Why Global Goals and Indicators Matter: The Experience of Sexual and Reproductive Health and Rights in the Millennium Development Goals
If maternal mortality was already part of a broad global public health agenda since Alma-Ata, or before, it was the 1987 Safe Motherhood Initiative (SMI), which ﬁrst set out a target to “reduce maternal mortality by 50% by the year 2000” (Starrs et al. 1987). Following the SMI, however, the absence of consensus with regard to key interventions, coupled with the lack of institutional leadership and a resonating frame for maternal health, made for a “protracted launch” of the SMI, and little change was visible until the mid-1990s (Shiffman and Smith 2006). By that time, not only was there a growing consensus on interventions to address maternal mortality, but maternal health was ﬁrmly embedded in a broader sexual and reproductive health and (reproductive) rights (SRHR) paradigm, deﬁned in the 1994 Programme of Action of the International Conference on Population and Development (ICPD) in Cairo and reafﬁrmed in the 1995 Platform for Action of the Fourth World Conference on Women, Beijing (United Nations [UN] 1994, 1995). These outcome documents set global goals and targets for reducing maternal mortality that were differentiated by development level, but they also called for sweeping changes in social structures and gender relations, which were not reducible to quantiﬁable outcome measures.