Social determinants of health pave the path to maternal deaths in rural Sri Lanka: reflections from social autopsies

Author:

Irangani Lasandha,Prasanna Indika Ruwan,Gunarathne Sajaan Praveena,Shanthapriya Sandaru Hasaranga,Wickramasinghe Nuwan Darshana,Agampodi Suneth Buddhika,Agampodi Thilini Chanchala

Abstract

Abstract Background Ending preventable maternal deaths remains a challenge in low- and middle-income countries (LMICs). Society perceived causes and real-life observations can reveal the intangible causes of maternal deaths irrespective of formal maternal death investigations. This study reports complex patterns in which social determinants act towards paving the path to maternal deaths in a rural Sri Lankan setting. Methods We conducted social autopsies for 15/18 maternal deaths (in two consecutive years during the past decade) in district A (pseudonymized). In-depth interviews of 43 respondents and observations were recorded in the same field sites. During thematic analysis, identified themes were further classified according to the World Health Organization framework for social determinants of health (SDH). The patterns between themes and clustering of social determinants based on the type of maternal deaths were analyzed using mixed methods. Results Discernable social causes underpinned 12 out of 15 maternal deaths. Extreme poverty, low educational level, gender inequity, and elementary or below-level occupations of the husband were the characteristic structural determinants of most deceased families. Social isolation was the commonest leading cause manifesting as a reason for many other social factors and resulted in poor social support paving the path to most maternal deaths. A core set of poverty, social isolation, and poor social support acted together with alcohol usage, and violence leading to suicides. These core determinants mediating through neglected self-health care led to delay in health-seeking. Deficits in quality of care and neglect were noted at health institutions and the field. Conclusion Social autopsies of maternal deaths revealed complex social issues and social determinants of health leading to maternal deaths in Sri Lanka, indicating the need for a socially sensitive health system.

Funder

Accelerating Higher Education Expansion and Development (AHEAD) Operation of the Ministry of Higher Education, Sri Lanka, funded by the World Bank

Publisher

Springer Science and Business Media LLC

Subject

Obstetrics and Gynecology,Reproductive Medicine

Reference52 articles.

1. World Health organization. World Bank Group UNICEF,UNFPA. UNPD. Trends in maternal mortality estimates: 2000 to 2017by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division [Internet]. 2019. Available from: https://www.who.int/reproductivehealth/publications/maternal-mortality-2000-2017/en/.

2. United Nations. The sustainable development goals report 2019. United Nations Publ issued by Dep Econ Soc Aff. 2019;64. ISBN: 978-92-1-101403-7.

3. United Nations Sustainable Development Group. Leaving No One Behind. A UNSDG Operational Guide for UN Country Teams. 2019. 2019;(March):1–24.

4. World Health Organization. ICD-10 to deaths during pregnancy, childbirth and the puerperium: ICD-MM. Int J Gynecol Obstet. 2015;129(1):30–3 ISBN 978 92 4 154845 8.

5. van den Akker T, Nair M, Goedhart M, Schutte J, Schaap T, Knight M. Maternal mortality: direct or indirect has become irrelevant. Lancet Glob Heal. 2017;5(12):e1181-2. https://doi.org/10.1016/s2214-109x(17)30426-6.

同舟云学术

1.学者识别学者识别

2.学术分析学术分析

3.人才评估人才评估

"同舟云学术"是以全球学者为主线,采集、加工和组织学术论文而形成的新型学术文献查询和分析系统,可以对全球学者进行文献检索和人才价值评估。用户可以通过关注某些学科领域的顶尖人物而持续追踪该领域的学科进展和研究前沿。经过近期的数据扩容,当前同舟云学术共收录了国内外主流学术期刊6万余种,收集的期刊论文及会议论文总量共计约1.5亿篇,并以每天添加12000余篇中外论文的速度递增。我们也可以为用户提供个性化、定制化的学者数据。欢迎来电咨询!咨询电话:010-8811{复制后删除}0370

www.globalauthorid.com

TOP

Copyright © 2019-2024 北京同舟云网络信息技术有限公司
京公网安备11010802033243号  京ICP备18003416号-3