IDEAS home Printed from
   My bibliography  Save this article

Generating political will for safe motherhood in Indonesia


  • Shiffman, Jeremy


In 1987 an international conference brought global attention to an issue that previously had been ignored: the world's alarmingly high number of maternal deaths in childbirth. The conference ended with a declaration calling for a reduction in maternal mortality by at least half by the year 2000. As the deadline approached, safe motherhood activists lamented the fact that the world was nowhere near to achieving this objective. They attributed this failure to a variety of causes, but were in agreement that the medical technology was available to prevent maternal deaths in childbirth, and the key was generating the political will to make such technology widely available to women in developing countries. What 'political will' means, however, has been left as an unopened black box. What causes governments to give priority to the issue of safe motherhood, given that national political systems are burdened with thousands of issues to sort through each year? In marked contrast to our extensive knowledge about the medical interventions necessary to prevent maternal death, we know little about the political interventions necessary to increase the likelihood that national leaders pay meaningful attention to the issue. Drawing from a scholarly literature on agenda setting, this paper identifies four factors that heighten the likelihood that an issue will rise to national-level attention: the existence of clear indicators showing that a problem exists; the presence of effective political entrepreneurs to push the cause; the organization of attention-generating focusing events that promote widespread concern for the issue; and the availability of politically palatable policy alternatives that enable national leaders to understand that the problem is surmountable. The paper presents a case study of the emergence, waning and re-generation of political priority for safe motherhood in Indonesia over the decade 1987-1997, to highlight how these four factors interacted to raise safe motherhood from near obscurity in the country to national-level prominence. While there are contextual factors that make this case unique, some elements are applicable to all developing countries. The paper draws out these dimensions in the hope that greater knowledge surrounding how political will actually has been generated can help shape strategic action to address this much neglected global problem.

Suggested Citation

  • Shiffman, Jeremy, 2003. "Generating political will for safe motherhood in Indonesia," Social Science & Medicine, Elsevier, vol. 56(6), pages 1197-1207, March.
  • Handle: RePEc:eee:socmed:v:56:y:2003:i:6:p:1197-1207

    Download full text from publisher

    File URL:
    Download Restriction: Full text for ScienceDirect subscribers only

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    1. Miller, Douglas L. & Paxson, Christina, 2006. "Relative income, race, and mortality," Journal of Health Economics, Elsevier, vol. 25(5), pages 979-1003, September.
    2. Angus Deaton, 2001. "Relative Deprivation, Inequality, and Mortality," NBER Working Papers 8099, National Bureau of Economic Research, Inc.
    3. Victor R. Fuchs & Mark B. McClellan & Jonathan S. Skinner, 2004. "Area Differences in Utilization of Medical Care and Mortality among U.S. Elderly," NBER Chapters,in: Perspectives on the Economics of Aging, pages 367-414 National Bureau of Economic Research, Inc.
    4. Christopher J. Ruhm, 2000. "Are Recessions Good for Your Health?," The Quarterly Journal of Economics, Oxford University Press, vol. 115(2), pages 617-650.
    5. Alberto Alesina & Reza Baqir & William Easterly, 1999. "Public Goods and Ethnic Divisions," The Quarterly Journal of Economics, Oxford University Press, vol. 114(4), pages 1243-1284.
    6. Michael Grossman, 1976. "The Correlation between Health and Schooling," NBER Chapters,in: Household Production and Consumption, pages 147-224 National Bureau of Economic Research, Inc.
    7. Jennifer M. Mellor & Jeffrey Milyo, 1999. "Re-Examining the Evidence of an Ecological Association between Income Inequality and Health," Discussion Papers Series, Department of Economics, Tufts University 9922, Department of Economics, Tufts University.
    8. repec:aph:ajpbhl:1998:88:7:1074-1080_3 is not listed on IDEAS
    9. repec:aph:ajpbhl:2001:91:3:385-391_5 is not listed on IDEAS
    10. David A. Jaeger & Susanna Loeb & Sarah E. Turner & John Bound, 1998. "Coding Geographic Areas Across Census Years: Creating Consistent Definitions of Metropolitan Areas," NBER Working Papers 6772, National Bureau of Economic Research, Inc.
    Full references (including those not matched with items on IDEAS)


    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.

    Cited by:

    1. Prata, Ndola & Sreenivas, Amita & Greig, Fiona & Walsh, Julia & Potts, Malcolm, 2010. "Setting priorities for safe motherhood interventions in resource-scarce settings," Health Policy, Elsevier, vol. 94(1), pages 1-13, January.
    2. Murray, Susan F. & Pearson, Stephen C., 2006. "Maternity referral systems in developing countries: Current knowledge and future research needs," Social Science & Medicine, Elsevier, vol. 62(9), pages 2205-2215, May.
    3. Baird, John & Ma, Steven & Ruger, Jennifer Prah, 2011. "Effects of the World Bank's maternal and child health intervention on Indonesia's poor: Evaluating the safe motherhood project," Social Science & Medicine, Elsevier, vol. 72(12), pages 1948-1955, June.
    4. Ensor, Tim & Clapham, Susan & Prasai, Devi Prasad, 2009. "What drives health policy formulation: Insights from the Nepal maternity incentive scheme?," Health Policy, Elsevier, vol. 90(2-3), pages 247-253, May.
    5. Parkhurst, Justin O. & Chilongozi, David & Hutchinson, Eleanor, 2015. "Doubt, defiance, and identity: Understanding resistance to male circumcision for HIV prevention in Malawi," Social Science & Medicine, Elsevier, vol. 135(C), pages 15-22.
    6. Billings, Deborah L. & Crane, Barbara B. & Benson, Janie & Solo, Julie & Fetters, Tamara, 2007. "Scaling-up a public health innovation: A comparative study of post-abortion care in Bolivia and Mexico," Social Science & Medicine, Elsevier, vol. 64(11), pages 2210-2222, June.
    7. Hui-Peng Liew, 2010. "The Migrant–Nonmigrant Differentials in Prenatal Care Utilization: Evidence from Indonesia," Population Research and Policy Review, Springer;Southern Demographic Association (SDA), vol. 29(5), pages 639-658, October.


    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:socmed:v:56:y:2003:i:6:p:1197-1207. See general information about how to correct material in RePEc.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: (Dana Niculescu). General contact details of provider: .

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    We have no references for this item. You can help adding them by using this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service hosted by the Research Division of the Federal Reserve Bank of St. Louis . RePEc uses bibliographic data supplied by the respective publishers.