|18. Cautious Champions: International Agency Efforts to Get Safe Motherhood onto the Agenda|
Question: What do PHC, MCH, SMI, MMR, MBP, MSM, SRH, MNH, PMM and MPS have in common (apart from being letters of the English alphabet)?
Answer: They are all acronyms for projects and programmes designed to help alleviate womens suffering and death in the cause of pregnancy and childbirth.
These acronyms fall into two classes. Some represent umbrella concepts within which maternal health and safe motherhood issues should be addressed - PHC (Primary Health Care), MCH (Maternal and Child Health Care) and SRH (Sexual and Reproductive Health). Others relate in a vertical, focused way to maternal mortality reduction - SMI (Safe Motherhood Initiative), MSM (Maternal Health and Safe Motherhood Programme), MBP (Mother-Baby Package), MNH (Maternal and Neonatal Health), PMMN (Prevention of Maternal Mortality Network) and MPS (Making Pregnancy Safer Initiative).
Alternating waves of broad, inclusive approaches and the more narrow focused ones have succeeded one another with predictable regularity. From the establishment of WHO to the late 1980s the strategy was to incorporate maternal health under a broader framework for basic health care for women and children. Starting in 1987 a different strategy was preferred and throughout the late 1980s and early 1990s there was a preference for vertical focused programmes, perceived (often correctly) to be more effective in reaching their target audiences and in delivering their promises (Werner & Saunders 1997).
In 1991, concerned about the continuing lack of progress in safe motherhood, several major donors pressed for the establishment of WHO Special Programme for Safe Motherhood, analogous to the Special Programmes for Research, Development and Research Training in Human Reproduction (HRP), the Special Programme for Research on Tropical Diseases (TDR) and the Special Programme on HIV/AIDS (GPA) (WHO 1991b). The WHOI administration of the time resisted such pressures for verticalisation and by the time of the International Conference on Population and Development in 1994, the pendulum had swung back again to favour the inclusive or horizontal approach. Safe motherhood programmes were presented as part of the overall concept of sexual and reproductive health (UNFPA 1994), or within a broader agenda of health sector reform (The World Bank 1999). At the start of the new century, concern that safe motherhood tended to disappear within these broad inclusive agendas resurfaced and interest in focusing more specifically on safe motherhood has waxed, for example, under the titles of Making Pregnancy Safer and Maternal and Neonatal Health.
None of this would matter were it not for the confusion in creates in countries. No sooner have the international health and development agencies managed to create brand recognition for one strategy, than the fashion changes and a new approach, new strategy and new set of acronyms is foisted upon the world.
Small wonder, therefore, that so many observers concur that getting safe motherhood onto the agenda and keeping it there has been a difficult challenge.