Taking avoidable danger out of pregnancy
Last October, in an attempt to make a dent in the huge, persistent toll of maternal deaths and disease, WHO launched a campaign to urge country health authorities to tackle the heavy toll of unsafe pregnancies. Of the 210 million women who become pregnant each year, about 20 million become ill and more than half a million die from causes related to pregnancy, childbirth or the immediate post-partum period.
The campaign has three targets. One is to reduce the number of unwanted pregnancies: preventing unsafe abortion by providing couples with greater access to safe contraception could reduce maternal deaths by up to 13%, WHO estimates. The second target is to increase the proportion of childbirths assisted by qualified health personnel from the current 5055% to 80% worldwide by 2005: this should help combat, for example, infection during and after delivery, which accounts for about 15% of maternal deaths, and also obstructed labour, which accounts for 8%. The third target is to ensure that more women have access to proper hospital care for complications of pregnancy, such as post-partum haemorrhage, which is linked to 25% of deaths, and convulsions due to high blood pressure, which causes about 12% of maternal deaths.
We know that maternal mortality and morbidity are related to several factors, Paul Van Look, director of WHOs Department of Reproductive Health and Research, explained to the Bulletin. Poverty is certainly an important one. We know, for example, that a woman in a family living on less than $ 1 a day is 300 times more likely to die or fall ill during or after pregnancy than a woman who is better off. Lack of education is another factor. Health problems, of course, are also critical, and that is where we hope to make a significant difference.
The WHO campaign will focus mainly on Africa and Asia, where the vast majority of maternal deaths occur. Ten countries will participate in an initial pilot phase Ethiopia, Mauritania, Mozambique, Nigeria and Uganda, in WHOs African region; Indonesia, in South-East Asia; the Lao Peoples Democratic Republic, in the Western Pacific; Sudan, in the Eastern Mediterranean; and Bolivia, in the Americas.
What is new about the campaign, Dr Van Look said, is the fact that its targets are specific and its scope comprehensive. Up to now, many countries have dealt with one or another of the three targets, putting, say, efforts into training skilled attendants but paying little attention to providing facilities where these attendants could send women who encounter life-threatening complications. Our aim is to make sure that all countries incorporate all three targets in their national health plans. 
John Maurice,
Bulletin