There has been a 20 percent increase in maternal deaths between 2005 and 2007, when compared to the previous three-year period, with HIV/AIDS accounting for over 40 percent of the deaths (43.7%).

Almost four (38.4%) out of every 10 deaths were "clearly avoidable within the health care system", according to researchers, which means they could have been prevented with proper care.

This is according to the report, "Saving Mothers 2005-2007", an analysis of all maternal deaths nationally, which was quietly released via the health department's website this week.

The report defines "maternal deaths" as "deaths of women while pregnant or within 42 days of termination of pregnancy from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes".

By far the most deaths occurred in KwaZulu-Natal, which has the highest HIV/AIDS rate. Over 350 deaths were reported in his province in 2006, the highest recorded rate of any province since 1998.

Although only around 60 percent of the almost 2000 women who died had been tested for HIV, almost eight out of ten of those tested were HIV positive.

Aside from AIDS-related infections, which killed three times as many women as any other complication, hypertension (15.7%), obstetric haemorrhage (12.4%), pregnancy-related sepsis (9%) and pre-existing maternal disease (6%) were the other main killers.

Of the deaths that could have been avoided, the report points to the need for better management of "complications of hypertension, obstetric haemorrhage, pregnancy related sepsis and non-pregnancy related infections".

These factors were responsible for four out of five of avoidable deaths. In most cases, health care providers either failed to diagnose the problem or failed to follow standard protocols in treating it.

The one piece of good news was that there was a "significant decrease" (14%) in women dying of complications of hypertension in health institutions, which means that health workers are getting better at managing this.

Women under the age of 20 were at greater risk of dying from hypertension while those 35 years and older were at greater risk of dying of haemorrhaging, ectopic pregnancies, embolism, acute collapse and pre-existing medical disease.

Deaths due to non-pregnancy related infections peak at 25-29 years and this peak is mirrored in deaths due to complications of abortion and pregnancy related sepsis following a viable pregnancy.

The report recommends that the department of health addresses maternal deaths by:

• improving health care provider knowledge and skills in providing emergency care and ensuring adequate screening and treatment of the major causes of maternal death;

• improving the quality and coverage of reproductive health services, namely contraceptive and termination of pregnancy services;

• better management of staffing and equipment norms, transport and availability of blood for transfusion;

• community involvement and empowerment regarding maternal, neonatal and reproductive health in general.