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Reproductive Health in Developing Countries: Expanding Dimensions, Building Solutions
therapy. Efforts should focus on reducing use of harmful intravaginal substances (i.e., douches and desiccants) and on curtailing inappropriate use of broad-spectrum, systemic antibiotics. The latter will require changing prescribing practices of both traditional and allopathic health care providers, pharmacists, and family members. Family planning and other health services should use simple, inexpensive tests of vaginal secretions for symptomatic women and provide appropriate management of endogenous RTIs.
Infection prevention, consisting of simple measures such as hand washing, appropriate use of gloves, and adequate sterilization of instruments, should be a minimum standard. Prevention of iatrogenic infection requires improvement in overall quality of reproductive health services, particularly transcervical procedures. One of the most effective ways to prevent iatrogenic RTIs is to reduce the number of unsafe abortions by improving the supply of contraceptive services, promoting the use of emergency contraception, and decriminalizing abortions.
In developing countries outside sub-Saharan Africa, between one-tenth and one-third of all recent births are reported as unwanted, and the same percentages are reported to be the result of mistimed conceptions. In Africa these percentages are typically lower, but since fertility rates are high, the proportion of women and families affected by unintended pregnancies is as high as elsewhere.
Reducing unwanted pregnancies promotes maternal health mainly by reducing the number of times that a woman is exposed to the risks of pregnancy and childbearing in poor environments. Children's health is also affected: unintended pregnancies are disproportionately in high-risk categories, and lower fertility results in increased family and social investments in health care, schooling, and nutrition for the planned children.
To meet existing and growing unmet need for contraception, access to contraceptive services should be expanded through clinical and nonclinical channels, including postpartum care and STD prevention services. Reducing unmet need for family planning through safe access to a range of contraceptive methods is a high priority for reproductive health programs. A basic task for family planning and health programs is to support informed choice by clients. Information, education, and communication programs and improvements in counseling are still needed, even where family planning programs are well established, because of gaps in the knowledge of providers, clients, and potential clients about how to