Trends, causes, and delays associated with maternal mortality in public hospitals of Hawassa City, Southern Ethiopia: a five-year retrospective study

Background: Despite national efforts, maternal mortality remains a major public health challenge in Ethiopia. Although reductions have been reported nationally, recent facility-based evidence from Sidama Region is limited. This study aimed to assess trends, causes, and contributing factors of maternal deaths in public hospitals of Hawassa City Administration. Methods: A five-year retrospective review was conducted on maternal deaths that occurred between January 2020 and December 2024 in three public hospitals in Hawassa City. The data were extracted from health facility maternal medical records. Descriptive statistics were used to present background information, causes of death, and delays based on the World Health Organization three-delay model. Maternal mortality ratios were calculated per 100,000 live births. Results: A total of 94 maternal deaths and 44,086 live births were documented. resulting in an overall Maternal Mortality Ratio of 213.2 per 100,000 live births. Most of deaths (86.2%) were due to direct obstetric causes, with hypertensive disorders of pregnancy (30.9%) and obstetric haemorrhage (27.7%) being the leading causes. Indirect causes accounted for 13.8% of deaths, primarily malaria and anaemia. The majority of maternal deaths (74.5%) occurred postpartum. Delay in reaching a health facility (63%) was the most common contributing factor, followed by delay in seeking care (32.1%). Conclusion: Maternal mortality in Hawassa City is higher than the Sustainable Development Goal target even though the number is lower than the national rate and the results of previous studies. Strengthening referral systems, increasing availability of emergency obstetric services and addressing delays in seeking and reaching care are critical to further reduce maternal deaths.