Bureaucratic systems are not set up to be what we refer to as human service organizations. They were established to collect revenue and maintain law and order and they used a law and order approach in providing family planning services.

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 hope to organize team residencies and a conference bringing together professionals from Latin America and from other groups around the world who are also focusing on this issue. We want to bring them together so we can learn from each other, and then widely publicize our conclusions.

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.

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

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."

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.