Maternal mortality: an ongoing challenge to perinatal medicine.

Maternal death is one of the most dramatic situations and often means the failure of preventive and therapeutic strategies. Nowadays, the problem of high maternal mortality is considered a pressing human rights issue, as well as being a public health problem. In this regard, it is accepted that preserving the lives of mothers is an imperative objective for social and economic development of a country. In recent years, this issue has received increased attention and has been assigned maximum priority. The inclusion of this intention to reduce maternal mortality in the fifth Millennium Development Goals (MDG) also shows the global commitment on this issue, pushing for significant changes from the point of view of health, ethics and gender equality as women still die unnecessarily. These deaths, avoidable and therefore unjust, reflect the unequal access of women to basic health services. Moreover, women in many developing counties lack education and do not participate in decision making in the household, let alone in politics. However, safe motherhood cannot be achieved only by improving services for maternal health care. Women themselves, their families and the community have to be active participants in the search for solutions and the proper monitoring of progress. In the aforementioned Millennium Declaration signed by 189 countries in 2000, clear goals were set to reduce poverty and other causes of human deprivation and to promote sustainable development. But how close are we to achieving these goals ? What resources are needed to help countries that are prevented from reaching the targets ? Sadly, it is a fact that in societies where maternal mortality is high, concomitant problems also exist, which in themselves increase mortality: poverty, illiteracy, gender inequality, poor hygiene and nutrition, deficient transportation and inadequate medical services. It is very possible that if we resolve all these problems, maternal mortality may be reduced substantially. Unfortunately, the results confirm that the MDGs have not yielded the expected results and maternal mortality has remained an unsolved problem in many developing countries, especially in sub-Saharan Africa and south Asia. It is essential that MDGs are incorporated into national strategies, and this involves close involvement of the different sectors: government, civil society, the private sector and international organizations. Unfortunately, sometimes the MDGs do not necessarily match the priorities of countries and regions that are at different stages of development. It is necessary to adapt the MDGs to regional, national and local realities. The Millennium Declaration and the MDGs have failed to motivate and gather the necessary efforts to stop being a mere statement and become the backbone of concrete policies and actions in developing countries. Current progress in reducing maternal mortality is less than a fifth of what it needed to achieve it. Only one in three women in rural areas in developing regions receives the recommended care during pregnancy. Progress in reducing the number of teenage pregnancies has stalled, leaving more young mothers at risk. Maternal death is more than a health problem. It implies non-observance of fundamental human rights of women and shows how disadvantaged and vulnerable they are. As acknowledged by the UN, maternal health is a concept that involves much more than the reduction of mortality. After more than 14 years since the establishment of the MDGs, in its aspects related to maternal health, it has to be accepted that the objectives have not been met and the big promises that were made were never fulfilled. There has been some progress, but unfortunately it is far from its objectives. In our opinion, the reasons for this must be seen in several ways. First is the failure of developed countries to invest at least 0.7% of their budgets on