BACKGROUND Maternal death has a huge impact on the family, society and the nation. The aim of this study was to calculate the Maternal Mortality Ratio over a period of ten years, to study the main causes and epidemiological factors of maternal death and identify areas needing targeted intervention to achieve the Millennium Development Goal-5 (MDG-5) of reducing Maternal Mortality Ratio (MMR) by three-quarters. RESULTSThere were 34,187 live births with 278 maternal deaths during the study period. The cumulative MMR was 813 per 100,000 live births. Majority 64.7% of maternal deaths occurred in the age group of 21 -30 years, 71.9% were from rural area, 62.9% belonged to low socioeconomic strata and 54.3% were in multigravida. There were 76% unbooked pregnancies and 23% were referred cases. Vast majority 67.9% died undelivered and 66.18% died within 24 hours of admission. Major causes of maternal deaths included eclampsia in 42.8%, anaemia in 26.6% and haemorrhage in 19.06%. CONCLUSIONEclampsia, anaemia and haemorrhage are the major killers. Quality antenatal care, early identification of high-risk pregnancies, early referral, early identification of anaemia during pregnancy and iron supplementation along with proper referral of eclamptic patients will go a long way in reducing maternal mortality. There should be a dedicated HDU and ICU for obstetric cases in tertiary care centres along with availability of blood components in blood banks attached to these centres for dealing with massive obstetric haemorrhage. KEY WORDSMaternal Death, Maternal Mortality Ratio, MDG-5, MMR, Jharkhand, Causes of Maternal Mortality. HOW TO CITE THIS ARTICLE: Rajluxmi T. Maternal mortality-a decade's experience in a tertiary care centre in Jharkhand.