Can a developed country’s maternal mortality review be used as the ‘gold standard’ for a developing country?

Background: Relative to other public health problems, maternal mortality ratio (MMR) differences between developed and developing countries are greater than expected. South Africa (SA) produced its first national report on maternal deaths in 1998. UK’s last report covered the period 1994–1996. Objective and Method: Compare the two reports to document reasons for the MMR differences using the Safe Motherhood analytical model of maternal mortality as a template. Results: The MMR for SA was estimated to be 12.3 times greater than the UK’s. Under-reporting was bigger in SA. Substandard medical care was common, but other quality of care issues were not assessed. Disease pattern differences included AIDS, non-pregnancy-related infections and postpartum haemorrhage in SA compared to thromboembolism and medical disorders in the UK. Autopsies were problematic. Demographic differences centred around ethnic origins. Biological differences may involve the immune system. Socio-economic or behavioural factors were not documented. Conclusions: Awareness of the magnitude of the problem requires better data collection systems. Sepsis and HIV/AIDS are a major problem in SA. Beyond the mutually common problem of substandard medical care, other quality of care issues were inadequately assessed.