Verbal autopsies of maternal deaths in Koppal, Karnataka: lessons from the grave
Introduction Maternal deaths bear important lessons for death prevention, as they occur mostly due to failures to prevent and respond to obstetric emergencies. These lessons are worth taking. Verbal autopsies can enable such learning and become useful resources for programme managers and policy makers if they identify lapses in death prevention in ways that suggest what corrective actions can be taken. A review of worldwide literature shows that most verbal autopsy applications to date focus solely on identifying the medical causes of maternal mortality. While such autopsies reveal how the different causes of death are clustered, they do not directly address health system issues. A smaller group of studies examine social causes using the ‘three delays model’ to classify the factors that prevent timely access to medical care in an emergency. However, the model does not directly identify the operational issues that constrain health system functioning nor familial and community-level barriers. Given this, the Gender and Health Equity (GHE) Project developed a qualitative methodology that departs from existing approaches in significant ways and enables in-depth analysis of the social and medical causes of pregnancy-related deaths. In this paper, we aim to (1) to describe the methodology developed by the GHE project to analyse and learn from maternal deaths, (2) to identify from the autopsies the types of failures that result in preventable maternal death, as well as the factors that drive them, and (3) to make suggestions for how death prevention measures by public health services can be strengthened. Methods The GHE project tracks on an on-going basis all pregnancy-related deaths that occur in 67 villages of Koppal district, Karnataka. Of these, 23 deaths were investigated using its qualitative methodology through six stages: (1) death notification, (2) data gathering, (3) construction of the narrative and timeline, (4 & 5) analysis of the social and medical causes of death using flow charts and standard guidelines, and (6) identification of corrective actions.