UN Population Division, Department of Economic and Social Affairs,
with support from the UN Population Fund (UNFPA)
|
| UN Population Division, Department of Economic and Social Affairs, with support from the UN Population Fund (UNFPA) |
|
Population Network News
No. 3, April 1993
Part IV
Demographic and Health Survey Results: Cameroon
----------------------------------------------------
The final report of the Enquete Demographique et de Sante au Cameroun
(EDSC), 1991 demonstrates that Cameroon is a relatively high fertility
country, with a total fertility rate of 5.8 children per woman, declining
somewhat from an estimated TFR of 6.4 from the 1978 World Fertility
Survey. The most striking characteristic of fertility in Cameroon is the
very young ages at first birth: over one half of those women surveyed
indicated they had borne a child before the age of nineteen. This young
age at first birth corresponds to a young median age at first marriage
(about age 17) and an early start to sexual relations (one-half of the
women interviewed indicated that they had experienced sex before age 16).
Contraceptive prevalence is low in Cameroon: only 4 percent of women use
a modern method while 20 percent use some method. However, that
prevalence may increase if family planning programs are expanded, given
that the desired number of children expressed by the women (5.2) is lower
than the current TFR (5.8).
Demographic and Health Survey Results: Namibia
-----------------------------------------------
The preliminary results from the 1992 Namibia Demographic and Health
Survey (NDHS) indicate a wide variation in fertility by region, with
fertility rates in the north much higher than those in the south (the TFR
for the Northwest region is 6.7, versus 6.0 in the Northeast, and 4.1 in
the Central/South region). The average TFR for the country is 5.6, in
line with the average for the Bank-defined Southern Africa region (AF6).
Contraceptive prevalence is still low in Namibia, with one-fourth of
married women of reproductive age using some sort of contraceptive (22
percent use modern methods, while 4 percent use traditional methods).
The pill is the most commonly used method, followed by injectables and
sterilization.
Demographic and Health Survey Results: Rwanda
------------------------------------------------
Preliminary data from the 1992 DHS for Rwanda suggests a TFR for the last
4 years of 6.2. The fall in fertility from a TFR of 8.3 in 1983 is one of
the most drastic declines observed in sub-Saharan Africa. Available data
suggest that over the last ten years there have been increases in the use
of contraceptives (currently used by 21 percent of married women of
reproductive age) and the age of first marriage.
Ecuador: Final Results of the U.S. Centers for Disease
Control and Prevention Survey of Family Planning and Child
Survival, 1989
-----------------------------------------------------------
This survey is the third of its kind to be conducted in Ecuador since
1982. The survey data imply a TFR of 3.8, falling 13 percent from an
estimated 4.3 in the 1987 survey. Contraceptive prevalence has increased
correspondingly in the 1980s, from about 40 percent in 1982 to 53
percent in 1989. The rapid decline in fertility appears to be caused
primarily by fertility control within marriage and later age at marriage.
The CDC believes that increased levels of educational attainment have
also played a significant role in bringing about declines in fertility.
As in most developing countries, fertility in Ecuador is higher among
rural women, women with less education, and women in lower socio-economic
households.
The survey also included a special module for women between the ages of
15 and 24, designed to learn about the attitudes, sexual experience, and
use of contraception by young Ecuadorians. The results indicate that 23
percent of young adult women in Ecuador have premarital sex, with those
in the 20-24 age bracket twice as likely as 15-19 year-olds to have
engaged in sexual activity before marriage (32 percent versus 15
percent). Use of contraception at the time of first intercourse is rare
in Ecuador: only 5 percent of the women responded that they or their
partner used a contraceptive.
Publications of Note
---------------------------
Huezo, Carlos M. and Catherine Briggs (IPPF): Medical and Service
Delivery Guidelines for Family Planning. This small handbook gives
practical guidelines intended for IPPF service providers on contraceptive
counselling, training, and the various forms of modern contraception. In
addition to these chapters, the manual provides a chapter on the rights
of the client, which embody IPPF's approach to ensuring quality
of care in its services.
Johnson, Brooke R., et. al.: Costs of Alternative Treatments for
Incomplete Abortion, WPS 1072 (January 1993). In this paper, the authors
explore the potential cost savings that could be achieved by replacing
the dominant method of treating incomplete abortion in developing
countries, dilation and curettage (D&C), with manual vacuum aspiration
(MVA). While finding that MVA does generally involve a shorter patient
stay and fewer hospital resources than D&C, the authors conclude that the
full benefits of adopting the procedure also depend on making certain
changes in patient-management practices.
Zinanga, Alex F.: Development of the Zimbabwe Family Planning Program,
WPS 1053 (December 1992). This paper charts the evolution of family
planning in Zimbabwe from its beginnings as a voluntary movements in the
1950s, through government involvement in the 1960s, to full government
control of the program following independence in 1980. Since
independence, the family planning program in Zimbabwe has contributed to
a remarkable increase in contraceptive prevalence from 14 percent in 1982
to 43 percent in 1988. The author reviews the elements of that success
and notes the many aspects of the program that will need reinforcing in
the future if the past progress is to be maintained or continued.
Arroyo, Cristino R., III: Economic Approaches to Modeling Fertility
Determinants: A Selective Review. The author reviews models of
fertility in which the fertility decision is regarded as the outcome of
economic choice behavior. He considers, separately, two classes of
models: static lifetime fertility models that explain lifetime fertility
aggregates, and dynamic-stochastic fertility models that analyze
intertemporal or intergenerational decision on birth-timing and
birth-spacing. Arroyo examines the theoretical specifications and
econometric implementation of these models, concluding that for the most
complete treatment of fertility issues, the analyst should adopt a
dynamic-stochastic view of the fertility decision.
---------------------------------------------------------------------
PNN is a quarterly round-up of news and information relevant to Bank
staff working in the population field. It is produced by the
Population, Policy and Advisory Service (PPAS) and edited by Chantal
Worzala.
--Boundary (ID a+n3UJJOFTM3At2IqL7XpQ)
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archive PHNFLASH PNN3C Population News
Population Network News
No. 3, April, 1993
Part III
Bank Veteran Sai to Receive U.N. Population Award
---------------------------------------------------
On February 18, 1993, the United Nations announced that Dr. Fred Sai of
Ghana will receive the 1993 United Nations Population Award. The award
honors individuals and institutions that have made outstanding
contributions to increasing public awareness of population problems and
their solutions. According to the U.N., Dr. Sai was chosen for "his
leadership in the field of family planning. He is noted for his
contributions to research on nutrition, community welfare and family
planning, and for his direct involvement in both national and
international programs that address the problems of high fertility
throughout Africa and the developing world." Dr. Sai will share the
award with the Mainichi Shimbun, Population Problems Research Council of
Japan, which publishes a newspaper, studies, books, and articles on
population. The award will be presented at a ceremony later this year.
Dr. Sai was Population Adviser for the Bank from January 1985 to July
1990. During that time he greatly increased the awareness of
member-country governments of population issues, especially in Africa.
Other achievements of Dr. Sai's distinguished career include serving as
Chair of the Main Committee of the 1984 World Conference on Population
and chairing the WHO/UNICEF Meeting on Infant and Young Child
Feeding. The findings of the latter meeting provided the impetus for the
establishment of the International Code of Marketing for Breast-Milk
Substitutes. Dr. Sai has been president of the International Planned
Parenthood Federation (IPPF) since he left the Bank.
STDs and Family Planning
---------------------------
Although the fields of sexually transmitted disease (STD) prevention and
family planning are logically linked as facets of reproductive health
that rely on contraceptive methods, the family planning and STD
prevention communities have not always worked together. The reasons for
the distance between these two fields and ways of integrating them were
the topic of discussion at two sessions with Dr. Ward Cates of the
Centers for Disease Control: one the lunch-time session at the Safe
Motherhood Seminar held on March 4, the other at a brown-bag lunch on
March 5, sponsored by the AIDS Working Group.
Dr. Cates' lively presentations (which included questions of personal
experience with various contraceptive methods) made clear the ways in
which current contraceptive methods tend to work best for either STD or
pregnancy prevention - - but rarely both (with the exception of
abstinence). Although Dr. Cates offered no panaceas for those concerned
about reconciling the two fields, the trade-offs between pregnancy and
STD protection involved in individual contraceptive choice were laid out,
facilitating the analysis of sound program design. A recent two-part
series by Dr. Cates and Katherine M. Stone, also of the CDC, entitled
"Family Planning, Sexually Transmitted Diseases and Contraceptive
Choice: A Literature Update," reviews the scientific literature on the
STD and pregnancy protection offered by specific contraceptive methods:
Parts I and II of the article appeared in the March/April and May/June
1992 issues of Family Planning Perspectives, respectively.
Population NGOs Special Grant Program
-----------------------------------------
The Population NGOs Special Grant Program is one of ten special grant
programs managed by the PHN department. Unlike the others, which fund
mostly single interagency groups such as the Global Program on AIDS or
the Program on Human Reproduction Research and Research Training
(HRP), the Population NGOs Special Grant program provides relatively
small grants to NGOs for service delivery or research in the fields of
family planning and reproductive health. The grant program committee,
with input from operations staff, has recently adopted a new statement of
purpose, which lays out the goals of the program: to identify and
strengthen the capacities of small, grassroots, indigenous NGOs working
in population-related fields in developing countries; and to fund new,
integrative approaches to demand creation and service delivery.
Replicability and potential for future involvement in Bank population
work are important criteria for judging proposals.
Due to the high administrative costs of managing numerous small grants,
the committee has agreed to use intermediary organizations to grant the
funds to NGOs and supervise their use. The first organization to serve
as an intermediary will be the Global Fund for Women, which will provide
grants of between $5,000-10,000 to small family planning and women's
groups throughout the developing world. The Global Fund for Women has an
excellent track record in providing early, catalytic grants to
organizations which make a difference by looking at all aspects of
women's status and their role in development, including family planning,
reproductive health and rights, violence against women, and income
generation. One example of the numerous groups funded by the Global
Fund for Women is the Anti-Early Marriage Women's Association in Nigeria,
which works to change legislation permitting early marriage and carries
out community-based programs to stop the practice. Early marriage can
result in high birth rates and high maternal mortality rates among very
young girls.
Other grants made by the Population NGOs SGP during FY93 include support
to the Program for Appropriate Technology in Health (PATH) for field
testing of a visual detection devise for cervical cancer (the Gynescope);
support of technology transfer in the production of Cyclofem, a
once-a-month injectable contraceptive, by the Concept foundation; support
of the U.N. Contraceptive Requirements and Logistics Management Needs
Initiative; and co-funding with the Safe Motherhood Special Grant
Program of an IEC replicability study undertaken by Marie Stopes
International.
African Development Bank Adopts New Population Policy Paper
-----------------------------------------------------------
On March 30, 1993, the board of the African Development Bank (AfDB)
approved a new Policy Paper on Population and Strategies for
Implementation. The statement will be used to guide the expansion of
that Bank Group's activities in population and give its member countries
a framework within which to expand their own population policies and
programs. The paper recognizes the demands rapid population growth is
putting on the scare public resources of many African countries, adopts
the fulfillment of unmet need for family planning services to both space
and limit childbearing as a goal, insists that services provided on the
continent should respond to the African sociocultural milieu, and seeks
to encourage a policy climate that allows women, men, and couples to make
free, informed decisions about their family size. In order to achieve
the goal of meeting unmet demand and increasing contraceptive prevalence
to 60 percent by 2025, the AfDB intends to ensure that financing
is available for family planning and human resources development
programs. Specific strategies include assisting in the development of
national population policies, building institutional capacity of member
countries in the area of population and family planning, and improving
the scope and quality of new and existing reproductive health services.
Internally, the AfDB will build its own capacity in population, and
emphasize coordination with other sectors and other donors.
U.S. Policies on International Population
Assistance Liberalized
-------------------------------------------
Since the election of Bill Clinton as President, U.S. policy toward
international population assistance has eased and more attention is
expected to be focused on the issue. Soon after his inauguration,
President Clinton signed an executive order rescinding the "Mexico City
Policy" adopted in 1984 by President Reagan, which stated that the U.S.
would not fund any organization which promoted or performed abortions.
This measure had led the U.S. to discontinue funding to IPPF. With the
new Clinton policy, the U.S. will begin funding this agency again. Still
unknown are the implications of two related amendments to the Foreign
Assistance Act. The Hyde Amendment bars U.S. funding of actual abortion
services, although it allows U.S. funds to support other aspects of the
work done by groups providing abortions, while the Kemp-
Kasten Amendment prohibits funds for any program or organization that
"supports or participates in management of a program of coercive abortion
or involuntary sterilization." This amendment led the Reagan
administration to withdraw funding from UNFPA, on the grounds that it
allegedly supports coercive family planning programs in China. While
President Clinton does have the authority to determine that UNFPA meets
the criteria for funding under the Kemp-Kasten amendment without the
approval of Congress, the amendment will probably be used in court to
challenge a March 31 Administration request for at least $20 million to
fund UNFPA next fiscal year.
Female Contraceptive News
--------------------------
Reality, a female condom, has received official FDA clearance as
both a contraceptive and an STD prevention device and is expected to be
sold in the U.S. market as early as next fall. The female condom has the
advantage of being woman-controlled. It has the disadvantage of being
relatively more expensive than male condoms (the expected market price
of the Reality condom in the U.S. is between $2.25 and $2.50; male
condoms cost about $0.75). A similar product is already on the market in
England, were it is reportedly selling better than marketers had
originally expected it would.
As reported in Openfile (February 1993), scientists in India and
China are both working to develop abortifacients similar to RU 486. The
Indian Institute of Chemical Technology has already developed the drug
which will soon be ready for commercial production at prices below the
cost of importing RU 486 from France. The Shaghai No. 12 Pharmaceutical
Plant in China is already producing a version of RU 486.
Research studies in Scotland and England have found Mifepristone
(RU 486) to be a safe and efficacious post-coital contraceptive. In
controlled studies, researchers found that in comparison to women using a
post-coital contraceptive based on oral contraceptive pills, women using
Mifepristone were less likely to become pregnant and less likely to
report side effects other than irregular menstrual patterns. They were,
however, more likely to experience irregular bleeding.
In 1991, the Indian government approved a weekly combined
contraceptive pill. Sold under the brand names of Saheli and Centron,
the drug is considered more safe and less expensive than other combined
pills. A recent report in Outlook (December 1992) indicates that
although the drug has been approved and the Ministry of Health and Family
Welfare has indicated that it will distribute the pill, the supply and
promotion of the contraceptive has been limited.
According to the Population Council, NORPLANT has been approved by
regulatory agencies in 24 countries and by family planning programs in
three others. The countries with the largest number of users are
Indonesia, with over 1 million users, and the U.S., with about half that
many.
Male Contraceptive News
--------------------------
Recent studies published in the Journal of the American Medical
Association (JAMA) indicate that there is a 60 percent greater risk of
prostate cancer among men who have had a vasectomy, with the relative
risk increasing with time since the procedure. While the studies are of
high quality, they do not prove a causal relationship between vasectomy
and prostate cancer, and follow in a long line of studies showing no
correlation between vasectomy and prostate cancer. Indeed, WHO convened
a meeting in 1991 to review the available biological and epidemiological
evidence on the safety of vasectomy in regard to prostate and testicular
cancer and found no substantial evidence of a link. Nevertheless, WHO is
currently supporting studies on any possible associations between
vasectomy and cancer in developing countries.
Debate on the appropriateness, feasibility and acceptance of male
contraceptive methods appears academic in light of the recent findings
from Danish researcher, Dr. Niels Skakkebaek. Reviewing the literature of
the last 50 years his research suggests a decline in both the quality and
quantity of sperm. This, coupled with a marked increase in testicular
abnormalities, is cause for concern. The causal factors that have been
implicated include: pollution, irradiation and disease, malnutrition,
socioeconomic status, chronic stress, emotional deprivation, altitude,
smoking, alcohol, drug abuse, and occupational noxious agents such as
heavy metals, pesticides, narcotics, cyctostatics, antimetabolites and
radiation.
Education and Fertility: Evidence from Pakistan
--------------------------------------------------
In a paper to be presented at the IUSSP's Twenty-Second International
Conference on Population in August 1993, Zeba A. Sathar (Pakistan
Institute of Development Economics) and Karen Oppenheim Mason (East-West
Center) discuss recent evidence on the impact of education on the
fertility of urban women in Pakistan. Their findings indicate that
urban women with more education do have fewer children than their less-
educated and rural counterparts. The analysis suggests that increased
education not only raises the age at marriage and encourages
breast-feeding (both of which lead to reductions in overall fertility),
but also change women's reproductive intentions and behavior toward
limiting family size within marriage. The intermediate variables that
help explain this phenomenon include higher-earning husbands and formal
sector employment. The study also identified a birth cohort effect which
may represent less quantifiable characteristics such as changes in values
or opportunities outside the labor market. It appears, however, that the
negative relationship between education and fertility in Pakistan may
take place only in urban areas, where there are more labor force
opportunities for women and less traditional cultural forces. The
authors suggest that, at least in the short-term, increasing educational
opportunities for rural women in Pakistan will have some effect on
fertility through delayed marriage, but is not likely to lead to
increased fertility control within marriage or increased use in
contraceptives, as seen in the urban areas.
---------------------------------------------------------------------
PNN is a quarterly round-up of news and information relevant to Bank
staff working in the population field. It is produced by the
Population, Policy and Advisory Service (PPAS) and edited by Chantal
Worzala.
--Boundary (ID a+n3UJJOFTM3At2IqL7XpQ)
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archive PHNFLASH PNN3B Conferences/Meetings/Training
Population Network News
No. 3, April 1993
Part II
Cincinnati Site of Population
Association Meeting
------------------------------------
>From April 1-3, 1993, demographers, researchers, and population
professionals alike met for the annual meeting of the Population
Association of America. This was the second largest PAA meeting ever,
with 1,216 participants registered at last count. Over 500 papers were
presented, ranging in subject from theoretical models of the European
demographic transition, to coping with the need to integrate STD
prevention and treatment services into family planning programs, to
measuring the impact of health insurance on the health of the poor in the
U.S. Bank staff input was considerable, with one session, "Evaluating
Whether Family Planning Programs are Effective and What Makes Them So,"
chaired by R.A. Bulatao (PHN:Population, Health Nutrition Dept),
and another session, "Costs of and Demand for Family Planning
Services: Sustainability of Public and Private Programs," having
Susan Cochrane (PHN) as a discussant. Other Bank staff who presented
papers include Nancy Birdsall, Martha Ainsworth, Elizabeth King, Mead
Over, and Ernest Massiah. One highlight of the meeting was the
Presidential Address, in which the PAA president, Albert I. Hermalin
(University of Michigan), emphasized the emerging importance of aging as
an area of concern for researchers and practitioners in both developed
and developing countries.
International Conference on Population and
Development (ICPD)
-------------------------------------------
Preparations for the 1994 Conference continue apace, with the Second
Meeting of the Preparatory Committee (PrepCom) to take place from 10-21
May, 1993. Key decisions will be made at this meeting regarding the role
of NGOs in the conference and the conceptual framework of the conference
document. Participants at the Second PrepCom will also consider the
recommendations proposed during the expert group and regional meetings
preparatory to the ICDP 1994. In addition to the meetings described in
past editions of PNN, one expert group meeting and two regional meetings
have taken place in recent months, leaving only one regional conference,
for Latin America and the Caribbean, yet to occur. That conference is
scheduled for 20 April - 4 May, 1993 in Mexico City.
The Expert Group meeting on Population Distribution and Migration took
place in Santa Cruz, Bolivia from 18-22 January. The discussion focused
on four broad areas: population distribution and internal migration;
international migration; refugees; and data and research needs in these
areas. The resultant 37 recommendations considered the rights and
responsibilities of both individuals and governments in issues concerning
internal and international migration patterns.
Migration was also a central concern at the European Population
Conference, which was held in Geneva from 23-26 March. According to Ok
Pannenborg, who represented the Bank at the Conference, the issue of
migration from Eastern European countries, and especially from the
countries of the former Yugoslavia, dominated the country statements,
leaving little room for discussion on the 1994 ICPD. Discussions of
international population assistance indicated that support for such
programs will continue, but may not meet projected needs.
The Population Conference for the Arab World took place on 4-8 April in
Amman, Jordan. The objectives of the conference were to review
population-related activities in the Arab countries, evaluate the
implementation of population-related policies in those countries, and
prepare a set of recommendations addressing key issues and policies in
the region. Mr. Koch-Weser, Vice President of the MNA region, spoke at
the conference; highlights of his speech are given in the facing box.
The Population Working Group
---------------------------------
Since the beginning of the year, the Population Working Group (PWG) has
held three meetings, as summarized below.
February 24, 1993: Dr. Nicholas Dodd and Mr. Robert Burn of UNFPA came
to discuss the UNFPA-led and Bank-funded Contraceptive Requirements and
Management Needs Assessment Initiative with members of the Bank staff.
Over 30 people attended the seminar, which provided the staff with
a chance to both influence the direction of the initiative and learn how
to coordinate their own work with that of UNFPA. The major foci of
debate during the seminar were: the use of demographic targets versus
measures of unmet need as the variable to determine contraceptive
requirements; local production of contraceptives; financing mechanisms
for contraceptive supplies; and future directions for the initiative.
March 22, 1993: At the kind invitation of Maria MacDonald and Janet
Hohnen (World Bank ), Dr. Carlos Huezo, medical director for the International
Planned Parenthood Federation (IPPF) came to discuss the issue of quality
of care with Bank staff. The IPPF has undertaken many initiatives to
increase the quality of care provided by its affiliates, including the
preparation of quality of care guidelines. At the regional level,
IPPF/WHR has recently hired a regional quality of care advisor, Dr.
Marcos Arevalo.
April 5, 1993: Dr. Jane Bertrand, Tulane University, presented a
framework for establishing and choosing evaluation indicators for family
planning projects. Dr. Bertrand has worked with the USAID Evaluation
Project and is co-author of the Handbook of Indicators for Family
Planning Program Evaluation prepared under that project.
Future seminars planned for this spring include:
April 23, 1993: Ms. Elizabeth Antarsh of the Association for Voluntary
Surgical Contraception (AVSC) will brief Bank staff on the work her
organization has done in counseling and sterilization training in the
former soviet republic of Georgia. This work was funded by the
Population NGOs Special Grant Program in FY92.
May 15, 1993: Andrew Foster of the East-West Center will present
evidence from his research on the impact of fertility on women's
education.
International Conference on
Post-Abortion Family Planning
--------------------------------
In early February 1993, an international Technical Working Group of
policy-makers, health care providers and women's rights advocates met in
Bellagio, Italy to discuss strategies to make preventive family planning
services more available and accessible to women who have undergone
abortion. The central tenet of the group's recommendations is that the
linkages between family planning and abortion care need to be improved.
High-quality family planning counseling and services should be available
to all women who have undergone abortion, while all family planning
facilities should be able to meet the needs of women who do not want
to become pregnant as well as those who are pregnant and do not want to
be, either by direct service provision or though referral. The group
also recommended that all abortion care facilities offer women either
information or services for contraceptive methods or referral to family
planning resources in the community.
The conference was convened by the International Projects Assistance
Services (IPAS), an international nonprofit organization that addresses
the global problem of unsafe abortion, and was attended by Anne Tinker
(PHN:Population, Health & Nutrition Dept.) The World Bank has supported
research and demonstration projects undertaken by IPAS in safe,
cost-effective treatment of incomplete abortion and in post-abortion
family planning.
---------------------------------------------------------------------
PNN is a quarterly round-up of news and information relevant to Bank
staff working in the population field. It is produced by the
Population, Policy and Advisory Service (PPAS) and edited by Chantal
Worzala.
--Boundary (ID a+n3UJJOFTM3At2IqL7XpQ)
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archive PHNFLASH PNN3A Population-Related Bank Work
Population Network News
No. 3, April 1993
Part I
Bank Projects Under Preparation
-------------------------------
* Guinea Health and Nutrition (Yellow Cover).
The government of Guinea recently adopted a population policy that
takes a multi-sectoral approach to addressing the problems associated
with an annual population growth rate of 2.7 percent. By integrating
family planning services into the public health system and encouraging
the private sector to work in this area, the government hopes to raise
contraceptive prevalence from 1 percent today to 25 percent by the
year 2010. The proposed sector credit will help in achieving that
goal by addressing family planning within broader health sector needs.
The project consists of two major components: expanding service
coverage and improving service quality; and strengthening sector
organization and management at local and central levels. Among the
specific subcomponents of the project is financing for the maternal
and child health and family planning program. In addition to
integrating family planning education and services into public health
facilities, this part of the project will finance two knowledge,
attitude, and practice (KAP) studies in the area of family planning
practice. The project is scheduled to go to the Board on May 25,
1993.
* Comoros Population and Human Resources (FEPS).
With a total fertility rate of 7.0 and per capita income of US$ 480 in
1990, Comoros is facing the double pressure of rapid population growth
and fiscal constraints. This project attempts to assist the
government in dealing with this situation by increasing the efficiency
and effectiveness of basic health services. The strategy includes
increasing community involvement in the delivery of services at the
district level and promoting complementary community development
activities. Family planning and AIDS control services will be
emphasized.
Bank Projects Approved to Date in FY93
--------------------------------------------
Many of the family planning and population-related projects that have
been approved to date in FY93 have been described in previous
additions of PNN. For example, the Iran Health and Family Planning
and Pakistan Family Health II projects, were described in PNN1.
Similarly, the Papua New Guinea Population and Family Planning and
Ecuador Social Development II projects appeared in PNN2. Other
population-related projects approved to date include:
* Indonesia Third Community Health: With the ultimate objective of
improving the infant, child and maternal health status of five
provinces in Indonesia, this project will build the institutional
capacity to plan, implement, and evaluate safe motherhood, child
survival, and nutrition interventions at the kapubaten, provincial,
and central levels. The choice of specific kapubaten to target
within the project is based on need, as defined by economic,
epidemiological and nutritional criteria. As the project will
strengthen the capacities of midwives and traditional birth attendants
to deliver family planning services through the safe motherhood
component of the project, it is an excellent example of an integrated
approach to providing family planning and maternal and child health
services.
* Jordan Health Management. Within the past year, the government of
Jordan has made the reduction of population growth an explicit policy
goal. While the Health Management project involves primarily reforms
and improvements in management and financing, as well as
rehabilitation of facilities, it will also finance upgrading of the
primary care system, including family planning services.
---------------------------------------------------------------------
PNN is a quarterly round-up of news and information relevant to Bank
staff working in the population field. It is produced by the
Population, Policy and Advisory Service (PPAS) and edited by Chantal
Worzala.