Each year an estimated 500 000 to 600 000 women die due to complications from childbirth, making this one of the leading causes of death globally for women in their reproductive years. In 1987 a global initiative was launched to address the problem, but few developing countries since then have experienced a documented significant decline in maternal mortality levels.

Honduras represents an exception. Between 1990 and 1997 the country’s maternal mortality ratio – the number of deaths due to complications during pregnancy, childbirth and the postpartum period per 100 000 live births – declined 40% from 182 to 108, one of the largest reductions ever documented in such a short time span in the developing world.

This paper draws on three political science literatures – constructivist international relations theory, policy transfer and agenda-setting – to explain how political priority for safe motherhood emerged in Honduras, a factor that underpinned the decline. Central to the explanation is the unusually cooperative relationship that developed between international donors and national health officials, resulting in effective transfer of policy and institutionalization of the cause within the domestic political system. The paper draws out implications of the case for understanding the political dynamics of health priority generation in developing countries.