Generating political will for safe motherhood in Indonesia

Soc Sci Med. 2003 Mar;56(6):1197-207. doi: 10.1016/s0277-9536(02)00119-3.


In 1987 an international conference brought global attention to an issue that previously had been ignored: the world's alarmingly high number of maternal deaths in childbirth. The conference ended with a declaration calling for a reduction in maternal mortality by at least half by the year 2000. As the deadline approached, safe motherhood activists lamented the fact that the world was nowhere near to achieving this objective. They attributed this failure to a variety of causes, but were in agreement that the medical technology was available to prevent maternal deaths in childbirth, and the key was generating the political will to make such technology widely available to women in developing countries.What 'political will' means, however, has been left as an unopened black box. What causes governments to give priority to the issue of safe motherhood, given that national political systems are burdened with thousands of issues to sort through each year? In marked contrast to our extensive knowledge about the medical interventions necessary to prevent maternal death, we know little about the political interventions necessary to increase the likelihood that national leaders pay meaningful attention to the issue. Drawing from a scholarly literature on agenda setting, this paper identifies four factors that heighten the likelihood that an issue will rise to national-level attention: the existence of clear indicators showing that a problem exists; the presence of effective political entrepreneurs to push the cause; the organization of attention-generating focusing events that promote widespread concern for the issue; and the availability of politically palatable policy alternatives that enable national leaders to understand that the problem is surmountable. The paper presents a case study of the emergence, waning and re-generation of political priority for safe motherhood in Indonesia over the decade 1987-1997, to highlight how these four factors interacted to raise safe motherhood from near obscurity in the country to national-level prominence. While there are contextual factors that make this case unique, some elements are applicable to all developing countries. The paper draws out these dimensions in the hope that greater knowledge surrounding how political will actually has been generated can help shape strategic action to address this much neglected global problem.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Decision Making
  • Female
  • Health Policy*
  • Health Priorities
  • Health Services Accessibility
  • Humans
  • Indonesia / epidemiology
  • Leadership
  • Maternal Health Services / legislation & jurisprudence
  • Maternal Health Services / standards*
  • Maternal Health Services / supply & distribution
  • Maternal Mortality*
  • Organizational Objectives
  • Politics*
  • Pregnancy
  • Public Health Administration / legislation & jurisprudence*