1. Alarming Maternal Mortality Rates (MMR) in India

• In 2012, India’s MMR was 130; in 2019–21, it dropped to 97.
  
  
• Despite the fall, 93 women still die for every 1 lakh live births — an avoidable tragedy.
  
  
• Sample Registration System defines maternal death as occurring during pregnancy or within 42 days of termination.
  
  

2. State-wise Disparities in MMR

• States categorized into:
  
  
  • EAG States (Empowered Action Group): Bihar, Jharkhand, MP, Chhattisgarh, Odisha, Rajasthan, UP, Uttarakhand, Assam – worst MMRs.
    
    
  • Southern States: AP, Telangana, Karnataka, Kerala, TN – better MMRs.
    
    
  • Other States/UTs: Mixed range.
    
    
• Example: Assam (167) vs Kerala (19), Karnataka (63), Andhra Pradesh (46).
  
  

3. Three Critical Delays in Maternal Health

(Adopted from Columbia University’s “Safe Motherhood” model)

• First delay: Deciding to seek care – influenced by lack of awareness, cultural beliefs, absence of women’s agency.
  
  
• Second delay: Reaching a health facility – poor roads, distance, transport infrastructure.
  
  
• Third delay: Receiving quality care at facility – shortage of specialists, absence of emergency obstetric care, poor referral systems.
  
  

4. Systemic Issues in Public Health Delivery

• Only 51.8% of community health centres have the required specialists.
  
  
• Only 5,286 FRUs (First Referral Units) functional out of 7,814 required.
  
  
• Lack of infrastructure, equipment, and trained staff limits capacity to handle obstetric emergencies.
  
  

5. Associated Causes of Maternal Mortality

• Medical causes: Sepsis, eclampsia, hemorrhage, unsafe abortion, obstructed labour.
  
  
• Indirect causes: Anemia, TB, malnutrition, adolescent pregnancies, domestic violence.
  
  
• Institutional failure: Delay in diagnostics, inadequate blood banks, failure to implement emergency care protocols.
  
  

6. Good Practices & Kerala Model

• Kerala’s Confidential Review of Maternal Deaths (CRMD) – audits all maternal deaths.
  
  
• Uses local level reviews for course correction.
  
  
• Emphasis on specialist accessibility, referral networks, infrastructure.
  
  

7. Way Forward and Policy Recommendations

• Universalize and strengthen FRUs with specialists and blood banks.
  
  
• Improve ambulance response & midwifery programs.
  
  
• Implement Minimum Service Guarantees at CHCs.
  
  
• Expand Confidential Reviews across all States.
  
  
• Promote awareness and contraception to reduce unwanted pregnancies.
  
  

UPSC-style Questions

GS Paper II – Governance, Social Justice, Health

10-Mark Questions (150 words)

Despite falling MMR, maternal deaths remain a concern in India. Examine the systemic causes responsible for this persistent issue.