ABSTRACT
An outline is given of progress made in understanding the causes of maternal mortality since the Safe Motherhood Initiative was launched a decade ago. It remains vital to analyse why women are dying from pregnancy-related conditions and to identify the weak links in the chain of care.
PIP: The first global estimates of maternal mortality were made by the World Health Organization (WHO) in 1987. Until then, the world was largely ignorant of the risks associated with pregnancy and childbirth in developing countries. The discovery that approximately 500,000 women died each year following pregnancy-related complications led to the development and implementation of the Safe Motherhood Initiative, a multi-agency effort to formulate strategies against the problem in a range of settings. WHO, a cosponsor of the initiative, has continued to monitor the situation while collecting data on the effectiveness of measures taken. However, while much has been learned about maternal mortality, there is little global evidence of progress in the field. Recent WHO and UNICEF estimates have even shown that the problem of maternal mortality is worse than was originally thought, with the coverage of maternal health care services inadequate in most developing countries. There is no indication that the level of maternal mortality has declined and little indication that the necessary interventions are reaching more women now than they did 10 years ago. Aspects of the initiative do, however, give reason to be cautiously optimistic, especially the recent consensus over how proven interventions can be implemented in extremely resource-limited settings. The chain of care, balancing interventions, avoiding overmedicalization, matching technology with setting, and basing interventions upon the available evidence are discussed.
