While Africa's overall death rates are now as low as Europe's, its maternal mortality ratios are almost fifty times higher. Reducing maternal mortality is one of the UN's Sustainable Development Goals, and a universally agreed public policy priority within East African countries. Yet, despite significant investment, maternal mortality trends have stagnated. By contrast, in the mid-twentieth century East African institutional maternal mortality rates declined as fast as those in the Global North. This paper will consider the long history of maternal health in modern East Africa: how and why it fell in and out of fashion within healthcare provision, how strategies of health communication have evolved, and how the factors shaping risk assessment and health-related decision-making in both clinical and domestic settings have changed since the 1920s.