Special Bulletin on Maternal Mortality in India 2021-23

88 Maternal Deaths Per 1,00,000 Births: Stable Progress or Stalled Momentum?

The Special Bulletin on Maternal Mortality in India 2021–23, released on 9 September 2025, reports an estimated Maternal Mortality Ratio (MMR) of 88 per 1,00,000 live births, consistent with the previous assessment period. At first glance, this stability suggests adherence to the National Health Policy (NHP) milestone of an MMR below 100. However, the static number raises foundational questions: is India merely maintaining its gains, or is the decline in maternal deaths slowing down under structural pressures?

Institutional Framework: A Wide Governance Network, Limited Coordination

The bulletin, prepared by the Office of the Registrar General of India (ORGI) under the Ministry of Home Affairs, utilizes data from the Sample Registration System (SRS). This places maternal mortality monitoring amidst a census-heavy mechanism, underscoring its technical credibility but also centralizing processes that often leave implementation gaps.

Maternal health programs span multiple ministries: the Ministry of Health and Family Welfare supervises initiatives like Janani Suraksha Yojana (JSY) and Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA), while the Ministry of Women and Child Development administers benefits under Pradhan Mantri Matru Vandana Yojana (PMMVY). Coordination demands are inherently high. For example, while PMSMA guarantees antenatal care every 9th of the month, logistical constraints at crowded rural health centers often lead to substandard service delivery.

The budgetary commitment for maternal healthcare programs remains under pressure. The allocation for PMMVY 2.0 was increased marginally under Mission Shakti, but at ₹5000 per pregnant woman (with additional incentives for a girl child), the coverage barely offsets out-of-pocket expenses (OOPE) that families incur for diagnostics and daily nutrition requirements.

Policy Depth: Achievements Tempered by Ground-Level Realities

India’s success in achieving an MMR below 100 is commendable, particularly considering the dire figures of the early 2000s when the ratio was well above 300. Programs such as LaQshya, which targets quality improvement in labor rooms, and state-specific innovations like Tamil Nadu’s Emergency Obstetric Care Model, have visibly contributed to safer deliveries. Similarly, Madhya Pradesh’s Dastak Abhiyan exemplifies effective early risk detection.

Yet, the stark regional inequities paint a more complicated picture. The Empowered Action Group (EAG) states, including Bihar, Uttar Pradesh, and Madhya Pradesh, continue to report disproportionately high MMRs compared to Southern counterparts like Tamil Nadu or Kerala. These discrepancies echo systemic failures: rural healthcare facilities in EAG states often lack trained personnel for emergency obstetric care, reliable transport, and antenatal counseling services.

Sociocultural challenges exacerbate the issue. Delayed care-seeking behavior is deeply entrenched in poor families with low literacy rates. For example, tribal women in Jharkhand frequently forego antenatal visits due to stigma or familial resistance. Additionally, national interventions have yet to internalize the surge in high-risk pregnancies caused by lifestyle diseases such as obesity and hypertension.

Structural Tensions: Budget Overreach and Policy Blind Spots

The gap between intent and execution remains striking. Consider the Maternal Death Surveillance Review (MDSR), a community-level accountability initiative aimed at corrective measures. Reports show that while MDSR has succeeded in documenting maternal deaths, actionable outcomes—such as timely staffing or procurement of life-saving drugs—lag far behind.

The friction between central schemes and state-level capacity further complicates progress. Health investments under flagship schemes like Janani Suraksha Yojana deliver results only where local governments ensure implementation fidelity. In hilly regions, such as Uttarakhand and Himachal Pradesh, maternal deaths often result from transport delays, an aspect inadequately addressed by central guidelines.

Funding levels, despite marginal growth, fail to tackle ground realities comprehensively. India spends approximately 1.3% of GDP on health, compared to 8-10% in countries like South Africa. South Africa’s centralized maternal care framework ensures that even its remote regions have access to fully staffed obstetric wards equipped with mobile blood bank services—a model India could adapt to bridge last-mile gaps.

What Would Success Look Like?

Achieving the Sustainable Development Goal (SDG) 3.1 target of an MMR below 70 by 2030 demands more than incremental improvements. Success hinges on refining emergency referral networks, training rural healthcare staff in anesthetic and obstetric skills, and expanding cash-based incentives under PMMVY into multi-child coverage irrespective of gender. However, results will also depend heavily on state-level leadership and capacity building.

Metrics such as maternal death audits, institutional delivery rates, and reductions in OOPE for emergency care should become central to evaluations moving forward. It remains unclear whether the current budget allocations will suffice—or whether political attention will shift as India nears its SDG deadline.

Exam Questions

• Prelims MCQ 1: What does the Maternal Mortality Ratio (MMR) measure?
  • (A) Number of maternal deaths per year.
  • (B) Maternal deaths per 1,00,000 live births. ✔️
  • (C) Total number of institutional deliveries.
  • (D) Rate of antenatal care uptake.
• Prelims MCQ 2: Which program provides free, quality antenatal care on the 9th of every month?
  • (A) Janani Suraksha Yojana.
  • (B) Pradhan Mantri Matru Vandana Yojana.
  • (C) Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA). ✔️
  • (D) LaQshya.

Mains Question: "To what extent has India’s institutional framework for maternal health, including government schemes, reduced maternal mortality? Assess the structural limitations and regional disparities in achieving SDG 3.1 targets."

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