Summary

As a matter of fact, the patterns of maternal mortality were very different during the 1870-1937 period in industrialised countries such as USA, England and Wales or Sweden. This chapter analyses the conditions under which the industrialised world has reduced maternal mortality over the last hundred years. Preconditions appear to have been early awareness of the magnitude of the problem, recognition that most maternal deaths are avoidable, and mobilisation both of professionals and of the community. Still, there have been considerable differences in the timing and speed of reduction of maternal mortality in different countries. These were related to the way professionalisation of delivery care was determined, first, by the willingness of the decision makers to take up their responsibility; second, by the strategy adopted for making modern obstetrical care available to the population (and particularly by encouragement or dissuasion of midwifery care); and third, by the extent to which professionals were held accountable for addressing maternal health in an effective way. Where preconditions have been met and professionalisation of obstetric care has been adopted in developing countries, the same pattern of reduction of maternal mortality was observed, be the country still poor (Sri Lanka) or wealthier (Malaysia, Thailand).