Making Childbirth Safer

How maternal deaths have fallen worldwide and in India, the role of incentives such as Janani Suraksha Yojana, and the remaining challenges.

For most of history, childbirth was one of the most dangerous events in a woman’s life. Today, most maternal deaths are preventable, and great progress has been made.

Global progress

The maternal mortality ratio measures maternal deaths per 100,000 live births. According to United Nations estimates, global maternal deaths fell by about 40 percent between 2000 and 2023. But hundreds of thousands of women still die each year, mostly in sub-Saharan Africa and South Asia, from causes such as bleeding, high blood pressure, infections and unsafe abortions.

India’s progress

India’s maternal mortality ratio has fallen dramatically, from several hundred per 100,000 births in the 1990s to below 100 in recent official estimates. Some states, such as Kerala, have ratios comparable to upper-middle-income countries, while others remain much higher.

Janani Suraksha Yojana

In 2005, India launched Janani Suraksha Yojana, a conditional cash transfer scheme that pays women, especially from poorer households, to give birth in health facilities. ASHA workers are also paid to help women reach facilities.

Institutional deliveries rose from about 39 percent in 2005-06 to about 89 percent in 2019-21, according to the National Family Health Survey.

Did it work?

Research found that the scheme greatly increased institutional deliveries. Its effect on maternal and newborn deaths was more mixed, partly because quality of care in some facilities was poor. Getting women to facilities is not enough; facilities must have skilled staff, blood supplies and emergency care.

Other programmes

Janani Shishu Suraksha Karyakram: free delivery, medicines and transport in public facilities.
LaQshya: improving quality in labour rooms.
Pradhan Mantri Matru Vandana Yojana: cash support for pregnant and lactating women.

Economics of maternal health

Maternal deaths devastate families; children who lose their mothers face higher risks of death and lower schooling.
Safe childbirth is highly cost-effective.

The journey to the hospital

In 2004, a woman in a village gives birth at home, assisted by relatives. In 2020, her daughter-in-law is accompanied by an ASHA worker to the district hospital in a free ambulance, gives birth with a trained nurse, and receives a cash transfer. The risks for mother and baby are far lower.

Thinking getting women to hospitals is enough

Facility births help only if facilities provide good quality care. Quality improvements are essential to reduce deaths.

Key takeaways

Global maternal deaths fell by about 40 percent between 2000 and 2023.
India's maternal mortality ratio has fallen to below 100 per 100,000 births.
Janani Suraksha Yojana raised institutional deliveries from about 39 to 89 percent.
Quality of care is crucial for further reductions.