From Population to Reproductive Health: Finding a New Yardstick
By BALLA MUSA SILLA

THE UNFINISHED REPRODUCTIVE HEALTH AGENDA
For the most part, the political consensus achieved at the International Conference on Population and Development in 1994 has persisted, although disagreements remained on how to address sensitive subjects such as abortion and adolescent sexual and reproductive health. In 1999, at the mid point review of progress on the reporductive health agenda outlined at Cairo, most countries reaffirmed their commitment to work toward the goal of ensuring universal availability of reproductive health services, primary education for all, and child mortality by 2015. In light of new realities and new research, countries also agreed to eliminate the gap between the number of people currently using contraceptives and the number expressing a desire to space or limit their families but not currently doing so, also known as "unmet need", and to reduce global prevalence of HIV infection in persons 15 to 24 years of age by 25 per cent.
While reaffirming the position on abortion adopted at ICPD, five years later at the UN follow up conference to ICPD "there was still no clear agreement on an expanded right to abortion, except that where legal, abortion should be not only 'safe' but also 'accessible'. Participants tried to strike a balance between "the rights, duties and responsibilities of parents" and "the evolving capacities of the adolescents" and "their right to reproductive health education, information and care," but the discussion reflects the continued ambivalence in some countries and regions to explicitly address adolescents needs. "
Despite considerable progress on the ICPD agenda, much remains to be done to meet reproductive health needs. Throughout the developing world, too many women who wish to limit or space their children's births cannot; too many women die because of pregnancy related complications; and too many people suffer the consequences of sexually transmitted diseases such as HIV/AIDS (see details in box, "ICPD The Unfinished Agenda"). However, the demographic and health challenges confronting developing countries now are far more complex than simple declines in total fertility rates. To address them requires mobilizing considerable resources strong institutions, capable and skilled professionals, political will and tackling sensitive social and cultural issues.
What is needed are approaches to reproductive health that focus on meeting individuals needs and desires. Knowledge and understanding of such approaches need strengthening so as to help promote their wider adoption and refinement. Often this means an integrated service delivery strategy, refocusing information education communication and counselling functions, and policies. The added challenge is to make these approaches directly applicable in different national, religious and cultural settings. This entails rethinking how health services that have not traditionally been provided together such as family planning, maternal care, and prevention and treatment of reproductive tract infections can be integrated or reorganized so that clients find the services they need are available to them in a manner which they want. Providing consistently high quality reproductive health services presents another, related set of challenges; direct services, information system, logistics and supplies, and staff must all be realigned toward meeting users needs.
Another area where progress is slow is in the broad domain of developing institutional and policymaking capacity, as the ICPD+5 experience has clearly documented. Many reproductive health issues touch on sensitive social and cultural values, making these issues difficult to tackle. At a policy level, the political will to address reproductive health concerns often remains shallow or fragile especially and understandably where religious and cultural sensitivities mitigate against overt action. These are also issues that in the past have proved to be highly sensitive to outside influence, if not completely intractable.
Institutions responsible for service delivery have experienced shortfalls because of these constraints and because of the organizational complexity of adopting an integrated reproductive health approach. The shortfalls include insufficient commitment of human and financial resources and failure to maximize the available knowledge, data and understanding available. In many countries, the processes of policymaking and programme implementation require further strengthening to ensure full and effective participation and accountability across civil society.
Within governments and public health services, organizational development has only recently been given the sustained attention it deserves. At this point, while there is undoubtedly much unfinished business, it seems that the question is not whether countries will continue to make progress on the ICPD agenda, but how?

ICPD THE UNFINISHED AGENDA
Millions of couples and individuals still lack access to reproductive health information and services. An estimated 100 to 120 million women who currently wish to space or limit further childbearing are not using contraception. Despite this potentially high demand, these needs go unmet for a variety of reasons, including, but not limited to, lack of knowledge or choice of methods, lack of access to quality health services, prevailing attitudes or beliefs among service providers, community or religious leaders, or others, lack of institutional capacity to provide good services, and lack of political commitment to meeting reproductive health needs, including family planning methods and services.
Maternal mortality and morbidity remain unacceptably high. According to the World Bank, the leading cause of death and disease for women between 15-44 years of age is pregnancy related illness. In fact, almost 10 percent of the global burden of disease in the developing world is due to maternal and delivery services, particularly in instances of complications during childbirth and the consequences of unsafe abortions are major factors.

Sexually transmitted infection including HIV/AIDS present a growing health threat.
The prevalence of STD s is rising in many countries. WHO estimates there are 333 million new treatable cases every year. In many countries, HIV has reached epidemic proportions, creating significant adverse effects on health and economic development prospects. 34 million people are now living with HIV/AIDS, 95 per cent of whom live in developing countries. Women account for half of new infections, and deaths from AIDS have left more than 11 million orphans globally.

Adolescents remain particularly vulnerable to reproductive and sexual risks.
Lack of access to the sexual and reproductive health information and services they need is particularly pronounced among hard to reach population like adolescents. Globally over 1 billion young people are entering their reproductive years; WHO estimates that more than 14 million adolescents given birth each year and 4.4 million abortions are sought by adolescent girls. Rapid social and economic changes are posing new challenges to society and the family in preparing young people. Traditional practices such as early marriage, and the expectation of early childbearing, remain clear evidence of a widespread prejudice against girls and young women. Harmful traditional practices such as female genital mutilation affect 2 million girls and young women each year.

Women and the girl continue to face discrimination. Women and girls disadvantaged position in many societies has limited wider use of reproductive health services and methods. From childhood through adult life, women in many cultures get less: less food than their brothers, fewer years of formal education, fewer opportunities to work for remuneration, and less freedom to move around outside their homes. One consequence of this persistent discrimination is that women lack the confidence or authority to make decisions about their reproductive needs, including whether or not to use contraceptives.
Financial commitments have been less than expected. The ICPD program of action was estimated to cost $17 billion in 2000. Of that two third was to donor countries. So far, both are falling short on their estimated share: donor countries are providing only about $2 billion, and a small number of developing countries (china, INDIA, Indonesia, Mexico) account for most of the $7.7 billion annually from domestic resources.

MEETING THE REPRODUCTIVE HEALTH CHALLENGE: LESSONS FROM THE PAST
Developing countries by definition do not have the resources available to developed countries to experiment with many different ways to provide high-quality, integrated health services in the time frame specified at ICPD. Therefore, policymakers and program managers must develop the best approaches possible given the demands of the environment and their available resources and capacity. When it comes to responding to sensitive cultural and social issues such as adolescent reproductive health needs or responding to HIV/AIDS, the models and approaches of the developed world may also be neither appropriate nor acceptable in the developing world.
For some seasoned family planning professionals, the challenges of responding to HIV/AIDS involve similar attitudinal obstacles. As with many issues related to family planning methods, policies and programs in the 1960s and 70s, the main barriers to successfully tackling the AIDS epidemic are the many contradictions in people's attitudes towards sex and sexuality. In the past, when international actors tried to address issues related to these topics, they were often accused rightly and wrongly of cultural insensitivity and their motives were suspect, which often complicated progress. It is clear that personal sexual attitudes and behaviors are driving the AIDS epidemic. Yet there remains a general reluctance to openly discuss sex and sexuality, even in the face of a growing epidemic. This issue must be included in any successful HIV/AIDS prevention program.
Although there are certainly variations in the social norms which determine the spread of AIDS in developing countries, many shared cultural characteristics are conducive to high risk behavior or may discourage people from adopting behaviors which make them less likely to contract HIV. HIV is likely to spread more widely where multiple, concurrent sexual partnerships are the norm. Social norms and peer pressure that encourage men to use prostitutes or that venerate men with many female partners while placing a high value on female chastity create the conditions for a severe HIV/AIDS epidemic.

SOUTH-SOUTH COLLABORATION IN HEALTH: TOWARDS A DEFINITION
South-South collaboration means many thing to many people. However, a common element of almost all working definitions of South-South cooperation in health is the use of the skills and expertise of developing country professionals in technical assistance, training or other activities which aim to facilitate transfer of knowledge. South-South exchanges take place between individuals and other individuals or groups, between national and regional government agencies, between NGOs, and through a combination of these entities. Collaboration involves a range of activities for sharing this technical expertise. Many of them are not so dissimilar from assistance from Northern institutions: study tours, regional conferences, meetings, workshops, seminars, training. These activities may be long term or short term; move through distance learning, internet or computer based channels; provide for internactive exchange using new technologies such as e-mail, or for dissemination of print and audiovisual material; or involve shared research, joint projects or the creation of regional centers of excellence to serve as model centers.
Some of the most successful examples of effective South-South exchange have shared certain characteristics: they are planned exchanges, not ad hoc activities; there is political, technical and operational commitment at several levels, ensuring that lessons learned from South-South exchange can be integrated by other organization; and partnerships are developed as long-term arrangements between governments or NGOs based on mutual commitment and understanding of needs and interests.

Efforts to encourage condom use among married couples for HIV prevention is difficult in countries where people want large families and a woman's social status and economic well-being increases with the number of children she has. This is largely the case in developing countries, where the benefits of increased condom use among married couples in suppressing the HIV/AIDS epidemic would be greatest.
Poverty also restricts people's decisions about hehavior which makes them vulnerable to HIV infection. Those with low incomes may not be able to afford to treat STDs or buy condoms. Poor families may see sex work as a profitable occupation for young and poorly educated daughters. Those with less education may have limited access to information about the dangers of high-risk behavior or be less able to understand prevention messages. This explains why those most likely to contract STDs and other infectious diseases are invariably the poor and uneducated.
Addressing these cultural norms is unlikely to be a short term effort, and will require the widespread internalization of new attitudes and behaviors on a sufficiently large scale. While external influences can play a powerful role in this process, developing country leaders and communities who are striving to effect changes to the cultural determinants of the spread of AIDS must take center stage.
Indeed, until policymakers in development opting countries adopt a more realistic approach to HIV/AIDS, little progress will be made. Despite the personal, social and economic catastrophes that the AIDS epidemic creates in developing countries, policies and programs to slow the spread of HIV are woefully limited and largely ineffective. Many countries still lack strong, sustained and unambiguous political support for safer sexual behaviors, such as the use of condoms and sex education for young people. Domestic public expenditures on AIDS prevention are minimal and stable in most countries. However, there are signs of hope in a few countries and a few communities; it is this hope which must be capitalized upon.
Uganda, Senegal and Thailand stand out as countries that have made good progress in responding to AIDS. While other developing country countries continued to deny that AIDS was their problem, these countries encouraged a more honest dialogue about the causes and transmission of AIDS. The willingness of political leaders to speak out about AIDS reduced the social stigma associated with the disease and encouraged individuals and NGOs to respond to the epidemic without fear of popular criticism. This also provided the foundation for acceptance of external financial and technical support which was offered by donors to combat the epidemic.
Organizations in these developing countries and others that have been proven effective in addressing HIV/AIDS have a lot of offer. For other countries to learn from these experiences and adapt them to their own reality is not trivial, but it can be done. The case of Bangladesh and Indonesia is one example of a highly effective exchange between two countries.

BANGLADESH-INDONESIA EXCHANGE: A LESSON IN HOW TO RESPOND TO HIV/AIDS?
This exchange took place over 11 years and involved almost 700 Bangladesh participants. The experience is well documented and was evaluated both at midcourse (with resulting reshaping) and following its conclusion. The findings are that this experience demonstratess the potential of South-South cooperation to deal with sensitive social issues which affect reproductive health programs, and to strengthen those programs and lead to sustained improvements.
In the 1980s, the Indonesian program was rapidly gaining recognition at one of the most successful population programs in the world. At that time, since Bangladesh and Indonesia characteristics, it appeared that some of the Indonesian experiences could be relevant for Bangladesh. Therefore, national officials and an international donor began to experiment with visits of Bangladeshis to Indonesia to observe their program in action.
Between 1980 and 1982, more than 300 family planning officers from thanas (sub-districts) in Bangladesh visited Indonesia to learn about its family planning program. Through this training activity, they were expected to return to Bangladesh and carry out some of the innovations they had observed, specifically to develop locally managed family planning programs. However, an evaluation showed that despite their enthusiasm and high motivation at the end of their trips, they returned to their thanas and found it very difficult to introduce what they had learned. They were impeded by a lack of understanding and support from within the thanas and from officials at higher levels. The report of this experience stated that "ˇ­within a few months, most retained warm memories of their visit to Indonesia, but little else."
The evaluation brought an unexpected benefit for the National Family Planning Coordinating Board of Indonesia (BKKBN) which coordinated the Bangladesh observational study tours. Before 1987, the BKKBN training program had conducted study tours without planned curriclum or clear procedures for managing the event, and with personnel assigned on an ad-hoc basis with no continuity. The evaluation findings prompted BKKBN to look closely at its own training procedures. Its training staff conferred with the Bangladeshis to determine their needs, developed appropriate training materials, and visited field sites ahead of time to prepare them for their role in the study tours. They then institutionalized the new approach in BKKBN's international training program, which continues to conduct study tours for participants from other developing countries.
In the case of Bangladesh, the results were remarkable. In 1987 the Ministry of Health and Family Welfare initiated a formal series of observational study tours to Indonesia through a USAID-funded project. From 1987 to 1993, a total of 392 people from 51 thanas and the Ministry directorate in Dhaka visited Indonesia on these study tours organized by BKKBN.
The Bangladesh participants were population program officers, community leaders, policymakers and representatives of NGOs. Their visits to Indonesia were three-week team programs for observing the Indonesian program in action, learning important lessons about the causes of success, and assessing whether and how these factors related to circumstances at home. Together the team then developed action plans focused on how lessons learned in Indonesia might be adopted or adapted in Bangladesh.
While many factors contributed to the success of the family planning program in Bangladesh, the impact of these visits to Indonesia on the Bangladesh program was significant. According to an external evaluation of the program (Howlader and Chakma, 1997), there were at least three positive outcomes for Bangladesh:
Participation in these study visits contributed to the knowledge and understanding of participants. This means that they returned home better equipped to assess people's needs and interests, shape the goals, methods and activities of their programs, and carry out their functions.
Lessons were learned about the role, process and importance of community participation, enabling participants to develop appropriate ways of promoting it in Bangladesh programs.
Observing Indonesian experience helped the Bangladesh participants to encourage the use of women as volunteers in their programs.
Now, in turn, Bangladesh also engages in South-South exchange, sharing with other countries how it has adapted the lessons learned. Today, people from countries as diverse as India, Kenya and the United States are adapting the Bangladesh experiences and approaches to use in their own countries.
Obviously, in the post-ICPD world, the areas for exchange have changed, but the need is still just as pressing. When it comes to remaining challenges in providing integrated, high quality reproductive health services, reducing maternal mortality, responding to HIV/AIDS, and addressing adolescent reproductive health needs, developing countries will have to look to each other for models and approaches. While the focus of the Bangladesh Indonesia exchange may not be as relevant, the process, and its potential, are still important.

SOUTH-SOUTH COLLABORATION IN REPRODUCTIVE HEALTH: ISSUES AND CONSTRAINTS
The principles of South-South cooperation have been repeatedly endorsed. It continues to have potential as a relevant and effective way to address the unfinished reproductive health agenda. However, the practice of South-South cooperation in reproductive health is not widespread. Given the nature of the current global health issues, the need for strengthened institutional capacity and political will to address reproductive health issues, the shortage of international donor resources for reproductive health programs, and the questionable relevance of Northern models and approaches, South-South cooperation in reproductive health will have to be a key part of the new approach to meeting the goals of ICPD.
However, several factors have inhibited or slowed down the progress towards stronger South-South reproductive health cooperation.
In developing countries
Resources and commitment for reproductive health and South-South cooperation
Reproductive health programs tend to receive limited resources. When domestic economies are performing poorly, resource commitments stay low and there is little or no room for expanding them, let alone for South-South cooperation. But even under current circumstances, additional resources could be found at the national level if those arguing the case for South-South activities (generally from the ministries of health. Population or planning) were able to convince their colleagues in other ministries (particularly education and finance) of the value and possible impact of such activities.

Capacity to share expertise
As the experience of Bangladesh and Indonesia demonstrated, knowing how to run a good reproductive health program does not automatically translate into knowing how to convey that to someone else. South-South exchange involves many of the same skills that are required in consulting or managing an ODA technical assistance project or area in which they are so outstanding internationally that others will (or could potentially be) interested in learning from them. This is not an insignificant challenge. Next, they must be able to write proposals or raise funds either domestically or internationally. They must be able to identify opportunities for exchange or understand how to produce effective information about their program and make it available so that others will come to them. They will also need language and cultural kills to work outside their own country.

The benefits of South-South cooperation in reproductive health
These benefits are not yet clear to many decision makers in developing countries. Policy and program leaders may not think about looking to their neighbors for models and examples. Even if there is interest inside a health ministry to engage in long-term exchange with another ministry, it may be difficult to persuade others to loosen the purse strings. High-level advocacy is required with such key ministries as Foreign Affairs and Finance if South-South cooperation in reproductive health is to become a priority in the allocation of domestic resources. This is crucial because South-South cooperation can become sustainable only if it eventually relies on resources from the developing countries themselves.
Organization working in reproductive health may also think about South-South cooperation only as an afterthought when programming and allocating resources, if they think about it at all. It is not clear how many developing countries would consider increasing the funding or intensifying the programming of South-South cooperation in reproductive health. Fortunately, within the framework of Partners in Population and Development, varied forms of such collaboration are now expanding and getting institutionalized among its 16 member countries.
Examples of South-South exchanges funded by the Partner members and the donor community include the following:
A program co-funded by the European Commission and the United Kingdom to support exchanges on reproductive health (in Mexico, Honduras, Dominican Republic and Peru), and sexually transmitted diseases/HIV/AIDS (Tunisia and Morocco) as well as programs for adolescents (in Colombia,, Ecuador, Venezuela and Panama), and for religious leaders (in Bangladesh, Thailand, China and Indonesia). The "Global Leadership Program", supported by the Cates Foundation, aimed at developing human resources on reproductive health through 12 institutions of recognized reputation, which offer training on multi-country experiences and will benefit 1000 trainees.
A "Small Grants Fund" supported by the World Bank and the Packard Foundation that has facilitated since 1998 the launching of 15 innovative South-South initiatives by NGOs in developing countries.
An international fellowship program that benefited around 200 trainees during 1999 and 2000 in programs in Egypt, Indonesia, India and Bangladesh with Southern institutions absorbing around 70% of the costs. The Rockefeller Foundation and the Cates Foundation have provided supplementary support.
The East Africa Reproductive Health Network (EARHN), which executes exchanges among Kenya, Uganda and Tanzania on family planning, safe motherhood, sexually transmitted diseases/HIV/AIDS, adolescent health and gender perspective, with support from USAID, the Rockefeller Foundation and the Packard Foundation, among others.
A program co-funded by the European Commission for exchanges on management of reproductive health services among Indonesia, Mali and Senegal, supported by a regional NGO(the Center for the Study of the African Family CAFS).
A communication program co-funded by the Rockefeller Foundation, USAID and the Hewlett Foundation, among others, exchanges through the Partners web site (www.south-south.org), a periodical electronic bulletin, e-learning workshops, as well as through printed and electronic country profiles, country briefs and inventories of institutions providng cooperation.

In the international donor community
Many of the traditional international donors have been very supportive in public of the concept of South-South cooperation in reproductive health. However, for a variety of reasons, the resources allocated to South-South projects in this area remain relatively small. Even when donors want to be supportive and provide funds, there are several significant obstacles, including:

Domestic constraints on foreign assistance programs
Of the $2 billion given annually in population assistance, nearly $1.6 billion is provided by a handful of donors: USAID, CIDA (Canadian International Development Agency), and the UK DFID (Department for International Development) (1996 aid data). Population assistance, like many kinds of international assistance, has often been linked with the national foreign policy agenda, domestic interests, and politics. This can occasionally make it difficult for international donors who must demonstrate the domestic benefits of foreign assistance to make such changes as using staff and consultants who are not donor country nationals on projects.

Evidence of developing countries' commitment to South-to-South cooperation
Many donors also with developing countries to demonstrate commitment to South-South cooperation in reproductive health by using in-country money for projects and activities not just asking for more donor money. A related need is to show the impact of the South-South program on a country's reproductive health program, particularly for bilateral programs. Without clear evidence that impact is likely to occur, some donors may shy away from programming funds for South-South activities in reproductive health.
Limited mechanisms for funding intercountry activities
Increasingly, donors are channeling funds directly to their bilateral programs, retaining relatively few funds for regional or global programming. Programming by bilateral or multilateral agencies on a country by country basis tends to diminish opportunities for South-South reproductive health exchanges. Donors tend to focus on achieving specific program objectives or results, and usually donors program most funds within one country. Unless there is demand from developing countries for Southern consultants or organizations to assist, a donor might not consider using those funds for that type of activity.
Usually, donors have more flexibility in programming global funds, which makes these funds easier to access for South-South cooperation projects in reproductive health. Administrative advantages in managing initiatives of a significant scale also make global allocations attractive to some donors.

CONCLUSIONS
Since the ICPD in 1994, donors and country planners and population, development and health agencies are still somewhat puzzled about how to program and funds post-Cairo activities. By separating population policy from family planning, ICPD has forced governments and donors to rethink how they can deal with population at the level of broad social and economic policy. Many of the issues of population momentum, changing age structure, household linkages between population and socioeconomic change, for example, and many of the measures needed to address these issues extend beyond the scope of traditional sectoral ministries such as health and education. They often extend beyond the capacity of national or even sub-national governments. Therefore, even when governments are committed to dealing with these issues, they cannot do it alone not in their current form of organization.
There is a well-deserved criticism from many directions that services, especially government service, especially government services, are often inefficient, insufficient, and inappropriate. The charge is that they too often rely on outworn approaches that are neither woman-friendly nor effective in reducing either reproductive morbidity and mortality or population growth rates. A vast literature has developed that focuses on the poor quality of reproductive health care offered in many places. All these assessments end with urgent recommendations that there must be massive 'structural' changes to improve the quality of care that government agencies, NGOs and the private sector programs that typically offer family planning services.
But even if all these badly needed reforms were put into place, there would still be another problem. Health care services are not the only ones whose activities affect and can enhance reproductive health. Many activities in education or economic development affect men's and women's ability to make their own health choices, and those activities will still be the responsibility of other players government ministries, agencies and NGOs, This means that a lot of Cairo's vision can only be achieved if others teachers, lawyers, parents, women's advocates, development specialists, and environmentalists can add their part. This kind of close collaboration and coordination has not been fully taken advantage of in the past, so it becomes all the more important that these partnerships should be established post ICPD+5.
This will require more than mere lip-service to "integration" of services, institutions and sectors. It will take ingenuity, flexibility, and a broad spirit of coordination and collaboration among a large number of governmental and non-governmental agencies. This is where government, NGOs, the private sector, multilateral and bilateral agencies can do a more effective job. They should try to ensure that intersectoral coordinating mechanisms and consultations are built into every project and program they design, fund or implement. In other words, even if reproductive health services cannot be made holistic overnight, a holistic approach to and understanding of the many faceted needs of women and men everywhere should still inform and guide the work of all program planners and all donors. This is where South-South collaboration can also make a difference, drawing on cases where the full menu of reproductive health services needed locally has been put together and functions well for users in the community.
The potential of South-South collaboration here is tremendous. At its best, it can inspire action on difficult reproductive health issues, demonstrate realistically and practically how services and programs can be improved in settings with limited resources, and build capacity through training and technical assistance. However, little concrete information is available on how to effectively design and implement South-South programs in reproductive health.
Also, developing countries need more actively to promote the potential of South-South cooperation for improving reproductive health programs. This action is needed in four areas:
Advocacy: Encourage international donors and national governments to use existing resources and additional allocations in support of South-South projects in reproductive health. This calls for developing effective responses to questions and perceptions conveyed by several donors. Developing countries negotiating grants and loans with donors should consistently request the inclusion of projects or project components for South-South cooperation in reproductive health. Recent experience suggests that, in response to feasible proposals in population reproductive health, the donor community can effectively complement domestic resources for South-South cooperation.
Transfer methods: Strengthen under-standing of the process of South-South transfer of knowledge in reproductive health. More operations research is needed on how this transfer works best and how it can contribute to increased capacity. Similar operations research and management skills have already been used in analyzing the institutional capacities of reproductive health/family planning organizations; these skills could be refined and reoriented for developing a better understanding of South-South collaboration in reproductive health.
Market analysis: Continue to develop the market for South-South collaboration by making sure that information on both supply and demand for such assistance is more widely available, Research and communications will play an important role here.
Tools: Become more virtual, offering more tools and training virtually to speed up learning about South-South collaboration in reproductive health and about strategies for initiating and managing such programs. New Internet and multimedia technologies are an important tool for supporting this strategy.

REFERENCES
S. R. Howlader and P. B. Chakma, "Impact of Observation Study Tour in Indonesia on Activities and Performance of Family Planning Program in Bangladesh: An Evaluation, unpublished report (Johns Hopkins University/Center for Communications Programs, May 1997).
A. Mundigo, "Reproductive Health: The Challenges of A New Field"; and A. Berquo,
"The ICPD Program of Action and Reproductive Health Policy Development in Brazil," papers presented at the session, "Reproductive Health: The Challenges of A New Field," IUSSP International Conference, Beijing, October, 1997.
Jyoti Shankar Singh, ed., South to South: Developing Countries Working Together on Population and Development (Population 2005: Washington D. C., 2000).
Partners in Population and Development, African Know-how to End AIDS: A Concept Paper, unpublished paper (Partners Secretariat, Dhaka, Bangladesh, May 2000).
World Bank Paper, "Population and Health" (Washington D. C. World Bank, 1999).
H. Zurayk, "Reproductive Health in Population Policy: A Review and a Look Ahead"; and H. Zurayk, et al., "A Holistic Reproductive Health Approach in Developing Countries: Necessity and Feasibility," Health Transition Review, vol.. 6, No. 1, pp. 92-94, 1996.
The author would like to thank Jyoti Singh, Tom Merrick, Atiqur Rahman Khan, Badrud Duza, Hernando Clavijo, and Bea Bezmalinovic for their suggestions and comments on various drafts of this paper. The views expressed here reflect the author's opinion, and to not represent an official position of Partners in Population and Development.