Maternal mortality in Andhra Pradesh districts of Andhra Pradesh in 2001 showed that most women were aware of female sterilization (19). In a recent study on demographic transition in Andhra Pradesh, the current contraceptive-use rate was 67.4%, and most of it was female steriliza- tion (20). However, the huge success in stabilization of the population was not replicated in the area of reduc- tion in maternal mortality. There are no policy documents or rigorous implementation in the case of maternal health. Although the Andhra Pradesh Population Policy intended to reduce the MMR, this intention was not translated into action since very little systematic and sustained action was tak- en to reduce maternal mortality subsequent to the formulation of the policy. The RCH I programme tried many interventions but no concerted efforts were made to provide comprehensive maternal care services. Of late, there is stress on institutional deliveries, indicating the narrow perspective that reduces comprehensive maternal health services to childbirth in hospitals. The level of government monitoring of a pro- gramme is an indicator of political commitment in that area. Reporting and analysis of maternal deaths are not given high priority either in performance reviews of health workers or in health statistics. Strict monitoring and reporting was implemented throughout the state for family-planning services. Bhatia showed that only one-third of identified maternal deaths were entered into the PHC and Subcentre records (10). The study by the IIHFW in 1997 reported that only 9 of 132 confirmed mater- nal deaths were found in official records (13). In an effort to audit maternal death, the Govern- ment prepared a plan for each medical college to undertake verbal autopsies of maternal death re- ports that they received from the district. Financial provision was made for their travel and expenses through NRHM funds. This plan has not been implemented. Ad-hoc action is, however, taken on individual officers or healthcare providers when there is a media report of a maternal death in a hos- pital, usually a government hospital. No long-term measures are initiated and followed up. Inadequate efforts at strengthening peripheral facilities for maternal healthcare For the first four decades after 1947, the Govern- ment focused on building infrastructure, district and block hospitals, teaching hospitals, PHCs, and Subcentres. Table 3 indicates this growth in 230 Prakasamma M facilities. First, the priority to family planning de- emphasized maternal health. Second, although the decision to have round-the-clock service was taken more than 10 years ago, adequate personnel were not posted to opertionalize the centres. Third, training of TBAs was given high priority in the early 1990s, and outreach care was emphasized. Fourth, the focus on strengthening the FRUs undermined the potential of PHCs and relegated them to refer- ring centres. As the family-planning programme took prece- dence, the PHCs were strengthened more for oper- ations of tubectomy than for routine maternal and child health and treatment. The PHCs that had fa- cilities to conduct tubectomy operations were called ‘service centres’. Women came to the PHCs for sterilization after having their childbirth in the home, usually with the help of TBAs or relatives. On the designated ‘operation day’, a team of high- ly-qualified and skilled personnel came to the PHC to deal with the additional workload. The lone staff nurse in the PHC became linked, in the minds of the public, with family-planning surgery. The de- cision to convert 450 of the 1,300 PHCs in 1997 into 24-hour service centres indicates that most PHCs had become non-functional, by then, due to inadequate support and monitoring. Most of these 450 PHCs did not conduct even one delivery, on an average, per day. Results of community studies indicate the unwillingness of people to use these facilities for maternal emergencies. With the creation of the Andhra Pradesh Vaidya Vidhana Parishad in 1986 for secondary-level hos- pitals, the focus shifted to hospitals. Nearly 200 community hospitals, area hospitals, and district hospitals were strengthened with new buildings, facilities, and equipment. Members of the staff were trained through a rapid in-service training programme. Although the scheme was conceived with lofty intentions, in reality, it widened the distance between the primary health facilities and the referral hospitals because the two came under different administrative structures from state-level downwards. Promotion of institutional deliveries became a ma- jor area of focus for Andhra Pradesh during the last decade due to successes observed in Tamil Nadu and Kerala. A provision was made to give additional honourarium to the staff to encourage round-the- clock childbirth services at the PHCs and CHCs. As part of this scheme, at least one medical officer, a nurse, and a cleaner were to be available beyond JHPN