Maternal mortality in Andhra Pradesh age and marital status was anaemic according to the NFHS 3, indicating the widespread gender dispari- ties in food consumption. The Anganwadi centres operated by the Women’s Development and Child Welfare department could not cope with improv- ing the nutrition of women despite several years of implementation. Efforts at increasing women’s use of public-health facilities for maternal health also did not show much success. The Mahila Swasthya Sanghs and mothers’ committees largely remained paper activities. Linkages were not built with self- help groups, resulting in lost opportunity to influ- ence the health of women. Conclusions and future action Andhra Pradesh achieved great success in develop- ment and demographic fields in the last two de- cades. It had the lowest decadal growth rate, the highest number of tubectomies performed on women, the largest number of women’s self-help groups, the first state population policy, etc. At the same time, the state has not been successful in overall development of women or in providing healthcare to women and children, indicating gross paradoxes in development of the state. The single focus on stabilization of the population resulted in negligence in broad primary healthcare. Andhra Pradesh presents perplexities and para- doxes relating to social development, gender, and use of health services. The state proved that it is highly successful at conceptualizing, systematically implementing, and rigorously monitoring the pro- gramme that it intends to achieve—slower popula- tion growth. The visible demographic transition in Andhra Pradesh is the result of this close match be- tween political will and programme implementa- tion. Maternal health has not yet received the focus of the Government, except on an ad-hoc basis and on a very narrow level of promoting institutional deliveries. The relatively-slow decline in the MMR in Andhra Pradesh compared to the rapid decline in population growth is the result of skewed politi- cal priority setting and selective programme imple- mentation. The state, therefore, provides fertile ground for advocacy towards concrete and sustained policies and programmes for safe motherhood. The suc- cess of the family-planning programme was due to political will and bureaucratic commitment at the highest level. Advocacy effort, therefore, needs to be concentrated at the highest political level in the state. Examples from the family-planning pro- gramme need to be reviewed, analyzed, and used for implementing a safe motherhood programme. Several NGOs and networks brought up the issue of Volume 27 | Number 2 | April 2009 Prakasamma M high maternal mortality during government meet- ings. As a result of this case study, the Academy for Nurs- ing Studies is collaborating with the Government of Andhra Pradesh to develop a model in Medak for operationalizing the PHCs as round-the-clock service centres for maternal and neonatal care by enhancing the midwifery of nurse-midwives in the periphery. The PHC doctors, staff nurses, and ANMs are actively involved in this project. The tracking of maternal deaths taken up through this case study in 2006-2007 has led to further advocacy at the state level and has developed links with other advocacy interventions. As part of this, 30 cases of maternal death were selected from all over the state and were analyzed from a rights and legal framework for ad- vocating with the State Government to strengthen its strategies for reduction in maternal mortality. ACKNOWLEDGEMENTS The author acknowledges the deep gratitude to Mr. Khaja Saleemuddin and Dr. Francis Raj for data collection and compilation and to Ms Sujatha and Mrs Olivia Benjamin for collecting data on mater- nal deaths and for coordinating assessment and in- terventions in Medak. The cooperation and support of the different departments of the Government of Andhra Pradesh is also appreciated. REFERENCES 1. Registrar General of India. Primary census abstract. Census of India, 2001. New Delhi: Registrar General of India, 2004:2-37. 2. Indian Institute for Population Sciences. National fami-ly health survey (NFHS-3), 2005-06: Andhra Pradesh. Mumbai: Indian Institute for Population Sciences, 2007:192-266. 3. Registrar General of India. Sample Registration Sys- tem Bulletin, 1999 and 2006. New Delhi: Ministry of Home Affairs, 2006:3-4. 4. National human development report 2001. New Delhi: Planning Commission, Government of In- dia, 2002:141-2. 5. Rural Health Statistics Bulletin, 2007. New Delhi: Ministry of Health and Family Welfare, Government of India, 2007:24-50. 6. Indian Institute for Population Sciences. Na- tional family health survey (NFHS-1), 1993-94: Andhra Pradesh, fact sheet. Mumbai: Indian Insti- tute for Population Sciences, 1995. 7. Indian Institute for Population Sciences. National family health survey (NFHS-2), 1998-99: Andhra Pradesh. Mumbai: Indian Institute for Popula- tion Science, 2000:114-48. 233