This cross-national study examines urban-rural disparities in maternal mortality across 45 low and middle-income countries using demographic and health survey data. Multilevel logistic regression models reveal significantly higher maternal mortality risks in rural areas, with the largest disparities observed in countries with weak health systems. Healthcare access, education, and economic factors mediated approximately 60% of the urban-rural disparity. Targeted interventions addressing rural healthcare infrastructure and socioeconomic barriers are urgently needed to reduce geographic inequities in maternal survival.