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The authors assert that the fifth Millennium Development Goal to reduce maternal mortality by two-thirds by 2015 will best be achieved by adopting a core strategy of intrapartum care based in health centres. A key message is that the professionalisation of maternity care must be prioritised. This demands strong political leadership to train, develop, and retain skilled health workers, and to maintain a strong focus on equity of access to facility-based obstetric care. Four papers in this series examine the basic epidemiology of maternal death (over 500 000 women die from pregnancy-related complications each year) and strategies for reducing maternal mortality.

Key points:

• The first paper discusses the general state of maternal mortality in the world today. Maternal deaths are clustered around labour, delivery, and the immediate postpartum period, with obstetric haemorrhage being the main medical cause of death. Targeting of interventions to the most vulnerable—rural populations and poor people—is essential if substantial progress is to be achieved by 2015.
• The next paper concludes that despite the complexity of maternal mortality, only a few strategic choices need to be made to reduce maternal mortality. The main priority should be for women to have the choice to deliver in health centres, in other words via a health centre intrapartum-care strategy. Ensuring appropriate provision of emergency obstetric care is an essential feature of all intrapartum-care strategies, but timely access is crucial and thus physical, cultural, and financial barriers must be addressed.
• The third paper discusses the importance of scaling-up professional skilled care since one of the main obstacles to the expansion of care is the dire scarcity of skilled providers and health-system infrastructure. To increase the supply of professional skilled birthing care, strategic decisions must be made in three areas: training, deployment, and retention of health workers.
• Households pay too great a share of the costs of maternal health services and the fourth paper discusses how to mobilise financial resources for maternal health. Available evidence creates a strong case for removal of user fees and provision of universal coverage for pregnant women, particularly for delivery care.
• A final paper issues a call to action for maternal survival. Donors need to increase financial contributions for maternal health in low-income countries to help fill the resource gap.

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