Delivering Safer Motherhood: Sharing the Evidence

Every year an estimated half a million women die in childbirth. Unfortunately, this global figure has changed little since the problem was first highlighted in 1987 at the Safe Motherhood Conference in Nairobi, Kenya. These deaths, mostly in developing countries, are primarily from haemorrhage, infection, and complications of abortion. Progress has been meagre in the poorest countries due to weak health systems, substandard quality of care, inadequate human resources, insufficient political commitment and funds, and lack of data to inform and monitor intervention strategies. In response, safe motherhood experts have proposed a variety of strategies over the last 20 years to help reduce maternal deaths, based on care in health facilities, as well as at home and in the community. Some strategies focus on increasing skilled attendants at delivery to ensure that more women deliver their babies with health care providers with midwifery skills. Other strategies focus on eliminating delays when complications arise by improving, for example, family awareness of danger signs, referral systems, or emergency obstetric services at health centres and district hospitals. In 2000, world leaders raised the profile of the problem of maternal death within the United Nations Millennium Declaration framework—a blueprint to promote global efforts to meet the needs of the world’s poorest people. Of the eight Millennium Development Goals (MDGs), MDG 5 aims to improve maternal health. Progress has been made in some low-income countries, though challenges remain, particularly in the poorest parts of the world. The Lancet’s Maternal Survival Series recently highlighted three barriers—financial, physical, and functional—to one of the key indicators of progress, the use of professional skilled care in childbirth. The series concluded that the best strategy for addressing these barriers, and thereby reducing maternal deaths, was to scale up coverage of deliveries by midwives, working in teams in health centres.1 Immpact, a global research initiative, offers new evidence to move us closer to achieving MDG 5. Immpact’s goal is to improve maternal health and survival in developing countries by providing rigorous evidence of the effectiveness and cost-effectiveness of safe motherhood strategies and their implications for equity and sustainability. The key messages presented here are the culmination of more than four years of Immpact research in Ghana, Burkina Faso, and Indonesia.