India has made significant strides in maternal health over the years, with more institutional deliveries, better access to healthcare, and a decline in maternal mortality. However, a recent analysis of the National Family Health Survey-5 (NFHS-5) by the Indian Council of Medical Research (ICMR) and the National Institute for Research in Reproductive and Child Health (NIRRCH) paints a concerning picture: nearly half of all pregnancies in India are now classified as high-risk. With around 3 crore pregnancies and 2.3–2.7 crore live births annually, India has the highest number of births globally, making the prevalence of high-risk pregnancies a pressing public health issue.
The ICMR analysis highlights that 33% of pregnant women have at least one high-risk factor, while 16.4% face multiple risk factors. Key contributors include short birth spacing, adverse outcomes in previous pregnancies, and caesarean deliveries. Geographically, the burden is uneven, with Meghalaya and Manipur reporting the highest prevalence of high-risk pregnancies at 67.8% and 66.7%, respectively. Age and gender differences are also notable, with women aged 31–40 years and those with pre-existing conditions being most affected.
The sharp rise in pregnancy complications is driven by a complex mix of factors. Advanced maternal age is increasingly common, particularly among urban women delaying childbirth for career or financial reasons, which increases the risk of chromosomal abnormalities, gestational diabetes, hypertension, and placental complications. Rising rates of gestational diabetes, obesity, and hormonal disorders such as Polycystic Ovarian Disease (PCOD) are further contributing to high-risk pregnancies. Poor dietary habits, sedentary lifestyles, and high-stress work environments exacerbate the problem, leading to hypertensive disorders, preeclampsia, and increased risk of miscarriage or complicated deliveries.
Chronic conditions such as anemia, hypertension, and other long-term illnesses are often poorly managed before and during pregnancy, putting women at higher risk of life-threatening complications such as hemorrhage and organ failure. While institutional deliveries have improved detection of high-risk pregnancies, the quality of care remains uneven across India. Access to emergency obstetric services, functional blood banks, and specialised care varies widely, especially in rural and underserved areas.
Despite improvements, India still faces a heavy maternal health burden. In 2023, the country recorded 19,000 maternal deaths, translating to 52 maternal deaths every day, making India the second-highest contributor globally. Experts warn that unless targeted interventions address both medical and socio-economic risk factors, India may struggle to achieve the Sustainable Development Goal of reducing the Maternal Mortality Ratio (MMR) below 70 per 100,000 live births by 2030. The findings underscore the urgent need for comprehensive strategies encompassing preventive healthcare, timely interventions, quality institutional care, and public awareness to safeguard maternal health nationwide.
