The maternal mortality (MM) rate is a universal indicator of the level of social wellbeing, quality and accessibility of medical care for women during pregnancy, labor and in the postpartum period, which characterizes the state of health and society generally.The authors of the article analyzed trends in the ratio and structure of MM in the period from 1990 to 2021 in the world (according to the data of WHO) and in the Russian Federation (according to the data of Heath Ministry of Russia), assessed the significance of the direct obstetric causes in the dynamics of the rate and structure of MM. In 2020, compared to 2015, 17 countries recorded an increase in the level of MM. Among them is Russia. The MM indicator in the Russian Federation according to the Russian Ministry of Health in 2020 increased by 52.3% compared to 2015 and amounted to 16.3 per 100.000 live births. The first place in the structure of MM was taken by extragenital diseases (71.4%), the second — septic complications (8.1%), the third — bleeding (6.4%). The growth of MM occurs against the background of the growth of critical obstetric conditions caused by direct obstetric causes. In 2021, the increase in the number of MM cases after abortions is noteworthy: twice as compared to 2017 and 1.6 times as compared to 2020. The leading causes of MM in early pregnancy are extragenital diseases, sepsis and bleeding. Taking into account the analytical information presented in the article, today it is impossible to recognize the MM problem as solved. In 2019, the historical minimum of the MM rate was observed in the Russian Federation, which is a confirmation of the potential of Russian Federation for the successful implementation of the United Nations Millennium Declaration in terms of eliminating preventable cases of MM.