|18. Cautious Champions: International Agency Efforts to Get Safe Motherhood onto the Agenda|
Awareness of the need to raise the level of discourse on maternal health grew during the late 1990s and in 1996 the SMI Inter-Agency Group embarked upon a two-year effort to bring maternal health to a wider audience and to a higher level of decision-makers. The preparatory phase culminated in an international technical consultation in Colombo, Sri Lanka in October 1997. The consultation brought together safe motherhood specialists, programme planners and decision-makers from international and national agencies. The consensus that emerged from the Colombo meeting helped to forge greater consensus on the interventions needed to reduce maternal mortality. This was extremely valuable in developing a communications campaign on the theme of safe motherhood and in mobilising UN agencies and high level decision-makers and political advocates on World Health Day on 7 April 1998, designated for safe motherhood by WHO. Around the world, street parties, theatrical presentations, marches, media events and poster campaigns, focused on safe motherhood. In Washington D.C., executive heads of major international agencies came together with high level politicians from the developing world and the US first lady to issue a Call to Action for safe motherhood.
There is no question that the 1998 Call to Action represented a significant upgrading of efforts for maternal health. In the years following the Call to Action, a number of new entrants to the safe motherhood field have come to add their weight to the growing movement. These include the White Ribbon Alliance for Safe Motherhood and Safe Motherhood Initiatives USA. Others, already involved in safe motherhood, such as Columbia University, PATH, AVSC and Marie Stopes have increased their existing commitment. UN agencies have promised greater resources and visibility, for example, through WHOs Making Pregnancy Safer Initiative, UNICEFs Women-Friendly Health Services strategy, UNFPAs Programme Advisory Note for Reducing Maternal Mortality and Morbidity, and The World Banks Safe Motherhood Action Plan. Four agencies - WHO, UNFPA, UNICEF and the World Bank - issued a joint statement on the essential strategies needed to reduce maternal mortality and affirming their collective engagement in support of safe motherhood (WHO/UNFPA/UNICEF/ World Bank 1999). Reduction of maternal mortality: a joint WHO/ UNFPA/UNICEF/World Bank statement.
It is impossible to estimate the extent to which the increased interest in safe motherhood was a direct result of this advocacy campaign or simply the outcome of a gradual increase in interest stimulated by other events such as ICPD. However the activities leading up to the Call to Action, known generically under the title of Safe Motherhood at 10, had two important strengths which had not previously characterised international safe motherhood advocacy efforts, namely, focus on effectiveness and high level involvement, particularly among UN agencies. Although by no means on a par with the 1990 Childrens Summit, this represented as major step forward in terms of visibility.
At the same time, the success of the 1998 campaign led to questioning among safe motherhood activists. To what extent is appropriate to keep a specific Safe Motherhood Initiative alive at a time when the move in international health and development circles is towards horizontal approaches and integration into broader concepts such as reproductive health? It has been suggested that there is a continuing need to focus on safe motherhood because the issue is often under-emphasised or omitted from reproductive health programmes. This raises a more general concern about safe motherhood -that of brand recognition, to use a marketing term.