BMJ  2004;329:1166-1168 (13 November), doi:10.1136/bmj.329.7475.1166

Education and debate

Reducing maternal and neonatal mortality in the poorest communities

¹ International Perinatal Care Unit, Institute of Child Health, University College London, London WC1N 1EH, ² Mother Infant Research Activities (MIRA), GPO Box 921, Kathmandu, Nepal

Current programmes are often failing to reach those at highest risk of maternal and neonatal death. The international community needs to learn from community trials in the South

The first 150 words of the full text of this article appear below.

Introduction

Every year 530 000 women die from maternal causes, four million infants die in the neonatal period, and a similar number are stillborn.^{w1 w2} Despite a plethora of newly validated interventions, the millennium development goals to reduce maternal mortality by three quarters and child mortality by two thirds are unlikely to be achieved.¹ One of the reasons for this is that current safer motherhood and newborn care programmes emphasise interventions that do not reach the poorest households. Community based interventions have been neglected and undervalued. In this article, we argue that large scale community effectiveness trials are both necessary and feasible if we are to make further progress with reducing maternal and child mortality.

Problems with current interventions

The fact that poor people are both more likely to become ill and less likely to get appropriate treatment has not changed since Tudor Hart articulated it in . . . [Full text of this article]

Community based interventions

Need for large scale community public health trials

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Investing on Traditional Birth Attendants to achieve a significant maternal and neonatal mortality reduction in the poorest countriest

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