Editor's Comment

This AMDD feature starts with a long needed review of the quality of evidence for the interventions commonly used to reduce maternal mortality [1]. As you might expect, the verdict is mixed. There is good evidence for efficacy of most clinical interventions which lend themselves to robust research methods including randomized controlled trials. But robust research methods are far more difficult to apply to programmatic interventions, although the authors make useful suggestions. Because of challenges facing programmatic evaluation, the conventional wisdom is sometimes not wisdom at all. Anyone planning one of the myriad programs to reduce maternal mortality should read this article carefully.

The remaining two papers come from what must surely be two of the more difficult situations in which to provide quality obstetric care. The international Rescue Committee has provided maternity care in camps for Afghan refugees in Pakistan for 20 years and gained the trust and participation of their clients as measured by the uptake of services [2]. When the article from Yemen was submitted, it described only the results of a needs assessment—a sad story indeed, with few obstetric services being provided [3]. But every needs assessment should be followed by a plan to address the deficiencies identified; otherwise, why do the assessment? One such assessment in Uganda, published earlier in this section, resulted in sector-wide discussions of high maternal mortality, an increased priority assigned to the issue, and a nationwide plan [4]. This is what is supposed to happen! The authors from Yemen were prevailed upon to provide their recommendations and tell us what progress has been made since the assessment results were presented to the government and outside donors.