Globally, maternal health is improving. Since 1990 the number of girls and women dying during pregnancy and childbirth has declined from 543,000 to 287,000 per year. But making quality maternal care a reality for all women remains a major global health challenge. Despite being one of the most pressing problems of the global health agenda it is difficult to understand why maternal mortality has received so little serious attention2 from the different stakeholders involved (donors, high burden countries, policy makers, health professionals…) until recent times.
The high proportion of maternal deaths due to entirely preventable and treatable causes reflects the limited access to and poor quality of basic maternity care including emergency obstetric care. Moreover, most maternal deaths result from one or more of the so called three delays: in seeking care, in arriving at a health facility, and in receiving appropriate care. Moreover barriers to implementation of evidencebased practices have also conspired towards achieving better maternal health outcomes. Until very recently despite the evidence that placed the greatest risk for women in childbirth and the postpartum period, interventions such as antenatal care or delivery care from traditional health agents, which by themselves do not contribute significantly to reduce maternal mortality, have been prioritized over more practical and strategic approaches based on proved facts such as providing professional obstetric care at childbirth.
Finally, maternal mortality is a key indicator of development because the level and the quality of care given to women before, during and after pregnancy, inside and outside the health system, reflects the relative value a given society concedes to women.