The necessary services include family planning, basic maternal care, skilled birth attendants, neonatal care and preventing and treating unsafe abortions and the complications of pregnancy and delivery. Despite their low incomes, China, Cuba and Sri Lanka have all reduced maternal deaths through efforts to improve access to primary health care, strengthen health systems and improve the quality of health care. Ninety-nine percent of maternal deaths occur in developing countries, most of them preventable. Infections, blood loss and unsafe abortion account for the majority of deaths. To reduce maternal mortality, more investment in health systems is needed to improve the quality and coverage of delivery services and to provide prenatal and postnatal care for the poor.
Maternal deaths are hard to measure.
The proportion of births attended by skilled personnel helps to track progress in reducing maternal mortality. In many poor African countries, one mother dies from complications of pregnancy and delivery for every 100 live births. Health workers with midwifery skills are the key to reducing maternal mortality. As well as attending births, they provide mothers with basic information about prenatal and postnatal care for themselves and their children. Improving women's social status and ensuring gender equity in health care are important in achieving this goal.