The current phase of the IAG's work builds on the Action Messages defined at the Sri Lanka Technical Consultation. Of the ten messages that emerged, the one that was clearly identified by participants as the most important was "Ensure Skilled Attendance at Delivery." Almost half of deliveries in developing countries still occur without a skilled attendant, and in some countries rates are still below 20 percent.
In 1987, when the global Safe Motherhood Initiative was launched, representatives from a range of international agencies and governments committed themselves to the goal of reducing maternal deaths. Since then, much has been learned about which interventions are most effective, and the focus has shifted from trying to predict or prevent obstetric complications to trying to manage them appropriately. Experts from around the world now acknowledge that almost all maternal deaths could be prevented with appropriate care. The most essential intervention, therefore, is to ensure that all women are cared for by a professional health worker (midwife, nurse, or doctor) with midwifery skills during the most dangerous period during and immediately after childbirth. Skilled attendants, when supported by a functioning referral system, can fill the following critical functions:
- Ensure that all deliveries are conducted hygienically and according to accepted medical practices, thereby preventing complications that are caused or exacerbated by poor care;
- Identify complications promptly and manage them appropriately either by treating or referring them to a higher level of care;
- Provide high-quality, culturally appropriate, and considerate care, ensuring necessary follow-up and linkages with other services, including antenatal and postpartum care, as well as family planning, postabortion care, and treatment of sexually transmitted infections.
In October 1999, the IAG launched a multi-step strategy to assess the importance and potential impact of skilled care during childbirth as a means of reducing maternal mortality. Key components of this strategy included:
- the preparation of a comprehensive paper reviewing the evidence on skilled care during childbirth. The report draws on published and unpublished literature, reports of country experiences, and interviews with technical specialists to assess the available evidence on the impact of skilled care during childbirth. The paper examines the historical and epidemiological evidence; defines the essential competencies of the skilled attendant; explores the "enabling environment" necessary for the skilled attendant to function effectively; delineates the cost and financing issues required for increasing the coverage and quality of skilled care at delivery interventions; and examines evaluation strategies to assess the impact of these interventions. The review paper is currently being finalized (expected completion date: early 2003).
- a Technical Consultation held in April 2000 at World Health Organization Headquarters in Geneva which gathered leading experts in the field of safe motherhood to assess the evidence on skilled care during childbirth, and to develop key strategies for implementing the intervention in a range of developing country settings. Participants included 60 key researchers and programme planners from developed and developing countries.
- a set of informational materials relating to the critical components of skilled care during childbirth. These materials include: a policy brief; an information booklet; and case studies on skilled care during childbirth
- an international conference "Saving Lives: Skilled Attendance at Childbirth" held in November 2000 in Tunisia. The aim of the conference was to facilitate in the development of national-level action plans on skilled care during childbirth in selected countries in sub-Saharan Africa and South Asia. In addition, a number of developing countries that have achieved reductions in maternal mortality and increases in the coverage of skilled attendants shared their experiences.