 This improvement was caused by lower pregnancy rates in some countries; higher income, which improves nutrition and access to health care; more education for women; and the increasing availability of "skilled birth attendants" — people with training in basic and emergency obstetric care — to help women give birth.The situation was especially led by improvements in large countries like India and China, which helped to drive down the overall death rates.In India, the government started paying for prenatal and delivery care to ensure access, and saw successes in reducing maternal mortality, so much so that India is cited as the major reason for the decreasing global rates of maternal mortality.