Introduction: Maternal mortality remains a major public health problem worldwide. According to recent estimates from the World Health Organization, approximately 287,000 maternal deaths were recorded globally in 2020, with more than 95% occurring in low- and middle-income countries. In the Democratic Republic of Congo (DRC), the maternal mortality ratio remains high, estimated at 760 deaths per 100,000 live births. The objective of our study was to identify the factors explaining maternal deaths among women who experienced obstetric complications in the Kasai Province. Methods: This was a mixed-methods study, combining quantitative and qualitative approaches. A case-control analytical design was complemented by a phenomenological design. The study was conducted in the Kasai Province from 2022 to 2024 and included 708 records of women who experienced obstetric complications. Results: Among women who experienced obstetric complications, 25% died, reflecting a high obstetric mortality rate. Reports from the Provincial Health Directorate (DPS) indicate a maternal mortality rate of 119 deaths per 100,000 live births. The main factors associated with maternal deaths were maternal age over 40 years, lack of skilled birth attendants, lack of follow-up antenatal care, interpregnancy interval of less than 2 years, and delayed access to care (p < 0.05). Postpartum hemorrhage was the direct obstetric cause, while gestational malaria was the indirect cause (p < 0.05). Responsibility for maternal deaths was shared among the community, healthcare facility administration, and healthcare providers. Conclusion: Maternal mortality remains high in the DRC, particularly in Kasai Province. The observed maternal deaths are linked to largely preventable factors and involve multiple responsibilities. An integrated approach, taking into account community, institutional, and professional dimensions, is essential for a sustainable reduction in maternal mortality.
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