• ectopic pregnancies that have increased every year since 1970 and have a fatality rate of 42 per 1,000 cases;

  • infertility that affects about 10 percent of married couples who want children; and

  • an epidemic of sexually transmitted diseases, including 4 million cases annually of chlamydial infection and 24 million people in the United States infected with human papillomavirus, many types of which axe associated with cervical carcinomas and severe dysplasia.

Research that provides solutions or partial solutions to some of these problems has the potential to generate significant reductions in health expenditures. For example, an Institute of Medicine committee1 conservatively estimated that, based on the costs of care in the early 1980s, a reduction in the rate of low birthweight from 11.5 percent to 9 percent just in women aged 15 to 39 years who receive public assistance and who have less than 12 years of education would save $188.2 million in the first year alone. Subsequent heavy health care, education, and other expenditures are incurred to care for the frequent long-term morbidity and disability sequelae of low-birthweight babies.

Origins of the Study

IOM Planning Committee

Questions about the state of research in obstetrics and gynecology (OB/GYN) departments arise in a troubling context: epidemics of sexually transmitted diseases and teenage pregnancy, lagging improvement of infant mortality, and the advent of new reproductive technologies such as in vitro fertilization. This context demands that serious attention be paid to OB/GYN research capabilities.

In 1988, the Center for Population Research of the National Institute of Child Health and Human Development asked the Institute of Medicine (IOM) to convene a committee to assess whether women's reproductive health would be better served if a stronger research base were developed in OB/GYN departments and whether IOM might usefully undertake a study to determine how to strengthen that research base. The planning committee convened by IOM noted the interdependence of several relevant factors: accomplishing needed research depends on the availability of human resources and funding, but generating a cadre of investigators depends on training programs, the quality of



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