India has achieved rapid progress in improving maternal and newborn health—beyond what would be expected based on economic development alone. Within the national story of progress, lessons can be learned from states that started with lower baseline levels of mortality and managed to further reduce mortality rapidly.
At the national level, India employed innovative strategies to reach disadvantaged populations, specifically poor and rural communities, through a series of programs that mitigated physical and financial barriers to care. These seminal national policies, as well as more targeted and localized efforts, were informed by data-driven decision-making and implemented by leadership that prioritized maternal and newborn health. While continued efforts are needed to further reduce India’s neonatal and maternal mortality rates—especially through continued targeting of disadvantaged populations—the country’s remarkable progress across states with both higher and lower mortality baselines in recent decades makes it a strong Exemplar in neonatal mortality rate and maternal mortality ratio reduction.
India’s lower mortality Exemplar states have made particularly rapid progress in reducing mortality. Quantitative evidence shows that in recent decades, improved coverage of key maternal and newborn health indicators underlies this progress, with quality of care improving as well, especially in the last decade as care shifts to higher-level facilities and more skilled providers. Qualitative findings support these results, as interviews with key informants highlighted the impact of specific policy and program levers that helped to improve access to and quality of care across lower mortality Exemplar states.
Learnings from the rapid mortality reduction experienced in India’s lower mortality Exemplar states may be valuable for other countries with comparable contexts looking to learn from settings that have experienced success in improving maternal and newborn health—or for other states within India looking to emulate the successes of Maharashtra and Tamil Nadu.