Objective: To study the difference in causes of maternal deaths at two tertiary centers one being rural and the other urban. Methods: A five years retrospective study from January 2001 to December 2005. Results: The maternal mortality ratio has decreased at Eden (6.09 to 2.81/1000 live births) and risen at Bankura (2.68 to 4.18/1000 live births) over the last five years. Most of the deaths were in the age group of 21-30 (65.48% and 60.62%) and unbooked (81.14% and 67.71%) at Eden and Bankura respectively. Greater number of deaths were noted in early puerperium (68.58% vs. 37.79%) and in multigravidas (71.68% vs. 50.78%) at Eden. Sepsis (30.70%) and jaundice (30.08%) were the major causes of death at Bankura and Eden respectively. Death due to toxaemia has gradually decreased. Conclusion: Majority of the deaths are preventable by proper antenatal care, counseling and asepsis practice. Antenatal care and EmOC are complementary to each other in reducing maternal mortality.