Maternal and Perinatal Death Surveillance and Response (MPDSR) is an established, sound and robust system for reviewing maternal deaths and establishing nationwide enquiries into deaths during pregnancy labour and puerperium. MPDSR is a system that measures and tracks all maternal and perinatal deaths in real time, helps to understand the underlying factors contributing to the deaths, and stimulates and guides actions to prevent future deaths. It is a form of continuous surveillance that links the health information system and quality improvement processes from local to national levels, permits routine identification, notification, quantification, and determination of causes of maternal and perinatal deaths, and is useful information to help respond with actions that will prevent future deaths. MPDSR also supports the delivery of quality maternal and newborn health care. This report explores the current status of MPDSR in countries in the ESA region, including tracking progress from and identifying implementation challenges and recommendations for strengthening MPDSR systems. Evidence shows that countries in the region are at different levels in implementing a robust MPDSR system. The report aims to identify country specific bottlenecks and highlights successful practices tailored to countries for the effective implementation of MPDSR.