Doke et al. BMC Public Health 2012, 12:543 http://www.biomedcentral.com/1471-2458/12/543 Page 3 of 6 Table 1 Outcomes of pregnancy in tribal and non-tribal PHCs of Maharashtra, India (2008–09) Area Tribal PHCs Non- Tribal PHCs 895,905 Total *SRB = Sex Ratio at Birth. 174,249 1,070,154 Pregnancies followed Abortions Spontan. (%) Induced (%) 4,776 (2.74) 1,744 (1.00) Total (%) 6,520 (3.74) 26,845 (3.00) 23,8 0 (2.66) 5,06 5 (5.66) 31,621 (2.95) 25,544 (2.39) 57,165 (5.34) Stillbirths (%) 3,416 (1.96) 13,148 (1.47) 16,564 (1.55) Male 87,262 Live births Female Total (%) 77,051 164,313 (94.30) 883 SRB* 451,478 380,634 832,112 (92.88) 843 538,740 457,685 996,425 (93.11) 850 spontaneous abortion was 0.91 and induced abortion was 0.38 in tribal PHCs, whereas the relative risk of stillbirths was 1.33. The sex ratio in tribal PHCs was better than non-tribal PHCs (χ2 = 73, P < 0.001). Table 2 gives of interquartile range of the outcomes. The highest figure of spontaneous abortion rate was 4.1 times the lowest figure. In the last quartile having high spontaneous abortion rate there were only two tribal dis- tricts. Variation in the statistics of induced abortion rate is very wide. The highest figure was 12.4 times the low- est figure. In the quartile recording lesser rates, there were six tribal districts and last three were all predomin- antly tribal districts. The last quartile of districts having high induced abortion rate comprised six non-tribal dis- tricts including two coastal districts of Sindhudurg and Ratnagiri. The highest stillbirth rate was 3.3 times the lowest rate. The high rate quartile included six tribal dis- tricts and the first three districts were predominantly tri- bal. Out of the eight districts in quartile recording higher sex ratio, four were tribal districts including the best two. The two coastal districts were also in that quartile. Excluding the two coastal districts Sindhudurg and Ratnagiri the correlation coefficient between induced abortion and sex ratio at birth was 0.42 (P < 0.02) and depicted in Figure 1. Discussion About 25% pregnancies result in abortions either spon- taneous or induced. About 75% of the abortions occur before 16–20 weeks of gestation and out of these abor- tions, 75% occur before eight weeks of gestation [9]. Abortion rate in the State of Maharashtra was found to be 7.6%, in the DLHS-3 carried out in 2007–08. The same survey recorded 61.6% pregnancies were registered in the first trimester of gestation [10]; meaning that 38.4% pregnancies were registered after the maximum Table 2 Outcomes of pregnancy in districts of Maharashtra, India (2008–09) S. No. 1 2 3 4 Outcome Spontaneous abortion rate Induced abortion rate Stillbirth rate Sex ratio at birth Interquartile range 2.09-3.51% 1.35-2.95% 1.31-1.89% 824-891 risk of abortion was almost over. We observed 5.34% pregnancies ended in abortions indicating high reliability of data. The reports from DLHS-3 indicated that in the country 6.5% pregnancies end in abortions [11]. Our study recorded that 44.76% abortions were induced. The percentage of induced abortions in state in DLHS 3 was 36.84% [10]. At the national level 28.92% abortions were induced [11]. The segregated data shows that 26.74% and 46.99% abortions are induced in tribal and non- tribal tribal PHCs respectively. The proportion of induced abortions is higher in non-tribal PHCs (χ2 = 957.03, P < 0.0001). This may be due to abundant availability of abortion services in the state, particularly in non-tribal areas, and social factors like literacy, eco- nomic status etc. It is estimated that in India, more than 6 million abortions are induced and only 10% are offi- cially reported [12]. Substantial percentage of induced abortions is suspected to be sex selective [12]. In most part of the world the reported data about abortions are usually underestimates [13,14]. As unsafe abortions are a threat to women’s health and survival, many studies at- tempt to estimate safe/unsafe abortions or legal/illegal abortions. Worldwide abortion rate range from 12 to 44 per 1,000 women aged 15–44 years [13-15].We did not differentiate between legally or illegally induced abor- tions to obtain precise information. A study carried out by one voluntary organization in Maharashtra recorded still birth rate of 31.5/1,000 births for the period 1998–2000 [16]. In 2005–06 a study car- ried out in the slums of Mumbai city recorded still birth rate of 16.5/1000 births [17]. Field based rural studies in the country reported stillbirth rates from 13.5 to 31.8 per 1,000 births [18-21]. Latest DLHS-3 recorded still- birth rate of 1.4% in Maharashtra [10]. The findings of present study closely match Mumbai study and DLHS-3. In India, reports from the SRS in the current millennium show that the stillbirth rate is almost constant at about 8-9/1,000 births. This estimate is the lowest among na- tional estimates [1,2]. The NFHS 3 and DLHS 3 recorded stillbirth rates between 1.92 and 1.3/100 preg- nancies in the country, [11] and both the periodical sur- veys have shown some decline over previous rounds. In the WHO estimates, stillbirth rate of India is shown as 39/1,000 births [4]. In the recent estimate India ranks 1st in absolute number and the estimated rate is about