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Objective: The health care system in many developing countries is less efficient compared with that in the industrialized world. The aim of the present study was to investigate the differences of the efficiency of the health care in obstetrics in Nigeria, Mali and Togo., Study Design: The data were collected in African district hospitals from Lomé/Togo (n = 1002), Bamako/Mali (n = 1462) and Kaduna/Nigeria (n = 1055) with a routinely applied questionnaire analyzed at the University Giessen and compared with the data from the Department of Obstetrics and Gynaecology Giessen (Germany) (referral hospital) (n = 1313) and the total data pool of the perinatal survey 1993 in Hesse (n = 58430)., Results: The medical history indicates important differences: the incidence of young mothers below 18 is highest in Mali (9.8%) compared with Nigeria (2.7%) and Togo (2.6%) (Hesse 0.6%). In general there is an increased rate of previous pregnancies of more than five: 13-28% (Hesse 2.1%). The rate of prenatal visits is also reduced: more than ten visits have 2% in Togo, 10.6% in Mali and 15.5% in Nigeria (Hesse 72%). Ultrasound examinations are very rare (1-12%) and tocolysis is nearly unknown. As a result the incidence of dead infants in the medical history is high: Mali 28%, Togo 18%, Nigeria 10.8% (Hesse 1.7%), as well as the rate of low birth weight infants. This is also reflected in the perinatal mortality which ranged from 115/1000 in Mali, 77/1000 in Togo and 68/1000 in Nigeria (Hesse 5.3/1000, Ob/Gyn Giessen 16.4/1000)., Conclusion: The improvement of perinatal and maternal health in the developing world can only be achieved if family planning, prenatal care, selection of high risk pregnancies goes in parallel with a sound organization implemented and supported by the government.