The state of political priority for safe motherhood in India.

Approximately one-quarter of all maternal deaths occur in India, far more than in any other nation on earth. Until 2005, maternal mortality reduction was not a priority in the country. In that year, the cause emerged on the national political agenda in a meaningful way for the first time. An unpredictable confluence of events concerning problem definition, policy alternative generation and politics led to this outcome. By 2005, evidence had accumulated that maternal mortality in India was stagnating and that existing initiatives were not addressing the problem effectively. Also in that year, national government officials and donors came to a consensus on a strategy to address the problem. In addition, a new government with social equity aims came to power in 2004, and in 2005, it began a national initiative to expand healthcare access to the poor in rural areas. The convergence of these developments pushed the issue on to the national agenda. This paper draws on public policy theory to analyse the Indian experience and to develop guidance for safe motherhood policy communities in other high maternal mortality countries seeking to make this cause a political priority.