Safe Motherhood: A Review - Family Care International

National Programs, Policies,
and Budgetary Commitments for Safe Motherhood
Factors contributing to the persistently high
levels of maternal mortality and
morbidity include:
• poor quality and availability of basic and
essential obstetric care, at primary and first
referral level;
• insufficient numbers and outdated skills of
health personnel, due to inadequate basic
education, and lack of continuing education
and supervision, with particular neglect of
midwifery cadres;
• poor-quality antenatal care;
• cost of health care, as a result of official and
unofficial charges, and fees for transport
and delivery-related supplies; and
• weak referral systems.
Indirect factors include the HIV/AIDS epidemic
and the increasing incidence of malaria;
distance to health facilities; the low status of
women and lack of decision making power;
and the widespread poverty and inequity in
access to health care.
Government Policy for
Safe Motherhood
Beginning in the 1960s, the government
pursued people-centered egalitarian
policies which aimed to ensure and expand
health services to the majority of the
population. With regard to safe motherhood,
there was no explicit policy prior to 1990;
the government’s health and development
objectives were laid out in the country’s fiveyear
plans, as outlined below.
The First and Second
Five-Year Plans
The First Five-Year Plan (1964–1969)
focused on the achievement of two
major objectives:
• self-sufficiency in health personnel
requirements and
• raising life expectancy from 35–40 to
50 years. 76
In 1967, the Arusha Declaration for Socialism
and Self Reliance put forward an egalitarian,
people-centered development philosophy
that aimed to rapidly extend primary
health care to all rural areas. Following the
promulgation of the Arusha Declaration, the
Second Five-Year Plan (1969–1974) sought
to expand services with particular emphasis
on controlling the spread of contagious
diseases. 77 Emphasis was placed on the
provision of preventive services and on the
construction of rural health units.
The Third Five-Year Plan
Largely informed by the egalitarian
philosophy of socialism and rural
development, the Third Five-Year Plan
(1976–1981), identified the following priority
areas for health: environmental sanitation;
good nutrition; expansion and consolidation
of preventive services; enrollment of all
school-age children in primary school;
and construction of rural health centers
and dispensaries. 78 This period marked the
beginning of a multi-sectoral approach in
76 Government of Tanganyika. Tanganyika Five-Year Plan for Economic and Social Development, 1 July 1964 – 30 June 1969.
Dar es Salaam: Government Printer, 1964.
77 United Republic of Tanzania. Tanzania Second Five-Year Plan for Economic and Social Development, 1 July 1969 – 30 June
1974. Dar es Salaam: Government Printer, 1969.
78 United Republic of Tanzania. Tanzania Third Five-Year Plan for Economic and Social Development, 1 July 1974 – 30 June
1979. Dar es Salaam: Government Printer, 1974.
75