<![CDATA[Maternal mortality ratio (MMR) remains a crucial indicator reflecting the quality of maternal health services in Grobogan Regency. This study aimed to analyze the main determinants of high MMR, identify gaps in the capacity of maternal health services, and describe efforts undertaken to address the issue. The research employed a descriptive qualitative design with a case study approach, involving in-depth interviews, focus group discussions, health facility observations, and a review of official documents. The findings revealed that direct causes of maternal death included postpartum hemorrhage, hypertensive disorders of pregnancy, and puerperal infection, while indirect causes were related to poor maternal nutritional status, delays in decision-making, and limited transportation access. Capacity gaps were identified in the competencies of health workers, availability of service infrastructure, suboptimal referral systems, and community behaviors favoring traditional home births. Efforts to address these issues encompassed the provision of village ambulances, midwife training, reproductive health education, and strengthening referral coordination. The study recommends more integrated interventions, including the enhancement of obstetric referral systems, improvement of transport infrastructure, increased reproductive health literacy, and multisector collaboration to accelerate the reduction of maternal mortality.]]>
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