was tenminated within the yaar due to a shortage of funds, but an unexpected side-event furthered the cause. In an effort to preserve Jamalca's foreign exchange reserves, infant formula had been placed on a list of foods subject to severe itportation restrictions; shiortly thereafter, studies in rural areas seemed to indicate a return to breastfeeding (Baer, 1981). Breastfeeding was studied between 1975 and 1976 in Jamaica as part of the World Fertility Study; results showed high rates of initiation of breastfeeding but low continuation rates (this is oft-en the case when women must work and can not arrange the schedules required for breastfeeding). The median age of weaning was 6 months, and by 12 months of age, only 12% of the infants still breast fed (Singh, 1982). In the Contraceptive Prevalence Survey by the National Family Planning Board in 1983, 97% of the women breast fed their infants of the preceding five years but they also weaned these infants early-the median age was 3 months (Jamaica-NFPB, 1984). It is difficult to tell whether :reastfeeding is declining because of shorter durations or whether perhaps, breastfeeding continues but supplementation has increased. In any case, the high prevalence of breastfeeding at birth is believed to be partly responsible for the relaoively long intervals between pregnancies (Jamaica-MOH, 1989).

5 THEORY BEHIND IDEAL ?YTERNAL HEALITH SERVICES Among the studies which recammend service patterns for maternal health in ThiLn World countries are Ratnam & Prassad (1984), Maine (1981), Herz and Neasham (1987), Weston (1986), and Lettenmaier et al. (1988). The first step L to provide family planning services to thc_; that want them. Family planning acts on maternal mortality in a number of ways first, unwanted pregnancies are avoided reducing the demand for abortions and the likelihood of having an apathetic mother who ignores her own and her fetus's health needs; second, parity is kept low-higher parities are at risk for camplication; third, family planning L'educes the overall risk pool by reducing the total number of pregnancies (this effect can be quite large (Walsh et al., 1989)); fourth, family planning can be used in conjunction with the community health program to identify women a. risk and reduce the number of pregnancies these women _1will_ have (called targeted family planning). We normally do not see a change in the maternal mortality ratio when we focus on family planning alone; however, the effect is quite obvious when we look at changes in the maternal mortality rate (deaths /100,000 women of reproductive age). The rate is an indication of the quality of both family planning and cbstetric care (Fortney, 1987). The second health services priority is providing good community based prenatal education and screening. A large number of cmaplications can be avoided thrcugh proper education. Barring that, early identification and treatment of ccmplications can prevent them from later becoming aggravated and causing disability or death. Wcmen can be taught warning synptoms to watch for and thus can help identify conditions before they became aggravated. Finally, wamen can be screened for major risks and then sent to better facilities, outside of the cummunity if necessary, for delivery care. Though direct evidence for tJ,e effect on outcomes of particular components of care is lacking, it is generally accepted that prenatal cdre improves the likelihood of better pregnancy outccmes. The Children's Defense Fund (1988) claims, for example, that the disparity in black and white maternal mortality rates in the United States is due to their differences in access to prenatal 9