Bangladesh has achieved important health gains over the last decade. However, equivalent progress has not been realised in the area of maternal health. The maternal mortality ratio as an indicator of maternal health in Bangladesh remains unacceptably high. In many ways the existence of a high MMR represents the failure of the health system to effectively respond to the needs of women in the country, yet it must also be seen as the end point in a life time experience of gender discrimination, neglect and deprivation for Bangladeshi women. From a health systems perspective, maternal mortality is an indicator not only of women's health but also of access, quality and effectiveness of the country's health sector.