Page 31 o Stronger referral or backup facilities -- hospitals and health centers with beds - - to act as a backup network, to take better care of complicated deliveries and obstetrical emergencies, and to provide clinical and surgical methods of family planning.

o An "alarm and transport" system to quickly transfer women with high risk pregnancies and emergencies from the community to the referral facilities (Herz and Measham 1987).

74. These maternal health and family planning services would normally be built into government or nongovernment programs of primary health care. Their cost will vary, and research is needed to refine the types of interventions that will be most cost-effective, considering variations in social and economic circumstances, the education of both spouses, and the physical environment.

75. Family Rlanning and women's health. Family planning services and information can improve maternal and child health by enabling women to time and space pregnancies. The effect of child spacing on child survival is well known. Less well known are the effects on maternal health. In many countries, from one-fourth to half of maternal deaths could be averted just by avoiding unwanted pregnancies (Maine 1986). Family planning does involve some medical risks. Every erfort should be made to explain and deal with those risks and improve methods of family planning for both men and women. But with current methods, family planning is far safer than bearing children repeatedly. For every 100,000 births in Africa, for example, anywhere from 200 to over 1,000 women die, depending on the country and area (WHO 1987). For every 100,000 women taking the contraceptive pill for a year, only one is likely to die (World Bank 1986). These estimates are not strictly comparable as women using no contraceptives do not bear children every year. But they show the enormous difference in the basic scale of risks associated with childbearing and family planning in the circumstances facing most women in developing countries today. Experience from diverse settings suggests that when safe, effective, and acceptable family planning services are provided, from one-fourth to two-thirds of couples choose to use them (see discussion of approaches to family planning in later section on population growth). Relatively more is known about costeffective aRproaches to family planning, as discussed below in the section on population. It is important to provide -- and exRlain -- a variety of methods suited to young women wishing to delay the onset of Rregnancy. to young mothers wishing to space births. and to older women who already have all the children they want. It is also imRortant to make family Rlanning services available through a variety of channels. including some close to home. (See section on population.) 76. Innovations in maternal health. More experimentation is needed on prenatal care, help with delivery, and followup. One dilemma is that the largest absolute number of maternal deaths occurs among women who are apparently at low risk. Relatively few women fall into the high-risk groups, such as pregnant teenagers or older women with five or more children. So many low-risk women are pregnant that they account for most deaths even though each individually faces strong odds of survival. Thus reducing maternal deaths will