Safe motherhood: a brief history of the global movement 1947-2002.

The health of mothers has long been acknowledged to be a cornerstone of public health and attention to unacceptably high level of maternal mortality has been a feature of global health and development discussions since the 1980s. However, although a few countries have made remarkable progress in recent years, the reality has not generally followed the rhetoric. Health and development partners have failed to invest seriously in safe motherhood and examples of large-scale and sustained programmes are rare. Safe motherhood has tended to be seen as a subset of other programmes such as child survival or reproductive health and is often perceived to be too complex or costly for under-resourced and overstretched health care systems that have limited capacity. Despite this, a consensus has emerged about the interventions needed to reduce maternal mortality and there are good examples (historical and contemporary) of what can be achieved within a relatively short time period. The activities of both grassroots organizations and international health and development agencies have helped to build political will and momentum. Further progress in improving maternal health will require outspoken and determined champions from within the health system and the medical community, particularly the obstetricians and gynaecologists, and from among decision-makers and politicians. But in addition, substantial and long-term funding--by governments and by donor agencies--is an essential and still missing component.