Maternal death is an avoidable tragedy. It can be prevented if women have access to basic and emergency obstetric care during pregnancy, childbirth and the post-partum period. 

Empower women by creating awareness. Gender inequalities and discrimination limit women’s choices and contribute directly to their ill health and death. Even if the best infrastructure and facilities are available, they will be of no use unless women are aware and have access to them. The first step is to empower women through correct information; the second by addressing gender-related concerns. A better-informed woman is more likely to take precautions and is, therefore, in a better position to try and avoid pregnancy-related problems. Legal reform and community mobilisation is the next step. Together, these initiatives help women safeguard their reproductive health by enabling them to understand and articulate their health needs and seek services with confidence and without delay.

Realise that every pregnancy faces risks: Every pregnant woman — even if she is well nourished and well-educated — can develop sudden, life-threatening complications that require quality obstetric care. Attempts to predict these problems have been unsuccessful because most of them are unexpected. What makes matters worse is that the majority of women with poor pregnancy outcomes do not fall into any high-risk categories. Maternal health programmes must aim to ensure that all women have access to essential services.

Ensure adequate and appropriate post-natal and newborn care. The early postnatal period is a vulnerable time for both mothers and newborns. A large percentage of both maternal and new born deaths take place during the first day after delivery. Education for families and communities about how to care for newborns and how to recognize health problems among mothers and newborns that require immediate attention is essential to improving maternal and newborn health.

Interventions to prevent maternal deaths do work. Preventive interventions like providing access to essential and emergency obstetric services and newborn care to every mother and child can prevent the majority of maternal and child deaths. Sri Lanka, for example, reduced its maternal mortality ratio from 555 deaths per 100,000 live births in the 1950s to 240 in 1960s and 30 in 1994 thanks to a nationwide extension of the healthcare system and skilled birth attendants.

Enhance health and nutrition interventions. These cost as little as Rs 135 per woman in developing countries. Health and nutritional interventions effectively prevent most maternal deaths; half of all infant deaths and the excruciating disabilities that befall on millions of women.

Ensure access to healthcare facilities, including licensed blood banks. This is often, the only way to identify and treat complications that could potentially result in an emergency or death. Over half the rural women live in villages that have no health facilities. Four out of 10 women are 10 km or further away from the hospital. Life-saving essential/emergency obstetric care could cost approximately Rs. 10,350 per woman.

Ensure access to antenatal clinics (ANC). Studies in India indicate that 72 per cent of maternal deaths can be prevented through ANC. Since most obstetric emergencies are not predictable, ANC alone will, however, not prevent maternal deaths. A combination of ANC and emergency obstetric care is essential for reducing maternal mortality.

Ensure skilled attendance during childbirth. The single most effective way to reduce maternal death is to ensure that a skilled health professional -- one who is able to conduct a safe, normal delivery and manage complications -- is present during childbirth. In most countries where MMR has been reduced to below 100 deaths per 100,000 live births there has been a high level of skilled attendance at delivery. 

Create a positive social environment. It is important to educate families and communities on care for pregnant women, teach them to recognise danger signs during pregnancy, delivery and the post delivery period, ensure that they make arrangements for finances and transportation and identify health facilities with essential obstetric care in case of an emergency. These arrangements must be made well in advance. In most Indian households, husbands and mothers-in-law are essential decision-makers. Without their awareness and active participation in ensuring appropriate care for the pregnant woman, the best of health services will be ineffective.

Scale up evidence-based interventions. This involves providing support to strengthen health systems across the country so that they deliver more effective maternal health services while addressing wider social and economic barriers to maternal health. Alongside, we need to address the barriers to maternal health in the wider environment. This will include raising the profile of maternal health as a way to promote the status and rights of women.

Develop and apply new knowledge. It is important to ensure that emerging evidence becomes well known and is used to identify gaps in existing systems. While this can, to an extent, be resolved by fresh research or other forms of evidence-gathering; it may be more practical to find ways to quickly implement already existing knowledge and tried-and-tested interventions.