Fauveau, V., K. Stewart, S. A. Khan, J. Chakraborty, DRAFT: "Mortality rmpact of a Community-based Maternity Care Programme in Rural Bangladesh", International Center for Diarrhoeal Disease Research, Bangladesh, 1991.

This paper reports the results of a study in the Matlab area of Bangladesh. A region of about 100,000 persons was divided into treatment and control groups, and for the period from 1984 to 1989, professional midwives were posted in the villages of the treatment area. Results showed that in the control area maternal mortality remained constant at 380 per 100,000 births, while in the treatment area it fell from 440 to 140 per 100,000 births. The report notes, however, that the treatment area made less intensive use of midwives than expected and suggests that further study is needed to determine the specific factors behind the fall in mortality, including factors that distinguish women who were attended by midwives from those who delivered alone or with traditional birth attendants.

Health of Adults in the Developing World, ed. by R. Feachem, T. Kjellstrom, C. Murray, M. Over, and M. Phillips, World Bank, 1990.

This work documents the nature and extent of adult health problems in the developing world, both in their type and evolution. It f'ocuses on the age and disease structure of morbidity and mortality for persons aged 15 through 59 years. The book also attempts to measure the burden of adult ill health, key determinants of adult ill health in developing countries, and types of intervention strategies that could modify these determinants and improve adult health. While maternal mortality is not a major focus of the book, it does receive some attention. The book does not, however, examine "health service issues such as financing, training, decentralization or the balance among primary, secondary and tertiary facilities." Maternal health issues are placed on what the work calls "the emerging agenda for adult health." The book contains a wealth of demographic and health data.

Herz, B. and Measham, A., The Safe Motherhood Initiative: Proposals for Action, World Bank Discussion Papers, World Bank, 1987.

This study, one of the seminal pieces on Safe Motherhocd programs, proposes a three part program: 1. stronger community based care, in which health workers provide screening, prenatal care, education, family planning, and o:her services; 2. an alarm and transport system to transfer high risk pregnancies and emergencies to referral facilities; and 3. stronger referral facilities, in both hospitals and health centers, to treat complicated deliveries, and obstetric emergencies, and to provide clinical and surgical methods of family planning. Expenditures would go primarily to increased staff, training and supervision, transport, equipment and supplies, health education, and monitoring and evaluation.

The study provides a speculative analysis of the costs of operation of two possible Safe Motherhood programs. The first is for a moderate effort in a poor, densely populated rural area with some health facilities. This program would be expected to cost $1.50 per annum per capita, and would reduce matemal deaths by 67%. The maternal mortality ?4