Assam cuts maternal mortality by over 82% in two decades, falls below national average for first time

Assam has recorded one of its most significant public health turnarounds in two decades, with the state’s Maternal Mortality Ratio (MMR) dropping from 480 maternal deaths per 100,000 live births in 2004–06 to 84 in the latest estimates, bringing Assam below the national average for the first time.

The latest Sample Registration System (SRS) estimates place India’s Maternal Mortality Ratio at 88 for 2021–23, while Assam has improved further to 84, a milestone many public health experts consider historic for a state that once recorded the country’s worst maternal mortality burden.

The Sample Registration System (SRS) estimates for 2021–23 show Assam’s Maternal Mortality Ratio (MMR) at 110 maternal deaths per 100,000 live births, placing it above the national average of 88 and indicating that maternal health challenges remain more severe in the state than across India overall. 

However, Assam now performs better than several traditionally high-burden states, including Odisha (153), Chhattisgarh (146), Madhya Pradesh (142) and Uttar Pradesh (141). Assam’s MMR is also marginally higher than Bihar (104) and West Bengal (104), while Rajasthan (86) has moved below both Assam and the national average. 

Southern states continue to maintain a substantial lead, with Kerala and Andhra Pradesh recording an MMR of 30 each, Tamil Nadu 35, Telangana 59 and Karnataka 68, pushing the southern states’ combined average to 42, less than half of Assam’s level.

The decline represents an improvement of more than 82 per cent from Assam’s 2004–06 level and nearly 79 per cent from 2007–09, when the state’s MMR stood at 390.

Two decades ago, Assam had the highest Maternal Mortality Ratio among major Indian states. 

During 2004–06, Assam’s MMR of 480 was substantially higher than Uttar Pradesh/Uttarakhand (440), Rajasthan (388), Madhya Pradesh/Chhattisgarh (335), Bihar/Jharkhand (312) and Odisha (303), states traditionally associated with higher maternal mortality burdens.

Southern and western states had already achieved substantially better outcomes at the time. 

Kerala recorded an MMR of 95 during 2004–06, Tamil Nadu stood at 111, Maharashtra at 130, West Bengal at 141, Andhra Pradesh at 154 and Gujarat at 160.

The trend over two decades shows major progress across India, but Assam’s improvement stands out because of the scale of reduction achieved from an exceptionally high baseline.

Nationally, India’s Maternal Mortality Ratio declined from 254 during 2004–06 to 212 during 2007–09 before reaching 88 in recent estimates.

Assam’s fall to 84 now places the state below the national average, a development that would have appeared difficult to imagine when maternal mortality levels in Assam were nearly double the national figure two decades ago.

Infant mortality indicators have also improved during this period. 

Assam’s Infant Mortality Rate (IMR), measured as infant deaths below one year per 1,000 live births, declined from 61 in 2009 to 29 in 2024. However, Assam remains above the national IMR average of 24.

Within the Northeast, Assam continues to lag behind several neighbouring states on infant mortality outcomes. Meghalaya reported an IMR of 31 in 2024, while Arunachal Pradesh recorded 17, Mizoram 12, Nagaland 12, Tripura 12, Sikkim 7 and Manipur 2.