<![CDATA[Background. According to the 2020 Long Form Population Census, Indonesia’s maternal mortality rate (MMR) remains at 189 per 100,000 live births. Strategies to reduce this rate require up-to-date and reliable information on causes of death. Objectives. To describe trends in causes of maternal mortality in Indonesia from 2019 to 2023, to examine shifts in the proportion of deaths due to pregnancy-induced hypertension (PIH) versus hemorrhage, and to assess the quality of data on causes of death. Methods. A descriptive-analytical study with a trend design using freely downloadable secondary data from the 2019–2023 Indonesia Health Profile. The proportion of each cause was calculated relative to total deaths. Changes in the composition of PH and hemorrhage were tested using the chi-square test and the Cochran–Armitage trend test, with 95% Wilson confidence intervals and sensitivity analysis. Results. The number of reported maternal deaths was 4,221 (2019), 4,652 (2020), 7,389 (2021; 40.4% due to COVID-19), 3,572 (2022), and 4,482 (2023). Hemorrhage, preterm birth, and infection accounted for 84–88% of deaths with specific causes from 2019 to 2022. The proportion of HDK relative to the combined total of HDK and hemorrhage rose from 45.4% (95% CI 43.4–47.5) in 2019 to 53.4% (95% CI 49.8–56.9) in 2023 (z = 4.72; p < 0.001), and PHE has surpassed hemorrhage as the leading cause since 2022. The proportion of deaths due to “other” causes rose from 31.1% to 63.0%. Conclusion. Hypertension in pregnancy has now become the leading specific cause of maternal mortality in Indonesia, while the quality of data on causes of death has declined. Midwifery care needs to strengthen the early detection and management of preeclampsia, continue to prioritize the management of postpartum hemorrhage, and contribute to improving data recording through surveillance and maternal mortality response.]]>
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