Why do some global health initiatives receive priority from international and national political leaders while others receive minimal attention? We propose a framework for analyzing this question consisting of four categories of factors: the strength of the actors involved in the initiative, the power of the ideas they use to frame the issue, the nature of the political contexts in which they operate, and characteristics of the issue itself.We apply this framework to the case of a global initiative to reduce (...) maternal mortality, launched in 1987. Using a process-tracing methodology commonly employed in qualitative research, we conducted archival research and interviewed actors involved in the initiative. We find that despite two decades of effort the initiative remains in an early phase of development, hampered by difficulties in all these categories. However, the initiative's twentieth anniversary year, 2007, presents opportunities to build political momentum. To generate political priority advocates will need to address several challenges, including the creation of effective institutions to guide the initiative and the development of a public positioning of the issue that convinces political leaders to act.We draw on the framework and case study to suggest areas for future research on the determinants of political priority for global health initiatives, a subject that has attracted much speculation but little scholarship. (shrink)

This paper presents an overview of the dimensions of unsafe motherhood, contrasting data from economically developed countries with some from developing countries. It addresses many common factors that shape unsafe motherhood, identifying medical, health system and societal causes, including women's powerlessness over their reproductive lives in particular as a feature of their dependent status in general. Drawing on perceptions of Jonathan Mann, it focuses on public health dimensions of maternity risks, and equates the role of bioethics in conscientious medical care (...) to that of human rights in public health care. The microethics of medical care translate into the macroethics of public health, but the transition compels some compromise of personal autonomy, a key feature of Western bioethics, in favour of societal analysis. Religiously‐based morality is seen to have shaped laws that contribute to unsafe motherhood. Now reformed in former colonizing countries of Europe, many such laws remain in effect in countries that emerged from colonial domination. UN conferences have defined the concept of ‘reproductive health’ as one that supports women's reproductive self‐determination, but restrictive abortion laws and practices epitomize the unjust constraints to which many women remain subject, resulting in their unsafe motherhood. Pregnant women can be legally compelled to give the resources of their bodies to the support of others, while fathers are not legally compellable to provide, for instance, bone‐marrow or blood donations for their children's survival. Women's unjust legal, political, economic and social powerlessness explains much unsafe motherhood and maternal mortality and morbidity. (shrink)

This paper presents an overview of the dimensions of unsafe motherhood, contrasting data from economically developed countries with some from developing countries. It addresses many common factors that shape unsafe motherhood, identifying medical, health system and societal causes, including women's powerlessness over their reproductive lives in particular as a feature of their dependent status in general. Drawing on perceptions of Jonathan Mann, it focuses on public health dimensions of maternity risks, and equates the role of bioethics in conscientious medical care (...) to that of human rights in public health care. The microethics of medical care translate into the macroethics of public health, but the transition compels some compromise of personal autonomy, a key feature of Western bioethics, in favour of societal analysis. Religiously‐based morality is seen to have shaped laws that contribute to unsafe motherhood. Now reformed in former colonizing countries of Europe, many such laws remain in effect in countries that emerged from colonial domination. UN conferences have defined the concept of ‘reproductive health’ as one that supports women's reproductive self‐determination, but restrictive abortion laws and practices epitomize the unjust constraints to which many women remain subject, resulting in their unsafe motherhood. Pregnant women can be legally compelled to give the resources of their bodies to the support of others, while fathers are not legally compellable to provide, for instance, bone‐marrow or blood donations for their children's survival. Women's unjust legal, political, economic and social powerlessness explains much unsafe motherhood and maternal mortality and morbidity. (shrink)

In the last several years, Brazil has gained international attention as an emerging BRIC economy, was awarded the 2014 World Cup and 2016 Olympics, and elected its first female president. This has led many to declare that Brazil is emerging as a potential world power for the 21st century. In addition to improving its international stature, in the last several decades Brazil has also significantly improved the availability and quality of health care within the country. Despite these gains, however, Brazil (...) still suffers from poor maternal health. In fact, Brazil's Maternal Mortality Ratio is five to ten times higher than the rates in high-income countries. Last year, these conditions lead the United Nations Committee on the Elimination of Discrimination against Women to issue a decision declaring that Brazil was violating its international obligations to provide pregnant women with adequate health care, and to call for a reduction in preventable maternal deaths. It is against this backdrop that Brazil enacted a new law last December, Provisional Measure 557, to require pregnant women to register with the state. (shrink)

In the last several years, Brazil has gained international attention as an emerging BRIC economy, was awarded the 2014 World Cup and 2016 Olympics, and elected its first female president. This has led many to declare that Brazil is emerging as a potential world power for the 21st century. In addition to improving its international stature, in the last several decades Brazil has also significantly improved the availability and quality of health care within the country. Despite these gains, however, Brazil (...) still suffers from poor maternal health. In fact, Brazil's Maternal Mortality Ratio is five to ten times higher than the rates in high-income countries. Last year, these conditions lead the United Nations Committee on the Elimination of Discrimination against Women to issue a decision declaring that Brazil was violating its international obligations to provide pregnant women with adequate health care, and to call for a reduction in preventable maternal deaths. It is against this backdrop that Brazil enacted a new law last December, Provisional Measure 557, to require pregnant women to register with the state. (shrink)