2 maternal health results from this development cycle in myriad ways. For example, female education tends to lower fertility "by delaying marriage, by increasing the effectiveness of contraceptive use, and by giving women ideas and opportunities beyond child bearing alone" (World Bank, 1984). Maternal health and nutrition improve directly as a result of lowered fertility, and indirectly as the development cycle gains another notch, which makes possible further advances in the living conditions of communities and individuals. While we will not dwell on these relationships, the contribution of family planning to maternal health that operates through overall development, clearly is of critical importance.

# I. DIRECT EFFECTS OF FAMILY PLANNING ON MATERNAL HEALTI

Here we examine the direct effect of family planning in preventing maternal mortality through fewer births, fewer high risk pregnancies and fewer crudely performed abortions.

# Fewer Births

The direct effect of family planning is most obvious anA dramatic in relation to the reduction of fertility. If a pregnancy do-, '.t occur, obviously its health risks are averted. Fortney (1985) il tes the impact with data from Egypt and Bali. There were 190 mater-. eaths per 100,000 live births in Menoufia, Egypt, in the early 1980s, cvmnared to 618 per 100,000 live births in Bali. This is the so-called maternal mortality rate (actually a ratio) which measures a woman's risk of dying once she is pregnant. The picture changes radically when we look at the true maternal mortality rate, i.e. the number of maternal deaths per 100,000 women of reproductive age, which measures both the rate at which women become pregnant and the risk of death once they are pregnant. This rate turns out to be 46 per 100,000 women in Egypt and 70 per 100,000 women in Bali. Bali still has the higher rate but the difference is much smaller. The difference between the two measures of maternal mortality reflects differences in the number of pregnancies in the two populations, which in turn largely reflects the use of family planning. In this case, about 50 percent of women were using contraception in Bali versus 25 percent in Menoufia, Egypt.

Maine et al (1986) used World Fertility Survey data to estimate the proportion of maternal deaths that would be prevented if all women saying they want no more children and currently not using effective contraception, were able with family planning to avoid all future births. The median proportion of deaths averted for twenty-six developing countries was 29 percent, with a range from 5 percent in Ivory Coast to 62 percent in Bangladesh. The median percentage reductions were as follows: 17 percent for 8 African countries; 35 percent for 10 Asian countries; and 33 percent for 8 Latin American countries. Two points deserve emphasis here. First, Maine et al estimate the proportion of deaths averted. The absolute number of lives saved obviously depends on the maternal mortality ratio. For many developing countries, especially those in South Asia and sub-Saharan Africa, the ratio is 400 - 1,000 maternal deaths per 100,000 live births, a level up to 100 times as high as that prevailing in Northern Europe and North