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.

In the late 60s, 70s and possibly early 80s, social scientists were interested in researching the diffusion of innovation and studying the link between applied research and policy and program development. Recently there has been less interest in these issues and we feel that this interest must be rekindled.

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.

International "experts" from technical assistance agencies or universities can make important contributions, but they certainly don't have all the answers. When ownership is local and national, and various stakeholders work together, program innovations have a greater chance to take root and survive.

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

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.

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.