The alarming series of maternal deaths and severe post-surgical complications in Rajasthan’s government hospitals has escalated into a national health emergency, drawing scrutiny from both India’s central government and the World Health Organization. Over the span of just two months, seven women have died, and dozens more have suffered life-altering conditions such as kidney failure after undergoing caesarean sections across Kota, Bikaner, and Jodhpur. The tragedy has exposed critical failures in drug quality control, hospital hygiene, and emergency transport systems. This investigation delves into the causes, consequences, and systemic reforms needed to prevent further loss of life.
The Unfolding Tragedy Across Three Cities
The Kota Cluster
The crisis first erupted in Kota, where five women died at the New Medical College Hospital following C-section deliveries between May 5 and May 17 . The deceased were identified as Payal, Jyoti, Priya Mahawar, Pinki Mahawar, and Shireen . Beyond the fatalities, five other women remain hospitalized and require ongoing dialysis after suffering kidney failure, which their families report has devastated their lives and finances. One husband, Mahesh Airwal, sold his wife’s jewelry to support the family after their newborn died following a premature delivery . Another patient, Dhanni Bai, has been on dialysis since May 4, with her husband describing the toll as unbearable .
The Bikaner Tragedy
Within weeks, similar incidents occurred at PBM Hospital in Bikaner. Six women developed acute kidney infections after C-sections, with two Preeti and Sharda Nayak succumbing to their conditions in June . A medical team identified widespread administrative lapses and unhygienic conditions as contributing factors, including irregular fumigation of the operation theatre, widespread post-operative infections in wards, and the absence of a dedicated ICU for the gynecological department .
The Jodhpur Crisis
On June 20, eight women who underwent C-section deliveries at the District Government Hospital in Paota, Jodhpur, fell seriously ill within hours of surgery . Six developed septicaemia, experiencing abdominal pain, high fevers, and dangerously low blood pressure, while the other two developed acute kidney infections and severe postpartum bleeding . One woman, Lalita, a diabetic, was transferred to the ICU at AIIMS Jodhpur, while another patient, Sonu, was admitted to MDM Hospital’s ICU . Health authorities shut down the operation theatre pending an inquiry .
Rajasthan Health Minister Gajendra Singh Khimsar has stated that the cases in Kota, Bikaner, and Jodhpur are unrelated . However, health experts and opposition leaders have rejected this claim, pointing to the striking similarities and the apparent systemic nature of the failures .
The Substandard Oxytocin Scandal
A Deadly Injection
The investigations zeroed in on ‘TOCIN’ (Oxytocin Injection 5 ml), manufactured by Jackson Laboratories Private Limited in Amritsar . Oxytocin is one of the most critical medicines in maternity care worldwide. It is routinely administered to induce labour, control excessive bleeding after delivery—a leading cause of maternal mortality—and manage incomplete miscarriages by contracting the uterus . All seven women who died reportedly experienced severe blood loss .
Laboratory Findings
Analysis conducted by the Rajasthan Drug Control Department revealed that the injection samples failed to meet quality standards because they did not contain the prescribed quantity of the active oxytocin ingredient . The Central Drugs Standard Control Organisation (CDSCO), together with state drug regulators in Punjab and Himachal Pradesh, conducted joint inspections at Jackson Laboratories’ manufacturing facilities .
Investigators discovered evidence of “record tampering,” including discrepancies in the dates of sample receipts and test reports, as well as alleged modification or deletion of data files on testing equipment . The company reportedly had no record of testing for key aspects of drug purity and stored finished oxytocin at around 27 degrees Celsius instead of the recommended 2 to 8 degrees Celsius . It was also alleged that tap water was used in the vials and that the firm performed no internal quality checks on finished batches .
Regulatory Action
Based on the inspection findings, the Union Health Ministry cancelled Jackson Laboratories’ manufacturing licences across its facilities, and the company’s distributor in Rajasthan, Rajasthan Medical Hall in Kota, also had its licence revoked . Authorities found that Rajasthan Medical Hall purchased 9,300 units of Tocin 1-ml injections from Jackson Laboratories but sold 10,050 units from the same batch, with the company claiming an additional 750 vials had been dispatched later by bus, an explanation that drug authorities found unsatisfactory .
Jackson Laboratories had reportedly been blacklisted in several other states, including Karnataka, Odisha, Tamil Nadu, and the Union Territory of Jammu and Kashmir .
WHO Intervention
The World Health Organization (WHO) has requested a detailed report from the Indian government, seeking to determine whether the issue is localized to Rajasthan or has broader implications for other countries . Sources indicated that this inquiry is a routine part of global pharmacovigilance protocols. The Union Health Ministry has also sought a comprehensive factual report from the Rajasthan government .
Systemic Failures and Administrative Negligence
Unhygienic Conditions
Former Chief Minister Ashok Gehlot, after visiting the affected hospitals, condemned the deaths and complications as “institutional killings” . He highlighted that preliminary findings from inquiries pointed to “negligence in treatment” as the direct cause of the Kota deaths and noted that AIIMS teams had raised suspicions of infection in the operation theatres . Reports confirmed that conditions at Bikaner’s PBM hospital included a lack of regular fumigation, widespread post-operative infections, and no dedicated ICU for gynecological care .
Paralyzed Emergency Transport
Adding to the crisis, the Janani Express ambulance service, a critical lifeline for transporting pregnant women, has been paralyzed for over 170 days due to an expired contract and failure to issue a new tender . Approximately 600 Janani Express ambulances are grounded, leaving around 1,700 pregnant women and newborns at risk daily . While authorities claim 108 ambulances are being deployed as replacements, a reality check by reporters revealed that these are only being sent for accident cases or women in extremely critical condition . This service disruption likely contributed to delays in care and referrals.
State Response and New Initiatives
Mandatory ABHA Cards
The Rajasthan government has decided to make the Ayushman Bharat Health Account (ABHA) card mandatory for all pregnant women . Each woman will receive a unique 14-digit health number that will digitally store her complete health records, including blood group, blood pressure, sugar levels, ultrasound and lab reports, history of illnesses and operations, and information on high-risk pregnancies . This measure aims to ensure that doctors have immediate access to a patient’s medical history, especially during referrals or emergencies, preventing delays in treatment . So far, over 7.1 crore ABHA accounts have been created in Rajasthan .
The RajPusht Programme
Since 2021, the government-led RajPusht programme has focused on improving nutrition during the first 1,000 days of a child’s development, from pregnancy to the child’s second birthday . The programme strengthens maternal nutrition during and after pregnancy by combining cash transfers with regular counselling from frontline health and nutrition workers . Since its launch, over 3 million women have benefitted from the programme, which has been recognized as a best practice in India’s Economic Survey 2025-26 .
Analysis of C-Section Trends in Rajasthan
The National Family Health Survey (NFHS-6) revealed that India’s overall C-section rate has risen from 21.5% to 27.2%, with private facilities reporting rates as high as 54% . Rajasthan mirrors this trend, with an overall C-section rate of 35%, while urban private hospitals report a rate of 49.4% . The World Health Organization has long maintained that population-level C-section rates above 10-15% do not necessarily improve maternal or neonatal outcomes, raising concerns about unnecessary medical interventions driven by convenience, financial incentives, and defensive medical practices .
Recommendations for Reform
A. Strengthen Drug Quality Surveillance:
The CDSCO and state drug regulators must conduct rigorous, unannounced inspections of all manufacturing units producing essential maternity drugs. Strict penalties, including permanent licence cancellation and criminal prosecution, must be enforced for violations.
B. Mandatory Hospital Audits:
Government hospitals must undergo regular clinical audits, with a focus on infection control, OT hygiene, and adherence to patient safety protocols. The WHO’s Robson Classification system should be used to monitor and evaluate C-section rates.
C. Restore Emergency Transport:
The Janani Express ambulance service contract must be immediately renewed or a new tender issued to ensure safe, timely transport for all pregnant women.
D. Enhance Digital Health Records:
The ABHA card mandate must be fully implemented with effective training for frontline workers to ensure accurate data entry and utilization.
E. Transparent Investigations:
All inquiries into maternal deaths must be made public to ensure accountability and rebuild public trust in government healthcare institutions.
F. Address Commercialization of Maternity Care:
The government must investigate the financial incentives driving high C-section rates in private hospitals and implement measures to ensure that childbirth decisions are based on medical necessity and informed consent.
Conclusion
The Rajasthan maternal deaths crisis is a wake-up call for India’s healthcare system. It reveals that increased access to institutional deliveries is not sufficient without stringent quality control, rigorous hygiene protocols, and transparent accountability mechanisms. The involvement of the WHO underscores the global implications of this tragedy. While the mandatory ABHA card and RajPusht nutrition programme are positive steps, they alone are not enough. A comprehensive overhaul of drug regulation, hospital administration, and emergency services is urgently needed to ensure that every woman can give birth safely and with dignity.
