[The initiative for a risk-free motherhood: which perspectives?]

The "Safe Motherhood Initiative" started off with a first conference held in Nairobi in February 1987. In 1989, several conferences were organised throughout the world which led to a new current of opinion in favour of maternal health improvement. Governments, decision markers and aid agencies have been called upon to support such Initiative. In this paper, we review the main characteristics of the Safe Motherhood Initiative and analyse two main constraints which were insufficiently discussed during the conferences. The first one is the need to increase the efficiency of the existing health system. The second one is the problem which arises from poor acceptability by the populations of certain health activities promoted by the Initiative. By giving various examples, we describe how these factors may restrict its expected results. Proposals are made to increase the efficacy of the programmes and of activities promoted by the Initiative and to ensure its mid-range continuation. The authors suggest that specific attention and more resources have to be given to achieving specific operational researches, by taking into account the health behaviour of the populations, the characteristics of the existing health services and the resources available. Such research will lead to improved maternal health activities.