Editorial [Women Deliver]

“Since the human race began, women have delivered for society. It is time now for the world to deliver for women” [1]. In October 2007 the Conference Women Deliver brought together almost 2,000 participants from 109 countries to look for joint actions to improve global maternal outcome. Many important initiatives were joined together and also relevant publications emerged previously and after the Conference. In a special issue of The Lancet many articles and editorials gave important information about the current situation and the relevance of the problem. Ann Starrs mentioned that “20 years ago the global health community came together to highlight the most striking inequity in public health: half a million women, 99% of them in the developing world, were dying every year in pregnancy and childbirth [1]. High fertility, inadequate and inaccessible health services, and women's low status meant that women in the poorest regions of the world were 500 times more likely to die from pregnancy-related complications (one in 20 risk) than women in northern Europe (one in 10 000 risk) [2]. The global Safe Motherhood Initiative was launched to generate political will, identify effective interventions, and mobilize resources that would rectify this horrifying injustice” [1]. Today, 20 years into the initiative, maternal mortality has declined in some regions, especially in middle-income countries in Latin America and northern Africa [2]. However, today each year still 536 000 women die from complications of pregnancy and childbirth—99% in the developing world—and another 10-20 million women have severe health problems, including obstetric fistula. Of all health indicators, maternal mortality reveals the greatest gap between rich and poor women, both between and within countries [1,2]. In 2005, women in developed countries had a one in 7300 lifetime risk of dying from pregnancy-related causes, compared with a one in 75 risk in developing countries. In Africa, the lifetime risk is one in 26. Little change has been seen in the hardest hit areas and the gap is widening [1,2]. At the midpoint in the timeline to achieve the Millennium Development Goals (MDG), the absence of progress in reduction of maternal mortality and morbidity is unacceptable. No woman should die giving life [1]. The Conference Women Deliver was willing to create the energy, the commitment, and the knowledge to fundamentally shift how women's health and women's contributions are viewed in the global agenda [3]. Women deliver babies, certainly, and that was a central theme of the conference. But women also deliver in many other ways: food, goods, and income for their families; education, affection, and care for their children; and energy, creativity, and inspiration for their communities [3]. Participants of the Ministers' Forum of this conference made the following statement: We, the participants in the Ministers' Forum of the Women Deliver Conference, once again declare our commitment to invest in women and children and to achieve Millennium Development Goals (MDGs) 4 and 5. All the MDGs will best be achieved within a human rights framework, which incorporates sexual and reproductive health and rights, and by recognizing that health and development are inextricably linked. Without substantial reduction in maternal mortality, there is little hope of achieving the overarching MDG goal of reducing poverty by half. Investing in women pays off in terms of social and economic benefits to the family, the community and society at large. Gender equality and women's empowerment are central. We recognize that poverty, income inequalities, underdevelopment, gender disparities, discrimination, poor education, conflict, gender-based violence, food and nutrition insecurity all contribute to the poor health of women and children. Therefore, interventions to address maternal and newborn health need to be multisectoral to maximize their impact. Efforts need to include education of women and girls, economic empowerment, including access to microcredit and micro-finance and legal reforms to deepen a woman's power of choice over her reproductive health. Special attention should be paid to the poorest of the poor, particularly women in rural areas, as well as other vulnerable populations such as immigrants, displaced persons and adolescents, and the impact of globalization on the health of these groups [3].