India has the largest number of births per year (27 million) in the world.1 With its high maternal mortality of about 300–500 per 100 000 births, about 75 000 to 150 000 maternal deaths occur every year in India.2,3 This is about 20% of the global burden hence India's progress in reducing maternal deaths is crucial to the global achievement of Millennium Development Goal 5 (MDG 5). Why is India's maternal mortality high in spite of rapid economic growth? We believe the key reasons are political, administrative and managerial rather than a lack of technical knowledge.