Maternal Mortality Ratio (MMR), Unexpected Rise in Kerala

Kerala, known for its advanced healthcare system and socio-economic indicators, is facing an unexpected challenge: a rise in its Maternal Mortality Ratio (MMR). This increase, despite the state’s historically low MMR, is attributed primarily to declining fertility rates rather than a genuine surge in maternal deaths.

Understanding Kerala’s Maternal Mortality Ratio (MMR)

Maternal Mortality Ratio is defined as the number of maternal deaths per 100,000 live births. Kerala has consistently reported the lowest MMR in India, with a current figure of 19 per one lakh live births. However, recent estimates from the state’s Health Department for the year 2024-25 suggest that MMR may have risen to 32. This rise is not necessarily due to an increase in maternal deaths but is linked to a significant decline in the number of childbirths.

Declining Fertility Rate in Kerala

Kerala has experienced a steady decrease in its fertility rate over the past three decades. In 1991, the state became the first in India to dip below the replacement fertility level of 2.1 children per woman. By 2020, the total fertility rate (TFR) had fallen to 1.5, and currently, it stands at 1.46, indicating that most couples in Kerala are having only one child or none at all. This trend is a crucial factor influencing the rising MMR, as fewer births amplify the ratio of maternal deaths to live births.

Key Factors Behind Declining Birth Rates

1. Demographic Transition: Kerala’s society has undergone significant changes in attitudes towards marriage and childbirth. Delayed marriages and decisions to have fewer or no children are now common, reflecting broader global trends in developed regions.
2. Migration and Workforce Loss: A large segment of Kerala’s reproductive-age population migrates abroad for better education and employment opportunities. Many of these individuals settle permanently overseas, contributing to a decline in the local birth rate.
3. Aging Population: Kerala’s demographic structure is shifting, with an aging population expected to surpass the child population within the next decade. This aging trend is linked to reduced birth rates and increased health challenges associated with an older population.
4. Delayed Childbearing: Women in Kerala are increasingly opting to have children later in life. Older mothers are at a higher risk of pregnancy-related complications and morbidities, which can contribute to higher maternal mortality. Delayed childbearing not only impacts maternal health outcomes but also exacerbates the decline in birth rates.

Conclusion

The rise in Kerala’s MMR, despite the state’s commendable healthcare achievements, highlights the complex interplay between declining fertility rates and maternal health outcomes. Addressing these challenges requires a multifaceted approach, including targeted healthcare interventions, support for maternal health, and strategies to manage the socio-economic implications of an aging population.

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