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.

If you are the kind of person who listens to conservative advice, you may do okay in life, but you probably won't ever be a fantastic leader. You have to take risks, and you also have to go against conventional wisdom, because conventional wisdom doesn't make for startling advances in society.

Our practical purpose is to facilitate expansion of service innovations on a larger scale to improve access to, and the quality of reproductive health care. We are very grateful to have received support from the Bill and Melinda Gates Foundation to continue our work.

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.

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.

If we succeed in learning more about how to expand program innovations from pilot projects so that they have broader program impact, this should be very relevant for public health initiatives in Michigan and elsewhere in the US.

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