Preventing early pregnancy and pregnancy-related mortality and morbidity in adolescents in developing countries: the place of interventions in the prepregnancy period.

This paper applies a life-course perspective to the problem of early pregnancy and pregnancy-related mortality and morbidity in adolescents in developing countries. It describes the contribution that two categories of "pregnancy-focused" programmes make-firstly, the provision of effective care and support in the antenatal, childbirth, and postnatal periods (downstream programmes), and secondly, the provision of effective promotive, preventive, and curative care in the prepregnancy period (midstream programmes). It then makes the case for these pregnancy-focused programmes to be set within the context of a third type of programmes, upstream programmes, that is, the provision of promotive and preventive care that contributes to children and adolescents-both male and female-being well nourished, healthy, knowledgeable about their health, and motivated and empowered to protect their health. It provides examples of successful initiatives of all three types of programmes. Finally, it discusses some practical considerations in planning, implementing, and monitoring these three programmes in a coherent manner.