aggravated by pregnancy: we include as reproductive health those programs that help prevent pregnancy but not those that disrupt malaria transmission. The framework we use does not include actions to improve child survival after the first week of life, though many of the interventions we discuss (improved pregnancy and delivery care and child spacing and fertility limitation) would have positive effects on child health.

For practical purposes, the panel concentrated on health problems for which causes, consequences, and effective remedies are linked programmatically. We recognize that in drawing limits around our subject we risk neglecting some useful linkages. The boundaries around our topics should be considered permeable membranes, not rigid walls.

The next four chapters of this report follow the sequence suggested by our organizing framework, dealing with healthy sexuality (Chapter 2), infection-free sex (Chapter 3), intended pregnancies and births (Chapter 4), and healthy pregnancy and delivery (Chapter 5). Each chapter discusses both the magnitude of problems and what is known about the effectiveness of interventions. The next two chapters deal with themes that link the interventions: program design and delivery (Chapter 6) and costs and financing (Chapter 7).

A recurring theme in this report is the need for more research. Although enough is already known to move programs and policies in more effective directions, continued organizational learning and adaptation is still needed. This need spans the spectrum from development of new diagnostic tools, pharmaceuticals, and contraceptives to field trials, survey measurement of reproductive morbidities and risk behaviors, operations research, and cost-effectiveness analysis of interventions. The panel finds good reason to believe that the investment in this research will pay off in terms of improved quality of life, especially for the people who are now the least well served.



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