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Feature Maternal and child health

Assam: India’s state with the highest maternal mortality

BMJ 2016; 353 doi: (Published 05 April 2016) Cite this as: BMJ 2016;353:i1908
  1. Sophie Cousins, journalist
  1. Kathmandu
  1. sophcousins{at}

Assam has almost double the national average maternal mortality rate. Why, and what can be done, asks Sophie Cousins

On a rainy afternoon in Dibrugarh, also known as India’s Tea City, pregnant women are crammed into the maternity ward at Assam Medical College. At least two or three women share each bed, and dozens more sit on the floor outside. The hospital is chaotic: the walls are mouldy and the corridor is stained with blood.

Angela Dungdin, aged 28, is seven months pregnant and works in one of Assam’s 800 tea plantations or “gardens,” which altogether employ more than 800 000 workers.

She was brought to the hospital with placental abruption, resulting in the placental lining separating from her uterus.

She is grateful that she made it to the hospital in time to stop the internal bleeding, she told The BMJ, unlike many of her peers. Her concern, though, is for the week’s wages that she’ll miss while in hospital.

“I’ll be discharged soon. I was working until the minute I came here and I’ll have to work the minute after I give birth,” she said. “I have no option.”

Maternal mortality in India

While India has been reporting a steady decline in its maternal mortality rate (MMR), it still has the most maternal deaths worldwide, with 50 000 in 2013, the United Nations reported.1

One of India’s millennium development goals was to reduce its MMR by three quarters—from 437 deaths per 100 000 live births in 1990-91 to 109 by the end of 2015.2 However, it did not reach this goal2 and its MMR currently stands at 190.1

Assam has the highest MMR of all India’s states, almost double the national average, with around 328 deaths per 100 000 live births.3

Three quarters of these deaths are in tea plantations, said …

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