O'Heir, J. (2004). Journal of Midwifery & Women's Health, 49(4S1), 14-18.
Across the globe, more than one half million women, most of whom live in developing countries, die each year from pregnancy-related complications. In 1987, at an international conference held in Kenya, the Safe Motherhood Initiative was launched, with goals of drawing attention to the magnitude of poor maternal health in developing countries and reducing maternal mortality by half by the year 2000. Although the second goal was not reached, important lessons were learned about effective interventions, barriers to access of care, constraints to program implementation, and the essential elements of care during pregnancy and childbirth.
Even in the best of times, developing countries have limited resources in terms of personnel, facilities, and equipment. During times of complex humanitarian emergencies, traditional responses have centered on food, clean water, sanitation, and basic healthcare. Few or no reproductive healthcare services have been available. Efforts to focus attention on this problem have had hopeful results. A field manual has been developed that describes services that should be available for women living in emergency and stabilized refugee settings. In stabilized settings, pregnant women need at least four antenatal visits that include careful assessment, early detection and management of pregnancy complications, syphilis screening and treatment, iron/folate and vitamin A supplementation, tetanus toxoid immunization, antimalarial and anthelmintics prophylaxis as appropriate, and advice and counseling about delivery site, maternal and newborn nutrition, birth spacing, HIV/AIDS prevention, and family planning. Women in labor need arrangements for a clean and safe delivery and the provision of essential newborn care, including early and exclusive breastfeeding. Postpartum women need follow-up care and assessment, family planning counseling and methods, iron/folate and vitamin A supplementation, and support for breastfeeding.
Judith A. Lewis