Maternal mortality remains as a major Public Health challenge despite numerous strategies devised by the international community to curb it. Globally, maternal mortality is the leading cause of death among females aged 15-49 years old. More than 1500 women die each day from pregnancy related causes resulting in an estimated 550 000 maternal deaths annually . In 2010, estimates developed by the WHO, UNICEF, UNFPA and the World Bank  suggest that worldwide, about 260 women die per 100 000 live births and most of these deaths occur in sub-Saharan Africa. These estimates indicate that Africa recorded the highest Maternal Mortality Ratio (MMR) of 620 per 100 000 live births, whilst Europe recorded the lowest MMR of 21 maternal deaths per 100 000 live births. Globally, Greece recorded the lowest maternal deaths by country with 2 per 100 000 live births compared with the alarmingly high MMR of 1400 deaths per 100 000 live births in Afghanistan . In sub-Saharan Africa, Cape Verde recorded the lowest MMR of 94 whilst Chad and Somalia recorded the highest MMR of 1200 . These figures show a very large discrepancy in maternal health, with sub-Saharan Africa experiencing the poorest outcome.
To respond to this challenge, the Millennium Development Goal 5 (MDG 5), which aims to improve maternal health was developed. The target is to reduce by three-quarters the MMR between 1990 and 2015 and achieve universal access to reproductive health care by 2015. A study by Hogan and colleagues, in 2010, found that there was a decrease in the global MMR estimates from 320 in 1990 to 251 in 2008 per 100 000 live births . Even in the presence of this change, very few countries are on track to achieve MDG 5 . This stagnation calls for different innovations and strategies to tackle this global menace.
A study by Thonneau et al., (2004)  carried out in twelve maternities in Benin, Ivory Coast and Senegal, found that hypertensive disorders and post-partum haemorrhage caused 29% and 15% respectively of maternal mortalities in these three African countries. These were the highest causes of maternal mortality among this group . Inconsistency in clinical diagnosis of the causes of maternal deaths has also been reported as a possible reason for why this challenge remains unabated . Infectious diseases related to maternal mortalities are often under-diagnosed whilst hypertensive disorders related to pregnancy (including Eclampsia) are in most cases, over-diagnosed .
Ghana's MMR continues to be unacceptably high despite efforts made in an attempt to meet MDG 5. The Ministry of Health has been called on to treat maternal mortality as a national emergency . Estimation of Maternal Mortality Ratio in Ghana varies widely by source and method of estimation . Figures from the WHO, UNICEF and UNFPA for Ghana indicate 740 maternal deaths in 1990, 590 in 1995, 540 in 2000 and 560 in 2005 per 100 000 live births [9, 10]. This contrasts lower estimation from the Ghana Statistical Service which were 214 in 1992 and 378 per 100 000 live births between 2000 and 2005 . This high level of uncertainty and discrepancy makes MMR unsuitable for monitoring maternal mortality/maternal health trends in short term .
The causes of maternal mortality are usually sub-grouped into direct obstetric and indirect causes. Direct causes of maternal mortality as indicated in previous studies conducted in Ghana include haemorrhage (postpartum and ante partum), abortion, miscarriage, sepsis, obstructed labour, ectopic pregnancy, (Pre-) eclampsia and embolism [11, 13–15]. The indirect causes of maternal mortality are mostly infectious and non-infectious diseases and other miscellaneous causes. These indirect causes include mainly malaria, HIV/AIDS, hepatitis, respiratory infections, anaemia, sickle cell disease, meningitis, cerebrovascular diseases and others [11, 13–15].
In Ghana, several interventions targeting the reduction of maternal mortality have been implemented. Notable among these is the user fee exemption policy instituted in 2003. This policy exempts all pregnant women from paying for delivery costs at public, mission and private health facilities . Evaluation of this intervention between 2003 and 2006 showed dramatic reduction of direct maternal deaths but no significant impact on indirect maternal deaths . Thus, maternal mortality can be prevented in many cases but this demands not only a comprehensive understanding of the causes, but also, more importantly, an understanding of how the different causes are distributed in various groups with different characteristics. A number of studies have been conducted on maternal mortality in Ghana [8, 11, 13–15, 18, 19]; however, only one  attempted to analyze causes of maternal mortality with respect to socio-demographic groups, and did so with limited detail. The study reported percentage distribution of maternal deaths by cause of death, according to age and region. Much emphasis was put on abortion in the analysis. The study did not report the maternal mortality cause-specific risks associated with the different socio-demographic groups. Thus, detailed analysis of the causes of these mortalities, stratified by various socio-economic and demographic characteristics, is essential for formulating specific interventions to deal with these causes in different socio-demographic groups. This would help to accelerate Ghana and other similar nations in sub-Saharan Africa, towards the realization of Millennium Development Goal 5. The aim of the study is, therefore, to assess and analyse the causes of maternal mortality according to socio-demographic factors in Ghana.