Governments have a legitimate concern with slowing population growth. But often this has been attempted with little concern for the individuals most affected.

If 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.

If you want to scale-up, the first thing you have to do is to expand your own team.

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.

We are trying to discover where this approach could have the greatest possibility of large-scale impact. We have to choose wisely and see where there is greatest interest and need.

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.

Strategies for research and policy development must simultaneously address people's needs, the capacity of programs to provide good quality of care, and the range of technological options available.