Meet Fred Sai et al.
Veteran Ghanaian researcher and family planning advocate Fred Sai and the Mainichi Shimbun Population Problems Research Council of Japan shared this year’s United Nations Population Award at a ceremony at UN headquarters in New York last month. They were chosen from among 16 nominees by a committee of representatives from 10 U.N. member states elected by the Economic and Social Council. Each received a diploma, a gold medal, and a monetary prize.
In the past, Dr. Sai served as chair of the Main Committee of the 1984 International Population Conference and of the 1987 World Heath Organization/U.N. Children’s Fund Meeting on Infant and Young Child Feeding, which was credited with providing the impetus for the International Code of Marketing for Breast-Milk Substitutes. He is in his second term as president of the International Planned Parenthood Federation, and was elected unanimously to chair the Preparatory Committee of the 1994 International Conference on Population and Development.
Mainichi Shimbun Population Problems Research Council is credited with raising awareness of population issues through Mainichi Shimbun, the newspaper that created the Council in 1949, and helped build support within Japan for international population programs (POPULI, Oct. 1993, vol.20, no.9, 2).
More on human papillomavirus
Human papillomavirus infections (HPV) include 65 subtypes of the virus. More than 1.5 million new cases are reported annually making it the most common sexually transmitted disease. The virus involves the basal layer of the epithelial cells and reproduces only within fully differentiated cells. It can remain latent for many years and can bring about local changes in epithelial cell immunology. Causative factors include smoking.
While HPV is not the sole cause of genital tract carcinoma it is probably an important cofactor. High risk male partners, human immunodeficiency virus (HIV), oral contraceptives, other immuno deficient states, and other sexually transmitted diseases are also considered cofactors. Viral types 16 and 18 are most frequently associated with carcinoma of the cervix, vulva, and vagina in the female. Males can also have lesions not only of the penis but also of the scrotum. Under those circumstances, condoms will not prevent genital transmission. Cancer of the penis is also associated with HPV type 16 and to a lesser degree with type 18, while most of the genital and anal warts in men are caused by benign types HPV 6 or 11.
Local treatment with podophyllin is still the first line for external lesions but cannot be used in the vagina or cervix because it is absorbed from the mucosa and is toxic. Treatments include trichloroacetic acid (TCA), 5-Fluorouracil (5-FU) and various lasers. Interferon has shown good results (L. J. Cibley, “Detecting and treating HPV infection,” Clinical Advances in the Treatment of Infections, Sept., vol. 7 1993, 1-3, 10-12).
Trial of Cyclofem in Indonesia
The high-pressure fertility reduction program of the Indonesian Government has only achieved 49.7% contraceptive prevalence and the total fertility rate remains at three percent. As a result, the BKKBN, the National Family Planning Coordinating Board of Indonesia, has decided that there is a need for a wider choice of methods. BKKBN has therefore begun a trial of a new once-a-month injectable contraceptive, Cyclofem; Cyclofem 25 mg medroxyprogesterone acetate (DMPA) and 5 mg of estradiol cypionate. It is produced by Upjohn in Mexico City and is designed as a once-a-month contraceptive for young women of low parity who wish to delay or space pregnancy. During the trial, the 337 complaints listed were said to have come from only six percent of the 835 women, mostly in months two to six of drug use with a second increase between 17 and 19 months. The symptoms most commonly reported were dizziness and nausea, followed by bleeding problems, vomiting, migraine headaches, and amenorrhea. A total of 139 women discontinued the method, a total life-table discontinuation rate of 33 percent. Medical and personal reasons made up 3/4 of the discontinuations while desire for pregnancy accounted for 15 percent (S.P. Pandi et al, “Introductory trial of the once-a-month injectable contraceptive cyclofem in Indonesia,” Advances in Contraception, 9 March 1993, 33-40).
Hypothyroidism in menorrhagic women wearing IUDs
Occult (meaning not obvious) hypothyroidism has been reported in menorrhagic women who wear IUDs. The thyroid function studies of 14 women who wore IUDs and suffered from menstrual bleeding (6 days or more, or with significant amount of blood clots) showed that TSH levels were significantly higher in the study group compared with the control group. They remained at the upper limits of the normal range. Thyrotropin-releasing hormone (TRH) tests were consistent with occult hypertension (M. Blum & B. Blum, “The possible relationship between menorrhagia and occult hypothyroidism in IUD wearing women,” Advances in Contraception, 8 Dec. 1992, 313-17).
Consolidating hold on world health resources:
The World Bank optimistically postulates a future increase in income and education “especially for girls who will later form the nucleus for family health, hygiene and nutrition.” It warns however that “health care systems will be taxed by a growing elderly population.”
The solution offered by the Bank is the “fostering [of] a richer economic environment, redirecting government health care spending and creating greater diversity and competition among service providers.”
The Bank views “disproportionate [health] funding” as existing at the international level, particularly in the U.S. “Of the $1.7 trillion spent on health care worldwide in 1990, 90 percent was directed toward high income countries,” according to Bank of officials. Forty-one percent of those funds were spent in the U.S. The Bank notes that “the poor are most likely to spend additional incomes on…a health improving diet, obtaining safe water and upgrading sanitation and housing” The Bank proposes a $20 billion program of “greater government regulation of health insurance or a mandate for alternatives.”
A suggested alternative to the Bank program is a redirection of half of current government expenditures and a 50 percent reduction in “cost-ineffective” services (World Bank: global economy hinges on health care,” Family Planning World, vol. 3, no. 6, Nov./Dec. 1993, 9).
Dosvidania to tradition!
Traditional ideas of ‘preventive’ health care must change, say family planning experts. The governments of Poland, Lithuania and the former East Germany are presently experiencing backlashes against abortion; Romania requires “numerous [health] tests” and “places hurdles” in the way of contraceptive use; Yugoslavia is “wracked by war.”
Marie Stopes International has had to “walk a fine line” in its Romanian clinic, “appeasing government while continuing to press for change.” Many clients are dubious of health hazards related to contraceptives.
The “key to defeating anti-abortion backlash” is to help governments and citizens develop “a tradition of family planning to prevent pregnancies altogether.” In Russia, the Family Planning International Association (FPIA is the international arm of Planned Parenthood of America) has clinics scattered in “18 factories, the Moscow University’s Women’s Health Center and the Moscow Medical Academy.” FPIA is also forming a school-based adolescence program as well as clinics in the Shakouskaya region and Irkutsk (Jim Kennett, “Family planning struggles to rise…,” Family Planning World, vol. 3, no. 6, 16).
Marie Stopes International puts Nicaraguans onstage
Ixchen, a Nicaraguan theatre group, stages street theatre in the street markets of Managua. A couple is fighting boisterously in the streets: “No condom, no sex!” screams the woman. As a crowd gathers, the woman turns to them and asks if she is wrong to ask for a “little protection.”
This carefully designed approach to the people is intended to involve the crowd in public discussions of “AIDS, sexuality and abuse of women.” Meg Braddock, director of the Nicaraguan project says, “The key is to talk in the everyday language that people are used to hearing.” In other words, the way to persuade the people is to talk to them in the language of their own culture — they’ll think you’re one of them and do what you say!
Marie Stopes International, with the help of the World Bank, expects to expand the project to groups in Malawi and the Philippines in the near future (“Theatres troop through AIDS crisis,” Family Planning World, vol.6, 110.3).
More from the fit, less from the unfit? — a hint for the wise
Business Week magazine predicts that the “U.S. will have a population rise through the year 2050” which may give the country “an economic edge” over the other industrialized countries. “America’s high fertility and immigration could prove to be a big plus in the decades ahead,” said Philip Suttle of the Morgan Guaranty Trust Co.
In contrast, most of the industrialized countries have experienced dramatic drops in population growth rates. Demographers predict a negative growth rate in Italy and Germany by the year 2(}25; an increase of only one million in France and Japan; and Great Britain can expect a rise of only about three million. By the year 2025, “76 million Americans will be born” and by 2050, the U.S. population “is expected to hit 383 million,” according to the Population Reference Bureau. In addition, an average of one million immigrants enter the U.S. every year while some European nations have “tightened the reins on immigration” (“U.S. population surging? Look on the bright side,” Family Planning World, Vol. 6, no. 3, 30).
Royally chosen:
The inside cover of the Population Concern annual report 1993 is ‘graced’ by the image of H.E. Prince Philip, the Duke of Edinburgh. The Prince, People Concern’s patron, explained his concerns: “My concern about the rapid growth in the world’s human population was sparked off through my involvement in the World Wide Fund for Nature and the problem it faces in the conservation of wild species of plants and animals and their habitats. It very quickly became apparent to me that the single greatest threat to the survival of such species was the human encroachment, pollution and exploitation of the last remaining wilderness areas and their inhabitants on land and in the oceans.”
It was almost possible to hear his empathetic sigh as he intoned: “it is discouraging to discover that such a large proportion of the women in less prosperous countries do not have any access to family planning facilities.” Why that is enough to make you de-encroach! In fact, that is exactly what the prince has in mind, and Population Concern, a British-based group, has set out to accomplish the task.
Population Concern engages in de-population projects among the people in India and Bangladesh with the assistance of the Overseas Development Administration, the European Commission and the local Family Planning Association. The organization maintains the same partnerships; in Nepal and Pakistan, Africa and Mexico. They are “recognized by the United Nations Population Fund” and “work in collaboration with the International Planned Parenthood Federation. They are happy to report an income of approximately U.S.$l.5 million. They have recently begun work in Tanzania and the island of Dominica, and have expanded their work in Ethiopia and Pakistan. Population Concern is “closely involved in preparation for the 1994 International Conference on Population and Development (ICPD).” They were, in fact, “represented on the official British delegation to the second Preparatory Commission for ICPD in New York” (Population Concern Annual Report 1993).
Limit the poor but the rich — “Have more!”
Singapore Prime Minister Goh Chok Tong has designed a program to “encourage poor families to help themselves” by limiting their births to two children. Under a program titled “Small Families Improvement Scheme,” education and housing grants worth up to US$16,000 per couple will be paid over a period of 20 years. For the rest of Singapore’s families, the former population slogan “two is enough” has been changed to “have three if you can afford it” (International Dateline, Populations Communications International, January 1994).
Mass media in control
Johns Hopkins University (JHU) is known for its Enter-Educate programs which aim at changing the traditional cultural values of people (at home and abroad) in order to inculcate population control acceptance. Dr. Phyllis Piotrow, director of the Center for Communication Programs at JHU, has described the program as aiming “to entertain and educate target audiences mainly through the mass media.” “Interpersonal communication,” she continued, is not “competitive” with mass media but is reinforced by it. “Through enter-educate,” the “mass media [works] to legitimate a subject for discussion, to create agendas for discussion, to introduce new ideas into the discussion, to reinforce ideas and to create role models for behavior” (JOICFP News, no. 223, Jan. 1993, 5).
Harvard congratulates China on its population policy
Dr. Richard Cash, Harvard School of Public Health, and fellow Harvard Institute for International Development was “very impressed with what he saw of Japanese assistance to the population program in China. Noting that China “has had a very strong family planning program for many years,” he congratulated the Japanese Organization for Cooperation in Family Planning (JOICFP) for “building on this.” He praised JOICFP, the State Family Planning Commission and the China Family Planning Association for their enthusiasm and “very good work” by appealing “to people’s self-interest.” Dr. Cash however reminded all of the importance of not allowing “people to slip back into having larger families” (“A Peoples’ Project in China,” JOICFP News, no. 234, Dec. 1994, 6).
Problems in the world of reproductive technology
International feminists view reproductive technology as a means “to control women’s procreative capacity.” They raise disturbing questions concerning the development of “provider-controlled technologies” which can become “purposeful instruments inspirited by eugenicists.” In these and other related interests, they reject amniocentesis, sex predetermination, embryo biopsy, in vitro fertilization and the manipulation of human embryos as well as the “industrialization and commercialization of reproduction in the surrogate mother.”
Their language expresses matters of universal concern when they describe population control policies as “designed to control the bodies, the fertility and the lives of women because it is women who bear children.” Their recognition of the strain of “racist and eugenic ideologies” running through the foundation of population concepts goes beyond the prescient to penetrate the realm of historical fact. Their statement that the goal of the policies is the “elimination of the poor instead of poverty” has the rumble and shriek of truth. Their insistence that “population policies represent the interests of privileged elites” must be heard in both South and North, for the women of the North share their fate. Not everyone will agree with everything they have to say, nor do I, but they are, in many ways, closer to breaking through the ideological murk of scientism which shrouds the modern world, than many others (Declaration of People’s Perspectives on “population” symposium, 12-15 Dec. 1993, Comilla, Bangladesh).
It is long past time that those of us in the North recognize the responsibility of our own governments in victimizing both Third World women and First World women through the imposition of population policies. We share a solidarity of responsibility and interests in this regard. It is time to exercise it.
Dead baby girls to “donate” eggs
The British Human Fertilization and Embryology Authority (HFEA) report highlights the dangers of experiments with aborted fetuses. The debate was sparked by an Edinburgh Medical School research team which believes that within five years it could create a child from eggs taken from an aborted female fetus. Apparently the HFEA reacted with “unease, distaste and surprise” when it first heard about the research. However, a after a period of reflection, “Members have now had time to calm down and reflect.”
Sir Colin Campbell, chairman of the authority which controls Britains test tube clinics, now sees possibilities which would “enable [women] to have children when they would otherwise remain childless.” On the closer horizon also, Sir Colin sees an “opportunity for research which might be of great value to future generations.” Questions which have been raised relate to whether ways should be sought to increase the supply of eggs for use in research and infertility treatment; should research be allowed to use eggs from female fetuses or women who have died; and should doctors be allowed to treat women using such eggs (“Public invited to give views,” Daily Express, 8 Jan. 1994).
Other views
“…improved seeds and farming systems have been raising the world’s crop yields at roughly double its population growth rate. It is food production technology, not population management, which has prevented hunger and massive famine in our densely populated world” (Dennis T. Avery, Global Food Progress 1991, Hudson Institute 1991, 71).
