Maternal and Child Health in Rural India
Across the quiet dusty lanes of rural India, a woman goes into labor, her family unsure whether to wait for the midwife or risk the journey to a distant primary health center. Her experience is not a rare exception. In fact, it is a recurring chapter in the broader story of maternal and child health in most parts of rural India.
While our government has made substantial strides in maternal and child health outcomes over the past two decades, the rural-urban divide remains quite stark. Dashboards show improvement. Yet the realities in underserved geographies demand a closer lens—one that moves beyond numbers to reveal the uneven terrain beneath them.
A Statistical Shift, With Persistent Silences
The numbers, though, tell a mixed story. India’s maternal mortality ratio (MMR) has declined from 398 per 100,000 live births in 1997–98 to 97 in 2020, according to the latest estimates by the Sample Registration System. The under-five mortality rate (U5MR) also fell to 32 per 1,000 live births in 2020. At face value, these are commendable achievements.
Yet beneath this aggregate progress lie deep fractures. In rural districts of Assam, Madhya Pradesh, and Uttar Pradesh, the MMR still hovers well above the national average. For every mother who receives four or more antenatal checkups (ANCs), several others fall through the cracks. They end up delivering at home, unsupported, or too far from timely emergency obstetric care.
According to NFHS-5 (2019–21), full immunization coverage in India stands at 76.1%, and the majority of children missing out on essential vaccines are from rural areas, where one in four remains unreached. The institutional delivery rate in rural India is rising, yet large pockets remain underserved due to distance, cost, cultural preferences, or systemic mistrust.
The Geography of Health Is Not Just Physical
Geographic access is just one part of the challenge. The maternal health ecosystem in rural areas is also shaped by a number of social factors like human resource management, accountability, and cultural norms that influence care-seeking behaviors.
A primary health center may exist on paper, but without a skilled birth attendant, regular drug stock, or reliable electricity, its utility is diminished. The availability of Accredited Social Health Activists (ASHAs) is uneven across India. Many work across multiple localities without transport, formal protection, or adequate remuneration. When ASHA workers themselves deliver babies at home without gloves or clean blades, the risk multiplies.
Caste, gender, and income further deepen health inequities. Dalit women, adolescent girls, and migrant mothers are disproportionately underrepresented in health coverage data and more likely to face disrespectful maternity care. In tribal districts, health-seeking behavior is often mediated by mistrust of medical systems or geographical isolation. In some regions, the delay is not in reaching a facility but in deciding whether it is even safe to go.
When Programs Reach, But Do Not Anchor
India’s flagship programs like the Janani Suraksha Yojana (JSY), Pradhan Mantri Matru Vandana Yojana (PMMVY), and the newer Surakshit Matritva Aashwasan (SUMAN) have attempted to incentivize institutional births and early child care. But implementation quality still remains uneven.
Take JSY, which offers cash assistance for institutional deliveries. Studies show that while it has increased hospital births, it has also inadvertently overwhelmed rural facilities, which are unequipped to handle the large volume of patient inflow. The infrastructure upgrades that should cater to the rising demands still lag behind. PMMVY’s maternity benefits are delayed or underpaid due to Aadhaar-linked errors or a lack of digital literacy among beneficiaries.
Moreover, programs still focus on visibility, rather than meaningful outreach and understanding patient needs. A digitized checklist may confirm that a mother received antenatal counseling, but it rarely captures whether she understood it, or whether language, gender norms, or fatigue got in the way.
Health Systems Must Listen Before They Speak
The issue isn’t the absence of health schemes, but the absence of listening. In many rural communities, women hesitate to visit public health facilities—not because they reject modern care, but because their past experiences have left them feeling unseen. A clinic may offer services, but when privacy is compromised, cleanliness is lacking, or the staff speak dismissively, dignity can feel out of reach.
Health decisions, especially during pregnancy, are rarely driven by information alone. They are shaped by how safe a woman feels, how she’s been treated before, and whether she believes someone will truly stand by her when the time comes. What matters just as much is whether someone walks beside her, through transport, delivery, and recovery.
Programs that succeed don’t just deliver services. They build relationships. And that begins by listening first.
What Will It Take?
Improving maternal and child health in rural India will not come from sweeping reforms alone. It must come from listening closely and designing policies with intent. Uniform policies rarely land where they are needed most. A mobile antenatal care camp may be the only lifeline in a forested village in Odisha, while in a flood-prone district of Bihar, continuity in postnatal support could hinge on a timely phone call. What works in one district may falter entirely in another.
Solutions must reflect this diversity, starting with the people closest to the ground. And it begins with the people at the frontlines. ASHAs, ANMs, and Anganwadi workers are not just a part of the system, but are themselves the system for many mothers. If they are equipped not only with tools but also with dignity, including timely payments, decision-making authority, and training in local languages, they can build trust in places where the state often feels absent.
It is equally critical to shift the approach to how success is measured. A visit logged into a register does not tell us if the mother felt heard, understood her care plan, or was treated with respect. Did the screening go beyond blood pressure? Was domestic violence considered? These are the markers that matter.
And we must think beyond the delivery table. The weeks following childbirth are often when health falters, particularly in areas such as nutrition, breastfeeding, immunization, and early stimulation. Continuity in care, built on relationships and follow-up, can mean the difference between progress and preventable loss.
A Health System That Remembers
India does not need more health programs. It needs a health system that remembers. A woman who walked ten kilometers in labor or the child who was underweight but not recorded is not just a one-off case. They are the margins where the system is most visible.
We need a future where the health of a mother and her child will not be decided in policy papers, but in whether someone shows up, listens, and stays. Because when it comes to maternal and child health, success is not in reaching everyone once. It’s in being remembered when it matters most.
Raj Kashyap Das – Knowledge & Insights Coordinator, Sambodhi
