Tanzanian projects seek "safe motherhood".

Network 14(3):22-3 (1994) PMID 12287509

In order for maternal mortality to occur, a woman must become pregnant, she must develop complications, and these complications must lead to her death within 42 days after the pregnancy ends. Interventions can influence the outcome of any of these factors: family planning (FP) can reduce the number of unwanted pregnancies, better prenatal care in better community health programs can reduce the number of complications, and better access to emergency obstetric care can reduce deaths due to complications. As part of the "Safe Motherhood Initiative," more than 70 agencies in Tanzania have taken various approaches to improving maternal health. Evaluation by the World Health Organization and the United Nations Development Program has revealed that safe motherhood activities generally take place in community programs concerned with nutrition, FP, education, and health. Thus progress has been made in bringing the issue to public attention, but there still exists a general lack of understanding that improving women's health and preventing maternal death require different interventions. Also, whereas knowledge of the importance of emergency care has risen, the quality and accessibility of services has not. Therefore, the maternal mortality rate in Tanzania is 400/100,000 births as compared to about 12 in North America. Also, only 30% of women who want no more children use modern contraceptives and only 10% of married women of reproductive age use contraceptives at all, including traditional methods (as compared to 43% in Zimbabwe). To improve obstetric care, health care providers and the community must work together, although there is little agreement about how this should occur. In fact, the setting of priorities and allocating of resources will vary from country to country. In Tanzania, the WHO/UNDP team recommended an emphasis on improving the quality of emergency obstetric care. Priorities will also become important because the term "safe motherhood" has been expanded to apply to women's rights in general. The effectiveness of various priorities must also be monitored, often using proxy indicators. The Safe Motherhood Initiative strives to halve the 500,000 annual maternal deaths by the year 2000, yet, with only 6 years to go, an increase in the annual number of pregnancies has kept the rate constant since the original estimate in 1985 despite the progress made.