Data Collection Technique/Process

This study utilized primary and secondary data to accomplish the objectives of the study. We used hospital-based records of all maternal deaths (N=317) that occurred in the Department of Obstetrics and Gynecology of the selected hospitals. The details of all 317 maternal deaths during November 2013 and October 2015 were collected using facility-based maternal death review form (FBMDR). We reviewed the individual case sheet of the women, death registers, referral letters, medical records, Bed Heat Tickets (BHTs) and previous antenatal care records to retrieve the data related to socio-demographic profile and clinical profile of the deceased women.

As far as primary data was concerned, we conducted 40 verbal autopsies (including 20 from eclamptic deceased women and 20 from non-eclamptic deceased cases) in the community. The 40 cases were purposively selected from the 317 maternal deaths occurred in the studied hospitals. We interviewed those people who had witnessed any stage during the process leading to death. Those people were mainly family members, neighbours and relatives. In some cases, both sets of relatives – from parent’s side and in-law’s side were also interviewed together. We used the residential address maintained in the selected hospitals to reach the respondents. The tool used was maternal mortality questionnaire (unstructured and semi-structured schedules), which incorporated the NRHM-validated Verbal Autopsy Questionnaire (VAQ). Most of the interviews were conducted in Bengali (regional language) but few interviews were also done in Hindi (official language of India). The written informed consent was obtained from all family members of deceased women and also from the competent hospital authorities to conduct the study. The whole qualitative interview process took 57 days to finish and each interview took almost 40 minutes.