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Maternal Mortality Rate - OBGY PG Answer (2025-26 Data)
1. KEY DEFINITIONS (High-Yield for PG)
| Term | Definition |
|---|---|
| Maternal Death | Death of a woman while pregnant OR within 42 days of termination of pregnancy, from any cause related to or aggravated by the pregnancy or its management, but NOT from accidental/incidental causes (WHO) |
| Maternal Mortality Ratio (MMR) | No. of maternal deaths per 1,00,000 live births in the same period |
| Maternal Mortality Rate (MMRate) | No. of maternal deaths ÷ person-years lived by women of reproductive age (15-49 yrs) |
| Late Maternal Death | Death from direct/indirect obstetric causes >42 days but <1 year after termination of pregnancy (ICD-10 codes O96, O97) |
| Pregnancy-related Death | Death during pregnancy or within 42 days, irrespective of cause (includes accidental/incidental) |
| Adult Lifetime Risk | Probability that a 15-year-old girl will eventually die from a maternal cause |
| PM (Proportion of Maternal Deaths) | No. of maternal deaths ÷ total deaths among women aged 15-49 yrs |
ICD-11 Update: Late maternal deaths + maternal deaths are combined as "Comprehensive maternal deaths"
2. TYPES OF MATERNAL DEATHS
Direct Obstetric Deaths - complications of the pregnant state itself:
- Obstetric hemorrhage
- Hypertensive disorders (Pre-eclampsia/Eclampsia)
- Sepsis/infection
- Complications of anaesthesia
- Complications of caesarean section
- Obstructed labour
Indirect Obstetric Deaths - pre-existing disease aggravated by pregnancy:
- Cardiac disease (most common indirect cause in developing countries)
- Renal disease
- Anaemia
- Hepatitis
3. INDIA MMR DATA (Most Recent - SRS/PIB 2025)
India's MMR Trend (SRS Data, per 1,00,000 live births):
| Period | MMR |
|---|---|
| 2014-16 | 130 |
| 2015-17 | 122 |
| 2016-18 | 113 |
| 2017-19 | 103 |
| 2018-20 | 97 ← Current most cited figure |
India has achieved the NHP 2017 target of MMR <100 per 1,00,000 live births by 2020. (PIB, March 2025)
India's SDG target: MMR < 70 per 1,00,000 live births by 2030
4. STATE-WISE MMR (India, 2018-20)
Empowered Action Group (EAG) / High-burden states:
| State | MMR |
|---|---|
| Assam | ~195 (highest) |
| Uttar Pradesh | ~167 |
| Madhya Pradesh | ~163 |
| Rajasthan | ~141 |
| Chhattisgarh | ~137 |
Low MMR / Best-performing states (already met SDG target):
| State | MMR |
|---|---|
| Kerala | 19 (lowest) |
| Maharashtra | 33 |
| Telangana | 43 |
| Andhra Pradesh | 45 |
| Tamil Nadu | 54 |
| Jharkhand | 56 |
| Gujarat | 57 |
| Karnataka | 69 |
8 states have already surpassed the SDG target of 70. - ICMR/JFMPC 2025
5. GLOBAL MMR DATA (2023-25)
| Country/Region | MMR (per 1,00,000 LB) |
|---|---|
| Global average | ~223 |
| Sub-Saharan Africa / South Asia | >500 |
| USA (2024) | 17.9 (latest CDC data) |
| OECD average (2023) | 10.3 |
| Lowest (Iceland, Norway, Denmark) | <3 |
| SDG 2030 Target (Global) | <70 |
- USA racial disparity: Black women - 44.8 vs White women - 14.2 per 1,00,000 live births (2024)
- US MMR 2021: 32.9 (COVID-era peak); declining to 17.9 by 2024
6. CAUSES OF MATERNAL MORTALITY
Developing Countries (including India) - HHSIO mnemonic:
- Haemorrhage (most common direct cause globally - ~27%)
- Hypertensive disorders (pre-eclampsia/eclampsia)
- Sepsis/infection
- Infection - unsafe abortion complications
- Obstructed labour
Developed Countries (USA/UK):
- Cardiovascular disease (cardiomyopathy) - now the #1 cause in USA (~30%)
- Infection/Sepsis
- Hemorrhage
- VTE (Venous thromboembolism)
- Amniotic fluid embolism (AFE)
Age distribution of maternal deaths in India:
- Peak age: 20-24 years (32% of all maternal deaths)
- Followed by 25-29 years (30%)
7. METHODS OF MEASURING MMR
- Civil registration systems (ideal/gold standard)
- Household surveys
- Sisterhood methods
- RAMOS (Reproductive Age Mortality Studies)
- Verbal autopsy
- Census-based estimates
- B-Mat model (Bayesian maternal mortality estimation - used by WHO/UN Inter-Agency Group)
8. KEY GOVERNMENT INITIATIVES (India)
- Janani Suraksha Yojana (JSY) - cash incentive for institutional deliveries
- Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA) - assured antenatal care on 9th of every month
- LaQshya Programme - Labour Room Quality Improvement
- POSHAN Abhiyaan - nutrition to combat anaemia
- ASHA workers - grassroots postnatal and antenatal support
9. HIGH-YIELD PG EXAM POINTS
- MMR is expressed per 1,00,000 live births (not per 1,000)
- Maternal death window: pregnancy or within 42 days (not 6 weeks - same thing)
- India MMR (2018-20): 97 - achieved NHP target (<100)
- Kerala MMR: 19 - lowest in India
- SDG 2030 target: <70 per 1,00,000 live births
- Most common direct cause globally: Haemorrhage
- Most common cause in USA: Cardiovascular disease (cardiomyopathy)
- Most common indirect cause in India: Anaemia/Cardiac disease
- Women at 20-24 yrs are most vulnerable age group for maternal death in India
- ICD-11 grouped late + maternal deaths as "Comprehensive maternal deaths"
Sources: Park's Textbook of Preventive & Social Medicine; Creasy & Resnik's Maternal-Fetal Medicine 9e; Harrison's Principles of Internal Medicine 22e (2025); PIB India press release March 2025; ICMR JFMPC 2025; CDC NCHS 2024; OECD Health at a Glance 2025
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