Deaths due to injury, including violence among married Nepali women of childbearing age: A qualitative analysis of verbal autopsy narratives

Objectives Self-harm and interpersonal violence are important causes of death among women in Nepal. We analysed prospectively collected data to investigate the extent and nature of injury-related deaths among married women aged 15–49 years, recorded through verbal autopsy in rural Sarlahi District, Nepal. Methods Verbal autopsies were systematically collected on all deaths of married women of reproductive age (15–49 years) over a 3-year period (1994–1997) as part of a randomised community-based trial of maternal vitamin A and β-carotene supplementation. This analysis included a three-way comparison of verbal autopsy data: qualitative free-response narratives, closed-ended responses, and physician-assigned consensus cause of death. Results We focused on 46 of 559 deaths (8.2%) that were determined to be injury-related. Of the 46, 28% were identified as intentionally self-inflicted, and 11% as intentionally inflicted by another. Inconsistencies were noted between verbal autopsy reports of causes of deaths and physician assessments. Conflicts within the family figured prominently in the narratives. Women with unstable family situations and suffering from mental illness were often described as having experienced violent deaths. Conclusions Findings highlight that intervention efforts might be necessary especially in situations where there are poor family dynamics or mental health issues in order to prevent potential intrafamily violence and possible death. Results also point to the need for further documentation of violent deaths in rural Nepal.