Current status of 'essential obstetric care' activities internationally: a literature review.

Reduction of maternal mortality in developing countries today is hindered by limited awareness of the magnitude and manageability of the problem. Ill-informed strategies have diverted attention from development of professional first-line midwifery. The lack of political will, government support and adequate allocation of resources are compounding factors. The low status and educational level of women, surrounding cultural values and beliefs, financial and family constraints, all contribute to under-utilization of professional delivery services even when they do exist. The quality of EOC at the point of service delivery in developing countries remains weak. Priority interventions designed to increase maternal survival in developing countries can be summarized with Donnay's six suggestions33: (1) improving availability and use of EOC for the management of complications; (2) strengthening family planning services; (3) ensuring skilled attendance at birth; (4) promoting women-friendly health services; (5) increasing district-level planning with community participations; and (6) monitoring process with process indicators. The tragedy of maternal deaths in the developing world has been neglected for too long. If we continue to fail to deliver high quality essential obstetric services for all, the Safe Motherhood Initiative of the 1980s will remain an orphan.