It’s MMR in 2005 reduced to from 540 per 100 000 live births (in 2000), to 450 per 100 000 live births.^[ii] Maternal morbidity and mortality rates are higher in young women aged between 15 to 19 and those above the age of 35. The risk of a female dying of maternal and non-maternal causes is higher in the rural areas. The leading causes of maternal death have been: haemorrhage, sepsis, and abortion. Low levels of education among females specifically enhance the risk of maternal death, lack of appropriate care during pregnancy and childbirth, and inadequacy of services for detecting and managing complications, causes most of the maternal deaths. Nearly 5,000,000 women suffer ill health due to pregnancy related complications alone. The resulting chronic state of anaemia coupled with poor healthcare for women underlie high morbidity and mortality in Indian women.^[iii]

Some studies have shown that generally maternal mortality and morbidity rate is higher amongst women who belong to the scheduled castes, tribal communities and those living in less developed villages. Other contributing factors include poor health, inadequate medical facilities, indifferent attitude of medical practitioners and a lack of transport.^[iv]

Many socio-cultural factors contribute to the poor status of maternal health in India, including gender discrimination and traditional practices. It is widely known that women have a poorer nutritional status due to food taboos during menstruation, pregnancy and lactation, as well as gendered behaviour which encourages women to eat last in the family. Women have lower literacy than men and poorer access to public information through mass media. This prevents them from gaining awareness about their entitlements and the health services available.^[v]  

The taboo surrounding sex, sexuality and reproductive health prevent young women from having much needed access to information about safe sex or from negotiation protected sex with their partners, leading to unplanned pregnancies. With the social premium on virginity, marriages are ‘settled’ at the earliest age so that the onus of protecting the girl’s chastity can be shifted on to the marital family. All major religions and castes frown upon autonomous seeking of marriage partners or delaying age of marriage. Women are valued after marriage primarily for their capacity to bear children, thus they are often compelled to demonstrate fertility at the earliest. Preference for sons, promoted by religion, leads to repeated pregnancies and often to repeated sex-selective abortions.^[vi]

Maternal health is also affected by the economic status of women, including their ability to make economic decisions regarding health care, and their access to material resources. Women are deprived of an active role in decision-making regarding the family finances until they become senior enough to count. Thus they often do not make the crucial decisions to seek healthcare in chronic or emergency ill-health.^[vii]

However, certain enabling factors do exist to improve women’s access to SRHR. These include the emerging tradition of judicial activism, an independent media, existence of ombudsperson agencies and a strong civil society, the existence of an independent media that helps efforts towards policy change and the existence of ombudsperson agencies such as the National Human Rights Commission, the National Women’s Commission, the Commission for Minorities, the Scheduled Castes and Scheduled Tribes’ Commission for Dalits and indigenous groups, and so on. While not all of these are effective or independent of party alliances, they do provide a forum for addressing grievances when the usual approaches fail.^[viii]