14 births, it will cost US$20 x 125/0.4, or US$6,250, to avert one maternal death.

The roughness of these estimates of the cost of averting maternal deaths deserves emphasis. The validity of the estimates depends critically on the assumptions used in the hypothetical illustrations. Of greater interest than the actual estimates is the fact that similar levels result from two quite different methodologies, which increases the plausibility of the results. And the order of magnitude of the cost of preventing a maternal death, which is a relatively rare event even in developing countries, is not high given the likelihood that the cost of preventing an infant or child death is several hundred dollars, and the cost of preventing an adult death from other causes is likely to be several thousand dollars (please see below). Finally, there is a pressing need for more research into the cost-effectiveness of alternative means of averting maternal (and other) deaths in develoriAng countries.

The cost of preventing a maternal death, whether by family planning or other means, seems high when compared to that of saving an infant and child, which for an infant is about US$700 in developing countries (Walsh and Warren, 1979). The main reason for the lower cost or preventing child deaths is their larger niuber, which produces economies of scale in health programs. Preventing adult deaths from other causes is also relatively costly. For example, the estimated cost per death averted from cancer of the cervix by a screening prog;am is US$501,000 in the U.S. (Barnes, 1981). Data from developing countries are scarce and show costs ranging from US$250 per malaria death averted (Walsh and Warren, 1979), to several hundreds of dollars per person effectively treated and several thousand dollars per death averted, for tuberculosis in Botswana (Barnum, 1986).

The cost-effectiveness of family planning, as well as other interventions, is greatly increased by the fact that for every death averted, at least ten women are saved from serious and often permanent health impairment. Moreover, when a woman dies from pregnancy-related causes, the loss is triple: her productivity and other contributions to society are lost, the infant usually dies (Chen, 1974), and the survival prospects of her other children are reduced substantially. We conclude that family planning is a cost-effective means of protecting women's health and lives.

A final, critical question for policymakers is whether the benefits of providing organized family planning services exceed the costs, both in the medium and the long term. The evidence clearly shows that benefits exceed costs in the long term (World Bank, 1984). A recent analysis of actual family planning program expenditures by the Mexican Social Security Institute (IMSS) provides impressive evidence of savings in the medium term (Nortman, Halvas and Rabago, 1986). Net savings (benefit minus cost) to IMSS began in year four of the program, and by years eleven and twelve (1982 and 1983) had reached a high of eleven pesos (in constant 1983 pesos) saved for every peso spent. 'A savings in maternal and child care expenditures of 45 billion pesos, or 8.5 percent of the 1984 budget, was thus available for other IMSS services' (Nortman et al, 1986). In the many countries where