From 130 to 97: India’s Maternal Mortality Progress and Its Missing Links
India’s maternal mortality ratio (MMR) has declined impressively from 130 per 100,000 live births in 2014-16 to 97 per 100,000 live births in 2018-20, achieving the National Health Policy target of below 100 a decade ahead of schedule. But as we chase the ambitious Sustainable Development Goal (SDG) 3.1 target of 70 per 100,000 live births by 2030, a deeper scrutiny reveals that the structural cracks in our maternal healthcare policy could derail this trajectory. Institutional deliveries are up to 89%, yet high out-of-pocket expenses, gaps in rural infrastructure, and rising high-risk pregnancies persist. The question is, can India sustain this progress or does the narrative mask deeper systemic challenges?
The Policy Instrument: A Multipronged Maternal Care Ecosystem
At the heart of India’s improvements lies an elaborate tapestry of schemes and interventions. The Janani Suraksha Yojana (JSY), launched in 2005, incentivized institutional deliveries among poor women, laying the foundation for robust maternal care uptake. Building on this, the Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA), rolled out in 2016, set a fixed day for free antenatal check-ups, while LaQshya prioritized infrastructural and service quality upgrades in labour rooms and operation theatres.
More recently, these national efforts have been complemented by state-level innovations like Tamil Nadu’s Emergency Obstetric Care Model and Madhya Pradesh’s “Dastak Abhiyan,” marking a shift towards localized solutions. Notable gains include a rise in institutional births to 100% in Kerala, Goa, and Tamil Nadu, while rural areas achieved 87% institutional delivery rates—an impressive feat in a country with deep regional disparities.
However, despite this growth, certain schemes face disconnects between intent and outcomes. For example, the Pradhan Mantri Matru Vandana Yojana (PMMVY), offering Rs. 5,000 as maternity benefit, applies only to the first live birth. Such exclusions leave vulnerable women, particularly those with successive high-risk pregnancies, outside its net.
The Case For: Numbers That Speak Progress
The argument in favor of India’s maternal health interventions is grounded in clear evidence. The correlation between institutional delivery rates rising from 79% (2015-16) to 89% (2019-21) and reducing maternal mortality is striking. Kerala, with 100% institutional births and well-equipped emergency obstetric systems, boasts an MMR of 19 per 100,000 live births, the lowest in India.
From an international perspective, India’s achievements far outpace even middle-income peers like Indonesia, where the MMR remains around 177 per 100,000 live births despite comparable economic indicators. Strategic gains in institutionalizing deliveries combined with programs targeting awareness, quality antenatal checks, and skilled birth attendance explain this edge.
Moreover, the implementation of Maternal Death Surveillance Reviews (MDSR) has enhanced accountability by identifying deaths and triggering corrective measures, a systematic effort rare in developing countries. When functional, such reviews reduce disparities by ensuring regions with historically poor performance do not lag unnoticed.
The Case Against: From OOPE to Fragmented Infrastructure
Despite the headline successes, worrying gaps persist. High out-of-pocket expenditure (OOPE), estimated to consume nearly 62% of maternal healthcare costs even after policy interventions, exposes families—especially rural and economically weaker households—to financial vulnerability. JSY incentives can barely cover medical emergencies involving diagnostics and specialist services.
The disconnect between schemes like PMMVY's restrictive eligibility of “first live birth” and actual demographic realities leaves out women with critical antenatal needs, particularly in socioeconomically disadvantaged and tribal regions. States with high MMRs like Assam (MMR 195) continue to grapple with poor accessibility to blood storage facilities and reliable emergency transport.
Rising high-risk pregnancies induced by obesity, diabetes, and delayed motherhood further stretch fragile infrastructure. Ironically, while antenatal programs aim at early intervention, India lacks holistic screening protocols for emerging risk profiles, leaving a growing demographic vulnerable in the absence of tailored maternal care mechanisms.
What Other Democracies Did: The Case of Sweden
India’s maternal health dilemmas find a sharp international comparator in Sweden, which reduced its MMR to 4 per 100,000 live births—among the lowest globally—through universal healthcare access and localized midwifery services. The Swedish model explicitly integrates specialized antenatal screening for high-risk conditions within its primary healthcare system, bridging gaps in early intervention. Sweden also places substantial emphasis on community-based care, ensuring maternal healthcare reaches sparsely populated areas without compromising quality.
India might learn from Sweden’s focus on guaranteed rural healthcare by expanding schemes like Village Health, Sanitation, and Nutrition Day (VHSND), which are currently too sporadic to ensure sustainable care delivery in tribal belts and hilly regions.
Where Things Stand: Striking a Realistic Balance
India’s maternal mortality reduction cannot be dismissed as policy tokenism. Institutional frameworks, evolving infrastructure, and targeted schemes have undoubtedly borne fruit. Yet achieving the SDG target of 70 MMR by 2030 requires more than tweaking budgets or celebrating incremental improvements. The tension lies between scaling high-quality services and addressing socioeconomic inequities that impede access, particularly in vulnerable geographies.
A decisive pivot is necessary—towards robust screening for high-risk pregnancies, universal cost coverage for maternal emergencies, and integrating gender-sensitive community involvement within existing frameworks. Otherwise, aggregate national success could conceal localized failures, derailing progress.
Practice Questions for UPSC
Prelims Practice Questions
- Statement 1: The Janani Suraksha Yojana was launched to incentivize institutional deliveries among poor women.
- Statement 2: The Pradhan Mantri Matru Vandana Yojana provides maternity benefits for all live births.
- Statement 3: Kerala has an MMR of 19 per 100,000 live births.
Which of the above statements is/are correct?
- Statement 1: Institutional deliveries have reached 100% in every state.
- Statement 2: High-risk pregnancies are on the rise.
- Statement 3: Many women lack access to emergency transport services.
Which of the above statements is/are correct?
Frequently Asked Questions
What are the key factors contributing to India’s decline in Maternal Mortality Ratio (MMR)?
India's decline in MMR can be attributed to a range of factors, including increased institutional deliveries due to schemes like the Janani Suraksha Yojana and the Pradhan Mantri Surakshit Matritva Abhiyan. Furthermore, enhanced accountability measures like Maternal Death Surveillance Reviews have facilitated timely interventions and identified gaps in maternal healthcare, ensuring that regions with higher mortality rates receive the necessary attention and resources.
How does out-of-pocket expenditure (OOPE) affect maternal healthcare access in India?
High out-of-pocket expenditure (OOPE) remains a significant barrier in accessing maternal healthcare in India, with reports indicating it consumes about 62% of maternal healthcare costs. This financial burden poses a heightened risk for families, especially those from rural and economically disadvantaged backgrounds, leaving them vulnerable to insufficient maternal care during emergencies.
What are some systemic challenges facing India's maternal healthcare despite the improvements?
Despite the progress made in lowering the MMR, systemic challenges such as gaps in rural infrastructure, rising high-risk pregnancies, and restrictive eligibility criteria for certain schemes continue to hinder optimal maternal care. The disconnect between policy intent and actual outcomes, particularly for disadvantaged groups, raises concerns about the sustainability of these health gains.
How do India’s maternal health interventions compare internationally, particularly with Sweden?
India's maternal health interventions have achieved significant improvements, yet they still fall short when compared to countries like Sweden, which boasts an MMR of 4 per 100,000 live births. Sweden's success stems from its universal healthcare access, community-based midwifery services, and specialized antenatal screening, which contrasts with India's fragmented and often inadequately funded healthcare infrastructure.
What role do state-level innovations play in improving maternal healthcare in India?
State-level innovations, such as Tamil Nadu's Emergency Obstetric Care Model and Madhya Pradesh’s Dastak Abhiyan, play a crucial role in tailoring maternal healthcare solutions to local needs. These localized approaches complement national schemes by addressing unique regional challenges, ultimately increasing institutional delivery rates and enhancing the quality of maternal care.
Source: LearnPro Editorial | Daily Current Affairs | Published: 24 December 2025 | Last updated: 3 March 2026
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