Doke et al. BMC Public Health 2012, 12:543 http://www.biomedcentral.com/1471-2458/12/543 abortions are being vehemently practiced in the districts in spite of the Pre-conception and Pre-natal Diagnostic Techniques (PCPNDT) Act, which provides deterrent punishment for sex determination [12,17]. The alarm- ingly low sex ratio at birth observed in this study should be a guiding factor to strengthen the steps against sex selective elimination in the state, especially in areas with high number of ultrasonography centers and high induced abortion rate. The better sex ratio at birth in tri- bal areas may be due to non-availability, non-affordability of the diagnostic techniques and also can be attributed to cultural and ethnic beliefs. Limitations of the study Physical verification of stillbirth/abortion could not be carried out as it was a retrospective study. Further in spite of imparting training to ANMs, some extent of the inherent misclassification of abortion, stillbirth and early neonatal death may have remained in the study. Conclusions In areas where tribal population is substantial separate data analysis and activities accordingly need be carried out to achieve the targeted goals under national pro- grams. The study indicates that tribal women are exposed to higher risk of adverse pregnancy outcome in the form of stillbirths. Therefore basic emergency obstet- ric care requires to be provided in tribal areas on a pri- ority. In non-tribal areas high induced abortion rate and poor sex ratio at birth is observed. These two indicators are correlated. This indicates that sex selective abortion is practiced. The data generated indicates that accurate information can be obtained independent to the Man- agement Information System data. This system seems to be replicable. Competing interests The author(s) declare that they have no competing interests. Authors’ contribution Doke PP initiated the concept of the study and finalized the design, participated in training of the block level personnel and followed the field level personnel for obtaining the data. Karnataki MV assisted in finalizing the concept, persuaded for acquisition of data and carried out maximum training. Deshpande SR assisted in finalization of design, participated in training and assisted in manuscript drafting. All authors read and approved the final manuscript. Acknowledgements We are thankful to the Directorate of Health Services and National Rural Health Mission Government of Maharashtra for supporting the study. 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