Page 65 planning information and services could be met. birth rates would certainly fall well below current levels in these countries.

164. The difficulty is that women in different stages of life and different circumstances require different kinds of family Rlanning service and information. As a broad-brush generalization, young women may wish to delay the onset of childbearing, many women in their twenties may wish to space births, and many women in their thirties may wish to stop bearing children. Of course, these age categories are not precise. Family planning programs must be adjustable to satisfy different user demands. Young women and those spacing pregnancies require temporary methods, particularly contraceptive pills and condoms, but also the others. (Some of those, such as injections, last several months cr more.) Other couples who want to stop having children altogether may prefer permanent surgical methods, particularly sirnce older women face increased risk of sideeffects from pills. In all age groups, it is important to offer male contraceptive options -- notably condoms and vasectomy -- and to encourage men not to leave the contraceptive decision up to their partners.

165. Septic induced abortion is an increasing concern in much of the developing world. It tends to occur more often when induced abortion is illegal. Family planning can prevent unwanted pregnancy.

166. Adolescent pregnancy has become a significant social problem in many countries, from Africa to Latin America -- and in some industrial countries. A direct result is the increased incidence of induced abortion, with corsiderable associated mortality and morbidity. It threatens both maternal and child health as young mothers are not physically mature enough to bear children easily (Herz and Measham 1987). And it contributes to high female dropout rates in secondary school, generally limiting the earning prospects of the young mothers. The economic consequences are particularly acute for single young mothers responsible largely for their own children.

167. Young women, and women in the prime childbearing years need access to information and ways of spacing children. Older ;:nmen need the means to cease childbearing. Many maternal deaths (15 to 60 percer.t in many countries) could be averted simply by preventing pregnancies that women now say they do not want - - even where couples want several children, women are having many unwanted pregnancies (Maine and others 1986). But programs cannot be aimed just at those who want no more pregnancies. To have maximum effect, family planning must be an option for any women of childbearing age.

# Promising Approaches to Family Planning

168. Variety of methods. More evidence is available on cost-effective ways to deliver basic family planning services than on many other basic services, including agricultural extension, credit, nonformal education, and other forms of health care (USAID 1988; World Bank 1986). Extensive international evidence demonstrates that family planning acceptance increases when women are offered a variety of clearly explained contraceptive choices and when services are brought closer to home, particularly where culture and poverty make it difficult for women to travel. It is essential to have a variety of good temporary