Please note: This archive was last updated in 2005.

RHO archives : Topics : Safe Motherhood

Overview and Lessons Learned


Motherhood should be a time of expectation and joy for a woman, her family, and her community. For women in developing countries, however, the reality of motherhood is often grim.For these women, motherhood is often marred by unforeseen complications of pregnancy and childbirth. Some die in the prime period of their lives and in great distress: from hemorrhage, convulsions, obstructed labor, or severe infection after delivery or unsafe abortion.

Worldwide, it is estimated that 529,000 women die yearly from complications of pregnancy and childbirth—about one woman every minute. Some 99 percent of these deaths occur in developing countries, where a woman's lifetime risk of dying from pregnancy-related complications is 45 times higher than that of her counterparts in developed countries. The risk of dying from pregnancy-related complications is highest in sub-Saharan Africa and in South-Central Asia, where in some countries the maternal mortality ratios are more than 1,000 deaths per 100,000 live births (Table 1). For more statistics on maternal mortality, see

Sixty to eighty percent of maternal deaths are due to obstetric hemorrhage, obstructed labor, obstetric sepsis, hypertensive disorders of pregnancy, and complications of unsafe abortion. These direct complications are unpredictable and most occur within hours or days after delivery (Figure 1).

Maternal death and disability are the leading cause of healthy life years lost for developing country women of reproductive age, accounting for more than 28 million disability-adjusted life years (DALYs) lost and at least 18 percent of the burden of disease in these women. For each woman who dies, an estimated 100 women survive childbearing but suffer from serious disease, disability, or physical damage caused by pregnancy-related complications. Long-term consequences of pregnancy-related complications include uterine prolapse, pelvic inflammatory disease, fistula, incontinence, infertility, and pain during sexual intercourse.

A mother's death carries profound consequences not only for her family, especially her surviving children, but also for her community and country. In some developing countries, if the mother dies, the risk of death for her children under age 5 is doubled or tripled. In addition, because a woman dies during her most productive years, her death has a strong social and economic impact—her family and community lose a productive worker and a primary care giver.

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The Safe Motherhood Initiative

In 1987 the World Bank, in collaboration with WHO and UNFPA, sponsored a conference on safe motherhood in Nairobi, Kenya to help raise global awareness about the impact of maternal mortality and morbidity. The conference launched the Safe Motherhood Initiative (SMI), which issued an international call to action to reduce maternal mortality and morbidity by one half by the year 2000. It also led to the formation of an Inter-Agency Group (IAG) for Safe Motherhood, which has since been joined by UNICEF, UNDP, IPPF, and the Population Council.

The SMI's target has subsequently been adopted by most developing countries. Under the Safe Motherhood Initiative, countries have developed programs to reduce maternal mortality and morbidity. The strategies adopted to make motherhood safe vary among countries and include:

  • Providing family planning services.
  • Providing postabortion care.
  • Promoting antenatal care.
  • Ensuring skilled assistance during childbirth (see Figure 2).
  • Improving essential obstetric care.
  • Addressing the reproductive health needs of adolescents.

Essential Obstetric Care

Ensuring access to essential obstetric care is especially important in reducing maternal deaths. Basic essential obstetric care (also called basic emergency obstetric care) at the health center level should include at least:

  • Parenteral antibiotics
  • Parenteral oxytocic drugs
  • Parenteral sedatives for eclampsia
  • Manual removal of placenta
  • Manual removal of retained products
  • Assisted vaginal delivery

Comprehensive essential obstetric care services at the district hospital level (first referral level) should include all of the above, plus:

  • Surgery
  • Anesthesia
  • Blood transfusion

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Ten years after: Key lessons learned

Ten years after the launch of the Initiative, the IAG held a Safe Motherhood technical consultation in Colombo, Sri Lanka in October 1997. The goal of the technical consultation was to review key lessons learned from the Initiative's first ten years and articulate a clear consensus on the most effective strategies and ways to implement these strategies at the country level (Starrs 1998). Click here for key action messages and fact sheets of the technical consultation (

In addition, commitment to the Safe Motherhood Initiative was further strengthened when safe motherhood was named the theme of WHO's World Health Day, April 7 1998 ( As part of World Health Day an International Symposium on Safe Motherhood was held in Washington, DC and attended by key representatives of governments, international aid agencies, and NGOs. The message of the symposium was clear: motherhood can and should be made safe.

Global experience from the Initiative's first ten years showed that maternal death and morbidity due to obstetric complications can be prevented (with existing knowledge and technology) by:

  • Recognizing that every pregnancy faces risks.
  • Increasing access to family planning services.
  • Improving the quality of antenatal and postpartum care.
  • Ensuring access to essential obstetric care (including postabortion care).
  • Expanding access to midwifery care in the community.
  • Training and deploying appropriate skilled health personnel (such as midwives).
  • Ensuring a continuum of care connected by effective referral links, and supported by adequate supplies, equipment, drugs, and transportation.
  • Reforming laws to expand women's access to health services and to promote women's health interests.

Key lessons learned from the global experience of efforts to make motherhood safe include:

  • Strong political commitment at the national and/or local level can help facilitate the implementation of safe motherhood interventions and ensure their integration into the health care system.
  • Involving national and local leaders and other key parties (including donors and both public and private health sectors) in the planning and implementation of safe motherhood activities helps facilitate the delivery of maternal health services and ensure sustainability.
  • Involving community members (particularly women and their families, health care providers, and local leaders) in efforts to improve maternal health helps ensure program success.
  • Training and deploying a range of health care providers at appropriate service delivery levels help increase access to maternal health services, especially life-saving services.
  • Effective communication between health care providers at both the community level and the district (first-referral) level is essential for management of obstetric emergencies and for ensuring continuity of care.
  • Community education about obstetric complications and when and where to seek medical care is important to ensure early recognition of complications and prompt care-taking behavior.

International commitment to reducing maternal mortality was reaffirmed in December 2000 when 149 government leaders from 191 United Nations member states committed themselves to achieving a set of Millennium Development Goals (MDGs, see by 2015. Reducing maternal mortality by three-quarters from its 1990 level is one of these key goals. The maternal mortality ratio and the proportion of deliveries with a skilled attendant will be used to monitor progress towards this goal. For more information, see the UN's web page on the MDGs (

In January 2004, the Partnership for Safe Motherhood and Newborn Health was established to promote the health of women and newborns, especially those who are most vulnerable. This group is expanding the scope of the global Safe Motherhood Initiative and aims to strengthen global, regional, and national maternal and newborn health efforts, in the context of equity, poverty reduction, and human rights.

The new partnership will:

  • Highlight the vital linkages between maternal and newborn health.
  • Encourage partnerships among a range of stakeholders, by involving a broader range of organizations.
  • Strengthen and expand efforts in maternal and newborn health.
  • Respond more effectively to the challenge posed by the Millennium Development Goals, which define concrete global targets for reducing maternal and child mortality.

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