Uncertainty about maternal mortality in India: New estimates from the National Family Health Survey

This paper presents new estimates of national and regional maternal mortality ratios (MMR) for India using the National Family Health Surveys (NFHS) 4 and 5, collected in 2014-15 and 2019-21. We compare the results to MMRs from the Sample Registration System (SRS), a nationally representative group of demographic surveillance sites. We estimate 256 maternal deaths (95% CI [222, 295]) per 100,000 live births in the NFHS-4 and 305 (95% CI [268, 344]) in the NFHS-5. The SRS reports an MMR of 130 for 2014-16 and 97 for 2018-20. Differences between the two surveys’ MMR measurements are largest in the socioeconomically disadvantaged states of north India. We discuss possible sources of sampling and non-sampling error in the two surveys. We conclude that these new NFHS estimates should inform discourse about the burden of maternal mortality in India.