Four United Nations agencies committed to promoting women's health have joined forces to fight maternal mortality, announcing a joint Statement on priority actions aimed at reducing the number of women who will die from pregnancy and childbirth.

Each year close to 600,000 women – more than one woman every minute – die from complications related to pregnancy and childbirth. In addition, these complications contribute to more than three million infant deaths within their first week of life and another three million stillbirths.

The joint Statement was presented today by the World Health Organization (WHO), the United Nations Population Fund (UNFPA), the United Nations Children's Fund (UNICEF), and The World Bank.

The Statement details three key areas for action:

• Safe motherhood can be advanced through respecting existing human rights, through empowering women to make choices in their reproductive lives with the support of their families and communities.
• The access to and quality of maternal health services need to be improved. All deliveries should be overseen by skilled attendants and essential care should be available when obstetric complications arise.
• Women need to be able to choose if and when to become pregnant, through ensured access to voluntary family planning information and services.

The joint Statement builds on 12 years of experience in implementing safe motherhood activities and research on the effectiveness of measures to reduce maternal deaths. It presents the causes of maternal mortality and the priority actions governments and societies need to take to reduce mother and infant deaths over the next decade.

"This Statement reflects the consensus between four key international bodies on the seriousness and extent of maternal mortality, as well as the best ways to reduce it," said Dr Gro Harlem Brundtland, Director-General of WHO. "It will result in greater synergy in our work at the country level, and in the end save more lives."

Maternal mortality represents one of the starkest and most unacceptable gaps between developed and developing countries, with 98% of all maternal deaths occurring in developing countries. In developed countries, there are approximately 27 maternal deaths per 100,000 live births each year. In developing countries the average is 18 times higher, at 480 deaths per 100,000 live births.

In some developing countries, one woman in ten dies from a pregnancy-related cause over the course of her child-bearing years. In industrialized countries, the chances average around one in 4000.

Reflecting on the tenth anniversary of the Safe Motherhood Initiative, World Bank President James Wolfensohn asked, "How it is possible that in a world about to enter a new millennium, in the midst of unprecedented economic growth and technological breakthroughs, we have managed to allow alarming numbers of young women to continue dying during pregnancy and childbirth?" He indicated that he believed a coalition of international and national actors together with governments, the private sector and civil society - each playing to their respective strengths - can rid the world of this scourge of high maternal mortality. He said that our goal should be nothing less than to make sure that when we meet in 10 years time, we can change our slogan from "Safe Motherhood" to "Motherhood Saved".

The joint Statement notes that the low social status of women in developing countries is an important factor underlying maternal mortality. Low social status limits women's access to economic resources and basic education, impeding their ability to make informed decisions on childbearing, health and nutrition. Poor nutrition before and during pregnancy contributes to poor health, obstetric problems, and poor pregnancy outcomes for both women and their new-borns.

Some 80% of all maternal deaths world-wide are the direct result of complications arising during pregnancy, delivery, or the first six weeks after birth. The five main causes of maternal mortality are haemorrhage – responsible for about a quarter of all maternal deaths –infections, high blood pressure, obstructed labour and unsafe abortion. The last condition, unsafe abortion, accounts for more than a third of maternal deaths in some parts of the world.

The remaining 20% of maternal deaths are the result of pre-existing health conditions that are exacerbated by pregnancy or its management. One of the most significant of these indirect causes of death is anaemia. Other important indirect causes of death include malaria, hepatitis, heart disease and, increasingly in some settings, HIV/AIDS.

The joint Statement holds that a ready supply of health providers with essential midwifery skills, backed up by referral services for complications, is critical in preventing maternal deaths.

At the present time, only 53% of deliveries in developing countries are attended by a health professional, and only 40% take place in a hospital or health centre. Some 15% of women who become pregnant experience life-threatening complications that require emergency care. Some 40% of pregnant women need professional care for a pregnancy-related complication.

As many as half of all pregnancies are unplanned and a quarter are unwanted. Prevention of unwanted pregnancies is one of the key strategies for reducing maternal mortality. Thus, in addition to midwifery and referral services, there is also a need to provide client-centred family planning services with safe and effective contraceptive methods and counselling.

"Motherhood cannot be safe until women are allowed to be more than mothers and properly valued and respected by their families and by society," said Dr Nafis Sadik, Executive Director of UNFPA. "Discrimination against women and girls in terms of nutrition, health care, education, and employment opportunities must be eliminated, and access to reproductive health, including family planning information and services, must be guaranteed."

A maternal death has implications for the family, the community and the society in general. However, its impact is most immediate and especially severe on young children. Poor maternal health care is also the cause of nearly half of all infant deaths. During the first week of life, 3.2 million neonatal deaths occur each year, largely a consequence of inadequate or inappropriate care during pregnancy, delivery, or the first critical hours after birth.

"One of the most significant inroads we can make in the fight to further reduce infant mortality is to address the preventable deaths that occur during the first days of life. The most effective way to prevent these deaths is by ensuring safe pregnancy for all," said Carol Bellamy, Executive Director of UNICEF.

Dr Brundtland, commenting on the role of society in reducing maternal mortality, said: "We need societies to firmly commit themselves to making pregnancy and birth safe for all women. All of us – but especially social and political leaders in developing countries – need to foster the perception that pregnancy and childbirth can and should be made safer. Communities must pay special attention to the nutritional and educational needs of girls and women, enabling women to make decisions for themselves about the number and timing of their children and use of maternal health care services."

This joint Statement represents a consensus between WHO, UNFPA, UNICEF and the World Bank and is an example of the common purpose and complementarity of programmes supported by the four agencies and designed to reduce and prevent maternal and neonatal mortality and morbidity. However, this consensus will enable each agency to define their comparative advantages and facilitate complementary efforts to reduce maternal mortality.

For further information from WHO, journalists can contact Mr Jitendra Khanna, Department of Reproductive Health and Research, WHO, Geneva, telephone (+41 22) 791 3345. fax (+41 22) 791 4171. Email: khannaj@who.ch or Gregory Hartl, Office of Press and Public Relations, WHO, Geneva, telephone: (+41 22) 791 4458, fax: (+41 22) 791 4858. E-mail: hartlg@who.ch. All WHO Press Releases, Fact Sheets and Features can be obtained on Internet on the WHO home page http://www.who.ch