India’s Maternal Deaths Decline, But Gaps Remain

By: Shreya Maheshwari Goel

India has made steady progress in reducing maternal deaths, with the Maternal Mortality Ratio (MMR) improving to 88 per 1 lakh live births. However, the national average masks wide gaps — while some states are leading the way, others continue to face serious challenges in ensuring safe motherhood.

India’s Maternal Mortality Ratio (MMR) has seen notable improvement in recent years, declining to 88 per 1 lakh live births in 2020-22 from 93 in 2019-21, according to data released by the Office of the Registrar General of India. While this overall progress is encouraging, it conceals wide disparities across different states — with some regions making great strides and others witnessing worrying trends.

Maternal mortality refers to the death of a woman during pregnancy or within 42 days of terminating a pregnancy, regardless of its duration or location. India’s MMR has steadily fallen from 130 in 2014-16 to the current figure of 88. In addition, the maternal mortality rate—the number of deaths per 1 lakh women aged 15-49—also improved, dropping from six to five. Experts attribute this decline to multiple factors, including fewer pregnancies as a result of higher education levels among women, and an increasing number of complex pregnancy cases being handled by the private healthcare sector.

Despite this national progress, some states are seeing an opposite trend. Chhattisgarh’s MMR rose from 131 to 141, Odisha from 135 to 136, Uttarakhand from 100 to 104, Gujarat from 53 to 55, Telangana from 45 to 50, and Andhra Pradesh from 46 to 47. In both Telangana and Andhra Pradesh, the ratio has been gradually increasing over the last three years, although both remain below the national average.

Health experts highlight that many maternal deaths stem from complications often linked to anaemia, with the latest National Family Health Survey reporting that 52.2 percent of pregnant women aged 15-49 are anaemic. Among the states, Madhya Pradesh, despite showing some improvement (from 173 to 159), continues to report the highest MMR in the country — well above the national average. The state’s maternal mortality rate stands at 14, with the lifetime risk of maternal death at 0.47 percent. These figures underscore persistent gaps in healthcare delivery, with issues such as inadequate infrastructure, poor rural access, and failing referral systems being cited. Experts stress the urgent need for better public awareness, stronger prenatal care, and more accessible institutional deliveries to address these gaps.

Conversely, Assam showed the most significant progress, reducing its MMR from 167 in 2019-21 to 125 in 2020- 22 — a notable improvement for a state that had previously reported the highest ratio.

Age also plays a key role in maternal mortality. Women aged 20-24 account for the largest share of maternal deaths (32%), followed by those aged 25-29 (31%). The share decreases with age — only 10% of deaths occur among women aged 35-49. Experts note that this pattern is unsurprising, as the majority of pregnancies occur in younger age groups. However, it is tragic that women in their prime are still dying from largely preventable causes. Further data reveals that in the 20-29 age group, 63% of deaths were due to maternal causes, while 22% were from non-maternal reasons.

Some states have demonstrated how targeted interventions can make a difference. Kerala, for example, has achieved the country’s lowest MMR at just 18 per 1 lakh live births. Officials credit this success to sustained efforts over the past decade, which included quality improvements in maternal healthcare services and steady reductions in annual childbirths.

Similarly, Haryana has made considerable progress, cutting its MMR from 106 to 89, saving an estimated 300 additional lives in the process. The state attributes this success to multiple reforms: nearly universal institutional deliveries (98.3%), upgrades to labour rooms, better emergency obstetric care, and comprehensive management of high-risk pregnancies. Key schemes such as Janani Shishu Suraksha Karyakram and Janani Suraksha Yojana have helped remove financial barriers to care, while regular maternal death audits have strengthened accountability. Campaigns promoting professional medical assistance during childbirth, such as the 'zero home delivery' initiative, have also boosted public confidence in government services.

India’s current Maternal Mortality Ratio of 88 stands as an encouraging sign of progress, especially when compared to neighbouring countries — Nepal (142), Bangladesh (115), and Pakistan (154) — and is well below the global average of 197 per 100,000 live births. Yet, the national average masks wide disparities among states. While states like Kerala and Haryana demonstrate what targeted healthcare investments can achieve, high-burden states such as Madhya Pradesh and Chhattisgarh continue to lag behind. Bridging these internal gaps is now critical. Sustained efforts — from strengthening rural healthcare systems to ensuring equitable access to quality maternal care — will be key to ensuring that every mother in India, regardless of where she lives, has a safe and healthy pregnancy.