Mother and Child Health – Immunization Program, BPBB, PMJSY, PMMSY, etc.

India’s Maternal Healthcare Crisis: A Call for Urgent Action


From UPSC perspective, the following things are important :

Prelims level: India's MMR, reports and findings

Mains level: India's high maternal mortality, Government efforts, challenges, and way ahead

Maternal Healthcare

Central Idea

  • A recent United Nations report revealed a startling reality that India, along with nine other nations, accounted for a staggering 60% of global maternal deaths, stillbirths, and newborn deaths. In 2020 alone, India accounted for over 17% of such fatalities, making it the country with the second-highest number of maternal deaths after Nigeria.

What is maternal mortality?

  • As per World Health Organization, Maternal death is the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes.

Gaps in maternal Healthcare in India

  • Maternal mortality rate: A United Nations report highlighted that India was among the top 10 countries responsible for 60% of global maternal deaths, stillbirths, and new-born deaths. In 2020, India accounted for over 17% of such deaths, making it the second-highest contributor after Nigeria.
  • Antenatal care (ANC):1% of mothers in India did not attend any ANC visit during their recent pregnancy. Furthermore, only 34.1% of mothers attended one, two, or three visits, falling short of the World Health Organization’s (WHO) recommendation of four visits.
  • Postnatal care: 16% of women in India did not receive any postnatal health check-ups, while 22.8% experienced delayed check-ups occurring two days after childbirth. In the poorest 20% of the households, 26.3% women never had a postnatal health check-up, whereas among the richest, only 7.9% did not.
  • Lack of skilled health providers: 8% of Indian women did not receive tetanus shots, which are crucial for preventing infections during and after surgery. In about 11% of cases, no skilled health providers were present at the time of delivery, posing risks in detecting and managing complications.
  • Decline in MMR: The Sample Registration System (SRS) 2016-2018 estimated India’s MMR at 113 per 100,000 live births. This represents a decline from previous years and indicates progress in reducing maternal deaths.

Facts for prelims

  • India’s maternal mortality ratio (MMR) has improved to 103 in 2017-19, from 113 in 2016-18.
  • Seven Indian states have very high maternal mortality. These are Rajasthan, Uttar Pradesh, Madhya Pradesh, Chhattisgarh, Bihar, Odisha and Assam.
  • The MMR is ‘high’ in Punjab, Uttarakhand and West Bengal. This means 100-130 maternal deaths per 100,000 live births.
  • It is ‘low’ in Haryana and Karnataka.
  • The states of Uttar Pradesh, Rajasthan and Bihar have seen the most drop in MMR.
  • West Bengal, Haryana, Uttarakhand and Chhattisgarh have recorded an increase in MMR over the last survey.

Challenges in achieving further reductions in MMR in India

  • Regional Disparities: States with limited healthcare infrastructure and resources often report higher MMR compared to more developed regions. Bridging these regional gaps in healthcare access and quality is crucial for ensuring equitable maternal healthcare outcomes.
  • Socioeconomic Factors: Socioeconomic factors play a substantial role in maternal health outcomes. Women from marginalized communities, low-income households, and rural areas face higher risks due to limited access to healthcare facilities, education, and economic resources.
  • Quality of Healthcare Services: The availability of skilled healthcare providers, adequate infrastructure, and essential medical supplies is lacking in many parts particularly in remote and ares.
  • Awareness and Education: Limited awareness among women, families, and communities about the importance of antenatal care, skilled birth attendance, and postnatal care hindering timely and appropriate care-seeking behavior.
  • Cultural and Social Factors: Deep-rooted cultural and social factors often influence maternal healthcare-seeking behavior and decision-making. Traditional beliefs, practices, and societal norms directly or indirectly affect women’s access to and utilization of maternal healthcare services.

Government’s initiatives to improve maternal health

  • National Health Mission (NHM): The NHM is a flagship program of the Government of India aimed at providing accessible and affordable healthcare services, including maternal healthcare. Under the NHM, the Reproductive, Maternal, Newborn, Child, and Adolescent Health (RMNCH+A) strategy focuses on improving maternal and child health outcomes through a continuum of care approach.
  • Janani Suraksha Yojana (JSY): The JSY is a conditional cash transfer program that encourages institutional deliveries and postnatal care utilization. It provides financial assistance to pregnant women from low-income households to cover the cost of delivery and associated expenses. The program aims to reduce financial barriers and promote institutional deliveries, ensuring access to skilled birth attendants.
  • Pradhan Mantri Matru Vandana Yojana (PMMVY): The PMMVY is a maternity benefit scheme that provides cash incentives to pregnant and lactating women for their first live birth. It aims to provide partial wage compensation to pregnant women for wage loss during childbirth and to improve maternal and newborn health outcomes.
  • Janani Shishu Suraksha Karyakram (JSSK): The JSSK program ensures free and cashless delivery, including caesarean section, in public health facilities. It covers the costs of essential drugs, diagnostics, blood transfusion, and transportation for pregnant women and sick infants. The program also provides free referral transport services for pregnant women in need of emergency care.
  • Maternal Death Surveillance and Response (MDSR): The MDSR system is an important component of the government’s efforts to reduce maternal deaths. It focuses on identifying, reporting, and analyzing maternal deaths to understand the causes and take appropriate actions for prevention in the future.
  • National Iron Plus Initiative (NIPI): The NIPI focuses on addressing anemia in pregnant women by providing iron and folic acid supplements. Anemia is a significant risk factor for maternal mortality, and the NIPI aims to ensure universal coverage and adherence to iron and folic acid supplementation during pregnancy.
  • Skill Development Initiatives: The government has also emphasized the training and skill development of healthcare professionals, especially in the field of obstetric and neonatal care. This includes the establishment of skilled birth attendant programs, enhancing the capabilities of healthcare providers, and promoting evidence-based practices for safe deliveries and postnatal care.

Way ahead

  • Strengthening Healthcare Infrastructure: Investing in healthcare infrastructure, especially in underserved areas, is crucial to improve access to quality maternal healthcare services. This includes ensuring the availability of skilled healthcare professionals, adequate facilities, and essential medical supplies in both urban and rural settings.
  • Enhancing Healthcare Workforce: Strengthening the healthcare workforce through training programs and capacity-building initiatives is essential. This involves increasing the number of skilled birth attendants, midwives, and other healthcare professionals who can provide comprehensive maternal care services.
  • Improving Access and Affordability: Addressing financial barriers is crucial to ensure that all women can access and afford maternal healthcare services. Enhancing the coverage and effectiveness of health insurance schemes, such as the Pradhan Mantri Jan Arogya Yojana (PMJAY), can significantly reduce out-of-pocket expenses for maternal healthcare.
  • Community Engagement and Awareness: Promoting community participation and awareness about maternal health is vital. Community-based programs can play a significant role in educating women, families, and community members about the importance of antenatal care, skilled birth attendance, postnatal care, and recognizing pregnancy-related complications.
  • Strengthening Maternal Death Surveillance and Response (MDSR): Enhancing the MDSR system can provide critical insights into the causes of maternal deaths and inform evidence-based interventions. Establishing robust systems for reporting, reviewing, and analyzing maternal deaths can help identify gaps in the healthcare system and facilitate targeted interventions to prevent future deaths.
  • Empowering Women and Gender Equality: Promoting gender equality and empowering women are fundamental to improving maternal health outcomes. This includes increasing access to education, economic opportunities, and decision-making power for women. Empowered women are more likely to seek and demand quality maternal healthcare services.
  • Collaboration and Partnerships: Collaboration between government agencies, healthcare providers, NGOs, civil society organizations, and other stakeholders is crucial. Partnerships can facilitate the sharing of resources, knowledge, and best practices to drive collective efforts toward reducing maternal mortality rates.
  • Monitoring and Evaluation: Establishing robust monitoring and evaluation mechanisms to track progress and identify areas that require further attention is essential. Regular data collection, analysis, and reporting on maternal health indicators can help assess the effectiveness of interventions and inform evidence-based decision-making.


  • India’s high maternal mortality rates necessitate immediate interventions to address the gaps in ANC, PNC, awareness, and access to skilled healthcare providers. Bridging the disparities based on education, wealth, and caste is crucial for equitable maternal healthcare. It is imperative to prioritize comprehensive maternal healthcare and take urgent action to save lives and ensure the well-being of women and newborns in India.

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