J HEALTH POPUL NUTR 2009 April;27(2):220-234 ISSN 1606-0997 | $ 5.00+0.20 ©INTERNATIONAL CENTRE FOR DIARRHOEAL DISEASE RESEARCH, BANGLADESH Maternal Mortality-reduction Programme in Andhra Pradesh M. Prakasamma ABSTRACT Academy for Nursing Studies, Flat 215, Amruthaville Apartments, Rajbhavan Road, Hyderabad 500 082, Andhra Pradesh, India Andhra Pradesh, a large state in southern India, has a high maternal mortality ratio of 195 per 100,000 livebirths despite the improvements in social, demographic and health indicators over the last two dec- ades. This contrary situation has been analyzed using findings of different studies on maternal mortality, and four factors have been presented for consistently-high maternal mortality in the state. First, the dis- proportionately-high focus on family planning towards population stabilization reduced the emphasis on maternal health in the peripheral hospitals, resulting in low use of these facilities for childbirths. Second, the growth of services in Primary Health Centres was not given adequate emphasis, resulting in the weak- ening of the peripheral health system. Third, there was little emphasis on developing a cadre of midwives who would have primarily focused on maternal health. Lastly, the low status of women in the state has hampered timely referral and access to services. Key words: Health facilities; Maternal health; Maternal mortality; Safe motherhood; India INTRODUCTION Profile of Andhra Pradesh Andhra Pradesh, one of the 28 states of India, is lo- cated in the southeastern part of the country with Karnataka in the West, Tamil Nadu in the South, Maharashtra, Chattisgarh, and Orissa in the North, and the Bay of Bengal in the East. Its total land area is 275,045 sq km with a long coastline of about 1,000 km. The state is ranked fifth in the country in terms of its area and population size. According to the Census 2001, the total population of Andhra Pradesh was 75,727,541. The density of population is 277 per sq km compared to 312 in the country. The state has 23 districts, including the capital district Hyderabad. It is divided into three sociocultural and geographic regions—Coast- Correspondence and reprint requests should be addressed to: Dr. M. Prakasamma Director Academy for Nursing Studies Amruthaville Apartments (Flat 215) Rajbhavan Road Hyderabad 500 082 Andhra Pradesh India Email: hyd2_dirans@sancharnet.in OR mytril1@yahoo.com al Andhra, Telangana, and Rayalaseema—with 10 districts, including Hyderabad in the Telangana re- gion, nine districts in the Coastal region, and four districts in the Rayalaseema region. Andhra Pradesh is predominantly rural and agricultural, with 73% of the total population living in 28,123 villages and hamlets, according to the Census 2001 (1). Andhra Pradesh fares better than other states on key demographic indicators (Table 1). Its population is growing at a slower decadal growth rate at 14.59% compared to 21.54% in the rest of India. The con- traceptive prevalence rate (CPR) is 68% according to the National Family Health Survey (NFHS) 3 compared to the national average of 56.3% (2). The total fertility rate (TFR) in Andhra Pradesh is 1.8 compared to 2.9 in the country. Overall, the demo- graphic profile indicates that the state has moved into the next phase of demographic transition. Over the last six decades, Andhra Pradesh has made great leaps in areas, such as information technology and population stabilization. In other areas, trends do not show much improvement, especially in terms of health of infants and status of women. Sex ratio in the state is slightly better than the national average with 978 females to 1,000 males compared to 933 in the rest of India. Infant mortality is nearly the same as the rest of India. In the area of mater- nal health, Sample Registration System (SRS) data