Maternal Mortality Ratio (MMR) refers to the number of maternal deaths per 1,00,000 live births during a given period.
A maternal death means the death of a woman while pregnant or within 42 days of termination of pregnancy, from causes related to or aggravated by pregnancy or its management, but not from accidental or incidental causes.
MMR is one of the most important indicators of women’s health, quality of healthcare, nutrition, institutional delivery, emergency obstetric care and overall social development.
Meaning and Calculation
MMR measures the risk of death associated with pregnancy and childbirth.
It is calculated as:
Number of maternal deaths ÷ Number of live births × 1,00,000
For example, if 100 women die due to pregnancy-related causes for every 1,00,000 live births, the MMR is 100.
MMR is different from maternal mortality rate. MMR uses live births as the denominator, while maternal mortality rate uses the number of women of reproductive age.
Major Causes
Most maternal deaths are preventable if timely and quality healthcare is available.
Major causes include:
- severe bleeding after delivery
- hypertensive disorders during pregnancy
- sepsis and infections
- unsafe abortion
- obstructed labour
- anaemia
- complications from pre-existing diseases
- delayed referral and poor emergency care
Maternal deaths often happen due to the “three delays”:
- delay in deciding to seek care
- delay in reaching a health facility
- delay in receiving proper treatment at the facility
This is why reducing MMR requires not only hospitals, but also awareness, transport, trained staff, blood banks and emergency obstetric services.
India’s Status
India has made major progress in reducing maternal mortality.
According to the Sample Registration System Special Bulletin 2019–21, India’s MMR declined to 93 per 1,00,000 live births.
This is a major improvement from earlier decades and shows better institutional delivery, antenatal care, skilled birth attendance and emergency obstetric care.
However, there is still strong state-level variation. Some states have achieved very low MMR, while others continue to have higher maternal mortality due to weaker health systems, anaemia, poverty, early marriage, poor nutrition and limited access to specialist care.
Significance
MMR is important because it reflects the condition of women’s health and healthcare systems.
A high MMR indicates problems in:
- antenatal care
- maternal nutrition
- institutional delivery quality
- emergency obstetric care
- blood transfusion availability
- transport and referral system
- postnatal care
- reproductive health services
Reducing MMR is also linked with Sustainable Development Goal 3, which aims to reduce global maternal mortality to less than 70 per 1,00,000 live births.
For India, lowering MMR is not only a health goal. It is also linked with gender justice, poverty reduction and human development.
Government Measures
India has introduced several programmes to reduce maternal deaths.
Important measures include:
- Janani Suraksha Yojana: promotes institutional delivery through cash assistance
- Janani Shishu Suraksha Karyakram: provides free delivery, C-section, drugs, diagnostics, diet and transport
- Pradhan Mantri Surakshit Matritva Abhiyan: assured antenatal care on the 9th day of every month
- LaQshya programme: improves quality of care in labour rooms and maternity operation theatres
- SUMAN initiative: aims to provide assured, respectful and free maternal and newborn healthcare
- Anaemia Mukt Bharat: addresses anaemia among women and children
- Maternal Death Surveillance and Response: reviews maternal deaths to identify avoidable causes
These schemes focus on antenatal check-ups, institutional delivery, high-risk pregnancy tracking, skilled care and postnatal support.
Key Challenges
The major challenge is improving quality of care, not just increasing institutional delivery.
Many women reach health facilities but may not receive timely treatment, blood transfusion, specialist care or emergency surgery.
Important concerns include:
- high anaemia among pregnant women
- shortage of obstetricians and trained nurses
- weak emergency referral systems
- poor quality of care in some facilities
- delays in C-section or blood availability
- unsafe abortions
- adolescent pregnancy
- regional inequality between states
- lack of postnatal follow-up
Antenatal care must identify high-risk pregnancies early. Delivery care must be safe and respectful. Postnatal care must detect complications after childbirth.
Conclusion
Maternal Mortality Ratio measures the number of maternal deaths per 1,00,000 live births.
It is a critical indicator of women’s health and the quality of maternal healthcare.
India has reduced MMR significantly, reaching 93 per 1,00,000 live births in SRS 2019–21. The next challenge is to reduce state-level gaps by improving anaemia control, high-risk pregnancy tracking, emergency obstetric care, referral systems and quality of institutional delivery.
