To address high levels of maternal mortality in Kigoma, Tanzania, the Program to Reduce Maternal Deaths in Tanzania increased women’s access to high-quality comprehensive emergency obstetric and newborn care (EmONC) by decentralizing services from hospitals to health centers where EmONC was delivered mostly by associate clinicians and nurses. This study presents the Program’s maternal health-related interventions and obstetric results from 13 years of implementation in Kigoma.