nal deaths. Many countries have legalized the access to safe abortion, and such service should be recommended where it is politically acceptable.

The policy makers and donor agencies need to consider these issues, ask for the evidence that the recommended solution is acceptable to people, feasible to implement, effective in reducing maternal and neonatal deaths, and is more cost-effective than other interventions. Recommendations based on what appears “sensible” but, not tested in large field trials may fail to produce the desired results, leading to one more round of disillusionment. Didn’t it happen many times in the past?

Obviously, we can not generalize and push for one universal health care solution. The recommended professional model of maternal-neonatal care is so resource-intensive that it may not be possible to provide that sort of care to 6 billion people. It also may not be the most cost-effective or acceptable option. Hence, I recommend that:

  1. No single model of maternal-neonatal care is appropriate for all countries.

  2. For some regions and countries the Model I, that is, home delivery by nonprofessionals backed by access to good-quality emergency obstetric care, may be one of the options at present, at least for some period.

  3. In the spirit of the Alma-Ata global declaration, and in respect to the social and cultural norms in developing countries, the efforts should be to provide maternal and neonatal care as close to community as possible, preferably at home.

  4. The professional/institutional model can be recommended only after its cost-effectiveness, feasibility, and consumer acceptance in developing countries is proved by controlled field trials and countries have resources to implement that model.

  5. Access to safe abortion should be available to all women who want it.


de Silva, DGH. 1999. Perinatal care in Sri Lanka: secrets of success in low income country. Seminars in Neonatology 4(3):201–207.

World Bank. 1993. World Development Report: Investing in Health. Oxford University Press. P. 117.

The National Academies | 500 Fifth St. N.W. | Washington, D.C. 20001
Copyright © National Academy of Sciences. All rights reserved.
Terms of Use and Privacy Statement