The Safe Motherhood Initiative has been the central theme of
international work on maternal care since 1987, with emphasis on
reduction of maternal mortality and on increasing safety in
birth for women no matter what their social, economic, or
cultural circumstances. When WHO took up this important work,
the hope was that maternal rates of death would be halved by
2000. Many strategies at national levels around the world relied
on the medical model of birth, with an emphasis on hospital-
based care for pregnant women. The doctor was seen as the main
provider of care. The technologies that are central to how the
medical model works, such as induction and acceleration of
birth, were accepted as important in securing maternal safety.
Doctors, midwives, epidemiologists, and other social scientists
have seen, however, that the medical model has had unfortunate
consequences. In several settings this model has led to the
official downgrading or exclusion of the skills of the
traditional midwife who, for most women in