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Abstract
The concept of knowing what works in terms of reducing maternal mortality is complicated
by a huge diversity of country contexts and of determinants of maternal health. Here
we aim to show that, despite this complexity, only a few strategic choices need to
be made to reduce maternal mortality. We begin by presenting the logic that informs
our strategic choices. This logic suggests that implementation of an effective intrapartum-care
strategy is an overwhelming priority. We also discuss the alternative configurations
of such a strategy and, using the best available evidence, prioritise one strategy
based on delivery in primary-level institutions (health centres), backed up by access
to referral-level facilities. We then go on to discuss strategies that complement
intrapartum care. We conclude by discussing the inexplicable hesitation in decision-making
after nearly 20 years of safe motherhood programming: if the fifth Millennium Development
Goal is to be achieved, then what needs to be prioritised is obvious. Further delays
in getting on with what works begs questions about the commitment of decision-makers
to this goal.