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

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.

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.

A focus on people's health and well-being must be the core of family planning research and policy. This may seem self-evident, but the realities of program implementation in third world countries has often shown that the health and well-being of individuals is not a priority.

It all started in India in the late 60s when I began helping my husband George, who was in the population field, evaluate the introduction of the intrauterine contraceptive device. At that time the IUD was considered to be the panacea for India's population problem. George's dissertation was focused on population and he became interested in the question of this new technology and how people were responding to it.

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.

Nobody had counseled women to expect the changes in bleeding patterns which are typically associated with IUD use, and they received no support from the health clinics with their problems. Because in traditional Hindu culture menstruation is associated with a variety of social taboos, prolonged menstrual bleeding produced conflicts within families.