Assessing the Health Status of Women in India: Key Mortality and Morbidity Indicators

Women’s health in India sits at the intersection of biology, economics, geography, and social structure. A woman’s chance of surviving childbirth, her risk of being anemic, and even how long she is likely to live depend not just on her own choices but on where she was born, which community she belongs to, and how much her family earns. Looking at mortality and morbidity indicators is the most reliable way to understand this complex picture, because numbers reveal patterns that personal stories alone cannot.

Why mortality and morbidity indicators matter 🔗

Mortality indicators measure deaths, while morbidity indicators measure the burden of disease and ill-health among the living. Together, they tell us whether a population is thriving or merely surviving. For women specifically, indicators like the Maternal Mortality Ratio (MMR), life expectancy at birth, anemia prevalence, and reproductive health metrics are critical because they capture risks that men either don’t face or face very differently.

These indicators also act as a report card for public health systems. When MMR falls, it usually means antenatal care, skilled birth attendance, and emergency obstetric services are improving. When anemia rises despite government programmes, it signals that nutrition policy and food security still have gaps.

Maternal mortality: significant progress, but uneven 🔗

The Maternal Mortality Ratio is the number of women who die from pregnancy-related causes per 100,000 live births. India has made remarkable progress here. According to the Special Bulletin on Maternal Mortality in India 2019-21, MMR declined from 130 per lakh live births in 2014-16 to 93 in 2019-21, a reduction of 37 points in just five years. The UN Maternal Mortality Estimation Inter-agency Group’s 2025 report indicates a further 23-point reduction between 2020 and 2023.

To put this achievement in perspective, India’s MMR has declined by roughly 86% over the past three decades, far outpacing the global reduction of 48%. Yet the country still hasn’t met the Sustainable Development Goal target of reducing MMR to below 70 per 100,000 live births by 2030.

Regional disparities tell a different story 🔗

The national average hides striking inequalities. Research published in BJOG found that about 63% of maternal deaths occur in poorer states, and most affected women are between 20 and 29 years old. States like Assam continue to record MMRs above 200, while Kerala and Tamil Nadu have brought theirs down to levels comparable with upper-middle-income countries. This means a pregnant woman’s geography can quite literally determine her chances of survival.

Life expectancy: longer lives, but not for everyone 🔗

According to the Sample Registration System data referenced in the NFHS-5 Key Insights compiled by UNFPA, female life expectancy at birth is 70.7 years, slightly higher than the male figure of 68.2 years. On the surface, this looks encouraging, since women across most populations tend to outlive men.

However, when life expectancy is broken down by social group, the picture changes sharply. A study published in Population and Development Review documented large and persistent life expectancy gaps between Scheduled Castes (SCs), Scheduled Tribes (STs), Muslims, Other Backward Classes (OBCs), and upper castes. Tribal women, in particular, face significantly shorter lives. Independent analyses cited by re-solve Global Health place the average life expectancy of Scheduled Tribe women at around 55 years, dramatically below the national average.

Anemia: a quiet epidemic among women 🔗

If maternal mortality is the dramatic, visible side of women’s health, anemia is the silent, pervasive one. It saps energy, increases the risk of complications during pregnancy, lowers productivity, and contributes to low birth weight in infants.

The trend here is genuinely worrying. The Indian Journal of Community Health reports that anemia prevalence among women aged 15-49 rose from 53% in NFHS-4 to 57% in NFHS-5, despite the launch of the Anemia Mukt Bharat campaign in 2019. More than half of pregnant women, around 52.2%, are anemic, a slight worsening from 50.4% in the previous round.

Why anemia persists 🔗

Several intertwined factors explain why anemia is so stubborn. Diets in many households are heavily cereal-based and low in iron, vitamin B12, and folate. Menstruation, repeated pregnancies, and lactation increase iron requirements that the diet often cannot meet. Worm infestations, malaria in some regions, and chronic infections also drain iron stores. A BMC Public Health analysis of aspirational districts shows that wealth, education, and access to nutritious food remain the strongest determinants of whether a woman becomes anemic.

Reproductive health and antenatal care 🔗

Antenatal care (ANC) is the package of health services a pregnant woman receives before delivery, and it is one of the most cost-effective interventions in public health. The Ministry of Health and Family Welfare recommends a minimum of four ANC visits during pregnancy.

Coverage has improved meaningfully. The NFHS-5 data shows that first-trimester ANC reached 70% of pregnant women, up by 11.4 percentage points from NFHS-4. Four or more ANC visits rose to 58.1%, while postnatal care visits climbed to 78%. Only 6% of women had no ANC visits at all, down sharply from 17% in the previous round.

Quality, however, lags behind quantity. A study in BMC Pregnancy and Childbirth analysing NFHS-5 found that although nearly three in five women attended the minimum four visits, only about one in five received care that met the criteria for “adequate quality,” covering blood pressure checks, urine and blood tests, iron-folic acid supplementation, and counseling.

Institutional delivery and the home-birth question 🔗

Home deliveries without skilled attendants used to be a major driver of maternal deaths. The shift has been dramatic. Institutional births rose from around 79% in NFHS-4 to 88.6% in NFHS-5, with most of the increase coming from public facilities, which now handle 61.9% of institutional deliveries.

Still, an analysis by the Centre for Economic Data and Analysis highlights that six states continue to report institutional delivery rates below 80%, including Nagaland at just 45.7% and Meghalaya at 58.1%. This is where the remaining 11% of women who deliver without skilled attendants are concentrated, and where preventable maternal deaths still cluster.

Socio-economic disparities in access 🔗

The most consistent finding across all women’s health research in India is that outcomes track wealth, education, and social group. A study on institutional deliveries in nine low-performing states found that Scheduled Caste, Scheduled Tribe, and Muslim women, along with those married before 18, were significantly less likely to deliver in a health facility. Women’s education, household wealth, and exposure to mass media were the strongest facilitators of facility-based delivery.

Distance to a health facility remains a major barrier for marginalised communities. NFHS-5 data analysed by re-solve Global Health shows that 34% of tribal women report being unable to visit a health facility because of distance, compared with 24% of Dalit women and 20% of women overall. When the nearest community health centre is hours away by foot or unreliable public transport, even free services become inaccessible.

Newer concerns: non-communicable diseases and screening 🔗

As infectious diseases recede, non-communicable conditions like hypertension, diabetes, and cancers of the cervix and breast are becoming more important. Yet NFHS-5 found that only 1.9% of women had been screened for cervical cancer and just 0.9% had received a breast examination. Given that cervical cancer is one of the most preventable cancers when caught early, these numbers represent a major gap in reproductive health services.

What the data tells us about progress 🔗

India’s women’s health story over the last decade is genuinely a story of progress. Fewer mothers are dying. More are giving birth in hospitals. ANC coverage is improving. Life expectancy is rising. The public health system, particularly through the National Health Mission and schemes like Janani Suraksha Yojana, has demonstrably saved lives.

But the same data forces an uncomfortable acknowledgment: the gains are unevenly distributed. A tribal woman in central India, a Dalit woman in rural Bihar, and an upper-caste woman in urban Tamil Nadu live in entirely different health realities, even though they share the same nationality and constitutional rights. Rising anemia despite a national mission, low cancer screening, and persistent gaps in care quality show that scaling up services is not the same as ensuring they reach everyone or work well.

The next phase of women’s health policy will likely be judged less by national averages and more by how aggressively these gaps close.

What do you think? If you had to choose between expanding the reach of existing maternal health programmes or improving the quality of care for women who already access them, which would you prioritise, and why? And what role do you think education and household decision-making power play in determining whether a woman actually uses the health services available to her?

References

1. https://www.pib.gov.in/PressReleasePage.aspx?PRID=2128024
2. https://pubmed.ncbi.nlm.nih.gov/34455679/
3. https://india.unfpa.org/sites/default/files/pub-pdf/nfhs_5_key_insights.pdf
4. https://onlinelibrary.wiley.com/doi/10.1111/padr.12489
5. https://www.re-solveglobalhealth.com/post/how-caste-is-a-major-barrier-to-health-equity-in-india
6. https://www.iapsmupuk.org/journal/index.php/IJCH/article/view/2523
7. https://link.springer.com/article/10.1186/s12889-024-17789-3
8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10657001/
9. https://ceda.ashoka.edu.in/here-is-what-nfhs-5-tells-us-about-india/
10. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8682830/