If the Women Deliver conference in London last week was an advocacy campaign, then it seems to have worked.

Ministers of Health and Finance turned up. They made a powerful declaration of support, and concrete suggestions for how to improve the status of maternal health on the international development agenda. Reproductive and maternal health organizations and agencies used the conference to invite other sectors to comment on their work – sometimes critically. And a lot of questions were asked about why 20 years after its launch, the Safe Motherhood Initiative (SMI) is not meeting its targets.

Although these targets have not been met, attitudes have changed. Fred Sai, who chaired the 1987 Safe Motherhood Conference, dismisses any concept that maternal health is a local, cultural issue that should not be tampered with. “There is only one culture that we need to look at. The culture of delay that maintains the terrible difference between rates of maternal mortality in the North and in the South,” he says. A Nigerian conference delegate agrees with him. “We don’t have time to stop and theorize about cultural influences. We see the problem every day, in women’s homes, on their doorsteps. We just need to get on with it.”

Others brought further realism to the conference. On the final day of the conference, The Norwegian Government announced a new financial commitment to Millennium Development Goals 4 and 5, with the proviso that resources will only be awarded to those organizations that can prove their effectiveness at local levels. Mia Faikenberg, a Danish parliamentarian who attended the Women Deliver Ministers’ Forum, said she had enjoyed the “big passion” and the creativity at the conference. “As a parliamentarian a lot of people are asking me about increased funding. It is a good agenda. I understand why it needs to be supported. But I want to know how effectively our existing funding is being spent. The real money should only go to those who are doing the real work.” IPPF Secretary General Gill Greer agrees, "Today, no-one has an automatic right to funding. We need to prove we are making a difference.”

In Malawi, a huge difference has been made in the fight against maternal mortality, thanks – in no small part – to the determination and vision of its Minister of Health Marjorie Ngaunje. “In my country we have a Road Map to reduce maternal mortality that is fully integrated into the health SWAp,” she explains. “We want pregnancy to become a cause for celebration not a death sentence in Africa. We know what we want, and we are using the development aid structures to make it happen.”

The expectations were high for this conference, but the organizers were optimistic about the outcome. Executive Vice President of Family Care International (FCI) Ann Starrs says “Women Deliver has put maternal mortality on the global agenda in a way that it cannot be ignored.” FCI’s President Jill Sheffield agrees. “This conference got people really thinking about what women deliver to the world. It has articulated the place of women in the broad context of development. And it has opened the doors to new partners outside the health sector.” What does she expect at the 40^th Anniversary of the Safe Motherhood Initiative? “We need to meet a lot sooner than then. We need to keep this agenda visible and strong.”

The UK Department For International Development pledged £100 million to UNFPA on the first morning of the conference. The Japanese Government sent a message to the conference announcing its intention to place global health at the centre of next year’s G8 summit in Japan. And The MacArthur Foundation pledged US $11 million to reducing maternal mortality in Nigeria and India.

On the first afternoon of the conference Sudanese midwife Awatif Altayib Mohamad Hussein addressed the plenary for three minutes. Awatif has travelled for up to 10 hours a day on a donkey to reach rural communities where women – as she did once – suffer from obstetric fistula. I asked her what her message to Women Deliver would be. “The US and others need to give more money so I can continue my work,” she says.

Whether or not Awatif gets more money for her work is beyond her control. It is not beyond the control of many others who attended Women Deliver. And to make the next 20 years a success rather than a further failure, some of the candour and pragmatism and good will shown at Women Deliver needs to be disseminated further afield – and the issues translated into a language that those who do not as yet understand the importance of the women deliver agenda will comprehend.