Overview of Maternal Mortality in India

A 2024 study published in The Lancet reports that India accounted for approximately 24,700 maternal deaths in 2023, ranking it among the countries with the highest maternal mortality globally alongside Nigeria, Pakistan, and Ethiopia. Despite a significant reduction in the Maternal Mortality Ratio (MMR) from 130 per 100,000 live births (2014-16) to 103 (2020-22) as per the Sample Registration System (SRS), the rate of decline has plateaued post-2015. This stagnation signals systemic challenges in healthcare delivery and socio-economic inequalities that impede further progress.

Constitutional and Legal Framework Governing Maternal Health

Article 21 of the Indian Constitution, interpreted by the Supreme Court to encompass the right to health, forms the legal basis for maternal healthcare rights. Landmark judgments such as Paschim Banga Khet Mazdoor Samity v. State of West Bengal (1996) have reinforced the state's obligation to provide maternal health services. The Medical Termination of Pregnancy (Amendment) Act, 2021 expanded access to safe abortion services, indirectly reducing maternal deaths from unsafe procedures. The Pre-Conception and Pre-Natal Diagnostic Techniques (PCPNDT) Act, 1994 addresses female foeticide, which indirectly impacts maternal health by influencing gender ratios and healthcare access. The National Health Mission (NHM), under the Ministry of Health and Family Welfare, operationalizes maternal health programs through its RMNCH+A strategy.

• Article 21 ensures the right to health as part of the right to life.
• Medical Termination of Pregnancy (Amendment) Act, 2021, allows abortion up to 24 weeks under certain conditions.
• PCPNDT Act, 1994, curbs sex-selective abortion, affecting maternal health indirectly.
• Supreme Court rulings emphasize state responsibility for maternal healthcare.
• NHM provides a platform for implementing maternal health interventions.

Economic Dimensions of Maternal Mortality

India’s public health expenditure remains low at approximately 2.5% of GDP (National Health Profile 2023), with a significant portion allocated to maternal health under NHM’s RMNCH+A component. The 2023-24 NHM budget was ₹37,000 crore, reflecting government commitment but highlighting resource constraints relative to population size. Maternal mortality and morbidity cause substantial economic losses through reduced female workforce participation and increased healthcare costs, with World Bank estimates placing these losses in billions annually. Improving maternal health is thus critical for achieving Sustainable Development Goals (SDGs) related to economic growth and gender equality.

• Public expenditure on health: 2.5% of GDP (NHP 2023).
• NHM budget 2023-24: ₹37,000 crore, focusing on RMNCH+A.
• Economic losses from maternal mortality include lost productivity and healthcare costs (World Bank).
• Enhanced maternal health boosts female labor participation and SDG achievement.

Institutional Mechanisms and Data Monitoring

The Ministry of Health and Family Welfare (MoHFW) formulates policies and oversees implementation of maternal health programs. The National Health Mission (NHM) executes RMNCH+A interventions at the grassroots level. The National Institute of Health and Family Welfare (NIHFW) supports capacity building and research. The Registrar General of India (RGI) manages the Sample Registration System (SRS), the primary source for MMR data. Globally, the World Health Organization (WHO) provides technical guidance and benchmarks. The Lancet’s recent study offers updated epidemiological insights critical for policy recalibration.

• MoHFW: Policy formulation and oversight.
• NHM: Program implementation focusing on RMNCH+A.
• NIHFW: Training and research support.
• RGI: SRS data collection and maternal mortality tracking.
• WHO: Global technical standards and benchmarks.
• The Lancet: Epidemiological research and global comparisons.

Data Analysis: Trends and Disparities in Maternal Mortality

While institutional deliveries have increased substantially in India, quality of care and postpartum follow-up remain inadequate, especially in rural and socio-economically disadvantaged populations. Causes of maternal mortality remain predominantly preventable, including haemorrhage, hypertensive disorders, infections, and complications from pre-existing conditions.

Comparative Insights: Nigeria vs India

Nigeria’s MMR at 512 per 100,000 live births is significantly higher than India’s 103, yet Nigeria has implemented community-based midwifery programs and conditional cash transfers that have yielded measurable improvements. India’s slower post-2015 progress suggests a need to strengthen community engagement and financial incentives to reduce rural-urban and socio-economic disparities.

• Nigeria uses community midwives to improve access in rural areas.
• Conditional cash transfers in Nigeria incentivize maternal care uptake.
• India’s programs focus more on institutional delivery numbers than care quality.
• India requires enhanced postpartum care and socio-cultural barrier reduction.

Critical Gaps in India’s Maternal Health Strategy

India’s maternal health programs emphasize increasing institutional deliveries but often neglect quality of care and continuity of postpartum services, which are crucial to reducing preventable deaths. Socio-cultural barriers, such as gender bias and low female literacy, compound access issues. Inadequate health infrastructure, especially in rural and marginalized communities, limits effective service delivery. These gaps contrast with international best practices that integrate community participation, financial incentives, and comprehensive care across the maternal health continuum.

• Overemphasis on institutional delivery numbers without quality assurance.
• Postpartum care coverage below 50%, risking late maternal complications.
• Persistent rural and socio-economic disparities in access and outcomes.
• Insufficient community engagement and culturally sensitive interventions.
• Infrastructure deficits in primary health centers and referral systems.

Way Forward: Policy and Programmatic Recommendations

• Shift focus from quantity to quality of maternal healthcare services, including skilled birth attendance and emergency obstetric care.
• Expand postpartum care coverage through home visits and community health worker engagement.
• Implement targeted financial incentives and conditional cash transfers to improve uptake among marginalized groups.
• Strengthen health infrastructure at primary and secondary levels, especially in high MMR states like Uttar Pradesh, Bihar, and Madhya Pradesh.
• Enhance data systems for real-time monitoring and accountability using digital health tools.
• Address socio-cultural barriers through awareness campaigns and female education initiatives.
• Adopt best practices from countries like Nigeria, adapting community midwifery and cash transfer models to Indian contexts.

Mains Question

Critically analyse the reasons for the plateauing of maternal mortality reduction in India post-2015 despite increased institutional deliveries. Suggest policy measures to accelerate progress in line with global best practices.