A rights-based approach to public health emergencies: The case of the 'More Rights, Less Zika' campaign in Brazil.

During health emergencies, the security agenda tends to impose itself over the human rights agenda. That happened when Brazil became the Zika-related PHEIC epicentre in 2016. While the federal government promoted a 'war against the mosquito' Aedes aegypti, some social actors emphasised the social determinants of health and women's rights. This article presents the United Nations Population Fund (UNFPA) led campaign 'More Rights, Less Zika' as a consistent example of the positive effects the coordination between global and local actors might have on health initiatives. We conducted field research in Recife, Northeast of Brazil, one of the campaign's target cities, where we interviewed main local actors. The campaign focussed on disseminating women's sexual and reproductive rights as an alternative to the strategy of the federal government, primarily focussed on controlling the vector, postponing pregnancies, and the use of repellent. Despite its scale limitations, the campaign demonstrates that a right-based approach can contribute to increasing the security of communities during health emergencies. The case also suggests that coordinating global actors' actions with local actors improves the quality of global health initiatives, which is particularly important when a conservative agenda opposing women's rights gains leverage in Brazil and other States.

Sexuality education on the job.

PIP: The Asociacion Demografica Salvadorena (ADS) has been working with the UN Population Fund (UNFPA) in El Salvador since November 1995 to provide sexual and reproductive health services to the country's working classes. UNFPA funding is provided through the Salvadoran government. ADS has entered the commercial and labor sectors to provide sexual and reproductive health services, and expand related public education programs to marginalized working class urban residents of El Salvador's Zona Central. The project has thus far created 25 Reproductive Health Units (UDESAR) in a number of companies, overseen by trained personnel who offer family planning and counseling services, including family planning methods, and the detection of cervical/uterine cancer, breast self-examination, HIV/STD prevention, and the determination of reproductive risk. Volunteers trained by ADS in sexual and reproductive health from a gender perspective, including decision-making and raising women's levels of self-esteem and decision-making capabilities in family planning, safe sex, and general sexual health, help project leaders by educating and motivating co-workers. ADS's involvement in promoting reproductive health in El Salvador has also given the organization an opportunity to broaden its relationship with international agencies.^ieng

On course for the 21st century?

PIP: Dr. Nafis Sadik, Executive Director of the UN Population Fund, notes that in the wake of the 1994 International Conference on Population and Development (ICPD), governments have been persuaded to abandon demographic targets and instead set specific social goals such as reductions in maternal, child, and infant mortality, and improvements in education, especially for girls. Progress is being made with regard to health and education, with all countries having set target dates for the enrollment of all children in school. The meaning of basic health services for all remains unclear. Progress is also being made against female genital mutilation and sexual violence, and improving women's status and the delivery of reproductive health care. Most countries could, however, do a lot more, and greater public support and resources are needed for programs. India, Brazil, Egypt, and Peru are cited as examples of countries which have begun to change policy following the ICPD. Developing countries and donors, with the exception of the US in 1996, have made efforts to increase their levels of spending on reproductive health services; the US has reduced its aid budget by 35%.^ieng

Steaming ahead in Guatemala.

PIP: In cooperation with local nongovernmental organizations (NGOs), the JOICFP Integrated Project in Solola State, where it is implemented by the Family Welfare Association of Guatemala (APROFAM), has been refocused on reproductive health (RH) and family planning (FP) within the predominately Mayan communities of Panajachel, San Pedro la Laguna, and San Lucas Toliman. Emphasis has been placed on sensitivity to cultural and gender issues. Mayan professionals, including a Mayan doctor who provides 2 days of service to clinics on a rotational basis, are employed. A clinic has been added in San Pedro la Laguna and another in Panajachel; the latter serves as the project's headquarters. Training of traditional birth attendants (TBAs) and of community-based distribution agents (CBDs) has been increased in order to broaden project coverage. 31 CBDs have been recruited from project communities to counsel and to educate clients in the local language, to provide referrals, and to sell low-cost contraceptives. A Japanese public health nurse serves as a Japanese Overseas Cooperation Volunteer at the APROFAM clinic in Solola. Six TBAs have received follow-up training in natural and modern FP. The project's Mayan doctor works closely with these health personnel. 28 CBDs have been trained to provide Depo-Provera; acceptance of this method has increased by 42%. Contraceptive acceptance between January and June of this year is greater than the total for all of 1996. Two UN Population Fund (UNFPA) representatives, Dr. Sergio de Leon (program officer) and Dr. Ruben Gonzalez (national coordinator of the project to reduce maternal mortality), visited during a monitoring/technical support mission in July and August.^ieng

Effective at the regional level.

PIP: The United Nations Population Fund (UNFPA) evaluated the regional project, Family Planning and IEC for Adolescents (RLA/92/P01) in Latin America, which it funds, and found it to be "effective and extremely necessary in the region." It was recommended that the strategy employed (a regional network through the American Conferences on Integrated Programs) by JOICFP, and the methodology used for IEC training in regional workshops on adolescents and IEC materials be continued and strengthened in the new regional project. The evaluation was conducted around San Lucas Toliman, Solola, Guatemala, during August 14-23 by Isabel Hernandez (advisor on sociocultural research, Country Support Team for Latin America and the Caribbean, UNFPA), Surama Lima de Juarez (national consultant on reproductive health, Nursery School of Quetzaltenango, Guatemala), Mirtha Carrera Halim (country director-UNFPA, Honduras and Guatemala), and Sergio de Leon (program officer-UNFPA, Guatemala). At the local level, although the Integrated Project (IP) had responded to many of the needs of the population, the following areas were not fully addressed: 1) health attention; 2) reproductive health; 3) IEC, particularly for adolescents; 4) nutrition; 5) sanitation; and 6) micromanagement. Obstacles to project promotion include: 1) interethnic relations based on indigenous prejudice which hamper community participation; and 2) the low status of women. The evaluation team recommended that research be conducted on ethnic consciousness in the indigenous population of Solola to define more effective strategies, and that a campaign be started against ethnic prejudice. Mechanisms of community intervention based on the findings of the studies could be used to raise the status of women.^ieng

Recommendations of the International Symposium on Contraceptive Research and Development for the Year 2000 and Beyond.

PIP: The government of Mexico and the UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development, and Research Training in Human Reproduction organized an international symposium on "Contraceptive Research and Development for the Year 2000 and Beyond" that was held March 8-10, 1993 in Mexico City. 11 recommendations were established: 1) reproductive and sexual health should be given priority in both governmental and nongovernmental health research agendas, with coordination and collaboration between public and private sectors, nationally and internationally; 2) more funds should be provided by international donors for such research in developing countries; 3) women's health advocates and potential users should be represented on advisory bodies and in the decision making processes; 4) the existing health infrastructure and family planning services available, method potential, and safeguards concerning safety, effectiveness, and consent should be considered before adopting a new procedure; 5) "basic biomedical, technological, clinical, epidemiological, and social science research" leading to new or improved methods that are safe, effective, affordable, suitable for different age groups and designed in response to user's needs should receive increased support; 6) support should also be increased for "introductory, sociocultural, programmatic, operational, epidemiological, and qualitative research" that improves information, method, or service delivery; 7) research is needed on sexuality, gender roles, and gender relationships in different cultures; in particular, on discrimination and violence against women, sexual behavior, risk taking attitudes toward disease transmission and pregnancy, men's perceived needs, and the reasons for refusal of or inability to use services available; 8) industry, especially in developing countries, should collaborate with national regulatory agencies in order to expedite the process of development; 9) research should be undertaken that ensures quality abortion services that are safe, affordable, and accessible; 10) special attention should be given to the needs of adolescents; and 11) research findings should be disseminated to policy and opinion makers, providers and users of methods, and the general public and applied to problem solving.^ieng

Senate votes to fund UNFPA, reverse Mexico City policy.

PIP: The US Senate has voted to restore funding to UNFPA and reverse the administration's Mexico City policy by passing a fiscal 1992-93 foreign aid authorization bill containing both provisions. The UNFPA issue has also been linked to the debate of the most favored nations (MFN) bill for China. Sen. Paul Simon introduced a floor amendment stipulating that none of the US aid could be used for UNFPA's China program; if this occurred, the full US contribution would have to be refunded. The Bush administration policy of boycotting UNFPA because of China's population policy is holding UNFPA hostage. Sens. Barbara Mikulski and Tim Wirth added another condition to the China MFN bill that would force the president to certify that the Chinese government does not support coercive abortion. The president has threatened to veto any bill that puts conditions on China's MFN status. However, evidence suggests that even Bush is uncomfortable with his own reasoning being used against him. He is condemning UNFPA for having the same policy toward China that he does. Both bills call for $20 million for UNFPA for fiscal 1992 and reverse the Mexico City policy. Both bills raise the ceiling for fiscal 1992 to $300 million for population aid. There would have to be some debate to reconcile the fiscal 1993 ceiling of $350 million passed by the House and the $300 million passed by the Senate. The president has threatened to veto both bills because of the family planning provisions.^ieng

Drawing attention to family planning.

PIP: In February 1990, the Mexican award winning director and animator, Carlos Carrera, went to Tokyo to oversee the photographing of the color frames (brought from Mexico) of the sex education animated film "Music for Two". The film begins with a warning that it should be shown as part of a sex education program. Further, a trained advisor guides the audience during the recommended discussion following the film. "Music for Two" is set in a large city and features a young female teen who daydreams about imaginary lovers. She soon discovers that her young male next door neighbor is interested in her. The moral of the story is that, once a woman is an adolescent, she must consider her future and have lifelong goals. In order for her to do so, however, she must know her mind and body, appreciate them, and not renounce them. This animated short feature includes both English and Spanish versions targeted to adolescents in their mid to late teens, especially females, in Latin America and the Caribbean. Mr. Carrera predicted that conservative older individuals will most likely not approve of "Music for Two". The Japanese Organization for International Cooperation in Family Planning (JOICFP) and the UNFPA sponsored this animated film and the Mexican Family Planning Foundation (MEXFAM) participated in its production. The Sakura Motion Picture Company in Japan and Kinam SCL International in Mexico coproduced it. The Japanese Ministry of Foreign Affairs underwrote the English version and the UNFPA and IPPF underwrote the Spanish version. Further, in 1989, Mr. Carrera played a major role in a successful sex education animated feature titled "Blue Pigeon". This film was geared to youth in their early to mid teens, however.^ieng

[Evaluating the impact of the United Nations funding act]. / Evaluando impacto del recorte de fondos a las Naciones Unidas.

PIP: Representatives of the principal donors supporting population assistance in India are concerned about the impact of the cuts in funds given by the US to the United Nations Fund for Population Activities (UNFPA). The suppression of US aid to the UNFPA will definitely affect the largest programs, including those in South Asia. India is the country receiving the most assistance from the UNFPA. The UNFPA contributed 63 million dollars for the current 5 year plan which began in April 1985. US spokesmen stated that UNFPA funding was cut off because of that organization's support for coercive family planning programs in China.^ieng

The people yet to come; avoiding the demographic trap.

PIP: The demographic trap is defined as the condition where a nation has passed through the process of lowering death rates, but has not been able to lower birth rates before ecological carrying capacity is exceeded. A minimal estimate predicts that by the year 2000, 63 countries, or 1.1 billion people, will be trapped by starvation, dependence on imported food, and resulting economic and political instability. Such a country that failed to complete the demographic transition will fall back to the original stage, of high death as well as birth rates. Most nations in Southeast Asia, Latin America, and Africa are at risk, notably Mexico, India, Nigeria, Ethiopia, because they already have falling living standards coupled with rapid growth rates. Most governments are unaware of the subtle signs that carrying capacity has been exceeded. Even those that are able to understand such events, often practice ineffective policies. For example, the U.S. has dropped U.N.F.P.A. support ostensibly because one nation, China, allowed forced abortions. On the other hand, some third world countries have initiated novel campaigns to reduce births, for example popular media campaigns in Mexico, free dissemination of birth control pills to all women in Brazil, and a separate family planning ministry in Zimbabwe.^ieng

POPIN Working Group on the Management of the Population Multilingual Thesaurus: report on the third meeting (26-29 March 1984).

PIP: The main objective of this meeting was to review the revised edition of the Thesaurus before its publication. Participating in the meeting were the members of the Working Group and observers representing the Information Systems Unit of the Department of International Economic and Social Affairs of the UN Secretariat and SEADE, Sao Paulo, Brazil. The agenda consisted of a progress report on Thesaurus-related activities of Working Group members; the revised edition of the Thesaurus (English, French and Spanish versions); other language versions of the revised Thesaurus (Portuguese, Arabic and Chinese); and recommendations. Discussion of the revised edition focused on: the alphabetical list of descriptors and nondescriptors, institutional terms and geographical names; distribution of descriptors and nondescriptors according to a thematic scheme; presentation of hierarchical display; permuted index; cover page; and the introduction. Each participant was called upon to give a brief progess report on related activities of their organization. The DOCPAL staff were working closely with the staff of CLADES concerning the development of a commen methodology, worksheets and the use of ISIS software. During the year, CICRED concentrated efforts on producing the revised edition of the Thesaurus, taking into account the recommendations of the Working Group at its 1982 and 1983 meetings which were endorsed by the POPIN Advisory Committee. DOCPOP focused on published and unpublished documents produced since 1980, on population and related fields on or about Brazil. The main activities of the ESCAP Regional Population Information Center related ot the Thesaurus included the creation of key file of EBIS/POPFILE descriptors and the integration of terms from the Population Multilingual Thesaurus and the OECD Macrothesaurus, as well as terms proposed by the Center to develop EBIS common indexing vocabulary. Work was focused on the preparation of the revised edition of the POPLINE THESAURUS, which was expected to be completed by June 1984. It was agreed that the terms to be included in the Population Multilingual Thesaurus should be listed vertically, instead of horizontally as in the draft presented to the Working Group. 3 language equivalents would appear (English, French and Spanish). Contributors to the revised edition were urged to continue their collaboration in updating the Thesaurus by constantly forwading suggestions for addition, deletion and substitution of terms.^ieng

Why family planning?

PIP: In response to its high population growth rate, the Mexican government enacted a general population law in 1973 stressing the right of parents to make responsible fertility decisions and the obligation of the government to make the means available for carrying out those decisions. The United Nations Fund for Population Activities (UNFPA) was asked to provide family planning education and services through federal health centers as part of a 10-year national health program. The immediate objective of the UNFPA-funded program, begun in 1975, included strengthening the health infrastructure of the Ministry in the areas of evaluation, training, education, and supervision. Special attention was given to training auxiliary nurses in rural health centers. While only 17% of Ministry health centers and hospitals were providing family planning services in 1974, this figure reached 80% by 1976 and the number of active contraceptive users jumped from 80,000 in 1973 to 275,000. In 1977 a National Family Planning Plan, which set up an integrated program for all government sectors concerned with population, was approved, and targets for promoting family planning, reducing abortion, and improving maternal and child health services were established. The growth rate has declined from 3.5% to 3.2% since the population law was enacted, but it is projected that resources of family planning programs must be doubled and tripled and family planning must become a national priority if the goal of a 2.5% growth rate by 1982 is to be achieved.^ieng

[Population and the new international economic order]. / La poblacion y el neuvo orden economico internacional.

PIP: The problem of population received little attention in the meetings on the New International Economic Order. Historically, governments have equated population increases with prosperity. Recently, governments have accepted the necessity to reduce population for the succcess of social and economic programs. This article points out the advances made by several countries in the areas of health, nutrition, education, contraception, legal aspects, planning, and research methods since 1972. The collaboration of different governments with UNFPA and their solicitation of help from this organization are regarded as further evidence of the advances made. Difficulties for the acceptance of family planning in developing countries such as social sanctions, lack of demographic data, and the role of UNFPA in the amelioration of these problems are discussed. Since population politics are seen as long-term strategical weapons, an intensification of persuasive methods in all countries and an increase in aid to underdeveloped countries are recommended.^ieng

The United Nations Fund for Population Activities.

PIP: The United Nations Fund for Population Activities (UNFPA), established in 1968, aims to: 1) promote an awareness of social and economic implications of population problems and their solutions, 2) extend aid to developing countries, and 3) coordinate UN and other organizations' activities to plan and implement population projects. Financial assistance is usually supportive of national programs and includes equipment, supplies, personnel, fellowships to study abroad, collection of population data, and assistance with population dynamics and policy. By the end of January 1973, UNFPA was supporting almost 600 population projects in 76 developing countries and areas with cumulative resources of more than $80 million.^ieng