Substantial efforts to measure maternal mortality ratios have been made recently in industrialized countries. In Europe the ratios appear to be the lowest in the world but two main questions are arising now. The first one is about the true value of the ratios. In the last British report (1994-96) on Confidential enquiries into maternal deaths, the ratio increased from 9.9 to 12.0 per 100,000 live births. This was the result of a linkage between the confidential enquiries and the vital data registrations. In France, the ratio is standing from 9.5 to 13.2 depending on the year. In the US in 1997 the reported maternal mortality ratio was 8.4 per 100,000 live births but studies based on linkages between death certification and birth registers suggest that actual maternal mortality may be more than twice as high than previously reported. The second question is: what sort of indicator do we need. A lot of possibilities exist:  maternal mortality ratio including only direct and indirect obstetrical deaths by live births; pregnancy related mortality rates including deaths of women being pregnant or recently delivered by number of reproductive age women; case fatality rate. The authors discuss the following proposals: maternal mortality ratio (usual WHO definition) as an indicator for evaluating the quality of obstetrical care; the pregnancy related mortality rate as a social indicator for women status and equity. They also propose to improve the accuracy of recording maternal deaths by methods of linkage between death and births certificates.