Study objective-To understand community based or socio-cultural factors that determine maternal morbidity and mortality in a semi-urban setting. Design-The study is an exploratory multidisciplinary operations research and the instruments were focus groups and interviews. Setting-Ekpoma, a semi-urban community with a population of 70 000 in central part of Edo state in southern Nigeria. Participants-Thirteen groups of women, two groups of men, and two groups of traditional birth attendants. Results-There is a fairly good knowledge of haemorrhage but this is circumscibed by attitudes, practices, and situations that keep women away from or delay the decision to seek modern obstetric care. Conclusions-For a fuller understanding of maternal morbidity and mortality, it is important to consider factors outside the hospital and formal medical practice. Furthermore, a change of existing knowledge, attitudes, practices, and situations can be enhanced through modelling on them. (J Epidemiol Community Health 1998;52:293-297) The level of maternal mortality in Africa, estimated at 100-fold to 200-fold that of the industrialised countries, is unacceptably high. 1Because of its very high fertility and death rates, Nigeria is said to account for 10 per cent of the world's maternal mortality.2 Moreover, most of these women suVer permanent disabilities.The most common medical causes of maternal deaths are haemorrhage, toxaemia, infection, obstructed labour, and unsafe abortion. Deaths from most of these complications can be prevented if promptly and eVectively managed. But in sub-Saharan Africa, the problem stems not only from inadequate health services, but is also the result of the interplay of many antecedent factors that could be social, cultural, economic and logistic, coupled with very high fertility. Such sex specific health problems ramify into the well known sociocultural diYculties and discriminations endured by women in Third World countries. 3Most of these women would have been neglected as children, overworked and underfed, espoused as adolescents, are quite often poor and illiterate, usually subjected to harmful traditional practices, denied equal social status in the society, and denied adequate family planning and maternal health services.Although the limitations of health care delivery facilities and, therefore, personnel in Third World countries are quite well known, nonmedical factors, which are no less important have turned out to be intractable problems and are often conveniently ignored by confounded oYcials. Even in situations where modern health care facilities and personnel are available, many routine traditional or normative practices may prevent or delay the decision to seek proper and more eVective care.The objective of this study is to highlight these community based factors and their implications in maternal mortality and morbidity. Methods EKPOMAEkpoma was chosen as the study site because the social and political situation were conducive to working with the community. It is also an area b...