[Maternal mortality in developing countries: statistical data and improvement in obstetrical care]

Since launching of the safe motherhood initiative in 1987, much work has been undertaken, understanding of the situation in developing countries has improved, and numerous health programs have been designed. However the end result of action has been considered disappointing more often than encouraging especially in Sub Saharan Africa. What is the true picture? The purpose of this article is to review the means available for studying all facets of maternal mortality and methodological precautions that must be applied in the interpretation of statistical data. Perusal of recent reports on maternal mortality reveals that estimated incidences in different populations vary widely from 85 to 1000 per 100,000 live births, that rural zones are more affected than urban areas, that reductions have been achieved in the major cities, that the most common direct obstetrical causes are postpartum hemorrhage, dystocia with uterine rupture, eclampsia, and sepsis, and that 70% of deaths are avoidable, i.e., due to absent or insufficient care. Although currently underused, qualitative study methods are gradually being implemented and will identify the health care sectors requiring priority improvement. Based on previous experience, it is unlikely that technical or obstetrical measures and action on the part of medical professionals alone will achieve any reduction in maternal mortality without the commitment of political authorities.