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. 4, July, 1993
Part IV
Demographic and Health Survey Results: Madagascar
-------------------------------------------------
The national population policy of Madagascar seeks to reduce its TFR from
its current level of 6.1 to 4.0 by the year 2000. The preliminary report
of the 1992 DHS indicates that achieving that goal may be quite
difficult given the low level of contraceptive use and knowledge in the
country. The contraceptive prevalence rate for all women is 3.7 percent
for modern methods and 13.8 percent for any method. Knowledge of methods
is substantially higher, with 62.4 percent of women knowing of at least
one method (modern or traditional), but only 45.8 percent knowing where
to obtain it.
One of the most important predictors of contraceptive use and fertility
in Madagascar is place of residence. In the capital of Malagasy, the TFR
is 3.2, while in rural areas it is more than twice as high at 6.7. The
TFR for all urban areas is 3.8. Similarly, use of any contraceptive is
51.1 percent in the capital (20.9 percent for modern methods) and only
11.9 percent in rural areas (2.9 percent for modern methods).
Approximately 80 percent of the population lives in rural areas,
resulting in a high TFR for the country as a whole.
The State of World Population 1993--The Individual and the World:
Migration and Development in the 1990s
------------------------------------------------------------------
UNFPA's 1993 report on the state of world population takes as its theme
migration, both internal and international. After a review of the global
trends and patterns of migration, the report looks at the costs and
benefits of migration for migrants themselves, sending countries, and
receiving countries. The rights and responsibilities of all affected
groups are also explored as essential considerations in the definition of
appropriate migration policies.
To elucidate the effects of specific policies on migration trends, the
report focuses on the individual. From this optic, migration patterns
are seen to be a collective expression of millions of individual and
family decisions made for economic, social and political reasons,
including some forced to seek asylum.
Through this lens, the report perceives the real impact and potential of
development policies to shape migration patterns to be exercised through
their effects on abilities and opportunities. To influence migration
decisions, policies must be focused on the "individual dimension of
development," including special attention to women's issues. "The
individual woman and man is both the object and the agent of every
effective development program: strengthening their capacity and
widening their range of choice is the best guarantee of balanced,
sustainable development."
Programs that would have such an effect include provision of social
services, including education, health care and family planning; attention
to infrastructure and services to the poor in rural areas, combined with
fostering of medium-sized cities and rural development; and examination
of the impact of the economic, trade, and development policies of
industrialized countries on the migration decisions of individuals in
developing countries.
Adolescent Fertility: Recent Reports
------------------------------------
The last few years have witnessed a growing recognition of the extent and
consequences of increases in adolescent sexual activity around the
globe. The reason for concern and action in providing services to
teens was also acknowledged in the WDR: "special efforts are appropriate
to address the needs of adolescents, both because they tend to be poorly
informed about reproductive health risks and because they often misjudge
the consequences of early childbearing." Many NGOs, advocacy, and
research groups have focused their attention on this age group, as noted
in the following publications:
*Youth for Youth, a program coordinated by IPPF, and funded by UNFPA,
with technical assistance from WHO. The project, which has the ultimate
goal of bringing "together young people and other interested
groups and individuals to work towards improving the reproductive health
of adolescents," is currently being implemented in Senegal, Jamaica, Sri
Lanka, Egypt, Colombia, and Sierra Leone. A report on activities has
just been published (Contact: IPPF).
*The Program Department and the Africa Regional Office of IPPF have
recently published reviews of pilot youth programs conducted by
affiliates in Ethiopia and Kenya (Contact: IPPF).
*The Population Reference Bureau has produced two publications providing
a regional look at adolescent fertility, one in Latin America and the
Caribbean and the other in Africa (Contact: PRB).
*The IPPF 1992-93 Annual Report includes a special report on adolescent
sexuality (Contact: IPPF).
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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.
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archive PHNFLASH PNN4B Conference/Meetings/Training
Population Network News
No. 4, July, 1993
Part II
International Conference on Population and Development (ICPD)
------------------------------------------------------------
The Second Preparatory Committee of the ICPD 1994, commonly referred
to as PrepCom II, was held from May 10-21 in New York. The event,
attended by representatives of 160 governments and over 400 NGOs,
marked the end of the series of expert group and regional meetings.
The PrepCom participants, including Tom Merrick, reviewed the
recommendations of the previous meetings and debated the proposed
conceptual framework for the final document to be considered at the
Cairo conference next September. This document is meant to provide a
new plan of action for addressing population issues in their proper
development perspective, embracing the Conference theme of
population, sustained economic growth, and sustainable development.
The PrepCom began on a contentious note, witnessing an initial
confrontation between women's health advocates led by the
International Women's Health Coalition, and the Chair of the PrepCom,
Fred Sai (former Population Adviser at the Bank), over the relative
weight that should be given to women's health concerns versus other
elements of the population question. Other hotly debated issues
included the place of environmental issues and the imperative of
reconciling individual rights and responsibilities with
societal-level goals and interventions.
Over the course of the PrepCom, however, the participants coalesced
around a document structure that balances the many issues involved in
addressing population in the context of development. The document
outline ultimately approved includes a set of principles to be laid
out up front, and fifteen specific chapters of recommendations
divided into four thematic groupings: Choices and Responsibilities,
Means of Implementation, Partnership in Population - Actors and
Resources, and From Commitment to Action. Staff at the United
Nations will be responsible for drafting the document, with
significant peer review.
The next official meeting in the lead-up to the Conference is PrepCom
III (to be held in New York from 11-22 April, 1994), to evaluate the
status of preparations for the Cairo conference.
WHO's Human Reproduction Program Meets
--------------------------------------
The WHO's Special Programme of Research, Development and Research
Training in Human Reproduction (HRP) held its annual Policy and
Coordination Committee (PCC) meeting in Geneva from June 23-25. The
Bank is a sponsor and major contributor to the program, which plays
an important role in the development and introduction of new
contraceptive methods. This was the sixth meeting of PCC and the
first under the leadership of HRP's new Director, Dr. Giuseppe
Benagiano.
Members of the PCC reviewed HRP's progress over the past year in such
areas as the development of post-ovulatory methods and vaccines for
fertility regulation and discussed HRP's proposed budget for
1994-1995.
Findings were presented from a review of HRP's social science
research on fertility regulation, along with a detailed presentation
on approaches to the introduction of contraceptives that addressed
issues of program quality and reproductive health concerns. The PCC
requested that WHO review its overall approach to reproductive health
and report the implications of this review for its special programmes
(HRP, Family Health, Global Programme on AIDS).
---------------------------------------------------------------------
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 AQ+FJNTV2ImYbac6MFy23w)
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archive PHNFLASH PNN4C Population News
Population Network News
No. 4, July, 1993
Part III
Reproductive Health in the Americas
-----------------------------------
Noting that the "region of the Americas provides a unique assortment or
even a microcosm of the prevailing reproductive patterns in the world as
a whole," PAHO recently published a comprehensive book on reproductive
health in the region. Two facets of reproductive health that receive
special attention in the report are adolescent pregnancies and abortion.
Adolescent pregnancy is seen as a "priority" issue, given the extent of
the problem--in Latin America, over 3.3 million children are born to teen
mothers each year--and the social and health consequences of adolescent
pregnancy for the mother and the child. On abortion, the report
acknowledges the extent and consequences of illegal abortion in the
region, where only Cuba allows abortion on request. For more
information, see Reproductive Health in the Americas, edited by Abdel R.
Omran, et. al.
Safe Motherhood Guidelines
----------------------------
Developing country governments and donor agencies rely on indicators to
determine priorities and allocate resources. Of all the human
development indicators measured, the one which shows the greatest
disparity between developed and developing countries is the
maternal mortality ratio (MMR, defined as the number of pregnancy-related
deaths to women per 100,000 live births). The gap between North and
South can reach a magnitude of 200 times when the industrialized
countries are compared to parts of Africa or South Asia. In total,
an estimated 500,000 developing country women die each year from causes
related to pregnancy and child birth.
To assist Bank staff, governments, and other agencies to lower the toll
of maternal mortality, the Safe Motherhood Initiative recently published
Making Motherhood Safe, also known as the safe motherhood guidelines.
The guidelines provide a practical outline of the essential elements of a
safe motherhood program, which include activities to prevent maternal
morbidity and mortality, recognize and treat complications as they arise,
and promote the health of women and their newborn children. Recognizing
the vast differences in conditions throughout the developing world, the
guidelines make recommendations tailored to meet the needs of countries
at three different stages of development, as determined by the level of
health care and social benefits available to women.
Among other messages, the guidelines stress that women need a continuum
of care to provide routine services and detect and treat complications.
The necessary range of services includes basic family planning and
maternal care at the community level, access (including transport) to a
well-equipped health center for clinical methods of family planning,
treatment of complications, and referral (including transport) to a
hospital or other large health center for care of obstetric emergencies.
Anne Tinker, coauthor of the paper, had this to say about the goals of
the guidelines: "We hope that the paper will serve as a practical tool
for policy dialogue, sector work, and project preparation in maternal
health and family planning. With accelerated action at the field level,
women will no longer need to risk death to give life."
Contraceptive News
------------------
* The Population Council has received a license from Roussel-Uclaf to
develop the capability and seek approval to produce and sell RU 486 in
the United States. The Population Council will locate a manufacturer and
shepherd the drug through the U.S. Food and Drug Administration approval
process. If all goes well, the drug should be available within two
years. (The New York Times, April 21, 1993).
* On June 17, 1993 the U.S. Food and Drug Administration approved an
extension of the shelf life of the Copper T 380A IUD from four to seven
years. The extension also applies to an earlier model, Copper T 200B.
Both models have been and are distributed for public sector use in
developing countries (Population Council news release, July 14, 1993).
* The U.S. FDA is now considering a "chemical vasectomy" for use by
veterinarians. The technique consists of a non-invasive zinc injection
which leads to permanent sterilization without affecting hormone levels
or sex drive. The technique, developed by Dr. Mostasa Fahim at the
University of Missouri, may eventually be modified for use by humans
(Open File, May 1993).
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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 AQ+FJNTV2ImYbac6MFy23w)
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Date: Wed, 10 Nov 1993 16:41:00 EST
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archive_replace phnflash PNN4A Population-Related World Bank Work
Population Network News
No. 4, July, 1993
Part I
PHN FY93 Population Lending
-----------------------------
While further verification is still to come, preliminary calculations
estimate that of twenty-five PHN (Population, Health, and Nutrition)
projects approved by the Board in FY93, fifteen support family planning
and population activities, to the tune of about $170 million in lending
and $320 million in total project costs. This sum represents an increase
of about $65 million over the FY92 lending figure.
Of these projects, only one - the Papua New Guinea Population Project -
is a stand-alone population project. The rest support family planning
activities through integrated health and social development projects.
One, the India Social Safety Nets project, is a sector adjustment credit,
which means that disbursement is tied to achievement of specific policy
goals, not specific investments. Brief descriptions of those projects
that were not covered in previous editions of PNN are included below.
On a regional level, the FY93 portfolio holds some surprises. The Middle
East and North Africa region, which has historically done very little in
the population field, received almost 40 percent of the Bank lending for
population, with projects approved in Iran, Jordan, and Yemen. Another
unlikely candidate, Latin America and the Caribbean, led the pack in the
number of projects that included population - four of the fifteen
approved were in Latin America Region. Three such projects were approved
in each of Africa, East Asia, and Middle East & North Africa; two in
South Asia; and none in Europe & Central Asia Region.
Population-Related Bank Projects Approved in FY93
-------------------------------------------------
* The Philippines Urban Health and Nutrition project will address
poverty in slum areas by focusing on service delivery in health and
nutrition, including family planning. The project seeks to build the
capacity of local governments to manage services and to support community
mobilization through grants to local NGOs and other fora designed to
bring community views into the planning and service delivery process. A
policy research and evaluation component will support operations research
studies to test and evaluate the progress of alternative delivery models.
The project will also finance provision of contraceptives.
* Yemen Family Health. One of the major goals of this project is to
help the government implement the national population policy. Focusing
on rural areas, the project will strengthen both lower-level primary
health clinics and district level hospitals that serve as referral
facilities. In addition, pilot activities will evaluate alternative ways
to improve services in very remote areas through the use of mobile teams
and/or promotion of community involvement in health care.
* Colombia Municipal Health. This project seeks to further the
decentralization process currently underway in the health sector by
supporting institutional development and delivery of primary health care
at the municipal level. The project will finance sub-projects developed
by municipal health authorities and targeted at providing a basic package
of services for all ages. One element of this package is maternal and
infant care, including family planning.
* Angola First Health. Following a protracted civil war, Angola is now
seeking to rehabilitate and expand its health care services. While the
bulk of this project will focus on rehabilitation of clinics and training
institutions and strengthening of capacities in health sector policy
and management, it will also finance studies to determine the future of
program efforts in the areas of family planning and AIDS prevention.
These studies may be used in preparation of a second health project.
* The Burundi Social Action program represents an integrated approach to
poverty alleviation through the financing of sub-projects in priority
areas. The activities to be financed include income-generation schemes;
rehabilitation of basic social infrastructure (e.g., schools and health
clinics); enhancement of physical infrastructure; promotion of family
planning, literacy, and food supplementation; and development of local
NGOs. The social action program will be accompanied by a poverty
monitoring component.
* Guinea Bissau Social Sector. Through the Social Action Fund, the
project will allow NGOs to compete for funds and provide a variety of
services, including family planning, to the grass-roots level. The Fund
will be complemented by activities designed to improve public health
services through training, IEC campaigns, and health facilities
improvements.
* Building on the experience of other social investment funds in Latin
America, the Guatemala Social Investment Fund will allow the government
to finance activities, including family planning and reproductive health
services, in poor communities. By relying on sub-projects, the
government can support poverty alleviation efforts identified by the
communities themselves.
Other FY93 projects are described in previous editions of
PNN. They include:
..Iran - Primary Health Care and Family Planning
..Pakistan - Second Family Health Project
..Papua New Guinea - Population and Family Planning
..Ecuador - Second Social Development Project
..Indonesia - Third Community Health and Nutrition
..Jordan - Health Management
..Honduras - Nutrition and Health
PHN Projects in FY92: Summary Report
-------------------------------------
For those still wondering what happened in FY92, the PHN Department just
published Population, Health, and Nutrition, Annual Operational Review
for Fiscal 1992.
This publication reviews the PHN projects approved in FY92, noting trends
and providing historical data on lending in the subsectors of population,
health, and nutrition. In addition to summary information on lending,
the FY92 review includes chapters on evaluating PHN's contribution to the
Bank's poverty alleviation objective and determining the quality of PHN
projects. The annexes provide useful statistics PHN lending and
its subsectoral components, including cofinancing and integrated social
sector approaches.
---------------------------------------------------------------------
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.