Maternal mortality continues to be one of the scourges in global health. The fact that women die as part of bringing life is an indictment against the overall status of women around the world, and underscores the failure to prioritize women, mothers, and children. Efforts to draw attention to the causes of maternal death and the solutions to maternal mortality abound, but they fail to get enough attention from the decisionmakers who establish health priorities and allocate resources that could actually make a difference.

Global advocacy efforts—such as those led by the White Ribbon Alliance (WRA)—have made progress in drawing attention to maternal mortality, as well as the need to improve maternal health services and outcomes. While improvements in these areas continue to take place, there is still much to achieve through advocacy to improve services and outcomes.  

Improved Maternal Health

A stark and damning fact: 800 women die each day around the world from preventable causes related to pregnancy and childbirth. But what makes those causes preventable?

When we look at the key causes of death, most are preventable. Excessive bleeding after birth can be prevented by widely available oxytocics. Many cases of infection after birth can be prevented by quality intrapartum and postpartum care and proper hygiene practices. High blood pressure during pregnancy can be controlled by quality antenatal care and the use of magnesium sulfate. And unsafe abortion procedures can be prevented by contraception to avoid unintended pregnancies.

The solutions are straightforward but putting them into practice is not. There are big challenges that need to be addressed to improve maternal health. Weak health systems pose one significant set of challenges. These systems often offer poor quality and experience of care, including disrespectful treatment of women during pregnancy and delivery which may discourage women from seeking care in the first place. An insufficient number of providers leaves women either entirely without care, or unable to obtain it in a timely way. Such systems often endure inadequate supply chains that result in insufficient quantities of essential medications and treatments to respond to maternity-related health needs. And suboptimal referral systems can prevent women from receiving appropriate and timely care for complications.

A second—and perhaps larger, and even more complicated—challenge is related to contextual and social issues. These issues include gender norms and inequalities that undermine the status of women and the social determinants—which are closely related—that limit women’s access to education, money, and autonomy.

As a result of both sorts of challenges, women around the world continue to experience greater risks of poor health outcomes. While efforts to improve health systems are underway in many parts of the world, contextual and social challenges are deeply rooted and more difficult to change.  

Long Shadows from the Setting Sun

Improving maternal health and reducing maternal mortality has moved to center stage through the efforts of many diverse actors. One organization that has acted on behalf of citizens and civil society has been the White Ribbon Alliance. Since its inception in 1999, WRA—through its global secretariat and its country-based alliances in 14 countries—has achieved landmarks in safe motherhood advocacy through directing advocacy to decisionmakers, working with media and champions, and educating and empowering the public.

WRA’s approach to center women and their communities in their advocacy movement has resulted in catalytic change in the prioritization of maternal health.  As the WRA global secretariat prepares to close its doors in 2024, it is important to reflect on what the organization has achieved. From the development of the safe motherhood field guide for grassroots advocacy in 2000, to the launch of the respectful maternity care charter in 2011, to the Midwives’ Voices, Midwives’ Realities global survey in 2016, to the What Women Want campaign in 2019 (reflecting the desires of 1.2 million women globally) WRA has worked tirelessly to improve maternal health and foster more accountability for follow-through on government commitments. The Alliance has been synonymous with civil society engagement on issues of maternal health and safe motherhood, working consistently to amplify women’s stories and bring about improvements in quality that will reduce maternal deaths and improve women’s health.

As the global secretariat of the WRA sunsets, its legacy and accomplishments continue to thrive in the now seasoned hands of local advocacy leaders. Country alliances will continue, regional efforts are emerging, and women’s voices will not be silenced. Through this commitment to women, safe motherhood has emerged as a global priority.

A New Dawn

In spite of this profound transition, the global movement on maternal health is strong and alive. And as the sun sets on the WRA global secretariat, its principles and goals rise again in each country where maternal health advocacy networks have formed.

The next chapter in safe motherhood global leadership will emerge and thrive because the number of people committed to the cause is increasing, their skills are stronger, and their voices are louder. And, of course, the cause itself is too important to not receive global attention.

The critical and long overdue trend toward localization puts countries and citizens at the center of decision-making, advocacy, and developing and implementing solutions. The growth of digital platforms for raising awareness, sharing best practices, and facilitating ongoing consultations can bring stakeholders together to advance the safe motherhood agenda.  However, we can’t expect these efforts to move forward without resources and support. Issues are localized and contextual, which means there aren’t one-size-fits-all solutions.

As nature abhors a vacuum, there is an opportunity for new leadership to emerge to fill the void. What it looks like or how it operates isn’t clear, but for an issue as important as maternal health, a strong leading voice for civil society will no doubt emerge and take on the complex but surmountable challenges ahead.