Maternal Mortality in India, Causes, Progress, Challenges, Solutions

Recent findings published in The Lancet highlight that India still accounts for 1 in 10 global maternal deaths, despite significant progress over the past three decades. 

Maternal Mortality Meaning

Maternal mortality refers to the death of a woman during pregnancy, childbirth, or within 42 days of termination of pregnancy, from causes related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes.

It is usually measured by the Maternal Mortality Ratio (MMR), which indicates the number of maternal deaths per 1 lakh (100,000) live births in a given period.

Extent and Trends of Maternal Mortality in India

India has made notable progress in reducing maternal mortality over time. Maternal deaths declined sharply from about 1.19 lakh in 1990 to 24,700 in 2023. Similarly, India’s maternal mortality ratio of 2023 has reduced by nearly 80 per cent since 1990 from 508 per one lakh livebirths to 116 per one lakh livebirths, according to a new global analysis published in The Lancet Obstetrics, Gynaecology, and Women’s Health journal.

According to the Sample Registration System (SRS) 2021-23, India’s MMR stands at 88 per lakh live births, indicating continued progress. 

According to the latest United Nations Maternal Mortality Estimation Inter-Agency Group (UN-MMEIG) Report, India has achieved an 86% reduction in MMR since 1990, which far exceeds the global average of 48%. Several factors have contributed to the decline in maternal deaths:

• Increased institutional deliveries: More women are giving birth in hospitals, ensuring timely access to skilled care.
• Better antenatal and postnatal care: Regular check-ups and monitoring have helped identify high-risk pregnancies early.
• Government programmes: Targeted public health interventions, awareness campaigns, and schemes like Janani Suraksha Yojana have played a crucial role.

However, despite this progress, India remains among the highest-burden countries globally, alongside nations like Nigeria, Pakistan, and Ethiopia. According to a major study published in The Lancet Obstetrics, Gynaecology & Women’s Health, India accounted for about 24,700 maternal deaths in 2023, which is roughly one in ten maternal deaths worldwide. 

Globally, around 2.4 lakh women died in 2023 due to pregnancy and childbirth-related causes. The global MMR stands at about 190 deaths per lakh live births, which is still far above the Sustainable Development Goal (SDG) target of below 70. More than half of the countries have not yet achieved this target, indicating that maternal mortality remains a major global health challenge.

State-wise Disparities in India

Maternal mortality in India shows significant regional variation.

• States like Kerala and Tamil Nadu have achieved near-global standards due to better healthcare infrastructure, higher institutional deliveries, and stronger public health systems. 
• In contrast, States such as Uttar Pradesh, Bihar, and Madhya Pradesh continue to report high maternal mortality due to weaker health systems and socio-economic challenges.

This disparity highlights that national averages often mask deep regional inequalities.

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Key Causes of Maternal Mortality in India

The study indicates that most maternal deaths in India are due to preventable causes, which reflects gaps in healthcare delivery. Major causes include: Haemorrhage, which remains the leading cause of maternal death, Hypertensive disorders such as preeclampsia, Infections due to poor postnatal care, Complications from pre-existing conditions. These causes are largely preventable with timely and quality medical intervention.

The most significant decline in maternal mortality occurred between 2000 and 2015. However, the pace of reduction has slowed in recent years, indicating that initial gains have been achieved, but deeper structural issues remain unresolved.

Structural Issues:

• Quality of Healthcare Services: While institutional deliveries have increased, the quality of care remains uneven. Many healthcare facilities lack trained personnel, infrastructure, and emergency obstetric services, leading to avoidable deaths.
• Delays in Access to Care: Delays in seeking care, reaching healthcare facilities, and receiving timely treatment continue to be major contributors to maternal mortality, especially in rural and remote areas.
• Socio-economic and Regional Inequalities: Women from poorer and marginalized communities face higher risks due to limited access to healthcare, low awareness, and financial constraints.
• Impact of COVID-19 Pandemic: The COVID-19 pandemic disrupted maternal healthcare services, reduced access to institutional care, and led to temporary increases in maternal deaths, affecting overall progress.

Way Forward

To meet the SDG goal of MMR below 70 by 2030, India must address persistent challenges in following ways: 

• Strengthen public health systems: Improve the quality and availability of maternal health services, particularly in high-burden states.
• Focus on high-risk pregnancies: Ensure timely identification and management of women with pre-existing conditions or pregnancy complications.
• Reduce regional disparities: Invest in health infrastructure in lagging states such as Uttar Pradesh, Bihar, and Madhya Pradesh.
• Expand awareness and access: Enhance education about maternal health and ensure that women can access skilled care before, during, and after childbirth.
• Mitigate systemic shocks: Build resilience in maternal healthcare systems against pandemics, natural disasters, and other disruptions.