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Lancet. 1987 Mar 21;1(8534):668-70.

The safe motherhood initiative: a call to action.



A conference on Safe Motherhood, convened in Nairobi in February 1987 by the World Bank, World Health Organization, and United Nations Fund for Population Activities, has issued a call to reduce maternal mortality in developing countries by 50% in 1 decade. Of the 500,000 maternal deaths that occur each year, 99% are in developing countries. This has been a seriously neglected problem, largely because its victims are those with the least power and influence in society--they are poor, rural peasants, and female. The roots of mush maternal mortality lie in discrimination agianst women, in terms of legal status and access to education, financial resources and health care, including family planning. It is essential that all women are ensured access to maternal health and family planning services, especially obstetric care for life-threating conditions such as obstructed labor, eclampsia, toxemia, infection, and complications from spontaneous and induced abortion. The primary health care system at the district and subdistric leveles needs strengthening to provide adequate prenatal care and family planning services and to upgrade district hospitals and maternity centers so they can perform emergency care in pregnancy and childbirth. Since illegal abortion from unwanted pregnancy accounts for 25-50% of maternal deaths, access to family planning services and safe procedures is particularly important. In his remarkes to the conference, Halfdan Mahler, Director-General of WHO, outlined a 4-part strategy to combat maternal mortality: 1) adequate primary health care and an adequate share of available food for females from infancy to adolescence, and universally available family planning; 2) good prenatal care, including nutrtion, with early detection and referral of those at high risk; 3) the assistance of a trained person at all births; and 4) access to the essential elements of obstetric care for women at higher risk.

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