Maternal Mortality Ratio, Meaning, Trends, Causes, Initiatives

Maternal Mortality Ratio (MMR) is an important indicator of a country’s healthcare system, particularly the quality of maternal health services. It reflects the risk associated with pregnancy and childbirth and highlights the effectiveness of healthcare delivery, nutrition, and social conditions affecting women.

What is Maternal Mortality Ratio?

Maternal Mortality Ratio refers to the number of maternal deaths per 100,000 live births in a given time period. A maternal death is defined as the death of a woman during pregnancy, childbirth, or within 42 days of termination of pregnancy, due to causes related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes.

Maternal Mortality Ratio (MMR) Trends

According to the Sample Registration System (SRS) 2021-23, India’s Maternal Mortality Ratio 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 Maternal Mortality Ratio since 1990, which far exceeds the global average of 48%. 

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.

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. 

At the global level, maternal mortality has declined significantly over the past few decades due to improvements in healthcare services, institutional deliveries, and access to skilled birth attendants. However, progress remains uneven across regions. Developing countries, especially in Sub-Saharan Africa and South Asia, account for the majority of maternal deaths. Under the Sustainable Development Goals, the global target is to reduce MMR to less than 70 per 100,000 live births by 2030. Achieving this target remains challenging due to inequalities in healthcare access, poverty, and gender disparities.

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Maternal Mortality in India Causes

Maternal mortality in India is a multifaceted public health challenge arising from a complex interplay of medical, socio-economic, cultural, and systemic factors that collectively increase the risk of death during pregnancy and childbirth.

Direct Medical Causes

• Severe bleeding, especially postpartum hemorrhage, remains the leading cause of maternal deaths in India, often due to lack of timely medical intervention.
• Hypertensive disorders such as pre-eclampsia and eclampsia contribute significantly to maternal mortality when not diagnosed and managed early.
• Infections like sepsis occur due to poor hygiene during delivery or lack of proper postnatal care.
• Unsafe abortions continue to cause maternal deaths, particularly where access to safe and legal abortion services is limited.
• Obstructed or prolonged labour leads to fatal complications when emergency obstetric care is not available.

Indirect Medical Causes

• Anemia is highly prevalent among Indian women and increases the risk of complications during pregnancy and childbirth.
• Malnutrition weakens the overall health of women, making them more vulnerable to pregnancy-related risks.
• Pre-existing diseases such as heart conditions, diabetes, and infections can worsen during pregnancy and lead to complications.

Healthcare System-Related Causes

• Inadequate healthcare infrastructure, especially in rural areas, limits access to quality maternal care.
• Shortage of skilled healthcare professionals, including doctors, nurses, and midwives, affects safe delivery services.
• Lack of emergency obstetric care facilities results in delays in managing complications.
• Poor quality of care in health institutions, including lack of equipment and overcrowding, contributes to maternal deaths.

Socio-Economic Causes

• Poverty restricts access to nutritious food, healthcare services, and transportation.
• Early marriage and early pregnancy increase health risks for young mothers.
• Low status of women in society often limits their decision-making power regarding healthcare.

Educational and Awareness-Related Causes

• Low female literacy leads to poor awareness about maternal health, nutrition, and the importance of institutional delivery.
• Lack of knowledge about danger signs during pregnancy results in delayed medical intervention.

Cultural and Behavioral Causes

• Preference for home deliveries in some areas increases the risk of complications.
• Traditional beliefs and practices may discourage women from seeking timely medical care.

Accessibility and Infrastructure Issues (Three Delays)

• Delay in deciding to seek care due to lack of awareness or social barriers.
• Delay in reaching healthcare facilities due to poor transport and connectivity.
• Delay in receiving proper treatment due to inadequate facilities or staff shortages.

Government Initiatives to Reduce Maternal Mortality in India

India has undertaken a comprehensive and multi-pronged policy approach to reduce maternal mortality by strengthening healthcare delivery, improving access to maternal services, promoting institutional care, and addressing underlying socio-economic and nutritional determinants.

• Janani Suraksha Yojana (JSY): Launched in 2005 with the objective of reducing maternal and neonatal mortality, JSY promotes institutional delivery among pregnant women especially with weak socio-economic status i.e. women from Scheduled Castes, Scheduled Tribes and BPL households.
• Pradhan Mantri Matru Vandana Yojana (PMMVY), is a maternity benefit program run by the Ministry of Women and Child Development, Government of India. The maternity benefit, of Rs. 5000/-, is available to a woman for the first living child of the family subject to fulfilment of conditionalities. All Pregnant Women who have their pregnancy for the first child in the family on or after 01.01.2017 are eligible for getting benefit under the programme. Further, as per the new guideline for ‘Mission Shakti’, applicable with effect from 01.04.2022, the scheme (PMMVY 2.0) seeks to promote positive behavioural change towards girl child by providing additional cash incentive for the second child, if that is a girl child. 
• Janani Shishu Suraksha Karyakaram (JSSK): Launched in 2011, JSSK aims at eliminating out-of-pocket expenses for pregnant women and sick infants by entitling them to free delivery, including caesarean section, free transport, diagnostics, medicines, other consumables, diet and blood in public health institutions.
• Surakshit Matritva Aashwasan (SUMAN): Launched in 2019, SUMAN aims to provide assured, dignified, respectful and quality healthcare at no cost and zero tolerance for denial of services for every woman and new-born visiting the public health facility to end all preventable maternal and new-born deaths.
• Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA): Launched in 2016, PMSMA provides pregnant women a fixed day, free of cost assured and quality Antenatal Care on the 9th day of every month. Further, Extended PMSMA (e-PMSMA) strategy is implemented to ensure quality ANC to pregnant women, especially to high-risk pregnancy (HRP) women and individual HRP tracking till a safe delivery is achieved by means of financial incentivization for the identified high risk pregnant women and accompanying ASHA for extra 3 visits over and above the PMSMA visit. As on March 21, 2025, more than 5.9 crore pregnant women have been examined under this scheme.
• LaQshya: Launched in 2017, LaQshya aims to improve the quality of care in labour room and maternity operation theatres to ensure that pregnant women receive respectful and quality care during delivery and immediate post-partum.
• Capacity building is taken-up for MBBS doctors in Anesthesia (LSAS) and Obstetric Care including C-section (EmOC) skills to overcome the shortage of specialists in these disciplines, particularly in rural areas. 
• Maternal Death Surveillance Review (MDSR) is implemented both at facilities and at the community level. The purpose is to take corrective action at appropriate levels and improve the quality of obstetric care. 
• Monthly Village Health, Sanitation and Nutrition Day (VHSND) is an outreach activity for provision of maternal and child care including nutrition. 
• MCP Cards and Safe Motherhood Booklet are distributed to the pregnant women for educating them on diet, rest, danger signs of pregnancy, benefit schemes and institutional deliveries.
• Reproductive and child health (RCH) portal is a name-based web-enabled tracking of pregnant women and new-born to ensure provision of regular and complete services to them including antenatal care, institutional delivery and post-natal care. 
• Anaemia Mukt Bharat (AMB) strategy as a part of POSHAN Abhiyan aims to strengthen the existing mechanisms and foster newer strategies to tackle anaemia which include testing & treatment of anaemia in school going adolescents & pregnant women, addressing non-nutritional causes of anaemia and a comprehensive communication strategy.

Several states have pioneered unique initiatives that have significantly contributed to reducing maternal mortality, including:

• Madhya Pradesh’s ‘Dastak Abhiyan‘: A community-driven campaign that focuses on early detection of maternal health risks and ensures timely medical intervention.
• Tamil Nadu’s Emergency Obstetric Care Model: A robust referral system that ensures pregnant women receive timely emergency care, reducing maternal complications.

By building on these success stories and adopting innovative approaches, India is on the right path to achieving further reductions in maternal mortality and ensuring safer pregnancies for all women. To further reduce maternal mortality, India must continue strengthening healthcare systems, enhancing policies, and expanding access to quality maternal health services.