proportion who are attended by a professional at delivery show some small gains from 1985 to 1996: from 48 to 53 percent in the developing world as a whole; 49 to 53 percent in Asia; 34 to 42 percent in Africa; and 64 to 75 percent in Latin America and the Caribbean (World Health Organization, 1997).

POLICIES AND PROGRAMS

Given the changing context of parenthood, policies and programs of particular interest for promoting successful transitions to first-time parenthood include those that (1) help young people have the option of delaying the first birth until they have completed their education and training, (2) allow new mothers whose schooling, training, or work were disrupted by pregnancy to return to school if they wish, and (3) support first-time parents in the adoption of family planning to allow proper spacing of a second birth. Evaluations of the impact of various programs in sexual and reproductive health designed for young people are fully reviewed in Chapter 4. We are not aware of evaluations in other policy domains with implications for first-time parents. Indeed, to our knowledge very few such programs specifically targeted to newly married couples or first-time parents are currently in operation. Even in a country like China, where marriage and family planning policy has impacted on the lives of all young people in the country for several generations, there has been no deliberate attempt by the government to influence the spacing of the first birth (Feng and Quanhe, 1996).

About 10 years ago, school policies as they related to pregnant students were reviewed for sub-Saharan Africa (National Research Council, 1993b). At that time, most policies required expulsion from school at the time of pregnancy, with some countries allowing for reentry under certain conditions after birth. We were able to update that review and add some data from South America (see Box 8-4). It would appear that the diversity of policies has increased with a growing number of countries allowing for more liberal reentry policies and some even allowing pregnant girls to remain in school during their pregnancy (e.g., Burkina Faso, Cameroon, Chile, Peru). An increasing number of countries allows for a return to school after some period of maternity leave. The extent to which these policies are actually implemented has not been documented, and the effects of such policies have not been evaluated. However, policies are more likely to follow changes in behavior than to lead those changes.

A recent review of programs addressed to married adolescents in developing countries found that most of the relatively few available were addressed to engaged or newly married women or couples but not to first-time parents (Graft, Haberland, and Goldberg, 2003). The Population Council’s



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