Articles on 8 July 2025

Context

• Maternal mortality remains a critical public health concern in India, reflecting the broader socio-economic, infrastructural, and systemic challenges facing the country's healthcare system.
• While India’s Maternal Mortality Ratio (MMR) has improved, falling from 103 in 2017–19 to 93 in 2019–21, this still translates to 93 women dying for every 1,00,000 live births.
• Therefore, it is important to analyse the various dimensions contributing to maternal mortality in India, highlighting the disparities among different states and strategic solutions.

The National Picture and Regional Disparities

• Empowered Action Group (EAG) States
  • States including Bihar, Jharkhand, Madhya Pradesh, Chhattisgarh, Odisha, Rajasthan, Uttar Pradesh, Uttarakhand, and Assam, represent the most concerning figures.
  • Madhya Pradesh (175) and Assam (167) have alarmingly high MMRs, highlighting acute systemic gaps.
• Southern States
  • Kerala, Tamil Nadu, Andhra Pradesh, Telangana, and Karnataka perform significantly better.
  • Kerala leads the nation with the lowest MMR of 20, exemplifying what committed governance, effective training, and community health initiatives can achieve.
• Other States
  • This list comprises Maharashtra, Gujarat, Punjab, Haryana, and West Bengal and displays a mixed picture, indicating the need for tailored policy interventions to address state-specific challenges.

The Three Delays Model: Understanding Maternal Deaths

• Delay in Decision-Making to Seek Care
  • Often rooted in poor health literacy, financial insecurity, or gendered social norms, this delay can be fatal.
  • Families underestimate complications, assuming childbirth is a routine process.
  • However, community engagement through ASHA workers, self-help groups, and financial incentives under the National Rural Health Mission have begun to shift attitudes, promoting institutional deliveries.
• Delay in Reaching Healthcare Facilities
  • Geographic isolation, inadequate transportation, and poor road connectivity are barriers in rural and tribal areas.
  • The 108-ambulance service and emergency transport provisions under the National Health Mission have mitigated this to some extent, but challenges persist.
• Delay in Receiving Adequate Care at the Facility
  • This is perhaps the most inexcusable of all delays.
  • Systemic issues like understaffed hospitals, lack of blood banks, absence of skilled obstetricians or anaesthetists, and delayed emergency response contribute significantly to avoidable deaths.
  • A non-functional operation theatre or delayed availability of lab results can mean the difference between life and death.

Medical Causes of Maternal Mortality

• Postpartum Haemorrhage
  • The leading cause, often due to uterine atony, which can lead to massive blood loss.
  • In the absence of timely blood transfusion and uterine contraction management, death occurs swiftly.
• Obstructed Labour
  • Especially prevalent among malnourished, stunted women with narrow pelvic structures.
  • Without timely Caesarean sections, prolonged labour can cause uterine rupture and foetal death.
• Hypertensive Disorders: Conditions like preeclampsia and eclampsia are often undetected and untreated, resulting in seizures, coma, or death.
• Sepsis: Caused by unsafe home deliveries or crude abortion practices, particularly in areas with poor access to contraception and trained medical personnel.
• Coexisting Illnesses: Diseases like tuberculosis, malaria, and urinary tract infections compound maternal risk, especially in underdeveloped states.

Models of Success: Learning from Kerala

• Kerala’s approach stands out as a national and even global benchmark.
• The state’s implementation of the Confidential Review of Maternal Deaths, pioneered by Dr. V.P. Paily, has helped identify and address avoidable causes.
• Strategies such as early use of uterine artery clamps, management of amniotic fluid embolism, and proactive treatment of antenatal depression exemplify a comprehensive model of care.
• This goes beyond the physical to address the psychological and social aspects of maternal health.
• This proactive approach, backed by routine audits, robust training, and community engagement, should serve as a template for other states, particularly in the south and parts of western India.

Recommendations and the Way Forward

• Enhance Antenatal Care: Early registration, regular check-ups, and management of pre-existing conditions must be rigorously implemented.
• Strengthen Institutional Deliveries: Public awareness campaigns and incentives must continue, especially in high-risk zones.
• Upgrade First Referral Units (FRUs): Each district must have fully functional FRUs with emergency obstetric services, a 24x7 blood bank, and trained personnel.
• Expand Human Resources: Training and deploying more obstetricians, anaesthetists, and nurses in rural areas is essential. Task-sharing models and telemedicine can also help bridge gaps.
• Robust Transport Mechanisms: Ambulance systems need to be expanded and better integrated with community health networks.

Conclusion

• Maternal mortality is not merely a health issue; it is a reflection of a society’s commitment to the well-being of its women.
• While India has made commendable progress in reducing MMR, the journey is far from over.
• The existence of high-performing models like Kerala proves that with political will, systemic investment, and community involvement, preventable maternal deaths can be a thing of the past.
• The tragedy of 93 women dying out of every one lakh live births should not be normalised and it is both a challenge and a call to action, for policymakers, healthcare professionals, and society at large.

Fostering a Commitment to Stop Maternal Deaths FAQs

Q1. What is India's Maternal Mortality Ratio (MMR) for 2019–21?
Ans. India's Maternal Mortality Ratio for the period 2019–21 is 93 maternal deaths per 1,00,000 live births.

Q2. Which state has the lowest MMR in India?
Ans. Kerala has the lowest Maternal Mortality Ratio in India, with only 20 deaths per 1,00,000 live births.

Q3. What is the leading medical cause of maternal death in India?
Ans. The leading medical cause of maternal death in India is postpartum hemorrhage, which is severe bleeding after childbirth.

Q4. What are the three delays in maternal healthcare?
Ans. The three delays refer to delays in deciding to seek care, delays in reaching a healthcare facility, and delays in receiving appropriate care once at the facility.

Q5. What program helped increase institutional deliveries in India?
Ans. The National Rural Health Mission (NRHM) helped increase institutional deliveries in India through community health workers and financial incentives.

Source: The Hindu