Safe motherhood: Implementation of risk approach in developing nations

How to cite this article:
Shrivastava SB, Shrivastava PS, Ramasamy J. Safe motherhood: Implementation of risk approach in developing nations. Ann Trop Med Public Health 2013;6:386-7


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Shrivastava SB, Shrivastava PS, Ramasamy J. Safe motherhood: Implementation of risk approach in developing nations. Ann Trop Med Public Health [serial online] 2013 [cited 2020 Sep 19];6:386-7. Available from:

Dear Sir,

In every society, there are communities, families, and individuals whose chance of future illness, accident, and untimely death are greater than others; they are said to be vulnerable owing to a peculiar set of characteristics they share. These characteristics could be biological, genetic, environmental, psychosocial, or economic. Antenatal care is the care of woman during pregnancy to ensure healthy outcome for mother and newborn at the end of pregnancy. [1] Though studies have shown the effectiveness of antenatal care in preventing maternal mortality and morbidity, [2] its coverage in the year 2011 in South-East Asia region (SEAR) countries was only 52.3%. [3]

Maternal mortality ratio is an important indicator suggesting the status of the healthcare system of entire nation. According to the World health report-2011, maternal mortality ratio for SEAR and India was 240 and 230 per 1,00,000 live births, respectively, as opposed to European and Western Pacific region where it was 21 and 51 per 1,00,000 live births. [4]

Risk approach (RA) is a managerial tool with emphasis on most efficient utilization of scarce resources, providing more care for those in need and proportionate to the need. It is based on early detection of mothers and children with high risk factors. [5],[6] The preventive and promotive elements of primary health care have greatest yield if applied by using risk approach in maternal and child health (MCH). RA encompasses prioritization of ‘targets’ or unwanted outcomes (based on the community priority and preference, prevalence, or frequency of occurrence, the seriousness of the problem, and degree of preventability and rising trend) followed by measurement of association between risk factors and the unwanted outcome (using relative risk and attributable risk) and finally planning interventions (screening, promotive, and diagnostic and therapeutic measures) for the wellbeing of pregnant women. [7] At the grass-root level, identifying all pregnant women in the community can be done by Accredited Social Health Activists/grass root workers. These pregnant women are then referred to Auxiliary Nurse Midwives, who will screen for high-risk pregnancies and refer such cases to medical officer of the primary health centre. If needed, they can also be referred to specialist doctors for expert opinion by the medical officer.

The benefits of RA strategy were found to be evident among the antenatal women of Kasongo district, in eastern Zaire. [8] The RA in MCH must be utilized as a means of maximizing the output from limited resources available especially in the developing countries. By this streamlining at multiple levels of healthcare delivery, RA not only eases the pressure on limited beds and facilities at the hospital level but also saves expert human resources and sophisticated equipment for those who need it most.

The strategy can thus be utilized for the benefit of self and families for appropriate allocation of resources, for expansion of healthcare coverage, improvement in referral services, and defining and planning priorities at regional and national level. Risk approach strategy has all the essential elements to promote safe motherhood and must be implemented effectively by policy makers for improvement in pregnancy outcomes in all developing nations.



1. World Health Statistics, 2011. Global health indicators: Maternal mortality ratio. World Health Organization. Available from: [Last accessed on 2012 Dec 24].
2. Antenatal care in developing countries: Promises, achievements and missed opportunities – An analysis of trends, levels and differentials, 1990-2001. World Health Organization/United Nations Children′s Fund; 2003.
3. Carroli G, Rooney C, Villar J. How effective is antenatal care in preventing maternal mortality and serious morbidity? An overview of the evidence. Paediatr Perinat Epidemiol 2001;15:1-42.
4. World Health Organization. MDG 5: Maternal health: Antenatal care coverage. World Health Organization, 2011. Available from: [Last accessed on 2012 Nov 19].
5. Park K. Preventive medicine in obstetrics, pediatrics and gynecology. In: Park K, editor. Text Book of Preventive and Social Medicine. 21 st ed. Jabalpur: Banarsidas Bhanot; 2011. p. 512.
6. Obionu CN. Primary Health Care for Developing Countries. 2 nd ed. Maternal Health Services; 2007. p. 219-23.
7. Backett EM, Davies AM, Barvazian AP. Public Health Papers No 76: The Risk approach in health care, with special reference to maternal and child health, including family planning. Geneva: WHO; 1984.
8. Dujardin B, Clarysse G, Criel B, De Brouwere V, Wangata N. The strategy of risk approach in antenatal care: Evaluation of the referral compliance. Soc Sci Med 1995;40:529-35.

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1755-6783.121021

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