According to the Countdown to 2015 for maternal, newborn, and child survival, only 9 of the 75 Countdown countries will reach the Millennium Development Goal 5 target to reduce the maternal mortality ratio (MMR) by 75% by 2015. Bangladesh is 1 country on track to reach this goal. This study was undertaken to determine how Bangladesh reduced maternal mortality, with a focus on change during 1998 to 2001 and 2007 to 2010. Data from 2 high-quality household surveys, the 2001 and 2010 Bangladesh Maternal Mortality Surveys, were used for the primary analyses. The surveys assessed the country for maternal health, particularly national estimates of MMR, by obtaining information on background characteristics, full birth histories from ever-married women aged 13 to 49 years, and indicators of maternal health. Data were also obtained from 6 demographic and health surveys performed between 1993 and 2011. The analysis focused on comparing the 3-year periods preceding the 2001 and 2010 surveys. Variables in the pooled data set were whether the mother died and, if so, whether the cause was maternal, socioeconomic and demographic characteristics, and maternal care-seeking behaviors. Poisson regression analysis was used to assess relationships between the change in risk of maternal death from 2001 to 2010 and various demographic, socioeconomic, and health care factors. Maternal mortality ratio decreased from 322 (95% confidence interval, 253-391) deaths/100,000 live births in 1998 to 2001 to 194 (95% confidence interval, 149-238) deaths/100,000 live births in 2007 to 2010, for an average annual rate of decrease of 5.6%. Although direct obstetric causes of death decreased between 2001 and 2010 (eclampsia by 50%, hemorrhage by 35%, obstructed labor by 26%, and abortion by 85%), most of these causes remained important in 2010. The 40% reduction in maternal mortality in Bangladesh in less than 10 years was attributed to several major measures. First, a series of 5-year plans focused on comprehensive maternal and child health services and access to family planning services. The main aim was to promote antenatal care, tetanus toxoid immunization, iron supplementation, clean delivery practices, and family planning. Major investments were made to establish and upgrade health facilities to deliver services and train community-based skilled birth attendants to promote safe delivery at home, stimulate demand for maternal health services, and strengthen health education and communication activities toward behavior change in reproductive health. Second, availability and access to facilities providing delivery services improved substantially, especially for private sector facilities. Improvement in access to public sector facilities was likely due to improved transportation. Third, use of maternal health services doubled during 1993 to 2011. A greater than 3-fold increase in deliveries by medically trained providers was noted, primarily after 2001. In addition, the overall cesarean section rate increased greater than 7-fold (2.6%-17.1%). Between 2001 and 2010, fertility dropped from 3.2 to 2.5 children/woman, consistent with the steady increase in use of modern contraceptives. Reductions in fertility were mainly among older, higher-parity women, thus contributing to MMR decrease. Fourth, major improvements in education of women and exposure to mass media contributed to increased awareness about maternal health and improved health-seeking behaviors. Increasing proportions of women live in urban areas with better access to health care. Economic situations in households also substantially improved during this period. The rapid decrease in the Bangladeshi MMR resulted from the changes in the age and parity distribution of births between 2001 and 2010, increases in the use of skilled attendants at delivery, and improved economic status of households along with improved access to facilities, growth of the communication sector, and higher levels of education. The evidence offers a strong rationale for accelerating access to and the quality of facilities providing care for maternal complications and safe delivery services in Bangladesh.