A mixed methods observational study with multiple stake holders was undertaken in Tamil Nadu and Meghalaya during 2019-20. The objective of the study was to identify key obstacles in achieving the targeted MMR (Maternal Mortality Ratio) by preventing preventable maternal mortality. The six identified domains were (i) Leadership, governance, accountability, program management, (ii) Health care financing, (iii) Access to quality services, (iv) Intersectoral convergence (v) Community participation, and (vi) Improve measurement systems data quality. In depth qualitative interviews along with secondary data analysis of NFHS-4 (2015-16) were undertaken. Findings suggested that maternal mortality is a compounded result of a multi-pronged problem. The issues include: (i) Lack of trained staff and unfilled vacancies of specialists at healthcare facilities to attend to delivery related emergencies, (ii) Missed opportunity in continuum of care in some states where health information is not comprehensive, especially for young couples by frontline workers; (iii) Maternal health services incur high out of pocket expenditure and are not covered by insurance schemes; (iv) Contextual barriers such as rural and poor women have scant access to information from FLWs; (v) Poor data quality limits our estimation of the incidence rates and true causes of maternal mortality at the national and sub national levels.