The Millennium Declaration includes two goals directly relevant to maternal and perinatal conditions: reducing child mortality and improving maternal health. The fact that two out of the eight Millennium Development Goals (MDGs) are exclusively targeted at mothers and children is testament to the significant proportion of the global burden of disease they suffer and to the huge inequities within and between countries in the magnitude of their burden. Achieving these goals is inextricably linked at the biological, intervention, and service delivery levels (Bale and others 2003).
Maternal and child health services have long been seen as inseparable partners, although over the past 20 years the relative emphasis within each, particularly at a policy level, has varied (De Brouwere and Van Lerberghe 2001). The launch of the Safe Motherhood Initiative in the late 1980s, for example, brought heightened attention to maternal mortality, whereas the International Conference on Population and Development (ICPD) broadened the focus to reproductive health and, more recently, to reproductive rights (Germain 2000). Those shifts can be linked with international programmatic responses and terminology—with the preventive emphasis of, for instance, prenatal care being lowered as a priority relative to the treatment focus of emergency obstetric care. For the child, integrated management of childhood illnesses has brought renewed emphasis to maintaining a balance between preventive and curative care. The particular needs of the newborn, however, have only started to receive significant attention in the past three or four years (Foege 2001).
Although health experts agree that the single clinical interventions needed to avert much of the burden of maternal and perinatal death and disability are known, they also accept that these interventions require a functioning health system to have an effect at the population scale. Levels of maternal and perinatal mortality are thus regarded as sensitive indicators of the entire health system (Goodburn and Campbell 2001), and they can therefore be used to monitor progress in health gains more generally. What is also clear is that maternal mortality and the neonatal component of child mortality continue to represent two of the most serious challenges to the attainment of the MDGs, particularly in South Asia and Sub-Saharan Africa.
An estimated 210 million women become pregnant each year, and close to 60 million of these pregnancies end with the death of the mother (500,000) or the baby or as abortions. This chapter focuses on the adverse events of pregnancy and childbirth and on the intervention strategies to eliminate and ameliorate this burden.