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PubMed1993

Restructuring federalism: the impact of Reagan policies on the family planning program.

Through fiscal cutbacks and structural changes, Reagan's federalism assaulted the ethos of public health. In assessing the effects of Reagan policies on a basic public health program, family planning services, we find a substantial decrease in spending for this program, a reduction in the numbers of patients served, and increased variation among the states in the provision of services to low-income women. These effects are comparable with findings from other studies on the impact of Reagan's federalism upon social programs and have manifold implications for public health.

Capital Financing↗
PubMed1986

Secular changes in divorce in England and Wales by class of decree--a socio-legal analysis.

The author describes changes in divorce law in England and Wales during the twentieth century, focusing primarily on the enlargement of the statutory grounds for divorce. "This paper traces such developments in order to gauge the changes which have taken place in attitudes to divorce, so providing the necessary background for interpreting the main demographic trends in divorce: the long-term increase in level and the changing patterns of petitioning--by grounds and by which partner initiates proceedings."

Attitude↗
PubMed1992

Taking health promotion on to the streets.

In Brazil, until 1990, the authorities could legally arrest a child found alone in the streets, and put them in prison-like institutions. Their crime? To be poor, usually black and living on the streets. The Brazilian Center for the Defense of the Rights of Children and Adolescents (SOS Crianca) was set up a few years ago with the aim of changing this legislation. Together with other nongovernment organizations, SOS Crianca drew up new legislation, lobbied politicians and policymakers, and publicized the issue at a new Child and Adolescent Statute, based on the International Declaration of Children's Rights, was made law. Lawyers volunteered their services to SOS Crianca, making sure that young people had access to legal support, so that the new law could be put into practiced. AIDS has added to the difficulties of young people living on the streets. In 1988, using a strategy similar to the one above, SOS Crianca started to work with key organizations and the children themselves, to draw up an HIV prevention strategy for street children. As well as being threatened with violence and police arrest, these children lack a basic human right--access to health care. Public health services in Brazil do not reach the 40% of the population who live in absolute poverty, which includes young people on the streets. Preventing AIDS is seen by SOS Crianca to be just a part of promoting better health and providing overall healthcare. Educational activities will not work if children do not have access to treatment, or to basic needs like food and shelter. SOS Crianca does not employ doctors because it is not the role of nongovernment organizations to take over the state's responsibility to provide basic health care. But how can the public clinics, staffed with underpaid professionals and lacking basic equipment meet the needs of street children? Meetings were organized with different health professionals, involving those most sensitive to the problem in setting up a referral system. Little by little we made progress. One day a doctor would make the appointment timetable more flexible, and the next a nurse would come to help develop counselling sessions. This support has helped to change the attitude of other health professionals towards these young people. Now a child on the streets can be told: "Go to this hospital, and you will be well treated." Our street educators try to give the children themselves an awareness of their right to use public health care facilities. The educators work every night on the streets, giving advice and counselling and assessing the children's health problems. In the mornings and afternoons the educators go with them to the clinics or follow up with other types of referrals. SOS Crianca also has an ongoing prenatal care program for girls and an STD diagnosis, counselling and treatment program, which includes HIV/AIDS. How many young people does SOS Crianca reach? The answer is not only to do with the numbers seeking health care, but also how many clinic doors are open to them. More and more young people, not just those living on the streets where SOS Crianca works, but others in poor communities, are using the service. It is called "Health Maloca," because the children call their makeshift homes--shelters made of cardboard and newspaper--"malocas." The name also symbolizes that these young people need to find their own ways of taking more control over their bodies and lives.

Acquired Immunodeficiency Syndrome↗
PubMed1994

Counselling on contraceptive use strengthened in Dominican Republic.

In the Dominican Republic a study was conducted to identify the main factors associated with the occurrence of induced abortion. The study involved interviews with 350 women admitted in two hospitals with abortion complications, review of their clinical records, and in-depth interviews with 30 of these patients. The results indicated that the majority of these women had a low socioeconomic status and a low level of education. Many were born in rural areas but had migrated to Santo Domingo, the capital, in search of employment. Their average age was about 26 years. Adolescents represented 16% of the total study sample. Most of these women were in some sort of union, but only 13% were formally married. Contrary to popular belief that it is only unmarried adolescents who resort to induced abortions, the study showed that the majority were in permanent or semi-permanent unions. In fact, most of them had been in the union for three or more years. The use of contraception was low and unsystematic, with high discontinuation rates. Although 75% of the total study population declared to have used at least one contraceptive method during their lifetime, only 42% had tried a second method. This project has had a significant policy impact. In 1993, a revised Health Code was presented to the Dominican Congress for discussion and approval. The Senator who introduced this legislation, using results from the study, proposed to modify the law with respect to therapeutic abortions to include a clause that would make abortion legal under certain conditions and make corresponding services available as part of maternal and child health care programs. Also, with a view to lowering the incidence of abortion, PROFAMILIA, an agency affiliated to the international Planned Parenthood Federation, has adopted improved measures, reinforcing counselling and communication efforts to improve understanding of the correct way of using modern methods.

Abortion, Induced↗
PubMed1983

Toward a social justice theory of demographic transition: lessons from India's Kerala State.

Recent research evidence, which suggests that observed demographic trends and patterns are largely consequences of broad structural changes in society, has raised serious doubts about the validity of traditional demographic theory and the framework for action it has generated. This theoretical essay 1st recasts classical demographic transition theory in general systems terms in order to make it consistent with the evidence and to place the processes of fertility and mortality in a larger social context. The demographic transition experience of Kerala State, India is then recounted to provide a concrete example of the demographic response in society to structural reforms based primarily on equity considerations.

Asia↗