Safe Motherhood Strategies: A Review of Evidence

Even champions of Primary Health Care have long had a blind spot for the
plight of mothers at childbirth. Only in the mid-eighties activists and enlightened professionals started mobilising around this poorly documented,
underestimated and neglected tragedy: “Every four hours, day in, day out, a
jumbo jet crashes and all on board are killed. The 250 passengers are all women, most in the prime of life, some still in their teens…” (WHO 1986).

Fifteen years after the Safe Motherhood Initiative was launched we have
a much clearer picture of what is actually happening throughout the world:
figures are more reliable and more readily available. Yet there is little scope
for triumphalism. More and better data mean that we now realise that the
situation is actually worse than even those who were sounding the alarm bell
in the 1980s had been thinking.

These years of efforts, documenting and mobilising have been humbling
and often discouraging (AbouZahr 2001, Campbell 2001). The successes are
overshadowed by the awareness of the persistence of this tragedy in large
parts of the world. Whatever their usefulness may be for other purposes,
some of the common-sense activities that had been promoted for decades –
risk screening at antenatal consultations, training of traditional birth attendants – proved to be of limited direct effect on maternal mortality (Bergsjø
2001, Bergström & Goodburn 2001, Kolsteren & De Souza 2001). By the
time the Safe Motherhood Initiative took stock of ten years of mobilisation
in Colombo it had become clear that there were no simple solutions (Starrs
& IAGSM 1998). Furthermore, the very real constraints of poverty and lack
of resources seemed to make maternal mortality into one of those wicked
and untracktable problems that are essentially non-vulnerable. The temptation to sit back and wait with tackling maternal mortality until poverty ‘disappears’ is real. It is not justified.