Demographic and health status risk factors in childbearing among Indian women. Evidence from hospital data for the later stages of fertility decline

Indirect estimates of maternal mortality in India indicate that fertility d ecline has reduced maternal deaths by reducing the frequency of pregnancy a nd childbirth. The earlier stages of fertility decline are also likely to h ave lowered maternal mortality by reducing the risk of pregnancy and childb irth as the proportion of births among risky multiparous, older women decli nes. However, further fertility decline may well be associated with some in crease in risk. Risk will also remain high if the health status of Indian g irls and women remains poor. This study uses a sample of maternal deaths an d deliveries among patients who survived which occurred in Civil Hospital, Ahmedabad, Gujarat during 1982-1993 to investigate these issues further. Th e women in the sample have relatively low fertility and represent a fairly late stage of fertility decline. They also have persistently poor health st atus. Legit regression analysis reveals that although fertility decline is associated with some increase in risk, poor health status is the more impor tant maternal mortality risk factor. Without attention to female health, ev en childbearing among expectant mothers with low fertility continues to be hazardous.