Pregnancy-related complications cause one-quarter to one-half of deaths among women of reproductive age in developing countries. In some countries pregnancy-related complications are the leading cause of death for reproductive-age women (87, 214, 288). Many thousands of women in developing countries suffer serious illnesses and disabilities, including chronic pelvic pain, pelvic inflammatory disease, incontinence, and infertility, caused by pregnancy or its complications (86).

WHO defines a maternal death as a death occurring within 42 days after pregnancy, irrespective of the duration or the site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management (288). Five direct causes—hemorrhage, sepsis, pregnancy-induced hypertension, obstructed labor, and complications of unsafe abortion—account for more than 80% of maternal deaths (218).

Safe motherhood consists of ensuring good health for women and their babies during pregnancy, delivery, and in the postpartum period. Men play many key roles during women's pregnancy and delivery and after the baby is born. Their decisions and actions often make the difference between illness and health, life and death (6, 229, 244).

Planning their families. The first step that men can take to promote safe motherhood is to plan their families (6). Limiting births and spacing them at least two years apart are good for maternal and child health. Every pregnancy carries potential health risks for women, even for women who appear healthy and at low risk (6, 217, 229). Unintended pregnancies are particularly likely to be risky because they are more likely to end in abortion. Complications of unsafe abortion cause 50,000 to 100,000 deaths each year (218, 288).

Supporting contraceptive use. Men can accompany their partners to meet with a family planning counselor or health worker. Together, they can learn about the available contraceptive methods and choose the one that best meets their needs. A man can help his partner use modern methods correctly (for example, he can help her remember to take her pill each day), he can use a male method himself, or the couple can practice periodic abstinence. Men can encourage their partners to seek help from a health care provider if side effects occur. They also can endorse trying another method if one method proves unsatisfactory.

Helping pregnant women stay healthy. When his partner becomes pregnant, a man can make sure that she gets proper antenatal care, which may entail providing transportation or funds to pay for her visits. He can also accompany her on the antenatal visits, where he can learn about the symptoms of pregnancy complications.

Good nutrition and plenty of rest also are important during pregnancy. Men can help women have safe pregnancies and healthy babies by ensuring that they receive nutritious food, especially food strong in iron and fortified with vitamin A (6, 227, 229, 257, 277). Anemia, while not a direct cause of maternal deaths, is a factor in almost all such deaths. An anemic woman is five times more likely to die of pregnancy-related causes than a woman who is not anemic (267).

Vitamin A is important to the health of both the mother and the fetus (227, 257). Women need to have enough vitamin A both to support the healthy development of their baby and to protect their own health, particularly their eyesight and immune system. Night blindness among pregnant women is a symptom of vitamin A deficiency. Antenatal vitamin A supplements, often provided in pill form, can greatly reduce maternal and child deaths (257). A study of pregnant women in southern Nepal found that low-dose vitamin A or supplements of beta-carotene, the nutritional precursor of vitamin A, reduced maternal deaths by an average of 44% (277).

Arranging for skilled care during delivery. In developing countries the majority of women deliver their babies without skilled assistance, helped only by untrained traditional birth attendants or family members. A trained attendant present during childbirth can mean the difference between life and death. Men can help by arranging for a trained attendant to be available for the delivery and by paying for the services. They also can arrange ahead of time for transportation and can buy supplies, if necessary.

Avoiding delays in seeking care. Delay often contributes to maternal deaths when complications of pregnancy occur (244). Three types of delay put mothers' health at risk—delay in deciding to seek care; delay in getting to a health care facility; and delay in receiving adequate care at the facility. Men and other family members play crucial roles in assuring prompt care (41, 244). Men are often the ones who decide when a woman's condition is serious enough to seek medical care. They also decide how a woman will be transported to the clinic. Men can avoid delays by learning the symptoms of imminent delivery and of delivery complications.

Helping after the baby is born. Most maternal deaths occur within three days after delivery, due to infection or hemorrhage, new research suggests (212). To prevent deaths, men can learn about potential postpartum complications and be ready to seek help if they occur. Men also can make sure that women get good nutrition. While they are breastfeeding, women continue to need extra vitamin A to ensure that they pass enough of the vitamin on to their infants.

During the postpartum period men can help with heavy housework, such as gathering wood and water and taking care of other children. They can encourage breastfeeding, which helps the uterus contract. Finally, they can begin using contraception, either a temporary method to space the next birth or possibly a vasectomy if no more children are desired (6, 182, 229).

Being responsible fathers. The roles that men play as fathers and the ways in which they affect their children's health have been gaining attention (44, 58, 70, 96). Men can become more involved in helping their children's healthy development—for example, ensuring that their children receive all of the needed immunizations. In Ghana a study found that the more education fathers have, the greater their role in deciding to immunize their children (40).

In the US, Baltimore's Urban Fatherhood Program helps young men become responsible fathers by promoting positive male role models. Program staff members, many of whom were teenage fathers themselves, encourage other young men to be good fathers through support groups, counseling sessions, and life skills classes. They also teach young men about fertility, reproduction, the menstrual cycle, pregnancy, and infant nutrition and care (127). In Newark, New Jersey, a similar program also teaches young fathers about contraception, including correct condom use (70).

Fathers, as role models, help to socialize their children (256). In particular, fathers can teach their sons to respect women and treat them as equals, support their daughters' school attend-ance, and encourage their daughters to play an active role in the family. In these ways, fathers can help to improve women's status and make a better future for their daughters (256).