Strategies for reducing maternal mortality [letter]

Oona Campbell and Wendy Graham provide evidence for an optimum strategy of intrapartum care in health centres with midwives operating in teams adding to evidence that countries with a high proportion of births in institutions assisted by skilled attendants (trained qualified and accredited) have low maternal mortality ratios. Campbell and Graham also mention three alternative all relying on home delivery by community-based workers. I prefer to call them strategies because although I am greatly concerned about their capacity to reduce maternal mortality I admit that they might be unavoidable in the short term under certain conditions. Many national programmes such as those of India Indonesia Pakistan Bangladesh Nepal Cambodia Kenya Malawi Sudan and Yemen have embarked on the formulation of…