The challenge of preparing and enabling 'skilled attendants' to promote safer childbirth.

The worldwide challenge to reduce maternal mortality is beset by numerous and complex issues. Currently, there is a special focus on the role of midwives and others who provide skilled care, their education and the environment in which they are challenged to practice. A review of some of the historical evidence highlights and considers some critical lessons learned in preparing and utilising skilled personnel to attend women at this vulnerable time in their lives. The importance of providing an environment that enables care providers to function effectively is explored. The indispensable merit of political commitment to reducing maternal mortality becomes evident through consideration of achievements in various countries both historically and currently. It is apparent that making childbirth safer is a multifaceted issue that still presents challenges across much of the globe in the 21st century and that this can never be taken for granted in any historical phase or geographical location. In this paper I embrace a major literature search and share findings emerging from studies and activities undertaken on behalf of various national and international organizations, though it does not necessarily reflect the views of those organizations.