N4S

Mothers are surviving births, yet hidden illnesses still stalk India’s women. UPSC usually turns such “population and health” themes into big GS 1 questions that ask “why” and “how,” much like the 2014 sex‑ratio poser that mixed prosperity with social bias; examiners expect you to go beyond numbers and trace deep causes and policy gaps. Many aspirants slip because they quote the falling MMR but ignore the silent crisis of anaemia or the uneven state data under “The Maternal Health Paradox: Falling MMR vs Rising Hidden Burdens” (Kerala MMR 19 vs Assam 195, anaemia 57%). They also forget to link welfare design flaws shown in “Disconnect Between Policy Success and Ground Realities” (institutional births 88.6% yet only 60% full ANC) and thus miss the continuity‑of‑care angle UPSC loves. This article rescues them by stitching both sides together: it pairs success metrics with unseen gaps, offers ready references like PMSMA coverage figures, and serves real solutions in “Way Forward” that move from delivery counts to healthy‑mother outcomes. Its standout gem is the “Back2Basics: Assessment of Maternal Health Governance” table, which condenses every key scheme—JSY cash support, LaQshya audits, Anaemia Mukt Bharat—into exam‑ready one‑liners you can drop as evidence. Read it once, and you have concept, critique, case studies, and policy toolkit all in one place.

PYQ ANCHORING

GS 1:  Why do some of the most prosperous regions of India have an adverse sex ratio for women? Give your arguments. [2014]

MICROTHEME: Population and associated issues

India’s maternal health story today is one of striking contrast. On one hand, the country has made significant progress—its Maternal Mortality Ratio (MMR) dropped from 97 (2018–20) to 93 (2019–21), marking a steady improvement and moving closer to global targets. Yet, beneath this success lies a persistent crisis: over 57% of women of reproductive age suffer from undiagnosed anaemia (NFHS-5), a silent epidemic threatening both mothers and newborns.

This paradox—a falling MMR but a rising burden of hidden illness—raises urgent questions: Is India’s maternal health progress truly inclusive and sustainable? Can policy success coexist with widespread nutritional and diagnostic gaps?

The Maternal Health Paradox: Falling MMR vs Rising Hidden Burdens

This paradox shows that while India has moved the needle on survival, it is still struggling to ensure health, nutrition, and dignity for all mothers. 

Here’s the content structured neatly into a table format with broader themes, causes, and examples — perfect for UPSC-style answers:

Disconnect Between Policy Success and Ground Realities in India’s Welfare Schemes

Local-level best practices

Several Indian states and districts have bridged the gap between access and quality in maternal health. 

1. Tamil Nadu, with an MMR of just 54, has built a robust system through 99% institutional deliveries, the 108 ambulance network, HMIS-based risk tracking, and nutrition kits under the Dr. Muthulakshmi Reddy scheme. Its RCH programme ensures seamless care across ANC, delivery, and postnatal phases.
2. In Odisha’s tribal Malkangiri district, maternal mortality has halved. ASHAs are trained to test haemoglobin, track high-risk pregnancies digitally, and provide counselling. Localised incentives and cultural adaptation—ASHAs speaking tribal languages and accompanying women—have driven uptake.
3. Kerala’s Kudumbashree model leverages women’s self-help groups to deliver ANC, mental health counselling, and 100% immunisation. Community-led monitoring in tribal areas via mobile vans has made care both inclusive and accountable.
4. Chhattisgarh’s Janani Shishu Suraksha Yatra (JSSY) and Mitanin model raised institutional deliveries from 40% to 80%. Mitanins provide doorstep ANC, track danger signs, ensure nutrition, and refer mental health cases.

These models show that when delivery systems are community-driven, context-specific, and continuous—not just coverage-focused—India can overcome both mortality and morbidity challenges in maternal health.

Way Forward

1. Shift the metric: from “delivery counts” to “healthy mothers.”
   Track haemoglobin, BMI and mental-health scores alongside institutional-delivery data.
2. Localise nutrition action.
   Mandatory point-of-care anaemia testing at every ANC visit; millet-based THR (take-home rations); women-led farmer-producer co-operatives for iron-rich crops.
3. Close the quality loop in facilities.
   Kayakalp-style audits for labour rooms and post-natal wards; e-partographs and mandatory second-opinions for C-sections.
4. Universalise mental-health screening.
   Integrate PHQ-9 or EPDS tools into PMSMA; train ASHAs to identify red flags.
5. Data convergence & accountability.
   Link Poshan Tracker, HMIS and civil-registration data to a single dashboard; empower panchayat-level social audits.

#BACK2BASICS: ASSESSMENT OF MATERNAL HEALTH GOVERNANCE

What’s Driving India’s Decline in Maternal Mortality?

Key Maternal Health Programmes Under the National Health Mission (NHM)

Infrastructure & Systems Strengthening

SMASH MAINS MOCK DROP 

Despite significant improvements in institutional deliveries and a declining Maternal Mortality Ratio (MMR), India’s maternal health outcomes remain uneven and exclusionary. Critically examine the disconnect between policy achievements and ground-level realities in maternal health, with a focus on nutritional and diagnostic gaps.