Background- India accounts for 22% (117,000) of all maternal deaths in the world and 62% of all maternal deaths in South Asia. Death registration in India is patchy, and the number of maternal deaths is under-reported in the country. To know the correct estimates of maternal mortality, it is important to understand the current maternal death-registration system and reasons for under reporting.

Methodology- This qualitative study was conducted during June-August 2008 and analyzed maternal deaths occurred during April 2007.March 2008. To understand the current reporting system of maternal deaths, semi-structured interviews were conducted with all the concerned officials. Forms and formats relating to death registration and registers containing information on deaths in the villages and towns were studied. Deaths of women in reproductive age group (15-49), reported by the district for the same year were also analyzed. Analysis of 15 verbal autopsy forms filled by the Medical Officers and Block Health Officers was also carried out using Epi Info software.

Results- The District Health Office reported 31,741 live births and 15 maternal deaths for 2007-2008. It was estimated that a minimum of 82 maternal deaths would have occurred during the same period in the district based on corrected estimate of MMR for Gujarat state by SRS 2003. Five maternal deaths were not reported by the district but were reported by the block health office, showing the lack of coordination. Only one death was reported from an urban area having 13,702 live births for the same year meaning MMR of 7.3 per 100,000 live births for urban areas. The other maternal death from urban area was reported by the civil registration system but was not reported by the district health department, showing lack of coordination between the two systems. Discussion with Anganwadi workers revealed pressure from higher officials for not reporting maternal deaths. District reported 231 deaths of women in reproductive age group against 665 expected deaths in the same age group.

Conclusion- The results indicate that there is an urgent need to have a nodal person, at the district level for documenting and reporting maternal mortality. This will improve enumeration and reporting of maternal deaths. There is also an urgent need for creating awareness for registration of maternal deaths in the community and private doctors. Health centres should be encouraged to report correct numbers of maternal deaths.