During the last years increasing attention has been drawn to input, process and output indicators to measure progress in maternal health. The main reason for this is the fact that the main outcome indicator the maternal mortality ratio is difficult to measure and large resources are needed to get reliable estimates. Different approaches, like the sisterhood method or reproductive age surveys have been applied to get an estimate of the maternal mortality ratio. However, all methods face problems mostly due to the fact that a maternal death is a rare event even in places where the maternal mortality is high and misclassification of the reason of death of women in reproductive age is common. The above mentioned constraints thus makes it difficult or even impossible to monitor safe motherhood programmes at district level and the effectiveness and cost-effectiveness of interventions are largely not known. The shift towards input, process and output indicators to measure progress in maternal health has led to the use of different approaches and various scientific groups favoured different indicators. The unmet obstetric need (UON)-network, based at the institute of Tropical Medicine in Antwerp, proposes the use of major obstetric interventions as tracer indicators to assess the responsiveness of the system to address obstetrical problems. The study in Mtwara region aimed at estimating the unmet obstetric need using the unmetobstetric-need-indicator in a prospective study and at the same time to assess feasibility of data collection through the routine hospital information system and the usefulness of the indicator for district planning. In addition maternal and perinatal outcome in relation to obstetric interventions were assessed.