May 21, 2013

The Lancet Publishes Correspondence regarding "A Manifesto for Maternal Health Post-2015"

AUTHOR:Harry Strulovici, MD, MPHSOURCE:The Lancet

The current issue of The Lancet has published a correspondence regarding "A manifesto for maternal health post-2015". The manifesto was published in The Lancet in February 2013. You can read the manifesto, the correspondence and author's reply below:


A Manifesto for Maternal Health Post-2015

On Jan 15–17, 2013, over 800 experts in maternal health came together in Arusha, Tanzania, to present
the latest evidence on improving the quality of care for women during pregnancy and childbirth. The past
25 years of the safe motherhood movement have seen extraordinary successes—notably a 33% reduction in
maternal mortality from 409 053 in 1990 to 273 465 in 2011. These achieve ments have motivated and
mobilised a welcome new generation of political and financial commitments to maternal health. But with the era of the Millennium Development Goals (MDGs) drawing to a close in 2015, a moment
of uncertainty hangs over the fate of more than 200 million women who become pregnant each year. As
the world moves towards the next set of development goals, will the gains of the past for women be protected, and can the unfi nished business for the future be
addressed? As a contribution to the process of redefining human development for women after 2015, participants at the Arusha conference supported writing a manifesto for maternal health based on the best available evidence, the lessons of safe motherhood from the past 25 years,
and the more recent experience of the MDGs. We welcome a vigorous debate about this manifesto.
Agnes Binagwaho, Rwanda’s Minister of Health, opened the conference in Arusha by looking back.

Panel: A manifesto for maternal health

1 The global health community must build on past successes
and accelerate progress towards eliminating all
preventable maternal mortality within a time-bound
period. To this end, a new and challenging goal for
maternal mortality reduction is needed within the
development goal framework for the post-2015 era, one
that is led and owned by countries not donors.

2 This maternal mortality goal must be broadened to embrace
the progressive realisation of political, economic, and social
rights for women. One critical lesson from the history of
women’s health is that maternal health will not be improved
to its full potential by focusing on maternal health alone.

3 As maternal mortality declines, the world must now focus on
both prevention and treatment of maternal morbidities, the
measurement of which is challenging but critical to tackle for
the health, productivity, and dignity of the women involved.

4 The successful framework of the continuum of care must be
redefi ned to make women more central to our notions of
reproductive, maternal, newborn, and child health. The
continuum needs to be more inclusive of frequently
neglected elements—eg, quality of care, integration with
HIV and malaria programmes, non-communicable diseases,
and the social determinants of health, such as poverty,
gender disparities, sexual and gender-based violence, water
and sanitation, nutrition, and transportation.

5 The global health community must devise a responsive
fi nancing mechanism to support countries in implementing
their plans to reduce maternal mortality and improve sexual
and reproductive health.

6 A much greater emphasis must be put on reaching the
unseen women who are socially excluded because of culture,
geography, education, disabilities, and other driving forces
of invisibility. If we are serious about redressing gender and
access inequities, we have to ask fundamental and diffi cult
questions about the nature of our societies and the value, or
sometimes lack of value, we ascribe to individuals, especially
women, in those societies.

7 One critically important element to address women’s health
and needs is attention to improving comprehensive quality
of care. Respectful maternal health care for all women is an
ethical imperative, not an option.

8 The maternal health community must invite, include, and
incorporate the voices of women themselves into writing
the future of maternal health. Too often, women’s voices
are silenced, ignored, or reported only second hand. Women
must be given the platform and power to shape their own
futures in the way they wish.

9 For the mother, her newborn child is a precious and
indissoluble part of her life and her future. Maternal health
outcomes cannot be fully addressed without attacking the
appalling global toll of preterm births, preventable
stillbirths, and newborn deaths.

10 A critical gap that threatens the future health of women and
mothers is the catastrophic failure to have reliable
information on maternal deaths and health outcomes within
and across countries. This gap in measurement, information,
and accountability must be a priority now and post-2015.

11 A tremendous opportunity lies in technology. Mobile and
electronic health technologies must ensure that women are
eff ectively and safely connected to the health system, from
education to emergencies, referral for routine antenatal care
to skilled birth attendance. Putting the right technologies in
the hands of women off ers one compelling opportunity to
make empowerment of those women a reality.

12 Finally, we must fulfi ll all of these actions sustainably, which
means universal access to services free at the point of
demand within a strong health system—to family planning,
to emergency obstetric care, to safe abortion, to properly
trained health individuals, especially midwives and those
providing midwifery services.
This online publication has been
corrected. The corrected version
first appeared at
on May 17, 2013

Copyright © 2013 Elsevier Ltd. All rights reserved.


Maternal health post-2015

  • a Life for Mothers Policy, New York, NY, USA
Refers To
Referred to by

The recommendations for maternal health1 are an excellent framework to build on to improve maternal health.

I believe that without strong political will and stewardship, these activities will be difficult to implement.

In addition, male partner involvement in securing women's access to health services cannot be underestimated.2 Their buy-in for acknowledging and accepting the rights of women will be critical to ensure healthy outcomes. I encourage the Maternal Health Task Force to include these additional points in the manifesto.

I declare that I have no conflicts of interest.


    • 2
    • G Barker, C Ricardo, M Nascimento
    • Engaging men and boys in changing gender-based inequity in health: evidence from programme interventionsWorld Health Organization, Geneva (2007)

Copyright © 2013 Elsevier Ltd. All rights reserved.

Maternal health post-2015 – Authors' reply

  • a Women and Health Initiative, Maternal Health Task Force, Harvard School of Public Health, Boston, MA 02115, USA
  • b Management and Development for Health, Dar es Salaam, Tanzania
  • c The Lancet, London, UK
Refers To
  • Jim Campbell, Luc de Bernis, Soo Downe, Helga Fogstad, Caroline Homer, Holly Powell Kennedy, Zoe Matthews, Mary Renfrew, Petra ten Hoope-Bender
  • Maternal health post-2015
  • The Lancet, Volume 381, Issue 9879, 18–24 May 2013, Pages 1717-1718
  • PDF (165 K)         

A note of appreciation to Jim Campbell and colleagues for recognising the error in the manifesto1 published as a result of the Global Maternal Health Conference held on Jan 15–17, 2013, in Arusha, Tanzania. The Maternal Health Task Force, Management and Development for Health, and The Lancet Editor sincerely regret the omission of midwives in the manifesto. The correction has now been made.

We want to take this opportunity to acknowledge the critical role midwives play in maternal health. Midwives are key to improving women's health and wellbeing through pregnancy, childbirth, and beyond.

Additionally, in response to Harry Strulovici's concerns, we heartily agree that working with men is key to changing the odds for women. With men's support of women's access and choices in reproductive, maternal, and neonatal health, as well as in the broader context of their lives, progress can be made and sustained that will benefit entire families.

As the global community defines the next set of development goals, the need to work with men is a given.

We declare that we have no conflicts of interest.


  • 1
  • A Langer, R Horton, G Chalamilla
  • A manifesto for maternal health post-2015

  • Lancet, 381 (2013), pp. 601–602

Copyright © 2013 Elsevier Ltd. All rights reserved.

Did you know?

Women in developing countries are 300 times more likely to die than those in the industrialized world.

Source:UNICEF, 2010

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