use contraceptives and the advantages and disadvantages of the methods available.

Use of contraceptive pills for emergency contraception appears safe and effective for women who have unprotected mid-cycle intercourse. Information on the techniques should be provided widely to health care and family planning staff and those who may need it.

Unsafe abortion remains a leading cause of maternal death. Access to safe means for abortion care, including early intervention to treat abortion complications, is needed to reduce the numbers of deaths. Even where abortion is legal, services are often low in quality, stigmatized, and access is difficult, making abortion needlessly dangerous. In those countries governments should ensure (through direct provision or regulation) adequate equipment and training for manual vacuum aspiration in the first trimester of pregnancy. Where medical supervision and surgical backup are feasible for medical abortions, the option should be available for first-trimester abortions. Health care and family planning providers will require training on medical abortion and contraindications. Where abortions are illegal, health services should ensure that women who have had septic and incomplete abortions are treated appropriately and promptly. Where the prevalence of infertility is high, as in much of Africa, measures to reduce infertility should be a high priority, including programs to control STDs, provision of aseptic abortion, and early treatment of septic abortion.

HEALTHY PREGNANCY AND CHILDBEARING

The major direct causes of maternal deaths in the developing world are hemorrhage, sepsis, obstructed and prolonged labor, septic abortion, and hypertensive disorders of pregnancy. Even among survivors, consequences of these conditions can be severe. It makes sense to consider maternal and perinatal health together, because both mother and child are affected by the direct causes of death and disability and because the interventions designed to promote maternal and perinatal health often overlap or are operationally linked.

Priority should be given to providing women with essential care for obstetric complications, in particular by establishing or strengthening obstetric units at hospitals. The quality and appropriateness of skills for the management of labor should be upgraded and maintained. The major causes of maternal mortality cannot be predicted or prevented well enough during pregnancy to allow reliance on primary prevention and screening for high risk. Many previous efforts to reduce maternal mortality in developing countries have foundered because they relied solely on attempts to train traditional birth attendants, screen high-risk pregnancies,



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