Families for children: international strategies to build in-country capacity in the Philippines, Thailand, Romania, and India.

Holt International Children's Services was founded in the 1950s to facilitate the adoption of Amerasian children in the aftermath of the Korean War. Today, its vision has expanded to encompass international policies, programs, and practices that will help establish nurturing, lifelong relationships for children. Working together with child welfare professionals and advocates, non-governmental organizations, and governments, Holt has helped to develop in-country, self-sustaining family resources for thousands of children. Efforts in the Philippines, Thailand, India, and Romania are highlighted.

Surveillance for ectopic pregnancy--United States, 1970-1989.

PROBLEM/CONDITION: From 1970 through 1989, hospitalizations for ectopic pregnancy have increased in the United States; the number of cases has increased fivefold, from 17,800 to 88,400. REPORTING PERIOD COVERED: 1970-1989. DESCRIPTION OF SYSTEM: Reported ectopic pregnancies were estimated from data collected by CDC's National Center for Health Statistics (NCHS) as part of the ongoing National Hospital Discharge Survey. Data from responding hospitals were weighted to represent national estimates. The number of deaths resulting from ectopic pregnancy was based on U.S. vital statistics collected by NCHS. Denominators for calculating ectopic pregnancy rates were the total number of reported pregnancies, which includes live births, legal induced abortions, and ectopic pregnancies. Data for live births were obtained from NCHS natality statistics and data for legal induced abortions from CDC's Division of Reproductive Health. RESULTS: From 1970 through 1989, more than one million ectopic pregnancies were estimated to have occurred among women in the United States; the rate increased by almost fourfold, from 4.5 to 16.0 ectopic pregnancies per 1,000 reported pregnancies. Although ectopic pregnancies accounted for < 2% of all reported pregnancies during this period, complications of this condition were associated with approximately 13% of all pregnancy-related deaths. During this period, the risk of death associated with ectopic pregnancy decreased by 90%: the case-fatality rate declined from 35.5 deaths per 10,000 ectopic pregnancies in 1970 to 3.8 in 1989. The risks of ectopic pregnancy and death from its complications were consistently higher for blacks and other racial/ethnic minorities than for whites throughout the period. INTERPRETATION: Although the general trend has been for the numbers and rates of ectopic pregnancy to increase over the 20-year period, the variability of the data does not permit meaningful conclusions to be made about year-to-year changes in the estimates of ectopic pregnancies, especially for the years 1988 and 1989. ACTIONS TAKEN: These findings indicate the need to characterize behaviors and risk factors that may respond to preventive interventions. Until these risks factors are better characterized, early detection and appropriate management of ectopic pregnancies will remain the most effective means of reducing the morbidity and mortality associated with this condition.