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Obstetrics & Gynecology 2007;110:972-976
© 2007 by The American College of Obstetricians and Gynecologists
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GLOBAL ISSUE

Two Decades of the Safe Motherhood Initiative

Time for Another Wooden Spoon Award?

Alan T. N. Tita, MD, PhD1, Jeffrey S. A. Stringer, MD1,2, Robert L. Goldenberg, MD3 and Dwight J. Rouse, MD, MSPH1

From the 1Center for Women's Reproductive Health and Maternal–Fetal Medicine Division, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama; 2Center for Infectious Disease Research in Zambia, Lusaka, Zambia; and 3Department of Obstetrics/Gynecology, Drexel University College of Medicine, Philadelphia, Pennsylvania.

After two decades of the Safe Motherhood Initiative, meaningful reductions in maternal mortality and disability during pregnancy and childbirth in developing countries have not been realized. Herein, we present an overview of the Initiative and review the reasons for this lack of impact, focusing on the issue of strategic effectiveness. An appraisal of strategies that are currently recommended reveals a lack of strong evidence to support their effectiveness. Drawing from the Initiative's history, we propose that, among essential elements to achieve safe motherhood, recommended public health strategies should be supported by good evidence of effectiveness, through (cluster) randomized trials when feasible, before their widespread implementation.




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