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RHO archives : Topics : Safe Motherhood

White Ribbon Alliance for Safe Motherhood
Technical Resource Packet

The publications listed below are recommended by the White Ribbon Alliance for persons or groups working with community programs. The White Ribbon Alliance was formed by a number of international organizations in an effort to raise awareness of the need to make pregnancy and childbirth safe for all women in both developed and developing countries. Please see the White Ribbon Alliance's website ( for more information.

To access more bibliographic entries, visit page 1, page 2, page 3, or page 4, or return to the complete list of topics covered in the Safe Motherhood Annotated Bibliography. Be sure to use the Glossary if you are unfamiliar with any of the terms on this page.

Please note that PDF files require Adobe Acrobat Reader.

Moore, K.M. Safer Motherhood 2000: Toward a Framework for Behavior Change to Reduce Maternal Deaths. The Communication Initiative (April 2000). Available online at
While many aspects of safe motherhood programs have been reorganized over the last several years and new efforts have focused on allocating resources to reflect lessons learned, the communications components have not received the same attention. This paper reviews recent literature and emphasizes the need to utilize focused, innovative, participatory research and community development methodologies to design communication efforts to reduce maternal deaths. An updated, evidence-based behavior-change communication framework is needed to reprioritize key behaviors and break down each behavior for each target audience into sub-behaviors. The author offers six priority themes, ranked in order of their potential contribution to maternal mortality reduction, to help guide communication efforts. Safe motherhood communication efforts can learn from the successful strategies and models used in other health campaigns, such as HIV/AIDS-risk reduction. Collaborative community partnerships have great potential for mobilizing communities to reduce maternal deaths. Instead of using a top-down approach to educate about medical risks, models need to include comprehensive community participation that considers social risks as well.

Ross, S.R. Promoting Quality Maternal and Newborn Care: A Reference Manual for Program Managers. Atlanta: Cooperative for Assistance and Relief Everywhere, Inc. (CARE) (December 1998). To order a copy of this publication, please contact [email protected].
This technical reference manual is intended to assist program managers in the field to design, implement, monitor, and evaluate maternal health programs. It summarizes the latest literature and lessons learned in maternal and neonatal care a decade after the start of the Safe Motherhood Initiative. While it is intended as a reference manual, it also can be used for training. The chapters include: (1) Why Women and Newborns Die; (2) Prepregnancy Factors; (3) Pregnancy-related Factors; (4) Program Design, Monitoring and Evaluation; (5) Interventions and Current Best Practices; and (6) Lessons Learned Through Country Programs. It includes clear, easy-to-follow tables summarizing the problems and current solutions to maternal and newborn health care. The lessons learned chapter offers brief descriptions of project activities worldwide and their results, organized by topic. Appropriate references are included with the many tables, and a comprehensive list, arranged by subject, is appended to the manual.

Sibley, L. and Armbruster, D. Obstetric first aid in the community partners in safe motherhood. Journal of Nurse-Midwifery 42(2):117-121 (March-April 1997). To order a copy of this publication, please contact [email protected].
This article describes a new initiative of the American College of Nurse-Midwives (ACNM) to train community members in obstetric first aid. Obstetric first aid includes actions that prevent complications, the prompt recognition of complications, safe and effective responses to complications, and arrangements to improve access to referral facilities. ACNM has developed and is planning to field test two performance-based training programs on obstetric first aid: one is designed for TBAs, while the other is directed to women and their families.

John Snow, Inc. Safe motherhood indicators: lessons learned in measuring progress. MotherCare Matters 8(1):1-28 (May 1999). Available at: MotherCare organized a workshop in June 1998 to assess selected maternal health process indicators; the presentations and debates are presented in this article. The most promising indicators for measuring access to and use of services include met need for essential obstetric care; unmet obstetric need; cesarean section rate; who delivers the woman, and where the delivery takes place. Indicators that are useful to assess quality of care are case fatality rate (and number of maternal deaths) and referral rates. The discussion includes information on how to calculate, use, and interpret each of these indicators, along with data sources, and examples from specific countries. The most important data source for access and quality of care indicators is the birth or delivery room register. However, these registers need to be revised to include specific information on complications, woman's home, and referring source. The cesarean section rate and information on where the woman delivers and with whom often can be gathered through existing data-collection systems or through surveys, and can give some indication of access. Met and unmet obstetric need are most usefully applied at the district or provincial level. The case fatality rate and referral rate need more field testing, and other quality-of-care indicators are needed to assess project and program impact.

White Ribbon Alliance for Safe Motherhood Global Secretariat. Building a Global Movement: The White Ribbon Alliance for Safe Motherhood, 1999-2000. Baltimore, Maryland: JHPIEGO (2003). Available at:
This document describes the formation of the White Ribbon Alliance, and how it has grown from a small group of committed people to a global movement encompassing 24 countries with more than 200 members. It also describes the strategic planning process used to strengthen the Global Secretariat’s organizational structure.

White Ribbon Alliance for Safe Motherhood, India and White Ribbon Alliance for Safe Motherhood Global Secretariat. Saving Mothers’ Lives: What Works—A Field Guide for Implementing Safe Motherhood Best Practices. Washington, DC : Child Survival Collaborations and Resources Group (CORE) (2003). Available as a printed copy or pdf file by request: [email protected].
This publication was originally produced for the international conference “Saving Mothers’ Lives: What Works?” held in New Delhi, India, October 3-6, 2002. It includes the most recent evidence-based knowledge and practices for reducing maternal mortality. It is intended for program managers and implementers working at the community level to reduce maternal and neonatal deaths.

World Health Organization (WHO). Reduction of Maternal Mortality, A Joint WHO/UNFPA/UNICEF/World Bank Statement. Geneva: WHO (1999). Available at: This joint statement represents the consensus between WHO, UNFPA, UNICEF, and the World Bank toward supporting programs designed to reduce and prevent maternal mortality and neonatal mortality and morbidity. It is addressed to governments, policy makers, program managers, and each of the respective agency's personnel, and is intended to guide their decision-making to ensure safer pregnancy and childbirth. It summarizes the key issues relating to maternal mortality and its reduction. The statement also defines maternal deaths, and explains maternal mortality ratios and rates. Safe motherhood is a human rights issue, not just a health problem. Although the direct medical causes of maternal deaths are the same worldwide, the risk of maternal death is much greater in the developing world. The low social status of girls and women in many countries is a fundamental determinant of maternal mortality. The statement reviews actions to be taken to address maternal mortality, including legislative and policy actions, society and community interventions, and health sector actions. Process indicators, which show progress in reducing maternal mortality through access to essential obstetric care, allow policy makers and program managers to target specific interventions to reduce maternal morbidity and mortality.

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