India’s Maternal Mortality Ratio has fallen to its lowest recorded level. But the national average conceals a deep and persistent regional divide: a woman in Uttar Pradesh is still more than six times more likely to die during pregnancy or childbirth than a woman in Kerala. The latest Sample Registration System data show both how far India has come and how unevenly that progress is distributed.
On paper, India’s maternal health story is one of steady progress.
The country’s Maternal Mortality Ratio (MMR) has declined from 130 maternal deaths per 100,000 live births in 2014–16 to 87 in 2022–24, according to the latest Special Bulletin on Maternal Mortality in India released by the Sample Registration System (SRS).
That decline places India closer than ever to the Sustainable Development Goal target of reducing maternal mortality below 70 by 2030. The achievement reflects years of investment in institutional deliveries, antenatal care, referral systems and national safe motherhood programmes.
Yet the numbers also reveal another reality: India’s maternal health outcomes depend heavily on where a woman lives.
Kerala records an MMR of 24, Tamil Nadu 25. Uttar Pradesh stands at 154, Madhya Pradesh at 135, and Chhattisgarh and Odisha at 124 each.
The contrast is not merely statistical. It reflects wide differences in public health capacity, women’s status, emergency care access, nutrition, literacy and state-level governance.
The latest SRS bulletin tells the story of two Indias: one that has brought maternal mortality down to levels approaching high-income countries, and another where preventable maternal deaths remain stubbornly common.
A national average that hides deep inequality
The SRS groups states into three broad categories to better understand regional patterns: the southern states, the Empowered Action Group (EAG) states plus Assam, and the remaining states and Union Territories.
The divide between these groups is wide.
The southern states- Andhra Pradesh, Telangana, Karnataka, Kerala and Tamil Nadu, collectively report an MMR of 41. By contrast, the EAG states and Assam record an MMR of 116, nearly three times higher. The “other states” category stands at 75, while the national average is 87.
The implications become even sharper when viewed through lifetime risk.
The SRS bulletin estimates that the probability of a woman dying from pregnancy-related causes during her reproductive years is 0.04% in Kerala and Tamil Nadu, compared with 0.44% in Uttar Pradesh.
In practical terms, that means the lifetime risk of maternal death in Uttar Pradesh is roughly one in 227 women, compared with around one in 2,500 in Kerala and Tamil Nadu.
Such disparities are rarely explained by a single factor. Maternal mortality is widely considered one of the clearest indicators of the overall functioning of a health system because it sits at the intersection of healthcare access, nutrition, transport, education, sanitation, poverty and women’s autonomy.
When maternal mortality falls, it usually signals broader improvements in the health and social environment. When it remains high, it often reveals structural weaknesses that extend far beyond labour rooms and maternity wards.
Why southern states continue to outperform
The success of southern states is not accidental or recent. It is the result of decades of sustained investment in public health systems and social development.
Kerala and Tamil Nadu, in particular, have built strong reputations for maternal and child health through a combination of high female literacy, robust primary healthcare networks and relatively strong public sector accountability.
Institutional deliveries are near universal in most southern states. Pregnant women are more likely to receive regular antenatal care, deliver in facilities with skilled birth attendants and access emergency obstetric services when complications arise.
The gains also reflect stronger referral systems. Ambulance networks such as the 108 emergency response service and 102 maternal transport services have reduced delays in reaching care, especially during obstetric emergencies.
Equally important is the emphasis on quality of care.
Several southern states have implemented maternal death audits more rigorously than many high-burden states. These audits investigate why maternal deaths occur, identify failures in care pathways and push district administrations to address recurring gaps.
Maternal mortality cannot be reduced through institutional deliveries alone. Women must reach facilities on time, be treated promptly and receive adequate emergency obstetric care, including blood transfusions and Caesarean sections when required.
Tamil Nadu’s maternal health model is often cited precisely because it focused not only on increasing hospital births but also on strengthening first referral units, ensuring blood bank access and standardising emergency obstetric protocols.
National schemes have also played a role.
Programmes such as Janani Suraksha Yojana, Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA) and LaQshya- the labour room quality improvement initiative, have generally performed better in states with stronger baseline administrative systems and better health infrastructure.
Maharashtra and Andhra Pradesh demonstrate another important point: even large and socioeconomically diverse states can significantly reduce maternal mortality when political commitment aligns with administrative efficiency.
Maharashtra’s MMR now stands at 37, while Andhra Pradesh reports 39.
The burden concentrated in the northern heartland
The challenge is very different across much of northern and central India.
The EAG states- Bihar, Jharkhand, Madhya Pradesh, Chhattisgarh, Odisha, Rajasthan, Uttar Pradesh and Uttarakhand, were historically identified because of weaker demographic and health indicators. Two decades later, maternal mortality data suggest that many of those structural gaps remain unresolved.
High fertility rates continue to increase cumulative maternal risk in several of these states. Women often experience repeated pregnancies beginning at younger ages, frequently with inadequate birth spacing and poor nutritional status.
The overlap between maternal mortality and anaemia is particularly significant.
Severe anaemia remains widespread among women of reproductive age in India and is a major contributor to postpartum haemorrhage, infections and maternal deaths. Malnutrition, poor access to antenatal screening and delayed recognition of high-risk pregnancies further compound the problem.
Health infrastructure deficits remain equally critical.
Many rural districts continue to face shortages of obstetricians, anaesthetists and trained nursing staff. Referral systems are often fragmented, blood storage facilities inadequate and transport delays common.
For women experiencing obstetric emergencies, these delays can become fatal within hours.
Socio-cultural barriers also continue to shape outcomes.
In some districts, women still have limited autonomy over healthcare decisions, delayed care-seeking remains common and awareness about danger signs during pregnancy is low. Early marriage and adolescent pregnancies further heighten risk.
The latest SRS data underline how heavily maternal deaths are concentrated among young women.
According to the bulletin, 30% of maternal deaths occur in women aged 20–24 years, while 36% occur among those aged 25–29 years. Together, these two age groups account for 66% of all maternal deaths in India.
That concentration matters because it reflects deaths occurring during the peak reproductive and economically productive years of women’s lives.
The demographic link: high fertility, higher burden
The maternal mortality data become even more revealing when viewed alongside broader demographic patterns from the SRS (Special Bulletin on Maternal Mortality in India 2022-24)
States such as Bihar and Uttar Pradesh continue to record some of the country’s highest birth rates. Higher fertility inevitably increases the number of pregnancies and, consequently, the overall exposure to pregnancy-related risk.
But fertility alone does not explain the gap.
The southern states underwent demographic transition earlier, with improvements in women’s education, delayed marriage, better contraceptive access and stronger health systems reinforcing one another over time.
This created a virtuous cycle: lower fertility improved maternal health outcomes, while better maternal health further strengthened child survival and family planning uptake.
Several high-burden states remain trapped in the opposite cycle, where high fertility, poor nutrition, weak health systems and poverty reinforce one another.
What India already knows works
One of the most striking aspects of India’s maternal mortality story is that the solutions are not theoretical. They already exist within the country.
The southern states provide a working blueprint for what sustained maternal health improvement looks like in practice.
The first lesson is that institutional delivery targets alone are insufficient. Quality of care matters just as much as access.
A poorly equipped facility without blood supplies, trained staff or emergency surgical capability may not substantially reduce maternal deaths despite increasing hospital births.
The second lesson is the importance of maternal death surveillance and response systems.
States that actively investigate maternal deaths are often better positioned to identify recurring failures, whether they involve delayed referrals, transport bottlenecks, shortages of medicines or gaps in clinical management.
The third lesson is the value of decentralised interventions.
India’s maternal mortality challenge is increasingly concentrated in specific districts rather than entire states. Targeted district-level strategies, supported by granular real-time data, are likely to produce better results than broad national approaches alone.
Technology could also play a larger role in the next phase of maternal health improvement.
Telemedicine support for remote obstetric consultations, digital pregnancy tracking systems and AI-assisted risk prediction tools can help identify high-risk pregnancies earlier, especially in underserved districts.
But technological solutions alone cannot compensate for weak infrastructure.
Ultimately, maternal survival still depends on whether a woman can reach a functioning health facility in time and receive competent emergency care when complications arise.
Signs of progress, even in difficult states
Despite the persistent divide, the national trend remains encouraging.
India’s MMR has steadily declined over successive reporting periods: from 130 in 2014–16 to 87 in 2022–24.
Even some historically high-burden states have shown gradual improvement.
Rajasthan, for instance, now reports an MMR of 87, equal to the national average. While challenges remain, the state’s trajectory suggests that sustained improvements are possible even in geographically and socioeconomically complex settings.
That matters because India’s maternal mortality burden is increasingly concentrated in a smaller number of states and districts. Accelerated gains in these regions could substantially lower the national average within a relatively short period.
The Sustainable Development Goal target of reducing MMR below 70 by 2030 therefore remains within reach, though it will require far more focused investment in high-burden regions.
The unfinished story of maternal survival
Maternal mortality is often discussed through statistics, ratios and confidence intervals. But each maternal death reshapes an entire household.
Children who lose mothers face higher risks of malnutrition, interrupted education and poorer long-term health outcomes. Families lose income, caregiving support and social stability. Communities lose women during some of the most productive years of their lives.
That is why maternal mortality remains one of the clearest measures of whether public health systems are functioning equitably.
India’s latest SRS bulletin offers both reassurance and warning.
The reassurance is that sustained policy attention works. The warning is that national averages can conceal deep inequality.
The country has already demonstrated that maternal mortality can be reduced substantially within the Indian context. States such as Kerala, Tamil Nadu, and several other southern states have shown that progress does not depend on extraordinary wealth or imported models. Rather, these outcomes reflect decades of sustained social development, including improvements in female literacy, demographic transition, women’s status, and public health capacity. Such gains are the result of long-term investments in primary healthcare, women’s education, emergency referral systems, and administrative accountability. They cannot be replicated within short policy timelines or through a mission-mode approach alone.
The challenge now is replication.
The evidence exists. The strategies are known. The remaining question is whether the same urgency that transformed maternal health in parts of southern India can be extended to the districts where childbirth still carries a far greater risk of death than it should.
