Kerala’s Maternal Mortality Ratio (MMR) Rise:

Context

• Latest SRS Special Bulletin (2021–2023): Kerala’s MMR rose from 18 to 30 per 1 lakh live births.

• Kerala and Andhra Pradesh share the lowest MMR in India, despite the rise.

Causes of the Increase

1. COVID-19 Impact (2021):

   • 97 maternal deaths due to COVID-19.

   • In 2021-22, maternal deaths rose to 220, pushing MMR to 51.

2. Declining Live Births (Denominator Effect):

   • Kerala earlier had 5–5.5 lakh live births annually.

   • By 2023: 3.93 lakh live births.

   • Projection for 2024–25: ~3.54 lakh.

   • Maternal deaths remain steady at 120–140 annually → fewer births inflate the ratio.

3. Demographic Transition:

   • Low fertility rate, ageing population, and delayed pregnancies increase high-risk cases.

4. Last-Mile Challenges:

   • While major causes (hemorrhage, sepsis, obstructed labour) have reduced,

   • New challenges: lifestyle diseases, caesarean-related complications, and co-morbidities in older mothers.

Data Discrepancy Issue

• SRS (Sample Registration System): Uses sampling → quoted in official records.

• Kerala Health Department (Line List Method): Records every maternal death → considered more accurate.

• Hence, variations between reported MMR figures.

Broader Implications

• Policy Concern: Declining births impact denominator, making Kerala’s MMR appear worse than ground reality.

• Safe Motherhood Efforts: Kerala has historically invested in institutional deliveries, skilled birth attendants, and maternal health infrastructure.

• Challenge Ahead: Further reducing maternal deaths in a state already at low levels requires tackling non-communicable disease risks, advanced maternal age pregnancies, and healthcare accessibility in remote areas.