Recent estimates from the State Health Department indicate that MMR in Kerala has increased to 32 in 2024-25.

• This spike is not due to a rise in maternal deaths but a significant decline in live births, resulting in a higher ratio.

What is the Maternal Mortality Ratio (MMR)?

• Definition: MMR refers to the number of maternal deaths per 1,00,000 live births due to pregnancy or childbirth-related complications.
• Global and National Targets:
  • WHO Global Target: Reduce MMR to less than 70 per 1,00,000 live births by 2030 under the Sustainable Development Goals (SDGs).
  • India’s National Target: Reduce MMR to below 70 by 2030. 
    • Kerala aims to reduce its MMR to 20 by 2030.
• Current Statistics:
  • India’s MMR stands at 97 (SRS 2018-20), significantly higher than Kerala’s figure of 19.

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Factors Contributing to Rising MMR in Kerala

Declining Fertility Rates: Kerala’s TFR dropped below replacement levels in 1991 and is now at 1.46 (2021).

• Couples in Kerala increasingly prefer fewer or no children, driven by societal, economic, and lifestyle changes.
• Kerala’s annual live births have plummeted from 5 — 5.5 lakh in the 1980s to an all-time low of 3.93 lakh in 2023.
  • The Total Fertility Rate (TFR), now at 1.46 (2021), has contributed significantly to this trend.
• Impact of COVID-19: During the pandemic (2020-21), COVID-19-related maternal deaths temporarily increased the State’s MMR.
• Demographic Transition: Kerala attained replacement-level fertility (2.1) in 1987-88 and has maintained a sub-replacement fertility rate for decades. This demographic shift has far-reaching implications on MMR trends.
• Shrinking Population of Women of Reproductive Age: The female population in the reproductive age group (15–49 years) has steadily declined.
  • From 93.32 lakh (2011 Census) to a projected 92.23 lakh (2021).

• The new cohort of women exhibits lower fertility, either by choice or natural decline, contributing to fewer live births.
• Delayed Marriages and Childbearing: Rising age at marriage and delayed pregnancies have led to an increase in older mothers, who are more prone to pregnancy-related complications.
• Immigration Trends: A significant proportion of the reproductive-age population migrates abroad for education or work, choosing to settle and have children in other countries.
• Impact of Demographic Transition: Kerala’s rapid demographic transition has resulted in an aging population, with the elderly soon expected to outnumber children.
  • This shift places a growing burden on healthcare resources and policies.
• Data Discrepancies: Concerns have been raised regarding delays in birth registration and potential underreporting of live births.
• Lack of Data on Abortions: The absence of abortion statistics hampers a comprehensive understanding of declining live births and its impact on MMR.

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Addressing Rising MMR in Kerala

• Strengthening Maternal Health Programs: Focus on high-risk pregnancies and older mothers to mitigate complications.Improve access to prenatal and postnatal care, especially in rural areas.
• Accurate Data Collection: Ensure timely registration of live births and maternal deaths. Conduct studies to analyze the impact of abortion and migration on live births.
• Raising Awareness: Promote education on the health risks of delayed pregnancies and the importance of institutional deliveries.
• Policies to Support Fertility: Encourage work-life balance policies to support young families. Introduce incentives for early marriages and childbearing.
• Preparing for an Aging Population: Develop infrastructure and policies to address the needs of the growing elderly population. Promote intergenerational care systems to balance societal dynamics.

Government Initiatives to Reduce Maternal Mortality Ratio (MMR)

• Pradhan Mantri Surakshit Matritva Abhiyan: To improve the quality and coverage of diagnostics and counseling services, along with providing assured comprehensive and quality antenatal care free of cost.
• POSHAN Abhiyaan: Pregnant Women are one of the key  target groups of the government’s flagship programme to improve nutritional outcomes.
• Pradhan Mantri Matru Vandana Yojana (PMMVY): It is a direct benefit transfer (DBT) scheme under which cash benefits are provided to pregnant women in their bank account directly to meet enhanced nutritional needs and partially compensate for wage loss.
• Surakshit Matritva Anushasan (SUMAN):  It aims to provide assured, dignified and respectful delivery of quality healthcare services at no cost and zero tolerance of denial of services to any women and newborn in any public health facility.
• Labour Room & Quality Improvement Initiative (LaQshya): Providing a positive birthing experience to pregnant women by improving the  quality of care in labor room, maternity Operation Theatre and Obstetrics Intensive Care Units (ICUs) & High Dependency Units (HDUs)
• Rise in Institutional deliveries: As of 2020-21, institutional deliveries in India have risen to 95.5%, with approximately 94% occurring in rural areas and 98% in urban regions. 
  • This marks a significant improvement from 2019-2021, when institutional deliveries accounted for 88.6% of births nationwide. 
  • The increase reflects the success of initiatives aimed at promoting safer childbirth practices across the country.
• Steps to promote institutional deliveries: operationalisation of Sub-Centres, Primary Health Centres, Community Health Centres and District Hospitals for providing 24×7 basic and comprehensive obstetric care.
• Training in obstetric care: Capacity building of healthcare providers in basic and comprehensive obstetric care to enable them to provide high quality services during childbirth.

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