Recording the number and causes of deaths of pregnant women and babies is essential health information. In all countries, audit shows that the causes of maternal and neonatal deaths have not changed much over the years. The problems are known. (A recent example of an audit of women who died on arrival at Jinnah Postgraduate Medical Centre, Karachi, Pakistan, revealed what everyone already knew: the need for going to hospital was not realised early enough; there was no male relative to sanction the travel to hospital; there was no transport). We are at a point where it is important to determine the action required of health care providers to impact on the numbers. It appears knowledge alone is not helping the mothers who die. The lack of progress is not puzzling when we live in a world where growing wealth and increasing poverty, advanced education and no education, superhighways and impassable mud roads, advances in health care and lack of access to health care all exist side by side. For most of these things there is need for strong political will to change situations--fighting poverty, building roads, making available essential drugs, increasing access to care.
Strong professional associations can sway political will
To influence the politicians, professionals cannot afford to be apolitical. To be included in the relevant meetings, professionals must be visible and they will not be if they are each working as an individual. There is need for strong professional associations to put the professions and their skills in the spotlight; to facilitate the drafting of programmes and projects that lead directly to saving lives; to lead in the development of effective partnerships and collaboration; and to advocate for women and newborn care in a manner that will influence the equitable distribution of resources for the benefit of women, newborns and children.
Involvement of communities
Ultimately it is the care-seeking behaviour of women and families that can lead to the reduction of maternal and neonatal mortality. Women die because they come late to the health care facility, because they have not recognised the seriousness of a complication or do not have the money or transport to access care anyway. They also die in the facility. Lack of essential drugs, equipment and skilled personnel have been identified and where these have been tackled, the results have been rewarding. The results will be just as rewarding if communities are empowered and...