YCLOAK

Worldwide cesarean section use has nearly doubled in two decades and has reached “epidemic” proportions in some countries, doctors warned Friday, highlighting a huge gap in childbirth care between rich and poor mothers.

They said millions of women each year may be putting themselves and their babies at unnecessary risk by undergoing C-sections at rates “that have virtually nothing to do with evidence-based medicine.”

In 2015, the most recent year for which complete data is available, doctors performed 29.7 million C-sections worldwide, or 21 percent of all births. This was up from 16 million in 2000, or 12 percent of all births, according to research published in The Lancet.

It is estimated that the operation, a vital surgical procedure when complications occur during birth, is necessary 10-15 percent of the time.

Varying country rates

But the research found wildly varying country rates of C-section use, often according to economic status: In at least 15 countries, more than 40 percent births are performed using the practice, often on wealthier women in private facilities.

In Brazil, Egypt and Turkey, more than half of all births are done via C-section.

The Dominican Republic has the highest rate of any nation, with 58.1 percent of all babies delivered using the procedure.

But in close to a quarter of nations surveyed, C-section use is significantly lower than average.

Reasons to opt for surgery

Authors pointed out that while the procedure is generally overused in many middle- and high-income settings, women in low-income situations often lack necessary access to what can be a life-saving procedure.

“We would not expect such differences between countries, between women by socioeconomic status or between provinces/states within countries based on obstetric need,” Ties Boerma, professor of public health at the University of Manitoba, Winnipeg, and a lead author on the study, told AFP.

Jane Sandall, professor of social science and women’s health at King’s College London and a study author, told AFP that there were a variety of reasons women were increasingly opting for surgery.

These include “a lack of midwives to prevent and detect problems, loss of medical skills to confidently and competently attend a vaginal delivery, as well as medico-legal issues.”

Doctors are often tempted to organize C-sections to ease the flow of patients through a maternity clinic, and medical professionals are generally less vulnerable to legal action if they choose an operation over a natural birth.

Sandall also said there were often “financial incentives for both doctor and hospital” to perform the procedure.

The study warned that in many settings young doctors were becoming “experts” in C-section while losing confidence in their abilities when it comes to natural birth.

Income a factor

It also identified an emerging gap between wealthy and poorer regions within the same country. In China, C-section rates diverged from 4 percent to 62 percent; in India the range was 7-49 percent.

While the U.S. saw more than a quarter of all births performed by C-section, some states used the procedure more than twice as often as others.

“It is clear that poor countries have low C-section use because access to services is a problem,” Sandall said. “In many of those countries, however, richer women who live in urban areas, have access to private facilities have much higher C-section use.”

Risks to mother, child

C-sections may be marketed by clinics as the “easy” way to give birth, but they are not without risks.

Maternal death and disability rates are higher after C-section than vaginal birth. The procedure scars the womb, which can lead to bleeding, ectopic pregnancies (where the embryo is stuck in the ovaries), as well as still- and premature future births.

The authors suggested better education, more midwifery-led care and improved labor planning as ways of ensuring C-sections are only performed when medically necessary, as well as ensuring women properly understand the risks involved with the procedure.

“C-section is a type of major surgery, which carries risks that require careful consideration,” Sandall said.

In a comment accompanying the study, Gerard Visser of the University Medical Centre in the Netherlands, called the rise in C-sections “alarming.”

“The medical profession on its own cannot reverse this trend,” he said. “Joint actions are urgently needed to stop unnecessary C-sections and enable women and families to be confident of receiving the most appropriate care for their circumstances.”
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Parties to a new global treaty to combat the illicit sale of tobacco products have taken the first steps toward cracking down on this multi-billion dollar trade.  At a three-day meeting at the headquarters of the World Health Organization in Geneva they have outlined a plan to shut down the lucrative black market trade in tobacco.

A global tobacco treaty (Protocol to Eliminate Illicit Trade in Tobacco Products) entered into force on September 25, with 48 countries joining the new protocol, which is part of the WHO Framework Convention for Tobacco Control (FCTC).  Two-thirds of the parties have enacted or strengthened national legislation aimed at tackling illicit trade in tobacco products.

Parties attending the meeting have set up a working group to create a monitoring system to track and trace the movement of tobacco products. They hope this global information sharing system will be up and running by 2023.  

Head of the FCTC Secretariat, Vera da Costa e Silva, says illicit trade accounts for one in 10 cigarettes consumed.  She says these cigarettes are low-priced and more affordable for young people and vulnerable populations.  She says this results in increased consumption of the toxic product by these groups.

She told VOA the black market in tobacco thrives in both rich and poor countries, but it is a much bigger problem in developing countries.

“In the streets of developing countries, you can see all over the world sales of illicit trade of tobacco products.  They are openly in their markets…. When it comes to the distribution, this is linked to street sales, to bootlegging as well through borders and even to sales to and by minors.  That is a real problem of illicit trade in tobacco products,” she said.

Da Costa e Silva said this flourishing illegal trade undermines tobacco control policies and public health.  She said it also fuels organized crime and increases tobacco profits through tax evasion, resulting in substantial losses in governments’ revenues.   

She said studies show governments lose $31 billion in taxes annually from the illegal trafficking in tobacco products.  

The World Health Organization reports seven million people die prematurely every year from tobacco-related causes.

 
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Health officials say the rate of new Ebola cases has more than doubled since September after rebel violence in northeastern Congo caused response efforts to be briefly suspended.

 

In a statement on Thursday, the International Rescue Committee says it is “alarmed” that there were 33 new cases between October 1 and Tuesday, versus 41 cases during all of September.

 

Officials say most of the new cases have been in Beni, where experts had to suspend Ebola containment efforts for days after a deadly rebel attack.

 

Earlier this week, the World Health Organization noted that all of the health workers who have caught Ebola in this epidemic have been infected outside of hospitals or clinics, meaning that the virus is spreading in the community.

 
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A U.S. astronaut and Russian cosmonaut are safe following an emergency return to Earth minutes after launching on what was supposed to be a mission to the International Space Station.

The U.S. National Aeronautics and Space Administration (NASA) said a booster on the Soyuz spacecraft failed after it took off Thursday from the Soviet-era cosmodrome in Baikonur, Kazakhstan.

“At that point, per the standard procedure, an abort was initiated,” International Space Station Operations Integration Manager Kenny Todd told reporters.

“My heart was beating hard,” astronaut Reid Weisman said of the moment he heard the booster had malfunctioned during his colleagues’ launch.

It was the latest in a string of recent failures for the Russian space program, which also takes American astronauts to the station.

Russian officials said they are investigating the incident, adding that all manned space flight missions would be suspended until investigators figure out what went wrong.

Officials said U.S. astronaut Nick Hague and Roscosmos’ Alexei Ovchinin experienced 6 to 7 times Earth’s gravity, followed by a brief moment of weightlessness, as they separated from the booster before falling to Earth.

Rescuers reached the crew after they landed in Kazakhstan, and both were in good condition. They are now reunited with their families.

Thursday was supposed to be Hague’s first time in space.

Hague, who is an Air Force colonel, was the first member of his class to be assigned to a mission. Todd said there was “no doubt” Hague would be selected for another mission, but it was “yet to be determined” when that would occur.

In an interview with VOA prior to the launch, Hague said he was excited and ready, but also nervous.

“Sitting on top of a rocket for the first time and being shot into space, you know, how can you not be nervous?” he said.

Hague spent the last five years preparing for his mission. When he gets the chance, he will serve as a flight engineer on the International Space Station, doing everything from maintenance of the aircraft to scientific research to study the effects of weightlessness.

The International Space Station is the largest space collaboration ever. Fifteen countries built and operate the live-in satellite, an “unprecedented” feat, according to John Logsdon, a professor emeritus at George Washington University’s Space Policy Institute.

“One of the real payoffs with benefits is to demonstrate peaceful collaboration, not only between allies, but between the United States and Russia, even in spite of all the current political tensions between the two countries,” Logsdon said.

Hague told VOA he enjoys working with space explorers from all over the country and world.

Typically, five to seven astronauts man the ISS at one time. Only about 250 people have ever lived on the International Space Station, which celebrates its 20th year in orbit next month.
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NASA says that two astronauts from the U.S. and Russia are in good condition after an emergency landing following booster rocket failure minutes after the launch.

U.S. astronaut Nick Hague and Roscosmos’ Alexei Ovchinin lifted off as scheduled at 2:40 p.m. (0840 GMT; 4:40 a.m. EDT) Thursday from the Russia-leased Baikonur cosmodrome in Kazakhstan atop a Soyuz booster rocket.

They were to dock at the orbiting outpost six hours later, but the booster suffered a failure minutes after the launch.

The two made an emergency landing in Kazakhstan at an unspecified time. Search and rescue crews scrambled to reach the expected landing site.

It’s the first space mission for Hague, who joined NASA’s astronaut corps in 2013. Ovchinin spent six months on the station in 2016.

Relations between Moscow and Washington have sunk to post-Cold War lows over the crisis in Ukraine, the war in Syria and allegations of Russian meddling in the 2016 U.S. presidential vote, but Russia and the U.S. have maintained cooperation in space.

 
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An estimated 44 million people 65 years and older worldwide have Alzheimer’s, the most common cause of dementia. Alzheimer’s is a degenerative brain disorder that causes memory loss, and impairs thinking, judgment and problem solving. So far, scientists have not found a drug that can stop the disease. But a research program in the United States is trying to prevent it by targeting the earliest changes in the brain while memory and thinking skills are still intact. VOA’s Deborah Block has more.
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Australia is rejecting the latest U.N. report on climate change, insisting coal remains critical to energy security and lowering household power bills.

The United Nations’ Intergovernmental Panel on Climate Change (IPCC) said in its report released Monday that global greenhouse gas emissions must reach zero by the middle of the century to stop global warming exceeding 1.5 degrees Celsius.

The authors warned that if warming was allowed to reach two degrees, the world would be on course toward uncontrollable temperatures.

They made special mention of coal, insisting that its use for power generation would have to fall to between zero and two percent of current usage.

The report has received a lukewarm response by Australia’s center-right government. It has said it has no intention of scaling back fossil fuel production because without coal, household power bills would soar.

Canberra also insists it is on target to meet its commitments under the Paris agreement, which attempts to unite every nation under a single accord to tackle climate change for the first time ever.

Australia earns billions of dollars exporting coal to China and other parts of Asia, while it generates more than 60 percent of domestic electricity.

Australia’s Environment Minister Melissa Price believes the IPCC report exaggerates the threat posed by fossil fuel.

“Coal does form a very important part of the Australian energy mixer and we make no apology for the fact that our focus at the moment is on getting electricity prices down,” Price said. “Every year, there is new technology with respect to coal and what its contribution is to emissions. So, you know, to say that it has got to be phased out by 2050 is drawing a very long bow.”

Australia has some of the world’s highest per capita rates of greenhouse gas pollution. A recent government report showed a failure to reduce levels of greenhouse gas pollution. The survey said that between January and March this year, Australia had its most elevated levels of carbon pollution since 2011.

Conservationists argue Australia is doing too little to protect itself from the predicted ravages of a shifting climate.

Australia is the world’s driest inhabited continent. Scientists warn that droughts, floods, heat waves, brush fires and storms will become more intense as temperatures rise, with potentially disastrous consequences for human health and the environment, including the Great Barrier Reef.
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America’s recycling industry is in the dumps.

A crash in the global market for recyclables is forcing communities to make hard choices about whether they can afford to keep recycling or should simply send all those bottles, cans and plastic containers to the landfill.

 

Mountains of paper have piled up at sorting centers, worthless. Cities and towns that once made money on recyclables are instead paying high fees to processing plants to take them. Some financially strapped recycling processors have shut down entirely, leaving municipalities with no choice but to dump or incinerate their recyclables.

 

“There’s no market. We’re paying to get rid of it,” says Ben Harvey, president of EL Harvey & Sons, which handles recyclables from about 30 communities at its sorting facility in Westborough, Massachusetts. “Seventy-five percent of what goes through our plant is worth nothing to negative numbers now.”

 

It all stems from a policy shift by China, long the world’s leading recyclables buyer. At the beginning of the year it enacted an anti-pollution program that closed its doors to loads of waste paper, metals or plastic unless they’re 99.5 percent pure. That’s an unattainable standard at U.S. single-stream recycling processing plants designed to churn out bales of paper or plastic that are, at best, 97 percent free of contaminants such as foam cups and food waste.

 

The resulting glut of recyclables has caused prices to plummet from levels already depressed by other economic forces, including lower prices for oil, a key ingredient in plastics.

 

The three largest publicly traded residential waste-hauling and recycling companies in North America — Waste Management, Republic Services and Waste Connections — reported steep drops in recycling revenues in their second-quarter financial results. Houston-based Waste Management reported its average price for recyclables was down 43 percent from the previous year.

 

“A year ago, a bale of mixed paper was worth about $100 per ton; today we have to pay about $15 to get rid of it,” says Richard Coupland, vice president for municipal sales at Phoenix-based Republic, which handles 75 million tons of municipal solid waste and 8 million tons of recyclables nationwide annually. “Smaller recycling companies aren’t able to stay in business and are shutting down.”

 

Kirkwood, Missouri, announced plans this summer to end curbside recycling after a St. Louis-area processing facility shut down. Officials in Rock Hill, South Carolina, were surprised to learn that recyclables collected at curbside were being dumped because of a lack of markets. Lack of markets led officials to suspend recycling programs in Gouldsboro, Maine; DeBary, Florida; Franklin, New Hampshire; and Adrian Township, Michigan. Programs have been scaled back in Flagstaff, Arizona; La Crosse, Wisconsin; and Kankakee, Illinois.

 

Other communities are maintaining recycling programs but taking a financial hit as regional processors have raised rates to offset losses. Richland, Washington, is now paying $122 a ton for Waste Management to take its recycling; last year, the city was paid $16 a ton for the materials. Stamford, Connecticut, received $95,000 for recyclables last year; the city’s new contract requires it to pay $700,000.

 

A big part of the problem, besides lower commodity prices overall, is sloppy recycling.

 

In the early days of recycling, people had to wash bottles and cans, and sort paper, plastic, glass and metal into separate bins. Now there’s single-stream recycling, which allows all recyclables to be tossed into one bin. While single-stream has benefited efficiency, and customers like it, it’s been a challenge on the contamination side.

 

A tour of Republic’s facility in Beacon, about an hour’s drive north of New York City, makes the challenges clear. A third of the material dumped by collection trucks is non-recyclable “contaminants” such as garden hoses, picnic coolers and broken lawnmowers. Workers have to pull that out and truck it to a landfill, adding to overall costs. Plastic bags contaminate bales of other materials and tangle machinery. Spilled ketchup and greasy pizza boxes turn otherwise marketable material into garbage.

 

“The death of recycling was completely avoidable and incredibly easily fixed,” says Mitch Hedlund, executive director of Recycle Across America, which advocates standardized labeling on recycling bins so people understand what goes in and what doesn’t.

 

A range of initiatives have been launched to get people to recycle right. Chicago is putting “oops” tags on curbside recycling bins with improper contents and leaving them uncollected. Rhode Island is airing “Let’s Recycle Right” ads.

 

While some recyclables have been diverted to other Asian markets since China’s closure, there are also signs of market improvement in the U.S. to offset the lost business, said David Biderman, CEO and executive director of the Solid Waste Association of North America. He noted Chinese paper manufacturers that had relied on recyclables imported into their country have recently purchased shuttered mills in Kentucky, Maine and Wisconsin.

 

Meanwhile, recyclable materials processors are re-negotiating contracts with municipalities to reflect the fact that prices paid for recyclables no longer offset the cost of collecting and sorting them.

 

“What we’re advocating is to step back and re-look at recycling,” Republic’s Coupland said. “This is the new normal. The model no longer funds itself.”

 
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Nearly 77 years after repeated torpedo strikes tore into the USS Oklahoma, killing hundreds of sailors and Marines, Carrie Brown leaned over the remains of a serviceman laid out on a table in her lab and was surprised the bones still smelled of burning oil from that horrific day at Pearl Harbor.

It was a visceral reminder of the catastrophic attack that pulled the United States into World War II, and it added an intimacy to the painstaking work Brown and hundreds of others are now doing to greatly increase the number of lost American servicemen who have been identified.

 

It’s a monumental mission that combines science, history and intuition, and it’s one Brown and her colleagues have recently been completing at ramped-up speed, with identifications expected to reach 200 annually, more than triple the figures from recent years.

 

“There are families still carrying the torch,” said Brown, a forensic anthropologist with the Defense POW/MIA Accounting Agency’s lab near Omaha, Nebraska. “It’s just as important now as it was 77 years ago.”

 

Officials believe remains of nearly half of the 83,000 unidentified service members killed in World War II and more recent wars could be identified and returned to relatives. The modern effort to identify remains started in 1973 and was primarily based in Hawaii until a second lab was opened in 2012 at Offutt Air Force Base in the Omaha suburb of Bellevue.

 

With an intensified push, the identifications climbed from 59 in 2013 to 183 last year and at least 200 and possibly a few more this year.

 

The increase has led to a surge of long-delayed memorial services and burials across the country as families and entire communities turn out to honor those killed.

 

Joani McGinnis, of Shenandoah, Iowa, said her family is planning a service Friday at the national cemetery in Omaha now that they have finally learned what happened to her uncle, Sgt. Melvin. C. Anderson.

 

Piecing together bits of history and DNA, the Omaha lab confirmed that remains found in 1946 in Germany were Anderson’s and that he died when his tank was hit in the rugged Hurtgen Forest during a battle that lasted for months and left tens of thousands of Americans killed and wounded.

 

Besides returning the remains, McGinnis said the agency gave her a thick file with details about how he died and how researchers unraveled the mystery.

 

“I wish my mom and my grandma were here to know all this information,” said McGinnis, who recalled a framed picture of Anderson that hung in her grandmother’s home in Omaha. “My grandmother was very sad about it. She just wanted to know what happened, and she never knew.”

 

In Kentucky, thousands of people lined roads for miles on a steamy August day to see a hearse carrying the remains of Army Pfc. Joe Stanton Elmore from the Nashville, Tennessee, airport to the small city of Albany.

 

Elmore was reported missing in action in December 1950 after an intense battle at the Chosin Reservoir in Korea and as deceased in 1953, but his great-niece April Speck said even decades later, her family would tell stories of “Joe going off to war and never coming home.” Speck said she knew her family would feel a sense of relief that his remains were finally returned, but she didn’t realize what it would mean to her community.

 

“There were people standing out with their signs and there were retired soldiers in their uniforms saluting, and then we get into Albany and it like was a sea of people with all the American flags,” she recalled. “The county did an awesome job of showing respect.”

 

The soaring number of identifications followed years of complaints about a cumbersome process, typically resulting in about 60 completed cases annually. Congress responded by setting a goal of 200 identifications annually, and it supported a reorganization and increased funding that saw spending climb from $80.8 million in the 2010 fiscal year to $143.9 million in 2018.

 

The effort now employs about 600 people.

 

Officials have streamlined the work of determining which remains should be disinterred. Historians focus on where clusters of servicemen died, and examine troop movements and conduct interviews with local residents.

 

“This work is very different from what most historians do,” said Ian Spurgeon, an agency historian in Washington. “This is detective history.”

 

Spurgeon’s focus is on battles in Europe and the Mediterranean, with a goal of disinterring 50 service members annually, up from fewer than five.

 

At Offutt, inside a lab built in a former World War II bomber factory, bones are arranged by type on black-topped tables. In another room, buttons, fabrics, coins and other items found alongside remains are studied for hints about a service member’s role or hometown.

 

DNA is key to identifications, but it can’t be extracted from all bones, and without a match from potential relatives, it has little value.

 

In some cases, lab workers refer to standard chest X-rays of World War II servicemen taken when they enlisted, focusing on the traits of the collarbones shown. An algorithm developed by the University of Nebraska-Omaha helps workers make comparisons of remains in minutes.

 

For Patricia Duran, the result has been finally learning what happened to her uncle, Army Air Forces Sgt. Alfonso O. Duran, who died in 1944 when his B-24H Liberator bomber was shot down. His remains were disinterred from a grave in Slovenia and identified this spring.

 

Duran had for years sought information about her uncle’s remains, and she said she clutched her cousin’s hand while watching him be buried Aug. 22 at Santa Fe National Cemetery, about 50 miles (80 kilometers) from his childhood home in the small mountain community of El Rito, New Mexico.

 

“We felt such a sense of closure about it because the whole family heard the stories” about him. “We felt we knew Alfonso,” she said. “We felt he’d come home.”

 
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