Abstract

PIP: The World Health Organization (WHO) Maternal Health and Safe Motherhood Programme developed the Mother-Baby package to facilitate the development of national strategies and plans of action. It was presented at an international meeting in Geneva in April 1994. The goals of the package are by the year 2000 to reduce maternal mortality by half and perinatal and neonatal mortality by 30-40% of 1990 levels. The package comprises: 1) a section on the technical basis and underlying strategies, 2) a section describing intervention before and during pregnancy, and during and after delivery, and 3) detailed recommendations on operating the program. The underlying strategy aims to reduce the number of high-risk and unwanted pregnancies; the number of obstetric complications; and the case fatality rate in women with complications. Interventions are based on a fourfold approach of family planning, quality antenatal care, clean and safe delivery, and access to essential obstetric care for high-risk pregnancies and complications. The district health system is the basic unit for planning and implementing the interventions. Midwives who live in the community are best equipped to provide appropriate community-based care to pregnant women. Pregnancy and obstetric complications requiring surgery and anesthesia should be available in the district hospital with an adequate referral system. Upgrading the skills of traditional birth attendants is also essential. National authorities should undertake a series of steps to carry out the interventions. A basic infrastructure, the upgrading of peripheral facilities, the development of human resources for safe motherhood, the effective delegation of responsibility, information, education, and communication (IEC), the involvement of nongovernmental organizations and women's groups, and the monitoring of results are other important elements in carrying out the interventions.