Message in a bottle: sinking in a sea of safe motherhood concepts

The experiences of implementing maternal health programmes over the last two decades have resulted in the development of many approaches and concepts to address the problems of maternal death and disability in developing countries. These safe motherhood "messages" are generally conveyed from international organisations to implementers of programmes working in developing countries. The messages are sometimes unclear, ambiguous and open to misinterpretation. Case studies are used to describe varying interpretations of messages on essential and emergency obstetric care, skilled attendance at delivery and measurement of progress. Limited technological access to information, rapidly changing ideology, overly complicated terminology, inadequate evidence, poor international and inter-agency consensus are key reasons contributing to confusion in implementation. Policy-implementation gaps can be bridged with better needs-based evidence, improved consistency and means of delivery of global messages, building capacity, strengthening partnerships and more inclusive participation in the global arena.