Q. Kerala has witnessed a rise in Maternal Mortality Ratio (MMR) despite being a leader in health outcomes. Discuss the reasons behind this paradox and suggest policy measures.

 

Q. Kerala has witnessed a rise in Maternal Mortality Ratio (MMR) despite being a leader in health outcomes. Discuss the reasons behind this paradox and suggest policy measures.

Answer:
Kerala has historically set benchmarks in health indicators such as infant mortality, life expectancy, and institutional deliveries. Yet, the latest Sample Registration System (2021–23) shows its MMR rising from 18 to 30 per 1,00,000 live births, even as it continues to rank among the lowest in the country.

The paradox arises primarily due to declining live births: annual births have fallen from 5–5.5 lakh to below 4 lakh, reducing the denominator in the ratio. While maternal deaths (120–140 annually) remain largely steady, the ratio inflates. The temporary spike during the COVID-19 pandemic, when 97 maternal deaths occurred in 2021, further accentuated this rise. Another issue is the variance between sample-based SRS data and Kerala’s line-list records, which capture every maternal death.

Policy measures should focus on:

• Shifting from ratio-based to absolute numbers and demographic-sensitive indicators in low-fertility states.

• Strengthening high-risk pregnancy management and last-mile maternal care.

• Investing in data harmonisation to reduce discrepancies.

Thus, while Kerala’s maternal health system remains strong, nuanced interpretation of indicators and targeted interventions are necessary to sustain progress.