Maternity Waiting Homes as Part of an Integrated Program for Maternal and Neonatal Health Improvements: Women's Lives Are Worth Saving

Every woman has the right to a healthy pregnancy and safe birth.1 Yet global maternal health has been neglected for many years. Still, more than 800 women are dying daily from pregnancy-related causes.2 By comparison, Liberia’s and Zambia’s maternal mortality ratio in 2013 was similar to that of theUnited States in 1918 and 1939, respectively.2,3 Maternal mortality started to decrease in Europe after the 1850s when handwashing was introduced.3 Most progress was made after World War II following the introduction of penicillin.4 The United States saw a sharp decline in maternal mortality in the mid-1930s.3 A contributor was the Title V Social Security Act, which is national public health legislation passed in 1935 aimed at promoting and improving the health and welfare services for mothers and children.5 Maternal health did not gain visible global recognition until the early 1990s, after years of single focus on population control.6 As men are not the ones dying, nor many women in high-income countries, and because maternal mortality is not a contagious condition, getting it on the political agenda was challenging.7 Once maternal mortality was recognized as important to address, efforts to decrease maternal deaths resulted in considerable success. Between 1990 and 2015, maternal mortality declined worldwide by 44%. Nevertheless, 303,000 women are still estimated to have died in 2015; 99% of thesematernal deaths occurred in lowandmiddle-income countries.8 The disparities in maternal mortality highlight the gap between rich and poor. They also show that women’s human rights have been ignored. The famous words of Professor Mahmoud, founder of the Safe Motherhood Movement, still hold true: “Women are not dying because of diseases we cannot treat. They are dying because societies have yet to make the decision that their lives are worth saving.”7(p10) Further declines in maternal mortality can be accelerated when given priority. If this tragedy manages to receive the same spotlight as the Ebola epidemic, which killed approximately 11,500 people, preventable maternal deaths could end.9 The required interventions are known and straightforward: pregnant women need access to antenatal care, skilled care at childbirth, and care and support in the early postpartum period.7 However, an isolated approach will not prove successful. A multisectorial approach is required, as formulated by the United Nations in the new Sustainable Development Goals.10