Presentation at the Global Maternal Newborn Health Conference, October 21, 2015
Background: Existing methods for measurement of maternal death in India give only aggregate maternal mortality ratios and do not provide information on who the women dying are or the causes and contributors in the pathways to their death. Verbal autopsies of maternal deaths by the government are infrequent and largely focus only on medical cause of death.
Methodology: Over two years, in a collaborative process called Dead Women Talking, several civil society groups in India documented maternal deaths through the use of a specially developed social autopsy tool. Community representatives documented the lived experiences of deceased women and their families to identify causes and contributors to deaths that went beyond the traditional bio-medical paradigm. An inductively developed framework called SSSR framework analyzed the different domains contributing to maternal deaths including science, health systems, and social issues and from a rights perspective.
Results: 124 maternal deaths were documented across ten states of India over two years. The documentations highlighted that the deaths happened in women with multiple vulnerabilities including very young women, those belonging to marginalized caste groups, poor women, migrant women. This provides crucial information on who the women dying are. Use of the social autopsy tool and the SSSR framework also revealed the complex pathways that led to women’s deaths highlighting both health systems issues like lack of emergency obstetric care and poor referral services, and social determinants including gender inequities as contributors. This has implications for interventions required to reduce maternal mortality. The analyzed information was used for local level action by communities themselves in addition to contributing to state and national level advocacy to demand more accountability for maternal health.
Conclusion: Community led social autopsies of maternal deaths can broaden the understanding of contributors to maternal deaths and lead to more accountability for maternal health.