If instead policy makers and program managers participate in an interdisciplinary assessment team, make informal visits to local families and have in-depth conversations with local providers and health authorities, the real needs and complex challenges of organizing good reproductive health services become apparent.The first country that implemented this participatory program of assessment, research and policy development was Brazil. I was one of the outsiders who provided support to the initiative.

I would like to see policy makers and international donor agencies realize that it is not enough to give money for demonstration projects. From the very beginning plans should be made for the scaling-up of successful innovations.

One of the things we have learned in the first year is that if you want to scale-up, the first thing you have to do is to expand your own team.

We felt that the Gates Foundation looked at our track record and our publications and decided that "this is persuasive; this needs to be done. Let's see what they can do."

A longer time perspective is needed because we face a daunting task both in an intellectual and practical sense.

Because in traditional Hindu culture menstruation is associated with a variety of social taboos, prolonged menstrual bleeding produced conflicts within families. The whole idea of fertility regulation was still extremely new in this setting and many husbands and other family members were angry when they found out that women had decided on their own to use the method and had gone to the clinic in secret.

My colleagues from the Department of Health Behavior and Health Education are working on participatory public health initiatives in Michigan, and there is much that we can learn from each other. In fact it is essential that we strengthen efforts to learn from each other, and stop considering public health in the third world and in the U.S. as separate intellectual and practical endeavors.