Safe motherhood: the making of a global health initiative

Launched in 1987, the Safe Motherhood Initiative has brought together UN agencies, donors, NGOs and academics to galvanise a political, financial and public health response to women’s pregnancy-related death and ill health in low income countries. This thesis presents an historical ethnography of the ‘making’ of this policy community over the past twenty years, as one of many so-called global health initiatives that populate the global health field. Compared with its competitors, the Safe Motherhood Initiative is often depicted as weak and in need of urgent revival. Drawing on in-depth interviews with over seventy actors within the field, participant observation and document review, I explore how safe motherhood practitioners have come to understand the problems that are credited for the field’s stymied status, and how their ‘diagnoses’ and situational analyses have informed their subsequent practices. My findings demonstrate that the Initiative has continually had to reposition itself in response to broader ideological, institutional and epistemological struggles. An impulse for self-preservation within a competitive global health field favouring disease-specific approaches has been in tension with safe motherhood practitioners’ fundamental conviction that comprehensive, socially-based policy change is needed to reduce maternal mortality. In order to pursue their common policy objectives and to secure their survival as an expert group, safe motherhood practitioners have sought to enhance the credibility of their policy proposals, establish new institutions and funding mechanisms, elaborate advocacy campaigns and pursue more sophisticated research to demarcate their practices as scientific, rather than ideologically driven. However, the benefits of such ‘self-management’ practices remain to be established. In conclusion, I challenge the widespread, if implicit, assumption that the success of a single advocacy issue, as measured through the rise of a global health initiative and growing political commitment to the specific issue, will necessarily lead to health improvement.