Forest Services
India’s Maternal Mortality Status and Lancet Projections
The Lancet study (2024) projects India’s maternal mortality ratio (MMR) to decline to 85 per 100,000 live births by 2030, short of the Sustainable Development Goal (SDG) target of 70. This projection is based on recent trends where India’s MMR declined from 130 (2014-16) to 103 (2017-19) as per the Sample Registration System (SRS) conducted by the Office of the Registrar General of India (ORGI). Despite this progress, the study underscores persistent regional disparities and systemic challenges that threaten India’s ability to meet the SDG deadline.
India’s maternal health scenario is marked by stark inter-state variation; for example, Kerala recorded an MMR of approximately 46, while Assam reported 215 per 100,000 live births (NFHS-5, 2019-21). Institutional delivery rates have improved to 89% nationally, yet rural-urban and socio-economic gaps remain significant. Indirect causes such as anemia and hypertension contribute to 40% of maternal deaths, highlighting gaps in comprehensive care (MoHFW 2023 report).
UPSC Relevance
- GS Paper 2: Governance - Health policies, SDG targets, public health infrastructure
- GS Paper 3: Economic Development - Health expenditure, economic impact of maternal mortality
- Essay: Public health challenges, gender and health, India’s development goals
Constitutional and Legal Framework Governing Maternal Health
Article 21 of the Constitution of India implicitly guarantees the right to life, which courts have interpreted to include the right to health and maternal care. The National Health Mission (NHM), under the Ministry of Health and Family Welfare (MoHFW), operationalizes maternal health programs such as Janani Suraksha Yojana and Pradhan Mantri Matru Vandana Yojana.
The Pre-Conception and Pre-Natal Diagnostic Techniques (PCPNDT) Act, 1994 (amended 2003) indirectly impacts maternal health by addressing female foeticide, which distorts sex ratios and affects women’s health outcomes. Maternal mortality data is systematically collected through the SRS by ORGI, enabling policy monitoring and evaluation.
Economic Dimensions of Maternal Health in India
India allocated approximately ₹37,000 crore (USD 5 billion) for the NHM in the 2023-24 budget, emphasizing maternal and child health. The Economic Survey 2023 estimates that every ₹1 invested in maternal health yields ₹4-5 in economic returns via improved workforce participation and reduced healthcare costs.
However, out-of-pocket expenditure on maternal health remains high at 70% despite government schemes (NFHS-5). State-level health spending disparities are pronounced, ranging from ₹1,200 to ₹5,000 per capita (NITI Aayog 2023), reflecting uneven resource allocation and affecting service quality and accessibility.
Institutional Roles and Data Monitoring
- MoHFW: Formulates and implements maternal health policies and programs.
- NITI Aayog: Monitors SDG progress, including maternal mortality indicators.
- ORGI: Conducts SRS for reliable MMR data.
- WHO: Provides technical guidance and global benchmarks.
- UNICEF: Supports maternal and child health initiatives.
- NHM: Implements maternal health schemes at state and district levels.
Comparative Analysis: India vs Sri Lanka in Maternal Mortality Reduction
| Indicator | India (2019-21) | Sri Lanka (2020) |
|---|---|---|
| MMR (per 100,000 live births) | 103 (SRS) | 36 |
| Institutional Delivery Rate | 89% | 99% |
| Health Infrastructure | Mixed public-private; variable quality | Robust primary health network with community midwives |
| Maternal Health Financing | ₹37,000 crore (NHM, 2023-24) | Universal free maternal healthcare |
| Focus Areas | Mostly antenatal and delivery care; limited postnatal and indirect causes | Integrated care including nutrition, anemia control, and postnatal follow-up |
Critical Gaps in India’s Maternal Health Programs
India’s maternal health initiatives often neglect socio-cultural barriers such as gender norms, early marriage, and low female literacy, which impede healthcare access. Quality of care in public health facilities remains inconsistent, with insufficient emphasis on indirect causes like anemia and hypertension.
Postnatal care coverage is inadequate, limiting early detection and management of complications. Unlike Sri Lanka’s integrated community midwife programs, India lacks systematic community engagement and continuous care models, reducing effectiveness.
Way Forward: Targeted Interventions to Accelerate Progress
- Enhance quality of maternal healthcare by standardizing protocols and training healthcare workers on indirect causes and postnatal care.
- Address regional disparities through targeted resource allocation and capacity building in high-burden states like Assam and Uttar Pradesh.
- Expand community-based interventions, including midwife-led care and socio-cultural sensitization to overcome access barriers.
- Increase public health financing and reduce out-of-pocket expenditure by strengthening public facilities and insurance coverage.
- Leverage data from SRS and NFHS to monitor program impact and inform evidence-based policy adjustments.
- MMR is the number of maternal deaths per 1,000 live births.
- The Sample Registration System (SRS) is the primary source of MMR data in India.
- The SDG target for India is to reduce MMR to below 70 per 100,000 live births by 2030.
Which of the above statements is/are correct?
- The National Health Mission (NHM) is responsible for implementing maternal health schemes.
- The PCPNDT Act directly aims to reduce maternal mortality by improving antenatal care.
- Out-of-pocket expenditure on maternal health remains high despite government schemes.
Which of the above statements is/are correct?
What is the current MMR in India and the SDG target for 2030?
India’s MMR was 103 per 100,000 live births during 2017-19 (SRS, ORGI). The SDG target for India is to reduce MMR to below 70 per 100,000 live births by 2030.
Which institution collects maternal mortality data in India?
The Office of the Registrar General of India (ORGI) collects maternal mortality data through the Sample Registration System (SRS).
How does the PCPNDT Act relate to maternal health?
The PCPNDT Act, 1994 addresses female foeticide, indirectly impacting maternal health by tackling gender imbalances that affect women’s health and social status.
What are the major causes of maternal mortality in India?
Major causes include direct obstetric complications and indirect causes such as anemia and hypertension, which account for approximately 40% of maternal deaths (MoHFW 2023).
How does India’s maternal health expenditure compare across states?
Health spending per capita varies widely from ₹1,200 to ₹5,000 across Indian states, reflecting disparities in resource allocation and healthcare quality (NITI Aayog 2023).
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