An historical overview of the first two decades of striving towards Safe Motherhood.

The paper examines some of the progress and problems encountered during the first two decades of the Safe Motherhood Initiative. Sufficient statistics are cited to identify the immensity of the persisting problems associated with maternal death and morbidity before the study focuses on some of the endeavours designed to enable women to survive their natural function of giving birth. Varying attitudes and approaches that have characterised the initiatives launched in the past 20 years are reviewed and their changing emphases noted. The stress on treating the medical causes of maternal death in the early years have been complemented by increasing attention to social and political issues as time has elapsed. The advent of the Millennium Development Goals (MDGs) has impelled efforts to provide skilled attendance for all women during childbirth; the poor, socially disadvantaged and vulnerable being those most at risk. MDG 5, concerning maternal health, is perceived as pivotal in the context of global development. Maternal death when viewed from the human rights perspective is perceived as a social injustice rather than a health disadvantage and Safe Motherhood is currently considered increasingly as a basic human right. The study offers a synthesis of concepts and actions that are contributing to building Safe Motherhood across the globe in the 21st century. In considering the factors that inhibit the degree of safety associated with giving birth, global efforts that are tackling a persisting buffer zone are identified and continuous action urged in order to strive towards the targets set for 2015.

An evaluation of the Africa Midwives Research Network.

OBJECTIVE: to evaluate the strengths and limitations of the Africa Midwives Research Network (AMRN) and provide feedback and direction to the network and the funding body. DESIGN: a qualitative study incorporating visits to three African countries and Sweden, using interviews, non-participant observation, an internet survey and review of records. SETTING: principally Tanzania, Uganda, Zambia and Sweden. FINDINGS: AMRN can be described as a small, dispersed, loosely coupled professional network which has made considerable impact on midwifery practice in the areas of its members. The biennial scientific conferences could be perceived as AMRN's flagship activity and have been notably successful, becoming renowned internationally. Around 1500 midwives have benefited from educational programmes at regional or national level. These include research methodology, evidence-based practice, scientific writing and communication skills. Attention needs to be given to some aspects of governance and organization, as well as to communication strategies including websites and newsletters. Technical support from the Karolinska Institute in Stockholm has provided good collegiate support and proved to be cost effective. KEY CONCLUSIONS: AMRN has shown resilience and continuity since its inception and has made a palpable difference to the quality of midwifery care and the professional development of midwives within the remit of its members. AMRN needs to be consolidated before expanding further. The work of AMRN is particularly pertinent in the context of the millennium development goals.

The challenge of preparing and enabling 'skilled attendants' to promote safer childbirth.

The worldwide challenge to reduce maternal mortality is beset by numerous and complex issues. Currently, there is a special focus on the role of midwives and others who provide skilled care, their education and the environment in which they are challenged to practice. A review of some of the historical evidence highlights and considers some critical lessons learned in preparing and utilising skilled personnel to attend women at this vulnerable time in their lives. The importance of providing an environment that enables care providers to function effectively is explored. The indispensable merit of political commitment to reducing maternal mortality becomes evident through consideration of achievements in various countries both historically and currently. It is apparent that making childbirth safer is a multifaceted issue that still presents challenges across much of the globe in the 21st century and that this can never be taken for granted in any historical phase or geographical location. In this paper I embrace a major literature search and share findings emerging from studies and activities undertaken on behalf of various national and international organizations, though it does not necessarily reflect the views of those organizations.