RESUMO
Resumen Objetivos: Determinar la asociación entre los factores sociodemográficos y reproductivos con la fecundidad adicional no deseada (FAND) en el Perú. Materiales y métodos: Se realizó un estudio observacional, analítico transversal, a partir de la Encuesta Demográfica y de Salud Familiar (ENDES) 2018 en el Perú. La FAND es una variable que se creó a partir de la diferencia numérica entre la fecundidad obtenida y la fecundidad deseada. La variable FAND, se creó a partir de la diferencia numérica entre la fecundidad obtenida y la fecundidad deseada y se agrupó en dos categorías donde la diferencia numérica positiva correspondió a la presencia de FAND. Se realizó una regresión de Poisson, tanto cruda como ajustada. Resultados: Se analizaron los datos de 6944 mujeres entre 40 y 49 años, con una edad promedio de 44,3 años. Se halló una prevalencia de FAND de 72,5% (IC95%: 70,4%-74,4%). En el modelo ajustado, se observó que pertenecer al quintil superior de riqueza (RPa 0,80; IC95%: 0,69-0,93) disminuía la probabilidad de FAND con respecto al quintil intermedio. Por otro lado, provenir del ámbito rural (RPa 1,07; IC95%: 1,01-1,14), aumenta la probabilidad de FAND con respecto al provenir del ámbito urbano. Conclusiones: La prevalencia de FAND en mujeres peruanas de 40 a 49 años que participaron de la ENDES 2018 es alta. Provenir del área rural aumenta la probabilidad de FAND; y pertenecer al quintil superior de riqueza, la disminuye.
Abstract Objectives: To determine the association between sociodemographic and reproductive factors with unwanted additional fertility (UAF) in Peru. Materials and methods: We carried out an observational, cross-sectional analytical study based on the 2018 Demographic and Family Health Survey (DHS) in Peru. The UAF variable was defined as the numerical difference between the general fertility rate and the total fertility rate. This variable was divided into 2 categories, UAF was considered when the numerical difference was positive. The Poisson regression was used, both crude and adjusted. Results: We analyzed data from 6,944 women with an average age of 44.3 years (range, 40 to 49). The prevalence of UAF was found to be 72.5% (95% CI: 70.4%-74.4%). In the adjusted model, patients in the top wealth quintile (aPR 0.80; 95% CI: 0.69-0.93) were found to have a lower probability of having unwanted pregnancies when compared to those in the middle quintile. On the other hand, patients from rural areas (aPR 1.07; 95% CI: 1.01-1.14) had a higher probability of having unwanted pregnancies when compared to those from urban áreas. Conclusions: The prevalence of UAF in Peruvian women between 40 and 49 years old who participated in the 2018 DHS is high. Patients from rural areas have a higher probability of having unwanted pregnancies, and those in the top wealth quintile have a lower probability.
Assuntos
Humanos , Feminino , Gravidez , Gravidez não Desejada , Anticoncepcionais , Planejamento Familiar , Fertilidade , Peru , Formulação de Políticas , Mulheres , Zona Rural , Coeficiente de Natalidade , Inquéritos e Questionários , Fatores SociodemográficosRESUMO
ABSTRACT Objective: to assess the complications, acceptability and causes of discontinuation of women who inserted copper intrauterine devices at a usual risk maternity for one year. Methods: a longitudinal-prospective study, lasting 12 months. Eighty-three women who received the device by a doctor or nurse in a maternity hospital between September and October 2017 participated. Data were collected at one, six and 12 months after insertion and underwent descriptive analysis. Results: most were inserted by nurses and 71 continued with the device. Women chose IUD use because there is no risk of forgetfulness, it is non-hormonal and effective. The 12 who discontinued use reported dysmenorrhea, menorrhagia, irregular bleeding, fall out, and endometrium perforation. Conclusion: the method was continued by most of participants and the complications found are common to the literature. There is a need to expand nursing training to increase the offer to the population.
RESUMEN Objetivo: relevar las complicaciones, aceptabilidad y causas de interrupción de las mujeres que insertaron el dispositivo intrauterino de cobre en una maternidad de riesgo habitual durante un año. Métodos: estudio longitudinal-prospectivo de 12 meses de duración. Participaron 83 mujeres que recibieron el dispositivo por parte de un médico o enfermero en la maternidad entre septiembre y octubre de 2017. Los datos se recolectaron al mes, seis y 12 meses después de la inserción. Los datos se sometieron a análisis descriptivo. Resultados: la mayoría fueron insertados por enfermeras; 71 continuó con el dispositivo y las razones para elegirlo no fueron hormonales, no hubo riesgo de olvido y fue efectivo. Las 12 que no continuaron refirieron dismenorrea, menorragia, sangrado irregular, expulsión o perforación del endometrio. Conclusión: hubo continuidad del método por la mayoría de los participantes, y las complicaciones encontradas son comunes a la literatura. Es necesario ampliar la formación de enfermeras para incrementar la oferta a la población.
RESUMO Objetivo: levantar as intercorrências, aceitabilidade e causas de descontinuação de mulheres que inseriram o Dispositivo Intrauterino de cobre em uma maternidade de risco habitual por um ano. Métodos: estudo longitudinal-prospectivo, com duração de 12 meses. Participaram 83 mulheres que receberam o dispositivo por médico ou enfermeiro na maternidade entre setembro e outubro de 2017. Os dados foram coletados com um, seis e 12 meses da inserção. Os dados passaram por análise descritiva. Resultados: a maioria foi inserida por enfermeiros; 71 continuaram com o dispositivo e os motivos de escolha foram por não ser hormonal, por não haver risco de esquecimento e por ser eficaz. As 12 que não prosseguiram relataram dismenorreia, menorragia, sangramentos irregulares, expulsão ou perfuração do endométrio. Conclusão: houve continuidade do método pela maioria das participantes, e as intercorrências encontradas são comuns à literatura. Há necessidade da ampliação da capacitação para enfermeiros, para aumentar a oferta à população.
RESUMO
O planejamento familiar, enquanto ação em saúde, tem sido reconhecido como uma necessidade do indivíduo, porém apresenta contradições entre o que é normatizado pelo Estado, praticado pela sociedade e ofertado pelos serviços de saúde. O objetivo deste estudo é entender a relação entre planejamento familiar e métodos contraceptivos e descrever a relação entre ambos. A abordagem metodológica é qualitativa de caráter descritivo. Como referência, utilizou-se o processo historiográfico para a construção da base teórica. Os resultados apontaram importantes aspectos para a consolidação do processo de construção do Planejamento Familiar, como a conquista de espaços pela mulher, a queda da fecundidade observada nas análises demográficas, a criação de políticas públicas voltadas para o controle da natalidade e a relação deste controle com o planejamento familiar. A grande variedade de métodos contraceptivos existentes hoje permite aos casais escolher entre as seguintes formas de contracepção: métodos naturais, métodos hormonais, métodos de barreira, dispositivo intrauterino (DIU), de cobre ou com hormônios; contracepção de emergência e métodos definitivos. Concluiu-se que a relação entre planejamento familiar e métodos contraceptivos, apesar de serem questões comuns na assistência primária, ainda se constituem em assuntos pouco discutidos no meio acadêmico.
Family planning as health action has been recognized as a need of the individual, but it presents contradictions between what is regulated by the state, practiced by the society and the health services offered. The aim of this study is to understand the relationship between family planning and contraceptive methods and describe their relationship. The methodological approach worked is qualitative with descriptive character, and as reference it was used a historiographical process to build the theoretical basis. The results showed important aspects for the consolidation of the construction of Planned Parenthood, as the conquest of space by women, the fertility decline observed in demographic analysis, the creation of public policies for birth control and its relation with family planning. A wide range of contraceptive methods available today allows couples to choose between the following forms of contraception: natural methods, hormonal methods, barrier methods, intrauterine device (IUD), copper or hormones; emergency contraception and definitive methods. It was concluded that the relationship between family planning and contraceptive methods, although they are common issues in primary care, are still in little matters discussed in academia.
La planificación familiar, en materia de acciones en salud, ha sido reconocido como una necesidad del individuo, pero, presenta contradicciones entre lo que es regulado por el Estado, lo que se practica por parte de la sociedad, y lo ofrecido por los servicios de salud. El objetivo de este es comprender la relación entre la planificación familiar y los métodos anticonceptivos y describir la relación entre ellos. Estudio con enfoque cualitativo y de carácter descriptivo. Como base teórica se utilizó como referencia la historiografía. Los resultados mostraron aspectos importantes para la consolidar el proceso de construcción de la Planificación Familiar, como la conquista de espacios para la mujer, la disminución de la fecundidad observada en los análisis demográficos, la implementación de políticas públicas orientadas para el control de la natalidad y su relación con la planificación familiar. Actualmente, la existencia de una amplia gama de métodos anticonceptivos permite a las parejas optar por las siguientes formas: métodos naturales, métodos hormonales, métodos de barrera, el dispositivo intrauterino (DIU), de cobre u hormonas, contraceptivos de emergencia y métodos definitivos. Se concluye que, la relación entre la planificación familiar y los métodos contraceptivos, a pesar de constituirse como temas comunes en la atención primaria, aún se constituyen asuntos poco debatidos en el ámbito académico.
Assuntos
Anticoncepção , Anticoncepcionais , Planejamento Familiar , Serviços de Planejamento FamiliarRESUMO
PIP: Dr. Nafis Sadik, Executive Director of the UN Population Fund, notes that in the wake of the 1994 International Conference on Population and Development (ICPD), governments have been persuaded to abandon demographic targets and instead set specific social goals such as reductions in maternal, child, and infant mortality, and improvements in education, especially for girls. Progress is being made with regard to health and education, with all countries having set target dates for the enrollment of all children in school. The meaning of basic health services for all remains unclear. Progress is also being made against female genital mutilation and sexual violence, and improving women's status and the delivery of reproductive health care. Most countries could, however, do a lot more, and greater public support and resources are needed for programs. India, Brazil, Egypt, and Peru are cited as examples of countries which have begun to change policy following the ICPD. Developing countries and donors, with the exception of the US in 1996, have made efforts to increase their levels of spending on reproductive health services; the US has reduced its aid budget by 35%.^ieng
Assuntos
Países Desenvolvidos , Países em Desenvolvimento , Política de Planejamento Familiar , Administração Financeira , Necessidades e Demandas de Serviços de Saúde , Cooperação Internacional , Política Pública , Medicina Reprodutiva , Nações Unidas , África , África do Norte , América , Ásia , Brasil , Economia , Egito , Saúde , Índia , Agências Internacionais , América Latina , Oriente Médio , Organizações , Peru , América do SulRESUMO
PIP: This article reports on the progress of the Brazil National Commission on Population and Development in achieving the mandates of the Cairo Conference on Population and Development's Plan of Action. The Commission is headed by a feminist demographer, Elza Berquo, and includes experts from all government ministries and 8 members from civic and academic institutions. It is preceded in its efforts by the Commission for the Study of Human Reproductive Rights during the 1980s and the National Women's Rights Council, which contributed to the inclusion into the Constitution in 1988 of the principle of family planning provision within the health sector. The new Commission will analyze the demographic impact of public and private policies and initiatives on the quality of life, among other areas. The Commission plans to promote teaching and training on population and development. Initial steps were taken to acquire data sets from various ministries that pertain to development and population. Catholic objections were met with statistics on high teenage pregnancy and the need for health education among youth. The Catholic Church agreed to reconsider its position. Brazil had a total fertility rate in 1996 of 2.5 children per woman, and 40% of reproductive age women were sterilized. The high rate of sterilization is attributed to the high rate of cesarean section and performance of joint procedures. Legal abortion is available when pregnancy results from rape or endangers the life of the mother. The Ministry of Health is criticized for not implementing the Women's Integrated Health Care Program (PAISM) throughout the country. 75% of the population is without health insurance, and the PAISM would improve the health of women and children and increase health budget savings. The Commission will provide links with international donors and nongovernmental groups.^ieng
Assuntos
Catolicismo , Escolaridade , Política de Planejamento Familiar , Mortalidade Materna , Política Pública , América , Brasil , Cristianismo , Demografia , Países em Desenvolvimento , Economia , América Latina , Mortalidade , População , Dinâmica Populacional , Religião , Classe Social , Fatores Socioeconômicos , América do SulRESUMO
PIP: Since some argue that the recent and marked fertility decline experienced in Brazil is related to institutional changes resulting from public policies promoted by the federal government since 1964, the author attempts to shed light upon the role played by such policies upon fertility regulation. Fertility in Brazil and the main explanatory theories are first discussed. The paper then considers the role played by the growth of the consumer society, social security coverage, mass media, and the medicalization of society upon changing patterns of fertility regulation in Brazil. The discussion of government policies and fertility regulation includes consideration of consumer credit policy, social security benefit policy, telecommunications policy, and health care policy. One salient conclusion of the analysis is that the lack of a policy to provide fertility regulation mechanisms other than through the marketplace hurts relatively poor populations.^ieng
Assuntos
Coeficiente de Natalidade , Atenção à Saúde , Economia , Política de Planejamento Familiar , Governo , Necessidades e Demandas de Serviços de Saúde , Meios de Comunicação de Massa , Controle da População , Preconceito , Política Pública , Previdência Social , América , Brasil , Comunicação , Demografia , Países em Desenvolvimento , Fertilidade , Administração Financeira , Financiamento Governamental , Saúde , América Latina , Política , População , Dinâmica Populacional , Problemas Sociais , América do SulRESUMO
PIP: Although Mexico's 1965 total fertility rate of 7.1 was similar to that of populations not using contraceptives, by 1976 some 21-23% of fertile aged women (FAW) used some contraceptive method. The National Family Planning Plan was approved in 1977 (NFPP-77). Its first phase, from 1977-82, began with careful collaboration among representatives of health sector organizations to establish guidelines and procedures for family planning activities. Contraceptive usage by FAW in union increased from 23.1% according to the 1976 Mexico Fertility Survey to 41.5% according to the 1982 National Demographic Survey. The natural increase rate dropped from 3.2% in 1976 to 2.4% in 1982. The 1987 National Survey of Fertility and Health indicated that the increase in contraceptive usage between 1982 and 1987 amounted to only 7.95%, and the natural increase rate in 1988 was estimated at 2.3%. The slowing of the increase in contraceptive usage between 1982 and 1987 has not yet been fully explained, but it may have resulted from personnel changes or the country's serious economic problems. By 1992, the National Survey of Demographic Dynamics indicated that 55.0% of married FAW used a method, and the 1995 National Survey of Family Planning revealed that 57.4% did so. The role of the public sector in supplying modern contraceptives increased greatly between 1979-95, while the contribution of the private sector remained more limited. In 1979, 16.4% of couples obtained their supplies from the public sector and 15.6% from the private sector. By 1995, 41.3% of couples obtained supplies from the public sector and 16.1% from the private sector. NFPP-77 is still in place and giving results, although it has assumed a lower profile than it previously displayed.^ieng
Assuntos
Comportamento Contraceptivo , Política de Planejamento Familiar , Planejamento em Saúde , Desenvolvimento de Programas , América , Anticoncepção , Países em Desenvolvimento , Serviços de Planejamento Familiar , América Latina , México , América do Norte , Organização e Administração , Política PúblicaRESUMO
PIP: National population policies have become broader and richer in the past 3 decades, as population growth is increasingly perceived as outpacing the possibilities for development and the carrying capacity of different regions. In the mid-1990s, slightly over 50% of the developing countries had comprehensive and explicit population policies (EPPs). Developed countries preferred policies and programs specific to different aspects of population, without a population policy per se. 77% of countries with EPPs formulated them in the 1980s or later. Significant changes have occurred in EPPs adopted for the major demographic components. The proportion of countries considering their growth too rapid increased from 28% in 1974 to 40.5% in 1995, and the proportion considering their growth rates very low decreased from 25% to 12% in the same period. By the late 1980s, around 37% of countries had undertaken actions to reduce their growth rates. The proportion of countries with policies of nonintervention in demographic growth exceeded 40% for the entire period. The proportion of countries providing direct support for access to family planning increased from 55% in 1974 to 80.5% in 1995. The proportion of governments satisfied with their spatial distribution of population to those desiring no change increased from 12% in 1974 to 26% in 1995. The proportion with policy objectives to modify internal migration trends declined from 75% in 1974 to 26% in 1995. Recent trends in demographic policies suggest they are being partially consolidated as elements of public action, even though many countries are reluctant to construct population policies integrated with social and economic development. The emphasis is currently on more delimited and focused programs.^ieng
Assuntos
Países Desenvolvidos , Países em Desenvolvimento , Política de Planejamento Familiar , Política PúblicaRESUMO
PIP: In November 1996 during her address to the Sixth Conference of Wives of Heads of State and Government of the Americas in La Paz, Colombia, and in her weekly newspaper column, US first lady Hillary Rodham Clinton pledged her own and the Clinton administration's complete support for reversing the severe reduction in funds for the international family planning program imposed by the 104th Congress. This revelation reflected the administration's preparation for a strong and vocal defense of the international family planning program, which will be facing its greatest political test in February 1997. Bolivia has the highest maternal mortality rate in South America, and half the deaths are due to illegal, unsafe abortions. Mrs. Clinton presented a $2.25 million USAID award to a $5 million Pan American Health Organization program that aims to reduce maternal mortality. In her December 3, 1996, column, she used family planning campaigns in Bolivia as an illustration of sensible, cost-effective, and long-term strategies for improving women's health, strengthening families, and reducing the abortion rate. Such programs educate people about the benefits of birth spacing, breast feeding, good nutrition, prenatal and postpartum visits, and safe deliveries. Mrs. Clinton has also visited other poor countries to learn about the special needs and conditions of women's lives. UN Ambassador Madeleine Albright has recently been nominated to be the first female Secretary of State. Many people see her commitment to improving the status of women through development efforts and her recognition of the close relationship between development and diplomacy as encouraging. The concern and commitment of these two powerful women could prove valuable in the upcoming test for international family planning aid. Congress must vote on a resolution to approve Clinton's report that the reduced funding is having a negative impact no later than February 28. If both the House and the Senate pass the resolution, already appropriated funds will be released in March rather than in July.^ieng
Assuntos
Estudos de Avaliação como Assunto , Política de Planejamento Familiar , Governo , Planejamento em Saúde , Cooperação Internacional , Liderança , Pessoal Administrativo , América , Bolívia , Comunicação , Países Desenvolvidos , Países em Desenvolvimento , Economia , Serviços de Planejamento Familiar , Administração Financeira , Conhecimentos, Atitudes e Prática em Saúde , América Latina , América do Norte , Organização e Administração , Política Pública , América do Sul , Estados UnidosRESUMO
PIP: The principal lines of act0ion contained in the Declaration of the 1995 International Conference on Population and Development in regard to the demographic situation, women, health, reproductive and sexual health, and family planning are synthesized in this work. The 114 pages and 16 chapters in the Declaration were approved by the 300 representatives of 170 countries. This work lists the major points of Chapter 4 on gender, equity, and the capacity of women for self-determination; chapter 5 on roles, rights, structure and composition of the family; and chapter 6 on population growth and structure, with particular attention to children and youth, the elderly, indigenous peoples, and the handicapped. For chapter 7, on reproductive rights and reproductive health, the two terms were defined and their components listed, after which the main proposals concerning family planning, sexually transmitted diseases, prevention of HIV infection, human sexuality and gender, and adolescents were outlined. The topics considered in chapter 8 on health, morbidity, and mortality included primary health care and the health sector, child survival, women's health and maternity without risks, and HIV infection and AIDS.^ieng
Assuntos
Política de Planejamento Familiar , Política Pública , Medicina Reprodutiva , Direitos da Mulher , América , Colômbia , Países em Desenvolvimento , Economia , Saúde , Agências Internacionais , América Latina , Organizações , Fatores Socioeconômicos , América do Sul , Nações UnidasRESUMO
PIP: This work identifies human rights conflicts that may result from the confrontation of the reproductive patterns of a population with family planning policies. It seeks to identify the parties involved in specific conflicts in order to document them and propose resources for their management. The fertility decline that began in Mexico in the 1970s and the significance of family planning policy as a means of facilitating the preexisting desire of couples to control fertility are examined. Possible sources of conflict are then explored in the relations between the population and health care providers. Class differences between service providers and clients, possible failure of providers to provide full information on reproductive and contraceptive options to their clients, imposition of one-sided decision making and power relations, and gender discrimination should all be examined from this perspective. Failure to allow a sufficient delay between birth of the last child and sterilization is a concrete example in which questions may be asked concerning safeguarding of the reproductive rights of individuals. The relationship of service providers to population and health policy is a potential source of conflict if, as has occurred in Mexico, the goals for fertility reduction are not met and the decision is made to redouble institutional efforts rather than modify the goal. A first step in confronting possible conflicts is to demonstrate systematically that inequalities exist in access to rights. Conflicts should be documented and interpreted in terms of underlying power relations. The concepts of reproduction, human rights, and family planning should be analyzed for their exact semiotic significance to indicate possible sources of conflict at the level of conceptualization. An awareness of reproductive rights and a willingness to defend them should be promoted in the population.^ieng
Assuntos
Agentes Comunitários de Saúde , Países em Desenvolvimento , Ética , Estudos de Avaliação como Assunto , Política de Planejamento Familiar , Fertilidade , Direitos Humanos , Pacientes , Filosofia , América , Demografia , Serviços de Planejamento Familiar , Planejamento em Saúde , América Latina , México , América do Norte , Organização e Administração , População , Dinâmica Populacional , Política PúblicaRESUMO
PIP: This article is a three-page description of Peru's national report on population and development, submitted in October 1993 for the 1994 International Conference on Population and Development in Cairo. The report contains five sections and a statistical annex. The sections describe the demographic context of Peru and trends in the major variables, with projections for the future. The population policy is considered in the framework of development. The National Population Program for 1991-95 and its eight specific subprograms are described. The report also covers activities of the health sector, especially the family planning and reproductive health program, and three other programs in which actions have been undertaken: population education and communication, promotion of women, and research and diffusion. Information on the sources of funding is provided. Some US $52.1 million in external aid was supplied by the US and Japanese governments (47%), the UN system (21%), and international nongovernmental organizations. The report ends with a description of future population actions. The proposed goal is an annual growth rate of 0.94% by the year 2020, which would still mean an addition of 356,000 persons in that year. The proportion using contraception would need to increase to 75% from the current level of 59%, which includes a high proportion of poorly prepared users of periodic abstinence methods. Other goals are a 68% reduction in infant mortality to 20/1000, an increase in vaccination coverage of infants to 95%, and professional attendance at delivery for 90% of pregnant women.^ieng
Assuntos
Política de Planejamento Familiar , Objetivos , Controle da População , Política Pública , América , Países em Desenvolvimento , Planejamento em Saúde , América Latina , Organização e Administração , Peru , América do SulRESUMO
PIP: This work questions the view of the family as a closed physical, economic, and emotional unit with longterm stability that has been the usual basis of demographic data collection and analysis, population policy formulation, and family planning program implementation. Simple models of the family assume that the parents and children live in the same household and function in a unified family economy, in which childbearing decisions reflect a longterm view of costs and benefits. But in reality, parents often live apart due to labor migration, polygamy, divorce, remarriage, or extramarital procreation. The hypothesis that family members share a household is valid only in some places, as Demographic and Health Survey (DHS) data have demonstrated. In families separated by migration for economic reasons, distance often loosens economic ties, especially with the passage of time. Financial exchanges are precarious when the father and mother are not united by marriage. It is frequently assumed that satisfaction of the family planning needs of couples is equivalent to satisfying the needs of men and women separately, but this assumption may be erroneous for nonmonogamous individuals. Recent research demonstrates that single women and their partners are a potentially important group of family planning users. The assumption that increasing costs of children in developing countries will discourage parents from having large families may overlook parental efforts to have some of the cost assumed by other relatives or the older children, or to invest in only some of their children. As new proofs of the limitations of the conventional view of the family are found, the need becomes clear for research including men, adding an individual perspective to the attention usually focused on couples, and establishing a more realistic perspective on the family in all its manifestations.^ieng
Assuntos
Comportamento Contraceptivo , Países Desenvolvidos , Países em Desenvolvimento , Estudos de Avaliação como Assunto , Características da Família , Política de Planejamento Familiar , Serviços de Planejamento Familiar , Fertilidade , Casamento , Dinâmica Populacional , Anticoncepção , Demografia , População , Política Pública , Ciências SociaisRESUMO
PIP: This work questions the assumption that population policies in Latin America and the Caribbean are closely related to population growth, identifies common obstacles to population policies, and recommends actions to increase the efficacy of population policies. The demographic transition has occurred in Latin American countries with widely varying levels of economic development, cultural traditions, and family planning programs. The governments of the region that regard their rates of population growth and fertility as satisfactory seldom intervene to modify them. The demographic transition is well underway in all these countries except Guatemala and Paraguay. A diverse array of strategies has been used by the countries that have achieved significant fertility reductions, ranging from family planning services provided through the national health system in Mexico to key roles by the private and commercial sectors and intensive use of the mass media in Brazil. Governments adopting population policies defined various institutional forms for them, ranging from small technical units at a high level to interministerial councils. Institutionalization of population policies created high hopes for integration of population concerns into development strategies, but performance has largely failed to meet expectations, both because of the fragility and inferior status in the government bureaucracy of policy structures, and because of their inability to develop effective programs integrating population and development. The economic crisis of the 1980s lowered the priority of population themes. Political instability, lack of adequate human resources and financing, limited decision making capacity, and failure to establish strong interinstitutional ties have all been factors in the disappointing results of population policies. The difficulty of pinpointing exactly what constitutes the population policy and the tendency to equate population policy and family planning have been other factors hindering their full implementation. The effectiveness of population policies appears to have been compromised by their lack of specificity among government policies. To increase their efficacy it will be necessary to define their uniqueness with respect to other social policies. Population policies, their institutional framework, and the actors called upon to support then must be redefined. A national population policy should orient interventions in three areas: establishment of consensus regarding population goals, channeling funds to the implementing agencies, and providing follow-up and evaluation of demographic effects. Implementation of population policies and programs should be decentralized and should be achieved through insertion of population parameters in the activities of the health, education, and other social sectors.^ieng
Assuntos
Demografia , Estudos de Avaliação como Assunto , Política de Planejamento Familiar , Organização e Administração , Filosofia , Dinâmica Populacional , Política Pública , América , Região do Caribe , Países em Desenvolvimento , América Latina , América do Norte , PopulaçãoRESUMO
PIP: In 1984, in Mexico City, the Reagan administration announced its policy prohibiting USAID from supporting any nongovernmental organization which used its own or US funds for any abortion-related activities. Even though this policy was intended to reduce the incidence of abortion, it had the opposite effect because the cut in funding left some areas of the developing world with no family planning services or information at all. Further, this policy resulted in a loss of $17 million (US) or 25% of the budget of the International Planned Parenthood Federation (IPPF). On January 22, 1993, US President Clinton reversed this policy. IPPF considered President Clinton's action to be a significant event for women's health, human rights, and global development. This reversal will provide family planning services to about 300 million couples who want to practice family planning but could not do so because they did not have access to it. SHortly after President Clinton's announcement, IPPF began writing a proposal to USAID for funds to restore programs that the Mexico City policy eliminated. IPPF hoped the reversal would spark international recognition of the need for safe access to abortion. Other actions President Clinton has taken to promote reproductive health are reversing the Reagan and Bush administrations' rule prohibiting abortion counseling at federally-funded clinics, requesting that the US Food and Drug Administration study the possible marketing of RU-486, removing the ban on abortion in military hospitals, approving regulations allowing fetal tissue research, and appointing an abortion rights advocate as Surgeon General. The Catholic Church opposed all of Clinton's abortion policies. However, many congregations, priests, and Vatican officials are dissatisfied with the Pope's anticontraception position.^ieng
Assuntos
Catolicismo , Aconselhamento , Países em Desenvolvimento , Política de Planejamento Familiar , Feto , Órgãos Governamentais , Governo , Direitos Humanos , Agências Internacionais , Legislação como Assunto , Mifepristona , Medicina Reprodutiva , Pesquisa , Aborto Induzido , Pessoal Administrativo , Instituições de Assistência Ambulatorial , América , Biologia , Cristianismo , Países Desenvolvidos , Sistema Endócrino , Membranas Extraembrionárias , Serviços de Planejamento Familiar , Saúde , Planejamento em Saúde , Antagonistas de Hormônios , Hormônios , América Latina , México , América do Norte , Organização e Administração , Organizações , Fisiologia , Gravidez , Política Pública , Religião , Reprodução , Estados UnidosRESUMO
PIP: Poverty, illiteracy, and lack of government commitment or ability to solve social ills translates into rapid population growth in central American isthmus countries: El Salvador, Guatemala, Honduras, Nicaragua, and even Costa Rica and Panama. The social conditions in Panama and Costa Rica lead to better family planning (FP). Educational and health resources are lacking for the rest of the countries. High birth and infant mortality rates and political unrest contribute to the total fertility rate in Honduras of 5.4 children/woman, the growth rate in Nicaragua of 3.4%, and the contraceptive use rate f 23% among married women in Guatemala and 27% in Nicaragua. The population of El Salvador is expected to double to 11 million in 25 years. FP efforts are being threatened in Costa Rica and Panama due to the doubling of the poor population since 1983 and the cutbacks in government spending for FP. For every North American woman who dies of maternal mortality, 134 die in Central America. Today the power of the Catholic Church is offset by the government population policy and programs of private organizations. Improvements have been made in Costa Rica in maternal and child health services and FP; life expectancy for children has increased 22 years in Honduras; and total fertility is under 3 children/woman in Panama. Private organizations have taken the lead in FP programs. Although population policy is part of development, national governments still lack the political will to solve the problems of access to basic health care and education, better water and sewers, and good food and jobs. The civil wars in Nicaragua and El Salvador and insurgency in Guatemala have diverted resources for health care, housing, and education. The gross national products in each of these countries is US$910/person/year. FP funds must compete with education, health care, and other basic services for government spending. The systems for FP have been established, but the political will is missing. In 1992, the isthmus countries participated in a Safe Motherhood Conference which adopted a Guatemala Declaration for reducing maternal morbidity and mortality, to prevent unwanted pregnancies, and to solve the problems of abortion complications. FP priorities were to link population with health and FP and the environment and education and woman's status, to expand FP, to provide sex education, and to involve men in FP.^ieng
Assuntos
Estudos de Avaliação como Assunto , Política de Planejamento Familiar , Planejamento em Saúde , Política , Crescimento Demográfico , América , América Central , Costa Rica , Demografia , Países em Desenvolvimento , El Salvador , Serviços de Planejamento Familiar , Guatemala , Honduras , América Latina , Nicarágua , América do Norte , Panamá , População , Dinâmica Populacional , Política PúblicaRESUMO
PIP: The US Senate has voted to restore funding to UNFPA and reverse the administration's Mexico City policy by passing a fiscal 1992-93 foreign aid authorization bill containing both provisions. The UNFPA issue has also been linked to the debate of the most favored nations (MFN) bill for China. Sen. Paul Simon introduced a floor amendment stipulating that none of the US aid could be used for UNFPA's China program; if this occurred, the full US contribution would have to be refunded. The Bush administration policy of boycotting UNFPA because of China's population policy is holding UNFPA hostage. Sens. Barbara Mikulski and Tim Wirth added another condition to the China MFN bill that would force the president to certify that the Chinese government does not support coercive abortion. The president has threatened to veto any bill that puts conditions on China's MFN status. However, evidence suggests that even Bush is uncomfortable with his own reasoning being used against him. He is condemning UNFPA for having the same policy toward China that he does. Both bills call for $20 million for UNFPA for fiscal 1992 and reverse the Mexico City policy. Both bills raise the ceiling for fiscal 1992 to $300 million for population aid. There would have to be some debate to reconcile the fiscal 1993 ceiling of $350 million passed by the House and the $300 million passed by the Senate. The president has threatened to veto both bills because of the family planning provisions.^ieng
Assuntos
Política de Planejamento Familiar , Administração Financeira , Legislação como Assunto , Política , Nações Unidas , América , Ásia , China , Países Desenvolvidos , Países em Desenvolvimento , Economia , Ásia Oriental , Agências Internacionais , América do Norte , Organizações , Política Pública , Estados UnidosRESUMO
PIP: This critique of the World Bank's role in developing country population programs begins with a description of a 1987 case in which an 80-year- old Bangladeshi man was persuaded to undergo vasectomy and then robbed of his incentive payment by the health agent. For over 20 years, the World Bank has pressured 3rd World governments to implement population control programs. Although there are divergent opinions within the World Bank, the most dominant is the neomalthusian view that the poor through their high fertility help perpetuate their own poverty. This view hides the real source of poverty in the Third World: the unequal distribution of resources within these countries and between the developed and developing countries. The World Bank has always been blind to the inequalities, and has associated with the elites of developing countries who monopolize the resources of their countries and thereby impede authentic development. Furthermore, the emphasis on population control distorts social policy and hinders the implementation of safe and voluntary family planning services. In many countries the World Bank has required governments to give greater priority to population control than to basic health services. It has pressured them to relax contraceptive prescription norms and has promoted the more effective methods without regard to proper use or side effects. In Bangladesh the World Bank has sponsored sterilization programs that rely on coercion and incentives. In that country of enormous inequities, 10% of landowners control over 50% of lands, while nearly half the population is landless and chronically underemployed. Political power is concentrated in the military government, which annually receives over 1.5 billion dollars in external aid. External aid primarily benefits the wealthy. 3/4 of the population are undernourished and less than 1/3 are literate or have access to basic health care. The poor of Bangladesh, as in many other countries, feel that their only source of security is to have many children, a significant proportion of whom will not survive. In rural Bangladesh, where chronic hunger and unemployment are rife, the incentives and the pressures of family planning and health workers were sufficient to persuade many persons to undergo sterilization. Payment of commissions to workers to promote sterilization has discouraged them from supplying adequate information about sterilization for fear of losing clients. Population from other donors and wide publicity about the abuses in the sterilization program and the high rates of regret among women undergoing sterilization only for the incentives have led to some modifications, but the World Bank has continued to exert pressure on the Bangladeshi government to develop fertility-control programs. The damaging effects of World Bank population programs can also be seen in Indonesia, Nepal, and other developing countries.^ieng
Assuntos
Coerção , Países em Desenvolvimento , Estudos de Avaliação como Assunto , Política de Planejamento Familiar , Motivação , Política , Pobreza , Nações Unidas , Ásia , Bangladesh , Economia , Agências Internacionais , Organizações , Política Pública , Fatores SocioeconômicosRESUMO
PIP: Recent warnings by the UN Fund for Population Activities about the rapid growth of the world population and the overwhelming role in it played by impoverished women in developing countries are of interest to all women in Latin America. According to the document, Third World Women require drastic improvements in their socioeconomic positions in order to achieve reductions in their family sizes and avoid an increase in the world population from 5 billion at present to 10 billion in 2025, which would be a disaster for the planet. The document states that much of the environmental damage that would occur would be attributable to the combination of poverty and rapid population increase. If the proportion of the world's women using contraceptives increases from the current 45% to 58% by the year 2000, the world population in 2025 will be 8.5 billion. The document recommends that the amount of money invested in family planning be greatly increased by 2000 in order to make possible increased use of family planning. It appears, however, that much of the funding for family planning is under the control of private organizations and is used to serve the interests of foreign countries. The 2 principal private family planning organizations in Brazil, for example, received 18.2 million US dollars between 1978--84, which were used largely to finance a campaign of mass sterilization. Brazil's rate of population growth, which was 2.1% in 1980-85 and 1.8% in 1990, is expected to drop to 1.6% in 1995. With the decline in the rate of growth, the population will be 170 million in 2000 instead of the 220 million projected using data from the 1970s. A much higher proportion of fertile-aged women in Brazil is sterilized than in the US or Europe . Closer examination of the premises behind family planning policies shows them to be questionable. The premise that population density affects the environment is questionable; Japan, West Germany, and Holland have some of the highest population densities in the world but are highly developed. On the other hand Bolivia and Peru are underdeveloped but have very low population densities. Brazil has 1 of the lowest population densities in the world at 14 inhabitants per sq km. Rural- urban migration in the past few decades has transferred a hugh contingent of rural dwellers to the outskirts of the large and medium sized cities. Brazil's perverse economic model that concentrates income, focuses on exports, and encourages latifundia, and not population density, is responsible for urban growth. A truly efficient demographic policy would seek a transformation of the economic model. Another myth is that environmental damage is caused by poverty and rapid population growth. The most polluting countries of the world are the most developed and richest. Population movements in Latin American countries with mass sterilization programs should divert the funds to programs improving the status of women, who could then control their own fertility.^ieng
Assuntos
Países em Desenvolvimento , Estudos de Avaliação como Assunto , Política de Planejamento Familiar , Planejamento em Saúde , Densidade Demográfica , Crescimento Demográfico , Política Pública , Esterilização Reprodutiva , América , Brasil , Demografia , Serviços de Planejamento Familiar , Geografia , América Latina , População , Dinâmica Populacional , América do SulRESUMO
PIP: This work analyzes the most recent goals of Peru's National Population Council using the TABRAP model and population projections, and concludes that the goal of reducing the total fertility rate by the year 2000 is unattainable. The paper begins with a brief discussion of Peru's recent demographic history and population policies and programs, which have received only lukewarm political support. The work is presented in 4 sections. 1) The fertility levels proposed by the official policy are used to obtain a population projection and the resulting growth rates are used to derive the corresponding crude birth rates, which are then evaluated in terms of the contraceptive prevalence required to achieve them. The feasibility of achieving this prevalence rate is assessed. 2) Trends in contraceptive usage are projected to determine the probable distribution of users of each method in the near future, assuming no significant changes in the family planning (FP) program. The resulting fertility rate is the basis for another projection, which establishes the upper limit for the population size and rate of growth in the year 2000. 3) The lower limit is projected assuming a fertility decline to replacement level sometime in the next century, and the FP effort needed to achieve the maximum realistic reduction in fertility is estimated. 4) Alternative projections between the 2 extremes are assessed. The alternatives assume that half of users of traditional methods switch to modern methods between 1990-2000, that the annual number of new acceptors increases, and that a combination of greater acceptance and switching occurs. The models used were the FIV-FIV for population projection and the TABRAP for evaluating the impact of contraceptive usage on fertility rates, both developed by the Population Council in New York. The fertility reduction goal of the National Population Council for 2000 was found to be unrealistic because of the very high rate of contraceptive prevalence it would require: 79.1% among married women aged 15-44. The upper of lower limits established by the study for population growth through the end of the century present alternatives that are compatible with a realistic and achievable level of contraceptive usage. According to the upper limit projection, the total population in 2000 would be 28,513,400 and the contraceptive prevalence rate would be 60.9%. The total fertility rates would be 4.30 for 1990-95 and 3.74 for 1995-2000. According to the lower limit projection, the total population would be 27,560.800 in 2000, with a growth rate of around 2% and a total fertility rate of 3.25 for 1995-2000 and a contraceptive prevalence rate of 74.4%.^ieng