mothers and children matter - so does their health 3 It may seem like a cold-blooded thing to say, but someone ought to point out that the Word War was a back-handed break for children . As more and more thousands of men were slaughtered every day, the belligerent nations, on whatever side, began to ee that new human lives, which could grow up to replace brutally extinguished adult lives, were extremely valuable national assets. The children took the spotlight as the hope of the nation. That is the handsomest way to put it The ugliest way-and, I suspect, the truer- is to say flatly that it was the military usefulness of human life that wrought the change. When a nation is fighting a war or preparing for another. it must look to its future supplies of cannon fodder"(7) Caring for the health of mothers and children soon gained a legitimacy of its own beyond military and economic calculations. The increasing involvement of a variety of authorities-medical and lay, charitable and governmental-resonated with the rising expectations and political activism of civil society (1 ). Workers'movements, women's groups, charities and professional organizations took up the cause of the health of women and children in many different ways. For example, the International Labour Organization proposed legal standards for the protection of maternity at work in 1919 the New York Times published articles on maternal mortality in the early 1930s; and in 1938 the Mothers Charter was proclaimed by 60 local associations in the United King dom. Backed by large numbers of official reports, maternal and child health became a priority for ministries of health. Matemal and child health programmes became a public health paradigm alongside that of the battle against infectious diseases (8) These programmes really started to gain ground after the Second World War. Global events precipitated public interest in the roles and responsibilities of governments, and the Universal Declaration of Human Rights in 1948 by the newly formed United Nations secured their obligation to provide"special care and assistance"for mothers and children (9). This added an international and moral dimension to the issue of the health of mothers and children, representing a huge step forward from the political and economic concerns of 50 years earlier. One of the core functions assigned to the World Health Organization(WHO)in its Constitution of 1948 was"to promote maternal and child health and welfare"(10 ) By the 1950s, national health plans and policy documents from development agencies invariably stressed that mothers and children were vulnerable groups and therefore priority"targets" for public health action. The notion of mothers and children as vul- nerable groups was also central to the primary health care movement launched at Alma-Ata(now Almaty, Kazakhstan)in 1978. This first major attempt at massive scal- ing up of health care coverage in rural areas boosted maternal and child health pro grammes by its focus on initiatives to increase immunization coverage and to tackle malnutrition, diarrhoea and respiratory diseases. In practice, child health programmes were usually the central-often the only- programmatic content of early attempts to implement primary health care(11) WHERE WE ARE NOW: A MORAL AND POLITICAL IMPERATIVE The early implementation of primary health care often had a narrow focus, but among 秀858卫 its merits was the fact that it laid the groundwork for linking health to development and to a wider civil society debate on inequalities. The plight of mothers and children soon came to be seen as much more than a problem of biological vulnerability. The 1987 Call to Action for Safe Motherhood explicitly framed it as "deeply rooted in the adverse social, cultural and economic environments of society, and especially the environmentmothers and children matter – so does their health 3 “It may seem like a cold-blooded thing to say, but someone ought to point out that the World War was a back-handed break for children ... As more and more thousands of men were slaughtered every day, the belligerent nations, on whatever side, began to see that new human lives, which could grow up to replace brutally extinguished adult lives, were extremely valuable national assets. [The children] took the spotlight as the hope of the nation. That is the handsomest way to put it. The ugliest way – and, I suspect, the truer – is to say flatly that it was the military usefulness of human life that wrought the change. When a nation is fighting a war or preparing for another ... it must look to its future supplies of cannon fodder” (7). Caring for the health of mothers and children soon gained a legitimacy of its own, beyond military and economic calculations. The increasing involvement of a variety of authorities – medical and lay, charitable and governmental – resonated with the rising expectations and political activism of civil society (1). Workers’ movements, women’s groups, charities and professional organizations took up the cause of the health of women and children in many different ways. For example, the International Labour Organization proposed legal standards for the protection of maternity at work in 1919; the New York Times published articles on maternal mortality in the early 1930s; and in 1938 the Mothers’ Charter was proclaimed by 60 local associations in the United King￾dom. Backed by large numbers of official reports, maternal and child health became a priority for ministries of health. Maternal and child health programmes became a public health paradigm alongside that of the battle against infectious diseases (8). These programmes really started to gain ground after the Second World War. Global events precipitated public interest in the roles and responsibilities of governments, and the Universal Declaration of Human Rights in 1948 by the newly formed United Nations secured their obligation to provide “special care and assistance” for mothers and children (9). This added an international and moral dimension to the issue of the health of mothers and children, representing a huge step forward from the political and economic concerns of 50 years earlier. One of the core functions assigned to the World Health Organization (WHO) in its Constitution of 1948 was “to promote maternal and child health and welfare” (10). By the 1950s, national health plans and policy documents from development agencies invariably stressed that mothers and children were vulnerable groups and therefore priority “targets” for public health action. The notion of mothers and children as vul￾nerable groups was also central to the primary health care movement launched at Alma-Ata (now Almaty, Kazakhstan) in 1978. This first major attempt at massive scal￾ing up of health care coverage in rural areas boosted maternal and child health pro￾grammes by its focus on initiatives to increase immunization coverage and to tackle malnutrition, diarrhoea and respiratory diseases. In practice, child health programmes were usually the central – often the only – programmatic content of early attempts to implement primary health care (11). WHERE WE ARE NOW: A MORAL AND POLITICAL IMPERATIVE The early implementation of primary health care often had a narrow focus, but among its merits was the fact that it laid the groundwork for linking health to development and to a wider civil society debate on inequalities. The plight of mothers and children soon came to be seen as much more than a problem of biological vulnerability. The 1987 Call to Action for Safe Motherhood explicitly framed it as “deeply rooted in the adverse social, cultural and economic environments of society, and especially the environment © Archives de l’Assistance Publique – Hôpitaux de Paris