Objective To examine the status of and coping strategies for maternal death related major medical expense and productivity loss among households in rural areas of China and to provide evidences for poverty alleviation among the households experiencing catastrophic events.

Methods We recruited 183 households experiencing maternal death between June 2009 and January 2015 in rural areas of Hebei, Henan, and Yunnan province using stratified cluster sampling; then we conducted base line survey (3 months within the incident of a maternal death) and follow up survey (one year after the maternal death) with household questionnaire interview to collect information on maternal death related expenditure and financial activities to cope economic difficulty of the households.

Results For all the households surveyed, the median direct expenditure related to a maternal death per household was 27 597 RMB yuan and averagely 53.82%, 23.20% and 10.13% of the payment to the direct expenditure was covered by borrowing from relatives and friends, hospital compensation and financial support from relatives and friends, respectively. Accepting financial support and borrowing money from relatives and friends were the most frequently used measures to cope the immediate catastrophic financial burden during the short period after the incident of maternal death. Reducing living expense and borrowing money continuously were major ways to cope with the maternal death related financial difficulty one year after the incident of catastrophic event; while, admission of new family member, letting a motherless newborn to be fostered or cared by relatives or others were main ways to cope with maternal death related productivity loss among the households.

Conclusion In rural China, families with maternal death adopt several measures to cope with financial burden and productivity loss caused by the incident but these initiatives may result in subsequent adverse impacts on livelihood of these families later on.