Reducing maternal mortality in the developing world: sector-wide approaches may be the key

doi:10.1136/bmj.322.7291.917

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Elizabeth Goodburn, reproductive health advisera (egoodburn@jsiuk.com),
Oona Campbell, head, maternal health programmeb

^a Centre for Sexual and Reproductive Health, John Snow International (UK), London NW5 1TL
^b Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London WC1B 3DP

Correspondence to: E Goodburn

Accepted 1 December 2000

Reducing “the rate of maternal mortality by 75% by 2015” is one of the development targets that has been endorsed at numerous international meetings.1 This target was selected because maternal ill health is the largest contributor to the disease burden affecting women in developing countries; because the lifetime risk of maternal death is much greater in the poorest countries than in the richest (1 in 12 for women in east Africa compared with 1 in 4000 in northern Europe); and because interventions are cost effective (costing £2 ($3) per woman and £153 ($230) per death averted).2^–5

Summary points

Reducing maternal mortality in developing countries is an international priority

Preventing maternal deaths requires a functioning health system

Sector-wide approaches allow donors to support improvements in health systems

Sector-wide approaches offer the opportunity to make a sustainable impact on maternal mortality

Improvements in maternal health can be used to measure the performance of sector-wide approaches

Preventing maternal deaths: what works?

The technical interventions needed to prevent maternal deaths are well understood.6 Traditional maternal and child health interventions, such as providing antenatal care and training traditional birth attendants, have failed. 2 7 The availability, accessibility, use, and quality of essential obstetric care for life threatening conditions, including complications after abortion, need to be improved (box). 2 6 7 What is less clear is how an environment can be created to enable interventions to be made in settings with few resources.8

Causes of maternal deaths

Severe bleeding 25%

Indirect causes including anaemia, malaria, 20% heart disease

Infection 15%

Unsafe abortion 13%

Eclampsia 12%

Obstructed labour 8%

Other direct causes including ectopic pregnancy, 8% embolism, or complications of anaesthesia

Creating a functioning health system is the most obvious means of providing this type of environment. Most of the resources needed to improve essential obstetric care exist as integral parts of …

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