ABSTRACT Introduction Maternal Mortality Rate (MMR) target in Indonesia based on the MDG’s is 102 and it was not reached during the 15 years of development. Recent studies in Indonesia showed that 50% of total maternal mortality in Indonesia took place in the island of Java (the most modern island in Indonesia) and 53% was caused by inappropriate clinical decision in the hospital. This research aimed to describe the factors, related to health service management, that caused maternal death in the hospital. Method This research uses a mixed method study. Obstetric structure data were collected at the province-level based on Ministry of Health in 2015. Results A significant bivariate correlation was found between high number of maternal mortality and number of hospital in each province and also number of obstetrician in hospital. The FGD revealed some problems accounted for high maternal mortality, such as the unskilled health care providers whereas obstetricians weren’t available, delayed hospital-arrival of the patients, unsuccessful high risk pregnancy restriction, and low support from husband. Conclusion Comprehensive and continuous antenatal care between primary health care and hospital has an important role in reducing maternal death in the hospital. Further studies should be done regarding the opportunity of policy implementation on 24 hours availability of obstetrician in hospital.