Women in developing nations run 100 to 200 times the risk of dying in pregnancy and childbirth compared to women in affluent countries. The vast majority of these deaths are preventable. We examine 3 models of health development for their potential impact on maternal mortality. Although universal primary maternal health care would be ideal, resource limitations render its implementation impractical in many regions. The nonavailability of transport and referral services limits the impact of community-based programs. Selective primary health interventions have some role, but more costly and complex services are required to deal with hemorrhage, the complications of illegal abortion and to provide operative deliveries. Public health workers should focus on intersectoral programs at the community level which mobilize women around health issues. Sustainable development has the greatest potential to produce lasting changes in the risks of childbearing.