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A method of assisted reproduction that involves combining an egg with sperm in a laboratory dish tramadol in dogs with arthritis order 15 mg meloxicam free shipping. The naturally occurring expulsion of a nonviable fetus and placenta from the uterus; also known as spontaneous abortion or pregnancy loss. As the risk of miscarriage (spontaneous abortion) and other problems increases with the number of fetuses present, this procedure may be performed in an attempt to prevent the entire pregnancy from aborting or delivering very prematurely. The administration of hormone medications (ovulation drugs) that stimulate the ovaries to develop a follicle and ovulate. A disk-shaped vascular organ attached to the wall of the uterus and to the fetus by the umbilical cord. Preeclampsia is characterized by high blood pressure, swelling, and protein found in the urine. This disorder, also know as toxemia, can restrict the fow of blood to the placenta. A lung disease that affects premature infants and causes increasing diffculty in breathing. The sperm head carries genetic material (chromosomes); the midpiece produces energy for movement; and the long, thin tail wiggles to propel the sperm. The administration of fertility medications in a manner intended to achieve development and ovulation of multiple ovarian follicles. Superovulation is often combined with intrauterine insemination as an infertility treatment. A picture of internal organs produced by high frequency sound waves viewed as an image on a video screen; used to monitor growth of ovarian follicles, to retrieve eggs, and to monitor a fetus or pregnancy. The hollow, muscular organ in the pelvis where an embryo implants and grows during pregnancy. The lining of the uterus, called the endometrium, produces the monthly menstrual blood fow when there is no pregnancy. Doses of 50 mg and 100 mg may provide a greater effect than the 25-mg dose, but doses of 100 mg may not provide a greater effect than the 50-mg dose. Higher doses may have a greater risk of adverse reactions [see Clinical Studies (14)]. The safety of treating an average of more than 4 headaches in a 30-day period has not been established. Perform a cardiovascular evaluation in triptan-naive patients who have multiple cardiovascular risk factors. Also, patients with migraine may be at increased risk of certain cerebrovascular events. Before treating headaches in patients not previously diagnosed as migraineurs, and in migraineurs who present with atypical symptoms, exclude other potentially serious neurological conditions. Medication overuse headache may present as migraine-like daily headaches or as a marked increase in frequency of migraine attacks. Detoxification of patients, including withdrawal of the overused drugs, and treatment of withdrawal symptoms (which often includes a transient worsening of headache) may be necessary. The onset of symptoms usually occurs within minutes to hours of receiving a new or a greater dose of a serotonergic medication. In general, anaphylactic reactions to drugs are more likely to occur in individuals with a history of sensitivity to multiple allergens. Some have occurred in patients with either a history of seizures or concurrent conditions predisposing to seizures. There are also reports in patients where no such predisposing factors are apparent. Table 1 lists adverse reactions that occurred in placebo-controlled clinical trials in patients who took at least 1 dose of study drug. There were insufficient data to assess the impact of race on the incidence of adverse reactions. In developmental toxicity studies in rats and rabbits, oral administration of sumatriptan to pregnant animals was associated with embryolethality, fetal abnormalities, and pup mortality. When administered by the intravenous route to pregnant rabbits, sumatriptan was embryolethal (see Data). The reported rate of major birth defects among deliveries to women with migraine ranged from 2. Clinical Considerations Disease-Associated Maternal and/or Embryo/Fetal Risk: Several studies have suggested that women with migraine may be at increased risk of preeclampsia during pregnancy. The Registry documented outcomes of 626 infants and fetuses exposed to sumatriptan during pregnancy (528 with earliest exposure during the first trimester, 78 during the second trimester, 16 during the third trimester, and 4 unknown). The occurrence of major birth defects (excluding fetal deaths and induced abortions without reported defects and all spontaneous pregnancy losses) during first-trimester exposure to sumatriptan was 4. The number of exposed pregnancy outcomes accumulated during the registry was insufficient to support definitive conclusions about overall malformation risk or for making comparisons of the frequencies of specific birth defects. Of the 20 infants with reported birth defects after exposure to sumatriptan in the first trimester, 4 infants had ventricular septal defects, including one infant who was exposed to both sumatriptan and naratriptan, and 3 infants had pyloric stenosis. In a study using data from the Swedish Medical Birth Register, live births to women who reported using triptans or ergots during pregnancy were compared with those of women who did not. Of the 2,257 births with first-trimester exposure to sumatriptan, 107 infants were born with malformations (relative risk 0. A study using linked data from the Medical Birth Registry of Norway to the Norwegian Prescription Database compared pregnancy outcomes in women who redeemed prescriptions for triptans during pregnancy, as well as a migraine disease comparison group who redeemed prescriptions for sumatriptan before pregnancy only, compared with a population control group. Additional smaller observational studies evaluating use of sumatriptan during pregnancy have not suggested an increased risk of teratogenicity. Animal Data: Oral administration of sumatriptan to pregnant rats during the period of organogenesis resulted in an increased incidence of fetal blood vessel (cervicothoracic and umbilical) abnormalities. Oral administration of sumatriptan to pregnant rabbits during the period of organogenesis resulted in increased incidences of embryolethality and fetal cervicothoracic vascular and skeletal abnormalities. Intravenous administration of sumatriptan to pregnant rabbits during the period of organogenesis resulted in an increased incidence of 9 embryolethality. Oral administration of sumatriptan to rats prior to and throughout gestation resulted in embryofetal toxicity (decreased body weight, decreased ossification, increased incidence of skeletal abnormalities). In offspring of pregnant rats treated orally with sumatriptan during organogenesis, there was a decrease in pup survival. Oral treatment of pregnant rats with sumatriptan during the latter part of gestation and throughout lactation resulted in a decrease in pup survival. There are no data on the effects of sumatriptan on the breastfed infant or the effects of sumatriptan on milk production. Adverse reactions observed in these clinical trials were similar in nature to those reported in clinical trials in adults. The frequency of all adverse reactions in these patients appeared to be both dose and age-dependent, with younger patients reporting reactions more commonly than older adolescents. These reports include reactions similar in nature to those reported rarely in adults, including stroke, visual loss, and death. Other reported clinical experience has not identified differences in responses between the elderly and younger patients. In general, dose selection for an elderly patient should be cautious, usually starting at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal, or cardiac function and of concomitant disease or other drug therapy. A cardiovascular evaluation is recommended for geriatric patients who have other cardiovascular risk factors. Volunteers (N = 174) received single oral doses of 140 to 400 mg without serious adverse reactions. Overdose in animals has been fatal and has been heralded by convulsions, tremor, paralysis, inactivity, ptosis, erythema of the extremities, abnormal respiration, cyanosis, ataxia, mydriasis, salivation, and lacrimation. It is unknown what effect hemodialysis or peritoneal dialysis has on the serum concentrations of sumatriptan. Sumatriptan succinate is chemically designated as 3-[2-(dimethylamino)ethyl]-N-methyl-indole 5-methanesulfonamide succinate (1:1), and it has the following structure: the empirical formula is C14H21N3O2S?C4H6O4, representing a molecular weight of 413. Sumatriptan succinate is a white to off-white powder that is readily soluble in water and in saline. Each tablet also contains the inactive ingredients croscarmellose sodium, dibasic calcium phosphate, magnesium stearate, microcrystalline cellulose, and sodium bicarbonate. Each 100-mg tablet also contains hypromellose, iron oxide, titanium dioxide, and triacetin. This compares with a Cmax of 5 and 16 ng/mL following dosing with a 5 and 20-mg intranasal dose, respectively.

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This appears to have been the case with nine of the programs discussed in this volume: Egypt (Gamal Abdel Nasser) arthritis pain shoulder order 15 mg meloxicam amex, Indonesia (Suharto), Pakistan (Mohammed Ayub Khan), the Philippines (Ferdinand Marcos), Singapore (Lee Kuan Yew), and Tunisia (Habib Bourguiba), as well in Iran, Morocco, and Nepal, where leaders were royal rulers or their key advisers. Second, some governments took action when they had broad support among the political and social elite, if not among the public at large, and we refer to these as con sensus policies. This appears to have been the case in 10 of the programs: Bangladesh, Colombia, Hong Kong, India, Kenya, Korea, Malaysia, Sri Lanka, Thailand, and Turkey. In some of these cases, private groups and influential individuals took the lead, organized national seminars, wrote articles, and succeeded in generating enough social momentum and public support to lead to the adoption of a formal government policy and program. Third, sometimes groups or institutions in the private sector were able to marshal enough resources and outreach to have an effect, and sometimes made the decision even when they lacked formal government support. Private family planning organi zations played a role in nearly all the programs, but took the lead in four: Chile, Ghana, Guatemala, and Jamaica. What we therefore can call informal policies and programs were created outside the structure of formal government. In Chile, Ghana, and Jamaica, official policies followed within a decade, but in Guatemala, four decades passed before the government acted. Several of these features are now discussed in turn, with attention to past experiences that offer guidelines to improved implementation. Strong and Consistent Leadership Political leadership was required to adopt a policy, but strong administrative leader ship was the key to successful program implementation. The various chapters in this volume underscore the vital role strong, effective leaders played or the weaknesses created by their absence. Most of the early successful programs are intimately linked with the names of key program directors: Hong Kong (Ellen Li), Indonesia (Haryono Suyono), Korea (Taek Il Kim), Singapore (Wan Foo Kee), and Thailand (Somboon). Elsewhere, even when the program ultimately proved successful, frequent turnover of key personnel was harmful (Egypt, Pakistan, the Philippines). Hybrid structures often persisted, with some functions remaining with the private associations (public information, research, demonstration projects, stan dards), while the health ministries were responsible for mainline services (Hong Kong, Korea). In any event, the transitions to health ministries proceeded unevenly, and remained limited to a degree in Colombia, and particularly in Guatemala. Health was often the weak est ministry in the cabinet, with few resources and little political clout. In countries with severe endemic health problems, many medical professionals did not see family planning as a priority issue. Furthermore, population control? was often more pop ular among economic planners than among health ministry staff members, who in some cases felt they were just being used as instruments for fertility reduction. Public health behavioral interventions on the scale being contemplated were almost without precedent. Thus was born the family planning board or the population commission, a vertical structure created to supervise and coordinate all family planning activities by cutting across regular ministerial lines (Egypt, Ghana, India, Iran, Jamaica, Malaysia, Nepal, Pakistan, the Philippines). A downside was that this model could project the attitude that family planning was not particularly a health issue, but rather an economic or sociopolitical one, weakening commitment on the part of the health ministry. Service Delivery Structures Whatever the overall structure might be, services had to be delivered. Typi cally, this system predominated where hospitals and urban-based clinics provided most health services (Chile, Hong Kong, India, Jamaica, Morocco, Singapore, Tunisia). These often included community based commodity distribution programs and private sector distribution schemes. The former proved costly because of maintenance problems, and the latter fell out of favor because of the intermittent undue pressures on local staff to produce clients. Providing access to services often required de-medicalization,? with a reduction in the power of established medical bureaucracies. Government subsidies to contraceptive distribu tion schemes, known as social marketing, were also employed (India, Iran, Pakistan, the Philippines). Indeed, two or more approaches were often pursued simultaneously, and over time, programs tended to broaden service delivery by adding new delivery chan nels. Interpersonal communication with fieldworkers, often at group meetings, and usually linked to the distribution of supplies. Community-based education involving village and neighborhood peer group activity, often linked to multipurpose development schemes. Print media employing posters, leaflets, and other materials given to clients at clinics, hospitals, and elsewhere. Some economies employed no communication strategy in the belief that a low profile was the safest way for the program to proceed at first in the face of real or imagined opposition, which appears to have been the case in the beginning in Egypt, Guatemala, Iran, Morocco, Nepal, Pakistan, and the Philippines. Resources Available to Programs the list of structures and strategies suggests that countries could freely choose among numerous options. In reality, most faced severe constraints and the resources avail able dictated choices. A lack?in some cases, a nearly total absence?of service delivery facilities and personnel imposed hardships in the more disadvantaged countries where illiteracy was common. Barren infrastructure cramped all programs, whether for health, education, or agriculture, and this was particularly true in rural areas. For a time at least, these initial shortages imposed sharp limitations on what was feasible, especially when the geography was already difficult and extraordinary efforts were required to reach out to rural populations. Nepal was an extreme case, but dispersed, small villages were common (Ghana, Guatemala, Kenya, Turkey), cre ating formidable logistics problems. Some rural populations lacked access to nearly all supplies, including contraceptives. Domestic infrastructure improved over time, especially roads and communication systems, but in many countries, the problem persisted. Civil unrest and lack of security also prevented some programs from work ing in certain rural areas (Guatemala, Ghana, Nepal, parts of the Philippines). They provided funds, but they also brought the experience of other countries and the results of applied research to bear. Soon, as the general field grew, major foundations, national aid agencies, and multilateral agencies took the stage. Donors, however, tended to favor their own models of how countries should organize efforts to use their funds, and this was not always helpful. The Population Council began as a research-oriented group and favored research combined with action demonstration projects that moved on to larger-scale efforts. The World Bank was still in its bricks-and-mortar phase, which led it to emphasize clinic and hospital construction and the parallel service delivery mode. On balance, donors? close involvement in some programs affected the choices open to program planners, while the funds and some of the tech nical assistance they provided greatly expanded the possibilities for action. The contraceptives themselves were less than ideal and placed heavy demands on services despite the historic breakthroughs they represented. Even if such problems were resolved over time, they could cause a client backlash in the short run. Personnel with quanti tative skills were lacking, as were equipment and facilities. Without such efforts, recognizing mistakes or making needed corrections was diffi cult. These activities took time to get in place, and the many limitations were not easy to overcome in the short run. Program Effort A final feature of the programs concerns their actual levels of effort. Here we explain the nature of available effort measures, and in later sections relate them to outcomes. Researchers devised measures of program effort in 1972, and since that time have applied them periodically to most developing countries (Ross and Stover 2001; Ross, Stover, and Adelaja forthcoming). In these studies, independent, informed observers have rated the degree of program effort on 30 features, separately from the outcomes of fertility change or contraceptive use. The original measures were on a scale from 0 to 4 and were converted to percentages. As the studies began only in 1972, they are somewhat late for our purposes; nevertheless, they shed considerable light on the cumulative development of program capacity up to 1972 and later. They are tracked as cohorts to keep the same 1972 group membership over the years.

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The tip of the iceberg: A validation study of the Victorian Congenital Malformations/Birth Defects Register arthritis pain relief natural medicine buy 7.5 mg meloxicam free shipping. Validation study of the Victorian Birth Defects Register, Journal of Paediatric and Child Health, 2004:40:544?548. Validating notifcations of pregnancy terminations for birth defects before 20 weeks gestation, Health Information Management, 2001;30: No. Methodological processes in validating and analysing the quality of population-based data: a case study using the Victorian Perinatal Data Collection. Birth defects in children conceived by in vitro fertilization and intracytoplasmic sperm injection: a meta-analysis. Birth defects after assisted reproductive technologies in China: analysis of 15,405 offspring in seven centers (2004 to 2008). Early on in your pregnancy, you can decide whether or not you would like to have prenatal screening. Open Neural Tube Defects Down syndrome* People with Down syndrome usually have mild to moderate intellectual delay. Individuals with Down syndrome may have a greater incidence of health conditions than the average person such as heart, stomach, bowel, thyroid, vision and hearing problems. Open Neural Tube Defects* these conditions occur when the brain or spinal cord does not form properly. Spina bifda causes physical disabilities such as difculty walking, and controlling the bladder and/or bowel. In Canada, the chance of having a baby with an open neural tube defect is about 1 out of every 2000 births. Family history: Other tests or genetic counselling may be suggested if you or your partner have a close family member who was born with a birth defect or has a serious health problem. The chance of having a baby with a chromosome condition like Down syndrome and trisomy 18 increases with the age of the mother as shown in the Table below. Remember? You might decide to have prenatal screening because you want to fnd out your chance of having a baby with Down syndrome, trisomy 18 or open neural tube defect. A screening test gives you more information about your chance of having a baby with one of these conditions than the chance shown in the table above. Many women have a difcult time deciding whether or not to have prenatal screening tests. Some women fnd it helpful to read all of this Guide frst, before making a decision. Here are some things to think about that might help you make your decision and maybe discuss with your partner, health care provider, family or friends. Do you want to know the chance of your baby having Down syndrome, trisomy 18 or open neural tube defect? If your screening test result says the chance is higher than expected (called screen positive see page 8), you will need to decide if you want diagnostic testing (see page 10) to fnd out for sure if your baby has Down syndrome, trisomy 18 or open neural tube defect. Diagnostic testing will tell for sure if your baby has one of these conditions, but has a small chance of miscarriage. If more testing shows your baby has a condition for sure, what will you do with the information? You will need to decide if you want to continue the pregnancy or have an abortion. If you fnd out for sure that your baby has a condition like Down syndrome, you can plan for the birth of your child and fnd out from others what it is like to raise a child with this condition. Remember, to know for sure you have to have a diagnostic test which has a small chance of miscarriage. If you have a child with mental and/or physical disabilities, how might this afect your life, your other children, your relationship with your partner and your extended family? Screening tests will fnd most babies with Down syndrome, trisomy 18 or open neural tube defects, but not all. You can discuss your options with your health care provider or genetic counsellor. You can have prenatal screening and make a choice whether or not to continue the process at each step. Will you give the baby up diagnostic testing which can tell for sure if for adoption? Remember that screening tests give a better estimate of risk than age alone, for those aged 35 to 39. In particular, women 40 and over should consider counselling about the pros and cons of screening and diagnostic testing. For more information about diagnostic testing see page 10 and talk to your health care provider. The following table will help you understand the diferent prenatal screening tests. If your frst visit with your health care provider is before 14 weeks (3-1/2 months) of pregnancy: You can have one of the new prenatal screening tests: First Trimester Screening, Integrated Prenatal Screening or Serum Integrated Prenatal Screening. In most areas triple screening has been replaced by quadruple screening because it is a little more accurate. Test Triple Screening Quadruple Screening Blood sample 15 20 weeks 15 20 weeks Results available at: 16 21 weeks 16 21 weeks Detection rate (Accuracy) Of every 100 pregnancies Of every 100 pregnancies with Down syndrome, about with Down syndrome, about 70 will be detected (70%) 75 to 85 will be detected (75-85%) False positive rate About 7 out of 100 About 5 to 10 out of 100 pregnancies (7%) pregnancies (5-10%) Diagnostic test if prenatal Amniocentesis Amniocentesis screening test is positive 15 22 weeks 15 22 weeks Diagnostic test results available at: 17 24 weeks 17 24 weeks Abortion if you decide to have 17 23 weeks 17 23 weeks Abortion timing will depend on local Abortion timing will depend on local this could be performed at: availability availability Or: Continuation with pregnancy Birth Birth How accurate are prenatal screening tests? Down syndrome the detection and false positive rates in the table only refer to Down syndrome. Trisomy 18 Generally, for all of the tests listed, the detection rate or accuracy is less for trisomy 18 than what it is for Down syndrome. Said another way, these tests are not quite as good at measuring the chance of having a baby with trisomy 18 (detection rate) as measuring the chance of having a baby with Down syndrome. Open neural tube defects Screening for open neural tube defects consists of a blood test done between 15-20 weeks. The ultrasound done at about 18 weeks of pregnancy also gives information about open neural tube defects. Of every 100 pregnancies with an open neural tube defect, 80 (or 80%) will be detected with prenatal screening. Most screen positive results turn out to be There is less than a 1 in 1,000 false, either by diagnostic testing or the birth chance of your baby having Down of a baby who does not have Down syndrome, syndrome that was not identifed trisomy 18 or open neural tube defect. Every pregnancy has 2 or 3 chances in 100 (2-3%) of having a condition that is not found by prenatal screening tests. It is important to remember that no test can detect every type of birth defect If your result is screen positive, you can talk to your health care provider about more testing. Diagnostic testing (page 10) is necessary to tell if your baby has a condition for sure. If your result is screen positive for a neural tube defect, you may have the option of a detailed ultrasound at 18 to 20 weeks instead of amniocentesis this will vary depending on where you live. If your screening test result is screen positive and testing says the baby has the condition for sure, you will be asked if you want to continue the pregnancy or have an abortion. Genetic counsellors are available to discuss what your results mean and your choices. These diagnostic tests are available only if your screening test result is positive or if you are 35 years of age (in some areas, this has changed to 40 years of age) or older at your due date and in certain other situations. Using ultrasound, a small piece of tissue is removed from the placenta for testing, usually through the vagina, but sometimes through the abdomen. Amniocentesis this test can tell for sure if your baby has a condition like Down syndrome or trisomy 18. Using ultrasound, a needle is inserted through the abdomen into the fuid around the baby and a small amount of amniotic fuid is withdrawn. Any woman can have a miscarriage at this time of pregnancy, but, if she has amniocentesis, this risk is increased an extra 1 in 400 (0. New studies have recently shown that the risk of miscarriage may be even lower, possibly as low as 1 in 1,600 (0.

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As you can see from the above arthritis in dogs how to treat 7.5mg meloxicam for sale, membership ad hoc Awards Committee is provides an opportunity to participate in a vari looking forward to receiving the following are additional strategic plan ety of activities. A panel dis cussion on this topic in San Antonio led to We are also working hard to provide helpful re some helpful insights that will guide our ef sources to birth defect abstractors. We hope you will take makes a difference toward ensuring we reach their PubMed abstracts. The revision of a manuscript currently under review, which the data committee are involved in a number of projects, in examines preterm births and birth defects. Please feel free to con strategies involved in the presentation of birth defects data. We meet trying to define the characteristics of a feasible program once a month via a conference call. Results from cuss the status of our projects and hear news from the March of a survey that was sent out to state contacts are currently Dimes, National Council on Folic Acid, and the Spina Bifida being developed into a manuscript by this work group, Association. We discuss new findings in the literature and oc which is led by Julianne Collins. Russ Kirby ous stages, including: is leading this work group, which should reconvene soon. Please contact Julianne Collins at spina bifida and anencephaly rates have declined or lev julianne@ggc. Jim Robbins is leading this work group and has received some data to analyze from state programs. Interestingly, providers who regularly Membership and Elections women aged 18 to 45 years. Recommendations for phone number and for the use of folic acid to reduce the number of cases of specific pass code spina bifida and other neural tube defects. Their contact information is listed K Green-Raleigh, H Carter, J Mulinare, C Prue, J on page 10. Trends in Folic Acid Awareness and Behav ior in the United States: the Gallup Organization for the March of Dimes Foundation Surveys, 1995?2005. This funding Anencephaly evaluated to consider an increase in the current Congenital Heart Defects ensures that the program can continue to conduct fortification level. These initiatives will bring us Cleft Lip its surveillance activities, which in turn support Cleft Palate closer to the goal of preventing up to 70 percent its work as one of nine Regional Research and Down syndrome of pregnancies affected by neural tube defects. Hydrocephaly Microtia Chapters are working on creating, improving, or Spina Bifida For more information, contact the March of protecting state birth defects surveillance pro Pregnancy Loss Dimes National Office of Government Affairs or grams through legislative (authorization and/or the local March of Dimes Chapter. Visit the Resource tab appropriations bills) or regulatory initiatives as a 2007 state advocacy priority. The list of research initiatives whose aims include assess dardization of analytical practices, generate inclusive over ing the prevalence of human genetic variation, the association views of fields-at-large, facilitate rapid confirmation of find between genetic variants and human diseases, the measurement ings, and avoid duplication of effort. An initial set of guidelines was agreed upon and will be refined over the coming months. Louis, Missouri programs about learning what you Location: Hyatt Regency Hotel need to know now to have a safe Website: Please send comment or questions about this newslet ter to Russel Rickard at russel. This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivs 4. No one We encourage elected and appointed health ofcials, had ever attempted to quantify 107 diseases and injuries in researchers, policy-makers, and others to explore the every region of the world. The 2017 study comprises seven papers and a complete edition of the international medical journal The Lancet. The number of collaborators totaled 3,676 from 146 countries and territories; it includes 38 billion estimates of 359 diseases and injuries and 84 risk factors in 195 countries and territories. Our organizations and both of us personally are committed to improving the accuracy, timeliness, and policy-relevance of health data and information. The memorandum of understanding we signed will result in increased awareness and understanding of health problems globally, as well as the evaluation of strategies to address them. Moreover, this agreement highlights our shared commitment to ensure that health policy is based on the most accurate and up-to-date data available. Life expectancy Number of years a person is expected to live based on their present age. Replacement rate The total fertility rate at which a population replaces itself from generation to generation, assuming no migration, or approximately 2. Super-regions Seven world regions whose constituent countries are grouped on the basis of cause of death patterns: Central Europe, Eastern Europe, and Central Asia High-income Latin America and Caribbean North Africa and Middle East South Asia Southeast Asia, East Asia, and Oceania Sub-Saharan Africa Total fertility rate The average number of children a woman would bear if she survived through the end of the reproductive age span (age 10 to 54 years) and experienced at each age a particular set of age-specifc fertility rates observed in the year of interest. Under-5 mortality The probability (expressed as the rate per 1,000 live births) that children born alive will die before reaching the age of 5 years. The 2017 study produced and used a Among age groups, the under-5 age group experienced huge new set of population estimates, which has led to substantial reductions in mortality between 1950 and 2017, while adults changes in mortality estimates in many countries. Life expectancy, 2017* Years *Data shown in the fgure represent life expectancy at birth for both sexes. Life expectancy? by sex globally, and by level of socioeconomic development, 2017 90 Disparities in life expectancy between males and 80 females were greatest in countries at the high-middle 70 and middle levels of development. Global, regional, and national age-sex-specifc mortality and life expectancy, 1950?2017: a systematic analysis for the Global Burden of Disease Study 2017. Despite this, mortality from cardiovascular diseases 200k has increased since 2007 worldwide. Global, regional, and national age-sex-specifc mortality for 282 causes of death in 195 countries and territories, 1980?2017: a systematic analysis for the Global Burden of Disease Study 2017. Nineteen 41% decrease in communicable diseases and new causes were added for a total of 359 causes. The study also neonatal disorders includes a more detailed analysis of healthy life expectancy. Years someone can expect to live in full health in 2017 Tere are large inequalities across countries in healthy life expectancy, which is the number of years a person can expect to live in full health. Healthy life expectancy** at birth, both sexes, 2017 Years of healthy life 45 50 55 60 65 70 74 **Healthy life expectancy is the number of years that a person at a given age can expect to live in full health, taking into account mortality and disability. The disease burden caused by these two risk factors, compared to the burden expected based on the level of socioeconomic development, varied considerably by region. Tose estimates confrm and extend our understanding of key population trends, including those related to health. Tat ensures in a population) that are then converted into single-year valid comparisons between diferent places and times. This conversion requires mathematical steps published and publicly accessible free of charge. Recent population growth has been highest in Africa, Asia, and Latin America Population growth rate, 2010?2017 <-1. The relationship between total fertility rate and population growth in 2017 Countries may continue growing in population even if their total fertility rates are below the replacement rate of 2. This is due to population momentum, in which past growth of birth cohorts leads to more females of childbearing age, which leads to birth rates that, for a time, remain high relative to deaths in the population. Countries plotted by total fertility rate and population growth rate, 2017 Countries with:? Oman Total fertility rate above the replacement rate and increasing population Total fertility rate above the replacement rate and decreasing population? Qatar Total fertility rate below the replacement rate and decreasing population 5. But if less progress is made, life and all-cause and cause-specifc mortality for 250 causes of expectancy could decrease by 0. Change in life expectancy, 2016?2040, both sexes* All countries are likely to experience at least a slight increase in life expectancy by 2040 0 to <1 1 to <2 2 to <3 3 to <4 4 to <5 5 to <6 6 to <7 7 to <8 8 to <10 10 to 12 *Diferences in life expectancy shown are based on what has been observed historically and the future trend based on that observation. It produces estimates for 41 of the 52 health the most countries likely to attain their targets. Note: Population census coverage is not included because of its binary status and because it does not have forecasts. Tese techniques have been developed and used by The Jackson Laboratory for over 75 years. They are safe, reliable, economical, efcient, and ensure that the mouse strains produced are genetically well defned.

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Becker (1960) does dis cuss in detail the importance of contraceptive methods in controlling family size arthritis pain relief lower back order meloxicam with a visa, but birth control techniques are not mentioned in his subsequent work (cf. Our interpretation is that the discussion of most of these articles focus on fertility in developed countries, such as the United States, where these contracep tive methods are affordable and readily available to the public. In addition, there is public awareness about their effectiveness in controlling pregnancies, and therefore the realized number of children is very close to the desired one. Our view is that this might not be the case for some developing countries, and this view seems to be backed by the empirical evidence (cf. In developing countries even when contracep tives can be obtained at low cost in public clinics, for example, they are often stocked out. Baudin, de la Croix, and Gobbi (2016) also consider un wanted fertility by assuming that a share of couples cannot control fertility, but this differs relatively cheaper and the gap between realized and wanted fertility decreases. He abstracts from fertility shocks and heterogeneity among households, while we explore such dimensions. In addition, he focuses on the role of modern contraceptives in the fertility transition, and we concentrate on the impact of family planning interventions on individual and aggregate outcomes. The role of modern contraceptives in the fertility transition is also studied by Bhattacharya and Chakraborty (2017) in a model in which modern contraceptives are costly. In a recent article, de Silva and Tenreyro (2017a) investigates the role of changes in social norms in the fertility transition and how population policies might have changed such norms. They investigate a family planning policy which sets the percentage of couples able to control their fertility 12 to one. Ashraf, Weil, and Wilde (2013) also study the effects of policies which reduce fertility on investment and output per capita. Fertility is exogenous in their framework and they feed different population dynamics into a growth model to investigate how each affects output through different channels. In our case, fertility and the use of costly contra ceptive methods are endogenous. This allows us not only to evaluate the effects of family planning interventions on output but also to show how the use of contraceptives, and thus fertility, changes along with other policies such as investment in education. Our general idea relies on the assumption that family planning interventions have a 13? For instance, Bloom, Canning, Fink, and Finlay (2009) show that removing legal restrictions on abortion signi? Joshi and Schultz (2013) study the long-run consequences of a randomized control trial of contraception provision in Matlab, Bangladesh. Sinha (2005) estimates similar effects of this family planning experiment on fertility. Using an experiment in Zambia, Ashraf, Field, and Lee (2014) show that the local average treatment effect estimation implies that use of family planning services during about two years of the experiment was associated with a 27 percent reduction in births. Using variation in the timing and location of the Profamilia program in Colombia, Miller (2010)? Banerjee, Meng, Porzio, and Qian (2014) estimate the effects of birth control policies in China before the one-child policy. See also de Silva and Tenreyro (2017b), May (2012), Miller and Babiarz (2016), and Schultz (2008), among many others. He shows that differential fertility risk is essential in generating plausible life-cycle patterns of births and abortions across educational groups. This paper therefore provides a bridge between the macro literature on fertility and growth and the empirical micro literature on family planning interventions, fertility, and human capital outcomes. In addition, with our framework it is possible to run and to evaluate a variety of counterfactual policies, not necessarily available in control trial experiments, and to disentangle different channels, such as the importance of general equilibrium ef fects. Therefore, we believe our paper is an important contribution to the literature on family planning policy and development,? The remainder of this paper is divided into six additional sections besides this intro duction. Table 1 shows the regression results in which the dependent variable is the unwanted fertility, or the gap between actual and wanted fertility, and the explanatory variable of interest is the percentage of women who have ever used modern contraceptive methods. There are 84 countries in total, but they appear in the sample in different frequencies and in years ranging from 1985 to 2010. Before we proceed with the analysis, it is important to emphasize up front that we do not aim to provide a causal effect of modern contraceptive use on the fertility gap, instead focusing on examining the relationship between the two. We are aware of issues related to unobservables which can 17 drive the correlations between these two variables and reverse causality problems. As we can see, there is a negative associa 15Choukhmane, Coeurdacier, and Jin (2016) show that the one-child policy? led to an increase in the savings rate and human capital accumulation in China. In our model family interventions, which decrease the gap between realized and desired fertility, also increase investment in physical and human capital. One possibility would be to use the relative price of modern contraceptive methods. Dependent variable: Unwanted fertility (fertility gap) (1) (2) (3) (4) (5) (6) % of women who ever used -0. Quantitatively this regression implies that an increase in one stan dard deviation (22 percentage points) in the percentage of women who have ever used modern contraceptive methods is associated with a decrease in the fertility gap of 0. The regression in Column (3) contains the same explanatory variables as the one 18 in Column (2) but we also introduce dummies for each decade. The correlation between the fertility gap and the percentage of women who have ever used modern contraceptive methods is weaker but still statistically different from zero at a 90 percent con? In Columns (4)?(6) of Table 1 we also add wanted fertility as an explanatory variable. Interestingly the fertility gap decreases with wanted fertility, and the negative association between the fertility gap and the percentage of women who have ever used modern con traceptive methods becomes stronger. This correlation is statistically different from zero at 18We do not introduce year? Dependent variable: Human capital attainment (1) (2) (3) (4) (5) (6) Unwanted fertility? That is, when fertility is closer to its desired level, educational attainment is higher. Fertility behavior (unwanted and wanted fertility) explains about 44 percent of the variation in education attainment in the sample, visible in Column (2). Educational attainment is also negatively correlated with wanted fertility, which re? Therefore what the reduced form evidence shows is that there might be a positive rela tionship between contraception use and education, via the reduction in the gap between actual and wanted fertility levels. And second, what are the aggre gate effects of family planning interventions on development and inequality? In order to 19The sample period in our regression is different from his since we have access to more recent observa tions, which might explain the difference. Individuals live for three periods: childhood, young adulthood, and old adulthood. Young adults have one unit of productive time and are endowed with skills that they acquire during their childhood. The production sector is characterized by a standard constant returns to scale technology, which depends on capital and ef? We assume that parents are able to provide some hours in the labor market even when they have the maximum amount of children, i. Preferences and optimal decisions: Consumption of couples during the young adulthood 0 period is denoted by cy, while co denotes consumption of the couple in the next period, when old. Preferences of households are represented by: 0 0 0 0 U(cy, co, n, h) = log(cy) +? The problem of the couple 0 is to choose cy, co, q, s, and e to maximize (6) subject to (4), (5), and the following budget constraints: cy + s +? Equation (8) implies that old couples consume their savings from the young adulthood period. Whenever q > 0, then the equations which describe 21 the solution of this problem are: 1?

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Thus arthritis pain in urdu buy generic meloxicam 15 mg on line, the menstrual disruption becomes planning, and supplemented providers? instructions visible? to spouses and other family members. In low with the experiences of women whose bodies and prevalence settings, where opposition to family circumstances are similar to their own (Watkins 1997). Rumors and Misinformation sell kola nuts, women say that if you take the pill, the pills will stack up in Little research has been undertaken that speci? Then I started about the biological and behavioral consequences of using injectables, and I haven?t had contraception use can lead both to a lack of uptake and to early discontinuation (Castle 2011). So now I use contraception despite not wanting to get preg don?t feel worried at all. Beksinska, Rees, and Smit (2001) found that the mean Although they acknowledged hearing rumors, most duration of nonuse was seven months (range 2?13 continuers rejected them and instead relied on their months). In addition, they con cant need for improved counseling in order to ensure sulted their health care providers, discussed the rumors correct and continuous method use. They also note with them, and were put at ease by the providers? that, in many settings (including the United States), explanations (see box). The continuing users exhibited providers often think that women need to take a break greater con? Less educated stand that they can still become pregnant even though women in other settings may not have the psychosocial they are not menstruating (2001:309). The evidence from Baumgartner et al (2007) on unintentional discontinuation? among injectable users in South Africa reinforces the need for improved 7. Intent, Motivation, and Ambivalence counseling that emphasizes the importance of sustain ing continued use, particularly for pill and injectable Evidence of the contextual reasons for discontinuation users who require regular renewal of their commodi is generally limited to qualitative research around ties, or of facilitating immediate switching to another method dissatisfaction and the role of rumors and side method. Family planning programs can also make efects, which implies that women make a conscious greater eforts to enable clients to overcome logistical decision to discontinue because of these reasons. The barriers to attending their appointments on time, for reality is more complex, however. For example, women example, through outreach and the use of mobile may choose to take a short break in using a hormonal phones and texts to remind clients of their appoint method but report that they are using continuously. There has been little research into the concept not want to risk becoming pregnant. Rather, their short or such as condoms, until her pregnancy status is long-term stopping may be due, for example, to a lack confirmed. It is recognized, however, that in many of understanding of the importance of the timeliness cases gender and power dynamics may make of resupply or reinjections or an inability to access a negotiation for condom use difficult for many provider due to not having sufcient time or money. In a review of reviews of patient social stigma often associated with sexual activity adherence to medical treatments (van Dulmen, Sluijs, among unmarried adolescents. Smit and Beksinska (2013) note enormous pressure to conceive immediately or early in that high-quality counseling improves adherence to their marriage. Contraceptive use is often initiated antiretroviral therapy and recommend that the same after fertility had been proven? and early discontinua emphasis needs to be incorporated into family planning tion may be the result of societal pressure from counseling, particularly for those using resupply meth husbands or mothers-in-law to have a child. Longitudinal research is needed to better under example, unmarried sexually active girls and women stand how hormonal contraception can be used more were scared of using hormonal methods because they consistently (Halpern, Lopez, and Grimes et al (2013). In such contexts, conception may not be desired but is You start by giving them lectures inadvertently (as opposed to deliberately) left to chance as women consider family planning neither a about the dangers of early sex personal responsibility nor an urgent matter. Further before they can convince you to qualitative studies drawing on psychosocial notions of give them what they want! Adolescents preferred to use condoms or no contraception at all in order not to risk becoming sterile? (Castle 2003). In almost every about how conception occurs and providers scolding country, a greater proportion of 15?19 year olds than sexually active girls seeking contraception. Providers? of 20?49 year olds reported a contraceptive failure unwillingness to acknowledge adolescents? experienc within a year of starting a method. On average, failure es as contraceptive users undermines the sustained rates were about 25% higher for adolescents aged use of contraception by girls; for example, some 15?19 years than for older women (aged 20?49 years). Younger that they were scolded by nurses if they returned late women may face more obstacles relating to a lack of for their follow-up visit or if they had lost or damaged 10 their cards. In some cases they preferred to stop prolonged breastfeeding who start postpartum using contraception altogether rather than face the contraception early using reversible methods were wrath of the providers. In short, it is unclear whether women starting use early in the Women in the postpartum period who become preg postpartum period have longer continued use than nant within 24 months of giving birth face increased those starting later, given the role of breastfeeding and health risks, and so sustained protection during this of population and method-speci? What is clear, however, is postpartum women has not been widely studied, with that women initiating long-acting or permanent most analyses focusing on the potential for redundant? methods postpartum are more likely to avert an method use when it overlaps with postpartum absti unintended pregnancy. Bradley and colleagues also found that the the impact of public-sector postpartum programs probability of failure rose sharply over time among that sought to involve husbands in decision-making women whose previous episode was a pregnancy/birth, about contraceptive use following delivery, and but declined or rose only slightly among other women. In Egypt, providing birth spacing messages abandoned in need, further suggesting that some to low-parity women during antenatal and postpar women may be experiencing failure and reporting it as tum care and also to husbands through community abandonment in need? (page 58). In India, a behavior change communica tion intervention using community workers from the Fortunately, such evidence is emerging. In their overview paper, nine months (including 41% using condoms), which Cleland and Shah (2014) concluded that women who was signi? Men short-acting method before their return to fertility had, in efect, redundant? protection (with the associated To date, few studies of matched couples have cost implications) for that period, which could be over explored male and female perspectives on the six months in populations with prolonged breastfeed timing and reasons for discontinuation, yet such ing, this was ofset by lower discontinuation rates at 12 information could be helpful in promoting gen months. Although clude that advocacy of early uptake of the most research on contraceptive discontinuation has widely used methods, injectables, and oral contracep addressed male perspectives. In such settings, sensitization and are made aware of the economic advantages of education programs need to involve men and provide family planning they may be more ready to support them with accurate information. Other programmatic its long-term use by their spouses or partner approaches may include arming women with negotia (Khosla 2009, Gribble, and Graf 2010). In Malawi, tion skills so that they can engage in reasoned and for example, emphasizing the? Such negotiation skills can also be employed to insist on condom use during periods when they are not protected by contracep tion. In addition, some women may live separately from their spouses or their partners may regularly be Sometimes they complain because absent due to short or long-term migration. Providers may therefore need to be aware of the changing this will make him complain because contexts of use and of couple dynamics that deter he will start accusing you that you mine the risk of both discontinuation and of pregnan are being unfaithful to him. As noted above, involving husbands in discussions about postpartum family Bruce (1990) has articulated a quality of care framework planning and engaging male leaders in community outlining six elements of quality for family planning level mobilization does improve continuation rates that still guides programming in many countries: choice during the postpartum period. Moreover, unwanted births were low-up/continuity mechanisms, and appropriate twice as high among those receiving low quality constellation of services. They report channels through which family planning services are ed that those women who received good quality care delivered beyond clinics to include households and were 1. Thus the quality of counseling when a ceptualizing, measuring, and evaluating quality of woman starts using a method appears to be linked family planning services is not straightforward. The difer planning services has also been shown to have a direct ences were quite striking?for example, in the Gambia, impact on whether a woman continues, discontinues, or 51% of those who felt that they were not properly switches method. For example, Blanc, Curtis, and Croft counseled stopped using compared with just 14% of (2002) analyzed quality of care using the Family those who felt that their counseling had been satisfac Planning Program Efort score and found that between tory (Cotton et al 1992). The authors conclude that, as contraceptive use intervention that improved preinsertion counseling increases, family planning programs would bene? This conclusion is supported by the interventions to improve quality of care and continuity analyses of Jain et al (2013) described above. The of use have failed to demonstrate a substantial efect challenge, therefore, is determining how programs can of the interventions. For example, the evaluation in the Philippines including simulations and cross-sectional and longitu (Jain et al 2011) described above found that although dinal studies. For example, women in Indonesia who women receiving higher quality of care were more received the method of their choice continued to use it likely to continue using contraception after three years, longer than women who did not receive their preferred and to report fewer unintended pregnancies and method (Pariani, Heer, and Van Arsdol 1991). In the unwanted births, the provider training intervention Philippines, quality of care received at the consultation itself did not have a direct efect on continuation, even was measured on a 20-point scale (Jain et al 2011); a though it did improve provider knowledge and provid follow-up interview with these women approximately er-client interactions. The authors propose that this is two years later showed that the quality of care re because other contextual and logistical factors may ceived was associated with continuation rates: contin also have in? The overall quality of evidence was consid Public facility midwife, Kenya ered moderate, and the intervention type and intensity varied greatly across the studies. Providers who wish to be reasonably certain that their client is not pregnant can 9. Training providers on consistent and correct use of the checklist in facilities Provider bias occurs when service providers believe where pregnancy tests are not widely available that they are better quali? Providers may be biased when delivering ers followed the national guidelines3 and virtually all services due to poor training and/or imposing inap women within two weeks received a reinjection, propriate personal values and beliefs. They may also whereas in Eastern Cape 36% of women did not be biased if they receive?

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Particular attention must be paid to raising awareness among hard-to-reach populations arthritis gout knee symptoms purchase meloxicam 7.5 mg. In this respect, the role of the mass media and/or oral tradition in ensuring that children have access to information and material, as recognized in article 17 of the Convention, is crucial both to providing appropriate information and to reducing stigmatization and discrimination. The Committee recognizes that anti-retroviral drugs administered to a woman during pregnancy and/or labour and, in some regimens, to her infant, have been shown to signif cantly reduce the risk of transmission from mother to child. However, in addition, States parties should provide support for mothers and children, including counselling on infant feeding options. Follow-up support is also required in order for women to be able to implement their selected option as safely as possible. To allocate f nancial, technical and human resources, to the maximum extent possible, to supporting national and community-based action (art. These development, minimum ages should be the same for boys and girls (article 2 of the 2003 Convention) and closely ref ect the recognition of the status of human beings under 18 years of age as rights holders, in accordance with their evolving capacity, age and maturity (arts. Further, adolescents need to have easy access to individual complaint systems as well as judicial and appropriate non-judicial redress mechanisms that guarantee fair and due process, with special attention to the right to privacy (art. These are fundamental in guaranteeing the right to health and development of adolescents. Article 17 states that the child has the right to access information and material from a diversity of national and international sources, especially those aimed at the promotion of his or her social, spiritual and moral well-being and physical and mental health. The right of adolescents to access appropriate information is crucial if States parties are to promote cost-effective measures, including through laws, policies and programmes, with regard to numerous health-related situations, including those covered in articles 24 and 33 such as family planning, prevention of accidents, protection from harmful traditional practices, including early marriages and female genital mutilation, and the abuse of alcohol, tobacco and other harmful substances. Health-care providers have an obligation to keep conf dential medical information concerning adolescents, bearing in mind the basic principles of the Convention. Adolescents deemed mature enough to receive counselling without the presence of a parent or other person are entitled to privacy and may request conf dential services, including treatment. Both the legal minimum age and actual age of marriage, particularly for girls, are still very low in several States parties. There are also non-health-related concerns: children who marry, especially girls, are often obliged to leave the education system and are marginalized from social activities. In addition, States parties should ensure that they have access to appropriate information, regardless of their marital status and whether their parents or guardians consent. It is essential to f nd proper means and methods of providing information that is adequate and sensitive to the particularities and specif c rights of adolescent girls and boys. States parties should take measures to reduce maternal morbidity and mortality in adolescent girls, particularly caused by early pregnancy and unsafe abortion practices, and to support adolescent parents. Young mothers, especially where support is lacking, may be prone to depression and anxiety, compromising their ability to care for their child. The Committee urges States parties (a) to develop and implement programmes that provide access to sexual and reproductive health services, including family planning, contraception and safe abortion services where abortion is not against the law, adequate and comprehensive obstetric care and counselling; (b) to foster positive and supportive attitudes towards adolescent parenthood for their mothers and fathers; and (c) to develop policies that will allow adolescent mothers to continue their education. However, if the adolescent is of suff cient maturity, informed consent shall be obtained from the adolescent her/ himself, while informing the parents if that is in the best interest of the child? (art. With regard to privacy and conf dentiality, and the related issue of informed consent to treatment, States parties should (a) enact laws or regulations to ensure that conf dential advice concerning treatment is provided to adolescents so that they can give their informed consent. Such laws or regulations should stipulate an age for this process, or refer to the evolving capacity of the child; and (b) provide training for health personnel on the rights of adolescents to privacy and conf dentiality, to be informed about planned treatment and to give their informed consent to treatment. According to Paragraph 60, The Committee is deeply concerned about the prevailing practice of forced sterilisation of children with disabilities, particularly girls with disabilities. This practice, which still exists, seriously violates the right of the child to her or his physical integrity and results in adverse life-long physical and mental health effects. Therefore, the Committee urges States parties to prohibit by law the forced sterilisation of children on grounds of disability. Should harmful practices be present, their rights inter alia early marriages and female genital mutilation, the State party under the should work together with indigenous communities to ensure their Convention, eradication. The Committee strongly urges States parties to develop and 2009 implement awareness-raising campaigns, education programmes and legislation aimed at changing attitudes and address gender roles and stereotypes that contribute to harmful practices. The Committee recommends States parties to take into account its general comments no. To date the on the Elimination of Racial Discrimination Committee has published 33 such General gives the Committee on the Elimination of Recommendations, but none focuses on Racial Discrimination the mandate to make reproductive rights. General Recommendation Provisions related to Reproductive Rights General Paragraph 2 says, Certain forms of racial discrimination may be Recommendation directed towards women specifcally because of their gender, such No. Racial discrimination may have consequences that affect primarily or only women, such as pregnancy resulting from racial bias-motivated rape; in some societies women victims of such rape may also be ostracized. Women may also be further hindered by a lack of access to remedies and complaint mechanisms for racial discrimination because of gender-related impediments, such as gender bias in the legal system and discrimination against women in private spheres of life. To date the Committee has pub ment or Punishment gives the Committee lished two such General Comments. General Comment Provisions related to Reproductive Rights General According to Paragraph 18, The Committee has made clear that Comment No. The Committee has applied this principle to States parties? failure to prevent and protect victims from gender-based violence, such as rape, domestic violence, female genital mutilation, and traff cking. Being female intersects with other identifying characteristics or status of the person such as race, nationality, religion, sexual orientation, age, immigrant status etc. The contexts in which females are at risk include deprivation of liberty, medical treatment, particularly involving reproductive decisions, and violence by private actors in communities and homes. Men are also subject to certain gendered violations of the Convention such as rape or sexual violence and abuse. Both men and women and boys and girls may be subject to violations of the Convention on the basis of their actual or perceived non-conformity with socially determined gender roles. States parties are requested to identify these situations and the measures taken to punish and prevent them in their reports. This was in 2011 and it tion of the Rights of All Migrant Workers concerns migrant domestic workers. General Comment Provisions related to Reproductive Rights General Paragraph 22 says, Under some countries? laws regarding work permit Comment No. It is not uncommon for women migrant workers to be Workers, 2011 subjected to mandatory health testing related to sexual and reproductive health without consent or counselling. The lack of social security benef ts and of gender sensitive health care coverage further increases the vulnerability of migrant domestic workers and their dependence on their employers. In this regard, migrant domestic workers should enjoy treatment not less favourable than that which applies to nationals of the State of employment (article 25). Particular attention should be given to women migrant domestic workers with irregular status, who are especially vulnerable during pregnancy, as they are often afraid to contact public health services out of fear of deportation. States should not require public health institu tions providing care to report data on the regular or irregular status of a patient to immigration authorities. States should ensure that migrant domestic workers in a documented or regular situation enjoy equal treatment with nationals in relation to social and health services (article 43(1)(e)). Moreover, the Committee recalls the obligations assumed by States under other core international human rights treaties, notably the International Covenant on Economic, Social and Cultural Rights, to take appropriate measures towards ensuring to all persons within their jurisdiction, irrespective of their immigration status, the highest attainable standard of physical and mental health and medical care, services and attention in the event of sickness. It is mandated to make such vention on the Rights of Persons with Dis recommendations under Article 39 of the abilities had its frst session in 2009 and it Convention. The following sum Nations treaty bodies have the mandate to mary is a selection of some decisions that hear individual complaints, also called com have dealt with issues of reproductive rights. Finally, the lack of an adequate legal adopted by the United Nations General remedy constituted a violation of Article 2. Assembly in 1966, came into force in 1976, On this basis, the Committee found that giving the Human Rights Committee the Peru should compensate Miss K. So far the Committee has made decisions concerning the reasoning of the Committee was as approximately 750 communications. The Committee obstetrician that the foetus she was carrying notes that the State party has not provided any had a serious abnormality, and termination evidence to challenge the above. It notes that of the pregnancy was advised based on the authorities were aware of the risk to the the risks to the life of Miss K. The avoid serious and permanent damage to subsequent refusal of the competent medical her health. The author states led to deep depression, requiring psychiatric that no effective remedy was available to her treatment. The author also claims that, owing to the the grounds of cruel, inhuman or degrading refusal of the medical authorities to carry out treatment.

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This is because it is most widely accepted arthritis in back and exercise order meloxicam 7.5mg visa, and addresses, sterilization cases from the analysis (n=7). Moreover, from a in particular, the individual level instead of group or community group of non-users we further excluded cases (n=1858) by level empowerment. Above all, it effectively covers nearly all the restricting our sample to those women who had an unmet need of key dimensions in the stated definitions. Consequently, analyses were performed on a total of structured framework used by Haque et al. The non practise contraception, compared with women who are not (or are response rate documented during the survey was 3%. All survey participants provided a written informed consent decides independently?, husband decides independently?, hus [32]. The fundamental difference between the two is empowerment, as well as for each of the empowerment that for couple methods which included male condom, dimensions as proposed in the framework above (figure 1). For the measure of overall empowerment degree of support, involvement or cooperation from, the husband. Because the number of indicators varied from one empowerment dimension to Outcome variables the next for example, the measurement of economic empower the outcome variable was current contraceptive use, which we ment was based on six indicators, household empowerment on classified into three categories: 0= non-users; 1= female-only five, and the dimension of physical mobility on three the methods (pill, injection, intra-uterine device, implant, and female contributions to the overall empowerment composite score were sterilization); 2= couple methods (condom, withdrawal and uneven. Thereafter, we constructed a composite score by adding decision-making the number of decisions. The total score ranged from 0?18, where We included thirteen questions regarding household decision a high score reflected a higher degree of decision-making power. Based on the decision-making, where cases were coded as 1? if couples took a conceptual framework (figure 1), these items were classified into joint decision, and 0? otherwise. Economic Decision-making: (1) buying or constructed two measures for each of the three dimensions of selling of property, (2) small household expenditures. The ages of the women and their husbands were also found application in demographic and health surveys. By notable contrast, separately, resulting in eight different models: (1) a crude model, empowerment measures for couples? joint decision-making sub to examine whether overall empowerment and its dimensions are stantially affected contraceptive use: a one-point increase in the significantly associated with contraception; (2) a partially-adjusted score was related to a 1. When adjusted with wealth quintiles, the relationship demographic characteristics were added to determine whether the held significance for only couple methods (odds ratio, 1. The score of couples? joint Descriptive analysis household decisions increases the likelihood of couple methods? Characteristics of the study population. Of the women use rather than no method by 29 per cent (model 3) with every interviewed, the majority (50. In general, the percentage Despite being one of the first countries in South Asia to start a of women with sole authority for decision-making was low. The national family-planning programme, Pakistan has had limited highest level of empowerment was observed in economic decision success in achieving desired outcomes in this area [23] as only making, while the lowest level was observed in physical mobility, 26% of couples use any modern contraceptive method [27]. The age of women also directly links with that of their husbands and the number of children. Dimensions of women Independent Couple decision Dimensions of women Independent Couple decision empowerment decision % % empowerment decision % % Household decision making 23. By contrast, when the element of her husband, or even mother-in-law, who is the primary decision couples? joint decision-making was considered, the empowerment maker [44]. On the other hand, couples? joint decision-making measures showed a substantial effect on contraceptive use. Moreover, the research project conducted in an urban squatter settlement in restriction of our sample to women who were either using any Karachi, Pakistan [23], it is pertinent to note here that the form of contraception or living with unmet needs for contracep measures of empowerment and outcome classification in these tion will further limit the generalizability. Unlike in previous studies, our relationships are ever-changing and multi-faceted [35], details that empowerment measures were regressed on a continuous scale, were not quantified in our paper. We suggest further research investigations in order to Despite these limitations, our study has important implications. This may be the reason for the higher use of mobility was identified as one of the barriers to contraceptive use condoms and withdrawal in Pakistan resulting in stark [45]. Thus, an women tend to make more independent decisions (table 3), while uplifting of the general social and cultural status of women in the chances of becoming pregnant decline with proximity to the conservative societies like Pakistan will have a positive effect on menopause [46], which eventually lessens the need for contracep contraceptive use. These results may be attributed to cultural aspects whereby empowerment of women in relation to household, economic and women in underprivileged communities receive greater encour physical-mobility affairs. Adopting contraceptives can help women agement to do pardah (veil), and young women are usually achieve their desired goals in relation to birth spacing or limiting, accompanied by men and elder members of their family [16]. By in addition to ensuring that they have proper information about, contrast, women deciding about their mobility jointly with their and a range of, contraceptive options. We encourage family husbands have higher chances of using female-only as well as planning programmes to engage men within the scope of their couple contraceptive methods. The fact that this finding contra interventions, as contraceptive use rests more on couples? decisions dicts an earlier study carried out in Pakistan [22] could be than on women-only ones. Moreover, efforts need to be made to attributed to the indicators used for the composition of this educate both partners equally about contraceptive methods that dimension. It is interesting to note the modest effect of overall empower Table S1 Comparison of key family planning indica ment measures as compared to the effect of each empowerment tors. For instance, the magni Acknowledgments tude is highest for the measure of physical mobility which is ranged We are grateful to all the data collectors and field workers; and, above all, from 0?3, followed by household decision-making (score range 0? to the study participants who enriched this study by sharing their 4), economic measure (score range 0?6), and, finally, overall experiences. Principally, the odds ratios for continuous variables are the ratios between individuals who are Author Contributions identical on the other variables but differ by one unit on the variable of interest. Kabeer N (2001) Conflicts Over Credit: Re-Evaluating the Empowerment mortalityfor181countries,1980?2008:asystematicanalysisofprogresstowards Potential of Loans to Women in Rural Bangladesh. National Institute of Population Studies Pakistan (2002) Pakistan population meeting on population and women Gaborone, Botawana. United Nations (1995) Report of the International Conference on Population protocol: using demand-side financing to meet the birth spacing needs of the and Development. Krishna A (2003) Social capital, community driven development and women have longer birth intervals? Agha S, Carton T (2011) Determinants of institutional delivery in rural Jhang, 13. Hennink M, Stephenson R, Clements S (2001) Demand for Family Planning in Karachi Pakistan. Marie Stopes Society Pakistan implemented an operational research project Evidence for Innovating to Save Lives?, to explore effective and viable intervention models that can promote healthy timing and spacing of pregnancy in rural and under-served communities of Sindh, Punjab and Khyber Pakhtunkhwa provinces of Pakistan. We used Stata? version 8 to report the net effect of interventions on outcome indicators using difference-in-differences analysis. Multivariate Cox proportional hazard regression analysis was used to assess the net effect of the intervention on current contraceptive use, keeping time constant and adjusting for other variables in the model. Additionally the Suraj intervention led to a 35 % greater prevalence (prevalence ratio: 1. Open Access this article is distributed under the terms of the Creative Commons Attribution 4. Currently Pakistan has an estimated popula that, in order to overcome the lack of contraceptive ser tion of over 190 million people [2] and is the sixth most vices in regions of the world, the implementation of con populous country [2, 3]. A high burden of population in tracting out, social franchising and voucher schemes are of developing countries with limited resources such as value [9]. It is essential to devise ways and means that address this problem in rural, hard to reach and underserved areas. Kindly refer to the below study design flow chart as Under this initiative, two intervention models were de Fig. Recent evidence, from Pakistan, shows that family plan Interventions were purposefully allocated: in Sindh, dis ning interventions, incorporating social franchising in com trict Naushero Feroze was selected as an intervention bination with voucher scheme, have been instrumental in (Suraj model) district and Nawabshah as a control dis raising awareness and enhancing the use of intrauterine de trict. Pakistan, implemented a 41-month (including 24 months of intervention) operations/operational research project titled b) Suraj model intervention arm Evidence for Innovating to Save Lives? [14?17]. Ten Suraj providers per district were Objectives of the research project selected. Each Suraj provider operated a health care fa the study was conducted to 1) to assess and compare cility, covering a population ranging from 12?16,000 the effectiveness of an intervention model, a private pro that resided within a 3?4 km radius around the heath vider partnership i. For the details of Suraj dius around the facility which is operated by a provider. Reproductive Health (2016) 13:25 Page 5 of 15 Table 2 Provider eligibility criteria Suraj intervention model adhere to the study protocol for control sites. Towards the end of project interventions, an health centers and tertiary care hospitals. Third, a series endline cross-sectional household survey was con of meetings with each provider/facility was conducted to ducted to gauge the impact of the two interventions by invite the providers for participation in the study.

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Estimates and Projections of the Number of Women Aged 15-49 Who Are Married or in a Union: 2015 Revision arthritis in the back and hips buy generic meloxicam pills. Vaginal barrier methods include diaphragms, cervical caps and spermicidal foams, gels, creams and sponges. Other modern methods include emergency contraception, female condoms and modern methods not reported separately. Categorization is mutually exclusive with more effective methods receiving priority when more than one method is reported. Detailed data and information are publicly available in an online data set (United Nations, 2015b). The labels modern? and traditional? or natural? are used here for convenience, although the terms are imprecise. The condom, in particular, has a long history of use, although modern condoms offer significant improvements in manufacture and acceptability. With regard to traditional methods, some of the more refined rules for observing periodic abstinence were developed relatively recently. Data since 2000 on the mix of contraceptive methods used are available for 163 countries or areas, and the most recent survey data from this time period were used to generate estimates of method-specific prevalence in 2015. Survey data from the time period 1985 to 1999 were used to generate estimates for 1994, resulting in 159 countries or areas with relevant data on method-specific prevalence. The survey based observations on the distribution of contraceptive users by method were applied to the model-based estimates of modern and traditional contraceptive prevalence in 1994 and 2015. If there were missing data on specific methods in a survey, then information from a different survey in the country within plus or minus 10 years of the reference survey year were used to allocate prevalence in the other modern methods? or other traditional methods? categories to the missing method categories. If there were no other relevant survey data in the country from which to draw, then the regional method-specific prevalence was used to allocate prevalence in the other modern methods? or other traditional methods? categories to the missing method categories. In three countries the estimates of method-specific prevalence do not sum exactly to the estimate of total prevalence because the relevant survey data observation showed no use of traditional methods while the model-based estimates for 1994 or 2015 showed a non-zero but small level of traditional method use. These three cases and the resulting differences between the estimated contraceptive prevalence of any method and the sum of method specific prevalence estimates are: Bhutan in 1994 (0. Aggregate group estimates are weighted averages of the country or area estimates, using as the weight the number of married or in-union women aged 15 to 49 in each country or area (see United Nations, 2015a). Estimatesofcontraceptiveprevalence(anymethodandmodernmethods),unmetneedforfamilyplanningandpercentageofdemandthatissatisfiedwith modern methodsamongmarriedorin-unionwomenaged15 to49,2015 Contraceptiveprevalence Contraceptiveprevalence Demandforfamilyplanningsatisfied (anymethod) (modernmethods) U nmetneedforfamilyplanning with modernmethods 2015 2015 2015 2015 M ajorarea,region, 80percent 80percent 80percent 80percent 80percent 80percent 80percent 80percent countryorarea N otes M edian lowerbound upperbound M edian lowerbound upperbound M edian lowerbound upperbound M edian lowerbound upperbound W O R L D 63. Estimatesofcontraceptiveprevalence(anymethodandmodernmethods),unmetneedforfamilyplanningandpercentageofdemandthatissatisfied with modernmethodsamongmarriedorin-unionwomenaged15 to49,2015 Contraceptiveprevalence Contraceptiveprevalence Demandforfamilyplanningsatisfied (anymethod) (modernmethods) U nmetneedforfamilyplanning with modernmethods 2015 2015 2015 2015 M ajorarea,region, 80percent 80percent 80percent 80percent 80percent 80percent 80percent 80percent countryorarea N otes M edian lowerbound upperbound M edian lowerbound upperbound M edian lowerbound upperbound M edian lowerbound upperbound N orthernAfrica 52. Estimatesofcontraceptiveprevalence(anymethodandmodernmethods),unmetneedforfamilyplanningandpercentageofdemandthatissatisfied with modernmethodsamongmarriedorin-unionwomenaged15 to49,2015 Contraceptiveprevalence Contraceptiveprevalence Demandforfamilyplanningsatisfied (anymethod) (modernmethods) U nmetneedforfamilyplanning with modernmethods 2015 2015 2015 2015 M ajorarea,region, 80percent 80percent 80percent 80percent 80percent 80percent 80percent 80percent countryorarea N otes M edian lowerbound upperbound M edian lowerbound upperbound M edian lowerbound upperbound M edian lowerbound upperbound Japan 56. Estimatesofcontraceptiveprevalence(anymethodandmodernmethods),unmetneedforfamilyplanningandpercentageofdemandthatissatisfied with modernmethodsamongmarriedorin-unionwomenaged15 to49,2015 Contraceptiveprevalence Contraceptiveprevalence Demandforfamilyplanningsatisfied (anymethod) (modernmethods) U nmetneedforfamilyplanning with modernmethods 2015 2015 2015 2015 M ajorarea,region, 80percent 80percent 80percent 80percent 80percent 80percent 80percent 80percent countryorarea N otes M edian lowerbound upperbound M edian lowerbound upperbound M edian lowerbound upperbound M edian lowerbound upperbound Israel 71. Estimatesofcontraceptiveprevalence(anymethodandmodernmethods),unmetneedforfamilyplanningandpercentageofdemandthatissatisfied with modernmethodsamongmarriedorin-unionwomenaged15 to49,2015 Contraceptiveprevalence Contraceptiveprevalence Demandforfamilyplanningsatisfied (anymethod) (modernmethods) U nmetneedforfamilyplanning with modernmethods 2015 2015 2015 2015 M ajorarea,region, 80percent 80percent 80percent 80percent 80percent 80percent 80percent 80percent countryorarea N otes M edian lowerbound upperbound M edian lowerbound upperbound M edian lowerbound upperbound M edian lowerbound upperbound A lbania 66. Estimatesofcontraceptiveprevalence(anymethodandmodernmethods),unmetneedforfamilyplanningandpercentageofdemandthatissatisfied with modernmethodsamongmarriedorin-unionwomenaged15 to49,2015 Contraceptiveprevalence Contraceptiveprevalence Demandforfamilyplanningsatisfied (anymethod) (modernmethods) U nmetneedforfamilyplanning with modernmethods 2015 2015 2015 2015 M ajorarea,region, 80percent 80percent 80percent 80percent 80percent 80percent 80percent 80percent countryorarea N otes M edian lowerbound upperbound M edian lowerbound upperbound M edian lowerbound upperbound M edian lowerbound upperbound Puerto Rico 78. N umberofmarriedorin-unionwomenaged15 to49 whoarecurrentlyusinganymethodofcontraceptionorwhohaveanunmetneed forfamilyplanning(thousands),2015 and2030 Contraceptiveprevalence Contraceptiveprevalence (anymethod) (anymethod) U nmetneedforfamilyplanning U nmetneedforfamilyplanning 2015 2030 2015 2030 M ajorarea,region, 80percent 80percent 80percent 80percent 80percent 80percent 80percent 80percent countryorarea N otes M edian lowerbound upperbound M edian lowerbound upperbound M edian lowerbound upperbound M edian lowerbound upperbound Dem. Modern contraceptive methods are technological Modern Contraceptive Method: A product or medical advances designed to overcome biology. In this regard, modern procedure that interferes with reproduction from methods must enable couples to have sexual intercourse at any acts of sexual intercourse mutually-desired time. With a clear definition of modern contraception methods, the term modern contraceptive is rarely defined. Thus, researchers who measure levels of modern We emphasize that our classification does not address contraceptive prevalence often differ in how they categorize concepts of contraceptive effectiveness or efficacy. For example, the United Nations the word modern should not be equated with higher efficacy. These organizations differ on other developed for the Standard Days Method to help women keep classifications as well. Nations Population Division labels all periodic abstinence High-technology devices have been developed to predict the techniques as traditional methods [4]. However, all of these technological improvements do not convert the approach to a modern contraceptive since they still require couples to avoid sex, or use a different method, on specific days of the menstrual cycle. David Hubacher has served on Advisory Boards for Bayer HealthCare logical criterion to be considered modern in that respect. James Trussell has served on Advisory Boards for Teva Pharmaceuticals, method should be abandoned in favor of other terms [6]. Commentary / Contraception 92 (2015) 420?421 421 Table 1 References Classifying different contraceptive methods. Adding it up: the costs and benefits of Sterilization (male and female) Fertility awareness approachesb investing in sexual and reproductive health. New York: Guttmacher Intrauterine devices and systems Withdrawal Institute and United Nations Population Fund; 2014 [Available at: Subdermal implants Lactational amenorrhea Condoms (male and female) [2] World Health Organization Family Planning Fact Sheet No 351. Demographic and Health Surveys; 2012 [Available Diaphragms and cervical caps at: In: Hatcher R, Trussell J, Nelson A, incorporating terms such as traditional, natural, physiology, and others had Cates W, Kowal D, & Policar M, editors. Global family planning metrics RhythmMethod, Two-DayMethod, Billings Ovulation Method, Symptothermal time for new definitions? No women viewed amenorrhea as protective against pregnancy, and all had started or planned to start a researcher, Institut method just before or when they resumed sexual activity. Half of the women abstained for six or more months, and National d?Etudes De some then either adopted a method they used incorrectly or did not adopt one at all. Integration of family Systems and Develop planning into immunization programs would provide opportunities to reach women who did not adopt a method ment, School of Public early in the postpartum period. Men should be involved Health and Tropical Medicine, Tulane Uni in the postpartum family planning consultation. In low-income countries, sociated with closely spaced births, medical guidelines women tend to adopt postpartum family planning meth recommend the uptake of a family planning method by ods only after the resumption of sexual intercourse or their six weeks postpartum. In urban Africa, the somewhat lower durations methods that can be started immediately after delivery. Durations of postpar low-income countries has been limited by poor access to tum abstinence are also shorter in West African cities than prenatal care, skilled delivery and postnatal care. First, many women facilities that offer family planning services in Ouagadou believed, incorrectly, that they were completely protected gou, four of which are public health facilities. The three other time frame, and this single opportunity was not suffcient facilities are run by nongovernmental organizations and to reach all women. Finally, before health care providers offer low-cost reproductive health services, including fam would dispense contraceptives, they sometimes required ily planning. Five of these seven health centers serve the amenorrheic women who were more than six weeks post population residing within the areas of the Ouagadougou partum to wait for the return of their menses or to take a Health and Demographic Surveillance system. An experienced Burkinabe female research assistant, In this study, we use a qualitative approach to investi contracted by the Institut Superieur des Sciences de la gate these and other obstacles to the early uptake of fam Population at the University of Ouagadougou, spent one ily planning methods after a birth in Ouagadougou, the week at each facility. In Ouagadougou, almost all women attend prena selected service statistics obtained from the facilities? regis tal visits (99%), deliver in a health facility (97%) and have ters. We use these observational data to describe current their child vaccinated (80% for all vaccines and 98% for postpartum family planning services in Ouagadougou. Despite these contacts with the Also between April and June 2012, the same assistant health care system, contraceptive use remains low between invited a convenience sample of 33 females and 12 males births: Only 27% of women have a satisfed need for fam at the facilities to participate in interviews. One-on-one ily planning for spacing in Ouagadougou (11% in Burkina interviews were preferred to focus groups to allow for in Faso as a whole). All discussions were conducted in Moore (the stinence, and to factors that may help women make a suc language of the Mossi, the main ethnic group in Ouaga cessful transition from abstinence to family planning. Inclusion sidering the gender inequalities that persist in urban West criteria for this study were residing in Ouagadougou and 88 International Perspectives on Sexual and Reproductive Health having given birth within the last 24 months or having a the one hand (short-term abstinence, 1?2 months; medi partner who had. We classifed correct use of mod nence, breast-feeding practices and duration, duration of ern methods (the lactational amenorrhea method, the postpartum amenorrhea, attitudes on birthspacing and Standard Days method, hormonal and surgical methods, limiting, attitudes on postpartum abstinence, past and condom) as safe, and traditional family planning method current contraceptive use, and preferred timing for post use (periodic abstinence, withdrawal) and improperly partum family planning services targeted at women and used modern methods (for example, inconsistent condom men. Simi diotaped and translated (into French, if in Moore) during larly, only women purposefully using the lactational amen transcription by several Burkinabe research assistants with orrhea method were classifed as lactational amenorrhea experience in transcription. Altogether, women were classifed Burkina Faso, only eight men who were visiting the fa as having gone through an easy and protected transition cilities were successfully recruited. Four more men were to family planning,? a protected but diffcult transition to found in the vicinity (working in the parking garage of the family planning? (both categories without a period of risk hospital, etc.

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Some 23 improving arthritis with diet cheap meloxicam 15mg otc,000 abortions were performed in authorized hospitals and clinics during 1972 to 1973 (Visaria and Jain 1976). Another 4 percent of respondents reported their use of withdrawal and abstinence (Visaria and Jain 1976). Because sterilization, usually adopted by older couples at the end of their childbearing years, was the favored method, the effect of the total family planning effort on fertility was less than would have been the case if spacing methods by younger, fecund couples had been more popular. Publicity Campaigns From the early days of the family planning program, the provision of contraceptives was accompanied by publicity campaigns to encourage their use. Raina (1988, 205?6) who continued his keen interest in the evolution of the family planning pro gram, paid tribute to Tyagi as quite a unique person, dedicated to the red triangle? and described the genesis of Lal Tikon as follows. When he met an unemployed elephant keeper, Tyagi motivated a small group of supporters to raise money and designed a badge featuring an elephant and red triangle to be worn by the sponsors. With their financial support, the elephant decked with red triangle, moved from place to place distributing flyers and condoms. To supplement the red triangle campaign, the family planning message was deliv ered through the mass media, including radio and television; puppet shows; and folk songs. Traveling troupes of actors and singers spread the message in the countryside (Narain 1968). What was foreign was the idea that the family should limit itself to one son and one daughter. While one daughter may have seemed plausible, given the need to provide dowries early in their lives, just one son was regarded as woefully inadequate to ensure enough field labor, proper old-age eco nomic security, and, more important, preservation of the family name. Considering the high levels of infant mortality, especially in rural areas, a family of two seemed absurd. No local staff members involved in the program, let alone foreign technical assistance personnel, appeared to have anticipated such opposition to their propaganda. Beginning in the early 1960s, a variety of research centers in India engaged in sys tematic attempts to measure family planning knowledge, attitudes, and practice. As part of its family planning efforts, the government supported a variety of demographic and communication action research projects coordinated by the Cen tral Family Planning Institute, a government-financed autonomous body. The Demo graphic Training and Research Center, established by the United Nations (later renamed as the International Institute for Population Studies) was a notable center for such research, as well as for training in demography (Narain 1968, p. Throughout the 1960s and 1970s, Indian social scientists at universities and free standing research institutes were reluctant, for the most part, to engage in research on family planning. Senior social scientists interviewed in 1971 reported that family planning operations were in the hands of physicians and that policy was set by senior civil servants, nei ther of which were particularly interested in contributions by social scientists. Ashok Mitra, head of the Planning Commission and himself a distinguished social scientist, ruefully noted that the bureaucracy viewed academics as troublemakers. For their part, academic social scientists avoided research on the national family planning pro gram, leaving it to those officially responsible for implementing family planning programs and employed by the Ministry of Health and Family Planning. Social Science Research Social science contributions to population issues were substantially enhanced by the formation of the Population Foundation of India (formerly known as Family Plan ning Foundation) was established in 1970 by a dedicated group of industrialists and population activists led J. The Population Foundation of India funded a number of high-quality social sci ence research studies directly relevant to the national family planning program, including an essay on the consequences of population growth by Ashok Mitra and an examination of family planning strategies by M. Renaming the Ministry of Health and Family Planning as the Ministry of Health and Family Welfare formalized this strategic transition (personal correspon dence with Ronald Ridker 2006). Neither of these two styles of colonialism were sufficiently respectful of the traditional culture that gov erned the lives of the majority of Indians, 80 percent of whom lived in rural villages. Nor were they willing to let Indians assume ownership of even their own initiatives. The Ford Foundation In the earliest days of the Indian family planning effort, the Ford Foundation took the lead in assisting, if not shaping, the emerging enterprise. Much of this can be attrib uted to the close association of their representative, Ensminger, with Prime Minister Nehru, who encouraged the foundation to take a leading role. While Freymann, King, Segal, Southam, and Wilder made significant contribu tions, as described earlier, many other technical assistance people whom Ensminger brought to India found themselves less useful. The collapse of the intensive family planning scheme in the late 1960s left foreign experts recruited to work in those dis tricts without Indian counterparts. Furthermore, the prominent role of foreign advisers in devising a variety of initiatives tended to discourage Indian ownership of some such projects. His toric monsoon failures in 1965?66 and 1967?68 raised fears of massive starvation in the following decade. In 1973, relations between the governments of India and the United States cooled, caused, among other things, by a perceived U. Prime Minister Indira Gandhi had embarked on a program of national self-reliance that affected the Ford Foundation as well. Das, secretary of the Ministry of Health and Family Planning, broke off arrangements with foundation-supported consultants to the ministry and refused to meet with foundation officials. Over the years, the United Nations Population Fund and the Danish, Japanese, and Norwegian assistance agencies donated smaller sums for a variety of family planning?related activities. The effect of all such investments was proportionate to the extent to which the donors understood the traditional values and cultural traits of the Indian population. Experimentation with a variety of approaches adapted to specific populations rarely occurred. Furthermore, hundreds of thousands of family planning workers were recruited without sufficient training or supervision. In rural areas, workers faced formidable obstacles in traveling to villages to which they were assigned. Many workers went unpaid for long periods because of difficulties in reaching them. Freedman (1987) notably contrasted the Indian experience with the more successful models used in the Republic of Korea, which featured small-scale experiments and adaptation by national programs based on lessons learned. One was the use of centrally decreed, time-bound targets for the acceptance of each major birth control method offered by the government and the application of such targets to family planning workers throughout the bureaucratic chain of command. More often than not, local family planning workers found targets completely unrealistic and simply ignored them. Targets were most eas ily applied to sterilization, leading to a focus on couples who wished to end their childbearing, with less effect on overall fertility than spacing methods used by younger couples at the height of their childbearing years. As most international assistance agencies subsequently switched from supporting demographically driven national efforts to curb population growth to focusing on the reproductive health and welfare of individual women and their families, the Indian model of the 1960s and 1970s has become the exemplar of what went wrong in nationwide family plan ning programs. The second hallmark was the use of relatively large monetary or in-kind incen tives to promote sterilization. Together with target setting, the early Indian pro gram has been criticized in some quarters as at least quasi-coercive, becoming, for a time, openly coercive during the emergency? of 1975?77. It is fair to say that coercive aspects of the Indian program (along with those in China and Indonesia) have given ammunition to donor agencies that have abandoned their efforts to reduce population growth, even in Sub-Saharan Africa, parts of the Middle East, and South Asia, where population pressure still has a profoundly negative effect on human welfare. A number of these individ uals made crucial contributions; others became redundant as the program matured. Furthermore, foreign experts tended to get ahead of the program and to be perceived as owning the initiatives they were intended to assist. Partly as a result of this experience, the Ford Foundation sharply altered its approach to operations in the developing world. Under Ensminger, some 80 percent of Ford Foundation funds in support of family planning went to U. S technical assistance personnel, with the remaining 20 percent going to Indian institutions. Wilhelm reversed these ratios, and the Wilhelm model now typifies Ford Foundation practice in all its overseas devel opment assistance. By the 1980s, examples of successful programs could be found even though a majority of the population still lived in tradition-bound villages. One example was the Project for Community Action in Family Planning, which covered more than 154 villages in the state of Karnataka. As early as the mid-1980s, more than 43 percent of couples were using family planning in the project area, fully 14 percentage points more than the state average. This is particularly notable considering how the deeply entrenched inferior status of women negates official efforts to decrease their fertility. Despite its weaknesses, the Indian family planning initiative of the 1960s and 1970s had significant achievements. It enjoyed support at the highest levels of gov ernment, illustrating the importance of political will in furthering a national enter prise. Too many family planning efforts in other countries have been handicapped by the lack of such will.