Ž .International Journal of Gynecology & Obstetrics 74 2001 118

Averting maternal death and disability

Editor’s comment: Monitoring obstetricservices: putting the UN guidelines into

practice in Malawi

J.A. Fortney�

Family Health International, Research Triangle Park Branch, Durham, NC, USA

The Safe Motherhood Conference in Nairobiin 1987 set the target of halving maternal mortal-ity by the year 2000. Soon after this, it becameclear that monitoring progress towards this goalmight prove almost as difficult as actually achiev-ing it. Despite improvements in measurement andestimation techniques, it was realized that count-ing deaths was not an efficient route to follow.Attention turned to developing a proxy for mor-tality. Access to effective maternity services wasbelieved to be the process by which mortalitywould be reduced. Therefore, UN agencies, incollaboration with others, developed a set of

� �process indicators 1,2 . The indicators were ac-cepted by the three UN agencies responsible for

Žreproductive health UNICEF, WHO and.UNFPA , and became known as the ‘UN Guide-

lines.’Malawi is the first national program to adopt

the UN Guidelines on a large scale, and thispaper describes the process by which the decisionto adopt them was implemented. This paper isimportant because it bridges the divide between a

� Corresponding author. Tel.: �1-510-237-2020; fax: �1-510-215-8113.

Ž .E-mail address: jafortney1@aol.com J.A. Fortney .

recommendation and a practice. Although thechallenges that national programs will face inimplementing the UN Guidelines will vary indetail from one country to another, the chal-lenges that Malawi faced � and overcame � arelikely to be, in one form or another, typical ofmany countries with limited resources for health.

The Malawian experience will serve as a modelto be emulated. It was inclusive in nature andemphasized both top-down and bottom-up col-laboration in problem solving. The inclusivenessof the development process will undoubtedly con-tribute to the long-term acceptance of the system,and the quality of the data.

Evidence of Malawi’s progress towards improv-ing the accessibility and quality of maternity ser-vices will be described in the next edition of theAverting maternal death and disability section.

References

� �1 Maine D, Akalin M, Ward V, Kamara A. The designand evaluation of maternal mortality programs. Colum-bia University, New York: Center for Population andFamily Health, School of Public Health, 1997.

� �2 UNICEF�WHO�UNFPA. Guidelines for monitoringthe availability and use of obstetric services. New York:UNICEF, 1997.

0020-7292�01�$20.00 � 2001 International Federation of Gynecology and Obstetrics. All rights reserved.Ž .PII: S 0 0 2 0 - 7 2 9 2 0 1 0 0 4 3 0 - 1