Tag: progress

  • WHO and European Investment Bank strengthen efforts to combat COVID-19 and build resilient health systems to face future pandemics

    • WHO and the European Investment Bank enhance cooperation to support countries in addressing the health impact of COVID-19
    • The first phase will address urgent needs and strengthen primary health care in ten African countries
    • Enhanced WHO-EIB partnership will scale up financing to assure the chain of essential supplies, including personal protective equipment, diagnostics and clinical management
    • New initiative will accelerate investment in health preparedness and primary health care with a focus on health work force, infrastructure, and water, sanitation and hygiene
    • The initiative involves measures to address the growing threat of antimicrobial resistance

    The World Health Organization and the European Investment Bank will boost cooperation to strengthen public health, supply of essential equipment, training and hygiene investment in countries most vulnerable to the COVID-19 pandemic.

    The new partnership between the United Nations health agency and the world’s largest international public bank, announced at WHO headquarters in Geneva earlier today, will help increase resilience to reduce the health and social impact of future health emergencies. 

    “Combining the public health experience of the World Health Organization and the financial expertise of the European Investment Bank will contribute to a more effective response to COVID-19 and other pressing health challenges,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. 

    “WHO looks forward to strengthening cooperation with the EIB to improve access to essential supplies including medical equipment and training, and deliver better water, sanitation and hygiene where most needed. New initiatives to improve primary health care in Africa and support the EU Malaria Fund hint at the potential impact of our new partnership,” Dr Tedros concluded.

    “The world is facing unprecedented health, social and economic shocks from COVID-19. The European Investment Bank is pleased to join forces with the World Health Organization as a key part of Team Europe’s efforts to address the global impact of the COVID-19 pandemic. The EU Bank’s new partnership with the WHO will help communities most at risk by scaling up local medical and public health efforts and better protect people around the world from future pandemics. This new cooperation will enable us to combat malaria, address anti-microbial resistance and enhance public health in Africa more effectively,” said Werner Hoyer, President of the European Investment Bank.

    Improving local public health efforts to tackle coronavirus

    The WHO and the EIB will increase cooperation to help governments in low- and middle-income countries to finance and secure access to essential medical supplies and protective equipment through central procurement.

    Building resilient health systems in vulnerable countries across Africa

    The WHO and the EIB will reinforce cooperation to support immediate COVID-19 needs and jointly develop targeted financing to enhance health investment and build resilient health systems and primary health care to address public health emergencies as well as accelerate progress towards Universal Health Coverage.

    The partnership will benefit from the EIB’s planned 1.4 billion EUR response to address the health, social and economic impact of COVID-19 in Africa.

    This will address immediate needs in the health sector and provide both technical assistance and support for medium-term investment in specialist health infrastructure.

    The collaboration envisages rapid identification and fast-track approval of financing for health care, medical equipment and supplies. 

    The first phase of the collaboration will see public health investment in ten African countries. 

    Long-term collaboration to overcome market failures in global health

    The agreement signed today establishes a close collaboration to overcome market failure and stimulate investments in global health, accelerating progress towards Universal Health Coverage. Increased cooperation between the WHO and the EIB will strengthen the resilience of national public health systems and enhance preparedness of vulnerable countries against future pandemics, thanks to investments in primary care infrastructure, health workers and improved water, sanitation and hygiene. 

    Future cooperation will strengthen the EIB’s 5.2 billion EUR global response to COVID-19 outside the European Union.

    Scaling up investment to tackle antimicrobial resistance

    The two organisations will also cooperate in an initiative to address investment barriers hindering development of new antimicrobial treatment and related diagnostics. Antimicrobial resistance is amongst the most significant global health threats.

    The WHO and the EIB are working on a new financing initiative to support development of novel antimicrobials and address the estimated 1 billion EUR needed to provide medium-term solutions to antimicrobial resistance. Other crucial partners have been invited to join this discussion. 

    Improving the effectiveness of malaria treatment

    Under the new agreement the EIB and WHO will support development of the EU Malaria Fund, a new 250 million EUR public-private initiative intended to address market failures holding back more effective malaria treatment. 

    Strengthening EIB support for healthcare, life science and COVID-19 investment

    In recent years the European Investment Bank has provided more than 2 billion EUR annually for health care and life science investment.

    In the context of the COVID-19 pandemic, the EIB is currently assessing over 20 projects in the field of vaccine development, diagnostic and treatment, leading to potential investments in the 700 million EUR range. The EIB will also take part in the EU’s rolling pledging effort for the coronavirus global response that is taking place on May 4th.

    Background information

    The European Investment Bank (EIB) is the long-term lending institution of the European Union owned by its Member States. It makes long-term finance available for sound investment in order to contribute towards EU policy goals.

    The World Health Organization provides global leadership in public health within the United Nations system. Founded in 1948, WHO works with 194 Member States, across six regions and from more than 150 offices, to promote health, keep the world safe and serve the vulnerable. Our goal for 2019-2023 is to ensure that a billion more people have universal health coverage, to protect a billion more people from health emergencies, and provide a further billion people with better health and wellbeing. For updates on COVID-19 and public health advice to protect yourself from coronavirus, visit www.who.int and follow WHO on Twitter, Facebook, Instagram, LinkedIn, TikTok, Pinterest, Snapchat, YouTube

    WHO’s information site on the COVID-19 pandemic

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    https://www.who.int/news-room/detail/01-05-2020-who-and-european-investment-bank-strengthen-efforts-to-combat-covid-19-and-build-resilient-health-systems-to-face-future-pandemics

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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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  • New GDO country profiles available

    New GDO country profiles available

    Countries across the six WHO regions are participating in the Global Dementia Observatory (GDO), a data and knowledge exchange platform. The GDO provides easy access to country-level key dementia data and functions as the monitoring mechanism of the Global dementia action plan on the public health response to dementia 2017-2025.

    GDO country profiles offer a baseline summary of countries’ progress on dementia actions outlined in the global dementia action plan. They provide an easy read snapshot of the more comprehensive data submitted by Member States across three key domains related to dementia: policies, service delivery, and information and research. GDO country profiles can be used to inform policy, service planning and health and social care systems decisions for dementia. Additional country profiles will be added as data becomes available.

     

    View GDO country profiles

    Access the GDO

    Read the GDO Reference Guide

    New GDO country profiles available
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    https://www.who.int/news-room/detail/28-04-2020-GDO-country-profiles

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  • Hard fought gains in immunization coverage at risk without critical health services, warns WHO

    Hard fought gains in immunization coverage at risk without critical health services, warns WHO

    Shutting down immunization services in the COVID-19 pandemic risks triggering a resurgence of diseases that can be prevented with safe and effective vaccines, warns WHO in the lead-up to World Immunization Week (24-30 April). 

    When immunization services are disrupted, even for brief periods during emergencies, the risk of vaccine-preventable disease outbreaks, such as measles and polio, increase. Last year’s deadly measles outbreak in the Democratic Republic of the
    Congo, which took more than 6000 lives in a country already facing its largest Ebola outbreak, highlights the importance of maintaining essential health services, such as immunization in times of emergency. Further disease outbreaks will also overwhelm
    health systems already battling the impacts of COVID-19.

    “Disease outbreaks must not remain a threat when we have safe and effective vaccines to protect us,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “While the world strives to develop a new vaccine for COVID-19 at record speed,
    we must not risk losing the fight to protect everyone, everywhere against vaccine-preventable diseases. These diseases will come roaring back if we do not vaccinate.”

    WHO is working with partners all over the world to accelerate research and development of a safe and effective vaccine and ensure equitable access for the billions of people who will need it.

    But even with an expedited process, development of a vaccine for COVID-19 will take time. Precautionary measures are essential now to help keep us safe from disease, including diseases for which vaccines already protect children and adults.

    Too many people are still excluded from the benefits of vaccines

    Prior to the COVID-19 pandemic, the world had made immense progress in ensuring that children are vaccinated. In 2018, 86 percent of children under the age of five globally were vaccinated with three doses of diphtheria, tetanus and pertussis (DTP3) and
    one dose of the measles vaccine, up from 72 percent in 2000 and 20 percent in 1980. The number of children paralyzed by polio has been reduced by 99.9 percent worldwide. 

    Yet, global vaccination coverage is still far from the 95 per cent coverage needed to fully protect communities against outbreaks of this vaccine-preventable disease. 

    In 2018 nearly 20 million children worldwide – more than 1 in 10 – missed out on lifesaving vaccines, such as measles, diphtheria and tetanus. Roughly, 13 million of the children have never received any vaccines, putting them and their communities
    at risk of disease and death. The majority of these children live in countries with already fragile health systems, further limiting their access to essential health services when they fall sick.

    Measles continues to remain an ever-present threat, especially if vaccination rates drops. Current projections indicate that the number of reported measles cases for 2019 will be at least 800 000. In 2020 there are increasing concerns about another
    resurgence, especially if vaccination rates fall due to delay or suspension of scheduled immunization activities as a result of COVID-19. 

    Outbreaks of polio, diphtheria and yellow fever are also of high concern, especially in the countries least able to respond quickly and decisively to address an emerging outbreak, as seen in previous emergencies such as the polio outbreak in Syria in
    2013. 

    Maintaining immunization services during COVID-19

    As the response to COVID-19 continues, countries must act now protect immunization services, in order to further minimize disease outbreaks and loss of life. This includes, facilitating urgent catch up programmes in places where
    services have been disrupted, ensuring strong supply chains, disease surveillance and trained health workers. Caregivers should also make sure they continue to vaccinate their children in line with national policies.

    New WHO guidelines on immunization and COVID-19 recommend that governments temporarily pause preventive immunization
    campaigns where there is no active outbreak of a vaccine-preventable disease. But it urges countries prioritize the continuation of routine immunization of children in essential service delivery, as well as adult vaccinations such as influenza
    for groups most at risk. If immunization services must be suspended, urgent catch-up vaccinations should be rescheduled as soon as possible, prioritizing those most at risk.

    Hard fought gains in immunization coverage at risk without critical health services, warns WHO
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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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