services, as well as action by sectors other than health to create the supportive environment for improvements in reproductive health. Implementing the Programme of Action will require improvements in the quality and range of existing services, as well as basic and applied research on new services. It will also require information on the magnitude of reproductive health problems, the effectiveness and feasibility of alternate actions to overcome the problems, and the resources needed to do so.
To aid in this process, the U.S. Agency for International Development, the Andrew W. Mellon Foundation, and the William and Flora Hewlett Foundation asked the Committee on Population of the National Research Council to: (1) assess the magnitude and severity of reproductive health problems in developing countries, (2) assess the likely costs and effectiveness of interventions to improve reproductive health, and (3) recommend priorities for programs and research. To carry out this task, the Research Council formed the Panel on Reproductive Health in Developing Countries.
To organize our research and presentation, the panel adopted the ICPD's vision of reproductive health:
Every sex act should be free of coercion and infection.
Every pregnancy should be intended.
Every birth should be healthy.
This vision is also consonant with other widely used definitions of reproductive health (see Fathalla, 1988; Germain and Antrobus, 1989).
No population in the world has attained the state of health described by the ICPD definition quoted above nor fully realized the vision adopted by the panel. By stating the goals positively, rather than in terms of reduction in morbidity, mortality, and other forms of suffering, we emphasize health and a broad focus. We consider social and behavioral change and policy changes, as well as programs targeted directly against particular causes of illness and death. Improving reproductive health involves social and cultural influences and the behavior of individuals and their families, at least as much as delivery of services by public and private agencies to their clients.
This report should be useful for those who design reproductive health programs in developing countries, set priorities for funding them, and conduct or fund research to improve programs. The geographic focus of this report is primarily the low- and middle-income countries of Asia, the Pacific islands, Africa, Latin America, and the Caribbean basin. However,