Safe motherhood and maternal mortality reduction strategies: a cross cultural perspective

This essay provides a review of 25 years of maternal mortality reduction policies proposed by international bodies under the Safe Motherhood Initiative(SMI), and explores the relevance of cultural preferences for birth care in maternal death reduction policies. \ud \ud This review is significant for public health because it addresses the public health mission of ensuring quality and effective health care for mother and child. From a global health perspective this essay provides a general view of the maternal death reduction interventions attempted, and of the successes and problems encountered in different areas of the world. This knowledge is a necessary step for preparing effective programs that build on previous experiences. As such the information contained here can be seen as an intervention history on which future programs can be tailored. Additionally it presents the case of maternal mortality reduction interventions in Peru.\ud \ud The articles included in this essay were obtained through a systematic search of academic online databases, and online and in print publications from international policy and advocacy bodies. Articles come from peer reviewed publications and have been published in the last twenty years. \ud \ud Database searches yielded 139 unique records; 90 of these articles, reviews and reports were directly related to the purposes of this essay. The selected publications which refer to policy strategies and interventions to reduce maternal deaths fall into four broad intervention categories: community level interventions, interventions in medical facilities, policy level interventions, and those related to a global policy change to skilled birth attendants.\ud \ud The results indicate that the most effective interventions focus on more than one intervention level. Furthermore they indicate an uneasy relationship between maternal death education strategies and the cultural preference for home birth care. The development of intercultural birthing in bio-medical facilities, as part of recent maternal mortality reduction efforts in Peru, provides a renewed perspective of cultural preferences in birth care. It also calls attention to the growing importance of cultural awareness in Latin America, and the increasing importance of cultural concerns in public health policy more generally