Health system density: India has about 37.6 health workers per 10,000 people, which is below the WHO recommended threshold of ~44.5 for essential services.
In many states and districts, access to antenatal care, skilled birth attendance and postnatal care are far lower among rural, tribal and marginalized women.
Social determinants such as poverty, caste, literacy, gender discrimination, distance from facility, transport, and delayed referral all contribute significantly to risk.
Example: The “model” state of Kerala records an MMR of around 53 per 100,000 live births, showing what is possible when infrastructure, access and equality converge.