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Introduction

Despite consistent decline, India’s Maternal Mortality Ratio (MMR) remains a concern. As per Sample Registration System (SRS) 2019–21, 93 women die for every 1,00,000 live births. While this marks improvement from 103 (2017–19), preventable maternal deaths persist due to a complex interplay of medical, social, and systemic factors, especially in Empowered Action Group (EAG) states like Assam (MMR 167) and Madhya Pradesh (MMR 175).

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Key Medical and Socio-Economic Factors

• Medical Causes
• • Postpartum Hemorrhage (PPH): The biggest killer, caused by uterine atony, leads to rapid blood loss. If the mother is anaemic, untreated bleeding leads to death in minutes.
  • Anaemia and Malnutrition: High prevalence of anaemia (over 50%) reduces shock resistance. Inadequate IFA supplementation worsens outcomes.
  • Obstructed Labour and Uterine Rupture: In young, stunted, underweight mothers with contracted pelvis, normal delivery becomes life-threatening without access to C-section.
  • Hypertensive Disorders and Eclampsia: Undiagnosed or untreated high BP during pregnancy leads to convulsions and coma, requiring urgent medical care.
  • Unsafe Abortions and Infections: Abortions by untrained quacks, home deliveries, or unhygienic practices lead to sepsis. UTIs, TB, and malaria are additional risks in EAG states.
• Systemic “Three Delays” (Deborah Maine Model)
• • Delay in Seeking Care: Ignorance, poverty, and patriarchal norms delay decision to seek help. Families often wait too long believing delivery is a “natural process”.
  • Delay in Reaching Facility: Women from remote areas face poor transport connectivity. Many die en route. Though 108 ambulances have helped, coverage gaps persist.
  • Delay in Receiving Care at Facility: Unforgivable delays at hospitals due to absence of obstetricians, anaesthetists, blood, or functioning OTs. 66% vacancies exist in CHCs.
• Socio-Economic and Regional Disparities
• • Regional MMR Disparities: Southern States (Kerala MMR 20, Telangana 45) outperform EAG states (Madhya Pradesh 175, Assam 167). Infrastructure, governance, and health literacy differ.
  • Teenage Pregnancies and Early Marriages: Leads to maternal complications. Poor BMI and underdeveloped anatomy increase mortality risk.
  • Financial Barriers: Low-income families cannot afford emergency care. Transport costs and diagnostic delays further endanger mothers.
  • Lack of Quality in FRUs: Out of 2,856 designated FRUs, many lack blood banks and OTs, violating NHM norms of having 4 functional FRUs per 2 million people.

Targeted Interventions to Reduce Maternal Mortality

• Strengthen FRUs and CHCs: Fill specialist vacancies, ensure blood storage units, and maintain 24×7 CEmONC services in all districts.
• Differential State-Specific Strategies: EAG states must focus on basic emergency care, while southern states should fine-tune quality and adopt Kerala’s Model (Confidential Maternal Death Review model).
• Empower Community Health Networks: Scale up ASHA-ANM coordination, incentivise institutional deliveries, and train SHGs for awareness building.
• Ensure Timely Transport: Expand 108 ambulance services in remote areas. Real-time tracking and referral linkage must be developed.
• Universal ANC and Anaemia Control: Mandate early registration, ANC checkups, and ensure universal coverage of IFA, calcium, and nutrition.
• Audit and Accountability: Strengthen maternal death surveillance under NHM. Ensure every death triggers institutional learning and policy correction.
• Promote Maternal Mental Health: Kerala’s efforts to manage antenatal depression and postpartum psychosis can be emulated nationally.

Conclusion

India’s maternal health crisis is not just medical—it’s a reflection of systemic neglect, gender bias, and infrastructural gaps. Addressing the three delays, ensuring skilled attendance, emergency care, and state-specific strategies are vital. As Kerala shows, political will, technical innovation, and compassionate governance can reduce MMR to single digits. A mother’s life must not be lost to causes that are entirely preventable.

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