admitting only to spontaneous abortion in Mérida, Mexico, in 1979, 77 percent later admitted that the abortion had been induced" (WHO 1994). Nevertheless, the WHO document from which this citation was taken is as thorough and recent a compendium as exists anywhere and should be considered definitive at this point in time. Still, as the document itself indicates, the numbers provided, especially the numbers of unsafe abortions, should be considered undercounts. This is so even in the United States.

This figure supersedes a prior estimate of 200,000 generated from projections based on hospital records. Three factors should be taken into account in interpreting this number: The possibility of a concomitant underestimate in rural areas owing to under-reporting; the difficulty of distinguishing primary from secondary causes of death; and, most importantly, its direct relation with the total number of annual maternal deaths (WHO/FHE, personal communication, November 1995).

The term "comparable market economies" refers to selected European countries and Canada. China, the former Soviet Union and newly independent states of central Europe, and most developing countries report ratios to live births that are significantly higher than those in either the United States or other economically comparable countries (Institute of Medicine 1995).

The term "rate" has been traditionally used for this figure; it is, however, really a ratio and measures obstetric risk .

However, the largest absolute number of maternal deaths actually occur among low-risk women, since there are so many more low-risk pregnancies altogether, and because the complications of pregnancy, which also occur among low-risk women, cannot be predicted in advance.

The reproductive tract infections (RTIs) have been broadly defined to include sexually transmitted infections and infections that are nonsexually transmitted, and comprise three types of infection: (1) sexually transmitted diseases (STDs), such as chlamydial infection, gonorrhea, trichomoniasis (which may or may not be sexually transmissible), syphilis, chancroid, genital herpes, genital warts, and human immunodeficiency virus (HIV) infection; (2) endogenous infections, caused by overgrowth of organisms that can be present in the genital tract of a healthy woman, such as bacterial vaginosis and vulvovaginal candidiasis; and (3) iatrogenic infections, associated with medical procedures, such as female genital mutilation, poor delivery practices, cesarean section, unsafe abortion, and improperly performed pelvic examinations and IUD insertions (Brunham and Embree 1992; Meheus 1992). Of the three types of reproductive tract infections—sexually transmitted, endogenous, and iatrogenic—the majority are sexually transmitted in direct fashion (Brunham and Embree 1992). However, the iatrogenic infections are also important because they are linked to contraception, or the lack of contraception, through sepsis during the medical procedures cited above. Of the eight major STD pathogens producing RTIs, four are bacterial (chancroid, chlamydia, gonorrhea, and syphilis) and four are viral (HIV, human papilloma virus/HPV, herpes simplex type 2/ HSV-2, and hepatitis B/HBV).

In the context of the sexually transmitted reproductive tract infections, it is unfortunately necessary at times to use the term "females" rather than "women." Normally, one would expect only women of fertile age to be at risk of such infection. However, rape and other sexual abuse of prepubescent females, as well as female genital mutilation where that is practiced, mean that it is sometimes the case that females—not women-—come to bear a burden of sexually transmitted disease.

It is important to note in this context the behaviorally and biomedically significant distinction between abstinence for pregnancy prevention and abstinence for STD prevention: While the former implies only avoiding penis-in-vagina intercourse, the latter implies avoiding vaginal, anal, and oral intercourse.

Clinical trials of the protection provided by the female condom against sexually transmitted infections are now in progress, under the aegis of the National Institute of Child Health and Human Development of the U.S. National Institutes of Health.