As part of the Confidential Enquiry into the Causes of Maternal Deaths in The Netherlands, substandard care was assessed in immigrant versus indigenous maternal deaths. Except for substandard care related to the women's and relatives' decisions, substandard care factors were hypothesised to occur in similar frequency among both groups of women. The results, however, indicate that substandard care factors related to all aspects of care were disproportionately more frequent in immigrant women. More research into the interpretation of these worrying data is needed.