In the late 1980s the world became acutely aware of the alarming fact that in many parts of the world, childbearing was not a joyful occasion. The risk of serious complications, disability and death was so high that women often said good bye to their other children and family members before embarking on the process of birth. The facts then were clear. More than a half a million women would die each year as a result of pregnancy and childbirth. In 1987, the World Bank, in collaboration with WHO and UNFPA, sponsored a conference on safe motherhood in Nairobi, Kenya, to help raise global awareness about the impact of maternal mortality and morbidity. The conference launched the Safe Motherhood Initiative, which issued an international call to action to reduce maternal mortality and morbidity, and the challenge was taken up. The M-word, motherhood, was chosen to reflect both pregnancy and childbirth and respect this rite of passage in a women's life. Safe Motherhood became the focus of country developed programmes and strategies. These included providing family planning services, providing post abortion care, promoting antenatal care, ensuring skilled assistance during childbirth, improving essential obstetric care and addressing the reproductive health needs of adolescents. All these areas are part and parcel of the global work terrain of midwives.
Two years earlier, in 1985, the Lancet had published an article by Allen Rosenfield and Deborah Maine, (1) which challenged the public health establishment, entitled 'Where is the M in MCH (Maternal Child Health'. They stated that scrutiny of existing MCH programmes had shown that they did little to reduce maternal mortality. The authors called for more attention to the maternal component of MCH. Emergency (also called essential) obstetric care was identified as the key strategy to reducing mortality. This is also an area of work that belongs to the field of midwifery in a growing number of countries.
At the beginning of the new Millennium (another M-word), international commitment to reducing maternal mortality was reaffirmed when 149 government leaders from 191 United Nations member states committed themselves to achieving a set of Millennium Development Goals (MDGs) by 2015. The fifth goal is the reduction of maternal mortality. The proportion of births with a skilled attendant will be used to monitor progress towards this goal.
ICM has been actively involved in the Safe Motherhood Initiative...