Health systems challenges for achieving the Millennium Development Goal for maternal health: selected Indian states.

Maternal mortality ratio is alarmingly very high and appears to have increased in India. The objectives of this study are to identify the association of core individual household community and health systems indicators on care during child birth and to suggest critical policy and program options for accelerating progress towards Millennium Development Goal for maternal health by the selected Indian states including Tamil Nadu West Bengal Andhra Pradesh Bihar Uttar Pradesh and Rajasthan. Data from National Family Health Surveys are used in this analysis. Multivariate logistic regression analysis results show a strong association of womens education household wealth womens ability to take decisions use of antenatal care and access to health services with the likelihood of delivery by medically trained provider. Study results emphasize the need for appropriate behavior change communication strategies social safety nets enhancing core skills of auxiliary nurse midwives and provider incentives to reduce maternal mortality. (excerpt)