With the “Every Woman, Every Child” global initiative1 and the “Global Strategy for Women's and Children's Health” implemented under the auspices of the United Nations Secretary-General,2 there are now unprecedented political priority and resources available to drive down global maternal and newborn deaths. Although this is certainly welcome, we risk squandering this opportunity if we continue business as usual. Several features of our current efforts are bogging us down, but there is a way forward.
WHAT IS THE PROBLEM?
Grand, Relatively Content-Free, One-Size-Fits-All Strategy
During the late 1990s and the early years of the new millennium, contesting camps in maternal health argued for approaches centered either on provision of: (1) tiered obstetrical services targeting an expected 15% or so of deliveries in which complications might be expected (Emergency Obstetrical Care), or (2) routine care for all deliveries by health care workers with midwifery skills (Skilled Birth Attendance).
Over the past half-decade, the dust from these earlier scuffles has settled; indeed, global leaders in maternal health have been advocating a more nuanced, multipronged approach. However, the one clear message emerging from essentially all global maternal health guidance is some version of “ensure skilled care for every birth”3—that is, to increase the proportion of deliveries attended by “skilled birth attendants” (SBAs). Ministries of Health have heard this message loud and clear and are acting upon it, largely to the exclusion of serious attention to the actual care being delivered—even if this was not the intent of global technical leaders promoting Skilled Birth Attendance.
There are important problems both with …