A study of refugee maternal mortality in 10 countries, 2008-2010.

CONTEXT Little is known about the prevalence of maternal mortality in refugee camps for populations displaced by conflict, or about the factors contributing to such deaths. METHODS Maternal Death Review Reports were used to analyze maternal deaths that occurred in 2008-2010 in 25 refugee camps in 10 countries. Assessed outcomes included causes of death; delays in women seeking, reaching or receiving care; and additional aspects of case management. We conducted detailed analyses of avoidable factors that contributed to deaths in Kenya, where the majority of reported cases occurred. RESULTS Reports were available on 108 deaths, including 68 in Kenya. In every country but Bangladesh, maternal mortality ratios were lower among refugees than among the host population. The proportion of women who had had four or more antenatal care visits was lower among refugee women who had died (33%) than among the general refugee population (79%). Seventy-eight percent of the maternal deaths followed delivery or abortion, and 56% of those deaths occurred within 24 hours. Delays in seeking and receiving care were more prevalent than delays in reaching care. In Kenya, delays in seeking or accepting care and provider failure to recognize the severity of the woman's condition were the most common avoidable contributing factors. CONCLUSIONS Additional interventions in community outreach, service delivery and supervision are needed to improve maternal outcomes in refugee populations.