• The study by Ram et al. has been conducted based on the rationale that although the national averages of IMR and MMR have improved drastically since the 1990s, the pace at which the states are achieving the same has been heterogeneous.

• The states were clustered into

1. HMS with lower PCI: Uttar Pradesh, Jharkhand, Bihar, Chhattisgarh, Madhya Pradesh, Rajasthan, Odisha, Uttarakhand, and Assam.

2. LMS with higher PCI: Gujarat, Karnataka, Andhra Pradesh, Haryana, Punjab, Kerala, Maharashtra, Tamil Nadu, Telangana, and West Bengal.

• The progress was analyzed in state clusters based on 5 areas of mortality transition models, which includes

1. Fertility

2. Causes 

3. Mortality levels

4. Socioeconomic development

5. Health intervention coverage/equity

• A mixed-method study consisting of qualitative analysis (document reviews and interviews with state and national specialists) and quantitative analysis (trend analysis) was conducted.

• Between 2000-2018, the findings showed a reduction of maternal and neonatal mortality by two-thirds and a half in Clusters 1 and 2, respectively.

• The coverage of antenatal care, institutional delivery, and postnatal care rose by three times, and 1.4 times in both clusters respectively,

• The findings suggest that the HMS would achieve the SDG target of ending preventable deaths of newborns and under-fives if the current rate of decline continues.

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