[1] This concept was originally proposed in the Latin American Association of Reproductive Health Researchers (ALIRH, 2013) in analogy of the epidemiological, demographic and nutritional transitions.
(1) Considering that maternal mortality is vastly determined by social, societal and contextual factors, this reduction is important not only because of the number of lives that have been spared in this period (an estimated 2,000,000 between 1990 and 2010), but because it denotes that the world is making progress towards development and gender equality.
(1,2) However, this progress is still insufficient, unequal and slow: recent estimates suggest that 287,000 women died of causes related to pregnancy and childbirth in 2010.
(9) Finally, Poppkin (1993) proposed the nutritional transition model, which helps to understand the transformations in human diets and the global epidemic of obesity.
In the Stage I (MMR> 1,000 / 100,000) most women are experiencing a situation close to the natural history of pregnancy and childbirth, with very little being done – if anything at all – to reduce the risk of maternal mortality at the population level.
As the minimal infra-structure is created, health services should strive to deliver quality care in order to become a sensible alternative to pregnant women (demand generation).
In other words, quality of care, with skilled birth attendance and appropriate management of complications and disabilities, is essential to reduce maternal mortality.
In order to further advance the reduction of maternal mortality, the main issue becomes quality of care and elimination of delays within health systems.
It is worth noting that the main purpose of this framework is to illustrate different phases of a dynamic process and offer a rationale for different focus and solutions for reducing mortality according to the stage in the obstetric transition.