For safe motherhood.

The Safe Motherhood Initiative is a global effort to reduce death and illness associated with pregnancy and childbirth launched at a conference in Nairobi, Kenya, in 1987. It is co-sponsored by a group of international agencies that founded the Safe Motherhood Inter-Agency Group, IAG. The following information was taken from the Safe Motherhood Initiative's website, www.safemotherhood.org.

Safe Motherhood means ensuring that all women receive the care they need to be safe and healthy throughout pregnancy and childbirth.

Most maternal deaths are due to five medical causes: severe bleeding (hemorrhage); infection; unsafe abortion complications; hypertensive disorders of pregnancy; and obstructed labor. More than 60 percent of maternal deaths take place in the period immediately following delivery, with more than half occurring within a day of delivery.

An estimated 40% or more of pregnant Women--50 million each year--experience pregnancy-related health problems (morbidities) during or after childbirth. Fifteen percent of these women suffer serious or long-term, often debilitating complications, such as uterine prolapse (sliding of the uterus from its normal position), fistulae (holes in the birth canal that allow leakage from the bladder or rectum into the vagina), pelvic inflammatory disease and infertility.

Preventing and managing these problems requires a well-functioning health system that provides accessible, high-quality care from the household to the hospital level. In addition, a range of social, economic and cultural factors also contribute to women's poor health before, during and after pregnancy.

Millions of women do not have access to good quality health services during pregnancy and childbirth--especially poor, uneducated or rural women:

* Almost 35% of women in developing countries receive no prenatal care during pregnancy; in some countries, prenatal coverage is as low as 26%.

* Approximately half of all deliveries in developing countries take place without a skilled attendant, with rates in some countries as high as 85%.

* Seventy percent of women receive no postpartum care in the six weeks following delivery.

A number of barriers limit women's access to care, including:

Distance and lack of transport: Nearly 80% of rural women live more than five kilometers from the nearest hospital, and many have no way to get to health facilities except by walking--even when they are in labor.

Cost: Millions of women cannot afford to use services, even when fees are low or services are provided for free. This is due to the additional, often hidden, costs patients that must cover--transport, drugs, medical supplies, and even food and lodging for themselves and their families.

Interactions with providers: Too often health care providers are rude, unsympathetic and uncaring. They often do not respect women's cultural preferences, e.g., for privacy, birth position or treatment by women providers.

Socio-cultural factors: Women in many areas of the world lack the power to make choices about their health and lives, with negative consequences for maternal health.Tradition, family mores and even laws limit women's decision-making and rights with regard to childbearing, contraception, initiation of sexual relations, and if and when to seek medical care. In some settings, a husband's permission is required for women to receive health services, including life-saving care; in others, mothers-in-law decide whether women can use available services.

Ensure Access

Safe motherhood can be achieved by providing high-quality maternal health services to all women during pregnancy, childbirth and the postpartum period. Services to help make motherhood safer include:

* Care by skilled health personnel before, during and after childbirth;

* Emergency care for life-threatening obstetric complications;

* Services to prevent and manage complications from unsafe abortion;

* Family planning to enable women to plan their pregnancies and prevent unwanted pregnancies;

* Health education and services for adolescents; and

* Community education for women, their families and decision-makers.

Address Gender Inequalities

Women's status must be improved and full value accorded to their reproductive and productive roles. Family and community attitudes that prevent women from receiving proper care during pregnancy and delivery must be addressed.

Advance Safe Motherhood Through Human Rights

Preventing maternal death and illness is an issue of social justice and women's human rights. Making motherhood safer requires women's human rights to be guaranteed and respected. These include their rights to good quality services and information during and after pregnancy and childbirth; their right to make their own decisions about their health freely, without coercion or violence, and with full information; and the removal of barriers--legal, political and health-related--that contribute to maternal mortality.

Governments have an obligation to address the causes of poor maternal health through their political, health and legal systems. International treaties and national constitutions that address basic human rights must be applied to safe motherhood issues in order to guarantee all women the right to make free and informed decisions about their health and access to quality services before, during and after pregnancy and childbirth.