Overview

India has made commendable progress in reducing maternal mortality, with the Maternal Mortality Ratio (MMR) declining from 384 in 2000 to 80 in 2023 — an 86% drop since 1990, outpacing the global average decline of 48%. Despite this, a recent study published in The Lancet Obstetrics, Gynaecology & Women’s Health highlights a concerning slowdown in progress after 2015. India still accounts for one in ten global maternal deaths, primarily due to preventable causes such as haemorrhage, infections, and hypertensive disorders.

To meet Sustainable Development Goal (SDG) Target 3.1 — reducing MMR to below 70 per 100,000 live births by 2030 — India must address systemic challenges in healthcare infrastructure, human resources, and deep-rooted socio-cultural determinants.

Key Highlights of the Study

Pace of Progress and Persistent Burden

  • MMR in India has dropped to one-fifth of its 1990 level.
  • Progress has slowed significantly after 2015.
  • Preventable causes remain leading contributors:
  • Postpartum haemorrhage
  • Infections (sepsis)
  • Hypertensive disorders (eclampsia, pre-eclampsia)

Regional Disparities

  • Kerala, Maharashtra, Tamil Nadu: MMR < 70 (achieved SDG target)
  • Assam: 195
  • Madhya Pradesh: 173
  • Uttar Pradesh: 167
  • Bihar: 118
  • National average: 80 (2023)

This stark inter-state variation reflects unequal access to quality maternal healthcare and differential implementation of public health programs.

Impact of the Pandemic

  • Covid-19 disrupted services: Antenatal visits and institutional deliveries declined.
  • Frontline health workers were redeployed, weakening routine maternal care.
  • Delayed referrals and reduced access to emergency obstetric care increased risks.

Need for Systemic Strengthening

  • Expanding infrastructure alone is insufficient.
  • Must integrate improvements in primary healthcare, midwifery, and social determinants like nutrition and gender equity.

What is Maternal Mortality?

  • Definition: Death of a woman while pregnant or within 42 days of termination of pregnancy, from any cause related to or aggravated by pregnancy or its management (excluding accidental or incidental causes).
  • Global Scenario (2023): ~260,000 maternal deaths annually (~700 per day), mostly preventable.

Maternal Mortality Ratio (MMR)

  • Number of maternal deaths per 100,000 live births.
  • A key indicator of maternal healthcare access and quality.
  • India’s MMR Trend:
  • 2000: 384
  • 2020: 103
  • 2023: 80

Challenges Hindering Quality Maternal Healthcare

1. Human Resource Crisis in Rural Areas

  • According to Rural Health Statistics (RHS) 2021–22:
  • Nearly 80% shortfall of specialists (OB-GYNs, surgeons, paediatricians) at Community Health Centres (CHCs).
  • Overburdened staff unable to provide timely care.

2. Underutilized Midwifery Cadre

  • India follows a doctor-centric model, unlike UK or Scandinavia where midwives lead low-risk deliveries.
  • Nurse Practitioner in Midwifery (NPM) initiative is in early stages.
  • Nurses are overworked and lack formal midwifery training.

3. Infrastructure and Supply Chain Deficits

  • Many First Referral Units (FRUs) lack 24x7 emergency obstetric care (EmOC) readiness.
  • Blood banks: Secondary facilities often lack functional blood storage units.
  • Delays in treating postpartum haemorrhage (PPH) increase fatality risk.
  • Drug shortages:
  • Magnesium sulfate (for eclampsia)
  • Oxytocin (for PPH)
  • Intermittent supply undermines frontline response.

4. Quality vs. Commercialization Divide

  • NFHS-5 Data:
  • C-section rate in private facilities: 47.4%
  • WHO-recommended ideal range: 10–15%
  • Over-medicalization leads to:
  • Unnecessary surgical risks
  • Longer recovery
  • Higher out-of-pocket expenditure

5. Social Determinants of Health

  • Anemia: 57% of women (15–49 years) are anemic (NFHS-5).
  • Patriarchal norms: “Women eat last and least” → chronic malnutrition
  • Minor bleeding can become fatal
  • Child Marriage: 23.3% of women aged 20–24 married before 18 (NFHS-5)
  • Teenage pregnancies → higher risk of cephalopelvic disproportion, prolonged labor, and maternal death

Measures to Strengthen Maternal Healthcare

1. Respectful Maternity Care (RMC)

  • Ensures dignity, privacy, informed consent, and emotional support during childbirth.
  • Includes:
  • Training staff in communication and empathy
  • Allowing birth companions
  • Eliminating obstetric violence (verbal abuse, neglect)

2. Midwifery-Led Care Units (MLCUs)

  • Establish Nurse Practitioners in Midwifery (NPM) as a dedicated cadre.
  • Midwives manage low-risk deliveries → reduce C-section rates → decongest tertiary hospitals.

3. Blood Storage and Transport

  • Expand “Hub and Spoke” blood bank model.
  • Ensure every high-delivery-load facility has a functional blood storage unit.
  • Critical for managing PPH within the “golden hour”.

4. Digital Tracking of High-Risk Pregnancies

  • Use Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA) portals to:
  • Identify high-risk cases (e.g., severe anemia, hypertension)
  • Enable early referral to specialists

5. Combatting Maternal Anemia

  • Strengthen Anemia Mukt Bharat program:
  • Mandatory IFA supplementation
  • Community-level counseling to change food distribution practices
  • Focus on adolescent girls and pregnant women

6. Empowering Frontline Workers

  • ASHA and Anganwadi workers need:
  • Better diagnostic tools (e.g., digital hemoglobinometers)
  • Higher incentives for tracking postpartum care (not just delivery)
  • Training in identifying danger signs

Conclusion

India has made strong strides in maternal health, but the final push to achieve SDG 3.1 requires a shift from mere access to quality, equitable, and respectful care. Addressing structural gaps in healthcare delivery and tackling social determinants — especially anemia, child marriage, and gender inequality — is essential for sustainable progress.

Drishti Mains Question

Q. “India has improved maternal health outcomes, yet structural and social challenges persist.” Critically examine.

Model Points:

  • Progress: Decline in MMR, expansion of institutional deliveries, schemes like Janani Suraksha Yojana (JSY), PMSMA.
  • Structural Challenges: HR shortages, poor EmOC readiness, underutilized midwifery, supply chain gaps.
  • Social Challenges: Anemia, early marriage, gender bias in nutrition, low female education.
  • Way Forward: Invest in primary care, scale up NPMs, enforce RMC, strengthen convergence between health and nutrition programs.

UPSC PYQ

Mains 2020: In order to enhance the prospects of social development, sound and adequate health care policies are needed particularly in the fields of geriatric and maternal health care. Discuss.

Approach:

  • Link maternal health to human capital and social development.
  • Discuss policy initiatives (JSY, PMSMA, HWCs).
  • Highlight gaps in quality, equity, and social determinants.
  • Emphasize need for integrated, gender-sensitive policies.