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## 1. INTRODUCI1ON

At the February 1987 Conference on Safe Motherhood in Nairobi', Herz and Measham (1987) presented a paper on 'The Safe Motherhood Initiative," in which they proposed a new approach to reduce maternal mortality and morbiditv in developing countnes. Herz and Measham noted that in spite of progress toward chi!d survival and improvements in life expectancv, an estimated 500,000 women, 99 percent of them from the devel(uping world, die each year from pregnancv-related causes-.

About three quarters of these deaths are the direct result of obstetrical complications hemorrhage, infection, toxemia, obstructed labor, and abortion (under primitive and illegal conditions). An estimated equivalent number of infants do not survive their mother's death. For surviving mothers, the consequences of pregnancy have a severe impact on health and family economics.

The proposed strategy for safe motherhood is based on two approaches. First, the encouragement of activities that indirectlv improve maternal health. These include education, policies to improve women's rights and working conditions, health care and nutrition, transportation and communication systems, water and sanitation facilities, and increases in fami;y income !,d food production.

The second approach, which serves as the core strategy for the Safe Motnerhood (SM) Initiative targets activities to reduce maternal deaths. These activities include reducing unwanted pregnancies through the provision of family planning services, and through national policies that recognize the importance of this issue (although Maine (1985) estimates that even if all unwanto-d pregnancies were avoided, only a fourth to two fifths of maternal mortality would be avoided). A second objective is to reduce thie' isks of pregnancy through providing community-based tamily planning and prenatal services to .ntify high-risk cases' adequate referral services for the complications of pregnancy, and commun -ation and transport systems to support patient referral procedures.

Given the long history of support for maternal health by international bilateral, multilateral, ano nongovernmental organizations (NGOs), the conference recognized that the limited progress in reducing maternal mortality and .norbiditv required moNing to a systems approach utilizing selected, targeted, core activities.

# II. TERMS OF REFERENCE

# A. Purpose

In response to a request from the Meeting of Interested Parties, which serves as the international forum for monitoring the Safe Motherhood Initiative, the World Bank has undertaken this study to measure aid flows for this program since the 1987 conference. The study is designed to measure financial trends and new initiatives in support of the program's objectives; identify issues of ' The Conference was co-sponsored by the World Bank, the World Health Organization (WHO), and the United Nations Fund for Population Activities (UNFPA), with the cooperation of the United Nations International Children's Fund (UNICEF), the United Nations Development Program (UNDP), the Carnegie Corporation, the Pathfinder Fund, and the Rockefeller Foundation.

2 South and West Asia, 300,000; Africa, 150,000, Latin America, 34,000, East Asia, 12,000.