The safe motherhood initiative: Why has it stalled?

Complications of pregnancy and childbirth are still the leading cause of de ath and disability among women of reproductive age in developing countries. After decades of neglect, the founding of the Safe Motherhood Initiative i n 1987 promised action on this problem. A dozen years later, there is no ev idence that maternal mortality has declined and there are still few sizeabl e programs. A major reason for this disappointing record is that the initia tive lacks a clear, concise, feasible strategy. This article reviews the available options and proposes a strategy based on improving the availability and quality of medical treatment of obstetric c omplications. Once district hospitals and health centers provide such neede d care, community mobilization to improve utilization may be beneficial. Su bstantial reductions in maternal deaths would be possible in a relatively s hort period of time if this strategy were embraced.