facilities with over 1000 deliveries per year and the capacityto perform caesarean sections were randomly selected.
The study population included women giving birth, from which data on all maternal near-miss and maternal death
cases, regardless of the gestational age and delivery status, and all maternal deaths during the study period between 1
May 2010 and 31 December 2011 were collected. Data collection took place on two levels: individual and facility levels. At the individual level, data related to pregnancy outcomes, severe complications, and the management
of women in the study, and their respective newborns, were extracted from medical records of the participating facilities
by trained research assistants. At the facility level, data on characteristics of each health facility, and their ability tomidentify and manage severe complications, were collected through a specific survey using a pre-tested questionnaire
among the professionals responsible for the participating facilities. This was to be used in the adjustment for the evaluation of the association between indirect maternal causes and pregnancy outcomes. The period of data collection ranged from 2 to 4 months, depending on the annual number of deliveries at the participating facilities.