Some scholars emphasize the significance of using human rights to hold states accountable to their commitment to global development goals, such as the Millennium Development Goals (MDGs) and the (renewed and expanded) Sustainable Development Goals (SDGs). Yet, others contest the extent to which such commitments indicate legal obligations, are enforceable, and can be fulfilled by developing states. This article draws on key informant interviews conducted with state and civil society actors in India, to explore the politics of using human rights to frame state accountability for maternal health (MDG 5 and SDG 3.1). The findings reveal that constitutional and institutional design peculiarities and lack of corresponding domestic legislative reforms complicate discursive framing of state accountability for maternal health using human rights, despite state commitment to MDG 5 obligations in form of resource allocation and agency creation. Yet, they also reveal the incremental opportunities to frame state accountability—rooted in citizenship entitlement, rather than human rights norms—made possible through ingenious civil society efforts, which leverage public investment in welfare that stem from state commitment to the MDGs. The findings are consequential to debates over the SDGs, which also lack discursive emphasis on human rights but reflect stronger human rights practices and standards, especially in Goal 16.