Tens of thousands of women die in India during pregnancy or childbirth or soon after giving birth, a new report says.
The Human Rights Watch (HRW) report says the deaths occur despite government programmes guaranteeing free maternal health care.
The focus of the study is on Uttar Pradesh - India's most populous northern state - where a large number of women die from "preventable causes".
The state is among the most backward in India with abysmal health care systems.
The 150-page report - No Tally of the Anguish: Accountability in Maternal Health Care in India - documents repeated failures both in providing health care to pregnant women in Uttar Pradesh and in taking steps to identify and address gaps in care, HRW said in a press release.
The state has one of the highest maternal mortality ratios in India, but government surveys show it is not alone in struggling with these problems, including a failure even to record how many women are dying.
'Life and death'
"Unless India actually counts all the women who die because of childbirth, it won't be able to prevent those thousands of unnecessary deaths," says Aruna Kashyap, lead researcher of Human Rights Watch.
"Accountability might seem like an abstract concept, but for Indian women it's a matter of life and death," she says.
India has made reducing maternal deaths a major health priority by making maternal health care free for poor women, and providing cash incentives for those delivering at health facilities instead of at home.
Despite this "priority" status, monitoring is so poor there is no reliable record of how many women are dying each year, and whether these initiatives are reaching those who need it the most, the report says.
It cites numerous examples where a breakdown in the system ended tragically.
India created a flagship programme - the National Rural Health Mission - in 2005 to improve rural health, with a specific focus on maternal health.
But the system is not working as it should in many cases, the report says.
It blames corruption and a lack of awareness among women for the sorry state of affairs.