Abstract

India’s maternal mortality and morbidity statistics remain contested due to methodological ambiguities and systemic data gaps. While the Maternal Mortality Ratio (MMR) is internationally standardized as deaths per 100,000 live births, confusion persists with the Maternal Mortality Rate, which uses women of reproductive age as the denominator. In India, estimates are derived largely from the Sample Registration System (SRS), household surveys such as the National Family Health Survey (NFHS), and facility-based reporting under the Health Management Information System (HMIS). These sources, however, are periodic, sample-based, and often modeled, rather than real-time. The PCPNDT Act presumes sex-selective abortion and female infanticide as the primary causes of skewed sex ratios, yet medical realities reveal a broader spectrum of female fetal loss — including spontaneous abortions, stillbirths, and medically indicated terminations — that household surveys cannot capture. Despite extensive digitization of hospitals, the absence of mandatory ICD coding and real-time reporting undermines the reliability of morbidity and mortality data.1 Consequently, policy formulations risk being based on self-supporting guesstimates rather than robust, coded health statistics. This paper argues for a shift from politically framed digitization claims to mandatory ICD-coded, real-time hospital reporting, centrally collated and analyzed state-wise. Only such a system can provide India with reliable health statistics, ensure medico-legal accountability, and support evidence-based policy in maternal and child health.

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