Doke et al. BMC Public Health 2012, 12:543 http://www.biomedcentral.com/1471-2458/12/543 G L O B A L H E A L T H Open Access Adverse pregnancy outcomes in rural Maharashtra, India (2008–09): a retrospective cohort study Prakash Prabhakarrao Doke1*, Madhusudan Vamanrao Karantaki2 and Shailesh Rajaram Deshpande3 Abstract Background: The study was carried out to record adverse pregnancy outcomes and to obtain information about sex ratio at birth in rural especially tribal areas in the State of Maharashtra, India. Although the tribal population is considered vulnerable to innumerable adversities, regretfully information about pregnancy wastage among them is not available. About 10% population of the state is tribal. The study of sex ratio at birth was planned as the overall sex ratio and child sex ratio had declined in the state. Methods: The cohort of antenatal cases registered in rural areas of Maharashtra in the calendar year 2008 was followed up to study the pregnancy outcomes. A retrospective study was carried out from October 2009 to August 2010. The outcomes of all the registered antenatal cases were recorded by the Auxiliary Nurse Midwives. The summary sheets were obtained by Block Medical Officers. The data was entered at the block level by trained data entry operators in specially designed web-based software. Adverse pregnancy outcome was categorized in two groups abortions and stillbirths. Results: About 1.1 million registered pregnancies were followed up. In the state 5.34% registered pregnancies ended in abortions. In tribal PHCs the relative risk of spontaneous abortion and induced abortion was 0.91and 0.38 respectively. It was also revealed that about 1.55% pregnancies culminated in stillbirth. The relative risk of stillbirths in tribal PHCs was 1.33. The sex ratio at birth in the state was 850. The ratio was 883 in the tribal PHCs. Correlation was observed between sex ratio at birth and induced abortion rate. Conclusions: The study indicates that women from tribal PHCs are exposed to higher risk of adverse pregnancy outcome in the form of stillbirths. In non-tribal areas high induced abortion rate and poor sex ratio at birth is observed. These two indicators are correlated. The correlation may be explained by the unscrupulous practice of sex selective abortion. Keywords: Relative risk, Abortion, Stillbirth, Sex ratio at birth, Tribal areas Background The Government of India in the year 2005 launched the National Rural Health Mission (NRHM), for a period of seven years aiming at reduction of Infant Mortality Rate (IMR), Maternal Mortality Ratio (MMR) and Total Fer- tility Rate (TFR). The NRHM has already completed seven years of implementation. * Correspondence: prakash.doke@gmail.com 1Community Medicine Department, MGM Medical College, Kamothe, Navi Mumbai 410 210, India Full list of author information is available at the end of the article The quality of maternal health services is a determin- ant for all the goals stated above. It was decided to study pregnancy outcome, which serves as a proxy to the qual- ity of maternal health care services. While deliberating infant mortality, neonatal deaths receive sufficient focus however stillbirths are not taken into account adequately. Although reports from India vary, [1-3] global estimates indicate that early neonatal deaths and stillbirths are of equal magnitude. [4-6] In India estimates are available from the Sample Registration System (SRS), National Family Health Survey (NFHS) and District Level House- hold Survey (DLHS) data. The Health Management © 2012 Doke et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.