SeriesStrategies for reducing maternal mortality: getting on with what works
Section snippets
Stripping complexity to reveal strategic choices
Making strategic choices requires decision-makers to be explicit about the values attached to alternative outcomes, since such values affect the target group and the packages of appropriate interventions. Some means of distribution are capable of delivering multiple packages aimed at multiple outcomes, and these opportunities are often taken for pragmatic reasons. This approach can result in a strategy that seems unfocused, with several valued outcomes and no sense of priority. As a result,
Intrapartum-care strategies must be the priority
Figure 2 shows the strategic options aimed at reducing maternal mortality. Some of these options share the same target group, whereas others are complementary and focus on different women.
Most maternal deaths occur during labour, delivery, or the first 24 h postpartum, and most complications cannot be predicted or prevented (see the first report in this series). Individual complications are quite rare, and timely diagnosis and appropriate intervention requires considerable skill to prevent
Strategies that complement those targeted at the intrapartum period
Intrapartum-care strategies are acknowledged as the priority focus for reduction of maternal mortality, but the role of complementary strategies with different target groups, such as pregnant women or women not desiring pregnancy, are also important to consider. We recognise the potential for four such strategies—antenatal care, postpartum care, family planning, and safe abortion—but also comment on broader-based strategies which relate to women's health and development per se.
Whereas an
Conclusions
In this paper we aim to replicate for maternal survival what other specialties within international public health have done so well—to strip away the complexities about what to do, and thereby remove excuses for inaction. And like in other specialties, such stripping away involves simplification of the issues, making heroic assumptions, and use of bold claims and language. Of course the reality is more complex: decision-making for scarce health resources is a matter of politics, values, and
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