health. But there are also examples of family planning programs serving (as opposed to coercing) large numbers of women even in unpropitious circumstances, as in Bangladesh (Cleland et al., 1994). Where women are illiterate, poor, and powerless, an ability to limit fertility may be an important (though not in itself sufficient) precondition for change in their status. This argument can be made not only with examples from what are now poor countries, but with historical examples from what are now rich countries, where improvements in the legal and political status of women typically followed by decades the onset of fertility declines.

The education of girls and the improvement of the legal, economic, and political status of women have much broader effects on society than just their impact on fertility and reproductive health. But in the narrow sectoral perspective of a report on reproductive health, they might be seen as the long-term measures that would ensure the sustainability of all short-term programs targeted directly at improving reproductive health. These are complementary investments working on different time scales and through different organizations in society, rather than substitutes.

In the short run, there are several relatively low-cost ways in which policy reforms can support the goal of intended births. Kenney (1993) provides a convenient "checklist" of laws and administrative regulations that limit the availability of safe contraception: health and safety regulations that restrict the choice of methods or of providers; taxes and barriers to trade; regulation of advertising; and restrictions affecting the private sector (both commercial and nonprofit institutions).

Though it is likely that improved access and quality of family planning services would reduce high rates of abortion in many countries, even widespread and high-quality family planning services will not eliminate the demand for abortions. In practice, the effectiveness of reversible contraception is always well short of 100 percent, and coerced or simply unplanned sexual relations remain common.

It is beyond the scope of this report to assess the arguments about whether abortion is morally justified, and under what circumstances, or whether public financing and provision of abortions is justified in a society where a significant minority believe induced abortion to be immoral. But there are many countries where early abortions, in particular, are completely legal, yet unsafe abortions are common, and complications are a major health problem (World Health Organization, 1994). Even where abortions are largely or entirely illegal, medical care for complications is still provided. Thus, regardless of the legal status of induced abortion, improved care for incomplete abortions and complications must be seen as a part of reproductive health services.



The National Academies | 500 Fifth St. N.W. | Washington, D.C. 20001
Copyright © National Academy of Sciences. All rights reserved.
Terms of Use and Privacy Statement