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The most common direct causes of such deaths were known to be:
- Severe bleeding
- Infection leading to sepsis
- The effects of unsafe abortion
- Eclampsia
- Obstructed labour
Methods of effective prevention or cure for these conditions are well known and widely accessible for women in the developed world. Midwives in all countries know how to treat the problems, to initiate management and where necessary to refer to a medical or other colleague. But in developing countries the risks of these conditions occurring are higher and are made more dangerous by the widespread incidence of:
- Malnutrition;
- Lack of access to clean water and sanitation;
- Epidemic levels of disease such as malaria, tuberculosis, HIV and AIDS;
- Inadequate or unaffordable transport facilities in remote areas so that women with complications cannot reach skilled help;
- Inadequate human resources, drugs and equipment being available at health centres and hospitals;
- Inequitable opportunities for women and girls, leading to poor levels of education including knowledge about their own bodies and basic hygiene practices;
- Inequitable social and cultural status for women and girls, leading to inability to achieve their human rights, including control over their own reproductive health.
All of these issues, including maternal and infant mortality, have since been identified among the targets of the Millennium Development Goals, set by the United Nations in 2000. It is clear that midwives on their own cannot solve these problems. However, by providing high quality care, and being aware of the broader issues, they can optimise situations - for example by teaching the women they care for to make best use of limited food and clean water supplies, to reduce the risks of spreading infection and to recognise the signs of potential complications in pregnancy and labour.
ICM's clear message in the campaign for Safe Motherhood, which has been widely
agreed by other agencies, is that care during childbirth from an attendant with
midwifery skills is the single most effective way to reduce maternal death.
ICM is a member and currently co-chair of an international coalition called the Partnership
for Safe Motherhood and Newborn Health. The steering group of this partnership includes representatives from WHO, UNFPA, UNICEF, the World Bank, the Population Council, the White Ribbon Alliance (WRA), Saving Newborn Lives/Save the Children, Family Care International (FCI), the International Federation of Gynaecology and Obstetrics (FIGO), the International Planned Parenthood Federation (IPPF). More specific regional input comes from the Latin American Taskforce for Maternal Mortality Reduction, the Regional Prevention of Maternal Mortality Network Africa and the Safe Motherhood Network of Nepal.
WHO's own current drive towards Safe Motherhood is the programme called Making
Pregnancy Safer. The programme’s activities are centred on the implementation of
appropriate health strategies, with a major emphasis on availability of a skilled attendant at
labour and birth. In 2004, WHO, ICM and FIGO published a joint statement called ‘Making
Pregnancy Safer: the critical role of the skilled attendant’. This document identified midwives – or doctors with midwifery skills or nurses with midwifery skills – as the major groups of skilled attendants.
In 2005, WHO brought out its annual report on the topic of materna and child health. Both the report and the focus of World Health Day were Make every mother and child count. In Chapter 4 of this report it is confirmed that ‘the prototype of the skilled attendant is the licensed midwife’. Worldwide efforts in the Safe Motherhood arena have been strengthened by the inclusion of neonatal and maternal health targets among the Millennium Development Goals for achievement by 2015. Goal 4 is 'Reduce child mortality' - to reduce by two thirds the mortality rate among children under five; and Goal 5 is 'Improve maternal health' - to reduce by three quarters the maternal mortality ratio in all 189 United Nations Member States.
Finally, ICM is governed by its mission to advance 'attainment of improved outcomes for
women … and their newborns' and its commitment to the belief that strengthening and
supporting midwives and the midwifery profession are the best ways to do this. ICM's policies and global strategy have been developed to achieve either directly or indirectly the goal of Safe Motherhood.
For further information on ICM and its partners visit:
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