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Socio-cultural and service delivery dimensions of maternal mortality in rural central India: a qualitative exploration using a human rights lens.

Jat TR, Deo PR, Goicolea I, Hurtig AK, San Sebastian M - Glob Health Action (2015)

Bottom Line: The study highlighted various socio-cultural and service delivery-related factors which are violating women's human rights and resulting in maternal deaths in rural central India.The data and analysis suggest that the deceased women and their relatives were unable to claim their entitlements and that the duty bearers were not successful in meeting their obligations.Based on the findings of our study, we conclude that to prevent maternal deaths, further concentrated efforts are required for better community education, women's empowerment, and health systems strengthening to provide appropriate and timely services, including emergency obstetric care, with good quality.

View Article: PubMed Central - PubMed

Affiliation: United Nations Population Fund, Bhopal, India.

ABSTRACT

Background: Despite the avoidable nature of maternal mortality, unacceptably high numbers of maternal deaths occur in developing countries. Considering its preventability, maternal mortality is being increasingly recognised as a human rights issue. Integration of a human rights perspective in maternal health programmes could contribute positively in eliminating avertable maternal deaths. This study was conducted to explore socio-cultural and service delivery-related dimensions of maternal deaths in rural central India using a human rights lens.

Design: Social autopsies were conducted for 22 maternal deaths during 2011 in Khargone district in central India. The data were analysed using thematic analysis. The factors associated with maternal deaths were classified by using the 'three delays' framework and were examined by using a human rights lens.

Results: All 22 women tried to access medical assistance, but various factors delayed their access to appropriate care. The underestimation of the severity of complications by family members, gender inequity, and perceptions of low-quality delivery services delayed decisions to seek care. Transportation problems and care seeking at multiple facilities delayed reaching appropriate health facilities. Negligence by health staff and unavailability of blood and emergency obstetric care services delayed receiving adequate care after reaching a health facility.

Conclusions: The study highlighted various socio-cultural and service delivery-related factors which are violating women's human rights and resulting in maternal deaths in rural central India. This study highlights that, despite the health system's conscious effort to improve maternal health, normative elements of a human rights approach to maternal health (i.e. availability, accessibility, acceptability, and quality of maternal health services) were not upheld. The data and analysis suggest that the deceased women and their relatives were unable to claim their entitlements and that the duty bearers were not successful in meeting their obligations. Based on the findings of our study, we conclude that to prevent maternal deaths, further concentrated efforts are required for better community education, women's empowerment, and health systems strengthening to provide appropriate and timely services, including emergency obstetric care, with good quality.

No MeSH data available.


The ‘three delays’ model and lack of elements of a human rights approach to maternal health (59).
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Figure 0002: The ‘three delays’ model and lack of elements of a human rights approach to maternal health (59).

Mentions: We applied the ‘three delays’ framework of Thaddeus and Maine to organise the findings of this study (75). This framework is based on the basic premise that many maternal deaths occur in developing countries because women experiencing obstetric complications do not get adequate care in time. According to the framework, this lack of care can be due to, first, delay in making the decision to seek care when obstetric complications develop; second, delay in reaching an appropriate health facility once the decision to seek care has been made; or, third, delay in receiving proper and adequate care after reaching a health facility (75). This framework has been used by researchers in different countries to examine the factors associated with maternal and neonatal deaths (67, 76). This framework was very useful as a classic conceptualisation of delayed treatment in obstetric emergencies. Maternal health services lacking the essential elements of a rights-based approach to maternal health contribute to the occurrence of the above three delays. The factors emerging from the study influencing the three delays are further examined in the ‘Discussion’ section regarding their linkages with the essential elements of a human rights approach based on the interactions illustrated in Fig. 2(56, 59).


Socio-cultural and service delivery dimensions of maternal mortality in rural central India: a qualitative exploration using a human rights lens.

Jat TR, Deo PR, Goicolea I, Hurtig AK, San Sebastian M - Glob Health Action (2015)

The ‘three delays’ model and lack of elements of a human rights approach to maternal health (59).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4385127&req=5

Figure 0002: The ‘three delays’ model and lack of elements of a human rights approach to maternal health (59).
Mentions: We applied the ‘three delays’ framework of Thaddeus and Maine to organise the findings of this study (75). This framework is based on the basic premise that many maternal deaths occur in developing countries because women experiencing obstetric complications do not get adequate care in time. According to the framework, this lack of care can be due to, first, delay in making the decision to seek care when obstetric complications develop; second, delay in reaching an appropriate health facility once the decision to seek care has been made; or, third, delay in receiving proper and adequate care after reaching a health facility (75). This framework has been used by researchers in different countries to examine the factors associated with maternal and neonatal deaths (67, 76). This framework was very useful as a classic conceptualisation of delayed treatment in obstetric emergencies. Maternal health services lacking the essential elements of a rights-based approach to maternal health contribute to the occurrence of the above three delays. The factors emerging from the study influencing the three delays are further examined in the ‘Discussion’ section regarding their linkages with the essential elements of a human rights approach based on the interactions illustrated in Fig. 2(56, 59).

Bottom Line: The study highlighted various socio-cultural and service delivery-related factors which are violating women's human rights and resulting in maternal deaths in rural central India.The data and analysis suggest that the deceased women and their relatives were unable to claim their entitlements and that the duty bearers were not successful in meeting their obligations.Based on the findings of our study, we conclude that to prevent maternal deaths, further concentrated efforts are required for better community education, women's empowerment, and health systems strengthening to provide appropriate and timely services, including emergency obstetric care, with good quality.

View Article: PubMed Central - PubMed

Affiliation: United Nations Population Fund, Bhopal, India.

ABSTRACT

Background: Despite the avoidable nature of maternal mortality, unacceptably high numbers of maternal deaths occur in developing countries. Considering its preventability, maternal mortality is being increasingly recognised as a human rights issue. Integration of a human rights perspective in maternal health programmes could contribute positively in eliminating avertable maternal deaths. This study was conducted to explore socio-cultural and service delivery-related dimensions of maternal deaths in rural central India using a human rights lens.

Design: Social autopsies were conducted for 22 maternal deaths during 2011 in Khargone district in central India. The data were analysed using thematic analysis. The factors associated with maternal deaths were classified by using the 'three delays' framework and were examined by using a human rights lens.

Results: All 22 women tried to access medical assistance, but various factors delayed their access to appropriate care. The underestimation of the severity of complications by family members, gender inequity, and perceptions of low-quality delivery services delayed decisions to seek care. Transportation problems and care seeking at multiple facilities delayed reaching appropriate health facilities. Negligence by health staff and unavailability of blood and emergency obstetric care services delayed receiving adequate care after reaching a health facility.

Conclusions: The study highlighted various socio-cultural and service delivery-related factors which are violating women's human rights and resulting in maternal deaths in rural central India. This study highlights that, despite the health system's conscious effort to improve maternal health, normative elements of a human rights approach to maternal health (i.e. availability, accessibility, acceptability, and quality of maternal health services) were not upheld. The data and analysis suggest that the deceased women and their relatives were unable to claim their entitlements and that the duty bearers were not successful in meeting their obligations. Based on the findings of our study, we conclude that to prevent maternal deaths, further concentrated efforts are required for better community education, women's empowerment, and health systems strengthening to provide appropriate and timely services, including emergency obstetric care, with good quality.

No MeSH data available.