Aims: The aims of this study were to investigate seasonal patterns of institutional maternal deaths and complications, and to test for an association with malaria seasons, rainfall, and household income. Methods: A systematic case review of hospital records in the Boucle du Mouhoun health region (Burkina Faso) was conducted over a 2-year period. A statistical smoothing procedure (T4253H) and Freedman's test were used to investigate seasonality and association with malaria, rainfall or household income variations. Results: The data consistently showed the greatest rates of maternal deaths, eclampsia and haemorrhage cases during the dry season, which is the low malaria transmission season, and the period of the year when households have most money available and the lowest opportunity cost of travelling to seek medical attention, suggesting that financial and geographical barriers may be major underlying factors. Conclusions: The management both of health resources in hospital and of referral systems should accommodate cyclical variations in the presentation of maternal complications. Effective mechanisms are needed to help reduce the significant barriers to uptake faced by women and their families at particular times of the year.