The Awakening

In February 1987, Hafdan Mahler, the Director-General of the World Health Organization (WHO) in his statement to the Nairobi Safe Motherhood conference, called for the creation of “...an awareness that something can, should - indeed must - be done, starting with the commitment of heads of states and governments” (Mahler 1987). The conference, sponsored by The World Bank and UNFPA along with WHO, represented the starting point of what came to be known as the Safe Motherhood Initiative (SMI). The three original Cosponsors were later joined in the SMI Inter-Agency Group (IAG) by UNDP, UNICEF, IPPF and The Population Council with Family Care International (FCI) serving as an informal secretariat.

The fledgling Safe Motherhood Initiative had two parents and a somewhat disparate set of genes. On the one hand, it was very much a product of the growing confidence of the international women’s movement, galvanised by the United Nations Decade for Women, 1976-1985, which helped focus attention on women’s rights and health. The Decade culminated in the formulation of the “Forward Looking Strategies” which called for a reduction in maternal mortality by the year 2000. A key perception to emerge over this period was the relative neglect of women’s health compared with the attention then being given to child survival and health, a point most forcefully made by Allan Rosenfield and Deborah Maine in their seminal article “Where is the M in MCH?” (Rosenfield & Maine 1987).

The other parent was more mathematically oriented. The figure of half a million deaths each year, the first attempt to come to grips with the dimensions of the problem, was produced thanks to the unsung efforts of the late Dr Robert Cook, Deputy Director of WHO’s Division of Family Health. He provided modest funding for the first community studies on levels of maternal mortality in developing countries (WHO 1985). The results of these studies were fed into an indicator database maintained by WHO which produced global and regional estimates on a range of maternal health issues including maternal mortality, coverage of maternity care, perinatal mortality and low birth weight (WHO).

These two strands - women’s health and rights and the dimensions of the problem - continued to provide the underpinning for maternal health advocacy messages by the international community throughout the 1990s. While both have been of inestimable value in raising safe motherhood to a higher position in international and national consciousness, neither is sufficient as the point of leverage.