Kerala pioneered confidential review of maternal deaths (CRMD) in India to determine the causes and to recommend appropriate measures to bring down maternal deaths. Interestingly, CRMD was initiated by the Kerala Federation of Obstetrics and Gynaecology (KFOG) with state government support, despite the government having its own maternal death audit. Dr VP Paily, one of the founding members of KFOG, explains how CRMD was established in Kerala, the challenges involved, and its impact on bringing down Kerala’s maternal mortality ratio (MMR) from over 80 at the turn of the century to 30 in 2023, which is the lowest in India. India’s MMR is 88. KFOG was established in 2002. I used to work in a medical college before that and so we were already monitoring maternal deaths, mode of delivery a

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