|Making Motherhood Safe (World Bank, 1993, 161 pages)|
More than 150 million women become pregnant in developing countries each year and an estimated 500,000 of them die from pregnancy-related causes. At least 7 million pregnancies result in stillbirths or infant deaths within the first week of life, also because of maternal health problems. The death of a woman of reproductive age translates into substantial economic and social hardship for her family and community. Most women in the developing world lack regular access to modern methods of contraception. Most pregnant women receive insufficient prenatal care or none at all and deliver without access to skilled obstetrical care when complications develop. Even in countries with relatively well-developed health systems, preventable maternal illness and death persist because of inadequate management of the complications of pregnancy.
To assist policymakers and program managers to design and implement programs to reduce maternal mortality, this paper discusses the lessons for reducing maternal mortality derived from experience and research in both developing and industrial countries. That evidence shows that community-based approaches such as family planning and training and the deployment of midwives have helped reduce maternal deaths in high-mortality settings. A World Bank analysis of health sector priorities identified prenatal care and delivery services as among the most cost effective government interventions for improving adult and child health.
The paper also recommends priorities and program strategies for making family planning services and maternal health care more effective by improving quality, increasing access, and educating the public about the importance of such services. Programs succeed best when they provide a package of services, including community-based family planning, health, and nutrition services. Substantial - and sustained - reduction of the risk of dying once pregnant, however, requires an effective continuum of care from the community to the first-referral level, supported by a public education program. No matter how effective community-based maternity care is, some women will continue to die from complications if adequate referral and treatment to deal with emergency obstetric complications are not available. A more comprehensive plan includes expanding women's opportunities in a variety of other sectors, particularly in education. While there has been some progress, the challenge remains to get safe motherhood programs rapidly in place at the country level.