1998 is declared the year of safe motherhood by WHO

1998 is declared the Year of Safe Motherhood by W H O It is now ten years since the terrible tragedy of maternal mortality was given prominent publicity throughout the world. In 1987 we were informed that 500 000 women die as a result of pregnancy and childbirth every year. Last year we were informed that instead of being well on the target to reduce the maternal death rate by half by the year 2000 the death rate had in fact increased to 600 000 per year (see International News in Midwifery 12(3), p153). However, death is only the end of a continuum of tragedy as a significant proportion of women are left with complications as a result of childbirth (Datta et al 1980) and Kelly (1991) has graphically described the effect of fistulae of obstetric origin on a woman's subsequent life. Where the mother has died, young children rarely survive more than two to three years. Maternal deaths can be prevented because only 1% occur in the developed world, the remaining 99% occur in developing countries. To celebrate the tenth anniversary of the Safe Motherhood Initiative a Technical Consultation has just been held in Colombo, Sri Lanka. Over 200 researchers and representatives of organisations committed to the prevention of death and illness from pregnancy and childbirth met to share information and success stories. The consultation was held in Sri Lanka because that country now has fewer than 100 deaths per 100 000 live births whereas Cote D'Ivoire, with a similar annual per capita level of about US$750, has 900 maternal deaths per 100000 live births. Sfi Lanka attributes its success to ensuring that skilled health workers with relevant midwifery skills are present at every birth. Whilst the direct causes of maternal mortality are well documented (see Kwast 1991) the underlying causes of these deaths are the poor socioeconomic and health status of women. Some of the Consultation's participants saw Safe Motherhood as an indicator of a country's respect for its female citizens and argued that if governments meant what they said about human rights for women they had to ensure equal access to quality care. The provision of education for girls can assist in this part of a programme because the educated woman is then better able to demand her human rights and to be able to make life-saving choices about pregnancy and childbirth. Other participants reported on the need to provide readily available family planning services in Midwifery (I 997) 13, 16I-I 62 © 1997Harcou~ Brace& Co. Ltd

order that women can have access to contraception and be able to make informed choices about when and whether to use it. The participants also discussed the need for readily available safe abortion facilities. Whilst abortion is a very emotive subject, if facilities are not available women resort to illegal, unsafe services which result in morbidity and mortality. The midwives' role in the provision of this type of care has previously been discussed in this journal (Hord & Delano 1994). In order to 'concentrate their minds' the Consultation participants were given Action Messages to be considered during their time together. These messages were entitled: 1. Establish Safe Motherhood as a human fight; 2. Safe Motherhood is a vital economic and social investment; 3. Empower women: ensure choices; 4. Delay marriage and first birth; 5. Every pregnancy faces risks; 6. Ensure skilled attendance at delivery; 7. Improve access to quality reproductive health services; 8. Address unwanted pregnancy and unsafe abortion; 9. Measure progress; 10. The power of partnership. As a result of the deliberations, the World Health Organization will be producing an information pack containing fact sheets about these topics and they are to be published on World Health Day, 7 April 1998, and next year is designated the Year of Safe Motherhood. One of the issues which midwives must address is how they are going to ensure that the 50% ot childbearing women in the world who currently have no attendant with any midwifery skills are going to be provided with such an attendant Midwives are a scarce resource and expensive commodity to produce. It is not feasible to have there available for every birth in the world. However~ midwives must take the responsibility to educate and train those who are present for a birth with the relevant midwifery skills. Midwives must then supervise, manage and support these attendants. That alsc means ensuring that they have a functioning referra~ system when complications occur. The Safe Motherhood Initiative, which organisec the Consultation, is a collaborative effort betweer

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the International Planned Parenthood Federation, the Population Council, UNICEF, UNFPA, the World Bank and the World Health Organization. Anyone wanting more information can obtain this from the Safe Motherhood Initiative secretariat via Jill Sheffield, Family Care International in New York, Tel: +1212 941 5300; Fax: +1212 941 5536, E-mail to: [email protected]

Ann Thomson

REFERENCES

Datta KK, SharmaRS, Razaek PM et al 1980Morbidity patterns amongstrural pregnantwomenin Alwar- a cohort study. Health and PopulationPerspectivesand Issues 3:282-292 Hord CE, DelanoGE 1994The midwife's role in abortion care. Midwifery 10:136-141 KellyJ 1991 Fistulaeof obstetric origin.Midwifery7:71-73 Kwast BE 1991 Maternalmortality:the magnitudeand the causes. Midwifery7:4-7