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Reproductive Health in Developing Countries: Expanding Dimensions, Building Solutions
Mass communication, social marketing7, and community-based distribution of contraceptive information and supplies are all strategies that have proved successful in spreading two basic messages—the existence of safe and effective contraceptive methods and the small family norm—even in countries like Bangladesh where the weight of tradition worked against them (Cleland et al., 1994; Lissance and Schellstede, 1993; Piotrow et al., 1994). Now, family planning programs face a new challenge in trying to convey subtler messages about the advantages and disadvantages of different methods and about effective use. There have been some successes in using proven strategies to convey information beyond the basic messages: for example, experiments with adapting the ''training and visit" system of agricultural extension to health and family planning in several Indian states.
Access to Safe Abortion
In the past three decades, more than 70 countries have changed their laws to remove criminal prohibitions of abortions or to expand the scope of provisions under which abortion had previously been legalized (Cook, 1989). More than 50 percent of all women in developing countries live in countries where induced abortion is legal under most circumstances, 27 percent live in countries where abortions are legal under various medical or social criteria, and 15 percent live in countries where induced abortion is either always illegal or legal only when a woman's life is threatened if she carries the pregnancy to term. These figures are heavily affected by China and India, however: excluding these countries, the figures are 19 percent (almost always legal), 52 percent (legal under specified criteria), and 28 percent (almost always illegal) (Population Reference Bureau, 1995; Henshaw and Morrow, 1990). The current legal status of induced abortion varies widely across regions: 174 million women live in developing countries where abortion is usually illegal, most of them in Central and West Africa, South Asia apart from India, the Middle East, and South America.
The legal status of abortion is without doubt important in determining whether women have access to safe abortions, but it is not the only
Sheon, Schellstede, and Derr (1987:367) define contraceptive social marketing as the distribution of contraceptives through existing commercial and retail channels, and their sale at low prices, with subsidies from national governments or donors, with the primary aim of achieving high distribution among low-income groups. (See also Sherris, Ravenholt, and Blackburn, 1985, for a review of social marketing.)