Decline or Denial? The Reality of Maternal Deaths in India

What is the maternal mortality rate in India?

Maternal Mortality Rate (MMR) is a chilling measure of the number of mothers who lose their lives during pregnancy, childbirth, or within 42 days after delivery, due to complications related to pregnancy or its management. It is expressed as the number of maternal deaths per 100,000 live births, serving as a stark reminder of the risks and inequalities women face in bringing life into the world.

Reproductive Health Failures: The Silent Killer of Mothers

The reproductive health of mothers is deeply intertwined with maternal mortality, forming the foundation upon which their survival during pregnancy and childbirth depends. 

Impact of Compromised Health on Maternal Survival: Poor reproductive health leads to complications such as severe bleeding, infections, unsafe abortions, and high blood pressure, which are the leading causes of maternal deaths globally (75%).

Access to Prenatal Care: Lack of adequate prenatal care leaves conditions like anemia, gestational diabetes, and infections undiagnosed and untreated. For example, anemia affects 50% of pregnant women in India, increasing the risk of severe postpartum hemorrhage, a major cause of maternal death.

Unsafe Abortions: Women with limited access to contraception often resort to unsafe abortions, contributing to 8-13% of maternal deaths globally.

Teenage Pregnancies: Early pregnancies are particularly dangerous, with girls aged 15-19 years facing double the risk of maternal death compared to women in their 20s. In India, about 16% of pregnancies occur in this age group, amplifying risks due to immature reproductive systems.

Unplanned and Frequent Pregnancies: Limited access to family planning results in short intervals between pregnancies, leaving mothers’ bodies insufficient time to recover. This increases the risks of hemorrhage and uterine rupture, leading to higher maternal mortality rates.

The Haunting Reality of Maternal Mortality Rate in India:

For every statistic, there is a devastating story—a mother lost, a family broken, and children left without care. These deaths are not just numbers; they are tragedies, often preventable, that disproportionately affect women in vulnerable communities. High MMR signifies the failure of healthcare systems, particularly for those in rural, tribal, and economically weaker regions where access to skilled medical care is limited or non-existent.

• According to UNICEF, India’s Maternal Mortality Ratio (MMR) has declined to 97 per 100,000 live births (2018-20), a significant improvement from 130 in 2014-16. This saved 8,580 mothers annually by 2020 compared to 2016. But the loss remains staggering, with an estimated 25,220 maternal deaths in 2020 alone. 
• Nearly two-thirds of maternal deaths stem from preventable complications like postpartum hemorrhage (severe bleeding), which accounts for most cases. These deaths remain especially high in areas with limited access to healthcare, highlighting glaring inequalities.
• The highest MMRs were reported in Assam (215), Uttar Pradesh/Uttarakhand (192), and Madhya Pradesh/Chhattisgarh (170), exceeding India's national estimate of 113 (2016-18).
• About 63% of maternal deaths occurred in economically weaker states.
• Women aged 20-29 years accounted for 58% of maternal deaths.
• Risks were most pronounced in rural and tribal areas of northern and northeastern states, even after accounting for factors like education.

The Deadly Trio Driving Maternal Mortality in India:

• Obstetric Hemorrhage (47%):

Severe bleeding, especially postpartum, is the leading cause of maternal deaths in India, particularly in poorer states like Assam and Uttar Pradesh. Lack of blood banks and emergency care turns treatable complications into tragedies. With only 1 blood bank per 82,000 people, countless lives are lost to this silent killer.

• Infections (12%):

Pregnancy-related infections, such as sepsis, claim over 1 in 10 mothers in India. Poor hygiene, unclean delivery tools, and limited access to antibiotics in rural areas are the root causes. Nearly 41% of deliveries in India occur without skilled healthcare, leaving women vulnerable to preventable infections.

• Hypertensive Disorders (7%):

Conditions like pre-eclampsia and eclampsia silently threaten mothers, causing seizures or strokes. With only 58% of women receiving proper prenatal care, many cases go undetected until it's too late, particularly among teenage and first-time mothers.

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UNICEF's Lifesaving Support for Maternal Health in India:

UNICEF partners with the Ministry of Health and Family Welfare, Ministry of Women and Child Development, NITI Aayog, and state governments to strengthen maternal health care in India. The focus is on supporting health managers and supervisors at the district and block levels to effectively plan, implement, and monitor maternal health services, especially for high-risk pregnant women and those from vulnerable communities.

Key interventions include:

• Skilled Birth Attendance: UNICEF supports the policy ensuring every delivery is attended by a skilled healthcare provider in a facility.
• Continuum of Care: A comprehensive approach to maternal and newborn health, covering family planning, antenatal care, skilled delivery management, emergency obstetric care, and postnatal care for both mothers and babies.
• Antenatal Care: Encouraging all pregnant women to register for antenatal care early to monitor and address potential risks.
• Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA): This initiative ensures quality antenatal care on the 9th of every month, offering free services and improving the detection of high-risk pregnancies.
• Janani Shishu Suraksha Karyakaram (JSSK): Provides free maternity services, strengthens emergency referral systems, and improves healthcare governance and management to reduce maternal mortality.

Maternal mortality in India remains a tragic reality, with preventable complications still claiming too many lives. Conditions like obstetric hemorrhage, infections, and hypertension continue to be major threats, especially in underserved areas. However, programs like Pradhan Mantri Surakshit Matritva Abhiyan and Janani Shishu Suraksha Karyakaram are making a difference, improving access to essential care and saving lives. While progress has been made, the fight continues. Every life saved brings hope, but we must keep working to ensure every mother survives childbirth and experiences the joy of holding her child.