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Of all the Millennium Development Goals, progress on the maternal health goal may be the most disappointing. The target is to reduce by three-quarters between 1990 and 2015 the maternal mortality ratio - the number of deaths per 100,000 live births. A study published last week in The Lancet estimates 535,900 maternal deaths in 2005, only a slight decline since the launch twenty years ago of a Global Safe Motherhood Initiative. The study reports no evidence of significant reduction over the past fifteen years in Sub-Saharan Africa, where maternal death rates are highest in the world.

Last week I attended the Women Deliver conference in London, England, organized in conjunction with the twentieth anniversary of the initiative. The conference's primary aim was to renew political commitment to address this issue. It was an impressive event in many ways. More than fifteen hundred persons from around the world attended, including the heads of several UN agencies, dozens of ministers from developing countries, legislators from rich and poor countries alike, and numerous civil society representatives. There were many interesting panels - too many for any one person to attend - on subjects as diverse as measuring maternal mortality, obstetric fistula, and advocacy strategies for maternal health.

This conference is one of several signs of emerging political commitment for the issue. Another sign is the Norwegian Government's pledge last month of one billion dollars over the next ten years for the cause of maternal and child survival. Its prime minister is spearheading a global campaign to achieve MDG 4 (on child survival) and MDG 5, joining the British and Dutch Governments as central participants. Another hopeful development is increasing cohesion among the global maternal survival policy community concerning technical strategies to address the crisis. The community has been divided for more than a decade on solutions, a situation that has hampered political progress.

This momentum notwithstanding, at least four political challenges remain. These were delineated in a CGD working paper subsequently published in The Lancet last week. After attending the conference, I still believe these remain key political concerns:

First is building on the growing cohesion in the policy community so that it can speak with authority and unity to international and national political leaders. Second is the creation of enduring guiding institutions to sustain the initiative...Third is finding external frames that resonate and will convince political leaders that they should be concerned about the issue...Fourth is building stronger links with national initiatives and mobilizing country-level civil society organizations. The weakness of such links and minimal social mobilization for the cause in countries with high maternal mortality has hampered the acquisition of global political support.

One danger is the false presumption that simply because enthusiasm now exists for addressing maternal survival, political commitment will persist effortlessly. Global health issues fall off agendas as quickly as they appear there. Unless strong institutions are built to guide maternal (and newborn and child) survival efforts, priority for the issue could diminish. It is incumbent in particular on the heads of UN agencies - especially the WHO, UNFPA and UNICEF - to exhibit leadership on the issue. Many mid-level technical officials within these agencies have been strong champions for the issue of maternal survival for many years. Their bosses, however, historically have given the issue disappointing levels of political support, if indicated by resources and energy devoted to the issue.

Let us hope that in the next several years the global safe motherhood policy community will devote its considerable expertise and passion to surmounting these persistent political challenges, so that twenty years from now we will be able to report significant progress in addressing this global tragedy.

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CGD blog posts reflect the views of the authors, drawing on prior research and experience in their areas of expertise. CGD is a nonpartisan, independent organization and does not take institutional positions.