Maternal Mortality Ratio (MMR) in India

08.07.2025

Maternal Mortality Ratio (MMR) in India

Context:
India’s Maternal Mortality Ratio (MMR) currently stands at 93 per 100,000 live births (as per 2019–21 data), reflecting gradual progress in maternal health outcomes.

• WHO Definition : A maternal death refers to the demise of a woman during pregnancy or within 42 days of the end of pregnancy, caused by pregnancy-related complications or conditions worsened by pregnancy.
• Maternal Mortality Ratio (MMR) is calculated as the number of maternal deaths per 100,000 live births, based on data from the Sample Registration System (SRS).

Latest Statistics (2019–21):

• National MMR: 93
• Kerala reports the lowest MMR (20), while Assam records the highest (167).
• Southern states perform significantly better than the Empowered Action Group (EAG) states, where maternal health remains a major concern.
   

Why Reducing Maternal Mortality Matters

• Health System Indicator: MMR is a crucial marker of healthcare access, women’s rights, and governance efficiency.
• Preventable Losses: A large share of maternal deaths can be avoided through timely care and basic obstetric interventions.
• Global Target: Under Sustainable Development Goal (SDG) 3.1, countries aim to reduce MMR below 70 by 2030. India must accelerate its progress to meet this benchmark.
   

Major Challenges Contributing to Maternal Deaths

1. Delay in Care – The 'Three Delays' Model:

• Delay in recognizing danger signs and deciding to seek care due to lack of awareness or social norms.
• Delay in reaching healthcare facilities, especially in tribal and remote regions with poor connectivity.
• Delay in receiving appropriate treatment at facilities due to shortages of specialists, surgical readiness, or essential supplies like blood.
   

2. Infrastructure Shortfalls:
Out of 5,491 Community Health Centres (CHCs), only 2,856 operate as First Referral Units (FRUs). Additionally, over 66% of specialist doctor positions remain vacant.

3. Medical and Health-Related Risks:
Major clinical causes include postpartum hemorrhage, hypertensive disorders, prolonged or obstructed labor, infections, and unsafe abortions.
Underlying conditions like anemia, poor nutrition, and infections such as tuberculosis or urinary tract infections add further risk—especially in EAG states.

Government Programs and Interventions

• Janani Suraksha Yojana (JSY): Encourages institutional births through financial support to mothers and Accredited Social Health Activists (ASHAs).
• Janani Shishu Suraksha Karyakram (JSSK): Ensures free transport, diagnostics, and delivery-related services for pregnant women.
• Strengthening FRUs: Government aims to operationalize at least four FRUs in every district, with trained staff and blood storage facilities.
• Maternal Death Reviews (MDRs): Under the National Health Mission, it is mandatory to review every maternal death to address service delivery lapses.
• Kerala’s Model: Kerala’s confidential maternal death audits, combined with staff training and emergency preparedness (e.g., uterine balloon tamponade, embolism kits), have helped it maintain the lowest MMR in India.
   

The Way Forward

• Priority to EAG States: Increased funding and efforts are needed to fill specialist vacancies, upgrade rural FRUs, and improve community awareness.
• Strengthen Emergency Obstetric Response: Ensure round-the-clock blood banks, surgical facilities, and ambulance access in underserved areas.
• Support Frontline Workers: Enhance coordination between ASHAs and Auxiliary Nurse Midwives (ANMs) for tracking high-risk pregnancies and providing counseling.
• Improve Antenatal and Postnatal Care: Focus on early registration, iron and folic acid supplementation, and regular risk screening during pregnancy.
• Scale Successful Models: Kerala’s confidential review approach can be replicated in other states like Tamil Nadu, Maharashtra, and Jharkhand for deeper impact.

Conclusion:
 Maternal deaths are mostly preventable with timely interventions and functional healthcare systems. India must bridge gaps in access, ensure skilled attendance at births, and empower frontline workers to reach its maternal health goals. Achieving safe motherhood—not just safe delivery—must remain the central objective of India’s maternal healthcare strategy.