Apart from a few countries, the average maternal mortality rate for SSA remained practically unchanged between 1990 and 2000, with a rate of reduction of 4 to 16 per cent. In 2000, 917 mothers died in Africa for every 100,000 live births, virtually the same as in 1990. In some cases progress was also reversed and, for 18 countries, the maternal mortality rate was over 1,000 per 100,000 live births.

The situation is more encouraging in North Africa, where the maternal mortality rate is less than 150 per 100,000 births during the same time period. Most births in that subregion are attended by professional health workers, which impacts positively on reduced maternal and infant mortality. In Egypt, in 2002, skilled personnel attended 61 per cent of all births, leading to a 50 per cent decline in all maternal deaths in only eight years. In stark contrast, in SSA, only about 50 per cent of all births are attended by health workers, though exceptions are found in Cape Verde, Mauritius and Botswana.

Once considered a public health issue only, the issue of maternal mortality is increasingly connected to the status o women fin society. Women’s lack of access to decision-making, employment, finance and education are at the root of this dilemma. Poor nutrition in girls, early sexual activity and teenage pregnancy all have consequences for these young mothers. Educated and empowered women are more likely to marry at an older age and to seek neonatal and postnatal care, all of which are crucial in reducing child and maternal mortality.

Many women cannot afford health care. On a continent where most still live in rural areas and have limited access to health clinics or hospitals, community partnerships can be the most immediate means to better health. For example, the important social status of traditional birthing assistants, or midwives, in the community can be harnessed. Training of these professionals by the public health authority can provide rural women in Africa with safe pregnancies and deliveries, as well as access to family planning information and services.