Background
The transport of pregnant women to an appropriate health facility plays a pivotal role in preventing maternal deaths. In India, state-run call-centre based ambulance systems (‘108’ and ‘102’), along with district-level Janani Express and local community-based innovations, provide transport services for pregnant women. We studied the role of ‘108’ ambulance services in transporting pregnant women routinely and obstetric emergencies in India.

Methods
This study was an analysis of ‘108’ ambulance call-centre data from six states for the year 2013–14. We estimated the number of expected pregnancies and obstetric complications for each state and calculated the proportions of these transported using ‘108’. The characteristics of the pregnant women transported, their obstetric complications, and the distance and travel-time for journeys made, are described for each state.

Results
The estimated proportion of pregnant women transported by ‘108’ ambulance services ranged from 9.0 % in Chhattisgarh to 20.5 % in Himachal Pradesh. The ‘108’ service transported an estimated 12.7 % of obstetric emergencies in Himachal Pradesh, 7.2 % in Gujarat and less than 3.5 % in other states. Women who used the service were more likely to be from rural backgrounds and from lower socio-economic strata of the population. Across states, the ambulance journeys traversed less than 10–11 km to reach 50 % of obstetric emergencies and less than 10–21 km to reach hospitals from the pick-up site. The overall time from the call to reaching the hospital was less than 2 h for 89 % to 98 % of obstetric emergencies in 5 states, although this percentage was 61 % in Himachal Pradesh. Inter-facility transfers ranged between 2.4 % –11.3 % of all ‘108’ transports.

Conclusion
A small proportion of pregnant women and obstetric emergencies made use of ‘108’ services. Community-based studies are required to study knowledge and preferences, and to assess the potential for increasing or rationalising the use of ‘108’ services.