SUMMARY The slow decline in perinatal mortality is a worldwide problem, which is particularly concerning in low- and middle-income countries, where perinatal deaths are most prevalent. In these settings perinatal deaths are often unregistered, unreviewed, and not learned from. Suriname faces similar challenges, with no formal review system or national strategy to reduce perinatal mortality. The objective of this thesis was to enhance understanding of perinatal mortality (and other adverse perinatal outcomes) in Suriname and establish nationwide, evidence-based and context-specific recommendations that have the potential to reduce adverse perinatal outcomes. This thesis bundles various studies conducted between 2016 and 2022, that provide insights into prevalence’s, risk factors, causes and modifiable factors of perinatal mortality and other adverse perinatal outcomes. Additionally, this thesis evaluates the international perinatal death classification system (ICD-PM) and studies Caesarean Sections (CS) and the corresponding perinatal outcomes in Suriname. This work formed the foundation for implementation of the first steps of the Perinatal Death Surveillance and Response (PDSR) cycle in Suriname, which was done using a bottom-up approach and made possible due to Surinamese health care professionals’ dedication and compassion. The findings described in this thesis offer valuable lessons that can enhance the quality of obstetric care in Suriname and beyond