It is a task that for 36 years has consumed the organisation known as Susu Mamas (mother's milk), started by a group of expatriate Australian women who wanted to help the local women with antenatal and postnatal care. Susu Mamas has been at the forefront of care for mothers in a country where women continue to struggle for social equality and a fair share of the public health dollar, and continue to die in childbirth at an alarming rate.

With help over the years from funding bodies such as AusAID, the Australian government's overseas aid arm, Susu Mamas has flourished and also has clinics in the provinces of Mt Hagen and Lae. Its ambitious vision for the next decade is to set up shop in another 19 provinces.

Five paid nurses and Westaway, a trained nurse who is the unpaid driving force of the organisation, minister to between 100 and 150 women a day in the Port Moresby clinic alone. In the 18 years that Westaway has run the capital city clinic, it has seen 1.5 million women.

In a country where patriarchy dominates and polygamy is still widely practised, wives and mothers trail decades behind their Western sisters. "Nothing has changed on that front in the 18 years I've been here," Westaway says.

For every thousand babies born, 70 die before their fifth birthday. Five women die in childbirth daily but the figures vary. The official figure from the United Nations is 253 per 100,000 live births but it is as high as 733 in some areas. Consider Australia's maternal mortality rate: 8.4 per 100,000 live births, meaning PNG's rate is about 30 times that.

Australia, less than 40 minutes away by plane, pours one-third of its overseas aid budget into improving the lives of people in a country it once managed.

The persistently high maternal mortality rate arises from a complex web of factors: male ignorance and dominance; lack of health infrastructure in remote villages and provinces; high rates of HIV and AIDS and domestic violence; and a shortage of trained midwives.

This uphill battle to save the mothers and babies is mainly left to national organisations, dedicated voluntary bodies and philanthropists, international aid bodies such as AusAID, and churches.

Signatories to the UN Millennium Development Goals last year adopted a global action plan, which aims to prevent the deaths worldwide of more than 15 million children under five by 2015, and prevent the deaths of 740,000 women from pregnancy and birth complications.

The World Health Organisation was one of several global bodies anointed by the 41 governments, non-profits and philanthropic bodies - which committed nearly $40 billion in resources - to mobilise the international community.

The PNG target is to reduce the mortality rate of under-fives to 32 per 1000 - halving the current level. As the infant mortality rate is linked to the survival of the mother at childbirth and her health in the first few years, improving the lives and health of mothers is vital.

The WHO is familiar with the entrenched problem. With the United Nations Children's Fund, it framed the nation's Child Health Policy and Plan 2009-2020.

This directive put myriad programs in place to stem the rise of maternal and infant deaths, including initiatives to attack deficiencies in the health system and streamline services; education programs for mothers; early health intervention; immunisation of babies and children; and nurse and healthcare training.

Dr Agatha Mwingi Lloyd, from the country's WHO office, says the primary focus is through the Integrated Management of Childbirth and Pregnancy initiative.

AusAID has joined WHO in the quest to reduce the mortality rate, pumping millions of dollars into women's and children's health programs, training programs for healthcare professionals, immunisation initiatives and other assistance.

Australia estimates its official aid for 2010-11 for PNG at $457.2 million, which is directed at infrastructure, health, education and community-building projects. AusAID programs absorb $415 million of that, and another $42.2 million goes to regional and global programs and other government agencies.

Along with a lack of infrastructure and basic health services, one of the greatest impediments to saving maternal lives in PNG, particularly in rural communities, is the dearth of trained midwives.

"There is a serious, really serious lack of midwives," Westaway says. "There've been a lot of words from the [PNG] government, a lot of moral support to take action, but … " she trails off.

In a semi-rural area near Port Moresby, set in unexpectedly manicured lawns with neat rows of buildings, the Pacific Adventist University is doing its bit to fix the midwife crisis. Lecturer and midwife Aketa Burete Kirabis weeps as she describes working in a health centre in the provinces.

"Someone came in and told us that a woman had delivered on the side of the road," she says. "We went up there and the road was so rough, and the mother had to walk many miles to get help. She just gave birth on the side of the road.

"I've seen them come in with the cord hanging, and a blue baby."

Seed funding from AusAid's Support Services Improvement Program enabled 13 midwives to graduate last month. They were the first students to finish the national bachelor of midwifery, a one-year course open to registered nurses.

Apart from two students from the Solomon Islands, the rest were from PNG. The health sciences dean, Esther Pelly, hopes the graduates will stay in their home country but says the government doesn't fund positions for midwives in rural areas, even though 80 per cent of the population lives outside Port Moresby.

"The positions are not being created," she says.

"It is in the national health plan that at least every health centre must have at least one midwife. The Department of Health wants us to take 40 to 50 students a year [in nursing and midwifery courses] but they are not creating the positions for them and they end up in private practice or leaving PNG."

Pelly believes the lack of infrastructure in rural communities and decent pay are stumbling blocks to qualified health professionals taking up positions.

"If there are no incentives and no infrastructure, then we can't expect people to go there," she says.

The author travelled to Papua New Guinea with the World Health Organisation.