The principal way of achieving maternal health and safe motherhood is to expand the specific functions and/or categories of midwifery personnel. This includes strengthening knowledge and skills to improve the quality and quantity of care. Success would ensure that for millions of women the prospect of childbirth would be one of joy rather than misery.
PIP: The safe motherhood initiative of 1987 calls for a 50% reduction in maternal mortality in one decade. The initiative's major planks include adequate access to food and primary health care for all female children, universal availability of family planning to avoid unwanted and high- risk pregnancies, improvements in prenatal care, the presence of a trained assistant at all births, and access to appropriate obstetric care. Achievement of these goals requires an expansion of both supply and functions of midwifery personnel. At present, midwives are concentrated in urban hospitals and lack access to women at the grass- roots level. To bridge the social and communications gap between the urban midwife and the rural population, greater attention must be given to the training and supervision of traditional birth attendants. However, since birth attendants cannot treat obstetric complications, and the long-term strategy must be to increase the supply of midwives in rural areas. Training programs for midwives have not received the same emphasis as those for nurses, and the medical establishment has resisted a view of midwifery as an essential public health activity. Midwives are not provided with an awareness of the magnitude of maternal mortality, and the concepts of team management and problem solving are not emphasized sufficiently. The safe motherhood initiative demands an intersectoral, collaborative approach to gynecology, family planning, and child health in which midwifery is the key element.