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PATTI SOLIS DOYLE
PaHi to
1
follow up
Gen Kleen -
Are you walling
on this staff now?
will you call me ?
Patte
THE WHITE HOUSE
Hillary-
This is a project
which COURS to grips
with learning disabled
and the sounds of
words to proudke
Creative imagination!
It, provides another
outlet Per those children
who find education
a Pustracting experience.
- Would it be appropriate
Por me to follow up
with Card Rasco, if
YOU would be interested
in RFB + D?
-
Recording for the Blind & Dyslexic of Metropolitan Washington
Board of Directors
Chairman
Mrs. B. Bernei Burgunder, Jr.
First Vice Chairman
March 17, 1997
Mary H. Curzan
Second Vice Chairman
Lorraine Creer Bibby
Secretary
Mrs. Hillary Rodham Clinton
Mrs. Bennett Boskey
The White House
Treasurer
Office of the First Lady
Mrs. Thomas Q. McNaughton
1600 Pennsylvania Avenue, N.W.
Washington, D.C. 20500
René 1. Augustine
Virginia M. Ayres
John T. Beaty. Ir.
Dear Mrs. Clinton,
Mrs. Alison B. Birney
Dr. Helen Walker Davison
Evelyn N. Duckenfield
We at Recording for the Blind & Dyslexic agree with you and
Mrs. Charlotte K. Ehrenhaft
President Clinton that every child should be reading well by the third grade,
Dr. Frederick C. Leavitt
Mrs. Charlotte Lichtenberg
however we know that there will always be many children who will only be
Mrs. Frederick Meyers
able to achieve this by listening to their books. RFB&D is eager to be
Robert E. Murphy
James M. Newmyer
included in your innovative project to upgrade the reading programs in D.C.
Mrs. Carl F. Norden
public schools. By including RFB&D in your program, you will help young
Mrs. Malcolm Price
Beth D. Ross
people who are blind or physically or learning disabled gain access to the
Roger 1. Stroh
printed word.
Mary W. Umbarger
Our agency is one of 22 throughout the country and is in upper N.W.
Mrs. Paul C. Warnke
James M. Wilson, Ir.
near the MD line. We are chartered by our National Board in Princeton, NJ to
work with children in the District, suburban Maryland, and northern Virginia.
Advisory Committee
Chairman
At our master tape library in Princeton we have 80,000 books already
Mrs. Andrew E. Taylor
transcribed and ready to mail out to students.
Mrs. David C. Acheson
Mrs. William H. Ayres
Often, learning disabled children who were considered backward or
Dr. Sue Bailey
Mrs. Robert G. Cleveland
slow have shown remarkable progress as they listen to the tapes while
Mrs. Daniel F. Collins
studying their textbooks. Not only do their reading skills and comprehension
Mrs. Robert A. Fearey
improve, but their grasp of mathematics, social studies and other subjects
Mrs. Carlos Gibson
Mrs. Harold Krents
also shows rapid progress. Equally important, their self-esteem rises along
Mary Louise McGee
with their grades.
Mrs. Howard Roman
Mrs. H. William Tanaka
Mrs. Lewis H. Ulman
In D.C. our core ambition is to be useful to children , with learning
Mrs. Robert M. Waggaman
disabilities in every public school. Our outreach committee is now working
Executive Director
with 25 schools and social work agencies in the city. We hope your inclusion
Michele R. Herrington
of RFB&D in your much-needed push to improve public education will benefit
more of the children we need to reach.
5225 Wisconsin Avenue, NW
Suite 312
Washington, DC 20015
202-244-8990
FAX 202-244-1346
[email protected]
We hope you will agree that RFB&D's work to improve the academic skills of
learning disabled children falls within your guidelines of addressing the needs of those
with severe economic and social problems, and helping them to emerge from low-
income, dysfunctional situations. This is precisely what happens in a remarkable
number of cases when children with learning disabilities use our tapes and see their
grades and achievements soar.
Thank you for considering this request, and for letting us know how we may help
your effort by calling or writing to Kay Marshall, Project Outreach Director, at our above
address.
Yours most sincerely,
amelie Burgunder
Amelie Burgunder
Board Chairman RFB&D
Recording for the Blind and Dyslexic of Metropolitan Washington
Annual Report
Year Ending June 30, 1996
Reaching Out To Our Community
"After a few days of listening to their social studies texts, three of
inquiries from those areas, and our staff
and volunteers now regularly present
my fifth grade students began to participate in class discussions
RFB&D's services to parent, teacher
of reading assignments for the first time. It was clear that the
and social agency meetings in these
communities as well.
experience of being able to understand the textbook has created a
We are indeed pleased with the
new enthusiasm and self-confidence for these children."
- District of Columbia Elementary School Teacher
This teacher's experience symbolizes
from kindergarten stories to third-grade
the tremendous success of Project
spelling to master's level computer
Outreach in telling local public school
science. Last year in the District of
students about RFB&D. As word has
Columbia, students in 18 public schools
spread about our taped textbooks, the
in all four quadrants of the city were
phones have been ringing constantly
using our service - a long way from the
with calls from inquiring parents and
situation just two years ago, when
teachers. In fact, more than 500
essentially no D.C. public school
students in the
area used
RFB&D for the
first time last
year.
What does
RFB&D do for
students? In the
words of a
borrower who
used to rely on
Hyde Elementary students learn by listening to their
her parents to
textbooks.
read her books to
substantial volume of new students who
her, "For the first
are using our services and we look
time in my life, I
forward to serving even more students in
could read on my
the years to come. Finally, it is becom-
own. My comprehension of material
students with learning disabilities were
ing better known that learning and visual
increased dramatically and I could read
taking advantage of our recorded
disabilities do not mean that a child
with greater speed. Today I no longer
textbooks.
cannot learn. Our students have the
avoid reading."
An interesting side-effect of Project
intelligence and capability to succeed,
Thanks to our donors and volunteers,
Outreach is that information about
but they require a different way of
students with visual, perceptual or other
RFB&D is also spreading to schools in
taking in information. As a visitor
physical disabilities learned by listening
Maryland and Northern Virginia. As a
recently remarked, "What the eyes can't
to their schoolbooks in subjects ranging
result, we are receiving a stream of
see, the ears can hear."
RFB&D NEWS
Recording for the Blind and Dyslexic of Metropolitan Washington
Taped textbooks for students with learning or visual disabilities
Volume 1, No. 2 Fall 1996
Reading Disabilities
How Do I Register?
are a Fact of Life!
Call RFB&D and request an
NEWS FLASH
application form. We will send it
Visual and learning
Institutional
to you asap!
disabilities, so prevalent in
Complete the application and
Membership now
available
society today, often prevent
have the certification signed by a
To make our service
students from achieving
professional --a teacher, a school
accessible to more students,
and succeeding in school.
counselor, your family doctor, or
RFB&D is now offering
a psychologist.
Many students with
Institutional Memberships.
Send in the application along
learning disabilities find
For schools in the District of
with your registration fee and
they are unable to keep up
Columbia which qualify, fees
book list.
may be waived for the first
with their reading
You can request book order
year. We hope this will
assignments. Often falling
forms to help you keep track of
encourage schools to
behind, they eventually lose
the information you need when
participate in a program that
interest in their school
you order books.
can benefit those students
work and confidence in
Special tape players are needed
unable to afford an individual
to play RFB&D tapes. Call Kay
their academic abilities.
membership. Following is a
or Joyce for more information on
list of schools currently
Listening to taped
how to purchase this equipment.
registered under our
textbooks will not solve all
Then What Happens?
Institutional Membership
reading problems.
It takes about two weeks to
Program and using RFB&D
However, taped textbooks
process your application.
taped textbooks:
will provide some students
Books already taped will be
with a tool that will make
shipped to you from our national
Adams Elem. School
office in Princeton, NJ.
Burreville Elem. School
reading easier and perhaps
We'll be in touch about what
Tyler Vision Program
more enjoyable. It may
books we do not have. We may be
Tubman Elem. School
also help them keep up
able to record books not in the
H.D. Cooke Elem. School
with their class work and
library, decisions are made on a
Janney Elem. School
gain self confidence.
case by case basis.
Hyde Elem. School
Is it easy to take
Good Things to Know:
advantage of RFB&D's
RFB&D has a sliding scale
Contact Joyce Zink or
taped textbooks service?
application fee and payment plan
Kay Marshall at the number
below for more information.
You bet! Here are the
for tape players.
When you order taped books,
steps you need to follow to
we need the title, author, edition
get your students
To order Books or request an
or copyright date, and publisher.
application :
registered:
Call us at: 202-244-8990
Fax us at: 202-244-1346
email us at: [email protected]
Seeing, hearing and feeling words
At a school in London,
word, they also learn to spell
RFB&D has thousands of taped
England, teachers are adopting
the word. Since reading,
schoolbooks for students of all ages!
a traditional method of teaching
Houghton Mifflin Series:
Dinosauring
reading. According to a recent
Just Listen
article in The London Times, the
Did You Know????
Lyle Lyle Crocodile
method is based on a multi-
Students taking the SATS can
Fast as the Wind
request that they be allowed to
sensory system devised to help
Beyond the Reef
listen to, rather than read, the
Silly Things Happen
dyslexic children learn to read.
questions. Call the SAT Special
Students using this approach are
Services at: (609)771-7137
General Reading:
reading six months to a year
The Indian in the Cupboard
above grade level.
The Great Gatsby
Dr. B. Hornsby, a speech
writing and spelling are inter-
Frankenstein
Lord of the Flies
therapist and psychologist,
related, this multi-sensory
The Cay
devised a system based on
approach will hopefully allow
My Brother Sam is Dead
phonics which is designed to
the student to master written
follow closely the patterns of
English also.
GED & SAT Study Guides
speech development.
The Hornsby School has
This newsletter is made possible by the
For example, children learn
proven that this approach
generosity of these foundations who support
the sound of each letter before
works. The school has also
RFB&D's Project Outreach:
Lois & Richard England Foundation
linking the letters to build up
shown that students who are
Fannie Mae Foundation
words. And, since this is a multi
dyslexic can be successfully
John Edward Fowler Foundation
Marpat Foundation
sensory approach involving the
taught along side their peers in
Gilbert & Jaylee Mead Foundation
aural, visual and tactile senses,
the regular classroom using this
Eugene & Agnes E. Meyer Foundation
Mobil Foundation
students hear, see and feel the
method, thus avoiding the need
Public Welfare Foundation
words.
for separation.
Alexander & Margaret Stewart Trust
After hearing the teacher
pronounce the letters C A T and
then the word CAT, the
SCHOLARSHIPS AVAILABLE
students then write the letters,
The Marion Huber "Learning Through Listening" Award for High School Seniors with
Learning Disabilities.
read what they have written and
Mary P. Oenslager Scholastic Achievement Award for College Seniors who are legally
then close their eyes and trace
blind.
the word in the air to memorize
Call 1-800-221-4792 or 202-244-8990. Deadline to submit application is 02/01/97
it. As the students write the
Recording for the Blind & Dyslexic
of Metropolitan Washington
5225 Wisconsin Avenue, NW, Suite 312
Washington, DC 20015
Look inside for information
to help students who are
struggling with reading.
MESSAGE CONFIRMATION
JUL-30-97 11:40
FAX NUMBER :
NAME
:
FAX NUMBER
:
94010596
PAGE
:
05
ELAPSED TIME
:
02'04"
MODE
:
G3 STD
RESULTS
: O.K
Recording for the Blind and Dyslexic of Metropolitan Washington
A letter from the chairman and
the executive director.
Dear Friends,
Recording for the Blind and
We're Number One!!!
Dyslexic of Metropolitan
Washington serves people
This year, the Washington chapter of RFB&D out-produced all of the other
who cannot read standard
studios in the U.S. To say that we are proud of our volunteers who made
print because of visual,
this possible is an understatement.
perceptual or other
In 1995/96, production increased 12.6% over the record we set last year and
physical disabilities.
was more than double our output only four years ago. To make this pos-
sible, our wonderful volunteers donated 22,858 hours of their time, repre-
RFB&D/Washington's 334
senting a value of nearly $600,000.
volunteers are part of a
What pleases us most, however, is the continual stream of complimentary
dedicated corps donating time
phone calls and letters we receive from students who use our recorded
at 22 chapters across the
books and from their parents, telling us about the change that RFB&D has
country. Together RFB&D's
made in their grades and in their lives.
volunteers have built the
Financial Results
largest library of taped
educational books in the
The expanded production required RFB&D to increase total expenditures
world, housed in our national
this year by 20%. Fortunately, our income also increased, thanks to the
office in Princeton, New
generous support we received from foundations, corporations and individu-
als. These increases in funding reflect a major effort on the part of our
Jersey. Nearly 1,400 people
volunteers, Board members and staff, as well as a wonderful response from
from grade schoolers to
our donors.
graduate students in the
Our projected budget for 1996/97 includes an increase in total spending of
Washington area borrowed
10%. We will continue our all-out fundraising efforts and we hope to count
taped books last year.
on your encouragement and assistance.
A Look Ahead
RFB&D/Washington serves
students in Northern Vir-
To keep pace with the huge increase in demand for RFB&D's services, we
ginia, Suburban Maryland,
are now installing two new recording booths, bringing the total to nine. In
and the District of Columbia.
addition, we plan to begin production of textbooks in a format known as E-
Through our Project Out-
text. E-text allows students to access books using a computer and adaptive
equipment such as large print, a braille screen or a voice synthesizer.
reach and borrower services
Before this program begins we must recruit and train volunteers to produce
programs, we help students,
these computerized books and purchase the necessary equipment.
parents and teachers gain
access to and use our
On behalf of our borrowers, we send great thanks to each and every one of
RFB&D's volunteers and donors for making this critical service available.
recorded books.
Sincerely,
202-244-8990
Fax: 244-1346
[email protected]
Michele.Harrington
Amelie
Michele Herrington
Chairman
Executive Director
2
Recording for the Blind and Dyslexic of Metropolitan Washington
Foundation and Corporate Support
Support from foundations, corporations and organizations in
books they need for class. We are most grateful to these donors
the Washington community is a major reason why RFB&D has
for helping RFB&D to move forward. We are also grateful to
been able to serve more students and to record more books year
the many RFB&D volunteers who encouraged their employers
after year. With their help, we built a comprehensive program
to donate, suggested places to submit requests and helped to
to help students gain access to our service and to record the
solicit the grants themselves.
Gifts of $15,000 or more
Fannie Mae Foundation
Lockheed Martin Corporation
Public Welfare Foundation
Eugene & Agnes E. Meyer Foundation
Gifts of $10,000 to $14,999
The Aid Association for the Blind
The Marpart Foundation
of the District of Columbia
Mobil Foundation
Eugene B. Casey Foundation
The Ruth and Vernon Taylor Foundation
The James M. Johnston Trust for Charitable
and Educational Purposes
Gifts of $5,000 to $9,999
Appleby Foundation
Kemper Open
The Clark Charitable Foundation
Occidental Petroleum Foundation
The Richard Eaton Foundation
Alexander & Margaret Stewart Trust
John Edward Fowler Foundation
Gifts of $2,500 to $4,999
Clark-Winchcole Foundation
Lois & Richard England Foundation
Dimick Foundation
Walter Henry Freygang Foundation
The Max & Victoria Dreyfus Foundation
Gilbert and Jaylee Mead Family Foundation
National Home Library Foundation
Gifts to $2,499
American Medical Association
Lucas-Spindletop Foundation
Atlantic Research Corporation
Mars Foundation
Bethesda Lions Club
Masonic Lodge: William R. Singleton-
Bethesda United Methodist Church Men's Club
Hope-Lebanon #7
Boeing Employees Good Neighbor Fund
Mid-Atlantic Medical Services (MAMSI)
The Charles Delmar Foundation
Nordstrom
Ferris, Baker Watts Foundation
The Palisades Community Church
The Walter Henry Freygang Foundation
Queenstown Harbor Golf Links:
GEICO Philanthropic Foundation
Kathryn Fox Samway Outback Steakhouse
Giant Food Foundation
Memorial Golf Classic
Paul & Annetta Himmelfarb Foundation
Luther I. Replogle Foundation
IBM Corporation
Rotary Foundation of Washington, D.C.
Junior League of Washington
Voorthuis Opticians
The S. Irwin Kamin Foundation
WSA St. Alban's
Legal & General America
The World Bank
Matching Gifts
We thank the following corporations which matched donations made by their employees to RFB&D.
Citicorp Foundation
William H. Donner Foundation
Connie Lee
Fannie Mae Foundation
3
MESSAGE CONFIRMATION
JUL-30-97 11:51
FAX NUMBER :
NAME
:
FAX NUMBER
:
94010596
PAGE
:
03
ELAPSED TIME
:
01'18"
MODE
:
G3 STD
RESULTS
: O.K
Seeing, hearing and feeling words
At a school in London,
word, they also learn to spell
RFB&D has thousands of taped
England, teachers are adopting
the word. Since reading,
schoolbooks for students of all ages!
a traditional method of teaching
Houghton Mifflin Series:
Dinosauring
reading. According to a recent
Just Listen
article in The London Times, the
Did You Know????
Lyle Lyle Crocodile
method is based on a multi-
Students taking the SATS can
Fast as the Wind
request that they be allowed to
sensory system devised to help
Beyond the Reef
listen to, rather than read, the
Silly Things Happen
dyslexic children learn to read.
questions. Call the SAT Special
Students using this approach are
Services at: (609)771-7137
General Reading:
reading six months to a year
The Indian in the Cupboard
above grade level.
The Great Gatsby
Dr. B. Hornsby, a speech
writing and spelling are inter-
Frankenstein
Lord of the Flies
therapist and psychologist,
related, this multi-sensory
The Cay
devised a system based on
approach will hopefully allow
My Brother Sam is Dead
phonics which is designed to
the student to master written
follow closely the patterns of
English also.
GED & SAT Study Guides
speech development.
The Hornsby School has
This newsletter is made possible by the
For example, children learn
proven that this approach
generosity of these foundations who support
the sound of each letter before
works. The school has also
RFB&D's Project Outreach:
shown that students who are
Lois & Richard England Foundation
linking the letters to build up
Fannie Mae Foundation
words. And, since this is a multi
dyslexic can be successfully
John Edward Fowler Foundation
Marpat Foundation
sensory approach involving the
taught along side their peers in
Gilbert & Jaylee Mead Foundation
aural, visual and tactile senses,
the regular classroom using this
Eugene & Agnes E. Meyer Foundation
Mobil Foundation
students hear, see and feel the
method, thus avoiding the need
Public Welfare Foundation
words.
for separation.
Alexander & Margaret Stewart Trust
After hearing the teacher
pronounce the letters C A T and
then the word CAT, the
SCHOLARSHIPS AVAILABLE
students then write the letters,
The Marion Huber "Learning Through Listening" Award for High School Seniors with
Learning Disabilities.
read what they have written and
Mary P. Oenslager Scholastic Achievement Award for College Seniors who are legally
then close their eyes and trace
blind.
the word in the air to memorize
Call 1-800-221-4792 or 202-244-8990. Deadline to submit application is 02/01/97
it. As the students write the
Recording for the Blind & Dyslexic
of Metropolitan Washington
5225 Wisconsin Avenue, NW, Suite 312
Washington, DC 20015
Look inside for information
to help students who are
struggling with reading.
Clinton Presidential Records
Digital Records Marker
This is not a presidential record. This is used as an administrative
marker by the William J. Clinton Presidential Library Staff.
This marker identifies the place of a publication.
Publications have not been scanned in their entirety for the purpose
of digitization. To see the full publication please search online or
visit the Clinton Presidential Library's Research Room.
Recording for the Blind and Dyslexic of Metropolitan Washington
Annual Report
Year Ending June 30, 1996
Reaching Out To Our Community
"After a few days of listening to their social studies texts, three of
inquiries from those areas, and our staff
and volunteers now regularly present
my fifth grade students began to participate in class discussions
RFB&D's services to parent, teacher
of reading assignments for the first time. It was clear that the
and social agency meetings in these
communities as well.
experience of being able to understand the textbook has created a
We are indeed pleased with the
new enthusiasm and self-confidence for these children."
- District of Columbia Elementary School Teacher
This teacher's experience symbolizes
from kindergarten stories to third-grade
the tremendous success of Project
spelling to master's level computer
Outreach in telling local public school
science. Last year in the District of
students about RFB&D. As word has
Columbia, students in 18 public schools
spread about our taped textbooks, the
in all four quadrants of the city were
phones have been ringing constantly
using our service - a long way from the
with calls from inquiring parents and
situation just two years ago, when
teachers. In fact, more than 500
essentially no D.C. public school
students in the
area used
RFB&D for the
first time last
year.
What does
RFB&D do for
students? In the
words of a
borrower who
used to rely on
Hyde Elementary students learn by listening to their
her parents to
textbooks.
read her books to
substantial volume of new students who
her, "For the first
are using our services and we look
time in my life, I
forward to serving even more students in
could read on my
the years to come. Finally, it is becom-
own. My comprehension of material
students with learning disabilities were
ing better known that learning and visual
increased dramatically and I could read
taking advantage of our recorded
disabilities do not mean that a child
with greater speed. Today I no longer
textbooks.
cannot learn. Our students have the
avoid reading."
An interesting side-effect of Project
intelligence and capability to succeed,
Thanks to our donors and volunteers,
Outreach is that information about
but they require a different way of
students with visual, perceptual or other
RFB&D is also spreading to schools in
taking in information. As a visitor
physical disabilities learned by listening
Maryland and Northern Virginia. As a
recently remarked, "What the eyes can't
to their schoolbooks in subjects ranging
result, we are receiving a stream of
see, the ears can hear."
Stephanie - -
BRIGHT BEGINNINGS, INC.
901 Rhode Island Avenue, NW
did recommend
Washington, DC 20001
That HRC duthis
April 28, 1997
not the lotus
VIA FAX (202) 456-2461 AND BY HAND
Stis Program a a good
The President
The White House
To: Patti Solis
1600 Pennsylvania Avenue, N.W.
Washington, DC 20500
am Stak
Dear Mr. President:
5/7/97
Bright Beginnings, a model public-private partnership day care center for homeless
preschool children in the District of Columbia, will open its new facility during May at
825 North Capitol Street, N.E. The new center will increase the number of preschoolers served,
from the current enrollment of twenty-six to fifty-two children, ages 2 1/2 to 5. We are writing
to invite you to dedicate the new center and to serve as our keynote speaker at an opening
celebration event. We would be thrilled to have your and/or the First Lady's personal
involvement.
Established in 1989 by the Junior League of Washington with a two-year, $200,000 grant
from the Department of Health and Human Services, Bright Beginnings, a nonprofit 501(c)(3),
received one of sixteen nationwide Homeless Demonstration grants awarded by Head Start in
1993. This past year Bright Beginnings, Inc. became a permanent Head Start grantee. Our move
to new space and doubling of program capacity is made possible through receipt of HUD's
Community Partnership funding. In addition, the program enjoys an increasing level of private
financial support from corporations, foundations and individuals.
Bright Beginnings' children and their families, along with its Board of Directors and the
Freddie Mac Foundation, corporate sponsor of the dedication event, would be delighted if you
could attend the opening dedication. Since our priority is to secure your participation and
accommodate your and the First Lady's schedule, we have selected a range of dates including
Tuesday or Wednesday, June 10 and 11, also Monday-Wednesday, June 16, 17 and 18. Please
advise us if an earlier or later date would better fit your schedule.
We plan a morning event, approximately 10-11 a.m., on the grounds of the center,
825 North Capitol Street, N.E. We envision a brief speaking program, followed by presentations
from the children, a tree planting ceremony and a reception inside the facility. Local and
interested national press will be invited. Other invited podium guests include: HHS Secretary
Donna Shalala, HUD Secretary Andrew Cuomo, Congresswoman Eleanor Holmes Norton,
Senator Chris Dodd, Representative Tom Davis and Steny Hoyer, Mayor Marion Barry, Head
250362
Start Director Helen Taylor, the Chairman of the Freddie Mac Foundation and others active in
the community.
The Bright Beginnings Board of Directors, dedicated staff and volunteers share your
commitment to improve the lives of Washington, D.C.'s vulnerable children and their families.
Our program not only provides socialization and a learning environment for these children, but
acts as the only safe haven for many of them. Given the current constraints of the welfare
program, the center allows their parents to pursue job training skills, complete their education,
secure adequate housing and eventually enter the workforce, knowing that their children are
properly cared for in a nurturing and stimulating environment.
Launched by volunteer spirit and vision, Bright Beginnings fills an acute need and
remains the only preschool program in the District of Columbia where homeless children and
their parents return each evening to shelters and transitional housing. We know you will be
impressed by the center and its children, and they would be thrilled by your visit.
Your consideration of our request is very much appreciated. I can be reached at (202)
457-6520, and would be happy to provide additional information on the center or the event.
Effective May 18, our new mailing address is 825 North Capitol Street, N.E., Washington, D.C.
20002. Please contact us at your earliest convenience so that we may plan accordingly. Thank
you.
Sincerely,
worthe kendrick kettmar
Martha Kendrick Kettmer
President
Bright Beginnings, Inc.
Board of Directors
cc:
Ann Stock
Carole Thompson Cole
250362
TO:
Melanne
FROM:
Jen J.K.
DATE:
5/29/97
RE:
Samuel Halperin Letter
I followed up with Gene on this letter, who had already received a copy directly
from the President. Gene and I will be holding a meeting next week to get a report on the
School to Work program. He is also following up "behind the scenes" to get a sense of
J.D. Hoye and the dynamics in the office.
I will keep you informed as I know more.
AMER CAN YOUTH POLICY FORL M
Tam
Appreciate
Samuel Halperin
to
of
Glenda Partee
Collints
of
Gene
smokending
11 April 1997
Co-Directors
Personil
Mrs. Hillary Clinton
The White House
1600 Pennsylvania Avenue, NW
Washington, DC 20500
Dear Hillary:
I write to share my views about the current status and future of the School-
to-Career movement. These observations are based on years of visiting programs
and practitioners coast-to-coast.
Despite the media-celebrated cooperation between Robert Reich and Dick
Riley, all is far from well within the working levels of the Executive Branch. The
National School to Work Office is starved for DoL and DoE resources to properly
execute its functions. The exceptionally able director, J.D. Hoye, is second-
guessed and hobbled from above in the exercise of her responsibilities. The feeling
of the STW Office staff -- and much of the field -- is that the Clinton
Administration's visionary initiative may well fall prey to being "just another
program," resented by many vocational educators and many in the Department of
Labor's employment and training arena as a "competitor" for scarce resources.
Since the legislation is to sunset in a few years, there is a real danger that, in most
school districts, the promise of School-to-Career will evaporate without a trace.
That is why the Administration's selection of a new Assistant Secretary of
Labor for Employment and Training is so critical to the future of the School-to-
Career movement. Unless the new appointee is thoroughly committed to the
success of this Administration initiative, even the scant progress to date may be
lost.
I hope that Paul Cole, Secretary-Treasurer of the New York State AFL-CIO
and a Vice President of the American Federation of Teachers, is considered for the
DoL assistant secretaryship. I have worked with Paul on the Jobs for the Future
"Youth Apprenticeship Initiative" and have come to see him as a thoroughly
dedicated educator, committed to school-to-career as a powerful lever to advance
comprehensive, high standards school reform. As an able teacher, Paul would
work to ease some of the antagonisms in the Department of Labor toward the
Department of Education's educators and educational programs. Well-acquainted
INSTITUTE FOR EDUCATIONAL LEADERSHIP
1001 Connecticut Avenue, N.W., Suite 719, Washington, D.C. 20036-5541
Tel: (202) 775-9731
Fax: (202) 775-9733
with European workforce preparation systems and the work of the National Center
for Education and the Economy, Paul would insist upon rigorous quality not only in
school-to-career grants but in all the manifold tasks of the Employment and Training
Administration. I believe, in sum, that he would be a great asset to Secretary
Herman and to the Clinton Administration.
If your schedule ever permits, I urge you to have a conversation with
Miss J.D. Hoye (401-6209, who does not know that 1 am writing). You will learn
a great deal from one of the stars of the Administration and get an unequaled view
of what is happening -- or not happening -- to school reform in the spirit of the
School-to-Work Opportunities Act.
Sincerely,
Sam
Samuel Halperin
Jennifer L. Klein
05/28/97 05:37:41 PM
Record Type:
Record
To:
Melissa Green/OPD/EOP
CC:
Subject: School to Work
Rather than try to talk to Gene, let's try this by e-mail. The First Lady was made aware of some
problems at the School to Work office. Supposedly, the director, J.D. Hoye, is being thwarted in
her efforts to do her job properly. Is this true? The person who told her all this thinks that Paul
Cole, Secretary-Treasurer of the New York State AFL-CIO and Vice President of the American
Federation of Teachers should be appointed as the new Assistant Secretary of Labor for
Employment and Training. What does Gene think?
I do need to get back to the First Lady when she returns at the end of this week. Thanks for your
help.
52
EDUCATION WEEK . MARCH 12, 1997
COMMENTARY
School-to-Work, Employers,
And Personal Values
By Samuel Halperin
fits critics are to be believed, the fledgling Amer-
I
ican school-to-work movement is a nefarious plot
by Big Government, abetted by willful or unwit-
ting industrialists, to control the academic con-
tent of learning and dictate the occupational futures
of American youths. What's more, opponents from
both extremes of the political spectrum contend, our
schoolchildren are in danger of becoming pawns in a
computer-driven national labor-market information
system that will funnel them into whatever jobs the
economy needs filled.
This Orwellian prospect flies in the face of com-
pelling success stories from many school-to-work pro-
grams here, as well as from long-standing efforts in
other democracies. On both sides of the Atlantic, there
is a healthy blending of school-based learning and
hands-on exposure to the world of work. School-to-
work champions can muster persuasive evidence that
experience in actual workplaces, and not just class-
room instruction, helps young people acquire essen-
tial job skills along with the habits of thought and be-
havior that underlie them.
Instead ot regarding school-to-work efforts as key
elements of genuine school reform, critics from the po-
litical right see a government-directed scheme to con-
trol the minds, the values, and ultimately the occupa-
tions and earnings of American workers-all of which
will allegedly subordinate family values to the imper-
atives of the economy. For its part, too, the anti-capi-
Rob Colvin
talist political left envisages generations of human
automatons and worker bees, brainwashed to serve
Observations From Overseas
the needs of corporate capitalism in cahoots with gov-
ernment bureaucracies. No longer capable of indepen-
dent thought and self-realization, our young people
are to become little more than cogs in the nation's in-
Study Missions
dustrial and economic machinery.
The gap between these baleful predictions and
ground-level reality came into sharp focus during re-
cent study missions to Europe and Israel. There, as
the youth-apprenticeship program of the Union Bank
cabinet hardware in Bregenz, Austria, the company's
we are beginning to see in the United States, enlight-
of Switzerland. Like its industrial neighbor ABB, this
training philosophy is exemplified by two mottoes:
ened businesses and supportive government policies
leading Swiss bank has been "training" student work-
"Never underestimate the capabilities of our youth.
are enabling young people to experience the best of
ers for over 125 years. What kinds of skills and values
Rather, find out what they are, and utilize them in
both worlds: high-quality academic learning and prac-
does UBS look for in admission to, and completion of,
helping to create a successful adult" and "A positive
tical experience in the workplace that reinforces class-
its four-year program? The composite response from
role model is the best way to form a young mind."
room study.
both trainer-coaches and graduates: self-initiative, ef.
Blum's 22 full-time and 11 part-time trainers serve
Several relevant examples demonstrate persua-
fective team player, ability to concentrate, decision-
the needs of 130 apprentices who, while completing
sively that critics from both sides of the political spec-
making ability, communication skills, flexibility, pro-
their fourth year of combined schooling and on-the-job
trum are plain wrong.
fessional appearance, good grades in secondary school,
Continued on Page 38
staying power, enjoying people. At a cost to the Union
t ABB (Asea Brown Boveri) in Baden,
Bank of Switzerland of as much as $23,000 per ap-
Samuel Halperin is a co-director of the American
A
Switzerland, high-school-age apprentices in
prentice per year, over and above what the state pays
Youth Policy Forum in Washington and a former pres-
the giant Swiss-Swedish engineering firm
for secondary education, the apprenticeship program
ident of the Institute for Educational Leadership. He
study in a state-approved and partially
enjoys high prestige with students, parents, and the
was the deputy assistant secretary for legislation in the
state-financed high school located on the factory's
public at large. (Here, as elsewhere in Europe, re-
U.S. Department of Health, Education, and Welfare
premises. When American visitors asked what quali-
quests for enrollment are often triple or more the
during the Johnson Administration.
ties are essential for success in the workplace and in
number of available slots, especially in the more com-
nonworking life, ABB student responses included: per-
petitive professions.) Moreover, the trend is to ever
sonal competence, self-discipline, independence, cTe-
higher job qualifications, more postsecondary acade-
ativity (imagination and problem-solving), team effort
mic specialization, and systematic follow-up through
(social competence, solidarity, communication skills),
advanced learning opportunities. Indeed, there is now
flexibility, focus on satisfying the needs of customers
talk in the financial-services industry of creating a
and colleagues, honesty, and loyalty.
"University for Applied Science."
In Zurich, we met with trainers and graduates of
At the Julius Blum firm, a precision manufacturer of
School-
opened a high school apprentice-
essential to survival. They know
Europe, high-tech industrial ex-
high-tech firms is how similar
ship program with neighboring
training is expensive, but believe it
ports are literally the lifeblood of
they are to each other, and to the
companies based on the tech-prep
is the only way they can compete
the society. There, the Manufactur-
kind of combined academic rigor,
To-Work
curriculum at its U.S. plant in
and win in world markets.
ers Association of Israel, in cooper-
practical work experience, and
Stanley, N.C. It will be interesting
In the classrooms of schools as-
ation with the Ministry of Educa-
continuous-learning values pro-
to see whether the same high
sociated with these and other em-
tion, has embarked on an
moted by the best U.S. school-to-
standards and performance can
ployers, we never once observed
ambitious program to expose all Is-
work programs.
And Values
be successfully transplanted in
the bars, metal detectors, or graf-
raeli students to "Think Industry,"
In all these countries and indus-
the New World.
fiti so common in American high
an interdisciplinary educational
tries, we found no instance of em-
At three middle-sized Austrian
schools. On the contrary, schools
project teaching "entrepreneurship
ployer or governmental interest
Continued from Page 52
firms-world-famous crystal man-
were characterized by quiet corri-
and industrial thinking." Seven
in narrow training for mind-
ufacturer Swarovski in Wattens,
dors and students absorbed in
Think Industry curricula have
numbing, repetitious, automaton-
learning at age 19 or 20, earn up
Zumtobel Lighting in Dornbirn,
their work. Moreover, it was clear
been developed for grades 1-12 in
like employment. On the contrary,
to $1,700 a month. Students are
both Hebrew and Arabic. School
what most impresses the Ameri-
offered free Saturday-morning tu-
classes are also brought to five em-
can observer is the extent to
toring, a physical-fitness pro-
In the classrooms
ployer-supported regional centers,
which leading European and Is-
gram, and first-aid instruction, as
where students mingle with indus-
raeli employers and curriculum
well as bonuses for "personality
try mentors and perform hands-on
specialists seek to develop indi-
development" (for example, $10
of schools
experiments with state-of-the-art
viduals who are much more than
monthly for not smoking, $15 for
teaching equipment.
skilled workers-who are creative
"proper conduct" in auto traffic).
associated with
And just what is the "industrial
thinkers and problem-solvers,
Unlike other youth-apprentice-
thinking" that Israeli manufac-
able to cope in a stressful, fast-
ship programs, Blum's downplays
these employers,
turers seek to inculcate in the
changing world.
a written contract defining roles
young? In the words of the cur-
While Americans seem to feel
for students, parents, and em-
riculum, it includes: "education
that values are the exclusive
ployer. The entire relationship, be-
we never once
for values-work, responsibility,
province of family, church, and
lieves the firm, is built instead on
mutual trust. Without trust, no
observed the bars,
precision, openness to criticism,
schools, Europeans practice the
professionalism, and a constant
belief that work and the work-
contract is enforceable.
In the city of Bregenz's em-
metal detectors, or
quest for quality."
place can also contribute power-
"These values are to be
fully to the development of au-
ployer-backed public high school,
where many of the apprentices
graffiti so common
achieved," the curriculum goes on
tonomous and effective human
to say, "by teaching teamwork
beings. All of this is done in a
study, and in Blum's own training
and interpersonal communica-
spirit of partnership with the
center, students work on state-of-
in American high
tion
thinking skills-creative
schools, which teach not only the-
the-art equipment because, as the
thinking, inventive thinking, logi-
oretical science and mathematics,
firm's educational director says,
schools.
cal thinking, critical thinking, and
but also a substantial load of so-
"We want our students to have
Rob Colvin
problem-solving abilities
learn-
cial sciences, humanities, and, in
the very best technology; if the
ing skills-the ability to acquire
the case of central Europe, virtu-
equipment in the plant is better
ski-lift and car-park manufacturer
that what Europeans call "envi-
basic knowledge, to build on exist-
ally mandatory courses in reli-
than in the schools, they will look
Doppelmayer in Wolfurt-and
ronmental responsibility" is wide-
ing knowledge, and to access new
gion, with a heavy emphasis on
down on schools." Far from being
their cooperating high schools, we
spread in the schools. Students
sources of information
connect-
getting along with others in an in-
deprived of independence and
met industrialists who, while
are responsible for the cleanliness
ing the student to real-life situa-
creasingly diverse society.
personal autonomy, students take
financial pressure to reduce
of their schools, for recycling, and
tions
intertwining thinking,
To be sure, this level of em-
from the company's value system
costs, proudly told us that their in-
for energy conservation.
values, and knowledge teach-
ployer involvement and leader-
the message that "the computer
vestment in apprenticeship and
When asked whether they would
ing entrepreneurship-taking the
ship developed over many years.
shouldn't be smarter than the
their adherence to national stan-
prefer either more time in class-
initiative to develop new products
Yet the fact that it happened is
computer operator; faster, not
dards substantially exceeded the
rooms and less in the plants, or
and marketing strategies, to iden-
encouraging for all who believe
smarter." Like other firms we vis-
minimum requirements arrived at
more in the plants and less in
tify problems and find original so-
that schools and employers can
ited, Blum's leaders practice what
in negotiations with the central
schools, Austrian and German stu-
lutions for them."
work together to produce high
they preach: "Smart workers are
government and local authori-
dents, to our surprise, complained
schools that work, future employ-
our best asset."
ties-and that the added cost was
mildly about the heavy demands
hat is interesting and
ees with impressive skills, and,
Overall, the Austrian manufac-
well worth it.
placed on them, but argued
turer has graduated more than
For these firms, and others we
strongly that the present mix of
W
compelling about the
most important, the kind of young
educational and train-
people whose personal values the
500 students, with only one
visited in Europe and Israel, suc-
experiences was the right one.
ing values embodied
critics on the political left and
dropout. The firm has recently
cess in quality export markets is
In Israel, as in much of Western
in both European and Israeli
right ought to find appealing.
TO Pauline Chu J- -
This is a good dea.
Date:
January 15, 1996
let's look tn an
To:
The First Lady
From:
Chick Koop
opportunity to do
Re:
Posthumous recognition of Papanicalaou.
It
George Nicholas Papanicalaou, inventor of the Pap Smear, was my teacher
at Cornell University Medical College. It is my opinion that, compared to
his contribution, his recognition as a person has been insignificant. Any
of a White House affair?
interest in honoring him, perhaps at a Cornell Commencement or as a piece
Melissa Skolfied is avere of this
HRC t PUPUS not selected
for correct
reed $ rule w/ Cabieb
Afla is recomments
Checky
Slake's
Commencent
Scheduler
send " to Jenkeen
+ Chris Jenniss
putter
June 20, 1996
JOUI
Shreveport Journal
The Shreveport Journal is now an
Letters to the editor are welcomed at
independent editorial page published
P. O. Box 31110, in Shreveport, La. 71130,
Monday through Saturday under an
or by e-mail at [email protected]. The
agreement between the Journal and
Journal's telephone number is 459-3365.
The Times. Its views are independent
of those on The Times editorial page.
The Shreveport Journal, founded in
1895. is locally owned. It was
Journal editorials represent the
published as an afternoon newspaper
opinion of the publisher and editors of
until March 30, 1991.
the Journal. Signed opinions are the
views of the writer.
Publisher
Editor
Editorial Writers
Charles T. Beaird
Jim Montgomery
Tim Greening
Rodney Grunes
This
No
EDITORIALS
efitarial
NO REFORM?
State woes show health care needs change
Gov. Mike Foster turned a few
is, the medical needs of its recipients
heads when he named Bobby Jindal,
didn't disappear along with the
a 24-year-old, to head the state's
program. They were notified by mail
Department of Health and Hospitals.
last week that they're on their own,
¡As it turns out, a young man was a
come the beginning of next month.
smart move to make because the job
The phones at DHH began ringing
is going to require a lot of youthful
off the hook.
resilience.
"We were surprised at the intensity
Having just been rescued by
of their problems," Jindal said at a
Washington, D.C. on our last crisis
press conference yesterday. "We
- when the state was told it could
knew people would be cut off from
no longer use the creative accounting
services, but we didn't realize how
methods that disguised federal
many. We thought there would be
Medicaid funds as state money to get
other programs to cover these
even more matching funds - the
people."
state health system already has
Jindal said the needs of around 25
another problem on its hands. While
percent of the recipients can be taken
it will immediately have to be dealt
care of by other forms of state and
with by Louisiana's leaders, we think
private assistance, but that still leaves
it is indicative of the need for a
a lot of people stranded. It will
restructuring of the way the entire
probably drive most of them to the
nation pays its medical bills.
state's charity hospitals and increase
Medicaid covers a lot of poor
their workload - just what they
people, but not all who need
need after having their budgets cut
assistance, so the state of Louisiana
$30 million in the last legislative
used some leftover federal money
session.
and created a fund called Medically
We are confident that Jindal and
Needy, to assist people whose
his DHH staff will do their best to
earnings are just above eligibility for
resolve the problem - and brace
Medicaid but not quite enough to
themselves for the next one, if recent
afford insurance. According to the
history is any indication. They've
Associated Press, it covers about
inherited a job that shouldn't be this
3,000 people in various ways,
hard, but our system of providing
whether its subsidizing prescriptions
and paying for health care in this
for families or paying nursing home
country leaves too many people
expenses.
unable to afford medical care. This is
Since this is not a program
perhaps the inevitable result - the
required by the federal government,
government can no longer. afford it,
the Legislature and the Department
either.
of Health and Hospitals agreed to
President Clinton tried to change
end the program and use its $72
this, but was overwhelmed by the
million operational funding to
few for whom the status quo works
balance the state's budget. Problem
too well. It is time to revisit his plan.
TO:
Hillary Rodham Clinton
FROM:
Jennifer Klein
RE:
Miscellaneous Projects
DATE:
7/22/96
I thought you might be interested in hearing about several projects that are
underway.
1.
Adoption/Child Welfare. Carol Rasco is holding a series of informal sessions with
experts and advocates in the field of child welfare which she has asked me to sit in
on. She sees this as the beginning of a long-term effort to learn about and address
the serious problems in our child welfare system. At the first session last week,
Jane Spinak (Legal Aid Society, Juvenile Rights Division) said that the most
important thing we can do to improve the child welfare system is to involve all
sectors of society, including business, lawyers and judges, the faith community, etc.
(which of course sounded very familiar). I know that you had expressed interest in
convening a meeting on adoption with representatives of these sectors. I plan to call
Jane to talk about what issues could be best addressed, possible people to invite, etc.
HHS is coming up with a list of executive actions on adoption that could be
announced quickly. I will meet with them early next week to discuss their
suggestions.
I know that Melanne told you about our discovery of HHS's National Strategic Plan
on Adoption. Truly unbelievable and infuriating! We are now part of the
development process and will have an opportunity to make changes to the plan
before it goes any further.
2.
Grandparent's Project. We are working on a project to help grandparents care for
grandchildren whose parents have died (often of AIDS). In many cases,
grandmothers attempt to get custody of these children, but there are a number of
legal and financial barriers to placing children with them permanently and to getting
health care, housing and other services that they desperately need. We are pursuing
changes that require legislation as well as changes that can be done by executive
action. The hope is to come up with a series of proposals to be released when the
AIDS quilt comes to Washington in October. Schedule permitting, you might want
to announce the proposals.
TO:
Hillary Rodham Clinton
FROM:
Jennifer Klein
DATE:
3/29/96
RE:
"Health Care Roulette" Column
You had asked me to respond to this column. I'm not sure that a response from you is
necessary. The author argues that insurance should be available and affordable when people
need it. If you do want to write a letter, we could say that we agree completely with that
point. We could also urge that the first steps can and should be taken right now by passing
the Kassebaum-Kennedy health insurance reform bill. The bill would stop insurance
companies from denying coverage to people with pre-existing conditions and ensure that
people don't lose their insurance if they lose a job or change jobs.
FRIDAY. FEBRUARY 2, 1996 0.7B
Health care roulette
U
pon reading Monday's column, in
which I reproduced a letter from a
reader in Nashville who had been
Meredith
denied health insurance by Blue Cross and
Blue Shield after a heart transplant, a read-
Oakley
er from Conway responded with his own
tale of rejection.
"In September 1994," he wrote, "I suf-
fered a minor stroke and was admitted to
tising dollars being spent by the insurance
the hospital for two days. My recovery was
companies touting their 'caring attitude
complete within a matter of hours. Since
(Now I see the insurance companies taking
then I have taken blood pressure medicine
aim at my mother on Medicare."
and a blood thinner. I walk two and a half
That last is a reference to recent are
miles every day and I am in relatively good
nouncements by several insurance compa
health for a person 68 years of age.
nies about premium increases in Medicare
Citing medical underwriting guidelines,
supplemental policies.
Conway Reader's inquiry about obtaining
The premier issue of Blue and You the
a Medi-Pak policy was rebuffed by Blue
new "customer-focused" magazine of Ar
Cross a month ago.
kansas Blue Cross and Blue Shield, ad
"Being somewhat concerned, I visited
dressed the subject of what it called "the
my doctor. He assured me I was in rela-
rate race."
tively good health, my blood pressure and
"If(rate increases) are so unpopular,' the
body functions were normal, and I had no
article stated, "why do health insurers raise
reason for concern. He stated that Blue
rates and risk the wrath of policyholders? It's
Cross wanted to make money and not be out
a simple choice: Raise rates or lose money.
anything on a patient. Since then, I have or-
Of course, popularity, or lack thereof, has
dered the same coverage through AARP."
nothing to do with rate increases. Ifit did,
What's the moral? That one should obtain
there would be none. Insurance companies
every type of health care coverage that could
are businesses like any other. They don't ex-
possibly be needed before it's needed? Ridicu-
ist to lose money, they exist to make it. So.
lous. If one could afford that much insurance,
what if rate increases incur the wrath of pol-
one wouldn't need that much insurance.
icyholders? What are they supposed to do
I'm rather superstitious. I have this ir-
cancel their policies and take their chances?
rational notion that I won't need insurance
Perhaps. Or they could shop around like
as long as I have it and that if I were to can-
the reader from Conway did. Blue isn't the
cel it tomorrow, I'd need it the day after.
only color in the spectrum.
I can afford insurance, and my health is
I daresay most critics did not fault the
good enough that I can have it, but I have
Clinton administration's desire to overhaul
another notion, not as irrational as the first,
the American health care system, only the
that if I were to become seriously or cata-
manner in which the administration set
strophically ill, I'd lose my insurance re-
about doing it.
gardless of my ability to pay the premiums
I've got a view that some acquaintances
(for as long as the savings account holds out).
in the insurance industry see as simplistic,
The fact is that people are denied cov-
even simple-minded. It is that insurance
erage every day, and every day people see
ought to be available when needed.
their insurance coverage priced beyond af-
have no quarrel with investing iti the
fordability or canceled altogether.
future, putting money aside, in the form of
A case in point is the experience that an
premiums paid, in anticipation of that day
unidentified Arkansan shared with law-
of need. But when that day comes, I want
makers last month.
the promised coverage to be thered not
"Three years ago, my father, who had re-
jerked away at the first glimmer of dawn
sponsibly paid health insurance premiums
and canceled somewhere around noem
for many years, had his health insurance
Unfortunately, health care isn't. ad
canceled by Arkansas Farm Bureau and
dressed in the Constitution. We may have
their insurance company, Blue Cross and
an unalienable right to life, but the quality
Blue Shield," he/she wrote.
of that life is left pretty much up to us as in
"He was having health problems at the
dividuals in a free-enterprise system.
time of the cancellation, and after an outcry
Until that is changed-by Supreme
by Rep. Lloyd George and a few others, he
Court edict, congressional mandate or the
was offered a new policy at about 10 times
groundswell of public opinion-we'r also
the premium he was paying. He could not
pretty much at the mercy of the system
afford it and passed away shortly there-
Thankfully, it's still a competitive system
after-uninsured,
As you can imagine, I am appalled and
Associate Editor Meredith Oakley's column appears
incensed when I
the millions of adver-
every Monday, Wednesday, Friday
Sunday
THITE
Kathy Binto - Dean Ornish Proposal 3/10
Demonstration under Medicare to try out new
things - - - - waive payment vules
Interested in proposal
Lost- effective alternative to services Med.
already pays for ( dut / exeruse to avoid
Payment mechanism
Surgery )
Would get worned out
300 Med. benef.
by HLFA
ranus it based on merit
Peer review panel to review /
How Med. research can enhance better outcomes
- - not just payment improvement
Loonma at seriously
summer - decisions get made
But - - Fauing recission
Mrg again W HCFA - - new data
TO:
Hillary Rodham Clinton
FROM:
Jennifer Klein
DATE:
August 4, 1995
RE:
Maternal Health Study: Female Genital Mutilation
You had asked about the numbers in the chart on female genital mutilation (FGM).
The estimate that 100 million women are affected by FGM represents approximately 34
percent of the female population of sub-Saharan Africa, since the total population is 586
million and roughly half (239 million) are women. Some of the countries with the highest
percentage of women subjected to FGM have very small populations, whereas some of the
more populated countries do not practice it so extensively. Therefore, the percentage chart
may make it appear as though a greater number of women would be affected.
In addition, the 100 million figure is only an estimate, as no one knows exactly how
many women are affected. Since social taboos and limited medical reporting make it
extremely hard to document the extent of the practice, the estimate may understate its true
extent. The estimate is based on research by Fran Hoskens (who has been studying FMG
since the early seventies and developed the first estimates of its prevalence) and Nahid Toubia
(a Sudanese physician who until recently worked for the Population Council).
I will put all of this in your Beijing briefing materials.
TO:
Hillary Rodham Clinton
FROM:
Jennifer Klein
DATE:
August 1, 1995
RE:
Maternal Health Study
The women's reproductive health study reported in the New York Times was prepared
by Population Action International, a research organization. The study ranks 118 countries on
a "Reproductive Risk Index" based on their average scores on ten indicators: (1) teen births;
(2) contraception; (3) abortion policy; (4) anemia during pregnancy; (5) prenatal care;
(6) attendance of trained personnel at birth; (7) HIV/AIDS rates among women; (8) infertility
(which often indicates STDs); (9) average number of births per woman; and (10) mortality
rates in childbirth or due to unsafe abortion.
The United States ranks 18th overall, but still falls within the "very low risk" category.
Italy, Denmark, Norway, Sweden, and Belgium rank highest. The main distinctions between
the United States and these top countries are:
The United States has a much higher rate of teen pregnancy (6 per 100 births as
compared to 1 or 2 per 100 births);
The United States has a lower rate of contraception use (71% as compared to
76% - 79%);
Fewer women in the United States receive prenatal care than in Italy, Denmark, or
Sweden (95% as compared to 100%); and
The United States has a higher fertility rate (average of 2.1 births per woman as
compared to 1.2 - 2.0).
The researchers believe that Italy rates well because of its high scores on all of the
indicators, rather than due to a single factor. Italy has fewer births (an average of 1.2 births
per woman as compared to 2.1 in the U.S.), a low mortality rate (4/100,000 as compared to
7/100,000 in the U.S.), and a very low rate of anemia (10% as compared to 17% in the U.S.).
In addition, 100% of women receive prenatal care and are attended at delivery by trained
personnel (as compared to 95% and 99% respectively in the U.S.). Also, despite the fact that
many women in Italy rely on traditional methods of contraception, such as withdrawal and
rhythm, reproductive health remains strong because a high percentage of women do practice
family planning and because women have access to safe abortions.
Italy ranks well on the chart comparing the risk of death from complications of
pregnancy, childbirth, or unsafe abortion because this risk is determined by looking at the
chance of dying during a given pregnancy (mortality rate) and the number of times a woman
is exposed to that risk (fertility rate). As noted above, Italy rates well in both of these
categories.
n a Ranking of Maternal Health, 7/2
U.S. Trails Most Developed Nations
Can out wave
than 100 per 100,000 births, whereas
By PHILIP J. HILTS
Reproductive Risks:
about half the world's nations have
rates of 200 to 1,750 per 100,000. The
ASHINGTON, July 25
Range Worldwide
study also cited Tunisia and Viet-
W
- The United States
nam as having made unexpected
Estimated risk of death from
ranks 18th in an index
progress.
measuring maternal
complications of pregnancy,
The report contained at least two
this thing w
health, lower than most other devel-
childbirth or abortion in a
oped nations in the world, a new
woman's lifetime in selected
study says.
countries.
The study reviewed the data in 10
categories of maternal health and
Italy
1 in 17,361
gave each of the 118 countries sur-
Norway
1 in 15,432
Money is one
veyed a score based on its perform-
ance in those areas. Areas rated
Australia
1 in 8,772
D taly
included the number of women who
answer, not
United States
1 in 5,669
die during childbirth, teen-age preg-
good
nancy, contraceptive use, prenatal
Poland
1 in 3,608
the only one.
care and availability of safe abor-
Cuba
1 in 1,286
tions.
so
The study, released on Monday,
China
1 in 439
shows that the chance of dying from
Zimbabwe
1 in 217
pregnancy or childbirth varies dra-
matically in different parts of the
Mexico
1 in 131.
surprises for researchers. One was
world, from 1 in 7 in Mali to about 1
India
1 in 59
that Italy ranked best in reproduc-
in 17,000 in Italy. The rate in the
tive health in the world.
United States is 1 in 5,669. The study
Kenya
1 in 31
"We didn't expect this," Dr. Conly
was done by the research group Pop-
Mall
1 in 7
said, "because while use of family
ulation Action International in Wash-
planning in Italy is high, over half of
ington.
Source: Population Action International
Italian couples use traditional meth-
ods like withdrawal and rhythm,
The countries with the best overall
which experts generally consider
rankings were, in order, Italy, Den-
less effective. However, Italian
mark, Norway, Sweden and Bel-
ceptive use.
women appear able to use these
gium. Ranked the worst were Mall,
Although it still fell in the study's
methods effectively, largely because
Congo, Somalia, Angola and Zaire.
"very low risk" group of countries,
safe abortion is available on re-
the United States ranked behind
Although an important factor af-
quest."
such emerging countries as Taiwan
fecting the ranking is a country's
Another surprise, Dr. Conly said,
relative wealth, said Dr. Shanti R.
and Singapore. And Dr. Conly con-
was that countries like Indonesia
tended that it "is likely to drop even
Conly, director of policy research for
and Bangladesh, which have become
farther if this Congress continues as
the group, some quite poor countries
exemplary nations in offering family
have worked on women's health is-
it has started." A proposal to end
planning broadly, nevertheless fall
public contraceptive services in the
sues and ranked well, while other
in the "high risk" category because
United States has been approved in
nations of great wealth scored rela-
their death rates from pregnancy
committee, and another to cut aid to
tively poorly.
and childbirth remain high.
developing nations in Africa by one-
The study looked at three areas
Last year, at the International
third may be an indication of what is
for each country: family planning,
Conference on Population and Devel-
to come, she said.
which the researchers said reduced
opment in Cairo, 180 nations reached
Some relatively poor countries
the risks associated with frequent
an agreement urging all countries to
have made long-term commitments
childbearing and reliance on unsafe
make reproductive health services
to health care and family planning,
abortion; pregnancy and childbirth,
and contraceptives available to all
Dr. Conly said, and have succeeding
including such related health con-
by the year 2015.
in several important measures.
cerns as AIDS and anemia, and post-
"Their programs may not be the
pregnancy issues like infertility.
The United States did not rank
Cadillac models," she said, "but
The nations of the former Soviet
higher largely because of teen-age
they give all people access to health
Union were not included in the sur-
pregnancies - its rate is about six
care of some kind."
vey because some data for those
times that of European nations -
Costa Rica, Cuba and Sri Lanka
nations were not available in compa-
and a relatively low rate of contra-
have maternal death rates lower
rable form.
Clinton Presidential Records
Digital Records Marker
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marker by the William J. Clinton Presidential Library Staff.
This marker identifies the place of a publication.
Publications have not been scanned in their entirety for the purpose
of digitization. To see the full publication please search online or
visit the Clinton Presidential Library's Research Room.
995 REPORT ON PROGRESS TOWARDS WORLD POPULATION STABILI 7 TION
Population Action
Health
pue,
Women's Sexual
JO
Risk: AWorldwide
Reproductive
PRESS
RELEASE
Population Action
International
Contact: Sally A. Ethelston
(202) 659-1833 Ext. 133
Formerly
(202) 387-6925 (home)
Population
Crisis Committee
Patricia Sears
(202) 659-1833 Ext. 131
HOLD FOR RELEASE UNTIL:
(301) 587-8671 (home)
24 J ULY 1995-6:00 PM EDT/22:00 GMT
WOMEN'S SEXUAL AND MATERNAL HEALTH
MARKED BY EXTREME INEQUALITY AMONG NATIONS
Washington-The health risks faced by women in sexual activity and
childbearing vary enormously from country to country, according to a new study
of more than 100 countries from Population Action International (PAI).
A woman in Italy, the best ranked country in the study, faces only a 1 in
17,000 risk of dying from causes related to pregnancy and childbirth over the
course of her lifetime. For a woman in Zaire, the worst ranked country, the risk is
more than 1,000 times greater, at 1 in 16. In fully 55 of the countries surveyed, a
woman faces more than a 1 in 100 lifetime risk of dying from maternal causes.
While access to medical care in pregnancy and childbirth is close to universal
in the industrialized countries, worldwide only slightly more than half of all
births are attended by any kind of trained personnel. In Nepal, Afghanistan and
Somalia, less than 10 percent of women receive prenatal care or have a trained
attendant at delivery.
The study, Reproductive Risk: A Worldwide Assessment of Women's
Sexual and Maternal Health, uses ten indicators to rank 118 countries-home
to 94 percent of the world's people-on a 100-point Reproductive Risk Index. The
study also includes data on 14 of the former Soviet Republics.
"For a woman in her childbearing years, good reproductive health is crucial
to her health overall and to her ability to play an active role in society," says
Shanti R. Conly, editor of the study and PAI's director of policy research. "The
vast disparities evident in this study reflect the failure of many countries to invest
in women's health, and the consequences for women are devastating."
more
Population Action International 1120 19th Street, N.W., Suite 550, Washington, D.C. 20036 USA
Telephone: 202-659-1833 FAX. 202-293-1795 Telex: 440450
Printed Paper
Reproductive Risk/Page 2
Population Action International
In the countries with the lowest reproductive risk-Italy, Denmark, Norway and
Sweden-the factors contributing to good reproductive health include low teen
birthrates and small family size overall; nearly universal access to maternal health
services; high levels of contraceptive use; low levels of infection with HIV, the virus
that causes AIDS, and access to safe abortion upon request. Out of 23 countries with
Very Low reproductive risk in the study, the United States ranks eighteenth, while
three non-European countries-Singapore, Canada and Australia-rank in the top ten.
In the three worst ranked countries-Zaire, Angola and Somalia-more than
one-fifth of 15- to 19-year-olds give birth each year and women have, on average, close
to seven children; most women lack access to basic health care in pregnancy and
childbirth; fewer than 10 percent of women use any method of family planning; and
abortion is illegal or permitted only to save a woman's life. Of 21 countries in the Very
High reproductive risk category, only two-Haiti and Afghanistan-are not in Africa.
The PAI study points to the lack of family planning and basic maternity care,
among other reproductive health services, as being largely to blame for women's poor
sexual and maternal health in many developing countries-especially in sub-Saharan
Africa.
"Country rankings on our Reproductive Risk Index tend to reflect income levels,"
says Conly. "However, some poorer countries-like Cuba, Costa Rica and Tunisia-
have made long-term investments in expanding access to family planning and health
care, and women are reaping the benefits."
A few countries where strong family planning programs have contributed to
relatively high levels of contraceptive use rank worse in the PAI study than would be
expected, namely Bangladesh and Indonesia. Pregnancy rates among teenage women
in Bangladesh are among the highest in Asia, while the percentage of women who
receive any formal maternal health care is among the very lowest. Even in Indonesia,
where more than half of all reproductive age women use contraception, only 40 percent
of births are attended by trained health personnel. Abortion is legal only to save the life
of the woman and an Indonesian woman's lifetime risk of dying due to maternal
causes-including unsafe abortion-is 1 in 72. The risk is 1 in 30 in Bangladesh.
But it is in sub-Saharan Africa that women bear the greatest burden of poor sexual
and maternal health, according to PAI. Fully 32 of the 46 countries falling into the Very
High and High risk categories in the study's Reproductive Risk Index are in Africa. Factors
threatening women's health in Africa include: high pregnancy rates among teens; low
levels of contraceptive use; levels of HIV infection in the medium and high range; high
--more-
Reproductive Risk/Page 3
Population Action International
levels of infection with sexually transmitted diseases (STDs), reflected in rates of
infertility that exceed 10 percent in all but a few countries; and a lack of health care
during pregnancy and childbirth. The study cites female genital mutilation as another
factor contributing to the abysmal reproductive health status of African women.
In all but three sub-Saharan African countries-South Africa, Zimbabwe and
Kenya-fewer than a quarter of women use any method of contraception. Restrictive
abortion policies severely limit women's access to safe abortion services throughout
most of Africa. Women bear, on average, more than five children-a factor that,
combined with high maternal death rates, results in a lifetime risk of dying in
pregnancy and childbirth that is greater than 1 in 100 in every sub-Saharan African
country surveyed except Zimbabwe and South Africa.
Among the 21 Latin American and Caribbean countries included in the study,
rates of contraceptive use exceed 50 percent in all but a handful of countries. Maternal
mortality remains high in a number of countries, however, and women face a more than
1 in 100 lifetime risk of dying from maternal causes in ten of the 21 countries, reflecting
a lack of access to maternal health care services. Cuba, Costa Rica and Uruguay, rank
best and fall in the category of Low reproductive risk on the study's Index. Haiti,
Guatemala and Honduras rank worst within the region.
"Reproductive health concerns were at the heart of last year's International
Conference on Population and Development in Cairo, and are again on the agenda for
the upcoming Beijing Conference on Women," says Conly. "Our study shows the
crushing burden of poor sexual and maternal health experienced by women in many
countries, and we hope it will strengthen international resolve to aggressively address
these issues in Beijing."
Beyond the availability of health services, a range of social and cultural factors
also influence women's health, according to PAI. The low status of women in many
societies helps perpetuate patterns of early and frequent childbearing and is often an
obstacle to their use of existing health services. Cultural traditions-such as female
genital mutilation, child marriage, and taboos against certain foods during pregnancy-
also harm women. In Bangladesh, for example, custom dictates that a woman give birth
alone or with only female relatives in attendance.
Thus, while access to reproductive health services is critical to improving
women's health, efforts to empower women-including educating girls and providing
economic opportunities to women-and to educate men about women's health needs
are also important.
--more--
Reproductive Risk/Page 4
Population Action International
PAI recommends a comprehensive approach to improving women's
reproductive health that would include the provision of prenatal and delivery care,
including emergency obstetrical care; access to STD services; and, at a minimum, access
to treatment for the complications of unsafe abortion. The study also underscores the
importance of family planning education and services to reproductive health, pointing
to its potential for helping prevent both high risk pregnancies-especially among
teenage girls-and the spread of AIDS and other STDs.
"A comprehensive approach to reproductive health is urgently needed," says
Conly. "Access to modern methods of contraception can dramatically reduce the
number of unwanted and high-risk births. To reduce maternal death rates, however,
women must also have access to emergency medical care during childbirth and
alternatives to unsafe abortion."
The ten indicators used in the study reflect both access to services that affect
women's sexual and maternal health and actual health outcomes. Under access, the
study includes four indicators:
Percentage of women using any method of contraception;
Percentage of pregnant women receiving prenatal care;
Percentage of births attended by trained personnel; and
Legal status of abortion.
Another six indicators reflect the health consequences of access-or a lack of access-to
reproductive health services:
Percentage of pregnant women with anemia;
Annual births per 100 women aged 15-19 years;
Level of HIV/AIDS infection among women [PAI places countries in one of three
categories: low, medium or high];
Percentage of women experiencing infertility [high infertility usually indicates
high prevalence of STD];
Average births per woman (total fertility); and
Number of maternal deaths per 100,000 live births, including deaths due to
unsafe abortion.
Each of the 10 indicators used in the study is scored on a 100 point scale and the
scores are averaged to yield a total score on the Reproductive Risk Index. Countries
identified as Very Low Risk have a total score of less than 15 points; countries with 15 to
29 points fall in the Low Risk category; countries with Moderate Risk scored 30 to 44
points; High Risk countries scored 45 to 59 points; and countries in the Very High Risk
category have total scores of 60 points or more. The lowest score, 6.6 points, is that of
Italy, while the highest, 76.5 points, is that of Zaire. The 118 countries included in the
study all have populations of 2 million or more people.
--more--
Reproductive Risk/Page 5
Population Action International
The PAI study includes a summary of findings for each of the ten indicators used
for the Reproductive Risk Index, noting the great disparities among countries. With regard
to early childbearing, for example, Japan's annual birthrate among 15- to 19-year olds
is less than 1 in 100, while in Angola and Guinea the rate is 24 in 100. The United States
also fares poorly on this indicator, with 6 in 100 of this age group giving birth each
year-the same number as in India and Pakistan.
HIV/AIDS among women poses a new threat to reproductive health, especially
in sub-Saharan Africa. PAI's classification of countries as having either low, medium or
high levels of HIV infection is based on small-scale studies, usually of pregnant women
in urban areas. All of Europe and North America and most Latin American and Asian
countries have low prevalence of HIV infection among women. However, 19 countries
fall into the medium classification, including 13 countries in Africa, 3 in Southeast Asia-
Thailand, Cambodia and Myanmar-and 3 in the Americas-Panama, the Dominican
Republic and Honduras. Another 14 African countries, plus Haiti, have high HIV
prevalence among women in the general population.
The risk of death in childbearing is dependent on both the chance of dying
during a given pregnancy, and the number of times a woman is exposed to that risk.
Thus the PAI study, while including data on both maternal mortality and family size,
assigns scores based upon a woman's lifetime risk of dying due to maternal causes,
including unsafe abortion. Family size is highest in Yemen, where women bear, on
average, 7.6 children. Women have the fewest children in Hong Kong, Italy and Spain,
where the average is just 1.2 children. Maternal mortality is highest in Mali and
Somalia, where more than 1,000 women die for every 100,000 live births; it is lowest in
Belgium, Denmark, Norway and Israel. However, a woman's lifetime risk is lowest in
Italy, Belgium and Hong Kong, while still highest in Mali and Somalia. Lifetime risk is
about 1 in 6,000 for women in the United States, which ranks fifteenth on this measure
of women's health.
The lack of comparable data for the former Soviet Republics (NIS) prevents their
inclusion in the Reproductive Risk Index, but the PAI study includes new data on these
countries. Use of modern contraception does not exceed 25 percent among women of
childbearing age in any NIS country, due to the limited availability of contraceptive
supplies. As a result, abortion rates are high throughout most of the NIS, with the
annual number of abortions per 100 women reaching 8.3 in Ukraine, 8.5 in Kazakhstan,
10.4 in Belarus, and 12.0 in Russia. By comparison, the annual abortion rate is 2.6 per
100 women in the United States, and 2.0 per 100 in Sweden.
--more--
Reproductive Risk/Page 6
Population Action International
Both family size and maternal mortality are higher in the Central Asian
Republics than in the European NIS. A woman's lifetime risk of dying from maternal
causes is highest in Turkmenistan-where 1 in 150 women die in pregnancy and
childbirth-and similar to the risk faced by women in Algeria, Colombia and Brazil.
Among the NIS, lifetime risk is lowest in Azerbaijan. In Russia, a woman's lifetime risk
of dying from maternal causes is about 1 in 1,000, as it is in Thailand and Uruguay.
Reproductive Risk: A Worldwide Assessment of Women's Sexual and Maternal
Health is the sixth in PAI's annual Report Card series. The 1994 Report Card, Financing
the Future: Meeting the Demand for Family Planning, found that spending on family
planning in developing countries averaged just 80 cents per capita per year. The 1994
study recommended a spending level of about $3.30 per capita for a basic package of
reproductive health services, including family planning, AIDS prevention and safe
maternity care. Only a handful of the 79 countries included in the 1994 study spent
more than $2.00 per capita. They included Costa Rica, Jamaica, Hong Kong, Taiwan
and Tunisia.
An increase in annual expenditures from the current $5 billion to a minimum of
$17 billion by the year 2000 is needed to meet the growing demand for services, while
improving their range and quality. Nations participating in the Cairo conference on
population and development last year endorsed both this spending goal and the
elements of a reproductive health care strategy. At the time, a number of countries—
including the United States, Britain, Germany and Japan-indicated their willingness to
increase assistance to developing countries for this purpose. Since then, however, no
new donor pledges have been made and overall development aid continues to fall.
"This study's cold statistics promise more death and disease for millions of
women and families, unless we implement the Cairo plan of action to make basic
reproductive health care available to every woman in the next 20 years," says Hugo
Hoogenboom, PAI's new president. "The nations of the world agreed to this last
September. The retreat from this goal by the donor community-as reflected in recent
actions of the U.S. Congress-is profoundly disappointing. Indeed, it is inexcusable."
Reproductive Risk: A Worldwide Assessment of Women's Sexual and Maternal Health
is available for purchase from: Population Action International
1120 19th Street, NW-Suite 550/Washington, DC 20036
Telephone: 202/659-1833
Population Action International, a Washington, DC-based, non-profit, non-governmental organization, was
founded in 1965. Population Action International is committed to universal access to voluntary family planning and
reproductive health services, reproductive choices for women and men, and early stabilization of world population.
--more--
The Reproductive Risk Index (continued)
Annual
Women
Pregnant
Women
Births
Births per
Using
Women
Receiving
Attended by
Level of
Maternal
Country
100 Women
Contra-
Abortion
with
Prenatal
Trained
HIV/AIDS
Infertility
Deaths per
Reproductive
Aged 15-19
ception
Policies*
Anemia
Care
Personnel
in Women
in Women
100,000
Risk Index
(%)
(%)
(%)
(%)
(%)
Births
Uruguay
6
72
C
37
80
96
Low
3
2.4
36
23.7
Vietnam
2
53
A
63
73
90
Low
2
3.7
120
25.7
Argentina
6
66
C
37
90
92
Low
3
2.9
140
26.9
Malaysia
3
48
C
34
75
92
Low
4
3.6
59
27.8
LOW RISK
Chile
6
43
E
21
91
98
Low
3
2.5
67
27.9
Tunisia
2
50
A
38
58
68
Low
7
3.3
127
29.8
Sri Lanka
3
62
E
62
86
94
Low
4
2.5
80
31.0
Jordan
5
40
C
50
76
87
Low
3
5.6
40
31.0
Turkey
4
63
A
74
43
76
Low
2
3.5
146
31.5
Jamaica
9
67
C
62
95
90
Low
7
2.9
115
31.6
Colombia
7
66
E
24
80
71
Low
2
2.7
200
32.2
Brazil
8
66
D
34
74
73
Low
2
3.0
200
33.1
Thailand
5
66
C
52
77
66
Medium
2
2.2
37
33.2
Saudi Arabia
12
14
C
31
86
90
Low
3
5.5
41
33.4
Venezuela
10
49
E
29
74
97
Low
2
3.6
200
34.2
Panama
9
58
C
42
72
84
Medium
3
2.9
60
35.3
South Africa
7
50
C
37
84
86
Medium
5
3.8
84
35.7
Lebanon
3
55
E
50
85
45
Low
3
2.9
128
36.2
Philippines
3
40
E
48
77
55
Low
2
4.1
74
36.2
Peru
6
59
C
53
64
60
Low
3
3.5
300
36.9
Mexico
8
53
D
41
60
69
Low
3
3.2
200
37.5
Ecuador
8
53
C
46
52
84
Low
5
3.8
300
37.6
MODERATE RISK
Oman
12
9
E
50
79
75
Low
3
6.9
7
37.8
Iraq
5
14
C
50
65
74
Low
3
5.7
117
38.3
India
6
41
B
88
49
70
Low
3
3.4
420
39.5
Algeria
3
47
C
42
58
15
Low
3
4.2
129
39.6
Nicaragua
15
49
E
42
92
73
Low
3
4.6
300
40.0
Paraguay
9
48
E
63
84
66
Low
3
4.4
300
41.2
El Salvador
13
53
C
42
34
66
Low
2
3.9
300
41.4
Libya
11
14
E
53
76
76
Low
3
6.4
80
42.1
Egypt
7
47
C
47
53
34
Low
4
3.9
266
42.2
Bolivia
8
30
C
25
45
55
Low
3
4.8
600
42.4
Dominican Republic
9
56
E
52
97
72
Medium
5
3.3
300
42.8
Iran
9
38
E
50
47
70
Low
3
6.0
120
42.9
Morocco
4
42
C
46
34
31
Low
3
4.0
327
43.4
Indonesia
6
55
E
74
76
40
Low
7
2.9
400
45.6
Syria
11
20
E
52
60
61
Low
3
6.2
143
45.7
Zimbabwe
10
43
C
47
92
69
High
10
5.0
77
46.3
Myanmar
3
46
E
58
75
57
Medium
5
3.8
460
46.9
HIGH RISK
Sudan
9
9
D
36
70
69
Low
9
6.1
550
47.2
Honduras
13
47
E
42
45
81
Medium
3
5.2
221
47.7
Population Action International
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1120 19th Street, NW, Washington, DC 20036
Reproductive Risk:
A Worldwide Assessment of Women's Sexual and Maternal Health
The Reproductive Risk Index
Annual
Women
Pregnant
Women
Births
Births per
Using
Women
Receiving
Attended by
Level of
Average
Maternal
Country
100 Women
Contra-
Abortion
with
Prenatal
Trained
HIV/AIDS
Infertility
Births per
Deaths per
Reproductive
Aged 15-19
ception
Policies*
Anemia
Care
Personnel
in Women
in Women
Woman
100,000
Risk Index
(%)
(%)
(%)
(%)
(%)
(TFR)
Births
Italy
1
78
A
10
100
100
Low
6
1.2
4
6.6
Denmark
1
78
A
8
100
99
Low
6
1.8
3
6.7
Norway
2
76
A
17
95
100
Low
5
1.8
3
8.1
Sweden
1
78
A
17
100
100
Low
5
2.0
5
8.4
Belgium
1
79
A
17
90
100
Low
7
1.6
3
8.7
Netherlands
1
76
A
18
95
100
Low
5
1.6
10
10.0
France
1
81
A
18
99
94
Low
6
1.7
9
10.1
Australia
2
76
B
20
100
99
Low
5
1.9
5
10.3
Singapore
1
74
A
18
95
100
Low
5
1.8
10
10.4
Canada
3
73
A
20
100
100
Low
7
1.8
5
10.6
Finland
I
80
B
17
100
100
Low
5
1.8
11
10.6
Austria
2
71
A
17
96
96
Low
5
1.5
8
10.7
United Kingdom
3
81
B
19
98
98
Low
6
1.8
8
11.8
VERY LOW RISK
Czech Republic
5
69
A
23
100
100
Low
4
1.7
10
11.8
Japan
0
64
B
20
99
100
Low
6
1.5
11
12.4
Taiwan
2
75
B
37
99
100
Low
5
1.7
9
12.9
Hong Kong
1
86
C
37
99
99
Low
5
1.2
4
13.0
United States
6
71
A
17
95
99
Low
6
2.1
7
13.0
Spain
1
59
C
9
96
96
Low
4
1.2
5
13.7
Germany
1
75
C
12
99
100
Low
5
1.3
11
14.1
Switzerland
1
71
C
17
-
99
Low
5
1.5
4
14.3
Slovakia
4
67
A
40
100
100
Low
5
1.9
10
14.4
Bulgaria
6
76
A
40
100
100
Low
6
1.5
12
14.5
Hungary
4
73
B
40
100
99
Low
5
1.7
13
15.1
Poland
3
75
C
16
99
99
Low
3
2.1
11
15.1
Portugal
3
66
C
17
96
98
Low
5
1.5
10
16.5
China
2
83
A
37
98
94
Low
5
2.0
95
16.8
North Korea
1
67
A
37
100
100
Low
2
2.4
130
17.0
Israel
2
65
C
25
90
99
Low
6
2.9
3
17.1
New Zealand
4
70
C
22
95
100
Low
5
2.1
13
18.2
Yugoslavia
4
55
A
40
100
86
Low
5
2.0
18
18.2
LOW RISK
Cuba
9
70
A
34
99
100
Low
6
1.8
36
18.5
South Korea
1
79
C
37
89
89
Low
2
1.6
32
19.1
Romania
4
57
A
40
100
99
Low
6
1.4
149
20.8
Costa Rica
9
75
C
28
91
97
Low
2
3.2
18
21.3
Albania
1
10
A
40
100
99
Low
5
3.0
30
22.2
Mongolia
4
38
A
26
100
99
Low
5
4.5
140
22.9
Population Action International
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1120 19th Street, NW, Washington, DC 20036
The Reproductive Risk Index (continued)
Annual
Women
Pregnant
Women
Births
Births per
Using
Women
Receiving
Attended by
Level of
Maternal
Country
100 Women
Contra-
Abortion
with
Prenatal
Trained
HIV/AIDS
Infertility
Deaths per
Reproductive
Aged 15-19
ception
Policies*
Anemia
Care
Personnel
in Women
in Women
100,000
Risk Index
(%)
(%)
(%)
(%)
(%)
Births
Papua New Guinea
2
5
C
75
68
43
Low
5
5.4
700
48.0
Guatemala
12
23
E
42
34
51
Low
3
5.4
300
49.7
Benin
15
9
E
55
64
45
Low
3
7.1
161
50.5
Bangladesh
13
40
B
51
12
7
Low
4
4.4
650
50.6
Pakistan
6
12
C
57
27
35
Low
4
6.1
600
51.4
Cambodia
13
44
E
63
100
47
Medium
5
5.3
800
51.8
Madagascar
16
17
E
47
78
58
Low
10
6.1
570
52.1
Ghana
13
13
C
64
82
59
Medium
3
6.0
1000
52.1
Laos
5
18
E
62
-
20
Low
5
6.3
300
52.4
Zambia
14
15
B
47
92
51
High
14
6.5
151
52.6
Cameroon
14
16
C
54
79
64
Medium
12
5.8
430
53.9
HIGH RISK
Yemen
10
10
E
50
26
16
Low
2
7.6
330
55.7
Rwanda
6
21
C
47
80
22
High
10
6.2
300
56.0
Togo
13
12
E
47
81
42
Medium
10
6.6
420
57.2
Malawi
17
13
C
49
78
50
High
10
6.7
167
57.9
Burundi
6
9
C
68
80
19
High
3
6.7
800
58.3
Senegal
16
7
E
55
21
40
Low
4
6.0
933
59.3
Kenya
14
33
E
57
77
45
High
7
5.4
500
59.4
Nepal
10
23
C
75
9
6
Low
6
5.5
850
59.9
Guinea
24
5
C
56
36
25
Low
6
6.0
800
60.7
Mauritania
13
3
E
56
26
20
Low
6
6.5
800
61.3
Liberia
23
6
C
78
50
58
Medium
4
6.8
600
61.4
Nigeria
15
6
E
43
57
37
Medium
8
6.5
800
61.5
Haiti
5
10
E
64
52
40
High
7
5.8
600
62.3
Tanzania
13
10
E
80
90
53
High
10
6.3
342
62.5
Uganda
22
5
C
47
86
38
High
10
7.4
550
63.4
Burkina Faso
17
8
C
56
49
41
High
6
6.9
810
63.8
Sierra Leone
21
12
C
45
30
25
Medium
10
6.5
450
64.4
Mozambique
13
12
E
58
50
25
Medium
14
6.5
300
64.6
Afghanistan
15
2
E
75
8
8
Low
5
6.9
640
66.3
Central African Rep.
16
16
E
67
69
66
High
17
5.7
600
66.9
VERY HIGH RISK
Ethiopia
17
4
C
47
20
10
Medium
10
6.9
900
67.7
Chad
19
20
E
54
30
15
Medium
11
5.9
710
68.9
Côte d'Ivoire
23
3
E
56
66
40
High
10
7.4
680
70.0
Niger
22
4
E
47
30
15
Medium
9
7.4
700
70.3
Mali
20
5
E
65
31
27
Medium
8
7.1
1750
71.1
Congo
15
15
C
54
35
-
High
21
5.5
900
72.1
Somalia
21
5
E
73
2
2
Low
10
7.0
1100
72.8
Angola
24
2
E
54
25
15
Medium
12
6.6
650
73.5
Zaire
23
8
E
76
90
-
High
21
6.7
800
76.5
This 1995 report on World Progress Towards Population Stabilization includes countries
*Key to Abortion Policies:
with a population of two million or more. The following countries were dropped because
A available on request
data were only available for eight or fewer indicators- Bosnia and Herzegovina, Croatia,
R= permitted on broad social and health grounds
Eritrea, Greece, Ireland and Macedonia.
C= permitted on limited health grounds
Numbers in italics indicate estimates.
D = permitted only for special cases (rape, incest, to save a woman's life)
E = illegal or permitted only to save a woman's life
Population Action
Population Action International
1120 19th Street, NW, Washington, DC 20036
Telephone (202) 659-1833
Fax (202) 293-1795
International
CHANCE OF A WOMAN DYING
FROM COMPLICATIONS OF PREGNANCY,
CHILDBIRTH OR UNSAFE ABORTION
DURING HER LIFETIME
Italy
1
in
17,361
Norway
1
in
15,432
Australia
1
in
8,772
United States
1
in
5,669
Poland
1
in
3,608
Azerbaijan
1
in
3,429
Costa Rica
1
in
1,447
Cuba
1
in
1,286
Russia
1
in
1,021
Uzbekistan
1
in
484
China
1
in
439
Zimbabwe
1
in
217
Tunisia
1
in
199
Turkmenistan
1
in
152
Mexico
1
in
131
Indonesia
1
in
72
India
1
in
59
Bangladesh
1
in
30
Zaire
1
in
16
Mali
1
in
7