STRATEGIES FOR REDUCING MATERNAL MORTALITY IN DEVELOPING-COUNTRIES - WHAT CAN WE LEARN FROM THE HISTORY OF THE INDUSTRIALIZED WEST

Ten years of Safe Motherhood Initiative notwithstanding,many developin g countries still experience maternal mortality levels similar to thos e of industrialized countries in the early 20th century. This paper an alyses the conditions under which the industrialized world has reduced maternal mortality over the last 100 years. Preconditions appear to h ave been early awareness of the magnitude of the problem, recognition that most maternal deaths are avoidable, and mobilization of professio nals and the community. Still, there were considerable differences in the timing and speed of reduction of maternal mortality between countr ies, related to the way professionalization of delivery care was deter mined: firstly, by the willingness of the decision-makers to take up t heir responsibility; secondly, by making modern obstetrical care avail able to the population (particularly by encouragement or dissuasion of midwifery care); and thirdly, by the extent to which professionals we re held accountable for addressing maternal health in an effective way . Reduction of maternal mortality in developing countries today is hin dered by limited awareness of the magnitude and manageability of the p roblem, and ill-informed professionalization strategies focusing on an tenatal care and training of traditional birth attendants. These strat egies have by and large been ineffective and diverted attention from d evelopment of professional first-line midwifery and second-line hospit al delivery care.