Analyse evolution of maternal deaths and quality of emergency obstetric care provided to the women admitted in four Benin referral maternities thus causes and reasons of deficiencies contributing to maternal death. A transversal retrospective study was conducted in two stage: evolution of maternal death ratio added to living births was analysed from 1994 to 2003, followed by extensive analysis of maternal death in 2003. Different hospital data recording and individual interviews were the main sources of data collecting. Maternal mortality ratio in hospitals didn't evolve since 10 years. The poor quality of care was noticed in 59 % of cases. Direct obstetric causes were prevailing in 74% of cases and the leading specific causes were haemorrhage (32,2%), infection (31,60%). Deficiencies in health system, medicals errors in treatment and monitoring, patients' financial unavailability and inadequate management of septic abortions were the main contributing factors. Maternal deaths continue to happen unacceptably in Benin. The drastic solutions have to be taken at all levels to improve maternal health.
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