Objective  To explore the socio-economic determinants of maternal mortality in Uganda through interviews with women who had ‘near-misses’.

Design  Observational study using qualitative research methods.

Setting  The postnatal and gynaecology wards of a large government hospital in Kampala, Uganda.

Sample  Thirty women who had narrowly avoided maternal deaths with diagnoses of obstructed labour (7), severe pre-eclampsia/eclampsia (3), post caesarean infection (6), haemorrhage (5), ectopic pregnancy (5) and septic abortion (4).

Methods  The semi-structured interviews were conducted in the local language by a woman unconnected to the hospital, and were recorded before being translated and transcribed. Analysis was conducted in duplicate using commercial software.

Results  The predominant theme was powerlessness, which occurred both within and outside the hospital. It was evident in the women's attempts to get both practical and financial help from those around them as well as in their failure to gain rapid access to care. Financial barriers and problems with transport primarily governed health-seeking behaviour. Medical mistakes and delays in referral were evident in many interviews, especially in rural health centres. Women were appreciative of the care they received from the central government hospital, although there were reports of overcrowding, long delays, shortages and inhumane care. There were no reports of bribery.

Conclusions  Women with near-miss maternal mortalities experience institutional and social powerlessness: these factors may be a major contributor to maternal mortality.