Table 4 Maternal health inequities in India

Even though the maternal mortality ratio (MMR) has reduced in India, from 556 (per 100,000 live births) in 1990 to 174 in 2015 [1], the country has one of the largest number of maternal deaths in the world. It is far above the national commitment to achieve the Millennium Development Goal - 5 target, i.e., to reduce the MMR by three quarters or 139 by 2015 [96]. An estimated 45,000 maternal deaths took place in India in 2015, accounting for about 19% of the global number [1]. Further, there are large intra-country disparities in MMR (maternal deaths per 100,000 live births): higher among the northern states such as Assam (328), Uttar Pradesh (292), and Rajasthan (255), and lower among the southern states such as Kerala (66), Maharashtra (87), and Tamil Nadu (90) [97]. Women, particularly from rural, poor, and certain castes, such as scheduled castes/scheduled tribes (SC/ST), continue to die from avoidable maternal causes across all Indian states [38, 67]. More than 70% of the maternal deaths in 10 Indian states were among women from SC/ST [38], while SC/ST constitute about 25% of the total population in these states [98]. The use of maternal health services is also particularly low among the rural, the poor, and women from the marginalized castes [99]. The latest available survey data show that institutional delivery was higher among urban (70.4%) than rural (37.8%); other castes (58.9%) compared with ST (32.5%), SC (41.9%), and other backward castes (OBC) (47.8%); and richest (highest wealth quintile) group (80.1%) compared with poorest (lowest wealth quintile) group (19.1%) [99].