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Saving Mother's Lives: Programs That Work


Clinical Obstetrics and Gynecology: June 2009 - Volume 52 - Issue 2 - p 224-236
doi: 10.1097/GRF.0b013e3181a4bddb
Obstetric Practice in the Third World

Maternal mortality is a complex problem requiring complex responses. Nevertheless, every intervention must operate through one of 3 pathways: preventing pregnancy, preventing complications, or preventing death when obstetric complications occur. We describe interventions following each pathway and assess their evidence base. In general, the more specific the intervention (such as procedures) the stronger the evidence. Broad interventions (“programs” for example) have a weaker evidence base although evidence is accumulating. The potential for robust evidence for effective programs is limited by epidemiologic design—the logistic difficulties of randomization, blinding, and single impact variables.

*School of Public Health, Columbia University, New York, New York

School of Medicine, Duke University, Durham, North Carolina

Correspondence: Judith A. Fortney, PhD, E-mail:

© 2009 Lippincott Williams & Wilkins, Inc.