Maternal Mortality Ratio in India: Down From 130 to 87

India’s maternal mortality ratio (MMR) has fallen from 130 deaths per lakh live births in 2014-16 to 87 in 2022-24, according to the Registrar General’s latest Sample Registration System (SRS) special bulletin, dated May 2026. That is a drop of 43 points in eight years, or about a third. It is real progress. It is also uneven: Kerala sits at 24, Uttar Pradesh at 154, and the national figure is still 17 points above the global target of 70 set in the Sustainable Development Goals.

This post sets out what the SRS bulletins actually say, where the state gaps are, which policies are credited with the fall, and what is still unexplained. Every figure below is tied to a source you can open yourself.

What does the latest SRS bulletin say about maternal deaths?

The answer is 87 per lakh live births for 2022-24, down from 88 in 2021-23. The SRS Special Bulletin on Maternal Mortality in India 2022-24 gives a 95 percent confidence interval of 78 to 95 for the national number. It also reports a maternal mortality rate of 5 deaths per lakh women aged 15-49, and a lifetime risk of 0.18 percent, which is the chance that a woman of reproductive age dies of a pregnancy-related cause over her reproductive years.

The bulletin shows the trend in one line. Here it is as a table, using the bulletin’s own three-year pooled estimates.

Two things stand out. The fall was steep through 2019-21 and flattened after that. The last three estimates (88, 88, 87) are within each other’s margin of error, so it is fair to say the national decline has slowed, not reversed. A review of the SRS series on Data for India puts the 1998 figure at 398, which shows how far the longer arc has come.

You may have seen the framing “122 to 87”. The 122 is the 2015-17 estimate. Counting from the first period in the current series, 2014-16, the starting point is 130.

What is the maternal mortality ratio, and how is it measured?

MMR is the number of maternal deaths in a period for every 100,000 live births in the same period. The World Health Organization defines a maternal death as the death of a woman while pregnant or within 42 days of the end of a pregnancy, from any cause related to or made worse by the pregnancy or its management, but not from accidents or incidental causes.

India measures it through the Sample Registration System, a large demographic survey run by the Office of the Registrar General. Field staff record deaths in sampled households, and trained workers then conduct a verbal autopsy, a structured interview with the family, to establish whether a woman of reproductive age died of a maternal cause.

Three features of the method matter when you read the numbers.

• Three-year pooling. Maternal deaths are rare events, so the bulletin pools three years of data. That is why each estimate carries a period such as 2022-24 and why consecutive estimates share two years of data.
• A correction factor. The bulletin multiplies the count of maternal deaths in each state by a correction factor to account for undercounting, mainly from out-migration. The factor is the ratio of all female deaths in an age group to the count captured in the verbal autopsy forms.
• Wide intervals at state level. Kerala’s 24 comes with an interval of 0 to 50. Assam’s 84 has an interval of 35 to 134. Small differences between states, or between two periods in one state, should not be over-read.

None of this makes the data weak. It means the national trend is solid and the state rankings are best read in bands, not as exact league tables.

Who is dying, and at what age?

The bulletin also breaks maternal deaths down by age. Most fall in the years when most births happen: 30 percent of maternal deaths are among women aged 20-24 and 36 percent among women aged 25-29. Another 18 percent are aged 30-34. Girls aged 15-19 account for 5 percent, and women aged 35 and above for 11 percent.

The bulletin does not give causes of death in this edition, so this post does not either. National and state health programmes have long pointed to bleeding after birth, high blood pressure in pregnancy, infection and anaemia as leading clinical causes, and these are the targets of the interventions described below. The point for citizens is simpler: a maternal death is overwhelmingly a death of a woman in her twenties, at the start of a family, and most such deaths are preventable with timely care.

How wide are the gaps between states?

Very wide. The 2022-24 bulletin groups states into three blocks, and the blocks tell the story before any single state does.

EAG is the government’s grouping for Bihar, Jharkhand, Madhya Pradesh, Chhattisgarh, Odisha, Rajasthan, Uttar Pradesh and Uttarakhand, and this bulletin adds Assam to it.

The southern block, at 41, is already inside the global target of 70. The EAG and Assam block, at 116, is almost three times higher. Within it, Uttar Pradesh (154), Madhya Pradesh (135), Chhattisgarh (124) and Odisha (124) are the four states with the highest ratios in the bulletin’s major-state table. Uttar Pradesh’s confidence interval, 115 to 192, does not overlap the national interval at all, which makes it the clearest statistical outlier.

Uttar Pradesh is also the largest state by population, with around one in six Indians. A high ratio there carries a heavy absolute burden. Our post on Uttar Pradesh and the per-capita gap looks at why scale makes every health indicator harder to move, and our piece on Madhya Pradesh covers the nutrition side of the same story.

Which states moved the most?

For a comparison point, the 2017-19 state estimates, as reported by Onmanorama, were Assam 205, Uttar Pradesh 167, Madhya Pradesh 163, Chhattisgarh 160, Rajasthan 141, Odisha 136, Bihar 130, Kerala 30 and Maharashtra 38. Set beside the 2022-24 numbers, the pattern is clear.

Assam’s fall, from 205 to 84, is the largest on the page and the one most worth examining. It needs a caution: Assam’s 2022-24 interval is wide (35 to 134), so the true figure could sit anywhere in that range. Even at the top of the range, 134, it would be a large fall. The bulletin does not attribute the change to any single cause, and neither should we. What is documented is that Assam, like every other high-burden state, was covered by the same national programmes described below.

Rajasthan’s move from 141 to 87 and Bihar’s from 130 to 96 are also large. Uttar Pradesh (167 to 154) and Odisha (136 to 124) moved far less. Because two bulletins published years apart use different samples and different pooled periods, treat these as directions of travel, not exact distances. Some of the 2017-19 state figures came from press coverage of the earlier bulletin, so check the original release if you plan to quote them.

What drove the fall in maternal deaths?

Three things are repeatedly credited, and the evidence for the first two is strong: getting births into health facilities, paying for that to happen, and improving what happens once the woman arrives.

Institutional delivery

In 1998, when the SRS recorded an MMR of 398, a large share of Indian births still happened at home. Facility births have since become the norm. As Drishti IAS reports from the National Family Health Survey, the share of births in institutions rose from 40.8 percent in NFHS-3 (2005-06) to 88.6 percent in NFHS-5 (2019-21). The newer National Family Health Survey, reported by DT Next, puts it at 90.6 percent for 2023-24.

The timing lines up: the country doubled its facility births over the same years in which the MMR fell. A woman who delivers in a facility is more likely to have a trained attendant, to reach a blood bank or a surgeon if she bleeds, and to be referred if something goes wrong.

Janani Suraksha Yojana

The Janani Suraksha Yojana (JSY), launched in 2005, was the first large central scheme to pay women to deliver in a facility instead of at home. As Down To Earth reported from the Union health ministry’s 2020-21 annual report, annual JSY beneficiaries rose from 739,000 in 2005-06 to over 10 million. The same article asks the right follow-up question: has paying for institutional birth ensured safe birth? A woman who reaches a facility that lacks a trained attendant, blood or an operating theatre is still at risk. That question leads to the third driver.

LaQshya and the quality of care

The Labour Room Quality Improvement Initiative, LaQshya, was launched by the Ministry of Health and Family Welfare on 11 December 2017. It targets labour rooms and maternity operation theatres in medical college hospitals, district hospitals, first referral units and high-load community health centres. Facilities are assessed against National Quality Assurance Standards, and a score of 70 percent earns LaQshya certification, with Silver, Gold and Platinum badges above 70, 80 and 90 percent. The National Health Mission page on LaQshya describes the design, and the Ministry’s year-end review reports that by 30 November 2023, 873 labour rooms and 663 maternity operation theatres were certified nationally.

Those numbers are small against the size of the system, and independent reviews of the programme in peer-reviewed journals point to understaffing, unclear directives and skill gaps as limits. LaQshya shows where policy is heading, from counting births to improving them. It is too early, and the evidence too thin, to credit it with a measurable share of the fall in the MMR.

Why did Kerala and Tamil Nadu stay ahead?

Kerala (24) and Tamil Nadu (25) are the two lowest major states, and their position is not new. Kerala recorded 30 in 2017-19. Both states combined high female literacy, near-universal facility births, a dense network of primary health centres and a habit of investigating each death instead of only counting it.

Kerala’s habit has a name: the confidential review of maternal deaths. According to the Kerala Federation of Obstetrics and Gynaecology (KFOG), the state’s Confidential Review of Maternal Deaths began in the 1990s, was revised in format in 2010, and covers deaths in both government and private facilities. KFOG, founded in 2002, runs its own reviews with state support. A report on measures to reduce MMR in Kerala notes that the state’s very high share of hospital births, close to 95 percent at the time, gave reviewers the records they needed.

The process works in a loop. District medical officers investigate each death. Findings go to a state nodal officer, who then takes up targeted fixes for the cause that keeps recurring, whether that is delayed referral, a missing blood unit or a gap in training. The point of a confidential review is that staff can describe what went wrong without fear of blame, so the same error does not repeat. It is the same logic aviation uses after a crash.

A fair caveat: no rigorous study has isolated the effect of the review from Kerala’s other advantages, including literacy and income. Tamil Nadu runs its own multi-level audits at community, institution and state levels, and our post on how Tamil Nadu built India’s best social outcomes sets out the wider package. Kerala’s overall model, including the role of women’s collectives, is covered in the Kerala post in this series.

Why have some states barely moved?

The bulletin does not explain, so any answer here is an inference from the data and from related indicators, and it is labelled as one.

Uttar Pradesh, Madhya Pradesh, Chhattisgarh and Odisha share three features that are visible in other official datasets: large rural populations, high rates of child stunting and maternal anaemia, and many births in facilities that are short of specialists. Our post on why child stunting persists in India explains how maternal anaemia and poor dietary diversity feed into both child and maternal outcomes. A woman who enters pregnancy anaemic has less margin if she bleeds.

Distance matters as well. A woman who goes into labour at night in a hill or forest block may reach a facility, but not the right one. The first referral unit, the level at which a caesarean section and a blood transfusion can be done, is the hinge of maternal survival. The JSY got women through the door; LaQshya aims at what happens inside.

It is also true that a state can show a high ratio partly because it measures its deaths better. States that investigate every death find more of them. A rising or stubborn ratio is not always a sign of worsening care.

How far is India from the global target?

The SDG target 3.1 asks countries to reduce the global MMR to under 70 per lakh live births. India is at 87, and the southern block (41) and Maharashtra (37) are already inside the target. Gujarat (64) is close behind. The states that decide whether India reaches 70 are the ones with the most births: Uttar Pradesh, Bihar, Madhya Pradesh and Rajasthan.

A simple piece of arithmetic shows why. If Uttar Pradesh moved from 154 to 100, the national figure would drop by several points on its own, because UP contributes so many births. No other single change would do as much. Focus on the highest-burden states is therefore both a fairness argument and the fastest way to move the national number.

What works, in practice?

The evidence in this post points to a short list.

1. Count and investigate every death. Kerala’s confidential review turns each death into a correction. A national maternal death surveillance system exists, and its value depends on the quality of district reviews.
2. Move from access to quality. JSY solved the first problem, getting women into facilities. LaQshya addresses the second. The next test is whether certified labour rooms have staff on duty at 2 a.m.
3. Fix anaemia before pregnancy. Iron and folic acid for adolescent girls and women before conception is cheaper than a transfusion later.
4. Plan the referral, not just the birth. A woman with a high-risk pregnancy needs to know in advance which facility has a surgeon and blood, and how she will get there.
5. Publish state and district data, with intervals. Citizens and officials can act on numbers they can see. The SRS bulletins already provide intervals, which keeps the debate honest.

What can you do?

Maternal health is not only a government matter. Some of the most useful steps are local and personal.

• Register the pregnancy early. Early registration with the ASHA worker or the nearest health centre brings a woman into free antenatal care, iron tablets and a birth plan. Public health centres also offer free check-ups on a fixed day each month under the Pradhan Mantri Surakshit Matritva Abhiyan; ask your ANM which day it is.
• Know the danger signs. Heavy bleeding, severe headache with blurred vision, fits, high fever, or the baby moving less than usual all mean going to a facility at once, not waiting for morning.
• Ask where the nearest facility with a surgeon and blood is. Do this in the fifth or sixth month, not in labour. Many districts run an ambulance service on 102.
• Delay first pregnancy until the girl is physically ready. Girls aged 15-19 account for 5 percent of maternal deaths in the bulletin, and early pregnancy raises risk for the baby as well. Our post on child marriage in India shows how persistent the problem is.
• Back women’s groups and local health committees. Village Health and Sanitation Committees and self-help groups can arrange transport funds and raise the alarm when an ambulance does not come.
• Use the right to information. You can ask a district hospital how many maternal deaths it recorded and what was done about each. The answer is a public record.

Frequently asked questions

What is India’s maternal mortality ratio now?

It is 87 deaths per lakh live births for 2022-24, according to the SRS special bulletin released in May 2026. The previous estimates were 88 for 2021-23 and 93 for 2019-21.

Which state has the lowest and which the highest MMR?

In the 2022-24 table of major states, Kerala (24) and Tamil Nadu (25) are lowest, and Uttar Pradesh (154) is highest, followed by Madhya Pradesh (135). Because intervals overlap, Kerala and Tamil Nadu are best seen as one band.

Has India met the global target?

No. The SDG target is below 70 per lakh live births. India is at 87. The southern states as a group (41) and Maharashtra (37) have already met it.

Why does the MMR change so slowly from one bulletin to the next?

Each estimate pools three years of data, so consecutive bulletins share two of three years. A real change takes time to show up, and a small movement such as 88 to 87 is within the margin of error.

Is giving birth in a hospital enough to be safe?

It lowers the risk sharply, but the quality of the facility matters. That is why programmes such as LaQshya focus on labour rooms and operating theatres, not only on bringing women to the building.

Why does the post use the 130 starting figure and not 122?

The SRS series in the latest bulletin begins at 2014-16 with 130. The 122 belongs to the next period, 2015-17.

The takeaway

A fall from 130 to 87 in eight years means thousands of women who would have died are alive. It came from putting the delivery into a facility, paying for it to happen, and slowly raising the quality of what happens there. The remaining gap is concentrated in a handful of large states and in the quality of care once a woman arrives. Kerala’s habit of investigating every death is the cheapest idea in the whole story, and it is available to any district willing to ask the question: what went wrong, and who will fix it?

Sources: Office of the Registrar General of India, SRS Special Bulletin on Maternal Mortality in India 2022-24 (May 2026); Ministry of Health and Family Welfare and Press Information Bureau on LaQshya; Rajya Sabha reply on NFHS-5; Down To Earth; DT Next; Onmanorama; Kerala Federation of Obstetrics and Gynaecology.