Maternal survival in developing countries: what has been done, what can be achieved in the next decade

Every year, approximately 600000 women die of pregnancy-related causes - 98% of these deaths occur in developing countries. For every woman who dies, at least 30 suffer injuries and often, permanent disability. The challenge today is to re-orient programmes on priority interventions, and to mobilize sufficient resources for their implementation. More resources have been put into antenatal care than into delivery care and the management of complications of births and unsafe abortions. This article describes the effective strategies for reducing maternal death, their policy requirements and programmatic implications, and provides examples of successful developing country programmes. Priority interventions include: (1) improving availability and use of essential obstetric care for the management of complications; (2) strengthening family planning services; (3) ensuring skilled attendance at birth; (4) promoting women-friendly health services; (5) increasing district-level planning with community participation; and (6) monitoring process with process indicators. Finally, the promotion of safe motherhood as a right is of crucial importance. Needed now is political commitment as well as coordinated action for the implementation of large-scale programmes in low-income countries.