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Induced Abortion and Unintended Pregnancy in Guatemala
Although Guatemalan law permits induced abortion only to save a woman's life, many women obtain abortions, often under unsafe conditions and in response to an unintended pregnancy. Recent studies indicate that unsafe abortion is a key factor contributing to maternal morbidity and mortality in the country, but no national data on the incidence of abortion exist.
Surveys of all hospitals that treat women for postabortion complications and of 74 professionals who are knowledgeable about the conditions of abortion provision in Guatemala were conducted in 2003. Indirect estimation techniques were used to calculate the number of induced abortions performed annually. Abortion rates and ratios and the level of unintended pregnancy were calculated for the nation and its eight regions.
Nearly 65,000 induced abortions are performed annually in Guatemala, and about 21,600 women are hospitalized for treatment of complications. Abortions occur at a rate of 24 per 1,000 women aged 15–49, and there is one abortion for every six births. The abortion rate is higher than average in the Southwest (less developed, mainly indigenous population) and Metropolitan (more developed, mainly nonindigenous population) regions (29–30 per 1,000 women). Over a quarter of all births are unplanned; combining unplanned births with abortions yields estimates that 32% of pregnancies in Guatemala are unintended, with an unintended pregnancy rate of 66 per 1,000 women.
Unsafe abortion has a significant impact on women's health in Guatemala. Comprehensive government programs are needed to address the issues of unintended pregnancy and unsafe abortion, with attention to regional differences.
International Family Planning Perspectives, 2006, 32(3):136–145
Unsafe abortion is a leading cause of reproductive morbidity and mortality in countries where abortion is illegal or severely restricted, as is the case in Guatemala.* In these settings, abortion is a clandestine event that is poorly documented and difficult to study. Little empirical research on abortion has been conducted in Guatemala, and no national-level data on abortion incidence are available. As a result, there is limited public awareness of the issue of unsafe abortion, its consequences for women's health or its impact on the health care system.
In Guatemala, abortion is against the law except to save a woman's life.1 Nonetheless, the little evidence that is available suggests that induced abortion is common. Much of this evidence is based on women hospitalized for treatment of abortion complications. However, Ministry of Health reports of the number of women treated for abortion complications in all hospitals are acknowledged to be undercounts.2 A large-scale surveillance initiative, part of the Postabortion Care Program of the Epidemiological Research Center in Sexual and Reproductive Health (CIESAR), reported that 13,928 incomplete abortions were treated in 22 public hospitals between July 2003 and December 2004.3 Other hospital-based studies further support the conclusion that induced abortion is common. One study of abortion patients treated in six hospitals between August 1993 and July 1994 found that about 50% were likely to have had induced abortions4; a 1995 Ministry of Health study found that 76% of abortion patients in seven hospitals had had a previous abortion.5 Treatment of abortion complications results in substantial costs to hospitals: In a study conducted over five months in 2000 at a Coatepeque hospital, 30% of the maternity budget and 10% of the total hospital budget were spent treating abortion complications.6
According to a recent government study on maternal mortality, abortion is the third most important cause of maternal deaths.7 A four-year surveillance program carried out in the Guatemala City metropolitan area found that between 1993 and 1996, 110 of 435 maternal deaths were due to infection, and 34 of these were related to induced or spontaneous abortion.8 The study did not provide a breakdown by type of abortion, but it is likely that induced abortion was a key factor.
In Guatemala, as in other countries, women may resort to abortion when they have an unintended pregnancy. Some are unable to care for a child; some already have all the children they want; others do not want the pregnancy because it is the result of forced sex or incest; and some women's lives or health are at risk if they continue with the pregnancy. A number of other factors also contribute to unintended pregnancy and abortion, including insufficient and inaccurate information about contraception, inadequate access to services and supplies, and incorrect and inconsistent contraceptive use. Survey data from 2002 showed that, on average, actual family size was 4.4 but the desired size was 3.7, and that 28% of all recent births were unplanned, a level similar to the 29% estimated for Latin America.9 Although overall contraceptive use increased from 23% in 1987 to 43% in 2002,10 this is still substantially lower than use in the region as a whole (71%).11 In addition, between 1987 and 2002, the unmet need for contraception among currently married Guatemalan women grew from 19% to 28%.
The government of Guatemala has recently enacted policies and plans to improve women's reproductive health, but no studies have assessed their impact.12 However, the issue of maternal death and illness resulting from unsafe abortion has not been properly addressed, and the lack of comprehensive and reliable data makes effective action difficult. Because unsafe abortion is a critical factor in maternal morbidity and mortality in Guatemala, and because it represents a significant cost for meager hospital budgets, quantitative indicators are needed to assess the extent of the practice, how it affects women's health and how reproductive health services, including postabortion care, could be improved.
In this article, we apply an established indirect estimation methodology and draw on new data collected from health facilities and health professionals to generate estimates for the basic indicators of unsafe abortion in Guatemala—the number of women hospitalized each year for the treatment of complications following unsafe induced abortions, and national and regional estimates of the incidence of induced abortion. In addition, we combine these abortion data with survey and other data on the planning status of births to obtain estimates of the rate of unintended pregnancy among Guatemalan women.
Data Sources
The key data sources for the estimates of abortion incidence were two surveys designed and fielded for this study—a survey of hospitals that treat postabortion patients and a survey of knowledgeable key informants. The study design and protocols were based on prior research that developed a methodology for estimating abortion incidence, and were adapted to the Guatemalan situation.13 Questionnaires for both surveys were pretested in early September 2003; the surveys were fielded from late September through October 2003. Details of the study design and fieldwork are described below.
Other data sources included the 1995 Demographic and Health Survey (DHS) and the 2002 Guatemala National Survey of Maternal and Child Health (ENSMI), which provide information on contraceptive use, planning status of births and unmet need for contraception. Sample sizes were 12,403 and 9,155 women aged 15–49 for the DHS and ENSMI, respectively. Although the 1995 survey did not include the Petén region, both surveys were based on nationally representative samples.†
•Health Facilities Survey. An inventory of hospitals was drawn from Ministry of Health lists and telephone directories; this list was updated during fieldwork with information provided by respondents. A total of 225 hospitals were initially identified. Of these, 42 were eliminated; 23 did not provide treatment for abortion complications, 13 did not exist at the time fieldwork was carried out and six were listed twice. Because the number of hospitals that provide postabortion care in Guatemala is relatively small, all 183 of the eligible hospitals—127 private and 56 public facilities—were surveyed. Public facilities are those operated by any branch of government, and include hospitals that are part of the Social Security system.
The respondent for each hospital was the senior professional deemed the most knowledgeable about the postabortion care provided at the facility, and was typically the chief of the obstetrics and gynecology department or an obstetrician-gynecologist. In five cases, we interviewed the next most senior professional. We completed interviews for 178 hospitals; of the five missing cases (all of which were private facilities), two respondents did not complete the interview and three refused to be interviewed, resulting in an overall response rate of 97%. The response rate was 96% for private hospitals and 100% for public hospitals.
The Health Facilities Survey provided estimates of the number of women treated for postabortion complications. Respondents were asked a series of questions, including: whether treatment of abortion complications is provided in an outpatient or inpatient setting, or both; and for the categories that apply, the total number of postabortion patients (spontaneous and induced) treated as outpatients and inpatients in the average month and in the past month. Specifying these two time frames increased the likelihood of accurate recall and of capturing variation from month to month. These two numbers were averaged and multiplied by 12 to produce an estimate for the calendar year. This information formed the basis for estimating the incidence of abortion using an indirect estimation methodology, described below.
•Health Professionals Survey. On the basis of information gathered from program planners and other stakeholders, the research team prepared a list of health professionals who were known to be familiar with postabortion services, covering all sectors and a wide range of professions, including clinicians, policymakers, researchers and women's activists. A purposive sample of 85 professionals was selected, and 74 were successfully interviewed. These professionals came from 21 of the 22 departments of Guatemala (Petén, the most remote and difficult to reach, was not represented in the survey). The majority were working in urban areas, but an effort was made to include professionals who were familiar with the conditions related to abortion in rural areas and among indigenous women. Of the entire group, 30% had worked in rural areas for six months or longer and about one in seven worked primarily in rural areas; 51% felt they were knowledgeable about both indigenous and nonindigenous populations (7% felt knowledgeable about only the indigenous and 42% about only the nonindigenous population).
The Health Professionals Survey was designed to elicit the perceptions of knowledgeable key informants on various aspects of induced abortion in Guatemala. This survey provided the necessary information to calculate the "multiplier" factor, which is used to adjust the estimate of the number of women who have induced abortions to include those who experience no complications, those who do not seek medical care or do not obtain treatment in a formal medical facility, and those who die as a result of the abortion. The multiplier is based on a series of questions: the distribution of all women seeking abortion, according to type of provider; the probability that women would experience complications requiring medical care, according to type of provider; and the probability that women who have a complication will receive medical care from a health facility.
•Data collection. CIESAR organized and conducted the fieldwork for both surveys. The fieldwork staff consisted of 15 female physicians—three regional coordinators and 12 interviewers. Women were chosen to field the survey because they are believed to be better interviewers on abortion and to have better knowledge about unsafe abortion than men. Health professionals were chosen as interviewers because respondents are more willing to talk about abortion with their colleagues than with persons outside the profession.14
Field staff were organized into five teams. One regional coordinator managed the team for the Metropolitan region, which included four interviewers; the other two coordinators were each in charge of two teams, each of which consisted of two interviewers. In August 2003, all fieldwork personnel attended a three-day training workshop to become familiar with the study, the questionnaires and the instructions for implementing the fieldwork.
•Adjustment for nonresponse. Because we included the universe of all health facilities that provide postabortion care in Guatemala, the only weighting necessary was a minor adjustment to compensate for nonresponse. The weighting factor used for nonrespondents was the inverse of the ratio between the actual and expected number of interviews. Weighting factors for private hospitals were 1.012 for the Metropolitan region, 1.068 for the Central and Northeast regions, 1.105 for the Southwest and 1.052 for the Petén; factors for other regions were 1.000. Weights were applied to the data from interviewed health facilities to obtain estimates for the total of 183 facilities nationwide.
Estimating the Incidence of Induced Abortion
Following an approach used in prior studies,15 we calculated the incidence of induced abortion by first estimating the annual number of women receiving treatment for abortion complications and then applying the multiplier, or inflation factor, that represents the proportion of women having an abortion who do not need treatment or do not obtain it at a health facility.
•Women treated for abortion complications. Using data from the Health Facilities Survey, we estimated that 27,014 Guatemalan women were treated for complications of spontaneous or induced abortion in 2003 (Table 1). Because complications of induced and spontaneous abortion often are similar, and because legal restrictions on induced abortion may lead to underreporting, it is difficult to correctly categorize postabortion cases according to the cause of pregnancy loss; we therefore used an indirect estimation approach to separate this total into complications of spontaneous and induced abortion.
We used available data on the biological pattern of all spontaneous abortions (unrelated to hospitalization), established by clinical studies,16 to indirectly estimate the number of Guatemalan women who have miscarriages at 13–22 weeks' gestation; these women are assumed to require care at a health facility.‡ Miscarriages at 13–22 weeks account for 2.9% of all recognized pregnancies, and live births for 84.8%; therefore, such miscarriages are equal to 3.4% of all live births. The number of births in Guatemala in 2003 was estimated using age-specific fertility rates from the 2002 ENSMI and estimates of the number of women in each five-year age-group, nationally and for each region from the 2002 census, the most recent sources for these types of data.17 According to these calculations, an estimated 405,017 live births and 13,811 late spontaneous abortions occurred in 2003 in Guatemala.
A further adjustment was needed because only a certain proportion of women who need treatment for complications of late spontaneous abortion have access to a health facility. We assumed that this proportion was equivalent to the proportion of women giving birth who deliver in a hospital—39% in Guatemala.§18 We estimated that 5,389 women are treated in health facilities each year for complications of spontaneous abortion.**Therefore, 21,625 women are treated for complications of unsafe induced abortion each year in all public and private facilities.
•Number of induced abortions. To estimate the total number of abortions, we derived a national multiplier that represents the number of other induced abortions that occur for each woman who is hospitalized for treatment of induced abortion complications. This multiplier is a function of the degree of safety of abortion services and of access to hospital care. Where abortion services are safe and easily accessible, the multiplier is higher, because for every woman receiving treatment for unsafe induced abortion, there are many others who do not experience complications and so do not require or receive medical care. Likewise, the less safe and accessible abortion services are, the lower the multiplier, because more women have serious complications and require or receive treatment.
We derived the multiplier from information in the Health Professionals Survey. The reported proportions of women obtaining abortions according to type of provider were multiplied by the proportion who would be expected to experience complications, for each provider type. The resulting overall proportion of women having abortions who experience a serious complication was then multiplied by the proportion who are likely to obtain care from a hospital. Because conditions vary greatly by socioeconomic status and place of residence, these questions were asked separately about each of four subgroups of women: urban poor and nonpoor, and rural poor and nonpoor. The preceding calculations were done for each subgroup, producing the proportion expected to be hospitalized for abortion complications. These proportions were weighted by the relative sizes of the four groups nationally to arrive at a multiplier for the country as a whole.
Because direct experience in treating women with abortion complications may influence key informants' perceptions, we estimated the multiplier for different groups of respondents: physicians (i.e., those directly involved in clinical care) and those who are not physicians, and those who work primarily in the public sector (which receives the larger number of postabortion patients and the more severe cases) and those who work in the private sector. The results show that key informants who are physicians and those who work in the public sector perceive that the probability of medical complications is greater (resulting in lower multipliers) than do those who are not physicians and those who do not work in the public sector (multipliers of 2.47 and 2.26 vs. 3.00 and 3.13, respectively).19 Those who are directly involved in clinical care are likely to be influenced by the acute and severe postabortion complications they treat; as a result, they may overstate the degree to which abortion service provision is unsafe and their estimate of the multiplier is likely to be low. In contrast, those informants who are somewhat removed from direct postabortion care are likely to provide a more comprehensive, representative and accurate perspective on the overall abortion situation. Therefore, we based the estimates of abortion in Guatemala on the multiplier of 3, reflecting the responses of the latter group of respondents.
Given the assumptions underlying our estimates of the total number of abortions in Guatemala, we calculated a range of estimates using multipliers of 2, 3 and 4, nationally and for each region. The middle set of results is believed to be the most accurate estimate. Because the multiplier depends on both the degree of safety of abortion services and access to hospital care, the range of estimates for each region provides an indication of possible variation within regions based on their specific circumstances.
Estimating Unintended Pregnancy
To estimate numbers and rates of unintended pregnancy, we first calculated the number of unplanned births by applying the proportion of births that are unplanned (mis- timed or unwanted at the time of conception, from the 2002 ENSMI) to the estimated total annual number of live births. Combining this number with the number of induced abortions yielded an estimate of the number of unintended pregnancies for 2003. We then calculated the rate of unintended pregnancies per 1,000 women of reproductive age and the proportion of pregnancies that were unintended.
Measuring Contraceptive Use and Unmet Need
We obtained the proportion of women using contraceptives from the 1995 DHS and the 2002 ENSMI. We look separately at modern methods (male and female sterilization, IUDs, pills, injectables, implants, condoms and spermicides) and traditional methods (periodic abstinence, withdrawal and country-specific methods, including lactational amenorrhea when it is mentioned). We present data for women who are married (legally or consensually) and for women who are unmarried but currently sexually active (defined as having had intercourse in the past three months). Using these two surveys, we also estimate unmet need for contraceptives among married women aged 15–49.
Provision of Postabortion Care
The 183 health facilities that treat postabortion complications are unevenly distributed across the country, being concentrated in the Southwest and Metropolitan regions (43 and 51 facilities, respectively—Table 2, page 139). The ratio of facilities per 100,000 women aged 15–49 also varies substantially across regions: The Northeast and Petén regions have 12–13 facilities per 100,000 women, whereas the ratio is much lower in the Metropolitan, Central and Southwest regions (seven facilities per 100,000), and even lower in the remaining three regions (four per 100,000). However, regions ranked differently on a more exact measure of availability of postabortion services, the number of beds per 100,000 women: The Metropolitan region has the best availability (395 beds per 100,000), followed by the Northeast, Central and Petén regions (312–363 beds per 100,000). The other four regions have poorer availability (169–234 beds per 100,000). The average annual number of abortion patients treated per site is highest in the Southeast region (227), somewhat lower in five regions (127–175), and much lower in the Northeast and Petén (79–86).
Of the 183 facilities that offer postabortion care, 69% are in the private sector and 31% are in the public sector (not shown). Although private facilities outnumber public facilities, the annual caseload of abortion complications per facility is seven times as high in public facilities as in private ones (365 vs. 52 patients). The public sector treats 76% of all postabortion patients, and has 74% of all hospital beds. Six in 10 of all facilities provide only inpatient postabortion care; most of the others provide both inpatient and outpatient care. Nearly a third of all facilities offer the vacuum aspiration procedure, but half of public facilities do so, compared with only a fifth of private facilities. Almost all facilities use the D&C (dilation and curettage) procedure.
Abortion Morbidity
A total of 27,014 women of reproductive age received postabortion care (including treatment for both spontaneous and induced abortions) in health facilities in Guatemala in 2003. Nationally, the annual rate of abortion complications treated at formal health facilities was 10 per 1,000 women; the rate was higher in the Metropolitan region (13 per 1,000), much lower in the North and Northwest (5–6 per 1,000), and moderate in the five remaining regions (9–11 per 1,000).
Subtracting the estimated number of women treated for spontaneous abortion complications from the total number treated leaves 21,625 women who were treated for complications from induced abortions. This means that eight out of every 1,000 women of reproductive age were hospitalized for complications of unsafe abortions each year. Morbidity from unsafe abortion treated at health facilities was somewhat higher than average in the Metropolitan and Southwest regions (10 per 1,000 women), about average in the Northeast, Southeast, Central and Petén regions, and lower than average in the North and Northwest regions (3–5 per 1,000).
According to the Health Professionals Survey, about two-thirds of abortions among relatively well-off urban women are performed by trained health professionals, such as physicians, nurses or midwives (not shown); however, only about four in 10 abortions among nonpoor women in rural areas are thought to be performed by professionals, and about the same proportion are done by less safe providers, particularly traditional birth attendants or comadronas tradicionales.20 Poor women (living in either urban or rural areas) and indigenous women have a similar distribution according to type of abortion provider.†† These disadvantaged groups are considered to obtain abortions primarily from birth attendants (49–63%), with only 15% or fewer going to each of the two categories of more highly trained providers (physicians and trained nurses or midwives); small proportions of these women go to pharmacists or self-induce. However, complications may result from procedures carried out by trained providers who have little experience or who work in unhygienic settings. In addition, a substantial proportion of abortions in all subgroups of women entail a high risk of complications because they are carried out by untrained providers (traditional healers, lay practitioners, pharmacists or the women themselves).
Abortion Incidence
Almost 65,000 induced abortions are estimated to have occurred in Guatemala in 2003 (Table 3). This is the medium estimate in a range that extends from 43,000 to 87,000 (using multipliers of 2, 3 and 4). The medium estimate indicates that, on average, one woman is hospitalized for every three who obtain induced abortions. We consider this estimate to be the best approximation of the number of induced abortions.
The estimated national abortion rate in 2003 is 24 induced abortions per 1,000 women aged 15–49 (based on the medium multiplier of 3—Table 4); the low estimate is 16 per 1,000 and the high estimate is 32 per 1,000 (based on multipliers of 2 and 4, respectively). Rates are higher than average in the Metropolitan and Southwest regions (29–30 per 1,000, based on a multiplier of 3), followed by the Northeast, Southeast, Central and Petén regions (21–24 per 1,000). The North and Northwest regions have substantially lower rates (8–15 per 1,000).
The abortion ratio is estimated to fall between 11 and 21 abortions per 100 live births, with a medium value of 16 per 100 births. This means that in Guatemala as a whole and in four regions with average rates (Northeast, Southeast, Central and Southwest), about one pregnancy is interrupted by an induced abortion for every six that result in a birth. In the Metropolitan region, however, there is one induced abortion for every four births. The lowest abortion ratios are found in the North, Northwest and Petén regions, where about one or fewer abortions occur for every 10 births.
Abortion in the Context of Unintended Pregnancy
To understand the context in which induced abortion occurs in Guatemala, it is important to examine the planning status of recent births. Although the overall proportion of unplanned births (mistimed or unwanted at the time of conception) has remained the same from 1995 to 2002 (28–29%—Table 5), rates have increased by 15–16% in three regions (North, Central and Southwest), and decreased by 13% and 27% in two regions (Southeast and Metropolitan, respectively).
Each year, an estimated 557,000 pregnancies occur in Guatemala (Table 6); 12% end as induced abortions, 16% as spontaneous abortions and the remaining 72% as births (not shown). The wide range in number of pregnancies among regions reflects variations in both population sizes and pregnancy rates.
Nationally, 66 unintended pregnancies occurred per 1,000 women in 2003, and one-third of all pregnancies were unintended. All but two regions had higher-than-average unintended pregnancy rates (68–77 per 1,000). The Northwest region had a noticeably lower than average unintended pregnancy rate (46 per 1,000), as well as the lowest proportion of unintended pregnancies (21%). The Metropolitan region had a somewhat lower than average unintended pregnancy rate (59 per 1,000), but a higher-than-average percentage of unintended pregnancies (37%), presumably reflecting both its higher levels of contraceptive use and its more educated population, which is likely to be more motivated to achieve fertility preferences.
Overall, 205 pregnancies occurred per 1,000 women aged 15–49 in 2003. The pregnancy rate varied substantially across regions, being lowest in the Metropolitan region (160 per 1,000) and highest in the Petén and North regions (258 and 264 per 1,000, respectively).
The abortion rate in Guatemala—24 per 1,000 women of reproductive age—is similar to the WHO estimated rate for Central America.21 However, although the overall rate in Guatemala is substantially lower than that of Latin America in 2000 (34 per 1,000 women),22 the two most populous regions of the country—the Metropolitan and Southwest regions—have abortion rates closer to the WHO Latin America regional estimate for 2000 and to rates that prevailed in some Latin American countries around 1990.23
Several decades ago, the conditions of abortion provision in Latin America were considered to be very unsafe: A 1965 Chilean study estimated that one in three abortions resulted in serious complications that required hospitalization.24 The same level of risk was estimated for Guatemala in 2003, suggesting that abortion provision in this country is also very unsafe, more so than in other Latin American nations in recent years: Estimates for six countries in the early 1990s found that about one in five abortions resulted in a complication that was treated at a hospital.25 Further evidence of unsafe abortion services in Guatemala is the high annual rate of hospitalization for complications (eight per 1,000 women). The burden of postabortion care falls primarily on the public sector, which treated three in four of the almost 22,000 women who were hospitalized with induced abortion complications in 2003.
Demographic factors—particularly preferences for family size and timing of births, as well as contraceptive use patterns—may explain the variation in abortion rates across the country. The Metropolitan region, which has a higher-than-average abortion rate (30 per 1,000), also has the highest rate of contraceptive use (60%), the lowest rate of unmet need for contraceptives (18%), and a small gap between actual and wanted family size (3.2 vs. 2.8).26 This region also has a lower-than-average unintended pregnancy rate, but a higher-than-average proportion of unintended pregnancies that end in abortion (51% vs. 10–40% in other regions). Education could be a factor in this elevated rate, because the more educated a woman is, the higher her motivation to terminate an unintended pregnancy and the greater her access to services. In the Metropolitan region, 52% of women aged 15–49 have secondary or higher education, whereas this proportion in the other regions is 21% or lower.27 In the Southwest region, where the abortion rate is also higher than average (29 per 1,000), other likely factors are found: Contraceptive use is lower than average (36%), the proportion of women with unmet need is among the highest in the country (34%), and the gap between actual and wanted family size (5.0 vs. 4.2) is wider than in the Metropolitan region. In the North and Northwest regions, both actual and desired fertility rates are much higher than the average; abortion rates are low (eight and 15 per 1,000 women, respectively), as is contraceptive use (32% and 27%, respectively).28
Nationally, women are having smaller families, which declined from an average of 5.6 children in 1987 to 4.4 children in 2002.29 At the same time, desired family size also declined, from 4.9 to 3.7, and the gap between the number of children women are actually having and the number they want continues to be substantial. The estimated number of pregnancies ending in abortion (one in eight) and the high level of unintended pregnancy (32%) indicate that unmet need for contraceptive services in Guatemala is likely to be high. Other evidence indicates that unmet need for effective contraception in all regions of the country increased between 1987 and 2002. In 1987, about one in five married women aged 15–49 did not want a child soon or at all but were not using a contraceptive method (19%); this proportion increased to 24% in 1995 and 28% in 2002.30 In the Metropolitan and Central regions, unmet need increased by 20% or less over the same period, but in the remaining regions it increased by 36–45%.
The relatively low use of contraceptives in Guatemala may be attributed to a number of factors: lack of knowledge of birth control methods and of sources for services, and barriers related to ethnicity, poverty and access to health services. In 2002, 45% of all women did not know of any contraceptive method.‡‡31 The lack of knowledge was higher in rural areas (56%), among indigenous women (66%), and in the Northwest, North and Southwest regions (78%, 57% and 52%, respectively). These high levels of inadequate knowledge are likely related to the government's long- standing resistance to providing family planning in public health facilities.32 Although the government recently approved a family planning law that guarantees universal, equitable access to voluntary family planning methods and adequate sex education, there is still strong opposition from religious and conservative groups to implementation of the law.33
Extreme poverty is another barrier that makes access to contraceptives and health facilities more difficult. More than half of Guatemalan families live below the poverty line (56%, including 16% who cannot afford a basic basket of food), and poverty is even higher in the indigenous population (76% and 27%, respectively).34 In addition, public health facilities tend to be underutilized due to the poor quality of services. People who can afford to often prefer to use private facilities, and the poorest frequently rely on care from members of their household or on self-medication.35 Considering that 41% of the Guatemalan population is of Mayan descent, family planning education campaigns should take into account Mayan values and beliefs. Furthermore, since Guatemala is still a predominantly rural country (54% of its people live in rural areas), there is a great need to improve the availability of and access to contraceptive services, as well as the quality of services in these areas.
Documenting the incidence of abortion is very difficult in countries where abortion is highly restricted by law and where official data may not exist or may be incomplete. Researchers have developed indirect estimation methodologies in response to the need for such estimates.36 Although the present methodology has been widely used and tested in several countries over the past 15 years, it relies on a number of assumptions, as outlined earlier. Because women often underreport their use of abortion services, we rely on the perceptions of health professionals who are knowledgeable about abortion service provision to estimate the proportion of all women having abortions who will be hospitalized for treatment of complications. We selected key informants who have a broad range of experience and who are familiar with the context of abortion in rural and urban areas; information was obtained on differences according to poverty level and ethnicity to improve the estimates.
We also depend on senior hospital officials to estimate the number of women treated at their facility for postabortion complications in the past month and in an average month. Their estimates are likely to be approximate, but are unlikely to be biased overall. Comparison with a surveillance program in 22 public hospitals provides some support for this study's estimates of the number of women treated for postabortion complications.37 The surveillance program covered an 18-month period (July 2003 to December 2004), while our estimate was for the 12 months of 2003. After adjustments to have a comparable 12-month period, the number of incomplete abortions reported in our study was similar—only 17% higher than the number reported in the surveillance study. Several factors might explain this difference. The surveillance program extracted information from medical records on patients who had been diagnosed as having or probably having an incomplete abortion, whereas we asked key informants at each hospital to estimate the number of inpatients and outpatients treated for abortion complications. Furthermore, the different calendar periods covered may result in some differences in number of patients. In addition, despite efforts to minimize underregistration in the surveillance study, some cases may have been missed, particularly outpatients. In contrast, our facilities survey specifically asked about postabortion treatment provided on an outpatient basis.
New estimates of the incidence of unintended pregnancy in Guatemala should help to raise awareness among policymakers and program managers of the difficulty that women and couples are having in planning pregnancies and births. These estimates highlight the inadequate access to contraceptive information and services. The increase between 1987 and 2002 in the proportion of married women who have an unmet need for contraception further indicates that provision of family planning services is falling increasingly behind the demand as the motivation to have smaller families continues to grow. National and regional estimates of the incidence of abortion and abortion morbidity, now available for the first time, provide evidence that unsafe abortion is occurring in all parts of the country and is having a substantial impact on women's health.
There is a critical need for a comprehensive and coordinated effort to assist the large numbers of women who want smaller families and want to space births, but who are not practicing contraception and are therefore at high risk of unintended pregnancy and unsafe abortion. The variation in fertility preferences across regions, as well as in the incidence of unintended pregnancy and abortion, suggests that informed and innovative policies and programs are needed. Governmental responses must also address the special needs of poor, rural and indigenous women and couples.
*Unsafe abortion is defined as a procedure for terminating pregnancy either by persons lacking the necessary skills or in an environment lacking the minimal medical standards, or both (source: World Health Organization (WHO), The Prevention and Management of Unsafe Abortion, Geneva: WHO, 1992).
†Petén is home to only 3% of the total population, suggesting that its exclusion from the 1995 DHS did not significantly affect the representativeness of the survey.
‡Although some women who experience spontaneous pregnancy loss at 12 or fewer weeks of gestation may seek medical care, many are likely to do so on an outpatient basis, and so relatively few will be hospitalized. Pregnancy losses at 23 or more weeks are not considered because they are usually classified as fetal deaths rather than spontaneous abortions.
§This proportion varied by region, and region-specific proportions were used in the calculations: 72% in the Metropolitan region, 25% in the North, 43% in the Northeast, 33% in the Southeast, 47% in the Central region, 31% in the Southwest, 20% in the Northwest and 31% in the Petén (source: reference 10)
**The number of women who are hospitalized was estimated to be 5,389 (13,811 x 39.02%). Information available on weeks of gestation of all postabortion patients from a study of 22 public hospitals (source: reference 3) was not used because these data are for both spontaneous and induced abortions, and because it is not known how representative the 22 facilities are of all 178 surveyed facilities that provide postabortion care in Guatemala.
††Fifty-four percent of Guatemala's people live in rural areas, and 41% are indigenous (source: reference 17).
‡‡The 2002 ENSMI reported that 92% of all women were aware of at least one method; this difference is likely due to interviewer probing for each specific method.
1. Guatemala Penal Code Decree No. 17-73, Articles 133 and 137, 1999.
2. Figueroa W and Schieber B, Study of the Use of Financial Resources in Reproductive Health and Postabortion Care, New York: Population Council, 2001.
3. Ministerio de Salud Pública y Asistencia Social (MSPAS) and Centro de Investigación Epidemiológica en Salud Sexual y Reproductiva (CIESAR), Expansión de la atención postaborto en 22 hospitales departamentales de Guatemala: 18 meses de resultados, Boletín del Programa Nacional de Atención Postaborto, 2005, Vol. 1, No. 4; and Kestler E et al., Scaling up post-abortion care in Guatemala: initial successes at national level, Reproductive Health Matters, 2006, No. 27, pp. 138–147.
4. Grajeda R et al., Estudio multicentro sobre el aborto, Guatemala City, Guatemala: World Health Organization (WHO), 1995.
5. Figueroa W and Schieber B, 2001, op. cit. (see reference 2).
6. Ibid., p. 12.
7. MSPAS, Informe Final: Línea Basal de Mortalidad Materna para el Año 2000, Guatemala City, Guatemala: MSPAS, 2003.
8. Kestler E and Ramírez L, Pregnancy-related mortality in Guatemala, 1993–1996, Pan American Journal of Public Health, 2000, 7(1):41–46.
9. The Alan Guttmacher Institute (AGI), Sharing Responsibility: Women, Society and Abortion Worldwide, New York: AGI, 1999, p. 42.
10. MSPAS et al., Encuesta Nacional de Salud Materno Infantil (ENSMI) 2002, Guatemala City, Guatemala: MSPAS, 2003.
11. United Nations (UN) Population Division, World contraceptive use, 2003, wall chart, New York: UN, 2004.
12. Ley de Desarrollo Social, Artículo 26, No. 5, Guatemala City, Guatemala, 2001; Secretaría de Planificación y Programación de la Presidencia (SEGEPLAN), Política de Desarrollo Social y Población, Guatemala City, Guatemala: SEGEPLAN, 2002; and Secretaría Presidencial de la Mujer, Política Nacional de Promoción y Desarrollo de las Mujeres Guatemaltecas y Plan de Equidad de Oportunidades, 2001–2006, Guatemala City, Guatemala, 2001.
13. Singh S and Wulf D, Estimated levels of induced abortion in six Latin American countries, International Family Planning Perspectives, 1994, 20(1):4–13; and Singh S et al., The incidence of induced abortion in Uganda, International Family Planning Perspectives, 2005, 31(4):183–191.
14. Kestler E and Ramírez L, Informe técnico parcial, unpublished document, Guatemala City, Guatemala: CIESAR, 2004.
15. Henshaw SK et al., The incidence of induced abortion in Nigeria, International Family Planning Perspectives, 1998, 24(4):156–164; Singh S et al., Estimating the level of abortion in the Philippines and Bangladesh, International Family Planning Perspectives, 1997, 23(3): 100–107; Juarez F et al., The incidence of induced abortion in the Philippines: current level and recent trends, International Family Planning Perspectives, 2005, 31(3):140–149; and Singh S and Wulf D, 1994, op. cit. (see reference 13).
16. Bongaarts J and Potter RG, Fertility, Biology and Behavior: An Analysis of the Proximate Determinants, New York: Academic Press, 1983, p. 39; and Harlap S, Shiono PH and Ramcharan S, A life table of spontaneous abortions and the effects of age, parity and other variables, in: Hook EB and Porter I, eds., Human Embryonic and Fetal Death, New York: Academic Press, 1980, Table 1, pp. 148 & 157.
17. Instituto Nacional de Estadística, Censo 2002: XI de Población y VI de Habitación, <http://www.ine.gob.gt/content/consul_2/pob/censo2002.pdf>, accessed Aug. 11, 2006.
18. MSPAS et al., 2003, op. cit. (see reference 10).
19. Prada E et al., Abortion and postabortion care in Guatemala, a report from health care professionals and health facility survey, Occasional Report, New York: AGI, 2005, No. 18, Table 4.
20. Ibid.
21. WHO, Unsafe Abortion, Global and Regional Estimates of the Incidence of Unsafe Abortion and Associated Mortality in 2000, fourth ed., Geneva: WHO, 2004.
22. Ibid.
23. Singh S and Wulf D, 1994, op. cit. (see reference 13).
24. Armijo R and Monreal T, Epidemiology of provoked abortion in Santiago, Chile, in: Muramatsu M and Harper PA, eds., Population Dynamics: International Action and Training Programs, Baltimore, MD, USA: Johns Hopkins University Press, 1965, pp. 137–160.
25. Ferrando D, Prevalencia del aborto inducido en el Peru, Lima, Peru: Pathfinder International and Flora Tristan, 2001; and Singh S and Wulf D, 1994, op. cit. (see reference 13).
26. MSPAS et al., 2003, op. cit. (see reference 10).
27. Ibid.
28. Ibid.
29. MSPAS, Instituto de Nutrición de Centro América y Panamá (INCAP) and Institute for Resource Development (IRD)/Westinghouse, Encuesta Nacional de Salud Materno Infantil (ENSMI) 1987, Columbia, MD, USA: IRD/Westinghouse, 1989; and MSPAS et al., 2003, op. cit. (see reference 10).
30. MSPAS, INCAP and IRD/Westinghouse, 1989, op. cit. (see reference 29); MSPAS et al., Encuesta Nacional de Salud Materno Infantil (ENSMI) 1995, Guatemala City, Guatemala: MSPAS, 1996; and MSPAS et al., 2003, op. cit. (see reference 10).
31. Gragnolati M and Marini A, Health and Poverty in Guatemala, Policy Research, Working Paper, Washington, DC: World Bank, 2003, No. 2966, p. 9.
32. Hall MK and Scott JB, An Unfulfilled Human Right: Family Planning in Guatemala, New York: Center for Reproductive Law and Policy, 2003.
33. Pérez S, La Corta de Constitucionalidad deja vigente Ley de Planificacíon, Prensa Libre, June 7, 2006, <http://www.prensalibre.com/pl/2006/junio/07/143603.html>, accessed Aug. 7, 2006.
34. Gragnolati M and Marini A, 2003, op. cit. (see reference 31).
35. Ibid.
36. Rossier C, Estimating induced abortion rates: a review, Studies in Family Planning, 2003, 34(2):87–102.
37. MSPAS and CIESAR, 2005, op. cit. (see reference 3).
Author's Affiliations
Susheela Singh is vice president for research, Guttmacher Institute, New York; Elena Prada is an independent consultant, based in Bogotá, Colombia; Edgar Kestler is director, Epidemiological Research Center in Sexual and Reproductive Health (CIESAR), Guatemala City, Guatemala.
This research was supported by the Netherlands Ministry for Development Cooperation, the World Bank and the United Kingdom's Department for International Development. The authors thank the fieldwork team of three regional coordinators and 12 interviewers for their invaluable contribution in carrying out the surveys. They also thank Emily Stone, Lindsay Dauphinee and Caroline Sten for research support, and Akinrinola Bankole and Lisa Remez for their insightful comments on earlier versions of this article. The findings and conclusions expressed are entirely those of the authors.


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Cute creatures with bad habits
To the uninitiated, the roar of howler monkeys in the wild has caused many a traveler to shiver with trepidation. However, the only danger these hairy tree dwellers pose to hikers is the fact that, in many regions, they have inherited some very bad habits. One of their favorite sports is to wait silently for people to walk directly beneath […]Read more

subset: commoncrawl


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Platform Screen Doors: Transit Solutions
Automatic Door Enterprises offers many customized solutions for all types of rail applications. Our design teams take pride in finding complex solutions to address the challenges of every unique project we take on. We are equipped to handle all project phases from engineering and design, all the way to post-sales support.
We have installed more than 50 people mover systems (APMs) in airports around the world, and are extremely proud of Automatic Door Enterprises's Platform Screen Door solutions that help people travel the globe every single day. International locations where we've installed platform screen door solutions that help keep people moving include Frankfurt Airport-Germany, Rome Airport, Madrid Barajas, Kuala Lumpur Airport-Malaysia, Las Vegas McCarran, Dallas Fort Worth, Houston – George Bush, Denver International, London Heathrow, Mexico City, Beijing Capital, Washington-Dulles, Atlanta's Hartsfield-Jackson and Toronto Pearson International Airport.


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Hopes lie in the recovery of its two key industrial hubs and markets of the US and China. Beyond that, the company's business plan to 2015 shifts the focus to emerging markets, especially Latin America and India, where it expects to combine 70% of its business next year, up from 5% in 2006.
Investor confidence, however, seems to lie more in the Spanish firm's US business. The company's share price rose 2% when Barrack Obama was re-elected as US president last month, due to raised hopes of renewal of the federal production tax credit. In contrast, the share price dropped by more than 2% the day after Gamesa announced its business plan at the end of October, together with plans to cut its workforce globally by 1,800 and to focus on higher margins from reduced business volume.
Investor doubts aside, Latin America is, with China, "one of the two main global growth markets," said Peter Sweatman of consultancy Climate Strategy. "Gamesa has a strong existing customer base, a common language and familiarity with Spanish banks and financing sources operating there," he said. Gamesa is expecting 47% of its 2013 sales to come from Latin America, which is already absorbing orders from the company's US turbine sites in Pennsylvania.
High stock market expectations for India's delayed wind boom were reflected in one of the highest hikes - nearly 5% - in Gamesa's share value in 2012, following a contract with utility SJVN Group to build a new wind farm in Maharashtra.
Meanwhile, Gamesa confirmed it is slowing down development of its 7-8MW offshore turbine to focus on the 5MW model, due to at least a two-year delay in the UK's Offshore Round 3, Gamesa's planned point of entry offshore.
Gamesa's offshore confidence was boosted by Spanish utility Iberdrola's October declaration that Gamesa would be among its offshore suppliers "providing it produces a good product", a spokesperson said.


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Hawaii (HI) OCR Permanent Courses & OCR Training Gyms & Boxes
A complete list of obstacle course training locations & OCR training gyms & OCR training boxes in HawaiiYou can go back to our list of states with permanent courses & OCR training gyms. Or check out the OCR Permanent Course & OCR Training Gym Map, or see all upcoming mud runs and OCRs in Hawaii!
Unfortunately, we don't know of any permanent courses or training gyms in Hawaii (HI) currently. However, if you know of one, let us know and we'll get it added.


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We are constantly trying to improve accessibility to our site, for all our visitors including those with disabilities. Our goal is to offer an equal opportunity to all visitors to participate in and benefit from all information, products and service offerings.
Should you have difficulty accessing the website and/or have suggestions on how we can improve, please do not hesitate to call us at 407-830-8554 or by email at firstname.lastname@example.com. Your feedback is important to us and we will do our best to address your concerns as soon as possible.
Immediate assistance
If you require immediate assistance for one of our products or services, please call us at 407-830-8554.


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Comstock Partners, Inc.Update on Attachments 12/7/16
LIMBO LIMBO, HOW LOW CAN IT GO? (Original Text 3/25/01)
Most investment professionals believe the US stock market and economy will reverse direction and rise once the lower rates kick in and Bush gets his tax cut package through Congress. We have tried to explain in these comments why we believe that the stock market will not be bailed out this time by either the Fed or fiscal policy (tax cuts). The reason it will not work this time (while the Fed was successful in the past) is due to the severity of the NASDAQ's bubble finally bursting and the reverse wealth effect kicking in. At the peak, the NASDAQ stock valuation was over $6.7 trillion. We have just gone through almost $4 trillion of that over the past year. Once a financial bubble as large as this one finally breaks it is very hard to stimulate demand. The only financial bubbles that even compare to this one have been in 1929 and in Japan in 1989. In both cases, interest rates were driven down to almost zero without stimulating demand. Since the recent financial bubble was greater than either of the other two, the stimulation of demand will be even more difficult, and the stock market could go much lower. This brings us to the question that is repeated in the chant of the Limbo game or dance, "How low can you go?" We have tried to answer this question in the attachment to today's comment. With the help of the charts and statistics of Ned Davis Research, we went back over the past 75 years of history to look for periods of time, which most resembled today's condition(some stats were not available). As we stated before, the 1929 experience is probably the closest, but there were 9 clear bull markets that peaked and were followed by bear markets. In each of these 9 periods of time we identified 5 different stock market metrics----1. Price to Dividends 2. Price to Sales 3.Price to Cash Flow 4. Price to Book Value 5.Price to Earnings. We measured these metrics at the peak of the bull market and also identified where these same metrics troughed in the bear market that followed. In order to determine "How low this stock market can go", all you have to do is to determine if this is a normal bear market. If you do, you might want to use historical averages (the average of the troughs). If you are as bearish as we are, you might want to use the lowest historical troughs since we believe this is the greatest bubble of them all. Lastly, if you are bullish (a new paradigm thinker) pick the average of the prior market peaks, or even the highest market peak. The various indices used in this study will have to fall another 50% from here to reach any of the bear market troughs. Any way you want to look at it... you will be shocked at how low it can go.


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While working, I also obtained a Masters in Accounting in 2010 from Northeastern University, and then completed the Certified Public Accountant exams and received my CPA. In the summer of 2013, I partnered with my father to form Zeitler & Zeitler, CPA's.
» Let's Talk
It all begins with a complimentary chat. Let's talk about your tax and financial picture today.
We have provided our clients with highly personalized tax, accounting, and financial advice for over 40 years.
We offer the best service possible at an affordable rate, helping our clients grow. Almost all of our new business comes from client referrals.
"Can't say enough good things about this firm, easy to work with, one phone call gets things done. The entire staff is very knowledgeable, and if they don't have an answer immediately, they get you one quick. What else can you ask for?"
-Fred & Sue Becker, Owners Backyard Shed Co. Inc. Selkirk, NY,
"Vince Anna's Restaurant in South Westerlo has been serving fine Italian/American food to the Greater Greenville area since 1945 and for the past twenty five years we have been fortunate to have Fred Zeitler, CPA as our accountant. And now we are even more fortunate to have his son Christopher partner with Fred, so that we now have Zeitler & Zeitler, CPA's to represent us in the future. They do our weekly payroll, file our quarterly sales tax returns, reconcile our bank accounts and keep track of where we are income wise throughout the year and so much more. They do things on time and hassle free which lets me do what I do best – cook"
-Jim Eufemia, President, Vince Anna's Restaurant, Inc. South Westerlo, NY,
"Fred has been my accountant for thirty years since when I started my company, Bullock Utilities, Inc. He has given me good, sound advice on a wide range of business and tax issues and I highly recommend him and his new firm, Zeitler & Zeitler, CPA's. You can count on them."
- Peter Bullock, President of Bullock Utilities, Inc., Ravena, NY,
"I can attest that the firm of Zeitler & Zeitler, CPA's and that includes the hardworking and competent staff, maintains confidences, they get the job done without delays and at a fair price. I trust them both for my business needs and for my personal tax preparation and advice."
- Mark Wilcox, President of Greenville Auto & Truck Parts, Inc.,
"I was selected for a random audit a few years ago, and Fred was right there to help me, at no additional cost. He asked if I wanted to visit the Feds by myself or with him or just have him go with me. We both agreed that the last choice was the best. Fortunately, because of Fred, my forms and receipts were up-to-date, and we 'endured' the audit and came out with flying colors. Very reassuring."
- Paul Swift, Rhinebeck, NY,
"As a woman with a small business and new to the area, I asked friends who I might engage as an accountant. More than one pointed me to Fred Zeitler, and I couldn't be happier to have him at my side in running my business, paying taxes, and looking for ways to deal with uncertain economic times."
- Sarah Hogan, Cairo, NY,
"What I like best about having Fred Zeitler as an accountant is that I get Fred Zeitler, not some junior accountant or, worse, a series of different junior accountants each time I have an appointment. Nothing beats a one-on-one business relationship"
- Mary Relyea, Greenville, NY,
"Fred saved me $8,765 in state and federal taxes the first year he handled my account. What more can I say in his behalf?"
- Daniel Carney, Kingston, NY,


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BP Album+ || New Features Requests and Discussion
If you need a free image gallery or photo album for BuddyPress, BP Album+ is probably the plugin you're looking for. BP Album+ adds instant, FaceBook style photo albums to all of your user's profiles.
You can always get the most up-to-date version from the WordPress plugin repository at this link:
Or, if you like living on the bleeding-edge of BuddyPress development, you can get the latest beta here:
This forum thread is for discussing new features the community would like to see in future releases of the BP Album+ plugin.
All ideas are welcome, no matter how crazy, bandwidth-intensive, or strange …but the final call on what goes into the plugin and when will be made by the development team.
Photos and user interfaces are a uniquely "visual" thing, so when posting an idea to this thread, please try to include a LINK to a website that's doing the thing you want included in the plugin. For original functions that don't exist *anywhere* yet, draw a sketch of your idea in a paint program and post a link to the image.
This will make it much easier for users that don't speak English to understand your idea.
So, Let's get started!
- The topic 'BP Album+ || New Features Requests and Discussion' is closed to new replies.


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International Introductory Training Course
February 4-5, 2015
South Jakarta, Indonesia
The Harman Asia Regional Sales office is hosting this two-day training course in South Jakarta, Indonesia. The course gives an introduction to HiQnet Audio Architect, the software platform that is used to configure, control, and monitor BSS Audio Soundweb London and the Crown DriveCore Install Network Series.
Class size is limited so please register right away and make travel arrangements for what promises to be an informative
Meals will be provided. Attendees are expected to arrange their own travel & accommodation.
Full details and a registration form are below.
| ● Audio Architect design principles and workflow
● Defining the Venue
● Adding devices
● Soundweb London introduction
● Routing audio
● Associating amplifiers with output zones
● Configuring monitoring
| ● Grouping devices into racks and arrays
● Single and master device control
● Custom panel design
● Scheduler
● Access control
● Going online
| ● Updating firmware
● File management
● Commissioning
● Working with automated control interfaces
● Day-to-day operation
● Full screen operation
● HiQnet Motion Control / Powered by Crown
| ● Basic design in Audio Architect
● Networking
● Networked audio practices
● Audio routing
● BLU link
● CobraNet
● Dante
● Going online to Harman Devices
Training location:
CSA Jakarta, MSI Building Jl.
Class will run from 9:30am - 4:30pm on each day of the course.
Courses are taught in English with local language translation provided. Both days are all-day training sessions. There will be plenty of breaks during these all-day sessions, in addition to the included lunches.
Required Materials:
Please bring a Windows-based laptop computer with the latest version of HiQnet Audio Architect installed, with the laptop meeting the guidlines delineated on the Audio Architect download page. An external mouse with scroll wheel is also required.
For questions about the course, please email.
Registrants are required to notify us by email prior to one business day of the course start date if unable to attend.


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Ready, Set, Knit! If you need a quick project, then super bulky Rasta is your yarn. Be dazzled by the gorgeous, kettle dyed colors, then fall in love with the soft feel. Perfect for gifted accessories.
Fiber Content: 100% Merino Wool
Weight: Super Bulky
Gauge: 2-2.5 stitches per 1" on US 13-17 (9-12.75mm) needles
Weight/ Yardage: 150g/ 90 yards
Care: Hand wash, lay flat to dry
Country of Origin: Uruguay


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Dr Prem Jagyasi Speaks With Elan in a conference in Delhi
Dr Prem Jagyasi is class personified. His stance and confidence at several conferences prove so. The Conference at Mumbai is yet another feather to his cap. Indeed an expert and a wow idol!
Dr Prem Jagyasi Delivering Keynote International India Conference 6
Dr Prem Jagyasi Touches Delhi
Not many men get to travel for a cause. Dr Prem Jagyasi has had the chance of doing so. A quick snap from a moment at the Delhi workshop that saw massive receptiveness and positive dabbling.
The Deep Seated Gaze Of A Global Speaker - Dr Prem Jagyasi
Dr. Prem has his mind seated on the audience at a conference, He is engaging and smooth in his talks as well as educating in his ability to convey an all important message. We understand his enthusiasm as part of his nature takes him a long way ahead in life.
Makings Of A Talented Speaker--Dr Prem Jagyasi
It is at times like this that Dr Prem's brilliance truly emanates. Seen here speaking at a Conference in Mumbai. The sheer flawlessness of the way he speaks and interacts with the audience thrills us.
Dr Prem Jagyasi - A Touch Of Class - During A Conference
this snap of Dr.Prem answering queries at a Chennai Conference speaks a million tongues. He indeed is one stalwart and a global icon. His commitment to the task at hand is commendable as is his focus on all things he loves doing.
Dr Prem Jagyasi Delivering Keynote International India Conference 3
Dr Prem Jagyasi On International News Channel
With so much great work defining Dr Prem Jagyasi, it is no rare news to report stuff like this. Yet every time this happens, it feels better while also boosting his self-image and giving him some more inspiration to get raring.
Dr Prem Enthralls As He Speaks
Dr Prem's subtle style that comes laced with deep knowledge has escalated hi m to the ranks of a great speaker. Much respected and valued for his knowledge and style across the world.
Dr Prem Jagyasi At Mumbai - Confering With Like Minds
Dr Prem is a renonwed speaker and global icon. The Mumbai conference is one among his many power-laced events where he creates great impacts. Thorough knowledge, baritone and gift of the gab lend him a charisma that truly comes alive on stage.
Motivational Speaker With A Passion For Global Change- Dr Prem Jagyasi
Seen here is the very famous and popular global leadership icon and speaker, Dr Prem Jagyasi at a Conference in Iran. With his style and knowledge, the audience is taken for a jolly good ride.
Dr Prem Jagyasi Delivering Keynote International India Conference
Lithuania Medical Tourism - Litcare - Dr Prem-005
Dr Prem Impresses At Iran Conference
The Iran conference was an astounding success thanks to the presence of Dr Prem Jagyasi. The world famous speaker has the best knowledge in his domain and offers ample enlightenment to his audience.
Dr Prem Jagyasi in Australia speaking during a summit
Dr Prem Speaking in Medical Tourism Summit - Melbourne Australia
Lithuania Medical Tourism - Litcare - Dr Prem-001
The Look Of A Thinker Captured On Dr Prem
The conference at Delhi brought in many moods for Dr Prem. One among them was thoughtful. The mind thinks deep and is indeed proven right about its closest thoughts. The icon, the man, the global inspiration--Dr Prem Jagyasi was a pleasure to hear at Delhi.
Dr Prem Jagyasi Delivering Keynote International India Conference 5
San Francisco And Dr Prem
At The Medical Tourism Association conference, Dr Prem enthralls audiences. With a gift of the gab and lots of potential that can actually change the face of medical tourism, here is Dr Prem raring to go now.
Dr Prem Jagyasi Delivering Keynote International India Conference 4
"I Smile I Shine And I Aim For The Stars" - Dr Prem Jagyasi
A jolly good smile during the toughest times can get you far. Dr. Prem proves so when his conference question answer sessions makes him smile bright. This casual click captures his confidence, his personality and his ability to smile big at all times!


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We have so many people from outside the U.S. how has the events of 9-11 effected you and the way you surf, also the U.S. people too.
im in the US...
my dads a pilot, and whenever he goes to the airport he waits in security for about an hour, i cant imagine, having to wait an hour in order to go to work! i can see why he gets pissed off about it
\"I am convinced that societies which live without government enjoy an infinitely greater degree of happiness than those who do.\" Thomas Jefferson
In my area like around central Illinois there have been a lot of false threats and all that other bullshit like people putting baby powder in envelopes and sending them around. We also got military MP's at our airport all they really do is just stand around and look tough and baddass. As far as I know before the events of Sept. 11 there was a high demand for pilots so I was going to go down to SIU Carbondale and work on becoming a commercial pilot, cause that has been my dream since I was very little. But now, man, I don't know what the situation is. Since no one wants to fly anymore. It seems after sept 11 once everyone finally calmed down and started to fly again that airbus went down like 2min after take off and now everyone is ****in paranoid. I don't have a problem with flying though. The only thing I get worried about up there is ******* instructors. So I dont know what the future holds for me I might as well just become an airplane mechanic and work on avionic systems.
**** happens.... but some **** is just too ****ed up!!!!!
give me a nuke and i'll release my wrath!!!!
(and i'm not even from the US, i'm just a bloody Dane)
Visit: http://www.cpc-net.org
\"Software is like sex: it\'s better when it\'s free.\" -Linus Torvalds
Well Im more concerned about what I write or say so as not to offend any Americans. Ireland was shocked by Sept.11 and well I suppose it's made me more aware of US pride you guys really know how to stick together when times get tough.
hey thor were is hehbris ?
Were is hehbris .... I was in Beirut the last time something like this happend, it's good to hear from other people and how they think
Thor, how has it affected you?
Sydney here.
Part of my job at work is to open letters and stuff and sought them. Past few weeks we have been getting alot of jiff and icing sugar in envelopes. It's pretty funny after we find out but till then the people who were unfortunate enough to open those letters get a bit shakey.
There are some real bastards out there who like to be 'funny'.
in The Netherlands the accident didnt really affected us.
offcourse on the stocks, and we where being blamed that our country was a good breeding and hiding land for terrorists!!
well whatever.
but I cant say that it was ALL osama and taliban's fault.
I think america had this coming for a while.
and I think its good in some way this **** happened, 'cause
the americans get kinda arrogant once in a while and someone has too stop that so now and then.
I am not saying that I agree with the terrorist actions.
but I am also not agreeing with what america is doing now
GOD invented evolution \'cause he couldn\'t do it all by himself.
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WASHINGTON (AP) — Employers will hire more workers this year, and the economy will grow faster than envisioned three months ago, according to an Associated Press survey that found growing optimism among leading economists.
But unemployment will stay chronically high — nearly 9 percent by year's end, the latest quarterly AP Economy Survey shows. A majority of economists say it will be 2016 or later before unemployment drops to a historically normal rate of around 5 percent.
Economists have become more confident 19 months after the worst recession since the Great Depression ended. Lower Social Security taxes and higher stock prices will embolden Americans to spend more and help power the economy, they say.
"People will finally recognize that an economic recovery is under way," said Lynn Reaser, a board member of the National Association for Business Economics. "This won't be a recovery seen only by economists."
The gains this year will be enough to withstand the threats still clouding the economy, the AP survey found. A majority of the economists doubt, for example, that falling home prices and higher mortgage rates will pose a major risk to the economy in 2011.
The AP survey collected the views of 42 private, corporate and academic economists on a range of indicators. Among their forecasts:
— The economy will grow 3.2 percent this year, compared with the 2.7 percent they forecast in October. That would top last year's estimated growth of less than 3 percent.
— Employers will create a net total of 2.2 million jobs. Three months ago, the economists predicted 1.6 million jobs would be added in 2011. Last year, employers added roughly 1.1 million.
— Consumers will spend 3.2 percent more this year than last year. That's stronger than the 2.5 percent growth the economists had forecast in October. And it's nearly double the spending growth that's estimated for 2010.
— Inflation will be 1.8 percent this year, barely more than the 1.7 percent the economists forecast in the previous survey and up only slightly from 1.5 percent last year. The 1.8 percent forecast falls within the range of inflation the Federal Reserve thinks a healthy economy needs.
Among the reasons for the economists' growing optimism: an extension of income-tax cuts, a cut in Social Security taxes for workers, easier access to loans, higher stock prices and a government that seems more sympathetic to the priorities of businesses.
The brighter outlook is also evident among people responsible for hiring.
Jerry Huddleston, human resources manager of the Ozark Natural Foods grocery store in Fayetteville, Ark., said he plans to hire for busy weekend shifts because sales are improving.
The store is generally slow to add jobs. But Huddleston said business is picking up. Customers seem more willing to pay more for organic milk, vitamin supplements and pre-made vegetarian meals.
"I think people are starting to be more confident that the job they have is the job they will have tomorrow," he said.
As the economy gradually strengthens, the economists expect interest rates will tick up, as they already have begun to do. They think the yield on the 10-year Treasury note, now at 3.4 percent, will reach 3.6 percent by midyear and 3.9 percent by year's end. Those higher rates would force up mortgage rates, which tend to track the 10-year Treasury yield.
Yet when asked about a range of threats — from falling home prices and rising energy prices to state budget woes and Europe's debt crisis — the economists called each a minor risk rather than a major risk to the economy.
In the spring and summer, many analysts had feared the economy might slide back into a "double-dip" recession.
"Consumers and businesses are in a better mood," said Nariman Behravesh, chief economist at IHS Global Insight. "They are spending a little more freely. Not a lot more freely, but a little more freely."
That helps explain why Behravesh has lifted his forecast for economic growth in 2011 to 3.2 percent, from 2.2 percent in October.
Still, the Fed said Wednesday that the economy isn't growing fast enough to lower unemployment and still needs help from the Fed's $600 billion Treasury bond-purchase program. The bond purchases are intended to lower rates on loans and boost stock prices, spurring more spending and invigorating the economy.
President Barack Obama still faces risks from voters skeptical of his economic stewardship, according to a new Associated Press-GfK poll. More than half disapprove of how he's handled the economy. Just 35 percent say it's improved on his watch; 40 percent had said so a year ago.
Yet public sentiment may brighten if the economists prove correct in their forecasts. Rajeev Dhawan, director of Georgia State University's Economic Forecasting Center, has raised his estimate for growth this year to 2.7 percent, from 1.8 percent three months ago.
This year "will be better than 2010 in terms of hiring, spending and economic growth," Dhawan said. "Yet unemployment will decline only slowly. At least we're not going backward."
AP Business Writer Christopher Leonard in St. Louis contributed to this report.
Copyright © 2011 The Associated Press. All rights reserved.


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Book News: Two Poems By Greek Poet Sappho Discovered
The daily lowdown on books, publishing, and the occasional author behaving badly.
Parts of two previously unknown poems by the Greek lyric poet Sappho have been discovered on an ancient papyrus. An anonymous collector happened to show the papyrus to the Oxford University classicist Dirk Obbink, who realized its significance.
Most of Sappho's work has been lost, and only one of her poems has survived in its entirety. The first of the two new poems mentions "Charaxos" and "Larichos," the names given to Sappho's brothers in the ancient tradition, though never mentioned in any of the poet's surviving work. The second, more fragmentary poem, seems to be a love poem.
In a preliminary version of a paper to be published in the journal Zeitschrift für Papyrologie und Epigraphik, Obbink writes that the "metre, language and dialect" as well as the subject matter "point indubitably to a poem by Sappho."
In an email to NPR, Margaret Williamson, a classics expert at Dartmouth College and the author of Sappho's Immortal Daughters, agreed: "I don't see much room for doubt that these are fragments of Sappho poems. They certainly sound very like her: they're in the right meter and the right dialect, and they are prayer-hymns of a kind she often wrote, addressed to Hera and Aphrodite, goddesses worshipped on Lesbos whom she appeals to in other poems."
Williamson added that the first poem, which mentions Sappho's brothers, is especially remarkable. "It's very exciting to have a new Sappho poem that isn't about erotic love or beauty," she writes. "Here, for a change, is a poem that seems to refer to other relationships. ... We've had far fewer poems of this type up till now, and as a result it's been too easy to interpret her poems as the lone cry of a woman in love, rather than looking at the cultural context these quite sophisticated poems grew out of."
- In the most dramatic Russian literary killing since a dispute over Kant turned deadly last year, a man allegedly stabbed an acquaintance for preferring prose to poetry. RIA Novosti has this report: "A former teacher was detained in Russia's Urals after being accused of stabbing an acquaintance to death in a dispute about literary genres, investigators said Wednesday. The 67-year-old victim insisted that 'the only real literature is prose,' the Sverdlovsk Region's branch of the Investigative Committee said. The victim's assertion outraged the 53-year-old suspect, who favored poetry, and the dispute ended with the ex-teacher stabbing his friend to death, investigators said."
- The Rumpus interviews Jerry Stahl: "Writing is like childbirth: I can never remember writing a book after it's written, and I think I'll never do it again. I guess there is a certain propulsive quality to them, but it takes a lot to make them come off. I always write like I'm being chased, because I fucked up most of my life, and didn't publish a book until I was forty — so I always had a sense of time. And plus, I had a disease and they kept telling me I was dying, for like twenty years. I always had that ticking clock sensation in my head when it came to writing."


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Our look at position groups in the Pac-12 continues.
Arizona: With Ka'Deem Carey off to the NFL, figuring out Arizona's running back situation requires a bit of guesswork. Backups Daniel Jenkins and Kylan Butler are out of eligibility and rising junior Jared Baker tore his ACL in the regular-season finale. That leaves no running backs who had a carry last season. Those competing for carries will be redshirt freshmen Pierre Cormier and Zach Green, and true freshmen Jonathan Haden, an early enrollee, and Nick Wilson.
Arizona State: The torch was passed from Marion Grice to D.J. Foster toward the end of last season, and Foster will have a full offseason to prepare to be the No. 1 guy. He showed impressive flashes in spot playing time in the past two seasons, and ran for 318 yards (6.2 yards per carry) in three starts after Grice was lost to injury.
California: Much was made about Brendan Bigelow's talent during his career in Berkeley, but it never materialized the way many expected it would. He was beaten out by true freshman Khalfani Muhammad a year ago, then opted out of his final year of eligibility for a shot at the NFL -- and subsequently was not invited to the combine. Getting a feel for how coach Sonny Dykes would like to use his running backs is tough considering the lopsided nature of most of the games last year, but Muhammad showed all the signs that he would develop into a good Pac-12 running back.
Colorado: Christian Powell and Michael Adkins II will both be back after combining for 1,097 yards rushing in 2013. With receiver Paul Richardson off to the NFL, there's the need for added production on offense, and while coach Mike MacIntyre showed at San Jose State he'd prefer that to come through the air, it could add up to more opportunities for Powell and Adkins.
Oregon: Does it even matter who the Ducks hand the ball to? Sometimes it doesn't seem like it, but, regardless, Oregon remains loaded with speed and talent at running back. Byron Marshall (1,038 yards rushing) and Thomas Tyner (711 yards) will both see plenty of carries when quarterback Marcus Mariota (715 yards) isn't running on his own. The team does lose De'Anthony Thomas, who opted to leave early for the NFL, but Thomas turned into a relative afterthought last season anyway.
Oregon State: It shouldn't be hard to improve the Beavers' running game after they ranked 115th in the country in rushing yards per game last season. Their top two backs -- Terron Ward and Storm Woods -- return and figure to see more use under new offensive coordinator John Garrett. There was a glimpse of what could be against Boise State in the Sheraton Hawai'i Bowl as the Beavers unleashed a more balanced approach. Woods ran for 107 yards on 16 carries and Ward added 54 yards on nine carries in a comfortable 38-23 victory.
Stanford:The Cardinal's running back situation is outlined here in more detail, but it should be noted that the competition between Remound Wright, Barry J. Sanders and Ricky Seale -- competing to replace Tyler Gaffney -- will also include Kelsey Young. Young was recruited to Stanford to play running back, but was switched to receiver and is now back at running back. Sanders has the name recognition, but all signs point to Wright getting the first crack at being the primary back. However it plays out, it would be a complete shock if one back was used as much as Gaffney was in 2013 and Stepfan Taylor the two seasons before that.
UCLA: If things play out the way UCLA coach Jim Mora hopes they will, linebacker Myles Jack will be just that … a linebacker. After winning Pac-12 Offensive and Defensive Freshman of the Year, the Bruins would ideally keep him on defense. For that to happen, someone needs to step up. That conversation still includes Jordon James and Paul Perkins, while Craig Lee, a four-star recruit who redshirted last year, also factors into the equation.
USC: After watching Bishop Sankey turn into one of the nation's premier backs under the tutelage of new coach Steve Sarkisian, USC's deep stable of running backs has to be intrigued. The Trojans will return four of their top five leading rushers from a year ago -- Javorius "Buck" Allen, Tre Madden, Justin Davis, Ty Isaac -- when they were predominantly a run-first team. Allen, who was named the team MVP in 2013, figures to get the first crack at being the starter, but that could be just in name only as a running-back-by-committee scenario seems likely.
Utah: Another season, another new offensive coordinator for the Utes. This time it's Dave Christensen's job to invoke life in the Utah offense, which will return leading rusher Bubba Poole (607 yards) and Lucky Radley (284 yards). The Utes averaged just 4.1 yards a carry as a team last year, which is partially to blame for the change from Dennis Erickson to Christensen after just one year.
Washington: The NFL combine taught us that Bishop Sankey might have been the most physically gifted running back in the country last year. It's not as simple as plugging in another guy to replace him, but the Huskies are still in good shape. Senior Jesse Callier (48 carries, 213 yards in 2013), who was slated to be the starter before an ACL tear in the season opener in 2012, is intriguing and will compete with fellow senior Deontae Cooper (43 carries, 270 yards) and sophomore Dwayne Washington (27 carries, 332 yards).
Washington State: Considering quarterback Connor Halliday had three single-game passing totals that were more than leading rusher Marcus Mason ran for in entire season (429), any discussion about the Cougars' running game is tough to take seriously. Yes, there will still be running backs on the roster. No, they probably won't combine to run for 1,000 yards as a team.
Previous positions


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NEW DELHI (30 March 2012) –– The United Nations Special Rapporteur on extrajudicial, summary or arbitrary executions, Christof Heyns, called on the Government of India to continue to take measures to fight impunity in cases of extrajudicial executions, and communal and traditional killings.
The Special Rapporteur on extrajudicial, summary or arbitrary executions, Christof Heyns, concluded today his official visit to India, which took place from 19 to 30 March 2012.
Mr. Heyns praised the openness and willingness of the Government of India to engage, shown also by the fact that it was willing to host a mission dealing with the right to life, an area in which issues to be tackled are often complex in various countries.
"This, together with the generally high level of commitment by the Indian Government to human rights and the fact that there have recently been improvements in some respects in the loss of life, could provide a window of opportunity to take decisive steps to ensure the greater realization of the right to life," stated Christof Heyns.
While recognizing the size, complexity, security concerns and diversity of India, the Special Rapporteur remains concerned that the challenges with respect to the protection of the right to life in this country are still considerable. "Evidence gathered confirmed the use of so-called 'fake encounters' in certain parts of the country. Where this happens, a scene of a shoot-out is created, in which people who have been targeted are projected as the aggressors who shot at the police and were then killed in self-defence. Moreover, in the North Eastern States, and Jammu and Kashmir the armed forces have wide powers to employ lethal force."
The above is exacerbated by the high level of impunity that the police and armed forces enjoy, due to the requirement that any prosecutions require sanction from the central government – something that is rarely granted. "The main difficulty in my view has been these high levels of impunity", stressed the Special Rapporteur.
Other areas of concern relate to the prevalence of communal violence, and, in some areas, the killing of so-called witches, as well as dowry and so-called "honour" killings, and the plight of dalits ('untouchables') and adivasis ('tribal people').
Christof Heyns proposed a number of provisional steps to be taken to address these concerns. In the first place, he called for the establishment of a Commission of Inquiry, consisting of respected lawyers and other community leaders, to further investigate all aspects of extrajudicial executions. This should entail a form of transitional justice.
"Institutions such as the National Human Rights Commission should establish to what extent the guidelines they provide on matters such as the use of lethal force by the police are in fact observed, as opposed to providing empty promises in practice," underscored the Special Rapporteur, recommending the immediate repeal of the laws providing for the immunity from prosecution of the police and the armed forces, and in particular the repeal of the Armed Forces (Special Powers) Act of 1958.
"India should ratify a number of international treaties, including the Convention Against Torture and the International Convention for the Protection of All persons from Enforced Disappearance," he said. "India should also host missions by other United Nations independent experts, in particular those related to torture, enforced disappearances and counter-terrorism measures."
The 12-day official mission by the Special Rapporteur was the first visit to India by an independent expert since that country extended an open invitation to UN Special Procedures in 2011, and the first mission to India by an expert mandated by the UN Human Rights Council to monitor and report on extrajudicial, summary or arbitrary executions.
The UN Special Rapporteur's final conclusions and recommendations will be submitted as a comprehensive report to the Human Rights Council at a future session in 2013.
The Special Rapporteur on extrajudicial, summary or arbitrary executions, Christof Heyns (South Africa), is a director of the Institute for International and Comparative Law in Africa and Professor of Human Rights Law at the University of Pretoria, where he has also directed the Centre for Human Rights, and has engaged in wide-reaching initiatives on human rights in Africa. He has advised a number of international, regional and national entities on human rights issues. Mr. Heyns' research interests include international human rights law and human rights law in Africa.
Read full statement below
Related articles
- UN rapporteur arrives on fact-finding mission in Kashmir (kractivist.wordpress.com)


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If you use a Samsung Galaxy smartphone you might have had this issue. This is a common problem and several Samsung Galaxy phones seem to have USB connection problems. Sometimes the USB connection stops working and even rebooting the phone does not solve the problem. It is not a driver problem on the PC, nor some dust on the USB connector but really a software/configuration problem on the Android phone itself.
Before you try to re-install the driver by installing Kies, try this simple method.
- Unplug the USB cable
- On the cell phone, dial the following number: *#7284# Once the last # is hit, the PhoneUtil application is launched.
- Choose USB -> Modem quit once. Then again dial *#7284# and then USB -> PDA mode.
- Now connect the USB cable for mass storage mode
You should have the USB Mass Storage option came back.
How to free GBs of space on an iPhone without deleting photos, apps and files – the Cleopatra trick


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Introducing to you the latest TH14 Clash of Clans base model Box Base TH14. The base template is suitable for regular War or Clans War League players.
Defender: 1 lava, 2hh, 3 ark
It is full of bomb defense works, flying mines, pet house. It resists 3 stars very well, you can adjust the inferno to the multi-rayed hell tower to optimize your defense. The arrangement of flying bombs in position around the multi-rayed inferno makes it very difficult to go super queen and combo of flying soldiers. The center area of the base model concentrates a lot of bombs and traps, the catapult defenses there are very supportive.
You can clone the base directly using this link but understand that obstacles will prevent buildings from being placed - if you have some obstacle like grass or many obstacles in the base you may need to build the parts manually from the image above.


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PARIS (AP) — She says her life is a lot calmer since she married fashionista-rapper Kanye West. And she prefers to stay at home with her baby.
But calm did not prevail Wednesday when Kim Kardashian, in a whistle-stop 24-hour visit to Paris, faced the incandescent lights of Valentino's couture show in a plunging ice blue gown that caused photographers to trip over themselves.
Away from the limelight, Emma Watson, demure in a black lace gown, quietly slipped in at the last minute.
Meanwhile, "Moulin Rouge" director Baz Luhrmann attended Jean Paul Gaultier's gender-bending display and spoke out about gay politics.
Here are the highlights of the last full day of Paris' haute couture fall-winter 2014-15 collections, including show reports from Valentino, Jean Paul Gaultier and Elie Saab.
It's been a roller-coaster of a year for reality star Kardashian, with the birth of her baby last summer and her highly-publicized Florentine wedding with West.
So little wonder that the 33-year-old feels her life has got more serene since she tied the knot.
"Laughter is such a good medicine. It's definitely got calmer since I married. I love my life with my husband and my baby," she told The Associated Press.
Kardashian looked radiant in a revealing silk Valentino floor length gown as she arrived arm-in-arm with house founder Valentino Garavani.
"Absolutely, calm on the inside can make you glow on the outside. I also get a lot of sleep. But I'm a happy person and in such a good place," she said.
Valentino climbed Mount Olympus for inspiration for his new season, bringing back the flowing, draped silks and flat crisscross sandals of the ancient Greek gods.
Maria Grazia Chiuri and Pierpaolo Piccioli produced a strong 61-piece collection in which they showed off the natural beauty of crepe silk, sheer tulle and marbled wool in draped or column silhouettes.
Often creations were cinched under the bust thanks to leather bandings in red, white and black, giving the models the illusion of goddess-like leg length.
Elsewhere, details normally seen on Greco-Roman vases, like flowers or olive leaves, were printed on garments.
But the show hit its highest point when the designers let the sumptuous couture-standard fabrics do the talking — with devastating simplicity.
One draped pale blue gown with gentle ripples could have been worn by goddess Hera, and, deceptively, it looked like it had been cut from a single piece of cloth.
There was more than a hint of Angelina Jolie's latest Disney villain in the air at Jean Paul Gaultier's bewitched show.
Fifty dark couture creations such as black fur coats, black paneled leather pencil skirts, circular crinoline skirts, exaggeratedly high fringes, and sleeves in black "mille feuille" organza couture slinked along the silken catwalk.
The piece de resistance? A look that Gaultier called "Maleficent." A model with an exaggeratedly long jaw-line, black bustier with mink bands and dark crepe pants held out a mirror in which she stared, pouted and cackled.
It had the audience hypnotized.
As is now common with the aging enfant terrible, many convergent silhouettes were thrown into the couture cauldron — including draped hoods, men's tuxedos and even silver silk sweat pants.
But the dark theme, and the layers of stiff organza that stood off the body and were delicately hand-cut in the atelier, gave this collection an unusual cohesion.
Baz Luhrmann, the director who brought drag-queens and gender-benders to the screen with gusto in films such as "Romeo & Juliet" and "Moulin Rouge," spoke out about gay rights at Gaultier's show.
The catwalk models included Conchita Wurst, the bearded drag queen who won this year's Eurovision song contest.
"Gaultier was always about transgender sexuality, about high and low," he said. Referring to Wurst, he added: "So for him to be having his show crowned by the grand dame of drag queen or transsexual expression is appropriate."
Luhrmann said there has been a backlash against gay rights around the world, especially in France and several US states, partly triggered by the legalization of gay marriage. But the 51-year-old said that this shows gay rights are advancing.
"What you see is a sort of reaction against how successful it's been," he said.
Haute couture is expensive to make, and for decades it has been known to eat up more money than it reaps for Parisian fashion houses. It's traditionally been used as a kind of advertisement, to raise the house profile and attract customers to the lucrative lines such as perfume and ready-to-wear.
But times are changing.
Gaultier says his haute couture is actually profitable — and healthily in the black.
It's perhaps a result of the recent renaissance of haute couture, after years of critics sounding its death knell.
"I can say 'Yes.' It is profitable. I love it as we have more and more clients. I am proud to be a designer of couture," said the designer, who publicly champions his main clients, such as socialite Mouna Ayoub, by placing them in the front row of his show.
He says the secret of his success is to make wearable clothes, but to not compromise on the couture craftsmanship.
"Do couture truly as couture," he said.
Myriad baroque chandeliers lit up as Elie Saab transformed his runway into a winter palace.
And it was, indeed, a dreamt-up Parisian palace that inspired the shimmer-rich collection, according to the Lebanese couturier.
Jewel-toned colors of crimson, glacial blue, midnight indigo, white and sultry black were designed to mirror the "prismic reflections" of crystal chandeliers. Floral embroideries on tulle and lace were taken from the scrolling patterns of stately murals.
The palace theme, however, was essentially a pretext for the master of va-va-voom to carry on his infinitesimal variations on the popular embellished gowns he produces season upon season.
As ever, there were the cinched-waist column dresses, or the pearly embellished full-skirts that sparkled in the light.
Saab is one of the main go-to designers for rich fashion-conscious brides hunting for a gown, and Wednesday's collection demonstrates why. Though it packed no surprises — far from it — everything is constructed to the ultimate finesse.
With models' faces masked or netted, Maison Martin Margiela's deconstructed show played with unfinished fashion designs.
Asiatic-style decorative gowns were cut away asymmetrically in the leg, as if the model had put on the dress before it was finished.
Elsewhere, a mish-mash patchwork of fabrics resembled the test samples designers use before they purchase fabric.
Dangling cords on blue and red dresses formed a lobster, meanwhile, sending up the Elsa Schaparelli look that Lady Gaga reinterpreted in 2010.
It was wacky and creative.
Thomas Adamson can be followed at Twitter.com/ThomasAdamsonAP