After a general discussion of the factors contributing to maternal mortality and morbidity, a solution to both of these problems is suggested for India: an initiative at the district level to improve support, supervision, training, essential midwifery and obstetric care. The general causes of the 200 or more times higher maternal morality risks in developing countries act throughout the woman's lifetime: powerlessness, illiteracy, malnutrition, deficiency of calcium, vitamin D and iron, heavy physical labor, unchecked fertility, lack of prenatal and obstetric care and illegal abortion. The most common causes of maternal morality and morbidity, eclampsia, obstructed labor, hemorrhage and sepsis, have been prevented in developed countries and in China. We know how to prevent them, by technical support and management at the district level. 4 elements are required: 1) adequate primary health care, food and universal family planning; 2) prenatal care and nutrition with referral if needed; 3) assistance of a trained person at every childbirth; 4) access to obstetric care for those at high risk. Rather than spend money or urban specialized hospital centers, half to 2/3 of all fatal complications of childbirth can be eliminated by local hospitals with the ability to do basic obstetrics such as caesareans and blood transfusions. There is a need for further health systems research in the given locale, but what we need now is an initiative on making pregnancy and childbirth safe for all women.

作者：H, Mahler

来源：The Nursing journal of India 1988 年 79卷 5期