The neglected tragedy of persistent high maternal mortality in the low-income countries is described. One of the millennium development goals states that the current number of maternal deaths of around 500,000 per year should be reduced by three quarters by 2015. Since the major causes and avenues for prevention are known, this may seem an achievable goal. It is concluded, however, that unless all stakeholders globally and within individual countries will demonstrate a real commitment to translate policy statements into actions, it is unlikely that the goal will be reached. A substantial increase in the resources for reproductive health care services is needed, and the human resource crises in the health care systems must be urgently addressed. Epidemiologists have an important role to play by designing randomized controlled trials for estimating the effect of different health care systems interventions aimed at reducing maternal mortality and other major health problems in low resource settings. The public health importance of such trials may be greater than the potential benefit of randomized trials for investigating effects of new vaccines and drugs. Within the field of perinatal epidemiology the disparity in public health importance of research conducted in the rich versus the poor world is glaring. Time is overdue for perinatal epidemiologists to turn their attention to the areas of the world where the maternal and perinatal health problems are overwhelming.
Maternal deaths in developing countries: A preventable tragedy