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While broader public awareness of maternal mortality around the globe been raised through advocacy organizations such as the White Ribbon Alliance, maternal mortality remains largely an underreported story. Still, it is a core indicator of the general well-being of a nation. One organization taking a multi-faceted approach is Save the Mothers, a master's program in public health leadership. Started in Uganda in 2005, Save the Mothers follows a multisectoral model that is similar to the model that was successful in Uganda to reduce its rate of human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS): develop indigenous leaders from within. Politicians, journalists, faith leaders, and community activists are among those who are now being trained to lead change.

Maternal Mortality Worldwide

The task that Save the Mothers has undertaken is daunting. Despite modern technology, communications, and medical advances, mothers continue to die at alarming rates around the world. Every year at least 525,000 mothers die from largely preventable complications of pregnancy and childbirth. That equals 1,450 mothers a day or one every minute. In addition, millions of children are stillborn or die within their first week due to inadequate care their mothers received during pregnancy and delivery.

This is because while 15 percent of all mothers—regardless of geography—will experience a life-threatening complication in pregnancy, many women live in regions where they can't access proper treatment. Of all maternal deaths, 99 percent are in the developing world, and most are due to lack of skilled birth attendants and emergency care at delivery. These factors are often fueled by cultural myths and patriarchal attitudes.

Many of the maternal deaths are of young women, often teenagers, with underdeveloped bodies that are not yet mature enough for childbirth. Other deaths result when women give birth to a large number of children, often eight or more; analogies have been drawn to crossing a dangerous bridge repeatedly until it gives way. One in four of maternal fatalities are from mothers bleeding to death. Thirteen countries share 70 percent of all maternal deaths. In Africa, they are Uganda, Tanzania, Kenya, Democratic Republic of the Congo, Ethiopia, Nigeria, and Angola. Outside of Africa, they include Pakistan, Indonesia, China, India, Bangladesh, and Afghanistan. From 1980 to 2000, about 12 million more women died in childbirth than of HIV/AIDS.

There are three major delays that lead to mothers dying from pregnancy complications. The first is the delay in seeking care. This can be the result of women needing (and sometimes being denied) permission from their husbands or male relatives to go to a health facility. The second delay is transport to the facility, which can be hours or even days away from a mother's home. Roads can be impassable due to heavy rains or there may be no vehicle. Finally, at the facility, medical treatment may not be available or affordable. Most women in these high-risk areas don't have the equivalent of a dollar in their pockets, even to get something as basic as blood.

Save the Mothers Internal Approach

Operating on the premise that multidisciplinary leaders can have an impact in their particular sphere of influence—and then network with each other to generate broader societal change—Save the Mothers enrolled or graduated 103 students in its first four years. In 2008, about 140 professionals applied for the 30 seats. In 2009, expansion began into east Africa, with strategic plans to launch a similar program in India.

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