Induced abortion is an urgent public health problem that can be controlled if it is approached in its true complexity and with a social and humanist perspective. Induced abortion has been discussed in Chile since the last century, but not always openly. Abortion is not just an individual and collective medical problem, it is also an ethical, religious, legal, demographic, political, and psychological problem. Above all it is a problem of human rights. In the past 60 years, more than 50 countries representing 76% of the world population have liberalized their abortion legislation. Around 980 million women have some degrees of access of legal abortion. The magnitude of illegal abortion is difficult to determine because of the desire of women to hide their experiences. Estimates of the incidence of abortion in Chile made some 25 years ago are no longer valid because of the numerous social changes in the intervening years. The number of abortions in Chile in 1987 was estimated using an indirect residual method at 195,441, of which 90%, or 175,897, were induced. By this estimate, 38.8% of pregnancies in Chile end in abortion. Data on hospitalizations for complications of induced abortion show an increase from 13.9/1000 fertile aged women in 1940 to 29.1 in 1965. By 1987, with increased contraceptive usage, the rate declined to 10.5 abortions per 1000 fertile aged women. The cost of hospitalization for abortion complications in 1987, despite the decline, was still estimated at US $4.3 million, a large sum in an era of declining health resources. The problem of induced abortion can be analyzed by placing it in the context of elements affecting the desire to control fertility. 4 complexes of variables are involved: those affecting the supply of contraceptive, the demand for contraceptives, the various costs of fertility control measure, and alternatives to fertility control for satisfying various needs. The analysis is further complicated when efforts are made to understand the dynamics of the process. Awareness of fertility control is a social process that matures slowly. Contraception and abortion have different significance for fertility control, with contraception preventing pregnancy and abortion is a sense curing it. Chile has progressed far in its fertility control awareness. 2/3 of sexually active women use some form of contraception. At the same time, induced abortion is also used. It is estimated that 58% of abortions occur after a contraceptive failure. It appears that recourse to abortion would be minimized if strategies centered on supply of contraceptives were complemented by stronger efforts to develop awareness of fertility control. Delivery of contraceptives should be accompanied by complete information on their effective use. Efforts should be targeted especially at groups at high risk abortion, including adolescents and women hospitalized for complications.
Chile's 1st case of AIDS was diagnosed in 1984. Some 250 AIDS cases and 1600 HIV positive persons have since been reported, although the actual number by some estimates may reach 5000. Chile, although in the initial stages of the epidemic, already has a serious problem which at present can only be combatted through education. It will be necessary to convince the population that significant modifications of sexual behavior are needed to control the spread of the disease. Education for AIDS prevention is a priority of the National Commission on AIDS (CONASIDA), which is basing its program on the premise that stable monogamy is the most natural form of expression of a couple. Manuals for prevention are under development, and the 1st, for health workers and the general population, is in process of publication. A series of pamphlets and educational videos for workers in sexually transmitted disease clinics are under development. Educational materials are also being created for specific groups such as university students and agricultural workers and for groups at high risk. A social communications campaign has been prepared and approved by the authorities, and is awaiting funding for dissemination. Education of the population is also a concern for the Catholic Church, which views reinforcement of the family and its mission of providing sex education as a primary means of preventing AIDS. CONASIDA is also responsible for epidemiological study of AIDS in Chile through surveillance of sentinel groups and in quality control of the blood supply. Condoms are to be distributed in sexually transmitted disease clinics for the purpose of AIDS prevention.
3 small scale sex education programs developed in recent years by nongovernmental organizations in Chile are described. In 1 case, PAESMI cooperated with the Organization of American States to develop a sex education program for schools in the municipality of Estacion Central. The 1st phase involved training of 40 teacher-monitors who attended a 3-day workshop during the 1988 summer vacation. They later served as instructors for the remaining teachers in the 12 participating schools. Saturday workshops were held over 4 months to familiarize teachers with the program and its objectives. No specific curriculum was established; teachers were to introduce the topics at their discretion into the existing program. A methodological guide was prepared for preschool and primary children in 1988, and in 1989 the program was extended to older children. The majority of participating teachers were enthusiastic, but at present the Biomedical Extension Center of the University of Chile is teaching a course on foundations for human sexuality for educators. It provides teachers with an improved factual basis to complement the stress on attitudes and ethics of the earlier course. A segment of the original course dealing with attitudes toward pornography is included. The 2nd program was a 10-session workshop organized by 4 psychologists, 2 teachers, and a midwife belonging to the Father Andre Jarlan Center for Research and Action in People's Health (CIASPO) for students in 4 intermediate schools in the commune of Santiago. The objective of CIASPO, a nongovernmental organization founded in 1985, is to provide sex education from a multidisciplinary perspective to enable students to assume responsibility for their own sexuality and improve attitudes. The workshop stressed the importance of the body, sentiments, and emotions, examined culture and sex roles, and contraceptive methods. A preworkshop evaluation questionnaire indicated that the participants had a deficient knowledge of sexuality. Workshop organizers emphasized the need for support from school authorities in implementing sex education programs. The final sex education initiative consisted of a mental health program developed by a group of professional women who worked with lower class urban women. The Center for Development of Women (DOMOS) began its work in the area of female sexuality, but by 1987 had become specialized in the mental health of women. DOMOS has a program of shortterm individual psychotherapy and a program of preventive education consisting of workshops on different themes lasting 4-12 weeks each. A sexuality workshop was held to help participants understand their sexuality as a natural function and an important part of human life.
The Catholic Church and the Christian faith in general have been accused of a history of sexual repression and denunciation of the dangers of all expressions of sexuality as well as of neglecting sex education within religious education. This work seeks to analyze the apparent conflict between Christian ethics and the experience of modern sexuality, and discusses the response of Christian ethics to the conflict. Beginning at the Renaissance and for the entire modern epoch, a moral system that might be called secularized has confronted that of the Church; it has been more liberal, utilitarian, and hedonistic in sexual matters. In the course of becoming more permissive, human sexuality like so many other aspects of modern culture has lost most of its sacred character. The sexual sphere in modern cultural and moral development is 1 of the aspects in which morals and customs are most distanced from religious influence. Despite the great sexual permissiveness of the mass media and the culture at large, adolescents and youth of today do not appear to have advanced any closer to a general state of happiness. Sexuality today--despite whatever sex education is available--is still enveloped in the same ignorance, feat, complexes, and conflicts as ever. The youth of today should have access to better sex education, they should be liberated from both religious taboos that impede health sexual adjustment and from the sexual permissiveness celebrated in much of the mass media. Teachers and moralists should engage in a dialogue in which the problem of sex education is examined in its complexity in order to identify elements of an improved process that would lead to a true humanization. An ethics that goes beyond the permissiveness of the present is needed, but it should not be based on fear of AIDS, fear of pregnancy, or any other fears or threats. A positive secular ethics moved by natural motivations and a Christian ethics motivated by faith in the love of God should appear more frequently and clearly in social commentaries, instead of the usual advice to shed all inhibitions. Human sexuality should be examined in the context of the other elements of the interior life, including affectivity, liberty, and religiosity.
Respiratory viruses and their complications are the most common diseases after dental caries, and the most important single cause of medical consultations. They are the 2nd leading cause of hospitalization and mortality in infants. The challenge in respiratory infections is to prevent complications. Since most respiratory infections are treated in the home, preventive interventions should begin there. Respiratory infections do not depend greatly on environmental conditions, they are not preventable by vaccination, and their course in the great majority of cases is self-limiting and benign. Respiratory viruses are characterized by a symptom complex which represents the reaction of the organism to the viral infection. Although the symptoms may be annoying, they play an important role in preventing bacterial complications. Nasal secretions contain substances that limit the virus and impede secondary bacterial infection. Nasal congestion should be treated only by aiding the evacuation of secretions. Nasal obstruction and resulting respiration through the mouth allow unfiltered air to reach the bronchial passages, causing irritation or contamination. Use of local or systemic decongestants or antihistamines may contribute to complications by decreasing defenses. Treatment of inflamed pharynx or tonsils with antiinflammatories is counterproductive because it too interferes with the body's defenses against viral invasion. Viral laryngitis should be treated only with steam vapor and never with steroids, which diminish the body's antiviral defenses and can produce serious side effects. Coughs are the body's means of evacuating viral secretions and should be aided only by ensuring adequate hydration to maintain the fluidity of the secretions. Expectorants should be used only in cases of chronic bronchitis. Coughs resulting from bronchial obstruction, cases in which bronchial dynamics are hyperactive, and dry and unproductive coughs resulting from pharyngeal irritation are the only ones that should be treated. Fever it probably the defense mechanism that has elicited the greatest treatment efforts. Lowering the fever through medication does nothing to fight the virus but makes children feel well enough to resume playing outside, thereby increasing the risk of secondary bacterial infection. Children with fevers should be kept hydrated. Only in the case of pain should medication be given to lower the fever. Aspirin should be avoided in children. An untreated fever provides information on the course of the disease: spontaneous decline followed by a rise may indicate bacterial infection.
