Tag: three

  • Police: Where is Mubarak Bala? By Leo Igwe

    Police: Where is Mubarak Bala? By Leo Igwe

    Leo Igwe
    Leo Igwe

    As it stands now, the fate of Mubarak Bala, Nigerian humanist who was arrested last week is unknown. Nobody is sure if Mr. Bala is alive or dead. If he is alive, no one knows the conditions of his detention. Mr. Bala was last seen on April 29, 2020, a day after police detectives from the Kano State Command arrested him in Kaduna. 

    As soon as the information reached me that Mr. Bala was in the police custody, I contacted the Commissioner of Police (CP) in Kaduna and the Police Public Relations Officer (PPRO). They confirmed the arrest of Mr. Bala but could not provide details. They made it clear that Bala’s case was not their case and that Bala would be transferred to Kano for investigation. They declined to disclose the reason for the arrest and if Bala’s case could be transferred to Abuja or any other neutral place. 

    Police: Where is Mubarak Bala? By Leo Igwe 1Leo Igwe


    After speaking with the police officers in Kaduna and it was obvious that Mr. Bala would be taken to Kano, I tried to interact with the chief police officers in Kano. I rang up the Assistant Inspector General (AIG), the CP, and the PPRO in Kano. The AIG said he did not know about the case and asked me to contact the CP, that the case must be with the state command. I called the CP and he confirmed that there was a petition against Mubarak Bala at the state command. That they had ordered his arrest in Kaduna. He said that they were waiting for him and asked me to go and get a lawyer. I could not reach the PPRO on that day. I called him several times but he did not pick his phone. The following day I called the CP several times, he did not pick the phone. I eventually got through to the PPRO after several attempts but he was more interested in knowing my relationship with Mubarak. He repeatedly asked me if I was among those encouraging him to make blasphemous posts on Facebook. I urged him to allow the lawyer to meet with Mubarak. The lawyer has gone to the state police command on three occasions without seeing Mr. Bala. The police officers that he met claimed that they had no knowledge of Mr. Bala’s case and where he was detained. 

    As it stands now, the whereabouts of Bala is unknown. No one has seen him since the police moved him to Kano. In fact, no one can confirm if Mr. Bala is dead or alive. The police have a responsibility to provide information about Bala’s current state. They need to disclose the conditions of his detention. The police cannot indefinitely keep Bala in custody. In fact, it is illegal for the police to detain a person without charge beyond 48 hours. So the police have a responsibility to produce Bala, give him access to a lawyer, charge him in a court, or unconditionally release him. 

    For now, the police need to provide answers to these very urgent questions: where is Mubarak Bala? Is he dead or alive?

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  • JUST IN: Delta Discharges Third COVID-19 Patient

    JUST IN: Delta Discharges Third COVID-19 Patient

    JUST IN: Delta Discharges Third COVID-19 Patient 2

    Delta State has discharged another person infected with COVID-19 after treatment.

    This was disclosed by the state government via its official Twitter handle, with the latest discharge bringing the total number of persons discharged in the state to three. 

    JUST IN: Delta Discharges Third COVID-19 Patient 3


    The state now has 11 active cases after recording 17 cases with three deaths and three persons discharged.

    The state government has in place a dusk-to-dawn curfew to restrict movement and contain the spread of the virus.

    Also, wearing of face mask has been made compulsory for anyone, who goes to public place.
     

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  • Billions worldwide living with herpes

    Billions worldwide living with herpes

    About half a billion people worldwide are living with genital herpes, and several billion have an oral herpes infection, new estimates show, highlighting the need to improve awareness and scale up services to prevent and treat herpes.

    About 13% of the world’s population aged 15 to 49 years were living with herpes simplex virus type 2 (HSV-2) infection in 2016, the latest year for which data is available.  HSV-2 is almost exclusively sexually transmitted, causing genital herpes. Infection can lead to recurring, often painful, genital sores in up to a third of people infected.

    Herpes simplex virus type 1 (HSV-1) is mainly transmitted by oral to oral contact to cause oral herpes infection – sometimes leading to painful sores in or around the mouth (“cold sores”). However, HSV-1 can also be transmitted to the genital area through oral sex, causing genital herpes.

    Around 67% of the world’s population aged 0 to 49 had HSV-1 infection in 2016 – an estimated 3.7 billion people. Most of these infections were oral; however, between 122 million to 192 million people were estimated to have genital HSV-1
    infection.

    Genital herpes is a substantial health concern worldwide – beyond the potential pain and discomfort suffered by people living with the infection, the associated social consequences can have a profound effect on sexual and reproductive
    health” says Dr Ian Askew, Director of the Department of Sexual and Reproductive Health and Research at the World Health Organization (WHO). 

    Herpes and HIV

    People with HSV-2 infection are at least three times more likely to become infected with HIV, if exposed. Thus, HSV-2 likely plays a substantial role in the spread of HIV globally. Women are more susceptible to both HSV-2 and HIV. Women living in
    the WHO Africa Region have the highest HSV-2 prevalence and exposure to HIV – putting them at greatest risk of HIV infection.

    No cure: vaccine needed

    There is no cure for herpes. Antiviral medications, such as acyclovir, famciclovir, and valacyclovir, can help to reduce the severity and frequency of symptoms but cannot cure the infection.

    Better awareness, improved access to antiviral medications and heightened HIV prevention efforts for those with genital HSV symptoms are needed globally. In addition, development of better treatment and prevention interventions is needed, particularly
    HSV vaccines.  

    “A vaccine against HSV infection would not only help to promote and protect the health and well-being of millions of people, particularly women, worldwide – it could also potentially have an impact on slowing the spread of HIV, if developed
    and provided alongside other HIV prevention strategies” says Dr Meg Doherty, Director of the WHO Department of Global HIV, Hepatitis, and STI Programmes.

    Authored by staff at the University of Bristol, the WHO, and Weill Cornell Medical College-Qatar, and published in the Bulletin of the World Health Organization, this new study estimates the global infection prevalence and incidence of HSV-1 and HSV-2
    in 2016. 

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  • Massive proportion of world’s population are living with herpes infection

    Massive proportion of world’s population are living with herpes infection

    Virus causing genital herpes may put millions of people at greater risk of infection with HIV

    About half a billion people worldwide are living with genital herpes, and several billion have an oral herpes infection, new estimates show.

    Authored by staff at the University of Bristol, World Health Organization (WHO), and Weill Cornell Medical College-Qatar, and published in the Bulletin of the World Health Organization,
    the new study estimates the global infection prevalence and incidence of herpes simplex virus types 1 and 2 (HSV-1 and HSV-2) in 2016. 

    “Herpes infection affects millions of people across the globe and can have far-reaching health effects. We need more investment and commitment to develop better treatment and prevention tools for this infection.” says Dr Sami Gottlieb, Medical
    Officer at WHO and an author of the study.

    Prevalence and incidence

    An estimated 491.5 million people were living with HSV-2 infection in 2016, equivalent to 13.2% of the world’s population aged 15 to 49 years. HSV-2 is almost exclusively sexually transmitted, causing infection in the genital or anal area (genital
    herpes).

    An estimated 3.7 billion people had HSV-1 infection during the same year – around 66.6% of the world’s population aged 0 to 49. HSV-1 is mainly transmitted by oral to oral contact to cause infection in or around the mouth (oral herpes). However,
    HSV-1 can also be transmitted to the genital area through oral-genital contact – during oral sex – to cause genital herpes. Most HSV-1 infections were oral; however, between 122 million to 192 million people were estimated to have genital
    HSV-1 infection, depending on the assumptions used in the estimation model.

    Because herpes is a lifelong infection, estimated prevalence increased with age; HSV-2 prevalence was also higher among women and in the WHO African Region.

    Health and social impacts

    Most people living with herpes, caused by either HSV-1 or 2, are unaware they have the infection.

    When symptoms do occur however, oral herpes infection can lead to painful sores around the mouth (“cold sores”). Genital herpes infection can cause recurring, often painful, genital sores, often referred to as genital ulcer disease. 

    WHO and partners published a study in March 2020 estimating that around 5% of the world’s population (187 million people) suffered from at least one episode of herpes-related genital ulcer disease in 2016 (1). Most of these episodes were due to
    HSV-2, which can recur frequently over many years.

    Recurrent symptoms of genital herpes can lead to stigma and psychological distress, and can have an important impact on quality of life and sexual relationships. However, in time, most people with herpes adjust to living with the infection.

    “Genital herpes is a substantial health concern worldwide – beyond the potential pain and discomfort suffered by people living with the infection, the associated social consequences can have a profound effect on sexual and reproductive health”
    says Dr Ian Askew, Director of the Department of Sexual and Reproductive Health and Research at WHO. 

    Herpes and HIV

    A strong association exists between HSV-2 infection and HIV infection. In 2019, WHO commissioned a modeling study to estimate how much HSV-2 infection might contribute to HIV incidence. The study estimated that almost 30% of new sexually acquired HIV
    infections in 2016 worldwide were likely attributable to HSV-2 infection (2). 

    Evidence shows that people with HSV-2 infection are at least three times more likely to become infected with HIV, if exposed. HSV-2 leads to inflammation and small breaks in the genital and anal skin that can make it easier for HIV to cause infection.
    In addition, people with both HIV and HSV-2 infection are more likely to spread HIV to others.

    Women have higher biologic susceptibility to both HSV-2 and HIV. Women living in the WHO Africa Region have the highest HSV-2 prevalence and exposure to HIV – putting them at greatest risk of HIV infection, with negative implications for their health
    and well-being. 

    For people living with HIV (or who are living with other conditions that compromise their immune systems) as well as HSV-2, the symptoms of herpes can be more severe and more frequent. 

    Neonatal herpes

    Neonatal herpes can occur when an infant is exposed to HSV in the genital tract during delivery. This is a rare condition, occurring in an estimated 10 out of every 100,000 births globally, but can lead to lasting neurologic disability or death. The risk
    for neonatal herpes is greatest when a mother acquires HSV infection for the first time in late pregnancy. Women who have genital herpes before they become pregnant are at very low risk of transmitting HSV to their infants.

    No cure – better treatment and prevention needed

    There is no cure for herpes. At present, antiviral medications, such as acyclovir, famciclovir, and valacyclovir, can help to reduce the severity and frequency of symptoms but cannot cure the infection.

    As well as increasing awareness about HSV infection and its symptoms, improved access to antiviral medications and heightened HIV prevention efforts for those with genital HSV symptoms are needed globally. 

    In addition, development of better treatment and prevention interventions is needed, particularly HSV vaccines. WHO and partners are working to accelerate research to develop new strategies for prevention and control of HSV infections. Such research includes
    the development of HSV vaccines and topical microbicides. Several candidate vaccines and microbicides are currently being studied.

    “A vaccine against HSV infection would not only help to promote and protect the health and well-being of millions of people, particularly women, worldwide – it could also potentially have an impact on slowing the spread of HIV, if developed
    and provided alongside other HIV prevention strategies” says Dr Meg Doherty, Director of the WHO Department of Global HIV, Hepatitis, and STI Programmes.

    Related publications

    WHO guidelines for the treatment of Genital Herpes Simplex Virus

    WHO preferred product characteristics for herpes simplex virus vaccines

     

    ———————-

    (1) Looker KJ, Johnston C, Welton NJ, et al. The global and regional burden of genital ulcer disease due to herpes simplex virus: a natural history modelling study. BMJ Glob Health. 2020;5(3):e001875. doi: 10.1136/bmjgh-2019- 001875.

    (2) Looker KJ, Welton NJ, Sabin KM, et al.Global and regional estimates of the contribution of herpes simplex virus type 2 infection to HIV incidence: a population attributable fraction analysis using published epidemiological data. Lancet Infect Dis.2020;20(2):240-249. doi: 10.1016/S1473-3099(19)30470-0.

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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

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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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  • 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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  • What matters to women in the postnatal period?

    What matters to women in the postnatal period?

    The right to a positive maternity healthcare experience at every stage 

    Each pregnancy is unique and clinical needs can change across the pregnancy, childbirth and postnatal periods. One thing that never changes is the right to a positive experience at every stage. 

    Achieving the best possible physical, emotional, and psychological outcomes for every individual and newborn requires health systems to take a human rights-based approach: not only preventing maternal death and morbidity, but prioritising person-centred
    care and well-being.

    WHO is developing new guidelines for a positive experience of postnatal care, due to be published next year. To inform these guidelines and ensure that postnatal services can better meet the needs of women and their babies, WHO undertook a qualitative
    systematic review on what matters to women in the postnatal period.

    Joys and challenges in the postnatal period

    There is limited research about values and preferences in the postnatal period, defined by WHO as the first six weeks after childbirth. Studies have often focused on the results of specific postnatal interventions, rather than on the individuals who use
    them. 

    ‘What matters to women in the postnatal period: A meta-synthesis of qualitative studies,’ published in PLOS ONE, gives long-overdue respect to the authority of women’s own experiences. The authors review first-hand data from 15 countries
    and 36 studies published after the year 2000 relating to women’s beliefs, expectations and values at this significant time of life.  

    These studies affirm that a positive postnatal experience can result in joy, self-confidence and enhanced capacity to thrive as both a person and a parent.

    They are also vocal about the potential challenges of adjusting to a ‘new normal’ following childbirth, including changes in self-identity, relationships, and sexual behaviour.

    What is a positive postnatal experience? 

    A positive postnatal experience for a woman will be one that responds to her specific context and preferences. 

    It will provide the confidence, knowledge and skills women need in the weeks following childbirth, supporting them to adjust to any changes in their intimate relationships and build new family ones. Women will be better equipped to navigate physical and
    emotional challenges and to experience the dynamic achievement of personal growth. 

    This should be a shared responsibility, not a solitary one. Community has a critical role in enabling a positive postnatal experience, including partners, family and elders.

    It is crucial that healthcare providers meet each woman’s needs, as well as those of their babies. 

    Supporting choices and rights to improve postnatal health outcomes

    There are an estimated 303 000 maternal deaths annually, according to recent WHO figures. Most of these deaths occur postnatally. 

    The postnatal period is therefore a vital opportunity to improve both maternal and neonatal health and wellbeing: supporting healthy behaviors, providing life-skills education, facilitating breastfeeding, counselling women about family planning options,
    supporting good mental health, preventing and treating childbirth-related complications. 

    Health care systems that empower individuals by supporting their values, preferences and rights are fundamental to improving maternal and newborn health outcomes. 

    WHO’s guidance for positive maternity care

    WHO has recently released recommendations on antenatal care for a positive pregnancy experience, and on intrapartum care for a positive childbirth experience.

    These publications made important clinical updates, including an increase from four to eight recommended antenatal contacts, and a revision to the decision-making process for interventions to accelerate labour. 

    They also uphold every woman’s right to a positive maternity care experience: one where her pregnancy does not erase her competency, autonomy and right to participate in decision-making for her own care and the care of her newborn. 

    Women’s choices and rights to sexual and reproductive health care, including maternity care, should be respected at every stage of the continuum of maternal and newborn care. This is true across all income settings, as well as in humanitarian settings
    and during public health emergencies.

    When WHO’s postnatal guidelines are released next year, they will complete the maternity care series built around what matters to women.

    Rather than dividing care into three periods of antenatal, intrapartum and postnatal, these publications can be used to establish a model in which health systems support women, their baby and wider network physically, psychologically, socially and emotionally
    through this significant life event. 

    Other resources

     

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  • THE RIGHT OF A CHILD TO A KNOWLEDGE OF SEX

    Social conditions of childhood changed.—The social conditions of childhood have changed much in the last fifty years. Just as our children have opportunities and possibilities far greater than had we when we were children; so they are exposed to temptations and dangers greater than were we, when we were children. The suggestive, and oft-times positively obscene pictures on post cards, in books and on billboards; the viciously immoral literature; the cheap moving picture shows of to-day, were not social problems threatening the purity of our childhood.

    Knowledge of self important.—There were ethical, biological and vital truths that our parents, because of mock modesty and a false and inadequate education, failed to give us in our childhood. This was a serious defect in our early education. We met with temptations, were often overcome by them and we are not what we might have been had we been safeguarded by a better knowledge of ourselves. But, because of the better social conditions of our childhood, we were better able to grow up without this information and with less injury to ourselves, than our children can, without this information, under present social conditions. If we would safeguard the character of the children of to-day and the youths of to-morrow and the manhood and the womanhood of the succeeding day we must give our children a correct knowledge of themselves.

    The confidence of childhood.—When children are born, they have a capacity for learning how to stand alone, crawl, walk, love and hate, speak and read, to judge of what is right and wrong. All they may come to know in the future, true or false, good or evil, they must learn. Coming into our homes without knowledge and utterly helpless, they naturally come to recognize their parents as their rightful teachers and to have absolute confidence in them. Ask a child from three to ten years old who he thinks is the best man in the world. The reply will be, “my papa.” Ask him who he thinks is the best woman in the world. The instinctive reply will be, “my mamma.” The answer may be true or false, but we do not question the sincerity of the child. The greatest calamity that can come to that child, comes when he is compelled by convincing evidence to reverse in his judgment this sincereand implicit faith in the goodness of his parents. No greater misfortune than this, can come to the parents. This natural and complete confidence and dependence of the child gives the parents a very decided advantage over all other teachers in the future training of the child.

    Inquisitiveness of childhood.—It is because of this natural confidence that the child goes to the parents with his many questions. The almost ceaseless activity and playfulness of a child, are in response to nature’s call for exercise in the natural and healthful development of every organ of the body. The many questions of a child are in response to nature’s call for exercise in the development of every faculty of the mind. The unfolding, growing, developing mind of a child naturally asks questions. It is for this reason that a child is said to be an animated interrogation point. Some of the questions of a child may perplex a philosopher, tax the patience of a Job, or embarrass a brass monkey; but the naturalness and sincerity of the child demand honesty, frankness and wisdom on the part of parents.

    How did I get into this world?—At the age of three, four and five the child will begin to ask questions as, “Where does the rain come from? Where does the snow come from? Where do the clouds come from?” When kittens, pups, pigs, a calf, a colt are born, the child very naturally asks about their origin. The child is told repeatedly that he is four, five or six years old; that he has had that number of birthdays and has seen that number of Christmases. He remembers only half of them. He listens with interest to his parents as they relate some thrilling event of years gone by. A bright inquiring child will naturally ask, “Mamma, was I in the world at that time?” The mamma replies, “No, darling, that happened six months before you were born.” How very natural it was for the child to ask, “Well, mamma, where was I at that time? How did I get into the world?” An angel could not be more sincere, or ask a purer question. This was no evidence of the child’s depravity. When I find a child of seven or eight years old who has not asked about his origin, I know that one of three conditions will explain this unusual mental state of the child. (1) The parents have not encouraged the child’s mental development by permitting him to be free in asking questions. (2) The child has heard the story of life told by vicious companions, in half truths, clothed in vulgar language and is keeping his information a secret from his parents. (3) The child is not developing quite as fast as I would like for my child to develop.

    The unsatisfied mind.—When the inquiring mind of a child has once become interested in this question, it is not possible for him to be satisfied until a plausible answer has been received. The child’s future, physical, mental and moral life more largely depends upon the answer given to this question, than to any other question of his childhood.

    The most vital part of a child’s education neglected.—In the past, parents, teachers, reformers and ministers have very largely held to the old theory, that, if children are to be kept pure and innocent, they must be kept ignorant of all information pertaining to sex. We have them learn the physiology, anatomy and hygiene of their brain, heart, lungs, digestive and nervous systems as if their very lives depended upon a correct knowledge of these parts; but we have allowed them to grow up in total ignorance concerning the sacred sanctuary and function of human reproduction, upon which so much of health, happiness and success in life depends.

    Mistakes of the past.—In the past all faithful parents have loved their children as much as we have loved our children. They were as much interested in safeguarding the virtue of their children as are the parents of to-day. They endeavored to train their children in harmony with their ideals of right. Our parents, in their childhood, got the idea that all language and information concerning sex was essentially impure. All their information was received from vicious, ignorant sources. In matured life, they came to see that all the words and language they had heard pertaining to sex and all the mental and moral impressions they had received, had done them great harm. Their experience led them unwisely to conclude that all information of this kind is injurious to a child. They failed to see the difference between receiving only half-truths, expressed in vulgar words and phrases, taught by the vicious and ignorant; and in receiving the pure truth, in chaste language from the lips of a wise teacher, a noble father or a pure mother. A nugget of gold may be pure gold, whether found in a mud hole, a slop bucket, a tar bucket, or a clear stream of water. But, if you come in contact with the surroundings of the gold, your remaining clean, becoming cleaner, or becoming soiled, will depend on the place where you find the gold. The effects, good or bad, of sex knowledge, upon a child are largely determined by where and how he gets his information. If he gets this information from a careful and wise teacher no harm can come from it. If he gets the information from the misinformed and the impure, only harm will follow.

    To teach sex truths, two qualifications necessary.—You would not think of having your child taught mathematics by one, who, himself, was never properly taught, or who knew only half-truths about mathematics. You might not demand of him a moral qualification, if he possessed the intellectual equipment. But, in the teaching of sex, a moral qualification is even more necessary than the intellectual. But few adults are prepared to tell the story of life to a child, and fewer still are prepared to give additional instruction as the child grows older. For one to do this work successfully two qualifications are absolutely necessary. (1) Parents and teachers must have a moral qualification. They must regard the organs of sex and their functions as pure and sacred. If they have the taint of lasciviousness in their thoughts of the creative function, it would be a dangerous experiment for them to attempt to teach their children about the origin of life, or to give other instruction to those more advanced in years. The misinformation and false education they received in childhood and the consequent mock modesty, are the greatest difficulties in the way of their performing this sacred duty to their children. For this reason the adult classes are as much in need of correct instruction in sex as are the children. (2) Parents and teachers must have a mental qualification. One-fifth of the names referring to the organs of sex, their functions and their abuse, that adults are forced to use when they try to express their thoughts about sex, could not be found in the dictionary, and, one-half of those that could be found in the dictionary would not refer in their meaning, even remotely, to the sexual system. They picked up these words in childhood from ignorant schoolmates and companions whose minds were tainted with debasing thoughts of sex. The use of these vulgar words, in the presence of a boy who has heard them before, suggests to his mind that which is lascivious. Those who would teach these things, to the young or old, should be able to command a chaste, clean, plain, language.

    How a father failed.—During one of my courses of lectures, a cultured lawyer invited me to his office for an interview. He reproduced, in language and gesture as best he could, a speech he had made to his twelve-year old boy warning him of the dangers of the secret sin. I saw the lawyer was deeply interested in his boy. He loved him and was deeply concerned about his future. The language he used was the same he had learned when a boy and the same his boy had evidently heard on the playground. I question whether the father’s advice did his son much good. Here was a case where good service was neutralized by suggestive language.

    How a teacher failed.—A few months ago I lectured in a city where immorality was appalling. The superintendent of schools called into the chapel about six hundred boys, from ten to eighteen, and attempted to lecture them on social purity. He soon became embarrassed, used some street terms, excited lascivious thoughts, looks, smiles and laughter among the boys and utterly failed in his efforts. If this lawyer and teacher failed with the advantages and solicitude they must have had, would not the great mass of parents, teachers and ministers fail for the same reasons.

    Parents not wholly responsible.—A few editors, doctors and reformers have censured parents severely for not teaching their children the truth on these subjects. They should remember that ten years ago a very few parents had read a sane book or listened to an intelligent lecture on these subjects. Their only information had been gained from the playground and street on the sly. Courses of lectures, adapted to age and sex, should be given in every community. Ministers, teachers, physicians, merchants, parents, young and old, educated and uneducated, all should hear them. A few standard books on sex-hygiene and social purity should be put in every home. Jesus said, “Ye shall know the truth and the truth shall make you free.” More people are in physical, mental and moral slavery because of ignorance concerning the laws of sex, than all other causes combined. It follows that those who have learned the truth should impart it to those who have it not.

    How children have been treated in the past.—We have seen how parents have been led in the past to conclude that all information as to the origin of life is injurious to a child. For a child to inquire, “Where was I before I was born? How did I get into this world?” was a sure sign of his depravity. As a result of these traditionary ideas some parents have slapped a child for asking about his origin. Still, others have scolded and ordered the child from the room, commanding him never to ask such ugly questions again. What must be the feelings of a child treated in such an unappreciative and heartless way! Such treatment has never satisfied the inquiring mind of any child. Under such treatment a child will go off alone, pained and puzzled to know what was wrong in that simple, natural, honest question. In most cases the child’s question has been evaded by some one of a hundred falsehoods about “swamps,” “sinkholes,” “hollow logs and stumps,” “bird nests,” “storks,” “old women,” “doctor’s satchel,” and “under a cabbage head.” When only a small boy, I was called from my bed early one spring morning to see a beautiful colt the mare had found. For awhile I looked at the colt with admiration and wonder. Then I very naturally inquired, “Where did the mare find her colt?” I was told that she found it in a nearby brush pile. For the next six months no brush pile escaped my eager eyes.

    An example.—On my second lecture trip through Canada, a father told me how he answered his little girl’s question, “Papa, how did I get into this world?” His answer was as follows: “Daughter, God dropped you out of heaven one day while it was raining. Papa saw you falling from a cloud and ran out and caught you in his arms and brought you into the house.” That father was boasting of his tact and wisdom.

    Another example.—A mother in the South, in reply to a similar question asked by her five-year-old boy, said: “Son, God sent you into this town on the Cotton Belt train, about three o’clock one afternoon. The doctor was at the depot and saw you. He knew that we wanted a little boy, so he put you in his satchel and brought you to mamma.” When this mother related this to me, her boy was nine years old and had not asked her another word about his origin. At the close of my lecture, with tears in her eyes, she said: “Professor, do you suppose that my little boy has been hearing vulgar stories and is keeping his information a secret from mamma?” “Yes, nine times out of ten, if you have a bright boy,” was my reply. Upon investigation she found that her boy had been hearing vulgar talk for about three years. How long do you suppose it will take that boy to eradicate from his mind and heart the evil effects of such training? It is not a question whether your child and mine shall get this information or not. That question is settled. The child will get the information. The questions for us to settle are: When shall this information be given? Who shall give it? What shall be given? How shall it be given?

    Results of the old method.—I shall not call in question the love, sincerity and honesty of these parents. In most cases they were sincere and did the best they knew how. I am concerned about the results of this time-honored method. Did the old method of deception, misleading and false replies ever satisfy the inquiring mind of a child? Did the old method ever make a child wiser? Did it ever lead a child to regard human reproduction as delicate, sacred and pure? Did it ever lead a child to greater love and faith in its parents? Only negative answers can be given to all these questions.

    How the child finds out.—As a rule, it is not long after a child becomes interested in his origin until some older child, a playmate or servant will say, “I know something that you do not know. You would like to know it. It is how little children come into this world. I will tell you all about it, if you will not tell your mamma and papa about it.” I do not care how good the child may be, how well trained, or how obedient: such is the intense interest of a child in the mystery of his life that he will agree to keep the story a secret. Now the child listens eagerly to the half-truths, couched in impure language and gets a perverted vision of the origin of life.

    What are some of the results?—Five very sad misfortunes have come to the child. (1) The child has learned that his parents evaded his question; in most cases, he discovers the answer to have been a falsehood. (2) To the extent that the child comprehends the falsehood, does he lose confidence in his parents. (3) He has learned to keep these vital matters a secret from his parents. (4) The child cannot think of his parents’ relation to the initial of his life, except in terms of vulgarity. Early images do not easily leave the mind of a child. Ugly words, impure pictures, obscene language, with all their vile suggestiveness, ofttimes remain through life. (5) He regards the organs of sex and their functions as vile and sinful. God never planned that any human being should entertain any such degrading and demoralizing views of the divinely created organs and function of human reproduction. It is impossible to estimate the evil effects of this false training. Yet, there are many people, often very religious, who estimate their modesty, refinement and culture by the degree of conscious shame they have when questions of sex are referred to. Just to the extent that we fail to see that God is the author of sex, that sex is sacred and pure, our glory and not our shame, has a false training degraded us.

    Boys lose confidence in their parents.—You ask, does a child lose confidence in his parents when he has discovered that they have told him a falsehood about his origin? Certainly he does. In the past three years not fewer than seven hundred and fifty young men from eighteen to thirty-five have written me for advice in regard to their youthful indiscretions. One question I have invariably asked those young men, “Did your father ever warn you of your sexual dangers?” Only two have replied in the affirmative. Those young men were once as innocent and pure as your little boy. They first went to their parents for information about these delicate matters. They were treated as I have described. They received their information from sources and in a way that led to sexual abuse.

    Girls lose confidence in mother.—While on a seven thousand-mile lecture trip, in company with twenty other lecturers, conducting purity conventions in many of the large cities in the United States and Canada, after the evening sessions were over, in company with one or two detectives and other parties of our crowd, we visited the “red light” districts and saw several thousand erring girls from twelve to twenty years old. Those girls were once as innocent, pure and sweet as yours or mine. They first went to their mothers and asked about the origin of their lives. Those were golden opportunities for safeguarding the virtue of those girls. More easily than at any other time in life could those girls have been impressed with the sacredness of sex. At no other time in life is it so true that “an ounce of prevention is worth a pound of cure.” Much more of Christian effort is put forth to rescue the fallen than to prevent the youths from falling. More churches are open to lectures on rescue work than on preventive work. More money can be raised for rescue work than can be raised to prevent youths from falling.

    Boys and girls want to know the real truth.—One morning a number of high school boys requested that I give them a lecture more advanced than the one I had given. While passing through the hall, at the close of this special lecture to the young men, I was approached by the lady principal with the request from the high school girls for a special lecture. She told me that fourteen had made the request and that several added: “We wish that Prof. Shannon was a lady lecturer. There are so many things we would like to know, but would hesitate to ask a gentleman lecturer.” Then the lady teacher added, “I said, girls, why do you not ask your mamma for such information?” With hands uplifted, a look of surprise, a gasp for breath, those girls replied: “I would not think of asking mamma such questions.” Why not? Let me tell you why. When they were little innocent girls they went to their mothers with their first questions of sex. They were treated as already indicated. Their inquiring minds and unsatisfied interests in the mysteries of life led them to go elsewhere for this information. It was at this point in their lives that a chasm started to form between themselves and their mothers. There is not one boy in twenty-five who will go voluntarily to his father for information or advice about his sex-nature. The same statement is almost as true about girls and their mothers.

    1,000,000 children adrift.—1,500,000 children are born annually in this Christian nation. One-third of this number die before they are ten years old. Annually one million children inquire, “How did I get into this world?” Not more than one in twenty receive a kind, truthful and intelligent reply. More than nine-tenths are treated in one of the following ways: (1) Told some one of fifty falsehoods. (2) A slap, with orders to clear out. (3) Some form of ridicule, such as “shame on you.” “Don’t let me hear you ask such an ugly question again.” “I am disgusted with you.” That settles it. The golden cords of confidence and influence are severed. Never again will those children go to their parents for information pertaining to sex. Elsewhere, they will find friends who will gladly give them the information. These children, one million strong, are now adrift on the storm-tossed sea of passion, without chart or compass; drifting, drifting, drifting for years toward ports, to them, unknown.
    Danger!

    Danger!

     

    The virtue of a quarter of a million of boys sacrificed.—Time passes. The boys are now sixteen to twenty-five. They have boon and base companions. Their imaginations are at fever heat with morbid interest and their ambitions are aflame with daring. One quarter of a million young men annually sacrifice the priceless gem of manhood’s virtue just here. Now, they are nearing the fearful rapids of vice where most of this number annually become diseased and many perish as sex-maniacs in the awful maelstrom of lust.

    60,000 girls annually.—With the passing of time, the girls from twelve to seventeen, many without the safeguard of knowledge, are associating freely, gayly with their boon male companions, exposed to all the temptations and dangers incident to young womanhood. Many, many thousand young women annually sacrifice the priceless gem of womanhood’s virtue just here. Owing to the double standard of morals, sixty thousand of this number are forced against their own wills into the public maelstroms of immorality.

    Who is to blame.—Thousands of poor prudish parents line the shores, and, with broken, bleeding hearts are crying out in anguish, “My God, my God, why has this awful blow fallen on us?” The poor, ignorant, diseased, exiled, passion-ridden children, in many cases beyond the reach of the home, society and the church, exclaim, “Oh, if I had only been told of these dangers!”

    All along the almost socially inaccessible rock-bound shores of this sea of human passion, the churches and philanthropists are building and maintaining rescue and foundling homes at an outlay of millions in money. They are not, and cannot, rescue one in twenty. The foundling homes are crowded to a dangerous, unsanitary overflowing with illegitimate children, whose mothers are out in the rapids of vice, or entirely lost in the maelstrom of immorality. Too long have the churches been satisfied with snatching, here and there, a piece of human wreckage from the waves of vice, instead of erecting a lighthouse system of properly warning and informing the childhood of the land.

    The new way.—We have seen the results of the old way of dealing with children in matters of sex. Is there a new and better way? We shall see. “Ye shall know the truth and the truth shall make you free.” The new and better way is to tell the truth to the child.

    How shall a child be told.—One day when our little girls were four and six, wife said, “Husband, I am in trouble about our little girls. They are asking where they were before they were born and how they got into this world. How am I to answer them?” “Tell them the truth,” was my reply. “But, they are not old enough to be told the whole truth,” was her reply. We talked over the problem and arrived at the following solution of the problem: Since I had been a teacher of biology for years, and it was presumed that I was familiar with the stories of life among the plants and animals, it was agreed that I should at once tell them a nice little story about God’s beautiful plan of bringing all the little plants into the world. Six months later I was to tell them the story of life about the oysters and fish. Every six months to a year I was to tell them a more advanced story. As they were girls, wife reserved the right to tell them the last story to be told when they were nine and ten.

    These stories were all told in the order given. Our girls are now twelve and fourteen. We have never had an occasion to regret that we have followed this natural method of instructing them. They seem to have no morbid curiosity about questions of sex. They look upon the facts as being natural, sacred and pure. Wife and I can approach them on these subjects without embarrassment to them or us.

    When should a child be told?—The average boy should be told all these stories by the time he is eight, not later than nine. The average girl should be told all these stories by the time she is nine, not later than ten. The developing mind of the average child and the social influences to which he is exposed, demand that he be safeguarded by the whole truth, this early in life. While the girl and boy develop alike until they are ten or eleven, the boy being exposed to vicious companions more than is his sister, he should be told the story of life earlier than she. At the age of seven, boys know more about these things than the girls do at ten and twelve. You had better tell the child the truth at six, than to have him told by the vicious at the age of seven. If a child could understand the story of life at three, and was properly trained afterward, this information could not do him one particle of harm. This statement is either absolutely true, or God is the author of a plan of human increase, the knowledge of which is essentially sinful. Personally, I decline to believe the latter.

    If the child has been informed by vicious playmates or servants and his mind has been tainted, the only sane and safe method is to tell him the full truth as quickly as possible, regardless of his age.

    If the child has been allowed to grow up to the age of nine or ten, ignorant of the story of life, I would tell him all the stories, beginning with the first story, telling them only a few days apart. Where parents are not prepared to do this, I would advise them to place a suitable book, presenting these stories in a clear, chaste and interesting way, in the hands of the child, saying, “Here is a very interesting little book telling you just what you will be interested in knowing and what I would like for you to understand.”

    The ideal way.—The ideal way would be to start with the child when he first inquires about his origin, telling him the first story about the plants. Promise to tell him other stories about the oysters, fish, insects, birds, animals and man as he grows older and can understand them. Where a child is naturally very inquisitive and insists on knowing more, I would not hold him off too long for the next story.

    How to introduce each new story.—I would introduce each new story by reviewing the story of the plants and flowers. There are at least three reasons for this. (1) You can go into all the details of reproduction in the flower without danger of awakening the sex consciousness of the child. (2) It saves going into the detail when you have come to the higher animals and man. The child’s mind usually comprehends more than we give it credit for. If he understands the details of reproduction in the flower, his innocent fancy will fill in the details when he hears the other stories. (3) If he has been so unfortunate as to fall in with bad company at any time and his mind has been tainted with their stories, there is no means you can use in ridding his mind of impurity, quite so effectively, as by telling him the story of life in the flower.

    Teaching these truths in the public schools.—The violation of the laws of sex is the chief cause of physical, mental and moral degeneracy. The degenerate classes are increasing at an appalling rate. Correct sex-instruction in childhood is the most important and effective step in the solution of this problem. There is a growing conviction among the students of sociology that sex-hygiene should be taught in the public schools. There are some teachers in all departments of school work, who, in morals at least, are not fitted for this delicate work. At present, an extremely few have the educational qualification for this delicate work. When teachers are required to take a course of training in these subjects, there will still be but few who are possessed of the natural talent for effectively and wisely presenting these subjects to children of the different grades.

    Already colleges and universities and even a few high schools have begun to teach sex hygiene in a limited scientific way. This work will first be introduced into the high school work and later, gradually be introduced into the lower grades. Definite instruction will not be given, for many years at least, and possibly never, to boys under eight, and girls under ten or eleven. If this statement is true, it will be seen that the schools will have left the first and most important part of this training to be done in the home. The teaching of morals in the public school can never be substituted for the teaching of morals in the home. The present great awakening on these subjects will shortly result in three-fourths of the parents teaching these truths in their homes. Since one-fourth of the children do not get any moral instruction in the home and they do not go to Sunday school or church, the public school is the only place where they can be given moral training for citizenship.

    How this can be done.—In my opinion, the safest and most effective method of dealing with these questions in the public schools, for the present at least, would be for the school boards in two or three counties to select and employ a gentleman and a lady lecturer, having natural gifts, moral and educational qualifications, whose duty it shall be to lecture to all the boys and girls; the male lecturer, lecturing to the boys and the lady lecturer, lecturing to the girls. All other teachers should be required to be sufficiently versed in these matters to enable them to solve any individual problems that may arise in their social relations to the pupils in school.

    Extract from EBook of Self Knowledge and Guide to Sex Instruction, by T. W. Shannon

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