After two decades of the Safe Motherhood Initiative, meaningful reductions in maternal mortality and disability during pregnancy and childbirth in developing countries have not been realized. Herein, we present an overview of the Initiative and review the reasons for this lack of impact, focusing on the issue of strategic effectiveness. An appraisal of strategies that are currently recommended reveals a lack of strong evidence to support their effectiveness. Drawing from the Initiative's history, we propose that, among essential elements to achieve safe motherhood, recommended public health strategies should be supported by good evidence of effectiveness, through (cluster) randomized trials when feasible, before their widespread implementation.
Among key elements for achieving safe motherhood (including commitment from governments, adequate funding, and continued advocacy), recommended strategies should be underpinned by good evidence of effectiveness.
From the 1Center for Women's Reproductive Health and Maternal–Fetal Medicine Division, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama; 2Center for Infectious Disease Research in Zambia, Lusaka, Zambia; and 3Department of Obstetrics/Gynecology, Drexel University College of Medicine, Philadelphia, Pennsylvania.
See related editorial on page 968.
Dr. Tita was funded by the National Institutes of Health Framework Program for Global Health, UAB Sparkman Center for Global Health.
The authors thank A. Metin Gulmezoglu, MD, PhD, (UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, World Health Organization) for contributing to earlier drafts of this manuscript.
Corresponding author: Alan Thevenet N. Tita, MD, MPH, PhD, Department of Obstetrics and Gynecology (MFM Division), University of Alabama at Birmingham, 618 20th Street South, Birmingham, AL 35233; e-mail: Alan.Tita@obgyn.uab.edu.
Financial Disclosure The authors have no potential conflicts of interest to disclose.