Summary

Successful advocacy requires clear messages and effective dissemination. The international health and development agencies have an important role to play in advocacy because of their visibility and access to resources. Yet advocacy for maternal health by the UN and other international agencies efforts has been relatively ineffectual because the messages have not always been clear and unambiguous and the dissemination strategies have been small-scale and sporadic. Messages have focused largely on the size of the problem of maternal mortality and its human rights dimensions. What has been missing until very recently, has been clarity about the interventions that work to reduce unsafe motherhood along with a way of measuring their impact. Dissemination strategies have included major international meetings, involvement of women’s health advocates, mobilisation of health care professionals and donor support. Yet on the whole these efforts have lacked conviction. Political commitment has been cautious, ambivalent, and at too low a level to make an impact either nationally or internationally. Alliances have been shifting and unstable and even “natural” allies have lacked conviction. Neither women’s advocacy groups nor health care professionals have invested in maternal health with the full force of their numbers or power. Real progress in improving maternal health will require outspoken and determined champions from within the health system and the medical community, particularly the obstetricians and gynaecologists, and from among decision-makers and politicians. But in addition, substantial and long-term funding - by governments and by donor agencies - is an essential and still missing component.