摘要：Maternal and perinatal mortality reduction has remained a priority on the international health agenda for nearly 2 decades. During this time, strategies for achieving these goals have shifted in emphasis from prevention of pregnancies to provision of care. Robust evidence is limited, particularly regarding what works best in delivering care in specific health system settings and at the population level. We describe the limited evidence base using a framework that highlights the consequences of the major gaps in measurement, evidence, and action, and we discuss existing opportunities for bridging these gaps at the policy level. Capitalizing on current global policy interests and generating demand-driven evidence is a priority for enabling documentation of progress toward reaching the United Nations Millennium Development Goals for 2015. SINCE THE LAUNCH OF THE international Safe Motherhood Initiative in 1987, 1 widely endorsed initiatives such as the 1994 International Conference for Population and Development and the 1997 Safe Motherhood Technical Consultation 2 have emphasized the need for an increased focus on reductions in maternal mortality. Although the priority health outcomes have essentially remained the same—less maternal and perinatal mortality—the intervention strategies have shifted in emphasis over time, from prevention of pregnancies to traditional birth attendant training on safe delivery care or provision of emergency obstetric care in hospitals. 3 , 4 The reasons for such shifts are varied; they include the changing agendas of international organizations, a degree of disillusionment regarding progress, and intensified competition for scarce health resources. As of yet, what has not been available to inform these shifts is what works best for a particular health system at the population level. This lack of knowledge is a reflection of 3 significant, interrelated gaps—in measurement, evidence, and action. Twenty years would seem like a sufficient time for these gaps to be narrowed and health burdens to be reduced. The reality is that the gaps still limit both our expectation and demonstration of progress. The United Nations Millennium Development Goals (MDGs), which aim to reduce global poverty and, in particular, seek a three quarter reduction in maternal mortality by 2015, have now brought a new time-line into focus. 2 What, then, are the prospects for narrowing the gaps during the next decade?
