Pakistan is the sixth most populous country in the world and is ranked 53rd in the list of countries contributing towards high maternal mortality ratios. According to a recent maternal mortality survey, the current maternal mortality ratio of Pakistan is 186 per 100,000 live births with high disparities among provinces; Balochistan is the highest contributor with MMR of 298 per 100,000 live births. This study specifically focuses on the causes and contributory factors of high maternal deaths in Balochistan based on the evidence generated by the Maternal and Perinatal Death Surveillance and Response system. MPDSR provides the decision-makers with reliable and timely data to take the required action to reduce preventable maternal deaths. Maternal mortality data was collected from the three pilot tertiary health care facilities and data was analyzed using Statistical Package for Social Sciences version (20.0). Out of 40 notified maternal deaths in the period January 2020 till July 2020 around 39 deaths were reviewed and analyzed. This study found that of these 39 maternal deaths around 32% were attributed to hemorrhage, and around 15% and 12% resulted from eclampsia and sepsis respectively. Other major causes of maternal deaths included obstructed labour (10%), embolism (10%), and anesthesia complications (2%) respectively. Non-medical causes of these maternal deaths included shortage of human resource (7.7%), lack of medical equipment (7.7%) and failure to recognize the danger signs earlier (5.1%). The major underlying factors of these maternal deaths included low antenatal visits, underutilization of family planning services, poor referral system, and delays at all levels in the three-delay model. The study concluded that almost all of these maternal deaths could be avoided by undertaking appropriate measures and timely actions.