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Contributors
Professor of Health Systems Economics Faculty of Public Health and Policy London School of Hygiene and. Department of Global Health and Development London School of Hygiene & Tropical Medicine London, United Kingdom.
About the Authors
The goal, of course, is improving health for everyone in the world, or global health equity. Due to the increasing number of global health programs, health benefits continue to accrue for each country.
Introduction
CUGH was established to promote, facilitate and enhance the growth of global health as an academic field of study. The search for the roots of global health brings us to the history of international public health.
The Origins of Public Health
The way was now clear for the development of public health administration based on a scientific understanding of the principles involved in the transmission of communicable diseases. One extremely influential development in the 1980s was the onset of the human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) pandemic.
The Origin and Growth of Global Health
By mid-June 2017, more than 65 million people had been forced to leave their homes (UN High Commissioner for Refugees, 2017) – the highest number recorded in 70 years (Mohammadi, 2016). The 1946 WHO Constitution stated that “the highest attainable standard of health as a fundamental right of every human being” (WHO, 2014, p. 1).
Measures of Health and Disease in Populations
The third section demonstrates the application of these methods to measuring health status and assessing global health trends. It examines current estimates and predicts trends in selected countries and regions, as well as examines the global burden of disease.
Rationale
The fourth section provides an overview of key underlying risk factors of disease and discusses recent efforts to measure the prevalence of key risk factors and determine their contributions to regional and global disease burdens. An important reason for the effective use of the evidence was that it was collected locally and presented in a form that was useful to decision-makers.
Measuring Health and Disease
Counting Disease
Severity of Disease
Mortality
Neonatal mortality rates (NMR; deaths of infants born alive before age 28 days per 1,000 live births), infant mortality rates (IMR; deaths of infants born alive before age 12 months per 1,000 live births), and child mortality (deaths of children younger than 5) are considered sensitive indicators of the overall health of nations. The MR is equal to the CFR multiplied by the incidence rate of the disease in the population.
Demographic and Epidemiologic Transitions
The CFR is the percentage of individuals with a given disease who die from that disease (at any time, unless otherwise specified). The distinction between the percentage of deaths attributable to a cause (number of deaths from the cause divided by the total number of deaths in a given population over a given period) compared to the probability of death from the cause (disease-specific MR ) is important to understand.
Other Health-Related Metrics
Infant mortality Number of live birth deaths before the age of 12 months per 1,000 live births. Neonatal Mortality Rate Number of live birth deaths before 28 days of age per 1,000 live births.
Morbidity and Disability
On September 25, 2015, UN member states adopted 17 Sustainable Development Goals (SDGs) as part of the post-. This has resulted in an underestimation of the presence and impact of morbidity in both LMICs compared to high-income countries.
Measuring Disability
In the first Global Burden of Disease 1990 study, estimates of the severity of disability were based on expert opinion. The full list of 235 unique health conditions and their disability weights is available in Salomon et al., 2015.
Data for Decisions
This approach was revised for the replication of the 2010 study, for which the process involved empirical studies involving simple paired questions and surveying the general public through household surveys in countries such as Bangladesh, Indonesia, Peru, Tanzania and the United States. United States, as well as a web-based study in English, Spanish, and Mandarin. The duration is generally calculated from the onset of disability until recovery, recovery or death.
Rationale for Composite Measures
This section focuses on the main approaches used to develop composite measures of population health status that summarize mortality and morbidity in a population using a single number. It discusses the rationale for composite measures, reviews the origins of each major approach, examines the methodological differences between these approaches, and outlines the strengths and limitations of each.
Uses of Composite Indicators
Understanding Summary Measures
With these measures, summing deaths and disabilities from each disease therefore gives the total number of deaths and disabilities for the population (a property called additive decomposition).
Composite Indicators
Healthy Life Year
If the disability is permanent and the disease does not affect life expectancy, then Dt is the life expectancy at the age when the disease occurs [Dt = E(Ao)]. HeaLYs lost due to death and disability are summed and expressed as the total number of years of life lost per 1000 population per year.
Disability-Adjusted Life Year
The YLD component is equal to the number of incident cases in the period multiplied by the average duration of the disease multiplied by a weighting factor for the degree of severity (extent) of the disease. This is true for the YLD component of DALY, but YLL is based on mortality in the current year.
Quality-Adjusted Life Year
HeaLYs and DALYs are both “health gaps” measures and can be considered part of the same family of measures. The QALY as originally used is essentially equivalent to the YLD of the DALY; in fact, it will be exactly the same as the YLD when the following conditions are met: (1) there is no discounting (r = 0);
Health-Adjusted Life Expectancies
The use of these cost-effectiveness studies as a decision-making aid is intended to increase the overall health care benefits obtained from the money spent by the NHS. The lack of correlation between a condition or disease entity and the measure made it less valuable for resource allocation and cost-effectiveness calculations.
Summary
Valuing Life: Social Value Issues
Expectation of Life
Valuing Life Lived at Different Ages
Valuing Future Life Compared with Present Life: Discounting
This is equivalent to investing money now to get more in the future. There is no consensus on the most appropriate choice of a discount rate in health, but most agree that it should be lower than that used in the private commercial sector.
Valuing Life for Its Economic and Social Productivity
Thus, a HeaLY now has greater intrinsic value for an individual or society than one in the future (Gold, 1996; Weinstein, Siegel, Gold, Kamlet, & Russell, 1996). The rate at which society is supposed to discount benefits, called the social discount rate (SDR), is a numerical reflection of societal values regarding the intertemporal allocation of current resources.
Valuing Equity in Relation to Efficiency
Historically, the 1993 World Development Report and the first GBD studies used a discount rate of 3% per year (more recent iterations of the GBD studies do not use discounting in their default calculations, but have it as an optional user-settable parameter); instead of other information, this rate has been adopted in many international public health cost-effectiveness studies. Nevertheless, the impact of using different discount rates, including zero, should be investigated in any study.
Data for Composite Measures
It would be important to assess the impact of specific health decisions to ensure they increase equity. Summary measures such as HeaLYs and DALYs can be used to guide resource allocation to ensure an equitable distribution of those resources to reach those most in need.
Types of Data
Provided that information on health by socioeconomic and vulnerable groups is available, one could easily proceed to use these aggregate indicators as tools for determining equity by calculating the healthy life per dollar gained by all socioeconomic and vulnerable groups.
Variables
Checking Data
Disease Groups: Classification
Implementing a Burden of Disease Study
Drowning, falls, fires and accidental poisoning were some of the important causes of injury to migrant children aged 5 to 14. 2 Ischemic heart disease Other musculoskeletal diseases Musculoskeletal system diseases 3 Other circulatory diseases Injuries requiring emergency care Circulatory diseases 4 Congenital anomalies Fracture of sternum, rib or bone Diseases of the respiratory system.
National Disease Burden Assessments
This section reviews a number of country-based and historical burden of disease studies to compare and assess trends in disease burden from country to country and over time.
The Andhra Pradesh Burden of Disease Study, 2001
The Burden of Disease and Injury in New Zealand, 2013
Burden of Disease Estimates for South Africa, 2000
The Burden of Disease and Injury in Australia, 2003
CHD Spinal disorders COPD Lung cancer Transport injury Self harm Diabetes Stroke Addictive disorders Bowel cancer Depressive disorders Skin diseases Dementia Asthma Prostate cancer CKD Hearing loss Falls Birth defects Psychotic disorders Anxiety disorders Dental disorders Arthritis Neonatal disorders Mechanical ViDA loss Melanoma IDA loss. Back Disorders CHD Depressive Disorders COPD Dementia Anxiety Disorders Breast Cancer Stroke Lung Cancer Asthma Skin Diseases Diabetes Migraine Bowel Cancer CKD Arthritis Birth Defects Psychotic Disorders Dental Disorders Hearing Loss Transport Injury Addictive Disorders Falls Neonatal Disorders Gynae Disorders Self Harm IDA Vision Loss. a) New Zealand Ministry of Health.
The Burden of Disease Attributable to 11 Risk Factors in Hubei Province,
WHO Estimates of Global Burden of Disease
Burden of Disease by Disease Groups
Global Assessments of Disease Burden
Such information is critical to the work of organizations such as WHO and UNICEF in their efforts to combat ill health and disease worldwide.
The Global Burden of Disease Study
The presence of perinatal conditions, tuberculosis, HIV/AIDS and malaria in the low-income world is indicative of the high impact of these conditions on premature mortality. Leading causes of the global burden in 2015 (TABLE 1-10) indicate how those conditions affect the global burden of disease.
Other Ways Burden Can Be Measured
Note that communicable diseases still account for a significant proportion of the burden of disease in 2015, particularly in sub-Saharan Africa. UNICEF publishes an annual report on the state of the world's children (UNICEF, 2016) that includes a ranking of nations based on this indicator (TABLE 1-11).
Projections
Mortality among children under 5 years of age is considered a sensitive indicator of the overall health of nations, but especially of the health of women and children. Injuries from road traffic accidents are the ninth leading cause of the global burden of disease and are expected to become more prominent.
The Burden of Selected Major Risk Factors
Although these major risk factors are associated with high-income countries, more than 88% of the total global burden of disease caused by them occurs in LMICs (Institute for Health Metrics and Evaluation, 2015). Some risk factors may have little impact on the overall global burden of disease, but be very important locally within certain populations and regions.
Acknowledgments
Discussion Questions
Some of the Health-Related SDG Indicators
Global and regional mortality by 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the 2010 Global Burden of Disease study. Meta-analysis, decision analysis, and cost-effectiveness analysis: methods for quantitative synthesis in medicine, second edition.
Culture, Behavior, and Health
It continues with brief descriptions of the different types of health belief systems and healers around the world. Some key theories of health behavior and behavioral and cultural change are then described and discussed.
Insider Versus Outsider Perspectives
The dilemma for the health workers, in the Guatemalan worms example, was to get the mothers to accept deworming medication for their children, because most of the time worms were considered normal. The widespread rejection of vaccines by some well-educated parents represents another example of the power of insider (emic) understanding.
Ethnocentrism
With culturally defined syndromes, it is essential that a stranger asks about the symptoms associated with the illness and proceeds with diagnosis and treatment based on those symptoms. Thus, it is important in global health that cultural outsiders be careful about making statements about what is good for someone else.
Holism
Thus, there is a delicate balance between judging without good reason and trying to introduce behavior change because there is real harm from existing behavior. In general, it is best to leave harmless practices and focus on understanding and changing harmful behaviors.
Health Literacy
This task is more difficult than it might seem, since the concept of cultural relativism also applies to perceptions of quality of life. It is particularly important to emphasize that health literacy is as much a problem for the health care provider and health communication staff as it is for the patient or people in the community.
Cultural Competence
It can mean psychological shock, or it can mean physical trauma, such as a blow to the head. When neurologists spoke to patients who had epilepsy and their parents from Latino cultures, the neurologists used the word "trauma" as a cause of seizures to mean a blow to the head.
Belief Systems
We can learn about the hot/cold balance system of Latinos, Asians, and Middle Easterners explained in the next section, but the details of the system will vary from country to country, village to village, and person to person . These categories are used for diagnosis and treatment and for explaining the etiology or origin of the disease.
Body Balances
From the insider perspective, it is referred to as a cause of the disease (caida de mollera) in Mexico and Central America. Good and Good (1981) talk about the importance of the heart to both Chinese and Iranian cultures.
Emotional Illnesses
Haitians have a particularly elaborate blood belief system, which includes concepts such as mauvais sang (literally "bad blood", when blood rises in the body and is dirty), saisissement (rapid heartbeat and cool blood, due to trauma), and faiblesses ( too little blood). The Hmong people of Laos associate many problems with the liver, referring to "ugly liver," "difficult liver," "broken liver," "short liver," "murmuring liver," and "rotten liver." These terms are said to refer to mental and emotional problems, and are therefore idiomatic rather than literal (O' Connor, 1995, p. 92; Thao, 1986).
Weather
For example, in Central America, some childhood diarrhea is considered hot, and protein-rich "hot" foods, such as meat, are withheld, which exacerbates the malnutrition that may be present and may be exacerbated by the diarrheal disease (Scrimshaw & Hurtado, 1988). Dislocation of body parts can occur with organs, but also with a physical aspect, such as the fontanelle or.
Vectors or Organisms
The Supernatural
Food
Sexual Illnesses
In India, sex is sometimes seen as a weakness for the man, so overindulgence is considered a cause of weakness. Returning to the concept of blood faith, it is believed that 30 drops of blood are needed to make one drop of semen, so blood loss weakens a man.
Heredity and Old Age
Illness in Various Forms
Healers
They are seen as both priest and physician and "claim to combine the ethics of Confucianism, the hygiene and meditation of Taoism, and the prayers and self-cultivation of the Buddhist monk". Only a few of the many theories of attitudes and behaviors about health and disease are covered in this section; those included here have been quite influential in general or are particularly applicable to international work.
Health Belief Model
Some theories developed by sociologists and psychologists in the United States were first developed for the US. In Medical Choice in a Mexican Village, Young (1981) describes a health decision-making process very similar to that found in the health belief model.
Theory of Reasoned Action
Self-efficacy has been defined as "the belief that one can successfully execute the behavior necessary to produce the desired outcome" (Bandura. The concept of locus of control, or the belief in one's ability to control one's life, has also been implicated .- inserted into this model.
Diffusion of Health Innovations Model
The value of the four basic premises of the health belief model has held up well under scrutiny. Antibiotics, for example, gained rapid acceptance in most of the world because they were much faster and more effective than traditional methods.
Transtheoretical Model
For example, a smartphone innovation among men who have sex with men (MSM) consists of a computer application designed to facilitate finding sex partners for men infected with a sexually transmitted disease. Globally, smartphones and wrist or belt units are most likely to be relevant for health-related applications in the near future.
The Harm Reduction Model
Explanatory Models
Other Theories
Communication and Health Promotion Programs
Some models, such as social learning theory, have been criticized by anthropologists who oppose the idea that humans are like a "black box" into which you can pour information and expect a specific change in behavior. Both programs have been adopted both internationally and in other cities in the United States.
Understanding Culture and Behavior
Validity refers to the accuracy of scientific measurements—“the degree to which scientific observations measure what they purport to measure” (Pelto & Pelto, 1978, p. 33). Reliability refers to repeatability—the extent to which scientific observations can be repeated and the same results obtained.
Epidemiology
Importantly, the study revealed the reality that a meal that needs to be cooked, however briefly, is unlikely to be chosen over fast foods that do not require cooking. Because households were already spending so much on these foods, there was clearly a place for a lower-cost fortified cereal, but it needed to be instant and available in small packages to be a financially viable option. for families.
Risk of AIDS Associated with Migratory Labor
Even after the countries' independence from Europe, their political, ecological and economic structures remained broken and often unstable. These factors and their connection to the AIDS pandemic are described in the following subsections.
Gender Roles and Cultural Traditions
In the case of Africa, traditional family, social and environmental structures were disrupted by European colonization, which imposed changes on the existing culture. In addition to illustrating the relationship between cultural norms, prevention and access to health care, and disease, this case study demonstrates the profound relationship between the general sociocultural, political, physical, and economic environment and health.
Additional Cultural Beliefs
Barriers to Prevention or Treatment of HIV/AIDS
Prevention Efforts by Community and Governmental Agencies and
Nongovernmental Organizations
There is also a growing movement in which doctors in Africa work with traditional healers to do AIDS outreach and education.
Antiretroviral Therapy
Antiretroviral Treatment Challenges
How would you address some of the cultural beliefs or traditions related to HIV/AIDS mentioned in the case study. Retrieved from https://www.hiv.gov/federal-response/pepfar -global-aids/global-hiv-aids-overview.
Global Health, Human Rights, and Ethics
The effects of the Ebola epidemic on global health structures, public health ethics and human rights have been far-reaching. Jonathan Mann, a public health physician, was an early advocate of the integration of medicine, public health, ethics, and human rights (Gostin, 2001).
Obesity and Taxation on Sugar-Sweetened Beverages
Health limitations can threaten individuals' ability to pursue their life course and independent priorities. The personal pleasure that can be derived from the consumption of SSBs is definitely worth considering, but such pleasure does not rise to the level of fundamental freedom (Kass et al., 2014).
HIV/AIDS
Under human rights provisions, states must take steps to enable the full realization of the right to the highest attainable standard of health. Against this background, this section will examine in detail the human rights and ethical dimensions of the global health challenge that is HIV.
Prevention
3 Mainly affected populations are defined as people who have been identified as belonging to population groups most at risk of HIV. Data from 49 countries showed that the risk of HIV infection was on average 22 times greater in people who inject drugs than in the general population (WHO, 2014).
Treatment as Prevention
Globally, 123 countries – that is, 78% of the total 158 countries reporting data on injection drug use – attribute HIV cases to injection drug use (WHO, 2014). Incarcerated in prisons, IDUs can be exposed to infectious diseases, violence, overcrowding, and high-risk behaviors.
Treatment: Equity and Access
In certain contexts, the objectives of public health, ethics and human rights can be very well aligned. Stigma, sexual health and human rights among women who have sex with women in Lesotho.
Understanding and Acting on Social Determinants
The implications of an SDH perspective for health systems and services, understanding the health system itself as a social determinant of health and health equity. Analysis of the relationship between disease and the social and material environment dates back to ancient medical-philosophical systems.
DEFINITIONS
However, the authors argue that the determinants of inequalities in health may be different from the determinants of health. Indigenous people in Australia (as in other countries) are not simply "disadvantaged citizens". The poverty and health inequality they experience reflects the association with systemic discrimination over centuries.
Relationships Between SDH, Gender Equality, and Human Rights
Human rights-based approaches thus increase the relevance of SDH-based action to better health, to comply with the provision of Article 25 of the 1948 Universal Declaration of Human Rights: “Everyone has the right to a standard of living adequate for the health and well-being of orphans. A human rights-based approach also draws attention to the SDH impacting health equity, for example.
DEFINITION
HiAP in the South Australian government, as enacted in 2008, was developed as a central governance process, rather than being run by and for the health sector. The implementation of HiAP is supported by the central government, in partnership with the health sector.
Investing in Primary Health Care-Oriented Services at the Local Level
There are several ways in which health systems can achieve positive outcomes and influence the distribution of health and well-being, summarized in FIGURE 4-5 overleaf. Health systems can promote health equity when they address the physical and social environments that influence different exposures to and vulnerability to ill health, including through cross-sectoral action.
Organizing Equitable and Universal Provision and Financing
This is particularly the case when services need to reach and address the health needs of the most marginalized groups (Gilson et al., 2011). It calls for leadership, communication and facilitation capabilities; for the decision-making space and resources to establish and manage connections with the public and other sectors; and for the political and social awareness and support for health professionals when acting in the public health field (Gilson et al., 2008; Loewenson, 2016; WHO, 2008).
Addressing Barriers to Equity Within Universal Policies
An evaluation found that these community health workers had a positive impact on health and well-being, and the authors suggested that this experience may be relevant to meeting the health needs of immigrant populations in the United States. Universalist policies can address SDH and processes that drive social exclusion, as for example intended in the health promoting schools described in APPENDIX 4-9.
Experiences of Extractive Industries in East and
The devolution of significant budgets to lower levels of the health system to facilitate and support social roles. A literature review of the health and SDH related to extractive industries in East and Southern Africa found that.
Social Determinants of Health and Health Equity
Health in all policies: a South Australian case study of action on the social determinants of health. Globalization Knowledge Network Final Report to the Commission on Social Determinants of Health.
Reproductive Health
Omar Rahman, Jane Menken, and Dipak Kumar Mitra
Eight Millennium Development Goals were established as part of the "Roadmap towards the Implementation of the United Nations Millennium Declaration" (UN General Assembly, 2001). This chapter emphasizes both the older and the newer views on family planning and reproductive health.
History of Population Growth
Of the $6.1 billion pledged in 2005, just over $3 billion was provided through 2003 (Population Reference Bureau, 2004; United Nations Commission on Population and Development, 2004). The share of the world population in these regions is expected to continue to rise, reaching 88% by the middle of the twenty-first century (United Nations Population Division, 2015b).
The Demographic Transition
As Table 5-1 shows, life expectancy has increased continuously in the second half of the twentieth century. Due to the sharp drop in the death rate coupled with continued high fertility rates (at that time the total fertility rate in Kenya was over 7 births per woman), Kenya's population growth rate increased from 2.77% per annum in 1950-1955 to 3.78% per annum in 1980–1985.
How Do People Control Their Fertility?
Thus, exposure to messages in which small families are treated as a marker for modernity may motivate couples to reduce their desired family size even in the absence of any changes in the structural costs and benefits of children. The whole continent is expected to have a negative growth rate (United Nations Population Division, 2009).
Fertility in the Absence of Contraception and Induced Abortion
From the time when conceptions are recognizable by virtue of late menstruation, approx. 24% in spontaneous abortion (French & . Bierman, 1962). The time added to the birth interval in the case of a recognized fetal loss is the sum of the time from pregnancy to the next ovulation (usually estimated to be a little more than 3 months on average, since the vast majority of spontaneous abortions occur very early in pregnancy) plus the time to the next conception .
Deliberate Control of Fertility
Women in the former Soviet Union, for example, are believed to have had six or more abortions, on average, in their lifetime (David, 1992). In the United States in 2002, female or male sterilization was the pattern method used by women older than 30 years (Mosher, Martinez, Chandra, Abma, & Willson, 2004).
The Effect on Fertility of the Proximate Determinants: Bongaarts’ Indices
In the first index, the adjustment takes into account infertility and sterility and assumes no use of contraception in infertile and sterile couples. In the 1970s, contraceptive use had little impact on fertility in the LMICs included in Table 5-2; lower fertility.
Stover’s Revision of Bongaarts’ Indices
The marriage index around 1970 is on average much lower in high-income countries than in LMICs. The documentation of a rather large effect on overall fertility (about 20%) in Cx is striking. The sexual activity index is dependent.
Unintended Fertility
The relationship between the level of fertility and the rate of unwanted births has changed in the last decade. The highest proportions of unwanted births (a quarter or more) were found in countries with a TFR between 2.5 and 5.5 births per woman.
Consequences of Unintended Pregnancies and Births
Some countries with high total fertility rates had low proportions of unwanted births (eg Niger), while Uganda has a high proportion of unwanted births despite a relatively high TFR. As desired fertility declines, the use and effective use of contraception and abortion may not increase rapidly enough to avoid unwanted births.
Abortion
Despite these differences in legal access, there is little difference in the likelihood of obtaining an abortion. Another abortion-related issue is the recent rise in the male-to-female birth ratio in Southeast Asia.
Consequences of Unintended Births for Infant Health
Human Capital Investments
Consequences of unintended births on infant health. resources for education and health) in the family as a whole. Cross-sectional relationships between large family sizes and lower health and education levels should be interpreted with caution, as parents who choose to have large families may also choose to invest differently in different children (Knodel, Chamratrithirong, & Debavalya, 1987 ).
Unmet Need for Contraception
Family planning programs have played an important role in reducing the unmet need for birth control by making birth control options both physically accessible and financially affordable. In contrast, supply-side advocates argue that family planning programs, if properly managed, can increase access to and availability of contraception even in the absence of changes in women's socioeconomic status.
The Challenges Facing Family Planning
Family planning programs work synergistically with improvements in socioeconomic status and are most effective when they are directed at an informed, educated, and empowered client base (Freedman, 1987). In summary, Bongaarts (1997) estimates that approximately 40% of the decline in fertility in the last three decades of the twentieth century in LMICs (from a TFR of 6 to 3 births per woman) can be attributed to family planning programs, and approximately 60 %.
Information Exchange
In fact, providing information is one of the key services a family planning program can provide. Third, attention to quality will improve efficiency and will allow the addition of new users to family planning services without new costs (Tsui et al., 1997).
Contraceptive Use and Method Choice
In reality, there is little contradiction or trade-off between paying attention to quality issues and achieving quantitative objectives for a number of users. In some situations, the knowledge and use of existing technology is not widely distributed.
Political, Social, and Financial Constraints
An example is emergency contraception - that is, preventing pregnancy through the use of contraceptive methods after unprotected sex - for. In any discussion of family planning programs and their performance, the issue of financial sustainability is key.
The Broader Effects of Family Planning Programs
In addition, law and policy in many countries restrict or prohibit access to abortion (Kenney, 1993).
A Broader Definition of Family Planning and Reproductive Health Programs
Organization and Structure of Family Planning Programs
Renewed efforts followed, led by a new family planning committee independent of the Ministry of Health. Over the years, Bangladesh's family planning program has continued to be revised, restructured and expanded.
Additional Reproductive Health Care Services
Post-abortion counseling and contraception This authors' report concludes that the breadth and scope of services to be provided present major challenges in terms of design, implementation, administration and evaluation. Additional requirements will be placed on any existing system if services related more generally to reproductive health are provided.
Reproductive Health Services Beyond Direct Health Care
Mass media are used to provide extensive relevant information; family planning and reproductive health are openly discussed in the public media. They argue that the demand for family planning and reproductive health services is now so great that women will travel outside their homes to obtain these services, and that such modernization should be encouraged.
