Reflections on maternal mortality in two decades.

The paper examines developments in the assessment and prevention of maternal mortality over the past 2 decades through review of the relevant literature. Problems of classifying and ranking causes, changing methodologies, discrepancies and illogical trends are demonstrated. Identifying causes of maternal mortality by surveillance and death reviews, rather than measuring ratios, appears to be more effective. Process indicators are considered as important as outcome indicators for monitoring safe motherhood. International technical reappraisal of maternal mortality is needed.