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The first part of this article examines the global progress towards target A of the fifth Millennium Development Goal (MDG5). The target is to reduce by three quarters the maternal mortality ratio between 1990 and 2015. This implies that most maternal deaths could be avoided. Recent sources are examined and the MMEIG data set is used for the comparison as being the one in use by the United Nations. Giving birth remains a risk process, particularly in Souhern Asia and sub-Saharan. In the second part data from Algeria, Lybia, Mauritania, Morocco and Tunisia, the five countries composing the Maghreb are examined. Four of these countries are in good progress and possibly on track. In Morocco a full process has been developed including emproved governance, accessibility and quality. This has included a full procedure of confidential enquiry into maternal health, including the five recommended steps of the process: enhanced identification, documentation, determination of causes, assessment of substandard care and recommendations based on the results of the four first steps. Maternal haemorrhage is the leading cause of death in that region. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: To describe the main results and recommendations from the seventh report on confidential enquiry into maternal death in the United Kingdom (UK) (2003–2005). Methods: Comparison with the most recent French data (1999–2001). Results: Maternal mortality tends to increase and indirect causes are more common than direct causes. Causes of deaths and their respective ranking are strikingly different with what is observed in France. This can probably be ascribed to the increasing role of obesity, maternal age, tobacco use and diabetes in the UK. Cardiac disease now ranks first among indirect causes and is linked in half of cases to ischaemic heart disease. This contrasts with the French situation where cardiac death remains rare. Thromboembolic disease remains the main cause of direct deaths while the role of haemorrhage has decreased. This also contrasts with the French situation where haemorrhage remains of concern. Sepsis is now the second cause in the UK (at the same level than preeclampsia), while it is a rare cause in France. In both French and UK reports, substandard care remains of concern in many cases of direct deaths. Anaesthesia is now a rare cause of death (n =6) although the UK report emphasizes that in a large number of cases, anaesthesia has contributed to death because of substandard care (n =31). In many cases, the report highlights the deleterious role of unsupervised residents. Conclusion: The United Kingdom report integrates modern strategies that might improve patient safety, including systems failure analysis, incident reporting and registries. Systematic auditing (with proposition of auditable standards) might also prove important in facilitating implementation of the top ten recommendations. All these strategies might also be implemented in France and hopefully might prove to be also beneficial here. [Copyright &y& Elsevier]