Safe motherhood: impossible dream or achievable reality?

In 1990, the maternal mortality rate in Australia was among the lowest in the world at 9/100,000 live births, but the rate among Aboriginals and Torres Strait Islanders was 40/100,000 vs. 2-3/100,000 among other women. The situation of the Aboriginal women reflects that seen in developing countries where 99% of maternal deaths occur. For every maternal death, another 30 women suffer severe and permanent maternal morbidity, including vesicovaginal fistula and damage due to delivery in women who have undergone female genital mutilation. The 585,000 annual victims of maternal mortality leave at least a million vulnerable motherless children and are no longer available to produce food and to care for households. Maternal mortality and morbidity are caused by poverty; poor access to health services; pregnancies that are "too many, too close, too early, too late"; poor nutrition and health; and women's low socioeconomic status. Since nearly all conditions that lead to maternal morbidity and mortality are preventable or treatable, many programs have been initiated to reduce maternal mortality and morbidity by half by the year 2000. The problem is greater than indicated by initial estimates, however, and will require major interventions. Relatively small increases in overall health budgets or minor changes in health care priorities would save lives and produce great economic benefits. Women's health will not receive greater priority until women become empowered to improve their social status.