Surveillance of maternal deaths in Barpeta district of Assam

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Assam has the highest maternal mortality in India. It is difficult to make a precise estimate of maternal mortality because the available information from various surveys has a wide confidence interval. Biomedical causes of maternal mortality are known, but there is little information on determinants of sociocultural and health system aspects. Delays at various levels such as at home (first level), during transportation (second level) and at hospital (third level) operate in a maternal death. Information on these determinants will give a better understanding of the circumstances of death. We aimed to estimate the maternal mortality ratio of Barpeta district in Assam and to understand the sociocultural factors and delays at various levels, which contribute to maternal death. We did a community-based, cross-sectional study. During the surveillance period of 1 year, all maternal deaths occurring in the district were identified from multiple sources and informants. These included all deaths occurring in the health facility or in the community. In 50% of such deaths, social autopsy was conducted. The data were analysed manually for descriptive statistics and thematic areas. The maternal mortality ratio of the district is 225 per 100 000 live-births. About 95% of respondents availed antenatal services and 57% delivered in hospital. The routine maternal death surveillance system is sensitive and detected 94% of maternal deaths. However, community-based verbal autopsy is yet to be functional. Most maternal deaths occur among women from low socioeconomic conditions. Delay at the first level occurred in 10 maternal deaths, at the second level in 18 maternal deaths and at the third level in 8 maternal deaths. Health-seeking behaviour is favourable and 90% of mothers sought services. Improved and functioning infrastructure will ensure better transportation facilities and early referral to a secondary- or tertiary-level health facility, which can prevent many maternal deaths.