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  • Indonesia firmly committed to eliminating lymphatic filariasis as a public health problem

    Indonesia firmly committed to eliminating lymphatic filariasis as a public health problem

    Indonesia recently completed the last of its annual large-scale treatment for lymphatic filariasis (also known as elephantiasis or Penyakit Kaki Gajah) in Malaka District located in its southernmost province, East Nusa Tenggara. Unprecedented
    progress by the National Lymphatic Filariasis Elimination Programme has strongly placed the country on the path to achieving the elimination of lymphatic filariasis as a public health problem.

    “We reached an estimated number of 40.7 million people living in the 118 high-risk districts during this month-long treatment campaign in October 2019” said Dr Anung Sugihantono, who recently retired as Director General of Diseases
    Prevention and Control, Ministry of Health Indonesia. “
    Single doses of diethylcarbamazine citrate and albendazole facilitated by WHO were delivered to all eligible populations.”

    In 2010, an estimated 125 million Indonesians were still at risk of the disease and required treatment.

    But things changed considerably in 2015 when Indonesia mounted an annual national campaign to resolutely address transmission of the disease and to tackle the morbidity and disability associated with it. The results were apparent as early as 2017, with
    remarkable progress.

    In Indonesia, LF is considered a significant public health concern. In 2009, risk mapping identified a population of 124.5 million people needing treatment for LF. The country initiated a national level LF elimination campaign in 2015, addressing both
    disease prevention and management. 

    “In 2017 and in just two years we managed to achieve 100% geographical coverage of all people requiring treatment” said Dr Sugihantono. “It meant achieving more than 78% epidemiological coverage – much higher than the generally recommended 65% to stop transmission.”

    Transmission of lymphatic filariasis can be stopped through large-scale treatment (or mass drug administration – MDA) of entire at- risk communities with recommended medicines once a year. These medicines kill the microfilariae in an infected patient’s
    blood preventing mosquitoes to transmit1 the disease to others. Through mass treatment, the aim is to reduce the reservoir of microfilariae in the blood to a level insufficient to maintain transmission by the mosquito vector.

    This strategy to interrupt transmission is the corner-stone of the World Health Organization’s (WHO) Global Program to Eliminate Lymphatic Filariasis (GPELF). Indonesia has been using the GPELF’s strategy since 2002 using a district or city
    as its implementation unit.

    In 2005, it listed the elimination of LF as a national priority for controlling infectious diseases and the medicines it has been using in large-scale treatment programmes are diethylcarbamazine citrate (DEC) and albendazole2 which are
    largely distributed by volunteer community health workers3.

    “Community health volunteers are themselves members of the community and know how to reach people effectively to improve compliance” said Dr. Stefanus Bria Seran, the Regent of Malaka District, one of LF endemic district in Indonesia. “Besides ensuring every single person ingests the medicine given to them, these community workers help in disseminating information well before a large-scale treatment campaign and also assist in reporting activities related to each treatment campaign”. 

    Indonesia’s efforts to eliminate lymphatic filariasis began in the 1970s but faced numerous challenges including programme coordination in the many inhabited islands, conducting information, education and awareness programmes, lack of capacity and
    insufficient medicines.

    Furthermore, the situation in Indonesia is unusual than in many other countries endemic for lymphatic filariasis as the country is endemic for all three species of thread-like filarial worms – Brugia malayi, Brugia timori, and Wuchereria bancrofti –
    that cause the disease. Most of the infections in Indonesia, however, are caused by B. malayi.

    In the past, some of the factors that prevented access to the medicines (DEC and albendazole) were social stigmatization linked to the disease, the vast geography of the territory and challenges in reaching remote populations.

    With an estimated population of 242 million, Indonesia is the world’s largest island nation and consists of approximately 17,000 islands, of which 5,000–6,000 are inhabited. It is the fourth most populated nation behind China, India, and the United
    States.

    Indonesia is endemic for many other neglected tropical diseases and an estimated 110 million Indonesians are believed to suffer from at least one neglected tropical disease (NTD), including lymphatic filariasis and soil-transmitted helminth infections.
    Leptospirosis (not classified as NTD) is also widespread.

    Indonesia is the only country of WHO’s South East Asia Region with endemic schistosomiasis. Like many other countries of the Region, it also faces recurrent threats of dengue outbreaks.

    Global progress

    The world has made significant progress towards the elimination of lymphatic filariasis as a public health problem.

    Sixteen countries4 and one territory are now acknowledged by WHO to have achieved elimination of lymphatic filariasis as a public health problem.  

    Seven additional countries have successfully implemented recommended strategies, stopped large-scale treatment and are under surveillance to demonstrate that elimination has been achieved.

    The disease

    Lymphatic filariasis is caused by infection with parasitic worms living in the lymphatic system. The larval stages of the parasite (microfilaria) circulate in the blood and are transmitted from person to person by mosquitoes.

    Infection involves asymptomatic, acute, and chronic conditions. Most infections are asymptomatic, showing no external signs while contributing to transmission of the parasite. Although asymptomatic, these infections still cause damage to the lymphatic
    system and the kidneys and alter the body’s immune system.

    When lymphatic filariasis develops into chronic conditions it leads to lymphoedema (tissue swelling) or elephantiasis (skin/tissue thickening) of limbs and hydrocele (scrotal swelling). Involvement of breasts and genital organs are common.

    Manifestation of the disease after infection takes time and can result in an altered lymphatic system, causing abnormal enlargement of body parts, and leading to severe disability and social stigmatization of those affected.

     


    1Lymphatic filariasis is transmitted by different types of mosquitoes – e.g the Culex mosquito which widespread across urban and semi-urban areas; Anopheles, mainly found in rural areas; and, Aedes, mainly
    in endemic islands in the Pacific.

    2In 2017, WHO recommended an alternative three drug treatment to accelerate the global elimination of lymphatic filariasis. The treatment, known as IDA, involves a combination of ivermectin, diethylcarbamazine citrate and albendazole.
    It is recommended annually in settings where its use is expected to have the greatest impact.

    3Community health workers, also called ‘cadres’, are volunteers who form part of the communities they serve and work with local
    communities to educate families. Their contribution in promoting health has been significant in the country.

    4Cambodia, The Cook Islands, Egypt, Kiribati, Maldives, Marshall Islands, Niue, Palau, Sri Lanka, Thailand, Togo, Tonga, Vanuatu, Viet Nam, Wallis and Futuna, and Yemen

    Indonesia firmly committed to eliminating lymphatic filariasis as a public health problem
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    https://www.who.int/news-room/detail/29-04-2020-indonesia-firmly-committed-to-eliminating-lymphatic-filariasis-as-a-public-health-problem

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  • THE FETICH OF THE BIRTH-RATE

    THE FETICH OF THE BIRTH-RATE

    To the student of the progress of the human race the consideration of the state of public opinion regarding the Birth-rate of nations is of great interest. To the careful observer there is evident the gradual evolution of intelligent public opinion on this subject even in the comparatively short space of time in which the present generation has played its part on the great stage of human development.

    Public opinion on this subject during the period named may be said to have passed through three general stages. These stages are, of course, more clearly defined among the peoples of the most prosperous and intelligent countries, as for instance, in Western Europe and America, and particularly in England, France, and the United States. While the peoples of certain of these countries have passed through these stages somewhat more rapidly than have others, still it is perceived that each of these peoples have in the main followed the same general course.

    The first stage of this evolution of popular opinion may be said to have been begun about 1850, and to have ended about 1880. In this stage the ideal of a large and rapidly increasing birth-rate became a popular fetich before which all men and women were supposed to fall down and render worship. In this period public opinion manifested great satisfaction and joy in the evidences of a high and rapidly increasing birth-rate. It was held that this increasing birth-rate tended toward the success and glory of the particular nation, and incidentally to the race as a whole. The idea of Quantity was elevated to the throne of public favor, and the question of Quality was ignored or overlooked.

    This period was one of an unusual expansion of industry, and the rising birth-rate was regarded as a token that the world was destined to be exploited and eventually governed by the people of those nations who were able to demonstrate the greatest efficiency in industrial pursuits, and who at the same time were wise enough to increase their respective populations by an increasing birth-rate. The populace were excited by the idea of the dominance and prosperity of their own countrymen, while the leaders of industry were delighted with the idea of an increasing supply of laborers which would tend to keep down the rate of wages which otherwise would have reached proportions which would have interfered with competition with other countries. At the same time, the militarists were secretly delighted by the signs of an increasing supply of military material with which to build up gigantic armies.

    A writer on the state of public opinion on this subject during this period has well said: “It seemed to the more exuberant spirits that a vast British Empire, or a mighty Pan-German, might be expected to cover the whole world. France, with its low and falling birth-rate, was looked down at with a contempt as a decadent country inhabited with a degenerate population. No attempt to analyze the birth-rate, to ascertain what are really the biological, social, and economic accompaniments of a high birth-rate, made any impression on the popular mind. They were drowned in a general shout of exultation.”

    But this period of uncritical optimism was followed by a natural reaction. The pendulum stopped in its course, and soon began to swing in the opposite direction. Here, about 1880, the second stage may be said to have begun. Public opinion began to manifest a subtle change, and this mental attitude was accompanied by a physical manifestation in the form of a decreasing birth-rate. The rate of births began to fall rapidly, and has continued to fall steadily since that time.

    The writer above quoted from says of this second period: “In France the birth-rate fell slowly, in Italy more rapidly, and in England and Prussia still more rapidly. As, however, the fall began earliest in France, the birth-rate was lower there than in the other countries named. For the same reason it was lower in England than in Prussia, although England stands in this respect at almost exactly the same distance from Prussia today (1917) as thirty years ago, the fall having occurred at the same rate in both countries. It is quite possible that in the future it may become more rapid in Prussia than in England, for the birth-rate of Berlin is lower than the birth-rate of London, and urbanization is proceeding at a more rapid rate in Germany than in England.”

    It is not difficult to arrive at the psychological reason underlying this great change in public opinion, as manifested in this second stage. In the first place, the wonderful era of world-expansion was arrested, by natural causes well understood by students of sociology. The ambitious dreams of world-empires were rudely interrupted. Moreover, public opinion was being affected by a quiet education along the lines of sociology and economics.

    The working classes began to perceive, on the one hand, the tendency of overpopulation to hold down, or even decrease, the scale of wages. The evils of over-production, and of under-consumption were dimly perceived. And, on the other hand, the capitalists began to perceive that another factor was at work—one which they had failed to include in their optimistic calculations. Instead of the cheaper wage rate which they had expected by reason of the over-abundance of human material, they found that the growth of popular education in the democratic countries had caused the working classes to demand greater comforts of life, and to oppose the cheapening of human labor. And at the same time, the masses began to revolt against the idea of raising children to become “cannon fodder” for ambitious autocratic rulers. The masses began to protest against selling their labor and their lives so cheaply.

    These changed viewpoints of the working classes began to result in attempts on their part to form associations to resist the tendency on the part of capitalists to force down the scale of wages to fit the increased population. Trade unions flourished and became powerful, and the same impulse carried many into the ranks of socialism, and still beyond into the fold of anarchism and syndicalism. And, here note this significant fact, with these new perceptions and these new movements among the masses, the birth-rate began to fall rapidly.

    The writer above quoted from says of this period: “The pessimists were faced by horrors on both sides. On the one hand, they saw that the ever-increasing rate of human production which seemed to them the essential condition of national, social, even moral progress, had not only stopped but was steadily diminishing. On the other hand, they saw that, even so far as it was maintained, it involved, under modern conditions, nothing but social commotion and economic disturbance. There are still many pessimists of this class alive among us even today, alike in England and Germany, but a new generation is growing up, and this question is now entering another phase.”

    It would seem that the race is now well started in the third period, phase, or stage of this conception of the birth-rate. Even the Great War is not likely to seriouslyinterrupt its ultimate progress, though conditions in all civilized countries will unquestionably be disturbed by the unusual conditions now prevailing and caused by the great conflict. The spirit of this third stage seems to be that the Truth is to be found between the two extremes, viz.: (1) the extreme of passive optimism of the first stage; and (2) the extreme of passive pessimism of the second stage. It realizes that there is excellent ground for hope in better things; but it equally realizes that hope alone is vain, and will accomplish nothing unless it is accompanied with and directed by a clear intellectual vision manifested in individual and social action based on that clear intellectual vision.

    The writer above quoted from says of this developing period: “It is today beginning to be seen that the old notion of progress by means of reckless multiplication is vain. It can only be effected at a ruinous cost of death, disease, poverty, and misery. We see this in the past history of Western Europe, as we still see it in the history of Russia. Any progress effected along that line—if ‘progress’ it can be called—is now barred, for it is utterly opposed to those democratic conceptions which are ever gaining greater influence among us. Moreover, we are now better able to analyze demographic phenomena, and are no longer satisfied with any crude statements regarding the birth-rate. We realize that they need interpretation. They have to be considered in relation to the sex-constitution and the age-constitution of the population, and above all, they must be viewed in relation to the infant mortality rate.

    “The bad aspect of the French birth-rate is not so much its lowness as that it is accompanied by a high infantile mortality. The fact that the German birth-rate is higher than the English ceases to be a matter of satisfaction when it is realized that German infantile mortality is vastly greater than English. A high birth-rate is no sign of a high civilization. But we are beginning to feel that a high infantile death-rate is a sign of a very inferior civilization. A low birth-rate with a low infant death-rate not only produces the same increase in population as a high birth-rate with a high death-rate, which always accompanies it (for there are no examples of a high birth-rate with a low death-rate), but it produces it in a way which is far more worthy of our admiration in this matter than the way of Russia and China where opposite conditions prevail.”

    The evolutionary process which all students of sociology clearly perceive to have been underway in the matter of the attitude of public opinion toward the birth-rate, and which is now underway with increased impetus, is perceived to be a natural process. It is a natural process which has been underway from the beginning of the living world. For a long time it operated and manifested along unconscious and instinctive lines of activity, but now it has emerged into the light of human consciousness and manifests along the lines of conscious, voluntary, and deliberate human action.

    In its present state of evolutionary progress human thought along these lines has found expression in what is generally known as “Birth Control.” The process which has been working slowly through the ages, attaining every new forward step with waste and pain, is henceforth destined to be carried out voluntarily, in the light of human reason, foresight, and self-restraint. The rise of Birth Control may be said to correspond with the rise of social and sanitary science in the first half of the nineteenth century, and to be indeed an essential part of that movement.

    The new doctrine of Birth Control is now firmly established in all the most progressive and enlightened countries of Europe, notably in France and England; in Germany, where formerly the birth-rate was very high, Birth Control has developed with extraordinary rapidity during the present century. In Holland its principles and practice are freely taught by physicians and nurses to the mothers of the people, with the result that there is in Holland no longer any necessity for unwanted babies, and this small country possesses the proud privilege of the lowest death-rate in Europe.

    In the free and enlightened Democratic communities on the other side of the globe, in Australia and New Zealand, the same principles and practice are generally accepted, with the same beneficent results. On the other hand, in the more backward and ignorant countries of Europe, Birth Control is still little known, and death and disease flourish. This is the case in those eight European countries which come at the bottom of the list of the Birth Control scale, and in which the birth-rate is the highest and the death-rate the heaviest—the two rates maintaining such a constant correspondence as to lead to the inevitable conclusion that they are associated as cause and effect.

    But even in the more progressive countries Birth Control has not been established without a struggle, which has frequently ended in a hypocritical compromise, its principles being publicly ignored or denied and its practice privately accepted. For, at the great and vitally important point in human progress which Birth-Control represents, we see really the conflict of two moralities. The morality of the ancient world is here confronted by the morality of the new world.

    The old morality, knowing nothing of science and the process of Nature as worked out in the evolution of life, contented itself with assuming as a basis the early chapters of Genesis in which the children of Noah are represented as entering an empty earth which it is their business to populate diligently. So it came about that for this morality, still innocent of eugenics, recklessness was almost a virtue. Children were held to be given by God; if they died or were afflicted by congenital disease, it was the dispensation of God, and, whatever imprudence the parents might commit, the pathetic faith still ruled that “God will provide.”

    But in the new morality it is realized that in these matters Divine action can only be made manifest in human action, that is to say through the operation of our own enlightened reason and resolved will. Prudence, foresight, self-restraint—virtues which old morality looked down upon with benevolent contempt—assume a position of first importance. In the eyes of the new morality the ideal woman is no longer the meek drudge condemned to endless and often ineffectual child-bearing, but the free and instructed woman, able to look before and after, trained in a sense of responsibility alike to herself and to the race, and determined to have no children but the best.

    Such were the two moralities which came into conflict during the nineteenth century. They are irreconcilable and each firmly rooted, one in ancient religion and tradition, the other in progressive science and reason. Nothing was possible in such a clash of opposing ideas but a feeble and confused compromise such as we find still prevailing in various countries of Old Europe. This is not a satisfactory solution, however inevitable, and is especially unsatisfactory by the consequent obscurantism which placed difficulties in the way of spreading a knowledge of the methods of Birth Control among the masses of the population. For the result has been that while the more enlightened and educated have exercised a control over the size of their families, the poorer and more ignorant—those who should have been offered every facility and encouragement to follow in the same path—have been left, through a conspiracy of silence, to carry on helplessly the bad customs of their forefathers. This social neglect has had the result that the superior family stocks have been tampered by the recklessness of the inferior stocks.

    In America, we find the two moralities in active conflict today. Until recently America has meekly accepted at the hand of Old Europe the traditional prescription. On the surface, the ancient morality had been complacently, almost unquestionably, accepted in America, even to the extent of tacitly permitting the existence of a vast extension of abortion, under the surface of society— a criminal practice which ever flourishes where Birth Control is neglected.

    But today, a new movement is perceptible in America. It would seem that, almost in a flash, America has awakened to the true significance of the issue. With that direct vision of hers, that swift practicality of action, and above all, that sense of the democratic nature of all social progress, we see her resolutely beginning to face this great problem. In her vigorous tongue she is demanding “What is all this secrecy about, anyway? Let us turn on the Light!” And the best authorities agree that America’s answer to the demand will be of the greatest importance, and of immense significance to the whole world.

    In concluding this portion of our discussion, I ask my readers to consider the following quotations from writers who have touched upon the question of the stimulation of the birth-rate by the State, for the purpose of military policy. These quotations speak for themselves, and need but little comment.

    The first authority, a German, whose name has escaped me for the moment, laments the falling birth-rate in his country, and urges his own nation to stimulate it by offering bounties; he says: “Woe to us if we follow the example of the wicked and degenerate people of other nations. Our nation needs men. We have to populate the earth, and to carry the blessings of our Kultur all over the world. In executing that high mission we cannot have too much human material in defending ourselves against the aggression of other nations who are jealous of us and our achievements and progress. Let us promote parentage by law; let us repress by law every influence which may encourage a falling birth-rate; otherwise there is nothing left us but speedy national disaster, complete and irremediable.”

    Havelock Ellis, an Englishman, says: “In Germany for years past it has been difficult to take up a serious periodical without finding some anxiously statistical article about the falling birth-rate, and some wild recommendations for its arrest. For it is the militaristic German who of all Europeans is most worried by this fall; indeed Germans often even refuse to recognize it. Thus today we find Professor Gruber declaring that if the population of the German Empire continues to grow at the rate of the first five years of the present century, it will have reached 250,000,000 at the end of the century. By such a vast increase in population, the Professor complacently concludes, ‘Germany will be rendered invulnerable.’ But Gruber’s estimate is entirely fallacious. German births have fallen, roughly speaking, about 1 per 1,000 of the population, every year since the beginning of the century, and it would be equally reasonable to estimate that if they continue to fall at the present rate (which we cannot, of course, anticipate) births will altogether have ceased in Germany before the end of the century. The German birth-rate reached its climax forty years ago (1871-1880) with 40.7 per 1,000; in 1906 it was 34 per 1,000; in 1909 it was 31 per 1,000; in 1912 it was 28 per 1,000; in an almost measurable period of time, in all probability before the end of the century, it will have reached the same low level as that of France, when there will be but little difference between the ‘invulnerability’ of France and of Germany, a consummation which, for the world’s sake, is far more devoutly to be wished than that anticipated by Gruber.”

    Writers of Teutonic sympathies have asserted that the aggressive attitude of Germany at the beginning of the Great War was to be legitimately explained and apologized for on the ground that the War was the inevitable expansive outcome of the abnormally high birth-rate of Germany in recent times. Dr. Dernburg, the German statesman, said not very long ago: “The expansion of the German nation has been so extraordinary during the past twenty-five years that the conditions existing before the war had become insupportable.” Another writer has said: “Of later years there has arisen a movement among German women for bringing abortion into honor and repute, so that it may be carried out openly and with the aid of the best physicians. This movement has been supported by lawyers and social reformers of high position.”

    Thus, it would seem that a birth-rate stimulated by unusual circumstances or by deliberate State encouragement, seemingly draws upon it the operation of natural laws which tend to increase its death-rate by War, as well as by an increased number of abortions, and an increased death-rate. It would seem as natural laws operate to bring down the population to normal by war if the other factors do not operate sufficiently rapidly and efficiently.

    Havelock Ellis makes the following interesting statement: “If we survey the belligerent nations in the war we may say that those who took the initiative in drawing it on, or at all events were most prepared to welcome it, were Germany, Austria, Serbia, and Russia—all nations with a high birth-rate, and in which the fall of the birth-rate has not yet had time to permeate. On the other hand, of the belligerent peoples of today, all indications point to the French as the people most intolerant, silently but deeply, of the war they are so ably and heroically waging. Yet the France of the present, with the lowest birth-rate, was a century ago the France of a birth-rate higher than that of Germany today, and at that time the most militarist and aggressive of nations, a perpetual menace to Europe.”

    Finally, let us quote Havelock Ellis once more; he says: “When we realize these facts we are also enabled to realize how futile, how misplaced and how mischievous it is to raise the cry of ‘Race Suicide.’ It is futile because no outcry can affect a world-wide movement of civilization. It is misplaced because the rise and fall of the population is not a matter of birth-rate alone, but of the birth-rate combined with the death-rate, and while we cannot expect to touch the former we can influence the latter. It is mischievous because by fighting against a tendency which is not only inevitable but altogether beneficial, we blind ourselves to the advance of civilization and risk the misdirection of our energies. How far this blindness may be carried we see in the false patriotism of those who in the decline of the birth-rate, fancy they see the ruin of their own particular country, oblivious of the fact that we are concerned with a phenomenon of world-wide extension. The whole tendency of civilization is to reduce the birth-rate. We may go further, and assert with the distinguished German economist, Roscher, that the chief cause of the superiority of a highly civilized state over lower stages of civilization is precisely a greater degree of forethought and self-control in marriage and child-bearing. Instead of talking about Race Suicide, we should do well to observe at what an appalling rate, even yet, the population is increasing; and we should note that it is everywhere the poorest and most primitive countries, and in every country (as in Germany) the poorest regions, which show the highest birth-rate.”

    The same authority says: “One last resort the would-be patriotic alarmist seeks when all others fail. He is good enough to admit that a general decline in the birth-rate might be beneficial. But, he points out, it affects social classes unequally. It is initiated, not by the degenerate and unfit, with whom we could well dispense, but by the very best classes in the community, the well-to-do and the educated. One is inclined to remark, at once, that a social change initiated by its best social class is scarcely likely to be pernicious. Where, it may be asked, if not among the most educated classes, is any process of amelioration to be initiated? We cannot make the world topsy-turvy to suit the convenience of topsy-turvy minds. All social movements tend to begin at the top and to permeate downwards. This has been the case with the decline of the birth-rate, but it is already well marked among the working classes, and has only failed to touch the lowest stratum of all, too weak-minded and too reckless to be amenable to ordinary social motives. The rational method of meeting this situation is not a propaganda in favor of procreation—a truly imbecile propaganda, since it is only carried out and only likely to be carried out, by the very class which we wish to sterilize—but rather by a wise policy of regulative eugenics. We have to create the motives, and it is not an impossible task, which will act even upon the weak-minded and reckless lowest social stratum.”

    PRIVATE Sex Advice to Women By R. B. Armitage, M. D.

    For Young Wives and those who Expect to be Married.

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  • WHAT BIRTH CONTROL IS, AND IS NOT

    WHAT BIRTH CONTROL IS, AND IS NOT

    The student of the progress of human affairs, or even the average person whose knowledge of the doings of mankind is derived from a hasty and casual reading of the daily newspapers and the popular magazines, cannot plead ignorance of the growing interest in the general subject which is embraced within the content of the term “Birth Control.”

    But while the general meaning of the term is at least vaguely grasped by the average member of the human crowd—the individual to whom we refer as “the man on the street”—we find a startling condition of mental confusion and often positive misconception concerning the essence and spirit of the general idea expressed by the term in question.

    While the fact is a reflection upon the average intelligence of the general public, it must be admitted that to the average person, or “the man on the street,” Birth Control means simply the teaching and practice of certain methods whereby men and women may indulge their sexual appetites, in or out of marriage, without incurring the liability or risk of conception and child-bearing. The average person does not stop to consider that such teachings and practices do not constitute “Birth Control” at all, but are, rather, merely the theory and practice of Birth Prevention, desirable only to those who seek sexual indulgences without being called upon to shoulder the responsibilities attached by Nature to the physical sexual union of men and women.

    The term “control” does not mean “prohibition,” or “prevention”; but, on the contrary, means “governing, regulating, or managing influence.” Birth Control, in the true meaning of the term, does not mean the prevention or prohibition of the birth of children, but rather the encouragement of the birth of children under the best possible conditions and the discouragement of the birth of children under improper or unfavorable conditions.

    Birth Control, in the true meaning of the term, does not mean theories and practices which would tend to reduce the population of the civilized countries of the world, but rather theories and practice which would inevitably result in the production of an adequate ratio of increase in the population of such countries, not only by reason of a normal birth-rate, but also by reason of a diminishing death-rate among infants—by the production of healthier children, accompanied by the raising of the standard of the average child born in such countries.

    Birth Control, in the true meaning of the term, therefore, is seen to consist not of the prohibition or prevention of human offspring, but rather of the governing, regulating, and managing of the production of human offspring, under the inspiration of the highest ideals and under the direction of the highest reason, for the purpose of the advancement and welfare of the race and that of the individuals composing the race. Instead of being an anti-social and anti-moral propaganda, Birth Control when rightly understood is perceived to be in accordance with the highest social aims and aspirations, and in accordance with the highest and purest morality of the race.

    Much of the opposition toward the general movement of Birth Control which has been manifested by many well-meaning, though misinformed, persons, has arisen by reason of the erroneous conception and understanding of the term itself, and of misleading information concerning the true nature of the best teachings on the subject. This prejudice has been heightened by certain zealous but ill-balanced advocates of the general movement who have overemphasized the incidental feature of the limitation of offspring under certain conditions, and who have appealed to the attention and interest merely of those who wished to escape the responsibilities of parenthood. This has caused much sorrow and distress to the many persons who have the highest ideals and results in view, and who deplore this unbalanced propaganda under the name, and apparently under the cloak of the general movement. Such persons have felt inclined to cry aloud “Good Lord, deliver us from our so-called friends!”

    One of the most distressing features of the popular prejudice against Birth Control, arising from a total misconception of the subject, has been the widely spread and popularly accepted notion that Birth Control is practically analogous to abortion—or, at the best, but a more refined and less repulsive and less dangerous form of abortion. In view of the fact that one of the important results sought to be obtained by a scientific knowledge of Birth Control actually is the prevention and avoidance of the crime of abortion which has wrought such terrible havoc among the women of civilized countries, it is most distressing and discouraging to the conscientious and high-minded advocates of Birth Control to have it said and believed that their teachings encourage and justify abortion.

    A reference to any standard dictionary or textbook will reveal the fact that “Abortion” means: “the premature expulsion of the human embryo or foetus; miscarriage voluntarily induced or produced,” etc. It is seen at a glance that the essence and meaning of abortion consists in the destruction of the human embryo which has resulted from conception. The embryo human child must already exist in its elemental form, before it can be destroyed by abortion. Therefore, if no such embryo form exists, it cannot be destroyed, and therefore there can be no abortion in such a case. And, it may positively be stated, no true advocate of Birth Control can possibly justify, much less advocate, the destruction of the human embryo or foetus, which act constitutes abortion. The difference between true Birth Control teachings and methods, and that of the advocates of abortion, is as great as the difference between the two poles. Instead of the two being identical or similar, they are diametrically opposed one to the other—they are logical “opposites,” each the antithesis of the other.

    Even in those forms or phases of the Birth Control propaganda in which the use of “contraceptives,” or “preventatives” is considered justified in certain cases—and these forms and phases are far from being the most important, as all students of the subject know—even in these exceptional forms and phases of the general subject the idea of abortion is combatted, and never justified or encouraged. A “contraceptive” agency merely tends to prevent or obviate undesirable conception; it never acts to destroy the result of previous and accomplished conception. A “contraceptive” merely prevents the union of the male and female elements of reproduction, and consequently the process from which evolves the foetus or embryo. A leading medical authority has said regarding this distinction: “In inducing abortion, one destroys something already formed—a foetus or an embryo, a fertilized ovum, a potential human being. In prevention, however, one merely prevents chemically or mechanically the spermatozoa from coming in contact with the ovum. There is no greater sin or crime in this than there is in simple abstinence, in refraining from sexual intercourse.”

    What then must we say when we consider the higher and more advanced forms and phases of Birth Control, those phases and forms which may be said to be mental or emotional “contraceptives,” rather than physical? Surely these cannot be considered as identical with or similar to abortion. And when we consider those phases and forms of Birth Control which are concerned with Pre-Natal Culture—the culture of the child before its birth—can one, even though he be intensely prejudiced against Birth Control, assert that there is to be found here anything which in any way whatsoever can be considered as relating to the theory or practice of abortion? And what must we say of the still higher phases in which the teachings are concerned with the mental and physical preparation of the parents prior to the conception of the child, to the end that the child may have the best possible physiological and psychological basis for its future well-being? Is not this the very antithesis and opposite of all that concerns abortion or abortive methods?

    The trouble about all great movements designed for the benefit of the human race is that at the beginning there is attracted to the movement, by reason of its novelty and “newness,” certain elements which seize upon certain incidental features of the general idea, make them their own while excluding or ignoring the more important things, and then exploit these incidental features in a sensational way, thereby attracting public attention and gaining much undesirable notoriety, and as a consequence bringing discredit and disfavor, prejudice and misunderstanding, to the general movement.

    Birth Control has passed through this apparently inevitable experience, and has suffered greatly thereby. But the Light is being thrown on the Dark Places, and the more intelligent portion of the public is beginning to realize that there is another side to the shield of Birth Control. And, as a consequence, much of the original prejudice is disappearing, and a new understanding of the subject is arising in the minds of many of the best individuals of the race. It is the purpose of this book to help to dispel the ignorance and misconception concerning this great subject of Birth Control, and to aid in presenting the higher and nobler aspects of the general movement to the attention of those who are concerned with the advance and progress of the race as a whole, and of the individual members thereof.

    The student of the subject of Birth Control will fall into grievous error if he begins his consideration of the subject under the impression that the questions concerned therein are new to the world of living things. If the process of Birth Control were something which had suddenly sprung into existence in the consciousness of man, without having an antecedent activity in the history of the race, and of living creatures in general, we might well hesitate to go further in the matter without the most serious and prolonged consideration of the entire principle by the careful thought of the wisest of the race. But while such consideration is advisable, as in the case of any and all important problems presenting themselves for solution and judgment, it is found that those so considering the subject have a sound and firm foundation upon which to base their thought and to test their conclusions.

    As many thoughtful students of the subject have pointed out to us, the question of Birth Control has been with the race practically since the beginning of human history; and it has its correspondences in the instinctive actions of the lower forms of life. The chief difference is that we are now seeking to deal with these problems consciously, voluntarily, and deliberately, whereas in the past the race has dealt with them more or less unconsciously, by methods of trial and error, through perpetual experiment which has often proved costly but which has all the more clearly brought out the real course of natural processes.

    We cannot hope to solve problems so ancient and so deeply rooted as these by merely the rational methods of yesterday and today. To be of value our rational methods must be the revelation in deliberate consciousness of unconscious methods which go far back into the remote past. Our deliberate methods will not be sound except in so far as they are a continuation of those methods which, in the slow evolution of life, have been found sound and progressive on the plane of instinct. This is particularly true in the case of those among us who desire their own line of conduct in the matter to be so closely in accord with natural law, or the law of creation, that to question it would be impious.

    It may be accepted without an extended argument or presentation of evidence that at the outset the prime object of Nature seems to have been that of Reproduction. There is evident, without doubt, an effort on the part of Nature to secure economy of method in the attainment of ever greater perfection in the process of reproduction, but we cannot deny that the primary motive seems to be that of reproduction pure and simple. The tendency toward reproduction is indeed so fundamental in Nature that it is impressed with the greatest emphasis upon every living thing. And, as careful thinkers have told us “the course of evolution seems to have been more of an effort to slow down reproduction than to furnish it with new facilities.”

    Reproduction appears in the history of life even before sex manifests itself. The lower forms of animal and plant life oftener produce themselves without the aid of sex, and some authorities have argued that the presence of sex differentiation serves rather to check active propagation rather than to increase it. If quantity, without regard to quality or variation, be the object of Nature, then that purpose would have been better served by withholding sex-differentiation than by evolving it. As Professor Coulter, a leading American botanist, has well said: “The impression one gains of sexuality is that it represents reproduction under peculiar difficulties.”

    To those who find it difficult to assimilate this somewhat startling idea, we now present a brief statement of the infinitely greater facility toward reproduction manifested by living creatures lacking in sex-differentiation as compared with those possessing it. It is seen that bacteria among primitive plants, and protozoa among primitive animals, are patterns of very rapid and prolific reproduction, though sex begins to appear in a rudimentary form in very lowly forms of life. A single infusorian becomes in a week the ancestor of millions, that is to say, of far more individuals than could proceed under the most favorable conditions from a pair of elephants in five centuries; and Huxley has calculated that the progeny of a single parthenogenetic aphis, under favorable circumstances, would in a few months outweigh the whole population of China. It must be noted, however, that this proviso “under favorable circumstances” reveals the weak point of Nature’s early method of reproduction by enormously rapid multiplication. Creatures so easily produced are easily destroyed; and Nature, apparently in consequence, wastes no time in imparting to them the qualities needed for a high form of life and living.

    And, even after sex differentiation had attained a considerable degree of development, Nature seemed slow to abandon her original plan of rapid multiplication of individuals. Among insects so far advanced as the white ants, the queen lays eggs at the enormous rate of 80,000 a day during her period of active life. Higher in the scale, we find the female herring laying 70,000 eggs at one period of delivery. But in both of these cases we find the manifestation of that apparently invariable rule of Nature, viz., that a high birth-rate is accompanied by a heavy death-rate, whether that high death-rate be caused by natural enemies, wars, or disease.

    At a certain stage of the evolutionary process, Nature seems to have awakened to a realization of the fact that it was better, from every point of view, to produce a fewsuperior beings rather than a vast number of inferior ones. Here, at last, Nature discloses a heretofore hidden aim, namely, the production of quality rather than quantity; and once she has started on this new path, she has pursued it with even greater eagerness than that of reproduction pure and simple. And here we pause to note a principle laid down by the students of Evolution, viz., that advancing evolution is accompanied by declining fertility.

    This new stage of Nature’s processes is marked by a constant and invariable manifestation of diminished number of offspring, accompanied by an increased amount of time and care in the creation and breeding of each of the young creatures. Accompanying this, we find that the reproductive life of the creature is shortened, and confined to more or less special periods; these periods beginning much later, and ending much earlier, and even during their continuance tending to operate in cycles of activity. Here, we see, Nature, grown wiser by experience, herself began to exercise her power in the direction of Birth Control—the use of preventive checks on reproduction.

    A writer has said along these lines: “As reproduction slackened, evolution was greatly accelerated. A highly important and essential aspect of this greater individuation is a higher survival value. The more complex and better equipped creature can meet and subdue difficulties and dangers to which the more lowly organized creature that came before—produced wholesale in a way which Nature seems to look back on as cheap and nasty—succumbed helplessly without an effort. The idea of economy began to assert itself in the world. It became clear in the course of evolution that it is better to produce really good and highly efficient organisms, at whatever cost, than to be content with cheap production on a wholesale scale. They allowed greater developmental progress to be made, and they lasted better. Even before man began it was proved in the animal world that the death-rate falls as the birth-rate falls.”

    Let us compare the lowly herring with the highly evolved elephant. The herring multiplies with enormous rapidity and on a vast scale, and it possesses a very small brain, and is almost totally unequipped to grapple with the special difficulties of its life, to which it succumbs on a wholesale scale. A single elephant is carried for about two years in its mother’s womb, and is carefully guarded by her for many years after birth; it possesses a large brain, and its muscular system is as remarkable for its delicacy as for its power, and is guided by the most sensitive perceptions. It is fully equipped for all the dangers of life, save for those which have been introduced by the subtle ingenuity of modern man. Though a single pair of elephants produces so few offspring, yet their high cost is justified, for each of them has a reasonable chance of surviving to old age. This contrast, from the point of view of reproduction, of the herring and the elephant, well illustrates the principle of evolution previously referred to. It brings clearly into view the difference between Nature’s earlier and her later methods—the ever increasing preference for quality over quantity. Unless we grasp this underlying principle of Nature in its wider aspects we may fail to perceive its operations in the case of man, which latter we may now consider.

    It is, of course, impossible to speak positively regarding the birth-rate and death-rate of the pre-historic primitive races of mankind, for there is not data upon which to base such a report. But reasoning upon the basis of conditions existing among the primitive tribes of the present time we are justified in holding that in the early stages of the evolution of the race there was manifested a high birth-rate and a correspondingly high death-rate. Upon the basis of conditions now existing among savage tribes it would appear that primitive man has a higher birth-rate than the average of mankind today, and likewise a higher death-rate. The rapidly increasing number of children born to the tribe was counteracted by deaths among children caused by neglect, poverty, and disease. In some cases the population was prevented from becoming larger than the means of subsistence justified by the practice of infanticide.

    As to the condition of the race in the early stages of “modern” civilization, we have modern Russia as a surviving instance of this stage. In modern Russia we find, side by side with the progress in neighboring nations, conditions which a few centuries ago existed all over Europe. Here we have an enormous birth-rate, and a terrible death-rate caused by ignorance, superstition, insanitation, filth, bad food, impure water, plagues, famines, and other accompaniments of overcrowding and misery. We find a mortality among young children which sometimes destroys more than half of the children born before they have attained the age of five years. As high as is the Russian birth-rate, it is a matter of record that at times the death-rate has actually exceeded it. And among the survivors there is found a startlingly large percentage of chronic and incurable diseases, with a large number of cases of blindness and other defects.

    Similar results follow in China, where the birth-rate is exceptionally high, and the death-rate correspondingly large; and where there is a large percentage of inferior physical development and pathological defects, the evil conditions which produce death also tending to produce deterioration in the survivors. In both of these countries we have an example of the result of unrestricted reproduction, and unrestricted destruction—as among herrings, so among men. And yet this condition of unrestricted reproduction is the logical goal of certain persons who, inspired by the best possible intentions, in their ignorance and criminal rashness would dare to arrest that fall in the birth-rate which is now beginning to spread its influence in every civilized land.

    In Western Europe before the nineteenth century the population increased very slowly. The enormous birth-rate was nearly equalled by the exceedingly heavy death-rate caused by plagues, pestilences, and famine, and by the frequent wars large and small. The mortality among young children was particularly heavy. Writers have pointed out that the old family records show frequently two or three children of the same Christian name, the first child having died and its name given to a successor.

    During the last quarter of the eighteenth century, when machinery was introduced and a new industrial era opened, the birth-rate rose rapidly. Factories springing up gave increased support to many, and as children were employed as “hands” in the mills at an early age, the richest family was the one with most children. The population began to increase rapidly. But soon disease, misery, and poverty arose from filth and insanitation, immorality and crime, overcrowding and child-labor, drink and lack of sane courses of conduct.

    In time, however, progress set in, and social reformers began the great movement for the betterment of the environment, sanitation, shorter hours of labor, and restriction of child-labor, factory regulation, etc. And when the environment is bettered, the death-rate drops, and the birth-rate accompanies it on its downward progress. As Leroy-Beaulieu says: “The first degree of prosperity in a rude population with few needs tends toward prolificness of reproduction; a later degree of prosperity, accompanied by all the feelings and ideas stimulated by the reduction of such prolificness.”

    The law of the reduction of reproduction in response to the improvement of environment is a natural law, arising from fixed biological principles. This is because when we improve the environment we improve the individual situated in that environment; and the improvement of the individual has always resulted in a check upon reproduction. We must remember, however, that this change is not the result of conscious or voluntary action; instead it is the result of unconscious activities and instinctive urge. As Sir Shirley Murphy has said: “Birth Control is a natural process, and though in civilized men, endowed with high intelligence, it necessarily works in some measure voluntarily and deliberately, it is probable that it also works, as in the evolution of the lower animals, to some extent automatically.”

    Science shows us that even among the most primitive micro-organisms; when placed under unfavorable conditions as to food and environment, they tend to pass into a reproductive phase and by sporulation or otherwise begin to produce new individuals rapidly. This, of course, because of the fact that their death-rate is increased, and an increased birth-rate must be manifested in order to maintain a balance. If the environment be improved, the death-rate decreases, and this is followed by a fall in the birth-rate, according to the constant laws of Nature manifesting in such cases.

    The same law is seen to be manifested in the case of Man. Improve his environment, and his death-rate drops, which is accompanied by a falling birth-rate. Here, once more we see the application of the scientific axiom “Improve the environment and reproduction is checked.” As Leroy-Beaulieu has said: “The tendency of civilization is to reduce the birth-rate.” And as Professor Benjamin Moore has said: “Decreased reproduction is the simple biological reply to good economic conditions.” And as Havelock Ellis has said: “Those who desire a higher birth-rate are desiring, whether they know it or not, the increase of poverty, ignorance, and wretchedness.”

    Among men, Birth Control has now evolved from the unconscious and instinctive phase, and is now unfolding and manifesting on the plane of conscious and voluntary activity. The influence of deliberate intention and conscious design is now one of the important factors in the process. Here at this point we reach a totally new aspect of reproduction. In the past stages of evolution the original impetus toward reproduction has been checked and directed by Nature, working along instinctive and unconscious lines; and the result has been an extreme diminution of the number of off-spring; a prolongation of the time devoted to the breeding and care of each new member of the family, in harmony with its greatly prolonged life; a spacing out of the intervals between the offspring; and, as a result, a vastly greater development of each individual, and an ever better equipment for the task of living. All this was slowly attained automatically, without any conscious volition on the part of the individuals, even when they were human beings, who were the agents.

    Now, however, we are confronted with a change which we may regard as, in some respects, the most momentous sudden advance in the whole history of reproduction, namely, the process of reproductive progress now become conscious and deliberately volitional. Birth control, no longer automatic, is now being directed by human mind and will precisely to the attainment of ends which Nature has been struggling after for millions of years; and, being consciously and deliberately directed, it is now enabled to avoid many of the pitfalls into which the unconscious method fell.

    Havelock Ellis says: “The control and limitation of reproductive activity by conscious and volitional effort is an attempt by open-eyed intelligence and foresight to attain those ends which Nature through untold generations has been painfully yet tirelessly struggling for. The deliberate co-operation of Man in the natural task of Birth Control represents an identification of the human will with what we may, if we choose, regard as the divinely appointed law of the world. We can well believe that the great pioneers, who, a century ago, acted in the spirit of this faith may have echoed the thought of Kepler when, on discovering his great planetary law, he exclaimed in rapture: ‘O God! I think Thy thoughts after Thee!’”

    The following brief general history of the modern Birth Control movement is quoted from Havelock Ellis, and will be of interest to students of the subject: “The pioneers of modern Birth Control were English. Among them Malthus occupies the first place. That distinguished man, in his great and influential work, ‘The Principles of Population,’ in 1798, emphasized the immense importance of foresight and self-control in procreation, and the profound significance of birth limitation for human welfare. Malthus, however, relied on ascetic self-restraint, a method which could only appeal to the few; he had nothing to say for the regulation of conception in intercourse. That was suggested twenty years later, very cautiously by James Mill, the father of John Stuart Mill, in the ‘Encyclopaedia Britannica.’ Four years afterwards, Mill’s friend, the Radical reformer, Francis Place, advocated this method more clearly. Finally, in 1831, Robert Dale Owen, the son of the great Robert Owen, published his ‘Moral Physiology,’ in which he set forth the ways of preventing conception; while a little later the Drysdale brothers, ardent and unwearying philanthropists, devoted their energies to a propaganda which has been spreading ever since and has now conquered the whole civilized world.

    “It was not, however, in England but in France, so often at the head of an advance in civilization, that Birth Control first firmly became established, and that the extravagantly high birth rate of earlier times began to fall; this happened in the first half of the nineteenth century, whether or not it was mainly due to voluntary control. In England the movement came later, and the steady decline in the English birth-rate, which is still proceeding, began in 1877. In the previous year there had been a famous prosecution of Bradlaugh and Mrs. Besant for disseminating pamphlets describing the methods of preventing conception; the charge was described by the Lord Chief Justice, who tried the case, as one of the most ill-advised and injudicious ever made in a court of justice. But it served an undesigned end by giving enormous publicity to the subject and advertising the methods it sought to suppress. There can be no doubt, however, that even apart from this trial the movement would have proceeded on the same lines. The times were ripe, the great industrial expansion had passed its first feverish phase, social conditions were improving, education was spreading. The inevitable character of the movement is indicated by the fact that at the very same time it began to be manifested all over Europe, indeed in every civilized country of the world.

    “At the present time the birth-rate (as well as usually the death-rate) is falling in every country of the world sufficiently civilized to possess statistics of its own vital movement. The fall varies in rapidity. It has been considerable in the more progressive countries; it has lingered in the more backward countries. If we examine the latest statistics for Europe, we find that every country, without exception, with a progressive and educated population, and a fairly high state of social well-being, presents a birth-rate below 30 per 1,000. We also find that every country in Europe in which the mass of the people are primitive, ignorant, or in a socially unsatisfactory condition (even although the governing classes may be progressive or ambitious) shows a birth-rate of above 30 per 1,000. France, Great Britain, Belgium, Holland, the Scandinavian countries, and Switzerland are in the first group. Russia, Austro-Hungary, Italy, Spain, and the Balkan countries are in the second group. The German Empire was formerly in the second group, but now comes within the first group, and has carried on the movement so energetically that the birth-rate of Berlin is already below that of London, and that at the present rate of decline the birth-rate of the German Empire will before long sink to that of France. Outside Europe, in the United States just as much as in Australia and New Zealand, the same progressive movement is proceeding with equal activity.”

    The same authority sums up the present attitude of the advocates of scientific and rational Birth Control, as follows: “The wide survey of the question of birth limitation has settled the question of the desirability of the adoption of preventing conception, and finally settled those who would waste out time with their fears that it is not right to control conception. We know now on whose side are the laws of God and Nature. We realize that in exercising control over the entrance gate of life we are not fully performing, consciously and deliberately, a great human duty, but carrying on rationally a beneficial process which has, more blindly and wastefully, been carried on since the beginning of the world. There are still a few persons ignorant enough or foolish enough to fight against the advance of civilization in this matter; we can well afford to leave them severely alone, knowing that in a few years all of them will have passed away. It is not our business to defend the control of birth, but simply discuss how we may most wisely exercise that control.”

    PRIVATE Sex Advice to Women By R. B. Armitage, M. D.

    For Young Wives and those who Expect to be Married.

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  • Strengthening accountability to end TB

    WHO today released a Checklist to enable Member States and their partners to assess the status of work at the national level to strengthen accountability to End TB, principally: national commitments made, actions taken on those commitments, monitoring & reporting approaches, and the nature of any high-level review mechanisms. The Checklist has been developed in response to requests from Member States, regions, civil society and partners as a tool to support the adaptation and implementation of the WHO Multisectoral Accountability Framework (MAF-TB) released in 2019. It responds also to the UN General Assembly request to WHO to ensure implementation of the Framework.

    There are four components of the MAF-TB that form a cycle for strengthening accountability: Commitments, Actions, Monitoring and Reporting, and Review, that were released during the World Health Assembly in May, 2019. In the political declaration of the first UN high-level meeting on TB, world leaders called for WHO to finalize the framework and ensure its implementation in 2019.

    After its publication in May, 2019, WHO began work with pathfinding country counterparts who were seeking to move ahead on key elements including, among others: formal adoption of country-specific targets for 2022 for increased TB case detection and treatment in line with the global targets in the political declaration; updating or development of new national TB strategic plans based on 2022 and 2030 targets and other new commitments; coordination platforms across sectors and stakeholders; formalizing engagement with civil society across End TB efforts;  producing robust performance reports; and, using those reports to inform high-level review bodies that will assess and drive faster progress.  Based on the MAF-TB document, relevant country experiences, and specific requests from countries and partners, WHO developed the MAF-TB Checklist. The Checklist is especially relevant for high TB burden countries, but has content relevant to all countries.  The appropriateness of different approaches may vary, according to national constitutional, legal and/or regulatory frameworks or other relevant factors.

    The MAF-TB Checklist has three annexes on:

    1. engagement across government ministries and bodies;
    2. engagement of civil society and affected communities; and,
    3. adoption  and implementation of WHO TB guidance.

    In releasing this MAF-TB Checklist today, Dr Tereza Kasaeva, Director of the WHO Global TB Programme noted,  “At this enormously difficult time, all countries and partners are focused on the COVID-19 pandemic.  Lessons learnt from ongoing TB programmes are helping the response. Likewise, TB efforts will benefit from learning underway on collaboration, innovation and accountability in confronting the virus.”

    WHO will be helping Ministries of Health and partners to use the Checklist, hold related consultations and move forward with more effective collaboration and review mechanisms.  The WHO Civil Society Task Force on TB also will support countries and civil society partners, using the Checklist. Progress in strengthening accountability will be assessed in the 2020 Report of the UN Secretary-General on progress since the 2018 TB UN high-level meeting, as well as in the WHO Global TB Report 2020.

    The WHO TB Civil Society Task Force, National TB  Programme Managers and other country officials, WHO staff at all levels, consultants working with WHO and The Global Fund, and staff of partner agencies, contributed content to, and/or provided feedback on, the MAF-TB Checklist during its development.   Access the Checklist and 3 annexes.  

    An online form of the checklist will be available shortly here, along with additional information.  

    Translations of the Checklist and annexes, as soon as available in Arabic, Chinese, French, Russian and Spanish, will be posted at the above link as well.   Kindly contact gtbprogramme@who.int if you have questions regarding the MAF-TB Checklist or to request versions in MS Word format if needed.

     

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    https://www.who.int/news-room/detail/08-04-2020-strengthening-accountability-to-end-tb

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