title: Maternal and perinatal death inquiry and response project implementation review in India.
abstract: OBJECTIVE
  Profile of maternal deaths in selected districts of four Indian states was studied to examine the regional differences in non-biological causal factors (socioeconomic and sociocultural) in maternal mortality and to examine the method and completeness of implementation of Maternal and Perinatal Death Inquiry and Response (MAPEDIR) process.
  
  
  METHODS
  An integrated qualitative and quantitative method was used to study the MAPEDIR process in selected districts of four states in India, through the use of standardized questionnaire for key informant interviews, participant observation checklist, analysis of verbal autopsy questionnaire, and maternal death reports.
  
  
  RESULTS
  A comparison of Profile's maternal deaths investigated showed that women died between 25 and 27 years of age. Half of the women died at home because of inability to afford transport (Delay II) and treatment costs. One third of the deaths had occurred in a health facility (Delay III) because of lack of specialists, equipments or blood. Two thirds of the delays (Delay I) were in seeking medical care. Review of the implementation process of MAPEDIR highlighted that the social audit review model is a unique field based collaborative initiative comprising of stakeholders from various sector in order to improve maternal health programming by reducing maternal mortality.
  
  
  CONCLUSIONS
  MAPEDIR has been able to identify socio-cultural, economic and health care systems related determinants of maternal deaths. Standardization the mechanism for information data sharing at district, sub-district and village level can maximize the use of available evidence for advocacy and policy shifts by developing policies and interventions suited to local needs.
authors.affiliation: School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, 160 012 India.
authors.forename: Tanzin
authors.initials: T
authors.lastname: Dikid
authors.affiliation: School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, 160 012 India.
authors.forename: Madhu
authors.initials: M
authors.lastname: Gupta
authors.affiliation: School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, 160 012 India.
authors.forename: Manmeet
authors.initials: M
authors.lastname: Kaur
authors.affiliation: School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, 160 012 India.
authors.forename: Sonu
authors.initials: S
authors.lastname: Goel
authors.affiliation: School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, 160 012 India.
authors.forename: Arun Kumar
authors.initials: AK
authors.lastname: Aggarwal
authors.affiliation: Country Office, UNICEF, New Delhi, India.
authors.forename: Jorge
authors.initials: J
authors.lastname: Caravotta
keywords: India; MAPEDIR; Maternal death; Social audit