Maternal mortality in Andhra Pradesh On the other hand, the data in Table 7 show that Andhra Pradesh has moved far ahead of Kerala and Tamil Nadu in female sterilization. It also shows a further decline in the TFR. This clearly suggests that the achievement of demographic goals received higher emphasis compared to maternal health ser- vices in Andhra Pradesh. Prakasamma M to the Andhra Pradesh State Population Policy. He translated this political commitment into action by setting sterilization targets and implementing a rigorous and continuous monitoring system to re- view achievements. The highest number of fami- ly-planning operations (800,000) performed each year was achieved during his tenure and continued Table 7. Demographic and family-planning indicators of Andhra Pradesh compared to Kerala, Tamil Nadu, and all-India, 1992-2006 NFHS 1 2 3 1 2 3 1 2 3 Andhra Pradesh 2.59 2.25 1.79 47.0 58.9 67.0 38.3 52.7 62.9 Tamil Nadu 2.48 2.19 1.80 45.2 50.3 60.0 37.6 45.2 55.0 Kerala 2.00 1.96 1.93 54.4 56.1 57.9 41.8 48.5 48.7 India 3.39 2.85 2.68 36.5 42.8 48.5 27.4 34.1 37.3 Indicator Total fertility rate Contraceptive prevalence rate (%) of women using any modern method % of women using female sterilization NFHS=National Family Health Survey Andhra Pradesh was the first state to formulate the state population policy in 1997 much ahead of the National Population Policy in 2000. The policy starts with a comparison of the demographic situ- ation in Andhra Pradesh with that of Kerala and Tamil Nadu and aims at doing better than the oth- er two states (18). The policy states, “In the short term, the state will aim at reaching the All-India de- mographic goals set for 2000 AD; and in the long term, it will aim for a Kerala-like situation where the third stage of demographic transition has been reached—low population growth with low fertil- ity and mortality” (p. 5). The policy says that the number of terminal method-users (those who un- derwent sterilization) in Andhra Pradesh is one of the highest in India with 8 per 1,000 compared to 6 in Tamil Nadu and 4 in Kerala. “Population control remains the most challeng- ing task before our nation and our state today. This policy document is a statement of the resolve by the Government of Andhra Pradesh to bring about a change in the size, structure and distribution of the population to a level that will result in improv- ing the standard of living and quality of life of the people in general and, in particular, in extending the benefits of such change and development to the most vulnerable and disadvantaged …. Fertili- ty reduction is at the heart of the development of the State,” stated N. Chandrababu Naidu, the then Chief Minister of Andhra Pradesh in the Preamble Volume 27 | Number 2 | April 2009 to stay at about 800,000 sterilizations per year for a decade. Female sterilization is the most used method of birth control in Andhra Pradesh. Sterilization com- prised 38.3% in 1992-1993, 52.7% in 1998-1999, and 62.9% in 2005-2006 of all contraceptive meth- ods reflecting the strong measures adopted by the Government for promoting sterilization (Table 7). So successful was the government population-con- trol drive that it influenced reproductive intentions of the women and resulted in the enhanced need for small families. In 1992-1993, 64.8% of women who had two children stated that they did not want any more children. This figure rose sharply to 83.7% at the time of NFHS 2 (1998-1999) and to 91.5% at the time of NFHS 3 (2005-2006). This shows the steadily-growing change in attitudes of women over a 14-year period. Even women who had only two daughters and no sons did not want any more children, indicating that son preference and sex composition of children are a lower priority for women in Andhra Pradesh compared to other states. The Government of Andhra Pradesh uses the above data to claim that its strictly-implement- ed family-planning programme was responsible for the low TFR and the decline in growth rate. There is a high level of awareness about female sterilization in the state. Results of a survey on ex- panded and informed contraceptive choice in two 229