Safer maternal health in rural Uttar Pradesh: do primary health services contribute?

India accounts for about one-quarter of maternal deaths world wide, with the most recent statistics showing an average maternal mortality ratio of 407 per 100 000 live births at the national level. The government had hoped to reduce maternal mortality to 200 by 2000, but it is clear that this was not achieved. This paper explores the reasons why the most populous state of Uttar Pradesh continues to have one of the highest reported maternal mortality ratios in India. Data from two districts of Uttar Pradesh on mother and child health-care utilization and the readiness of the public sector to provide antenatal and emergency obstetric services are used to illustrate the reasons why maternal mortality has not declined. While blueprints for safe motherhood programmes exist, the equipment and technical competence to provide services is weak at the present moment. Reductions in maternal mortality would require interventions to improve service delivery as well as community mobilization to improve utilization of services, especially in life-threatening situations.