Contents -- Foreword -- Acknowledgments -- Executive Summary -- Overview -- Maternal Mortality Can Be Halved in Developing Countries Every 7 to 10 Years -- Maternal Mortality Reduction Is Affordable Regardless of Income Level and Growth Rate -- Maternal Mortality Declines Rapidly with the Provision of a Synergistic Package of Health and Social Services That Reach the Poor -- Governments Can Afford to Provide the Critical Elements of Maternity Care Free of Charge to the Client -- Different Tactics Are Needed at Different Stages of Health Systems Development -- Official Recognition of Professional Midwifery Is a Crucial Step toward Reducing Maternal Mortality -- Raising the Importance of Maternal Death through Recording, Reporting, and Subsequent Advocacy Will Improve Program Performance -- Conclusion -- Note -- 1 The Ingredients of Success -- The Conceptual Basis -- Aims of the Study -- Study Approach -- The Evidence -- Maternal Mortality Transition: A Model for Action -- Conclusion -- Notes -- 2 Malaysia -- Background: Malaysia Today -- Political Context -- Study Approach -- Decline in Maternal Mortality -- Key Policies and Program Interventions -- Conclusion -- Notes -- 3 Sri Lanka -- Background: Sri Lanka Today -- Political and Social Context -- Study Approach -- Decline in Maternal Mortality Ratio -- Trends in Maternal Mortality Ratio and Female Death Rates -- Development of Maternal and Child Health Services -- Implementation of Critical Health Policies -- Health System Expenditures, Affordability, and Sustainability -- Conclusion -- Notes -- Appendixes -- 1 Data Availability and Quality in Malaysia -- 2 Data Availability and Quality in Sri Lanka -- 3 Assessment of Affordability -- 4 Key Informants -- References -- Tables -- 1 Public Expenditures on Health Services and Maternal Health Care, Malaysia and Sri Lanka, 1950s-90s.

2 Per Capita Gross National Product for Selected Countries -- 3 Amount of Time to Halve Maternal Mortality Ratio, Malaysia and Sri Lanka, 1949-92 -- 4 Key Health Features, Malaysia and Sri Lanka, 1940-61 -- 5 Public Expenditures on Health Services and Maternal Health Care, Malaysia and Sri Lanka, 1950s-90s -- 6 Malaysia at a Glance -- 7 Amount of Time to Halve the Maternal Mortality Ratio, Peninsular Malaysia, 1933-97 -- 8 Maternal Mortality Ratio, by Ethnic Group, Peninsular Malaysia, 1957-90 -- 9 Overview of Health Service Capacity and Skilled Attendance during Childbirth, Peninsular Malaysia, 1949-95 -- 10 Total Fertility Rates, by Ethnic Group, Peninsular Malaysia, 1957-97 -- 11 Expenditures on Public Health, Malaysia, 1946-95 -- 12 Estimated Public Sector Expenditures on Maternal Health Care, Malaysia, 1971-95 -- 13 Trends in Expenditures for Maternal Health Care, Malaysia, 1946-95 -- 14 Sri Lanka at a Glance -- 15 Trends in Adult Literacy, Sri Lanka, 1901-91 -- 16 Time to Halve the Maternal Mortality Ratio, Sri Lanka, 1930-96 -- 17 Deliveries with Skilled Attendance and Maternal Mortality Ratio, 1939-95 -- 18 Deliveries in the Private Sector, Sri Lanka, 1981-93 -- 19 Decline in Cause-Specific Maternal Mortality Ratio, Sri Lanka, 1942-52, 1955-70, and 1980-96 -- 20 Development of Government-Employed Birth Attendants, Sri Lanka, 1930-95 -- 21 Contraceptive Prevalence Rate, Sri Lanka, 1975-2000 -- 22 Development of Maternal-Health-Care-Related Infrastructure, Sri Lanka, 1931-95 -- 23 Categories of Institution, Sri Lanka -- 24 Place of Delivery by Monthly Family Income, Sri Lanka, 1982 -- 25 Place of Delivery by Sector, Sri Lanka, 1982 -- 26 Maternal Health Care Expenditures, Sri Lanka, 1950-99 -- 27 Public and Private Health Services, Sri Lanka, 1953-96 -- Figures -- 1 Maternal Mortality Ratio, Sri Lanka, 1930-95.

2 Maternal Mortality Ratio, Malaysia, 1950-99 -- 3 Maternal Mortality Ratio and Expenditure on Health as a Percentage of Gross Domestic Product in Countries That Have Gross National Product Comparable Per Capita to Sri Lanka's -- 4 Maternal Mortality Ratio and Expenditure on Health as a Percentage of Gross Domestic Product in Countries That Have Gross National Product Comparable Per Capita to Malaysia's -- 5 Maternal Deaths as the Proportion of Deaths among Women of Reproductive Age, Sri Lanka and Malaysia, 1950-2000 -- 6 Maternal Mortality Ratio in Less-Developed States Compared to Other States, Peninsular Malaysia, 1970-97 -- 7 Maternal Mortality Ratio and Skilled Attendance at Birth, 1995: Countries with Gross National Product Comparable to That of Malaysia in the Early 1960s -- 8 Maternal Mortality Ratio and Skilled Attendance at Birth, 1995: Countries with Gross National Product Comparable to That of Sri Lanka in the Early 1960s -- 9 Maternal Mortality Ratio, 1919-20, in Countries with Deliveries Predominantly Assisted by Midwives, Doctors, or Both -- 10 Determinants of Health-Sector Outcomes -- 11 Maternal Mortality Ratio, Malaysia and Sri Lanka, 1950-99 -- 12 Critical Elements of Maternal Health Care -- 13 Maternal Mortality Ratio and Percentage of Live Births with Skilled Attendance, Malaysia, 1949-95 -- 14 Maternal Mortality Ratio and Percentage of Live Births with Skilled Attendance, Sri Lanka, 1930-96 -- 15 Maternal Mortality Transition: A Model for Action -- 16 Total Fertility Rate and Maternal Mortality Ratio, Malaysia, 1957-95 -- 17 Total Fertility Rate and Maternal Mortality Ratio, Sri Lanka, 1952-95 -- 18 Neonatal Mortality Rates, Malaysia and Sri Lanka, 1938-99 -- 19 Place of Birth and Birth Attendance, Peninsular Malaysia, 1949-95.

20 Phases of Health Systems Development for Maternal Health as Related to Reduction in Maternal Mortality Ratio, 1933-97 -- 21 Admissions to Public Sector Hospitals for Complications of Pregnancy, Peninsular Malaysia, 1971-95 -- 22 Public Operating Expenditures on Maternal Health Services as Percentage of Gross Domestic Product, Malaysia, 1971-95 -- 23 Public Capital Expenditures on Maternal Health Services as Percentage of Gross Domestic Product, Malaysia, 1971-95 -- 24 Maternal Mortality Rates and Female Death Rates, Ages 15-49, Sri Lanka, 1950-96 -- 25 Deliveries in Specialized Units, Medical Offices, and Primary-Level Government Institutions, Sri Lanka, 1984-99 -- 26 Maternal Mortality Ratio Attributed to Hypertensive Disease and Sepsis, 1930-96 -- 27 Maternal Mortality Ratio Attributed to Hemorrhage, Sri Lanka, 1930-95 -- 28 Maternal Mortality Ratio and Total Fertility Rate, Sri Lanka, 1930-95 -- 29 Age-specific Fertility Rates, Sri Lanka, 1962-2000 -- 30 Age-specific Maternal Mortality Ratio, Sri Lanka, 1954-96 -- 31 Expenditure on Maternal Health Services as Percentage of Gross Domestic Product, Sri Lanka, 1950-99 -- Boxes -- 1 Midwives and Nurse-Midwives in the 1960s and 1970s -- 2 Midwifery Practice in Small Hospitals in the 1960s and 1970s -- 3 The Referral Chain -- 4 We Are Proud of Our Public Health Midwives.