Maternal Health systems in India: A Narrative Review and policy analysis of Primary Healthcare and Referral pathways for Viksit Bharat 2047

Abstract

Maternal health remains a sensitive indicator of health system performance in India. India’s maternal mortality ratio has undergone an outstanding decline, dropping from 254 in 2004–2006 to 88 per 100,000 live births in 2022, reflecting sustained policy commitment. However, the gains remain uneven, with structural deficiencies in frontline care delivery and interfacility transfer mechanisms continuing to drive preventable deaths. Despite this progress, critical gaps remain in primary healthcare quality and referral systems, particularly in rural, tribal, and economically weaker communities. Strengthening primary healthcare centre (PHC) and referral systems is essential to achieving equitable maternal care and the goals of Viksit Bharat 2047 ensuring that maternal care benefits reach the most underserved populations and advancing the goals of Viksit Bharat 2047. This paper employs a policy-oriented narrative review of national health policies, maternal mortality data, and published research to analyze gaps in primary healthcare and referral systems. Key findings reveal referral rates of 25%–52% from peripheral facilities, a 79.9% specialist shortfall at rural Community Health Centers, fewer than 45% of PHCs functioning 24 × 7, facility bypass rates of 22%–60% across states, collectively indicating systemic failures across the maternal care continuum. By strengthening PHC as the cornerstone of maternal care and establishing smooth referral systems to advanced facilities, India can minimize avoidable maternal fatalities, enhance care quality, and promote equity. These reforms directly support the Viksit Bharat 2047 vision of Universal Health Coverage, zero preventable maternal deaths and a robust and adaptive health system equipped for future challenges.