OBJECTIVES: Maternal mortality rate in India: a comprehensive literature review. METHODS: Information was retrieved from websites of World Health Organization, Pubmed and grey literature retrieved using key terms like maternal mortality, MMR etc. The relevant prevalence data were extracted and compiled. RESULTS: The maternal mortality rate (MMR) is maternal death per 100,000 live births in one year. WHO estimates show that out of the 529,000 maternal deaths globally each year, 136,000(25.7%) are contributed by India. According to registrar general of India estimates for the year 2000, MMR for India was 407/100,000 live births. The trend has not changed significantly in the last 5 years. In the Armed Forces the scenario is very encouraging with a MMR of 36 per 100,000 live births. In 1980, India reported about 677 maternal deaths per 1, 00,000 live births but in 2008, this was down to 254 deaths. MMR has reduced by 4% a year since 1990. High MMR was reported in Hindu (573) than Muslims (384) and in Illiterate people (574) (1994). India has climbed from bottom to 127th place in the MMR ratings, above Pakistan and just below Nepal. Hemorrhage (25.6-38%) ranks first as the cause of maternal death, followed by anemia (14-24%) sepsis (13-16%), toxemia of pregnancy (11.9%), abortions (8-9%) and obstructed labor (6.2-10%) while other causes together total 35.3%. Tamil Nadu has taken initiatives to improve maternal health services leading to reduction in maternal mortality from 380 in 1993 to 90 in 2007 due to increased rate of institutional deliveries from 20% in 1971 to 97.7% in 2007. CONCLUSIONS: A consistent decline in the maternal mortality rate has been observed in India but it attributes to a few states. Initiatives need to be taken by government in regard to proper facility in hospitals, efficient supply of blood, and iron containing medicines.