- Email: [email protected]
December news
ARTICLE IN PRESS
International news ‘Every child has a right to a name and a nationality’: campaign to promote birth registration The ICM and International Council of Nurses have identified the issue of birth registration as one where both midwives and nurses, especially those working with children and families, may have a significant part to play. The campaign to heighten awareness of the problem was launched in June on World Refugee Day, to draw attention to this particularly vulnerable group of families. Midwives and nurses the world over are aware that for a number of reasons many babies are not registered at birth. They may be loved and cared for within the family, but if this structure is broken or dispersed, particularly in situations of war or civil unrest, then the difficulties start. The child’s name, age and relatives may not be known. Health and education needs are more difficult to assess, opportunities for interventions, such as immunisation, may be missed and -on top of the devastating emotional loss of parents, siblings and home -the child suffers the lack of an official identity. Members of both professions can encourage new parents to remember birth registration; assist in the process if family members are not literate; explain the advantages of registration; and ensure that babies whose parents have died are named and registered. Those who have experience of working in orphanages, refugee camps or health facilities in areas of hostility will know the importance of helping to re-unite family members and establish a child’s identity.
The importance of birth registration For individuals, birth registration confers rights and privileges: the right to a name, a nationality and personal identity. Unregistered children will not have access to health services such as immunisation and other public Midwifery (2003) 19, 337^341 doi:10.1016/j.midw.2003.09.001/midw.2003.0387
health initiatives. Registration helps protect children against child trafficking and illegal adoption, prostitution and being tried as an adult in a court of law while still a minor. Birth registration opens the door to all the rights of society, such as the right to marry, to vote and stand for election and to own property, that are usually taken for granted. For governments, birth registration is essential for effective disease surveillance and public campaigns. It assists governments in planning for social services, such as education and health, and is a basis for effective administration and good governance. As well, governments require information on vital statistics, such as birth, death, marriage and fertility rates, for accurate planning, implementation and monitoring the impact of development programmes.
The mandate for birth registration Registration of babies at birth is mandated by Article 7 of the UN Convention on the Rights of the Child, ratified by 162 countries in 1989. The convention stipulates that, each child shall be registered immediately after birth and shall have the right from birth to a name (and) the right to acquire a nationality. UNICEF’s Innocenti Digest no 9 ‘Right from the start’ sets out how the cultural and legal approach to registration varies among countries: Most states consider a delay of more than 30 days in registering a birth as a late registration. While there are cases where allowances can be made for late registration, the act of registration should, ideally, take place as close to the date of birth as possible. This not only ensures that a child enjoys the right to family ties, a name and nationality from the earliest moment, but helps to guarantee up-to-date and accurate national statistics. In some countries, registration fees and even fines and judicial procedures may be imposed if the child is not registered soon after birth. While this may encourage parents to register their children in a timely way, it may present yet another barrier to those whose marginalisation, such as families who live in remote areas poorly
served by registration services or who cannot afford the costs of registration, already makes timely registration unlikely. UNICEF suggests there is a research challenge here. At what point do fees for late registration tip the balance in favour of timely registration? At what point do they begin to work against it? And what other factors -- geographic, ethnic and traditional -- need to be considered when addressing late registration or considering the introduction or abolition of fees or fines?
A worldwide problem Almost two-fifths of the world’s children are born without being registered. In 2000, approximately 50 million babies born in different parts of the world did not receive official identities because they were not registered. Unregistered children are vulnerable to exploitation of every kind -they are marginalised from birth, as there is no official recognition of their existence. The problem exists in every country but is greater where families are more likely to be poor, or disadvantaged socially or educationally. Of all unregistered births worldwide, 70% are estimated to be in sub-saharan Africa and south and south-east Asia. Why births are going unregistered A number of factors contribute to non-registration of births:
*
*
*
*
*
*
The process may be complicated and expensive for poor families and the value may not be obvious to them; Registration offices may be out of reach for rural people. Illiteracy may prevent people from completing the registration process; Health-care workers may be unaware of the importance of birth registration. Religious beliefs may stand in the way of registration. The birth and naming of a child may be considered sacred and the ‘interference’ of the registration process may not be acceptable. Population movements for economic or security reasons, wars and civil unrests and natural dis-
ARTICLE IN PRESS 338 Midwifery
*
asters make registration of births more difficult everywhere. Lack of skilled attendants at birth -- this last is of particular relevance to midwives and reinforces the current work being carried out by WHO, ICM and partners to expand birth attendance by a person with midwifery skills.
The roles of midwives and nurses Midwifery and nursing associations are being asked by the ICM and ICN to initiate and support action to determine the extent of birth nonregistration in their countries and take part in developing and implementing plans to facilitate birth registration by: *
*
*
*
*
raising awareness of the issue among their own members and the public; ensuring that the birth registration issue is included in education programmes for health-care professionals; reviewing practice so that midwives and nurses use all opportunities to encourage or assist parents to register their child; assessing the registration processes in their country; influencing/lobbying policy makers to facilitate/simplify the registration procedures if needed.
More information about the campaign is available on ICM and ICN websites, www.internationalmidwives.org and www.icn.ch. UNICEF (2002). Birth registration right from the start. Innocenti Digest No. 9. March 2002, UNICEF Florence, Italy: Innocenti Research Centre UNICEF. End decade databases -birth registration. Seen: 17 April 2003 www.childinfo.org United Nations General Assembly (2002) Resolution adopted by the General Assembly: S-27/2. A world fit for children. New York, UN
World Health Organization (WHO) welcomes new Director General Dr Lee Jong-wook was elected to the post of Director General of the agency on 21 May by the Member States of WHO. The Director General is
WHO’s chief technical and administrative officer. Lee Jong-wook took office and started his five-year term as Director General of WHO on July 21, 2003. Born in 1945, in Seoul, Republic of Korea, Lee Jong-wook has a medical degree from Seoul National University and a Master of Public Health degree from the University of Hawaii. He has worked at WHO, at country, regional and HQ level for 19 years in technical, managerial and policy positions, notably leading the fight against two of the greatest challenges to health and development: tuberculosis and vaccine-preventable diseases of children. After heading the WHO Global Programme for Vaccines and Immunizations and serving as a Senior Policy Advisor, he became, in 2000, director of the coalition ‘Stop TB’. In 1994, Dr Lee moved to WHO headquarters in Geneva as Director of the WHO Global Programme for Vaccines and Immunization (GPV) and Executive Secretary of the Children’s Vaccine Initiative. He was responsible for a series of strategic developments in GPV, including an open approach to working with industry and management reforms to assure the highest technical competence of staff and increase the proportion of women in professional posts. In his speech to the World Health Assembly in May 2003 he described his desire to carry out an ‘aggressive pursuit of measurable health objectives, including the Millennium Development Goals, y adopted at the UN General Millennium Summit in September 2000. They set clear objectives for countries in nutrition; access to safe water; maternal and child health; infectious disease control; and access to essential medicines. These goals are strategic focal points within a broad health agenda.’ He also said: ‘We see the unmet challenges in women’s health, including maternal health. There has been little progress in reducing maternal mortality rates over the last decade y Behind such figures lie struggling health systems. Many countries face critical gaps in infrastructure, medical technologies, and human resources for health.’ The recognition of the need to address scarcity of human resources
was welcomed by ICM, who in partnership with the ICN, had presented a strong statement to the assembly on ‘Strengthening nursing and midwifery’. More information on the new WHO DG is available on the WHO website www.who.int The ICM/ICN statement to the WHA is published in full in International Midwifery, 16(4): 45
European ‘Atlas of Health’ An Atlas of Health in Europe has been published by the WHO Regional Office for Europe. This statistical atlas presents key health figures for the WHO European Region. They cover basic demographic data, mortality and morbidity, lifestyles and environmental indicators such as alcohol consumption and road traffic accidents, and types and levels of health care. Most indicators are presented as a map to show overall regional variations, a bar chart to indicate country rankings and a time chart to show trends over time in three main country groupings. In a handy pocket size, this atlas is designed to be an easily accessible resource at all times, in the office or on the road. The atlas has 112 pages, and text is in English. It can be ordered from WHO Europe for 20 Sw. fr. (ISBN 92 890 1370 2; Order no. 1340049). The Atlas of Health is also freely available on-line: visit www.euro.who.int/informationsources
Reproductive health in Afghanistan Scottish midwife Sheena Currie has sent a report from her work with HealthNet International in Afghanistan. This country’s health systems suffered particularly badly under a succession of re! gimes which failed to give adequate priority to women’s and children’s health. However, recent changes have enabled professionals
ARTICLE IN PRESS International news
with expertise to begin rebuilding capacity. Sheena writes: ‘In their ongoing commitment to the reconstruction of health care in Afghanistan the Interim Government has identified a National Health Policy in which maternal and child health are top priorities. The current situation of high maternal and infant mortality is embedded in years of crisis and a complex chain of causes many of which problems remain unresolved. Undoubtedly women and children remain the most vulnerable members of the population. The Ministry of Health (MOH) in Kabul has endorsed the ultimate goals of lowering maternal mortality and morbidity in women and children. The key performance indicators will be: * * * * *
maternal mortality rate; infant mortality rate; under-five mortality rate; adequate nutritional status; total fertility rate.
To work towards achieving this, a Basic Package of Health Services (BPHS) y will provide a minimum range of primary care services to which everyone should have equal access. One problem in achieving this is how to address the lack of female staff. In Afghanistan gender-linked inequality continues to be an obstacle to the improvement of the position and health of women. ‘With the support of UNICEF, the annual workshop for the safe motherhood Initiative was held in Kabul in April 2003, just one of the many activities taking place. Three main strategies were identified: *
*
*
to improve coverage, utilisation and quality of emergency obstetric care (EOC); to improve the coverage of skilled attendance at birth; to ensure effective antenatal care.’
‘There is widespread consensus on the importance of having ‘skilled providers or attendants’ with knowledge and experience in preventing, managing -- or referring -- obstetric complications, thereby reducing maternal mortality and morbidity. Countrywide, more training of professionally recognised community and
339
facility-based midwives is needed to strengthen the capacity to deliver quality services to women, their families and communities in remote and rural areas. One such initiative is the Auxiliary/ Community Midwife Training (whose) aim is that on completion of the training these skilled professionals based in rural communities will provide care to women in pregnancy and birth, handle basic obstetric emergencies using life-saving skills within their levels of competency and make referrals to higher-level care for the rest. This programme is ongoing but early impressions are very positive and it may be extended to other areas in Afghanistan’. Antenatal care is just one of the areas which the newly formed Reproductive Health Taskforce is reviewing, along with intrapartum care; postnatal and newborn care as well as family planning. Recommendations will be made on standards and protocols, which are based on recent evidence and which -- most importantly -- are achievable. All levels of health-care workers will be involved including traditional birth attendants and community health workers whose key role will be information and education. ‘It is hoped that Afghanistan will experience a period of stability in which all elements of the country’s infrastructure are strengthened and the targets for improving health care will be achieved.’
Currie S. Afghanistan: more midwives are future hope for women’s and children’s health. International Midwifery 2003; 16(3): 32. More about HNI’s work is on www.healthnetinternational.org
‘Women’s rights are human rights’ A new website ‘Women’s Rights are Human Rights’ has been made available by the United Nations Office of the High Commissioner for Human Rights (OHCHR). The OHCHR has devoted a section of its website, www.unhchr.ch/women, to women’s human rights.
The site contains links to: *
*
*
*
*
international instruments on the rights of women (treaties and monitoring bodies); women’s rights on the agenda of UN bodies; documents on gender equality and women’s human rights; issues in focus (violence against women; racial discrimination; trafficking in persons; reproductive rights; traditional practices; HIV/ AIDS); world conferences.
This information was forwarded to ICM from the Zimbabwe Women’s Resource Centre and Network, a nongovernmental organisation working in the gender and development field, to allow women to make informed choices about their lives and influence government to implement gender sensitive policies. E-mail: [email protected] Website: http://www.zwrcn.org.zw
Ethical issues in health research in developing countries A symposium and workshop on ethical issues in health research in developing countries was held on August 14--18, 2003, at the Aga Khan University (AKU), Karachi, Pakistan. The symposium began on August 15 with a formal inaugural session in which the chief guest was Shamsh Kassim-Lakha, President of AKU. This was followed by a keynote address by Dr Carel B. Ijsselmuiden on: ‘Research Ethics and the Developing World: Where To?’ The 18 talks included in the four sessions revolved around four themes: ethics and equity, informed consent, standards of care and ethical review process. The symposium was followed by a two-day workshop, in which participants discussed research protocols. Two videos were also shown which highlighted ethical issues in health research. On the final day, a research subject narrated his story as to how he was
ARTICLE IN PRESS 340
Midwifery
recruited by his physician to participate in a pre-registration marketing trial of a drug to lower blood glucose levels. The drug helped him significantly but was abruptly withdrawn after the termination of the study without providing him with a supply or any possibility of acquiring it. He narrated the ordeal that he had to go through after the completion of the study as nothing else would now work on him. The principal investigator of that study was also invited to present his viewpoint and a very lively discussion ensued.
challenges of globalisation and create viable solutions. Working together, and harnessing the power of new communication and network technology, members of the global breastfeeding movement can have a positive impact on the structures and on individuals -- both internationally and within local communities -- that influence and enable women to breast feed and to provide optimal care for their children.
For more information visit the WABA website, www.waba.org
The full report is available on www.aku.edu/bioethics/newsnatsymp Boycotting Nestl!e products
Breast feeding in a globalised world The World Alliance for Breast-feeding Action (WABA) designated August 1-7 as World Breast feeding Week. This year’s theme was ‘breast feeding in a globalised world’. WABA explains the choice of theme: ‘Globalisation is a manifold and sometimes even an elusive concept -- it has been defined as the intensification of worldwide social relations which link distant localities in such a way that local happenings are shaped by events many miles away and vice versa. The result of this interconnectedness of globalisation can have both positive and negative impacts on breast feeding.’ ‘The current trend of globalisation is predominantly based on structuring a single global economy powered by transnational corporations and financial markets. Increasingly, globalisation is shaping a world where trade agreements, world trade organisation priorities and the economic interests of transnational corporations hold sway and are no longer accountable to governments, let alone the needs of mothers and children.’ Clearly, globalisation is presenting at least as many challenges as benefits. Breast-feeding advocates, including midwives, are urged to use the mechanisms available to them through globalisation to bring people together, find positive ways to address the
Many midwives in the UK and elsewhere refuse to buy products manufactured by Nestle! , the global corporation perceived as ‘least ethical company’ in a recent survey, because of its violations of the WHO code restricting marketing of breastmilk substitutes. They may be pleased to know that a number of popular items now no longer produced by Nestle! include Branston pickle, Gale’s honey and Sun-Pat peanut butter. Good news for midwives’ sandwiches -- but Nestle! activities appear still to require constant monitoring. Nestl!e boycott campaigners in Italy ran a successful campaign to have Nestle! banned from Rome’s famous Eurochocolate Festival in March 2003. They reminded the City Council of its undertaking ‘not to accept manufacturers of dried milk, infant food and other products covered by WHO international codes, for the sponsoring and advertising of cultural, sports and educational activities, as well as public works within the municipal area.’ South African media have reported that Nelson Mandela’s Children’s Fund charity would not only refuse money from Nestl!e, but had previously done so in the past. In a statement, the Children’s Fund reiterated the position it took in 2000 regarding a donation Nestle! proposed to make towards its Aids Orphan Appeal: ‘ y given the Nestl!e debacle in relation to HIV/AIDS infected mothers and their campaign on promot-
ing formula milk as opposed to breast milk y, the Nelson Mandela Children’s Fund declined the donation.’ Boycott supporters in Sweden have protested at concerts of the pop group GES, because free tickets to the concerts are being offered with the purchase of 300 Swedish Krones worth of Nestl!e products. Members of the pop group said they would not have entered into the deal if consulted . beforehand. Niklas Stromstedt of GES said: ‘It’s awful to be associated with that company.’ A Nestle! leaflet found in Botswana provides evidence of how Nestl!e idealises artificial infant feeding and undermines breast feeding. ‘Growing is thirsty work’ is the message on the front of the leaflet, promoting the idea that babies need additional fluids. The inside of the leaflet suggests that formula is equivalent to breast milk, and claims that, by using the formula, ‘diarrhoea and its side effects are counteracted’. This leaflet was handed out on a public bus in Gaborone, Botswana during 2003. Seeking direct contact with mothers, to distribute leaflets such as this or for any other reason, is banned by the international Code. Nestl!e is being sued in the USA for alleged false advertising over its ‘Poland Spring’ brand of bottled water, marketed as coming from ‘deep in the woods of Maine’. The lawsuit alleges that the Poland Spring has not flowed for over 35 years and the water is drawn from wells more than 30 miles away within asphalt car parks and potentially contaminated land.
Baby Milk Action’s ‘Boycott News Summer 2003’, accessible on www.babymilkaction.org
Midwives of the Americas meet in Trinidad The ICM Mid-triennium meeting and Americas Regional Conference will be held in Port of Spain, Trinidad, West Indies on April 23--24, 2004. The theme is ‘midwifery in the Americas -- yesterday, today and tomorrow’, and the conference is hosted by the
ARTICLE IN PRESS International news
Trinidad and Tobago Association of Midwives. Sub-themes include education; autonomy; traditional midwifery; globalisation; humanisation in childbirth. There will be conference sessions in both English and Spanish.
341
Conference notif|cations The 10th International Conference of Maternity Care Researchers will be held in Lund Sweden in June 2004. Further information can be found at: http://www.maternity2004.omv.lu.se.
More information on the ICM website www.internationalmidwives.org
Midwifery Today Conference -Authentic Midwifery, Philadelphia, Pennsylvania, March 18--22, 2004. Information at http://www. midiwferytoday.com/conference Midwifery Today International Conference, Bad Wildbad, Germany, October 20--24, 2004. Information at http://www.midiwferytoday.com/ conference
The Editor and Publishers would like to thank the following for their assistance with refereeing during 2003: Christine Furber Christine Hallett Geraldine Main
Rosemary Mander Barbara Mullan David Richards
Chris Roberts Virginia Schmeid Hora Soltani
International news ‘Every child has a right to a name and a nationality’: campaign to promote birth registration The ICM and International Council of Nurses have identified the issue of birth registration as one where both midwives and nurses, especially those working with children and families, may have a significant part to play. The campaign to heighten awareness of the problem was launched in June on World Refugee Day, to draw attention to this particularly vulnerable group of families. Midwives and nurses the world over are aware that for a number of reasons many babies are not registered at birth. They may be loved and cared for within the family, but if this structure is broken or dispersed, particularly in situations of war or civil unrest, then the difficulties start. The child’s name, age and relatives may not be known. Health and education needs are more difficult to assess, opportunities for interventions, such as immunisation, may be missed and -on top of the devastating emotional loss of parents, siblings and home -the child suffers the lack of an official identity. Members of both professions can encourage new parents to remember birth registration; assist in the process if family members are not literate; explain the advantages of registration; and ensure that babies whose parents have died are named and registered. Those who have experience of working in orphanages, refugee camps or health facilities in areas of hostility will know the importance of helping to re-unite family members and establish a child’s identity.
The importance of birth registration For individuals, birth registration confers rights and privileges: the right to a name, a nationality and personal identity. Unregistered children will not have access to health services such as immunisation and other public Midwifery (2003) 19, 337^341 doi:10.1016/j.midw.2003.09.001/midw.2003.0387
health initiatives. Registration helps protect children against child trafficking and illegal adoption, prostitution and being tried as an adult in a court of law while still a minor. Birth registration opens the door to all the rights of society, such as the right to marry, to vote and stand for election and to own property, that are usually taken for granted. For governments, birth registration is essential for effective disease surveillance and public campaigns. It assists governments in planning for social services, such as education and health, and is a basis for effective administration and good governance. As well, governments require information on vital statistics, such as birth, death, marriage and fertility rates, for accurate planning, implementation and monitoring the impact of development programmes.
The mandate for birth registration Registration of babies at birth is mandated by Article 7 of the UN Convention on the Rights of the Child, ratified by 162 countries in 1989. The convention stipulates that, each child shall be registered immediately after birth and shall have the right from birth to a name (and) the right to acquire a nationality. UNICEF’s Innocenti Digest no 9 ‘Right from the start’ sets out how the cultural and legal approach to registration varies among countries: Most states consider a delay of more than 30 days in registering a birth as a late registration. While there are cases where allowances can be made for late registration, the act of registration should, ideally, take place as close to the date of birth as possible. This not only ensures that a child enjoys the right to family ties, a name and nationality from the earliest moment, but helps to guarantee up-to-date and accurate national statistics. In some countries, registration fees and even fines and judicial procedures may be imposed if the child is not registered soon after birth. While this may encourage parents to register their children in a timely way, it may present yet another barrier to those whose marginalisation, such as families who live in remote areas poorly
served by registration services or who cannot afford the costs of registration, already makes timely registration unlikely. UNICEF suggests there is a research challenge here. At what point do fees for late registration tip the balance in favour of timely registration? At what point do they begin to work against it? And what other factors -- geographic, ethnic and traditional -- need to be considered when addressing late registration or considering the introduction or abolition of fees or fines?
A worldwide problem Almost two-fifths of the world’s children are born without being registered. In 2000, approximately 50 million babies born in different parts of the world did not receive official identities because they were not registered. Unregistered children are vulnerable to exploitation of every kind -they are marginalised from birth, as there is no official recognition of their existence. The problem exists in every country but is greater where families are more likely to be poor, or disadvantaged socially or educationally. Of all unregistered births worldwide, 70% are estimated to be in sub-saharan Africa and south and south-east Asia. Why births are going unregistered A number of factors contribute to non-registration of births:
*
*
*
*
*
*
The process may be complicated and expensive for poor families and the value may not be obvious to them; Registration offices may be out of reach for rural people. Illiteracy may prevent people from completing the registration process; Health-care workers may be unaware of the importance of birth registration. Religious beliefs may stand in the way of registration. The birth and naming of a child may be considered sacred and the ‘interference’ of the registration process may not be acceptable. Population movements for economic or security reasons, wars and civil unrests and natural dis-
ARTICLE IN PRESS 338 Midwifery
*
asters make registration of births more difficult everywhere. Lack of skilled attendants at birth -- this last is of particular relevance to midwives and reinforces the current work being carried out by WHO, ICM and partners to expand birth attendance by a person with midwifery skills.
The roles of midwives and nurses Midwifery and nursing associations are being asked by the ICM and ICN to initiate and support action to determine the extent of birth nonregistration in their countries and take part in developing and implementing plans to facilitate birth registration by: *
*
*
*
*
raising awareness of the issue among their own members and the public; ensuring that the birth registration issue is included in education programmes for health-care professionals; reviewing practice so that midwives and nurses use all opportunities to encourage or assist parents to register their child; assessing the registration processes in their country; influencing/lobbying policy makers to facilitate/simplify the registration procedures if needed.
More information about the campaign is available on ICM and ICN websites, www.internationalmidwives.org and www.icn.ch. UNICEF (2002). Birth registration right from the start. Innocenti Digest No. 9. March 2002, UNICEF Florence, Italy: Innocenti Research Centre UNICEF. End decade databases -birth registration. Seen: 17 April 2003 www.childinfo.org United Nations General Assembly (2002) Resolution adopted by the General Assembly: S-27/2. A world fit for children. New York, UN
World Health Organization (WHO) welcomes new Director General Dr Lee Jong-wook was elected to the post of Director General of the agency on 21 May by the Member States of WHO. The Director General is
WHO’s chief technical and administrative officer. Lee Jong-wook took office and started his five-year term as Director General of WHO on July 21, 2003. Born in 1945, in Seoul, Republic of Korea, Lee Jong-wook has a medical degree from Seoul National University and a Master of Public Health degree from the University of Hawaii. He has worked at WHO, at country, regional and HQ level for 19 years in technical, managerial and policy positions, notably leading the fight against two of the greatest challenges to health and development: tuberculosis and vaccine-preventable diseases of children. After heading the WHO Global Programme for Vaccines and Immunizations and serving as a Senior Policy Advisor, he became, in 2000, director of the coalition ‘Stop TB’. In 1994, Dr Lee moved to WHO headquarters in Geneva as Director of the WHO Global Programme for Vaccines and Immunization (GPV) and Executive Secretary of the Children’s Vaccine Initiative. He was responsible for a series of strategic developments in GPV, including an open approach to working with industry and management reforms to assure the highest technical competence of staff and increase the proportion of women in professional posts. In his speech to the World Health Assembly in May 2003 he described his desire to carry out an ‘aggressive pursuit of measurable health objectives, including the Millennium Development Goals, y adopted at the UN General Millennium Summit in September 2000. They set clear objectives for countries in nutrition; access to safe water; maternal and child health; infectious disease control; and access to essential medicines. These goals are strategic focal points within a broad health agenda.’ He also said: ‘We see the unmet challenges in women’s health, including maternal health. There has been little progress in reducing maternal mortality rates over the last decade y Behind such figures lie struggling health systems. Many countries face critical gaps in infrastructure, medical technologies, and human resources for health.’ The recognition of the need to address scarcity of human resources
was welcomed by ICM, who in partnership with the ICN, had presented a strong statement to the assembly on ‘Strengthening nursing and midwifery’. More information on the new WHO DG is available on the WHO website www.who.int The ICM/ICN statement to the WHA is published in full in International Midwifery, 16(4): 45
European ‘Atlas of Health’ An Atlas of Health in Europe has been published by the WHO Regional Office for Europe. This statistical atlas presents key health figures for the WHO European Region. They cover basic demographic data, mortality and morbidity, lifestyles and environmental indicators such as alcohol consumption and road traffic accidents, and types and levels of health care. Most indicators are presented as a map to show overall regional variations, a bar chart to indicate country rankings and a time chart to show trends over time in three main country groupings. In a handy pocket size, this atlas is designed to be an easily accessible resource at all times, in the office or on the road. The atlas has 112 pages, and text is in English. It can be ordered from WHO Europe for 20 Sw. fr. (ISBN 92 890 1370 2; Order no. 1340049). The Atlas of Health is also freely available on-line: visit www.euro.who.int/informationsources
Reproductive health in Afghanistan Scottish midwife Sheena Currie has sent a report from her work with HealthNet International in Afghanistan. This country’s health systems suffered particularly badly under a succession of re! gimes which failed to give adequate priority to women’s and children’s health. However, recent changes have enabled professionals
ARTICLE IN PRESS International news
with expertise to begin rebuilding capacity. Sheena writes: ‘In their ongoing commitment to the reconstruction of health care in Afghanistan the Interim Government has identified a National Health Policy in which maternal and child health are top priorities. The current situation of high maternal and infant mortality is embedded in years of crisis and a complex chain of causes many of which problems remain unresolved. Undoubtedly women and children remain the most vulnerable members of the population. The Ministry of Health (MOH) in Kabul has endorsed the ultimate goals of lowering maternal mortality and morbidity in women and children. The key performance indicators will be: * * * * *
maternal mortality rate; infant mortality rate; under-five mortality rate; adequate nutritional status; total fertility rate.
To work towards achieving this, a Basic Package of Health Services (BPHS) y will provide a minimum range of primary care services to which everyone should have equal access. One problem in achieving this is how to address the lack of female staff. In Afghanistan gender-linked inequality continues to be an obstacle to the improvement of the position and health of women. ‘With the support of UNICEF, the annual workshop for the safe motherhood Initiative was held in Kabul in April 2003, just one of the many activities taking place. Three main strategies were identified: *
*
*
to improve coverage, utilisation and quality of emergency obstetric care (EOC); to improve the coverage of skilled attendance at birth; to ensure effective antenatal care.’
‘There is widespread consensus on the importance of having ‘skilled providers or attendants’ with knowledge and experience in preventing, managing -- or referring -- obstetric complications, thereby reducing maternal mortality and morbidity. Countrywide, more training of professionally recognised community and
339
facility-based midwives is needed to strengthen the capacity to deliver quality services to women, their families and communities in remote and rural areas. One such initiative is the Auxiliary/ Community Midwife Training (whose) aim is that on completion of the training these skilled professionals based in rural communities will provide care to women in pregnancy and birth, handle basic obstetric emergencies using life-saving skills within their levels of competency and make referrals to higher-level care for the rest. This programme is ongoing but early impressions are very positive and it may be extended to other areas in Afghanistan’. Antenatal care is just one of the areas which the newly formed Reproductive Health Taskforce is reviewing, along with intrapartum care; postnatal and newborn care as well as family planning. Recommendations will be made on standards and protocols, which are based on recent evidence and which -- most importantly -- are achievable. All levels of health-care workers will be involved including traditional birth attendants and community health workers whose key role will be information and education. ‘It is hoped that Afghanistan will experience a period of stability in which all elements of the country’s infrastructure are strengthened and the targets for improving health care will be achieved.’
Currie S. Afghanistan: more midwives are future hope for women’s and children’s health. International Midwifery 2003; 16(3): 32. More about HNI’s work is on www.healthnetinternational.org
‘Women’s rights are human rights’ A new website ‘Women’s Rights are Human Rights’ has been made available by the United Nations Office of the High Commissioner for Human Rights (OHCHR). The OHCHR has devoted a section of its website, www.unhchr.ch/women, to women’s human rights.
The site contains links to: *
*
*
*
*
international instruments on the rights of women (treaties and monitoring bodies); women’s rights on the agenda of UN bodies; documents on gender equality and women’s human rights; issues in focus (violence against women; racial discrimination; trafficking in persons; reproductive rights; traditional practices; HIV/ AIDS); world conferences.
This information was forwarded to ICM from the Zimbabwe Women’s Resource Centre and Network, a nongovernmental organisation working in the gender and development field, to allow women to make informed choices about their lives and influence government to implement gender sensitive policies. E-mail: [email protected] Website: http://www.zwrcn.org.zw
Ethical issues in health research in developing countries A symposium and workshop on ethical issues in health research in developing countries was held on August 14--18, 2003, at the Aga Khan University (AKU), Karachi, Pakistan. The symposium began on August 15 with a formal inaugural session in which the chief guest was Shamsh Kassim-Lakha, President of AKU. This was followed by a keynote address by Dr Carel B. Ijsselmuiden on: ‘Research Ethics and the Developing World: Where To?’ The 18 talks included in the four sessions revolved around four themes: ethics and equity, informed consent, standards of care and ethical review process. The symposium was followed by a two-day workshop, in which participants discussed research protocols. Two videos were also shown which highlighted ethical issues in health research. On the final day, a research subject narrated his story as to how he was
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recruited by his physician to participate in a pre-registration marketing trial of a drug to lower blood glucose levels. The drug helped him significantly but was abruptly withdrawn after the termination of the study without providing him with a supply or any possibility of acquiring it. He narrated the ordeal that he had to go through after the completion of the study as nothing else would now work on him. The principal investigator of that study was also invited to present his viewpoint and a very lively discussion ensued.
challenges of globalisation and create viable solutions. Working together, and harnessing the power of new communication and network technology, members of the global breastfeeding movement can have a positive impact on the structures and on individuals -- both internationally and within local communities -- that influence and enable women to breast feed and to provide optimal care for their children.
For more information visit the WABA website, www.waba.org
The full report is available on www.aku.edu/bioethics/newsnatsymp Boycotting Nestl!e products
Breast feeding in a globalised world The World Alliance for Breast-feeding Action (WABA) designated August 1-7 as World Breast feeding Week. This year’s theme was ‘breast feeding in a globalised world’. WABA explains the choice of theme: ‘Globalisation is a manifold and sometimes even an elusive concept -- it has been defined as the intensification of worldwide social relations which link distant localities in such a way that local happenings are shaped by events many miles away and vice versa. The result of this interconnectedness of globalisation can have both positive and negative impacts on breast feeding.’ ‘The current trend of globalisation is predominantly based on structuring a single global economy powered by transnational corporations and financial markets. Increasingly, globalisation is shaping a world where trade agreements, world trade organisation priorities and the economic interests of transnational corporations hold sway and are no longer accountable to governments, let alone the needs of mothers and children.’ Clearly, globalisation is presenting at least as many challenges as benefits. Breast-feeding advocates, including midwives, are urged to use the mechanisms available to them through globalisation to bring people together, find positive ways to address the
Many midwives in the UK and elsewhere refuse to buy products manufactured by Nestle! , the global corporation perceived as ‘least ethical company’ in a recent survey, because of its violations of the WHO code restricting marketing of breastmilk substitutes. They may be pleased to know that a number of popular items now no longer produced by Nestle! include Branston pickle, Gale’s honey and Sun-Pat peanut butter. Good news for midwives’ sandwiches -- but Nestle! activities appear still to require constant monitoring. Nestl!e boycott campaigners in Italy ran a successful campaign to have Nestle! banned from Rome’s famous Eurochocolate Festival in March 2003. They reminded the City Council of its undertaking ‘not to accept manufacturers of dried milk, infant food and other products covered by WHO international codes, for the sponsoring and advertising of cultural, sports and educational activities, as well as public works within the municipal area.’ South African media have reported that Nelson Mandela’s Children’s Fund charity would not only refuse money from Nestl!e, but had previously done so in the past. In a statement, the Children’s Fund reiterated the position it took in 2000 regarding a donation Nestle! proposed to make towards its Aids Orphan Appeal: ‘ y given the Nestl!e debacle in relation to HIV/AIDS infected mothers and their campaign on promot-
ing formula milk as opposed to breast milk y, the Nelson Mandela Children’s Fund declined the donation.’ Boycott supporters in Sweden have protested at concerts of the pop group GES, because free tickets to the concerts are being offered with the purchase of 300 Swedish Krones worth of Nestl!e products. Members of the pop group said they would not have entered into the deal if consulted . beforehand. Niklas Stromstedt of GES said: ‘It’s awful to be associated with that company.’ A Nestle! leaflet found in Botswana provides evidence of how Nestl!e idealises artificial infant feeding and undermines breast feeding. ‘Growing is thirsty work’ is the message on the front of the leaflet, promoting the idea that babies need additional fluids. The inside of the leaflet suggests that formula is equivalent to breast milk, and claims that, by using the formula, ‘diarrhoea and its side effects are counteracted’. This leaflet was handed out on a public bus in Gaborone, Botswana during 2003. Seeking direct contact with mothers, to distribute leaflets such as this or for any other reason, is banned by the international Code. Nestl!e is being sued in the USA for alleged false advertising over its ‘Poland Spring’ brand of bottled water, marketed as coming from ‘deep in the woods of Maine’. The lawsuit alleges that the Poland Spring has not flowed for over 35 years and the water is drawn from wells more than 30 miles away within asphalt car parks and potentially contaminated land.
Baby Milk Action’s ‘Boycott News Summer 2003’, accessible on www.babymilkaction.org
Midwives of the Americas meet in Trinidad The ICM Mid-triennium meeting and Americas Regional Conference will be held in Port of Spain, Trinidad, West Indies on April 23--24, 2004. The theme is ‘midwifery in the Americas -- yesterday, today and tomorrow’, and the conference is hosted by the
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Trinidad and Tobago Association of Midwives. Sub-themes include education; autonomy; traditional midwifery; globalisation; humanisation in childbirth. There will be conference sessions in both English and Spanish.
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Conference notif|cations The 10th International Conference of Maternity Care Researchers will be held in Lund Sweden in June 2004. Further information can be found at: http://www.maternity2004.omv.lu.se.
More information on the ICM website www.internationalmidwives.org
Midwifery Today Conference -Authentic Midwifery, Philadelphia, Pennsylvania, March 18--22, 2004. Information at http://www. midiwferytoday.com/conference Midwifery Today International Conference, Bad Wildbad, Germany, October 20--24, 2004. Information at http://www.midiwferytoday.com/ conference
The Editor and Publishers would like to thank the following for their assistance with refereeing during 2003: Christine Furber Christine Hallett Geraldine Main
Rosemary Mander Barbara Mullan David Richards
Chris Roberts Virginia Schmeid Hora Soltani