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NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.

This report has been reviewed by a group other than the authors according to procedures approved by a Report Review Committee consisting of members of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine.

The Institute of Medicine was chartered in 1970 by the National Academy of Sciences to enlist distinguished members of the appropriate professions in the examination of policy matters pertaining to the health of the public. In this the Institute acts under the Academy's 1863 congressional charter responsibility to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Kenneth I. Shine is President of the Institute of Medicine.

The project was supported by funds from the Carnegie Corporation (contract nos. B-5269 and D-93065). Additional project support was provided by the Special Programme of Research, Development, and Research Training in Human Reproduction, World Health Organization (contract no. HQ/93/043301); the Kellogg Endowment Fund; and the National Research Council's NAS/NAE independent funds and IOM independent funds.

Library of Congress Catalog Card Number: 95-72800

International Standard Book Number: 0-309-05430-3

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Copyright 1996 by the National Academy of Sciences. All rights reserved.

COVER: Oil painting by Ablade Glover. Reprinted, with permission, from the Carnegie Corporation of New York. Ablade Glover is a Ghanaian artist who has exhibited widely in the United States, Switzerland, Zimbabwe, England, Germany, and his home country. He is represented in collections in many countries. He studied art in the United Kingdom and at Kent State University and Ohio State University in the United States. Currently he is associate professor, Department of Art Education, University of Science and Technology, Kumasi, Ghana, on sabbatical in Accra, where he is directing a cooperative gallery called Artists Alliance.

Printed in the United States of America

The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The image adopted as a logotype by the Institute of Medicine is based on a relief carving from ancient Greece, now held by the Staatlichemuseen in Berlin.

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