One death every two minutes: why most maternal deaths are preventable but not prevented

Every year, roughly 287,000 women die from causes directly related to pregnancy or childbirth. One death every two minutes. More than 94% of those deaths occur in low- and middle-income countries, and most of them happen from conditions that medicine has known how to treat for decades. The drugs exist. The procedures are not complex. What maternal mortality represents, in most cases, is not a failure of medical knowledge. It is a failure of healthcare delivery.

India accounts for approximately 17% of global maternal deaths, a figure that sits alongside a genuine story of progress. According to WHO’s 2023 Trends in Maternal Mortality report, India’s maternal mortality ratio fell from 254 per 100,000 live births in 2004 to 97 in the 2018-20 period, a reduction driven in large part by the Janani Suraksha Yojana cash-incentive scheme for institutional delivery and the LaQshya facility-quality programme. That reduction is real and worth acknowledging. What it also does is conceal a nine-fold gap within the country: Kerala’s MMR stands at 19, while Assam’s sits at 195. A woman’s odds of surviving childbirth in India depend substantially on which state she was born in.

What actually kills women in childbirth

Most maternal deaths trace to a short list of causes: severe postpartum bleeding, dangerously high blood pressure in pregnancy, blood infection after delivery, and complications from unsafe abortion. Postpartum hemorrhage alone accounts for roughly 27% of maternal deaths in India, according to ICMR data. Think of it as a tap that will not switch off: a uterus that fails to contract after delivery can drain a woman of fatal blood volume within 30 minutes, and in a facility without oxytocin on the shelf or a trained hand to administer it, that window closes fast.

Pre-eclampsia and eclampsia, the blood-pressure conditions of pregnancy, are the second major cause. Magnesium sulfate prevents most eclamptic seizures from becoming fatal. It costs less than 100 rupees per dose. Its presence at a delivery facility, alongside someone trained to use it, is the difference between a complication that is managed and one that kills.

What the evidence says could change this

Bhutta et al., publishing in The Lancet in 2014 as part of the Every Newborn Action Plan series, estimated that universal coverage of evidence-based interventions, including oxytocin for hemorrhage, magnesium sulfate for eclampsia, skilled birth attendance, and antenatal screening, could prevent up to 71% of maternal deaths globally. That figure has been updated in subsequent analyses and has not moved dramatically. The interventions themselves are not the scientific frontier. The problem is coverage.

Neighbouring countries make this concrete. Sri Lanka has an MMR below 30. Nepal reduced its MMR from above 900 in the 1990s to under 150 today. Both achieved this not through specialist hospital construction but through scaling skilled birth attendance and ensuring 24-hour access to emergency obstetric care at primary facilities. The common factor in both settings was consistent investment in who is present at delivery and what they are trained and equipped to do, not the sophistication of the facility behind them.

India’s own data reinforces the point. Research drawing on NFHS-4 survey data found that institutional deliveries were associated with substantially lower maternal mortality risk compared to home births without skilled attendance. The JSY scheme, by removing the cost barrier for government hospital delivery for women below the poverty line, contributed directly to the national MMR reduction over the period that scheme was in effect.

Where the system still falls short

The 71% figure assumes universal coverage of known interventions. India is not there. Fewer than 40% of Community Health Centres currently provide round-the-clock emergency obstetric care, according to government facility survey data. Oxytocin stockouts at tier-2 and tier-3 facilities remain documented and recurring. The drug is on the WHO Essential Medicines List. It is not always on the shelf when it is needed.

Human resources are the second gap. India’s NHM Midwifery Initiative aims to deploy nurse-midwife practitioners with full prescribing authority at the last mile, a model that removes the physician bottleneck at facilities too small to staff an obstetrician. States that have moved fastest on midwifery deployment show earlier improvements in skilled birth attendance rates. Implementation across high-burden states has remained uneven.

District-level MMR data, published annually and tied to accountability mechanisms, would expose the gaps that state averages absorb. The Assam-Kerala disparity is visible at the national level. The facility-level gaps within high-burden districts are not, and those are where preventable deaths are concentrated. Bringing district-level reporting into the national health system accountability framework would cost relatively little and create the pressure that drives local action.

I have spent time with the district data from high-burden states, and what stays with me is not the aggregate scale but the specificity of what is already known. The facilities not functioning at night are identifiable by name. The oxytocin stockouts are documented in facility surveys. The districts with the widest skilled attendance gaps are listed in NFHS tables. Maternal mortality at this stage of India’s health system development is not a research problem. It is a last-mile delivery problem, and most of its components are visible to anyone who looks at the data.

This article is for educational purposes only and does not constitute medical advice, diagnosis, or treatment recommendations. Consult a qualified healthcare provider for any health concerns. See our Medical Disclaimer.

Sources

1. World Health Organization. Trends in Maternal Mortality 2000 to 2020: Estimates by WHO, UNICEF, UNFPA, World Bank Group and UNDESA/Population Division. Geneva: WHO; 2023.
2. Bhutta ZA, Das JK, Bahl R, et al. Can available interventions end preventable deaths in mothers, newborn babies, and stillbirths, and at what cost? Lancet. 2014 Jul 26;384(9940):347–70. PMID: 24853604. DOI: 10.1016/S0140-6736(14)60792-3.
3. Registrar General of India. Special Bulletin on Maternal Mortality in India 2018–20. Office of the Registrar General, India; 2022.
4. Randive B, Diwan V, De Costa A. India’s Conditional Cash Transfer Programme (the JSY) to promote institutional birth: is there an association between institutional birth proportion and maternal mortality? PLoS One. 2013;8(6):e67452. PMID: 23840693. DOI: 10.1371/journal.pone.0067452.
5. Nove A, Friberg IK, de Bernis L, et al. Potential impact of midwives in preventing and reducing maternal and neonatal mortality and stillbirths: a Lives Saved Tool modelling study. Lancet Glob Health. 2021;9(1):e24–e32. PMID: 33338443. DOI: 10.1016/S2214-109X(20)30397-1.
6. WHO. WHO recommendations for the prevention and treatment of postpartum haemorrhage. Geneva: WHO; 2012. ISBN: 9789241548502.