cancer screening. As noted above, these complications are a major source of reproductive morbidity and mortality. For many of these conditions, the associated disability costs are fairly high, but so are the perceived costs of intervention. Consequently, the threshold to intervene is often quite high and a vicious cycle has developed. Because interventions have rarely been attempted, proven models for successful program development in resource-poor settings are lacking, and inexperience fuels programmatic complacency.
Strengthening the clinical management of women who go to health facilities with complications of septic abortion is a priority area for intervention. Effective programs have the potential to avert many of the deaths that occur each year as a result of unsafe abortion (McLaurin, Hord, and Wolf, 1990). A number of programs for training providers in the use of appropriate technology, such as manual vacuum aspiration, have been developed and implemented. Of course, efforts to manage the complications of septic abortion must be accompanied by concerted efforts to prevent septic abortion in the first place. Strengthening postabortion contraceptive services is an important strategy.
Another life-threatening complication of some RTIs is ectopic pregnancy. When this occurs, it typically presents as a medical emergency requiring urgent surgical intervention. Successful clinical management of this uncommon, but serious, condition will depend largely on the availability of appropriate diagnostic and transport systems to ensure safe maternity (see Chapter 4). This is particularly important for women in rural areas who must travel considerable distances to surgical facilities.
The management of infertility and the development of screening programs to detect and manage cervical neoplasms are examples of other areas where interventions are needed to manage the complications of reproductive tract infection. Recently, the WHO Special Programme on Human Reproduction has developed a manual on "simplified infertility management" for developing countries (Rowe et al., 1993). A number of pilot projects for cervical cancer screening have also been recently started (Blumenthal et al., 1994; AVSC International and Program for Appropriate Technology in Health, 1994). To date, however, little data are available concerning cost-effective interventions to reduce the impact of these complications.
We present first our general recommendations for the promotion of infection-free reproductive health. Specific recommendations are then discussed in three areas: immediate priorities for existing reproductive health programs, including those programs initially established either