Maternal mortality in Andhra Pradesh state as part of the SBA training of the Government of India but the quality and skills are inadequate. In 2006, the Government of Andhra Pradesh, in collaboration with Academy for Nursing Studies, opened a Centre for Advanced Midwifery Training. Tutors received in-service training, and some focus was laid on midwifery strengthening. However, there is no move in the state to start a midwifery cadre or to more efficiently use the staff nurses for childbirths and maternity services in the PHCs. Low status of women has not generated de- mand for quality maternal health service Around 18% of girls aged 15-19 years were already mothers or pregnant in Andhra Pradesh at the time of interview according to the NFHS 3. The median age at first birth for women aged 25-49 years, who were interviewed as part of the three NFHS surveys, showed only marginal improvement. It was 17.9 years in 1992-1993, 18.0 years in 1998-1999, and 18.8 years in 2005-2006, indicating that progress in the reproductive pattern of women has changed only in terms of the number of childbirths and not in other areas (Table 8). Data from the recent study on demographic transi- tion in Andhra Pradesh cited earlier showed that Indicator Percentage of women aged 20-24 years married by 18 years of age Median age (years) at first birth for women aged 25-49 years NFHS=National Family Health Survey there is a slight shift in age at marriage in the state (20). This gives an impression of early stages of nuptiality transition in Andhra Pradesh. Andhra Pradesh lags behind most Indian states in terms of female literacy. While 53.67% of females aged seven years and above are literate in the coun- try, only 50.43% are literate in the state (Table 9). Andhra Pradesh lags far behind the other three southern states (Karnataka, Kerala, and Tamil Nadu) Table 8. Trends in age at marriage in Andhra Pradesh, 1992-2006 Prakasamma M in the percentage of females aged above seven years who are literate according to the Rural Health Sta- tistics Bulletin of 2007. The 1990s witnessed a high level of women’s activ- ism with the launching of a sustained antiliquor movement (1994). Participation in the Interna- tional Conference on Population and Develop- ment (1994) and in the Fourth World Conference on Women (1995) also created higher aware- ness among women. The main political opposi- tion—Telugu Desam—led by N.T. Rama Rao and Chandrababu Naidu—supported the women’s movement and made promises to prohibit liquor and take up overall development of women, along with higher political participation. When they suc- ceeded in the election, they fulfilled some of these promises. The Andhra Pradesh State Women’s Poli- cy (1996) was, therefore, formulated as a result of activism and political commitment. A three-day state-level consultation was held with participation of several national experts. The policy also included a women’s health component that placed stress on enabling women to seek health services. The deci- sion to convert one-third of the PHCs to Women Health Centres to provide round-the-clock services was an outcome of this consultation. However, no NFHS 1 1992-1993 NFHS 2 1998-1999 NFHS 3 2005-2006 68.6 17.9 major focus was laid on overall improvement of the health of women in the state, and the wom- en’s health policy was not actually finalized. The State Commission on Women gradually reduced its functions. Anaemia is a major problem among women in Andhra Pradesh. Compared to only 22.6% ever- married men aged 15-49 years who were anaemic, a higher percentage (62.0%) of women of the same Table 9. Female literacy rates (%) in Andhra Pradesh and southern states Year 1981 1991 2001 232 Andhra Pradesh 24.16 33.71 50.43 Karnataka Tamil Nadu 33.16 44.34 56.87 40.43 52.29 64.43 64.3 18.0 Kerala 73.36 86.17 87.86 54.7 18.8 All-India 29.84 39.37 53.67 JHPN