Title: Pakistan: focus on women's issues.

POPULATION HEADLINERS, 1996 Mar-Apr;(251):2.

Abstract:


In April 1996 at the senior officials' segment of the 52nd Session of the Economic and Social Commission for Asia and the Pacific (ESCAP), a representative of Pakistan informed participants that population well-being efforts are part of the means used in implementing Pakistan's Social Action Programme. The Minister of State for Parliamentary Affairs noted that US$3 billion has been allocated to the Programme for implementation during the Eighth Five-Year Plan (1993-1998). The Programme aims to develop human resources and to improve the quality of life of the population, using life expectancy, access to primary health care, and literacy as indicators of quality of life. A key target group of the Programme is women. The Programme includes education, health, nutrition, training, and employment projects. In Pakistan, the mass media are contributing greatly in effecting the social change required to increase participation of women in economic activities.

Keywords:


Pakistan
Population Programs
Social Development
Financial Activities
Quality of Life
Mass Media
Social Change
Women's Status
Women
Changes
Asia, Southern
Asia
Developing Countries
Population Control
Population Policy
Social Policy
Policy
Economic Factors
Social Welfare
Communication
Socioeconomic Factors
Demographic Factors
Population

Index page



POPLINE Article Titles:
[The de facto population of Greece at the census of March 17, 1991]


First results from the 1991 census of Greece are presented. The data concern total population for the whole country, regions, departments, and eparchies. (ANNOTATION)

Census of India 1991. Series--1: India. Part VII: tables on houses and household amenities.


This report contains data on housing and households from the 1991 census of India. These data, which are primarily on housing alone, are presented by state and Union territory. (ANNOTATION)

Ireland, census 91. Volume 2: ages and marital status.


This volume presents results from the 1991 census of Ireland concerning age, sex, and marital status. The data are presented by province, county, and county borough. (ANNOTATION)

[Liechtenstein population census, 1990. Vol. 2: family names of Liechtenstein citizens residing in the principality of Liechtenstein]


This publication contains 1990 census data on the family names of Liechtenstein citizens residing in Liechtenstein. The data are broken down by sex, municipality of residence, and place of birth. (ANNOTATION)

Malawi population and housing census, 1987. Volume II, analytical report.


This report analyzes the results of the 1987 census of Malawi. There are chapters on data quality, fertility, mortality, and population projections. (ANNOTATION)

Malawi population and housing census, 1987. Volume IV, migration.


This report presents results from the 1987 census of Malawi on migration. Data are included on migration since birth, rural-urban migration, and the age and sex distributions of migrants and nonmigrants. (ANNOTATION)

Population of Nepal by districts and village development committees/municipalities (population census 1991).


This report presents data from the 1991 census of Nepal on total population by sex and total number of households for districts and villages. (ANNOTATION)

[Census 91. Final results. Northern region]


This is one of eight volumes presenting final results from the 1991 census of Portugal for the five mainland provinces, Madeira and the Azores, and Portugal as a whole. This volume concerns the northern region and contains data on individuals, families, and housing. (ANNOTATION)

[History and population in Mexico (sixteenth to nineteenth century)]


This is a selection of 10 articles originally published in the journal Historia Mexicana on various aspects of the historical demography of Mexico. The topics covered include the depopulation that occurred in the sixteenth century; the indigenous population in the seventeenth century; the indigenous population of the Puebla region; regional variation in the demography of Spanish colonial America; population trends in Cholula; the social structure of the mining population in northern Mexico; marriage and race in a rural parish; population and economy in Nueva Galicia; ethnic groups, class, and occupations in Guanajuato; and urbanization in the nineteenth century.

History, marriage politics, and demographic events in the central Himalaya.


"This chapter examines the demographic consequences of culturally motivated political strategies implied by relationships created and maintained by marriage within a natural fertility society. It explores the creation and maintenance of stratified groups as an outcome of historical patterns of migration buttressed by the needs of authority during the consolidation of the Nepali state. Once these groups are defined, it demonstrates that their members manipulate culturally given possibilities of marriage with a view to orchestrating advantages in the flow of obligations and labor....A second exploration will focus on the relevance of marriage-linked political dimensions to the timing of childbearing....I first provide a narrative history of status-group formation in Timling. Subsequent sections explore the implications of these hierarchies for marriage strategies, age at marriage, and age at first birth." (EXCERPT)

Marginal members: children of previous unions in Mende households in Sierra Leone.


"In Africa, as elsewhere, one of the key factors affecting children's access to resources is their mothers' conjugal status. Yet in the context of a massive rise in short-term or informal relationships across much of the continent...we know virtually nothing about what happens to the children of these unions as their mothers enter subsequent ones. This paper shows that because both women and men feel pressure to allocate resources disproportionately to children by unions they most value currently, the children of extant unions often fare better than do those of broken ones....The paper draws on ethnographic and demographic data from the Mende of Sierra Leone." (EXCERPT)

[Gambia]


The capital of Gambia is Banjul. As of 1995, Gambia had a population of 1.1 million governed by a military regime. 1994 gross national product and per capita income were, respectively, $373 million and $360. Per capita income grew at 0.5% per year over the period 1985-94. In 1994, Gambia owed $419.2 million, then being serviced at $31.8 million. For the same year, Gambia exported $163.1 million in goods and services and imported $225.6 million. As of 1995, the population was growing in size by 5.3% annually. In 1992-93, life expectancy at birth was 45 years, the infant mortality rate was 132 per 1000 births, and 90% had access to health services. Other data are presented on the country's topography, climate and vegetation, demographics, principal cities, population distribution, religions, political structure, economics and finances, foreign commerce, and transportation and communications.

[Gabon]


The capital of Gabon is Libreville. As of 1995, Gabon had a population of 1.3 million governed by a presidential, multiparty regime. 1994 gross national product and per capita income were, respectively, $3.7 billion and $3,550. Per capita income declined by 2.3% per year over the period 1985-94. In 1994, Gabon owed $3.967 billion, then being serviced at $1.441 billion. For the same year, Gabon exported $2.418 billion in goods and services and imported $2.275 billion. As of 1995, the population was growing in size by 2.8% annually. In 1992-93, life expectancy at birth was 53.5 years, the infant mortality rate was 94 per 1000 births, 90% had access to health services, and 68% had access to drinkable water. Other data are presented on the country's topography, climate and vegetation, demographics, principal cities, population distribution, religions, political structure, economics and finances, foreign commerce, and transportation and communications.

[Egypt]


The capital of Egypt is Cairo. As of 1995, Egypt had a population of 62.9 million governed by a presidential regime. 1994 gross national product and per capita income were, respectively, $42.3 billion and $710. Per capita income grew at 1.6% per year over the period 1985-94. In 1994, Egypt owed $33.358 billion, then being serviced at $2.685 billion. For the same year, Egypt exported $15.585 billion in goods and services and imported $16.121 billion. As of 1995, the population was growing in size by 1.9% annually. In 1992-93, life expectancy at birth was 63.6 years, the infant mortality rate was 67 per 1000 births, 99% had access to health services, and 90% had access to drinkable water. Other data are presented on the country's topography, climate and vegetation, demographics, principal cities, population distribution, religions, political structure, economics and finances, foreign commerce, and transportation and communications.

[Djibouti]


The capital of Djibouti is Djibouti. As of 1995, Djibouti had a population of 600,000 governed by a presidential regime. 1994 gross national product and per capita income were, respectively, $445.1 million and $830. Per capita income declined by 2.8% per year over the period 1985-94. In 1994, Djibouti owed $246.9 million, then being serviced at $13 million. For the same year, Djibouti exported $404 million in goods and services and imported $463.2 million. As of 1995, the population was growing in size by 2.6% annually. In 1992-93, life expectancy at birth was 48.3 years and the infant mortality rate was 115 per 1000 births. Other data are presented on the country's topography, climate and vegetation, demographics, principal cities, population distribution, religions, political structure, economics and finances, foreign commerce, and transportation and communications.

[Ivory Coast]


The capital of Cote d'Ivoire is Yamoussoukro. As of 1995, Cote d'Ivoire had a population of 14.3 million governed by a presidential, multiparty regime. 1994 gross national product and per capita income were, respectively, $7.1 billion and $510. Per capita income declined by 5.2% per year over the period 1985-94. In 1994, Cote d'Ivoire owed $18.452 billion, then being serviced at $2.144 billion. For the same year, Cote d'Ivoire exported $3.177 billion in goods and services and imported $3.59 billion. As of 1995, the population was growing in size by 3.2% annually. In 1992-93, life expectancy at birth was 51 years, the infant mortality rate was 92 per 1000 births, 30% had access to health services, and 76% had access to drinkable water. Other data are presented on the country's topography, climate and vegetation, demographics, principal cities, population distribution, religions, political structure, economics and finances, foreign commerce, and transportation and communications.

[Congo]


The capital of Congo is Brazzaville. As of 1995, Congo had a population of 2.6 million governed by a presidential, multiparty regime. 1994 gross national product and per capita income were, respectively, $1.6 billion and $640. Per capita income declined by 2.7% per year over the period 1985-94. In 1994, Congo owed $5.275 billion, then being serviced at $1.524 billion. For the same year, Congo exported $1.078 billion in goods and services and imported $1.4 billion. As of 1995, the population was growing in size by 2.7% annually. In 1992-93, life expectancy at birth was 51.3 years, the infant mortality rate was 84 per 1000 births, 83% had access to health services, and 38% had access to drinkable water. Other data are presented on the country's topography, climate and vegetation, demographics, principal cities, population distribution, religions, political structure, economics and finances, foreign commerce, and transportation and communications.

[Cape Verde]


The capital of Cape Verde is Praia. As of 1995, Cape Verde had a population of 400,000 governed by a presidential, multiparty regime. 1994 gross national product and per capita income were, respectively, $346 million and $910. Per capita income grew at 1.8% per year over the period 1985-94. In 1994, Cape Verde owed $169.9 million, then being serviced at $11.9 million. For the same year, Cape Verde exported $53 million in goods and services and imported $188 million. As of 1995, the population was growing in size by 5.5% annually. In 1992-93, life expectancy at birth was 64.7 years and the infant mortality rate was 130 per 1000 births. Other data are presented on the country's topography, climate and vegetation, demographics, principal cities, population distribution, religions, political structure, economics and finances, foreign commerce, and transportation and communications.

[Comoros]


The capital of Comoros is Moroni. As of 1995, Comoros had a population of 700,000 governed by a presidential regime. 1994 gross national product and per capita income were, respectively, $249 million and $510. Per capita income declined by 1.3% per year over the period 1985-94. In 1994, Comoros owed $188.7 million, then being serviced at $12.7 million. For the same year, Comoros exported $59.2 million in goods and services and imported $75.6 million. As of 1995, the population was growing in size by 1.9% annually. In 1992-93, life expectancy at birth was 56 years and the infant mortality rate was 89 per 1000 births. Other data are presented on the country's topography, climate and vegetation, demographics, principal cities, population distribution, religions, political structure, economics and finances, foreign commerce, and transportation and communications.

[Central African Republique]


The capital of Central African Republic is Bangui. As of 1995, Central African Republic had a population of 3.3 million governed by a presidential regime. 1994 gross national product and per capita income were, respectively, $1.2 billion and $370. Per capita income declined by 2.8% per year over the period 1985-94. In 1994, Central African Republic owed $890.6 million, then being serviced at $79.6 million. For the same year, Central African Republic exported $185.5 million in goods and services and imported $280.4 million. As of 1995, the population was growing in size by 2.4% annually. In 1992-93, life expectancy at birth was 49.4 years, the infant mortality rate was 102 per 1000 births, 45% had access to health services, and 24% had access to drinkable water. Other data are presented on the country's topography, climate and vegetation, demographics, principal cities, population distribution, religions, political structure, economics and finances, foreign commerce, and transportation and communications.

[Cameroon]


The capital of Cameroon is Yaounde. As of 1995, Cameroon had a population of 13.2 million governed by a presidential, multiparty regime. 1994 gross national product and per capita income were, respectively, $8.735 billion and $680. Per capita income grew at 3% per year over the period 1985-94. In 1994, Cameroon owed $7.3 billion, then being serviced at $374 million. For the same year, Cameroon exported $2.3 billion in goods and services and imported $2.5 billion. As of 1995, the population was growing in size by 3% annually. In 1992-93, life expectancy at birth was 56 years, the infant mortality rate was 63 per 1000 births, 41% had access to health services, and 50% had access to drinkable water. Other data are presented on the country's topography, climate and vegetation, demographics, principal cities, population distribution, religions, political structure, economics and finances, foreign commerce, and transportation and communications.

[Burundi]


The capital of Burundi is Bujumbura. As of 1995, Burundi had a population of 6.4 million governed by a presidential regime. 1994 gross national product and per capita income were, respectively, $898 million and $150. Per capita income declined by 1% per year over the period 1985-94. In 1994, Burundi owed $1.126 billion, then being serviced at $41 million. For the same year, Burundi exported $163 million in goods and services and imported $333 million. As of 1995, the population was growing in size by 2.8% annually. In 1992-93, life expectancy at birth was 50.2 years, the infant mortality rate was 102 per 1000 births, 80% had access to health services, and 57% had access to drinkable water. Other data are presented on the country's topography, climate and vegetation, demographics, principal cities, population distribution, religions, political structure, economics and finances, foreign commerce, and transportation and communications.

[Burkina Faso]


The capital of Burkina Faso is Ouagadougou. As of 1995, Burkina Faso had a population of 10.3 million governed by a presidential, multiparty regime. 1994 gross national product and per capita income were, respectively, $3 billion and $300. Per capita income declined by 0.2% per year over the period 1985-94. In 1994, Burkina Faso owed $1.1 billion, then being serviced at $43 million. For the same year, Burkina Faso exported $495 million in goods and services and imported $933 million. As of 1995, the population was growing in size by 2.5% annually. In 1992-93, life expectancy at birth was 47.4 years, the infant mortality rate was 130 per 1000 births, 49% had access to health services, and 56% had access to drinkable water. Other data are presented on the country's topography, climate and vegetation, demographics, principal cities, population distribution, religions, political structure, economics and finances, foreign commerce, and transportation and communications.

[Botswana]


The capital of Botswana is Gaborone. As of 1995, Botswana had a population of 1.5 million governed by a presidential, multiparty regime. 1994 gross national product and per capita income were, respectively, $4 billion and $2800. Per capita income grew at 6.6% per year over the period 1985-94. In 1994, Botswana owed $691 million, then being serviced at $97 million. For the same year, Botswana exported $2.3 billion in goods and services and imported $2.1 billion. As of 1995, the population was growing in size by 2.9% annually. In 1992-93, life expectancy at birth was 64.9 years, the infant mortality rate was 43 per 1000 births, 89% had access to health services, and 51% had access to drinkable water. Other data are presented on the country's topography, climate and vegetation, demographics, principal cities, population distribution, religions, political structure, economics and finances, foreign commerce, and transportation and communications.

[Benin]


The capital of Benin is Porto-Novo. As of 1995, Benin had a population of 5.4 million governed by a plural democratic regime. 1994 gross national product and per capita income were, respectively, $2 billion and $370. Per capita income declined by 0.8% per year over the period 1985-94. In 1994, Benin owed $1.6 billion, then being serviced at $52 million. For the same year, Benin exported $405 million in goods and services and imported $518 million. As of 1995, the population was growing in size by 2.9% annually. In 1992-93, life expectancy at birth was 47.6 years, the infant mortality rate was 86 per 1000 births, 18% had access to health services, and 51% had access to drinkable water. Other data are presented on the country's topography, climate and vegetation, demographics, principal cities, population distribution, religions, political structure, economics and finances, foreign commerce, and transportation and communications.

[Angola]


The capital of Angola is Luanda. As of 1995, Angola had a population of 11.1 million governed by a presidential regime. 1994 gross national product and per capita income were, respectively, $4.6 billion and $430. Per capita income declined by 0.9% per year over the period 1985-94. In 1994, Angola owed $10.6 billion, then being serviced at $1.1 billion. For the same year, Angola exported $3 billion in goods and services and imported $1.6 billion. As of 1995, the population was growing in size by 3.3% annually. In 1992-93, life expectancy at birth was 46.5 years, the infant mortality rate was 53 per 1000 births, 30% had access to health services, and 41% had access to drinkable water. Other data are presented on the country's topography, climate and vegetation, demographics, principal cities, population distribution, religions, political structure, economics and finances, foreign commerce, and transportation and communications.

[Algeria]


The capital of Algeria is Algiers. As of 1995, Algeria had a population of 27.9 million governed by a presidential regime. 1994 gross national product and per capita income were, respectively, $40.2 billion and $1470. Per capita income declined by 2.04% per year over the period 1985-94. In 1994, Algeria owed $29.898 billion, then being serviced at $5.4 billion. For the same year, Algeria exported $9.698 billion in goods and services and imported $12.919 billion. As of 1995, the population was growing in size by 2.2% annually. In 1992-93, life expectancy at birth was 67.1 years, the infant mortality rate was 55 per 1000 births, 88% had access to health services, and 68% had access to drinkable water. Other data are presented on the country's topography, climate and vegetation, demographics, principal cities, population distribution, religions, political structure, economics and finances, foreign commerce, and transportation and communications.

[Liberia]


The capital of Liberia is Monrovia. As of 1995, Liberia had a population of 3 million governed by a government in transition. 1994 gross national product and per capita income were, respectively, $1 billion and $374. In 1994, Liberia owed $2.056 billion, then being serviced at $160 million. For the same year, Liberia exported $433 million in goods and services and imported $574 million. As of 1995, the population was growing in size by 3.2% annually. In 1992-93, life expectancy at birth was 41.3 years, the infant mortality rate was 126 per 1000 births, 39% had access to health services, and 50% had access to drinkable water. Other data are presented on the country's topography, climate and vegetation, demographics, principal cities, population distribution, religions, political structure, economics and finances, foreign commerce, and transportation and communications.

[Saudi Arabia]


The capital of Saudi Arabia is Riyadh. As of 1995, Saudi Arabia had a population of 17.9 million governed by an absolute monarchy. 1994 gross national product and per capita income were, respectively, $126.597 billion and $7240. Per capita income declined by 1.2% per year over the period 1985-94. In 1994, Saudi Arabia owed $17.089 billion. For the same year, Saudi Arabia exported $41.5 billion in goods and services and imported $22.893 billion. As of 1995, the population was growing in size by 3.5% annually. In 1992-93, life expectancy at birth was 69.7 years, the infant mortality rate was 29 per 1000 births, 97% had access to health services, and 95% had access to drinkable water. Other data are presented on the country's topography, climate and vegetation, demographics, principal cities, population distribution, religions, political structure, economics and finances, foreign commerce, and transportation and communications.

[Iraq]


The capital of Iraq is Baghdad. As of 1995, Iraq had a population of 20.4 million governed by a presidential regime. 1994 gross national product and per capita income were, respectively, $24 billion and $1200. In 1994, Iraq owed $75-86 billion. As of 1995, the population was growing in size by 3% annually. In 1992-93, life expectancy at birth was 66 years, 93% had access to health services, and 77% had access to drinkable water. UNICEF estimates that almost 100,000 children have died in Iraq since the beginning of the Gulf War, while the FAO estimates that the UN embargo against Iraq has precipitated the death of 560,000 children in the country since the end of the War. Other data are presented on the country's topography, climate and vegetation, demographics, principal cities, population distribution, religions, political structure, economics and finances, foreign commerce, and transportation and communications.

[Iran]


The capital of Iran is Teheran. As of 1995, Iran had a population of 67.3 million governed by an Islamic republic regime. 1994 gross national product and per capita income were, respectively, $122 billion and $1820. Per capita income declined by 1% per year over the period 1985-94. In 1994, Iran owed $22.7 billion, then being serviced at $3.7 billion. For the same year, Iran exported $19.765 billion in goods and services and imported $16.384 billion. As of 1995, the population was growing in size by 2.1% annually. In 1992-93, life expectancy at birth was 67.5 years, the infant mortality rate was 66 per 1000 births, 80% had access to health services, and 89% had access to drinkable water. Other data are presented on the country's topography, climate and vegetation, demographics, principal cities, population distribution, religions, political structure, economics and finances, foreign commerce, and transportation and communications.

[Israel]


The capital of Israel is Tel-Aviv. As of 1995, Israel had a population of 5.6 million governed by a parliamentary regime. 1994 gross national product and per capita income were, respectively, $80.9 billion and $14,900. Per capita income grew at 2.5% per year over the period 1985-94. In 1994, Israel owed $19 billion. For the same year, Israel exported $16,884 billion in goods and services and imported $23.775 billion. As of 1995, the population was growing in size by 1.5% annually. In 1992-93, life expectancy at birth was 76.5 years and the infant mortality rate was 6.6 per 1000 births. Other data are presented on the country's topography, climate and vegetation, demographics, principal cities, population distribution, religions, political structure, economics and finances, foreign commerce, and transportation and communications.

[Jordan]


The capital of Jordan is Amman. As of 1995, Jordan had a population of 5.4 million governed by a parliamentary monarchy regime. 1994 gross national product and per capita income were, respectively, $5.8 billion and $1390. Per capita income declined by 6.3% per year over the period 1985-94. In 1994, Jordan owed $7.1 billion, then being serviced at $878 million. For the same year, Jordan exported $4.151 billion in goods and services and imported $4.783 billion. As of 1995, the population was growing in size by 3.3% annually. In 1992-93, life expectancy at birth was 67.9 years, the infant mortality rate was 36 per 1000 births, 97% had access to health services, and 99% had access to drinkable water. Other data are presented on the country's topography, climate and vegetation, demographics, principal cities, population distribution, religions, political structure, economics and finances, foreign commerce, and transportation and communications.

[Kuwait]


The capital of Kuwait is Kuwait City. As of 1995, Kuwait had a population of 1.8 million governed by a monarchy endowed with a parliament regime. 1994 gross national product and per capita income were, respectively, $25.14 billion and $14,360. Per capita income declined by 1.3% per year over the period 1985-94. In 1994, Kuwait owed $17.24 billion. For the same year, Kuwait exported $10.8 billion in goods and services and imported $6.6 billion. As of 1995, the population was growing in size by 3.2% annually. In 1992-93, life expectancy at birth was 74.9 years, the infant mortality rate was 18 per 1000 births, 100% had access to health services, and 100% had access to drinkable water. Other data are presented on the country's topography, climate and vegetation, demographics, principal cities, population distribution, religions, political structure, economics and finances, foreign commerce, and transportation and communications.

[Lebanon]


The capital of Lebanon is Beirut. As of 1995, Lebanon had a population of 3 million governed by a parliamentary republican regime. 1994 gross national product and per capita income were, respectively, $9.5 billion and $3200. In 1994, Lebanon owed $2 billion, then being serviced at $122 million. For the same year, Lebanon exported $1.532 billion in goods and services and imported $5.476 billion. As of 1995, the population was growing in size by 1.8% annually. In 1992-93, life expectancy at birth was 68.5 years, the infant mortality rate was 34 per 1000 births, 95% had access to health services, and 92% had access to drinkable water. Other data are presented on the country's topography, climate and vegetation, demographics, principal cities, population distribution, religions, political structure, economics and finances, foreign commerce, and transportation and communications.

[Oman]


The capital of Oman is Muscat. As of 1995, Oman had a population of 2.2 million governed by an absolute monarchy. 1994 gross national product and per capita income were, respectively, $10.1 billion and $5200. Per capita income grew at 0.6% per year over the period 1985-94. In 1994, Oman owed $3.1 billion, then being serviced at $525 million. For the same year, Oman exported $5.839 billion in goods and services and imported $5.558 billion. As of 1995, the population was growing in size by 3.9% annually. In 1992-93, life expectancy at birth was 69.6 years, the infant mortality rate was 30 per 1000 births, 96% had access to health services, and 84% had access to drinkable water. Other data are presented on the country's topography, climate and vegetation, demographics, principal cities, population distribution, religions, political structure, economics and finances, foreign commerce, and transportation and communications.

[Palestine]


As of 1995, Palestine had a population of 2.3 million governed by an autonomous regime. 1994 gross national product and per capita income were, respectively, $2.4 billion and $1200. Palestine exported $236 million in goods and services and imported $1130 million. As of 1995, the population was growing in size by 4.2-4.8% annually. In 1992-93, life expectancy at birth was 64.9-67.4 years and the infant mortality rate was 44 per 1000 births. Other data are presented on the country's topography, climate and vegetation, demographics, principal cities, population distribution, religions, political structure, economics and finances, foreign commerce, and transportation and communications.

[Qatar]


The capital of Qatar is Doha. As of 1995, Qatar had a population of 600,000 governed by an absolute monarchy. 1994 gross national product and per capita income were, respectively, $7.85 billion and $14,540. Per capita income declined by 0.8% per year over the period 1985-94. In 1994, Qatar owed $2.1 billion. For the same year, Qatar exported $3.1 billion in goods and services and imported $1.8 billion. As of 1995, the population was growing in size by 2.1% annually. In 1992-93, life expectancy at birth was 71 years, the infant mortality rate was 2.6 per 1000 births, 100% had access to health services, and 89% had access to drinkable water. Other data are presented on the country's topography, climate and vegetation, demographics, principal cities, population distribution, religions, political structure, economics and finances, foreign commerce, and transportation and communications.

[Syria]


The capital of Syria is Damas. As of 1995, Syria had a population of 14.7 million governed by a military presidential regime. 1994 gross national product and per capita income were, respectively, $17 billion and $1250. Per capita income declined by 2.4% per year over the period 1985-94. In 1994, Syria owed $20.6 billion, then being serviced at $1.53 billion. For the same year, Syria exported $5.332 billion in goods and services and imported $5.979 billion. As of 1995, the population was growing in size by 3.3% annually. In 1992-93, life expectancy at birth was 67.1 years, the infant mortality rate was 39 per 1000 births, 90% had access to health services, and 74% had access to drinkable water. Other data are presented on the country's topography, climate and vegetation, demographics, principal cities, population distribution, religions, political structure, economics and finances, foreign commerce, and transportation and communications.

[Turkey]


The capital of Turkey is Ankara. As of 1995, Turkey had a population of 61.9 million governed by a parliamentary republican regime. 1994 gross national product and per capita income were, respectively, $149 billion and $2450. Per capita income grew at 1.5% per year over the period 1985-94. In 1994, Turkey owed $66.3 billion, then being serviced at $9.4 billion. For the same year, Turkey exported $32.711 billion in goods and services and imported $30.785 billion. As of 1995, the population was growing in size by 1.8% annually. In 1992-93, life expectancy at birth was 67 years, the infant mortality rate was 56 per 1000 births, % had access to health services, and 92% had access to drinkable water. Other data are presented on the country's topography, climate and vegetation, demographics, principal cities, population distribution, religions, political structure, economics and finances, foreign commerce, and transportation and communications.

[Yemen]


The capital of Yemen is Sanaa. As of 1995, Yemen had a population of 14.5 million governed by a presidential regime. 1994 gross national product and per capita income were, respectively, $3.7 billion and $280. Per capita income grew at 1.6% per year over the period 1985-94. In 1994, Yemen owed $5.9 billion, then being serviced at $360 million. For the same year, Yemen exported $3.069 billion in goods and services and imported $3.178 billion. As of 1995, the population was growing in size by 3.2% annually. In 1992-93, life expectancy at birth was 50.7 years, the infant mortality rate was 119 per 1000 births, 38% had access to health services, and 32% had access to drinkable water. Other data are presented on the country's topography, climate and vegetation, demographics, principal cities, population distribution, religions, political structure, economics and finances, foreign commerce, and transportation and communications.

[Zaire]


The capital of Zaire is Kinshasa. As of 1995, Zaire had a population of 43.9 million governed by a presidential regime. 1994 gross national product and per capita income were, respectively, $6 billion and $135. Per capita income declined by 0.8% per year over the period 1985-94. In 1994, Zaire owed $12.336 billion, then being serviced at $1.294 billion. For the same year, Zaire exported $1.2 billion in goods and services and imported $600 million. As of 1995, the population was growing in size by 3% annually. In 1992-93, life expectancy at birth was 52 years, the infant mortality rate was 93 per 1000 births, 26% had access to health services, and 39% had access to drinkable water. Other data are presented on the country's topography, climate and vegetation, demographics, principal cities, population distribution, religions, political structure, economics and finances, foreign commerce, and transportation and communications.

[Chad]


The capital of Chad is Ndjamena. As of 1995, Chad had a population of 6.4 million governed by a presidential regime. 1994 gross national product and per capita income were, respectively, $1.2 billion and $190. Per capita income grew at 0.9% per year over the period 1985-94. In 1994, Chad owed $816 million, then being serviced at $25.3 million. For the same year, Chad exported $181 million in goods and services and imported $336 million. As of 1995, the population was growing in size by 2.8% annually. In 1992-93, life expectancy at birth was 47.5 years, the infant mortality rate was 122 per 1000 births, 30% had access to health services, and % had access to drinkable water. Other data are presented on the country's topography, climate and vegetation, demographics, principal cities, population distribution, religions, political structure, economics and finances, foreign commerce, and transportation and communications.

[Tanzania]


The capital of Tanzania is Dodoma. As of 1995, Tanzania had a population of 29.7 million governed by a presidential regime. 1994 gross national product and per capita income were, respectively, $3 billion and $100. Per capita income grew at 4.8% per year over the period 1985-94. In 1994, Tanzania owed $7.4 billion, then being serviced at $548 million. For the same year, Tanzania exported $855 million in goods and services and imported $2.067 billion. As of 1995, the population was growing in size by 2.8% annually. In 1992-93, life expectancy at birth was 52.1 years, the infant mortality rate was 85 per 1000 births, 76% had access to health services, and 50% had access to drinkable water. Other data are presented on the country's topography, climate and vegetation, demographics, principal cities, population distribution, religions, political structure, economics and finances, foreign commerce, and transportation and communications.

[Morocco]


The capital of Morocco is Rabat. As of 1995, Morocco had a population of 27 million governed by a constitutional monarchy regime. 1994 gross national product and per capita income were, respectively, $29.5 billion and $1150. Per capita income grew at 1.1% per year over the period 1985-94. In 1994, Morocco owed $22.5 billion, then being serviced at $2.981 billion. For the same year, Morocco exported $9.096 billion in goods and services and imported $9.901 billion. As of 1995, the population was growing in size by 1.8% annually. In 1992-93, life expectancy at birth was 63.3 years, the infant mortality rate was 68 per 1000 births, 70% had access to health services, and 54% had access to drinkable water. Other data are presented on the country's topography, climate and vegetation, demographics, principal cities, population distribution, religions, political structure, economics and finances, foreign commerce, and transportation and communications.

[Swaziland]


The capital of Swaziland is Mbabane. As of 1995, Swaziland had a population of 900,000 governed by a monarchy regime. 1994 gross national product and per capita income were, respectively, $1 billion and $1160. Per capita income declined by 1.3% per year over the period 1985-94. In 1994, Swaziland owed $237 million, then being serviced at $26.7 million. For the same year, Swaziland exported $1.016 billion in goods and services and imported $1.083 billion. As of 1995, the population was growing in size by 5.7% annually. In 1992-93, life expectancy at birth was 57.5 years and the infant mortality rate was 75 per 1000 births. Other data are presented on the country's topography, climate and vegetation, demographics, principal cities, population distribution, religions, political structure, economics and finances, foreign commerce, and transportation and communications.

[Sudan]


The capital of Sudan is Khartoum. As of 1995, Sudan had a population of 28.1 million governed by a military, Islamic regime. 1994 gross national product and per capita income were, respectively, $5.9 billion and $250. In 1994, Sudan owed $18 billion, then being serviced at $1.3 billion. For the same year, Sudan exported $609 million in goods and services and imported $2.209 billion. As of 1995, the population was growing in size by 2.7% annually. In 1992-93, life expectancy at birth was 53 years, the infant mortality rate was 78 per 1000 births, 51% had access to health services, and 48% had access to drinkable water. Other data are presented on the country's topography, climate and vegetation, demographics, principal cities, population distribution, religions, political structure, economics and finances, foreign commerce, and transportation and communications.

[Somalia]


The capital of Somalia is Mogadishu. As of 1995, Somalia had a population of 9.3 million governed by no central state regime. 1994 gross national product and per capita income were, respectively, $835 million and $110. In 1994, Somalia owed $2.5 billion, then being serviced at $11 million. For the same year, Somalia exported $91 million in goods and services and imported $433 million. As of 1995, the population was growing in size by 3.1% annually. In 1992-93, life expectancy at birth was 47 years, the infant mortality rate was 122 per 1000 births, 27% had access to health services, and 37% had access to drinkable water. Other data are presented on the country's topography, climate and vegetation, demographics, principal cities, population distribution, religions, political structure, economics and finances, foreign commerce, and transportation and communications.

[Sierra Leone]


The capital of Sierra Leone is Freetown. As of 1995, Sierra Leone had a population of 4.5 million governed by a transitional, military regime. 1994 gross national product and per capita income were, respectively, $741 million and $150. Per capita income declined by 1.9% per year over the period 1985-94. In 1994, Sierra Leone owed $1.4 billion, then being serviced at $186 million. For the same year, Sierra Leone exported $146 million in goods and services and imported $285 million. As of 1995, the population was growing in size by 2.3% annually. In 1992-93, life expectancy at birth was 39 years, the infant mortality rate was 166 per 1000 births, 38% had access to health services, and 37% had access to drinkable water. Other data are presented on the country's topography, climate and vegetation, demographics, principal cities, population distribution, religions, political structure, economics and finances, foreign commerce, and transportation and communications.

[Seychelles]


The capital of Seychelles is Victoria. As of 1995, Seychelles had a population of 72,000 governed by a presidential regime. 1994 gross national product and per capita income were, respectively, $471 million and $6210. Per capita income grew at 4.5% per year over the period 1985-94. In 1994, Seychelles owed $170 million, then being serviced at $21 million. For the same year, Seychelles exported $291.1 million in goods and services and imported $306.8 million. As of 1995, the population was growing in size by 1.1% annually. In 1992-93, life expectancy at birth was 71 years, the infant mortality rate was 76 per 1000 births, and 85-100% had access to drinkable water. Other data are presented on the country's topography, climate and vegetation, demographics, principal cities, population distribution, religions, political structure, economics and finances, foreign commerce, and transportation and communications.

[Senegal]


The capital of Senegal is Dakar. As of 1995, Senegal had a population of 8.3 million governed by a presidential, pluralist regime. 1994 gross national product and per capita income were, respectively, $5 billion and $610. Per capita income declined by 0.5% per year over the period 1985-94. In 1994, Senegal owed $3.7 billion, then being serviced at $465 million. For the same year, Senegal exported $1.349 billion in goods and services and imported $1.74 billion. As of 1995, the population was growing in size by 2.7% annually. In 1992-93, life expectancy at birth was 49 years, the infant mortality rate was 68 per 1000 births, 40% had access to health services, and 48% had access to drinkable water. Other data are presented on the country's topography, climate and vegetation, demographics, principal cities, population distribution, religions, political structure, economics and finances, foreign commerce, and transportation and communications.

[Sao Tome and Prinicple]


The capital of Sao Tome and Principe is Sao Tome. As of 1995, Sao Tome and Principe had a population of 100,000 governed by a presidential regime. 1994 gross national product and per capita income were, respectively, $31 million and $250. Per capita income declined by 2.5% per year over the period 1985-94. In 1994, Sao Tome and Principe owed $252 million, then being serviced at $8.7 million. For the same year, Sao Tome and Principe exported $12.4 million in goods and services and imported $46.5 million. As of 1995, the population was growing in size by 2.2% annually. In 1992-93, life expectancy at birth was 51 years and the infant mortality rate was 72 per 1000 births. Other data are presented on the country's topography, climate and vegetation, demographics, principal cities, population distribution, religions, political structure, economics and finances, foreign commerce, and transportation and communications.

[Rwanda]


The capital of Rwanda is Kigali. As of 1995, Rwanda had a population of 8 million governed by a presidential regime. 1994 gross national product and per capita income were, respectively, $579 million and $75. Per capita income declined by 2.2% per year over the period 1985-94. In 1994, Rwanda owed $954 million, then being serviced at $31.5 million. For the same year, Rwanda exported $51 million in goods and services and imported $495.6 million. As of 1995, the population was growing in size by 2.6% annually. In 1992-93, life expectancy at birth was 47.3 years, the infant mortality rate was 110 per 1000 births, 80% had access to health services, and 51% had access to drinkable water. Other data are presented on the country's topography, climate and vegetation, demographics, principal cities, population distribution, religions, political structure, economics and finances, foreign commerce, and transportation and communications.

[Uganda]


The capital of Uganda is Kampala. As of 1995, Uganda had a population of 21.3 million governed by a presidential regime. 1994 gross national product and per capita income were, respectively, $3.9 billion and $200. Per capita income grew at 3% per year over the period 1985-94. In 1994, Uganda owed $3.5 billion, then being serviced at $173 million. For the same year, Uganda exported $344 million in goods and services and imported $901 million. As of 1995, the population was growing in size by 2.9% annually. In 1992-93, life expectancy at birth was 44.9 years, the infant mortality rate was 115 per 1000 births, 49% had access to health services, and 31% had access to drinkable water. Other data are presented on the country's topography, climate and vegetation, demographics, principal cities, population distribution, religions, political structure, economics and finances, foreign commerce, and transportation and communications.

[Nigeria]


The capital of Nigeria is Abuja. As of 1995, Nigeria had a population of 111.7 million governed by a military regime. 1994 gross national product and per capita income were, respectively, $33 billion and $280. Per capita income grew at 1.2% per year over the period 1985-94. In 1994, Nigeria owed $33.5 billion, then being serviced at $5.8 billion. For the same year, Nigeria exported $9.795 billion in goods and services and imported $11.94 billion. As of 1995, the population was growing in size by 2.8% annually. In 1992-93, life expectancy at birth was 50.4 years, the infant mortality rate was 84 per 1000 births, 66% had access to health services, and 36% had access to drinkable water. Other data are presented on the country's topography, climate and vegetation, demographics, principal cities, population distribution, religions, political structure, economics and finances, foreign commerce, and transportation and communications.

[Niger]


The capital of Niger is Niamey. As of 1995, Niger had a population of 9.2 million governed by a transitional military regime. 1994 gross national product and per capita income were, respectively, $2 billion and $230. Per capita income declined by 2.2% per year over the period 1985-94. In 1994, Niger owed $1.6 billion, then being serviced at $242 million. For the same year, Niger exported $254 million in goods and services and imported $351 million. As of 1995, the population was growing in size by 3.3% annually. In 1992-93, life expectancy at birth was 46.5 years, the infant mortality rate was 124 per 1000 births, 32% had access to health services, and 59% had access to drinkable water. Other data are presented on the country's topography, climate and vegetation, demographics, principal cities, population distribution, religions, political structure, economics and finances, foreign commerce, and transportation and communications.

[Namibia]


The capital of Namibia is Windhoek. As of 1995, Namibia had a population of 1.5 million governed by a presidential regime. 1994 gross national product and per capita income were, respectively, $3 billion and $2030. Per capita income grew at 3.4% per year over the period 1985-94. In 1994, Namibia owed $370 million. For the same year, Namibia exported $1.3 billion in goods and services and imported $1.2 billion. As of 1995, the population was growing in size by 2.6% annually. In 1992-93, life expectancy at birth was 58.8 years, the infant mortality rate was 60 per 1000 births, 72% had access to health services, and 52% had access to drinkable water. Other data are presented on the country's topography, climate and vegetation, demographics, principal cities, population distribution, religions, political structure, economics and finances, foreign commerce, and transportation and communications.

[Mozambique]


The capital of Mozambique is Maputo. As of 1995, Mozambique had a population of 16 million governed by a multiparty, presidential regime. 1994 gross national product and per capita income were, respectively, $1.3 billion and $80. Per capita income grew at 3.5% per year over the period 1985-94. In 1994, Mozambique owed $5.5 billion, then being serviced at $361 million. For the same year, Mozambique exported $395 million in goods and services and imported $1.403 billion. As of 1995, the population was growing in size by 3.4% annually. In 1992-93, life expectancy at birth was 46.4 years, the infant mortality rate was 148 per 1000 births, 39% had access to health services, and 22% had access to drinkable water. Other data are presented on the country's topography, climate and vegetation, demographics, principal cities, population distribution, religions, political structure, economics and finances, foreign commerce, and transportation and communications.

[Mauritania]


The capital of Mauritania is Nouakchott. As of 1995, Mauritania had a population of 2.3 million governed by a presidential regime. 1994 gross national product and per capita income were, respectively, $1.1 billion and $480. Per capita income grew at 0.2% per year over the period 1985-94. In 1994, Mauritania owed $2.3 billion, then being serviced at $188 million. For the same year, Mauritania exported $451 million in goods and services and imported $587 million. As of 1995, the population was growing in size by 2.5% annually. In 1992-93, life expectancy at birth was 51.5 years, the infant mortality rate was 101 per 1000 births, 45% had access to health services, and 66% had access to drinkable water. Other data are presented on the country's topography, climate and vegetation, demographics, principal cities, population distribution, religions, political structure, economics and finances, foreign commerce, and transportation and communications.

[Mauritius]


The capital of Mauritius is Port-Louis. As of 1995, Mauritius had a population of 1.1 million governed by a parliamentary regime. 1994 gross national product and per capita income were, respectively, $3.5 billion and $3180. Per capita income grew at 5.6% per year over the period 1985-94. In 1994, Mauritius owed $1.4 billion, then being serviced at $144 million. For the same year, Mauritius exported $2.087 billion in goods and services and imported $3.86 billion. As of 1995, the population was growing in size by 1.1% annually. In 1992-93, life expectancy at birth was 70.2 years, the infant mortality rate was 18 per 1000 births, 100% had access to health services, and 97% had access to drinkable water. Other data are presented on the country's topography, climate and vegetation, demographics, principal cities, population distribution, religions, political structure, economics and finances, foreign commerce, and transportation and communications.

[Lesotho]


The capital of Lesotho is Maseru. As of 1995, Lesotho had a population of 2.1 million governed by a constitutional monarchy regime. 1994 gross national product and per capita income were, respectively, $1.4 billion and $700. Per capita income grew at 0.5% per year over the period 1985-94. In 1994, Lesotho owed $600 million, then being serviced at $32 million. For the same year, Lesotho exported $665 million in goods and services and imported $1.108 billion. As of 1995, the population was growing in size by 2.6% annually. In 1992-93, life expectancy at birth was 42.9 years, the infant mortality rate was 79 per 1000 births, 80% had access to health services, and 47% had access to drinkable water. Other data are presented on the country's topography, climate and vegetation, demographics, principal cities, population distribution, religions, political structure, economics and finances, foreign commerce, and transportation and communications.

[Kenya]


The capital of Kenya is Nairobi. As of 1995, Kenya had a population of 28.3 million governed by a presidential regime. 1994 gross national product and per capita income were, respectively, $6.6 billion and $260. Per capita income remained stable at 0% per year over the period 1985-94. In 1994, Kenya owed $7.273 billion, then being serviced at $1.356 billion. For the same year, Kenya exported $2.666 billion in goods and services and imported $2.844 billion. As of 1995, the population was growing in size by 2.8% annually. In 1992-93, life expectancy at birth was 55.7 years, the infant mortality rate was 69 per 1000 births, 77% had access to health services, and 49% had access to drinkable water. Other data are presented on the country's topography, climate and vegetation, demographics, principal cities, population distribution, religions, political structure, economics and finances, foreign commerce, and transportation and communications.

[Equatorial Guinea]


The capital of Equatorial Guinea is Malabo. As of 1995, Equatorial Guinea had a population of 400,000 governed by a presidential regime. 1994 gross national product and per capita income were, respectively, $167 million and $430. Per capita income grew at 1.6% per year over the period 1985-94. In 1994, Equatorial Guinea owed $290.6 million, then being serviced at $22.3 million. For the same year, Equatorial Guinea exported $66.1 million in goods and services and imported $85.6 million. As of 1995, the population was growing in size by 2.55% annually. In 1992-93, life expectancy at birth was 48 years and the infant mortality rate was 117 per 1000 births. Other data are presented on the country's topography, climate and vegetation, demographics, principal cities, population distribution, religions, political structure, economics and finances, foreign commerce, and transportation and communications.

[Guinea Bissau]


The capital of Guinea Bissau is Bissau. As of 1995, Guinea Bissau had a population of 1.1 million governed by a multiparty, presidential regime. 1994 gross national product and per capita income were, respectively, $253 million and $240. Per capita income grew at 1.9% per year over the period 1985-94. In 1994, Guinea Bissau owed $816 million, then being serviced at $68.7 million. For the same year, Guinea Bissau exported $55.4 million in goods and services and imported $101.6 million. As of 1995, the population was growing in size by 2.1% annually. In 1992-93, life expectancy at birth was 43.5 years, the infant mortality rate was 140 per 1000 births, 40% had access to health services, and 41% had access to drinkable water. Other data are presented on the country's topography, climate and vegetation, demographics, principal cities, population distribution, religions, political structure, economics and finances, foreign commerce, and transportation and communications.

[Guinea]


The capital of Guinea is Conakry. As of 1995, Guinea had a population of 6.7 million governed by a presidential military regime. 1994 gross national product and per capita income were, respectively, $3.3 billion and $510. Per capita income grew at 1.2% per year over the period 1985-94. In 1994, Guinea owed $3.1 billion, then being serviced at $244 million. For the same year, Guinea exported $687 million in goods and services and imported $952 million. As of 1995, the population was growing in size by 2.9% annually. In 1992-93, life expectancy at birth was 44.5 years, the infant mortality rate was 134 per 1000 births, 80% had access to health services, and 55% had access to drinkable water. Other data are presented on the country's topography, climate and vegetation, demographics, principal cities, population distribution, religions, political structure, economics and finances, foreign commerce, and transportation and communications.

[Ghana]


The capital of Ghana is Accra. As of 1995, Ghana had a population of 17.5 million governed by a multiparty, presidential regime. 1994 gross national product and per capita income were, respectively, $7.3 billion and $430. Per capita income grew at 1.4% per year over the period 1985-94. In 1994, Ghana owed $5.389 billion, then being serviced at $322 million. For the same year, Ghana exported $1.395 billion in goods and services and imported $2.123 billion. As of 1995, the population was growing in size by 2.9% annually. In 1992-93, life expectancy at birth was 56 years, the infant mortality rate was 81 per 1000 births, 60% had access to health services, and 68% had access to drinkable water. Other data are presented on the country's topography, climate and vegetation, demographics, principal cities, population distribution, religions, political structure, economics and finances, foreign commerce, and transportation and communications.

The bomb is a dud. Population patrol.


Paul Ehrlich in 1968 endorsed compulsory sterilization in India, and criminal sanctions against overbreeding in 1971. Paul and Anne Ehrlich have recently argued that environmental pollution, homelessness, starvation, global warming, deforestation, depletion of the ozone layer, and the ever-expanding AIDS pandemic are the result of human overpopulation. Urgent action is needed to curb population growth and reduce current population size. The author critiques their position as marred by a casual treatment of evidence and a tendency for hyperbole and doomsday predictions. The environmental and social ills described by the Ehrlichs are indeed real, but their diagnosis is weak. It is more realistic to understand that environmental degradation benefits some while imposing costs upon others. Rapid population growth is a symptom of the unequal distribution of wealth and power. The author discusses the dangers of population reductionism.

Bankers, babies, and Bangladesh. Population patrol.


For more than 20 years, through its leverage over other forms of development aid, the World Bank has played a strategic role in pressuring Third World governments to implement population control programs. While there is a divergence of views within the World Bank, the dominant Bank view of population is neo-Malthusian, with the poor helping to create and perpetuate its own poverty through too high fertility. Reducing birth rates through population control programs will therefore help the poor help themselves. This approach, however, overlooks the true cause of poverty in the Third World: the unequal distribution of resources and power within individual countries and between the developed and underdeveloped worlds. Furthermore, the emphasis upon population control distorts social policy and undermines the delivery of safe, voluntary family planning services. The World Bank-funded government population control program in Bangladesh goes so far as to routinely offer tangible incentives such as several weeks' wages and a new sarong for undergoing sexual sterilization.

Scientific and Technical Advisory Group (STAG). Report of the third meeting, Geneva, 30 March - 1 April 1993.


The Safe Motherhood Initiative is a global collaborative effort to reduce levels of maternal mortality and morbidity by the year 2000. The Maternal Health and Safe Motherhood Program Scientific and Technical Advisory Group (STAG) advises the World Health Organization (WHO) Director-General on the overall strategy, approaches, and priorities which are most appropriate to achieving these objectives. During its March 30 - April 1, 1993 meeting in Geneva, STAG commended the program's approach to addressing safe motherhood in the context of the totality of women's health within a framework of human rights, commended the clarity and comprehensiveness of the program's reporting of workplans and budgets, recommended that the proposed mother and baby packages be made immediately operational as an integrated and complementary part of all national safe motherhood action plan development, recommended flexible and timely responses to country requests for support in maternal and newborn health, recommended the creation of a joint task force for research on safe motherhood, stressed for need for WHO to give high priority to strengthening midwifery skills and competencies and increasing the number of personnel with such skills, commended the proposal to strengthen the technical capability of WHO regional and country offices to collaborate with countries in developing national action plans for safe motherhood and the care of newborns, supported the recommendations of the regional advisors meeting and recommended that they be taken into consideration in further development of the program, urged that the organization reaffirm its commitment to accelerate progress toward safe motherhood at the highest levels, and recommended that the organization enlist high profile personalities to act as goodwill ambassadors for safe motherhood.

The effects of food shortage on human reproduction.


The first dramatic effect of food shortage is upon fertility. The authors attribute the marked decline in fertility in Dresden following the second world war to a sudden reduction in food supplies from the formerly occupied territories following the fall of the German armies. There were also epidemics of low birth weight, miscarriage, and congenital malformations. The epidemic of low birth weight in Leipzig immediately after the war is illustrated, with note made of the existence of similar epidemics in all European cities affected by food shortages. Epidemics of miscarriage contributed to the decline of fertility wherever there was a food shortage. The effects of food shortage upon hormone status, how food shortage increases the risk of neural tube defects and other congenital malformations, and the long-term consequences of poor maternal nutrition are considered.

A conceptual framework for the integration of primary health care in the BSN curriculum.


A conceptual framework is a set of interrelated ideas designed to describe, explain, and predict a phenomenon of interest. That set of ideas forms an image of the behavior of the phenomenon in the real world. The author presents a conceptual framework for integrating primary health care (PHC) in the nursing curriculum at the bachelor degree level (BSN). The concepts in the framework include the demographic, socioeconomic, and health context; PHC development; community development; health for all; and quality of life. This paper explains what a conceptual framework is and its uses, the conceptual framework for the integration of PHC in the BSN curriculum and some data in support of the framework, as well as some illustrations of the link between the concepts in the framework and the year and course level concepts.

The response of aggregate production to fertility-induced changes in population age distribution.


With a particular focus upon long-term supply effects, the authors explored the implications of different population age distributions for the productive capacity of an economy. A multilevel aggregate production process was specified, plausible values assigned to its parameters, and steady-state solutions obtained under a range of alternative fertility assumptions. The theoretical model was calibrated to conform with Canadian data and published estimates of age-sex substitution elasticities. The study found productive capacity to be related to age distribution, although the output effects exceed 8%, regardless of the structure of the economy, only when total fertility rate is less than 1.6 or well above 3.0; within the range of variation, productive capacity and output per capita are lower for both younger and older populations; altering the elasticity of substitution between different tasks has negligible effects upon the sensitivity of the economy to changes in age distribution; altering the elasticity of substitution between different age-sex groups for a given task has a markedly greater effect; introducing either increasing or decreasing returns to scale has only a minor effect upon the sensitivity of the economy to changes in age distribution; and marginal products are quite sensitive to changes in age distribution for both younger and older workers, but far less sensitive for middle-aged workers.

Retrospect and prospect of social scientific research on reproductive health in China -- roundup of the International Seminar of Social Scientific Research on Reproductive Health.


The International Conference on Social Scientific Research on Reproductive Health was held in Shanghai during October 11-14, 1994. It was co-sponsored by the National Committee of Family Planning, UNFPA, and the World Health Organization, and hosted by the Shanghai Institute of Family Planning Research. More than 200 experts in the field from China and abroad attended the conference. Researchers at the conference presented academic papers and discussed various aspects of social scientific research on reproductive health. The conference received more than 200 contributed papers, including 25 read to the entire conference and 83 at various divisions. The papers covered a wide range of topics, including the concept of reproductive health, evaluation of birth control, birth control service, contraception and family planning, men's participation in family planning, abortion, sex behavior, and sexually transmitted diseases, reproduction in special groups, and reproduction health research in other Asian countries. This paper presents a summary of the conference.

Norplant system insertion and removal rates in relation to negative media coverage among a low income, inner-city population.


The Maternity, Infant Care - Family Planning Projects (MIC-FPP), a service division of the Medical and Health Research Association of New York City, Inc., provides comprehensive family planning care to approximately 17,000 low-income postpartum and family planning patients annually in 10 inner-city clinics. In October 1993, the Norplant contraceptive system was added to the MIC-FPP formulary of available contraceptives in their clinics. Prior to that date, many women had requested Norplant, explaining that they had heard about it from satisfied friends both in the US and their countries of origin. 117 women requested and received Norplant between October 1, 1993, and July 31, 1994. Only 45 women, however, requested and received Norplant during the subsequent ten-month period of August 1, 1994, to May 31, 1995. Moreover, during August 1, 1994, to May 31, 1995, 52 of these 162 women requested removal of the system. Negative media coverage in the popular press is most likely responsible for the decline in use of Norplant over the period. Indeed, it seems that the popularity, acceptance, and rejection of a contraceptive method is often more strongly influenced by mass media than by other factors such as age, country of origin, prior pregnancies, pregnancy terminations, or number of children.

Factors influencing condom use among African-American women: implications for risk reduction interventions.


AIDS and HIV infection disproportionately affect minority women in the US. 279 sexually active African-American women were recruited from community health clinics and community-based settings in Jackson for a study of the factors which influence their condom use. Participants were of mean age 30.7 years with 13.8 mean years of education. More than 50% reported an annual family income of less than $10,000. 58% were in an exclusive sexual relationship, 19% were in a fluid relationship, and 20% were not in a relationship. 34.5% of the women never used condoms during vaginal intercourse during the preceding year, 45.1% were inconsistent users, and 20.4% always used condoms during vaginal intercourse. Consistent users were younger and had fewer children than inconsistent users, who were younger and had fewer children than nonusers. Consistent condom users had relatively fewer sex partners during the preceding year, were concerned about preventing AIDS, intended to use condoms in the future, explained their sexual limits to their partners more frequently, reported higher levels of partner support for condom use, and were more likely to discuss condoms with their friends and to believe that their friends used condoms. Although 40% reported condom use at most recent sexual intercourse, condom use was not related to knowledge about AIDS or to perceived personal risk for HIV infection. While the women overall perceived themselves to be at low risk for HIV infection, they had been exposed to significant sex behavior-related risks.

A controlled HIV / AIDS-related health education programme in Managua, Nicaragua.


Findings are reported from the evaluation of the impact of a community-wide intervention to increase HIV/AIDS-related knowledge, change attitudes, and increase safer sex practices in Managua, Nicaragua. Four neighborhoods were involved. Two received the intervention consisting of a health education campaign emphasizing HIV transmission and condom use, while two served as controls. Intervention and control samples were comparable with regard to sex, age, and age at first intercourse, although significantly fewer intervention residents had formal education. 2160 and 2271 randomly selected residents aged 15-45 were interviewed at baseline and follow-up, respectively. Condom use increased from 9% to 16% among intervention women, but only from 9% to 11% in control women. Among men, increases were from 31% to 41% and from 30% to 37%, respectively. Levels of worries about HIV/AIDS decreased in all groups, but perception of individual risk increased only among intervention women. It is concluded that while the household-targeted health education intervention appears to have had some effect, sustained efforts are still needed to improve levels of knowledge and to increase condom use in Managua.

HIV epidemic in India: opportunity to learn from the past.


The World Health Organization estimates that there are now more than 1.75 million HIV-infected adults throughout India and that by the year 2000, India will have more AIDS cases than any other country in the world. The predominant HIV-1 subtype in India is C. HIV-1 subtype C replicates especially well in Langerhans cells, which are found in genital mucosal epithelium and are thought to be the cells through which vaginal infection occurs. Core groups, such as prostitutes, play a critical role in the heterosexual spread of HIV, the dominant mode of transmission in India. The second most important, and preventable, mode of transmission is through infected blood and blood products. 6-20% of HIV-positive samples from STD clinic attenders in Pune and Bombay are HIV-2 reactive either alone or in combination with HIV-1, the first evidence for a substantial spread of HIV-2 outside of Africa. The clinical presentation of AIDS in India is broadly similar to that found in other developing countries, with tuberculosis the most important HIV-associated infection. The epidemic has started to spread out of high-risk groups in the major cities and into the general population and to rural areas. This expansion must be immediately contained in order to avoid what will otherwise be a major catastrophe.

Habitat II: city summit to forge the future of human settlements in an urbanizing world.


Half of the world's population will be living in cities by the year 2000. 40% of urban residents worldwide, however, do not have access to safe drinking water or adequate sanitation and more than 60% of urban residents in some areas live in poverty. Unemployment, homelessness, growing insecurity, rising pollution, and increasing vulnerability to disaster abound in cities. To discuss what can be done to cope with the overwhelming tide of urbanization, UN Member States will convene in Istanbul during June 3-14, 1996, for the second UN Conference on Human Settlements (Habitat II). This paper describes advances since the first UN Conference on Human Settlements held in Vancouver in 1976, the aims of Habitat II, urbanization, the Habitat agenda, new partnerships, best practices, final preparations, goals and principles, commitments and action, and ten policies capable of making a difference with regard to sustainable human settlements.

Health care in Kazakstan.


The fall of the Soviet Empire led to considerable political and economic turmoil in Kazakhstan during its transition to an independent country. Presently, almost all indicators of public health are declining; the health budget fell from 4% of gross national product in 1991 to 1.6% in 1992 and severe pollution, poor nutrition, and increasing consumption of alcohol and cigarettes prevail. Kazakhstan enjoys a high ratio of 400 physicians per 100,000 population, but a shortage of material resources constrains the delivery of quality health care. Civil discord could result unless the interests of different population groups are met. In this context, Kazakhstan is trying to strengthen its health care system. Aid from international, national, and private groups during the past few years has led to improvements in maternal and child health services and in supplies of essential drugs, baby food, vaccines, and medical equipment. Health care facilities in most parts of the country, however, urgently need support and there is a need to develop training programs for administrators, public health professionals, educators, and family planning workers. The control of tuberculosis has received top priority, followed by esophageal cancer.

Unsafe abortion.


Annually, worldwide, there are approximately 150 million births and 50 million abortions. In Africa, more than 90% of abortions are unsafe, the highest rate in the world. One in 200 women in Africa who have abortions die as a result of the procedure. This mortality rate is the highest in the world, accounting for more than 30% of total maternal mortality in some countries. The latest UN report, published in February 1996, found Africa to claim 20% of the world's births and 40% of global maternal mortality. The best way to reduce abortion-related maternal mortality is to prevent unwanted pregnancy. The second-best defense against the mortality of unsafe abortion is the provision of safe abortion services. The appropriate management of the complications of unsafe abortion can also reduce maternal mortality and morbidity.

Health education for safe motherhood.


In many African countries, costly advertising campaigns have warned the public about smoking, sexually transmitted diseases, and AIDS. Similar campaigns should be launched to reduce maternal mortality. Radio and television should deliver messages, focused upon specific target groups, which relate both to family planning and safe motherhood. The aim of such health education should be to improve traditional practices and to help women and communities understand that factors such as early marriage, too many pregnancies, poor nutrition, lack of antenatal care, illegal abortions, use of medicinal herbs, and home delivery contribute to the toll of maternal mortality. All health messages should reflect the realities of village life and promote behavior which requires little or no financial expenditure. Community participation is important. Successful strategies to prevent maternal mortality will highlight the role that women and communities can play. A willingness to use health services, a belief that preventive measures are worthwhile, and community participation in changing behavior are crucial in any program.

Contraceptive social marketing.


Worldwide, with the exception of most countries in sub-Saharan Africa, contraceptive use is rising rapidly. Unmet need is, however, widespread, with demographic, health, and other surveys in more than 45 countries indicating that 20-30% of couples want to contracept, but lack access to services. The UN median variant projection forecasts an ultimate global population of 12 billion toward the end of the 21st century. The average couple will have to reach replacement fertility by around 2035 in order for that total population size to not be exceeded. This will be possible only if the prevalence of contraceptive use in developing countries is raised by 0.5% annually for the next 20 years. Many governments, however, are unable, unwilling, or slow to expand family planning services. Together with the removal of government regulatory and financial constraints upon the family planning involvement of nongovernmental organizations and private doctors, the retail marketing of affordable contraceptives is proving to be the most efficient and cost-effective way forward. The author discusses contraceptive social marketing.

A new population studies programme.


The Wellcome Trust supports research in the biomedical sciences and in the history of medicine. It supports the work of academic staff in universities, medical, and veterinary schools, from the basic sciences related to medicine to the clinical aspects of medicine and veterinary medicine. In January 1995, the Trust held a workshop on population to identify areas of research relevant to human population growth and development. Following the workshop, the trust committed up to US$75 million over five years to a new Wellcome Trust Population Studies Program. The program's advisory committee has defined research priorities and begun to develop a portfolio of funding schemes. The need to address areas of research neglected by other funding bodies is of particular importance. Where appropriate, however, collaboration with other organizations active in the population and reproductive health fields may be considered. The author considers Africa's challenges for the 21st century.

Factors related to condom use with casual partners among urban African-American and Hispanic males.


The authors report their findings from an examination of factors related to condom use with casual female partners among a probability sample of urban African-American and Hispanic males aged 15-24 years from low-income areas of Detroit. 1435 interviews were completed during February-July 1991, resulting in an overall response rate of 85%. 137 of the 590 male respondents who reported having had sexual intercourse with women during the past year reported casual partners. The men with casual partners were similar in age and educational level to other males, although a larger proportion of males with casual partners were not married and were Hispanic. Moreover, men with casual partners had a larger mean number of partners ever and during the past year. Based upon the use of constructs from the Health Belief Model and the Theory of Reasoned Action, the authors stress the importance of promoting a sense of male responsibility regarding condom use, promoting the belief that condoms should be used with all partners, developing skills for condom use and partner communication, and increasing perceived susceptibility to HIV infection when designing intervention programs.

Abortion and the risk of breast cancer. Is there a believable association? [editorial]


Epidemiologic evidence on the association between abortion and the risk of breast cancer is limited and inconsistent. The slight increase in risk observed in some studies may or may not reflect a real association between induced abortion and breast cancer. Recent data presented by Newcomb et al. shed light upon the issue. The most important concern in studies exploring the link between abortion and breast cancer may be the difficulty in obtaining, especially from control subjects, accurate recall of an event that was illegal in the US before 1973, and has garnered increasingly negative public attention since then. Newcomb et al. report an overall 23% increase in risk reflecting a 35% increase among women reporting an induced abortion before 1973, but only a 12% increase among those reporting an induced abortion after that date. This difference in risks is not statistically significant. The authors note that Newcomb et al.'s use of telephone interviews may have minimized the level of underreporting in their study. Choice of the referent group, the possibility of differences in effects across age groups, and the inability of other investigations to confirm the findings of any one previous study which identified a subgroup of women who may have a particularly high risk are other methodological problems in such studies. Despite the limited and inconclusive evidence on the relationship between abortion and the risk of breast cancer, policymakers irresponsibly discuss and extrapolate from the scientific findings. Bills addressing the possibility of a link between abortion and breast cancer have been introduced in approximately ten states. Legislative measures, however, are premature.

Third-generation pills may elevate risk of venous thromboembolism, slightly lower heart attack risk.


The preliminary report of a multinational case-control study indicates that oral contraceptive users who take pills containing third-generation progestins gestodene and desogestrel may have a greater risk than women using older pill formulations of developing venous thromboembolism. This study is part of one of the projects whose results led the British Committee on Safety of Medicines to issue a warning in late 1995 about the possible link between pill use and venous thromboembolism. The analyses focused upon risks associated with the current use of various types of combined oral contraceptives among women aged 16-44 years. The initial results of a related study suggest that users of third-generation pills may also have a slightly reduced risk of heart attack, but that relationship is statistically insignificant.

Prenatal and delivery care and childhood immunization in Guatemala: do family and community matter?


The authors studied the extent to which family and community characteristics affect the use of formal, modern health services in Guatemala; specifically, family choices about pregnancy-related care and the use of childhood immunization. Data for the analysis come from the National Survey of Maternal and Child Health conducted in Guatemala in 1987, based upon a nationally-representative sample of 5160 women aged 15-44 interviewed between September and December 1987. 4627 births occurred during the five years prior to the interview; 4230 of which were alive at the time of the interview. Results yielded via use of the multilevel logistic model indicate that the use of formal health services differs substantially by ethnicity, by social and economic factors, and by the availability of health services. It is also shown that family and community membership are very important determinants of the use of health care, even in the presence of controls for a large number of observed characteristics of individuals, families, and communities.

The effect of expansions in Medicaid income eligibility on abortion.


The issue of abortion has provoked a sustained and volatile public debate in the US. One federal government social policy which may affect abortion is the public funding of prenatal and pediatric health care for low-income women. Between 1987 and 1991, states expanded Medicaid income eligibility in response to federal initiatives, making many women eligible for free health care associated with a birth. As a result, the proportion of all births financed by Medicaid increased from 14.5% in 1985 to 32% by 1991. Together with these expansions in Medicaid eligibility, the fertility rate in the US rose by 6.5% over the period 1986-91, while the abortion rate fell from 28.0 per 1000 women aged 15-44 to 25.9 by 1992. These data suggest that recent changes in Medicaid eligibility may have had a significant impact upon pregnancy outcomes. The authors estimated the effect of expansions in Medicaid income eligibility upon pregnancy outcomes using individual-level data from South Carolina, Tennessee, and Virginia. They found that for unmarried, non-Black women with less than a high school degree, the expansions of income eligibility lowered the probability of abortion by 2-5%. Most of the impact of the Medicaid expansions upon abortion occurred during the first round of expansions from approximately 45% of the federal poverty level to 100%. For Black unmarried women with less than a high school degree, the expansions in Medicaid income eligibility therefore had generally no effect upon abortion.

Longitudinal analysis of the effects of infant-feeding practices on postpartum amenorrhea.


Extensive research has documented that breast feeding has significant effects upon fecundity, but researchers still do not fully understand how spacing is affected by a range of behaviors involved in infant feeding. The authors used data from the Cebu Longitudinal Health and Nutrition Survey (CLHNS) in their study of the effect of various components of infant feeding patterns upon the return of menses postpartum. The CLHNS is a longitudinal survey of a 12-month birth cohort conducted on the island of Cebu in the Visayas region of the Philippines. They found that factors such as active suckling, the use of two breasts versus one, breast-feeding on demand instead of upon a fixed schedule, and the feeding of other milks and of non-nutritive or low-caloric other liquids can be important under certain circumstances. Discrete-time logistic hazards modeling is used to estimate the weekly probability of return to menses.

Case studies in emergency contraception from six countries.


Largely available in the United Kingdom, the Netherlands, Malaysia, China, Mexico, and Nigeria since the late 1960s and early 1970s, the level of availability and use of postcoital, or emergency, contraception vary widely depending upon the prevailing relevant regulations and policies, providers' and women's understanding of and attitudes toward it, and cost. Now, in the Netherlands and the UK, postcoital contraception is an accepted and important part of family planning practice, well-known among both physicians and women at large. In Malaysia, where abortion is strictly regulated, emergency contraceptive methods are marketed legally, but family planning organizations avoid offering them. In China, emergency contraception has long been offered by the government family planning service, but they have not been separated into methods advocated for emergency use only and those recommended for ongoing use. In Mexico and Nigeria, awareness of emergency contraception remains low among both health care providers and the public. Information on these countries' experiences with emergency contraception is summarized. The authors then draw upon the experiences to suggest lessons for other countries seeking to introduce or expand use of the method.

Emergency contraception: the International Planned Parenthood Federation's experience.


Established in 1952, the International Planned Parenthood Federation (IPPF) has promoted and offered guidance on emergency contraception for more than 10 years. In 1994, the IPPF surveyed its affiliates on their practices with regard to the provision of emergency contraception. On the basis of these results, as well as review of the available research literature, IPPF developed a revised, broadened policy statement on emergency contraception. The IPPF experience with emergency contraception is as follows: despite the IPPF leadership's strong support for emergency contraception, many affiliates do not offer it; at least one affiliate in every region except the Arab world offers emergency contraception; the lack of an approved product designed and marketed specifically for emergency contraception is an obstacle to at least some affiliates which are willing to offer the service; the lack of a perceived need reported by several affiliates may reflect ignorance about the therapy; the survey data indicate that women may need emergency contraception at any age during their reproductive years, for a variety of reasons; staff at all affiliates should be trained to provide emergency contraception and be familiar with the protocols for its use, whether or not the family planning association can currently offer emergency contraception; and emergency contraception needs to positioned as an option distinct from abortion.

Legal, ethical and regulatory aspects of introducing emergency contraception in the Philippines.


Emergency contraception is the use of drugs or devices to prevent pregnancy within a few days after unprotected coitus. A variety of legal and political obstacles may, however, impede the introduction of emergency contraception into developing countries. Many of these obstacles are rooted in a lack of knowledge about the mode of action of emergency methods, the indications for their use, and their availability. This paper describes the influences of regulatory laws, religion, politics, and ethics on the provision of emergency contraception in the Philippines, which has no law specifically governing the use of emergency contraception. Emergency methods are little known in the Philippines, but several factors suggest that they may be well suited to the Philippines. The Philippine legal context and barriers to emergency methods are described.

Introducing emergency contraceptive services: communications strategies and the role of women's health advocates.


Emergency contraception is the use of drugs or devices to prevent pregnancy within a few days after unprotected coitus. The IUD and a variety of hormonal methods can be used for emergency contraception. Although first used in the 1960s, emergency contraception remains a largely unknown method. This paper suggests ways in which emergency contraception can be responsibly and safely introduced into established health services and discusses the role of women's health advocacy groups and communications efforts in the process. The authors stress that no single path to the introduction of emergency contraception will prove acceptable or relevant in all settings. Numerous issues and questions should nonetheless be addressed by all countries and programs desiring to improve women's access to emergency contraception. Key issues, introduction options, communication strategies, and building consensus are discussed.

Recommendations of the Abidjan workshop.


In June 1995, the Joint United Nations Economic Commission for Africa/OAU/ADB Secretariat, in cooperation with the UN Population Fund (UNFPA) and the International Planned Parenthood Federation (IPPF), organized a workshop on the implementation of the Dakar/Ngor Declaration and the Cairo Program of Action. Major recommendations from the workshop are summarized. Recommendations were addressed to African governments, African nongovernmental organizations (NGO), and regional and international institutions. Salient recommendations are: African governments should recommence long-term economic and social development planning, they should take steps to ensure the implementation and evaluation of national population programs, and countries should set realistic targets based upon the careful analysis of their demographic and socioeconomic conditions. NGOs should increase their efforts to favor groups with limited access to population programs, develop gender-sensitive approaches, and step up campaigns to remove legal barriers on adolescents' access to reproductive health services.

The quantitative goals of the Dakar / Ngor Declaration and the Cairo Programme of Action.


The adoption of quantitative goals with an implementation schedule by the Dakar and Cairo conferences is considered by many to be a remarkable improvement upon previous population conferences. The scope of the goals is, however, more important than their quantitative character. A feasibility assessment of the goals based upon the UN Demographic Projections was presented at the Abidjan Workshop. It seems that the Dakar/Ngor Declaration and the Cairo Program of Action objectives on demographic growth, life expectancy at birth, and child mortality may not be achieved, at least within the set time limit. In fact, population trends, as projected by the UN indicate that the objective's implementation rate in Africa may be slower than expected by the countries which met in Dakar and Cairo. The quantitative goals of the Dakar/Ngor Declaration and the Cairo Program of Action are discussed.

The Fourth World Conference on Women.


The Fourth World Conference on Women held in Beijing during September 4-15, 1995, was a major success. The platform for action adopted by consensus at the conference is comprised of the mission statement, a global framework, critical areas of concern, strategic objectives and actions, and institutional and financial arrangements. The conference was an extension of other large international conferences organized under UN initiative over the past 15 years. The Beijing platform of action aims to remove all obstacles to women's active participation in all spheres of public and private life through a full and equal share in economic, social, cultural, and political decision-making. The following concerns were defined by the conference: eradicating poverty, increasing school enrollment and eliminating gender inequalities in access to education, improving access to health care and eliminating gender inequalities in access to services, eliminating violence against women, mitigating the consequences of armed conflicts against women, securing equal access of men and women to economic resources and employment, providing equal participation of men and women in power structures and decision making, enhancing national mechanisms to promote the advancement of women, protecting the rights of girls and women, eradicating stereotypes about women, participating in the management of natural resources and environmental protection, and improving the status of girls.

Maternal health and safe motherhood: findings from concluded research studies.


Women in developing countries continue to be at high risk of death or disability due to complications of pregnancy, delivery, or the postpartum period. The extent of such morbidity and mortality will be reduced only if effective interventions which are feasible in conditions where resources are limited can be developed and applied. Research can play an important role in identifying such interventions. The relevant national health research must be a high priority for every nation where maternal mortality and morbidity continue to be major public health problems. The World Health Organization (WHO) has supported studies on the issue since 1984. WHO is the executing agency of the Safe Motherhood Operational Research Program created to establish, document, and disseminate the knowledge needed to reduce maternal mortality and morbidity. 84 studies received funding under the program. Although not all of the studies have been completed, the findings of several which have been are published in national and international journals. This paper introduces a special issue of World Health Statistics Quarterly which brings together some of the unpublished research results.

AIDS deaths may exceed 100,000 per year in Uganda over the next 25 years.


The World Bank began a study in 1990 to assess the demographic and economic impact of AIDS in Uganda. It determined that as of 1993, an estimated 15% of Uganda's adult population, 1.3 million people, was infected with HIV. The annual number of AIDS-related deaths has been climbing steadily and is not likely to peak until early in the next century. AIDS deaths may exceed 100,000 per year in Uganda over the next 25 years. The epidemic has also increased child mortality rates and decreased life expectancy at birth. These findings are based upon data from a variety of sources, including a 1987-88 serological survey, the 1991 census, the national AIDS control program, and numerous small-scale studies of HIV infection. The researchers based fertility and mortality estimates upon data from the 1988-89 Demographic and Health Survey. Current HIV and AIDS prevalence, projected prevalence, demographic implications, and recommendations are presented.

The male role in family planning: what do we know?


Family planning policies and programs must include males, especially in the current context of a global AIDS epidemic. The evidence reviewed in this study indicate that many males may be receptive to initiatives designed to prevent unintended pregnancies and the transmission of HIV and other sexually transmitted diseases. Contrary to the assumptions of some about the low male use of and negative attitudes toward contraception, many males are favorably inclined to use contraception. Men play key roles in contraception because they use condoms or take other preventive measures, while also influencing their partners' use of contraceptive methods. The evidence suggests that working with males, at least young males, can lead to more effective contraceptive behavior. This paper examines the patterns and trends in the use of contraception by males in the US; the factors which appear to influence males to use contraception; studies of partner dynamics, exploring the influence of male and female partners on each other's contraceptive behavior; and the current status of males' use of family planning services, and how family planning policy and services may be more responsive to the reproductive needs of American males.

A national health plan for South Africa. Draft.


Apartheid policies in South Africa have created major disparities between racial groups in terms of socioeconomic status, employment, education, housing, and health. The health care system is fragmented, with generally inequitable access to health care. Health care delivery in South Africa was uninformed by, isolated from, or simply opposed to international norms and standards of health care. The net result has been the development of institutions more concerned with political control than service. The apartheid health system has also been biased towards domination by doctors, by men, by curative care, and by the private sector. Post-apartheid South Africa now needs to design a comprehensive program to redress social injustices, to eradicate poverty, reduce waste, increase efficiency, and to promote greater control by communities and individuals over all aspects of their lives. This second draft of a national health plan for South Africa presents the guiding principles for the vision of health in South Africa, an analysis of the existing situation, health policies, the national health system, the management support system, and health priorities.

Diphtheria control in the Republic of Moldova. Follow up visit August 30 - September 9, 1995. Follow up visit October 9-26, 1995. Additional follow up via Internet.


Across the Republic of Moldova in 1994, there were 376 cases of diphtheria, with 19 case fatalities reported. Diphtheria is therefore a major public health problem in the republic, with a high probability of a major increase of epidemic diphtheria with the return of cold weather. An initial supply of anti-diphtheria vaccines arrived in Moldova during July-October 1995, but the shortage of syringes prevented the early immunization of the adult and adolescent population. Moldova's government has declared a State of Epidemic enabling compulsory immunization and the involvement of the Extraordinary Committee on Epidemics at the ministerial and local government levels. Except for the provision of syringes for immunization and antibiotics for case management and primary contact prophylaxis, diphtheria control campaign preparations are well advanced. The author presents his findings on cases, supplies, equipment, national policy and plans for disease control, district level activity plans, multisectoral cooperation, donor coordination, diphtheria control activities during 1996-97, and recommendations.

Nepal. Final report: village based-IEC projects training and orientation videos. Fixed price contract between the Johns Hopkins University Population Communication Services and SJE SAARC / Reel Images, November 13, 1992 - February 28, 1994, AS-NEP-06.


Since 1991, the Family Planning/Maternal and Child Health Division of Nepal's Ministry of Health has sought to expand contraceptive services and increase the level of adoption of family planning and family health practices at the village level. To help the division realize these objectives, the Johns Hopkins University Population Communication Services (JHU/PCS) launched the Village-Based Information, Education, and Communication Action Program (VIP) in the villages of Lele and Lamatur in Lalitpur District. The goal was to develop an affordable and replicable community-based strategy for increasing the acceptance of modern birth spacing methods focusing upon training local health workers and motivating volunteers among eligible couples. A key component of the VIP was the development and production of two videos for use in training field workers and community members. JHU/PCS contracted with SJE SAARC/Reel Images, a local production company in Kathmandu. The total project cost was $10,352. This final report describes key activities and results, lessons learned, problems, personnel, a financial report, and future prospects.

Social and cultural issues in human resources development for maternal health and safe motherhood. Report of a working group meeting, Stockholm 30-31 May 1991.


A small working group of the Task Force on Human Resources Development for Maternal Health and Safe Motherhood met in Stockholm during May 30-31, 1991, with the goal of examining training needs for safe motherhood in the context of social and cultural issues which may sometimes conflict with the overall goal of reducing maternal mortality by half by the year 2000. It was recommended to the program of Maternal Health and Safe Motherhood that someone with ethnographic skills be included on the needs assessment teams in each country selected for accelerated action, those skills should be developed in a number of individuals through an ethnographic skills workshop, guidelines on ethnographic considerations should be developed for use by countries in planning national maternal health programs, a library of scenarios from around the world should be compiled as a source book of ideas for overcoming social and cultural obstacles between the official biomedical system and the community which it serves, outlines for new chapters should be written for the TBA Trainers' Kit to facilitate its adaptation to the social and cultural context of the community in which it will be used, and models for evaluating training in psychosocial skills and sensitivity to psychosocial issues should be developed.

Resource allocation, use, and management.


Ministries of health must determine what should be the nature of their relationship with the private sector, what they can do internally to improve their allocation of resources and the defense of their budgets, and what is the policy and legal environment and how that environment affects operations. Although they typically receive only a small portion of national budgets, ministries of health can take many steps to help ensure that their limited resources have the largest possible programmatic effect. The authors consider resource allocation, use, and management in sections on human resources, financial resources, material resources, information, institutional development, the efficient use of resources, cost containment, strategic and financial planning, logistics, and management skills. Future directions are also considered.

Health care costing.


Costing tools are used in economic analyses to guide resource allocation decisions and choices among technologies, as well as in the management of service delivery. Examples include the cost analysis of services, facilities, alternative delivery mechanisms, cost-benefit, and cost-effectiveness analysis. Costing tools play an integral role in policy evaluation and planning, helping to determine whether a given approach is feasible or appropriate within resource constraints. This paper discusses issues surrounding the technique of costing, as it applies to health policy planning and analysis, clarifying some of the major issues in costing based upon the Health Financing and Sustainability (HFS) Project's first year. The plans for assignments to use costing in analytical work and attempts to forecast which issues may arise are also described.

Public-private collaboration.


The authors discuss the dimensions of public-private collaboration in health and identify key issues of concern in developing countries, based upon experiences gained through the Health Financing and Sustainability (HFS) Project. HFS activities in public-private collaboration in Belize, Ecuador, Haiti, the Dominican Republic, Peru, Kenya, the Central African Republic, and Pakistan are described, as well as future project directions. HFS experience and research over the past decade suggest that additional information is needed about the characteristics and use of private sector health services in developing countries. Moreover, the private sector could provide more services, governments are unaware of the potential for private sector involvement, the private sector is inadequately regulated by the government, and the private sector may not provide health services efficiently and effectively.

Cost recovery.


The authors discuss the following issues with regard to cost recovery in the delivery of health care: the relation between ability and willingness to pay; how quality, access, and time interact with price to affect demand; the association between quality and demand; if increasing fees results in improved quality; whether additional revenues can be translated into improved quality of care; whether exemption policies foster equity and whether they are politically and administratively feasible; how much cost recovery is possible; how can price structures enhance efficient and appropriate use; what is the political feasibility of different policy options; whether the management environment can effectively handle a user fee system; and what incentives can be instituted to encourage fee collection. Health Financing and Sustainability (HFS) Project activities in cost recovery and future directions are presented.

Social financing of the demand for health services.


Social financing refers to financial risk-sharing arrangements which cover the health needs of a defined membership, usually the contributors. The term refers to the possibility of an illness-related financial loss causing deviation from a desired state or outcome. Risks can be avoided or reduced through diet and behavior. From an insurance perspective, risk can be shared with others and/or transferred to a third party. This paper reviews the major issues regarding social financing in developing countries. These issues were identified in the general literature and by Health Financing and Sustainability (HFS) Project personnel during field visits. The paper also describes HFS Project activities and requests for technical assistance received from the field. The focus and direction of HFS Project assistance in social financing are specified.

Lessons without borders: the sharing of lactation management education approaches between developed and developing countries.


Initially launched in 1977 in San Diego as an independent, nonprofit organization, Wellstart has offers a variety of educational programs to more than 10,000 multidisciplinary health professionals locally, nationally, and internationally in the areas of breastfeeding, weaning, and maternal nutrition. Wellstart now includes a domestic component and two international programs, the Lactation Management Education (LME) Program and the Expanded Promotion of Breastfeeding Program. The LME Program approach was originally developed in the US, refined and expanded overseas through work funded by the US Agency for International Development, and has now been readapted into programs serving US populations. This case study describes the cross pollination of lessons learned from Wellstart International's educational programs in developing countries, Europe, and the US.

Sterilization of minors.


The issue of children's rights is a burgeoning area of law which has recently received increased national attention. Parents have a right to determine what is best for their children, but children also have rights as individual human beings. The dilemma in deciding whose rights are most important is particularly difficult when determining whether a parent has the right to have a child sterilized. The issue most often arises when a mentally or physically disabled child enters puberty and the child's parents or guardians must deal with the child's growing sexual awareness. Some parents and guardians believe that it is best for the child to be sterilized. The child, however, also has the fundamental right to procreate. A physician asked to sterilize a child must face the legal dilemma of whether the written informed consent of a parent or legal guardian is sufficient to perform the sterilization or whether a court order is required. The requirements for a guardian and requirements for a parent are discussed with regard to Minnesotan law.

South Africa and AIDS: seven years wasted.


When HIV was first detected in South Africa, its seroprevalence in the general population was extremely low. Efforts could have been made to head off the HIV/AIDS epidemic in the country. This opportunity, however, was squandered and there is now nothing to distinguish South Africa epidemiologically from the rest of sub-Saharan Africa. There are credible predictions that 18-24% of the adult population will be infected with HIV by the year 2005, that the cumulative death toll will be 2.3 million, and that there will be about 1.5 million AIDS orphans. In South Africa, there have been two almost completely separate epidemics, one in the male, mainly White, homosexual community, and one in the heterosexual, predominantly Black, population. It was only from 1988 that the epidemic expanded in the Black heterosexual population. The first national survey of women attending antenatal clinics, conducted during October/November 1990, found an overall HIV seroprevalence of 0.76%; that doubled 12 months later and an estimated more than 200,000 adults were infected by the end of 1991. Regionally, seroprevalence was highest in Natal/Kwazulu at 2.87%, followed by Orange Free State at 1.49% and Transvaal at 1.11%. Blacks were worst infected at 1.84%, with much lower percentages in other racial groups. Women are infected more often and earlier in life than men. The third annual national survey, conducted during October/November 1992, will probably show a further doubling in some antenatal clinics of Zululand and Soweto. The author notes the enormous rift which exists between White public servants and the majority Black population in need of AIDS education and information. Moreover, many White, heterosexual doctors either overtly refuse or covertly avoid treating people with HIV.

World refugee total soars as over 19 million people flee violence, but host countries are pulling in the welcome mats. News release.


Approximately 47 million people are dispossessed in the world. UN statistics indicate that the number of people crossing international borders annually to escape violence or persecution has increased 19-fold over the past two decades and continues to increase. This movement of population is not limited to a few highly destabilized areas, but is a pervasive global problem affecting almost every country. Indeed, 21 countries have become willing or unwilling hosts to refugee populations of 250,000 or more each, with some providing asylum for a million or more. This UN count of "official" refugees, however, far understates the problem; more than 25 million people have been driven from their homes by violence or the fear of violence, but remain in their own countries. The UN does not classify such internally displaced refugees as refugees, although many could eventually seek asylum in other countries. These new, large refugee flows are increasingly unwelcome.

Participatory advocacy: a counter to media imperialism.


Western media have a history of defining news worldwide, presenting news from a Western perspective which distorts and denies the truth as perceived from developing countries. Western news coverage of developing countries seems to emphasize countries' fragility, instability, and corruption, leading people to believe that the economic problems of developing countries are due to internal failures. That view is then transferred back to indigenous peoples and communities through major Western news agencies and mass media. Participatory communication is based upon the notion that people have the right to decide how they want themselves and their situations to be portrayed, to decide what information is useful to them and their community, and to be integral players in the communication process. With regard to media imperialism, the author discusses implications for advocacy activities, participatory communication approaches, participatory advocacy, participatory advocacy in South Asia, girl child drama in Nepal, drug abuse television drama in Nepal, and the advocacy challenge.

Primary health care in Melanesia: problems and potentials.


Despite political and financial constraints, the independent Melanesian island nations of the South Pacific have managed to successfully deliver clinical health care to their people. They have not, however, achieved health for all as outlined at the 1978 Alma Ata Primary Health Care Conference. The reasons for the failure of the primary health care approach in Melanesia can best be understood be a careful analysis of the successes and failures of its individual components and how they relate to the precepts outlined in the Declaration of Alma Ata. The author describes the concept of illness in the village, community participation versus government responsibility, the causes of failure, successes, and development of a comprehensive approach. It is concluded that only through improving the accountability of health workers and introducing the concept of responsibility for one's health, including individual, family, and community well-being, can progress be made toward a self-sustaining comprehensive primary health care approach which promotes national development.

Towards better health in Africa: Africans take charge.


The authors argue that African health programs, and health in Africa, are excessively and unnecessarily dependent upon outside forces and partners; reducing that dependency is essential to sustainable health improvements in Africa; and Africans have the potential and are, in some circumstances, assuming increasing leadership on health issues, internationally and domestically. That Africans are assuming increasing leadership is beginning to be felt through the work of the Better Health in Africa Expert Panel at the World Bank, through the new leadership of the World Health Organization African Regional Office, and potentially through the health component of the new Special Initiative on Africa of the UN Secretary-General. It is clear that Africans can and are increasingly beginning to take charge of health in Africa.

Health finance policy simulation model version 1.0: a user's manual.


This manual introduces a computer program designed to provide a quantitative approach to health finance policy analysis. The program simulates policy interventions and predicts the effect a given proposed policy change will have upon different areas of the health sector. The viewer is presented with menus which provide the projections of per capita expenditure and services as well as the financial conditions of both the public and private sector. An additional set of menus allows data to be input on the current health care situation and the proposed policy changes for the health care sector. The model simultaneously considers several relationships and influences on the health sector, useful for generating informed policy dialogue. Following an introduction, the manual explains model operations, policy simulations, interpretation and presentation, and model setup. A technical reference section is included.

Health services for low-income families: extending coverage through prepayment plans in the Dominican Republic.


Igualas Medicas are private firms which combine the financing and service delivery aspects of health care. They have existed for more than 20 years in the Dominican Republic, with most being physician owned and operated. The author explores the potential for extending health services to low-income families residing in Santo Domingo through Igualas. Analyzing eight of the largest of a total of 20 Igualas operating in Santo Domingo and the operations of two lending associations which provide loans to informal sector microenterprises, he considers the financial and administrative arrangements by which the Igualas can be matched with a large, yet specific segment of the informal work force, microenterprise entrepreneurs, and employees. These groups currently receive inadequate health care at state health facilities or pay out-of-pocket for private care. The report concludes that the US Agency for International Development has an opportunity to facilitate a match between lending associations and the Igualas Medicas to provide health coverage to a potential population of 100,000 people in Santo Domingo. It is recommended that USAID facilitate the creation of the lending association-based risk pool and help the Igualas set up the provider network and design the appropriate benefit package. Three extension models are suggested, with a pilot project proposed whereby at least two of the models are tested on a demonstration basis. The question of adverse selection and risk-sharing arrangements between the Igualas and the lending associations will need further study before coverage is extended. It is suggested that the lending associations assume the risks of premium collection while the Igualas assume the risks of service delivery to members.

Trip report and technical notes: Egypt Cost Recovery Programs in Health Project component one (cost recovery hospitals): project design and implementation -- some issues. December 7-21, 1990.


The author traveled to Egypt as a Health Financing and Sustainability consultant to continue work with the Cost Recovery Programs for Health Project in the area of economic analysis. Several questions regarding project design and implementation were raised, and the consultant drafted a paper addressing a number of implementation issues. Some issues addressed include the public finance situation in Egypt, objectives for pricing policies, government subsidies and organizational formats for cost recovery facilities, and getting cost recovery started. The author also met with staff from Embaba Hospital, USAID/Cairo and the directorate, with plans made for the hospital staff to gather information and draft short-term workplans.

Cost recovery in public hospitals in Belize.


Approximately 2% of recurrent costs for health services in Belize are recovered through fee revenues. This percentage is lower than might be expected given that the government has legally mandated the implementation of user fees. The implementation of user fees has been of low priority for the Ministry of Health (MOH). In the current context of increasing budget deficits and pressure from government financial authorities to improve efficiency, however, MOH officials are exploring the full potential of cost recovery through user fees. The following factors account for the poor performance of current user fee policy: the fee schedule has not been changed since 1967, means testing is ineffective as a tool to target subsidies to the poor, and the billing and collection systems are dysfunctional. This paper provides a tool for choosing the level of cost recovery. Simplified adaptations of the current fee schedule are used to develop partial and full cost-recovery revenue simulations. The authors conclude that enforcing the current fee schedule would recover 10% of costs; doubling current charges and adding nominal fees for outpatient services would recover 25% in Belize City Hospital and 40% in the districts. Full cost recovery can only be achieved through the design and implementation of a comprehensive health insurance system. If the government of Belize intends to vigorously pursue cost recovery, it must provide incentives for facility staff to collect fees. Further, it is recommended that the same rates be charged to all patients, public and private; without denying services to indigent patients. Prospects for substantial cost recovery in the health sector are good, based upon relatively low fees at many places in the system. Demonstration programs should, however, be run for one or two years given the lack of experience with cost recovery.

Assessment of health systems, financing and policy options in Arequipa region, Peru. Revised ed.


This paper presents the results of an assessment of health systems and health financing in the Arequipa Region of Peru. Detailed quantitative and qualitative information is presented upon the structure, use, operating costs, and financing systems of public, quasi-public, and private health services in the region. The results of a household survey conducted to obtain information on health service utilization patterns are also presented. This information provides a baseline for the development of sound health resource allocation and financing policy, generating recommendations for ways in which the regional government can take a more active leadership role in health policy formulation, more effectively generate revenue within ministry of health facilities, and more appropriately allocate scarce public health resources to the region's population.

The Ecuadorian Social Security Institute (IESS): economic evaluation and options for reform. Revised ed.


The Ecuadorian Institute of Social Insurance (IESS) administers numerous programs including pensions, maternal health care, occupational risks, severance pay, and funeral aid. Together, however, pensions and maternal health care absorb approximately 90% of IESS benefit expenditures. This paper analyzes the economic-financial situation of the IESS, discussing its organization, population coverage, financing, expenditures, and financial equilibrium. All IESS programs are covered in the report, but central attention is given to pensions and maternal health care. The final section of the report provides policy guidelines for the future reform of the social security system, as well as a research agenda for the future. The author recommends reform of the IESS through the creation of a mixed system combining a reformed IESS, which would provide basic benefits, with private sector participation, which would provide supplementary benefits.

Operating costs and marketing analysis for the Bon Repos Hospital.


The Health Financing and Sustainability (HFS) Project conducted a cost and marketing analysis for the Bon Repos Hospital (HBR) in Haiti. The assessment team concluded that the HBR can be a viable health care facility capable of recovering a significant portion of its operating costs. The average per patient operating costs for running HBR will range from Haitian Dollars (HD) 8.68 for outpatient services to HD 387.24 for surgery patients. The Health 2000 program can benefit HBR, with the average per person monthly premium recommended to be set at approximately HD 3.25. If compensation is competitive, doctors will be willing to use HBR, despite the hospital's distance from the urban center. Furthermore, poor patients, in the absence of HBR services, pay more than current Centers for Development and Health (CDS) prices demand that they pay. Increasing CDS prices will therefore allow HBR to recover a greater percentage of its operating costs without adversely affecting demand. The demand for hospital beds, among those able to pay a price above cost, is greater than the supply of private beds. It is noted that the September 30, 1991, military coup d'etat in Haiti has led to the HBR's closure. All socioeconomic and financial conditions upon which the analysis is based have changed. The data and specific recommendations presented in the text are therefore no longer valid and should be reformulated if and when HBR reopens.

Youth at risk: meeting the sexual health needs of adolescents. Questions and answers.


The high incidences of unwanted pregnancy and HIV infection in some societies demand that people become more open and realistic about adolescent sexuality. Many young people around the world become sexually active at an early age, but most do not use any contraception. Addressing the sexual health needs of youth requires a comprehensive approach, beginning with universal and relevant sexuality education. Such education should ideally be introduced before young people become sexually active. The school systems in most countries, however, have largely failed to meet the sexual health education needs of adolescents and children. Contrary to popular opinion, sexuality education does not seem to encourage earlier sexual activity. It instead teaches young people the skills they need to practice safe and responsible sexual behavior, and may encourage young teenagers to delay first intercourse until they are older. To be effective, sexuality education must be directly linked to contraceptive counseling and services. The scope of current efforts to reach youths needs to be dramatically expanded. Efforts are also needed to address the social context of adolescent sexuality and childbearing.

MotherCare: lessons learned 1989-1993. Summary final report.


In 1987, the Safe Motherhood Initiative was launched by representatives from a number of international organizations in collaboration with many from developing countries concerned with the high levels of maternal mortality. Responding to the need to address the issue, the US Agency for International Development launched the five-year Maternal and Neonatal Health and Nutrition Project in 1989, a component of which became MotherCare. The goals of this subproject include the reduction of maternal and neonatal mortality and related morbidities, and the promotion of the health of women and newborns. This paper reports lessons learned over the project period 1989-93. After five years of program activity, the following are recommended as fundamental to successful maternal and neonatal health and nutrition programming: put maternal and neonatal health and nutrition at the top of the agenda, know and cater to the woman's and her community's needs and constraints, know and address the service providers' needs and constraints, move services closer to the woman, move women closer to services, and provide a comprehensive package of services to women and their newborns.

MotherCare, 1989-1993: country project descriptions.


In 1987, the Safe Motherhood Initiative was launched by representatives from a number of international organizations in collaboration with many from developing countries concerned with the high levels of maternal mortality. Responding to the need to address the issue, the US Agency for International Development launched the five-year Maternal and Neonatal Health and Nutrition Project in 1989, a component of which became MotherCare. The goals of this subproject include the reduction of maternal and neonatal mortality and related morbidities, and the promotion of the health of women and newborns. This report is a companion to MotherCare's summary final report, and provides a brief overview of twelve projects sponsored by MotherCare during 1990-93. Demonstration projects and applied research studies are outlined, with inputs and results through September 1993. Projects and studies took place in Indonesia, Uganda, Nigeria, Bolivia, Guatemala, Bangladesh, the Philippines, Kenya, Ecuador, and Indonesia.

Zambia's AIDS orphans will change the structure of society.


In Zambia, 10-15% of the rural population and 25-30% of the urban population is infected with HIV. An estimated 500 new people in the country are infected daily with HIV. HIV infection in Zambia is therefore widely disseminated and spreading rapidly. Infection rates are expected to peak in urban areas in 1998 at 28% and in rural areas in 2004 at 22%. AIDS mortality rates continue to increase. As the toll of AIDS mortality mounts, the number of orphans will increase. Indeed, the number of orphans will continue to increase well into the next decade, stabilizing approximately six years after national HIV prevalence rates peak. The number and concentration of orphans are highest in urban and periurban areas. A 1993 national survey determined that 42% of urban households cared for an orphan, compared to 33% in rural areas. In 1995, the national AIDS program estimated that there are 200,000-250,000 orphans and that the total should increase to 550,000-600,000 by the year 2000. 53.9% and 18% of orphans in Zambia are paternal and maternal orphans, respectively. The number of children who have lost both parents will continue to increase. The author discusses the differing living standards of orphans and coping.

AIDS and the orphan crisis in Zimbabwe.


Before AIDS, the number of orphans in most developing countries was decreasing due to improvements in life expectancy. Orphans were likely to be older than age five years and have lost a father. It was uncommon for a child to have lost both parents. This scenario no longer prevails. As growing numbers of young adults die, sibling- and grandmother-headed households are becoming increasingly common. A 1991 survey in Zimbabwe found that less than 0.5% of orphans were being cared for in orphanages. Once a grandmother dies who may have taken in her orphaned grandchildren, many older siblings opt to raise the family. Many children prefer to stay together as a family unit despite the inevitable hardship and obstacles they will encounter to survival. These families are weak, but surviving. The AIDS pandemic will likely cause a ten-fold rise in the number of maternal orphans. In Zimbabwe alone, it is possible that 40% of children may have lost their parents within a decade.

A legacy of humanistic family planning. Chojiro Kunii.


The late Chojiro Kunii was Chairman of JOICFP. After serving in the Second World War, Kunii mounted an unsuccessful effort to create and sustain production cooperatives. His efforts then turned to controlling the widespread parasitic infections throughout the Japanese population, through which he made a tidy profit. That profit funded the development of the Hoken Kaikan group of preventive health organizations. Concerned about family planning and maternal and child health, Kunii established the Japan Family Planning Association in 1954 and the Tokyo Health Service Association in 1967. He emphasized building family planning programs around the individual, something he coined "humanistic family planning." Kunii's ideas were translated into the practical approach of the Integrated Project and applied in developing countries in Asia, Africa, and Latin America.

Inayatullah takes Vision 2000 forward. IPPF.


Dr. Attiya Inayatullah is the newly appointed president of the International Planned Parenthood Federation (IPPF). She expresses her hopes that Japan people through its national and local government institutions and the Diet will continue to support IPPF objectives. Inayatullah commends the positive and consistent role played by the Japanese parliamentarians and recognizes the excellent work of the Municipal Coordinating Committee for Overseas Bicycle Assistance. Japan is of particular importance to the IPPF because it is actively helping the global process of democratization. Inayatullah discusses the IPPF's commitment to women, women and HIV/AIDS, empowering women, and the role of nongovernmental organizations.

"White people" and US military are to blame for AIDS, says German doctor.


"AIDS - Origin, Spread and Healing" was written by Wolff Geisler, a German doctor. Geisler claims in the book that HIV can be spread by mosquitoes and other insects specifically bred for that purpose. He further argues that the West has developed a cure for AIDS, but refuses to share it with African doctors, and that the US military has infected water supplies and milk with opportunistic diseases. On sale in German and English and available in Uganda, Kenya, Zimbabwe, Germany, and the US, the book quickly became the most high-profile work at Harare's recent book fair. Geisler's claims are unfounded and will only threaten the success of prevention programs across Africa. The book simply plays into the hands of people who do not want to accept that the pandemic is real. It has drawn strong criticism in Germany. The author, however, is not bothered and counters that it takes time to promote alternative views. He claims to have found 37 examples in the research literature in which drugs administered to HIV-positive people caused HIV to disappear.

All children in developing countries will be affected by AIDS, not just orphans.


The HIV/AIDS pandemic will transform the situation of children in the developing world through direct and indirect increases in child mortality, rising rates of adolescent HIV, widespread orphaning, and the deterioration of societal and community conditions due to adult mortality. Children aged 0-4 years comprise 10-18% of reported AIDS cases in southern African countries. By precipitating additional deaths, the effect of AIDS upon child mortality rates will be most marked in relatively low child mortality rate (CMR) countries such as Zimbabwe, Kenya, and South Africa, as well as in south Asia. Scant attention has been given to issues surrounding the burden of care for pediatric AIDS cases. Among the infants, children, and adolescents who do not succumb to HIV infection and AIDS, many will lose one or both parents due to AIDS. The World Health Organization (WHO) projects that by 1999, 5-10 million children aged 10 years and younger worldwide will have lost either their mothers or both parents to AIDS. Adolescents are being infected in increasing numbers, with the WHO estimating that 60% of new infections occur in the 15-24 year old age group. This article stresses the devastating effect that AIDS has not only upon AIDS orphans, but to all children and society at large.

Spread of infectious diseases continues. International (North and South America).


The World Health Organization has warned that infectious diseases are the world's leading cause of death, killing at least 17 million people annually. Such diseases continue to spread across the Western hemisphere, even in the US. The Pan American Health Organization reports that respiratory infections, diarrheal diseases, and AIDS are the deadliest threats, with the former two being the leading causes of death among the region's children. Problematic throughout the Americas, infectious diseases are most troubling in Haiti and the Andean countries, where the lack of proper sanitation is most acute. Experts believe that the expansion of development into rural and forested areas increases populations' exposure to new disease agents and upsets the ecology, forcing those agents to seek new ways to survive. Urbanization and the early success in combating infectious diseases have also played an important role in fostering the spread of infectious disease. Early successes have led to a decrease in government funding and general lassitude about combating disease. Since the eradication of smallpox and other diseases, however, at least 20 new infectious diseases have been recognized. Longstanding diseases once thought to be controlled have also reappeared.

The Pathway: a strategic model for child health activities.


Approximately 12 million children under age five years die annually. Although this figure may seem high, only 15 years ago as many as 14 million children died each year. The rate of child mortality has therefore fallen. Mothers, fathers, and other relatives and neighbors within a community, and professional health care providers guard children's well-being. To help understand and describe the ways in which these groups interact with sick children and with each other, the US Agency for International Development's Basic Support for Institutionalizing Child Survival (BASICS) Program developed the Pathway to Survival framework. The Pathway is a model, but also a tool which can help guide the content of child health programs and the allocation of resources within them.

The Yaounde "Njuh" women association: potential for community based health care financing.


Since free health care in Cameroon is limited, inaccessible, and often of poor quality, and health insurance is either limited or nonexistent, receiving timely and good quality health care services in the country requires money. Cameroonians, however, do not save for health care. Emergency care and advanced health services create financial hardship for patients and their families. Paying for health care in Cameroon is contemporary, costly, and requires preparation. The experience of the Yaounde "Njuh" Women Association in raising funds to finance health care costs is described. The Yaounde "Njuh" Women Association was formed in 1980 by eight women as an association of women from the Wibum tribe who resided in Yaounde. In 1985, its membership increased to 88. Membership was open to every woman, although priority was given to wibum women and to women married to wibum men. Most members had completed primary school, although only about four had completed secondary school or higher. The association's philosophy is to use cultural norms to promote the primary health care concepts of self-health care and self-reliant development. Njuh is a wibum women's traditional dance. The njuh management concept was selected because it adhered to traditional rules and norms. Members participated in weekly meetings and a variety of family, community, and development activities. The four main types of banking services created for the women were the revolving savings, regular savings, and development and emergency funds. These services are described.

A warning to women on AIDS: counting on condoms is flirting with death.


While consistent, proper condom use reduces the risk of HIV transmission, it does not eliminate the risk. Dr. Helen S. Kaplan, director of the Human Sexuality Program at New York Hospital-Cornell Medical Center, believes that women should take steps to eliminate their risk of becoming infected. Laboratory tests have shown that latex condoms block the transmission of HIV, but there is no scientific evidence that they do so during sexual intercourse. Condoms have a 10% failure rate in preventing pregnancy, but HIV is many times smaller than a human sperm cell. Moreover, a woman can get pregnant during only a few days each moths, but is at risk for HIV every time she has sex with an infected partner. That noted, it should be understood that only 1 in 40,000 men (1 in 10,000 in New York) who do not inject drugs is infected with HIV. It is therefore unlikely that most women will be exposed to HIV through sexual intercourse with a man. Nonetheless, to be absolutely certain that there is no risk of contracting HIV, Kaplan believes that men and women should be tested for infection with HIV before engaging in the exchange of bodily fluids, including deep kissing. Allowance must be given for the six-month window period of HIV seroconversion.

Sexual attitudes in the Chinese.


Much has been written about the sexual attitudes of the Chinese. Scholars have alternately depicted Chinese culture as freely embracing sexual expression, puritanical, and asexual. This paper relates relevant data to these differing views on Chinese sexuality, describes the factors responsible for the controversies, and suggests a change of approach by which the contradictions may be better integrated and studied. Legendary practices; the Chinese philosophies of Yin-Yang, Taoism, and Confucianism; historical practices; literature and arts; Chinese medicine; tribal practices; and the modern Chinese are considered. The authors explain that in order to draw something from the conflicting data on Chinese sexual attitudes, the data must be sorted and reexamined to build testable hypotheses. During that process, certain features common to civilizations and some characteristics of the Chinese culture which can cause variation and controversy in sexual attitudes must also be considered. Such features and characteristics can affect the source of sexual knowledge, observation and reasoning, communication, the target of application of sexual standards, the strength of enforcement of sexual standards, and conformity. These issues as well as the developmental approach are discussed.

Psychosocial consequences to women of contraceptive use and controlled fertility.


A framework is suggested for thinking about the psychological consequences to women of contraceptive use and controlled fertility. Given the dearth of available literature based upon empirical studies, the author draws mainly upon common sense possibilities and ethnographic reports of how women talk about their lives. Sections explore concepts of health and well-being with attention to the indicators of psychosocial stress and psychosocial stress and role performance. Conjugal, occupational, and maternal roles; domestic, kinship, and community roles; and women as individuals are discussed under the broader topic of contraceptive and reproductive patterns as potential stressors. With few exceptions, the demographic analysis of the health consequences to women and children of contraceptive use and controlled fertility has largely ignored the issue of mental health. The psychosocial consequences to women of contraceptive use and controlled fertility are, however, as important as the consequences to their physical health and life opportunities.

Reproductive rights in Mexico.


The author examines how Mexico's legal system governs human sexuality and reproduction. She argues that there are contradictions in the system which undermine women's right to maintain control over their bodies. She further discusses national policies and laws on human reproduction, and concludes that, in Mexico, reproductive rights do not correspond with human rights. It is stressed that the definition of human rights has not given enough consideration to the reproductive rights of individuals. In its effort to eradicate extreme poverty, the Mexican government has developed family planning policies designed to prevent the poor from reproducing. At the same time, religious and political ideologies continue to encourage an increase in population. The tensions arising between these two opposing forces have had a detrimental impact, especially with regard to women. Basically, population policies, as enforced by the Mexican legal system, are structured in such a way that women are regarded largely as objects of human, social, and cultural reproduction.

Coping with change: an overview of women and the African economy.


The author explains how, in Africa, macroeconomic analyses and related policies are biased against women. These analyses and policies focus upon gross domestic product which, in itself, fails to acknowledge or value women's contribution in reproduction and maintaining human resources. Much of the current women in development (WID) literature exacerbates this lack of recognition by offering only a weak analysis of how to improve women's economic situation. Many WID studies posit that positive policy measures on behalf of women would result were national development plans and activities more aware of women's labor input. The author counters, however, that from a macroeconomic perspective, many complexities are involved. Despite development rhetoric lauding women's contribution to the African economy, legislation and policy fail to support women's efforts. Structural adjustment programs are of particular concern due to their production of major increases in unemployment and underemployment. The paper concludes in expressing the hope that women will challenge the structures which oppress them and which have undermined the African economy.

Factors related to inconsistent condom use with commercial sex workers in northern Thailand [letter]


A successful condom promotion program was implemented throughout Thailand in 1991 to prevent HIV transmission during sex with female prostitutes. The program involves the government distribution of condoms to commercial sex establishments, together with a media campaign to promote condom use and sanctions against establishments which show evidence of noncompliance. The reported rates of sexually transmitted disease have declined dramatically over the period 1989-93. The authors studied the factors related to consistent condom use in two cohorts of 21-23 year old military conscripts between 1991 and 1993. The men were interviewed at baseline and every six months until their discharge two years later about their STD and medical history, frequency of sex with prostitutes, and condom use. Of the 2191 men followed, at least 1622 had sex with a prostitute at least once during the two years; at each six-month interval, about half visited a prostitute. Among those visiting a prostitute, consistent condom use improved from 66.6% during the first six months to 79.1% during the last interval. Lower educational level, being unmarried, alcohol and/or illicit drug consumption, intoxication, having sex with prostitutes more than once per month, use of antibiotics before sex with a prostitute, a history of STD, and the beliefs that condom use reduces sexual pleasure and that their prostitute was free of infection were associated with inconsistent condom use. Condom availability did not influence inconsistent use.

Following the thread of Ariadne to the health of women.


Women's health has gained priority in medical research. Comparative studies of female morbidity are called for as a step toward the creation of hypotheses and design of more extensive studies of determinants, such as social, ecological, and individual factors. The authors have, in previous studies, noted differences in female hospitalization between Heraklion in Greece and Linkoping in Sweden. They were related to age and to urban versus rural dwelling, and fit projections for a more archaic and a more technocratic society, respectively. The authors demonstrate in this paper how the study of women's health may proceed from relevant hospitalization observations to the next level, of exploring already available indicators of self-perceived health in elderly females.

Abortion and contraceptive practice in central Asia.


In 1989, there were 2.98 mean births in Kazakhstan among women aged 35-39, the rate of total fertility in urban areas was 2.41, and the abortion rate was 2.32-2.85. An urban-based survey conducted in 1994 identified a drop to 1.72 in the number of mean births among women aged 35-39. The abortion rate and the prevalence of modern contraceptive method use both increased. Kazakhs and Russian/Ukrainians have comparable levels of fertility. The frequency of abortion is also quite similar for women of both ethnicities aged 18-29. Above the 25-29 year old age group, however, the incidence of abortion decreases among Kazakh women, but continues to rise among Russian/Ukrainian women. It may be that women in the region use induced abortion to postpone childbearing, to space births, and to terminate childbearing. A significant proportion of women had tried the IUD, oral contraceptives, and condoms. A decidedly smaller proportion had ever used injectable contraceptive methods.

Informed consent to AIDS-vaccine trials in Brazil: a pilot study.


A pilot study was conducted to assess the possibility of designing a study of the use of informed consent in HIV vaccine trials and to draw some preliminary conclusions about what aspects of the informed consent process need particular attention. 20 gay and bisexual men of mean age 25.6 years participated in the study. 14 stated their willingness to participate, if asked, in an HIV vaccine trial. They all noted the need to continue to avoid high-risk behavior even if they participated in such a trial. This proportion of participants willing to enter a vaccine trial is greater than that found by researchers in a recent study of drug users' willingness to enroll in HIV vaccine trials. It is concluded that a study of the adequacy of the informed consent process must go beyond asking simple questions about the trials. One must instead ask more complex and deeper questions about the details of the trial design and potential participants' understanding of the possible benefits and risks. Only then can researchers determine and report something of substance about whether potential participants understand enough to give truly informed consent.

The taste of condoms.


DKT International manufactures flavored condoms for sale in the Philippines. One year after introduction to the market, flavored condoms now already 10% of total condom sales in the country. The production and sale of flavored condoms by DKT comes on the heels of recent market research. The organization examined the sex behavior and practices of 300 prostitutes in Pasay, and found that about half of the sex workers performed fellatio for their customers. Of those prostitutes who engaged in oral sex, 50% chose not to use condoms because they tasted bad. Were pleasant-tasting condoms put on the market, however, people may choose to use them more often during oral sex. BFAD had held up the renewal of DKT's license to market the flavored condoms pending data on why a flavored condom was being marketed. The author notes the anti-condom lobby's attempt to keep flavored condoms off of the market. Detractors claim that such condoms may be eaten by children who think that they are candy.

Sexual activities of Malaysian adolescents.


The authors examined data on the sexual activities of 1200 Malaysian adolescents aged 15-21 years (mean age, 17.6 years). 792 respondents were male and 408 were female. 748 were students. Of the 1181 unmarried respondents, 9% reported having had sexual intercourse, with males being significantly more experienced than females. Older age groups were more sexually active than younger ones. Among the 521 who had experienced dating, 20% had experienced sexual intercourse, 44% have kissed and necked, 35% experienced petting, and 24% had not been physically intimate. Condoms, oral contraception, and withdrawal were the most commonly employed contraceptive methods among those who were sexually experienced, although the level of contraceptive prevalence was low; only 37% of the sexually active respondents used any form of contraception. The condom was the most common method used. Males began masturbating at the mean age of 14.4 years, compared to girls who began at mean age 15.5. Almost half of those who masturbate are worried by that behavior, especially the females.

Black South African freshmen's experience of first coitus and contraception.


An anonymous questionnaire investigating Black South African first-year college students' experience of first intercourse and contraception was administered during the February 1993 orientation at a Black university. 754 females and 959 males of mean age 20.4 years in an age range of 16-50 years participated. 96.5% of the respondents were single. The study findings relate to the 894 single students who reported having experienced sexual intercourse. Male and female respondents' mean ages at first intercourse were, respectively, 15.5 and 17.8 years. 35.7% of males and 32.8% of females reported not using contraception during first intercourse, 12.3% of males and 7.1% of females were unsure, and 6.2% reported using withdrawal. 36.8% reported not using a condom because first sexual intercourse was unplanned, while 38.1% simply did not think about contraception at the time. Peers were reported as the primary first source of learning about sexual intercourse as well as the preferred source. These findings lend support to the need to target safer sex messages to college freshmen in this setting. In so doing, safer sex behavior can be encouraged and possibly adopted before high-risk sex behavior patterns develop.

Correlates of condom use among incarcerated adolescents in a rural state.


The entire incarcerated population of the Department of Youth Services for a mostly rural southern state was asked to complete an AIDS survey. The 455 adolescents had been detained by the criminal justice system for criminal activity, incorrigibility, or serious neglect. The survey was completed by 393 respondents during the summer of 1988. 335 of these young men reported being sexually active. Study results are based upon the analysis of data from this sexually active subpopulation. 82.9% were male. 1.8% were aged 12 years and younger, 13.0% were aged 13-14, 44.6% were aged 15-16, 37.9% were aged 17-18, and 2.7% were aged 19 or older. 41.4% were White and 53.5% Black. 17.6% reported having had sexual intercourse with a total of 6-10 sex partners, while 42.1% had had more than 10 partners. 42.8% reported frequent condom use. Multivariate logistic regression analysis found not smoking marijuana, not drinking beer, asking sex partners about their sexual histories, and being worried about friends contracting HIV to be associated with frequent condom use. The relationship between substance use and the HIV epidemic is discussed, as well as the importance of teaching substance refusal skills and sexual communication and negotiation skills to incarcerated adolescents.

National workshop on RH / IEC held.


The three-day National Workshop on Reproductive Health Information, Education, and Communication (IEC) was held in Kathmandu during December 5-7, 1995. It was jointly organized by the Family Planning Association of Nepal (FPAN), the Japanese Organization for International Cooperation in Family Planning (JOICFP), and the UN Population Fund (UNFPA). The national workshop was conducted to review and assess the effectiveness of IEC materials on reproductive health, as part of the implementation activities of the Sustainable Community-based FP and Maternal and Child Health Project with Special Focus on Women. The project is implemented in Nepal by FPAN. Specific objectives were to conduct an analytical review of the existing IEC materials on reproductive health based upon their message content, style, purpose, and target audience; to identify problems and constraints associated with the development, production, and distribution of IEC materials; and to assess the future needs of IEC materials production in Nepal.

Administration of iodized oil during pregnancy: a summary of the published evidence.


The administration of iodized oil to entire populations, and especially to women of childbearing age and during pregnancy, has been proposed as an emergency prophylactic and therapeutic approach in areas with severe iodine deficiency complicated by endemic cretinism where universal salt iodization has not yet been successfully introduced. In so doing, brain damage in the fetus and neonate due to iodine deficiency would be prevented. The author's extensive review of the available published studies confirms that the administration of iodized oil before or during pregnancy prevents endemic cretinism and brain damage by correcting iodine deficiency and thyroid function in pregnant women, fetuses, neonates, infants, and children. The potential benefits derived from using iodized oil immediately before or during pregnancy greatly outweigh the potential risks in areas of moderate and severe prevalence of iodine-deficiency disorders, where iodized salt is not yet available.

Knowledge, practices, and perceptions about malaria in rural communities of Zimbabwe: relevance to malaria control.


411 household heads in Gokwe district, Zimbabwe, were surveyed to gain insight into villagers' knowledge, practices, and perceptions about malaria and their implications for malaria control. The survey found that while the government has sustained an annual indoor insecticide spraying program for more than four decades, about half of the respondents did not fully understand its purpose. Fully 26% believed that the program was designed to kill domestic pests, not including mosquitoes. During the 1991-92 spraying cycle, 72% of the villagers had their homes sprayed. 21% of the villagers, however, refused to have some rooms in their homes sprayed. Homeowners' understanding of the purpose of the spraying program was significantly related to their compliance with it. 82% of respondents reported not taking any measures to protect themselves from malaria. Taking preventive measures was significantly related to one's knowledge of the causes of malaria. These findings point to the need to thoroughly explain to communities what malaria is and how it can be prevented. Furthermore, communities must be involved in any given malaria control program to ensure their understanding and compliance.

Clinical and epidemiological evaluation of a live, cold-adapted influenza vaccine for 3-14-year-olds.


Considerable progress has been made in recent years in developing live, attenuated influenza vaccines, with most attention having been directed to the development of cold-adapted (CA), attenuated reassortant vaccines. Such vaccines are widely used in the Russian Federation to immunize children. Findings are reported from a study of live, CA reassortant mono-, di-, and trivalent influenza type A and B vaccines in a series of controlled clinical and epidemiological investigations involving almost 130,000 children aged 3-15 years. Clinical, immunological, and morbidity investigations of the vaccinated children and a control group over a six-month follow-up period indicate that the vaccines were completely attenuated by the children. Transient febrile reactions occurred in less than 1% of the children after vaccination, including double seronegative individuals with low antibody titres. The type A reisolates examined were genetically stable. Furthermore, the reassortants did not suppress each other after simultaneous inoculation of children and stimulated antibody response to influenza virus strains A1, A3, and B. The incidence of influenza-like diseases was approximately 30-40% lower among the vaccinated group than among the control group. It is noted that this study demonstrates, for the first time, the efficacy of CA vaccine against infections caused by influenza B virus.

Leishmaniasis in AIDS patients: results of leukocytoconcentration, a fast biological method of diagnosis.


The biological diagnosis of an infectious disease is ideally based upon isolating and identifying the pathogenic agent in the host tissue and establishing cultures after direct examination under a microscope. That procedure allows both an accurate diagnosis and an epidemiological survey of the disease. When leishmaniasis occurs in an AIDS patient or any other immunocompromised patient, however, the procedure is often unsatisfactory for the following reasons: the samples are difficult to collect, there may be few parasites, and their growth is slow or impeded by other pathogenic agents. The clinical features, when they are not specific, may be attributed to an etiology other than leishmaniasis. This paper describes an easy, fast, and inexpensive technique for diagnosing leishmaniasis from peripheral blood. Leukocytoconcentration involves concentrating blood parasites on a small surface of a microscope slide while the red blood cells are removed by lysis. The results, compared with those derived from examining cultures of blood samples and bone marrow smears, were very good and accurate. All but one of the cases of leishmaniasis studied were patients co-infected with HIV. Leukocytoconcentration facilitates the follow-up of cases and fast detection of any relapse.

The timing of breastfeeding initiation and its correlates in a cohort of rural Egyptian infants.


The authors report their findings from a study of the patterns and correlates of the timing of breastfeeding initiation for newborns. 150 apparently healthy, single neonates and their apparently healthy mothers in four villages in rural Bilbeis, Egypt, were recruited within four days of child birth and followed prospectively during 1987 through 1989. All 150 neonates included in the analysis were breastfed for some duration. At the time of the first breastfeed, 36%, 37%, and 27% of the neonates were aged less than 2, 2-5, and 6 or more hours, respectively. All neonates, however, received their first breastfeed within 72 hours of delivery. Multivariate analysis found modern birth attendants and more than 8 hours of labor to be significantly associated with the deferment of breastfeeding initiation until the neonate was aged 6 hours or older. This delay in the initiation of breastfeeding seems unwarranted given the apparently healthy status of the study mothers and infants during the early postpartum period. Later initiation of breastfeeding was associated with indiscriminate prelacteal feeding, earlier termination of breastfeeding, and unwelcome supplementation practices. These findings attest to the need to initiate and/or strengthen programs to promote appropriate breastfeeding practices in Bilbeis and other similar areas.

Misoprostol is as effective as gemeprost in termination of second trimester pregnancy when combined with mifepristone: a randomised comparative trial.


Findings are presented from a prospective randomized study conducted to compare the efficacy of misoprostol with gemeprost when combined with mifepristone to terminate second trimester pregnancy. 50 patients requesting the induced abortion of second trimester pregnancy were randomized into two groups of 25 women each. The mean age, parity, and mean gestational age of the two groups of women were comparable. 200 mg of mifepristone was administered to both groups of women 36-48 hours before the administration of prostaglandins. Women in group 1 were given 400 mcg of oral misoprostol every 3 hours up to five doses, while patients in group 2 were given 1 mg of vaginal gemeprost every 6 hours up to four doses. There was no significant difference in the median induction-abortion intervals or the incidence of side effects between the two groups of patients. The authors therefore conclude that misoprostol is as effective as gemeprost in terminating second trimester pregnancy when combined with mifepristone.

Morphological observations of vas deferens occlusion by the percutaneous injection of medical polyurethane.


Findings are reported from a study of the mechanism of vas occlusion by medical polyurethane (MPU). Histological observations were made of 20 occluded vas segments obstructed by the standard procedure of medical polyurethane vas occlusion in 10 volunteers requesting vasectomy and of 20 vas segments with plugs removed from 10 vas-occluded men requesting vas reversal. 20 vas deferens in the vasectomy group were ruptured, with only a small amount of MPU elastomer remaining within the vas lumen, most having leaked through to encircle the ruptured vas. Histomorphology of the removed vas segments from the 10 vas-occluded men who had undergone vas-occlusion four years earlier showed diffuse proliferation of connective tissue, fibrosis, or hyalinization of fibroplastic tissue and local infiltration of lymphocytes and macrophages. The vas lumen both proximal and distal to the plugs was completely blocked. Sperm granuloma, foreign body granuloma, proliferation of nerve fibers, and local infiltration of lymphocytes were found in four vas-occluded men with painful nodules. These findings suggest that the contraceptive mechanism of MPU-vas occlusion could be the result of secondary obstruction due to tissue proliferation by MPU irritation after the rupture of the vas deferens.

History and efficacy of emergency contraception: beyond Coca-Cola.


Over 30 years of clinical use of emergency contraception has confirmed that such methods substantially reduce the chances of pregnancy, do not entail onerous service provision requirements, and are acceptable to women. The major obstacle to the more widespread use of postcoital methods is a lack of awareness on the part of both potential acceptors and service providers of this important option. Most extensively researched have been the Yuzpe method (200 mcg of ethinyl estradiol and 1.0 mg of levonorgestrel, taken within 72 hours of unprotected intercourse and then 12 hours later), levonorgestrel (two doses of 0.75 mg 12 hours apart starting within 48 hours of unprotected intercourse), and postcoital insertion of a copper IUD. Two new agents--RU-486 and the synthetic progestin and antigonadotropin danazol--offer promise, but require further evaluation. The Yuzpe method is estimated to reduce the likelihood of pregnancy by at least 75%. Lacking in the available literature are studies with rigorous research designs and methodologies capable of generating reliable data on efficacy and side effects, especially among women in developing countries. There is a need, for example, to limit samples to women who have had only one act of unprotected intercourse during a menstrual cycle and to those of proven fertility. Also important are studies that evaluate a range of distributional systems (e.g., vending machines) and user educational approaches. Finally, studies are needed to determine whether the Yuzpe method can be broadened to encompass all the progestins (e.g., desogestrel) used in combined oral contraceptives.

Emergency contraception in the United Kingdom and the Netherlands.


In both the UK and the Netherlands, emergency contraception is an established part of family planning practice and its cost is covered by the national health insurance systems. The experience in these two countries points to the needs both for education of providers and potential acceptors and for a comprehensive network of sources of method supply. In the UK, where the Department of Health has approved emergency treatment for up to 72 hours postcoitally, there is support for making PC4 (50 mcg of ethinyl estradiol and 0.5 mg of norgestrel) available from pharmacists without a physician's prescription. 2.5 million packets of PC4 have been sold since the regimen was licensed in 1984. A PC4 dose costs US$19-74 and saves the government health service $727-806 per unwanted pregnancy averted. Emergency contraception users in the Netherlands tend to be adolescents who have never been pregnant and seek the method from a family planning clinic. There are serious concerns about the strength of the hormonal dose required in the Yuzpe method and calls from the medical profession to make RU-486 available. In both the UK and the Netherlands, the success of postcoital contraception as a method of last resort is related to the overall high quality and accessibility of the national family planning programs.

Research on new methods of emergency contraception.


The ideal emergency contraceptive would be highly effective (surpassing the 75% effectiveness rate of the Yuzpe method), free of side effects, non-disruptive of the menstrual cycle, easily administered, interceptive, and affordable. Prevention of fertilization rather than ovulation would be an important advance since it would increase the window of time after unprotected intercourse that a drug can be administered. Recent research in this area has focused on levonorgestrel alone, danazol, anti-estrogens, gonadotropin-releasing hormone antagonists, and progesterone inhibition. Crucial to further advances is basic research on embryonic development and signaling before implantation, tubal transport and milieu, endometrial development before implantation, and the inter-relationships between the embryo and uterus during implantation. Until more knowledge is amassed about these physiological mechanisms, no new methods are likely to emerge. In the interim, an emphasis is being placed on the evaluation of anti-progestogens such as RU-486 that are easier to administer and associated with fewer side effects than the Yuzpe method.

The effectiveness of the Yuzpe regimen of emergency contraception.


A review of the 10 clinical trials of the Yuzpe method of emergency contraception that reported the data required to calculate effectiveness rates suggests that this may be a more accurate measure of efficacy than the failure rate. The Yuzpe regimen, which involves the administration of 200 mcg of ethinyl estradiol and 2.0 mg of norgestrel, was associated with failure rates ranging from 0.2% to 2.8%; the pooled rate was 1.5% (95% exact confidence interval, 1.2-1.9%). The equality of failure rates across studies was compromised by two assumptions: women lost to follow-up (as high as 22%) became pregnant at the same rate as women observed, and all women in the trials had an equal probability of failure. The effectiveness rate--the proportionate reduction in the probability of conception caused by emergency contraception use--avoids these sources of error by including data on both the observed and expected number of pregnancies and computing the risk of conception for each day of the menstrual cycle. These estimates range from 55.3% to 94.2%, with a pooled effectiveness rate of 74.0% (95% exact confidence interval, 68.2-79.3%). On the other hand, four methodological issues are inherent in use of the effectiveness rate: the assumption of homogeneity implicit in pooling observations, bias introduced by the unknown pregnancy rate among women lost to follow-up, the probability some women violated study protocol and had more than one unprotected act of intercourse during their cycle, and possible underestimation of the expected number of pregnancies.

Third generation oral contraceptives and risk of myocardial infarction: an international case-control study.


A case-control study conducted at 16 centers in Austria, France, Germany, Switzerland, and the UK found that third generation oral contraceptives (OCs) were associated with a reduced risk of myocardial infarction when compared to their second generation counterparts. The third generation OCs investigated contained 20-30 mcg of ethinyl estradiol and either gestodene or desogestrel. Included were 153 cases of myocardial infarction in women 16-45 years of age and 498 matched hospital and community controls. Current OC use was defined as within three months of infarction for cases and the date of admission or interview for controls. The odds ratio for myocardial infarction risk was 0.36 (95% confidence interval, 0.1-1.2) for current users of third generation OCs compared to users of second generation OCs and 0.3 (0.1-1.0) when third generation OC use was compared with no history of OC use. Cigarette smoking was associated with a far greater excess risk of myocardial infarction than use of either generation of OCs (10.1; 5.7-17.9). These findings imply that a switch from second to third generation OCs is linked with 46 fewer deaths per year from myocardial infarction in Germany and 12 fewer such deaths in England and Wales. Further research is required, however, since the reduced risk of myocardial infarction associated with third generation OCs may be offset by an increased risk of venous thromboembolism.

Third generation oral contraception and venous thromboembolism. The published evidence confirms the Committee on Safety of Medicine's concerns.


Emerging data from multicenter case-control studies validate the British Committee on Safety of Medicine's concerns about a risk of venous thromboembolism associated with oral contraceptives (OCs) containing the progestogens gestodene and desogestrel. All three projects--a subanalysis of data from a World Health Organization study of women in 10 countries, an investigation of current OC users identified through the British general practice research database, and a reanalysis of the Leiden thrombophilia study--revealed a statistically significant doubling of the adjusted odds ratio for venous thromboembolism in users of third generation OCs compared to second generation OCs. The available data indicate a pooled relative risk estimate of venous thromboembolism of about 2.0 (95% confidence interval, 1.4-2.7). The greatest risk occurs among young women who smoke while taking OCs, regardless of type. Practitioners are urged to screen women for personal and familial venous thromboembolism risk factors before prescribing third generation OCs; however, in cases where there are no risk factors and third generation OCs are already being used, women should be provided the option of continuing their use.

Many pill users in Egypt lack adequate knowledge about how to take the pill.


According to data from the 1988 Egypt Demographic and Health Survey, incorrect use patterns are widespread among oral contraceptive (OC) acceptors. 1258 of the 8911 ever-married women ages 15-49 years included in the survey identified themselves as current OC users. 90% did not start a new pill pack on the correct day, 37% had missed one or more pill in the preceding cycle, 24% failed to take all the pills in their proper sequence, and 61% were unaware that they should take two pills the day after a dose was missed. Most disturbing was the finding that 22% took the pills on an "as needed" basis. Survey respondents had been using OCs for an average of two years. Logistic regression analysis found that proper OC use was significantly greater among women whose husbands purchased their pills than among women who obtained their supply themselves and among those who did not experience OC-related side effects. Rural women with no schooling who relied on government supply sources were seven times more likely to take the pills out of sequence than urban, educated women with a private supply source. Recommended, to improve compliance, are training programs for providers such as pharmacy clerks and package inserts that include clear, simple, pictorial instructions.

Two combined monthly injectables prove highly effective in Chinese trials.


In a trial involving women from 15 clinics in China's Shanghai, Sichuan, and Zhejiang provinces, the effectiveness of two of three injectable contraceptive regimens was confirmed. Tested were Cyclofem (25 mg of medroxyprogesterone acetate and 5 mg of estradiol cypionate), Mesigyna (50 mg of norethisterone enanthate and 5 mg of estradiol valerate), and Injectable Number 1 (250 mg of hydroxyprogesterone caproate and 5 mg of estradiol valerate). The participants were women 18-35 years of age with regular menstrual cycles who were not pregnant or lactating and not taking medications known to affect the cardiovascular or hepatic systems. At the time of first injection, women were given a physical examination and a menstrual diary; follow-up was monthly over a one-year period. Initial results indicated Injectable Number 1, manufactured and used only in China, was significantly less effective in preventing pregnancy than the other two formulations. Thus, the study was modified to compare 1724 woman-years of Mesigyna use with 1647 woman-years of Cyclofem use. The one-year discontinuation rate was 19% in the former and 26% in the latter group. There were six pregnancies among Mesigyna users (0.3/100 woman-years) and three among Cyclofem users (0.1/100 woman-years). The one-year discontinuation rate related to bleeding irregularities or amenorrhea was significantly higher among Cyclofem users (12.7/100 woman-years) than Mesigyna users (7.9/100 woman-years). However, discontinuation for other medical reasons (primarily weight gain and breast tenderness) was comparable: 3.4/100 and 3.6/100 woman-years, respectively. At the first monthly follow-up visit, 16% of Cyclofem users and 12% of Mesigyna users complained of bleeding irregularities; by the 12-month visit, these percentages had dropped to 3% and 1%, respectively. Overall, the discontinuation rates for bleeding irregularities compare favorably to those reported for progestogen-only injectables.

Executive summary.


Introduction of the Copper T-380A (TCu 380A) IUD in Bangladesh's national family planning program in 1989 has been associated with increased requests for removals due to bleeding problems. A comparative double-blind randomized clinical trial of the TCu 380A, its predecessor the TCu 200, and the Multiload 375 was conducted to assess the side effects, continuation rates, and acceptability of these three IUDs. The 801 women presenting to 18 participating centers for contraception who agreed to try an IUD were distributed equally among the three devices. Women in all three groups were comparable in terms of age (mean, 27.8 years), educational level (43% had attended secondary school), previous IUD use (about 35%), and other socio-demographic characteristics. During the one-year study period, the duration of menstrual bleeding was significantly higher for the TCu 380A (a 6- to 7-fold increase) and Multiload (a 3- to 5-fold increase) compared to the TCu 200. 26.9% of TCu 380A acceptors compared to 24.0% of TCu 200 acceptors reported excessive bleeding. The cumulative one-year discontinuation rate was 33.1% in the TCu 380A group, 24.9% in the TCu 200 group, and 26.9% in the Multiload group. Excessive bleeding was the reason for discontinuation for 14.2%, 7.1%, and 10.4% of acceptors, respectively. The only pregnancy occurred in a Multiload user at nine months. Overall, 40% of IUD acceptors expressed satisfaction with the method, chiefly because of its long-term protection. Dissatisfaction was almost always associated with menstrual disturbances. Interviews with 27 providers at the participating centers confirmed that there were more client complaints and requests for removal associated with TCu 380A than the other two methods; these providers expressed preference for the Multiload 375.

Need for change in female sterilisation procedure and selection [letter]


Female sterilization is selected by about 40% of contraceptive acceptors in Sri Lanka. Of concern is the finding that at least 14% of these women later regret their decision. Typical of such cases is a woman who underwent sterilization at 21 years of age, when she had two children. She was not counseled about the procedure, including its permanence, at the time, nor was she questioned about family size ideals or the stability of her marriage. This woman presented for reversal at age 30 years following the deaths of both of her children. Laparotomy revealed very short proximal and distal tube segments. After bilateral ampulo-isthmic tubal anastomosis, the tubal length was under 3 cm; 4 cm is regarded as the minimal tubal length for successful reversal. The woman had not achieved pregnancy by the six-month follow-up visit. This case highlights the importance of thorough counseling of sterilization seekers, including identification of couples at risk of subsequent regret, and the use of isthmus-isthmus anastomoses surgical procedures that preserve at least 4 cm of tube.

Listening and learning from women about mifepristone: implications for counseling and health education.


Focus group discussions proved to be an effective modality for identifying potential barriers to mifepristone/misoprostol-induced abortion as well as special informational and counseling needs. The eight focus groups, conducted in 1994 in New York, Oregon, and California, included a total of 73 nonpregnant White, Black, and Hispanic women recruited from local family planning clinics. The mean age of respondents was 25.8 years; 63% had been pregnant and 45% reported a prior abortion. Respondents were asked to identify the information they would need to make an informed choice between vacuum aspiration and mifepristone/misoprostol abortion. Their questions centered around the drugs and their mechanisms of action, the abortion process (especially pain and the appearance of the expelled products of conception), postabortion fertility, and the role of health care staff. Discussions identified several factors--e.g., the length of time a woman requires to make a decision to abort, the degree of control she wants to exert over the abortion process, religious beliefs, and support from significant others--that can help counselors to identify women for whom vacuum aspiration may be a more feasible alternative. Overall, the group discussions highlighted the importance of a woman's unique life circumstances to reproductive health decisions.

The use of misoprostol for termination of early pregnancy.


To ascertain whether vaginal administration of the prostaglandin analogue misoprostol is sufficient for producing termination of an early pregnancy (under 10 weeks' gestation), 58 abortion seekers received varying doses of misoprostol, either alone or in combination with laminaria or tamoxifen. The overall rate of complete abortion was 61.1%. This rate was unaffected by use of laminaria or tamoxifen. Increasing the dosage and decreasing the dosing interval did not affect the results. Women with a successful abortion received an average of two doses; the interval between first dose and abortion averaged 9.9 +or- 4.1 hours. There were no significant differences between those who aborted and those who failed to pass products of conception in terms of gestational age, beta-human chorionic gonadotropin level, parity, body weight, or prior abortion history. Vaginal misoprostol was associated with a low incidence of pain and side effects such as nausea (5.7%) and vomiting (3.8%). Side effects were most pronounced when the dosing interval was shortened to every four hours. Until mifepristone is available in the US, vaginal application of misoprostol should be considered as an alternative to surgical abortion given its availability, ease of administration, and low incidence of side effects.

Anaphylactic shock following an injection of Depo-Provera.


Described in this letter is a case of anaphylactic shock that occurred in a 22-year-old British woman immediately following Depo-Provera injection. The woman reported heavy menstrual periods for the three years preceding injection and was obese. She had no history of allergies. Each of her three children was a result of contraceptive failure (IUD, condom, and oral contraceptives). Immediately following injection of 150 mg of Depo-Provera by a domiciliary family planning nurse, the patient collapsed. No radial or carotid pulse was evident, and she was non-responsive to stimuli. The woman regained consciousness within one minute of administration of 1.0 adrenaline. Heavy bleeding persisted for three months after the Depo-Provera injection.

Death following local anaesthesia for Norplant [letter]


Reported in this letter is a death at a Rwandan district hospital associated with administration of 40 mg of lignocaine hydrochloride as cutaneous anesthesia for Norplant insertion. After trocar insertion but before the Norplant capsule was introduced, the 25-year-old patient was demonstrating bradycardia, irregular pulse, and obnubilation. Adrenalin administration produced temporary recovery, but the woman died later that day after pulmonary edema developed. The woman had delivered a healthy infant six weeks previously after an uneventful pregnancy. After delivery, 10 ml of lignocaine was administered for episiotomy and cervical repair, with no adverse reaction. There was no personal or familial history of cardiac problems. Cardiac arrhythmia and arrest have been associated with lignocaine use, but the minimal lethal dose is considered to be about 200 mg. Although this case does not provide cause for concern about the safety of Norplant implants, health workers should be alert to this rare complication.

Gynecologic problems are common among recent mothers in parts of India.


In a survey of 3600 women from southern India's Kamataka State, 23% reported symptoms of anemia, 17% reported lower reproductive tract infection, 7% had menstruation-related problems, and 5% described symptoms consistent with pelvic inflammatory disease. Those most likely to report such problems were women who had obstetric problems during their last birth, women who had been sterilized, rural residents, and those who had delivered their last child at home or in a government institution. All respondents had at least one child under five years of age; 59% had obstetric problems such as excessive bleeding or postpartum lower abdominal pain associated with that birth. 58% were not using contraception and 35% were sterilized. 43-56% of respondents had sought medical treatment for their self-reported health problems, generally from private sources of care. The causation of this high maternal morbidity is unclear. It is speculated, however, that women who are sterilized and those who receive obstetric care at a government hospital are often exposed to unsanitary conditions and thus the risk of infection.

Fetal loss is a relatively uncommon experience, but risk doubles among women aged 35 and older.


The analysis of data on the 94,346 live-born and stillborn infants weighing at least 500 g who were delivered at a Montreal, Canada, hospital in 1961-74 and 1978-93 suggests that women aged 35 years and older are about twice as likely as their younger counterparts to experience fetal loss. The fetal death rate dropped from 12/1000 births in the earlier period to 3/1000 in the more recent period, while the neonatal death rate fell from 14/1000 to 3/1000. The fetal death rate for mothers under 35 years of age declined from 11/1000 in the 1960s to 3/1000 in the early 1990s; among older women, this decline was less pronounced: from 17/1000 to 6/1000. Logistic regression analysis, controlled for age, parity, and maternal risk factors that increase after 35 years of age, revealed slightly dissimilar patterns for 1961-74 and 1978-93. In the former period, women in their thirties were at no increased risk of fetal death, but this risk was almost double (odds ratio, 1.8) among women aged 40 years and over. Also elevated were the risks for women having their first child (1.9) and those with three or more previous births (1.7). In the later period, the fetal death odds ratios were significantly increased for women in their late thirties (1.9) and those aged 40 years and over (2.4). Women who had three or more previous children remained at risk (1.8), but not women having their first child. Pregnancy history-related variables such as abortion had no effect on risk. Finally, multiple gestations put women at increased risk of fetal death in both time periods (1.5 and 3.4, respectively). The decrease, over time, in fetal deaths is in part related to control of maternal diabetes, treatment of Rh-negative women, and prenatal detection of fetal abnormalities; on the other hand, there has been an increase in multiple gestations resulting from fertility enhancing treatments.

Female genital mutilation: consequences for reproductive and sexual health.


An estimated 80 million women worldwide have been subjected to female genital mutilation and 2 million new procedures are performed each year. The procedure, generally performed at home by medically untrained persons, has severe long-term physical and psychological consequences. At Northwick Park Hospital in the UK, genitally mutilated immigrants from countries such as Somalia and Sudan have presented health care personnel with immense challenges. Routine gynecologic and obstetric procedures cannot be performed when access to the vagina is inadequate, and there is often a need for psychosexual counseling. To address the unique needs of these women, the Hospital established an African Well Woman Clinic that was attended by 50 women (including 14 primigravidae and 23 multigravidae) in its first six months of operation. Women are offered de-infibulation, ideally before becoming pregnant, and infibulated women are not resutured after delivery. Tact and cultural sensitivity on the part of all medical personnel are essential to reduce feelings of shame. Although most attendees at the Northwick Park Hospital program state they do not intend to infibulate their female children, they are at risk of pressure from family when they visit their homeland. Ongoing counseling, education, and support are necessary to break the cycle of female genital mutilation.

Sterilization, contraception and abortion: global issues for women.


Research in contraceptive technology, investments in family planning programs, and the availability of safe abortion are essential not only to control population growth and improve the health of mothers and children, but also to improve the status of women. At present, however, it is estimated that 25% of married women in sub-Saharan Africa, 18% in Latin America and the Caribbean, and 13% in Asia, the Middle East, and North Africa have an unmet need for contraception. Without rapid advances in access to family planning, more women will die during this decade from pregnancy, childbirth, and abortion than in any other decade in history. Although the 1994 Cairo Conference achieved consensus on a range of reproductive health issues, strategies for implementing and funding these programs remain undefined.

Maternal exhaustion as an obstetric complication: implications of TBA training.


Certain practices encouraged by traditional birth attendants (TBAs), such as oxytocin administration and urging the mother to bear down early in labor, are associated with increased pain and maternal exhaustion. To help TBAs identify women with obstetric complications and discourage harmful delivery practices, a training program was initiated in four of the 10 health districts in Quetzaltenango, Guatemala, in 1992. To evaluate the effectiveness of this training, data on TBA-referred women before and after training and in intervention and non-intervention districts were compared. The most common reasons for TBA referral were malpresentation, maternal exhaustion, and retained placenta. Pushing for more than two hours was the strongest predictor of maternal exhaustion. Comparative analyses failed to show any declines in the incidence of extended pushing as a result of the TBA training; moreover, oxytocin administration increased significantly for trained TBAs during the post-intervention period. The failure of the TBA training program to change specific practices is assumed to reflect community expectations and resistance to modifying cultural standards.

Assessment of post-abortion family planning services in Vietnam.


In Viet Nam--one of the few developing countries where abortion is legal--the number of procedures performed increased 10-fold from 1976 to 1987 and reached 1.4 million in 1993. This trend is attributed to widespread use of induced abortion as a method of birth control in the absence of access to modern methods. To determine whether abortion patients are being offered post-abortion family planning counseling, interviews and medical chart review were conducted with 508 women admitted in 1994 with post-abortion complications to eight hospitals in four provinces. Their average age was 31 years; the average number of children was 1.8. 49% reported a prior abortion and 60% were using a contraceptive method at the time of the index pregnancy, chiefly withdrawal and condoms. Although 77% claimed they wanted the service, only 54% actually received post-abortion family planning counseling; this rate was highest for family planning/maternal-child health centers (67%) and lowest for district hospitals (44%) and private offices (33%). Women over 30 years of age, rural residents, and those desiring no more children were significantly more likely to be counseled. 85% of abortion patients reported they planned to initiate use of a family planning method before or after their next menstrual period. Factors significantly associated with this intent were older age, two or more abortion, desire for no more children, past contraceptive use, and receipt of post-abortion counseling. These findings indicate an unmet need to strengthen family planning services for abortion patients, especially to encourage use of modern methods such as the IUD or sterilization.

Latest figures on HIV pregnancies.


According to the Fifth National Human Immunodeficiency Virus (HIV) Survey, 7.57% of South African women attending public health service antenatal clinics were HIV-infected at the end of 1994. The survey entailed the screening of 18,630 blood specimens from pregnant clinic patients. Based on the assumption that HIV prevalence in antenatal clinic attendees reflects the rate of infection among fertile women and that the male/female ratio of infection is 0.73:1, the survey's findings suggest there were 1.2 million HIV-positive persons in South Africa at the end of 1994. There are geographic variations, with the highest rate of HIV infection in KwaZulu-Natal and the lowest in the Capre provinces.

Epilepsy in a focus of onchocerciasis in Burkina Faso [letter]


The hypothesized association between onchocerciasis and epilepsy was investigated as part of an ongoing survey of Burkina Faso's National Team Against Onchocerciasis in the villages bordering the river Bougouriba. 1424 people in five villages, 1062 of whom were 15 years of age and above, were screened. Screening involved the microscopic examination of two skin snips from the iliac crests of each subject after incubation in water to detect the presence and number of Onchocerca volvulus microfilariae. All negative samples were re-examined 24 hours later. To diagnose epilepsy, villagers who reported at least two seizure episodes were examined by a neurologist. Positive skin snips for onchocerciasis were found in 135 villagers. Of the 16 epileptics identified, two had positive skin snips. Since the prevalence of epilepsy in this area (1.5%) did not differ from that found in areas where onchocerciasis is not endemic, and the prevalence of onchocerciasis in epileptics (12.5%) was not significantly different from that among non-epileptics (12.7%), the hypothesized association between these two conditions appears spurious.

ADDR workshop: Linking Applied Research with Policy, February 24-28, 1996.


At a workshop in Cuernavaca, Mexico, sponsored by the Applied Diarrheal Disease Research Project (ADDR), 45 international scientists and policy makers discussed ways to link applied research with technical (specific health interventions) and allocative (allocation of resources, organization, and financing) policies. The research to policy linkage was conceptualized as part of a broader continuum leasing to action and implementation. Politics and interest groups, concept confusion, and the differing motivations and contexts of research and policy were identified as obstacles to progress in this area. Recommendations emerging from the gathering included development or strengthening of national research councils to promote interaction with policy makers, incentives for researchers to work with policy makers, training policy makers to interpret research findings, and the development of communication strategies. At the workshop, the BASICS representative proposed a follow-up workshop on "Linking Public Health Policy with Public Health Program Implementation."

The International Dialogue on Micronutrient Malnutrition: Forum on Food Fortification, 6-8 December, 1995, Ottawa, Canada.


The International Dialogue on Micronutrient Malnutrition: Forum on Food Fortification, convened in Ottawa, Canada, in 1995, promoted partnership between the private and public sectors aimed at eliminating global malnutrition through strategies such as food fortification and supplementation. Participants agreed on the goal of eliminating micronutrient malnutrition by the year 2000, with an emphasis on iodine, iron, and vitamin A deficiencies. Achievement of this goal will entail, for each country, a needs assessment and discussion of the role of micronutrient fortification, establishment of a hierarchy of foods to reach the maximum population at risk, and dialogue to provide a link for technology and information exchange. The public sector will assist in the development of standards, provide incentives, and contact industry, while the private sector will provide scientific research and development, conduct market research, develop appropriate products, and disseminate and market the products; the role of international organizations will be to provide financial support and serve as liaison between the public and private sectors.

[Sample survey: methodology and findings]


The 1995 Morocco Sample Survey on Population and Health (EPPS) included 4753 women aged 15-49. The sample was a subsample of the Second National Survey on Population and Health (1992) (ENPS-II). The survey encountered two major problems: sample loss (i.e., women interviewed in 1992, but not found in 1995) and introduction of changes to the population as time passed. 71.9% of women interviewed in 1992 were successfully reinterviewed in 1995. The reinterview rate increased to 77.5% for married women. It was highest in rural areas, the Tensift and South regions, and illiterate women. The comparisons between fertility and mortality rates of the ENPS-II and those from EPPS confirmed the consistency of the findings and good data quality for both studies. The number of infant deaths by year of birth were somewhat higher in the EPPS than in ENPS-II. 7% of infant deaths were mentioned in one survey but not in the other survey, most of which were omitted in ENPS-II. Agreement was good between the two surveys for number of surviving children by year of birth, however. The total fertility rate for women aged 15-49 was 4.5 for both surveys. Irregularities in age-specific fertility rates were rare. Most women not using contraception in 1992, who intended to use contraception in the future (>60-85%), had indeed used contraception during 1992-1995. Predictors of intention to use contraception were urban residence and secondary education or higher.

[Male contraception by testicular heating]


In Toulouse, France, nine healthy men volunteered to have their testicles elevated to the level of the inguinal canal and held in place with either modified underwear (3 men) or a flexible ring/strap (6 men) so clinical researchers could evaluate the contraceptive effectiveness of this testicular heating method. Eight of the partners of these men had had at least one child. The three men using modified underwear (technique 1) had 42 cycles and the six using the other method (technique 2) had 117 cycles. The mean number of mobile sperm in the technique 1 group was 1.86 million/ml. 41% of records of detailed examination of sperm had a mobile sperm count of no more than 1 million/ml. One pregnancy occurred during the second cycle after the man started using the method again after stopping it for 7 weeks. The sperm count at the time of conception was 10.4-19.3 million/ml. The Pearl Index rate for technique 1 was 28.6 per 100 years. Technique 2 had a lower level of mobile sperm than technique 1 (0.12 vs. 1.86 million/ml). 11.3% of the readings were azoospermic. 86% of records had a mobile sperm count of no more than 1 million/ml. No pregnancies occurred. No man in either group had secondary effects or quit using the method for intolerance. The libido was not affected. Sperm counts returned to normal within 6-18 months. All the men who wanted to become a father indeed had no problem becoming one. The mean duration of use was 17 months, suggesting that the hyperthermia method was acceptable.

Patterns and determinants of maternal nutritional status during lactation in Malawi.


A doctoral student analyzed anthropometric data collected during December 1986-July 1987 in a rural area of northern Malawi to understand the conditions under which lactational depletion can occur and to develop a tool for identifying women at risk of lactational depletion. The study area was characterized by poverty and seasonal food insecurity. Mothers of infants who weighed less than 3 kg experienced net weight loss from conception to parturition, suggestive of energy depletion associated with pregnancy. Season strongly influenced the pattern of weight change during pregnancy. Mean arm circumference, skinfold thicknesses, and arm muscle and fat areas fell markedly during the last half of pregnancy and increased during early lactation. These physiological changes occurred regardless of season of delivery, maternal body mass index (BMI) after delivery, or infant birth weight. Maternal weight had a negative association with infant weight velocity. Supplementary feeding with non-breast milk foods reduced this effect. Lactation-induced maternal weight loss was greatest in women who had smaller arm circumferences and who were poor. Improved nutrition of vulnerable mothers would help maintain maternal energy stores from the effects of breast feeding. It would also increase the benefits from promotion of breast feeding. The best predictor of energy deficiency (i.e., BMI <18.5 kg/sq. m) was postpartum BMI. Since arm circumference compared favorably to BMI and is simpler and less expensive to measure, health workers in many situations may prefer it.

User satisfaction and characteristics of women who use Norplant at selected community health centers in rural southern Illinois.


In the early 1990s, in southern Illinois, a graduate student mailed a questionnaire to 377 Norplant users aged 14-44 attending community health centers in Anna, Murphysboro, Carterville, and Carbondale to examine user satisfaction and characteristics of Norplant acceptors and why they chose Norplant. The student was able to use only 150 of the 177 questionnaires returned. The community health centers served primarily low income women from a multi-county region. 85% of the Norplant acceptors who responded to the questionnaire were White. Mean parity was 1.53. Most women accepted Norplant during the postpartum period. Easy to use/convenient was the leading reason for choosing Norplant and what they liked most about Norplant (41.2% and 44.8%, respectively). Menstrual changes were what women liked least about Norplant (68.5%). 79.2% of Norplant acceptors were still using Norplant, 66.9% of whom intended to continue using it. 70.1% were satisfied with Norplant. 76.3% of women still using Norplant would recommend it to a friend. 61.9% would use it again. 64% of the women who used Norplant for less than one year were satisfied with Norplant compared to 61.9% for current users who used Norplant for at least one year. Among short-term users, satisfaction levels decreased as the number of months used also decreased. The leading reasons for Norplant discontinuation were menstrual changes (34%), headaches (17.8%), and weight gain (13.6%). 70.9% of the women who discontinued Norplant use had used it for at least one year before discontinuation (mean duration, 14.1 months). 13.8% of respondents did not receive adequate information on Norplant before insertion. These findings suggest that most Norplant acceptors were satisfied with Norplant, intended to either continue to use it, or to use it again.

A case-control study of the effectiveness of BCG vaccine for preventing clinical leprosy in Yangon, Myanmar.


A doctoral student conducted a study in Yangon, Myanmar, of 245 persons aged 6-24 years listed in the National Leprosy Registry who were actively being treated for leprosy during December 1992-April 1993 and of 245 controls matched for age, sex, and neighborhood. She aimed to evaluate the effectiveness of BCG vaccine in preventing leprosy. The overall effectiveness of BCG vaccine against leprosy was 66%. Vaccine effectiveness increased with the number of doses (55% for 1 dose, 68% for 2 doses, and 87% for 3 doses). The effectiveness of one dose of BCG vaccine against leprosy in this study was much higher than that obtained in a clinical trial conducted in the early 1980s (55% vs. 21%). The BCG vaccine was most effective against paucibacillary disease (74% vs. 57% for multibacillary), but the confidence intervals overlapped. The greater odds of having leprosy were related to being older than 12 months at administration of the first dose of the BCG vaccine (odds ratio = 1.68). If BCG vaccine had not been administered, the estimated number of leprosy cases in Yangon among persons aged 6-24 would be 1.75 to 5 times higher. These findings and those from other studies worldwide indicate that Myanmar public health officials should use BCG vaccine as a tool for leprosy control.

Fathers of children born to adolescent women: the impact of family of origin on paternal behavior.


In Northern California, a doctoral student conducted a study of 52 unmarried men who each fathered a child with a woman aged 13-19 to examine the relationship between a father's perceived family functioning and paternal involvement. She recruited them at various programs providing job placement or continuing education services or at public places. Frequency of father's visitation, amount of financial involvement, and father's involvement in family tasks around the house, in decision making, and in child care were used to assess paternal involvement. Family acceptance of the father's child and the mother of his child was the only significant predictor of father visitation and financial involvement, family tasks, decision making, and caretaking, even when the father was involved in high risk behavior. The second best predictor of the father's involvement in family tasks around the house was effective problem solving skills, even when the father had high risk behavior. Underreporting by participants may account for the relative lack of influence of the father's involvement in high risk behaviors. The fathers wanted to be more involved with their children born to adolescent mothers than they were. These findings show that father's family's acceptance of the father's child and the mother of his child and the father's problem solving skills were the two most critical factors affecting paternal involvement.

Causative factors in first trimester abortion failure.


Induced abortion at a gestational age of no more than 10 weeks has been legal in Turkey since 1982. During 1989-95 there were 42 cases of abortion failure among the 23,000 abortion performed for an abortion failure rate of 0.18%. Eight of the abortion failure cases had unsuspected uterine anomalies. Two had an IUD in situ. Seven cases exhibited uterine malposition (2 anteverted and 5 retroverted). Two cases had benign tumors in the smooth muscle of the uterus. None of the remaining 25 women had a genital disorder. 10 of these 25 women had gestations greater than eight weeks. Suction curettage followed by sharp curettage were performed on these 10 women. Only suction curettage was performed on the remaining 15 women. 13 of these 15 women had a gestation of less than 6 weeks. 40.5% of all abortion failure cases exhibited some type of anatomic distortion of the uterus. Providers should rule out ectopic pregnancy and consider other causes of abortion failure when an induced abortion fails, when scanty tissue is removed, or when they doubt the abortion was complete. The researchers advised their colleagues to conduct a meticulous pelvic examination before the abortion, to accurately determine gestational age (preferably by last menstrual period), and to use an appropriately sized suction cannula.

Pakistan: focus on women's issues.


In April 1996 at the senior officials' segment of the 52nd Session of the Economic and Social Commission for Asia and the Pacific (ESCAP), a representative of Pakistan informed participants that population well-being efforts are part of the means used in implementing Pakistan's Social Action Programme. The Minister of State for Parliamentary Affairs noted that US$3 billion has been allocated to the Programme for implementation during the Eighth Five-Year Plan (1993-1998). The Programme aims to develop human resources and to improve the quality of life of the population, using life expectancy, access to primary health care, and literacy as indicators of quality of life. A key target group of the Programme is women. The Programme includes education, health, nutrition, training, and employment projects. In Pakistan, the mass media are contributing greatly in effecting the social change required to increase participation of women in economic activities.

Beliefs about Depo-Provera among three groups of contraceptors.


During May 1993-October 1994, interviews were conducted with 836 women aged older than 15 attending family planning clinics in Dallas, Texas; Pittsburgh, Pennsylvania; and New York City serving mainly low income women to compare their beliefs about Depo-Provera. 54% of the women chose Depo-Provera as their reversible contraceptive method. 34% chose Norplant. 12% chose oral contraceptives (OCs). Depo-Provera acceptors gave Depo-Provera a higher rating for contraceptive effectiveness than the Norplant and OC acceptors (4.52 vs. 4.08 and 3.92, respectively; p < 0.01). Nevertheless, all three groups considered Depo-Provera to be effective in preventing pregnancy. They were also more likely to give it a higher rating for convenience than the other groups (4.52 vs. 3.33-3.41; p < 0.01). The three groups gave essentially the same rating for the number of side effects of Depo-Provera (2.77-2.93). Depo-Provera users were less likely to associate Depo-Provera use with acne and long-term health problems (p < 0.01). OC users considered Depo-Provera to be much more risky than the other two groups (p < 0.01). OC and Norplant users were more likely to believe Depo-Provera to be painful than Depo-Provera users (40% and 29% vs. 20%, respectively; p < 0.01). They were also more likely to consider Depo-Provera to be expensive than the Depo-Provera group (15% and 19% vs. 10%, respectively; p < 0.01). More than 50% of women from each group knew that menstrual changes were associated with Depo-Provera. The researchers were surprised that this proportion was not higher, since this side effect is indeed associated with Depo-Provera.

Sexual activity during and after pregnancy.


In Nnewi, Anambra State, Nigeria, trained nurses interviewed 352 pregnant women aged 16-40 attending the prenatal clinic of Nnamdi Azikiwe University Teaching Hospital and Summit Specialist Hospital over a six-month period so an obstetrician-gynecologist could determine the frequency of sexual activity during pregnancy and after childbirth. Coital frequency was slightly higher after childbirth than during pregnancy (1.7 vs. 1.5 times/week). Neither social class nor age influenced coital frequency. Primigravidae were more likely to have sexual intercourse than women of parity 4 and above (33.5% vs. 6.8-10.8%; p < 0.05). 69.9% of the women experienced vulval itching. Vulvo-vaginal candidosis accounts for the high incidence of vulval itching. Vulval itching had no effect on sexual activity for 46.3% of these women. 29.3% of women with vulval itching suffered enough discomfort to abstain from sexual intercourse. 18.7% of vulval itching cases suffered from painful intercourse. 48.7% of all women resumed sexual relations 6-11 weeks postpartum (range, 3 days to 84 weeks). The leading reason for late resumption of sexual intercourse during the postpartum was family planning (41%). Overall mean resumption time of sexual activity was 16.5 weeks. It ranged from 3.2 weeks for reasons of pleasure to 41 weeks for breast feeding/cultural reasons. These findings suggest that these pregnant women had a very positive and purposeful attitude towards sexuality. Providers should consider this attitude when they advise pregnant women on management of sexuality. The high level of vulval itching indicates a need for routine screening for sexually transmitted diseases including HIV infection.

Luteinizing hormone releasing hormone agonist for postpartum contraception.


In Mexico, staff of the obstetrics-gynecology department of the University Hospital in Torreon, Coahuila, took early morning urine samples from 39 breast feeding women to measure estrone and pregnanediol levels in order to determine the effects of a luteinizing hormone releasing agonist (buserelin) on ovarian function. The study also examined the effects of buserelin on bleeding patterns and breast feeding patterns. The women were allocated to the group that either received no treatment (controls) (10) or buserelin once daily by nasal spray (cases). One group of cases received 300 mcg buserelin for more than 17 weeks (9), while the other group of cases received 600 mcg buserelin (20). Buserelin was the only contraceptive method used for the study groups. Most women receiving 300 mcg buserelin had an initial stimulatory phase estrone level during the first two weeks of treatment. These levels were much higher than those in controls (p < 0.05). After the initial rise, estrone levels fluctuated irregularly. In all cases, pregnanediol did not increase after the increase in estrone. No mother in the 300 mcg group ovulated. In the 600 mcg group, urinary estrone levels increased significantly when compared with controls and the 300 mcg group (p < 0.005). Two women in the 600 mcg group ovulated more than once. Buserelin appeared to have no significant effect on initiation of supplementary feeds and their number, total duration per day spent breast feeding, and the total number of breast feeds. All controls had menstrual bleeding. Only one mother in the 300 mcg group had three light bleedings, which were preceded by a high increase and decline in the estrone level without an increase in pregnanediol. Eight women in this group had amenorrhea. 14 women in the 600 mcg group had spotting. Two had light bleeding. Four had amenorrhea. No side effects associated with buserelin were reported. At no time during the study period did cases or controls experience estrone levels on par with menopausal levels. These findings suggest that buserelin may be a reliable, acceptable, and safe contraceptive method in lactating women.

UNFPA committed to ICPD goals.


In April 1996, at the 52nd Session of the UN Economic and Social Commission for Asia and the Pacific (ESCAP), a UNFPA representative told participants that recent series of international conferences have acknowledged that development must focus on meeting human needs. The increasing urban population is in need of education, housing, employment, health care, improved water supply, sanitation, and public transportation. Countries of the Asia-Pacific region must deal with meeting these urban needs over the next quarter century. Urban population growth and urban poverty are part of the global agenda for the 21st century. Future UNFPA aid will center on helping individual countries achieve the goals of the International Conference on Population and Development by 2015. These goals revolve around education (especially for girls); reducing infant, child, and maternal mortality; and providing universal access to reproductive health services. UNFPA aims to continue to work with governments, ESCAP, and nongovernmental organizations in reducing poverty through sustainable development in Asia and the Pacific.

Bangladesh indicators improving.


In April 1996, at the 52nd Session of the UN Economic and Social Commission for Asia and the Pacific (ESCAP), the delegate from Bangladesh reported improvements in various demographic indicators for Bangladesh. Infant mortality and maternal mortality have fallen to 84/1000 and 4.5/1000, respectively, while life expectancy at birth has risen to 58 years. The Expanded Programme of Immunization and expanded use of oral rehydration therapy have played key roles in improving child survival. The contraceptive prevalence rate is at about 45%. The total fertility rate has decreased from 4.3 to 3.4. The Government of Bangladesh has an action plan to improve the status of women by developing or redirecting political, economic, and social processes and institutions to enable women to participate in decision making at the family, community, national, and international levels. The number of elderly is rising and is rather large in absolute terms; so the Ministry of Social Welfare is addressing problems the elderly encounter. The government's social development policies are geared to minimizing poverty, improving living standards, and developing human resources.

Status of women must be at programmes' core.


In a speech at Rice University in the US, UNFPA's Executive Director stated that individual issues of women must be addressed before population and environmental issues can be addressed. For a long time, policy makers thought that providing women with accessible family planning services would control population. Reality is more complex, however. Women also need access to employment, education, and equal rights. About 50% of all couples in developing countries use contraceptives. The Executive Director mentioned that international meetings help maintain the focus on the interconnectedness between women's issues and sustainable growth. The International Conference on Population and Development, for instance, promoted women's rights as human rights. Religious and conservative groups objected strongly to this promotion because they considered it to be pro-contraception and pro-abortion. The Executive Director emphasized that nobody wants to promote abortion. The worldwide community needs to understand why abortions happen and to try to eliminate the underlying causes of abortion.

Population awards announced.


The 1996 Population Award will soon be bestowed on Philippine Senator Shahani and Pathfinder International. The Senator has been a key advocate for population policies and programs in the Philippines. She contributed greatly to the preparations for and deliberations of the 1994 International Conference on Population and Development. The Senator has also actively participated in the Asian Forum of Parliamentarians on Population and Development, the Global Committee of Parliamentarians on Population and Development, and the International Green Cross. Pathfinder International has invested in people and organizations dedicated to deliver family planning services to those most in need. This investment has initiated many improvements in family planning. Grants that Pathfinder International have provided were used to found 29 family planning associations. Pathfinder International had supported more than 2000 programs in more than 30 countries. These programs include training programs, technical assistance, adolescent programs, service delivery models, and integrated family planning and HIV/AIDS/sexually transmitted disease prevention programs.

Thai royalty honours four for family planning.


A committee of health specialists selected four physicians and scientists out of 66 candidates to receive the distinguished Prince Mahidol Award. The Thai Royal Family awarded each of them medals, certificates, and US$50,000 for their exceptional contributions to family planning. Her Royal Highness Princess Maha Chakri Sirindhorn presented the awards to each recipient on January 31, 1996. UNFPA's Executive Director, Dr. Nafis Sadik, was recognized for her leadership at the 1994 International Conference on Population and Development. IPPF President, Dr. Frederick Sai, who also serves as a public health professor at the University of Ghana, received honors for promoting family planning in Africa. Dr. Carl Djerassi, an organic chemistry professor at Stanford University in California, was selected for his research in developing oral contraceptives. Dr. Egon Diczfalusy, a retired professor of the Karolinska Institute in Stockholm, Sweden, was honored for his reproductive endocrinology research, especially his work on the reproductive system's steroid hormones. The Prince Mahidol Foundation serves to celebrate the birth of Prince Mahidol of Songkhla, the father of the King of Thailand and the Father of Thai Medicine.

Poverty linked with population says Chinese delegation.


In April 1996, at the senior officials' segment of the 52nd Session of the UN Economic and Social Commission for Asia and the Pacific (ESCAP), the Vice Foreign Minister from China told participants that excessive population growth along with many other adverse factors strongly hampers further sustained development of Asia-Pacific countries. Other adverse factors include environmental degradation, ecological imbalance, over-exploitation of resources, and an uncertain economic environment. Widespread poverty exists in the Asia-Pacific region. 730 million people, 25% of the region's population, live in poverty. This poor population makes up about 66% of the world's poor. Even though most poor people live in rural areas, urban poverty is expanding along with rapid urbanization. China has 65 million people living below the poverty line. The Chinese official endorsed ESCAP's work in poverty and population. The official backs the value of information activities.

The risks and benefits of contraceptive method regarding sexually transmitted infections.


The ideal contraceptive would protect against unwanted pregnancy and sexually transmitted diseases (STDs). Unwanted pregnancy and STDs tend to biologically prefer women and youth (i.e., <25 years old). Sexual abstinence is the only sure way to prevent these unwanted complications. For most people, however, a mutually monogamous relationship is more practical. Consistent correct use of a good quality condom is the method that best protects against STDs/HIV. Simultaneous use of a condom and a highly effective contraceptive method may provide protection against STDs/HIV and unwanted pregnancy in some relationships. Combined use should be practiced at least during the fertile period. First-year contraceptive failure rates are rather low for Norplant (0.09%), Depo-Provera (0.3%), combined oral contraceptives (0.1%), female sterilization (0.4%), and vasectomy (0.1%). Family planning providers should ask clients about their sexual history and behavior as well as consider their clients when they recommend specific contraceptive methods.

Emergency contraception -- a prescription for change.


Policy makers in the UK are considering deregulation of emergency contraception. Specifically, they are thinking about making it available through pharmacies without going through a physician first. This would improve access to emergency contraception, but keeps many young girls from making their first contact with a health provider. The family planning service of the North Mersey Community Trust in Liverpool, England, implemented a pilot project in April 1994 to improve access to emergency contraception and to simultaneously provide sex education. A proforma and a protocol on nurse administration of hormonal postcoital contraception were drafted. By the end of December 1993, all agencies had approved the proforma and protocol. The training program began in January 1994, which involves a senior nurse and a physician facilitating small group discussions. It aims to acquaint nurses with the final version of the protocol and the proforma. It also updates nurses on emergency contraception and general hormonal contraception as required. Family planning nurses in community clinics provide emergency contraception. A city center clinic (ABACUS) serves clients requesting family planning services from 9 am to 7 pm Monday through Friday and from 9 am to 3 pm on Saturdays. Beginning in January 1995, ABACUS provides emergency contraception in the absence of a medical officer. The entire medical team at ABACUS supported the pilot project. During the pilot project, minor changes in the proforma were identified. No nurse is forced to participate in distribution of emergency contraception. Nurses have requested a policy for allowing nurses to also provide oral contraceptives to women seeking emergency contraception. During March 1994-April 1995, the number of visits for emergency contraception increased from 1928 to 2712, indicating that the user friendly city center service and easier access to emergency contraception through nurses were successful.

[Migration and knowledge of AIDS in the rural Cameroon environment: comparison between men and women]


Individual interviews conducted during 1992-93 with 772 women 14-49 years old and 637 men 18-55 years old in 5 villages of Kadey Department in eastern Cameroon, where AIDS seroprevalence has been increasing rapidly, were the basis for this analysis of the relationship between migration and knowledge of AIDS. The 5 villages were of varying size, ethnic composition, religion, economic structure, and migratory pattern. 3/4 of both men and women had migrated for at least 6 months at some time, but the men migrated more frequently and were more likely to migrate to an urban area. 53% of men and 31% of women had spent at least 6 months in an urban area. 85% of men but only 68% of women knew about AIDS. 62% of men and 51% of women had correct knowledge of AIDS transmission. 33% of men and 16% of women knew about the protective role of condoms. Bivariate and multivariate analysis indicate that migration, differences between men and women, and interactions between the 2 types of variables are determinants of knowledge about AIDS. Multivariate analysis was used to study the relative influence of having or not having migrated, migrating to an urban or to a rural area, and number of migrations on knowledge of AIDS for men and women. Knowledge of the existence of AIDS was significantly affected by urban migration and by the interaction between sex and having migrated. A man who had migrated had almost 4 times the probability of knowing about AIDS as a woman who had never migrated. None of the factors concerning migration history or sex had a significant influence on correct knowledge of AIDS transmission. Migration increased both correct and erroneous knowledge of transmission. The fact of being a man tripled the probability of knowing about the protective role of condoms, while having migrated several times or having migrated to urban areas nearly doubled the probability.

[Ictus, pregnancy and contraception]


Ictus is a severe complication of pregnancy and the puerperium and a significant cause of maternal mortality. The risk of ictus increases by 3-13 times during pregnancy because of a tendency toward hypercoagulability, hemodynamic alterations related to increased blood volume, and severe arterial hypertension. This work outlines the incidence, etiology, diagnosis, and treatment of ischemic cerebrovascular pathology, cerebral venous thrombosis, and hemorrhagic cerebrovascular pathology occurring during pregnancy. Risk factors are indicated. The role of oral contraceptives (OCs) as a risk factor for cerebrovascular pathology is then discussed. Various prospective and retrospective studies to establish the causal or casual relationship between OC use and ictus have been published since 1962. Two important studies published in 1969 found a statistically significant increased relative risk of ischemic cerebrovascular accident in OC users. The Collaborative Group for the Study of Stroke in Young Women included hemorrhagic ictus in a retrospective study for the first time in 1973, finding that the risk of thrombotic and hemorrhagic cerebrovascular accident was significantly greater in OC users. In 1975, using the same sample, the group found a positive relation between increased blood pressure and risk of ischemic and hemorrhagic events in OC users. The largest prospective study, begun by the Royal College of General Practitioners in England in 1968, found an increased risk of mortality from circulatory diseases in OC users, with mortality risks for coronary ischemia and subarachnoid hemorrhage statistically significant. The study found that the use of OCs increased the risk of fatal subarachnoid hemorrhage, especially in women over 35 who smoked. Other prospective studies found an increased incidence of nonfatal cerebrovascular accident, with relative risks for all cerebrovascular accidents ranging from 5 to 6.5. A recent continuation of the Royal College Study found that patients using OCs had a relative risk for cerebrovascular accidents of 1.5. The risk was increased at higher doses and for some specific progestins.

[The role of CERPOD in the development of population policies in the Sahel]


The mission of the Center for Study and Research on Population and Development (CERPOD) in the development of population policies for Sahel countries was reinforced by the 1989 Program of Action of Ndjamena for Population and Development in the Sahel. CERPOD's role must be adapted to the level of policy development in the region and within each country. The first major phase of population policy development is raising the awareness of decision makers concerning interactions between population and development. Chad, which has not conducted a general census, is the least advanced Sahel country in policy development. Senegal in 1988 became the first to complete the second phase, development and adoption of a population policy. Burkina Faso and Mali followed in 1991 and Niger in 1992; all are now at the third stage, developing programs of action and identifying investment priorities. No Sahel country has reached the fourth stage, implementation of the program of action, or the fifth stage, evaluation and follow-up. Cape Verde, Gambia, Guinea-Bissau, and Mauritania are still at the first stage. CERPOD contributes technical assistance to development of national population policies, usually at the request of the country. For the first stage, CERPOD helps conduct censuses and demographic surveys to provide data, and helps organize seminars on the theme of population and development. At the second stage, CERPOD helps develop facilities and train personnel to develop population polices, and assists with preparation of the document. As Sahel countries arrive at the stage of execution of action plans, CERPOD will train personnel, assist in IEC, and conduct studies and research. Most of the Sahel countries are expected to arrive at the evaluation stage between 1993 and 1997. CERPOD will play a leading role in coordinating population policies within the region, especially in response to problems such as international migration and the spread of AIDS that transcend national borders.

source: www.popline.org