London School of Hygiene & Tropical Medicine

Experts will issue a stark warning today that Millennium Development Goal (MDG) 5, which aims to reduce maternal deaths by 75% before 2015, will only be met with intensified commitment and a focus on effective strategies.

The warning comes from a team writing in the Lancet as part of its Maternal Survival Series, which begins today. The authors call for action on the part of donors and governments to develop a clear strategic vision to reduce the 'largest discrepancy of all public health statistics'.

Women living in the world's poorest countries face a hugely disproportionate burden. Women in Sub-Saharan Africa face a one in 16 risk of dying during pregnancy or childbirth, and in South Asia a one in 43 risk, compared with one in 30,000 in Sweden. Good maternal health is crucial to the welfare of the whole household. Preventing the death of a mother has critical impacts on the health of a child, and improvements in maternal health link to achievements in other MDGs related to poverty eradication, female empowerment, child survival and infectious disease. The authors say that although the challenge of reducing maternal deaths is complex, we already know enough about what works to begin to take action. Dr. Carine Ronsmans, Reader in Epidemiology and Reproductive Health at the London School of Hygiene & Tropical Medicine, and one of the series authors, comments: 'Maternal deaths cluster around labour, delivery and the immediate postpartum, with obstetric haemorrhage as the main medical cause. For this reason delivery with a skilled attendant must be the priority. This is a huge challenge with no quick fixes and progress in the poorest countries is jeopardized by absence of human resources, weak health systems, continuing high fertility, and poor data.

'The immediate priority for Governments and donors should be to invest in the training, deployment and retention of skilled attendants, especially midwives, who we know can make a huge difference and save large numbers of lives. Having midwives and other workers in teams in facilities will optimise high coverage. Skilled attendance has also been endorsed as an effective strategy to reduce neonatal deaths.

'The challenge of reducing maternal deaths will require long-term support, and by long-term, we mean at least ten years, and probably longer. Donor investment will be vital, as will resource-tracking mechanisms to hold all countries, donors, and other actors to account.

Dr. Oona Campbell, Reader in Epidemiology and Reproductive Health at LSHTM, and Professor Wendy Graham, Professor of Obstetric Epidemiology at the University of Aberdeen, the authors of the second paper in the series, conclude: 'In signing up for MDG 5, countries have indicated their vision. But it is meaningless unless it is translated into a clear strategy for achieving it. During the 20 years of international and national advocacy for safe motherhood, an estimated 10 million women have died of maternal causes. For this to happen in a world where we state that we know what works and that nine out of ten of these deaths are preventable is obscene'.

NOTES:

Maternal Survival 1
Maternal mortality: who, when, where and why
Carine Ronsmans, Wendy J Graham, on behalf of the Lancet maternal survival series steering group

Maternal Survival 2
Strategies for reducing maternal mortality: getting on with what works
Oona M R Campbell, Wendy J Graham, on behalf of the Lancet maternal health steering group

Maternal Survival 3
Going to scale with professional care
Marjorie Koblinsky, Zoe Matthews, Julia Hussein, Dileep Mavalankar, Malay K Mridha, Iqbal Anwar, Endang Achadi, Sam Adjei, P Padmanabhan, Wim van Lerberghe, on behalf of the Lancet maternal survival series steering group

Maternal Survival 4
Mobilising financial resources for maternal health
Jo Borghi, Tim Ensor, Aparnaa Somanathan, Craig Lissner, Anne Mills on behalf of the Lancet maternal survival series steering group

Maternal Survival 5
Maternal health in poor countries: the broader context and a call for action
Veronique Filippi, Carine Ronsmans, Oona M R Campbell, Wendy J Graham, Anne Mills, Jo Borghi, Marjorie Koblinsky, David Osrin, on behalf of the Lancet maternal survival series steering group