Beyond maternal mortality: A qualitative study of non-pregnancy related deaths in rural Bangladeshi women of reproductive age

While maternal deaths in rural Bangladesh have been well studied, excess adult female mortality unrelated to pregnancy has been largely ignored. We describe the distribution of female deaths and identify barriers to seeking care that may have contributed to these deaths. We analyzed 341 non-pregnancy related verbal autopsy narratives collected from family members of deceased women in a cohort of ~125,000 women of reproductive age followed between 2001 and 2006 in northwest rural Bangladesh. We conducted qualitative textual analysis of these narratives to identify factors contributing to care seeking delays. Physician reviewers assigned biomedical causes of death. Non-pregnancy mortality represented 58% (n=686) of the total 1192 female deaths. Of 341 deaths with an assigned cause, 73% (n=250) were attributed to chronic causes, 12% (n=40) to infectious causes, and 15% (n=51) to injuries. About 70% (n=174) of women who died from chronic diseases had first sought care from a traditional provider, and only 24% (n=61) from a medical doctor. Among women who died of infectious causes, a higher percentage of respondents (38%, p<0.01) perceived poverty as a barrier to receiving medical treatment compared to 16% (n=49) for all other causes combined. Overall, 15% (n=52) of deaths were reported as associated with the woman being possessed by an evil spirit, which could delay seeking medical treatment. Traditional beliefs, an initial preference for traditional rather than trained providers, and cost of treatment should be addressed as important contributing factors to the delay in seeking medical treatment leading to female mortality in rural Bangladesh.