Bakshi Ravleen Kaur, Kumar Neeta, Srivastava Arti, Kumari Sonam, Aggarwal Pradeep, Khan Md Asif, Singh Khangembam Jitenkumar
Division of Descriptive Research, Indian Council of Medical Research (HQ), New Delhi, India.
Division of Development Research, Indian Council of Medical Research, New Delhi, India.
J Family Med Prim Care. 2025 May;14(5):1807-1817. doi: 10.4103/jfmpc.jfmpc_916_24. Epub 2025 May 31.
The Sustainable Development Goals (SDGs) aim to reduce the global maternal mortality ratio (MMR) to less than 70 maternal deaths per 100,000 live births by 2030. In India, the MMR has significantly declined over the years and currently stands at 97 per 100,000 live births. Despite this achievement, accurately estimating maternal mortality remains a challenge, mainly because of incomplete records of maternal deaths and their causes. This study aims to review national trends in maternal mortality, using data from the Sample Registration System (SRS) and National Family Health Survey (NFHS). Additionally, it explores the relationship between improvements in the utilization of maternal healthcare services and their impact on reducing maternal mortality.
The study examines trends in maternal mortality using nationally available datasets such as the SRS, NFHS, National Sample Survey, and government administrative records. These publicly available sources provide insight into maternal healthcare utilization patterns over time. Key indicators analyzed include antenatal care (four or more visits), skilled birth attendance, and postnatal care utilization. Additionally, secondary sources like the World Health Report were reviewed for historical context.
India has achieved a remarkable decline in MMR over the past three decades, dropping from 570 maternal deaths per 100,000 live births in 1990 to 103 in 2019-2020 and further to 97 in 2023. Historically, the MMR was much higher, with 1,287 maternal deaths per 100,000 live births recorded in 1957. The following decades witnessed a steady reduction: 1,355 in 1960, 892 in 1970, 437 in 1991, 327 in 2000, 212 in 2009, and 130 in 2015. A recent decline of 8.8% was observed between 2016 and 2018 (MMR: 113) and 2020 (MMR: 103). Concurrently, maternal healthcare utilization demonstrated significant improvement, with upward trends in antenatal care, institutional deliveries, and postnatal care across the country.
The consistent decline in India's MMR is because of improvements in socioeconomic conditions, healthcare infrastructure, and public health initiatives such as Janani Suraksha Yojana and Pradhan Mantri Surakshit Matritva Abhiyan. Enhanced transport networks, mobile communication, and rural infrastructure have improved access to maternal care, while grassroots workers such as Accredited Social Health Activists have strengthened antenatal and postnatal service delivery. However, direct obstetric causes like hemorrhage, infection, and sepsis still significantly contribute to maternal deaths. Achieving the SDG target of 70 maternal deaths per 100,000 live births by 2030 requires addressing regional disparities, strengthening health systems, and overcoming resource constraints. Closing gaps in maternal healthcare utilization and fostering collaboration among stakeholders is critical for implementing sustainable and equitable health reforms.
可持续发展目标旨在到2030年将全球孕产妇死亡率降低至每10万例活产少于70例孕产妇死亡。在印度，多年来孕产妇死亡率已显著下降，目前为每10万例活产97例。尽管取得了这一成就，但准确估计孕产妇死亡率仍然是一项挑战，主要原因是孕产妇死亡及其原因的记录不完整。本研究旨在利用抽样登记系统（SRS）和全国家庭健康调查（NFHS）的数据回顾孕产妇死亡率的全国趋势。此外，还探讨了孕产妇保健服务利用的改善与其对降低孕产妇死亡率的影响之间的关系。
本研究使用全国可用数据集，如SRS、NFHS、全国抽样调查和政府行政记录，来研究孕产妇死亡率趋势。这些公开可用的数据源提供了对不同时期孕产妇保健利用模式的洞察。分析的关键指标包括产前检查（四次或更多次就诊）、熟练接生和产后保健利用情况。此外，还查阅了《世界卫生报告》等二手资料以了解历史背景。
在过去三十年中，印度的孕产妇死亡率显著下降，从1990年的每10万例活产570例孕产妇死亡降至2019 - 2020年的103例，2023年进一步降至97例。从历史上看，孕产妇死亡率要高得多，1957年记录的孕产妇死亡率为每10万例活产1287例。随后几十年稳步下降：1960年为1355例，1970年为892例，1991年为437例，2000年为327例，2009年为212例，2015年为130例。2016年至2018年（孕产妇死亡率：113）和2020年（孕产妇死亡率：103）之间出现了8.8%的近期下降。与此同时，孕产妇保健利用情况有显著改善，全国产前检查、机构分娩和产后保健呈上升趋势。
印度孕产妇死亡率持续下降归因于社会经济状况的改善、医疗基础设施以及诸如“贾纳尼·苏拉卡莎·尤贾纳”和“总理安全孕产倡议”等公共卫生举措。交通网络、移动通信和农村基础设施的改善提高了孕产妇保健服务的可及性，而经认证的社会健康活动家等基层工作人员加强了产前和产后服务的提供。然而，诸如出血、感染和败血症等直接产科原因仍然是孕产妇死亡的重要因素。要实现到2030年每10万例活产70例孕产妇死亡的可持续发展目标，需要解决地区差异、加强卫生系统并克服资源限制。缩小孕产妇保健利用方面的差距并促进利益相关者之间的合作对于实施可持续和公平的卫生改革至关重要。
