This article presents harm reduction, which was recently developed in response to the expansion of injection drug use and the HIV/AIDS epidemic. The authors describe the essence of harm reduction, proposing that harm reduction is a pragmatic strategy from a public health perspective to deal with injection drug use. Also, how harm reduction complements the traditional strategies to eradicate illicit drug use based on abstinence (so called, War on Drugs, or Just Say NO) is discussed. By describing key principles of harm reduction, such as low-threshold programs, non-judgmental attitudes, priority of immediate goals, and balancing costs and benefits, the authors introduce major harm reduction programs, which include needle/syringe exchange, outreach, counseling and education, supervised injection sites, and substitution treatment. Substantial evidence demonstrates harm reduction is effective in preventing the spread of HIV. Although international bodies, such as UNAIDS and WHO, advocate harm reduction strategies for the better prevention from the spread of HIV/AIDS, and some countries have adopted national harm reduction policies, United States discourages harm reduction policies in fighting the global HIV/AIDS pandemic. Finally, the authors address the effectiveness of harm reduction from the public health perspectives to deal with AIDS epidemic among injection drug users and the necessity of comprehensive understanding and multifaceted application of harm reduction. They also present the need to rethink Japanese government policies and social programs to meet drug users' health needs.

Objectives

  The aim of this study was to investigate the knowledge, attitude, and practice (KAP) of healthcare providers regarding the utilization of oxytocin for induction or augmentation of labor.

Methods

  A qualitative study composed of direct observation and individual interview was conducted at a national tertiary maternity hospital in Phnom Penh, Cambodia in January and February 2013. The progress of labor in women who received oxytocin for induction or augmentation of labor was directly observed to confirm the healthcare providers’ management of oxytocin infusion. The attending doctors and midwives were individually interviewed after the women delivered.

Results

  During the study period, 10 women were observed, and 12 healthcare providers (three doctors and nine midwives) were interviewed individually. Indications for labor induction or augmentation seemed to be appropriate for nine women. However, we found discrepancies between the national protocol and healthcare providers’ knowledge and actual practices. For example, 11 healthcare providers had never read the national protocol for the management of labor induction and augmentation, which implied limited access to the correct knowledge. A misconception was noted in that the sudden increase of oxytocin was not dangerous during the second stage of labor, despite the establishment of a good contraction pattern. Furthermore, a lack of unified initial dose and extremely high maximum dose above that recommended by the national protocol were observed. About half of observed women were not monitored for more than 2 hours from the beginning of oxytocin infusion.

Conclusion

  　In the present study, lack of knowledge, misconceptions regarding the management of oxytocin infusion, and a large gap between the national protocol and the actual clinical practices were confirmed. To maximize patient safety and therapeutic benefit, dissemination of the national protocol through in-service training is required.

Introduction  The Sustainable Development Goals adopted at the 2015 United Nations Summit emphasized the importance of global partnerships for the realization of sustainable goals by 2030. The concept of “humanization of childbirth” was central idea of the international technical cooperation “Maternal and Child Health Improvement Project” that was successfully implemented in Brazil from 1996 to 2001. Further, this concept was introduced through relevant laws and legislations in other countries in Latin American countries. Under this umbrella, the current study was constituted to describe how the concept of humanization of childbirth has contributed to the development of relevant regulations, as well as to examine the regional expansion and sustainability of the concept in Latin American countries.Methods  We searched the websites of governments and ministries of health in 20 Latin American countries for relevant laws and regulations and international technical cooperation projects in the field of maternal and child health. We particularly searched for legislations and projects which employed phrases such as “humanization of childbirth” and “humanized care.” Further, we analyzed laws and regulations in these countries to understand how the humanization of childbirth was perceived.Results  By 2018, 16 countries had passed laws and regulations regarding the humanization of childbirth and four have implemented international technical cooperation projects. Five among them passed laws which focusing on the humanization of childbirth itself and incorporated the concept into the comprehensive care.Conclusions  Following the implementation of the project in Brazil, the concept was legalized throughout Latin America. The humanization of childbirth concept aimed to guarantee respect toward and dignity of all human beings. Finally, the development of each legal provision with the intention of incorporating the idea of humanization of childbirth into the comprehensive care services offered by the maternal and child health sector has improved the concept’s sustainability.