Women are at much greater risk inchildbirth in developing countries than in developedcountries. This report explores why maternal mortalitycontinues to be so high in developing countries, and whyemergency obstetric services are little utilized, throughresearch carried out in poor areas in Ghana (Kassena-Nankanadistrict), India (Uttar Pradesh state), and Kenya (Nairobislums). The study employed both quantitative (householdsurveys, verbal autopsies, and health facilities surveys)and qualitative (focus groups and in-depth interviews)methods. Among the three settings, maternal mortality ratiowas highest in the Nairobi slums, followed by Uttar Pradesh,while the Kassena- Nankana district had the lowest. It isintriguing that among the three settings, Nairobi slums hadthe highest proportion of women (70 percent) who soughtprofessional assistance during delivery and yet the highestmaternal mortality. One possible explanation is thedifferent extent of legality of induced abortion in thesethree countries. Of the major causes of maternal mortality,the largest contrast among the study areas involvedcomplications of abortion, which were almost four timeshigher in the Kenya slums than in the north of Ghana or inUttar Pradesh. A large proportion of health facilitiesassessed in the three study areas were not capable ofproviding all six elements of basic emergency obstetric care.
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