Maternal mortality in Eritrea: Improvements associated with centralization of obstetric services.

To reduce maternal mortality and move more effectively toward achieving Millennium Development Goal (MDG) 5 it is important to learn from positive national experiences and to try to isolate the significant factors that were successful. Maternal mortality in Eritrea is still high, but within the period since the country's independence in 1991, the Eritrean Government has received support to improve maternal health from two German nongovernmental organizations: the Hammer Forum and Archemed. This support has focused on prenatal care, contraception counseling, postabortion care, and most notably the centralization of obstetric and neonatal services in the capital, Asmara, and in the second biggest city, Keren. It is now possible to tentatively evaluate the effect of this approach. National data show that the maternal mortality ratio declined from 998 per 100000 live births in 1995 to 486 in 2010. Although the positive effect of skilled birth attendants in the periphery is also well documented, the centralization of obstetric services in Eritrea seems to have been a major factor in the country's considerable progress toward achieving MDG 5.