Maternal Mortality in Rural Varanasi: Delays, Causes, and Contributing Factors

BACKGROUND: Pregnancy and motherhood are natural processes and considered to be full of positive experiences. However, for various reasons many women end up dying during pregnancy, childbirth, and the postpartum period. Improving maternal health and reducing maternal mortality have been prioritized in several international declarations and national policies. OBJECTIVES: The objective of the study is to assess delays, cause, and its contributing factors related to maternal deaths in rural Varanasi. METHODOLOGY: Verbal and Social Autopsy have been done for each maternal death occurred between April 2015 and March 2016 in four randomly selected blocks of rural Varanasi. The “3 Delay Model” and “Pathway analysis” concept was used in collection and analysis of data through in-depth interview of three people (family member, neighbor, and a health worker) for each maternal death. Cause of death and delays was identified by two reviewers (obstetrician) independently. RESULTS: In almost half of the autopsied cases two different delays were found, and in one-third case, only one delay was found. Direct obstetric cause found in more than half (54%) cases. Hemorrhage and anemia were found major direct and indirect obstetric cause, respectively. Other causes identified were sepsis (direct), jaundice, and meningitis. A number of social, behavioral, and cultural factors were identified, that had been contributed to different delays related to the maternal deaths. CONCLUSIONS: First delay was present in most of (90%) cases. Nonbiological (social, behavioral, and cultural) and health service factors were also identified in this study.