To the business world, it’s location, location, location. Here in Delhi, though, at the Global Maternal Health Conference, the mantra is context, context, context. There are many ways to improve and save women’s lives, but the success of any given intervention depends on local context. What works in one country or one community may not work in another. Many people here are talking about the importance and value of understanding how and why an intervention succeeds or fails at the local level. This means investigating and evaluating not just how widely an intervention reaches or the quality of the services, but also the specific, local factors that play into its uptake and impact. How do these realities affect whether an intervention that saved lives in one place would work equally well somewhere else?

This idea of the importance of the local context became woven into presentations on the first day of this groundbreaking conference. In one session, a representative of the SEWA Rural Society for Education, Welfare and Action, Rural (SEWA Rural) talked about how they had found that in Gujarat, India, a woman’s decision to deliver at home or in a hospital in her last pregnancy often influences where she delivered in a subsequent pregnancy. The question for us all to ponder was raised: is the key to saving women’s lives to encourage them all to deliver in hospitals? If so, how much would this cost? Can governments really afford this now? How far would women have to travel to a hospital? The reality, though, is that for some communities, encouraging hospital- or health facility-based delivery may be part of the answer, but in others it may still be an impractical approach. This question led to a discussion about home delivery versus institution-based delivery—as well as the value of traditional and trained birth attendants.

Whether we are talking about where women deliver, how they deliver, who helps them deliver, what we are really talking about is how we evaluate and minimize a woman’s risk during pregnancy and childbirth. Where distance and a lack of health facilities make facility-based delivery improbable, a community may need programs that improve the quality of care offered by trained birth attendants during a home delivery even though in an ideal world there would be another option. What I’m hearing in Delhi is, in some ways, what I already know. There are no easy answers. We must support communities to succeed within the context of their own limitations in terms of the availability of and access to health facilities and health workers. At the same time, we have to remain committed to helping communities to change these limitations.