Generating political priority for safe motherhood.

In 1987 a conference on safe motherhood in Nairobi, Kenya, drew international attention to alarmingly high levels of maternal death in childbirth in developing countries. Global levels are estimated to be between 500,000 and 600,000 per year, with approximately one-tenth of these deaths occurring in Nigeria alone. The conference ended with a call for a reduction in maternal mortality by half by the year 2000. In the decade following the conference, advocates made considerable progress in understanding the medical and technical dimensions of maternal mortality. They determined its primary biomedical causes, developed indicators to measure safe m o t h e r h o o d o u t c o m e s , i d e n t i f i e d interventions to avoid maternal death in childbirth, and considered ways to surmount socioeconomic obstacles to for women. They made little progress, however, in institutionalizing political priority for the cause of maternal mortality reduction in Nigeria and other countries. This shortcoming in part explains why, as the year 2000 passed, the world was nowhere near to achieving the 50 % reduction goal. obstetric care The national-level political dimensions of safe motherhood deserve as much attention as its medical and technical dimensions. Attention to generating political priority will be particularly critical as safe motherhood advoca tes pursue the Mi l l ennium Development Goals that call for a reduction in the maternal mortality ratios of 1990 by three-quarters by the year 2015. Generating such priority can be approached systematically. Political scientists and public policy scholars have identified factors that increase the likelihood that an issue will receive meaningful attention by national political elites. In this presentation I would like to highlight four such factors, and illustrate how they interacted in two countries where safe motherhood became a political priority in the 1990s: Indonesia and Honduras. The four factors are: