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The Safe Motherhood Initiative emerged as a
powerful campaign for women’s health. It highlighted the potential for
improved care for pregnant women and better functioning health services to
reduce the burden of maternal and newborn ill-health.
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The
Safe Motherhood Initiative has given much greater visibility to the hidden
inequity of maternal ill-health. The Initiative was launched in 1987 by WHO, UNICEF, UNFPA, The World Bank and other organizations
directly concerned with maternal health. Its starting point was the potential
for improved care for pregnant women, and better functioning health services
to reduce maternal ill-health. The Initiative has spearheaded advocacy and
brought maternal mortality to the international public health agenda.
The Safe
Motherhood Initiative mobilized resources, identified the individual and
societal costs of maternal deaths, and highlighted the human rights
perspective. It also increased awareness among governments, international
agencies, donors, nongovernmental organizations and professional associations
about maternal mortality.
The
Initiative has supported evidence-based practices and contributed to the
Joint WHO/UNFPA/UNICEF/World Bank Statement on Reduction of Maternal
Mortality which is now the basis for consensus on:
 prevention and management of unwanted
pregnancy and unsafe abortion;
the need for every woman to have skilled care
in pregnancy and childbirth, and
the importance of
access to referral care when complications arise.
The
Safe Motherhood Initiative has, thus emerged as a powerful campaign for
women’s health. Concurrently, child survival programmes
have reduced the overall infant mortality, especially in the postnatal
period. However, HIV/AIDS is reversing these gains in several countries where
the epidemic is most advanced.
Lessons learnt from the Safe Motherhood Initiative
In
spite of all efforts, maternal and neonatal deaths and morbidity and
stillbirth rates have remained high. The reasons vary by country and region
but generally reflect a combination of interrelated factors. The Safe
Motherhood Technical Consultation held in Colombo,
Sri Lanka,
in 1997, ten years after the start of the Safe Motherhood Initiative, cited
some key factors:
Lack of clearly defined priorities and
inclusion of interventions in safe motherhood programmes
that were not always the most focused and effective.
When the Initiative was launched, information
was inadequate on the interventions most likely to have a significant and
immediate impact on reducing maternal mortality.
Some Safe Motherhood strategies took too broad
an approach, giving equal emphasis to raising women’s status, improving
family planning, strengthening basic
maternal health services, and expanding emergency care. This
resulted in programmes that were too ambitious and
expensive for many governments and donors to implement.
Programmes that
specifically focused on maternal health services were also not always
strategically sound ( research findings later proved
some of the strategies recommended during the 1987 Safe Motherhood Conference
to be ineffective). These included risk-screening during antenatal care, and
large-scale training of traditional birth attendants.
Omission of some interventions known to be
effective, such as the management of abortion complications from safe
motherhood programmes, largely due to political
sensitivity about the issue.
Finally, technical and programming guidelines,
training curricula, and other resources to guide effective programmes were not made widely available.
Inadequate political commitment and resources.- While financial investments in safe motherhood programmes have increased dramatically over the past ten
years, they have remained far below the levels required for significant
change.
Lack of awareness and commitment among both
donor and government decision-makers have contributed to the problem, as well
as a lack of a clear high-level commitment to a joint programme of action by
the United Nations agencies.
 Within
WHO also, key departments were not sufficiently
coordinated, especially those with the expertise to reduce maternal and
neonatal deaths and morbidity, e.g. blood safety, infection control and
health systems.
At
the country level, economic difficulties, heavy indebtment
and structural adjustment programmes frequently
aggravated the already precarious situation of the health care system.
Finally,
until recently the Safe Motherhood Initiative paid inadequate attention to
reducing the risk of HIV/AIDS infection among women and their babies as well
as to the management of HIV-infected women and their newborns.
Making
Pregnancy Safer Initiative is a significant component of the Safe Motherhood
Initiative that will be implemented within its framework to ensure that all
pregnancies are wanted, that women can go safely through pregnancy and childbirth, and that infants are born alive and healthy. (Figure
2) Figure 2
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