Tamil Nadu made remarkable progress in reducing maternal and neonatal mortality between 2000 and 2018. The state achieved the Sustainable Development Goal (SDG) targets for both maternal mortality ratio (MMR) and neonatal mortality rate (NMR), and by 2018 had the second lowest NMR among major states in India. The fastest decline in neonatal mortality occurred within the first two days of life, signalling improvements in delivery care and newborn health. The Exemplars in Maternal and Newborn Health study documents the positive outliers and informs policy and practice.  

Key Findings:

  • Rapid increases in four or more antenatal care visits, antenatal care with essential components, institutional deliveries (particularly in hospitals), and C-sections among rural and poorer populations. Hospital deliveries reached 80% of all births by 2019–21, reducing neonatal deaths in both public and private facilities. 
  • Expansion of Basic and Comprehensive Emergency Obstetric and Newborn Care (BEmONC and CEmONC) through skilled birth attendants, strengthened Primary Health Centres, and increased density of comprehensive care facilities. 
  • Investments in public medical colleges, incentives for rural postings, and robust capacity-building for nurses and doctors. 
  • Introduction of maternal death reviews, near-miss audits, prenatal screening, IV anaemia treatment, birth companionship, breastfeeding support, and high-risk pregnancy monitoring. 
  • Establishment of the Tamil Nadu Medical Service Corporation (TNMSC) to ensure the timely procurement of drugs and free medicine access across facilities. 
  • Implementation of the Dr. Muthulakshmi Reddy Maternity Benefit Scheme, which incentivised care among poorer women, improved nutrition access, and involved private facilities through conditional cash transfers for quality maternity care. 

This report presents the Tamil Nadu sub-study and provides background information on the broader India study. 

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