The
Environment,
Population and
Reproductive Health
Slide 2
Estimated Number of Births
& Deaths Resultant Population
Increase, Mid-2003
Total Pop., Mid-2003 6.3 billion (G.R. 1.3%)
Population
Births Deaths Increase
|
|
|
No. per year 139,000,000 57,000,000 82,000,000 |
|
|
|
No. per week 2,673,000 1,096,000 1,577,000 |
|
|
|
No. per day 381,857 156,571 225,286 |
|
|
|
No. per minute 265 109 156 |
Slide 4
Population Growth Rates
|
|
|
|
|
Growth Rate (%) Doubling Time (yrs) |
|
4.0 17 |
|
3.0 23 |
|
2.0 35 |
|
1.0 69 |
|
0.002 35,000 |
Estimates of Birth,
Death
and Growth Rates, Mid-2003
|
|
|
Pop. Births/
Deaths/ Growth D.T. |
|
1000 1000 rate (%) (yrs) |
|
|
|
WORLD 6,314M 22 9 1.3 53 |
|
|
|
Africa 861M 38 14 2.4 29 |
|
Asia 3,830M 20 7 1.3 53 |
|
L. America 540M
23 6 1.7 41 |
|
Europe 727M 10 12 -0.2 - |
|
N. America 323M
14 8 0.5 138 |
|
|
Estimate of Birth, Death
& Growth Rates
Mid-2003, Selected Countries
|
|
|
Pop. Births/
Deaths/ Growth D.T. |
|
1000 1000 rate (%) (yrs) |
|
|
|
China 1,289M 13 6 0.6 115 |
|
India
1,069M 25 8 1.7 41 |
|
Russia
145M 10 16 -0.7 - |
|
U.S. 291M 14 9 0.6 115 |
World Population, 1950-2020
(millions)
|
|
|
Less More |
|
World Developed Developed |
|
(x1,000,000)
(x1,000,000) (x1,000,000) |
|
|
|
1950
2,501 1,644 (68%) 857 (34%) |
|
1970
3,610 2,526 (70%)
1,084 (30%) |
|
1985
4,845 3,671 (76%)
1,174 (24%) |
|
2003
6,314 5,112 (81%)
1,202 (19%) |
|
2010*
6,903 5,687 (82%)
1,217 (18%) |
|
2025*
8,082 6,842 (84%)
1,240 (16%) |
|
*United Nations Medium Projection |
Population
Projections
(Millions)
|
|
|
1994 2003
2010 2025 |
|
World 5,607 6,314
6,903 8,082 |
|
Africa 700 861
979 1,288 |
|
Asia 3,392 3,830
4,235 4,965 |
|
Latin America 470
540 591 697 |
|
Europe 728 727 731
715 |
|
North America 290
323 333 376 |
Population
Projections,
Selected Countries
(Millions)
|
|
|
1994 2003 2010 2025
2050 |
|
China 1,192 1,289 1,394
1,561 1,394 |
|
India 912 1,067 1,197
1,441 1,628 |
|
U.S. 261 292 298 335 422 |
|
Indonesia 200
221 239 275 316 |
|
Russia 148 146 142 135 119 |
|
Nigeria 98 134 150 203 307 |
|
Mexico 92 104 118 140 153 |
Momentum of World
Population Growth
|
|
|
Eventual point |
|
at which |
|
Year in which the World population population |
|
world attains at
replacement stabilizes |
|
replacement fertility (x1,000,000) |
|
|
|
|
|
2000-2005 5.9 8.4 |
|
2020-2025 8.4 11.2 |
|
2040-2045 12.0 15.1 |
Slide 12
Slide 13
Slide 14
Slide 15
Slide 16
Urban Populations
(Millions)
|
|
|
1970 2001 2015 |
|
Sao Paolo 8 18 21 |
|
Mexico City 9 18 20 |
|
Shanghai 11 13 14 |
|
Mumbai 6 17 23 |
|
Calcutta 7 13 17 |
|
Jakarta 4 11 17 |
|
Beijing 7 11 12 |
Urban Areas Larger
Than
5 Million People
|
|
|
Developing Developed |
|
countries countries |
|
1970 11 9 |
|
2000 37 11 |
|
|
|
|
Contraceptive
Prevalence:
Developing Countries
(Approximate %)
Percent of married women
15-49 using modern methods of contraception
Percent of married women
15-49 using modern methods of contraception
Health Benefits of
Contraception
|
|
|
187 M unintended pregnancies |
|
60 M unplanned births |
|
105 M abortions |
|
2.7 M infant deaths |
|
215,000 pregnancy-related deaths |
|
|
|
Still an additional 201 million women
with unmet need |
1974 Population
Conference,
Bucharest
|
|
|
North-South Debates |
|
Western Nation Imperialism |
1984 Population Conference,
Mexico City
|
|
|
U.S. Stance: Free Market Systems |
|
Population Growth Not An Issue |
|
Abortion (With Catholic Church) |
|
|
|
Developing Country Concerns Re: |
|
Population |
International Conference on
Population and Development (ICPD)
(Cairo, September, 1994)
|
|
|
Major Issues: |
|
Population |
|
Environment |
|
Human Rights |
|
Empowerment of Women |
|
Women’s Sexual & Reproductive
Health & Rights |
Cairo - The Setting
|
|
|
15,000 Attendees |
|
3,700 Delegates from 179 Countries and |
|
8 Observer Delegations |
|
4 Presidents, 7 Prime Ministers, 5 Vice
Presidents, Many Parliamentarians |
|
1,200 Nongovernmental Organizations
(NGOs) |
|
4,200 Journalists |
Brundtland of Norway
|
|
|
“Morality becomes hypocrisy if it means
accepting mothers suffering or dying in connection with unwanted pregnancies
and illegal abortions, and unwanted children living in misery ..” |
Environmental Issues
|
|
|
Conflicts Between Developed and Less
Developed Countries |
|
|
|
Developed Countries |
|
|
|
Consumption Patterns |
|
Industrialization |
|
Pollution |
Environmental Issues
(cont.)
Less Developed Countries
|
|
|
Population |
|
Deforestation |
|
Loss of Top Soil |
|
Early Industrialization - Pollution |
|
Urbanization |
Water Issues
|
|
|
Projections for the future are daunting |
|
Again, impact heaviest on the poorest
countries |
|
Increases in population numbers play a
major role |
ICPD Programme of Action
|
|
|
Overall emphasis on sustainable development, humanitarian goals, and
status of women rather than on demographic targets |
Empowerment of Women
|
|
|
“The empowerment and autonomy of women
and the improvement of their political, social, economic and health status is
a highly important end in itself …” |
Empowerment of Women
|
|
|
Economic Equity: |
|
Access To Jobs, Equal Pay |
|
|
|
Health Equity: |
|
Right to Reproductive and Sexual Health |
|
|
|
Political, Legal, Educational and
Social Equity |
|
|
Abortion in Cairo
|
|
|
“In no case should abortion be promoted
as a method of family planning … |
|
All governments …are urged …to deal
with the health impact of unsafe abortion as a major public health concern… |
|
In circumstances in which abortion is
not against the law, such abortion should be safe.” |
Human Rights
|
|
|
“These [human] rights rest on the
recognition of the basic rights of all couples and individuals to decide
freely and responsibly the number, spacing and timing and to have the
information and means to do so and the right to attain the highest standard of
sexual and reproductive health … free of discrimination, coercion and
violence ..” |
Reproductive Health Issues
|
|
|
Family Planning Services |
|
Prevention, Diagnosis and Treatment of |
|
STDs and HIV/AIDS |
|
Adolescent Sexuality and Pregnancy |
|
Maternal Mortality |
|
Abortion |
Family Planning Services
|
|
|
Make Available All Effective and Safe
Methods of Contraception On A Voluntary Basis With Full Informed Consent |
Family Planning Methods
|
|
|
Oral Contraceptives |
|
IUDs |
|
Injectables & Implants |
|
Barrier Methods |
|
Periodic Abstinence |
|
Sterilization Procedures |
STDs and HIV/AIDS
|
|
|
Gonorrhea and Syphilis |
|
Chlamydia |
|
Herpes |
|
Trichomonas |
|
Monila |
|
HPV |
|
HIV/AIDS |
STDs and HIV/AIDS (cont.)
|
|
|
Prevention Education |
|
Condom Use |
|
Women-Controlled Methods |
|
Diagnosis and Testing Issues |
|
Treatment Issues |
Adolescent Sexuality and
Pregnancy
|
|
|
The Issue Worldwide, Particularly in
Urban Areas |
|
The Controversies |
|
“The Rights, Duties and
Responsibilities of Parents” |
Maternal Mortality
|
|
|
500,000 Deaths Annually, 98% in LDCs |
|
MM Ratios 10-100 Times Those in
Developed Countries |
|
LDCs: 100-1000/100,000 Livebirths |
|
US:
8/100,000 Livebirths |
Maternal Mortality (cont.)
|
|
|
High Incidence of Home Deliveries,
Particularly in Rural Communities, with TBA, Relative or No-One in Attendance |
Maternal Mortality: Causes
|
|
|
Obstructed Labor/Ruptured Uterus |
|
Postpartum Hemorrhage |
|
Toxemia/Eclampsia |
|
Postpartum Sepsis |
|
Abortion Complications |
|
Role of Age and Parity |
Maternity Care
Interventions:
Emergency Obstetrical Care
|
|
|
Transfusions |
|
Parenteral Antibiotics |
|
Cesarean Section |
|
Treatment of Abortion |
Abortion
|
|
|
Incidence Worldwide: |
|
40-50 Million |
|
Estimated Deaths Annually From Unsafe
Abortions: 60,000-110,000 |
|
Single Most Controversial Issue in
Society Today |
Global Summary, HIV/AIDS
Pandemic,
December 2002
|
|
|
|
|
|
|
Total Children<15 |
|
People living with HIV/AIDS 42 million 3.2 million |
|
|
|
People newly infected, 2002 5 million 800,000 |
|
|
|
AIDS deaths in 2002 3.1 million 600,000 |
|
|
|
|
Adults and children
estimated to be living
with HIV/AIDS as of end 2002
Estimated number of adults
and children
newly infected with HIV during 2002
Estimated adult and child
deaths
from HIV/AIDS during 2002
About 14 000 new HIV
infections a day in 2002
|
|
|
|
More than 95% are in developing
countries |
|
2000 are in children under 15 years of
age |
|
About 12 000 are in persons aged 15 to
49 years, of whom: |
|
almost 50% are women |
|
about 50% are 15–24 year olds |
Women and AIDS
|
|
|
“…It is only when women can speak up,
and have a full say in decisions affecting their lives, that they will be
able to truly protect themselves -- and their children -- against HIV.”* |
|
|
|
*UN Secretary-General Kofi Annan |
Women and AIDS
|
|
|
|
The vulnerability of women |
|
12-13 African women infected per 10 men |
|
The threat to sex workers |
|
The threat to spouses |
|
Relationship with F.P. programs |
|
The role of prevention |
|
Safe sexual practices |
|
Microbicides & condoms (male &
female) |
|
Vaccines |
|
|
The AIDS Orphan Tragedy
|
|
|
An estimated 12-14 million children
have lost one or both parents |
|
Loss of the mother is particularly
devastating |
|
Educational, food, housing and nurture
needs are grossly neglected |
Slide 55
Slide 56
Slide 57
Slide 58
HIV-1 Seroprevalence Among
Pregnant Women from Capital City or Major Urban Centers in Selected Countries
Slide 60
Factors that influence the
spread of HIV
|
|
|
Viral Factors |
|
-HIV-1 strains |
|
-Viremia |
|
Local Genital Factors |
|
-Presence of STDs |
|
-Male circumcision |
|
-Use of vaginal products |
|
Sexual Behavior |
|
-Rate of partner exchange |
|
-Sexual mixing patterns |
|
-Type of intercourse |
|
-Size of and rate of contact with core
groups |
|
-Level of condom use |
|
Demographic Factors |
|
-% sexually active age groups to other
age groups |
|
-Male to female ratio |
|
-Urban:rural% |
|
-Migration patterns |
|
Economic and Political Factors |
|
-Level of poverty |
|
-War and social conflicts |
|
-Status of transport and mobility of
population |
|
-Performance of health care system |
|
-Response to epidemic |
|
(from Piot-1994) |
Slide 62
Slide 63
Leading causes of death
globally, 1999
|
|
|
|
|
1 Ischaemic heart disease |
|
2 Cerebrovascular disease |
|
3 Acute lower respiratory infections |
|
4 HIV/AIDS |
|
5 Chronic obstructive pulmonary
disease |
|
6 Perinatal conditions |
|
7 Diarrhoeal diseases |
|
8 Tuberculosis |
|
|
|
11 Malaria |
|
|
Leading causes of death in
Africa, 1999
|
|
|
|
|
1 HIV/AIDS |
|
2 Acute lower respiratory infections |
|
3 Malaria |
|
4 Diarrhoeal diseases |
|
5 Perinatal conditions |
|
6 Measles |
|
7 Tuberculosis |
|
8 Cerebrovascular disease |
|
9 Ischaemic heart disease |
|
10 Maternal conditions |
|
|
|
|
Slide 66
Slide 67
Infectious Disease
Control
Basic Principles 1:
|
|
|
Modes of transmission |
|
Stages of the epidemic |
|
Epicenters/ “hot zones” Concept of
“core transmitters” |
|
Those most likely to transmit/Those
most likely to contract (“TMLTC”) |
HIV
Transmission
Global Summary
Infectious Disease
Control
Basic Principles 1:
|
|
|
Modes of transmission |
|
Stages of the epidemic |
|
Epicenters/ “hot zones” Concept of
“core transmitters” |
|
Those most likely to transmit/Those
most likely to contract (“TMLTC”) |
RISK POPULATIONS
|
|
|
Commercial sex workers |
|
Male migrant workers (e.g. truckers,
construction workers, seafarers, urban skilled and unskilled) |
|
Military/police |
|
Civil servants |
|
Men who have sex with men (MSM) |
|
Injecting drug users |
|
University students |
|
STD patients (private and public
sector) |
|
Youth (young men and women), single
women |
|
|
RISK LOCATIONS
|
|
|
Brothels, bars, hotels, massage
parlors, beauty salons, night clubs |
|
Truck stops, border crossings, bus
terminals, train stations |
|
Military bases/Harbors |
|
Video parlors |
|
Worksites (mines, construction sites) |
Supporting Elements for an
HIV/AIDS Program
|
|
|
Policy Reform
(government commitment, allocation of resources, dealing with
discrimination, stigma) |
|
Biomedical Research
(STD Diagnostics, microbicides, Mother-to-child transmission interventions,
preventive and therapeutic vaccines) |
|
Social Science Research |
|
Surveillance (biologic and behavioral) |
|
Improved distillation and use of
research and “lessons learned” |
|
|
Global
Response:
Successes
|
|
|
|
At project level, we have evidence of
sustained behavior change to reduce the risk of HIV transmission, resulting
in decreased HIV and STD prevalence |
|
At national level, we have two
categories of success: |
|
Preventing a major epidemic |
|
(Senegal, Philippines, Indonesia) |
|
Reducing an existing severe epidemic |
|
(Uganda, Thailand, Zambia, Dominican
Republic) |
Slide 75
Slide 76
Key Elements of the Uganda
Response to HIV/AIDS
|
|
|
Strong political commitment starting in
1986 which encouraged all political leaders to speak out on AIDS at all
opportunities |
|
Free press encouraged to print candid,
powerful articles on AIDS-intense ongoing use of mass media (radio, TV, soap
operas, etc) |
|
Reliable ongoing national
seroprevalence data which was routinely disseminated |
|
|
|
|
|
|
Key Elements of the Uganda
Response to HIV/AIDS
|
|
|
Public figures openly discussed HIV
status (Philly Bongole Lutaya, Major Ruranga) |
|
TASO established in 1987-has served
50,000 clients |
|
AIDS Information Centers established in
1990-have served 500,000 clients (same day results and “post test clubs”) |
|
Strong religious networks established
for both care and prevention (Islamic Medical Association, Protestants,
Catholics) |
|
|
|
|
|
|
Key Elements of the Uganda
Response to HIV/AIDS
|
|
|
Condom social marketing program was
initially resisted by government, now openly endorsed |
|
Multiple “AIDS in the workplace”
programs (implemented by Federation of Ugandan Workers-banks, breweries,
military, police, etc.) |
|
|
|
|
|
|
Key Elements of the Uganda
Response to HIV/AIDS
|
|
|
Consistent outreach to young people
(use of radio, Straight Talk clubs, etc.) |
|
Orphans program with strong commitment
to keep children in communities and not support institutions, includes
microenterprise efforts. |
|
Staffing for AIDS programs was strongly
supported, attracting the best and the brightest |
|
|
|
|
|
|
Key Elements of the Uganda
Response to HIV/AIDS
|
|
|
Active, well supported research
programs with international collaborations (AIDS vaccines, mother to child
transmission, TB, pneumococcal vaccine, Vitamin A, mass STD Rx, etc) |
|
Ongoing, consistent, reliable donor
support, averaging $18 million/year |
Major Challenges for
HIV/AIDS Programs
|
|
|
Political will |
|
Resource limitations |
|
Absorptive capacity |
|
Stigma |
|
Prevention versus care |
|
Drugs |
|
Mitigating the impact of the pandemic |
|
Urgent need for new technologies |
Estimated Costs for Care
The Cost of Care
|
|
|
In Brazil, > 2/3 of pharmaceutical
budget devoted to ARVs covering less than 20% of those infected. This $350 million is $20 million more than
the annual USAID budget for HIV/AIDS |
|
Treating all 36 million infected
persons would cost $36 billion at the lowest price frame ($1000/p/y) |
Resource Needs and Gaps
Reproductive Health and
HIV/AIDS Programs
|
|
|
Increased vulnerability of girls and
women |
|
Mutual goals and messages (high rates
of pregnancies and HIV infections, particularly in young women and girls) |
|
“No missed opportunities” |
|
Recognize extensive FP infrastructure
compared to HIV |
Slide 87
Slide 88
Slide 89
Slide 90
Perceived advantages for
the use of FP Settings
|
|
|
Access to women |
|
May improve contraceptive compliance |
|
Burden of disease |
|
STDs have implications for choice of
contraceptives |
|
Impact of STDs on HIV transmission |
|
Cost and time effective |
|
Holistic approach to patient |
Perceived obstacles for the
use of FP Settings
|
|
|
Dilution of resources (staff, costs,
time) |
|
Stigma |
|
Physical space for pelvic exam |
|
Access to commodities |
|
Partner referral issues |
|
Lack of STD diagnostics for asx women |
|
Deficiencies of syndromic approach to
vaginal discharge |
|
Public health impact-is this the most
critical population? |
Age Distribution of
Reported AIDS Cases and Age Specific Contraceptive Prevalence
Limitations of Family
Planning Settings
|
|
|
|
“…inherently weak interventions for
often the wrong populations…” |
|
Behavior Change |
|
(dual protection-can it work?) |
|
STI management |
|
significant number of asx cases |
|
vaginal discharge syndromic algorithm
lacks sensitivity and specificity |
Slide 95
What Family Planning
Programs Can Do-1
|
|
|
Determine phase of epidemic and risk
potential for impending generalized epidemic |
|
Determine profile of Family Planning
Clients-considering both dual protection messages and STI management |
|
Expand counseling, condom distribution
and promotion (focus on couples, men) |
|
|
|
|
What Family Planning
Programs Can Do-2
|
|
|
Generate demand and extend
contraceptive and condom use through social marketing |
|
Broaden use of mass media by
integrating HIV/AIDS messages with family planning messages |
|
During policy dialogue, include
HIV/AIDS |
|
Increase outreach to youth |
|
Recognize special needs of HIV positive
women (contraception, abortion, MTCT) |
|
|