The promotion of a healthy pregnancy and safe childbirth is a major goal of most, if not all, health care systems. Malta and Gozo have been monitored continuously thanks to the National Obstetric Information System and its predecessor projects. The data for a ten year period (1999-2008) was analysed for Malta and Gozo. The data was also analysed to compare with data collected from other similarly populated islands or states such as Gibraltar, Liechtenstein, the Shetland Islands and the Faroe Islands. The healthcare centres available in many small islands such as Gozo, Gibraltar, Liechtenstein, the Shetland Islands and the Faroe Islands may benefit from a detailed investigation into possible reforms to improve on current systems of care. Further data and research is needed to ensure that the most effective strategies for safe motherhood are integrated into essential service packages.