social norms as well as ways to involve community leaders. Section 12 reviews ways of working with and involving people living with HIV/AIDS, and the final section considers family issues.
Cresskill, New Jersey, Hampton Press, 1995. xv, 171 p. (Quantitative Methods in Communication)Innovations, such as ideas, products, or opinions, spread or diffuse through society at a rate and specificity which can be understood by analyzing the pattern of communication (the social network) which exists between individuals in a social system. Analysis of such network models of diffusion reveals tipping points in the process that are studied through threshold models, which focus on individuals, and critical mass models, which describe social systems. Together, these models provide a comprehensive picture of how social systems determine social change. This book opens with an introduction which reviews the theory of diffusion of innovations, network analysis, and the three diffusion datasets used as examples. The concept of "contagion," or the specific process of innovation diffusion (also known as the "diffusion effect"), is defined. Chapter 2 provides a framework for understanding threshold and critical mass models by describing prior research on their effects. Chapter 3 describes relational diffusion network models, which maintain that individuals adopt innovations based on their direct relations with others in their social system. Structural diffusion network models, presented in chapter 4, hold that individuals adopt innovations based on their position in their social system, regardless of their direct ties to others. Chapter 5 covers threshold models of diffusion and introduces the notion that individuals may be innovative with respect to their personal network as well as to the social system. Chapter 6 deals with critical mass models of diffusion and points out that competing definitions of critical mass and a lack of clarity in critical mass research has hindered the theoretical development of these models. This chapter tests alternative models and shows how centralness and radiality of personal networks contribute to the critical mass. Chapter 7 develops a network threshold model which can be conceptualized in both relational and structural terms and which allows individual innovativeness to be measured relative to an individual's personal network or relative to a whole social system. This model can be used to predict diffusion, identify opinion leaders, understand the two-step flow model of opinion formulation, and determine the critical mass. Chapter 8 discusses other possible methods which are useful for understanding network models. The final chapter discusses applications, contrasts network thresholds with the classic diffusion model, and concludes that network characteristics are associated with adoption behavior at both the individual and the system level of analysis. The shortcomings of the modeling systems presented in this book and the limitations of the research are discussed, and indications for future research are given.
In: AIDS. Prevention through education: a world view, edited by Jaime Sepulveda, Harvey Fineberg, Jonathan Mann. New York, New York, Oxford University Press, 1992. 255-72.US public health officials have depended on the broadcast media to deliver potent anti-AIDS messages to vast audiences. While most Americans now know a great deal about AIDS, this knowledge has not always resulted in the adoption of preventive behavior. Since promoting condom use will result in the greatest reduction in AIDS transmission, messages which are targeted to homosexual, bisexual, and heterosexual audiences and are designed to address the psychological barriers to condom use are needed. It is difficult to convince the broadcast media to communicate targeted messages, even to heterosexuals, for fear of the political and economic repercussions of viewer alienation. The media has been used successfully to promote health, and anti-AIDS campaigns have achieved a high level of understanding of the disease on the part of the public. These include the American Red Cross' "Rumors Are Spreading Faster Than AIDS" and the Centers for Disease Control's "America Responds to AIDS" and print advertisements for condom use. The news media has played a role in informing, and sometimes confusing, the public by presenting unchallenged and unsubstantiated inaccurate reports, especially in the early days of the disease. Surveys now indicate that AIDS knowledge is good in areas that have been the focus of media reports, and awareness of the role of condoms to prevent transmission is high, higher in fact than the use of condoms. It is time to move beyond delivering current information and to begin motivating condom use. Condoms are maligned in the US and are associated with reduced pleasure or "illicit" sex, requesting their use also raises issues of interpersonal trust. These specific concerns need to be addressed, but the current standards of the national broadcast media block delivery of messages to motivate condom use. Entertainment programming is a possible source, since it is only subject to general guidelines, depending on audience and context, but these opportunities are not frequent enough to make a significant difference. To successfully promote condoms, their image has to be changed to that of a product used by couples rather than individuals which might actually enhance sexual pleasure, and peer consensus in favor of condom use must be implied. Marketing efforts using suggestive names and slogans and offering different shapes, colors, and textures are attempting such an image change. In light of current media restrictions, it is important to develop community-based educational programs which focus on condom promotion and can be assisted by local mass media. Local sentiment will ultimately dictate whether paid condom adds or public service spots will be used to address the psychological barriers to condom use.
Accra, Ghana, Marketing and Social Research Institute, 1990 Jul. , 58 p.Consumers of Ghana Social Marketing Program (GSMP) products were questioned to determine their socioeconomic, demographic, attitudinal, and behavioral characteristics, measure GSMP product advertising awareness levels among them, and determine the impact of GSMP promotional efforts on their adoption of these products. Products include the Panther condom, Kamal vaginal foam, Norminest oral pill, and oral rehydration solution (ORS). Study findings are summarized per product for user profile, product knowledge, attitudes, usage, distribution, availability, quality, image, and price, purchasing pattern, brand loyalty, and advertising awareness. The Panther condom has met with great success as the major condom product on the market. It does, however, suffer the reputation of tearing among some users. Kamal's market share is growing at the expense of a government-sponsored competitor and the pill, while Norminest users demonstrated inadequate product knowledge of compliance issues and contraindications. ORS is also successful, but with much potential to expand its market share. Recommendations targeted to each product are provided.
WOMEN'S GLOBAL NETWORK FOR REPRODUCTIVE RIGHTS NEWSLETTER. 1991 Jul-Sep; (36):60.A dilemma exists over who should care for, and where to place 4 delinquent female runaways with AIDS. These girls have also engaged in prostitution, crime, and are addicted to drugs, thus prompting society to view them more as dangerous adults than aberrant adolescents. While they are presently in the hands of the National Institute for Minors (Iname), organizations in Uruguay are ill-equipped to face such challenges presently by these and other HIV+\AIDS adolescents. Discussion of the issue and society's views is suggested. The views of a few civil servants from Iname are briefly presented in the text. They generally disagree with incarceration of such youths, and recommend there placement in a semi-open environment supported by specially trained doctors, psychologists, psychiatrists, and nurses. Ideally, a home-like setting is preferred where these young women and others in similar situations may undergo treatment while carrying on with their lives.
Guestworker question or immigration issue? Social sciences and public debate in the Federal Republic of Germany.
In: Population, labour and migration in 19th- and 20th-century Germany, edited by Klaus J. Bade. New York, New York, Berg Publishers Ltd., 1987. 163-88. (German Historical Perspectives Volume 1.)The organized recruitment of the people originally called Gastarbeiter was connected with the basic idea of getting seasonal workers, i.e., lower-paid workers with a less secure status. Rotation of workers was another basic idea that was not only accepted, but forced, by the unions, who feared steady competition from a cheaper and more easily manageable labor force. This policy has been a failure. Politicians and political administrators are unable or unwilling to accept the failure of the Gastarbeiter policy. In current parliamentary debates, 2 contrasting positions are apparent, with 1 side demanding increased repatriation and the other calling for better intergration ending in naturalization. There is a relationship between skill requirements, the percentage women employed, the type of manufacturing process, and the employment of foreign workers. Foreign workers are more often paid on a piecework basis, they work more shifts, and they figure more frequently in the accident statistics. The German school system was in no way prepared to cope with massive immigration. German parents became angry about crammed elementary school classes, crowded with children of various nationalities, but by 1980 the school system had taken up the challenge and begun to tackle the problem. Foreign children today receive regular education, mostly in normal German classes, their school attendance quota is the same as for German children, and an ever-increasing number successfully finish secondary school. All investigations of housing establish unequivocally again and again that foreigners live under worse conditions but pay proportionately more rent than their German counterparts. It is not enough to illustrate ever more clearly through new surveys the social situation of foreign workers and their families. It is more cogent to examine the inseparable connection between politics and social research, particularly exemplified by migrant labor and participation of foreigners in the work force.
HEALTH EDUCATION QUARTERLY. 1986 Winter; 13(4):395-406.Because of their training and experience in education, policy development, and legal and ethical issues in health care, health educators are uniquely qualified to address the problems of AIDS-related issues in the workplace. Employees with AIDS face many problems in the workplace, among which are confidentiality, protection of the right to work, discrimination by fellow employees, and inadequate health insurance. Employers need to be fully informed about the legal and ethical aspects of these issues, both for high-risk, potentially infectious employees and healthy workers. Although a variety of federal, state, and local laws have been enacted to protect employees with AIDS against discrimination, other legislation ensuring a safe working environment for all employees seems to conflict with anti-discrimination laws. Some companies have adopted a risk management approach to the AIDS crisis, but such an approach may cause companies to overlook other problems associated with AIDS. Health educators need to take the initiative in contacting corporations to establish strategies for dealing with AIDS-associated problems. Education about AIDS for all employees is a major recommendation of many experts in the field. Other issues, such as the need for legal counsel and the decision to establish a formal policy about AIDS are issues that could be addressed by health educators. By initiating contact with corporations, law firms, insurance companies, and special interest organizations, health educators can make a significant contribution toward the successful resolution of AIDS-related problems in the workplace.
In: The patient as partner. A theory of human-experimentation ethics [by] Robert M. Veatch. Bloomington, Indiana, Indiana University Press, 1987. 36-65.The principle of autonomy as the foundation for informed consent is characterized in this chapter dealing with the ethics governing human-subject research. The implications for public policy of 3 theories of informed consent are discussed. The 1st theory of informed consent is the patient-benefit theory, which has its roots in the Hippocratic tradition. This casts doubt on the adequacy of patient-benefit grounds for informed consent, considering that it would eliminate all experiments unrelated to therapeutic intervention. Its implications for public policy, founded as it is on the ethical principles of a private group, should be minimal. The social-benefit theory of informed consent is grounded in the principles of utilitarianism--the greatest good for the greatest number. This theory allows for non-therapeutic intervention, but conflicts with the individual's right to informed consent by its insistence that only in cases where consent facilitates the research is consent necessary. This can lead to large-scale abuses, as evidenced by the Nazi experiments in the 1940s. The 3rd theory of informed consent is the self-determination theory, based partly on the social-benefits idea, but with a limiting principle of informed consent that upholds the rights of the individual over the society. Discussed next is the standard of reasonably informed consent, with suggested additions to the DHHS guidelines. Section III examines the implications of the self-determination theory of consent for subjects in various research settings. Group II subjects (those subjects whose capacity to consent is problematic), present special considerations. This group includes children, formerly competent adults, prisoners, clinic patients, and subjects in experiments where consent would destroy the research. Special review procedures are suggested for this group. A principle beyond autonomy, that of the obligation to promote justice, holds promise for further refining the basis for the ethical principle of informed consent.
SOCIOLOGICAL REVIEW. 1987 Feb; 35(1):123-49.The activities of 2 main pressure groups in the decade of the 1970s--the Society for the Protection of the Unborn Child (SPUC) and the LIFE organization--and the evidence they submitted to the Lane Committee, established in 1971 to examine the working of the Abortion Act, and the Select Committee, formed to discuss James White's Amendment Bill in 174, are reviewed. Official campaign literature, public statements on the part of leading anti-abortion activists, national press reports, and parliamentary debates on the issues have helped to provide some insight into the ideological stance of the anti-abortion movement in England and Wales during the 1970s. Fieldwork was undertaken which included nonparticipant observation at local branch meetings of SPUC and LIFE, the completion of a self-administered questionnaire by 64 group members, and semi-structured interviews with 25 local campaign leaders and group activists. The subsequent analysis presents anti-abortion protest as an example of moral crusade by focusing on Gusfield's notion of cultural fundamentalism and his analytical distinction between assimilative and coercive reform. Some participants in the anti-abortion campaign accept that a small number of abortions may need to be performed for genuine medical reasons and do not adopt the extreme position that abortion should be prohibited. This group does demand a change in the law to prevent mass abortion on demand. Both LIFE and SPUC have a clearly recognizable moral reform dimension. The analysis of the campaign literature and the study of a small sample of campaign activists revealed that pressure group members share a common concern about the erosion of moral standards. To adopt the terminology of Gusfield, the anti-abortion movement can be construed, in part, as a movement of cultural fundamentalism, which favors the reestablishment of traditional values and seeking an end to the moral uncertainty endemic in modern society. As the anti-abortion movement is primarily concerned about amending existing legislation, a coercive strategy of reform prevails. The analysis makes it evident that the anti-abortionists in their emphasis on fundamental values seek to promote a traditional sexual morality but also are trying to establish what they believe to be the moral superiority of the traditional nuclear family. Due to the fact that no abortion amendment bills have been proposed on which to focus their campaign, in recent years the anti-abortionists have increasingly focused on the enforcement of existing legislation in an effort to reduce the number of abortions and publicize their moral stance.
NEW REPUBLIC. 1986 Jan 27; 13-5.RU-486, a new drug which enables women to perform abortions privately at home, could transform, if not end, the abortion debate. This steroid compound, developed by the French drug company Roussel-Uclaf, blocks the cells in the lining of the uterus from receiving progesterone. Deprived of progesterone, the wall of the uterus breaks down. The ovum breaks off from the uterine wall and is discharged in a period. Unlike the "morning after" pill, RU-486 does not contain massive dosages of estrogen, which causes unhealthy side effects and thus limits its use to rape cases and other emergencies. At least 5 years away from the commercial market, RU-486 is being tested in Paris, Stockholm and the University of Southern California as a chemical alternative to surgical abortions and as a post-coital contraceptive to replace current methods like the IUD and oral contraceptives (OCs). Used instead of OC and the IUD, a woman could take the drug on the last 3 days of each cycle. If fertilization had occurred, RU-486 would prevent the ovum from implanting; if not, the drug would merely bring on her monthly period within 48 hours. Dr. Daniel Mishell of the University of California reports that his trials have revealed that 100 milligram doses of RU-486 have induced complete abortions in the first 6 weeks of pregnancy for 80% of the women who have taken it. Swedish tests have been 90% successful when RU-486 is supplemented with prostaglandins, which induce mild contractions of the uterus. Several women bled seriously in early tests, but Mishell states that fewer women have hemorrhaged in more recent trials with lower doses. He predicts the drug will prove to be safer and more effective when an optimal dose is found and tested in earlier pregnancies. If RU-486 became the abortion method of choice in the US, the abortion debate would be over for many who now consider it an open question. Polls show that the pro-life movement has failed to increase the number of Americans who support a legal ban on abortions. They have succeeded in making Americans uncomfortable about abortion generally. This soft support is vulnerable to RU-486 because polls also show that Americans oppose early abortions less fervently and in fewer numbers than late abortions. It is also likely that if RU-486 becomes the preferred method of abortion, abortion clinics in the US would close, replaced by 24-hour clinics to treat potential complications. And, if RU-486 is used monthly, pro-lifers would have a difficult time convincing the public that the drug isn't just another contraceptive. Although RU-486 erases much ambiguity in the abortion debate, it will create some. Women could take RU-486 without ever knowing whether they are pregnant.
ANNALS OF THE AMERICAN ACADEMY OF POLITICAL AND SOCIAL SCIENCE. 1986 Sep; 487:201-12.US attitudes toward both legal and illegal immigration tended to be highly restrictionist during the 1st half of the 20th century. Both legislative and executive-branch policy supported this restrictionist outlook up until the 1940s, when a gradual liberalization of immigration policy toward refugees began to occur because of foreign policy requirements and the onset of the cold war. Although only a very small percentage of Americans have advocated increasing the number of immigrants, the percentage who feel that the numbers should be decreased began to decline during the 1950s and 1960s. Liberalization of public opinion and governmental policy occurred. During the past 15 years, however, public opinion and government policy began to diverge. Because of economic and other problems, Americans became more restrictionist toward immigrants, at least when surveyed by public opinion polls. But the government has difficulty implementing a more restrictionist policy for a variety of reasons, among them the strong lobbying efforts of pro-alien activist groups combined with American ambivalence toward the plight of immigrants as individuals. (author's)
YEARBOOK OF POPULATION RESEARCH IN FINLAND. 1986; 24:29-42.The goal in this paper is to present and discuss results from several Dutch research projects dealing with the acceptance and demographic effects of new policy measures aimed at increasing fertility. The discussion covers the history of Dutch population policy since 1945, research on the acceptance of future pronatalist policy measures, a preliminary test of Mancur Olson's collective action theory applied to the relationship between population concern and acceptance of population policy, and evidence from social demographic research on the demographic impact of 1 particular type of pronatalist policy. The population has increased by over 10 million people over the last 100 years with some 45% of the increase taking place after 1945. The years immediately following the war were characterized by high birthrates. Natural population growth, mainly in the early 1950s, was attenuated by the number of persons leaving the country. This lasted until about 1960. Since then there has been an immigration surplus, yet in the 1970s the annual population growth was smaller than in the early years. A marked decrease in fertility was responsible for this. The fertility decrease is caused mostly by the fact that the number of high parity births has decreased. Since 1970, the number of 1st births also has decreased. The 1st stage in Dutch population policy covers the period 1945 to the late 1960s. In the first 15 years after World War II, the annual marked increase in population numbers worried the government and several segments of the general population, but an explicit interest on the part of the government in steering (natural) population growth did not exist. The 2nd stage of population policy covers the period from 1970 to the early 1980s. A Royal Commission on Population was established in 1972, and the essential message of their 1974 report was the termination of natural growth as soon as possible. 2 years after the publication of the Commission's final report the government stated their position, that is, for the Netherlands to reach a stationary population. During the 1970s, the total fertility rate declined from 2.6 (1970) to 1.6 (1980). It was this decline, combined with the aging of the population, that led the Interdepartmental Commission on Population Policy (ICB) in 1982 to become alert to the forecast that a stationary population of 12-14 million might not be reached in the near future. In early 1983 the government formulated a new position. The government now considers as imperative a change in the fertility trend over the next several years. If this change fails to occur, they maintain that it may be necessary to implement pronatalist policy measures. A public opinion survey conducted in early 1983 showed that 22% of the respondents responded affirmatively to the question about whether or not they would like to have more children when a pronatalist policy is introduced, yet only 12% indicated a willingness to reconsider their fertility intention upon implementation of this type of policy (N=250). Only 1/3 indicated a willingness to change their fertility intention in a pronatalist way. A government that uses data obtained from public opinion surveys instead of information stemming from demographic policy research may be deceived in the long run. More attention needs to be paid to demographic policy research.
Attitudes towards demographic trends and population policy: a comparative multi-variate analysis of survey results from Italy and the Netherlands.
[Unpublished] 1987. Presented at the European Population Conference, 1987, Jyvaskyla, Finland, June 11-16, 1987. 18 p.The results of surveys of the attitudes toward current demographic trends and population policies conducted in Italy and Netherlands were compared. The Dutch and Italian surveys were comparable because their aims and parts of the questionnaire were similar, making it possible to analyze the common aspects. The Italian data were taken from a recent survey of the National Institute of Population Research. The survey population included all those of reproductive and marriageable age. 1503 interviews were conducted. The survey was initiated in November 1983 and terminated in February 1984. 952 people were interviewed in the Dutch survey, initiated in 1983. It comprised a representative 2-stage stratified random sample of the Dutch population aged 20-64 years. Both the Dutch and the Italians knew that the birthrate had been declining: 93% of the Italians and 63% of the Dutch. This trend was rated positively by 52% of the Italians and 46% of the Dutch. 52% of the Italian respondents and 58% of the Dutch wanted the population to remain stationary in the future. The 1st important difference was that in Italy the number of respondents who evaluated the birth decline negatively was about 2.5 times as high as in the Netherlands where there was a very high percentage of people who were indifferent to the problem--40% in the Netherlands, 10% in Italy. In Italy, 15% favored an increase in population size in contrast to 8% in the Netherlands. The respondents in both countries had clear ideas on the causes of the fertility decline, but the Italians generally had less set ideas than the Dutch. The economic crisis and the lack of confidence in the future were identified as the most important causes; in the Netherlands, women's work outside the home was considered to be more important than in Italy. In both countries, state intervention concerning fertility was rejected in the majority of cases--67% of the Italians and 81% of the Dutch. A 2-step elaboration was carried out for the identification of typologies of respondents. The Multiple Correspondence Analysis was carried out on 2 subjects: Knowledge and evaluation of current demographic trends; and the acceptance of population policies concerning fertility in relation to their perception of the falling birthrate. The analysis identified typologies of respondents with different levels of information and opinion towards population trends, and 4 clusters for Italy and 4 for the Netherlands were comparable. both the "pronatalist" and the antinatalist" respondents in both countries were, in general, well informed, and in both countries the "interventionists" were, in general, people with a low level of education.
Lancet. 1987 Aug 15; 2(8555):394.I have questioned 1000 people in 4 sample populations in China about their attitude to and knowledge of health information on smoking and about smoking habits. I then interviewed 50 people from this sample in greater detail. I also studied past smoking control efforts in China. Greater attention must be given to health education in schools and to young people. Smoking is common among schoolchildren and, and at least in Guangzhou, Canton, health education about smoking appeared limited. Of 250 schoolchildren only 40% reported exposure to health education. Smoking is banned in schools and the attitude seemed to be that there was therefore no need for education about the dangers. On the other hand, 70-80% of the whole sample seemed aware that smoking is harmful to health. Thus there is a need to increase not only the level of health education but also its sophistication, so that the gap between health knowledge and behavior can be closed. Attention must be given to women's attitudes to smoking. Generally I found a small proportion of female smokers (a study in Tianjin excepted), and the impression at interview is that smoking among women is considered impolite or "not done." Add this to the fact that women were more aware of the dangers of smoking (77% of 286 females vs 63% of 701 males, with 62% of women saying smoking was "very" harmful compared with 37% of men) and the potential for using women as health educators becomes apparent. The increasing understanding of passive smoking and the fact that women are usually the casualties might also be useful ammunition in this context. However, there may be competition for the attention of women--'Slim Kings' aimed specifically at the female market, have already been introduced into Hong Kong. 1 of the most important elements in any approach to smoking control must be an attempt to influence public policy. The history of government China is 1 of sporadic initiatives originally formulated by a joint committee involving several departments (public health, finance, agriculture, and light industry), but more recently only involving the Department of Public Health. Some action has been taken but a question mark remains over the strength of political will. Many factors operate against a reduction in cigarette production, which earned the state $6 million in 1984. Remarks by a representative of the State Tobacco Company suggest enthusiasm for increased production and more joint ventures with the multinational tobacco companies. Both British American Tobacco and Reynolds are now working in China, and the Canton Biannual Trade Fair and Grand Prix Tennis Tournament were sponsored by tobacco companies. I recently revisited China after 2 years and was struck by the volume and increasing sophistication of advertising and by the continuing cheapness of cigarettes which are now sold by increasing numbers of private entrepreneurs. Deregulation of the market and farmland may encourage increased tobacco production. These are all worrying developments for the "antismokers", who will need all the determination Sir John Crofton talks of to help them push forward a multipronged attack on the smoking pandemic and the vested interests that support it. (full text)
WASHINGTON POST. 1987 Feb 3; E1, E8.This newspaper feature story documents how the major U.S. television networks are breaking their self censorship of mentioning contraception and sexual responsibility in programs and advertisements. The first direct screening of word "condom" occurred on the series "Cagney and Lacey" in January 1988, followed by screening an image of a condom package on "Valerie" in February. At the same time, some stations are broadcasting tasteful 15-second ads for condoms. Phrases used in these ads included "for all the right reasons," and "I'll do a lot for love...but I'm not ready to die for it." It is likely that the threat of AIDS has prompted the revolutionary airing of the forbidden word during family viewing hours. The public response, particularly that of educators, has been largely favorable, although a Catholic spokesman complained that the ads encourage illicit sex purely to enlarge market share of condom markers. Five references to the value of sexual responsibility were cited on prime time shows in recent months. The vice president of CBS said that the network was trying to do anything that would help prevent AIDS and sexually transmitted diseases. They have permitted no reference to practice of contraception in programming so far, even though characters are frequently shown in sexually explicit situations.
JOURNAL OF THE FLORIDA MEDICAL ASSOCIATION. 1986 Oct; 73(10):763-8.The increase in safety and public confidence in oral contraceptives (OCs) stems essentially from 3 factors: the availability of lower dose OCs, a better identification of risk factors, and more public awareness of noncontraceptive health benefits associated with OC use. The combination OC, used by 99% of women using OCs, continues to contain estrogen and progesterone in synthetic form, but the dosages and formulations have changed, giving the new pill a wider margin of safety. The OCs of today contain 1/5 the estrogen and 1/10 the progesterone as in the original OCs. During the decade of the 1980s, with estrogen dosage as low as therapeutically possible, medical research has shifted toward a more thorough evaluation of the progesterone component. In 1974 the Royal College of General Practitioners Study found a correlation between progesterone dosage and the frequency of high blood pressure developing in OC users. Subsequent studies reported that high blood pressure, which was likely to develop in about 5% of OC users on higher dose pill, will revert to normal when OC use is stopped. Additional research has linked pills containing progesterone in high dosages to elevations in blood sugar and blood cholesterol. Since progesterone dosage has declined from 10 milligrams in the original pill to 1 milligram or less in current formulations, there appears to be a wide margin of safety for most healthy young women using OCs. In the mid-1980s, further research on OCs has become more fine tuned with greater emphasis on how different types and combinations of hormones influence side effects and safety. The most recent development has been the introduction of "multiphasics" or sometimes called "triphasics." Multiphasic pills are basically low dose pills which vary hormone dosage in each of 3 separate phases in an effort to roughly simulate changes that would occur in a normal menstrual cycle. A better understanding of risk factors has increased markedly the margin of safety for women considering OC use. The report of the Alan Guttmacher Institute, "Making Choices," revealed that if women over 35 or who smoked did not use OCs, 86% of the approximately 500 pill-related deaths that occurred each year could be prevented. The Guttmacher report also attempted to quantify health benefits and risks to provide a more accurate overall picture of OC effects. Table 1 shows that many more hospitalizations are prevented than are caused by OC use. Among hospitalizations prevented, most were for benign breast disease, pelvic inflammatory disease, ectopic pregnancy, ovarian cysts, ovarian cancer, and endometrial cancer. No evidence has linked defects or miscarriages to pregnancies conceived immediately after stopping OC use. The overall fertility of OC users and non-OC users is identical regardless of how long a woman uses OCs. A lack of consistent health education programs in the public schools has contributed in some instances to misinformation about OC and other contraceptive methods.
[Health personnel in the matter of legal abortion: physicians and other personnel should have the right to refuse to perform abortions] Lakare och ovrig personal skall ha ratt vagra utfora aborter.
LAKARTIDNINGEN. 1983 Sep; 80(39):3541-5.712 responses to 765 questionnaires distributed to health care personnel revealed that, since 1975 when the abortion law came into effect in Sweden, attitudes toward abortion have become less critical than a 1972 survey had indicated. Most of the respondents (91%) were women, 50% worked in women's clinics, while the 114 control subjects were employed in psychiatric or surgical wards. Most had participated in abortion procedures (305 vacuum extractions and 296 late abortions), and only 125 had no direct experience with abortion. Most respondents (87%) had not had an abortion. Results showed that about 20% had a critical and uninformed view of legal abortion, 1/3 had difficulty with the thought of seeking an abortion, another 1/3 preferred adoption to abortion, and 50% thought society should curtail abortions. The attitudes of psychiatric staff were more liberal: 80% approved of seeking an abortion for themselves as opposed to only 50% of ob-gyn personnel. More respondents expressed a negative view of abortion in 1981 than in 1972 (only 20% approved of it in cases where there was no medical risk to the mother, whereas 37% had approved of it in 1972). Most respondents thought that the decision to seek abortion should also involve men, and to a lesser degree, gynecologists, psychiatrists, and social workers. The majority (92.8%) approved of extensive counseling prior to abortion. 64% approved of special abortion clinics and also gave a positive response to the question of whether performing abortions was one of the duties of physicians. Another 46% of the respondents agreed that medical personnel had the right to deny abortion. A large percentage (66%) considered the abortion procedure a negative experience, especially doctors and operating room nurses. The majority of respondents (344 = 80%) thought that better information about contraception, fetal development, and sexuality would help reduce prevailing abortion figures. About 1/2 of those surveyed also favored a more restrictive abortion law. Finally, many respondents stressed that socio-economic factors, employment, and male attitudes about child rearing contributed to individual decisions.
Lancet. 1987 Sep 5; 2(8558):575.Dr. Seaman (Aug. 8, p. 339) expresses his concern at Edinburgh and Glasgow Universities' advice to medical students not to undertake electives in certain African countries for fear of HIV infection. To this sad list must now be added the University of Aberdeen, which has included staff visiting these countries in respect of academic interests in their "very strong advice", and has produced a waiver for staff to sign. As Dr. Greenwood points out (June 13, p. 1374) the risk of acquiring AIDS during a trip to Africa as a result of emergency treatment with infected instruments or blood is remote; much more so than the health and travel risks to which students and staff are exposed in other elective activities. 2 issues seem clear to us--1 medical and the other academic. It is a contradiction of professional ethics that doctors (either those in the making or the finished article) should shrink from the sick. The academic judgment is more open to question. Many of us believe that by being members of a university we belong to a wider community of learning than is encompassed by our local campus, a community to which we owe an obligation as teachers. We feel a commonality of purpose and a duty to our colleagues in the universities of Africa. It is a remarkable coincidence that such controversial adviceshould have been issued simultaneously by 3 of the 4 Scottish medical schools. It is a pity that the Aberdeen advice was distributed during vacation time when few were available to benefit from the instruction and when an adequate response to it could not be organized. Perhaps the deans of the medical shools concerned should write to The Lancet to explain their stand and state how they expect members of their universities to respond to academic invitations from, for example, Uganda, Zambia, Kenya, Nigeria, and The Gambia, all countries with which we in this department have academic connections. To ask us to ostracize our colleagues in Africa is a serious matter. It marks a profound departure in university attitudes and policy. (full text)
INTERNATIONAL QUARTERLY OF COMMUNITY HEALTH EDUCATION. 1987; 7(3):201-10.Bangladesh is an example of a developing country where tobacco use and its subsequent social costs are increasing. The production of cigarettes in Bangladesh increased by 300% in the 1972-84 period. To assess attitudes toward the use of tobacco and reactions to various alternative governmental policies aimed at discouraging smoking, a cross-section of 772 adult residents of the capital city of Dhaka were interviewed. Respondents were selected from 5 distinct groups: university students, the informal working class, skilled blue collar workers, housewives, and the entrepreneurial-white collar management class. The results indicate that smokers and nonsmokers in Bangladesh differ in their awareness regarding the dangers of smoking. Both smokers and nonsmokers agreed that the governments should warn people of the dangers associated with tobacco use and that high schools should educate young people about such health hazards, although nonsmokers felt more strongly about these issues than smokers. Nonsmokers were also significantly more likely than smokers to support the idea of a ban on cigarette production. Both groups expressed agreement with the notion that women should not smoke during pregnancy. In general, however, smokers were less likely than nonsmokers to be aware of the health hazards associated with tobacco use. Limitations on public places where smoking would be allowed were accepted as a viable government policy by most respondents. Neither group advocated an increase in cigarette production as a means of increasing government revenues. It is hoped that market pressures in the form of a reduced demand for tobacco products, social pressure resulting from nonacceptance of smoking in public places, and government intervention in the form of a ban on the advertising of tobacco products will force the tobacco companies to reallocate their resources.
CLINICS IN OBSTETRICS AND GYNAECOLOGY. 1986 Mar; 13(1):1-17.Attention is directed to preindustrial and transitional societies to illustrate the great variety of techniques and conditions under which abortion is practiced. The discussion covers changes in abortion status and attitudes through time as well as past and current attitudes in the US. Abortion traditionally has been performed under 2 primary sets of circumstances: the mother (or couple) does not want the pregnancy; or, for a variety of reasons, the pregnancy is deemed unacceptable by the given society, extended family, or a specific family member, usually the husband. Most accounts of abortion deal with its voluntary practice, revealing often the lengths to which women will go to control their fertility in the absence of contraception. Yet, examples exist from both preindustrial and modern societies where the decision to have an abortion is not made by the woman alone but is influenced either wholly or in part by political or cultural factors. Women who want an abortion either have performed the procedures themselves or have sought help from community practitioners, friends, or relative. Abortion techniques are highly varied and include abortifacients, magic, mechanical methods (such as instrumentation, constriction, and insertion of foreign objects into the uterus), heat applied externally, strenuous physical activity, jolts to the body, and starvation. Although abortion is extensively and rather openly practiced in many primitive societies, few groups give it unqualified approval. Cross-culturally, the most prevalent conditions for either approving of or imposing abortion include unmarried status of the mother, adultery, ambiguous paternity, mother's poor health, lactation of the mother, consent of the father, death of the father, rape, incest, and other varieties of illegal union. In Western civilization attitdues vary and have been changing in most cases. As of mid-1982, 10% of the world's population lived in countries where abortion was prohibited under all circumstances and 18% in countries where it was permitted only to save the mother's life. Close to 2/3 of the countries in Latin America, most countries in Africa, most Muslim Countries in Asia, and the 5 European countries of Belgium, Ireland, Malta, Portugal, and Spain belong in these 2 categories. An additional 8% lived in countries that permitted abortion under broad medical grounds. The remaining 64% of the world's population were governed by statutes that either allowed abortion on broad social grounds, such as unmarried status of the mother and financial problems, or permitted it on demand (usually within the 1st trimester). Recent estimates of the number of abortions have ranged up to 55 million, corresponding to an abortion rate of 70/1000 women of reproductive age and to an abortion ratio of 300/1000 known pregnancies. The US liberalized its abortion policy and then subsequently added restrictions at federal, state or local levels. Abortion is 1 of the most divisive issues in the US. Opinions range from disapproval under all circumstances, even to save the mother's life, to approval for any reason, i.e., on demand.
WORLD HEALTH FORUM. 1986; 7(2):165.The Expanded Program on Immunization has proved to be the most cost-effective public health scheme yet undertaken in Nigeria, as it costs very much less to prevent diphteria, pertussis, tetanus, measles, poliomyelitis and tuberculosis than it does to cure them. About US$5 are sufficient to fully immunize a child against all these diseases, allowing for a nurse's salary, vaccines, syringes, cold chain equipment, and all other items. This is about 5% of the cost of treating a child with any one of the diseases (and the child could still die). It is quite possible to achieve a high level of immunization initially, but maintaining a satisfactory level is more difficult. Consistent government support, and public awareness of the importance of immunization, are vital for the success of any immunization scheme. Because the attitudes and understanding of mothers to immunization are crucial, we interviewed 575 women of childbearing age in Bendel State, 320 of whom had failed to complete or had not even started the immunization of their children. The replies of the latter group (in table) show that for maximum gains to be made from the Expanded Program on Immunization, which receives strong financial support from the Nigerian authorities, as well as from the WHO and the UN Children's Fund, community education and the mobilization of mothers have to be stepped up. This becomes even more obvious when it is realized that the women in this study had received some form of health education in antenatal clinics, infant welfare clinics, general practice clinics, and immunization centers. This group represents less than 25% of women of childbearing age in Nigeria: over 75% in most rural areas and in improverished urban areas have no access to modern health facilities. Consequently, there is a need to create and sustain public and official support, and to induce a widespread demand for immunization. (full text)
JOURNAL OF APPLIED SOCIAL PSYCHOLOGY. 1986; 16(2):95-106.Government policy toward provision of sex education and contraception for adolescents is influenced by public opinion. This is reflected in the fact that recent program formulation appears to follow the conventional wisdom of a general conservative shift among the American public; i.e., recent policy toward adolescent pregnancy is conservative in the sense of being reactive rather than preventive. The validity of this conventional wisdom was checked by examining available data on public opinion toward sex education and birth control services for teenagers. However, these data reveal an upward, not a downward, trend in public approval of such services for adolescents, which runs counter to the conventional wisdom. The available data on American opinions and values demonstrate that the overall movement in attitudes decisively contradicts the idea of a simple conservative swing. Provision of more and better contraceptive services and sex education to teenagers is an important policy goal that would lower the incidence of adolescent pregnancy and would be supported by the American people. (author's modified.)