Providing medicines and diagnostics – alone or in packages – to prevent maternal death does not always yield the predicted response. Giving A to B does not always lead to C. They have shown us once again that life is not as simple as we would like it to be.
Maternal health care must be just that, care. Remarkably useful drugs like misoprostol to prevent hemorrhage or antibiotics to treat infection have yielded great results, but they cannot be the whole story nor do they absolve us of our responsibilities to support the complex systems in which care must be given.
The approaches in the mentioned trials have historical precedent, and every country that has successfully reduced the death rate of its mothers has used these approaches. And they cannot be abandoned. Care for mothers and newborns is complex – delivered by skilled health workers, in equipped facilities, within a functioning system.
How to best deliver that care may need further study, but whether to deliver it is ethically unquestionable.—Jeffrey Smith is an obstetrician at Jhpiego and director of maternal health for USAID’s global Maternal and Child Survival Program.