More than two decades after the launch of the Safe Motherhood Initiative, maternal health in many developing countries has shown little or no improvement. Year after year, more than half a million mothers continue to die in silence. The specificities of the complex cross-cutting issue only partly explain why tireless efforts have led to insufficient progress so far. While some success stories prove that results can be obtained quickly, the dissensions and deficiencies the Initiative has encountered have strongly weakened its impact. However, recent developments over the past 3 years allow us to foresee the silence will soon be broken. While advocacy begins to subsequently raise awareness, more financial means are mobilized. As a consensus on the priority interventions has finally been reached (Women Deliver conference, London, October 2007), more coordinated actions and initiatives are being developed. The strive for the achievement of the Millennium Development Goals helps to create the political momentum the cause strongly needs to generate new leadership, develop and implement the adequate strategies. Sensible focus on resources and structure as well as innovative management will be crucial in that process.