A state health department reports that the maternal mortality ratio (MMR) in a northern state is 167 per 100,000 live births, compared to the national average of 97. The leading causes of maternal death are postpartum hemorrhage (35%), infection/sepsis (25%), and hypertensive emergencies (20%). The state has adequate numbers of primary health centers and trained birth attendants in most districts. However, 60% of deliveries still occur at home, and only 40% of pregnant women receive 4 antenatal care (ANC) visits. What is the most appropriate next step to reduce MMR in this state?