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) |
|
************************************************************************
This newsletter is being made available by the Population Information
Network (POPIN) of the United Nations Population Division/DESIPA and the
Population Reference Bureau, with funding from the Andrew W. Mellon
Foundation.
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Population Today
Monthly newsletter of the Population Reference Bureau
September 1996, Vol 24, No. 9
Please note: The graphics that appeared in the printed copy of
Population Today have not been included here. For a complete
copy of Population Today, send $2.00 to Population Reference
Bureau,1875 Connecticut Ave., NW, Suite 520, Washington, D.C.
20009.
In this issue: ** Report Calls for New Revolution in
Contraceptive Technology ** The 1996 Olympics: And the
Winner Is--Tonga? ** The Calm Before the Juvenile Crime
Storm? ** Spotlight on Burundi **
*****
Report Calls for New Revolution in Contraceptive Technology
By Stefanie Durbin
High rates of abortion and contraceptive failure are
evidence of the "dramatic need" for new contraceptives and for
a "second contraceptive revolution," said members of an
Institute of Medicine panel, speaking on Capitol Hill
recently.
Despite promising advances in science and a demand for
new products, the range of contraceptives available in the
United States has not changed appreciably since oral
contraceptives were developed 30 years ago, according to Allan
Rosenfield, the panel's chair and dean of the Columbia
University School of Public Health. He argued that existing
contraceptives failed to meet the needs of significant
populations at great cost to "societies, families, and
individuals."
In the early 1960s, advances in science and technology
brought oral contraceptives and intrauterine devices (IUDs) to
millions of women. Since then, social, legal, and financial
barriers have stalled efforts to develop new contraceptives,
according to the panel's report. The bulk of development
activity has built on modifying existing hormone-based methods
rather than creating new technology.
Increased contraceptive choices could help prevent
unintended pregnancies and decrease abortion rates, the report
suggests. Nearly 60 percent of U.S. pregnancies and 24 to 64
percent of all pregnancies worldwide are unintended: either
mistimed or not wanted at all. Slightly less than
half of these occur after contraception has failed or was used
improperly. In 1995, about one-third of the 190 million
pregnancies in the world were aborted, the same proportion as
in the United States. Worldwide, an estimated 228 million
women are classified as lacking contraception.
The environment for developing new contraceptives looks
"quite good in terms of research," according to Donald
McDonnell, a panel member and Duke University professor.
Immunology and cancer research have opened doors to new
technology for contraceptives. This technology includes
better oral contraceptives, diaphragms, and IUDs; vaginal
microbicides (a chemical sheath that protects against
pregnancy and STDs, including HIV/AIDS); transdermal (on-the-
skin) patches that would disperse contraceptives; and improved
condoms.
Removing legal, regulatory roadblocks
Despite the scientific leads and unmet need for new
contraceptives, few have been developed. While the panel
pointed to a number of obstacles, the need for stronger
support and creative collaborations among government,
industry, private insurers, and the public topped the list.
The Institute of Medicine (IOM) panel found that
although current U.S. Food and Drug Administration (FDA)
guidelines for new drug approval are adequate, especially
since reforms were made in the 1980s, the pharmaceutical
industry wants clearer guidelines on drug regulatory
requirements before they develop new contraceptives to reduce
uncertainty and error. As a litmus test for future clinical
trials, the panel recommends that approval guidelines be
developed promptly for the high-priority areas of spermicides
and vaginal microbicides.
Product liability is "if not the most important, one of
the most significant" obstacles to new contraceptive
development, argued Rosenfield. Because contraception is
preventive_that is, used on a healthy person_fewer side-
effects will be tolerated by users than of a drug that treats
an illness. Huge punitive damage awards to injured consumers
(for example, in suits involving the Dalkon Shield IUD) have
put a damper on contraceptive research.
"Liability has a major chilling effect" on new
contraceptive development, "especially in this country, far
greater than in other countries," Rosenfield said.
As a solution to product liability constraints, the
report reiterates a recommendation made by a 1990 report on
contraceptive development also issued by the IOM and the
National Research Council. The panel calls on Congress to
enact a product liability statute that would protect
manufacturers from certain lawsuits if their contraceptives
had been approved by the FDA. In legal circles, this is known
as the "FDA defense."
Any FDA defense proposal considered by Congress is
likely to limit manufacturers' liability or cap damage
awards, which observers expect will draw vigorous opposition
from consumer groups.
Countering organized opposition with public-private
partnerships
Organized opposition also contributes to gridlock. One
example is antiabortion groups' protest against introduction
in the United States of RU-486 (mifepristone), an
antiprogestin drug that can be used to induce abortion. Such
groups may also challenge the development of a promising new
contraceptive: a once-a-month pill, called a menses inducer
and classified as a postimplantation contraceptive.
Despite the probable controversy over menses inducers,
the IOM panel urges that research and development go forward
on anti-implantation and postimplantation methods "as a
response to a major public health need." In fact, the
committee ranks this as a priority for funders. To spread the
legal and financial risks, the panel recommends that small
biotech firms form partnerships with nonprofit organizations
and large pharmaceutical companies in the United States and
elsewhere.
"Large pharmaceutical industries will not get involved
in any of the menses inducers because of the abortion
controversy. The only hope for private industry involvement is
small biotech companies that capitalize themselves for this
purpose, don't care about attacks from the right-to-life
groups, and don't have enough money to be sued, and if it
doesn't work, they'll go out of business," Rosenfield said.
A global purchasing scheme for contraceptives
Another option for developing new contraceptives is a "global
contraceptive commodity program," a multilateral purchasing
pool for new contraceptives. Under this scenario, agencies or
firms in industrialized countries would fund a two-tiered
pricing and distribution system. Manufacturers would compete
to develop and produce pilot lots of contraceptives that meet
developing countries' needs. Winning firms would be eligible
for volume purchases of their products by the sponsoring
agencies.
"Although the contraceptives would be purchased at a
lower cost, because of the volume, this would be economically
attractive," Rosenfield said.
But Carl Djerassi_a Stanford University chemist who
developed the synthetic hormones used in oral
contraceptives_disagrees. In a letter to Science magazine,
Djerassi called the report's assertion that the global
contraceptive commodity program would induce companies to
develop low-cost products a "pipe dream...a pharmaceutical
company would go broke if it focused on the low-cost public-
sector market for a new contraceptive."
The IOM panel included physicians, lawyers, and
representatives of the pharmaceutical industry and women's
groups. The IOM is a health policy branch of the National
Academy of Sciences.
The draft version of Contraceptive Research and
Development: Looking to the Future is available from the
National Academy Press, 2101 Constitution Ave., NW,
Washington, DC 20418; (800) 624-6242. Price: $49 includes
shipping and handling. The final version is scheduled for
release later this year.
******
The 1996 Olympics: And the Winner Is...Tonga?
The Centennial Olympic Games in Atlanta were the largest
in history, with a record 10,750 athletes representing 197
nations. An estimated 9 million spectators attended_more than
the combined attendance of the Seoul (1988) and Barcelona
(1992) Games. Moreover, the Atlanta Games had the greatest
number of medal events (271). And, a record number of
countries (79) won medals, including first-time medalists
Burundi, Tonga, and Ecuador.
The United States led the medal count with 101,
including 44 gold. Germany followed with 65 medals (20 gold),
with Russia third at 61 medals (26 gold). But if you look at
the medals count from a demographic perspective, the medals
race has a far different spin.
The Crude Medal Rate (CMR), which takes account of a
country's population size, is similar to the crude birth and
death rates. It is derived by dividing the total number of
Olympic medals a nation received in Atlanta by its total
population and multiplying the result by 1 million. Under this
measure, the top country is not the United States, but Tonga.
This South Pacific nation won one medal in Atlanta (a silver
in boxing), but with a population of just 106,000, that single
medal converts into a rate of 9.4 per million (see table).
That places Tonga far ahead of the nation in second place_the
Bahamas, with a rate of 3.6 medals per million. Like Tonga,
the Bahamas won one medal in the Olympics, but its population
of 280,000 accounts for its high crude medal rate.
By contrast, the United States, with a population of
over 265 million, had a CMR of just 0.4 medals per million,
good for only 40th place among the 79 nations whose athletes
won medals.
The United States does fare better under a second, more
refined measure_the General Olympic Medal Rate (GOMR). This
measure accounts for the number of athletes a nation sent to
Atlanta_the actual population eligible to win a medal. (The
concept is similar to the general fertility rate, which
measures the number of births per 1,000 women of childbearing
age). Using the GOMR, the United States, whose 658 athletes
comprised the largest delegation in Atlanta, has a rate of
15.3 medals for every 100 participants, good enough for 10th
place. Three nations tied for the highest rate here_North
Korea (whose 24 athletes won 6 medals), Namibia (8 athletes, 2
medals), and Mozambique (4 athletes, 1 medal). All three had
General Olympic Medal Rates of 25 medals for every 100
participants (see table). Using the GOMR, Tonga drops from
first to fourth place.
Neither the CMR nor the GOMR account for all the
complexities of the Games. For example, the Olympics contain
a mixture of individual and team events. Moreover, some
athletes competed_even won medals_in more than one event, and
not all nations competed in every sport contested in Atlanta.
And, any talk about which nations did best in the medal
standings (regardless of the measure used) obscures the fact
that athletes, not the countries they represent, are the
ultimate Olympic champions.
Crude Medal Rate (medals per million inhabitants)
Rank Country Rate
1 Tonga 9.4
2 Bahamas 3.6
3 Jamaica 2.3
4 Cuba 2.3
5 Australia 2.2
6 Hungary 2.1
7 Bulgaria 1.8
8 New Zealand 1.7
9 Norway 1.6
10 Trinidad & Tobago 1.6
11 Belarus 1.5
12 Namibia 1.3
13 Netherlands 1.2
14 Denmark 1.1
15 Ireland 1.1
16 Czech Republic 1.1
17 Slovenia 1.0
18 Switzerland 1.0
19 Sweden 0.9
20 Romania 0.9
40 United States 0.4
General Olympic Medal Rate (medals per 100 participants)
Rank Country Rate
1 North Korea 25.0
(tie) Namibia 25.0
(tie) Mozambique 25.0
4 Tonga 20.0
5 Burundi 16.7
6 China 16.1
7 Iran 15.8
8 Kenya 15.4
(tie) Trinidad & Tobago 15.4
10 United States 15.3
11 Cuba 14.8
12 Russia 14.7
13 Syria 14.3
14 Ethiopia 13.6
15 Bulgaria 13.5
16 Germany 13.2
17 Jamaica 12.5
18 Romania 12.1
19 France 12.1
20 Turkey 11.1
(tie) Zambia 11.1
Note: Rankings are based on unrounded figures.
Source: Atlanta Committee for the Olympic Games (medals and
participants); PRB's 1996 World Population Data Sheet
(population data).
*****
The Calm Before the Juvenile Crime Storm?
By James Alan Fox
In May, a jury made headlines by convicting a Michigan
couple of violating a city parental responsibility ordinance
for failing to control their 16-year-old son's violent and
criminal behavior. Thirty-three other states have similar
statutes. Parents convicted under these laws face counseling,
fines, and even jail sentences.
Juvenile crime is also the focus of debate in the presidential
race and in Congress. Presidential candidate Bob Dole supports
passage of a federal law mandating that juveniles who commit
violent crimes be tried as adults and not be automatically
released from prison when they reach age 18 or 21.
For his part, President Clinton has sponsored
legislation that would give federal prosecutors the discretion
to prosecute as adults juvenile violent offenders as young as
13 years old.
In Congress, Rep. Bill McCollum (R-FL), the chairman of the
Subcommittee on Crime, has introduced a bill that would
mandate adult prosecution of juveniles who commit serious
federal violent crimes.
This get-tough attitude toward violent juvenile
criminals comes at a time when the number of crimes committed
by juveniles is at an all-time high_and projections point to
more of the same.
Between 1996 and 2005, the teen population in the United
States will increase by 20 percent. This population bulge will
contain the newest _ and increasingly, the most violent _class
of criminals: youths ages 14 to 17. With the population of
juveniles about to surge, and with many of those children
living in poverty, the United States could confront a tide of
youth violence more deadly than we have seen yet.
Two crime rates
Recent reports of a declining rate of violent crime in
cities across the country would seem to be at odds with the
growing problem of youth violence. The overall drop in crime
hides the grim truth. There are actually two crime trends in
America_one for the young, one for the mature_that are moving
in different directions.
From 1990 to 1994, for example, the overall rate of
murder in America changed very slightly, declining by 4
percent. For the same period, the rate of killing by adults
ages 25 and over declined 18 percent and that by young adults
ages 18 to 24 rose barely 2 percent. However, the rate of
murder committed by teenagers ages 14 to 17 jumped 22 percent
(see figure).
The baby boomerang
The recent surge in youth crime actually occurred while
the population of teenagers was on the decline. But this
demographic benefit is about to change. The "baby boomerang"
(the offspring of baby boomers) has resulted in 39 million
children under the age of 10, more young children than we've
had for decades. Close to 10 million of them live in poverty.
These children will soon reach their high-risk years. As
a result, we could face a future wave of youth violence that
will be even worse than that of the past 10 years.
A new crime paradigm
Contrary to conventional wisdom, teens now exceed young
adults in absolute rates of arrest for violent crime overall.
From 1989 to 1994, the arrest rate for violent crimes (murder,
rape, robbery, and aggravated assault) rose over 46 percent
among teenagers, but only about 12 percent among adults. In
terms of arrest rates per 100,000 population, the arrest rate
for youths ages 14 to 17 now has surpassed by a small margin
that of young adults ages 18 to 24, usually thought to be the
most violence-prone age group.
From 1985 to 1994, the rate of murder committed by teens
ages 14 to 17 more than doubled, increasing from 7.0 to 19.1
per 100,000. The rate of killing rose sharply for both black
and white male teenagers, but not for females. By the year
2005, the number of teens ages 14 to 17 is projected to
increase by 20 percent, with a larger increase among blacks in
this age group (26 percent).
Although males ages 14 to 24 constitute less than 8 percent of
the population, they commit 48 percent of all murders. At just
above 1 percent of the population, black males in this age
group now make up 17 percent of the victims of homicide and
over 30 percent of the perpetrators. Their white counterparts
remained about 10 percent of the victims, about 18 percent of
the perpetrators, yet declined in proportionate size of the
total population.
Patterns of teen violence
Guns_especially handguns_have played a major role in the
surge of juvenile murder. A gun in the hand of a 14-year-old
is more dangerous than in the hand of an older person because
juveniles are more likely to shoot without considering the
consequences. Since 1984, the number of juveniles killing with
a gun has quadrupled, while the number killing with all other
weapons combined has remained virtually constant (see figure).
The largest increase in juvenile homicide involves
offenders who are friends and acquaintances of their victims.
The spread of guns among teens who are commonly exposed to
media-glamorized violence makes it easy to engage in deadly
disputes over trivial matters such as a pair of sneakers or a
challenging glance.
Juvenile violence peaks during the after-school
hours_not after midnight, when curfew laws might be
contemplated as a solution to the problem. The time-of-day
patterns of juvenile violence reflect the problem of
unsupervised youth: as many as 57 percent of U.S. children do
not have full-time parental supervision. Deep funding cuts in
support programs for youth_from after-school care to
recreation, from mentoring to education_may exacerbate this
problem.
Outlook
Even if the per capita rate of teen homicide remains the
same, the number of 14- to 17-year-olds who will commit murder
could increase from 4,000 per year to nearly 5,000 annually by
2005 because of changing demographics alone. But the causes of
increasing youth violence go beyond demographics. More
dangerous drugs, more deadly weapons, and an apparently more
casual attitude toward violence make this generation of youth
more violent than previous generations. If offending rates
continue to rise because of worsening conditions for our
nation's youth, the number of teen killings could increase
even more.
The challenge for the future, therefore, is how best to
deal with youth violence. Without a large-scale effort to
educate and support young children and preteens today, we can
likely expect a much greater problem of teen violence
tomorrow. There is still time to stem the tide, and to avert
the coming wave of youth violence. But time is of the essence.
The preceding was adapted from "Trends in Juvenile Violence,"
a report prepared for the Bureau of Justice Statistics in
March 1996. James Alan Fox is dean of the College of Criminal
Justice at Northeastern University.
[At press time, the FBI released preliminary 1995 data showing
the arrest rate for violent crimes perpetrated by juveniles
had declined in 1995. For youths ages 10 to 17, the rate
dropped by 2.9 percent, reaching 512 youths per 100,000
violent crime arrests. The murder arrest rate for the same age
group fell 15.2 percent, to 11 juveniles per 100,000 murder
arrests. Although Attorney General Janet Reno applauded the
decrease, she warned that because the number of young people
will increase over the next 15 years, the actual number of
crimes is likely to go up. _Editor ]
Burundi
Population mid-1996: 5.9 million
Land area: 9,900 square miles
Births: 46 per 1,000 population
Deaths: 16 per 1,000 population
Infant deaths: 102 per 1,000 live births
Natural increase: 3 percent per year
Total fertility: 6.6 births per woman
Life expectancy: 48(male)/52(female)
Capital: Bujumbura
By Aunling Lim
Burundi is a landlocked nation in western Africa
surrounded by Rwanda, Zaire, and Tanzania. Eastern Burundi is
mountainous, but the rest of the country is a plateau between
4,600 to 5,900 feet above sea level. The majority of the
population lives in this western region because of its fertile
volcanic soil.
There are two main ethnic groups in Burundi. The Hutu
(Bantu) comprise 85 percent of the population and the Tutsi
(Hamitic), 14 percent. The rest of the population is made up
of 1 percent Twa (Pygmy), about 3,000 Europeans, and 2,000
South Asians. The Tutsi minority has dominated high positions
in government, the judiciary, the army, education, and the
economy since the country's independence from Belgium in 1962.
Sixty-seven percent of Burundians are Christian, 32 percent
practice indigenous religions, and 1 percent are Muslim.
Burundi made headlines recently because of a military
coup that replaced the Hutu president with a Tutsi army
officer. The coup is only the latest in the violent ethnic-
based civil war between Hutus and Tutsis that began in October
1993, when the first democratically elected president_a
Hutu_was assassinated by Tutsi troops.
Since the failed 1993 coup, an estimated 1 million
people have been displaced and more than 150,000 people (both
Hutus and Tutsis) have been killed. The continual civil strife
in Burundi has sent a steady flow of refugees to neighboring
countries, as well as displaced many within the country. As
many as 100,000 Burundians were displaced in March 1996 alone,
according to Refugees International.
Along with the political unrest, there has been a
substantial rise in cases of arrest, detention, and
disappearances. UN officials have recently aired fears that
Burundi will fall victim to a wave of genocide similar to
Rwanda's in 1994, when Hutu extremists instigated the massacre
of about 500,000 Tutsi civilians. During the summer of 1996,
Burundi's Tutsi-led army and Hutu-led militias were blamed for
hundreds of civilian deaths each week.
The recent violence has undermined Burundi's economy.
Fighting, water shortages, and electricity outages frequently
disrupt production. Burundi is financially dependent on coffee
exports, which account for 80 percent of foreign exchange
earnings and are susceptible to bad weather and price
fluctuations.
Burundi's health indicators reflect its classification
as one of the world's poorest countries (Burundi's 1994 per
capita GNP was only US$150). UNICEF estimates that about half
of Burundi's children under five years are malnourished.
Maternal mortality is very high, estimated to be 1,300 deaths
per 100,000 live births. High infant mortality levels
contribute to Burundi's low life expectancies: 48 years for
men and 52 years for women. The UN projects deaths from AIDS
may reduce Burundi's population by 4 percent by 2005.
Contraceptive prevalence is low; only 1 percent of married
women use modern contraceptives.
Burundi's small area, only slightly larger than
Maryland, gives it a high population density of 600 persons
per square mile. Like the majority of African nations, the
total fertility rate (the average number of children born to a
woman during her lifetime) in Burundi remains high at 6.6
births per woman. At the current rate of growth, Burundi's
population will double in 23 years.
Only 6 percent of Burundi's population lives in urban
areas. Most (85 percent) of rural Burundians fall below the
absolute poverty level, as do more than half (55 percent) of
urban residents. Only half of the rural population has access
to safe water and adequate sanitation.
****************
NEW and RESOURCES
New estimates on maternal deaths, child malnutrition
New estimates from UNICEF suggest that almost 600,000
women worldwide die in pregnancy and childbirth each year. And
for every woman who dies, 30 more suffer serious pregnancy-
related injuries, according to the latest edition of a yearly
report.
One in 13 women in sub-Saharan Africa dies of maternal
causes, as does 1 in 35 in South Asia, UNICEF reports. The
figure for western Europe is 1 in 3,200. In the United States,
it is 1 in 3,300, and in Canada, 1 in 7,300. The estimates are
new and more comprehensive than earlier studies. They were
compiled by UNICEF, the World Health Organization, and Johns
Hopkins University.
The report also examines child malnutrition. It shows
that contrary to popular belief, malnutrition rates for under-
fives are significantly higher in South Asia than in Africa.
Half of the world's malnourished children are to be found in
just three Asian countries_Bangladesh, India, and
Pakistan_where malnutrition rates are typically twice as high
as in the poor countries of sub-Saharan Africa. The likely
explanation for South Asia's high rates of malnutrition, says
UNICEF, seems to be the region's far higher rates of babies
with low birth weight, the generally lower status of many
Asian women, the far greater population density, poorer
hygiene, and less satisfactory patterns of breastfeeding and
weaning.
For a copy of The Progress of Nations 1996, contact the
U.S. Committee for UNICEF, 333 E. 38th St., New York, NY
10016; (212) 686-5522; single copies free. Or see
http://www.unicef.org/pon96.
Dissertation fellowships for African students
Doctoral students from sub-Saharan Africa are invited to
apply to the Rockefeller Foundation for dissertation research
support. The program enables Ph.D. students enrolled in U.S.
and Canadian universities to return to Africa for extensive
research involving field observation of the use of primary
sources available only in Africa. Priority is given to
research topics in the fields of agriculture, environment,
health, life sciences, population, and schooling.
The maximum award is $20,000. Application deadlines are
Oct. 1, 1996 and March 1, 1997. Contact: African Dissertation
Internship Awards, The Rockefeller Foundation, 420 Fifth Ave.,
New York, NY USA 10018-2702.
Family planning policy research funds available
The POLICY Project, funded by USAID, invites submission
of concept papers for funding consideration under its global
policy research program. Awards will range from $50,000 to
$250,000 for studies beginning in 1997. Concept papers should
describe proposed research pertaining to family planning and
1) health financing, 2) benefits to the development of human
capital, 3) abortion prevention, 4) the impact of policy
changes, and 5) young adult health.
Collaboration with researchers from developing countries
is strongly recommended. Submission deadline for concept
papers is Oct. 4, 1996. Before submitting a concept paper,
please request a copy of the submission guidelines and a
detailed description of the priority research themes from:
Director, POLICY Project, The Futures Group; (202) 775-9680;
fax (202) 775-9694; e-mail: policyinfo@tfgi.com; Internet:
http://www.tfgi. com.
Slowing global climate change possible
Worldwide carbon emissions, atmospheric concentrations
of greenhouse gases, and global average temperatures all
reached record highs last year, according to a new Worldwatch
Institute report. All 10 of the warmest years since record
keeping began 130 years ago have occurred since 1980.
But the report notes optimistically that "recent
innovations hold promise for the rapid development of an
economical, low-carbon energy system based on many of the
decentralized electronic technologies that are reshaping
communications, entertainment, and medicine."
For a copy of Climate of Hope: New Strategies for
Stabilizing the World's Atmosphere, contact the Worldwatch
Institute, 1776 Massachusetts Ave., NW, Washington, DC, 20036-1904;
(202) 452-1999; fax (202) 296-7365. Cost: $8.