This report documents maternity care failures that include abuse of maternity patients by health workers and substandard care in Eastern Cape Province, putting women and their newborns at high risk of death or injury. It examines shortcomings in the tools used by health authorities to identify and correct health system failures that contribute to poor maternal health. Eastern Cape has some of the worst health indicators in South Africa, including high infant, child, and maternal mortality rates. But analyses by government and other public health experts show that other regions experience the same problems, including negative attitudes by health workers, poor quality care, administrative and financial management inefficiencies, and lack of accountability for health system failures.