Objective To evaluate progress made at district level in Malawi towards reaching the 5th Millennium Development Goal, the reduction of maternal mortality.

Methods In 2006, community-based maternal mortality in Thyolo, Malawi was calculated by applying the ‘sisterhood method’, a survey that relies on participants responding to basic questions about maternal mortality in their families. Results were compared with a 1989 sisterhood study in the same district. Information on facility-based maternal mortality in 2005 was extracted from district hospital records.

Results The community-based maternal mortality ratio (MMR) was calculated as 558 per 100 000 live births (95% CI 260 to 820). A comparison with the MMR from the 1989 survey (409 per 100 000 live births) shows that maternal mortality had not declined. The hospital-based MMR was 994 per 100 000 live births in 2005.

Conclusion Maternal mortality in this district has not reduced and may actually have increased. The threat of failure to achieve Millennium Development Goal 5 increases the moral obligation to improve access to quality health care.