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A confidential system of enquiry into maternal mortality, based on that used in England and Wales, was introduced in Malaysia in 1991 with a view to identifying deficiencies in care and recommending remedial measures.

Despite its many advantages, the employment of women in economic activity in India has been associated with increased mortality for infants and young children. Simultaneously, narrower gender differentials in child mortality among employed women have been noted.

Every minute of every day a woman dies as a result of pregnancy or childbirth. The loss per annum of 500,000 women is mind boggling. A maternal death is the outcome of a chain of events and disadvantages throughout a woman's life.

Maternal death has been recognized as an area of maternity care that requires urgent attention. The most striking feature about maternal health today is the extraordinary difference in maternal death rates between developed and developing countries.

In 1991, an article on the Maternity Care Program in Matlab, Bangladesh, reported a substantial decline in direct obstetric deaths in the intervention area, but not in the control area. The decline was attributed primarily to the posting of midwives at the village level.

The tribal population groups from 7.95 percent of the total population of India. About 67.76 million persons have been enumerated in the country (excluding Jammu & Kashmir) as members of the Scheduled Tribes (1991 census).

Most studies of maternal mortality are hospital based. However, in developing countries, where many such deaths take place in the home, hospital statistics do not reflect the true extent of maternal mortality.

India has made appreciable progress in improving its overall health status since the beginning of the century. The crude death rate has declined, but there is no sign of a decline in the maternal mortality rate. Also, most of the evidence relating to high maternal mortality rates is fragmentary.