In the wake of the 1994 International Conference on Population and Developm
ent in Cairo, considerable activity has occurred both in national policymak
ing for reproductive health and in research on the implementation of the Ca
iro Program of Action. This report considers how effectively a key componen
t of the Cairo agenda-integration of the management of sexually transmitted
infections, including human immunodeficiency virus, with maternal and chil
d health-family planning services-has been implemented. Quantitative and qu
alitative data are used to illuminate the difficulties faced by implementer
s of reproductive health programs in Ghana, Kenya, South Africa, and Zambia
. In these countries, clear evidence is found of a critical need to reexami
ne the continuing focus on family planning services and the nature of the p
rocesses by which managers implement reproductive health policies. Implicat
ions of findings for policy and program direction are discussed.