Maternal mortality and morbidity: Consolidating the gains, addressing the ongoing disparity

In the developing or majority world, girls and women continue to die from largely preventable causes of maternal death. Each year nearly 289,000 die another twenty million suffer from non-fatal, but significant complications of pregnancy. These devastating deaths and disabilities of mothers are attributable to three delays: delays in the home, in transportation and at the health care facilities. The problems created by these delays are compounded by the low rate of deliveries that are assisted by skilled birth attendants, the low utilization of modern contraceptive methods and poor access to quality care. Of course, the health of babies and children is intricately linked to the health of the mothers who deliver them. Around the world, 3.6 million newborns die annually with another 2.65 million unborn babies dying before birth. Well-documented innovations and models to improve maternal care have been established with some countries using locally developed social and economic interventions along with clinical and facility based inputs and especially the provision of Emergency Obstetric and Neonatal Care (EmONC). A central theme is ensuring mothers (and their babies) have a safe and dignified delivery. The world's attention focused on mothers and children through the Millennium Development Goals, which were the main global development objectives for the first 15 years of the new millennium. The promotion of women's and children's rights and education-along with a trans-disciplinary approach to safe motherhood-play an important role in realizing genuine, sustainable improvement in the lives of millions of mothers and their dependent children. Despite some regional gains and a shift in global focus to maternal/newborn/child health, these foundational steps continue to be major challenges for communities, governments and international organizations.