Abstract
INTRODUCTION: Maternal health, a crucial indicator of human development and social justice, faces persistent challenges, especially in low- and middle-income countries. This study analyzes policies and interventions aimed at reducing maternal mortality in Iran. METHODS: In this multimethod qualitative study with case study approach semi-structured key informant interviews with 43 key Iranian policymakers and experts (selected via purposive sampling), and a review of literature was conducted to explore the type and content of the national maternal mortality reduction policies and interventions employed in Iran from 1981 to 2021 (last 40 years). The data were analyzed using the WHO’s Six Building Blocks framework and the Universal Health Coverage approach. RESULTS: The study identified 11 macro policies and 56 health interventions, categorized within the WHO’s Six Building Blocks framework (leadership, workforce, financing, service delivery, health information, and medical products and technologies) and 14 sub-areas. Key policies, including the integration of medical education, the establishment of health networks, and free antenatal care, significantly contributed to maternal mortality reduction (from 44 in 2000 to 22 in 2020, per 100 000 live births), aligning with Universal Health Coverage (UHC) principles. Document and evidence review indicates that policies and interventions, both within and outside the health sector, significantly reduced maternal mortality in Iran (from 44 cases in 2000 to 22 in 2020). However, limited empirical evidence exists regarding intervention effectiveness (only 4 relevant studies were found). CONCLUSION: This analysis demonstrates that policies and interventions within the Iranian health system have significantly reduced maternal mortality. Further research prioritizing the evaluation of policy effectiveness, particularly those outside the health system, is crucial. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12913-025-13688-4.