Maternal mortality in Assam’s informal economy: the household burden of precarious work

Maternal mortality remains a pressing public health concern globally, with low- and middle-income countries bearing a disproportionate burden. Despite notable progress, India continues to record high maternal mortality rates (MMR), particularly in socio-economically marginalized regions such as Assam. This study investigates maternal mortality among informal worker households in Assam using household-level data and estimates the Maternal Mortality Ratio (MMR) based on WHO's standard methodology. The findings reveal an estimated MMR of 675.68 per 100,000 live births substantially higher than both the national average (97) and the state average (195). This discrepancy reveals the compounded vulnerabilities faced by women in informal employment, who lack access to adequate maternal healthcare, nutrition, and social protection. The study contextualizes India's maternal health performance relative to countries with comparable levels of economic and social development, where India's ranking remains significantly low. The results highlight the need for targeted interventions to strengthen maternal healthcare access and delivery, particularly for women in precarious informal employment. The study also calls for improved data collection and policy attention toward this under-researched population to effectively reduce preventable maternal deaths.