(Segree, 1985). The most common STDs in 1985 were gonorrhea, syphilis, and mixed vaginal infections. Chronic disease create problems with utilization of health services because 1) synptcus are not easily recognized and a-A thus likely to remain untreated until they beccme cumplicated and cause disability, 2) work restraints or 3) lack of funds may delay seeking-of-cu,re until oonditions become serious (Segree, 1985) -perhaps during pregnancy when they are aggravated.

3.4 STRESS AND SOCIAL PROBLEMS The major factors causiuq stress for Jamaican wcme are summarized as: unemployment, econcmic inadequacy, separation of partners, mile prcmiscuity, limited availability of schooling for children, unreliability of goods and services, and violence (Segree, 1985). These social concerns have imrportant health implications, particularly for maternal health. The American Nurses Association, in setting out guidelines for prenatal care, stressed the importance of identifying and addressing factors causing stress in o,-der to adequately provide for the health of the prospective mother (Americar. Nurses Association, 1987). In order to improve the outcames of pregnancy and delivery through reductions in stress and social problem, reforms in a number of arenas are usually necessary. Maternal education is the most ccmmonly prcposed reform, but others include directed economic development targeting wamens' ability to gather resources ard lower the burden of household responsibilities, and socio-political canpaigns which increase the ability of waxen to attain their ideal fertility levels at appropriate ages and to get medical care when they need it. In spite of literacy estimates of nearly 90% (1984), school drop-out rates are high in Jamaica and remain a barrier to maternal education (World Bank, 1987). Unemployment is also high; the rate of unemployment was around 25.5% in 1984 and has remained close to that level (World Bank, 1987). Moreover, unemployment differentially affects the young and wanen. In October 1983, the total unemployment rate was 27%; the rate for 14-24 year olds was 48.2% and the rate for female 14--, year olds was 65.2% (Segree, 1985). Unemployment is significant because the majority of Jamaicans are unmarried, especially the younger ones, and this results in single parent far-ilies with unstable earning power. One Jamaican study found that most young mothers are dependent-on partners mostly (58.8%), and parents (30%) or other relatives (8.6%). Studies of infant nutrition also found that the children of young, unemployed, and single womn were particularly vulrerable (Bailey, 1988) and that poverty, not neglect, was responsible for the failure of children to thrive (Sheffer et al. 1981). The most ccmmon female occupations in decreasing order are damestic work, street traders, clerical, semi-skilled, and hairdresser or other service. There is considerable room for improving the econcmic potential of wcmen and thereby improving their health and that of their families. Reducing exposure to the stress causing agent is one part of good care. One must also watch for stress relieving behaviors which are health threatening such as prcmiscuity or tobacco, alcohol, and other substance abuse. Although studies on marijuana use in Jamaica have produced no evidence of deleterious cognitive effects for the infants (Hayes et al., 1988), the drug's general popularity and suspicions of long-range functicnal 7