UP in India has a high rate of MMR. Obviously there must be some contributory toxicological causes.
Without details of exposure one cannot be sure, a potential, candidate is aflatoxin. exposure increases non-irondeficient anemia, and adverse pregnancy outcomes. See
http://onlinelibrary.wiley.com/doi/10.1111/j.1365-3156.2009.02435.x/full
Is there a maternal mortality surveillance group? Without that, I wouldn't say that a toxicological cause is obvious. Maybe it's undiagnosed preeclampsia/hypertensive disorders of pregnancy. Maybe it's associated with domestic violence. In the US, environmental pollutants certainly affect pregnancy outcomes. Mostly, their associations with birth defects have been studied, but some diminish reproductive capacity in general. I've heard of placental abruption being associated with some pesticides. That may impact maternal mortality.
I am looking for exposure to chemical toxicants through environment or occupation as bacterial infections are to a certain extent already documented as a cause of maternal mortality in the perinatal period. These often have a direct as well as indirect impact. In case a particular toxicant like environmental tobacco smoke can be identified, it would be fairly easy to formulate strategies.
http://www.dshs.state.tx.us/birthdefects/bd_risk_main.shtm
I've found this website really useful in looking at environmental/occupational exposures as they relate to birth defects. If exposures are impacting maternal mortality, then they also would impact rates of anomalies and infant mortality.
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