3 America. The second point is that unwanted births are more likely to be high risk pregnancies and/or to end in crudely performed abortion, the next topics to which we turn.

Fewer High Risk Pregnancies It has long been known that the risks of pregnancy are higher for - certain groups of women vary younig women, these aged 35 or older, and women who have already borne 4 or more children (WHO, 1985).

Moreover, pregnancies among these groups of women are disproportionately likely to be unwanted. In addition, there is a higher probability that an unwanted pregnancy will end in a crudely induced abortion with all its attendant risks. For all of these reasons, unwanted pregnancies account for a disproportionate share of maternal deaths. Family planning can greatly reduce maternal deaths from unwanted pregnancies; the evidence is clear.

A major reason why there are now far fewer maternal deaths in the U.S. than half a century ago is that many fewer births occur in older, higher parity women (Berry, 1977). A recent study estimated what maternal mortality would have been among some family planning clinic clients in Atlanta without contraception. Twenty-four pregnancy-related deaths would have been expected among over 30,000 women, but only 2 deaths occurred (Ory, 1984).

The potential for family planning to reduce maternal deaths is high in most developing countries because most pregnancies pose high risks for the woman (Population Reports, 1984). China has reduced substantially maternal deaths over the past forty years through improved overall living conditions (and thus better health and nutritional status of women), better obstetrical care, and widespread use of family planning and abortion services. In Shanghai, for example, the maternal mortality rate declined from 320 to 30 per 100,000 live births between 1950 and 1980 (Puqui, 1983). In rural Bangladesh, a recent study estimated that the maternal mortality ratio would decline by more than one fifth, if births were confined to women aged 20 to 39 having their first through fifth births (Trussell and Pebley, 1984).

The evidence is less clear regarding the role of closely spaced pregnancies in maternal'mortality. Very high death rates have been found in Bangladesh and Indonesia, fcr example, among women under 20 with three or more children, in whom pregnancies must have been closely spaced. However, no studies have measured the effect of birth intervals on maternal mortality independent of age and parity (Population Reports, 1984).

# Fewer Primitive Abortions

Women in all societies are more likely to have their pregnancies terminated if they are personally unwanted and/or socially proscribed. In situations where safe and legal abortion services are available, the health risks of the procedure are less than those of carrying the pregnancy to term. In the United States, for example, legal induced abortion in the first 20 weeks of pregnancy carries a lower mortality risk than childbearing; (Rochat, 1986). Where safe abortion is not an option available to women, they still will seek to terminate their pregnancies by whatever me.ns are available, in proportions varying by country, but always in substautial