Over 57% of women of reproductive age in India suffer from undiagnosed anaemia, posing a serious threat to maternal and child health.

About Maternal health

• Maternal health refers to the health of women during pregnancy, childbirth and the postnatal period. 
• Each stage should be a positive experience, ensuring women and their babies reach their full potential for health and well-being.
• Ensuring maternal well-being is essential for reducing maternal and infant mortality and achieving the Sustainable Development Goals (SDGs), particularly SDG 3.1: Reduce MMR to less than 70 per 1,00,000 live births by 2030.

Status of Maternal Health in India

• Maternal Mortality Ratio (MMR) fell from 130 (2014–16) to 93 per 1,00,000 live births (2019–21) — a 29% decline in 5 years, as per Sample Registration System (SRS).
• India has achieved the National Health Policy 2017 target of <100 MMR before 2020.
• As per the UN Maternal Mortality Estimation Inter-agency Group (MMEIG), 2025:
  • India’s MMR fell by 86% between 1990 and 2023, compared to a global average reduction of 48%.
  • From 2020 to 2023 alone, India reduced its MMR by 23 points, reflecting major recent improvements.

State-wise MMR Highlights

Antenatal and Institutional Care (NFHS-5, 2019–21)

Drivers of Decline in Maternal Mortality in India

• Financial Incentives Boost Institutional Deliveries: Janani Suraksha Yojana (JSY) promotes safe institutional births by offering cash transfers to pregnant women.
  • Over 1 crore women benefited annually; expenditure rose to ₹1814.86 crore in FY 2023–24.
• Free Maternal Care Reduces Out-of-Pocket Burden: Janani Shishu Suraksha Karyakram (JSSK) ensures free delivery, drugs, diagnostics, and transport.
  • 1.36 crore women availed JSSK benefits between April–December 2024.
• Early Detection of High-Risk Pregnancies Saves Lives: PMSMA facilitates monthly ANC check-ups and tracks high-risk pregnancies digitally.
  • 78.27 lakh High-Risk Pregnancies identified till December 2024; supported by e-PMSMA portal.
• Quality Standards Improve Clinical Outcomes: LaQshya and SUMAN promote respectful maternity care and labour room quality certification.
  • 1110 Labour Rooms and 808 Maternity OTs nationally certified; 47,700+ facilities under SUMAN.
• Critical Care Expansion Reduces Maternal Deaths: Government set up Obstetric ICUs/HDUs and MCH wings to manage complications.
  • 400+ Obstetric ICUs/HDUs and 650+ MCH Wings with 42,000+ beds operational across India.
• Skilled Workforce Strengthens Emergency Care: Training of MBBS doctors and nurses boosts capacity in rural and referral facilities.
  • 2,518 EmOC-trained doctors, 2,683 LSAS-trained, and 3.3 lakh SBAs deployed nationwide.
• Real-Time Monitoring Enables Quick Response: Digital tools like Maternal, Perinatal, Child Death Surveillance and Review (MPCDSR) and Reproductive and child health (RCH) Portal track maternal deaths and service delivery.
  • Maternal Death Surveillance Review (MDSR) institutionalized, with portal-based MPCDSR replacing manual reporting systems.

Government Initiatives to Improve Maternal Health in India

Policy Framework and National Commitments

• SDG 3.1 Target: Reduce Maternal Mortality Ratio (MMR) to ≤70 per 1,00,000 live births by 2030.
• National Health Policy (NHP) 2017 Goal: Achieve MMR <100 by 2020 — India achieved this with MMR at 93 (SRS 2019–21).
• Implementation Strategy: The Ministry of Health and Family Welfare (MoHFW) supports States/UTs under National Health Mission (NHM) through the Reproductive, Maternal, Newborn, Child, Adolescent Health and Nutrition (RMNCAH+N) approach.

Key Programmes under NHM

• Janani Suraksha Yojana (JSY) (2005): Promotes institutional deliveries for women from SC/ST/BPL households.
  • Provides cash incentives to reduce maternal and neonatal mortality.
• Pradhan Mantri Matru Vandana Yojana (PMMVY) (2017, updated 2022 as PMMVY 2.0):
  • Maternity benefit of ₹5,000 for first living child; additional incentive for second child if a girl to promote positive behavior toward girl children.
  • Eligibility: Pregnant women for first child post-01.01.2017.
• Janani Shishu Suraksha Karyakaram (JSSK) (2011): Eliminates out-of-pocket expenses for pregnant women and sick infants.
  • Covers free delivery (including C-sections), transport, diagnostics, medicines, consumables, diet, and blood in public facilities.
• Surakshit Matritva Aashwasan (SUMAN) (2019): Ensures free, dignified, quality healthcare with zero tolerance for service denial.
  • Aims to end preventable maternal and newborn deaths.
• Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA) (2016): Provides free antenatal care (ANC) on the 9th of every month.
  • Extended PMSMA (e-PMSMA): Tracks high-risk pregnancies (HRP) with financial incentives for additional ANC visits; over 5.9 crore women examined (as of March 21, 2025).
• LaQshya (2017): Improves quality of care in labor rooms and maternity operation theaters.
  • Ensures respectful and quality care during delivery and postpartum.
• Anaemia Mukt Bharat (AMB) (under POSHAN Abhiyan): Tackles anaemia in pregnant women and adolescents through testing, treatment, and non-nutritional interventions.
  • Includes comprehensive communication strategies.

Infrastructure Strengthening

• Comprehensive Abortion Care (CAC): Strengthened through training, drug supply, equipment, and IEC.
• Delivery Points: Upgraded with infrastructure, equipment, and trained manpower for RMNCAH+N services.
• First Referral Units (FRUs): Functionalized with manpower, blood storage, and referral linkages.
• Maternal and Child Health (MCH) Wings: Established at high-caseload facilities to improve care quality.
• Obstetric ICU/HDU: Operationalized at tertiary care facilities to manage complicated pregnancies.

Key Health Challenges in Maternal Health in India

• High Burden of Anaemia Among Pregnant Women: NFHS-5 (2019–21) reports that 52.2% of pregnant women are anaemic.
  • Causes include iron deficiency, folate and B12 deficiencies, hookworm infections, and low dietary diversity.
  • The WOMAN-2 trial cited in government documents warns that anaemia increases risk of postpartum hemorrhage (PPH) by 7 times and significantly raises maternal mortality. 

• Regional Disparities in Maternal Mortality: As per Sample Registration System (SRS) 2018-20, MMR varies starkly across states:
  • Assam (195) and Madhya Pradesh (173) have the highest MMR, compared to Kerala (19) and Maharashtra (33).
  • BIMARU states (Bihar, Madhya Pradesh, Rajasthan, Uttar Pradesh) consistently report MMR above the national average (97), reflecting poor health infrastructure and access.
• Inadequate Postnatal Care (PNC): While antenatal care (ANC) has improved, postnatal care is often neglected, despite 1/3 of maternal deaths occurring post-delivery.
  • The government launched the “Scheme on Optimization of Post-Natal Care” in 2023 to address this gap and reduce maternal deaths post-discharge, with PNC activities integrated into state PIPs (2024–26).
• High Risk Pregnancies (HRPs) Remain a Concern: Over 78.27 lakh HRPs identified since the launch of PMSMA in 2016 across all States/UTs.
  • Despite identification, HRPs require long-term tracking and follow-up, which remains inconsistent in several districts, affecting maternal outcomes.
• Inadequate Critical Care Infrastructure in High Burden Areas: Though 400+ Obstetric ICUs/HDUs have been sanctioned, gaps persist in BIMARU and remote areas where referral systems are weak and transport is delayed.
  • For instance, maternal deaths often result from delayed referrals in critical stages due to lack of emergency obstetric care, especially in rural northern states.
• Persistent Burden of Unsafe Abortions: 8 to 20% of maternal deaths in India are attributed to unsafe abortions.
  • Despite training 26,000+ Medical Officers in Comprehensive Abortion Care (CAC), access to safe abortion services is limited in many rural and underserved regions.
• Human Resource Gaps and Overburdened ASHA System: Although over 3.3 lakh staff nurses, LHVs, and ANMs have been trained as Skilled Birth Attendants (SBAs), availability of specialists for C-sections and anaesthesia (LSAS) remains a concern in rural hospitals.
  • The ASHA workforce, critical for community-level maternal outreach, is burdened with multiple roles (JSY, PNC visits, HRP tracking), affecting the quality of maternal follow-ups.

Role of Technology and Innovation in Maternal Health in India

• Digital Tracking and Real-Time Monitoring: Technologies like the Maternal Perinatal Child Death Surveillance and Response (MPCDSR) system enable real-time, portal-based reporting and analysis of maternal deaths. 
  • The Reproductive and Child Health (RCH) portal tracks pregnant women by name, ensuring continuity of antenatal care, institutional delivery, and postnatal follow-up.
• High-Risk Pregnancy Identification and Follow-Up: The Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA) integrates digital platforms to identify and track High-Risk Pregnancies (HRPs).
  • The e-PMSMA system enables health workers and specialists to monitor HRPs until safe delivery, with financial incentives encouraging compliance.
• Telemedicine and Remote Consultations: Telemedicine platforms provide pregnant women in remote and underserved regions access to specialist consultations without travel.
  • Teleconsultations also support frontline health workers in decision-making during emergencies.
• Training Simulations and Skill Labs: Use of simulation-based training labs with mannequins and virtual reality aids healthcare providers to practice emergency obstetric care, C-section procedures, and neonatal resuscitation.
  • Over 127 standalone skill labs have been established nationwide to enhance competencies of doctors, nurses, and midwives.
• Data Analytics and Predictive Modeling: Advanced data analytics on maternal health records help identify geographic and demographic risk clusters, enabling targeted interventions.
  • Predictive modeling supports resource allocation by forecasting demand for maternal health services and supplies.
• Mobile Health (mHealth) Solutions: Mobile apps and SMS services deliver reminders for ANC visits, immunizations, nutrition advice, and danger sign awareness directly to pregnant women and caregivers.
  • ASHA workers use mobile tools for registration, follow-up, and health education, improving outreach efficiency.
• Innovations in Medical Devices: Introduction of low-cost, portable diagnostic devices (e.g., haemoglobinometers, portable ultrasounds) allows early detection of anaemia, gestational diabetes, and fetal health issues at peripheral health centers.
  • Use of Continuous Positive Airway Pressure (CPAP) machines in newborn care improves neonatal survival.

Role of International Organizations

• Technical Support and Research Collaboration: Organizations like the World Health Organization (WHO) and United Nations Population Fund (UNFPA) provide technical expertise, guidelines, and standards for maternal health interventions.
  • Collaborative research initiatives such as the Longitudinal Ageing Study in India (LASI) involve international partners like Harvard T.H. Chan School of Public Health and University of Southern California (USC) to study health trends including maternal health.
• Funding and Programmatic Support: Agencies including United Nations Children’s Fund (UNICEF), WHO, UNFPA, and World Bank provide financial and technical aid for maternal health programs.
  • Support extends to strengthening health systems, training health workers, and improving infrastructure for maternal and newborn care.
• Setting Global Health Standards and Targets: The Sustainable Development Goals (SDGs) framed by the United Nations set global targets for reducing maternal mortality (SDG 3.1) which India commits to achieving.
  • International bodies assist in framing National Health Policies aligned with global goals.
• Capacity Building and Training: International organizations support training initiatives for healthcare providers, including skilled birth attendants and midwives, to improve quality of care.
  • Facilitation of workshops, e-learning, and exchange programs improve knowledge and skills related to maternal health.
• Monitoring, Evaluation, and Data Systems: Support for strengthening maternal health data collection, surveillance, and reporting systems (e.g., Maternal Death Surveillance and Response (MDSR)).
  • International organizations help in capacity building for data analytics and use of technology in health monitoring.
• Advocacy and Awareness: Global health agencies lead advocacy campaigns emphasizing the importance of maternal health and mobilizing resources.
  • They promote rights-based approaches ensuring respectful maternity care and address socio-cultural barriers affecting maternal health.
• Innovation and Best Practices Exchange: Facilitate adoption of international best practices and innovative interventions (e.g., emergency obstetric care models, digital health tools).
  • Enable pilot projects and scaling of successful models in India by sharing global learnings.

Way Forward for Maternal Health in India

• Focus on Postnatal Care (PNC) and Continuum of Care: Nearly one-third of maternal deaths occur after delivery and hospital discharge. 
  • Strengthening home-based and facility-level PNC with timely follow-up through ASHAs and ANMs is critical. 
• Targeted Interventions in High-Burden States: States like Assam, Madhya Pradesh, Uttar Pradesh, and Chhattisgarh still have MMRs well above the national average (93). 
  • Customized district-level strategies, supported by increased HRP tracking and critical care infrastructure, are essential.
• Strengthen Midwifery and Skilled Birth Attendance: Scaling up the Midwifery Training Initiative through more National and State Midwifery Institutes will ensure respectful and skilled maternal care, especially in underserved areas with a shortage of obstetricians.
• Expand Critical Care and Emergency Transport Networks: More Obstetric ICUs/HDUs and CEmONC centres (like Tamil Nadu’s model) are needed in remote districts. 
  • Integrating ambulance services with referral tracking will reduce first and second delays in critical maternal care.
• Universalize Anaemia and Nutritional Screening: Anaemia affects over 50% of pregnant women (NFHS-5). 
  • Universal preconception and antenatal screening for iron, B12, folate, thyroid, and diabetes must be institutionalized through Anaemia Mukt Bharat 2.0.
• Real-Time Monitoring and Use of Digital Health Tools: Strengthen usage of MPCDSR, e-PMSMA, and the RCH portal across all states to enable real-time tracking of maternal deaths, HRPs, and service delivery. 
  • Integration with Ayushman Bharat Digital Mission can streamline records.
• Improve Behavioural Communication and Gender Norms: Invest in community-led IEC/BCC campaigns to promote early ANC, institutional deliveries, birth preparedness, and girl-child health. 
  • Expansion of PMMVY 2.0 (with second-child girl incentive) can reinforce positive social change.

Conclusion

India’s remarkable progress in reducing MMR to 93 per 100,000 live births reflects the success of initiatives like JSY, PMMVY, JSSK, SUMAN, and AMB under NHM. Strengthening postnatal care, addressing anaemia through preconception screening, and scaling up critical care infrastructure in high-burden states are critical to achieving the SDG target of MMR <70 by 2030, ensuring healthier mothers and future generations.

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