Maternal Mortality in India: Progress & Challenges

Context:

Maternal Mortality is a key indicator of public health. India’s Maternal Mortality Ratio (MMR) is declining steadily, but significant regional disparities and systemic challenges remain—especially in the EAG states. Achieving SDG 3.1 (MMR < 70 by 2030) requires targeted interventions.

Definition:

• Maternal Death (WHO): Death of a woman during pregnancy or within 42 days of its end, due to causes related to pregnancy, excluding accidental causes.

• MMR: Number of maternal deaths per 1,00,000 live births.

MMR Trends in India:

• National MMR:

  • 103 (2017–19)

  • 97 (2018–20)

  • 93 (2019–21)

• Highest MMR (EAG States):

  • Madhya Pradesh – 175, Assam – 167, Uttar Pradesh – 151

• Lowest MMR (Southern States):

  • Kerala – 20, Andhra Pradesh – 45, Tamil Nadu – 49

• Other States:

  • Maharashtra – 38, Gujarat – 53, Punjab – 98

Major Causes of Maternal Deaths:

• Postpartum Hemorrhage (PPH)

• Obstructed labor due to anemia/malnutrition

• Hypertensive disorders (eclampsia)

• Sepsis from unsafe home deliveries

• Unsafe abortions

• Infections and co-morbidities like malaria, TB

Government Initiatives:

• Janani Suraksha Yojana (JSY): Promotes institutional deliveries

• PM Matru Vandana Yojana (PMMVY): Financial support for mothers

• Surakshit Matritva Abhiyan (PMSMA): Free monthly check-ups

• 108 Ambulance Services: Emergency transport

• NHM: Focus on maternal and child health

• ASHA/ANM Workers: Awareness and care linkage

Kerala Model (Best Practice):

• Introduced by Dr. V.P. Paily

• Uses confidential reviews, modern tools like uterine clamps, and manages rare complications

• Addresses mental health

• Kerala’s MMR is only 20, lowest in India

Key Challenges:

• Regional inequality, especially in EAG states

• Lack of specialists, blood banks, emergency services

• Social issues: poverty, early marriage, poor nutrition

• Three delays: in seeking, reaching, and receiving care

Way Forward:

• State-specific strategies based on local needs

• Strengthen First Referral Units (FRUs)

• Replicate Kerala model in high-burden states

• Focus on nutrition, awareness, and quality care

Conclusion:

India is progressing, but achieving SDG 3.1 requires targeted, inclusive, and well-coordinated healthcare reforms with focus on high-risk regions.