Safe Motherhood Initiative: getting our priorities straight

Abstract

Developing countries, nongovernmental organizations, and the international development community support the Safe Motherhood Initiative. These partners know why they need to take action to assure safe motherhood, but do not agree on how to make motherhood safe. The dominant view is that the 1st priority is to provide and/or improve needed obstetric care at the 1st referral level and manage complications once they occur. It is based on the fact that the medical community cannot yet identify most women with pregnancy complications in time to prevent their occurrence. 2 safe motherhood advocates challenge this view. They point out that it only centers on reducing maternal mortality. 2nd they believe that prenatal care and health education do play a strategic role in making motherhood safe because they can inform, motivate, and empower women to use formal emergency care services. 3rd health workers should not dismiss prenatal care since some interventions are indeed effective, e.g., prevention, detection, and investigation of anemia and hypertensive disease of pregnancy and prevention and treatment of sexually transmitted diseases. Finally some areas in developing countries do not have the resources to establish or upgrade referral level health facilities so they must maximize existing resources to intervene and treat complications such as training midwives, nurses, and traditional birth attendants. The advocates propose 3 tired strategies to bring about safe motherhood. The provision of prenatal care, trained attendance at delivery, accessible emergency services, and family planning and abortion services comprise the 1st tier. The 2nd tier of activities targets youth. These activities include sexual and reproductive health programs, education, female employment opportunities, and legislation on age of marriage. The 3rd tier embraces all factors that influence women's health and status: sexual and reproductive health, education, income, social and cultural practices, and laws that govern women and their social position.