Generating Political Will for Safe Motherhood in Honduras

Each year an estimated 500,000 to 600,000 women die due to complications from childbirth, making this one of the leading causes of death globally for women in their reproductive years. Few developing countries have experienced a documented significant decline in maternal mortality levels, despite a global initiative to address the problem. Honduras represents an exception. Between 1990 and 1997 the country’s maternal mortality ratio – the number of deaths due to childbirth per 100,000 live births – declined forty percent from 182 to 108, one of the largest reductions ever documented in such a short time span in the developing world. This paper offers an explanation for the emergence of political priority for safe motherhood in Honduras, a major cause underpinning the decline. We argue that this emergence was connected to five factors: an existing legacy of priority for maternal health in the country; the appearance of safe motherhood on the global health agenda; the alarm generated in the Honduran health system by a 1990 study revealing a significantly higher level of maternal death in childbirth than was thought to exist; the subsequent mobilization of the health bureaucracy by a group of midlevel civil servants; and the collaboration of this group with a network of international donors with offices in Honduras. More broadly, we argue that safe motherhood scholarship has been unable to produce adequate accounts of maternal mortality change in developing countries because of an excessive focus on analysis of medical and technical interventions to the neglect of political and social processes. We draw on political science scholarship concerning agenda setting and international relations to explain the emergence of political priority for safe motherhood in Honduras, and to demonstrate the need to consider both processes and interventions, not just interventions alone, in order to offer comprehensive accounts of maternal mortality change.