Organisation of perinatal care in developing countries

Everyone acknowledges that maternal and perinatal mortality in developing countries represents an appalling and shameful disrepect for mankind - figures speak for themselves. The question, however, is what has been done about it? The answer is nothing. What can be done? The answer is a lot.
Although perinatal care is a medical problem it is also, and primarily, a social-political affair. The first step is education. To tiy to deliver medical sendees to an illiterate population with a great preponderance of women is a pointless exercise. It is then a Public Health matter to provide minimal housing and sanitation without which it is fruitless to even attempt to have any sort of health care; to improve nutritional status of women of reproductive age; to implement a nationwide vaccination schedule for mothers-to-be; to eradicate malaria and other parasital infections; to instruct women on HIV infection and transmission (whether they will have any choice is a different matter); to identify and train 2-3 midwives per 1000 inhabitants in the communities, providing them with the skills for family planning, antenatal care and advice, applying scientific knowledge to local customs; to advise mothers on simple but veiy important issues of personal hygiene; to encourage mothers to breastfeed and kangaroo mother care; to create small personalised health centres ("Day Hospitals") with minimal facilities for a normal birth in safety and make them available to the population; to initiate immunisation schemes for babies immediately after birth; to supervise the welfare of mothers and babies by offering postnatal consultations and follow-up clinics for children which can easily lie run by trained nursing personnel under the regular supervision of medical officers.
These measures should start at local level and then spread regionally, establishing priorities and goals. Most pregnancies and deliveries are normal and physiological - efforts .should be made to keep them that way. Once a risk pregnancy has been identified regional services should then make arrangements to provide advice and care in loco.
With these simple measures some women and many babies will, of course, continue to die but a lol more will be saved. It can be argued that the organisation of perinatal care in developing countries is a total and unrealistic Utopia and this may be true. However, many of the past attempts and failures are not just due to the lack of financial resources but also due to indiscriminate misuse, to permissiveness, to greed and corruption, often with the blessing of the Western World. It should be emphasised that the organisation of perinatal care in developing countries does not include the availability of high technologies which, I am convinced, will make no difference whatsoever to the overall perinatal scene at this stage.