Maternal Survival 2

what works Oona M R Campbell, Wendy J Graham, on behalf of The Lancet Maternal Survival Series steering group* The concept of knowing what works in terms of reducing maternal mortality is complicated by a huge diversity of country contexts and of determinants of maternal health. Here we aim to show that, despite this complexity, only a few strategic choices need to be made to reduce maternal mortality. We begin by presenting the logic that informs our strategic choices. This logic suggests that implementation of an eff ective intrapartum-care strategy is an overwhelming priority. We also discuss the alternative confi gurations of such a strategy and, using the best available evidence, prioritise one strategy based on delivery in primary-level institutions (health centres), backed up by access to referral-level facilities. We then go on to discuss strategies that complement intrapartum care. We conclude by discussing the inexplicable hesitation in decision-making after nearly 20 years of safe motherhood programming: if the fi fth Millennium Development Goal is to be achieved, then what needs to be prioritised is obvious. Further delays in getting on with what works begs questions about the commitment of decision-makers to this goal. “We know what works”1 is a deceptively simple phrase, often used in international advocacy aiming to reduce the burden of maternal mortality in developin