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Objective: In 2009, the Ministry of Health of Morocco launched a national confidential enquiry around maternal deaths based on the newly implemented routine maternal death surveillance system (MDSS). The objective of this paper is to show the importance of substandard care among the factors associated with maternal deaths., Methods: The Moroccan National Expert Committee (NEC) organised an audit of maternal deaths identified by the MDSS to determine the medical cause, the preventability of the deaths and the type of substandard care involved., Results: Three hundred and three cases of maternal deaths were analysed for the year 2009. Direct causes accounted for 80.8%. 75.9% were considered avoidable by the NEC. The three main factors were insufficient follow-up of care in 45.6% of cases, inadequate treatment in 43.9% and delay in seeking care in 41.3%. The auditors found that 54.3% of all maternal deaths could have been avoided if appropriate action had been taken at the health facilities., Conclusion: The audit of maternal deaths in Morocco enabled a better understanding of the circumstances contributing to maternal deaths and pinpointed that more than half of maternal deaths were associated with substandard care in hospitals., (© 2013 Blackwell Publishing Ltd.)