India still does not know what most of its people are dying from, a new analysis by the Indian Council of Medical Research (ICMR) has found. Despite being home to nearly 18% of the world’s population, the country continues to lag far behind in medically certified causes of death, raising serious questions about how health policies are designed and resources allocated.
Just 22.5% deaths were medically certified
According to data from the Office of the Registrar General of India cited in the study, only 22.5% of deaths in the country were medically certified in 2020. In other words, in nearly 8 out of 10 deaths, the exact cause was not officially recorded by a doctor.
What worries researchers further is the slow pace of progress. The share of medically certified deaths has risen by just 2.5 percentage points over the last decade, from about 20% to 22.5%. The ICMR analysis, published in the journal Scientific Reports, is the first to examine death certification patterns across all states and Union Territories over 15 years.
Three clusters of states, sharp regional gaps
The study groups states and Union Territories into three clusters based on how often deaths are medically certified.
- The largest cluster includes 23 states where, on average, only 18% of deaths are medically certified. These regions also have just 0.14 doctors per 1,000 population and only around 27% of hospitals regularly report causes of death.
- In the other two clusters, around 60–63% of deaths are medically certified, with almost double the doctor density and over 80% of hospitals actively reporting death details.
Nationally, medically certified deaths increased from about 15% in 2006–2010 to nearly 21% in 2016–2020, showing a gradual but uneven improvement.
North lags, South performs better
The study highlights stark regional disparities.
- Among Union Territories, Lakshadweep leads with medical certification close to 95%, while Puducherry and Chandigarh certify around 70% of deaths.
- Delhi has improved modestly, from roughly 57% to nearly 60% certification over the years.
- North India records the lowest average rate, with only about 13% of deaths medically certified between 2015 and 2020.
Within the North, Punjab and Himachal Pradesh have shown gradual improvement, but Haryana and Uttar Pradesh continue to lag with gaps in reporting and incomplete data. Southern states fare relatively better:
- Tamil Nadu has increased medically certified deaths from about 28% to over 43%, emerging as one of the top performers.
- Karnataka and Andhra Pradesh maintain consistently high certification levels, while Kerala, though improving, still trails its southern peers.
Beyond doctor numbers: hospitals and systems matter
The ICMR researchers found that regular hospital reporting has a major influence on whether deaths are medically certified. However, they stress that the problem is not only about the number of doctors.
Healthcare infrastructure, state-level policies, socio‑economic conditions and overall health system management all shape how reliably deaths are recorded. In low‑performing states, weak hospital reporting and administrative gaps appear alongside workforce shortages.
Why poor certification is a public health risk
Without accurate information on what people are dying from, health authorities are forced to plan on incomplete or misleading data. This can lead to misdirected priorities, inefficient spending and missed chances to prevent avoidable deaths.
The authors argue that improving medical certification of the cause of death must be treated as a public health priority. They recommend strengthening hospital reporting systems, increasing and better deploying medical staff, and improving health administration so India can build a clearer picture of its disease burden — and ultimately save more lives.
