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

Despite national efforts, maternal mortality remains a significant public health challenge in Ethiopia. Although overall reductions have been reported nationwide, recent facility-based data from the Sidama Region are limited. This study aimed to examine trends, causes, and factors contributing to maternal deaths in public hospitals within Hawassa City. A five-year retrospective review of maternal deaths that occurred between January 1, 2020, and December 31, 2024, was conducted at three public hospitals in Hawassa City. The data were collected from the maternal medical records of each health facility. Maternal deaths were classified according to the case definition by the International Classification of Diseases and were categorized as either direct or indirect causes. Descriptive statistics were used to present background information, causes of death, and delays based on the three-delay model. Maternal mortality ratios were calculated per 100,000 live births. A total of 94 maternal deaths and 44,086 live births were recorded, resulting in an overall Maternal Mortality Ratio of 213.2 per 100,000 live births (95% CI: 206.2–232.2). The maternal mortality ratio peaked at 293 per 100,000 in 2020, then declined to a low of 179 per 100,000 in 2022 and 180.7 per 100,000 in 2023, before slightly rising to 195 per 100,000 in 2024. Most of the deaths (86.2%) were due to direct obstetric causes, with hypertensive disorders of pregnancy (30.9%) and obstetric hemorrhage (27.7%) being the leading causes. Indirect causes accounted for 13.8% of deaths, primarily malaria and anemia. Delay in reaching a health facility (63%) was the most common contributing factor, followed by delay in seeking care (32.1%). Maternal mortality in Hawassa City is higher than the Sustainable Development Goal target. Strengthening referral systems, increasing the availability of emergency obstetric services, and addressing delays in reaching and seeking care are critical to further reduce maternal deaths.