Manorama Bakshi
India’s maternal mortality ratio (MMR) has seen a significant decline, dropping from 556 deaths per 100,000 live births in 1990 to 89 in 2022, reflecting an 84% decrease. This progress is commendable, yet it masks persistent challenges that continue to affect women’s health across the nation. While national programs like Janani Suraksha Yojana (JSY) and Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA) have contributed to these improvements, issues such as maternal mental health, unsafe abortions, and nutritional deficiencies remain pressing concerns.
Maternal Mental Health: An Overlooked Priority
Postpartum depression (PPD) affects nearly 1 in 5 women in India, yet it remains largely invisible in public health discourse. The lack of integration of mental health screenings in maternal care, especially in rural and underserved areas, exacerbates this issue. Training frontline workers like ASHAs and ANMs to recognize and address PPD is crucial for the well-being of new mothers.
Unsafe Abortions: A Persistent Threat
Despite the liberal provisions of the Medical Termination of Pregnancy (MTP) Act, unsafe abortions continue to account for 8% of maternal deaths in India. Access to safe abortion services, particularly in rural and tribal regions, is limited. Enhancing community awareness, providing counseling, and ensuring the availability of trained providers are essential steps toward reducing these preventable deaths.
Nutritional Deficiencies: A Systemic Neglect
Anemia remains a significant health issue, with 57% of women, 59% of adolescent girls, and 52% of pregnant women affected. Programs like Anemia Mukt Bharat have been launched to combat this, yet the persistence of anemia indicates systemic neglect. Factors such as poor diet diversity, social norms prioritizing men’s nutrition, and lack of nutrition counseling contribute to this ongoing problem.
Contraceptive Choices: Gender Disparities
According to NFHS-5, only 0.3% of Indian men opt for vasectomy, while female sterilization accounts for approximately 38% of contraceptive use. This disparity highlights deeply entrenched gender norms that place the burden of family planning on women. Additionally, a 9.4% unmet need for contraception persists, particularly among rural, poor, and adolescent populations.
Adolescent Health: A Neglected Frontier
Nearly 59% of adolescent girls in India are anemic, and 23.3% are married before the age of 19. Early marriage and pregnancy, coupled with poor nutrition, perpetuate intergenerational health inequities. Despite schemes like Rashtriya Kishor Swasthya Karyakram (RKSK), many adolescent girls remain untouched by services meant for them.
Vaccination Equity: The HPV Challenge
The HPV vaccine, crucial in preventing cervical cancer, remains inaccessible to many adolescent girls due to cost constraints. Only a few states have included it in their Program Implementation Plans (PIPs), making universal coverage a distant goal. Increased allocations for adolescent health and affordable, community-based delivery models are necessary to address this gap.
Jammu and Kashmir: A Closer Look
In Jammu and Kashmir, the maternal mortality ratio is reported at 12 per 100,000 live births, indicating progress. However, challenges persist. The sex ratio at birth has improved to 921 females per 1,000 males, yet disparities remain, especially in urban areas where the ratio is 840 females per 1,000 males. Birth and death registration rates are also concerning, with only 65% of births and 51% of deaths registered, highlighting the need for improved civil registration systems.
Reaching the Last Mile
Rural and remote areas, particularly in the border regions of Jammu and Kashmir, face significant healthcare access challenges. A lack of healthcare infrastructure, non-availability of doctors, and low doctor-patient ratios contribute to poor health outcomes for women. Addressing these issues requires targeted interventions, including mobile health units, telemedicine services, and incentives for healthcare professionals to serve in underserved areas.
Global Context: A Comparative Perspective
Globally, the maternal mortality ratio stands at approximately 223 per 100,000 live births, with significant disparities between high-income and low-income countries. India’s MMR of 89 is below the global average, yet continuous efforts are needed to sustain and further this progress. Comparative analysis underscores the importance of comprehensive healthcare strategies that address both medical and socio-cultural determinants of women’s health.
Conclusion: From Celebration to Action
While acknowledging the strides made in improving women’s health, it is imperative to recognize and address the persistent challenges that remain. A holistic approach that includes mental health support, safe abortion access, nutritional interventions, equitable contraceptive options, adolescent health services, and robust civil registration systems is essential. Only through sustained commitment and targeted action can we ensure that women’s health is not just celebrated but truly prioritized.
Manorama Bakshi is the Director & Head of Healthcare & Advocacy at Consocia Advisory, Founder of the Triloki Raj Foundation, senior visiting Fellow at IMPRI.
The article was published in EXCELSIOR HOUSE as Women’s Health deserves more than celebration on 30th May 2025.
Disclaimer: All views expressed in the article belong to the author and not necessarily to the organisation.
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Acknowledgement: This article was posted by Khushboo Dandona, a research intern at IMPRI.
