ABSTRACT

Most developing countries in south Asia and sub-Saharan Africa are high-mortality settings, which are defined, in particular, in terms of maternal and infant deaths. In 2003, it was estimated that there were 540 maternal deaths per 100,000 live births in India, compared to 350 in low-and middle-income countries. The overall figure for the infant mortality rate in India is in the region of 72 deaths per 1000 births, although some states in India compare with countries in sub-Saharan Africa, with much higher figures, between 80 and 90 deaths per 1000 live births. Other states, such as Kerala, have much lower figures, comparable to those of developed countries (Government of India 2001; Misra, Chatterjee and Rao 2003). While maternal mortality is perhaps the most visible manifestation of the ill health of women, it is maternal morbidity (or reproductive conditions, ranging from anaemia to reproductive tract infections, which can translate into life-threatening conditions) which is a better indication of the widespread and deep-rooted nature of the risks associated with childbearing and motherhood. Maternal and child well-being is a product of a complex set of interrelated social, biological and environmental factors. Poverty, as embodied in the lack of adequate food and nutrition, absence of clean water and good sanitation, and the poor quality of the public health services, are some of the main factors which underlie the high levels of maternal morbidity in developing countries. An obvious means of addressing maternal health has been for governments to focus on building up health infrastructure in terms of equipment and personnel. Such an approach has been limited, especially in high-population contexts, where public health programmes and delivery have been guided by the objectives of population control and, in particular, the control of women’s fertility.