Maternal health: time for a radical reappraisal.

It is tempting to see progress towards better maternal health in linear terms. If only, the argument goes, one could scale up evidence-based interventions and policies in all countries for all women, maternal mortality would fall and maternal health would advance. The past year has shown the desperate fallacy in this argument. The mortal dangers and uncertainties faced by millions of women and young mothers who fi nd themselves in the midst of confl ict-induced displacement across large parts of the Middle East, Africa, and Europe prove that such idealised notions of progress are little more than a comforting myth. Added to this unprecedented predicament is the epidemic of Zika virus infection across Latin America, and now the southern parts of the USA, which has spread understandable fear among millions of women of childbearing age. The result—the appearance of a new teratogenic condition, congenital Zika syndrome—has introduced a tragic and severe burden on the lives of countless new mothers and families. The lesson from these crises is that progress in maternal health is fragile and non-linear. The gains that have been made—and genuine gains have been made during the era of the Millennium Development Goals— must never be taken for granted. Constant vigilance is essential. Now is therefore the moment for a radical reappraisal of practices, programmes, and policies to achieve sustainable maternal health and wellbeing worldwide. In an attempt to understand and take stock of eff orts to improve maternal health, and add momentum for maternal health in the era of the Sustainable Development Goals (SDGs), The Lancet now publishes a Series of six papers that dissect the epidemiology of maternal health, the landscape of maternal health care and services, and the future challenges and strategies to improve maternal wellbeing. We also publish Comments from Mary Kinney and colleagues and Lynn Freedman, who examine how maternal health fi ts into the broader picture for the future of women and children. This Series must be seen in the context of a much larger health agenda for women and prospective mothers. Access to modern contraception is a critical foundation for maternal and child health. The London Summit on Family Planning, held in 2012, committed countries to provide access to contraception for an additional 120 million women by 2020. That goal required 15 million women each year to gain such access. According to data from FP2020, a global initiative to deliver the promises of the London Summit, only 8 million additional women each year are accessing modern contraceptive methods. This failure must be owned by the international health community. The same story of failure is also true for maternal and child nutrition. Undernutrition during pregnancy is a major determinant of both stunting of linear growth and subsequent obesity and non-communicable disease in adulthood. Despite the committed eff orts of initiatives such as Scaling Up Nutrition, adequate maternal nutrition remains a marginal concern for most countries. As one maternal and child nutrition scientist wrote to us recently, “health and nutrition programs are no closer now than 20 years ago”. The unfi nished agenda for maternal health is a huge obstacle to further progress. Meanwhile, a new agenda beckons. The SDGs off er a once-in-a-generation political moment to add energy to maternal health advocacy and action. At the centre Published Online September 15, 2016 http://dx.doi.org/10.1016/ S0140-6736(16)31534-3